BBC Wales news: ‘Humanitarian crisis’ for ME sufferers in Wales

BBC Wales News article, 11 May 2019: ‘Humanitarian crisis’ for ME sufferers in Wales

 

“People thought I’d moved away or joined a nunnery”, said Marian Gray, who admits going “missing from life”.

She disappeared because she was one of the 13,000 people in Wales battling ME.

Campaigners say there is a “humanitarian crisis” and promises of better support from the Welsh Government have failed to materialise.

On Saturday, Cardiff joins 300 places around the world is holding an event for ME awareness week, with empty shoes symbolising people missing from life.

“I’m a profoundly sociable person but people in Aberystwyth thought I’d moved away or joined a nunnery because they hadn’t seen me in the places they should see me,” said Ms Gray.

“I had to leave my mountain biking shoes, my violin playing shoes.

“To continue working, I had to empty my life of anything else, including a social life.”

Myalgic encephalomyelitis (ME) or Chronic Fatigue Syndrome is usually triggered by a viral infection which leads to muscle fatigue, pain and neurological symptoms such as short term memory loss.

About 13,000 people in Wales are thought to suffer from ME, and 70% of those are women.

Ms Gray, an international officer at Aberystwyth University, first had symptoms at primary school – but more than 30 years later, she says little has improved.

“The dialogue has not changed,” she added.

“The doctor says ‘you have this diagnosis but there is nothing we can do’.”

By being allowed to work from home at times, she manages a career – but said some people suffering severe symptoms cannot bear bright lights or being around loved ones.

“There is a humanitarian crisis in the healthcare system,” said Jan Russell, who has suffered with the condition for 30 years.

“There is 13 to 15,000 people with ME in Wales, 25% of which are severely affected.

“In Wales people are missing from the healthcare system, and when they go to the surgery, not always treated with respect.”

Ms Russell, who is chairwoman of Working for ME in Wales, said few GPs had enough knowledge of the condition – and those left housebound felt “invisible and ignored”.

“You are lucky if you can find a doctor who has an understanding of ME,” said Miriam Wood, a former NHS worker who is part of Cardiff-based ME Support in Glamorgan.

“They might be thinking the person is depressed and just give them antidepressants.”

Ms Wood said the First Minister Mark Drakeford had pledged to create a pathway for people to get help more easily when he was health minister between 2013 and 2016.

“We have been trying to find out what progress has been made but haven’t been able to,” she said.

“We are still in the same place we were all those years ago when Mark Drakeford said changes would be made.”

‘Invisible condition’

A Welsh Government spokesman said: “We understand the challenges faced by people living with this condition and the impact it can have on their lives and their families.

“That is why we are working with healthcare professionals and the third sector to strengthen ME services available across Wales.”

Royal College of General Practitioners chairman Dr Peter Saul said ME is very difficult to diagnose and distinguish from other conditions.

“It can take longer to diagnose it than other conditions but patients should not feel that they are being ignored or dismissed,” he added.

“It is a sort of invisible condition for which there are no quick medical treatments.”

Read the full article with all the links

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Cardiff University plans research into ME/CFS using ME/CFS Biobank samples

CureME (leading research into ME) blog post: Biobank users

Samples from our Biobank are available to external researchers around the globe. Making these samples available to other researchers increases the chances of achieving much-needed breakthroughs in the aetiology and treatment of ME/CFS, in the most cost-effective manner.

Here are our current collaborators, and their stories:

Professor Duncan Baird is a geneticist with an interest in telomere biology and genome stability, based at Cardiff University. Telomeres are the structures that cap the ends of linear eukaryotic chromosomes. Due to a quirk in the way that DNA is replicated, as cells divide and as we age, telomeres become progressively shorter, ultimately obtaining a length at which they become dysfunctional and trigger the cells to enter a non-dividing state called replicative senescence. Telomeres therefore provide a limit on the number of times cells can divide.

This project hopes to provide an in-depth understanding of cellular ageing of immune cells in patients with ME/CFS and whether this may impact on the pathology of this condition. Providing an understanding of these processes and the technologies to monitor them may in turn lead to prognostic tools and potential therapeutic interventions.

The samples released to Professor Baird were distributed free of charge, as one of the two awardees from the UKMEB’s Christmas Appeal 2017/18, to enable priority research to happen without cost being a barrier. Thank you to everyone who donated.

Read about more recipients of Biobank samples

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ME awareness – in the workplace

Explaining ME in the workplace

Raising awareness of ME is always a good idea – yes? 

But is telling others about your experience of ME always a good idea?

There are many creative ways to describe to friends and family how ME affects the way you feel and disrupts your life. You might unfortunately fear that being so forthcoming with your employer, line manager or work colleagues may backfire, causing them to lose confidence in you, could lead to resentment or bullying, or affect your prospect of promotion or job development.

You are not obliged to disclose any health issues to an employer unless it could lead to health and safety problems.  You may feel you have to give some explanation however if you decide that ‘reasonable adjustments’ or changes in your workplace or work routines will be necessary to avoid relapsing, to enable you to continue working, or be effective in your job. You can also ask your employer or line manager to keep the fact of your illness confidential, and s/he is obliged to do so, when practical.

Many written introductions to ME highlight the severity and long term nature of the condition, which may not aid your employer’s understanding of your needs if you are mildly affected. Though your employer may have access to NHS, DWP or Union leaflets about CFS, so you should be ready to explain exactly how ME affects you, how this could affect your ability to do your job, and if necessary, how your approach to treatment and management differs from NICE recommendations!

Research employment & disability

Do some research or consult an advisor to find out about your rights and your employer’s responsibilities as this might affect what and how you disclose – a good place to start is the ME Association’s leaflet: Employment issues and ME/CFS

Pitch the info at the right level

Any leaflets or videos about ME you offer your employer should be short & easy to digest – the Canadian guidelines for clinicians might be overkill! You can always give more information later once you know what they want or need.

Decide how much info to give

If you tell your employer you are recovering from a severe phase of ME, then you will probably have to give them a lot more info about the illness and ask for more support, than if you are requesting one or two adjustments to your work practices in order to enable you to keep on an even keel and avoid relapse. Read the ME Association’s leaflet for ideas on Explaining ME/CFS to other people

Decide which info to give

Try to work out the key triggers that will make your symptoms worse and which adjustments could help. A US article gives some suggestions: Working with Chronic Fatigue Syndrome & Myalgic Encephalomyelitis   You may need to provide your employer with information about specific difficulties so s/he can suggest feasible changes e.g. for sensory overload, activity pacing, pain, mobility & travel, cognitive problems.  It may not be necessary to mention ME at all if you only need adjustments for a symptom that is common and easily understandable e.g. migraines, back pain

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Millions of parents missing millions of moments

Millions of parents
Missing millions of moments

Missing due to lack of research and care for people with myalgic encephalomyelitis

Do not let them miss a moment more

#MillionsMissing  

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We had lives. Now we are the #MillionsMissing.

We were dancers
We were athletes
We were adventurers

We had careers
We had plans
We had dreams

We had lives
Now we are the #MillionsMissing

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Join #MillionsMissing virtual & visibility actions, May 2019

#MillionsMissing – a global campaign for health equality

A global, grassroots network for people with Myalgic Encephalomyelitis and Chronic Fatigue Syndrome

Join the virtual action in Wales on ME Awareness day – May 12th

Sign up  to show you are missing from your lives and:

  • post a selfie
  • post a photo of your empty shoes
  • share a photo from the protests
  • use your social media profile to show your support
  • Tweet at government leaders about the #MillionsMissing

Join the visibility action in Cardiff on Saturday 11th May

between 11am – 4pm

  • at the Hayes – a pedestrianised shopping street in the city centre

Over the border:

Check the calendar for events in other places

 

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Cognitive behavioural therapy for ME/CFS is not effective. Re-analysis of a Cochrane review

Cognitive behavioural therapy for ME/CFS is not effective. Re-analysis of a Cochrane review, by Mark Vink and Alexandra Vink-Niese in Health Psychology Open

Review abstract:

Analysis of the 2008 Cochrane review of cognitive behavioural therapy for chronic fatigue syndrome shows that seven patients with mild chronic fatigue syndrome need to be treated for one to report a small, short-lived subjective improvement of fatigue. This is not matched by an objective improvement of physical fitness or employment and illness benefit status.

Most studies in the Cochrane review failed to report on safety or adverse reactions. Patient evidence suggests adverse outcomes in 20 per cent of cases. If a trial of a drug or surgical procedure uncovered a similar high rate, it would be unlikely to be accepted as safe. It is time to downgrade cognitive behavioural therapy to an adjunct support-level therapy, rather than a treatment for chronic fatigue syndrome.

From the discussion section of the paper:

Our analysis of the RCTs included in the Cochrane CBT review identified 12 areas of concern. These included potentially selecting patients who do not have the disease. A failure to exclude patients with comorbid depression and anxiety, even though CBT is the most effective treatment for both, as a meta-analysis by Tolin (2012) found. One of the other important problems of the trials and the review itself was the use of subjective primary outcomes even though in non-blinded trials, self-reported outcomes can
produce highly inflated estimates of treatment-related benefits contrary to objective outcome measures (Wilshire et al., 2018b). Moreover, it is unclear why the trials relied
on subjective primary outcomes when the basis of CBT for CFS is that patients suffer from false illness beliefs and they do not know how to interpret their symptoms correctly.

The flaws in the review and the trials, as discussed at the beginning of this article, all created a bias in favour of the intervention. It was therefore crucial to demonstrate
accompanying improvement on more objective measures yet these did not yield significant treatment effects. Most notably, treatment did not affect fitness.

Our analysis shows that CBT did not improve the quality of life scores either, in a disease where these scores are much lower than in the general population and the lowest compared to 20 other chronic illnesses which included stroke, lung cancer and MS (Falk Hvidberg et al., 2015). Nothing has changed in that respect compared to the 1996
health status report (Komaroff et al., 1996) despite the widespread use and promotion of CBT and GET as effective treatments, which provides indirect evidence of their inefficacy…

Real-world application of CBT in NHS CFS clinics shows equally poor results. Moreover, patients who had been treated with CBT and GET in these clinics had less improvement in fatigue at 12 months than those who had been offered activity management (Crawley et al., 2013).

This is in line with the outcomes of patient surveys which have repeatedly shown that rest and activity management (pacing) are the most helpful, with CBT and GET among the least effective therapies (Kirke, 2017). Just 3 per cent of CFS patients report no longer having CFS after NHS treatment; 2–5 years after the initial assessment, this was 5.7 per
cent (Collin and Crawley, 2017), which is essentially the same as the naturally occurring recovery rate of 5 per cent (Cairns and Hotopf, 2005).

The impact of CFS results in disruptions to productivity and meaningful occupation, which is often not the case with other conditions (Roberts, 2018). An influential systematic review by Cairns and Hotopf concluded in 2005 that because there is increasing evidence for the effectiveness of CBT and GET, that ‘Medical retirement should be postponed until a trial of such treatment has been given’.

Yet our reanalysis, just like the reanalysis of the Cochrane GET review (Vink and Vink-Niese, 2018b), shows that CBT and GET do not improve the number of hours worked or sickness and disability benefit status.

Implications for practice

1. For clinicians
If a skilled CBT therapist is available, who acknowledges the severity of this debilitating multisystem disease, then offering CBT to patients as an adjunct support therapy is
something to consider. Especially when patients also suffer from a comorbid depression or anxiety disorder or have problems adapting to a life of disability/dependence on others. The findings of this reanalysis do not encourage to instigate treatment programmes of CBT for people with CFS as has been the case so far.

2. For policymakers, occupational health services and illness benefit assessors
This reanalysis shows that CBT does not lead to an improvement of fitness, a reduction of the number of patients on sickness and disability benefits or an improvement of employment status. Forcing patients to undergo this expensive treatment as a requirement to be eligible for illness benefits or medical retirement causes a lot of stress for
patients and their families without any benefits to patients and society.

3. For people with CFS
For many patients with CFS, becoming involved in a CBT programme has been compulsory to be eligible for illness benefits or medical retirement. Based on the notion that if they did not want to be treated with CBT, they were after secondary gains and not motivated to get better. This reanalysis however shows that CBT does not lead to significant improvement in quality of life. Nor does it lead to an improvement in fitness or employment status or reduction of the number of patients receiving sickness and disability
benefits.

In any event, people with CFS, if offered this therapy, should know that any effect on fatigue is likely to be short-lived and small in degree. Also, that six out of seven patients will undergo the treatment without any benefit andone in five will suffer negative consequences because of it. However, if patients suffer from a comorbid depression or
anxiety disorder, or they need help coping with a debilitating illness, then it would be wise to consider help or support from a qualified and knowledgeable psychologist.

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Social Services can threaten families of children with Chronic Fatigue (ME)

Online blog Broadly highlights the fact that one in five children with ME are investigated by social services, with some even being forcibly placed in a hospital or foster homes, with destructive effects on their health.

Social services can threaten families of children with Chronic Fatigue, by Natasha Wynarczyk, May 2 2019

In the article WAMES’ medical advisor Dr Nigel Speight gives his view of the situation:

This is approaching a “national scandal,” according to Dr. Nigel Speight, a pediatrician from the North East of England who specializes in ME. Throughout his 30-year career, he has helped large numbers of families fight child protection cases where children with the condition have been at risk of removal from their parents. He says that anyone—including the child’s doctor, their teacher, and even a neighbor or relative—can get social services involved, and the decision to take a family to court often rests with people who have never even met the children…

“Many doctors these days don’t take proper case histories,” Speight says. “They are focused on ordering tests—but you can diagnose ME in an hour if you properly investigate the patient’s history. Either through ignorance or wilful avoidance, many doctors fail to make the diagnosis.”

“you can diagnose ME in an hour if you properly investigate the patient’s history”

“In some cases of GET, children with ME are being told to increase their energy levels by 10 per cent a week—if I did this, I’d be an Olympic athlete,” Speight says. He adds that when families complain that the child is being made more ill, they can be told to “push through the pain.”

“One of the most heartbreaking cases I’ve dealt with was an eight-year-old girl who was forced to have GET,” he adds. “Her parents were told that if they didn’t comply, she’d be taken away [by social services].

“Her parents reluctantly allowed her to be admitted to hospital where she was given vigorous physiotherapy for several months. She was able to walk before being admitted, but after she deteriorated to the extent that she became bed-bound and needed to be fed via a tube.”

He adds that while he may have an “unduly pessimistic view” of the situation due to his involvement in many of the worst cases around the UK, these may be the tip of the iceberg. For every family who have involvement with social services, he says, there are many others subjected to “disbelief and pressure, especially around school attendance”.

Read the full article

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ME: a global health scandal – Stop ignoring ME video – ME Awareness week 2019

ME: a global health scandal

People with ME are not asking for special treatment.

We are asking for humane treatment and health equality.

ME Awareness week 6th – 12th May 2019

Produced by Broken Battery, 2 May 2019

ME is one of the most misunderstood diseases.

1 in 5 parents face child protection proceedings, patients have been sectioned and abused, NHS treatments make over 50% of patients worse, biomedical research has been pitiful. A global health scandal that has been ignored for over 30 years.

Low quality of life

ME has a lower quality of life than HIV/AIDS, Stroke, Parkinsons, Multiple Sclerosis [1], but is one of the most misunderstood diseases. 80% of doctors think its psychosomatic [2].

Child protection proceedings

Misunderstanding has led to 1 in 5 parents face child protection proceedings [3]. A recent example is an April 2019 iNews article where Georgia Whyard’s teachers said she had ‘school phobia’ despite having  an official diagnosis of myalgic encephalomyelitis [4].

Mental health sectioning

Misunderstanding has led to patients being sectioned. In 2003 police forced entry into Sophia Mirza’s mother’s home, sectioned, and forced Sophia to a mental hospital. After being released Sophia had severely deteriorated and later died. An independent Neuropathologist found Sophia’s spine contained massive infection and Sophia was the first patient to have ME listed as her cause of death [5].

Physical abuse

Misunderstanding has led to abuse, Ean Proctor was removed from his home against his parents’ wishes and hospitalized under a “Place of Safety Order.” While in the hospital his health deteriorated as he was subjected to inhumane treatments: being placed into a therapy pool to force him to use his arms to swim, although he was unable to and would sink underwater; [6]

Harmful treatments

Many ME/CFS patients have been harmed by Graded Exercise Therapy. Over 50% of patients consistently report a worsening of their condition in an analysis of 18000 patients from 10 surveys from multiple countries [7]. Many have been made permanently disabled.

Fraudulent scientific research

The PACE Trial has been widely discredited [8] Over 100 scientists and over 80 international charities (Nearly every one) signed an open letter asking for the trial to be independently reanalysed [9]. Former science teacher Carol Monaghan MP described PACE as “one of the greatest medical scandals of the 21st century” and said “As a scientist, I am appalled by the methods used in the trial, which included changing the parameters and success criteria midway through the study. This has been widely discredited in the research community” Over 30 MPs have signed up to the MAIMES Campaign calling for an investigation into The PACE Trial [10].

Underfunded research

ME receives a disproportionally small amount of UK research funding given the prevalence of the condition. Despite the disease burden, the level of research spend per ME/CFS patient is considerably lower than in other illnesses. MS, for example, receives approximately 20 times more funding worldwide despite 2.5 times less prevalent than ME [11].    Read references & credits

#StopIgnoringME     #TimeForUnrestWales     #HelpNHSbeMEaware

#BeMEaware    #WAMESMECFS

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Epigenetic components of ME/CFS uncover potential Transposable Element activation

Epigenetic components of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Uncover potential Transposable Element Activation, by  Eloy Almenar-Pérez, Tamara Ovejero PhD, Teresa Sánchez-Fito MSc, José A Espejo BSc, Lubov Nathanson PhD, Elisa Oltra PhD, in Clinical Therapeutics [Published online 23 March 2019] https://doi.org/10.1016/j.clinthera.2019.02.012

 

Review abstract:

Purpose:
Studies to determine epigenetic changes associated with myalgic encephalomyelitis/ chronic fatigue syndrome (ME/CFS) remain scarce; however, current evidence clearly shows that methylation patterns of genomic DNA and noncoding RNA profiles of immune cells differ between patients and healthy subjects, suggesting an active role of these epigenetic mechanisms in the disease.

The present study compares and contrasts the available ME/CFS epigenetic data in an effort to evidence overlapping pathways capable of explaining at least some of the dysfunctional immune parameters linked to this disease.

Methods:
A systematic search of the literature evaluating the ME/CFS epigenome landscape was performed following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria. Differential DNA methylation and noncoding RNA differential expression patterns associated with ME/CFS were used to screen for the presence of transposable elements using the Dfam browser, a search program nurtured with the Repbase repetitive sequence database and the RepeatMasker annotation tool.

Findings:
Unexpectedly, particular associations of transposable elements and ME/CFS epigenetic hallmarks were uncovered. A model for the disease emerged involving transcriptional induction of endogenous dormant transposons and structured cellular RNA interactions, triggering the activation of the innate immune system without a concomitant active infection.

Implications:
Repetitive sequence filters (ie, RepeatMasker) should be avoided when analyzing transcriptomic data to assess the potential participation of repetitive sequences (“junk repetitive DNA”), representing >45% of the human genome, in the onset and evolution of ME/CFS. In addition, transposable element screenings aimed at designing cost-effective, focused empirical assays that can confirm or disprove the suspected involvement of transposon transcriptional activation in this disease, following the pilot strategy presented here, will require databases gathering large ME/CFS epigenetic datasets.

Read full article

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