Dr. Alan Gurwitt’s opinions here are his own and do not represent the Massachusetts CFIDS/ME & FM Association or its Board.

Stuck? Four Months of Almost Nothing

by Alan Gurwitt, M.D.
June 10, 2015

Four months have passed since the release of the report, "Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness," from the Institute of Medicine on February 10^th. In spite of much thoughtful review and debate on the part of patient advocates to attempt to arrive at some consensus about an appropriate name and diagnostic criteria for this terrible disease, so far these efforts have changed nothing, nor will they ever make a difference without major changes in our tactics and attitudes.

The federal DFO’s (designated federal officers) come and go. The Chronic Fatigue Syndrome Advisory Committee (CFSAC) keeps making reasonable recommendations but is often ignored. There is not a peep from HHS and NIH. Indeed, except for some promising responses from the CDC, there is silence. Dr. Francis Collins, the director of NIH, says he is aware of the requests for greater NIH involvement but continues to do nothing. Dr. Anthony Fauci, in office since 1984 as head of the National Institute of Allergy and Infectious Diseases (NIAID), continues to make it clear he wants nothing to do with ME/CFS. While many agree that the work on ME/CFS belongs in one of NIH’s Institutes, not in an unfunded Office of Women’s Health, there is no person or group at NIH and HHS who is leading the charge and no indication so far that the leaders of these huge “health” agencies have paid attention to the findings of the IOM report and the preliminary P2P report and plan to respond promptly and significantly. Some individual lower-level personnel have gotten the message and have done what they can but overriding indifference has prevailed for thirty years and there are no signs of motivation to change. I believe only strong outside forces will cause HHS and NIH to change.

Under present circumstances, it does us no good to sit and wait another four months for the government’s response. Whether or not HHS and NIH respond we patients, advocates, researchers and allies in the medical professions must review and change our tactics and direction, otherwise we will remain stuck in nowheresville. We have tried for years with some success to make our illness and cause known, but our struggle too often is ignored or seen as unwelcome. At times it seems like war for recognition and survival.

Alone, we are weak, vulnerable, and ineffective. We must supplement and organize our forces and improve our strategies going forward.

So, where should we go from here? I believe that there needs to be a series of coordinated steps to build an effective and constructive force. As I see it, the possible steps are the following:

• We have been told for years that the federal health agencies will only shift course when Congress demands it. We should establish a group to research and plan how to best educate and recruit Congress people from as many states as possible to act together in Congress. ME/CFS is a bipartisan cause and a very serious national problem. Coordination will be absolutely key.
• Recruit a coalition of medical professionals, both researchers and clinicians, and institutions outside of the government to map out a plan to address the key areas of needed research, both basic and clinical. This may not be hard to do as there is already much cooperation thanks to the IACFS/ME.
• Form a planning group to think through the goals of a long overdue national ME/CFS organization, its possible structure, and means of creating and coordinating the above steps. After doing so (six months to no more than a year), implement.
• Create a group to collaborate with patient groups and clinicians in other countries. ME/CFS doesn’t recognize boundaries. There is much to learn from one another. Australia and New Zealand have succeeded in educating a higher percentage of physicians. Norway is doing key research on whether ME/CFS is an autoimmune illness. In all these cases patient organizations have played a key part.
• We must stop the pattern of fighting and undercutting among ourselves. Such has been an important reason for limited participation and contributed to our fragmentation. If we don’t all work together in a respectful manner to achieve common goals we defeat ourselves. We have large challenges to overcome but at times we have been our own worst enemies.
• Time is of the essence, otherwise positive components of the IOM report might die. Let us not miss the opportunities opened up by the IOM report and important new research.

I believe the IOM and P2P reports are game changers if we utilize the achievable big findings and recommendations. Of course name and diagnostic criteria are important but it is only with further research that both will become clear. The other big findings with which we can propel our work now are:

1. ME/CFS is a biological, not psychological, disease.
2. For many years patients with ME/CFS have been undiagnosed, misdiagnosed, mistreated and harmed by uninformed healthcare professionals and shamefully negligent medical educators and medical organizations. We must figure out what are the blocks to learning and how to overcome them, otherwise ignorance will continue.
3. Children and adolescents present somewhat differently but have a better prognosis IF diagnosed early and well managed. Useful pediatric ME/CFS research is even sparser than for adults. That must change.
4. There are huge gaps in our scientific understanding of ME/CFS in both children and adults as a result of a biased and indifferent federal government which has almost totally failed for decades to provide the necessary research funds and leadership. Despite the initiatives on the part of HHS and NIH to bring about the P2P and IOM reports, the reports seem DOA (dead on arrival) and the leaders AWOL (absent without leave).

In summary, nothing will change until we change. We must not keep waiting for the federal health agencies nor should we go it alone. We must take a series of steps. One step is to create a multi-pronged coordinated and comprehensive effort to recruit congressional support. We must also build a strong national coalition of patients, advocates, and professionals. We have many wonderfully informed, thoughtful, and active patient advocates among us but our failure to coalesce has created a major obstacle. The challenges are great so our efforts must be greatly smarter, focused, and more effective.

Failure to change our efforts and directions will doom us to remaining stuck. We should utilize our own capacities and wait no more.

Alan Gurwitt is currently chair of the Medical Advisory Committee of the Massachusetts CFIDS/ME & FM Association. He was Association president for four years. He has had ME/CFS for 29 years and has been active as an advocate for 27 years. He is a co-author of the IACFS/ME's "ME/CFS: Primer for Clinical Practitioners," both 2012 and 2014 editions. He is currently working with an international group of pediatricians and researchers to write a primer for pediatricians and primary care providers. Dr. Gurwitt has served on the clinical faculties of the Yale Child Study Center, University of Connecticut Medical School and the Harvard Medical School. He evaluated and treated 94 patients with ME/CFS prior to his retirement in 2003. His opinions here are his own and do not represent the Massachusetts CFIDS/ME & FM Association.