Does graded exercise therapy cure ME?

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Thanks to Tate

http://bit.ly/HoKm9u

Does graded exercise

therapy cure ME?

If there were a cure, there would be no controversy.

Evidence for this is provided by the large number of severely

affected individuals around the UK, most of whom have tried

just about every treatment on offer, yet remain severely

affected.

In 2007, NICE Guidelines gave qualified approval to Graded

Exercise Therapy (GET) and Cognitive Behaviour Therapy

(CBT) due to limited evidence that they might be helpful in

mild and convalescent cases.

In 2007, NICE Guidelines gave qualified approval to Graded

Exercise Therapy (GET) and Cognitive Behaviour Therapy

(CBT) due to limited evidence that they might be helpful in

mild and convalescent cases.

There is no significant evidence that they help severe cases,

and plenty of evidence from the patient community that

over-enthusiastic forms of GET can be positively harmful.

The danger of doctors placing too much faith in the efficacy

of these forms of management is that, when they fail to

work, the doctor may start *blaming the patient*.

They may say:

*this can’t be ME/CFS because they are not responding to

orthodox treatment* and invoke a psychiatric diagnosis eg

Pervasive Refusal Syndrome, abnormal illness behaviour, or

Munchausen Syndrome by Proxy / Factitious Induced

Illness in children.

Alternatively, the family can be blamed for *sabotaging* the

treatment, and their access to the child (if in hospital)

restricted.

This well-meaning but in my opinion seriously misguided

belief system leads to the family being subjected to the

juggernaut of Child Protection proceedings, which in the

case of an already severely affected patient amounts to

*Child Abuse by Professionals*.

In the past one felt that once a young person reached 18

they were safe from these pressures but now the same sort

of belief system is leading to an adult form of Care

Proceedings.

Using the Mental Capacity Act, the patient who declines

*treatment* (typically, admission to a psychiatric unit) is

said to lack *capacity* to make their own decisions.

The spectre of Munchausen Syndrome by Proxy is invoked

to deprive patients of their liberty on the grounds that they

do not understand their own best interests.

Perhaps the next version of NICE Guidelines should state

loud and clear:

There is no form of treatment for ME/CFS

of such efficacy that it could ever justify

a coercive approach.

Once the limitations of GET and CBT are accepted, doctors

can recommence their duty to support and care for their

patients in a more humane way.

Dr Nigel Speight

Consultant Paediatrician

Tymes Trust Professionals

Referral Panel

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GET is based on the theory that patients have

just become unfit (deconditioned)

*If the child doesn’t fit the theory then the theory is wrong. In

the severely ill, bed rest is not harmful and may be

essential […] Activity levels will naturally increase as the

child’s symptoms improve […] Excessive activity can be

harmful.*

The late Dr Alan lin

Consultant Paediatrician

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*Papers that disprove the “deconditioning”

theory in ME/CFS include:

(i) Scroop GC et al; Med J Aust 2004:181:578-580;

(ii) Schmaling KB et al; J Psychsom Res 2005:58(4):375-381;

(iii) Newton JL et al; Q J Med 2007:100:519-526.

Professor Malcolm Hooper

Emeritus Professor of Medicinal Chemistry

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The Young ME Sufferers Trust

Registered Charity 1080985