Parliamentary Questions, getting to the bottom of WHO disease classification and enforcement, 19 May 2011

May 20, 2011

The difference between chronic fatigue and ME/CFS

Further to a written answer given by Lord Freud on 5 May 2011 in which he referred to Chronic Fatigue Syndrome and not Myalgic Encephalomyelitis/CFS, the Countess of Mar asked why the Department for Work and Pensions did not recognise the difference between chronic fatigue, categorised as a mental health condition in the World Health Organisation International Classification of Diseases 10th Revision, and CFS/ME.

In a written answer, Lord Freud (Parliamentary Under-Secretary of State at the DWP) replied:

The training programmes for Atos Healthcare professionals refer to chronic fatigue syndrome/myalgic encephalomyelitis. This was merely an omission from the Written Answer which should have clearly stated both, although – as I made clear in my answer to the noble Countess on 9 May ((Official Report, col. WA174) – assessment of entitlement to benefit does not depend on the condition itself, the underlying cause or how they are classified, but on the disabling effects of the condition(s) present.

Who in Government is responsible for the recognition, diagnosis and treatment of medical conditions?

Is Government under any obligation to enforce WHO classifications of disease?

The Countess then asked two questions, for which written replies were supplied by Earl Howe (Parliamentary Under-Secretary at the Department of Health).

Question 1: To ask Her Majesty's Government who in Government are ultimately responsible for determining policy on recognition, diagnosis and treatment for particular medical conditions.

Question 2: To ask Her Majesty's Government, in view of their agreement with the World Health Organisation's classification of myalgic encephalomyelitis/Chronic Fatigue Syndrome as a neurological disease (under ICD10 G93.3), whether they are under any obligation to enforce recognition of this classification throughout government.

Earl Howe replied to both:

Clinicians are responsible, within their area of competence, for diagnosing medical conditions and for advising patients on the treatment options available. They are expected to take account of best professional practice, guidance from the National Institute for Health and Clinical Excellence and authoritative advice from other relevant bodies, including the World Health Organisation (WHO).

The department has no obligation, or powers, to enforce recognition of WHO's classification throughout government.

6 thoughts on “Parliamentary Questions, getting to the bottom of WHO disease classification and enforcement, 19 May 2011”

  1. ..and the Map of Medicine refers to Chronic Fatigue Syndrome and Myalgic Encephalopathy…

    A further omission? Not that I care overly much anymore. I do wish the WHO would clarify matters though. A mere reference is pants to all concerned, whichever way you look at it…

    Still – Chronic Fatigue might be recorded in WHO, but Chronic Fatigue Syndrome ain’t… or is it? 🙂

    1. CFS is indexed to G93.3, where ME and PVFS are.

      Fatigue syndrome is placed at F.48.0

      The WHO has made is very clear several times in the last decade that you cannot mix anything in G93.3 with F48.0 as NICE has done in creating their guidelines that describe both under the umbrella term CFS/ME.

  2. Lauding the WHO classification as the single definitive description of M.E/CFS has served as a 20 year diversion for M.E/CFS advocacy and the response from the Health Secretary should serve as the end point for pursuit of this logical fallacy.

    Disease classification is neither disease description nor diagnosis; in the case of the WHO it is a bureaucratic process of creating a filing system by agreement amongst disparate political interests. As an advocacy position reliance on the WHO classification is wholly unsustainable, demonstrably so when many M.E/CFS affected people are volubly supporting an infectious causation (XMRV) model. That many of us have neurological symptoms does not make our illness unequivocally ‘neurological’, either by ‘disease description’ or ‘diagnosis’. That the ‘disease description’ and diagnostic criteria accepted by the NHS and NICE are inadequate is undoubtedly the case, but reliance on WHO provides no basis for a logical argument for change.

    1. I concur.

      Except for your use of the word ‘many’ of course in relation to voluble support of XMRV 🙂

    2. There is plenty of evidence that proves ME patients have neurological symptoms. Taking people who do not have the disease and pointing at them for a different classification is a futile exercise.

      The classification arrived at in 1964 and entered into the WHOs manual in 1969 was built upon solid evidence that still exists today and for which so much more is known.

      As for XMRV, the data supports the association and the overwhelming literature that ME is infectious.

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