On Wednesday and Thursday of this week, BACME (British Association for CFS/ME) held their annual conference in Liverpool.
“BACME is a multidisciplinary organisation for UK professionals who are involved in the evidence-based management of patients with CFS/ME.”
“BACME exists to promote and support the delivery of evidence-based treatment for children, young people, and adults with CFS/ME in the UK.”
Members of the South Sefton ME/CFS Support Group and Chester MESH were able to hand out leaflets and copies of the ME Association guide to clinical issues to attendees.
Joan Crawford wrote to members of Chester MESH who were unable to attend, and kindly agreed that we could share her thoughts about Day 2 of the conference with you on our website blog.
Well done to Joan, and members of Chester MESH and South Sefton ME/CFS Support Group. An excellent example of local advocacy at work.
Dear Chester MESH members,
I hope you will have seen previous posts about the BACME conference, which was taking place yesterday and today in Liverpool.
I was able to attend this conference as a healthcare professional on Day 2 with a plan to challenge some of the less helpful speakers, for example, Prof Crawley from Bristol, and Prof Fink from Denmark.
Chester MESH members leafletted the conference goers as they entered on day 1 of the conference, along with giving them fliers for the film Unrest. This went really well.
Also, the South Sefton ME group were able to arrange a stand inside the conference venue and were able to distribute ME Association Purple books along with International Guidelines. This was amazing as the majority of these were distributed over the two days with hardly any left by the time I went home today!
Thanks so much to everyone involved in all of this – a lot of effort went into it and we got a really good, positive result with a lot of professionals receiving information they otherwise would not.
My overall impression from today was a lack of specific material relating to M.E.
We heard about Mast Cell Disease (this has been misdiagnosed as M.E.), Microbiome changes in many conditions, nonspecific fatigue following infection, joint hypermobility, and Prof Fink’s view that M.E. can be better understood as a Bodily Distress Disorder!
Overall, I think this mission creep is due to lack of understanding of the core M.E. symptoms i.e. the lack of ability to generate energy, post exertional malaise (PEM) and weakness. The focus on ‘fatigue’ really doesn’t help focus the research to the task.
Prof Crawley (Bristol University) a paediatrician who is a fan of GET, shared the results of various randomised trials. This included such gems as the SMILE trial investigating the Lightening process.
Most of the trials she discussed, SMILE, GETSET, FITNET, etc. use subjective, patient reported outcome measures.
I asked her if there was a trend in future trials that will incorporate objective measures to ensure that the small, modest improvements seen in such trials are not due to the placebo effect.
She really didn't like that at all. She did manage to tell me that using accelerometers is not that objective and her young patients cheat…. She is a fan of more passive recording of data via, for example, Smartphones.
I kind of get what she is saying but I think the game is up as regards funding for such trials in the future – if there is nothing objective as a primary outcome measure I do hope it doesn’t get funded.
David Butcher (Chairman of the Optimum Health Clinic) stated that blood testing for mitochondrial function was gold standard. [Within the Chester MESH we have data that disputed this.]
Later, Prof Anne McArdle (Liverpool University) made it clear why blood sample testing is not reliable and can be inaccurate and misleading. Skeletal muscle samples need to be tested directly via biopsy.
Prof McArdle shared pretty much the only M.E. specific work at the conference. She reported on new work that examines skeletal muscles and cytokines. She uses subjective and objective measures, which is great.
This work is still being analysed but is indicating that the effect that M.E. has on patients is like those of older, elderly adults. She thinks that skeletal muscles are producing high levels of cytokines (e.g. IP10), which is possibly causing flu-like symptoms.
She is taking this research forward with more funding looking at flavonoids and exercise tolerance. She is also keen on subgroups.
I took the opportunity to ask her if the 2-day exercise test difficulties identified in M.E. is perhaps linked to her work. She thinks it is and she also thinks that the 2-day exercise test would show problems in elderly patients too.
Next up was Prof Per Fink (Aarhus University, Denmark). He lumps ME/CFS together with other conditions he refers to as ‘functional’ – IBS, Fibromyalgia, etc. He views these as ‘medically unexplained’ and calls this new disorder: Bodily Distress Disorder (BDD).
Scientifically this is a mess. I asked him what this new condition adds to patient’s medical care and to patient’s psychological support. He didn't understand my question. So, I asked him what this adds beyond how many professionals would understand distress in such conditions to often be part of an adjustment reaction to response to developing a debilitating condition.
His view is that BDD provided a “homogenous” sample of patients and provides a nice name for patients. My mind boggled at this!
Prof Hugh Perry (Professor of experimental neuropathology – University of Southampton), who was chairing the discussion session, made it clear that the way forward is to stratify samples of patients (i.e. subgroups). This is the view of the UK Medical Research Council (MRC) as well.
Prof Fink is a lonely voice. I forgot to ask him about the validation studies that need to be done for BDD. I have emailed him about this. This work is vital if he is to get his new disorder into the International Classification of Disease (ICD-11), which is currently under review. [In ICD-10, which is used in the NHS, ME/CFS is classified under neurology.]
A GP (Dr Nutt from the Sheffield CFS service) asked him to clarify if he sees ME/CFS as a BDD and Prof Fink thinks it is – and then contradicted himself saying they are differences as well! It is my view that everyone in the audience ‘got’ the points being made here. Clinicians can see no benefit to them or patients from a disorder without boundaries.
Prof Fink showed the outcomes from a trial. This used subjective measures only. Again, he showed the small, modest improvement that would be expected in a placebo effect. If I got this right, it seemed to show an increase in physical functioning of the SF-36 to 40.
40 is a diabolically low score and represents a very high level of debility – far worse than heart failure, COPD, end stage renal disease. How he thinks this is effective ‘treatment’ is anyone’s guess. Healthy controls score 90-100!
Dr Joshua Milner (National Institute of Health, America) talked about Mast Cell Disease/Mast Cell Activation Syndrome (MCAS), which was of interest as future work in this area may shed light on certain M.E. symptoms.
I am aware of MESH members who have diagnoses in this area. I’d be happy to run through this with individuals, so they can learn more.
This could be relevant for allergy/sensitivity related symptoms, migraine, movement and vibration triggering symptoms along with shocks (including physical and psychological) and possible treatments blocking the alpha tryptase gene.
Deb Roberts (from Liverpool’s Broadgreen CFS service) gave a brief roundup of research which was interesting as I was unaware of a few papers.
I also had a discussion with her regarding the Broadgreen service along with the need for domiciliary (home) visits for those most severely affected. This is something we can try and take forward.
Due to work commitments I am unable to make the infrequent ME group leaders meeting at Broadgreen as it is now on a Wednesday. If anyone from the group can attend future meetings, please do let me know.
I hope that brings you all up to date. And a big thank you to all the patients who made a huge difference over the 2-days of this conference getting M.E. information directly to clinicians.
A top-class effort!