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Patients Slam Guidelines on Chronic Fatigue Syndrome

By Helen Carter

Chronic fatigue syndrome (CFS) patient groups have slammed Australia's first CFS clinical practice guidelines, saying they will lead to misdiagnosis, and inappropriate and inadequate medical care.

They are concerned that the guidelines, to be published in the 6 May issue of the Medical Journal of Australia, place too much emphasis on psychological and psychiatric issues relating to CFS causation and management, and not enough on biological issues.

"We're not saying don't mention the psychiatric/psychological approach, but we want a balanced consideration," said Mr Simon Molesworth, AM, QC, chairman of the ME/Chronic Fatigue Syndrome Association of Australia. The association represents all state CFS patient groups.

Mr Molesworth wrote to the Royal Australasian College of Physicians (RACP), which developed the new CFS guidelines, claiming they "fall seriously short" of being reliable information about diagnosis and management.

"The guidelines make management suggestions that are potentially harmful for many with CFS and do not mention other ways of effectively managing the illness," he said.

For example, the guidelines suggest inappropriate sleep management practices and antidepressants, which lack evidence, yet ignore other approaches with better evidence, he said.

These include pacing, where patients know their capacity and work to their potential, pacing themselves to gradually increase mobility.

Mr Molesworth also claimed he had letters from 40 Victorian GPs experienced in CFS overwhelmingly supporting the syndrome as a biological illness.

RACP president Professor Richard Larkins said the authors were very careful not to take a bias in the guidelines, which were well balanced, and continually updated.

He said every individual paper could not be included, only those that were consistent over time.

"I am a bit disappointed, as is the working group, that the support group has not endorsed the guidelines because we feel they will be of benefit to people who suffer CFS," Professor Larkins said.

© Copyright Medical Observer 3 May 2002

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