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After more than two years' gestation, an independent working group, set up by the previous Chief Medical Officer for England, published its final report on the subject of chronic fatigue syndrome (CFS) in January of this year. 1 This is a topical subject in the English speaking world as two other management reports have been published in the last six months, by the US government and the Australasian Royal College of Physicians. 2, 3 The Canadians are also close to a final draft of their own report. This has occurred at the same time as the release of two independent systematic reviews of management. Remarkably the two teams from Texas (USA) and York (UK) reached such similar conclusions that they combined their findings into the one paper. 4 The York group has just published their own guidance based on their systematic review. 5
So, has the mystery of myalgic encephalomyelitis (ME) been resolved? Is everyone agreed on how to manage the enigma of patients presenting with chronic unexplained fatigue? Have we finally solved the riddle of CFS?
On first reading of the management guidelines, the answers seem to be a qualified "yes". All are agreed that CFS and ME are essentially synonymous. All agreed that CFS is a discrete illness, although they further suggested that CFS is either an umbrella term for several different disorders, or that the aetiology is multifactorial. Both the Australasian and English management reports suggested that there are three management options that are worth consideration. These are cognitive behaviour therapy, graded exercise therapy, and "pacing". All agreed that patients have not been well served by the medical profession and that a mutually respectful doctor-patient relationship is essential for optimal care.
So far so good. Closer reading of the reports and awareness of the politics surrounding them qualifies the optimism and spreads some doubt. Five clinicians and two patients resigned just before publication of the English report, 6 being unable to endorse it. There was a five year delay and much controversy between publication of the Australasian draft report in 1997 and this year's final report. 3 There were three main reasons for the politics and polemic. Firstly, some clinicians were keen on a more biopsychosocial approach to both assessment and...