Talk:Myalgic encephalomyelitis/chronic fatigue syndrome/ME archive

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NOTE: PAGE MERGE

On wikipedia, per WP:UNDUE, WP:MEDRS, WP:FORK and WP:V, myalgic encephalomyelitis is considered synonymous with chronic fatigue syndrome; accordingly, the main page has redirected to CFS and the talk page has been merged into an archive for the CFS talk page. Before redirecting or recreating the talk page or main page for myalgic encephalomyelitis, please seek consensus on talk:chronic fatigue syndrome. WLU (t) (c) (rules - simple rules) 00:42, 24 October 2008 (UTC)

Article

This page is not needed; proper article at Chronic fatigue syndrome. —Preceding unsigned comment added by Thedreamdied (talk • contribs) 13:34, 9 December 2006 (UTC)

This page is needed - read the text of both pages! Chronic fatigue syndrome and Myalgic Encephalomyelitis are not the same - although very similar. If you disagree than take it up with the WHO. It is not normal for Wikipedia to list different things as one and the same.
This page should address the specifics of ME for those who want to know them. The CFS page should address the specifics of CFS. If you want to discuss the similarities then these can be mentioned in the relevant sections of each page or a seperate page can be created for that. If you want to debate the name or nature of the illnesses then wikipedia isn't the place.
Kmclellan 16:06, 10 April 2007 (UTC)

Treatment section

Removed some inappropriate text from the treatment section. Jklsc 22:51, 30 April 2007 (UTC)

Redirected

Obviously, chronic fatigue syndrome has now grown enormously, and this page is just a placeholder for those who disagree with the terminology. I strongly suggest we keep this as a redirect. JFW | T@lk 06:05, 28 May 2007 (UTC)

Redirect Removed

Jfdwolff, please read, and contribute to, the discussion page of a topic before you start applying redirects willy nilly and taking over. This is not a POV Fork as you implied. In fact, your redirect is the opposite of a neutral point of view (please see "NPOV" and the NPOV tutorial) it can also be argued to be original research as it advances the position that ME and CFS are the same thing despite debate in the wider community, declarations and classifications by the WHO, and published scientific articles.

As the user above mentions, CFS and ME maybe very similar, they may be the same thing, I don't know. However, they are different terms with different histories and deserve different, albeit related, entries (hyperlinks are an easy tool to add to an article you know). Personally, when the World Health Organisation decides to list them as the same thing then I will let you implement the redirect. Until then, separate entities deserve separate entries.

I have labeled this page as controversial for now. Jklsc 11:15, 1 September 2007 (UTC)

I have reverted your reinstatement, and will leave a post for discussion on Talk:Chronic fatigue syndrome. You need not lecture me on NPOV. NPOV does not mean we should have articles about different names, and most authorities (e.g. the new NICE guideline) state unequivocally that whether it's called ME or CFS, it is the same condition. This WHO business is the result of heavy political lobbying, and I am unaware of a source that does not map chronic fatigue syndrome to G93.3. I suggest you participate in discussion on the CFS talkpage. JFW | T@lk 09:47, 3 September 2007 (UTC)
You seem convinced that CFS and ME are the same thing despite the evidence to the contrary. I do not know of this consensus which you refer too. You may not have noticed that the NICE guidelines you refer to have had more objections by health profesionals and researchers (let alone other interested parties) than any previous guidelines. I personally feel that international consensus (i.e. the WHO) trumps my opinion whether I like it or not. Since my arguments haven't worked on you, and yours have not worked on me nor the others who have posted here, what would convince you that there is a need for a separate ME page?
Incidentally, I see that G93.3 makes no mention of CFS... perhaps you are using the wrong term or they are different things? Mapping to G93.3 is not the same thing as being listed under it.
NB this is a dispute about the ME page so it belongs on the ME page not the CFS page.
Jklsc 15:00, 11 October 2007 (UTC)
JFW should be well aware of the objections to the NICE Guidelines - I have already pointed out to him on the CFS Talk page that the national patient organisation, The ME Association has called in a press release for the withdrawal of the guidelines and that this call is supported by the national charities, The 25% ME Group (for severe sufferers) and the Young ME Sufferers Trust. CFS comes in several different flavours; Wessely and KCL's version of CFS is NOT ME - this is a concept that JFW (who is very busy on the Wessely Talk page) has yet to grasp. MEagenda 14:54, 18 October 2007 (UTC)

There has been discussion on this at Talk:Chronic fatigue syndrome. Please look there - at the moment there is no consensus for dual articles. JFW | T@lk 21:07, 15 October 2007 (UTC)

Sorry, in discussions elsewhere there is no case for forking this article. If you want to turn this into a fork, please encourage other contributors to discuss either on the CFS talkpage or here. JFW | T@lk 11:34, 16 October 2007 (UTC)
Jfdwolff please stop forcing your opinion on the contributors of this page. Contributors to this page have given valid reasons for it's existence. You have not provided anything other than your opinion that this page should be redirected to the CFS page. The relevant justification for the redirect should be provided here and agreed to here. This page is not a fork and should not be treated as one. As you are the only person here who has a problem with this page then you need to encourage other contributors to discuss this page here.
Let me re-iterate that CFS and ME are not the same thing. ME criteria fit within the American CFS criteria but not the other way round. A fitting analogy is that it would be unusual for there to be a page on Great Apes but not on Homo Sapiens as Homo Sapiens are Great Apes but not all Great Apes are Homo Sapiens. Also, the contributors to one page do not automatically override the contributors to the other. So, again, please make your case and back it up with evidence, rather than point of view, that ME and CFS are the same thing and that ME should redirect to CFS. Alternatively, please state what we can do to convince you that this page should stay. Kmclellan 01:37, 17 October 2007 (UTC)

vascular damage

ME is a historical diagnosis CFS is not. This is the position of Vance Spence, Byron Hyde, Betty Dowsett, Ramsay and numerous other experts on ME. Nice are very good on CFS I am sure but ME patients don't have fatigue as a symptom- so saying they suffer from chronic fatigue syndrome is erroneous- they suffer from CNS dysfunction that can be measured using SPECT etc. Whilst autopsy of these patients always shows vascular injury. At Akureyri this was vascular injury in the basal ganglia, vascular injury was also found in the sporadic Newcastle outbreaks via autopsy.

THIS PAGE MUST STAY!

88.108.49.106alpinist —Preceding signed but undated comment was added at 19:32, 5 October 2007 (UTC)

I am working on the historic aspect of the disease which is different from CFS- please can we not have any reverts- I have used one source which is copyright free and am about to work on cross referencing etc. —Preceding unsigned comment added by 88.108.49.106 (talk) 19:48, 5 October 2007 (UTC)

Alpinist, there is a general consensus that CFS equals ME. If you want to quote the dissenting opinions, do so on chronic fatigue syndrome. Please discuss further forks there. JFW | T@lk 06:15, 7 October 2007 (UTC)
No, such a concensus does not exist. The two are certainly not the same, and cannot be, since they are different types of entities. CFS is intended for the same patients, but it's a different diagnosis, where many people get diagnosed with CFS that do in fact not have ME. Guido den Broeder 23:53, 15 October 2007 (UTC)

move?

Shouldn't this be Myalgic encephalomyelitis with a lower-case e rather than capital? It's per WP:MOS#CAPS. WLU 16:07, 14 October 2007 (UTC)

Good question. Even an example that they gave at WP:MOS#Article_titles.2C_headings_and_sections doesn't follow the rules: The Rolling Stones as it is title case and starts with 'The'. The illness is normally refered to as Myalgic Encephalomyelitis, so I don't think that it matters either way. Still, since Multiple Sclerosis is 'Multiple sclerosis' on wikipedia and yet 'Multiple Sclerosis' almost every where else, we might as well stick with Jfdwolff's conversion to Myalgic encephalomyelitis... Kmclellan 02:10, 17 October 2007 (UTC)

Some comments on the below discussion:

  • the ICD10 link proves that the ICD uses the ME diagnosis. If reliable sources agree that it's substantially the same as CFS, it should only be one page. Link 4 on CFS seems to though I can't read the article itself.
  • age isn't the best way of determining the page name, it's usefulness. Which is more common? If they are interchangeable (in reliable sources), it should be one or the other. If doctors are settling on CFS (as CFS ref 4 suggests), it should be CFS.
  • The Rolling Stones point does not support the move - the name of the band is The Rolling Stones, not Rolling Stones.
  • patient advocacy sites are sources for discussions of controversy, not suggestions for page names. Peer-reviewed trumps all. No-one has brought it up yet in this discussion, but I figure I might as well strike pre-emptively.
  • rather than advocating on talk pages, finding and citing sources would be much more helpful. If ME is not CFS, find a RS and cite it. WLU 20:38, 17 October 2007 (UTC)

Redirect or Not

Should the Myalgic encephalomyelitis page redirect to the Chronic fatigue syndrome page?

The page was previously 'Myalgic Encephalomyelitis' and experienced many reverts by two users.

Please note, many contributors to this page may have this illness and may not be able to respond quickly.

What is your definition of "quickly"? JFW | T@lk 11:30, 21 October 2007 (UTC)

Opinions

  • Keep - CFS or ME are similar but complex and separate entities with different histories and different diagnostic criteria. Redirecting ME to CFS is not necessary, confusing, and ignores the fact that ME is internationally recognised as an illness in it's own right (see ICD10 G93.3). Kmclellan 02:56, 17 October 2007 (UTC)
  • Keep - Since CFS is only a syndrome diagnosis and ME is 30 years older than CFS, it is otherwise not possible to provide certain information, at least not in a comprehensible and readily recognizable manner. Guido den Broeder 10:27, 17 October 2007 (UTC)
    Terminology changes, but that does not mean an condition should be left with multiple separate articles, one for each previous term. Hence we do not have individual articles on Consumption, Phthisis, King's Evil etc; but rather the one description using the modern term of Tuberculosis.David Ruben Talk 23:25, 20 October 2007 (UTC)
    This is not a case of terminology change. The two diagnoses coexist and have different purposes. Guido den Broeder 01:03, 21 October 2007 (UTC)
  • Redirect - Most authorities use CFS and ME interchangeably, and given the enormous overlap this can only justifiably be dealt with on one page, which I submit should be chronic fatigue syndrome. Please note that this issue has already been discussed in extenso on Talk:Chronic fatigue syndrome. JFW | T@lk 19:47, 17 October 2007 (UTC)
  • Redirect - Both terms exist, but that does not mean they need individual articles. They are currently used largely interchangeably by reliable sources, and any historical differences can be adequately summarized in a single article. In addition, content forks of controversial or battleground articles are a generally poor idea, as they simply diffuse the conflict and often end up contradicting each other.MastCell
  • Neutral - I'm neutral due to a lack of expertise, but if reliable sources document them as the same or discuss (subtle?) differences, a single page with a controversy section or possibly a main seems the solution. If RS fail to document the difference, or document that they are the same thing, the page should reflect this. Verifiability, not truth, until a difference is discovered and discussed in RS, they are verifiably the same thing. Is this a straw poll or a discussion?WLU
  • Redirect - I agree with everything JDW says - most people use both terms to mean the same thing, and we can include an explanation of why and when some people use different terms in the main CFS article.Thedreamdied 21:30, 17 October 2007 (UTC)
  • Redirect - Everything JFW says. And as discussed in the CFS page, ME implies an etiology that simply doesn't exist.Sciencewatcher 16:09, 18 October 2007 (UTC)
  • Combine - I agree ME and CFS/CFIDS are different and a cause for much confusion. Yet most researchers have moved beyond the name argument and reference ME/CFS. Why not combine the name(s)/entry? Provide sections w/the differences/histories,etc. If this were a published encyclopedia there would be separate entries; however we users desire current info, which seems best suited to one entry. How will sub-group names be managed - such as VICD? Jlasf1 20:15, 20 October 2007 (UTC)
  • Redirect - Sure ME as a term was certainly notable in its medical and lay media usage, and the history of the condition needs mention the selection (and I grant controversy) over names. But ME & CFS both describe the same condition and Wikipedia should not fork information. David Ruben Talk 23:25, 20 October 2007 (UTC)
  • Keep - M.E., or myalgic encephalomyelitis, has been diagnosed for half a century since it was created in the mid-1950s to describe three cluster outbreaks of disease. The major characteristic of M.E. is significant central nervous system disruption - NOT "fatigue". At the same time, the name "epidemic neuromyesthenia" was used in the U.S. to refer to the same illness. The name "chronic fatigue syndrome" was created in an effort to deliberately keep the public from knowing about cluster outbreaks of a serious disease. Experts on M.E. and E.N. told the CDC committee that met on the disease in 1987 that these cluster outbreaks were indeed M.E. The CDC chose to ignore this, and adopt a name that does not really have a medical meaning - and focuses on a vague sensation (fatigue) as the primary symptom. In the ensuing years there have been no fewer than 7 competing definitions for "CFS", which can be divided between those that focus on CFS as a biological illness, and those that present CFS as a psychosomatic illness. Clearly the name "CFS" has not helped our understanding of the disease. Those who wish to continue to use the name and definition M.E. should be permitted that choice. —Preceding unsigned comment added by Aberdab (talk • contribs) 18:06, 27 October 2007 (UTC)
  • A source for these statements might help sway the opinion of members. As is, this looks like an observation on Aberdab's own research. Also looks vaguely like a WP:REDFLAG issue. If this is to influence the page name, it requires sources. Also, see points below - the purpose of the name of the page is to aid readers and editors in finding the page. WLU 21:20, 27 October 2007 (UTC)
Here are some sources for the difference between M.E. and CFS. See the Ramsay definition for M.E. that was published in his textbook [A. Melvin Ramsay, M.A., M.D. Myalgic Encephalomyelitis and Postviral Fatigue States: The saga of Royal Free disease (London, 1st ed. 1986, 2nd ed. 1988). Ramsay died in 1990.] This definition is available at the following website:[1]. Recently Byron Hyde has added a new definition for M.E., which is available at the Nightingale Foundation's website: [2]. Contrast this with the CDC's Fukuda (1994) definition for CFS(revised), which is available here: [3]. The Fukuda defintion requires six months of debilitating fatigue, then 4 of 8 physical symptoms, and major melacholic depression is exclusionary. The Oxford definition for CFS does not require any physical symptoms - the definition is basically 6 months of fatigue, and mood disorders are NOT excluded. Clearly there is a problem when some research on "CFS" is conducted using ONE definition, while a lot is conducted using a completely different definition. The Oxford definition has been used mainly by psychiatrists and psychologists who are convinced that CFS is a somatic disorder and can be "cured" by cognitive behavioral therapy (CBT) and graded exercise (GET). The Oxford definition [Sharpe et al, Journal of the Royal Society of Medicine, "A Report: Chronic Fatigue Syndrome: Guidelines for Research Volume 84 February 1991 p.118-121] can be found online at the following website: [4].
Here are the salient points: CFS researchers are using two very different definitions - one might say diametrically opposed definitions - the Fukuda definition tends toward he biological; the Oxford definition towards the psychological. The resulting research is thus confusing, particularly since neither group generally refers to the work of the other group.
Secondly, CFS is diagnosed by a small number of subjective symptoms, and then by what it is NOT. M.E. is diagnosed by what it IS. Aberdab 02:59, 28 October 2007 (UTC)
I've re-ordered and formatted your comments for easy reading, I'll try to read these over tomorrow and had a quick look - the first appears to be from 1985, the Nightingale document and definition does not appear to be used or published in peer-reviewed publications. The fourth appears to use ME as one name among many, including CFS, and does not actually advocate for the sole use of ME. And any comparison that would have to be done would pretty much be OR as far as I'm concerned. In my opinion, backed by WP:RS, the pages should stay as they are - CFS as the actual article, ME as a main. Possibly the sources could be used to document the issues people have with ME. WLU 03:05, 28 October 2007 (UTC)
The definitions might be different, but that doesn't mean they are talking about different illnesses. Many researchers have done studies using both the CDC and Oxford definitions. The Nightingale document is not peer reviewed, and if you read it you will see it has some fundamental flaws that make it unusable: e.g. saying there is brain damage in CFS that can be measured by SPECT scans. First of all SPECT does not measure brain damage, it measures functional blood flow (which may or may not be due to brain damage). Patients with depression have abnormal SPECT, but we don't say they have brain damage (they don't). Second, no autopsies have shown brain damage in CFS (or ME) patients. There are many people out there that want ME to remain as a separate diagnosis because it sounds more like a physical illness than CFS, but the problem is that there is no evidence that ME actually exists in the way that it was originally defined, which is why the majority of researchers now use the term CFS to describe the illness. --Sciencewatcher 22:28, 1 November 2007 (UTC)
Few researchers, if any, have used both the Oxford and CDC criteria, since these are based on different views on the classification of the disease.
Brain damage in ME is shown on MRI scans of living patients, an autopsy is not needed.
The majority of reseachers now are in favour of the combined term ME/CFS or CFS/ME. There just might have been a good reason for the IACFS/ME, previously IACFS, to change there name, don't you think? Guido den Broeder 10:01, 2 November 2007 (UTC)
MRI scans have not shown "brain damage". Some have shown differences between CFS patients and controls, but never "damage". This is confirmed by autopsies which have shown no damage. If you actually look at the research many researchers have used both criterias in their studies and compared the results. It is mostly patients that want the ME name - it has been rejected by most researchers because it is incorrect. --Sciencewatcher 20:37, 2 November 2007 (UTC)
Yes they have shown damage, or "cerebral atrophy" by up to 11% loss of volume, associated with severity but not duration of illness, which means it's unlikely to be merely the result of deconditioning. There have been at least three studies finding loss of both white and grey matter, although I don't know if they were MRI or some other technology. This is in keeping with cognitive dysfunction findings (again objectively testable for insurance purposes, not merely "self reported"). Older ME studies/autopsies showed perivascular bleeding in the cranium. More recently one of the first studies (Peterson & Cheney I think) into "CFS" found evidence of CNS inflammation and demyelination, and inflammation is currently the big thing and underpins much of Dr Kerr's ME research. These should be on the CFS article page and have been discussed on its talk page, but I expect you only read and acknowledge the psychiatric studies, eh Sciencewatcher! Professor Charles Poser (multiple sclerosis expert) discussed the different placement of punctate lesions in ME/ICD-CFS and MS for a US charity publication as misdiagnosis is not unknown, and he should know. MEspringal (talk) 07:44, 14 February 2008 (UTC)


"it has been rejected by most researchers because it is incorrect"
A rather handy circular argument: most researchers are researching CFS, looking for CFS, selecting with CFS, so it's small wonder that such ME findings as may by chance be found are subsumed within the "insignificance" of a pre-ordained heterogenity where fatigue is deemed the most important (or only, I'm looking at you Judith Prins) feature while ME signs such as loss of muscle strength, dysautonomia, inverted T-waves, irregular respiration, "boiling bowel", hormonal deficiencies and so on remain uninvestigated, conveniently dismissed as "interoception" or some such pomposity. A clever ruse -- as long people uncritically rely on an appeal to authority rather than looking at all the facts, new and historical, for themselves, where it's plain ME has simply been driven underground, redefined and rebranded into non existence or triviality. Sophia Mirza is only an "abberation" if the misdiagnosis is maintained as the diagnosis. MEspringal (talk) 07:44, 14 February 2008 (UTC)

Other options

Third Opinion: Two things before I go about with the third opinion. First, third opinions are given when disputes involve only 2 editors. As can be seen in both articles' talk pages, a couple (more than 2) editors are involved and therefore other methods in the dispute resolution process are encouraged; such as the request for comment that was initiated above. Second, as per WP:VOTE, polling such as the above table is highly discouraged as people tend to forget that it's not a subsitute for discussion regardless of the outcome of the vote.

As for the third opinion, from what I can ascertain, ME can easily be dealt with in the CFS article to differentiate the two terms if that is indeed necessary. At this point in time, there is no need to fork the two. — Dorvaq (talk) 16:27, 19 October 2007 (UTC)

If you have only the CFS article to go on, you can't know what is missing. Guido den Broeder 00:18, 20 October 2007 (UTC)
The purpose of the 3O is to provide a third opinion. Though it's really outside of the 3O bounds, the opinion was to say the CFS article should document the discussions, differences and disagreements between the terms and uses of CFS and ME or any other terms. It's a statement I agree with. If the differences are major (as documented in reliable sources), then discussion can begin on breaking out to a new article. Start the article, here, or ideally on a sub-page of your user talk on the disagreements about ME/CFS and labelling, and ask for comments once you are done. As is, given the vote/opinions above and the 3O, it looks like it's going to be a redirect to a single article. If you've a better idea, write it first, then post and ask for comments. Wikipedia isn't going away, so you can at least get it done eventually, even if it isn't right now. WLU 02:48, 20 October 2007 (UTC)

Dispute resolution is not necessary at the moment. The choice is basically trichotomous: fork, redirect, neutral. People who suggest a merge should closely review the present CFS article, which is already a combination of CFS and ME research, given that most authorities (apart from Byron Hyde, obviously) feel that these are either identical or strongly overlapping conditions.

I agree with WLU, with the added request that any rewritten article should be composed in a user's own userspace, and moved to mainspace when there is consensus that it is good enough for prime time.

Can we please agree to automatically strike the votes of any new users (account <1 week old)? However much I appreciate the opinion of Jlasf1 (talk · contribs), I refuse to let this turn into an astroturfing and sockpuppeting game. JFW | T@lk 21:00, 20 October 2007 (UTC)

As long as we are striking votes, I'd like to strike Mastcell's, in view of his open hostility remarkable view regarding ME patients. But no, this is not an official vote, nor does there need to be a vote to start an article. It is the content that matters, or at least that is how it should be. Guido den Broeder 22:09, 20 October 2007 (UTC)
Um, so you are advocating striking MastCell's vote on the basis of absolutely nothing in his/her vote? The problem with Jlasfl's vote is a lack of history, which MastCell does not suffer from. WLU 22:18, 20 October 2007 (UTC)
MastCell does indeed suffer from something else an abundance of history, but no, I'm advocating that these votes have no meaning. Guido den Broeder 22:38, 20 October 2007 (UTC)
I don't quite get it - whats wrong with Mastcell's vote? And since this isn't a vote, more an exchange of opinions, it doesn't matter whether or not Jlasfl's account is new or old. Thedreamdied 22:46, 20 October 2007 (UTC)
"MastCell does indeed suffer from something else", I'ld strongly suggest Guido den Broeder that you retract or appologise for gross breach of WP:Civility and WP:Assume good faith. David Ruben Talk 23:01, 20 October 2007 (UTC)
Wow. It took me months to figure out how to create a post (the ole cognitive difficulty). I'll leave the battle to those with more bandwidth and time on their hands...i need to focus on treatments and locating relevant research for my subgroup of symptoms. Btw, why is CFS used at times and others it's ME/CFS? Perhaps some consistency will help. Jlasf1 23:21, 20 October 2007 (UTC)

MastCell is allowed to offer his opinion and vote. I support calls for an apology here by Guido, and really wonder why we are tolerating this; MastCell did not comment in any way on ME patients personally. My point in questioning the eligibility of Jlasf1 (talk · contribs) to vote was the fact that these votes were his first edits. I left a message on his talkpage that my request was made in good faith, but that I did not want an eruption of sockpuppets. It has nothing to do with the content of Jlasf1's vote, which is available for everyone's consideration. JFW | T@lk 11:30, 21 October 2007 (UTC)

Here is a proposed compromise. When the Canadians found M.E. and CFS placed in ICD-10 under neurology in G93.3, Health Canada called for a conference of experts to meet and produce a compromise document for M.E./CFS that could then be used by the Canadian government. It offers practitioners a comprehensive diagnostic model and suggested treatments that are missing in the U.S. CDC's formal website (where the CDC insists "there are no tests and there are no treatments.") The Canadian compromise document for ME/CFS took up 100 pages in the peer-reviewed Journal of Chronic Fatigue Syndrome 11:1 (2003); a shortened overview of 30 pages written by Dr. Bruce Carruthers and Marjorie Van de Sante can be found at the website of the ME/FMS Action Network of Canada at <http://www.mefmaction.net/Portals/0/docs//ME-CFS%20Overview.04-07.pdf>. Perhaps (because this remains a very controversial issue) for the time being Wikipedia could use the Canadian compromise position and the name M.E./CFS. Aberdab 22:55, 28 October 2007 (UTC)
Regards Wikipedia's policy on article names, we should choose the best name for users - the page name that is most useful for users. Though that could be a very good source for the article itself. Another issue that's being touched on here is if the two should be separate pages - given the above, it looks like they shouldn't. Though again it could be used to explicitly address the controversies involved in name choice, diagnosis, etc. WLU 01:28, 29 October 2007 (UTC)
Disagree, whilst quite true that the "user" term indeed generally used for article names, consensus previously reached "that medical articles ought to be named scientifically, with good redirects in place" - see Wikipedia:WikiProject_Clinical_medicine#The_naming_issue; example, Heart attack is a redirect to Myocardial infarction. David Ruben Talk 03:35, 29 October 2007 (UTC)

ICD-10 code and choice of name

The article currently lists G93.3 as its code, but this links specifically to Post-Viral fatigue. As this article currently notes "Post-viral fatigue syndrome (PVFS); this is a related disorder", ie not quite the same general topic.

A search on the WHO ICD10 website comes up with F48.0 which, unusually for the ICD10 listings has a very clear description of conditions, and under the term "Neurasthenia" states it is "feelings of bodily or physical weakness and exhaustion after only minimal effort, accompanied by a feeling of muscular aches and pains and inability to relax." - is this not the description being described by this article ? However wikipedia's Neurasthenia article suugests that term is purely historical, and this Chronic fatigue syndrome article makes no mention of "Neurasthenia".

So, given the accepted worldwide acceptance of the WHO's ICD10 as a naming and classification system, that might suggest that this article be merged into Neurasthenia ! Now until I just started digging about the WHO ICD10 website, I had never heard of the term "Neurasthenia" and I hazzard that neither have most UK doctors. So can anyone enlighten me on "Neurasthenia", whether it is the same thing as ME/CFS or just a subset of cases, and does this specific point affect above discussion over CFS vs ME ? David Ruben Talk 23:44, 20 October 2007 (UTC)

Neurasthenia is a psychiatric condition, while ME is a disorder of the central nervous system. Neither is a subset of the other. If you read a little further, you will see that postviral fatigue syndromes are explicitly excluded from F48.0. An older term for ME is 'atypical poliomyelitis', and before that it was included in 'muscular rheumatism' (which is now a much narrower diagnosis). Guido den Broeder 00:55, 21 October 2007 (UTC)

Except most "ME patients" have no abnormality on MRI brain, EEG etcetera. Unless you go to Byron Hyde, who thinks that SPECT is great. But then see WP:WEIGHT. JFW | T@lk 08:17, 21 October 2007 (UTC)

Thanks for showing why it is important to have a separate article on ME. IMHO, 'undue weight' rather applies to advocating points of view that are at oddds with the WHO classification. Guido den Broeder 09:29, 21 October 2007 (UTC)

On 16th October 2001, Dr B Saraceno from the WHO provided the following clarification in writing: "I wish to clarify the situation regarding the classification of neurasthenia, fatigue syndrome, post-viral fatigue syndrome and benign myalgic encephalomyelitis. Let me state clearly that the World Health Organisation (WHO) has not changed its position on these disorders since the publication of the International Classification of Diseases, 10th Edition in 1992 and versions of it during later years. Post-viral fatigue syndrome remains under the diseases of nervous system as G93.3. Benign myalgic encephalomyelitis is included within this category. Neurasthenia remains under mental and behavioural disorders as F48.0 and fatigue syndrome (note: not THE CHRONIC FATIGUE SYNDROME) is included within this category. However, post-viral fatigue syndrome is explicitly excluded from F48.0. The WHO ICD-10 Diagnostic and Management Guidelines for Mental Disorders in Primary Care, 1996, includes fatigue syndrome under neurasthenia (F48.0) but does not state or imply that conditions belonging to G93.3 should be included here. I would also like to state that the WHO's position concerning this is reflected in its publications and electronic material, including websites. It is possible that one of the several WHO Collaborating Centres in the United Kingdom presented a view that is at variance with WHO's position. Collaborating Centres are not obliged to seek approval from WHO for the material they publish. I understand that the Collaborating Centre concerned has now made changes to the information on their website after speaking with WHO".[5] Guido den Broeder 10:56, 21 October 2007 (UTC)

As I have been trying to explain numerous times, the concepts of ME and CFS are used interchangeably in the literature, and only very few (such as Hyde) claim that they both exist but are separate. We cannot devote an entire article to the views of one person, especially given the fact that he has not actually published any academic work to support his opinions; that is WP:WEIGHT. SPECT is a novel technique very rarely used in general medical practice. If someone with "classic ME" has a normal SPECT, does that exclude the diagnosis?
The continuous lawyering about the WHO definition by patients' groups is troubling. The WHO should never interfere with scientific hypothesis, and you will notice that Saraceno carefully avoids committing himself to the classification of the chronic fatigue syndrome (for which a case definition has been available since 1994). At any rate, the CFS article already explains clearly that many take the G93 classification as an implicit endorsement of a "physical cause" of CFS/ME. JFW | T@lk 11:30, 21 October 2007 (UTC)

However, the above is your personal interpretation, view, knowledge and speculation, which should not be decisive. Guido den Broeder 11:38, 21 October 2007 (UTC)

Well, the interchangeability of the CFS and ME terms is not my opinion but established fact borne out by both the present CFS article and any PubMed search on the subject. My opinion on the WHO classification is definitely my opinion, to which I am entitled. The task of the WHO is to classify, not to act as an arbiter. Medical research is in a constant state of flux, and it would be wrong for an international body to suppress hypotheses, however radical. JFW | T@lk 12:01, 21 October 2007 (UTC)

A Wikipedia article cannot be used as a source. The WHO classification can, as well as the WHO treaty, whether you agree with the content or not. Guido den Broeder 12:10, 21 October 2007 (UTC) By the way, my PubMed and Embase searches have so far not produced a single publication that uses ME and CFS interchangeably. Guido den Broeder 12:27, 21 October 2007 (UTC)

Within any one paper, one should expect a single term to be used - it is merely good scientific paper writing to be consistent with ones terms and likewise a paper on heart disease will stick to "Coronary Heart Disease" or "Ischaemic Heart Disease" and certainly "Myocardial Infarct" vs "Heart attack". But are the authors of those papers using the terms interchangeably between themselves (ie between the papers, rather than between one sentance and the next)? It would be similar to claiming US vs British spelling of hypokalemia vs hypokalaemia never being used in the same article (which is true) means that they are different conditions - yet clearly within the literature (vs within any one paper) the terms are interchangeable and consistancy within any one paper is merely good copyediting :-) David Ruben Talk 13:52, 21 October 2007 (UTC)
Hi David. There are many different approaches. Some authors are of the opinion that the CFS diagnosis replaced the ME diagnosis, some simply refuse to ever mention one of the two, some consider ME a subset of CFS, some write ME/CFS or CFS/ME to show respect to different views or just because they are tired of the discussion. There are several other names in use as well, and there are authors who believe that all the names are wrong and the patients are just lazy. And then there are some authors - a small minority, unfortunately - who are aware of the history and use both names in context, as they should be used. The reason why the terms can't just be interchanged is that ME is a disease entity, presupposing a specific nature of the disorder, whereas CFS is a syndrome of symptoms. Guido den Broeder 14:18, 21 October 2007 (UTC)
I have previously offered Guido the example of Prof Leonard Jason of DePaul university in Chicago, whose work uses the terms interchangeably, and not necessarily when using different case definitions (PubMed "Jason LA"[Author]).
Searching PubMed for "myalgic encephalomyelitis"[All Fields] yields 203 papers, most of which use the term in conjuction with CFS.
Do we need more evidence? Searching PubMed for "chronic fatigue syndrome"[All Fields] yields 3520 citations. Whether ME is identical to, a subset of, or overlaps with CFS, it cannot be labeled an unrelated condition without violating WP:WEIGHT. JFW | T@lk 16:52, 21 October 2007 (UTC)
Please do not put words into my mouth. Guido den Broeder 18:20, 21 October 2007 (UTC)
I am not putting words in your mouth, and nor do I plan to. I am reminding you that on Talk:Chronic fatigue syndrome I tried to explain the situation through the Jason example. All I am doing, and without reserve, is refreshing your memory. I'd be pleased if you could address the point I made about the Pubmed results. JFW | T@lk 19:11, 21 October 2007 (UTC)
I have a fair number of Jason's articles (not just the abstracts) and I have no clue why you mention him here. Obviously what we have here is a failure to communicate. You seem to think that I claim ME and CFS to be unrelated, and that authors never mention them both. That is, however, not even remotely my stance. Guido den Broeder 19:29, 21 October 2007 (UTC)
Fine, drop Jason. Aren't the PubMed results rather obvious? JFW | T@lk 21:12, 21 October 2007 (UTC)
Again, I have no clue what it is you're trying to demonstrate. Guido den Broeder 21:21, 21 October 2007 (UTC)

What my Pubmed search demonstrates is that most of the >200 papers mentioning "myalgic encephalomyelitis" do so in conjunction with CFS. Hence, I think it is a safe assessment to say that for most authorities regard CFS and ME as identical. Sorry, I thought my point was pretty clear. JFW | T@lk 21:49, 21 October 2007 (UTC)

Well, there are two authorities. You could ask them. Guido den Broeder 22:07, 21 October 2007 (UTC)

Which two authorities? I can come up with a long list of people with lots of peer-reviewed work on CFS/ME. But I'm sure that is not what you mean. JFW | T@lk 22:38, 21 October 2007 (UTC)

Is there a reliable source that discusses the difference and controversy between the two terms? I'd say to look at the interchangeability of ME and CFS on pubmed results and conclude they are the same is a bit OR for my taste. Claiming they aren't the same thing based on experts is dubious as well, and the WHO quote above seemed sufficiently full of multiple statements and conditions as to render it unclear to me at least. One reliable source is worth two and a half archives of discussion. WLU 00:35, 22 October 2007 (UTC)
Some refs, if these are helpful, to decide on CFS=ME ? Five refs to suggest equivalence, with Hamilton's paper noting that choice of term seems in itself to be a predictor of altered prognosis...
  1. Spracklen FH (1988). "The chronic fatigue syndrome (myalgic encephalomyelitis)--myth or mystery?". S. Afr. Med. J. 74 (9): 448–52. PMID 3055363.
  2. Hamilton WT, Gallagher AM, Thomas JM, White PD (2005). "The prognosis of different fatigue diagnostic labels: a longitudinal survey". Family practice. 22 (4): 383–8. doi:10.1093/fampra/cmi021. PMID 15805126.{{cite journal}}: CS1 maint: multiple names: authors list (link) - abstract notes "Several different diagnostic labels exist for the fatigue syndromes, including chronic fatigue syndrome (CFS), myalgic encephalomyelitis (ME) and postviral fatigue syndrome (PVFS)" and goes on to consider prognostic outcome of having used one label as against another and concludes "There is considerable debate in the patient and researcher communities about whether fatigue syndromes are essentially one illness with several synonyms, or whether there are distinct subgroups which should be studied separately. This is the first study to show an important difference among the groups. However, caution should be exercised before using this study to strengthen the case for there being distinct subgroups. This is because we cannot be sure which came first: the different prognosis or the different label, although finding no significant difference in recorded fatigue before the diagnosis of CFS and ME suggests the latter interpretation."
  3. Shepherd C (2006). "The debate: myalgic encephalomyelitis and chronic fatigue syndrome". British journal of nursing (Mark Allen Publishing). 15 (12): 662–9. PMID 16835542.
  4. Hashimoto N (2007). "[History of chronic fatigue syndrome]". Nippon Rinsho (in Japanese). 65 (6): 975–82. PMID 17561685.
  5. White P, Murphy M, Moss J, Armstrong G, Spencer P (2007). "Chronic fatigue syndrome or myalgic encephalomyelitis". BMJ. 335 (7617): 411–2. doi:10.1136/bmj.39316.472361.80. PMID 17762005.{{cite journal}}: CS1 maint: multiple names: authors list (link) (abstract) - begins with "The uncertainty inherent in making a diagnosis of chronic fatigue syndrome (CFS) is reflected by the variety of names (such as myalgic encephalomyelitis; ME) it has been given". This editorial is about the article:
So we have a British Medical Journal editorial commentating on a paper summarising the recently completed UK National Institute for Clinical Excellence guidence on the condition - I think that meets WLU's sensible observation to locate at least "One reliable source". David Ruben Talk 01:48, 22 October 2007 (UTC)
If you read the actual NICE guideline, however, you will see that no claim of equivalency is made. They have avoided the issue by combining the two diagnoses. Guido den Broeder 10:42, 22 October 2007 (UTC)
WLU, I didn't suggest all papers used the terms in conjunction. But if you start counting, the majority does. Guido happens to be a self-declared follower of Byron Hyde, a Canadian doctor who runs the Nightingale Foundation and believes that CFS exists, but that ME is a different medical entity altogether. This view is not shared by the vast majority of researchers looking into CFS/ME, neither in the UK nor in the USA, Canada and Australia.
Thanks David for mapping out some WP:RS to support my assertion. JFW | T@lk 05:58, 22 October 2007 (UTC)

I can hear the cave troll coming. So, before that happens, one final time:

  • ME and CFS are different entities (one a disease, the other a syndrome);
  • they are different, but related diagnoses;
  • they are intended for the same patients but describe them in a different manner;
  • ME is intended to diagnose individual patients in practice;
  • CFS is a simplification intended for research;
  • no set of CFS criteria includes all major symptoms of ME;
  • fatigue is not the primary symptom of ME;
  • many patients that get the label CFS do not have ME but later appear to have a different disease;
  • the WHO do not consider the two synonymous;
  • the WHO classification is binding. Guido den Broeder 09:39, 22 October 2007 (UTC)
Please remain WP:CIVIL. "Cave troll" is not a pleasant term, and is easily taken as a personal attack and an accusation of actual trolling.
You have summarised your opinion very succinctly.
In what way is the ICD-10 classification "binding"? Will a doctor be struck off the register for making a diagnosis in violation of WHO ICD-10 G93? In what way is CFS a simplification, and is ME not a simplification?
I have objections against most of your statements, most of which are easily disproved from casual literature searches. It's a shame you are seem to be unwilling to address the results I showed above, because I think doing so will bring us closer to common ground. JFW | T@lk 09:48, 22 October 2007 (UTC)
The above ('you are unwilling') is a violation of WP:AGF. I will wait for your apologies before I answer any of your questions. Guido den Broeder 10:20, 22 October 2007 (UTC)
OK, in my opinion, for what it's worth, given the above sources, it does look like functionally they are used indistinguishably (though I'd love to be able to read a whole article defining the fine points). Guido den Broeder - for your opinion to have weight, rather than giving a list, provide sources which distinguish between the two explicitly. Ideally, if your list is sourced, provide the sources for each point. I can read the list of your opinions, but it has no weight at this point because it just looks like a list of opinions. We publish verifiability, not truth, meaning if the list is from a discussion you had with a colleague that can not be sourced, as far as wikipedia is concerned, they are the same thing (the only exception I can see is an application of WP:IAR in which contributors agree with the list and its distinctions, and allow it on the page in a controversy section). If you do have sources, then we've just finished the discussion - by my reading, CFS and ME should redirect to the same page, with a paragraph distinguishing between them by saying one is for research, one for diagnosis, etc. including all the main referenced points. The page should redirect to CFS as the main article, though perhaps the ME redirect could include a #Controversy modification. CFS should be used because it is the term most useful to all readers - it's easier to spell, remember, and it's most common. Patients with CFS/ME may know it as more than that, and have a sophisticated understanding distinguishing between the two, but wikipedia is for all readers, not patients with conditions. WLU 11:34, 22 October 2007 (UTC)

Thanks, WLU. I doubt that the term CFS is the single most useful one to all readers. Firstly, it is somewhat misleading, since fatigue is just one symptom. Secondly, most readers don't follow the research, where CFS is dominant, but encounter patients or a patient organization, who are often using the term ME. On the research frontier, too, the term ME is on the rise again, because of recent findings. The international organization of researchers and clinicians have just changed their name from IACFS to IACFS/ME. It is conceivable, that the diagnosis CFS will disappear in due time.

Now, the reason that most research articles concentrate on the term CFS and only mention ME in passing, is precisely the fact that these are research articles: CFS is meant for research. Relevant sources are rather those that discuss the classification and history, such as

  • Report from The National Task Force on Chronic Fatigue Syndrome (CFS), Post Viral Fatigue Syndrome (PVFS), Myalgic Encephalomyelitis (ME)", Westcare, 1994
  • Lavrich C, Kenney KK, Lapp C, Herd J, Kahn D, Levine S, Klimas NG, Jason LA (2003), "Recommendations of the Name Change Workgroup Presented to DHSS CFS Advisory Committee", September

The distiguishment is typically made in these sources. A primary source, however, is the ICD10 itself. The WHO, who follow concensus as they see it, do not consider ME and CFS equivalent. Finally, you can compare defintions and see for yourself that ME definitions differ from CFS definitions. A number of those definitions are included in Hyde (1992). Guido den Broeder 12:21, 22 October 2007 (UTC)

I have changed my above remark, as you can see.
So we have a CFS case definition that may cover large numbers of people, but nobody actually has the disease because they all have something else that doesn't get published in the medical literature but gets perpetuated at meetings of sufferers? And it purports to involve CNS inflammation, but all conventional tests of CNS inflammation (MRI, EEG and EMG) tend to be normal?
It would help immeasurably if you could offer complete references (i.e. name of publication, ISBN if possible), so we could actually review your evidence.
ICD-10 does not have the purpose of being an arbiter in etiology. I cannot imagine a single doctor changing his professionally and scientifically held views because a bureaucrat in a grey office block in Geneva has decided that it must be so. You show me one other disease where the ICD-10 has been the arbiter in such a way. JFW | T@lk 23:19, 23 October 2007 (UTC)
And yes, there is the cave troll. Perpetuated at meetings of sufferers? Must be good pot.
Alzheimer and epilepsy come to mind, but doctors changing their opinion would indeed be a novelty remarkable. No, the MRI's are not normal, and do some other conventional tests (SPECT, PET, qEEG, fRMI, immunology, biopsy), or perhaps nonconventional ones (EEG from inside the skull). Guido den Broeder 07:36, 24 October 2007 (UTC)
You will need to explain your use of the word "cave troll" a bit more. Are you aware of the very strongly negative connotation of the word "troll" on Wikipedia, and can you accept that I regard its use as a personal attack? JFW | T@lk 07:43, 26 October 2007 (UTC)
ICD-10 codes M.E. in G93.3, under neurology. Psychiarist Simon Wessely tried to recode the disease as "neurasthenia" (a term that was originally invented in the mid-1800s to warn parents not to allow their daughters to go to high school or study science, because the result would be either "neurasthenia" - nervous disorder, or "hysteria", generally meaning the wandering womb, but in this case specified as the shrunken womb. British Parliament asked WHO if M.E. could be placed in F54.0 with neurasthenia (in the chapter on neuroses). WHO responded that a signatory nation cannot place a disease in a different chapter than the one designated by WHO. Therefore the effort to portray M.E. as CFS as "neurasthenia" was at least blocked to that point - it is not neurasthenia. M.E. has been in neurology since the late 1960s; that category is now G93.3. It is unclear why postviral fatigue syndrome and chronic fatigue syndrome were added to G93.3 in ICD-10, but that is where they are. There is an excellent clinical definition for the merged category ME/CFS at the following website:

<http://www.mefmaction.net/documents/me_overview.pdf>.—Preceding unsigned comment added by Aberdab (talk • contribs) 19:15, 27 October 2007

You are not addressing numerous points made above, and Simon Wessely plays no role here at all. As I've been trying to explain, the WHO cannot enforce its classification on the profession, and this is not an exception. Neurasthenia is as much an archaic diagnosis as hysteria, and it is doubtful whether one can map CFS to F54 (given that its etiology remains unknown).

I have brought substantial evidence that while ME has been "in neurology" for a long time, most researchers now use a new nomenclature that regards it as a synonym for CFS. Rather than slinging mud at psychiatrists, perhaps you could address those points? JFW | T@lk 21:21, 27 October 2007 (UTC)

CFS is also a neurological diagnosis, remember? Guido den Broeder 09:04, 29 October 2007 (UTC)

What is your point? If anything, we have a change in terminology. JFW | T@lk 23:41, 29 October 2007 (UTC)

New subsection to speed my preview

'Useful' is in terms of people attempting to access wikipedia, not sufferers and experts - from WP:NAME, Names of Wikipedia articles should be optimized for readers over editors; and for a general audience over specialists. Chronic fatigue syndrome is easier to spell, easier to remember, and probably the one most of the population would be familiar with. Further, google gives only 250K for ME and almost 2 million for CFS. For now at least, CFS seems the better term for wikipedia, but if this changes in the future, so can wikipedia. Article names are not misleading in the sense of an abstract reality (how you appear to be using it), it's a matter of deciding if CFS is a better term for Wikipedia to use. Think of readers in terms of every single possible person with an internet connection, not someone who has the disease and wants to find out more or a researcher who is looking to update the page. Better than a near-duplicate second page is a sourced discussion of the two diagnoses and the apparent differences between them probably within the nomenclature section. Guido - were you to accept CFS with reference to ME in the lead (the status quo), what would you change or add to this section? Perhaps ME, being the 'second-most-important term' could have its own sub-heading and a more involved discussion of the terminology controversy?
Also, the above references are indeed not useful in resolving the dispute - without a weblink or even a paper reference, I can't read them. The Westcare reference turns up about 120 google hits or so; they appear to be mostly blog-type pages and some scholarly articles, the two I read offerred a single bullet that the report offerred one definition out of many (google). The other turns up fewer hits, none of which seem particularly useful. Can you provide weblinks or an electronic version? I would think, were they major publications of great use and greatly used, they would be available on-line, but I'm of the internet generation and thus impatient. And are these recognized bodies producing these documents, which trump any discussion that has taken place in scholarly articles? Unfortunately, according to WP:RS, articles should be based on reliable, third-party, published sources with a reputation for fact-checking and accuracy and there is very little that trumps peer-reviewed publications, particularly in terms of medical diagnoses. This does not mean non-peer-reviewed sources can not be used to discuss the controversy of naming. From WP:RS#What is a reliable source?,

In general, the most reliable publications are peer-reviewed journals and books published in university presses; university-level textbooks; magazines, journals, and books published by respected publishing houses; and mainstream newspapers. As a rule of thumb, the greater the degree of scrutiny involved in checking facts, analyzing legal issues, and scrutinizing the evidence and arguments of a particular work, the more reliable a work or publication is. Academic and peer-reviewed publications are highly valued and usually the most reliable publications in areas where they are available, such as history, medicine and science. Material from reliable non-academic publications may also be used in these areas, particularly if they are respected mainstream publications. The appropriateness of any source always depends on the context. Where there is disagreement between sources, their views should be clearly attributed in the text.

To my mind, this means non-academic publications can be used, and when there is disagreement, it should be made obvious who says what rather than trying to conclude what is real. Oh my, that's far too long, no-one is going to read this.
Incidentally, would this be handy? It came out three days ago:
Nye F (2007). "Chronic fatigue syndrome and myalgic encephalomyelitis: The 2007 guidelines from the National Institute of Clinical Excellence". doi:10.1016/j.jinf.2007.09.012. PMID 17953992. {{cite journal}}: Cite journal requires |journal= (help) WLU 13:57, 24 October 2007 (UTC)

WLU, I totally agree. But how do we extend this to article naming? JFW | T@lk 07:43, 26 October 2007 (UTC)

Quote: "Perhaps ME, being the 'second-most-important term' could have its own sub-heading and a more involved discussion of the terminology controversy?"
If it deserves its own subheading, then it deserves its own article. No, that would only serve to further confuse and mystify the issue. It's not a terminology controversy, it's about claiming or denying that there are a cause and a history. Guido den Broeder 09:59, 26 October 2007 (UTC)

That is not automatic. As I have stated, most people see ME as an older term for CFS. If you want to increase the understanding of ME, and you are of the opinion that ME is not CFS, you need to differentiate it from CFS. JFW | T@lk 14:02, 26 October 2007 (UTC)

  1. GdB - Were your point about subheadings valid, all wikipedias would quadrouple in page numbers and all pages would be one-fourth their former size - subheadings are for information that is notable and valid, but not worth it's own article. Were there enough sources about the ME/CFS naming controversy (and I don't remember seeing any reliable ones in english), then yes a {{main}} could be inlcuded with a discussion of said controversy. But ME would still not deserve a separate page. At this point I remain convinced by the use of ME/CFS in peer-reviewed journals that as far as medical research is concerned, they're the same thing.
  2. Wolff - I think my RS quote applies more to acknowledging the controversy. For naming, I think I'll use common sense and acknowledge that the two terms appear to be used interchangeably. I've seen no sources that convince me of the other point. I may have forgotten though, so if they're there, please feel free to remind me. I re-read the abstracts from above, they're sufficient to convince me that CFS/ME are interchangeable without sources to the contrary.
  3. Final point for GdB - I just can't see any validity in the cause/history argument you've presented, particularly without sources. If patient groups object to grouping CFS and ME, that can be documented. But to date I have not seen anything convincing that persuades against the idea that ME and CFS should be separate pages. Further, consensus is against you. Perhaps it would be better to put your efforts towards finding sources that support your point, then revisiting this at a future time. WLU 15:41, 26 October 2007 (UTC)
At this point I am just trying to explain the difference between ME and CFS. If people here don't see it, than they won't understand the need of a separate article. Sources won't matter if you don't understand why some sources are relevant and others are not. Guido den Broeder 19:39, 26 October 2007 (UTC)
At this point I'm wondering if you've ever read WP:RS or WP:OR - if you can't prove it with sources, you can't put it on the page, unless there is general agreement that the information is accurate. To my mind, you have failed to demonstrate a difference between the two that should be acknowledged on wikipedia. Either re-read your posts to see if there is a convincing point you have neglected to post and source, or accept the consensus and move on. Other editors - am I missing something here? Is consensus to keep ME and CFS together? WLU 21:14, 27 October 2007 (UTC)
Sigh. Apparently you have not read my post above. Yes, I can prove it with sources (and have in fact already done so, which you may have missed), but you cannot recognize the sources for what they are if you don't understand what I am sourcing. Guido den Broeder 09:50, 2 November 2007 (UTC)

Guido, you have been able to explain that some (e.g. Byron Hyde) feel that ME is not the same as CFS. That is an opinion that should be addressed in chronic fatigue syndrome. However, we cannot hide from the plain fact that most researchers use the term synonymously and interchangeably.

WLU, all I see is Guido (and our new friend Aberdab) against all the others. That is as close to consensus as we'll ever get it. Unless Guido has a better suggestion. JFW | T@lk 21:21, 27 October 2007 (UTC)

Agreed. At this point, I see absolutely no reason to fork to, or change the name of, CFS to ME. Barring the addition of sources to the discussion or other new information, this discussion should pretty much cease. WLU 21:24, 27 October 2007 (UTC)

The proper way IMHO is to follow standard Wikipedia procedure. Write the article and judge it on its content. There does not need to be concensus to start an article, only to keep it. Note that the article Post-viral fatigue syndrome was deleted several times as well until it was clear from the text that it is a separate entity. Guido den Broeder 14:04, 28 October 2007 (UTC)

We have been following standard procedure, which has ended up here. Until more reliable sources appear for ME being different from CFS, ME redirects to CFS. What procedure has not been followed? If you have a suggestion for the ME page, I suggest you draft a version on a sub-page rather than edit-warring or even posting more messages on talk pages. We're going in circles and it's getting frustrating. WLU 14:14, 28 October 2007 (UTC)
Please make a mental note that I have not been edit-warring. Standard procedure can be followed more than once. Creating a draf version on a sub-page is also standard procedure and certainly has my vote. Guido den Broeder 14:27, 28 October 2007 (UTC)
Great, do the sub page.
Edit warring was in general, not a comment directed at you; apologies, I see that it could have been seen that way. WLU 14:40, 28 October 2007 (UTC)

No problem. It'll be a while before I have time though, my present work on the Dutch guideline has priority. Regards, Guido den Broeder 14:46, 28 October 2007 (UTC)


CDC: ME is Distinct

"Various terms are incorrectly used interchangeably with CFS. CFS has an internationally accepted case definition that is used in research and clinical settings. ... The name myalgic encephalomyelitis (ME) was coined in the 1950s to clarify well-documented outbreaks of disease; however, ME is accompanied by neurologic and muscular signs and has a case definition distinct from that of CFS."

December 26, 2007

http://www.cdc.gov/cfs/cme/wb1032/chapter1/overview.html

MEspringal (talk) 00:16, 21 February 2008 (UTC)

Resurrection

For those still following this page: I am hereby stating my intent to resurrect this article, as part of the ME project initiated by Strangelv. Guido den Broeder (talk, visit) 20:37, 15 September 2008 (UTC)

That's a conversation for the CFS talk page, where it is occurring, and that's not an official wikiproject. It's a users' sub-page. WLU (t) (c) (rules - simple rules) 20:49, 15 September 2008 (UTC)
That's not how Wikipedia works, but if you follow your own advice and stay away from this page that would help things along here, so be my guest. Guido den Broeder (talk, visit) 21:18, 15 September 2008 (UTC)

This has been discussed ad nauseam and there is presently no consensus to recreate the article. The fact that someone has a subpage in his userspace doesn't abrogate consensus. To recreate the ME page, you would need to carefully form consensus. If there were ever to be a separate page about ME, there would need to be a very clear NPOV idea behind it. Specifically, I would want it to mention clearly that many authoritative sources regard ME as a form of CFS, perhaps with the notable exception of the WHO. JFW | T@lk 23:00, 15 September 2008 (UTC)

Please. The consensus was formed when the project started, thanks. Not that it is relevant, anybody can start an article. There does not need to be an NPOV idea behind it either, as long as the text itself is neutral. Guido den Broeder (talk, visit) 23:05, 15 September 2008 (UTC)

There has been a longstanding consensus to keep CFS and ME on the same page. I'm not expecting any members of the "ME project" to write a neutral article about ME. Prove me wrong by writing a draft in your userspace. JFW | T@lk 23:19, 15 September 2008 (UTC)

No such consensus exists, nor is it relevant. You do not own Wikipedia. Do not insult other users. Guido den Broeder (talk, visit) 23:24, 15 September 2008 (UTC)

Indeed I do not own Wikipedia. Nor do you. No insult was intended - I am simply concerned that any article on ME is not going to be neutral, and other editors will have to spend excessive amounts of time trying to redress the balance. Again, please prove me wrong by writing a draft for this page in your userspace; if my worries are assuaged I'm likely to change my stance on this. JFW | T@lk 23:29, 15 September 2008 (UTC)

Expressing such concerns is totally inappropriate. And no, there is not going to be a draft in my userspace. Guido den Broeder (talk, visit) 23:34, 15 September 2008 (UTC)

I think I explained why it was necessary to express these concerns. You have done little to put my mind at ease. You know as well as I do that attempts to resurrect this article are going to be met with opposition, and it is a bit of a shame that you have turned down my suggestion at drafting something on your userpage. JFW | T@lk 23:37, 15 September 2008 (UTC)

Opposition regardless of content? Is that what you're about? Guido den Broeder (talk, visit) 23:41, 15 September 2008 (UTC)

Show me that you can write a neutral article on this subject. I think your userspace is the ideal place. At the moment I am led to believe that whatever content emerges here is going to need substantial reworking. So you are not correct about me being all about "opposition regardless of content"; if I am persuaded that someone can write an NPOV article on this condition, I will eat my words. JFW | T@lk 23:46, 15 September 2008 (UTC)

I have no problem with ME having a separate page, provided there's evidence that at least a substantial minority of the scholarly community considers the two conditions separate. I have yet to see any evidence of this. There wasn't any in 2007, there seems to be even less now. There needs to be clear, unambiguous evidence of this. The WHO does not provide this. The WHO statement has never clearly separated CFS form ME, the G93.3 statement does not state "Benign myalgic encephalomyelitis, to be distinguished from CFS." It says nothing at all about CFS. A sub-page will go very far towards demonstrating good faith to work with the project, solicit input and avoid a POV fork. Making an ME page to demonstrate a point is not a good idea. WLU (t) (c) (rules - simple rules) 23:48, 15 September 2008 (UTC)
I suggest that you leave such interpretations to users that actually know the material. And no, the artcile ME will not be written to make a point. It will be written to freely distribute knowledge, knowledge that you are trying to hide. Guido den Broeder (talk, visit) 23:51, 15 September 2008 (UTC)
If you really know the material, YOU SHOULD CITE IT. It really, really feels like you have been engaging in a long, pointless bluff with other contributors. Lacking any ability to source the changes you want to see, you're engaging in pointless original research, pointless soapboxing on talk pages, and pointless disruptive editing. If you really know the reliable sources, medically reliable sources, demonstrate this with clear citations that state, explicitly and unambiguously, that ME and CFS are considered different by at least the substantial minority required by WP:UNDUE. Otherwise, you're wasting your time. You haven't provided a single new citation despite a year's gap, that supports your point, which is essentially empty rhetoric. The sources you provided before were unconvincing, for the same reasons - there's no way to track down and verify the information, there's no evidence that they're accepted by the majority of scholars. With no new citations, WE ARE DONE HERE. This isn't a POV problem, it's a source problem. There aren't any. WLU (t) (c) (rules - simple rules) 00:51, 16 September 2008 (UTC)
Thanks for the pile of insults.
Obviously, the article will contain references. I have published several times on the topic, and nobody ever accused me of not sourcing my text. I have already started writing. Guido den Broeder (talk, visit) 00:54, 16 September 2008 (UTC)
Good, please post it on a subpage before making any changes to mainspace. WLU (t) (c) (rules - simple rules) 01:05, 16 September 2008 (UTC)
No can do. Guido den Broeder (talk, visit) 01:09, 16 September 2008 (UTC)

If your new work suddenly appears out of nothing instead of the redirect, I don't think it will last very long. What is the exact reason for not using the subpage facility, other than no can do? JFW | T@lk 05:59, 16 September 2008 (UTC)

Please stop making threats. Guido den Broeder (talk, visit) 08:51, 16 September 2008 (UTC)

I'm sorry I just started trying to catch up here. What is the purpose for two articles about the same thing? I did a quick Google search for Chronic Fatigue Syndrome/Myalgic Encephalomyelitis and got 6,280 hits and after checking the first few the two names are synonyms. [6], [7] This is just two examples that I looked at that was near the top of the search. It seems that this debate is for naught, one article should be appropriate, and then pick a name that is most common which IMO is Chronic fatigue syndrome. Just my outside opinion, --CrohnieGalTalk 11:36, 16 September 2008 (UTC)

Two articles about the same thing would indeed serve no purpose. ME and CFS are, however, not the same thing at all. They have completely different definitions. Guido den Broeder (talk, visit) 11:50, 16 September 2008 (UTC)
Guido, JFW's suggestion of making a draft ME page on your userspace could be the most practical step forward. This might not be what you want, but it seems unlikely that you'll be successful in resurrecting the page first and then working on it later. People with more editing power than you won't allow it, and I doubt that trying to take action against them will be successful either. On your own userspace, you can spend the time and effort required to fine tune a more robust ME candidate without constant interruptions from other editors. - Tekaphor (TALK) 13:52, 16 September 2008 (UTC)
The article is written elsewhere because I don't want to get attacked already while I'm still writing it. Your analysis of Wikipedia having editors with more editing power than others is one I can relate to. It is a grave concern, because this editing power seems not to be based on what they can contribute. It is IMHO a clear sign that Wikipedia has no future. Guido den Broeder (talk, visit) 14:04, 16 September 2008 (UTC)
I will not edit your sub-page unless asked guido, though I will post comments on the talk page. There's no point in me editing a sub-page until it is put forward as a possible candidate for a mainpage. There is nothing to lose by using a sub-page and much to gain - issues with sources can be addressed, you can have input from a variety of other editors, and editors who think similarly as you can contribute as well; wikiformatting can be put in place and adjusted, you can preview, there is quite literally no downside to a sub-page, but a wholesale paste from your hard drive to wikipedia is unlikely to stand and you will have no consensus support. WLU (t) (c) (rules - simple rules) 14:20, 16 September 2008 (UTC)
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