General practitioners' perceptions of chronic fatigue syndrome and beliefs about its management, compared with irritable bowel syndrome: qualitative study

Editor- In case readers of the BMJ evaluate this article by Raine et
al without first learning something of the nature of ME/CFS, may I point
out that the following list of replicated findings appears on the MERGE
website (1):

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

"Physiological and biochemical abnormalities found in groups of
patients meeting the broad criteria for 'CFS'. Example references are
given in the brackets.

BIOCHEMICAL

Oxidative stress — explained on the next page (Richards et al., 2000;
Manuel et al., 2001; review by Pall, 2001; Kennedy et al., 2003; Vecchiet
et al., 2003)

Dysregulation of anti-viral pathways — i.e., abnormal activity of the
anti-viral immune responses (Suhadolnik et al., 1994; De Meirleir et al.,
2000; Tiev et al., 2003)

VASCULAR (relating to the circulation)

Endothelial dysregulation — i.e., abnormal responses of small blood
vessels selectively to acetylcholine (Spence et al., 2000; Khan et al.,
2003 and 2004)

Altered brain perfusion — i.e. areas of reduced blood flow in the
brain (Ichise et al., 1992; Costa et al., 1995; Tirelli et al., 1998)

Orthostatic hypotension — i.e., physiological changes to blood
pressure/cardiovascular mechanisms on standing (Streeten et al., 2001;
Naschitz et al., 2002; Stewart et al., 2003)

BRAIN

Metabolic abnormalities — e.g., alterations of brain choline
(important in brain function) (Tomoda et al., 2000; Puri et al., 2002;
Chaudhuri et al., 2003)

MUSCLE

Altered metabolism — e.g., changes in muscle composition or use of
fuel (Fulle et al., 2000, Vecchiet et al., 2003, Fulle et al., 2003)

Abnormal response to exercise (Lane et al., 1998; Paul et al., 1999;
McCully et al., 2004)

Enteroviral sequences in muscle — i.e., evidence of a persisting
virus in some CFS patients (Lane et al., 2003; Douche-Aourik et al.,
2003)"

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Ensuring that GP`s are kept up to date with reliable scientific facts
of the matter would be a start, but clearly a more effective way to combat
the negative stereotyping of others will ultimately be found through the
proper and generous funding of biomedical scientists, many of whom are
already doing excellent work to unravel causal and other mechanisms in
ME/CFS, on a shameful shoestring.

Sincerely,
Douglas T Fraser

1.http://www.meresearch.org.uk/melibrary/publications/advances.html

Competing interests:
None declared