Evidence that the GDG has not conceded to all the demands of the Wessely School
The Wessely School clearly endeavoured to get its own way (see quotations below from the responses submitted by Simon Wessely and Peter White to the Questionnaire) but on a number of fronts they did not succeed. The Wessely School got all its own way with the 1996 Joint Royal Colleges’ Report and were infuriated that patients’ views were given such weight in the 2002 Chief Medical Officer’s Working Group report; this time, NICE seems to have treated them on the same basis as any other stakeholder among many, to the extent that this NICE Guideline now includes the Canadian definition, in full, over several pages. That is a significant step forwards.
Specifically, the NICE Guideline does not state that “CFS/ME” is a behavioural disorder, a psychiatric illness, a somatic/functional disorder, an illness belief, depression or anxiety.
It emphasises the need for an individualised management plan that should be provided in ways suitable for the individual, and it highlights the importance of shared decision-making between healthcare professionals and patients.
Section 5.5 of the draft Guideline stated: “a view held by a few individuals on the GDG was that CFS/ME could not be identified or managed unless a broader view was taken”. This “broader view” was that a “biopsychosocial” approach to ME was required, lumping it together with other states of chronic “fatigue” and thereby affording psychiatrists the right to be involved in the care of all ME/CFS patients, regardless of whether those psychiatrists were needed or wanted. One of the patients’ representatives (BRAME) challenged the fact that if only “a few” members of the GDG group held that view, why was their opinion allowed to dominate the recommended management regime?
This seems to have forced the GDG into a remarkable admission: the Guideline does not accept any of the favoured theories of the Wessely School: “In considering the explanation for CFS/ME, we have followed the report of the Gibson Inquiry, which accepts that there is insufficient evidence to fully substantiate any of the current theories of causation, and that more high quality biomedical research is needed”.