Monday, 25 July 2016

Switzerland

My brother and sister-in-law, Tim and Lois, have recently been to Switzerland.  I have inserted a small selection of their photos below (they took about 500!), with comments by Tim.

NB Clicking on the photos will enlarge them and bring up a slideshow.


Reformation Wall, Geneva
Statues of William Farel, John Calvin,
Theodore Beza, and John Knox

Calvin's Chair,St. Pierre Cathedral, Geneva

Grindelwald
View from a skylight!

A little part of "Jardin Anglaise", the English
garden,
near the lake in Geneva

Taken from a boat on Lake Thun

Taken from a boat on Lake Thun

Parts of the Grindelwald valley

Parts of the Grindelwald valley

Edelweiss flowers, Switzerland's most famous flower (despite originally coming from the Himalayas!)
Paragliding - happens a lot in Switzerland, for those not content to see the mountains while standing on other mountains!


Lake Thun and part of Interlaken

The hundred year old railway on Schynige Platte that takes you up to the hotel/restaurant and alpine botanic garden. The little station at the end is 1970 metres up

Alphorn players in Zermatt,
a regular and frequent occurrence

The Matterhorn as seen from Zermatt


Saturday, 16 July 2016

Toddler injected with 37 vaccines before the age of two left paralyzed and wheelchair-bound for life


(NaturalNews) At just 17 months of age, Otto Coleman's life changed drastically and suddenly. After receiving a shocking number of vaccines – 37 to be exact – he ended up being paralyzed with transverse myelitis, and will spend the rest of his life in a wheelchair.

His father, Joshua Coleman, said that he took a close look at his son's vaccination records and was startled by what he found. "At seventeen months old, he had received thirty-seven vaccines, which is about three times the amount I got in my entire adult life."

He said that doctors initially gave him the runaround, despite initial MRIs pointing to vaccine injury as the likely culprit. Incidentally, this was later proven to be the cause at Johns Hopkins. He says that doctors did not seem too interested in investigating to pinpoint what made his son go from being a normal toddler who was walking and running to someone who would be confined to a wheelchair for the rest of his life. He says no one told him about the Vaccine Injury Court, and he was taken by surprise by the expenses that were involved in taking care of his paraplegic son. That's why he fought against SB277.

Coleman points out that while autism rightfully garners a lot of attention as a part of vaccine injury, it's not the only type of vaccine injury people need to worry about. This does a great disservice to those who have non-autism vaccine injuries, particularly when such a big segment of society still erroneously believes that the link between vaccines and autism has not been proven, and that there is therefore nothing to worry about when it comes to vaccines.

He says that when people ask him why his son is wheelchair-bound, he doesn't hesitate to tell them it's because of a vaccine injury, and most people respond that they have never heard of vaccine injury. He finds this particularly concerning given the fact that many times the people saying this are parents themselves, which means they are vaccinating their children without being aware of the risks.

More people need to speak out

Coleman says that although there is a vocal group of people banding together to try to bring about change, more people need to speak up and fight, especially medical professionals.

In an interview with Age of Autism, Coleman mentions that it has become a political issue. He feels that if Hillary Clinton becomes president, federal vaccine mandates will come down that will be nearly impossible to fight against. He says that Donald Trump, on the other hand, has acknowledged that vaccines do cause autism, and that the vaccine program is problematic. Coleman feels that a lot of people will vote based on this issue.

Coleman calls idea of herd immunity 'insane'

He also calls out those who claim we need herd immunity in order to protect everyone. He says that the idea is "insane," adding: "There is no product ever that has required every single person on the planet to use it in order for it to work. How convenient for them."

Vaccine adjuvant likely behind the paralysis

A 2009 study from the Sheba Medical Center in Israel looked at 37 different cases of transverse myelitis that were linked to vaccines, including MMR, DTP and hepatitis B. They believe that the fact that so many different vaccines are linked to this one autoimmune phenomenon indicates that an adjuvant or other common denominator of the vaccines in question could be the cause.

Unfortunately, vaccines are highly profitable for Big Pharma, which is why they will continue to devote a lot of resources to trying to get everyone to get vaccinated, ignoring less profitable yet incredibly healing supplements like turmeric. This means it is up to each individual to educate themselves on the issue of vaccine damage, and make an informed decision for themselves and their children.

Sources include:



Friday, 15 July 2016

The fire shall ever be burning upon the altar; it shall never go out


C H Spurgeon’s Morning Devotional for 15th July

"The fire shall ever be burning upon the altar; it shall never go out.”

Leviticus 6 v 13

Keep the altar of private prayer burning. This is the very life of all piety. The sanctuary and family altars borrow their fires here, therefore let this burn well. Secret devotion is the very essence, evidence, and barometer, of vital and experimental religion.

Burn here the fat of your sacrifices. Let your closet seasons be, if possible, regular, frequent, and undisturbed. Effectual prayer availeth much. Have you nothing to pray for? Let us suggest the Church, the ministry, your own soul, your children, your relations, your neighbours, your country, and the cause of God and truth throughout the world. Let us examine ourselves on this important matter. Do we engage with lukewarmness in private devotion? Is the fire of devotion burning dimly in our hearts? Do the chariot wheels drag heavily? If so, let us be alarmed at this sign of decay. Let us go with weeping, and ask for the Spirit of grace and of supplications. Let us set apart special seasons for extraordinary prayer. For if this fire should be smothered beneath the ashes of a worldly conformity, it will dim the fire on the family altar, and lessen our influence both in the Church and in the world.

The text will also apply to the altar of the heart. This is a golden altar indeed. God loves to see the hearts of His people glowing towards Himself. Let us give to God our hearts, all blazing with love, and seek His grace, that the fire may never be quenched; for it will not burn if the Lord does not keep it burning. Many foes will attempt to extinguish it; but if the unseen hand behind the wall pour thereon the sacred oil, it will blaze higher and higher. Let us use texts of Scripture as fuel for our heart's fire, they are live coals; let us attend sermons, but above all, let us be much alone with Jesus.

Monday, 4 July 2016

Jane Colby – My Speech At The House Of Lords, 30 June 2016


Introduction: Well I'm now pretty exhausted! Never mind - I'm also over the moon at the tremendous success and attendance at the Afternoon Tea and Awards, held in the House of Lords for members and guests of Tymes Trust and the Nisai Virtual Academy. Our host was the Lord Clement-Jones, who welcomed everyone with his usual great good humour and aplomb.

We were also pleased to have journalist David Tuller with us, who was presented with a Tymes Trust Press Award.

I launched a new leaflet on ME for families and GPs. This will be online soon, along with my introductory speech, on the Tymes Trust website.

However, I thought you'd like to read the speech as soon as possible, so here is the text. It's called:

THE TYRANNOSAURUS REX IN THE ROOM

Because I was a GP's wife, I know that GPs need practical ways to help patients where there is no curative treatment. And they also need knowledge of what treatments, or types of management, might be actively unhelpful.

Because I was a headteacher, I know how education can be modified for sick children so they can achieve whilst protecting their health and recovery.

And because I got ME (diagnosed by that name) from a coxsackie B virus, I have personal experience. But of course I have also learned a huge amount through working with medical professionals who understand ME. And when I say ME, I do mean, ME. More of that later.

The late Dr Alan Franklin was one of the foremost experts in paediatric ME, and it was a real privilege to work with him on the Chief Medical Officer's Working Group on CFS/ME. This leaflet I'm holding, which we're launching today, has been produced in commemoration of him and his wonderful, compassionate work for children. Everyone respected Alan and he still is sorely missed. Now some of that personal information is in the leaflet. There's a reason for that.

OK, so here was the challenge. One sheet of paper. Why? And what's it all about?

First, the Why. Over my years dealing with – and suffering from – ME, I've worked with some pretty eminent doctors. Dr Elizabeth Dowsett was my first. She was a renowned microbiologist who probably knew more about ME than anyone in the medical establishment at that time. She diagnosed me, she demonstrated the cause, through tests – a virus related to polio. She told me that mine was almost the severest case she had ever seen. And she asked me to help her, long before I was really well enough (and she got told off for it by my mum, who was my main carer!) She asked me to help spread knowledge of ME in children, and that was how our schools research began. We discovered that no other illness causes such long term sickness absence from school. It really is that disabling and Lord Clement-Jones has explained to you one of the reasons for that.

Among the doctors I've worked with, including our guest Dr Charles Shepherd, there was a GP with whom I wrote articles. He called me in to advise the local education authority in a very severe paediatric case of his. He said to me: “Hmm. GPs. Keep it to one sheet!” We've taken his advice.

What's it all about? Well, we thought it was high time to tackle the Tyrannosaurus Rex in the room – the thorny issue of how ME and CFS are actually not the same thing, and why the present emphasis on fatigue is potentially unsafe for people who would once have been diagnosed with ME – myalgic encephalomyelitis – as originally described by Ramsay – but who now either go undiagnosed or more likely end up under another illness name such as postviral fatigue or CFS – Chronic Fatigue Syndrome.

That's important because it affects treatment and for children, it affects the type of education recommended too.

I made a typing mistake when I first typed Tyrannosaurus Rex. I put a y in the middle. Tyranny saurus Rex. I thought that was spookily accurate. The fatigue label and the recommendations that have followed from it have become a tyranny. I don't need to tell you how oppressive it is to have your children forced to school when they are not yet well enough, and when there is an excellent replacement in virtual education. The Establishment can be a bit of a dinosaur when it comes to this type of revolution. There are those who seem to believe that there is some kind of moral virtue in just getting to the school building, never mind the educational results. And then I suppose there is the fear: we surely can't buy in a virtual education course for this child – suppose they all want one! But the bottom line is - a child's needs must be catered for. That's the law.

Tymes Trust, whenever it can, sticks to talking about ME. But this is an occasion when it is important to give you one sheet that your GP can see is fully medically referenced, explains how ME, CFS and SEID (systemic exertion intolerance disease - a name suggested by the American Institute of Medicine) relate to each other, and carries medical authority for the information within it.

Of course, doctors, patients, me - author of the leaflet – we're all human. Connecting personally with other people is what it's all about. In the final analysis, GPs want solutions for their patients. We hope this will help.

Jane Colby
STRIPEYSOCKS BLOG

Friday, 1 July 2016

The ‘all in the mind’ myth of myalgic encephalomyelitis


The ‘all in the mind’ myth of myalgic encephalomyelitis/chronic fatigue syndrome | Nursing in Practice | 27 June 2016

Article written by Dr Keith Geraghty

The ‘all in the mind’ myth of myalgic encephalomyelitis/chronic fatigue syndrome

Health professionals should be made aware that ME/CFS is not a psychological illness and in order to improve patient care, nurses need to better understand this illness and its impact on patients.

Nurses often witness close-up the impact of acute and chronic illness on patients. Myalgic encephalomyelitis (ME)/chronic fatigue syndrome (CFS) is one illness that nurses may encounter that causes profound life changes for many sufferers. This controversial illness is sometimes presented as a psychosomatic disorder that requires psychological treatment. However, there is no compelling evidence that ME/CFS is a mental health condition and increasing evidence shows it is a biological disease with a range of complex symptoms. This article discusses how the ‘all in the mind’ myth of ME/CFS has permeated both medical discourse and popular culture, with negative consequences for patients living with this poorly understood condition.

1. Is ME/CFS really a mental illness?

In a recent Nursing in Practice article, Roberts (2016)1 suggests that ME/CFS is a psychosomatic disorder, best treated with psychotherapy and mindfulness. The erroneous idea that mindfulness is an optimum treatment masks a hidden and more important story; that very little is understood about ME/CFS and many health professionals are skeptical about whether ME/CFS is even a real illness. For example, NICE guidelines do not mention mindfulness.2 A GP once exclaimed to me that ‘all these patients need is anti-depressants and a good pair of running shoes’. While discussing my ME/CFS research at a hospital in Leicester a nurse offered me a similar opinion by suggesting that ‘ME/CFS patients would get out of bed if you paid them £5000 per day’. Such negative views among doctors and nurses are not uncommon and are perhaps fueled by misinformation about the illness being psychological.

In a recent book, All in Your Head: True Stories of Imaginary Illness,3 Dr Suzanne O’Sullivan, a London-based consultant neurologist, includes a chapter on ME/CFS. O’Sullivan argues ME/CFS is strongly associated with psychological complaints and illness beliefs. In contrast, a growing body of scientific evidence suggests that ME/CFS is not an imagined illness, nor is it a psychological condition, but a complex biological disease that is often triggered by an infection that causes observable neuro-immune dysfunction. Far from being ‘all in the mind’, sufferers often experience life-changing and disabling physical symptoms and physiological abnormalities (see Table 1).

Table 1: Biological abnormalities observed in ME/CFS

· Alterations in grey and white brain matter.

· Muscle cell dysfunction.

· Immune cell abnormalities.

· Raised inflammatory markers.

· Cellular and oxidative stress.

· Autonomic irregularities.

· Cardiovascular deficiencies.

· Orthostatic intolerance.

The World Health Organization (WHO) classifies ME as a neurological disorder in the International Classification of Diseases (ICD-10: G 93.3; WHO, 1992).4

The US Institute of Medicine (2015) conducted an extensive review of the evidence and concluded that ME/CFS is ‘a serious, chronic, complex, systemic disease’.5

The US National Institutes for Health confirmed ME/CFS as a disabling physical illness and stated that the medical profession has been responsible for causing distress to patients with ME/CFS by ignoring patients’ calls for medical help and failing to adequately research the disease.6

2. So why is ME/CFS treated with psychotherapy?

Psychiatrists have long been interested in attempting to explain the medically unexplained. Sigmund Freud, the father of modern psychiatry, explored the connection between the mind and health. The famous French neurologist J. Charcot believed traumatic life events may bring about a form of hysteria or paralysis in patients; while George Beard put forward the theory of neurasthenia (exhaustion of energy within the nervous system).7 These theories continue to influence how doctors perceive medically unexplained illnesses, particularly ME/CFS.

A brief time-line of how ME (neuro-immune disease) became CFS (a psychosomatic fatigue syndrome)

· 1955: Melvin Ramsay describes a viral outbreak illness among staff at the Royal Free Hospital in London as a post-infectious disease affecting brain, nerves and muscle tissue (Myalgic Encephalomyelitis).

· 1970s: UK psychiatrists McEvedy and Beard state that ME is nothing more than a case of ‘mass hysteria’.

· 1980s: A London newspaper runs a story about ME being ‘Yuppie Flu’. Since then, ME has been indelibly linked with stressed-out professionals complaining about exhaustion.

· 1988: The US Centers for Disease Control recommend replacing ME with a new syndrome (Chronic Fatigue Syndrome).

· 1990s: UK psychiatrist Simon Wessely argues ME (now CFS) is a biopsychosocial syndrome, partly created by social trends and maintained by patients’ illness beliefs and behaviours.

· 2000s: Colleagues of Wessely, including nurse/researcher Professor Trudie Chalder, conduct clinical trials of psychotherapy to treat CFS, including the £5 million PACE trial testing cognitive behavioural therapy and graded exercise therapy.8

· 2007: The UK National Institute for Health and Care Excellence (NICE) conducts a review and recommends CBT and GET for the treatment of ME/CFS.2 This decision is criticised by ME/CFS patient groups who deem CBT and GET inappropriate treatments. In particular, GET attracts much criticism.

· 2015: A large patient survey finds CBT has little impact on the condition: 74% of patients report that GET makes their symptoms worse, while simple pacing is preferred by patients.9 Such concerns are echoed in scientific studies that suggest exercise therapy may be harmful, given biological abnormalities found in ME/CFS.10

3. So, does cognitive therapy or exercise therapy help anyone with ME/CFS?

The answer to this question is rather complex. ME/CFS is an umbrella term often used for patients with ongoing unexplained fatigue. Hooper (2006) points out that ‘Amorphous definitions and diagnostic symptom criteria have contaminated study cohorts and corrupted research data’.11 Essentially, it may be difficult to differentiate patients with ME/CFS from patients with fatigue or depression, given the generality of the diagnostic criteria for CFS: patients are often lumped together in studies, with depressed patients responding better to CBT compared with ME/CFS patients.12 In addition, CBT may help with the secondary depression or anxiety that occurs in most illness states. Clinical trials of CBT and GET tend to recruit mild to moderately unwell CFS patients, as more severe cases are too unwell to take part. Yet, even if we accept these research biases, the evidence for the success of psychological or exercise therapies in ME/CFS is unconvincing:

· Cochrane review:A meta-analysis found that while CBT and/or GET may benefit some patients with ME/CFS in the short term, the benefits are short-lived and have little impact on restoring physical function over the long term.13

· PACE trial:The largest clinical trial of CBT and GET for CFS reported that 22% of patients recovered following CBT/GET added to standard care, while only 7% did after standard care alone.14 However, ‘recovery’ here did not mean a return to normal physical function. A patient could be deemed recovered with a SF-36 (quality of life) score of 60/100 or higher,8 even though a score of 65/100 indicates severe disability with 57/100 being a score of patients with Class II congestive heart failure.15 At follow-up, two years after treatment, there was no clear benefit of adding CBT or GET to standard medical care.8

· FINE trial:A study of nurse-provided community-based CBT and GET for 296 CFS patients failed to find any evidence for the long-term effectiveness of these therapies.16FINE stood for ‘Fatigue Intervention by Nurses Evaluation’. CBT-GET was compared against a supportive listening treatment. The FINE investigators found no statistically significant benefits to either pragmatic rehabilitation (CBT-GET) or supportive listening at 70 weeks. The authors concluded that the community setting was inappropriate, rather than the psychotherapy treatment.

4. Why is it important to know the facts?

In a recent Centers for Disease Control ‘Grand Rounds’ event (2016) discussing ME/CFS research, Professor Anthony Komaroff of Harvard University stated that the medical profession were wrong to adopt the name Chronic Fatigue Syndrome in 1988, as this term led to inaccurate perceptions of the illness. Komaroff points out that that there are thousands of published articles on biological dysfunction in ME/CFS, with no compelling evidence to suggest the illness is psychogenic (an illness of the mind).16

Many ME/CFS sufferers and advocacy groups are deeply concerned about the portrayal of the disorder as a psychological illness in medical publications and the wider media. Misinformation may negatively impact patients. Patient surveys consistently reveal that many ME/CFS patients experience medical scepticism, difficult interactions with health professionals and poor care quality (AfME, 2001).17 Sufferers report finding it difficult accessing benefits and social care and often have to fend off accusations of laziness and hypochondria – perhaps a consequence of the perception that the illness is a self-generated psychological illness.

The 25% ME Group, a charity that supports the most severely ill sufferers, state that the medical establishment has largely ignored these ME/CFS patients.18 Many are housebound or bedbound, with family members as full-time care-givers.

We must consider the harrowing case of Miss Sophia Mirza, a young ME sufferer forcibly removed from her home and sectioned under the Mental Health Act to impose psychiatric treatment on her. Miss Mirza died in 2005 and is one of the first patients in the UK to have ME as the official cause of death. The reality that ME/CFS kills some patients and dramatically shortens life expectancy is rarely reported in the media. In addition, ME/CFS sufferers are six times more likely to commit suicide compared to the general population;19 most likely as the result of having to deal with debilitating symptoms, such as chronic pain and sleep deprivation, but perhaps also having to deal with feelings of social isolation and poor medical treatment.

5. What can nurses do to support ME/CFS patients?

Many nurses will encounter ME/CFS patients, particularly in primary care. Nurses often have the capacity to form close therapeutic relationships with patients. Offering empathy and understanding to patients experiencing distressing symptoms is a central part of the nursing role. In the absence of a cure for ME/CFS, nurses are well placed to provide supportive care. By understanding the symptoms generated by the illness, nurses may be able to offer patients better care. ME/CFS severity varies from mild to severe and patients experience the illness in different ways. Some sufferers may be able to continue work on a limited basis, while others may be bed-bound, reliant on family and carers. Retired nurse Greg Crowhurst, a care-giver to a wife with severe ME/CFS, writes eloquently about how nurses may support patients with the illness.19

Practical tips for nursing practice are as follows:

· Sufferers experience profound fatigue – nurses may be able to ensure patients are not left in waiting areas for long periods of time.

· Sufferers experience cognitive problems – nurses may assist patients in medical consultations, perhaps asking whether the patient understands the information provided.

· Sufferers experience sensory overload – nurses may ask patients if they require a quiet area or darkened room, or on home visits, nurses may avoid causing sensory distress by speaking quietly and ensuring mobile phones are turned off.

· Sufferers symptoms vary and fluctuate – nurses should liaise with family members or care-givers to get a personalised account of the patient’s health status and care needs.

· Sufferers often feel disbelieved and anxious – nurses may reassure patients, particularly if they convey empathy and knowledge of the illness to the patient.

Nurses also have an another important role as advocates for ME/CFS patients, helping to liaise between the patient and doctor and also helping to promote the patient voice in the public domain. However, to fulfill this important role, nurses need to better understand the illness and to understand that ME/CFS is by no means ‘all-in-then-mind’.

Conclusion: The key message for nurses

Most people feel fatigued following illness, stressful events, or after working long hours. This is quite different from the severe fatigue and the range of symptoms that patients with ME/CFS endure, including: unrelenting painful joints and muscles; cognitive dysfunction, including memory problems; gastrointestinal complaints; transient paralysis; hypersensitivity to light, noise and touch; unrefreshing sleep; post-exertional malaise after minimal effort; and the inability to maintain an upright posture for any significant period. Overwhelming evidence shows that these symptoms are not psychosomatic. Nurses have a valuable role to play in assisting and supporting patients with ME/CFS. Nurses should not underestimate the power and importance of the nursing position to relieve suffering, prevent harm and promote better care for ME/CFS patients.

References

1. Roberts D. Diagnosing and managing chronic fatigue syndrome. Nursing in Practice 2016, 89.

2. NICE. Chronic fatigue syndrome/myalgic encephalomyelitis (or encephalopathy) – Diagnosis and management of CFS/ME in adults and children. NICE 2007, 53.

3. O’Sullivan S. All in Your Head: True Stories of Imaginary Illness, 2016.

4. WHO. International Classification of Diseases, Tenth Revision (ICD-10). WHO 1992; G93.3.

5. IOM (Institute of Medicine). Beyond myalgic encephalomyelitis/chronic fatigue syndrome: redefining an illness. Washington, DC; 2015. ISBN: 978-0-309-31689-7.

6. Green CR, Cowan P, Elk R, O’Neil KM, Rasmussen AL. National Institutes of Health pathways to prevention workshop: Advancing the research on Myalgic Encephalomyelitis/chronic fatigue syndrome. Annals of Internal Medicine 2015;16;162(12):860-865.

7. Beard G. Neurasthenia, or nervous exhaustion. The Boston Medical and Surgical Journal 1869;217-221.

8. White PD, Goldsmith KA, Johnson AL et al. Recovery from chronic fatigue syndrome after treatments given in the PACE trial. Psychological Medicine 2013;43(10):2227-2235.

9. ME Association. ‘ME/CFS Illness Management Survey Results: No decisions about me without me’. Patient Survey, May 2015.

10. Twisk F, Geraghty K. Deviant Cellular and Physiological Responses to Exercise in Myalgic Encephalomyelitis and Chronic Fatigue Syndrome. Jacobs Journal of Physiology 2015;1(2):007, 2015.

11. Hooper M. Gibson Inquiry – Day 1 April 18th 2006 – Group Testimonies, Comments by Professor Malcolm Hooper 21st April, 2006.

12. Jason LA, Torres-Harding S, Brown M et al. Predictors of change following participation in non-pharmacologic interventions for CFS. Tropical Medicine and Health 2008;36(1):23-32. DOI: 10.2149/tmh.36.23.

13. Price JR, Mitchel E, Tidy E, Hunot V. Cognitive behaviour therapy for chronic fatigue syndrome in adults. Cochrane Database of Systematic Reviews 2008, Issue 3.

14. Sharpe M, Goldsmith KA, Johnson AL, Chalder T, Walker J, White PD. Rehabilitative treatments for chronic fatigue syndrome: long-term follow-up from the PACE trial. The Lancet Psychiatry 2015a;2(12):1067-1074.

15. Juenger J, Schellberg D, Kraemer S, Haunstetter A, Zugck C, Herzog W, Haass M. Health related quality of life in patients with congestive heart failure: comparison with other chronic diseases and relation to functional variables. Heart 2002;87(3):235-241.

16. Wearden A, Dowrick C, Chew-Graham C et al. Nurse led, home based self help treatment for patients in primary care with chronic fatigue syndrome: randomised controlled trial. British Medical Journal 2010;340:c1777.

16. Komaroff AL. Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Real Illness. Annals of Internal Medicine 2015;162:871-872.

17. Action for ME. ‘Severely neglected’. Patient Survey, 2001.

18. 25% ME Group. Stakeholder Response to NICE CG53 Three Yearly Review, Nov, 2010.

19. Roberts E, Wessely S, Chalder T et al. Mortality of people with chronic fatigue syndrome: a retrospective cohort study in England and Wales from the South London and Maudsley NHS Foundation Trust Biomedical Research Centre (SLaM BRC) Clinical Record Interactive Search (CRIS) Register, Lancet, (published online Feb 9.), 2016.

20. Crowhurst G. Supporting people with severe myalgic encephalomyelitis. Nursing Standard 2005;19(21):38-43

About the Author
Dr Keith Geraghty
Honorary Research Fellow, Centre for Primary Care, University of Manchester