Yuppie flu loses medical status to chronic fatigue

Chronic Fatigue Syndrome, previously labelled as the debilitating illness ME, is both psychological and physical but is not linked to any social class or occupational group.

A report yesterday by the Royal Colleges of Physicians, Psychiatrists and General Practitioners, showed that there is no doubt that CFS is a common condition affecting 1 to 2.5 per cent of the population.

The term ME has been officially derecognised by medical experts, who said it led to confusion and a wrong approach to the problem of chronic fatigue.

The name ME - myalgic encephalomyelitis - implied an inflammation of the brain or spinal cord, when there was no evidence of such a clear physical link with chronic fatigue.

There are no social, geographical or environmental factors linking sufferers. "It isn't yuppie flu. It affects all classes," said psychiatrist Dr Simon Wessely. "The previous stereotype of the upper-class professional is just that, a stereotype."

As a illness, CFS is defined by six months of severe disabling fatigue made worse by physical or mental exertion.

There are still no medical explanations for this illness and no evidence that it is linked to common viral infections, except for the fatigue following glandular fever. While viruses might trigger CFS, experts cannot prove that persistent viral infection accompanies persistent fatigue.

Findings do show that there are both psychological and physical elements to the illness and that doctors should adopt a more holistic approach.

"To try to distinguish between a physical illness and a psychological illness is not just wrong, it's meaningless," said Dr Robert Kendell, president of the Royal College of Psychiatrists.

More than 20 studies had produced evidence that up to three quarters of CFS sufferers had some kind of psychiatric disorder. These included depression, anxiety and somatisation - a condition where physical symptoms have a psychological cause.

"It's very important that everybody, patients, relatives and doctors doing research on the problem should realise that the distinction between the physical and psychological is illusionary."

This had led to "controversy and passions" in the medical world and outside, he said.

He admitted that some doctors could be dismissive of chronic fatigue, telling patients to "pull themselves together" and failing to recognise a genuine problem.

However, patients often wrongly thought that doctors who talked of psychological factors believed their condition was all in the mind.

Too much bed-rest and over-ambitious exercise were equally unhelpful to CFS patients, the experts said.

There was also no evidence that drugs, including anti-depressants, had any real impact.

The report recognised that treating CFS was inevitably a long term process and might require extra NHS resources.

Treatments using drugs, such as the anti-depressant Prozac, and diets have proved unsuccessful in a large number of cases. Instead, the report calls for joint medical and psychological treatment such as Cognitive Behaviour Therapy - a form of counselling where a patients needs and activities are assessed and controlled by specialists.

tOne in 10 professorial chairs in British medical schools are vacant and scores of other teaching posts are unfilled because universities can no longer afford to match NHS salaries for doctors, writes Liz Hunt.

Dr Sandy Macara, chairman of the British Medical Association's Council, yesterday appealed to the Prime Minister to intervene in the "unprecedented crisis" facing medical education.

Clinical academics - doctors who spend half their time on research and teaching, and half in hospitals - account for 10 per cent of the NHS medical workforce. They have traditionally been paid the same as their full-time NHS colleagues. A senior hospital consultant earns a basic salary of between pounds 43,000 and pounds 52,000 per annum.

However, funding per student has declined by a third since 1988 and has left universities unable to pay clinical academics the same as hospital colleagues, the British Medical Association annual clinical meeting in Istanbul was told.