psychiatric disease.
Permission to repost.
http://www.meactionuk.org.uk/dwp_doh_classification.htm
The Rt Hon Iain Duncan Smith MP
Secretary of State for Work and Pensions
The Department for Work and Pensions
Level 4
Caxton House
Pothill Street
LONDON
SW1A 9NA
18th July 2011
Dear Secretary of State
re: The major discrepancy between your Department and the Department of He=
alth
on the same medical issue
I write to alert you to a serious error in the Statutory Payments
Manual (SPM) which addresses how HM Revenue and Customs administer
statutory payments including Statutory Sick Pay
(http://www.hmrc.gov.uk/manuals/spmmanual/SPM50600.htm). The document
(SPM50605 =96 Medical Referrals - Incapacity Reference Guide) which is
currently used by decision makers states that matters concerning
policy on these statutory payments are the responsibility of your
Department.
The error concerns the description of myalgic encephalomyelitis (ME,
synonymously known as ME/CFS or as CFS/ME) as a mental health
disorder, despite the fact that the World Health Organisation has
formally classified ME as a neurological disorder since 1969.
According to NICE, adherence to the WHO classification is mandatory in
the UK (see Communications Progress Report from the Director of
Communications, 18th September 2002; 2.7.1.5).
ME/CFS is not a mental disorder but a serious multi-system neuroimmune
disorder affecting the central, autonomic and peripheral nervous
systems as well as the immune, cardiovascular, respiratory,
neuroendocrine, gastrointestinal, musculo-skeletal, visual and
reproductive systems.
It is a matter of record that there are over 5,000 published papers
demonstrating serious organic pathology in ME/CFS; that the Royal
Society of Medicine accepted ME as a nosological organic entity in
1978; that the Department of Health accepted ME as an organic disease
in 1987; that the Health Minister, the Rt Hon Stephen Dorrell MP,
confirmed that =93ME is established as a medical condition=94 in 1992;
that the Chief Medical Officer, Professor Sir Liam Donaldson, publicly
confirmed in 2002 that ME should be recognised alongside disorders
such as multiple sclerosis and motor neurone disease; that ME has been
classified as a neurological disorder in the UK Read Codes (F286) used
by all GPs since 2003; that ME has been included in the UK National
Service Framework for long-term neurological conditions since its
inception in 2005, and that ME is accepted to be a neurological
condition by the UK Government as recorded in Hansard, Lords, 2nd June
2008 (the Parliamentary Under Secretary of State for Health, Lord
Darzi, was unambiguous: =93My Lords, the Government accept the World
Health Organisation=92s classification of CFS/ME as a neurological
condition=85.I have acknowledged that CFS/ME is a neurological
condition=85the Government=85have made it clear that=85 it is a neurologica=
l
rather than a mental condition=94).
There is thus a major discrepancy between two Departments of State,
because your Department rejects the status quo and perversely
categorises ME/CFS as a mental disorder, along with hysteria, nervous
debility, neurasthenia, neurosis and personality disorder.
You may be aware that since 1987, a small but influential group of UK
psychiatrists and their supporters known as the Wessely School
(Hansard, Lords, 9th December 1998:1013) who are closely involved with
the medical and permanent health insurance industry have consistently
rejected the significant body of biomedical evidence and continue to
assert that ME/CFS does not exist except as an aberrant belief held by
those who claim to suffer from it and by those clinicians and medical
scientists naive enough to believe and support them.
The lead advisor on ME/CFS to your Department, Professor Peter White
from St Bartholomew=92s Hospital, is a prominent Wessely School
psychiatrist, whose vested interest in maintaining ME/CFS as a mental
disorder is a serious concern to a number of senior Parliamentarians
including the former Chairman of a House of Commons Science and
Technology Select Committee and former Dean of Biology; a member of
the Home Affairs Select Committee; a Minister of State for the
Environment; a former President of the Royal College of Physicians;
the Deputy Speaker of the House of Lords, and a former Health Minister
and Honorary Fellow of the Royal College of Physicians
(http://erythos.com/gibsonenquiry/Docs/ME_Inquiry_Report.pdf).
An international perspective on the disorder was given in the Press
Briefing held on 3rd November 2006 by the US Centres for Disease
Control to announce its ME/CFS awareness campaign, referring to it as
=93this terrible illness=94, Anthony Komaroff, Professor of Medicine,
Harvard Medical School, said: =93It=92s not an illness that people can
simply imagine that they have and it=92s not a psychological illness.
In my view, that debate, which was waged for 20 years, should now be
over. Brain imaging studies=85have shown inflammation, reduced blood
flow and impaired cellular function in different locations of the
brain=94.
However, your Department=92s lead advisor on the disorder teaches UK
clinicians to ignore the WHO classification of ME/CFS as a
neurological disorder
(http://www.meactionuk.org.uk/magical-medicine.htm pages 53-54) and in
2004 he was awarded an MBE for his work on CFS, the citation being
=93For services to medical education=94.
This is disturbing, because since about 1987 the Wessely School have
consistently denied and rejected the biomedical evidence on ME: in
1992 they directed that in patients with ME, the first duty of the
doctor is to avoid legitimisation of symptoms and reinforcement of
disability1; in 1994 ME was described by them as merely =93a belief=942;
in 1996 they recommended that no investigations should be performed to
confirm the diagnosis3; in 1997 they referred to ME as a
=93pseudo-disease diagnosis=94 4, and in 1999 they said about ME patients:
=93Those who cannot be fitted into a scheme of objective bodily illness
yet refuse to be placed into and accept the stigma of mental illness
remain the undeserving sick of our society and our health service=94 5.
I should be grateful if the error in SPM50605 and any associated
documents could be corrected immediately and the manuals amended
accordingly.
Please also ensure that members of your Department, officials and
advisors to the DWP will henceforth act in accordance with the
Department of Health and with NICE about the correct categorisation of
ME/CFS, the idiosyncratic stance by your Department being an illogical
and insupportable position for it to adopt.
Your Department=92s error is not a matter of semantics or opinion, since
the DWP specifically targets those with a diagnosis of ME/CFS for
removal of their Incapacity Benefit/Employment Support Allowance and
other sickness/disability benefits, a matter of grave concern to
informed clinicians and of immense distress to sick and vulnerable
ME/CFS patients of whom, at their worst, 88% are bed/housebound, being
unable to shower, bathe or wash themselves, with 15% being unable to
eat unaided (http://www.actionforme.org.uk/Resources/Action%20for%20ME/Docu=
ments/get-informed/ME%202008%20%20What%20progress.pdf).
In the interests of transparency favoured by your Coalition
government, this letter will be placed in the public domain.
I look forward to hearing from you.
Yours sincerely
Malcolm Hooper
Emeritus Professor of Medicinal Chemistry
University of Sunderland.
Please reply to :
Professor Malcolm Hooper
2,Nursery Close
Sunderland
SR3 1PA
Email: hoopersecundus@talktalk.net
cc. The Rt Hon Andrew Lansley MP
Secretary of State for Health,
The Department of Health
Richmond House, 79 Whitehall LONDON SW1A 2NF
1. Medical Research Council Highlights of the CIBA Foundation
Symposium on CFS, 12-14th May 1992, reference S 1528/1 (section
entitled =93The Treatment Process=94), now held in the MRC secret files on
ME/CFS at the National Archive, Kew, and closed not for the customary
30 years but for the unusually lengthy period of 73 years
2. =93Microbes, Mental Illness, The Media and ME =96 The
Construction of Disease=94. Simon Wessely; 9th Eliot Slater Memorial
Lecture, Institute of Psychiatry, 12th May 1994 (transcript and
Wessely=92s own working notes)
3. Chronic Fatigue Syndrome. Report of a Joint Working Group
of the Royal Colleges of Physicians, Psychiatrists and General
Practitioners; Royal Society of Medicine (CR54), October 1996
4. =93Chronic Fatigue Syndrome and Occupational Health=94; A
Mountstephen & M Sharpe; Occupational Medicine 1997:47:4:217-227
5. =93ME. What do we know =96 real physical illness or all in the
mind?=94 Lecture given in October 1999 by Michael Sharpe, hosted by the
University of Strathclyde (transcript).
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