Quo vadis, Science Media Centre?

Living with M.E. is an extraordinarily difficult existence. Blessings are hard to list at times but I am ever thankful I am not living with M.E. in the UK. In that country, M.E. is not considered a physical disease and those who perpetrate that myth reap huge financial rewards from keeping patients sick. Utting Wolff gives an outstanding critique of the UK media release of yesterday’s good news from the Hornig/Lipkin study. Also, if you have not already read it, Mr. Wolff’s recent post on hate speech and Prof. Shorter is excellent as well.

Utting-Wolff Spouts

Yesterday saw some positive media headlines for the ME community. The research from Columbia University by Hornig et al, concerning the level of cytokine activation as a potential biomarker for ME, looks promising[1]. ME research indicating a biological pathology is often dismissed due to the small number of participants but this was a study comprising 298 ME patients and 348 controls, which will hopefully give it more weight in scientific circles[1]. Unfortunately, as is usual with UK media coverage, reporting was not unequivocally positive; the difference in tone between the UK and US media coverage was marked. In the former, most of the usual suspects promoting the psychogenic paradigm were quoted, aided by the Science Media Centre (SMC). There is little hope of this group of psychiatrists going quietly into the night and we will probably experience a backlash from that quarter; they have much to lose if and when…

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What’s With All The Hate?

A popular M.E. patient activist reposted an epic troll comment, in which she was vilified, on her Facebook page last night. (Purposely not linked) Trolls are everywhere and the comment, though particularly eloquently vicious, was not that surprising. The fact it was made in the first place is what strikes me and leads me to these thoughts:

We are not the first patient community to face public ridicule but, in this age of no bully, no hate movements everywhere, why is it still continuing?  Why it is okay to ridicule an incurable, life-devastating disease and the people who suffer from it? How is that not hate and why aren’t the decent people in the world stepping up to stop it?

I get why it is happening–the public has never been given an honest look at the true nature of the disease, M.E.  Plus, we are all sick, mostly at home, in bed, invisible to society and seemingly insignificant in a busy world. Out of sight, out of mind. I am just having a hard time grasping why my getting sick with an unusual disease with a funny name opens me, and my fellow sufferers, up to ridicule in public and the media? Is it really that inconceivable a disease exists which causes the body’s energy generating system to malfunction? Every other system in the body can malfunction, why not energy? And, how is that funny?

Disparage any other disease or patient and people will call out the bullies loud enough the media provides coverage for the next three news cycles. Never with M.E., ever. This being the case, perhaps we should be thankful our issues are publicly ignored and things like the IOM report media blitz happen rarely.

The hateful behavior of the public towards M.E. needs to stop. People battling M.E. face so much obstruction in their lives; they need an outpouring of support, not a load of hate. Trolls should be called out and shamed.  People with their snarky remarks should stop and realize they are a big part of the overall perception problem. It is a disgrace this is even an issue.

Last night’s troll comment crossed my line in the sand. I cannot watch this happen any longer. I am going to do something about this. I don’t know what yet, and I don’t know where I’m going to draw the energy from to do it, but I’m too angry not to do something.  I am open to ideas and anyone who wants to join me is welcome. “No Hate” needs to apply to the M.E. patient community too.

Vanessa Li Update

We got the news this morning. Vanessa Li took her own life. Her brother posted a notice on Vanessa’s Facebook memorial page.

https://www.facebook.com/vanessali19812015

The family found a note addressed to them on her email account a few days after her death. The pain from M.E. had become too much and, with no cure, she could no longer go on.

Vanessa wanted us to know a few things, stated in her brother’s notice:

Here are a few messages that Vanessa wished to share with you all.

For Vanessa, the pain from ME was impossible to describe. She could not go on anymore, not like this without any cure. It was too painful. She felt that ending her life was simply a practical solution.

She wanted the world to know that she ended her own life and she wanted her death to serve something. She wanted to spread awareness of the truth about ME, and the lack of research into the illness as a result of neglect from medical authorities worldwide.

She wanted her body to be donated for the purpose of researching ME. We have already arranged for this to happen.

Lastly, she wished to say sorry to all her friends, to whom her passing comes as a shock.

Vanessa said ending her life was simply a practical solution. Those words gut me and I am not alone. To those of us she touched, even in the smallest of ways, losing Vanessa was anything but a practical solution.

Suicides are too common in the M.E. community; each one a stunningly tragic loss. We are becoming too accustomed to this kind of unique heartbreak. Every M.E. patient lives with the knowledge that decades of neglect by our world governments lead to these kind of deaths, making the grief cut that much deeper. This unjustice has to stop, now, for Vanessa and for the others who find the same practical solution to the pain of M.E.

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There will be an online vigil for Vanessa tomorrow (Wednesday) at 1:00 pm EST on her memorial page, linked above.

Beyond the Roll-Out

The Institute of Medicine rolled out their report, “Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, Refinding an Illness” on February 10th, and it is pretty much as expected. First glance gives readers the impression the committee nailed it but closer inspection reveals some serious flaws. But, at least, it is better than the 1994 Fukuda criteria clinicians are still using. And the committee gave us a close variation of the Canadian Consensus Criteria, which surprised more than a few in the M.E. community. The IOM committee also made it clear they do not expect this criteria to stand the test of time and recommended it be changed as new research studies are completed, in no later than five years. In the meantime, they tell us the report is a solid foundation from which to build.

Also, the IOM, almost apologetically, christened the disease with a new name: Systemic Exertion Intolerance Disease, or SEID, thus replacing the name hated by all, Chronic Fatigue Syndrome.  Now, instead of people making jokes that they must be sick because they are “fatigued”, they are making jokes that they must be sick because they are “intolerant to exertion”.  Hardly an improvement but at least we don’t have a “syndrome” anymore; at last, we have a “disease”.  However, apparently the committee did not give thought to the fact SEID spelled backwards is DIES, which, I have to say as a patient, is kind of alarming.

In a move which still has advocates scratching their heads, the committee reported they could not justify joining most of the rest of the world in calling the disease the much preferred name, Myalgic Encephalomyelitis. They claim they could not find research to justify muscle pain and brain inflammation as dominant symptoms as the name M.E. implies. Advocates were quick, however, to point to the studies they could have referenced but chose to ignore. There are studies currently in progress which could provide further justification for use of the words myalgic and encephalomyelitis, so it begs the question why not simply defer renaming the disease until their recommended review in five years or less?  At least one committee member has been quoted as saying the committee fully expects the name to change at the future review, so why throw SEID into the mix at all?  Many patients, including myself, have decided to stick with M.E. when referring to the disease.

With the IOM report roll-out came a media blitz like nothing the M.E. community has ever seen. Hear ye one and all! The Institute of Medicine today declares Chronic Fatigue Syndrome is a real disease!  And, a real disease deserves a new name! Goodbye CFS, hello SEID. Articles appeared in print as soon as the press embarkgo was lifted at 11:00 a.m. EST. Publications ranging from major medical journals to home town newspapers published articles reporting the big news. Nearly every article featured a picture of a pretty caucasian woman, sporting beautifully manicured nails, well-coiffed and well-dressed, resting her tired head on her delicately placed hand so as not to smudge her perfect make-up; a stark contrast from the typical housebound, unkempt M.E. patient lying on a couch.

Each online article garnered its share of “expert” commentators.. As usual, there were arrogant doctors dismissing the disease and calling us simply depressed. And, there were the folks who used to have it for a few months but got better by doing x, y or z and those who exercised their way back to perfect health. The postive thinkers and nutrition nuts were out in force  And every article had an ample share of bullies calling patients lazy parasites on society, opining that it must be nice to lay around all day, doing nothing but collecting disability money.

Nightly news on all the major networks gave the IOM report release at least ninety seconds. Television news anchors generally looked amused as they dutifully read off  teleprompters that chronic fatigue syndrome is a real disease and that patients are no longer fatigued but exertion intolerant instead. Network news called in their television doctors to add their professional confirmation, although glaringly clear the doctors knew nothing about the disease and had not read a word of the report. NBC had to issue a correction after their television doctor reported that exertion intolerant patients frequently get better with exercise.

A television outlet, KOAT in Albuquerque, New Mexico, livened up their morning news segment by asking people on the street how much sleep they got the night before. No one bothered to read the report there either and they fed their viewers eighty seconds of outlandish “facts” and ten seconds of truth. The woman anchor ended the segment by telling her co-anchor, as an aside out the side of her mouth, she had been tired for 13 years. In a helpful touch to us tired sufferers, they announced they are going to feature their favorite Wakeup app in a future report.

This evening, two days after the roll out, the M.E. patient community was in a reflective mood on social media. It is as if we are experiencing collective post-exertional malaise. The IOM report had been much anticipated, and hotly contested. Now that we have it, and have had a chance to read and digest it, exhaustion from the exertion is taking a toll. We have fought hard for this disease to be recognized and validated. Now that the IOM committee gave us that validation, it leaves us pondering our next move or even if we have the physical and emotional ability to move at all.

One thing the IOM report roll-out made glaringly clear is how M.E. and M.E. patients are perceived in the eyes of an unknowing public and prejudiced medical profession. It is going to take so much work to turn those perceptions around. We won a big battle but it pales in comparison to the war that rages on. Advocates are questioning how much they have left to give to this cause. Some are leaving the fight, realizing their health will no longer permit them to give of themselves for the greater good.

IOM committee chairman Ellen Clayton, near the conclusion of the roll-out meeting, took a moment to speak personally to the M.E. community. She urged us to take this report and use it as fodder to secure the much needed research funding. She urged us to ACT UP, as the AIDS activists had done; to rise up and fight to make our government help. I understand others are urging the same. It is unfortunate they do not realize M.E. does not allow us to ACT UP. We are too sick to march on Washington D.C. We are too sick to lobby Congress as extensively as will be needed. We are too sick to stage awareness concerts. We are too sick to do much more than write a few letters, compose a few tweets and forward some e-mails. Our families give their all as our caregivers and have little left to fight for the cause on our behalf.

Every other major disease–and make no mistake M.E. is a major disease–has at least one celebrity spokesperson but, what celebrity wants to be associated with a disease the general public finds as fodder for jokes? Every major disease has at least one rich philanthropist to provide a financial base for their awareness and research efforts but who can afford being associated with a disease that invokes laughter? Every major disease has at least one corporate sponsor to underwrite awareness campaigns but what corporation wants to sponsor a bunch of tired, lazy people? And, as was made crystal clear over the past three days, unless M.E. has actually touched their lives, members of the general public are more inclined to make light of the disease than fight for the sufferers.

The Institute of Medicine panel formed a unanimous consensus and gave us a report which will be respected by those with the power to invoke real change. We have the needed validation to draw the attention of Congress and get the desperately needed research funding.  It is a tragedy the M.E. community may be too sick to use it and no one else cares enough to help.

 

Link

Wednesday, February 4, 2015 will be a day the close-knit Myalgic Encephalomyelitis community will long remember as being extraordinarily painful. Activist Vanessa Li succumbed to heart failure during the night. She was 34 and had fought M.E. for 15 years. A shockwave could be felt running through social media and M.E. forums as news of her death spread. In the M.E. patient’s’ world, where emotional stressors are paid for in physical pain, Vanessa’s death felt literally like a gut punch.

Vanessa was a superb activist and, although frequently bedbound, she worked tirelessly to advance the M.E. cause. She instigated the Microbe Discovery Project and raised almost a quarter of a million dollars for Dr. Ian Lipkin’s research. She knew the science behind this disease and shared that knowledge freely. Her opinion was valued and many considered her a treasured friend. Vanessa touched many and she is sorely missed.

A day after Vanessa’s death, grief is turning to a slow burn of anger. M.E. claimed Vanessa before she could see the results of her hard labor. She deserved that and more. Vanessa deserved to live her life with M.E. far better than she was allowed.

Vanessa deserved solid, tested M.E. treatments, established by well-funded research teams. She deserved her government to recognize the disease and not turn a blind eye to her suffering. She deserved medical professionals who had received training in M.E. in medical school. She deserved doctors who realize M.E. is not going to be cured by exercise and positive thinking and who worked for her instead of against. And, Vanessa deserved a public who knows about M.E. and who give the disease the same credibility and empathy as MS, Parkinson’s, Alzheimer’s, Polio and AIDS.

On February 10th, the Institute of Medicine Committee on Diagnostic Criteria for ME/CFS will spend an hour unveiling their long-anticipated report. The Pathways to Prevention (P2P) has issued their draft report, collected responses and the final report is due to be released soon. HHS has stalled the patient population for over eighteen months waiting for these reports; this on top of years without advancing a single step toward helping the M.E. community. Now, the reports are done and the waiting is over. It is the government’s time to act.

Congress must be made to hold HHS/NIH and CDC accountable for their neglect of M.E. patients and Congress must ensure that reasonable recommendations from CFSAC and M.E. experts are enacted. Every unreasonable recommendation made by the IOM and P2P must be loudly discredited by patients and the experts. Media needs to finally step up and do their part in educating the public and showing M.E. in an honest light. Benefactors need to recognize the tragedy of M.E. and start donating as they do other chronic diseases, including the establishment of a M.E. Society. The hard work is just beginning and every M.E. activist is needed to join the common cause.

Vanessa Li will be sorely missed as the M.E. patients take on this next fight to better their lives. It is tragic she did not live to see real change made in how the world treats M.E. patients. She deserved better. Everyone living with M.E. deserves better.

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Please join me in remembering Vanessa Li by donating in her memory: http://www.microbediscovery.org/  http://www.meadvocacy.org/

The Marketing of Justina

After a year of review hearings keeping Justina Pelletier in foster care, the dependency court judge is due to give a ruling Tuesday on motions he heard at a March 19th hearing. It is expected he will transfer the dependency action to Connecticut and Justina will be transferred to a treatment facility near Tufts. I have lived with Justina in my thoughts for a year and I tell her story to all who will listen. What Boston Children’s Hospital and the State of Massachusetts is doing to Justina and her family is deplorable. People need to take notice, educate themselves, speak out and keep the conversation going in order to stop this from happening to any more children. People need to get the message and spread the word. But what happens when that message gets marketed in a manner which is not helpful to the cause? Is the recent marketing of Justina Pelletier a good thing?

If you are unfamiliar with Justina Pelletier, she is fifteen years old, suffers from a little known disease and has spent over a year in the custody of the Massachusetts Division of Children and Families (DCF), mostly as a patient in the psychiatric unit at Boston Children’s Hospital (BCH). She was removed from her parents after an ER doctor at BCH disagreed with Justina’s mitochondrial diagnosis and treatment plan. She was under the care doctors at Tufts in her home state of Connecticut and fell ill with the flu while visiting Boston. In the span of less than 24 hours, BCH psychiatrists examined Justina and made a determination she suffers from a mental disorder, caused by over-attentive parents who were over-medicating her with an assorted batch of supplements. When the Pelletiers refused to sign a treatment plan requiring them to dramatically change their daughter’s course of treatment, DCF was called and Justina was placed in the custody of the State of Massachusetts, where she remains.

If you wish more history on the Pelletier case, the Boston Globe has been following Justina’s story for months, as has Fox Connecticut and Glenn Beck.

Since early days of Justina’s confinement, the pediatric psychiatrists and BCH have been targeted by advocates. The psychiatrists misused their privilege by making a medical recommendation to DCF and Dependency Court guaranteed to get Justina removed from her parents, with medical power of attorney to the State. This procedure was not new to these particular doctors or BCH; it had been done before. The psychiatrists are able to use these kidnapped patients in their somatoform disorder studies with the luxury of no interference from parents. They are only accountable to the State and the State will always bow to their professional recommendations.

Advocates have also focused on raising the awareness of mitochrondrial disease. The best way to help patients like Justina is to make the basics of mitochondrial disease common knowledge. The reason Boston Children’s Hospital and their psychiatrists were able to get away with these types of dependency actions is because the public knows so little about the disease. It is hard to bring mitochondrial disease to public view; research dollars are scarce and the disease is relatively rare and misunderstood. Medical school education is essentially non-existent so few doctors recognize it.

Lou Pelletier broke the court’s gag order on the Glenn Beck show a year after Justina was taken. Although I’m not a fan of Glenn Beck, I applauded Mr. Pelletier’s courage and, at the time, was grateful for the attention being paid to the cause. Within a matter of hours, Fox News picked up the story, as did ABC. Wire services were alerted and it became international news in mainstream media outlets.

The protest quickly moved away from the core issues and became a marketed referendum on religious freedom, right to life, parental rights and an fevered attack on the entire child services system. A vigorous protest has been mounted in a relatively short time but it has not hastened the progress of the dependency action.

Other people jumped into the mix within days. Reverend Patrick Mahoney, of the Christian Defense Coalition, bought a one-way ticket to Boston and immediately stepped forward as the Pelletier family spokesman. Rev. Mahoney has enlisted the aid of his followers to organize prayer vigils and protests. He is called upon for frequent updates and his opinions are shared widely on social media.

Not all of the Reverend’s activities have been helpful to the cause. For example, he accompanied the Pelletiers on their once weekly visit to see Justina, seeking entry as her spiritual advisor. Rev. Mahoney had to have known the facility is bound by a court order to limit visitors to immediate family only. The family-only visitation rules have been a point of contention for months and have been publicly debated. Instead, he went to the facility, was denied access to Justina, and broadcast that fact as an injured party. Weeks later, this incident involving the Reverend is still being continually portrayed as a violation of Justina’s constitutional rights regarding religious freedom. Facility staff were classified as enemies on social media. Telephone campaigns were launched, encouraging people to register their objection and demand Justina have access to a spiritual advisor of her own choosing. When it was brought to Rev. Mahoney’s attention that tying up facility staff with telephone calls could result in poor care for Justina, protesters were asked to flood DCF phone lines instead. Apparently, no one considered that the stunt likely caused Justina more stress at the time because her parents entered the visit fresh from confrontation. Did any part of that incident help Justina? No, but it did give the Reverend a desired talking point.

Mat Staver, founder and chairman of Liberty Counsel, joined in the fight. He made a motion to the court to be allowed to represent the family but Judge Johnston has not yet ruled on his motion. Despite his not being recognized as counsel for the Pelletiers, today Mr. Staver filed a motion for contempt against the DCF for failure to allow Justina to be seen by the doctors from Tufts. DCF has publicly stated they are holding off making medical appointments at Tufts pending the court’s decision. Judge Johnston has publically stated his intent to render that decision by close of business Tuesday. Filing a motion for contempt one day prior to the decision, which will likely make the issue moot, accomplishes nothing except draw publicity to Mat Staver.

Dr. Phil taped a show with members of the Pelletier family and Rev. Mahoney. Coincidentally, the show aired the same day as the latest court hearing, which many felt would be the day Justina would be given her freedom. To his credit, Dr. Phil presented a balanced show and discussed the core issues. There was a lot of interest generated online prior to the show and he likely enjoyed good ratings that day. I imagine a follow-up show, taped after Justina is returned home, is in the works and it can expect good ratings as well.

A handful of lawmakers in Connecticut and Massachusetts, acquiescing to demands of constituents, gave interviews promising to attempt legislative action to free Justina, while knowing, but not saying, they lack the jurisdiction to override the dependency court’s order. Lawmakers are promising parental rights legislation, as well as an overhaul of children’s services, but are forgetting they make these same promises every election year. They can’t help Justina but have instilled good feelings in their voters, so it is a win for them.

Following the lead of Glenn Beck, Rev. Mahoney and Mat Staver, Christian conservatives have vigorously embraced the Pelletiers and their cause. Facebook groups supporting Justice for Justina have ballooned in size. Twitter campaigns are ongoing, as are telephone campaigns. Instructions have been given on how to file formal complaints against the hospital, the doctors, the DCF staff and Judge Johnston. There is an all out social media blitz to make life difficult for anyone who has had a hand in Justina’s ordeal. Today, in anticipation of Tuesday’s court ruling, specific instructions were given to Justina’s supporters to telephone the judicial offices to make clear “the whole world is watching.”

The amount of vitriol in the Facebook groups dedicated to Justina’s case is overwhelming. Everyone from Judge Johnston to DCF to the people caring for Justina are being vilified. Anyone who disagrees with the new hardline conservative stance is pounced on and chewed up on social media. Advocates, sick themselves, who have worked tirelessly on Justina’s behalf have grown weary of having to defend themselves and have slipped into the shadows. This kind of activity does nothing to get Justina home and I hope she never reads the comments on the pages dedicated to justice for her.

In summary, how successful is this new form of protest? Has all the new activity from the Pelletiers’ legal team helped move the dependency along? Not at all. Plans to transfer Justina’s case to Connecticut DCF jurisdiction were well underway before Lou Pelletier broke the gag order. It is entirely possible Judge Johnston would have signed the order transferring the case to Connecticut on March 19th had he not been inundated with new motions.

Justina was transferred from BCH to a temporary juvenile housing facility about six weeks ago because she proved to be a poor study subject, NOT because of public pressure. She was not showing improvement after a year under the BCH treatment plan and the psychiatrists could no longer justify her confinement. Her doctors recommended a transfer back to Tufts for further treatment and DCF and Judge Johnston set the transfer process in motion.

Are banging the drums of religious freedom, right to life and parental rights helping Justina come home? No, but it is garnering publicity for some, paving the way for lucrative civil lawsuit contingency fee retainers for others and guaranteeing press and TV show ratings. Will there be a book? A TV-movie? A spread in magazine? Does she need an agent? How soon before Jessica is asked to go before the television cameras and talk about her captivity? Has anyone asked Justina how she feels about all of this?

The pieces are in place for Justina to leave Massachusetts and such an order could be signed tomorrow. She has a long road ahead but will soon be recovering in the arms of her family. The circus will quickly move on to the next photo op and vows to change the system will be forgotten. For Justina, I wish her a steady physical and mental recovery. Mostly, I hope the world will allow her to quickly achieve closure so she can resume normal life, out of the public eye and away from the storm.

Meanwhile, M.E. and other invisible illness advocates will continue to work hard to make sure another patient is not kidnapped in the name of medicine. Karina Hansen in Denmark still needs to come home.