Comment on: Life insurance MDs sceptical when chronic fatigue syndrome diagnosed. [CMAJ. 1990]
As a physician with chronic fatigue syndrome (CFS) since the early days of the Lake Tahoe, Calif., outbreak, in 1984, I read Olga Lechky’s report (Can MedAssoc J 1990; 143: 413- 415) with particular interest. It was refreshing to hear Dr. Richard Proschek, assistant medical director of Mutual Life of Canada, admit that the industry’s attitude to CFS is one of hostility. Unfortunately for the thousands of severely debilitated patients with the condition this scepticism and hostility are not restricted to that industry, which in many instances has behaved with compassion and responsibility toward its clients. The hostile viewpoint is also widely prevalent in the medical profession and is often freely communicated to patients.
To hold that CFS is not a real disease it is necessary to imagine that in 1984 people of all ages began to manufacture a condition with clearly defined symptoms that begins as a flu-like illness, persists and evolves. How many diseases fit this description? When, before 1984, did depression present so? Can it be true that thousands of our brightest citizens, including children, Olympic aspirants, several members of some families, alarming numbers of teachers, 50% of a symphony orchestra and 10% of the population of Incline Village, Nev., abruptly and concurrently elected to drop out of life, then continued to complain in the face of widespread scepticism, hostility, marital breakdown and, frequently, isolation? What, other than an infectious agent, could cause this?
Proschek’s bias arises from his position. Physicians in practice, however, see many CFS patients who have no insurance or are quite wealthy. The degree to which imagination must extend to accommodate a diagnosis of secondary gain in these people is beyond belief. Many physicians lament the lack of a blood test for CFS. What, pray, is the test for malingering, a diagnosis we seem to have no difficulty making?
You can read the rest of this letter here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1452931/pdf/cmaj00229-0013.pdf
Source: Sean J. O’Sullivan, MD. Life insurance MDs sceptical when chronic fatigue syndrome diagnosed. CMAJ. 1990 Dec 15;143(12):1283-6. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1452931/