Dr E.G. Dowsett is Honorary Consultant Microbiologist, Basildon and Thurrock Health Authority and is the President of the Myalgic Encephalomyelitis Society.
DR P.D. WELSBY: I, and indeed many general physicians, are often asked to see patients whose main complaint is ‘tiredness all the time (TATT)’. From my previous experience also of general practice it seems that there is a wide continuous spectrum of debility ranging from a few days or weeks, but sometimes, distressingly, lasting for years. Such illnesses may or may not follow symptoms of an infection. Does the Myalgic Encephalomyelitis (ME) Society differentiate between post-viral debility, postinfectious (often an undefined infection) fatigue syndrome, chronic fatigue syndrome and ME? If so, how, and should it make any difference to medical management?
DR E.G. DOWSETT: One of the most striking features of ME is that the patient is not tired all the time! Extreme and sudden variability of energy levels both within and between episodes of illness differentiate this syndrome from other diseases associated with fatigue. One can only deplore the current fashion in the United States as well as the United Kingdom to redefine and rename a disability which has been clearly described in the literature for at least 100 years.’ There is nothing to be said in favour of the American acronym CFIDS (chronic fatigue immune deficiency syndrome) with its connotation of a primary immune dysfunction. The term ‘chronic fatigue syndrome’ recently adopted in this country also is nonspecific and non-descriptive because most of the definition is based on a vast number of exclusions (some of which, for example, endocrine disturbance, are actually found in ME). ‘Post-viral fatigue syndrome’, another British name, describes one essential feature (the association of the illness with viral infection) but gives the impression that the infection was antecedent rather than, as we now know, persistent. I prefer to use the more specific term ‘myalgic encephalomyelitis’ as it emphasizes the essential encephalitic component of the illness, the muscle pain, and the close clinical and epidemiological similarity to poliomyelitis.
You can read the rest of this interview here: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2399326/pdf/postmedj00061-0066.pdf
Source: E. G. Dowsett. Conversation piece. Interview by P. D. Welsby.Postgrad Med J. 1992 Jan; 68(795): 63–65. PMCID: PMC2399326 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2399326/