Charles Shepherd, Letter to the BMJ, 2 September 2007
http://www.bmj.com/cgi/content/short/335/7617/446

NICE guideline is unfit for purpose and too costly
to implement

1 September 2007

Dr Charles B Shepherd,
Medical Adviser
ME Association, 4 Top Angel, Buckingham,
MK18 1TH, UK


The National Institute for Health and Clinical
Excellence (NICE) recommends that everyone with
mild or moderate ME/CFS (myalgic encephalopathy/
chronic fatigue syndrome) should be offered a course
of either cognitive behaviour therapy (CBT) or graded
exercise therapy (GET).

This is despite published evidence remaining weak
(especially for group CBT) and inconsistent [1].
Patient evidence submitted to the Chief Medical
Officer's report concluded that CBT produced "no
change" in 67% of cases and made the condition
"worse" in 26% of cases [2].

Around 50% of respondents reported that
inappropriate exercise therapy had also made their
condition "worse" [2].

Using the NICE estimate on prevalence, this
controversial recommendation will affect around
200,000 people. A one-to-one course of CBT covering
12 to 16 sessions will cost well over £1500. The cost
of a professionally supervised exercise therapy
programme is also likely to be substantial.

So where is around £300 million of new money going
to come from at a time when very limited funding for
some of the newly established NHS clinical services
for people with ME/CFS is now being cut? [3]

And where are all the therapists going to come from?
Those already in post often cannot even cope with
the present workload.

These are important questions that I raised at a
NICE implementation and planning meeting in
October 2006 - but nobody from NICE could provide a
convincing answer.

These recommendations are going to be of no value
whatsoever to many people with ME/CFS. They are
also going to be impossible to implement due to a
lack of both funding and human resources.

REFERENCES

1: Shepherd C and Chaudhuri A. ME/CFS/PVFS - An
Exploration of the Key Clinical Issues. ME
Association, July 2007.

2: CFS/ME Working Group. A Report of the CFS/ME
Working Group: report to the chief medical officer of
an independent working group. London: Department
of Health, 2002.

3: ME Association. Summary of key points to emerge
from All Party Parliamentary Group meeting held in
Committee Room 17 at the House of Commons on
Thursday 12 July.
www.meassociation.org.uk/content/view/307.

Competing interests: Physician with personal
experience of this illness