Showing posts with label advocacy. Show all posts
Showing posts with label advocacy. Show all posts

Tuesday, October 11, 2016

Millions Missing Day of Protest Draws Attention to Plight of ME/CFS Patients All Over the Globe

This article was first published on ProHealth.

By Erica Verrillo

On September 27, ME Action sponsored the second Millions Missing global event. (The first was in May 2016.)

The purpose of the Millions Missing events was to draw public attention to ME/CFS, to demand increased funding into research for biomarkers and for effective treatment, and to improve medical education and patient care. (You can read the demands HERE.)

The global day of protest was a resounding success, with demonstrations in twenty-five cities in ten countries, and more being planned. The Millions Missing events drew ample media attention, as well as interest from government representatives and hundreds of passersby who saw the moving displays of empty shoes and stopped to talk to the volunteers – both patients and supporters – who dedicated their day to this worldwide effort.

I have selected some representative photos below, but to get the full impact of the event, I encourage you to browse ME Action's gallery of inspiring photos HERE.

Please donate to this admirable initiative! This is the first time that there has been a coordinated international movement to bring attention to this disease, and to raise awareness at such an impressive scale. Millions Missing deserves our whole-hearted support!

DONATE HERE.
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UNITED STATES




ATLANTA

In Atlanta, Georgia, a group gathered at the State Capitol to give speeches about personal tragedies, the history of ME/CFS and hopes for a new science leading to a brighter future. State Representative Michael Caldwell was present and several other Representatives and staffers stopped by to listen and learn.



BOSTON

Patients and supporters met in front of the JFK building to raise awareness for ME/CFS. They laid out shoes, handed out flyers, displayed posters, and chatted with passersby. A couple of patients did performance pieces!




CHICAGO

Over 70 patients gathered outside the James Thompson Center in Chicago. Carol Head spoke as a patient and the president of SolveME/CFS Initiate stating "we will no longer be ignored." She focused her speech on the Institute of Medicine's report. Leonard Jason spoke about the severity of the disease and Marcie Zinn described the brain research she is working on at DePaul University in Chicago.

Press: Chicago Residents To Protest Lack Of Support For Those Suffering With Myalgic Encephalomyelitis/Chronic Fatigue Syndrome




DALLAS

Eight people attended the Millions Missing protest at Dallas City Hall Plaza. A 25-foot banner was displayed among posters and photos of patients who were unable to attend. The protest demands were read and posted on Facebook live.



LANSING

The Lansing #MillionsMissing protest was held on the East steps of the Michigan State Capitol building, and several local news crews were present. Nineteen attendees from all over Michigan held signs and sat on the steps under a large banner. Patients shared their stories, and there was a long moment of silence for those who have died and those who are bed-bound.




MORRISTOWN

In Morristown, NJ, the demonstration lasted from 3:30 - 8:30 PM. Many people stopped by to learn more about ME/CFS, as well as the lack of funding and support from the NIH, CDC and HHS. The patients who were able to stop by were very grateful for this initiative.



NEW YORK

The NYC protest had approximately forty people in attendance with a full agenda of speakers. Dr. Susan Levine, Dr. Mady Hornig, Jim Eigo (ACT UP/NY), Annette Gaudino (Treatment Action Group), ME Activist Terri L. Wilder as well as other people living with and affected by ME spoke at the demonstration. A few reporters showed up and at the end of the demonstration Terri and Annette attempted to deliver a "bad report card" to the HHS regional office director but were stopped by building security and threatened with a citation! (See pictures in NYC photo folder HERE.)

After tweeting "at" Jackie Cornell, HHS Regional 2 District Director, and asking her what she has done for New Yorkers with ME, ME Activist Terri Wilder received a private tweet from Ms Cornell stating "I'd love to sit down and discuss. I'm in DC a few days of this week and next but please email me and we can set up a time. Thank you for your advocacy and reaching out!"

Press: “More than a million Americans are suffering from a debilitating disease that makes simple tasks impossible — and they’re fed up with being ignored,” Business Insider



NORTHAMPTON

About a dozen patients and supporters gathered in front of City Hall in Northampton, MA. Passersby stopped to look at the display of shoes on the steps of City Hall, as well as read handouts and talk about ME/CFS with demonstrators. Lisa Hall, RN, from Northampton Wellness Associates gave a speech about the countless patients with ME/CFS she has seen, and described the severity of the disease. One patient spontaneously went into the town hall to invite the mayor to come down and visit. He did, and after speaking with the demonstrators offered a City Proclamation making May 12 official recognition day for ME/CFS.

Press: The local NBC station came and shot footage for a TV piece that ran on the evening news: http://wwlp.com/2016/09/27/millions-of-americans-suffer-from-chronic-fatigue-syndrome.



SAN FRANCISCO

Well over 100 people showed up for the Millions Missing day of action in San Francisco. Over 150 patient profiles were stretched across 120 feet and a 60-foot quilt made over 17 years ago was displayed. The quilt was a created in three countries as a desperate plea for visibility and funding.

Hundreds of individuals passed these displays, many of them stopping to look for several minutes and ask demonstrators about the illness. Patient Sonya Heller Irey gave a passionate speech about the devastation this disease can inflict on an individual. A proclamation provided by Mayor Ed Lee was announced, naming a day of Awareness for ME in San Francisco, and a certificate of honor was issued by the San Francisco board of supervisors in recognition of the advocacy of the Millions Missing campaign.

Groundbreaking ME/CFS researchers, Dr. Eric Gordon, Dr. Ron Davis, and Dr. Jose Montoya, attended this event. Dr. Eric Gordon talked about potentially having a biomarker in the near future based on the recent metabolomics study.

“CFS/ME has devastated the lives of millions of people worldwide. The pain, suffering and solitude that this disease has brought to so many human beings is immeasurable. For the past 35 years, CFS / ME patients have been ignored, humiliated, misdiagnosed, mistreated and told that the disease is the product of their imagination. As a clinician investigator at Stanford University, when I close my eyes and I see the disease in all its enormity and complexity, I can only conclude that this is likely one of the greatest medical and scientific detective stories we face in the 21st century,” said Jose Montoya, professor at the Stanford University Medical Center.

Dr. Ron Davis added. “Unfortunately this [protest] is really necessary…. NIH funding gives you a steady state level of funding for five years so you can plan and you can hire people and you can do a much more effective job of doing the research... it’s not about doing one study, it’s about a sustained effort to figure it out and that’s why we need government funding in this project.”



SEATTLE

Demonstrators handed out flyers and held up signs for about two hours while passersby stopped to talk. Those who stopped were saddened and surprised by the fact that many people get so ill they can no longer work at all and stay in bed most of the day. It was a wonderful opportunity to come together to spread awareness of this debilitating disease.



WASHINGTON, D.C.

A large protest was held at the U.S. Department of Health and Human Services in Washington. Speakers included Ryan Prior and Hillary Johnson. Laura Benson and her husband, a retired Air Force officer, also gave compelling speeches. Three journalists covered the event, and the Montgomery County Council (home of NIH) issued a proclamation supporting ME/CFS awareness day.

Press: #Millionsmissing ME/CFS Protest in Washington, D.C.,” Inspire
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CANADA






TORONTO, CANADA

A protest was held at the Health Canada Regional Office at 180 Queen St West, Toronto on October 6, from 12 - 2PM. ME/CFS specialist Dr. Alison Bested attended the event.

You can find more information here: https://www.facebook.com/events/1120173071406359/?active_tab=posts

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UNITED KINGDOM



LONDON

“The day was in equal measures surreal, empowering, saddening and desperately emotional. The sense of brotherhood felt almost palpable as we stood together and spoke about our experiences with ME – our personal struggles, our deepening concern over graded exercise trials, particularly in children, and how one mother now cares for her husband and two children, all of whom suffer from ME.

We were grateful to have been live a total at least three, perhaps even four times throughout the protest thanks to London Live News (footage to follow) as well as grasp the attention of hundreds of passers-by with our strong words, our prominent display of shoes, and of course, our naked protester holding up the sign, You can’t ignore ME now.”

PRESS: “Striking protest about ignored ME sufferers outside the Department of Health in London today #MillionsMissing” (Christopher Hope, Assistant Editor and Chief Political Correspondent, The Daily Telegraph, on Twitter)https://twitter.com/christopherhope/status/780725734432247808



BELFAST

Dozens of shoes were laid out at Stormont, the seat of the Northern Ireland Assembly. Twenty-seven protestors held signs, including Sally Burch, long-time patient and Trustee of Hope 4 ME and Fibro. According to the Telegraph, Ulster Unionist health spokeswoman Jo-Anne Dobson MLA hosted the campaign. She said: "The sheer passion and drive of campaigners on display today at Stormont must be met by real and positive change in the treatment of thousands of patients across Northern Ireland."

Press: “Demonstrators at Stormont urge more research into chronic disease ME,” The Irish News, 28 September 2016

ME sufferers step up drive for more help,” Belfast Telegraph, 28 September 2017



BRISTOL

Bristol displayed 150 shoes on College Green in central Bristol, for a day of protest on behalf of the Millions Missing. ME patients, loved ones and family members gave out leaflets and talked to passersby, most of whom were visibly shocked to learn the truth about this devastating illness. One individual stayed for almost an hour reading every single label on every pair of shoes. Many wanted to donate to fund research.

Press: BBC Radio Bristol (at 2hrs 11mins):http://www.bbc.co.uk/programmes/p046wd9k

Bristol Post: 100 pairs of shoes used to make poignant protest on ME research in Bristol city centre



CARDIFF

The Millions Missing event in Cardiff was held on the steps of the Welsh Assembly that looks out over Cardiff Bay. Rows of empty shoes were a very poignant reminder of what the demonstration was all about. The Cardiff Rock Choir volunteered their services free of charge and drew the attention of passersby. A dance trio also performed, adding to the day.

A number of Assembly Members came out to speak with the demonstrators, including Julie Morgan who sponsored the group. Jan Hutt Assembly Member for the Vale of Glamorgan also came out onto the steps of the Assembly to speak to the demonstrators. Other Assembly Members stopped to find out more about Millions Missing, including Vikki Howells AM for Cynon Valley, David Melding AM for South Wales Central, and Dai Lloyd AM for South Wales West.

Press: Made in Cardiff TV came to film the event and presented a good report at 6 pm and 9 pm on their Tuesday evening News.



NOTTINGHAM

About 15 patients, family and friends gave out 200 flyers, spoke to 300 people, and got 30 signatures to stop GET trials on children. A passing ME patient couldn't believe that someone was standing up for ME "as people never do anything for us."

Press: BBC Nottingham Radio, covered on news bulletins throughout the day and had a 10-minute segment (about 5:20) as part of drive show (prime driving home from work time)

BBC East Midlands Today covered the demonstration on local TV news on the evening news segment. They filmed at the event and at a patient’s home.



OXFORD

The Oxford event took place in front of the Radcliffe Camera Landmark. Over 100 pairs of shoes were laid out. Volunteers helped to hand out around 200 leaflets and explained ME to curious passersby, many of whom stopped to read the shoe tags describing each sufferer's experience with ME.

Press: BBC Radio Oxford

BBC South Today

Oxford Times

Oxford Mail

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CONTINENTAL EUROPE



HAMBURG, GERMANY


Patients and relatives met at the Hamburg harbor to raise awareness of ME/CFS. People came from all parts of the country and there was huge virtual support.

“ME/CFS must be considered as a severe physical illness. It’s time to take us seriously!” said Daniel from the German Society of ME/CFS. Nicole from the Lost Voices Foundation pointed out that “Patients are left alone! This day is so important for us to raise awareness of ME and to eventually improve overall care and treatment.”



THE HAGUE, NETHERLANDS

A Millions Missing protest was held from 10:00 AM to 4:00 PM in front of Parliament in The Hague. About 1000 pairs of shoes were displayed, which drew the attention of many visitors. Fifteen demonstrators handed people flyers and talked with them about ME. Dr. Frans Visser gave a speech. The group spoke to two members of Parliament from two different political parties.

Press: ME Patients Display Thousands of Shoes on the Square

Omroep West: ME patients demonstrate in The Hague Square

De Telegraaf: Silent shoes parade before Lower House

Radio 1 interview with Carolien van Leijen: ME patients want more understanding, not comments like "get a dog"

Read more about Dutch press coverage HERE.



OSLO, NORWAY

Demonstrators in Oslo displayed 250 pairs of shoes and spoke with 300 passersby. Olaug V. Bollestad, a member of Parliament, and two speakers from patient organizations gave speeches. Three musicians performed. One patient group brought fruit and yoghurt for the participants to tide them through the event. The participants intend to start a collaboration with the Norwegian research fundraising group to help fundraise for clinical studies here in Norway.

Press: The demonstrators were interviewed by a national radio station at 3pm and filmed all day by a documentary filmmaker who is creating a documentary about ME and the Rituximab study in Norway. The film will come out in 2018. The event was filmed live and had about 120 people watching the live feed.

ME: – De meldes til barnevernet for omsorgssvikt,” Side Two, Sept. 27 2016

Additional links:https://www.facebook.com/elisabeth.royseth/posts/10153863829561680

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VIRTUAL


SOUTH AFRICA

The recently formed ME/CFS Foundation South Africa held a virtual event. They asked patients for their stories and photos of shoes/activities they could no longer participate in, made posters, and posted these throughout the day on Facebook, posted on Twitter, sent the virtual event to numerous online newspapers. They also texted and emailed radio presenters throughout the day.

Press: Shoes for a Syndrome
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MELBOURNE, AUSTRALIA

#MillionsMissingMelbourne will be held on 12 October at Victorian Parliament

Tuesday, August 30, 2016

Urgent Call to Action! Support Congressional Call for Increased ME/CFS Research!

By Mass CFIDS/ME and FM Association

You can help if you ACT NOW !!

A letter in support of ME/CFS research to NIH Director Dr. Francis Collins, sponsored by two Representatives from California, is now circulating in Congress (House of Representatives) and we need as many U.S. Representatives as we can to be co-signers. Please CALL and send a FOLLOW-UP EMAIL to your U.S. Representative (not your Senators) and urge him or her to sign this letter. Complete instructions, including a phone and email script which you can personalize, can be found here. The number of calls to each Congressional office to make this request really matters. Your Representative may not be inclined to act as a result of one or two calls, but 10 calls will make a strong statement. Please call right away. The deadline for your Representative to sign the letter is this coming Wednesday, August 31.

This action is the result of months of hard work by #MEAction, Solve CFS/ME Initiative, and the U.S. Action Working Group Congressional Committee.

GET and CBT have been downgraded as treatments for ME/CFS as a result of follow up work by the Agency for Healthcare Research and Quality.


In the initial Evidence Review prepared by AHRQ as input to the Pathways to Prevention (P2P) report commissioned by NIH, studies evaluating the effectiveness of Graded Exercise Therapy (GET) and Cognitive Behavioral Therapy (CBT) which used subjects meeting only the Oxford case definition (6 months of fatigue). Based on the initial inclusion of studies using the Oxford definition, notably the PACE trials, the Evidence Review suggested that GET and CBT were "moderately effective" treatments. The P2P report recommended that the Oxford definition no longer be used, and the PACE research has come under increasing criticism for its methodology.

As a result of advocates requests, AHRQ re-analyzed the evidence for GET and CBT, without including any studies based on the Oxford definition (e.g. PACE). The conclusion was that there was no evidence to suggest that GET or CBT were effective treatments for ME/CFS. Read more here

This outcome is the direct result of repeated requests to AHRQ by advocates. Advocates' next step is to make sure that this change is strongly noted in future medical education materials, particularly the websites commonly used by doctors, such as the Centers for Disease Control and Prevention (CDC), Mayo Clinic and Up To Date.

You can find your congressional representative HERE.

Email Template:

Dear ___________ (name of representative goes here)

I’m emailing with an urgent request regarding the disabling neuro-immune disease Myalgic Encephalomyelitis, also known as Chronic Fatigue Syndrome or ME/CFS.
Representatives Lofgren and Eshoo of California are sponsoring a letter to NIH Director Francis Collins in support of ME/CFS patients and research. ME/CFS costs the U.S. economy $17-24 billion annually; leaves its patients with lower quality of life scores than lung cancer, stroke, and rheumatoid arthritis; and has no known FDA-approved treatment or cure. Would you please support me and the 1 to 2.5  million Americans suffering from this disabling disease, by signing this letter? It would mean the world to me, my family, and other ME/CFS patients in our district to have your support.

Please contact Angela Ebiner, Legislative Assistant for Rep. Zoe Lofgren (CA-19) at Angela.Ebiner@mail.house.gov or (202) 225-3072 to coordinate your participation. The letter’s deadline is 8/31.

Thank you so very much for your support on this critical action. I look forward to your reply on this request at your earliest convenience.

Warmest Regards,
[Your Name]
[Your Contact Info, Including address and +4 zip]

Friday, May 6, 2016

Patients with Chronic Illness Rally to Raise Funds, Awareness, and Hope

Note: For some easy ways to participate in May 12 Awareness Day, please see May 12th is International ME/CFS, Lyme, and FM Awareness Day!

This article first appeared on Huffington Post. Reprinted with permission.

By Stephanie Land

Ron Davis, best known for helping to spearhead the Human Genome project, posts a selfie where he’s wearing a cape and a pair of briefs over his regular clothing. Hands on hips in the manner of superheroes everywhere, Davis mugs for the camera, happy to be ridiculous – for a cause.

Davis is the Board Director at the Open Medicine Foundation, a nonprofit set up to raise funds for the research he does with a team (including three Nobel laureates) at the Stanford Genome Technology Center. The Open Medicine Foundation has raised 4 million dollars since 2012 to help combat modern illnesses with elusive etiologies and challengingly complex presentations, such as Lyme, fibromyalgia, myalgic encephalomyelitis. His interest in studying myalgic encephalomyelitis or ME/CFS is to save his son Whitney’s life.

“ME/CFS symptoms include but are not limited to severe post-exertional fatigue, sleep dysfunction, cognitive impairments, and muscle/joint pain,” explained Stacy Hodges, a 32-year-old who is an advocate and activist for awareness of her condition. “After countless doctors' appointments, many individuals with ME/CFS quickly deplete their life savings but remain unable to work. There is very little hope for a cure, due to the government's lack of commitment to the disease, which results in almost no funding dedicated to medical or scientific research.”

In a public plea in December of 2015, Davis wrote, “My son Whitney woke me this morning to inform me that he is dying. He did not say he is dying – he cannot speak. He did not write he is dying – he cannot write. He used scrabble tiles to spell out his message.”

Whitney Dafoe’s story broke into the mainstream media after Ron Davis, his wife Janet Dafoe, and their daughter Ashley Davis held fundraisers to raise money to fund Ron’s research after his grant applications to the National Institute of Health were denied. “This tells me I am running out of time,” Ron went on to say. “I must find out soon what is causing the disease and how to cure it. I know I’m not the only one working on this disease, but there are too few researchers, too few medical specialists, too little research funds and too many patients.”

Undies on the Outside,” a fundraiser set up for the Open Medicine Foundation, is only one of many springing up currently as ME Awareness Day on May 12th draws closer.

An idea for a protest began to form, and Hodges started to articulate what that would look like. “Understandably, the idea of a protest was met with some initial resistance and hesitation because many patients are just way too sick to get out of bed, much less attend a protest,” said Hodges in an email interview. “The co-founders of #MEAction supported the idea of activism and together we launched the first step of many: our protest in Washington, D.C.”

As the group began planning, and posting about the protest on social media, the idea for a #MillionsMissing campaign started to form. “#MillionsMissing speaks to the invisible nature of our illness,” said Hodges. “Millions of patients are missing from their careers, schools, social lives and families due to the debilitating symptoms of this disease.” There are also millions missing in funds to research the disease, and millions of healthcare workers lacking proper medical training about ME/CFS.

On May 25th, several groups across the nation will stand (or sit in wheelchairs, lie on stretchers or the ground, depending on their severity of the disease) outside Departments of Human and Health Services to protest a lack of funding to research their disease. So far, there are protests taking place in Washington D.C., Seattle, San Francisco, Atlanta, Dallas, and London, England.

The combined efforts, fronted by Hodges, have been incredible. Many patients participate in several conference calls a week, sometimes using up their energy reserves to talk, plan, organize, and formulate the protest’s demands.

Understanding that many patients with ME/CFS won’t be able to attend the protests in person due to being house- or bed-bound, there are several virtual protest options listed on their website. People around the world can mail a pair of shoes to represent one of the millions who are missing from their once-active lives. On the day of the protest, supporters are also encouraged to place a pair of shoes on their front stoop or driveway with a sign explaining who they represent. “At the protest, we will be displaying many pairs of empty shoes sent in from sick and disabled patients around the world, many homebound and bedridden,” added Hodges. “The haunting display of empty shoes will represent the #MillionsMissing who make up our ME/CFS community.”

Hodges reached out to The Blue Ribbon Foundation, the nonprofit behind the documentary Forgotten Plague, which features the Davis-Dafoes, showing a rare glimpse into the room where Whitney has lived for over three years.

The Blue Ribbon Foundation offered a special Congressional DVD Pack through the Forgotten Plague website, and joined efforts to attend the protest in D.C.. “Real change is about engaging with the institutions in society that hold the power,” said Ryan Prior, who wrote and co-directed the film. “We need policymakers to watch a film that conveys the human struggle, scandalous politics, and world-changing science of the ME/CFS story. By using the film and the protest to build an increasingly unified front on Capitol Hill we can tell our story in a way we've never done before to the audience we need most.”

The focal point in each of these campaigns, protests, and fundraisers aligns with Ron Davis’s sentiment: a search for ‘what I can do to start a movement’.

It’s a movement towards recognition, for people to see how many people are suffering at home in dark rooms, behind closed doors, imprisoned in a body that can no longer function enough to perform daily self-care tasks. “Many patients have no caregivers at all, and they are struggling to get food in their refrigerators or just get to the doctor,” said Hodges. “Many patients are too sick to fight for themselves. Something has to be done, because the status quo is unacceptable. The patients can not live like this. I hope the public recognizes that this is a growing movement.”

It’s a movement with a groundswell of fundraising, advocacy, and groundbreaking medical research that has the potential to help ME/CFS patients find their feet.

____________________

About the author: Stephanie Land is a writing fellow for the Center for Community Change, and a board member at the Blue Ribbon Foundation. Her work has been featured through The New York Times, The Washington Post, and The Guardian. She lives in Missoula, Mont., with her two daughters. Read more of her story at stepville.com or follow her @stepville.

Thursday, March 3, 2016

Help Irish Patients with ME - A Petition to Allow Ampligen in Ireland


This petition was started by Noreen Murphy, an Irish ME patient. Currently, Ampligen is unavailable in Ireland.

As the oldest immune-modulating drug for ME, Ampligen has a long track record, and has benefited thousands of patients. 

While it is available in much of Europe and America it is not available in Ireland.

____________________




You can sign Noreen's petition HERE:

Make the drug Ampligen available for M.E. patients in Ireland


Petition:

There are thousands of people with M.E. (Myalgic Encephalomyelitis) in Ireland. At the very best, we receive only symptom management from our doctors, that's the best they can do for us. There is a drug, Ampligen (Rintatolimod), for the treatment of M.E.

Ampligen has been successfully trialled in the U.S.A. for the last two decades. Many M.E. patients have gone into FULL REMISSION with this drug.

We are asking the Minister For Health to make Ampligen available to us.

M.E. is an neurological illness as defined by the WHO (World Health Organisation). It affects all systems: neurological, immune, endocrine, gastrointestinal, musculoskeletal, etc. The symptoms can vary from mild, moderate, severe to very severe. It can be remitting/relapsing or progressive. Some people spend their days in a darkened room, unable to tolerate light or sound. Some are tube-fed. Others are mildly affected.

My name is Noreen Murphy. I have M.E. for over 29 years. Initially, I was very severe, then moderate for a number of years but have Severe M.E. for past few years.




HIGHLIGHTS

February 28
Ampligen should be available for those sickened by myalgic encephalomyelitis. It is a reasonable treatment option to try and a way to return some to normal life again.
February 23
Any drug that's deemed safe should be made available to people with this illness. The pain and suffering never stops, I know this as I care for my daughter who's been ill for 28 years since the age of nine.
February 18
Please make this drug available to MS sufferers. They deserve a better quality of life.
February 16
Petition has reached 500 signatures!
February 11
I have been on Ampligen on a cost-recovery, compassionate-care basis since 1999 (except for four years when I lost it); It made my immune biomarkers disappear and my viruses go dormant.. FDA has said in writing that there are no major toxicities. There are no other drugs specifically targeted to ME... show more
February 11
Petition has reached 100 signatures!
February 10
We are now live!

Thursday, February 4, 2016

HHS Ignores Request to Review PACE Trial

On February 3, 2016, a group of advocates wrote the Agency for Healthcare Research and Quality(AHRQ) asking them to reconsider the inclusion of the PACE trial in their review.

The AHRQ Evidence Review for ME/CFS formed the basis for the P2P report, in which GET and CBT were reported as beneficial treatments. This conclusion was based on the results of the PACE trial, a study which has been roundly criticized for its flawed methodology.

In November 2015, a group of U.S. organizations sent a letter to the U.S. Health and Human Services (HHS) asking them to address concerns raised in a series of articles about the PACE trial by journalist David Tuller. Based on these concerns and the call by the National Institute of Health (NIH) Pathways to Prevention report to retire the Oxford definition because it could “impair progress and cause harm,” the letter recommended the following steps as appropriate and necessary to protect patients:
  • The AHRQ revise its evidence review to reflect the issues with PACE and with studies using the Oxford case definition in general; 
  • The Centers for Disease Control and Prevention (CDC) remove findings based on PACE and other Oxford case definition studies from current and planned medical education; 
  • HHS use its leadership position to communicate these concerns to other medical education providers; 
  • HHS call for The Lancet to seek an independent reanalysis of PACE.
In the AHRQ’s response, the authors of the evidence review said that they had already considered some of the concerns raised by Tuller and that the additional information would not change the review’s conclusions. This is completely inconsistent with the published review. (The evidence review ranked PACE as a “good” study with “undetected” reporting bias.) AHRQ’s response failed to address the use of the Oxford case definition as the basis of clinical trials for ME/CFS patients. 

The CDC’s response stated that the IOM and P2P “have placed the findings of the PACE trial in an appropriate context for moving the field forward.” (That is bureaucratese for "we are doing nothing.") Like the AHRQ, the CDC failed to address the inclusion of studies based on the Oxford case definition.

HHS did not respond to the request to call on The Lancet to seek an independent review.

If you have not done so, please sign this petition calling for AHRQ and CDC to investigate the PACE trial.

Related Posts



__________________________________________

To: Dr. Arlene Bierman

CC: Dr. Suchitra Iyer, Dr. Wendy Perry

Subject: AHRQ response to community request on PACE and Oxford studies

Date: February 3, 2016

Thank you for your December 24 response to the November 15 patient community letter requesting that AHRQ and CDC investigate the concerns with the PACE trial raised by journalist Dr. David Tuller.1 As you know, this issue is of paramount importance because of the risk of harm to patients from inappropriate treatment recommendations based on flawed studies.

The patient community has requested that AHRQ investigate Dr. Tuller’s concerns and then revise its Evidence Review in light of those concerns and with Oxford definition studies more broadly. The evidence review authors responded that the provided information would not change the conclusions of the report. We disagree.

First, while the authors acknowledge some of the problems with the PACE trial in the full evidence review posted on the AHRQ site, they did not report these problems in the article published in Annals,2 leaving the journal readers unaware of these issues. Of greater concern, in spite of recognizing these issues and stating that they are considered in rating the evidence, the authors still rated PACE as a “good” study with “undetected” reporting bias.3 Such ratings are incompatible with the known flaws in this study and call into question the validity of the evidence based methods used for such a controversial evidence base. Even based on just the information available at the time of AHRQ’s evidence review, the rating of this study and its subsequent impact on the overall treatment conclusions need to be reassessed.

Second, the patient community had also raised concerns with the inclusion of treatment recommendations based on Oxford studies. This problem was highlighted to AHRQ staff when the evidence review protocol was first issued.4 The review itself acknowledged that the Oxford criteria are problematic because Oxford can include patients “with other fatiguing illnesses.” The Pathways to Prevention report stated that the Oxford criteria could “impair progress and cause harm” and called for it to be “retired.”

And yet, the evidence review made general conclusions about the benefits and harms of CBT and GET. For example, the report stated, “GET improved measures of function, fatigue, global improvement as measured by the clinical global impression of change score, and work impairment.” It also concluded that CBT resulted in improvement in physical function scores.

Notably, the evidence review did not qualify these conclusions on treatment effects by case definition. Such statements can reasonably be inferred to apply to all “ME/CFS” patients.5

The obvious question is whether these conclusions would still be true if the Oxford studies had been removed and analyzed separately. In a reply to a published comment on the Annals article raising this issue, the authors acknowledged the importance of analyzing treatment benefits by case definition. They then stated that the improvement in physical function following CBT was seen in Oxford studies, but not in Fukuda studies.6 However, this finding was not stated in the Annals article itself nor did the article report other differences in benefits and harms by case definition. Given that Oxford is acknowledged to include patients with other diseases and given P2P’s call to retire Oxford, the failure to report Oxford findings separate from findings with other case definitions is a serious flaw of this evidence review. The study limitation statements do not compensate for this flaw.

This has real world consequences for patients. The evidence review’s general conclusions about treatment benefits are already being incorporated into clinical guidelines. For instance, referencing AHRQ’s evidence review along with the PACE trial, UpToDate recommends CBT and GET for patients diagnosed by the IOM criteria.7 But CBT and GET have been studied in Oxford cohorts, where they are used to reverse presumed deconditioning, fear of activity, and false beliefs of having an organic disease. Such treatments are obviously inappropriate for the disease that the IOM said is organic, not deconditioning, and characterized by a systemic intolerance to exertion.8 Mixing and matching patient populations in both the evidence review and in clinical guidelines is of questionable medical ethics and creates a significant risk of harm for patients.

We strongly urge AHRQ to work with the evidence review authors to ensure that the PACE trial and its impact on the evidence review’s treatment recommendations is reassessed. Further, it is critical that the authors explicitly report findings for Oxford studies separately from findings in studies using other case definitions. Finally, to ensure that findings in one group of patients are not being harmfully applied to another group of patients, it is essential that the authors explicitly state that treatment conclusions based only on Oxford studies should not be applied to patients meeting other case definitions, particularly those that require post-exertional malaise.

This matter is of the utmost importance to patients. We hope you will give it the full attention that it deserves. Contact Mary Dimmock if you need additional clarification or background.

Signed

Massachusetts CFIDS/ME & FM Association
The Myalgic Encephalomyelitis Action Network (#MEAction)
MEadvocacy.org
New Jersey ME/CFS Association, Inc.
Open Medicine Foundation (OMF)
Phoenix Rising
Solve ME/CFS Initiative
Pandora Org
Wisconsin ME and CFS Association, Inc.
Mary Dimmock
Claudia Goodell
Denise Lopez-Majano (Speak Up About ME )
Matina Nicolson
Donna Pearson
Jennifer Spotila JD (OccupyCFS)
Meghan Shannon
Erica Verrillo (Onward Through the Fog)

1 Patient organizations’ letter to AHRQ and CDC on PACE and Oxford definitions. November 15, 2015. https://dl.dropboxusercontent.com/u/89158245/CDC-AHRQ%20Request%20PACE%20Nov%202015.pdf

AHRQ response to November 15, 2015 letter. December 24, 2015. https://dl.dropboxusercontent.com/u/89158245/AHRQ%20response%20to%20PACE%20request%20-%20Dec%2024%202015.pdf

David Tuller. “TRIAL BY ERROR: The Troubling Case of the PACE Chronic Fatigue Syndrome Study.” Virology Blog. October 21-23, 2015.

First installment: http://www.virology.ws/2015/10/21/trial-by-error-i/

Second installment: http://www.virology.ws/2015/10/22/trial-by-error-ii/

Third installment: http://www.virology.ws/2015/10/23/trial-by-error-iii/

2 Smith MB, Haney E, McDonagh M, Pappas M, Daeges M, Wasson N, et al. “Treatment of Myalgic

Encephalomyelitis/Chronic Fatigue Syndrome: A Systematic Review for a National Institutes of Health Pathways to Prevention Workshop.” Ann Intern Med. 2015; 162: 841-850. http://dx.doi.org/10.7326/M15-0114

The full report is posted on the AHRQ site at this location: http://effectivehealthcare.ahrq.gov/ehc/products/586/2004/chronic-fatigue-report-141209.pdf

3 Ibid.

• Appendix E: Quality Rating Criteria states that in a “good” study, for instance, “important outcomes are considered.” But as Tuller reported, outcomes were changed midtrial, criteria were changed, and some outcomes/analyses were not reported.

• Appendix F: Strength of Evidence Criteria defines reporting bias, which it states includes: ”Study publication bias, i.e., nonreporting of the full study; Selective outcome reporting bias, i.e., nonreporting (or incomplete reporting) of planned outcomes or reporting of unplanned outcomes; and Selective analysis reporting bias, i.e., reporting of one or more favorable analyses for a given outcome while not reporting other, less favorable analyses.”

• Appendix K: Strength of Evidence tables reported Reporting bias as “Undetected” in rows that included PACE, even when the only study covered in a particular outcome was PACE.

4 The authors state that they correctly included the Oxford criteria because the protocol specified it. However, the problems with inclusion of Oxford were raised immediately after the protocol was issued on May 1, 2014.

• Spotila, J. “Protocol for Disaster.” OccupyCFS. May 3, 2014. http://www.occupycfs.com/2014/05/02/protocolfor-disaster/

• M. Dimmock contacted Dr. Beth Collins Sharpe (of AHRQ and ex-officio to CFSAC at the time) by email on May 4, 2014 with this concern. On 6/4/2014, Collins-Sharpe responded that she didn’t “think that the different diagnoses will be lumped together for analysis.” She added, “You’re right that it would be comparing Oxford apples to CCC oranges.“ But then the authors lumped together all definitions in the analyses.

Additionally, this issue was raised directly with Dr. Collins

• Spotila J, Dimmock M. Letter submitted to Dr. Francis Collins, Director of NIH, regarding Pathways to Prevention Workshop on ME/CFS.” May 28, 2014.

https://dl.dropboxusercontent.com/u/89158245/Dr%20Collins%20P2P%20Letter%20Public%20052814%20w%20attachments.pdf

See attachment 2 (Page 20) discussed the Review Protocol and stated. “At least one case definition
[Oxford] requires no more than unexplained fatigue for a diagnosis of CFS, despite the mounting evidence that such case definitions capture a different study population than definitions that require post-exertional malaise, cognitive dysfunction or other multisystem impairments.“

5 UpToDate is one example where the conclusions of this evidence review have been interpreted as applying to all patients.

It is important to note that PACE trial publications have said that the PACE trial findings also apply to patients defined by the CDC CFS criteria and the London ME criteria. But this patient characterization was done after first selecting patients by Oxford. As Dr. Bruce Levin said in Dr. Tuller’s series on PACE, it is not correct to extrapolate from a subgroup selected from a group of Oxford patients to ME patients as a class. Further, the PACE recovery publication noted that CDC CFS criteria had been modified to require symptoms for just one week and that these modifications could result in inaccurate patient characterizations. The impact of PACE modifications to the ME criteria are unknown.

• White PD, Goldsmith K, Johnson AL, Chalder T, Sharpe M, PACE Trial Management Group. “Recovery from chronic fatigue syndrome after treatments given in the PACE trial.” Psychol Med. October 2013’ 43(10): 2226-2235. PMID: 23363640. http://dx.doi.org/10.1017/S0033291713000020

6 Smith MB, Haney E, McDonagh M, Pappas M, Daeges M, Wasson N, et al. “Treatment of Myalgic
Encephalomyelitis/Chronic Fatigue Syndrome: A Systematic Review for a National Institutes of Health Pathways to Prevention Workshop.” Ann Intern Med. 2015; 162: 841-850. http://dx.doi.org/10.7326/M15-0114

In the comments section, the authors stated, “Dr. Chu’s comment regarding the importance of analyzing data based on case definitions used for inclusion to trials is consistent with our approach. For example, in the trials of cognitive behavioral therapy (CBT) using the SF-36 physical function item as an outcome measure, the two studies using Oxford criteria indicated improvement, while the two using CDC criteria reported no improvement.”

7 UpToDate clinical guidelines, updated in July 2015, include:

o Gluckman, Stephen. “Clinical features and diagnosis of chronic fatigue syndrome (systemic exertion intolerance disease)” UpToDate. Deputy Editor Park, L. Last updated July 30, 2015. Literature review current through August 2015. http://www.uptodate.com/contents/clinical-features-and-diagnosis-of-chronic-fatiguesyndrome-systemic-exertion-intolerance-disease#H15

o Gluckman, Stephen. “Treatment of chronic fatigue syndrome (systemic exertion intolerance disease)” UpToDate. Deputy Editor Lee, P. Last updated July 30, 2015. Literature Review current through August 2015. http://www.uptodate.com/contents/treatment-of-chronic-fatigue-syndrome-systemic-exertion-intolerancedisease?source=see_link

8 Tucker, M. “IOM Gives Chronic Fatigue Syndrome a New Name and Definition” Medscape Multispecialty. February 10, 2015. http://www.medscape.com/viewarticle/839532

Dr. Clayton, IOM panel chair, noted, "The level of response is much more than would be seen with deconditioning," with reference to the belief voiced by some clinicians that physical abnormalities in these patients are merely a result of their lack of activity.

Tuesday, December 22, 2015

Announcing the Formation of a National ME/CFS Advocacy Initiative

Today, a group of patient advocates announced the formation of a national advocacy initiative. 

With the recent announcement that NIH funding is to be increased, this could not have come at a better time. 

The doors are open to anybody who wants to join.


__________________________

More than ever before, 2015 has been a year that has brought fresh hope to Myalgic Encephalomyelitis (ME) patients. The Institute of Medicine (IOM) and NIH Pathways to Prevention (P2P) reports confirmed the neglect and disbelief that have held the disease hostage for decades and strongly recommended action to improve patient care. Publications from Stanford, Columbia and Haukeland (Norway) Universities brought new insights into the biology. World-renowned scientists have joined the fight. Stories about severely ill patients like Ron Davis’s son have created more public awareness. And the Tuller series brought greater exposure to the concerns with the PACE trial and psychogenic theories.

For the first time, there’s a sense that we have huge opportunities to change the future for ME patients. And just as importantly, there’s a sense that if we want to turn those opportunities into reality, then we need to find new ways to work together across the community to increase the impact of our voices.

To that end, a number of organizations, bloggers and independent advocates, listed below, have started having discussions to identify those areas where they can agree on goals and work together to achieve what is needed for patients.

Thus far, we have identified common goals to focus on, including the need to dramatically increase funding, to advance the research agenda, to resolve the definitional challenges, and to improve clinical care through quality medical education. We expect that this will lead to actions directed toward Congressional leaders, HHS and its agencies, and public awareness through the media.

To achieve these goals, we are going to need broad participation across the community. We will leverage the Groups feature on the MEAction.net platform to get input on these goals and to share proposals for joint actions. Because we are working as a loose collaboration, groups and individuals will be given the opportunity to opt in or opt out of specific actions.

Working in this way and at this scale is new for all of us and we will be learning as we go. We also know that we won’t all agree on every tactic or policy direction. But we believe there is power in numbers and coordination and are all committed to taking advantage of every opportunity that we can to regain our future.

Please join us and share your ideas and enthusiasm. If you are interested in participating and providing input, you can join in the discussion on MEAction Groups here: http://www.meaction.net/us-action-working-groups/

Signed

Patient Organizations

Connecticut CFIDS Association, Inc.
ImmuneDysfunction.org dba The Vermont CFIDS Association, Inc
Massachusetts CFIDS/ME & FM Association
The Myalgic Encephalomyelitis Action Network (#MEAction)
Open Medicine Foundation (OMF)
New Jersey ME/CFS Association, Inc.
Pandora Org
Phoenix Rising
Simmaron Research
Solve ME/CFS Initiative
Wisconsin ME and CFS Association, Inc.

Patient blogs

Health Rising (Cort Johnson)
OccupyCFS (Jennifer Spotila)
Onward Through the Fog (Erica Verrillo)
Race to Solve ME/CFS (Claudia Goodell)
Speak Up About ME (Denise Lopez-Majano)

Independent Advocates

Lily Chu. MD, MSHS
Mary Dimmock
Sonya Heller Irey
Robert and Courtney Miller
Donna Pearson
Staci R. Stevens, MA
Steve Krafchick, MPH, JD
Rich Carson

Saturday, February 2, 2013

CFS patient starts hunger strike for FDA approval of Ampligen

Bob Miller

Bob Miller on Hunger Strike: Send This 1-Minute Email to Get FDA Approval for Ampligen

February 1, 2013, Phoenix Rising
by Sasha

http://phoenixrising.me/archives/15415

Bob Miller has started a hunger strike to push for FDA approval of Ampligen. He and his wife, Courtney Alexander, who are well-known for drawing President Obama’s attention to the plight of people with ME/CFS, urge us not to do the same.

Instead, they’d like us to send the email below, alerting key decision-makers to his strike, to add pressure to approve Ampligen as a therapy for ME/CFS.

The FDA is expected to announced its decision sometime around  2nd February – this Saturday – so there’s no time to lose.

Wherever you are in the world, please use Bob’s template to email, and do it right now. It takes less than a minute: I’ve already sent mine.

Bob’s message

Yesterday January 29th, I began a hunger strike seeking FDA approval of Ampligen, the only medication in FDA-approved clinical trials for Chronic Fatigue Syndrome, (ME/CFS).

The FDA Advisory Committee voted Ampligen is safe given the serious nature of CFS and the critical unmet need of patients.

Please support access to Ampligen for ALL ME/CFS PATIENTS by sending a note like the one below to the Secretary of Health Kathleen Sebelius, Assistant Secretary of Health Dr Howard Koh, FDA Commissioner Dr Margaret Hamburg, and FDA CDER Director Dr Janet Woodcock and Deputy Director Dr Sandra Kweder.

You can just copy and paste the email below.

Please also email or call your Congressional Representatives and Senators (look them up here and just click on your state) and ask them to investigate why the FDA refuses to approve the ONLY medication for CFS despite safe testing for 20 years. This is a health crisis!

The email


Subject: CFS patient starts hunger strike for FDA approval of Ampligen

“Long-time ME/CFS patient Robert Miller from Reno, Nevada began a hunger strike in advance of the FDA’s Feb. 2nd deadline to decide on Ampligen, the ONLY medication in clinical trials for my illness. I support Mr. Miller because my life has been stolen by ME/CFS and I need real treatment options. We have waited 20 years, and we can’t wait any longer. The FDA Advisory Committee voted Ampligen is safe enough to market because CFS is so serious and there are NO medications to treat patients. Please don’t let the FDA reject the only medication CFS patients can hope for any time soon.”

Your Full Name Here:
Address Here:
Years ill:

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