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February 9, 2000

Chronic Fatigue: Syndrome or Disease?

Author Affiliations

Phil B.FontanarosaMD, Deputy EditorIndividualAuthorStephen J.LurieMD, PhD, Fishbein FellowIndividualAuthor

JAMA. 2000;283(6):744-745. doi:10.1001/jama.283.6.741

To the Editor: The book review by Dr Ehrlich1 portrays individuals with chronic fatigue syndrome (CFS) as victims of sensationalist media propaganda and medical charlatanism. We find such a portrayal very disturbing, since individuals who have CFS are actually victims of a medical establishment that has failed them.

Ehrlich argues that illnesses such as CFS are lacking in scientific validity. However, the process of scientific validation has been greatly hampered by the diagnostic criteria developed by the Centers for Disease Control and Prevention in 1994.2 This case definition relies on self-reported subjective symptoms that cannot be confirmed or measured and, for the most part, are the same symptoms commonly used to diagnose various primary psychiatric disorders. The 1994 case definition does not adequately discriminate between cases and noncases, and instead increases the probability that patients who have primary psychiatric disorders will be diagnosed as having CFS.

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