Gap lies between patient and doctor

Press, 14 April 1984, Page 19

Gap lies between patient and doctor

H The way in which sufferers from the mystery disease M.E. are seeking help outside the medical profession calls into question the way in which doctors are being trained, according to the professor of general practice at Otago Medical School, Dr Cambell Murdoch.

He had just received a letter from a Christchurch woman who wrote to him after' reading his reported comments on the disease in “The Press”. She contracted the disease in 1980 and improved by about 1982, but had to go for help to homeopaths and herbalists. The sufferer made the point that “it helps to talk with others who have felt the same, if only to prove to yourself you are not turning into a psychological case; and when conventional methods fgil, anything within reason is worth a try." These people, says Professor Murdoch, are disqualified from being accredited as ill. The effects of illness are not related only specifically to diagnosis, but also to discomfort, isolation, and disability. Diagnosis should be effective not just in physical terms, but in

psychological and social terms. “We should be just as concerned about how the patient feels about her illness, as about what the rest of the profession or the medical school feels about it.”

Dr Murdoch says with M.E. a major problem is guilt because people feel they really ought not to Se suffering in the way they are. “Colleagues are coming to me surreptitiously saying they have had something like M.E. for six months and are trying to fight it. “These are general practitioners. If they are in such a bind, what about the poor patients?” he asks. In four studies in Scotland, symptoms noted in M.E. were associated with the Coxackie group of viruses, which seem to affect the immune system over a long period. The condition differs from typical virus infection in that it is a long illness. “I would be reluctant to label anyone as having M.E. until these Stems had been experienced six months,” says Professor Murdoch.

He accepts a real danger of the

balance being tipped too far the other way. “The disease must not become a slip-shod excuse for every chronic relapsing and undiagnosed disorder that is around.” In a research project, the profes-

sor and his team have deep frozen blood samples from M.E. sufferers. When a virus invades the body, antibodies are produced which bind the virus into what is called an immune complex. These circulate and probably account for most of the symptoms of the disorder. Researchers have a technique for measuring the presence of the immune complexes. Probably some time this year, there will be techniques evolved which not only perform this function, but also determine which virus the immune complex is responsible for. The research team plans to compare sufferers with a control a being built up from hospital donors.

“We hope to apply new techniques to see if there is any difference between the sufferers and the controls as to the presence of these immune complexes,” says Professor Murdoch. “If there is a difference, this would prove a very important step forward.” He acknowledges that his survey is based on 70 people who consider they have the disease, but who

have not all been diagnosed as M.E. sufferers. But he considers the number who do not have the disease included in the survey is small. What does Professor Murdoch think happens when this mysterious disease attacks? When a virus invades, immune complexes are set up and there is a kind of “raging inferno.” The virus invades the cells in that part of the body it is most likely to go for. The Coxackie virus invades the central nervous system and the musculo-skeletal system. Extremely small particles get into the substance of the cell. With the immune complexes, there is a disordered function in each system affected. For example, in the central nervous system, you concentrate less, and tend to get depressed. Antibiotics are no use against viruses, but are used to combat secondary infection involving bacteria. M.E. raises new questions. Previously viruses were thought to come and go, leaving a person on his back for only a few days, but

symptoms now being experienced show this is not necessarily so. It is now being asked whether virus infections are so trivial. Professor Murdoch asks: “Are we changing, or are the viruses changing as to their effect on human beings?” If the Coxackie group of viruses initially cause M.E. then perhaps a live vaccine could be developed and given to large populations. Another approach would be some kind of antidote injected into the blood.

“We don’t really know why people get the symptoms they suffer,” the professor adds. “A colleague from Owaka thinks his patients are suffering from postinfluenza depression, and he finds they improve with anti-depres-sants.

“Maybe we are describing the same thing here, just coming at it from a different angle. Hopefully this will lead to systematic relief.”

Professor Murdoch considers it quite possible the disease is New Zealand wide, “but we simply don’t know.”