Dear Professor Garner,

It is indeed joyous news that you are on the mend. I wish you and all longhaulers well.

There are two very important caveats to be made to avoid harm to others, all factors detailed within the recent draft NICE ME/CFS guideline and/or reviewed by the committee. This includes sufficient evidence of harm to result in withdrawal of both exercise therapy and cognitive approaches to "encouraging" activity. Similar warnings have been put in place for post-covid patients by NICE.

The literature does suggest that early and sustained rest, when initial post viral fatigue strikes, results in higher probability of remission. It does sound as if you benefited from this good advice, which is as good as it gets in terms of evidence based counsel. Conversely, empirical probabilities of remission do collapse as time goes on. It is critical to

Obsolete - now hosted and updated at the Doctors with M.E. Medico-legal/Compliance site

Executive summary

Post-viral disease is an undermined field of risk assessment, pricing, budgeting, compliance management, reputation management and liability generation. Elevated probability of unlawful clinical judgement and/or administrative decision-making in this field pervades clinical and therapeutic services and related contracting parties. Risks from the following factors are routinely misjudged and exacerbated by normalised procurement of fallacious services or testimony:

  • Clinical judgement, administrative decision-making, policy formulation or policy implementation that fail to meet the requirements of the law are not lawful by definition and carry risk
  • Claims that do not meet the thresholds of scientific probity, rigour and/or process cannot be described as science and are thus legally unsustainable and carry risk (regardless even of partial or total contradiction by bodies of work that are sufficiently substantive)
  • Claims that are legally unsustainable do not change their risk-profile when obfuscated by office-holders or purported eminence, which instead introduce additional risks
  • Clinical judgement or administrative decision-making that depends on such claims cannot therefore sustain claims of lawlulness and carry risk
  • Claims of the habitual nature of consequent failings do not form a legally sustainable defence and are counterproductive
  • Education or organisational policies that encourage otherwise and carry risk, by directly cultivating unlawful behaviour, versus statutory provisions, duties of care, policy and regulation

Medico-legal issues, requirements and enforcement factors are discussed. Legal obligations on service providers versus current risk generation are then outlined, along with their impacts on liability, malpractice-risk and indemnification. Risk-mitigation measures are offered throughout and are followed by compliant education resources.

This document is a live pre-released draft that is specifically not structured for scientific audiences and will receive ongoing updates. Communication of factual or typographical errata or other suggestions is welcome.

This is a Doctors with M.E. announcement of developments within Modality of public health importance and not a joint release with Modality

England's largest GP super partnership, the Modality Partnership, with nearly half a million patients, has placed itself at the forefront of post-viral disease management in UK primary care following discussions with the Doctors with M.E. Governance Board. A leading example of best practice amongst GP surgeries and family medicine. As of January 2021, Modality's medical directors group have agreed that their organisation will be informed that patients with myalgic encephalomyelitis will be consistently offered the seasonal influenza vaccination under the NHS GMS contract. This is due to its longstanding status as a neurological condition, which will be consistently reflected across the organisation.

Modality's medical directors group have also been provided with current and evidence based educational resources for clinicians to meet the empirically quantified need for compliant educational resources in the field (linked resources follow this press release). These support the need for improvements in care and rigour for the profession, as outlined in recent NICE documentation and in preparation for the upcoming renewal of NICE guidelines.