Wikipedia:Articles for deletion/Idiopathic chronic fatigue

The following discussion is an archived debate of the proposed deletion of the article below. Please do not modify it. Subsequent comments should be made on the appropriate discussion page (such as the article's talk page or in a deletion review). No further edits should be made to this page.

The result was no consensus‎. Probably in no small part due to lengthy argumentation from the primary authors of the article discouraging participation by uninvolved editors. – Joe (talk) 12:24, 5 May 2023 (UTC)[reply]

Idiopathic chronic fatigue[edit]

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This is a WP:POVFORK of Chronic Fatigue Syndrome. CFS activists have tried for years to characterise CFS as myalgic encephalomyelitis, because they reject outright any suggestion of anything other than a purely physical cause. Medical consensus is that etiology is unknown. There is no ICD code distinguishing the two conditions. Guy (help! - typo?) 09:59, 11 April 2023 (UTC)[reply]

Note: This discussion has been included in the list of Medicine-related deletion discussions. Shellwood (talk) 11:10, 11 April 2023 (UTC)[reply]
Merge to "chronic fatigue". It's basically the same thing, not meeting enough "check boxes" to be officially diagnosed as the main disease state. There are no medical journals that differentiate the two; patients seem to want it to be it's own disease, but it isn't, as far as the medical community sees it. This can change of course, at present, it's still lumped together. ---- Oaktree b (talk) 12:21, 11 April 2023 (UTC)[reply]

*Delete The fake ICD and WHO references to resources that never use the term speak volumes. If there is anything worth wile it can be added to Chronic Fatigue Syndrome — Preceding unsigned comment added by Random person no 362478479 (talk • contribs) 10:25, 15 April 2023 (UTC)[reply]

Please mark up/highlight these references.- Amousey (they/them pronouns) (talk) 01:22, 18 April 2023 (UTC)[reply]

@Amousey Sorry for the late response, I did not get a notification. I'm referring to the fact that the ICD and WHO references talk about "fatigue", not "idiopathic chronic fatigue". -- Random person no 362478479 (talk) 19:34, 21 April 2023 (UTC)[reply]

See below for my changed vote. -- Random person no 362478479 (talk) 08:07, 27 April 2023 (UTC)[reply]

Oppose - See Idiopathic chronic fatigue#Differential diagnosis from chronic fatigue syndrome - New section added to clarify]. Requester's info on ICD being the same codesis not correct when I checked the footer templates. ICD-11 ICF is MG22 (Signs and symptoms category) but CFS/ME/Postviral Fatigue Syndrome all share 8E49 in Neurological - 8E49 which states ICF is excluded, ICD-10 codes were in the R category for ICF and G for CFS, ICD-9 codes also in different categories. CDC Fukuda 1994 defines ICF and CFS separately with different criteria stating ICF is diagnosed only when CFS criteria are not met. There's nothing on the talk page about concerns. No reverts have been placed for POV, and multiple different editors have been working on this over several years so I can't see why this is an AfD. Multiple sources in new section include exercise testimg differences See :Talk:Idiopathic_chronic_fatigue, source from Nature, Cochrane trial, and others state different prevalence, different criteria, TNF-alpha differences, and different diagnostic codes. Diagram on CDC Fukuda1994 (pdf) might be useful, co-authors imclude Simon Wessely and Michael Sharpe. Keep separate due to the different ICD codes, and different diagnostic criteria, very different prevalence, different age at onset, very different recovery rates and the number of editors separately editing.. - Amousey (they/them pronouns) (talk) 01:22, 18 April 2023 (UTC)[reply]

Relisted to generate a more thorough discussion and clearer consensus.
Please add new comments below this notice. Thanks, Courcelles (talk) 13:44, 18 April 2023 (UTC)[reply]

Comment The ICD references do clearly indicate that certain other fatigues, including CFS, are classified elsewhere; but that's not the claim they are being used to support within the article—with neither of the linked conditions actually stating idiopathic chronic fatigue at those codes. CFS has a specific index trail: syndrome, fatigue, chronic and the tabular entry explicitly states chronic fatigue syndrome at G93.3 (in the case of ICD-10). ICF, on the other hand, does not. Nor are there essential modifiers at the fatigue index term for chronic or idiopathic. However, I don't see how any argument relying on the ICD alone to keep ICF separate from CFS, wouldn't be accidentally arguing for the target of a merge/redirect to be Fatigue instead. Little pob (talk) 13:48, 18 April 2023 (UTC)[reply]

Merge to article Fatigue. The present Idiopathic chronic fatigue article cites adequate sources that state "chronic fatigue" and "Idiopathic chronic fatigue" are differential diagnosises from Chronic fatigue syndrome. Therefore the proper place to merge the material would be in a subcategory to the article on "fatigue". Ward20 (talk) 22:10, 18 April 2023 (UTC)[reply]

Oppose - See Amousey‘s comment above. As he notes, the Idiopathic chronic fatigue#Differential diagnosis from chronic fatigue syndrome section addresses differential diagnosis from CFS which was laid out in CDC’s 1994 Fukuda CFS and ICF case definitions. The suggestion to merge with CFS is a non-starter. Merging with fatigue#chronic, a two sentence subsection of Fatigue doesn’t make sense because ICF (1) is too big a topic and will bloat the fatigue article if this separate article isn’t maintained. And (2) it’s very important to maintain clarity about distinctions between the various terms as they are so easily confused as is shown in the OP and others’ conflation of CFS and ICF. ICF is an extremely common syndrome/cluster of syndromes and Total illness burden is immense. It’s extremely important as an entity in order to timely diagnose those who fit in the category of ICF AND also extremely important to be aware of for differential diagnosis of ME/CFS and the very many other serious illnesses which include prominent fatigue as a symptom. If this page were removed, the understanding of those learning about ME/CFS would be impacted and would almost certainly very negatively impact the large numbers of people who have ICF and don’t see it and thus will probably continue to be unaware of its existence. The article could use some work and I have edited it a bit recently and plan to edit a bit more. Some more WP:MEDRS cites would help. Another editor Amousey has recently been making a lot of edits to the page.JustinReilly (talk) 25 April 2023 (UTC)
Still opposed Further info: User:Ward20 suggested a merge with another page. I added neurasthenia differences which may have been what the OP was thinking of (neurasthenia vs CFS coding being a previous controversy but not on the Controversies about chronic fatigue syndrome page. I added clarification that ICF is physical (neurasthenia was classified as psychological but was deprecated). To ICD classification raised by [[User:User:Random person no 362478479 I added a section that this does not have a unique code on its own but is under general signs and symptoms- see quotes in added citations for coding it. I definitely had the wrong ICD-9 code so will remove but there are other classifications to add plus images. The use of profound in the lede implies always/normally rather possibility/occasionally profound - this may be incorrect since severe ICF wasn't found in anyone in the studies I added. Any refs appreciated. - Amousey (they/them pronouns) (talk) 23:34, 25 April 2023 (UTC)[reply]
But you can't get round the fact that this is a term coined by militant "ME, never CFS" activists, promulgated by them in an attempt to erect a distinction that the medical community does not make, and not appearing in medical texts. When you google the term, the first hit is Wikipedia, followed by the ME Association and MEPedia, both "ME, never CFS" activist websites.

This is a WP:POVFORK, written entirely by you and Justito, both long-term proponents of the "ME-never-CFS" agenda on Wikipedia.

In fact, Google lists only 103 unique hits for this subject in the decade or so since it first appears, mostly from activists, quacks or in predatory journals.

It is not Wikipedia's job to blaze the trail in changing public perceptions of medical subjects, however outraged you might be by the slowness of the medical profession to reflect your viewpoint. Guy (help! - typo?) 12:50, 29 April 2023 (UTC)[reply]
This is definitely not a POV-fork and the term ICF was not coined by activists, AFAIK. The POV is neutral and consistent with that of relevant articles such as that on CFS. As we’ve noted CDC’s ICF case definition was drafted and published by its Fukuda committee which in the same paper debuted CDC’s Fukuda CFS definition, by far the most used CFS definition until CDC released its latest definition, IIRC, in 2017. Keiji Fukuda was hardly a fringe activist, later serving as WHO’s “flu chief” and assistant director-general.

Yes, @Amousey wrote this article 3 years ago and I am the only other person who’s added substantially to it, beginning recently. I don’t know anything about Amousey, so can’t speak for him, but I am not a “long-term proponent of the ‘ME-never-CFS’ agenda on Wikipedia.” Off of Wikipedia, I am a proponent of using the term ‘ME’ and not using the term ‘CFS,’ as are the vast majority of patients. On Wikipedia I don’t think I’ve ever taken this position. If I have it would have only been many years ago when starting and not knowing the Wikipedia guidelines well. On these two threads on the name change I have strongly supported a change to “ME/CFS.” I do not support a change to any term that does not include “CFS,” since that is not currently nor has it ever (except prior to around 1986) been supported by the sources indicated in the relevant Wikipedia guidelines; so, on Wikipedia my position is hardly “ME-never-CFS.”

The ME Association is a pretty conservative, mainstream organization which has historically been unpopular with many patients for not being activist enough. It’s a British organization and in Britain the term “ME” is in much more common usage than in the US as historically “ME” has been the term most used there, including among non-patient laypeople and the media.

The article is not a POV fork. CFS is a particular syndrome characterized by a particular constellation of signs and symptoms. There is consensus that it is an organic, not a psychiatric illness as National Academy of Medicine strongly emphasized in the 2015 report.

On the other hand ICF is chronic fatigue of unknown cause- it’s etiology is unknown and it is not caused by any disease or syndrome including CFS. Almost all syndromes (and even some diseases) do not have known etiology (ie root cause). For example, we do not know the etiology of MS or ALS. Fatigue is a symptom of both diseases and is prominent in MS. This does not mean that MS and ALS are synonymous with ICF; quite the contrary. Thus, contrary to what @JzG claims, it does NOT matter that the etiology of CFS is unknown or whether the etiology is psychological or physical. The existence and recognition of ICF implies NOTHING about the etiology of CFS including whether it is physical or psychological and nothing in the ICF article does either. It simply says there are some cases of chronic fatigue that neither the etiology is known nor are caused by any recognized disease or syndrome, including CFS and the thousands of other syndromes and diseases which feature chronic fatigue, some with unknown etiology (root causes). Thus, @JzG’s central reason for deletion is entirely without merit.

I do not know how widely the term is used in medicine or by whom the term was coined or if it was ever championed by patient activists- not to my knowledge and I was pretty highly aware of what’s going on in the patient community for quite a while- probably a total of about 15 years.

I am certainly open to hearing arguments about it not being in wide enough usage. I will look into what you are saying about that, but I will not be able to do that until around May 20th. I’d ask that the discussion be left open until the end of the month so I can get a chance to check this out and respond (though even now, without being able to look into it, I still Oppose deletion). JustinReilly (talk) 06:44, 2 May 2023 (UTC)[reply]
@JzG And holding that ME should be used to the exclusion of CFS is not the mark of an activist patient; as noted earlier, it’s by far the most mainstream position among patients.

A survey by The MEAction Network in 2016 found that the majority of patients prefer the name myalgic encephalomyelitis (69% said “ME” was an acceptable name) to other names including ME/CFS (28% said acceptable) and chronic fatigue syndrome (only 6% found acceptable).

See p. 27:

https://www.nih.gov/sites/default/files/research-training/initiatives/mecfs/rfi-patient-organizations.pdf

Most ME NGOs use “ME” only in their names (66 (53%) of 125 total ME orgs worldwide by my count) including almost all of the major ME orgs. Some ME orgs use ME/CFS (38 (30%)) and a few use CFS (10 (8%): most are relatively small Italian or Spanish orgs). A few more use CFS/ME (5 (4%)), CFIDS (3 (2%)) or Neuro-Immune Disease (3 (2%)). None use SEID or CF. JustinReilly (talk) 09:35, 2 May 2023 (UTC)[reply]

In light of @Ward20’s excellent comment of May 2, below, I take back my request for more time to review @JzG’s claims re origin of the term and prevalence of use in the medical literature. @Ward20’s Google Scholar search showing 1,140 results shows that “ICF” is clearly in wide enough usage in medicine to merit an article. JustinReilly (talk) 10:50, 2 May 2023 (UTC)[reply]

Relisted to generate a more thorough discussion and clearer consensus.
Please add new comments below this notice. Thanks, Guerillero ^{Parlez Moi} 19:14, 26 April 2023 (UTC)[reply]

Don't care anymoreMerge into Fatigue The article has been improved, questionable information has been amended and further references added. Based on this I no longer vote "delete". I think merging the important information into Fatigue would be appropriate. -- Random person no 362478479 (talk) 08:13, 27 April 2023 (UTC) -- Random person no 362478479 (talk) 13:51, 3 May 2023 (UTC)[reply]
Reply to Guy: That doesn't seem to correlate when I look at WP:MEDRS sources on Google, Google Scholar and PubMed.

The earliest source I found using "Idiopathic chronic fatigue" was published in January 1988,[1] by Ed Byrne (neuroscientist). He used?, coined?, "Idiopathic chronic fatigue" apparently before "Chronic Fatigue Syndrome" was defined or named in March 1988.[2] He wasn't a "militant "ME, never CFS" activist" by any means.

After the three most popular hits for "Idiopathic chronic fatigue"[3] from Google, there is a long list of about 95 sources for "Idiopathic chronic fatigue", mostly medical journal articles. But that search is for the most relevant results. Repeating the search with the "omitted results included" link at the bottom of the page displays many more. Many articles are dups, but I don't know how to separate them. A Google Scholar search shows About 1,140 results.[4]

It seems a bit unfair to call the ME Association a "ME, never CFS" activist website" when it was founded in 1976[5] when the nomenclature for the illness was ME.

Seaching for "Idiopathic chronic fatigue" in PubMed gives about 60 journal results (I don't know why this differs from Google Scholar),[6] and browsing review sources, a good comparison is: "Fatigue is a commonly experienced symptom, but not all patients with fatigue can be diagnosed as having CFS[fig 1]. A proportion of patients with fatigue have chronic fatigue. A sub-proportion of these patients have idiopathic chronic fatigue, i.e. when there are no psychiatric or medical disorders to explain the chronic fatigue.[7] CFS comprises an even smaller part of these patients in whom fatigue is associated with other symptoms characteristic of the disorder."[7]

A 1997 article, authored by Simon Wessely, states very much the same: We have employed three definitions of chronic fatigue as follows: (1) Chronic fatigue(CF) was defined as all cases of fatigue exceeding the predetermined cut-off with a duration of 6 months or more. It thus included all cases of idiopathic chronic fatigue and CFS. (2) Idiopathic chronic fatigue(ICF) was defined as chronic fatigue failing to meet the criteria for CFS. (3) Chronic fatigue syndrome(CFS) was defined according to the operational criteria."[8]

From the literature review, it is my understanding that fatigue, chronic fatigue, idiopathic chronic fatigue and Chronic fatigue syndrome are all defined differently, and "ME activists" were and are not involved in how these definitions are used in the medical literature. Many of these studies go back to early reseach and may not use the present ME/CFS nomenclature used by CDC, NHS and other medical sources. Ward20 (talk) 09:15, 2 May 2023 (UTC)[reply]

It's used occasionally in the literature, yes, as I noted above. But rarely, as per the tiny number of unique hits. It is a term that the ME-Never-CFS community are trying to push. They may succeed, they haven't yet, and it's very much not our job to help them. Guy (help! - typo?) 11:00, 2 May 2023 (UTC)[reply]

Don't care anymore Comment I don't know what this ME/CFS debate is about, but I don't see the relevance to this article. The problem with the article is that ICF is neither an illness, nor a syndrome. It's just an isolated symptom that lasts over six months. There is no need to list dozens of conditions that have to be excluded for ICF. All known conditions have to be excluded. That's the definition of "idiopathic". Seriously anyone who understands the words "idiopathic", "chronic", and "fatigue" knows practically everything that is to know. Add some information about epidemiology and that it is sometimes treated with counselling or antidepressants. Voila, that's it. All the relevant information can be merged into the Fatigue article. There is no justification for a stand-alone article. If you take out the unnecessary information it boils down to this:

Idiopathic chronic fatigue (ICF) is fatigue with no known cause that lasts at least six consecutive months and is not accompanied by connected symptoms. There is no approved drug therefore treatment options are typically limited to counseling or antidepressant medication. Between 30% and 50% of patients recover within one year. ICF affects between 2.4% and 6.4% of patients, with females more likely to be affected than men. Onset is typically over 50 years of age.

~~That's not an article, that's barely a stub. Therefore delete the article add relevant information to Fatigue. -- Random person no 362478479 (talk) 09:32, 3 May 2023 (UTC)~~ -- Random person no 362478479 (talk) 13:51, 3 May 2023 (UTC)[reply]

Comments: I don't see any consensus, either from a medical perspective or the Wikipedia community. Bearian (talk) 16:34, 4 May 2023 (UTC)[reply]

The above discussion is preserved as an archive of the debate. Please do not modify it. Subsequent comments should be made on the appropriate discussion page (such as the article's talk page or in a deletion review). No further edits should be made to this page.