Chronic Fatigue Syndrome Advisory Committee Recommendations 2011 to 2004 

(Keep Scrolling Down for public documents of CFSAC Meetings from November 2011 thru September 2004)

CFSAC Recommendations – November 8-9, 2011 

The specific recommendations articulated by the Committee are:

1.  This recommendation addresses the process by which CFSAC transmits recommendations to the Secretary and the Secretary communicates back to CFSAC whether or not a recommendation was acted upon. CFSAC recommends that this process be transparent and clearly articulated to include regular feedback on the status of the committee’s recommendations. This communication could originate directly from the Office of the Secretary or be transmitted via the relevant agency or agencies.

2.  CFSAC recommends to the Secretary that the NIH or other appropriate agency issue a Request for Applications (RFA) for clinical trials research on chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME).

3.  CFSAC would like to encourage and support the creation of the DHHS Interagency Working Group on Chronic Fatigue Syndrome and ask this group to work together to pool resources that would put into place the “Centers of Excellence” concept that has been recommended repeatedly by this advisory committee. Specifically, CFSAC encourages utilizing HHS agency programs and demonstration projects, available through the various agencies, to develop and coordinate an effort supporting innovative platforms that facilitate evaluation and treatment, research, and public and provider education. These could take the form of appropriately staffed physical locations, or be virtual networks comprising groups of qualified individuals who interact through a variety of electronic media. Outreach and availability to underserved populations, including people who do not have access to expert care, should be a priority in this effort.

4.  This multi‐part recommendation pertains to classification of CFS in ICD classification systems:

a) CFSAC considers CFS to be a multi‐system disease and rejects any proposal to classify CFS as a psychiatric condition in the U.S. disease classification systems.

b) CFSAC rejects the current classification of CFS in Chapter 18 of ICD‐9‐CM under R53.82, chronic fatigue unspecified, chronic fatigue syndrome, not otherwise specified.

c) CFSAC continues to recommend that CFS should be classified in ICD‐10‐CM in Chapter 6 under Diseases of the Nervous System at G93.3 in line with ICD‐10, the World Health Organization, and ICD‐10‐CA, the Canadian Clinical Modification and in accordance with CFSAC’s recommendations of August 2005 and May 2011. CFSAC rejects CDC’s National Center for Health Statistics Option 2 and recommends that CFS remain in the same code and the same subcode as myalgic encephalomyelitis because CFS includes both viral and non‐viral triggers.

d) CFSAC recommends that an “excludes one” be added to G93.3 for chronic fatigue, R53.82, and neurasthenia, F48.8. CFSAC recommends that these changes be made in ICD‐10‐CM prior to its rollout in 2013.

This final recommendation was also provided to the National Center for Statistics at the CDC prior to the November 18, 2011 deadline for comments along with the following rationale:

We feel that the interests of patients, the scientific and medical communities, continuity and logic are best served by keeping CFS, (B)ME (Benign Myalgic Encephalomyelitis) and PVFS (Post Viral Fatigue Syndrome) in the same broad grouping category. Current scientific evidence would indicate there are more similarities between the three entities than there are differences. Whether they are synonyms for the same underlying concept, disease entities and sub‐entities, or merely the best coding guess is unclear. In reality, any or all of the above may be correct. While the relationship between CFS, B(ME) and PVFS is not stated, that they are grouped together in ICD 10 (WHO) would indicate some rationale for a connection. Our understanding is that this association will be maintained in the ICD 11, which may also include further description of the relationship. Exclusions specific to chronic fatigue (a symptom present in many illnesses) and neurasthenia (not a current diagnosis) also seem to be under consideration for ICD 11.

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CFSAC Recommendations – May 10-11, 2011

The specific recommendations articulated by the Committee are:

  1. CFSAC rejects current proposals to code CFS in Chapter 18 of ICD-10-CM under R53.82: Chronic fatigue, unspecified > Chronic fatigue syndrome NOS. CFSAC continues to recommend that CFS should be classified in ICD-10-CM in Chapter 6 under “diseases of the nervous system” at G93.3, in line with ICD-10 and ICD-10-CA (the Canadian Clinical Modification), and in accordance with the Committee’s recommendations of August 2005. CFSAC considers CFS to be a multi-system disease and rejects any proposals to classify CFS as a psychiatric condition in US disease classification systems. (Note: no disease classification system under HHS’ control proposes to move or to include CFS in or among psychiatric conditions.)

  2. ME/CFS is an illness with enormous economic and human costs. The April 2011 NIH State of Knowledge Workshop indentified a number of gaps in what is known about the illness. To address these gaps warrants an interagency effort comprising, but not limited to, NIH, CDC, and AHRQ. Further, the focus should be on interdisciplinary discovery and translational research involving interacting networks of clinical and basic science researchers. Areas to be examined would include the following: identification of patient subsets for detailed phenotyping and targeted therapeutic interventions, biomarker discovery, systems biology approaches and disability assessment.

    To facilitate the above goal, CFSAC recommends that ME/CFS research receive funding commensurate with the magnitude of the problem and that the NIH (and/or other appropriate agencies) issue an RFA specifically for ME/CFS.

  3. CFSAC asks that HHS organize a workshop to engage experts in disability assessment, the outcome being a document useful to patients and adjudicators which could contribute to more efficient and fair disability process.

Read documents related to the May 10-11, 2011 meeting:

  • CFSAC Recommendations Since September 2004 Chart (updated July 2011) (pdf)
  • CFSAC May 2011 Recommendations (pdf)
  • Secretary’s Response to CFSAC Advisory Committee Chair for May 2011 Meeting (pdf)                            *********************************************************
  • CFSAC Recommendations - May 10, 2010

    1.                The Secretary should ask the blood community to defer indefinitely from donating any blood components, any person with a history of chronic fatigue syndrome.

    2.                The Secretary should recognize the special challenges of ensuring that CFS is part of any efforts to train or educate health care providers under health reform.

    3.                The Secretary should direct CMS, AHRQ, and HRSA to collaborate on developing a demonstration project focused on better value and more efficient and effective care for persons with CFS.  This can be a public-private effort, and monitoring outcomes and costs should be part of the overall evaluation.

    4.                The Secretary should ask the Designated Federal Officer to explore adding a web-based meeting to conduct CFSAC business.

    5.                CFSAC rejects proposals to classify CFS as a psychiatric condition in U.S. disease classification systems.  CFS is a multi-system disease and should be retained in its current classification structure, which is within the “Signs and Symptoms” chapter of the International Classification of Diseases 9-Clinical Modification (ICD 9-CM).*

    *DFO Note:  The ICD 10-CM is scheduled for implementation on October 1, 2013.  In that classification, two mutually exclusive codes exist for chronic fatigue:

    ·                     post-viral fatigue syndrome (in the nervous system chapter), and

    ·                     chronic fatigue syndrome, unspecified (in the signs and symptoms chapter).

    HHS has no plans at this time to change this classification in the ICD 10-CM.

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    CFSAC Recommendations - October 13-14, 2010

    The specific recommendations articulated by the Committee are:

    1.                Develop a national research and clinical network for ME/CFS (myalgic encephalomyelitis/CFS) using regional hubs to link multidisciplinary resources in expert patient care, disability assessment, educational initiatives, research and clinical trials.  The network would be a resource for experts for health care policy related to ME/CFS.

    2.                Engage the expertise of CFSAC as HHS moves forward to advance policy and agency responses to the health crisis that is ME/CFS.

    3.                Adopt the term “ME/CFS” across HHS programs.

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    Committee Recommendations

    October 28-29, 2008

    CFSAC voted upon and agreed for the following recommendations to be forwarded to the Assistant Secretary for Health and the Secretary:

    1. It is recommended that DHHS develop, or contract with a third party vendor to develop, a CFS Tool Kit for Patients and caregivers of patients (something similar to the CFS Tool Kit for Providers). This toolkit should contain information pertinent to diagnosis, treatment, and a detailed list of tools for CFS patients to help alleviate their symptoms. CFSAC recommends that this be done with diagrams of exercises that are beneficial, sleep health tips, and pain relieving tools that include physical therapy, medication, and other tools. The Patient Tool Kit should provide the patient and caregivers with resources to help patients manage their illness and find evidence-based treatment options.

    2. It is recommended that CDC’s external review process evaluate CDC’s use of third party contracts for provision of logistical support for research projects.

    3. It is recommended that DHHS solicit the Department of Education’s cooperation on issues relating to pediatric CFS.

    4. It is recommended that the Transition report to the new Administration and Secretary include the background of the CFSAC and CFS and a list of the recommendations that have been developed by this Committee over the past two chartered periods, with any action taken on each point.

    5. CFSAC endorses the planned State of the Knowledge Conference to be developed by the NIH.

    6. CFSAC recognizes that much can be done to ensure that every child with CFS has the best possible access to support and treatment and asks that the Secretary facilitate a taskforce or working group to establish an ongoing interagency and interdepartmental effort to coordinate school, family, financial, and health care support for children and young adults with CFS.

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      Committee Recommendations

      May 5-6, 2008

      CFSAC voted unanimously to send the following recommendations to the Assistant Secretary for Health to be forwarded to the Secretary:

      1. CFSAC recommends that the Secretary of Health and Human Services requests HHS operating divisions to produce a concept paper on CFS to be considered by the Office of the Surgeon General for development of a future Surgeon General’s workshop.

        NOTE: A preamble of this recommendation was written by the Committee. The preamble follows the recommendation.

      2. CFSAC recommends to the Secretary of Health and Human Services that the Centers for Disease Control and Prevention (CDC) consider the following specific individuals for its external peer review process of the CDC CFS research program: Drs. Lucinda Bateman, David Bell, Birgitta Evengard, Kenneth Friedman, Elke van Hoof, Anthony Komaroff, James Oleske, and Christopher Snell.

      3. CFSAC recommends to the Secretary of Health and Human Services that CDC’s external peer review process focus on the CFS program’s progress on provider education , the search for specific diagnostic biomarkers and the identification of CFS’ etiology; evaluate CDC’s use of expertise outside the agency; and, evaluate CDC’s establishment of research priorities.

      4. CFSAC recommends to the Secretary of Health and Human Services that the Administrator of HRSA communicate with each Area Health Education Center (AHEC) regarding the critical need for provider education of CFS. HRSA has the potential to disseminate information on CFS to a wide range of providers, communities and educational institutions. HRSA should inform these groups that persons with CFS represent an underserved population and that there is a dramatic need for healthcare practitioners who can provide medical services to CFS patients. HRSA should further inform these groups that the CDC offers a web based CME program on CFS atwww.cdc.gov/cfs; and encourage AHEC providers to participate in this CME program. Additionally, HRSA should alert AHECs of the availability of a CDC CFS provider toolkit.

      Preamble: Recommendation #1

      CFSAC Meeting, May 5-6, 2008

      Dear Secretary Leavitt:

      Chronic fatigue syndrome (CFS) is a debilitating and complex syndrome characterized by profound fatigue and other serious symptoms. Population-based studies estimate that CFS affects more than one million people in the United States. These studies indicate that CFS is one of the more debilitating medical illnesses affecting our population, that it affects individuals who are at the prime of their work career, and that fewer than 20% of CFS patients in this country have been diagnosed. This has led to a significant medically underserved population compared to many other chronic diseases. The economic direct and indirect costs are estimated to be from $19 to $24 billion a year. Another study estimated a 37% decline in household productivity and a 54% reduction in labor force productivity among people with CFS. CFS patients are thus subject to both economic and health care disparities.

      Over the past 20 years, basic and clinical researchers, through funding from the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC), have tried to better understand the causes(s) and pathophysiology of CFS. Despite such efforts, the cause(s) of CFS remains unknown. As a result, most patients with this illness are not able to find informed medical professionals to treat their serious illness.

      CFS represents a complex, difficult to treat condition that needs the attention of a Surgeon General’s workshop. In the late summer of 2007, members of the Chronic Fatigue Syndrome Advisory Committee (CFSAC) met with the Office of the Surgeon General (OSG) to ask the Acting Surgeon General to disseminate information about CFS to primary care providers and public health officials with the goal to link these individuals with resources on CFS diagnosis, clinical management and the status of research into the causes of CFS. At CFSAC’s most recent meeting in May 2008, we learned that the OSG is unable to disseminate this information at this time. We also learned that if a CFS concept paper from NIH and CDC was sent to the OSG, the Surgeon General might be willing to host a workshop on the topic. A workshop pulls together experts and science in order to review what is currently known. We further learned that such a Surgeon General’s workshop would result in a document summarizing the meeting and the vision put forth by the participants of the meeting. A workshop such as this can also serve to accelerate the search for additional science and therapeutic modalities that will help patients affected by CFS. The CFSAC would very much like to pursue this option.

      CFSAC members hope that you will be willing to work with the NIH and CDC to develop a CFS concept paper as the first step in the process of having the Surgeon General host this important workshop. Our committee members, consisting of clinicians and researchers who focus on this illness, are most willing to help HHS in any way in the drafting of this concept paper.

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      Committee Recommendations

      May 16-17, 2007

      CFSAC Recommendation #1

      The magnitude of CFS warrants a strong call to action to address the unmet needs of this underserved population. CFS affects at least one million Americans, 85% of whom have not been diagnosed. The degree of functional impairment experienced by CFS patients is equivalent to patients with end-stage renal failure, COPD, and late-state HIV/AIDS.

      The CFSAC has listened to public testimony at each of its meetings, and meeting after meeting patients and family members bring heart rending stories of limited access, physicians with no knowledge of diagnosis or treatment, and lives set aside waiting for effective treatment. These lives set on hold translate into an enormous economic impact, with families effected losing half of the household income, costs the U.S. economy $9.1 billion per year in lost productivity alone and up to $25 billion annually when medical costs are added to that estimate.

      The lack of diagnostic markers and effective treatments, or even treatment guidelines, represents a crisis for evaluation and management of this large population. These factors in combination mandate the creation of innovative measures to focus resources on identifying solutions to these critical problems.

      There have been basic science advances which should be leading to new treatment strategies, yet progress in translating these advances into effective treatments has been slow. This is in large part due to a complete lack of clinical care centers and research centers. Investigators are frustrated by a lack of access to representative patient populations, and patients are frustrated by a lack of accessible expert clinical treatment centers. Funding mechanisms to develop new centers for either clinical care or centers for research are shrinking, but the needs of this underserved very ill patient population are unmet and growing.

      Therefore, the CFSAC recommends that the Secretary use the resources and talent of the agencies that make up the HHS to find ways to meet these needs. One starting point is our request that the HHS establish 5 regional clinical care, research, and education centers, centers which will provide care to this critically underserved population, educate providers, outreach to the community, and provide effective basic science, translational and clinical research on CFS. The advisory committee understands that fiscal exigencies have to date prevented the formation of these previously recommended centers, but it is our hope the Secretary will use the full weight of his office to effectively fund this program through existing funding mechanisms that might be available or new programs.

      CFSAC Recommendation #2

      CFSAC recommends that the Secretary for HHS request the Surgeon General send a letter to state health departments, health professional education programs, national organizations for physicians, PAs, nurses, and other allied health professional groups informing them about the CDC and NIH CFS resources, including the CDC toolkit, CME course and other resources. Members of the CFSAC Education Subcommittee are willing to assist in the preparation of a ‘briefing’ for the Surgeon General about this matter.

      Miscellaneous:

      1. Committee requests the Chair and Executive Secretary to use the below language in drafting a letter to third party providers. “The Department of Health and Human Services Chronic Fatigue Syndrome (CFS) Advisory Committee is evaluating the medical care and rehabilitation of persons with CFS. We are seeking information from 3rd party providers as to classification and coverage for CFS. We are asking representatives of major medical insurance providers to present to the Committee how companies process claims for CFS. Specifically we would appreciate information as to standards for diagnosis of CFS and documentation of associated disability; what treatments are covered and to what extent; and, how rehabilitation and disability are assessed and covered. We would like to invite a representative of your company to provide the Committee a presentation as to how your company addresses these issues. ———-“

      2. Committee also requests a report from each relevant HHS agency on existing resources and programs for provider education that might be useful in disseminating information to providers on CFS diagnosis and management.

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      Committee Recommendations

      November 28-29, 2007

      CFSAC voted unanimously to send the following recommendations to the Assistant Secretary for Health for transmittal to the Secretary:

      • It is recommended that a representative of AHRQ be added as an ex officio member to CFSAC effective immediately, but at least in advance of the next CFSAC meeting. The next CFSAC meeting is scheduled to be held in May 2008.

      • It is recommended that the CDC effort on CFS be restructured to reflect a broader expertise on the multifaceted capabilities required to execute a comprehensive program that incorporates the following elements:

        • an extramural effort directed by the Office of the Director;

        • sufficient funds for a program for which the authority and accountability is housed at the level of a coordinating center director;

        • a lab-based component that maintains the current search for biomarkers and pathophysiology;

        • the recommendations of the external CDC Blue Ribbon panel, including developing, analyzing, and evaluating new interventions and continuing support for longitudinal studies; and

        • an expanded patient, healthcare provider, and family caregiver education effort that is managed by staff with appropriate expertise in clinical and public education strategies.

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          Committee Recommendations

          May 16-17, 2007

          CFSAC Recommendation #1

          The magnitude of CFS warrants a strong call to action to address the unmet needs of this underserved population. CFS affects at least one million Americans, 85% of whom have not been diagnosed. The degree of functional impairment experienced by CFS patients is equivalent to patients with end-stage renal failure, COPD, and late-state HIV/AIDS.

          The CFSAC has listened to public testimony at each of its meetings, and meeting after meeting patients and family members bring heart rending stories of limited access, physicians with no knowledge of diagnosis or treatment, and lives set aside waiting for effective treatment. These lives set on hold translate into an enormous economic impact, with families effected losing half of the household income, costs the U.S. economy $9.1 billion per year in lost productivity alone and up to $25 billion annually when medical costs are added to that estimate.

          The lack of diagnostic markers and effective treatments, or even treatment guidelines, represents a crisis for evaluation and management of this large population. These factors in combination mandate the creation of innovative measures to focus resources on identifying solutions to these critical problems.

          There have been basic science advances which should be leading to new treatment strategies, yet progress in translating these advances into effective treatments has been slow. This is in large part due to a complete lack of clinical care centers and research centers. Investigators are frustrated by a lack of access to representative patient populations, and patients are frustrated by a lack of accessible expert clinical treatment centers. Funding mechanisms to develop new centers for either clinical care or centers for research are shrinking, but the needs of this underserved very ill patient population are unmet and growing.

          Therefore, the CFSAC recommends that the Secretary use the resources and talent of the agencies that make up the HHS to find ways to meet these needs. One starting point is our request that the HHS establish 5 regional clinical care, research, and education centers, centers which will provide care to this critically underserved population, educate providers, outreach to the community, and provide effective basic science, translational and clinical research on CFS. The advisory committee understands that fiscal exigencies have to date prevented the formation of these previously recommended centers, but it is our hope the Secretary will use the full weight of his office to effectively fund this program through existing funding mechanisms that might be available or new programs.

          CFSAC Recommendation #2

          CFSAC recommends that the Secretary for HHS request the Surgeon General send a letter to state health departments, health professional education programs, national organizations for physicians, PAs, nurses, and other allied health professional groups informing them about the CDC and NIH CFS resources, including the CDC toolkit, CME course and other resources. Members of the CFSAC Education Subcommittee are willing to assist in the preparation of a ‘briefing’ for the Surgeon General about this matter.

          Miscellaneous:

          1. Committee requests the Chair and Executive Secretary to use the below language in drafting a letter to third party providers. “The Department of Health and Human Services Chronic Fatigue Syndrome (CFS) Advisory Committee is evaluating the medical care and rehabilitation of persons with CFS. We are seeking information from 3rd party providers as to classification and coverage for CFS. We are asking representatives of major medical insurance providers to present to the Committee how companies process claims for CFS. Specifically we would appreciate information as to standards for diagnosis of CFS and documentation of associated disability; what treatments are covered and to what extent; and, how rehabilitation and disability are assessed and covered. We would like to invite a representative of your company to provide the Committee a presentation as to how your company addresses these issues. ———-“

          2. Committee also requests a report from each relevant HHS agency on existing resources and programs for provider education that might be useful in disseminating information to providers on CFS diagnosis and management.

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          Committee Recommendations

          November 20-21, 2006

          CFSAC voted unanimously to send recommendations 1-4 to the Assistant Secretary of Health and the Office of the Secretary:

          1. The Committee recommends that the FY08 and 09 budgets of the CDC for research be restored to or increased beyond the FY05 level in order to sustain the CDC’s remarkable momentum including the ability to finish the Georgia Study (especially the longitudinal portions).
          2. The Committee recommends that the FY08 and 09 budgets of the CDC for CFS public awareness education be restored to or increased beyond the FY06 level based on the positive initial response to the November 2006 campaign launch.
          3. The Committee recommends that CFS be included in the Roadmap Initiative of the NIH.
          4. Based on the positive response to the NIH’s Request for Applications (RFA) issued in July 2005 (funded in 2006), the Committee recommends equivalent funding for a second RFA.        ******************************************

            Committee Recommendations

            August 2005

            CFSAC submitted the following recommendations to the Secretary in August 2005.

            • Recommendation 1: We would urge the DHHS to direct the NIH to establish five Centers of Excellence within the United States that would effectively utilize state-of-the-art knowledge concerning the diagnosis, clinical management, treatment, and clinical research of persons with CFS. These Centers should be modeled after the existing Centers of Excellence program, with funding in the range of $1.5 million per center per year for five years.

            • Recommendation 2: We would urge the DHHS, through the NIH, to expedite the issue of an RFA with sufficient set aside funds to attract senior level researchers to engage in the study of CFS. DHHS should fund extramural grants, reviewed by a special emphasis panel knowledgeable in CFS, through RO1, RO3, R21, and Directors Pioneer Award mechanisms.

            • Recommendation 3: The DHHS should provide funds to develop an international Network of Collaborators that would allow for multidisciplinary CFS-related research using standardized criteria accepted by the international CFS research community. Such a network would pool a large number of patients from around the world and would require investigators to develop and employ common protocols.

            • Recommendation 4: DHHS should provide support and funding for an intramural staffed laboratory committed to CFS research.

            • Recommendation 5: The DHHS should promote, encourage, and fund research directed toward the diagnosis, epidemiology, and treatment of CFS in children and adolescents.

            • Recommendation 6: The DHHS, through the CDC and NIH, should continue to sponsor, even accelerate, focused workshops in specific areas of CFS and to invite investigators not currently working on CFS who have been identified as having an interest in the illness.

            • Recommendation 7: The DHHS should pursue making CFS a topic of training for healthcare providers, wherever appropriate, at regional and national conferences sponsored by the Department.

            • Recommendation 8: The DHHS should encourage continuing education for Social Security reviewers and adjudicators. The secretary of DHHS should recommend that adjudicators follow the Social Security Policy Ruling 99-2P, which specifically clarifies policies regarding CFS.

            • Recommendation 9: The DHHS should increase public education on CFS through a public awareness campaign. Discrimination in healthcare, education, and the workplace should be actively confronted.

            • Recommendation 10: We would encourage the classification of CFS as a ‘Nervous System Disease,’ as worded in the ICD-10 G93.3.

            • Recommendation 11: The DHHS should consider participation of the Department of Defense, Department of Veterans Affairs, Agency for Healthcare Research and Quality, and the National Institute of Disability and Rehabilitation Research as ex-officio members of the CFSAC for future deliberations of recommendations.

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              Committee Recommendations

              September 27, 2004

              1. We would urge the DHHS to direct the NIH to establish five Centers of Excellence within the United States that would effectively utilize state of the art knowledge concerning the diagnosis, clinical management, treatment and clinical research of persons with CFS. These Centers should be modeled after the existing Centers of Excellence program, with funding in the range of $1.5 million per center per year for five years.
              2. We would urge the DHHS, through the NIH, expedite the issue of an RFA with sufficient set aside funds to attract senior level researchers to engage in the study of CFS. DHHS should fund extramural grants, reviewed by a special emphasis panel knowledgeable CFS, through ROl, R03, P.21, and Directors Pioneer Award mechanisms.
              3. The DHHS should provide funds to develop an international Network of Collaborators that would allow for multidisciplinary CFS-related research using standardized criteria accepted by the international CFS research community. Such a network would pool large number of patients from around the world, and would require investigators to develop and employ common protocols.
              4. DHHS should provide support and funding for an intramural staffed laboratory committed to CFS research.

                Secondary Recommendations
              5. The DHHS should promote, encourage and fund research directed toward the diagnosis, epidemiology, and treatment of CFS in children and adolescents.
              6. The DHHS, through the CDC and NIH, should continue to sponsor, even accelerate, focused workshops in specific areas of CFS and to invite investigators not currently working on CFS who have been identified as having an interest in the illness.
              7. The DHHS should pursue making CFS a topic of training for health care providers, wherever appropriate at regional and national conferences sponsored by the Department.
              8. The DHHS should encourage continuing education for Social Security reviewers and adjudicators. The secretary of DUllS should recommend that adjudicators follow the Social Security Policy ruling 99-2P which specifically clarifies policies regarding CFS.
              9. The DHHS should increase public education on CFS through a public awareness campaign. Discrimination in health care, education and the workplace should be actively confronted.
              10. We would encourage the classification of CFS as a “Nervous System Disease” as worded in the lCD-b G93.3.
              11. The DHHS should consider participation of the Department of Defense, Department of Veterans Affairs, Agency for Healthcare Research and Quality, and the National Institute of Disability and Rehabilitation Research (NIDRR) as ex-officio members of the CFSAC for future deliberations of recommendations.*********************************************
              12. Five Agendas And Presentations             http://www.hhs.gov/advcomcfs/meetings/index.html
              13. SOURCE-Health and Human Services Website:  http://www.hhs.gov/advcomcfs/recommendations/index.html
              14. SOURCE-Health and Human Services Website:  http://www.hhs.gov/advcomcfs/meetings/index.html
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