The text below is from the Legislative Assembly of Manitoba, Canada. The "Volume XLV No 51 session" was held at thursday, October 19, 1995 Web document: http://www.gov.mb.ca/manitoba/leg-asmb/hansard/1st-36th/vol51/h051_4.html The text has been edited into a ascii text ! The first part of the document has been deleted, since it was not on CFS ----------------------------------- PRIVATE MEMBERS' BUSINESS DEBATE ON SECOND READINGS--PUBLIC BILLS Bill 201--The Health Services Insurance Amendment Act The proposed resolution of the honourable member for Kildonan, Chronic Fatigue Syndrome. Res. 32--Chronic Fatigue Syndrome Mr. Dave Chomiak (Kildonan): Mr. Deputy Speaker, I move, seconded by the member for Crescentwood (Mr. Sale), WHEREAS Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (also known as Chronic Fatigue and immune Dysfunction Syndrome, Fibromyalgia Syndrome) is a devastating illness for which there is no known cure or effective treatment, and for which the method of transmission of the disease is unknown; and WHEREAS Myalgic Encephalomyelitis/Chronic Fatigue Syndrome strikes people of all age groups, including a growing number of children, but women between the ages of 25 and 40 are most at risk; and WHEREAS recent biomedical research has identified Myalgic Encephalomyelitis/Chronic Fatigue Syndrome as a serious illness which affects a number of systems in the human body, including the immune system; and WHEREAS the syndrome is characterized primarily by chronic debilitating pain, incapacitating fatigue and many influenza-like symptoms, and is often accompanied by a variety of cognitive dysfunctions; and WHEREAS more serious and longer-lasting neurological impairments, including seizures, psychosis and dementia, have also been observed in some patients; and WHEREAS the disease can produce extreme debilitation and prevent sufferers from working and other normal daily activities, leading to a severe decline in their quality of life; and WHEREAS because so little is known about the disease, people with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome are often misdiagnosed and receive inadequate medical treatment; and WHEREAS there is a need for education and training of health professionals regarding Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and increased public awareness of the disease; and WHEREAS estimates indicate that approximately 5,000 to 7,000 may be infected; and WHEREAS a number of groups and organizations and individuals, including the ME Support Network, and the Nightingale Research Foundation are asking for treatment and education programs to combat this debilitating disease. THEREFORE BE IT RESOLVED that the Legislative Assembly of Manitoba urge the provincial government to consider developing education and treatment programs for the general public and health care professionals to deal with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Motion presented. Mr. Chomiak: I welcome the opportunity of having a chance to debate in this Legislature a very significant health issue, health preventative issue, women's issue, children's issue and an issue that affects many, many Manitobans. Mr. Deputy Speaker, for those members who may not be familiar with the disease, I just want to point out some of the aspects of this disease. This severe disease is characterized by muscle failure with marked fatigue, pain or exhaustion in the exercised muscle, inability to return to the normal state of mental and physical activity, marked variability and fluctuation of symptoms, major sleep disturbances, problems of dyslexia, memory loss, aphasia and severe malaise. ME is a non-HIV acquired immune deficiency syndrome. It injures both the immune system and the central nervous system. This double injury allows the chronic viral infection and illnesses to take hold. Although some people recover, most individuals remain chronically ill or weakened. Others follow and relapsing occurs. Despite the fact that many ME patients may appear normal, their muscles and memory fail. Many are left in chronic pain. They have difficulty standing, reading and walking. They frequently lose or have to lose their occupation. Mr. Deputy Speaker, to try to assist members of this Chamber in understanding this disease and this problem, I would like to read to you an abridged letter that I received a while ago from someone who is a sufferer, and I will just quote from this letter: Like many people with ME, I am relatively young, 32 and well educated. Before I became ill in 1987, I was the marketing director for a company, one of Canada's leading presses, and I had a bright future ahead of me, but, for the last several years, I have lived on a combination of social assistance and CPP. I desperately want my old life and my old health back. I was lucky to find a knowledgeable physician quickly that many of the estimated 5,000 to 10,000 ME sufferers in Manitoba have spent years before finding a physician competent to diagnose their condition, and a lack of physicians who are trained to identify or understand this condition means that many others are still on their own, wondering why their lives are being taken from them. Leaving aside the personal cost, the drain on the health care budget from the many physicians and specialists typically seen before the diagnosis is substantial, and because the length of time before diagnosis is a major risk for the condition becoming permanent, lack of knowledgeable treatment increases the cost to society of having so many who could be the most productive members of society permanently disabled. This is brought to my attention by an individual named Duncan Thornton. Mr. Deputy Speaker, we have spoken to many people about this disease, and one of the problems with it is that we encounter scepticism by friends, family and health care professionals. So little is known about the disease that people are often misdiagnosed and receive inadequate medical treatment. As I indicated earlier, it is estimated that 5,000 to 7,000 Manitobans with this disease are receiving care, and how many are not receiving care or are being misdiagnosed? This goes to the heart of this resolution. Mr. Deputy Speaker, there are many support groups and individuals involved in support groups who have been lobbying for some time to have some form of formal recognition for this disease, and we in this legislative Chamber have a very unique opportunity during the course of this debate and this resolution to pass a resolution saying we recognize that this exists. There is no doubt that it does, and we recognize that a role must be played by the Department of Health in educating professionals and others and providing support and research to try to deal with this debilitating disease. We have many resolutions of a great deal of importance that appear before us on a regular basis in private members' hour. Sometimes it is symbolic what we say and what we do, and sometimes it is quite significant. I believe that by members of this Chamber unanimously passing this resolution, we could go a long way towards helping those who suffer from the disease and helping those in the health care professions to better understand and to better deal with this debilitating disease. This is not the first time we have brought this resolution forward. This is not the first time we have raised the issue in the Chamber. We have raised it during Question Period, and I dealt with this issue with the present Minister of Health (Mr. McCrae) during the course of Estimates quite extensively. We had discussions about it in our attempts to try to enlighten and inform the Department of Health and others that something should and ought to be done about this disease, Mr. Deputy Speaker. You know, this disease has probably been with us for some time. It has only been recently that we have probably been able to isolate it and to try to deal with it, and therein lies one of the major problems. I wonder, as we advance in technology and as we advance in society and in science, if there is going to be a variety of ailments and diseases that have to be recognized and have to be dealt with, and there are many that come up regularly in Question Period in this Chamber. We have to be able to adapt our health care system to recognize the reality of new diagnoses, new illnesses, new treatments and new forms of education, and this is one of those examples where we cannot be inflexible, we cannot sit back and say, no, this does not exist, we cannot sit back and say, no, we are not going to do anything because maybe two provinces out of the 10 are not doing anything about it. This is an opportunity, a unique opportunity, presented to us in Manitoba to do something positive and something concrete to assist those sufferers and all those potential sufferers, Mr. Deputy Speaker, and help them with their disease. We are not asking for millions and millions of dollars in research money to be put forward by the province. We are not asking for hospital beds to be opened up to study. Our goals are not to spend substantial amounts of money. Our goals are quite modest but very significant. Our goals are to have the Chamber recognize the significance of this disease and to, within and throughout the Department of Health and through the Department of Health with health care professionals, have them come together to educate them better, Mr. Deputy Speaker, as to this type of disease. In fact, we will probably, by virtue of doing this, save money in the health care system, save costs, and of course more importantly and above all, save pain and needless suffering by many, many of our fellow Manitobans. * (1710) So this is not a political issue by any stretch of the imagination. It is not even controversial. It is well recognized and well documented, and there are many Manitobans who suffer from this illness today. All we are asking is for recognition and acknowledgement and support, and that is not, I do not think, too much to ask of the Department of Health and of the province in order to help, at minimum, the 5,000 to 7,000 chronic sufferers in the province of Manitoba. Several months ago, I was door knocking in my constituency, and I returned to a house that I had been at previously. I met a woman who had been vibrant and dynamic and actively employed, and she was no longer vibrant, active or employed. I asked her what the problem was. She was suffering from this illness, Mr. Deputy Speaker, and it was a stark contrast from the woman whom I had remembered meeting approximately a year or a year and a half earlier in previous door knocking. It very much brought home to me the significance of this illness by this encounter with this woman. I was shocked to see her condition, and when I discussed it with her, in some ways she was fortunate because she was in a situation where her health insurance plan was such that it recognized it and was paying for her long-term disability which she was under because of the disease. But there are many, many Manitobans, some of whom I have talked to, who are not so fortunate to have either health care plans that recognize it or to have health care plans at all, insurance plans that is, that provide for disability and therefore they are caught. In addition, Mr. Deputy Speaker, the thrust of this particular resolution is to educate. It is to educate professionals and to educate those in the health care field to recognize and to be on guard and to diagnose as early as possible, in the early stages, these illnesses to prevent both deterioration of the individual and of their system as it relates to this disease, but also to lessen the impact on the health care system. Mr. Deputy Speaker, we have many opportunities to deal in this Chamber with a variety of issues. We have just come through a controversial Question Period where we have disagreed about a number of actions of the Department of Health. It is legitimate on all sides of this Chamber to have legitimate viewpoints on particular issues and to argue them. I do not think in this case we are in a situation where we can argue about the disease itself, the significance of the disease itself and the problems encountered by sufferers and those in the health care field in diagnosing and treating this illness. We have an opportunity in this Chamber to move forward and to do something very positive in the health care field, to actually proceed from this resolution which will alert professionals, which will alert the health care department, which will assist those who are sufferers and members of support groups and say, yes, we recognize. We will lend you our support, what support we can lend you. We will try to do our part to improve your quality of life and to deal with this illness so that we can do as legislators our part, which is what we are elected to do, to try to improve the life and the quality of life for not only those suffering from the illnesses but their friends and families who must watch their loved ones deteriorate as the disease progresses, Mr. Deputy Speaker. Now, I have brought forward many resolutions, and I have been fortunate to have a number of them passed in this Chamber, some of them unanimously, and I thank all of my colleagues in the Legislature when they have done that and they have recognized the significance. I am asking all members of this Chamber, imploring all members in this Chamber, to take this next step to recognize this illness, to do our part--it is modest, but it is significant--to educate and to try to provide some support to those in Manitoba who are suffering from this debilitating disease, Mr. Deputy Speaker. There is no ownership. There is no politics in this. It is a straight health issue; in fact, it is more than that. It is a human issue. It is something that we are elected in this Chamber to do, to try to better the lives of our fellow Manitobans. It is an opportunity for members of this Chamber to do something positive to assist our fellow Manitobans who are suffering from this, and I urge all members of this Chamber to look very carefully at this resolution, to recognize the significance it has on Manitobans, to look at what we are asking for. It is simply a recognition, an acknowledgment and an education component that will, in fact, Mr. Deputy Speaker, go a long way towards helping those Manitobans who are suffering from this disease and those potentially who will suffer from this disease in the future. I urge all members of this Chamber to seriously consider this issue and to assist all the sufferers and to pass this resolution today, to pass it unanimously and to send a positive message to those 5,000 to 7,000 Manitobans and their families who are suffering from this. Hon. James McCrae (Minister of Health): Mr. Deputy Speaker, I am pleased to rise today in this private members' hour to say thank you to the honourable member for Kildonan for raising the issue of chronic fatigue syndrome in our Legislature today. I do not think that issues like this get discussed as often as so many other issues of the day, as they sometimes tend to come and go; but, with respect to this particular matter, I think that a discussion like this today and any other consciousness-raising exercises with which we can become engaged help all of us and help the general public, too, because a debate in the Legislature of a province can have the effect of tending toward a greater level of public awareness about a matter like chronic fatigue syndrome. So I say to the honourable member for Kildonan (Mr. Chomiak) that he does a service when he raises an issue like this. I am sure anyone who suffers from this syndrome would be able to speak more eloquently than I or even the honourable member for Kildonan to help create and promote an understanding of the kind of life people suffering from this syndrome have to live. So, on behalf of those people especially, I think that we should be pleased that this private members' hour part of our procedures offers us an opportunity to discuss this particular problem which can be so devastating for people who suffer from it. As the honourable member's resolution points out, the syndrome is devastating, and the fact that there is no known cure or even effective treatment makes the sense of desperation more acute, because, imagine if you can, Mr. Deputy Speaker, what it must be like to have to live with the symptoms that people with chronic fatigue syndrome have and live with the knowledge that not enough is known about it for there to be an effective treatment or cure, let alone any knowledge about the method of transmission of the syndrome. It causes some concern too to know, as the honourable member's resolution says, that the syndrome is affecting a growing number of children; women as well between the ages 25 and 40 being at risk causes me and everybody concern. You know, a lot of people think that between the ages of 25 and 40, maybe I hope a little older since I am a little older, that one is at--[interjection] I am 47. But at that kind of an age there is a recognition that in the average, healthy person that those are the productive years of a person's life when they make their greatest contribution to their family or to their society or to their community or to their fellow citizens. * (1720) So it is a very serious prospect to have to be thinking that especially among women in that age group they are going to be facing that risk and potentially depriving themselves of the satisfaction of making the kind of contribution that they might be able to make but depriving society as well of the benefit of those contributions. Now, I do not claim to have any more expertise than the honourable member or indeed all of the professionals who have yet to complete research on areas related to cause and effect and treatment and cure, so that is what makes this discussion so difficult. But I think if the honourable member for Kildonan (Mr. Chomiak) and myself and others who take part in this discussion today, if we raise a little bit more awareness about the whole matter then we will be more likely to be engaged in further discussions in the future, which is the right thing to do. This and other conditions for which little is known or not enough is known are in the same sort of position as other syndromes and diseases of the past for which research has been done and much has been learned and people have been able to benefit. So there is reason to be hopeful even if it does not seem to loom very large today; there is reason to be hopeful because of the wonders of technology and research and the results those efforts have brought to us in the history of mankind and certainly in the modern history as it relates to medical research. The College of Physicians and Surgeons of Manitoba has been forwarded the revised case definitions of the chronic fatigue syndrome so that the medical profession can be better informed about the subject, and I think that is one of the things the honourable member wants to achieve by bringing this resolution to us today. I realize that if you are a medical practitioner and you get into the practice of your profession you deal with the things you know about for the most part and research is left to researchers and others, but it is important that any new developments that might come to light with respect to chronic fatigue syndrome be shared with the profession and that they make whatever use they can of that information in order to alleviate the concerns, the problems, the symptoms, the effects that their patients have, because certainly in my travels throughout this province and in all my discussions with professionals of all kinds, but certainly physicians, they too have as their central desire that of the alleviation of suffering amongst their fellow citizens. So I think that in the crush of the everyday life of the average physician, busy keeping their appointments and looking after their patients, there is not enough information around about this problem, and so they are not able to be as helpful as they would like to be. It is my hope that a recently revised working definition of the syndrome will lead to increased research so that treatment and prevention technologies can be advanced. Chronic fatigue syndrome is a clinically defined condition, characterized, as the honourable member for Kildonan (Mr. Chomiak) has set out, by severe disabling fatigue and a combination of symptoms that prominently feature impairments in concentration and short-term memory, sleep disturbances and musculoskeletal pain. Diagnosis of chronic fatigue syndrome can be made only after alternative medical and psychiatric causes of chronic fatiguing illness have been excluded. When you are dealing with a process of elimination, when you cannot, I guess, figure out whatever else it is might not be wrong with a person, that is how you come out with that sort of a diagnosis. I guess if I were a practitioner, I would find that really not a very satisfactory sort of way to arrive at any kind of definitive diagnosis of my patient's condition. So, therefore, because of all of that, no definitive treatments exist. I am told that some people affected by the syndrome, some people's symptoms improve some with time, but I am told also that with most they remain functionally impaired for years. That must be an extremely terrifying prospect to go on day after day, month after month, year after year, not knowing what the problem is, not being able to get help from the family doctor or anybody else and wondering if it will ever go away. I cannot imagine, Mr. Deputy Speaker, anything more frightening than that. There are some issues with respect to chronic fatigue syndrome research, and the central issue in this research is whether the chronic fatigue syndrome or any subset is a discrete entity. This issue depends on whether clinical, epidemiologic and pathophysiologic features convincingly distinguish the chronic fatigue syndrome from other illnesses. Anxiety disorders, major depression and other symptomatically defined syndromes can manifest severe fatigue as well. Several psychological symptoms are diagnosed more frequently in populations affected by chronic fatigue syndrome. With respect to clinical evaluation of cases, that includes history, physical examination and mental status examination, tests that strongly suggest an exclusionary condition must be resolved, and there, again, the frustration. There are some conditions that explain chronic fatigue; those are the ones. The following ones exclude a patient from the diagnosis of unexplained chronic fatigue. I put some of this information on the record simply in an effort to assist in bringing the matter forward in the sense that there is a real--if you happen to be a person or a family member or associated with a person with chronic fatigue syndrome, these matters are extremely important, even though not enough is yet known about the condition. There are some things that exclude a person, so that if you happen to think that you have symptoms of chronic fatigue syndrome and some of the following situations reflect your life, you may be able to, in consultation with your physician, exclude the diagnosis of chronic fatigue syndrome, which may create another problem for you, but at least you can set that one aside if you have these conditions. Any active medical condition that might explain the presence of chronic fatigue is, of course, what we are going to be told is what explains your fatigue, so some other medical condition will do that--any previously diagnosed medical condition whose resolution has not been documented beyond reasonable clinical doubt, any past or current diagnosis of a major depressive disorder, alcohol or other substance abuse within two years before the onset of the chronic fatigue and, lastly, severe obesity. The honourable member certainly, as I repeat, does us all a service. Every time he--and he brings up a lot of things in this House. There is no question about that. We do not always appreciate his efforts, but on this one I think we can probably find agreement that we do indeed appreciate the fact that the honourable member has cared enough to bring forward this matter to ask that we consider developing education and treatment programs for the general public and health care professionals to deal with chronic fatigue syndrome. * (1730) That is something that I will certainly bring to the attention of our epidemiological people within the department just to ensure that our department is, as busy as we are and as many things as we have to do, this is certainly an area of significant concern for people in our province, our fellow citizens. So we will take the concerns raised throughout this resolution by the honourable member, take them seriously and discuss them further within the Department of Health. Mr. Gerry McAlpine (Sturgeon Creek): Mr. Deputy Speaker, I, too, rise and am pleased to put a few words on the record with regard to this chronic disease, as it is so called, whether it is chronic fatigue syndrome or chronic mononucleosis or chronic Epstein-Barr or whatever other name that you want to give. I think what I would like to do, and I do not know whether I am going to be able to have all the time to be able to put all the remarks that I wish to put on the record, but I will go to the point that you ask and give me the full time that I am allotted. I want to express some understanding of the history of this. You know, I had some difficulty with what the honourable member, even in his compassion, because I share his compassion, but I have some difficulty with what he is proposing. Maybe once we hear what we have in terms of what I am offering, and I do not profess to be an expert on this aspect of chronic fatigue syndrome, but chronic fatigue syndrome goes back 125 years. It was first diagnosed or referenced by a psychiatrist, a Dr. George Beard, in 1869. He called it at that time, and I cannot even say it, neurasthenia, which is an exhaustion of the nervous system. Then sometime after that, a neurologist, Dr. Silas Mitchell, diagnosed the similar symptoms and recommended rest care as a prescribed form of treatment. In that he suggested that the treatment deal not only with rest, but with proper health in terms of proper diet, rest and to remove the patient from the environment in which they were being affected that would cause them to have this condition. It is interesting that, during the epidemics that there have been over the 125, 130 years the history of this diagnosis, and even in the epidemics in the USA and in Europe, this practice of removing the patients from their environment was carried out for many years to follow. This was practised even before medicine became a science, and it was a treatment of contextual healing. If we examine contextual healing, what we are doing is that we are looking at the context of the people who are affected by these symptoms that are described with this so-called illness. Fifty years ago, Mr. Deputy Speaker, there was medical research that begged to believe and suggested that chronic fatigue syndrome was a brucellosis bacteria. The people who have spent years on the farm around animals, because that is a bacteria of animals, and people who have spent time around animals know how it affects animals in terms of their ability to provide milk for their young. So there have been many diagnoses over the 125 years. Studies in the 1950s and 1960s demonstrated that victims of postinfectious fatigue to be inherent and what they would do is the psychoneurotic suggesting meant that the people who had this were mentally disturbed. Then in 1955 there happened to be an outbreak of chronic fatigue syndrome in the Royal Free Hospital in London and the neighbourhoods around that hospital where a medical student and subsequently a doctor and then a nurse and subsequent to that followed by 300 staff were affected by this. But, Mr. Deputy Speaker, the epidemic outbreak, most recently, was in 1985 in Lake Tahoe and the medical authorities again studied it and they came up with nothing--some over a hundred years later after studying this. The profile reflects that CF is a nervous disorder related to stress but no evidence exists to support that. One of the things that I think is really important here and I think that a doctor going back to 1765, a Dr. Robert Whyatt, wrote that physicians of the day--and this is when we are talking about trying to determine what the causes of diseases are--tend to diagnose as hypochondriacs or hysteric all cases whose nature and causes they were ignorant of. Maybe that, Mr. Deputy Speaker, exists today. You know, I have on my wall in my home this wall plaque, and I think that really what it does it describes in terms of where I am coming from and I think that the way society has to go in dealing with health care or any diseases that we are dealing with. I would like to say that for the record. I would ask that if there is anybody who--and this is a quote that goes back a number of years just to give you an illustration and I share this with you. I quote: The doctor of the future will use no medicine but will care for his patients in the use of diet and the cause and prevention of disease. Now I wonder how many people in this Chamber are aware of who made that quote. I will tell you, it was Thomas Edison. Thomas Edison made that quote. But where have we gone in society today? Diseases to qualify, in terms of our medical, as thing-like entities in terms of what we are talking about. And I respect what the honourable member for Kildonan (Mr. Chomiak) is saying because people are devastated because they are looking, they are seeking for help, and the only place that they can reach out for help on this is through the medical profession. They are the so-called experts, but there have been some failings over 125 years, and the reason being that the diseases to qualify as thing-like entities must have specific characteristics. They must have a check list in order to determine and to be able to diagnose and then to treat. If they cannot diagnose, they cannot treat it, which is a problem with chronic fatigue syndrome, because we heard the honourable minister list all the symptoms with chronic fatigue syndrome. Now, what symptom do they treat? It is quite obvious that chronic fatigue syndrome cannot follow that checklist like blood pressure or cholesterol, and it gets confusing for many because of the many other conditions. It gets confused with such symptoms as malignancies and auto-immune deficiencies or diseases, chronic and subacute bacterial conditions, fungal and parasitic chronic inflammatory conditions. * (1740) In search of a cause for chronic fatigue syndrome, Mr. Deputy Speaker, why do we not look at the contextual conditions, contextual healing. As I said at the outset of my remarks, I do not profess to have a great deal of knowledge, but I have done a great deal of studying, and the research that has been done and whose direction I follow is from a Dr. Dean Black. Many of you have heard in this Chamber--I have spoken of Dr. Dean Black who has done an insurmountable amount of research and study on all aspects of health, and a lot of what I am sharing here with this Chamber today is what he offers in terms of dealing with contextual healing. Chronic fatigue syndrome, as both the honourable member for Kildonan (Mr. Chomiak) and the honourable minister have indicated, affects young, middle-aged people who are active in their professions and have achieved a level of professionalism. Those are the people who are affected by this, and it is sad to see the debilitating conditions that some of these people are in. But I do not share the same feeling that the member for Kildonan shares in saying that we should throw more money into this, because if we examine that, Mr. Deputy Speaker, who are we going to give the money to? Who is going to do this? Is it the medical doctors? Is it the drug companies? The honourable members across the way, they talk about drug companies as the big problem to society in terms of our health care, the people who are making the money. I do not disagree with that, but I think if we examine what this resolution is going to suggest, I do not feel that that is going to be the answer. I mean, people have been trying to deal with this in a positive way and in a compassionate way for 125 years. The condition we now call CF or chronic fatigue syndrome as I mentioned was first described in 1869, and since then we have had recurring epidemics to the point it has grown to be the seventh most common medical complaint, yet the medical profession, by their own admission, cannot explain it. In 1985, there were the two separate research reports that CF was caused by a virus. The offending virus is the one called Epstein-Barr. The medical profession at that time felt that they had hit on something, but there is no conclusive evidence to support that as well, and the virus is associated with the infection, mononucleosis. The authors were careful to say that this theory was only a possibility. Mr. Deputy Speaker, I think that we certainly do have some difficult decisions to make on all the things that we are going to do in terms of dealing with health care in the province of Manitoba. I do not think anyone here denies that, but I do not think that the answer is to put more money into it. [interjection] The member for Kildonan (Mr. Chomiak) says that is not what he is saying, but what do you do? Who do you involve? Well, I distinctly heard the member for Kildonan suggest that he did not say that, but if you read the resolution that he brings before this House, that is-- Mr. Deputy Speaker: Order, please. The honourable member's time has expired. Mr. Gary Kowalski (The Maples): Mr. Deputy Speaker, I just wanted to put on the record that myself and my two colleagues, Liberal MLA members in this Legislature, support this resolution, and we would like to see it come to a vote. Mr. Tim Sale (Crescentwood): Mr. Deputy Speaker, I have had the misfortune to have two young friends, both very active people at the peak of their learning careers and in the beginning years of their jobs, neither of them in any sense people with any history or any indication of any kind of mental illness or any sense people who were not highly energized and highly active, who have had this syndrome. I think it is most important that we pass this very nonpartisan resolution so that people who are suffering from this very debilitating condition can have a sense that the members of this Legislature understand the need for further research, as the member for Sturgeon Creek (Mr. McAlpine) has pointed out and as the honourable Health minister (Mr. McCrae) and the mover of this motion. I think all of us have had calls from people with chronic fatigue syndrome. Probably many of us have either friends or, even closer, perhaps family members who have suffered from this debilitating disease. So I urge all members to support this motion. Thank you, Mr. Deputy Speaker. You may call for the question. Mr. Mervin Tweed (Turtle Mountain): I too am pleased to speak to the House today on this resolution. I think all members in the House and the people of Manitoba share with everyone the common thought that health and fitness, health issues, are certainly in the hearts and on the minds of the people of the province of Manitoba, as being identified in this House every day as I sit and listen to the members opposite and members from this side of the House speak about health care and health issues. I think that it is very important that we have new ideas like this brought to the floor. It is certainly new to me as far as I have heard of the illness, but, personally, I do not know of anyone who has it. I certainly, from listening to the other members speak on it, know that they have a personal interest in it. Thinking of people's health and the care of the people, particularly with an illness such as this, and reading through the resolution, and it is stating that there is no known cure. I am sure, for anybody who becomes diagnosed with this syndrome, I guess that to be told or to understand that they really do not have a cure at this point in time for the illness must be very devastating--not only a cure, but there is no treatment for it. Again, it seems like it is so vague in the sciences. There is certainly a lot more room for study and a lot more room to make people understand the illness. I also note in the resolution that the member discussed that the method of transmission is completely unknown also. I cannot relate it to anything that I have ever done in my life, except I do know, myself, personally, when there is something wrong that I cannot fix, and I cannot understand why it is not working properly and I do not know what caused the breakdown of it, it certainly frustrates me. I am sure that, when it deals with people's health and the health issues, it certainly has to be catastrophic to the person. * (1750) It is a term "chronic fatigue syndrome" that is used to describe a very large group of symptoms. A lot of these symptoms can be persistent, or you can go into a relapsing fatigue which is lasting six or more consecutive months. I just cannot imagine experiencing something like this myself for that long a period of time. To suffer with this syndrome, and, again, not know how I got it, not know if there is a cure for it, knowing there is no cure for it or even effective treatment, it would certainly be very disheartening. I understand, too, that the illness may also include short-term memory defects, difficulty concentrating, unrefreshing sleep--and I think everybody in this House can identify with that as far as one of the symptoms. After spending long hours here some days, no matter though your eyes are closed, whether you are resting or whether you are getting any sleep or not is certainly up for the question. A sore throat is also one of the symptoms, tender lymph nodes, muscle pain. Again, I think something that we can probably relate to, to a degree, but maybe not understand again why it happened to us, what caused us to get this. Whenever I suffer from muscle pain and joint ache, I usually know why I have it. It is from exertion or overexertion, and I know that in a couple of days it will go away. Unfortunately, the people that suffer from this particular syndrome do not know that. They have really no understanding of when it will end, and, if it does end, why it ended. Headaches and sickness follow exertion, and again, in this case, I am led to understand that exertion is basically just any kind of movement that we consider to be normal. In this case, with people that are suffering from the syndrome, they become sick and ill after those kinds of exertion. The definition, chronic fatigue syndrome, has been revised over the years and has recently been revised and will likely continue as we do get to know more about this illness and understand it, understand how we get it, how it is transmitted, and hopefully the cure will follow. It is something we have seen throughout history, so it is not a new illness. It has just recently been systematically separated out so that we can identify it and understand it and study it. The illness appears to be associated with abnormalities of the immune system, which I think even I can understand that. If your system is abnormal, is the word, I would say, weak or suffering some sort of a defect, it certainly would suggest that it can enter your system. Certain hormones, as well as depression, frequently, but not always, follow the infection. Again, I think that the depression part of it, you definitely are going to feel that way after enduring some of the symptoms that I have described earlier. It would certainly be an easy thing to fall into as far as you are tired, you are worn down and you are susceptible. The diagnosis of the syndrome can be made only after alternative medical and psychiatric causes of chronic fatigue illness have been excluded. So, before they can actually tell you that you are suffering from the fatigue syndrome, they must separate through a series of testings and alternative medical causes to eliminate the idea of a chronic fatiguing illness. The presence of prolonged or chronic fatigue requires clinical evaluation, so therefore there is a lot of time spent studying the patient, and the clinical evaluation is used to identify underlying or contributing conditions that require treatment. There are many conditions which exclude a patient from the diagnosis of unexplained chronic fatigue. They are any medical condition that may explain the presence of chronic fatigue, i.e., if you exhibit some of the suggestions I presented to you earlier, that would be one of the first steps. Any previously diagnosed medical condition whose resolution has not been documented beyond reasonable clinical doubt--I would think from this statement that would mean that the process is a very long and drawn-out affair, and a lot of clinical diagnosis has to take place. Any past or current diagnosis of a major depressive disorder--and I would certainly suggest again we have endured some of that type of medical history in our own families or people that we know, and I am sure it is certainly one of the causes. Something else that I found to be quite interesting was the fact that alcohol or any other substance abuse within two years before the onset of chronic fatigue and severe obesity may also be contributing factors to the disease. Although the illness may be prolonged, many patients do gradually improve and eventually recover. I am certainly pleased to hear that. I think if you can take on this syndrome, not know how you got it, not know how to treat it and to know that basically there is no cure for it, it has to be a very frustrating time in one's life. I guess if there is a bright side to it, it is the hope that many patients do gradually improve and eventually recover. In that instance, I can cite an example where I have a person that I know that has suffered from a disease that basically they said in time, hopefully, it would leave him. The chances were good and I certainly know that that encouraged everyone within our family and his family to look forward to that day. Something that struck me about the syndrome, and it quite actually astonished me or astounded me was the fact that it includes a growing number of children, but particularly women between the ages of 25 and 40 are most at risk. I would suggest, not being clinically wise or a doctor of any profession, that these are as I like to look at myself and the minister has suggested earlier, those are we hope to be our most productive times of our lives. When you think of people that age, usually with children, with families, careers, there are so many things that are happening to them--[interjection] Yes, athletics also. It must be a devastating blow to these people to come into contact with this kind of an illness. Mr. Deputy Speaker: Order, please. When this matter is again before the House, the honourable member will have three minutes remaining. The hour being 6 p.m., this House now stands adjourned until tomorrow morning at 10 a.m. (Friday). -end of file-