XMRV Replication Studies

[fresh_eyes]

Lloyd is part funded by the CDC[/URL] and publishes with Reeves and Simon Wessely. Lloyd and his psychiatrist coauthor Ian Hickie have suggested that the more disabled you are by ME/CFS the more likely you are to be suffering from a somatoform or somotization disorder. http://www.mecfscanberra.org.au/docs/sydbet.htm

Oh, boy. Thanks for the background, catch.

 

[alice1]

Thanks for the info.

 

[Martlet]

The authors suggest that those CFS patients who are more severely affected are, by definition, suffering from somatoform disorder. Those with more symptoms, who are ill for longer periods of time, whose symptoms are more severe and who request medical assistance more often are automatically seen by the researchers as psychiatric cases. The result of this reasoning, of course, is that those most in need of medical assistance would be the least likely to receive appropriate care.

I guess the upside is that they have not suggested that the sickest amongst us have been the subject of some voodoo curse. But seriously, this leaves me - flabbergasted.

 

[Megan]

Dubbo Study

Thanks for this info Megan. Do you know if the Dubbo group has verified its XMRV test using samples from the WPI?


Catch,

Thanks for the information on Professor Lloyd. I was only vaguely aware of this as I have been more focussed on his 2006 Dubbo study. I note that the 2006 study varies to a degree with the earlier findings you quoted. It found no association between EBV viral load and CFS, no association between 'personality style' or 'psychological disorder' and CFS, and then in a strange leap of logic at the very end of the paper it finishes up with a CFS brain injury hypothesis.

I was aware of his public comments on XMRV which is one of the reasons I wrote to him in the first place to tackle some of those points. The current study is looking at the original Dubbo group. All I will say is that he remains ever cynical about XMRV (he would say sceptical), so I do not hold high hopes. He has not revealed the result of his study or even if it has been completed. In answer to your question, Professor Lloyd did not respond when I asked how their study was validating their tests (though I may have pushed my luck too far by that stage).

I share your concerns regarding early studies and the validation of tests. Professor John Coffin expressed great concern about XMRV tests at the CFSAC hearings and there have been conflicting results in the area of prostate cancer prior to the WPI findings, from which I can only conclude that this is no simple matter (and presumably prostate cancer does not suffer from the sample selection difficulties that make CFS research so problematic).

My sense is that there will be many conflicting study results and we will be in for a long haul in terms of having the XMRV/CFS issue resolved one way or the other.

Megan.

 

[Cort]

Remember that Dr. Lloyd is the creator of a large study that looked at what happened when people came down with four kinds of different infections. The focus was on whether the immune system acted differently or the pathogen was not eradicated in people who came down with ME/CFS vs the people who did not. That's the biggest project of his career. Does that sound like someone who thinks ME/CFS patients are simply somatizing?

I just looked at those guidelines from Australia in 2002. This is one thing they say.

Although depression is a common symptom in people with CFS, the disorder as a whole cannot be regarded simply as a "somatised" variant of a depressive illness.

They also say this

Perhaps the most difficult diagnostic uncertainty between CFS and psychological illness is in relation to "somatoform" disorders (DSM-IV107). In these disorders, people present with medically inexplicable physical symptoms that are hypothesised to be the result of underlying psychological processes. As the causes of CFS are "unexplained", there is an obvious overlap between the diagnostic criteria for the somatoform disorders and CFS.16,90,109-112

A recent international multicentre study attempted to stratify patients diagnosed with CFS in tertiary referral centres, without prior clinical assumptions.113 The results suggested heterogeneity, with variation between centres, but it was not possible to determine whether the hypothesised subgroups (with "classical CFS" versus "multiple somatic" symptoms) lie on a continuum or represent truly distinct aetiological categories. Nor was it clear whether somatic symptoms were the result of a constitutional vulnerability or were secondary to chronic illness.

I see them saying that they simply don't know. They do cover immune, CNS and HPA axis studies. Dr. LLoyds emphasis has never been somatization; he's never done a study on that to my knowledge and he's done lots of immune and gene expression studies. Yes, he was funded by the CDC but that was determine the immune status of people who came down with an infectious illness. I think we can all probably agree that that was a good idea.

They're very conservative, they don't recommend many treatments and they do recommend CBT/GET but note that they say exercise 'without relapse'; ;these are not the hated GET program that pushes patients until they fall apart.

Dr. Lloyd is skeptical about many things in CFS research. He's kind of known for stepping in the middle of an exciting issue and saying this doesn't make sense. He believes, for instance, that gene expression is a waste (based on his results).

I trust him -he's not going to manipulate data and he has a good group to test. It'll be interesting.

 

[I Wanna Be Well]

Remember that Dr. Lloyd is the creator of a large study that looked at what happened when people came down with four kinds of different infections. The focus was on whether the immune system acted differently or the pathogen was not eradicated in people who came down with ME/CFS vs the people who did not. That's the biggest project of his career. Does that sound like someone who thinks ME/CFS patients are simply somatizing?

I just looked at those guidelines from Australia in 2002. This is one thing they say.



They also say this



I see them saying that they simply don't know. They do cover immune, CNS and HPA axis studies. Dr. LLoyds emphasis has never been somatization; he's never done a study on that to my knowledge and he's done lots of immune and gene expression studies. Yes, he was funded by the CDC but that was determine the immune status of people who came down with an infectious illness. I think we can all probably agree that that was a good idea.

They're very conservative, they don't recommend many treatments and they do recommend CBT/GET but note that they say exercise 'without relapse'; ;these are not the hated GET program that pushes patients until they fall apart.

Dr. Lloyd is skeptical about many things in CFS research. He's kind of known for stepping in the middle of an exciting issue and saying this doesn't make sense. He believes, for instance, that gene expression is a waste (based on his results).

I trust him -he's not going to manipulate data and he has a good group to test. It'll be interesting.

For someone who is supposed to have his finger on the pulse of all things ME/CFS, that is one ignorant post and you obviously know nothing of the history of Lloyd. If you can't see where he is coming from and where his sympathies lie (and I'm not convinced that you don't) then I despair. You may have a lot of people fooled Cort, but not all of us. It's "funny" how often you are the "voice of reason" and appear keen to offer support for people such as Lloyd and his pals and support stress research etc etc.

 

[winsomme]

a little confused about a report being due in January 2010.

So, leaving aside whether or not Dr Lloyd has a bias, do we know for a fact that he has conducted a study looking for XMRV in CFS patients, and do we know that the study is completed and the results due next month?

 

[MEKoan]

I just did an image search for Peter White and got this:

http://aboutmecfs.org/Conf/HHV6PtII.aspx

with explains some history re Lloyd, White, et al, and Dubbo....

 

[Robin]

For someone who is supposed to have his finger on the pulse of all things ME/CFS, that is one ignorant post and you obviously know nothing of the history of Lloyd. If you can't see where he is coming from and where his sympathies lie (and I'm not convinced that you don't) then I despair. You may have a lot of people fooled Cort, but not all of us. It's "funny" how often you are the "voice of reason" and appear keen to offer support for people such as Lloyd and his pals and support stress research etc etc.

If you think Cort is wrong, then tell him why he's wrong. Give us a good history of Lloyd, or respond to what Cort said directly (see Catch's post, above.)

There's no reason to call someone ignorant and or attack their loyalties; that doesn't fly here. Argue about the issues, not the people bringing them forth.

 

[MEKoan]

I think Cort makes his position very clear in the piece he wrote at the link I provided above.

It cleared up something that had always confused me about Cort. (Hi Cort!)

I realize now that Cort's approach to writing about and reporting on ME/CFS is, by design, very neutral. It's who/what/when/where/why with as little editorializing as he can manage.

I'm going to stray a little bit here from the facts. I also think Cort takes people at face value when he meets them. They make sense, they seem decent and that's what he reports. I don't know if his writing style would change with more knowledge of the back story.

I also think that NAs don't really understand just who they are hosting when they have certain people from over the pond.

 

[I Wanna Be Well]

If you think Cort is wrong, then tell him why he's wrong. Give us a good history of Lloyd, or respond to what Cort said directly (see Catch's post, above.)

There's no reason to call someone ignorant and or attack their loyalties; that doesn't fly here. Argue about the issues, not the people bringing them forth.

I'm not feeling well enough to write loads of information and look up all the relevant details. Anyone who really knows the history surrounding ME will know about Lloyd and his work and ideas. Cort knows. He also gets the message, so, no, I don't need to write anything more. I'll do it my way thanks. If you don't like it that's your problem. There is plenty of evidence of what Cort Johnson stands for, and I personally don't like it. Am I not allowed to have that opinion? That's called censorship. Cort loves himself a bit too much and all of you worshippers at the Cort alter just serve to reinforce that.

 

[fresh_eyes]

I'm not feeling well enough to write loads of information and look up all the relevant details. Anyone who really knows the history surrounding ME will know about Lloyd and his work and ideas.

Leaving Cort aside, I don't know all that history and would be interested to hear it (even just the basics) when/if you're up for it.

 

[Martlet]

I'll do it my way thanks. If you don't like it that's your problem.

Actually, no it is not our problem. It is yours. We try hard not to step in and moderate but personal attacks are simply not permitted in this forum and I echo Robin's request that you argue on the issues, not on personalities.

 

[CBS]

Educate Me

I'm not feeling well enough to write loads of information and look up all the relevant details. Anyone who really knows the history surrounding ME will know about Lloyd and his work and ideas. Cort knows. He also gets the message, so, no, I don't need to write anything more. I'll do it my way thanks. If you don't like it that's your problem. There is plenty of evidence of what Cort Johnson stands for, and I personally don't like it. Am I not allowed to have that opinion? That's called censorship. Cort loves himself a bit too much and all of you worshippers at the Cort alter just serve to reinforce that.

I Wanna Be Well,

One of the things that I value most about this group is that it is a civil place to learn more and that we can disagree without tearing the group to pieces. I've dealt with CFS for 16 years but I never accepted the label until very recently and still only because I feel that it is very short lived.

I've only recently started to appreciate just how good I have it. The situation in the UK sounds horrid. I'd like to second Fresh Eyes and say that I too would like to learn more about what you KNOW.

I know that the energy is often not there for a long and drawn out analysis but facts are essential. I'd even be satisfied for the moment of you could just point me in the right direction.

Thanks,

Shane

 

[fresh_eyes]

I never accepted the label until very recently and still only because I feel that it is very short lived.

Hi Shane. Interesting, me too on the above. I imagine there are probably many like us.

FYI there is a post with some links re Lloyd at #42 on this thread. But I'd still like to hear from IWanna, whenever he/she is able.

 

[CBS]

Cytokines and definitions (again)

Didn't Dr. Klimas publish an article recently on cytokine activation and CFS. I'll need to do some looking but it seemed like there was a very specific subset that she found differentiated CFS from controls. If this is correct, has anyone looked at the cytokines referred in Lloyd's early study lined up with the Klimas study?

As for a history of Dr. Lloyd's work and his present stance, I do find his recent statements about the WPI XMRV interesting. He clearly has a close relationship with, and seemingly a respect for, the CDC.

I thought that it was ironic that one of the studies in which he participated (What is chronic fatigue syndrome? Heterogeneity within an international multicentre study.) essentially states that "There was substantial variation in subclass prevalences between the study centres (Class two range 6-48%)." That's an eight fold difference!

To me that should read "We're all defining this in different ways and whether or not you are Dx as having CFS has more to do with where you are seen that what you have. As so called scientists, have screwed this whole thing up to such a degree that none of us could even tell you what we are studying!"

It does leave me wondering who he will be including in his XMRV studies and what expectations he brings to this work (read - how hard he will look given his expectations?).

 

[Martlet]

It does leave me wondering who he will be including in his XMRV studies and what expectations he brings to this work (read - how hard he will look given his expectations?).

Isn't that going to be the case with most studies? When I was diagnosed, the Holmes Criteria was the standard. Then we got the Fukuda compromise and have been going downhill since then. If doctors decided they were just studying those who meet the Holmes, or even the Canadian criteria, would there not be an outcry from those who can meet neither yet have a diagnosis of CFS/ME? And if they include all those with a diagnosis, then there would be an outcry from those who meet the more stringent requirements that the data has been diluted. All I know is that I would not want to be a researcher at this point!

 

[justinreilly]

Canadian ME/CFS definition

It seems obvious to me that the Canadian 2003 definition is the only valid one. I really don't think we should throw up our hands and say let them use all the definitions because people will be upset if we limit the studies to one definition. Our biggest problem over all seems to me to be the continued acceptance of ludicrous definitions like Reeves and Oxford which were intentional made overly inclusive and vague so that when they studied the patients fitting these loose definitions they will find psychopathology. Reeves and Oxford defs are just a sophisticated way to discredit us and retard the science.

 

[Cort]

My knowledge regarding Dr. Lloyd comes almost entirely from the research end.

I know that he's a controversial figure in Australia; someone pointed me to a paper he wrote on exercise in chronic fatigue syndrome. What I remember from that paper is that he very plainly stated is that if exercise causes a flare in symptoms that the patient is doing too much. That I didn't have any trouble with. I don't know about other things.

But my experience of him is through the Dubbo studies - in my opinion the potentially single most mportant set of studies (until XMRV came about) we've had. Dr. Lloyd took four sets of patients who came down with an infectious illness (viruses or bacteria) and followed them see if ones that came down with CFS and some immune dysfunction or if they had trouble finding of the pathogen.

He found that the people who came down with CFS after an acute infectious onset had and exaggerated immune response; their cytokine levels were much higher than they had worse symptoms than the people who recovered. This is the first time anyone has caught "CFS' in the act. It suggested that somehow this temporarily high-level of cytokines caused damage in the central nervous system.

I don't know how you cannot like that work. Unfortunately Dr. Lloyd has gotten very little financial backing for his studies. Oddly enough the CDC was his major funder; once they backed out he tried twice to get an NIH grant and was rejected both times.

This is why when I see someone suggesting that Dr. Lloyd is 'somatizer' or whatever I just don't get it. Maybe there is information that I'm not aware of but I do know that he is responsible for one of the most exciting, physiologically based set of studies ever undertaken on this disorder. That's what I associate with Dr. Lloyd.

http://aboutmecfs.org/News/PRFeb06.aspx

 

[CBS]

Where is the IACFS/ME on this?

I was going to post this weeks ago on the thread discussing 'How the CAA was doing?' but didn't because I thought that it was as much the responsibility of a group like the IACFS/ME ('Dedicated to research, education, treatment and finding a cure for ME/CFS').

If doctors decided they were just studying those who meet the Holmes, or even the Canadian criteria, would there not be an outcry from those who can meet neither yet have a diagnosis of CFS/ME? And if they include all those with a diagnosis, then there would be an outcry from those who meet the more stringent requirements that the data has been diluted. All I know is that I would not want to be a researcher at this point!

Do we really think that patients are happier just because we're all stuck together in the same miserable sinking boat? Heterogeneous samples to not lead to clear concise conclusions and a well defined literature.

A group such as the IACFS/ME needs to step up and set some standards and define patient groups (God knows the CDC isn't going to do it!). They need to DEMAND that researchers clearly identify exactly how a cohort will be defined and then place the results of each study into it's appropriate category.

Such as:

Documented infectious onset - meets XYZ criteria
Suspected infectious sudden onset - meets XYZ criteria
No apparent infection - gradual onset - meets XYZ criteria

Who it to say that by setting those of us with a documented infectious onset aside that the studies of gradual onset folks won't lead to an answer for them first? And regardless of which group is studied, any definitive explanation/diagnosis for a particular subgroup helps everyone else by getting rid of statistical 'noise.'

We are all better off with a clear concise taxonomy. This is not about some people complaining. Right now this is about everyone complaining and with good reason. This is about good science and the lack there of leaving all of us stuck in this hell hole.

Cort;

Thank you for the additional info and your perspective on Dr. Lloyd.