Neuroendocrine and immune contributors to fatigue (CDC) (mostly on CFS)

(Despite its title, most of this article is on CFS)

This article is now available for free at:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2933136/

Christine Heim and Urs Nater have been heavily involved in the CFS program at the CDC. One gets an insight into their views with this review which is largely on CFS

e.g.
Immune System

[..]

I had to abbreviate as one can only so many characters in the title - maybe I should have made this more clear.

However, it is important to remember that there is a core CDC CFS program (around US$4-5m a year) and team. Only 5-10 people would have been corresponding authors on papers. If one searches PubMed for "reeves wc"[au] cfs one can see the names that keep coming up with Nater and/or Heim involved in a lot of the studies and I don't think they are particularly better papers.
There is not really a NIH program as such.

Silverman the lead author you refer to appears to be more into fatigue research - she has no references for CFS papers in this paper. My guess is she was more responsible for the more general fatigue parts with Heim and Nater having a lot of influence on the CFS part. They certainly signed it so it gives an idea what they are willing to agree to. I'm not particularly interested in what Silverman might agree to as she seems to be a nobody in CFS terms. ETA: I just searched for Silverman and nothing showed up for CFS papers.

Their Early Life Stress (ELS) papers used the so-called empiric criteria (Reeves et al., 2005) for CFS. I think it's best to regard these as not CFS papers at all. I'm not one to say Fukuda studies are rubbish but this hugely inflated the prevalence rates (around 10-fold) giving an idea how diluted a definition it is.

Yes, something along those lines. The others were the CFS "experts" and what one sees is much more likely to be their views. Or as I said, they signed up to it anyway.

Also, she is unlikely to be called as a CFS expert while the others might. So I think it is of more interest to hear what they are saying. Similarly it might give an idea where the CDC's budget might be spent more than how the NIH budget might be spent (especially as it doesn't have much of an inhouse program and it's unclear that she would be involved if they were doing research).

You are right that it would be different from a lot of what is said which is more about lifestyle e.g. one could get better simply by doing more.

At the same time, it is unclear how treatable trauma is while if there's an infection involved, that could be treated.

But mainly I think the two CDC studies they quote, although they can look impressive as they are randomly done community studies, are junk because of the definition used.

I think this shows how difficult it is to put the CDC CFS research program into a box or into a tight category...this is not just a psychological interpretation of CFS; it at times attempts to account for symptoms using physiological measures; ie inflammation - low cortisol...

They do not believe that the problems of at least a subset of patients are driven by a chronic infection but they also tie in these other factors. They show that inflammation in CFS is not simply the result of depression or is not simply tied to depression - and they believe that it contributes to the fatigue in the disorder as well. It's an interesting blend of 'psychology' and physiology. I actually think we'll be seeing more of this as researchers look deeper into things like neuro-inflammation and inflammation overall. This is like a demi-Sickness behavior approach.

One problem is that they are very slow - that inflammatory study they talked about just measured two or three factors.....They do not appear to be interested in looking for a herpesvirus subset....they are very conservative but the physiological findings are keeping parts of their feet on the ground.