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New Klimas Paper- NPY, Stress, HPA Axis and CFS

Discussion in 'XMRV Research and Replication Studies' started by shannah, Dec 29, 2010.

  1. WillowJ

    WillowJ Senior Member

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    And there are others in your subgroup.

    But there are others in my subgroup, too, who just don't find any correlation between stress and our disease (other than that having a chronic disease causes a certain amount of stress--which doesn't make this a stress-related disease; and this disease in particular makes certain kinds of stress harder to deal with, especially if there's any adrenalin involved--which still doesn't make this a stress-related disease).

    And studying the stress connection in your subgroup at this point in time will reinforce negative stereotypes and stymatizing myths, even if that wasn't intended, even if linked to a real biomarker. The psychobabble crowd will either ignore the biomarker or make an ad hoc fallacy incorporating it into their model (like they have done with cytokines).

    And it still doesn't explain why their background reads like most of it was written by William Reeves, James Jones, or Samuel Harvey.

    edit: background sounding like it was written by Reeves, etc. was probably an overreaction on my part, due to higher expectations given Klimas and Fletcher's names on the study and given that I don't normally read psychology studies other than those related to CFS, and particularly given the politicized environment surrounding ME/CFS at the current time (and that a huge part of that politicization is the fraudulent idea that stress and maladaptive coping, such as focusing on symptoms [or even on "normal bodily processes" erroneously believed to be symptoms] and believing one has a serious debilitating physiological disease which should be treated with rest/pacing, cause the disease instead of an organic disease process).

    The paper did leave a lot to be desired as far as explaining what the disease was (which, in my opinion, should be done at every opportunity--although possibly they had a better chance of being published without), and as far as being careful to define what they meant by terms which have standard uses in CFS (standard uses which were established by the Wessely crowd) but which this study was using differently.

    The focus on excacerbation via stress was understandable given that they were specifically talking about those patients who have a worse response to stress (patients who do exist), but this was still a little confusing to me given the points that 1) they were also talking about a group who doesn't respond to CBT (if you can't remediate it through psychotherapy, it's doubtful that psychosis played any significant role, even in an exacerbatory role) and 2) they were talking about a biomarker they tied to a viral infection (also doubtful that stress plays a role, even in an exacerbatory function).
  2. lansbergen

    lansbergen Senior Member

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    The renewed interest in viral infections in CFS suggests further studies. It is possible
    that NPY is induced by such infections. As reliable assays become available it will be important to determine the relationship of plasma NPY to potential pathogens.
  3. IamME

    IamME Too sick for an identity

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    The paper claims the neuropeptide reflects symptom severity yet the only symptoms they could find mysteriously enough were psychological ones, no muscle weakness/fatiguability, pain, sensory abnormalities, cardiovascular, gastroenteric etc. And using Reeves' definition? Not happy at all about this. this is the sort of thing that just reifies "symptoms = mood and psych stuff". How about actually trying to objectively measure disability as good papers have done in the past.
  4. WillowJ

    WillowJ Senior Member

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    not Reeves definition; that was my bad. they were citing that other paper about resolving ambiguities (with Jason and Klimas in addition to Reeves), and used Fukuda as modified by the international group cited previously in this thread
  5. Angela Kennedy

    Angela Kennedy *****

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    Thank you Willow. Key problems. I will say I believe 'sub-groups'/'subsets' are highly problematic notions at this time also (and may always be.) I think these notions, accepted uncritically, have caused terrible trouble for people with the neurological, cardiovascular and other physiological impairments that fall into the Canadian Criteria, and have confounded nearly all research on 'CFS'.
  6. Angela Kennedy

    Angela Kennedy *****

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    Yes- beautifully put IamME. "symptoms = mood and psych stuff'. Funny but completely apt. I wish Klimas and colleagues could understand this problem that they actually perpetuate. It shocks me they appear not to, frankly.
  7. eric_s

    eric_s Senior Member

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    I would also prefer a study that focuses less on stress and the sort of symtoms looked at here, but if what they've found is true then it's true and one step forward. If they have found a biomarker then that seems like quite a breakthrough and could lead to more knowledge if they follow that lead.

    Some people have those symptoms and i think the idea that a pathogen could explain the abnormally high NPY and thus those symptoms is interesting. I don't consider ME/CFS stress-related, btw, and don't like that idea. I believe it's caused by a pathogen.
  8. oceanblue

    oceanblue Senior Member

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    I think the Fukuda criteria modified by Reeves (2003) are fine; this work was done by an international study group including Lenny Jason and just tweaked the Fukuda definition. It was the later Reeves 2005 Empirical definition, produced in isolation by the CDC, that causes the problems since it allows patients to qualify for CFS even if their inactivity is the result of psychological factors.

    However, the ability of NPY as a biomarker is not supported by the data. An ROC of around 0.65 for separating CFS patients from Healthy and Gulf War Illness patients is very poor, given that random chance would give an ROC of 0.5, and a perfect marker would give a score of 1.0. I think you need at least 0.85 to be useful in clinical practice.
  9. eric_s

    eric_s Senior Member

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    Thanks Oceanblue for that information. So in this case, i guess they think the more important finding is that NPY correlates with some symptoms and is a biomarker for those, not so much for the illness itself. Are the numbers better there?

    Is it possible to say how likely it is (in a number) that the difference in NPY values between ME/CFS and healthies they have found is due to chance? What i also think would be interesting is if there was data about people suffering from depression, for example, if they also have elevated NPY.
  10. aruschima

    aruschima I know nothing

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    It is unfortunate, actually very manipulative, that this study (paper) highlights the stress factor of elevated NPY . NPY has been found and associated in many disorder and diseases. It is certainly wrong (I think) that elevated levels should be construed as a bio marker for ME/CFS, since it is found elevated, or decreased, in many other diseases associated with the brain diseases, even cancers.
    I wonder what Nancy Klimas role was in this study and I am also not happy with the interpretation of this study.
    ADD ON, if elevation correlates with symptom severity, than yes, it could be helpful for disability claims, but it should not be construed as a marker in respect to stress or shady behavior studies in ME/CFS

    http://www.google.co.in/search?hl=e...ancer&btnG=Search&aq=f&aqi=&aql=&oq=&gs_rfai=

    http://atlasgeneticsoncology.org/Genes/NPYID44438ch7p15.html


  11. Angela Kennedy

    Angela Kennedy *****

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    Well, bearing in mind Oceanblue and Arsuchima's comments, this study does become even more preposterous in appearance, because of its focus on 'perceived stress' and negative thoughts etc.

    At its best it's confounding ubiquitous psychosocial variables that are found in response to major illness or even other conditions, and allowing causation direction fallacies as found in psychogenic explanations to abound, AND ignores the physiological abnormalities associated with 'Canadian' defined ME/CFS.

    And no matter how we here can pick up the flaws and problems - Klimas et al are not likely to take them on board, and Heim, Reeves, Wessely, Jones et al will make their own predictable flawed interpretations, and the 'CFS = mood and psych stuff' myth is further reified.
  12. oceanblue

    oceanblue Senior Member

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    Not really. First, they only had data on 42 CFS patients. Second, they looked mainly at psychological factors and not at the more physical measures such as the SF36 Role Physical and Physical Functioning sub-scales. The only SF36 measure to correlate with p<0.05 (the standard level of significance in studies) is the General Health sub-scale which other studies have shown correlates only weakly with CFS severity. OR put another way, they haven't measured CFS illness severity very well, and they've only used a small sample so it's all a bit of a waste of time and space. Guess I'm not feeling very charitable post-Christmas.

    Sorry, my stats isn't up to this but from what I know their findings on CFS vs healthy are not clinically useful. Just look at the data on page 27 to see the overlap between healthy and patients.
  13. alex3619

    alex3619 Senior Member

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    Hi everyone, if the data holds NPY is a correlating biomarker for CFS severity, not a diagnostic marker. Bye, Alex
  14. WillowJ

    WillowJ Senior Member

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    I'm not saying stress correlation is an invalid subgroup. It seems to be valid. I'm saying this is the wrong point in time to be looking at that, and/or the wrong way to write a background section without fully explaining that the stress is a symptom resulting from the disease.
  15. Cort

    Cort Phoenix Rising Founder

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    Exactly......
  16. Cort

    Cort Phoenix Rising Founder

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    It may be because she measured those variables. I have had similar complaints with hypercortisolism; its also found in FM and PTSD - which is always mentioned but it is also found in rheumatoid arthritis, I believe, which is never mentioned......

    I would hope that she would reference those other connections in the conclusions of the paper...I don't know if she did...However people researching NPY should be familiar with them.
  17. Angela Kennedy

    Angela Kennedy *****

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    But trying to find a 'stress-correlated subgroup' for G.93 Myalgic encephalomyelitis/Canadian defined ME/CFS is like looking for a 'stress-correlated subgroup' for AIDS, or MND. It only gets entertained because of the incorrect conflation of ME with 'chronic fatigue', and the special pleading given about people diagnosed with 'CFS' but with signs and symptoms of 'ME' or other neurological/cardiovascular conditions.

    That's before we even consider the problems in claims around 'stress' and somatic illness per se (which has been critiqued by others, by the way).
  18. Angela Kennedy

    Angela Kennedy *****

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    But 'people' researching ME/CFS, especially given the amount of logical errors made in ME/CFS research, are likely to fixate on the myth of 'stress' and other psychosocial variables as causative .

    Yes- I'm accusing the scientists of getting it very, very wrong. That's why people are in the mess they are in: various scientists have been getting it very, very wrong. (What was that about a recent press release getting it very, very wrong? From scientists?)
  19. Cort

    Cort Phoenix Rising Founder

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    I understand and I fully agree that I am part of one subgroup that does not apply to others.....I think she is elucidating a subset - the subset who's ANS is aroused and just will not turn off..On the other hand that is what she has found....Stress is tough subject...for sure...full of pitfalls

    Here's from a paper I did.

    The thing about NPY is that it regulates immune and other systems. I'm still trying to find out how...I know I wrote something on it...
  20. Cort

    Cort Phoenix Rising Founder

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    I agree after reading the abstract again that it is a difficult pill to swallow....My hope is that she ties this to physiological measures; ie these factors are contributing or causing these problems. Of course it does reinforce stereotypes - you just can't get away from that....its rough, that's for sure.

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