The patients in The dutch XMR study had symptoms purely of psychological cause XMRV Prevalence of xenotropic murine leukaemia virus-related virus in patients with chronic fatigue syndrome in the Netherlands: retrospective analysis of samples from an established cohort Frank J M van Kuppeveld, associate professor experimental virology1,5,6, Arjan S de Jong, molecular medical microbiologist1,5, Kjerstin H Lanke, research technician1,5,6, Gerald W Verhaegh, senior research fellow2,6, Willem J G Melchers, molecular medical microbiologist1,5,6, Caroline M A Swanink, medical microbiologist1, Gijs Bleijenberg, professor psychology4,5,7, Mihai G Netea, professor experimental internal medicine3,5, Jochem M D Galama, professor clinical virology1,5, Jos W M van der Meer, professor internal medicine3,5 Blood samples were sent to the central laboratory of the blood transfusion service in Amsterdam, where peripheral blood mononuclear cells were isolated for a study of lymphocyte subsets and apoptosis.11 Lets follow the blood trail reference 11 is the study below Swanink CM, Vercoulen JH, Galama JM, Roos MT, Meyaard L, van der Ven-Jongekrijg J, et al. Lymphocyte subsets, apoptosis, and cytokines in patients with chronic fatigue syndrome. J Infect Dis 1996;173:460-3.[Web of Science][Medline] Lymphocyte Subsets, Apoptosis, and Cytokines in Patients with Chronic Fatigue Syndrome Caroline M. A. Swanink, Jan H. M. M. Vercoulen, Joep M. D. Galama, Marijke T. L. Roos, Linde Meyaard, Johanna van der Ven-Jongekrijg, Ron de Nijs, Gijs Bleijenberg, Jan F. M. Fennis, Frank Miedema, and Jos W. M. van der Meer Departments of General Internal Medicine, Medical Microbiolog Me y, and MEDICAL PSYCHOLOGY, University Hospital Nijmegen, Nijmegen; Department of Clinical Viro-Immunology, Central Laboratory of the Netherlands Red Cross Blood Transfusion Service, and Laboratory for Clinical and Experimental Immunology, University of Amsterdam, Amsterdam, Netherlands Materials and Methods Subjects. Seventy-six patients and 69 healthy controls matched for sex, age, and neighborhood were included in the study. As de- scribed before, patients were randomly chosen from a data base of 298 patients with CFS using a table of random numbers . This larger patient group, which was self-referred, is described in detail by Vercoulen et al.  . All patients complained of severe debilitating fatigue lasting at least 1 year that impaired both physical and mental functioning and for which no explanation was found in previous medical investigations. All The mean age of the patients was 40 years (range, 20-60), and the male-to-female ratio was 1:3. The selected patients were invited to visit our outpatient clinic for a detailed medical history and physical examination. Fatigue, depression, and psychological well-being were assessed by the Checklist Individual Strength (CIS), Beck Depression Inventory, and Sickness Impact Profile as previously described . Trial 11 follows (see attachment) The trial in question is attached TELEPHONE DIAGNOSIS SELF REPORTS OF SELF REFERED PATIENTS WHICH PERSON WITH ME/CFS SELF REFERS TO A CBT CLINIC!? This is the cohort the Dutch study used Ive included an explanation of the table in the study attached Characteristics below (see attached study & table that form the basis of the failed Dutch study) The attached table is quite difficult to understand If you look at fatigue then the level of fatigue changes with your psychological wellbeing your level of self sufficiency and your level of functional impairment. The worse your psychological wellbeing the more fatigue the patients felt. The less the patients did the the more fatigued they were. The more self sufficient they were the less fatigued .get the idea. As another example the level of psychological well being determined the problems the patients had with concentration,sleep disturbances causal attributions social function and functional impairment. Again the symptoms get worse as the levels of psychological wellbeing fall. The catch 22 is that attribution of a physical cause such as a virus infection is linked to psychological function!! If you can stand going through it all you will find that the origin of all the problems are all psychological. So if the conclusions of the authors are true then none of the patients in the subsequent trials including the failed dutch study had CFS. If the origins are psychological then the patients had psychological problems.Most likely the cause was depression as these patients are the most likely to self refer.