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P2P workshop Dec. 9 & 10, 2014

CBS

Senior Member
Messages
1,522
I found it odd that menopause was considered a comorbid condition. It's like saying 'being female and over 50 is a comorbid condition'.

@Sasha

If I heard her (Klimas?) correctly, menopause is associated with changes in ME/CFS severity (mostly worsening but also improvement in some). At the time this point was being made (eiither immediately before or after menopause was singled out), wasn't she emphasizing the association of many endocrine issues with changes of severity in some patients? I know that the slide listed hypothyroidism and low testosterone in males in a very high percentage (+35%) of patients?
 

Sasha

Fine, thank you
Messages
17,863
Location
UK
@Sasha

If I heard her (Klimas?) correctly, menopause is associated with changes in ME/CFS severity (mostly worsening but also improvement in some). At the time this point was being made (eiither immediately before or after menopause was singled out), wasn't she emphasizing the association of many endocrine issues with changes of severity in some patients? I know that the slide listed hypothyroidism and low testosterone in males in a very high percentage (+35%) of patients?

I was a bit misleading - I was actually picking up on a slide from someone's earlier presentation on comorbidities (possibly yesterday's). Sorry, my brain has gone...
 

Kati

Patient in training
Messages
5,497
In closing we need good measures for mecfs. Case definition alone will be insufficient. ( what does that mean?)
Case definition will always bring bias, because it can not be measured the same way that an antibody titer can be measured, for instance.
 

Kati

Patient in training
Messages
5,497
Klimas

Disclosure - I am broke (?)

This is not an early IOM report says Klimas.
The way I interpreted it is that Dr Klimas is by all means not getting rich from practicing medicine and operating a research center. This is a labor of love. She probably spends more money than she is making caring for her patients and researching them/us.
 
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Rrrr

Senior Member
Messages
1,591
Idea: Let's flood P2P's email with this short note below. I think it has to be sent to them TONIGHT for them to consider including it in their initial report. Feel free to forward or post on social media, without my name or email attached.
___

FLOOD P2P'S EMAIL -- TONIGHT ONLY (10/10/14)
Their email: prevention@mail.nih.gov


Dear P2P Members,

Please consider this in your discussions as you prepare your report on ME.

ABCNews, California, Dec 8, 2014
http://abc7news.com/428225/
"New technology could help doctors ID chronic fatigue syndrome in patients"

Best,
XXXXXX
XXXXX
 

snowathlete

Senior Member
Messages
5,374
Location
UK
They would have given a very different presentation in private. All three have published together, and shown a strong BPS belief - they believe that maintaining factors in CFS are due to thoughts and behaviors, all functional syndromes are the same psychosomatic disorder, and 100% of the symptoms which they acknowledge us as having are due to us being over-sensitized.

So they settled for peripheral topics while trying to imply that it's actually relevant, while inserting little BPS jabs now and again.

If they'd been more outspoken and even intelligible about those points when they implied them, they would have started a war in the lecture hall. I think they were relying on the panel members picking up on code words and implications, but that's only likely to work among people with a strong BPS background. So the panel members hopefully just found those three to be off-topic, annoying, and a bit bizarre.

What concerns me is what does go on behind closed doors? I mean, this is a jury model, right; but does that mean the jury are locked away and 'witnesses' and 'experts' aren't allowed to talk with them? Or is it really open to abuse in which case what gets said behind closed doors could be what really matters. Anyone know?
 

snowathlete

Senior Member
Messages
5,374
Location
UK
Since high levels of anellovirus are seen in immune suppression, I've wondered if the low levels in ME/cfs reported by Lipkin might be a marker of an immune system in high gear.

Me too.
Many don't get colds/flu etc, and I believe it is because part of our immune system is ramped up all the time as if we have a viral infection. So when a virus does show up there is no lead time to getting the troops out to fight the invader, it just gets blown aPart by the AK47s before it has a chance to really do much.
 

geraldt52

Senior Member
Messages
602
ABCNews, California, Dec 8, 2014
http://abc7news.com/428225/
"New technology could help doctors ID chronic fatigue syndrome in patients"

I live in the SF bay area and saw the news clip above when it was broadcast live. Unfortunately it was at 11PM, so not sure how many viewers were paying attention in a city where the commute begins at 4AM. Nonetheless, it was a decent report as reports on CFS go...very brief, but accurate and respectful...no doubt thanks to Dr. Jose Montoya, truly one of the best friends of PWME.
 

Sing

Senior Member
Messages
1,782
Location
New England
Looking over my notes from the past two days, I found some points to address.

1. The first one clearly is that they should support an accurate case definition which is both sensitive and selective, giving priority to selectivity--in other words, a narrower, more specific definition. The Epidemiologist, Dr. Nacul explained exactly why this is so. He showed how Fukuda leaves itself open to far too many possible combinations of symptoms which don't have key characteristics of ME/CFS. Dr. Jason went through this too, with the full analysis of the 8 definitions.

2. The second is to establish valid biomarkers and tests.

3. Treatments which have already been shown to be effective in at least well characterized patients or subgroups, such as Ampligen and Rituxan, ought to be studied conclusively so they could become approved.

4. However, as far as other treatments already accepted or known to be useful in sometimes overlapping, co-morbid or similar conditions, these treatments ought NOT to be assumed to be useful in ME/CFS. Dr. Susan Maier in her opening talk on Monday proposed this idea and it seemed to me implied with the Mapp (?) model of collaboration with research into other conditions with some similarity. As Dr. Klimas clearly stated at the end of Day 2, it is necessary to test IN our patient population and not just generalize from other conditions. She gave the example of Dr. Peter Rowe assuming that Fludrocortisone would be as useful in our population as in others with Orthostatic Intolerance but this turned out not to be so.

Two other glaring examples of treatments used for other conditions which do not work for us:

a. Anti-depressants which work for FM and for Depression but which make people with ME/CFS, who have been shown to have upregulated serotonergic pathways/levels, worse.

b. CBT and GET which have been known to work for patients who are depressed--known for at least 30 years as the only two non drug treatments which can help Depression--this was generalized to us by the British psych researchers. Because the definition for CFS used was so broad and non-specific, and because it applied equally well to depressed patients, and because there are far more depressed people than those with ME/CFS, the numbers of primarily depressed patients in these studies could overwhelm our numbers and shift the findings to what applied to them, not us.Those studies that Dr. Nelson admired so much for their methods might have been fine as studies--only they weren't studying ME/CFS. They were studying Depression and incorporating depressed patients as subjects, and their results apply predominantly therefore to this group.

The call is for more money, but no amount of money will help if the research done does not apply to us. Neither should studies be designed and chosen on the basis of what just seems "interesting" to particular researchers or what is most high tech or advanced. The research needs to be selected on the basis of how well it improves OUR QUALITY OF LIFE. And whenever treatments are found, they need to be affordable and accessible to everyone.
 
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alex3619

Senior Member
Messages
13,810
Location
Logan, Queensland, Australia
ABCNews, California, Dec 8, 2014
http://abc7news.com/428225/
"New technology could help doctors ID chronic fatigue syndrome in patients"
I think this will be automatically excluded, for a bunch of reasons. They are following rules, and those rules will exclude almost everything of interest. What is of some value though is not only sending them the message, but making it public that you have done so. When its ignored then we have an additional action point for advocacy.

The paper on the right arcuate fasciculus was published some time ago, and this is what was referred to in the news link. It either is or is not already in the literature review. I guess not, but have not checked - my computer is fubar right now.
 
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melamine

Senior Member
Messages
341
Location
Upstate NY
Dr. Natelson is trying to recruit more severely affected patients - esp. bedbound/ homebound -- and it sounds like they are trying to make home visits. So for those in the NY/ NJ area or if you know people/ support groups in those areas, here's his contact info:

Beware. Maybe it's legit, but my experience with Dr Natelson makes me highly skeptical of his intent. Ask questions and know what you're getting into.
 

Wally

Senior Member
Messages
1,167
@Wally,

I think this will be automatically excluded, for a bunch of reasons. They are following rules, and those rules will exclude almost everything of interest. What is of some value though is not only sending them the message, but making it public that you have done so. When its ignored then we have an additional action point for advocacy.

The paper on the right arcuate fasciculus was published some time ago, and this is what was referred to in the news link. It either is or is not already in the literature review. I guess not, but have not checked - my computer if fubar right now.
@alex3619,

I think your reply may have been meant for @Rrrr? Fighting a nasty migraine today and I am definitely cognitively challenged :ill:, so perhaps the tag was meant to tie into something else that I have posted? :confused: Always enjoy reading what you post, so either way - thanks for the tag. :)

Wally :cool:

P.S. Typing with my eyes closed while wearing sunglasses today, so excuse any typos I might have made. Yikes! I hope I have not given away any inside secrets about the drafting of the P2P and IOM reports. :eek:
 

Sidereal

Senior Member
Messages
4,856
Who are they? I can only comment on one, Benjamin Natelson, who is attached to one of the hospitals in NY. I will preface by saying that I have a decades-long history of post-viral CFS (with encephalitis), followed about 18 years later by a degenerative period that is even more consistent with ME. Most of my symptoms were directly associated with infections or other medical events and definitive points in time.

Dr Natelson is involved in a CFS study that sounded decently useful, so I went to see him last June for the purpose of being evaluated for inclusion in it. I offered to provide any of the many test results I've had in recent years, including those demonstrating chronic immune abnormalities. None were requested and no more than a superficial history was taken, after which Dr Natelson told me I was excluded. Based on?.....too many symptoms? Too many complications from long-standing neglect?...He didn't say directly, but recommended psychotherapy after giving me a dose of the usual - though shocking in this instance -"When did you go on disability, what were you doing before that, why haven't you been working", etc. Zero interest in critical - medical - aspects of my history.

Thanks a lot for sharing this. With friends like these, who needs enemies?
 

Anne

Senior Member
Messages
295
(haven't read the entire thread)

Those of you who followed the workshop, any chance you could sum up your impressions just in a few sentences? Was is as bad as could be expected?

Thanks to everyone reporting and keeping us updated.
 

Esther12

Senior Member
Messages
13,774
Was is as bad as could be expected?

Depends on your expectations.

I thought that it wasn't entirely terrible. I didn't see a number of the presentations, I paid the most attention to my areas of interest, but my impression was:

If it wasn't for some problems with the way the evidence review assessed CBT and GET, it could have been good. And even here, they did still acknowledge problems with the way PACE had defined recovery, some slight reference to potential problems with bias for treatments that themselves make positive claims about their own efficacy, etc.

If this process had been done well, I think it would have been really good for patients. That was never likely to happen. Its quality was at the point where I do not know if it will end up being good or bad for us overall. I fear bad, but hope for good. I guess we'll have to see.

We're still at the point where we don't have much to go on and the most immediate and important impact on patients will be whether they suggest doctors recommend CBT and GET to all patients. I have no idea whether their recommendations on criteria are likely to be helpful for research going forward.
 
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Valentijn

Senior Member
Messages
15,786
There were a few bad and irrelevant presentations, but most were very good, as were the audience questions. I think their people who were summarizing the research really understood it, and understood many of the criticisms of the CBT/GET stuff.

But they were still giving a lot of weight to PACE and other research using the Oxford definition, despite recommending that the Oxford definition be retired. They also used the PACE outcomes farce as an example of why they wouldn't say that these therapies resulted in recovery. But if the methodology is so unreliable, it's a bit nutters to still use the results from those trials as an indication that CBT or GET is at all successful.

There was also a lot of good discussion about what needs to be researched, which everyone seemed to agree is "quite a lot, with large studies". Yet a good question from audience members was: "What's the point in recommending these projects, since the NIH has already refused to fund those exact projects in the very recent past?"

So I think they understand what is going on, are making a couple concessions, and are deliberately spinning the rest so that they can continue to elevate CBT and GET as being "evidence-based". There is a push for research, but no push for funding it, which means that the research situation will continue to stagnate indefinitely.
 

Kati

Patient in training
Messages
5,497
The problem I forese is that i believe the panel has a good idea of what will be in the report and is not likely to change its mind.

I could see that in the one CBT presenter who appeared in a few presentations.
While our own experts did a good job talking about the topic they were asked to talk about and many of them who asked good questions (Klimas, Kogelnik, Fletcher, Jason are examples) I wonder how much weigh they will be given considering that the panel did not read that kind of science.
 
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Sing

Senior Member
Messages
1,782
Location
New England
I wouldn't give up before this is over. I hope a number of people here do write to the panel starting on Dec. 18th, when input will be taken. I thought our specialists, patient advocates and patients made a really strong showing. We were clear, informed and spoke with one common voice, repeating many of the same ideas. We had the emotional power, science and reason all working together.