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Infectious Diseases 4e chapter: Chronic Fatigue Syndrome by van der Meer & Bleijenberg

Snow Leopard

Hibernating
Messages
5,902
Location
South Australia
I'm not sure if this is simply an updated chapter for the 4th edition, which is officially released in 2017.

http://www.sciencedirect.com/science/article/pii/B9780702062858000708

Those of you who are familiar with van der Meer and Bleijenberg don't need to read it, you already know what it says. I'll save you the trouble by listing key points below.

Notable omissions are any discussion of post-maximal-exercise testing or the 2-day CPET. Likewise, almost nothing about POTS or autonomic dysfunction.

Oh and this very strange mistake:

There is no evidence-based drug treatment (hormones, immunomodulatory drugs, antimicrobials, psychotropic drugs) for CFS.4,78,79 In a small recent trial, a rather late beneficial effect of the anti-CD23 monoclonal antibody rituximab has been found.84 If this effect is real, it would imply an immunologic pathogenesis of CFS, possibly involving the T helper-17 pathway. However, given the serious potential side effects (e.g., progressive multifocal leukencephalopathy) and the costs of this treatment, further well-controlled trials are mandatory.

Reference 84 is of course: Fluge Ø., Bruland O., Risa K., et al.: Benefit from B-lymphocyte depletion using the anti-CD20 antibody rituximab in chronic fatigue syndrome: a double-blind and placebo-controlled study. PLoS ONE 2011; 6(10):e26358.

Now how they confused anti-CD23 (lumiliximab) with anti-CD20 (rituximab) and the mention of T helper 17 pathway shows you how little thought they put into trying to understand this therapy.

Oh and:
The recovery rates for CBT can go up to 70%, depending on the definition of recovery
citing themselves: Knoop H., Bleijenberg G., Gielissen M.F.M., et al.: Is a full recovery possible after cognitive behavioural therapy for chronic fatigue syndrome? Psychother Psychosom 2007; 76:171-176.

An important issue with regard to efficacy is the aim of CBT. In many studies improvement and rehabilitation is the treatment goal. Our CBT studies86,88–92 aimed to cure (i.e. disappearance of symptoms and functional impairment as its defined goal, ability to return to work and other activities and no longer considering oneself as a patient).1 It should be realized that if cure is not the goal of treatment, it will never be attained. Of great interest is our observation that – as mentioned above – there is a regain of gray matter with successful CBT, underscoring that the loss of gray matter in CFS is neurobiologically important, that CBT induces morphologic changes that point to plasticity of the brain.68
Another important question is whether the effect of CBT is lasting; a number of follow-up studies have shown that there is a sustained effect.93,94 However, there are a couple of problems with CBT. The first is availability: although the term cognitive behavioral therapy is widely used, specific CBT, tailor-made for CFS, is hard to get. A second major problem – fed by some patient organizations – is that many CFS patients have strong somatic attributions and reject the idea that a psychologic intervention may help them.

Conclusion
Over recent years, although our insight into the pathogenesis of CFS has increased and we have made progress with regard to our abilities to manage and treat the disorder, our knowledge of the syndrome is still too limited. Controversies about CFS between doctors, researchers and patients have not been particularly helpful in facilitating solid research and further solving the enigmas of the syndrome. In addition, such controversies are harmful to patients; healthcare workers should do their utmost to facilitate effective management of the condition, as proposed in the NICE guidelines

Yeah, you knew they would say that didn't you!

The wonders of avoiding pre and post-peer review (book chapters)!
 
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Gijs

Senior Member
Messages
690
Not depending on the definition of recovery also dependig on selection, Oxford is not CFS! If we use rituxmab and we use a lower rate for the definiton of recoverey maybe this drug can make 85% of the CFS patiënts better! Vd Meer and Blijenberg are no real scientists, they are clowns and charlatans. They are obsessed by CBT and fatique because it makes them a lot of money (fundings).
 

sarah darwins

Senior Member
Messages
2,508
Location
Cornwall, UK
So it's okay for me to use this line to sell my magic beans? Great.

Sarah's Magic Beans - only $5,000 / bag

Guaranteed up to 99% recovery from ME/CFS!!
(depending on the definition of 'recovery'*)

* This week I'm mostly using the "feel exactly like I did before I ate them only maybe a bit nauseous" definition
 
Messages
15,786
This statement is so ridiculous that it was laugh out loud funny. :rofl: Until I consider the fact that people might actually accept the statement as reasonable.
I don't think anyone would think that is reasonable, except the delusional people making the statement. Normal people don't think that "recovery" can be defined in various ways - if someone is recovered from their disease, that is recovery. It looks dodgy as hell to suggest that we can get different success rates if we fudge around with how we define recovery.
 

Snowdrop

Rebel without a biscuit
Messages
2,933
I don't think anyone would think that is reasonable, except the delusional people making the statement. Normal people don't think that "recovery" can be defined in various ways - if someone is recovered from their disease, that is recovery. It looks dodgy as hell to suggest that we can get different success rates if we fudge around with how we define recovery.

You're right of course but I think that there are people who will believe simply because an authority spoke and said that's how it works. There are plenty of people who don't have any understanding of science. It was these people I was thinking of.
 
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Hip

Senior Member
Messages
17,824
The recovery rates for CBT can go up to 70%, depending on the definition of recovery

It's incredible how psychologists and psychiatrists can get away with making such a fudged statement.

If they were selling a drug, the FDA would come down on these psychiatrists like a ton of bricks for making such dubious and misleading claims.

What we really need is for the FDA to also regulate medical psychological therapies such as CBT, and hold these therapies to the same standards of evidence that they apply to other medical treatments and interventions.

The FDA often respond to and close down websites or product advertising making false or misleading claims about a drug or other medical treatment. For example, here is what the FDA say about false or misleading product advertising:

Prescription Drug Advertising > Incorrect Product Claim Ad


We need the same regulations and the same standards of rigor applied to the claims of medical psychological therapies.
 
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sarah darwins

Senior Member
Messages
2,508
Location
Cornwall, UK
If they were selling a drug, the FDA would come down on these psychiatrists like a ton of bricks for making such dubious and misleading claims.

What we really need is for the FDA to also regulate medical psychological therapies such as CBT, and hold these therapies to the same standards of evidence that they apply to other medical treatments and interventions.

Exactly. That was kind of the point I was making with my 'magic beans' bit of nonsense. If I tried selling something that way I would soon be hearing from Trading Standards or the Advertising Authority here in the UK (it happened to the Lightning Process guy for making unsupported claims about recovery). But apparently it's just fine for people to advance their careers in the national health services and academia by using exactly the same tactics. Something very wrong here.
 

Sean

Senior Member
Messages
7,378
Considerable controversy surrounds CFS, with the potential for negative implications for the doctor–patient relationship.
Gee, I can't imagine whose fault that is.

Conceptually it makes sense to distinguish predisposing factors, precipitating factors and perpetuating factors.
As is true for every single disease or disorder humans suffer. Or indeed probably every single phenomenon in this world.

Congratulations, you have just discovered the concept of causation. The one that the rest of us discovered a few millennia ago. Do try to keep up.

Cognitive behavioral therapy, aiming at the perpetuating factors, and graded exercise therapy are the only treatments of proven efficacy.

The recovery rates for CBT can go up to 70%, depending on the definition of recovery.
Straight fraud.

I can understand how this irresponsible drivel might have made its way into a hopelessly compromised psych manual, but an infectious diseases manual?

The editors of that book should be ashamed of themselves, fired on the spot, and told to go clean toilets for the rest of their careers. Might need some training for that though.
 
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alex3619

Senior Member
Messages
13,810
Location
Logan, Queensland, Australia
The recovery rates for CBT can go up to 70%, depending on the definition of recovery

Somewhat funny.
[Satire] We could make em go up to 100% with just one visit, and no treatment at all, by making the definition of recovery that they are still breathing at the end of the first visit. So what? Umm, at least I hope so, don't want anyone to stop breathing.

Realistic recovery definitions, with objective criteria, are what count.
 

BruceInOz

Senior Member
Messages
172
Location
Tasmania
Controversies about CFS between doctors, researchers and patients have not been particularly helpful in facilitating solid research and further solving the enigmas of the syndrome. In addition, such controversies are harmful to patients; healthcare workers should do their utmost to facilitate effective management of the condition, as proposed in the NICE guidelines
So they admit other researchers have reached conclusions that differ from theirs but then assert that those holding different views should just go away because any view other than their own is damaging to patients.

Yeah right!
 

Little Bluestem

All Good Things Must Come to an End
Messages
4,930
As I often do, I am eating while I read this forum. There should be a warning to avoid threads like this while eating. :vomit:

The editors of that book should be ashamed of themselves, fired on the spot, and told to go clean toilets for the rest of their careers.
I would not want to use a toilet cleaned by these people. I do not think you could ever train them to do any work carefully and correctly. :nervous: