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Science at the UK CMRC Conference, 1-2 Sept 2014

Jonathan Edwards

"Gibberish"
Messages
5,256
Actually it does look the model for central sensitization is something of an issue.

Apologies for being out of the loop for a microsecond or two - just doing an interview for Canary in a Coal Mine this afternoon in some weird shed in Brixton - nice to meet Jen Brea, and Lindsey again, tho'. (Only teasing - it was good fun.)

To be precise: I think Valentijn and Marco are both absolutely right - gradually homing in on the nub of the matter.
 

Simon

Senior Member
Messages
3,789
Location
Monmouth, UK
I haven't been able to keep up with this thread, but it seems a good time to mention the work of Hugh Perry, Chair of the immune section at the CMRC conference and a professor of experimental neuropathology. He's been one of the leading lights in looking at the role of microglial priming in age-related disorders. This is a recent Nature review of his:
Microglial priming in neurodegenerative disease : Nature Reviews Neurology (2014)

His interest stemmed from the observation that infection often resulted in cognitive decline in illnesses such as Alzeheimers.

He recently proposed that primed microglia could play a role in ME/CFS, though he doesn't explicitly doesn't see this an a neurodegenerative disease:
Primed microglia in ME/CFS? (blog)
At the recent International Symposium for CFS/ME in Australia Perry suggested that priming of microglia could be behind this illness as well (though he doesn’t think neurones degenerate in ME/CFS the way they do in the other illnesses he studies). Once primed, Perry argues, an infection could send the microglia into a permanently activated state, triggering a long-term sickness response.
 
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NK17

Senior Member
Messages
592
Apologies for being out of the loop for a microsecond or two - just doing an interview for Canary in a Coal Mine this afternoon in some weird shed in Brixton - nice to meet Jen Brea, and Lindsey again, tho'. (Only teasing - it was good fun.)

To be precise: I think Valentijn and Marco are both absolutely right - gradually homing in on the nub of the matter.
I was starting to wonder about your secret super hero quality: internet ubiquitousness.
 

Jonathan Edwards

"Gibberish"
Messages
5,256
Getting back on topic I'd like to ask @Jonathan Edwards a simple question.

I have never joined or even followed any ME/CFS internet groups until 2009 when the XMRV paper was published. Prior to to that it just seemed that there were a bunch of unrelated and often harebrained theories but no progress.

Debacle as it turned out to be, the XMRV story did have some major benefits in attracting the attention of major researchers, private funding and even the MRC research programme now has a sense of purpose. But still we have a wide range of sometimes incompatible theories.

Question being - how optimistic is Jonathan that we will have an 'answer' within the next 5 years (a cure or even effective treatment strikes me as a little too much to ask).

We will have the answer in five years, Marco. All these groups of people in ME research, however awful some of them may seem to be, have been whittling away at the possibilities. A whole lot of other scientists from other fields are now homing in on the problem. We need some careful thinking but somebody will come up with the answer. It may be a very complicated answer but I think it will be clear.
 

Marco

Grrrrrrr!
Messages
2,386
Location
Near Cognac, France
To be precise: I think Valentijn and Marco are both absolutely right - gradually homing in on the nub of the matter.[/quote]

Bio - psycho - social - and diplomatic !
 

Marco

Grrrrrrr!
Messages
2,386
Location
Near Cognac, France
Bio - psycho - social - and diplomatic !

Now that's a bit of a curveball Marco.[/quote]

No big deal. I hope you agree that a physician needs to consider non-medical issues even if considered secondary to proper medical treatment? As for diplomacy - I appreciated the summary of me and Valenijn's discussion and really we're not too far apart.

That's all!
 

A.B.

Senior Member
Messages
3,780
No big deal. I hope you agree that a physician needs to consider non-medical issues even if considered secondary to proper medical treatment? As for diplomacy - I appreciated the summary of me and Valenijn's discussion and really we're not too far apart.

That's all!

Biopsychosocial might sound sensible to the naive reader (taking all aspects into account is certainly better than taking just one into account, right?), but in practice it is an euphemism for psychosomatic. Remember: psychiatry specializes in language, not medicine. To understand what they really think one has to look at their actions, not their words. There is almost no "bio" in the BPS. The "psycho" and "social" aspects are profoundly misanthropic and antagonistic.

The BPS model doesn't really exist either in the sense that there is no model, merely the statement that biological, psychological and social factors all matter. Which is then used to label illnesses as psychosomatic and pretending to treat them with psychotherapy or antidepressants.
 

chipmunk1

Senior Member
Messages
765
Maybe, or it's pseudo-neurology, used by quacks to sound impressive while still reaching their universal conclusion that CBT is the One True Cure.

if something is said to be good for everything it might be effective for nothing. CBT does certainly fit into this.
 

chipmunk1

Senior Member
Messages
765
To understand what they really think one has to look at their actions, not their words. There is almost no "bio" in the BPS. The "psycho" and "social" aspects are profoundly misanthropic and antagonistic.

There is BIO in the BPS but it doesn't have an active function. It doesn't do anything on it's own. It's entirely governed by PSYCHO and SOCIAL and SOCIAL is mostly influenced by PSYCHO.

The model is brilliant in the sense that it allows BIO to exist and acknowledges it's existence and at the same time it makes BIO irrelevant in practice. Many psychoanalytic ideas wouldn't have survived with advances in medicine and science.

100 years ago it was acceptable to claim bleeding was entirely psychosomatic. Physiology is always harder to ignore the more advanced medical testing becomes. Now we can claim physiological problems are caused by poor lifestyle choice which are due character flaws which may be due inner unresolved conflicts and childhood trauma.

Nothing has changed. The causes have remained the same but the theories have changed and are more compatible with modern thought.

EDIT: I have to correct myself. Apparently it is still acceptable to believe bleeding is psychological. Never underestimate the babblers.

http://en.wikipedia.org/wiki/Somatization_disorder

Reproductive organ symptoms
  • Painful sensations in sex organs/genitals
  • Irregularity in menstrual cycles
  • Excessive menstrual bleeding
 
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Dx Revision Watch

Suzy Chapman Owner of Dx Revision Watch
Messages
3,061
Location
UK
Also, for DSM-IV's Somatization disorder criteria

"vomiting throughout pregnancy"

But for DSM-5, the DSM-IV Somatoform Disorders categories: somatization disorder [300.81], hypochondriasis [300.7], pain disorder, and undifferentiated somatoform disorder [300.82] were eliminated and have been replaced by Somatic Symptom Disorder and new criteria.
 
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Messages
1,446
.
Current political/economic application of the biopsychosocial theory:

https://mikesivier.wordpress.com/20...-gets-the-blame-for-the-biopsychosocial-saga/

‘Unum, Atos, the DWP and the WCA; Who gets the blame for the biopsychosocial saga?’

‘…… The Engels [Biopsychosocial] theory forms the basis of the system of insurance claims management adopted by US giant Unum when its bosses realised that their profits were being threatened by falling interest rates – meaning the company’s investments were losing value – and a rise in claims for “subjective illnesses” which had no clear biological markers – Myalgic Encephalomyelitis (ME), also known as Chronic Fatigue Syndrome (CFS), Fibromyalgia, Chronic Pain, Multiple Sclerosis, Lyme Disease, even Irritable Bowel Syndrome (IBS).

………Unum adapted the biopsychosocial model into a new medical examination that stripped it of its ‘bio’ and ‘social’ aspects in order to concentrate on the ‘psycho’ – with a relentless emphasis on an individual claimant’s beliefs and attitudes.

The new [Sickness Benefit] test aggressively disputed whether the claimant was ill, questioning illnesses that were “self-reported”, labelling some disabling conditions as “psychological”, and playing up the “subjective” nature of “mental” and “nervous” claims.

The thinking behind it was: Sickness is temporary. Illness is a behaviourall the things that people say and do that express and communicate their feelings of being unwell. The degree of this behaviour is dependent on the attitudes and beliefs of the individual, as well as the social context and culture. Illness is a personal choice. In other words: “It’s all in the mind; these people are fit to work.......”
 

lansbergen

Senior Member
Messages
2,512
@ Jonathan Edwards

When there is no adaptive response to an infectious agent will B cells still respond with antiibody production ad random?
 

user9876

Senior Member
Messages
4,556
@Jonathan Edwards

When there is no adaptive response to an infectious agent will B cells still respond with antiibody production ad random?

To expand on that question how does the rate of antibody production change when an infectious agent is present. Does the rate at which new (random) antibodies differ from that of copies of known antibodies. Is there any feedback loop to encourage particular antibodies that match with a given infectious agent?
 

Jonathan Edwards

"Gibberish"
Messages
5,256
@ Jonathan Edwards

When there is no adaptive response to an infectious agent will B cells still respond with antiibody production ad random?

The key distinction is between the generation of new B cells, each with a different antibody, and growing up of these B cells into clones of plasma cells that make enough antibody to have an effect in the bloodstream.

New B cells are produced at random every day of our lives. This does not change in the presence of infection. Infection cannot have any effect on the genesis of antibodies because there is no way of 'telling DNA what antibody to make'. So the immune system has to use what seems like a very wasteful process. It makes a billion new antibodies every day and hopes that maybe a handful of these may be just the ones needed to bind to any infection that happens along.

The system works because if any of these B cells happen to pick up a foreign protein binding to the antibody carried on their surface they immediately multiply to form maybe 100 cells, maybe 100,000 cells, each producing the antibody that sticks to the foreign protein. This is the 'response', which is quite distinct from the random antibody invention.

A reasonable analogy might be the way people write books. Regardless of whether or not anybody will ever publish them there are always millions of authors writing books they hope people will read. Every day a vast range of 'random' manuscripts are produced. Sadly, 99.99% of these never sell a single copy. For some the publisher just says no thanks - and the B cell dies in the bone marrow. For some the publisher says why not write a shorter book just using the first six chapters - that is called 'receptor editing' and the B cell has another chance. For some the publisher publishes and the books lie on the table by the door in Waterstone's but nobody buys. Within a month the B cell gets pulped. For the lucky few someone picks them up and reads and says 'wow, I must tell everyone about this, this is so-o-o timely and relevant to the world situation'. Millions of copies get sold.

So life-enhancing books get sold at the time when they are of interest.

But imagine that one of our random authors writes a book called 'Mein Kampf'. It lies on the table and people pick it up and say 'wow, this is so-o-o timely for us in Germany, it is the way to restore the health of our great nation'. Millions of copies are sold and the result is the catastrophe of war. That is how I view autoimmunity.

So the answer to the historians' eternal question of what causes a war is that human society is so complex that it is inherently unstable from within. A particular set of circumstances within society itself can set off an unstoppable cascade of destruction. I see the immune system as very similar. It is a society of individual cells co-operating but also competing. It is complicated enough to be susceptible to the same internal instabilities.
 

MeSci

ME/CFS since 1995; activity level 6?
Messages
8,231
Location
Cornwall, UK
Also, for DSM-IV's Somatization disorder criteria

"vomiting throughout pregnancy"

But for DSM-5, the DSM-IV Somatoform Disorders categories: somatization disorder [300.81], hypochondriasis [300.7], pain disorder, and undifferentiated somatoform disorder [300.82] were eliminated and have been replaced by Somatic Symptom Disorder and new criteria.

Sorry this is O-T (as are the above posts :D and sorry if there is a later post telling us to stop - I haven't seen it yet and am in a rush as usual) but this weird site lists alternative/earlier terms for psychosomatic.
 

alex3619

Senior Member
Messages
13,810
Location
Logan, Queensland, Australia
Going back to the issue of central sensiti(z/s)ation, its potentially a scientific argument as it has specific mechanisms that can be disproved. This does not mean the idea is not being misused in BPS arguments for example. What it means is that even if it is wrong it is not necessarily unscientific as a concept.

Most of BPS arguments are waffle and sleight of hand. From the beginning of its formal use it has been synonymous with psychosomatic hypotheses. I do think constant reference to insurance industry misuse of the concept can be misleading, as there is a much wider political, ideological and economic support base than just that.

Psychosomatic claims about specific diseases on the other hand are unscientific, or what used to be called nonscience. Claiming them as science is pseudoscience. Read my signature for more on this.

I wrote a blog in three parts on a book on BPS here ;

http://forums.phoenixrising.me/inde...e-and-fall-of-the-biopsychosocial-model.1075/
http://forums.phoenixrising.me/index.php?entries/the-fall-of-the-biopsychosocial-model.1081/
http://forums.phoenixrising.me/index.php?entries/part-three-what-next.1099/

I have addressed the issues in many other blogs as well. The core fallacy I address here:
http://forums.phoenixrising.me/index.php?entries/the-witch-the-python-the-siren-and-the-bunny.1149/

Some of BPS uses a confidence trick. Say a bunch of obviously right things. Everyone agrees. Say a bunch more less obvious things, and show good data. Everybody agrees. Say a bunch of irrational things, with vaguely suggestive and woolly data. Some are so fooled by the pattern of argument that they agree.

The social aspects of why this stuff gets support I blogged about here:

http://forums.phoenixrising.me/index.php?entries/the-doggy-treat-model-of-why-it-is-so.830/
http://forums.phoenixrising.me/index.php?entries/the-zombie-age-part-a.1333/
http://forums.phoenixrising.me/index.php?entries/the-zombie-age-part-b.1334/

I had a whole series of planned blogs after this, plus work on my book Embracing Uncertainty, but then my cognition collapsed. I am still waiting to get my brain half working again.
 

Marco

Grrrrrrr!
Messages
2,386
Location
Near Cognac, France
So the answer to the historians' eternal question of what causes a war is that human society is so complex that it is inherently unstable from within. A particular set of circumstances within society itself can set off an unstoppable cascade of destruction. I see the immune system as very similar. It is a society of individual cells co-operating but also competing. It is complicated enough to be susceptible to the same internal instabilities.

Very nicely expressed.
 

alex3619

Senior Member
Messages
13,810
Location
Logan, Queensland, Australia
The only antidote to Zombie Science is open scientific debate. Its why conferences are important. While I have issues with the politics of what goes on in the CMRC, its not about the science for the most part, so long as rational negative criticism of BPS models is not dismissed without being addressed. Sadly the history of the PACE trial, with numerous demonstrable flaws in reasoning, methodology, statistics and so on, is that very few seem to care, and anyone who does is directly or indirectly tarred as an extremist. That is not science. The argument and evidence are critical.

If the mood of the attendees at the CMRC conference reflects a different attitude to what has gone before, that is a good sign. The science is certainly encouraging. Yet the political forces that underlie the BPS claims are still there. Its only a beginning. We need science untainted by political ideology. Its the science that matters. Wherever I see science and politics clash I see unreason proliferate.