An insight into some of the views of the CDC's James (Jim) Jones

Dolphin

Senior Member
Messages
17,555
Likes
28,233
This probably won't be that much news to people if they have previously read:

http://listserv.nodak.edu/cgi-bin/wa.exe?A2=ind0909A&L=CO-CURE&P=R3247&I=-3
Unofficial transcript- James F. Jones, MD, CDC, speaking at the Univ. of Arizona Health Sciences- OB/GYN Gr and Rounds-'Chronic Fatigue Syndrome in
Women'- Monday, April 23, 2007
The video of this education talk for doctors is still available at: http://streaming.biocom.arizona.edu/people/?id=11525
His flight etc. would have been paid for out of the CDC's CFS budget and he probably gave other doctors. I have been told his specific role at the CDC is physician education
-----------

James Jones was a peer reviewer for:
Chronic fatigue syndrome: Harvey and Wessely's (bio)psychosocial model versus a bio(psychosocial) model based on inflammatory and oxidative and nitrosative stress pathways Michael Maes and Frank NM Twisk. BMC Medicine 2010, 8:35

One can read his comments at:
http://www.biomedcentral.com/imedia/1264910103403848_comment.pdf
and
http://www.biomedcentral.com/imedia/1675113865366577_comment.pdf

Appended below are some extracts.


Review #1:
----
The authors recognize differences between and among CFS patients. The emphasis on the adverse effects of CBT and GET in this regard is peculiar.
It is clear that patients with inflammatory/autoimmune/immune deficiency diseases who share symptoms with CFS may not respond to CBT and GET alone; nor would patients with untreated primary sleep disorders or hypothyroidism.
----
Likewise as seen in the paragraph 2, page 8, the roles of personality, periodic relative overactivity, and deconditioning are well established factors in perpetuating CFS. Such factors have not been disproven as contributors to CFS and they do affect the outcome of treatment. Selective citing of the literature, as seen here, does not enhance the veracity of an opinion paper such as this one.
-----

Harm following CBT and GET are certainly possible, but likely to occur only in misdiagnosed patients.
-----


Review #2:

3. Questions about the pathophysiology and therapy of CFS, as well as the validity of the illness as distinct entity, continue to be raised in many venues. One area of interest is the role of cytokines. B Cameron and colleagues add to the uncertainty of ongoing laboratory measurable host responses and their relationship to CFS as recently as the Jan 15 2010 issue of Clinical Infectious Diseases (50(2):278-9). The long list of alterations in immune function presented on pages 5 and 6 is an accumulation of observations from a variety of studies.

Have the authors asked themselves if all of these observations can occur in the same person and if so why have each of the studies documented dissimilar changes? Likewise how can an illness (CFS) of varying severities and outcomes (including spontaneous or therapy-associated resolution) be caused by such a plethora of immune-mediated phenomena?

4. An important issue is the apparent mixing of active immune mediated behaviors associated with ongoing infection/ inflammatory processes that are readily identified with easily available laboratory tests and conditions in which such evidence is lacking, but similar symptoms are present. The authors seem to have jettisoned any concept of symptom persistence in the absence of active immune factors.
-----
I respectfully comment that if this piece is considered to be a commentary, it is far too lengthy with too much hyperbole, exaggerated and misinterpreted statements regarding cited publications as seen, for example, in the paragraph regarding predisposing factors on page 9 and comments regarding depression on pages 11-12, and 19. In addition, the piece contains considerable redundant material. Much of the material in this piece has been previously published, particularly the criticisms of CBT and GET intervention. The inclusion of this material may be considered by some as extraneous to the question at best.

The Harvey and Wessely comments only mention "behaviorally focused interventions" as effective ways of reducing fatigue. These interventions are evidence-based in distinction to hypothetical approaches mentioned in this piece.
 

muffin

Senior Member
Messages
940
Likes
15
"...the roles of personality.." Oh let's just blame that damn neurotic patient!

I think that most CFIDS people actually were very driven and productive pre-CFIDS/ME. Aren't successful, hard working, decent people driven and productive? Isn't that how we raise our children to be? I don't recall my parents telling me to just lay back and take it easy. Did any or YOUR parents tell you to be a lazy slob on the couch? Didn't think so...Not with this crowd of super brights and super talented types on this forum.
 

Dolphin

Senior Member
Messages
17,555
Likes
28,233
Also:
periodic relative overactivity, and deconditioning
is a bit of a joke.
There isn't evidence that I recall on the first item.

Basically you have to do exactly the right amount, even though of course it can be hard to tell from day to day how much energy one has used especially when you consider that as well as for physical activity, your body may use energy to keep you a certain temperature, for being upright vs seated vs horizontal (and all the angles), cognitive energy used, energy used for emotional issues that might arise, dealing with infections you might be exposed to and other antigens, etc. Your body may not have recovered from activities from previous days. Your sleep quality can vary from day-to-day.

Then of course one could be on course at 6pm say and then something out of the blue happens and you wish you hadn't used us up so much energy earlier.

Do too little and you're making yourself or keeping yourself deconditioned; but if you to do too much, it's "periodic relative overactivity".
 

Sean

Senior Member
Messages
7,378
Likes
18,042
the roles of personality, periodic relative overactivity, and deconditioning are well established factors in perpetuating CFS.
Harm following CBT and GET are certainly possible, but likely to occur only in misdiagnosed patients.
Stopped reading at that point. Useless hack.

[Shakes head, walks away...]
 

acer2000

Senior Member
Messages
814
Likes
641
This paper is written as such that anyone with a real illness would be excluded from their definition and thus not respond to their proposed treatment (CBT + GET). So yeah, if you move the goal posts enough to only include patients with (CBT+GET) responsive illness then I guess it makes sense. But that just means they are ignoring the majority of other patients who are ill with symptoms of CFS and don't have hypothyroid, autoimmune, etc... but don't fit their study group. So what about those people, eh CDC? Why are they sick?

I guarantee you that if XMRV turns out to cause "CFS" symptoms they will say "oh yeah, well of course those people had XMRV - therefore they didn't have CFS and wouldn't be expected to respond to our psych treatments". Cop-out central.

I'd love it if GET and CBT would make me better. They are free and easy. Unfortunately, they didn't.