Collected information on James Jones (now the real head of the CDC's CFS program?)

Dolphin

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I have read somebody who is knowledgeable say that James Jones (who used to Bill Reeves' number 2) is now the real head of the CDC's CFS program.

I've collected links to further information about him including papers he wrote, talks he gave, comments he made, etc. Also, commentary from others.

--------------
James Jones on CFS (in reverse chronological order except for the first link)

Link to recording of a "grand rounds" talk given by James Jones MD of
the CDC CFS team
Univ. of Arizona Health Sciences- OB/GYN Grand
Rounds- ‘Chronic Fatigue Syndrome in Women’- Monday, April 23, 2007

http://streaming.biocom.arizona.edu/people/?id=11525

Direct links:
RealPlayer: http://video.biocom.arizona.edu:8080/ramgen/realstor/2007/04/23/OBGR2007_04_23.rm
Windows Media: mms://stream08.ahsc.arizona.edu/video/2007/04/23/OBGR2007_04_23.wmv


- Unofficial transcript by Tate Mitchell:
http://bit.ly/9zF4Jw i.e.
http://listserv.nodak.edu/cgi-bin/wa.exe?A2=ind0909A&L=CO-CURE&P=R3247&I=-3&m=20052


- Extracts from talk by CDC #2, Dr James (Jim) Jones (April 23, 2007)
(by Tom Kindlon) http://bit.ly/9VrmAB i.e.
http://listserv.nodak.edu/cgi-bin/wa.exe?A2=ind0909D&L=CO-CURE&P=R2822&I=-3&m=20052


- Some brief notes/commentary by Tom Kindlon (written earlier so a lot
of duplicates with extracts post) http://bit.ly/dbkWZH i.e.
http://listserv.nodak.edu/cgi-bin/wa.exe?A2=ind0802C&L=CO-CURE&P=R236&I=-3&m=14951

==========

- An insight into some of the views of the CDC's James (Jim) Jones
[Extracts from when he was a peer-reviewer on a Maes and Twisk paper]
http://bit.ly/bdr6IH i.e.
http://listserv.nodak.edu/cgi-bin/wa.exe?A2=ind1006D&L=CO-CURE&P=R1836&I=-3&m=20052

(I've appended this at the end)

=============

(Tom Kindlon, October 2009)
http://bit.ly/9zr9kV i.e.
http://listserv.nodak.edu/cgi-bin/wa.exe?A2=ind0910B&L=CO-CURE&P=R4473&I=-3&m=20052

Buried in the latest CDC paper on CFS (corresponding author is James
(Jim) Jones and Bill Reeves also signed it:

--------
An evaluation of exclusionary medical/psychiatric conditions in the
definition of chronic fatigue syndrome.
Jones JF, Lin JM, Maloney EM, Boneva RS, Nater UM, Unger ER, Reeves WC.
BMC Med. 2009 Oct 12;7(1):57. http://www.biomedcentral.com/1741-7015/7/57
--------

is the following:

"As those with CFS suffer from personal, social, workplace [1] and
observed financial losses [23], should not all individuals fulfilling
CFS inclusion criteria, with or without exclusionary diagnoses, be
considered in future public health planning? For instance, would both
groups benefit from prevention and intervention efforts such as
cognitive behavioral therapy and graded exercise therapy [24, 25]? A
similar question could be asked of those who are unwell but who do not
reach the diagnostic threshold."

=======

James Jones was one of three external validators for a (biased) report
in Belgium, 'Federal Knowledge Centre for Healthcare' report on CFS
http://tinyurl.com/326xe6b i.e.
http://listserv.nodak.edu/cgi-bin/wa.exe?A2=ind0810B&L=CO-CURE&P=R2946&I=-3&m=14951

======

"An extended concept of altered self: Chronic fatigue and
post-infection syndromes" by James Jones

Full free text:
http://bit.ly/cvzijf i.e.
http://listserv.nodak.edu/cgi-bin/wa.exe?A2=ind0801B&L=CO-CURE&P=R2&I=-3&m=14951

Commentary on:

a) "CDC's Jim Jones Blame-the-Patient Rhetoric: The Shape of Things to
Come" by Clara Valverde RN, BSc http://tinyurl.com/2v5lc3x i.e.
http://listserv.nodak.edu/cgi-bin/wa.exe?A2=ind0801A&L=CO-CURE&P=R1060&I=-3&m=14951

b) An insight into how CDC CFS researcher, James Jones is thinking
(which is possibly how others in the CDC CFS team are also thinking)
by Tom Kindlon http://tinyurl.com/2w3pwgs i.e.
http://listserv.nodak.edu/cgi-bin/wa.exe?A2=ind0712E&L=CO-CURE&P=R554&I=-3&m=14951

c) WHAT A LOT OF TWADDLE! By Gurli Bagnall http://bit.ly/a3HFOD i.e.
http://listserv.nodak.edu/cgi-bin/wa.exe?A2=ind0801A&L=CO-CURE&P=R2330&I=-3&m=14951

d) J mascis (also includes comment on Bill Reeves: "Bill Reeves, CDC,
'illness', and disease) http://bit.ly/agvmOB i.e.
http://listserv.nodak.edu/cgi-bin/wa.exe?A2=ind0811C&L=CO-CURE&P=R3130&I=-3&m=20052

============

2004 AACFS conference:

"Since his 1995 comment, Reeves surrounded himself with researchers
who seemed to share his early viewpoint. At the 2004 Oct 8-14
AACFS conference, Dr. James Jones (widely considered Reeves right-hand
man) postulated the idea that the CDC believed CFS may be a severe
form of post-traumatic stress and fear/avoidance." (Craig Maupin)
http://tinyurl.com/35ym6od i.e.
http://listserv.nodak.edu/cgi-bin/wa.exe?A2=ind0605D&L=CO-CURE&P=R790&I=-3&m=14951

This was probably this talk:
A Novel Approach to CFS: James Jones, MD, CDC

=========
Information processing in chronic fatigue syndrome. A preliminary
investigation of suggestibility.
Journal: J Psychosom Res 2001 Nov;51(5):679-86
Authors: Jeannie D. DiClementi * [a, b], Karen B. Schmaling [c] and
James F. Jones [d]

Full free text:
http://bit.ly/cMwfN4
i.e.
http://listserv.nodak.edu/cgi-bin/wa.exe?A2=ind0112A&L=CO-CURE&P=R3193&I=-3

=========
http://www.me-cvs.nl/index.php?pageid=3278&printlink=true&highlight=ebv
AACFS Conference 1996:

"Drs.David Bell and Jim Jones discussed CFS in adolescents. Once again, Dr.
Jones insisted that CFS in adolescents resolves within 2 years, which
generated considerable disagreement among the attendees."
[From: CFS-L Date: 17 October 1996 Author: Charles W. Lapp, MD URL:
http://www.grad.clemson.edu/project/lapp/home.htm]

[I can't put my hands on it just now but I think he said if it
hadn't resolved in two years it was psychiatric and/or the parents
were the problem. Somebody else may remember]


-------
(from a Co-Cure post)
Annex 1:

This probably won't be that much news to people if they have previously
read:
http://tinyurl.com/kv3u92 i.e.
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

-----------

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.

Tom


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.

===========
 

SOC

Senior Member
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**sigh**

Where is the "real" CFS program at the CDC these days? I know they transferred some of it to Infectious Diseases, or Retrovirology, or somewhere semi-sensible, but didn't they leave something behind for Reeves in the psychobabble dept? They're playing so many shell games over there, I'm not keeping up.

If James Jones is the real head of CFS in Infectious Diseases or whatever, I am completely and utterly, totally, unreservedly disgusted with the CDC. Of course I was before I read Dolphin's post, so nothing new....

I'm just back from 2 hrs at a potluck picnic in the heat :victory: so I am a bit mentally tired. Am I missing the whole point?
 

Dolphin

Senior Member
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Some "bad" CDC CFS studies James Jones has been involved in in recent years

James (Jim) Jones has also generally (always?) been a co-author of the dangerous studies the CDC has been churning out in recent years following them adopting the empiric criteria http://www.ipetitions.com/petition/empirical_defn_and_cfs_research/ .

Psychother Psychosom. 2010 Jul 28;79(5):312-318. [Epub ahead of print]

Personality Features and Personality Disorders in Chronic Fatigue Syndrome: A Population-Based Study.

Nater UM, Jones JF, Lin JM, Maloney E, Reeves WC, Heim C.

Chronic Viral Diseases Branch, Coordinating Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Ga., USA.

Abstract
Background: Chronic fatigue syndrome (CFS) presents unique diagnostic and management challenges. Personality may be a risk factor for CFS and may contribute to the maintenance of the illness.

Methods: 501 study participants were identified from the general population of Georgia: 113 people with CFS, 264 with unexplained unwellness but not CFS (insufficient fatigue, ISF) and 124 well controls. We used the Personality Diagnostic Questionnaire, 4th edition, to evaluate DSM-IV personality disorders. We used the NEO Five-Factor Inventory to assess personality features (neuroticism, extraversion, openness, agreeableness and conscientiousness). The Multidimensional Fatigue Inventory measured 5 dimensions of fatigue, and the Medical Outcomes Survey Short Form 36 measured 8 dimensions of functional impairment.

Results: Twenty-nine percent of the CFS cases had at least 1 personality disorder, compared to 28% of the ISF cases and 7% of the well controls. The prevalence of paranoid, schizoid, avoidant, obsessive-compulsive and depressive personality disorders were significantly higher in CFS and ISF compared to the well controls. The CFS cases had significantly higher scores on neuroticism, and significantly lower scores on extraversion than those with ISF or the well controls. Personality features were correlated with selected composite characteristics of fatigue.

Conclusions: Our results suggest that CFS is associated with an increased prevalence of maladaptive personality features and personality disorders. This might be associated with being noncompliant with treatment suggestions, displaying unhealthy behavioral strategies and lacking a stable social environment.
Since maladaptive personality is not specific to CFS, it might be associated with illness per se rather than with a specific condition.
=====

Psychosom Med. 2009 Jun;71(5):557-65. Epub 2009 May 4.

Psychiatric comorbidity in persons with chronic fatigue syndrome identified from the Georgia population.
Nater UM, Lin JM, Maloney EM, Jones JF, Tian H, Boneva RS, Raison CL, Reeves WC, Heim C.

Chronic Viral Diseases Branch, National Center for Zoonotic, Vector-borne and Enteric Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.

Comment in:

Psychosom Med. 2010 Jun;72(5):506-7; author reply 507-9.

Abstract

OBJECTIVE:
To compare the prevalence of psychiatric disorders in persons with chronic fatigue syndrome (CFS) identified from the general population and a chronically ill group of people presenting with subsyndromic CFS-like illness ("insufficient symptoms or fatigue" (ISF)). Previous studies in CFS patients from primary and tertiary care clinics have found high rates of psychiatric disturbance, but this may reflect referral bias rather than true patterns of comorbidity with CFS.

METHODS:
We used random digit dialing to identify unwell individuals. A detailed telephone interview identified those with CFS-like illness. These individuals participated in a 1-day clinical evaluation to confirm CFS or ISF status. We identified 113 cases of CFS and 264 persons with ISF. To identify current and lifetime psychiatric disorders, participants completed the Structured Clinical Interview for DSM-IV.

RESULTS:
Sixty-four persons (57%) with CFS had at least one current psychiatric diagnosis, in contrast to 118 persons (45%) with ISF. One hundred one persons (89%) with CFS had at least one lifetime psychiatric diagnosis compared with 208 persons (79%) with ISF. Of note, only 11 persons (9.8%) with CFS and 25 persons (9.5%) with ISF reported having seen a mental healthcare specialist during the past 6 months.

CONCLUSIONS: Our findings indicate that current and lifetime psychiatric disorders commonly accompany CFS in the general population. Most CFS cases with comorbid psychiatric conditions had not sought appropriate help during the past 6 months. These results demonstrate an urgent need to address psychiatric disorders in the clinical care of CFS cases.
======

Free full text at: http://archpsyc.ama-assn.org/cgi/content/full/66/1/72
Arch Gen Psychiatry. 2009 Jan;66(1):72-80.

Childhood trauma and risk for chronic fatigue syndrome: association with neuroendocrine dysfunction.
Heim C, Nater UM, Maloney E, Boneva R, Jones JF, Reeves WC.

Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Woodruff Memorial Research Bldg, Ste 4311, Atlanta, GA 30322, USA. cmheim@emory.edu

Abstract

CONTEXT:
Childhood trauma appears to be a potent risk factor for chronic fatigue syndrome (CFS). Evidence from developmental neuroscience suggests that early experience programs the development of regulatory systems that are implicated in the pathophysiology of CFS, including the hypothalamic-pituitary-adrenal axis. However, the contribution of childhood trauma to neuroendocrine dysfunction in CFS remains obscure.

OBJECTIVES:
To replicate findings on the relationship between childhood trauma and risk for CFS and to evaluate the association between childhood trauma and neuroendocrine dysfunction in CFS. Design, Setting, and

PARTICIPANTS: A case-control study of 113 persons with CFS and 124 well control subjects identified from a general population sample of 19 381 adult residents of Georgia.

MAIN OUTCOME MEASURES: Self-reported childhood trauma (sexual, physical, and emotional abuse; emotional and physical neglect), psychopathology (depression, anxiety, and posttraumatic stress disorder), and salivary cortisol response to awakening.

RESULTS: Individuals with CFS reported significantly higher levels of childhood trauma and psychopathological symptoms than control subjects. Exposure to childhood trauma was associated with a 6-fold increased risk of CFS. Sexual abuse, emotional abuse, and emotional neglect were most effective in discriminating CFS cases from controls. There was a graded relationship between exposure level and CFS risk. The risk of CFS conveyed by childhood trauma further increased with the presence of posttraumatic stress disorder symptoms. Only individuals with CFS and with childhood trauma exposure, but not individuals with CFS without exposure, exhibited decreased salivary cortisol concentrations after awakening compared with control subjects.

CONCLUSIONS: Our results confirm childhood trauma as an important risk factor of CFS. In addition, neuroendocrine dysfunction, a hallmark feature of CFS, appears to be associated with childhood trauma. This possibly reflects a biological correlate of vulnerability due to early developmental insults. Our findings are critical to inform pathophysiological research and to devise targets for the prevention of CFS.
==========

BMC Neurol. 2006 Nov 16;6:41.

Sleep characteristics of persons with chronic fatigue syndrome and non-fatigued controls: results from a population-based study.
Reeves WC, Heim C, Maloney EM, Youngblood LS, Unger ER, Decker MJ, Jones JF, Rye DB.

Viral Exanthems & Herpesvirus Branch, Division of Viral & Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control & Prevention, Atlanta, GA, USA. wcr1@cdc.gov

Abstract
BACKGROUND: The etiology and pathophysiology of chronic fatigue syndrome (CFS) remain inchoate. Attempts to elucidate the pathophysiology must consider sleep physiology, as unrefreshing sleep is the most commonly reported of the 8 case-defining symptoms of CFS. Although published studies have consistently reported inefficient sleep and documented a variable occurrence of previously undiagnosed primary sleep disorders, they have not identified characteristic disturbances in sleep architecture or a distinctive pattern of polysomnographic abnormalities associated with CFS.

METHODS: This study recruited CFS cases and non-fatigued controls from a population based study of CFS in Wichita, Kansas. Participants spent two nights in the research unit of a local hospital and underwent overnight polysomnographic and daytime multiple sleep latency testing in order to characterize sleep architecture.

RESULTS:
Approximately 18% of persons with CFS and 7% of asymptomatic controls were diagnosed with severe primary sleep disorders and were excluded from further analysis. These rates were not significantly different. Persons with CFS had a significantly higher mean frequency of obstructive apnea per hour (p = .003); however, the difference was not clinically meaningful. Other characteristics of sleep architecture did not differ between persons with CFS and controls.

CONCLUSION: Although disordered breathing during sleep may be associated with CFS, this study generally did not provide evidence that altered sleep architecture is a critical factor in CFS. Future studies should further scrutinize the relationship between subjective sleep quality relative to objective polysomnographic measures.
============

Free full text at: http://archpsyc.ama-assn.org/cgi/content/full/63/11/1258

Arch Gen Psychiatry. 2006 Nov;63(11):1258-66.

Early adverse experience and risk for chronic fatigue syndrome: results from a population-based study.
Heim C, Wagner D, Maloney E, Papanicolaou DA, Solomon L, Jones JF, Unger ER, Reeves WC.

Viral Exanthems and Herpesvirus Branch, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30322, USA. cmheim@emory.edu

Abstract
CONTEXT: Chronic fatigue syndrome (CFS) is an important public health problem. The causes of CFS are unknown and effective prevention strategies remain elusive. A growing literature suggests that early adverse experience increases the risk for a range of negative health outcomes, including fatiguing illnesses. Identification of developmental risk factors for CFS is critical to inform pathophysiological research and devise targets for primary prevention.

OBJECTIVE: To examine the relationship between early adverse experience and risk for CFS in a population-based sample of clinically confirmed CFS cases and nonfatigued control subjects.

DESIGN, SETTING, AND PARTICIPANTS: A case-control study of 43 cases with current CFS and 60 nonfatigued controls identified from a general population sample of 56 146 adult residents from Wichita, Kan.

MAIN OUTCOME MEASURES: Self-reported childhood trauma (sexual, physical, and emotional abuse and emotional and physical neglect) and psychopathology (depression, anxiety, and posttraumatic stress disorder) by CFS status.

RESULTS: The CFS cases reported significantly higher levels of childhood trauma and psychopathology compared with the controls. Exposure to childhood trauma was associated with a 3- to 8-fold increased risk for CFS across different trauma types. There was a graded relationship between the degree of trauma exposure and CFS risk. Childhood trauma was associated with greater CFS symptom severity and with symptoms of depression, anxiety, and posttraumatic stress disorder. The risk for CFS conveyed by childhood trauma increased with the presence of concurrent psychopathology.

CONCLUSIONS:
This study provides evidence of increased levels of multiple types of childhood trauma in a population-based sample of clinically confirmed CFS cases compared with nonfatigued controls. Our results suggest that childhood trauma is an important risk factor for CFS. This risk was in part associated with altered emotional state. Studies scrutinizing the psychological and neurobiological mechanisms that translate childhood adversity into CFS risk may provide direct targets for the early prevention of CFS
.
===========

J Psychosom Res. 2006 Jun;60(6):567-73.

Coping styles in people with chronic fatigue syndrome identified from the general population of Wichita, KS.

Nater UM, Wagner D, Solomon L, Jones JF, Unger ER, Papanicolaou DA, Reeves WC, Heim C.

Viral Exanthems and Herpesvirus Branch, Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA.

Abstract
OBJECTIVE: Studies of primary and tertiary care patients suggest that maladaptive coping styles contribute to the pathogenesis and maintenance of chronic fatigue syndrome (CFS). We assessed coping styles in persons with unexplained fatigue and nonfatigued controls in a population-based study.

METHODS: We enrolled 43 subjects meeting the 1994 Research Case Definition of CFS, matching them with 61 subjects with chronic unexplained fatigue who did not meet criteria for CFS [we term them insufficient symptoms or fatigue (ISF)] and 60 non-ill (NI) controls. Coping styles and clinical features of CFS were assessed using standard rating scales.

RESULTS: Subjects with CFS and ISF reported significantly more escape-avoiding behavior than NI controls. There were no differences between the CFS and ISF subjects. Among participants with CFS, escape-avoiding behavior was associated with fatigue severity, pain, and disability.

CONCLUSIONS: We demonstrate significantly higher reporting of maladaptive coping in a population-based sample of people with CFS and other unexplained fatiguing illnesses defined by reproducible standardized clinical empirical means in comparison to NI controls.
==========
Am J Med. 2005 Dec;118(12):1415.

Orthostatic instability in a population-based study of chronic fatigue syndrome.
Jones JF, Nicholson A, Nisenbaum R, Papanicolaou DA, Solomon L, Boneva R, Heim C, Reeves WC.

Division of Viral and Rickettsial Diseases, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Ga 30333, USA. jaj9@cdc.gov

Comment in:

Am J Med. 2007 Mar;120(3):e13.

Abstract

PURPOSE: Autonomic nervous system dysfunction has been suggested as involved in the pathophysiology of chronic fatigue syndrome. This population-based case control study addressed the potential association between orthostatic instability (one sign of dysautonomia) and chronic fatigue syndrome.

SUBJECTS AND METHODS: Fifty-eight subjects who fulfilled criteria of the 1994 chronic fatigue syndrome research case definition and 55 healthy controls participated in a 2-day inpatient evaluation. Subjects had been identified during a 4-year population-based chronic fatigue syndrome surveillance study in Wichita, Kan. The present study evaluated subjects' current medical and psychiatric status, reviewed past medical/psychiatric history and medication use, used a stand-up test to screen for orthostatic instability, and conducted a head-up tilt table test to diagnose orthostatic instability.

RESULTS: No one manifested orthostatic instability in the stand-up test. The head-up tilt test elicited orthostatic instability in 30% of eligible chronic fatigue syndrome subjects (all with postural orthostatic tachycardia) and 48% of controls (50% with neurally mediated hypotension); intolerance was present in only nonfatigued (n=7) subjects. Neither fatigue nor illness severity were associated with outcome.

CONCLUSIONS: Orthostatic instability was similar in persons with chronic fatigue syndrome and nonfatigued controls subjects recruited from the general Wichita population. Delayed responses to head-up tilt tests were common and may reflect hydration status. These findings suggest reappraisal of primary dysautonomia as a factor in the pathogenesis of chronic fatigue syndrome.