Lancet editorial: Chronic fatigue syndrome: going viral? (avail. online Sept 16)

Wayne

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How do you think this should end?
How about something like:

"""There's been an impressive accumulation of evidence over many years now, indicating many physical abnormalities associated with ME/CFS. XMRV research and news is just the latest, but perhaps most significant development.

This mounting and compelling evidence indicates ME/CFS is a very real physical illness. This of course is leading to the chagrin of those who have long advocated ME/CFS to be purely psychological. It appears they could end up with egg on their face, in a major way."""

............................................

The above isn't in the normal jargon of medical journals, but at least it's closer to the truth than what they published in their ridiculous article.

That really puts me in the mood to go slap somebody.
LOL Laurel, thanks for that one. Helps keep a little levity here (if that was your intent???). Your comment is a reminder for me not to let these people take more from us than they already have.

Wayne
 

Dolphin

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I didn't look to see if people can comment......
They don't allow e-letters anymore.
They have to be letters to the editor which would need to have at least one reference and be fairly tight.

I hope some people will write in. Perhaps not so much to bash the editorial itself but other attitudes and/or the lack of biomedical research.

Correspondence
We welcome correspondence on content published in The Lancet or on other topics of interest to our readers. Letters for publication in the print journal must reach us within 2 weeks of publication of the original item and should be no longer than 250 words. Letters of general interest, unlinked to items published in the journal, can be up to 400 words long. Correspondence letters are not usually peer reviewed (we rarely publish original research or Case Reports in this section), but the journal might invite replies from the authors of the original publication, or pass on letters to these authors. Only one table or figure is permitted, and there should be no more than five references and five authors. All accepted letters are edited, and proofs will be sent out to authors before publication.
Ref: http://download.thelancet.com/flatcontentassets/authors/lancet-information-for-authors.pdf
 

LaurelW

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LOL Laurel, thanks for that one. Helps keep a little levity here (if that was your intent???). Your comment is a reminder for me not to let these people take more from us than they already have.

Wayne
Welllllll, yes, but I'm not sure if I could restrain myself if the guilty party(s) were standing right in front of me. Definitely would be some "colorful metaphors" directed at them.
:tongue:
 

Esther12

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yep its true Esther, infact its probably higher the 1 in 4 http://www.apa.org/pi/families/resources/child-sexual-abuse.aspx
its devastating! The connection of child abuse, mental illness and CFS, just dont fit.
Thanks for the link villagelife.

To me, they're using a bit of a diluted definition that could even include teenagers decieving one another into a snog. These things are difficult to measure though, and we all have different ideas as to what it means to be coerced.
 

bakercape

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That's the way

How about something like:

"""There's been an impressive accumulation of evidence over many years now, indicating many physical abnormalities associated with ME/CFS. XMRV research and news is just the latest, but perhaps most significant development.

This mounting and compelling evidence indicates ME/CFS is a very real physical illness. This of course is leading to the chagrin of those who have long advocated ME/CFS to be purely psychological. It appears they could end up with egg on their face, in a major way."""

............................................

The above isn't in the normal jargon of medical journals, but at least it's closer to the truth than what they published in their ridiculous

Wayne
Wish it had ended. I don't know who wrote the conclusion but I'm sure some british goverment type was involved. SW perhaps our sweet McClure.
 

*GG*

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oh my god. this is a horrible editorial! horrible. they say that cfs could be a virus, and give all this solid evidence of such, and then they say cfs could still be a psychological illness!

what is wrong with this picture? why is the UK so dedicated to calling cfs a mental illness!?
Uh, there mental?! Dribble, crap. No disrespect meant people.
 

leela

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There must be an entire class of doctors who missed school the day they taught the difference between
"psychological" and "neurological". Now they've all teamed up for cover--strength in numbers, guv. Not to mention my dog ate my homework.
 

Esther12

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There must be an entire class of doctors who missed school the day they taught the difference between
"psychological" and "neurological". Now they've all teamed up for cover--strength in numbers, guv. Not to mention my dog ate my homework.
No, no, no.... they've realised that our minds might have something to do with our brains now, so to act as if any sort of useful distinction can be drawn between psychology and neurology is to only reveal your own deep naivety. It's not that they've not been taught about the difference, it's that they've realised the distinction brings with it rather inconvenient moral problems that can be entirely avoided if they adopt the sophisticated stance of pretending a patient whose brain drives them inexorably towards the rape of children should be no more stigmatised than a patient with a broken hip.

It's all really very clever, in a stupid kind of way.

@ ggingues - Equating mental disturbance with dribbling and crap - I don't see how anyone could see that as disrespectful.
 

Wayne

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Hi KFG,

LOL, thanks for the laughs (even though it probably wasn't meant to be humorous). You get an A for creative writing!! (from me anyway). :D And an A+ for "not beating around the bush".

Wayne
 

leela

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KFG

Yes, thanks for a hearty guffaw! :tear:
Though this phrase is truly sad in its accuracy: "....lost their objectivity a long time ago."
 

muffin

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And you all expected better from Lancet?

It's a crap medical journal. I think its glory days are behind it. No body quotes from it anymore.
would have to see circulation details in comparison to JAMA, NJM, and others, but I seem to have a feeling that Lancet is basically written by old male doctors.

If someone finds the contacts, then post and we will slam them. We can send them the REAL studies from WPI/CC/NCI and NIH/Harvard - and can cite the over 5,000 real studies done. Fight a weak flame with a huge blaze.

I like to stick it to old, nasty, pompous doctors. Just read that it must be a written letter. Ok. If one of you ultra smart people wants to take a shot at them go for it. Might also tell them the UK psychobabble CBT/GET is criminal and will shortly be shown as criminal. Can you all sue for government medical malpractice? None of us in th US seems to know that answer either - yet.
 

Cort

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The controversy surrounding the possible causes of chronic fatigue syndrome (CFS) resurfaced this month, after results published in the Archives of Paediatrics and Adolescent Medicine showed that children with the disease had higher levels of oxidative stress and white blood cell apoptosis than controls—findings suggesting that the children with CFS are fighting a viral infection.

The theory that CFS may be viral in origin first came to prominence in October, 2009, when a study in Science showed that 68 (67%) of 101 patients with CFS who were tested were infected with the murine leukaemia virus XMRV, compared with eight (37%) of 218 controls. A string of negative results followed, with several groups unable to detect any trace of XMRV in patients with CFS. But a study published recently in Proceedings of the National Academy of Sciences reported a strong association between CFS and a murine virus very similar to XMRV. However, it is impossible to say at this stage whether these murine leukaemia viruses cause CFS, or whether they are bystander infections.

It is already established that many cases of CFS are preceded by an acute viral infection. Studies in cohorts of patients with infectious mononucleosis caused by Epstein–Barr virus (EBV) show that a small proportion do not recover from post-infection fatigue, and subsequently go on to develop CFS. But it seems unlikely that CFS is a consequence of EBV, because most people make a full recovery.

There is a general consensus that CFS is a heterogeneous family of disorders, and it seems most likely that these disorders arise from a constellation of pathophysiological causes. The results in the Archives of Paediatrics and Adolescent Medicine received great media attention. But they do not prove that CFS is a physical disease. CFS is still far from being a well-defined entity. When the totality of available evidence is considered, the uncertainty around our understanding of the physical–psychological interaction taking place in patients with CFS only strengthens the case for giving research into chronic fatigue the high priority it deserves.
I do not at all understand the overwhelmingly negative reaction to this article. After reading most of the comments I expected to see an article flushed with psychological innuendo's but that's not what I see at all. As I see it, Lancet - a very respected and traditional journal -is leaving the door open for ME/CFS.

children with the disease had higher levels of oxidative stress and white blood cell apoptosis than controls—findings suggesting that the children with CFS are fighting a viral infection.
#1. First they report that ME/CFS adolescents with high rates of oxidative stress may be fighting a viral infection! (What more do you want? When the last time pre-XMRV that Lancet or any major journal suggested a viral infection was the cause?

Actually in a way they are not wrong stating that the theory that ME/CFS came to 'prominence' in Oct. 2009; that is when it became prominent in the research world and the media. I forgive them for missing the Defreitas study 18 or so years ago or HHV-6/EBV - which have never made a splash in the media or even in the research world outside of CFS.

It is already established that many cases of CFS are preceded by an acute viral infection. Studies in cohorts of patients with infectious mononucleosis caused by Epstein–Barr virus (EBV) show that a small proportion do not recover from post-infection fatigue, and subsequently go on to develop CFS. But it seems unlikely that CFS is a consequence of EBV, because most people make a full recovery.
This is a little sketchy. Actually most people in that study did recover, I think, but it took quite awhile. Still it was only one study and other studies do not suggest that. I think they are inaccurate here.

This is the biggy..

There is a general consensus that CFS is a heterogeneous family of disorders, and it seems most likely that these disorders arise from a constellation of pathophysiological causes.
It seems most likely these disorders arise from a constellation of pathophysiological causes. Nothing about behavior here - no psychology - the consensus is these disorders are biological in nature. So they don't annoint XMRV as 'it' in CFS - the most prestigious medical journal in the UK (180 years old!) just said CFS arises from biological causes. I'll take that from them gladly.

CFS is still far from being a well-defined entity. When the totality of available evidence is considered, the uncertainty around our understanding of the physical–psychological interaction taking place in patients with CFS only strengthens the case for giving research into chronic fatigue the high priority it deserves.
So they backtrack a bit...but then they say the confusion about ME/CFS means research should get high priority...and in the context of this article that means physiological research - I'll take that too!

I don't expect these prestigious medical journals to do an about face (although at times Lancet just about did). Sure you can find negative things in it but for Lancet to do this for me was a big step forward.
 

Cort

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This mounting and compelling evidence indicates ME/CFS is a very real physical illness. This of course is leading to the chagrin of those who have long advocated ME/CFS to be purely psychological. It appears they could end up with egg on their face, in a major way."""
Didn't they in an indirect way kind of say this????? There's alot of physiological stuff in there - a focus on viruses - and very little psychological. In my opinion you have to dig to find the psychology.
 

Esther12

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I do not at all understand the overwhelmingly negative reaction to this article. After reading most of the comments I expected to see an article flushed with psychological innuendo's but that's not what I see at all. As I see it, Lancet - a very respected and traditional journal -is leaving the door open for ME/CFS.
Yeah - you're right.

For myself, I was irritated by the soft call for more research, which I can't imagine them really caring about. I suppose I think that if they really believed what they said, and recognised the uncertainty that surrounds CFS while realising the way in which patients are so casually presumed to be mentally disturbed by much of the medical community, that there would be some greater level of outrage, or sense of moral impetus.

To me, it read like an arse-covering exercise in which they say reasonable things but with no real concern or interest in the problems faced by CFS patients. I could well just be jaded by the way CFS has been treated in the past.
 

Cort

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Yeah - you're right.

For myself, I was irritated by the soft call for more research, which I can't imagine them really caring about. I suppose I think that if they really believed what they said, and recognised the uncertainty that surrounds CFS while realising the way in which patients are so casually presumed to be mentally disturbed by much of the medical community, that there would be some greater level of outrage, or sense of moral impetus.

To me, it read like an arse-covering exercise in which they say reasonable things but with no real concern or interest in the problems faced by CFS patients. I could well just be jaded by the way CFS has been treated in the past.
But how do you know there's no real concern? We really don't know. I agree that skepticism is natural and we'll have to see how it turns out but you just had the major UK medical journal say CFS is based on pathophysiological problems. You had an article focused on oxidative stress and pathogens - and then you had them state that CFS research should be given 'high priority'. I would never expect Lancet, of all journals, to posit a viral cause for adolescent ME/CFS based on high rates of oxidative stress!

The editorial is not all roses, I agree, but I was very surprised to see it come from Lancet. I think it represents a slow turning of the medical establishment. I wonder what the last Lancet editorial on CFS was like :(. I imagine they were not talking about viruses...
 

leela

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I agree with you, Cort, it was surprisingly forthcoming about the proliferation of evidence indicating physical disease.
And though it's just one sentence:
But they do not prove that CFS is a physical disease.
it seemed like a bizarre and jarring contradiction to the preceding (and subsequent) facts, like the author was taking a quick U-turn, or some editor stuck it in after the fact so as to avoid slings and arrows.
It colored the overall positive feeling of the article for me, because it was opposite to what had just been said.
In fact rather than use the word "opposite", I'd say antithetical, because it was an unsubstantiated, almost editorial claim that was in direct conflict with the bulk of the information
proferred in the article.
 

Esther12

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But how do you know there's no real concern? We really don't know. I agree that skepticism is natural and we'll have to see how it turns out
Quite true. I hope I'm wrong, and this has become an issue that the Lancet is genuinely concerned about.

In a way, the fact that they presented a fair summary of our understanding of CFS makes their general lack of concern about the way CFS patients have been treated even more galling. If they'd come out saying the CFS was a psycho-social illness and should be treated as such, I'd think that these claims were not supported by the evidence, but there would be some internal consistency to them and the relaxed nature of the Lancet's coverage. If it is the case that "CFS is a heterogeneous family of disorders, and it seems most likely that these disorders arise from a constellation of pathophysiological causes" then the emphasis placed upon psycho-social factors by those withing the British medical community is disgraceful and has caused a lot of undue hardship to patients - I've not seen anything that indicates the Lancet is concerned by this.

Maybe I'm just in a bad mood though. (I burnt dinner.)
 

Cort

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Quite true. I hope I'm wrong, and this has become an issue that the Lancet is genuinely concerned about.

In a way, the fact that they presented a fair summary of our understanding of CFS makes their general lack of concern about the way CFS patients have been treated even more galling. If they'd come out saying the CFS was a psycho-social illness and should be treated as such, I'd think that these claims were not supported by the evidence, but there would be some internal consistency to them and the relaxed nature of the Lancet's coverage. If it is the case that "CFS is a heterogeneous family of disorders, and it seems most likely that these disorders arise from a constellation of pathophysiological causes" then the emphasis placed upon psycho-social factors by those withing the British medical community is disgraceful and has caused a lot of undue hardship to patients - I've not seen anything that indicates the Lancet is concerned by this.

Maybe I'm just in a bad mood though. (I burnt dinner.)
I think we're in an in-between space in the research community and the article reflected that. It was almost as if parts of it were written by two different people - and I imagine that is what happened; you have some members of the editorial staff pushing for the viral explanation and others saying, no, no no- we have to put this other part in there.....

It'll be very interesting to see how things proceed if XMRV wins out.....I think we will see researchers standing up and saying "How could you". I imagine Lancet and other Journals will have some explaining to do when that occurs. It may very well be that Lancet is covering their ass as well by giving a more positive slant to the viral issues but the fact that they feel compelled to do so is a very positive one, indeed :).