Ok, couple questions for anciendaze or alex or anybody who might be able to weigh in.
First - we know the WPI picked "highly viremic" (I suppose one should properly say retroviremic) patients for the Science paper - and the deniers were biased toward picking people *without* "signs of active viral infection."
Does anyone know exactly what signs we are talking about? What made some people look more "viremic" than others? Is it just the typical symptom set of sore throat/fever/swollen lymph nodes that "looks" like an active viral infection, or was it a matter of picking people who were more debilitated, i.e. housebound/bedbound? I'm assuming they would have excluded people with co-infections - or would they?
I'm going to take this in stages, after reminding people I am not an authority. What you get from me are the words I post, nothing else. I do not have any relevant degrees or certifications. These are the opinions of an affected individual. You are free to check them however you can.
"Tender lymphadenopathy", meaning those swollen lymph nodes, has been on lists of symptoms since about day one. This has disappeared from recent CDC definitions, and what mention they've made of use of this, and similar signs, by others has been in the context of exclusion.
Peterson and Cheney (who consulted the world expert on EBV) had used available tests for antibodies to EBV, and complete absence of those which hold the virus latent, as an indication of reactivated infection and immune dysfunction. This was misinterpreted to mean EBV was responsible. Recent CDC statements against testing immunological status are striking, considering the wealth of data currently available.
To tell the truth, we still don't know what the CDC consider exclusionary. I will quote myself, (a vile habit,) from un-posted material.
This empirical definition hardly seems to be a definition. On the one hand, it claims to implement the Fukuda definition, on the other we have conflicts with the CCC. After considerable effort I had decided any patient meeting the CCC will automatically satisfy the Fukuda definition. That is CCC is a subset of Fukuda. With the assertion that meeting CCC might be exclusionary, I am now at a loss to describe the relationship, as viewed by the CDC group. Attempting to pin down the empirical definition in print is an exercise in frustration. They did not even get good repeatability themselves. In clinical practice, it is manifestly unusable.
With the
median hours per week worked for one cohort in Wichita put at 40, we have the possibility of "CFS patients" working overtime and not seeing a doctor regarding fatigue. On the face of it, this sounds like a sizable part of the healthy general population. I have the distinct impression this is like the definition offered by Humpty Dumpty:
`When I use a word,' Humpty Dumpty said, in rather a scornful tone, `it means just what I choose it to mean -- neither more nor less.'
`The question is,' said Alice, `whether you can make words mean so many different things.'
`The question is,' said Humpty Dumpty, `which is to be master -- that's all.'
The whole surrounding passage in 'Through the Looking Glass' has considerable relevance to CFS definitions.
Where does the relative absence or presence of specific *neurological* symptoms play into all this? Undoubtably the WPI picked some people with pretty serious neurological manifestations, and we know the CDC tends to consider neurological symptoms exclusionary for CFS.
This takes us into a morass. They have made illness with unknown etiology, like MS, exclusionary for CFS diagnosis. Unfortunately, in the absence of clear lesions on MRI scans, MS is also a diagnosis of exclusion. The logical fallacy here is having two diagnoses of exclusion with the same symptoms.
It would be awfully interesting to catch an XMRV infection in its initial stages, which I don't think anyone has done or tried to do yet. After all, if you have an acute flu-like onset, what reason would you have to think it's anything other than the flu? ... until you've gone through the long slow nightmare of it NOT GOING AWAY...
I'm going to cut off some of that question, because it is based on a false assumption. Earlier outbreaks with the same symptoms were not merely reported, but actively investigated with the technology available at the time. One particular outbreak, in Punta Gorda Florida, was investigated by a CDC Epidemic Investigation Service team which not only talked to doctors in the community, but went around knocking on doors to find the 50% of patients not reported by physicians. They wrote up their findings and published them in NEJM in April 1959. The same issue contains an investigation by Alexis Shelokov of an outbreak at Chestnut Lodge Hospital in Rockville, MD, as well as a survey article on prior outbreaks. The goal was that, when the next outbreak took place, investigators would be prepared to go in early and capture data which had eluded these investigators. All three people went on to distinguished careers, demonstrating they were not flakes. In this context, the squandered opportunities at Incline Village or Lyndonville are especially poignant.
In response to the notorious 1970 paper attributing these outbreaks to 'mass hysteria', one investigator, David Poskanzer, wrote a very good letter to BMJ. He made the remarkable suggestion that instead of attributing the illness to psychoneurotic people, they might consider all psychoneurotic illness the result of residual deficits from infectious disease. This has been widely ignored.
I can envision a scenario where the CDC et. al, the whole chorus of deniers (not just of XMRV but of the idea that there ever was a viral infection involved in CFS) are going to attempt to cover their exposed hindquarters with a lot of tsk-tsking about how of COURSE nobody would have been able to detect XMRV before, it is only now with our modern knowledge that it was detectable, what a shame it was *impossible* to detect any sign of a viral infection before 2009 or so...
I'm going to trim some of these statements, not because I disagree, but because this post is already long.
So, persons who actually know the science, riddle me this: If research into a viral cause of CFS *hadn't* been quashed back when Elaine DeFreitas's work was rubbed out, is there actually anything about the state of the science at the time that would have prevented researchers from detecting XMRV? Is there something about the state of the science *now* that made this the soonest possible time XMRV could have been detected?
Because I strongly suspect that's going to be the cover story from now on.
Here's the real kicker in that episode. Before she crashed and burned, Elaine DeFreitas had TEM micrographs showing more than one virus. The really interesting one for me was a C-type virus with a diameter of approximately 70 nanometers. This pretty well shouts retrovirus, and one expert who saw the pictures said so at the time. The whole series of pictures has not, to my knowledge, been published anywhere. What I would love to get my hands on is the picture showing a virion inside a mitochondrion. MuLV is known to infect mitochondria, and I don't think any other virus is known to do this. All by itself, the discovery of a retrovirus in human beings which infected mitochondria should have been a major result. Yes, it was possible; it was done.
DeFreitas had a mess in the samples she was given, from patients with multiple infections, and she had teased out clues that a retrovirus was involved. She thought it was related to HTLV-1 or HTLV-2, but she stated it was neither of these. This didn't stop people from testing for those, and announcing they had shown her wrong. In terms of sensitivity and specificity, she was really pushing the envelope of the state of the art. It is not surprising others had trouble replicating, even if they tried.
When Tom Folks was personally involved in the CFS work, he got preliminary results confirming DeFreitas. He had to go chasing a contamination problem, leaving Heneine, who "did not get along" with DeFreitas (extreme understatement) on CFS. The end result was that one lab got no response at all, while a different lab got response to every sample from any source. These conflicting results were taken to discredit DeFreitas. She never did finish her work, because Wistar management forced her out, hurricane Andrew hit Miami, and her health deteriorated. We don't know what might have happened if she had had support.
We had another mess with a researcher (John Martin?) who found spuma virus apparently causing cytopathology, which is not characteristic of spuma virus. I suspect they were both seeing the recombination action of an "acutely transforming" virus shuffling genes. Historians will have to sort this out. I'm sure there are other episodes I know nothing about.
How this plays out will be
VERY interesting.