NIH post-infectious CFS study

Bob

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And removal of the FMD and Lyme groups, pending a rational explanation them. But we don't know who all of the psychobabblers are yet. It's a huge list of investigators.
What's the problem with the post-infectious Lyme control group, in your opinion, Val? The rationale is that they are asymtomatic, despite having had an infection that often leads to a post-infectious disorder. Is the issue that we never know if Lyme patients or supposed post-Lyme patients or (misdiagnosed) ME patients are free of Lyme bacteria because of inadequate testing? Won't it be an adequate control simply for the reason that the patients are asymptomatic, and we're interested in working out why some (very similar) patient groups are asymptomatic whereas others are symptomatic? That seems like excellent rationale to me. Am I missing something? I'd appreciate understanding your perspective on this.
 

Valentijn

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What's the problem with the post-infectious Lyme control group, in your opinion, Val?
It represents an unknown quantity, with no clear benefit in making a comparison. Is Lyme really gone? Do abnormalities persist? In short, I see no explanation beyond "they had an infection once" ... yeah, just like every other human being.

Another concern is that it could play into the psychogenic beliefs of some researchers: "On the one side we have psychosomatic controls. They think they're ill even though I say they aren't. On the other side we have the Lyme controls. They're the non-psychosomatics who recovered when we told them they should. Which group are the ME patients most similar to?"

I don't think we need to be compromising with studies showing a strong psychosomatic interest. It has been proven extensively that this is a biomedical disease, but the control groups are effectively forcing us to prove it all over again ... with an unpredictable variable in the form of a lead investigator who has already decisively declared that ME/CFS is psychosomatic.
 

Nielk

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@Neilk, @dancingstarheart, I get the feeling that you are angry because your petition hasn't had a response yet, whereas other communications have been responded to. But I don't think you should expect such a quick response to a petition.

No - we are not upset that we didn’t get a reply yet. As we stated, we are angry about the type of communication selected by a US government health agency, but understand this is a learning process for some officials who apparently were not familiar with our disease or the thirty years of neglect and disdain that their institution has perpetrated, which actually proves how neglectful NIH has been. Everyone knows about AIDs and Act-Up, but claims not to know about the abused ME community. That is perplexing.

With regards to their communications in general, we've been told repeatedly that the information we require will be published shortly, so I'm not sure why we should be angry about the communications. Personally, I'm more than happy for informal lines of communication to be open, both ways, between our community and the NIH, as long as there is ultimately a degree of transparency.

As we have stated in our blog and in our petition, this was an urgent matter. Dr. Nath was presenting about the study at the CDC Grand Rounds to “thousands” of medical professionals. Dissemination of wrong information, like the Reeves criteria would have been harmful to the entire ME community. The website page that had shown the protocol information went dark with no replacement. If that information was inadvertently posted, as they later claimed, it should have been immediately exchanged with the correct protocol. It would have avoided a lot of distress and misunderstanding. Instead, little bit of pieces of information were being leaked around, with no official addressing what Nath was going to present at the Grand Rounds.

I understand that you personally don’t mind this type of communication but, many US patients do mind and are confused and enraged.

I understand why the community is angry about things in general, taking into account the historic context, but the anger surrounding this project is bewildering to me. I think there may be lots of misinformation perpetuated by our community that is confusing people. I've seen bizarre things being said about the project and plenty of unhelpful and confused speculation. And now there have been bizarre complaints that the NIH is communicating with patients and that the NIH study is a fishing expedition.

Your statement that things you are hearing are bizarre, is subjective to you and I am not sure exactly what you are referring to. The protocol as posted on the website was very flawed. A study with a flawed design is much worse than no study at all.

I wonder if most people had read about the background to the project, and it would have been nice to see ME Advocacy helping the community to understand what information was available. i.e. to inform people that the patients are to be selected using the CCC, and selected by the expert physicians that Dr Unger is using in her project. And that the study will investigate immune and neurological abnormalities. This might have helped avoid unnecessary anger and stress.

The ever-changing background of the project was not available to the public, just to those following certain advocates. The information that you are stating above was not available until Dr. Nath’s presentation yesterday. Therefore, your comment is a misrepresentation of the timeline of what actually happened. For example, the last indirect, unofficial communication from NIH was that Reeves was still included.

The thing I'm most angry about is the ME Advocacy petition, which I've kept quiet about until now.

I find it ironic that ME Advocacy is called ME Advocacy when they are advocating exactly the opposite of what I believe are in my interests (i.e. in the interests of ME patients). They've created a a petition to shut down the most promising study in the history of ME, and they're rebutting the apparent renewal of good-will and renewal of relations from the NIH. And now there's an attempt to shut down friendly communication channels between the NIH and the patient community.

I respect the fact that your opinion is against the petition. Again, you are misrepresenting the true information. MEadvocacy called for the study to be cancelled as is and to replace it with an appropriate study. MEadvocacy prioritizes the needs and plight of severely ill patients above compromising with government officials that may be uncomfortable making the best high quality decisions for a severely sick and dying patient population. We have been an abused group way too long. If we are going to finally have an intramural study at NIH, we expect it to be a robust study of the patients who actually suffer from myalgic encephalomyelitis, not the umbrella syndrome of fatigue.

I
t's one thing to do constructive criticism, or to protest with a specific goal in mind, but this seems like an attempt to say no to everything: to destroy community relations with the NIH and to destroy research. Not in my name, thanks. ME Advocacy do not represent me or my interests.

There was a specific goal in mind and it was stated in the petition. Again, it is your misunderstanding that we are destroying research - we are destroying any chance of bad research. We hope that those designing and approving the study protocol will continue to listen to the community's feedback. We realize that the study is a collaborative effort at NIH. The petition may very well give those in NIH trying to make change for the better, more leverage against the remaining biased researchers.
 
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@Neilk, @dancingstarheart, I get the feeling that you are angry because your petition hasn't had a response yet, whereas other communications have been responded to. But I don't think you should expect such a quick response to a petition.

I am not angry about a delayed response from the recipients. I did not expect a quick response. The confusion came from how others were responding to that email and trying to elicit a response from MEadvocacy, but that has been resolved.

I will not become fearful of government officials making wrong decisions, and therefore stop pushing for the truth. It is on the conscience of those officials for their actions. I can just make sure they will not be able to claim they were unknowledgeable of our expectations.
 

duncan

Senior Member
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@Bob, please note that the study protocol does not say these are former Lyme patients that have been cleared of infection. The asymptomatic Lyme group may be problematic once you realize that some within the mainstream Lyme community perceive any post-Lyme (technically post-treatment) symptoms as psychosomatic.

In effect, there is an argument here, if I am interpreting the Lyme control characteristics correctly, that there are TWO control groups who many within the NIH consider psychosomatic.
 
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Scarecrow

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@Bob, please note that the study protocol does not say these are former Lyme patients that have been cleared of infection. The asymptomatic Lyme group may be problematic once you realize that some within the mainstream Lyme community perceive any post-Lyme (technically post-treatment) symptoms as psychosomatic
In the now removed protocol, one of the exclusions for the antibiotic treated Lyme group is "symptoms or diagnosis of Post-Lyme Disease syndrome".

I copied the Lyme specific exclusion and inclusion criteria into this post before the details were taken down.
http://forums.phoenixrising.me/inde...infectious-cfs-study.42873/page-7#post-694796
 

A.B.

Senior Member
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What do you think about putting something like this on the ME Action? Please suggest improvements. We want to be 100% clear, but also respectful.

Dear Dr Nath,

We are ME/CFS patients that have followed the announcement of the NIH study on ME/CFS with interest. In many ways, the study is very encouraging and speaks of a serious committment to help patients. We are also pleased to hear that you are welcoming patient input.

We are writing you because we are concerned about the lead investigator Brian Walitt. It appears that Walitt has strong beliefs about CFS being a psychosomatic condition. We ask that Dr Walitt be replaced by an impartial researcher. The IOM report last year confirmed that the biomedical literature on ME/CFS shows abnormalities consistent with an organic disease. We need researchers that can look at the problem from a fresh angle, and are determined to discover the biological basis of ME/CFS.

We also question the inclusion of a group of patients with functional movement disorders, and a group of patients that recovered from lyme disease. At $5 million a year, NIH funding of ME/CFS research is very low. We feel that the money would be better spent enrolling more ME/CFS patients into the study. The money could also go towards funding other ME/CFS projects.
 

duncan

Senior Member
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Right, thank you @Scarecrow , I remember that now. And good point.

Then why do they equivocate? Why not just say "former Lyme patients that have been cured"?

The stigma associated with continued Lyme - of any sort - after treatment is real. I think they may know that, especially since some believe the origins (or source of continuation) of that stigma in part can be found in Bethesda.

That aside, how can they even begin to use Lyme patients as a control if there is a scintilla of doubt the disease has been eradicated? If they cannot use that control as a contrast of cured disease, then why include it?
 

Scarecrow

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Then why do they equivocate? Why not just say "former Lyme patients that have been cured"?
Call me naïve if you wish but I'm not sure that they are being equivocal. I would say that's an interpretation based on what you believe and/or know about Lyme and what you believe the NIH believe and/or know about Lyme.

I am choosing to accept that the intent of the NIH is that the Documented Infection Lyme group be comprised of people who were once infected with Borrelia but are no longer infected because of successful antibiotic treatment.

I think they could have, and I wish they had, picked a far less controversial group of documented infection than Lyme. (And what's with the antibiotic treatment anyway? Why not choose a group that recovered naturally?)

I do hope that the NIH respond promptly to the questions that have been put to them about the Lyme and FMD groups. This uncertainty isn't helpful.
 

Bob

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I still don't understand the objections to the Lyme control. The whole point is that the patients are asymptomatic. So the point of the study is to compare patients with symptoms (ME patients) to patients without symptoms (post-Lyme) but who had potential to very easily develop an ME-like illness. It's not the illnesses that they are comparing but they are comparing an absence of symptoms with the presence of symptoms in patients who might have a very similar infection history. It seems like a perfect control.

It represents an unknown quantity, with no clear benefit in making a comparison. Is Lyme really gone? Do abnormalities persist? In short, I see no explanation beyond "they had an infection once" ... yeah, just like every other human being.
Thanks for your reply, Val. See above for my opinions on why I think there is a benefit.

Re "Do abnormalities still persist?" I think the only issue is whether the patients say they feel well. It's actually helpful if any biological abnormalities still exist (when the patient feels well) because we're seeking only the abnormalities that cause illness/symptoms, so such a comparison would help distinguish abnormalities that cause symptoms from abnormalities that don't cause symptoms.

Valentjin said:
Another concern is that it could play into the psychogenic beliefs of some researchers: "On the one side we have psychosomatic controls. They think they're ill even though I say they aren't. On the other side we have the Lyme controls. They're the non-psychosomatics who recovered when we told them they should. Which group are the ME patients most similar to?"
Re the bolded text, but you could say that about any control group that had been cured of an illness. So you're effectively excluding any control that has previously been ill. I don't think that's a helpful approach. If they're really trying to prove that ME is a psychosomatic illness then we might as well give up on the NIH completely. On the other hand, if they're trying to prove that its a biological illness, as they say they are, then even FMD controls would be helpful because those patients don't have ME.

Not that I'm defending the FMD control. I don't think that's particularly helpful because it's such a heterogeneous illness with unknown cause. And there may be overlap with ME.
 

Sasha

Fine, thank you
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A.B. said:
We also question the inclusion of a group of patients with functional movement disorders, and a group of patients that recovered from lyme disease. At $5 million a year, NIH funding of ME/CFS research is very low. We feel that the money would be better spent enrolling more ME/CFS patients into the study. The money could also go towards funding other ME/CFS projects.

I think you need to explain why you question the inclusion of those groups.
 

Scarecrow

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I still don't understand the objections to the Lyme control. The whole point is that the patients are asymptomatic. So the point of the study is to compare patients with symptoms (ME patients) to patients without symptoms (post-Lyme) but who had potential to very easily develop an ME-like illness. It's not the illnesses that they are comparing but they are comparing an absence of symptoms with the presence of symptoms in patients who might have a very similar infection history. It seems like a perfect control.
The antibiotics are confusing me. And there didn't seem to be any requirement in the inclusions that the participants ever had active Lyme disease anyway.

What's your take there?
 

Bob

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@Nielk, thank you for taking the time to patiently explain your position and opinions, in response to my earlier post. I appreciate you taking the time to do that; its helped me understand things a bit better with regards to some of the reactions to the project. Obviously I don't agree with everything you say, but I appreciate the civil discourse.
 

Valentijn

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I still don't understand the objections to the Lyme control.
What's the point of Lyme controls? Why aren't ME/CFS specialists, exercise physiologists, Rituximab trialers, etc, using Lyme controls? What positive aspect do they add to the study?

I'm coming up with a blank. They don't make sense, they introduce unknown variables, and they make a complicated situation even more complicated.
 

Bob

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The antibiotics are confusing me. And there didn't seem to be any requirement in the inclusions that the participants ever had active Lyme disease anyway.

What's your take there?
Actually, I'm pretty sure that it was clear that the controls did have to have an earlier active Lyme infection that had resolved.

Antibiotics are the standard treatment for Lyme. I don't know the stats relating to how many patients recover from Lyme naturally vs with treatment, but I had assumed that anyone presenting to their doctor with Lyme would automatically be treated? So I assume it's just a case of it being the standard treatment for anyone presenting with Lyme.
 

Comet

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What's the point of Lyme controls? Why aren't ME/CFS specialists, exercise physiologists, Rituximab trialers, etc, using Lyme controls? What positive aspect do they add to the study?

I'm coming up with a blank. They don't make sense, they introduce unknown variables, and they make a complicated situation even more complicated.

I'm very excited and happy about this study, but the control groups make me nervous. Are they trying to compare them to see if they are all psychosomatic? Or, if the others are 'accepted' as psychosomatic, do they want to see how ME./CFS compares to determine it's psychosomatic-ness?

Actually, it would be great to hear from the NIH why these control groups have been chosen. I highly doubt that FMDs have much to do with post-infectious illness in the eyes of the NIH.

ETA: Just to be clear, I'm not trying to throw this study under the bus AT ALL. Just expressing concern about some of the stranger facets of it.
 
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