What one DOCTOR says -- David S. Bell, M.D., who has been researching CFS since the 1984 Lyndonville epidemic, author of "The Doctor's Guide to CFS", treating hundreds of CFS patients for the past 22 years.
Note that even Dr. Bell says that CDC/NIH don't know what they're talking about. And *why* don't they know? Because they have done very few CFS studies (as compared to the many done with private funding) and because many (including the current batch) of the ones they have done have been invalid because of the inclusion of people with a diagnosis of primary depression, which would skew the results. Distinguishing criteria (such as exercise intolerance) are missing in the CDC diagnostic criteria, although they are in the internationally-accepted criteria (
formatting link
). CDC's definition focuses on "fatigue", the international criteria focus on the neurological factors that are conspicuously absent in the CDC definition.And now, I turn the microphone over to Dr. Bell...
formatting link
Cerebral Atrophy Introduction Literature Review: The Presence of Cerebral Atrophy in CFS Literature Review: Cognitive Symptoms of CFS Literature Review: Abnormal Cerebral Perfusion in CFS
I do not like to deliver discouraging news. But for many years the medical world has been dismissing CFS/ME because there has been no science to say that this illness is serious. Now that scientific information is pouring in abundantly. Is the medical world going to continue to maintain that ME/CFS is a trivial psychosomatic problem of neurotics and hypochondriacs?
In this issue of the Lyndonville News I would like to summarize several studies, two of which show the presence of cerebral atrophy. In lay terms, that means that the brain has decreased in size, presumably because of death of brain tissue. The other reviews outline a new study proving the cognitive symptoms and some older studies demonstrating decreased blood flow to the brain (cerebral hypoperfusion). In my opinion these issues are connected or linked.
Many standard neuropsychological testing results have been considered ?normal? or ?consistent with depression?, primarily because the areas studied were not the areas of impairment in CFS. If neuropsychological testing were to be done, the focus should be on ability to maintain attention, verbal processing speed, reaction times, and the ability to acquire new information. For a review of the neurocognitive studies, see Jason L, Corradi K, Torres-Harding S, Taylor R, King C. Chronic fatigue syndrome: the need for subtypes. Neuro-psychology Review
2005;15(1):29-58. Hopefully this study by Lange et al will put to rest the controversy of the presence of cognitive deficits in CFS, because they can be seen on fMRI.
For those persons with severe CFS persisting for more than five years, the likelihood of recovery is slim. I would assume that the neurological damage that causes the symptoms is also causing the cerebral atrophy, and that is not likely to be reversed.
ME/CFS is a debilitating disease of the central nervous system that causes widespread disability. Unlike Alzheimer?s disease, ME/CFS affects young people in the prime of their life and affects children as well. It should no longer be considered a trivial problem.
The NIH and CDC say that this illness does not run in families. Every clinician who studies ME/CFS knows that it does.
There are probably six known genes that could be involved in ME/CFS (see below). Is the NIH studying it? I have fifteen families in my practice where parent and children are ill. Anyone out there want their blood? Why is this not important ? and don?t say its because of subtleties in the diagnostic criteria. I think that is merely an excuse to do nothing. I would say to the CDC, pick your criteria and study it. To the NIH ? fund some studies. You complain that there is no proof, but no one will put up the money to do a study. By the way, I just read that the NIH has funded five Botanical Research Centers for five years each to look at botanicals from flaxseed to tarragon.
Genes that may play an important role in ME/CFS, partial listing:
- Polymorphism in PON1 gene encoding paraoxonase/arylesterase, an enzyme that hydrolyzes organophosphate poisons to harmless products (Haley R, Billecke S, La Du B. Association of low PON1 type Q (Type A) arylesterase activity with neurologic symptom complexes in Gulf War veterans. Toxicol Appl Pharmacol 1999;157:2129-2137).
- Familial corticosteroid-binding globulin deficiency, due to null mutation in globulin gene (Torpy D, Bachmann A, Grice J, Fitzgerald S, Phillips P, Whitworth J, et al. Familial corticosteroid-binding globulin deficiency due to a novel null mutation: association with fatigue and relative hypotension. J Clin Endocrinol Metab 2001;86:3692-3700.
- Hypofunction of 5-HT system due to long allelic variants in the serotonin transporter (5-HTT) gene promoter (Narita M, Nishigami N, Narita N, Yamaguti K, Okado N, Watanabe Y, et al. Association between serotonin transporter gene polymorphism and chronic fatigue syndrome. Biochemical and Biophysical Research Communications 2003;311:264-266.
- Myoadenylate deaminase (AMPD1) mutation cause of myopathy.
- Carnitine palmitoyltransferase (CPT2) gene mutation causing myopathy.
- I/D polymorphism in ACE gene (DCP1) (Vladutiu G, Natelson B. Association of medically unexplained fatigue with ACE insertion/deletion polymorphism in Gulf War verterans. Muscle Nerve 2004;30:38-43.)
- Polymorphism of the corticosteroid binding globulin Ser/Ala 224 (Torpy D, Bachmann A, Gartside M, Grice J, Harris J, Clifton P, et al. Association between chronic fatigue syndrome and the corticosteroid-binding globulin gene ALA SER 224 polymorphism. Endocrine Research 2004;30(3):417-429.
Patients with chronic fatigue syndrome experience severe fatigue, orthostatic intolerance and numerous other symptoms that are similar to known illnesses of the autonomic nervous system.
- * There you have it -- a doctor whose life's work for the past 22 years has been researching and treating CFS, reporting on research that CDC claims doesn't even exist with their disingenuous "first evidence" speech last week.
If you want to see psychological factors, that's all you'll see. If you're looking for physical/biological factors, you'll find plenty.
Dr. Sheila Bastien, neuropsychiatrist: Many medical disorders present as psychological disturbances. Pancreatic cancer can cause visual hallucinations. Adrenal tumors will cause behavior that can seem psychotic. So you have to be very careful not to accept psychiatric diagnoses at face value. ... I remember thinking that if I were testing nothing but Alzheimer's patients, then I would say "This group isn't very impaired." But they were more impaired than the head concussion cases that I've tested that have been in litigation. ... And it looked worse than most of your average depressions.
In 1985, Dr. Bastien produced the first neuropsychological "signature" for CFS; CDC ignored it because it didn't fit into what *they* wanted to find.
As I said initially, what CDC claims to have found, and what the researchers who have dedicated their lives to CFS have *actually* found, are two radically-different things, because CDC's goal, since 1985, has been to portay CFS as a purely psychological disease, to discredit the patients, so that the government and insurance companies can apply the two-year limit on disability benefits for psychological problems, instead of having to pay benefits for life.
Hillary J. Johnson, author of Osler's Web, commented that the name "Chronic Fatigue Syndrome" was selected "by a small group of politically motivated and/or poorly informed scientists and doctors who were vastly more concerned about costs to insurance companies and the Social Security Administration than about public health. Their deliberate intention ?? based on the correspondence they exchanged over a period of months ?? was to obfuscate the nature of the disease by placing it in the realm of the psychiatric rather than the organic. The harm they have caused is surely one of the great tragedies of medicine."
The government is not always your friend ... sometimes, the government is a better friend to those with the big lobbying bucks.