Talk:Myalgic encephalomyelitis/chronic fatigue syndrome/Archive 2

message: * Page was over 160kb, archived.
* Note: please do not feed trolls posing as doctors or medical students who post messages here about how CFS is "funny" and is not taken seriously by doctors.
◄██  Unit 5 (Talk)  ██► 18:26, 14 December 2006 (UTC)
replies: text: He did not say CFS is funny, he said the article is funny.  He did not say CFS is not taken seriously by doctors, he said many doctors consider it to be a somatoform disorder.  And it was not trolling.  Despite being a CFS sufferer, I was able to see where he was coming from. 86.129.148.112 10:29, 15 December 2006 (UTC)
thread_title: Old talk page archived

message: I have a Chronic Fatigue Forum and Blog, I wanted to add it to the CFS Links Section. 
My site is www.chronicfatiguetreatments.com There is also a pretty extensive treatments blog and CFS News. Let me know what you guys think
: My vote is no.  I don't think it is appropriate.  Perhaps have a link to your site placed in a relevant section of the Open Directory and then place a link to that. Jklsc 19:27, 24 April 2007 (UTC)
replies: text:  I agree with Jklsc, at this point links need to be trimmed.  If it's not hard science it needs to be left out.  Only so much can be gained from forums and blogs, imo this article is at its limit for them.  Thank you for consulting first though, it shows that you actually care about the topic rather than promotion. Foolishben 10:58, 24 July 2007 (UTC)
thread_title: CFS Community Link

message: I wanted to add some information about methylation cycle and cfs. Im using that treatment right now and its helping me alot. Is it ok if i write about it ,if so where should i put it
: You could put it in the "Descriptive list of other etiologies/treatments". - Tekaphor 09:07, 28 February 2007 (UTC)
replies: text:  Added a blurb about research including a link to a poster paper. 68.85.119.250 23:04, 3 April 2007 (UTC)
thread_title: Methylation cycle

message: In the (now archived) discussion page, MikeEsp made the following statement:
"The Canadian definition has I believe influenced the latest Australian guidelines though I can't remember what that said exactly and I've lost the link I had for that."
I know of at least two such guidelines issued recently in Australia, both serious documents worth reading:
1. http://www.sacfs.asn.au/index.html
(Check the right hand column for downloads. The specific document is 'ME/CFS Guidelines: Management Guidelines for General Practitioners (English)', but there are also other interesting documents available on this site that people may wish to read.)
2. http://www.mja.com.au/public/guides/cfs/cfs2.html
(Has a PDF version link on this page.)
The final version of the MJA guidelines, done under the auspices of the Royal Australasian College of Physicians, was published in 2002 (with the original draft released in 1997). So it cannot have been influenced by the Canadian guidelines, which were published in 2003.
However, the 'ME/CFS Guidelines: Management Guidelines for General Practitioners' were published in 2004, and list the Canadian guidelines in the references section, so probably were influenced quite a bit by them.
Bricker 20:59, 15 December 2006 (UTC)
replies: text: Thanks for that, Bricker! MEspringal 23:55, 11 June 2007 (UTC)
thread_title:  Australian Guidelines 

message: Just been looking at the Multiple sclerosis article, a disease just as confusing as ME/CFS, but with a much more sensible article structure and division. Perhaps we should begin to move bits of the article to other pages, such as "Proposed Etiologies for Chronic Fatigue Syndrome" and so on. The article is fairly long and doesnt appear properly at all on a modern AXIM PDA.
And maybe also get rid of that table - it doesnt look very nice and I dont think the formating is amazing either. Thedreamdied 00:35, 30 December 2006 (UTC)
replies: text: Other pages could be CFS Research, CFS Proposed Etiologies and CFS Controversy, so the endless repetition of how hard to diagnose/how people dont understand etc etc could go elsewhere and make this a purely medical article. Thedreamdied 14:44, 4 January 2007 (UTC)
thread_title: dividing this article up

message: This article is very confusing in its present state. There has been some new research into CFS and memory, showing a difference between CFS patients and controls regarding medial prefrontal region activation in n-back tests. The abstract is here. Gregs 23:48, 3 January 2007 (UTC)
replies: text: I agree, the article is ridiculously confusing. There needs to be a new break-off page entitled CFS Research, or similar, for this kind of thing. Thedreamdied 14:43, 4 January 2007 (UTC)
thread_title: Unsure where to put new research

message: As it stands, the CBT section contains a biased POV view from patients
::Actually all the criticisms come from MDs and biological researchers into the illness. See my quote from Carruthers et al about CBT above.  Your attempt to use this to discredit and character-assassinate sufferers won't be tolerated.
which does not correspond with the science, while the "alternative view"
contains the current scientific facts. It is my proposal that the
"alternative view" of CBT be moved to the main article, and the current
CBT article either be moved to the "alternative view" or deleted completely.
My own view is that it should be deleted completely, as it is mostly biased, false and
POV. However as the view is shared by many CFS patients, support groups
and researchers, we could leave it there as the "alternative view", while
pointing out that it is not supported by science.
::This is going to cost you a lot of time and you will end up with a lengthy section about the controversies of CFS/ME and CBT. Other people have tried that before you and that's about the optimum you can achieve. 
Please do not post insults or abuse - you will be ignored if you do.
Stick to the science and the facts.
::And I respectfully suggest restraint from patronising supercilliousness good form too.  You don't have some special god-given insight into the "science". 
Anticipating the arguments in advance that this proposal is likely to
generate, here are responses to some of the most likely objections:
"all the evidence supporting CBT is based on the Oxford criteria, so
the people may not even have had CFS in the first place" - the reason
why most studies use the Oxford criteria is because most of the
research comes from the UK, where the Oxford criteria is the main research
criteria used. However if you actually read the case studies of people who have
recovered from CFS using CBT, you will see that they also
conform to other criteria for CFS, such as the Canadian definition (Carruthers),
and the latest CDC criteria (Fukuda).
::No, most of the BEHAVIORAL reasearch comes from the Netherlands/the UK. 
::As for the applicability across definitions - so far you only came up with weasel words (that's no abuse, look it up in wikipedia). Prove it or forget it. Anecdotes don't count. Nor do your personal interpretations of what single cases had or had not.
::If you insist on your Oxford stuff in an Article about CFS, you will have to live with the controversy around it.
:::LOL The "Oxford" arguments and counter-arguments are so early 90's don't you think.  CDC CFS is such a car crash of a concept it doesn't need Oxford to mess things up.  And peer review is often so poor that the criteria are still seen as optional despite claims to using the CDC definition (Judith Prins anyone).
"CBT can only cure psychiatric symptoms such as depression, anxiety and
fatigue, it cannot cure the physical symptoms of CFS, such as exercise
intolerance, myalgia, NMH, shrunken adrenal glands, hypoactive HPA axis etc." -
research into IBS has shown that behaviour therapy significantly reduces
the physical symptoms of IBS (). Also, if you read the case
notes of people who have been cured of CFS using CBT you will see that
it does cure their physical symptoms as well. All of these physical symptoms
are seen in other stress-related illnesses such as PTSD and burnout.
::Good for CBT. But we are talking about CFS. So prove your point. Also, if the case notes are anecdotes, you are waisting everybodies time.
:::Also choose your "physical symptoms" very well ScienceWatcher, even though they're not all officially part of the CDC criteria. I'd like to see you do the same with pyrexia or subnormal core temperature, chronic delayed OI with POTS, blackouts, ataxia, dysphasia, exertional respiratory dysregulation, dyspnea, diastolic cadiomyopathy, white matter atrophy, etc.  Where is the evidence that physical signs (which many CBTers actively refute exist, hence their excision from the 1994 criteria) are cured?  From the CBT studies I've seen claiming success, this is not what is reported as happening. Perhaps we should talk of the biologica findings rather than mere signs/symptoms, but I doubt the CBTers bother looking for Rnase-L, activated elastase, arterial stiffness, ventrical dysfunction etc... as they might not find them in their patients...
"Many people recover naturally from CFS over time, so anyone who recovers
due to CBT was probably about to recover naturally, and the CBT had no
effect" - clinical trials show that CBT results in significant improvement
over "natural course" treatment (doing nothing at all) ( and
others).
::The study you cite did not use the Fukuda Criteria. Read the entire study. It did not require the 4 out of 8 criteria. 
::BTW: the government just examined the CBT/GET CFS-Centers, and they did not live up to the promises made in the Prins et al. studies. Weasel words from me, but I can provide you with a link to the report.
:::Another quack study into CFS. Ho hum.
"If you recovered using CBT then you couldn't have really had CFS in the
first place" - this argument is founded on the firm belief that CFS cannot
be psychiatric in origin, and it is expounded every time someone says that
they were cured by CBT or indeed any psychosocial intervention.
However when you actually look at the evidence, by looking at the actual case
studies of people who have recovered from CFS using CBT and similar therapies,
you see that they did really have CFS as described by all the major criteria
(Fukuda, Carruthers, Oxford, etc).
::Are you going for anecdotes? Weasel words, prove required.
:::Where's the actual "case studies"? And of course the Canadian definition doesn't say remission is impossible. I know a few sufferers who've had temporary or lasting remissions, and if they don't recognise a relapse-remitting potential these "natural causes" comparison groups may be as weighted as their success groups. WHich sometimes required an increase of just a few points on the ratings scale (from +60% to start off with)
"CBT is based on a flawed, unproven etiology of CFS" - this I would tend to
agree with. However, just because the treatment is based on a flawed theory of
the illness does not imply that the treatment does not work. Lithium
has been used as a treatment for bipolar disorder for over half a century,
but its exact mechanism of action is still unknown. Further research
should refine CBT - both the therapy itself, and the theory of how
it cures CFS.
::I also tend to agree with this. Your suggestions for further research are your suggestions, and there are other suggestions. 
::From the new, public founded studies in the USA 6 out 7 center on physical research. 
"CBT does not cure everyone" - agreed, CBT only results in significant
improvement in between 27% and 50% of patients, depending on the study.
However just because it doesn't cure everyone does not mean it should
be rejected. The research shows that CBT is significantly more effective
than doing nothing at all.
::Depending on the study, that's what I agree with, too. Unfortunately everything looks always good for the oxford criteria and rather bleak for everything else. So come up with the studies, than we take it apart peace by peace.
:::Get with the programme SW, CFS is *heterogenous*, so of course some people with nonspecific symptoms such as fatigue, sleep problems, headaches, sore throat and lymph nodes have a psych illness.  That's not in question.  What is in question is that such cases aren't wholly representative and don't tally with the original "aim" of CFS based on the Lake Tahoe etc ME epidemics and the original Holmes definition which while still flawed had physical signs included.
"CBT can be harmful to some patients" - there is no evidence that this
is the case. In addition, many of the clinical trials state that no
harmful effects were noted.
:::If a patient with leg pain (to use an example from an episode of House is admitted, has a treatment and immediately feels (audibly) worse, is that "evidence"?  The fact is that there have been more than one patient survey where for the severely affected particularly (for whom just seeing a visitor will make them worse, assuming they're not expected to overcome being house/bedbound). One patient's experience was that she relapsed after a three-hour introductory interrogation, sorry, session. Most severely affected sufferers struggle to talk for more than fifteen minutes. 
:::And that's before the inevitable Graded exercice (GET) part of the CBT kicks in.  Yes, "re-exposure" is part of CBT.
::Well, in theory it should not be harmful. In reality "if you look at the case studies" (<-- sorry, but you started that...) you will find that patients feel that they are blamed for their own misunderstood illness - which has a long tradition in psychiatry. Just think about diabetis, multiple sclerosis (<-- once called: 'The fakers disease') or psychologies latest disapointment: Helicobacter pilory infections.
::I wouldn't argue though, if you edit that one out. In my personal view, it's an undue waste of money and undue airtime for psychiatry, but not harmful. 
::BTW - "Sciencewatcher", if you can take some advise - and that I mean in all earnesty - don't devote too much time to this. You can probably edit some overshooting or too edgy wordings - but you won't be able to turn the tide for CBT. The godfather of psychologising in CFS, Prof. Wessely disengaged already.
Supporters of a purely somatic point of view (and you can argue that that's wrong until your blue in the face - the not*psychology*world won't listen anyway, be that right or wrong) have the comfort of an exponentially growing and converging body of evidence in their back - so its a downhill battle for that group. The two countries which are currently devoting the most money to CFS Research(Japan and the USA, with Japan being No1 in the world right now, they supposedly have an own ministry for it) are not investing into psychological viewpoints, so you can guess which way the wind blows in terms of the paperwork they are going to produce. The turning point in both countries came when the figures about annual economic costs were published. Money, money money, isn't it funny? 
--Sciencewatcher 00:18, 14 February 2007 (UTC)
replies: text: Okay, now I'm confused as to whom I was responding to... -MEspringal 02:15, 12 June 2007 (UTC)
replies: text: I agree that there is bias against psychiatrie. Part of it is due it's crass 
===CBT Evidence===
Actually I was wrong. I assumed that because the studies were in the UK they used the Oxford criteria, but I actually looked at one study and it uses the CDC Fukuda (1994) criteria (see http://www.kcl.ac.uk/content/1/c6/01/47/68/QuarmbyComparisonofoutcomerswithinandoutsideconfinesoftrial2006.pdf). Anyway, this removes the argument that the studies are invalid because they only use the Oxford criteria. And even if they did use the Oxford criteria, that does not mean they are not talking about the same illness. --Sciencewatcher 18:49, 15 February 2007 (UTC)

text: I'm sure if you were using weasel words you'd say that ;)  MEspringal 02:15, 12 June 2007 (UTC)
thread_title: Proposal: moving the CBT "alternative view" to main article

message: Actually I was wrong. I assumed that because the studies were in the UK they used the Oxford criteria, but I actually looked at one study and it uses the CDC Fukuda (1994) criteria (see http://www.kcl.ac.uk/content/1/c6/01/47/68/QuarmbyComparisonofoutcomerswithinandoutsideconfinesoftrial2006.pdf). Anyway, this removes the argument that the studies are invalid because they only use the Oxford criteria. And even if they did use the Oxford criteria, that does not mean they are not talking about the same illness. --Sciencewatcher 18:49, 15 February 2007 (UTC)
replies: text: I'm sure if you were using weasel words you'd say that ;)  MEspringal 02:15, 12 June 2007 (UTC)
thread_title: CBT Evidence

message: The CBT/GET issue seems mostly resolved, but I would like to comment on the associated 'psychosomatic' issue since it is still causing agitation on the talk page.
It is totally understandable why some people with CFS have a strong resistance towards the word "psychosomatic", when for so long it has been commonly associated with accusations of being 'just in the mind' or 'not real', plus its likely they have received such bias from others in the course of their illness. Also, its no surprise that the mind-body split currently affects the medical profession regarding poorly understood illnesses like CFS when it still troubles philosophers and scientists after many centuries of advancements. Personally, I think there is a very wide and complex 'grey area' between the traditionally classed 'physiological' and 'psychological' aspects which remains to be understood. 
On a more subtle note, 'psychosomatic causes' should be emphasised as being different to 'psychosomatic illnesses'; in other words, even if psychosomatic causes (i.e. stress) contribute to CFS, it doesn’t automatically mean the illness itself is psychosomatic. A good example of this is how multiple sclerosis was once viewed as being just psychosomatic but is now commonly accepted as physiological, and yet a large study in Denmark found that parents who had lost a child unexpectedly were 50% more likely to develop MS than parents who had not, suggesting that psychosomatic causes also influence the development of MS but obviously don't necessarily make it a psychosomatic illness.
I think the studies on genetics and stress are major breakthroughs; with these aspects likely being interrelated in the development of CFS. If people have an inherently different ability to handle stress, it makes sense that genetics are proposed as a factor. Its also interesting that 'psychological problems' don't seem to be a factor in the development of CFS (and perhaps neither its prognosis?), yet a 'stressful childhood' can greatly increase the likelihood of acquiring it. Perhaps some of the same people who reported a stressful childhood were also more likely to report one because they were inherently/genetically more 'sensitive to stress' than others, further suggesting a predisposition. 
Conclusion: if stress remains the only identified 'psychosomatic aspect' associated with acquiring CFS, the article should stick to the term "stress" rather than flame agitation with the term "psychosomatic".
Tekaphor 09:27, 28 February 2007 (UTC)
replies: text: As far as I am aware, ME/CFS isn't in the DSM, and I doubt adding it would be beneficial. - Tekaphor 05:25, 24 March 2007 (UTC)
thread_title: Resolving the 'psychosomatic' issue

message: The "testing" section starts by saying that the NIH recommends a number of laboratory tests. However it seems that people have just been adding additional tests to this list, and there are quite a few there that I would very much doubt if the NIH would recommend them. Does anyone have a reference to the actual NIH document? --Sciencewatcher 17:50, 14 March 2007 (UTC)
thread_title: Testing

message: This really needs looked at. It includes two fictional characters (neither of whom are said to suffer CFS in the fiction) and an awful lot of (frankly bizzare) speculation.  Daibhid C 21:48, 17 March 2007 (UTC)
replies: text: I've removed the fictional characters, and two others that I'm fairly certain were intended as "jokes", and added a "sources" tag. I suspect the whole section may need wiped, but I'd like an expert opinion. Daibhid C 21:54, 17 March 2007 (UTC)
replies: text: I'm no expert, but my opinion is that every notable sufferer should have a source found, or be deleted. Thedreamdied 23:45, 17 March 2007 (UTC)
replies: text: I agree. Most of the wikipedia entries for those people don't mention CFS. - Tekaphor 13:53, 19 March 2007 (UTC)
thread_title: Notable sufferers

message: Present text: "Chronic fatigue syndrome (CFS), also known as myalgic encephalomyelitis (ME), post-viral fatigue syndrome (PVFS)"
The above seems not to be in accordance with the ICD-10, nor with the point of view of the CDC, nor with the historical meaning of the terms. CFS, ME and PVFS are not synonymous:
* PVFS is the title of G93.3. This is an umbrella term. At present, only ME appears in the tabular classification as a form of PVFS, but more could be added just as is the case with other codes.
* ME is a diagnosis listed under the header of PVFS. It is not a group term but a specific diagnosis, pretty much defined by its name.
* CFS appears only on the alphabetic list of the ICD-10. It has been given the code G93.3, which means that it falls under the header of PVFS. That, however, does not imply that it is identical to PVFS or another name for ME. There are several more terms on the alphabetic list with the same code, too. 
Historically, CFS is a working case definition, nothing more. It is what is used in research because it is expensive to diagnose ME. To be certain, one would have to do an autopsy, which is a rather taxing procedure to the living patient. CFS targets the ME patients, but it is not ME itself, and people can get diagnosed with CFS that do, in fact, not have ME, but another disease like Lyme, Hashimoto, depression, metabolic disorder etc.--Guido den Broeder 10:12, 18 March 2007 (UTC)
replies: text: And how could you diagnose ME from an autopsy? Thedreamdied 19:28, 18 March 2007 (UTC)
replies: text: I agree that CFS/CFIDS/ME/PVFS may not all be exactly the same illness, however they are clearly used synonymously in the medical profession quite often - I don't think CFS is the best name but it still seems to be the most common one. At wikipedia both ME and CFIDS lead directly to the CFS page, and PVFS has a short entry which also leads to CFS. If the name PVFS was adopted in an attempt to represent CFS/ME more accurately (although this is debatable), doesn't this further highlight how the names are used synonymously? So unless someone is going to rewrite separate definitive articles for each one of these, I don't think its practical to remove the ICD references from the CFS page, especially when these illnesses have so much overlap and whose etiologies remain murky. - Tekaphor 04:12, 19 March 2007 (UTC)
replies: text: Just because someone put a redirect on the ME page to CFS doesn't mean it should be there.  i.e.  Just because many people use the terms synonymously does mean they are synonymous.  There should be seperate pages for seperate things. However, I do agree that there should be links between the pages in appropriate context. —The preceding unsigned comment was added by 82.41.24.187 (talk) 07:11, 15 April 2007 (UTC)
replies: text: You are right. It has become increasingly obvious to me lately that the original term C.F.S. was too loosely created, over-emphasizes fatigue and under-emphasizes the other symptoms; at the expense of the more severely affected patients who are being lumped into the same group as those who lack additionally disabling key symptoms of M.E. such as Myalgia and post-exertional malaise. I now better understand why some people are angry at this discrepency. - Tekaphor 09:27, 25 April 2007 (UTC)
thread_title:  CFS, ME, PVFS 

message: This page is far too long.  I tried to fork it but Jfdwolff unforked it because:
 
: "Such moves should only be made after ample discussion on the talk page, especially in such a controversial topic.
: The page is presently too large. I'd much rather that time is spent removing irrelevant or off-topic material and concentrating on the various schools of thought in CFS. There is a lively discussion on Talk:Chronic fatigue syndrome"
That may be so but everyone here agrees that the page isn't good enough and it's length far surpases the wikipedia norm.  I think that it should be forked now so that people can actually read it!  It is completely inaccessible the way it is.  Sure, it needs to be tidied up but that isn't going to happen any time soon so, let's have a little discussion and then fork it. Jklsc 19:24, 24 April 2007 (UTC)
replies: text: How or where might we fork it?  A central article that has summaries and links to other articles? Split according to competing and frequently incompatible definitions?  Other? -- Strangelv 07:24, 29 April 2007 (UTC)

text: If we decide to fork, this article should be turned into solid gold without NPOV issues. For instance, if we were to fork a history of the chronic fatigue syndrome we would need a concise but very good, heavily sourced and uncontroversial paragraph titled "history" on this page, with a  link to the content that has been split off. JFW | T@lk 12:04, 29 April 2007 (UTC)
replies: text: Today I was going to add my few months of work to the CFS article; but I didn't continue because it would just further bloat an article that is already too large. I believe these additions are important, with the work being on (studies into): physical fitness, neurocognitive dysfunction and neurological abnormalities, psychological and psychiatric factors, immunological abnormalities, oxidative stress, and history. Maybe Jklsc has a good idea about each large section being forked with a brief summary remaining on the main page, although JFW has a good counter point about quality control. However, I have come across articles before that implemented a similar structure, and as long as each page was clearly linked to all related pages, it seemed to work well. Another reason I now support forking is that the section on controversy needs a lot of work and is obviously going to become larger since most people here seem to want to expand/contribute to it. JFW, it may be slightly hypocritical of me to make suggestions for trimming/removing since I have a few pages of text I want to introduce, however, my suggestions would be (besides general copy-editing and/or condensing): some of the proposed etiologies that seem unrelated to CFS could be reduced to a list of bullet points with one sentence descriptions; the list of notable sufferers could be severely shortened; the paragraph in the "activity levels" section about 2 people could be removed. - Tekaphor 10:26, 5 May 2007 (UTC)
thread_title: Forking

message: This site is definitely too long, my wireless server drops out before I can even make a contribution, not everyone lives in the fast lane! You are probably all at this time, beavering away dividing it up anyway, but allow me to make a suggestion, Rather than divide it up along some ideal medical template, I would suggest you split it up to suit the uninformed who are likely to visit the sites. For instance
Article 1 CFS Deinition and Diagnosis  ‘So I have CFS, what is it’, “what do I need to know to discuss it with my practitioner’?
Article 2 CFS Treatment and Therapies  ‘What can I do to help myself’, ‘What can my pratitioner do’, ‘what other options do I have’?
Article 3  CFS Research  ‘If there is no cure where is Hope’ ‘What is in the pipeline in the future’, 
Article 4  CFS Hypotheses and Controversies  ‘ I have been told or heard this or that but it does not fit with my experience, are there other opinions,? 
More Articles as need be, in other words stucture the site to suit potential users, not just contributors. Some great stuff here, now the challenge is to make it more accessable.Jagra 11:44, 19 June 2007 (UTC)
thread_title:  More on need for new Site Design 

message: The below document is a clinical guideline on ME/CFS for psychiatrists written by a psychiatrist (featured on a link from an earlier talk page post by Bricker), and may be a good starting point to explore for issues relating to the psychiatric vs physiological debate: http://www.sacfs.asn.au/download/guidelines_psychiatrists.pdf
Of particular interest are the references contained in the following sections:
*2.4 Etiology (p5)
*3. ME/CFS is NOT a Psychiatric Disorder (p7)
*3.1 Rates of Psychiatric Disorder in CFS Are Similar to Rates in Other Chronic Medical Conditions (p7)
*3.2 Rates of Personality Disorder in ME/CFS Are Not Elevated (p7)
*3.3 Genetics of Depression and ME/CFS Are Independent (p8)
*3.4 Physiological Measures Between ME/CFS and Depression Differ (p8)
*3.5 Illness Severity and Not Psychological Factors Predict Outcome (p8)
*8. Treatment Issues (p17)
*8.1 Drug Dosage and Drug Sensitivity (p17)
*8.2 Utility of CBT/Graded Exercise in ME/CFS (p17)
Hope this helps. - Tekaphor 06:18, 27 March 2007 (UTC)
replies: text: Tekaphor: this article seems to be very POV - the psychiatrist is really just putting forward her view that CFS is not a psychiatric disorder and using selective evidence to do that. For example, she says that CFS patients are no more likely to have personality disorders, but she neglects to point out the many studies that show CFS patients have different personality traits and coping styles from controls. She also points out the CFS is not depression, but that does not mean it is not psychiatric. Depression is not the only psychiatric illness out there. The document above is only useful to people like Bricker who are trying to promote their POV that CFS is not psychiatric. --Sciencewatcher 03:57, 1 April 2007 (UTC)
replies: text: Sciencewatcher, you were kind of right, the paper was of limited value for the research I wanted to do so I searched PubMed instead, however in that process I also came across studies finding comorbid and even possibly premorbid personality traits in neurodegenerative disease. Perhaps CFS is partially neuropsychiatric. - Tekaphor 06:24, 5 May 2007 (UTC)

text: Sciencewatcher, you said that there are "many studies that show CFS patients have different personality traits and coping styles from controls". Do any of these studies demonstrate a causal link? In the study you posted previously that found there is a higher rate of defensive high anxious coping style in people with CFS, it is proposed that this is a way to deal with poor self esteem. However, the majority of the participants with CFS in the study didn't have this coping style and it isn't clear how it would cause all the CFS symptoms for those who do, and what about those who don't have poor self esteem? Also, without access to the full text I don't know what illnesses the "chronic illness controls" were affected with, which is important since neurological illness can also cause mood/personality disruptions. Without demonstrating that a particular coping style is causal of CFS and only that it exists more commonly in people with CFS, it may still be a maladaption or even a symptom. CBT may improve this, but it also seems to help the coping strategies, psychological wellbeing and perceived health competence of people with multiple sclerosis. - Tekaphor 13:04, 1 April 2007 (UTC)

text: Sciencewatcher, ME/CFS is a neurological disease by definition. To be exact, CFS is a working case definition for Myalgic Encephalomyelitis. You could (wrongly) claim that the disease doesn't exist, but you cannot claim that it is something else.--Guido den Broeder 01:51, 4 April 2007 (UTC)
replies: text: A study of gulf war veterans suffering from CFS () showed that biopsychosocial factors (including personality, negative coping strategies and wartime stressors) were significant predictors of current physical function. Nobody is saying that a particular coping style is causal in itself, it is just a factor. The most likely explanation for CFS is that it is burnout caused by stress, and all of the evidence seems to point to this. --Sciencewatcher 15:16, 1 April 2007 (UTC)
replies: text: There is no such evidence. What you are saying is by definition impossible. If any patients that were diagnosed with CFS later appear to be suffering from a psychocological or psychiatric disorder (and this not as co-morbidity), then they were simply misdiagnosed.--Guido den Broeder 01:51, 4 April 2007 (UTC)

text: What "all the evidence points towards" is still open to interpretation and debate (not to mention the need for more research), although some kind of "burnout" triggered by stress does make some sense (using the word "caused" may be premature) - stress seems to promote many different illnesses, some psychiatric and some physiological. A proven physiological etiology is what seems to separate assumed psychiatric illnesses from known neurological illnesses, so I'm guessing that your main point on this issue is that unless a physiological etiology has been identified for CFS, it remains a candidate for psychiatric status because of the stress factor? - Tekaphor 08:08, 3 April 2007 (UTC)

text: Not necessarily. Positive proof is there in terms of people going from severely disabled with CFS to full recovery after undergoing treatments which are psycho-social in nature. The problem is that not all people are cured by the current treatments. I think this is partly because CBT is based on a flawed theory of the illness, and patients won't invest the necessary belief/motivation/energy (or whatever is required) if they think the treatment is a load of crap. A fibromyalgia study showed that self-efficacy was the biggest predictor of recovery for patients undergoing treatment, and I think the same will be shown to be true for CFS. --Sciencewatcher 13:39, 3 April 2007 (UTC)
replies: text: There is no such proof. On the contrary, there is proof that CBT has no curative effect on the illness (e.g. the RIZIV evaluation study in Belgium, 2006). The few studies that claim a positive curative result are flawed. Patients that participated simply did not have ME/CFS, among other things, and the results have been polished by deleting participants whose condition deteriorated.--Guido den Broeder 01:51, 4 April 2007 (UTC)

text: If that was the study where the Belgian Government found out that CBT did not live up to psychiatrists promises it should be taken into the article, if not already contained. —The preceding unsigned comment was added by 192.68.211.173 (talk) 10:34, 4 April 2007 (UTC)
replies: text: This is the reference: RIZIV, "Referentiecentra voor het Chronisch vermoeidheidssyndroom (CVS), evaluatierapport 2002-2004", Brussels, July 2006 —The preceding unsigned comment was added by Guido den Broeder (talk • contribs) 10:59, 4 April 2007 (UTC)
thread_title: references for the psychiatric vs physiological debate

message: # 84.70.87.190 03:00, 3 April 2007 (UTC)
replies: text: I think the article is much better than it was. People such as Tekaphor have done a good job of improving it recently. --Sciencewatcher 13:42, 3 April 2007 (UTC)
thread_title: Comment that was pasted to article space

message: Ok, a massive change to the article, with no edit summaries whatsoever, or any order to the changes. Theres been quite a lot of arbitrary removing of information, and a massive new section, with bias, on anti-depressants.
However, lots of the new additions have been great, so im thinking we should revert to the last good version, then selectively add in User Talk:67.82.232.151's edits? Thedreamdied 03:19, 15 April 2007 (UTC)
thread_title: Edits by [[User Talk:67.82.232.151]]

message: I've added some info to the history of ME/CFS. It transpires that several references now appear more than once. I don't know how to point to an already existing reference, so who can help out?--Guido den Broeder 08:48, 15 April 2007 (UTC)
replies: text: Where the reference is first mentioned, instead of having (reference information), type (reference information) and when you want to mention the same reference again later on, just type  (note that whatever can be any label you want and the rest of the reference information doesn't need to be copied again). - Tekaphor 15:38, 17 April 2007 (UTC)

text: Note: Leave a space in between the two tags or there will be an error message. - Tekaphor 15:20, 1 May 2007 (UTC)
thread_title:  History 

message: My mother was diagnosed with CFS many years ago and something that pointed to it was something about her T-cells. Can someone please put something in the Testing section on that. I think that would be of great benifit. SadanYagci 02:57, 19 April 2007 (UTC)
replies: text: This will be covered by an immunology edit I am still working on, however it doesn't really belong in the testing section yet. Previously, this section became bloated with tests and someone ended up simplifying it with the exclusionary testing recommended by the CDC. Even though some studies have shown lowered T-cells in some CFS patients, it doesn't seem to be officially recognized as a reliable diagnostic tool. - Tekaphor 08:50, 23 April 2007 (UTC)
thread_title:  T-Cells 

message: I think the "deaths" section should be merged into the sub-section on "outcome," or in the alternative, the material in "outcome" regarding fatality should be merged into the section on "deaths."  69.140.164.142 06:19, 29 April 2007 (UTC)
replies: text: I agree with moving the "deaths" section into the "outcome" section (as a subsection). - Tekaphor 06:36, 29 April 2007 (UTC)

text: It belongs in a section on "prognosis". JFW | T@lk 12:04, 29 April 2007 (UTC)
thread_title:  Fatalities? 

message: A paper on MRI in CFS: . JFW | T@lk 12:04, 29 April 2007 (UTC)
thread_title: fMRI

message: I reworked the intro a bit with a few specific goals in mind. First, I tried to make it a bit more concise. Second, there seemed to be a consensus on this page that the existance and scope of the controversy should be well addressed in the intro, so I emphasized that a bit more. Third, I took the terms "myalgic encephalomyelitis" and "post-viral fatigue syndrome" out of the first sentence, since the assertion that they are synonymous with CFS, or are appropriate descriptions given the level of etiologic evidence, is highly controversial. They still appear in the opening section, but their controversial nature is noted. Fourth, aside from the above-mentioned two terms, I tried to leave only non-controversial assertions in the intro, since it is really next to impossible to wade into the minutiae of diagnostic criteria, for instance, in a manner which is both NPOV and appropriately concise for the intro. Feedback & improvements are welcome. -RustavoTalk/Contribs 23:52, 7 May 2007 (UTC)
replies: text: Good job, now we may get somewhere. Guido den Broeder 09:18, 8 May 2007 (UTC)
replies: text: That does sound like an accurate depiction of the situation in 2007. Way to go, Rustavo. JayEffage 10:04, 8 May 2007 (UTC)

text: This is exactly what I had in mind - external sources supporting the general perception of a dichotomy in views. JFW | T@lk 21:46, 20 May 2007 (UTC)
thread_title: Changes to intro

message: The two terms have been used interchangably by authors on this page, but they are very different concepts. In common medical usage, "genetics" refers to DNA sequences, and to say that a disease is "genetic" or has a "genetic componant" implies that patients have a polymorphism or mutation in their DNA. Usually, these diseases are hereditary (may be dominant or recessive). In contrast, "gene expression" refers to genes being activated in cells to make proteins, a process that varies between all cell types and changes in response to innumerable internal and external stumuli. There is no disease in existance which does not involve changes in "gene expression", but that does not make them genetic diseases. -RustavoTalk/Contribs 12:27, 11 May 2007 (UTC)
replies: text: Thanks for fixing this section. I had contemplated deleting that introduction when creating the gene expression subsection; I knew there was a difference between genetic mutations and gene expression, but did not realize that "genetic component" specifically implied genetic disease so I left it. All the studies mentioned in gene expression are clearly about "gene expression", but I found 7 studies and 1 review not yet mentioned in the article that seem to suggest "genetic polymorphisms" in CFS too, unless I am mistaken?[][][][][][][][] - Tekaphor 15:56, 11 May 2007 (UTC)
replies: text: Yes, these studies do discuss what are claimed to be genetic associations. I couldn't get access to the review article, which seems to be in a pay-to-publish (rather than peer-reviewed) supplement to a journal. Of the studies I could access, they seemed to be very small, and I don't believe any of them validated their findings in an independant cohort (generally the gold standard for all medical association studies). This isn't to say they aren't valid or interesting, just that they are probably too preliminary to be discussed at any length in a Wikipedia article. -RustavoTalk/Contribs 22:16, 11 May 2007 (UTC)
thread_title: Genetics vs. Gene expression

message: I don't want to get into an edit war here, but the sections that I deleted (and was subsequently reverted) really violates undue weight issues.  Vitamins are what anyone should be doing if their diet is deficient.  I couldn't find any of the sources that specifically said, "take vitamin B12, and it cures CFS."  In fact, it doesn't.  And the mitochondrial stuff really belongs with the naturopathy crowd.  There's no serious evidence.  And one or two articles from less than legitimate sources is not convincing.  We can't have people read this article and think "oh yes, that works."  That's why we are careful of undue weight.  Of all the treatments, maybe these fringe thereapies deserve a line, maybe.  That's all.  Orangemarlin 20:29, 21 June 2007 (UTC)
replies: text: Good work. - Tekaphor 02:24, 22 June 2007 (UTC)
replies: text: Second on the good work. Thedreamdied 00:35, 23 June 2007 (UTC)
thread_title:  Fringe science 

message: Time to clean up this pseudoscientific piece of dung.  Hopefully, you're up for it!!!!  Once more, into the breech. Orangemarlin 14:43, 29 June 2007 (UTC)
replies: text: Improved, but I cannot believe this crap.  Orangemarlin 22:18, 29 June 2007 (UTC)
replies: text: It's coming along though. Wonder how long before the herbal healer turn up. ornis 22:30, 29 June 2007 (UTC)
thread_title: [[Herbalism]]