[Co-Cure ME/CFS & Fibromyalgia Information Exchange Forum Logo]

Co-Cure Weekly Digest of research and medical posts only - 26 Mar 2007 to 2 Apr 2007

Topics of the week:
[Return to digest index]

                       This is a special digest of
                  Co-Cure Research & Medical posts only
               Problems? Write to mailto:mods@co-cure.org


Date:    Tue, 27 Mar 2007 14:44:42 +0200
From:    "Dr. Marc-Alexander Fluks" <fluks COMBIDOM.COM>
Subject: RES,NOT: Submaximal exercise variables in Women with CFS

Source: Archives of Medical Research
        Preprint/Vol. 38, #3, pp 350-353
Date:   April 2007
URL:    http://www.sciencedirect.com/science/journal/01884409

[Brief Report]

Can Submaximal Exercise Variables Predict Peak Exercise Performance in
Women with Chronic Fatigue Syndrome?
Jo Nijs(a,b), Seppe Demol(a) and Karen Wallman(c)
a Department of Human Physiology, Faculty of Physical Education &
  Physiotherapy, Vrije Universiteit, Brussels, Belgium
b Division of Musculoskeletal Physiotherapy, Department of Health Care
  Sciences, University College Antwerp, Antwerp, Belgium
c Human Movement & Exercise Science, University of Western Australia,
  Perth, Australia
* Address reprint requests to: Jo Nijs, Vrije Universiteit Brussel,
  MFYS/Sport, KRO-gebouw e1, Laarbeeklaan 101, B-1090 Brussels, Belgium;
  E-mail: Jo.Nijs@vub.ac.be

Received for publication September 1, 2006; accepted October 26, 2006


This study aimed at examining whether physiological exercise variables at
the submaximal level, defined as 75% of the age-predicted target heart rate,
are able to predict peak exercise performance in women with chronic fatigue
syndrome (CFS) (n=222). Subjects performed a bicycle ergometric test
against a graded increase in workload until exhaustion with continuous
monitoring of electrocardiographic and ventilatory variables. Oxygen uptake
at the submaximal level (VO_2SUBMAX) correlated strongly with peak oxygen
uptake (VO_2PEAK) (r=0.70). For the prediction of VO_2PEAK, linear
regression analysis determined the line of best fit as:
   VO_2PEAK = 0.95 x VO_2SUBMAX + 372.3.
Using this equation, the mean error in the prediction was 14.6 p/m 11.2%
(range 0.1-63.7%). It is concluded that the prediction of VO_2PEAK based on
VO_2SUBMAX might be useful for analyzing group differences or treatment
effects but not for individual (clinical) purposes.

Key Words: Submaximal, Exercise test, Prediction, Chronic fatigue syndrome,


Chronic fatigue syndrome (CFS) is a debilitating disorder characterized by
debilitating fatigue, widespread musculoskeletal pain, sleep impairments,
headache, and symptoms of poor concentration and memory (1). Maximal or peak
exercise performance testing is widely used for the assessment of people with
CFS, and it appears to be both reproducible and valid (2). Peak exercise
capacity variables correlate with activity limitations and participation
restrictions (3), supporting the clinical importance of peak exercise testing
in individuals with CFS. However, the role of maximal exercise tests is
limited in people whose performance may be limited because of pain or fatigue
rather than exertion (4). In CFS, symptoms are typically made worse after a
peak exercise stress test (5,6), and a delayed recovery from exercise appears
characteristic of the disorder (7). Therefore, a submaximal exercise test
appropriate for CFS patients would have a number of advantages over a test
performed until exhaustion: submaximal testing is likely to diminish symptom
exacerbations following peak exercise testing (8) and consequently, decrease
recovery time; it may encourage more severely disabled people with CFS to
participate in research studies using exercise testing (8); and it has
greater (clinical) applicability (for instance, to physical therapists) (4).
The Aerobic Power Index Test has been used as a submaximal test in people
with CFS: the test-retest reliability has been established (9), and it was
the first submaximal test able to replicate previous findings of decreased
exercise performance in CFS cases compared to healthy controls (8). However,
there are currently no published data indicating that a submaximal exercise
test is able to predict peak exercise performance in CFS patients. Prediction
of peak aerobic capacity is one of the primary goals of submaximal exercise
testing (4). Therefore, the present study aimed at examining whether
physiological exercise data corresponding to a submaximal level, defined as
75% of the age-predicted target heart rate (8), are able to predict peak
exercise performance in women with CFS.

Materials and Methods

Patient Recruitment and Research Design

The exercise capacity testing data of all women with CFS attending our
university-based Chronic Fatigue Clinic between November 2003 and December
2005 were reanalyzed. The study focused on women to preclude bias originating
from pooling of gender data (10). All participants fulfilled the Centers for
Disease Control and Prevention criteria for CFS (1). Therefore, all patients
underwent an extensive medical evaluation prior to exercise testing (for more
details regarding the diagnostic strategies as applied in the present study
the reader is referred to Reference 11). To be selected for data analyses,
women had to be within the age range of 18e65 years at the time of exercise
testing. Accordingly, 222 women with CFS were selected. The mean age was 38.6
p/m 9.8 years (range: 18-61 years) and the mean illness duration was 6.2 p/m
6.4 years (range: 1-31 years). The study protocol was approved by the local
ethics committee (Academic Hospital Vrije Universiteit Brussel; O.G. 016).

Exercise Testing

The participants performed a bicycle ergometric test against a graded
increase in workload until exhaustion was reached (12). There was continuous
monitoring of electrocardiographic and ventilatory variables. In order to
obtain an optimal test duration of 8-12 min (13), subjects started the test
at 10 W, with an increase of 10 W/min (12). The age-predicted peak heart rate
(HRPEAK) was calculated as 220 minus the subject's age in years (14). For a
detailed description of the exercise test as applied in the present study,
the reader is referred to Reference 15.

Statistical Analysis

All data were analyzed using SPSS 14.0 for Windows (SPSS Inc., Chicago, IL).
A one-sample Kolmogorov-Smirnov (K-S) goodness-of-fit test was used to
examine whether the variables were normally distributed. In case of
normality, the associations between the submaximal and peak exercise
performance data were analyzed using Pearson product-moment correlation
analysis. If a variable was not normally distributed, then a Spearman
correlation analysis was applied. If certain submaximal exercise performance
variables correlated strongly with their corresponding peak variables, then a
linear regression analysis was performed for constructing a regression
equation for the prediction of the peak exercise performance. Accuracy of the
prediction was determined using the coefficient of determi- nation (r2), the
standard error of the estimate (SEE), and the mean error or 'the mean
absolute percentage deviation' counted as predicted peak value measured peak
value/predicted peak value. Significance level was set at 0.01 to help
protect against potential type I errors.


Of the 222 study participants, only 156 (71%) achieved the submaximal level
(defined as 75% of the age-predicted tar- get heart rate) and were used for
further data analysis. The descriptive statistics of the exercise testing
variables are presented in Table 1. In addition to the peak ( p=0.045) and
submaximal work capacity attained p=0.025), all variables were normally
distributed. The outcome of the correlation analysis is presented in Table 2.
Oxygen uptake at the submaximal level (VO2_SUBMAX) correlated strongly with
peak oxygen uptake (VO2_PEAK) (r=0.70; F=151.2; df=154; p<0.001). For the
prediction of VO2PEAK, linear regression analysis determined the line of best
fit as:
   VO_2PEAK=0.95 x VO_2SUBMAX + 372.3
where both VO_2PEAK and VO_2SUBMAX are in mL/min. Using this equation, the
mean error in the prediction was 14.6 p/m 11.2% (range 0.1-63.7%; r2=.49;
SEE=224.4) when compared with measured VO_2PEAK. Likewise, the body
weighted-adjusted VO_2SUBMAX correlated strongly with the body
weight-adjusted VO_2PEAK (r=0.69; F=144.7; df=154; p<0.001). For the
prediction of body-weight adjusted VO_2PEAK, linear regression analysis
determined the line of best fit as:
   VO_2PEAK=0.98 x VO_2SUBMAX + 5.47
where both VO_2PEAK and VO_2SUBMAX are given in mL/kg per min. Using this
equation, the mean error in the prediction was 14.6 p/m 10.9% (range
0.1-66.6%; r2=.48; SEE=3.59) when compared with measured VO_2PEAK. The
remaining correlations between variables at the submaximal and peak level
were lower and were therefore not entered in a regression analysis.


There is a need for standardized submaximal ergometer tests not only for
patients with CFS but for people with various disorders that require close
monitoring during exercise (4). Therefore, the present study aimed at
examining whether a standardized submaximal ergometer test was able to
predict peak exercise performance (including peak aerobic work capacity) in
people with CFS. We utilized an exercise protocol (starting at 10 W with an
increase of 10 W/min) that has previously been used for the assessment of
peak exercise performance in people with CFS (3,11,12,15,16) and defined the
submaximal level in accordance with the Aerobic Power Index Test (8,9). The
results of the study suggest that exercise variables at the submaximal level
are strongly associated with their corresponding variables at the peak
(maximal) level. Despite this observation, the associations appeared too weak
to predict peak exercise variables with an error margin <10%. Both VO_2PEAK
and body weight-adjusted VO_2PEAK can be predicted from their corresponding
submaximal variable with an error margin of 14.6%. For analyzing group
differences or treatment effects (research purposes), an error margin of
14.6% might be acceptable and can be taken into account in an a priori power
calculation. However, for individual (clinical) purposes, the error range
(0.1->60%) should be taken into account. It is therefore concluded that, for
clinical purposes, the submaximal exercise testing protocol used here is
unable to make an accurate prediction of peak exercise performance in women
with CFS.

The results should be interpreted in light of the study
limitations. Only 71% of the subjects studied here attained
the submaximal exercise level, defined as 75% of the age-
predicted target heart rate. Thus, the results (and the regres-
sion equations) are applicable solely to women attending

a specialized chronic fatigue clinic and able to achieve 75% of the
age-predicted target heart rate during graded exercise tests. This limits the
external validity of the results. Further studies are warranted, for
instance, by using the exercise protocol of the Aerobic Power Index Test (an
increase of 25 W every minute) or by applying other exercise testing
protocols previously used for studying peak exercise performance in people
with CFS. Fulcher and White used a treadmill walking test at a constant speed
of 5 kph and a gradient increase of 2.5% every 2 min (17). Sargent et al.
applied cycle ergometry starting at 0 W with incrementing the power output by
25 W every 2 min (10). Bazelmans and colleagues applied an individually
tailored bicycle ergometer test: the workload was increased every minute in
steps of 10% of estimated maximal workload (5).

In summary, the results of the study suggest that exercise variables at the
submaximal level are strongly associated with their corresponding variables
at the peak level in women with CFS. VO2PEAK and body weight-adjusted
VO_2PEAK can be predicted from their corresponding submaximal variable with a
mean error margin of 14.6%, which might be acceptable for analyzing group
differences or treatment effects. For individual (clinical) purposes, the
submaximal exercise testing protocol was found inappropriate for predicting
peak exercise performance in women with CFS.


The authors are grateful to Kenny De Meirleir for diagnosing the study


Table 1. Descriptive statistics of the exercise capacity variables (n=156)
Variable                                Mean  p/m   SD        Range
Submaximal exercise duration (min)       6.8  p/m   2.4     0.38-5.6
Peak exercise duration (min)             9.5  p/m   2.9      3.4-18.2
Submaximal HR (bpm)                    135.9  p/m   9.8       60-155
Peak HR (bpm)                          152.2  p/m  24.7       80-210
Submaximal RER                           1.04 p/m   0.13    0.73-1.43
Peak RER                                 1.14 p/m   0.13    0.73-1.57
Submaximal workload (W)                 72.8  p/m  24.4       10-160
Peak workload (W)                       91.5  p/m  28.9       30-180
Submaximal VO2 (mL/min)                951.3  p/m 233.5      305-1862
Peak VO2 (mL/min)                     1196.8  p/m 325.9      489-2273
Submaximal VO2 (mL/min/kg)              15.2  p/m   3.5      4.5-27.4
Peak VO2 (mL/min/kg)                    19.1  p/m   5.1      9.1-38.0
SD, standard deviation; HR, heart rate; RER, respiratory exchange ratio;
VO2, oxygen uptake.

Table 2. Correlation analysis between the variables at the submaximal
         and peak level (n=156)
Variable                              Pearson correlation   p value
Submaximal vs. peak exercise duration         0.58         <0.001
Submaximal vs. peak HR                        0.43         <0.001
Submaximal vs. peak RER                       0.69         <0.001
Submaximal vs. peak workload                  0.63^a       <0.001^a
Submaximal vs. peak VO2                       0.70         <0.001
Submaximal vs. peak body weight               0.69         <0.001
  adjusted VO2
SD, standard deviation; HR, heart rate; RER, respiratory exchange ratio;
VO2, oxygen uptake. ^a Non-parametric Spearman correlation analysis.


 1. Fukuda K, Strauss SE, Hickie I, Sharpe MC, Dobbins JG, Komaroff A.
    The Chronic Fatigue Syndrome, a comprehensive approach to its def-
    inition and study. Ann Intern Med 1994;121:953-959.
 2. Manu P, Affleck G, Tennen H, Morse PA, Escobar JI. Hypochondriasis
    influences quality-of-life outcomes in patients with chronic fatigue
    syndrome. Psychother Psychosom 1996;65:76-81.
 3. Nijs J, De Meirleir K, Wolfs S, Duquet W. Disability evaluation in
    chronic fatigue syndrome: associations between exercise capacity
    and activity limitations/participation restrictions. Clin Rehabil 2004;
 4. Noonan V, Dean E. Submaximal exercise testing: clinical application
    and interpretation. Phys Ther 2000;80:782-807.
 5. Bazelmans E, Bleijenberg, Voeten MJM, van der Meer JWM,
    Folgering H. Impact of a maximal exercise test on symptoms and
    activity in chronic fatigue syndrome. J Psychosom Res 2005;59:
 6. Lapp CW. Exercise limits in chronic fatigue syndrome. Am J Med
 7. Paul L, Wood L, Behan WMH, Maclaren WM. Demonstration of de-
    layed recovery from fatiguing exercise in chronic fatigue syndrome.
    Eur J Neurol 1999;6:63-69.
 8. Wallman KE, Morton AR, Goodman C, Grove R. Physiological
    responses during a submaximal cycle test in chronic fatigue syndrome.
    Med Sci Sports Exerc 2004;36:1682-1688.
 9. Wallman K, Goodman C, Morton A, Grove R, Dawson B. Test-retest
    reliability of the Aerobic Power Index Test in patients with chronic
    fatigue syndrome. J Chronic Fatigue Syndr 2003;11:19-32.
10. Sargent C, Scroop GC, Nemeth PM, Burnet RB, Buckley JD. Maximal
    oxygen uptake and lactate metabolism are normal in chronic fatigue
    syndrome. Med Sci Sports Exerc 2002;34:51-56.
11. Nijs J, Meeus M, McGregor NR, Meeusen R, De Schutter G,
    Van Hoof E, et al. Chronic fatigue syndrome: exercise performance
    related to immune dysfunction. Med Sci Sports Exerc 2005;37:
12. De Becker P, Roeykens J, Reynders M, McGregor N, De Meirleir K.
    Exercise capacity in chronic fatigue syndrome. Arch Intern Med 2000;
13. Davis JA. Direct determination of aerobic power. In: Maud PJ,
    Foster C, eds. Physiological Assessment of Human Fitness. Cham-
    paign, IL: Human Kinetics;1995. pp. 9-17.
14. Astrand PO, Rodahl K. Evaluation of physical performance in the
    basis of tests. In: Astrand PO, Rodahl K, eds. Textbook of Work
    Physiology: Physiological Bases of Exercise. 3rd ed. New York:
    McGraw-Hill;1986. pp. 354-387.
15. Nijs J, Vanherberghen K, Duquet W, De Meirleir K. Chronic fatigue
    syndrome: lack of association between pain-related fear of movement
    and exercise capacity and disability. Phys Ther 2004;84:696-705.
16. Nijs J, De Meirleir K. Prediction of peak oxygen uptake in patients
    fulfilling the 1994 CDC criteria for chronic fatigue syndrome. Clin
    Rehabil 2004;18:785-792.
17. Fulcher KY, White PD. Strength and physiological response to exer-
    cise in patients with chronic fatigue syndrome. J Neurol Neurosurg
    Neuropsych 2000;69:302-307.

(c) 2007 Elsevier/ScienceDirect B.V.
(c) 2007 Instituto Mexicano del Seguro Social (IMSS)

[Return to top]


Date:    Tue, 27 Mar 2007 13:29:17 -0400
From:    Fred Springfield <fredspringfield VERIZON.NET>
Subject: RES: On commonness and rarity of thyroid hormone resistance: A discussion based on mechanisms of reduced sensitivity in peripheral  tissues

On commonness and rarity of thyroid hormone resistance: A discussion based
on mechanisms of reduced sensitivity in peripheral tissues.

Journal: Med Hypotheses. 2007 Mar 23; [Epub ahead of print]

Authors: E. Tjørve [*], K.M.C. Tjørve, J.O. Olsen, R. Senum and H. Oftebro

Affiliation: Lillehammer University College, 2626 Lillehammer, Norway.
[*] Corresponding author. Tel.: +47 612 88 219; fax: +47 612 88 170.

Received 16 December 2006;
accepted 10 January 2007.
Available online 26 March 2007.

NLM Citation: PMID: 17383828

Reduced sensitivity to thyroid hormone (TH) in peripheral tissues can occur
as defects in TH transport into the cell, intracellular TH metabolism,
cytosolic mechanisms, TH entry into the nucleus, thyroxin receptors (TRs)
and receptor binding, transcription and post-transcriptional mechanisms.
Current literature reveals an extensive list of mutations, drugs, toxins,
metabolites and autoimmune antibodies that may impair TH action in the
cell, but such impairment may not be picked up by assays of TH and TSH in
blood plasma.

Substances may induce tissue specific resistance to thyroid hormone (RTH),
e.g. by affecting numbers of different TR isoforms. Recent literature also
indicates mechanisms by which different conditions, for example, chronic
fatigue syndrome (CFS), chronic renal failure (CRF) and nonthyroidal
illness, can be accompanied by acquired RTH caused by inhibition of TH
metabolism, cell uptake, TR binding and transcription. This prompts us to
reassess commonness and rarity of congenital vs. acquired RTH.

We hypothesise that observed clinical symptoms of hypothyroidism in
chemically euthyroid patients are typically caused by changes in hormonal
systems, autoimmune antibodies, metabolites or other substances in the
body, leading to reduced sensitivity to TH in peripheral tissues. These
changes may be a by-product of other processes and a reversible biological
response in the body, and may also result in chronic acquired RTH.
Antibodies may prove to be the most common cause of chronic reduction in TH
sensitivity. It is argued that the acquired form of RTH, caused by
endogenous and exogenous sources, may indeed be more common than the
congenital, as in insulin resistance.

If acquired RTH exists, then it may not be picked up by blood assays of TH
and TSH. An appropriate test to assess TH action in peripheral tissues is
therefore greatly desired.

Copyright © 2007 Elsevier Ltd All rights reserved.

[Return to top]


Date:    Tue, 27 Mar 2007 15:31:56 -0400
From:    "Dr Julie Donalek <jdonalek depaul.edu> via Co-Cure Moderator
Subject: NOT,RES: DePaul University researcher seeks Chicago area families in which an adult has CFS to participate in a research study

I am a DePaul nurse researcher seeking Chicago area
families in which an adult has CFS.  The study particulars
are as follows:

Families Affected
Chronic Fatigue Syndrome:
A Research Study

A caring, experienced, knowledgeable nurse-researcher wants to talk to
people with CFS and their families about how CFS has affected the family.
If you are an adult who has been diagnosed with CFS, are in a family, and
have a teenage or older child or children living in the home, Dr. Julie
Donalek would like to talk to you about her research. Julie is a nursing
faculty member at DePaul University and has worked with people with CFS and
their families as part of the DePaul CFS research team. Participants will
receive payment for participation.

Please call:

Dr. Julie Donalek
DePaul University Department of Nursing
jdonalek depaul.edu

[Return to top]


Date:    Wed, 28 Mar 2007 01:55:29 +0200
From:    Jan van Roijen <j.van.roijen CHELLO.NL>
Subject: not,res: Female volunteers sought for study of ME/CFS


Send an Email for free membership
       >>>> Help ME Circle  <<<<
 >>>>       28 March 2007       <<<<
Editorship : j.van.roijen chello.nl
Outgoing mail scanned by Norton AV


Courier News

Female volunteers sought for study of chronic fatigue syndrome

The National Institutes of Health in Bethesda, Md., are
supporting an ongoing study by the UMDNJ Pain and Fatigue
Study Center to further investigate the clinical nature of chronic
fatigue syndrome. The study requires 80 female volunteers in the
New York/New Jersey area.

The research team, led by Dr. Benjamin Natelson, a professor of
neurosciences at New Jersey Medical School, theorizes that the
cause of chronic fatigue syndrome may be related to a type of
substance in the blood called cytokines, which are related to
immune function and which can specifically affect feelings of
alertness. Natelson hypothesizes that cytokines may be
malfunctioning in people with chronic fatigue syndrome. For
example, those cytokines that in healthy people would cause
them to become tired at night and awake during the day may
make those with chronic fatigue syndrome sleepy during the day
and "wired" at night.

A successful outcome could lead to therapies that could
"rebalance" patients' immune systems. Because about three of
every four cases of CFS affect women — and because cytokine
levels also are affected by gender —the study is only seeking
women volunteers at this time.

Researchers would like to study a mix of women diagnosed with
chronic fatigue syndrome and women who are healthy, but lead
a relatively sedentary lifestyle. (Vigorous exercise also affects
cytokine levels.) Finding healthy women to volunteer for this
study is critical, so the researchers have a proper basis for

Volunteers will be asked to sleep in a research lab at The
University Hospital in Newark on three to four nights, to be
completed over a few months. Volunteers will be compensated
for their time, depending on the circumstances of their medical
history and also will receive a travel allowance. All medical
treatment will be free.

If you or a family member may be interested in participating in
the study, contact FitzGibbons at (973) 972-4800 or at

For more information on chronic fatigue syndrome, visit

[Return to top]


Date:    Wed, 28 Mar 2007 17:03:22 -0400
From:    Co-Cure Moderator <ray CO-CURE.ORG>
Subject: NOT,MED: Kent Holtorf, MD, on Treating Chronic Fatigue  Syndrome & Fibromyalgia - An Update

Dr. Kent Holtorf, MD, is Medical Director of the Holtorf Medical Group Center
for Hormone Imbalance, Hypothyroidism and Fatigue in Torrance, California. He
specializes in treatment of CFS and FM patients.

Question: Dr. Holtorf, in your article on the effective treatment of Chronic
Fatigue Syndrome and Fibromyalgia you stated that "individuals with these
syndromes have measurable hypothalamic, pituitary, immune and coagulation
dysfunction. These abnormalities then result in a cascade of further
abnormalities, in which stress plays a role." Could you discuss in detail
how you approach testing for and treating these problems in CFS and FM

Dr. Holtorf: There is a mixture of underlying causes of Chronic Fatigue
Syndrome (CFS) and Fibromyalgia (FM), and each underlying abnormality can
trigger further problems. This results in a cascade of multiple physiologic
abnormalities and a perpetuating vicious cycle. Successful treatment
requires that this vicious cycle be addressed on multiple levels. This
cascade of abnormalities [beginning with the "Genetic Predisposition" and
then "Triggering Event of Physiologic Stress"] is graphically depicted below
 - and a few of the abnormalities are also discussed.

Read this Q&A at

[Return to top]


Date:    Wed, 28 Mar 2007 14:16:57 -0700
From:    "charles stafford <luceat1 yahoo.co.uk> [via Co-Cure Moderator]
Subject: MED, ACT: myalgic encephalomyelitis

From: charles stafford <luceat1@yahoo.co.uk>

For Posting.

I was diagnosed 30 years ago, with acute onset myalgic encephalomyelitis by a
tenured Harvard M.D. who had personally studied one of the USA outbreaks. This
definitely is not the same as Chronic Fatigue Syndrome. I have suffered and
still suffer from the confusion that the creation of CFS causes my medical
providers, the community as a whole and my friends.

Part of the consequence of this is that all the research into CFS has been, as
far as the ME patients are concerned, a tragic waste of our time and our
money. The data are invalid due to the lack of specificity of the inclusion
criteria, and their replication is uncertain. Even where the data are based on
a classic epidemic of Myalgic encephalomyelitis such as the Lake Tahoe
epidemic, they still are published under CFS.

Unfortunately, Myalgic encephalomyelitis affects many people. We can be
diagnosed under both the Ramsey definition and the Canadian Consensus
definition. We need to be studied as Myalgic encephalomyelitis, WHO ICD 10 G
93.3. We are not a sub-set of CFS, which has a separate WHO ICD 10 code.

Yours Sincerely,

[Return to top]


Date:    Thu, 29 Mar 2007 11:44:27 -0400
From:    "Bernice A. Melsky" <bernicemelsky VERIZON.NET>
Subject: RES: Fibromyalgia, cognitive problems and  independence:physical activity may be useful in home health care

Fibromyalgia, cognitive problems and independence:physical activity may be
useful in home health care.

Home Health Care Serv Q. 2007;26(1):19-28.

Karper WB.

School of Health and Human Performance, PO Box 26170, Greensboro, NC,
27402, wbkarper uncg.edu

PMID: 17387049

Home health care providers often deal with older clients who have cognitive
deficits. Cognitive problems have a negative impact on independence.
Certain chronic pain conditions present with cognitive dysfunction as a
co-morbidity. Fibromyalgia syndrome is one such condition.

Home health care providers need to know that mild-moderate exercise may
positively affect fibromyalgia-related cognitive deficits at very low cost.

All of the above is discussed in this paper along with advice concerning
the provision of exercise for older, homebound people.

[Return to top]


Date:    Fri, 30 Mar 2007 13:36:44 -0400
From:    "Bernice A. Melsky" <bernicemelsky VERIZON.NET>
Subject: RES: Subgroups of fibromyalgia

[Subgroups of fibromyalgia.]
[Article in German]

Schmerz. 2007 Mar 29; [Epub ahead of print]

Muller W, Schneider M, Joos T, Hsu HY, Stratz T.

Rheumatologische Forschungsabteilung, Park-Klinik Bad Sackingen,
Weihermatten 1 , 79713, Bad Sackingen, Deutschland.

PMID: 17393187

As has been shown by a number of working groups, primary fibromyalgia
syndrome does not represent a single clinical entity.

It is possible to distinguish between a subgroup with high pain sensitivity
and no associated psychiatric condition, a second subgroup characterized by
depression and concomitant pain symptoms associated with fibromyalgia
syndrome, and a third group with somatoform pain disorder of the
fibromyalgia type.

Bland inflammatory processes must be considered as the cause in the first
group, while depression is the underlying reason for the development of
pain in the second group. In the third group, serious previous or still
existing psychological problems or also insufficient coping with illness
symptoms must be regarded as the reason for pain chronification.

Group 1 benefits from a blocking of the 5-HT3 receptors by means of
tropisetron, for example. This not only affects pain chronification but
also the inflammatory process itself. Group 2 needs antidepressant
treatment, whereas the focus should be on psychotherapy is group 3. Groups
1 and 2 will also profit from multimodal physical treatment programs; to a
certain extent this applies to group 3 as well. So-called mixed types
require a combination of therapeutic measures.

[Return to top]


Date:    Fri, 30 Mar 2007 13:40:54 -0400
From:    "Bernice A. Melsky" <bernicemelsky VERIZON.NET>
Subject: RES: Gabapentin in the treatment of fibromyalgia: A  randomized, double-blind, placebo-controlled, multicenter trial

Gabapentin in the treatment of fibromyalgia: A randomized, double-blind,
placebo-controlled, multicenter trial.

Arthritis Rheum. 2007 Mar 28;56(4):1336-1344 [Epub ahead of print]

Arnold LM, Goldenberg DL, Stanford SB, Lalonde JK, Sandhu HS, Keck PE Jr,
Welge JA, Bishop F, Stanford KE, Hess EV, Hudson JI.

University of Cincinnati College of Medicine, Cincinnati, Ohio.

PMID: 17393438

OBJECTIVE: To assess the efficacy and safety of gabapentin in patients with

METHODS: A 12-week, randomized, double-blind study was designed to compare
gabapentin (1,200-2,400 mg/day) (n = 75 patients) with placebo (n = 75
patients) for efficacy and safety in treating pain associated with
fibromyalgia. The primary outcome measure was the Brief Pain Inventory
(BPI) average pain severity score (range 0-10, where 0 = no pain and 10 =
pain as bad as you can imagine). Response to treatment was defined as a
reduction of >/=30% in this score. The primary analysis of efficacy for
continuous variables was a longitudinal analysis of the intent-to-treat
sample, with treatment-by-time interaction as the measure of effect.

RESULTS: Gabapentin-treated patients displayed a significantly greater
improvement in the BPI average pain severity score (P = 0.015; estimated
difference between groups at week 12 = -0.92 [95% confidence interval
-1.75, -0.71]). A significantly greater proportion of gabapentin-treated
patients compared with placebo-treated patients achieved response at end
point (51% versus 31%; P = 0.014). Gabapentin compared with placebo also
significantly improved the BPI average pain interference score, the
Fibromyalgia Impact Questionnaire total score, the Clinical Global
Impression of Severity, the Patient Global Impression of Improvement, the
Medical Outcomes Study (MOS) Sleep Problems Index, and the MOS Short Form
36 vitality score, but not the mean tender point pain threshold or the
Montgomery Asberg Depression Rating Scale. Gabapentin was generally well

CONCLUSION: Gabapentin (1,200-2,400 mg/day) is safe and efficacious for the
treatment of pain and other symptoms associated with fibromyalgia.

[Return to top]


Date:    Sat, 31 Mar 2007 11:13:39 -0400
From:    "Bernice A. Melsky" <bernicemelsky VERIZON.NET>
Subject: RES: Social functioning and peer relationships of adolescents with juvenile fibromyalgia syndrome

Social functioning and peer relationships of adolescents with juvenile
fibromyalgia syndrome.

Arthritis Rheum. 2007 Mar 29;57(3):474-480 [Epub ahead of print]

Kashikar-Zuck S, Lynch AM, Graham TB, Swain NF, Mullen SM, Noll RB.

Cincinnati Children's Hospital Medical Center, and the University of
Cincinnati College of Medicine, Cincinnati, Ohio.

PMID: 17394218

OBJECTIVE: To assess peer relationships of adolescents with juvenile
primary fibromyalgia syndrome (JPFS) compared with matched classroom
comparison peers (MCCPs) without a chronic illness. JPFS is characterized
by chronic musculoskeletal pain, sleep disturbance, fatigue, and difficulty
with daily functioning. Adolescents with JPFS often report problems with
school and participating in peer activities, placing them at risk for
social isolation from their peers and psychosocial adjustment problems.

METHODS: Participants were 55 adolescents with JPFS (ages 12-18 years) from
a pediatric outpatient rheumatology clinic and 55 MCCPs. Data on peer
reputation and peer acceptance were collected from teachers, peers, and
self report in a classroom setting with no focus on JPFS.

RESULTS: Adolescents with JPFS were perceived (by peer and self reports) as
being more isolated and withdrawn and less popular. Adolescents with JPFS
were less well liked, were selected less often as a best friend, and had
fewer reciprocated friendships.

CONCLUSION: Our findings suggest that adolescents with JPFS are
experiencing problems with peer relationships. Given the central role that
peer relationships play in psychological development of children, and
because peer rejection and isolation have been associated with subsequent
adjustment problems, these findings are concerning. Longitudinal studies of
adolescents with JPFS are needed to ascertain whether these patients are at
long-term risk and will provide a foundation for the need for early
interventions. Results are discussed within the context of earlier findings
for other adolescents with chronic illness and rheumatic conditions, such
as juvenile idiopathic arthritis, who demonstrated no social problems.

[Return to top]


Date:    Sat, 31 Mar 2007 11:23:28 -0400
From:    "Bernice A. Melsky" <bernicemelsky VERIZON.NET>
Subject: RES: Fibromyalgia, Facial Expression and Emotional Experience

Fibromyalgia, Facial Expression and Emotional Experience.

Psychopathology. 2007 Mar 29;40(4):203-208 [Epub ahead of print]

Kirsch A, Bernardy K.

Department of Clinical Psychology and Psychotherapy, Saarland University,
Saarbrucken, Germany.

PMID: 17396046

Background: The present study aims at analyzing the nonverbal affective
behavior of female fibromyalgia (FM) inpatients in comparison to healthy

Methods: Videotaped psychodynamic interviews of each of 15 female FM
inpatients and healthy women were analyzed. Afterwards the analyses of
facial expression were related to gazing behavior and emotional experience.

Results: FM patients exhibited neither a reduction in total activity of
facial expression nor in absolute frequency of primary affects in
comparison to healthy women, who, however, (also in eye contact) also
exhibited a significantly higher proportion of 'genuine joy' and a lower
one of 'contempt'. No congruence between the patient's emotional experience
and affective expression was found.

Conclusions: The absence of reduced total activity of facial expression is
in contrast to the elaborate descriptions of complaints provided by the
patients. Nevertheless, our detailed analysis shows a lack of elements that
stabilize the relationship and the presence of dissociating elements in the

Copyright (c) 2007 S. Karger AG, Basel.

[Return to top]


Date:    Sun, 1 Apr 2007 10:22:53 -0400
From:    "Bernice A. Melsky" <bernicemelsky VERIZON.NET>
Subject: RES: Primer: establishing a clinical trial unit-regulations and infrastructure

Primer: establishing a clinical trial unit - regulations and infrastructure.

Nat Clin Pract Rheumatol. 2007 Apr;3(4):234-9.

Fleischmann R.

R Fleischmann is a Clinical Professor of Medicine at the University of
Texas Southwestern Medical Center at Dallas, and Co-Medical Director of
Metroplex Clinical Research Center, Dallas, TX, USA.

PMID: 17396109

The performance of clinical trials can be very rewarding for the practicing
or academic clinical rheumatologist. There are at least 50 new
compounds-small molecules and biologics-in development for rheumatic
diseases such as rheumatoid arthritis, osteoarthritis, systemic lupus
erythematosus, ankylosing spondylitis, psoriatic arthritis, scleroderma,
gout and fibromyalgia.

Clinical trials are important to try to determine the appropriate use of
these compounds, as well as to answer questions about their safety. To
carry out clinical trials effectively, the physician-investigator must be
aware of, and adhere to, the regulatory requirements.

The purpose of this article is to review these requirements in depth, as
well as to discuss the infrastructure required to establish a successful
clinical trial unit.

[Return to top]


Date:    Mon, 2 Apr 2007 17:47:45 +0200
From:    "Dr. Marc-Alexander Fluks" <fluks COMBIDOM.COM>
Subject: RES,NOT: Ampligen Update

Source: Philadelphia Business Journal
Date:   March 30, 2007
Author: John George <jgeorge bizjournals.com>
URL:    http://eastbay.bizjournals.com/eastbay/othercities/philadelphia/stories/2007/04/02/story8.html?b=1175486400^1439140

Hemispherx finalizing fatigue drug filing

Hemispherx BioPharma Inc. is finalizing its new drug application for
Ampligen, an experimental treatment for chronic fatigue syndrome that has
spent more than 30 years in clinical studies. Dr. William Carter, the
Center City biotechnology company's chairman and CEO, said he expects the
application will be completed in early April.

Carter said he is "cautiously optimistic" the company will be able to
secure an accelerated review from the Food and Drug Administration, given
the absence of any approved treatments for chronic fatigue syndrome. The
Centers for Disease Control and Prevention estimates the disorder afflicts
1 million people in the United States. Accelerated reviews are typically
conducted in six months, as opposed to the one-year review for most new
drug applications.

If the company gets such status for its Ampligen filing, and the FDA
approves the application without raising any issues, Hemispherx would be
in a position to launch the product by the end of this year or early 2008,
Carter said.

Carter expressed a sense of vindication that his company has reached this
point. "It's been a long and arduous journey... There were a lot of
skeptics," he said.

The skepticism remains evident in the company's stock price. Hemispherx's
stock was trading recently at $1.69 a share, near its 52-week low of

According to documents filed earlier this month with the Securities and
Exchange Commission, Hemispherx has recorded an accumulated deficit of
about $167 million since its inception. Hemispherx posted a net loss of
$19.4 million last year, up from a deficit of $12.4 million in 2005. The
increase was due primarily to higher research and development costs
associated with Ampligen and Alferon N, which the company acquired in
2003, is a treatment for genital warts and Hemispherx's only FDA-approved
product in the market. The company is testing both Ampligen and Alferon N
as potential treatments for viral infections such as avian flu.

Carter co-invented Ampligen in the early 1970s when he was a researcher at
Johns Hopkins University. Ampligen is a synthetic, specifically configured
double-stranded RNA compound designed to work by stimulating and enhancing
the ability of a patient's immune system to fight disease. Initially, the
drug was tested as a potential treatment for cancer and later for AIDS
then for chronic fatigue syndrome. Carter even tinkered with the idea of
using the compound to treat tobacco and create a "healthy" cigarette.

Hemispherx has spent the past 15 years testing the drug as a treatment for
patients with chronic fatigue syndrome. The company estimates the global
market for an effective treatment for the disorder to be in excess of $1

"We're not the first company to go into this disease category," Carter

In a presentation with stock analysts last month, the company noted drugs
developed by a half-dozen major pharmaceutical and biotechnology companies
- including GlaxoSmithKline, Shire and Cephalon - have been considered
as potential treatments for chronic fatigue syndrome, but said none proved
to be effective.

Jenifer Antonacci, a Cephalon spokeswoman, said the company's flagship
drug Provigil, approved as a treatment for narcolepsy and other
sleep-related disorders, was tested in patients with chronic fatigue
syndrome about two years ago. She said the study was conducted by
researchers from outside of the company, with Cephalon support. The
clinical trial, which involved 14 patients, did not produce sufficient
results for Frazer-based Cephalon to consider seeking approval to expand
Provigil's label to include the disorder.

Matt Cabrey, a Shire spokesman, said that while company executives have
discussed the potential of testing its products for chronic fatigue
syndrome, Shire never launched any formal product development program and
has no current plans to do so. Based in England, Shire's U.S. headquarters
are in Wayne.

Up Close

COMPANY:               Hemispherx BioPharma Inc.
LOCATION:              Philadelphia
CHAIRMAN AND CEO:      Dr. William Carter
TYPE OF COMPANY:       Biopharmaceutical
2006 NET LOSS:         $19.4 million
2006 REVENUE:          $933,000
52-WEEK HIGH/LOW:      $3.85, $1.65
RECENT PRICE:          $1.69
EMPLOYEES:             52 full time, 19 part time
BIG DEVELOPMENT:       Finalizing new drug application for Ampligen, an
                       experimental treatment for chronic fatigue syndrome.
Source:                SEC, company, Yahoo! Finance

(c) 2007 Philadelphia Business Journal

[Return to top]


Date:    Mon, 2 Apr 2007 18:06:15 +0200
From:    "Dr. Marc-Alexander Fluks" <fluks COMBIDOM.COM>
Subject: RES,NOT: Doctors, friends, and relatives dismiss FM

Source: The Ledger
Date:   April 2, 2007
Author: Gary White <gary.white theledger.com>, phone 863-802-7518.
URL:    http://www.theledger.com/apps/pbcs.dll/article?AID=/20070402/NEWS/704020367/1004

Some Doctors, Friends, Relatives Dismiss Sickness

   As a teenager, Lakeland resident Jiwa Farrell was diagnosed with lupus,
   an autoimmune disease that affects mostly women and often mimics
   fibromyalgia and chronic fatigue syndrome.

It's easy to make personality judgments about people with fibromyalgia and
other chronic pain disorders. The patient's current lethargy and
inactivity can yield assumptions of lifelong laziness and aversion to
work. Those diagnosed with the ailments say it's a common and frustrating

"I don't think I have ever met a person with fibromyalgia who is lazy,"
said Lynne Matallana, president of the National Fibromyalgia Association.
"Quite the opposite."

Matallana said a high percentage of fibromyalgia patients are "Type A"
personalities who were high-achieving professionals before the illness
struck. Matallana, 51, worked as a partner in a prominent advertising firm
and was athletic before she became ill in the early 1990s, eventually
spending two years in bed after being wrongly diagnosed with lupus.

Local patients have similar backgrounds. Martha Grierson of Winter Haven
worked long hours as a sales manager for a large corporation before
fibromyalgia prematurely ended her career. Lynn Anderson of Polk City used
to show horses in competitions, though fibromyalgia now prevents her from
even mounting a horse.

Lakeland's Laura Bodner, another fibromyalgia patient, formerly worked as
a firefighting trainer and exercised five days a week. Davenport resident
Millie Haddad was a nurse with a side business until being diagnosed with
chronic fatigue syndrome, and Teresa Kucera, a Lakeland resident with the
same disorder, worked as a medical assistant and said she "used to be like
a tornado."

Government medical agencies have recognized fibromyalgia and CFS as
legitimate disorders in the past decade or so, but patients say skepticism
remains commonplace, especially among general practitioners. Every
fibromyalgia patient seems to have at least one story of rude or
dismissive treatment from a doctor.

Grierson and other local patients said doctors have suggested their
problems are psychological rather than physical. "I've actually had a
doctor tell me I need mental health help, that it was all somatic, which
is a kind way of saying it's all in your head," Grierson said.

Bodner, 45, described the hostility she received from a local doctor after
seeking a refill of Darvocet, a prescription pain medicine.

"My daughter got real upset because she sees how much pain I'm in, and she
goes, 'Can't you just give her something that's going to help her instead
of Darvocet?'" Bodner said. "And (the doctor) said, 'I don't even like
giving her Darvocet because I think she's overreacting. Somebody who's got
fibromyalgia shouldn't be in this pain.' My daughter just went off on the
doctor. She was saying, 'You know, I wish you could just have it for one
week so you could see what my mother goes through.'"

Matallana said the lack of compassion and understanding from doctors
compounds the physical and emotional distress of the illness itself. "I
know in my case I just had the idea if you got sick you went to a doctor
and they treated you," Matallana said. "I never, ever imagined someone
would question my pain and my inability to function. That was to me almost
as bad as enduring the physical symptoms."

Confusion, skepticism

The transformation of dynamic people into suffering wrecks, without any
apparent cause, prompts confusion and questioning. Fibromyalgia patients
say even friends, relatives and spouses find it hard to accept the reality
of what has been called an invisible illness.

"Even my family was skeptical at first," said Randy Jones, a Dade City
resident who receives treatment for her fibromyalgia at Salazar Family
Clinic in Mulberry. "Even my husband, it was like, 'Maybe you just don't
want to get out of bed.' "

Jones, 60, admitted she had doubts about fibromyalgia before the illness
struck her in 2000, leaving her incapacitated for long periods. "Nobody
walks in your body but you, and how can one person say what another person
is feeling?" she said. "Why would I want to do this to myself?"

Grierson likewise has had friends and relatives question her condition.
"Some I thought would understand have accused me of being drug-seeking, of
being lazy, of doing this for attention," she said. "It's just awful the
things people will say because they don't understand and it's not a common
thing and you don't carry scars on the outside of your body. It makes
coping with what's wrong with you that much worse because if you hear it
enough you begin to think maybe you are a little crazy. That's the
insidious thing of it."

If the medical world has been slow to accept fibromyalgia and other
chronic pain disorders, it's perhaps no surprise patients describe having
difficulties with medical coverage and government disability programs.

Grierson said she faced constant battles with her insurance company over
payments for treatments, and at one point when she lived in Pennsylvania a
doctor sued her over the plan's failure to pay medical bills. She had
equal trouble getting approved for Social Security Disability Income,
going through two years of denials before she hired a lawyer who helped
her prevail in a court hearing.

Bodner said she has twice been turned down for SSDI since applying last
year. She has enlisted a lawyer to help her push for the government

Anderson has Medicare coverage, but she said the plan doesn't cover
massage therapy, the only treatment that offers her significant relief
because the effect is temporary. Her sister, Terry Anderson, became a
massage therapist after observing Lynn's ordeal, and she sometimes travels
from Pinellas County to offer her services.

Haddad, who required a court hearing before being approved for SSDI, said,
"It took a long time before I was able to collect disability because they
didn't believe this till a lot of doctors started getting the disease

'The F-Word'

Dr. Patrick Wood, an assistant professor of medicine at Louisiana State
University, decided to specialize in fibromyalgia in part because it was a
verboten term during his training. As Wood points out, many diseases now
universally accepted - including malaria, asthma and Parkinson's - were
previously dismissed or relegated to non-medical categories.

"When I was in medical school, it was the F-word," Wood said. "You didn't
even say it around other physicians. I was very intrigued to think there
was a medical entity you could choose not to believe in, like a ghost or a
fairy... I've always kind of stuck up for the underdog, and fibromyalgia
patients are kind of the underdogs of the medical world." Despite recent
progress, Wood said, "I've been at the same institution for 10 years, and
there's still tremendous hostility toward the disorder (fibromyalgia) and
toward the diagnosis from people who certainly should know better."

Chronic pain patients and their advocates cite several factors behind the
lingering skepticism among many doctors. One is the lack of verifiable
causes. The ailments arise gradually in some patients, while others point
to a specific traumatic event as the trigger. The trauma can be physical -
in Anderson's case, being kicked in the face by a horse - or emotional,
such as a divorce or the death of a spouse.

Advocates say the varying intensity of symptoms also fosters doubts. "The
illness can wax and wane, and when people feel better oftentimes they push
themselves so others see them up doing what normal people would do, and
the next week they're back in bad," Matallana said. "That doesn't make
sense; we think of illness as being continuous."

Wood, noting that doctors dislike uncertainty, said many general
practitioners are loath to admit they don't have an explanation for a
patient's complaints and react by questioning the patient's description.
"I don't think it makes me popular with my colleagues, but we're trained
to be little gods and anything that challenges our god-like capacity we
dismiss," Wood said. "(A doctor) could say, 'There's nothing to
objectively demonstrate you're really sick. How do I know you're sick?'
You have to trust the patient's report, which we're often not willing to
do when it comes to pain."

Patients say it often becomes clear they know much more about their
conditions than the doctors charged with treating them. Haddad of
Davenport has attended countless seminars on chronic fatigue syndrome
since being diagnosed with it, and she said most doctors dispense merely
obvious advice - eat right, sleep right, lose weight.

"A lot of health-care providers feel uncomfortable because of the limits
of their expertise," said Dr. Roland Staud, a professor of medicine at the
University of Florida specializing in fibromyalgia. "Many physicians
wanted these patients to be seen by psychologists and psychiatrists and
did not feel equipped to deal with this."

A gender issue

Matallana and others say the gender factor also affects perceptions of
fibromyalgia. The preponderance of patients are women, and advocates cite
a long history of medical authorities dismissing female- oriented
illnesses as forms of hysteria. "You have to look back on the medical
community - it has basically been male-dominated," Matallana said. "I
don't think it's something they have done intentionally, but I know when
you have experienced something yourself it's much easier to understand
what it really is."

Lakeland's Jiwa Farrell was diagnosed at age 16 with lupus, an autoimmune
disorder that often mimics fibromyalgia and chronic fatigue syndrome and
disproportionately affects women. "I'm not trying to make this a feminist
movement or anything," she said, "but... it amazes me how many drugs they
have out for ED (erectile dysfunction) all of a sudden, and we haven't had
a new drug for lupus since the '60s."

Fibromyalgia and other chronic pain disorders sometimes occur in family
clusters. For example, Bodner said her two daughters, both in their 20s,
have been told they have fibromyalgia since she received her own
diagnosis, and several other local patients also said relatives share
their ailments. The phenomenon might suggest a genetic component to the
disorders, but to a skeptical mind it can also raise the prospect of

Confusing matters further, fibromyalgia and related disorders seem
intertwined with psychological components. Many patients exhibit signs of
depression, leading to a chicken-and-egg question about the relation
between psychological distress and physical pain.

"The question that was raised in the past was in what category of medical
illness these symptoms would fall," said Staud, the UF professor. "Many
physicians believed they would fall in the psychological-psychiatric area,
where some physicians believed it was in the purely physical area, and of
course the truth is halfway in between, because for 200 years we know
there is no mind-body dichotomy. Every illness has these components. To
say someone has a purely psychological illness - this is not an up-to-date

Patient profiling

Dr. Edward Lubin of Winter Haven's Gessler Clinic said some general
practitioners engage in "patient profiling" when they encounter the
typical fibromyalgia patient - a middle-aged woman complaining of vague
pains. Lubin, a pain-management specialist, also cited the financial
pressures that limit the time doctors spend with each patient,
discouraging a thorough exploration of the patient's medical history and
fostering cynical reactions. "Some physicians have a sketch in their
minds," Lubin said, "so when a patient comes to their office with
complaints that can be treated with either antidepressants or narcotics,
they immediately have a picture in their mind of a patient, and they
either don't explore the nature of it or essentially they punt the patient
to a pain management doctor."

Lubin said some doctors dismiss patients with vague complaints of pain as
hypochondriacs or malingerers, lazy people looking for an excuse not to
work. Lubin said it doesn't help matters that he and other doctors
regularly encounter true malingerers, about whom they must make judgments
to determine government disability payments. "Every doctor is faced with
being a useful idiot, being a tool for somebody who wants to get out of
work," said Lubin, who trained at Yale and Harvard. "I'd rather you fooled
me once and then I could say, 'Shame on you,' rather than try to prevent
my ego from ever being bruised by assuming everyone whoever asked me for a
pill for their pain is a drug-seeker. We can't lose our humanity just
because we're afraid of being hoodwinked."

(c) 2007 The Ledger

[Return to top]


Date:    Mon, 2 Apr 2007 18:35:51 -0400
From:    "Dr Charles Shepherd <charles.c.shepherd btinternet.com> [via Co-Cure Moderator]
Subject: NOT,MED: Northern Ireland ME Association Medical Meeting on Saturday April 14th 2007


The programme for this full day meeting for doctors, organised by the
Northern Ireland ME Association, can be found in the news section of the
MEA website at:


Charles Shepherd
Hon Medical Adviser, MEA

[Return to top]


End of Co-Cure Weekly Digest of research and medical posts only - 26 Mar 2007 to 2 Apr 2007

[Return to digest index] 

Copyright © 2007 Co-Cure
Last Revision: April 26, 2007
Please report any problems with this page to the Webmaster.