Topics of the week:
11. RES: Differentiation of thoracic outlet syndrome from treatment-resistant cervical brachial pain syndromes: development and utilization of a questionnaire, clinical examination and ultrasound evaluation
[Return to digest index] --------------------------------------------- This is a special digest of Co-Cure Research & Medical posts only Problems? Write to mailto:firstname.lastname@example.org --------------------------------------------- ---------------------------------------------------------------------- Date: Tue, 22 May 2007 18:41:43 -0400 From: Fred Springfield <fredspringfield VERIZON.NET> Subject: RES: Personality Profile of Patients with Chronic Fatigue Syndrome Personality Profile of Patients with Chronic Fatigue Syndrome Journal: J of Chronic Fatigue Syndrome, Vol. 14(1) (2007), pp. 55-68 Authors: Olivier Le Bon MD, PhD [1, *], Bernard Cappeliez MD , Daniel Neu MD, Luc Stulens MSN , Guy Hoffmann PhD , Michel Hansenne PhD , Luc Lambrecht MD, PhD , Marc Ansseau MD, PhD , Paul Linkowski MD, PhD  Affiliations:  Brugmann University Hospital, Department of Psychiatry, Université Libre de Bruxelles, Belgium  University Hospital Liége, Department of Psychiatry, Université de Liége, Belgium  University Hospital Gent, Department of Internal Medicine, Gent, Belgium [*] Corresponding Author: Olivier Le Bon, CHU Brugmann Service de Psychiatrie, Plaza A. Van Gehuchten, 1020 Brussels, Belgium E-Mail: <oliver.lebon chu-brugmann.be> Personality may play a role in the predisposition, the precipitation and/or the maintenance of the CFS. Thirty-six consecutively examined female patients hospitalised for a sleep workup, filled out a Temperament and Character Inventory (TCI) questionnaire. A MANOVA compared the patients with a control group of females matched for age. Significant scores were obtained for dimensions such as Harm Avoidance, Reward Dependence, and Self-Directedness. However, the only subdimension of Harm Avoidance that proved significantly higher in CFS than in controls was "Fatigability," which is likely to overlap with the core CFS symptom. All in all, the personality structure does not appear to play a major role in the CFS. Keywords: Personality, chronic fatigue syndrome, TCI [Return to top] ------------------------------ Date: Wed, 23 May 2007 11:01:56 -0400 From: Fred Springfield <fredspringfield VERIZON.NET> Subject: RES: Treatment of chronic fatigue and orthostatic intolerance with propranolol Treatment of chronic fatigue and orthostatic intolerance with propranolol. Journal: J Pediatr. 2007 Jun;150(6):654-5. Authors: Wyller VB [1, 2], Thaulow E , Amlie JP . Affiliation:  Department of Pediatrics, Rikshospitalet-Radiumhospitalet Medical Centre, Oslo, Norway  Department of Physiology, University of Oslo, Oslo, Norway  Medical Outpatient Clinic, Rikshospitalet-Radiumhospitalet Medical Centre, Oslo, Norway. Reprint requests: Vegard Bruun Wyller, Dept of Paediatrics, Rikshospitalet-Radiumhospitalet Medical Centre, N-0027 Oslo, Norway. NLM Citation: PMID: 17517256 We describe the effect of propranolol [U.S. brand name: Inderal] in an adolescent with chronic fatigue syndrome and orthostatic intolerance. Our observations suggest that the head-up tilt-test and beta-blocker treatment might be considered in patients with chronic fatigue syndrome and that enhanced sympathetic nervous activity might be part of the underlying pathophysiology. [Return to top] ------------------------------ Date: Wed, 23 May 2007 11:07:29 -0400 From: "Bernice A. Melsky" <bernicemelsky VERIZON.NET> Subject: RES: Reduction of fibromyalgia symptoms through intravenous nutrient therapy: results of a pilot clinical trial Reduction of fibromyalgia symptoms through intravenous nutrient therapy: results of a pilot clinical trial. Altern Ther Health Med. 2007 May-Jun;13(3):32-4. Massey PB. Complementary and Alternative Medicine at Alexian Brothers Hospital Network, Elk Grove Village, Ill, USA. PMID: 17515022 OBJECTIVE: To evaluate the effectiveness of a modified Myers' formula of intravenous nutrient therapy (IVNT) on the symptoms of fibromyalgia (FM) in therapy-resistant FM patients. Methods: In this pilot clinical trial, 7 participants with therapy resistant FM were given IVNT once per week for 8 weeks. Patient's pain levels, fatigue, and activities of daily living were evaluated weekly. RESULTS: All participants reported decreased pain levels, decreased fatigue, and increased activities of daily living. Participants noted increased energy levels within 24-48 hours of the initial infusion. At the end of the study, all participants reported increased energy and activities of daily living as well as a 60% reduction in pain (P=.005) and an 80% decrease in fatigue (P=-.005). No participants, however, reported complete or lasting resolution of pain or fatigue. No side effects were reported. DISCUSSION: Anecdotal reports have indicated benefit for IVNT for patients with chronic pain, including FM. However, except for 2 reports, the medical literature is devoid of any studies of IVNT for the treatment of FM. In this pilot study, 7 participants received IVNT once a week for 8 weeks. All participants had long-standing FM (at least 8 years) and had tried conventional therapies, such as antidepressants, nonsteroidal anti-inflammatory drugs, and exercise, without significant or lasting relief. All had improvement in symptoms and increases in their activities of daily living, although no participant reported complete resolution of symptoms. IVNT appears to be safe to reduce FM symptoms. [Return to top] ------------------------------ Date: Wed, 23 May 2007 21:46:10 +0200 From: Jan van Roijen <j.van.roijen CHELLO.NL> Subject: res: fish-oil supplementation & myocardial fatty acids ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Send an Email for free membership ~:~:~:~:~:~:~:~:~:~:~:~:~:~:~:~:~:~:~:~ >>>> Help ME Circle <<<< >>>> 23 May 2007 <<<< Editorship : j.van.roijen chello.nl Outgoing mail scanned by Norton AV ~:~:~:~:~:~:~:~:~:~:~:~:~:~:~:~:~:~:~:~ Martin Lerner, Arnold Peckerman, Paul Cheney, Benjamin Natelson and others published their research, finding that most ME/CFS patients suffer from cardiac abnormalities. Therefore this study may be of interest for these patients. ~jvr `````````` http://www.immunesupport.com/library/showarticle.cfm?id=8003&T=CFIDS_FM&B1=EM052307C Effects of fish-oil supplementation on myocardial fatty acids in humans ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ by RG Metcalf, et al. ImmuneSupport.com 05-14-2007 Journal: American Journal of Clinical Nutrition, 2007 May;85(5);1222-8 Authors and affiliation: Metcalf RG, James MJ, Gibson RA, Edwards JR, Stubberfield J, Stuklis R, Roberts-Thomson K, Young GD, Cleland LG. Rheumatology Unit and the School of Medicine, University of Adelaide, Adelaide, Australia. PMID: 17490956 Background: Increased fish or fish-oil consumption is associated with reduced risk of cardiac mortality, especially sudden death. This benefit putatively arises from the incorporation of the long-chain n-3 [omega-3] fatty acids eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) into cardiomyocyte phospholipids [fatty acids found in the heart muscle cells]. Objective: The study examined the kinetics of incorporation of n-3 fatty acids into human myocardial membrane phospholipids during supplementation with fish oil and alpha-linolenic acid-rich flaxseed oil. [Note: Omega-3 and omega-6 fatty acids are both essential to cellular function and must be obtained through the diet. Omega-3 EPA and DHA is found most commonly in fish and fish oil. Omega-3 ALA is found in vegetable oils such as olive and flax seed oil. Omega-6 (arachidonic acid) is synthesized from the linoleic acid in animal foods such as meat, eggs, dairy. Researchers believe the optimum balance of omega-3 to omega-6 essential fatty acids in the cells is one-to-one, whereas in most developed countries the scale is tipped significantly toward omega-6 – a diet-based situation they believe may promote chronic inflammation and a number of physical disorders.] Design: Patients with low self-reported fish intake (<1 fish meal/wk and no oil supplements) accepted for elective cardiac surgery involving cardiopulmonary bypass were randomly allocated to 1 of 6 groups: * No supplement; * Fish oil (6 g EPA+DHA/day) for either 7, 14, or 21 days before surgery; * Flaxseed oil * Or olive oil (both 10 mL/d for 21 days before surgery). Right atrial appendage tissue removed during surgery and blood collected at enrollment and before surgery were analyzed for phospholipid fatty acids. Results: Surgery rescheduling resulted in a range of treatment times from 7 to 118 days. * In the fish-oil-treated subjects, accumulation of EPA and DHA in the right atrium was curvilinear with time and reached a maximum at approximately 30 days of treatment and displaced mainly arachidonic acid [omega-6]; * Flaxseed oil supplementation yielded a small increase in atrial EPA but not DHA; * Whereas olive oil did not significantly change atrial n-3 fatty acids. Conclusion: The results of the present study show that dietary n-3 fatty acids are rapidly incorporated into human myocardial phospholipids at the expense of arachidonic acid during high-dose fish-oil supplementation. [Return to top] ------------------------------ Date: Wed, 23 May 2007 17:02:46 -0700 From: Steven Du Pre <isaiah40 SONIC.NET> Subject: NOT, MED, ACT: CDC's Big Tent "Fatiguing illnesses" Hello, Dr. Reeves in his empirical definition (2005) is proposing that if you are fatigued and disabled to some extent and have a certain symptom profile and don't have any other diseases, then by definition you have CFS. Dr. Jason, however, pointed out that several of the Reeves questionnaires in the SF-36 and MFI concentrate solely on emotional or mental aspects of fatigue and disability. Two SF-36 questionnaires focus on emotional problems and mental health and one MFI questionnaire focuses on reduced motivation. This suggests that under the new CDC criteria fatigued people with emotional problems but not necessarily with the physical components of CFS could meet the criteria for CFS and participate in CFS studies. The 1994 CDC revised case definition, broadened what could be researched under the name of "Chronic Fatigue Syndrome" by calling for an "integrated approach to the evaluation, classification, and study of persons with CFS and other fatiguing illnesses." Then, throughout the text of the case definition, they seek to lay a framework and some justification to get these "fatiguing illnesses" into the CFS research funding structure. This shaky foundation, as Craig Maupin has pointed out, http://www.cfidsreport.com/Articles/Case%20Definition/Case%20Definition%203.htm has led to deemphasizing the Activity/exertion response in M. E./CFS, in which the hallmark type of fatigue experienced is very distinct. First, it is closely related to exertion response. People with M. E./CFS typically have an exacerbation of symptoms 24-72 hours after exertion. M. E./CFS sufferers typically describe paying a price for the activities they wish to participate in. Unlike the typical fatigue experienced by healthy people, sleep or rest cannot alleviate it. Those with M. E./CFS also describe this fatigue as flu-like. This very distinct type of fatigue is the most telling symptom of M. E./CFS, and it is testable with the "Bicycle Ergometry Test with Gas Analysis" showing almost immediate movement to anaerobic threshold in M. E./CFS patients in contrast to normal controls. In contrast, according to the 1994 CDC CFS case definition, a diagnosis of CFS can be made in patients without this hallmark symptom should a researcher choose to do so. Researchers may simply choose from a set of symptoms which fits their whims and interests. Also, nailing down the diagnosis of CFS becomes a long, frustrating process for both patient and physician, internists said. There is no diagnostic test or laboratory marker for CFS, so physicians must rule out other potential causes, like thyroid or neurological disorders, before they confirm the diagnosis. Since the main symptoms of CFS-fatigue, pain, headaches-are common to many other illnesses, the exclusion process means repeat visits, a lot of lab work, and a lot of time. As Craig points out, the authors of the 1994 Fukuda criteria go on to encourage physicians and researchers to integrate into CFS research samples "Any condition defined primarily by symptoms that cannot be confirmed by diagnostic laboratory tests, including fibromyalgia, anxiety disorders, somatoform disorders, nonpsychotic or nonmelancholic depression, neurasthenia, and multiple chemical sensitivity disorder." Thus, the authors were crafting was a recipe for confusion and conflicting results. Of course, the distinct neurological disease, Myalgic Encephalomyelitis with clear criteria and some distinct testing parameters has been buried even though the history is clear since the 1934 Los Angeles epidemic and the cover-up was thoroughly investigated and reported by Hillary Johnson in the newly updated book, Osler's Web: Inside the Labyrinth of the Chronic Fatigue Syndrome Epidemic (Paperback - June 8, 2006). Meanwhile in the rest of the world where Myalgic Encephalomyelitis has not been removed from the view of the general public & from medical professionals, Myalgic Encephalomyelitis is NOT a "subgroup" or "subset" of Fatiguing Illnesses/CFS. Instead, ME is an autonomous, infectious neurological entity ICD-10 G93.3 Steven Du Pre Poetry website: http://www.angelfire.com/poetry/soareagle/index.html "By words the mind is winged." Aristophanes Website for National Alliance for Myalgic Encephalomyelitis: http://www.name-us.org [Return to top] ------------------------------ Date: Thu, 24 May 2007 16:51:43 -0400 From: "Bernice A. Melsky" <bernicemelsky VERIZON.NET> Subject: RES: Effects of mud-bath treatment on fibromyalgia patients: a randomized clinical trial Effects of mud-bath treatment on fibromyalgia patients: a randomized clinical trial. Rheumatol Int. 2007 May 23; [Epub ahead of print] Fioravanti A, Perpignano G, Tirri G, Cardinale G, Gianniti C, Lanza CE, Loi A, Tirri E, Sfriso P, Cozzi F. Rheumatology Unit, Department of Clinical Medicine and Immunogical Sciences, University of Siena, Siena, Italy. PMID: 17520260 The efficacy of balneotherapy in fibromyalgia syndrome (FS) has been well demonstrated, while controlled studies using mud packs are lacking. We performed a randomized clinical trial to evaluate the effects and the tolerability of mud-bath treatment in FS patients, who are poor responders to pharmacological therapy. Eighty patients with primary FS, according to ACR criteria, were randomly allocated to two groups: 40 were submitted to a cycle of 12 mud packs and thermal baths, and 40 were considered as controls. At baseline, after thermal treatment and after 16 weeks, patients were evaluated by FIQ, tender points count, VAS for "minor" symptoms, AIMS1 and HAQ. Control patients were assessed at the same time periods. A significant improvement of all evaluation parameters after mud-bath therapy and after 16 weeks was observed. Mud packs were well tolerated and no drop-outs were recorded. Our results suggest the efficacy and the tolerability of mud-bath treatment in primary FS. [Return to top] ------------------------------ Date: Fri, 25 May 2007 14:08:29 -0400 From: Fred Springfield <fredspringfield VERIZON.NET> Subject: RES: Body Mass Index and Fatigue Severity in Chronic Fatigue Syndrome Body Mass Index and Fatigue Severity in Chronic Fatigue Syndrome Journal: J of Chronic Fatigue Syndrome, Vol. 14(1) (2007) pp: 69-77 Authors and affiliations: Ellen A. Schur MD, Department of Medicine, University of Washington, Seattle, WA Carolyn Noonan MS, Department of Medicine, University of Washington, Seattle, WA Wayne R. Smith PhD, Department of Psychiatry and Behavioral Science, University of Washington, Seattle, WA Jack Goldberg PhD, Department of Epidemiology, University of Washington, Seattle, WA Dedra Buchwald MD, Department of Medicine, University of Washington, Seattle, WA Background: It is uncertain how much fatigue is related to weight in patients with chronic fatigue syndrome (CFS). Objective: To assess the association of body mass index (BMI) and fatigue in CFS patients. Methods: Consecutive patients seen in a referral-based specialty clinic were eligible if they met CFS criteria and had completed required measures. Fatigue measures were the vitality subscale of the Medical Outcomes Short-Form 36 and the global fatigue index from the Multidimensional Assessment of Fatigue. Results: In women, there was no relationship between BMI and vitality subscale or global fatigue index scores (P = 0.99 and P = 0.44). For men, vitality subscale scores significantly decreased as BMI increased (P = 0.02). Conclusions: In CFS patients, the prevalence of obesity was low despite risk factors for weight gain. Fatigue severity and BMI were unrelated in women with CFS, but this relationship may differ for men. doi:10.1300/J092v14n01_07 Keywords: Chronic fatigue syndrome, fibromyalgia, fatigue, weight [Return to top] ------------------------------ Date: Fri, 25 May 2007 14:39:30 -0400 From: Fred Springfield <fredspringfield VERIZON.NET> Subject: RES: The impact of informational interventions about cognitive behavioral therapy for chronic fatigue syndrome on GPs referral behavior The impact of informational interventions about cognitive behavioral therapy for chronic fatigue syndrome on GPs referral behavior. Journal: Patient Educ Couns. 2007 May 21; [Epub ahead of print] Authors: Scheeres K, Wensing M, Mes C, Bleijenberg G. Expert Centre Chronic Fatigue, Radboud University Nijmegen Medical Centre, The Netherlands. NLM Citation: PMID: 17521842 OBJECTIVE: This study investigated the impact of an informational intervention among general practitioners (GPs) about a new treatment with cognitive behavioral therapy (CBT) for chronic fatigue syndrome (CFS) in a mental health center (MHC). The outcome measures concerned GPs knowledge and attitudes towards CFS and their actual referrals of CFS patients to this new treatment setting. METHODS: Three hundred and one GPs, who all had received written information about CFS four times, and who partly had also visited an informational group session, completed a short questionnaire survey on CFS knowledge and attitudes. Referral data were obtained from the mental health center. RESULTS: During 16 months 22% of all GPs in the concerning region had referred at least one CFS patient. Concerning knowledge and attitude, the survey results showed that 70% of the GPs had remembered the intervention's main message, namely the new treatment possibility. These informed GPs reported better knowledge and more positive attitudes towards CFS than the non-informed GPs, who had not seen and read the intervention's information. CONCLUSION: This study showed that disseminating written materials can be a useful method for stimulating GPs to refer CFS patients for CBT. PRACTICE IMPLICATIONS: In future implementation projects concerning CBT for CFS (or other 'new' treatments for a disputed illness) in a MHC or other institution, the informational intervention evaluated here can be a suitable and efficient method to inform GPs and let them refer patients. [Return to top] ------------------------------ Date: Sat, 26 May 2007 11:50:05 -0700 From: "Jacqui Footman <email@example.com> via Co-Cure Moderators" Subject: MED, NOT: Holistic Healthcare (UK) Hi folks I would like to share some information about an organisation of which I am a member, the British Holistic Medical Association, www.bhma.org I receive from them quarterly the excellent Journal of Holistic Healthcare, a journal based in the School of Integrated Health, University of Westminster, London. Anyone sharing their values may join or become a friend of the association, but the journal seems to be mainly written by/aimed at practising doctors/health professionals. The May 2007 journal's main feature article is their campaign, "Medicine as if People Matter". Here is a small excerpt from the report of the focus group, under the subheading 'Putting the heart back into healthcare': "Some members of the group talked about GPs and nurses who have said the NHS tick-box culture is making them lose heart. The group agreed that the 'heart' of NHS healthcare has been its vast reserves of individual goodwill and shared vocational values. Pondering on what the most essential feature of holistic healthcare might be, the group concluded it would be 'medicine as if people matter' and proposed that the mission of the BHMA should be to do work that supports patients and staff whose needs are poorly met in the NHS. In particular the group identified: a.. people with long-term conditions b.. people with medically unexplained physical symptoms c.. frail elderly d.. staff who aspire to deliver medicine as if people matter." I'm posting this because from this quote we can see that they are clearly setting out to support pwme, amongst others, so I suggest that we support them and maybe a joint project could be possible. Please look at BHMA membership details at http://www.bhma.org/modules.php?op=modload&name=PagEd&file=index&topic_id=0&page_id=51 also see the left-hand menu on that page to click onto "Core Values and Action" and "About us". Thanks, Jacqui (Footman) South Molton ME Support Group, North Devon, UK. [Return to top] ------------------------------ Date: Sat, 26 May 2007 20:34:56 -0400 From: Fred Springfield <fredspringfield VERIZON.NET> Subject: RES: The effect of acclydine in chronic fatigue syndrome: a randomized controlled trial The effect of acclydine in chronic fatigue syndrome: a randomized controlled trial. Journal: PLoS Clin Trials. 2007 May 18;2(5):e19. Authors: The GK, Bleijenberg G, van der Meer JW. Affiliation: Department of General Internal Medicine, Nijmegen Expert Centre Chronic Fatigue, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. NLM Citation: PMID: 17525791 OBJECTIVES: It is unclear whether insulin-like growth factor (IGF) function is involved in the pathophysiology of chronic fatigue syndrome (CFS). Unpublished data and reports in patient organization newsletters suggest that Acclydine, a food supplement, could be effective in the treatment of CFS by increasing biologically active IGF1 levels. Here we aimed to measure the IGF1 and IGF binding protein (IGFBP) 3 status of CFS patients compared to age- and gender-matched neighborhood controls, and to assess the effect of Acclydine on fatigue severity, functional impairment, and biologically active IGF1 level (IGFBP3/IGF1 ratio). DESIGN: A randomized, placebo-controlled, double-blind clinical trial. SETTING: Radboud University Nijmegen Medical Centre, The Netherlands. PARTICIPANTS: Fifty-seven adult patients who fulfilled the US Centers for Disease Control and Prevention criteria for CFS. IGF status of 22 CFS patients was compared to that of 22 healthy age- and gender-matched neighborhood control individuals. INTERVENTION: Acclydine or placebo for 14 wk. OUTCOME MEASURES: Outcomes were fatigue severity (Checklist Individual Strength, subscale fatigue severity [CIS-fatigue]), functional impairment (Sickness Impact Profile-8 [SIP-8]), and biologically active IGF1 serum concentrations. Analyses were on an intention-to-treat basis. RESULTS: There was no difference in IGF status in 22 CFS patients compared to healthy age- and gender-matched control individuals. Treatment with Acclydine did not result in significant differences compared with the placebo group on any of the outcome measures: CIS-fatigue +1.1 (95% CI -4.4 to +6.5, p = 0.70), SIP-8 +59.1 (95% CI -201.7 to +319.8, p = 0.65), and IGFBP3/IGF1 ratio -0.5 (95% CI -2.8 to +1.7, p = 0.63). CONCLUSION: We found no differences in IGF1 status in CFS patients compared to healthy matched neighborhood controls. In addition, the results of this clinical trial do not demonstrate any benefit of Acclydine over placebo in the treatment of CFS. Note: This is an Open Access article. The full text is available at http://clinicaltrials.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pctr.0020019 [Return to top] ------------------------------ Date: Sun, 27 May 2007 14:12:45 -0400 From: "Bernice A. Melsky" <bernicemelsky VERIZON.NET> Subject: RES: Differentiation of thoracic outlet syndrome from treatment-resistant cervical brachial pain syndromes: development and utilization of a questionnaire, clinical examination and ultrasound evaluation Differentiation of thoracic outlet syndrome from treatment-resistant cervical brachial pain syndromes: development and utilization of a questionnaire, clinical examination and ultrasound evaluation. Pain Physician. 2007 May;10(3):441-52. Jordan SE, Ahn SS, Gelabert HA. Neurological Associates of West Los Angeles, Santa Monica, CA and UCLA Department of Vascular Surgery, Los Angeles, CA. PMID: 17525778 OBJECTIVE: The present study was undertaken to determine which factors differentiate patients with a good outcome after treatment for Thoracic Outlet Syndrome (TOS) from patients with a poor outcome. METHODS: A total of 85 patients, who were examined during one year, had at least 6 months of follow up after treatment for TOS with either surgery or botulinum chemodenervation. RESULTS: Socioeconomic factors of work disability or workers' compensation claims did not differentiate treatment-responsive TOS from treatment-resistant cases. There was no difference between the 2 groups regarding the presence of anomalous anatomy detected by ultrasonography or regarding the presence of subclavian artery flow acceleration or occlusion detected by duplex sonography. Several factors were noted more frequently in treatment-resistant patients: sensory complaints extending beyond lower trunk dermatomes (42% vs. 10%), weakness extending beyond lower trunk myotomes (19% vs. 2%), histories of previous non-TOS surgery of the neck or upper limbs (50% vs.17%), comorbidities of fibromyalgia or complex regional pain syndrome (81% vs. 12%), and depression (35% vs. 10%). Treatment-resistant patients complained about more widespread functional impairments on a validated Cervical Brachial Symptom Questionnaire (CBSQ) than treatment-responsive patients. Resistant cases responded less often to a scalene test block (38% vs. 100%), which is designed to simulate the effects of targeted treatment. CONCLUSION: In summary, compared to patients with a good outcome after targeted treatment, patients with a poor outcome had more diffuse complaints and responded less often to a scalene test block. [Return to top] ------------------------------ Date: Mon, 28 May 2007 16:45:25 +0100 From: Ellen Goudsmit <ellengoudsmit HOTMAIL.COM> Subject: ACT, RES: editorial policy undermines scientific process. 312. The covert editorial policies of UK journals continue to interfere with the scientific process, denying information to scientists about alternatives to CBT, who are not able to study and offer potentially helpful treatment programmes to patients. I have written about the lack of rigorous peer review in relation to CFS before. The situation is not getting better, possibly due to recent appointment of CBT school supporters as editors and co-editors). Here are a few more examples of comments, this time in response to a paper on a treatment programme which is as effective as CBT and safer for those with neurological and immunological abnormalities. Given the lack of therapeutic options available to these patients, the rejection of papers on the basis of arguments which are hard to justify and amount to nitpicking, is a particularly serious matter. To emphasize, rejection on the basis of sound arguments (bad design, inappropriate statistics, flawed outcome measures etc) is fine. The paper, however, was not rejected for those reasons. "Why were people who did not fulfil the criteria included in the study?" (They weren't). "it could be argued that the person who stopped taking oral contraceptives should have been retained for the data analysis." (No, as stopping the pill resolved her symptoms, i.e. they were not due to CFS. The study was on CFS.) "was the scale on which patients rated their overall impression of the change in their health a standard scale?" (No, as described in the text, and this is quite normal in trials of CBT. Often referred to as global measures or assessments). "There were too many primary outcomes." (This refers to the inclusion of measures assessing somatic and cognitive symptoms, as well as fatigue, emotional distress and functional impairment. If we applied this reasoning to breast cancer, a paper might be rejected because it also looked at secondary tumours, quality of life and survival, in addition to the effect on the primary and side-effects). "The intervention was not controlled in that participants appeared to receive the intervention at slightly different time points." (Patients were assessed at baseline (entry into study) and six months later. One group had treatment, the other was on the waiting list. The use of a waiting list control is acceptable and has been used by the Nijmegen team, apparently without problems). "To what do authors attribute improvements in fatigue and functioning, if the programme was primarily aimed at helping patients to cope with and manage their condition?" (There wasn't an improvement in functioning had the referee read the results. We gaver some reasons why. Pacing is aimed at reducing fatigue and that's why, we think, there was an improvement in fatigue. All the information was covered in the discussion.) "there is no evidence base for the advice about energy management." (This comment ignores 30 odd years experience reported by doctors and patients, surveys, the existence of four controlled trials, including 2 RCTs relating to pacing, and a few references in the text.) "While it is true that a proportion of patients do not get better the treatment effects are not modest." (This comment relates to CBT/GET. Measures of effect size e.g. Cohen's delta, Hedges' g, indicate modest treatment effects based on data for fatigue. Reviews have also been wary of making grand claims. The recent reviews which supported the argument re modest effects were listed. The referee did not support his/her argument that CBT is a cure or has major effects for the majority. But they don't have to support their opinions with references, data etc). You get the picture? I submit that this editorial bias helps to perpetuate the use of CBT in spite of growing evidence against it. Ellen Goudsmit Chartered Health Psychologist and Chartered Scientist. [Return to top] ------------------------------
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