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CO-CURE Medical & Research Posts Only Digest - 4 Dec 2006 to 11 Dec 2006 (#2006-56)

There are 14 messages totalling 1622 lines in this issue.

Topics of the week:
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Date:    Tue, 5 Dec 2006 09:48:28 -0000
From:    Jacqui Footman <jacquiftmn@xxxxx.xx.xx>
Subject: MED: Interesting article on source of ongoing infection

Hi everyone

I came across an interesting article about root canal fillings providing =
an ongoing source of infection and cause of systemic illness - something =
I'd never heard about before.  I thought others might be interested to =
have a look too.

Best wishes

"We believe now that every root canal filling does leak and bacteria do =
invade the structure. But the variable factor is the strength of the =
person's immune system. Some healthy people are able to control the =
germs that escape from their teeth into other areas of the body. We =
think this happens because their immune system lymphocytes (white blood =
cells) and other disease fighters aren't constantly compromised by other =
ailments. In other words, they are able to prevent those new colonies =
from taking hold in other tissues throughout the body. But over time, =
most people with root filled teeth do seem to develop some kinds of =
systemic symptoms they didn't have before."=20

"Once a tooth gets infected and the cavity gets into the nerve and blood =
vessels, bacteria find their way into those tiny tubules of the dentin. =
Then no matter what we do by way of treatment, we're never going to =
completely eradicate the bacteria hiding in the miles of tubules. In =
time the bacteria can migrate through lateral canals into the =
surrounding bony socket that supports the tooth. Now the host not only =
has a cavity in a tooth, plus an underlying infection of supporting =
tissue to deal with, but the bacteria also exude potent systemic toxins. =
These toxins circulate throughout the body triggering activity by the =
immune system - and probably causing the host to feel less well. This =
host response can vary from just dragging around and feeling less =
energetic, to overt illness - of almost any kind. Certainly, such a =
person will be more vulnerable to whatever "bugs" are going around, =
because his/her body is already under constant challenge and the immune =
system continues to be "turned on" by either the infective agent or its =
toxins - or both."

Read the rest at:=20

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Date:    Wed, 6 Dec 2006 11:43:53 -0500
From:    Fred Springfield <fredspringfield@xxxxx.xxx>
Subject: RES: Long-term outcomes of an integrative rehabilitation  program on quality of life [in CFS]: A follow-up study

Long-term outcomes of an integrative rehabilitation program on quality of
life: A follow-up study.

Journal: J Psychosom Res. 2006 Dec;61(6):835-9.

Taylor RR, Thanawala SG, Shiraishi Y, Schoeny ME.

Department of Occupational Therapy, College of Applied Health Sciences,
University of Illinois at Chicago, Chicago, IL 60612, USA.

PMID: 17141674

OBJECTIVE: To assess the long-term effects of an integrative rehabilitation
program on the overall quality of life of individuals with chronic fatigue
syndrome (CFS).

METHODS: This study utilized a within-subjects, repeated measures cohort
design. Twenty-three subjects diagnosed with CFS attended eight sessions of
an illness-management group followed by 7 months of goal-oriented,
individualized counseling that occurred once weekly for 30 min per session.
Quality of life was assessed at five time points (baseline, following the
group phase, following the one-on-one phase, and 4 and 12 months following
program completion).

RESULTS: A within-subjects repeated measures ANOVA revealed significant
increases in overall quality of life for up to 1 year following program
completion [F(4, 21)=23.5, P<.001].

CONCLUSIONS: Definitive conclusions about program efficacy are limited by
design issues. However, findings suggest that the program may have led to
improvement in quality of life for up to 1 year following program completion.

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Date:    Wed, 6 Dec 2006 20:34:34 -0500
From:    Fred Springfield <fredspringfield@xxxxx.xxx>
Subject: RES: A case with chronic fatigue syndrome with positive  antinuclear antibody followed by postpartum thyroiditis

A case with chronic fatigue syndrome with positive antinuclear antibody
followed by postpartum thyroiditis.

Journal: Mod Rheumatol. 2004 Nov;14(5):406-9.

Authors: Itoh Y, Hamada H, Igarashi T, Kuwabara N, Imai T, Fujino O,
Fukunaga Y.

Affiliation: Department of Pediatrics, Nippon Medical School, 1-1-5
Sendagi, Bunkyo-ku, Tokyo, 113-8603, Japan, yasuhiko@xxx.xx.xx.

NLM Citation: PMID: 17143702

Autoimmune fatigue syndrome (AIFS) is defined by chronic nonspecific
complaints, a positive antinuclear antibody (ANA) assay, and the absence of
another explanation for the complaints. Some severe cases fulfill the
criteria for chronic fatigue syndrome (CFS). CFS is a syndrome
characterized by disabling severe fatigue and defined by the criteria
proposed by the U.S. Centers for Disease Control and Prevention.

In this report, a patient with chronic fatigue syndrome and positive ANA
assay was described as having developed postpartum thyroiditis 5 years
after the onset. Subchemical hypothyroidism is characterized by clinical
hypothyroidism not meeting biochemical criteria but showing evidence of
thyroid autoimmunity. The relation between AIFS and subchemical
hypothyroidism is discussed.

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Date:    Thu, 7 Dec 2006 11:18:24 -0500
From:    Fred Springfield <fredspringfield@xxxxx.xxx>
Subject: RES: Highlights from 5th International Conference on HHV-6 and -7

Highlights from 5th International Conference on HHV-6 and -7.

Journal: Herpes. 2006 Nov;13(3):81-2.

Authors: Komaroff A, Jacobson S, Ablashi V, Yamanishi K.

Affilialtion: Harvard Medical School, Boston, MA, USA.

NLM Citation: PMID: 17147913

This article reports on key presentations at the 5th International
Conference on Human Herpesvirus (HHV)-6 and -7, organized by the HHV-6
Foundation. New assays for HHV-6 and -7 promise to be more accurate and
better able to distinguish between HHV-6A and B or differentiate active
from latent infection. Nevertheless, more research is needed to enhance the
sensitivity and specificity of these assays.

Cellular receptors for both HHV-6 and -7 have been identified. Both viruses
have in vitro tropism for neurons and dendritic cells of the central
nervous system (CNS), and their role in producing CNS disease in the
immunocompromised (particularly transplant recipients and the HIV-infected)
is well established. HHV-6 may enhance the progression of simian
immunodeficiency virus in monkeys, as suggested by in vivo data.

In immunocompetent children and adults, HHV-6 and/or -7 may play a role in
triggering and perpetuating several diseases of the nervous system, namely
encephalitis, multiple sclerosis, chronic fatigue syndrome and epilepsy.

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Date:    Thu, 7 Dec 2006 11:41:42 -0500
From:    Fred Springfield <fredspringfield@xxxxx.xxx>
Subject: MED: Navigating through the swampy lowlands - Dealing with the patient when the diagnosis is unclear

Navigating through the swampy lowlands - Dealing with the patient when the
diagnosis is unclear.

Journal: Aust Fam Physician. 2006 Dec;35(12):991-4.


Affiliation: Medical Educator, SIGPET, New South Wales.

NLM Citation: PMID: 17149475

Case study: Jenny, 56 years of age, is well known to your practice. Your
registrar asks for advice regarding her management. Together you summarise
her history: noninsulin dependant diabetes, irritable bowel syndrome,
chronic headache, and a background of social and emotional issues. She is
obese, a light smoker, and has worked intermittently since her youth. You
know her marriage is rocky and her children have had various health issues
including chronic fatigue syndrome. You admit to some ambivalent, if not
overtly hostile feelings toward Jenny, and you are uncomfortable
acknowledging this; it seems so unprofessional. Her current issue is joint
pain, for which the diagnosis is unclear despite referral and
investigations. How can you help your registrar manage this patient?

The full text of this article is available for free in PDF at

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Date:    Thu, 7 Dec 2006 12:39:00 -0500
From:    "Bernice A. Melsky" <bernicemelsky@xxxxx.xxx>
Subject: RES: Pain clinic experience in a teaching hospital in Western, Saudi Arabia. Relationship of patient's age and gender to various  types of pain

Pain clinic experience in a teaching hospital in Western, Saudi Arabia.
Relationship of patient's age and gender to various types of pain.

Saudi Med J. 2006 Dec;27(12):1882-6.

Kaki AM.

Department of Anesthesia, Faculty of Medicine, King Abdul-Aziz University
Hospital, PO Box 2907, Jeddah 21461, Kingdom of Saudi Arabia. Tel. +966 (2)
6408335. Fax. +966 (2) 6408335. E-mail: amkaki@xxxxx.xxx.

PMID: 17143369

OBJECTIVE: To show the practice of a pain clinic in Saudi Arabia, to
estimate the prevalence of various types of chronic pain managed in there
and to find the relationship of patient's age and gender to type of pain.

METHODS: A retrospective study was carried out over a period of 5 years
(January 2000 - December 2004) at a teaching hospital in Jeddah. A total of
1686 patient's data was reviewed, including the giving diagnosis, types of
pain and demographic data.

RESULTS: The common age was 50-59 years (25.4%), with a preponderance of
female (56.8%) over male (43.2%). For given diagnosis low back pain (LBP)
was the most common (45.4%), followed by painful neuralgia (15.6%),
headache (9.7%), cancer pain (8.7%), and cervicobrachialgia (8.1%). The
prevalence of fibromyalgia (7.9%), headache (12.1%) and cervicobrachialgia
(10.7%) was more common among female, in comparison to male (2.4%), (6.4%)
and (4.7%) respectively. While painful neuralgia was more frequent among
male (19.9%) than female (12.3%), (p<0.001). Low back pain showed higher
prevalence among old patients, while headache and sickle cell disease were
more common among younger age group. Combined nociceptive and neuropathic
pain was the most common pathophysiological type observed (39%), followed
by nociceptive pain (36.2%) and the least one was psychological pain (2.7%).

CONCLUSION: Various types of chronic pain managed in the pain clinic
requ[ire] full understanding of pain neurophysiology as well as familiarity
with contributing factors to the prevalence of pain.

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Date:    Thu, 7 Dec 2006 12:44:24 -0500
From:    "Bernice A. Melsky" <bernicemelsky@xxxxx.xxx>
Subject: RES: Sphygmomanometry-evoked allodynia - a simple bedside test indicative of fibromyalgia: a multicenter developmental study

Sphygmomanometry-evoked allodynia - a simple bedside test indicative of
fibromyalgia: a multicenter developmental study.

J Clin Rheumatol. 2006 Dec;12(6):272-4.

Vargas A, Vargas A, Hernandez-Paz R, Sanchez-Huerta JM, Romero-Ramirez R,
Amezcua-Guerra L, Kooh M, Nava A, Pineda C, Rodriguez-Leal G, Martinez-Lavin M.

From the National Institute of Cardiology, ISSSTE Hospital Leon,
Autonomous University of Puebla and Medica Sur., Mexico.

PMID: 17149055

BACKGROUND: One of the 2 classification criteria for fibromyalgia (FM) is
the presence of tender points on specific anatomic sites. It has been
established that these tender points reflect a state of generalized
allodynia (defined as pain resulting from a stimulus that does not normally
provoke pain). Patients with FM often describe pain elicitation during
blood pressure testing (sphygmomanometry).

OBJECTIVE: The objective of this study was to define if a universally used
clinical test, sphygmomanometry, is helpful in the identification of
patients with FM.

METHODS: The authors conducted a prospective multicenter study in 3
different public rheumatology outpatient services. Each center studied 20
patients with FM, 20 with rheumatoid arthritis, 20 with osteoarthritis, and
20 healthy individuals. The following question was asked of each
participant: "When I take your blood pressure, tell me if the cuff's
pressure brings forth pain." The blood pressure cuff was inflated at an
approximate rate of 10 mm Hg per second up to 180 mm Hg or to the point
when pain was elicited.

RESULTS: Sixty-nine percent of patients with FM had sphygmomanometry-evoked
allodynia in contrast to 10% of patients with osteoarthritis, 5% with
rheumatoid arthritis, and 2% of healthy individuals (P < 0.001). The mean
blood pressure value at which allodynia was elicited was lower in patients
with FM (143 ± 40 mm Hg) when compared with the other 3 groups (176 ±
11 mm Hg) or higher (P < 0.001). In patients with FM, there was a
significant negative correlation between the blood pressure value at which
allodynia developed and total Fibromyalgia Impact Questionnaire (FIQ)
score, number of tender points, and the FIQ visual analog scales for pain
intensity and fatigue (P < 0.05). The test yields a diagnostic sensitivity
for FM of 0.7, specificity 0.96, positive predictive value 0.86, and
negative predictive value 0.91.

CONCLUSIONS:: In this developmental study of patients attending
rheumatology clinics, the generation of pain during blood pressure testing
was strongly associated with the diagnosis of FM. This robust linkage
probably reflects a tautologic phenomenon. A sine qua non element for FM
diagnosis is the presence of tender points in discrete anatomic sites.
These tender points in turn reflect a state of generalized mechanical
allodynia that can be locally elicited by the cuff pressure during blood
pressure testing. Sphygmomanometry is a simple bedside test that may be
useful in the recognition of patients with FM. Blood pressure testing is a
universal procedure in all clinical environments. Based on our results, we
suggest searching for FM features in any person who has
sphygmomanometry-evoked allodynia.

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Date:    Thu, 7 Dec 2006 13:18:29 -0500
From:    "Jodi Bassett <jodibassett@xxxxx.xxx>" [via Co-Cure Moderators]
Subject: NOT,MED:The Misdiagnosis of CFS: A new paper in 2 parts

*permission to repost*

The Misdiagnosis of Chronic Fatigue Syndrome: A new paper in 2 parts

There are now more than 9 different definitions of CFS. Despite the fact
that the new name and definition of CFS were originally created in a
response to an outbreak of what was unmistakably Myalgic Encephalomyelitis,
this new name and definition did not describe the known signs, symptoms,
history and pathology of M.E. The same is true of each of the subsequent
definitions. So what is defined by these definitions? What does a diagnosis
of Fukuda (CDC), Oxford, or Australian CFS actually mean?

The first part of this paper looks at each of these questions.

The second part of this paper is comprised of a list comparing the symptoms
of some of the illnesses commonly misdiagnosed as CFS, with several of the
most common CFS definitions.

As with all original papers on my website, both of these new texts may be
downloaded in Word or PDF format, both together or singly.

Part one (by far the more important part) is only 3 pages long. This
includes a full reference list and list of additional resources from some of
the world's leading M.E. experts and the paper is also fully referenced
throughout. This paper in particular is especially designed to be widely
redistributed both to doctors and sufferers.

These are vitally important questions and issues for everyone who has a CFS
or M.E. diagnosis, as well as for any doctor who diagnoses patients with CFS
or M.E. themselves. Happy reading!

See: http://www.ahummingbirdsguide.com/misdiagnosis.htm

Best wishes everyone,
Jodi Bassett
A Hummingbirds Guide to Myalgic Encephalomyelitis:
The term myalgic encephalomyelitis (means muscle pain, my-algic, with
inflammation of the brain and spinal cord, encephalo-myel-itis, brain spinal
cord inflammation) was first coined by Ramsay and Richardson and has been
included by the World Health Organisation (WHO) in their International
Classification of Diseases (ICD), since 1969. It cannot be emphasised too
strongly that this recognition emerged from meticulous clinical observation
and examination. Professor Malcolm Hooper 2006

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Date:    Thu, 7 Dec 2006 17:29:44 +0100
From:    Jan van Roijen <j.van.roijen@xxxxx.xx>
Subject: act,med: Nov. APPG Meeting -RiME


Send an Email for free membership
       >>>> Help ME Circle  <<<<
 >>>>  7 December 2006    <<<<
Editorship : j.van.roijen@xxxxx.xxx
Outgoing mail scanned by Norton AV


Campaigning for Research into Myalgic Encephalomyelitis

Summary of the APPG Nov. 16 2006

MPs in attendance: Des Turner, Tony Wright, Andrew Stunell, Ian
Gibson, Steve McCabe, Betty Williams and John Hutton. Also in
attendance were members of the public and an observer from
NICE. The meeting was chaired by Des Turner and was quorate.

First to speak was the secretary of State for work and Pensions,
John Hutton. He spoke about benefits and assessments system
reforms and about the draft medical guidance on M.E./CFS for
Disability Living Allowance and Carer's Allowance decision
makers. He explained his Department was trying to improve
decision-making and to agree on a fair and transparent process.
He said the draft guidance was based on medical advice, and
that there are difficulties assessing a medical condition that
fluctuated. He also said that achieving consensus was
impossible in an area where there is differing medical opinion.

Charles Shepherd (MEA) mentioned how the DWP 'Panel' were
now on their 'ninth draft Guidelines' and how polarised views
were preventing consensus; the neurologist on the panel, for
example, does not accept the ICD listing of ME. Dr Shepherd
said that 1,000 PWME pa were having to 'win' their benefit on

Barbara Robinson (Suffolk) and Doris Jones (Independent
Researcher) drew people's attention to an NHS Document
entitled 'Occupational Aspects of the Management of CFS'. The
document discusses 'pathways to work', leading PWME of
working age to fear that the Govt might try to force them into
work. Doris said the Document preempted the NICE Guidelines.

Second item was the confirmation of elected officers. Because
of complaints made to the Parliamentary Commissioner by
members of the public concerned that the last APPG meeting
was held as an AGM, and officers were elected even though the
meeting was not quorate, the process was correctly repeated at
this meeting with no changes to officers other than the group
secretary Steve McCabe was replaced by Ian Gibson MP. At
that point Dr Gibson made an exit for the door. On the way, he
talked briefly about his imminent Inquiry, saying how difficult it
had been to reach any sort of consensus due to the range and
diversity of views.

Third item was a discussion regarding the NICE guidelines for
ME/CFS. They have been condemned as unfit for purpose by
the ME community. Dr Turner said they were fit for 'neither man
nor beast', and the Health Dept would be unwise to try to
implement them. Points raised were (1) the aspects of the costs
to the NHS of implementing them (2) the risk to sufferers (3) the
legal ramifications of prescribing exercise. Paul Davis RiME
said the crucial issue, again, was terminology and that based on
a 'wide Fukuda, Section 1.2.' what followed was both skewed
and irrelevant. The person from NICE did say a few words, but
he was at the back of the room and barely audible. Dr Turner
said he would write to the Chairman of NICE, Professor Rawlins,
to convey concerns raised, and also to invite him to the next
APPG meeting.

Doris Jones expressed her concern that the NICE Guidelines
were based on the 2005 York review, which is psychiatrically
biased. Paul Davis agreed and pointed out that the CMO
Report, which had been mentioned a number of times during the
course of the meeting, had been largely based on the original
York Review 2002. Paul read out sections 46 + 48 of the CMO
Report: they associate ME with activity avoidance and abnormal
illness beliefs to be combated by GE and CBT respectively; ME
patients do not view these recommendations as dissimilar to
those in the NICE Guidelines; by signing the misguided CMO
Report the ME Charities had put the ME cause on the backfoot,
and they were now 'running with the hare and the hounds'.

Finally, at the end of the meeting Paul expressed his concern
that discussion of issues such as the NICE Guidelines was
deflecting attention away from the issue of research - what
PWME primarily want. He asked Dr Turner what he intended to
do about it only to receive the same question back. Paul pointed
out that he was campaigning for research into ME but didn't
have the same powers MPs have at their disposal, and that if
330 MPs thought there should be research into the physical
causes of ME, it should happen.

Disclaimer: Due to technical problems, there has been no
tape-recording to work from this time. The following is based on
scribbled notes made at the meeting. Those who took the notes
said there was difficulty in hearing what some peolpe said. We
have tried to make the summary as accurate as possible.

After the meeting members of the public were given an A4 sheet
of paper. It declared that the APPG on ME does endorse the
ICD Classification of ME. It also lists a set of rules under 'Code
of Practice for the APPG on ME'. Although not unsurprising, it is
ironic that the public were handed these rules given the fact that
the Parliamentary Commissioner recently received a number of
complaints asking for the rules governing APPGs to be
strengthened, and he refused to do so on the grounds that it
would be unduly prescriptive. It waits to be seen how these rules
will be enforced, but the fact that this action was taken only
serves to strengthen people's dissatisfaction with politicians. It
would appear it is deemed unduly prescriptive when the public
asks for safeguards to be directed at MPs, but not so if MPs
decide - for whatever reason - they want safeguarding from the
public. Most of those in attendance at the APPG for ME are in
reality either extremely ill with ME, or caring for someone that is.
They justifiably feel they have been left with no other choice than
to try to address politicians directly.

Ian Mclachlan


Thanks to Ian for above.

News re. RiME newsletter No.8 will follow very shortly....

Paul Davis

RiME 10 Carters Hill Close Mottingham SE9 4RS


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Date:    Thu, 7 Dec 2006 21:13:32 -0500
From:    "skevin <skevin@xxxxx.xxx> [via Co-Cure Moderators]
Subject: NOT,MED:SWP Article Criticising the New Labour Government's use of CBT & approach to Mental Health

SWP Article Criticising the New Labour Government's use of CBT &
approach to Mental Health. MAY BE REPOSTED.

Dear All, I have pasted below - with permission to repost from the
copyright holder - an article on the misuse of CBT by the UK New Labour
Government which I believe will be of interest to the ME Community. The
article is on the SWP website today and takes up a full page in their
'Socialist Worker' newspaper December 9th issue. The authour is Iain
Ferguson, a senior lecturer in social work at the University of Stirling.
Best wishes, Kev Short. Norfolk, UK. 7 December 2006.

Socialist Worker 2030, 9 December 2006 (www.socialistworker.co.uk)

Richard Layard, inequality and the 'science' of happiness

Walk into any high street chain bookstore these days and before very
long you are likely to encounter a stand packed with books devoted
solely to the subject of happiness.

These range from academic texts at one end of the spectrum to Positively
Happy: Cosmic Ways to Change Your Life by the nauseating Noel Edmonds at
the other.

The issue of happiness – what is it is and how to get it – has become
one of the dominant themes of the first decade of the 21st century.

Discussions around happiness, of course, are hardly new. The
relationship between happiness and other valued social goals such as
justice and freedom has been a central concern of philosophers from
Aristotle to Jeremy Bentham.

What is new, however, is the way in which a certain “scientific” notion
of happiness has moved in recent years from the fringes of public
debates to having a profound influence on the government’s policies over
mental health and the welfare system.

The past few years have been marked by the development of a “happiness
industry” on an international level.

This industry even has its own academic journal – the Journal of
Happiness Studies. Over 3,000 articles have been published on happiness
and numerous websites have been set up on the subject, such as Professor
Martin Seligman’s Authentic Happiness, which claims 400,000 users.

In Britain, the key role has been played by Richard Layard, a professor
at the London School of Economics who also sits as a Labour member of
the House of Lords. In contrast to other key figures in the happiness
industry, Layard is not a psychologist but an economist.

He is also the author of a study called “The Depression Report: A New
Deal for Depression and Anxiety Disorders”, published earlier this year.

The language of “New Deals” is not accidental – Layard is an influential
figure in New Labour circles and helped draw up the government’s “New
Deal” for the unemployed.
The report’s starting point is that “crippling depression and chronic
anxiety are the biggest causes of misery in Britain today”.

Layard and his colleagues note that one in six of us will be diagnosed
as having depression or chronic anxiety disorder. That works out as one
family in three being affected at any one time.

But the “good news”, as they call it, is that most of this misery is
totally unnecessary and avoidable since “we now have evidence-based
therapies that can lift at least half of those affected out of their
depression or chronic fear”.

Good news?

This, they argue, is good news for two groups of people – not just those
who are currently experiencing mental distress, but also for a New
Labour government seeking to slash spending on incapacity benefit.

Layard’s report acknowledges that mental ill-health is a waste of
people’s lives, but swiftly adds:

“It is also costing a lot of money. For depression and anxiety make it
difficult or impossible to work, and drive people onto incapacity benefit.

“We now have half a million people on incapacity benefits because of
mental illness – more than the total number of people receiving
unemployment benefit.”

A key objective, then, of Layard’s report is to find ways of reducing
the number of people with mental health problems currently claiming
incapacity benefit. He proposes the recruitment of an army of 10,000

Half of these would be clinical psychologists, while the other half
would comprise nurses, occupational therapists, counsellors and social
workers. They would be given part-time training over one or two years to
become “psychological therapists”.

On the all important question of costs, by 2013 the gross costs of the
service would have reached about £600 million a year, with an additional
annual training cost of around £50 million.

But the report’s authors suggest that these costs would be “fully
offset” by “rapid savings to the Department of Works and Pensions and HM
Revenue and Customs” – presumably by removing hundreds of thousands of
people from incapacity benefit.

Critical look

So how should we respond to Layard’s proposals? The first thing is to
take a critical look at the basis of this new “science of happiness” –
and in particular at the “evidence-based therapies” it relies on so
heavily to deal with the problems of mental ill-health.

Foremost among these techniques is cognitive behaviour therapy (CBT),
which is based on the notion that depression is caused by negative and
irrational ideas that people hold about themselves, including ideas of

When something goes wrong in their lives, such as unemployment or
divorce, these individuals automatically blame themselves and become
depressed. The aim of CBT is to help people challenge these “automatic
negative thoughts” and assess situations “objectively”.

Despite the overriding role which Layard and other “science of
happiness” theorists give to ideas in the creation of mental ill-health,
there is curiously little interest in any of these texts as to where
these supposedly “irrational” ideas come from – or why people persist in
holding on to them.

Yet as the 19th century Italian Marxist Antonio Labriola put it, “Ideas
do not fall from heaven, and nothing comes to us in a dream.”

In other words, if people persist in believing that they are inferior,
or even worthless, human beings, then surely we should be looking to see
where these ideas are so widespread and why they seem so powerful.

Nevertheless there is clear evidence that many people find such
counselling much more helpful than drugs in dealing with depression.

For that reason, we should support any initiative which makes
counselling services of whatever type more available and accessible.

There are major problems, however, with Layard’s suggestion that CBT, as
an “evidence-based approach”, is the answer to the high levels of
depression found in society.

While there is evidence to show that CBT can be effective for people
with simple, uncomplicated, mild depression, there is less evidence for
its effectiveness in helping people with more complicated or prolonged
depression, including depression arising from early trauma – the sort of
people who are more likely to be on long-term benefits.

Moreover, Layard and his colleagues suggest that CBT should become the
primary, if not the sole, form of therapy on offer, at the expense of
all other approaches, including person-centred and psychoanalytic

To state the obvious, different approaches are likely to work for
different people. The government likes to promote a “choice agenda” in
education and social care, and continually attacks a “one size fits all”
approach in these areas.

So it ironic, to say the least, that New Labour should be persuaded to
adopt precisely such an approach in field of mental health policy.

The science behind CBT can also be criticised. CBT lends itself more
easily than other therapies to quantitative methods of evaluation – but
this is not the same as saying that is necessarily more effective.

Randomised control trials are not the only, or even the most effective,
way of measuring how helpful a particular therapy may be.

And neither in The Depression Report nor in the “happiness” literature
more generally is there any reference to the considerable body of
research that criticises the “medical model” of treating mental
ill-health as a “disease” to be “cured”. On the contrary, within the
work of Layard in particular there appears to be an uncritical
acceptance of this medical model.

Social inequality

But the most important objection to the “science of happiness” is the
fact that it systematically ignores the entire question of social

Despite its frequent references to “evidence-based” practice, there is
no discussion anywhere within Layard’s report of one of the most
powerful bodies of evidence in any field of social science research
anywhere – namely the tight link between inequality and mental ill-health.

In a classic study of depression among women almost 30 years ago, two
British academics, George Brown and Tirril Harris, also found very high
levels of depression in society. In common with the happiness theorists,
they too found that in the development of depression “it is change in
thought about the world that is crucial”.

Unlike them, however, they sought to locate that change in thought in a
complex model which stressed the impact of people’s past and present
experience, especially their experience of social class, on their
self-esteem and the way they viewed the world.
That model helped explain their finding that working class women were
four times more likely to develop depression than middle class women.

Layard’s silence over the question of inequality relates to the
political climate in which these “happiness” theories are being proposed.

For the key themes of the science of happiness fit perfectly with the
individualism of New Labour and with the policy, announced by the
government in July, to save billions of pounds by removing one million
people from incapacity benefit.

In this context, should Layard’s plans be implemented, one can only feel
concern for those with mental health problems who, for whatever reason,
have failed to attain good mental health after the prescribed 16 weeks
of CBT.

Simply focusing on the ideas in people’s heads and seeing depression as
an attitude problem may help get some off incapacity benefit.

But it will do little to reduce the overall levels of depression – that
requires addressing the poverty, inequality and the lack of hope that
blight the lives of millions across the country.

Perhaps the best answer to the happiness theorists is to revive the
slogan from the 1960s: “Do not adjust your mind – there is a fault in

[Return to top]


Date:    Fri, 8 Dec 2006 14:23:14 -0500
From:    Co-Cure Moderator <ray@xxxxx.xxx>
Subject: NOT,MED: Enrollment and Satisfaction Levels Remain Low in Consumer-Driven Health Plans, Survey Finds [US]

Kaiser Daily Health Policy Report
Friday, December 08, 2006

Health Care Marketplace
Enrollment and Satisfaction Levels Remain Low in Consumer-Driven Health
Plans, Survey Finds

       Enrollment in consumer-driven plans among privately insured U.S.
residents is low, and satisfaction with the plans continues to lag,
according to a report released Thursday by the Employee Benefit Research
Institute and the Commonwealth Fund, the Denver Post reports. The survey
queried 3,158 privately insured U.S. residents ages 21 to 64 (Shanley,
Denver Post, 12/7). For the survey, a high-deductible plan was defined as
having a deductible of $1,000 for individuals or $2,000 for families
(Blinkhorn, CQ HealthBeat, 12/7). The survey found that 1% of privately
insured adults were enrolled in high-deductible plans with tax-exempt
health savings accounts, about the same level as last year. The report also
found that 7% of privately insured adults, or 8.5 million people, were
enrolled in high-deductible, low-premium plans but had not signed up for
tax-exempt HSAs, compared with 9% of adults last year (Congress Daily,
12/7). Adults who qualified for HSAs but did not have them usually could
not afford to contribute to the accounts, according to the report (Von
Bergen, Philadelphia Inquirer, 12/8). While participants in high-deductible
plans were more aware of health expenditures than people in more
comprehensive plans, they also were more likely to skip doctors
appointments or delay filling prescriptions, according to the report. The
survey also found that 20% of U.S. residents reported being familiar with
high-deductible plans (CQ HealthBeat, 12/7). The report concluded, "Despite
the expectations of some policymakers that the lower premiums and tax
benefits of consumer-driven health plans would substantially reduce the
number of people without health insurance, adults in these plans were no
more likely to have been uninsured before enrolling in their plans" (Denver
Post, 12/7).

Dallas Salisbury, EBRI president and CEO, said, "It will be interesting to
see if continually rising health care costs prompt more workers to conclude
that the trade-off of lower premiums for higher deductibles, and
potentially higher out-of-pocket costs, is worth it." Karen Davis,
president of the Commonwealth Fund, said that a solution to the high number
of uninsured U.S. residents "will have to be a mix of public and private"
(CQ HealthBeat, 12/7).

The report is available online at
Note: You will need Adobe Acrobat Reader to view the report.

A related webcast is available online at

[Source: http://www.kaisernetwork.org/daily_reports/rep_index.cfm?DR_ID=41560 ]

[Return to top]


Date:    Fri, 8 Dec 2006 14:53:23 -0500
From:    "Bernice A. Melsky" <bernicemelsky@xxxxx.xxx>
Subject: RES: Sleep-Disordered Breathing Among Women With Fibromyalgia  Syndrome

Sleep-Disordered Breathing Among Women With Fibromyalgia Syndrome.

J Clin Rheumatol. 2006 Dec;12(6):277-281.

Shah MA, Feinberg S, Krishnan E.

 From The Reading Hospital and Medical Center, West Reading, Pennsylvania;
Eastern PA Comprehensive Sleep Disorders, Wyomissing, Pennsylvania; and the
Division of Rheumatology, University of Pittsburgh, Pittsburgh, Pennsylvania.

PMID: 17149057

BACKGROUND: In clinical practice, polysomnograms ("sleep studies") are
seldom ordered for patients with fibromyalgia, although sleep issues
dominate the symptom complex. One reason for this is the lack of
understanding how information from these studies could aid clinical decisions.

METHODS: The authors conducted a chart review of one rheumatologist's
community-based practice where polysomnograms were offered routinely to all
women who met the American College of Rheumatology criteria for
fibromyalgia. Interpretation of these standardized protocol-based
polysomnograms was performed by a board-certified neurologist using
standard criteria.

RESULTS: Mean age of the study subjects (n = 23) was 45 (standard
deviation, 7.8) years. Median body mass index was 27 kg/m (interquartile
range 20-48). These women had poor sleep with many arousals (median arousal
index 23), apnea-hypopneas (median apnea-hypopnea index 22, interquartile
range 17-30). Desaturation was common with half the patients having nadir
oxygen saturation less than 87%. Restless legs were detected in
polysomnograms among many women who clinically denied it (mean leg movement
index 5.8).

CONCLUSIONS: A large proportion of women with fibromyalgia in a general
rheumatology practice had sleep-disordered breathing, which can be detected
using sleep polysomnograms. Studies are needed to examine if treatment of
the commonly detected sleep apnea will have a beneficial effect on symptoms
of fibromyalgia.

[Return to top]


Date:    Fri, 8 Dec 2006 16:17:20 -0500
From:    "Jill Diprose <jill@xxxxx.xx.xx> via Co-Cure Moderators"
Subject: MED: Questions and Answers with Dr. Nancy Klimas from Wellington Patient Lecture on 8th September 2006

QUESTIONS and ANSWERS with Dr Nancy Klimas
 From Wellington Patient Lecture date 8th September 2006

By Jill Diprose

What is HHV6 virus ? and what is the therapy?

HHV 6 is a virus, there are two  types  - a and b. We are talking about type a.
It is the virus that causes measles in childhood, usually lasts maybe 3
days. Therefore all of us have had it, and it is usually held in check our
immune system.

Some believe it to be the set up virus for epilepsy and there is large body
of work implicating it in MS (at least in a subgroup).  They are just
beginning clinical trails of therapy at the NIH for MS.

Now HHV6 is being studied in CFS and  it appears to be playing a role in at
least  a  subgroup of CFS patients. Remember Peterson and Knox had showed
it in spinal fluid. HHV6 definitely shouldn't have been there and the big
gun treatments for the virus are valid in those proven cases.

The exciting new research was the work by Dr Jose Montanya at the
University of Stanford . He is new to the CFS world and his first study was
based on serology .ie high antibody levels (4 fold + incr  to both HHV6 and
EBV) . He  was using the new oral valgancyclovir. It was a great small
study, titres went down,  9/12 patients improved  meaning they went back to

He is now funded and up and running doing a phase 2 trial (i.e. having a
placebo control arm). It is after phase 3 trails that a medicine is able to
be called "standard of care" and be released general use.

Check out HHV6 Foundation Website at http://www.hhv-6foundation.org/. They
are a committed group of researchers doing great work and raising money for
research. The researchers  intend to make testing available in the near future.

How do you prove disability/severity  which test is best from the list of
about 30 tests that I've been looking at on a website.  Is SPECT the best test?

SPECT shows lots of aberrant things but Dr Klimas said she wouldn't use it
to prove disability, as it is costly.
Dr Klimas proves CFS disability from: -

Immune Activation Panels : (DR, CD26 expression, TH2 cytokine shift,
proinflammatory cytokine expression TNF-a, IL-1, IL6)
+ Functional defects : (NK cell dysfunction, CD8 abnormalities, decreased
perforins, granzymes, macrophage abnormalities, antibody production.)

Q. Are these available in New Zealand?
A. "Putting panels together shouldn't be a problem". These kinds of tests
are not routine, but they should be do-able by immunologists here.
The subtle endocrine abnormalities  low cortisone, small adrenal gland.
Cognitive Assessment  psychological  tests to confirm a drop in IQ (can be
done with reference to occupation and past employment proficiency
records  superior intelligence back to average intelligence for example).
Tests can show  - Short term memory problems; attention loss; concentration
loss ; reduced  ability to process complex numbers i.e. problems with
"working memory".
      The problem is that you need a pre illness reference or the fact that
your job has to require that you need a certain level of competency.
Sleep studies. (very objective  very little stage 3 and 4 sleep, often
stuck in stage one or alpha sleep stage alpha wave intrusion pattern)
5.  Viral serology is sometimes helpful eg elevated antibodies to HHV6, EBV
  MRI scans  show higher number of   hyperintensity white spots  areas of
inflammation. Normals have say 5, CFS patients 20-30.
  Tilt table (very objective)

So given the evidence of an inflammatory response, wasn't the old name,
ME,  better than CFS?

Sure, ME is a much better name. The problem is that we've fought so hard in
the US to get recognition as CFS, and there is a social security ruling
under that name, that changing it now would cause a lot of issues. I'm just
trying to get slash(/) ME into it. i.e. CFS/ME

Does duration of the disease matter in terms of likelihood of recovery?

Two  issues:
1. There seems to be a myth around that says that the longer you've had
CFS, the less likely you are to recover. Nancy said she hasn't seen a study
that shows this. (The problem is that the issue HASN'T actually been
studied at all)
2. But on the other hand Nancy thinks duration does matter in terms of
doing studies. There are inevitably going to be differences between
a  person who has been ill 20 years versus a person who has been ill for 2
years . There could be a host of other contributing factors in the longer
term patient, but that doesn't mean they can't get better especially with
newer treatments. Studies should be comparing apples with apples, not
apples with apples + a whole host of other things.
The big compounding factor she mentioned was menopause. There has not been
one study on the effect of female hormones in this illness, yet we know as
clinicians that the illness shifts in nature/severity in the
peri-menopausal woman, is different again in menopause, and different again
post menopause.

Should we use hormone replacement therapy post menopause?

After the big heart/stroke scare with HRT last year a lot of Dr Klimas's
patients came off HRT. Within 9 months they were all begging to go back on
it. Clearly not having the hormones made them "much, much worse". It begs
the question that whilst well women can come off HRT, what does it mean to
a body with ME and messed up hormones? What does it tell us? Nancy goes on
patient report, tries to keep to lowest doses, checks lipids, watches
weight  and other risk factors etc. But basically said she doesn't have
guidelines because yet again there is no good research  to go from.

Why is there a Type 2 shift?

By measuring the number of Type 1 lymphocyte cells and comparing them to
Type 2 lympocyctes, we find more of the Type 2. We also find a fewer
numbers and poorer functioning Natural Killer cells which is an outcome of
this shift. We proved that this was implicated in the symptomatology of the
illness by the self autologous infusion (the proof of principle study)
experiment where people were reinfused with the corrected ratio and their
symptoms improved, especially their cognitive symptoms. Why the immune
response is being pushed this way is at the heart of the cause of the illness.

What are the consequences of this Type 2 shift?

A lot of pro-inflammatory immune activation is not held in check and this
gives rise to a host of symptoms. The NK cell reduction implies reduced
surveillance of viral, bacterial and neoplastic (cancer) cells.

Doctor Mary- Ann Fletcher then spoke about a study that they have just got
funding for, where they are going to track patients over time with ME/CFS
looking for a biomarker. She said that the problem has always been that
patients are not all in same state when bloods are drawn for study.
They are going to measure blood parameters at 4 points in time . Once at
start, once at finish and 2 times in between where the patient themselves
classify themselves as feeling "well" and then at "sickest". This they hope
will try to catch what it is that is fluctuating and hopefully detect
either a biomarker or proxy biomarker. Once a biomarker is elucidated, then
self report outcome measures (that are problematic) don't have to be used
all the time and good "hard" data gets generated.
         Witness the self report problem from  the Growth Hormone study -
which showed improvement in patients as they went back to work, but because
"quality of life questionnaire" was used as outcome measure  the study
showed no benefit. All that good work has now stopped, all because the
outcome measure didn't measure the appropriate thing.

Is the immune activation the reason I don't get colds anymore?

Well, who knows? You certainly have a lot of immune activation and it is
possible that maybe the high levels of interferon that are present are
fighting the cold virus off before you know it. But clearly the antiviral
activity isn't good enough in other respects because we are seeing the
re-activation virus problems. Also it maybe that you don't contact many
small children with colds because you don't get out as much.

How does gluten sensitivity relate to CFS?

Gluten sensitivity can sometimes be a problem alongside CFS but this is
very rare. Gluten sensitivity is measurable and should be screened for at
diagnosis and treated (i.e. gluten avoidance diet). If a person does have
it,  it will be causing a degree of immune activation and so reducing that
activation is a good thing to do  but please don't cut out wheat etc if you
don't have gluten sensitivity.

You mentioned the Holter monitor, can you explain what does a holter
monitor test for in CFS?

A holter-monitor  is a device that cardiologists use . It is portable and
patients wear it all day and all night and it measures every beat your
heart makes .( normally 24 hours). It is usually used to check for arrhythmias.

It can be used as a cheap  alternative to the tilt-table test to show
autonomic dysfunction/involvement .

If the r-wave shows a pattern of stretched activity , then scrunched
activity (wide, then narrow) then this means your heart is filling
irregularly and thus an autonomic problem exists.

Does melatonin help sleep?

Yes patients report that it does. You have to get good quality as it is a
hormone and it should be prescription. Often the over-the -counter stuff is
not what it says. I am glad to see here in NZ it is on prescription  this
means you are getting a reputable brand.

Remember what I said about alpha trappers  don't take diazepam/valium
derivatives (exceptions  Clonazapam, Ambiem). Low dose tricyclics often
helpful for both keeping people asleep as well as for the pain relieving-
her favourite is Doxepin as it has strong antihistamine effect; she doesn't
like Amitriptyline as much. Doxepin comes in liquid and can be titrated to
the best dose to suit each person.

So, one of the first things you would suggest is a sleep study?

Sure thing.  Good sleep is the first step for all patients.   Don't you all
find that if once in a while you wake up refreshed you have a good day to
follow? We want to aim for good sleep and the newer sleep medications (as
discussed eg Xyrem) seem to be working really well, much better than
anything we've had before , for this disorder of lack of stage 4 sleep.

Hypersomnia  can I oversleep?

Yes, certainly people can oversleep. Some of my patients do and it isn't
normal.  The normal band is 7-9 hours (9 hours better). Getting a sleep
study in this situation is also correct procedure. Sometimes though
extended sleep is what helps patients.

Is Yoga good for me?

Tighter abs and a strong 'core' really helps. Pilates is great  as it works
on the core. The largest vein in the body runs through the lower
abdomen  the vena cava. If you can tighten the muscles around these veins
you will help stop the massive pooling in this blood bed that occurs (ie if
you can tighten around the pipe). Get a low key video  of Pilates for mat
exercises (not ball or anything else). If you can get through a 1/2 hour
video, in 10minute chunks, throughout the day then that is great. Remember
try to work on :
1.      strength (sand bag weights, upper body one day, lower body the next)
2.       tone (Pilates)
3.       aerobic exercise (in 5min bursts)
5mins on, 5 mins rest, etc or swimming ( swimming doesn't create any
orthostatic constraints, you should be able to go longer maybe?) . Don't
work to build up aerobic work each week, this will eventually cause
relapse. We just want you to try to keep a certain amount of cardiac work.

If you have fibromyalgia you are doing yourself no favours if you don't
stretch every muscle in your body twice a day (a physio should be able to
teach you how to do this)

So, we have low blood volume. Could you explain the study you were doing
that addressed this and why you said you thought you'd undershot the mark?

OK  a normal person has 4.5 litres of blood. My CFS patients averaged a
litre less. Blood is made out of red cells +plasma (fluid). There is a
hormone (called erythropoietin)  produced by your kidney that tells your
bone marrow to make red blood cells.

So to increase volume you need more red cells, plus more fluid.

We wrote a grant to study just this, but the NIH would only give us the
funding to study just adding red blood cells alone (via erythropoietin).
This was very scarey because there was a chance of effectively thickening
the blood too much. We had to draw blood every week to check this and I had
patients increase salt. I monitored very carefully. By adding just the red
blood cells we managed to bring volumes up by maybe 1/2 litre. I feel
really frustrated because the study may not show great results, but I know
it could have been designed better ( meaning  the volume needed adding
too), and I think there is a story there , but this may put off the NIH
from funding us further in this area.

I will be reporting the final results of this study at the up coming
conference in Jan. The majority of patients I think gained some
benefit  we'll see when I get the data. Patients with CFS don't placebo
respond as much as other illnesses and my sense is that patients found it
"somewhat helpful"- if we'd been able to volume expand who knows??

Should I drink more to keep my blood volume up?

No drinking excessive amounts  may make things worse. If you overhydrate it
causes your kidneys to diuresis (i.e. it has a diueratic effect) and you
pee more and volume drops further. If you have low blood volume you need to
take the medications like Florinef plus salt. If you have been avoiding
salt and you have low blood pressure please eat more salt "I give you
permission to eat potato chips". There is enough salt in one bag of potato
chips to bump up your blood volume. About quarter to half tsp a day extra
is all it takes.

Should people with ME give blood?.

No I don't think it's a good idea  for two reasons
a . Most patients are 1 litre low in blood (most of Dr Klimas's patients at
around 3.5l instead of 4.5l why would you want to take out another litre!
b. To my mind, there are no studies to prove that ME is not infectious  so
we can't say with complete certainty that an infection will not be passed
on. "I wouldn't want your blood, you can keep your blood to yourself for now"

Where do you think that the brain dysfunction comes from?

That's hard to say, the sudden 'brain fog' would seem to be a blood
pressure/volume issue. Other stuff is probably a combination of volume and
inflammatory response in the brain.

What about the headaches?

The sinus 'thickening across the head' is a fibro type headache. Fibro pain
meds should help.
b.   The new onset migraine is more of a vascular (blood pressure) problem.
Treat as for migraine  sometimes that works well.

The last slide you mentioned about the Japanese study's - can you explain again?

There are three very good Japanese studies underway. One in particular is
very exciting using Neurotropin (usually used in Sympathetic Reflex
Dystrophy  an autonomic disorder with pain). In  a very small study it
resolved all symptoms. The data is to be presented at upcoming conference
in Fort Lauderdale in January. The Japanese are spending more money on CFS
than any other country at the moment!

What is folinic acid and have you got any comment on the recent study using it?

Hadn't seen study, but folinic acid is downstream product of folic acid,
and the folate pathway was one of the pathways that came out as relevant in
the gene assay studies.  Usually folinic acid is used as a rescue therapy
in chemotherapy patients. It is used to bypass enzymes in the pathway that
are knocked out due to chemotherapy. If the folate pathway is screwed up it
would make sense to investigate.

[Return to top]


Date:    Fri, 8 Dec 2006 22:48:21 +0100
From:    Jan van Roijen <j.van.roijen@xxxxx.xx>
Subject: not,med: Explaining Unexplained Illnesses -Martin L. Pall


Send an Email for free membership
       >>>> Help ME Circle  <<<<
 >>>>    8 December 2006    <<<<
Editorship : j.van.roijen@xxxxx.xx
Outgoing mail scanned by Norton AV


The Haworth Press, Inc.

Start treating the causes of these previously puzzling diseases,
instead of symptoms

Explaining Unexplained Illnesses

Disease Paradigm for Chronic Fatigue Syndrome, Multiple
Chemical Sensitivity,

Martin L. Pall, PhD, BA
Professor, Biochemistry and Basic Medical Sciences,
Washington State University, Pullman

About the Book

Discover the answer to the mysteries of these debilitating

Explaining "Unexplained Illnesses" provides long-sought
explanations for the properties of chronic fatigue syndrome
(CFS), multiple chemical sensitivity (MCS), fibromyalgia, and
posttraumatic stress disorder. This groundbreaking book
examines common symptoms and signs; short-term stressors
such as infection, chemical exposure, physical trauma, and
severe psychological stress; why people are often diagnosed as
having more than one of these illnesses, and approaches for
treating the cause of each disease, rather than the symptoms.
The book presents a detailed and well-supported mechanism
(the NO/ONOO- cycle) that provides consistent explanations for
many of the puzzling elements of these diseases.

At least a dozen scientists have proposed that chronic fatigue
syndrome, multiple chemical sensitivity, and fibromyalgia must
share a common mechanism; others have suggested
posttraumatic stress disorder may belong to this group as well.
This unique book provides explanations for their previously
unexplained properties with more than 1,500 references to
scientific literature, creating a whole new approach to therapy
and treatment of these illnesses.

Explaining "Unexplained Illnesses" provides answers to these

      *  how do short-term stressors initiate chronic

      *  how does the biochemistry of the NO/ONOO- cycle
      produce chronic illness?

      *  how can the diverse symptoms and signs of these
      illnesses be generated as a consequence of their
      common biochemistry?

      *  why is there so much variation in symptoms from
      one sufferer to another?

      *  what are the principles underlying the NO/ONOO-
      cycle mechanism?

      *  how does the NO/ONOO- cycle provide
      explanations for a dozen previously unexplained
      properties of these illnesses?

      *  how might 14 additional illnesses/diseases also
      be caused by the NO/ONOO- cycle etiology?

      *  and many more

Explaining "Unexplained Illnesses" is a must-read for physicians
and scientists, and for anyone who suffers from-or knows
someone who suffers from-these previously puzzling illnesses.

Hard Cover:  $89.95
Soft Cover:  $39.95

Product Details
Hard Cover / ISBN-13: 978-0-7890-2388-1 / ISBN-10:
Soft Cover / ISBN-13: 978-0-7890-2389-6 / ISBN-10:
Sku: 5139
Status: Forthcoming
Available: Available Spring 2007.
Number of Pages: Approx. 535 pp. with Index.

[Return to top]


End of CO-CURE Medical & Research Posts Only Digest - 4 Dec 2006 to 11 Dec 2006 (#2006-56)

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