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:
[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, 5 Dec 2006 09:48:28 -0000 From: Jacqui Footman <email@example.com> 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 Jacqui "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 http://www.mercola.com:80/article/dental/rootcanal/root_canals.htm [Return to top] ------------------------------ Date: Wed, 6 Dec 2006 11:43:53 -0500 From: Fred Springfield <firstname.lastname@example.org> 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. [Return to top] ------------------------------ Date: Wed, 6 Dec 2006 20:34:34 -0500 From: Fred Springfield <email@example.com> 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, firstname.lastname@example.org. 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. [Return to top] ------------------------------ Date: Thu, 7 Dec 2006 11:18:24 -0500 From: Fred Springfield <email@example.com> 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. [Return to top] ------------------------------ Date: Thu, 7 Dec 2006 11:41:42 -0500 From: Fred Springfield <firstname.lastname@example.org> 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. Author: Stone L., MBBS, BA, MPH, DipRACOG, FRACGP, FACRRM 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 http://www.racgp.org.au/Content/NavigationMenu/Publications/AustralianFamilyPhys/2006issues/20061205/20061205stone.pdf [Return to top] ------------------------------ Date: Thu, 7 Dec 2006 12:39:00 -0500 From: "Bernice A. Melsky" <email@example.com> 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: firstname.lastname@example.org. 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. [Return to top] ------------------------------ Date: Thu, 7 Dec 2006 12:44:24 -0500 From: "Bernice A. Melsky" <email@example.com> 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. [Return to top] ------------------------------ Date: Thu, 7 Dec 2006 13:18:29 -0500 From: "Jodi Bassett <firstname.lastname@example.org>" [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: www.ahummingbirdsguide.com -- 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 [Return to top] ------------------------------ Date: Thu, 7 Dec 2006 17:29:44 +0100 From: Jan van Roijen <email@example.com> Subject: act,med: Nov. APPG Meeting -RiME ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Send an Email for free membership ~:~:~:~:~:~:~:~:~:~:~:~:~:~:~:~:~:~:~:~ >>>> Help ME Circle <<<< >>>> 7 December 2006 <<<< Editorship : firstname.lastname@example.org Outgoing mail scanned by Norton AV ~:~:~:~:~:~:~:~:~:~:~:~:~:~:~:~:~:~:~:~ PERMISSION TO REPOST Campaigning for Research into Myalgic Encephalomyelitis RiME 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 appeal. 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 email@example.com www.erythos.com/RiME [Return to top] ------------------------------ Date: Thu, 7 Dec 2006 21:13:32 -0500 From: "skevin <firstname.lastname@example.org> [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) http://www.socialistworker.co.uk/article.php?article_id=10280 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 therapists. 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 worthlessness. 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 approaches. 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 inequality. 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 reality.” [Return to top] ------------------------------ Date: Fri, 8 Dec 2006 14:23:14 -0500 From: Co-Cure Moderator <email@example.com> 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). Comments 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 http://www.cmwf.org/usr_doc/IB-Dec06-Final-E-CF-Logos.pdf Note: You will need Adobe Acrobat Reader to view the report. A related webcast is available online at http://www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=1984 [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" <firstname.lastname@example.org> 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 <email@example.com> 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 work. 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 <firstname.lastname@example.org> Subject: not,med: Explaining Unexplained Illnesses -Martin L. Pall ~~~~~~~~~~~~~~~~~~~~~~~~~~~~ Send an Email for free membership ~:~:~:~:~:~:~:~:~:~:~:~:~:~:~:~:~:~:~:~ >>>> Help ME Circle <<<< >>>> 8 December 2006 <<<< Editorship : email@example.com Outgoing mail scanned by Norton AV ~:~:~:~:~:~:~:~:~:~:~:~:~:~:~:~:~:~:~:~ http://www.haworthpress.com/store/Product.asp?sku=5139 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 illnesses 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 questions: * how do short-term stressors initiate chronic illness? * 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: 0-7890-2388-1 Soft Cover / ISBN-13: 978-0-7890-2389-6 / ISBN-10: 0-7890-2389-X Sku: 5139 Status: Forthcoming Available: Available Spring 2007. Number of Pages: Approx. 535 pp. with Index. [Return to top] ------------------------------
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