Talk:Chronic fatigue syndrome

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Dr Patient Relations[edit]

This section is partisan and lacks Neutral Point of view. When compared with the sources it gives an exaggerated view of the conflict between patients and doctors. This is particularly the case when the audio files from the BBC report are listened to. It is clearly stated in those interviews that this issues revolves around a tiny minority of patients. The failure to state this in the article gives 'undue weight'.

The article as a whole also fails to make a few key points that 'paint the full picture'.

  1. Simon Wessley and Esther Crawley were key players in the committee criticized by Dr Ian Gibson's enquiry into biased funding towards psychiatric research. Much of the funding of that 'almost entirely' psychiatric panel was aware to members of that panel. This is a key aspect of the relationship between these two individuals and patients in general. This section lacks journalistic integrity by omitting this key information - since it is the imbalance in those awards are the primary focus for criticism/outrage.
  2. Myra McClure sourced the patient for her XMRV study from Simon Wessley who discluded patients suffering common physical symptoms of ME such as Orthostatic Intolerance - thus again there was particular reason for outrage.
  3. If fails to mention that those taking a psychological view of the disease regularly attack researchers taking a physical view of the disease denouncing them as 'activists' or 'quacks'. There are numerous letters supporting this assertion in the lancet and BMJ.
  4. If also fails to mention the groundless complaints made against doctor Sarah Myhill in some cases relating to life saving actions. It also fails to indicate that the committee 'judging' her conduct contained one person with close professionals affiliations to one of the false complainants. This material is all public record available with a freedom of information request from the British Medical Council.
I am curious why this source of this and some other comments is not listed by the site. Anyone know why and who wrote them?JustinReilly (talk) 05:49, 20 May 2014 (UTC)
Leopardtail didn't sign the post. [1] Ward20 (talk) 07:12, 20 May 2014 (UTC)
Thanks, Ward20.JustinReilly (talk) 20:53, 25 May 2014 (UTC)

UK Situation in General[edit]

The material on the 'British situation' has undue weight in terms of it's presence on this page that does nothing to improve understanding of the illness, while the symptoms section is little more than a list and very hard to read. This should be moved into the Controversies page. Leaving it here creates a fork lacking balance and lacks a Neutral point of view WP:NPOV.

It also needs to be much more 'Journalistically sound' by properly drawing together the full impact of those targeted and the limited extent of that activity.

Treatment Section[edit]

This should be a simple one paragraph introduction that gives not particular weight to any form of treatment. The view the CBT/GET are at all effective is far from universal and strongly disputed yet they are the only treatments shown here. This violates forking rules in WP:NPOV.

The needs to be simplified to something such as:

There is neither any no current treatment for CFS that provides full recovery, nor any treatment that universally provides significant improvement. Which treatments are or are not effective is the subject of vigorous debate and is covered fully in <link here>. Researched methods include a wide variety of behavioural methodologies, nutritional supplements and pharmacological treatments. Some aim to deal with hypothesised causes of the disease, others aim purely to produce symptomatic improvements. — Preceding unsigned comment added by Leopardtail (talkcontribs) 13:47, 11 May 2014 (UTC)

Actually, there are multiple reviews that say CBT and GET are effective, so we have to say that. --sciencewatcher (talk) 16:02, 11 May 2014 (UTC)
Hi Leopardtail. Please remember to add ~~~~ at the end of your comment everytime you post on talkpages. I agree with you that more could be said about other treatments, if a reliable source can back it up, but Sciencewatcher is correct that we have to give most weight to CBT and GET. Wikipedia reflects the published literature, even if that literature is dubious, Wikipedia is not about the truth.
Treatment research is generally regarded as poor without blinding or placebo control. As Sciencewatcher stated on his talkpage in relation to some study, "there was no placebo arm, so the results are pretty much useless". CBT and GET have the unfair advantage of getting a free pass from this requirement. The evidence base for CBT and GET would disappear if it was held up to the same standards as biological research.
While there are many reviews purporting that CBT and GET are effective and we must include that, there are also plenty of sources showing no substantial objective improvements. Some of this is already covered in the treatments article. You might find some useful information in the following papers, but not enough research has been done, and the available evidence is generally poor, inconsistent, or not replicated.
http://www.ncbi.nlm.nih.gov/pubmed/19619330
http://www.ncbi.nlm.nih.gov/pubmed/22059223
http://www.ncbi.nlm.nih.gov/pubmed/19821361
http://www.ncbi.nlm.nih.gov/pubmed/21982120
http://www.ncbi.nlm.nih.gov/pubmed/21615974
If you can find a source that is acceptable to WP:RULES rules for the debate about which treatments are effective or not, it should go in the article too with the appropriate weight. I'm currently looking into a new potentially useful paper which critically discusses the debate about recovery from CFS. - Tekaphor (TALK) 03:11, 15 May 2014 (UTC)
Basically we just parrot out what the reviews say (as I think Tekaphor mentioned before). In regard to placebo: for something like CBT you could say it is entirely placebo. Also for CBT and GET you can't really pretend that you're doing exercise or getting therapy when you're not. The best you can do is compare to other treatments to see if it is better. In my own opinion (which is worth squat on wikipedia) CBT probably works for reasons other than those given by its proponents. --sciencewatcher (talk) 14:46, 15 May 2014 (UTC)
The CBT section is large because of the large body of literature about it. WP has to explain the positives and negatives published according to the proportion of the MEDRS articles. There is some bloat in the section though, and some parts could be more clearly written. Ward20 (talk) 22:34, 17 May 2014 (UTC)

──────────────────────────────────────────────────────────────────────────────────────────────────── I am concerned that many of the sources added by Tekaphor are not WP:MEDRS compatible. PMID 22059223, for instance, is just a survey and we cannot justify including it just to spell out that there's no evidence for pharmacotherapy. A claim like that should be supported by a high-quality secondary source. The moment we start compromising on that, we're back to anecdotal evidence warfare. JFW | T@lk 09:48, 25 May 2014 (UTC)

I casually mentioned 5 sources in the above discussion, 3 of which were systematic reviews. I merely suggested that these may be useful to Leopardtail's investigation, and reminded them of WP:RULES.
Regarding my article edit involving PMID 22059223 which JFW reverted for being "just a survey", the authors also reviewed 20 RCTs from biomedical databases and described the results in Table 4. Maybe not the best source, but no one said "there's no evidence for pharmacotherapy", the paper used the phrase paucity of RCTs, which means insufficient research. Maybe some of the other treatment reviews say something similar.
If my other article edits about recovery from CFS are called into question instead of the conversation above, those statements are based on the conclusions of WP:MEDRS-compatible recent systematic reviews of the literature, are among the best sources available on the subject, and apparently reflect the current consensus achieved at the CFS treatment article talkpage.
Overall, not really a justifiable "concern" about me adding "many" (hyperbole much?) WP:MEDRS incompatible sources to Wikipedia. - Tekaphor (TALK) 00:49, 26 May 2014 (UTC)

The treatment section is a mess. It emphasizes CBT/GET too much compared to various official guidelines. CBT/GET is barely mentioned on the CDC's CFS page for example, yet here it's 90% of the treatment section. There is also no evidence that psychological interventions can correct the biological abnormalities commonly found in CFS. CBT/GET may be appropriate for some patients suffering from fatigue. Te notion that they can cure physical illness is ridiculous, but that's exactly the impression given here. 93.34.1.54 (talk) 14:38, 6 June 2014 (UTC)

Singling out HPA axis abnormalities is not NPOV[edit]

HPA axis abnormalities are not a key or main feature of CFS and therefor it is not NPOV to emphasize them over all the other abnormalities. See the Canadian Consensus Criteria and the International Consensus Criteria. Besides, we have a dedicated article on pathophysiology. 93.34.1.151 (talk) 09:20, 7 June 2014 (UTC)

Speaking of pathophysiology, the article should mention that many cases of CFS begin with an infection. This is something all agree on. 93.34.1.151 (talk) 09:23, 7 June 2014 (UTC)

If by "infection", you mean "illness", it's already mentioned at Chronic fatigue syndrome#Onset. I'm not aware anything that highlights infection itself as commonly triggering onset. RobinHood70 talk 09:45, 7 June 2014 (UTC)
There are many sources for this. Here for example "a large percentage of CFS patients note an acute infectious event that triggers their fatigue." Or here "Initial infection was reported by 77% [of CFS patients]." Another source "A majority of CFS patients (80%) had an acute infectious onset" — Preceding unsigned comment added by 93.34.1.151 (talk) 10:10, 7 June 2014 (UTC)
My only concern there is that the variations of "acute infection" those sources use could all just be using a broader term for "flu-like illness". Still, I don't think it would hurt the article in any way to make a similar change on our end. Anybody else see any concerns with that? (I'm not commenting on the HPA Axis issue, since I'm not well-versed on that.) RobinHood70 talk 13:50, 7 June 2014 (UTC)
We already mention infections in the 'Onset' section. HPA axis abnormalities do seem to be 'key' and 'main' important features according to the reviews - that is why I added it. The pathophysiology article is a more detailed version of the section in this article, so this article should summarise all the important pathophysiology. According to the recent reviews such as Cleare, the HPA axis does seem to be important and notable. Your assertion that the ICC and CCC are the 'best sources available' is not correct. Well cited reviews in high impact journals are the best sources for wikipedia. I'd recommend you read all the reviews such as Cleare (as well as the other ones we use) before making any edits. --sciencewatcher (talk) 15:18, 7 June 2014 (UTC)
"HPA axis abnormalities do seem to be 'key' and 'main' features according to the reviews." Which reviews? The Cleare paper says no such thing. It says that they are present (which is old news) and that they should be investigated further. Trying to present them as the most important abnormality is POV pushing. They are one of several abnormalities and definitely not generally considered the most important one. See for example this review http://journal.nzma.org.nz/journal/118-1227/1780/ If you believe otherwise, provide reviews that clearly say it is the most important feature. 93.34.1.151 (talk) 17:23, 7 June 2014 (UTC)
My edit doesn't say they are 'the most important feature' or anything like that. Just important enough to justify a bit of space in the main article. It was you who said 'key' and 'main', not me. That review you gave summarises it pretty nicely, although there are better reviews (more cited) that we already use. We can perhaps add short sections about immune and ANS dysfunction as well. --sciencewatcher (talk) 17:38, 7 June 2014 (UTC)
"Just important enough to justify a bit of space in the main article." this implies more important the others, which is completely false. It's POV pushing, plain and simple. We have a dedicated pathophysiology page, there is no need to repeat information, nor is it justified to emphasize one particular abnormality. 93.34.1.151 (talk) 17:42, 7 June 2014 (UTC)
We should be summarising the main points here in this article. The patho article doesn't replace this article - we still have a section in the main article, and it should be a short summary of the patho article. I'd be interested in hearing the views of the other editors. --sciencewatcher (talk) 18:03, 7 June 2014 (UTC)
IIRC, several of the earlier reviews showed that roughly half of the studies did not find HPA axis abnormalities. Does the new review discuss this issue? Tekaphor (TALK) 05:35, 13 June 2014 (UTC)
The evidence seems to be a lot stronger in this review, hence the reason to add it to the main article. I think the main point is that simply measuring cortisol itself isn't very useful. More useful is cortisol awakening response and HPA axis challenge, e.g. "three large studies using the CAR test all found blunted or attenuated saliva cortisol responses in patients with CFS compared with controls." and "Three new in vivo studies published in the past 8 years have lent further support to the presence of enhanced negative feedback and glucocorticoid receptor function". --sciencewatcher (talk) 16:11, 13 June 2014 (UTC)

Expanding pathophysiology section[edit]

I think the best solution might be to expand the pathophysiology section. If you look at the article it is much shorter than other sections (e.g. treatment). I was thinking of looking into the ANS and immune system and updating those sections in the pathophysiology article with the latest reviews, and perhaps adding some info to the main article. However I don't really have time and there are other articles in more need of attention than this one right now. Also there don't seem to be any new recent reviews. The main reason I updated the HPA axis info was because of the new review from Cleare. If someone wants to update the article, go for it. --sciencewatcher (talk) 22:31, 7 June 2014 (UTC)

LA County Hospital and Royal Free excluded?[edit]

I'm curious in the recent edits how LA County Hospital and the Royal Free group are excluded from the definition of CFS. My first question is: which definition? And then the obvious second question is: what is it in that definition that excludes these groups? RobinHood70 talk 14:03, 14 June 2014 (UTC)

I think it's only neurological ILLNESSES that it excludes. It's well established that CFS (and even depression) has neurological signs. It seems to be WP:OR. Also there are issues of WP:COI here. --sciencewatcher (talk) 14:55, 14 June 2014 (UTC)
Also, as Rob points out the mecrit2014 ref is not a reliable source - see WP:MEDRS. --sciencewatcher (talk) 14:58, 14 June 2014 (UTC)