Talk:Chronic fatigue syndrome

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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.

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)

Then why is Myalgic Encephalomyelitis included when the WHO classes it as neurological? Kezzareece (talk) — Preceding undated comment added 14:47, 10 December 2014 (UTC)

Because nobody really agrees on what it is. The neurological classification is just that - a classification. Most scientists agree that ME is not a valid etiology, and even the scientist who coined the term ME noted back in the 1950s about criticism about the etiology. See https://en.wikipedia.org/wiki/Alternative_names_for_chronic_fatigue_syndrome#Myalgic_encephalomyelitis. --sciencewatcher (talk) 17:26, 10 December 2014 (UTC)

Classification[edit]

A newer editor added some material on the ICC definiton to the lead. There were no WP:MEDRS secondary sources cited and the material was removed. I have no issues with that. However, It got me thinking. The CCC and ICC definitions have been out for a while, chances are good there are secondary sources that discuss the utility (or not) of the newest definitions. The information might be useful in the classification section. Ward20 (talk) 01:40, 4 October 2014 (UTC)

Who is going to look for those sources? JFW | T@lk 21:08, 7 October 2014 (UTC)
Whoever gets to it first I guess. I haven't been as active lately, but I've got it on my to do list. I'll probably list sources on here first that I find and then come back later to add the material. Help welcomed from anywhere of course. Ward20 (talk) 17:13, 8 October 2014 (UTC)

Links to classification reviews:

Draft: For use "if and when" published by a high impact journal. Diagnosis and Treatment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)

Contrasting Case Definitions: The ME International Consensus Criteria vs. the Fukuda et al. CFS Criteria [1]

Case definitions for chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME): a systematic review [2]

Ward20 (talk) 22:48, 14 October 2014 (UTC), list revised 19:39, 2 December 2014‎ Ward20 (talk)

Suddenly we have an addition[3] that states that the ICC don't require 6 months for diagnosis. There is no other discussion of the ICC so I don't think readers will find this very useful. JFW | T@lk 13:08, 21 October 2014 (UTC)

Pathways to Prevention: Advancing the Research on Myalgic Encephalomyelitis/ Chronic Fatigue Syndrome[edit]

Just highlighting the current process which will produce a definitive report some time in 2015 - March, April, May ???

A draft statement is out for consultation: https://prevention.nih.gov/docs/programs/mecfs/ODP-MECFS-DraftReport.pdf and background material is located here - https://prevention.nih.gov/programs-events/pathways-to-prevention/workshops/me-cfs. Seems likely that the final report will form an appropriate source for the CFS article, so editors might want to start considering where things might fit. It's not clear how much of the draft report will be altered but it is unlikely that the main thrust of the document will change. --In Vitro Infidelium (talk) 17:10, 27 December 2014 (UTC)

Thanks for the heads-up. Shall we await the full publication then? JFW | T@lk 22:49, 27 December 2014 (UTC)

Only the final document would meet WP:RS but editors might want to use the draft to explore what changes could be necessary once the final doc is released. On the face of it, given that this is an NIH document a wide range of edits could be required, mostly I think additions but I'm unclear about that, I've only just finished reading the document and haven't begun any systematic approach to applying to WP articles. --In Vitro Infidelium (talk) 10:29, 29 December 2014 (UTC)

Also pending with a publication date of 10th February 2015 - Public Release of the Report by the Committee on the Diagnostic Criteria for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome - See more at: http://www.iom.edu/Activities/Disease/DiagnosisMyalgicEncephalomyelitisChronicFatigueSyndrome/2015-FEB-10.aspx#sthash.9AJRsk57.dpuf

--In Vitro Infidelium (talk) 15:11, 12 January 2015 (UTC)