4 ms·

Wait, how was Chronic Fatigue not a metabolic illness? I always assumed it was a mitochondrial disfunction from the way it was described in the literature.

lsiebert 9y ago
Many people believed it to be a psychological disorder.
- stult 9y ago
  Maybe it's my philosophical materialism, but I've never found that to be a satisfactory alternative explanation for anything. What can explain a psychological disorder other than underlying physical disease? Attributing a disease to psychological disorder is indistinguishable from saying "we don't understand what causes this."
  - naasking 9y ago
    > What can explain a psychological disorder other than underlying physical disease? Attributing a disease to psychological disorder is indistinguishable from saying "we don't understand what causes this." It might be ultimately reducible in this way, but the treatments for various psychological conditions are often very different than physiological problems.
    - didibus 9y ago
      Right, but that's also often just due to limitations in science. All psychological problems are physical, they're just very complex physics and chemistry of the brain which we still don't understand and have no medicated or surgical ways of altering for the better. Just as you can heal a muscle injury with simple rehabilitating exercises, some psychological injuries can be rehabilitated similarly with exercise of the brain. That doesn't change the physicality of it.
  - cpncrunch 9y ago
    >What can explain a psychological disorder other than underlying physical disease? It's well established that the causality works both ways, i.e. physical illnesses can cause psychological symptoms, and psychological factors can cause physical symptoms, e.g.: - fever-causing illnesses cause "sickness behaviour" consisting of depression, anxiety, fatigue, brain fog and other symptoms, causing by pro-inflammatory cytokines. - exam stress has been shown to significantly increase EBV antibodies. - psychological stress causes significant changes to the immune system through the effects of cortisol and adrenaline (the two main stress hormones are also two of the main immune modulators). - psychological stress causes a release of TNF-a (a pro-inflammatory cytokine that is involved in sickness behaviour). - fear causes bowel movements, due to the fact that the HPA axis (the main stress system) also influences bowel motility. >Attributing a disease to psychological disorder is indistinguishable from saying "we don't understand what causes this." Not really. If there are factors that point to psychological causation, it should be considered as much as other possible causes.
zkms 9y ago
There was an infamous clinical trial called "PACE" that purported to show that psychotherapy (CBT), along with exercise ("graded exercise therapy", or "GET") gradually increased beyond one's initial limits, was an effective treatment for chronic fatigue. The idea is that CFS patients do not have a metabolic illness; rather, they are suffering from self-reinforcing "unhelpful beliefs" that cause them to fear and avoid physical activity. Even the very act of attributing one's chronic fatigue to a physical illness is itself pathologised (and is to be attenuated via CBT) under this framework. However, the PACE trial was a complete bodge; the protocol and criteria for classifying "recovery" were changed during the trial (to the point that a patient that got worse could nevertheless be classified as having "recovered), the outcome measures were subjective and self-reported (which are liable to be affected by CBT or other forms of social pressure), and conflicts of interest were not reported to participants. Re-analyses of the data were thwarted by the fact that the researchers did not publish anonymised trial data, which violated the requirements of one of their funding sources and the requirements of one of the journals in which they published. There were plenty of methodological criticisms of the trial (http://www.virology.ws/2015/10/21/trial-by-error-i/ http://www.virology.ws/2015/10/21/trial-by-error-i/) but the actual trial data was still not available. Academicians and patients alike unsuccessfully tried to get access to anonymised PACE data for years, and the PACE researchers did their absolute best to prevent that from happening -- including labelling legitimate requests for anonymised trial data (that they were obliged to publish) and criticism of their study as "vexatious" and "harassment" in a BMJ feature article (https://doi.org/10.1136/bmj.d3780 https://doi.org/10.1136/bmj.d3780). The Information Commissioner's Office ordered the PACE researchers to release the trial data, the researchers appealed that decision -- and got laughed out of court. The tribunal concluded that there indeed was a very strong academic interest in the data being released, that it was sufficiently anonymised to prevent re-identification, and went as far as to say that the PACE researchers were overly disparaging of patient groups and skeptical researchers -- and that legitimate requests for trial data and criticism of the PACE study did not constitute harassment. Given how hard the PACE researchers tried to prevent release of the anonymised trial data, the results of the independent re-analysis (http://dx.doi.org/10.1080/21641846.2017.1259724 http://dx.doi.org/10.1080/21641846.2017.1259724) should not be too surprising. There was no basis for an in-flight change to criteria and protocols and CBT/exercise did not provide a statistically significant change in recovery. There are other serious issues with the PACE study's methods that are addressed in http://www.virology.ws/2017/03/13/an-open-letter-to-psychological-medicine-about-recovery-and-the-pace-trial/ http://www.virology.ws/2017/03/13/an-open-letter-to-psycholo... or in the independent reanalysis linked (and there's a quite decent timeline and overview of the PACE trial here: http://me-pedia.org/wiki/PACE_trial http://me-pedia.org/wiki/PACE_trial). Serious biological research (not nonsense by CBT-obsessed wankers who lie with statistics) into CFS continues and there's indeed many findings on potential biomarkers for CFS -- more keeps getting published, 10.1186/s40168-017-0261-y nor 10.1186/s12967-017-1161-4 weren't there last time I looked into this, for example. There's robust evidence of biomedical anomalies in CFS patients -- far more than enough for CFS to be considered a legitimate medical syndrome and not a psychiatric/psychological/"somatic" syndrome. That we haven't yet identified a biomarker useful for diagnosis nor know an aetiology certainly shouldn't disqualify CFS from being a medical syndrome! Since there's plenty of evidence against the PACE trials' findings -- why do CFS patients object to it? After all, papers regularly do get proven wrong or have their findings revised, it's kinda how science operates. It's not the actual publication of the PACE results that have caused harm -- it's how the results were used. Since PACE was the first clinical trial of its scale on CFS patients, its findings ended up single-handedly defining clinical policy, treatment recommendations, and public policy relating to welfare and insurance. CBT and making patients do physical exercise is infinitely cheaper than any sort of medical treatment; and if the PACE trial happened to find that those will help people with CFS "recover" and get back to work, well, that's just a happy coincidence. That CBT is useless and excessive physical exercise harmful to CFS patients is immaterial; there's research that says it helps, so if you're a recalcitrant patient who complains, you're clearly not doing the CBT or the exercise enough! Similarly, the mere belief that CFS has a physical (and not psychological) cause is explicitly called out as one of the "harmful beliefs" that CBT is to neutralise -- disagreement with the treatment method (or familiarity with current medical research) is itself a sign that you're not taking CBT seriously. It is not just through treatment guidelines (and denial of medical access beyond CBT and forced exercise) that the PACE results have materially harmed patients. Extremely unusually for a clinical trial, PACE was funded by the UK DWP -- and could not have returned better results to justify the DWP's agenda of cutting disability spending: http://www.centreforwelfarereform.org/uploads/attachment/492/in-the-expectation-of-recovery.pdf http://www.centreforwelfarereform.org/uploads/attachment/492... . The DWP wanted findings to show that CBT and GET would get disabled people off benefits; and the PACE researchers (by changing the protocol/criteria halfway through) handed that to DWP on a silver platter. That CBT/GET are, in reality, useless (at best) is immaterial here -- DWP doesn't give a flying fuck whether people actually do get better or even manage to survive without disability benefit, they only needed these published findings to justify benefit cuts.

lsiebert 9y ago

Many people believed it to be a psychological disorder.

stult 9y ago
Maybe it's my philosophical materialism, but I've never found that to be a satisfactory alternative explanation for anything. What can explain a psychological disorder other than underlying physical disease? Attributing a disease to psychological disorder is indistinguishable from saying "we don't understand what causes this."
- naasking 9y ago
  > What can explain a psychological disorder other than underlying physical disease? Attributing a disease to psychological disorder is indistinguishable from saying "we don't understand what causes this." It might be ultimately reducible in this way, but the treatments for various psychological conditions are often very different than physiological problems.
  - didibus 9y ago
    Right, but that's also often just due to limitations in science. All psychological problems are physical, they're just very complex physics and chemistry of the brain which we still don't understand and have no medicated or surgical ways of altering for the better. Just as you can heal a muscle injury with simple rehabilitating exercises, some psychological injuries can be rehabilitated similarly with exercise of the brain. That doesn't change the physicality of it.
- cpncrunch 9y ago
  >What can explain a psychological disorder other than underlying physical disease? It's well established that the causality works both ways, i.e. physical illnesses can cause psychological symptoms, and psychological factors can cause physical symptoms, e.g.: - fever-causing illnesses cause "sickness behaviour" consisting of depression, anxiety, fatigue, brain fog and other symptoms, causing by pro-inflammatory cytokines. - exam stress has been shown to significantly increase EBV antibodies. - psychological stress causes significant changes to the immune system through the effects of cortisol and adrenaline (the two main stress hormones are also two of the main immune modulators). - psychological stress causes a release of TNF-a (a pro-inflammatory cytokine that is involved in sickness behaviour). - fear causes bowel movements, due to the fact that the HPA axis (the main stress system) also influences bowel motility. >Attributing a disease to psychological disorder is indistinguishable from saying "we don't understand what causes this." Not really. If there are factors that point to psychological causation, it should be considered as much as other possible causes.

zkms 9y ago

There was an infamous clinical trial called "PACE" that purported to show that psychotherapy (CBT), along with exercise ("graded exercise therapy", or "GET") gradually increased beyond one's initial limits, was an effective treatment for chronic fatigue. The idea is that CFS patients do not have a metabolic illness; rather, they are suffering from self-reinforcing "unhelpful beliefs" that cause them to fear and avoid physical activity. Even the very act of attributing one's chronic fatigue to a physical illness is itself pathologised (and is to be attenuated via CBT) under this framework. However, the PACE trial was a complete bodge; the protocol and criteria for classifying "recovery" were changed during the trial (to the point that a patient that got worse could nevertheless be classified as having "recovered), the outcome measures were subjective and self-reported (which are liable to be affected by CBT or other forms of social pressure), and conflicts of interest were not reported to participants. Re-analyses of the data were thwarted by the fact that the researchers did not publish anonymised trial data, which violated the requirements of one of their funding sources and the requirements of one of the journals in which they published. There were plenty of methodological criticisms of the trial (http://www.virology.ws/2015/10/21/trial-by-error-i/ http://www.virology.ws/2015/10/21/trial-by-error-i/) but the actual trial data was still not available. Academicians and patients alike unsuccessfully tried to get access to anonymised PACE data for years, and the PACE researchers did their absolute best to prevent that from happening -- including labelling legitimate requests for anonymised trial data (that they were obliged to publish) and criticism of their study as "vexatious" and "harassment" in a BMJ feature article (https://doi.org/10.1136/bmj.d3780 https://doi.org/10.1136/bmj.d3780). The Information Commissioner's Office ordered the PACE researchers to release the trial data, the researchers appealed that decision -- and got laughed out of court. The tribunal concluded that there indeed was a very strong academic interest in the data being released, that it was sufficiently anonymised to prevent re-identification, and went as far as to say that the PACE researchers were overly disparaging of patient groups and skeptical researchers -- and that legitimate requests for trial data and criticism of the PACE study did not constitute harassment. Given how hard the PACE researchers tried to prevent release of the anonymised trial data, the results of the independent re-analysis (http://dx.doi.org/10.1080/21641846.2017.1259724 http://dx.doi.org/10.1080/21641846.2017.1259724) should not be too surprising. There was no basis for an in-flight change to criteria and protocols and CBT/exercise did not provide a statistically significant change in recovery. There are other serious issues with the PACE study's methods that are addressed in http://www.virology.ws/2017/03/13/an-open-letter-to-psychological-medicine-about-recovery-and-the-pace-trial/ http://www.virology.ws/2017/03/13/an-open-letter-to-psycholo... or in the independent reanalysis linked (and there's a quite decent timeline and overview of the PACE trial here: http://me-pedia.org/wiki/PACE_trial http://me-pedia.org/wiki/PACE_trial). Serious biological research (not nonsense by CBT-obsessed wankers who lie with statistics) into CFS continues and there's indeed many findings on potential biomarkers for CFS -- more keeps getting published, 10.1186/s40168-017-0261-y nor 10.1186/s12967-017-1161-4 weren't there last time I looked into this, for example. There's robust evidence of biomedical anomalies in CFS patients -- far more than enough for CFS to be considered a legitimate medical syndrome and not a psychiatric/psychological/"somatic" syndrome. That we haven't yet identified a biomarker useful for diagnosis nor know an aetiology certainly shouldn't disqualify CFS from being a medical syndrome! Since there's plenty of evidence against the PACE trials' findings -- why do CFS patients object to it? After all, papers regularly do get proven wrong or have their findings revised, it's kinda how science operates. It's not the actual publication of the PACE results that have caused harm -- it's how the results were used. Since PACE was the first clinical trial of its scale on CFS patients, its findings ended up single-handedly defining clinical policy, treatment recommendations, and public policy relating to welfare and insurance. CBT and making patients do physical exercise is infinitely cheaper than any sort of medical treatment; and if the PACE trial happened to find that those will help people with CFS "recover" and get back to work, well, that's just a happy coincidence. That CBT is useless and excessive physical exercise harmful to CFS patients is immaterial; there's research that says it helps, so if you're a recalcitrant patient who complains, you're clearly not doing the CBT or the exercise enough! Similarly, the mere belief that CFS has a physical (and not psychological) cause is explicitly called out as one of the "harmful beliefs" that CBT is to neutralise -- disagreement with the treatment method (or familiarity with current medical research) is itself a sign that you're not taking CBT seriously. It is not just through treatment guidelines (and denial of medical access beyond CBT and forced exercise) that the PACE results have materially harmed patients. Extremely unusually for a clinical trial, PACE was funded by the UK DWP -- and could not have returned better results to justify the DWP's agenda of cutting disability spending: http://www.centreforwelfarereform.org/uploads/attachment/492/in-the-expectation-of-recovery.pdf http://www.centreforwelfarereform.org/uploads/attachment/492... . The DWP wanted findings to show that CBT and GET would get disabled people off benefits; and the PACE researchers (by changing the protocol/criteria halfway through) handed that to DWP on a silver platter. That CBT/GET are, in reality, useless (at best) is immaterial here -- DWP doesn't give a flying fuck whether people actually do get better or even manage to survive without disability benefit, they only needed these published findings to justify benefit cuts.