Failure to detect false illness beliefs

Well, this is interesting.

If you've been following the news about ME/CFS, you'll already know all about the latest storm that's been brewing. If not, here's a brief summary.

Back in October, the Whittemore Peterson Institute discovered a link between a retrovirus called XMRV and ME/CFS: 67 percent of the patients sampled tested positive for XMRV, as compared to 4 percent of the healthy controls. The WPI paper was published in Science.

Last week, a group of researchers at Imperial College London published "Failure to Detect the Novel Retrovirus XMRV in Chronic Fatigue Syndrome" online. They claim they were unable to replicate the WPI's findings.

The WPI stands by its results. In an official statement, they list various reasons why they believe the new Erlwein et al. study is useless. One is the difference in the patient populations.

Significant and critical questions remain as to the status of patient samples used in the UK study as those samples may have been confused with fatigued psychiatric patients, since the UK has relegated “CFS” patients to psychiatric care and not traditional medical practices.

Nothing too surprising here. One of the paper's authors is Simon Wessely, who believes that people with ME/CFS (and fibromyalgia, and Gulf War syndrome) have "false illness beliefs." Here's a quote from an interview he did with New Scientist

Such symptoms only become a problem when people get trapped in excessively narrow explanations for illness - when they exclude any broader consideration of the many reasons why we feel the way we do.

But today he and a couple of coauthors posted a rebuttal to the WPI's dismissal of the new results. Here are the bits that interest me:

We follow the same psychiatric exclusion criteria as mandated by the Fukuda criteria. We do this on the basis of semi structured interviews and assessment that we have also published. In addition, we also exclude patients with chronic somatisation disorder as defined by DSM-IV, which is not required by the Fukuda criteria, but most experts and clinicians agree are a different population.

and ...

patients in our service have also co operated in studies of PET and fMRI neuroimaging, autonomic dysfunction, neurochemistry, respiratory function, vitamin status, anti nuclear antibodies, immune function, neuroendocrine function and genetics (see references). Hence it is untrue to state that patients at King’s for example do not show alterations in immune function – in fact they do - see Skowera et al, High levels of type 2 cytokine-producing cells in chronic fatigue syndrome." Clinical and Experimental Immunology 2004: 135: 294-302. Similarly, many of our patients also show altered neuroendocrine, neurochemical and other biological parameters, and we have published many examples of these (see references below). It is therefore simply untrue that we either seek to find no biological changes in CFS, or fail to report those that we do find.

So, people only have ME/CFS because they think they do. But our patient population is legitimate, because look how sick they are!