Talk:Myalgic encephalomyelitis/chronic fatigue syndrome/Archive 11

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Chronic fatigue syndrome is associated with chronic enterovirus infection of the stomach.

An article appearing in the Journal of Clinical Pathology has linked some cases of ME/CFS to chronic enterovirus infections. I feel like this should be mentioned perhaps in the Mechanisms section. Judderwocky (talk) 16:07, 14 April 2009 (UTC)

http://www.ncbi.nlm.nih.gov/pubmed/17872383?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=1&log$=relatedarticles&logdbfrom=pubmed

It's unclear from the abstract whether they're saying that the enterovirus might cause CFS symptoms, or simply be an opportunistic infection. Unless they're more clear on that in the full PubMed article, any additions we make to the one here should make that ambiguity clear as well. --Rob (talk) 23:41, 14 April 2009 (UTC)

The mechanism of a so called "smoldering" infection can be seen here:

- A severe flu-like illness occurs in most cases of chronic fatigue syndrome (CFS), suggesting that an infection triggers and possibly perpetuates this syndrome - Common viral infections and unusual causes of CFS could be diagnosed based on the details of the initial flu-like illness, if present, epidemiological history, and early virological testing - Different laboratories from Europe and recently from the USA have found enteroviral RNA in the tissues, including peripheral blood mononuclear cells and muscles, of patients with CFS - Viral persistence through the formation of stable double stranded RNA reconciles the two opposing observations of the past two decades: (1) the absence of live virion in chronically infected patients and animals and (2) the presence of enteroviral RNA in the blood or other tissues - Smouldering viral infection of various cells with continuous expression of double stranded RNA and viral antigens could result in a chronic inflammatory state in the local tissues, accounting for the diverse symptoms - Interferon α and γ act synergistically against enterovirus in vitro, and preliminary studies suggest that this combination may be an effective treatment for patients with chronic enteroviral infection ""

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1770761

Judderwocky (talk) 16:53, 15 April 2009 (UTC)

A recent study (PMID 19366500) found that viral infections were a risk marker (2.3-6.3 fold) for "a fatigue syndrome" (CFS is discussed in the abstract). This is in line with some previous research, such as that described in the debate paper "There is only one functional somatic syndrome" (2004)[1] where White mentions that "there is a five-fold risk of chronic fatigue syndrome in patients suffering from infectious mononucleosis (White et al, 1998)" versus ordinary upper respiratory tract infections (citing PMID 9926075). - Tekaphor (TALK) 10:02, 16 April 2009 (UTC)

This article is not a literature review where single purpose editors take out some one sentence from publication they like. I know the extreme patient groups desparately want infectious cause but it is conteroversial and no strong evidence, lets wait on a review to confirm it. RetroS1mone talk 12:19, 16 April 2009 (UTC)

Simply being controversial is not a precedent for omission. I believe there is ample research listed here and cited elsewhere to justify a section discussing the possible mechanisms of a viral trigger for some patients with CFS. Its unlikely that viral infections can explain all cases, and it is important to point out the pitfalls of this theory... for instance the fact that they could be opportunistic infections etc...

Many enteroviruses are known to persist in the body long after the acute infection wears off. The similarities should at least be noted. The article already presents a psychological causes section and there has been little research showing CBT or any class of psychoactive medications sending the disorder into remission. There are however multiple reports and papers showing improvement in patients given antiviral therpay, or immune factors alpha and gamma. All I'm saying is that it deserves the same level of attention that other less likely mechanisms have already been given in the article.

Also, http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1770761 is a review.

Judderwocky (talk) 17:29, 16 April 2009 (UTC)

This is another report on enteroviruses in CFS patients. Its older, very small population size, so it may not be relevant. http://vir.sgmjournals.org/cgi/reprint/78/2/307.pdf Judderwocky (talk) 20:05, 16 April 2009 (UTC)

The review is by an author that has a letter to editor and only one more paper about enterovirus and chronic fatigue, so not a recognized expert in field. RetroS1mone talk 00:41, 17 April 2009 (UTC)

I would also like to point out that the wikipedia article on Enteroviruses also mentions Jia's work. If it meets the standards for other articles why not this one? Judderwocky (talk) 19:36, 20 April 2009 (UTC)

If you start here and read the next two sections from the archives it will give you an indication of how the polarization of the physiological model verses psychological model is being played out on this article. IMO there is undo weight in the article of the psychological model because of removal of much physiological and biological research. Ward20 (talk) 20:31, 20 April 2009 (UTC)

I have to agree. Judderwocky (talk) 00:57, 21 April 2009 (UTC)

Agree, A number of editors have recently commented about continuing imbalance in the Article. I see the problem and would agree that for a start the Mechanism section is a bit lop sided. Whilst the first para mentions a number of possible mechanisms only ’Psychological factors’ is seen to justify a separate subsection, which in itself is seen to demonstrate bias. For a NPOV section either all major mechanisms should warrant such separate treatment or none of them. As far as viral/infection goes there is no lack of Reviews by Experts that discuss this, like PMID 18177602, PMID 17561687 so what is the problem?

Or perhaps to give a measure of balance to the current dichotomy, I would suggest we add a subsection called ‘Organic basis’ there are also any number of RS sources to cite including the CDC. Jagra (talk) 03:01, 21 April 2009 (UTC)

Sounds good. Alternately we could call it Physiological factors if we want parity but perhaps it would be better to look for WP:RSes that frame the two models and stick with the vocabulary they use. I would also suggest we start at the sub article Pathophysiology of chronic fatigue syndrome and make sure that article is properly balanced. Then we can use that article to determine the proper weight in the main article section. Ward20 (talk) 03:24, 21 April 2009 (UTC)

I do like the "smouldering" phrasing, although as I hang out with far too many programmers I tend to refer to it as a "terminate and stay resident" infection myself.

Once upon a time this poor benighted article did have a mention of the theories which state that low-level infections are a possible cause of CFS, regardless of the type of initial infection (cf. post-polio and post-viral fatigue), and that this high viral etc. load showed in patients' blood titers and even spinal fluid, as well as some tissue samples. I would include the enterovirus work, as well as the spinal fluid and organ tissue information (I recall a study showing long-term viral infection causing microscopic heart tissue damage?) together in a section.

Feyandstrange (talk) 08:23, 23 April 2009 (UTC)

Well on reading pathophysiology article, at present it does not recognise that viruses either initial infection or persistant can cause CFS, only CFS like symptoms?? and further that post-viral fatigue only resembles CFS?? Despite several viruses being documented to trigger CFS to any number of criteria.

A bit weasel worded to say the least, and I think probably needs a complete redo, seems to be a consensus here! Jagra (talk) 03:43, 24 April 2009 (UTC)

It should start out with the current thinking that there are probably subgroups of patients that are being studied under the broad definition CFS PMID 18042608 PMID 17853290 PMID 15929497. I believe that the diagnostic criteria should be specified for each of the various studies to identify the patients under study. That is one way to gain incite into the conflicting results. Ward20 (talk) 04:46, 24 April 2009 (UTC)

Agree that where a study identifies a subgroup, we should also as it is an important caveat. One of the problems with citing reviews is that they often don't distinguish subgroups (either intentionaly or in ignorance!) as a result compare apples with oranges. Where a review does not but the primary papers relied on do so, then in edits it is proper to do so. Jagra (talk) 00:57, 3 May 2009 (UTC)

No that is original research. You have problem with a review, write a review and show it, Wikipedia is not your personal journal to refute stuff in med literature. RetroS1mone talk 22:23, 2 June 2009 (UTC)

Dispute your interpretation MEDRS says evaluate the quality of sources in reviews and that is not OR, read it some time it has a whole section on quality scales for editors to evaluate. Jagra (talk) 05:33, 5 June 2009 (UTC)

FYI, the existence and nature of cognitive impairment in CFS

A recent investigation into the cognitive deficits associated with CFS as defined by "strict adherence" to the CDC-1994 criteria (PMID 19452031) found that they do indeed exist when measured objectively, occur independently of co-morbid anxiety and/or depression, and some (but not all) are correlated to subjective reports of fatigue as well as illness severity. It also sheds light on discrepancies found in previous studies on this subject (ie small group samples, tests lacking sensitivity, inadequate controls). The journal is open access (oh no!) and the full-text is freely available.[2] Also, the introduction briefly summarizes some previous research and remaining questions. After detailing the specific results which I won't bother to summarise here, it concludes: "The current study provides compelling evidence, not only for the existence of cognitive deficits in Chronic Fatigue Syndrome, but for the nature of these same impairments." - Tekaphor (TALK) 03:48, 27 May 2009 (UTC)

Neuroticism

[3] "High scores of neuroticism and introversion on psychological tests have also been linked with a predisposition to developing CFS.[28]" = PMID 16443043.

The source for this is Prins's unsystematic overview, where Prins cites only one source:

48. Hoogveld S, Prins J, de Jong L, et al. Persoonlijkheidskenmerken en het chronisch vermoeidheidssyndroom: een literatuuroverzicht (Personality characteristics and the chronic fatigue syndrome: a review of the literature). Gedragstherapie 2001; 34: 275–305.

No PMID, same author, not translated from Dutch, may well be another unsystematic overview. A strong statement depending entirely on a low status, unobtainable and unverifiable source. Has anyone here actually checked this out? I doubt very much whether the Lancet did. Sam Weller (talk) 10:44, 27 May 2009 (UTC)

Seems my request for clarification sparked off an edit war, and a block on new users. Hmmm. For editors who don't have access to the Prins Lancet 2006 overview, this is all they say: "In a review of personality characteristics, neuroticism and introversion have been reported as risk factors for the disorder.48" 48 is their own Dutch language review from 2001, as above.

Tekaphor has been looking at this [4]. The following recent review represents current (lack of) knowledge. I will replace the self-referential Prins 2001(2006) review with this if there are no objections.

van Geelen SM, Sinnema G, Hermans HJ, Kuis W. "Personality and chronic fatigue syndrome: Methodological and conceptual issues.". Clin Psychol Rev (2007 Jan 27). PMID 17350740. Sam Weller (talk) 08:54, 28 May 2009 (UTC)

More recent research. J Psychosom Res. 2009 Jan;66(1):13-20. Chronic fatigue syndrome and DSM-IV personality disorders. PMID 19073288 "The results indicate a striking lack of statistical significant differences between the CFS sample and the Flemish control group at the level of dimensional Trait scores, number of criteria, and prevalence rates of personality disorder diagnoses." Has there been a recent systematic review of this topic? Sam Weller (talk) 09:06, 28 May 2009 (UTC)

Sam, as you noticed, this issue is like a hornet's nest. It's been active before, perhaps more than once. Another main instance was during mid-December 2008 and was part of a wider edit war; you can see it spill into the talkpage here: [5] There are several problems remaining: (1) a shortage of secondary sources on this issue (prior neuroticism), at least ones that are easily accessible; (2) the Prins paper is feverishly defended as being high quality and practically unquestionable; (3) the main CFS article is kept lean on text, further fuelling a highly selective and competitive attitude towards conflicting sources. Therefore, even if other secondary sources exist that contradict the claim in question, there's going to be a fight over the fact that it's published in the Lancet, regardless how questionable and inaccessible the primary source used within is (remember the CBT fiasco?).

I don't know if PMID 17350740 is a systematic review, have you seen the full text? PMID 18624602 is a review which covers the alleged role of prior neuroticism in CFS onset, but I haven't seen the full text. A concern is how CFS criteria is applied, which is not only a problem with CFS research in general, but one that specifically applies to the very source you have questioned, so the sloppiness you alluded to wouldn't surprise me at all (see the "CFS and Cures" section above). You might also be interested in this study [6] on "functional somatic syndromes": involved 45 CFS patients, 41 FMS patients, 41 IBS patients, and 138 control patients (MS, RA, IBD, respectively); had investigated personality, illness worry, illness attributions, and life events shortly before illness onset; concluded that "Overall, patients with FSS were remarkably similar to non-FSS diseased patients in their psychological characteristics." However, I can't find it in PubMed. As a side question, do you know if primary sources cited in other primary sources can be classed as secondary? - Tekaphor (TALK) 10:22, 28 May 2009 (UTC)

Thanks for the link, Tek. In that quarrel, there seemed to be an ignorance of the difference between the EBM status of systematic reviews and traditional narrative overviews. Put it this way, traditional overviews are no longer used for creating guidelines, since they are subject to all sorts of bias, conscious and unconscious. WLU said:

PMID 17350740 would also be a good qualifier ... Something along the lines of "Though personality traits have been associated with CFS (prins perhaps?) the association is not well understood and questions remain about causality, possible sub-types of CFS and..." works for me.

And for me. I haven't seen it, but 'concise review' suggests not systematic, which is why I asked. Nevertheless, it is more recent than Prins 2001/2006, and states the situation clearly. Sam Weller (talk) 14:25, 28 May 2009 (UTC)

It's online here [7]. The selection criteria show it was a systematic review, so I think it is safe to use it. They found evidence for neuroticism, but express serious caveats. Introversion has completely inconsistent evidence. Sam Weller (talk) 23:39, 28 May 2009 (UTC)

Good work finding the full text. It does appear to be a systematic review and I agree that it should replace the less relevant citation of Prins et al's overview on CFS. This systematic review concludes that the association of personality and CFS isn't definitive. It might be important to note that the authors still state that personality seems to play a role in CFS and is an important area of research, but that under careful scrutiny the stereotype (described in the abstract) isn't justified by evidence. Much of any association is explained by methodology, a minority proportion of patients with a mood disorder or personality disorder, and is similar to people with other medical conditions. I updated my userpage with a broader summary [8] to reflect the information within the review (second paragraph). - Tekaphor (TALK) 11:16, 29 May 2009 (UTC)

Sam, I noticed that you didn't make an edit yet, so I just replaced the statement in question with this: "A systematic review on personality and CFS, published in 2007, concludes that the association isn't definitive." (this edit [9]) Note to others, any expansion of this statement needs to be balanced. - Tekaphor (TALK) 04:25, 2 June 2009 (UTC)

Single purpose accounts should stop the vendetta on Prins! It is a Lancet review it is not our job, saying Lancet editors were bad or Prins is bias and wrong and bad sources. Start a journal or some thing people, it is not Wikipedia. Prins review in Lancet is at least so good as Review in minor journal. OK? Stop the OR, it is fine you have opinion WIkipedia is not where you do opinions. RetroS1mone talk 22:21, 2 June 2009 (UTC)

[outdent] There are no vendettas in evidence based medicine, User:RetroS1mone. Prins is not a systematic review - and has only one (1) sentence on the subject, where they state neuroticism/introversion are 'risk factors'. Van Geelen is a 19-page systematic review of the entire topic - and says they are not 'risk factors' because "many studies eventually conclude that the found personality differences are consequences of the disease, rather than precipating factors and as such play no causal role in CFS. All in all, under careful scrutiny the previously mentioned stereotype of patients with CFS does not seem to be justified." WLU suggested van Geelen, several editors agree, so do you have a problem with that? Sam Weller (talk) 23:17, 2 June 2009 (UTC)

RetroS1mone's claim about "wordiness" was ridiculous. There were a few normal sized sentences on psychological factors from a primary source and one overview, but another similar sized single sentence for a systematic review, is such a massive burden on the brain and Wikipedia that it simply must be reduced further to "This association may not be definite"??? What association exactly? The systematic review discusses much more than just neuroticism and introversion, and that's why the description I used mentions what the review is about (ie personality and CFS). Sam was right to revert, and appropriately explained why. Also, so what if this account is single purpose, it has nothing to do with the issue at hand, and it's not like editing a few irrelevant articles would change anything. - Tekaphor (TALK) 01:13, 3 June 2009 (UTC)

You say ridiculous and pffft that is incivil, Tekaphor it is also what you do, you are a spa editor with coi. Stop please. You like on taking the medical literature and picking out what you want and saying oh look a systematic review in a minor journal and saying it is so much better then a systematic review in a major journal and then Sam Weller says, RetroS1mone is stupid she does not know what a systematic review is. It is all OR and your opinions and trying on impose your personal opinions on Wikipedia. I said it before start your own journal Wikipedia is not your play ground OK? RetroS1mone talk 04:33, 4 June 2009 (UTC)

RetroS1mone please don't attack other editors or accuse them of something they did't say or do. Ward20 (talk) 07:42, 4 June 2009 (UTC)

User:RetroS1mone, you said previously that Prins 2006 Lancet is a systematic review. I asked you to show us your evidence for that. Sorry if I missed your reply. A general overview is always interesting as background information, but it has no status when it comes to specific hypotheses. For those we use systematic reviews, that are designed and conducted like experimental studies. Psychological state vs trait factors in disease are gigantic questions, not to be summarised by a single sentence in an overview of the disease. It's up to you to show you understand the basic principles of EBM, including hierarchies of evidence, if you want your POV to be taken seriously and not dismissed as trolling. Sam Weller (talk) 10:02, 4 June 2009 (UTC)

I added [10] another systematic review, which looked at "a variety of demographic, medical, psychological, social and environmental factors to predict the development of CFS/ME", and was published in the "Psychological Medicine" journal, which as far as I can tell has a higher impact factor than "Clinical Psychology Review". ... RetroS1mone, would you like some crow with your strawman? You don't know what my position on the subject is. I'm trying to improve this article and am bound to make mistakes. Perhaps I'll try to stop using such outrageously offensive words like "ridiculous". If you explained the edit in terms of the journal's impact factor, that would have made more sense that changing the text due to "wordiness". However, you tend to target the editor rather than the edit. - Tekaphor (TALK) 12:08, 4 June 2009 (UTC)

All from you have always been incivil to me and other editors that try and improve article with positive references bc you are trying to delete and question and censor any thing that is any mention from psychological. I will not take the bullying and ownership by people that have coi and only interest on saying psychology is crap and CFS is absolute not psych factors at all and writing ridiculous resume articles for people you idolize or your selves?? RetroS1mone talk 21:00, 4 June 2009 (UTC)

Sam Weller it is OR and being condescending on me like on every thing that does not agree to your opinion of CFS. Are you a CFS researcher?? Well it does not matter to ridicule other Wiki editors is not nice just because you think you are smarter then me. RetroS1mone talk 21:02, 4 June 2009 (UTC)

RetroS1mone, who is saying that psychology is "crap" or that CFS "absolutely" has no psychological factors? Please stop removing reliable sources on the basis of your assumptions about editors' opinions and motivations. I have not "always" been uncivil to you, and your claims of "incivility" are usually exaggerated. I gradually lost patience for your convenient stereotyping and repetitive attack of people's legitimate edits. You don't show much "good faith" so I don't feel obliged to return much. Additionally, I have made previous edits to support psychological factors, you are just unaware of that. Should I cry about "incivility" now that you used the word "ridiculous"? I also wonder if you have violated WP:3RR! - Tekaphor (TALK) 05:09, 5 June 2009 (UTC)

No, I don't think WP:3RR was violated but was at the limit. Ward20 (talk) 05:02, 5 June 2009 (UTC)

I don't understand 3RR all that well yet. Looking at the edit history, RetroS1mone seems to have effectively reverted newly edited text on 7 occasions within 24 hours, 1 of those reverting a whole bunch of edits made by various editors. Please help me understand. - Tekaphor (TALK) 05:16, 5 June 2009 (UTC)

My understanding is that it is 3 reverts of same material, but if there are 3 or more reverts on very similar material then a decision will be made at the 3RR noticeboard and action taken accordingly. Jagra (talk) 05:43, 5 June 2009 (UTC)

Ward20 is right, RetroS1mone did not violate 3RR I understand now: WP:3RR states, "Contributors must not perform more than three reverts on a single page within a 24-hour period, whether or not the edits involve the same material, except in certain circumstances." The material in question does not appear to be exempt by the "certain circumstances". However, it also says that "A revert is any action, including administrative actions, that reverses the actions of other editors, in whole or in part. A series of consecutive saved revert edits by one user with no intervening edits by another user counts as one revert." When considering this 2nd statement, RetroS1mone only performed 3 reverts, and I also misread the date of one of the edits I counted previously as within 24 hours. My mistake! - Tekaphor (TALK) 05:58, 5 June 2009 (UTC)

Yes. One of the keys is that a block of edits that is uninterrupted counts only as one edit. Ward20 (talk) 07:09, 5 June 2009 (UTC)

It seems that RetroS1mone has asked for an RS opinion on this issue, but she didn't mention it anywhere that I could find. For those who may be interested, it can be found here. --Rob (talk) 05:29, 7 June 2009 (UTC)

Thanks Tekaphor for citing "Hempel, S., Chambers, D., Bagnall, A.M. & Forbes, C. (2008). Risk factors for chronic fatigue syndrome / myalgic encephalomyelitis: A systematic scoping review of multiple predictor studies. Psychological Medicine, 38:7, 915-926", ref 17. It can be downloaded here: [11] Sam Weller (talk) 13:35, 9 June 2009 (UTC)

Thanks Sam. User:Bricker brought up this paper last year during a dispute on psychological factors re "stress" in particular (see Archive 5 of the talk page, under "Overtraining and CFS", Bricker's larger post in the 2nd half of first subsection [12]). Looking at the full text, this systematic review also included stress studies. - Tekaphor (TALK) 03:42, 10 June 2009 (UTC)

Popular culture references

Add it to Cultural_references_to_chronic_fatigue_syndrome if you must. Doesn't belong in main article. Ward20 (talk) 03:15, 3 June 2009 (UTC)

It present view from many medicine doctors and popular culture, you do not have to agree with it. RetroS1mone talk 04:29, 4 June 2009 (UTC)

Agree this type of material has no place in the main article, House is an actor reading a script by a writer, nothing to do with 'medicine doctors' does it belongum anywhere?. Jagra (talk) 05:27, 5 June 2009 (UTC)

Ward20 says "positive" popular culture references have place in sub article, deletes and rewrites any thing he says is negative. Pls stop the tag team ownership of CFS articles. RetroS1mone talk 14:09, 5 June 2009 (UTC)

Kindly provide proof that Ward20 says what you've accused him of saying. --Rob (talk) 04:51, 6 June 2009 (UTC)

I explain my edits sam weller requested

House reference can go there, it does not need MEDRS, it is a main popular culture reference of CFS and a verifiable opinion from many people, like New York timessaid in the reference. Why we need so many sub articles, i do not know that, my opinion, we should not have ownership of the article, pls give reason why you say doesn't belong, do you think whole section is bad??

23% full recovery it was discussed before, consensus it is the CDC criteria are used mostly, full recovery is not known what it is so pls leave out. RetroS1mone talk 21:57, 4 June 2009 (UTC)

I don't fully understand the debate about the House episode. What "medical opinion" do you think this episode supposedly presents? I haven't seen the episode. The text describes how a patient of House thinks they have CFS or FM but House disagrees and instead gives the patient a placebo (perhaps implying the patient is "neurotic" or whatever). The text contains no "medical opinion" on CFS itself, only that some people think they have it when they probably don't. ... Yes, "23%" was discussed before, but by "consensus" you really mean some editors wanted it in but you kept reverting it; I dispute the claim of "consensus". - Tekaphor (TALK) 04:24, 5 June 2009 (UTC)

Several issues about the House episode. First, the present summary is original research. The film can be viewed here, see part 2 at minute 5:02 thru 6:09 and 21:00 thru 21:10. The transcript can be read here. The film never mentions hypochondriac, or shows the patient is convinced he has CFS or fibromyalgia, or talks about delusions, or indicate the the pills work. A NPOV version I wrote using the actual plot is here which RetroS1mone reverted with the rather twisted edit summary of remove OR by spa editor. One of the plot lines is that House gobbles down Vicodin like candy and he stole the patient's pain killers to emphasize that issue. Second, who is to say what cultural reference belongs on the main page? There is no second source to indicate which is the most notable. Third the House episode only has a primary source, the video itself. Our Cultural references to chronic fatigue syndrome article has four entries and the only one with a second source is The Golden Girls episode so that one should be the one on the main page if any should be. But there shouldn't be trivia on the main page of a medical article without a second source to say how notable it is so Golden girls shouldn't be on the main page either. Ward20 (talk) 05:47, 5 June 2009 (UTC)

Even going with the transcript version, this would be a better reference to hypochondria or aging, not to CFS/FMS. --Rob (talk) 08:00, 5 June 2009 (UTC)

Group of editors is deleting all when it does not agree w their opinion, CFS has no psych factors. RetroS1mone talk 14:08, 5 June 2009 (UTC)

23%, you want it there, OK. It was discussed before not by me alone, now you say I revert against consensus. RetroS1mone talk 14:28, 5 June 2009 (UTC)

Actually, a correction. I don't think the 69%/23% belongs there at all, I just think adding the 23% clarifies the study further. This is a non-RCT with an unusually higher success rate, a primary source being used to bolster up the support for psychological treatments. If anything, it belongs (and already is) on the sub-page. You have previously argued that it's important because it discusses full recovery. However, I'm arguing that it doesn't belong on the main page when used in this way, especially when you don't allow any conflicting primary sources to be used in the same manner. And stop grouping editors. - Tekaphor (TALK) 09:28, 6 June 2009 (UTC)

Hypochondriasis

Would anybody (apart from Retro, who added it in the first place) object if I asked an Administrator to revert the recent two edits regarding CBT and hypochondriasis? This, at least in my mind, is a prime example of tendentious editing, using unclear quoting to espouse a specific view without any attempt at seeking consensus before the edit was made. The only material quoted directly from the book does not reference CFS at all, and I would think that nearly any quote from a book entitled "Cognitive Behavioural Therapy and Hypochondriasis" would probably be better quoted on the hypochondriasis page. --Rob (talk) 04:48, 6 June 2009 (UTC)

Is this the study? "Participants were 80 patients from primary care practices and 107 volunteers" and the article says "A randomized controlled CBT trial studied 589 hypochondriasis patients", am I looking at the right study? Ward20 (talk) 05:48, 6 June 2009 (UTC)

Ward20, yes, that's it (PMID 15039413). "A total of 102 individuals were assigned to CBT and 85 were assigned to medical care as usual.", so the "589" figure is wrong. Rob already noted above the lack of relevance to CFS. The closest thing resembling such a mention about CFS is:

• "Empirically, clinical experience and intervention trials for a variety of functional somatic syndromes suggest that the patients who do best are those who learn to compensate for, rather than attempting to eliminate, their somatic distress. Conceptually, hypochondriacal somatic symptoms cannot simply be stripped away with symptomatic treatment because they exist for underlying psychological and interpersonal reasons. This suggests that a realistic goal in treating hypochondriasis is amelioration of distressing fears and beliefs and improved coping, rather than the elimination of somatic symptoms per se."

I have no objection to its removal, because the edit(s) were inappropriate for multiple reasons: (1) it is not about CFS specifically, so why is it in the "Treatment" section on the main page?; (2) there is consensus that the main page is for a balanced summary of the topic while expansion of different perspectives go on the sub-pages, yet this is just another example of unbalanced additions of primary sources into a section that was already arguably unbalanced with selectively used secondary sources. It also looks like an attempt to make the questionable slant on the "House episode" appear less OR than it really is. - Tekaphor (TALK) 09:13, 6 June 2009 (UTC)

Relavence, it is in CBT section, this study is about CBT. CBT helped hypochondriacs. Lots of them had symptoms like CFS and FM, medically unexplained symptoms. They are in common with alot of CFS patients, they think psych treatments are nonsensical also when they work!! RetroS1mone talk 17:24, 6 June 2009 (UTC)

"Would anybody )apart from Retro" pls stop trying on silencing and excluding me, I am an editor to and I do not have a COI at all. I am not a patient like Rob and some other people, I do not know any of these people, I do not have any bias of what causes CFS, no body knows and I do not know. RetroS1mone talk 17:26, 6 June 2009 (UTC)

I'm not silencing you, though I am excluding you on the basis that you were the one that added the material in the first place, and you will therefore obviously think it belongs. There is a lot of information out there about CBT. It belongs on the CBT article. As the material you cited never mentioned CFS specifically, it has absolutely no relevance here.

As to your claim that you are not biased about what causes CFS, have you ever added material to the CFS article that significantly enhanced a non-psychological POV? Or have you ever reverted material that signficantly supported a psychological POV? --Rob (talk) 18:55, 6 June 2009 (UTC)

Also, as Sciencewatcher has stated he has a bias, I also have an obvious bias, given that I have CFS. But at the same time, I would ask, is that "bias" or "insight"? Probably both. In the end, I know what I feel - Retro, who has never suffered from this debilitating disease, does not. --Rob (talk) 19:47, 6 June 2009 (UTC)

{{editprotected}} I am requesting reversion of two recent edits due to the fact that they have been proven to be incorrect quotes of the source material (as shown by Ward20 and Tekaphor, above). As you can see, we don't have universal consensus, however the only person objecting is the person who added the material in the first place. If this is inappropriate, please remove this request and we will pursue appropriate RfC or AIN action once the article is unprotected. --Rob (talk) 19:16, 6 June 2009 (UTC)

I object to removal. Rephrasing might be necessary, as might be changing the numbers (if Retro was conflating two different studies), but it's clearly relevant, whatever the accurate numbers are. — Arthur Rubin (talk) 19:31, 6 June 2009 (UTC)

The 589 figure has been cited, but there's no evidence of that in the source material, which you addressed. If it is indeed conflated, then temporary removal would seem appropriate until the correct source and info can be inserted. There's also no mention of CFS in the source material, only hypochondriasis, so I'm not sure how that's a relevant quote in a CFS article. As the arbitrating admin, it's obviously your choice, but I would appreciate it you could explain your thinking a little bit further. --Rob (talk) 19:44, 6 June 2009 (UTC)

I consider myself "involved", so I'm not ruling on your request. As I can't see a rational dispute as to the relevance of the reference, whatever the numbers, I think that it should remain, but with any disputed details removed. — Arthur Rubin (talk) 19:56, 6 June 2009 (UTC)

I agree that removing disputed details would make sense, but I still fail to see the relevance of a quote about hypochondriasis. The phrase "who often report CFS symptoms" is entirely synthesis and is never mentioned in the study itself according to Ward20 and Tekaphor. If you remove that phrase, the entire paragraph then can be seen to have no bearing on CFS at all, but rather on hypochondriasis. Of course, if there's extreme conflation going on here, it's possible that the correct material does say something about CFS, but as it stands, it appears that the cited source does not. --Rob (talk) 20:06, 6 June 2009 (UTC)

Going to the article here and clicking on full text I was able to get the full text as a guest. I looked and did a page search for "chronic fatigue syndrome" and "CFS". I didn't see or find any mention of it in the article. I looked and searched for symptoms and found "somatic symptoms" being talked about, but no specific symptoms. I looked and did a page search for "fatigue" and and didn't see or find any mention in the article. There seems to be no basis in PMID 15039413 for hypochondriasis patients often report CFS symptoms. Given the edit by RetroS1mone seems to be pure original research, all this material should removed from the article. The hypochondriasis article was put in by RetroS1mone after material about a purported hypocondriacal patient that thought they might have CFS or FM in a TV House episode was inserted into the article 4 separate times by RetroS1mone.[13] [14] [15][16]. The house material was also original research because the episode never said or indicated the patient was a hypochondriac.[17] I believe it would be appropriate for RetroS1mone to explain these edits. Ward20 (talk) 22:38, 6 June 2009 (UTC)

I have removed the paragraph in question for now. If the issues can be sorted out and its relevance established, please rerequest its addition. — Martin (MSGJ · talk) 14:18, 7 June 2009 (UTC)

The purpose of the Canadian-2003 consensus document

Under the "Classification" section, the text claims that this document (Canadian-2003) was developed to "exclude psychiatric cases". Although this is a massive oversimplification of why it was developed, the reference to this third-party opinion is reliable and isn't really a problem in the right context. After all, a study by L Jason et al provides evidence for the notion that the Canadian-2003 criteria tends to select a group of patients with less psychiatric comorbidity. However, what about the consensus document's actual authors' statements about its purpose and why it was developed? While the text in question is on this main page, the issue really belongs on the Talk:Clinical_descriptions_of_chronic_fatigue_syndrome page so I posted the bulk of my message there.[18] It's not an important issue right now compared to what's going on right now, and isn't worthy of too much weight, it's just something I noticed a while ago and posted now about it. - Tekaphor (TALK) 08:24, 7 June 2009 (UTC)

New study linking severe CFS to Prions and H2S

Dr. De Meirleir just published the results of a study on severe, bedridden M.E. patients in Norway. He presented his findings last week at a conference in London.

My question is, should the possible connection of CFS to H2S and Prions be mentioned on this Wikipedia page about CFS? If so, where would it fit in?

Here are the links to his presentations and summary of his study: [19]

Thanks!

Kosovokelly (talk) 10:42, 7 June 2009 (UTC)

Ha ha ha ha ha!!!You expect the powers that be on this site to allow any evidence of a physical etiology. You must be joking. With this article it's just psychological, psychological, psychological all the way. It's just descended into farce at the moment. We've even now got a paragraph about Hypochondriasis with no real reference to CFS whatsoever. And then there is the piece about a TV show script. It's laughable. This article has absolutely nothing to do with CFS anymore. It totally needs rewriting from a NPOV. It portrays and represents nothing about CFS in general and does nothing to enhance the credibility of Wikipedia!!!! lol, lol, lol..

87.112.69.59 (talk) 14:15, 7 June 2009 (UTC)

The points 87.112.69.59 mentions are being resolved at the moment. The article certainly isn't all psychological at the moment. Regarding Dr Meirleir's article, it is a bit of a joke. Patent pending prion illness?!?! By quoting nonsense like this, it is no wonder that some people think that CFS patients are just a bunch of hypochondriacs. Sometimes I shake my head at patients. Please actually read and understand the science. Not only will you learn something, but it might actually help you to recover. Rant over. --sciencewatcher (talk) 15:14, 7 June 2009 (UTC)

Oh SW. I have to retort to that. I just cannot resist it!! And then I'm going to leave it at that!!.You say "Please actually read and understand the science. Not only will you learn something, but it might actually help you to recover." Ha you actually assume that I have CFS?. You jump to conclusions too quickly my friend..Also the previous line " it is no wonder that some people think that CFS patients are just a bunch of hypochondriacs". Hmmmm. I too don't put much hope for people with CFS from that particularly study..But for you to make that assumption!!!!! It's attitudes like that which make me feel the way I do about this article and the people who edit it. There is nothing like a closed mind.. That is not a personal attack on you, it is just a reflection on that type of attitude..And another thing.. so are you actually saying that all people with CFS have to do to recover is to "read the science and understand"..I'm sure all the people with the illness who are basically crippled with it will really appreciate your advice. Well here in the UK ,thankfully, it is treated as a real physical illness even if they don't understand it properly..

Anyway another rant over..

Best wishes 87.112.69.59 (talk) 15:58, 7 June 2009 (UTC)

It's not often we agree ;), but I have to go with Sciencewatcher on this one, at least in general terms. The announcement is premature, to say the least. Until such time as he actually does publish his findings in a peer-reviewed journal, it probably doesn't belong on Wikipedia. A big red flag for me on this article is the home testing kit for sale online via his company. That, to me, is the sign of someone trying to profit from the desperation of many CFS patients to find a cure, not a serious researcher. --Rob (talk) 20:01, 7 June 2009 (UTC)

Yup, needs replication and summary in some sort of review article indicating it's actually got legs and is going somewhere other than a blind alley. If it's not published in a peer reviewed (and high-quality) article, it's a waste of time to discuss it. WLU (t) (c) Wikipedia's rules:^simple/_complex 01:08, 8 June 2009 (UTC)

Yes what Rob, SW, WLU said. Hi IP, CFS is a real serious physical illness and hypochondria is to, the brain is part of your body. Of hypochondria, the body part where it is, that is brain, for CFS, no body knows what body part and what cause, medical consensus is, may be more then one unknown causes, and more conditions also. Article has the job, describe this by MEDRS from experts. RetroS1mone talk 15:01, 8 June 2009 (UTC)

Excellent Book on Chronic Fatigue Syndrome

Hello all! I just want to share that the book "Overload Beating M.E. The Chronic Fatigue Syndrome", written by Jacqueline Steincamp, has helped me to understand CFIDS. The writer comes from New Zealand. I agree with the content of the book. Here is the link to Google Books http://books.google.co.za/books?id=mpwqAAAACAAJ&dq=overload+beating+m.e. . Detoxification, diet changes and alternative therapies are part of the path to healing as stated in the book.

In my personal struggle I have found that alternative medicine and a type of pritikin (stone age) diet has help me to control my fatigue. I believe both the body and the mind must be supported for healing to take place. Bold Vier (talk) 20:00, 7 June 2009 (UTC)

Thank you for posting that recommendation, but even a talk page is probably not the place for this sort of thing unless it has a direct impact on the article or on other discussions. You're probably best off putting suggestions of this nature in forums. --Rob (talk) 21:01, 7 June 2009 (UTC)

The publisher is Fontana Collins, with no indication that I can find on the internet that it is a sufficiently reliable source. WLU (t) (c) Wikipedia's rules:^simple/_complex 01:04, 8 June 2009 (UTC)

Wikiquette Alert

In order to save time and notify everybody at once, I'm posting this here, rather than individual talk pages (though I did inform RetroS1mone on her talk page independently, since I specifically named her in the alert). I believe all the affected editors read this page, but please inform anybody whom I may have missed if they are not regular readers of this page. Anyway, on to business...

I have started a Wikiquette Alert about our ongoing concerns. I tried to give a brief description of both sides of the issue, but if anybody feels I've missed something important, please feel free to add to the points I've made. The instructions said to keep it light on content, so I did that. Because the issues are fairly broad-based, I didn't provide any specific diffs for the time being, but I suspect that will be warranted as the discussion develops. --Rob (talk) 21:59, 10 June 2009 (UTC)

Thank you, i replied. When you are wanting to take it to more heavy steps, i am sure Guido has many diffs about me and he is glad to share them, when you do not have his email, pls ask the others. I am saying it bc i do not have one thing to hide and i want totally scrutiny for me. It is sad, we have so much time doing diffs and making accusings, yes i do it too and i am ashamed but i have to defend, we are not using the time on the Wiki for real. RetroS1mone talk 23:37, 10 June 2009 (UTC)

I hope it doesn't come to the need for the heavier WP:DR steps, but if it does, I would not use Guido as a source. Any issues you and Guido may have had with each others' edits are most likely not relevant to the current issues, and it would obviously be biasing to use citations that involve a banned user. --Rob (talk) 20:33, 12 June 2009 (UTC)

I am glad you say that. RetroS1mone talk 01:15, 13 June 2009 (UTC)

Noted Researchers

Once the page protection is lifted, what do people think about adding a "Noted Researchers" section for people like David Bell, Simon Wessely, Malcolm Hooper, and whomever else we feel appropriate?

Rather than debate who's notable and who's not, I would suggest we simply link to researchers' pages. If they don't yet have a page, they're probably not notable enough to be mentioned here. If it's thought that they're not notable enough, but they do have a page on Wikipedia, we simply "take it on faith" that they are until such time as the researcher's page is deleted (implying that they're therefore also not worthy of being in this article). If we do go ahead with the section, does that sound like a reasonable policy to prevent any dispute on the issue? --Rob (talk) 07:43, 12 June 2009 (UTC)

It would be nice, i do not think that is very much used on Wiki. It is difficult bc most "noted researchers" on CFS are not having Wiki pages, like the people that publish in best journals. I think, we link to people when there name is in article but a seperate section, it is danger to be a who's who of people that oppose psychiatric cause and treatment. Bell, Hooper, Fennell, more articles that got written from a CFS advocate w a internet site where they help patients discuss and get doctors that will agree w/ them and give experimental treatments, so i am worrying, we add doctors, that is just promotion of people that some times have not much notability in academics and medical but may be alot of interest to get more attention on Wiki. I am sorry i have to be this person that says it. RetroS1mone talk 01:14, 13 June 2009 (UTC)

I don't think unnotable doctors are likely to have their pages stay on Wikipedia for long. As I've said elsewhere, who wrote the articles initially is irrelevant to the discussion - the point is just that they satisfy WP:NOTABLE criteria. If they don't, they'll have their pages stubbed or removed, at which point we would agree to remove their names here as well. Does anybody else have an opinion on this? --Rob (talk) 03:13, 13 June 2009 (UTC)

I theory it sounds good. I can see some problems though. Regardless of the consensus on the inclusion criteria now, people will try to insert who they believe are noteable. A couple very difficult issues I know of right off the bat would be Elaine Showalter and Trevor Marshall. Don't get me wrong, I am not saying not to do it I just want to discuss the merits. I guess Richard Louis Bruno, Donald Acheson, Jacob Teitelbaum, and Peter Snow (doctor) would probably be candidates too. Ward20 (talk) 05:59, 13 June 2009 (UTC)

CBT Curiosity

I'm just noticing something that many of the CBT citations seem to have in common (though I didn't look at every last one). It seems that most of the CBT has been geared towards getting people to exercise as part of the program. Are there any studies out there that look strictly at CBT in its own right without the exercise? Most literature and even many patient groups agree that exercise, whether it's in the form of GET, pacing, or whatever else, is beneficial for most patients. Is CBT actually just a Trojan Horse that appears effective only because of the exercise component? It strikes me that one of the reports said that CBT for depression was entirely ineffective for CFS, which to me implies that that may have been less exercise-oriented. Of course, I'll be the first to admit, that could also be a straw man.

Obviously the above is pure speculation, but I'm wondering if there are reliable sources of any kind that have studied CBT on its own that we should be adding to the article. If not, it might be worth noting somewhere in the CBT section that all forms of CBT for CFS also include an exercise component. If we do, we'd have to be careful about wording to ensure that we incorporate the information in cited sources without drawing any specific conclusions and turning it into OR.

Thoughts? --Rob (talk) 20:27, 12 June 2009 (UTC)

Not sure, but I'd suggest looking through "BMJ clinical evidence", "Interventions for the treatment, management and rehabilitation of patients with chronic fatigue syndrome/myalgic encephalomyelitis: an updated systematic review" by Chambers and "Efficacy of cognitive behavioral therapy for chronic fatigue syndrome: A meta-analysis" by Malouff. I have full-text for these if you need them.

From what I can tell, CBT seems to vary quite a bit depending on the practitioner, so it isn't surprising that some studies have better results than others. --sciencewatcher (talk) 21:10, 12 June 2009 (UTC)

There's a DARE review of Malouff here [20]. Sam Weller (talk) 22:25, 12 June 2009 (UTC)

Full text would be great, SW...errr...sciencewatcher, that is. You still have my e-mail address? If not, send me a Wiki e-mail and I'll reply...or look at my profile page here, then click over to the one on UESP - it's not my main address that's published there, but it'll do. --Rob (talk) 22:41, 12 June 2009 (UTC)

Sorry it is me again, i am not attacking!! i would like that, every journal is open access but they are not yet, pls be careful when you are sending copyright things. I do not know this one is copyright?? when there are copyright things to send may be discuss off the Wiki. RetroS1mone talk 05:12, 13 June 2009 (UTC)

onset

I am reading the onset part again about onset in winter, is it confirmed in review sources?? Thx, RetroS1mone talk 05:14, 13 June 2009 (UTC)

I'm just looking at the same PM summaries that you did, and I notice that both are fairly small studies, which is concerning right there. But to your point, I couldn't find any secondary sources on that issue (though I only did a quick search). Having said that, primary sources are okay unless contradicted by a secondary source, as long as we follow the conclusions of the sources fairly closely in the article. But looking at the first of the two links, it does clearly say that the hypothesis is about a subgroup of CFS patients. So I would suggest changing the wording to reflect that statement. But if you want to remove the statement altogether, personally I wouldn't object. --Rob (talk) 07:10, 13 June 2009 (UTC)

poorly understood?

Why not,

Chronic fatigue syndrome (CFS) is the most common name given to a variably debilitating disorder or disorders of uncertain causation. It is also commonly known as myalgic encephalomyelitis or ME.

What does poorly understood add for the reader? Ward20 (talk) 07:50, 13 June 2009 (UTC)

So now an anonymous editor has switched it back to "an inadequately" with a complaint about the grammar. I'd be interested to hear the explanation for that one.

But as to your point, while I think it does help the reader understand that CFS is not well understood, they can probably get that from numerous other places in the article, so I'd be good with the above. --Rob (talk) 09:17, 13 June 2009 (UTC)

The thing about CFS all the reviews in good journals say is, no one knows what causes or how it works, that is why "poorly understood" but it is not my words it was on the lead for two years. RetroS1mone talk 11:37, 13 June 2009 (UTC)

I think the reasoning for using "inadequate" is that "poorly" can imply that people haven't taken the time to understand it, or haven't read enough about it or whatever - "inadequately" says that there simply isn't enough knowledge about the subject...that nobody understands it. I'm not terribly picky, I think most readers wouldn't make much of a distinction between the two, but given a choice, "inadequately" is the better word, IMO. But working around the wording entirely is another way to deal with it too. --Rob (talk) 18:07, 13 June 2009 (UTC)

Yes, that is my understanding too Rob, "inadequate" implies there isn't enough knowledge about the subject. But this is the first sentence of the article so there is great weight about "inadequate" knowledge about the subject. I suppose the article does say that but there are researchers in the article that state looking for physical causes are a waste of time and researchers that state looking for psychosocial causes are a waste or time.

Poorly is rather ambiguous as you state. Is the science poor, is the understanding by medical professionals poor, is the understanding by the public poor, is the understanding by the patients poor, is the understanding by policy makers poor? Maybe all of the above. But there is a great deal known about the illness in certain subsets also, right down to the cellular level. Eliminating the vague term allows the reader to concentrate on the terms "causation" is "uncertain" which is neutral, specific and well supported. IMO. Ward20 (talk) 19:09, 13 June 2009 (UTC)

fact tag [21]

This is not a critical statement concerning the tag, more of a question on my part. On some other articles, I was under the impression that if something in the lead was an overview of material in the article and adequately sourced, then it wouldn't have to be re-sourced in the lead. I believe almost all the material in the paragraph in question can be sourced but it would be very dense with citations. I would like to know what the other editors understanding is. WP:LEADCITE appears to be written loosely. Ward20 (talk) 05:10, 16 June 2009 (UTC)

I wasn't aware of that particular guideline when I added the tag. Given what it says in the guideline, I would normally say that we could just remove the tag and leave that paragraph uncited, but given the history of this page, I'm hesitant to do so. So like you, I think I'll leave it to other editors to make the call on this one. --Rob (talk) 06:04, 16 June 2009 (UTC)

I'm not a big fan of the last paragraph in the lead, its screaming for someone to add weasil and npov tags. Fuzbaby (talk) 05:13, 21 June 2009 (UTC)

Psychological Factors

I was just researching the removal of the phrase "The success of psychiatric treatments suggests CFS may be perpetuated when patients fixate on a physical cause of illness or their symptoms and when exercise is avoided, and a" by an anonymous editor, and in doing so, I discovered a couple of things of note:

First of all, I believe the original insertion was made in good faith. However, the subject matter of the cited material and the subject matter of the quote are entirely different, and I suspect this may have been a case of mistaken citing. Given that, I have reinserted the line (in a more logical place, I think) and added a {{Fact}} tag. Hopefully the original editor (or someone else) will be able to cite it properly. Let's not provide grounds for the accusation that editors on the article are trying to excise psychological information from it.

Secondly, researching the other source in the original version of that section, the infamous Prins 2006 source, I noticed that there were replies to that article in the Lancet. A free account at the Lancet allowed me to view those replies (here and here), both of which are highly critical of Judith Prins' research. Her reply to those comments can be viewed here. I assume you'll need your own account at the Lancet to view them.

Noticeably in her reply, Prins says "There is overwhelming evidence that a biopsychosocial approach has been more fruitful for patients than a biomedical approach", and yet she fails to provide a reference for that statement as she has for other statements in her reply. --Rob (talk) 20:16, 16 June 2009 (UTC)

Rob, that quote about the success of psychiatric treatments was attributed to Prins 2004 (PMID 15031590, "Social support and the persistence of complaints in chronic fatigue syndrome.") and not Prins 2006 (the Lancet review. I don't have access to the full text of this 2004 article, but I'm guessing that sentence is a quote from it. --sciencewatcher (talk) 20:50, 16 June 2009 (UTC)

I may have explained myself poorly there. The text that was removed was indeed cited as being from the "Social support..." article, and like you, I don't have access to the full material. Given that the conclusions in the abstract seem to have nothing to do with exercise or fixation on a physical cause, however, I'm a little dubious that that's the correct citation. If someone has the full source availalbe to them, it'd be great if we could confirm that. In the mean-time, however, rather than remove it entirely, as someone had done, I thought it was better to re-instate it, but with a Fact tag. If there's some "this may be an incorrect source" tag that I'm not yet familiar with, it would be even better if we re-instated the original citation with that questioning tag as well.

The "Secondly" portion of the my commentary above was related to the Prins 2006 source which I checked just in case the original citation was confounding the two sources or something. My comment on that wasn't directly related to the removal of the original statement. I just thought it was interesting to see the two critical replies in light of the weight that RetroS1mone has been trying to give it. --Rob (talk) 22:01, 16 June 2009 (UTC)

I don't have the 2004 article either but "CFS may be perpetuated when patients fixate on a physical cause of illness or their symptoms and when exercise is avoided," is supported in the Prins 2006 article, " Psychological processes seem to be involved in the perpetuation of complaints in patients with CFS. These processes involve ideas or cognitions of patients about complaints and behavioural factors such as persistent avoidance of activities associated with an increase in symptoms. A strong belief in a physical cause of the illness, a strong focus on bodily sensations, and a poor sense of control over complaints contribute to an increase in fatigue severity and functional impairment."

I agree the Prins article has a lot of unsourced opinioned statements much like Hoopers article. The other problem with Prins is that she insists that her studies on patients who have 6 months of fatigue without any other physical symptoms defined by the Fukuda definition are valid for chronic fatigue syndrome. Indeed, that is the enrollment criteria for many of her studies. Her CBT 2001 study states, "Patients were eligible for the study if they met the US Centers for Disease Control and Prevention criteria for CFS,¹ with the exception of the criterion requiring four of eight additional symptoms to be present." Ward20 (talk) 22:12, 16 June 2009 (UTC)

Hmmm...yeah, perhaps we should just re-source it to the Prins 2006 article then. Or contact WLU directly (who made the original addition) and see if he knows something we don't.

As for the CBT 2001 study, I find it interesting that she goes on to say that "Severe fatigue and severe functional impairment were defined by cut-off scores—a score of 40 or more on the subscale fatigue severity of the checklist individual strength and a score of 800 or more on the sickness impact profile." Nowhere else in the study does she mention the word "severe", and she doesn't explicitly state that that was a criteria for inclusion. Also, she gives no statistics on why a large percentage of patients were unwilling to participate. I know for myself, I would have been forced to refuse unless the treatment centre were next door, as travelling any significant distance on a regular basis makes my condition much worse. Was she inadvertently excluding the worst-affected patients from her study? But I digress...this has little to do with the actual source in question.

So back to the question at-hand, should we simply re-source the statement to Prins 2006's article? --Rob (talk) 22:59, 16 June 2009 (UTC)

I took a crack at trying to fix the material with what we discussed.[22] Ward20 (talk) 23:21, 16 June 2009 (UTC)

Looks good, though I fixed a tiny bit that you had missed. --Rob (talk) 23:29, 16 June 2009 (UTC)

I cannot find find any support in the cited reference to the success of "psychiatric treatments" but only to Cognitive Behavior Therapy - which is a psychological therapy and not a "psychiatric treatment". Therefore I have removed this comment. If anyone actually has a source for psychiatric treatments then provide it but if not then leave it out and only include what is verifiable. Afterwriting (talk) 09:04, 17 June 2009 (UTC)

Some editors might be unaware that psychiatry is a medical discipline, whereas CBT can be delivered by non-medical clinical psychologists, or even by computer. Sam Weller (talk) 10:16, 17 June 2009 (UTC)

I just re-referenced the sentence in question, as it's quite clearly taken from the Prins 2006 review. And I agree on removing the "psychiatric treatment" part, as psychiatry is not mentioned in that section and neither is CBT. About all it says that even comes close is that there appear to be psychological processes involved in perpetuating the illness. I do love the last line in that section though...it really shows Prins' bias in this area. Maybe it's just me, but I essentially read that as "Despite all the disadvantages of having CFS, I think many of them are simply malingering."

Oh and what's with this anonymous IP editor lately who thinks it's fashionable to make commentary or edits and then revert them? --Rob (talk) 16:52, 17 June 2009 (UTC)

Prins last sentence is sourced by 2 refs. Also, I have met people who this applies to (not necessarily with CFS, but with illnesses in general). It is hypochondria rather than deliberate malingering. --sciencewatcher (talk) 18:32, 17 June 2009 (UTC)

Hypochondria is simply the obsession with the idea that you might have a serious disease; malingering is pretending to be ill, or drawing out an illness because of the benefits/attention you receive from it. To me, when she talks about the "desirable consequences" of having CFS, she's clearly talking about malingering. (And if she thinks this disease has any desirable consequences, she's welcome to have mine!) But no matter how you look at it, the sad thing is, there are people out there who are either hypochondriacal or malingering, and it really confounds diagnosis and treatment for those who aren't. That she would include such a statement without any attempt to qualify it or indicate that some patients may perceive "desirable consequences" does show bias in my view. As for her sources, one of them indicated that the results could be interpreted in multiple ways and that further research was needed, and the other source came across as somewhat sensationalistic to me, and goes counter to most research on a number of different conditions. It was apparently so...notable, let's say...that it managed to garner nine responses. (And while I'm not going to pay $US15 to see it for a day, it's a fair bet that they're not all rave reviews of the work.)

But regardless of my perception of her bias, that is, of course, not something that belongs in an article. I just found it a rather interesting statement on her part and thought I'd mention it, since we were talking about that section anyway. --Rob (talk) 20:12, 17 June 2009 (UTC)

Yes there is intense hatred for Prins by many patients but i do not know why it is relavent for article. And, hypochondria is a very serious and improtant medical problem, hypochondriac sufferers describe medically unexplained symptoms like w FM, CFS, MCS, GWI, i think we should say it in the article there are alot of good sources. RetroS1mone talk 04:03, 21 June 2009 (UTC)

(outdent) "Intense hatred" would be your wording...personally, I just think she's wrong, and her studies have gaping holes in them. As for hypochondria, as you can see at the article on hypochondria, there are any number of symptoms that don't overlap...the most obvious of which is the obsessing over symptoms or constantly being worried when there's clearly nothing wrong. With CFS, patients don't generally obsess over their symptoms...they just have them. There are also often some medically measurable problems (measurable balance disorders, excessive heart palpitations or orthostatic intolerance, positive ANA titers, etc.), there's just no explanation as to what's causing them. Hypochondria typically lacks any sign of problems, other than anxiety-related problems. Unless you can find clear and unquestionable evidence that hypochondria is somehow linked to FM, CFS, MCS, or GWS, it would be unsubstantiated OR and would not be appropriate for an article. Oh and a House episode does not constitute unquestionable evidence. --Rob (talk) 04:25, 21 June 2009 (UTC)

POV tag

In light of the continuing revert war, I've added a POV tag to the main article. I think it's only appropriate until such time as we can all come to some agreement here. --Rob (talk) 05:07, 21 June 2009 (UTC)

This is patently unhelpful. In some situations, putting POV tags on articles is itself an act of POV pushing, so please tread carefully.

If there is a revert war, have the page protected and work out a compromise. Slapping such tags is usually unhelpful in articles that are well recognised to be subject to heavy discussion, because the difference in perspective is not going away. I would suggest reserving POV tags for articles that are not edited regularly because they are more likely to remain in a state of POV. JFW | T@lk 09:30, 21 June 2009 (UTC)

My impression was that the tag was to be used in any case where there were point-of-view issues on an article. As you said in your edit summary, this article is a "POV battleground". Given that at any given moment, some editor is likely to feel that there are POV issues, how does a POV tag not apply here? I'm not espousing for any view in particular by adding the tag, simply indicating that at any given time, there may be POV issues with the article. Quite the opposite of "patently unhelpful", I thought that addition would be entirely non-controversial to all editors! As for working together, if you look closely, I think you'll see that the majority of editors here have no difficulty working together, no matter what their POV. And while page protection is a good short-term measure for pronounced edit wars, I don't think there's a clear case of that at this time. --Rob (talk) 16:29, 21 June 2009 (UTC)

I guess what it comes down to is that while any editor of this page will know that there are POV issues, a casual reader searching for information would not. In that context, I think it's important to highlight the fact that there may be POV issues on the page. --Rob (talk) 17:26, 21 June 2009 (UTC)

I agree with Rob. If you read the edit summaries of just the last ten days [23] there are several comments about POV and OR. Readers should be informed there might be a problem, and the POV tag helpfully directs editors to discuss these POV issues on the talk page which is supposed to be a good thing. I believe Jfdwolff's warning, "In some situations, putting POV tags on articles is itself an act of POV pushing, so please tread carefully." was way off the mark in this instance. Ward20 (talk) 19:25, 21 June 2009 (UTC)

Explanation of reversions

I'm reverting a few of RetroS1mone's recent changes. Specifics follow:

• Intro: "poorly" back to "inadequately", as discussed here. Several editors have now changed "poorly" to "inadequately" and we've explained why, but for reasons I don't understand, RS keeps reverting it.
• Psychological Factors section: information differs significantly from sources, as discussed here.
• Naming section, 2nd para: "Some CFS patients" back to "Many people" to reflect source (second para); removed redundant "they think" references - "believe" at the beginning of the sentence should be sufficient. Also changed "Other patients" in the next sentence to "Some patients", since this no longer follows on the previous sentence. Note that in this sentence, the term "patients" is supported by both sources.

--Rob (talk) 07:54, 21 June 2009 (UTC)

Some more discusssion. Under Disease associations is the wording, "Hysterical diagnoses are not merely diagnoses of exclusion but require criteria to be met on the positive grounds of both primary and secondary gain."[24] How does that impart useful information to the reader about Hysterical diagnoses and ME/CFS? I don't have ready access to the book to improve the material. Ward20 (talk) 20:36, 21 June 2009 (UTC)

I can see that as possibly stating that there must be primary and secondary gain in order to be a hysterical diagnosis instead of CFS, though it's certainly not clear. Looking at some of the other statements in that section, though, I wonder if it might not be better to have a "differential diagnosis" section where some of that information would be more relevant. --Rob (talk) 21:14, 21 June 2009 (UTC)

Yes, I think that is a good idea. A "differential diagnosis" section would be a better title IMO and also be appropriate next to the Co-morbidity section. Ward20 (talk) 02:11, 22 June 2009 (UTC)

Post-viral fatigue syndrome

The chronic fatigue syndrome article says Post-viral fatigue syndrome is the same or a subset of ME/CFS, and the WHO lists them both at disorders of the nervous system under G93.3 pg 528/770 alphabetic index (Volume 3) of the ICD and chapter VI (Volume 1) of the ICD. So we have a chronic fatigue syndrome article that never links Post-viral fatigue syndrome. Should they be linked or merged? Ward20 (talk) 22:18, 22 June 2009 (UTC)

I think it should be a redirect to CFS (which it was in the past). Looks like it has become a bit of a POV fork, with help from Guido. --sciencewatcher (talk) 22:31, 22 June 2009 (UTC)

I agree, there's no need for a PVFS fork. I've added a {{merge}} tag to the PVFS article. --Rob (talk) 23:06, 22 June 2009 (UTC)

Is there anything from that article that we can use for Chronic fatigue syndrome? I like the Risk factors section but I don't know where the material would go since the research is rather specific for Post-viral fatigue syndrome. Ward20 (talk) 23:52, 22 June 2009 (UTC)

If we merge there should be some discussion about nomenclatures. this recent review does not indicate that PVFS and Chronic fatigue syndrome are the same. It says, Chronic fatigue syndrome (CFS) is a specific clinical condition" and "Similar disorders have been described for at least two centuries and have been differently named neurasthenia, post-viral fatigue, myalgic encephalomyelitis and chronic mononucleosis." This review also seems to draw some distinctions between the two.

The Alternative names for chronic fatigue syndrome article says, "Several of the more common alternative names used to describe what most believe to be the same condition or subtypes include post-viral fatigue syndrome, benign myalgic encephalomyelitis (often shortened to myalgic encephalomyelitis, ME), and chronic fatigue immune dysfunction syndrome (CFIDS)." But there is no source for that assertion and reading the article I didn't find sources stating the nomenclatures are the same illnesses or subtypes. Ward20 (talk) 04:25, 23 June 2009 (UTC)

While I understand the distinction that you're making, I'm not sure if the report is necessarily doing the same - the intent of the wording is ambiguous. I think the problem lies with the fact (as it always does with CFS) that we don't know what causes it, therefore we don't know if other illnesses with similar symptoms are the same or not, and thus the term "similar disorders" is being used as a catch-all phrase here for those that may or may not be the same illness. My biggest concern is that if we assume PVFS is a separate illness, then we have to assume that all those other names we've listed might be separate illnesses as well and create separate articles for those as well, probably with all the same issues as we have on this article. As you say, I think if we do merge them, the ambiguity of any particular name should be pointed out.

I personally disagree that they're intended to be interpreted as different entities since none of the classification systems listed on either article list both entries as separate and distinct. In fact, the MeSh entry even specifically equates the two.

Also, the first comment and DX Diagnosis comment on the PVFS talk page may be something to look at for anyone who hasn't already. I don't think the case for PVFS being a separate designation is proven in either the article or the talk page, but YMMV. --Rob (talk) 06:37, 23 June 2009 (UTC)

I agree with you, it has not been proven they are different. By the same token it has not been proven they are the same either. Nor do I see any sources that say most believe them to be the same condition. "Similar disorders" is cautious wording by the review article. I believe we should be as cautious, not saying they are different or the same. I don't have a problem with the merge, just with stating they are the same without a reference. It doesn't appear entry terms state they are equal to the primary term, "Entry terms are not always strictly synonymous with the preferred term in the record or with each other." Ward20 (talk) 07:32, 23 June 2009 (UTC)

{outdent}The table from ICD-10-CM (2009 Update) removes the confusion of the present ICD-10, by unambiguously separating CFS from PFVS/ME [25]

(p. 358) G93.3 Postviral fatigue syndrome [aka] Benign myalgic encephalomyelitis Excludes1: chronic fatigue syndrome NOS [no other symptoms] (R53.82)

(p. 1340) R53.82 Chronic fatigue, unspecified [aka] Chronic fatigue syndrome NOS [no other symptoms] Excludes1: postviral fatigue syndrome (G93.3)

(My emphases for clarity, with explanations in square brackets.) The User Notes on p. 1 defines

Excludes1 A type 1 Excludes note is a pure excludes. It means "NOT CODED HERE!" An Excludes1 note indicates that the code excluded should never be used at the same time as the code above the Excludes1 note. An Excludes1 is for used for when two conditions cannot occur together, such as a congenital form versus an acquired form of the same condition.

In other words, ME/PVFS and CFS are in process of being coded by WHO as separate disease categories that "should never be used at the same time" and "cannot occur together". Sam Weller (talk) 10:37, 23 June 2009 (UTC)

But Sam the ICD-10-CM is the draft version of the ICD produced by the US agency National Center for Health Statistics (NCHS). Anticipated implementation date is October 1, 2013. The Chronic Fatigue Syndrome Advisory Committee (CFSAC) has instead recommended CFS be put under G93.3.[26]. SNAFU. Ward20 (talk) 15:46, 23 June 2009 (UTC)

True, Ward, but the CFSAC minutes are 4 years old, and I did write 'in process' re 2013. At least the ICD 2009 update is clear, unlike the current publication and earlier proposed revisions. Sam Weller (talk) 18:33, 23 June 2009 (UTC)

You're right Sam, data is data and we have to put it in perspective. Ward20 (talk) 20:06, 23 June 2009 (UTC)

As far as I know, we have to go by what current medical documentation states. So while it may well be that PVFS and CFS are two different entities and will be recognized as such in the future, I don't see anything conclusively stating they are. Draft documentation is, of course, just that, and should not be used. I would agree that a nomenclature intro would be appropriate in one or both articles (if we keep both), though - clearly there's ambiguity in their usage, whether or not they're different. --Rob (talk) 20:35, 23 June 2009 (UTC)

The 2009 update is for information only, Rob. As a matter of interest, ICD-10-CM (2007 revision) is already cited here: [27], so I've posted the 2009 update there. It should probably appear in the Controversies article as well. Sam Weller (talk) 22:12, 23 June 2009 (UTC)

It seems the discussion went slightly stale. How about posting at Wikipedia:Requests for comment? Ward20 (talk) 22:18, 25 June 2009 (UTC)

What about WikiProject Medicine instead? I'd have to review the reasons for posting an RfC, but I suspect WP:Med would get more knowledgeable responses. --Rob (talk) 02:37, 26 June 2009 (UTC)

Whatever gets some neutral responses. Ward20 (talk) 03:20, 26 June 2009 (UTC)

Done. --Rob (talk) 04:40, 26 June 2009 (UTC)

Thanks. Ward20 (talk) 04:56, 26 June 2009 (UTC)

I am for linking them, but not merging them. --Una Smith (talk) 05:24, 26 June 2009 (UTC)

So am I. A search for ME ought to redirect to PVFS, not CFS. Sam Weller (talk) 08:46, 26 June 2009 (UTC)

I totally concur with the above 2 comments. I think we should put a link in to redirect searches about ME to PVFS. But I certainly do not agree with the idea of merging CFS with PVFS. StevieNic (talk) 10:06, 26 June 2009 (UTC)

Don't have time to read or comment, but I do have a couple sources to drop off: [28], [29], [30], [31], [32], [33] (this one has some interesting stuff on the classification within the WHO ICD-10), [34], [35]

My emphasis was on recent (2006-2009) and reliable. There's 62 hits total, I didn't review them all. Preliminary look suggests they're generally considered interchangeable, but there are some exceptions. WLU (t) (c) Wikipedia's rules:^simple/_complex 14:34, 26 June 2009 (UTC)

That doesn't make sense. It's generally agreed that the terms CFS and ME are used synonymously, but that isn't the case for PVCS/ME.

The Alternative Names page already discusses ME and PVCS, so if you prefer we can have ME and PVCS redirect to that page. --sciencewatcher (talk) 14:38, 26 June 2009 (UTC)

Why should "PVFS" and "CFS" be merged when not all "CFS" is post-viral and not all "PVFS" meets CFS criteria? As for the "conflicting" risk factor research in the PVFS article, I notice that the first study (full text: [36]) uses laboratory evaluations and the CDC-1994 criteria for CFS, while the second study (PMID 7916407) uses phrases like "GP-diagnosed viral illness", "infective symptoms", and "criteria for chronic fatigue" (without the full-text I can't tell how relevant these are to CFS and PVFS). These two studies may not be examining the same condition.

Some view "post-viral" FS (M Sharpe [37]) and "post-infectious" FS (Oxford 1991 definition) as a subtype of the general "CFS", but arguments also exist for the reverse: The Hickie et al 2006 study above suggests that post-viral CDC-1994 defined CFS is a "subtype" of a broader concept of post-viral fatigue. The CDC-1994 and Canadian 2003 definitions don't seem to mention subtypes as such but view infection as an onset trigger or pathway. But is PVFS just "post-viral fatigue" that lasts more than 6 months? Earlier descriptions of ME indicate a post-viral condition that goes much further than "fatigue". Additionally, the term "post-viral" is limited to viral pathogens, whereas the Hickie et al 2006 study was also relevant to a few non-viral pathogens.

NOS in ICD means "not otherwise specified" rather than "no other symptoms". According to the WHO's ICD, ME is under PVFS as G93.3 while there is also F48.0 (neurasthenia / "fatigue syndrome", which describes more than just "fatigue") and R53 (Malaise and fatigue). To make it even more complicated, different parts of the world use somewhat altered ICD, right? Where does "CFS" fit in when all three classifications are mutually exclusive? According to one of the sources that WLU posted ("Contesting illness"), ME is G93.3 while CFS is R53 (rather than F48).

_Tekaphor (TALK) 13:42, 27 June 2009 (UTC)

I would oppose merging, whilst not being an expert in this area I know that these two syndromes are not the same. Whilst CFS does have an evidence base for being triggered by viral infections in many (but not all) cases it is not the same as post viral fatigue. Post viral fatigue can occur and linger for weeks or months without it progressing into CFS and is always triggered by a virus whereas CFS is not always triggered by a virus. I myself have had very nasty flu's and cold's which knocked me down for several months but then I recovered fully. I never had CFS but had PVF. Lots of people get PVF at some time in their lives after a nasty infection. They should be seperate articles I feel.--Literaturegeek | T@1k? 02:06, 28 June 2009 (UTC)

I made an error in my post above in my wording, I have re-edited it so it reads right what I mean.--Literaturegeek | T@1k? 02:06, 28 June 2009 (UTC)

I also think merging is a bad idea and more than a little problematic, mostly for the reasons stated in the previous paragraph.Goal (talk) 01:22, 28 June 2009 (UTC)

Okay, it looks like the consensus is against the merger. My only concern in this case is finding suitable sources to support this in the event that it becomes a question again. --Rob (talk) 02:32, 28 June 2009 (UTC)

It has been previously suggested that discussions like this be copied onto a separate page like an FAQ for easy reference when these topics reappear. I am not sure how to accomplish this. Ward20 (talk) 02:53, 28 June 2009 (UTC)

Sciencewatcher's suggestion that ME should redirect to ME/CFS nomenclature is sensible. I was surprised to find myself here after searching for ME a few months ago. Sam Weller (talk) 10:30, 28 June 2009 (UTC)

• Support merge. Not evidence for seperating PVFS from ME/CFS, these are medically unexplained symptoms and so is FM, MCS, GWI. They are all overlap and no person knows what causes. RetroS1mone talk 21:58, 7 July 2009 (UTC)

Osler's Web: Inside the Labyrinth of the Chronic Fatigue Syndrome Epidemic

RetroS1mone, are you saying that "Osler's Web" does not satisfy Wiki's requirement as a RS or external reference? Anyone disagreeing with the author's POV can easily relegate it to a conspiracy theory, perhaps it is an alternative point of view aside from the medical establishment or medical profession's POV? Surely there is some room for alternative POV that in reality does exist in the real world. Terry Macro (talk) 04:53, 9 July 2009 (UTC)

O yes there is room on Wikipedia but this is a medical article the nonmedrs can go at conteroversies related to chronic fatigue syndrome article. RetroS1mone talk 05:04, 9 July 2009 (UTC)

Thanx for the redirection. However you should consider making it clearer in the body or beginning of the article that readers can access the controversies etc sections other than in the fineprint at the very bottom of the page. It is not made clear at the beginning of the article that the focus of the topic is a medical article and other issues related to CFS can be found at other topics etc. Terry Macro (talk) 07:29, 9 July 2009 (UTC)

between the title and lead it should state something like the following:

This article is mainly about the medical symptoms associated with chronic fatigue syndrome. For history of chronic fatigue see History of Chronic Fatigue, for Alternative names for chronic fatigue syndrome see XXXX for controversies related to chronic fatigue syndrome see, for cultural references to chronic fatigue syndrome see etc
Terry Macro (talk) 07:42, 9 July 2009 (UTC)

Why aren't there any links to the CFS controversy page?

Yes, Terry has a point. I'm going to add some links now. Also note that the small collapsable table at the bottom of the article with all the mini-links to the relevant CFS pages, is as far as I know, dependant on the web browser having JavaScript enabled (not everyone enables it). - Tekaphor (TALK) 09:07, 9 July 2009 (UTC)

Recent edits

• "CFS is also thought to be among the medical conditions most commonly feigned by malingerers, usually done for financial reasons." (PMID 17938038). In light of RetroS1mone's semi-recent edits on hypochondriasis in CFS and the alleged "medical opinion" about hypochondriacs in the TV show "House" (both which ended up being reverted because it was original research), I am wondering if the more recent edit on "malingering" is also original research. Does the full text actually mention CFS specifically? The abstract says, "While in theory any ailment can be fabricated or self-induced, pain--including lower back pain, cervical pain, and fibromyalgia--and cognitive deficits associated with mild head trauma or toxic exposure are feigned most frequently, especially in situations where there are financial incentives to malinger. Structured assessments have been developed to help detect both types of malingering; however, in daily practice, the physician should generally suspect malingering when there are tangible incentives and when reported symptoms do not match the physical examination or no organic basis for the physical complaints is found." So by definition, the author thinks malingering should be generally suspected in all "medically unexplained" syndromes. A similar review (PMID 15502686) published in 2004 says "There are, however, no valid clinical methods of assessment of possible malingering of pain." So what's changed in 3 years, and is this statement of malingering in the CFS article based on actual research or is it just an opinion? The Australian 2002 clinical practice guidelines for CFS (already in the CFS article under "Social issues") states that, "In the absence of evidence of malingering, speculative judgements about unconscious motivation should be avoided. The psychoanalytic concept of 'secondary gain' has been misused in medicolegal settings and does not rest on a solid empirical base.[526][527]" ([526] = Fishbain DA. Secondary gain concept: definition problems and its abuse in medical practice. Am Pain Soc J 1994; 3: 264-273 ... [527] = Fishbain DA, Rosomoff HL, Cutler RB, Rosomoff RS. Secondary gain concept: a review of the scientific evidence. Clin J Pain 1995; 11: 6-21).

• Although I haven't seen the full text, RetroS1mone's wording "Childhood abuse is also a disposing factor to CFS and other medically unexplained symptoms like fibromyalgia." seems at odds with what the authors say in the abstract: "Compared with healthy controls, childhood sexual abuse was significantly more likely to be associated with outcomes of idiopathic chronic fatigue, chronic fatigue explained by a psychiatric condition, and chronic fatigue explained by a medical condition. None of the abuse history types were significant predictors of chronic fatigue syndrome. A closer examination of individuals in the chronic fatigue syndrome group revealed that significantly fewer individuals with CFS reported abuse as compared with those who did not." (PMID 11708672)

• As for the part about "CFS patients have a low placebo response compared to...", the text was changed from "possibly due to altered patient expectations regarding psychological and psychiatric expectations about their conditions" to "partly because some patients reject in advance treatments they believe are psychological in nature." The study was on placebo response in general, not just "psychological-psychiatric" treatments, "biological" treatments also showed a lower placebo response. Perhaps the psychological-psychiatric treatments had the lowest response, but the full text [38] discusses the possible reasons; the most concise summary of the issue is in this sentence in both the abstract and towards the end of discussion in the full text: "...possibly because of patients' lower expectations." Anything else seems rather selective, and this study has been discussed before [39].

_Tekaphor (TALK) 08:30, 9 July 2009 (UTC)

Thanks for the discussion, Tek. The edits you've reverted were OR, bordering on systematic misrepresentation of sources. Sam Weller (talk) 10:11, 9 July 2009 (UTC)

You want more of the malingering literature bc i can add alot more references. Tek is doing the OR w 1994 papers vs a 2007 review i added. I am reading alot on this and i am finding there is alot of doctors that think CFS and FM and other things are the same problem. RetroS1mone talk 13:29, 9 July 2009 (UTC)

Wait that is interesting, "Thanks for the discussion, Tek. The edits you've reverted were OR" so StevieNic and Tekaphor are the same person?? Interesting sam RetroS1mone talk 13:39, 9 July 2009 (UTC)

I didn't make any edits relevant to the above comments, merely discussed RetroS1mone's edits. Perhaps Sam was talking about something else. I was simply encouraging discussion on the subject, RetroS1mone, please point out the "OR" (a term you have used so loosely over the last year that it's become meaningless). Also, you never addressed all my other concerns, merely accused me of "OR". Over the last few months you have actually been involved in disputes where several of your edits were reverted for being OR and not properly representing the sources, hence my concern. I asked if the full-text specifically discusses actual research into CFS; are you telling me that you added the malingering review simply because, (a) some people fake or exaggerate FM, (b) some doctors think CFS and FM are the same? Take a look at the WP:SYN page:

• "Do not combine material from multiple sources to reach a conclusion not explicitly stated by any of the sources. Editors should not make the mistake of thinking that if A is published by a reliable source, and B is published by a reliable source, then A and B can be joined together in an article to reach conclusion C. This would be a synthesis of published material that advances a new position, and that constitutes original research." (emphasis added).

As for me being StevieNic, another "cabal" conspiracy hypothesis brewing eh RetroS1mone? How about another checkuser "joke" on my user talkpage, that would be fun. Anyway, according to your edit summary, you thought my minor edits (adding internal links) were good, yet you failed to reinsert them when reverting SteveNic [40]. Thanks for the extra work.

_Tekaphor (TALK) 15:22, 9 July 2009 (UTC)

Again with the accusations by RetroS1mone of "liking" or "disliking" sources. Again with the same response I've given time and time again: I do not "like" or "dislike" sources. I simply fail to see the relevance of citing facts about feigned illnesses on the page of the real thing. You've also cited facts in your edit summary that have no verifiability that I can see. At best, the phrase you've introduced into the header might have a place in an "overlap with other illnesses" or similar section, but I can't see how a feigned illness statistic has any bearing on the real thing...unless, of course, you believe the entire condition is feigned by millions of people world-wide...which would be OR in its own right.

I'll let someone else revert that, if they agree, as I don't want to be accused of edit-warring. --Rob (talk) 02:08, 10 July 2009 (UTC)

It is a very notable thing when a MEDRS review says 25-30% from FM/CFS is feigned or exagerate. I do not think every one is doing that, i hope you do not say that about me. It is important to say it in the Wiki that it is so common. You do not think it would be notable, someone finds out 30% of heart disease is faked, come on people. RetroS1mone talk 03:30, 10 July 2009 (UTC)

Um, "25-30%" is only "very notable" if it cites a very large study on CFS. And if it's just an opinion about malingering, you have failed to demonstrate that the "MEDRS review" actually pinpoints CFS, despite multiple requests for you to do so. Please confirm whether (1) it cites an adequate CFS study to make such a sweeping claim, (2) any opinion about malingering actually discusses CFS specifically. Otherwise you're engaging in "original research" as per WP:SYN, just like you did recently with the study on CBT for hypochondriasis. CFS and FM aren't even synonymous at Wikipedia. Also, when are you going to address the other above mentioned concerns? - Tekaphor (TALK) 06:14, 10 July 2009 (UTC)

I reverted it back, I cannot see how this can be even remotely relevant. If they are malingerers then they do not have CFS. They have not passed that particular criteria and therefore it has no place in an article about the illness.StevieNic (talk) 07:56, 10 July 2009 (UTC)

I don't see how it could fail to be relevant, although if there were a separate article on CFS symptoms it would be more relevant there. — Arthur Rubin (talk) 08:03, 10 July 2009 (UTC)

It can easily fail to be relevant, because we still don't know whether McDermott mentioned cfs. Can I ask Retro if you have actually read the article? I can't access it, but I'm not too bothered since it's been cited only once on PubMed. Sam Weller (talk) 08:24, 10 July 2009 (UTC)

Since RetroS1mone added this material [41] it has been added and deleted several times. Since there is a dispute about its relevance, I am requesting RetroS1mone or Arthur Rubin provide direct quotes from the source, and details about the original studies cited by the source (also as requested by Tekaphor above), as a courtesy to substantiate the information per policy. (Note #2.) Thank you. Ward20 (talk) 08:53, 10 July 2009 (UTC)

RetroS1mone has promoted this same review at the Fibromyalgia article, inserting it into the "Causation hypotheses" section (isn't it more of a diagnostic problem?). Anyway, when asked on the talk page (08 July 2009) to provide the relevant page number or section, RetroS1mone had no problem giving the page numbers and alluding to a primary study.[42] Why hasn't RetroS1mone been as forthcoming on this CFS talkpage? Later on at Talk:Fibromyalgia there is this explanation:

• "the review is about Medically Unexplained Symptoms, fibromyalgia/CFS is a most common Medically unexplained symptoms. Alot of people that get diagnose, CFS are also diagnose, FM or MCS or GWI so alot of doctors think, they are different names for same condition, a MUS review is a FM review" [43].

But the title of the review is "Malingering in the medical setting" and it talks about pain, so where is the usage of "medically unexplained symptoms" coming from? As for the primary study, this seems to be PMID 12650234, which states that " ... 35% of fibromyalgia/chronic fatigue, ..." claims "resulted in diagnostic impressions of probable malingering". I'm not clear on how the sample group applies to CFS cases in general, but CFS is not "fibromyalgia" or "chronic fatigue" anyway.

_ Tekaphor (TALK) 09:41, 10 July 2009 (UTC)

"Why hasn't RetroS1mone been as forthcoming on this CFS talkpage?" Why you think, bc people here call me "it" and "this" and revert MEDRS w/o discussing. CFS is not chronic fatigue?? Pls, authors talk about CFS and some say "chronic fatigue syndromes" and some say "chronic fatigue" you are saying CFS and chronic fatigue are not same thing or things?? What is MEDRS for it. And you think CFS symptoms are medically explained?? Every review says the cause is not known. The MUS reviews say CFS and FM and MCS and IBS are medically unexplained symptoms, do you want me cite three of them,five how many?? Do you want one quote from each, five?? Do you want, I ignore copy rights like some people and send you whole PDFs?? Pls go to a library people and you can get internet access through library when you can not leave house there are programs. RetroS1mone talk 12:30, 10 July 2009 (UTC)

OK i try to help, here is some reading on CFS and MUS

• Deary V, Chalder T, Sharpe M "The cognitive behavioural model of medically unexplained symptoms: a theoretical and empirical review" |journal=Clin Psychol Rev |volume=27 |issue=7 |pages=781–97 |year=2007 |month=October |pmid=17822818 |doi=10.1016/j.cpr.2007.07.002
• Nimnuan C, Hotopf M, Wessely S |title=Medically unexplained symptoms: an epidemiological study in seven specialities |journal=J Psychosom Res |volume=51 |pages=361–7 |year=2001
• Frederick Wolfe the top citing fibromyalgia researcher says FM and CFS and IBS and "chronic Lyme" are the same thing, there is like 20 articles i read by this person, most recent ones is a review April, Wolfe F |title=Fibromyalgia wars |journal=J Rheumatol. |volume=36 |issue=4 |pages=679-83 |month=April |year=2009 |pmid=19342721 and a editorial "Fibromyalgianess" Arthritis Rheum. 2009 Jun 15;61(6):715-6. "the distinction between FM and other MUS conditions is clearly artificial, as the pool of underlying symptoms is the same"
• Mohammed Yunus is another top MUS FM expert, he says MUS like FM and CFS is a "Central Sensitization Syndrome" I am sorry i do not have the yunus references before me, ask when you want.
• A good book by another MUS expert Hadler NM Worried sick. Chapel Hill: The University of North Carolina Press; 2008, it says

"if you ask rheumatologists to examine the patients in a gastroenterology clinic, they will diagnose "fibromyalgia" in the majority of patients previously diagnosed as suffering "Irritable Bowel Syndrome" by the gastroenterologists. The gastroenterologists will return the favor if they examine the "fibromyalgia" patients in the rheumatology clinic. The symptoms of patients labeled as "Chronic Fatigue Syndrome" overlap those of patients with "fibromyalgia" (the tender points as well) so as to render the distinction untenable. Hence, there is the argument that all of htese patients have a single "functional somatic syndrome" characterized by a spectrum of "medically unexplained symptoms.""

"people who are predisposed to somatize when under stress, and this predisposition takes over their lives when they are overwhelmed by life's difficulties. Unfortunately, they are then rendered more ill by the process of medicalization."

• Barsky AJ, Borus JF Functional somatic syndromes. Ann Intern Med 1999;130:910–21

"These syndromes include multiple chemical sensitivity, the sick building syndrome, repetition stress injury, the side effects of silicone breast implants, the Gulf War syndrome, chronic whiplash, the chronic fatigue syndrome, the irritable bowel syndrome, and fibromyalgia. Patients with functional somatic syndromes have explicit and highly elaborated self-diagnoses, and their symptoms are often refractory to reassurance, explanation, and standard treatment of symptoms. They share similar phenomenologies, high rates of co-occurrence, similar epidemiologic characteristics, and higher-than-expected prevalences of psychiatric comorbidity. Although discrete pathophysiologic causes may ultimately be found in some patients with functional somatic syndromes, the suffering of these patients is exacerbated by a self-perpetuating, self-validating cycle in which common, endemic, somatic symptoms are incorrectly attributed to serious abnormality, reinforcing the patient's belief that he or she has a serious disease."

• Wessely S What do you think is a non-disease? Pros and cons of medicalisation. BMJ 2002;324:912 It says some doctors says CFS is "not yet a disease because no unambiguous evidence has yet been presented that has commanded widespread acceptance by the scientific community"
• Wessely S, Hotopf M Is fibromyalgia a distinct clinical entity? Historical and epidemiological evidence. Baillieres Best Pract Res Clin Rheumatol 1999;13:427–36 "fatigue and myalgia syndromes are arbitrarily created syndromes that lie at the extreme end of the spectrum of polysymptomatic distress"
• Huibers MJ, Wessely S The act of diagnosis: pros and cons of labelling chronic fatigue syndrome. Psychol Med 2006;36:895–900 "labeling makes a patient "believe she has a serious disease, leading to symptom focusing that becomes self-validating and self-reinforcing and that renders worse outcomes, a self-fulfilling prophesy. Diagnosis leads to transgression into the sick role, the act of becoming a patient even if complaints do not call for it, the development of an illness identity and the experience of victimization. The dangers of labeling have raised some voices to abandon diagnostic labels such as CFS altogether"
• Deary "A precarious balance: using a self-regulation model to conceptualize and treat chronic fatigue syndrome." Br J Health Psychol. 2008 May;13(Pt 2):231-6. Epub 2008 Feb 8. RetroS1mone talk 12:53, 10 July 2009 (UTC)

O and here is textbook on malingering,

• Clinical assessment of malingering and deception By Richard Rogers "The majority of patients who present with CFS symptoms are likely legitimate. However, skepticism surrounds the diagnosis." and "the potential for deception is certainly present" and page 41, table with 3 kinds of malingering with CFS and how it happens. RetroS1mone talk 13:12, 10 July 2009 (UTC)

Retro, please answer the question. To repeat myself, and everybody else: "Can I ask Retro if you have actually read the article?" (by McDermott). That was a polite request for relevant information addressed to you. Have you read it? From here it looks like you thought that the mention of FM in the abstract applies to CFS. Your list of quotes that try to prove CFS is part of a single MUPS syndrome get us nowhere, because that is an extreme position associated with Simon Wessely. Peter White completely disagrees, and believes it is scientifically and clinically retrograde: [44] Sam Weller (talk) 14:18, 10 July 2009 (UTC)

I'm struck by how little there is to link malingering with CFS when you Google cfs + malinger. Here are some MEDRS that state the opposite:

• Heilbroner & Castaneda. Pediatric neurology: essentials for general practice. 2006 ISBN 0781769450: "CFS is a debilitating illness and not caused by depression or malingering." p. 44.

• Cantor C.; Neulinger K. Premorbid functioning, welfare issues and ethics in chronic fatigue syndrome. Australasian Psychiatry, 11: 2003 312-318 "...no reports declared evidence of malingering."

• Grace (ed). Medical management of infectious disease, 2003. ISBN 0824708504. [on CFS] "These patients are not malingering." p.730

And a non-MEDRS that hits the nail on the head:

• UK NHS resource for chronic disease patients:"It once earned the nickname of "Yuppie flu" as it seemed to affect young, hard-working people, but this cynical name only served to show that this debilitating illness often strikes the people least likely to malinger."

I've removed the stigmatizing remark, pending evidence that McDermott actually says anything at all about CFS, or until empirical evidence of malingering in CFS is presented.Sam Weller (talk) 16:16, 10 July 2009 (UTC)

Why is MUPS suddenly cropping up here and elsewhere? Wessely is quoted in the MUPS article as equating MUPS with somatoform disorder. It looks like MUPS is being defined there and spammed here to facilitate "CFS = somatoform disorder". In other words, the phrase 'medically unexplained physical symptoms' is being used not as an statement of regrettable medical ignorance, but as a Trojan horse for a judgement about patients' moral inadequacy. I think careful editing of the MUPS article and all the articles where MUPS has recently been introduced is required. Retro removed longstanding criticism of Wessely's 'single functional somatic syndrome' at the MUPS article, although it's a highly controversial theory. I've added White's MEDRS critique there to even things up. Sam Weller (talk) 19:13, 10 July 2009 (UTC)

Very sad to me, people in 2009 say affective disorder or somatoform disorder or hypochondriasis is "moral inadequacy." I do not say that, i do not think that, I am sorry Sam Weller thinks that. Also malingering, there is criminal malingering and financial malingering and also malingering with psychiatric causes, not all malingering is "moral inadequate" and i think "moral" is a wierd thing to say for some one that says they are a scientist.

White's editorial statement w/ Wessely is not a MEDRS. Yes there is alot from critique for Wessely and there needs be all big opinions on Wikipedia, but MEDRS pls. Wessely also not only person that thinks about CFS/FM like that, it is sad patient activist groups make Wessely a monster and put all hate on him, alot doctors and scientists agree on what he says.

Sam Weller is right about it tho, this article has deficients, it does not say about malingering and somatization and social construction and sensitization hypotheses, it should have correction. Let us work together and improve the article for these major view points from MEDRS. RetroS1mone talk 02:42, 11 July 2009 (UTC)

This "MUPS" argument seems like a red-herring to the real issue of "original research". The above references don't even demonstrate that CFS and FM etc are synonymous, they discuss the overlap and the supposed unifying similarities. Some authors might hypothesise that CFS, IBS, FM etc are all variants of the same general disorder (or category of disorders), but that doesn't mean the scientific consensus is that they are all equivalent (especially when differences have been found between syndromes, besides the blatantly obvious like how CFS is not PMS or migraine); so a study on FM doesn't necessarily apply to all "MUPS". - Tekaphor (TALK) 03:57, 11 July 2009 (UTC)

Retro, In reponse to your personalized banter (weird, says he's a scientist), I'll just suggest that you bring yourself up to date with research into moral stereotyping of CFS in healthcare settings: Asbring P, Närvänen AL. Ideal versus reality: physicians perspectives on patients with chronic fatigue syndrome (CFS) and fibromyalgia. Soc Sci Med. 2003 Aug;57(4):711-20. PMID 12821018 See sections: Moral judgement of illness and Moral judgement of patients. Conclusion: "Freidson (1971) suggests that there is often a moral, i.e. judgmental assessment of illness related conditions, which is also shown in this study." Sam Weller (talk) 08:22, 11 July 2009 (UTC)

Up to date for Sam Weller is a interpretation in 2003 from one person may have "suggested" in 1971? I do not read a MEDRS says somatization, somatoform disorder says patient is "moral inadequate" that is a thing activists accuse doctors about but i do think it is not MEDRS. So wierd it is like it says in holy bible, thou shall not have a physical symptom that come from a mental process?? Pls, it is not science, talk about "moral" is a way for dividing people. RetroS1mone talk 13:39, 11 July 2009 (UTC)

The "moral" argument is too narrow, and I'm sure there are plenty of other sources which discuss the poor treatment and negative attitudes towards CFS patients in general, even from the pro-biopsychosocial crew I'm not going to look for them all now, but from the top of my head, Wessely has written on the subject saying that patients are generally viewed as an "unavoidable, untreatable and unattractive burden" and that some doctors see them as "neurotic" and will be "disgusted by them". The enlightened notions sometimes floated around here about "patient care" probably aren't representative of what actually happens in the real world. A typical response to criticism of psychological factors in CFS is that it doesn't mean CFS is "all in the head" etc, but that's exactly what many medical professionals and lay persons alike interpret it as meaning; I think someone (maybe White) has written about how this "misinterpretation" on behalf of the patient is at least partly the fault of doctors. - Tekaphor (TALK) 10:16, 13 July 2009 (UTC)

I previously brought up 3 issues under this "Recent edits" section. #1 was verifiable and #2 was fixed by someone else, but #3 remains unresolved. I tried to explain that the text on the placebo response was emphasizing only lowered response for psychological-psychiatric treatments when in reality it was also for treatment in general. Another meta-analysis already used in the section for CBT/GET (PMID 18060672) also discusses the systematic review on placebo in question as: "Cho, Hotopf, and Wessely (2005) used meta-analysis to examine the placebo effect in treatment of CFS and found that the placebo response across studies was less than for some other medical disorders and was lower for psychological interventions than for drug treatment." This is exactly what I was trying to convey earlier. - Tekaphor (TALK) 14:22, 20 July 2009 (UTC)

Add POV tag?

Some time ago, I added a {{POV}} tag to the main article and it was reverted. I would like to seek consensus to do so again. I don't do this as any kind of disruptive measure, simply as an acknowledgement of fact. At any given time, I'm sure there's at least one editor who believes that the article supports a specific POV, and in fact the edit summaries of numerous users on both sides of various debates would certainly indicate that. As I said after the initial reversion: while any editor of this page will know that there are POV issues, a casual reader searching for information would not. In that context, I think it's important to highlight the fact that there may be POV issues on the page.

Is there anybody who would object to a POV tag at this point? (And if so, please explain why.) Thanks! --Rob (talk) 17:02, 10 July 2009 (UTC)

• oppose i say the article is good and w additions Sam Weller reminds us, it will be better and have more view points. RetroS1mone talk 02:44, 11 July 2009 (UTC)

  I find it amusing that you said the article is good less than a day after asking that the article be protected for edit warring. So you're saying that there's absolutely no POV concerns with any variation of the article in the edit war? --RobinHood70 (talk) 18:31, 14 July 2009 (UTC)

• support in view of the MUPS discussion below and that a perfectly good edit that supplied a source for an unsourced tag was reverted[45]. The study reported on a range of results by several other studies. In that sense it's a secondary source for the material that was presented. Ward20 (talk) 04:24, 20 July 2009 (UTC)

• support because MUPS in the lead acts as a POV fork to a controversial psychiatric interpretation. Sam Weller (talk) 08:30, 21 July 2009 (UTC)

Is there one thing about CFS which is not conteroversial?? The "controversial psychiatric interpretation" is a major view point that people are able to keep out of this article so far but it should in with all major view points bc this is encyclopedia. RetroS1mone talk 12:46, 21 July 2009 (UTC)

That would be an excellent point in favour of a {{POV}} tag...you clearly feel that there is a point-of-view being presented here which is not in line with a more balanced interpretation...the very thing that POV tags are for. On the other hand, I count 28 references from psychological or psychiatric publications, and I see several sections that include mention of psychiatric viewpoints, so I don't really see how you can claim that it has been "[kept] out of this article". --RobinHood70 (talk) 18:14, 21 July 2009 (UTC)

A lot of people think there is too much of a psychiatric viewpoint in the article. Retro thinks there is too little. It's probably just about right, in my opinion. The article pretty much reflects what people like the CDC are saying, and that is what we should be aiming for. --sciencewatcher (talk) 19:51, 21 July 2009 (UTC)

It's been a while since I've really sat down and read over the entire article as a whole, but from the look I just had at it above for mentions of psychology/psychiatry, I'm inclined to agree. I don't question that there are some cases where it's either the entire cause or a signficant contributing factor, and similarly, I think research is showing that there are at least some cases where a virus seems likely. From what I've seen, I think we reflect both those points and more in the article, which is in line with the research I've seen. I have it on my "to do" list to go over the entire article and see how it reads when taken as a whole rather than one or two edits at a time. --RobinHood70 (talk) 19:58, 21 July 2009 (UTC)

Depends what RetroS1mone means by "psychiatric viewpoint" and what they expect to be included. I'm guessing "keep out of this article" means "the bad group of editors were challenging the good Prins review with POV systematic reviews", which reminds me of a fundamental point applicable to "psyche" and "bio" alike; you can't present promotional pieces without the appropriate qualifiers and caveats. Users "WebHamster" [46] and "sciencewatcher" [47] touched on a similar issue; it's not necessarily the sources but they way you represent them. R1, that's why you're continually being challenged, but you seem to prefer the convenient explanation that psyche factors aren't "politically correct" and are against "patient advocate agendas" (challenging the psyche perspective also seems "politically incorrect" [48]). Although perhaps more work could be done, the psyche aspects already make up the largest subsections in the article(s)! The whole point of having subpages is to expand the relevant text there, but apparently R1 wants to continue bloating up the main article with the "psychiatric viewpoint" as if the Mechanism section (for example) isn't already swollen up out of proportion over everything else? (ie 1 sentence for the "bio" and 10 sentences for the "psyche"). - Tekaphor (TALK) 02:58, 22 July 2009 (UTC)

OK Tek i am very sorry for the review thing it was a mistake from me bc several reversions but it does not make progress, when you call Lancet review a promotional piece. There is MEDRS and nonmedrs, Prins is MEDRS. The other reviews are MEDRS, i am sorry i reverted that but i am not the person that said, a major review is not reliable.

I would say, there needs be more about somatization, social construct, and the malingering literature but that is me like Sciencewatcher said it needs to be weighted with the literature, i want it also, i do not say look there is not the medicalization theory in this article so i put a POV tag. When article has most of main view points from MEDRS it does not have POV tag. OK some changes here, there, by me, Rob, Tek, but I agree on Sciencewatcher, it is ok now. RetroS1mone talk 03:13, 22 July 2009 (UTC)

I did not mean that the Lancet review was a promotional piece (authors promote their own view anyway), but rather the presentation of any particular viewpoint in general. Neither did I say it was unreliable, although I'm assuming you meant Sam Weller's comment relating to when the issue was brought to the RS noticeboard? - Tekaphor (TALK) 03:00, 31 July 2009 (UTC)

Malingering propose

I do not think most CFS is malingering. I do not know any person thinks most CFS is malingering.

• All sources say, most CFS is not malingered.
• A MEDRS review says FM and CFS are second most malingered condition

I do not know why, people are saying they are exclusive from the other. Why we do not say that?

Sam Weller yes i did read Mcdermott the whole thing and alot from other things. I read the references in it for the FM/CFS and malingering. I read some textbook, i read some primary sources. Here is two qutoes from Mcdermott,

"While almost any medical illness can be malingered, there is evidence that certain types of medical problems are more likely to be malingered than others. In a study of over 30,000 cases referred to 144 neuropsychologists, the most likely ailment to be malingered was mild head injury, followed by fibromyalgia or chronic fatigue syndrome, pain, neurotoxic disorders, electrical injury, seizure disorders, and moderate or severe head injury"

"It is relatively easy to malinger pain because everyone has had the experience of pain and therefore knows how it should appear to others. Hamilton and Feldman [22] note that the malingerer's pain complaint “will vary according to the medical sophistication of the patient; they may present with diffuse pain, or patterns of pain that are not consistent with known medical conditions or with the anatomy of the peripheral nervous system” (444-5). In particular, these cases may present as specific maladies, such as repetitive strain injury or variable limb pain (ie, in reflex sympathetic dystrophy, 'fibromyalgia, or chronic fatigue syndrome), though the bulk of the literature has focused on low back pain or pain related to the cervical and thoracic spine (especially whiplash injuries). The malingerer commonly knows the characteristics of the pain associated with the condition he or she is feigning. One unfortunate result of the wide availability of high quality medical information on the Internet is that malingerers now have abundant guidance on how to convincingly display pain and disability"

Malingering primary sources

• van der Werf SP et al NNBN 2000, from 67 CFS patients, 30% indicated reduced effort, they were not trying. That is significantly higher then in group of MS patients that were controls. This is better control group then most people use, healthy people, bc they are compare sick people w sick people that have a knowing cause.
• Busichio gave an effort test to 34 CFS patients and said they did not fail it but they do not show data and they did not do it on any controls.
• Binder LM et al gave another effort test to 32 GWI patients w CFS symptoms, did not find a large difference from control.
• Mittenberg W et al 2002 look to 33,531 patients and there is evidence for malingering in CFS/FM. In personal injury cases with CFS or FM it is 37-39%.

Textbooks on malingering

• Clinical assessment of malingering and deception By Richard Rogers "The majority of patients who present with CFS symptoms are likely legitimate. However, skepticism surrounds the diagnosis." and "the potential for deception is certainly present" and page 41, table with 3 kinds of malingering with CFS and how it happens
• Neuropsychology of Malingering Casebook By Joel E. Morgan, Jerry J. Sweet, J. Morgan They say most CFS is not malingering and they have a case study about malingering CFS and how doctors can tell and also not be confronting.

My opinion, the article should say like malingering is a mean thing that people said about CFS in past. Most CFS is not malingered. Some CFS may be malingered and estimates are of range from very very small to second most malingered condition w FM, 25-30%. More motive to malinger in personal injury cases, a study w 33,000 cases find 37-39% of FM and CFS cases malingered. There is MEDRS for all from those sayings. It does not need be in lead. RetroS1mone talk 03:01, 11 July 2009 (UTC)

With appropriate citations, I would be okay with something similar to the above in the "History" or "Society and culture" section, or maybe even in an "Alternative diagnoses" section. I don't think something that was a negative perception in the past is appropriate in the header, though. --Rob (talk) 03:17, 11 July 2009 (UTC)

Agreeing w Rob, RetroS1mone talk 03:23, 11 July 2009 (UTC)

It's misleading to imply that 33,000 cases of CFS were studied. And can anyone else confirm that the McDermott source actually says "fibromyalgia or chronic fatigue syndrome"? Because the apparent resistance towards providing this full-text until now has made me suspicious about the bolded text "syndrome"; RetroS1mone implied earlier that CFS and "chronic fatigue" are the same, and the primary reference used (PMID 12650234) says "fibromyalgia/chronic fatigue". It needs to be clear that CFS was studied, and not some assumption of equivalency. While some have argued that the cut-off point for "fatigue" is arbitrary, all CFS definitions (as far as I know) differentiate themselves from "chronic fatigue" and "fibromyalgia". As a note, using "effort testing" on people with "central fatigue" (and possibly co-morbid depression) to demonstrate "malingering" sounds questionable. - Tekaphor (TALK) 03:37, 11 July 2009 (UTC)

That is rediculous Tek and tendentious and mean. You accuse me that I am lying about what source says?? Two full quotes in context w/ "chronic fatigue syndrome" and you do not believe?? You want I should post whole article on Wiki?? You want I should steal the article from the journal and ignore copy right and send you it?? Why you do not go to a library or get a program with a academy where they will let you download things remotely. You want to lecture scientists how they can do effort testing?? BTW I did not imply 33,000 CFS cases, you accuse me of it.

BTW Mittenberg et al says "fibromyalgia, chronic fatigue syndrome" p1094 right column, and "fibromyalgia, chronic fatigue" they use it interchange, they call CFS chronic fatigue for short, alot of people and researchers do that.

People, MEDRS says medical review by recognized expert. Dedra Buchwald and McDermott are recognized experts. They say 25-30%. You want more, you want exact quote. I give exact quote, you want more. You want full text, that is copyvio, i can't do. You want another confirming. Then you want to analyze the primary source, you want say, the scientists are stupid, how do they do effort testing, like they did not think about it. You want to know, do they say CFS and FM or is there one place where they say chronic fatigue for short not CFS and you can delete every thing. You want to know, what was there method. You ignore the textbooks I give, you just want, delete every where the word malinger or MUS is. Why?? RetroS1mone talk 04:03, 11 July 2009 (UTC)

Tek: It's a bit roundabout, but yes, we can all confirm the wording "fibromyalgia and chronic fatigue syndrome" here (see wording underneath "PSYCHIATRIC CLINICS" hit). As for the 33,000 figure that Retro cites in her example text, we'd have to see the appropriate source for that before making any judgments, of course. It was obviously written off-the-cuff, so I wouldn't be too concerned about the specifics until citations are present and it's ready to be put into the article. --Rob (talk) 04:36, 11 July 2009 (UTC)

(Out) Here is the full text McDermott article. Ward20 (talk) 05:07, 20 July 2009 (UTC)

Oddly, I could see the full text yesterday, but I can't today. --RobinHood70 (talk) 22:29, 20 July 2009 (UTC)

I can't view it today either. I got a copy yesterday though. Ward20 (talk) 23:08, 20 July 2009 (UTC)

RetroS1mone, I never said that all mentions of malingering and MUPS should be deleted (and I haven't reverted the text even once!). And it would have been much more helpful if you simply presented the full text when first asked, instead of "beating around the bush" for a few days. So your source is verifiable afterall, and now the issue is weight and appropriate placing. I think a degree of suspicion was quite reasonable when considering your significant history of previous OR disputes on several articles, in combination with your view that CFS and "chronic fatigue" and FM are all interchangeable. I never said that you should post the entire article online, and I never said scientists were "stupid", I made a side-comment that it "sounds questionable". So what? You seem a little touchy for someone who has been slinging false-accusations at several editors for about a year. - Tekaphor (TALK) 05:14, 11 July 2009 (UTC)

Thanks Rob. Now the issue is about weight and appropriate placing. - Tekaphor (TALK) 05:15, 11 July 2009 (UTC)

Tek I did not say my view is, CFS and chronic fatigue and FM are interchangeable; i said, alot of doctors and scientists think that and it is in MEDRS. Wiki needs have these medical POVs also. When you are called "it" and "that" and made fun of you can get touchy, i am sorry. RetroS1mone talk 13:32, 11 July 2009 (UTC)

Perhaps this will help to refresh your memory:

Support merge. Not evidence for seperating PVFS from ME/CFS, these are medically unexplained symptoms and so is FM, MCS, GWI. They are all overlap and no person knows what causes. RetroS1mone talk 21:58, 7 July 2009 (UTC)[49]

Sam Weller (talk) 22:25, 11 July 2009 (UTC)

I said They are all MUS and they overlap, i did not say they are exact same thing. I do not know they are or are not exact same thing. No person knows they are or are not exact same thing. RetroS1mone talk 04:00, 13 July 2009 (UTC)

Who says "they are all MUS"? Do you mean, "Some psychiatrists maintain they might all be..."?

You yourself have written that MUPS can be used interchangeably with somatoform disorder and somatization disorder. Nevertheless, you have inserted MUPS overtly or covertly https://secure.wikimedia.org/wikipedia/en/w/index.php?title=Gulf_War_syndrome&diff=prev&oldid=301613070 in the lead of several articles about poorly understood conditions as if it were an uncontroversial description of medical ignorance. It is not used as a confession of ignorance - it is used as a psychiatric pseudonym or euphemism for somatization. When challenged about the hypothetical nature of somatization theory, you bluster 'what's wrong with having a mental cause?'. But no mental cause has ever been proven for any of these diseases. Sam Weller (talk) 09:07, 13 July 2009 (UTC)

Sam raises an important point; that is, terms like "MUPS", "somatoform disorder", "somatization", "functional somatic syndrome" have their own conceptual issues, and I'm sure there are many general sources for this. Also, RetroS1mone previously brought up Yunus 2008 (R1 said, "Mohammed Yunus is another top MUS FM expert, he says MUS like FM and CFS is a Central Sensitization Syndrome"), this is PMID 18191990, but the abstract of the review states that:

• "Terminologies currently used for CSS conditions predominantly represent a psychosocial construct and are inappropriate. On the other hand, CSS seems to be the logical nosology based on a biopsychosocial model. Such terms as "medically unexplained symptoms," "somatization," "somatization disorder," and "functional somatic syndromes" in the context of CSS should be abandoned. Given current scientific knowledge, the concept of disease-illness dualism has no rational basis and impedes proper patient-physician communication, resulting in poor patient care."

Yunus seems to be suggesting that while the biopsychosocial model is an adequate framework, the psychosocial aspect is overused when conceptualising these conditions. - Tekaphor (TALK) 11:41, 13 July 2009 (UTC)

Protected

The article has been protected per an accepted request at WP:RFPP. This was done mainly to prevent further disruption to Wikipedia by continued edit warring. Please continue your discussion to resolve any outstanding issues and once consensus is reached alert me on my talk page or request unprotection at WP:RFPP. Nja²⁴⁷ 10:40, 11 July 2009 (UTC)

New source of reference

There is a great book on ME and CFS called "missed diagnoses" by Dr. Byron Hyde which perhaps might help with this article. You can get it from Amazon. Also another great book is "Charcot's Bad Idea" which I just ordered —Preceding unsigned comment added by Michigancat (talk • contribs) 14:48, 21 July 2009 (UTC)