CFS cohorts and the definition for CFS that the CDC used was different in
the two cohorts. The CDC followed people in Wichita in 1997-2000. They
used the Fukuda CFS definition as most people would use (i.e. not empiric)
(but, as with most/all of the CDC research, they were possibly/probably too
strict with exclusions e.g. you were excluded if you had a positive Romberg
sign - see: http://tinyurl.com/y8wtbls i.e.
http://listserv.nodak.edu/cgi-bin/wa.exe?A2=ind0911A&L=CO-CURE&P=R2443&I=-3
).
However, if you were diagnosed at any stage with CFS between 1997-2000, you
were invited back in for testing, Jan-July 2003 as were lots of other
people. For this group, they redefined what CFS was (i.e. the
empiric/Reeves definition was used to define CFS) so that CFS for this group
is different and covers a very broad group. The studies on the 2003 cohort
didn't start being published till the end of 2005 (these studies include the
Pharmacogenomics and CAMDA papers). Given the amount of data the CDC has on
the 2003 cohort, my guess is that they will be the samples they use if
testing for XMRV, along with Georgia samples (also empiric/Reeves
definition). The comment below on a Wichita cohort is based on data before
the empiric/Reeves definition for CFS. Tom]
=====================================================
Comment on:
Use of medications by people with chronic fatigue syndrome and healthy
persons: a population-based study of fatiguing illness in Georgia
Roumiana S Boneva , Jin-Mann S Lin , Elizabeth M Maloney , James F Jones
and William C Reeves
Health and Quality of Life Outcomes 2009, 7:67
doi:10.1186/1477-7525-7-67
=============
http://www.hqlo.com/content/7/1/67/comments#374659
Differences in medication usage in the Wichita and Georgia cohorts could be
due to the different methods of operationalizing the Fukuda criteria that
were used
Tom Kindlon (04 December 2009) Irish ME/CFS Association - for
Information, Support & Research
Medication usage was not the same in the CFS populations found in the
Wichita and Georgia populations.
The authors summarise the similarities and differences in the following
paragraph:
"Our findings confirm those from a previous study of medication use in
persons with CFS from Wichita, Kansas. Both studies found significantly
higher usage of pain relievers, gastrointestinal drugs, antidepressants and
benzodiazepines by persons with CFS compared to Well controls. Unlike the
Wichita study, though, persons with CFS in Georgia were not significantly
more likely than controls to use hormones and supplements but were
significantly more likely than controls to use muscle relaxants and
anti-allergy and cold/sinus medications. Overall, compared to persons with
CFS from the Wichita study7, a smaller proportion of persons with CFS in
Georgia used pain-relievers (65.5% in Georgia vs. 87.8% in Wichita),
supplements/vitamins (44.3% vs. 62.2%), antidepressants (36.3% vs. 41.1%),
antibiotics (7.1% vs. 16.7%), hormones (43.4% vs. 52.5%. among women only,
11.8% among all CFS), antihypertensive drugs (17.7% vs. 21.1%), muscle
relaxants (8.9% vs. 12.2%), anti-asthma medications (7.1% vs. 12.2%),
glucose-lowering drugs (0.9% vs. 4.4%.). Use of other prescription drug
categories such as lipid-lowering drugs (11.5% vs.12.2%) and benzodiazepines
(12.4%, vs. 11.1% respectively) was similar in Georgia and Wichita (Kansas).
The relatively lower usage of most prescription drug medications by persons
with CFS in Georgia compared to Wichita may reflect lower seeking of, or
lower access to, health care."
An alternative reason could be that the two sets of criteria for CFS used
were not selecting the same type of patients.
The current study[1] uses the empiric definition for CFS[2]. As one can see
from the paper that gives the criteria involved in the empiric definition,
although it is also based on the Fukuda definition[3], a different number of
patients satisfy the criteria [2] compared to how the authors used the
definition in the initial study of the Wichita population.
This change looks more significant when one looks at the prevalence rates
for CFS obtained in the two cohorts. In the Wichita study[4], the prevalence
of CFS was 0.235% (95% confidence interval, 0.142%-0.327%). In the Georgia
study[5], the prevalence of CFS was 2.54%, 10.8 times the prevalence in the
Wichita study!
Concerns have been raised[6,7] about the newer method[2] of operationalizing
the Fukuda definition[3] that were used in the current study[1]. In the only
study[7] using the empiric criteria [2] that I am aware of that did not
involve the CDC CFS team, 38% of those chosen as patients with Major
Depressive Disorder but not CFS, were found to satisfy the new criteria[2]
for CFS.
References
1] Boneva RS, Lin JM, Maloney EM, Jones JF, Reeves WC. Use of medications by
people with chronic fatigue syndrome and healthy persons: a population-based
study of fatiguing illness in Georgia. Health Qual Life Outcomes. 2009 Jul
20;7:67.
[2] Reeves WC, Wagner D, Nisenbaum R, Jones JF, Gurbaxani B, Solomon L,
Papanicolaou DA, Unger ER, Vernon SD, Heim C. Chronic fatigue syndrome--a
clinically empirical approach to its definition and study. BMC Med. 2005 Dec
15;3:19.
[3] Fukuda K, Straus SE, Hickie I, Sharpe MC, Dobbins JG, Komaroff A. The
chronic fatigue syndrome; a comprehensive approach to its definition and
study. Ann Int Med 1994, 121:953-959.
[4] Reyes M, Nisenbaum R, Hoaglin DC, Unger ER, Emmons C, Randall B, Stewart
JA, Abbey S, Jones JF, Gantz N, Minden S, Reeves WC: Prevalence and
incidence of chronic fatigue syndrome in Wichita, Kansas. Arch Int Med 2003,
163:1530-1536.
[5] Reeves WC, Jones JF, Maloney E, Heim C, Hoaglin DC, Boneva RS, Morrissey
M, Devlin R. Prevalence of chronic fatigue syndrome in metropolitan, urban,
and rural Georgia. Popul Health Metr. 2007 Jun 8;5:5.
[6] Jason LA, Richman JA. How science can stigmatize: The case of chronic
fatigue syndrome. Journal of Chronic Fatigue Syndrome 2008, 14, 85-103.
[7] Jason LA, Najar N, Porter N, Reh C. Evaluating the Centers for Disease
Control's empirical chronic fatigue syndrome case definition. Journal of
Disability Policy Studies 2009, 20, 93-100. doi:10.1177/1044207308325995
Competing interests
No competing interests
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