issues relating to ME and CFS to write a professionally balanced
article. Many maybe unfamiliar with the scientific literature and do
not seek out sources that can familiarize them with the background
necessary to add meaningful context.
However, this article is balanced by professional journalism
standards. The writer, Emma Hitt, followed professional protocols in
including multiple sources and points of view including opposing
viewpoints not just sources saying essentially "What they said." This
is important whether covering conflicting politics, criminal trials,
or ME and CFS issues. Science is often a contentious process and there
are often multiple points of view.
The writer also asked about conflicts of interest as any good health
and medicine reporter should. What is interesting is that the reporter
states there are no relevant conflicts of interest. The question there
is relevant according to whom?The writer? The sources? Please note, in
asking this question no malfeasance is implied in anyway, it is simply
part of the journalistic protocol of asking questions. You don't know
if you don't check. And as another publication, the Lancet, outlines
on their website, conflicts of interest are not limited to financial
conflicts although other forms are more difficult to define or prove.
http://www.thelancet.com/lancet-information-for-authors/statements-permissi=
ons-signatures#conflicts-of-interest
'Final Nail' for XMRV in Chronic Fatigue Syndrome?
Emma Hitt, PhD
July 1, 2011 =97 Results outlined in a new commentary challenge the
findings of a 2009 study suggesting that xenotropic murine leukemia
virus (MLV)=96related virus (XMRV) is associated with chronic fatigue
syndrome (CFS). In fact, XMRV may not be a genuine human pathogen, and
its presence in that study may have resulted from contamination of
laboratory reagents, the commentary authors conclude.
The=A0article by Vincent C. Lombardi, PhD, with the Whittemore Peterson
Institute, in Reno, Nevada, and colleagues, in the October 23, 2009,
issue of=A0Science, described the presence of XMRV, a gammaretrovirus,
in the white blood cells in 67% of patients with CFS vs only 3.7% of
healthy controls.
But in a new=A0commentary=A0published online first June 21 in=A0The Lancet,
Dr. Frank J. M. van Kuppeveld and Professor Jos W. M. van der Meer,
with the Radboud University Nijmegen Medical Centre in the
Netherlands, review 3 new independent studies that have questioned the
validity of these findings.
"In these studies, no XMRV was detected in patients with CFS and
healthy controls," the editorialists write, and these "three new
publications seem to provide the final nail in the coffin of the
XMRV-CFS story."
Dr. van Kuppeveld and Dr. van der Meer add, "We have to conclude that
the world has witnessed another false claim that gave new hope to
patients with CFS, who are desperately seeking a cause for their
suffering."
Nails in the Coffin
The=A0first nail=A0was an article by Clifford Shin and colleagues at the
University of Utah in Salt Lake City, published online May 4 and
appearing in the current July issue of the=A0Journal of Virology. These
researchers concluded that their findings "do not support an
association between CFS and MLV-related viruses, including XMRV, and
the off-label use of antiretrovirals for the treatment of CFS does not
seem justified at present."
The other 2 article were both published online in=A0Science=A0=97 one by
Konstance Knox, from the Wisconsin Virus Research Group in Milwaukee,
and colleagues and the other by=A0Tobias Paprotka, from the Viral
Mutation Section of the National Cancer Institute's HIV Drug
Resistance Program in Frederick, Maryland, and colleagues. Both
studies found no link to XMRV, and the authors of both reports
speculated that the previous association likely resulted from
laboratory contamination. The study by Knox and colleagues actually
included patients who were examined in the original study by Lombardi
and colleagues.
The negative outcome of the Knox study was one reason that=A0Science
subsequently asked for a retraction of the article by Lombardi and
colleagues. However, lead investigator of that paper, Judy A.
Mikovits, PhD, director of research at the University of Nevada's
Whittemore Peterson Institute for Neuro-Immune Disease in Reno, has
refused.
Science=A0editor-in-chief Bruce Alberts, PhD, went so far as to publish
an Editorial=A0Expression of Concern=A0about those findings online May 31,
along with the articles by Knox and Paprotka and colleagues. Since
that first publication, Dr. Alberts writes, "at least 10 studies
conducted by other investigators and published elsewhere have reported
a failure to detect XMRV in independent populations of CFS patients."
He added that the study by Lombardi and colleagues "attracted
considerable attention, and its publication inScience=A0has had a
far-reaching impact on the community of CFS patients and beyond.
"The US National Institutes of Health is sponsoring additional
carefully designed studies to ascertain whether the association
between XMRV and CFS can be confirmed," Dr. Alberts concluded.
"Science=A0eagerly awaits the outcome of these further studies and will
take appropriate action when their results are known."
Responding to the=A0Science=A0papers and editorial, Dr. Mikovits contended
that Knox and colleagues failed to replicate data from the study by
Lombardi and colleagues because the researchers used different, less
sensitive methods.
She told=A0Medscape Medical News=A0at that time,=A0"There are no data in
Knox et al to support the authors' conclusions or those expressed in
the Editorial Expression of Concern. In fact, a close look at Western
blots shows seropositive patients. They did not use our assays for
infectious virus."
The 4 'P's'
According to Dr. van der Meer, the current thinking of the etiology of
CFS can be described by the 4 "P's."
Patients have predisposing factors, which are to some extent genetic.
There may also be precipitating factors, such as an infection and such
as mononucleosis, as well as perpetuating factors, which probably are
located in the brain, although it remains unclear which
neurotransmitters are involved. Psychological factors also play a
role, and this explains the success of cognitive behavioral therapy
for CFS, he told=A0Medscape Medical News.
"We do not have any effective drug for CFS," said Dr. van der Meer.
"Essential in the approach of the patient is empathy and the avoidance
of quarrel about the illness," he said. "We should acknowledge that we
do not understand the full picture and we are open to new
developments."
Jay Levy, MD, with the University of California, San Francisco, senior
investigator on the article by Knox and colleagues that found no
association, noted that although there are many theories about the
etiology of CFS, the one that he prefers is a "disorder of the immune
system in response to an infectious agent, an allergen, or some
pollutant.
"The immune system gets activated but does not quiet down as normally
occurs," Dr. Levy told=A0Medscape Medical News. "Patients with CFS
should recognize that they have a definite illness and that more
research and attention must be given to this syndrome so that a
solution can be obtained," he said.
The editorialists have disclosed no relevant financial relationships.
http://www.medscape.com/viewarticle/745688
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