Sunday, January 17, 2010

All of the Above?

I have added a new entry in my blog on the subject of the McClure denial of the Lombardi, et al, article in "Science" magazine on the new retrovirus XMRV.  Specifically, McClure denied finding any evidence whatsoever of XMRV in controls or patients. In contrast, the group from the Whittemore-Peterson Institute, Cleveland Clinic, and National Cancer Institute behind the Lombardi article found that 2/3 of patients diagnosed with "chronic fatigue syndrome" tested positive for the newly discovered retrovirus XMRV, as opposed to only 3.5% of controls.

The essay questions the focus on single causation for "CFS," and research programs that too quickly claim to have "disproved a cause" when applied to a small sample with dubious symptoms.  Bluntly said, sound research using even the CDC's Fukuda definition has generally involved clinicians who already had a way to diagnose the disease - and the way Simon Wessely diagnoses CFS at King's College, London, bears no resemblance whatsoever to the way Dan Peterson diagnoses it at Incline Village, Nevada.  Dan Peterson started out trying to understand a cluster outbreak of disease.  Simon Wessely started out with an ideology that seemed to perfectly fit a disease with a vague name, "Chronic Fatigue Syndrome," that was applied mainly to women.  The two models are incompatible.

If the process by which data is collected differs so strongly among groups of researchers, it is time to take an honest look at the patients in the data sets and how they were chosen.

Furthermore, it is well past time to adopt multivariate modeling in the study of The Disease.  Most patients who have one biomarker have another.  There is an identifiable, complex disease - perhaps diseases - but it cannot be modeled so simply as "X" causes "Y". 

Our understanding of AIDS as a complex, multi-factoral disease preceeded the finding that HIV predicted the emergence of AIDS.  In looking at the effects of XMRV - in evaluating the usefulness of XMRV - we will have to construct the complex disease that results from scratch, because the CDC has done so much to deny any and all characteristics that did not fit every single patient. 

Not everyone with AIDS has Karposi's Sarcoma.  But we could never have understood AIDS without first acknowledging the damage wrought by Karposi's Sarcoma.  We need the CDC - and its equivalent overseas - to go back and re-examine all the immune biomarkers, biophysical abnormalities, and viruses that have been summarily dismissed because they did not fit every single "CFS" patient.

The essay, entitled "Is there a case to be made for 'All of the above'?" can be found at:

Mary M Schweitzer, Ph.D.

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