Wednesday, January 13, 2010

A doctor's observations on PLOS One

The dogma of the last 20 years has been created by the system that has had
control of "CFS/ME".

If Professor Wessely and his colleagues had no fear of finding XMRV in
patients with a diagnosis of Chronic Fatigue Syndrome then they would not be
frightened of using a selection criteria not used previously ie. the
Canadian Consensus Criteria.

If Lombardi et al were able to effectively utilise the Canadian Criteria as
they were then why were those at Imperial not allowed to use patients
selected the same way?

Surely if one wants to replicate a groundbreaking study with the best
possible source material then one would want to do things in accordance with

The only reason I can see for the failure to replicate the Lombardi patient
selection protocol is that those behind the patients selected for the
Imperial study were actually afraid of the outcome had they used the same
methods for selecting patients.

What other explanation can there be?

Sure it would have taken longer but then that would have prevented the rapid
publication but then again I was always told that if you wanted to do a job
well you should do it thoroughly regardless of rushing yourselves to get a
quick yet flawed result or outcome.

I guess for Imperial that did not come into their deliberations.....

Wessely, Cleare and Collier claim that their patients were not mental health
patients yet time and again Wessely, Cleare, White, Sharpe et al discuss
their patients in terms of mental health perpetuation and treat their
patients with CBT and Graded Exercise.

Two examples of exactly how the "Wessely School" demonstrate their beliefs
surrounding mental health and Chronic Fatigue Syndrome are given in my
previous e-mail that includes the PLOS One comments.

Another observation -

Why exactly were the same old patients chosen for this study?

Why were no severely affected patients chosen who have never had the luxury
of attending a clinic run by Professor Wessely or one of his colleagues?

The 25% ME Group have a membership list of prime candidates all severely
affected patients with G93.3 Myalgic Encephalomyelitis who are too ill to
take part in CBT and Graded Exercise.

Why exclude those too ill to be "regulars" at Professor Wessely's clinic and
why use patients already "screened" by Professor Wessely and his colleagues.

As there are potential conflicts of interest with the involvement of ANY
psychiatrists such as Cleare, Wessely, White, Sharpe et al, why accept a
study that has any involvement of any of the usual collaborators?

This may be unfair but on a very basic level, one XMRV positive patient
previously diagnosed with CFS is one less recruit for a CBT and Graded
Exercise session or indeed one less participant for the PACE trial.

So when are we going to get a genuine replication study that isn't tainted
by any interests that could possibly pollute or distort the outcomes?

Lombardi et al did their work diligently and produced their study over a
period of six months.

Lombardi et al tested their study over three centres of excellence to ensure

All of their work was vigorously assessed by those who published the study
in Science.

They did not on the other hand knock out a "quickie" study in an obscure
journal to grab some misleading news media headlines in the space of only a
few weeks.

If any UK study is to be worthy of any scientific credibility then it has to
be a genuine independent objective replication study with no conflicts of

It has to use the precise patient replication process employing Fukuda AND
the Canadian Consensus Criteria that was so apparently easy to employ by
Lombardi et al yet impossible and overly complicated to use here in the UK.

Why the complication - surely those wanting to get it right would want to
make an effort to do it right?

Any studies worth reading are also obliged to use the precise testing and
analysing protocols used by Lombardi et al. such as isolating the white
blood cells to concentrate the sample instead of diluting the samples by
only looking at whole blood.

Anything less would lead any scientist to wonder why a study has
deliberately chosen not to replicate.

Anything less than genuine replication is open to legitimate questions and
deconstruction including the motivations of those deliberately failing to
replicate when there is no real reason why they could not do so.

We live in interesting times and I have a feeling that this is not going to
be the first study from the UK, produced in association with psychiatrists
with vested interests where 0% of patients test using non-replication of
Lombardi et al find their results being plastered all over the media for
superficial but effective political gains at that.

Should we be surprised - absolutely not.


Stephen Ralph DCR(D) Retired.

* * *
Someone has noted that since the US researchers found XMRV in 4% of healthy controls, it should raise suspicion that the UK study claims 0% XMRV in either patients or controls.

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