While waiting for the chemical warfare on my brain conducted by a daily scopolamine analog (to prevent asthmatic bronchitis) and 2.5 mgm oxycodone at 3 AM (to stop the coughing so I can sleep) to be over; here are a few more thoughts on the subject. I’d love to be back reading Anslyn and Dougherty and retaining what’s in there, but not with what I’ve got on board. For what scopolamine does to memory see https://luysii.wordpress.com/2011/03/24/scopolamine-where-is-thy-sting/. Oxycodone is a narcotic — enough said.
There’s been a huge amount of controversy about the XMRV connection to chronic fatigue syndrome ever since the paper came out in October of 2009. People have had and continue to have huge difficulties reproducing each other’s results. For example, 4 papers reported 12/10 in Retrovirology implied that reports linking XMRV to CFS could be based on false positives (e.g. picking up mouse DNA or similar mouse viruses). At long last, the proper experiment is being performed. [ Science vol. 331 p. 17 ’11 ] Blood from 150 CFS patients and 150 controls from 6 geographically dispersed USA sites will be sent (blind) to several labs (to include the NIH, CDC and Mikovits) for testing. That should help explain the discrepancies (or further establish them).
While we’re all waiting with baited breath, suppose the work cited in the previous post is correct and that XMRV is a ‘new’ virus, created in the lab sometime in the 90s. It seems clear that it can infect man. Even if this is true it couldn’t possibly explain the cases I saw in the 70s and 80s. To which I say — So What ! ! It is most unlikely that chronic fatigue syndrome is one condition (more later). To get a flavor of how controversial the whole area (including whether the syndrome even exists as a nonpsychiatric entity) see http://pipeline.corante.com/archives/2011/01/11/xmrv_its_ugly_but_thats_science.php#comments along with 68 comments it brought forth.
First, a few unpleasant facts. No one who hasn’t worked in retail (say a supermarket) has any idea what the general public is like. Similarly, no one who who hasn’t worked in medicine has any idea of the clientele. Believe it or not, there are people who love being sick, or at least adopting the sick role. This behavior does not confine itself to workmen’s compensation or auto accidents where there is money involved. Much neurologic disease is obscure, with a variety of weird symptoms, so multiple sclerosis (MS) was a favorite refuge of some of these folks (in the pre-MRI era at least). For that reason, I actively discouraged my patients from attending MS support groups, because there was often someone there spewing medical garbage. “Should I have my teeth removed because fillings caused Mrs. Jones’ MS” etc. etc. Any disease for which diagnostic criteria are nebulous or undefined attracts these people. Chronic Lyme disease seems quite popular here in New England.
A true story: An ophthalmologist friend was trying to make some small talk with an octagenarian sent to him for a cataract. Opthalmologist: Well, Mrs. X. you must have done something right to be so hale and hearty at 87. Octagenarian: Young man, I’ve never had a well day in my life !
So I guarantee that in any group of of individuals claiming to have chronic fatigue syndrome, there are a few (probably around 5% but this is just a guess) who don’t have anything like it. That’s why any blood test which claims to be positive in 99% of patients with chronic fatigue syndrome simply has to be wrong. At some point a claim was made that 98% of patients with CFS had a positive test for XMRV. This doesn’t pass the smell test. To which I still say — So What ! !
If XMRV can cause only some CFS, this would still be worth knowing — particularly since antiretroviral drugs show some activity against XMRV (in cell culture, not (so far) in people). It would be the first time a viral cause has actually stuck. It’s certainly worth a look.
The last time you had the cold or flu you were probably fatigued. Fatigue is almost as common a symptom of infection as fever, and to look for a single cause of CFS is probably as quixotic as the pre-Pasteur physician looking for a single cause of fever. We know that multiple organisms can cause infections and fever, and it seems likely to me, that multiple organisms can cause chronic fatigue
This is somewhat reminiscent of the search for ‘the‘ schizophrenia gene. For details, see https://luysii.wordpress.com/2010/04/25/tolstoy-was-right-about-hereditary-diseases-imagine-that/. Schizophrenia has a myriad of genetic associations, each of which seems causative in a given family, but none of which are found in even 5% of cases. Well, schizophrenia is strongly hereditary and CFS is not, but the analogy holds.