Talk:Pathophysiology of chronic fatigue syndrome

Neuroticism

Once again, "Neuroticism and introversion may predispose to CFS. The correct source is not Prins 2006, but Prins 2001, in Dutch. Nobody here has seen that, let alone checked the conclusions. IMO, it should not be used until verified. To avert further reverts, I've left Prins 2006 in, but it must be qualified by more recent systematic reviews (incl. van Geelen), which failed to support the personality link. Sam Weller (talk) 22:36, 5 June 2009 (UTC)

That is wrong, we do not do original research, when international experts in field write a review in Lancet we do not say, these people are stupid or there research is not valid and there sources are not enough. Pls, Sam, Tek, Ward20, are you CFS researchers?? Do you know CFS researchers?? Are you scientists or doctors?? Write a letter to lancet, ask them to retract the review and finding, and then Prins 2006 is not a reliable source at Wiki. Now it is, i am very sorry you do not like Wiki policy. RetroS1mone talk 17:19, 6 June 2009 (UTC)

RetroS1mone, where is the "original research" that you regularly complain about? WP:OR says "Wikipedia does not publish original research or original thought. This includes unpublished facts, arguments, speculation, and ideas; and any unpublished analysis or synthesis of published material that serves to advance a position. This means that Wikipedia is not the place to publish your own opinions, experiences, arguments, or conclusions." No one is posting unpublished material into the article, so I'll assume you mean explanations that Sam has given on the talkpages. As for advancing a synthesis, WP:OR says "Do not put together information from multiple sources to reach a conclusion that is not stated explicitly by any of the sources." OK, so please point out specific examples of this so they can be discussed properly. Also, no one said X was "stupid" or that X's research is "not valid". As for X's sources not being enough, this depends on the situation. It has weight because it was published in the Lancet, but at the same time, shouldn't be used at the exclusion of any conflicting systematic reviews. - Tekaphor (TALK) 04:29, 7 June 2009 (UTC)

Since it seems she hasn't mentioned it, RetroS1mone has started an RS discussion here, FYI. You may wish to add your POV to that discussion. --Rob (talk) 05:18, 7 June 2009 (UTC)

I've reverted Retro's most recent edit on the basis that Sam left the Prins reference intact, his wording was better and included links to relevant articles, and he presented an opposing point of view, which was suggested would be appropriate in the discussion I mentioned above. --Rob (talk) 05:42, 7 June 2009 (UTC)

I was going to respond but thought that Sam Weller might want to say something there and I didn't want to muddy the water and get something wrong. But I agree with you RobinHood70 that the systematic review is appropriate. I can't understand where the "High scores" comes from in the Prins material though. Ward20 (talk) 07:30, 7 June 2009 (UTC)

Thanks for the above notice about the RS discussion, I just posted a large message there.[1] - Tekaphor (TALK) 12:44, 7 June 2009 (UTC)

I don't really have anything to add to the concern that opened this section. I don't know where the 'high scores' came from, except they were in the last POV version that I qualified with van Geelen. I notice the disruptive editor is still edit warring and making defamatory statements in spite of repeated warnings from SW, so I'm staying clear of this for now. I've registered an opinion at the RS discussion. Sam Weller (talk) 14:41, 7 June 2009 (UTC)

At this point, I'm wondering if WP:RFC/USER or WP:AIN would be appropriate. Especially when taken all together, the points in Tekaphor's post on the Reliable Source Noticeboard were very telling. As I've mentioned elsewhere, I think going through list on the tendentious editors page highlights any number of problems. I'm not the one to write up that sort of thing, though - my ability to focus and present a well-thought-out summary of the issues was maybe equal to that of Tekaphor's on my best day before the CFS. Now...not so much. :) In all fairness, and according to guidelines, I think we would need to summarize all the problems on Retro's talk page first, and give her the chance to respond before initiating any other actions. --Rob (talk) 18:18, 7 June 2009 (UTC)

I totally agree on RFC or ANI that it should be when you want it and i know we all have accusations of the other but i think some of us can work together, can we try harder?? I will try. RetroS1mone talk 15:17, 8 June 2009 (UTC)

OK and i am OK w/ the article now i was upset by Sam Weller when said Prins is not a valid source, that is not right, but i want balance from other review also. I do not make changes to this. RetroS1mone talk 15:19, 8 June 2009 (UTC)

I have asked for clarification at the RS discussion about the weight that should be given in science articles to claims that are not subsequently replicated. here Sam Weller (talk) 13:17, 9 June 2009 (UTC)

Retro has now claimed that neuroticism was identified in 'numerous studies, as summarised in two recent reviews', one of which was the disputed Prins 2006 'seminar', the other an unsystematic 'narrative review' by Chalder et al. The same edit also tried to erase Van Geelen's systematic review findings by stating that it merely 'argued' the opposite. If 'numerous' remains, it will have to be quantified. Sam Weller (talk) 11:24, 8 July 2009 (UTC)

I also noticed this, you beat me to it. Especially the part about the systematic review being downplayed/relegated as "others argue". As for "numerous studies", it reminds me of the the recent "numerous high-quality studies" claim which turned out to be false. However, what do you mean by Prins 2006 "seminar"? - Tekaphor (TALK) 12:05, 8 July 2009 (UTC)

I think Seminar is or was a section heading in The Lancet, to let you know you aren't reading guidelines, results or anything that's been scientifically evaluated. It was cited as Seminar in the Lancet itself, in a response to Prins 2006 which began:

The Seminar by Judith Prins and colleagues[1] purports to review chronic fatigue syndrome with emphasis on “scientific aspects”, yet it falls far short of this aim. Research on biomedical aspects of the syndrome is covered only perfunctorily (318 words in a 4900 word review), yet much work has already been done by others,[2] and the role of definitional issues in understanding clinical trial results is barely addressed. PMID: 16698406

Sam Weller (talk) 15:19, 8 July 2009 (UTC)

That is great OR guys, two reviews say it is one review says it is not and i think you are exagerate the Geelen stuff, they do not say, no role for neuroticism they say it is more complicated then just personality. RetroS1mone talk 22:42, 8 July 2009 (UTC)

There are two unsystematic reviews that claim neuroticism is a "risk factor", and two systematic reviews that were unable to verify that. I hope I've clarified things by quoting Van Geelen directly from their neuroticism section, where they found that "many of the findings of high neuroticism were later accounted for by co-morbid depression". If anything, Van Geelen's "overarching conclusions" (p.898) have been understated here:

... the heterogeneity of findings within the CFS groups implies that, on the trait or psychopathological level, there are no unique personality characteristics that are either a necessary condition for, or an unavoidable consequence of CFS. Secondly, although personality traits such as neuroticism and perfectionism are generally considered to be stable, non-conditional and not effected by life changes (Watson & Walker, 1996; Costa et al., 1986), most studies seem to agree on the possibility that the pre-morbid personalities of their subjects might have changed as a result of their condition. Diverse forms of chronic illness seem to be able to alter personality in similar ways and increased levels of neuroticism and introversion for example (not to mention depression), could well be a feature of many different diseases.

[my emphases]

Sam Weller (talk) 09:10, 9 July 2009 (UTC)

Sam, thanks for catching my mistake (regarding use of the word "study" instead of "review"). Also, as for the "Seminar" you referred to, I haven't read the full-text yet so I can't comment. As for the alleged "exaggeration" of the systematic review by van Geelen et al, perhaps RetroS1mone needs to re-read sections "3.1. Neuroticism" (page 890), "3.3. Perfectionism, social desirability and extroversion/introversion" (page 894) and "3.4. Personality: predisposing, initiating or perpetuating?" (page 894) in the full-text here [2]. - Tekaphor (TALK) 15:43, 9 July 2009 (UTC)

Guys, the fraudulent science, such as the 'neuroticism' and 'abnormal illness beliefs' garbage, has got to go. I don't care if it is published in an ostensibly 'reliable source', if it is fake science then it is morally wrong to include it in wikipedia, which so many people rely upon as a source of information. There are guidelines that support this. I read these a while ago and will look them up again. As I recall, they were guidelines like 'guidelines are only guidelines, if doing the right thing conflicts with the guidelines, then do the right thing.' Sorry this is not a through treatment of this topic, but i am outraged at the lies that you put up under the guise of coming from a 'reliable source.' This is morally wrong and must end. Talk to you later. JustinReilly (talk) 12:33, 26 November 2011 (UTC)

The problem is, how does an outsider know that the research is fraudulent? If you didn't have ME/CFS, or didn't know someone who did, and you came in and saw some people saying it's a physical disease and others saying it's psychological, how would you know to dismiss one explanation over the other? The problem with this being a wastebasket diagnosis is that there almost certainly are some people where the cause is psychological, and they just get mixed in with the rest of us.

Remember, the criteria for inclusion on Wikipedia is verifiability, not truth. When psychologists go to study the phenomenon, it stands to reason that they'll get a higher percentage of psychological patients involved, so it skews their results and they think they're proving the general case. Their conclusions are probably correct (and hence, verifiable) as far as they go, they just don't look at who their patients actually are. This is why the Canadian and International criteria are starting to come to the fore - to rule out these psychological cases. Heck, the Canadian criteria specifically rule out all patients who have a primary psychological condition. Sucks if you actually do have physical CFS along with your psychological condition, but it does tend to filter out a lot of the rest of the wastebasket.

Until such a time as there's a widely accepted physical diagnosis, however, we will still have to put up with the admixture of psychological and physical. In point of fact, however, as it stands now, the first of the two wordings you mention is presented as a point-counterpoint paragraph, and the second of the two isn't even there any more, so I think at least for those, we're okay. – RobinHood70 ^talk 21:59, 26 November 2011 (UTC)

Sustained arousal

We should probably add this review. --sciencewatcher (talk) 20:59, 15 February 2011 (UTC)

I don't think it is classified as a review but I don't have a problem with it as long as it is presented as a hypothesis and is short as it only has two pubmed citations. Ward20 (talk) 21:37, 16 February 2011 (UTC)

According to google scholar it has 15 citations (I don't think pubmed really knows anything about citations), and when you click on the full-text of the article it says 'review' right at the top. I'm not sure why it isn't classified as a review in pubmed. I agree it hasn't lot of citations, but seems to be slightly more authoriatative than the reference we have in the sensitization section. I was thinking of just putting in a single sentence, either in the stress section or in a new sub-section. --sciencewatcher (talk) 22:03, 16 February 2011 (UTC)

The Stress and trauma section would make sense, as that seems to be how they're using the term "arousal" in this context. – RobinHood70 ^talk 00:42, 17 February 2011 (UTC)

Sciencewatcher said, "I don't think pubmed really knows anything about citations". I would assume PubMed citations were PubMed citations while Google Scholar citations include non-PubMed citations and the "grey-literature" (some of which wouldn't pass WP:RS)? A similar example, according to Google Scholar on [Maes CFS], this Maes 2009 review on "inflammatory and oxidative and nitrosative stress pathways underpinning chronic fatigue, somatization and psychosomatic symptoms" had 18 citations, but on PubMed it only has 2 PubMed citations. However for both above mentioned papers I found some of these "non-PubMed" citations listed in Google Scholar can actually be found in the PubMed database during the search, so Sciencewatcher may have a point. - Tekaphor (TALK) 03:58, 27 February 2011 (UTC)

Medical Wiki Relocation

The too technical template is right. Online_medical_wiki_encyclopedia These kinds of pages should be relocated to a medical wiki and incorporated by reference in the main CFS page. Wikipedia is not intended to be a site for rapidly updating technical information. In mathematics and physics, highly technical articles, for settled areas, esp. theoretical ones are probably OK due to the fact these change very little over time. If you don't find a good medical wiki, propose one to wikimedia, or start your own. Online_medical_wiki_encyclopedia#External_linksCodwiki (talk) 22:38, 3 June 2011 (UTC)

Medicine is not that rapidely updating. It is a slow process that takes place over years. We do not need another medical wiki when we have this one. --Doc James (talk · contribs · email) 00:10, 4 June 2011 (UTC)

Behavioral section

The first paragraph describes a primary source (study) with only 49 CFS patients.[3] Additionally, it is only cited by 5 PubMed articles,[4] some of those off topic. Not a strong way to start the section and probably should be removed. Ward20 (talk) 14:52, 11 October 2011 (UTC)

All the research should really be from reviews. I'd suggest looking through the major reviews and rewriting this section. --sciencewatcher (talk) 18:12, 11 October 2011 (UTC)

I have removed this reference. This article purports to show support for behavioral factors in "CFS" but the article itself admits that this is only one of several possible reasons for the increased incidence of doctor visits, another could be that pre-clinical ME was present or that patients had other pre-ME illnesses which were somehow related to the eventual ME, such as making the body more vulnerable to contracting additional diseases such as ME. JustinReilly (talk) 12:22, 26 November 2011 (UTC)

Capitalization in the names of viruses, bacteria, etc, and their taxonomic groups (genera, families, etc)

I noticed this page now offers quite a comprehensive survey of viruses and bacteria associated with CFS. Nice.

Just one point: the use of capitals is not quite right in some of the viruses listed on this page. It took me a while to get to grips with the rules of capitalization in this area, and here is what I believe to be the correct capitalization rules:

General rule in all taxonomy: species names are uncapitalized, but all other taxa (genus, family, order, etc) are capitalized.

This is why names of bacteria, which include both the genus + the species together (such as Chlamydia pneumoniae, Staphylococcus aureus, Escherichia coli, Clostridium difficile, Mycoplasma pneumonia), capitalize the genus, but not the species. Similarly for fungi (examples: Aspergillus fumigatus, Candida albicans) and protozoa (examples: Toxoplasma gondii, Blastocystis hominis).

Since viruses are generally referred to just by their species name alone, virus names are always uncapitalized, except in cases where the name contains the name of a person or place (viruses are often named after the place they were discovered), and in these cases, the person or place alone receives capitals as per usual.

So for example, all these virus names are uncapitalized: cytomegalovirus (CMV), human herpes six virus (HHV-6), herpes simplex virus (HSV), parvovirus B19, rhinovirus, echovirus, poliovirus, enterovirus 71, varicella zoster virus, adenovirus, norovirus, coronavirus, influenza virus, parainfluenza virus, human papillomavirus, human T-lymphotropic virus type I (HTLV-1).

But the following viruses contain the name of a person or place, so are written with capitals as shown: Epstein-Barr virus, Ross River virus, West Nile virus, California encephalitis virus, Rift Valley fever virus.

A subtle one is the Coxsackie B virus. As it stands, this is written with the town of Coxsackie capitalized; however, this virus is also written in an amalgamated form: coxsackievirus B which then does not get capitalized. Similarly for Borna disease virus, which is often amalgamated to bornavirus, without a capital.

Capitalization rules for taxonomic groups (genera, families, etc)

When dealing with the genus or family that a virus belongs to, there are some subtle points to observe. When referring to genera and families, these are capitalized. For example, poliovirus, echovirus and coxsackievirus B all belong to the Enterovirus genus, and the Enterovirus genus itself is part of the larger Picornaviridae family.

So far so good. However, sometimes people want to refer not to the Enterovirus genus as a taxonomic group, but to a generic virus from this genus, and in this case, it is written without a capital: just as enterovirus. So we can say: poliovirus, echovirus and coxsackievirus B are all examples of enteroviruses, and they all belong to the Enterovirus genus. Similarly, when you want to refer to a generic virus from the Picornaviridae family, you call this a picornavirus, without capitalization. Likewise, when you want to refer to a virus from the Herpesviridae family, you call this a herpesvirus, without capitalization.

You have choice, though, when referring to taxa: you say "Herpesviridae family", or equally "herpesvirus family". The former has the emphasis on the taxon, the latter on the set of species in that taxon, but they are essentially the same thing. Actually with the former, the tag "family" is not necessary, as this is implied in the name "Herpesviridae". Similarly: "Picornaviridae family", "Picornaviridae" and "picornavirus family" are all fine, and mean the same thing. Likewise: "Enterovirus genus", "Enterovirus" and "enterovirus genus" are all correct, and have the same meaning.

I hope this is helpful. It took me while to figure this out through my brain fog, and I am still not completely clear about it. (I like to be anal sometimes, just to help combat the damn brain fog!) Drgao (talk) 15:53, 20 October 2011 (UTC)

Excellent guide! It reminds me a lot of the rules around capitalizing a person's title (e.g., "the prince" vs. "the Prince of Wales"). This could probably be transplanted elsewhere on Wikipedia, like in WP:MEDMOS or somewhere similar if there isn't already something there. – RobinHood70 ^talk 16:54, 20 October 2011 (UTC)

Glad you like it! I have followed your suggestion, and put these capitalization guidance rules for consideration on this page: Wikipedia talk:Manual of Style. Quite a few Wikipedia articles have incorrect capitalization on virus names, so it might be an idea to set some guidance rules set. Drgao (talk) 00:03, 21 October 2011 (UTC)

Sources

• PMID 20425282
• PMID 21792218

Proven infectious causes of CFS

In the Infections section of this CFS pathophysiology article, it says:

QUOTE: Many viral and bacterial infections have been proposed to cause or associate with CFS, but no infectious influence on pathophysiology has been proven.

Is this quoted statement actually true? Chlamydia pneumoniae infection has been called "a treatable cause of CFS". And Coxiella burnetii infection has been known to lead to both chronic fatigue, and to chronic fatigue syndrome proper. Chlamydia pneumoniae and Coxiella burnetii CFS can be treated with antibiotics. References:

• Chronic Chlamydia pneumoniae infection: a treatable cause of chronic fatigue syndrome — full article

• Chronic fatigue following infection by Coxiella burnetii (Q fever): ten-year follow-up of the 1989 UK outbreak cohort — full article

• Chronic fatigue syndrome after Q fever — full article

• Treatment of chronic fatigue syndrome with antibiotics: pilot study assessing the involvement of Coxiella burnetii infection — full article

Drgao (talk) 23:54, 23 June 2012 (UTC)

I would suggest you read our guideline for reliable sources for medical claims. Those primary studies are not suitable as sources here. Yobol (talk) 00:08, 24 June 2012 (UTC)

I know they are primary studies, and I know the policy about having no primary studies here. Nevertheless, to say that there is no proof of an infectious influence on CFS does not seem strictly correct when there are cases of CFS that arise from these bacterial infections — cases that then clear up when the bacteria are treated with antibiotics. Drgao (talk) 00:31, 24 June 2012 (UTC)

All these are is speculation in primary literature. If you can find an appropriate secondary source that says otherwise, we have something to talk about. Yobol (talk) 00:41, 24 June 2012 (UTC)

Well, if you think this "no proof" caveat needs to be kept in the Infections section, let this same "no proof" caveat be equally applied to all the other etiological factors in the pathophysiology article where there the studies have demonstrated statistical association, but not proof of causation (which is all the factors, as no factors have been proven to play a causal role in CFS).

So I suggest in the Stress and trauma section, we change the introductory sentence:

The majority of people who experience stress or trauma do not develop CFS, but these factors may increase the likelihood of acquiring CFS.

to:

The majority of people who experience stress or trauma do not develop CFS, but these factors may increase the likelihood of acquiring CFS; however no stress or trauma influence on pathophysiology has been proven.

This is correct, as the studies on stress or trauma have only demonstrated an association to CFS, and association does not imply causation. Similarly, in the Fixation section, the introductory sentence should be changed to read:

Some research suggests that CFS may be perpetuated when patients fixate on a physical cause for their symptoms or when exercise is avoided, but no fixation influence on the perpetuation of CFS has been proven.

This is correct too, as again the fixation studies only demonstrated an association to CFS.

In summary: in order to maintain a balance in this article, if you explicitly state that there is no definitive proof of infectious causes of CFS, to be evenhanded, you also need to explicitly state, in each case, that there is no definitive proof that trauma, fixation, genetic polymorphisms, toxins, etc, etc, play a causal role in CFS.

Drgao (talk) 04:14, 24 June 2012 (UTC)

Numerous secondary sources associate infections with triggering or perpetuating the illness in subsets meeting a number of the definitions used. The problem lies in the multiplicity of infections, subsets, and definitions. The sentence being contested has no source should probably read something like this.

Many viral and bacterial infections have been associated with triggering or perpetuating CFS, PMID 18458765 but no infectious influence on pathophysiology has been consistently identified across the subgroups of patients described by the major definition.PMID 21415952

Secondary sources:

PMID 21964849

"The evidence is consistent with the hypothesis that CFS, in some cases, can be triggered and perpetuated by several chronic infections that directly or indirectly affect the nervous system, and that symptoms are a reflection of the immune response to the infection."

Epstein-Barr Virus, HHV-6, bacterial infections, Enterviral Infection, Parvovirus.

PMID 21415952

"Today CFS, as defined in 1994 by the CDC of Atlanta (USA), really represents a multifactorial syndrome characterized by a chronic course, where reactivation and remission phases alternate, and by a good prognosis. The etiopathogenetic role of EBV is demonstrated only in a well-examined subgroup of patients, while in most of the remaining cases this role should be played by other infectious agents - able to remain in a latent or persistent way in the host - or even by not infectious agents (toxic, neuroendocrine, methabolic, etc.)."

PMID 21892413

"Broderick et al. (2010) applied network analysis to cytokines in patients with ME/CFS and healthy controls, and outcomes were consistent with a latent viral infection (i.e., attenuated Th1 and Th17 immune responses, an established Th2 inflammatory milieu, diminished NK cell responsiveness) [4]."

PMID 21618868

"About 80 different aetiological CFS factors are mentioned, which can be classified into five basic groups: genetics, immunology, infectious diseases, endocrinology and neuropsychiatry-psychology."

PMID 19758205

"Likewise, an association between some infectious agents, antibody production, and later CFS onset has been reported."

PMID 18458765

Multiple infectious agents have been linked to CFS, including Borna disease virus,24,25 parvovirus B19,26,27 glandular fever,28 Enterovirus,29 human herpesviruses 4, 6, and 7,30–32 infectious mononucleosis,33 Nipah virus encephalitis,34 and Q fever.35

Infections have not only played important etiologic roles, but also have been considered predictors of better prognoses when compared to noninfectious CFS cases."

PMID 17853290

"Although CFS is often associated with viral infection, the presence of viruses has as yet not consistently been detected."

Ward20 (talk) 04:57, 24 June 2012 (UTC)

That is not a bad suggestion for replacing the contested sentence, Ward20. Another suggestion for the replacement sentence is this:

The possibility that infectious agents play a causal role in CFS has generated considerable interest among researchers, and several infectious agents have been linked to CFS.

And then after this single sentence introduction to the Infection section (which is in fact a paraphrase of what is stated in the review PMID 18458765), just launch straight into the existing text detailing the bacteria and viruses that have been linked to CFS.

Drgao (talk) 06:03, 24 June 2012 (UTC)

I have no problem suggesting correlations where it is well supported by appropriate MEDRS, with the caveat that any discussion of correlation needs to be tempered so that any suggestion of causality is explicitly noted as speculative at this point, as the cause is unknown. Yobol (talk) 14:34, 24 June 2012 (UTC)

I suggest that a note on the caveat that correlation does not imply causation, if you want such a note, might best be placed a section of its own at the end of the article — a special section which explains to the reader a bit about the difference between correlation and causation. This is because this correlation does not imply causation caveat applies to all the various potential etiological factors discussed in the article, not just the infectious factors. For example, the findings that child abuse correlates to CFS do not prove that child abuse causes CFS, so this section would require the correlation does not imply causation caveat too, to create a balance article.

So if you feel inserting the correlation does not imply causation caveat is important, then include this caveat in ALL the sections in the article; or more elegantly, as suggested, place it a small explanatory section of its own at the end of the article.

What I think is wrong with the current introductory sentence to the Infections section, namely:

Many viral and bacterial infections have been proposed to cause or associate with CFS, but no infectious influence on pathophysiology has been proven,

is that this intro seems to give the causal reader the (erroneous) impression that "researchers have looked into this infectious etiology angle, but not got much mileage out of it, and have given up". This is the wrong impression to give, as the infectious etiology research is a very active field. Hence I prefer something like:

The possibility that infectious agents play a causal role in CFS has generated considerable interest among researchers, and several infectious agents have been linked to CFS, PMID 18458765

which I suggest more accurately depicts the state of affairs in CFS infectious etiology research.

Drgao (talk) 15:35, 24 June 2012 (UTC)

Redirect of this article

Propsal to make this article a redirect to the main CFS page - see https://en.wikipedia.org/wiki/Talk:Chronic_fatigue_syndrome#Pathophysiology_.E2.80.93_actions_taken_and_proposal_for_redirect for discussion --In Vitro Infidelium (talk) 13:27, 15 January 2016 (UTC)

Not sure if this is supposed to be a discussion or vote. If it's a vote, please feel free to add a "Support" to the beginning of this reply. As long as any relevant info has been copied to the main article, which I know you've been working on but I haven't been watching closely, I'm all for a redirect. I think we've split that article up a bit too much. – Robin Hood  ^(talk) 00:12, 16 January 2016 (UTC)