Monday, April 25, 2011

WHAT'S GOING ON?


I received two dozen letters from patients with more than one family member diagnosed with ME/CFS.  Most were mother and daughter, a few were mother and son, father and daughter/son, and husband and wife.

The most compelling case for an infectious ME/CFS etiology may be the family of Keith Baker, better known as bakercape on the forums. 

Now 41, Baker was 16 when he suddenly became  ill. At the time, Baker was a high-school track star and Junior Olympic metal winner in Waterville, Maine. As he testified to the Chronic Fatigue Syndrome Advisory Committee, “I was running a race and suddenly I could not put one foot in front of the other. I stopped in the middle of my race and knew something was terribly wrong with me.”

Baker was diagnosed with mono the next day and came down with chicken pox a week later. Next, his 12-year-old brother got chicken pox and mother became ill with shingles (a reactivation of the chicken pox virus) and Bell's palsy. 

When his adult sister came to visit, she too got sick.  And when Baker and his brother visited their father—his parents were divorced—his father became ill as well.  In a matter of months, everyone in the family was sick with ME/CFS.

Today Baker still has ME/CFS, as do the rest of his family. Baker hasn’t been able to run since he first became ill.  His wife is healthy, but their two children have high-functioning autism, and the elder child also has seizures. Of all the family members, Baker’s brother is the most severely affected with ME/CFS.

Genetics can’t explain this entire family coming down with ME/CFS, because Keith Baker’s parents clearly don’t share the same genetics, and neither does Baker: He’s adopted. 

Interestingly, years after becoming ill, Baker met his birth family, and no one was ill with ME/CFS.

So what happened?  Was there a common infectious agent that made the Baker family sick?  That would explain the illness that afflicted Keith Baker and his brother and mother, and perhaps his sister as well.  But Keith Baker’s father doesn’t fit neatly into that scenario as he wasn’t living in the house.  The fact that the father got sick after his sons visited indicates the illness may be contagious as well.  

No one in the family has been tested for XMRV, but they plan on getting tested this summer. 

This family’s ME/CFS history is anecdotal yes, but anecdotes shouldn’t be dismissed, especially after nearly three decades of hearing similar stories.  Over the years, there have been compelling sagas of couples or family members becoming ill with a flu, and one goes on to develop ME/CFS, while the others recover.  Sometimes the lucky family members who recover come down with ME/CFS years later, however.

I’ve also heard of couples who come down with a flu and one develops ME/CFS, while the other develops another illness, including Parkinson’s, multiple sclerosis and diabetes.

Clearly, after three decades, it’s beyond time that the CDC and the NIH study these families and establish the cause. 

Friday, April 22, 2011

NOT ENOUGH INFORMATION


My nephew is a second-year medical student at Jefferson Medical College in Philadelphia, PA.  I asked him what he's learned about ME/CFS in school, and he said only one paragraph, and this is it:

CHRONIC FATIGUE SYNDROME typically includes widespread pain as well as the history suggestive of a preceding infection, tender lymph nodes, sore throat, and low-grade fever. Fibromyalgia and chronic fatigue syndrome share the symptoms of overwhelming fatigue and problems with memory and recall, but chronic fatigue syndrome is not characterized by the 11 or more tender points of fibromyalgia.

How can future physicians treat ME/CFS effectively if all they get is a paragraph of information--and not all of it correct at that?  Many patients with ME/CFS do indeed have the fibromyalgia tender points. 

In contrast, other diseases, including lupus, multiple sclerosis and Parkinson's disease each rate a full lecture at Jefferson and about 20 pages of notes.  And the school devotes several lectures to HIV/AIDS, including one class just on drug treatments.


Wednesday, April 13, 2011

Q & A with CAA's
Dr. Suzanne Vernon


CFS Central:  At the NIH conference, you talked about the need for someone to lead the interdisciplinary research. Do you want the CAA [CFIDS Association of America] to do this?

Dr. Suzanne Vernon:  The Association is transforming to leverage and lead the kind of collaborative research that can be fostered by talent and technology from diverse disciplines. But the federal agencies, particularly the NIH and the Centers for Disease Control & Prevention, must engage more deeply in supporting this kind of research and directing their resources – human and financial – to the expanded study of nature of CFS at the molecular, cellular and clinical levels. It was clear to many of us who attended the State of the Knowledge Workshop that collaboration and leadership are required in equal measure to advance diagnostics, treatments and patient care. This is the Association’s core strategy to make CFS widely understood, diagnosable, curable and preventable.

CFS Central:  Is the NIH helping to fund the CAA’s biobank?  
 

Vernon:  No, the Association launched the SolveCFS BioBank with the help of gifts from individuals, all of whom are affected directly by CFS. We’re grateful for their support to build this important repository of clinical information and samples voluntarily provided by well-characterized CFS patients and healthy controls who share our commitment to advancing the understanding of CFS.

CFS Central:  In your view, what are some of the more important findings raised in the conference?

 
Vernon:  Having worked on CFS for 13 years, it feels to me like there is tremendous synergy around the need to be more collaborative across institutions, disciplines and settings (basic research, applied research and clinical research) to develop a shared set of tools that will accelerate the pace of discovery. The involvement of so many top people from the NIH at the meeting (especially under the circumstances of a near government shut-down) and Dr. Wanda Jones’ leadership at the Department of Health and Human Services make this a very hopeful and promising time.

CFS Central:  Why did you ask Dr. John Coffin what’s next for XMRV but didn’t ask Dr. Judy Mikovits?

 
Vernon: As I recall, we were already behind schedule and the moderators were moving on to the next topic in a very tightly packed agenda. It is also well established from Dr. Mikovits’ presentation at this meeting and in other recent presentations that the WPI will pursue its XMRV-focused studies and continue participating in the blood safety study and the multi-center study being coordinated by Ian Lipkin of Columbia University.

Sunday, April 10, 2011

YOU'RE IT

A Patient Advocate for an Adult Daughter with ME/CFS Addresses Dr. John Coffin's Pain

By Lilly Meehan

Dear Dr. Coffin,
I was sitting near you at the NIH State of Knowledge Workshop when you said that the patients’ online comments about you were “painful.”  As the mother of a 25-year-old young woman who has been fully disabled with ME/CFS for ten years, and affected since childhood, I would like to tell you a little bit about “painful.” 

“Painful” is being six years old and realizing there is something wrong with you because you cannot keep up with the other kids in a game of tag and are always “it” because you can’t run fast enough.

“Painful” is being fifteen years old and having ME/CFS hit you so hard you cannot get out of bed, go to school or do anything besides sleep.

“Painful” is hearing your doctor say to your mother, “If she were my daughter, I’d get her to go to school.”

“Painful” is migraines and severe fibromyalgia nearly every day.

“Painful” is trying to keep up with your studies, missing school, getting farther and farther behind, and realizing there is no way to be in school at all, despite trying desperately to hang on to your life as a high-achieving high-school student.

“Painful” is finally being forced to drop out of school because you’re just too sick.

“Painful” is the day your classmates graduate from high school and you’re not there. 

“Painful” is being dismissed by doctors from Santa Barbara to San Diego who either don’t recognize a clear case of ME/CFS sitting right in front of them or don’t have any idea how to help.

“Painful” is when your friends go off to college and graduate and you do not go, nor are you well enough to even attend their graduations.

"Painful" is realizing the medical community doesn’t care much about your illness, and the government isn’t funding any research to help you.

“Painful” is when your friends get jobs and have lives and don’t seem to have much in common with you anymore, and then slowly drift away. 

“Painful” is the day your sister gets married and you can barely keep up with the festivities, and you know this day is not coming for you.

“Painful” is being an adult and having to depend on your mother to do your dishes, wash your clothes, do your grocery shopping, run your errands, bring you food and give you the only emotional support you get from anyone.

“Painful” is accepting Section 8 housing benefits and Supplemental Security Income benefits, which are $700 per year below the poverty level, when you’d prefer to be paying taxes and being a contributing member of society.

“Painful” is seeing little future ahead of you unless this illness gets more funding and a treatment and/or cure is found.

“Painful” is wondering what’s going to happen to you when your parents die and can no longer pay for your needs or be your caregivers.

This kind of daily pain is why the patients are upset, Dr. Coffin.  We know you’re an experienced scientist and have done many important things in your career. We don’t think you necessarily know the depth of suffering that is going on out here in the real world of ME/CFS.  It is hard to feel sorry for you when we deal with these harsh realities and struggle daily.

I think you need to see the reality of this dreadful situation and realize the pain you feel about online comments about you is less important than the profoundly disrupted life that most with this illness endure day in and day out, for many years. Perhaps you should put on your big boy pants and just cope.  It seems to me to be a much easier task for you than for us.


Lilly Meehan and her daughter live in Ventura, California.

Friday, April 1, 2011

IS ME/CFS CONTAGIOUS?


If you have ME/CFS and your significant other or child also has ME/CFS, please contact CFS Central: mindykitei.cfscentral@comcast.net

Thursday, March 24, 2011

More on Dr. Judy Mikovits's New Role

The Whittemore Peterson Institute announced today that Dr. Judy Mikovits will transition from research director to director of translational research.  Dr. Vincent Lombardi, lead author of the Science paper that found the retrovirus XMRV in patients with ME/CFS, assumes the job of director of research.

"The point of the change is that the basic research grants and papers are not being funded or published because of the baseless contamination rumors," Mikovits wrote to CFS Central in an email.  "Therefore, I cannot mentor young investigators [and] students, who cannot move their careers forward because of these politics. I will be out seeking collaborations with other institutions--academic, private foundations and industry. Whenever we show and discuss all of the details of the data with investigators, they see and know it is not contamination.

"Prior to the reorganization," Mikovits continued, "I spent my days unable to help thousands... who have evidence of infection and cannot get help from their government or other research organizations.... I am totally confident that XMRV and a family of human gamma retroviruses is playing a role in ME/CFS.... [and] our reorganization reflects that confidence and allows me to move forward drug and diagnostic development."

Saturday, March 19, 2011

WILLARD


Question of the day:  Are vaccines contaminated with XMRV and related retroviruses?  After all, XMRV has found its way into common lab reagents and contaminated the 22Rv1 prostate-cancer cell line, among others. To quote the Wellcome Trust, a British foundation, “One in fifty human cell lines they examined were infected with XMRV-related viruses.” And to quote British researcher Mark Robinson, XMRV is “ubiquitous” in laboratory specimens.  Shouldn’t researchers then be testing vaccines as another possible vector for XMRV?

Since XMRV is the third infectious human retrovirus, it would be prudent to ensure that the vaccines aren’t contaminated.  In addition to blood transfusions, vaccinations are another potential way to spread the XMRV retrovirus.  Vaccine safety is as important as blood safety.


Wednesday, March 16, 2011

BRITISH INVASION


Here's my published letter on "Fighting for a Cause," the recent profile on XMRV researcher Dr. Judy Mikovits in the British publication Nature News.

I have to address the odd comment by [British retrovirologist] Greg Towers, who said of Harvey Alter: "He doesn't get variation, he gets a totally different virus." Harvey Alter would beg to differ. I interviewed him about his XMRV study for my blog, CFS Central. 

Alter [the NIH researcher who, along with Shyh-Ching Lo, found XMRV related viruses in CFS patients] said that he does indeed believe that his group and Mikovits’s group are looking at the same retrovirus.  “Viruses tend not to be homogeneous,” Alter explained.  “The fact that we didn’t find XMRV doesn’t bother me because we already knew that retroviruses tend to be variable. They mutate a lot, basically. This is true of HIV and HCV [hepatitis C virus]. It’s not one virus. It’s a family of viruses.” 

Alter is far more than “a hepatitis expert” that [reporter] Callaway describes.  He's a Lasker Award winner--his NIH research led to the discovery of hepatitis C--and he developed methods to screen for hepatitis, essentially eradicating the risk of acquiring hepatitis from donor blood.  Clearly, Harvey Alter is capable of speaking for himself, so it certainly begs the question:  Why didn’t Ewen Callaway ask him?

Earlier in his article, Callaway wrote: “The authors delayed publication of both papers for several weeks to assess discrepancies.” This statement is not correct. The authors didn’t delay publication. In a highly unusual move, as reported in the Wall Street Journal on June 30, 2010, higher-ups at Health and Human Services (HHS) put these two XMRV studies on hold, one by the CDC and another by Alter and the FDA’s Shyh-Ching Lo.

HHS officials wanted the two groups to reach a consensus, the Wall Street Journal reported, or at least determine how they arrived at different conclusions, a highly unusual move. 

Scientists disagree all the time, especially with new findings. That’s one reason why pulling the Alter/Lo paper appears to be more about politics than science, particularly because in an abrupt about-face the CDC, which didn’t find XMRV in CFS patients, published its study a day after the Wall Street Journal article, on July 1. So much for reaching consensus.

Alter and Lo, who did find XMRV-related retroviruses, were asked to conduct more research, and their study was finally published August 23.

What makes this case even more unusual is that the Alter/Lo paper had already been accepted by Proceedings of the National Academy of Sciences when it was pulled. I interviewed the journal's editor-in-chief, Randy Schekman, for CFS Central. He said that putting a paper on hold had occurred only one other time that he knew of in his nearly four-year tenure at the journal.  

Given these highly unusual events, the Chronic Fatigue Syndrome community is concerned that government health officials have been behaving more like politicians than scientists. Indeed, Bill Reeves, the former head of CFS research at the CDC, told the New York Times after the Mikovits paper came out: “We and others are looking at our own specimens and trying to confirm it [XMRV]. If we validate it, great. My expectation is that we will not.” 

As far as the XMRV negative papers are concerned, Nature News missed key facts.  For instance, rather than do a true replication study that reproduces precisely the methods and patient cohort of the Science study--something students learn in 9th grade science--the CDC as well as the Dutch and British researchers chose not to.

In addition, many of the patients these researchers are studying don’t have CFS, but have in fact idiopathic fatigue and depression, as confirmed by the research of Leonard Jason of DePaul University.

Mikovits’s study as well as Alter and Lo’s, however, did look at patients with bona fide CFS.

No one yet knows the role of XMRV in CFS, and no one will ever know until scientists examine the correct cohort and reproduce precisely the methods of the Mikovits study.

Friday, March 11, 2011

CD57: A Marker for ARVs?

 
One of the biggest problems in monitoring ME/CFS patients on antiretroviral therapy is the lack of markers to evaluate the drugs’ effects on the immune system.  For patients on medications to treat diseases like HIV and hepatitis, often their immune markers improve and the viral loads decrease well before the patients feel better.  This phenomenon is particularly common in patients with longstanding illness.

CD57
However, as there is no commercial viral-load test yet for XMRV and as immune markers haven’t been established, patients on antiretroviral (ARV) cocktails are flying blind.  One patient who’s been on ARVs for six months reports to CFS Central that although she isn’t feeling significantly better physically, two markers have been steadily rising:  CD57 and Vitamin D.  CD57 is a natural killer cell often depressed in Lyme and CFS patients.  The norm is 60 to 360, but some Lyme-literate physicians believe the count should be at least a hundred, and that the curve has been skewed due to so many Lyme patients getting tested. 

Prior to her initiating therapy, this patient’s CD57 hovered around 25—and it had been stuck there for several years since a serious crash that left her mostly housebound.  Prior to that crash, she was ill but more functional, and her CD57 count registered between 55 and 60. After six months on ARVs her CD57 is 74, an increase of 49 points. 

Vitamin D
Her vitamin D levels have jumped from 31, where they had been for several years, to 47.  Optimal is considered 50 to 125 nMol/L.  Prior to her being on ARVs, five thousand IUs of Vitamin D daily for three years had improved her vitamin D status only from 29 to 31.

Of course this patient’s findings are purely anecdotal, but they shouldn’t be dismissed either.  Vitamin D is easy to test, and in the U.S., Labcorp tests for CD57.

Cholesterol and blood sugar
Two other interesting tidbits:  A few patients have reported to CFS Central that their blood sugar has normalized on ARVs and their cholesterol has dropped.  One pre-diabetic patient forced to eat an Atkins diet of mostly protein and fat to avoid spikes in blood sugar after meals no longer has that problem on ARVs and can eat carbohydrates without any increase in blood sugar.  This is in contrast to the more common reaction of HIV patients on ARVs, who can experience both an increase in cholesterol and blood sugar.
------------------------
I'd be interested in hearing from patients who've had significant changes in their vitamin D or CD57 status on ARVs—or anything else noteworthy.  mindykitei.cfscentral@comcast.net

Tuesday, March 8, 2011

THE CROI INSIDER


An HIV clinician who attended last week’s CROI (Conference on Retroviruses and Opportunistic Infections) in Boston told CFS Central that it was pretty much a bust all around, but that would be par for the course with CROI, which is “notoriously good at keeping out those they don’t want in.”  As far as the XMRV presentations, the physician said it was glaringly obvious to him and to others that the opposing side—those who have found the retrovirus XMRV in ME/CFS patients and in prostate cancer patients—wasn’t being heard. 

His impressions of the discussions in the hallways were that the HIV researchers thought XMRV was a joke, but that many clinicians were taking XMRV seriously.  It reminded him of the early days of HIV when the doctors who were treating these sick patients knew something was seriously wrong with them, while the official word from government was much ado about nothing. “The feeling that I got,” he said, “was the same underlying sense of information being tightly controlled.”

Tuesday, March 1, 2011

THE DEVIL MADE ME DO IT


Below is my response to CFIDS Association board member Jennifer Spotila's comments from yesterday.  Spotila was responding to my "Bad Company" blog post, particularly to my commentary on CAA President Kim McCleary's statement to CNN about the PACE trial.  McCleary told CNN:  “I think it would be challenging, at least in the U.S. system, to purchase the services that they've tested in this trial,” adding this:  The alphabet soup of acronyms that represent the interventions used in Britain is “just not something that our health care service offers, is reimbursable, or is really available here.” And, finally, this: “It's kind of a shame that we're still limited to talking about approaches to coping mechanisms as the only therapy that's available.” 

Spotila's comments are below mine.


Jennifer Spotila,

If McCleary hadn't made those comments to CNN, CNN wouldn’t have included those comments. No one held a gun to McCleary’s head or laid a cattle prod to her feet and forced her to utter those problematic remarks. She did that all on her own. Granted, it’s difficult to articulate a string of perfect quotes, but McCleary’s endorsement of cognitive behavioral therapy (CBT) and graded exercise therapy (GET) was inexcusable in my view and the view of many patients. After all these years, there is no excuse for defending these ineffective therapies.

Defending McCleary’s statements, you wrote: “Both reporters had also been prepped by the authors of the PACE trial to expect and dispute the objections raised by McCleary and other advocates to the study.”  Prepped?  Says who?  Jennifer, each side makes his or her case.  You’re an attorney.  Think of it like the defense and the prosecution in a murder trial. That’s how it works.  McCleary’s job was to make her points, not to endorse those of the opposing side.

Kim McClearly could have told CNN something like this:  “The PACE trial is problematic, and here are some reasons why. The selection process eliminated most bona fide CFS patients.  Instead, the PACE patients had idiopathic fatigue and depression. Cognitive behavioral therapy and graded exercise therapy are primarily helpful for those with idiopathic fatigue and depression, not those with Chronic Fatigue Syndrome. In fact, the hallmark of CFS is post-exertional crashing, so graded exercise therapy would make the symptoms of most CFS patients worse.

“Many patients with CFS are severely ill and suffer from seizures; swollen lymph nodes; fevers; autonomic dysfunction that makes it difficult or impossible to sit or stand; heart failure; immune dysfunction, including reactivation of herpes viruses; and rare cancers. Some patients are dying, others are consigned to a living death, and compelling evidence points to a newly discovered retroviral infection in these patients that’s similar to the one that causes HIV. 

"Despite its trivial name, this is not a trivial disease.  To suggest that patients can power through CFS through GET or CBT would be as incorrect as suggesting that those with Parkinson’s disease or multiple sclerosis or AIDS can be restored to health simply with exercise and a positive attitude.”

Jennifer Spotila, even if I had been on hallucinogens, I couldn’t have said something as unhelpful as what McCleary told CNN.

On another note, you wrote, “The Association did make changes to its website and operations in response to feedback we received through Khaly's postings and other venues.”  Khaly Castle posted a reply to you that said in her view there were no significant changes (see her response, below). Jennifer, I would appreciate if you would tell the readers of CFS Central what those changes were, and let the patients weigh in on their significance.

The CAA survey on the patient forum Phoenix Rising gives patients the choice of voting that the CAA is doing great, or needs some minor changes, or needs changes in direction, or needs changes in both direction and leadership.  So far, 143 out of 153 patients—that’s 93 percent—have voted for changes in direction and leadership.  I would argue that the CAA is doing poorly on the Phoenix Rising survey because it’s not representing what the patients want and need. 

Patients deserve better representation.  Patients deserve a CAA that strongly opposes the money spent on CBT and GET studies/treatment for ME/CFS. Patients deserve bona fide biomedical research, not this appalling, make-believe, psychoneurotic PACE study.  Patients, in my view, deserve an advocacy organization that actually advocates for them.

You wrote: “I strongly encourage you to balance your reporting on the advocate point of view by interviewing a diverse sample of us.”  Jennifer, I strongly encourage you to hear what the patients are saying and to stop defending the indefensible:  McCleary’s statements to CNN are inexcusable.

Jennifer Spotila's remarks:
Mindy, If you had contacted me, I would have been happy to answer any questions you have about the Association or the incidents you cite here. I did respond to Khaly Castle in 2009. The Association did make changes to its website and operations in response to feedback we received through Khaly's postings and other venues. 

Kim McCleary gave a very lengthy interview on PACE to CNN, and another to NPR. Both reporters chose to use only one quote from those interviews. Both reporters had also been prepped by the authors of the PACE trial to expect and dispute the objections raised by McCleary and other advocates to the study. Their questions to McCleary and the pieces they produced reflect this. 

I strongly encourage you to balance your reporting on the advocate point of view by interviewing a diverse sample of us. Reasonable minds can and do differ on many aspects of CFS advocacy. I continue to believe that dialogue serves us better than monologue.   

Khaly Castle's response to Jennifer Spotila:
Jennifer, to say that the CAA responded would be accurate. To say that the CAA responded in a meaningful way would be inaccurate. In 2009, a thread was started on Phoenix Rising. The discussion over there continues to this day, about basically the same issues.

After we tried to have a meaningful dialogue, CAA was asked to help us fight the DSM5 issues. The response was meager and meaningless, basically boiling down to the suggestion that we should go ask the IACFS/ME as CAA did not feel informed enough to take a stance. I notice the same conversation evolving regarding ICD codes right now.

Mindy already cited and linked to two of my articles voicing some of the concerns we had in 2009. We are still facing the same concerns...lack of adequate response to ill-defined cohorts in X-negative studies, inability to take a stand that CFS is NOT what the CDC likes to describe, inability to advocate for the sickest of us, inability to verbalize a distinction between this illness and the grab bag of fatiguing illnesses....on and on.

For more on some of these issues, see: http://www.cfsuntied.com/archivedblog4.html#caaxmrv
You will notice that not much has changed.

A few months ago, after the "Inside Voices" article was presented to us, I asked the CAA on Facebook if the CAA still considered itself an advocacy organization, or if it had decided to become a science and research organization. You answered, that they were indeed an advocacy organization, but that there were many ways to advocate. The conversation and surrounding events are documented here: http://cfsuntied.com/blog2/2010/10/07/be-vewy-vewy-quiet-im-hunting-wabbits/

This can no longer be about promotion of promotion. It has to be promotion of what will save us. Many of us are facing not only the end of our ropes, but the end of our time. The clock is ticking. 


FLIP WILSON on ED SULLIVAN: THE DEVIL MADE ME DO IT

Monday, February 28, 2011

BAD COMPANY

Why Some Patients Have Had Enough 
of the CAA


When it comes to the CFIDS Association of America, patients Khaly Castle, Otis Quila and Liz Willow have reached critical mass.  They’ve just devised a “Petition to disassociate from CFIDS Association of America as our advocacy representative” because they believe that the CAA isn’t doing its job.  In one day, 205 patients have signed the petition, with a goal of one thousand signatures from all over the world.

Castle, Quila and Willow will present the petition at the May 2011 Chronic Fatigue Syndrome Advisory Committee meeting and also let the NIH and the CDC know that the CFIDS Association no longer speaks for the majority of patients. Explains Liz Willow, “[NIH administrator] Dennis Mangan realizes the patient community is diverse and reaches out to a number of individual advocates, Facebook page founders and bloggers on a regular basis.  But the CAA still seems to be perceived by many government officials as representative of patient wishes.  We didn't feel we could wait for a new organization to establish itself before rolling out the petition.  Patient sentiment for this type of petition is high, and we wanted to capture that momentum.”

Brewing dissatisfaction
The dissatisfaction with the CAA has been brewing for a long time but deepened after the first paper linking XMRV to ME/CFS was published in October of 2009.  Khaly Castle observed that the CAA maintained “an air of skepticism when they could have instead taken this new piece of science and turned it into a platform for some pretty powerful advocacy. In my mind,” Castle contends, “it just confirmed that this group is nothing but an arm of the entity it had contracted itself to for so long:  the CDC.”

Brian Smith and Jennifer Spotila 
A blogger as well as a patient, Castle in 2009 wrote two articles on the CAA that garnered huge response from patients.  (To read the articles, click here and here.)  After Castle posted them, CAA board member Brian Smith told her on Facebook that the CAA was listening.  “Then I never heard from him again, despite friend-requesting him,” Castle recalls.  However, Jennifer Spotila, who at the time was board president, contacted Castle directly, asking her to forward whatever patients wanted to tell the CAA. 

That’s when Castle started a new post, “CFIDS Association— What do you want to say to them?”  Gathering the hundreds of patient comments and questions that resulted, she forwarded them to Spotila.  But in the end, says Castle, “We got very little feedback and little or no visible change from the CAA.”

McCleary's response to the PACE trial
Most recently, it’s been CAA President Kim Kenney McClearly’s reaction to the PACE trials that Castle, Quila and Willow have found problematic. Of the PACE trial, which endorsed cognitive behavioral therapy and exercise for CFS, McClearly rattled off to CNN a peculiar commentary that appeared to endorse the bogus findings: “I think it would be challenging, at least in the U.S. system, to purchase the services that they've tested in this trial,” McClearly stated, adding this:  The alphabet soup of acronyms that represent the interventions used in Britain is “just not something that our health care service offers, is reimbursable, or is really available here.” And, finally, this lackluster shrug: “It's kind of a shame that we're still limited to talking about approaches to coping mechanisms as the only therapy that's available.”

Castle says that with McCleary’s response to the PACE trial, it’s clear that the CAA’s advocating for a chronic fatigue light kind of illness that’s primarily about generalized fatigue—as opposed to the serious neuroimmune disease that ME/CFS really is.  The result is “muddying the diagnostic waters,” Castle says.  “This is not only unhelpful, it's extremely harmful.”

Suzanne Vernon and spinal fluid
McCleary isn’t the only CAA representative who’s been a problem.  Last week Dr. Steven Schutzer’s team at the University of Medicine and Dentistry of New Jersey published on a distinct abnormal protein signature in the spinal fluid of ME/CFS patients, which apparently was a yawn to CAA Scientific Director Suzanne Vernon, who told the Wall Street Journal’s Amy Dockser Marcus: “It’s difficult to have a diagnostic test based on spinal fluid. You can’t just go poking everyone in the spine.” 

Vote to be heard
On the Phoenix Rising patient forum, so far 147 patients have participated in a new CAA poll, with 138 voting that it’s time for a change in direction and leadership. Cast your vote on Phoenix Rising and be heard.  If you believe the CAA doesn’t speak for you, cast your vote on the “Petition to disassociate from CFIDS Association of America as our advocacy representative.”

Thursday, February 24, 2011

Training Day

Dog day afternoon at the NIH as Dr. Fred Gill, who hails from the psychoneurotic school of CFS, questions whether CFS is even a disease.  He’s pitted against Dr. Harvey Alter and Dr. Shyh-Ching Lo, who believe in science.

By Charlotte von Salis


Curious to find out the National Institute of Health’s take on CFS these days, I attended the agency’s in-house lecture "Chronic Fatigue Syndrome:  Is there a virus?" on February 22.  One in a series in the NIH’s Demystifying Medicine presentations, the lecturers were the NIH’s Harvey Alter and the FDA’s Dr. Shyh-Ching Lo, co-authors of the 2010 paper "Detection of MLV-related virus gene sequences in blood of patients with Chronic Fatigue Syndrome and healthy controls.”   

The third speaker was Dr. Fred Gill, a medical doctor and chief of the Internal Medicine Consultation Service at the NIH.  He’s the self-proclaimed protégé of NIH psychobabbler extraordinaire, the late Dr. Stephen Straus.  In addition, Seabiscuit author Laura Hillenbrand is a former patient of Gill’s.

So there I was, the sole member of the public, along with about fifty other NIH attendees.  The good news:  Lo and Alter were terrific.  Lo, in particular, went to great lengths to explain how they carefully ruled out contamination in their study. 

Gill: worse than expected
The bad news:  Gill was even worse than I expected, touting graded exercise therapy as the best treatment for CFS.  That wasn’t terribly surprising, as Gill worked with Stephen Straus and treated Straus's patients. Gill remarked that when he was in private practice, he asked his patients to exercise, and they improved. He noted that many patient advocates feel that exercise exacerbates their symptoms, but he believes exercise is the right treatment for CFS.

Gill gave kudos to the just-released PACE study. "For those of us who've been preaching this [graded exercise therapy],” he said, “it's nice to show this study." Gill was particularly pleased that the same fatigue questionnaires used by the CDC were also used in the PACE study.

Gill’s a big fan of the Centers for Disease Control’s Empirical case definition, AKA the Reeves definition. He loves the—gasp—"excellent" questionnaires that the Reeves definition used, as well as the CDC's 2006 gene study.

The clinician's approach, he said, should mirror the CDC's toolkit recommendations.  Gill’s big on reassuring the patient, avoiding unnecessary tests, avoiding debate over whether it’s psychological, and above all, getting patients to remain active and exercise no matter what.

And the topper?  Gill’s condescending presentation of a CFS patient whom he called Velma (a pseudonym).  A middle-aged former pharmacist, Velma had a sudden CFS onset in 2006.  She reported the classic CFS symptom of suddenly needing to sit down and then lie down.  The next day Velma said she could barely get out of bed to go to the bathroom. Like many patients, she saw several doctors before getting a diagnosis, including physicians at the Mayo Clinic.  (Given the center’s piss-poor track record with CFS, it’s not surprising that they couldn’t find anything wrong.)

Velma admitted to secondary depression.  “It’s depressing when you’re debilitated, but I’m not a depressed person,” she summed up to the audience.  While she’s better than she was five years ago, she still has crashes. She’s not concerned whether CFS is caused by a virus; she just wants to get well.

Velma explained that she takes fludrocortisone— a steroid that treats low blood pressure and neurally mediated hypotension, common autonomic nervous system problems in CFS.  However, the patronizing Gill deemed this drug “useless” for CFS patients—despite that Velma said the drug helps her. 

Velma reported feeling feverish and having swollen lymph glands, but Gill said he found no discernible fever or lymphadenopathy.

Pushing herself to exercise
Velma isn’t the typical CFS patient, as post-exertional crashing isn’t a big issue for her.  She claimed, for instance, that she feels “much better” after she pushes herself to exercise on her “bad days.”  That made Gill smile.

Gill, who looks to be well into his 60s, went through a series of ancient slides from the 1980s. Oh joy—he started by pointing out that CFS was first recognized as neurasthenia by Beard in 1869, and it went downhill from there.  He went through the different names for CFS and selected case definitions (ignoring the Canadian).

Just in case anyone in the audience still thought there might be a real disease buried under the CFS construct, Gill ran through all the studies done by Straus that rebutted any positive treatment trials. Resurrecting his BFF Straus once again, he gave a big thumb’s up to studies done on stress and CFS. As to "pacing,” Gill oddly claimed that “he didn't fully understand pacing.”

Gill concluded his presentation by recommending the CDC's CFS website as well as that of the CFIDS Association of America (CAA). Gill said that he has a high regard for the CAA because he agrees with their views.  So now it’s abundantly clear the kind of scientists whose thinking dovetails with the CAA’s. 

I quickly and loudly called out that for real information, as opposed to misinformation, attendees should check out mcwpa.org and iacfsme.org. I actually got the attention of those present, many of whom copied down the URLs.

Alter’s talk
Alter explained that XMRV and related murine leukemia viruses (MLVs) aren’t yet accepted as human invaders or pathogens by most of the scientific community. (Sad, but true.)  Alter also noted that scientists are still debating whether CFS is physiological or psychological. (Sad, but true.)  He went through his slides, which unfortunately have been taken down from the course material website.  My favorite was the last slide, which indicated that clinical trials with antiretroviral drugs could potentially prove whether XMRV causes CFS.

Alter said that XMRV is a simple retrovirus (compared to the more complex HIV) that could be passed on to progeny.  He didn’t specify whether this infection occurred in utero, during breastfeeding or both.

Infection with XMRV, Alter said, can lead to viremia, which affects the immune and neurological systems.  Alter explained that it made sense to look for XMRV in CFS because many patients have an acute onset that leads to a chronic illness, cluster outbreaks had been reported, concomitant herpes infections are common, and defects in the antiviral RNASE-L pathway have been found. He briefly addressed the XMRV and MLV studies to date, including the negative ones. To my relief, everything he said indicated that he continues to believe CFS is a serious, physiological disease.

Lo’s talk
Lo, too, followed his slide presentation.  I'm kicking myself for not downloading the slides—I was surprised to find them gone from the course material website.  Lo reviewed the methodology and findings in the joint FDA/NIH study in extreme detail (to this non-scientist).

His research team, Lo explained, developed a "highly sensitive assay targeting mitochondria DNA, mouse DNA, that are well-conserved in multiple copies" and used that assay to re-test the positive samples before publishing the study. Lo then brilliantly rebutted the contamination articles.  As to the negative studies, he pointed out that differences in methodology, assays, and sample preparation were among the contributing factors that could explain the disparate results.  He noted that two CDC samples tested positive for MLVs using the FDA assay.

Questions and answers
In the Q & A session that followed the talks, Gill was hopelessly out of touch, invoking the Simon Wessely school of misinformation about CFS, circa 1988, by insisting that the disease is "not common" in children.

During the Q & A, I said that the Canadian Consensus Criteria (CCC) should be used to select patient cohorts and that audience members should read it as well as Dr. Lenny Jason's "Development of a Revised Canadian Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Case Definition.”

I was cut off as I was making a statement rather than asking a question.  So I don't know if what I said will make it to the edited videotape.

I did ask Gill a detailed question (mainly for the audience's benefit) about the Pacific Fatigue Lab's findings with repeat exercise testing, as well as the Lights’ exercise studies in CFS patients.  Both groups of researchers found objective, measurable and significantly abnormal biomarkers that distinguished the sick from the healthy controls after exercise.  Their findings allowed me to bring up post-exertional malaise as the hallmark of CCC-defined patients.

Gill replied that he disagreed with those studies but didn’t explain why.

In the Q & A, I told Gill that I was on the drug Midodrine for neurally mediated hypotension, and that was the only reason I was functional enough to attend the lecture.

Gill’s response was that studies have shown that there’s no orthostatic intolerance in CFS.  Earth to Gill:  Have you not read any of the formidable research by cardiologist Hugh Caulkins’ and pediatrician Peter Rowe’s group at Johns Hopkins?

Harvey Alter spoke again, pointing out that CFS has a viral-like “picture.” 

Gill asked Alter, “Is CFS a real disease—and if so, what’s its etiology?”  

Alter replied cryptically, as if he were the wisest of fortune cookies:  “The answer depends on the effort to find the cause.”

--------------
Charlotte von Salis, an attorney, has lived with ME/CFS for 20 years.

Tuesday, February 22, 2011

GET FAUCI

Stop hunting the puppets.
Hunt the puppet master.

“Nationwide—my God, they were frightened of Muskie and look who got destroyed.  They wanted to run against McGovern, and look who they're running against. They bugged, they followed people, false press leaks, fake letters, they canceled Democratic campaign rallies, they investigated Democratic private lives, they planted spies, stole documents, on and on.  Don't tell me you think this was all the work of little Don Segretti.”
  —Deep Throat to Washington Post reporter Bob Woodwood in All the President’s Men 
on why Nixon and his top aides were the Watergate masterminds, not lawyer Don Segretti, 
a foot soldier for the Committee to Re-Elect.
 

Frequently, I get emails from patients asking my advice on whom they should target in their protests, and I always say the same thing:  the higher up the better.  For instance, tremulous Dr. Beth Unger, who heads up “CFS” research at the Centers for Disease Control, has about as much power as the popcorn girl at my neighborhood movie theater.  In my view, pleading with Unger will have as much effect on ME/CFS policy as playing Barbies will have on instilling world peace.

To change anything, it's my view that you have to change the mindset of the people in charge and forget about the mid-level sump-pump bureaucrats with their cheap brown suits and Payless shoes who do as they're told.  And stop trying to make anybody in the government like you, like something out of Sally Field's "you like me" Oscar acceptance speech for Places in the Heart (watch it at the end of this post).

Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases at the National Institutes of Health (NIH), would be number one on the list of targets. He's incredibly powerful.  If ME/CFS patients could cause him enough grief, maybe the 70-year-old Fauci will cry uncle or just drop dead.

Fauci has been firmly in the psychobabble CFS camp for more than 20 years.  As evidence, on July 28, 1988, New York Times health reporter Jane Brody interviewed Dr. Stephen Straus, who headed up psychological CFS research at the NIH until his death in 2007.  Brody wrote that Straus said he and "his colleagues at the National Institutes of Health had demonstrated that many patients were psychologically 'different' long before they developed the syndrome. He described some patients as having been anxious and depressed with various neurotic symptoms for years before becoming ill. In other cases, patients were motivated, dynamic, driven individuals who were functioning at peak levels when stricken. Some may be under an undue amount of stress trying to maintain busy lives."

What does this have to do with Fauci?  After the piece appeared, journalist Hillary Johnson reported in Osler's Web and later on her blog that a dentist stricken with ME/CFS wrote an irate letter to Fauci, demanding that Straus be fired from the NIH because of his false statements to the press.

According to Johnson, Fauci responded to the dentist with a cordial letter that invoked the name Dr. Peter Manu, who agreed with Straus that neuroses and stress caused the disease. Fauci’s letter delivered Manu’s stinging supposition that 50 percent of CFS patients had an underlying mental illness and, Johnson wrote, Fauci provided the journal citation for that statistic and signed his “best regards.”
***
So when people ask why British retrovirologist and Simon Wessely colleague Dr. Myra McClure was appointed to the Center for Scientific Review Special Emphasis Panel, which approves NIH grants for ME/CFS, there is, ultimately, one reason why:  Anthony Fauci. 

Force Fauci to change his mindset about ME/CFS, and like a flip of a switch, the energy changes.  That's when quavering Beth Unger—and the rest of them—will see ME/CFS for the serious and sometimes fatal neuroimmune disease that it really is.  And that's not because Unger will have had a change of heart. It'll be because like all good government foot soldiers, she'll do as she's told.


Saturday, February 19, 2011

ISLAND OF LOST LUGGAGE

UFO Sightings and Wastebasket Diagnoses
 
Right now, CFS is classified in the “G” category on the International Classification of Diseases (ICD).  "G" indicates diseases of the nervous system.  The planned move in 2013 is to reclassify the disease in the “R” category, the island of lost luggage, also known as:  “Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified.”  In other words, CFS will slither to the wastebasket of ill-defined, unexplained and generally inconsequential diseases.

This change would be detrimental.  Assigning CFS to the “G” category in the ICD is respectable and accurate.  By moving it to UFO territory of “R,” CFS will become a bigger joke than its flimsy name has conferred.  Doctors will be less inclined to treat an ill-defined disease than a neurological one, or prescribe medications.  Besides, “R” is probably just a pit stop before hitting rock bottom, from which there is no escape:  Mental and behavioral disorders, the "F" category.

A patient on the Phoenix Rising forum queried CFIDS Association board member Jennifer Spotila, “Would you explain what the CAA is doing about ICD-10-CM plans to move CFS to R53: Malaise and fatigue? (See http://wp.me/pKrrB-Un.) This has to be stopped, as it would be a big step backward in our ability to get proper diagnosis and treatment.”

Spotila responded, “Unfortunately, we have neither the time nor expertise to engage on this issue. We have no clinicians on staff, and no expertise in making the case for how diagnostic codes will have a negative impact on reimbursement. The IACFS/ME or CFSAC might be in a better position with the right expertise.”

Jennifer Spotila, how can the CAA pass the buck on this one?  How can the CAA not issue a position statement?  This isn't about diagnostic codes. This is about stating what the disease is and what it isn’t and protecting what little credibility CFS still has left.  Surely CAA Scientific Director Suzanne Vernon and CAA President Kim Kenney McCleary can pen a robust paragraph that explains why the classification should remain in the neurological camp, widely distribute it to the media and stand firmly behind it.

How about this for starters:  CFS is a serious neuroimmune disease that affects the brain, the immune system and the autonomic nervous system.  The “G” classification is accurate and should not be changed to an “R” classification.

Come on guys.  Step up to the plate, stand up for the patients, and do your job.

If readers of this blog feel the same, here’s the contact info for Vernon and McCleary.  Tell them, if you agree, to take a firm position that endorses the G classification.
1-704-365-2343


WPI FUNDRAISING EVENT

COUNT ME IN is a global fundraising event for the Whittemore Peterson Institute (WPI).  It'll be held on the 20th of every month to keep the Institute alive and well.  That’s this Sunday.  You can donate via the WPI website or the Cure for ME Causes on Facebook.  If you use PayPal, put COUNT ME IN under “special instructions for seller.”

Friday, February 18, 2011

SIX DEGREES OF SEPARATION

 Updates on the PatientsLikeMe Study and an Intriguing Connection to Simon Wessely

The social networking health site PatientsLikeMe recently commissioned a study by New Zealand psychologist Keith J. Petrie on "illness perceptions and their impact on health outcomes" in fibromyalgia and ME/CFS.  Stated simply, this means that one’s “perceptions” cause the illness.

PatientsLikeMe was named one of “15 companies that will change the world” by CNN Reports.  Certainly an organization as vital and life-changing as PatientsLikeMe should be aware what “illness perceptions” means when it comes to ME/CFS.

1,100 patients participating

Eleven hundred patients are participating in this PatientsLikeMe study by New Zealand scientist Dr. Keith Petrie. Petrie believes ME/CFS is psychological and has done several studies with Dr. Simon Wessely. The study was closed on February 6.

However, patients can withdraw from the study at any time, which is one reason I’m posting about this study now.  If you believe that Petrie's study is problematic, consider withdrawing from the study and sharing your concerns with patients on the PatientsLikeMe site, who may then elect to withdraw from participation in that study.

If enough patients withdraw, the study will die.  More importantly, I believe it’s important to explain to PatientsLikeMe what's wrong with the study, and thereby change the mindset and the direction of research.

Already, several patients have posted or written to me that they have withdrawn from the study, much to the consternation of Dr. Michael Massagli, who's overseeing the study at PatientsLikeMe. One patient, Omerbasket, received this letter back from Massagli when he asked to withdraw:

Hello Omer.

I've received your request and will do as you ask.
But there is no reason for us to cease the study.  As I've described the purposes of the study in the survey invitation and in the Forum http://www.patientslikeme.com/forum/show/90352, I'm not going to repeat myself here. 

Thank you for your participation in PatientsLikeMe, limited as it has been. 

Michael Massagli

CFS Central sent a letter on February 7 to Massagli and to Jamie Heywood, co-founder of PatientsLikeMe, explaining why the study is problematic. (Heywood started the company when his younger brother Stephen was stricken with ALS.) 

I have yet to hear back.

Simon Wessely connection
Since then, a patient who calls himself Doogle on the boards sent CFS Central an intriguing series of connections, starting with the fact that a scientist named Dr. Paul Wicks is director of research and development at PatientsLikeMe. 

Why is this important?  Wicks received his doctorate from the Institute of Psychiatry, King's College London, where Dr. Simon Wessely serves as vice dean for the department of psychiatry.  

At King’s College, Wicks’s supervisors were Dr. Laura Goldstein and Dr. Sharon Abrahams. Dr. Laura Goldstein helped draft Matthew Broome’s journal article "A neuroscience of hysteria," which categorizes chronic fatigue syndrome as a “somatoform condition.”  Somatoform is code for mental disorder.
In addition, Laura Goldstein serves on the executive committee of the British Neuropsychiatry Association with Anthony David, a staunch CBT/GET advocate for ME/CFS.

To be fair to PatientsLikeMe's Paul Wicks, he’s intrigued with the emotional overlay in other diseases.  In fact, according to his profile, his main thrusts are the emotional and cognitive effects caused by ALS and Parkinson’s disease.

Neuoimaging studies not psychological studies
In addition, Wicks has collaborated with Dr. Martin Turner on a neuroimaging project using PET scans of the brain. However, at PatientsLikeMe, it doesn’t appear likely that he'll be involved in ME/CFS neuroimaging.  But perhaps the readers of this blog can change that.

If you believe this PatientsLikeMe study on how “illness perceptions” impact health should be stopped, consider withdrawing from the study and explaining on the PatientsLikeMe boards what's problematic with it, thereby encouraging other patients to withdraw.  Tell PatientsLikeMe what biomedical studies you do want.

Wouldn’t it be outstanding, and a far better use of money, if PatientsLikeMe would do a neuroimaging study on ME/CFS instead?  Wouldn't this be a better use of Paul Wicks's time and expertise?

Sample letter 

Below are excerpts from the letter I sent to Heywood and Massagli:

Feb 7

Dear Mr. Heywood and Dr. Massagli,

As a science reporter, health-book author, and blogger to 100,000 Chronic Fatigue Syndrome patients, I'm discouraged by your recent questionnaire devised by Professor Keith J. Petrie on PatientsLikeMe.  His field of expertise is "understanding illness perceptions and their impact on health outcomes," and the questionnaire is for patients with fibromyalgia or Chronic Fatigue Syndrome.  "Illness perceptions" is a well-known phrase to the CFS community. What it means is that your perceptions cause your disease.

I've been reporting on CFS for 20 years and have lost one of my best friends to the illness. Four patients whom I interviewed back in 1994 for a story on the experimental HIV and CFS drug Ampligen called "The AIDS Drug No One Can Have," for Philadelphia magazine, have died from the disease, one in her 40s, another in his 50s. Their "perceptions" did not cause their deaths.

Despite its benign name, CFS is anything but, and it's certainly not the psychogenic disorder that this questionnaire and Petrie's other studies indicate. For many, CFS is a living death and causes seizures, heart failure, rare cancers, and immune and autonomic dysfunction. For many, CFS is comparable to end-stage AIDS and heart disease in its severity.  Due to its pathetic name, coined by the CDC to ward off disability claims, the disease has been hijacked by psychologists, including Petrie.  Doing this study is yet another slap in the face for CFS patients desperate for biomedical research.

In 2009, a retrovirus called XMRV, similar to the retrovirus that causes HIV, was found in the majority of CFS patients tested. That finding was repeated by the NIH this past summer.  This is not a psychological disorder, and it is way past time to stop treating it as such. Patients with CFS need biomedical research in the same way that patients with ALS and HIV do.

Although I'm sure that you mean well, you're only causing damage and doing patients a great disservice with this study. Please stop Petrie's study, and stop being a party to such studies in the future.

If I can help in any way where CFS is concerned, please let me know.  I would be happy to direct you to researchers who really understand what CFS is and who would draw many more CFS patients to your site.

You may not know that many of the patients Petrie studies don't have CFS; they have idiopathic fatigue or chronic fatigue--entirely different entities.  In addition, Petrie dubs those with CFS "castrophizers."  Is that what you call individuals who are desperately sick, many for decades, with no drugs, little support from doctors or the community because of the stigma caused by the disease's trivial name?  I call these patients courageous.  I call them survivors.

Sincerely,
Mindy Kitei
CFS Central
http://www.cfscentral.com


Contact info: 
Mr. Jamie Heywood: jheywood@als.net
Dr. Michael Massagli: mmassagli@patientslikeme.com
Dr. Keith Petrie: kj.petrie@auckland.ac.nz 
Dr. Paul Wicks: pwicks@patientslikeme.com

Sunday, February 6, 2011

"We Are Not Crumbs": An Editorial


"We must not accept crumbs"

Is it time for ME/CFS patients to become organized warriors?  Is it time for ME/CFS patients to form an army, united against the common enemy, the government?

As I’ve said many times on this blog, when the HIV/AIDS patients started fighting back, that’s when they got results.

Bullies
I see the CDC and many in the NIH as insidious bullies—why else would the NIH have appointed Dr. Myra McClure to the Center for Scientific Review Special Emphasis Panel (SEP), which approves National Institutes of Health grants for ME/CFS?  As soon as patients voiced their disapproval, she said she would resign.


The only way to get people and the government to do the right thing is to stand up to them.  Every kid learns that when you stand up to bullies, they get afraid and back down.  For the government to be afraid of ME/CFS patients, it’s going to take a lot of organization and thousands of people rallying against them. It can be done.  But until there is organized action, nothing will change. 

If fifty thousand people from all over the world bombarded the NIH, torturing the agency with emails, faxes, phone calls and letters, demanding that the agency fund the Whittemore Peterson Institute’s research, I believe it will happen.  If fifty thousand people from all over the world bombarded the NIH, torturing Drs. Antony Fauci and Francis Collins, as well as Secretary of Health and Human Services Kathleen Sebelius on a daily basis with emails, faxes, phone calls and letters, demanding that Dr. Jim Jones be removed from SEP and telling them who ME/CFS patients do want in McClure’s and Jones’s places, I believe it will happen.  Patients need to ask retrovirologists and other scientists whom they respect if they'd be willing to sit on SEP, and once they say yes, those names need to be rammed down the government’s throat.  It’s time to take control.

Patients have the power.  It’s my view that they don't realize that they have the power, and they haven’t become organized enough to harness it.  But once they harness it, they can’t back down, or the government will clamp down harder than before.

There already is a blueprint, ACT UP, for coercing the government to fund biomedical research.  Most HIV/AIDS patients, even without treatment, have more energy than ME/CFS patients to coerce the government, but ME/CFS patients have the Internet and email, which ACT UP didn’t have 25 years ago.

Creative tactics
ME/CFS patients can develop effective and creative tactics, as ACT UP did.  (One of my favorite stunts of ACT UP was draping a giant condom over Senator Jesse Helms's house.) Even small gestures can make a difference.  Do you remember when the NIH’s Dr. Wanda Jones politely asked the ME/CFS protesters to sit down during the last Chronic Fatigue Syndrome Advisory Committee meeting?  What would have happened if the patients had calmly refused?  If the patients had been removed, patients could have emailed the video to reporters, and it could have become a news story.  The government would look bad, punishing ME/CFS patients for their peaceful act of civil disobedience, and patients would look fearless, strong and a force to be reckoned with.  The government needs to be exposed for being responsible for the deaths and living deaths of millions of patients all over the world during the past 25 years.  Only the patients can do it. 

The media
As far as the media is concerned, when a reporter writes an inaccurate, paternalistic, condescending, psychobabble story about ME/CFS, if ten thousand patients flood the online and print advertisers with this mantra, “We’re boycotting you as long as you support trash stories about ME/CFS," how long do you think those kinds of stories would continue, particularly given that newspaper and magazine revenues are in the toilet?  Advertisers get nervous when they get one angry letter.  What would ten thousand letters do?

The same goes for television or radio.  Any time something untrue or dismissive is said about ME/CFS, the barrage of angry phone calls, emails, faxes should begin.  We’re boycotting your show.  We’re boycotting your products.

Nancy Klimas
I believe one of the reasons that patients became so pissed about the recent Klimas study was because it felt like a slap in the face:  How could Nancy Klimas, who knows full well that biomedical research is what’s needed, participate in a cognitive behavioral therapy study?  I believe Klimas’s name on that study shows that her priorities are not always patients’ priorities, no matter how proactive she’s been to the cause over the years. Patients have to stand up for themselves; they can’t depend on anyone else to help, even Nancy Klimas or its own support group, the CFIDS Association of America. 

"We are not crumbs"
Below are key excerpts from AIDS activist Larry Kramer’s 2007 speech, “We are not crumbs.  We must not accept crumbs.”  It highlights the warrior tactics ACT UP used to usher in effective government cooperation and drug treatments.  One thing that struck me is Kramer’s belief that if you want justice, fairness has to be tossed out the window.

“Our days of being democratic to a flaw at those endless meetings must cease,” Kramer said.  “It has been a painful lesson to learn but democracy does not protect us. Unity does.”  Being polite, fair and reasonable doesn’t cut the mustard when you’re dealing with the government, as the HIV/AIDS patients found out 25 years ago and as ME/CFS patients surely know by now.  Being fair got McClure on that panel. Being fair hasn't gotten WPI NIH research dollars. 


Women versus men
I believe 25 years ago had women been the first to get HIV, ACT UP would never had occurred. Most women are taught to be compliant and sweet and reasonable and fair, but it’s going to take cajones to make change happen for ME/CFS. 

Below are key excerpts from Kramer’s speech.  If you’d rather watch the speech, scroll down to the bottom of this post.

“One day AIDS came along. It happened fast. Almost every man I was friendly with died. Eric [Sawyer, an HIV/AIDS activist] still talks about his first boyfriend—180 pounds, 28 years old, former college athlete—who became a 119-pound bag of bones covered in purple splotches in months. Many of us will always have memories like this that we can never escape.

“Out of this came ACT UP. We grew to have chapters and affinity groups and spin-offs and affiliations all over the world. Hundreds of men and women once met weekly in New York City alone. Every single treatment against HIV is out there because of activists who forced these drugs out of the system, out of the labs, out of the pharmaceutical companies, out of the government and into the world. It is an achievement unlike any other in the history of the world. All gay men and women must let ourselves feel colossally proud of such an achievement. Hundreds of millions of people will be healthier because of us. Would that they could be grateful to us for saving their lives.

"The appalling indifference to the suffering of so many"
“So many people have forgotten, or never knew what it was like. We must never let anyone forget that no one, and I mean no one, wanted to help dying faggots.  Senator Edward Kennedy described it in 2006 as 'the appalling indifference to the suffering of so many.' Ronald Reagan had made it very clear that he was 'irrevocably opposed' to anything to do with homosexuality. It would be seven years into his reign before he even said the word 'AIDS' out loud, by which time almost every gay man in the entire world who'd had sex with another man had been exposed to the virus. During this entire time his government issued not one single health warning, not one single word of caution. Who cares if a faggot dies? I believe that Ronald Reagan is responsible for more deaths than Adolf Hitler. This is not hyperbole. This is fact.
Fake blood and giant condoms
“These are just a few of the things ACT UP did to make the world pay attention: We invaded the offices of drug companies and scientific laboratories and chained ourselves to the desks of those in charge. We chained ourselves to the trucks trying to deliver a drug company's products. We liberally poured buckets of fake blood in public places. We closed the tunnels and bridges of New York and San Francisco. Our Catholic kids stormed St. Patrick's at Sunday Mass and spit out Cardinal O'Connor's host. We tossed the ashes from dead bodies from their urns on to the White House lawn. We draped a gigantic condom over Jesse Helms' house. We infiltrated the floor of the New York Stock Exchange for the first time in its history so we could confetti the place with flyers urging the brokers to 'SELL WELLCOME.'

Die-ins
“We boarded ourselves up inside Burroughs-Wellcome—now named GlaxoSmithKline—which owns AZT, in Research Triangle so they had to blast us out. We had regular demonstrations—die-ins we called them—at the Food and Drug Administration and the National Institutes of Health, at City Halls, at the White House, in the halls of Congress and at government buildings everywhere, starting with our first demonstration on Wall Street, where crowds of us lay flat on the ground with our arms crossed over our chests or holding cardboard tombstones until the cops had to cart us away by the vans-full.

“We had massive demonstrations at the FDA and the NIH. There was no important meeting anywhere that we did not invade, interrupt and infiltrate. We threatened Bristol-Myers that if they did not distribute it immediately we would manufacture it ourselves and distribute a promising drug some San Francisco activists had stolen from its Canadian factory and had duplicated. The drug, now known as Videx, was released. Ironically, Videx was discovered at Yale, where I went to school and with whom I am still engaged in annoyingly delicious activist battles to shape them up; they, too, are a stubborn lot. We utterly destroyed a Hoffmann-LaRoche luncheon when they delayed a decent drug's release.
Attacking the New York Times
“And always, we went after the New York Times for their shockingly, tragically inept reporting of this plague. We plastered this city with tens of thousands of stickers reading, 'Gina Kolata of the New York Times is the worst AIDS reporter in America.' We picketed the Fifth Avenue home of the publisher of the Times, one Arthur Sulzberger. We picketed everywhere. You name a gross impediment and we picketed there, from our historic 24-hour round-the-clock-for-seven-days-and-nights picket of Sloan Kettering to another hateful murderer, our closeted mayor Edward I. Koch. Three thousand of us picketed that monster at City Hall.
“And, always we protested against our ignoble presidents: Reagan. We actually booed him at a huge AmFAR benefit in Washington. He was not amused. And Bush: 2,500 of us actually tracked him down at his vacation home in Kennebunkport, Maine, which did not know what had hit it. And Clinton. I cannot tell you what a disappointment he was for us. He was such a bullshitter, as I fear his wife to be. And Bush again. The newest and most evil emperor in the fullest, most repellant plumage. We can no longer summon those kinds of numbers to go after him.
“Slowly we were noticed and even more slowly we were listened to.
“Along this journey some of our members taught themselves so much about our illness and the science of it and the politics of it and the bureaucracy of it that we soon knew more than anyone else did. We got ourselves into meetings with drug company scientists who could not believe our people weren't doctors. I took a group to a meeting with Dr. Anthony Fauci, whom I had called our chief murderer in publications across the land.
“Dr. Fauci was and still is the government's chief AIDS person, the director of infectious diseases at NIH. We were able to show him how inferior all his plans and ideas under consideration were compared to the ones that we had figured out in minute detail. We told him what they should be doing and were not doing. We showed him how he and all his staff of doctors and scientists and researchers and statisticians did not understand this patient population and that we did. By then, we had located our own doctors and scientists and researchers and statisticians to talk to, some of them even joining us. When our ideas were tried, they worked. We were consistently right.
Our chief murderer
“Our 'chief murderer,' Dr. Fauci, became our hero when he opened the doors at NIH and let us in—a historic moment and a historic gesture. Soon we were on the very committees we had picketed, and soon we were making the most important decisions for treating our own bodies. We redesigned the whole system of clinical trials that is in use to this day for every major illness. And, of course, we got those drugs out. And the FDA approval for a new drug that once took an average of 7-12 years can now be had in less than one. ACT UP did all this.
“My children—you must forgive me for coming to think of them as that—most of whom are dead. You must have some idea what it is like when your children die. Most of them did not live to enjoy the benefits of their courage. They were courageous because they knew they might die. They could and were willing to fight because they felt they soon would die and there was nothing to lose, and maybe everything to gain.
“[AIDS activist] Rodger McFarlane made this list of ACT UP's achievements: accelerated approval of investigational new drugs; expanded compassionate use of experimental drugs and new applications of existing drugs; mathematical alternatives to the deadly double-blind-placebo-controlled studies of old; rigorous statistical methods for community-based research models; accelerated and expanded research in basic immunology, virology and pharmacology; public exposure of and procedural remedies to sweetheart practices between the NIH and FDA on one hand and pharmaceutical companies on the other. 
“Now, with our own decline, unfortunately out of control again; institutionalized consumer oversight and political scrutiny of FDA approvals for all drug classes and for vast NIH appropriations for research in every disease; state drug assistance programs; and vastly expanded consumer oversight of insurance and Medicare and Medicaid reimbursement formularies. Each of these reforms profoundly benefits the health and survival of hundreds of millions of people far, far beyond AIDS and will do so for generations to come.
“Perhaps you did not know we did all this. As we know, historians do not include gay anything in their histories. Gays are never included in the history of anything.
Before ACT UP and after
“Dr. Fauci now tells the world that modern medicine can be divided into two periods. Before us and after us. 'ACT UP put medicine back in the hands of the patients, which is where it belongs,' he said to The New Yorker.
“How could a population of gay people—call us the survivors, or the descendents, of those who did all this—be so relatively useless now? Maybe useless is too harsh. Ineffectual. Invisible. No, useless is not too harsh. Oh let us just call ourselves underutilized. As long as I live I will never figure this out.
“Then, we only had the present. We were freed of the responsibility of thinking of the future. So we were able to act up. Now we only have our future. Imagine thinking that way. Those who had no future now only have a future. That includes not only everyone in this room but gay people everywhere. We are back to worrying about what 'they' think about us. It seems we are not so free, most of us, to act up now. Our fear had been turned into energy. We were able to cry out fuck you, fuck you, fuck you. Troy Masters, the publisher of LGNY, wrote to me: ACT UP recognized evil and confronted it loudly.
“Yes, we confronted evil. For a while.
“We don't say fuck you, fuck you, fuck you anymore. At least so anyone can hear.
Doesn't anything make you angry?
“Well, the evil things that made me angry then still make me angry now. I keep asking around, doesn't anything make you angry, too? Doesn't anything make anyone angry? Or are we back in 1981, surrounded and suffocated by people as uninterested in saving their lives as so many of us were in 1981. I made a speech and wrote a little book called The Tragedy of Today's Gays about all this. That was about two years ago. Lots of applause. Lots of thanks. No action.
There was a Danish study a few weeks ago. The life expectancy after infection by HIV is now thirty-five years. Thirty-five years. Can you imagine that? That is because of ACT UP. A bunch of kids who learned how to launch street actions and release a propaganda machine and manipulate media masterfully, and use naked coercion, occasional litigations, and adept behind-the-scenes maneuverings that led to sweeping institutional changes with vast ramifications. We drove the creation of hundreds of AIDS service organizations across the country, leveraging hundreds of millions of dollars a year and fielding tens of thousands of volunteers, all the while amassing a huge body of clinical expertise and moral authority unprecedented among any group of patients and advocates in medical history.
“We did all this. And we got all those drugs. The NIH didn't get all those drugs. The FDA didn't get all those drugs. We got all those drugs. And we rammed them down their fucking throats until they approved them and released them.
“It was very useful, old ACT UP.
“It is no longer useful. The old ACT UP is no longer useful enough. There are not enough of us. Few people go to meetings. Our chapters have evaporated. Our voice has dimmed in its volume and its luster. Our protests are no longer heard.
“We must be heard! We must be.
Utter disdain
“We are not crumbs! We should not accept crumbs! We must not accept crumbs! There is not one single candidate running for public office anywhere that deserves our support. Not one. Every day they vote against us in increasingly brutal fashion. I will not vote for a one of them and neither should you. To vote for any one of them, to lend any one of them your support, is to collude with them in their utter disdain for us. And we must let every single one of them know that we will not support them. Perhaps it will win them more votes, that faggots won't support them, but at least we will have our self-respect. And, I predict, the respect of many others who have long wondered why we allow ourselves to be treated so brutally year after year after year, as they take away our manhood, our womanhood, our personhood. There is not one single one of them, candidate or major public figure, that, given half a chance, would not sell us down the river….
“We are not crumbs! We must not accept crumbs!
“The CDC says some 300,000 men who had sex with men have died during the past 20 years. If I knew at last 500 of them, I know this CDC figure is a lie. Just as I know the CDC figure of gay people as only several percentage points of the population is a lie, instead of the at least some 20% of the population that the Williams Institute at UCLA Law School calculates it is possible to maintain. Who says that intentional genocide of 'us' by 'them' isn't going on? They don't want us here. When are we going to face up to this? …
“I wish I could make all gay people everywhere accept this one fact I know to be an undisputed truth. We are hated. Haven't enough of us died for all of us to believe this? Some seventy million cases of HIV were all brewed in a cauldron of hate.
Activism out of love
“[AIDS researcher] Mark Harrington said to me last week that one of the great things about ACT UP was that it made us proud to be gay. Our activism came out of love. Our activism came out of our love for each other as we tried to take care of each other, and to keep each other alive.
“No one is looking out for us anymore the way ACT UP looked out for us once upon a time.
“ACT UP is not saving us now. This is not meant as finger-pointing or blame. It just is. No one goes to meetings and our chapters all over the globe have almost disappeared. And we must recognize this, I beg of you.
“I don't want to start another organization. And yet I know we must start another organization. Or at the very least administer major shock therapy to this one.
“And I know that if we do go down a new road, we must do it right and just accept this fact that the old ACT UP we knew is no longer useful enough to the needs that we have now and move on to reparative therapy.
An army with elected leaders and a chain of command
“I also know that any organization that we start now must be an army. You have resisted this word in the past. Perhaps now that the man in charge of America's army is calling you immoral you won't resist it army anymore. We must field an organized army with elected leaders and a chain of command. It must be a gay army with gay leaders fighting for gay people under a gay flag, in gay battle formations against our common enemies, uncontaminated by any fear of offending or by any sense that this might not be the time to say what we really need to say.
“We must cease our never-ending docile cooperation with a status quo that never changes in its relationship to us…. Taxation without representation. Safety. Why aren't they all supporting Hate Crimes bills that include us? Twenty-thousand Christian youths now make an annual pilgrimage to San Francisco to pray for gay souls. I am sorry but this is not free speech. This is another version of hate. If any organization sent 20,000 Christian youths to pray for Jewish souls they would lose their tax-exempt status, or they would have before George Bush. Do we protest?
‘It is very wearying to witness our carrying on so passively year after year, particularly now that all of us—and I mean all of us—have been given the gift of staying alive. I know that young gays don't think this way, but many of us died to give you this gift of staying alive. You are alive because of us. I wish you would see this. And we all owe it to the dead as well as to ourselves to continue a fight that we have stopped fighting.
“We do not seem to realize that the more we become visible, the more that more and more of us come out of the closet, the more vulnerable we become to the more and more increasingly visible hate against us. In other words, the more they see us, the more they hate us. The more new gays they see, the more new ways they find to hate us. We do not seem to realize that the more we urge each other to come out—which indeed we must never stop doing—the more we must protect ourselves for and from our exits from our closet on to the stage of the world that hates us more and more. I don't think we realize this and we must. We must.
Strength and discipline scares people
“Why do I think we need the word 'army'? Because it connotes strength and discipline, which we desperately need to convey. Because it scares people, and God knows nobody is all that scared of us. Which they were for a while. The drug companies were afraid of us. The NIH and FDA were afraid of us. Closeted everybodies were afraid of us. No more. Our days of being democratic to a flaw at those endless meetings must cease. It has been a painful lesson to learn but democracy does not protect us. Unity does. United commitment to confront our many foes….
“When will we acknowledge that we are constantly being lied to? We must have fiercely observant eyes. We must understand and confront the unprecedented, with 'attentive facing up to, and resistance of, reality—whatever that might be.' (Arendt) Intelligent people—and gays are certainly that—have proved more than once that we are less capable of judging for ourselves than almost any other social group. When a conservative columnist can get away with calling presidential candidates 'a faggot' and 'a queer,' without any serious reprisals, than why can't we see that we are in trouble? When the New York Times does not run an obituary on quite possibly the most famous lesbian in modern times, Barbara Gittings, than we are in trouble. When I can't get US News and World Report to publish a letter about an insidiously homophobic cover story they wrote on Jamestown, we're in trouble. When our country's top military officer can call us immoral, we're in trouble.

“No, ACT UP is not saving us now. No one is saving us now.
Our friends are not protesting with us
“We all think we have straight friends. We think if we have straight friends then everything is OK. But these friends are not protesting with us. They aren’t fighting with us. They enjoy the freedoms they have with their marriages and all their fringe benefits. Yes, they like us but are they going to sacrifice any of their freedoms to get us ours? Of course not. And what’s more we should not expect them to. Even though it sure would be nice; we’ve fought for them and theirs often enough.
“The old ACT UP model served us well but it is time to take the next step. I am not saying that there are not more fights to be had for AIDS. There are and we must continue to fight them. Infections are up again. Prevention efforts are not good enough. It is still illegal for HIV foreigners to enter America. But these issues no longer appear to excite sufficient participation. Few people come to meetings and our chapters have disappeared. Many of us have tried to figure out what happened to us and why we ceased to be what we were. We all have thoughts about what happened but as I said I think its time to stop trying to figure it out and just move on. Expanding our demands will hopefully not silence our past concerns but invite increased numbers to meld these newer concerns I am talking about into a stronger, total mix.
“ACT UP requires a new model to do this. A new model that will allow for different kinds of actions, tactics and issues, not just HIV. I am not asking you if you even want another organization. I am hoping that you are smart enough to realize–eureka!–that the great deeds we once accomplished which changed history can be accomplished again. For we are still facing the same danger, our extermination, and from the same enemy, our own country, our own country’s “democratic process.” Day after day our country declares that we are not equal to anything at all. All the lives we saved are nothing but crumbs if we still aren’t free. And we still aren’t free. Gay people still aren’t free….
“We have right on our side and we must make everyone know it. If ACT UP is to stand for anything, let it stand for our Army Corps to Unleash Power.
“Think about it. Think about all of this. Please.
“We are the only people in America that it is socially acceptable to hate and discriminate against. Indeed so much hate of us exists that it is legally acceptable to pass constitutional amendments to hate us even more. This is democracy? This is how our courts and laws protect us? These are the equal rights for all that America’s Bill of Rights proclaims for all?
“The biggest enemy we must fight continues to be our own government. How dare we stop? We cannot stop. We are not crumbs and we must not accept crumbs and we must stop acting like crumbs.
Grass roots
“ACT UP is the most successful grass roots organization that ever lived. Period. There never was, never has been one more successful that has achieved as much as we. We did it before. We can do it again. But to be successful, activism must be practiced every day. By a lot of people. It made us proud once. It united us.
“I constantly hear in my ears the refrain: “an army of lovers cannot lose.” Then why are we losing so? We must trust each other to an extent we never have, enough to allow the appointment of leaders and a chain of command to stay on top of things and keep some sort of order so that we not only don’t self destruct as we seem to have more or less done, but also, this time, as we did not do before, institutionalize ourselves for longevity.
“I am very aware that as I spin this out I am creating reams of unanswered questions. Well, we didn’t know when we first met in this very room twenty years ago what we wanted ACT UP to become. But we figured it out. Bit by bit and piece by piece we put it together. We have a lot to thrash out and codify in a more private fashion. Armies shouldn’t show all their cards to the world. Many parts of the old ACT UP will still serve us: the choices of a variety of issues to obsess us in the detail that we became famous for; the use of affinity groups that develop their own forms of guerilla warfare….
“Much of what I am calling for involves laws, changing them, getting them. We need to cobble together an omnibus gay rights bill and then hold every politician’s feet to this fire until he or she supports it. We’d find out fast enough who are friends aren’t. TAG and AmFAR once cobbled together a bunch of research priorities into a bill that they got through congress.
“How about this: Jim Eigo wrote me: “a full generation after AIDS emerged as a recognizable disease, having sex still poses the same risk for HIV infection or reinfection. Having a sexual encounter with another person–a central, meaningful activity in most people’s lives–has been shadowed by fear, by the prospect of a long-term disease and by a whole new reason for guilt for more than a quarter of a century now. How have we allowed this unnatural state of affairs to persist for so long? Where are the 21st century tools for preventing the sexual transmission of HIV: cheap, effective, and utterly unobtrusive. Lovers deserve nothing less. Instead of sinking time, effort, and money into excavating the fossils of its ancient achievement, ACT UP might consider marking its birthday by mounting a fresh drive to remind government and industry that people have a right to sex without fear, without being forced to make a choice between pleasure and health. It’s an issue that might actually speak across the divides of generation, race, gender and sero-status.
“And it might regain for the organization some measure of the relevance it once had for the grassroots activists that gave of themselves as if their lives depended on it, because they really did.” Jim is calling for nothing less than the reclamation of our sex lives. What an utterly fantastic notion, or shall I now say goal? Why even raising this issue will find us hated even more. I am so ready for another organized fight.
“Are you beginning to see how all this that I am talking about can be streamed into one new ACT UP army?
The power of the Internet
“I have asked Eric to convey the main difference of what is available to us now that we did not have to work with in the past: 
“In the age of the Internet we can do much of what we did in our meetings and on the streets, on the world wide web.
 “The information technology available today could help end the need for those endless meetings.
 “Creating a blog could, in fact, incorporate even more voices and varieties of opinions and ideas than any meeting ever could. 
“Where ACT UP once had chapters in many cities, we could now involve thousands more via simple list-serves and blogs. We can draw in students and schools and colleges all over the world. It is the young we have to get to once again. Creating a blog would allow for expression and refinement of ideas and policies, like a Queer Justice League for denouncing our enemies.
 

A well organized website could function as an electronic clearing house for sharing information, for posting problems, for demanding solutions, for developing and communicating action plans.
 List-serves and a website could coordinate grassroots organizing and mobilize phone, e-mail and physical zaps or actions. They could also be used to spotlight homophobic actions, articles, movies and TV, and laws.
 “Why aren’t we fighting fire with fire? Where is our radical gay left think tank? We need our own ‘700 Club’ and our own talk radio show. Developing such gay content programming for the LOGO or Here Networks or for streaming on-line is completely possible today. Why are all the shows our community is producing about fashion, decorating or just another gay soap?”
“Why even Time magazine is now stating as a fact that websites drive the agendas of political parties.
“I know that even without these tools we reordered an entire world’s approach to a disease that would have killed us all. Surely with these tools and with all our creativity we can start to take control of our destinies again.
“With these tools, and with a renewed commitment to love and support and to fight to save each other, with a renewed commitment to the anger that saved us once before, with the belief that anger, along with love, are the two most healthy and powerful emotions we are good at, I believe that we could have such a historical success again.
“May I conclude these thoughts, these remarks toward the definition of a new ACT UP that will hopefully begin to be discussed forthwith, with this cry from my heart:
“Farewell ACT UP.
“Long live ACT UP.
“Thank you.”