Saturday, September 10, 2016

55 Members of Congress Sign Letter Supporting Biomedical Research for ME/CFS

After dogged work by advocates, fifty-five members of Congress have added their signatures to a letter initiated by representatives Zoe Lofgren (D - CA) and Anna Eshoo (D - CA).

The letter urges NIH to respond in a timely fashion to requests for grants. It also asks NIH to report its efforts to fund research as well as the status of specific plans for funding over the next two years.

Congressional support is crucial for obtaining funding for research because unlike agencies, which are beyond our influence, representatives have an obligation to support the interests of their constituents.
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Advocates Obtain Congressional Support for Strengthened ME/CFS Research at NIH

LOS ANGELES, September 9, 2016 – After years of neglect by the National Institutes of Health (NIH), patients suffering from myalgic encephalomyelitis (ME), commonly known as chronic fatigue syndrome (CFS), created a win today as members of Congress came together urging the NIH to do the right thing and strengthen ME/CFS research.

In a formal U.S. House of Representatives letter published today (“the letter”), 55 members of Congress called upon NIH Director Francis Collins to strengthen the NIH’s efforts in ME/CFS biomedical research through a reinvigorated trans-NIH ME/CFS working group as well as additional intramural and extramural research programs.

As the letter explains, “ME/CFS is a complex, debilitating, and chronic disease afflicting 1 to 2.5 million Americans. It costs individuals, the U.S. health care system, and our economy an estimated $17-$24 billion annually. Yet, as the Institute of Medicine noted in its report, ‘Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness,’ there has been ‘remarkably little research funding’ to date to discover its cause or possible treatments.”

Thanks to the hard work of #MEAction, the Solve ME/CFS Initiative (SMCI), and dozens of independent advocates, the letter attracted a broad coalition of bipartisan cosigners led by U.S. Representatives Zoe Lofgren and Anna Eshoo of California. In addition to encouraging advocates all across the country to reach out to their own representatives, SMCI President Carol Head also wrote a personal letter to all 435 representatives, urging them to sign onto the letter.

Said SMCI President Carol Head, “The NIH has failed to live up to its commitment to ME/CFS patients and has not followed the recommendations put forth in the 2015 IOM report; now, thanks to the actions of a coalition of hardworking advocates and members of Congress, we expect this to change.”

To read the letter and see the 55 members of Congress who signed on, view the letter here.

About the Solve ME/CFS Initiative (SMCI)

The Solve ME/CFS Initiative (SMCI) was founded in 1987 and has established itself as the leading non-profit organization dedicated to ME/CFS. The organization’s mission is to make ME/CFS widely understood, diagnosable, and treatable by stimulating and conducting research aimed at the early detection, objective diagnosis, and effective treatment of ME/CFS. SMCI is the first and only ME/CFS organization to earn the highest possible distinction (a 4-star rating) from Charity Navigator, America’s largest independent charity evaluator.

September 9, 2016

Wednesday, September 7, 2016

Tribunal Orders Release of PACE Trial Data: Is This the End of an Error?


On August 16, the First Tier Tribunal (UK) ordered the release of the PACE Trial data to Alem Matthees, marking the end of a two-year battle. (You can read the order HERE.)

Mr. Matthees is an Australian researcher, and ME/CFS patient, who has made repeated attempts under the Freedom of Information Act to obtain anonymized data from the PACE trial. Queen Mary University of Londom (QMUL) has managed to quash every request - until now.

In this historic ruling, the tribunal determined that:

1) The information Mr. Matthees requested is not personal, and therefore an exemption based on the possibility that people in the trial could be identified does not apply.

2) Because data are anonymized, invasion of privacy does not apply.

3) There is no indication that the release of anonymized data would discourage future research.

4) There is a strong public interest in releasing the data.

This last point is especially important, as it directly addresses the issue of transparency in research, a topic that has been much in the news lately.

In a 2005 article published in PLoS ONE, Stanford professor John Ionnides claimed that most published research findings were false. There are a number of reasons why research is falsified, including outright plagiarism, conflict of interests (especially true in cases where research is being paid for by pharmaceutical companies), poor methodology, scientific malfeasance, false premises, and general incompetence.

In the case of the PACE trial, conflict of interests led directly to scientific malfeasance. The conflict here stemmed from the unwillingness of NHS to pay for treatment for ME patients. In comparison to treatments such as Ampligen, IVIG, and other immunotherapies, cognitive behavior therapy (CBT) and graded exercise (GET) are relatively cheap to administer.

The PACE trial is not the first trial to make the claim that CBT and GET are beneficial for ME/CFS patients. Trudie Chalder, one of the principals in the PACE study, has been publishing articles since 1989 touting the benefits of CBT and exercise for ME/CFS patients. Nor is she a stranger to faulty methodology as the statistics on some of these studies were questionable.

The PACE trial was the crowning glory to over two decades of research for Chalder, as well as for several other psychiatrists involved in the study. While it is unlikely QMUL will spend any more money on challenging the tribunal's decision, it is equally unlikely that the PACE trial group will abandon its "research" into CBT and GET. In fact, a second PACE study involving adolescents is already under way.

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Press Release from ME Action:

Thursday, 18th August 2016, London, UK - A tribunal has ruled that data from a treatment trial into
Chronic Fatigue Syndrome (CFS) must be released, rejecting an appeal from Queen Mary University
of London (QMUL).

PACE was a £5 million, publicly-funded clinical trial of exercise and cognitive behavioural therapy for CFS. It has been highly influential in determining treatment in the UK and abroad, but has been
controversial. Academics and patients have both voiced concerns over “misleading” claims. Dr
Richard Smith, former editor of the British Medical Journal, said in December 2015 of QMUL’s failure to release the data, “…the inevitable conclusion is that they have something to hide”.

QMUL spent over £200,000 on legal fees in this case, to appeal the Information Commissioner’s
decision that they should release anonymised data from the trial. The request for data was made
under the Freedom of Information Act by Mr Alem Matthees, to allow analysis of the data according
to the study’s original published protocol.

QMUL made several arguments why the data should not be released, their main claims being that
the data was personally identifiable information, and was not sufficiently anonymised. However, the
tribunal rejected these arguments, noting that QMUL had already shared the data with a small
selection of other scientists, stating, "In our view, they are tacitly acknowledging that anonymization
is effective, or else they would be in breach of the consent agreement and the DPA principles."

The tribunal was satisfied that the data “...has been anonymised to the extent that the risk of
identification is remote.” The tribunal also noted the "strong public interest in releasing the data
given the continued academic interest" and "the seeming reluctance for Queen Mary University to
engage with other academics they thought were seeking to challenge their findings."

In his correspondence with the court, Mr Matthees expressed “concerns that QMUL are restricting
the registered researchers to whom they disclose the data upon request.” The tribunal said, “The
evidence before us is not clear but if QMUL are cherry-picking who analyses their data from within
the recognised scientific research sphere to only sympathetic researchers, there could be legitimate
concerns that they wish to suppress criticism and proper scrutiny of their trial.”

In its submissions QMUL made a number of accusations of harassment from patients, while QMUL’s
expert witness characterized PACE trial critics as "young men, borderline sociopathic or
psychopathic", remarks the Information Commissioner dismissed as "wild speculations".

When pushed to provide evidence of these threats and harassment under cross examination,
witnesses speaking for QMUL were unable to do so, and ultimately conceded that "no threats have
been made either to researchers or participants."

The tribunal found QMUL's assessment of activist behaviour to be, “grossly exaggerated” stating
that “the only actual evidence was that an individual at a seminar had heckled Professor Chalder.”
[Professor Chalder is a leading researcher in the PACE trial and a key witness for QMUL.]

Expert reaction to the decision

Jonathan C.W. Edwards, MD
Emeritus Professor of Medicine
University College London

“I think this is the right decision and I congratulate Mr Matthees on persevering with a very
reasonable request. The report indicates that the Tribunal considered arguments from both sides
very thoroughly. It has become clear that the reasons given for not providing the information
requested are essentially groundless. It is also clearly appreciated that critics of the PACE trial are
not young sociopaths - they include senior medical scientists like myself, concerned about poor
science!”

Bruce Levin, PhD
Professor and Past Chair
Department of Biostatistics
Columbia University
Mailman School of Public Health
722 West 168th Street
MSPH Box 12, Room 647
New York, NY 10032

“I am heartened by the Tribunal’s finding that the Commissioner had reached a correct decision in
ordering release of anonymized data for the PACE trial. The Tribunal’s assessment that the
perceived risks of data release were neither substantiated nor demonstrated in the evidence before
them and that such minimum risk as had been expressed to them would not in their view outweigh
the public interest in disclosure of the disputed information is quite important, not only for patients
in this trial and around the world, but also because it underscores how essential transparency and
open, critical review of clinical trials are to the scientific method.”

Keith Geraghty, PhD
Honorary Research Fellow
University of Manchester

"I read the tribunal decision with great interest. I was surprised that the PACE authors declared in
evidence that they had shared their trial data with other researchers. I contacted lead author Prof.
Peter White to request access to PACE data to run an independent analysis, but my request was first
ignored, then later refused. I now understand that the authors shared the data with a select few
academics who they picked to co-write papers, but they have failed to share the data with the
broader scientific community. Selectively sharing this publicly-funded data with collaborators but
refusing to share data with anyone else, is not in the best interests of patients or science, and it
creates a perception that the PACE team do not want independent critical analysis of this trial. I find
it regrettable that the Medical Research Council, who partly funded this very expensive study, did
not specify that the trial data be made available to other researchers.”

Dr Charles Shepherd
Hon Medical Advisor, ME Association

“The tribunal decision to firmly reject the QMUL case for not releasing anonymised PACE trial data
will be widely welcomed by the ME/CFS patient community.

This means that there can now be an independent analysis of data from the PACE trial that has been
used to support a number of conclusions and recommendations regarding the benefits of CBT and
GET in ME/CFS that are just not consistent with patient evidence for these interventions
Having attended the hearing, where a number of unsubstantiated and serious accusations were
made against the patient community, I am pleased to see that this 'red herring' was also rejected by
the tribunal. I hope that QMUL will now accept this judgement to release the data and do so without further delay and that they will not spend any more public money on an appeal.”

David Tuller, DrPH, Investigative journalist and public health expert
University of California, Berkeley

"This decision is a thorough repudiation of the efforts by the PACE investigators to protect their
claims and findings from being exposed as utter nonsense. You don't actually need the data to
determine that the trial is a piece of garbage, but having the data at last will make it clear to
everyone. They will likely appeal, but they will ultimately lose."

Alem Matthees
Patient and Second Respondent
Australia

I am very pleased with this outcome. Both the Tribunal’s decision and commentary are a long
overdue victory for the patient community, as well as for advocates of clinical trial transparency and
open data sharing. I want to thank everyone who gave support, advice or assistance, as well as
anyone who engaged in debate over the PACE trial and the sharing of clinical trial data. This case
ended up costing me greatly in time, energy, and health (currently bedridden).

I utilised the FOIA to loosen the vice grip control over the data and allow truly independent and open
analyses that do not rely on the approval of QMUL or the PACE trial investigators. All this came
about largely because of their refusal to publish or release the protocol-specified outcomes, and
their generally questionable and poorly or erroneously justified changes to the published trial
protocol, i.e. outcome switching, after the trial was over and/or after seeing trial data. Claims of
clinically significant improvement may be open to interpretation, but false or misleading claims of
recovery or remission from debilitating illness simply have no place in the scientific literature.

Tom Kindlon
Information Officer
Irish ME/CFS Association

I hope Queen Mary University of London won't appeal again and cause more public money and
resources to be spent on the case. Now that a court has ruled that the data is non-identifiable and
that releasing it will not contravene agreements with trial participants, there is no good reason to
continue to withhold it. If QMUL appeal, people may suspect this case was at least partly about
trying to hide inconvenient results. Indeed, the tribunal decision notice itself raised the question of
whether QMUL may wish to avoid proper scrutiny of their trial.

Patients want nothing more than to recover from this condition, so misleading claims about recovery
rates are a particularly serious matter. Many are very sceptical of suggestions they can recover with
talk therapy or by steadily increasing their levels of exercise. This is not their experience.

Extraordinary claims require extraordinary evidence but the researchers have not yet released such
evidence: they revised all four aspects of the recovery criteria to make it much, much easier to be
classed as recovered and have so far failed to provide valid justifications for these changes. Some of
the PACE Trial investigators have conflicts of interest, such as doing work for insurance companies,
which can make people concerned about bias.

This is a huge victory for patients, who have a right to examine the evidence for the treatments that
affect their lives. I expect that the recovery rate will only be a small fraction of what the PACE
researchers claimed, due to the dramatic changes they made to the criteria.

Jane Colby
Tymes Trust Executive Director

"Tymes Trust is pleased at the judge's ruling. We believe that, pending independent analysis of PACE
data, the MAGENTA (PACEstyle) study in children should be suspended immediately."

Leonard A. Jason, PhD
Professor of Psychology and Director
Center for Community Research
DePaul University
990 W. Fullerton Ave.
Suite 3100
Chicago, Il. 60614

“I believe that an independent analysis of the controversial trial would be in the best interest of
scientists, clinicians and patients.”

Monday, September 5, 2016

Approval for Commercial Sale of Ampligen to Treat Severe Cases of ME/CFS in the Argentine Republic

At long last, Ampligen is approved somewhere. Not here, unfortunately, but it's a first step. With Argentinian approval, there is the possibility of approval elsewhere. 

More to the point, in Argentina at least, there is official acknowledgement that ME/CFS is not a psychological illness.

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Breakthrough Approval Provides Clear Path for Growth in Latin America and the European Union

PHILADELPHIA, Aug. 26, 2016 (GLOBE NEWSWIRE) -- Hemispherx Biopharma, Inc. (NYSE MKT:HEB) (the “Company” or “Hemispherx”), announced that it has received approval of its New Drug Application (NDA) from Administracion Nacional de Medicamentos, Alimentos y Tecnologia Medica (ANMAT) for commercial sale of rintatolimod (U.S. tradename: Ampligen®) in the Argentine Republic for the treatment of severe myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). The product will be marketed by GP Pharm, Hemispherx’s commercial partner in Latin America. We believe that rintatolimod is the first drug to receive approval for this indication anywhere in the world. We also believe that there are no other products in the pipeline for approval, worldwide, for this debilitating disease. A copy of the official approval from ANMAT, translated in English, is available on the Company’s website at http://ir.hemispherx.net/Events_Presentations.

The approval was based on submission of two pivotal studies, AMP-502 and AMP-516. Safety data also included additional CFS and non-CFS studies for a total of over 800 subjects including over 100 subjects with severe CFS who received Ampligen® for one year or longer. Several post-approval activities are required to be completed before product launch, including manufacturing site inspections and reimbursement evaluation by the Health Services Authority (SSS), the central health authority in Argentina. “Working closely with our partner in this effort, GP Pharm, our team at Hemispherx addressed all medical and scientific issues presented by ANMAT and deserves great credit for this major success. At Hemispherx, we may be small by big pharma standards, but our commitment to addressing this dire unmet medical need makes us mighty,” stated Hemispherx CEO Tom Equels.

Approval for commercial sale in Argentina provides a platform for potential commercial sales in certain countries within the European Union under regulations that support cross-border pharmaceutical sales of licensed drugs. Hemispherx and GP Pharm are now working to expand the approval of rintatolimod to additional countries with a focus on Latin America. In Europe, approval in a country with a stringent regulatory process in place, such as Argentina, adds further validation for the product as the Early Access Program (EAP) is launched in Europe.

“In Argentina, rintatolimod (Ampligen) has just been commercially approved for the severe disabling form of ME/CFS. The number of patients with ME/CFS is estimated to be over three million worldwide, however, only a portion of these have the severe and disabling form of the disease which we are targeting with this drug,” stated Tom Equels. “Until now, there has been no commercially available effective treatment and there are no advanced clinical candidates, other than rintatolimod, that we are aware of. This commercial approval in Argentina will dramatically improve our ability to treat patients suffering from severe ME/CFS in Latin America. We continue to work aggressively to clarify a path toward approval for those with severe ME/CFS in the United States, where we have Orphan Drug status, and therefore seven years of product exclusivity upon approval. We are greatly encouraged by this new regulatory approval in Argentina. This is the most significant accomplishment to date in Hemispherx’s plan to bring our drug to severe sufferers of ME/CFS worldwide.”

“We have worked diligently with Hemispherx to get to this point, and are now preparing for the commercial launch of rintatolimod for ME/CFS in Argentina,” commented Jorge Braver, chief executive officer of GP Pharm Latin America. “Looking ahead, we will continue to seek approval in additional Latin American countries.”

Wednesday, August 31, 2016

Researchers Identify Characteristic Chemical Signature for Chronic Fatigue Syndrome

By Scott Lafee

Press Release: U.C. San Diego, August 29, 2016. Chronic fatigue syndrome (CFS) is a mysterious and maddening condition, with no cure or known cause. But researchers at the University of California San Diego School of Medicine, using a variety of techniques to identify and assess targeted metabolites in blood plasma, have identified a characteristic chemical signature for the debilitating ailment and an unexpected underlying biology: It is similar to the state of dauer, and other hypometabolic syndromes like caloric restriction, diapause and hibernation.

Dauer is the German word for persistence or long-lived. It is a type of stasis in the development in some invertebrates that is prompted by harsh environmental conditions. The findings are published online in the August 29 issue of PNAS.

“CFS is a very challenging disease,” said first author Robert K. Naviaux, MD, PhD, professor of medicine, pediatrics and pathology and director of the Mitochondrial and Metabolic Disease Center at UC San Diego School of Medicine. “It affects multiple systems of the body. Symptoms vary and are common to many other diseases. There is no diagnostic laboratory test. Patients may spend tens of thousands of dollars and years trying to get a correct diagnosis.”

As many as 2.5 million Americans are believed to have CFS. It most often afflicts women in their 30s to 50s, though both genders and all ages can be affected. The primary symptom is severe fatigue lasting at least six months, with corollary symptoms ranging from muscle pain and headaches to sleep and memory problems.

Naviaux and colleagues studied 84 subjects: 45 men and women who met the diagnostic criteria for CFS and 39 matched controls. The researchers targeted 612 metabolites (substances produced by the processes of metabolism) from 63 biochemical pathways in blood plasma. They found that individuals with CFS showed abnormalities in 20 metabolic pathways. Eighty percent of the diagnostic metabolites measured were decreased, consistent with hypometabolic syndrome or reduced metabolism. The diagnostic accuracy rate exceeded 90 percent.

“Despite the heterogeneity of CFS, the diversity of factors that lead to this condition, our findings show that the cellular metabolic response is the same in patients,” said Naviaux. “And interestingly, it’s chemically similar to the dauer state you see in some organisms, which kicks in when environmental stresses trigger a slow-down in metabolism to permit survival under conditions that might otherwise cause cell death. In CFS, this slow-down comes at the cost of long-term pain and disability.”

Naviaux said the findings show that CFS possesses an objectively identifiable chemical signature in both men and women and that targeted metabolomics, which provide direct small molecule information, can provide actionable treatment information. Only 25 percent of the metabolite disturbances found in each person were needed for the diagnosis of CFS. Roughly 75 percent of abnormalities were unique to each individual, which Naviaux said is useful in guiding personalized treatment.

“This work opens a fresh path to both understanding the biology of CFS and, more importantly to patients, a robust, rational way to develop new therapeutics for a disease sorely in need of them.”

The study authors noted additional research using larger groups of participants from diverse geographical areas is needed to validate both the universality and specificity of the findings.

Co-authors include: Jane C. Naviaux, Kefeng Li, A. Taylor Bright, William A. Alaynick, and Lin Wang, all at UC San Diego; and Asha Baxter, Neil Nathan, Wayne Anderson, and Eric Gordon, Gordon Medical Associates.

Funding for this research came, in part, from the UC San Diego Christini Fund, The Wright Family Foundation, The Lennox Foundation, the It Takes Guts Foundation, the UC San Diego Mitochondrial Disease Research Fund and gifts from Tom Eames and Tonye Marie Castenada.

For more information about CFS and mitochondrial research, visit naviauxlab.ucsd.edu

Journal Reference: Robert K. Naviaux, Jane C. Naviaux, Kefeng Li, A. Taylor Bright, William A. Alaynick, Lin Wang, Asha Baxter, Neil Nathan, Wayne Anderson, Eric Gordon. Metabolic features of chronic fatigue syndrome. Proceedings of the National Academy of Sciences, 2016; 201607571 DOI: 10.1073/pnas.1607571113

Tuesday, August 30, 2016

Urgent Call to Action! Support Congressional Call for Increased ME/CFS Research!

By Mass CFIDS/ME and FM Association

You can help if you ACT NOW !!

A letter in support of ME/CFS research to NIH Director Dr. Francis Collins, sponsored by two Representatives from California, is now circulating in Congress (House of Representatives) and we need as many U.S. Representatives as we can to be co-signers. Please CALL and send a FOLLOW-UP EMAIL to your U.S. Representative (not your Senators) and urge him or her to sign this letter. Complete instructions, including a phone and email script which you can personalize, can be found here. The number of calls to each Congressional office to make this request really matters. Your Representative may not be inclined to act as a result of one or two calls, but 10 calls will make a strong statement. Please call right away. The deadline for your Representative to sign the letter is this coming Wednesday, August 31.

This action is the result of months of hard work by #MEAction, Solve CFS/ME Initiative, and the U.S. Action Working Group Congressional Committee.

GET and CBT have been downgraded as treatments for ME/CFS as a result of follow up work by the Agency for Healthcare Research and Quality.


In the initial Evidence Review prepared by AHRQ as input to the Pathways to Prevention (P2P) report commissioned by NIH, studies evaluating the effectiveness of Graded Exercise Therapy (GET) and Cognitive Behavioral Therapy (CBT) which used subjects meeting only the Oxford case definition (6 months of fatigue). Based on the initial inclusion of studies using the Oxford definition, notably the PACE trials, the Evidence Review suggested that GET and CBT were "moderately effective" treatments. The P2P report recommended that the Oxford definition no longer be used, and the PACE research has come under increasing criticism for its methodology.

As a result of advocates requests, AHRQ re-analyzed the evidence for GET and CBT, without including any studies based on the Oxford definition (e.g. PACE). The conclusion was that there was no evidence to suggest that GET or CBT were effective treatments for ME/CFS. Read more here

This outcome is the direct result of repeated requests to AHRQ by advocates. Advocates' next step is to make sure that this change is strongly noted in future medical education materials, particularly the websites commonly used by doctors, such as the Centers for Disease Control and Prevention (CDC), Mayo Clinic and Up To Date.

You can find your congressional representative HERE.

Email Template:

Dear ___________ (name of representative goes here)

I’m emailing with an urgent request regarding the disabling neuro-immune disease Myalgic Encephalomyelitis, also known as Chronic Fatigue Syndrome or ME/CFS.
Representatives Lofgren and Eshoo of California are sponsoring a letter to NIH Director Francis Collins in support of ME/CFS patients and research. ME/CFS costs the U.S. economy $17-24 billion annually; leaves its patients with lower quality of life scores than lung cancer, stroke, and rheumatoid arthritis; and has no known FDA-approved treatment or cure. Would you please support me and the 1 to 2.5  million Americans suffering from this disabling disease, by signing this letter? It would mean the world to me, my family, and other ME/CFS patients in our district to have your support.

Please contact Angela Ebiner, Legislative Assistant for Rep. Zoe Lofgren (CA-19) at Angela.Ebiner@mail.house.gov or (202) 225-3072 to coordinate your participation. The letter’s deadline is 8/31.

Thank you so very much for your support on this critical action. I look forward to your reply on this request at your earliest convenience.

Warmest Regards,
[Your Name]
[Your Contact Info, Including address and +4 zip]

Saturday, July 9, 2016

It's All in Your Gut

A study out of Cornell University made the news recently when Maureen Hanson's team found distinct alterations in the gut flora of patients with ME/CFS. The headlines trumpeted the "first" biological marker for the disease in the microbiome.

Those of us who have kept track of the research know that this is not a "first." De Meirleir, Maes, Lemle, as well as Dunstan, and Butt in Australia have all published papers documenting alterations in gut flora in patients with ME/CFS (not to mention Lipkin and Hornig's huge Microbe Discovery Project). Those alterations laid the groundwork for Butt's successful treatment of ME with fecal transplants in the late 90s.

The question that needs to be asked is whether these alterations are the cause or the result of the disease. Every disease produces alterations in gut flora - diabetes, Crohn's, heart disease, HIV, and cancer are among them, as well as all infections. (For a good paper on this topic go HERE.) The gut, which is the seat of your immune system, responds instantly to pathogens. It even changes in accord with what you are eating withing a few hours.

But rather than chicken or egg, these gut changes could be chicken and egg. For example, the pathogen that causes ME results in changes to the microbiome, then subsequent chronicity due to an altered immune system results in a perpetuation of microbiome changes. These, in turn, lead to more chronicity as commensal bacteria enter the bloodstream.

It's a good model, even if it doesn't identify the original culprit that started this chain of events.

You can read the full study HERE.

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Key to chronic fatigue syndrome is in your gut, not head

By Melissa Osgood, Cornell University

Physicians have been mystified by chronic fatigue syndrome, a condition where normal exertion leads to debilitating fatigue that isn't alleviated by rest. There are no known triggers, and diagnosis requires lengthy tests administered by an expert.

Now, for the first time, Cornell University researchers report they have identified biological markers of the disease in gut bacteria and inflammatory microbial agents in the blood.

In a study published June 23 in the journal Microbiome, the team describes how they correctly diagnosed myalgic encephalomyeletis/chronic fatigue syndrome (ME/CFS) in 83 percent of patients through stool samples and blood work, offering a noninvasive diagnosis and a step toward understanding the cause of the disease.

"Our work demonstrates that the gut bacterial microbiome in chronic fatigue syndrome patients isn't normal, perhaps leading to gastrointestinal and inflammatory symptoms in victims of the disease," said Maureen Hanson, the Liberty Hyde Bailey Professor in the Department of Molecular Biology and Genetics at Cornell and the paper's senior author. "Furthermore, our detection of a biological abnormality provides further evidence against the ridiculous concept that the disease is psychological in origin."

"In the future, we could see this technique as a complement to other noninvasive diagnoses, but if we have a better idea of what is going on with these gut microbes and patients, maybe clinicians could consider changing diets, using prebiotics such as dietary fibers or probiotics to help treat the disease," said Ludovic Giloteaux, a postdoctoral researcher and first author of the study.

In the study, Ithaca campus researchers collaborated with Dr. Susan Levine, an ME/CFS specialist in New York City, who recruited 48 people diagnosed with ME/CFS and 39 healthy controls to provide stool and blood samples.

The researchers sequenced regions of microbial DNA from the stool samples to identify different types of bacteria. Overall, the diversity of types of bacteria was greatly reduced and there were fewer bacterial species known to be anti-inflammatory in ME/CFS patients compared with healthy people, an observation also seen in people with Crohn's disease and ulcerative colitis.

At the same time, the researchers discovered specific markers of inflammation in the blood, likely due to a leaky gut from intestinal problems that allow bacteria to enter the blood, Giloteaux said.

Bacteria in the blood will trigger an immune response, which could worsen symptoms.

The researchers have no evidence to distinguish whether the altered gut microbiome is a cause or a whether it is a consequence of disease, Giloteaux added.

In the future, the research team will look for evidence of viruses and fungi in the gut, to see whether one of these or an association of these along with bacteria may be causing or contributing to the illness.

Journal Reference: Ludovic Giloteaux, Julia K. Goodrich, William A. Walters, Susan M. Levine, Ruth E. Ley, Maureen R. Hanson. Reduced diversity and altered composition of the gut microbiome in individuals with myalgic encephalomyelitis/chronic fatigue syndrome. Microbiome, 2016; 4 (1) DOI: 10.1186/s40168-016-0171-4


Friday, June 17, 2016

Chasing Competent Care Conference Report


By Sally Burch

Hope 4 ME & Fibro Northern Ireland ran an ambitious and exciting conference on Monday 6th June in The Stormont Hotel, Belfast.  The conference, “Chasing Competent Care” delivered a strong message calling for change to the currently inadequate care situation for ME and fibromyalgia patients in Northern Ireland.

Chairperson, Martina Marks opened the meeting, welcomed everyone and thanked the Big Lottery Fund for their sponsorship of the event. Her welcome was followed by an impassioned plea from Joan McParland, the founder and treasurer of Hope 4 ME & Fibro NI, to have medical professionals take patients’ symptoms seriously.  Joan explained that she had been ill, and operating at less than 30% of her normal capacity, since 1999. In that time no effective treatments had been offered, and one consultant had even suggested she was simply reading too much into her symptoms and that she should see a psychiatrist!

Joan thanked the many volunteers and family members who made the event possible, and also the medical professionals and MLAs in the audience for taking time to attend.

Sally Burch, another charity trustee, then pointed out that ME (myalgic encephalomyelitis) and fibromyalgia are both disorders recognised by the World Health Organisation. She then explained that the most severely affected by ME could be left bed-bound, tube fed and lying in darkened rooms for weeks, months and years! She further described the severely debilitating nature of fibromyalgia and how the invisible pain that sufferers endure can have devastating life consequences. Sally outlined the symptom overlap between these conditions and suggested that biomarker development and medical research was now urgently required.

Lined up, to the side of the speakers’ podium, was a haunting display of over 200 pairs of empty shoes. These were part of the global #MillionsMissing campaign. Each pair of shoes carried a tag with the name of a patient unable to participate in their active lives due to ME and/or fibromyalgia.  During the conference many attendees took time to read the comments on the tags and to consider the magnitude of the devastation caused by these largely forgotten and ignored conditions.

Joe McVeigh
First speaker up was Dr. Joe McVeigh, who outlined the problems with exercise and fibromyalgia. He explained that whilst exercise is important for maintaining health, that it must be conducted at a level manageable for each individual patient. He called this the “Goldilocks approach”, and explained that at no time should attempted exercise cause a patient to relapse.

Professor Malcolm Hooper next gave a strong talk berating the inadequacies and misleading conclusions of the PACE Trial.  At one point, he suggested that the PACE Trial was potentially fraudulent and told us that he had once even said as much in The House of Lords.  This elicited a spontaneous round of applause from the audience. Feelings run high amongst patients on the PACE trial, mostly because it has been used to support the NHS recommended therapies of Cognitive Behaviour Therapy (CBT) and Graded Exercise Therapy (GET), both of which have been demonstrated to cause harm in patient surveys.

Malcolm Hooper
Professor Hooper questioned the motives of the PACE trial authors in promoting results that carry such marginal benefits and such great potential risks. He recommended that patients reference Mark Vink’s paper, “The PACE Trial Invalidates the Use of Cognitive Behavioral andGraded Exercise Therapy in Myalgic Encephalomyelitis/ Chronic Fatigue Syndrome:A Review,” any time they were asked to undertake these therapies.

After this lively and well received talk, the conference paused for a comfort break. The weather was uncharacteristically balmy for Northern Ireland, and some of the audience sat outside in the evening sun as they contemplated the issues raised.

Natalie Boulton, carer to her daughter who has severe ME, spoke next.  She opened by showing a clip from the video “Voices from the Shadows”, that gave the audience a disturbing insight into the annihilation caused by very severe ME.  Natalie told us she had recently followed up with some of the patients from the video and found many of them had worsened, and that both Emily Collingridge and Lyn Gilderdale had since died. She spoke of the horror of the treatments doled out by psychiatrists who believed patients to be faking their illness. Hers was a genuinely moving and sobering talk.

Next Professor Mady Hornig from Columbia University, USA, gave a detailed and highly informative account of her work towards developing blood biomarkers.  She explained how immunity and gut microbiota can be linked to the brain, its functioning and mood.  She talked about the epigenetic changes that can occur in the microbiome during a person’s lifetime and the link to serotonin production. She also talked about measuring blood molecules such as cytokines before and after an exercise challenge in ME patients, and comparing these changes to healthy controls. These cytokines being the most promising as potential biomarkers. Although much of what she described cannot be simply summarised, the audience was left with a strong feeling that Professor Hornig is now working determinedly to solve the biochemical riddles produced by ME.

Pamela Bell
Dr. Pamela Bell then took the podium to talk about the problem with pain. Dr. Bell has worked extensively in the field of pain, and is now chair of the Pain Alliance Northern Ireland. She emphasised the widespread nature of chronic pain and its disabling effects, noting that once pain becomes chronic it no longer serves a useful purpose in the body. She recognised the difficulties with effectively treating ongoing pain and explained that different types of pain needed different drug types to alleviate symptoms.

The final speaker of the evening was Louise Skelly from the Patient and Client Council of Northern Ireland.  She spoke of her frustration at trying to bring about change to the current impasse with Health and Social Care Board in Northern Ireland regarding the care on offer for ME and fibromyalgia patients. She spoke of her determination to follow through with the campaign to improve the situation, and of the great need of these neglected patient cohorts.

Martina Marks then brought the conference to a close. Overall the atmosphere of the evening was one of both frustration, and of optimism. Frustration that change seems to be taking so long to happen and for the injustices that have occurred along the way, but also optimism that things are starting gain momentum towards real medical advances for the future.

As the hall emptied, the lines of lonely shoes from the #MillionsMissing campaign were gathered up, their labels still attached, and some-one was heard to say: “These are the folk we do all this for, they will not be left forgotten any longer.”

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