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A perspective on causation of the chronic fatigue syndrome by considering its nosology, 2019, White

Discussion in 'PsychoSocial ME/CFS Research' started by Andy, Aug 3, 2019.

  1. Andy

    Andy Committee Member (& Outreach when energy allows)

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    White astounding us with his insight into ME.....
    Paywall, https://onlinelibrary.wiley.com/doi/abs/10.1111/jep.13240
    Sci hub, https://sci-hub.se/10.1111/jep.13240
     
  2. Cheshire

    Cheshire Moderator Staff Member

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    Thanks (irony inside) Dear Peter, for acknowledging that your Oxford CFS definition is just shit, after claiming for years that CBT/GET is the only way to go, when it helps (at best) a small subset of patients that you never cared to try to identify.

    Edited to withdrew useless remark.
     
    Last edited: Aug 5, 2019
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  3. Wonko

    Wonko Senior Member (Voting Rights)

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    Didn't he say that he was only studying Oxford defined CFS and that PACE had absolutely nothing to do with ME, and hasn't he also said that he's completely left the field as he's far too terrified of pwME, as they might occasionally say things he considers mean about his 'work'?

    So it's reassuring to know that he is a man of his word and this paper doesn't exist.
     
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  4. Kalliope

    Kalliope Senior Member (Voting Rights)

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    There's also a "philosophical epilogue":

    The preceding evidence suggests that CFS/ME is not one illness, and understanding its aetiology is therefore challenging in the absence of clearly defined subgroups, some delineated by biological factors, and others by psychological factors. But finding psychological or social factors associated with this illness does not however imply that the illness is a mental illness; many chronic and disabling diseases show such associations. Similarly, if and when biomarkers are eventually established, this will not imply that the illness cannot be a mental illness, since biomarkers are already apparent in some mental disorders.54 Western medicine is still the bedevilled by Cartesian dualism, which determines that phenomena are either physical or mental, whereas the reality is more complex and compelling. So the question as to whether CFS/ME is a neurological or mental illness is clearly meaningless, since it has features of both, and cannot be classified convincingly as one or the other.54

    It was the Scottish neurologist Kinnier Wilson who suggested that“This antithesis between organic and functional disease states still lingers at the bedside and in medical literature, though it is transparently false and has been abandoned long since by all contemplative minds.“55 The American philosopher John Searle described the monist solution to our dualist conundrum, by his theory of biological natural- ism, pointing out that conscious states are caused by neurophysiolog- ical processes, and are realized in neurophysiological systems.56 But this should not be taken to imply that humans have no mind, only a brain. Light can be studied as either photons (particles) or waves; in similar fashion, illnesses can be considered usefully from a mental as well as a physical point of view. And we have to go back to Hippocrates, who presciently concluded that “the nature of the body can only be understood as a whole, for it is the great error of our day in the treatment of the human body that physicians separate the soul from the body.”57
     
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  5. Cheshire

    Cheshire Moderator Staff Member

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    The question was meaningless too for ulcers, autism, arthritis patients because psychiatric care did wonders for them, they all recovered, and never suffered because of psychiatric treatments. Thanks to all contemplative minds for their priceless contribution to science.

    Edit for clarity
     
    Last edited: Aug 3, 2019
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  6. strategist

    strategist Senior Member (Voting Rights)

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    White should be ashamed for ever promoting the false illness beliefs and deconditioning theory. He has no credibility as far as any attempts to discover the cause of ME/CFS or any hypothetical subsets is concerned.
     
    sea, alktipping, Anna H and 14 others like this.
  7. NelliePledge

    NelliePledge Moderator Staff Member

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    I thought he’d retired? Wasn’t that said when they were fighting the release of data. Maybe if he’s out of retirement he can now get off his arse and fully cooperate in releasing data.
     
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  8. Trish

    Trish Moderator Staff Member

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    He's right on one thing - the diagnostic picture with so many criteria is messy. What he doesn't anywhere acknowledge is his own major contribution to the confusion by running PACE using Oxford criteria which should never have been invented.

    I read this as directly targeted at supporting the BPS model with a mix of central sensitisation for the biological bit, and psychological and social factors, and also aimed to support the current NICE guidelines.

    Like Sharpe, he's attempting to turn it into a philosophical argument about body/mind dualism. I suspect this is all part of the same campaign by Sharpe and others to try to scupper NICE guideline changes. In this case with the focus on trying to prevent them changing the diagnostic criteria to prioritise PEM. As far as he's concerned, it has to be still all about fatigue.

    And his stuff about having comorbid FM and IBS as indicating functional disorder is rubbish. People with wholly biological conditions like Parkinson's disease and MS have lots of these symptoms too. That doesn't mean they have functional disorders.
     
  9. Trish

    Trish Moderator Staff Member

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    He's retired from his university post (listed as emeritus professor), but still working for insurance companies etc.
     
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  10. Cinders66

    Cinders66 Senior Member (Voting Rights)

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    So where is the evidence that ME has universally or even in the majority symptoms indicating mental illness . ? Depression and anxiety are not core features or explanatory features eg someone who has had to give up work might get depressed but the pain and fatigue etc that’s caused them to give up work wasn’t caused by depression.
    They Just want this “debate “ to continue when America Australia etc seem to have well gotten over it and are quite happy to classify it and define it as “physical”. It’s like the climate change debate, vested interests saw their best defence to perpetuate ideas of uncertainty. You don’t act on something that’s a grey area, keep up the doubt and nothing changes.
    I think that if ron Davis makes a biomarker from his nano needle test showing cells struggling in a stressed salt environment, that would support a physical not mental health classification?
     
    Last edited: Aug 3, 2019
  11. Dolphin

    Dolphin Senior Member (Voting Rights)

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    I can't find the exact quote now, but it involves "cfs/me" not ME. I have seen a number of people say this but it looks to me like a misrepresentation.
    It seems much more likely to me that he meant the Canadian criteria.
    There was a specific subgroup analysis with regard to ME in the Lancet paper which even made it to the abstract:
     
  12. feeb

    feeb Senior Member (Voting Rights)

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    If this isn't sophistry, I don't know what is.

    Well, knock me down with a feather!
     
  13. Sly Saint

    Sly Saint Senior Member (Voting Rights)

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    this is incorrect. Per Finks BDS is not in the ICD-11
    https://causehealthblog.wordpress.com/about/
    https://twitter.com/cause_health?lang=en
    White says:
     
    Last edited: Aug 3, 2019
  14. obeat

    obeat Senior Member (Voting Rights)

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    If a large cohort had been followed for 30 years we might have a better understanding of patterns and subtypes.
     
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  15. Annamaria

    Annamaria Senior Member (Voting Rights)

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    Didn't White specifically say on Australian radio that there were no subjects with ME in PACE? Sorry, can't find a link.
     
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  16. Dolphin

    Dolphin Senior Member (Voting Rights)

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    Given the extract I posted from the Lancet, I very much doubt it:
     
  17. Andy

    Andy Committee Member (& Outreach when energy allows)

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    Are you thinking of the interview that Sharpe and Horton did on Australian radio?
    https://www.abc.net.au/radionationa...tments-for-chronic-fatigue/2993296#transcript

    I've had a quick skim through the transcript but I couldn't see anything that stands out as a clear statement saying that they didn't have anybody with ME in the trial.

    I had a quick look on MEpedia and there is no information there on White doing any radio interviews.

    To be fair, given the rubbish they come out with it wouldn't surprise me if they had.
     
  18. Snow Leopard

    Snow Leopard Senior Member (Voting Rights)

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    The manuscript is strange, with White simultaneously trying to justify both lumping (CFS with other medically unexplained syndromes, Chronic Fatigue as a broad non-specific diagnosis) as well as splitting CFS patients into subgroups.

    Yet White and colleagues have published much literature claiming just that - psychological associations in non-prospective studies theorised as predisposing factors.

    He proposes prospective studies - something which patients have demanded for years and indeed a few have been carried out over the last few decades, despite their cost, but they have been fairly shallow in what they have investigated.

    He mentions subgrouping by:
    - Initial trigger, eg specific infection
    - Categorisation based on comorbid mood disorders or other functional somatic syndromes
    - Behaviour in the form of physical actigraphy and/or sleep architecture
    - Biological subgrouping based on hypothalamic‐pituitary‐adrenal axis findings
    - Psychosocial associations based on life events and consequences (example: heart rate variablility, or low-cortisol)

    The problem with all of these proposals is they have already been extensively explored and found to be non-specific, therefore I strongly doubt that subgrouping on these factors will have prognostic value.

    Wow, he first invokes dualism (mental vs physical illness) and then contradicts it with the next sentence!?!

    Overall, I can't really say there is anything new in this manuscript. White has discussed the case of lumping vs splitting before so there is nothing new.

    The new, most interesting consistently replicated finding is that of workload at the ventilatory threshold (with corollaries such as effort perception in CFS accurately predicts the ventilatory threshold and therefore altered effort perception is unlikely to be the primary problem), but White continues do demonstrate little interest in exercise physiology and does not discuss this finding at all.
     
    Last edited: Aug 3, 2019
  19. Annamaria

    Annamaria Senior Member (Voting Rights)

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  20. Wonko

    Wonko Senior Member (Voting Rights)

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    Are there any London criteria for ME?

    I thought that all of them, used in London, were criteria for CFS - in which case comparing the results gained using the London criteria for 'ME', against those obtained using the criteria for CFS, in London, would appear to be meaningless doublespeak.

    Designed to misdirect and deceive.
     

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