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

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

 

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.

 

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

 

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.

 

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?

 

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:

 

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

Well, knock me down with a feather!

 

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:

 

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

 

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

 

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

 

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.

 

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.

 

Yes, that's the one. I was sure I heard during that interview PW say that there were no subjects with ME in PACE. Was I mistaken?

 

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.