USA: National Institutes of Health (NIH) intramural ME/CFS study

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<heavy sarcasm> That should mean they process about 20 patients in 2 years then I guess?

 

I get your point, but part of the issue seems to have been a relative lack of suitable people with ME/CFS coming forward.

 

Well that is an issue for the researchers to solve, and that takes a lot of thought and effort as the DecodeME team will confirm. The NIH picked a cohort that would be difficult to find in the first place, and then have made minimal outreach attempts, their assumption that the right patients would be queue up in sufficient quantities to take part is on them.

 

I, for one, do not buy that BS. The will simply isn't there. As problems go, this is an easy one.

 

I’m afraid I dislike this sort of attitude: this is not some sort of company where the ME community doesn’t benefit from the project. And DecodeME are in such a strong position with regard to recruitment partly because people with ME and ME charities promoted the recruitment. My point is that the ME community could similarly make a big effort to promote this rather than simply say “it’s in them”.

 

DecodeME are in a strong position because they engaged with the community before the start of the study, the NIH haven't come close to doing that, before or after, to the same level. You are as aware as I am that there is a lot of suspicion towards the NIH which will mean, rightly or wrongly, that the community won't make much effort at promotion.

And sure, the patient community could promote it more, but to help them do so it needs to be made as easy as possible and the NIH haven't done that. It's not going to help the NIH if the finger is pointed at the community and it's said "it's your fault because you didn't promote it"; they need to understand where they didn't do enough to engage the community, I don't get the sense though that they are open to that kind of feedback.

 

Those may be some relevant issues. But if people are complaining that the progress with this project is slow, it suggests they or at least many of them think the project is worthwhile. If that is the case, I think they should try to promote recruitment of it. I don’t think it’s that complicated to do: last time I checked, there was a specific webpage.

There is no guarantee research progress happens for a particular condition as quickly as someone with it would like. I think people should try to do what they can to speed progress and highlighting research opportunities generally is free.

Also this isn’t specific to the NIH: quite a lot of studies in the field struggle with recruitment.

 

I think they’ve been way too restrictive with cohort requirements thinking this is going to give them cleaner results in the end or help with discovery. I highly doubt it.

I went through the entire enrollment process years ago, right when they started enrolling, they got every single one of my ME and other medical records from 10 years prior to that time. I have post-viral ME and medical records show that and fully meet CCC and ICC criteria.

I wasn’t accepted because I wasn’t severe enough at the time and because I supposedly tried too many different drug treatments. It was really absurd to me. I also found it really annoying because in the beginning they used not have the very severe symptom specification to enroll in the study.

This phrase was added after unless I’m not remembering my reaction at that time:

https://mecfs.ctss.nih.gov/

 

How are you going to get pwME who “have severe symptoms”, so meaning at the best moderate-to-severe severity or worse, to travel to NIH??? It’s stupid.

 

Thanks for applying and for sharing your medical records.

To be honest, if you had tried a lot of different drug treatments, it's not the worst exclusion i.e. it wouldn't make me think less of them for doing it.

 

It's a difficult one all right. But then some people would say that you are going to find more abnormalities, the more severe people are. Some people complain that people with severe ME are not used enough in studies.
So again, it wouldn't make me think less of them.

Some people have come forward and I think if it was promoted more, more progress might be made towards the relatively modest target.

 

The problem I’ve always found with that reasoning is there is ZERO scientific basis for this assumption, it’s just completely made up.

Maybe more severe patients will make it much more difficult and clouded to analyze and interpret the results, because they could have more downstream abnormalities that are harder to connect to each other and back to the core pathophysiology of this disease, therefore also making it much harder to generate new hypotheses from the results.

They are assuming that the more severe you are that you supposedly have the same abnormalities as a mild patient but more pronounced. This is a wild assumption and it could be like I said not necessarily more pronounced but severe patients have many more abnormalities that are harder to connect and interpret.

 

it’s an interesting question alright. Do you think there are many abnormalities that would show up in the mild but not the moderate and moderate severe?

If this study found no abnormalities, it would be disappointing and might have a negative effect on NIH interest. To me, it seems a safer option for an initial study to be towards the more severe end of things.

 

Sorry I probably didn’t word my response well.

Having more abnormalities (which might be what they are assuming regarding more severe patients) is not necessarily going to help with interpreting study results, understanding this disease, and getting to the root of ME pathophysiology. Sure it might show “OK we see many different things going wrong”, but we already have a ton of literature showing that, all with no real answers.

If many of these abnormalities in more severe patients are downstream and very different consequences of the core pathophysiology, it could become really complex for researchers to figure out what’s truly going on.

If one were designing a study where you only want to take more severe patients, then to me it makes much more sense when you have evidence that severe patients likely have the same abnormalities as mild patients, but those abnormalities are more pronounced.

Maybe that’s what they are assuming. But then again it’s been 5 long years and they’ve only enrolled 20 people so far while we still suffer year after year, all to try and find some perfect signal.

I remember from the last NIH ME/CFS conference I attended that Brian Walitt’s presentation of intermediate results didn’t really find anything truly meaningful and was inconclusive.

 

Dr. Jarred Younger: "The hardest part of running research is recruiting study participants, so I'm really interested in helping connect researchers and potential participants.”
https://cdmrp.army.mil/gwirp/research_highlights/18younger_highlight

The Nutt sleep study was one of the few biomedical ME/CFS studies the Medical Research Council in the UK has ever funded. It hasn't been published yet. And I wonder whether we may never see any data; last time I saw anything they were struggling to recruit sufficiently. They definitely could have done more to highlight it, but similarly I think it could also have been highlighted more by the ME community.

 

Naths project now appears in NIH Reporter
https://projectreporter.nih.gov/project_info_history.cfm?aid=10265885&icde=31258613

 

I just saw that the status is now listed as "suspended": https://clinicaltrials.gov/ct2/show/NCT02669212

(h/t to someone on Reddit for sharing this.)

Anyone know what's up?

 

I think the explanation was given by Dr. Nath in the March 30th 2021 NIH ME/CFS Advocacy Call. Sounds like COVID-19 took precedence, but it gave them an opportunity to analyze the ME/CFS data they had sooner than they otherwise would have.

[ETA: A "BSL3 lab" is a "Biosafety Level 3 laboratory." It's a "high containment" lab, second only to the relatively rare BSL4 "max containment" labs.]

 

Based on the timelines that were discussed before, if they are planning to process 50 long COVID patients and 50 controls, that will keep them busy for years. From Dr. Nath’s quote above, I am definitely concerned that they have shifted focus.

Has any preliminary data or information been shared on the ME/CFS cohort? Do we know approximately how many patients were processed before the pandemic shut everything down?