Co-Cure: In Hyde's own words:

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Fri, 7 Mar 2008 13:28:38 -0600

LK Woodruff <lkw777

In Hyde's own words:

 

 

In Hyde's own words:

 

 

The (first) 1988 CDC definition did several things, all of which caused

immeasurable confusion.

 

Why did the 1988 CDC definition damage our knowledge and understanding of

this epidemic and endemic disease?

 

Remember in describing the Lake Tahoe epidemic this committee were

describing a typical Myalgic Encephalomyelitis (ME) Epidemic.

 

 

Major Problems of the 1988 CDC definition

 

It is my opinion that the CDC 1988 definition of CFS describes a

non-existing chimera based upon inexperienced individuals who lack any

historical

knowledge of this disease process. The CDC definition is not a disease process.

It

is (a) a partial mix of infectious mononucleosis /glandular fever, (b) a mix

of some of the least important aspects of M.E. and © what amounts to a

possibly unintended psychiatric slant to an epidemic and endemic disease

process

of major importance. Let us try to decipher this definition.

 

1. The principal author: Dr Gary Holmes is one of those men who it is

difficult not to like. From my limited knowledge of Dr Holmes it is my opinion

that

he is well organized, brilliant, a kind man and the sort of person any

university would want to have on staff. To my knowledge he never continued to

show

any interest in this disease process and Pub Med and Google searches fail to

reveal any subsequent scientific papers concerning M.E. or CFS.

 

2. The other authors: So curious was the 1988 CDC definition that if you

review the authors, you will find that the majority had never published on M.E.

or CFS either before or after this definitional publication and the majority

had never ever to my knowledge ever before or since examined or investigated

any serious number of CFS patients. In fact, I would estimate that the

majority had never actually examined and investigated as single M.E. patient.

 

3. The curious name: The authors named the disease Chronic Fatigue Syndrome:

Fatigue is a totally undefinable concept. Fatigue is impossible to measure

or quantify. Fatigue is so non-specific that it can be a common element in any

acute or chronic disease and many psychiatric diseases. Worse, it redirects

the medical and public attention to the totally undefinable fatigue and away

from the obvious Central Nervous System changes in these patients. Much

worse, it makes fun of a serious illness since most people and most physicians

tend to equate fatigue with laziness, work avoidance, something that a bit of

effort will chase away. It has turned out to be a damning indictment to all

M.E. patients.

 

4. The first Major Criteria: This 1988 CDC definition contains (a) two major

criteria, (b) 11 Minor Criteria, © three physical criteria.

 

Let us start with the first major criteria:

 

" A new onset of persistent or relapsing, debilitating fatigue or easy

fatigability in a person who has no previous history of similar symptoms, that

does

not resolve with bed rest, and is severe enough to reduce or impair average

daily activity below 50% of the patients premorbid activity level for a

period of at least 6 months. " This major criterion does not clearly distinguish

between acute or gradual onset diseases. In all M.E. epidemic or endemic

patients the patients represent acute onset illnesses. The fatigue criteria

listed

here can be found in hundreds of chronic illnesses and clearly defines

nothing.

 

5. The second Major Criteria: This makes the illness CFS a disease of

exclusion. The definitional statement is:

 

" Exclude all other disease processes. "

 

Any disease process that has major criteria, of excluding all other disease

processes, is simply not a disease at all; it doesn't exist. In effect, by

either the first or second major criteria this is nor a measurable illness and

a disease that is not measurable or testable simply does not exist. What did

Dr Holmes and his colleagues miss? They missed the fact that M.E. is (a) an

acute onset illness, (b) the fact that M.E. is a measurable diffuse brain

injury, © in a complete form, M.E. has a dual inception, an infectious illness

followed by the diffuse neurological aspects of this disease.

 

6. The Minor Criteria are consistent with M.E. but unfortunately for the

greater part, are also consistent with Infectious Mononucleosis that I believe

the authors of these diagnostic criteria thought they were describing.

 

7. The Three Physical Criteria of the CDC 1988 Definition: These findings

are totally related to infectious mononucleosis and not to the normal or

average Myalgic Encephalomyelitis. The criteria fail to distinguish the

biphasic

nature of M.E. as mentioned before, the initial infectious illness that often

resembles the minor infection that heralds another biphasic disease,

paralytical poliomyelitis. The infectious disease process varies but is usually

minor

and after three or four days is usually unverifiable so that any researcher

who quotes the patient as having the three physical criteria when he or she

examines the patient probably at the very least can be accused of being very

imaginative. First it is not possible to examine any patient in the first days

of illness unless it is an epidemic situation. In several chronic thousand

patients I have examined the three physical criteria simply do not exist in

more than 1% of the patients examined. What are the CDC Physical Criteria?

 

a. Low-grade fever with an oral temperature between 37.6 and 38.6

centigrade,

 

b. Non-exudative pharyngitis (without any pus or discharge),

 

c. Palpable or tender anterior or posterior cervical or axillary lymph nodes

less than 2 cm in diameter.

 

In the chronic patients the temperature tends to be normal or subnormal.

Most chronic patients have no pharyngitis, they may have a dry pharynx, they

may

have an injected pharyngeal area around the tonsilar pillars, (Anne Mildon

effect) but generally they don't have a classical pharyngitis as seen in any

acute infectious disease. As to the palpable lymph nodes, all healthy patients

well or otherwise unless they are severely obese have palpable lymph nodes.

Since many M.E. patients have hypersensitive skin or fibromyalgia-like pains

of course they have tenderness. But painful lymph nodes scarcely are

different from what is found in any acute upper respiratory tract infection. If

you

are going to list physical findings then you have to first specify whether

this is in the first few days of the illness or in the chronic phase and as

mentioned almost no physician will ever see acute onset illness unless in an

epidemic. In other words these physical criteria are at best of no diagnostic

importance and in general, useless.

 

8. The Insurance Company - psychological bias: the direction given in the

name Chronic Fatigue Syndrome has opened the door for insurance companies to

invent and support a pseudo-psychological treatment of physical and cognitive

therapy that in my view has been used to push the patients so far that they

then quit the program and this allows the insurance company to define the

disabled patient as non-compliant and allows the insurance company to stop

insurance payments. Since many if not most insurance policies also cut the

patient

off after two years of disability, this psychological interpretation has been

destructive to the many patients disabled by M.E.

 

9. The pharmaceutical companies bias: These companies have also jumped into

the door opened by this name of chronic fatigue - depression association in

recommending a non stop series of " new and better " antidepressive medications

that not only have added little if anything to the patients recovery but in

many cases have caused suicides and even greater fatigue. Since many of these

medications have a side effect of causing obesity, the patient's self worth

is often further deteriorated.

 

_http://www.imet.ie/imet_documents/BYRON_HYDE_little_red_book.pdf_

(http://www.imet.ie/imet_documents/BYRON_HYDE_little_red_book.pdf)

 

 

 

 

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