The Times

A resurrection, brought forth a miracle of publcity

2008-06-24T01:16:00.000-07:00

The Times 22th June.

Every night less dramatic ailments, such as chronic fatigue syndrome, alcoholism and neck pain, are being “cured” in Tigers Bay by the simple laying on of ...

ME: 'Invisible disease' is now easier to read

2008-03-20T03:59:00.000-07:00

A simple blood test may revolutionize the way we treat patients with ME, reports Bob Ward

Taken from The Times Last Updated: 12:01am GMT 18/03/2008

British researchers are close to developing, for the first time, a blood test and potential drug treatments for myalgic encephalomyelitis (ME), also known as chronic fatigue syndrome (CFS), following groundbreaking work on its genetic origins.

ME/CFS affects about one in 200 people, and women sufferers outnumber men by six to one. It causes a constant feeling of extreme exhaustion and malaise for more than six months, along with sleep abnormalities, memory and concentration difficulties and a great deal of pain.

In its most extreme form, the disease leaves sufferers bed-ridden and can even be fatal.

But patients now have new hope, thanks to research published in the Journal of Clinical Pathology by Dr Jonathan Kerr of St George's University of London and his colleagues.

They have identified 88 genes that produce different levels of proteins and other molecules in ME/CFS sufferers compared with the rest of the population.

Dr Kerr's team carried out a complex analysis of the records of 55 patients and found that they could be divided into seven sub-types according to the specific gene combinations found in their white blood cells, and the severity of their symptoms.

The most acutely affected patients had 71 of the 88 gene abnormalities.

The results of this work should allow better understanding of the causes and development of the disease. Many of the genes are known to be affected when a person contracts a virus, a factor which is believed to trigger many cases of ME/CFS.

Importantly, the researchers also recognised that five of the 88 genes are targeted by drugs which are already used to treat other diseases.

The team is now investigating whether the faulty genes produce abnormal levels of proteins that can be detected as minute quantities of "biomarkers" in the blood of patients.

"If proven to be sensitive and specific indicators of the illness, the discovery of protein biomarkers could lead to the development of a diagnostic test for ME/CFS, which would revolutionise our approach to this disease," explains Dr Kerr.

He will present his results at a conference on ME/CFS biomedical research in Cambridge in May.

The research may even lead to a change in attitudes to the disease, often trivialised as "yuppie flu".

Sarah, 31, who was diagnosed with ME/CFS two years ago, says: "The stigma associated with the disease can sometimes be as much of a problem as the symptoms.

"Some think that it is 'all in the mind' and can be cured by a good night's sleep. It can be difficult to get friends and work colleagues to understand just how difficult it is to live with a disease that is so debilitating but virtually invisible."

Attitudes among funders of medical research also need to change, says Dr Neil Abbot, operations director at the charity ME Research UK. "Studies on the psychological aspects of ME/CFS seem to have vacuumed up attention and funding at the expense of hard-core biomedical studies," he says.

"Most of the £3 million spent by the Medical Research Council on the illness in the last six years has gone towards projects on the psychological management of the disease, while there is evidence that around 30 applications, some from established biomedical research groups, have not been funded."

The work carried out by Dr Kerr and his colleagues is funded by a small charity, the CFS Research Foundation, which was set up in 1993 by a group of doctors and scientists who were concerned about the direction and quality of work on the disease.

Its director, Anne Faulkner, is optimistic about the search for a cure: "We believe that this disease can and will be conquered, but it will need the dedicated work of distinguished research scientists and the determination of people in the community to bring this about."

Bob Ward has donated the fee for this article to the CFS Research Foundation and ME Research UK. He is former winner of the Bayer/Telegraph science writer award, judged by a panel that includes Sir David Attenborough and Adam Hart-Davis, which is now open to 15-year-olds too. The closing date is March 31. See science-writer.co.uk for details.

Cognitive behavioural therapy

2008-03-19T05:16:00.000-07:00

The Times

From The Times

September 15, 2007

Cognitive behavioural therapy (CBT), which seeks to improve the symptoms of illness by changing patients’ attitudes, thoughts and feelings, often strikes people as flaky. It sometimes seems to suggest the power of mind over matter, chiming both with New Age ideas that a healthy body flows from a healthy spirit and the old-fashioned “pull yourself together” approach to psychiatric medicine.

Few psychiatrists, however, dispute that CBT can be helpful to patients with depression, anxiety and even schizophrenia. Courses seem to change the way that people approach mental illnesses, allowing them to alter their behaviour in constructive fashion.

Now the technique is showing promise in more unlikely fields, too. Several studies have shown that it can improve the prognosis for some cancers, and this week, Professor Trudie Chalder, of King’s College London, announced that it can help people with type 1 diabetes.

Though her study has not yet been peer reviewed or published, Professor Chalder described the results as positive. Not only did subjects report improved attitudes towards their condition, but their blood sugar levels went down, too. She took pains to point out that they were not “thinking themselves better”; CBT instead seems to have empowered people to eat more sensibly and to exercise more, improving their physical condition. But the message was clear: the technique can have tangible benefits in a disorder that has a manifest physiological cause.

Such studies are feeding a growing consensus that CBT has a lot to offer throughout medicine, beyond those conditions in which patients’ thought processes are more obviously involved. Even when diseases have a clear physical cause – a virus, as in HIV, or an auto-immune reaction, as in diabetes or arthritis – psychological factors can have a major effect on outcomes. Compliance with treatment regimens, diet and exercise, and background mental health are often critical to a good prognosis, and CBT can improve all of these. It is decidedly not a treatment that can help only when illness is all in the mind.

That misleading impression, however, still inspires hostility towards CBT among people who might benefit greatly. Chronic fatigue syndrome (CFS) is a case in point. The National Institute for Health and Clinical Excellence has recently recommended CBT and a related strategy, graded exercise, for the condition, on the back of good randomised clinical trials that indicate a benefit. There are no other therapies for CFS with such good evidence in their support, yet some patient groups have reacted with anger.

For these critics, CBT is part of a medical crusade to write off their condition. A prescription that sounds like glorified counselling seems like an allegation of malingering. Yet while the origins of CFS remain obscure, and factors such as infection may be involved, an acknowledgement that psychology may also be implicated does not imply this at all. Even if CFS can be at least partially psychosomatic, such symptoms can still be real and distressing. They deserve to be taken seriously.

Medicine has moved on from the view that only conditions with an unambiguous cause – a virus, tumour or injury – are worthy of attention. The problem comes in finding an appropriate treatment, and nonspecific therapies such as CBT, which help patients to manage their symptoms, are often the best there are.

A recommendation for CBT, too, says nothing about the origins of ill-health. The biology of cancer and diabetes is quite well understood, yet there is evidence that CBT can help and many patients are keen to have it. It is unfortunate that people with CFS do not think likewise. To embrace the one treatment that has been shown to be effective against their illness does not mean it is imaginary.

Mark Henderson is the Science Editor of The Times Dr Copperfield returns next week