Community Action

I returned from Hawaii to requests to post these powerful statements of our efforts to get help and to help ourselves:

  • The WPI’s response to the Singh study. link
  • Angel Mac’s notes from her wonderful, authentic CFSAC testimony. link
  • Mindy Kitei’s moving testimony before the CFSAC. YouTube
  • Demonstration before the Department of Health and Human Services. YouTube   link to Rivka’s write-up
  • Updated healKick social networking for young adults. link

I got called on my description of myself as being at 90% by a number of people. I was foolish to attempt to quantify it. I certainly didn’t mean that I felt recovered to 90% of my baseline when I got sick in 1995; I meant that I was feeling pretty close to what I might expect of this body now, which has definitely been through the mill. I am still doing very well since returning home, even after the red eye and missing a night of sleep. I expected to feel the altitude by now and I do feel a little weaker, but I don’t feel particularly sick. More like I’ve been sick for a long time and need rehab. I can get up at will and do what I need to. I’m not short of breath, though I haven’t exerted myself like I did in Hawaii. Still sleeping well. No real physical suffering at all. Ali however continues to struggle. Nothing fair about this disease.

    The Shell Game

    The Singh paper was yet another study where an apparently decent scientist proved beyond a shadow of a doubt that she couldn’t find XMRV in anyone. Or at least that she couldn’t find a VP62 plasmid clone in any CFS patients or controls. But since she did not use a human isolate as a positive control, her results are meaningless. She also proved again that a test derived from monkey antibodies to a VP62 clone doesn’t detect anything in humans. What she didn’t prove is that XMRV and other similar viruses are not infecting humans and she certainly didn’t prove anything that doctors or patients should care about with respect to their treatment decisions. That she would presume to comment is outrageous.

    It hurts more because she seemed to be our friend. I met her in Reno last August. She was very excited by our responses to antiretrovirals, chosen because of her in vitro drug testing paper. Interesting that she was able to find XMRV in human tissue when she was studying prostate cancer in 2009 (XMRV is present in malignant prostatic epithelium and is associated with prostate cancer, especially high-grade tumors. Schlaberg/Singh). Odd that she so recently applied for a broad patent with respect to the virus. Then she stabs the WPI, a collaborator, in the back. Very peculiar behavior. My best guess? Follow the money.

    In my opinion, the scientific community is still asking the wrong questions. It is important to validate the original work of course, but that is a very small part of what needs to happen. Given that it is obvious from the pathology that we are dealing with one or more previously unrecognized retroviruses, most likely simple animal retroviruses that jumped to humans in some way, the correct question is, which virus or viruses? Not how do we make this one go away so we can all go back on coffee break, rather than recognize the public health disaster in front of our noses. Pretty poor performance, even for government work.

    Since the science is progressing glacially, it is not possible for me to evaluate what antiretrovirals are doing for me now, having taken Viread and Isentress for more than 14 months. However, I am approaching 90% of function this week, still in Hawaii. I have been out every day, most of the day, for 12 days. I went snorkeling (a little). I have walked up some steep hills. I have had no PEM. Only very brief episodes of feeling sick, which are not severe and pass quickly. I am eating, sleeping, dreaming normally. I am not short of breath at rest, or even with reasonable exertion. I am very deconditioned, but feel like I can start a measured program to get back in shape. I am choosing upright and the usual energy calculation that runs through my head when I think about whether to get up or not isn’t happening.

    I do think it likely that this latest improvement has something to do with the change in altitude; I became polycythemic when I moved to Santa Fe, which is at 7500 feet. I could exercise and was never short of breath without appropriate exertion before that. It will be interesting to see how I do when I go home this week. It may be that going back up will be good too, due to epo which is anti-inflammatory. Athletes know that going up and down is the hot ticket. I’ve been thinking about transitioning to the islands since I left in 1981, but never seemed to be able to make it happen. Our son is finishing up the 11th grade, doing really well, and we are committed to keeping our home in Santa Fe at least until he graduates. But life is full of possibilities again beyond the bed and the couch. My life has improved immeasurably from the positive XMRV culture I received from VIP Dx a year ago January.

    Sleep architecture is an important indicator of severity of illness in ME/CFS, certainly for me, but for many others as well. I had been sleeping better for some time before this trip, so the improvement I’m experiencing isn’t all from palm trees and tropical air. It is hard for me, currently beating the odds (knock on wood), to believe that antiretrovirals are hurting me. Though it is possible that I have improved further from going off AZT, I still believe that it helped me in the beginning. It should be remembered that an efficacious treatment paradigm may turn out to be completely different from what has evolved for HIV. It may be possible to take antiretrovirals for a time to knock it back, clean out reservoirs, in conjunction with other things that are conducive to proviral latency. Even inhibiting replication, provirus is sitting there silent, or waving in the breeze. Our knowledge of HIV suggests there are things we can do to encourage latency. Our observation of the disease over decades has taught us that the balance can be tipped in our favor in various ways. Working with the internal and external environments is crucial for recovery.

    As for Dr. Singh’s desire to practice clinical medicine? I guess she thinks this patient should not be allowed to continue his meds. From my email this morning:

    I tested positive for XMRV. I have been taking zidovudine, tenofovir, and raltegravir for just over 5 months. I started over a 2 1/2 month period and I was on all three by January. Since the end of January, I have experienced very short periods of unmistakable clarity and no symptoms (much more pronounced compared to any period of reduced symptoms that I may have experienced in the past twelve years that I have been ill).

    I wish I could report that Ali is doing as well as I am. She didn’t change noticeably one way or the other from stopping AZT. She is in no way as sick as she was when we started this journey. She is stable, but still just below the surface. She has been having some MCS symptoms recently. We are going to step it up again, considering mild HBOT, Meyer’s cocktail/glutathione IV’s and possibly Nexavir. Ali has inflammatory skin stuff and Nexavir is indicated for skin problems; always good if a therapeutic option addresses more than one problem. She only needs a small additional increment of improvement to be able to get a life again. She is hoping to experience Hawaii too. Neither of us would stop the things that have helped, Actos, Deplin, B12, vitamin D, bioidentical hormones. Nor do we have any inclination to stop antiretrovirals, certainly not on Dr. Singh’s say so. We have done too well on them so far to rock that boat. We need to keep building on our gains.

    Further comments from Dr. Snyderman

    Dear Dr. Deckoff-Jones:

    I would like to respond to the questions about EBV. Before I had read about retroviruses, I focused on EBV and CLL, because there were a couple or reports of EBV being found in about 25% of CLL patients. Just looking at serology is problematic as almost everyone has had an EBV infection and antibody testing is always positive. My plasma was negative for EBV DNA. A concentrate of my lymphocytes was tested at the Mayo Clinic and was also negative for EBV proteins and nucleic acid sequences.

    To anonymous commenter “anciendaze”: The point is that this specific virus (similar only to the Rauscher murine leukemia virus) was found only in malignant cells and not in normal cells. If one reads the articles, one will see that other viruses were looked at but only the Rauscher virus worked in the assays. Conversely, in breast cancer, Spiegelman found evidence of the mouse mammary tumor virus not the Rauscher virus and this work has been confirmed by multiple other labs, including very recently by Pogo and Holland. I have attached this reference (Particles Containing RNA-Instructed DNA Polymerase and Virus-Related RNA in Human Breast Cancers. Axel/Spiegelman).

    I too have read the article in which the term “rumor” viruses was first coined. That term speaks to the negativity and timidity that often accompanies a new way of looking at things. One must have an open mind, which is called for by the scientific method and not ignore data; otherwise one is guilty of holding back progress that could help thousands and thousands of patients.

    Sol Spiegelman was highly respected and was awarded a Lasker prize for his work with nucleic acids. This is often a prelude to the Nobel prize. Robert Gallo respected his work enough to pursue it. Unfortunately Spiegelman died relatively young and his laboratory closed. Robert Gallo moved on to HIV. Nothing further happened with MLRVs and thirty years was lost until the Cleveland Clinic and WPI published their studies. We, that is we cancer patients, and we CFS patients, lost thirty years and don’t want to lose any more time needlessly. Much work remains and must start now.

    Michael Snyderman, MD

    Aloha

    Some of the responses to Dr. Snyderman’s letter indicated that my introduction was misinterpreted by a few people, so I’d like to clarify. I didn’t say that Dr. Snyderman would be dead by now if he’d not taken arv’s. I said that he would never have gotten a chance to try them if he’d waited for the science to run it’s course, to be given permission to do what he did. His numbers, and  ALC doubling time, suggested that he should be dead about a year from now. The evidence he presented suggest that he has impacted the expected course of the disease, but it is too soon to know if his life has been prolonged. He had no prior treatment for his CLL, because he didn’t like the cost/benefit ratio.

    Several people requested references for Dr. Snyderman’s statement that the “supporting data actually goes back to the 1970s. Three different research labs including Robert Gallo’s the co-discoverer of HIV found MLRVs in many different types of lymphoma and leukemia.” Here are references he sent:

    I’d like to thank Dr. Hodgson for his considered comments, however I disagree with them in a fundamental way. If you don’t have HIV, you don’t get AIDS.  Period, end of discussion.  The retrovirus is the only meaningful biomarker. There are predictable lab abnormalities once things start to go south, like CD4 depletion, but the presence of the virus is what matters. Similarly, abnormalities of NK cell number and function may occur down the road in ME/CFS, but normal results in no way rule out the disease. Likewise there are cytokine/chemokine abnormalities, but no single signature pattern that defines the disease to the exclusion of other patterns. It would be a serious mistake and disservice to patients everywhere to define the disease narrowly based on either lab tests or symptom combinations. That would be like saying that AIDS patients with pneumocystis pneumonia have the disease, but patients with Kaposi’s sarcoma don’t.

    A complicating factor may well be the presence of more than one virus. It seems likely that different combinations of virus(es), genes, types of injury are responsible for the different presentations. It is crucial that the problem be defined in the broadest possible way. There are likely an enormous number of infected people who are a little sick, or not sick at all. These are the people who should be getting the most attention, not excluded from consideration because their NK cell and cytokine profiles are normal. And then there are the uninfected…

    I haven’t posted in ten days, and I was on such a roll for a while that I’m getting mail asking if I’m OK. Actually, I seem to be on a slow uphill course again. My sleep is especially improved lately, sleeping all night and even dreaming. The truth is, I’m in Hawaii. I needed to come here for personal reasons, but my husband and I have managed to squeeze in some vacation, our first since New Year’s 2003, when we were all still healthy, even me, relatively speaking. It’s been three years since I’ve been to sea level. I live in Santa Fe, at 7500 feet of elevation. I am much less short of breath with exertion here and hiked in a half a mile to a waterfall yesterday, with no PEM. I am sitting on a stunning beach as I write this. I have even been able to swim a little. My husband is snorkeling. I get little pangs of sadness that I can’t do it with him like I used to, but I am so happy that he can. It is amazing to me that I am here. I lived here when I was a young doctor and always imagined that I would return. I thought my life was over, but it is starting again. Who knows? Maybe the best is yet to come.

    Aloha nui loa this beautiful May Day. A hui hou.

    Another Perspective

    I received this letter from Dr. Michael Snyderman, the Director of Clinical Oncology for the WPI, this morning. I am posting it with permission. He is hoping to lend some balance to the discussion. This is what one doctor did with early testing, even before the scientific process had run its course, since he would have been dead before ever starting treatment had he been unable to connect the dots.

    Dear Dr. Deckoff-Jones:

    It is a shame that the WPI has lost time from having to be on the defensive. I am a believer in MLRVs causing human disease. The supporting data actually goes back to the 1970s. Three different research labs including Robert Gallo’s the co-discoverer of HIV found MLRVs in many different types of lymphoma and leukemia. I believed in “XMRV” enough that when Dr. Mikovits told me that my blood sample was positive, I put myself on AZT and raltegravir for my chronic lymphocytic leukemia and CFS. At the time I started treatment (5/27/10) both were getting worse quickly. I had no treatment for cancer or CFS prior to ARV’s.

    I have been a hematologist/oncologist for 40 years. I am tired and am not cured but I am improved at 11 months on treatment. Both the leukemia and the CFS improved coincident with disappearance of infectious virus from my plasma.

    I am plotting total lymphocyte count, total B-cells (CD19) and an unfavorable clone of CLL cells (trisomy12). As you can see, my counts were going up rapidly and now are slowly improving. To my eye it looks convincing that there has been a definite biological change in the leukemia. I also feel somewhat less fatigued and my neuropathic pain is gone. Attached are my lymphocyte count, CD19 (leukemia cells) and trisomy 12 cells (the worst group of cells of my leukemia), as well as my original cytokine profile, vs. 9 months of treatment.
    There is no other reasonable explanation than that XMRV, or another retrovirus, was at least making things worse, and subtracting its influence has improved my disorders. This is proof of principle in my opinion. Obviously, an enormous amount of work needs to be done. For example, we don’t have a protease inhibitor, and ARVs are not going to be the only answer. My perspectives are mine, but I believe there is a scientific basis.
    I have B-cell CLL with unfavorable prognostic factors: doubling time < 1 year and trisomy 12. I also had the characteristic elevations of cytokines, fatigue and pain seen with CFS. I started AZT and raltegravir May 2010, because I felt things were deteriorating and I had little to lose. More importantly, if I was successful, it could translate into a treatment option for cancer patients that otherwise could not be helped.

    The use of ARVs for treatment of cancer is not new; it was used in the 1990s for treatment of HTLV-1 associated lymphoma and did help. I knew then that if I used it on patients I would be vulnerable to censure from my fellow oncologists. I look at the fact that I got CLL as the opportunity of a lifetime to do some good. I am a one person project. I hope sharing my data will encourage people that we will prevail. I will be submitting this data to an online Hematology Oncology journal soon. Some excerpts from the paper are included below.

    Michael Snyderman, MD 

    Click to enlarge

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    Preview
    Review of murine leukemia virus-related viruses and malignancy and outcomes of anti-retroviral drug therapy in a Xenotropic Murine Leukemia Virus Related Virus XMRV positive patient with Chronic Fatigue Syndrome and chronic lymphocytic leukemia.
    Abstract
    Background: Xenotropic Murine Leukemia Virus-Related Virus (XMRV) was identified in 2006 in some patients with prostate cancer and first isolated in 2009 from most patients with the Chronic Fatigue Syndrome (CFS). Of a cohort of 300 patients with CFS from the 1984 Nevada outbreak, 13 developed B-cell malignancies. The 13 patients were positive for XMRV and a gd T-cell clonal expansion. Causality of XMRV associated CFS and malignancy can be addressed by treatment with anti-retroviral drugs. A patient with both CFS and CLL was available for study. Materials and Methods: Peripheral blood mononuclear cells were isolated. XMRV infection was detected by RT-PCR for gag and env expression; isolation of infectious virus and seroreactivity to XMRV antigens. Cytokine profiles were determined by multiplex analysis of 30 cytokines chemokines and growth factors on a Luminex platform. T-cell clonal expansion was determined by testing for clonal T-cell receptor gamma gene rearrangement (TCRg) by assays available from commercial clinical laboratories. Results: A patient with CFS and B-cell chronic lymphocytic leukemia (CLL) was positive for XMRV and clonal TCRg. He showed improvement in his cytokines, CFS symptoms and hematological parameters simultaneous with disappearance of infectious XMRV in plasma after treatment with AZT and raltegravir. Conclusions: Improvement of both the CFS and CLL simultaneous with disappearance of infectious XMRV from plasma after anti-retroviral therapy suggests that XMRV was etiological for both. Anti-retroviral therapy might have a positive impact on CFS and XMRV associated malignancy in other patients.
    Results
    A patient with CFS and B-cell CLL tested positive for XMRV in both plasma and leukemia cells. His virus was sequenced and was closely related to the previously sequenced XMRV strains in our laboratory. He had antibodies to XMRV proteins. He was also positive for a clonal TCRg by both quantitative and qualitative assays. He had unfavorable prognostic factors including a trisomy 12 clone and a doubling time of less than one year and had no prior therapy. He started treatment with AZT and raltegravir 571 days after diagnosis. By day 56 of treatment, infectious XMRV was no longer detectable in plasma and his cytokine levels had improved. This coincided with improvement in symptoms of CFS which included fatigue, difficulty in concentration and neuropathic pain. He continues on treatment for eight months with good tolerance of drugs and works full time. His previously increasing absolute lymphocyte count (ALC), CD 19 cells and trisomy 12 cells are trending downward. At start of treatment, his ALC was 16,348/cu mm and CD 19 cells 11,658/cu mm up from 3,303 at diagnosis. His trisomy 12 cells peaked at 8,490/cu mm day 117 of treatment up from 1,550 at diagnosis. After 285 days of treatment his ALC was down to 10,600/cu mm, CD 19 cells down to 6,015 and trisomy 12 down to 4,558.
    Discussion
            We have previously reported that most CFS patients are positive for XMRV if multiple detection methods are used. The development of lymphoid malignancies in 13 of 300 CFS patients suggests that CFS patients are at a several hundred fold increased risk for malignancy compared to generally quoted incidences in the general population. Of these 13 patients, all that were tested were positive for both XMRV and a clonal gd T-cell expansion. The greatly increased risk for B-cell malignancy in an XMRV infected population may be due to infection of the B-cell line by XMRV. Cancers have mutated genes and changes in gene expression that could make them permissive to infection by retroviruses. Retroviruses have been thought to cause cancer by insertional mutagenisis. This mechanism requires that the retrovirus proviral DNA be integrated into host cell DNA next to a proto-oncogene thereby inducing activation of the proto-oncogene. A more important mechanism with XMRV may be the ability of viral proteins to change gene expression. Several independent groups have found that shortly after a permissive cell line is infected with XMRV, multiple genes are expressed and that these genes could be involved in production of the malignant phenotype. Spadafaro has shown that reverse transcriptase can cause gene activation and lead to the malignant phenotype. In some cancers env and gag may also be important in malignant transformation.
           A complementary hypothesis is that T-cells are also infected by XMRV resulting in a clonal T-cell expansion. The clonal T-cells produce elevated cytokine levels which may be partially responsible for the CFS. Furthermore these cytokines may have a paracrine activity that stimulates a simultaneous neoplasm to behave in a more aggressive fashion.
           One objection to considering XMRV a pathogenic virus is that there was previously no explanation as how a murine leukemia virus could have entered the human population. However, early vaccines were prepared by passaging human virus through mice for the purposes of viral isolation and for attenuation. This would have allowed for contamination of vaccines with murine leukemia viruses. The original Yellow Fever Vaccine was made in the early 1930’s by culturing the virus in mouse cerebral tissue. Some patients received both the Yellow Fever virus and infected mouse cerebral tissue. 
           The YF17D strain was used to immunize over 400 million people world-wide over the next 65 years. It was the policy of the U.S. Armed Forces to vaccinate service men for Yellow Fever from the 1940’s through the 1970’s. The polio vaccination trials in the United States started in 1952. The polio virus was passaged through mice, cotton rats and primates to achieve attenuation. Although the Salk vaccine was treated with formalin, many patients received the live oral attenuated polio virus. Indeed, the patient studied here, received the live oral polio vaccine in the early 1950s, fifteen years later developed symptoms of CFS and fifty-five years later developed CLL. He also received the Yellow Fever vaccine in the early 1970’s on entering the Armed Services.
            In summary, a new patient with both CFS and B-cell CLL was identified. Both his leukemia cells and plasma were positive for XMRV and he had antibodies to viral proteins. He also was positive for a clonal TCRg and had elevated cytokine levels. With anti-retroviral therapy he showed improvement in his cytokine levels, CFS symptoms and hematological parameters simultaneous with the disappearance of infectious XMRV from his plasma. Presumably his improvement was related to the anti-retroviral effects of treatment.
            Alternative explanations for the therapeutic effect of his anti-retroviral therapy have been offered. One of these is “selective toxicity” which has never before been seen with the hundreds of agents use as cancer therapeutics and seems an unlikely explanation for his improvement. Anti-telemorase activity of the AZT has also been considered, but the rapid response to treatment does not fit the kinetics of depletion of telomers.
            There is nothing unique about this patient’s clinical presentation to suggest that his case is any way unrepresentative. His response to anti-retroviral therapy suggests that XMRV was etiological for both his CFS and CLL and that anti-retroviral therapy might help other patients with CFS and XMRV associated malignancy. Many more patients need to be studied. Ultimately questions that should be answered are what neoplasms are associated with XMRV, will existing anti-retrovirals have activity in these neoplasms and what would be the optimal combination of anti-retrovirals.

    David and Goliath

    A lot of the dissension here feels like the squabbling of a lively, dysfunctional family, with lots of crazy relatives:). Lately, there’s been some progress in being more respectful of one another. But this being the internet, there are strangers in our midst, trying to find chinks in our nonexistent armor. That’s fine, for we are here to look at the truth. The naysayers are an opportunity to sharpen our thinking and confront rumor head-on.

    I decided to blog because I couldn’t stand all the suffering in isolation. Even as a doctor, when my family got sick and started seeing Lyme doctors, there was a feeling that there were people that knew something that I didn’t, a way in which the information wasn’t freely given. I now think that happens because of everyone’s unwillingness to admit what they don’t know, even to themselves.

    My only serious concern about my outspokenness on the internet has been the recent comments that my being controversial might somehow hurt the WPI. For this reason, in part, I have elected to be a consultant for the WPI, as an independent contractor, rather than an employee. I’ll take this opportunity, in advance of an announcement on the WPI website, to say that the opening of the clinic will not take place in May as hoped, primarily because of financial constraints. Our plans remain unchanged however, and I am hopeful of opening before the end of the year.

    So let’s take advantage of our devil’s advocate, John, who has questioned both the science and integrity of the main protagonists at the WPI. With permission, I’d like to tell you what I’ve learned about the institute and the people involved. In particular, I’d like to address the oft heard thread that runs something like this: the Whittemores are richer than God, so why don’t they just cough up another few million dollars to save us?

    Here is the reality. At a time when money was not as big an issue as it is now, the Whittemores, and other concerned patients, joined with Redlabs, owned by Dr. De Meirleir in Belgium, to start VIP Dx. This happened at great personal expense because a clinical research lab was needed to save their daughter, and others. The “and others” make the Whittemores special. They didn’t just have the money. Lots of people have the money. They thought about the problem and applied the money in a way that no one else had done before. It wasn’t about money, but the embodiment of parental love. This all happened well before there was a research lab. XMRV as a cause of CFS wasn’t even a twinkle in anyone’s eye.

    Everyone knows that Harvey and Annette spent many millions, and raised millions more, to fund an institute so that everyone would be helped. They brought together the necessary ingredients in the form of Mikovits and Lombardi. Having heard the story from each of them and others, it was a synthesis of talent, skill and luck, as genius always is. The WPI scientists support and promote each other’s contributions, a rare thing in the world of science. Also unheard of, everybody passed up any intellectual property rights in favor of the institute. Any interest in eventual profit from the use of the WPI’s intellectual property by VIP Dx was passed to the institute when it was founded.

    When the Science paper was published, a lab called Cooperative Diagnostics, owned by a scientist named Satterfield, brought an unvalidated test to market for XMRV, even though they had never found it in a human being. Their test was a PCR for a VP62 plasmid. Recently, in an interview with Cort Johnson, Dr. Satterfield admitted that they never did find it in anyone. More of the “I can’t find it, so it isn’t there” insanity. I thought it pretty strange that he isn’t ashamed of having charged people a bunch of money for a test, even though he knew that he had never found XMRV in an actual patient. How can you disprove an association, if you can’t find it all?

    Dr. Satterfield’s attempt to jump into the market, forced VIP Dx to bring a test to market, even though there had been no intention to do so until further research was done. But the prospect that there would be a flood of negative test results that needed to be immediately challenged forced their hand. At that time, it seemed likely that the major commercial labs would be testing soon, so it was considered a band aid for the short term.

    The first 10 people who write to me that have a receipt for a negative test from Cooperative Diagnostics will be tested at VIP Dx for free. Email: jdeckoffjones@gmail.com. Also, if anyone received a positive test from Cooperative Diagnostics, I’d like to hear from you.

    So testing for XMRV is a gold mine, right? Wrong. VIP Dx hasn’t even begun to pay back the original founders, nor can it cover all of its current existing expenses. It pays WPI a royalty (calculated as the net profit for administering the test) that puts it further in the red. Some of the founders donated their holdings or had their holdings placed in trust for the benefit of WPI. And Harvey, who manages the lab, has never been paid a dime. Never. The lab exists to unravel the mystery of our illnesses, as it was intended from the beginning. Here’s the truth. VIP Dx has lost almost a million dollars since inception. Not accountants fiddling with red ink, but real losses. I have seen the actual numbers. Anyone want to donate to the cause?

    I can tell you that in planning the clinic, VIP Dx is just as important as the WPI translational research lab. Integral parts of a unique whole. Dr. Lombardi will make available any testing that our doctors decide we need. He is looking into the tests I have asked for, so that they will be available when we open. They recently moved into their new state of the art facility next to the clinic, a tremendous undertaking. All testing done in the clinic will go into our database, so contributes to our overall understanding of the illness and how to approach it.

    So why don’t the Whittemores give some more money? Because they don’t have it at the moment. If they did, they would. In my opinion, everyone who has spent a few dollars on an XMRV test from VIP Dx is contributing to the greater good. The sooner we start to think about the illness as related to XMRV, or another related but unspecified human gamma retrovirus, the better; it will affect those we tell. Personally, I’ve had good luck explaining my illness to the uninitiated as “a newly discovered retrovirus like HIV that isn’t fatal”. We are in much better shape now, with our decisions informed by this understanding, than we were before. Understanding is everything to me. For that reason, no matter how it all turns out, I owe my hugely improved quality of life to the Science paper. I’m still sick, but living in the light.

    As for Dr. Mikovits being right or wrong? She questions herself every day, as any real scientist would. Clearly, she (and the WPI) were unprepared for the thousands of desperate patients who turned to her, all needing immediate help. She is a deeply compassionate person and has trouble telling patients that the science is going to take time. She bleeds for us. A consummate scientist, not a politician, she is under unimaginable pressure, caught in the center of the perfect storm. We all owe her a debt of gratitude for what she has already given.

    Finally, I have spent time in the labs of both Drs. Mikovits and Lombardi, in two different places many miles apart. They can both grow the virus. Not from everyone, but in a significant percentage of patients. I wonder how they keep contaminating only some of the samples. To John. I will address your objections 1-8, 9, 10, 11….99, 100, etc. in a future post. But it is my belief that if you use the methods, materials, and processes outlined in the Lombardi paper, in an appropriate sample, you will find XMRV. Other labs besides these two can find it. We know that there are plenty of people out there who can design and complete a PCR study looking for XMRV and not find VP62. They know, and we know, that they are looking for the wrong XMRV and using the wrong methods, materials, and processes. It is that simple.

    Uninsulated Wiring

    Any intelligent fool can make things bigger and more complex… It takes a touch of genius – and a lot of courage to move in the opposite direction.
    ~ Albert Einstein

    I speak to a lot of doctors. It is common to hear that they do a bunch of elaborate tests that let them “individualize” treatment. They feel they have identified The Defect, and can address it, in this way or that. There will be an overly intellectualized theory, but mostly, the strategy involves replacing a substrate, using a little known intermediary, or overwhelming a block in a metabolic pathway. That strategy can make the difference, though it often doesn’t, because no matter how far you take it, you don’t know enough. I know a woman who was housebound for a decade who was able to return to work after she started B12 shots. But for every one of her, there are an awful lot of people for whom B12 made no noticeable difference at all. To make matters worse, an intervention might not work, but “work” at another time for a given patient. For every case of something definite that brought about a remission, I hear about a few spontaneous ones, even after many years, where there was nothing that could be identified as making the difference. One of the most tantalizing things, and you hear it regularly, is that something worked for a few days, and there was a taste of almost normal. That implies reversibility.

    The blog has a tracker that shows the most recent readers on a map of the world. There is often someone tuning in from Tromsø Norway, at the top of the world. It is interesting to note that MS is more prevalent in northerm latitudes. The very extreme form of ME, which seems to be more common in Norway in particular, reminds me of an adult form of autism in a sicker body, with PEM and pain thrown in. ASD looks different because it occurs in the developing brain, but the obvious commonality of symptoms is there. Extreme sensory overstimulation. Can’t stand light and sound. Problems with touch. Problems communicating. Concurrent GI dysfunction.

    We haven’t heard from the Gulf War Illness community here yet, but it seems to me, it is the same illness. I had more of a GWI, than typical CFS, presentation. If it’d been a couple of years earlier and I’d been a soldier returning from war, instead of a post-partum ER doctor, GWI would have been my diagnosis. I had olfactory hallucinations, or flashbacks, of the worst burn case of my career. I now think of them as 1rst cranial nerve discharges, rare and without emotional content at this late date, but it seemed pretty classic PTSD at the time. My psychiatrist called it “vicarious PTSD” from the ER. Do you believe it? He didn’t even let me own my own trauma. I said it felt like the flu. I used the word malaise. Psychiatrists have done me a lot of harm. But I shouldn’t single them out; it’s just somehow more personal. But the rest of my doctors and dentists, in hindsight, mostly chose the stupidest thing too, because of profound misunderstanding of the illness and disbelief. And speaking their language didn’t help at all.

    Being unable to depend upon the stability of the ground beneath me has been a tough, but effective, teacher. I don’t sweat the small stuff anymore. Acceptance is my mantra. My uninsulated wiring and limited physical ability require a simplification of thought and action that in the end boils down to common sense, something I didn’t always have. I have learned to ride over the bad moments and find great joy in the good ones. It is all very close to the surface. I spoke to a woman last week who referred to herself as “an idiot savant”. That struck a chord in me. We have all had to learn to live with diminished capacity. For me, functioning requires first surrendering to the illness. If there is a silver lining, it’s easy access to my own truth. I don’t over-think things or worry much any more. It already happened. It’s become about what I can do, instead of what I can’t.

    P.S. My email has gotten away from me, as it is very heavy. The survey has taken a lot of attention. If you emailed me about something important to you and I missed it, please resend. Once in a while, if I think about a question too much, it doesn’t get answered. Sometimes I have nothing to say and don’t answer because I think it might come to me. I read every word and am sustained by hearing that it is helping in some way. Your emails make me think and care. I try to cover recurring themes here.

    A Rose By Any Other Name

    At this juncture, with the science in an embryonic state, I am in favor of the most inclusive definition. The only problem with non-HIV AIDS is that “Deficiency” isn’t exactly right, though the disease can clearly progress to an immune deficiency, just not a devastating one like endstage HIV. Dysregulation would be a better word. However “Acquired Immune Deficiency Syndrome” unrelated to HIV, is close enough for government work, and the name evokes what it should. Before the causative agent of Hepatitis C was identified, it was clear that there was another infectious virus that caused hepatitis that had a different clinical course than either Hep A or B. This is exactly analogous to that. We will eventually have a laboratory profile that is inclusive of all the cohorts, or maybe I should say, factions.

    Neuromyasthenia isn’t a bad name. It takes into account the full history of the phenomenon, but the overemphasis on muscle is inappropriate for many and it leaves out the immune problems. It also brings “the vapors” to mind for me for some reason. I haven’t heard a perfect name. Another new acronym won’t take at this time, even if accurate, because everything is in such a state of flux. It will all be easier when the causative agents are identified. For now, non-HIV AIDS explains it in very few syllables. Even a doctor should get it.

    AIDS has case surveillance criteria that include “AIDS-defining conditions”. Revised Surveillance Case Definitions for HIV Infection 2008. If you are HIV positive, whether you get PCP or Kaposi’s Sarcoma, it is still AIDS. Whether you have HIV dementia or not, it is still AIDS. It is the same for us, whether you have HHV-6, Lyme Disease, CLL or ASD.

    I don’t like any of the existing case definitions, though most full-blown cases are caught by the Canadian Criteria. Using us, as examples; I didn’t have a viral onset and I don’t have sore throats, fever, adenopathy. I got sick post-partum with various neurological symptoms which were all transient. I was always hyperimmune. I worked in the ER for 16 years; I was exposed to everything and never caught anything. I’ve had an influenza a few times, including Swine Flu, which was no big deal, but that’s it for viral illnesses, other than childhood illnesses, all of which I had naturally before my early teens. However, I had persistent Babesiosis despite lots of treatment, so that’s pretty immune deficient. I have never met CDC criteria. I meet Canadian Criteria (6/6), but didn’t for the first decade of my illness. As for ME? I didn’t have PEM for over a dozen years, though it’s bad now, and I still don’t have problems with cognition or memory. I have sensory deficits. I have a positive Babinski and Rhomberg. I have mini-clubbing that started before my first crash. I have low titers of autoimmune markers, sometimes. I am XMRV positive. I’ve had negative nerve conduction studies. I have been given many diagnoses over the years including chronic Lyme Disease, fibromyalgia, Crohn’s, PTSD, dysautonomia, arrhythmias, peripheral neuropathy, Raynauds, atypical migraines, intestinal migraines, pain syndrome of unclear etiology, most recently CFS. I have recurrent hypertensive crises. I have a sleep disorder from being an ER doctor, predating my illness by many years, but it’s much worse now. I am probably an Ehlers Danlos variant. I have become more flexible with each major exacerbation of my illness. My wingspan is greater than height, though I am short. Ritchie Shoemaker says my genes are “poison”, but Ali “drank” the lesser of the poisons. What do you think I have?

    Ali is more classic CFS, though she also had an onset that was related to a major hormonal shift, and her illness responded to oral antibiotics for years. She does not meet CDC criteria. She does meet Candian criteria, except when she doesn’t. No sore throat, fever, nodes. She catches viral illnesses very lightly; barely registered Swine Flu. She has had inflammatory skin stuff since she was little, predating illness. She has a history of treatment resistant Lyme Disease, atypical migraine, a mild cerebral vasculitis and leukocytoclastic vasculitis twice from PICC lines. She has POTS. She has a little brain fog that comes and goes, but is really sharp mostly. Little sleep issues, but not bad. She has PEM, but didn’t always. She has a little MCS. Not much pain. She is XMRV positive. Do you think we have different diseases from each other? From you?

    There is aggressive prostate cancer, Parkinson’s Disease, Multiple Myeloma, ASD and Marfan’s Syndrome in our family, which is in no way an outlier. The surveys we are receiving look compelling for demonstrating both the genetic and infectious pieces, as well as associated conditions. Thank you to everyone participating. These informal responses are helping us to determine the right questions and how to proceed. Please keep them coming, even if you are an isolated case. Our intention is to proceed with a formal study. There will be a secondary mailing to fill in the blanks and provide consent for publication. If you’ve sent in a survey, please stay tuned over the next few months for additional requests for information, and if you change your email address, let me know.

    It is completely outrageous that the epidemiology has not been formally studied by our government agencies over the last decades, while so many people were getting sick. How did they let this happen? How come the Center For Disease Control has never even looked? An obviously infectious disease spreading through the population for decades. Whole families affected. But they buried their heads in the sand, because it wasn’t straight forward. It was easier to think the patients were lazy, crazy and faking. After all, they were an unusually labile bunch, hard to deal with, quite hysterical sometimes, and so fixated on their symptoms, which any good doctor could tell, couldn’t be a real disease. No wonder the people responsible can’t let it in. Imagine realizing that you were one of the people who allowed an incurable infectious virus to invade a second and third generation, ruining the lives of millions of people. No way to contain it anymore. The health of the species affected on an evolutionary scale. Just because you were wrong. That could make for some serious denial.

    So, we will study the family piece ourselves. With talented, sick volunteers. Without funding. For free.

    God loves to help him who strives to help himself.
    Aeschylus ~500 BC

    Pandora’s Box

    Watching Harvey Alter, Judy Mikovits and John Coffin on YouTube struck me as life immitating myth. Spock, Kirk and the Klingon. Yoda, Skywalker and Darth Vader. God, Moses and Pharaoh.

    Here is the tape of Dr. Alter as King Solomon, one of our dragon slayer, Dr. Mikovits, and another of Dr. Coffin trying helplessly to close Pandora’s box with this unbelievable statement: “I see the next step as leaving the virus that we know as XMRV behind.”

    Dr. Coffin’s conclusions don’t make any sense to me. Let’s for a moment say he is correct and XMRV was created in the lab in the early 90’s. It is still a xenotropic MuLV related virus, capable of infecting human cells. Why does he think it couldn’t have infected humans in the lab and gotten out that way? Because there were sick patients before the event? A more likely explanation would be that there was already something else out there before this one. It’s not clean and neat, so let’s all close up shop and go home for another couple of decades. Even he said there could be another retrovirus. And why pray tell isn’t he looking for it? The patients have something consistent with retroviral infection. You won’t find it unless you look.

    The discussion of the name is a sad one. I don’t have much of a stake in the name. I don’t mind CFS that much and I don’t think it’s going to go away. I think of the word fatigue the way materials, like metal, can become fatigued. I don’t like ME much either because I think it’s stigmatizing in another way. It implies we’re all brain damaged, encephalopathic, and I believe the damage is mostly reversible. I like non-HIV AIDS.

    The case definition discussion also seems besides the point to me. My belief is that the presence of infectious retroviruses is the only true biomarker for the disease and we don’t know what is there yet. There are clearly XMRV negative people who are clinically indistinguishable from the positives. Those people shouldn’t be excluded from a diagnosis. Like Hep C used to be non A non B hepatitis, I think our disease should be called non-HIV AIDS. Personally I think that the people excluded by this or that set of criteria mostly do in fact have the disease. Another problem with definitions is that it is a relapsing remitting process. People who meet a set of criteria today, may not tomorrow (thank God).

    Case definitions and new names aren’t going to save us. The only biomarker for the disease is the detection of the responsible retroviruses. For now, that is XMRV, but there will be more. Until then, we can only measure downstream effects, cytokines and NK cell profiles, inflammatory markers, a few other things that demonstrate how sick we really are.

    Our down and dirty survey is producing fascinating unanalyzed data. We’ve already refined the questions slightly based upon what’s coming back to produce a more complete picture and thank you to everyone who has responded to requests for further clarification. We will report. For now, the impression from reading the surveys is that many CFS patients have family members with CFS and associated diseases. Please spread the word and encourage everyone with the disease to reply, whether you have an affected family member or not. If any statisticians or epidemiologists are interested in participating, please get in touch.

    I thought this article about Google’s founder inspiring and relevant to our predicament: Sergey Brin’s Search for a Parkinson’s Cure.

    Informal Family Survey

    The blog’s readership has been growing recently, currently averaging well over 1000 pageviews/day. Not a big number in internet terms, but still an awful lot of people. Knowledgeable people, because it isn’t exactly easy reading.

    Dr. Snyderman and I have been discussing how we might use the blog as an investigative tool. Polls with self-selection are not statistically valid but may provide clues about what to look at in a more formal study. In this case, we are hoping to demonstrate patterns of transmission. As an initial exploration, we’d like to get a sense of how many ME/CFS patients reading have family members, by marriage and blood, with ME/CFS or other neuroimmune diseases. Include ASD, GWI, MCS, atypical MS, fibromyalgia, chronic Lyme Disease, other. Include neurodegenerative diseases, MS, ATLS, Alzheimer’s, Parkinson’s Disease, other. Note inflammatory bowel diseases, IBS, Crohn’s and UC. Note any prostate cancer, leukemia, lymphoma, other cancers. Also please include neuropsychiatric diseases, PTSD, OCD, bipolar disorder, other. Do include subclinical disease. Please err on the side of inclusion. If you are familiar with the Canadian Criteria for CFS, note if you meet criteria or not.

    We are asking ALL readers with ME/CFS to send an email, even if you have no other affected family members, in an attempt to have a denominator. If your spouse/partner is ill, report as a family member. Please present the information with yourself first and family members listed below, in the following format.

    For yourself:
    Diagnosis
    Gender
    Age
    Date of birth
    Place of birth
    Breastfed?
    Date of onset of illness
    Location where became ill
    Trigger if known
    Number of children, note if adopted
    Are Canadian criteria met?

    For your family members:
    Relationship to you
    Diagnosis
    Gender
    Age
    Date of birth
    Place of birth
    Breastfed?
    Date of onset of illness
    Location where became ill 
    If ME/CFS diagnosis, trigger if known
    If ME/CFS diagnosis, are Canadian criteria met?

    For ALL respondents, including those with no affected family members, please answer the following questions:

    Do you have a spouse/partner? How long together?
    Is your spouse/partner (or an ex-spouse/partner) ill? If yes, do you think you became ill independently (both ill prior to meeting)? Please provide details.

    How many unaffected children do you have?
    Were unaffected children breastfed or not?
    How many unaffected siblings do you have?
    Do you think that a vaccination was implicated in yours or a family member’s illness? If yes, provide any details remembered.
    Have you or any family members been tested for XMRV? If so, please report results.

    All information will be kept confidential and used for statistical purposes only. The surveys will only be shared with involved physicians and biostatisticians. Results will be shared publicly.

    Please share the link to this page, but it would be helpful if the survey were NOT posted elsewhere in full (except for translations, thank you!), as we’d like to track responses as a percentage of pageviews.

    Send with subject line: Family Survey
    If you have no affected family members, please put NEG in the subject line.
    Cc both of us:
    mcs@buffalo.edu
    jdeckoffjones@gmail.com

    Thank you,
    Michael Snyderman MD and Jamie Deckoff-Jones MD