July - August 1999
Gender may affect drug reactionMen and
women may have dramatically different reactions to medications, yet very few drugs have been studied to
determine the proper dose and potential side effects according to sex. Scientists are just beginning to
learn how hormones and other gender differences interact with certain drugs and affect their potency.
For instance, certain male hormones seem to protect men from the irregular heartbeat side effect of the
allergy drug Seldane. Also, women's hormones fluctuate according to their menstrual cycle; women with
asthma seem to metabolize theophylline much more slowly during ovulation, thus improving their lung function
during that time.
To complicate matters, researchers are also discovering dozens of enzymes
that help certain drugs get inside the body's cells, and some of those enzymes are more prevalent in one
gender than the other. One study found, for instance, that morphine controls pain much better in women
than in men, while another study suggested that the over-the-counter painkiller ibuprofen is more effective
It wasn't until the early 1990s that the FDA forced drug manufacturers to allow
women of childbearing age into drug studies. Last August, the FDA began requiring manufacturers to consider
gender as a factor in analyzing responses to experimental drugs. These changes could be significant for
persons with illnesses such as CFIDS and fibromyalgia, a majority of whom are women.
FM common in inflammatory bowel disease
A team of researchers at
in Israel sought to estimate the prevalence of fibromyalgia in 113 patients with either Crohn's disease
or ulcerative colitis. Nearly 20% of patients with ulcerative colitis and 49% of those with Crohn's disease
met the American College of Rheumatology's criteria for fibromyalgia. Patients with Crohn's disease had
more tenderness and more tender points and they reported more frequent and more severe fibromyalgia symptoms
than did those with ulcerative colitis.
The researchers suggested that recognizing fibromyalgia
in patients with inflammatory bowel disease would help to ensure correct treatment. The paper, titled
"Fibromyalgia in inflammatory bowel disease," by D. Buskila, et. al., was published in the May 1999 issue
of the Journal of Rheumatology.
hypoglycemia reduced in FM
The hypothalamic-pituitary portion of the hypothalamic-pituitary-adrenal
axis and the sympathoadrenal system are impaired in women with fibromyalgia, resulting in reduced production
of adrenocorticotropic hormone (ACTH) and epinephrine in response to hypoglycemia. The study, led by Dr.
Gail K. Adler of Harvard Medical School, involved only 15 patients and 13 healthy controls, all of them
premenopausal women. While the ACTH and epinephrine responses to hypoglycemia (low blood sugar) was 30%
lower in women with fibromyalgia compared with controls, the prolactin, norepinephrine, cortisol and dehydroepiandrosterone
(DHEA) responses were similar in the two groups. The study was published in the May 1999 issue of the
American Journal of Medicine.
agitates CFIDS supporters
A review article (Barsky, A.J., and Borus, J.F., 1999. "Functional
somatic syndromes." Annals of Internal Medicine, 130:910-921) suggests that CFIDS is a form of
mass hysteria/somatisation disorder, along with sick building syndrome, multiple chemical sensitivity,
repetitive stress injury, the side effects of silicone breast implants, Gulf War syndrome, irritable bowel
syndrome, candidiasis hypersensitivity, mitral valve prolapse, chronic Lyme disease and fibromyalgia.
The authors suggest that the "suffering of these patients is exacerbated by a self-perpetuating, self-validating
cycle in which common, endemic, somatic symptoms are incorrectly attributed to serious abnormality, reinforcing
the patient's belief that he or she has a serious disease." They argue that the sick role is reinforced
and the disability perpetuated by sensationalized media coverage, sympathetic physicians, litigation,
disability compensation and hotlines.
While the authors state that patients often "dismiss
medical authority and epidemiologic evidence that conflicts with their beliefs," the authors themselves
seem to have done the same thing. Psychologist Ellen Goudsmit, commenting on this paper for the Capita
Selecta Quarterly, wrote that this paper "ignores or distorts research evidence," often refers to
articles on fatigue when focusing on chronic fatigue syndrome, and dismisses medical evidence as "premature,
though this does not apply to theories relating to phobic avoidance, etc." She notes that the authors'
search of published articles "seems to have missed all the studies and reviews suggesting that biological
factors play a major role.(and) the various studies challenging the effectiveness of CBT," despite their
use of more than 200 references.
The authors are psychiatrists at Brigham and Women's Hospital
in Boston. Their review research was supported in part by a grant from the National Institute of Mental
(Editor's note: The CFIDS Association has asked a number of respected physicians
and researchers to respond professionally to the article.)
CBT: Best option for sick veterans?
Cognitive behavioral therapy
help veterans affected by Gulf War syndrome manage their symptoms and lead more productive lives, according
to a report in the June 1999 issue of the Journal of Occupational and Environmental Medicine.
"Patients must be helped to the recognition (and they must discover it themselves) that
there is no specific treatment for neurotoxic disease and that clinical improvement will involve learning
to live with what they have, to increase endurance and strength, and to move past this phase of their
lives," conclude Drs. Michael J. Hodgson of the University of Connecticut Health Center and Howard M.
Kipen of the University of Medicine and Dentistry of New Jersey.
Even if some environmental
exposure is found to be the cause of the muscle aches, fatigue, headaches, memory problems and other symptoms,
an effective treatment probably will not be found, Drs. Hodgson and Kipen write. "With this in mind, we
believe it is critical to address the practical question of what to do for those Gulf War veterans and
family members who suffer."
In the same issue of the journal, Drs. Timothy R. Gerrity and
John R. Feussner of the Veterans Health Administration announce the largest, best designed trial to date
to study whether a combination of CBT and exercise can help relieve the symptoms of Gulf War syndrome.
Chiari I malformation studied
of the Chiari
I malformation based on close examination of 364 patients determined that the symptoms, often duplicative
of those of CFIDS, seem to be related to disturbances in the cerebrospinal fluid and direct compression
of nerve tissue. The study, by Dr. Thomas H. Milhorat of the State University of New York Health Science
Center in Brooklyn, was published in the May 1999 issue of Neurosurgery.
I malformation is a disorder involving the crowding of the back portion of the brain with herniation of
brain tissue through the foramen magnum, the opening in the back of the skull where the brain and spinal
cord are connected. Symptoms may result from a broader range of abnormalities in the brainstem and upper
spinal cord than were previously understood, according to the study. The most common symptoms are pressure
headaches at the back of the head and neck, fatigue and muscle weakness, vision disturbances, short-term
memory difficulties and dizziness. Since these and many less common symptoms overlap with those of CFIDS,
research is currently under way to determine whether this condition may be the cause of illness in some
patients with CFIDS and fibromyalgia (see article in the May/June 1999
From the Journal
articles in the Journal of Chronic Fatigue Syndrome,
Vol. 5(1), 1999. (Articles are available for a fee from The Haworth Document
Delivery Service: 800/342-9678, or by E-mail at
M. Reyes, et. al., Chronic
Fatigue Syndrome Progression
and Self-Defined Recovery: Evidence from the CDC Surveillance System.
155 patients from the
CFS surveillance study undertaken from 1989 through 1993 were followed through 1997. The CDC researchers
determined that the cumulative probability of recovery was 31% during the first five years of illness
and 48% during the first 10 years. Patients reporting recovery and those remaining ill were similar, with
no significant differences with respect to age at onset, race, gender, education, presence of children,
income or prior hospitalizations. Recovery rates were similar for those with sudden and gradual onset.
All patients, including those who reported recovery, continued to have some CFS-defining symptoms. While
sudden onset cases reported many more symptoms at onset than gradual onset cases, particularly sore throats
and fevers, over time the two groups reported similar symptom profiles. The researchers recommended that
a standard definition of recovery in CFS be developed and that studies take into account the variable
duration of illness.
N. Endicott, Chronic
Fatigue Syndrome in Psychiatric
Patients: Evidence of Premorbid Anomalous Patterns of Brain Organization.
This psychiatrist examined
46 patients from his practice who had developed CFS and compared them to his patients who had not. He
focused on 20 different anomalous brain conditions, such as speech disorders, fingernail biting, motion
sickness, mixed handedness, migraines, seizures and learning disorders. He determined that psychiatric
patients who later developed CFS had a higher number of pre-CFS anomalous brain conditions than did patients
who did not develop CFS. The findings support the hypothesis that central nervous system dysregulation
is an integral aspect of the pathogenesis of CFS.
W.M.H. Behen, et. al.,
In Vitro Study of Muscle Aerobic
Metabolism in Chronic Fatigue Syndrome.
This study in Scotland examined muscle tissue from 16
CFS patients and 10 controls to determine if there were defects in the way that the muscle fibers in a
CFS patient use oxygen. The researchers found evidence of mild aerobic defects in some cases of CFS, although
the defects were not consistent. They concluded the results support their hypothesis that some cases of
CFS might be due to mitochondrial disorders.
Jiaxu, C., and Weiyi,
Y., Treatment of Chronic Fatigue
Syndrome with Chinese Medicine.
These authors argue that Chinese herbs, some that have been used
for 4,000 years, may be effective in treating severe fatigue. They believe that fatigue results from a
disturbance in the flow of qi or energy force, rather than the more traditional theory of a deficiency
in one of the qi pathways called the spleen meridian. With the support of the National Natural Science
Foundation Committee of China, they plan a study to test the effects of specific Chinese herbs on stress-induced
fatigue in rats and to attempt to understand how the herbs work.
Layander, J.A., A Nutrient/Toxin
of the Etiology and Pathogenesis of Chronic Pain-Fatigue Syndromes: Part I and II.
This paper by
a graduate student at the University of New Mexico proposed the theory that CFS, fibromyalgia and Gulf
War syndrome share a common underlying etiology at the subcellular level: a deficiency of magnesium and
an excess of fluoride. The author argues that these syndromes present a growing worldwide public health
problem due to decreasing magnesium intake in diet and increasing exposure to fluoride compounds in industry,
agriculture, medicine and personal hygiene products. Hormones make women more vulnerable to the condition,
he argues, and stress and various other minerals also affect the interaction of magnesium and fluoride.
The author argues that, if the theory is correct, effective treatment would include increasing intake
of magnesium, eliminating exposure to fluoride (including fluoridated water, certain types of seafood,
gelatin, and many toothpastes and mouthwashes), adding other specific vitamins and dietary supplements,
eliminating alcohol, managing pain and lifestyle aggressively to reduce stress, and maintaining a regular
following briefs summarize articles in the
Journal of Chronic Fatigue Syndrome, Vol. 5(2), 1999.
Bell, I.R., et. al.,
Differing Patterns of Cognitive
Dysfunction and Heart Rate Reactivity in Chemically Intolerant Individuals With and Without Lifestyle
These researchers looked at people with the symptom of intolerance to low levels of environmental
chemicals (a common symptom in CFS). They attempted to differentiate between those who had made lifestyle
changes as a result of the symptoms and those who had not. While the study group was quite small, just
18 persons, the group that was forced to make lifestyle changes showed a higher rate of family history
of alcohol problems, abuse and attention deficit disorder. The ultimate conclusion, however, was that
persons with chemical intolerance "comprise a heterogeneous population."
Ax, S., Coping Differences
Between Chronic Fatigue
Syndrome Sufferers and Their Careers.
This study in England considered coping strategies used by
CFS patients and caregivers. Strategies include "planful problem solving, positive reappraisal, self-controlling,
escape/avoidance, accepting responsibility and distancing." The results indicated no differences in strategies
between patients who were supported by a caregiver and those who were not. There were few differences
by gender. Male caregivers were the least active in seeking social support, and husband carers reported
the lowest use of coping strategies of any group. The author did not attempt to determine whether the
coping strategies reported by sufferers and carers were perceived as helpful.
Green, J., Romei, J.,
and Natelson, B., Stigma and
Chronic Fatigue Syndrome.
The results of this study in New Jersey supported the hypothesis that
persons seeking relief from symptoms of CFS would feel stigmatized, and that the stigma was made worse
when doctors attributed the symptoms to psychological causes. More than three-quarters of the subjects
had been labeled a psychological case by at least one physician. The same percentage coped by using an
educating strategy, while 39% saw a need to be secretive about their symptoms in some circumstances. The
researchers concluded that ignorance or skepticism of CFS by physicians might influence attempts by patients
to legitimize their symptoms, especially by educating others, and to seek out another doctor.
New service alerts scientists
CFIDS Association of America has started an E-mail announcement list for scientists who are interested
in receiving news about possible funding sources for their CFIDS research. For more information, visit
the web site www.onelist.com/subscribe.cgi/cfsgrant-info or contact
Vicki Walker at firstname.lastname@example.org.