📰 News coverage of the NMCB research consortium on ME/CFS.
Science editor of De Volkskrant, one of the largest papers in the Netherlands, interviews Jos Bosch consortium project leader.
Some highlights below and a link to the article.
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Facts noted about the project:
➡️ All academic hospitals participating
➡️ Over €7m euro gov. funding available
➡️ Large biobank being established
➡️ 6 studies underway
➡️ Expansion thereof is planned
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Background to the consortium:
➡️ Began in 2013 via citizen's initiative
➡️ ME patients gathered petition w/ 50k signatures
➡️ Which led to advisory opinion from Health Council
➡️ ... which finally recommended investing in biomedical research
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Patients sit on the board and the research program and approach are based on their input.
"It's incredible how much knowledge patients possess," says Bosch."
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"His workplace at the Amsterdam UMC is just around the corner from the post-COVID expertise center that opened there at the end of last year. This is for good reason: doctors and scientists collaborate."
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"The clinical features overlap; many post-COVID patients have symptoms of ME/CFS. The aftermath of an infection is something many patients share; for the majority of ME/CFS patients, symptoms began after an infection."
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"Patients with chronic Q fever (contracted by a bacterium in goats or sheep) and chronic Lyme disease (contracted after a tick bite) have similar symptoms. Therefore, in addition to post-COVID, these two post-infectious diseases are also included in the study."
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"A biobank is being developed with bodily material from two thousand people: patients from four groups and, as a control, a group of healthy individuals."
"They will complete questionnaires and perform tests."
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"[Researchers] don't have to spend a large portion of their time and budget recruiting patients first. And, importantly, there's funding for eight years. This allows us to retain researchers for a longer period."
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"Q: If the disease isn't taken seriously, were researchers even available?
For the 1st rnd of consultations, we'd sent invitations to hospitals and universities, we'd rented a room, and I expected at most a handful of interested parties. To my surprise, the room was full."
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"Many doctors offered same explanation: because of the success of medicine, they're increasingly seeing serious illnesses become chronic. And these patients sometimes have the same symptoms as patients with ME. Patients with MS or RA, for example, can also experience intense exhaustion or unexplained pain."
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"Doctors are no longer surprised by it. Some even told me: I think we've always mistreated patients with chronic fatigue syndrome."
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"Q: You said the patients are in charge. Did they have any special requests?
A: At their request, children and young people are also participating in the study, which is unique worldwide. Another special feature: they wanted us to include homebound patients. In international studies, at most a few percent of patients are bedridden. Yet, we can learn the most from this group. That's why we'll soon be visiting patients at home."
In my opinion, the potential for repeated PEM episodes to trigger a longlived or permanent decline in baseline health should be included in the definition of PEM.
Then re-examine the common assertion that PEM occurs in many illnesses on that basis.
Maybe even more precise - a longlived or permanent decline in baseline health accompanied by an increasing tendency to trigger PEM with less and less exertion.
The common focus on fatigue in the context of PEM is a trap. Focus instead on what makes PEM a distinct and nasty phenomenon. Its quicksand like quality, the boom-bust cycles, the moving target of exertion threshold, its multifacted manifestation, etc.
I'm impressed by this handout on PEM. This is attached along with the information every GP needs to register patients with the Long COVID clinics in the Netherlands.
I will put the salient text below in thread.
What is PEM?
Post-exertional malaise (PEM) is the worsening of symptoms after physical, cognitive and/or emotional exertion. In addition to the worsening of existing symptoms, it can also lead to physical and/or cognitive symptoms that have not occurred before.
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A majority of patients who suffer from Q fever, Long COVID and ME/CFS experience PEM after minimal effort. It can also occur in people with long-term symptoms after vaccination. The severity and duration of the symptoms that arise are not proportional to the degree of effort ...
The 7th documentary by German doctor and presenter Eckart von Hirschhausen is now up on YouTube. It's 44 mins long and the quality is high.
Below I'll set out: 1. Overview of topics covered 2. More detailed summary of each part 3. Relevant links
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1. Topics covered (with timestamps)
(00:00) - Intro / catchup with a severe patient
(03:39) - Segment on anti-vax misinformation
(06:30) - Long COVID feat. PostX @TeamPostX!
(10:00) - Liegendemo in Berlin
(11:26) - ME/CFS
(13:21) - Patients taking action, feat. @U2Fight_World
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@TeamPostX @U2Fight_World (14:55) - Vaccine side effects / post-vac
(19:27) - Severe post-vac patient Louis (24yo)
(22:20) - Distressing segment where Louis has cardiac seizure
(28:50) - What happens to severe ME patients in hospital, feat. 30yo Mats
(36:50) - Patients need to treat themselves
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Everything is on the patient. Everything. Finding out how the illness works. Finding out you need to pace (despite what you're told). Deciding how to much risk to take with infection. Finding out how to mitigate infection. Deciding how much risk to take with treatment.
Living with the consequences of (a) not doing anything, (b) doing something that doesn't go well. Educating people in your life. Pushing through misunderstanding, disbelief, dismissal, or ridicule. Managing expectations. Deciding when to push and attend and when to disappoint.
Deciding whether it's riskier to say something to your doctor or not to say something. Whether it's riskier to show up with a mask because you lose credibility with the doctor or to risk another infection that makes you too ill to get to the doctor in the first place.
@DrDavidACox @BBC_Future Thanks so much, Dr. Cox, for spending the time and going into detail on this topic and for bringing in such a wide array of experts.
The article does a good job of painting a line between standard fatigue and the beast that is PEM, which is neuroimmune in character.
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@DrDavidACox @BBC_Future I also really like how you've chosen to draw a line between various forms of fatiguing illness, which might be regarded as infection-associated chronic conditions (IACCs) - I think this is appropriate.
It's nice to see mention of how inadequate the term fatigue is...
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@DrDavidACox @BBC_Future ...when it comes to describing PEM in particular - which I've also seen described as PENE or post-exertional neuroimmune exhaustion. It really is like quicksand; the more you struggle the worst it gets.
And worth mentioning how the word fatigue has been used historically...
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It opens with a quite from Der Spiegel journalist Nikolaus Blome describing psychological instability as a risk factor for LC (paraphrasing),
"People who were not doing so well before now have an official ticket to get compensation"
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The piece goes on to set the scene in the German press, with many headlines sowing doubt, i.e. "Is it psychological? Is it just for people who are work-shy?" etc.
He then goes through the official definition of Long COVID as per the German Ministry of Health.
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