Talk:Chronic fatigue syndrome management

Split
Split article from Chronic fatigue syndrome per talk. I have kept the dispute tag invocation, only changing which tag it invokes as this is no longer a section but a standalone article. As with more than one split off section, the summary in the main article is in much better shape -- work is needed here. -- Strangelv (talk) 02:34, 18 April 2008 (UTC)

Edits removed for discussion
The following unsourced edits have been removed from the article. If appropriate citations can be found, the material can be considered, Jagra (talk) 07:08, 7 June 2008 (UTC)


 * "Subsequent studies have shown that CBT is ineffective toward treating CFS. There may be some value in treating any related depression or anxiety.  However, researchers have tried to make CFS a psychosomatic disorder when in fact there have been numerous studies proving underlying physiological abnormalities in these patients."


 * "Subsequent studies have shown GET has no benefit for CFS patients. In fact, patients' symptoms may worsen with aerobic and anaerobic exercise.  This may be due to the mitochondrial abnormalities that have been found in patients with this disease. "

English Summary of Belgian CBT study
I forgot to add a comment with my edit. I found an English summary of the Belgian CBT study, so I added it as a new reference. Also added a comment saying that it used group CBT therapy, which may be less effective than individual therapy. --Sciencewatcher (talk) 22:43, 1 September 2008 (UTC)
 * Which is your personal (faulty) guesswork and should not be in the article. Guido den Broeder (talk, visit) 23:02, 1 September 2008 (UTC)

Typical comment of yours Guido. Are you looking to get banned again? If so, you're going about it the right way. --Sciencewatcher (talk) 00:02, 2 September 2008 (UTC)
 * The comment is typical because you repeat yourself ad nauseam. No other comment applies. Guido den Broeder (talk, visit) 01:00, 2 September 2008 (UTC)

I have edited some of the worst stuff out of several CFS and related articles but there seems no end to the tendentious pov statements, erroneous attributions, selectiveness, utter nonsense, inaccuracies, messes, etc. These articles have only deteriorated since I last looked at them, I am sorry to say. They look more like a warzone than like something encyclopedic. Cleaning up seems a tall order; I'm much inclined to restart from scratch. Guido den Broeder (talk, visit) 02:15, 2 September 2008 (UTC)

NPOV
I have tagged the section on CBT for failing NPOV since it makes claims to the effectiveness of this therapy that are not supported by the referenced sources, and when I corrected that, User:Sciencewatcher reverted all corrections. Please reinstate my corrections or find sources supporting the text before removing the template. Guido den Broeder (talk, visit) 22:44, 3 September 2008 (UTC)


 * If you would work with other editors instead of just insulting them, perhaps we would not have these problems. I've removed the invalid npov tag. --Sciencewatcher (talk) 23:11, 3 September 2008 (UTC)


 * The reason for the tag is explained above without any insult whatsoever. Find sources to support your text, as it is disputed, or allow it to be corrected. Do not remove the template until the issue is resolved. Guido den Broeder (talk, visit) 23:13, 3 September 2008 (UTC)


 * You said "Which is your personal (faulty) guesswork and should not be in the article" which sounds like an insult to me. It certainly isn't harmonious editing behaviour. And the revert to your other change was because you changed a large chunk but you said you only made "small changes" and you wouldn't explain what you have done, instead insulting me again saying I didn't understand diff. If you have any specific npov issues, please discuss them reasonably and I'll be happy to work harmoniously with you. --Sciencewatcher (talk) 23:47, 3 September 2008 (UTC)


 * See above. I will be waiting for sources to support your text. Guido den Broeder (talk, visit) 00:09, 4 September 2008 (UTC)


 * Do you mean the comment "This study used group CBT therapy, which other studies have shown to be less effective than individual therapy"? If you look at the conclusion of the ref I added it says "Group CBT did not significantly improve ... although such changes have been demonstrated in the literature for individual CBT". Feel free to reword the comment or discuss here what problems you have with it. --Sciencewatcher (talk) 00:24, 4 September 2008 (UTC)


 * Also, can you explain why you tagged this as a minor edit when it clearly isn't a minor edit? --Sciencewatcher (talk) 14:28, 4 September 2008 (UTC)

← Guido, you need to provide diffs and give a more thorough description of the problem. Verbal  chat
 * I refer to my edit summaries. As a consequence of your reverts, the article now again contains the same unsubstantiated, tendentious statements by Sciencewatcher, in part falsely attributed to sources that say something else entirely, and the tags indicating so have gone. Guido den Broeder (talk, visit) 20:39, 10 September 2008 (UTC)
 * Please justify with reasons here, thanks. Verbal   chat  21:10, 10 September 2008 (UTC)
 * I have already done so at the beginning of this thread. There is nothing more to say at this time except that I would appreciate it if nobody would revert disputed text back in or remove indications that it is disputed while the dispute is ongoing. It's up to you to convince me that these statements are neutral and verifiable after all. Guido den Broeder (talk, visit) 21:31, 10 September 2008 (UTC)

I've removed Sciencewatcher's statement on the diminshed effectiveness of group CBT. I checked the article (abstract and full text) and it seems to be saying that group CBT was superior to individual CBT on some measures and comparable on others, including the one they defined as overall success. So this particular study doesn't back up the claim in the article; in fact, it is closer to working against it. Mango juice talk 14:04, 11 September 2008 (UTC)

Quote from the full article: "It is difficult to compare this treatment with individual CBTs for this condition." and "If the definition from [] trial were used, it would appear that the current trial has demonstrated a successful clinical outcome when compared with individual CBTs." (2nd paragraph, pg. 42) Mango juice talk 14:14, 11 September 2008 (UTC)

Move?
I'd suggest moving the page to treatment for chronic fatigue syndrome or something similar, but I'm not sure, so I started a discussion at WT:MEDMOS. WLU (talk) Wikipedia's rules (simplified)  11:40, 9 September 2008 (UTC)
 * So far the article has little to do with treatment. These are management therapies and one coping strategy that is not a therapy. Guido den Broeder (talk, visit) 21:44, 10 September 2008 (UTC)
 * Good enough for me. I'll move it.  WLU (t) (c) (rules -  simple rules) 22:19, 10 September 2008 (UTC)


 * Please reinclude ME in the title. With the present title, there is no place in Wikipedia for ME management that does not fall under the header of CFS management, e.g. brain stimulation exercises and dietary regimes. Guido den Broeder (talk, visit) 08:22, 11 September 2008 (UTC)
 * I've yet to see a source that states they are different, but I haven't looked. Are there peer-reviewed journals or other medically reliable source that deliniate a difference between CFS and ME?  Without such a source they will, and should be treated as functionally identical.  WLU (t) (c) (rules -  simple rules) 19:47, 11 September 2008 (UTC)

Placebo
Here I've moved the placebo statement out of the lead and into CBT. I think this is a pretty terrible place for it, because CBT involves behaviour, i.e. not just thinking about stuff, which can impact purelyl physical and purely mental conditions. I'm not saying it's great, it's mostly a placeholder. There needs to be a better distinction made about the physical and mental aspects, attibiutions and arguments made about the etiology and pathophisiology. CFS is controversial and fuzzy, and the placebo statement is probably better placed in another page that is not about management. WLU (t) (c) (rules - simple rules) 16:18, 11 September 2008 (UTC)


 * I agree it's a bit confusing placing it in the placebo section - it doesn't really fit in there. Perhaps it would be better in the psychiatric section of the CFS etiology article. --Sciencewatcher (talk) 17:50, 11 September 2008 (UTC)


 * I would leave it out altogether. Nobody else has found this weird result, and Wessely uses a deviant definition of CFS. Guido den Broeder (talk, visit) 19:27, 11 September 2008 (UTC)
 * Discarding because we don't like the definition is original research, it's valid for inclusion without a singificant countering source saying it's bunk. It seems like it would be an extermely valuable source to address claims that it's all in CFS patients' heads, as well as the objections to it being all in their heads.  That doesn't make it in the right place right now though, it seems like a solid source for somewhere in the set of articles.  WLU (t) (c) (rules -  simple rules) 19:45, 11 September 2008 (UTC)
 * What we like is irrelevant. Important is that a result for one group of patients (functional syndrome) cannot be counted for a totally different group (chronic fatigue syndrome). As far as being a 'valuable source': besides being pov, it works the opposite way. If placebo effects are small, than a small result is ascribed to the therapy rather than a possible placebo effect. Guido den Broeder (talk, visit) 19:52, 11 September 2008 (UTC)


 * So just because you don't agree with it, it makes it 'pov'? If you actually look at the article it doesn't use Wessely's definition, whatever that is. They searched on medline for CFS articles, not "functional syndrome". It doesn't say what diagnostic criteria the chosen articles used. --Sciencewatcher (talk) 20:38, 11 September 2008 (UTC)
 * Yes it does. A large portion of the selected studies used Wessely's definition (the Oxford criteria), and the lowest placebo effects were found there. Read the full article. Guido den Broeder (talk, visit) 20:55, 11 September 2008 (UTC)

Why would the lower placebo response necessarily be mainly due to patient beliefs in a physical cause, especially if biological treatments had a lower placebo response too? The full text states: "Very few trials accurately recorded patient attributions, but the sample source suggested they were typical of specialist samples—they were actually from specialist clinics, had poor baseline functioning or had a specific label denoting a physical cause—and were likely to have in general a bias toward physical attributions." As if people with organic diseases don't have a "general bias toward physical attributions"? As far as I can tell, the review didn't directly compare patient beliefs to placebo effect, so it's a secondary conclusion rather than a primary outcome of the study. The full text also talks about patient expectations and mentions that CFS is perceived by both doctors and patients as very difficult to treat. When considering that the figure of 30% is also used for medical disease where patients are told they have physical pathology for their symptoms (right?), why is CFS so special, "patient expectation" seems more important than "physical attribution", especially when expectation is key to the placebo effect. A physical attribution could help explain the reduced response for psychiatric and psychological therapies, but not the lowered placebo response for biological treatments as well (it should have instead increased it). The WP article phrases this study in regards to CBT, but fails to mention that the lowered placebo effect was on average lower for all types of treatments/therapies studied, including biological ones. - Tekaphor ( TALK ) 04:13, 13 September 2008 (UTC)
 * All good points. One may also wonder what the effect could be of the researcher's attributions, as the placebo effect seems lowest for those researchers that use the deviant Oxford criteria. Guido den Broeder (talk, visit) 10:25, 13 September 2008 (UTC)
 * I have removed the placebo study. Apart from being weak, it has nothing to do with the article's topic. Guido den Broeder (talk, visit) 17:18, 13 September 2008 (UTC)

CBT vs cognitive impairment, continued
Continuation from the archived CFS talkpage: ...

Sciencewatcher, you're right that the related research uses a range of measures. However, the problem with only removing the (bracketed) text is that the author's suggestion remains: "distorted perception of cognitive processes is more central to CFS than actual cognitive performance". When considering the other research, it seems that mental fatigue is more central to CFS-related cognitive impairment than "distorted perception of cognitive processes". Of course, the mental fatigue may cause the distortion, but the current wording could be somewhat misleading. I suggest either removing the authors suggestion, or leaving it but adding something like "Other researchers have found that mental fatigue is an important component of CFS-related cognitive dysfunction.". - Tekaphor ( TALK ) 04:36, 13 September 2008 (UTC)
 * The most significant cognitive finding seems to be that information processing is distorted. This is more specific and not necessarily caused by (but of course aggrevated by) mental fatigue. fRMI shows that patients often need both halves of the brain for certain tasks where one half is normal. High-resolution MRI shows the most grey matter loss to be in the cognitive area (Okada, 2004). Guido den Broeder (talk, visit) 10:22, 13 September 2008 (UTC)

Tekaphor: while I agree that mental fatigue is important, I think the authors' point is that patients' perception of their impairment is greater than their actual impairment. However as I said before this could depend on what you measure (time to do the task, ability to do the task given unlimited time, or brain activity required to do the task). --Sciencewatcher (talk) 14:24, 13 September 2008 (UTC)
 * The current text, however, gives this a fact, rather than the authors' conclusion. Their personal conclusion is not supported by their results, it is mere speculation. The higher likelihood is that the researchers imposed their perception of patients' impairment on the patients, since this is what CBT actually does. I.e. the therapy did in fact change the patients' perspective, but did not improve their condition. I agree with Tekaphor, and will change the text accordingly. Guido den Broeder (talk, visit) 16:56, 13 September 2008 (UTC)

pov tag
I added an inportant comment from the Belgian study, Guido reverted it with the comment "-pov" with no explanation, so I added it again. He has now put in a pov tag, which I removed, and he has put back, again with no discussion here as to what the problem actually is. I think he may have broken 3RR but I'm not sure.

Anyway, in order to avoid an edit war I'm going to let mangojuice or another admin resolve this. Any further edits from me will simply provoke an edit war with Guido so I'm going to stop editing until someone resolves the problem. --Sciencewatcher (talk) 23:12, 13 September 2008 (UTC)
 * The pov of your statement was already pointed out to you on another page. However, in addition:
 * With the abundance of information, there is no room to mention each bit of speculation or each question raised in all the references.
 * Singling out the one question of a great many because you think you personally have the answer to it is not neutral.
 * Writing in a manner that your personal answer seems to be the actual answer is not neutral. Guido den Broeder (talk, visit) 23:34, 13 September 2008 (UTC)
 * Writing "The results of the Belgian study are not good as the results in the published evidence based studies" is original research and seems incorrect. The results seem quite comparable. Guido den Broeder (talk, visit) 00:31, 14 September 2008 (UTC)

Furthermore, disputes are not resolved by someone. If you have a dispute, it is expected that you make some effort yourself to resolve it. This is not done by removing the tag that indicates the existence of the dispute, nor by removing your opponent, nor by adding more versions of the already disputed statement. Guido den Broeder (talk, visit) 23:40, 13 September 2008 (UTC)


 * Those comments I added are taken almost verbatim from the English summary of the study itself, they are not my "personal answer". I would appreciate it if you could discuss here before removing items. Also please do not assume that I am automatically wrong when I post something. According to wikipedia guidelines you should assume good faith. I would appreciate it if you would either reinstate the comment and remove the pov tags, or discuss the reasons here why you think it is inappropriate.


 * The reasons for adding it is because the study goes against the results of other studies, so it is important to point out why this might be the case. --Sciencewatcher (talk) 14:41, 14 September 2008 (UTC)


 * No response from Guido, so I'm assuming he doesn't have any problems and I'm removing the tags. --Sciencewatcher (talk) 00:04, 16 September 2008 (UTC)


 * You have yet to address my concerns. Guido den Broeder (talk, visit) 00:16, 16 September 2008 (UTC)

Thanks for returning the tags.

Attempt to explain the issues further
You say it is a quote. However, the text doesn't show that. In fact, it is a quote from an unofficial summary. At present, it is just an unsourced claim by Wikipedia. The text reads: How would we know that? It sounds unlikely since this study and the evidence-based studies all say that patients report feeling somewhat better after the therapy. However, the Belgian study investigated if that feeling was a true reflection of their actual situation, and found that it was not. Which evidence-based studies on the same approach have made a similar investigation? Who compared them and published that the evidence-based studies produced better results regarding actual functioning? As it stands, the statement fails WP:OR. Then follows: This is not true. The Belgian reference centres used a combination of individual and group therapy. See page 14 of the report:
 * The results of the Belgian study are not good as the results in the published evidence based studies.
 * The report asks if this depends on the way the interventions are organised. The published studies used individual therapy, whereas the Belgian reference centres performed group therapy.
 * ...en naargelang de ‘context’ van het therapeutische contact(individueel, in groep, telefonisch)... (Translation: ...and depending on the context of the therapeutic contact (individually, groupwise, by telephone)...

The summary does however give the true answer to any comparison attempt: The summary itself, by the way, was not taken from the report, which contains no English summary, but was written by a patient on a forum. That is not a reliable source, as is clearly demonstrated above. Guido den Broeder (talk, visit) 08:26, 17 September 2008 (UTC)
 * Comparison of the results of the CFS reference centres with published evidence based studies was difficult as the published studies often used other measurements. Furthermore, scientific studies often used more stringent criteria to select patients. Finally, sometimes the published studies used other selection criteria than the CDC criteria that were applied in the reference centres.


 * Guido, looking at the pdf, it seems that changing the text to "mostly group therapy" would be in line with the Dutch text (see e.g. pg 67 of 182, numbered 58 in the document, last paragraph: it cleally indicates that it were mostly group sessions with a limited number of indivdual sessions, and it also compares this to the published research, which was about individual therapy. Adding "mostly" to the text would in my opinion very accurately reflect the Dutch text.
 * As for the summary: it was on a forum, but was not written by "a patient", but by PhD Bart Stouten, who seems to be quite well versed in CFS research (see e.g. this publication in the Journal of Chronic Fatigue Syndrome). He may of course also be a patient, I don't know, but it shouldn't be dismissed this easily. Then again, since you have been in contact with Bart Stouten before, I suppose you already knew this... Fram (talk) 10:10, 17 September 2008 (UTC)
 * Thanks, I have edited the text and added another consideration to solve the neutrality issue there. I also gave Bart due credit for his summary, which makes it clear to the reader that the summary was not written by the evaluators. I still think there is a reliability concern, but weighing this against informing the English reader I'm inclined to let it stay. I have also removed the NPOV tag. The section still needs cleaning up further, IMHO. Guido den Broeder (talk, visit) 10:35, 17 September 2008 (UTC)
 * If wqe only had the summary and not the original report, I would agree that it was not reliable enough. The combination of the two seems to be acceptable though. Fram (talk) 11:27, 17 September 2008 (UTC)


 * Thanks, this is great. Now we are getting somewhere! I have also change the lead text to reflect what is actually said in the clinical evidence review. I also changed the link to the full text (previously it just led to a page asking you to subscribe). --sciencewatcher (talk) 14:27, 17 September 2008 (UTC)

Gibson enquiry does not have medrs
The Gibson enquiry does not have reliable source. It does not come up on Medline search, it is not on any google news. It is only on ME special interest group websites where its described "independent parliamentary enquiry." erythos.com is the source, that is a commercial site that does graphic design and it is also an Orchid society. ?? So obviously this does not belong in a med article. I do not know it even belongs in conteroversy article w/o better sources but that is better then here, this is an article about management, not what person 1 said on their orchid society website group 2 thought organization 3 said about management. RetroS1mone  talk  03:55, 13 November 2008 (UTC)

Merge this with Treatment article
Treatment and management should be merged. Yes i guess there is a difference between treatment and management but lets face it the difference is technical and alot of reviews put things like CBT and GET in treatment catagory. RetroS1mone  talk  13:43, 14 November 2008 (UTC)


 * Yes, I agree. There is no proven treatment for CFS so treatments and management are just the same for now anyway. With CBT and GET there is no agreement if the are actually treatment or management. --sciencewatcher (talk) 14:20, 14 November 2008 (UTC)
 * OK I merged. RetroS1mone   talk  04:45, 18 November 2008 (UTC)
 * No objections on my part, although for another reason. While treatment and management are significantly different, it has some advantages to have them in the same article: it makes it possible to indicate the difference and to mention the sometimes existing confusion. Guido den Broeder (talk, visit) 09:30, 24 November 2008 (UTC)