Intended for healthcare professionals

Rapid response to:

Primary Care

General practitioners' perceptions of chronic fatigue syndrome and beliefs about its management, compared with irritable bowel syndrome: qualitative study

BMJ 2004; 328 doi: (Published 03 June 2004) Cite this as: BMJ 2004;328:1354

Rapid Response:

Professor Wessely and Dr White's views

Professor Wessely and Dr Peter White were kind enough to send me
messages of clarification on their views.

"Dear Mr. Johnson

People only need to read my papers to know that I do not think CFS/ME is
primarily psychological."

Dr Peter D White

Reader in Psychological Medicine

Barts and the London

Queen Mary School of Medicine and Dentistry,
St Bartholomew's Hospital,
London EC1A 7BE, UK

Message from Professor Wessely:

"I agree that excessive exercise is counter productive, and that
activity needs to be carefully managed to avoid symptom exacerbations

you mention inflammatory changes - whilst there is little evidence of
inflammation in the usual sense of the word, there is evidence of immune
activation in CFS"

"I am afraid that contrary to the view that our research group is
exclusively concerned with promoting psychological research on CFS, we
take a broad view."

"I hope things improve for you one day"

Professor Simon Wessely

Subject: High levels of type 2 cytokine-producing cells in chronic
fatigue syndrome

Both sections as posted by Fred Springfield to the Co-Cure list:

High levels of type 2 cytokine-producing cells in chronic fatigue

Journal: Clin Exp Immunol. 2004 Feb; 135(2): 294-302.

Authors: Skowera A, Cleare A, Blair D, Bevis L, Wessely SC, Peakman

Affiliations: Departments of Immunology and Psychological Medicine,
Guy's, King's & St Thomas's School of Medicine, King's College London,
London, UK.

NLM Citation: PMID: 14738459

The aetiology of chronic fatigue syndrome (CFS) is not known.
However, it
has been suggested that CFS may be associated with underlying immune
activation resulting in a Th2-type response.

We measured intracellular production of interferon (IFN)-gamma and
interleukin (IL)-2; type 1 cytokines), IL-4 (type 2) and IL-10
(regulatory) by both polyclonally stimulated and non-stimulated CD4 and
CD8 lymphocytes from patients with CFS and control subjects by flow

After polyclonal activation we found evidence of a significant bias
towards Th2- and Tc2-type immune responses in CFS compared to controls.
In contrast, levels of IFN-gamma, IL-2 and IL-10-producing cells were
similar in both study groups. Non-stimulated cultures revealed
significantly higher levels of T cells producing IFN-gamma or IL-4 in CFS

Concluding, we show evidence for an effector memory cell bias towards
type 2 responsiveness in patients with CFS, as well as ongoing type 0
immune activation in unstimulated cultures of peripheral blood cells.

I would like to thank both Professor Wessely and Dr. White for their
responses and clarification of their views that CFS is not primarily a
psychological illness.

This implies that GET aimed at "Deconditioning" and CBT to correct illness
behaviors may be therapies that are not directly concerned with addressing
the primary dysregulation that underlies the physiological exercise
intolerance and psychological consequences from having the illness.

Since Professor Wessely and Dr White share the belief that CFS/ME is not
primarily a psychological illness then I trust that research and therapy
will be directed at the primary physiological origins of CFS/ME in
accordance with these views.

Again, I wish to thank Professor Wessely and Dr White for their responses
to my concerns.
-Erik Johnson

Competing interests:
None declared

Competing interests: No competing interests

18 June 2004
Erik R Johnson
Prof. Wessely - Dr Peter White
Incline Village NV 89450