This is about chronic fatigue syndrome and the association with
XMRV. I apologize in advance for the provocative title, and the
subsequent gratuitous references to the Nobel Prize, but there is a
point to this.
Take a look at this summary of the “old-fashioned disease”:
During the nineteenth century general paresis of the insane
emerged as a new psychiatric disorder which was extremely common and
completely devastating. While retrospective studies have found earlier
instances of what may have been the same disorder, the first clearly
identified examples of paresis among the insane were described in Paris
after the Napoleonic Wars. Initially regarded as a complication of
insanity by such influential psychiatrists as Jean-Etienne Dominique
Esquirol, general paresis was first described as a distinct disease in
1822 by Antoine Laurent Jesse Bayle.
It is now known to be a late stage of the disease of syphilis…
General Paresis of the Insane was once the most common diagnosis in
psychiatric hospitals. (Or so I recall, but can’t quickly locate
Wagner-Jauregg was granted a Nobel Prize for developing a treatment
for General Paresis of the Insane, now known as
neurosyphilis. He was one of only two
psychiatrists to have been a Nobel laureate. [The other was Eric
R. Kandel. (Egas
Moniz, who developed the prefrontal
lobotomy, doesn’t count; he was a neurologist.)]
In the history of medicine, it was an eye-opening moment: an illness
that had been thought to be psychogenic, turned out to be the result of
Ordinarily, the discovery that an apparent mental illness was
caused by an infection would result in a reduction in stigma.
That wasn’t the case with General Paresis of the Insane, due to
the nature of the infection.
Another historical note: when the connection between a form of insanity
and syphilis was first postulated, it was met with great
Finally having earlier established
to his satisfaction that tabes
was due to syphilis he now pointed to
high correlation between that disorder and general paresis. Given
the large volume of his data, these were impressive observations.
he met skepticism. ‘Several times,’ Fournier complained, ‘I had the
of having to diagnose syphilitic madness in the presence of very
and justly famous psychiatrists; and almost invariably my opinion was
as a hypothesis which was possible, rational, perhaps tolerable, but
adventurous and tainted with heresy.’
Come to think of it, this is much like the history of chronic fatigue
syndrome. Neurosyphilis is worse than chronic fatigue
syndrome, but the mysteriousness of the loss of function, malicious
stigmatization, and the rejection of a somatic basis, plus the
skepticism heaped upon early investigators, are all similar.
One of the big items in recent medical science
news is the discovery
of a strong association between xenotropic
murine leukemia virus-related virus (XMRV)
and chronic fatigue
syndrome (CFS). In fact, it is the
News of the Week in Science Magazine (subscription required
The association will have to be replicated and otherwise
validated, preferably by the development of effective treatment based
upon the discovery. Even so, it seems solid.
From the NYT
“I think this establishes what had always been considered a
psychiatric disease as an infectious disease,” said Dr. Mikovits, who
is research director at the Whittemore Peterson Institute in Reno, a
nonprofit center created by the parents of a woman who has a severe
case of the syndrome.
Dr. Mikovits’ colleague, Dr. Peterson, was interviewed
on NPR. He emphasized the issues of stigma:
MONTAGNE: Was your work, though, in the early stages, in a
sense, you know, looked down upon. Like you’re working on something
that everyone knows isn’t really a disease.
Dr. PETERSON: Absolutely. Absolutely. It was a problem in the early
’80s, particularly, and this federal agencies never showed particular
interest in this disease as well.
Stigma is a socially-broadcast value judgment, often imbued with
moralistic overtones. It is characteristic of a particularly
mean-spirited form of logical error. As we see from the
reluctance of federal agencies to fund research on CFS, it can have
serious unintended consequences.