Monday, February 20, 2012

Dr. Sarah Myhill, I presume

This piece article was posted on, supposedly by Dr. Sarah Myhill. I can only presume it is meant as a parody of a quack, as it does not supply any evidence for its numerous claims – the only shred of evidence revolves around "Mitochondrial Dysfunction", which is only mentioned in passing at the beginning and is furthermore not central to any of the theories presented. As it seems to be a parody, I will take the liberty to answer with a few sarcastic remarks.
Dr. Myhill’s notes on fatigue, the immune system’s energy demands, and Rituximab
by Dr. Sarah Myhill, MD*
February 17, 2012

Dr. Sarah Myhill is a UK-based physician with a special interest in nutrition and fatigue. Her pioneering research (“Chronic Fatigue Syndrome and Mitochondrial Dysfunction”) suggests the cells’ energy generating mitochondria are dysfunctional in chronic fatigue syndrome (ME/CFS) and other 'neuro-immune' illnesses. This article is excerpted with kind permission from Dr. Myhill’s educational website (*


Energy Expenditure in ME/CFS: Immune Wastage of Energy and Rituximab

In ME/CFS either that pot of energy can be small (because of poor mitochondrial function, poor fuel supply, poor adrenal function, poor thyroid function and so on), or we can be spending energy wastefully.
How about we throw in some more human organs (the "and so on") without supplying evidence? OK, here we go: In ME/CFS either that pot of energy can be small (because of poor mitochondrial function, poor fuel supply, poor adrenal function, poor thyroid function, poor liver function, poor muscle function, poor brain function, poor skin function, poor bladder function, poor bone function and so on).

However, I suspect a greatly overlooked cause of wasting of energy is immunological.
If Dr. Myhill has any evidence for this, why does she keep it for herself?
Energy must be expended on daily "house keeping" duties. I was intrigued to see the following energy expenditure breakdown in Wikipedia:

- Liver 27%,
- Brain 19%,
- Heart 7%,
- Kidneys 10%,
- Skeletal muscle 18%,
- Other organs 19%.
It astonished me that the liver consumes more energy than the heart and brain combined! Much of this has to do with assimilating and detoxing food from the gut!
 Or simply it's the role the liver has in carbohydrate metabolism (among other).
Immunological Energy

I see the immune system to be like the brain, i.e. it is enormously demanding of energy. We all know this - if a healthy person develops influenza, then he becomes bed-bound for two weeks (she becomes bed-bound for a week….!).

Work done by Caroline Pond has demonstrated that when wild animals put on weight, the first place they dump their fat resources is around lymph nodes; i.e., the immune system.
Oh, that's were the extra Kilogramms went! Doh! To my lymph-nodes! Especially the lymp-node at my stomach! How stupid of me. Must be all the toxins from my gut.
Bone marrow, of course, is very fatty, so this suggests the immune system is not just demanding of energy, but energy in an intensive form; i.e., fats and oils.

The immune system spends energy fighting infection, which is, of course, highly desirable. However, if it gets its wires crossed, it may end up fighting the body itself (autoimmunity), or fighting substances which do not cause harm, and this is allergy.
Here we have the best explanaition of autoimmunity of, like, ever: Crossed wires! And we all know what happens when wires are crossed: The battery goes flat in no time. So the next time your car won't start, you know it is an allergy.
However, in ME I suspect there is another immunological waste of energy which has to do with microbes, possibly “allergy” to microbes.
So the "immunologic waste of energy" Dr. Myhill postulated without evidence was just a decoy? WTF?! "Allergy" to microbes?
Post-Infectious ME
Here, Dr. Myhill crosses her wires. Or her terms. I don't know.
A great many cases of ME follow viral infection and/or vaccination. In these conditions the immune system is switched on to fight the offending microbe.
And there is great evidence that Dr. Myhill is stupid and/or uses weasel words. And if there is an "offending microbe", why doesn't Dr. Myhill test for it and treat it?
In the short term this is highly desirable. To be effective, all vaccinations contain immune adjuvants which are there specifically to fire up the immune system. When this works in our favor, we call it immunity.
And when vaccines work, Dr. Myhill will fight this because she is anti-vax.
However, when it works against us, we call it allergy. Clinically, we know that vaccinations can trigger allergies.
Yet, Dr. Myhill fails to mention the most serious disease that is caused by vaccines: Antivaccinitis Stupidis, or stupid anti-vaxxer syndrome. And for anti-vaxxers "we know" seems to be some evidence surrogate.

And what's with her allergy fetish? Can Dr. Myhill ever stop thinking of allergies? And is that a sign that Dr. Myhill has an allergy to the scientific method? Inquiring minds want to know!
There is no doubt that there are some ME patients who do not recover until they start taking antivirals (see work by Dr. Martin Lerner in my page "Valacyclovir in the treatment of post viral fatigue syndrome,” Sep 2010), antibiotics or antifungals.
Would antiquacks help too? As I would guess there is more evidence of quack involvement, and I have not seen evidence from Dr. Myhill that viruses, microbes or fungi(!) are involved.
 In these cases, there is often no overt evidence of infection.
What, wait. No evidence! No shit, sherlock! No evidence. I am puzzled. So Dr. Myhill bases her case on her rampant imagination?
I suspect what is going on here is that these microbes are present in low levels which would not normally cause harm to the body, but the immune system continues to fight.
And I suspect Dr. Myhill throws around all kinds of fancy terms and evidences-less theories to impress people. No, that can't be!
It is a sort of inappropriate immune activation against microbes or “allergy” to microbes. This is hugely wasteful of energy. Such patients will have a large immunological hole draining their daily energy bucket.
"Allergy". To Microbes. An "allergy" to microbes. And "allergy", with quotation marks. I can hear Robert Koch spinning at the RKI.
Immune Mapping
Immune Mapping?
What we perceive going on in the body is not what is really going on in the body, but it is what the brain tells us is going on in the body!
And the same goes for Dr. Myhills "explanations" about ME/CFS – she does not tell us what is really going on in this illness. I'd say she hasn't got a clue but spinning lots of evidence-less theories – but who am I to tell?
The brain has a complete map of the body, which includes sensory and motor functions. Ref “Phantom Limb Syndrome” by Dr. VS Ramachandran (University of California, San Diego).

It is possible that this could explain the mechanism by which healing and touch therapies such as Bowen therapy, Reiki, Kinesiology, etc. work. These techniques are literally re-mapping the brain to perceive things quickly, or direct motor actions correctly.

It is possible that the immune system has a similar mapping process.
And it is possible that Nazis are living on the far side of the moon – don't ask me for my non-existent evidence, and I won't ask Dr. Myhill for her non-existent evidence, OKAY?
I think of the immune system as having a “map” of what should and should not be present in the body. I imagine it “sniffing” about the place looking for foreigners.
And I think of Dr. Myhill as someone talking out of her arse. The immune system having a "map". Yeah, Dr. Galileo Galilei Myhill, misjudged and unrecognized medical genius, creator of medical theories without a shred of evidence.
There are many good doctors who have experimented with many different types of immunotherapy, such as neutralization, enzyme potentiated desensitization (EPD) and, of course, homeopathy; and it may well be that they are having their beneficial effects because of this re-mapping of the immune system.
"Good" doctor and "experimented with homeopathy" in the same sentence. My irony meter, broketh it hath.
All these mechanisms are characterized by extremely low levels of molecules or antigens being applied with profound effects that cannot be explained by conventional pharmacology.
And that cannot be explained by any evidence from Dr. Myhill.

You, Milady Myhill, are full of shite.
Treatment of Badly Educated B Lymphocytes
"Badly educated" B-cells? What in the name of Darwin?
Immune mapping probably takes place in B lymphocytes. They start life in the bone marrow, move into the blood stream, and are educated by the thymus gland and lymph nodes. This takes a few months. The mature B lymphocytes become the decision makers for immune attack or immune tolerance (war or peace!).
More like "Idiocy or Madness!"
Post infectious ME patients may have B lymphocytes constantly at war. These white cells have been badly educated, their wires are crossed.
Plus, ME patients may have doctors that are constantly talking out of their arse. These doctors have been badly educated, their wires are crossed – it happens.
This therefore gives us a model for treatment.
A model for treatment that solely exist in the head of the good Dr. Myhill.
Either we can re-educate these B lymphocytes or we can kill them, or we can try to reduce the things they are inappropriately reacting against, which may be foods (diet) or microbes (with antimicrobials which could be drug or herbal, change the gut flora with probiotics).
Cultural Revolution and Re-Education for B-cell lymphocytes!
Re-educate B Lymphocytes with Immunotherapy

Perhaps desensitization with neutralization, EPD or homeopathy are techniques directed at re-educating these B lymphocytes to respond appropriately by remapping the immune system?
Or perhaps the good quack doctor will respond to some re-education? Nah.
In the case of neutralization the result may be immediate. With EPD (and I know much more about this because I have been using EPD for 25 years!) the result is often delayed by a few months, it lasts weeks to months, and then patients may need a top up of the treatment.
And I know much more about Dr. Myhill because I have been spending 15 minutes with this dreck.
Although these desensitizations are largely directed at foods, inhalants and chemicals, some microbial antigens are also included. See “Enzyme Potentiated Desensitisation (EPD) - how it works".
See also "Evidence – how not to provide any".
Kill B Lymphocytes with Rituximab

This drug is a monoclonal antibody specifically effective against the CD20 receptor on B lymphocytes. It specifically depletes B lymphocytes; i.e., it kills off the standing army – if this army is involved in civil war, then its depletion is a very desirable action!
And Maoism is Constant Struggle!
Rituximab is primarily used in cancer chemotherapy. By pure chance a patient who had severe ME received this drug as part of a treatment for her lymphoma and her ME symptoms disappeared. She was delighted! Her daily energy bucket was no longer being immunologically drained!

This prompted a study by her Norwegian oncologists, Prof Olag Mella and Dr. Oystein Fluge at Haukeland University Hospital, Bergen, to conduct a placebo controlled double blind trial into the effectiveness of Rituximab in ME.

This was done with 15 patients receiving the active preparation and 15 the placebo… [See “Benefit from B-Lymphocyte Depletion Using the Anti-CD20 Antibody Rituximab in Chronic Fatigue Syndrome: A Double-Blind and Placebo-Controlled Study.”] Rituximab had a highly significant beneficial effect.

What was so interesting about this effect is that it took 2 to 4 months to start, it lasted for 2 to 6 months, then some patients relapsed but some were cured!

This fits very nicely with the time scales I see in my EPD patients – again there is a delayed start, improvement, then top ups required according to the clinical response.
And this fits very nicely with my theory that Dr. Myhill simply has no idea what she is talking about and is just throwing around fancy terms.
Another way to tackle this problem of inappropriate activation against microbes would be to use therapeutic agents which may be herbal, or prescription medication, to try to reduce the level of microbes so much that the immune system stops reacting.
Herbs to the rescue! How fitting, that she does not know what she exactly fights, but she fights it with herbs about which she does not know whether they work, at all, let me repeat does not know whether they work AT ALL, against anything.
It may be that this approach explains the success of Dr. Martin Lerner’s work with antivirals, treatments with antibiotics for Lyme disease, and with antifungals for chronic yeast problems.
Or it may be that Dr. Myhill talks out of her arse. I'm still not sure.
It is the old story - we have a lot more good questions than good answers, but at least we are asking the right questions!
Yes, it is the old story! You, Milady Myhill, are not asking any good questions, you are simply and carelessly providing bad answers in the form of unsubstantiated theories.

I, for one, am thankful for this satire posted by and the opportunity to return this gift with a few sarcastical words of mine.

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