The Psychological Stress Confussion

NPR interview on the topic of GWI:

DANKOSKY: So Dr. Steele, what do we know about the causes? Because there have been a number that we've heard about over the years. Maybe we can run through a few of them. One of the things that is mentioned sometimes is stress or PTSD, something that we've heard a lot about from these last few wars, Iraq and Afghanistan. How much does stress have to do with it, do you think?

STEELE: That's a really good question. I think for many years after 1991, after the war got over, a lot of folks really didn't know what to make of Gulf War Illness or Gulf War Syndrome. But at this point, now 22 years later, we actually have a lot of students that tell us a lot about what may have caused Gulf War Illness.

Most of the studies early on looked at things like stress and post-traumatic stress disorder, but we now know very definitely that Gulf War Illness, specifically in 1991 Gulf War veterans, is not a stress-induced or trauma-induced kind of disorder. The rates of things like post-traumatic stress disorder are very low in 1991 Gulf War veterans, much lower than we're seeing in current returning veterans from Iraq and Afghanistan.

However, there is a long list of potential causes that different people have looked at over the years, many things like the vaccines that veterans receive, the oil well fires that many of us remember from that time, all kinds of chemical toxicants that they were exposed to.

And just looking over the broad range of studies, at the many epidemiologic studies that have been conducted in this population, we know that several of these risk factors or toxicants have risen to the top in terms of the strength of evidence that suggests that they are connected with Gulf War Illness.

And at this point we can say that the highest risk factors relate to use of prophylactic medication given to veterans to protect them from nerve agents. That pill was called pyridostigmine bromide. In addition, there was extreme overuse of pesticides in some groups of veterans during the 1991 Gulf War. And so those are also linked to higher rates of Gulf War Illness.

And then we also know that some veterans were exposed to very low levels of nerve agents during the Gulf War, and there's also some evidence supporting an association between Gulf War Illness and the nerve agent exposures that happened during and after the war.

Overall, though, the studies consistently show no link between for example serving in combat and higher rates of Gulf War Illness.

Why is it, that if someone postulate that "stress" (or "lack of resilience" or some other "psychological fault" of the patient) is causative for a (hard to grab) disease, that there is so little scepticism? Why are people not challenged more if they spread their "psycho-stress confusion"? And we are not talking here about physical stress, no here supposed psychological stress (combined with some sort of supposed defect of the patient) should be able to cause physical disease like GWI? A disease that is unique to the gulf war veterans?

I'm sure the Theologians of the Wessely School have an explanation for why there are so many gulf war veterans have GWI – this will be an explanation however that does not create clarity, but an explanation that creates confusion instead…

IgM and IgG Seronegative Q Fever: A Hypothesis for Veterans? Medically Unexplained Chronic Multi-symptom Illnesses.

Immunoglobulin M and Immunoglobulin G Seronegative Q Fever: A Hypothesis for Veterans? Medically Unexplained Chronic Multi-symptom Illnesses.

Chagaris MJ, Smith RC, Goldstein AL.

J Spec Oper Med. 2012 Spring;12(1):37-48.

Abstract
We present Q fever as a credible hypothesis for Gulf War Veterans Illnesses (GWVIs) and as a possible etiology for prevalent symptomologies affecting currently serving servicemembers.

Q fever is caused by the bacteria Coxiella burnetii, which is endemic throughout the Middle East. Q fever may manifest in many forms of widely varying and often inconstant symptoms. Due to false-negative interpretations in current and past diagnostic testing, Q fever has not received appropriate consideration as a possible causative agent for medically unexplained veterans illnesses.

Review of current literature invites us to consider that a form of Q fever involving an incomplete immune response is a potential cause of these debilitating illnesses.

We hypothesize C. burnetii infection coincidental to exposures suppressing antibody-specific immune response results in infection mediated by immunoglobulin D (IgD). Literature indicates that successful treatment for this form of Q fever requires the concurrent administration of doxycycline and hydroxychloroquine.

Well, it is a hypothesis – without any evidence, it seems.

Usually at the acute phase of an infection you get an IgM titer increase, and after the acute phase the IgM titers level off. And an IgG titer increase follows that, usually persistent for life, even when the pathogen is long gone ("Adaptive Immune System"). So it is intruging that IgD titers might be raised and not IgM or IgG – but where is the evidence?

Because, I've seen this before and I bloody hate it: These f*cking "out of the blue" hypothesis without any evidence. Stupid quacks who write things like "Oh, CFS could be an allergy to an pathogen" without any shroud of evidence for their quack hypothesis. Is it too much to ask that they do some minimal testing for their hypothesis and supply at least some results – before publishing?

A wild guess

So, if we assume that an Enterovirus causes ME/CFS (and Gulf War Illness) and I had to take a wild guess which one, I would pick Echovirus 30 and Echovirus 11.

Data from: Enterovirus Surveillance --- United States, 1970--2005 (cdc.gov)

You can see one wave/peak in the early 1980ties ("Osler's Web"), and one more after 1990 (Gulf War). Two different viruses could explain two different illness presentations (e.g. with/without POTS).

But this is just a wild guess...