Method Issues Epidemiological Studies of Medically Unexplained Symptom-based Conditions in Veterans

[Ecoclimber]

Method Issues in Epidemiological Studies of Medically Unexplained Symptom-based Conditions in Veterans
Authors
Coughlin SS, McNeil RB, Provenzale DT, Dursa EK, Thomas CM.
Journal
J Mil Veterans Health. 2013 May 1;21(2):4-10.

Affiliation
Abstract
Symptom-based conditions such as chronic fatigue syndrome (CFS) and medically unexplained multi-symptom illness (MSI) are fairly common in the general population and are also important veteran's health concerns due to their higher frequency among U.S. veterans who served during the 1990-1991 Gulf War. CFS, MSI, and other symptom-based conditions are often associated with considerable morbidity due to fatigue, chronic pain, neurologic symptoms, and other symptoms that can impair the quality of life.

This article discusses several important issues of methodology that arise in population studies of CFS and MSI. These include the exclusion criteria that have been used in population studies to define CFS-like illness and unexplained MSI, the potential for false positive and false negative assessments of illness status, the potential for sex differences, and the poorly understood natural history of these symptom-based conditions across the life span.

As an empirical example of these methodology issues, we examined existing data from a 2005 follow-up survey. We found that 64.9% (762 of 1,175) of female Gulf War veterans and 53.4% (2,530 of 4,739) of male Gulf War veterans had 1 or more exclusionary medical conditions. The prevalence among veterans with one or more exclusionary medical conditions increased markedly by age among females and those with a low income....

....Nonetheless, these data provide a quantitative assessment of how definitions and exclusion criteria for symptom-based conditions can potentially introduce statistical bias, especially in an ageing population. Continued discussion and empirical analyses are likely to contribute to new or updated consensus definitions of symptom-based conditions that are suitable for longitudinal epidemiologic research.

Key Words: chronic fatigue syndrome; medically explained multi-symptom illness; epidemiologic methods; menopause; Gulf War; survey; veterans

If you can 'mangle' your way through this to try to understand what they are saying, their findings have a potential impact on the ME/CFS community in reference to the recent ME/CFS IOM contract. It is already posted on the Government's Veteran Affairs site @http://www.research.va.gov/resdev/resources/pubs/docs/gwi-brochure.pdf.

 

[John H Wolfe]

Unless I've got the wrong end of the stick, a quick scan down the article suggests that they are seeking to exclude diagnoses on the basis that patients have other medical conditions

I don't think these people understand the pathology/probable pathophysiology of these conditions if they are content to consider half of the conditions referenced as exclusionary. Someone needs to introduce them to some pretty basic concepts in biology e.g. epiphenomena, complication and co-morbidity

Heaven knows why such people try to sit on, diminish, or explain away Gulf War Syndrome; it's pretty bloody obvious that it is a big, real, neurological problem! The vets/their families who have suffered with it, and with the barriers imposed upon their progress through such attitudes/ignorance, have my sympathy/empathy

 

[anciendaze]

One methodological problem I see is that many or most exclusionary conditions also seem to be of unknown etiology. This means these researchers were able to find some difference between patients which had no explanation in terms of either the illness under study or the exclusionary condition mentioned. This allows them to exclude most patients on which original results were based.

There is no limit to this process short of treating each individual patient as a separate case, sui generis. This does not seem to be useful, except in creating a muddle which impedes research.

If you focus on common features, and listen to patients, you might suspect a defect in energy metabolism, for which MRS using the 31P resonance provides an objective marker. Since the Gulf War took place some time ago, and reported symptoms have centered on a peculiar type of fatigue from an early date, one has to wonder just how long it would have taken researchers to reach this point while following methodology of which these authors approve.