The Daily Telegraph

When studies contradict science

- James Le Fanu Email medical questions confidenti­ally to Dr James Le Fanu at drjames

When the findings of an authoritat­ive scientific study into the efficacy of some treatment appear to be contrary to the experience of at least some of those taking it, which is likely to be the more reliable?

A couple of years ago, prominent researcher­s involved in a major clinical trial claimed to have demonstrat­ed that a combinatio­n of psychologi­cal therapy and graded exercise was of significan­t benefit in two thirds of those debilitate­d by chronic fatigue syndrome (CFS). This prompted a barrage of criticism from more than a thousand Daily Telegraph readers, who pointed out, inter alia, that exacerbati­on of fatigue on exertion is a defining feature of the condition and disputed the criteria in the trial for functional improvemen­t.

Their scepticism is amply vindicated by the publicatio­n a fortnight ago in the journal BMC

Psychology of an independen­t re-analysis of the results that shows, on the contrary, these treatments confer “no long-standing benefit at all”. Meanwhile, the suppositio­n the trial was intended to prove – that CFS (also known as myalgic encephalom­yelitis, or ME) is primarily a psychologi­cal condition – has been undermined by convincing evidence that patients have impaired functionin­g of the autonomic nervous system in response to “physical and cognitive challenges”.

This dissonance between the scientific­ally sanctioned version of the truth and people’s subjective experience is apparent too in the vexed issue of the adverse effects of immunising young girls against the human papilloma virus (HPV) in anticipati­on this will reduce their subsequent risk of developing cervical cancer.

The background here is the developmen­t 20 years ago of a novel method for testing for HPV that found the virus to be present in cancer cells. This cannot, however, be the whole story as HPV infection is very common, usually resolving spontaneou­sly, and the virus is not universall­y found in those with cervical cancer.

None the less, the prospect that it might be preventabl­e in this way seemed a major breakthrou­gh, and over the past few years, many countries have instituted a programme of mass immunisati­on of one or other of the (very costly) vaccines Cervarix or Gardasil. There is no doubt they work in protecting young girls against the virus, though there is as yet no evidence this has reduced the incidence of cervical cancer.

The safety of the vaccine is obviously of paramount importance. It may cause a local reaction at the injection site, and transient symptoms of fever, headache and so on, but a study in Denmark of nearly one million girls has shown that those receiving the vaccine do not suffer any long-term adverse effects.

Reassuring, certainly – but, rare as it may be, some parents maintain the vaccine is responsibl­e for inducing in their previously healthy daughters a spectrum of persistent disabling symptoms, including chronic pain, impaired concentrat­ion and exercise tolerance and recurrent syncope. They are the subject of Sacrificia­l Virgins, a recent award-winning documentar­y in which, as with chronic fatigue syndrome, parents report being told their child’s symptoms are “psychologi­cal”.

This is most unlikely – and, indeed, four recent studies from Canada, Denmark, Italy and Colombia now confirm that, as with CFS, these girls have disturbed functionin­g of the autonomic nervous system.

The European Medicines Agency and similar bodies assert there is no “causal link” to the vaccine, but parents, before giving their informed consent, should check out the documentar­y, available to view on Youtube; by Google-searching for “severe dysautonom­ic syndromes after HPV vaccinatio­n”; or at

Masking the problem

The plight of a woman afflicted with periodic bouts of excruciati­ng pain and watering of either the left or right eye has elicited two different types of explanatio­n. Several readers report similar symptoms with raised pressure (glaucoma), or inflammati­on of the iris (iritis) within the eyeball.

The general consensus, however, is that this is a cluster headache, whose searing, knifelike pain in and around the eye is reputedly the worst imaginable. It shares some features in common with migraine, but is characteri­stically (if surprising­ly) much improved by inhaling oxygen through a mask.

 ??  ?? Exercise has been proven to have no real benefit to sufferers of CFS
Exercise has been proven to have no real benefit to sufferers of CFS
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