Phoenix Rising - Cort Johnson's Column
...Presenting complex chronic fatigue syndrome (ME/CFS) research in a way we can all understand.
Tuesday, May 25th, 2010:
Learning CFS: Dr. Lerner on his Longterm Antiviral Treatment Study
by Cort Johnson
Background: Dr. Lerner had quite a career before CFS. A check of his research record revealed over five decades of infectious disease work focusing on Coxsackie virus, herpes simplex virus, pseudomonas, interferon, Staphylococcus, Mycoplasma, enteroviruses, myocarditis, etc. A contributing author to one of the seminal works in the medical field - Harrisons Principals of Internal Medicine - hes published over 150 papers over the past fifty years.
In 1986 he began having troubles with dizziness and severe fatigue. A visit to the Cleveland Clinic found his heart was found to be grossly dilated. 10 years later hed figured out how to treat himself recovered.In the meantime he did a 180 degree career turn and plunged, largely working alone, into wilderness of ME/CFS research. His first post-CFS paper in 1989 A new continuing fatigue syndrome following mild viral illness proposed that mild heart abnormalities involving T-waves in a group of post viral patients would be amplified greatly upon exercise and recommended that these patients not exercise vigorously. A 1993 paper cinched the T-wave problem and documented what he called a subtle cardiac dysfunction that showed up response to normal everyday tasks. In a 1997 paper he proclaimed that CFS is a persistent nonpermissive herpes virus infection of the heart.A small 2001 study finding that antiviral therapy was indeed effective in CFS provided still more evidence for his theory.
In 2002 he documented a finding that would lay the foundation for his subsequent work - the presence of early gene products (for cytomegalovirus) in a subset of patients with CFS. 2002 would bring another successful small antiviral trial - this time using valacyclovir for 6 months in patients with Epstein-Barr virus infection. In 2004 he again documented the presence of early gene products in ME/CFS; this time to Epstein-Barr virus.He cemented his non-permissive infection hypothesis later that year when he demonstrated that abnormal heart wall motion and other problems were associated with incomplete replication of both viruses in CFS.
A 36 month followup of his patients in 2007 indicated further progress on all fronts; the heart problems continued to decline, antibody levels felland he reported that many patients resumed normal activities. A 2008 paper validated the effectiveness of his Energy Point Index Score in measuring fatigue in ME/CFS.
Now Dr. Lerner has published his largest and most comprehensive study to date. While Dr. Lerner is an acknowledged pioneer in the antiviral field on CFS his theorys have yet to gain acceptance outside of the immediate CFS community. Attempts to gets grants - not a problem at all in his pre-CFS career - have failed.. Will this paper finally translate into federal dollars for funding antiviral trials?Will it result in increased funding in this area? Only time will tell.
Did he regret turning his back on such a fertile career and journeying into the desert of CFS research? With no funding publications came much less frequently post-CFS but Dr Lerner had no regrets at all saying the work has been so fascinating that I just couldnt stop.He is clearly very excited about the possibilities present in the field.
The Study : Dr. Lerners study presents a culmination of his work with patients over the last ten years. This is not your typical 25 or 50 patient treatment trial. Virtually everyone he saw in his clinic over the past 10 years is in it. The study involved examining patient records every three months for the past 10 years - thats ten years of replicated data. Ultimately it involved 7,000 patient visits that generated 35,000 fields of data.
While this is not the placebo controlled, double blinded treatment trial the research community loves its clearly dense with replicated data.
Findings: the paper presents some startling findings.
- Long term antiviral therapy was effective - very effective - in many of his patients. Many of them, while not completely cured, are able to work and lead normal lives again - an astounding finding in this field. Some are completely cured.
- About 25% did not respond- a finding that may be related to the limited duration of their treatment.
- While Dr. Lerners protocol can and often does work for longer duration patients - duration of illness does make a difference in treatment response
- About 30% of his patients had, in addition to herpesvirus infection, another related infections such as Lyme disease, Babesia or Streptococcyus. The fact that these patients improved but not to the extent of herpesvirus only patients has profound implications for how to treat both ME/CFS and Lyme disease and other infected patients.
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