Are Singh and Bateman Afraid of Proof of Principle Studies? Why?

“Our findings do not support an association between CFS and MLV-related viruses including XMRV and off-label use of antiretrovirals for the treatment of CFS does not seem justified at present.^”

^{-Dr. Ila Singh et al}

^{http://jvi.asm.org/cgi/content/abstract/JVI.00693-11v1}

^{After yet another study purporting to look for HGRVs such as MLVs and XMRV in ME/CFS patients but not following the exacting protocols of the original Lombardi et al study published in Science in 2009, nor those of the Alter/Lo study, the scientific conclusions of this study were predictable. The question still unanswered: When will researchers actually replicate the original study they seek to refute? And how can they, in scientific honesty and in good conscience, keep claiming to refute the study they refuse to actually replicate?}

^{And why add the editorial and unscientific comment attempting to discourage proof of principle studies? Is it about your patent applications, Dr. Singh?  From April 7, 2011 publication of her patent application:}

Title:

COMPOSITIONS AND METHODS FOR TREATING MLV-INFECTION, AND PREVENTING AND TREATING MLV-INITIATED DISEASES

Abstract:

Compositions and methods for inhibiting infection by XMRV or other MLV are disclosed. Also disclosed are methods for treating cancers resulting from infection by XMRV or other MLV, and for preventing such cancers. The anti- XMRV/anti-MLV compounds are predominantly integrase inhibitors, such as globoidnan A, L-000870812, S/GSK1349572, S/GSK1265744, Raltegravir and Elvitegravir, and also reverse transcriptase inhibitors AZT, tenofovir, and tenofovir DF. The compounds are also useful for treating chronic fatigue syndrome or other diseases with neuroimmune symptoms resulting from an infection by XMRV or other MLV. The compositions can also include other therapeutic agents known for treating prostate cancer, breast cancer, lymphomas, and leukemias, such as anti-androgenic agents, radioisotopes, and conventional anti-cancer compounds.

^{What Is “Proof of Principle”?}

^{See my earlier post: http://biomedicalmecfs.blogspot.com/2011/01/xmrv-proof-of-principle-studies.html}

^{In short, proof of principle studies, in the case of ME/CFS, would treat a cohort of patients who have been diagnosed with the illness by competent physicians and, preferably, who have tested positive for XMRV and/or other MLVs/HGRVs, with antiretrviral drug “cocktails”, perhaps in combination with other antiviral drugs to treat some of the co-infections such as those found by Dr. Montoya at Stanford. Another possible combination might include Ampligen.}

^{Dr. Singh herself has already found that at least 3 of the ARVs considered safe enough for HIV/AIDS patients, are effective against XMRV in the lab. Is she afraid that ME/CFS patients will use this information to justify trying to save their own lives by trying those drugs? And if they come to harm, that they would blame her? That doesn't seem logical to me, but I'm trying to understand why she would come out against proof of principle trials and I can't think of any scientific reason. It has been obvious since the mid-1980s, from the brain scans of the Incline Village patients, that the disease is associated with a retrovirus and/or virus(es). Not knowing specifically which RV or virus is no excuse for not treating for them.}

^{She and her collaborators seem to have bought, or wish to promote, the establishment stereotype of ME/CFS patients as a bunch of uninformed fanatics, so desperate that they would harm themselves for no reasonable chance of improvement. Surely she is aware that any patient who tries “off-label” use of antiretroviral drugs to treat the retroviruses associated with ME/CFS are not getting these drugs without the support and assistance of their own physicians. Why accentuate the “risks”, which are acceptable for other patients with retrovirus-associated diseases such as AIDS, without acknowledging the potential benefits? The risks are well known and physicians are doing the tests and surveillance required, so they don't need to be cautioned by researchers. The cautions appended to this study create a murky atmosphere and lead to suspicions of ulterior motives by this group of researchers. At best, it only serves to support the CDC's mantra, there are no tests for ME/CFS, there are no treatments for ME/CFS. Chant three times for maximum inculcation.}

“...off-label use of antiretrovirals for the treatment of CFS does not seem justified at present.^”

^{-Dr. Ila Singh et al}

^Justified?

^{What a curious assessment and what an arrogant, giant leap of logic!}

^{Why should Dr. Singh, the Drs. Light and Bateman make this judgment for others who are equally, or better informed than they are on the subject?}

^{Does anyone actually think that Dr. Snyderman and Dr. Deckoff-Jones should have just accepted their “fate” while waiting for researchers to do the “science” in their own sweet time? See their takes on the subject on her blog: http://treatingxmrv.blogspot.com/}

^{Each of these physicians with personal knowledge of the disease, the research and the potential treatments and side effects came to the conclusion that intervention was and is “justified”. Each has experienced substantial improvement in quality of life. It may even be that Dr. Snyderman has saved his own life, or at least prolonged his survival.}

^{As a cancer researcher, Dr. Singh ought to be more cognizant than she appears to be of the association of all known retroviruses with immune dysfunction and rare cancers, which turn out to be not so rare in ME/CFS patients. This is just one of many similarities that ME/CFS shares with HIV/AIDS. Surely Dr. Singh is not so young or so uninformed that she does not know that early drug interventions were trialed in AIDS before all researchers were convinced that HIV was the cause.}

^{To tell ME/CFS patients like Dr. Snyderman and Deckoff-Jones, and all the rest of us, that we should keep experiencing disease progression, the deterioration in quality of life, the impoverishment, degradation and premature death that comes with having a debilitating illness that has not been dealt with in a scientific, ethical or pragmatic manner for so many decades is incomprehensible to me. It seems like an underhanded swipe at the translational medicine and research of those scientists and physicians at WPI and the University of Nevada, who are collaborating to save lives right now, not in some distant future when “consensus” has arrived.}

<sup>I have to wonder if she would have said the same thing to my mother when she was pressured by her doctor to trial tamoxifen, an unproven cancer drug that patients had to pay for themselves since it was deemed “experimental”. Why is it OK for AIDS patients and cancer patients to try “experimental” or “off-label” drugs when the alternatives can only offer an earlier death or further disease progression?

Why is Singh's co-author, Dr. Bateman, getting involved in the pay-for-treatment study of Ampligen which could be described, in part, as an antiretroviral drug? Who but ME/CFS patients will participate in this study? Hemispherx has said that those who test postive for XMRV have a higher success rate than those who don't.</sup>

^{The conclusions of this study might as well have been “...treatment of CFS does not seem justified at present.”}

^{The only “advancement” of science this study provided: more proof that no one will find the retroviruses WPI found unless and until they actually REPLICATE the study. Just going through the motions without actually REPLICATING the original study does nothing but waste money and, more importantly for me, time.}

^{The ethical, moral and scientific questions I pose to Dr. Singh and her collaborators are these: Why didn't you replicate the WPI study? Why do you engage in this double standard of attitude and treatment of ME/CFS patients vs. those with other diseases?}

Alter, Lo and Gill Live Webcast, February 22, 3pm CST: CFS: Is There a Virus?

Demystifying Medicine - Chronic Fatigue Syndrome: Is there a virus?

The NIH is airing a live webcast and the event can be viewed live at: http://videocast.nih.gov/

Air date:           Tuesday, February 22, 2011, 4:00:00 PM EST

Description:     This event will include the presentation of patients, pathology, diagnosis and therapy context of major disease problems and current research. The course is designed to help bridge the gap between advances in biology and their application to major human diseases. Each session includes clinical and basic science components presented by NIH staff and invitees. These seminar series are primarily directed toward PhD students, clinicians and program managers. All students, fellows and staff are welcome, as well.

For more information, visit http://www1.od.nih.gov/oir/DemystifyingMed

Author:            Shyh-Ching Lo (FDA), Fred Gill (NIDDK) and Harvey Alter (NIDDK)
Runtime:         120 minutes

***********************

Maybe this time we can get the straight talk without the interference and insinuations of smoke screeners and denialists like Dr. Stoye and others of his ilk we suffered at the Blood Products production.

Still no new info on this as of 2/15/2011.

Here's the NIH profile of Dr. Gill:

Biosketch
After receiving his medical degree from Northwestern University Medical School, Dr. Gill trained in internal medicine as an intern and resident at New York University-Bellevue Hospital followed by research training as a research associate of the National Institute of Allergy and Infectious Diseases (NIAID). He completed his clinical training as a medical resident and infectious disease fellow at Cornell-New York Hospital. Dr. Gill is an elected fellow of the American College of Physicians and the Infectious Diseases Society of America.
 

After many years of private practice in Bethesda, Maryland, Dr. Gill initiated the Internal Medicine Consultation Service for the Clinical Center in 1998. His practice in the Bethesda community combined primary care in internal medicine and consultation in infectious diseases. He served as chief of the Division of Infectious Diseases, Rheumatology and Allergy and chair of the Infection Control Committee at Suburban Hospital and as attending physician on the Consultant Service of NIAID’s Laboratory of Clinical Investigation. During this time, he participated as a co-investigator on research projects in the NIAID, the CC Clinical Pathology Department (now the Department of Laboratory Medicine), and the National Cancer Institute.

Dr. Gill led the development of the AIDS clinic for the Montgomery County Health Department and has chaired the AIDS Committee of the Medical and Chirugical Faculty of Maryland. He has served on many committees, including the Maryland Governor’s Advisory Council on AIDS, NIAID’s Advisory Council for Lyme Disease and Suburban Hospital’s Board of Trustees.

At NIH, besides heading the internal medicine consult service, Dr. Gill is chair of the CC Ethics Committee, principal coordinator for clinical education for the NIH Clinical Research Training Program, and an attending physician for NIAID’s Infectious Disease Consultation Clinic. He is a co-investigator on protocols of the National Human Genome Research Institute, National Eye Institute and NIAID. and served as the medical monitor for a National Human Genome Research Institute study. He is a member of data and safety monitoring boards for other institutes and of several CC and NIH committees.

And Dr Alter:

Biosketch
Dr. Harvey Alter earned his medical degree at the University of Rochester Medical School, and trained in internal medicine at Strong Memorial Hospital and at the University Hospitals of Seattle. In 1961, he came to the National Institutes of Health as a clinical associate. He then spent several years with Georgetown University, returning to NIH in 1969 to join the Clinical Center's Department of Transfusion Medicine as a senior investigator becoming Chief of the Clinical Studies and Associate Director of Research in the Department of Transfusion Medicine at the NIH Clinical Center.

Dr. Alter is also a clinical professor at Georgetown University.

Dr. Alter co-discovered the Australia antigen, a key to detecting hepatitis B virus. Later, Dr. Alter spearheaded a project at the Clinical Center that created a storehouse of blood samples used to uncover the causes and reduce the risk of transfusion-associated hepatitis. He was principal investigator on studies that identified non-A, non-B hepatitis, now called hepatitis C. His work was instrumental in providing the scientific basis for instituting blood donor screening programs that have decreased the incidence of transfusion-transmitted hepatitis to near zero.


In 2000, Dr. Alter was awarded the prestigious Clinical Lasker Award and in 2002, he became the first Clinical Center scientist elected to the National Academy of Sciences (NAS) and in that same year was elected to the Institute of Medicine. Only a small number of scientists nationally are elected to both these scientific societies.

XMRV Proof of Principle Studies = Clinical Trials Now

Are ME/CFS patients first and foremost lab animals or patients?

Apparently, it depends on your point of view.

With the news that XMRV, a newly discovered retrovirus may contribute to or be the cause of chronic fatigue syndrome, or myalgic encephalomyelitis, as it is called by the World Health Organization, some patients, doctors and researchers called for clinical trials of the drugs already developed for HIV/AIDS.

Courgnaud et al, Department of Medicine, University of Alberta, Edmonton, AB, Canada wrote, in a commentary on the Alter/Lo paper in PNAS:

"As we currently lack postulates to prove a causal association with a prevalent agent and a chronic disease with genetic predisposition, it would also be appropriate to conduct interventional studies. Indeed, the Helicobacter pylori hypothesis of peptic ulcer disease was only accepted after Barry Marshall showed that bacterial eradication with antibiotics cured peptic ulcer disease (21). Studies to gain proof of principle have been performed with antivirals in other chronic, idiopathic diseases linked to retroviral infection, such as primary biliary cirrhosis associated with mouse mammary tumor virus, another possible murine zoonosis (22). Trials using a combination of reverse transcriptase inhibitors led to significant improvements in clinical, histological, and biochemical outcomes in these patients, albeit with some evidence of viral resistance to therapy (23). Such studies are now feasible for CFS, because reverse-transcriptase inhibitors, such as
tenofovir and emtracitabine, and the integrase inhibitor raltegravir can inhibit XMRV (24). The caveats for conducting clinical trials in patients with CFS and MLV infection are that the potential benefits of treatment should outweigh the risks; also, studies should be conducted as randomized controlled trials with meaningful and feasible endpoints using robust therapies. At this juncture, studies to establish proof of principle are justified to determine whether safe antiviral regimens can impact on CFS and to determine whether xenotropic or polytropic MLV is causally associated with this debilitating disease."

On the other side of the argument Mary Kearney and Frank Maldarelli, HIV Drug Resistance Program, National Cancer Institute, National Institutes of Health, Bethesda, Maryland declared that :

“Such pressures are not justification for testing of therapies in an uncontrolled manner. Indeed, because they are of no help whatsoever to other patients, physicians, pharmaceutical companies, or regulatory agencies, such uncontrolled therapy works directly against the goal of providing effective therapy to the million or more individuals experiencing these serious conditions.”

OK, so some researchers, pharmaceutical companies and regulatory agencies have decided to wait and see. To them , the one million or more people who have CFS are to be the source of lab samples to be tested. Some researchers have predicted it will be at least ten years before treatment could become available. Others are still contesting whether XMRV is the cause of disease, or whether it is even a human pathogen.

In the meantime, physicians who have been trying to help CFS patients for decades look at this research and ask themselves and their patients, what have we got to lose?

Dr. Ila Singh has already found that three drugs developed for HIV/AIDS treatment are also effective in the lab against XMRV and the related MLVs that further research has found in CFS patients.

Physicians have been prescribing drugs “off label”, or for conditions the drug wasn’t developed or approved for, since forever.

When selecting a drug to prescribe for any ailment the physician never knows whether it will work for her/his patient until the patient tries it.

It wouldn’t be the first time a disease was proven to exist by its response to treatment. Barry Marshall, PhD, proved peptic ulcers were caused by bacteria, not stress, by infecting himself with that bacteria and then curing himself with antibiotics. He got a Nobel Prize in Medicine for it.

Physicians are ethically obligated to do the best they can for the individual before them. They tend to see patients as people who need treatment rather than potential contributors of lab samples. If they and the patient, after assessing the risks of the treatment and the risks of doing nothing, decide to try antiretroviral drugs, there is nothing unethical or zealous about it. They can do the same monitoring for these patients that they would do if the patient were HIV positive instead of XMRV positive. They can discontinue therapy if there are warning signals indicating they should.

A physician’s first responsibility is to the patient, not to research, regulatory agencies or pharmaceutical companies. To withhold reasonable treatment in an attempt to advance science would be unethical.

Haven't both medicine and research progressed past the "Tuskegee Mentality"?

From 1932 to 1972, when public outcry stopped the program, patients infected with syphilis were "observed" but not treated by the US Public Health Service in Tuskegee AL. At some point the CDC was created and took over the study.

From the CDC's account of the experiment:

[1969 CDC reaffirms need for study and gains local medical societies' support (AMA and NMA chapters officially support continuation of study).


1972 First news articles condemn studies.


1972 Study ends.


1973 Congress holds hearings and a class-action lawsuit is filed on behalf of the study participants.


1974 A $10 million out-of-court settlement is reached and the U.S. government promised to give lifetime medical benefits and burial services to all living participants. The Tuskegee Health Benefit Program (THBP) was established to provide these services.]

In 1947 penicillin was found to effectively treat syphilis, but it was not offered to the men in the study. Reminiscent of Nazi medical experiments, it was decided to observe the men until they died, do autopsies on them and pay for their burial.

From 1946-48 the US did the same thing in Guatemala except that it purposefully infected prisoners and mental patients with syphilis.

It bears repeating: A physician’s first responsibility is to the patient, not to research, regulatory agencies or pharmaceutical companies. To withhold reasonable treatment in an attempt to advance science, however misguided that attempt might be or however highly approved it might be by other researchers, would be unethical.

Prisoners and mental patients may lose their civil rights but they never lose their human rights, even as those rights are being abused. Persons with ME/CFS have long had their human rights abused and arguably, their civil rights as well. But more about that in another post.