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Open Access Research article

A train-the-trainer education and promotion program: chronic fatigue syndrome – a diagnostic and management challenge

Dana J Brimmer, K Kimberly McCleary, Teresa A Lupton, Katherine M Faryna, Kevin Hynes and William C Reeves*

  • * Corresponding author: William C Reeves wcr1@cdc.gov

  • † Equal contributors

BMC Medical Education 2008, 8:49  doi:10.1186/1472-6920-8-49

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The references don't show that CFS "affects at least 4 million adults in the United States"

Tom Kindlon   (2009-01-15 16:56)  Irish ME/CFS Association - for Information, Support & Research email

This is not necessarily a major point to do with the methodology. However given the paper involves CFS medical education, and gives few facts about CFS, one would think that the statements that are made are at least reasonably accurate.

However, this statement clearly isn't: "CFS affects at least 4 million adults in the United States [2-4]."

The references given are the first three references below. The second study found a prevalence of 422 per 100,000 adults and the third study found a prevalence of 235 per 100,000 adults. These aren't even close to 4 million adults - the second one suggests a figure of at least 400,000 adults. This study involved one of the authors (William C Reeves).

The other study[1], also involved Reeves, did find a prevalence of 2540 per 100,000 adults, which would equate to over 4 million adults. As can be seen, this is much higher than previous estimates of the prevalence of CFS in the US. The reason for the huge discrepancy is largely because it used a different method of defining CFS[4].

There has been some criticism of this new definition[5].

Unlike previous times when the CDC produced definitions for CFS[6,7], the definition used in this study is generally only being used by the CDC-funded CFS research team [the cohorts from the Wichita 2-day study in 2003 (not to be confused with the Reyes study) and the Georgia prevalence study[3]]. So it's far from clear that most people would accept that CFS "affects at least 4 million adults in the United States". But certainly two of the three studies given to back up this reference did not find anything close to such a prevalence.

[1] Reeves WC, others: Prevalence of chronic fatigue syndrome in metropolitan, urban, and rural Georgia. Population Health Metrics 2007, 5:5.

[2] Jason LA, Richman JA, Rademaker AW, Jordan KM, Plioplys AV, Taylor RR, McCready W, Huan CF, Plioplys S: A community-based study of chronic fatigue syndrome. Arch Int Med 1999, 159:2129-2137.

[3] Reyes M, Nisenbaum R, Hoaglin DC, Emmons C, Stewart G, Randall B, Stewart JA, Abbey S, Jones JF, Gantz N, Minden S, Reeves WC: Prevalence and incidence of chronic fatigue syndrome in Wichita, Kansas. Arch Intern Med 2003, 163:1530-1536.

[4] Reeves WC, Wagner D, Nisenbaum R, Jones JF, Gurbaxani B, Solomon L, Papanicolaou DA, Unger ER, Vernon SD, Heim C: Chronic Fatigue Syndrome – A clinically empirical approach to its definition and study. BMC Medicine 2005, 3:19 (15 December 2005)

[5] Jason LA, Richman JA: How Science Can Stigmatize: The Case of Chronic Fatigue Syndrome. Journal of Chronic Fatigue Syndrome, Vol. 14(4), 2007

[6] Fukuda, K., Straus, S.E., Hickie, I., Sharpe, M.C., Dobbins, J.G., & Komaroff, A. (1994). The chronic fatigue syndrome: A comprehensive approach to its definition and study. Annals of Internal Medicine, 121 (12):953-959. http://www.annals.org/cgi/content/full/121/12/953

[7] Holmes GP, Kaplan JE, Gantz NM, Komaroff AL, Schonberger LB, Straus SE, et al. Chronic fatigue syndrome: a working case definition. Ann Intern Med. 1988; 108:387-9.

Competing interests

No competing interests

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