Solving the Puzzle of Chronic Fatigue Syndrome

Solving the Puzzle of Chronic Fatigue Syndrome


by Michael Rosenbaum, M.D. &
Murray Susser, M.D.,

Published by Life Sciences Press

P.O. Box 1174, Tacoma, WA 98401,

1991, 171 pages

Perhaps 3 million Americans are afflicted with chronic fatigue syndrome - yet a specific etiology has not been found. The syndrome has been as nebulous as its cause. Is it merely a variant of neurasthenia as described by Beard well over a century ago, or is it caused by a pathogen? Is it primarily a physical or a psychiatric disorder?

Solving the Puzzle of Chronic Fatigue Syndrome does not propose a simple solution to the puzzle. The book is the result of a collaboration between two senior clinicians, both respected physicians with many years of experience in dealing with real patients complaining of chronic fatigue. While they share with the reader their scientific knowledge gleaned from carefully studying the literature, it is their clinical perspective which makes the book a delight to read. Their clinical perspective stops them from traveling too far down blind alleys - the seductive (and increasingly dubious) Epstein-Barr hypothesis, for example. They have seen too many patients respond, often dramatically, to treatments aimed at different etiologies, to accept, at present, any specific etiology doctrine.

The lack of evidence for a specific etiology for the syndrome does not mean, however, that etiologies cannot be identified. Rosenbaum and Susser propose that chronic fatigue syndrome is primarily a manifestation of immune dysregulation. This dysregulation, in turn, is commonly caused by what the authors call a "mixed infection syndrome" in which viruses, bacteria, fungi and protozoa may participate. Many other factors may contribute. These include endocrine dysfunctions, depression, food and chemical sensitivities and heavy metal toxicities.

Rosenbaum and Susser describe testing procedures which can often discover evidence of one or more contributory factors. If, say, a pathogen or an endocrine dysfunction is identified, treatment can include specific measures to correct that factor. In all cases, however, the authors suggest a broad-based approach to treatment.

Some will argue that much of the treatment protocol suggested by the authors consists of unproven treatments. However, physicians like Rosenbaum and Susser who are dedicated to the Hippocratean model would not leave a patient to suffer when reasonably safe and apparently effective treatments are available simply because these treatment have yet to be proven under carefully controlled conditions. They believe that physicians are obligated to heal today's patients today; they would consider it unethical to avoid using such apparently successful treatments until investigators prove how and why they work.

The good news is that Doctors Rosenbaum and Susser find chronic fatigue syndrome to be a treatable illness. They report that their patients improve and may even recover. (The scientist part of me wishes that they had presented some hard data to support this claim.) Ultimately, this is a "how-to-treat" book in which the authors show you, step-by-step, how they evaluate and treat their patients who present with chronic fatigue syndrome. They invite you to try their approach to see for yourself how your patients will respond to their protocol.

The authors conclude the book with an excellent series of flow charts summarizing their recommendations for approaching the diagnosis and treatment of chronic fatigue syndrome. These are a special delight for the reader, as they provide a "nuts and bolts" guide for proceeding to deal with this puzzling illness.

Michael Rosenbaum and Murray Susser may not have solved the puzzle, but they have resolved much of the mystery. Anyone concerned about chronic fatigue syndrome will find this highly readable book indispensable.

Townsend Letter for Doctors & Patients.


By Melvyn R. Werbach

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