Monthly Archives: June 2010

CFS and “the god of the gaps”

Chronic fatigue syndrome is a “god of the gaps” disease. Although the phrase has its origins in, obviously, religion, it works perfectly well for illnesses and conditions about which medical science knows only so much. And filling in those gaps we have quacks, scammers, controversial physicians, and other pseudoscientists trying to make a buck off what we don’t know. Some may genuinely believe that they have the answer; others are just banking on the sick and the exhausted to pony up in hopes of feeling better.

I’ve been asked a few times recently how patients are supposed to figure out who is trying to help them, and who is trying to scam them. And then, like a gift, I got a comment on my post about CFS awareness. I read it carefully, and then decided it was more suited as a way to answer that question than as an advertisement on that particular post. Here is the comment in its entirety. The only thing I have changed is that I removed the hyperlink to the site at the end, as I do not wish that site to get any referral traffic from mine. (The commenter’s personal link was the same URL.)

Great post. I have found that a lot of doctors don’t really believe in CFS and they seem to think I was making it up, but the book “Beat Sugar Addiction Now!” is written by a doctor and he knows so much about it. I feel like I learned a lot about my own body just by reading the section on CFS, and it made me annoyed that no one had told me this before. I started reading the book because I thought it was a diet book and would maybe help me lose weight, and if I wasn’t carrying around so much weight maybe I would feel better overall and be less achy. But it’s actually a whole part on CFS is in it and I learned a lot about my hypothalamus that I never knew before. The information is good and smart science but not too hard to understand. You need to find help if you have what I have-so much pain it hurts to pull my shirt over my head or bend down to tie my shoes. I had to start wearing ugly crocs just because they were easier to put on and more comfortable, and that is not who I wanted to be-a fat person in unstylish shoes who has trouble getting in and out of the car. I feel like if I can find a doctor who will help me and I can do what it says in this book, I will get a lot better. It is written very convincingly and you can tell he knows what he’s talking about. Plus he has a list to help you find doctors that treat CFS and I am ready to get treated and stop feeling like my nerves are exposed every time I move. Here’s the website for Dr. Jacob Teitelbaum: http://endfatigue.com/

By the time you get to the end of this, you’ve passed by a bevy of red flags. Let’s check them out.

  • The first two words are the only reference to my post at all.
  • The very next sentence introduces the subject of this advertisement, a book by “a doctor” — that’s intended to impress.
  • The person’s situation is not indicative of CFS. Many scammers either intentionally or out of ignorance conflate chronic fatigue, a symptom of many things, with chronic fatigue syndrome/myalgic encephalopathy, a condition that has specific criteria for a patient to be diagnosed with it. The commenter discusses being overweight and having a lot of intense physical pain — neither of which are signs or symptoms of CFS.
  • The commenter attempts to gain sympathy by weaving in a sob story, but in a 12-sentence comment, only three sentences did not refer to this amazing book.

At this point, I have enough information that I don’t need to waste my limited time and energy checking out the website, nor will I allow this comment to sit on my post about CFS awareness. “But Joey,” you may cry, plaintively if you like, “perhaps this person is not a shill, but merely someone whose life was truly changed by this doctor and his book.” Very well, if we’re going to be skeptics, let’s go check out the source. (Of course the very name of the website is a clue. As I mentioned previously, fatigue and CFS are not the same thing. The former is a symptom of just about everything, and the latter is an illness.)

Are you back? Me too. Let’s dig in.

The first thing I saw was Teitelbaum purporting to diagnose someone from Fox News in two minutes and thirty seconds. The clip itself is called “Diagnosing chronic fatigue,” (not CFS), and he doesn’t even do that. The entire front page is about branding, and that is a major red flag. Research physicians whose work has been vetted by medical science do not need to pimp themselves out with iPhone apps, mailing lists, and cute names like “Dr. T.” Right off the bat it’s clear this is a site with the intention to sell.

Next, I checked out who this fellow is. He appears to be a legitimate M.D., but his affiliations, publications, and speaking engagements do not exactly trumpet the career of a man who is regularly published by respected sources. It’s noted that he’s appeared on Oprah’s and Dr. Oz’s shows, two continuing advertisements for all manner of pseudoscience and bad medicine. In addition, this sentence caught my eye:

Dr. Teitelbaum knows CFS/Fibromyalgia as an insider — he contracted Chronic Fatigue Syndrome when he was in medical school and had to drop out for a year to recover.

One whole year to recover, huh? (Are my fellow patients laughing yet?) And has a miracle cure? If the lumping together of a cure for fatigue, CFS, and fibromyalgia didn’t set off your radar, that certainly should.

Next I checked out the site’s information page about CFS and fibromyalgia. Here, fibro is referred to as a “sister illness” of CFS. Now while this is a common theory — one my own doctor subscribes to as well — a connection has not been definitively identified by medical science, nor is patient management identical between the two. In addition, many of the “other common symptoms” of CFS listed here (such as increased thirst, weight gain, and recurring infections) are not part of either the Fukuda criteria or the Canadian Clinical Case Definition.* The man cannot even define CFS correctly. But here’s the biggest, reddest flag you could possibly want if after all this you’re still not sure if this is worth looking into.

What Causes These Illnesses?
Hypothalamic dysfunction.

That’s it, folks. We can all go home. He has the single answer that hundreds of researchers have not been able to come up with for years, and not only that — it fits all patients with CFS or fibromyalgia. It’s also conveniently vague enough to fit into any actual, valid research that might turn up. And what is a patient’s next course of action? Reading about and eventually buying products and services from “Dr. T.”

There are plenty more howlers on the site, but hopefully I’ve made my case. This guy and his presumed shill are perfect examples of the gods of the gaps who are preying on sick people by claiming to have not only an answer, but the answer. And like all good scam artists, his rap has a grain of truth to it. It is certainly suggested for people with CFS to eat less sugar. Not only that, while you may blow me off as someone primed for suspicion, I’m in fact a believer when it comes to sugar “addiction.” I saw a nutritionist in college who forced me to cut all sugars whatsoever out of my diet, and the improvements to my health and weight, plus how it felt when I fell off the wagon, left me pretty convinced that breaking that addiction is a good thing to do, if you can manage it. (I don’t know if it qualifies as a true medical addiction; I’m using the term casually here.)

And this is why this kind of person is so insidious. He does give good advice, but it’s surrounded by so much bad science and speculation and overreaching claims that he’s rendered totally untrustworthy. My hope is that any CFS patient who has any amount of knowledge about her illness (which is every patient I’ve met!) can see past the peppy nickname and shreds of decent advice, underneath to Teitelbaum’s colossal failure as a source of legitimate information or treatment for CFS or anything else. Except perhaps sugar addiction. If that’s your only problem, then knock yourself out.

I recognize that this is a long discussion of what will appear to some of my readers as a very straightforward and obvious scam to avoid. But if people didn’t buy into it, this guy wouldn’t still be around. My hope is that by examining both the comment and, briefly, the site itself, I might inspire other chronically ill people to look equally carefully at the links and sites and doctors that are recommended to them.

* “Marked weight change” is one of the many symptoms that may be used in the Canadian definition, but not specifically “weight gain.”

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A delicious friend is me!

Although I adore games like Mass Effect and Bioshock, being disabled by chronic illness means I’m not always able to handle, physically or mentally, real-time combat and tasks requiring hand-eye coordination. For those times when my brain wants to play something but my body wants me to curl up and not pick my head up off the pillow, I’ve become a great fan of turn-based games played in a web browser.

One of the best known, and one I’ve written about before, is Kingdom of Loathing (KoL). You are given a base 40 turns a day, which can be increased to hundreds depending on the food, drink, equipment, and other items you use. While there is a daily limit of 200 turns you can store up (in other words, you can’t stop playing for a couple of months and come back to thousands of turns), there is no limit to how much time you can spend playing all the turns you’ve generated. Other games, such as the delightful Paradox! The Musical (not an entirely disinterested plug), Metroplexity, and Game! hew pretty closely to KoL’s model of turn generation.

As much as I enjoy the intricate puzzles and engaging writing of the above titles, they can prove a roadblock to chronically ill gamers who may be especially limited by cognitive dysfunction, or are unable to read a lot or spend too much time on the computer. Echo Bazaar, by Failbetter Games, manages to create a remarkably vivid and intriguing world while keeping gameplay simple, and effectively forcing a casual approach.

Echo Bazaar takes place in Fallen London, which is what became of Victorian London when it was mysteriously carried away, down a mile beneath the surface. Inhabitants are defined by four character traits — Dangerous, Watchful, Persuasive, and Shadowy — and these traits, along with myriad other story-related characteristics (such as Hedonist or Ruthless), contacts (such as Bohemians, Constables, the Church, or Hell), and menaces like Wounds or Nightmares, develop your character as he, she, or it pursues an overarching Ambition. The gameplay is a mixture of card game and RPG, with an ambiance that evokes Lovecraft, steampunk, and other familiar themes while managing to keep Fallen London feeling mysterious and unique, not derivative. While it is text-based like the other games mentioned, the story is meted out in tantalizing tidbits rather than requiring a large investment of time to read.

Players of Echo Bazaar are rewarded for patience, due to its unusual turn-generation model, speaking of tantalizing tidbits; people who are used to the more common methods found in other games can be frustrated here, but it’s one reason I recommend it for chronically ill gamers. You are given 70 actions a day, which cannot be increased. You can “bank” a maximum of 10 actions and as you use them, they refresh at the rate of one every 7 minutes. This does mean that you are losing turns as soon as your candle refills if you aren’t logged in, so the best attitude to take is a very relaxed one. Don’t worry about playing optimally, or not having a chance to play on a given day. You don’t have to compete with anyone (PvP, in the form of the game “Knife and Candle,” is entirely optional) and as yet there is no “end” to the game past 90 to all stats. So it’s perfectly suited for people who want a casual but engrossing experience, who can only log in once or twice a day but will always find their 10 turns awaiting and will proceed slowly, but inevitably.

(One might observe that it is a bit cruel of the folks at Failbetter to invent such a fascinating world in which to get lost…and then to limit one’s time in that world so harshly. If one were to be gauche about it.)

If you’re on Twitter and you don’t play the game, you may consider it either a curiosity or a pain in the ass, depending on how considerate are your friends who play. Echo Bazaar requires you to log in with a Twitter account, but if you want, that can be the limit of your involvement. Players are enticed to tweet at least once a day, since every 24 hours you get the option to refill your actions immediately, giving you 20 to play at once instead of 10. However, this is not required, and you can also edit what you say aside from the link. (Which, as some reviewers have gotten wrong, is not a referral link. I loathe those games.) I usually replace the default text with something tailored for my character, and I also enjoy tweeting out some of the funnier, creepier, and most intriguing bits, so I created a separate account to avoid spamming my main account’s followers.

This brings me to my final point about the game. I’m not much for multiplayer anymore, since even if I do have the energy to game, I may not have the energy to interact with strangers. This is an area where I really enjoy Echo Bazaar‘s design. There are myriad benefits to interacting with fellow players, who are people you follow (mutually or not) on Twitter. However, it all takes place in an appropriately genteel manner, as if through a matchmaker. You send an invitation to something — possibly a “visit” to decrease the menace of your Nightmares — through the game, and the recipient gets an automated DM from the @EchoBazaar account. That person can then accept the invitation, conferring benefits on both of you, or reject it. (Update: Thanks to another player for pointing out that some of the “benefits” received from these interactions aren’t necessarily positive, depending on your goal.) There is no actual chat interface or need to form a group, which cuts down greatly on my own energy costs when playing a game. However, especially if you do create a separate account, you can get involved in conversations with your fellow players, in character or otherwise…and even with the Masters of the Bazaar and other notorious inhabitants of the Neath. The level of personal interaction is completely up to you.

I’m utterly enchanted by Echo Bazaar, and in a way I want more — more actions per day, more hints about…well, everything, and just who is this mysterious Cheesemonger? But the truth is I really enjoy the fact that it can be played with one finger while lying on my side, and that due to the mechanics it’s in my favor not to get obsessed. You’ll find me exploring the dark corners of Fallen London when my body’s put the kibosh on playing anything more taxing. And you can find my character, Ms. Antoinette Divertimenta, on Twitter. I await your visit, delicious friend.

(art © Failbetter Games)

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