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Boudewijn Van Houdenhove
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=== By researchers === ====Too much stress? ==== Boudewijn Van Houdenhove's approach to ME/CFS has been questioned by researchers and patient advocates. A recurring criticism is that his emphasis on stress in the etiopathogenesis of ME/CFS is not supported by sufficient evidence. Harvard professor and renowned ME/CFS expert [[Anthony Komaroff]] for example commented: <blockquote> "Van Houdenhove and colleagues would have to concede, however, that many patients with chronic fatigue syndrome do not report unusual stressors in the months before the onset of their illness and do not have evidence of hypothalamic dysfunction. Available data do not support the hypothesis that stress leading to hypothalamic dysfunction explains all cases of chronic fatigue syndrome. It must be more complicated than that."<ref>Komaroff AL. [[pubmed:11126311|The biology of chronic fatigue syndrome]]. Am J Med. 2000 Feb;108(2):169-71.</ref> </blockquote> Neurologist [[Benjamin Natelson]] essentially made the same remark: <blockquote>"While we also occasionally find patients whose history of fatigue precedes their getting a flu-like illness from which they are unable to recover, our own careful approach certainly does find appreciable numbers of patients who were perfectly well until succumbing to a sudden flu-like illness."<ref name=":0">Natelson B. [https://muse.jhu.edu/article/46036 Reply to Dr. Van Houdenhove.] Hum Biol. 2003 Jun;75(3): 413.</ref></blockquote> Others pointed out that even if stress is a factor in the development of ME/CFS, this doesn’t necessary mean much, since stress plays a role in almost every disease. As the De Meirleir & De Becker wrote: <blockquote>"It is clear that stress can influence the course of disease adversely as in cancer for example but do we treat stress instead of the biological correlates in cancer patients?"<ref>Van Houdenhove B, Vanthuyne S, Neerinckx E. [[pubmed:11023437|Chronic fatigue syndrome.]] Am J Med. 2000 Aug 15;109(3):257-9.</ref></blockquote> ==== Not a sound scientific method ==== Another criticism states that Van Houdenhove uses antidotal evidence rather than research, e.g., using 'the story of the patient' and case examples to put forward his own preconceptions about the illness. As Natelson wrote: <blockquote>"While we as clinicians depend heavily on narration to inform us about the patient and the patient’s illness story, we believe that the evidence-based approach is the only way the medical field can solve the problem of illness cause."<ref name=":0" /></blockquote> [[Frank Twisk|Twisk]] & [[Michael Maes|Maes]] wrote about Van Houdenhove and colleagues: <blockquote>"[…] the authors neglect the fact that there is a considerable gap between their philosophical point of view which they erroneously call evidence-based and numerous scientific papers which show that ME/CFS is a medical disorder with a biological pathophysiology."<ref>Maes M, Twisk FN. Treatment of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), a multisystem disease, should target the pathophysiological aberrations (inflammatory and oxidative and nitrosative stress pathways), not the psychosocial "barriers" for a new equilibrium. Patient Educ Couns. 2010 Jul;80(1):148-9; author reply 147. [[doi:]][https://linkinghub.elsevier.com/retrieve/pii/S0738399110000510 10.1016/j.pec.2010.02.017.] [[PubMed Identifier|PMID]] [[pubmed:20303231|20303231]]</ref> </blockquote> ==== Recall and selection bias ==== Natelson also questioned the means by which Van Houdenhove and colleagues profile ME/CFS patients as being perfectionistic, action prone or [[trauma |abused during childhood years]]: <blockquote>"Self-reported data are open to substantial recall bias. For example, a number of studies have linked abuse in childhood as reported to have occurred by adults with fibromyalgia( e.g. Walker et al. 1997). However Raphael et al.(2000) have recently shown that rates of widespread pain do not differ in people with documented abuse in childhood compared to nonabused samples."<ref name=":0" /> </blockquote> [[Gijs Bleijenberg]] made the argument that Van Houdenhove' method suffers from selection bias: because he is known as a doctor who treats ME/CFS from a psychiatric point of view, he might see more patients with more comorbid psychological problems than are present in the general population. Bleijenberg wrote (Translated from Dutch): <blockquote>"The percentage of patients with psychopathological problems underlying or related to CFS complaints reported by them – 75% -, is very different from the percentages mentioned in the literature. […] We know from presentations at conferences that other CFS patients end up in the group of Van Houdenhove et al. than for example, in Nijmegen. The average scores in research with questionnaires for psychological or psychopathological problems are considerably higher in his group; they are comparable to scores of psychiatric patients. The scores in our group are comparable to those of other patients who visit the hospital because of physical complaints. If the patients of Van Houdenhove et al. were to be compared to a control group with equal scores for psychological or psychopathological problems, it would almost certainly be concluded that the presence of traumatic childhood experiences is not characteristic for patients with CFS."<ref name=":22">Bleijenberg G and Van der Meer J.W.M. (1997) [https://www.ntvg.nl/artikelen/moe-met-drie%C3%ABntwintig-oes/ingezonden-mededelingen Onderschrift.]</ref></blockquote> Bleijenberg also criticizes Van Houdenhove for using [[antidepressant]]s in the treatment of ME/CFS, as this is not evidence based.<ref name=":22" />
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