David Bell

Dr. David S. Bell - Source: FaceBook

David S. Bell, MD, is a retired American doctor who had a practice in General Medicine and Pediatrics. He was at the center of the 1985 Lyndonville outbreak of the disease in upper New York state in the United States. Dr. Bell serves on the Scientific Advisory Board of the Open Medicine Foundation.

He is one of the authors of the 2011 case definition, International Consensus Criteria.

Notable studies

• 2012, Understanding long-term outcomes of chronic fatigue syndrome.

  Abstract: "In a follow-up study "of the 25 participants diagnosed with CFS 25 years ago, 5 self-reported that they maintained a diagnosis of CFS, while 20 reported no longer having a CFS diagnosis...Those who remitted from CFS showed significantly more impairment on 21 out of 23 outcomes compared with controls,...suggest[ing] that over time many individuals will not maintain a CFS diagnosis but will not return to their premorbid level of functioning."

• 2009, Severe versus Moderate criteria for the new pediatric case definition for ME/CFS. The study analyzed the Canadian Consensus Criteria when applied to pediatric patients and concluded: "Findings indicate that the Pediatric Case Definition for ME/CFS can distinguish between those with this illness and controls, and between those with Severe versus Moderate manifestations of the illness."
• 2006, "A Pediatric Case Definition for Myalgic Encephalomyelitis and Chronic Fatigue Syndrome"

  "Summary: For a diagnosis of chronic fatigue syndrome (CFS), most researchers use criteria that were developed by Fukuda et al. (1994), with modifications suggested by Reeves et al. (2003). However, this case definition was established for adults rather than children. A Canadian Case Definition (ME/CFS; Myalgic Encephalomyelitis/CFS) has recently been developed, with more specific inclusion criteria (Carruthers et al., 2003). Again, the primary aim of this case definition is to diagnose adult CFS. A significant problem in the literature is the lack of both a pediatric definition of ME/CFS and a reliable instrument to assess it. These deficiencies can lead to criterion variance problems resulting in studies labeling children with a wide variety of symptoms as having ME/CFS. Subsequently, comparisons between articles become more difficult, decreasing the possibility of conducting a meta-analysis. This article presents recommendations developed by the International Association of Chronic Fatigue Syndrome Pediatric Case Definition Working group for a ME/CFS pediatric case definition. It is hoped that this pediatric case definition will lead to more appropriate identification of children and adolescents with ME/CFS."

• 2006, Guidelines for the Diagnosis of Pediatric Chronic Fatigue Syndrome: Things Parents Need to Know

  "Abstract - In this volume, chronic fatigue syndrome (CFS) in children and adolescents is specifically addressed. It is a topic long overdue. It is my sincere hope that the criteria presented here will begin a process of rigorous clinical testing and refinement so that pediatricians and other medical providers will come to have a reliable and accepted way of making the diagnosis of ME/CFS in a person under 18 years of age. This short review is meant for parents and other caregivers as a brief summary of the guidelines that may be of value. The primary role of these guidelines is to present a strict and rigorous definition that can be tried and tested. This summary is to make the process of diagnosis somewhat easier for parents and caregivers alike until the testing process is completed. Therefore, for more detailed symptom description and exclusionary illness description, I would refer the reader to the primary article. Professional caregivers and clinicians may make this article available to inform parents with a child/adolescent suffering from CFS."

• 2003, Predictive immunophenotypes: Disease-related profile in chronic fatigue syndrome
• 2001, Thirteen-Year Follow-Up of Children and Adolescents With Chronic Fatigue Syndrome

  Abstract - Objective: To describe the educational, social, and symptomatic outcome of children and adolescents with chronic fatigue syndrome 13 years after illness onset. Methods: Between January 1984 and December 1987, 46 children and adolescents developed an illness suggestive of chronic fatigue syndrome. Follow-up questionnaires were obtained from 35 participants an average of 13 years after illness onset. Data were obtained concerning subsequent medical diagnoses, amount of school missed, presence and severity of current symptoms, and subjective assessment of degree of illness resolution. Results: Of the 35 participants, 24 were female (68.6%) and 11 were male (31.4%). Average age at illness onset was 12.1 years. Eight participants (22.9%) had an acute onset of symptoms, 27 (77.1%) had a gradual onset. No participant received an alternative medical diagnosis that could have explained the symptom complex between illness onset and follow-up. Thirteen participants (37.1%) considered themselves resolved of illness at follow-up; 15 participants (42.9%) considered themselves well but not resolved; 4 (11.4%) considered themselves chronically ill; and 3 (8.6%) considered themselves more ill than during the early years of illness. Correlation with the Medical Outcomes Study Short Form Health Survey was good for current level of symptoms and degree of recovery. Eight participants (22.9%) missed >2 years of school, and 5 of these were still ill at follow-up. Amount of school missed correlated with both illness severity at follow-up and perceived social impact of the illness. Conclusions: These data demonstrate the presence of an illness consistent with the current definition of chronic fatigue syndrome. Eighty percent of children and adolescents affected had a satisfactory outcome from their fatiguing illness, although the majority of these participants had mild to moderate persisting symptoms. Twenty percent of participants remain ill with significant symptoms and activity limitation 13 years after illness onset. Chronic fatigue syndrome in children and adolescents may result in persistent somatic symptoms and disability in a minority of those affected.

• 2000, The roles of orthostatic hypotension, orthostatic tachycardia, and subnormal erythrocyte volume in the pathogenesis of the chronic fatigue syndrome

  Method: "Fifteen patients were randomly selected from a large population of patients with chronic fatigue syndrome, studied, and observed for several years (by DSB). Blood pressure (BP) and heart rate (HR) measured with Dinamap every minute for 30 minutes supine and 60 minutes standing were compared with these findings in 15 healthy age- and gender-matched control subjects and later during lower body compression with military antishock trousers (MAST). Plasma catecholamines and circulating erythrocyte and plasma volumes were also measured by isotopic dilution methods." Results: "Abnormal findings in the patients included excessive orthostatic reductions in systolic (P < 0.001) and diastolic BP (P < 0.001) and excessive orthostatic tachycardia (P < 0.01), together with presyncopal symptoms in 11 of the 15 patients and in none of the control subjects after standing for 60 min. Lower body compression with the MAST restored all orthostatic measurements to normal and overcame presyncopal symptoms within 10 min. Circulating erythrocyte but not plasma volumes were subnormal in the 12 women (P < 0.01) and plasma norepinephrine concentration rose excessively after standing for 10 min."

• 1998, Circulating Blood Volume in Chronic Fatigue Syndrome
• 1997, Illness Onset Characteristics in Children with Chronic Fatigue Syndrome and Idiopathic Chronic Fatigue

Talks & interviews

• December 2015, Dr. David Bell, Tunstin, California
• June 2015, Dr. David S. Bell, ME/CFS Presentation, Swedish Medical Center, Seattle Washington
• October, 2011, Dr. Bell on Norwegian ME chemotherapy drug trial. [English with Norwegian subtitles]
• January 2010, Q & A After XMRV Lecture By Dr David Bell part 2
• January 2010, Q & A After XMRV Lecture By Dr David Bell part 1
• 2000 Documentary, I Remember Me, directed by Kim A. Snyder
• 1996, Primetime Live TV Show - Sick and Tired

Articles

Journal of Chronic Fatigue Syndrome

• 1995, Chronic Fatigue Syndrome in Children

  Abstract - "Chronic fatigue syndrome (CFS), formerly called chronic Epstein-Barr virus syndrome, chronic mononucleosis, and numerous other names, is a symptom complex characterized by marked functional limitation which affects children as well as adults. The symptom complex, physical examination, laboratory evaluation, clinical course, and differential diagnosis are reviewed with particular emphasis upon CFS in children. Management consists of a comprehensive treatment plan including medical, educational, and psychosocial support wiih the aim of reducing both symptom and activity limitation. While etiology is unknown, the use of the term "chronic fatigue syndrome" is appropriate for children with marked functional limitation due to unexplained fatigue who have the associated symptom complex and physical examination findings characteristic of this condition."

Open Medicine Foundation

• Aug 1, 2016, Prognosis of ME/CFS

Health Rising

• Oct 4, 2015, Dr. Bell on Understanding Orthostatic Intolerance in Chronic Fatigue Syndrome and Fibromyalgia
• Oct 2, 2015, When Panic Isn't: Dr. Bell on Maggie's ME/CFS and Fibromyalgia Story
• Sept 30, 2015, Dr. David Bell on Low Blood Volume in Chronic Fatigue Syndrome
• Aug 18, 2015, Dr. Bell's Home Orthostatic Intolerance (OI) Test

Books

• Neuro-immune fatigue ME/CFS/FM and cellular hypoxia, David Bell - WingSpan Press - 2007
• Faces of CFS: case studies of chronic fatigue syndrome, David Bell - The Author - 2000
• A parents' guide to CFIDS: how to be an advocate for your child with chronic fatigue immune dysfunction, David Bell - Haworth Medical Press - 1999
• The doctor's guide to chronic fatigue syndrome: understanding, treating, and living with CFIDS, David Bell - Addison-Wesley Pub. Co. - 1994
• Curing fatigue: a step-by-step plan to uncover and eliminate the causes of chronic fatigue, David Bell - Stef Donev - Rodale Press - 1993
• The disease of a thousand names: CFIDS--chronic fatigue/immune dysfunction syndrome, David Bell - Unknown Binding – 1991

Open Letter to The Lancet

Two open letters to the editor of The Lancet urged the editor to commission a fully independent review of the PACE trial, which the journal had published in 2011. In 2016, Dr. Bell, along with 41 colleagues in the ME/CFS field, signed the second letter.

• 10 February 2016, An open letter to The Lancet, again - Virology blog

Online presence

• PubMed - DS Bell

Learn more

• Wikipedia - David Sheffield Bell
• 2016, Dr. David Bell Joins OMF Scientific Advisory Board (see Open Medicine Foundation)
• 1990, Chronic Fatigue Syndrome

See also

• Bell disability scale
• Open Medicine Foundation

Canadian Consensus Criteria (CCC) - A set of diagnostic criteria used to diagnose ME/CFS, developed by a group of practicing ME/CFS clinicians in 2003. The CCC is often considered to be the most complex criteria, but possibly the most accurate, with the lowest number of patients meeting the criteria. Led to the development of the International Consensus Criteria (ICC) in 2011.

myalgic encephalomyelitis (M.E.) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

subjective outcome An outcome of a clinical trial that depends on the judgement or opinion of the assessor or patient, e.g. asking if fatigue has increased or decreased "a little" or "a lot", patient questionnaires like the Chalder Fatigue Scale, and other patient-reported outcome measures (PROMs).

somatic symptoms Physical or bodily symptoms. May be used to mean bodily symptoms that are not the result of a known physical or biological illness.

somatic symptoms Physical or bodily symptoms. May be used to mean bodily symptoms that are not the result of a known physical or biological illness.

somatic An adjective relating to the physical body or physical symptoms. It is often contrasted with the adjective "psychological", which refers to the human mind or mental symptoms. In biology, "somatic cells" refer to all the cells of the body, except those which form an egg or sperm.

tachycardia An unusually rapid heart beat. Can be caused by exercise or illness. A symptom of postural orthostatic tachycardia syndrome (POTS). (Learn more: www.heart.org)

heart rate (HR) - the number of times the heart beats within a certain time period, usually a minute

heart rate (HR) - the number of times the heart beats within a certain time period, usually a minute

supine lying on the back or with the face upward

plasma The liquid part of blood, lymph, or milk after removing any suspended material. Most of the time, "plasma" simply refers to blood, after all the blood cells have been removed. If you also remove the clotting factors, then the plasma is referred to as "serum".

chronic fatigue (CF) - Persistent and abnormal fatigue is a symptom, not an illness. It may be caused by depression, multiple sclerosis, fibromyalgia, chronic fatigue syndrome or many other illnesses. The term "chronic fatigue" should never be confused with the disease chronic fatigue syndrome.

etiology The cause of origin, especially of a disease.

Chronic Fatigue and Immune Dysfunction Syndrome (CFIDS) - Chronic Fatigue and Immune Dysfunction Syndrome is another term for Chronic Fatigue Syndrome, but one which emphasizes the immunological aspects of the disease. Popular in the 1990s, this term has apparently fallen into disuse.

myalgic encephalomyelitis (M.E.) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.