Kenneth Friedman

Kenneth J. Friedman, PhD, is a retired Associate Professor of Pharmacology and Physiology, New Jersey Medical School, University of Medicine and Dentistry of NJ, Newark, New Jersey. He was a trainer of the Centers for Disease Control & Prevention’s Chronic Fatigue Syndrome Continuing Medical Education Course and delivered continuing medical education courses to physicians and other healthcare professionals throughout the United States. After the CDC discontinued its continuing medical education course for Chronic Fatigue Syndrome, he developed his own continuing medical education course for Chronic Fatigue Syndrome, approved by the American Academy of Family Physicians, and delivered that program to physicians around the U.S. His passion for ME/CFS advocacy is fueled by the fact that his daughter has CFS and fibromyalgia after getting mononucleosis her freshman year in college.

2017 Pediatric Primer

Dr. Friedman was one of the authors of the 2017 Pediatric Primer published in Frontiers in Pediatrics.

• Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Diagnosis and Management in Young People: A Primer (OPEN ACCESS/FULL TEXT). Authors: Peter Rowe, Rosemary A. Underhill, Kenneth J. Friedman, Alan Gurwitt, Marvin S. Medow, Malcolm S. Schwartz, Nigel Speight, Julian M. Stewart, Rosamund Vallings and Katherine S. Rowe

  Abstract:Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a complex disease that affects children and adolescents as well as adults. The etiology has not been established. While many pediatricians and other health-care providers are aware of ME/CFS, they often lack essential knowledge that is necessary for diagnosis and treatment. Many young patients experience symptoms for years before receiving a diagnosis. This primer, written by the International Writing Group for Pediatric ME/CFS, provides information necessary to understand, diagnose, and manage the symptoms of ME/CFS in children and adolescents. ME/CFS is characterized by overwhelming fatigue with a substantial loss of physical and mental stamina. Cardinal features are malaise and a worsening of symptoms following minimal physical or mental exertion. These post-exertional symptoms can persist for hours, days, or weeks and are not relieved by rest or sleep. Other symptoms include cognitive problems, unrefreshing or disturbed sleep, generalized or localized pain, lightheadedness, and additional symptoms in multiple organ systems. While some young patients can attend school, on a full or part-time basis, many others are wheelchair dependent, housebound, or bedbound. Prevalence estimates for pediatric ME/CFS vary from 0.1 to 0.5%. Because there is no diagnostic test for ME/CFS, diagnosis is purely clinical, based on the history and the exclusion of other fatiguing illnesses by physical examination and medical testing. Co-existing medical conditions including orthostatic intolerance (OI) are common. Successful management is based on determining the optimum balance of rest and activity to help prevent post-exertional symptom worsening. Medications are helpful to treat pain, insomnia, OI and other symptoms. The published literature on ME/CFS and specifically that describing the diagnosis and management of pediatric ME/CFS is very limited. Where published studies are lacking, recommendations are based on the clinical observations and practices of the authors.

Advocacy positions

Dr. Friedman has served on the Board of the International Association for Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (IACFS/ME) and is a Trustee of the New Jersey Chronic Fatigue Syndrome Association (NJCFSA). Dr. Friedman was, also, the Secretary and Chair of Public Policy for PANDORA Org and an advisor to the website cfsKnowledgebase. He is currently serving as a Board member of both the New Jersey Chronic Fatigue Syndrome Association and the Vermont Chronic Fatigue Immune Deficiency Syndrome Association.

Writing Committees

He was a member of the writing committee for the 2002 Consensus Manual for the Primary Care and Management of Chronic Fatigue Syndrome sponsored by The Academy of Medicine of New Jersey and the New Jersey Department of Health and Senior Services. The authored the first chapter "Pathophysiology in CFS" and co-authored chapter 3, "Infections in CFS," and chapter 10, "Gastrointestinal Symptoms in CFS."

• 2006, Chronic Fatigue Syndrome in Children and Adolescents

  "Abstract - Objective: An overview of the unique aspects of Chronic Fatigue Syndrome in children and adolescents (CACFS) is herein provided for healthcare professionals who may be called upon to diagnose and/or treat this illness. Young age of onset, puberty, and interactions with peers and the educational system provide greater diagnostic and treatment challenges than found with adult onset CFS. Method: A review of diagnostic procedures and treatment protocols found in the contemporary literature is coupled with the professional experiences of the authors in treating CACFS to delineate the roles and responsibilities of family, healthcare providers and educators in diagnosing, treating and supporting the CACFS patient. Results: Areas discussed include: pathogenesis, patient evaluation, clinical evaluation, laboratory evaluation, treatment options, psychological issues, role of schools, and the roles of primary and tertiary care providers. Conclusion: CACFS can be diagnosed and treated with varying levels of success if all the professionals involved in the treatment program have a clear understanding of their roles and responsibilities. Primary care physicians, pediatricians, other subspecialists, family members, social workers and educators, may all be called upon to participate in the treatment program of CACFS. While it is best to have one, compassionate physician in charge of care, the CACFS may benefit from the inclusion of specialized treatment options available from or through a tertiary care provider. To the extent possible, socialization, education and psychological support of the CACFS should be provided."

Dr. Friedman was a member of the writing committees for both the 2012 and 2014 editions of ME/CFS: A Primer For Clinical Practitioners sponsored by the International Association for Chronic Fatigue Syndrome/Myalgic Encephalomyelitis.

CFSAC

From 2003-2006, he served on the Chronic Fatigue Syndrome Advisory Committee (CFSAC) for the U.S. Department of Health and Human Services, as a member of the Research Committee. During his term, he wrote a Research Committee minority report entitled, “Fish Or War." In it he argues that the National Institutes of Health had not solved CFS in the past 15 or 20 years, so new "more aggressive funding elements should be incorporated into the United States’ future funding of CFS research."

In 2014, he was the Sub-group Chair of the CFSAC Working Group justifying the establishment and funding of ME/CFS Centers of Excellence by the U.S. Department of Health and Human Services.

Speaking Engagements

On Apr 28, 2011, the National Institutes of Health invited Dr. Friedman to the NIH-Sponsored ME/CFS State of Knowledge Workshop, where he delivered a speech: "Elephants in the Room: Acknowledging Impediments to ME-CFS Research, Education, and Clinical Care".

On May 12, 2007, Dr Friedman presented the keynote speech at the Vermont CFIDS Association CFS Awareness Day held in Burlington, VT.

Advocacy writings

After the Institute of Medicine report was released, Dr. Friedman wrote a review in which he states:

"The report was written to develop a series of recommendations to assist in the development of policies that will guide future ME/CFS research, education and patient support. The IOM report needs to be placed in the broader ME/CFS environment. Additional input regarding the historical, medical, social and research environment of ME/CFS needs to be received by the Department of Health and Human Services prior to the development of new ME/CFS policies and initiatives. That input should be provided by responsible ME/CFS researchers, clinicians, healthcare educators, patient advocacy organizations, patients, social scientists and social services organizations. Only then can the correct path forward for ME/CFS be projected."

On Oct 13, 2016, Dr. Friedman wrote a position paper, "Increasing Efficacy of the CDC’s ME/CFS Educational Program" about the Centers for Disease Control (CDC) fourth attempt of revising and creating meaningful educational materials for its Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) educational program so as to not contain illness stigmatizing elements.

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. Friedman, 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

Talks and Interviews

• 2016, Immune Dysfunction (ME/CFS) Awareness Panel 2016
• 2014, Rituximab & ME/CFS
• 2014, ME/CFS: Why Do I Feel This Way
• 2014, ME/CFS What We Know About Causes
• 2014, Biomarkers
• 2011, Radio interview with Dr. Ken Friedman

Learn More

• Interview with Cort Johnson
• "Fish Or War"

See Also

• Chronic Fatigue Syndrome Advisory Committee
• New Jersey Chronic Fatigue Syndrome Association (NJCFSA)
• Vermont CFIDS Association
• Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Diagnosis and Management in Young People: A Primer

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.

etiology The cause of origin, especially of a disease.

cognition Thought processes, including attention, reasoning, and memory.

lightheadedness the condition of being dizzy or on the verge of fainting

orthostatic intolerance (OI) - The development of symptoms when standing upright, where symptoms are relieved upon reclining. Patients with orthostatic intolerance have trouble remaining upright for more than a few seconds or a few minutes, depending upon severity. In severe orthostatic intolerance, patients may not be able to sit upright in bed. Orthostatic intolerance is often a sign of dysautonomia. There are different types of orthostatic intolerance, including postural orthostatic tachycardia syndrome (POTS).

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.

Chronic Fatigue Syndrome Advisory Committee (CFSAC) - (sometimes pronounced SIF-SACK) A US government advisory council that met twice per year, covering current topics related to Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. Meetings usually lasted for two days and the results were presented to the Secretary of Health and Human Services (HHS). After 15 years, on September 5, 2018, CFSAC's charter was not renewed by the Department of HHS, effectively dissolving the committee without notice or warning.

Institute of Medicine report (IOM report) - A report that was commissioned by the U.S. government and was published by the Institute of Medicine on February 10, 2015. The report was titled "Beyond Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness" and proposed the term Systemic Exertion Intolerance Disease (SEID). Among its key findings were that "This disease is characterized by profound fatigue, cognitive dysfunction, sleep abnormalities, autonomic manifestations, pain, and other symptoms that are made worse by exertion of any sort." The report further stated "Between 836,000 and 2.5 million Americans suffer from myalgic encephalomyelitis/chronic fatigue syndrome."

projection 1. In psychology, a defense mechanism involves attribution unpleasant feelings to another person. May be abusive, e.g., a person accusing someone else of something that they themselves are doing or feeling. Often linked to gaslighting.
2. Estimate or forecast based on trends.
3. Something that extends out from something else.
4. How something is presented. (Learn more: www.forbes.com)

Centers for Disease Control and Prevention (CDC) - The Centers for Disease Control and Prevention is a U.S. government agency dedicated to epidemiology and public health. It operates under the auspices of the Department of Health and Human Services.

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.