Christopher Snell

Christopher R. Snell, PhD, is the Scientific Director of Workwell Foundation, Ripon, California. Dr. Snell was Chair of the Health and Human Services's CFSAC committee from 04/01/07-04/01/11.

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. Snell, 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

Notable studies

 * 2012, Minimum data elements for research reports on CFS. Full text "Abstract: 'Chronic fatigue syndrome (CFS) is a debilitating condition that has received increasing attention from researchers in the past decade. However, it has become difficult to compare data collected in different laboratories due to the variability in basic information regarding descriptions of sampling methods, patient characteristics, and clinical assessments. The issue of variability in CFS research was recently highlighted at the NIH's 2011 State of the Knowledge of CFS meeting prompting researchers to consider the critical information that should be included in CFS research reports. To address this problem, we present our consensus on the minimum data elements that should be included in all CFS research reports, along with additional elements that are currently being evaluated in specific research studies that show promise as important patient descriptors for subgrouping of CFS. These recommendations are intended to improve the consistency of reported methods and the interpretability of reported results. Adherence to minimum standards and increased reporting consistency will allow for better comparisons among published CFS articles, provide guidance for future research and foster the generation of knowledge that can directly benefit the patient.'"
 * 2010, [[Post-exertional malaise] in women with chronic fatigue syndrome]
 * 2007, Legal and Scientific Considerations of the Exercise Stress Test"'Abstract - This article examines the legal and scientific bases on which an exercise stress test can provide medically acceptable evidence of disability for the Chronic Fatigue Syndrome (CFS) patient. To qualify for disability benefits, a claimant must establish the existence of a serious medically determinable impairment (MDI) that causes the inability to work. The single stress test has been used to objectively establish whether a claimant can engage in “substantial gainful employment” and is an important determinant of the award or denial of benefits. A review of case law indicates problems associated with a single test protocol that may be remedied by a “test-retest” protocol. The results of a preliminary study employing this approach indicate that the test-retest protocol addresses problems inherent in a single test and therefore provides an assessment of CFS related disability consistent with both medical and legal considerations.'"
 * 2001, Assessment of Functional Impairment by Cardiopulmonary Exercise Testing in Patients with Chronic Fatigue Syndrome"'Summary - Functional impairment in a population of patients with chronic fatigue syndrome (CFS) was determined by exercise testing. The criteria established by Weber and Janicki (1) were employed because impairment levels are based on maximal oxygen consumption. Oxygen consumption was obtained by cardiopulmonary exercise testing and was used to classify subjects according to the severity of impairment. All the subjects in this study met the CDC case definition (2) for CFS. All patients underwent at least two maximal graded exercise tests in which expired air was collected for assessment of V02max. Data are included for eighty-seven CFS patients, the highest V02 was used for determining impairment. Although all patients met the CDC case definition for CFS, only 35 (40%) would be classified as having greater than “Mild” functional impairment. The highest V02 of any of the patients in this study was 29.5 ml/kg/min, very close to what normative data predicts to be the average maximal value for the entire group. Without a sedentary control group it is unclear if the low V02 in this population is due to the pathology of CFS or results from the inactivity that accompanies the disease. However, use of maximal V02 during exercise can clearly discriminate between levels of functional impairment and may be efficacious for diagnosis of CFS. Additionally, in cases where cardiopulmonary analysis is unavailable, exercise duration on a standardized test may also be employed.'"
 * 2001, Chronic Fatigue Syndrome, Ampligen, and Quality of Life: A Phenomenological Perspective"'Summary - The purpose of this investigation was to identify significant quality-of-life issues for two women previously diagnosed with chronic fatigue syndrome (CFS), and their families. Both women were participants in a cost-recovery, clinical trial of the antiviral and immuno-modulatory drug, Ampligen. A qualitative, case study approach was adopted to access information not normally available from clinical trials. Specifically, semi-structured, in-depth interviews were conducted with the CFS patients, and their spouses, to discover if these families perceived any changes in their patterns of daily living contingent with participation in the Ampligen trial. Patient diaries were also analyzed for the purpose of triangulation. Content analysis of the interview transcripts and diary entries revealed a number of significant quality of life improvements for the women and their families, for which they perceived the drug therapy responsible. After an initial acclimation period, and with the exception of the day when the drug was administered, both women reported a reduction in pain, increased energy levels, and improved cognitive functioning. They each cited numerous cases to illustrate their improvement.'"

Talks and interviews

 * 2016, 12th International IACFS/ME Biennial Clinical and Research Conference, Emerging Science and Clinical Care, How Cardiopulmonary Exercise Testing Informs Pathology and Treatment(Workshop given with Mark VanNess, Ph.D. and Betsy Keller, Ph.D.)

Learn more

 * 2012, Clinical exercise testing in CFS/ME research and treatment