Charles Lapp

Charles W. Lapp, MD, is a retired Internal Medicine physician and the Medical Director Emeritus at Hunter-Hopkins Center in Charlotte, North Carolina, US, which has a practice specializing in ME/CFS, fibromyalgia, and related conditions. Earlier in his career, he practiced family medicine and pediatrics in Raleigh, NC. He became interested in ME/CFS following an outbreak of three small epidemics of a chronic fatiguing illness in the Raleigh area. One of these outbreaks was among all the members of the N.C. Symphony Orchestra.

From 1992 to 1995 Dr. Lapp acted as Medical Director of the Cheney Clinic in Charlotte, in collaboration with Dr. Paul Cheney. In August 1995, Dr. Lapp opened the Hunter-Hopkins Center in Charlotte, North Carolina where he practiced until his retirement in 2018. His center does testing for disability insurance such as the two-day cardiopulmonary exercise test (2-day CPET) and a computer-assisted cognitive function test.

Following Dr. Lapp's retirement in 2018, the Hunter-Hopkins Center director became Dr. Vincent F. Hillman with Dr. Laura Black continuing on staff.

Dr. Lapp serves on the editorial board of the journal, Fatigue: Biomedicine, Health & Behavior, published on behalf of the IACFS/ME.

Awards

• 2009, Nelson Gantz Outstanding Clinician Award awarded to a physician who emulates Nelson Gantz's clinical acumen, his passion for medicine, and his empathy for persons with CFS/FM awarded by International Association for Chronic Fatigue Syndrome/Myalgic Encephalomyelitis.

IOM Committee on Diagnostic Criteria for ME/CFS

Dr Lapp was a reviewer for the 2015 report produced by the Institute of Medicine's Committee on Diagnostic Criteria for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome.

Pediatric Case Definition

• 2006, A Pediatric Case Definition for Myalgic Encephalomyelitis and Chronic Fatigue Syndrome (Full Text)

Clinical Trials

The Hunter-Hopkins Center was one of two clinical sites participating in the Hemispherx Biopharma 511/open label Ampligen trials to gain FDA approval, which was ultimately unsuccessful. The Ampligen phase III trial results were published in 2012. Ampligen, a brand name for Rintatolimod, is an IV medication, and was given twice weekly at the Hunter-Hopkins infusion room during the trial. The Hunter-Hopkins Center is currently one of four clinics that can administer Ampligen in the US.

Clinic location

Dr Lapp retired in 2018, other physicians with expertise in ME/CFS can be contacted at the clinic he founded.

Hunter-Hopkins Center

7421 Carmel Executive Park Dr.

Charlotte, North Carolina 28226

Telephone: (704) 543-9692

Email: drlapp@drlapp.net

Notable studies

• 1997, Management of Chronic Fatigue Syndrome in Children: A Practicing Clinician's Approach
• 1998, Downregulation of RNase L inhibitor correlates with upregulation of interferon-induced proteins (2-5A synthetase and RNase L) in patients with chronic fatigue immune dysfunction syndrome.
• 1999, The Relationship Between Chronic Fatigue Syndrome and Chemical Exposure
• 2006, Recognizing Pediatric CFS in the Primary Care Practice: A Practicing Clinician's Approach
• 2007, Defining the Occurrence and Influence of Alpha-Delta Sleep in Chronic Fatigue Syndrome (Abstract)
• 2009, Severe versus Moderate criteria for the new pediatric case definition for ME/CFS (Abstract)
• 2012, A double-blind, placebo-controlled, randomized, clinical trial of the TLR-3 agonist rintatolimod in severe cases of chronic fatigue syndrome (Full Text)
• 2014, No association found between the detection of either xenotropic murine leukemia virus-related virus or polytropic murine leukemia virus and chronic fatigue syndrome in a blinded, multi-site, prospective study by the establishment and use of the SolveCFS BioBank (Full Text)
• 2016, CDC Grand Rounds: Chronic Fatigue Syndrome — Advancing Research and Clinical Education. Morbidity and Mortality Weekly Report - (Full Text)
• 2017, Multi-Site Clinical Assessment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (MCAM): Design and Implementation of a Prospective/Retrospective Rolling Cohort Study (Full Text)
• 2019, Initiating care of a patient with Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) (Full text)
• 2019, Estimating Prevalence, Demographics, and Costs of ME/CFS Using Large Scale Medical Claims Data and Machine Learning (Full text)

Talks and interviews

• Dr. Lapp’s recommendations on supplements
• 16 Feb 2016, CDC Grand Rounds - Chronic Fatigue Syndrome: Advancing Research and Clinical Education with Charles Lapp, MD, Elizabeth Unger, PhD, MD, Anthony Komaroff, MD and Avindra Nath, MD

Grand Rounds Video

Grand Rounds Presentation Slide Deck

• 17 Apr 2017, Dr Charles Lapp - An overview of ME/CFS Diagnosis and Management

HHS/CFSAC Testimony

• Oct 29, 2009 Testimony (read by Cort Johnson)

Open Letter to The Lancet

Three 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. Lapp, along with 42 colleagues in the ME/CFS field, signed the second letter. In 2018, Dr. Lapp, with more than 100 colleagues in the ME/CFS field, signed the third letter.

• 10 February 2016, An open letter to The Lancet, again - Virology blog
• 18 June 2018, Trial By Error: An Open Letter to The Lancet, Two Years On

Online presence

• PubMed - Charles Lapp
• Hunter-Hopkins Center Facebook page
• Hunter-Hopkins Center website

Learn more

• 2012, What Are The Most Important Things To Remember About CFS/FM?
• Curriculum Vitae - Charles W. Lapp, MD
• 2018, An ME/CFS and FM Pioneer Says Good-bye: The Charles Lapp Interview

See also

• Hunter-Hopkins Center
• NIH Post-Infectious ME/CFS Study
• Ampligen
• 1984 Chapel Hill outbreak
• Dr Vincent F. Hillman
• Dr Laura Black

two-day cardiopulmonary exercise test (CPET) - A diagnostic test which involves testing an ME/CFS patient exercising on an exercise machine, while monitoring their respiration, especially oxygen consumption. This test is repeated the following day in order to confirm the patient's inability to replicate the first-day performance. This test is thought to be the most objective way to detect post-exertional malaise.

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

National Academy of Medicine (NAM) - An American non-profit, non-governmental organization which provides expert advice to governmental agencies on issues relating to biomedical science, medicine and health. Formerly known as the Institute of Medicine (IOM).

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.

phase three Last phase of clinical trials before a drug can be approved for public use. Whereas Phase one assesses basic safety, and Phase two assesses basic efficacy, Phase three uses many trial participants to fully assess both safety and efficacy, and overall benefit/risk.

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.

double blinded trial A clinical trial is double blinded if neither the participants nor the researchers know which treatment group they are allocated to until after the results are interpreted. This reduces bias. (Learn more: www.nottingham.ac.uk)

agonist A chemical that binds to the receptor and stimulates it's function, e.g., morphine is an opioid agonist that binds to the opioid receptor, reducing pain. The opposite of an antagonist.

blinded trial A clinical trial is blinded if either the participants or the researchers don't know which treatment group they are allocated to until after the results are interpreted. (Learn more: www.nottingham.ac.uk)

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.

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.