To the Editor.
—Dr Bou-Holaigah and colleagues1 report a significant improvement in symptoms in a group of patients with CFS treated for NMH. Three aspects of the study were not clearly explained: Who were the patients? What was the therapy? Why did the patients improve? Furthermore, the study design was flawed.Patients in the study had a median of three of the three possible signs of CFS listed in the 1988 Centers for Disease Control (CDC) case definition. However, signs are rarely found in CFS and were actually deleted from the 1994 International Chronic Fatigue Syndrome Study Group case definition.2 Did the study patients have CFS or some other illness?The protocol did not specify the prescribed amount of dietary salt, the modified doses of fludrocortisone, the doses of β-blockers, or the dose of disopyramide used in the study. What specific treatments were used?The response of CFS
Klonoff DC. Chronic Fatigue Syndrome and Neurally Mediated Hypotension. JAMA. 1996;275(5):359-360. doi:10.1001/jama.1996.03530290029023