Issues and problems in the conduct of epidemiologic research on chronic fatigue syndrome

The epidemiologic research approach is perhaps most appropriate for initial studies of chronic fatigue syndrome since the syndrome is vaguely defined, scientific knowledge about it is limited, and an infectious etiology is suspected. Several priority needs appropriate for epidemiologic research are identified, including a refinement of diagnostic criteria; a greater understanding of the natural history of the syndrome; basic incidence, prevalence, and mortality statistics; information on whether asymptomatic cases exist; etiologic studies of possible heterogeneity of cases; investigations of clusters of cases; and determinations of whether patients with the syndrome have an increased risk of malignancy. Because of the lack of cogent etiologic hypotheses regarding the syndrome, case-control studies are identified as a high priority for research. The many difficulties encountered in conducting such research are discussed and approaches to dealing with these problems are suggested.