elicit students’ interest in learning more about the possible roles of
vaccines and the microbiome in CFS/ME (we deliberately cut discus-
sions of the latter short so that students were free to research and
explore available information from all sources). We have usually fol-
lowed the format of the sessions described in Zaitsev (2009b). The
case study was given at the end of the semester, so that students were
already familiar with the basic structure and functions of human body
systems. The learning outcomes of the case study are as follows:
(1) Students will be familiar with symptoms of a disease and the
complexity of diagnosis.
(2) Students will be acquainted with the scientific method,
research strategy, and peer-reviewed journals.
(3) Students will formulate arguments concerning a controversial scientific issue and make a presentation.
(4) Students will integrate their knowledge to make interdisciplinary connections.
First Session: The Mysterious
In our classes, students usually were given the case study (see Box 1)
two weeks before the scheduled oral presentation. Each group con-
sisted of four students, and there were six groups in each class. Each
group chose one of the following six topics to present in front of the
(1) General Review of CFS/ME
(2) Contribution of Virus to CFS/ME
(3) Contribution of Vaccine to CFS/ME
(4) Contribution of Microbiome to CFS/ME
(5) Treatment of CFS/ME
(6) Innovative approaches to diagnosing and treating CFS/ME
Each topic represents an important aspect of the disease. Students
were instructed to read the case study and focus on their own topic.
Questions in the case study provide guidelines for preparation of the
presentations. To introduce CFS/ME, the case study starts with a
character in a well-known TV show; the controversy over whether
it is a real disease and how to diagnose it follows.
Box 1: Case Study
The Golden Girls is a popular TV sitcom (1985–1992) still
shown in reruns. The plot involves four compatible,
unattached, retired women who share a house in Florida. In
season 5, episode 2 (“Sick and Tired”), Dorothy
Hollingsworth, one of the women, has been complaining of
extreme exhaustion, which her physician dismisses as either
hypochondria or depression. Other doctors with whom she
consults concur until Dr. Chan tells her that she is suffering
from chronic fatigue syndrome (CFS). Relieved that her
condition has finally been identified, she goes to a
restaurant with her mother and housemates to celebrate.
At the next table she notices the physician who had
dismissed her complaints as imaginary. Unable to resist
confronting him, Dorothy gives vent to the frustration
of having suffered, as many CFS patients have, not
understanding why their physicians dismiss them. Enraged,
Dorothy says that “I do not know where you, doctors, lose
your humanity, but you lose it.” She concludes her tirade:
“You better start listening to your patients. They need to be
heard. They need caring. They need compassion. They need
attending too. You know, someday, Dr. Bird, you will be on
the other side of the table. And as angry as I am, and as
angry as I always will be, I still wish you a better doctor than
you were to me.”
This episode of The Golden Girls demonstrated a need for
social awareness of a debilitating and complex disorder that
had been trivialized due to the lack of scientific evidence
supporting its diagnosis. CFS was dismissed for decades as
the “yuppie flu” and widely regarded as a psychosomatic
disorder (Palca, 1991). Chronic fatigue sufferers were often
treated with sarcasm and skepticism by family, friends, and
coworkers who accused them of malingering. This led CFS
patients to feel demoralized, frustrated, and angry.
(1) On what basis would you think Dr. Chan was able to
(2) What criteria are used by doctors to diagnose patients
with CFS today?
(3) Could something like the story portrayed in this Golden
Girls episode, written more than 20 years ago, happen
(4) Write a list of questions that patients might be asking
their physicians about this disease today.
In each group, students divided among themselves the workload
responsibilities for the presentation. Since CFS/ME is still controver-
sial in medical research, students were instructed to be impartial
during collection of information. Students were required to use fig-
ures and graphs from other publications in their presentation. They
were also encouraged to prepare questions for their classmates who
would be presenting on other topics, which ensured that each
group’s presentation had engagement from their peers. We asked
each group the following questions:
(1) In 2009, a research team led by principal investigator Judy
Mikovits reported that xenotropic murine leukemia virus
(XMRV) causes CFS/ME (Lombardi et al., 2009). Since that
report, there have been many debates over whether a single
virus could lead to CFS/ME. What is your opinion and why?
(2) A principal investigator in a CFS/ME study purposely
removed lab notes from the research lab she was in charge
of. Was this action lawful? Explain.
(3) Do you think that CFS/ME affects a person’s mental health?
(4) In 2017, the National Institutes of Health (NIH) announced
it would provide over $7 million to study CFS/ME. This
demonstrates an ongoing need for this type of research.
What do you think should be investigated first?