
Biomarker for chronic fatigue syndrome identified - lichtenberger
http://med.stanford.edu/news/all-news/2019/04/biomarker-for-chronic-fatigue-syndrome-identified.html
======
Smaug123
Paper at
[https://www.pnas.org/content/pnas/early/2019/04/24/190127411...](https://www.pnas.org/content/pnas/early/2019/04/24/1901274116.full.pdf)

Pleasantly surprised to discover that it was legally available!

The test appears to be _ridiculously_ good. Perfect separation of 40 subjects
into those who have been diagnosed with CFS and those who are known to be
healthy, from blood samples.

I want to see this replicated, by people who are not the original authors; but
if this test is anything like as good as it looks, it's revolutionary.

~~~
danieltillett
I have to agree with you here - the separation is too good. You just never get
anything in the real world that works this well with complex diseases.

~~~
kurthr
AIDS was once considered a very complex disease, but it has a very accurate
(HIV) test today. My big concern would be if, like cancer, there are really
many diseases and Chronic Fatigue symptoms are common, not differentiating.

~~~
Someone
AIDS, like CFS, was never considered a disease in the medical sense. They both
are called “syndrome”, which is medical short-hand for “interesting enough to
study further, but frankly, we don’t know shit about what’s causing this”.

[https://en.wikipedia.org/wiki/Syndrome](https://en.wikipedia.org/wiki/Syndrome):
_”A syndrome is a set of medical signs and symptoms that are correlated with
each other and, often, with a particular disease or disorder.”_

That’s why AIDS became “HIV infection” when medical science discovered what
caused AIDS.

If this research gets confirmed, and a mechanism is found, that will happen
here, too.

However, as you say, if that happens, there’s a good chance there are people
currently diagnosed with CFS who don’t show this biomarker.

If so, those people run the risk of getting stigmatized even more than current
CFS sufferers do.

The real solution to that problem, I think, would be for the world to accept
that, if you have a mental problem, a) that doesn’t imply you put it there,
and b) it doesn’t imply you should be able to get it out without outside help.

Only a few centuries ago, people were being blamed of being “unfaithful to
god” when they got sick, be it due to a bacterial infection or due to mental
illness. I see blaming people for their mental problems as a remnant of that.

~~~
rfugger
On the other hand, there are times when blaming people for their misfortune is
appropriate, and serves a social purpose. The hard part is telling when it is
appropriate. It does seem pretty clear though that we tend to both give
ourselves too much credit for our successes, and too much blame for our
failures, overall.

~~~
amanaplanacanal
My impression is that people give themselves the credit for their successes,
and blame somebody else for their failures.

My successes are due to my moral worth, and others' failures are due to their
moral failings.

------
ipunchghosts
Journalists, this is quite the story. Here you have a bunch of really sick
patients with docs around the world saying it's in there head. Then a UK study
comes out (PACE) saying patients should engage in activity to help themselves.
This only makes the patients worse and eventually so bad that the study was
pulled.

In comes dr ron davis. His son acquired me cfs while traveling in india.
Completely unsatisfied with the lack of care provided by his doctors, he
ventured off to research the disease himself assembling a team of esteemed
scientists. They all begin to promptly kick ass and take names making more
headway on understanding the disease more than anytime in history. Meanwhile,
they have open conferences which are posted on YouTube for patients to watch
(and see hope) and other scientists to learn from.

Davis and his collaborators discover all sorts of cfs links and debunk a bunch
of myths.really interesting research is occurring on trypanosomes, metabolic
traps, and the microbiome. Eventually a large signal is found when the cells
are stressed and voila, we arrive at the test mentioned in the link.

This folks is how science is supposed to unfold and it all happening right in
front of our eyes for everyone to see in real time. Quite astonishing. These
folks will eventually win the Nobel, im sure of it.

~~~
heavenlyblue
>> This folks is how science is supposed to unfold and it all happening right
in front of our eyes for everyone to see in real time. Quite astonishing.

So you imply that only scientists with money and direct personal interest in
the research are supposed to work on the given topic?

~~~
ipunchghosts
Not at all. What i mean is that scientists discovered a problem and 1) pursued
it regardless of what the major funding agencies thought of it 2) encouraged
patients to get involved and 3) informed the public of their progress
regularly allowing for open discussion and collaboration.

~~~
cpach
Amazing!

------
whalabi
I'm just astonished by this.

Millions of people (in the US alone!) suffer from this illness and I think
everyone has wondered, or heard it wondered, if it's imaginary.

For all these people to know there's something actually physically wrong with
them is massive. It'll shift the thinking of everyone in the profession, of
their families and friends and colleagues, and of themselves.

It's a huge, huge breakthrough.

~~~
jdietrich
_> Millions of people (in the US alone!) suffer from this illness and I think
everyone has wondered, or heard it wondered, if it's imaginary.

For all these people to know there's something actually physically wrong with
them is massive._

IMO the broader issue is the stigma against mental illness. The leading
hypothesis remains that chronic fatigue syndrome is a mental illness. Both
your comment and the linked article imply a false dichotomy between "real"
physical illness and "imaginary" mental illness. Mental illnesses are every
bit as "real" as physical illnesses. They cause real suffering, real
disability and real death. If chronic fatigue syndrome happens to have a
psychological etiology, then sufferers still deserve compassion, effective
treatment and proper research.

The research in question has a relatively small sample size and only compares
CFS patients with healthy volunteers. Identifying abnormalities in
immunological or stress-response functioning may not be particularly useful in
proving that CFS is "real" (i.e. non-psychological), because we have
identified similar abnormalities in patients with depressive disorders. Some
researchers argue that major depressive disorder may be an autoimmune
disorder, although this is far from a mainstream opinion.

[https://doi.org/10.1073/pnas.1901274116](https://doi.org/10.1073/pnas.1901274116)

[https://doi.org/10.1371/journal.pone.0138904](https://doi.org/10.1371/journal.pone.0138904)

[https://doi.org/10.1016/j.it.2005.11.006](https://doi.org/10.1016/j.it.2005.11.006)

[https://doi.org/10.1016/j.pnpbp.2004.11.003](https://doi.org/10.1016/j.pnpbp.2004.11.003)

~~~
tempguy9999
> IMO the broader issue is the stigma against mental illness

Yeah yeah that rubbish again. I have mental illness (see my posts for boring
details) and I've always been open about it, except when it's so obvious that
people pick up on it without my assistance.

I've never had a problem. Stop saying there is a stigma. Any stigma _may_ be
down much more to the individual's anticipation of stigma which might cause
them to not admit stuff, but my experience is society (UK anyway) is very
tolerant of it. You're really not helping.

There's no frigging stigma for mental illness alone. If it causes someone to
reek or act unpredictably there might be, but it's a reaction to the sad
manifestations, not the illness per se.

NB. I contacted a company I'd previously contracted for, explained the
situation, met some of the guys, became evidently stressed in front of them
(people + noise get overwhelming quickly), and now I'm working for them. It
gives me summat to do and to get used to social situations again, and they get
a DB guy. Win/win! No drama.

So I repeat, STOP claiming this crap. You're making it harder for people who
have to deal with it.

(Edit: no argument with the rest of your post)

~~~
stordoff
> In my judgment, the 2017 regulations [...] were blatantly discriminatory
> against those with mental health impairments and which cannot be objectively
> justified. The wish to save nearly £1 billion a year at the expense of those
> with mental health impairments is not a reasonable foundation for passing
> this measure.

[https://www.bailii.org/ew/cases/EWHC/Admin/2017/3375.html](https://www.bailii.org/ew/cases/EWHC/Admin/2017/3375.html)

Or in my sister's case, her employer not accepting a sick note because she is
"making it up".

I've seen an autistic student being heckled by a member of staff as he should
stop being such a baby.

There definitely is a stigma against mental illness. It may not be as bad as
some people make out, but it's there.

~~~
tempguy9999
Regarding your link, I don't have time to read it (did skim it) but I'm
talking about personal levels of discrimination, not governmental. If you want
to talk about institutional discrimination, some may have it worse, I know a
trans girl whose operation is being repeatedly pushed back. I can see why,
given the strictures on NHS funding, but it really has made things miserable
for her.

Your sister may have just had a shitty employer. Someone I knew told me of
finding someone literally crying in pain due to RSI, and the employer's
response was telling them to take painkillers. There are bad employers, for
sure. Mine aren't.

Does your sister's experience invalidate mine? No. Does mine invalidate hers?
No. We are stuck, perhaps on terminology of what discrimination is, or perhaps
I've been very lucky. People have been extremely decent to me, that's all I
can say.

My fear is that by talking up the alleged stigma, we're reinforcing or even
creating it. I hope that makes sense.

------
UglyToad
This sounds brilliant if it can be replicated. From what I've read and heard
large parts of the medical establishment still treats ME/CFS patients as
lazy/making it up. For there to be a positive diagnosis rather than a
diagnosis of exclusion is the first step to getting these people the help they
deserve.

------
daedalus_f
This looks very promising, but it’s too early to say how accurate this test
truly will be. Even if this papers methodology is replicated and the test
again perfectly selects ME/CFS from healthy controls, it may perform terribly
when used in a real clinical setting where the test has to distinguish CFS
from the spectrum of other disorders that it will encounter.

In other words while the current paper suggests the tests sensitivity is
likely to be high it’s much harder to come to any conclusion about it’s real
world specificity.

------
thrrrrrway
I had CFS like symptoms so bad I was stuck in bed for several years and the
doctor basically would not help me. Eventually I decided to treat it myself
with antibiotics and anti parasitic medication. I basically came to the
conclusion that for my specific case I had an unknown blood parasite and the
fatigue was being caused by neurotoxins. I don't think all CFS are caused by
an infection but mine definitely was and I have my life back. If you a
researcher looking for a cure, try to test medications that flush neurotoxins
out to see if the disease goes away and then try figuring out what is creating
them in the first place to treat them.

------
jaxgeller
If you are living with CFS i recommend giving
[https://cfsremission.com/](https://cfsremission.com/) a look.

~~~
jchw
Woah, I’m now wondering if CFS might be what’s been wrong with me for a while,
but I’m not sure. I definitely have terrible sleep, I can barely stay awake
during meetings, and I have some of the other symptoms sometimes associated
with this (tender lymph nodes in neck, IBS, tinnitus.)

I’ve been in and out of the doctor for a couple years, with weird pains, and
most recently a lymph node that is a little enlarged in the neck. Obviously
there are some scary (but unlikely) potential explanations. But, my sleep
quality degrading over the years is something that has been happening much
slower, and started much earlier.

Not a huge fan of self diagnosis but maybe some of the proposed dietary
changes would be worth trying, since they seem fairly innocuous. I’m sure
eating more apples won't hurt.

If anyone has experience with CFS and has advice, I’m all ears. I’d kill to
sleep like I did when I was 18.

~~~
erentz
Create a spreadsheet of possible illnesses that cause the symptoms you have,
and start working through what testing needs to be done to exclude them. A
number you may be able to exclude off the bat because they don't fit well or
you have recent testing from a physical that would exclude them (e.g. common
cancers). Then working with your doctor to get tests to exclude the rest. Have
you done a sed-rate test? (Often it is low <3 for ME/CFS, but normally nobody
looks at it in that direction, they only look for it being a marker of
inflammation if its high.) Have you had a sleep study to rule out sleep apnea
for example? Have you checked yourself for orthostatic intolerance or POTS?
(Easy to do with a pulse oximeter at home before worrying about official
tests.) And so on. You'll find plenty of information at me-pedia to help you
along the path of a differential diagnosis.

~~~
GordonS
For anyone reading this that doesn't know what a "sed-rate test" is, it's an
erythrocyte sedimentation test[0]

[0]
[https://en.wikipedia.org/wiki/Erythrocyte_sedimentation_rate](https://en.wikipedia.org/wiki/Erythrocyte_sedimentation_rate)

------
freeradical13
Why did they need machine learning? It seems from Figures 2B-G that there's a
clear cut off.

"Moreover, to create a classifier for ME/CFS patients capable of identifying
new patients, required for a robust diagnostic tool, we developed a trained
kernel Support Vector Machine (SVM), a supervised machine-learning algorithm,
using our experimental data. To classify new patients based on whether they
fall to the right of the decision boundary, we initially selected the two
features with the largest significance: change from the baseline to the
plateau and change from the minimum to the plateau for the in-phase components
of the impedance. Using these features, a cubic polynomial kernel SVM was able
to classify the two populations, although the two features are highly
correlated, as shown in Fig.2H."

[https://www.pnas.org/content/pnas/early/2019/04/24/190127411...](https://www.pnas.org/content/pnas/early/2019/04/24/1901274116.full.pdf)

~~~
L2R
Nothing wrong with an SVM. How else would they create a decision boundary for
classifying patients? The choice of the polynomial kernel is interesting, but
I don't think it causes any issues given the data.

~~~
freeradical13
I see, so basically instead of intuiting a simple threshold (e.g. >X% change),
they apply an SVM which is able to discover more accurate thresholds (and
error ranges). Do you have any suggested resources on learning more about SVM?

I guess my question comes from the observation that these advanced statistical
techniques such as machine learning haven't been around for long and yet
medicine has often created decision boundaries, presumably just looking at the
data and making a reasonable cutoff. Is all the extra effort in a case like
this worth the time investment?

~~~
verroq
SVMs are as old school ML as they get. They guarentee the maximum separation
at the decision boundary. However it doesn’t scale very well for higher
dimensional data. The standard used to be to use some dimensionality reduction
technique like PCA to preprocess before feeding it into the SVM.

This is all before deep learning.

~~~
ufo
Exactly. Perhaps the paper could have given a clearer message if the abstract
had characterized SVMs as a quadratic optimization technique instead of as
machine learning?

------
jxramos
Can anyone explain the idea of salt as a cell stressor?

> The idea is to stress the samples from both healthy and ill patients using
> salt, and then compare how each sample affects the flow of the electrical
> current.

Is this an osmotic pressure change that stresses the cytoskeleton or
something? Does a cell under a hypertonic solution change its cell membrane
channel’s behavior?

~~~
reubens
They were bumping the Na to 200mOsm/L, which is insanely high compared to our
plasma.

Hypertonicity like this causes the cell to shrink, which spoils the delicate
relationships and ionic bonds between molecules in the cell. This causes a
litany of issues, but one thing is an increase in production of reactive
oxygen species, a byproduct of normal metabolism. ROS, otherwise known as free
radicals, is what they use to measure cell stress.

------
rufus85
I have some doubts that this will be 100% specific to CFS, but as professor
Davis said at this point it's important to demonstrate that these patients
have something wrong with them.

Davis called this the last major disease we know almost nothing about. It's
2-3 as common as multiple sclerosis with worse impact on the person's life.
It's also the most underfunded illness when the number of patients and the
severity is taken into account.

------
NautilusWave
This biomarker seems incredibly general; I suspect people with certain
presentations of a mitochondrial disease would have the same biomarker.

~~~
GordonS
Agreed, but it's still great to have evidence of a _physical_ condition, as
many CFS patients have been made to feel like crackpots at some point, and
indeed some doctors use it as a convenient label for people they believe to be
mentally ill.

Of course, this also raises a question about how those with mental illness are
often treated.

~~~
rfugger
To be fair, if someone is overly anxious and neurotic about minor physical
symptoms, to the point that the anxiety is making things worse, often the best
thing a doctor can do is reassure them that they are fine, to stop worrying,
and send them home. Taking those patients' physical symptoms too seriously may
be the worst thing to do. I can see that it must be hard for doctors,
especially if they only really have about 12 minutes to make a
determination...

~~~
GordonS
Hypochondriasis is real, sure.

But I'm not talking about cases like that, I'm talking about patients behaving
perfectly rationally, but insistently.

------
not_a_moth
Since poor sleep quality is a core symptom of CFS I can't help wonder if sleep
is the underlying component. I think we've all underestimated the critical
nature of sleep in immune, metabolic, stress, cognitive aspects, etc. It's
also hard to self-assess the quality of your sleep, eg. clock-time at each
phase, central apnea events, 02 saturation, noise/ light/ movement
disturbances while you are asleep, etc.

~~~
rfugger
A sleep study is critical to ruling out sleep issues before getting a proper
diagnosis of ME/CFS. No good doctor would diagnose CFS without a sleep study.

~~~
not_a_moth
That could rule out apneas but not the overall possibility, based on typical
sleep studies anyways. e.g. you regularly go to bed thinking about the stuff
you have to do tomorrow, so your brain doesn't enter deep sleep phases for
long; your doctor thinks 6-7 hours of sleep is good, when you in particular
need more like 8.5 ; your neighborhood is noisy, etc.

------
rufus85
There is something akin to a daily exertion limit in CFS. When patients exceed
it, they have a relapse. It is very easy to have these relapses because the
exertion limit is so low.

There must be a biological mechanism behind this limitation. It could be
something to do with energy generation in cells and this test may be measuring
the associated impairment.

------
drchewbacca
There's a movie called "Unrest" which, in part, covers Dr Davis and his son I
think. I thought it was a pretty interesting movie, it's on Netflix in the UK,
not sure about elsewhere.

------
hourislate
Ron Davis has worked on this day and night for years. I remember reading about
his effort to figure out CFS to save his son. I'm not even sure this was his
field of expertise. He just wanted to save his sons life and gave his every
waking moment to try and figure it out. It makes me very happy that he seems
to have accomplished it. I'm curious if his son is still with him, he was in
really bad shape back in 2016.

------
lsiebert
My mom has this. While I'm hopeful this may lead to an effective treatment, it
won't give her back the many years she's lived with the disease.

------
daegloe
Off topic, but does anyone know why this post didn’t match up with my
submission from last week [0]? I know scheme and querystring can throw it off.
But in this case the links appear to be the same? Not sore about it, genuinely
curious what the matching rules look like!

[0]
[https://news.ycombinator.com/item?id=19783668](https://news.ycombinator.com/item?id=19783668)

~~~
GordonS
Sometimes the mods let dupes through, if they feel it's an important story
that didn't get any/enough attention last time round.

------
viburnum
That you can measure stress response in blood cells doesn’t rule out that the
disease is psychological in origin (although I doubt CFS is).

~~~
rfugger
At this point, I don't care about the origin nearly as much as finding an
effective treatment :)

~~~
Erik816
Agreed, people are very hung up on the mind/body problem. It's a pretty
interesting philosophical question, but not that relevant to helping truly
sick people get better.

------
ipunchghosts
Look over at r/medicine about this topic.

[https://www.reddit.com/r/medicine/comments/blc7tv/stanford_l...](https://www.reddit.com/r/medicine/comments/blc7tv/stanford_laboratory_claims_to_identify_robust/)

Doctors seem to be overly critical and ignorant. Any reason for this?

------
cpach
For the record, here’s a permalink that uses HTTPS:
[https://med.stanford.edu/news/all-news/2019/04/biomarker-
for...](https://med.stanford.edu/news/all-news/2019/04/biomarker-for-chronic-
fatigue-syndrome-identified.html)

------
starchild_3001
YouTube talk about the same:
[https://www.youtube.com/watch?v=bXGCQPLUtdQ](https://www.youtube.com/watch?v=bXGCQPLUtdQ)

------
olliej
40 people isn’t a super large sample size. Given there are huge numbers of
people who claim to have cfs I would have expected much larger.

~~~
nosianu
This is a poor statement since you leave out important qualifiers that would
give it some beef. you can't just auto-post "sample size too low" whenever you
don't see a thousand people, you have to go deeper to justify your opinion.
This sample size can be way to low or it can be very high, completely depends
on the population and what you want to show and with what confidence. Summary
here:
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2876926/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2876926/)

But a study like this one here, i.e. if one were to be made, would have plenty
of power with a sample size of 40:
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC300808/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC300808/)
(also consider the opposite, how many participants it would take before you
believe the result, but that kind of study would not be permitted; how many
does it take to be saved before you believe it) This study - or the lack
thereof, which the paper is about - nicely shows that when there is confidence
about the underlying mechanism you feel much less (here: no) need for
statistics and an RCT.

~~~
olliej
Ok, the sample size was 20 cfs, and 20 non cfs.

The problem I have is that the sample size means the there are reasonably good
odds that their a significant genetic difference between the two groups.

I am making no claim as to whether it’s real - I’ve known people who say they
have it, and to me seems plausible, but I’ve also known people who are just
not 20 any more, and have children, who also claim to have it - it seems
plausible in the latter case that people have been sold on a message of “eat
healthy and you won’t feel age”.

The problem with weak sample sizes is that it has a significant negative
impact whether CFS exists or not:

    
    
      * if it’s a real disease it could be an incorrect marker - for example let’s say the CFS positive group were all Bostonians living in California. It’s highly likely that a random sample of California natives will have at least some uniform marker. Now people who have the disease, but aren’t from Boston may not have the marker, so are told they’re not sick.
    
      * the disease doesn’t exist, but you’ve got a marker now. People who happen to have the bogus marker are now diagnosed with something that they don’t have. Now they have a diagnosis that prevents an actual diagnosis of real issues.
    

So I don’t believe it is justifiable to publish a press release on something
that effects millions of people, based on a sample that is so small.

The initial small sample size might justify a larger sized sample looking at
specifically that marker. Then you also have better science (you have a “this
marker indicates cfs” hypothesis), and more statistical robustness.

------
derefr
Does it say anywhere in the paper what the “promising drug” that decreases the
effect might be?

~~~
vaelin
Not in the paper, but Ron gave a talk where he mentioned an MS drug (I have
forgotten which) and a new drug that targets mitochondria which is not yet
licensed for anything.

Sorry I can't be more specific. I don't remember the details.

------
leemailll
So what they measure and where is the paper? I read the linked pr but find
nothing about them

~~~
ufo
I don't understand the details but here is the link to the paper

[https://www.pnas.org/content/early/2019/04/24/1901274116](https://www.pnas.org/content/early/2019/04/24/1901274116)

~~~
leemailll
Thanks for the link. I read the paper and it seems that they just measure the
impedance (or resistance) of the cell membrane with an artificial increase of
NaCl in the extracellular environment (ie plasma in the text). The final NaCl
concentration looks like to be doubled than the normal range.

This might be an intersting finding, but I can't figure out why the impdecance
of membrane need to be measured with increased NaCl in the plama. And whether
it is only related with Na+ or Cl- change.

~~~
ufo
The salty plasma removes water from inside the cells by osmosis. The authors
say that this technique is a common model for studying cellular response to
stress.

~~~
leemailll
The thing is if they just want to create a hyperosmotic solution they can add
something won't be transported across the membrane, the way they did will
change a lot of things on the membrane and inside the cell rather than stress
introduced by hyperosmotic stress

------
johnchristopher
Wait... does it mean chronic fatigue syndrom is recognized now ?

~~~
johnchristopher
Thanks for the downvote but where I live it's still not recognized and
patients are either told it's a depression or some kind of fibroid-myalgia.

------
soulofmischief
Medicine is a must for any empathetic society. However I wonder if the dawn of
modern medicine was the end of natural human evolution.

Now that people with diseases such as CFS and diabetes can receive help, we
are no longer breeding these diseases out of the gene pool. As a result, we
are actually spreading them epigenetically over time.

We will be forced to turn to science, such as vaccines and pre- and post-birth
biological modification, in order to continue the progression of our species
in our battle against ailments and germs.

As a side note, what is the best way to get tested for CFS? Is it possible to
devlop CFS after contracting certain immuno-suppressant diseases?

In my youth I was constantly sleeping in class, but I chalked it up to a
combination of insomnia and 24/7 forced consumption of amphetamines to treat
ADHD. I mean I would sleep literally _anywhere_ if I had more than half an
hour to kill with nothing to do, much to the embarrassment of my guardians. At
the time I was not interested in getting tested for narcolepsy and adding yet
another item to my list of mental illnesses.

Then right after high school, I contracted mononucleosis. I was completely
bed-ridden for almost six months, and for about two years I basically had no
energy at all. Always sleeping. Those two years went by in a flash. And now I
still feel that to a degree, years later. I'm Bipolar II, and when I'm in my
manic phase I have near unlimited energy, but when I'm at baseline or in my
depressive phase I basically crawl into a permanent coma for two weeks
punctuated by work.

A lot of people intentionally allow their children to contract mono in their
youth, similarly to chicken pox, so that the virus comes at a more manageable
period in their life. It can be devastating/disruptive to an adult life. I was
homeless and unable to work for a long time. I wonder if any research has been
done towards the link between early contraction of these diseases and CFS.

~~~
GordonS
I was diagnosed with CFS after being prescribed an immunosuppressant. I
reacted badly to it, developing chronic pain and fatigue, so it's possible
that's a vector (I say possible as CFS is a diagnosis of exclusion, and it's
highly likely thatany people diagnosed with CFS have some other, undiagnosed
condition of which fatigue and pain are a symptom).

~~~
soulofmischief
Makes sense. CFS, like schizophrenia, is essentially a symptom of some unknown
collection of ailments.

