I think the comments are all held for moderation. In any case, I can't see any. But I did manage to send one for posting (a bit longer than I intended):
Ms. Brazier, thank you for this thorough article, and especially for walking through some of the recent biomedical research into ME/CFS.
Much is promising today, including:
-the Institute of Medicine's comprehensive report, which reviewed thousands of studies, and concluded: "The primary message of the committee’s report is that ME/CFS is a serious, chronic, complex, systemic disease that often can profoundly affect the lives of patients." The IOM called for much more research funding, expressing surprise that there has been so little to date.
http://iom.nationalacademies.org/Reports/2015/ME-CFS.aspx
and
-the NIH's recent announcement in response to the IOM report that they will "ramp up" biomedical research into this illness, which has been woefully underfunded (at about $5 million a year for many years, less than hay fever).
As others have pointed out, the article does miss some of the biggest questions surrounding the scientific validity of the PACE trial. It also misses the fact that "CBT," as discussed in relation to PACE-style treatment, is not about coping, but about overcoming "false illness beliefs" -- i.e., thinking oneself healthy. CBT to help patients cope, as in other serious diseases, might be helpful. But the CBT pushed on ME/CFS patients in the UK is wholly inappropriate for this physical disease. ME/CFS patients can no more "think" themselves healthy than can multiple sclerosis, AIDS, or cancer patients.
Beyond the research noted in this article, there are other promising threads, including:
-exercise physiology research, gene expression research, and other work, which is beginning to sketch out why exertion (which may be only getting up to use the bathroom, or for the most seriously ill, rolling over in bed) causes adverse physiological reactions in ME/CFS patients.
-research into treatment for ME/CFS, most excitingly, research into rituximab, a monoclonal antibody used in B cell cancers and autoimmune diseases, which in early trials has shown a 60-70% success rate for improvement, and is now in a Phase III trial.
-research into causes and triggers, which could someday help prevention. If rituximab continues to show results, for example, this suggests a B-cell-mediated autoimmune disease in responders.
Again, thank you for this helpful article. Hopefully, there will be many more answers to report soon.