I only have access to the abstract. The final line of the abstract appears to have no logical connection to the bulk of the discussion. This journal (Clinical Infectious Diseases) is the IDSA professional journal. The conclusion states simply: "Conclusions. In British Columbia, a setting with low Lyme disease incidence, ADCLS patients have a similar phenotype to that of CFS patients. Disagreement between alternative and reference laboratory Lyme testing results in this setting is most likely explained by false-positive results from the alternative laboratory." Their primary point seems to be that CFS and a new entity they term "Alternatively Diagnosed Chronic Lyme Disease" are indistinguishable. Therefore, they conclude that "Alternative laboratories" are producing false positives, as "No ADCLS patient was confirmed as having positive Lyme serology by reference laboratory testing." 25 of the 26 "ADCLS" patients were diagnosed by one "alternative laboratory" (presumably Igenex). There is no mention in the abstract of comparison of "non-alternatively diagnosed" chronic Lyme patients (people who test CDC positive on whatever BC considers a "reference lab") with CFS patients and controls, which I would think would be critical to making the point that these so-called "alternative diagnoses" are bogus. The main problem, of course, is assuming that the "reference lab" test is some kind of gold standard with a high degree of sensitivity and specificity, rather than a low sensitivity and high specificity (high false negative rate, low false positive rate). http://cid.oxfordjournals.org/content/61/7/1084.short?rss=1 Clinical Infectious Diseases Volume 61, Issue 7 Pp. 1084-1091 Lyme Disease Diagnosed by Alternative Methods: A Phenotype Similar to That of Chronic Fatigue Syndrome David M. Patrick1,2, Ruth R. Miller1, Jennifer L. Gardy1,2, Shoshana M. Parker3, Muhammad G. Morshed4,5, Theodore S. Steiner6, Joel Singer1,3, Kam Shojania6, and Patrick Tang4,5 for the Complex Chronic Disease Study Group -Author Affiliations 1School of Population and Public Health, University of British Columbia 2British Columbia Centre for Disease Control 3Centre for Health Evaluation and Outcome Sciences 4Department of Pathology and Laboratory Medicine, University of British Columbia 5British Columbia Public Health Microbiology and Reference Laboratory 6Department of Medicine, University of British Columbia, Vancouver, Canada Correspondence: David M. Patrick, MD, MHSc, UBC School of Population and Public Health, 2206 East Mall, Vancouver, BC V6T 1Z3, Canada firstname.lastname@example.org). Abstract Background. A subset of patients reporting a diagnosis of Lyme disease can be described as having alternatively diagnosed chronic Lyme syndrome (ADCLS), in which diagnosis is based on laboratory results from a nonreference Lyme specialty laboratory using in-house criteria. Patients with ADCLS report symptoms similar to those reported by patients with chronic fatigue syndrome (CFS). Methods. We performed a case-control study comparing patients with ADCLS and CFS to each other and to both healthy controls and controls with systemic lupus erythematosus (SLE). Subjects completed a history, physical exam, screening laboratory tests, 7 functional scales, reference serology for Lyme disease using Centers for Disease Control and Prevention criteria, reference serology for other tick-associated pathogens, and cytokine expression studies. Results. The study enrolled 13 patients with ADCLS (12 of whom were diagnosed by 1 alternative US laboratory), 25 patients with CFS, 25 matched healthy controls, and 11 SLE controls. Baseline clinical data and functional scales indicate significant disability among ADCLS and CFS patients and many important differences between these groups and controls, but no significant differences between each other. No ADCLS patient was confirmed as having positive Lyme serology by reference laboratory testing, and there was no difference in distribution of positive serology for other tick-transmitted pathogens or cytokine expression across the groups. Conclusions. In British Columbia, a setting with low Lyme disease incidence, ADCLS patients have a similar phenotype to that of CFS patients. Disagreement between alternative and reference laboratory Lyme testing results in this setting is most likely explained by false-positive results from the alternative laboratory.