But that wasn't what Cindy was on about - was it? She was talking about your CPET tests being buried. Unger was talking about the practicalities of getting such testing - IF it can be proven to be a realistic indicator of the disease (and not functional ability) - into the clinic. If I did not display and relate my experiences of PEM I would not have been diagnosed with ME. And it was certainly one of the main things asked of me again even more recently by the - yes indeedy - NHS CFS/ME Specialist Clinic and my GP is most certainly aware it is a symptom to be included within a diagnosis and before a diagnosis is made. But - to be the devil's lawyer once again - asking a patient is not the same as confirming it as being key to a disease mechanism. And I hate to do it but referring to the 'meme' discussion... well pretty much anyone who is unwell will feel worse after they have 'done too much' and could report it as PEM. I just don't think we are there yet - maybe wont ever be - and perhaps PEM will not emerge as the de facto requirement. I still refer back to conversations I have had with RR MS friends and even with my Mum who has RA. They will similarly 'flare' after over exertion. Maybe this test can be shown to demonstrate something 'different' about people like you and me with this diagnosis: but establishing cause and a mechanism is more likely to - in my opinion - be the thing to eventually make it into the clinic and be part of any diagnostic testing.