I totally agree with you. I suppose I was trying to explore the reasons why the CDC don't yet see PEM as being of primary importance in a clinical setting. If we understand their point of view, then we can better refine our arguments when we present evidence to them and other service providers. As I said in my previous post, the UK NICE guidelines do require PEM for a CFS/ME diagnosis (although I think the wording is ambiguous) and, as everyone knows, CBT & GET are the only treatments recommended by NICE for CFS/ME. So the requirement of PEM in the NICE guidelines has made zero difference for us. If we're extremely 'lucky' in the UK, we might be offered graded activity programs or counselling instead of CBT/GET. So, our experiences in standard clinical settings are influenced very little by the diagnostic criteria used, and I think this will continue to be the case until we have biomarkers or biomedical treatments. That's not to say that we shouldn't advocate for change. I'm just pointing out what little difference some changes might make in practical terms in the average general practitioner setting. The CBT/GET lobby in the UK argue that CBT/GET are appropriate interventions for CFS/ME patients with PEM, because (they claim) the therapies help to remove the boom and bust cycle that CFS/ME patients experience, etc etc. The PACE trial, they claim, is proof of safety.