Thank you for the invitation to speak on behalf of Phoenix Rising. We are a non-profit patient-led organization which hosts the largest online forum for ME/CFS patients. We have enlisted our members to comment on the question posed by the IoM in their study to recommend clinical diagnostic criteria for ME/CFS: “What is the most important aspect or information that this committee should consider throughout the course of the study?” Phoenix Rising members have identified several points of focus: ME is an organic, complex, seriously disabling disease · ME needs a definition at least as strict as the CCC or ICC · ME is not a psychogenic somatoform illness · Myalgic Encephalomyelitis (ME) should be the term used for the disease 1-ME is an organic, complex, seriously disabling disease ME is a complex, severely disabling disease involving multiple systems in the body. It involves extreme muscle weakness, drastic loss of stamina, cognitive dysfunction and viral symptomatology along with neurological and endocrine dysfunction. Fatigue is only a small part and not necessarily the most prominent symptom. ME renders half of the patients unable to work. A quarter of the patients are left bedbound, some unable to feed themselves. Others have died due to complications of ME. In the U.S. estimates show that there are 800,000 adults and children suffering from ME/CFS. This would mean that 200,000 patients might be listening to us from their beds. In addition, this large group of disabled patients is a great strain on the U.S economy. You might be surprised then to hear that in each of the past ten years the NIH has spent less on ME than on hay fever - a mere $3m to $6m. 2-ME needs a definition at least as tight as the CCC or ICC Most of the experts treating and researching ME have endorsed and are currently using the Canadian Consensus Criteria (CCC). They have recognized that by using post exertional malaise (PEM) as a hallmark of the disease and mandating neurological and immune dysfunction, the CCC best captures the patients who are suffering from this particular disease. Any new definition for ME must include PEM as a minimal prerequisite for the diagnosis of ME. The CCC were created to distinguish ME patients previously diagnosed using broad CFS definitions such as the Oxford Criteria of 1991 and the Fukuda Criteria of 1994. These definitions selected many who suffered from vaguely defined idiopathic fatiguing illnesses. These broad definitions have impeded serious research into the complex disease and have held the disease hostage without a chance of effective recognition and advancement. The time has come to move the understanding of ME forward and to stop being stuck in the past. Studies on the disease have shown that there are testable biomarkers, such as the two day cardio-pulmonary exercise testing (CPET), which show remarkable abnormalities in ME patients. The fact that PEM/PENE is a hallmark of the disease is no longer debatable. Immune dysfunction has been shown with multiple studies uncovering defects in natural killer cells in ME patients. Neurological/cognitive dysfunction has been shown by abnormalities in cerebrospinal fluid and structural MRIs. We therefore ask the panel that the population of severely ill and disabled ME patients should be separated out from the broad fatigue-based definitions, using a definition at least as 'strict' as the CCC or ICC. 3-ME is not a psychogenic somatoform illness Terms previously used to describe the syndrome CFS, such as “depressive mood”, “deconditioning”, “somatoform”, “personality disorder”, “childhood abuse”, “hypochondria”, “laziness”, “malingering” , or “unwellness” do not apply to the organic disease of ME. Other illnesses such as Asthma,Stomach Ulcers, Multiple Sclerosis, and Inflammatory Bowel Disease have been thought as ‘psychosomatic’ until a known and identifiable physical element was discovered. Any research into ME as a psychological, psychogenic or functional disorder should be disregarded. Attempts to give a psychiatric or somatization explanation for our illness have utterly failed to explain the realities of the disease, and are incompatible with the details of its progression. 4 Myalgic Encephalomyelitis (ME) should be the term used for the disease The term “Chronic Fatigue Syndrome” (“CFS”) is not appropriate for this disease. No disease should be characterized by a symptom shared by many healthy people. Patients with different illnesses and different clinical needs are mixed together under a single ‘CFS’ label. CFS as defined by Fukuda may include people suffering from depression and idiopathic fatiguing illnesses. This leads to confusion in clinical settings often leading to chronic neglect. ME, as described by the CCC, has a distinct and definable nature. It best describes our members’ complex and specific symptoms of muscular and neurological dysfunctions. We would like you to know that our members have expressed many concerns about this study, including and especially the fact that many members of the panel, as currently constituted, lack appropriate expertise in the treatment or diagnosis of this disease. In addition, there is a large group of stakeholders, experts, advocates and patients who are calling for a cancellation of this study and the adoption of the CCC now. Their concerns are due to the fact that they believe that a new definition can come only from a panel of knowledgeable experts. Some have questioned the legality of the contract as well as the lack of transparency in the actions of HHS. These feelings have resulted in them boycotting these proceedings and choosing not to take part. Please keep in mind that the recommendations that this study will produce will directly affect the lives of millions of patients worldwide. We hope that you will take the patients’ voice to heart and that you will continue to invite us to be part of the process.