I ask this question from a place of relative ignorance on other long term diseases. I know that in MS for example, there are often lesions in the brain that appear to be irreversible even, in some cases, with HSCT. In my understanding, this doesn't appear to be true in ME/CFS. For example abnormal SPECT scans merely show a lack of blood flow that can (in theory) be corrected during periods of remission. And full recoveries in the RituxME trials (as well as global symptom improvement from spontaneous remission, Ampligen, and mold avoidance) seem to indicate that, at least in some people, damage is not permanent. Of course there are co-morbidities that can cause structural damage (e.g. heart, bone structure). A few questions for discussion: Is there truly a lack of non-permanent damage in pure ME/CFS or is this an unfounded assumption that no one really knows the answer to? Are other long term diseases fundamentally different in the irreversibly of their harm to the body? What constitutes permanent damage? (e.g. non-regenerative tissue destruction?) Given medical research and technical advances, how likely is it that the scope of "permanent damage" will become more narrow? In the context of reversing damage, is the model of "flipping the switch" upstream with healing occurring downstream more plausible than addressing each organ system derangement on its own to cumulatively restore equilibrium? I've seen these topics briefly addressed on other posts, but not in a dedicated way on one thread.