Prof. Edwards could not possibly know the personal loss which caused me to lose patience with an entire profession. If I have said anything personally abusive or intemperate, I apologize.
What I would like to do is focus on a positive aspect of this study correcting a lack which has maddened me in discussions with immunologists. In my experience it was Dr. Paul Cheney who pointed out that most patients with real ME/CFS have low cardiac output, and that cardiac output plays a crucial role in immune function.
Once this was pointed out the realization was blinding: cardiac output controls the rate at which immune cells reach tissues, and the rate at which information from infected tissues reaches other parts of the immune system. Many immune processes require multiple trips on this transport system. The delay between initial immune stimulus and a powerful response determines a great deal about the effect of infectious agents. The expectation that patients with low output would have immune problems is confirmed in the case of recognized heart failure. This insight also caused a number of things I've seen over a lifetime of visiting those who are ill to fall into place.
Now, my experience in dealing with immunologists has been discouraging. Generally, they don't know a patient's cardiac output, or a proxy for same. Worse, they are not particularly curious. You can get responses ranging from disputing objective measures, to denying relevance, to insisting "we knew this all along". There was a time when I thought this was simply because I was only dealing with practitioners who were small cogs in a larger system. Research literature disabused me of this notion.
(I'm still wondering what goes on in the minds of most practitioners. My impression is of a flotsam of disparate facts drifting about in a kind of Sargasso, and forming random constellations on which some kind of pattern-matching takes place. Expertize in reading tea leaves might help one to delve deeper.)
Consider a patient with low cardiac output whose immune system is doing the best it can with limited resources. Now, consider a patient with good cardiac output whose immune system is barely handling ordinary challenges because of defects confined to that system. They may both exhibit the same poor overall effectiveness in immune response, but for very different reasons. If you conduct research which lumps the two together you can expect the result to be confusion.
By comparing healthy identical (homozygous) twins this study finally matches immune behavior in people with the same cardiac output. What took so long?
