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Interview: Ian Lipkin’s Million Dollar Appeal for Microbiome Study

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Simon McGrath recently secured an interview with the world famous Dr Ian Lipkin – a scientist who continues to believe that ME/CFS has a physical cause – to discover more about his plans for a major study of the gut microbiome and to find out why he's asking the patient community for its support…

lipkin22.jpg

Dr W. Ian Lipkin has demonstrated a clear commitment to ME/CFS research. First came his study looking at Borna virus in the 1990′s, and then the landmark study that ruled out XMRV as a cause, and most recently we have heard about the huge pathogen and immune study – a vast collaboration with many key clinicians and researchers, including Dr Dan Peterson and Professor Jose Montoya.

That research had already found clear signs of immune activation in patients and, when I spoke to him, Lipkin was clearly excited about the very latest results to emerge from the study - I wish I could reveal more, but a paper has just been submitted and details are embargoed until publication.

Lipkin believes that immune activation may be responsible for driving the symptoms associated with ME/CFS. And that the immune activation and could itself be triggered by bugs, not in the blood, but found in the vast ecosystem of bacteria, viruses and fungi, that constitute the gut microbiome.

However, he doesn’t have the funds to pursue this research and so he’s appealing to the patient community for the one million dollars he needs to get the work done. The payoff? A better understanding of the illness and the possibility of new treatments.

Dr Lipkin on ME/CFS

Lipkin made a splash in the world of ME/CFS when he led the XMRV study that both disproved its role in the illness and also managed to unite the patient community. At the press conference for that study he said his first brush with CFS was a large study in the 1990s that demonstrated no connection between the Borna virus (one of many viruses he’s discovered) and CFS. But he stressed that their findings in the same study of B-cell activation in CFS patients was a clear sign that this was not a psychosomatic disorder. The findings in his new study have only confirmed his views:

“There is no question in my mind that this is a physical disorder. The fact that we haven‘t been smart enough or invested enough in it to sort that, doesn’t mean that this is anything else.”

The smoking gun

The immune activation he’s found could explain fatigue – it’s almost a universal symptom of infections like flu, and is actually a consequence of immune activation rather than caused by pathogens themselves.

The same could be true of other ME/CFS symptoms including disturbed sleep and brain dysfunction which again are typical symptoms of immune activation.

Lipkin is eager to build on this work. He believes the immune activation is a smoking gun and now wants to track down who or what pulled the trigger.

“I am more keen than ever … to see if we can identify the trigger”
- all quotes are from Dr Lipkin
smokeNOreuse.jpg

There are several credible places to look for the culprits triggering the activation. One is white blood cells: some viruses could be hiding out in cells and so wouldn’t have been found by the initial search in the blood plasma – and Lipkin already has a white blood cell study lined up.

However, his attention is particularly focused on the microbiome, the large ecosystem of bugs that live on our skin and within our ‘inner tube‘ that leads from mouth to bottom.

There are at least one trillion bugs in the gut microbiome – and there are more immune cells in the gut than anywhere else: it’s a great place to hunt for bugs that might be triggering immune activation.

Microbiome problems are increasingly being linked to serious illness. The most striking example is the superbug Clostridium Difficile (C. diff), which has become a major problem in hospitals. C. diff lives in most of our guts harmlessly at low levels, but it can take over (particularly if ‘good’ bacteria are killed off) – causing diarrhoea and even death. Happily, doctors have discovered that severe C. diff cases can be treated relatively easily by restoring the microbiome; unhappily, this involves a faecal transplant.

The potential to treat disease by restoring the microbiome is one reason this area of research is attracting so much attention. This recent article explains more about the microbiome, how it might link to ME/CFS and looks at other research being performed.

“If the answer were simple, it would be done by now”

Irritable Bowel Disease is another example – here inflammation is believed to result from changes in the microbiome. Lipkin’s team have just been studying women in sub-saharan Africa and found that certain bacteria in the vaginal microbiome increase the risk of HIV infection. Lipkin thinks the gut microbiome could be playing a similarly important role in ME/CFS:

“By analogy with animals and human situations, we see that different populations of fungi, bacteria and viruses in the colon can have an impact on the immune system and give rise to cytokine activation which could cause the symptom complexes we see in ME/CFS”

in other words:

changes in microbiome > immune activation > symptoms of ME/CFS

I asked Lipkin if this meant particular bugs causing inflammation and he said that is certainly possible. But, he added, another route to illness is that an overgrowth of ‘’bad’’ bacteria could form a film, preventing ‘’good’’ bacteria from interacting positively with the immune system (see this article for more) – an indirect way of causing immune dysfunction.

The exact role that microorganisms in the gut play in health and in the development of disease is complex and still being determined. There are many plausible hypotheses, says Lipkin, and only research can show which (if any) are right.

If the microbiome is the cause, is it treatable?

If the microbiome is the cause (or a cause, or even a contributor) of ME/CFS, it might be relatively easy to treat, perhaps with probiotics, restriction diets, drugs, or even faecal transplants.

Cause or effect?
Of course, the first step in this process is demonstrating a strong link between the microbiome and ME/CFS. If one is found then the next step is to look for evidence it plays a causal role: i.e. do microbiome changes cause immune dysfunction, as opposed to being a consequence of or simply associated with immune dysfunction?

Lipkin says one option is to use an animal model: the idea would be to introduce the microbes suspected of triggering ME/CFS into the gut microbiome of animals, to see if this leads to similar symptoms and immune activation as seen in humans. Something that has been used to study Metabolic syndrome.

Personalised medicine
If there is evidence of a causal role, Lipkin says they would look to establish clinical trials of treatments that could include probiotics, antibiotics followed by prebiotics, restriction diets and possibly even faecal transplants. He believes that there would not be a single microbiome cause of the illness, but different types – potentially fungal, bacterial and viral problems causing three separate types of immune dysfunction.

Lipkin calls these different types ‘endophenotypes’ and it could lead to personalised medicine, where the particular treatment depends on the specific form of the illness. There will be endophenotypes beyond those in the gut, such as genetics endophenotypes, and it is highly unlikely that the microbiome would account for all forms of ME/CFS – but this approach could tackle a very substantial proportion of cases.

The study breakdown

Lipkin’s proposed study will look at all three trees of life: bacteria, fungi and viruses in the microbiome of 100 patients and 100 controls recruited for a previous NIH study. It will cost a cool million dollars:

1. Sample collection: $150,000
Collection of faecal (and blood) samples from patients, including checking the initial ME/CFS diagnosis remains valid and shipping chilled samples back to the labs at Columbia.

2. Faecal Microbiome sequencing and Analysis: $317,000
- Separate, purify and perform high-throughput sequencing of viruses, fungi and bacteria
- Complete sequencing of viruses; partial sequencing to identify bacteria (using 16S rRNA) and fungi (using ITS, the ‘fungal barcode’)
- Generate microbiome profile for each patient, one each for bacteria, fungi and viruses​

Comparison of patient and control microbiomes: bacteria, fungi and viruses that differ in prevalence between CFS subjects and controls will be considered candidates for contributing to either health or disease.

3. Development of highly-accurate real-time PCR assays to confirm findings and levels of microbes: $328,000
This will quantify how much there is of each bug of interest (the main high throughput sequencing approach gives an indication of quantity but is less accurate than real-time PCR).

It’s possible, that the most important thing isn’t the presence or absence of a microbe, but the amount of it – as with C.Difficile. These assays will also be used to check that key microbes haven’t been missed in any patient or controls who were negative for them in initial sequencing, as PCR assays are far more sensitive than high-throughput sequencing.

4. Cytokine analysis: $86,000
The study will again measure cytokines in blood and undertake data analysis to see if there is an association between cytokine profiles and immune profiles. It would then provide strong evidence of an important relationship between the microbiome and immune dysfunction – the hypothesis driving this study. Sophisticated analysis will be required on the vast amount of data generated by microbiome and cytokine profiling; happily, Lipkin’s Center for Infection and Immunity have a team of biostatisticians dedicated to such work.

5. Development of antibody tests for important bugs identified by the microbiome work: $249,000
It could be a few individual species or particular groups of microbes, but antibody tests will be developed by Lipkin’s lab to allow much easier testing to see if the same problems in this sample are found in the wider patient population.

As well as guiding treatments, the PCR assays and antibody tests developed here could both provide a diagnostic test for ME/CFS.

Lipkin’s record


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Featured in the New York Times, described by Discovery magazine as the world’s foremost virus hunter, and consultant to a successful Hollywood movie, Dr W. Ian Lipkin has a higher profile than most researchers. But this profile is built on a stellar scientific reputation.

He’s discovered more viruses than anyone else. He’s part of the World Health Organization (WHO) diagnostic discovery and surveillance programme designed to catch pandemics as they arise. And the Chinese recruited him play a leading role in their fight against SARS.

Amongst other things he is John Snow Professor of Epidemiology and Director, Center for Infection and Immunity at Columbia University. Full biography.

He is passionate about communicating science to a wider audience but is insistent the science is right.

Lipkin only agreed to consult on Contagion, a movie about the terrifying potential of epidemics, because of director Steven Soderbergh’s desire to make a film that was true to the science – having turned down offers to advise on several movies with somewhat wilder plots.

When Lipkin was shown a near-final version of the film he threw up his hands at the scene near the climax where a scientist injects herself in the leg with the new vaccine, through her tights – a poor practice that could easily introduce an infection.

This might seem a small detail given everything else the film had right, but Lipkin was adamant it had to go: cue a $100,000 reshoot.

This near-obsession with getting things right is a Lipkin hallmark. The very first point he made to me about this study, before discussing any details, was the need for real, robust findings – because there have been too many false dawns in this field.

At the end of the interview he emphasised the need of crisp, rigorous data. Whatever the findings from this new study – positive or even negative, we should be able to rely on them.​


Scientist in a hurry for answers

Dr Lipkin is a scientist in a hurry for answers. That’s true both in his work trying to stop a new pandemic in its tracks, and in his work on ME/CFS.

He wants to follow up as many promising leads as possible, as soon as possible – rather than waiting for the results of a single study before planning a new one if the first draws a blank.

That’s why he set up a huge study looking for specific pathogens such as EBV, but also used deep sequencing alongside that to search for any other pathogen, known or unknown.

He’s looked in blood plasma for pathogens but is also about to look for them in white blood cells too.

He set the study up to look at immune markers including cytokines as well as for pathogens – and the significant findings of immune activation show the value of backing more than one horse.

On top of all this, Lipkin has invested in a gene expression study using samples from the same study, with results expected shortly that could throw up new leads in epigenetics and genomics.

Dr Lipkin has committed a huge amount of his 60-strong institution’s time to pursuing numerous studies, all aiming to uncover what’s really going on in ME/CFS

Too much, too soon?
However, it may be that the NIH is not in such a hurry as it has declined to fund the study at this time.

But then the NIH has only ever committed relatively small amounts of funding to ME/CFS – around $5 million a year, compared with around $115 annually for MS and $284m for Asthma.

Its funding record firmly suggests the NIH’s priorities lie elsewhere.

So, as Lipkin says, “we are stuck”. It’s possible that the NIH will fund this work in the future, and possible they won’t.

The question is, do we want to wait?

“We are already well behind where we should be”

Dr Lipkin has now appealed to patients to fund his latest study that aims to hunt in the gut microbiome for the ‘trigger’ of the immune activation his study found in ME/CFS. And he needs a cool million dollars to pay for the study outlined above.

Actually, the study comes to a bit over a million dollars (see above) - $1.13 million, to which another $140,000 of costs for maintaining the high-tech equipment used and general lab costs making $1.27 million in total. However, the initial target has been set at $1 million.

In his CDC telecast to patients last September, Lipkin explained the microbiome project was being held up by this lack of funds, and urged patients to contact their representatives in Congress.

He also appealed directly to patients who could afford to do so, to invest in research:

“it may not be appropriate to pass the hat, but that is exactly what I am doing”

How long will it take for the results? “Within a year”, said Lipkin

The man is in a hurry, and the study is all set up and ready to go – once funding is available.

“As long as I can do it, I will do it. I‘m eager to start, I‘m optimistic it will bear fruit, it‘s not just an academic exercise, it could lead to treatment”
When I mentioned to Dr Mady Hornig, the Principal Investigator on this study, that I was interviewing Dr Lipkin she added: “Terrific – we need the resources to get this done”.

Crowdsourcing: Together we can make it happen

I do think we are very lucky to have Dr Lipkin on our case and believe that we should back his new study, which will be performed at his Center for Infection and Immunity, Columbia University – the world’s largest and most advanced academic center in microbe discovery, identification and diagnosis.

“Why don‘t we crowdsource this, we are all losing valuable time in our lives?”
Vanessa Li, Phoenix Rising member and fundraiser

ME/CFS patient, Vanessa Li, responded to Lipkin’’s call last year, by contacting his office and suggesting crowdsourcing in a similar way to MEandYou, which through the efforts of Dr Maria Gjerpe had raised an astonishing $0.5 million towards the Norwegian Rituximab trial in 90 days.

Lipkin was a physician in San Francisco at the start of the AIDS epidemic and commented how, when the government was reluctant to pay, much of the important early work was funded by private donors so he’s very open to this possibility. He continued to seek funds for his work from institutions, but as that hasn’t worked he is now asking patients if they can make the study happen - and has given this interview to launch the million dollar appeal.

Donate to the the ME/CFS microbiome study
I have just donated and hope many other patients will do too. Just click on the button below and follow the instructions. The option is to donate to CFS research, but in the next page you can add ‘special instructions’ such as ‘for the microbiome study’.

We need only for every US patient to donate $1. Or one in ten patients to donate $10.


If people want to do more to help – and this is a big target – they can help to promote this crowdsourcing initiative at this new group, or email Vanessa Li. I will give her the last word:

The CDC says there are more than one million ME/CFS patients today in the US alone. There is no reason why, if every patient were made aware of Dr. Lipkin’s appeal and donated $1, that we should fail to raise the $1 million. An esteemed researcher doing high-caliber work is taking a serious interest in finding out the cause of our desperately under-researched illness. Now is the time to act!​

Simon McGrath tweets on ME/CFS research:


Phoenix Rising is a registered 501 c.(3) non profit. We support ME/CFS and NEID patients through rigorous reporting, reliable information, effective advocacy and the provision of online services which empower patients and help them to cope with their isolation.

There are many ways you can help Phoenix Rising to continue its work. If you feel able to offer your time and talent, we could really use some more authors, proof-readers, fundraisers, technicians etc. and we’d love to expand our Board of Directors. So, if you think you can help then please contact Mark through the Forum.

And don’t forget: you can always support our efforts at no cost to yourself as you shop online! To find out more, visit Phoenix Rising’s Donate page by clicking the button below.


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The thing with RA was that - and from what I have understood - the association with the microbiome had been made in humans and then they took it to mice models. It may be that Lipkin will do similarly - as was said.

Yes - unfortunately it has become a research norm that associations in humans are then tested on non-human animals to try to ascertain any direction of causality. The non-human models then turn out to be extremely misleading in relation to what happens in humans. They are therefore pointless, or worse. They frequently lead to the expenditure of massive sums of (often publicly-donated) money trying to extrapolate animal findings to humans, and end in failure, often causing harm to humans in the process, or at the very least bitter disappointment, as has repeatedly been the case in attempts to develop Alzheimer's drugs.

My comment related to the study you cited above. I have already made it clear here and in numerous other threads - and my blog - that I consider the gut microbiome to be a very likely site for ME/CFS causation, and have also stated that I support Lipkin's (and others') human microbiome research, in humans.

I believe that it is very important to stress the folly of animal models. Just like the pseudoscience that is widespread about our illness, the pseudoscience of animal 'models' has become widely accepted, and most people are not aware that it is pseudoscience.
 
Edited my post above to include NIH article relating to the original Rheumatoid Arthritis study of fecal matter in humans, the discoveries made, and the subsequent testing in mice.

From my blogpost linked to above:

...postdoctoral researcher Hachung Chung and her colleagues at Dennis Kasper's Lab at Harvard Medical School tried raising mice with exclusively human gut microbiota.

The human microbes did pretty well in the mice guts (the researchers could tell by culturing fecal pellets from these mice). Interestingly, though, the mice with these microbes did not: their immune systems remained underdeveloped. Even when researchers gave rat microbiota to mice, the mice's immune systems failed to mature.

So, as I had guessed prior to seeing the article and associated paper posted in my blog, even healthy human microbiota do not perform normally in mice, so what is the sense of using mice to test abnormal human microbiota? The gut-immune connection is central to hypotheses of ME causation. I have reams of further info about gut-immune differences between species but haven't had time to edit it to put in my blog yet.

I am just trying to help people save time, money, false hope and health damage from trusting non-human studies. It is a thankless and never-ending task, as almost everyone seems to trust this particular norm.
 
The blog said:
But then the NIH has only ever committed relatively small amounts of funding to ME/CFS – around $5 million a year, compared with around $115 annually for MS and $284m for Asthma.

Turns out it's not just the NIH who aren't interested in ME/CFS, neither are the CDC according to their 2014 Financial plan: an increase of just 0.8% ($40k) to $5.4 million. Which frankly isn't anywhere near enough.

@sjmnotes (me) tweet:

MT #CDC 2014 Plan: #CFS spend up just 0.8% to $5.4m. Compare asthma, up $1.4m to $27.5m

I'm afraid that for now, it's down to us patients to do what we can if we want to see more research funded.
 
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Just an interesting little aside, for anyone interested in changing diet to change the gut microbiome:

Gut Microbes Respond within Days to Major Diet Changes
http://www.scientificamerican.com/article/gut-microbes-respond-within-days-major-diet-changes/

There's a little bit more about it here:
http://www.newscientist.com/article...arks-gut-bug-revolution-in-just-24-hours.html

And this is the actual study:
Diet rapidly and reproducibly alters the human gut microbiome
David L, et al.
Nature (2013) 10.1038/nature12820
doi:10.1038/nature12820
11 December 2013
http://www.nature.com/nature/journal/vaop/ncurrent/full/nature12820.html
 
A series of videos about the microbiome from Canadian Digestive Health Foundation:

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We have 10 times more bacteria cells than human cells in our bodies. Bacteria living within our gastrointestinal tract makes up an environment known as our gut microbiome. The number and variety of bacteria residing in our gastrointestinal tract are as individual as we are and have an immense influence on our health. The CDHF is embarking on a journey to better understand the microbiome and its impact on human health. We invite you to join us on this exciting journey of discovery.

How We Communicate with Our Microbiota and How It Communicates with Us

Dr. Karen Madsen, Professor of Medicine at the University of Alberta and Co-director of the "Center of Excellence for Gastrointestinal Inflammation and Immunity Research (CEGIIR) provides a fascinating overview to help us gain an appreciation of how microbial metabolism can influence gut health, understand how gut microbes can modulate immune function and, recognize the different ways in which microbes and the host interact with each other.

Watch Video

IBS and the Microbiota

Gastroenterologist and Associate Dean for Research at McMaster University, Dr. Steve Collins, provides insightful fact to help us understand current concepts of IBS, the interactions between the intestinal microbiome and the gut-brain axis, and microbiome-directed therapies for IBS.

Watch Video

Microbiota 101 : Microbes and the Human GI Tract


This presentation from Dr. Richard Fedorak, Professor of Medicine, University of Alberta and President, Canadian Digestive Health Foundation helps us understand the development of the human microbiome, understand changes in the human microbiome in human disease, understand the role or probiotics in the treatment of human diseases, and learn how microbes can become biomarkers for us in the future.

Watch Video

Microbiota in Health and Disease

In this presentation, Dr. John Marshall, Professor of Medicine at McMaster University and Chief of Service for Gastroenterology at Hamilton Health Sciences in Hamilton discusses the long term sequelae of enteric infection, links among gut flora, IBS and IBD how changes in the microbiome can both induce and heal C. Difficile infection.

Watch Video

Your Microbiome - Good or Bad Gut Bacteria?

Listen to a fascinating presentation by Dr. Richard Fedorak, CDHF President and Professor of Medicine at the University of Alberta, Edmonton, AB who introduces you to the marvellous world of our gut microbiota.

Watch Video

Understanding and Harnessing the Power of Probiotics

There is much buzz out there about probiotics these days. These friendly bacteria can be used to prevent and treat disease -- particularly in our gut. Probiotics stimulate the immune system and displace harmful bacteria that might otherwise cause disease. Specific digestive benefits of probiotics can include: reducing the severity and duration of diarrhea, treating constipation, improving the symptoms of, preventing ulcerative colitis from relapsing, counteracting lactose intolerance and more.

Watch Video

Understanding and Fostering a Good Gut Environment, Richard Fedorak, MD FRCPC FRCP(London) FRSC

LEARNING OBJECTIVES:
  • To learn what your microbiome is and how it originates
  • To understand how your microbiome affects your body
  • To learn how you can change your microbiome with probiotics and prebiotics
Watch Video
 
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BTW, I just managed to post in the non-FB (I think) bit of the comments section of that Tuller piece by replying to someone else's comment, rather than trying to make an original comment.

Argh, social media! But it's clearly possible - please do post on there to say you've donated, if you have. It really does encourage other people - plenty of research to show that. :)
 
BTW, I just managed to post in the non-FB (I think) bit of the comments section of that Tuller piece by replying to someone else's comment, rather than trying to make an original comment.

Argh, social media! But it's clearly possible - please do post on there to say you've donated, if you have. It really does encourage other people - plenty of research to show that. :)
Sasha, I'm afraid I still can't see either of your comments. I can't see yours in the "FB Conversations" section, nor in the lower section either.

Is anyone else having this problem or is it just me?

ETA: attached is a screencap. Unfortunately I do not see Sasha's comment anywhere, even when I scroll down to the bottom!
 

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hi, just wanted to make a point about funding. I think there are so many patients out there who just don't know about this- I've only found out about it because I've come onto this site. in my local support group there are over 100 people but they just don't have the energy to find this stuff out. Just think of how many support groups there are in each country and then all over the world-I bet the majority aren't even aware of this funding drive. I don't know if such a thing already exists but how about establishing email contacts with as many local groups as possible to filter through such such news? many local groups produce newsletters too which could feature it. there's always the risk of donation fatigue but the flip side is more people know=more money. And I agree it's a scandal our governments aren't helping more.
 
hi, just wanted to make a point about funding. I think there are so many patients out there who just don't know about this- I've only found out about it because I've come onto this site. in my local support group there are over 100 people but they just don't have the energy to find this stuff out. Just think of how many support groups there are in each country and then all over the world-I bet the majority aren't even aware of this funding drive. I don't know if such a thing already exists but how about establishing email contacts with as many local groups as possible to filter through such such news? many local groups produce newsletters too which could feature it. there's always the risk of donation fatigue but the flip side is more people know=more money. And I agree it's a scandal our governments aren't helping more.

Thats a great idea. Does anyone have contacts at various support groups?
 
Thats a great idea. Does anyone have contacts at various support groups?

We have compiled a dataset of the organisations and support groups that we could locate in many countries around the world, and will be planning a campaign of awareness that tries to establish contact with them, and raise awareness of the proposed study and need for donations.

But, we could do with your suggestions - we might have missed some! I think this is especially true of America - the local 'on the ground' networks especially. The UK is especially well organised in this respect, and by comparison: but while we will try and produce translations - we do aim to target the English-speaking countries initially: and America is our main target in this regard.

So. If you guys do have some specific suggestions for 'grassroots' support groups and/or local networks - then please let us know.

You can contact the campaign team via our email (from the website http://www.microbediscovery.org/contact/) info@microbediscovery.org with your suggestions. We would need the name, a designation contact perhaps, an email and/or Facebook address. As much information as you can provide.

Or if you feel able to take along the information to a local support group meeting, we will shortly have available 'support packs' that will include flyers, posters, and other campaign materials, for distribution.

We said from the start that this campaign was in large part about connecting with patients across many countries and trying to gain affordable donations from a wide pool of donors. The more people we can reach in this way - hopefully the better for the campaign :)
 
that sounds great-but it isn't something I've heard of amongst my local group. I know the group Action for Me has a list of all/majority of support groups in the UK- this could potentially be a resource? I wonder how many of these names you have? It's fantastic that a network is established that could help with ME related issues eg.to add votes to Newry & Mourne's campaign to adopt the CCC in Northern Ireland-yet I only found out about this as I happened to come across it in a post. If this network was one where groups such as this with a current campaign could tap into they'd have all the votes they'd need by now rather than hoping more people just 'come across' it. They do appear to be a particularly active group so it seems that both a national and international network of ME groups is yet to realise its full potential.
 
New total update:
As of today, $57,189 (£34,075 or EUR41,692) has been raised from 362 donations. Thank you to every one of you for your continued support for this project.

Please help us spread the word by inviting your friends to 'like' the page https://www.facebook.com/microbediscovery
, by sharing our website www.microbediscovery.org which contains information about the study, the scientists (including Dr. Ian Lipkin) or by following us on Twitter: www.twitter.com/microbeproject and by donating directly to Columbia University at www.bit.ly/DonateToDrLipkin

Together we can do it!