This small MEA study in my view, would not be published with great scientific fanfare to help approve or disaprove of Dr Myhill's test, which, is not expensive considering how much tests cost on the market.
The major study design issue, is this:
The novel Dr Myhill test is on Lymphocyte ATP - white blood cells. This is interesting as its white blood cells that are linked to all manner of immune dysfunction in CFS research. Note this is blood, not tissue. The tissue in desperate need of research in neuro sign severe ME is lymphatic tissue - biopsies. Here may lie a pathogens reservoir, including prions.
But:
Those who don't want people to link low ATP in WBC with chronic infection in PWME, will perhaps attempt to discredit the WBC ATP findings in patients as 'unproven' using any method they can.
Historically, the pro BPS lobby (who deny ME is an organic disease, distinct from CF) would love to crush the sale of any biomedical test that exposes the huge gap in science, BPS CFS is based on - no science remember, only beliefs.
Yes, the classical way to measure Mito function in Mito disease is a muscle biopsy, but ME is an aqquired disease (like AIDS or MS), not a congenital muscle weakness disorder, hence most (not all) PWME muscle biopsies are negative apart from the odd non specific virus plenty PWME never get nailed by. (There's an issue of disease latency, subsets, length of disease - all variables unable to be controlled for by the researcher). Then you need to add in which patients have inflammation, then types of inflammation (CRP/ESR vs Oxidative Stress etc).
Combined, its too complex without the kind of budget the MRC would grant ME denial researchers.
So, comparing two different areas of biology to conclude which is best in a paper is impossible, because they are different areas of biology and no method is right or wrong, they are complimentary exclusionary or (theoretically) inclusionary.
Yet the BPS CFS guru's will revel in potential to cite 'research evidence' that challenges clinical usefullness of Dr Myhill's test, should this occur.
To prove which test is better you need to do bloods and biopsies on the same research participants. (Arm biopsies aren't generally sufficient, you'd need thigh surgery to get good mitochondrial muscle samples).
Yet an 'open' mitochondria muscle biopsy is very painful (can't anethatise muscle as it ruins sample) and is somewhat risky (nerve damage, infection, blood loss is possible). Ethical approval is thus going to be challenging in a bunch of presumed 'tired people'.
I would then remember, that a simple blood test, such as Dr Myhill's carries much less risk to a patient, even if the results are not muscle centric, they are still cellular ATP based.
In my view, I would let Dr Myhill sell her test and not interfere on the grounds of worries over cost/which is more suitable etc, because by potentially stopping it, you reduce patient legitimacy in the community, who otherwise have zero proof of organic weakness (unexpected low WBC ATP go a sceptical GP etc).
Cohorts won't accurately reflect which test is more appropriate anyway due to heterogeneous issue:
Some accuracy occurs using ME-ICC or CCC CFS. Yet, no one with the confusing CFS/ME need complain of, or display, any medical sign of muscle weakness or any other medically verifiable sign of disease.
How then, one determines which research group had 25% or 85% of probable 'ME' patients in a muscle study Vs a Lymphocyte ATP blood test, using British CFS/ME diagnostic criteria...is anyone's guess.
This is a massive problem when determining any test validity in CFS or ME, meaning few robust conclusions can be made, especially when selecting assays.
As long as weak diagnostic criteria is allowed, the more tests, the merrier. More tests = more data. Once subgroups are identified, then we can decide fairly, which test is more suitable for whom.