I am looking forward to hearing his analysis of this new Tomas et al study.
Absolutely. This is also my main response - it should hopefully be very interesting (from an academic perspective) to hear how Dr John McLaren-Howard explains things. And if any new insights come from this.
When the 2016 Lawson study found higher than normal ATP levels the cells of ME/CFS patients
Oh yes, that apparent contradiction stimulated very interesting debate and was how I cut my teeth first posting on this forum, ultimately contacting Xinnan Wang for
these direct responses. (A couple months before
your post on the response from McLaren-Howard, as you already linked.
)
In other words, the more severe patients tend to have a worse Mitochondrial Energy Score (MES) on the Acumen test than the less severe.
Right. The original Myhill et al papers show the Acumen test to correlate very closely with disease impairment. And their plots showed complete separation between patients and
healthy controls. Which is why I've said that the (disapointingly small) sample size in the replication study should still have found a very strong signal (i.e. probably also complete separation) if their lab method and patient selection was sound (and the original studies were correct). Right?
In the discussion, people panned patients taking supplements in response to the test.
Right. I'm not sure how much the recent paper misframes the context of the use of the Acumen test by the Myhill group. Or if the criticisms it levels are all justified (and appropriate) given the reported findings. Or if there is bias against Myhill via the funding bodies, which commissioned the PACE trial, or directly from the researches, which I know not of...
But it certainly highlights the philosophical disparity between approaches: the conventional medical approach (e.g. of the NHS) to do nothing when there's no proven test/treatment and let patients suffer (and die). Verses the more compassionate and pragmatic overall approach of Dr Myhill (and others here). A kind of tinkering and learning by trial and error experience of what helps.
While I know that this has definitely helped a lot of patients significantly (and is something I support), I'm still sceptical of some of her explanations when it comes to the scientific specifics. On occasion, her reported views on things have seemed dogmatic, given a lack of supporting evidence - explanations probably more tailored to convincing patients to implement difficult but helpful changes.
Similarly I'd be staggered (pleasantly surprised) if McLaren-Howard was, in relative isolation, perfectly 100% correct about such novel technical findings. Given how science is such an iterative, conversational process of decreasing misconceptions, etc (and how messy biology is, specifically). Although the Acumen tests seem to have been a ahead of their time, in correctly looking at reduced mitochondrial energy output, it seems unlikely that he would have pinpointed the correct/entire mechanism(s) of action, there.
At any rate, it doesn't seem to explain the route cause or curative treatments, right? (Compared to a theory like Phair's metabolic trap, etc.) Myhill's treatments only ever seem to remedy/mitigate the worst of the downstream consequences of the illness. Similarly, my expecation is that, if the test is (ultimately) valid, it will only indicate differentiation between severity of ME/CFS disability. (Hmmm, I've rambled on unnecessarily here, sorry.
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