You are here: Simmaron ResearchME/CFSThe Big Fishing Expedition: Report From the NIH Intramural Study on ME/CFS

The Big Fishing Expedition: Report From the NIH Intramural Study on ME/CFS

A Big, Deep Fishing ExpeditionNIH jpeg

“We’re throwing every known sophisticated technology at these patients.”

Avindra Nath, MD – Lead Investigator of NIH Intramural Study on Chronic Fatigue Syndrome

The NIH’s Intramural Study on ME/CFS now underway is almost certainly the most comprehensive chronic fatigue syndrome (ME/CFS) study ever done. In fact, it may be one of the more multi-faceted studies done in any disease. It’s breadth is astonishing. Besides the blood, urine, fecal matter and saliva gathered, participants will spend a night in a metabolic chamber, get their brains scanned, have their their immune systems transplanted into mice, and their neurons grown in a petri dish. After years of patient advocacy – at least in this one study – ME/CFS has abruptly transitioned from being one of the poorest studied diseases of all to getting an array of cutting-edge technologies thrown at it.

NIH intramural study net me/CFS

The NIH is casting a wide, wide net in its intramural ME/CFS study

Featuring top researchers at the NIH’s big research hospital its results are guaranteed to get noticed. This one study won’t solve ME/CFS – no one study can do that –  but it could and really should provide dramatic new insights into it, and, most importantly, provide the foundation for years and years of study into it.  Nath, for instance, recently suggested the study could produce the bio-signature we’ve been seeking for years.

The study is basically a huge fishing expedition, an anomaly for an institution known for its strict adherence to hypothesis testing. The NIH is looking (and building data) just about everywhere in patients.

We probably have NIH Director Francis Collins to thank for that. Collins has more control and discretion over the intramural site than any other part of the NIH and it shows. Collins got this study started before the NIH allocated money for the research centers. He wanted and got Avindra Nath – a highly prestigious researcher specializing in neuro-infectious diseases – to lead it and he got the NIH to bring out its fishing poles and fish.

Round One: The NIH’s “Deep Phenotyping Exercise”

Not only is the breadth of the study unusual, but the rigor with which it’s being run is unmatched. The first part of the study (participants come in for two rounds of testing) is partially being done to ensure that only one kind of patient participates. This is an important point since the ME/CFS disease population is very heterogeneous and mounting studies are identifying distinct subgroups.

In order to capture post-infectious ME/CFS patients, the study requires participants to have a sudden flu-like onset that’s been documented in a doctor’s files.  After taking questionnaire after questionnaire, a complete review of a patient’s medical records are being made by a panel of ME/CFS experts. Dr. Dan Peterson noted that one patient’s file ran to 191 pages (he said read every one). Dr. Peterson, longtime expert ME/CFS clinician and Simmaron Scientific Advisor, is reviewing patient selection for the NIH Intramural study.

Even the ME/CFS doctors reviewing the patient records have been taken aback at times with the strictness of the study. Dr. Peterson relayed one incident where Brian Walitt’s questioning of whether a patient should be included in the study raised eyebrows. (Walitt is the clinical lead investigator. Wallitt promptly dug into the Canadian Consensus Criteria to show the exact criteria the patient didn’t meet.)

Dr. Peterson noted that the reviewers have debated how “sudden” a sudden onset needs to be for someone to be included in the study. Does a patient have to remember the exact date they became ill or is something more general sufficient?

Another interesting twist concerns the rigor with which prospective patients have been tested. ME/CFS doctors that do more testing that others are more likely to find something that could kick a patient out of the study. That same patient coming from an ME/CFS doctor that doesn’t do a lot of testing might get into the study.

The first part of the study is apparently an attempt to level the playing field. Test after test after test is being done during the nine days a) to gather data and b) to ensure that nothing other than ME/CFS (and specified co-morbid diseases) is going on in these patients. At least in these early stages anything that looks off is being investigated. The NIH is calling the visit a “deep phenotyping” exercise.

An ME/CFS Patient Reports: Brian Vastag on Round One of the Intramural Study

It was fitting that Brian Vastag be one of the first ME/CFS patients to go through the first part of the study. He did after all, play a role in getting it started.

Vastag’s  “Dear Dr. Collins: I’m Disabled. Can the N.I.H. Spare a Few Dimes?” piece effectively used Vastag’s personal story to highlight the devastating funding problem and, importantly, provide a way out of the problem that was probably very appealing to Collins. (The dark humor in the piece didn’t hurt either.)

Francis Collins - Brian Vastag

Francis Collins, the Director of the NIH stops by for a visit. Vastag pushed for more ME/CFS funding and asked for ME/CFS to be assigned to a single institute

Vastag used to work for the NIH; in fact, Vastag worked with John Burklow, Francis Collins’ right hand man for communications for years. Vastag also worked with the Journal of American Medical Association (JAMA), and then reported for the Washington Post on science and medical issues. He knows the NIH well and used his personal connection to Collins to lobby for more funding.

He got in the study the old-fashioned way – by emailing the study recruiter.  In the months leading up to his stay, Vastag reported he had several conversations with the lead clinical investigator, Dr. Brian Wallitt, provided his medical records, was fully informed what he was in for and was provided several opportunities to bow out if he chose.

Thus far the reviews of Dr. Walitt from two people (Dr. Peterson, Vastag) participating with him have been positive.  Dr. Peterson said he found him attentive and interested, and Vastag, who said he spent a lot of time with him, found him available and dedicated.

Vastag spent five or six hours relaying his medical history to Dr. Walitt and nine full days in the NIH hospital. The history, he said, was very detailed.

Some people have worried that the ME/CFS patients well enough to participate in the NIH’s intramural aren’t sick enough to get results. Brian Vastag is exhibit number one why that hopefully is not the case.

When Vastag got sick he got really sick. At one point, he was 98% bedbound.  On his eighth or nineth doctor journey, Vastag saw neurologists and got checked out at a multiple sclerosis clinic.  Now he’s probably moderately ill for an ME/CFS patient and has to limit his walking to about 2 blocks a day; e.g. Vastag cant work at all, and he’s functionally very limited.

My guess is that if you can only walk two blocks a day without getting whacked there is something seriously, seriously wrong with you. Ditto with work; if you can’t work without getting hammered you have something seriously wrong with you that should be discoverable.

Having moderately ill people (by ME/CFS standards) participate in a study may not get the sickest patients in the study but it also brings with it the bonus that researchers don’t have to worry about the confounding factors that severe deconditioning brings. If there’s something to find in the testing the NIH is doing it should be found in these patients.

Cutting-Edge Technology

“I can’t believe they are letting us do all this stuff”.

Brian Walitt, MD MPH

The NIH is after all, throwing a lot of new technology at this disease. Vastag was told the intramural researchers have the green light to do a deep exploration of this disease and to let the evidence take them where it will.  They also have carte blanche to add to the study if the need arises.

Nath-Vastag-NIH

Avindra Nath stops by. Vastag said Nath had a great sense of humor. (Photo by Beth Mazur)

The head of Clinical Neurology at the Intramural Center, Avindra (Avi) Nath, heads the study. Nath has co-authored hundreds of journal articles and is on the editorial board of several journals. His main research focus – on the effects of infection on the brain – couldn’t be better suited to ME/CFS.

His latest paper on the cerebral spinal fluid in the survivors of the Ebola epidemic is exactly the kind of post-infectious work he’s been tasked with doing in ME/CFS. His 2016 review of Ebola survivors highlighted the functional declines seen in those who survived the outbreak. The study also noted that joint and muscle pains were “persistent problems” in more than half the 200 plus survivors assessed.

“Tellingly, the survivors reported a functional decline when compared with before the EVD outbreak. In comparison with the household contacts, the survivors were more likely to report a decline in both overall health (70% vs 18%) and ability to work (70% vs 7%).”

Nath told Dr. Peterson, after Peterson’s NIH talk on epidemic presentations of ME/CFS, that the Incline Village outbreak was probably an infectious encephalitis type of outbreak but that the technology at the time wasn’t up to diagnosing it. Nath has also collaborated often with Dr. Ian Lipkin on infectious diseases, and we know Lipkin’s work in ME/CFS is refining our understanding of immunity in the disease. Nath’s 2015 review paper demonstrated that the HIV virus may be able to survive in reservoirs in the brain indefinitely.

Nath will oversee a huge amount of work and do some cutting-edge work of his own. Using a new technique developed in his lab, Nath will knock out the immune systems of transgenic mice and give them the immune systems of ME/CFS patients.  He’ll also turn white blood cells from ME/CFS patients into “brains in a dish” neurons grown in the lab that Nath can then test. This technique, pioneered by Nath for other neurological diseases, can point highlight certain types of cellular problems.

A ton of data is being gathered in the first part of the study.  Besides his half a day of questionnaires, Vastag had standard labs done, provided his spinal fluid, did a sleep study, got 3.4 billion white blood cells drawn for Nath’s experimental studies, had his blood drawn for the Sea horse (mitochondria/energy production) study, had an EMG done to rule out muscle myopathy, did a tilt table test( positive for POTS), an MRI, and gave samples for the metabolomics part of the study. Just about every “tissue” possible, from blood, to urine, to cheek swabs to cerebral spinal fluid was gathered.

Seahorse-Vastag-chronic-fatigue

Rebekah Feng is studying the mitochondria in ME/CFS

Some results may already be showing up.  The Seahorse study results from just three patients were unusual enough that the intramural mitochondrial expert came down to Brian’s room and chatted with him.

Part II of the study will require a week’s stay and include an exercise test on a stationary bicycle, sleeping in a metabolic chamber, cognitive testing, and more blood and other tests.

The study’s only down-side appears to be its size and the time it is taking. Vastag reported that Nath expressed regret that the study was taking so long and told him that he was trying to speed things up. A couple of months ago, Vastag said he was the fourth patient to go through the study. At the NIH Telebriefing Nath said ten people have now gone through the first part of the study and one will start the second part at the end of July. Since the second part of the study was originally slated to begin in fall, it appears that Nath may indeed have speed things up.

Some researchers and doctors have expressed concern about the study’s forty-patient size, but Nath is convinced he can peel off any subsets with the patient group he has to work with.

 

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50 Comments

  • joe

    July 24, 2017 at 11:33 pm - Reply

    looks like promising stuff

  • Troy

    July 25, 2017 at 12:35 am - Reply

    “ME/CFS has abruptly transitioned from being one of the poorest studied diseases of all to getting an array of cutting-edge technologies thrown at it.”

    This is a single study. ME/CFS continues to be one of the poorest studied diseases.

  • Johannes

    July 25, 2017 at 1:19 am - Reply

    This study is breathtakingly comprehensive. Thanks for reporting on it, Cort.

    Might the federal government good for something after all? 🙂

  • aquafit

    July 25, 2017 at 1:53 am - Reply

    The requirement that all participants in the study be proven in a doctor’s record to have a definite post-infectious onset excludes all those who have been subject to chronic or sudden chemical toxicity and those whose onset started with a major injury. So the “sheep dip”, “toxic building (including mold) onsets will be completely ignored.

    Is this a study aimed at getting to the root of ME in all its forms and building a true comprehensive picture or is this a bid by NIH to come up with a “comprehensive” study which “proves” that ME is simply infection related? Why? Why skew the picture by purposefully excluding whole categories of patients?

    • Troy

      July 25, 2017 at 2:01 am - Reply

      Yeah. That really destroys the usefulness of this study for a very large number of patients.

    • Johannes

      July 25, 2017 at 4:13 am - Reply

      I agree that it included a large number of ME patients. However, they have to start somewhere. And by starting with this tightly defined group, they might be able to at least help that subgroup.

      That said, I understand your disappointment if you are not in that group. I could well imagine though that the insights they gather in the post-infectios onset group also helps people in other onset groups of ME.

    • James

      July 25, 2017 at 4:42 am - Reply

      They only get 40 patients for this study. By studying a (hopefully) homogeneous group of ME/CFS patients they hope to make the results more certain. It is likely that many of the findings will carry over to other ME/CFS patients as there are virtually no other conditions that have a similar set of symptoms, in particular the severe delayed symptoms from any kind of exertion (physical or mental). Assuming that some very unusual findings come out of this study, more studies with a broader array of patients will almost certainly take place.

      • Cort Johnson

        July 25, 2017 at 10:42 pm - Reply

        Absolutely. They seem determined to investigate every nook and cranny of this disease. I would be surprised if ME/CFS the disease will not surrender at least some of its secrets to this investigation. If and when it does the NIH will be bound to investigate further. That’s the key thing for me – the NIH has to trust results from the NIH!

        Anything that can stop people from exercising and work will hopefully be discoverable in a study of this type.

        • Carole

          August 11, 2017 at 7:05 pm - Reply

          I am glad we are going the extra mile in research-however, unless there are enough Physicians available to see someone and you don’t have to wait 1-2 years to see them. This means little. I have had my condition since 1989. had infectious disease Dr then diag it then he went onto Aids treatment when Aids was the Big Disease. I live in Atlanta where the CDC is. Still no one here to treat anyone for this. There are many that are Environmental or Holistic-but that is just a Band aid for us.The time frame for this is ridiculous.

          • Jennifer

            August 12, 2017 at 6:18 am -

            Carole, our fellow Atlantan Ryan Prior (Forgotten Plague, Blue Ribbon Foundation) has spoken of Karen Bullington in Marietta as instrumental in his wellness process. She is an MD who apparently has had ME/CFS. My daughter and I, both bed-bound moderately severes, have not seen her — my husband schleps us to Dr. Cheney (who treats with a battalion of anti-inflammatories et alia). As Cheney’s retirement impends, we’re feeling pretty crazed over the slim pickings here. Dr. Bullington’s is the one local name we have. Let’s hold out hope that we’ll have great choices in ME clinicians as soon as the ATL metro area expands to the left coast…

    • Forebearance

      July 25, 2017 at 8:26 pm - Reply

      aquafit, my ME/CFS had a sudden onset and it happened while I was living in a building with a toxic mold problem. The patients in the Lake Tahoe epidemic had environmental factors happening at the time of the outbreak and they had sudden onsets.

      I would bet that many patients aren’t aware of the part that environmental factors may have played in their illness onset.

    • Cort Johnson

      July 25, 2017 at 10:09 pm - Reply

      I think it gives the NIH the best shot at finding something given the budget they have. Remember there’s probably still very little agreement among many at the NIH that ME/CFS is worth studying at all. It’s really important therefore that they find something in this study that the NIH can build on. That’s what this study is really all about…It’s about finding a solid foundation that the NIH can devote money to. Once that happens, and I’m confident it will, the NIH can turn to other less well known subsets of ME/CFS.

      Plus there’s the issue of expertise. Dr. Nath studies neuro-infectious diseases so it makes sense that he would be given this subset of patients to study.

  • Pat

    July 25, 2017 at 3:10 am - Reply

    Cort, thank you so much for this information which I find to be so encouraging. After 31 years with this horrible illness, I really needed something to cling to again. Some days it is very difficult to continue to hope for a solution in my lifetime. The light does seem a little bit brighter now. I had a sudden onset of what we thought was mono in January of 1986 and had vacationed in Lake Tahoe in late August of 1985, which I’ve always believed had some connection.

    • Cort Johnson

      July 25, 2017 at 10:32 pm - Reply

      I think and Ron Davis’s severe ME/CFS study are the single most exciting projects I’ve seen. Plus the metabolomics work really does seem to be getting down to something – so yes, there’s hope!

  • Esther Siebert

    July 25, 2017 at 5:16 am - Reply

    Hi Pat,

    Your story sounds exactly like mine. I vacationed in Tahoe in August of 1985 and started getting sick in maybe May of 1986. My doctor asked me if I had been in Tahoe the previous year which of course I had. I had an EBV infection which came on slowly over a couple of months–the doc followed my titers–until I was completely bedridden with Raggedy Ann symptoms. The funny thing is that when I went on Valcyte years later, those Raggedy Ann came back during die off. Dr. Montoya had warned us that it would make me worse before better. I’m in my 32nd year too but am 70 now so am not expecting a solution in my lifetime, at least for me. But I hope they will find something to help more recent patients, especially the children and young people. My onset was more gradual–over several months–but was caused by EBV and perhaps other factors cause I was pregnant in Tahoe and had my son November 20th. It’s a long time to be sick, but I hope they start solving the mystery and finding treatments soon. Best to you, Pat.

    • Maija Haavisto

      July 25, 2017 at 7:19 am - Reply

      It’s not just antivirals: my doctor Olli Polo, one of the most important CFS/ME researchers, has reported that e.g. LDN can “rewind” the course of the illness, temporarily bringing back symptoms that were there years ago. (This may be confused with an adverse effect, even though it’s a very good sign.)

    • Pat

      July 25, 2017 at 8:05 am - Reply

      Thank you Esther. I too am hoping more for the younger generations than for myself at this age. It breaks my heart to see so many young lives destroyed. I’ve lost track of the number of research studies I’ve been in. God bless all the clinicians and researchers, especially those who have been at it for such a long time like Dr. Klimas, Dr. Montoya, Dr. Peterson, and so many others!

    • Carole

      August 11, 2017 at 7:10 pm - Reply

      Esther- Mine was also EBV, with CMV . Started out with Fever, Boils under the arms and in the groin area. Acute stage lasted many months. Immune Globulin started me on recovery. Also had problem sequencing things and memory. Would come and go. Still have it and it started in 1989. Just ridiculous that there are really No answers-at least none that most Dr will accept.

  • Thomas

    July 25, 2017 at 9:53 am - Reply

    Thanks for sharing!
    Do you have any information for the estimated time schadule for this process?

  • MsJustice

    July 25, 2017 at 10:21 am - Reply

    How many participants?

    • Cort Johnson

      July 25, 2017 at 9:35 pm - Reply

      I believe its 40 ME/CFS and 40 healthy controls.

  • Merry

    July 25, 2017 at 7:50 pm - Reply

    Now I really feel sick. It’s been YEARS since I could walk 2 blocks, I can’t do 1 block!

  • Karen

    July 25, 2017 at 8:22 pm - Reply

    Thank you Cort! I just watched the clip of the movie, “Unrest” and was crying because its my life onscreen, but reading this makes me feel so much better that we are being heard and believed! Thank you for all uour efforts!

    • Cort Johnson

      July 25, 2017 at 10:33 pm - Reply

      Thank you Karen and thanks very much to Brian for his work and his willingness to share.

  • Brian Vastag

    July 25, 2017 at 8:37 pm - Reply

    Thanks, Cort. I just confirmed that the NIH has begun part 2 of the study this week. That is, they have a patient back for a second visit for the exercise test and metabolic chamber.

    • Cort Johnson

      July 25, 2017 at 9:34 pm - Reply

      Thanks for relaying that Brian. Great to see Part II underway. The sooner they can complete this thing the better. It’s going to be fascinating and hopefully will bring in a new era of ME/CFS research.

      • Carole

        August 11, 2017 at 7:15 pm - Reply

        I also want to thank you Cort. I am sure you are discouraged also -but remain hopeful. I have now also been diag with White matter Disease with Infarcts in the Brain. These have been there evidently for awhile. I think it is all from the same Disease process.

        • Cort Johnson

          August 11, 2017 at 7:30 pm - Reply

          Thanks. I’m more interested than discouraged. I think its an interesting result – which not really a surprise for ME/CFS; it seems to be different!

  • Rita

    July 26, 2017 at 4:08 am - Reply

    I guess if you didn’t have a infectious desease, viral or tram a you may not get the answers your looking for. I had car accident 2005 whiplash, concussion. But didn’t get severe chronic fatigue until 1 year after contacting Mrsa and cellulitis,a year later. Unfortunately because of the whack to my spine , my pain sensation was off the chart so I was diagnosed with fibro and chronic fatigue, they tried to find Lyme because I had went camping but always negative, I know there are coexisting symptoms like anterior pituitary deficiencies But I also believe the symptom of insominia is the domino effect,
    I had severe mono at 14 (enlarged spleen , liver, severe temp) my recent IGG -ebna/Vca very high postitive.
    I also see abnormalities on test that dr’s don’t seem to think it’s important enough to look at.
    Like in 2005 behind ear horribly swollen with pain, MRI showed right mild mastoiditis with fluid in mass air cells, after antibotics treatment, but funny thing is in 2007 mastoiditis with fluid in mast air cells had progressed from previous mri?
    I just hope 40 people are enough to map out all the effective posabilities, and Co morbid brought on because of illness. FOR ALL!

    • Cort Johnson

      July 26, 2017 at 4:37 pm - Reply

      Me too…It is a small number for such a diverse disease but hopefully they will dig deep enough to uncover a good number of subsets. I think they will.

  • Simon McGrath

    July 26, 2017 at 9:25 am - Reply

    Wow, an amazing study and a great write-up, thank you, Cort.

    Yes, the speed is pretty frustrating.

    Given the small sample size, I think they had to focus on a homogenous group and that will inevitably disappoint anyone not in it. I do have concerns, more over severity than anything; if people have never been very ill (unlike Brian) they may be less representative.

    But generally, this is very encouraging.

  • Ben

    July 26, 2017 at 11:30 am - Reply

    Interesting stuff. Do we know their publication strategy? Will they publish findings as they arise (I’d be fascinated to see the Seahorse results) or will there be one giant publication at the end?

    • Cort Johnson

      July 26, 2017 at 4:38 pm - Reply

      Man oh man….I hope they publish as the results come out. That would be good to find out. I hope the NIH researcher makes it to the Ron Davis/OMF Symposium in August.

  • Roland Cheung

    July 26, 2017 at 4:10 pm - Reply

    Hi Cort. Thank you for this encouraging update. There are so many people to thank for making this work possible. Thank you very much too, Brian!

    I’m American, but I have been working in the Netherlands since 2012. I got the flu in 2013 and have been sick with ME/CFS since, but only received an official diagnosis in January 2017. The Netherlands is overly focused on the psychology of the disease. They sent me to get CBT/GET which caused me to experience horrendous crashes. I hope that all future studies exercise more rigor for ME/CFS patient selection and does not fall victim to the controversy surrounding the PACE trial.

    Do you happen to have new information regarding the NIH funding setback for ME/CFS? Dr. Collins had mentioned that funding for ME/CFS research should rise to around $15 million in 2017. However, the Solve ME/CFS Initiative recently estimated that this would only be about the same as what was allotted in 2016. http://solvecfs.org/update-on-the-nih-research-funding-totals/

    Is there any information on what FY2018 will look like for ME/CFS funding?

    • Cort Johnson

      July 26, 2017 at 4:36 pm - Reply

      Thanks for providing that link. I didn’t know that and will check that out. It could be because the money allocated for the research centers isn’t going to show up until the 2018 budget but I will check it out.

  • konijn

    July 26, 2017 at 5:24 pm - Reply

    I had a more gradual onset and went worse and worse. Now I am 98% bedridden. So I have bad luck with my gradual onset 🙁 to be not investigated although I hope to survive to have the strengt to eat. If the NIH would be really serious (and I am glad for those with a sudden onset that this is investigated) they would look for the other sub groups to. Just seperated them. And made the numbers off patients much larger as for other deseases.

  • Beatrijs

    July 27, 2017 at 8:18 am - Reply

    I’am really excited to understand the extent of this study, even though I understand the criticism of excluding all ME/CFS patients whose illness started other than post-infectious onset. Hopefully the results give enough information to be extanded for all ( subgroups of) ME/CFS patients. Do you know when the first results will be expected?

    • Cort Johnson

      July 28, 2017 at 3:36 pm - Reply

      I don’t know. Hopefully this approach will be successful enough that the NIH finally gets serious about all of ME/CFS. I think that’s its goal.

      • Beatrijs

        July 28, 2017 at 5:31 pm - Reply

        Keep the goal in your mind! ME is serious business!!! I hope, as a patient , to know one day what is going
        wrong and, the next day. what I can do to become better. Sp please: keep going!!! I wish you good luck!

  • dejurgen

    July 30, 2017 at 1:39 pm - Reply

    Having such large fishing study done by the NIH is great. Let us hope they catch something really significant in their nets as to not lose interest in ME for some additional years. The USA is still a leading nation for high profile medical research, so if they have clear results other nations could be persuaded to leave the CBT/GET only trail too. That won’t happen that easily without such external stimuli a successful NIH study could give.

    Great write-up once more Cort, thanks.

    I expect a lot from this “participants will spend a night in a metabolic chamber”. I would be very curious to know if that would include the morning till noon too. For patients with severe morning sickness and clear difficulties “to get started” the morning may well be a period of clearing waste metabolites so it could be a good time to fish for oddities.

    Kind regards,
    dejurgen

    • Cort Johnson

      August 1, 2017 at 1:56 am - Reply

      Good point! The morning is often the toughest part of the day for me. I hope to learn more about the metabolic chamber as well – one of the more fascinating parts of the study. I believe it is a 24 hour stay but am not sure.

  • Forebearance

    August 5, 2017 at 10:25 pm - Reply

    Are they going to look at Lymph fluid?
    Is it possible to to test it?

    Because if people with ME/CFS are more vulnerable to getting lymphoma, wouldn’t it make sense to find out what is going on in the lymphatic system?

    Can the lymphatic system host an infection?

    And also, THANK YOU BRIAN!!!!

    • Cort Johnson

      August 11, 2017 at 3:14 pm - Reply

      I don’t but honestly if there’s a tie–in I would be surprised if they didn’t give it a try.

      • Forebearance

        August 11, 2017 at 11:20 pm - Reply

        Thank you so much for everything, Cort.

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