Journal of IiME Volume 6 Issue 1 (June 2012) organization, even if we are as yet unaware of its details. • Contrariwise the new ICC encourages that symptom structure be observed on-line as interacting embodied and embedded causally interactive dynamical process(es) that have multiple subjective/objective manifestations. These are first observed (or ignored) in a clinical dialogue as (subjective) symptoms and (objective) confirmatory signs which are disambiguated on-line, in their natural context, as temporally dense and as having felt/observed causal efficacy. These individuated observations are in turn confirmed by objective biochemical measures, pathophysiological functional testing and imaging. The “same” phenomena can also be studied off-line using epidemiological studies which observe the generalisable constancies found in groups of variously homogenous groups of cases using standardizing techniques of questioning and observation to obtain generalisable results and case definitions. In the standardized and properly randomized environments of scientific experiments, the effects of interventions can be properly controlled, and thus general rules of causality inferred and quantified. • As the ICC panel members add clinical guidelines and symptom scales (ICSS), these three essential kinds of observation will be integrated by using a transductive and mutually confirmative language that matches the dynamical causal patterns to be found in each realm. This pattern “language” must be flexible enough to negotiate the changes in scale and context involved in comparing observations arising from disparate clinical, epidemiological and research methodologies, scales and contexts, all of which necessarily remaining distinct, yet interrelated. We are confident that this will lead to mutually confirmed outcomes that can be generalized and standardized world-wide- meanwhile remaining adequate to the particularities and Invest in ME (Charity Nr. 1114035) demands of each patient’s complex illness/disease structure. • As Osler also said “Listen to your patients. They are giving you the diagnosis”. Now we have the technology to confirm this directly for this complex disease- if we use it. Since this presentation was given in Ottawa Sept 24, 2011, the Journal of Internal Medicine has published 3 articles concerning these issues that are freely accessible on line1/ The ICC for ME was published- J Internal Med Oct 2011, 270: 327-38. 2/ A critique- ´A controversial consensus” published JWM van der Meer and AR Lloyd J Internal Medicine 271: 29-31, Jan 2012. In particular the above authors discussed the “unscientific” way the ICC was laid out, discussing the “pseudoscience of pathophysiology” “notional” pathophysiology, and the “intrinsic heterogeneity in syndromal diagnoses” but neglecting to mention how their recommended approaches to syndrome description had contributed to this situation by treating symptoms as separated subjective things on lists, thereby destroying any consideration of their embodied interactive dynamic context or “syndromalness” (Gk etymology, running together on a track), and rendering research directed towards underlying causality more elusive. 3/ A rebuttal of the critique by G Broderick J Internal Med vol 213-17 Feb 2012. corrects some of these misapprehensions, and points out that the Reeves and Oxford criteria for CFS select patient sets that are approximately 10x larger and more inclusive than those selected by the Fukuda criteria, and that the Canadian consensus criteria selected patients with even more severe physical functional impairment, less psychiatric comorbidity than the Fukuda definition(see Jason et al Am J Biochemistry and Biotechnology 6: 120135, 2010) and obviously brought to salience the distinctive pathophysiological pattern of delayed reactive fatigue, which it made criterial. This symptom is not the simple name of an isolated subjective feeling put on a list, but points to its participation in a higher level fatigue/activity www.investinme.org Page 10 of 108
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