BY: Ciaran Farrell, Myalgic Encephalomyelitis sufferer

Medical tests for a specific disease need to be an accurate and reproducible means of establishing the unique pathophysiology of the disease concerned

I have a scientific background and I have studied the contents of the presentation made by Professor Kenny de Meirleir. His hypothesis is that high levels of hydrogen sulphate in the urine may possibly be diagnostic of the presence and or overgrowth of relatively certain common microbes living within the gut. This he then claims produces the symptoms of MyalgicEncephalomyelitis.

This is not a new idea; it is a new variant on the “leaky gut” hypothesis that has been around for some time and has been associated with the Candida overgrowth hypothesis of ME which produces the same kind of “leaky Gut” in which candida travels through the gut and invades the body through the gut walls. This hypothesis has been largely discredited although it still hasits supporters.

The current hypothesis follows much the same lines, that the micro organisms that ought to be contained within the gut are somehow able to penetrate the walls of the gut and end up just about everywhere in the body including the brain

There are a number of problems and issues here which can be summarised but are not limited to :-<p>

• How can such organisms penetrate the gut wall and invade the body in the manner claimed, as this was the Achilles Heel of the previous Candida hypothesis?

• Assuming that it is possible for these micro organisms to invade the body in the way Prof. Kenny de Meirleir hypothesises, then the person would be suffering from a very nasty case of infection by one of the micro organism concerned, and not ME, since all the micro organisms cited by Prof. Kenny de Meirleir are already known to medicine and medical science, and this would be picked up by a battery of microbiological tests which would confirm the presence of a bacterium as being the cause of the infection suffered by the patient. Not all the organisms concerned are not that easy to treat and some can be resistant to antibiotics, but diagnosisand treatment are relatively strait forward. This leads to the academic scientific question as to whether certain levels of some of these microbes live in the gut anyway, and speculation as to what would lead them to cause an infection.

• That in order for a given specific disease to be produced through the invasion of the body by a specific microbe, there must be an equation made between the microbe responsible and the disease. One cannot have the same disease produced by an unspecified number of certain specified and also by other un-named and or un-specified microbes because this wouldsimply be termed a general bacterial infection. It would not be ME.

• That in order for a diagnostic test to detect the presence of a given single microbe or family of microbes a given test must detect the microbes concerned in the presence of other microbes which may be harmless, or not the subject of the test, and therefore the test will not producefalse positives results when applied to samples taken from patients. There is no indication that the proposed test will do this

• That in order for a diagnostic test to detect the presence of a given microbe or family of microbes it is necessary for the test to have a given provable and reliable sensitivity to the organism it is intended to be a test for so that medics and researchers can have confidence that if the test says that there is nothing there, then that is indeed the case. This is to avoid the problem of false negatives. There is no information whatsoever from Prof. Kenny de Meirleir on this subject, so I can only assume that the proposed test does not meet the stringent standards of any national or international Health Board. This is presumably why the test is not beingmarketed to doctors or to governments or Health Boards, but only to individuals.

• That in order that for a diagnostic test to be accepted as the means of diagnosing a given disease it must be accurate, and it must be reliably accurate to a very high standard so that again medics and researchers can have confidence that the test really does do what it claimsit can. Again, there is no information whatsoever from Prof. Kenny de Meirleir on this subject, so I can only assume that the proposed test does not meet the stringent standards of any national or international Health Board. This is presumably also why the test is not being marketed to doctors or to governments or Health Boards, but only to individuals.

Lastly but by no means least, the theory behind the test must be based on a unique aspect of the pathophysiology of the disease because only then can the equation between a given specific microbe and a given specific disease be made. In order to be in a position to make this equation the theory which underpins the use and application of any diagnostic test must accountdirectly for the disease process itself and not be a consequence or artefact of that disease process that could be produced in other ways.

I consider that Prof. Kenny de Meirleir’'s hypothesis and Hydrogen Sulphide diagnostic test based upon it fails this test on the grounds listed above and for the simple reason that he has not accounted for the well known fact that patients with ME/CFS/CFIDS are known to have compromised immune systems.

This would mean that as with HIV/AIDS patients who also have compromised immune systems that there is very considerable likelihood that in ME/CFS/CFIDS patients the presence of the microbes that Prof. Kenny de Meirleir observes and the numbers in which he observes them are simply due to the secondary consequences of having ME/CFS/CFIDS as a result of opportunistic infections by microbes that would largely be kept at bay by the body’'s immune system in a healthy person.

I note that Prof. Kenny de Meirleir has been a controversial figure when he served as a Board Member of the American Association for Chronic Fatigue Syndrome, and editor of The Journal of Chronic Fatigue Syndrome put out by The Haworth Medical Press and that the Board of The National CFIDS Foundation, Inc. (NCF), in America, called for his resignation as the resultof his previous research activities.

I also note that Prof. Kenny de Meirleir’s recent work on this matter is not published in a Peer Reviewed Journal, and that he does not appear to have any plans to publish his work in such a journal, possibly because his work on this matter may not reach the standards required by such journals.

I further note that Prof. Kenny de Meirleir is one of the Editorial Panel of the proposed new Journal of Fatigue where presumably he would be able to publish this work as presumably this journal does not have the same status and standing as a regular Peer Reviewed journal, and he would be standing in favourable judgement over his own work.

In view of the entirety of the above, my advice would be to think long and hard before committing £13 or any other sum of money to buy the home testing kit proposed by Prof. Kenny de Meirleir or on whether to have the test performed in any other way, and I would be very wary indeed of any treatment options that may be advanced by Prof. Kenny de Meirleir on the basis of a positive test result, or the consequences of a negative test result.

Ciaran Farrell Myalgic Encephalomyelitis sufferer