Once (if) we find a biomarker, how will things evolve?

[Yann04]

I often hear the claim that the reason ME/CFS is neglected psychologised etc. is that we don’t have a biomarker for the disease. In my opinion, it is a possibility that we have a biomarker within the next decade, even though it might only be usable in specialist laboratories.

How do you think the scene would change if this happened?

I assume, even if we have a biomarker, it wouldn’t mean we necessarily have a good understanding of the aetiology. As to how the disease is treated, is it as clear cut as many people say it is, or would we still suffer from psychosomatic medicine. An example being that even though MS is a disease with a semi-accurate biomarker (although still a diagnosis of exclusion), fatigue in MS is still often seen through the lens of the cognitive behavioural model.

 

[Kitty]

I'm not sure we will find a single biomarker. It seems more likely it'll be indications of pathology, which aren't necessarily consistent across patients with similar symptoms.

But it's a really interesting question all the same.

Replication of any results might be needed in different cohorts in different centres, which would cost money and take time. But if it looked fairly convincing it might accelerate research, potentially quite dramatically. People would probably start talking about questions and collaborations they might be able to get funded even before replication came in, which would mean they'd be better placed to hit the ground running.

 

[Jonathan Edwards]

I assume, even if we have a biomarker, it wouldn’t mean we necessarily have a good understanding of the aetiology. As to how the disease is treated, is it as clear cut as many people say it is, or would we still suffer from psychosomatic medicine. An example being that even though MS is a disease with a semi-accurate biomarker (although still a diagnosis of exclusion), fatigue in MS is still often seen through the lens of the cognitive behavioural model.

What we may get is not so much a biomarker as a biological clue - maybe from genetic studies. But once we have a biological clue, whether or not it marks a process directly, I think the game will change overnight. I also think that the explanation may become clear very rapidly.

I don't think fatigue in MS is comparable. MS is primarily treated because it causes paralysis and loss of sensations. As such it is treated with the latest biologic drugs. Fatigue happens to be a side effect that probably reflects the problems of coping with damage. It is only approached with CBT because when doctors find a problem won't respond to drugs they call in any old therapist that claims to be able to help. If a mechanism for symptoms I ME/CFS is found it is likely that treatment would be fully effective, because there is no damage as far as we know. Nothing would be left untreatable to sent to the magic therapists.

 

[Yann04]

Thanks for the really interesting and well-thought reponses Kitty and Jonathan.

magic therapists.

As for that quote you literally made me laugh out loud even though I’ve been non-verbal for months. Thanks for that I needed it