Medscape isn't just any online medical resource; it's a highly respected website aimed at medical professionals. How sweet it's been then to see Miriam Tucker blast out three articles on the IACFS/ME Conference thus far. Post-Exertional Malaise Takes Center Stage Tucker, an astute reporter who's covered chronic fatigue syndrome several times before, probably knocked many medical doctors right between the eyes in her first article when she asserted that post-exertional malaise, not fatigue, was the core symptom of the disease. Notice how Tucker completely recontextualizes this disease in her first paragraph by mentioning PEM first, and then speaking about ME/CFS in light of it. Post-exertion 'Crash', not Fatigue per se, Marks Syndrome Suddenly, ME/CFS is not just about tired people; it's about people who experience the "the phenomenon of post-exertional malaise" when they engage in activity. That put a whole different light on ME/CFS. If the docs didn't didn't get it about fatigue, PEM and ME/CFS from that, Tucker made sure they did with this: Tucker buttressed her claim that exertion and its effects are the key problems with findings from studies presented at the conference indicating that exercise alters cytokine levels, impairs cognition, alters brain functioning, increases lactate levels and results in inhibited heart rate increases. Exercise studies are finally coming into their own in chronic fatigue syndrome; in no other disease do they hold such a pivotal place in explaining what is going on. That fact, alone, should give many naysayers pause. Biomarkers Tucker's next paper pointed out that the more than 100 papers presented at the conference substantiate the assertion that something has gone wrong biologically in this disease. Harvard professor, Tony Komaroff, sounded a note of vindication when he referred, at the end of the conference, to Dr. Montoya's cytokine paper, stating: Biomarker Research Advances in 'Chronic Fatigue Syndrome' Researchers and doctors, Komaroff asserted, will find that chronic fatigue syndrome (ME/CFS) can stand on its own biologically if they'll just check out the literature. Tucker rounded off her IACFS/ME review with immune studies from Dr. Montoya, a potential immune diagnostic panel from Dr. De Meirleir, brain imaging studies and Dr. Hanson's metabolomic study suggesting that a hypometabolic state exists in ME/CFS. Immune Drugs Having Impact Her coup de grace came, however, I felt, in her latest article "Immune-Modulating Agents Eyed for 'Chronic Fatigue Syndrome'" where she introduced the physician-heavy Medscape audience to the work of two Norwegian oncologists, Drs. Fluge and Mella. Many eyes must have widened considerably as doctors learned these two oncologists have found success with heavy-duty chemotherapy/autoimmune drugs such as Rituximab or cyclophosphamide. Those eyes may have widened further when they learned that the responders, with their long lag times between treatment and effect, are responding as if they had an autoimmune disease. Findings like these chip away at the belief systems that have pervaded this disease in too many doctors' eyes for too many years. Fluge's metabolomic results suggesting that only underscore the perhaps unique exertional problems in this disease. Finally, Tucker noted that Mella suggested that treatments for this puzzling disease may not be as far off as some might think. My favorite part of Tucker's piece, though, came in a comment from Leopold Stengyl, a health care provider: It's getting harder and harder for doctors and researchers to dismiss ME/CFS. Coming up shortly - Health Rising begins its survey of the conference.