For newcomers: disease definitions are critical. This post will not illuminate the general issues, but others will.
A new definition, called the International Consensus Criteria, has been approved for publication in what seems to be a pretty major journal.
My bottom line: this is a huge improvement. I am grateful to the authors. I think it deserves our support.
It is an extraordinary effort, global and voluntary.
Sure, there are things that are being worked on. I look forward to differential diagnosis, biomarkers in particular, practical suggestions, prevalence data, and many other things. There is a question about its specificity that I don't know the answer to yet. For what it's worth, from a personal perspective it feels extremely watered down, as it requires only a minuscule fraction of my symptoms and it only even mentions in total a fraction. I might like to see a dimension of severity that measures number and type of signs and symptoms and not only degree of impairment. HIV/AIDS seems to do that. There are questions about the mild end too. There are subtleties of defensive wording and defensive thresholds and timing and tradeoffs and compromises. People are doing good analysis of this definition, and all of it is important. …
… However, there's an overriding factor: artillery shells are exploding all around us. This is the best and most usable definition we have. The authors continue to improve it. Nobody will be left behind.
This is elevated ground. It is a starting point. Its predecessor made me feel uncomfortable (even though it was the best we had), this one much less so.
Our urgent goal is defending and furthering science. Without research, physicians have nearly nothing they can do, and the ICC is a huge opportunity for getting research done.
As long as it lets in few false positives and is reasonably representative — it doesn't have to be perfect but it does have to be good enough and it does have to be used — I am going to call it a winner.
As a battalion commander who served as my typist was fond of saying: that sounds like a plan.
Speaking of which, given that this is a war between allowing science to happen and stopping science at all costs, let's have USA's General George Patton close out the post.
My men don't dig foxholes. I don't want them to. Foxholes only slow up an offensive. Keep moving. And don't give the enemy time to dig one either. —
Pushing means fewer casualties. I want you all to remember that. —
A good solution applied with vigor now is better than a perfect solution applied ten minutes later. —
Have taken Trier with two divisions. What do you want me to do? Give it back? — to Eisenhower (after being told to bypass Trier because it would take four divisions to capture).
Accept the challenges, so that you may feel the exhilaration of victory. —
Thank you, George. That works.