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Several "physical" diseases also have a complete lack of "biomarkers" if you will. AIDS was diagnosed before they ever discovered the HIV virus. There are several diseases and conditions nowadays that that are diagnoses based solely on certain symptoms and not on an actual determination of a causing agent.
RSI, kawasaki syndrome, early rheumatoid arthritis, and a host of other diseases and conditions depend on what the patient tells the doctor about their symptoms and not necessarily tests for causes.
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