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This is all very well, @Trish, but might it not be something completely different. I think you are talking about people who had known and undisputed trauma. It might be a child physically abused by an alcoholic parent or it might be a spouse grieving over a child who had committed suicide. I...

I am not sure about the demonstrable pathology but that is a red herring. I am trying to get a handle on this stuff for my book. It is shocking how it can be acceptable for old wives tales about getting people to think better thoughts are presented as evidence-based therapy. If this sort of...

But also those people were on the committee because people like Charles Shepherd and Margaret Mar had convinced Mark Baker that an attempt at an independent committee was needed. Certain people were very obviously bounced, even if some others were not. The decision to have a committee to...

Yes 'number needed to treat = 100'. Even for good treatments NNT can be around 7 but you only have to look at the PACE graphs to see that this as a pretty feeble effect. I think it was modestly called 'modest' by the authors.

Another point is that Newton's MRC project was on fatigue and maybe not on ME/CFS as such. So the only group that has had substantial biomedical funding (several million from US NIH) for ME/CFS is probably London School of Hygiene.

You have to remember that is £20K to get one more satisfied customer than placebo. A treatment course might cost £200.

It takes some time to get to a publication after starting involvement with a service - probably 2 years minimum, so I am not sure the time lag means much. Two things may be relevant. Julia Newton had a close collaboration with the psychiatrist Stuart Watson looking at ME/CFS. Watson seemed to...

People with factitious illness are very aware they are creating their signs. What they do can every elaborate. But a dog may do all sorts of things to try to get the stick, knowing she is trying to get the stick and yet have no idea why she wants to. The action is deliberate but I am sceptical...

Sounds as if they must be some of those who are doing the treatment wrong. I seem to remember that all Simon Wessely's patients loved him to bits.

Was that why Brian Hughes said something about scoring 11 for nostalgia? Seems it was. I should go back to sleep.

Yes that as it. And I think the reason it has been used so much is because its very short, it’s easy to administer, it includes items related to physical and mental fatigue, and its got eleven items Really rigorous stuff then.

As the authors say, this is quite different from malingering. The malingerer presents a plausible account of a standard illness such as back pain with the conscious intention of getting a sick note and then going to work. I remember a man with an immobile 'frozen shoulder' unable to work who...

I think this is relatively unlikely as a formal diagnosis although I see it as a major concern as an unproven presumption of what might underlie someone's ME. In my experience factitious illness stands out as very out of place. Something is very inconsistent with normal illness but often...

An after lunch fatigue scale then?

I cannot remember where I read this but apparently she was suggesting that this was really Simon's idea and that she just made up a bit of a scale for him or something. So maybe disowned is a bit strong. Maybe she was just too modest to acknowledge her mastery of method

Perhaps it should be called the Simon fatigue scale since Trudie Chalder has disowned it and said it was really Simon's.

It is good to see a detailed analysis of this. It is good example of the old adage 'lies, damned lies and statistics'. Statistics so easily creates make believe data.

This looks to me like a very reasonable, measured account of factitious illness cases. I think it is unwise to dismiss it as inappropriate. Illness of this sort is real. I have only come across two clear cases under my specific care but they were not in doubt. If most of them are women then...

But what if the peppermint oil works through taste and smell - like onions make you cry and curry makes you sweat? I drink peppermint because the taste makes the drink refreshing. My autonomic nervous system must think it is good.