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Good article. Thank you, Fred Rossi.

Yes, what about relevance, safety, and conflicts of interest?

And this, ladies and gentlemen, is why relying on superficial correlations is so dangerous.

Any hypothesis must explain the delayed component of PEM. It is a distinct and core feature, and the main clue, I think. It is not fatigue, tiredness, deconditioning, DOMS, etc. It is something different to all those.

So what that tells me is, ME/CFS is not a single disease, but it is a disease with different biological subtypes. Maybe. Cancer has a wide range of forms, symptoms and signs, and causes (genetic, chemical, infectious, radiological), and different treatments. But all cancers have one thing in...

This.

Functional somatic disorder (FSD) is a common condition characterised by persistent patterns of physical symptoms that cannot be better explained by other physical or mental conditions. Unless there is a translation issue, then this is a disingenuous rhetorical sleight-of-hand. They are not...

I qualify for a disabled parking permit, but have not taken it up for exactly these reasons. Not going to add another layer of abuse to what I already have to deal with. In a practical sense it doesn't make much difference, for various reasons. But there are occasions when I could benefit from...

I agree, as long as there are good records of what the patients do so it can be factored in. Should help reveal what helps and what doesn't, among other things. The key is having a large sample size, and doing it for long enough.

My answer is yes. Two actimeters. One on the dominant hand (wrist), and one on either ankle. Maybe a third on the upper dominant arm, just below the shoulder. Though that may be too impractical for long-term measurement. Using a range of bio-monitors on a large number of patients to measure...

Typically, even. At least initially. Something we are all guilty of to some degree. Which is why robust methodology is so important.

Fibromyalgia (FM) and irritable bowel syndrome (IBS) are increasingly recognized as disorders involving central sensory processing and gut–brain axis dysregulation, Recognised by whom? Mostly by people who claim these conditions involve central sensory processing and gut-brain dysregulation...

Forgot to say that this testing was done more than 25 years after getting sick, which included some periods of being more or less bedridden. If deconditioning was going to show up it should have shown up by that point.

Adding to my initial comment on deconditioning: I have had some basic core strength testing done by doctors and physios and they could not find anything to be concerned about. Which is one of the reasons I am not convinced about deconditioning being a significant or primary feature of ME/CFS.

The deconditioning claim was made long before Garner got into the game. It was a central pillar of the original psycho-behavioural model put forward by Wessely, Chalder, et al, back in the early 1990s.

I have considerable doubt about that. If patients are more than mildly deconditioned then why can they immediately get up and do stuff when they have a good day or few hours? Obviously I am not saying they can suddenly run a marathon or do a two hour workout in the gym, especially not the more...

There are two levels of proof in play here. The first is establishing that A causes B, at least on a probabilistic basis. The second is establishing the mechanism by which that happens. The psycho-behavioural advocates have established neither.

Vaccination, receiving drug treatment within three days of acute infection, and avoiding repeated infections are the greatest modifiable influences of long COVID development, decreasing risk by up to 63 % under modelled scenarios. :thumbsup:

So the 'functional' part is...?

Yep. Takes two to have a rational debate. But it only takes one to make it irrational.