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Comparing GET with CBT was actually a good scientific idea. Although they drew on the same theory and were both 'active test' treatments they were methodologically separable and so could act as plausible controls for each other. The problem is that they gave the same result so neither had power...

I formally declare the material in the above quote to be unethical. Specifically the engagement bit because there is no valid evidence.

The argument is similar for GET but may not be quite so watertight. For GET the therapist can simply say that they think the patient may improve if they give exercise a try. CBT is different in that it explicitly takes the position that the patient has incorrect beliefs that need to be changed...

But the point I raised is actually an ethical one. If taken logically it is a very serious ethical one that makes the use of CBT and GET so far unethical and possibly illegal. My reason for not raising it more loudly is that I doubt the HRA people would understand the argument.

There is an issue about ethics that I have been intending to raise in another context. The CBT used in PACE was, as I understand it, based on concepts such as 'educating patients' and using 'cognitive strategies' to persuade them that their views about their physical capacities were erroneous...

But there is an important asymmetry. It is not difficult to say there isn't evidence that GET/CBT helped them. The issue of harm is subtle. It is that there are only two consistent views to hold. 1. What patients say in terms of considering they are better or worse is unreliable. In which...

A good point. This statement: Our view remains that, while potentially moderately helpful for a minority of people with M.E. and/or CFS, these treatments are not effective or safe for everyone. reveals a complete misunderstanding of what the debate has been about for the last five years...

I worry about this. All the doctors I know who diagnose fibromyalgia will also support the biopsychosocial model in departmental discussion. Fibromyalgia is almost universally used as a codeword for psychosomatic. Patients do not get told that. Low growth hormone levels occur in people who do...

As far as I know nobody has suggested that mirtazepine is of value for CFS or neurasthenia. So there are two negative pill type comparators, neither of which are meaningful controls for CCBT.

A good point. Maybe either David or another investigative reporter needs to investigate this other investigative reporter. They could ask them questions about who pays them and whether they are running a campaign or have a doctorate that makes them in a position to write about what they write about.

I think the general view is that symptomatic treatments follow general principles that do not relate specifically to ME so nothing specific needs to be put in an ME guideline. If there is no evidence that is not a problem. The conclusion has to be that there is no evidence. That would not be in...

I think everyone involved in this is aware that nothing is now accepted. The committee has to start afresh and look at the evidence. Received wisdom has no authority. Since something near half of the committee are sceptical about the evidence for anything much I cannot see how anyone can push...

Now there's a let down. I think they have cold feet.

I wondered that and whether it will ever materialise. Maybe some people think you can just out-blather those who disagree and get them to go quiet, especially if you hassle them. I am tempted to think that as usual there are different people with different agendas involved and what may appear...

Yes, well that wouldn't be the Guardian then, would it?

I don't think there is a recipe. A controlled trial is one with adequate controls - and as in all science what counts as adequate is dependent on the detailed contextual factors of every experiment. Every situation is different, just as in ordinary life. If you want to know if the are iron...

No, David, Art is the Lie that tells the Truth. You are just telling the Truth. On the other hand if performance art is't really art (I have wondered) you may qualify. The methodology certainly has a degree of artistry to it.

A tough question. I suspect the best guides would be that it was produced in the USA and that it was published sometime between 1980 and 2000. Medical literature has been dumbed down since then. I have to say that I fear that reading epidemiology textbooks may be one of the more boring...

Sorry, I have not read one myself for a couple of decades.

I don't think that follows. Peter Stastny's recognition that rheumatoid arthritis had a largely stochastic causation was what allowed us to work out how it works. In a sense recognising that ME may involve stochastic pathways might be the essential clue to what is going on. If Fluge and Mella's...