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This is very true. However: If the evidence for the efficacy of GET is shown to be no good on general principles of method then it will be very difficult to replace GET with another treatment using the same known-to-be-flawed methods.

No, as JTJ says, this is the clever twist to BPS. There is no 'cause'. And that is a valid analysis; there is rarely a single 'cause' of anything. But they get away with the double speak that yes trauma is relevant but no it is not the whole story so CFS is not caused by emotion. This is why...

I don't think you can ever build an ethical argument on numbers like that. It is a matter of reasonable diligence in making the right diagnosis. It seems to me a red herring. What matters is whether GET is the wrong treatment for PWME. That revolves around harm to PWME. I am now pretty convinced...

It depends on what you mean by authoritative I think. If it just means 'eminent' then as you say, it is just an argument from authority which cuts no ice. If it means better informed and more cogent in interpreting the available evidence I am not very sure either. The IOM report as I remember...

I agree there are complexities to interpreting blood counts like this but I do not see what this has to do with a guideline on ME. People with established ME may develop vitamin and mineral problems but I don't think that is what the guideline is relating to - it is under the diagnostic section...

I agree but how do we take ME/CFS out on present evidence if we have none? If CBT and GET for ME are withdrawn that will knock the MUS programme but I rather doubt it will impact on the belief in psychosomatic illness. I agree if the debate moves forward to acknowledge that there is no reason...

I am afraid they wouldn't. The current NICE guidelines is very reasonable on these tests. There is no need to do tilt table tests routinely and I am sceptical they are actually very useful. They don't actually prove what is causing orthostatic intolerance. NK cells are a waste of time. It is now...

This I very much agree with. So the key debate is about whether it is legitimate to continue with these. It really doesn't matter what theory they carry along with them. The problem is that they provide a means for GPs to offload patients on to cheap therapists and wash their hands of the...

Absolutely, but there is nothing in the NICE guidelines that says PWME must be ignored as hypochondriacs. And it is nothing to do with the 'psychosomatic' debate since if you re a hypochondriac you don't actually have an illness. It is just an extension of the usual laziness that has become...

The comment about FND being emotionally generated is intriguing but I don't think you would find any consensus about that amongst doctors who specialise in the condition. And anyway it is only a theory of how FND come about. The term FND describes the clinical category. Edit: Interesting that...

There is a horrendous neglect of almost all groups of patients in the NHS. I think ME patients are mostly ignored because they are considered to be hypochondriacs - with nothing wrong with them at all. It seems to me that people are taking 'medical' here to mean involving some structural or...

I am not sure about that. Functional neurological disorder seems to me to be a very reasonable category for a narrow group of patients with movement disorders or sensory loss that is not explained by any identifiable structural neurological lesion of the sort that would normally explain such...

I think more likely they are a psychological and a physical therapy designed to alter psychological behaviour. I agree it is moot - but I see so little point in making these distinctions. The important question is whether they work. And I agree that the other important questions are exactly as...

I agree that raising doubts about CBT and GET for ME have major implications for the CBT and GET industry. But whether ME has served as a quintessentially psychosomatic disorder or not I am not sure and am not sure it matters. We do not know what ME is. The useful debate is not about that. It is...

Diane and I have agreed to differ over this. While I think all publicity about the debate is good because we need more people within medicine to think about it, virtually every point Diane makes is, I think, off target. The IOM report has not changed the debate in my view. The problems with...

I forget exactly who Sue Pemberton is. Her comments sound sympathetic but I worry about bits like: What evidence base is there for this either? Why is it the focus of what she does? I am not sure what sleep or fluid has to do with 'supporting' the HPA axis.

I am sure it is - hence the quotation marks around 'placebo effect'.:)

Yes, I think these results are a nice indication that this positive psychological effect people like Chalder think works through affecting physical functional potential is pure and simple subjective bias aka a 'placebo effect'. If you can switch it on like a light bulb it has nothing to do with...

One thing that is striking about all these get up and go therapies is that there isn't a single grain of information that isn't just what any of us could have thought up if we were convinced getting up and going was the answer. In contrast, skilled advice always includes things you didn't...

I don't think this is that easy. There are drugs that inhibit mast cell signalling to a degree but not very cleanly and anyway you would have to challenge under controlled conditions, with and without. I am not sure what sorts of symptoms you link to the triggers? Mast cell activation will...