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So what are the statistical chances of more than one person in the trial having undiagnosed PA? I am sorry but, like most studies of supplements, this is junk and I see little point in trying to find obscure reasons to justify it! They should have done a proper trial and they could easily have...

There is also the puzzle that the responders already had higher B12 levels at the start. Maybe they 'responded' because they were into vitamins and had taken more before. The possible confounders here could fill a book. There is no justification for not just doing a double blind trial.

I think an important point of the Nacul study was that definition of ME is so uncertain that you have a tenfold range of possible prevalence and in order to know what prevalence is for any given set of criteria you have to re-check each case because the raw data on records will be wildly...

I suspect the non-responders could not cope as well with the faff of going on sticking stuff in their nose and were non-responders because they didn't really buy in to the placebo effect on offer. I thought B12 absorption was supposed to be dependent on intrinsic facts in the stomach and since...

According to the abstract B12 increased significantly in both groups.

In the non-responders, only a small but significant increase in vitamin B12 levels was observed. In contrast, in responders, the number of steps, the physical activity scale of the RAND-36, and the vitamin B12 serum levels increased significantly. I cannot be bothered to read more than the...

This struck me hard in the context of the NICE committee. The answer to the criticism of PACE from the therapists is that they do not do the treatment that way anyway. So there is no evidence base at all! They do not appear to understand the ethical responsibility to know what they are doing. It...

Dear @phil_in_bristol, I understand your commitment and desire to help. However, 'it wouldn't look good' is never a reason to misinform is it? Keeping up appearances isn't what care is about. Real care is saying 'sorry but we have realised that our information is not as helpful as it should be...

That abstract sounds to me like a misunderstanding of statistics. I d not see what it means to be statistically confident of a change in an individual. If there was a change, however, small, there was a change. I am not sure that the variance in others is relevant.

I have come to think of the GRADE handbook as inexpert opinion!

Actual usefulness is what clinical usefulness means. Clinical usefulness means relevant the patient rather than a lab or pathology specimen or questionnaire. It has nothing to do with statistical significance - it is defined as not being that, so I cannot see how it can have anything to do with...

I agree with Alex.

I don't actually think statistics come in to the concept of a clinically useful difference. A clinically useful difference is defined by clinical usefulness and should have nothing to do with variance or SD as far as I understand it. I had never heard of this way of defining useful difference...

I don't think that is right. 'Clinical experts' do not come into it, only evidence. I am not sure what 'best practice' means other than practice based on reliable evidence in this context. Experts may be useful in pointing out potential flaws in what looks like reliable evidence but that is...

This does not look like an article to be pleased about. it seems to be a mish-mash of second hand material put together by someone with no idea about ME.

I don't disagree with the need for more accountability in medicine. But I think it really is very difficult to see how you rate individual clinics or practitioners without spending huge amounts of money. And for the last few decades governments have focused on cutting costs and sweeping the...

On the contrary. Proper trials check that methods work. You then apply them and you can check that you are applying them consistently. But you don't get information about whether treatments work from auditing routine clinics.

I doubt this can ever be done. For most specialities it is never done because it is realised that there are too many confounders to generate data that makes any sense. In rheumatology nobody checks clinics to see if they are getting good results with rheumatoid arthritis. We understand that...

This sounds like a quicker test rather than a better one. I cannot see that antibody based tests can do anything more than indicate that the person is likely to have met a Lyme bacterium some time in the past.

I think the idea is to stick to what can reasonably be called facts. Promising results are something quite different.