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I had never heard of this MID before getting into ME studies - and I had spent years working on trials and acting as expert witness in the law courts on trials. As far as I can see it has no relevance to clinical importance. I used a slide of the 3.4 change in PACE for my NICE presentation with...

I think it may be the way around. All advocacy groups are pretty much agreed that treatments like CBT and GET are not based on good evidence. The need to emphasise evidence quality is because ‘biomedical’ (drugs or surgery) treatments based on just as weak evidence are not similarly being called...

No need. That was the sort thing I was referring to - empty vessels.

They are by the empty academic vessels who make most noise, just as coronary artery disease has been. To someone trained in inflammatory pathology these proclamations make little sense.

If I knew the answer @Bill, we wouldn’t be in this mess!

Not in any very meaningful sense of inflammation. There may be some microglial activation but I rather suspect that microglial activation in brain disease is an effect of what is wrong, not a cause.

Yes, but this is not realistic. Lots of cells use anaerobic respiration - like cartilage cells for instance. Normal brain is aerobic but if there is more lactate then it is clearly not normal. The problem with blaming immune cells is that if there were enough immune cells (white blood cells...

My spellchecker screwed up on csf pressure.

Lactate is not a sign of inflammation. It is a sign of altered respiration. I think Younger has conceded that calling this inflammation may not be very helpful.

I think it is a fair point that there is a problem with EBM in capitals, not with evidence based medicine. There is certainly a problem that people who make a living out of extolling EBM, like Paul Glazsiou, are not helpful to a reliable evidence base - quite the opposite.

Hilda Bastian’s blog makes a lot of important points but, in her own words, it does not go nearly far enough. Presumably there is some value in being polite to the new editor but somewhere it needs to be stated that the flaws in the analysis are far deeper than she addresses. When I refereed...

I am fairly that brain tissue itself does not generate pain as a result of injury or inflammation to brain itself. Pain is usually ascribed to meningeal irritation. Brain inflammation is one of the causes of raised coffee pressure, which produces headache worse in the morning but I don’t think...

Probably is certainly way less than would normally be considered adequate evidence for efficacy of a treatment. I think we would in medicine generally expect to be 90% sure, preferably 95%. But probably at least has a standard meaning to medics. If we say someone probably has measles it is...

I think to be scientific a word just needs to have an adequately defined meaning. Probably has a very precise meaning in ordinary English: a more than 50% chance. So it is fine - if based on adequate evidence.

I get that probably is what moderate quality is supposed to mean but you cannot use the same probabilistic statement twice in a sentence. It is a bit like a double negative, it should combine to produce something else. I think there is a Freudian slip at work here. They wanted to say there was...

I do not see how an editor could have approved ‘moderate certainty evidence that probably...’ This is meaningless. Moderate certainty cannot then be qualified by probably. The text appears to be an appalling case of confused English. I had thought that Cochrane’s GRADE system gauged evidence of...

I am supposed to be properly educated about this, as a professor of medicine and immunology who worked on the role of mutation in immune disease. The radiation theory looks to be a non-starter to me. All the suggestive connections fall apart on inspection of detail. For a start the epidemiology...

‘Evidence-based medicine’ has got a bad name for being recipe-based and that is a potential problem but the ideal is simple and sound. What I think people are beginning to realise is that meta-analysis is a pretty unreliable process. I have always preferred to look for a single cast iron study...

I think this is well worded. There are potential confusions around ‘evidence-based’ and ‘science - based’ but I think the intention is clear enough. Science is generally about explanatory hypotheses. The hypothesis that a treatment will work is not explanatory so we tend to think of a test of...

It has to be a filter because there is no mechanism for shining a searchlight on your own neural activations, or looking to see what shows up either. The searchlight idea was never a going concern back to my student days as far as I am aware. Maybe at least these researchers have cottoned on to...