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In general terms I think shifting people about like this would mostly be expected to dilute and difference between test and comparator, so prima facie, this may not be a big deal. The fact that the numbers in the group seem to keep jumping about may be more a concern in terms of sloppy analysis...

Interesting. I was not told it would appear. Sterne's name seems to have disappeared from the author list but that may be an artefact of alphabetical formatting for the RR section.

So why did the placebo group get a little worse on all measures? Not much of a placebo it seems.

I have sent in a Rapid Response letter, as recommended by Dr Godlee at BMJ. I have copied this to the editor in chief at Cochrane. Letter: In the recent publication in BMJ of the finalised Risk of Bias 2 tool (RoB2), used in the context of the GRADE system by Cochrane for assessing quality of...

I actually think 'physical' is no better than 'real'. They mean the same. Wessely would happily say the illness is physical. The problem I see is that if claims are made about physiological abnormalities that do to stand up then it will be very easy to level the same criticism that has been...

I absolutely agree - there is definitely something wrong.

This may be true. Nevertheless, I do hold out some hope that what NICE says may impact the prevailing view. I think that if new guidelines make it clear that ME is not just unexplained symptoms that can be shunted off to a therapist team for treatments with no evidence base there is some hope...

I don't really get what they are getting at. Presumably sharks have fight and flight responses but they don't have any bones. We fight or fly long before these hormones get going. OK the body readjusts its physiology, but loads of factors contribute to that. The fact that adrenalectomised...

Yes, but then the GP became the named person responsible for monitoring all their ill patients anyway when they took the job. If someone actually needs to point that out there is something wrong. (And I agree there is definitely something wrong.)

I just looked at this sites you posted. I agree that are plans should be person directed and involve the patient. But I have always assumed that throughout 40 years of being a doctor. When I hear people use these terms it is always in the context of window dressing, usually be a...

Yes, that was my conclusion. The problem that I see is that in practical terms there is no real way to get 'representative' information so the only real value is in making committee members aware of salient problems that can occur. I think we can be certain that some committee members, and I...

I think we have to consider what NICE can be expected to do and what they should base it on. As I understand it the main function of the committee is to provide evidence-based recommendations for what is though to be useful management for the benefit of health professionals and commissioning...

I tried to find out exactly what that meeting was. Nothing comes up in association with Royal Society of Medicine itself. It appears to be a meeting run by a syringomyelia and Chiari foundation and the UK EDS organisation. It may be that they have used RSM facilities for a private meeting...

No, only the people who are putting out hypothesis about ME as if they were medically knowledgeable. I see no reason to think the cord would suffer with stretching alone in the context of a hyper mobile spine. As Henderson implies, you need also to have some sort of entrapment at a particular...

But a tenfold change can be to 10%. We often say change by an order of magnitude - when it is already assumed which way. They probably mean change to 60% but why not say so? We normally say a 40% decrease.

I don't think this is at all clear. A 0.6 fold change could be a change to 60% or to 166% or even to 160% or 40% as far as I can see. Nobody normally says this. Unless it is some special technical term in a particular area it sounds like half-baked usage.

I think you need to ask a dermatologist. This is not a common rash. I don't think it is of serious concern but it should be checked out by a specialist, not a GP. If you have history of immunological drug therapy that may be relevant.

I agree that our main problem is lack of evidence, so everything is speculation. But we are seeing people speculate without knowing basic anatomy and clinical neurology and saying things that are entirely implausible I am completely unbiased because I am on a pension and have no financial...

I think you are confusing two issues. Henderson is talking about the situation where there is pressure on the cord from disc herniation or osteophytes. that traps the cord at certain points. In this context normal movement of the spine may pull at particular points and cause shear. Everyone in...

I am not sure that I see this proposal as unreasonable. NICE is at least making an attempt to get input from patients. There is a limit to what is practical and also a limit to what can be done without being intrusive or breaching confidentiality relating to children. People have to be asked to...