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Charles Shepherd sent this for interest! Mail on Sunday – letters page October 24 Fatigue treatment is safe and effective Ethan Ennals asked last week in Health whether doctors or patients are right about the lack of effectiveness and safety of graded exercise therapy (GET) for chronic...

I would stop fretting about the guideline publication. There is no reason to think it won't come out next week.

At the moment, slim. And so do, I. Brian Hughes puts it very clearly. There is a long way to go. But trying to engage those who are intelligent enough to see what the guideline says, and why it says that, seems to me worthwhile

No it is down to health professionals. I was simply illustrating the fact that varying views on CBT cut across all groups of people involved. My point was. 1. Best not to mention CBT. 2. It seems that the health professionals on the committee could not bring themselves to do this - maybe it was...

Yes, I made it clear that I thought the continued use of CBT was unethical in my expert witness testimony to the NICE committee.

I am not aware of any suggestion that sympathetic activation normally induces cytokine release. And there isn't any cytokine release in ME as far as I know. So it doesn't seem to have much going for it.

I think a sensible reading is curative = aiming for recovery. I think that is clear enough in the guideline for anyone with sense but...

yup

No, but if it is accepted that CBT has a place I think it would have been very hard on the committee to argue more precisely for what was not to be allowed. I personally would have preferred to see no mention of CBT but I was not on the committee. There is a wide range of opinion. A lot of...

The same. She resigned, but after signing up to the revised guidelines. Why she resigned nobody seems to know.

I don't think it will be. I agree that a clearer distinction would have been helpful However, I suspect that getting that through the committee with a clinical psychologist used to the old ways on it may have been a bridge too far. I don't know the story but I suspect that the guideline as it...

Maybe with global warming levels of Co2 will b e so high that life will go backwards. Perhaps we can look forward to dinosaurs vlove-ing again and dodos strutting across the croquet lawn.

That makes a lot of sense. I was thinking of the phenomenon of 'second wind' where agonising exhaustion at 8,000 metres in a 10,000 metre race can suddenly be replaced by a rhythm that will get you to the finishing line and even with a reasonable placing. I think ME must have something to do...

By talking to them?

Whoever is interested. An interesting point was made both by a health professional whose identity might be guessed and by a NICE committee representative at RT in response to the suggestion that ME/CFS needs to be dealt with by people properly trained in eg. rehabilitation. The response was...

Yes this is exactly what I am trying to say. More than that, dysregulation is always weird and unknown. Solving it has nothing to do with pushing things according to regulation. A broken thermostat does not keep the temperature right just because you put it very high when you are cold and very...

I agree with all of that. But you have to start somewhere. For me the situation is very reminiscent of that for RA in the early 1980s. At least there is a desire to look at some physiological systems about which we can generate testable theories of going wrong. The current explanations are not...

I repeat myself but it helps to try to get clearer what I want to know A theory of dysregulation needs two parts. 1. An account of the mechanisms that explain how things are normally controlled (homeostatic). 2. An account of a quite different mechanism that explains why in disease the...

Hampstead is lovely. But it is a favourite place for people into the woo of psychologising. There are lots of other sorts of people there too

Yes, but that's bit like saying there are some nice people living in Palm Beach.