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The problem is that the processes of muscle use involve chemical changes that will re-equilibrate within five minutes at most. A purely energy metabolic account just doesn't fit the time course of PEM. Delayed signals preventing re-use, in whatever way, could.

Yes, I took that as read. I guess the same applies to a large extent in the stroke case. The aim is to prevent a cycle of spasm. Whether you can find a way of providing a better opportunity to improve with a more specific approach would be the question. Some people do improve and if there is any...

That would be analogous to the more direct reflex effect with pain.

I think energy is unlikely to be the problem. There is no evidence for a problem with energy severe enough to explain the symptoms of ME/CFS. In general I think it is best not to try and mange people with ME/CFS on the basis of theories - of any sort. So far we don't seem to have a theory that...

Not a shred of evidence for that as far as I know. It is so sad to see medical science swamped by studies that try to answer questions that have no need to be answered when we have questions that do need answers.

What I am unsure about is why amino acid levels that feed into TCA should be low if PD is blocked. Doesn't this require a compensatory up regulation of the steps that feed the AA's into the cycle? It is fair enough to suggest that an illness is mediated by an abnormal block in PD but is there a...

Cochrane is not fit for purpose but the reasons behind that, as I indicated, are to do with a completely different political story than the one Monbiot addresses. They are to do with territoriality within the medical profession. A Monbiot article on that might be very good but it is not...

These people understand the arguments perfectly well but allow their motivations to override their reasoning. Maybe this is a different sort of lack of understanding. I get the impression that quite a lot of people can understand a concept but do not 'understand' in a different sense meaning...

But to be devil's advocate - who else was persuaded by this? Everyone sensible in the ME/CFS world already thought PACE was rubbish. Everyone dumb still thinks as they did before as far as I can see. There has been a shift in media coverage following NICE 2021 and a lot of advocacy but I don't...

Who is the audience though? Everyone involved has made up their mind one way or another. The public aren't going to see much of a story in patients telling Cochrane that Monbiot has told them off for reasons they know about.

Pretty much every trainee that I have worked with understands the essential critique. It is, after all, the reason why we spend millions on properly controlled trials that avoid bias. But those same trainees will then forget they understand this and make the same mistake. It isn't really an...

But if we send them a copy that won't be public, will it? Cochrane see their analysis of exercise as something quite separate from the SMC politics. Their analysis derives from GP politics wanting to throw stones at big Pharma and hospital medicine and make everything primary care and exercise...

But I don't think that is actually true David. I submitted my testimony to NICE without any reference to the data revelations. NICE put PACE through its assessment system without any reference to data revelations. It decided the evidence was of too poor quality to recommend CBT and GET purely on...

But, over and above the arguments given, that is just another appeal to authority. George doesn't actually mention why the trial was a non-starter. My wife commented that NICE saying the quality was low or very low does not exclude it being at least suggestive that there might be a positive...

I don't think it made any difference in reality, David. It may have provided information on how they were able to make statements about 'recovery' but from a scientific point of view you don't even read those statements, you look at the trial design and the data. It was transparent that the data...

OK but that is actually wrong too. The poor methodology and invalidity of the results is transparent from the original Lancet article - which was the basis for my expert witness testimony to NICE. Getting the PACE data was a huge and necessary achievement in order to see the detail of the...

I don't know. Monbiot raises no evidence that Cochrane do not have in front of them. He mentions David Tuller so will be seen as part of the activist conspiracy. I actually think George gets some things wrong here. And he says CBT and GET are no good because NICE says so. But that is just...

George knows about this. In fact some members have had quite lengthy discussions with George and the material in the latest article reflects that. The political motivations at Cochrane are less clearly within George's field of interest - more to do with internal medical politics.

https://www.theguardian.com/society/2024/oct/17/repair-bill-for-crumbling-nhs-buildings-soars-to-almost-14bn

An asphalt drive! Thee wert looky. At UCH we had nowt. Nowhere to park an ambulance rickshaw monocycle.