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What would that be exactly? I live in Woodbridge in the summer months and get there off and on in the winter.

I think you are splitting hairs and elsewhere I make it clear that I am not expecting any of these distinctions to be cut and dried. I talk about extensive grey areas and the similar overlap in arthritis that still do not stop us from thinking that something different is going on in a certain...

I didn't invent the term PEM so I don't know exactly but it presumably refers to more general symptoms than 'fatigue'. In its original sense malaise implies a state that can include nausea, OI and pain (generally widespread muscle pain) yes.

Much of the article is very good but it is a pity that Dr Kane goes off at a tangent on unproven treatments towards the end. In some ways I think it is a pity that CBT got let off the hook at NICE 2021, and was allowed to stay in as a means of 'support'. If anything the most important message...

Agreed.

Also very nice!

Neat!

Maybe it would be clearer just to add an 'and' - myalgic encephalitis. and chronic ... Then the both follows. I agree. Everyone should have access to a counsellor. What I see as entirely negative is making this counsellor part of a 'team'. As soon as you have a team you have gossiping about...

I know a nurse who has very deep insight into the impact of ME/CFS. Quite a lot of counsellors have a nursing training. I strongly suspect that, free of psychological mumbo jumbo they are much more likely to do good than psychologists. There are some critical thinkers like Brian Hughes, yes...

I address this directly. The only thing that I can think of is prevention of plantar contractures from lying in bed with bedclothes on. I had a sense that J T-B may have had a problem of that sort when she got back on her feet. But a competent nurse can handle that perfectly well. ITU nurses are...

Strictly speaking I think that is true but there is a step that is not being considered in all this. I have spoken personally with Maeve's mother and I think things are more complicated. I would prefer not to be more explicit. I think there were different views amongst physicians and I think the...

He is not delusional. He has an acute political intelligence. But I think this was a very real concern for fairly obvious reasons. His agenda was to maintain the claim that highly trained psychotherapists and psychiatrists knew what they were talking about and were therefore essential and needed...

I agree with the latter. And the multidisciplinary guff may have been a useful sop to prevent an outright revolt prior to signing (instead of a mini-revolt afterwards). But nobody would have revolted if it had been pointed out that 'complex multi system' was not based on any evidence. As long as...

I think that that is only half of the story. Maeve was triaged into a place where nobody would help her. I think there is an important contrast with Bob, who recovered from a period of starvation as a psychiatric inpatient. It seems that he then made a decision he could not go on, but he did not...

We don't even get that amount of interest. We just get eyes going upwards and out the door. At least you get some faux sympathy. We just get disdain when we ask for a prostate test (when a week later the biopsy shows Gleason stage 4+3 invasive disease).

In the UK 'Man-flu' is a term of derision to indicate that men always moan more when they are ill and should be told to grow up.

Not all of them. That is the bare reality. Physicians with opposite assumptions managed to create a situation where Maeve had no chance it seems to me. Unfortunately it seems likely that we will never know exactly what went on but I have had accounts from several people directly involved.

There are probably quite a lot of odd clinical clues around to ways in which unexpected molecules have profound signalling effects on brain and pain and nausea and all sort of similar generalised symptoms. I don't think we know why people with hepatitis suddenly cannot stand cigarettes for...

My understanding is that Amolak withdrew from NHS ME/CFS practice a while back. Yes, if we had just a dozen people with his interest, which we did forty years ago, things would be very different. I have been reading Tronstad's paper with Fluge and Mella on pyruvate dehydrogenase activity and...

'why not fire them a couple of antihistamines for three months? Give it a try.' Holy Moses.