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A little puzzle for you Trish. What mantra do you remember that goes: A B A B, B B A A, A C A C, C C A A with some jingly bells, drums and stuff.

The alternatives are nice but I think miss the point. The article is not about some new conceptualisation of ME/CFS or something emerging. The concept I am talking about has been around for twenty years and has been well described by others. The key point of the article is to disentangle the...

I think it is recognised by anyone of any use to people with ME/CFS in the research and clinical world. It is standard usage at conferences. And it has been around for twenty years. Lots of patients are not aware of it and lots of doctors simply cannot be bothered to take an interest but if they...

Yes but Acheson was describing something quite different from ME/CFS -which is the main point of the article. He was describing something that he thought existed on etiological grounds, that, incidentally, Ramsay had suggested was a trigger for something like ME/CFS. ME/CFS isn't Acheson's...

Except that Acheson's idea was different from Ramsay's idea and those were different again from Peterson and Cheney. I agree that ME/CFS carries over concepts that we no longer want but at least it does not try to revive any specific ideas we do not want. Acheson's idea was as I understand it of...

I think it is now serving that purpose. Nobody using the term is wanting to invoke the meanings either of ME or CFS. They are wanting to invoke a new meaning with a new consensus - basically the motivation for the Canadian Criteria publication. Alastair Miller builds exactly the same argument in...

He was regarded as perhaps the most rigorous and articulate UK medical mind in the last decades of the twentieth century. He is still around and as sharp as ever. He may be a distraction but the target audience is the physicians who ought to see the need to set up and take responsibility for...

I would like to have some evidence for this. When I had the worst pain known to man - renal colic, said to be worse than childbirth, a nurse thought I was a silly wimp when I pointed out that the entonox machine she had offered me was actually turned off. She insisted it was fine despite nothing...

It is both but I don't want to get too complicated.

For physios, talking in the round as I was, it is very definitely the physios who invent the unfounded treatments. In the 1970s we just sent patients off to the physios to wave whatever magic wands they fancied. For GET it may have involved psychiatrists and rehab physicians but I suspect it...

They may not deserve to be insulted for the sake of it but if the question is whether it is fair to speak openly about the lack of critical thought in these disciplines I think it is. They have a responsibility to patients to know why they are doing what they do. They have no right to make use...

Actually the history is a bit wonky and I remember it quite well. The term was originally used ny Hench and Yunus around 1975-80 as an alternative for 'fibrositis' which was thought to be a specific local problem that produced tender nodules. By 1990 everyone was agreed that there was no...

You remove the financial incentive on individuals to cut corners. GPs get paid to disbelieve people have any serious disease, including cancer. Obstetricians get paid to be in their private rooms and assume NHS mums will be fine.

No. A compartment syndrome is where a body compartment has an enclosing structure that fixes its maximum volume. The common example is a muscle compartment bounded by a non-stretchable epimysium or fascia. If the tissue swells new blood cannot get in at all. A compression syndrome is where a...

Actually I reckon I can be just as insulting but not as abrasive by removing 'uncritical'.

I think doctors will recognise an element of truth in the sitting up claim, even if it is not universal. It is not purely a matter of milder fatigue. People with terminal metabolic collapse from heart, respiratory or liver failure often prefer to sit up in a chair up until the point where they...

Did they ask any men what they thought? If not the results just show the NHS is broken surely.

The first herb is interesting. It has four legs and antlers - the Red Deer or American Elk. Presumably some sort of virility component.

Thanks to all for excellent points.