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The advice seems to me to be a reasonable policy on the basis of limited information. Information is always going to be limited since nobody is going to do trials of people playing rugby earlier and earlier after the illness until the rate of splenic rupture rises by a statistically significant...

So why doesn't Dr Vogt stick to homeopathy or Mexican adipose stem cell transplants - which no doubt would give very positive results in the same way in an open trial laced with moral blackmail.

I think in this sort of context 'risk factor' just means a predictor of an association. No causal link is presumed either way. If there is a time sequence that may be relevant at least in excluding a backwards causation.

I am not familiar with reasons for small volume hearts. Both of those options sound possible.

'An interesting question that the presented facts pose.'

The cardiac volume may not mean much at all. An athlete's heart is thick-walled but not enlarged in terms of volume capacity. A diseased heart has a bigger volume but a reduced proportion of that volume is pumped at each beat (lower ejection fraction).

Smoking turns out to be relevant to a remarkable range of diseases. We were very surprised when it became clear that smoking increases both risk of and severity of rheumatoid arthritis, which was supposed to be a purely immune disease. Button course smoking is likely to correlate non-causally...

They have to state it the way the analysis was made. There is no interpretation. Which is what is good about the paper. They are not drawing any conclusions, just giving us facts. That can seem boring but it allows us to do our own interpretations.

In most situations where the heart muscle is failing the cardiac volume is large. An increase in size is almost the definition of heart failure, as laid down by Starling and Bayliss a century ago. A poor heart sags into a bigger heart. What is interesting here is that the situation is the opposite.

I am certainly not the first to spot it or write about it. I cannot give chapter and verse though.

I think it has been explicit on two occasions and maybe implicit on one or two others. I have also come across it in conversations with psychologists and psychiatrists in relation to criticising PACE in general rather than specifically refereeing my manuscripts.

I am quite sure this is the case. People reviewing my manuscripts on PACE have more or less admitted it and used it as a reason for asking me to remove references to the problem. At least their lack of rigour is transparent.

Vasoconstriction in the lower limbs on standing does not seem to fit with low blood volume. The vasoconstriction ought to be there all the time - as in shock. It sounds more like autonomic/adrenergic overdrive. That in turn would suggest an operating autonomic system being pushed by some central...

As you say, the trouble with this list is that it overlaps with ME/CFS features. Also it is very unclear which of these symptoms go with standing and which are simply symptoms that people with POTS have at other times (not related to the physiological stress of standing). It also includes...

I think this is interesting. My only disappointment is that they did not give us scatter plots for the data but only histograms. Nevertheless, the difference between patients and controls looks biologically relevant. A paradoxical relation to cardiac volume is also intriguing, since that would...

Note that he says (I think the correct wording now) 'And actually in a way what we are going back to here is believing that the outcomes of the trial should be the ESR or swelling of the joint [examples used to counter criticisms by a rheumatologist by the name of J Edwards, as he understands...

I can understand that line of thinking. What puzzles me is that looking at the reviews ahimsa quoted it seems that a rising heart rate is not a sign of autonomic dysfunction. It said that if the autonomic system is failing you would not expect to get any change in heart rate - which makes sense...

I would personally not recommend any further petitions at present. The OMEGA petition stands as an indication of patient opinion. The process of producing the Buzzfeed article will have involved a number of people who will have had to re-think their position, like Dr Bishop. Recent events have...

Mouse 'models' like this are always self-fulfilling and tell us nothing about causation in human disease.

I fully agree with Derya Unutmaz. Jen has shown the sort of understanding of human nature that the so-called professionals seem so sadly to lack. I think there is no real need for petitions now. The tide has turned. SMILE is so ludicrous nobody can defend these trials now. There will be some...