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That seems very reasonable to me. If the person's strategy for managing their illness includes not doing things that require sudden changes in activity or diurnal schedule (i.e. not getting up for a 6 o clock flight or pollarding a tree or swatting for an exam or hiking in freezing conditions)...

The problem is that in the open label follow on study with rituximab people repeatedly showed major improvement in a time frame that matched expectations of how long the drug's effect would last. Then it became clear that in fact this was a placebo response. I don't know if altimetry or step...

I don't think it is anything like as simple as that. For some, yes, but you have to remember that trials are carried out on people at all stages of going in and out of bad phases of an illness. And we have no way of knowing whether in fact there is not a subgroup who are highly...

As far as I can see the results show that their measures do not measure what they thought they measured. Hair levels were supposed to be the average over the short term levels, indicated by saliva. They weren't, so it looks as if their assumptions about interpretation were wrong. There is...

I am sceptical of that approach. We have not so far ever known that mitochondrial function is affected in ME. It is a speculation that is quite difficult to marry with the clinical picture. And if you fail to find something you cannot really just say, oh we did not need to find it anyway for...

I had assumed that he was just talking about some soluble or suspendible factor of the sort that has been proposed to explain previous results with ME plasma affecting normal cells. (Maybe a protein or cell fragment.)

The problem is that for CCI we do not even have controls, so it makes no difference whether measures are objective or subjective. Moreover, in this context step counts are subjective measures. Placebos are very likely to be able to improve step counts. What they do not improve are things like...

That would be an autopsy, but basically yes, biopsies of living brain are only justified if you have very good reason to think that you have encephalitis or tumour in a potentially dispensable area. Effectively that means you need gross neurological signs on physical examination suggesting that...

The situation is complicated. I think I would probably have turned down the great majority of applications for ME research, just as the funding bodies did. So maybe if good projects are put forward they will get funding - partly because ME is designate as a priority area in the UK. But there are...

As I see it CBT implies a process that draws on a theory of how 'cognition' and behaviour relate causally. From what I have seen all such theories in clinical psychology that claim to go beyond common sense and compassion are more likely to be wrong and damaging than right and useful. What...

So much so that they are laying off senior staff like there's no tomorrow. The problem is not that too much money is going to biomedical research but that it is going to people interested in furthering personal ambition and not in getting the right answer to a scientific question. How you...

That looks to me like a clear case of sour grapes. Not a single argument is produced to support the case - other than that those other meanies have lots of money.

Really, David, I thought you were a well read man of letters. Ralph Waldo Emerson: A [certain? - sources vary] foolish consistency is the hobgoblin of little minds'. He attributed it to statesmen and religious folk but there is no lack of it in medicine and science.

Indeed. I am constantly reminded of Emerson's ' A foolish consistency...

yup

This is an interesting suggestion. In days gone by I would not have doubted it for a minute. But things are changing and one could argue that nobody owns data if it is in the public domain and is of public interest in terms of medical implications. I think this would be a very interesting test...

This suggests that the active ingredient is a 'therapy room' - maybe the wallpaper. So maybe not the cardigan?:( Good to disprove a theory though.

You would have thought so, but not in this field. For a professor in the field to not understand this or deliberately obfuscate seems to me less being misguided and more incompetent. I have a terrible suspicion that part of the descent of medicine into this sort of post truth situation is to...

As far as I can see 'validation' means nothing other than that you get the same sort of answers on several trials. It means a questionnaire is probably being adequately understood. Nothing more. It has nothing to do with validation of the measures in the sense most people would think of. Anyone...

At least the second part of this sentence seems fair. I agree that validation means nothing much more than that people who speak English can understand the questions. Subjective endpoints are to be preferred if they reflect key features of distress or disability. But that is irrelevant if they...