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Dear @phil_in_bristol, I understand your commitment and desire to help. However, 'it wouldn't look good' is never a reason to misinform is it? Keeping up appearances isn't what care is about. Real care is saying 'sorry but we have realised that our information is not as helpful as it should be...

That abstract sounds to me like a misunderstanding of statistics. I d not see what it means to be statistically confident of a change in an individual. If there was a change, however, small, there was a change. I am not sure that the variance in others is relevant.

I have come to think of the GRADE handbook as inexpert opinion!

Actual usefulness is what clinical usefulness means. Clinical usefulness means relevant the patient rather than a lab or pathology specimen or questionnaire. It has nothing to do with statistical significance - it is defined as not being that, so I cannot see how it can have anything to do with...

I agree with Alex.

I don't actually think statistics come in to the concept of a clinically useful difference. A clinically useful difference is defined by clinical usefulness and should have nothing to do with variance or SD as far as I understand it. I had never heard of this way of defining useful difference...

I don't think that is right. 'Clinical experts' do not come into it, only evidence. I am not sure what 'best practice' means other than practice based on reliable evidence in this context. Experts may be useful in pointing out potential flaws in what looks like reliable evidence but that is...

This does not look like an article to be pleased about. it seems to be a mish-mash of second hand material put together by someone with no idea about ME.

I don't disagree with the need for more accountability in medicine. But I think it really is very difficult to see how you rate individual clinics or practitioners without spending huge amounts of money. And for the last few decades governments have focused on cutting costs and sweeping the...

On the contrary. Proper trials check that methods work. You then apply them and you can check that you are applying them consistently. But you don't get information about whether treatments work from auditing routine clinics.

I doubt this can ever be done. For most specialities it is never done because it is realised that there are too many confounders to generate data that makes any sense. In rheumatology nobody checks clinics to see if they are getting good results with rheumatoid arthritis. We understand that...

This sounds like a quicker test rather than a better one. I cannot see that antibody based tests can do anything more than indicate that the person is likely to have met a Lyme bacterium some time in the past.

I think the idea is to stick to what can reasonably be called facts. Promising results are something quite different.

I had never heard of this MID before getting into ME studies - and I had spent years working on trials and acting as expert witness in the law courts on trials. As far as I can see it has no relevance to clinical importance. I used a slide of the 3.4 change in PACE for my NICE presentation with...

I think it may be the way around. All advocacy groups are pretty much agreed that treatments like CBT and GET are not based on good evidence. The need to emphasise evidence quality is because ‘biomedical’ (drugs or surgery) treatments based on just as weak evidence are not similarly being called...

No need. That was the sort thing I was referring to - empty vessels.

They are by the empty academic vessels who make most noise, just as coronary artery disease has been. To someone trained in inflammatory pathology these proclamations make little sense.

If I knew the answer @Bill, we wouldn’t be in this mess!

Not in any very meaningful sense of inflammation. There may be some microglial activation but I rather suspect that microglial activation in brain disease is an effect of what is wrong, not a cause.

Yes, but this is not realistic. Lots of cells use anaerobic respiration - like cartilage cells for instance. Normal brain is aerobic but if there is more lactate then it is clearly not normal. The problem with blaming immune cells is that if there were enough immune cells (white blood cells...