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Dear @Badpack You make some valid points but there are a couple of things I would add. Pretty much all effective soluble antibody is made by plasma cells, none of which have CD20. I was aware of that when we introduced rituximab for autoimmune disease. The rationale for rituximab is actually...

I doubt it is worth speculating much about these antibodies. The differences in levels between controls and disease cohorts are not big enough to suggest a role in disease mechanism. When autoantibodies cause disease the differences are much more stark.

Precisely. It is non sequitur and deliberately so.

I am not sure the new tool is any clearer on general risk of bias. It is actually wrong where the original tool assumed people new how bias works. The general risk of bias is always worse than the worst specific risk. Any reasonably intelligent person knows that. If bad weather includes rain...

I doubt Gary’s post cancer fatigue would have ever got to Knoop or been considered for psychotherapy. Major thoracic surgery leaves people in catabolic state for months - as he says a purely physiological reaction to tissue trauma. The people Knoop treats appear to be in a different category...

Because there is a new breed of professionals only interested in personal and political gain rather than the right answer. And they are now in charge of quality control for Cochrane etc. it seems.

I think the Wikipedia account is valid. The paper gives what people who do pragmatic trials want to claim they can do - which simply indicates they donor understand what they are doing. The pragmatic people have got this meme that these trials are in contrast to explanatory trials. Wrong. An...

A pragmatic trial does not even tell you if it works - that is the definition of a pragmatic trial - it cannot tell you that. Goodness knows what use it is.

Excellent, more sense than I can!!

Yes, I think it is all politics. The BMJ is doing a jolly good job keeping people well by supporting the cost cutting agendas advocate by both parties (or all six) because it reduces taxes.

My impression is that post viral fatigue is quite well documented as a causal relation - bye things like the decay curve for fatigue in the Dubbo study. What I see as more problematic here is that if you have a specialist unit set up to take referrals for 'post-cancer fatigue' they will get...

So maybe they have ME? Or maybe they have prolonged fatigue of another sort that can be triggered by lots of things. The authors here treat the problem as 'post-cancer fatigue' because they think it is all about the psychological state of having had cancer. Is this a real category? Does anybody...

I had a look on PubMed and it seems that Lipkin and Hornig have not published their big viral screen. They presented the findings sometime around 20114 I think.

My memory is that Davis did not find any evidence of more viruses either. But Lipkin is a professional virologist. Davis would have made use of other people's expertise. If Lipkin found nothing I think one would need some fairly strong evidence to suggest he had not looked hard enough.

How could anyone know that? There is no reason to think sequestered virus would be more common in ME as far as I am aware.

But it sounds as if they are saying, by analogy that after treatment people are no better at coping with spiders, they just say they are. (Which I would be prepared to bet is because that is what they think they are supposed to say!)

But is any of this reliable evidence or just spin? Macmillan give no references. The systematic reviews we have seen on exercise for fatigue are dreadful by and large.

Lipkin and Hornig reported this maybe three years ago. But being negative findings I am not sure I ever saw a publication.. I think there was something that included finding some odd viruses less in ME, but not ones that seemed likely to be relevant clinically.

I may be misinterpreting the paper but it looks to me to be disproving that activity is actually any use in post cancer fatigue.

But hang on, these authors seem to be saying that it isn't actually more activity that makes people better at all. It is just that if they think they are doing more they will say they are better. Are there actually any studies that, in contrast, suggest that doing more activity actually mediates...