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Lots but it depends on the dose. It kills a lot of B cells at low dose but they may well be the ones due to die anyway. It kills some T cells but stimulates others. It is much too complicated to get any handle on really. Maybe the only thing we really know is that lethal doses, followed by stem...

I did a stint as a trainee at the Camden Rehabilitation Centre that did just this in 1984. Soon after it was closed down. The aim was the same - more people able to participate in the working forces.

The serendipitous improvement of lymphoma patients with ME on immunoablative therapies suggested that some cases might be autoimmune or perhaps hyperimmune/auto inflammatory as in psoriasis. The only reasonably safe and effective treatments for such conditions are either anti-TNF drugs (which do...

Better tests would be good but we always have to work with what we have. My experience of PSA is that an intelligent interpretation makes it a very useful test - which is why I am still on the forum. The same for MRI. The important thing is to have highly skilled people reporting the...

Matching a nausea-inducing placebo would not be convincing in my view. The only way to address this sort of problem is to do a dose response study. With varying doses everyone will get some nausea but because nausea is very unpredictable in severity nobody will know what dose they are having. If...

One might say 'psychiatrist, heal thyself'.

Why would one trust units that get their income and academic kudos out of doing trials?

The changes are smaller than in PACE but it is worth remembering that the changes in PACE were small (maybe three times the changes here but still trivial). I think this could be quite a useful illustration of the problem with these trials. It goes along with the main case I made for NICE, that...

It's an old ruse, used by a boss of mine in the 1970s. If patients answer the questionnaires right they stay on the consultant's clinic list. Otherwise they get to see the registrar. The cure is the magic of the consultant. It worked very well until colleagues cottoned on. These days colleagues...

In fact it probably took control of the bias rather well!!

I agree that that is possible. I guess that normally with intention to treat if someone drops out of a treatment they get a null score of some sort - like lost to follow up. People write long papers about al the possible biases that can come in with different ways of dealing with these. What...

I think you may be misunderstanding. If they are counted as having received LP and they did not get brainwashed into saying they were better they will drag down the average reported improvement for LP - which is better than switching them to the other group and allowing the LP average to be...

The point of intention to treat analysis is that inflation is worse if you cut these people out because you then average just over the ones who liked it. If you use intention to treat then the ones who decided they didn't like LP are included and they drag the scores down rather than inflate...

In general terms I think shifting people about like this would mostly be expected to dilute and difference between test and comparator, so prima facie, this may not be a big deal. The fact that the numbers in the group seem to keep jumping about may be more a concern in terms of sloppy analysis...

Interesting. I was not told it would appear. Sterne's name seems to have disappeared from the author list but that may be an artefact of alphabetical formatting for the RR section.

So why did the placebo group get a little worse on all measures? Not much of a placebo it seems.

I have sent in a Rapid Response letter, as recommended by Dr Godlee at BMJ. I have copied this to the editor in chief at Cochrane. Letter: In the recent publication in BMJ of the finalised Risk of Bias 2 tool (RoB2), used in the context of the GRADE system by Cochrane for assessing quality of...

I actually think 'physical' is no better than 'real'. They mean the same. Wessely would happily say the illness is physical. The problem I see is that if claims are made about physiological abnormalities that do to stand up then it will be very easy to level the same criticism that has been...

I absolutely agree - there is definitely something wrong.

This may be true. Nevertheless, I do hold out some hope that what NICE says may impact the prevailing view. I think that if new guidelines make it clear that ME is not just unexplained symptoms that can be shunted off to a therapist team for treatments with no evidence base there is some hope...