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I am one of maybe no more than a score of musculoskeletal physicians worldwide who have made connective tissue structure, pathology and biomechanics a special interest. I used to write the chapters in textbooks on connective tissue physiology. I still sometimes get things wrong but the situation...

Some points of interest. 1. Clinical trials can be divided into explanatory and operational. An explanatory trial addresses mechanisms of disease or treatment action. An operational trial addresses whether a treatment works. Both sorts try to show cause and effect. Explanatory trials try to...

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We probably should not post the whole thing for copyright reasons. For me it would be against College rules. But somewhere a few days back pretty much all the relevant paragraphs were pasted in to a thread here. Sorry not sure exactly where. It really does not say much other than that.

Interesting point, of relevance to NICE members @adambeyoncelowe and @Keela Too. It reminds me that Simon Wessely said to me that his only concern about PACE was that it would be followed by rolling out of 'CBT' done by subcontracted services using people who were inadequately trained. Of...

https://www.ncbi.nlm.nih.gov/pubmed/28961036 It has been quoted earlier on this thread or another, not sure which. I have access to full text but not sure if someone has found open access.

I can think of videos produced by subcontracted Health Authorities showcasing 'Body Psychotherapy' and graded exercise?

Moderator note: This post has been copied to this thread, where there may be further discussion of it. https://www.s4me.info/threads/trial-by-error-an-open-letter-to-dr-godlee-about-bmj%E2%80%99s-ethically-bankrupt-actions.10988/page-3#post-200086 I have today sent a letter to Dr Godlee of...

Moderator note: This post is copied from this thread. https://www.s4me.info/threads/news-from-scandinavia.647/page-37#post-200059 I have today sent a letter to Dr Godlee of BMJ about the Lightning Process. The content is given below. Dear Fiona, I note the recent publication in BMJ of an...

Although it has given rise to much debate and critique from patient organizations, the to-date largest trial comparing CBT to graded exercise, adaptive pacing and standard medical treatment showed moderate but evident improvements in functioning (111) The more I looked at my slide for NICE the...

You have expressed some interesting points @butter. Just two points in reply. We have discussed here in the past the fact that although people have improved in terms of symptoms dramatically after cervical fusion that does not necessarily tell us there was anything wrong with the neck prior...

I think that is what happens when you get a collection of 'experts' round a table and chuck in everything they suggest, including some stuff that probably should not be there.

I meant OK in the sense of being able to manage - better than, as you say, you can when 'slammed into the ground the next day'. This is what people repeatedly tell me occurs.

Yes, good question, it would be useful for people to have a handle on this. Immune cells / white blood cells in general derive from bone marrow stem cells that can decide to follow one of several maturation paths. They can become B lymphocytes or macrophages or even red cells. To follow a path...

This is the problem. It seems unlikely that other cells/systems can do that. The genetic material should not be changed. The effect should be epigenetic, but in general epigenetic changes involved in cell maturation and function do not survive transformation into immortalised lines.

High hydroxyproline levels would be an effect of collagen breakdown, not a cause. But in any case it makes no sense to relate collagen breakdown to ligamentous laxity. This is where people are simply not understanding the anatomy. Ligaments are like elasticated cords. The collagen provides the...

I believe that there is a rare syndrome reported in young children where pharyngitis appears to be followed by cervical instability problems. I know very little about it and I doubt anyone does much. Whether it is anything to do with viruses or not I do not know. The pharynx is very close to the...

I think the answer is that by and large virus infections do not cause structural damage to tissues, except sometimes epithelia like skin vesicles. I do not think there is evidence for viruses causing structural change to ligaments.

I appreciate your explanation is very helpful @Woolie but cognition is neural as far as I am concerned. I realise that I may be seen as a 'reductionist' biologist by some but in reality I am an anti-reductionist Leibnizian if one really wants to go in to metaphysics. (Like Leibniz and Descartes...