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This is just voodoo, apparently written by a junior level psychiatrist - and it sounds like it. This is really what is meant by person-centred care - in the same sense that a sausage machine provides sausage centred care.

Well at least is its bespoke one should expect the male therapists to be in made-to measure pinstripes and the ladies in the very best Cashmere.

Yes, the discussion of the response from therapists that they don't do his GET anyway suggests a certain peevishness has set in. Even the handmaidens turning against.

That article is billed as summer2021 but I did not know of its existence. Did @Caroline Struthers ? Edit: No it seems to be current in the April 2022 Newsletter. Same old tired non-sequiturs.

If I remember rightly it is actually only a proportion in many mitochondrial problems because the cells form a mosaic of abnormal and normal ones.

Interesting case. They say: Fatigue may be present already without any physical activity or only in association with physical exercise. The latter is also known as exercise intolerance or exhaustibility. That does not immediately sound like exercise intolerance as understood in the context of...

Yes, I found it a bit dated and lacking practical insight. The senior author Leemon McHenry I know from my philosophy world. A very nice guy, interested in Whitehead, Leibniz and such people but I was not aware of an interest in medicine. There is a muddling up of science and evidence too...

The other thing is that 'evidence-based' is nearly always rolled out when things are suspect - 'but we can assure you that our treatment is evidence-based'. It is mostly used precisely in those situations, like psychotherapy, where the evidence is rubbish.

They acknowledge this but I am not convinced they have guarded against it well enough.

Can you explain that in plain English. What would be obvious? Surely we only 'know' about what happens in standard situations with healthy controls, which might not happen for all sorts of reasons with patients?

Interesting to see this paper. The points that strike me: 1. The increased association with NHL is not that great at 1.29. It is potentially of scientific interest but tends to suggest an indirect or spurious link could be involved. 2. The CFS rate of 05% seems high. 3. The use of medical...

I don't follow that. If it shows up on the graphs as the result that we see then it does. I realise things are complicated but as far as I can see at the moment it is possible that increased ventilation occurs at a lower work rate in the second CPET for PWME because of some inhibition of that...

Are you sure? It seems to me a bit odd to do a CPET two days running to show reproducibility. I would expect in the context of ME to leave it for a week or two at least before trying again. I thought it was a deliberate attempt to demonstrate fatiguability - which after all was supposed to be...

When I have flu I don't actually have a choice. I collapse shivering if I try to do anything vigorous. But my point was exactly this - that to overcome feeling so ill you need to be in a very particular mental state supported by adrenaline and cortisol and goodness knows what and that may matter.

That sounds a bit weird. I thought the post of doing it twice was to show a difference?

Another interesting example of the CPET not correlating with PEM in time scale - but the other way around. I go out of my way to be sceptical because it is the way to get debate going and I am happy to believe that there is some consistent finding on the 2day CPET of relevance to what is going...

Yes, I agree with all your points, but there remains the key point that if we are tracing a complex series of cause-effect interactions then it is unwise to assume they can be treated as a simple; 'exertion'>>'PEM ' relation and interpret findings as if it were. The 2day CPET is often quoted as...

Agreed. And I can see the logic of the original experimental design trying to show a dip in function on day 2 by looking for maximal performance twice, studying people who are bad enough to show an effect but not bad enough to find it distressing. But if the aim is to study metabolic changes...

Actually I don't think I could. I think I would vomit and collapse on the floor. Over the years I have looked after people in hospital with all sorts of reasons for feeling acutely ill and I am quite sure they could not get on an exercise bike and start pedalling. I have assumed that PEM feels...

I think this is highly possible and I think it is worth discussing in the context of this study. I understand the desire to keep discussions in pigeonholes but my brain is a bit too old to keep dotting about threads once a line of thought has started!! Breathing patterns are very much affected...