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We raised this specifically. I wanted an assurance that evidence gathering would not just be done by the 'techies' and the conclusions passed on to the committee. The NICE co-ordinator was clearly ready for the question and said that it had been agreed that a much more proactive interaction...

Yes, I think I found that second study before - basically you cannot say anything because the studies are rubbish - and it even pretty much says that. If we can convince the right people that the ME studies are uninterpretable I think doing the same for MUS will be like shooting fish in a...

This is where the ACR criteria for improvement in arthritis do the job. You only score improvement to the degree that you improve on both subjective and objective endpoints. It is a bit more subtle than that but that is the basic idea. Simon Wessely has said that psychiatry is for grown ups...

I would be interested to know what the evidence base for therapist-delivered treatments for MUS is - if there is any. My impression has been that PACE and the GET meta-analysis for ME have been taken as the bedrock evidence from which to extrapolate. If we can get to the point where it is agreed...

I have been trying but it can be an uphill struggle. Charles Shepherd would like to see more flexibility in treatment options. But to my mind that is a Trojan Horse.

This is my view. When I started looking after rheumatoid arthritis in 1977 we were using poisonous ineffective treatments and I knew that my real job was to listen to patients, tell them what I could about their illness and keep in touch. Fifteen years later in 1992 I was still seeing some of...

The term 'multidisciplinary team' is a political buzzword introduced in the early 1980s. Before that we had lots of different professionals doing different jobs. We had nurses and OTs and physios and even 'lady almoners' who came to be known as social workers. We each did our job. Someone was in...

I very much agree with this analysis. We are all going to be suspicious, like @Esther12, that the same psychiatrists and their therapists will continue managing people much in the same vein for the foreseeable future. However, I see no possibility of changing that without giving NICE the...

I am more optimistic. Charles and I met this guy before at RSM and I gave him a pretty hard time there for saying that there has to be something doctors can offer even if the evidence is weak. This time he seemed to realise that the tide had turned and that there would actually be support for...

A minor observation that intrigued me. The new chair of the guideline committee, Peter Barry, came up to Charles Shepherd and myself, who were sitting next to each other nattering. He quipped that he thought the organisers had managed to split us up. If the new chair knows who we both are...

I think the meeting went well. There seemed little or no sign of psychiatrists there and psychiatrists did not appear on the guideline suggestions for committee members. We had an opportunity to air the relevant issues and the staff from NICE who will be involved in the guidelines seemed receptive.

A neurological examination is a routine for any hospital specialist faced with relevant symptoms, not just neurologists. Thousands upon thousands of PWME will see such specialists and if there was clinical evidence of radiculopathy it would have got written in the textbooks by now. It is written...

I wouldn't get excited by the report of ganglionitis. It does not explain much,if anything specific, in relation to ME. If it was a causal feature of even a few percent of people with ME then I think we would have stuff in the textbooks about specific neurological signs - and we don't. The...

It is very hard to know whether 2 day CPET tells us anything about a physiological basis for the cause of the illness or effects of the illness. Again, gene expression studies may just show that, for instance, the white blood cells in PWME hang around longer and tend to be a bit old because of...

Yes, I think this demonstrates the fact that what they say in different places does not add up. But Chalder and Wessely were mostly saying that you need the cognitive strategies of CBT. The PACE people introduced the idea that GET might work too. But it remains the logical case that the...

Quite so, but if you read carefully it is clear that to justify CBT these must be beliefs that can only be overcome if you use special techniques involving 'cognitive strategies' rather than just rehabilitation. There is no need for CBT if people's beliefs are soft enough for them to agree to...

Because the point of the trial was to satisfy a desire to please the DWP and to gain academic kudos and job security for psychotherapists. It is very clear that the trial was not designed to discover the truth. We now know that actimeters were not used for follow up assessment because there was...

Do we have that on record? It would seem pretty hard to substantiate the claim that people who need professional brainwashing techniques do not have strong enough beliefs to act on!

I have been thinking this over recently. The BPS model that informs Chalder's CBT does not so much imply that patients know before hand exercise is bad for them. It is very clearly based on the line of argument (in Wessely, Chalder et al 1989) that the problems that patients BELIEVE that...

Sorry Inara, but Cheshire is right here. The failure of PACE has no impact on the theory because the results are uninterpretable either way and do not test the theory as such anyway. The only way it might disprove the theory is if we could reliably say that CBT made people say they were better...