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Dying of Neglect
Article by Samuel Kronen, currently on the home page of The Dispatch. Possible to read by registering on site.
#2OMG; Dr David Strain, expert on everything medical so long as it gets him in front of a microphone. Giving it large on diabetes BBC Radio 4 Today (pre 7:00 BST this am).Strain took Maeve off the list for admission under specialist CFS service and advised eating disorder ward "7-10 days of NG" feed
#3would be adequate, made 0 attempt to treat her OI & refused to prescribe low dose Abilify she was asking for in hospital.NHS starvation diet insisted upon pushing her so far into anaerobic digestion she was crashed 18 hours a day, ie complete paralysis; extreme sensitivity to sensory stimuli.
At the final discharge meeting he said she needed to meet other people in recovery from being so poorly. She was literally being starved to death; and there are no venues or opportunities for meeting other people in recovery from very severe ME anywhere. The man is a narcissist equal to all others.
From Sarah Boothby‘s (Maeve's mum) Bluesky account:
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ME/CFS Final Delivery Plan. (A national healthcare policy document)And Strain is inputting into e learning modules ?
The previous IDP action ‘NHS England will develop an e-learning module on ME/CFS, which will be aimed at health and social care professionals and available to members of the public’ has been updated to include an additional 2 modules, covering:
- primary care, which has universal access
- severe ME/CFS (which includes both severe and very severe ME/CFS), access to which will be limited to users with NHS, GOV, and ac.uk email addresses
“Requests from the Task and Finish Group include ensuring learning resources, such as the NHS England e-learning modules, are shared more widely for expert input, available to allied health professionals, and made mandatory for health and social care professionals. Members also suggested that indicators should be developed for measuring the effect of e-learning on changes in practice. Furthermore, members recommended including training on ME/CFS as part of mandatory safeguarding training for CYP and adults, and suggested ensuring mental capacity assessments are suitable for those with severe ME/CFS.”
Principle
The TE was not relevant on the facts of Montgomery and so it is perhaps understandable that Lords Kerr and Reed did not set out a justification for its retention. They did however make clear that:
[The TE] is a limited exception to the general principle that the patient should make the decision whether to undergo a proposed course of treatment: it is not intended to subvert that principle by enabling the doctor to prevent the patient from making an informed choice where she is liable to make a choice which the doctor considers to be contrary to her best interests.
Clinical concerns and ethical arguments
Some doctors feared that more stringent disclosure requirements would risk overwhelming patients with information, causing distress or leading them to make poor decisions, while doctors’ time would be taken up with lengthy explanations, creating a drain on healthcare resources. Information overload is unlikely given that information should be tailored to the patient. But doctors must judge what is appropriate for each patient and how their exercise of judgment might be assessed by the courts. The doctor might think that disclosure of certain information could lead the patient to a decision that is not in their best interests, as was true for the Montgomery case. But the ethical and legal position is clear: doctors must not withhold information simply because they disagree with the decision the patient is likely to make if given that information.
Making sure that patients understand all the information they need to make a decision will inevitably take longer. But allocation of health resources should be tackled systematically rather than individually. Healthcare policy should cover, for example, which treatments should be available and how consent procedures should be handled.17 The doctor’s duty is simply to treat patients according to their interests, which might include being given more information than usual.
A second concern was that the ruling would encourage “defensive medicine,” shifting the focus from helping the patient to protecting the doctor. But doctors should have already been following GMC guidance, which highlights the importance of communication.13
Finally, doctors criticised the focus of patient autonomy over medical paternalism. But this is a false dichotomy—the idea of a fully autonomous patient making choices completely independent of the doctor’s input does not reflect the complex reality of medical decision making, nor does the caricature of a paternalistic doctor riding roughshod over patients’ objections.
Patients are not always aware of the facts of their treatment after consent related discussions,26 and they are influenced by the way in which information is presented (the “framing effect”).27 But the difficulties of conveying information about treatment and risks should not be taken to indicate that patients are incapable of understanding medical information or that patient autonomy in decision making is meaningless. Rather it shows that the communication process has a strong influence on how patients understand, remember, and evaluate information—all of which are essential to informed consent. The doctor’s role is to ensure that relevant information is presented to enable the patient to use it meaningfully.
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Image: Professor David Strain
University of Exeter Medical School, Exeter
Dr David Strain based in the Diabetes and Vascular Research Centre at the University of Exeter Medical School.
His main focus is the health of older adults with diabetes; ensuring the right patient gets the right treatment. He has performed the only study to date demonstrating the feasibility of individualizing targets for older adults across Europe. This has informed the new UK guidance document for the management of older adults with diabetes and Frailty, of which he was lead author.
Additionally, he has performed a global project exploring the causes of clinical inertia in diabetes in conjunction with the IDF called ‘Time 2 Do More in Diabetes’. As a result he has initiated several projects in the UK across primary and secondary care aiming to reduce this phenomenon
ME/CFS Final Delivery Plan. (A national healthcare policy document)
My PA who has been a professional carer for 25 years will not be able to access the 3rd eLearning Module on severe and very severe ME/CFS, due to be available later this year because she does not have the required email account. For those who do not know the 'IDP' is the 'My Reality: Interim Delivery Plan' attached to the public consultation which took place in Sept/Oct 2023. Below are what I believe are the reasons why.
The following quotes are from the Final Delivery Plan
This feeds in to a problem with informed consent because of Montgomery v. Lanarkshire Healthcare Board [2015] Supreme Court decision.
Below is from a review of the legal aspects surrounding the principle of informed consent. It includes a discussion about the 'therapeutic exception' formerly known as 'therapeutic privilege'.
Author Emma Cave Professor of Healthcare Law, published 29 June 2017 https://journals.sagepub.com/doi/10.1177/1473779517709452#fn90-1473779517709452
Long read - mostly for medico-legal people - but includes this on therapeutic exception i.e. withholding of information:
GMC guidance on consent:
This guidance came into effect on 9 November 2020.
The guidance was updated on 13 December 2024 when regulation of physician associates and anaesthesia associates by the GMC came into effect.
https://www.gmc-uk.org/professional-standards/the-professional-standards/decision-making-and-consent
In this BMJ article written 2 years after the Montgomery decision, whose authors include a QC - 12 May 2017 https://www.bmj.com/content/357/bmj.j2224
It could be argued that the ME/CFS Final Delivery Plan, as a cross government healthcare policy document, tells doctors it's OK to carry on as before regarding severe and very severe patients, in particular.
ETA: The Montgomery case involved a pregnant woman with diabetes.
Action for ME made Dr David Strain their Medical Advisor in 2021. He is setting us back decades.
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President, patrons and medical advisors
Our President, Clare Francis MBE, has worked closely with Action for ME since 1987 and has had ME for more than 20...www.actionforme.org.uk
Sonya Chowdhury, Chief Executive, Action for ME, says:
'Dr David Strain is our Medical Adviser and was appointed in June 2021.
Dr Strain brings a wealth of clinical and academic experience to our charity, as Senior Clinical Lecturer at the University of Exeter Medical School and as a consultant to the Devon ME/CFS specialist service. He leads the British Medical Association’s Covid-19 response team and has repeatedly drawn parallels between Long Covid and ME/CFS, calling for research to benefit all post-viral illnesses.'
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Ps I'd like to know the geography of groups writing guidance, but I query the cohort of particularly exclusive doctors who dont want other doctors involved, and so they dicker about current consultancy criteria, regardless of what warrants what. It became a closed shop. Consultants to the industry cite opinions tooWith Dr strains many jobs
- diabetes dr, old age dr, BMJ rep, long covid research Co ordinator,
how much time is he devoting to ME/CFS
& how many severely affected, besides A handful of critical cases, has he ever seen,
to have the role he has writing guidance?
I gather that he did not have the time to spare, which Action for ME could do with more of, from their ?Medical Advisor. At that time he seemed to be spread thin, like many dedicated people working, befriending, caring and loving in gaps designed, yes designed, into all systems - something being universally out of whack.
Well globally out of whack. It might not be the universe. "Do not adjust your set, there is a fault in reality". I remember that from the last century. But who tells my doctors its not my fault. My Reality is not my reality.
All I knew then about Dr Strain, was that he insisted to our MPs, in some all-party Parliamentary Group, that M.E and Long Covid be researched together, which I thought was unusually perceptive for the times, superbly laudable, sounded like good leadership, my hero etc. Can Action for ME still consult him, and ask him things?
Where does he stand now on malnutrition and options on trialling various medical feeds? Is he still medical advisor for a charity? Does he know why special medical feeds for the unspecified conditions were withdrawn?
Did he agree with the hoi-polloi that a healthy diet is sufficient in all cases? Does he now agree that there is a distinct subgroup, with partial digestive failure, to be manageably prevented, before it becomes total failure?
Might he surmise that maybe there is another sub-group, following a virus, which mutated some time between 1985 and 2005, maybe, which sub-groups hasn't got the same chance, of preventing total failure?
Ps I'd like to know the geography of groups writing guidance, but I query the cohort of particularly exclusive doctors who dont want other doctors involved, and so they dicker about current consultancy criteria, regardless of what warrants what. It became a closed shop. Consultants to the industry cite opinions too
Lucy Letby got targeted by a police consultant and expert witness with insufficient clinical experience. But Its not altgether consistent and rational, once its a closed shop. Group-think is supposed to be pre-empted by good practice and industry standards. It took an ex-MInister to say its the wild west out there. Once off the job
Realistically, who is the alternative though? We don't have a lot of experienced ME community leaders to choose from. Dr Weir? Dr Bansal?The trouble with adopting m.e community leaders from the long covid cohort, which dr strain mainly is , as is Jo platt & dr binita Kane, is their starting point was 5 years ago.
Visited for 3 minutes today. A NHS London hospital doing everything it can. The contrast with how it was before #MaeveInquest made me weep. Staff are protecting Savannah from visitors, without intruding on her autonomy. Very high bar. Strain could learn much from them. @ashleydaltonmp.bsky.social
sarah boothby @swastrosarah.bsky.social
Justice4me.uk good news out later today!Meanwhile, another shout out for the Queen Elizabeth NHS Hospital, Woolwich, where Savannah (formerly known as Gigi) is being treated as everyone with very severe ME should be. Outstanding adjustments being made, despite no #ME expertise anywhere in the NHS.
September 30, 2025
sarah boothby
@swastrosarah.bsky.social
sent to Paul Garner this morning, in reply to his comment on my linkedin page,"Hello Paul, I am so pleased to hear from you. Thank you for reaching out. I am sure you know by now that my daughter died from medical neglect of ME. I have been hoping to speak with you and/or those you campaign1/2
with for rehabilitation and recovery for all those with a chronic fatigue diagnosis. Do any of you have the capacity to meet with me in person, for a proper conversation about risk and safe management, in central London? Email a reply if you prefer. justice4me.uk2/2