Paul Garner on Long Covid and ME/CFS - BMJ articles and other media.

I agree and that is not the point I was trying to make. I don't think you grasp the fact that by posting these kinds of threads mocking him and repeatedly attacking his character, you are stunting opportunities for your community. Either because researchers don't want to work in this area or because patients recovering don't want to make themselves known and share what helped them, for fear of also being ridiculed. You don't have to listen to me, but I wanted to at least share the impact from my perspective.

Actually he has been attacking PwME especially those who don't agree with his point of view. He has done that using his links to the media and pushing a message out that PwME are attacking him. Just as an example one journalist, who I believe is a friend of his, quoted half a tweet of mine on Newsnight. Why half a tweet - well to manipulate the message (maybe I should have sued the BBC for $1b.

PwME are angry about how they are and have been treated because they have been treated very very badly by the medical profession and officials more generally. Hence people speak out. The government does now understand the issued but it is clear that the medical profession does not and will continue to dismiss and abuse patients. PG's message goes to help support those views (whether he intends it to or not).
 
I agree and that is not the point I was trying to make. I don't think you grasp the fact that by posting these kinds of threads mocking him and repeatedly attacking his character, you are stunting opportunities for your community. Either because researchers don't want to work in this area
There are researchers from all over the world and at the most prestigious institutions working on the biological causes of MECFS. Researchers from Harvard, Yale, MIT, Stanford, Oxford, Columbia, Cornell, MIT, Mt Sinai, John Hopkins, University of Edinburgh, LaTrobe, Universite de Montreal, Uppsala, Charite, UoBergen - those are the ones off the top of my brain-fogged head. Thankfully all these researchers (and the many more I haven't listed) are considerably more resilient than Gardner and his BPS ilk.

Might I suggest obtaining information from outside of your private FB groups for a more thorough read on the current research landscape.
 
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The entire M.E and LC community rightly wants their subjective accounts of their symptoms to be believed. All pain, all fatigue, many neurological symptoms are only subjective and dynamic. I appreciate there are things like heart rate measures showing POTS, but if you want your subjective symptoms to be taken seriously then you also need to appreciate research has a right to take the subjective report of symptoms seriously too. If a patient told me they were in severe pain and had severe PEM, I wouldn't tell them they didn't because they have no objective proof. I would take their report as factual.

I don't understand why you would want to argue that patients reporting improvements in trials that run for weeks or months shouldn't carry any weight when it risks people not believing how unwell some of you are. And yes, I appreciate some people can measure time in bed, steps walked, etc but they are still falsifiable and subjective, in reality. The only way of understanding M.E, both level of illness and level of improvement or decline is subjective self-report. The CPET isn't valid, based on current research. It is also questionable ethically, if participants are scared of going through it. Many recovering patients I've spoken to say they wouldn't have wanted to do it when still ill in case of being pushed into a long lasting crash by it.

There is a difference between taking accounts of symptoms from a large number of people (and clumping) to describe a disease and making anecdotal claims that a particular treatment works. For treatments you need objective evidence of change particularly when treatments are unblinded as otherwise, as I'm sure you know, you get reporting bias.

When trials are run the more subjective the measure the greater the improvement (but still small). That suggests reporting bias rather than any actual effect. Quite honestly I think it is unethical to run trials without robust measures (and they are possible).

I would try to measure activity rather than symptom reports as its more objective and especially with modern tech quite possible.

I personally don't think the CPET test is a good thing, I believe some in the US are forced into it to get insurance cover.

I do worry about the lack of systematic thinking about trials that seems to be acceptable in the medical profession especially those who claim to believe in evidence. It suggests that critical thinking and an ability to analyze a system is not taught.
 
You have a right to your feelings. I'm not here to persuade you it's the answer, I'm trying to nudge you as best I can to look at the reality of the brain retraining situation as it stands.

Nudge into a direction that has harmed people and without any evidence to back it up. The fact that you have yet to respond with a piece of evidence to back up your arguments should concern you.
 
Patients recover and do so in large numbers, they just keep it quiet as they don't want to be attacked. That is a problem that needs deep reflection here.
I find that insulting to me and our members. We don't allow personal attacks, questioning of someone's recovery story or symptoms, or speculation about why any individual recovered.

We do, however allow questioning of the claims made by professionals using their professional status to promote potentially harmful and unevidenced treatments on the basis of personal anecdotes and secret groups.

I think you need to do some deep reflection about the basis of some of your claims, your judgement about this forum's members, and your lack of response to people who are harmed by the treatments Garner promotes.
I don't think you grasp the fact that by posting these kinds of threads mocking him and repeatedly attacking his character, you are stunting opportunities for your community. Either because researchers don't want to work in this area or because patients recovering don't want to make themselves known and share what helped them, for fear of also being ridiculed. You don't have to listen to me, but I wanted to at least share the impact from my perspective.
I have never mocked Garner, nor have I attacked his character. It's his words and actions I am deeply worried about. If anything I am concerned for his wellbeing. Why would a senior doctor steeped in evidence based medicine suddely turn evidence on its head and go all out to become a media junkie using every opportunity offered and touting for more to tell his personal anecdote of a brief spell of illness and what he believes cured him? It's not exactly normal behaviour of a scientist.

As for 'stunting our opportunities'. Please, come on, listen to yourself. We are open to examining all scientific evidence, regardless of the type of treatment involved. We have discussed the papers Garner has co-authored. Individual members can make up their own minds. Just do a forum search for threads with Garner in the title and you will see we have reviewed his publications in research journals about ME/CFS and Long Covid.

You may want good clinical trial evidence. I do too, but in the absence of that, you're being told severe sufferers are recovering this way. I've met some of them in person and some online and they were ill for decades in some cases and housebound etc. If I was you I'd have curiousity about that but I'm not you.
Again the insults - of course we have curiosity. Why else would we use our very limited energy participating in forum discussions and reading articles and research papers. Why would we examine seriously the evidence or lack of it for a whole swathe of treatments brought to us initially with anecdotes? Of course we want to learn more and understand the basis of claims.

If I want to find out about what brain retraining actually involves, I am told I have to read some books that are peripherally related, or pay hundreds of dollars to sign up to a course being run by someone with no medical training.

Been there, done that. The book I read about reverse therapy was a jumble of unsubstantiated claims, bits of science that had nothing to do with human health and the author clearly didn't understand but thought sounded clever, and waffle. The Gupta program I bought a set of CD's to follow was all hokum and silly things to do that made me sicker, and a few quite nice relaxation sessions.

When we asked the person who joined the forum to tell us about the program they followed, they told us to read a vaguely related book and refused to say more.

Perhaps as a gesture of good faith you could ask one of the many brain retraining trainers,n who charge lots of money, to publish their methods so we can discuss it. People who sign up for LP are told not to reveal the contents of their courses and frightened into staying silent about the harm is has done them, sometimes for years.

And I wish those who have recovered a long and healthy life. Don't ever accuse me of attacking them.
You have a right to your feelings. I'm not here to persuade you it's the answer, I'm trying to nudge you as best I can to look at the reality of the brain retraining situation as it stands.
The reality is hard for us to look at when it's all happening in secret.

The so called 'situation' is of their making, not ours. The trainers set up a system based on secrecy and high fees, and in some cases pyramid selling where they charge thousands to train as trainers and take a cut of their income from it, as Phil Parker does with LP. He also demands participants keep the method secret. No wonder, when those who break the secrecy tell us what a load of twaddle his so called scientific basis is, and how much his methods depend on patients being told to lie about their symptoms and even to sign documents to say they have recovered as part of their training.
I know a fair amount about brain retraining and I have only come across one instance of people being told they aren't using the correct method to recover.
You need to get out more. What a blinkered view.
I don't understand why you would want to argue that patients reporting improvements in trials that run for weeks or months shouldn't carry any weight when it risks people not believing how unwell some of you are. And yes, I appreciate some people can measure time in bed, steps walked, etc but they are still falsifiable and subjective, in reality. The only way of understanding M.E, both level of illness and level of improvement or decline is subjective self-report. The CPET isn't valid, based on current research. It is also questionable ethically, if participants are scared of going through it. Many recovering patients I've spoken to say they wouldn't have wanted to do it when still ill in case of being pushed into a long lasting crash by it.
Look at the different outcomes of the blinded and unblinded Rituximab trials. Learn about clinical trial methodology. It's funny that the promoters of the PACE trial of CBT and GET for ME/CFS defend their use of subjective outcomes in unblinded trials and say the same stuff about symptoms being subjective and we have to believe them, yet they refuse to accept their patients who report serious harm from their methods in large surveys should also be believed.

Please, before you try to respond to anything I have said, read every one of the patients accounts of LP in this document:
https://lp-fortellinger.no/en/lp-stories/
And when you have read them all, write a considered response to their experiences that by your own words we have to believe. And compare them with the claims made about LP by its promoters.

If there is nobody in the secret brain retraining groups you belong to reporting getting sicker after doing the training, have you asked why? Have you asked whether people who say negative things get kicked out of such groups? Have you asked whether they do follow up on every single member who has joined and undertaken the training for at least 3 years to find out whether they relapsed? UK ME/CFS clincs don't keep such information about harms and long term follow up of all their patients, so have got away for years with harming people. Maybe the same is happening with brain retraining. You can't know that if the research isn't done.

Think of the harm you and your friend Paul Garner may be unwittingly doing to thousands of people. Neither of you know whether that's the case because you haven't done the research.

If Garner wants to show what a good scientist he is, let him come here and work with us to ensure any trials happening now have registered their protocols, and follow all the trial methodology needed to make them have valid outcomes.
______________

I have had ME/CFS for decades as has a family member I care for. You judge us wrongly and very hurtfully with your assumptions about us.

We are well aware of the stories of secret groups full of recovered people. You seem to think we dismiss them because we don't want to get better, or because we are prejudiced. You couldn't be more wrong.

Open your eyes. Listen with an open mind to the experience of people who have suffered terribly at the hands of people Garner supports.

Learn why we question evidence, ask for clinical trial evidence and don't fall at the feet of every snake oil salesman, whatever professorial status they may use to push their unevidenced claims.

And now I must stop. Please prove to all of us that it has been worth using up our limited energy trying to make you see how much harm Garner is doing with your support. Open your eyes. Listen and learn.
 
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I know him and I don’t like him.
I’d be really conflicted if he had run DecodeME, but as he’s bimbling through untested brain training luckily I’ve not had a mismatch.

Public Figures will always attract comment, and he’s very much a public figure.

Isn’t it funny you picked a name very similar to my user name?

No need to worry about me, thanks. I know my own mind. Unfortunately for some…

Yes I'll admit I was thrown re: the username and then how it certainly did not sound like your voice at all, and it is a real struggle with the quotes where there is no symbol which eventually was the one thing to double check.

I think that whilst it mightn't normally be an issue if a name was similar the fact that the first 5 characters are identical and the last two are similar shapes (well known in scientific psychology that people will skip words and scan by shape so ee instead of oo at the end is extraordinarily similar)

@MrMagoo:

@MrMagee:


makes this a big issue because of replies and quotes


Is there an easy, nice person type solution like MrMagee being happy to become eg 222MrMagee or even just 2MrMagee if the 2 doesn't just get lost on a test of the quoting - or anything that they want that doesn't look so similar to another username?

I don't know how these things work so hope that it isn't a more awkward suggestion than it seems :)
 
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I don't understand why you would want to argue that patients reporting improvements in trials that run for weeks or months shouldn't carry any weight ...

Surely you know, as an expert, that in a disease that fluctuates in severity and where spontaneous recovery is well documented, two year follow up would be the minimum in the initial trials? The larger confirmation trials would likely follow people for five years.

... when it risks people not believing how unwell some of you are.

Please don't worry. Grownups don't mistake "trials running for weeks or months"—that have no blinding, controls, measurements, analysis, follow-up, publication, or release of data—for medical trials.
 
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It is interesting to see how brain retraining can make people believe that charlatans are bona fide scientists. Sorry @MrMagee, but you sounding like the archetypal disciple of the quack guru. Trials are difficult... No they aren't, I have spent my life doing them. Nobody wants to work on ME/CFS because the patients are difficult... No they aren't, they see the reality of all the patronising garbage thrown at them and the good researchers are never put off.

Like Dr Garner, I am a professor of medicine. Like him I decided to devote my time in retirement to ME/CFS. But all I see Garner produce is the very worst of phoney science. No doubt you will continue to follow him but please do not assume you understand more than the people here with ME/CFS who have got real science going.
 
Hi MrMagee, Thank you for taking the time to come to S4ME.

I agree with a lot others have replied already but was only able to skim. Especially I don't understand why you think you know that S4ME members are biased if you just came here. As you are now a forum member yourself, maybe you would like to have a look at the threads discussing the evidence and especially the threads on research methodology. We would not need to repeat everything that has been discussed on several other threads dedicated to the topics and could continue to discuss your points there?
The entire M.E and LC community rightly wants their subjective accounts of their symptoms to be believed. All pain, all fatigue, many neurological symptoms are only subjective and dynamic. I appreciate there are things like heart rate measures showing POTS, but if you want your subjective symptoms to be taken seriously then you also need to appreciate research has a right to take the subjective report of symptoms seriously too. If a patient told me they were in severe pain and had severe PEM, I wouldn't tell them they didn't because they have no objective proof. I would take their report as factual.

I don't understand why you would want to argue that patients reporting improvements in trials that run for weeks or months shouldn't carry any weight when it risks people not believing how unwell some of you are. And yes, I appreciate some people can measure time in bed, steps walked, etc but they are still falsifiable and subjective, in reality. The only way of understanding M.E, both level of illness and level of improvement or decline is subjective self-report. The CPET isn't valid, based on current research. It is also questionable ethically, if participants are scared of going through it. Many recovering patients I've spoken to say they wouldn't have wanted to do it when still ill in case of being pushed into a long lasting crash by it.

Why do you mix methodological critique on treatment trials relying solely on subjective outcomes in unblinded trials with what is relevant for clinical care and research in general?

Also, measuring objective outcomes in therapist-delivered treatments doesn't mean to take subjective reports not seriously; e.g. forum members have suggested to combine subjective and objective outcomes in a sensible way.

But what do you think of unblinded trials where sensible objective measures don't corrobarate self-reported improvements? Or, as said above, look at the improvements reported by participants of the blinded Rituximab trials and how they could not be attributed to the threatment after unblinding?

These are all topics we have discussed on many many threads -- now only able to link to one general thread.

If you'd like to have a look -- it's here: https://www.s4me.info/threads/bias-due-to-a-lack-of-blinding-a-discussion.11429/post-203656

Also, there are other research methodology subforums with more specific discussions, especially on developing/ adjusting apt objective measurements [I think most forum members now agree that CPET or even the 2day CPET aren't apt outcomes forME/CFS in treatment trials], improving measures of subjective symptoms for different research purposes as well as for clinical practice. You will find them by scrolling through the subforums or by using the search function.


edit: some wording/ additions for clarity
 
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But what do you think of unblinded trials where sensible objective measures don't corrobarate self-reported improvements? Or, as said above, look at the improvements reported by participants of the blinded Rituximab trials and how they could not be attributed to the threatment after unblinding?
What is more, and highly relevant, is that when those negative results came out patients accepted them because the trial methodology was robust, despite it being a disappointing result.

Whatever else we might be, @MrMagee, hypocrites we are not. We hold all claims and hypotheses, including our own, to the same high standard.

Why? Because there is no other reliable way to find out what works and what doesn't, and safely.

The bottom line is that subjective self-report outcomes, which is what brain retraining techniques rely on for their 'results', are simply far too unreliable when used on their own, and too easy to manipulate by the less scrupulous. They have to be properly controlled by also using either adequate blinding or objective measures (or both) to keep the whole show honest.

Without at least one of those means of control it is impossible to tell which factors in the results are genuinely therapeutic and which are merely spurious confounders and artifacts of poor methodology.

None of this is new. It is Methodology 101, and has been for at least 50 years. So people like Garner, supposedly an expert at methodology and evidence, have no excuse for not knowing this stuff and making sure it is done properly.

And now neither do you.
 
Not gonna lie “most of his friends are woman” is a contender for weirdest comment in a crowded field.

I’m glad it’s the private networking groups the many Drs and recovered patients are using, saves them cluttering up the comments sections.

The Revolutionary Communist Party used to drum it in, I think I even recall Fiona saying it “if you’re not for us, you’re against us” and I think sometimes that has shaped my attitude, even today.
 
Most would be reluctant to do a trial on M.E these days is the truth.
That's too bad. Unfortunately, that's the kind of evidence that's needed for a medical treatment.

What we do have is patients recovering. That is one of the points I'd like you to understand rather than dismissing it as meaningless. Patients recover and do so in large numbers, they just keep it quiet as they don't want to be attacked. That is a problem that needs deep reflection here.
You keep saying this, but it's not evidence. It's just a person making an incredible claim. Anyone can come on the forum and say that they know of large numbers of people cured by a treatment.

Even if you're really seeing many people in these online groups who say they have recovered, it might be worth considering whether those who share these stories are the only ones allowed to stay in those groups. And whether some of those glowing reviews might be the result of practitioners encouraging patients to say they have recovered even if they have not.
 
I won't disclose my profession but I know enough about his work and brain retraining to worry for the people on this forum. You think he is a lone person who is banging a drum. He's not. Through my work and my links with him, I know of several people who used to have moderate, severe (and very severe) M.E who have recovered through brain retraining who support Paul.
These treatments don't work and that is why, instead of reliably evidence, all that can ever be presented to support these claims is testimonials, uncontrolled studies, sentences like "I know people for whom it worked" and "Paul Garner is very kind and has many friends".

This is all marketing, not reliable evidence. If the treatments really worked there would long exist reliable evidence.
 
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@MrMagee

You need to understand that Paul Garner threw the ME community under the bus when we were very kind to him during his Covid infection a few years ago, he disengaged and then accused us of attacking him after he recovered (naturally btw) from Covid or ME. Whatever. This is not what compassionate engaging people do.
It's interesting that there are so few likes on his Twitter, but I can tell you it's not because he's having no influence. Professionally, other doctors are scared of being seen to support him because of the kinds of posts you write about him.

Are you serious??? :thumbsdown: Why don't you identify yourself? Are you afraid us too?

The only reason I'm responding to you is because you tagged me, btw.
 
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Professionally, other doctors are scared of being seen to support him because of the kinds of posts you write about him. A lot has actually been pushed underground because of this.
It does not inspire confidence in your knowledge of this issue that you can seriously say this. The rehabilitation model has been completely dominant for decades, despite, as you admit, there being no actual evidence for it. You might as well claim that the government is some itty-bitty little thing with no power over, I don't know, street gangs. It's so wildly out of touch with reality it would be comical if the consequences weren't millions of destroyed lives.

PG is not doing this in his personal capacity as Paul, known to friends for being friendly. He has from the start used his credibility as a medical expert to promote his personal anecdote. His personal chumminess is absolutely no bearing to this, and as others pointed out, all it does is taint everything he has done professionally, casting doubt on its, well, professionalism.

What does matter is that, as you admit, there is no evidence for it. For something that has been the only game in time for most of our lives. You lot like to say that trials take time, but that time has long passed. There have been easily 500+ trials of this exact model, and none of them have shown any actual evidence. The trials and the treatments are pretty much identical, it's been nothing but copy-paste for the most part. This is not something that will ever yield anything.

This is a science forum and nothing PG is selling has any evidence. It's funny that you speak of us being biased when our bias is towards evidence. In that you are right, though, our biases are quite different than that of PG and others promoting pseudoscience. The fact that Garner's job was in evidence-based medicine, a name that is almost ironic all things considered, is just a cherry on top of a very weird cake.
 
I agree they are thin on the ground. Most would be reluctant to do a trial on M.E these days is the truth.
Before you say embarrassing things, please look around in the forum. The psychosomatic research is filled with pages and pages of those trials, including recent ones, they are easy to find. There have been hundreds for Long Covid alone, published or currently running and that's on top of easily 1000+ performed in the last 4 decades. These things breed like rabbit, and they are about 99% identical, which makes it all so much more frustrating. It's just the same motions done over and over again.

No one is reluctant to do any of this anymore than Catholic mass is reluctantly held at the Vatican. Good grief, this exact paradigm has been applied to millions of people with Long Covid already, right from day 1. This is a science forum, please stick to facts because our biases run very strong against false claims.
That is one of the points I'd like you to understand rather than dismissing it as meaningless. Patients recover and do so in large numbers, they just keep it quiet as they don't want to be attacked. That is a problem that needs deep reflection here.
It has been known for years that natural recoveries are common, and it makes all those claims null and void. None of this has anything to do with any specific treatment. In the early days of Long Covid, so many people were promoting supplement stacks and swearing that they were key to their recovery, and they have exactly as much value: none.

This forum is a great place to learn about ME/CFS. You are very welcome to learn, but please make some effort to learn the basics before you start teaching to people who know about this topic. It takes time and effort and we have been doing this for a long time, have seen it all. Nothing you say we have not seen hundreds of times before.
Either because researchers don't want to work in this area or because patients recovering
We are all very much aware of why researchers are not interested in ME/CFS and it's the exact opposite of that. It's because they think it's psychological and that the illness is completely disrespected by the medical profession. You make far too many false claims in your posts and it doesn't work here, is not conducive to productive dialogue.

And one thing you might not notice immediately, there are a few hundred users on this forum, a few dozens who are regulars. We are not influential and we can very little. You claim there are thousands and thousands of recovered who cower before that? No, please be serious, this is not happening.
 
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