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Yes, I completely agree that BDD is a terrible construct. I’ve written a proposal to reject it that has now been escalated to the medical sciences committee. BDD is as reckless and unscientific as “MUS”. All of those BPS constructs are awful full stop. I’m just clarifying the passage that...

What I’m saying is that while BDS criteria specifically target ME, BDD criteria do not. So if the UK recognizes ME as a biological disease - and I have hopes that this change is underway - that new approach will not conflict with BDD. The BDD construct does not force any doctor to include ME...

I have asked you many times why you believe doctors do get it right most of the time. Can you answer that question, with evidence? First, your question is too confused for me to answer clearly. Are you asking me, again, to run through the section of the article where I support this...

Can I ask what conclusion you think we might draw from this? For example, do the authors understand MUS consistently - or do they shift (as most do) between understanding MUS as undiagnosed symptoms and understanding them as psychosomatic? How do those shifts bear on their final figures? Are...

I'm still having a lot of trouble understanding that. Most of the time when people talk about MUS they mean as the BPS camp sees MUS - i.e. psychosomatic symptoms. In that context yes, of course, without doubt the 50% figure is completely ridiculous. Totally unsupported by science. So if...

Lots of great questions and insights here. * Up to Date summarizes current consensus on every medical condition in a way that's useful right there in the room with the patient. So they don't do their own research and they never go out on a limb. They played no role in the 50% figure that's...

I sure appreciate your diligence and your clarity, Trish. I think it's important that the 50% figure does not directly support the Wessely approach. The Wessely approach is one way of managing the 50% problem that's extremely cost effective - but that doesn't mean the Wessely approach is the...

That's just not tenable. There is far, far too much research to support it, and this research is global. The Up To Date system, for example, is the global leader in research review and summary (made in the US), and they use the 50% figure. Keep in mind that it's 50% undiagnosed patients - not...

The paper's arguments do not depend on the 50% figure - that's not accurate. I suppose it will feel more or less important as a problem depending on how many patients you think are undiagnosed. You are correct that I am not challenging the idea that roughly half the time outpatients do not get...

I mean, genuinely, that the people on s4me are good, well meaning people. You're also highly intelligent, articulate and very well informed.

I have to go to work now, but quickly - you are so right that there's conflation of proportion of symptoms and proportion of patients. And you're right about how important this is to the statistical picture! The research on this stuff is so bad that they have not reckoned with this problem...

Ah, I see now. The reason that Up to Date states "over 50% of patients are not suffering from a medical condition" is that this has been received opinion for decades, particularly in health policy. There is a ton of research over many decades that established this picture. Try looking up...

Thanks so much for your collaborative efforts @Lisa108. I do not take credible critique personally, and there's been a whole lot of that about my work on s4me. I've learned so much from those discussions. You good people are very trusting, and I think you don't know what an attack looks like...

I've recently collaborated with Keith Geraghty on a chapter about MUS for the Oxford Handbook of Ethics and Psychotherapy, and there we use the 50% figure. (That chapter is still under review.) I think there's a big misunderstanding here about what I'm saying when I say that MUS professionals...

It's a good question, Trish. It might help to know that the higher estimate in Kroenke and Mangelsdorf (in the body of the paper) was incredibly influential. That's a big part of this - it's not just what the papers say. It's also a matter of knowing which ones are really influential and...

I know that you do not have expertise in ethical reasoning @Jonathan Edwards, but I think you should be expected to accurately determine the central ideas in a paper from AJOB. After the review of research, the article notes that there's a very substantial, very clear difference between...

Thanks Trish for your questions. You're absolutely right that some research focuses on number of symptoms, while other research focuses on number of patients. Researchers generally fail to note that difference in comparisons and that's really a huge problem. Research on MUS is very...

It might be helpful to note that when it comes to prevalence MUS is not the same as somatoform disorder, and neither is the same as FSS or groupings of that kind. I mean, all of those are based on the same BPS reasoning, but they capture different patient groups. MUS is a non-DSM psychosomatic...

@Cheshire I'm sure not suggesting that you shouldn't check things for yourself. I think the research of ME advocates is so astute that it actually achieved a change in professional consensus - and I've written that, publicly. If you read more carefully you'll see that I'm not saying you should...

@Jonathan Edwards I have not made an argument from authority, as I have in no way suggested that you should believe my 50% figure based on my authority. In fact, there's not a word in there about my authority. To dispute what I've said in a credible way you'll need to take issue with the...