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My guess is that after the pandemic Nath didn't really want to be working on this given the other projects he had/has going on. As a result, he got Walitt to write up the majority of the paper and then probably felt he couldn't push back as he hadn't done the work. Given how long it took, there...

I wonder if blood flow to the brain had any impact on the results. There is at least some good evidence to suggest that, when upright, blood flow to the brain is reduced in pw ME/CFS. Surely this would impact decision making as time goes on. I assume no effort was made to determine if this...

The Kynurenine and Pro measurements are having a lot of pull on that trend line. Still without those two, the measurements don't line up particularly well. Interested to hear what others think about this and if this level of variability is typical.

Exactly. This whole discussion makes me so angry. Not because this conversation isn't great, but because this is a nonsense test which should have had no impact on the conclusions of the paper. Instead, because of the beliefs of one researcher, we have this terrible test shaping the entire...

Just adding on, I think the authors reasoning for excluding HC F is that his split between easy and hard tasks don't match his true "effort preference". However, I think this is inappropriate because I don't think that the choice between easy and hard tasks correlates with a nonsense term like...

I am not sure anyone said HC F had the best strategy, but it is clearly more effective. There are some ways to play that are just better if your goal is to win more money. For example, it is always better to fail easy tasks so long as you can complete and win two hard tasks. What you are saying...

Not quite sure what your point is here. It is clear that HV F's strategy is better from the point of view of achieving more money. It may not be optimal but just look at the graph of the expected prize money. Why should the study authors chose which strategies to exclude unless participants...

The EEfRT is also terrible because takes a complex decision making task, with many 100s or 1000s of inputs and simplifies it to a single measure of "effort preference". If we think about the reasons why people might chose one task over another, there are obvious reasons like: the level of...

Just adding on, this isn't a problem with the the use of EEfRT in this study, it is a problem with the test in general. The fact that the strategy that makes the most money is different from the strategy that takes the most effort is a conflict. If participants don't actually care about the...

They should have just stayed away from all of these poorly defined terms and just stuck to the actual (very limited) findings.

What really sickens me about all this is the insistence that what they are doing is in the best interest of patients. It takes a whole other level of delusion and arrogance to insist you are helping when those same patients are telling you the opposite.

Their evidence for this is we just made it up.

Great, an economics task where your data is removed if you utilize the economically optimal strategy. How this kind of test can be seen as useful is beyond me.

From the perspective of a healthy control, the aim of the game has to be to maximize the reward they receive. From this perspective it makes complete sense to fail any task with a lower reward and thus remove it from the pool of possible rewards. The true optimal strategy would depend on how the...

Perhaps, but I'm not convinced. MRI is a sensitive indicator of swelling and damage in the brain. It doesn't seem to be as good at detecting what immune cells are doing. Perhaps inflammation isn't a good term here as I agree that ME clearly doesn't involve inflammation in the same way or cause...

I think it is more accurate to say it describes something which we do not have sufficient evidence to conclude that it occurs.

I agree with everything you said. Especially given that it was a 21 year old guy who figured it out, there is no way he didn't at least mention his strategy to the investigators once he realized he could beat the system. There is clearly bias all throughout this test and the fact that Walitt...

They were certainly told this before hand "Participants were told at the beginning of the game that they would win the dollar amount they received from two of their winning tasks, chosen at random by the computer program (range of total winnings is $2.00–$8.42)." Of course, there is the...

That's awesome, I think that's exactly what's going on. The authors concluding that this is a test of effort preference when the optimal strategy involves failing the vast majority of tasks is so ironic. You know it's bad when you can maximize returns by pressing the button a total of zero...

Definitely or as others have mentioned it might not really be relevant at all. Perhaps having to worry about the real threat of PEM causes that part of the brain to act in a different way. Maybe they are already experiencing the effects of PEM and the pain/discomfort/and associated symptoms with...