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If a placebo effect has been defined as having to involve a belief in the treatment then that is fine. But even if someone believes in the treatment and experiences a placebo effect, we don't know that it was the belief that caused the effect and not some other factor. In any given example we...

If the way you feel changes, then the part of your brain that manages the relaxed feeling in your brain was affected by something. I would argue that a placebo effect just means we don't have good reason to think that there is a causal pathway between the chemical in the substance and physical...

If people are actually being helped by this surgery why not produce the data showing its efficacy? All we get are anecdotal reports and hypothesis papers when it would be easy to track the outcomes of these surgeries over time and publish the data. How many people are not helped or made worse by...

A increase of HR to > 120bpm isn't the criteria for POTS. There is a graph that shows two people would qualify for POTS with changes in heart rate of around 45 and 35 in the ME group. There are 3 controls who had heart rate increases around or just below 30. None of the Long Covid patients had...

Is it possible that the spinal cord is unaffected but instead some other nerve in the neck is getting compressed? Do we have any idea if repeated compression of something like the Vagus nerve could cause ME/CFS like symptoms? I really have no idea just thinking about if this surgery could be...

For sure, the table labeling confused me too. Given they excluded people for not reaching the 30 bpm I think it has to be the case that those results are from the standing test. Because a full on TTT is pretty intense. Given they did a TTT during the screening you would think it might make...

I think does introduce some valid criticisms. I'm imaging being a study participant and going in and them saying we are going to up the dose. That might suggest you are in the placebo group but it could also be equally valid that the dose of the real drug was too low to produce a response. I...

Yes fair enough. It might not be the best way to stratify, but given the relevance of HR to standing it seems at least reasonable and worth considering. I do think that there is some connection between POTS above average fatigue. But I don't know if that is a part of the syndrome or a result of...

They say that every one of them did a tilt table test at the start that confirmed POTS. Some of them did not have POT during the 3 min standing test but that doesn't mean they don't have POTS...

Agreed, although I don't think this breaks blinding any more than noticing an effect on heart rate and wellbeing might. I also understand why they might do this do avoid having anyone experience very low resting heart rates when lying down (which coincidentally is what happened to me when I...

We are discussing POTS not POT. Clearly the tachycardia is associated with the syndrome but I don't hold the position that the tachycardia causes the various symptoms. Some may take that position, but not me. I don't think we are in a position to know what role the elevation in rate has other...

Besides the small sample size and lack of tilt testing for the HR data, I actually think this study was relatively well done (at least for a POTS or ME/CFS study). It is the fact that the improvement in QoL aren't that impressive that is the biggest issue for me. But still I think this helps to...

It seems like all the patients did a tilt-table test as part of the screening for the study. Only people who met the 30BPM on that tilt table were included in the study as 3 did not meet the threshold on that test and were excluded. Given that the QoL measures were so low, I think it is fair to...

I think that is this study. If you go to the study protocol you find: "The clinical trial will be registered under www.clinicaltrials.gov. Subjects between the ages of 18-65 who have a POTS diagnosis will be enrolled. Specifically, we will enroll patients who have hyperadrenergic POTS as...

POTS is a clinical disorder classified by: 1) symptoms upon standing such as lightheadedness, palpitations, tremors, weakness, blurry vision, and fatigue; 2) increase in heart rate ≥30 beats/min upon postural change from recumbent to upright position within 10 min of standing; and 3) absence of...

I think we can agree that it doesn't characterize the OI many people with ME/CFS experience. But it can still be the case that having ME/CFS increases the chances of having POTS like OI issues. In the summary of the ME/CFS v controls for POTS the ME/CFS patients had 2/3rd more POT than controls...

The patients were diagnosed as having POTS so at some point in the past they must have done a tilt table test with the HR increase and have the corresponding OI symptoms. I agree the 30bpm is somewhat arbitrary, all sorts of factors depending on the type of test, length of test, hydration...

As others have said, every drug that successfully makes people feel better will always break blinding. I do agree that more blinding is broken the more important it is to have a large effect. But just because some patients might guess they have the real drug does not mean the trial is worthless...

Why not? We don't think ME/CFS has anything to do with inflammation of the spinal chord and yet it is a fine label. It depends on how much they are connected. An increased probability suggests that heart rate is in some way connected to the symptoms of POTS. It doesn't mean it is the cause, it...

I think it is very much up for debate if an individual with an excessive increase in heart rate on standing is more likely to have OI. There are clearly people with no OI that can have large increases in HR when standing. But the important question is if we randomly took a group of people with...