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Perhaps the 74 year old senior author feels a need to maintain his output of a paper a week over the last forty years (2,112).

From what you say it seems there might be a big difference in mental state between patients and controls. And in hormonal responses over the 48 hour period and so on. Cortisol levels are likely to behave very differently, as well as adrenaline. Vagal control of respiration might well differ. And...

OK I am beginning to remember half-understanding this. It seems that the change in work rate at ventilatory threshold could be affected by all sorts of shifts in neural control of the sort I was thinking of. So I am not sure why it should be interpreted as a metabolic phenomenon. One of the...

The trouble is that this screws up any scientific analysis. PEM is a symptom pattern - as I understand it of feeling ill after exertion. If we then want to use the same word to mean what causes PEM we get PEM causes PEM and that opens things up to confusion. Maybe exertion releases some...

I continue to be very puzzle by all this CPET stuff. I would like to get to grips with it but fail every time because of the jargon. If you have pain you may have a reduced ability to do work without altering utilisation of metabolic pathways. You put effort into protecting painful parts...

This means absolutely nothing. How can standards medical care be the one without the standardised approach? It is gibberish. I thought the whole point of multidisciplinary care was that it was person tailored and not standardised? How come there were two ways of treating patients at the same...

I can see that but did they demonstrate a poorer performance to explain? If they didn't I don't see the point. There seems to me to be a confusion between PEM as defined as the symptom complex that occurs after exertion and PEM as defined as some fall in ability to do work - a sort of delayed...

I continue to be puzzled by the interpretation of the 2 Day CPET in relation to PEM. I would have thought that anyone with ME who got PEM from the first maximal exercise would want to avoid a second one. If a feel lousy enough not to be able to carry on with normal daily activities I am pretty...

My back is itching again.

The abstract suggests that mitochondrial membrane potentials are down in leucocytes from people recovered from Covid so I fail to see the relevance to LongCovid?

It's the same chatty, chummy style that has taken over RCPhysicians memos and BJGP, that creates patients as inconveniences.

I think @Mithriel raises an important point here that maybe we have tended to gloss over. Prolonged fatigue after EBV is well recognised. I remember having it for about 6 months. That is not due to prolonged active replication of EBV. Control of viral proliferation occurs within the first few...

Jesus, my back is itching, isn't yours?

Just the latter I think. It is not surprising that there are lots of nice reviews. These are professional mutual backscratchers. More or less the circle of the Self-righteousness Marketing Company.

This was the response letter to NICE: Dear Heather, Thanks for the implementation document draft. I have consulted with the S4ME committee and would like to convey the following comments: Much of the implementation statement looks appropriate and we would support. Several issues came to our...

Absolutely. That is what I mean by trying to find out what is going on - cause and effect.

As far as I am concerned there is no such thing as ME research, just research that tells us what is going on. The assumption that there is 'a disease called ME' is a mistake, as it is for all medical problems. The task is to understand what is going on for everyone who is ill. If we want to...

yup I did some specialist training in neurology, although I didn't become a neurologist. I had quite a few people whose symptoms we're hard to explain but I don't recall a new patient with 'FND' in six months of doing my own clinic. I know what they mean by FND and have looked after people with...

It's nice to hear that this isn't conversion after trauma any more - although last time we had something on this it seemed to just have changed the names. The attempts at scientific explanation do not look very coherent to me. I was intrigued by the comment - brain scans of FND patients appear...

That's pretty much a perfect match for my own thoughts. Improving on this would not be hard I suspect. Stick to the relevant bits and trim out the flaky stuff. I think the bit about the Babinski certainly needs to go. The last thing we need is doctors missing important neurological diagnoses...