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It's certainly the first time I have seen the blind inspecting the blind using Relativist epistemology and Critical Realism ontology. Maybe if you can't use bifocals that's all you can do?

It is all muddle of semantics. Most doctors do not really understand the difference between a causal disease category and a syndrome category. When the time comes that we can answer questions about cause for all cases then terms like ME/CFS or CFS or fibromyalgia will have disappeared anyway. At...

Except that these people are banging on about tired old ideas that all of us have looked at and seen the shortcomings of. I don't see any new ideas in any of these twitter threads - I see sheep wandering off to nowhere in particular and taking large numbers of dollars with them. Science...

I don't think we have any scientific evidence base for this. Changes in urine metabolites may be completely irrelevant. Apart from anything, most people with ME/CFS do not spend half an hour on an exercise bike on any day of the week!! I think this is just bullshit from BACME type people -...

It is absolutely routine in specific circumstances. For hypertension you measure BP without medication and then with. In RA you measure CRP without medication and then with. In diabetes you measure blood sugar without medication and then with. In infection you do cultures without drugs and then...

My personal knowing refers to the UK equivalent, who has sat on just as many eminent committees and written just as many papers - and regularly he would tell me about some new discovery about dysautonomia or POTS by friends like Peter Rowe. I was otherwise meaning knowing in the sense of having...

And I guess I should say that I base my viewpoint on knowing these people very well personally, to the extent that I was asked to take over the main UK clinic when the relevant person retired. My working life was steeped in this stuff.

I understand your sentiments @mango but I am in a bind here. @Hutan kept chastising me for not pointing out that 'FND' is a bogus concept that can only do people harm to believe in. I actually agreed with that in terms of the way Stone and Carson use it but I thought it might be useful for...

I find it hard to take seriously a document that comes out with " A variety of other clinical diagnoses may coexist with POTS, but it is largely unclear whether the presence of one of these other diagnoses defines a unique pathophysiological subset of POTS. Patients with POTS may simultaneously...

I trained with the UK equivalent of Rowe and learnt a lot about how not to learn in medicine. It is not at all difficult for doctors to fail to learn for forty years. We only have to look at the BPS people. And remember that although Rowe produced the first paper on EDS and fatigue it was Knoop...

I actually doubt very much that these guidelines are based on clinical experience. Early on in my career I found myself parroting and even making up stuff that doctors imagined ought to be true because it seemed to make sene to them but was based on no actual evidence from experience. Rowe's...

I am pretty sure all that stuff is just made up. I don't believe any of it has been tested for validity. It is exactly what someone would make up if they thought they knew what was going on and how to deal with it. But nobody does.

My impression was that AISA was an imaginary disease invented by Yehuda Schoenfeld. Since there is no inflammation in ME/CFS I don't see much point in trying to link it to a non-0existent inflammatory syndrome.

Indeed

I am not aware of any official guidelines. There isn't any reliable evidence about what is the best thing to do in the long term so there shouldn't be any guidelines. I think I mentioned in my Qeios article that some serious research into the effects of posture would be worthwhile. Perhaps the...

'Sarcoid' covers two largely distinct problems. Acute sarcoid with hilar lymphadenopathy and often diffuse calf swelling due to oedema tends to remit after a short period. Chronic sarcoid is almost certainly a lifelong condition once it has appeared and so post-sarcoid is pretty meaningless. The...

I think there is a risk of oversimplifying the situation, as has been clear for post Covid illness. ME/CFS type illness may well occur after sepsis but I suspect that most people who cannot work after sepsis, like a small but not insignificant number after hospitalisation for Covid, have major...

As far as I am aware none of the information on that sheet is based on evidence and is likely to get patients involved in unnecessary rigmaroles and potentially dangerous overuse of salt.

Except that people with Long Covid don't get 'the help they need' because there isn't any beyond advice on not trying to push through. The 100 clinics are presumably sending people off for GET and CBT - the post-sepsis patients are probably lucky!

How about the Ninja Turtle Protocol On the basis that Americans call tortoises turtles and the tortoise won the race by taking things steadily.