PEM is not a single symptom; it's a pathological state in which response to exertion is shock-like: drops in BP, drops in oxygenation, drops in HR, drops in temp, transient drops in cognitive ability.

And doing exercise more, or harder, or more often does not alter the nature of the response.

Hey Paul. You've had a whole career in evidence-based medicine yet seem determined to push hypothesis-driven illness models, which lack robust evidence and are often based on anecodes or, worse, 'vibes' (see McEvedy and Beard, 1970). You say you want dialogue but I don't see it.

You are complicit in spreading harmful nonsense — the fact that you've commissioned this tripe should be noted.

Hello Chris.

Lots of articles reporting this 404,000 figure as for England and not UK as a whole. Can you confirm that this estimate is for the UK population?

Could you please post this on X, where your reach is far higher.

clickhole.com/which-team-m...

Thank you @georgemonbiot.bsky.social . You might be aware that the person doing the most damage is now Paul Garner, who believes long COVID is social contagion, and is pushing brain retraining for 'fatigue conditions'.

Anyone reading this, please consider signing and sharing the petition calling for Cochrane to withdraw its harmful review of exercise therapy for CFS: www.change.org/p/cochrane-w...

No doubt Paul Garner is having an influence, with his lobbying for pseudoscience and constant false information on ME/CFS and long covid.

I don't understand how you can meet ME/CFS criteria (owing to COVID-19 infection) but not long covid criteria — especially given how vague most LC definitions are.

People would buy these. Could be a good fundraising opportunity.

Thanks David. You may have seen that there are now two more responses—one from @mecfsskeptic.bsky.social and one from a medical statistician at Oxford. Both excellent.