The MEA (evidence based) guidance in our purple booklet covering clinical assessment, differential diagnosis and management of ME/CFS is clearly aimed at health professionals (HPs) here in the UK - where the vast majority of HPs work within the National Health Service and consequently have to work to restrictions in relation to the way in which patients can be investigated and managed. I am not defending the situation and the MEA has made it very clear that we do not regard the NICE guideline on ME/CFS, with its emphasis on CBT and GET, as being fit for purpose. So I think there are real difficulties in producing guidelines on ME/CFS that are going to be acceptable on an international basis. And this is one of the reasons why guidelines produced by doctors outside the UK (e.g. Canadian Criteria) are not being endorsed for use in the UK NHS.