Here and elsewhere, I really think you're onto something that's more potent than the depression/medication confounder. A staggering 80% of candidates were excluded from the trial. 3 sweeps of exclusions?! Others have already discussed on this thread the discrepancies between clinical cohorts vs research cohorts so I won't need to. Diagnosis of exclusion has been taken too far by the biopsychosocialists. We would expect common and obvious explanations for CFS-like symptoms to be excluded, but now anything that even remotely suggests organic disease is excluded as well, to a fault. Such a CFS construct changes from an "unexplained physical syndrome" into a circular ideology of: let's exclude all symptoms or signs or tests which may indicate obscure pathological disease processes as well, (pretend to) wonder why no pathology is found, assume or claim CFS is a functional disorder, then imply blanket application to all forms of ME/CFS. If the DSM-5 continues down the path it is, they can always fall back on the new SSSD and CSSD categories whenever organic pathology is found! Obvious neurological disorders and "organic brain diseases" would have been excluded from PACE. However, I think there is a grey area, or a limbo perhaps, between classical neurological signs and symptoms vs the more subtle manifestations which may not result in a diagnosis of a neurological disease but would exclude a patient from PACE. White (and Reeves) would want to exclude this grey area as much as possible to get a "clean" cohort. We know that White dislikes the CCC for including "neurological-like symptoms". I enjoyed David Tuller's response to this claim from the principal investigators of the PACE trial: "Patients and their doctors now have robust evidence that there are two safe treatments that can improve both symptoms and quality of life, however the illness is defined." Tuller's answer was basically, your 3 different CFS cohorts were all subgroups of the same Oxford criteria, not a gold standard of truly different cohorts. I'd like to see White et al justify (with a straight face) the use of 60 as the threshold for "normal" levels of the physical function subscale of the SF-36, and then watch Bleijenberg & Knoop repeat their editorial with a straight face. Have any "non ME/CFS community" articles about PACE picked that up about the absurdly low threshold for normal. When I first started reviewing the research on CBT and GET for ME/CFS and was open to whatever the "science" suggested, even if it contradicted my own anecdotal experiences, I also came across polite but strong wording in patient advocate commentary such as "smoke and mirrors", which at the time I thought was probably an exaggeration of valid criticisms or at least a colourful description of them. However it seems this is accurate afterall! Much of it seems to be "ideo-psychological" research.