Peter White: PACE trial I think I can only describe Dr White’s presentation as out of place. He presented a single slide of outcomes in the PACE study and claimed that it showed clearly that two treatments worked. He then spent the rest of his talk saying how unreasonable it was that patients did not gratefully accept this conclusion, indicating that this was an attack on science (if I remember rightly). I have not scrutinised the PACE trial in detail but my understanding is that it was an unblinded trial and that, indeed, for such treatments it could only be unblinded. What Dr White seemed not to understand is that a simple reason for not accepting the conclusion is that an unblinded trial in a situation where endpoints are subjective is valueless. Even where there is traditional double blinding you have to be very careful. My old boss at UCL who is a clinical trials expert, immediately pointed out to me in a recent discussion that the crucial weakness even of a randomised double blind placebo controlled trial of something like rituximab in ME is that if either the researchers or the patients get a hint as to what treatment they have (from some minor side effects maybe) the whole thing becomes uninterpretable. Methodological problems for ME trials are almost insuperable. Open efficacy studies are not worth embarking on. I think it was unfortunate that Dr White suggested that people were being unreasonable over the interpretation of the PACE study. Fortunately nobody seemed to take offence.