Angry Emails to the NIH -- Good or Bad? (Split thread)

[duncan]

I think it is important that we remember that there is a reason for these angry emails, whether we agree with their tone or language, or not.

As it stands now, a good chunk of the study protocol is unacceptable. It has the hallmarks of a disaster for the ME/CFS community. Some of these emails are a result of what are perceived as outrageously dangerous study elements and disdain for PWME. Many feel these elements demean the patient population before the process even begins. It only follows that patients will be scared and angry.

Those well enough might endure the stress and fallout they risk by emailing architects of what they fear might result (inadvertently or not) in thrusting them deeper into the hole.

Moreover, let's not lose sight that engaging the NIH must be daunting for many with ME/CFS. I doubt any are simply getting their jollies here, or even "just venting". As we are intimately aware, doing the latter can carry a big price tag for us.

So I'm not sure the onus should be on the patients right now. Maybe the onus rests with the NIH till it remedies the appalling shortcomings that we all know remain.

In the meantime, I think it odd that they would ask us to rein in complaints about their behavior when their behavior is, well, kinda insulting, and could result in a study that propels us deeper into the dark for another 30 years.

 

[Research 1st]

The allegation that patients have been responsible for the neglect of m.e. is a lie

Well pointed out Akrasia, I've noticed this trait tends to come out from pro government associated doctors/researchers also as well as twitter posters. It's inevitable as they're being defensive about being questioned with logic, and thus logic says the state is responsible for the 30 year neglect of non HIV-AIDS (ME CFS). Hence all they can do, is turn on the patients out of red faced embarrassment.

Indeed some anti ME advocates (pro Chronic Fatigue) pretend that patients are responsible for their own downfall (Not people on PR) entirely, I mean the people with power and influence, the lowest of the low, the people keeping you sick via CBT GET. Naturally, patients don't have power and influence, because they have no money (unless they win powerball) and they quite frankly, have no legs to walk anywhere and stand up and protest, or if they do, it relapses them so there's never any numbers and never any consistency. The bad people, take advantage of us, they brush our concerns aside, and try and call us 'extreme' for making perfectly rational points, or expressing perfectly rational emotions. Easiest trick in the book of course, if the patients are invisible and invalid and you have easy contact with the media where the patients awful lives are never or rarely exposed.

People living in terrible pain and suffering can be emotional. This is normal human behaviour and should not be 'exposed' or twisted by anyone as a sign of being mentally unstable or 'wrong'. Imagine having Vertigo forever (not just for 14 days) or being in pain all over with flu like symptoms and short of breath, forever. I'd be emotional too, after 1hr, never mind 10 years of being ignored. Yet it's not hard to imagine that, as that's what ME does to people, and children. People with normal mental health, who became like this usually after an infection (As seen in other autoimmune responses in multiple diseases including MS).

If we break down our own personal disagreements (pro or against NIH proposed study), we can see the utter ghastly futility of not being able to save ourselves due to who owns us and directs us into the sea, but their is logic in futility that cannot be argued against as 'mad' or 'unstable' or 'militant' not because of what ME is and what CFS is (debatable) but of the level of disability it causes and how this affects people, who are all incorrectly told they share the same condition, the UK and now the Americans are bizarrely calling ''ME/CFS'' instead of ME and CFS.

It is thus normal, to protest and any level people chose to do. Normal, not abnormal. (Anyone who is being tortured, protests). Uncontrolled severe ME CFS, is being tortured. It is not chronic fatigue, it is 30, 40, 50+ symptoms, many of the simultaneous and disabling. (Can't stand up, walk, eat, dress, breath properly, and immune suppressed).

*The problem we have is no one knows what ME is, but we know ME is contained within CFS, meaning we know know cause will ever be found, it is an impossibility.

Why?

Because CFS doesn't require anything wrong with the patient at the time of diagnosis.

Sadly, some alleged 'CFS' advocates dont' like to make this point regarding research study design, on our behalf, when greatly compromising our future lives even more.

 

[searcher]

In the meantime, I think it odd that they would ask us to rein in complaints about their behavior when their behavior is, well, kinda insulting, and could result in a study that propels us deeper into the dark for another 30 years.

I want to make clear that I don't think anyone at NIH asked us to rein in complaints. When I spoke once with Vicky I asked her offhandedly if she had gotten a lot of negative emails that go beyond criticism of the study design and she said she had, as have people at NIAID (I presume because of the history with Fauci because as far as I can tell the associate investigator on the study from NIAID has impeccable credentials in mast cell/EDS research.) I also want to reiterate that Vicky has literally nothing to do with the study design or team composition. I think NIH is doing their best to respond to all the emails they have received. And, as I mentioned up-thread, multiple people including me have explained to people at NIH why the history of discrimination and marginalization of the patient community and the devastation of the disease has led to the deluge of emails. But even though the personal emails may be understandable, it doesn't mean that they are helpful.

Edit to add: I also wanted to make clear that I think the NIH has done a very poor job at communications since day 1. They need to find a way to be more open and communicative with the whole community and need to address all the issues that have been brought up here, in petitions and emails, and in other communications.

 

[duncan]

I appreciate that, @searcher .

Truth be told, though, evidently very little has been helpful since removal of the FMD control, since the psych presence remains, the inexplicable Lyme control remains, etc.

So I guess what some of us are wondering is, how does removing or reducing any of our meager leverage help? Aren't we just making it easier for whomever at the NIH is behind these elements to keep them in the protocol?

Either way, the NIH should be open to remedying what most patients and advocates agree is unacceptable. IF anything will help minimize the emails, it should be the very issues that gave rise to them.

 

[Kati]

I want to make clear that I don't think anyone at NIH asked us to rein in complaints. When I spoke once with Vicky I asked her offhandedly if she had gotten a lot of negative emails that go beyond criticism of the study design and she said she had, as have people at NIAID (I presume because of the history with Fauci because as far as I can tell the associate investigator on the study from NIAID has impeccable credentials in mast cell/EDS research.) I also want to reiterate that Vicky has literally nothing to do with the study design or team composition. I think NIH is doing their best to respond to all the emails they have received. And, as I mentioned up-thread, multiple people including me have explained to people at NIH why the history of discrimination and marginalization of the patient community and the devastation of the disease has led to the deluge of emails. But even though the emails may be understandable, it doesn't mean that they are helpful.

Thank you for reporting this @searcher. It's a sad state of affair. We as a patient group can be our own ennemies. And yet, we are here in 2016 because of horrible past decisions by the governments. Some of the decisions made for the current study are raising red flags. I wish we could be heard and we could have clear answers about our concerns.

Perhaps some will say that we have been heard. Only time will tell, but perhaps if they increased their communication with us the stakeholder, we would be more at ease.

I am not sure they understand how much is at stake for the patients. Or maybe they do.

 

[searcher]

You're welcome @Kati. I didn't want to talk about it publicly because I worried it would be conflated with the media manipulation against patients in the UK. But this really is very different-- no one at NIH is trying to portray patients negatively in the media (as far as I can tell.)

There is obviously still a big issue with communication from NIH. NIH's policy, I believe, is to respond to all email inquiries. Thus I think they are spending a lot of time formulating and sending responses to what sounds like an unprecedented number of emails, but I don't think most are being shared by the recipients (which is understandable.) It would be great if people could share them with meaction for publication (you can just email info@meaction.net with the email exchange.) NIH can't post the answers publicly since they can't share private emails. And for some reason they are not making frequent updates to their website to answer questions.

As you probably know Dr Nath will be doing a webinar with SMCI later this month (http://solvecfs.org/2016 Webinars Announced.) I think that will be a great opportunity to get answers straight from the PI. And hopefully there will be clearer answers from NIH before that time, especially as to how they will incorporate patients and experts going forward. I know that several groups have sent in questions about the study design, the researchers, patient selection, and patients+expert involvement.

 

[Kati]

You're welcome @Kati. I didn't want to talk about it publicly because I worried it would be conflated with the media manipulation against patients in the UK. But this really is very different-- no one there is trying to portray patients negatively in the media (as far as I can tell.)

There is obviously still a big issue with communication. NIH's policy, I believe, is to respond to all email inquiries. Thus I think they are spending a lot of time formulating and sending responses to what sounds like an unprecedented number of emails, but I don't think most are being shared by the recipients (which is understandable.) It would be great if people could share them with meaction for publication (you can just email info@meaction.net with the email exchange.) NIH can't post the answers publicly since they can't share private emails.

As you probably know Dr Nath will be doing a webinar with SMCI later this month (http://solvecfs.org/2016 Webinars Announced.) I think that will be a great opportunity to get answers straight from the PI. And hopefully there will be clearer answers from NIH before that time, especially as to how they will incorporate patients and experts going forward.

The thing is I am not sure that SolveCFS is the appropriate venue to ask the kind of questions about inclusions of team members who are associated with psych aspect of ME/cfs. It is not something that Nath would be very happy answering publicly, or to be asked by either Carol Head or Dr Nahle.

In my opinion the best case scenario would be to include patients in design of the study, for NIH to invite criticisms, and altering the 'course' of the study appropriately. (Who they partner with (co-investigators), how patients get included, who pick the patients- is what is most contentious)

Patients should be seen as partners. We have come a long way from the mid 1970's obedient patients, and it should be reflected here.

 

[searcher]

Don't worry, you don't have to convince me-- https://my.meaction.net/petitions/nih-put-me-cfs-patients-at-heart-of-research-design-process

Carol has of course already spoken with NIH about Walitt and others, but I get what you are saying about them asking questions about specific researchers in a public forum. I think she would be prepared to ask those questions though-- both she and Zaher have written critically about the inclusion of "psychosomatic sympathizers" on the study.

 

[medfeb]

I appreciate that, @searcher .

Truth be told, though, evidently very little has been helpful since removal of the FMD control, since the psych presence remains, the inexplicable Lyme control remains, etc.

Can you help me understand the concern with the Lyme control group?

As I understand it, these are patients that at one point had a proven Lyme infection, were treated with antibiotics and are now symptom free. Recent publications on Lyme reported that 10-20% of Lyme patients go on to have long term problems but many don't. The Dubbo study showed something like 11% of patients went on to develop ME/CFS post three different types of infections.

Assuming that the Lyme patients are definitely symptom free, it seems like it could be useful to look for the differences between the post-infectious Lyme patients who did not develop long term problems and post-infectious ME patients who have.

Is the concern that they will not be truly asymptomatic or that a different post -infectious group would be better or something else?

 

[Forbin]

In our every day lives, as in the momentous affairs of nations, we must decide: What does it mean to do the right thing? How do we deal with an enemy? Should we ever take advantage of someone who treats us kindly? If hurt by a friend, or helped by an enemy, should we reciprocate in kind?

-Carl Sagan

http://tetrahedral.blogspot.com/2010/10/prisoners-dilemma-by-carl-sagan.html

I don't know if this will be helpful, but the late Carl Sagan wrote a piece on cooperation (see above). It basically described which strategies were found to be the most mutually beneficial. The findings were based on multi-round computer simulations of various strategies.

The most effective strategy was what Sagan described as "tit-for-tat," which basically means that you begin by being cooperative and then you see what the reaction is. Then you respond in kind.

If the other side is helpful to you, you help them and vice versa. If the other side does not help you, you do not help them and vice versa. This can obviously turn into mutual retaliation (a feud) going forward, and both sides suffer.

Eventually, one side may take a chance and try to be helpful despite the past feud. If it is repaid in kind with helpful action, or if it is not, both sides learn how the other will currently react. Being mutually helpful rewards both sides. It was interesting to see that the most effective strategy was when each side attempted to break feuds/stalemates 10% of the time.

This is not a perfect strategy; it was merely the best strategy.

I'm not exactly sure what the correct analogy is with the NIH, but it could be argued that the NIH "cooperated" when they eliminated the FMD arm of the trial. It would seem that the most helpful strategy at that point might have been for patients to show some support for the NIH and to encourage them to consider further changes. ("Patients praise NIH for its flexibility. Seek further improvements in study.") Writing nasty emails about the remaining problems probably does not qualify as "encouragement," and, in "tit-for-tat," it could easily decrease the NIH's willingness to listen to patients suggestions.

Patients, may wonder what currency they have with the NIH in return for responsiveness to patient concerns. I think that perhaps all the NIH can ask of patients is positive engagement, including constructive criticism*. That's not because they are inherently "nice," it's because having patients on board makes their endeavor look better. [*Patients would obviously also have more leverage if they had actual political support.]

This may not be the most emotionally satisfying strategy in the near term, but it may be the most productive in the long term. Give them support when they listen. Make them fear losing it when they don't. If they've already lost all of our support, we have no leverage.

It's an incremental game. There's more than one round. Chances must be taken. Trust must be built. Major concessions usually don't come at the start.

There's no guarantee that it will work; only that the alternatives are worse.

 

[Valentijn]

I think it is important that we remember that there is a reason for these angry emails, whether we agree with their tone or language, or not.

That might be true, but it doesn't excuse any inappropriate content in such emails. We are all adults, and should not be patronizing each other with the characterization that we are unable to rein in our anger long enough to communicate politely.

In the meantime, I think it odd that they would ask us to rein in complaints about their behavior when their behavior is, well, kinda insulting, and could result in a study that propels us deeper into the dark for another 30 years.

No one is objecting to complaints. We should be complaining, and loudly. But we should do it in a constructive manner which opens communication channels instead of blowing them up.

So I guess what some of us are wondering is, how does removing or reducing any of our meager leverage help?

Offensive interactions with someone trying to cooperate with us are not leverage. That's taking the crow bar and trying to bash the house down, instead of using it to apply a little pressure in the right place to get in the front door.

 

[duncan]

@medfeb , let me see if I can express some of my reservations. These are just mine, I'm sure there are more that others from the Lyme community can better speak to.

First, the Lyme Teams from the NIH. Over many years some of their members have contributed to some of the most offensive (to many patients, at least) studies and articles one can imagine. The most recent abstract I saw with a Marques signature seems to suggest that, when asked to fill out questionnaires over a four year period, Lyme patients demonstrate they really don't feel all that sick by the end of the time frame. Indeed, they feel their QoL is actually better than the average healthy person. So, maybe this group of patients DID feel better. But to extend this logic out to cover ALL Lyme patients would be absurd. Worse, it is dangerous.(She didn't do this, but keep in mind the new IDSA Guidelines are due this year, and what a delightful reference this little foray could provide) Sure, many if not most Lyme patients DO recovery. But even the IDSA says up to 20% do not. As I recall, Marques's abstract doesn't even seem to give a nod to those 20%.

For me, this is part of a historic pattern many feel the CDC/IDSA/NIH bring to the table - denigrate the patient experience by claiming many only imagine their symptoms, or exaggerate or catastrophize. The "it's just the aches and pains of every day life" refrain. Marques is listed an investigator for the CFS study, and if she could import this established approach from one marginalised patient community to another.... Why would we ever want that?

Second, is the Lyme control group a healthy control or not? Are the 20 100% cured, or merely asymptomatic (many feel Bb has a relapsing/remitting quality, and while someone can feel fine after initial treatment for months, eventually many will suffer a return of symptoms, only this time the symptoms don't go away)? Are they free of TBD's - not just Lyme, but B myamotoi, babesia, bartonella and others? This needs to be clearly declared. But they haven't declared squat unequivocally, and I think we need to know why they haven't.

Out of all the diseases in the world to compare to ME/CFS, why choose one that soooo many patients and advocates feel either the NIH is in the dark about, or is simply dragging its feet for whatever reason as 60,000 patients a year, year after year, are jettisoned into Hell with little to no resource, to the sound of ex NIH leaders complaining about Lyme "loonies"

Finally, I believe the reason they are not saying "cured" is they cannot know the patients are cured. And that's ok, if they'd just admit that. But they have to say that upfront if they want to use infected Lyme patients as comparisons to ME/CFS patients, don't you think? Shouldn't that be volunteered? That the Lyme control group may NOT be disease free? So, they will be comparing one set of diseased patients with another? That is ok, if that is their intent, I guess. But I don't think that is what they are saying.

I think there are other issues, but that's all my brain can muster right now.

 

[duncan]

@Valentijn , I am not excusing anything. I don't have that right. I am offering up possible explanations. As an adult I can appreciate circumstance and context. I am assuming all of the NIH investigators are adults.

Yes, I agree that we should be trying to communicate in a constructive manner.

Relative to offensive interactions, I believe it is a two way street, and it is actually worse when an action hurts me physically - like the results of a dangerously poor study protocol might over time - than someone screaming at the top of their lungs that I'm a jerk. The NIH is carrying a much bigger bat than these email writers. These email writers, in part, may be responding to feeling threatened by that bat. That being said, I agree that controlled complaining that doesn't get personal is preferred.

Here's a key factor as I see it: Who is bullying whom? It's great to attempt to resolve conflict, and we all want that, but I think it is important to get a handle on who is really being wronged here, before we will be able to resolve anything. Who initiated the problem, and why, and who is responsible for maintaining it? I think we are all agreed this involves adults, but this is basic parenting 101.

 

[Justin30]

I am absolutely exhausted reading about this.

My brain and eyes hurt with fatigue.

Can we not agree that personal attacks are not Ok? Are Childish etc.?

• The answer: stop it
• They are justified Wallit and his group have no right be involved in a highly neglected patient community
• If your pissed about come to PR and set up a thread labelled "Wallit and Co how we ditest you" and bash away

Can we not agree that there is a serious flaw in that many ME/CFS Organizations have not saught out a strategy to unite and have a common voice?

• I would say there is universal consensus on this.
• This would lead to people taking matters into their own hands after 30 yrs plus of neglect.

There are absolute flaws in the NIH study.

• Wallit and Co.
• ME/CFS Patient Selection
• Control Groups
• Actual amount of participants invoved
• One that has not been contested enough is types of testd conducted around OI and excluding other diseases (hopefully this will be taken care of by the ME/CFS Clinics)

The government and NIH and CDC are all at fault here

• Universal consensus I am sure
• Cover up more than likley
• ME different than CFS posibbly/probably
• Disease overlapp for sure
• Weak patient community lack of voice=to sick to fight
• CDC name to CFS to cover up true ME guaranteed
• CFS name damaged further research=for sure
• Insurance Company Involved=definately
• Lack of government and NIH funding, hiding funds and moving funds=unacceptable
• Sheer impact of disease burden undetermined but likley more than 1 million in the US = Epidemic
• Why are ME/CFS sufferes mad again?

A healthy group of individualds has not been established to fight on behalf of sick ME/CFS Patients. Protest, Media Coverage, etc.

• Self explanatory

I had more to say but I am very upset and am concerned as a fairly young ME sufferer.

What I have been waiting to see in the headlines on MEAction is that all the North American, Canadian, Australian, and UK groups start a separate organization to seriously contest the profound issues with the NIH trial.

1 member from each organization could be elected to speak on behalf of each group. All members could choose their argumenets and come up with a a core set of elements that needs to be readdressed by the NIH. This could happen rather quickly as it would take one day for the meeting, another meeting to review recommendations with the group and consensus could be drawn.

What this will do:

• Establish Unity between all groups
• Will show a commitment of strength to the patients
• Can discuss how best to address the NIH appropriately
• Will hopefully brain storm a solution as to how best to have healthy people fight on our behalf
• Can communicate to the patient community that this united organization will fight on our behalf.
• Will detour negative emails and personal attacks
• Will showcase to the government, NIH amd CDC that we aren't just going to get dealt the card they choose. Like they have done to us in the past.
• Will allow for one group to actively address US not a bunch of scattered views

I just dont get how difficult this can be to organize a large meeting via skyp etc. there are healthy enough people in these organizations to work together as a team.
Am I wrong? What does it take for one person from one group to reach to all these ME/CFS organizations?

I dont know anymore there are flaws to the study hands down.

@viggster I commend your effort. I could not deal with this cause I live in to much fear of relapsing further and I have a family that needs me.

If I was well I would be doing more. My suggestions are what I put forward.

But please one organizations figure this out. MEAction is on track but 2 sick people running it can only do so much.

I dont see any other orgaizations members on here and if so I would love to hear your thoughts on uniting as one and creating a list revisions to the study, signed by all ME/CFS Organizations or a new organizations represenring many organizations.

There are many positives going on but aome things need to change with regard to this study.

I Once thought this study was on the right track and we could overcome obstacles and that at the NIH people had our best interests at heart.....but something to me just doesnt sit right, especially from what I have read from both members and the NIH reaponse. Somthing stinks....

I want our organizations to ellicit change from the NIH and I want to know about it.

 

[JT1024]

This thread was a lot of material to digest...

Recent communications with the NIH is not unlike dealing with anything else of great importance. Case in point, Congress, the 2016 election, etc. Representatives communicate for the benefit of the individuals (patients or citizens). When representative communication (or what is reported by various media outlets) differs from the desires of patients or individuals, there will be substantial conflict and unrest.

Patients have been derided, dismissed, and deceived for too long... and not just by physicians and government agencies. Advocacy groups have had their share of controversy and mistrust by patients as well. The use of "inside voices" while lives are lost is unacceptable. The NIH, CDC, physicians, and advocacy groups (including PR) need to work to regain the trust of patients and it will not be easy.

What comes to mind is how physicians came together to develop the Canadian Consensus Criteria for defining the illness. Even that great effort was dismissed to a degree.. the IOM had to develop their own. The various interested parties (patients/advocates, physicians, and government agencies) need to hammer out what is undeniably agreed upon.

When Duncan mentioned free speech, all I could think of was the meltdown of this forum a few years ago. Threads got ugly, people were banned from the forum, and many left. Content of some threads seems to be re-written or deleted.

I once used this forum as an example hoping that the forum format and the tools available on Patientslikeme (aka PLM) could work together for the benefit of patients and researchers. I shared this thought with Cort and Ben Heywood, co-founder and President of PLM. It didn't get very far since I had limited ability to pursue the idea.

The stakes are very high for everyone barely living with ME/CFS and similar conditions. I pray the NIH will listen to Ron Davis, Jose Montoya, and others in time.

 

[Karena]

Obviously, no one should be sending insulting personal emails to people at the NIH, particularly those not responsible for flaws in the upcoming study.

But the notion that scientists would abandon ME/CFS research because their feelings are hurt infuriates me. In the real and virtual world, many people are treated badly and unfairly--particularly those without money, power or prestige. Still, they manage to ignore or look beyond the insults and go about their jobs.

I would like to think the NIH is staffed by professionals who care about the research. I would like to think the doctors there follow the Hippocratic Oath. The oath doesn't mention that it's OK to turn your back on patients you don't like.

 

[ahimsa]

I tried to read the messages on this thread but I feel like I'm missing something obvious due to my brain fog. There were a lot of good points made but here's the bottom line for me.

1. The answer to the question in the subject line seems obvious - Angry emails to NIH are bad.

2. I'm not sure I could do anything to stop another patient from sending angry emails. Who would listen to me?

So, I must be missing something basic. Why this thread is here? (please don't take this as criticism, I'm just confused)

Is the idea that the angry patients will see this thread and it will convince them to stop sending the angry emails?

OR is there some other action that I should be doing to influence these angry patients to stop those emails?

yours in confusion ...

 

[BurnA]

But the notion that scientists would abandon ME/CFS research because their feelings are hurt infuriates me. In the real and virtual world, many people are treated badly and unfairly--particularly those without money, power or prestige. Still, they manage to ignore or look beyond the insults and go about their jobs.

I would like to think the NIH is staffed by professionals who care about the research. I would like to think the doctors there follow the Hippocratic Oath. The oath doesn't mention that it's OK to turn your back on patients you don't like.

The thing is we are all human, the scientists who get into ME/CFS research decide to do it of their own accord. They are not obliged to do it, the same way anybody has the right to choose their job or profession. So its only natural if anybody found themselves getting abusive emails in any walk of life that they would question themselves and consider changing path.

 

[BurnA]

I tried to read the messages on this thread but I feel like I'm missing something obvious due to my brain fog. There were a lot of good points made but here's the bottom line for me.

1. The answer to the question in the subject line seems obvious - Angry emails to NIH are bad.

2. I'm not sure I could do anything to stop another patient from sending angry emails. Who would listen to me?

So, I must be missing something basic. Why this thread is here? (please don't take this as criticism, I'm just confused)

Is the idea that the angry patients will see this thread and it will convince them to stop sending the angry emails?

OR is there some other action that I should be doing to influence these angry patients to stop those emails?

yours in confusion ...

Yes i think the thread title is a bit odd because i cant comprehend how anybody thinks they are a good idea. However some people must because otherwise they wouldn't be sending them.

If you take the approach "who would listen to me" as a reason for not speaking, well then its self fulfilling, so i don't think that's a particularly useful approach
I don't think the purpose of discussing this here is for one individual to stop another from sending an angry email, the point is, as a community we should be doing something to stop it.
One of those methods might be to openly criticize anybody who does.
Another may be to be more vocal to our advocacy groups.
So, by discussing it here we may be able to come up with a strategy to prevent angry emails from being sent.
Even if we don't manage that, i think anybody who reads this thread should realise that angry emails are a bad idea.

 

[medfeb]

@medfeb , let me see if I can express some of my reservations. These are just mine, I'm sure there are more that others from the Lyme community can better speak to.

Thank you, Duncan. That's useful.