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BMJ b/s painting PWME as threatening psych patients

Discussion in 'General ME/CFS News' started by Tammie, Jun 23, 2011.

  1. Tammie

    Tammie Senior Member

    Woodridge, IL


    BMJ 2011; 342:d3780 doi: 10.1136/bmj.d3780 (Published 22 June 2011)

    Cite this as: BMJ 2011; 342:d3780

    Medical Research
    Dangers of research into chronic fatigue syndrome
    Nigel Hawkes, freelance journalist
    London, UK

    Nigel Hawkes reports how threats to researchers from activists in the
    CFS/ME community are stifling research into the condition

    There are jobs that carry a risk, such as volunteering as a human
    cannon ball at a funfair. There are jobs that attract opprobrium and
    abuse, such as becoming an estate agent, driving a white van, or
    selling double glazing over the telephone. And then there is the job
    of trying to conduct research into chronic fatigue syndrome/myalgic
    encephalomyelitis (CFS/ME).

    CFS/ME is a common condition, and very debilitating. The evidence
    suggests a population prevalence of at least 0.2-0.4% in the UK. 1
    Patients are incapacitated for years, unable to move, sometimes bed
    ridden and fed through a tube. Yet it doesnt prevent some people, who
    claim to be its victims, from conducting a relentless personalised
    attack on doctors and academics who are trying to discover its cause
    and improve its treatment.

    Simon Wessely, professor of epidemiological and liaison psychiatry at
    Kings College School of Medicine in London, has been the target of
    such attacks for years. Hes been compared on the internet to Josef
    Mengele, the Nazi doctor who performed experiments on inmates of
    concentration camps. Hes had threats against his life, been accused
    of throwing a boy into a swimming pool to check if his paralysis was
    genuine, been bombarded with offensive emails, and had complaints
    against him made to his employers and to the General Medical Council.

    The campaign has gained new life since the publication in March in the
    Lancet of the PACE trial, a comparison of four treatments for CFS that
    concluded, to the fury of the campaigners, that cognitive behavioural
    therapy and graded exercise therapy can be effective. Pacing, a
    treatment favoured by leading ME charities, was found to be
    ineffective. 2

    The publication prompted a 442 page response to the Medical Research
    Council (MRC), which part funded the trial, and a shorter 43 page
    rebuttal to the Lancet. Both were written by Malcolm Hooper, emeritus
    professor of medicinal chemistry at the University of Sunderland, who
    branded the trial unethical and unscientific. He wrote: Entry
    criteria were used that have no credibility; definitions and outcome
    measures were changed repeatedly; data appears to have been
    manipulated, obfuscated, or not presented at all (so it cannot be
    checked) and the authors interpretation of their published data as
    moderate success is unsustainable.

    Both the MRC and the Lancet have considered the submission and
    rejected it, the Lancet commenting that the volume of critical letters
    it received about the PACE trial smacked of an active campaign to
    discredit the research.3 Frances Rawle, head of corporate governance
    and policy at the MRC, who spent several days reading the 442 page
    rebuttal, says it made many accusations of bias. She adds: I
    responded and two weeks later got another list of questions.

    Personal attacks

    Asking detailed questions about an important trial is a legitimate and
    proper activity, though questioning academics integrity and honesty
    is not normally part of the process. But far more unpleasant are the
    activities of a group of activists who have resorted to threats and
    personal abuse.

    It is a relentless, vicious, vile campaign designed to hurt and
    intimidate, Professor Wessely says. For some years now all my mail
    has been x rayed. I have speed dial phones and panic buttons at police
    request and receive a regular briefing on my safety and specific

    Since PACE was published this has become more intense, and at present
    the police are looking into two cases in which specific threats have
    been made to my physical safety. These people are sulphurous, vicious,

    Professor Wessely is not alone. All of those who approach CFS/ME from
    a psychiatric perspective are the targets of critics who believe the
    disease has a physical cause that would have been discovered by now if
    the debate, and the research money, had not been cornered by what they
    see as a conspiracy of psychiatrists, characterised by them as the
    Wessely school.

    This point of view, if not the actions it inspires, is defended by
    Charles Shepherd, medical adviser to and trustee of the ME
    Association. The anger and frustration patients have that funding has
    been almost totally focused on the psychiatric side is very
    justifiable, he says. But the way a very tiny element goes about
    protesting about it is not acceptable.

    Its not representative of the patients as a whole. Its a very very
    tiny minority50 to 100 people, maybe. What they do is not pleasant
    and totally unacceptable.

    Dr Shepherd has good reason to know, as he has been the target of
    attacks. One website claimed he had a psychotic illness, was
    physically violent, and a medical failure. He consulted the police.
    More recently his scepticism about the claim that CFS/ME is caused by
    the retrovirus XMRV has exposed him to further attacks.

    The personalised nature of the campaign has much in common with that
    of animal rights activists, who subjected many scientists to abuse and
    intimidation in the 1990s. The attitude at the time was that the less
    said about the threats the better. Giving them publicity would only
    encourage more. Scientists for the most part kept silent and
    journalists desisted from writing about the subject, partly because
    they feared anything they wrote would make the situation worse. Some
    journalists have also been discouraged from writing about CFS/ME, such
    is the unpleasant atmosphere it engenders.

    While the campaigners have stopped short of the violent activities of
    the animal rights groups, they have another weapon in their
    armouryreporting doctors to the GMC. Willie Hamilton, an academic
    general practitioner and professor of primary care diagnostics at
    Peninsula Medical School in Exeter, served on the panel assembled by
    the National Institute for Health and Clinical Excellence (NICE) to
    formulate treatment advice for CFS/ME.

    Our report, based on a solid review of the evidence, was that graded
    exercise and cognitive behavioural therapy were the best, indeed only,
    treatments. This position was resisted vociferously by the patient
    representatives on the committee, using a very strange mixture of
    quasi-scientific argumentsthe trials were biasedand utterly
    unscientific claptrap.

    Actually, it was a visceral fight not to allow graded exercise and
    cognitive behavioural therapy to be approved by NICE. Why? To this day
    I dont know.

    The NICE guidance was taken to judicial review, its opponents claiming
    that the experts were biased or had conflicts of interest. The case
    was dismissed, the judge, Mr Justice Simon, warning that: Unfounded
    as they were, the allegations were damaging to those against whom they
    were made and were such as may cause health professionals to hesitate
    before they involve themselves in this area of medicine.

    After this, the argument got even more personal. I was reported to
    the GMC, says Dr Hamilton. The complaint was risible. I was accused
    of breaking almost every rule in the GMC rulebook. And of course the
    GMC fell totally into the trap.

    Instead of accepting that its complaints process can be hijacked by
    pressure groups, it treats all complaints the same. So I had all the
    rigmarole of a formal complaint, which naturally dragged on for
    months. Eventually it was chucked out and I got an utterly ungracious
    letter from the GMC saying the complaint wont lead to a case but Im
    to make sure to obey the GMC rules anyway. It sounded as if it thought
    Id got off on a technicality and needed a good telling off.

    Peter White, professor of psychological medicine at Barts and the
    London School of Medicine, was the principal investigator of PACE. He
    says the campaign against the trial has gone on ever since it was
    first funded. There was a campaign by the ME Association, lots of
    letters to organisations involved, not least the MRC, and a petition
    to No 10 Downing Street.

    It did upset our ability to recruit patients, and it took up a lot of
    time. Complaints and Freedom of Information requests have to be dealt
    with properly. The paradox is that the campaigners want more research
    into CFS, but if they dont like the science they campaign to stop it.
    They want more research but only research they agree with.

    Professor White has been accused of coercing patients, paying general
    practitioners to enlist patients, having conflicts of interest, and
    accepting improper financial contributions. These accusations, which
    he insists are all untrue, have also been sent to his employers. In Dr
    Hamiltons case, the dismissal of the complaint to the GMC was
    followed by Freedom of Information requests for the evidence the GMC
    had gathered from his five employers and in its case handling. The
    GMC hadnt the grace to tell me thisit still hasntbut my employers
    did, he says. As far as I know this stage still grumbles on.

    While psychiatrists and those who work with them have been the main
    targets, others also come into the activists sights. Esther Crawley,
    a paediatrician and consultant senior lecturer at Bristol University,
    is principal investigator for the SMILE trial, which aims to
    investigate a treatment called the Lightning Process. Developed by
    Phil Parker, an osteopath, the process claims to combine the
    principles of neurolinguistic programming, osteopathy, and clinical
    hypnotherapy to treat a variety of conditions, including phobias and
    CFS/ME. There has been no proper medical study of whether it works.

    Critics of the method opposed the trial, first, Dr Crawley says, by
    claiming it was a terrible treatment and then by calling for two
    ethical reviews. Dr Shepherd backed the ethical challenge, which
    included the claim that it was unethical to carry out the trial in
    children, made by the ME Association and the Young ME Sufferers Trust.
    After re-opening its ethical review and reconsidering the evidence in
    the light of the challenge, the regional ethical committee of the NHS
    reiterated its support for the trial.

    Dr Crawley says it doesnt make sense to argue that the trial should
    not be carried out in children. The aetiology of CFS in children is
    different, and so is the prognosis. Ninety four per cent of children
    get better, while only a third of adults do. So you couldnt just do
    the trial in adults. Anyway, were recruiting teenagers, not

    The attacks soon turned personal. They said I was having an affair
    with a lightning practitioner, they doctored a video I appeared in,
    they reported me to the GMC. It was very harassing. The GMC said I
    didnt have a case to answer.

    Research threatened

    Dr Crawley runs the biggest CFS/ME service for children in the UK,
    seeing about 200 a year. If the Lightning Process is dangerous, as
    they say, we need to find out. They should want to find it out, not
    prevent research.

    I expected families and patients to have a twisted view of research,
    given the amount of stuff [criticisms, personal abuse, etc] there is
    on the internet about CFS, but they dont. We have to warn them there
    is this stuff out there, and they get very angry about itthey say we
    need answers and you mustnt be stopped.

    Professor Wessely, whose research interests have moved away from
    CFS/ME, still sees patients and agrees that their attitudes are
    completely different from those of the campaigners. I still do the
    clinic, and its perfectly fine. Weve seen 2000 patients, with very
    few complaints. The service is the least complained about in the
    Maudsley [hospital].

    The underlying belief of the campaigners is that CFS/ME has a real
    cause, which would have been discovered by now if serious efforts had
    been made. So there was great excitement in 2009 when a US team from
    Whittemore Peterson Institute in Reno, Nevada, published a paper in
    Science claiming a link between CFS/ME and the XMRV retrovirus. The
    paper said that they had found the virus in 68 out of 101 CFS/ME
    patients tested. Annette Whittemore, whose husband made money in
    property and who has a daughter with CFS, had funded the institute.
    She was joyful at the discovery. It ends the debate, she said. CFS
    is not and never was a psychological disorder. Those who are ill have
    always known this.

    Alas, at least 10 follow-up studies, including one in the BMJ,4 have
    now failed to reproduce the original results, prompting Science to
    issue an expression of concern. But some of those who failed to
    reproduce the finding have found themselves the object of the same
    intimidatory behaviour as the psychiatrists. John Coffin from Tufts
    University in Boston, whose team showed that XMRV is a laboratory
    hybrid, has said that nobody went in with the intention of disproving
    the link between CFS/ME and the virus. Criticisms of his motivations
    from patient advocates had been painful to read.

    Professor Wessely says that scientists have been appalled at their
    treatment and that some have sworn never to work in the field again.
    Many scientists end up being threatened if they publish any research
    that gives the wrong results. So most just stop.

    Pretty typical is a response posted on the ME Association website to
    the republication of a Nature story reporting the failure to reproduce
    the XMRV results. It quoted Jonathan Stoye, a retrovirologist at the
    National Institute for Medical Research, as saying; Its a bust.
    People who are interested in this condition will have to move on. The
    comment, posted by somebody calling himself Soloman, reads: Will HE
    move on to some decent research instead of just knocking down others
    work? And what do we move on tomore nonsense from the

    Dr Crawley admits she did get very low as a result of the pressure
    and was planning to leave the field. But there isnt anybody else in
    my generation whos come in and stayed in. If I stop, theyll have

    Dr Shepherd is more sanguine. The problems dont relate to all
    researchers. There are some who would say they havent had any
    trouble. It may discourage some people, those on the psychiatric side,
    because they know about White and Wessely and they know theyre going
    to get the same flak. But what discourages people on the biomedical
    side is this atmosphere in laboratories that you shouldnt be involved
    with this at all if you want to advance your career, that its all a
    psychiatric condition and theres no point in searching for a physical
    cause when weve had so many negative results.

    Dr Shepherd is pleased by a new initiative by the MRC, which has set
    aside 1.5m for CFS/ME research. He credits Stephen Holgate, an
    immunopharmacologist at Southampton University, who set up an expert
    group to advise the MRC, with moving the process forward. Professor
    Holgate believes that a lack of good scientists working in the field
    has held up progress, and the new MRC funding is designed to rectify
    that. Proposals, which had to include at least one scientist who does
    not already work on CFS/ME, had to be submitted to the MRC by 7 June.
    Whoever wins the grants will have tremendous support from patient
    groups, Dr Shepherd promises.

    Time will tell if his optimism is justified, but it does little to
    help those who have been categorised as enemies by the activists. The
    law appears relatively powerless, just as it did for many years during
    the campaigns against scientists working with animals.

    I regularly go to see a lawyer on the Medical Defence Union, says
    Professor Wessely. They say, Yes, it is a gross libel. But if you
    took them to court, theyd love it. Theyd get what they want. I did
    get an injunction against the person who was comparing me with
    Mengele. That was a particularly nasty example, because my
    grandparents may actually have been murdered by Mengelethey were
    transported to the camp where he worked and never seen again.

    The motivation of the most persistent campaigners puzzles those who
    are their target. My gut feeling is that some dont even have this
    illness at all, says Dr Shepherd. They have personality problems.
    Professor Wessely says: Theyre damaged and disturbed, with an
    obsession about psychiatry. With these people, it isnt that they
    dont want to get better but if the price is recognising the
    psychiatric basis of the condition, theyd rather not get better.

    Dr Hamilton has also been advised by lawyers not to answer
    complaintsthe complainant will simply twist anything you say. He
    says he is at a loss to know how to deal with them. Theres no
    morality here. The judicial reviews wrist slap would have made anyone
    with any conscience stop playing this game. It hasnt. I get hate
    emailsthats what the delete button is for. The GMC need to realise
    they are losing the trust of the medical profession by its procedures.
    Very few doctors feel they will receive natural justice from it.

    As for Professor Wessely, he gave up active research on CFS/ME 10
    years ago. He now specialises in the problems of war veterans. I now
    go to Iraq and Afghanistan, where I feel a lot safer, he says.

    Competing interests The author has completed the ICJME unified
    disclosure form at www.icmje.org/coi_disclosure.pdf (available on
    request from him) and declares no support from any organisation for
    the submitted work; no financial relationships with any organisation
    that might have an interest in the submitted work in the previous
    three years; and no other relationships or activities that could
    appear to have influenced the submitted work.

    Provenance and peer review: Commissioned; not externally peer reviewed.

    1 NICE. Chronic fatigue syndrome /myalgic encephalomyelitis: NICE
    guideline. http:// guidance.nice.org.uk/CG53/NICEGuidance/doc/English.

    2 White PD, Goldsmith KA, Johnson AL, Potts L, Walwyn R, DeCesare JC,
    et al on behalf of the PACE trial management group. Comparison of
    adaptive pacing therapy, cognitive behaviour therapy, graded exercise
    therapy, and specialist medical care for chronic fatigue syndrome
    (PACE): a randomised trial. Lancet 2011;377:823-36.

    3 Patients power and PACE. Lancet 2011;377:1808.

    4 Van Kuppeveld FJ, de Jong AS, Lanke KH, Verhaegh GW, Melchers WJ,
    Swanink CM, et al. Prevalence of xenotropic murine leukaemia
    virus-related virus in patients with chronic fatigue syndrome in the
    Netherlands: retrospective analysis of samples from an established
    cohort. BMJ 2010;340:c1018.

    Cite this as: BMJ 2011;342:d3780
  2. Dolphin

    Dolphin Senior Member

  3. WillowJ

    WillowJ คภภเє ɠรค๓թєl

    WA, USA
    perhaps these folks should read the report from the Gibson Inquiry
  4. Snow Leopard

    Snow Leopard Hibernating

    South Australia
    Since when did Professor Wessely give up on active research? Not being a first author is not the same as giving up active research. He is still co-authoring papers as of 2011.
  5. Valentijn

    Valentijn Senior Member

    There's one thing we can agree on - these morons obviously aren't trying to treat ME/CFS. Indeed, we don't have the simple chronic fatigue that might respond to counseling. Maybe the psychologists should call whatever it is they're treating something other than "ME/CFS" so we don't get confused and angry when we think they're talking about people with real ME/CFS :D
  6. Wayne

    Wayne Senior Member

    Ashland, Oregon
    I'd say this about wraps up Wessely's view toward us rather succinctly.

    And the author (and others) wonder why we find these kinds of attitudes disconcerting??? Is it really that hard to figure out??? :rolleyes:
  7. Enid

    Enid Senior Member

    This journalese seems a deliberate try on - still missing the essential point - there are no researchers in the UK save a few named investigating from a psychiatric perspective only. It is equally unedifying for ME/CFS sufferers to have to sit and view the continuing resistance of a section of a profession which now appears as a vendetta against anyone opposing their views.

    I don't have an obession with psychiatry Mr Wessely, but I do object to a diagnosis "all in the mind" by 4 junior Docs in A & E when in a totally collapsed state. Under persuasion from the psychiatrist I mentioned my degree with psychology - his reply "you are the worst". Now does that sound like a medical/professional diagnosis. So stop complaining or your treatment may be as bad as this. And Hawkes would have a better grasp of affairs if he had read Dr Melvin Ramsay's book on the "Royal Free" - relating to the prejudice in ME as an organic disease.
  8. Dx Revision Watch

    Dx Revision Watch Suzy Chapman Owner of Dx Revision Watch

    [Content deleted by Suzy Chapman who has now left the forum.]
  9. Trooper

    Trooper Senior Member

    The purpose of this article is to dissuade biomedical scientists from trying to help people with ME/CFS.

    "He now specialises in the problems of war veterans. I now go to Iraq and Afghanistan, where I feel a lot safer, he says." - This flippant comment speaks volumes about the man.
  10. eric_s

    eric_s Senior Member

    Switzerland/Spain (Valencia)
    Those perfidious bas*ds really manage to portray themselves as the victims here... incredible.

    Where are the UK ME charities? They must counter something like this in one way or the other. It's so full of manipulation and misinformation. You can't possibly let these things pass uncontested.

    Dr. Crawley got very low and Wessely felt harrassed... Poor little things... Guess what, we are sick, unable to work or do most other things and thanks to their work usually don't even get recognized by the authorities that decide on financial assistance.
    We've been screaming for more research ever since the beginning, donate the little money we have and treat the people who actually help us like heroes.

    How much more perverted can things get?

    I hope Invest in ME invite will never again invite someone from the BMJ (it was the BMJ, not the Lancet, right) to their conference. This is some of the most despicable propaganda i've ever seen, a paper that publishes something like that has absolutely no place on a ME/CFS conference, in my opinion.

    This part seems to make some sense at least:
  11. insearchof

    insearchof Senior Member

    A generalized characture of the community.

    Three words to advocates: never give up, never give up, never give up. :thumbsup:
  12. Enid

    Enid Senior Member

    Quite agree eric - it's perfidious - an astounding reaction from the BMJ invited as they were to learn about the current research/pathology findings and treatments being used. Just cannot get away from the conclusion that there is a hard core at work determined to oppose everything except psychiatric treatment. What have hurt feelings to do with the science now unravelling ME.
  13. Dx Revision Watch

    Dx Revision Watch Suzy Chapman Owner of Dx Revision Watch

    [Content deleted by Suzy Chapman who has now left the forum.]
  14. Bob


    England (south coast)
    On a slightly unrelated matter, in a 'summary' about CFS on their website, the BMJ say something which could have very dangerous consequences for patients. It's a highly irresponsible assertion, and I'd like to know what evidence they base their conclusion on:
    "The syndrome is associated with ... lack of compliance with recommended treatments"
    http://bestpractice.bmj.com/best-pr...ign=Feed: bestpractice/recent &forumid=331851

    And on the same page:
    "Graduated, low-impact exercise and cognitive behavioural therapy (CBT) is recommended for all patients."
    This is another dangerous statement, considering how severely ill patients react to exertion, and so many patients report to have been harmed by GET and CBT in the 2008 Action for ME survey.
    The FINE Trial proved that severely affected patients don't respond to psychological interventions, so their statement is not based on the latest evidence.
    Also, the BMJ should qualify their statements by saying that patients should be able to refuse any specific intervention, without prejudicing their overall treatment plan, as per the NICE Guidelines.

    The NICE guidelines state that a patient should be able to refuse GET and CBT without prejudicing their treatment:
    "Healthcare professionals should be aware that like all people receiving
    care in the NHS people with CFS/ME have the right to refuse or withdraw
    from any component of their care plan without this affecting other aspects
    of their care, or future choices about care."

  15. Enid

    Enid Senior Member

    Very dangerous Bob - now if they could catch up with advising tests for all the pathogens being found (as Byron Hyde "missed diagnoses") they might be more relevant. Nice Guidelines seem to be somewhat better informed though - patient choice.
  16. insearchof

    insearchof Senior Member

    "....lack of compliance with recommended treatments''.....Hmmm I wonder why that is? Could it be that:

    (a) it does not work, works poorly or works for very few patients?

    (b) has an inherent risk that outweights any benefit?

    (c) is dangerous?

    (d) one or more of the above? :rolleyes:

    Lets hope there are still a few intelligent and enquiring minds left in other fields of general medicine, who might be pondering these very questions when they read that statement.

    I have not read the article, so cannot comment.

    However, I do see a lot of what appears of late, to be desperate attempts from the medical profession to hold onto a flawed treatment model (CBT/GET) that is successfully being challenged....and maybe that is why. ;)

    Lack of compliance with recommended treatment is rife - right through out medicine: failure to take the full prescribed course of medication, refusal to take certain medications or undergo certain procedures because of the risk of side effects/adverse outcomes, seeking second opinions, etc. That is the direct result of the requirements imposed on the medical profession and inherent in the medico/legal doctrine of consent to medical treatment and informed consent, to such treatment.

    In point of fact, a patient maintains the right to refuse any and all medical treatment full stop.

    I wounder whether the doctors who scold ME CFS patients for lack of compliance with a recommended but questionable treatment (CBT/GET), would scold other patients who refuse to take other questionable medical treatments ?
  17. Dx Revision Watch

    Dx Revision Watch Suzy Chapman Owner of Dx Revision Watch

    [Content deleted by Suzy Chapman who has now left the forum.]
  18. insearchof

    insearchof Senior Member

    I agree with your observations Suzy.

    Precisely, because to do otherwise, might well constitute assault, battery and a violation of human rights under international law.
  19. jace

    jace Off the fence

    To give the BMJ their due, they also published as an article an excellent piece by Ollie Sones, and you can read that, plus the other three pieces in full, on the MEA website: http://www.meassociation.org.uk/?p=6711

    I agree totally that Hawkes's piece was one-sided, and full of bias. No surprise there, while Ollie's letter was. To return to the subject of threats by patients, where is the evidence? We have plenty of insensitive, inaccurate statements published by those that believe ME/CFS is a somatic disorder: "viral attribution [reflects] somatization par excellence" (1) "The description given by a leading gastro-enterologist at the Mayo clinic remains accurate. 'the average doctor will see they are neurotic and he will often be disgusted with them.' " (2), but I have yet to see any threats other than verbal insults on online forums from patients generally too ill to leave their homes, many of whom have suffered medical neglect and even actual physical abuse (3).

    The great advance in the June 22nd edition of the BMJ is the clear call to use only the Canadian Consensus. Who'd have imagined that, a while ago?

    Extracts from Ollie's commentary
    1) Wessely S - 'What your patients may be reading', British Medical Journal, 1989;298:1532-3.
    2) Wessely S : Chronic fatigue and myalgia syndromes", in N. Sartorius et al (eds), 'Psychological Disorders in General Medical Settings', publ. Hogrefe & Huber, 1990.
    3) http://www.mecfsforums.com/index.php/topic,8003.0.html
  20. Sasha

    Sasha Fine, thank you

    Thank God someone like Ollie is getting a word in. Getting the CCC established would be fantastic.

    The main piece, though, is one of the most depressing things I've seen in a long time. The only thing that keeps me going through the mediaeval mire that is the treatment of ME in the UK is that we can do positive things to get more action in our favour. If you're not already taking part in the Vivint contest, I beg you, start! The WPI are already the frontrunner by a mile to win $100,000 (they are leading their region by thousands of votes). They can win another $150,000 of free cash if we all join in.

    One of the frustrating things for me about our illness is that we are huge in numbers and vocal on forums and yet this energy - which is in so limited supply for us all - isn't always reflected in participation in easy activities that have realistically achievable benefits, such as daily online voting in a contest which takes ten seconds a day.

    If you're angry about how we're being treated, please join in with the Vivint contest if you haven't already. And get a tasteful signature like jace's (or a tacky one like mine!).

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