Randeep

This is not a loss. Palestine Action was so effective in disrupting the Israeli weapons industry, that the state threw all its might at us. By doing so, they've exposed how they prioritise the Zionist regime over its own citizens. As long as we continue to resist, we've won.

@martinshawx @HudaAmmori That faith is shared! But for me, video of Carr describing Suffragettes (who unlike PA killed people) as peaceful in contrast to PA + Johnson’s conduct have shredded any remaining vestige of faith in UK courts. Worth appealing but IMO disavowed of any respect for UK “justice”.

@randeep_93 I’m expressing faith in @HudaAmmori’s case. Somewhere along the line, the outrage of this decision will be recognised.

The UK Court of Appeal has seriously overreached itself by basing its decision on the manifest untruth that “Palestine Action overtly promotes unlawful violence amounting to terrorism”. Reading this, and squaring it against the evidence, the Supreme Court or failing that the European Court will overturn this ruling.

@meerkat34344416 @chrisaikenmd @elonmusk @durov @Clavicular0 You might be able to get some of these through other indications? Vyvanse and/or clonidine for ADHD, for instance?

@chrisaikenmd in my arsenal i have vyvanse, clonidine, lamotrigine, seroquel, abilify, promethizine... but can i find a dr to help me put the protocol together? NO I CAN'T. THEY WON'T GO NEAR ME AS A PATIENT. TOO RISKY. @elonmusk @durov @clavicular0

Here's how meds ranked in large network analysis of borderline personality. At the top: ▪ Topiramate ▪ Aripiprazole ▪ Lamotrigine ▪ Carbamazepine ▪ Asenapine But the methodology has flaws, and meds are not first-line. Learn more: psych-partners.com/medications-fo…

@RabbiSamStern @Alonso_GD Uhhh x.com/alonso_gd/stat…

@Alonso_GD Uhhh x.com/elliotmalin/st…

Israel killed 344 Palestinian footballers between 2023 and 2024 alone

Attaching "terrorist connections" to the Filton 4 was probably intended to make an example of them by lengthening their sentences. The problem for the establishment is, now every Jury in Palestine-linked cases will be wondering if they're being told the full picture.

@angryhacademic One way to respond to this problem is to point out that it's largely a consequence of a failure to understand basic probability. You've explained some causal links between them quite well, but one doesn't even have to understand that to understand (eg) that P(POTS|LC) > P(POTS).

Some doctors seem to disbelieve chronically ill patients have > 1 condition, claiming we "collect" labels. Part of this is probably poor diagnostics & medical education giving the false impression that certain diseases are rare. Another part is likely outright prejudice🧵

Apartheid South Africa and Nazi Germany needed compliant judges to provide a legal veneer to their darkest crimes. Judge Johnson joins their wretched company. He overturned a jury's conviction of four anti-genocide activists for criminal damage and sentenced them as terrorists instead. As one their barristers pointed out, the four defendants were initially arrested by police on suspicion of involvement in an act of terrorism. But the prosecution decided not to charge them with terrorism offences because it knew no jury would ever convict them based on the evidence. Instead the Crown held two trials: a sham one for the jury, and the real one conducted in secret by the judge. That is not justice. It is a show trial worthy of the worst tyrannical regimes.

@matthewstoller Really disappointing to hear this from you. Medea isnt talking about her emotions here - she’s talking about quite serious and reasonable concerns we have relating to auboptimal (to say the least) positions on Gaza have that stand to indirectly cause real harm to Palestinians.

Good. You get to rudely interrupt as a protester, the price is you get thrown out. Bernie has no obligation to act like a therapist to people interrupting and screaming at him.

"It brings me no pleasure to compare what Israel is doing to what the Nazis did, but how can we not? When you have things like ghettos, starvation, concentration camps and planned systematic extermination of people" Jewish journalist @kthalps CC: LBC @lewis_goodall @hasanthehun

@sanilrege All of this supports the fact that the lines between psychiatry, neurology and immunology are fundamentally blurred. A fact that I think clinicians and patients alike would generally stand to benefit from appreciating more!

Psychiatry cant be ignored - here’s why 👉Many medications that make a meaningful difference in ME/CFS, POTS and Long Covid are often classified as “psychiatric medications”. 🚨 The clinical question is not whether a medication is psychiatric, neurological, immunological or cardiovascular. The question is whether it targets a relevant biological process. Psychopharmacology provides a major framework for targeting several domains seen in ME/CFS, POTS and Long Covid: autonomic instability, hyperarousal, sleep disruption, pain amplification, cognitive dysfunction, sensory sensitivity, fatigue, threat circuitry, inflammatory signalling and mast-cell-related pathways. But psychiatry is portrayed as the emery. Most patients are seen by psychiatry late in the picture and it’s often when physicians have tried everything and now they refer to psychiatry . So the irony is psychiatry is really a refuge for the physician’s hopelessness here . So the list - not exhaustive, but includes 1. Naltrexone / low-dose naltrexone 2. Aripiprazole / low-dose aripiprazole 3. Memantine 4. Prazosin and clonidine 5.Guanfacine 6. Vortioxetine 7. Psychostimulants - methylphenidate, dexamphetamine, lisdexamfetamine 8. Modafinil and armodafinil 9. SNRIs :duloxetine, venlafaxine, desvenlafaxine, milnacipran 11. TCAs : amitriptyline, nortriptyline, doxepin 12. Mirtazapine, Trazodone 13. Gabapentinoids : pregabalin, gabapentin 14.Beta-blockers : propranolol 15.’Benzodiazepines 16.Melatonin 17.Low-dose antipsychotics with antihistaminergic properties where hyperarousal, sensory amplification or agitation are dominant 18. Mood stabilisers / anti-kindling agents -e.g lamotrigine in highly selected neuropsychiatric phenotypes Many of these medications are called psychiatric because psychiatrists are often the clinicians most familiar with their mechanisms, dosing, adverse effects, interactions and clinical sequencing. Most physician’s struggle to use these appropriately because this is psychopharmacology. That does not mean they are only treating depression or anxiety. And if the construct infront of them is anxiety or ADHD or agitated depression then the medications re used in a very specific way that makes a difference Several agents used in psychopharmacology have effects on inflammatory signalling, autonomic tone, sleep architecture, pain processing, cognition, arousal, mast-cell-related symptoms, or central threat prediction. This is where the mind–body split becomes clinically unhelpful. A patient may decline an “antidepressant” because they do not have depression. 
A clinician may avoid a medication because it is seen as psychiatric. 
A biological target may then be missed because the medication carries the wrong label. In practice, when brain–body integration is understood, the framing changes. These medications are biological tools. And in complex conditions such as ME/CFS, POTS and Long Covid, dismissing them because of category stigma can limit treatment options and reinforce the very split that prevents more integrated care.

@RslewisSally I don’t see that as an equivalence so much as a comparison. Only one of those gets coverage in cases of regret; it’s appropriate to put that into perspective. I agree with the rest of what you’ve said - though many (including me) argue we should do that with most interventions.

Of course, this is a false equivalence. But anyway: We should be tracking patient-reported outcomes for every person undergoing these (and other) procedures and publishing the data with full transparency. This is necessary for truly informed choice.

@StarmertheFraud @SusanMichie Aside from all the other problems with this, students at the University of Manchester have faced an extreme amount of repression for protesting against that genocide there. That kind of repression of his constituents should concern him whatever terminology he sees fit to use.

"Burnham declined to describe the catastrophe on the ground in Gaza as a genocide. 'I can’t judge things of that enormity from where I am as mayor of Greater Manchester,' he said. Why not? Don't you have a phone? Can't you read the UN reports & ICJ? This "Aw shucks I'm just a smol bean Mayor trying to become PM" shtick about *a genocide* really demeans him and the voting public. Get a fucking backbone.

@awgaffney If you’re going to criticise clinical trials being blocked bc more research must be done (a goal I 100% support!), surely a better target for ire would be the enormous disparity between impact and funding? 14% of its disability commensurate funding!! nature.com/articles/s4385…

… the proponents of the dubious chronic infection theory of LC for off-label antiviral use? No, the subject of not merely skepticism, but activist efforts to block clinical trials from even *happening* is rehabilitative approaches only: exercise-based physical therapy & things

I’m all for careful interpretation of clinical trials, but what’s striking in this space is the extreme scrutiny of any trial showing modest improvements in exercise-tolerance from use of exercise, but crickets about widespread prescription of off-label HIV antivirals, …

@awgaffney There probably would be furore over these if they were systematically forced upon patients; and if they fostered an environment in which patients are routinely not taken seriously in general practice. And targeting abnormal coagulation has helped me **tremendously**!

Where is the furor at the proponents of the dubious microclot theory prescribing “triple anti-coagulation” therapy? Where is the furor at the proponents of the craniocervical instability theory who have even performed neurosurgery for CFS? Where is the furor at …

@Starseeker1986 @kasha_x_ God, I'm sorry to hear you've had such shit experiences. FWIW, it might be worth looking to see if there are any more GP surgeries available to you; there are usually more than 2. And some accept out of area registration! + U can even request the NHS cardio not be carried over!

@kasha_x_ @randeep_93 The consultant was very arrogant and dismissive. He’d already made his mind up and opinions from the moment I mentioned I developed all my symptoms and complex health conditions (NHS diagnosed) from covid which I caught at work IN THE NHS! He didn’t believe me.

I’m getting fucking fed up of this! #NHS are REFUSING to acknowledge my POTS diagnosis which was made privately by Dr Gupta a NHS Cardiologist & POTS Specialist I had to go private, as the NHS Cardiologists stated I do not have POTS as my tilt table results were satisfactory

@AlanLevinovitz @davidtuller1 @SalvMattera No worries and likewise, I’d thank you for engaging with this with curiosity and overall in good faith since having written the article. Despite having disagreed with a lot of what you’ve said, I’ve seen some shift their positions over time largely because of that engagement. 👍🏾

But thank you for engaging with my point and showing me where I was wrong about Health Rising. I have to admit, I was writing my reply quickly, and simply assumed they — with whom I am less familiar than other organizations and publications — would be in line with what I've seen elsewhere.

It agree 100% with @AlanLevinovitz that is terrible that patients reporting benefits have been dismissed or attacked for faking, etc. That is off-bounds. I would say the same if people reported recovering from crystal therapy--and I'm sure those people are out there.

@AlanLevinovitz @davidtuller1 @SalvMattera That’s hardly pushing surgery as a miracle cure. That ‘may’ is underlined makes it particularly hard to view it that way. I 100% agree with Wood it should be further researched and that often starts with a few isolated cases. Mind-body is sometimes on HR: healthrising.org/blog/2023/12/0…

The opinion piece is cautionary. It points out that these kinds of surgeries are for craniocervical instability. It hedges everything. But if you substitute mind-body for surgery, or "nervous system dysfunction" for "CCI", you basically get the exact same story that people who recover with mind-body therapies are telling. They say their version of severe ME/CFS was a nervous system dysfunction, which responded extremely well to mind-body therapy. Surely possible! But that kind of article would never, EVER appear on Health Rising.

@acerbicwit12 @sanilrege One thing that the Wired author and many of his critics (rightly) agree on is that PAIS are very heterogeneous and I think that’s relevant here. Someone with PEM à la Wust et al’s tissue biopsies might need a lot of rest. Whereas eg LC-POTS may benefit from eg Levine protocol.

@sanilrege Graded exercise therapy has been proposed for people with CFS/ME. The level of rest you need is hard to imagine for most people. I am extremely active, and it was intolerable. Of course, that impact is viewed through the lens of past experience. How could it not be?

There might finally be a way forward for Long COVID treatment, and I will talk about it 🚨 A few months ago, I shared an image: Pain + Context = Suffering and behaviour. 🚨 It got a lot of backlash. I expected it. Today Alan Levinovitz’s Long COVID article was published, titled: “There might finally be a way forward for Long COVID treatment; if only you were allowed to talk about it.” Again, a predictable backlash. So what I want to do is link Levinovitz’s article with my clincial work, Mark Solms’ recent paper on “function” in functional neurological disorders, and other literature on predictive processing, active inference, and interoceptive dysfunction. All biology. In addition, I will explain the neuroscience of how the brain reacts to allostasis, shaping a new 'person'. It's a long post, so I'll break it down into chapters. Chapter 1: The Image, the Backlash, and the Question The image and the article can create an almost reflexive judgment about what I am going to say, before I can make an argument. But before reacting with anger, dismissal, contempt, or the urge to block, pause for a second because that reaction is part of the very mechanism I want to explore. Ask: What exactly am I reacting to? (You haven't read what I'm about to say; have you made a prediction of what I mean before knowing what I mean? ) Because what I am about to describe is precisely that process. -How a lower-level bodily signal (arousal, anger, reflex reactions, etc.) becomes a prediction. -How a prediction becomes a feeling. -How a feeling becomes a conscious thought. -How a conscious thought becomes an action. -And how repeated action becomes a loop. That loop is NOT “mindset”, willpower, “just think differently”. It is the brain doing what brains do: predicting, protecting, acting. So before going further, let me be clear. This does NOT mean MECFS, Long COVID, FND, or chronic pain are not real. It does NOT mean symptoms are “all in the head”. It does NOT mean people should push through. None of that. What I am saying is that there is/ may be a way forward, and that way forward requires understanding how the brain organises around pain, fatigue, threat, uncertainty, bodily collapse, and the loss of a previous life. Chapter 2: From Signal to Action In medicine, one of the most neglected questions is still this: How does the brain turn a body signal into an action? A signal comes in. Pain. Fatigue. Dizziness. Weakness. Breathlessness. A strange internal sensation. But the brain does not simply receive the signal. It asks: (note - The Brain asks; Not you consciously) -What is this? -Have I felt this before? -What happened last time? -Is this safe? -What should I do next? The basic pathway: Perception → prediction → meaning → threat/safety → attention → action. Input → prediction → prediction error → updating → conscious thought → action Chapter 3: The Staircase Most of this is not conscious. You see stairs. You do not consciously calculate vestibular input, muscle contraction, joint angle, cardiovascular demand, expected effort and recovery curve. Your brain predicts: “I know stairs.” “My legs can do this.” “This cost is manageable.” “I will recover.” So you climb. Chapter 4: The Same Staircase After Illness Now take the same staircase after illness. --After Long COVID or FND or pain. -After ME/CFS. -After repeated PEM. -After dizziness. -After pain flares. -After months, your body no longer behaves like the body you knew. Now the staircase is not just a staircase. It is a prediction. (the meaning; easily misinterpreted as thought) What will this cost? Will I crash? Will I recover? Will this take hours, days, or weeks? That is the nervous system trying to protect the organism based on prior experience. Chapter 5: The Solms article It's likely people look at the word psychoanalysis and immediately filter the article through old memories. which is exactly what Solms argues. "Memories are about the past, but they are for the future." Solms revisits the old idea of a “lesion of an idea”, but places it within a modern neurobiological frame. The point is not that symptoms are imaginary. The point is that not all pathology is structural in the simple textbook sense. Some pathology is functional, which is not 'made up' but rather how the brain / CNS organises perception, affect, memory, attention, prediction and action. Doctors are trained to look for textbook lesions. -A nerve lesion should follow a nerve. -A spinal lesion should follow a tract. -A cortical lesion should follow a map. But the brain does not only work from our diagrams. The brain has its OWN IDEA of the body. And sometimes, after illness, pain, trauma, collapse, autonomic dys, humiliation, medical fear or repeated bodily alarm, the brain develops its own idea of what the body can or cannot safely do. Not fake. Not imagined. A functional model. (brain's model of functions) Chapter 6: FND, ME/CFS and Long COVID A patient with FND may consciously want to move their leg. But the motor system may be operating under a stronger prediction: “This leg is not available for safe action.” A patient with ME/CFS may consciously want to walk. But the system may have learnt: A patient with Long COVID may desperately want their old life back. But the body has been 'teaching' the brain: “Exertion has consequences.” Chapter 8: Precision: When Prediction Becomes Policy This is where prediction is so easily misunderstood. People hear “prediction” and think: belief, mindset, choice, attitude, willpower, try harder NO! The brain has a hierarchy of predictions. Some become conscious thoughts. Many never do. They sit in interoception, autonomic regulation, motor control, salience, memory, arousal, habit and action selection. A lower-level prediction can rise into conscious experience as: “I feel unsafe.” “I can’t do this.” “This will make me worse.” Then it becomes behaviour: -stopping -lying down -avoiding -withdrawing -resting. Sometimes that action is protective. Sometimes it is necessary. But sometimes, over time, the protective response can become a 'trap'. In predictive processing, the keyword is precision. Precision means confidence. (it's below thought) A flexible prediction sounds like: “Maybe this hurts, but I can test it.” A high-precision prediction sounds like: “If I move, I will crash.” “If I stand, I will collapse.” “If I use this leg, it will fail.” Once a prediction becomes high precision, the brain stops treating it as a question. It becomes a policy. A habit. An automated protective solution. That is why “just push through” isn't helpful. Changing your thoughts isn't helpful . The problem is NOT a lack of effort. The problem is that the nervous system has assigned too much confidence to a protective prediction. Chapter 8: The Cost of Effort This is also why the newer cost-of-effort paper in chronic fatigue is important. In that study, people with chronic fatigue watched videos of others exercising and estimated how effortful it looked. They were not exercising themselves. Yet they predicted higher exertion across effort levels than controls. More importantly, in the chronic fatigue group, the prediction bias was shaped less by the person in the video and more by the observer’s own fatigue and disability. Because the system is not only responding to the task. It is responding to what the task is predicted to cost. Again, not consciously or wilfully. Not “all in the mind”. But through a brain-body system that has 'learnt' from experience. Chapter 9: Why People React And yes, I understand why people react. Patients with Long COVID, ME/CFS, FND and chronic pain have been dismissed for years. They have been told, “It is anxiety.” “Your tests are normal.” “Just exercise.” “It is stress.” “It is in your head.” So when words like prediction, meaning, attention, function or brain are used, many understandably hear invalidation. ..and the new neurobiology is filtered through the lens of memories. But Prediction IS biology. The mistake is thinking that biology only counts if it appears as a visible lesion, an abnormal blood test, or a scan finding. Biology also includes: -interoception -autonomic state -salience -memory -attention -arousal -precision -motor output -habit -action selection Chapter 10: What I See Clinically As a clinician who spends months, yes, months, with this same complexity on the ward in a multidisciplinary private setting, with chronic pain, MECFS/ Long covid, FND, this is not abstract to me. Alan Levinovitz’s article makes an important observation: Kennedy, who had worked in a Long Covid speciality group, felt she had “too little time with patients to form the kind of relationship necessary for this approach.” Time is a core part of the treatment. We incorporate the neuroendocrine, ANS, inflammatory, circadian, etc., layers, as well as the biological aspects of interoceptive processing, predictive processing, and active inference. It is rarely one or the other. Some patients recover rapidly with a specific biological intervention - medication, sleep, autonomic, inflammatory, endocrine, pain or circadian treatment and return to high-level function. Others improve symptomatically but stall, because the body is better, but the nervous system has not updated its model: movement still means danger. Then there is a third group, where years of pain, withdrawal, dismissal and failed treatments shape everything. Doctors, medications, reassurance, physiotherapy, side effects, even recovery, are filtered through the same predictive lens: "this will harm me, this will fail, if I improve, I will crash, no one believes me, I'm not being heard; I'm trying, and no one sees the effort." This is why I admit for months. I don't just do second opinions because an opinion without a plan behind it doesn't mean much. The patterns play out in real time, with me, new clinicians, medications, boundaries, ruptures and repairs. (objects never before encountered) Therapeutic alliance is crucial. For some patients, trust takes months because the brain has spent years learning that resistance was protection. You see the brain organise around real biology. You see pain become linked to threat. You see fatigue become linked to cost. You see dizziness become linked to loss of control. Avoidance reduces prediction error in the short term, while shrinking the person’s world in the long term. And you also see change. Not by saying 'think positively'. But because the nervous system gradually updates, through a combination of safety, pacing, autonomic regulation, medication, physiotherapy, psychotherapy. etc Sometimes, even through supplements or interventions that may not work by the mechanism claimed, but because they provide a new object around which agency can restart. "Stranger still are patients’ stories of astonishing recoveries from severe long Covid, achieved entirely outside mainstream medicine." (Levinovitz) The common factor is often something (often multiple things) that allows the system to reduce prediction error and test a new action. Maybe something has changed. Maybe I can try. Maybe this body can act again. Chapter 11: The Clinical Question The clincial question needs an additional question. Not Where is the lesion? Or what are the mechanisms, BUT also What has the nervous system reorganised around? Because sometimes the lesion is not where the textbook tells you to look. Sometimes it is visible in the function: what the brain predicts, attends to, avoids, automates, and what action it no longer permits. If you want to keep the prediction that biology only means visible numbers and visible lesions, that is okay. But at least allow others to learn the broader biology. Because the invisible CAN be made visible when you learn what to look for. @AlanLevinovitz