Two Years Late, Spurs Vs Liverpool delivers.

Was this the game of the season? It sounds like a big call, but I was already convinced after four minutes. The game had barely begun, and it already had the stamp of a seven goal thriller. James Milner (yes, James Milner) had a lovely left-footed shot on target, and Trent Alexander Arnold had a lovely left-footed shot on target. It was all systems go. This was a game played at such a frenetic pace that the doors on my advent calender started opening by themselves.

By half time, the stats suggested Liverpool had dominated, and yet that old saying springs to mind – Lies, damned lies, and playing a high line is fucking dangerous. Liverpool could have easily been five-nil down. Tottenham had the best of the chances, Son and Dele Alli wasting glorious opportunities to pour cold water on the visitor’s vim.

It was Spurs who took the lead, at a time when it looked like their more solid and experienced midfield was starting to dominate. A probing run from Alli was repelled, but only as far as Ndolembe who played a through ball to Kane, the Englishman allowing the ball to beat him and making mince pies out of Konate and Alisson.

Liverpool recovered their composure, and despite the obvious grit and organisation that Antonio Conte has instilled in this team, the Reds started to probe. Mo Salah thumped a right footed half volley into the body of Hugo Lloris, and the Frenchman’s left knee served as adequate reposte to Trent Alexander-Arnold attempting the same intrusion. Could the young Scouser become the first right back to score 100 goals for his club?

The game fizzed and sparkled, and Liverpool became Liverpool again. The only downside of this performance was perhaps the first signs that James Milner is mortal. At 146 years old, he is allowed to have the odd bad game. And tonight, it was well compensated for by the presence of Tyler Alonso Morton, adding class and vision to Naby Keita’s spics and stomach. Harry Kane should have seen red for an awful studs-up challenge on Robertson, and Diogo Jota, fouled in the box, saw one of the most obvious claims for justice turned down since OJ Simpson tried on those gloves in a Los Angeles court room.

The equaliser, whist not quite predictable, had the hallmarks of everything that was coming, and everything that Liverpool and Jota do best. Breaking from their own half, there was the usual interplay down the left-hand side before a lovely ball found Jota unmarked. But somehow, he’s always unmarked. That can’t be a coincidence, can it? For a player of his stature, his prowess in the air is remarkable. Accuracy, power, and a strange technique that makes him look slightly childlike as he bobs his head forwards. Inevitably though, it’s always into the top corner. Half time. Can this game get any better?

In the second half, Spurs were at it again. They picked apart Liverpool’s defence too easily, and should have scored but for a wonder save from Alisson when Dele Alli cut back to Harry Kane. Kane should have buried, but the Brazilian’s anticipation was outrageous. Flinging himself forward, his cat-like paw came out and blocked as the open goal beckoned.

Seventy minutes gone, and Spurs were now looking strong and ambitious, until suddenly the narrative changed. A strong penalty appeal was turned down at one end when Dele Alli fell from a push in the back by Alexander-Arnold, and Liverpool broke. Mohamed Salah could not convert a cross to the back post with Hugo Loris saving well, but when Alexander-Arnold appeared majestically at the other end of the pitch, he hooked the ball across the six-yard box to Andy Robertson who headed into the empty net.

The statistics pop up showed that Liverpool had had eighteen chances to Spurs eight, but something didn’t feel right. Within minutes Spurs would teach Hublot and Opta to mind their own fucking business. A clever run from Son in behind left Joel Matip for dead and Alisson rushed from his line. His anticipation, Liverpool’s saving grace so many times in this game, and this season, was here his undoing. Any touch on the ball would have eliminated the danger, but instead it drifted through the keeper’s legs like the ghost of Christmas present. Son gratefully accepted the gift and slotted into the empty net. It was cruel on Alisson, who otherwise might have been man of the match.

With 10 minutes to go, Andy Robertson was sent off and the game took on a different complexion. Liverpool now had to defend their point, but it was telling that in the closing minutes, it was Liverpool who had the better chances and showed most urgency, whilst Spurs were happy to run the game down. A draw in the end, seemed fair.

So many talking points. So much drama. What a game. Two years ago, this fixture was described as the worst European Cup final in history. It may be too late to make up for that, but both teams showed their class here. For Liverpool fans, a huge positive has to be their ability to compete even with so many senior players missing. They took the game to Spurs from the off, and were it not for that goalkeeping error, and some contentious refereeing decisions, they would have taken all three points.

My take home memory from the game was the performance of Tyler Morton, who looks a better prospect than Curtis Jones. Which makes him a very good prospect indeed. And watching Jota head the ball of course. I just want to watch him head the ball all day on Christmas day. There are lots of reasons to believe that this Liverpool team will be right in the mix at the very end of the season- whenever that turns out to be.

A different way of living.

By Paul Mc Daid (@paulthedaid)

A few weeks ago, my dear friend Joan Mc Parland asked me to write a blog post chronicling some of my own experiences with ME. I wasn’t keen on the idea to begin with, as I tend to be quite a private person about these matters, and prefer only to write publicly about ‘ME politics’. Some of my friends (and particularly my long-suffering ex-fiancé) may roll their eyes at this last statement and say that I never stop talking about my illness, and I am in fact the definition of an extrovert. But, as most extroverts will tell you, usually this behaviour is a superficial diversion from what is really going on underneath. I keep my feelings and thoughts to my inner circle of friends, and can be quite shy about going public. However, when I do open up a little, I find that it is the best way to really connect with other ME sufferers, and it is also the way in which I invariably feel the most supported in return. And so, without any further ado…

***

I have four toothbrushes. Not one toothbrush and three spares; nor two toothbrushes, with two more toothbrushes in a toiletry bag; but four toothbrushes. All four in current use.  Unless you are lucky enough to own four separate residences, or perhaps were a 17th century king of France, I think it is quite unusual to have four toothbrushes. The reason I have four toothbrushes is that I suffer from very severe noise sensitivity, and I must choose from the type of bristle that I feel I can tolerate on any particular day. You can tell this is going to be a very exciting blog post. Welcome to my life.

Noise sensitivity is by far the worst symptom that I have experienced from a long list of God-awful symptoms since falling ill with ME nine years ago. Hyperacusis, as it is called, impacts virtually every single aspect of my life, and informs my decisions and my activities almost every minute of every day. I am unable to have even basic conversations or social interactions, I am prohibited from listening to music or watching TV, and worst of all I can’t spend proper time with my kids. Even short phone calls are difficult or impossible for me, making basic administration a challenge, and meaning that I must rely on others to help. I am mostly trapped indoors because of the noise of the outside world, and even when inside I must wear earplugs plus industrial ear defenders over the top, to cope with background domestic noise like a kettle boiling or a toilet flushing. Sadly, these ear defenders are not as attractive as they sound.

I have occasional good days when I can see friends or when I can take my kids to the park, but these are rare.  If I have a few glasses of wine at the weekend I can have a semi-normal social evening with friends or family, providing people keep their voices down and spend the entire evening catering to my needs. But even then, I always pay for it with days of screaming tinnitus, pain and swelling to follow. I am often left wondering if it is worth it, and if I am doing permanent damage to my ears by pushing, thereby making the situation worse for myself.

As far as I am aware, there is no treatment, and it is something I’m just stuck with. I therefore spend my days in a permanent state of noise-fear, and noise-avoidance . If I am exposed to too much noise (either loud noise or just extended background noise), I can have a severe flareup. During the flareups, even quiet background noise like central heating or clipping my nails elicits in my body a response similar to nails being scraped down a blackboard. It is the most nightmarish sensation I have ever experienced in my life. I would not wish it on my worst enemy. Flareups can take weeks to resolve, and so as you can imagine I do my best to try and avoid them. Psychiatrists may say that by avoiding noise I am making the situation worse for myself. They might argue that I get stuck in a loop of negative thinking and increased anxiety, causing the fear of noise to become more harmful than the noise itself. The problem itself lies in the anxiety, they might say. Fuck the psychiatrists.

Back to the toothbrushes. This is where it gets exciting. I almost exclusively brush my teeth in the shower, because the background noise of the water helps drown out the noise of the toothbrushing. I turn the heat up ridiculously high so the searing temperature gives me a boost of adrenaline, which also helps coping with the sound. On especially good days when my tinnitus is low, and I know my ears are good, I will use the big guns – my electric toothbrush. I enjoy nothing more than being able to tolerate the low growl, and I luxuriate in tenderising my neglected gums and feeling my teeth get a proper deep clean –  something I can only do perhaps once or twice per month. I then have two different manual toothbrushes of different stiffness from which to choose from depending on my sensitivity that day, or whether I am drunk or sober.

But my most commonly used toothbrush, my main man, is a specially adapted toothbrush which I bought online from Japan. This toothbrush is more like a sponge, with two thousand extra-soft bristles that were designed for brushing the teeth of pets. Yes, that’s correct. I use an animal toothbrush. Clever dentists from the Far East have designed a quiet toothbrush that make it less frightening for your horse, your parakeet, or your alligator to have their teeth brushed. An indirect benefit is that those of us with crippling hyperacusis can now brush our teeth with some comfort. This is the life of the ME patient – finding solutions, no matter how silly.

My four toothbrushes stand proudly on my sink every day awaiting selection. I may however design a utility belt, so that I can wear my four toothbrushes and carry them around with me, having each one within reach at all times. My oral hygiene has been a concern of late, as sadly I recently separated from my fiance and I am now single. I am therefore suddenly interested in the appearance of my teeth. Looking in the mirror today I decided I just have the teeth of a 41-year-old man. A 41-year-old man in 1870. I suppose my smile is the least of my concerns, but it has been difficult to keep my teeth whiter than white. On the occasions when my hearing sensitivity is not a problem, I am sometimes simply too weak to brush my own teeth. (Or anyone else’s teeth for that matter. Just to be clear.) Sometimes I have had to enlist a carer to brush them for me. At other times I just put a manual toothbrush in my mouth and chew it.

Flashy smile or no flashy smile, I think my ear defenders are my biggest obstacle, as they terrify anyone who I try to speak to. At least this is how it seems when I try to make occasional chitchat with a cashier at the shop, or on the very rare occasions when I can tolerate the noise in a café. It probably isn’t helped by the fact that I have lost some social skills as a result of being housebound for nine years. Before I fell ill, I was reasonably chatty, but I at least knew how to be a tiny bit cool. I knew not to jump all over strangers like a puppy dog, trying to forge instant friendships and bonds. I am aware that this is what Alan Partridge does. I have become Alan Partridge with added industrial ear covering. I guess I am a little bit like a thundercloud, weighed down with loneliness.  Whenever a human being passes by in close proximity, I am unable to stop my loneliness from discharging itself upon them. Whenever I speak to the waitress in the nearby café she immediately becomes defensive and wary, as if rather than saying that brownie was lovely thank you, I have just said ‘thanks for the coffee CAN I MOVE IN WITH YOU PLEASE?’

A short anecdote I like to tell illustrates just how completely unsuitable I probably am for dating due to my noise problems. A few years ago I heard some loud noise coming from the street outside the home I used to live in. Generally when this happens, I will sometimes venture outside and speak to the gardener or the labourer who is making the noise, and ask how long that it might last for.  If it is only going to be noisy for a brief spell I may take a shower to escape the sound for a few minutes. If it’s going to be an hour or so I may have to take some diazepam. Any longer than that, and I need to get dressed and take my ass the fuck out of Dodge.

On this particular occasion I couldn’t see where the noise was coming from by looking out of the window. I walked to the edge of the garden, and squinting down the street still could not see anything that could be responsible for the loud rumbling noise that was being made. Walking into the middle of the road, I peered to the end of the street and stood for a while wondering if I had the strength to walk the extra one hundred yards to investigate. As I stood there, a young schoolgirl came walking down the hill opposite my house towards me. As she turned a corner to pass me by, I gave her a small smile and a wave that I hoped communicated that I was not crazy. Hi there I was trying to say with my body language. Don’t worry about me. I’m just checking out the noise. You know how that goes.

She avoided my gaze, put her head down and hurried on. It was only after she had scuttled off into the distance that I considered my bizarre appearance. I was a forty year old man standing directly in the middle of the street, staring into apparently empty space with a look of fear and concentration on my face. I was wearing pyjamas, slippers, a dressing gown, sunglasses, my industrial ear defenders, and best of all, a baseball cap that said: WAYNE’S WORLD. It’s lucky that I was not arrested.

Realistically it’s going to be difficult for me to get a girlfriend isn’t it, what with the whole being housebound thing. Perhaps I can meet someone online. They say there’s someone for everyone don’t they? In the charming comedy novel The Rosey Project by Graham Simsion, we follow the ups and downs of professor Don Tilman, a likeable, handsome genetics professor with Asperger’s syndrome who is in search of love. The moral of the story is despite the funny adventures and mixes he gets himself into, in the end he still gets the girl. Hope springs eternal. There are people who get a kick out of caring for the weak. I think it’s got a name – Florence Nightingale syndrome. There might be someone out there for me right now – my soulmate, a girl who laughs at the same things I do and is attracted to men with teeth like Wyatt Earp.  Maybe dating online I could find someone who is stupid gullible desperate caring enough to give me a chance. I think on my profile however, I may omit the facts that I am unable to tolerate the sound of a kitten licking its own fur, and that I have the breath of a Japanese dog.

***

Ultimately, I don’t know if my noise sensitivity will ever improve. Of my other major symptoms, including severe physical fatigue and cognitive impairment, the last few years have been a story of slow progress, painful relapses, and more slow progress. But in general, I can see some improvement in many aspects of my quality of life. My noise sensitivity is the only symptom that appears to be getting worse. I don’t know if I have damaged an extremely sensitive part of the body, or if it is just another ME phase. Just another illusionary aspect of this unpredictable and cruel merry-go-round. If treatment becomes available for ME, I’m not sure if my noise sensitivity will respond. It is impossible to tell, because we don’t know what is wrong.

For now, like most ME patients, I cling to the good days, and look to the future with hope, as well as expectation. We have reason to believe that changes are afoot and that research is slowly answering questions about this illness. But I have a life to lead regardless. As painful and as difficult as it is, it is a life. It’s just different. A different way of living.

Paul Mc Daid has lived with severe ME/CFS for nine years. He is single and enjoys romcoms, cooking, and giving footrubs.

@paulthedaid

The Disturbing Fightback against NICE (cont.)

Below is the text of the email I sent to Scienenorway.no. It has not yet been published.

Sir/Madam,

I take issue with the recent article by Live Landmark on ME/CFS, which appeared in sciencenorway.no ( The British guideline for CFS/ME is the result of activism, not research Wed, 1 Dec).

There are far too many inaccuracies in this piece to list, so I will concentrate on the two most staggering:

‘As a result, guidelines for diseases or illnesses should therefore not be based on reports of experience. Such anecdotal reports are inappropriate for medical policy, and not consistent with modern health practice.’

The author here is stating that guidelines for disease should ignore patient feedback – EVEN in the case of harm. If it were up to the author, patients would still therefore be receiving drugs that passed clinical trials, but caused harm in the community. These include Thalidomide, Viox, Voltarol to name a few. You could extend her argument to include more extreme medical procedures or even agricultural chemicals that were considered safe until put into widespread practice. This is the most dangerous thing I have read by a so called ‘scientist in a long time.

Secondly, she says the guidelines were arrived at by a committee composed of mostly ME patients, rather than scientific review. This is absolute nonsense. There was a three year review of all scientific studies available in the field, before recommendations were made to the committee. She also says that:

‘several randomized controlled trials have been performed on thousands of patients with CFS/ME. The studies, and the systematic reviews, show that the treatments have an effect and no serious side effects have been reported.’

Over 250 such studies were included in the evidence review, and every single one of them was graded as either ‘low quality’ or ‘very low quality’ by an independent scientific review panel.

The author has ignored that these studies have been discredited and has continued to cite them as scientific evidence. She has ignored reported harms from the community because there were no reported harms in the (discredited) trials which focussed on only mildly ill patients. She has perpetuated myths that the  ME community base their views on ‘beliefs’ and unscientific practices, which is patently the opposite of the truth, as has been made clear by this entire episode.

I found this article offensive, and it’s content dangerous and outdated.  In short, this in an unscientific, prejudiced rant that refuses to accept the outcome of an important and thorough scientific review.

I ask that sciencenorway.no prints my objections or considers distancing themselves from the author, who states herself in her conflict of interest section that she works for a company who provide ( presumably for a profit) treatments which have been found to be dangerous by the new guidelines. The wellbeing of  many Norwegian patients may depend on embracing some balance in this debate.

Yours Sincerely,

Paul Mc Daid

@Paulthedaid

The Disturbing Fight Back against NICE

Even in progressive – and ME savvy – Norway, ‘scientists’ continue to push non evidence based and harmful treatment.

Below is a worrying – and wholly disingenuous – suggestion that the ‘evidence’ for psychological treatments has been suppressed in the UK.

In the next blog, I will post my email response to this piece.

Posted Sciencenorway.no on Wed Dec 01 by ‘Live Landmark.’

There has been a long-term debate in Norway about the controversial condition chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME).

Sociology researchers try to understand the phenomena through a historical lens and in a cultural context.

Biomedical researchers try to explain the symptoms by investigating possible underlying processes from a biomedical angle. Doctors considering how the mind and body have a role in illness try to help the patients with rehabilitation strategies and research.

The poor quality of the guidelines

It is both good and important to try to understand CFS/ME from various perspectives, but lately, there has been an inappropriate emphasis on the new British guidelines, called NICE guidelines. This is unfortunate, as the UK guidelines for CFS/ME are not based on rigorous research. Instead, they were created by a committee, a third of which was made up of CFS/ME patients, members of ME associations and ME forums, also called the “ME community”.ANNONSE

The committee has used “experience”, “opinion” and “agreement” as a basis for its advice on how to manage this condition, instead of controlled treatment studies and systematic reviews (quantitative studies). Three of the professionals on the committee withdrew ahead of the publication, while one was asked to leave, as reported in the British Medical Journal.

The guidelines have since received massive opposition from the major professional bodies of the UK medical professions and have equally been criticized by a broad section of the Norwegian professional community (Aftenposten, in Norwegian).

The difference in experience and measured effect

It is great to listen to patient experiences and clinicans’ practice-based knowledge, but, as discussed in this study in British Journal of Health Psychology, this has to include the experience of those of us who have recovered from CFS/ME. Unfortunately, no one was representing those voices in the committee.

The members of the ME community consider CFS/ME to be a purely biomedical disease and reject any treatments that do not support their views on the cause of their symptoms.

It is also important to note that experiences can say nothing about the cause, effect of treatment or prognosis. As a result, guidelines for diseases or illnesses should therefore not be based on reports of experience. Such anecdotal reports are inappropriate for medical policy, and not consistent with modern health practice. Instead, decisions need to be based on an independent critical appraisal and summary of the research that has been done, including quantitative studies that were set up to rigorously assess both the effects and side effects of treatment.

However, during the process of creating these new guidelines, no researchers with relevant scientific expertise were invited to contribute, which is both unusual and incomprehensible. Therefore, instead of using rigorous treatment studies and unbiased systematic reviews, they based their recommendations on “agreement” in the committee, and a few experience-based studies and refer, among other things, to the “ME community”.

The ME community and the polarization of the debate

The ME community is an Internet-based community, which has been described by Lian and Nettleton in this study. The study followed 14 ME forums over three years and revealed a virtual society with strong unity and a sense of belonging.

That is all well and good, but the challenge with such societies is that it creates a group identity, with clear divisions between “us” and “them”. The consequence is that those who participate in such societies view the “others” as adversaries. This can contribute to the polarization of the debate, which affects both researchers and patients.

The members of the ME community consider CFS/ME to be a purely biomedical disease and reject any treatments that do not support their views on the cause of their symptoms. The attitude is that one must save energy and adapt activities, even if there is no scientific evidence to support it, as discussed in this study in The Lancet.

The norm in the online communities is that there is a strong pressure on what is allowed and what is not allowed to be said, and there is no room for dissent. Lian and Nettleton found no examples of reporting positive experiences of the healthcare services. They found that members spread knowledge that corresponded with their perception of reality and warned about the “danger of psychological treatment”.

Diagnostic criteria

There are more than 20 sets of criteria for CFS/ME, where the different sets of criteria more or less overlap in the descriptions of fatigue and other symptoms. None of them have been validated, because no one can say what “real ME” is, but the Fukuda criteria (1994) are mostly used in research. A research group at the National Institute of Public Health in Norway assessed all the criteria. They did not find that one diagnostic set was better than the other and concluded that there was no basis for developing new diagnostic criteria. Research published in BMJ Open shows that the effect of treatment is independent of the diagnostic criteria.ANNONSE

The members of the NICE Committee, on the other hand, were concerned with the ME community. These patients believe that those who have recovered through psychological methods must have been incorrectly diagnosed with CFS/ME. The logic is: Those who recover from psychological methods cannot have had a biomedical disease. Thus, such experiences are rejected.

But the ME community represents a self-selected sample of patients. We do not know if they have been diagnosed with CFS/ME, by what criteria, or if they have diagnosed themselves. They, therefore, do not represent everyone with CFS/ME, and they exclude those of us who have recovered.

Criteria based on experience

The committee members nevertheless took their experiences and established new criteria, “NICE2021 consensus-based diagnostic criteria”. These criteria are based on the patients’ description of being tired, having concentration problems, sleeping poorly and experiencing worsening after activity.

The committee drew up guidelines based on its interpretation of qualitative studies, personal opinions and experiences from the ME community.

According to the NICE guidelines the diagnosis can be given after just three months of symptoms. In any case, the criteria are based on the committee members’ “experiences”, and it is telling that the guidelines conclude by encouraging research on the new criteria to see how good they are at identifying patients with CFS/ME.

Qualitative studies

The problem escalated further when the committee members agreed on using these new criteria for CFS/ME as a basis when previously performed studies should be evaluated. As a result, the evidence in all studies on patients who met other diagnostic criteria (such as the Fukuda criteria) got downgraded through GRADE, a method for assessing the certainty of the evidence base. This contributed to the studies on cognitive behavioral therapy (CBT) and graded exercise therapy (GET) being ranked as being of “low” or “very low” certainty. The consequence was that the committee was then able to discount research studies that showed a benefit of these interventions.

When the committee’s opinions resulted in the discount of evidence, they should have refrained from making guidelines until one had a more solid scientific basis from more research. Instead, the committee drew up guidelines based on its interpretation of qualitative studies, personal opinions and experiences from the ME community.

Normally, such experiences are used as a basis for developing hypotheses, for example, whether one believes that a treatment works or not. The hypotheses then form the basis for conducting larger studies that measure the effect of treatment, such as in quantitative studies. It is only in such studies that one can confirm whether a treatment has an effect or can be harmful. And it is only through systematic reviews, which involve a report on several such studies, that one can see the problem as a whole.

“Disastrous misapplication”

In the case of both cognitive behavioral therapy (CBT) and graded exercise therapy (GET), several randomized controlled trials have been performed on thousands of patients with CFS/ME. The studies, and the systematic reviews, show that the treatments have an effect and no serious side effects have been reported.

The committee’s opinions nevertheless caused a downgrading of all these studies. This action was immediately attacked by those who developed the GRADE method they had used calling it a “disastrous misapplication” of the GRADE procedures to develop guidelines.

Undocumented and unscientific advice

As a result of these concerning events, it is the committee members’ assessment of experiences and their own opinions, and not rigorous research, which has resulted in the British guidelines being changed and no longer recommending cognitive behavioral therapy (CBT) as treatment for CFS/ME, nor graded exercise therapy (GET) or the Lightning Process, despite the fact that research has shown effect for all of these interventions.

In practice, British patients with CFS/ME have now been deprived of opportunities to help them rehabilitate and recover. This is not what we want in Norway.

The illness that it is ok to mock (Part II)

 by Paul Mc Daid (@paulthedaid)

This is the second entry of a longer blog piece. Please see Part one for full context. 

The position of the ME community in the broader debate is easy to summarise: we know that the mind and body are linked. However, far too much funding has been spent purely on those who study the mind in ME – specifically, a small section of the UK psychological community who ignore biomedical research. Of course, a holistic approach to medicine that includes psychology is the best way to approach any chronic disease. But you can approach holistic medicine by speaking to alternative health practitioners, by going online, and by reading self-help books. When you speak to your doctor or consultant, you want not just holistic advice, but conventional medical advice. If you were suffering from cancer, you would choose to be referred to an oncologist, not a psychologist. If you protested, would that mean you don’t understand that your illness is multi-faceted, with a psychological component? Of course not. But this is the ridiculous situation ME patients find themselves in when they ask that biomedical researchers have their research applications approved. Dr Fitzpatrick says however, that by ‘repudiating any recognition of psychological factors… ME advocates implicitly endorse stigmatisation of mental health disorders.’ Wait a minute – because we want a scintilla of biomedical funding in this field, we are guilty of undermining a separate group of illnesses that bear little resemblance to our own? As someone who has suffered from depression, and who has lost a close friend to suicide, I wholeheartedly reject any notion that we have stigmatised mental health disorders in any way.  This is the kind of slanderous nonsense that we have to deal with on a constant basis.

Even though the mind and body are connected, in practice, medicine is compartmentalised. It is the only way to provide diagnosis, management and care to patients. When you enter a hospital, you turn left for neurology, right for cardiology, or go straight ahead for… You get the idea. When an ambulance arrives in casualty with an individual on a stretcher, action is taken. The patient is taken to surgery, to imaging, to cardiology, or to the appropriate ward. Surgeons and consultants do not stand around discussing the philosophical nature of cartesian dualism and the impact of the mind on the body. There is a time and a place for holistic thinking, and there is a time for action. This perhaps, is the crux of the schism – ME patients want their disease to be treated like any other, and for biomedical action to be taken. According to the best available science, psychology does not play a larger role in this disease than in any other. And that is a problem, because the lion’s share of the funding goes, every single year to a small group who Dr Fitzpatrick refers to as ‘the leading doctors in the field,’ and ‘the very men and women who are trying to help us.’  We fully accept and welcome psychological support, but we want it in proportion, and alongside other forms of medical funding.

The research published by the Wessely School that has defined the narrative surrounding this disease is staggeringly flawed. The general consensus is that results have been exaggerated, thereby wildly skewing the argument. This has two main outcomes – firstly, funding and attention are drawn away from biomedical research; and secondly, treatments that are declared as safe and effective may in fact be neither.

The most notorious example of course, is the now infamous PACE trial, which was described by MP Caroline Monaghan in a recent Parliamentary debate as ‘the biggest medical scandal of the 21st-century’. Criticism does not come from within the ME lobby alone. Even the UK psychological community are appalled at what they see as scientists dragging British psychology into disrepute. David F. Marks, editor of the Journal of Health Psychology, called the PACE trial ‘a text book example of bad science.’ Bruce Levin, a respected Columbia statistician called the PACE trial ‘the height of clinical amateurism.’ David Tuller, a Berkely lecturer in Journalism and Public Health described the study as ‘a sham; a fraud.’ Similar quotes from esteemed academics around the world form a landslide when one begins to pull at any loose thread of this argument. And yet, this is the study that has formed the backbone of orthodox treatment for ME in the UK for over a decade. These are the leading doctors in the field who Michael Fitzpatrick refers to in the Telegraph. A similar, but still ongoing, saga is a study named FITNET, led by Esther Crawley at Bristol University. In my own personal opinion, FITNET is even more flawed and disingenuous than the PACE trial. Esther Crawley has recently been awarded a £1.6m grant to study GET and CBT in children with Long Covid. Biomedical funding into Long Covid research has been given peanuts by comparison.

In February of 2015 the Institute of Medicine in the USA published a report entitled Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: Redefining an Illness. The reports states that ME/CFS ” is a medical – not a psychiatric or psychological – illness”, and goes on to say that “This disease is characterized by profound fatigue, cognitive dysfunction, sleep abnormalities, autonomic manifestations, pain, and other symptoms that are made worse by exertion of any sort.” Compare this to Michael Fitzpatrick’s withering definition. It was a breakthrough in many was for the community to have such an influential body put down in print that the disease was even real. We were being recognised for the first time. The momentum was felt across the Atlantic. In 2017, NICE announced that they were going to revisit their guidelines on the use of GET for ME/CFS.

In November of last year, the draft guidelines were published. After three years spent scrutinising 1,500 peer reviewed scientific studies, a judgement call was made. There was no ambiguity. The draft guidelines stated that “there is NO evidence to support the use of GET as a treatment for ME/CFS, and due to reported harms from the ME community… it should not be offered as a treatment for this illness.” The guidelines continued, “There is no evidence that CBT is a cure for ME/CFS, and it should only be offered as a supportive therapy.” Everything that campaigners had been saying for decades finally had the support of the highest medical research authority in the land. Then of course, came the twist.

The day before the guidelines were due to be published in August, the Royal College of Physicians and the Royal College of Psychiatrists announced that they would be telling their members not to follow the guidelines. In effect, the revision of the guidelines was being blocked. NICE had no choice but to ‘pause’ the publication. Since it’s its inception, the purpose of NICE has been to dispassionately and objectively review all scientific evidence and advise practitioners on what therapies and protocols are safe and effective. They had never been challenged, undermined, or blocked in this way. Dr Andrew Goddard, president of the Royal College of Physicians said in an interview with The Guardian, ‘GET is not without some risk, but benefits quite a lot of people.’ Technically speaking, you could say the same thing about thalidomide. The devil was in the details. What was the scale of the risk? What was the scale of the benefit? Repeated patient surveys from all across Europe had shown that the majority of those who undertook GET deteriorated, whilst only a small minority reported an improvement. Such a woolly, nebulous statement from a man of his office was shocking.

In 2019, Dr Keith Geraghty of the University of Manchester published a paper that compared all available studies on the efficacy of GET and CBT (n=1,428) with all the available feedback surveys (n=16,665) from patients who had been given the therapies. To anyone who isn’t already initiate in this area, the results make for eye watering reading. Whilst the PACE trial found that GET helped between 8% – 22% of patients (depending on whose statistical analysis you believe), 55% –74% of those polled reported that Graded Exercise Therapy had made them worse. This was already well known in the ME community. But now that NICE had reviewed all the available evidence, their judgement was clear. Of all the studies that they looked at in favour of GET, totalling more than 250, the quality of evidence was categorised as either ‘low quality’ or ‘very low quality.’ Brian Hughes, professor of psychology at the National University of Ireland in Galway, and author of ‘Psychology in Crisis’ is a well known critic of the Wessely school. In a recent blog post he described the NICE evidence review as a ‘bloodbath’. However, as if ignoring the idea that a therapy might make you worse, Dr Alastair Miller, an adviser to the NICE panel and an advocate of Graded Exercise Therapy said ‘since there are no new therapies, there is no need to change the guidelines.’ In other words, a treatment that has been shown to be harmful is better than no treatment. Jesus wept.


I’m sure Dr Fitzpatrick is a nice person. He is the symptom after all, not the problem. But I believe he has harmed and offended thousands of people. Was my suffering worsened upon reading this article? Absolutely. I was devastated and deflated. The hope that keeps me going every day took a hammering. I’m sure that was the same for many. There is also clear evidence that this practitioner represents a danger to the many ME and Long Covid patients that he is likely to encounter in daily practice. He is determined that they have psychiatric problems that there is no evidence that they have. He is determined that they should be given therapies that have been shown to be harmful. He scoffs at the idea of evidence, and has clearly ignored the development of biomedical understanding in this field over the last two decades.

Confronting the establishment is an exhausting, quixotic task for a chronically ill patient. Like the looming presence Wordsworth describes in his poem The Prelude we exist perennially in the umbra of a twisted and outdated paradigm, that has the disturbing quality of shifting its form when challenged or scrutinised from any angle. It defiantly resists the passage of time, and self-righteously claims it is built upon logic and reason, despite failing every scientific test and refusing to answer grown up questions put by reasonable men and women. Occasionally, when we diligently chip away at it, it seems to lessen in size, and the shadow shrinks, allowing a chink of light and a ray of hope to pass. At other times, like the publishing of Dr Fitzpatrick’s article, or the blockage of the NICE guideline publication, it rears up and doubles in size, making us feel that we are back to square one. Who are we, anyway, the patients caught in the middle of this nonsense? We feel voiceless. We are at times made to feel outcast, maligned and despised.

In the end, after a roundtable discussion with all the concerned parties on October 19th, NICE opted to go ahead with publication of the new guidelines, despite the disgruntled Royal Colleges. It was a huge victory and vindication for ME patients. It underlined the fact that science is on the side of ME advocates, and ME advocates are on the side of science. Those who attacked us for lobbying were in fact themselves the poorly informed harassers. None of this could have happened if we had not rattled the cage. But this is just the beginning for us. This is just common sense prevailing – protecting patients from a dangerous therapy that is more likely to harm them than help them. Decades of lobbying just to get to this point, and always, always swimming against the tide.

The Wessely school have not given up, already publishing a paper and an article in the Daily Mail defending their ideas. Professor Brian Hughes believes they are suffering from denial and cognitive dissonance. They are unable to let go of therapies that they developed themselves, based on theories that they developed themselves, despite the fact that they have now been completely discredited. And so, the fight will continue. We don’t want to fight. We are exhausted, and want to get on with our lives.

The Dalai Lama once said that anger is never justified, but righteous indignation is sometimes necessary to remove injustice. Amaritya Sen, the Indian Nobel prize winning economist famously said that human beings have no definition for ‘justice’. Instead, he said, we must simply seek out injustice and remove it wherever we find it. That is all the ME community have ever tried to do. It’s hard to know how to react when I read articles like Dr Fitzpatrick’s. Should I just ignore it, and get on with my life, for the sake of my mental health and happiness? That is the advice of ME ‘activists’. Don’t get upset, don’t engage, lest you be branded a psychology denier and accused of online harassment. This is usually my approach. But then sometimes something in me snaps, and I think: if we don’t fight, nothing is going to change. Does this make me a militant? Actually, yes. Perhaps it does. Maybe I can give him that one. I am recently converted.

@paulthedaid

The illness that it is ok to mock

 by Paul Mc Daid (@paulthedaid)

Every so often, something strange occurs in the British press. An offensive article is published about patients who suffer from a well known chronic disease. Sometimes it is written by an esteemed researcher or physician, at other times by a respected journalist. There is no backlash or ruckus kicked up; it just happens, is accepted, and the world moves on. Heads don’t roll, regardless of any inaccuracies in the piece. If any complaints are made through the appropriate channels, a worryingly large section of the establishment rapidly closes ranks around the writer. The perpetrator of what is effectively a hate crime, becomes the victim. 

The illness in question is ME, sometimes referred to as ‘Chronic Fatigue Syndrome’ or CFS (ME/CFS is the most commonly used appellation. I will mostly use ME hereinafter). The arguments contained in such articles are often scurrilous and baseless, and are calmly refuted by ME charities and patient groups. But similar articles stubbornly return like summer flies to be swatted away. Efforts to repudiate the stories continue, based on rational lines of thought and scientifically legitimate evidence. But patients and charities are mocked, jeered at, and accused of harassment simply because they lobby for truth and justice. I doubt this would happen in any other disease. So why does it happen to us?

Patients with ME are in the unenviable position of suffering from a disease that has no complete explanation, and no treatment. Usually, the traditional solution begins with allocating levels of funding to study the disease commensurate with the suffering caused and incidence of the illness in the population. However, according to charities and patient groups, in the case of ME/CFS, funding falls pitifully short when compared to other similar illnesses. What is perhaps worse however, is that most of the funding is siphoned away by a small group of psychiatrists and psychologists who promulgate a psychosomatic theory of the disease that has been disproven many times over, but who also enjoy a disproportionate amount of influence within the British medical establishment and media. Their work has come in for fierce criticism from academics right around the globe, who say their studies and theories do not stand up to basic scientific scrutiny. When any patients complain however, they are branded as militants, activists, or worse – mental health deniers. The latter argument is particularly powerful and seductive, and consciously or unconsciously, deploying it allows the psychologists in question to behave more or less with scientific impunity.

A few weeks ago, The Telegraph published an article by a regular GP columnist (How I became a target for the ME Militants, Dr Michael Fitzpatrick, 26th Sept), which raked over the old, tired accusations once again. The article suggests that ME patients don’t understand that psychology plays a role in their illness and instead have a ‘fixation with the minutiae of immunology.’ Well, no. Patients are in fact fixated with getting better, that is all. And, based on the best available science, immunology is one route we could follow to develop better understanding and treatment of this disease. Immunological studies in the USA and elsewhere have shown – since the 1980s in fact – huge abnormalities in ME patients that could account for the spectrum of immunological symptoms reported. Inflammation is seen in neuroimaging studies, and impaired metabolism and energy production have been clearly demonstrated in the laboratory. It is thought that the immune system is somehow blocking cellular metabolism, leading to the most well-known symptom of crushing physical and cognitive exhaustion. But in the British media, the idea that ME patients might wish to investigate immune system abnormalities is something to poke fun at apparently. Because the old story goes that we simply don’t grasp the fact that the human body is complicated, and the mind and body are connected. We want to focus only on the body, and not the mind, say the accusers. The mind and body are connected? Really?

This is something that we already knew, and have always been on board with. It has never been the crux of the argument. As my own consultant, a respected Harley Street infectious diseases practitioner, puts it: ‘Your grandmother could tell you that if you stress an animal out it will get sick.’ The first thing he ever suggested I do when I met him was to meditate. The mind-body connection is something any enlightened physician or patient understands. It is a truth so obvious that it barely needs to be discussed. It is known technically as the biopsychosocial (BPS) theory of disease, and the ME lobby are time and time again accused of being cave-dwellers who deny it’s reality, and who are afraid of the stigma of mental health playing any role in their illness. As such, the narrative suggests, we angrily reject any involvement of psychology in the battle to understand this complex disorder. Nothing could be further from the truth.

Virtually every ME patient I know is aware that their psychological state may have affected how they became ill, and affects their condition on an ongoing basis. Psychological intervention is usually welcomed by all. Further, since inflammation of the brain is suspected in this disease, more serious psychiatric symptoms also play a major role. It is not psychology or psychiatry we are at war with – it is a very small group of researchers who have an appalling approach to scientific methodology and medical ethics.

This political friction surrounding the management of ME/CFS dates back at least four decades, but is arguably more important now than ever before. Since the Covid pandemic began, roughly 5% of those infected with SARS-CoV-2 have gone on to develop lasting symptoms, that have identical properties to those seen in ME/CFS. This has led many Covid researchers around the world, including Dr Anthony Fauci, to conclude that at least a subset of these ‘Long Covid’ patients are in fact now suffering from ME. Some experts believe that the total number of those afflicted with ME – currently estimated at around18 million globally – may triple as a result of Covid. Clearly, it is about time we resolved any lingering questions that surround how best to manage the disease, using the limited information we have at our disposal.

In his article in the Telegraph, this is opposite of what Dr Michael Fitzpatrick endeavours to do, instead choosing to muddy the waters by dragging up old, out of date ideas and accusations. The thrust of the article concerns a recent debate about the treatment of ME/CFS patients in the UK, that the author says bears a ‘striking resemblance’ to one that he became embroiled in himself two decades ago. At that time, he penned an offensive Op-Ed in the British Medical Journal expressing that in his considered opinion ME patients simply don’t grasp the fact that psychology and medicine overlap. But the current debate Michael Fitzpatrick is referring to in The Telegraph bears no resemblance to anything that was being discussed twenty years ago.

The recent disagreement surrounds the publication of new guidelines by the National Institute for Health and Care Excellence (NICE) on the best way to manage ME in the UK. NICE were due to publish new, updated guidelines in August after a three year review, but at the last minute were blocked by a small group of influential establishment figures. No-one has ever prevented NICE from publishing guidelines before – it was an utterly unprecedented occurrence. The ME community were upset, as for many years we had been attempting to overhaul the current treatment options for ME, based on patient experiences and new evidence. The existing NICE guidelines stated that a form of physiotherapy known as Graded Exercise Therapy, or GET should be offered by GPs and physios to anyone with ME, based on research carried out by psychologists. However, patients have long claimed that this therapy is not only ineffective – but it actively makes them worse. GET has been the main form of treatment in the UK for decades, based on the psychosomatic model of the disease that has always been controversial. But as time passed, worrying reports began to emerge, suggesting not only were the therapies ineffective, but they were harmful. Most patients who underwent GET programs were getting worse, they said. Sometimes severely worse, and sometimes permanently.

How did these ideas come about in the first place? The UK psychologists and psychiatrists who have taken an interest in ME/CFS are often collectively entitled the ‘Wessely School’, after Professor Sir Simon Wessely, who first suggested the use of GET and Cognitive Behavioural Therapy (CBT) in a 1989 paper. In this now seminal study, he sets out his hypothesis for the disease: patients fall ill with a virus and suffer from fatigue, then recover. But the trauma of the illness means that patients develop a ‘fear of recovery’ and begin to entertain ‘false illness beliefs,’ due to symptoms which actually come from their anxieties. They then subconsciously employ ‘exercise avoidance strategies’ and confine themselves to bed whereupon their muscles decondition. After this, patients enter into a ‘feedback loop of negative thinking,’ which causes their fatigue to worsen. These are direct quotes. It is, the paper suggests, a self-propagating phenomenon. Since there is no biological impediment to recovery, the negative thinking loop can therefore be broken by therapy, and a patient can be restored to full health with physiotherapy.

This hypothesis was never evidence-based, and sounded fanciful to begin with. It could not account for the majority of the symptoms, the severity of the illness, the three-to-one female to male ratio, the sudden and aggressive onset, and the lack of correlation with pre-existing mental health and psychological problems. But now, the theory has been repudiated by decades of biomedical research, and a complete failure on behalf of the Wessely School to demonstrate that their techniques actually help patients. Moreover, since the onset of Long Covid, patients in their millions are reporting identical symptoms, strengthening the argument that ME is a post viral immune system disorder.  Nevertheless, the psychosomatic paradigm persists, for several reasons. It was always cheaper to fund psychological studies than drug trials, and so a tidal wave of papers from the Wessely School followed the first publication. Sadly, they all suffered from the same scientific flaws. The results were predictable before the studies even began.

Dr Fitzpatrick bemoans the fact that NICE wanted to change their guidelines based on ‘scientific evidence’ (the inverted commas in this case, are his, and not mine), and have been bullied into this position by ‘ME militants’. The ‘evidence’ however, is not quack science that comes only from the ME lobby. It is evidence from Harvard, Columbia, Stanford, and similarly respected research centers. The evidence has now been studied very closely by independent and highly experience men and women at NICE for three years. I have never heard a doctor sneering at the idea of evidence before. It is one thing for scientists and doctors to disagree about the interpretation of evidence. But this is the first time I have heard a physician dismiss the concept of evidence so disdainfully.

He dismissively describes ME as a disease which causes ‘extreme tiredness and generally feeling unwell.’ This is probably the most inaccurate and trivialising description of the illness I have ever come across. Alas, none of this humiliation is new. There is a lengthy history of journalists attacking ME patients, and spreading misinformation about the illness and the behaviour of campaigners. Rod Liddle, who had once previously labelled ME sufferers ‘pretend disabled’, wrote in the Times in 2015: ‘They are hopping up and down with rage over at the ME association… At least they would be if they could. As it is, they are probably sitting quite still.’ He went on, ‘No matter what evidence is marshalled by the likes of Simon Wessely, some sufferers cling with grim and livid determination to a non-existent biomedical explanation.’ Mr Liddle has had a bee in his bonnet for a while about this illness, and has further smeared patients elsewhere. Describing the fervour with which ME patients have to protest and fight to gain access to medical treatment, he saw fit to opine in The Spectator magazine: ‘When it is finally proven that ME is a mental health disorder, I am convinced that it will be the least of their problems.’ 

This is part one of a longer blog entry, which will be continued soon.

@paulthedaid

Thiago grows and grows and grows.

By Max Gallagher (@Maxgallwrites)

It was cold and it was dark. In a champions league group game at Anfield, the ball sat up to be hit at the Kop end, and was smashed into the right hand side of the net. The crowd, tension released, erupted. Thiago Alcantara’s strike against Porto midweek will not be as pivotal as the one seventeen years ago that changed the direction of history for Liverpool. But it was an important moment nonetheless. It was a goal that said: I have arrived.

***

Football is full of surprises. Remember when Gary Neville was widely considered to be a vile, odious little twerp? When Sky Sports hired him as a pundit, most people thought that it was so he could be the bad guy – to play the Simon Cowell, or the Nasty Nigel to the handsome blue-blooded prince of punditry, Jamie Redknapp. Most people, then, were surprised whenever he started talking, and brought new life to Sky commentary with his sincere and urgent insights. There was nothing Jamie Redknapp could do to keep up. He even went so far as to pump his face full of chemicals and leave his wife, but all to no avail. Brilliant sentences just kept falling out of Neville’s mouth, often with that hypnotic blank look on his face. Other pundits simply couldn’t match him for words and brains. Redknapp was out in the cold, relegated to post match tunnel interviews and writing columns for right wing newspapers. The nation had a new darling of armchair sports digestion. We all loved him. You did. I did. We all did.

What I like most about Gary Neville is that he does not hold back in his praise for teams that were once his rivals. Some of his most gushing outpourings of enthusiasm have been for the likes of Kevin De Bruyne, Virgil Van Dyke and Mo Salah. But the most surprising thing I’ve ever heard him say came after the Liverpool versus Leeds game in late September: ‘I was watching Thiago today, and he just reminded me of Paul Scholes,’ Neville purred. ‘In those big games we used to play, the games against the likes of Arsenal when everything would be frantic and rushed, and then there’d just be this little guy in the middle of the pitch calming everything down. Thiago has done exactly what Liverpool brought him in to do.’

As I heard this, my jaw nearly hit the floor. There is an unwritten rule that no one is allowed to compare anyone to Paul Scholes. It is prohibited. Like looking the emperor in the eye in the forbidden city, or grabbing a centurion’s balls. Even mentioning Paul Scholes in this way can get you into serious trouble. Especially if you’re a Manc. Especially if you’re a United fan. Especially if you graduated from the same famous class of ‘92 youth team that Paul Scholes did. As far as compliments go, this was like Buzz Aldrin comparing somebody to the Moon. Praise just doesn’t come any higher than this.

Thiago won seven straight bundesliga titles at Bayern Munich

The Spaniard’s debut was a sumptuous affair, perhaps my favourite of all time. There had been a long summer of flirting between Bavaria and Merseyside. Karl Heinz Rumenigge would drop his handkerchief, and then gaze longingly across the Rhineland as he peeked from behind his fan, waiting for Liverpool to respond. Months and months of this went on, until we started to wonder if it had just been newspaper guff all along. In a typical piece of Michael Edwards brinkmanship however, the deal was done at the death, for the small matter of an initial £20million. The talk was that this guy was the real deal. His actual surname is Do Nascimiento – the same as Pele’s. His father, Mazinho, was a Brazilian international who won the world cup in 1994. But those that had read Pep Guardiola’s autobiography murmered that it might not be that straight forward Alcantara had been Pep’s first signing at Bayern, but hadn’t impressed, and failed to nail down a regular starting spot under his former Barcelona manager. Without a pre-season and having missed the start of the league campaign already, we didn’t quite know what to expect from our new signing. How would he bed in? Where would he play? When would he play?

Klopp elected to unleash Thiago on the world at half time in a home game against Chelsea. The blues were a different prospect under Lampard, and had just had a player sent off. Henderson was subbed, Thiago came on, and the world loved every single minute of it. It was more like being at the circus than watching a football match. With Chelsea sitting back, Thiago had almost the entire pitch to himself to demonstrate his entire repertoire of passing. There were dinks, prods, pokes and knocks. Chips, wedges, curls and lobs. Nibbles, tickles, tiki and taka. Fizzes, pings, sprays and drills. All of this without getting out of first gear. It was like an audience with Thiago. Thiago the musical. Thiago on Ice. After the game, a 2-0 win for Liverpool, Peter Crouch tweeted: ‘Thiago is gonna be a joy to watch.’ And that’s how we all felt. This season was going to go so smoooothly.

Alas. What followed was complete and utter chaos – the worst period in Klopp’s reign. It was as if the Gods of soft tissue and ligament injuries had picked up the entire club and upended it like a snow globe. Our very own winter of discontent had begun, and no one knew when it was going to end. Thiago himself was hacked down in the midst of the slaughter of the famous Red Wedding of Goodison Park. The defence were as skittles in a bowling alley. Juergen Klopp had no choice but to pull senior midfielders out of place to cover, leaving the centre of the team badly exposed.

By Christmas we were just about hanging together, but still in contention for the major trophies. Whilst little children looked to the sky in search of Santa Claus, there was another name on the lips of Liverpool fans. Thiago. When Thiago comes back from injury it will be okay won’t it? Thiago will fix everything. Despite his glittering skill and his La Masia schooling, Thiago was actually brought in as a defensive midfielder. At Bayern, his stats told the story. He had fewer goals and assists than any of the other midfielders, but had the greatest number of tackles and interceptions during his spell at the Allianz. The maestro had been the lynchpin, as opposed to the desequilibriante. This took me by surprise – this little guy, who I’ve been watching on Youtube all summer? He’s a defensive player? The guy who lets the ball beat him whilst wiggling his arse, showing that you can roll a six-foot-four defender and salsa dance at the same time? If his stats were correct, then Liverpool could dare to dream that we had a player on our hands. Perhaps even that mythical creature – the complete midfielder.

Before Thiago had arrived, Liverpool have been doing rather well, beating every other football team in the world and winning every single trophy in the process. They were a functioning unit, a finely tuned machine, a well drilled platoon. The group had been together for a long time, and formed that rare thing seen nowadays – a team. Liverpool were a throwback to the days when footballers used to spend years in each other’s company. Teammates would go round to one another’s houses on Christmas Day to smoke fags and presumably shag one another’s wives. Having played together for so long, everyone was on the same wavelength and everyone – even squad players – knew exactly what their role was. Under Klopp, the defence began to climb higher and higher up the pitch with the confidence of a horny dog. The midfield trio formed a battering ram as formidable as the Macedonian phalanx. Firmino had perfected the false nine role, hovering in gaps and spaces, like a Matador teasing and drawing defences out of position, to make space for the fianchetto of Mane and Salah. Everything was ticketyboo. Until it wasn’t.

The worst thing about our injury crisis last season was that it was making a mockery of our first title defence for thirty years. No one thought things could get any worse. But then of course, they did.  And although no one could blame Thiago for what happened next, it will hardly be the highlight of his CV that Liverpool had gone fifty-four matches unbeaten at home by the time he returned from injury, but after he had been re-introduced into the team, Liverpool not only blew that spectacular statistic with a limp performance against Burnley, but went on to notch up a record six home defeats in a row. It didn’t say much about the immediate impact of the Spaniard. So much for that sumptuous debut.

Gini Wijnaldum’s mind was clearly elsewhere, and Thiago was thrown in at the deep end to shore up a team that were falling apart. It was like tossing a paper aeroplane into a tornado. Opposition teams smelled blood, and were tearing into Liverpool like never before, taking full advantage of our new psychological and personnel weaknesses. Thiago was trying to adapt to a new culture and to find his feet in the middle of a maelstrom. On the ball he was ineffective and subdued, off the ball he was chasing shadows. Like a cork bobbing around on the surface of tempestuous waters, Thiago was all at sea. Most commentators concluded that the pace of the Premier League was just too much for him. Liverpool fans watched through their fingers. It was a horror show. One of my friends texted me drily: ‘I see Liverpool are shite again.’

Football is full of surprises. No one can pinpoint the exact moment it turned around. But at some point, Nat Phillips put his magic hat on. Along with Rhys Williams, they put together the most unlikely heroic partnership since Turner and Hooch. Klopp had found his settled back four, and Liverpool began to look a bit like themselves again. With Fabinho and Henderson back in midfield, we started to see glimpses of the Thiago Alcantara we had read about and seen playing on the continent. The guy who had almost single handedly played Chelsea like a musical instrument. Then Diogo Jota thumped in a left footed finish against his former club Wolves, and it was on.

Ten games to go. Liverpool were eight points outside the top four, sitting in eighth place. The teams around us were all formidable, but we did have a kind fixture list. Was it possible?  Of course it was. Thiago was at the centre of everything as Liverpool finished the season the form team in the league, playing like champions again. Thiago found the niggle and the grit and the fuck you part of his game, imposing himself on games and disrupting teams who liked to play. But on the ball, he was just sublime to watch. The little guy in the centre of the pitch, just calming everything down. At his best, he is perhaps the first truly world class midfielder to play for us since the dream team combination of Gerrard, Alonso and Mascherano. Perversely, I think I enjoyed last season as much as the previous two, when we won the league and champions league. Although we finished without a trophy last year, it was such a rollercoaster, with so many twists and turns. Buddhists say it is the journey, not the destination that matters. Maybe that counts for sports too. Maybe the Buddha was talking about Thiago the entire time. All things must pass. Jesus, it all makes sense when you think about it.

He still has his critics, and has a long way to go to prove he can really stamp down his authority in this team. But this season he started as he had left off, in imperious form. Once more, Liverpool were a fine-tuned machine, putting teams to the sword, but with a new look midfield of Thiago, Fabinho and Elliott. Unfortunately, this seasons rhythm has again been interrupted by injury, most notably to the youngster Elliott, but also to the veteran Spaniard. Tellingly, Thiago was missing from the starting line-up for the defeat to West Ham. Fitness may ultimately be the major factor in how much he can contribute to this Liverpool project. Only time will tell.

He might even do it again against Southampton

On Wednesday night, FC Porto arrived at Anfield for their ritual mauling. Porto are a solid defensive team with great attacking options, but for some reason when facing Liverpool, Porto behave like a teenage girl at a Beatles concert. But here they played well, until the hour mark when the ball sat up for Thiago, skipping across the surface, whispering hit me, hit me. The technique was extraordinary, struck with venom by a player clearly full of confidence. He opened his foot up and picked his spot almost disdainfully, like a Victorian judge sending a peasant to the gallows. There was nothing dismissive about the celebration however. He celebrated like a midfielder who doesn’t score enough. Like a player who feels he is going to make an impact this year, in a team that is going to make an impact. Like a player who is growing, growing, growing.

What a hit son. What a hit.

@Maxgallwrites

The Curious Case of Joel Matip 

Players these days can play well past the age of 65. But some are even getting better as they age. 

by Max Gallagher (@maxgallwrites) 

I saw a quote from an interview with Joel Matip on Twitter recently. The  quote read: ‘I have been here five years already. It is a special club and a special city. You feel it everywhere you go.’  If you want to endear yourself to the Anfield faithful, you simply need to – sincerely or otherwise – mention how much you love Liverpool itself. Underneath the quote, a fan tweeted: ‘name going on the back of my shirt for defo’. Five years ago if you had suggested you were getting Matip’s name on the back of your shirt you would have been laughed at. Or for that matter, five months ago. So what has changed? 
 
I think most independent observers and commentators would agree without doubt at this point that Joel Matip looks a bit like a giraffe. He has a long neck and an adorably small head. I know it’s not polite to compare human beings to animals. But since a giraffe is everyone’s favourite creature, and Matip is the world friendliest centre half, I doubt he’ll mind. Who doesn’t love a giraffe? Incidentally, giraffes are the only animals other than human beings who bury their dead. This is a fact. At least, I read it somewhere reliable a long time ago. I don’t want to google it now and ruin the illusion for myself. It does seem unlikely though. It’s hard to picture – a crowd of giraffes standing around in the cold drizzle nudging one of their mates into a big hole. Then afterwards shuffling off in groups of two or three, pondering mortality and the passage of time. It just doesn’t seem plausible. 
 
When Joel Matip  arrived on a free transfer in the summer of 2016, Jurgen Klopp said he would save Liverpool millions. At the time, that didn’t seem very plausible either. When a new manager arrives from a lower league, they will usually try to bring in a couple of cheap-ish signings from their homeland who they hope will be sneaky successes, but are usually donkeys. For example, in the same transfer window, Ragnar Klavan was also brought in from the Bundesliga. He was another unknown quantity, and eyebrows were raised. As the captain of Estonia, he had some pedigree, but not much. Estonia is that small Baltic country that nestles up against Russia. Since Russia is apparently now hellbent on trying to infiltrate the West and undermine it geopolitically with every statecraft trick in the book, Estonia is in a rather vulnerable place, a little bit like Europe’s adam’s apple. With all the cyber espionage and Novachek flying around, Estonians have to be tough as nails. Klavan was certainly that ( the man is named after a Viking, for Christ’s sake ), but he was a little bit short, and a little bit slow, and was never going to be the answer. But who was this slender, elegant German-Cameroonian? 
 
When Klopp first arrived, it was off the back of a managerial sacking that had been brought about mostly by defensive calamities. But in his first season in charge, Liverpool conceded two goals more than Brendan Rodgers had done in his terminal final season. In fact Klopp’s first season represents Liverpool’s largest goals against tally in the premiership area. Most people were sure that Klopp would ring the changes at the first opportunity. One January transfer window went by and club did not act. In the summer of 2016 therefore, all the talk was of who club was going to bring in to solve our defensive problems. The answer apparently, was no-one. Matip was the main addition to the back line – a free transfer from Schalke. The fans took to him immediately, it must be said, due to his clear ability and off field demeanour. He was a ball player, an athlete, and a goal threat from set pieces. But he had injury niggles, and although he was Liverpool’s first choice defender that season, the stats were not particularly flattering.  

After Klopp’s first full season at the helm, although we had made the top four and showed some improvement, playing aggressive attacking football, the defence was still the major problem. Liverpool were conceding an average of a goal per game in the Premier League, and every press conference was identical to the one before. After one match, Klopp stormed off in the tunnel during the post-match interview when a reporter had the audacity to mention our poor defensive record. ‘Always the same, always the same!’ hissed the German as he walked away. Despite the manager’s indignance, it was a concern for every single fan that he had not apparently made overhauling the defence a major priority. However, unbeknownst to us, Klopp was simply waiting for the right man to come along. A bit like a romantic waits for a knight in shining armour, or that girl next door who looks a bit like your mum. Sometimes miracles do happen though. Sometimes dreams can come true. And history of course, would prove Klopp right. 

In January 2018, Virgil Van Dyke arrived, if my memory serves me correctly, upon a cloud flanked by angels playing harps and weeping. Around the same time, Joe Gomez and Trent Alexander Arnold were promoted from the reserve team, and Andy Robertson was plucked from an obscure team on the river Humber. Suddenly Liverpool had the best defence in the league, if not Europe. We had centre halves with the pace and the nous to play on the halfway line, and two overlapping fullbacks from hell that made us look like a scorpion with two tails. The next two and a half years were a story of record breaking success, and while Matip made for a decent squad player, it seems as if his day was over, and his chance was gone. Or was it? 
 
When the infamous defensive crisis of 20/21 hit, Liverpool lost their two treasured centre backs. Having sold Lovren in the summer, there were only youth team players and Joel Matip to turn to. This was Matip’s chance to stamp down his authority, and to shepherd the team through crisis, at a time when we were still league champions and in the running for both of the league and the Champions League. It had been said that Matip was too injury prone to be relied upon. Now was his chance to prove us wrong.  

Including the pre-season of 2020, Matip had already had four separate spells on the sidelines before Christmas. On the 29th of Dec, he picked up a groin strain. Nerves were already fraught, and well when Matip limped off the pitch, Anfield – already devoid of supporters – fell quieter than a giraffes funeral. He missed four games, but on his return match away to Tottenham, he made an important tackle against Heung-Min Son and picked up the ankle injury that would rule him out for the rest of the season. There was one day left in the transfer window – just enough time for the club to bring in Davies and Kabak as late cover, but the Joel Matip era it seemed was well and truly over. He had failed on the biggest stage, blown his chance, let the side down. 

This summer, during the usual transfer hysteria, sacrificial names were offered forward in order to raise funds to bring in a world-class attacking player. With the purchase of Ibrahima Konate, and the near cult status of Nat Phillips, it seemed as though our central defence was sorted. Matip was to be sold. On one reliable forum, it was suggested that offers would be listened to in the region of £5 million. Matip had indeed saved us millions – but only five of them it appeared. 

No offers came in for Matip in the summer, and so Liverpool now had a new defensive crisis-too many top-class centre halves. Konate had been brought in as the first choice companion to Van Dyke, and Gomez and Phillips were fans favourite. So where was Matip going to fit in in all of this? The answer, surprisingly, was in the starting line-up on our opening game of the season against Norwich. Watching that game, it seemed perhaps Matip felt he had a point to prove – a note of contrition for failing to step up in the previous season. He played with determination, guile, and an aggression that perhaps had been lacking in his previous outings. 
 
As the season progressed, this became a familiar thread, and his performance level never dropped. By four games in to the season, during our away game at Leeds Utd, Joel Matip looked simply undroppable, and unrecognisable. If he had been playing all season with a fake glasses-nose-and-moustache disguise, and we had been told he was a brand new £75 million signing named Jim O’Petal, fans would have been purring about our new Irish bespectacled centre-half, and how you just need to spend big sometimes to bring in quality. He had always been a ball carrier, but now he was striding out of defence with the purpose and intensity of Franz Beckenbauer giving Alan Hansen a piggyback.  

Liverpool have been putting teams to the sword the season and it has come, ironically, as much from their renewed confidence in defence as the return to form of their star strikers. This has been in no small part due to the stunning form of Joel Matip. Konate got a chance against Manchester United and Matip was rest rested, perhaps due to the physicality of Cristiano Ronaldo. A five nil win at Old Trafford meant that Konate deservedly kept his place against Brighton at home one week later. But once again Liverpool’s defence was in the headlines for the wrong reasons, blowing a two-goal lead and struggling at times to keep Brighton at bay. Matip was re-introduced for the home game against Atletico Madrid, and Liverpool were once more imperious. At times it has been the former Cameroon international who has been providing the leadership and reassurance that we are used to seeing from Van Dyke. You might even say that Matip is temporarily the senior member of that partnership, whilst the Dutchman recovers his confidence after his cruciate ligament injury. 
 
I wonder if that bloke ever did get Matip on the back of the shirt. It doesn’t seem so laughable anymore. If Matip were to be sold right now his age might reduce his fee, but he is currently playing like a world class centre back. Jurgen Klopp has been proven correct. Joel Matip has genuinely saved us millions. But if there is a trophy at the end of the season, we will have our mild-mannered camelopardine defender to thank – and you can’t put a price on that. 

The Beatification of Harvey Elliot

 

By Max Gallagher (@Maxgallwrites ) 

Once, when Gandhi was running to catch a train, a sandal fell off onto the platform. As the train pulled away, Gandhi took off his remaining sandal and threw it out of the train door. ‘Bapu, why did you throw away your good sandal?’ asked one of his followers. ‘One sandal would be of no use to whoever finds it,’ replied Gandhi.  

This story came to my mind in the aftermath of seeing Harvey Elliott’s ankle wrenched out of his left leg, and seeing how gracefully the young playmaker dealt with it. In the hours after the incident, Elliott showed a level of maturity and benevolence that suggests he doesn’t simply have the potential to become a great number ten, but he may also one day become a global spiritual leader. Not only did he accept Pascal Struijk’s apology, but he campaigned online for the red card to be rescinded, and sent Struijk a message of support when the appeal failed. Harvey Elliott may as well have appeared beside Struijk’s bed dressed in a long white robe, anointed his head with oil, and offered him his right ankle to smash. 
 
There was a lot of discussion after the match as to whether the tackle merited a yellow card or a red card. The consensus seemed to be that the sending off was harsh. I have to say I disagree. It was a tackle from behind, and tackling from behind was outlawed in the 1990s. In the 1990s you could still drive without a seatbelt, and smoke in hospital waiting rooms. There was no malice or intent, and Struijk’s studs were not raised, but it was still a dangerous tackle. Ninety-nine times out of one hundred, when you tackle someone from behind no one will get hurt. You will simply end up in a tangle of limbs, as per lovers in a smutty romance novel. Afterwards, both players stand up and blush, try to avoid eye contact and get on with the game. This time however, someone’s ankle fell out of their arsehole. And that’s bad. Which is why tackling from behind was made illegal twenty-five years ago, along with CFCs and dogfighting. If barbarians from the twentieth century can figure it out then we should be able to as well. For me it was a straight red. 

But the most interesting voice in the discussion was surely that of Elliott himself. ‘Wasn’t his fault whatsoever!’ he said on Instagram, ‘neither was it a red card, just a freak accident, but these things just happen in football!’ The following day Elliott issued a heartfelt message thanking the medical staff at Leeds General Hospital and the crowd at Elland Road, as well as the entire football world at large for their support and love. He even sent another message to Struijk to commiserate with him for failing in his appeal to have his red card rescinded, telling him to ‘stay strong’ during his three-match ban. All this before having his ankle sewn back onto his body. It’s a little bit early to suggest canonising Harvey Elliott, but from such a young man this is remarkably saint-like behaviour.  

As every young kid with a good coach knows, talent will only take you so far in the game. If you want to be a success, you have to have the right attitude. It certainly seems that Elliott has got his head screwed on, and that has to bode well for his prospects. In the hours after the match, pictures circulated on social media of a young Liverpool fan in a Leeds Hospital holding up the number sixty-seven shirt, and Elliott’s right boot. Fair enough, Harvey won’t be needing his shirt or his boots for a while, but some people may have been too distracted by the thought that their season was over, and their career was in jeopardy, or just the agonising pain to indulge in charity work. I just hope Elliott gave him the other boot as well, for Gandhi’s sake. 

Isn’t he lovely?

To say I am enamoured with Harvey Elliott would be an understatement. I’ve loved everything that he’s done since coming to the club, from his first pre-season, to his first League Cup appearances, to ‘that’ FA Cup win against Everton, when a Liverpool youth team vanquished Carlo Ancelotti’s full strength blues on a cold night at Anfield. It was Curtis Jones who took the plaudits that night for his thumping winner, but for me it was Elliott who stood out, all presence, poise and confidence. There was humility on show also, however. At one point the ball had gone out for a corner on the right-hand side, and the young midfielder had the ball in his hands ready to take what should really have been an in-swinger. But Neco Williams had also trotted up from right back, and on seeing his team mate, Elliott deferentially pointed towards him, then respectfully passed the ball to the Welshman, only two years his senior.  

When talented young players first burst onto the scene, they are usually a little raw or inconsistent. Even Ronaldo, for all his dazzling brilliance and indisputable end-product, was sometimes guilty of avarice and poor decision-making. Some players however simply appear fully formed, as if they have been playing top level football for twenty years. Think Messi, Rooney, or Fabregas. It’s as if you could unpack a self-assembly footballer with the brain of Gary McAllister and the body of a 27-year-old, then subtract ten years from his passport and inflate them with a foot pump. Elliott Appears to be in this mould, showing awareness and an all round game intelligence that belies his tender years. In fact he reminds me a little of Rooney, although he lacks the blistering pace and physicality. The other obvious difference being that at roughly the same age that our young prodigy was performing Father Christmas duties in a Yorkshire hospital, Rooney was signing an autograph for the geriatric prostitute he had just nailed. It’s okay to be a bit of a scumbag when you’re eighteen. There is no judgement here. But Elliott is showing signs that he is as classy off the pitch as he is on. If this really is the case, then he has a great chance of living up to his extraordinary potential. 

During his loan spell at Blackburn, it was more difficult to follow his progress, but from internet clips, his developing maturity was there for all to see. He never wants too much of the ball, and plays with his head up. Despite his wonderful quick feet and dribbling skills, he likes to operate from deep, threading through balls and playing glorious cross field passes.  It’s possible that Elliott may even turn out to be the much prophesised, much fabled ‘Coutinho replacement’ that we have read about in the ancient scriptures and holy books. Old men will chew hallucinogenic leaves, hobble off into the desert, and then return describing how they have seen such a player in their visions. I have a sneaky feeling that Klopp feels the same way. I think Elliott featured heavily in his plans for this season. For the record, Coutinho in my eyes was the complete number ten, but Klopp often deployed him on the left-hand side, with Adam Lallana operating through the middle. To me this always made about as much sense as resting your genitals in your girlfriend’s armpit, and then making love to her with your earlobe. There appears to be less confusion with Elliot’s role this season, all three of his premier league starts being in central midfield. Could Elliott be even more Pipco than Pipco himself? 

I was devastated when he got injured. I would rather see almost anybody have their left ankle brutally yanked out of their corpus. Virtually anybody, with the possible exception of Mo Salah, my two children, and Michelle Obama. But, ‘these things just happen in football’, as Mahatma Elliott once said. It’s been four weeks now since his injury, and by all reports, his surgery and rehabilitation have all given us glimpses of hope that he may return this season. Imagine that – his glorious left foot getting the headlines again for the right reasons. What a boost that would be, an injured prodigy who almost lost it all returned from the brink at the end of the season, especially if Liverpool are in contention for major honours. In the meantime, whilst he recuperates, I hope Harvey Elliott records a podcast of guided meditations. He definitely has the Dharma for it, and I will be first in the queue to download. Harveylujah. 

@maxgallwrites.