Gravitas

Turn, turn, turn. How it has all turned.

In the long history of men, a few turning points stand out. Take the day the Spaniards met the Incas. In December of 1532, Henry VIII was trying to get a divorce that would tear Europe apart, but that was nothing compared to what was going on in Peru. Conquistador Francisco Pizarro led a rag-tag group of 198 soldiers to meet the Emperor Atahualpa, who had a standing army of 80,000 men. Pizarro told the Emperor that it would all be nice and friendly, and he should come unarmed. The Incas didn’t know much about Europeans.

It took a few decades to wipe out the Incas completely, the colonialists swept along on a wave of smallpox and lying. But that day is considered to be the main turning point. The Spanish slaughtered 7,000 unarmed Incas and took the Emperor hostage without losing a single man. Popular themes when discussing how they overturned odds of 400-1 are the presence of steel and horses, and of course, the fact that the invaders were evil bastards. But historians still argue about the finer details of what it was that made the Europeans so superior on the day. Sometimes, when I’m watching Ryan Gravenberch play, I think like this. Why is he so much better than all those other blokes? He’s clearly not carrying a wave of contagion, or concealing a blade. So… maybe he’s got a horse?

It seems unlikely. But then, sometimes when he accelerates away from the group of players he’s just ghosted, or when he’s hunting down a marauding interloper inside Liverpool’s penalty area, it does sort of look like it. He has a way of playing with his chin raised so high that it’s almost gravity-defying, like a man leaning back in his saddle (It’s a well-known fact that Gravenberch and Ibrahima Konate are in a private competition to have the most upright posture in Europe. Both players have grown an inch since joining Liverpool by sheer dint of trying). It seems unfair to allow someone to play football on horseback. It seems unfair to allow anyone to field Ryan Gravenberch in current form.

Like most fans, I was very happy with Liverpool’s midfield overhaul last summer, performed with the efficiency and economy of a battlefield surgeon. The canny acquisitions of Alexis Macallister and Dominic Szoboszlai were followed up with the even cannier swoop for Wataru Endo, who after a shaky start earned himself the confidence of the manager and the fanbase. But, I thought, why the deadline day move for an attacking midfielder who had struggled at Munich? We were already stocked in that department, and were still incubating Curtis Jones and Harvey Elliot, waiting for Trey Nyoni to hatch.

Gravenberch’s first season on Merseyside was forgettable. Introduced late, he struggled to make an impact when deployed higher up the pitch. There were moments of brilliance, flashes of a mercurial talent. But they were usually followed up with poor decision making and losing possession, leaving him skulking on the periphery of games with his head down. To me there was plenty of Dutch swagger, not enough meat and potatoes. Had he been sold this summer for a huge loss, I would not have mourned. I had written him off already. When someone suggested during the off season on Twitter that Ryan Gravenberch could be the answer for Liverpool at number 6 instead of Martin Zubimendi, I laughed it off. The kid had more holes in his game than a leaky colander, and would be ruthlessly exposed in a defensive role. We might as well put Atahualpa in nets.  

How to account for such a turnaround in Gravenberch’s form? Well the horse, obviously. But what are the other factors? Having settled into a new team and a new city would have helped, as would the new Dutch coach putting faith in him from pre-season. And at 22 years of age, being one year older is a significant percentage of your time on earth so far. But surely it is this new system, playing Gravenberch deeper as part of a double pivot, allowing him to pick the ball up more frequently and dictate games, which is, somewhat implausibly, now playing to his strengths. He played this role at Ajax under Erik Ten Hag as a teenager, but it was thought that he preferred and was better suited to attacking football whilst in Bavaria.

A term that has been coined recently to describe players like Gravenberch is ‘press-resistant’. You’ll find it dripping from the pages of The Athletic, a publication which churns out neologisms and statistics like a group of Superbowl commentators at their Christmas party. The general consensus is that football has changed. It’s no longer your striker or your number 10 who are required to be most comfortable in possession: now it’s your centre-halves. The ubiquitous ethos of high-pressing means that even the most plucky underdogs are going to have their entire team besieging the edge of your box like it’s Rourke’s Drift. Your third-choice goalkeeper is now expected to play tiki-taka with the verve of a pot-bellied former Brazil international on the Copacabana.

Into this new reality then comes Ryan Gravenberch, and he is a thing to behold. Receiving the ball in tight spaces his touch, decision making and passing are exemplary. With his back to goal, his awareness and his ability to pirouette and spin away from his man at will is simply jaw-dropping. One of the most satisfying things to watch in football is a player who allows the ball to beat him and then rolls his man, using the pace of the ball to advance up the pitch. It takes extraordinary technique and vision, and often physicality. At Barcelona, the likes of Xavi, Iniesta, and Messi made such an art form out of it that there were entire goals scored without anyone touching the ball. The whole team just sold dummies and wheeled about like banshees until the ball ended up in the net. Gravenberch has made this his signature move, often deep inside his own half, turning defence into attack in the blink of an eye.

Liverpool are currently top of everything you can point at, and the current system revolves around Ryan Gravenberch. With Rodri out injured, and Declan Rice suffering a slump in form, it feels like the whole footballing world orbits Gravenberch right now. He’s got the numbers – in possession and out of it, he tops all of the little charts and infographics. At some point, Gravenberch will have a blip or suffer an injury, and it really is hard to imagine Liverpool’s embryonic title charge not suffering as a result. But it speaks volumes that this scenario causes greater concern in some quarters than the potential loss of Mohamed Salah or Virgil van Dijk. Suggestions that Liverpool are still shopping for a number 6, or could be tempted by a chastened Aurélien Tchouaméni or Martin Zubamendi in January have been dismissed dismissively by club sources.

I really can’t remember a more remarkable turnaround in a player’s form and importance over such a short period of time. Given his young age and Liverpool’s ascendancy under Arne Slot, it could be a turning point of great significance, and one that will be discussed for a long time to come. It’s a bit like the way Gravenberch spins away from his marker and bears down on the space in front of him like a medieval king routing the enemy. Sorry, I can’t help it. It really does feel like he’s on horseback sometimes. Regardless, we can all sit back and watch the spectacle unfold. Ryan has got his Grav back.

A note about the author…

Right, so I don’t know if anyone would actually be bothered hearing ‘my story’, but here goes nothing. Someday I’ll write about this in more detail, but here’s a condensed version. I know how impatient you all are.

After leaving school I first qualified as an optician, and worked happily for a few years in London, Scotland and Donegal. Then in 2007 I decided to go back to uni to pursue my dream of becoming a professional astronomer.

I finished my degree and Master’s, and was part way through my PhD in Exoplanetary Atmospheric Science, when I picked up a mild chest infection at a conference in Crete. Then I got sick. Really, really, really, really sick. (Trigger warning: This article contains self-pity.)

After four months I was in wheelchair and couldn’t read, write, or speak. I couldn’t tolerate any form of conversation – being asked questions or being given information made me feel like I was being electrocuted. I couldn’t tolerate noise or light, and to a lesser extent, touch or movement. I was completely trapped and isolated, unable to communicate or interact, and in agony. It was hell on earth.

I was diagnosed with severe ME, and told that there was no treatment. If I was lucky, I might make a partial recovery. To this day I have still never met a single doctor or consultant who has even been able to give me any helpful practical advice. Everything I have learned in order to survive, I learned from the online ME community. It has been a long road back from there.

I’m nowhere near fully recovered, but I have a quality of life now (I almost wrote ‘good quality of life’, but I’m trying to keep this grounded in reality). Unfortunately, I still can’t work, and I now live with my parents, who are my full-time carers. I’m bed-bound for most of the day, and I only leave the house on really good days. My noise sensitivity is still a significant barrier to most activities, and makes it impossible to watch TV, listen to music, or socialize normally. It’s also incredibly difficult on those around me who have to adapt, and keep noise to a minimum at all times. To say people have to tiptoe around me is to use the phrase more literally than figuratively.

I have two small children who are happy and healthy, and this matters more than anything to me. A painful fact however, is that I have never been able to contribute to my children’s welfare, beyond what I bring in in benefits. Their mother has always had to do the heavy lifting, both physically and financially. I would give anything to be able to change this, even for a little, while, to take the burden off her, and to provide for my kids. What father wouldn’t?

I started writing creatively mostly as a hobby (and to keep myself from going insane) as soon as I recovered the ability to read and write. I’ve completed my first novel and screenplay, and have written a handful of short stories. New works are also progressing. Originally it was just for myself, but I’d love to turn it into something remunerative eventually. Recently, I published my first children’s book – ‘Captain Toe Beard,’ and early sales have been promising. I came up with the character along with my six-year-old, Ronan, who deservedly has his name on the front cover. I used A.l. for the artwork, which I know is controversial, and will put a lot of people off buying the book. But with my health and financial situation as they are, it was the only option I had. Once Ronan and I had the idea, and I saw how much it made him laugh, I felt I just had to get it out there as quickly as possible. I hope that this is just the beginning of something for me and I can grow my platform from here.

No one would ever choose falling ill. But like everything else in life, you adapt and find a way through. We each have an extra ‘gear’ of tenacity that we don’t realise we possess until the worst happens. There are silver linings, too. Being laid low and made so vulnerable is genuinely humbling, and I now look at the world in a very different way. I’m grateful for so many small things that I once took for granted, and my priorities in life have changed completely. In some ways I’m a happier person now than I was before I fell ill. ( Not many ways, I’ll be honest. But some.)

The thing I’m most grateful for is the opportunity to be a father. But just after this, what I’m most grateful for in life is the opportunity to be a son. The time that I get to spend with my parents – and the love and joy that I have shared and experienced as a result – is something I would never have had if I hadn’t developed health problems. It’s something I appreciate every single day. Before I got sick I was very focused on my career, and like many people, I was too busy to spend regular time with my family. Now, my parents are stuck with me, but there have been a lot of laughs along the way. I have so much to be grateful for.


Gratitude is always the first word that comes to my mind when I try to talk about my illness, despite the undeserved and almost comical horrors it has dealt out to me and my family, my kids and my ex-fiance. I’m grateful to everyone who has supported me on this journey so for. And I’m grateful to everyone who supports me on my new journey as a writer. Thank you all.

Someone’s knocking at the door.

The agony of hitting the post in the 21^st century.

By Max Gallagher          @maxgallwrites

In Uruguay, there is a myth told to children about a monster who lives in the woods called The Darwin. You can’t outrun him. You can’t even see him coming – his movement is too clever and his runs are too stealthy. The best you can hope for is that when he catches you, he doesn’t devour you and grind up your bones for soup. You can hope that he’s having one of his erratic off days, and he just gives you some sweets and lets you go. Uruguayan fairy tales are notoriously inconsistent.

Debates about whether or not it’s a good or a bad thing to hit the post are nothing new. A remarkable stat – in 2011/12 Liverpool hit the post or the bar over thirty times, more than double their nearest rivals, Tottenham. The woodwork fascination began on the opening day of the season when Stewart Downing rattled the crossbar from distance, and extended all the way to the dying minutes of the FA Cup final when Petr Cech wildly clawed Andy Carrol’s header against the post, after it had probably already crossed the line. I’ve always wondered why people don’t talk more about this save. It was extraordinary, like watching someone catch Gordon Banks as he leapt from a passing car.

It would be interesting to ask what Darwin Núñez thinks about this. He loves hitting the post. He’s hitting the wood section more often than a conductor who’s sleeping with the oboe, clarinet, and bassoon player simultaneously. Last Wednesday night, he became the first player to hit the woodwork four times in a single Premier League match. But no-one knows what this actually means. Is it a good thing or a bad thing? Is he hitting, or missing? I mean, the framework is a small target compared to the goal. It’s harder to hit. He’s hit it 12 times in the league, whilst scoring only eleven goals across all competitions. Surely he deserves some reward for that feat. Half a goal, maybe?

Commentators love to opine that Darwin is an ‘instinctive finisher’. Give him too much time to think, and he’ll fluff it. I’ve always thought this is a bit insulting. Imagine saying that about any other profession. My MP, she’s an instinctive speaker. But if she prepares any of her speeches, she’ll start ranting about how the Moon landings were faked and how all Mexicans are thieves. Don’t give her too much time to think! Need brain surgery? My guy is the only guy in town. He’s an instinctive brain surgeon. But whatever you do don’t show him any scans! He’ll make a right mess of it if he has time to think. Are we seriously saying Darwin shouldn’t be allowed to think? When there’s so much intelligence in the rest of his game?

Maybe he just needs practice. Or is it psychology? Let’s strap him into a chair and force him to watch clips of great strikers in one-v-ones with Beethoven’s seventh playing over loudspeakers. Put him in front of an empty goal and recondition his brain with a Pavlovian reward system. If he scores, he gets a cup of Yerba Mate with Alexis Mc Allister. If he misses, he gets headbutted by Joachim Anderson.

But what if he hits the crossbar? Or the post? What does that actually mean? The footballing world is undecided if it’s good or bad. Do we reconfigure Darwin’s neural architecture with positive reinforcement when he strikes the upright? Or does it mean he’s shite? Even Pavlov himself would struggle to work that one out. In quantum physics, they say the cat is both dead and alive at the same time. At least they spell it out for you. At least they make it simple. That old conundrum is nothing compared to trying to elucidate the merits of a striker who can’t stop rattling the framework. A man who can touch the outline of a thing, but can’t touch the thing itself. It’s more Greek Mythology than football.

Liverpool signed Darwin from… (You already know all this )

You can spin it either way. He’s missing. He’s not aiming for the post, after all. Liverpool don’t get awarded anything for this. Those are all facts. And they’re all bad. But there’s an optimistic view out there too. To engineer this number of misses must mean he’s doing an extraordinary number of things right. Right? Hitting the post is really, really, really close to scoring. And at least some of the time – surely – it must be bad luck, and not bad finishing. Which is to say, at least sometimes, his decision making and technique are fine, but factors outside his control are stopping the net from bulging. If this latter statement has any truth, then things will have to change at some point. If even half of those twelve rebounds had gone in, his stats would look less like a ration book and more like the spoils of war. From this perspective, Núñez isn’t so much a striker waiting to explode, it’s a foregone conclusion. It has already happened. We just haven’t seen it yet. Lock the door. The Darwin is getting closer.

I have a confession to make. I still believe in Darwin Núñez. I know it’s embarrassing at my age. But it’s so special around Christmas time, especially for the kids. I’m one of the optimists. He’s still young. At 24, Fernando Torres, Luis Suarez and Mo Salah were better players than Núñez is now. But they were nowhere near what they would become. And so we can expect Núñez to improve. We can expect his luck to change. I have purposefully not discussed his all-round game, because that would be a whole different article. This is just a story about a man who always hits the post, a quantum hinterland between success and failure, and how it may or may not mean something or nothing.

Sometimes, Darwin gets sad.

Tuck your kids in well tonight. Sprinkle some holy water on the bedroom door. Huddle around the fire and tell old folk tales. And if you hear four knocks on the door, beware. Because The Darwin is coming. I have no idea what it means.

The Boy Who Would Be King.

The Rise And Fall And Rise Of Curtis Jones. 

Max Gallagher @maxgallwrites

Curtis Jones has risen through the ranks since joining Liverpool’s academy as a nine-year-old.

Not since the final scene of Shakespeare’s Richard III has a boggy field in Leicester seen such a dramatic plot twist. Curtis Jones – whose career had seemed as dead as the Bard himself – arrived in the box to guide home a far post cross from Mo Salah and put Liverpool ahead. There was something in the composure of the finish, something in the audacity of the run, that reminded Liverpool fans of the promise this young player had once shown. It only lasted five minutes of course. By that stage, he had done it again.

We all know how this story started. Even John F. Kennedy can tell you where he was the night Curtis scored THAT goal. Local lad turns Carlo Ancelotti blue on cold Monday night. From there, it seemed only a matter of time before we’d be seeing him regularly in a red shirt. There were flashes of brilliance when he did get a brief run out. Jones had a top class first touch, a burst of acceleration, and a cockiness and swagger that boded well. There was a childlike joy to watching him. He is uninhibited, and plays with freedom. When he sprints, he tilts his whole torso forward and runs like a cartoon character. Liverpool’s settled midfield of Henderson, Milner and Wijnaldum – once described by The Guardian’s Brian Ronay as being as hard working as a team of piano lifters – had always been notoriously goal shy. The pressure to score in Klopp’s greatest teams was always on the front three. Liverpool missed the directness and goalscoring presence of Steven Gerrard, and even when they were winning, fans longed to see a player who could dictate the game, but also arrive in the box on cue. Right from the start, Curtis Jones was always keen to test the keeper when within sight of goal. It made you want to see him play for Liverpool. It made you want to see him succeed.  Fans began to hope for a midfielder who, birthed in the maelstrom of Klopp’s mad clockwork, could not only lift the piano, but then maybe sit down and tinkle out some Cole Porter afterwards.

Jones has impressed for England at youth level. He scored the only goal and was named Man of the Match in the final of the U-21 European Championships.

But at that time Liverpool were a well-oiled machine, and breaking into the first eleven was going to be difficult for anyone. Competition in a team that were winning trophies was tough, and Jones’ chances were limited. His meteoric rise wasn’t quite as meteoric as some had expected, but he continued to stake his claim with promising appearances for the reserves or in cup games. As a young player, the flaws in his game were  evident enough. He played all too often with his head down, holding on to the ball always a second or two too long. He was casual when he should have been urgent, and like all young players, he was often rushed when he should have been composed. Seasoned top class midfielders can instinctively release the ball before their opponents are within three feet, but Curtis liked to draw his man in close, like the kid in the schoolyard who wants to get the better of his opponent just to show how good he is. The result was that a player who had a God-given ability to speed a game up, would more often than not slow it down.

It was inevitable that there would be a ‘Second-Act Setback’ in his career. All good stories have one, after all. During the astonishing quadruple chasing season of 21/22, Liverpool were firing on all cylinders. Thiago was pulling the strings, the spark of Harvey Elliott was once more available after injury, and the work-horses were work-horsing. Even James Milner played regularly, winning man of the match in a league game against Aston Villa right at the business end of the season. Of Liverpool’s eight senior midfielders (including Elliott), Jones was comfortably at the bottom of the pecking order.

Then, of course, things changed for Liverpool. They say a boxer ages overnight. Something similar seemed to happen to Liverpool’s midfield in the 22/23 season. After the glory of lifting two trophies and almost winning more, Klopp’s team simply fell apart. The rigours of the previous campaign surely played a part as Liverpool were regularly overrun by younger, more energetic teams. Outfits like Brighton, Brentford and Wolves thought nothing of slotting three goals post Allison, and even had the audacity to do it in three consecutive games. Liverpool were on the ropes. They needed legs, lungs, and scrap. A horse, a horse, my Kingdom for a horse.

But when opportunity presented itself, Jones could not deliver. This was his big moment – it was time for the young Prince Hal to stop loitering and pissing about. Now was the time to go and smash the French at Agincourt with a threadbare army of starved peasants, a few archers, and Naby Keita. But Jones could only watch as Liverpool floundered, sidelined by a rare foot injury. ‘Fasciitis’ is said to be so painful that elderly nuns will scream ‘just cut the fucker off’ rather than put pressure on the afflicted foot. The timing could not have been worse. The Afield faithful, for so long famously divided on the prospects of the lad from Toxteth, could finally agree: Curtis Jones just wasn’t going to make it.

The turning point for Curtis came last April in a match against Arsenal. Klopp opted to start Jones, and he contributed to a fiercely earned point from a losing position against the title challengers. Liverpool went on a remarkable run from then until the end of the season. Jones started every game as the Reds became the form team in the league for the final eleven games. The highlight of this spell, from the point of view of the young pretender, was almost certainly that night in Leicester – his own miniature Bosworth field – when he bagged those two goals and announced his return. A Trent Alexander-Arnold free kick into the top corner could not take the limelight away from the real star that night.

Jones wheels away after scoring the opening goal against Leicester on 15th May 2023 at the King Power Stadium.

But what about the revamped Liverpool? Where does Jones fit into Liverpool 2.0? Will he be at the front of the vanguard, or waiting in the wings making the occasional cameo dressed as an Abbott of a ghost? The stats would suggest the former. Both last season and this, Jones has the highest rate of successful passes in the entire team. A pleasing number of these are forward passes, and Jones compliments this side of his game with healthy numbers for his interceptions, tackles and distances covered. He has become the new standard bearer for Klopp-ball, the flag-ship in the armada. Not even the arrival of Szoboszlai, Macallister, Gravenberch and Endo can keep him out of the team. Klopp has reinvigorated Liverpool’s midfield with the dazzling economy of a jewel thief, but Jones still seems to be his first name on the team sheet.

His game has come on leaps and bounds. He carries the ball forward with dream-like fluidity, now pulling the trigger in front of goal with increasing frequency. His header against Norwich at the weekend was more difficult than it looked. If you watch, you can see that he aims past the post, knowing that the forward momentum of James Mc Connell’s cross will cause the ball to bend ground the keeper and sneak in at the back post. It was a great finish, and the sheer satisfaction he took from congratulating Mc Connell on getting an assist spoke of leadership qualities. The flaws in his game are diminishing, with the help of some straight talking from Klopp and Pep Linders. The maturity of his decision making can no longer be questioned, he is full blooded in the counter press, and his tactical positioning off the ball is improving. We all know how much a player’s performance off the ball matters to this coach. The German recently said that Curtis Jones now sets the bar for the rest of the team.

The bombshell announcement of Jurgen Klopp’s departure last week might change all of this of course. Klopp’s successor may envisage a different role for Jones. He may think less of his abilities. He might recoil at his self-confidence, rather than encourage it. But for now, Curtis Jones remains the beating heart of this Liverpool team. At the very beginning of Jones’ senior career, Jurgen Klopp once advised the youngster to ‘ defend like a
soldier; attack like a scouser’. He is now finally doing that on a week in – week out basis. Liverpool are currently favourites to lift more than just one major trophy this season. No one has contributed more than Jones to the manoeuvring of his club back into this unlikely position. It remains to be seen whether this will end as tragedy, comedy, or romance. But the story has me on the edge of my seat.

@maxgallwrites

A New Era For Liverpool? FSGers crossed.

By Max Gallagher (@maxgallwrites) 

And so another World Cup is here. And I can’t remember one that was attended by less heraldry, less anticipation, less clamour for tickets, sweepstakes at work, less excitement or boozy plans for the group stages. I first got the World Cup bug in 1986, as the cameras struggled to cope with the glare of the Mexican sun reflecting off the players shiny kits. Maradona dazzled, and I was hooked for life. But it wasn’t until 1990 that I first understood the real joy of a World Cup. The buildup. The anticipation of pleasure is pleasure itself, said Jane Austen. It still strikes me as strange that she agreed to do the commentary for the BBC in 1966. But it stands out so clearly – the Qatar world cup has already partially failed because it has failed to entice.

  After the Republic of Ireland qualified for their first World Cup in 1990, for months in advance it was all we could think about or talk about in primary school. The tournament itself did not fail to deliver. Maradona was booed. Gazza cried. Pavarotti sang. And the Republic of Ireland made it all the way to the quarter finals, eventually getting knocked out in a narrow 1-0 defeat by the hosts. Legends were made. This year an even more extraordinary World Cup awaits, perhaps. The unthinkable has happened. It is FIFA’s worst nightmare. And an outcome that even the Qatari government could never have predicted when their money-greased bid for the World Cup 2022 was accepted: Nobody cares. 

 Back home, as the footballing lights go out all over Europe, there is still a war being waged in Liverpool. The club’s owners have recently gone public with their intentions to sell up shop, or at least part of it, and it has left the fan base in a frenzy, turning on each other with the ferocity of cousins at a gypsy wedding. The last occurrence on Merseyside that attracted this level of controversy was when EMI offered Pete Best a record deal on the condition that he drop his three other band mates. Currently, the only people Liverpool fans seem to hate more than supporters of Everton and Utd, are Liverpool fans themselves. Three letters divide them: F.S.G. 

Liverpool principal owner John W. Henry. Love him or hate him, you’re gonna get death threats.

Twelve years ago, Fenway Sports Group saved Liverpool FC from bankruptcy and paid off their debts. They pumped a handsome amount of money into the first team squad, even if this money was largely spent on players who would flop. The early signs seemed good. They had Luis Suarez, and the risky appointment of Brendan Rodgers seemed to pay off early. It wasn’t to be of course, and one year after almost delivering a first league title since 1990 Rodgers’ failings were exposed. Seven years of progress have followed under Jurgen Klopp, bringing among other things, four major European finals and that long-awaited league trophy. Both the stadium and commercial reach have been extended, meaning that by 2020 FSG had delivered everything that they promised. The question is: Did they achieve what they achieved by luck or by design? 

 Supporters of John Henry’s consortium will point to the overhaul not just of Liverpool’s corporate structures, but their scouting network and their youth team system that has delivered so spectacularly. Their acquisitions and their sales have been the most productive in the modern era. Barely a penny has been wasted at Liverpool – a frugal and canny approach that has put Liverpool back on their perch without having the spending clout of the super-rich clubs they compete with. They even managed to win a European Cup in an era where it has eluded even Manchester City and Paris Saint Germain. FSG have laid out a clear self-sustaining philosophy for Liverpool. They believe that in the future FIFA will clamp down harder on fair play, limiting the amount that wealthy owners can pour into football clubs.  Some would say FSG have created the perfect blueprint of a club that can operate within these future constraints. Should their financial muscle continue to grow on the same trajectory that it has been since Fenway took over, Liverpool will eventually sit alongside Man Utd and Real Madrid in an elite group of the most lucrative clubs in the world. Everything that they need will be provided for by sheer dint of their turnover. However. The reality is, at the time of writing FIFA have absolutely no power (and perhaps appetite) to police or enforce their financial fair play rules, and Liverpool’s rivals have seemingly endless resources. It has been pointed out by many that this current Liverpool squad seems to be at a turning point – most analysts agree that they have reached their peak, and almost overnight, now seem to be in quick decline.  

Last year Liverpool almost achieved the impossible. Had Aston Villa kept their knickers on for fifteen minutes they might have won a treble, and were closer to winning a quadruple than perhaps any team ever will be. The narrative seemed to be that FSG were back in control after the wobble caused by the post-pandemic slump. Liverpool’s record purchase arrived in the form of the £85m Uruguayan heavyweight Darwin Núñez at the start of the summer, and Mo Salah was granted his record-breaking contract. Then the plot all went a bit Game of Thrones. Liverpool’s on-field and off-field philosophies have suffered a crash in confidence on the scale of Kwasi Kwarteng bursting into a casino with a machine gun. Suddenly, the critics of FSG who had long been saying that their tenure at the club was over were impossible to ignore. 

 Darwin Nunez has been a non-instant instant hit on Merseyside.

Liverpool fans seem to be split almost 50-50. A tense schism has emerged that revolves around whether FSG are fit and proper owners for the club, and no one is pulling any punches. On social media, fans will attempt to virtually scratch each other’s eyes out when the subject is raised. The hashtag ‘FSGOUT’ has been trending so often this year that Elon Musk could charge $8 per month to use it and probably double his wealth. Chris Bascombe, writing in the Daily Telegraph in 2020 said that “there are only two clouds on the horizon for Liverpool at the moment. One is the brilliance of Manchester City, and the second is the negativity of some of their own fans.” But is it possible that some of this negativity justified? Fenway Sports Group have made mistakes, there is no doubt, and some fans have long memories.

 Broadly speaking, Liverpool fans are divided into two: an older group, who loosely support FSG, perhaps because of their long memories of the dull and bleak years before their arrival. These fans are conservative and calm, and are grateful for FSG’s contribution. The other, typically younger group of fans are passionate and ambitious, and argue that in elite sport resting on your laurels is not an option. FSG’s achievements are fine, but they are more concerned about the future of the club. Liverpool simply cannot continue to compete under the auspices of FSG they argue. The club has momentum, but something must change drastically if they are to continue on the same path. Put simply, FSG spend less on players than Donald Trump spends on Mexican artwork.

The disagreement sometimes feels a bit like an argument between two soldiers from different eras: the son frustrated that his father remains loyal to a general who had clearly lost his mind. 

‘But father, you don’t understand. You would send us to fight on horseback against Sheikh Mansour! You don’t know what this man is capable of. If we don’t ally with Lord Bellingham soon he will surely join forces with our foes.’ 

‘You young blades. You think you know it all! You don’t understand war. You were never at Istanbul. We were three nil down at halftime.’ 

‘We can’t rely on miracles forever. Not with the developments our enemies have made. Istanbul was a fluke.’  

‘It wasn’t a fucking fluke! It was tradition and honour and… and spirit.’ 

 ‘For fuck’s sake Father! Vladimir Smicer scored in the final. Even Igor Biscan scored in the last sixteen!’ 

Or something like that. 

FSG’s transfer policy has been miraculous, it is true. But hoping for miracles is not a safe policy when planning for the future. No one could possibly have foreseen just how brilliant Mo Salah was going to be when he was purchased from Roma, or Sadio Mané from Southampton. No one could have foreseen that these two players would lead the club to glory, remaining almost completely injury free for five years. The purchases of Roberto Firmino, Luis Diaz, and Diogo Jota all for similar fees of around £40m were equally brilliant. Was this good scouting, or good luck? The answer is, of course, a bit of both. It was phenomenal work from Liverpool to bring this group of players, and for such low prices. But a club can’t move forward expecting the scouting department to pull them out of trouble by continuing to find gems at rock bottom prices. The #FSGOUT contingent of Liverpool fans feel that the club’s woes this season are a direct result of FSG’s failure to grasp this point, and their failure to reinforce the club’s midfield in this summer’s transfer window. Rumours circulate about FSG’s problems with liquidity, but these were addressed when they recently purchased The Pittsburgh Penguins ice hockey team for $800m. They are notorious for attempting to keep each of their operations financially separate from one another, and where possible, keeping each one financially self-sufficient. However, it does now seem that perhaps even FSG agree that fiscal stimulus is required at Liverpool, and quickly.  

What this actually means for the club, and for fans, is still unclear. Is the club for sale completely? Or are they seeking new investment? Which one of these routes is in the best long interests of the club? The two different groups of Liverpool fans are at odds on this topic as well. Should Liverpool sell wholesale to a megarich owner in the manner of a Newcastle, Man City or PSG? They would have limitless funding to compete on the pitch, as well as continuing to expand the stadium, the infrastructure, and even redeveloping the area surrounding Anfield. The problem of course would be that the club may end up sports-washing a murderous oil funded regime, a villainous oligarch or a dark army tech-billionaire who wants to hack into the NHS database and reprogramme your Granny’s pacemaker. Money alone does not bring success- strategy is also required. Looking around, it is not hard to find situations where rich owners have brought only chaos to a football club.  

The other option for FSG is to sell a stake of the club. Between 25% and 35% of ‘Liverpool FC and Stadiums’ could be sold, leaving FSG with the all-important majority stake. Such a sale would raise an excess of a billion dollars. Since Fenway do not take money out of Liverpool in the form of dividends, we can have some confidence that all of this money will be reinvested in the first team squad and the ongoing extension of Anfield itself. Such a huge sum would surely make Liverpool competitive in the transfer market for between five and ten years, even if some of the money was spent on infrastructure. The benefit of this model is that FSG would remain in charge, continuing the tradition of frugal, sensible, farsighted management. If his press conferences are to be believed, this is the path forward preferred by Jurgen Klopp, who seems to be quite comfortable both with the stewardship of FSG and his relationship with their man on the ground, Mike Gordon. The Athletic recently suggested that any such investment would most likely come from America. This is not for cultural or ethical reasons, but simply because most investment in European football comes, contrary to common misconception, from the west rather than the east.  

What happens next is anyone’s guess, but Liverpool fans have cause to be excited. The worst-case scenario is that nothing will happen. Even then, there is a decent squad in place that – injuries notwithstanding – are still capable of competing for major honours for the next year or two. But it seems more likely than not the change is coming. How the different groups of fans will reconcile themselves and heal the rifts between them depends on the nature of that change. A complete cessation of hostilities is about as likely as a Pride parade in the centre of Doha to coincide with the World Cup final. Passions run high, and social media will continue to fan the flames of any discontent. The camp will remain divided on this matter I believe. After all, human beings will always find reasons to hate figures of authority, even if they are most successful or benevolent. But we can hope for de-escalation, if FSG turn on the taps in some form or other. 

Jude Bellingham is just one of many Liverpool targets who will be on show at the World Cup in Qatar. And so Liverpool fans have got at least one reason to tune in to the most boring and controversial World Cup in history. By the time the January transfer window rolls around, we may know more about the future of Liverpool. It’s even possible that fans will stagger out of the trenches on Christmas Eve for a brief truce, while we look forward to the next chapter in the history of this great club. Time will tell if the Boston Tea Party is over, or just shifting gears. 

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”.

• RELATED: ME/CFS may be linked to failure in energy supply to the cells
• RELATED: Cancer drug helped patients with chronic fatigue syndrome (CFS/ME)

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.

• RELATED: Few physical differences found between healthy individuals and those afflicted by chronic fatigue syndrome
• RELATED: Norwegian researchers have tested music therapy for chronic fatigue

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