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If you have a trial for a heterogeneous condition like #MECFS, then looking at average effects is no longer a good option to determine effectiveness.

If half improve and half get worse, we determine the intervention ineffective.

Instead we should explore *why* those who responded did respond and vice versa.

For the non responders we should then move them on to another intervention

We also need to consider poly-interventions to address multiple pathologies
This is a whole different way of trialling drug efficacy than we do now.

Folk will rightly point out the flaws in this such as the bias it introduces but fail to understand the bias current trials introduce
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