In medicine, as in life, it is sensible to be cautious about claims that seem too good to be true. Back in 1999, software engineer Ollie Cornes contracted a throat infection that transmuted into a state of “unbelievable exhaustion, with an intense flu-like malaise”, leading to him eventually being diagnosed as having postviral fatigue syndrome.

Since then, the severity of his fatigue has waxed and waned, but is invariably exacerbated by doing more than his usual level of activity allows – leaving him “bedridden for weeks with muscle weakness, dizziness and loss of appetite”. This phenomenon of fatigue following minimal physical or mental exertion is a well recognised feature of many neurological disorders, affecting two thirds of those with multiple sclerosis and being almost universal in the Post Polio Syndrome (PPS) that afflicts the survivors of the polio epidemics of the 40s and 50s. The precise mechanism remains obscure, but is obviously related to disturbed functioning of the relevant parts of the brain.

By contrast, the mainstream medical explanation for those like Mr Cornes with post-viral fatigue – otherwise known as chronic fatigue syndrome, or, even more commonly, ME (myalgic encephalomyelitis) – is very different, being attributed to the “unhelpful belief they have some persistent medical condition” that is exacerbated on exertion. This results, it is claimed, in a “chronic fatigue state in which symptoms are perpetuated by a cycle of inactivity and deconditioning with further deterioration in exercise tolerance”.

Hence the proposal that breaking this cycle with a combination of cognitive behavioural therapy together with a regime of graded exercise should promote recovery. And, indeed, as reported in this paper last week, researchers at Oxford University who have evaluated this approach found that, two years later, “most” patients had benefitted feeling less tired and being able to complete most tasks more easily”.

The researchers may be persuaded by their optimistic conclusions, but Telegraph readers certainly are not, as is clear from the impressive number (more than 1,200) of highly critical comments posted online, drawing attention to, for example, the remarkable absence of any measurable criteria for assessing what “recovery” entailed. It is far too good to be true to suppose that positive thinking and graded exercise should reverse a debilitating illness that, as with Mr Cornes, can last for decades – and it would be good to think the sheer implausibility of asserting otherwise could be the last hurrah for the psychological explanation for post-viral fatigue.

'Having reviewed all the medical evidence on chronic fatigue over the past 50 years, the Institude of Medicine advised it be classified as a physical brain disorder' James Le Fanu

Earlier this year, the Institute of Medicine in the United States, having reviewed all the medical evidence on chronic fatigue over the past 50 years, advised it be classified as a physical brain disorder, which in view of its “complexity and severity” should be redesignated Systemic Exertion Intolerance Disease, the better to reflect its defining feature: that “physical and cognitive exertion adversely affect these patients in many aspects of their lives”.

Medical conundrum: ear pain

This week’s medical query comes courtesy of Mrs NA from Bolton, who experienced a stab of pain in her right ear during a procedure that required inserting a probe into the ear canal to dislodge an obstinate lump of wax. Later, when walking out to her car, she noticed a peculiar bell-like sound – similar to that made by tapping the side of a full glass of water with a teaspoon. She has subsequently found the sound is induced by “any downward movement of the head that is brought to a sudden stop”, as when walking downstairs or driving over a bump. The source of this bell-like sound has apparently “stumped all local medical expertise”. Any suggestions would be much appreciated.

The best way to swallow pills

Finally, further to the recent comments on ways to facilitate swallowing pills, several readers have kindly volunteered their favoured methods. A gentleman who considers himself something of an expert in this matter, from having to take 13 pills a day for his various ailments, has found yoghurt to be ideal, while, on similar lines, another reader commends taking the pill on top of a dessert spoonful of ice-cream or ready-made custard. A woman with an aversion to taking pills is grateful to a helpful pharmacist who commended eating a grape with each tablet, which “makes swallowing them much easier”. Further useful tricks include drinking through a flexible straw that directs the pill down the throat or placing it as far back on the tongue as possible, “fill the front of the mouth with water, and then swallow”.