My Letter to Professor Chew-Graham about the Cost of MUS

By David Tuller, DrPH

In multiple venues, Professor Carolyn Chew-Graham of Keele University has misstated the reported cost of so-called “medically unexplained symptoms” to the NHS. Professor Roger Jones, editor of the British Journal of General Practice, recently corrected such a misstatement in a 2017 editorial written by Professor Chew-Graham and several colleagues. (Thank you, Professor Jones!)

Now that this BJGP correction has been posted, I am urging Professor Chew-Graham to address the same mistake in one of her other articles. Some of her colleagues have made similar errors; I have cc’d a few of them. I do find it odd that those who present themselves as leaders in this field have had such difficulty in accurately citing a seminal study in their domain of purported expertise. Their apparent inability to understand basic statistical information does raise questions about whether anyone should listen to their policy recommendations.

Below is the letter I e-mailed Professor Chew-Graham earlier today.


Dear Professor Chew-Graham—

As you undoubtedly know, the British Journal of General Practice has now taken the responsible step of correcting a false statement in a 2017 editorial written by you and several co-authors. That false statement involved the reported cost of so-called “medically unexplained symptoms” to the National Health Service.

Frankly, I was a bit surprised that you chose not to initiate this step after I alerted you to the issue early this year. That letter was primarily focused on the deficiencies of the METRIC ME/CFS training program for GPs, developed by you and colleagues under the auspices of the Royal College of General Practitioners. In the letter, however, I noted as well your untrue claims about the cost of MUS and indicated that I planned to contact BJGP about the matter.

When I first approached Professor Roger Jones, BJGP’s editor, he suggested that perhaps no correction was warranted because the data cited were ten years old. This was an unexpected and somewhat mystifying response, especially since your editorial was published just two years ago. Professor Jones further suggested that I send in a “short” sentence or two that the journal might deign to publish.

I declined this offer, which I found to be inappropriate. It is of course up to journals and authors to correct their own mistakes; it is not the responsibility of those who have alerted them to errors. My sole goal was to safeguard the integrity of the medical literature by making sure you and/or BJGP fixed the problem; I had zero interest in having the journal publish a letter that few people, if anyone, would see. I very much appreciate that Professor Jones switched gears and did the right thing.

Given this development, I thought that you might, on your own, decide to correct a second article in which you made a similarly bogus claim—a blog post on the site of Keele University’s Research Institute for Primary Care and Health Sciences. Perhaps I was naïve to expect that. Perhaps correcting self-evident mistakes in this domain of inquiry is not a particular priority for you and other UK investigators.

In any event, here’s what you wrote in that blog post, dated February 21, 2017:

“MUS actually accounts for a considerably high proportion of NHS activity, with approximately 10% of total NHS expenditure being spent on services for the working age population in England with medically unexplained symptoms.”

As you know, this is a serious mis-citation of the relevant 2010 study, Bermingham et al. That study reported that National Health Service costs for working-age individuals in England accounted for around 10% of NHS expenditures on that age group–not 10% of total NHS costs. Since Bermingham et al is a seminal study in the MUS field, I am perplexed that this misinterpretation of the reported findings has gained such traction among those who purportedly have expertise in this domain.

This false claim about reported costs has been deployed to promote specific public health policies, in particular the expansion of the Improving Access to Psychological Therapies program. I assume you would agree that advancing public health policy on the basis of disinformation is not optimal. I therefore urge you to take the necessary steps to address the error in your Keele blog post without further delay.

I have cc’d some other researchers who have made the same mistake in various publications–Professor Richard Byng of the University of Plymouth, Professor Helen Payne of the University of Hertfordshire, Dr Richard Brown of the University of Manchester, and Dr Susan Mizen, a consultant psychiatrist with the NHS. I intend to contact them individually as well to try to ensure that they take the necessary corrective action. I have also cc’d Sarah Bermingham, the lead author of Bermingham et al, whose work that has been so routinely misrepresented, and Professor Vincent Racaniello, the Columbia University microbiologist and host of Virology Blog, where I post most of my reporting on ME/CFS.

Given the perceived links between ME/CFS and MUS, and the apparent desire to shunt patients diagnosed with either into the IAPT program for cognitive behavior therapy and related interventions, I have also cc’d several physicians involved in developing the new guidance for ME/CFS under the auspices of the National Institute for Health and Care Excellence, as well as two patient representatives on that NICE committee. Finally, I have cc’d Carol Monaghan MP, who has been troubled by the poor quality of research into ME/CFS, such as the studies that formed the basis of your METRIC training program for GPs.

For full transparency, I plan to post this letter on Virology Blog. Thank you for your quick attention to this troubling issue.


David Tuller, DrPH
Senior Fellow in Public Health and Journalism
Center for Global Public Health
School of Public Health
University of California, Berkeley





5 responses to “My Letter to Professor Chew-Graham about the Cost of MUS”

  1. Judee Avatar

    I just wanted to say thank you for working so tirelessly for us, Dr. Tuller.

  2. Couch Turnip Avatar
    Couch Turnip

    Great letter David, thank you for doing all this.

    As I commented on the previous blog, how was it that Marta Buszewicz was among the authors who put the same MUS cost information over CORRECTLY in a February 2017 article –

    Warner, A., Walters, K., Lamahewa, K., & Buszewicz, M. (2017). How do hospital doctors manage patients with medically unexplained symptoms: a qualitative study of physicians. Journal of the Royal Society of Medicine, 110(2), 65–72.


    – when she co-authored the February/March 2017 BJGP article where it was incorrectly given?

    I wonder if Professor Chew-Graham might be able to throw any light on that conundrum for us?

  3. Lisa Avatar

    I so appreciate your work but it takes the patience of a saint. Really gives one pause to consider how much more the politics of status matter to those involved than the health and well being of the people the NHS exists to serve.

  4. H.Holddworth Avatar

    Brilliant and necessary. Thank you David Tuller.

  5. Ann Avatar

    Thank you once more Dr Tuller for your tireless efforts to bring these matters to the attention of those who should know better.

    Your work should be in a journal of it’s own. What a story that would tell the world.

    One day perhaps.