By David Tuller, DrPH
I have previously documented that some of the leading experts in “medically unexplained symptoms” (MUS) have regularly misstated a core finding from a seminal study in their field. The study—”The cost of somatisation among the working-age population in England for the year 2008–2009”—was published in 2010 in the journal Mental Health in Family Practice.
The same mistake has been repeated in journal after journal, and at least a couple of these instances have been corrected. It has recently been brought to my attention by a shrewd observer that the venerable journal Psychological Medicine published one such study two years ago, with Professor Sir Simon Wessely as a co-author.
Psychological Medicine is the journal that, in 2013, published the infamous PACE trial “recovery” paper, in which participants could get worse on the two primary measures and still be counted as “recovered.” At that time, the journal’s editors-in-chief—Professor Robin Murray from King’s College London, and Professor Kenneth Kendler at Virginia Commonwealth University–refused to acknowledge the paper’s methodological and ethical lapses.
In March of 2017, Virology Blog sent an open letter to the journal requesting retraction of the paper. More than 100 scientists, clinicians, and other experts signed the letter. The journal ignored it. Perhaps relevant to that decision was the fact that PACE lead investigator Professor Michael Sharpe is on the journal’s editorial board. For that matter, so is Sir Simon, who is also a King’s College London colleague of one of the journal’s two top editors, Professor Murray.
Given these links, and judging by the problematic results, it is easy to believe that the Psychological Medicine peer review process for papers from authors viewed as eminent is less than rigorous. Anyway, below is the letter I sent yesterday to Psychological Medicine.
Dear Professors Murray and Kendler:
There is a serious factual error in a 2020 paper (epub 2019) published by Psychological Medicine called “Characteristics of patients with motor functional neurological disorder in a large UK mental health service: a case-control study.” The authors are O’Connell, Nicholson, Wessely, & David.
In their introduction, the authors misstated the core finding of Bermingham et al, a seminal study in their field. They included this sentence: “Bermingham et al. (2010) reported that the incremental cost incurred by somatising patients is £3 billion per year, accounting for 10% of total NHS expenditure.”
This is definitely not what Bermingham et al reported. In fact, Bermingham et al reported that the costs of treating working-age patients assessed to be “somatising” accounted for 10% of NHS expenditures for people of working age–not for the overall populatio. For the year studied in Bermingham et al, total NHS expenditures were around £!00 billion–not the £30 billion implied by O’Connell et al in declaring that £3 billion represented 10% of the total. The statement in O’Connell et al had the obvious but unfortunate effect of more than tripling the apparent impact of the costs of these patients to the NHS.
Other experts in “medically unexplained symptoms” (MUS) have similarly cited Bermingham et al inaccurately. Both the British Journal of General Practice and BMJ Open have acceded to requests that the exact same error in papers they published be corrected (see here and here). That some of the most eminent scholars in the MUS field have made this significant mistake in multiple publications over the course of a decade is rather perplexing, as is the repeated failure of the peer review process at multiple journals to catch it.
I am writing to you directly because this does not seem to be a matter for correspondence or for an exchange of views with the authors. The statement about Bermingham et al is false and needs to be corrected.
I have cc’d the corresponding author on this message. I have also cc’d the primary author of the mis-quoted study, Bermingham et al, in case there is any confusion over the meaning of the data.
Thank you for your prompt attention to this matter.
David Tuller, DrPH
Senior Fellow in Public Health and Journalism
Center for Global Public Health
School of Public Health
University of California, Berkeley
8 responses to “A Letter to Psychological Medicine about Error in MUS Paper from Sir Simon and Colleagues”
Worth noting that a self-made neuropsychiatrist – who used to teach other doctors when to diagnose ‘MUS’ – missed an obvious migraine dx for me. Her ‘MUS’ training aid disappeared from the internet shortly after I exposed its flaws as part of the NHS complaints ‘procedure’.
Also worth noting that when I rocked up to a public engagement meeting about ‘MUS’ (the speaker is a psychiatrist) almost all the ‘MU’ symptoms he mentioned could be explained by anyone with a half-way decent understanding of vestibular/neurovestibular contributions to health and disease. As far as I can tell it is less expensive to diagnose these symptoms as ‘MU’/’somatisising’ or ‘Functional Neurological (Conversion) Disorder’ (or whatever other top down/’blame the patients’ term is trending) than it is to diagnose and treat them.
This is not OK since diagnostic delay/missed diagnoses/misdiagnoses all result in a negative impact on our quality of life. It also results in loss of data (for example about Mal de Debarquement Syndrome (MdDS), other rare conditions *and* more common ones (eg Vestibular Migraine, which is under diagnosed). It also makes life considerably harder for the awesome people who work around the clock to fund and conduct scientific research into MdDS etc.
With medical knowledge set to double every 73 days this year (pre COVID-19 estimate) the number of ‘MUS’ should drop considerably. Whether that will result in reduced or increased costs, overall, is a moot point. But – for the sake of patients who just want our lives back – I hope any increased costs won’t be deemed to be our responsibility, at least in the UK.
Why, I wonder, has the UK’s great Regius Professor of Psychiatry fallen so badly here at the first hurdle – a bit of primary level maths? How could he have got this wrong? Doesn’t he know what the NHS spends in total per annum? Isn’t he aware that mental health accounts for around 10 to 13% of total NHS expenditure? Doesn’t he remember that mental health spend in 2010/11 was some £14billion according to this 2012 report -https://cep.lse.ac.uk/pubs/download/special/cepsp26.pdf – that I assume he helped to produce and expect he should have read as part of the CEP’s Mental Health Policy Group? [see page 10 (or 14 of 34)]
Given that this false statistic has already had to retracted from multiple papers in this area, I find it … surprising … that Wessely wasn’t already aware of the issue.
On the other hand, this whole area of research seems to be full of claims that turn out not to be true if you bother to go read the citation.
Professor Anthony David was also a co-author of the BMJ Open paper about the PRINCE Primary trial that had to be corrected.
Both Professor Anthony David and Dr Tim Nicholson seem to be on the Medical Advisory Board of the FND Action charity. Dr Nicholson is also on the International Medical Advisory Board of FND Hope.
It is indeed perplexing that such leading lights don’t appear to check their own papers properly.
David, what does it tell us about Psychology / Psychiatry in the UK. How do we know who to trust. Is fraud now endemic across medicine.
RW said, “How do we know who to trust.”
That is a critical question and applies all across society. Turns out that 40 years of “Greed Is Good” is corrosive to the social bonds necessary to have a complex functioning society. When a crisis hits it’s kinda handy to have people pulling in generally the same direction.
Does Regius Professor Sir Simon and pals ever reflect on their substantial contributions to the atmosphere of distrust of self-appointed “experts”? Perhaps they are too busy trying to shore up their crumbling reputations…
I’ve just gone back through the papers that have been mentioned by David in his blogs as making this schoolboy/schoolgirl error and, by my counting, 9 of the authors are/were professors at the time of publication. In my day, professors were learned people who knew their stuff. From time to time, they wrote carefully crafted papers that were highly regarded. What happened?
I see George Monbiot has done a follow up article in The Guardian taking issue with M Sharpe’s criticism of him and the idea that he is spreading a Long Covid meme.