By David Tuller, DrPH
A recent Wall Street Journal opinion piece accused an apparently powerful “queer feminist wellness collective” of causing an international wave of mental illness, which is being expressed as reports of persistent disabling symptoms after an acute bout of COVID-19. The article was written by a psychiatry resident at Canada’s McMaster University in Canada. Given the arguments advanced by the resident, my friend and colleague decided to check in with the university’s psychiatry department.
Here’s his report.
Can McMaster University Medical School Psychiatrists Be Trusted to Treat ME/CFS Patients?
By Steven Lubet
There were many problems with Dr. Jeremy Devine’s disturbing oped in the Wall Street Journal, as I have detailed here. In addition to gaslighting Long Covid patients and disparaging patient advocacy groups, Devine asserted that the PACE trial’s psychogenic theory of ME/CFS is “the prevailing view among medical practitioners.” As readers of this site know, that has not been true since at least 2015, when the U.S. Institute of Medicine (now the National Academy of Medicine) reported its finding that ME/CFS is a “serious, chronic, complex, systemic disease”— not a psychiatric or psychological disorder.
Devine is a 2017 University of Toronto medical school graduate and currently a psychiatry resident at the McMaster University Faculty of Health Sciences in Hamilton, Ontario. As a doctor-in-training, he obviously must have obtained at least some of his misinformation from his supervising senior physicians. This raises the troubling likelihood that McMaster psychiatry residents are still being taught that ME/CFS is, as Devine put it, “an underlying mental-health issue,” presumably treatable with cognitive behavior therapy and graded exercise therapy per the PACE trial (which Devine linked in his oped).
Because prospective ME/CFS patients have a right to know about the quality of care they can expect from McMaster physicians, I sent an inquiry to Drs. Nick Kates and Karen Saperson, respectively the chair and vice chair of McMaster’s Department of Psychiatry and Behavioural Neuroscience, recognizing of course that Devine is entitled to his own opinions about Long Covid:
Dr. Devine also wrote that the “prevailing view among medical practitioners” is that ME/CFS is a symptom of “an underlying mental-health issue,” linking to the UK’s 2011 PACE trial. That was more than a statement of his opinion, and it seriously misrepresented the actual state of current medical practice.
The US Institute of Medicine (now the National Academy of Medicine) issued a report in 2015 finding that ME/CFS is a “serious, chronic, complex, systemic disease”— not a psychiatric or psychological disorder. The PACE trial’s recommended treatments of Graded Exercise Therapy (GET) and Cognitive Behaviour Therapy (CBT) have since been discontinued by the U.S. National Institutes of Health and Centers for Disease Control. Likewise, the UK’s National Institute for Health and Care Excellence (NICE) issued a revised draft of its clinical guidelines, dropping both CBT and GET as treatments for ME/CFS, and strongly advising against the latter. Promising biomedical research on ME/CFS is now underway at major U.S. Universities, including Stanford, Columbia, and Cornell.
It is simply untrue to maintain that the “prevailing view among medical practitioners” is that ME/CFS is mental-health disorder.
Consequently, I am writing to ask whether Dr. Devine’s understanding of the “prevailing view” is taught in the McMaster psychiatry program. Does your department continue to follow the recommendations of the PACE trial (which the NICE draft called a “low quality” study)? Are your patients advised to engage in Graded Exercise Therapy? Are your residents made aware of post-2015 developments in the U.S.?
It appears to me that Dr. Devine’s outdated views of ME/CFS may reflect poorly on the quality of training and care provided by your program. Kindly let me know if I am mistaken.
Jeremy Devine, who you refer to, is a medical resident in the Department of Psychiatry and Behavioural Neurosciences at McMaster University. The views he expressed, in an opinion piece, were his own and he does not speak on behalf of our department or the university.
As a Department we do not have a “prevailing view” on this topic, but leave such decisions up to each individual practitioner.
Kates’s answer strongly suggests that some psychiatrists at McMaster do indeed adhere to the outmoded recommendations of the PACE trial, but I wanted to make sure. My followup was therefore quite specific:
Can you please identify for me any “individual practitioners” at McMaster who regard ME/CFS as a “mental-health disorder” or recommend CBT or GET as treatments, so that I may request their views directly.
Finally, what is your own view, or Dr. Saperson’s, of ME/CFS? Do you consider it a mental-health disorder? Do you consider the PACE recommendations valid? Do you approve of CBT or GET as treatments for ME/CFS?
Kates declined to answer, stating only “I have nothing else to add.” I also wrote to Dr. JoAnn Corey, the director of postgraduate education, who did not reply to repeated inquiries.
This is bad news for prospective ME/CFS patients in Ontario. Given Kates’s evasiveness, and the absence of a clear denial, it seems certain that some McMaster psychiatrists – perhaps many or most, and even Kates and other department leaders – continue to push CBT and GET as ME/CFS treatments, even though the latter has been recognized as contraindicated by the NICE draft guidelines. I have identified at least one McMaster faculty member who apparently endorses GET, but he is a chiropractor who was somehow appointed in the department of anesthesiology.
Young Dr. Devine appears to have been following the lead of his seniors in mischaracterizing ME/CFS and possibly providing mistreatments. Prospective patients should therefore approach the McMaster psychiatry department warily, if at all.
NOTE: Canada follows British spelling conventions such as “behavioural.” As a half-Canadian and dual citizen, I did the same in Canadian proper nouns and in my emails to the McMaster physicians, but not otherwise in the body of this post.
13 responses to “Northwestern Law Professor Steven Lubet Corresponds with McMaster U. About That WSJ Op-Ed”
There are 560,000 Canadians with MECFS in this country. Up until 2019, we had no funding to speak of, and when we finally got biomedical funding, it was only $200,000 a year. Not even 50 cents per patient. This is how little the government thinks of us.
Our “advocates” and our scientists still believe in stupid sh*t like neuroplasticity, CBT, and GET like Devine. They are too close to the government in my opinion and coddle MDs and government officials rather than correcting their wrong opinions based on non-evidence. My province of Ontario is crumbling under these same weaknesses during Covid19. When the boat is sinking due to stupidity, it is doing so because you didn’t rock it when you should have done.
“As a Department, we do not have a “prevailing view” on this topic, but leave such decisions up to each individual practitioner.” some idiot from McMaster wrote.
Frankly, as a Canadian, this bogus PR statement concerns me. What the person is saying is that in a disease with double the disease burden of HIV, and lower quality of life than congestive heart failure- without a diagnostic test (yet) and no treatment, that practitioners of medicine at McMaster rather than following and updating based on the latest biomedical evidence, which is publicly available and easy to find if you can type words into a medical journal would rather continue being poorly educated fools. Yes, I called you fools, you McMaster douches who are reading this. Dr. Ron Davis, the Director of the Stanford Genome and Technology gave me leave to do so, so I’m doing it.
There have been four symposiums on the molecular basis of ME/CFS at Stanford. This is just absurd. We’ve got Stanford, Harvard, I bet you getting Yale is just a matter of time now with Dr. Akiko Iwasaki there.
As an ME/CFS patient living in Canada, I can rhyme off numerous biomedical papers, names of research scientists, research we are still waiting to see published, but what is the use? I’m stuck in this house, while idiots getting MD’s in Canada can’t even type in ME/CFS into the journal of translational medicine or Nature.
As a Canadian, No apologies for this deserved rant.
Thank you for writing McMaster, Doctor, and I’m not at all surprised that the view of medical practitioners in Canada is outdated and non-evidence-based, stupid, and weak. When we cannot confront what is wrong, what is wrong comes for us anyway.
This is all so grubby isn’t it? Psychiatry would like us to think they are a ‘science’ (good luck with that!) but on this evidence they cannot even claim to be an ‘artform’ unless it’s ‘Surrealism’ because the behaviours of psychiatry & psychiatrists in the Western world are becoming ever more peculiar as they tie themselves in knots which have been lashed by cronyism and a need to feign logic, data and decency where none exists.
If I were in Canada I would be noting down McMaster (and the names included in this blog) as a place to avoid on the basis that it can’t be trusted, can’t provide clear and open answers to perfectly sensible requests and seems to have an ‘open door policy’ (my words) about how each psychiatrist can work, which might include using junk (and very probably *imo* fraudulent) science as their professional evidence base. In so doing they appear utterly cavalier regarding the warning from both sides of the Atlantic that those in their department who might wish to use GET on patients with ME run a high risk (I’d say a 100% chance if patients have been properly diagnosed) of causing harms.
So to sum up, what they think of both Lubet, and patients (given the context in which Lubet framed his queries)is: you aren’t worth a reply; we can believe whatever the heck we each want to believe; and we don’t give a **** if we make you more ill than you are already. Is that really how a department at a University should be behaving? If it was a kindergarten spat, fair enough, but these are the very people that those going through, possibly, the worst times of their lives look to for answers. This is where I require a ‘shrug emoji’ because eventually we just run out words to express the sheer mindf**kery of how these people operate, don’t we?
Regarding plasticity of the brain there is probably a mad scientist somewhere currently working on inter-species creations that will enable amphibian like humans to grow extra/or replacement limbs. If I can take it upon myself to speak for the collective what we want is bottom up medicine not top down. In ‘Dystonia Self-Help Groups’ there is talk of doctors at the top of their speciality preventing younger doctors investigating treatments that visibly help patients. In deliberately denying the facts in order to protect their reputation they are constructing walls between patients and healing.
Thanks Steven, this is really appreciated.
Speaking from experience, it’s true that McMaster University has no clue when it comes to Myalgic Encephalomyelitis or Chronic Fatigue Syndrome.
I recall that some years ago CDC’s Elizabeth Unger stated (boasted?) that three-quarters of US clinicians believed that “CFS” is psychological. This attitude is considered a feature, not a bug.
Recently NIH officials flatly refused to issue public statements that would correct public perceptions. They are deliberately and knowingly harming us. And laughing in our faces as they do it.
“we do not have a “prevailing view” on this topic”
Perhaps Professor Lubet should have started with more basic questions like:
What is McMaster’s prevailing view of leeches and blood-letting?
What is their view of miasma?
Do physicians really need to wash hands before delivering babies?
Thanks for following up on this! We need to aggressively push back on the medical professional and those who distribute harmful information and mis-guided clinical treatment.
I have had ME for over 11 years, and I have undertaken every possible (logical) treatment option in an attempt to get my life back. I have experienced incrementally small improvements. I am now working with one of the best neuropyschiatrists in Canada, to help reduce the pain that comes with my illness. I feel so privileged to get to work with him, as he is a brain specialist, and that is what I need to help rewire my synaptic responses to the feedback they’re getting from my nociceptors. I am very clear that there are many difficult aspects of this disease, and it will take many different medical approaches to solve our illness.
Is there any way we can get our hands on the McMaster teaching materials on ME/CFS?
I am reminded of a McMaster University family doctor who was planning a brain retraining study and made a presentation about a preliminary study about the effectiveness of it for patients with ME and FM. To be honest, Ontario patients, just like all Canadians, have been totally left behind and patients are at the mercy of physicians with the idea that the BPS model of care is the best. In fact all 3 programs that exist are based on the BPS and not based on science. Thank you for reporting David, and i use ‘behavioral’, humor and diarrhea spelling, usually not in the same sentence.
This is very upsetting for me on a personal level. I live in Burlington, which is next door to Hamilton. When I was looking for a new doctor I chose a clinic that had McMaster residents in their practice. The family health clinic is associated with McMaster University. My thinking was that the young minds of the residents may be eager to learn more about M.E. That hasn’t happened and now I understand the very poor quality of care I receive from my family doctor. She most likely has received her M.E. medical information from the staff at McMaster. (she had never heard of M.E. before I arrived) Little did I know, I was right in the very middle of the hornet’s nest of people thinking it’s all in my head. I’m too sick to shop around for a new doctor and train them, but after reading this, I have no choice.
This article may also explain the horrific treatment I recieved from an anesthesiologis at Joseph Brant Hospital which has a lot of staff educated at McMaster. Just before being put under for a procedure she told me my M.E. “was in my head, you choose to live like this, if you wanted you could stop it and on and on” She spoke in a very condecending and cruel tone. I told her I had lost my job, my home, my car and my life savings, if I could control it why wouldn’t I have stopped it a long time ago. Her response “I don’t know, only you can answer that. You’re probably doing this to get attention. You chose to now be broke and near homeless. Maybe you had better stop pretending and get your life back on track”
She told me she was going to put me under with fentanyl. I explained that I had Multiple Chemical Sensativity and had become allergic to morphine and demerol and ask that she give me a small drop to see if reacted to it before giving me the full dose. She didn’t. She gave me the full dose in one shot. I’m so lucky I wasn’t allergic to fentanyl or I would be dead. All because of a doctors ignorance.
Patricia Jackson : I’m seldom shocked these days but that is a truly shocking narrative. Did you make a complaint? How cowardly to have you in that vulnerable position and to gaslight, full-on abuse you like that?
This is excellent! I wish you would also publish in the mainstream Canadian/Ontario/local media about this. One reason it can continue is that there is never enough *public* accountability. If the big media did an “expose’” on McMaster (and other Canadian) university’s harmful, unscientific practices, then maybe they would start to get the hint? I love this blog, but how many Canadian doctors will see it? How many Canadian patients? (I wish I could do more myself, but being one of the ME/CFS crowd, it is just not in my deck of cards.)