Professor David’s Third Mis-Citation of Seminal Study of “Medically Unexplained Symptoms”

By David Tuller, DrPH

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I have recently blogged about the multiple mis-citations of a seminal study involving so-called “medically unexplained symptoms” (MUS). The 2010 study, Bermingham et al, found that the amount spent by the National Health Service on working-age people who were assessed as “somatising” accounted for around 10% of what was spent on that population. Since the study was published more than a decade ago, experts in MUS have routinely misrepresented it by asserting that these costs accounted for 10% of total NHS expenditures—in effect more than tripling their apparent financial impact.

The costs of addressing MUS have been cited regularly as a reason to increase psychological services for patients identified with the conditions that qualify for such a diagnosis. Under its current framework, the NHS’ Improving Access to Psychological Therapies program considers anyone with ME/CFS, irritable bowel syndrome and other ailments without a clear etiology to be suffering from MUS. That makes them all eligible to be shunted immediately from primary care to IAPT interventions, which are mostly variations on cognitive behavior therapy.

On April 17th, I wrote to Professor Anthony David, a neuroscientist at University College London. I was seeking information about why he hasn’t yet corrected this mistake in a paper of which he is the senior author–even though another paper he co-authored was corrected for the same mistake 18 months ago.

Professor David, an expert in the MUS field, was formerly at King’s College London, home to some of the leaders of the biopsychosocial ideological brigades. KCL luminary Professor Sir Simon Wessely is a co-author on the un-corrected paper. Another KCL scholar, Professor Trudie Chalder, was the senior author of the paper co-authored by Professor David and corrected in October, 2019, after I wrote to her and BMJ Open, the journal that published it.

Two days ago, I sent a follow-up note to Professor David after I was alerted by a smart observer to yet another paper of which he is the senior author that includes the same mis-citation. (This one also featured a misspelling–“Birmingham” instead of “Bermingham.”)  For Professor David, that’s three separate mis-citations of Bermingham et al–or at least that’s the number we know of.

I have not heard back from Professor David. Whether he responds or not, I do hope he follows through with quick corrections of the two uncorrected papers. And if he made the same mistake elsewhere, I hope he corrects those instances as well so I don’t have to bother pointing them out.

To be clear: I’m not suggesting that Professor David or anyone mis-cited Bermingham et al deliberately. I assume it happened unintentionally and, over the course of a decade, the false “fact” self-replicated in the literature because no one bothered to double-check it–or noticed that it was wrong if they did double-check it. And why would that be? Perhaps because the higher cost meshed nicely with the interests and perceptions of those mis-citing it in the first place. Confirmation bias at play.

This rote repetition of untrue information happens routinely in journalism. In this case, the dissemination of the inaccurate data point has the potential to impact public health policy, and perhaps it already has. Given the significance of the error, it seems fair to ask those who have made it to explain how it happened and why other claims they make should be taken at face value. Yet when asked that kind of question and others suggesting problems with their data or argumentation, members of this cohort of investigators have seemed to prefer to utter words like “harassment” than to provide reasonable and credible responses.

Below is my second letter to Professor David.


Dear Professor David–

I have noticed that a 2016 paper on which you were the senior author contains the same misstatement about Bermingham et al as the two more recent papers that I have already highlighted. The 2016 paper, “Medically unexplained visual loss in a specialist clinic: a retrospective case–control comparison,” was published in the Journal of the Neurological Sciences. I have cc’d the corresponding author on this e-mail, and again Vincent Racaniello, Columbia’s Higgins Professor of Microbiology and host of Virology Blog. (Incidentally, in the paper “Bermingham” is misspelled as “Birmingham.”)

The 2016 paper includes this sentence: “In estimation of the associated health costs of medically unexplained symptoms, Birmingham [sic] & colleagues propose that healthcare utilisation amounts to £3billion per annum, or 10% of total NHS expenditure.” Clearly, this needs to be corrected, since the figure actually represented 10% of NHS expenditures for the working-age population and only about 3% of “total” NHS expenditures. 

For what it’s worth, the title of Bermingham et al itself specifies the age parameters of the study population, so the repetition of this false information across a decade continues to mystify me. Any explanation you might offer to help me understand this phenomenon would be much appreciated.

Thanks for your quick attention to this matter. I look forward to seeing the corrections in both this paper and the more recent one in Psychological Medicine


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


14 responses to “Professor David’s Third Mis-Citation of Seminal Study of “Medically Unexplained Symptoms””

  1. CT Avatar

    How could these authors not have seen this error, IF they’d read the Bermingham et al paper? Rather than those poor patients, I’m starting to think that these UK professors must be the ones suffering from functional vision loss. Confirmation bias at play? I’m not sure that I’d be that generous. Mistakes can arise for other reasons too, like laziness and corner-cutting.

  2. SusanC Avatar

    Back when I was a grad student, they told me to always actually read a paper that you cite, rather than relying on what other authors claim the paper says. Often, when you read the paper, it doesn’t say what people claim it does.

    This , of course, is how (before pandemic) I found myself in a reading room at the British Library, hoping they at least had a copy of an book so I could check that it actually says what everyone citing it claims it says. The British Library had”lost” their copy of the book too. (i.e. some reader stole it, probably).

    [Explanation for non-UK or non-academics: The British Library is entitled to a copy of everything published in the UK. They don’t always exercize their right to have a copy, and they may have lost it, but there’s a reasonable chance…]

    P.P.S. If the book you want is very recent or very old, its probably online. Recent enough to still be in copyright and old enough to not be in SpringerLink etc. is the problem area.

  3. CT Avatar

    Some journals state that all authors are expected to have read all the papers that they cite. I think the rot in the UK probably set in when doctors started getting financially rewarded based on the research that they’d done rather than on how good they’d been at practising medicine. If you get rewarded for the number of research papers that you produce (rather than for their quality) then the temptation will be to share the work with others, share authorship and cut corners. You can probably tell the good doctors out there, the ones who are truly committed to giving their patients the best possible care, not by how many research papers they’ve produced but by how few!

  4. Lady Shambles Avatar
    Lady Shambles

    That made me chuckle.

    I’m also interested in this careful phrasing: “false “fact” ” . Personally I’d call it ‘a lie’ albeit we don’t know if it was done deliberately (badly done) or through lack of reading the title of the paper they keep banging on about ( also badly done).

  5. CT Avatar

    See 10th paragraph here – – for what the Countess of Mar said about Anthony David, (but it’s useful to read from the 8th). I assume it’s the same Anthony David?

    And from this - it appears that Professor David nominated Wessely for the John Maddox Prize.

  6. Lady Shambles Avatar
    Lady Shambles

    CT: your first link to Hansard doesn’t take me to where I need to be.. even allowing for repasting the URL without hyphens. Is it possible to copy the text I wonder?

  7. SusanC Avatar

    I am starting to notice that almost all the bad research in this area comes from the same university department. (It is either authored by someone from the offending department, or was refereed by someone from there).

  8. Lady Shambles Avatar
    Lady Shambles

    CT: thank you that works. I remember watching the debate live. It was less a debate and more an orchestrated sandbagging of the CoM. Imo Lord Winston’s part in this was notably reprehensible.

  9. CT Avatar

    Lady Shambles: I can’t see that Lord Winston took part in that Lords debate I linked to. Do you mean this one about the PACE Trial - ? I watched that one and agree that it was not at all pleasant to watch. Lord Layard, of IAPT – let’s categorize England’s ME patients as having MUS and code them all with somatization disorder – fame, took part in that 2013 debate about the PACE Trial too and wrapped it up by bringing up death threats and by paying tribute to Simon Wessely. It was a truly nauseating spectacle, IMO.

    Getting back to Anthony David, Wessely puts him on somewhat of a pedestal, looks up to him, it seems. ‘Nuff said.

  10. Lady Shambles Avatar
    Lady Shambles

    CT: yes silly me. Brain like the proverbial sieve. I was making the giant leap in my muddled brain that I was re-reading the infamous PACE debate which you’ve usefully added. I’ll return to hibernation where I’ll make more sense of the world!

    Worrying to think Wessely has a hero!

  11. CT Avatar

    Lady Shambles wrote: “Worrying to think Wessely has a hero!”

    See - (from 1:19:00 to 1:21:15 )

    If you watch this clip you’ll also learn that Prof David apparently had a h-index of 90 when this panel discussion was held. I believe that means that, up to that time, he’d had 90 papers published that had each been cited by others 90 or more times. Hmm.

  12. jimells Avatar

    It’s amazing how the psychobabble crowd has so thoroughly infected the UK medical establishment. There is a new IBS guideline titled “British Society of Gastroenterology guidelines on the management of irritable bowel syndrome” [1]. One of the authors is our old pal Rona Moss-Morris, a name familiar to many ME patient advocates.

    It will come as no surprise to dedicated cynics that the *very first* treatment recommendation is … EXERCISE! And of course “psychological therapies” are highlighted with its very own section. Patients can choose from “Gut-directed hypnotherapy” or “IBS-specific cognitive behavioural therapy”. They are both highly recommended.

    What really stands out in the guideline is that almost every recommendation comes with the notation “quality of evidence: low” or worse. The message is clear that low quality research evidence is good enough for patients. I wonder if the guideline’s authors would think low-quality was good enough for their personal automobile.


  13. Nancy Mik Amos Avatar
    Nancy Mik Amos


    Living as a hepatitis B patient for five years. I discovered it when I gave birth to my first child. I was given an admission to the university to study nursing but they don’t allow me to do what l like most. Am so happy to be negative today After using HBV HERBAL FORMULA I purchased from Worldherbsclinic online. Going back to study again is my greatest joy.