By David Tuller, DrPH
This week, a journal under the umbrella of the British Journal of General Practice published–and a day later unpublished–a laudatory piece about the Lightning Process from a Lightning Process practitioner. The author, Anna Chellamuthu, is also a GP at Royal Cornwall Hospital. She wrote that the controversial program combining neurolinguistic program, osteopathy and life-coaching cured her daughter of ME/CFS and inspired her to train in the technique herself.
The article in BJGP Life was called “Reflections on NICE, CFS/ME, and the Lightning Process.” It functioned as both a tirade against the new ME/CFS guidelines from Britain’s National Institute for Health and Care Excellence and an advertisement for an unproven commercial intervention. The new NICE guidelines, issued last October, explicitly advise against offering ME/CFS patients the Lightning Process.
Dr Chellamuthu has her own site for her Lightning Process practice and takes umbrage at this negative recommendation. She claims it runs counter to the evidence and is based on misunderstandings of the LP. Here’s how she starts her piece: “I have never (not knowingly, anyway) disregarded a NICE recommendation before now.” And it goes on from there, accusing NICE of “using opinions over facts to act in a discriminatory way towards the LP.”
To support her argument, Dr Chellamuthu naturally cites the discredited pediatric Lightning Process study from Bristol University’s methodologically and ethically challenged grant magnet, Professor Esther Crawley. Another key reference is a review paper from Phil Parker, the Lightning Process founder himself, that appeared in the Journal of Experiential Psychotherapy, published the Romanian Society of Experiential Psychotherapy in partnership with the University of Bucharest.
Given the hot-button nature of the topic, the article drew quick responses from Lightning Process critics—that is, people who value proper science and dislike self-promotional material appearing as reasoned opinionating. Among the respondents was Jonathan Edwards, emeritus professor of medicine and University College London, who had made a presentation on evaluating evidence to the NICE committee developing the ME/CFS guideline.
In his letter to Dr Euan Lawson, the editor of BJGP, Professor Edwards put the matter succinctly: “This is straightforward advertising by misinformation masquerading as professional comment. It makes no difference that the author may feel a righteous desire to misinform people.” (Full text of Professor Edwards’ letter below.)
Dr Lawson initially responded to the outpouring of negative remarks under the article by noting that the author’s commercial interests as an LP practitioner were clearly disclosed and thanking commenters for engaging in the debate. It seems he soon reconsidered. By today, the article had been disappeared—or, in the journal’s language, “unpublished.” Note to Dr Lawson: Is that the same as “retracted”?
Here’s what Dr Lawson wrote in an editor’s note dated March 4th:
“It is somewhat ironic that no sooner was the March issue published where I mention post-truth and we run into a dispute around evidence on BJGP Life. I wrote in the Briefing: “Publishing research is a business that deals with verifiable facts; the BJGP’s commitment is to strive to be accurate and, if we get it wrong, to correct the record with full transparency.”
It has to be emphasised that we don’t publish research here on Life — this is our platform for debate, discussion, viewpoint and opinion. That certainly means that we will publish online content that will sometimes arouse impassioned comment. We do want the content to be accurate and I stand by that commitment to full transparency.
On Thursday 3rd March 2022 we published an article titled: Reflections on NICE, CFS/ME, and the Lightning Process. (It is possible you have been re-directed to this page after clicking on a link for that article elsewhere on the internet.)
We felt there were important areas the article covered: the experience of being a GP parent to a child with ME/CFS; and the experience of working clinically outside of guidance (and this does happen to many GPs in many circumstances) are certainly worthy of coverage.
While we stand by the need to discuss and debate all these areas, we recognise the legitimate concern that this article offered a platform to an intervention and a commercial interest which hasn’t got a clear evidence base. On reflection, after discussion in the editorial team, and in consultation with some members from the Editorial Board, we have taken the decision to unpublish the article. I’m sorry for any distress this has caused. We will remain a space for lively debate for practising clinicians.
Many thanks for your feedback.”
It must be said that this minimalist and opaque explanation is not very satisfying. It would be interesting to know, for example, who made the decision to publish the piece in the first place, and on what basis? Were concerns raised about the apparent promotion of an unproven modality by a practitioner claiming success among her patients? Was there a specific piece of evidence or input that exactly caused the turnaround?
**********
Professor Jonathan Edwards’ letter to the editor of BJGP
Dear Dr Lawson,
The piece by Chellamuthu on NICE and ME is, as you should realise, unacceptable in a medical professional journal. Your comment below it does not excuse the publication. It looks naïve.
This is straightforward advertising by misinformation masquerading as professional comment. It makes no difference that the author may feel a righteous desire to misinform people.
I have no personal interest in ME but got involved eight years ago having been asked to advise on research quality, based on my experience with clinical studies in immunology. I don’t see clear evidence of immunological change in ME but I realised that people with ME have had a poor deal and that almost all the research supporting therapies is too poor quality to be usable. Notably that includes work from establishment psychiatry.
The piece refers to NICE by insinuation without evidence. It is an insult to Peter Barry and Ilora Finlay who worked very hard to maintain quality analysis. As far as I know not a single person on the committee favoured use of Lightning Process despite the fact that half the committee consisted of professionals with vested interests in research and delivery of non-pharmacological therapies (which the committee decided were not justified either).
The inuendo directed at patients is totally unprofessional. Material like this should not be permitted any more than anti-vaxx propaganda for Covid. The Lightning Process involves brainwashing and, as I indicted in my witness statement for NICE, use of such methods is unethical in the absence of meaningful evidence of efficacy. A few people miraculously recover* (often becoming LP coaches) but so do people given ineffective drugs like rituximab. For those who do not recover, being told by LP practitioners that the illness is all their own fault is inhumane.
I have been very disappointed to see people like Clare Gerada and Helen Stokes-Lampard weighing in with spurious arguments supporting therapies in ME. I was even more disappointed to see Andrew Goddard do the same. You have written a piece about being political in medicine. I rarely get involved but if there is something worth tackling it is the recent trend to allow personal promotion to take precedence over evidence in a way that will harm people. Being righteous is not enough, whether in ecopolitics or medicine. You actually have to make sure you are not doing harm. I think BJGP has allowed itself to be involved in potential harm. You would do well to think hard about it.
Yours sincerely,
Jonathan Edwards
Professor Emeritus
UCL
*I think a medical professional giving information about their child’s health in a journal may be a breach of confidentiality. It seems to indicate a complete lack of understanding of others’ interests.
Comments
20 responses to “British GP Journal Retracts “Opinion” About Lightning Process Written By LP Practitioner”
Unpublishing without mentioning why the article was published in the first place, and then taken down, is the antithesis of transparency, and leaves behind a very bad example.
‘Publish and don’t remove unless someone complains’ is a very low bar for quality.
If an astute person who knew the paper was unacceptable hadn’t noticed, would the article still be there, pretending to be true? Doesn’t say much for the editors, does it?
As pointed out by Professor Edwards on S4ME, a certain Prof. Carolyn Chew-Graham is on the editorial board of the journal.
A coincidence I’m sure.
https://www.s4me.info/threads/uk-dr-anna-chellamuthu-gp-and-lightning-process-practitioner-and-her-article-in-a-gp-journal.24850/page-4#post-408535
WhenI took my 15 year old son with his agreement (diagnosed age 13 with ME) to a private former NHS Allergist and ME consultant, I was treared bt local paediatrician as a harming FII mother……
Just sayong it appear diffetent rules applied here. Exposing a.very sick child (claimed to have ME) to sessions of 3 hours or more was potentislly misguided possibly dangerous.
My son would.not have ben able to sustain 5 minutes! I know, as that’s what happened in tbe paediatric OT session locally.
Sorry for annoying typos in my comment….can I edit it?
I think there’s a mistaken widespread belief that doctors are scientists when, on the most part, they are not. (I’m not saying that there aren’t exceptions.) It seems that they are trained in medical school to believe and do what they are told by their superiors, rather than to question and scrutinize the evidence, so it’s unsurprising to me that they appear to fall for pseudo-scientific propaganda so readily. Association and causation are often confused and anecdotes (or token “case-studies”) may be far more accessible and memorable than the good science is.
I’d suggest that, rather than being well-trained scientists, GPs are mostly practitioners of what they believe to be correct. As such, generally, they will bow to and obey the NICE guidelines, but occasionally they may follow or submit to a different or higher order when they believe it’s right to do so. The concern then is what that other order might be. It’s good that doctors aren’t compelled to adhere to NICE guidelines – the recent changes to the guidelines for ME have demonstrated that they haven’t always been best for patients. However, if our doctors choose not to follow the NICE recommendations, I think it would be wise for us to grill them on their reasoning, to ensure that they’re not replacing that advice with their own personal (even madcap/cultish) beliefs and that any deviation they take from the set path is backed up by evidence that we find convincing.
Following on from my previous comment –
Patients should be told when their doctor’s advice is not in tune with, or goes against, the NICE recommendation so they can make their own mind up whether to follow it or not (or see another doctor).
Following on from CT’s observations, many patients who saw the article before it was ‘unpublished’ , raised issue with the notion that the GP who wrote the article also, at her own website, ‘Dr Anna’, seems to claim some sort of synergy between her use of the Lightning Process and her Christianity thus:
“I personally have found that the Lightning Process has given me tools to enable me to put my Christian faith into practice on an even deeper level.
‘Be transformed by the renewing of your mind’ (Rom 12:2). I think that the concept that our brains have the ability to actually change according to how we use them is actually a very biblical one.
The Lightning Process teaches tools which can enable us to ‘take thoughts captive’ (2 Cor 10:5). Becoming aware of our thoughts and how they affect us and learning to change this is one of the key parts of the Lightning Process. ‘…whatever is true, whatever is noble, whatever is right, whatever is pure, whatever is lovely, whatever is admirable – if anything is excellent or praiseworthy – think about such things’ (Phil 4:8).”
(The latter is the word according to Philippians, not Phil Parker, although one might wonder in this context!).
She concludes by saying “The Lightning Process is a way of making this a daily reality. The impact on health is astounding”.
What does the GMC say about this? Under ‘Personal Beliefs and Medical Practice’ point 54 says:
“You must not express your personal beliefs (including political, religious and moral beliefs) to patients in ways that exploit their vulnerability or are likely to cause them distress.”
Given LP is a spurious therapy which demands its patients / followers (call them what you will) to deny their own reality (see Joan McParland’s useful Medical Error Interview by Podcast, search for ” “I have been conned” – When sick patients are sold psychological snake oil”), surely adding a ‘Christian’ dimension to support her thesis is exploitative of those who have a Christian faith? I’d add that having been brought up in a very fervently Evangelical Christian home that I’d be surprised if most Evangelical Christians would agree with her tenuous con-joining of Bible texts to substantiate her (presumably lucrative) practice? Surely this is exploitative? Has anyone made a GMC complaint against her I ponder? There seem to be reasonable grounds.
In response to Barbara’s comment –
So doctors are allowed to disagree with NICE recommendations and disregard them when they feel so inclined, without any repercussions, but parents aren’t allowed to seek a different opinion for their sick children without being accused of FII?
NB I’m not suggesting they should have to follow NICE guidelines or face accusations of abuse themselves, (see my first comment), but surely there shouldn’t be one rule for them and another for everyone else?
According to the editor, “[LP] hasn’t got a clear evidence base.”
Actually the evidence is very clear that LP is quackery and telling young people to deny their symptoms is child abuse.
I keep expecting to see a real campaign to get rid of the new NICE guideline. If this awful article is the best the Royal Societies can come up with, then the guideline will stand and we will only have to wait another decade or two before its principles are finally accepted by the medical industry.
The following was posted on youtube by Phil Parker after the guidelines were finally released: https://www.youtube.com/watch?v=Cj-JjqrOs6M
He obviously wasn’t happy about his pet being advised against, and at least those who looked up who he was could see this was just ranty anger about this.
So this BJGP Life article is worse, because it seems to be that but under the pretence of not being ‘from the LP’ as an advert.
The article/comment, I’d personally say it was advertorial, was from an LP practitioner – NOT a GP with declared interests.
Comparing and contrasting what she wrote with what Phil Parker (and/or other stooges he may have doing the LP coaching) would have written leaves only her story from her own personal website as light between the two. This is easily done by looking up what he writes.
For Euan to think that he has published comment from a GP, with her GP hat on – taking a view on ‘working outside guidance’ (her daughter wasn’t her being a GP but a mother) is either disingenuous or deluded.
Even the response from the publications raises huge issues regarding entryism/lack of awareness regarding what they have done and what this happenning represents.
In the post David Tuller, DrPH asks:
… Is that the same as “retracted”? …
One would think that should have been disclosed … so we would not have to ask or look through the voluminous Retraction Watch (Retracted Science Papers) database.
LP doesn’t tell anyone to deny their symptoms. It isn’t brainwashing and patients who don’t recover are never told it’s their fault.
I suppose that the only way we can really know what a therapy entails is to see and hear it in action e.g. via a video recording that has been verified by all the people present.
The patients are sworn to secrecy about what the lightning process therapy actually consists of which is highly irregular. If people knew what it consisted of they would be much less inclined to try it at great expense. The therapy is all about being positive basically you proclaim to the world you are cured after a weekend course of brain washing no matter how you are actually feeling(very handy for the lightning process practitioners) then they claim its a miraculous cure. I have some personal knowledge
as my son tried it years ago and came home after the weekend white as a sheet and clearly unwell and he is still ill.
Worth resurrecting one of David’s former posts: https://www.virology.ws/2019/08/21/trial-by-error-joan-mcparlands-lightning-process-experience/
“Trial By Error: Joan McParland’s Lightning Process Experience”
It does make me wonder why the Lancet is so supportive of the PACE trial. I think UK doctors should be providing patients a letter when they deviate from all NICE guidelines to including the lightning process otherwise they are at serious risk from both GMC and litigation claims. ME patients and their families may need to start complaining.
It does make me wonder why the Lancet is so supportive of the PACE trial. I think UK doctors should be providing patients a letter when they deviate from all NICE guidelines to including the lightning process otherwise they are at serious risk from both GMC and litigation claims. ME patients and their families may need to start complaining.
The Oxford/Cambridge dictionaries should be updated with the entry:
The ‘Lightning Process’: implausible, unproven, hyped and expensive — in other words, quackery
Thank you David for all your hard work once again.
To think a GP would find the LP of interest for the Medical Profession, because of her Christian beliefs . This is so wrong !
Iv now heard it all for the last 45 years that iv had severe M.E.
When is all this nonsense going to stop ?
l now fear for Long Covid Patients. Something has to be done urgently.
My brother in law was extremely ill with Covid then dx with Long Covid . He couldnt work due to his symptoms of Long Covid ,but after 11 months encouraged to go back to work. He collapsed after 4 days !! and now dx with serious heart problems. He had no heart problems before. He will unlikely ever work again.
As a M.E patient l was encouraged to go back to work, even though l was in lots of neurological pain and on very high pain killers. My M.E turned severe after 6 months.
LP supporters want us to shut up and just go away.
It’s impossible….we are not able to shut up and we are definitely not just going to go away !
Please have a look at the NHS covid recovery program. It looks like a rehash of GET. It also looks like the onus to recover is on the patient . It will be interesting to see if they give an honest account of the numbers that have “recovered” and what criteria they have used.