By David Tuller, DrPH
Professor Trudie Chalder recently published a systematic review of CBT and GET studies for “chronic fatigue syndrome” in the journal Psychological Medicine, which seems to publish anything from the CBT/GET ideological brigades, no matter how poorly conducted or reported. Not surprisingly, given its provenance, the review was a piece of crap, as I noted in a recent post. I wrote a letter to the journal about it. Not surprisingly, they rejected it. Also not surprisingly, I responded. Below is our exchange.
Correspondence re: “A systematic review of randomized controlled trials evaluating prognosis following treatment of adults with chronic fatigue syndrome” (published September 5th, 2022)
Dear Dr Tuller,
Thank you for submitting to Psychological Medicine. Your manuscript has been evaluated by our editors.
I am sorry to inform you that your manuscript, although interesting, was not assigned to external peer review…
I hope you will find a suitable publication forum for your manuscript. Our editors would be happy to evaluate future reports of your research projects
They do not think that the issues are sufficiently novel to allow them to assign your paper the priority necessary for publication.
Thank you for giving us the opportunity to see it.
On behalf of the Editor in Chief
(I cc’d the two top editors, Professors Murray and Kendler)
Thank you for the response.
I am not surprised that the editors of Psychological Medicine do not consider the issues I have raised to be “sufficiently novel” to warrant their concern. This is, after all, the same Psychological Medicine that in 2013 published the highly misleading and arguably fraudulent article on “recovery” in the PACE trial, which tested cognitive behaviour therapy (CBT) and graded exercise therapy (GET) as treatments for chronic fatigue syndrome (now often called ME/CFS). As a reminder, the PACE team–including Professor Chalder, the senior author of the systematic review under discussion–weakened all four of the “recovery” thresholds outlined in the protocol. These post-hoc changes created a nonsensical and even surreal situation in which participants could get worse on the study’s primary outcomes and still be found to have “recovered.”
The PACE investigators did not mention any oversight committee approval of these dramatic changes in “recovery” thresholds. That omission presumably meant they did not obtain such approval and unilaterally decided to tweak their outcome measures in ways that ensured more attractive results than the null findings yielded by their original protocol strategy. When I wrote directly to the editors of Psychological Medicine about the paper’s peculiar anomalies and its violations of reporting norms–matters that patients had already raised through standard correspondence–they refused to acknowledge such disqualifying issues.
Instead, Professor Murray suggested that I seek to replicate the PACE trial.
Psychological Medicine continues to publish specious papers in this domain, with the recent systematic review finding benefits from CBT and GET being a prime example. Among other flaws, this supposedly comprehensive assessment fails to mention that the National Institute for Health and Care Excellence (NICE) flatly rejected Professor Chalder’s favored therapeutic interventions in its most recent guideline for ME/CFS, which was published a month before submission of the review to Psychological Medicine. Professor Chalder and her colleagues might dislike the fact that NiCE has reversed course on ME/CFS–but it has. And that means the systematic review was out-of-date the moment the journal published it.
In short, Psychological Medicine is providing core public relations support for a group of methodologically, ethically and factually challenged investigators seeking to promote and defend their misguided and unproven theoretical construct. The journal’s actions are an insult to the scientific enterprise and to honest researchers everywhere.
David Tuller, DrPH
Senior Fellow in Public Health and Journalism
Center for Global Public Health
School of Public Health
University of California, Berkeley