By David Tuller, DrPH
When it comes to ME and ME/CFS, The BMJ—formerly called The British Medical Journal but now, like the food franchise once known as Kentucky Fried Chicken, officially reduced to a mere acronym—is a long-time champion of the “biopsychosocial” ideological brigades. (I use the “scare quotes” because the term is a misnomer, given that these experts focus pretty much exclusively on the “psycho” and “social” while largely ignoring the “bio” part of the equation.) So it should not surprise anyone that The BMJ recently published yet another ignorant and misguided screed from this crew—a commissioned opinion piece titled “Patients with severe ME/CFS need hope and expert multidisciplinary care,” from Miller et al. (I first posted about this propaganda piece a few days ago.)
Indeed, The BMJ, and the many other titles under the BMJ publishing umbrella, have for decades provided opportunities for the GET/CBT zealots to air their theories about deconditioning and problematic illness beliefs as causal factors for ME/CFS—theories now extended to Long Covid. A 1989 letter written by Dr Melvin Ramsey, an early ME researcher, reveals the historical nature of this prejudicial and biased approach.
Dr. Ramsey investigated the 1950s disease outbreak at London’s Royal Free Hospital, the event that subsequently gave rise to the name “myalgic encephalomyelitis.” In 2021, an invaluable Twitter (now X) account, Royal Free 1955, which has released an impressive archive of relevant documents, posted Dr. Ramsey’s letter. In the letter, addressed to someone named Edith, Dr. Ramsey discussed the challenges he was confronting in trying to publish ME-related research. Here’s the key section:
“For many months we have been in difficulty by the influence exerted by a psychiatrist, Dr. Simon Wessly [sic] who has secured for himself the position of referee to the BMJ whose Assistant Editor has been strongly anti-ME and we cannot get anything published in British medical journals in our favor. Simon Wessly cuts right across my fundamental tenet of “rest” for chronic M.E. cases and tries to get them admitted to Psychiatric Units where they are immediately put on vigorous exercise.”
The BMJ’s skewed view of this issue continued during the reign of Dr Fiona Godlee, the previous editor in chief. I had many go-round with Dr Godlee, who stepped aside in 2021, over some of the nonsense published in various BMJ journals during her tenure. That included the report on the fraudulent pediatric study of the woo-woo Lightning Process conducted by Professor Esther Crawley, Bristol University’s ethically and methodologically challenged pediatrician and grant magnet. (Professor Crawley has since retired from the university and from medical practice, for reasons that have not been publicly explained. No great loss!)
That clinical trial, published in 2018 in BMJ’s Archives of Disease in Childhood, violated core principles of scientific research, rendering its findings unreliable and essentially uninterpretable. Specifically, the authors recruited more than half the participants before the trial was formally registered, and swapped primary and secondary outcomes after having collected much of their data. All major medical journals have policies forbidding such actions, none of which were revealed in the published trial report. The paper should clearly have been retracted. Instead, it now carries a 3,000-word correction and a 1,000-word editorial note offering tortured but unconvincing excuses for why it was re-published with the exact same findings.
Dr Godlee’s successor was Dr. Kamran Abbasi. I have had prior dealings with Dr Abbasi as well. He was formerly the editor of the Journal of the Royal Society of Medicine. During his tenure, the journal published a seriously problematic paper whose authors included Professor Sir Simon Wessely and Trudie Chalder, King’s College London’s mathematically and factually challenged professor of cognitive behavior therapy. The paper was called “Cognitive Behavioural Therapy for chronic fatigue and CFS: outcomes from a specialist clinic in the UK.”
Among other concerns, the authors made causal claims of success for their intervention even as they acknowledged that their observational study was incapable of documenting causal relationships. Dr Abbasi refused to take any corrective action. We ended up publishing our critique as a full-fledged paper in the Journal of Health Psychology.
In other words, Dr Abbasi protected Professor Sir Simon, Professor Chalder and their colleagues from accountability for their indisputable errors. His failure to pursue the necessary steps to ensure the accuracy of the scientific literature was extremely disturbing and represented a violation of his responsibilities to both the field of medicine and the general public. Dr Abbasi’s decision revealed his true colors—and his biased approach to this issue. No one should expect anything different from him during his stewardship of the BMJ stable of publications.
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Snippets from some of the rapid responses
The recent opinion piece has now racked up more than a dozen rapid responses, many of them quite eloquent in their expressions of dismay at the bogus arguments advanced by the authors. I’ve included a few quotes from these responses here.
Elke Hausmann, GP in Derby: “There are thousands of us, including many doctors with Long Covid or ME, who argue that continuing to invest in researching mind/body approaches is taking away from the real research we need, into understanding the underlying pathophysiological mechanisms at play in ME and Long Covid, which has always been where progress in medicine and medical treatments has come from.”
Tom Parsons, severe ME patient in Sussex, England: “The so-called biopsychosocial approach is continuously presented as a new and cutting-edge approach to treating people with ME/CFS when it has been the dominant treatment paradigm in this country and elsewhere since the 1990s and, in that time, its advocates have failed to produce any good quality evidence that these approaches help people recover any significant degree of functioning. To present these approaches as exciting new science is, to borrow a phrase, serving old wine in new bottles.”
David Putrino, neuroscientist and professor at Icahn School of Medicine at Mount Sinai, along with more than a dozen other experts and patient advocates: “Miller et al continue to promote the unsubstantiated claims that ME/CFS is deeply rooted in psychosomatic aetiology and occurs due to a combination of deconditioning and “unhelpful illness beliefs.” They argue that “the patients’ belief that they won’t recover can harm their mental wellbeing.” These assertions lack credible scientific basis, contradict current NICE guidelines, and risk causing further harm to people with ME/CFS.”
Dom J. Salisbury, patient advocate in Lancashire, England: “In their opinion piece, Miller and coauthors ignore PEM when listing common symptoms of ME/CFS. This is an attempt to continue framing this illness as belonging to a family of ‘fatiguing conditions’, which, along with other ‘medically unexplained symptoms’, they argue can be treated with psychological interventions and rehabilitation.”
Michiel Tack, patient in Hulst, The Netherlands: “The view that ME/CFS is maintained by unhelpful thoughts and behavior is poorly supported by current evidence and may unfairly blame patients for their illness and failure to recover. This model has been tested in the past with disappointing results, which is likely why NICE no longer recommends it.”