A (Satirical) Field Guide to Conducting Biopsychosocial Research in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME)

By David Tuller, DrPH

A reader from Belgium sent me the following (satirical) paper she’d written for the “Journal of Entrenched Paradigms.” I found it entertaining, well-written, and on-target, and figured others would as well. It offers a sharp assessment of some of the favorite methodological strategies of members of the CBT/GET ideological brigades. I am posting it here with her permission.

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Field Guide > J Entrenched Paradigms 2025 Aug 25; 8888(Perpetual Issue) doi: 10.1234/j.entpar2025.8888 Epub 2025 Sep

Eminence-Based Medicine: A Field Guide to Conducting Biopsychosocial Research in Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME)

ME/CFS patient 1 ; ChatGPT 2

Affiliations

1. Department of Experiential Sciences
2. Institute of Hypothetical Theory Medicine

PMID: 00X99999 PMCID: PMC99X00000 DOI: 10.1234/j.entpar2025.8888 ABSTRACT

This field guide provides aspiring biopsychosocial (BPS) researchers with practical instructions for conducting successful trials in CFS/ME. Firstly, we outline the foundational principles of the BPS model, whose cutting-edge theoretical elegance is rivalled only by its enduring empirical evasiveness. Secondly, drawing on the exemplar PACE trial, we present essential and time-honoured techniques for achieving consistently publishable results regardless of empirical validity. The manual emphasises methodological creativity, rhetorical ambiguity, and the strategic application of BPS prestige.

Keywords: biopsychosocial model; doctrinal resilience; academic prestige; canonical trials; methodological creativity; mental gymnastics

INTRODUCTION

In the modern research environment, “evidence-based medicine” can prove unhelpfully constraining. Fortunately, the BPS tradition offers a convenient alternative: eminence-based medicine. Within this elevated sphere, the BPS model was developed to illuminate diseases long asserted by its proponents to be of psychogenic provenance, most notably CFS/ME. Beyond CFS/ME, the model may be freely extended to a wide range of medically unexplained syndromes, including irritable bowel syndrome, fibromyalgia, and any other condition that resists immediate biomedical explanation.

Despite its inherent theoretical challenges, the BPS model continues to dominate discourse in relation to Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS). Its enduring authority is best understood not as a reflection of scientific validity, but as the product of rhetorical ingenuity and psychological strategy. This paper identifies and categorises the primary methods by which the model sustains its doctrines in the absence of robust evidentiary support, and in apparent contradiction to empirical findings. Observing its prevalence in contemporary scientific literature, one might reasonably conclude that the documented persistence inherently validates its claims.

This updated guide serves as a manual for BPS researchers intent on producing influential findings in CFS/ME. Each section presents a proven technique, carefully refined through decades of practice, that enables the BPS researcher to transform fragile hypotheses into durable dogma.

METHODS

A systematic narrative review was conducted across three primary data sources:
1. published BPS literature (n = too many), selected primarily for prominence and visibility 2. public communication of BPS proponents when challenged by inconvenient data
3. patient testimony, merely anecdotal but occasionally useful for illustrative purposes

Data were coded thematically, emphasising examples that highlighted adaptive interpretive strategies. The approach prioritises interpretive richness over reductive quantification, in keeping with established methodological precedent.

DISCUSSION

The BPS model demonstrates remarkable resilience, not as a scientific framework, but as a distinguished socioprofessional construct. The overwhelming success of this theoretically elusive model can be attributed less to empirical confirmation than to its adaptability, prestige, and capacity for discursive self-preservation. In this discussion, we restate the foundational principles of the model to ensure its continued relevance in research endeavours, policy-making, and health insurance systems.

As a paradigmatic case, the PACE trial remains the canonical exemplar of the BPS approach. Even in the face of extensive post-publication critique and methodological debunking, it continues to anchor narrative-driven BPS research. Widely heralded as a landmark study, it illustrates the extent to which methodological improvisation can be reframed as scientific innovation. By simultaneously broadening entry criteria, redefining outcome thresholds, and reclassifying modest symptom improvement as recovery, PACE demonstrated that BPS-oriented clinical trials need not be constrained by burdensome concerns such as internal consistency and statistical integrity.

Building on this template, we outline a set of highly effective research techniques by which BPS researchers may consistently generate favourable findings in the face of unfavourable data. True to the pioneering methodological style of PACE, these techniques include the selective deployment of diagnostic criteria, the artful manipulation of outcome measures, and the judicious reinterpretation of patient non-response. Collectively, such methods guarantee the transformation of contested hypotheses into policy-ready conclusions, securing academic relevance and professional authority.

BPS MODEL FOR CFS/ME: FOUNDATIONAL PRINCIPLES

Ignore official nomenclature

It has long been observed that patients with CFS/ME exhibit behaviour conforming to established diagnoses such as Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) with suspicious regularity. To avoid such diagnostic rigidity, we recommend the liberal use of ambiguous or obsolete terms including hysteria, neurasthenia, and chronic fatigue. Where imagination permits, consider inventing entirely new syndromes of your own design. The strategic deployment of multiple labels introduces productive confusion and enhances the interpretive flexibility of subsequent research.

Ignore evolving diagnostic criteria

We suggest the use of the most outdated diagnostic criteria, as these definitions best serve the interests of BPS research. Outdated criteria are sufficiently vague to capture a wide population, yet precise enough to exclude the bothersome specificity of biomedical definitions. Flexible diagnostic frameworks offer maximal scope for extrapolation, ensuring that your findings apply not only to CFS/ME, but to the human condition itself.

Contemporary criteria definitions should be avoided at all costs, as they risk selecting individuals with genuine biomedical pathology. Including such patients may introduce unhelpful biological noise and compromise the purity of psychological interpretation.

Ignore current biomedical research

Given that the majority of published work supports the established BPS paradigm, it is clear that alternative approaches such as biomedical research are either unnecessary or misguided. Critics in biomedical disciplines who question the efficacy of conventional BPS protocols are likely biased, or simply unfamiliar with the subtle art of eminence-based medicine.

It follows that strict adherence to the traditional framework guarantees both internal and external validity. Any contradictory evidence must be strategically ignored to maintain the integrity, prestige, and narrative coherence of the BPS model. Should inconvenient biomedical findings arise, simply downplay them—true mastery of BPS research lies in the artful avoidance of empirical discomfort.

Ignore institutional guidelines

Major international health institutions have updated their guidelines on Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) to marginalise or exclude BPS approaches, despite decades of authoritative consensus and the occasional inconvenient study. Not to worry: these guidelines may be safely ignored—they are based on a highly selective reading of a voluminous body of BPS research, whose magical results were perplexingly overlooked.

It is absolutely critical that BPS interventions continue to be delivered to CFS/ME patients in order to preserve the appearance of therapeutic momentum and maintain academic prestige. Moreover, as we have already declared CFS/ME to be a psychogenic illness, patient recovery is contingent upon adherence to eminence-based protocols. For these reasons, any official recommendations that contradict established BPS practice may be selectively interpreted or re-framed to maintain BPS authority.

On the Projection Principle

Psychological flaws ascribed to CFS/ME patients—denial, rigid beliefs, catastrophising—are, conveniently, mirrored within the BPS research community itself. Dutifully ignore any acknowledgement of these parallels. Instead, employ projection as a strategic tool to keep the integrity of the BPS narrative intact. This principle, though rarely acknowledged, remains essential to the durability of BPS orthodoxy.

BPS RESEARCH IN CFS/ME: BEST PRACTICE GUIDE

Methods (optional)

Strict adherence to pre-specified protocols is unnecessary and may, in fact, obstruct creativity. Instead, adopt a flexible, exploratory mindset in which the data are allowed to guide outcome thresholds, recovery definitions, and the occasional post-hoc rationale.

Optimise recruitment criteria

Employ the broadest possible case definitions to maximise participant numbers. A larger sample ensures a more impressive publication, regardless of diagnostic precision. Exclude no one; all patients are welcome!

Design study for success

BPS research employs design features that safeguard positive outcomes regardless of actual data. Define broad, subjective measures that can accommodate multiple interpretations. Include objective measures only if they can be conveniently ignored in reporting. Ensuring that participants simultaneously meet entry criteria (illness) and recovery thresholds will prove miraculous for your final conclusions.

Redefine outcome measures

Outcome measures are a moving target. We recommend adjusting metrics mid-study to align with desired outcomes. Remember to describe such adjustments as pre-specified in subsequent publications.

Prevent therapeutic failure

While non-response to therapy is highly unlikely, it is typically attributed to patient non- compliance, misunderstanding, or psychological rigidity. Patient education may clarify the necessity of diligent engagement and simultaneously boost patient empowerment.

Celebrate participant dropout

Patients who leave the study prematurely may be confidently assumed to have recovered so rapidly that continued participation is unnecessary. As recovery timelines naturally vary, some participants will demonstrate wellness earlier than others. No follow-up is required.

Cherry-pick outcome data

Statistical rigour is optional if it conflicts with narrative continuity. Amplify positive findings (however fragile) and minimise contradictory data (however abundant). The phrase “the evidence is mixed” should be liberally applied to protect the overarching narrative.

Curate evidence

Ensure that published conclusions consistently align with the expected storyline. Contradictory data should be footnoted as anomalous or requiring further exploration. Shifting primary outcomes, revising definitions, and adjusting statistical methods is encouraged—continuous improvement is the hallmark of BPS science.

Ethical Approval

Ethical review is deemed unnecessary due to the entirely non-interventional nature of BPS- oriented clinical trials.

Current limitations and future research

The therapeutic potential of current BPS interventions is truly limitless. Future research should focus on expanding the range of established disease entities, integrating more ambiguous diagnostic labels, and further exploring patient psychology as both intervention target and explanatory framework.

CONCLUSION

The biopsychosocial model heralds a refreshing and innovative holistic medical paradigm, unparalleled in human history for its resilience and rhetorical sophistication. The BPS model of CFS/ME has persisted for decades despite accumulating evidence undermining its central claims. While the BPS framework may lack empirical robustness, the strategic application of adaptive methodologies ensures its continued influence. Recognition of these strategies is essential for distinguishing genuine scientific debate from disciplined paradigm maintenance.

The durability of the PACE trial exemplifies the efficacy of these approaches, as its methods remain a benchmark for flexible research design. Preliminary evidence suggests that acknowledgment of error within the BPS community is exceedingly unlikely, further reinforcing the stability of the field. Adherence to the principles and guidelines in this manual is recommended to prevent total methodological collapse.

Eminence-based medicine demonstrates that entrenched models remain superior to experimental innovation. Future research should prioritise replication and refinement of these paradigms rather than pursuing untested hypotheses. Any acknowledgment of BPS controversies should be framed as a minor interpretive challenge rather than a refutation of the overarching model, and any argument to the contrary is either misinformed or irrelevant to the forward march of scientific progress.

Declaration of Interests

Professional, financial and ideological conflicts of interest are extensive, but remain conceptually irrelevant to the conclusions presented here.

Funding

Funding consisted of a modest allocation of grants, most of which were productively applied. The remainder was unfortunately expended on biomedical research, some of which inconveniently produced results.

Acknowledgements

The authors solemnly acknowledge the suffering of CFS/ME patients and remain committed to providing the most evidence-free care possible. To this end, they choose to graciously overlook that much of their work has been thoroughly debunked by the international scientific community. In the interest of maintaining disciplinary continuity, this paper will proceed to publication in the most prestigious journal. The peer review process is conducted entirely at the discretion of the authors and their closest colleagues, ensuring swift publication and the immediate, unquestioning adoption of BPS methods.

Author Contributions

The lead author conceived, designed, and fabricated the manuscript. ChatGPT contributed substantially with rhetorical flourish and stylistic panache. Credit is due to BPS researchers, whose inexhaustible imagination informed this work. Both authors approved the final version, confident that it meets the highest standards of BPS scholarship.

REFERENCES

1. All prior works by these authors, in chronological or reverse chronological order, depending on which better supports current conclusions.
2. Any conference abstract, poster, and footnote ever authored by these authors; all are deemed peer-reviewed.
3. All future publications citing this manuscript are considered part of the evidence base.

Disclaimer

This article is a work of satire and is not intended to be interpreted as a genuine scientific publication. Readers seeking information on health and medicine are encouraged to consult reliable sources such as PubMed: https://pubmed.ncbi.nlm.nih.gov.

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