MAGICAL MEDICINE: HOW TO MAKE AN ILLNESS ... - Invest in ME

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The Canadian Guidelines are rejected by the Wessely School, probably because they do not support the use
of CBT/GET: Dr Bruce Carruthers, Fellow of the Canadian Royal College and principal lead of the
international expert team that produced the highly respected ME/CFS Clinical Case Definition, states in the
Overview ( http://www.mefmaction.net/documents/me_overview.pdf):
“A hypothesis underlying the use of Cognitive Behaviour Therapy (CBT) for ME/CFS is based on the
premise that the patient’s impairments are learned due to wrong thinking and ‘considers the pathophysiology
of CFS to be entirely reversible and perpetuated only by the interaction of cognition, behaviour, and
emotional processes. The patient merely has to change their thinking and their symptoms will be gone.
According to this model, CBT should not only improve the quality of the patient’s life, but could be
potentially curative’. Supporters suggest that ‘ideally general practitioners should diagnose CFS and refer
patients to psychotherapists for CBT without detours to medical specialists as in other functional somatic
syndromes’. Proponents ignore the documented pathophysiology of ME/CFS, disregard the reality of
patients’ symptoms, blame them for their illness and withhold medical treatment. Their studies have often
included patients who have chronic fatigue but excluded more severe cases as well as those who have other
symptoms that are part of the clinical criteria of ME/CFS. Further, their studies fail to cure or improve
physiological impairments”.
At the conference on “CFS” held on 28 th April 2008 at The Royal Society of Medicine, PACE Trial Chief
Investigator Peter White argued that the less symptoms a definition of “CFS” has, the better. To back up his
claim, and using a graph from a study by Simon Wessely, White said: “You notice a fairly straight line showing
the more physical symptoms you have, the more likely you are to meet the criteria for psychiatric distress. The cut‐off
for CIS (Clinical Interview Schedule, revised in 1990 by Wessely School psychiatrist Anthony Pelosi) for
psychiatric morbidity is about 12. So once you get above 4 symptoms – you can see once you get 5,6,7,8 symptoms as
the Canadian criteria suggest, you are more likely to find someone with a psychiatric disorder and not CFS/ME. So I
would suggest you do not use the Canadian criteria” (Co‐Cure ACT: 1 st July 2008).
International ME/CFS experts do not agree with the Wessely School’s dismissal of the Canadian criteria.
Although the 9 th International Association for ME/CFS Research and Clinical Conference (formerly the
American Association for CFS [AACFS] but now the IACFS/ME) held in Reno, Nevada in March 2009 took
place after recruitment for the PACE Trial had ceased, evidence pertaining to the PACE Trial was presented
by Belgian researchers Drs Greeta Moorkens and Elke van Hoof.
A Report of the conference written by Kim McLeary and Dr Suzanne Vernon from the US CFIDS
Association shows that the Belgian research provides yet more evidence of the contra‐indication of CBT for
ME/CFS:
“Dr Moorkens reported that the majority of 180 patients treated with 10 sessions of CBT over six months reported
some improvement but did not show statistically significant improvement on fatigue or physical functioning
scores. Dr van Hoof confirmed earlier studies that show a high percentage (30%) of drop‐outs due to deterioration
during CBT trials (and) her studies do not support large scale application of CBT”. (“ME Essential”, Issue
110, Summer 2009, pp 17‐19).
At the same Reno conference, Professor Leonard Jason, a world‐renowned ME/CFS investigator from De
Paul University, USA, reported in his presentation “Activity Management” that one group of ME/CFS
patients did not benefit from cognitive behavioural interventions: this was the subset of patients whose
laboratory investigations showed them to be the most severely affected and who had increased immune
dysfunction and low cortisol levels. This provides ever more evidence of the need for sub‐grouping ‐‐ a
need to which the Wessely School remains adamantly opposed.
In his Statement presented on 28 th May 2009 to the US CFS Advisory Committee, the new President of the
IACFS, Dr Fred Friedberg, commented on the lack of research into clinical treatment for ME/CFS: