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

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aberrant behaviour that is amenable to cognitive restructuring and exercise, a notion that the PACE Trial
seems designed to support.
The MRC PACE Trial Principal Investigators
There are three PACE Trial Principal Investigators and all are mental health professionals. Why two
psychiatrists (Professors Peter White and Michael Sharpe) and a behavioural therapist (Professor Trudie
Chalder, a former mental nurse who works with Wessely and who is now Professor of Behavioural
Psychotherapy) should be in charge of an MRC clinical trial relating to ME/CFS, a neurological disease, is ‐‐
like so much to do with this trial ‐‐ a matter open to conjecture. Professors White, Sharpe and Chalder all
have fixed beliefs about patients with “CFS/ME” which remain uninfluenced by the substantial biomedical
evidence that proves their beliefs to be seriously misinformed.
The Principal Investigators’ insistence that no investigations should be done to define the “CFS/ME” patient
population seems to reinforce the prevalent perception that they are conducting research that will deliver
their intended outcome.
Professor Peter White is the PACE Trial Chief Investigator.
Peter White has long been determined to carry out such a trial: on 2 nd March 1989 he wrote to Dr DA Rees,
the then–Secretary of the MRC, saying: “RESEARCH ON POST‐VIRAL FATIGUE. I understand that the
Medical Research Council may be considering special grant awards for research in this area. If this is the case, I would
like to forewarn you that I shall be looking for funding for substantive projects to test various hypotheses regarding the
physical and psychological aspects of this putative diagnosis…I will be seeking funding…(for) a treatment trial of a
graduated return to physical activity and exercise”.
On 10 th April 1989 Dr Katherine Levy from the MRC replied on behalf of Dr Rees, informing Peter White
that he had been misinformed.
However, Peter White persisted, and the PACE Trial is the result.
Peter White seems certain that “CFS/ME” is a somatoform disorder. In his chapter on CFS in the section
“Psychological Medicine” co‐authored with the late Professor Anthony Clare (Kumar and Clark: “Clinical
Medicine”, August 2005: pp1281 ff), White states:
“Abnormal illness behaviour occurs when there is a discrepancy between the objective somatic pathology present and
the patient’s response to it…’Functional’ disorders are illnesses in which there is no obvious pathology or anatomical
change in an organ…The psychiatric classification of these disorders would be somatoform disorders. Examples of
functional disorders (include) fibromyalgia, chronic or post‐viral fatigue syndrome, multiple chemical sensitivity,
irritable or functional bowel syndrome, irritable bladder syndrome.
“CFS: There has probably been more controversy over the existence and aetiology of CFS than any other functional
syndrome in recent years. This is reflected in its uncertain classification as neurasthenia in the psychiatric
classification and ME under neurological disorders….aetiological factors include physical inactivity…Immune and
endocrine abnormalities noted in CFS may be secondary to the inactivity…The general principles of management of
functional disorders (include) cognitive behaviour therapy (to challenge unhelpful beliefs and change coping strategies)
and graded exercise therapy (to reduce inactivity and improve fitness). However, few patients regard themselves as
cured after treatment…Outcome is worse with…the conviction that the illness is entirely physical. Perpetuating
(maintaining) factors include avoidant behaviours (and) maladaptive illness beliefs”.