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

38
functional deficiency of the B vitamins, particularly pyridoxine, but also of riboflavin and thiamine.
The study involved only 12 patients, yet the conclusion states: “But clearly, many patients with CFS
are currently taking vitamin and other supplements with little evidence of benefit”. If the study involved
only twelve patients, to conclude that “many” patients show “little evidence of benefit” from taking
supplements is remarkable, but it does concur with section 9.20 of the 1996 Joint Royal Colleges’
Report (CR54), which states: “We have concerns about the use of complementary therapy and dietary
interventions”, a statement that is in accordance with the published views of HealthWatch, of which
Wessely is a”leading member of the campaign” (see below)
• advising Government bodies that the reported biomedical abnormalities “should not deflect the
clinician away from the biopsychosocial approach and should not focus attention towards a search for an
‘organic’ cause”, and for their recommendation that no advanced tests should be carried out on
“CFS/ME” patients when it is those very tests that reveal the unequivocally organic nature of the
disorder (Joint Royal Colleges’ Report 1996: CR54).
When the Centre for Reviews and Dissemination (CRD) at the University of York produced its 2005
Systematic Review of “evidence‐based” (mostly Wessely School) studies on behavioural interventions for
ME/CFS that was commissioned to support the 2007 NICE Clinical Guideline 53, there was much concern
throughout the ME/CFS community, not least because some of the studies had used the Oxford criteria
which, by definition, excluded those with ME.
The 2005 Systematic Review was an update by Bagnall et al of the CRD’s own 2001 Systematic Review by
Whiting and Bagnall et al (JAMA 2001:286:11:1360‐1368). The 2005 Systematic Review was exposed in a
comprehensive analysis by Hooper and Reid as a travesty that many people believed amounted to research
misconduct (http://www.meactionuk.org.uk/FINAL_on_NICE_for_Gibson.html).
Hooper and Reid pointed out that the Bagnall et al (York) Review cited the same Wessely School papers as
in their first (2001 JAMA) review but with a significant difference: virtually all the negative comments about
CBT/GET that had appeared in 2001 in JAMA had been removed from the 2005 up‐dated review.
This meant that the same team’s negative comments about methodological inadequacy, withdrawal rates,
drop‐out rates, unacceptability of treatments and the exclusion of severely affected patients were omitted
from their up‐dated review, as were their previous observations which recorded that (i) improvements
might be illusory, (ii) there was no objective evidence of improvement, (iii) there was little lasting benefit
from CBT, and (iv) the data in the Wessely School studies relied upon had been corrupted. Furthermore,
previous reports of adverse events were excluded, as was the fact that follow‐up revealed relapse after the
interventions.
Despite the acknowledgement by the 2001 team of the paucity of good quality evidence to support the
recommendations of CBT/GET, none of these previous observations was mentioned in the 2005 up‐date
for NICE. All negative comment, no matter how eminent the source, was simply removed to the extent
that it seemed inescapable that Bagnall et al had been subjected to covert external influence. As Hooper
and Reid noted: “It would be most unfortunate if a powerful outside influence has been able to impose his
own concepts on a team of supposedly neutral reviewers”.
Even more disturbingly, not only had those caveats disappeared from the 2005 version, but citation of the
JAMA 2001 article in which they had appeared was also deleted. In 2001 Bagnall’s work appeared in one
of the world’s most prestigious medical journals (JAMA) but in 2005 she disowned her own 2001 work
and there is abundant evidence that in 2005 Bagnall was prevailed upon to dilute or delete opinions she
held in 2001, a matter that some considered to be research misconduct. What rationale could possibly
underlie this astonishing self‐censorship?