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

Wessely School members have long been charged with misusing science to support their particular bias.
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For example, in 2003, in the spirit of correcting misinformation Dr Linda Goodloe, a biopsychologist,
commented on a paper that was co‐authored by Trudie Chalder (Illness perceptions and levels of disability
in patients with chronic fatigue syndrome and rheumatoid arthritis. R. Moss‐Morris et al. J Psychosom Res
2003:55:4:305‐308): “This study is an exceptional example of misusing science to support a particular
bias…Biased assumptions permeate both the design and interpretation of data of this study…The bias is not subtle and
appears in every step of the analysis. However the main fault is in the design of the experiment. To even begin to
discuss differences in ‘perceived disability’ between groups, the authors would have to find some way of controlling for
any symptom differences, and this study doesn’t even mention that there ARE any symptom differences, much less
factoring them into the design. Symptom differences between these groups is such a huge source of error that it makes
using these differences to make inferences about psychological states bizarre. There is nothing in the design of the
experiment or the data to justify even floating the suggestion that the perceptions of the (ME)CFS group are
less valid or less grounded in reality than those of the RA group. The authors ignored the large body of
knowledge, the documented findings of irregularities in assorted (immunological, neurological, hormonal,
gastrointestinal etc) systems in those with (ME)CFS that are not shared with RA subjects. However, the bottom line is
that even without the biased interpretations, the methodology doesn’t meet even the most minimally acceptable
standards” (Co‐Cure ACT: 23 rd September 2003).
Other illustrations include the following:
The study by Sue Butler, Trudie Chalder, Maria Ron and Simon Wessely (JNNP: 1991:54:153‐158) was
remarkable for its inexplicably high refusal and drop‐out rates, lack of a control group and no independent
assessment of outcome; it was criticised in a Cochrane Review on CBT for CFS (2000: issue 4) for its poor
scientific quality and for not excluding medical causes of fatigue; furthermore the design failed to permit the
effects of concurrent antidepressant therapy to be satisfactorily distinguished from purely psychological
treatments (with grateful acknowledgement to David Sampson and to Dr Charles Shepherd for the analysis
which was taken from his book “Living with ME”).
The above study would be of little interest were it not for the fact that in the original study there was an
unacceptably high refusal and drop‐out rate, whilst an almost identical study published in 1997 by the same
authors showed these rates to be much lower (American Journal of Psychiatry 1997:154:408‐414).
In this 1997 study of 60 patients, half received CBT in the form of “graded activity and cognitive restructuring”
and half received “relaxation”. The authors stated: “CBT is used to modify behaviours and beliefs that may
maintain disability and symptoms”. Three subjects withdrew from the CBT group and four withdrew from the
relaxation group. The authors stated that at final follow‐up (six months after the course of CBT and
relaxation completed), 19 patients “achieved good outcomes compared with 5 patients in the relaxation group”.
Somatisation disorder and severe depression were cited as exclusion criteria; nine participants, however,
were described as having ‘major depression’ and there were high levels of existing psychiatric morbidity in
the study cohort. Outcome measures were said to relate to “subjectively experienced fatigue and mood
disturbance, which are the areas of interest in chronic fatigue syndrome”. This statement alone indicates that the
study cannot have been considering people with ME/CFS because neither “fatigue” (or “tiredness”) nor
mood disturbance is a defining feature of ME/CFS (the defining feature of ME/CFS being post‐exertional
muscle fatigability with malaise).
Of concern is the fact that the authors stated: “The aim was to show patients that activity could be increased
steadily and safely without exacerbating symptoms”. That is a remarkable statement. It demonstrates that the
authors had decided ‐‐ in advance of the outcome ‐‐ that activity could be increased without exacerbating
symptoms. This is not merely the authors’ hypothesis: that this will be the outcome is taken for granted. Of
note is the fact that the outcome did not meet the authors’ certainty, and the authors had to concede that:
“cognitive behaviour therapy was not uniformly effective: a proportion of patients remained fatigued and
symptomatic”. Perhaps for this reason, the presentation of results was mostly reported as averages, rather