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

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attacking ungrateful patients: “Many sufferers are bitterly opposed to (CBT), arguing that their condition is
physical, not psychological. ‘Many patients have a personality which hinders recovery’. ‘ME is an escape
route for the middle classes’ claimed one psychiatrist”. What was not made public was the fact that Rob
Stepney’s wife was one of the Oxford therapists involved with the trial.
On 30 th March 1996 The Independent published a letter from a trial participant (Catherine Rye): “I am a
sufferer and participated in the trial. The article implies that a new successful treatment has been found for ME but
that sufferers do not want to accept it. There are facts about the trial that throw into doubt how successful it is. It is
stated that patients in the control group received standard medical care. I was in that group but I received
nothing. Patients who ‘improved significantly’ only increased their score from 70 to 80 on a scale of general
functional ability”.
Despite having to acknowledge the fact that few patients reported resolution of symptoms, the authors
nevertheless asserted: “The results show that a return to normal functioning is possible in most cases. We
believe that our results have important implications for the management of patients with chronic disabling
fatigue”.
Once again, Wessely School psychiatrists seemed determined to confuse chronic disabling fatigue with
ME/CFS. The ME Association’s Medical Advisor wrote on 18 th January 1996 in The Times: “Although 22
patients out of 30 in the Oxford trial of CBT achieved an improvement of approximately 10% in their disability rating
after a year, the only other two controlled trials of CBT to be published found no benefit from this fashionable form of
short‐term psychotherapy. The ME Association believes that the results so far obtained do need to be viewed with a
considerable degree of caution”.
Notwithstanding, the Sharpe et al study forms the “best practice evidence‐base” for NICE’s
recommendation of CBT for all patients with “CFS/ME” in the UK, including those with ME/CFS.
Another of the PACE Trial Chief Investigator’s studies merits consideration (Lancet 2001:358:9297:1946‐
1953). This study calls into question the validity of the broad‐based definitions such as the Oxford criteria,
largely because the Oxford criteria include patients with mood disorders, which makes any conclusions
about ME/CFS per se virtually impossible.
In White’s 2001 study, fatigue syndromes were classified into three groups and participants were selected
according to (i) White’s own empirically defined fatigue syndrome (Psychological Medicine 1995:25(5):917‐
924), (ii) the Oxford criteria and (iii) the CDC 1994 Fukuda criteria.
White et al had hypothesised that a previous psychiatric history and/or social adversity would predict all
three definitions of fatigue syndromes on the basis of the “psychosomatic” model of “CFS/ME”, but he
found that neither univariate nor logistic regression analyses supported his hypothesis and that the
strongest predictor for developing a fatigue syndrome following infectious mononucleosis was a positive
Monospot result (ie. evidence of infection).
However, White concluded that the most likely explanation for the lack of correlation between previous
psychiatric morbidity and an empirically defined fatigue syndrome was: “that we studied participants in the
first six months of their illness, whereas most previous studies observed patients several years after onset….This
explanation would fit in with the hypothesis that psychosocial factors are unimportant in a fatigue syndrome of several
months duration but may become more important with time”.
White’s explanation, however, is not supported by his data.
White ignored one critical fact: all his fitness measurements were made after diagnosis, so he could have
had no idea of how fit (or how deconditioned) participants were before they became ill, since patients may
become deconditioned when they develop a fatigue syndrome, but this does not mean that such