NICE guidance: Daily Telegraph, November 19

November 19, 2007

The Daily Telegraph's medical columnist, Dr James Le Fanu, discusses CBT and graded exercise in today's paper.

Common sense would suggest it is unwise for doctors to claim a treatment is effective when the patients on the receiving end insist otherwise.

Yet this happens more often than one might suppose, most recently in relation to chronic fatigue syndrome, which affects about a quarter of a million people in Britain.

Last week, the One Click pressure group announced it is taking legal action challenging the policy of the National Institute for Health and Clinical Excellence (Nice) that a combination of cognitive therapy and the related strategy, graded exercises, offer "the clearest researched evidence of benefit".

This policy would seem to contradict the verdict of those with the illness, nearly three-quarters of whom report that cognitive therapy has "no effect", while the remaining quarter say it makes their condition worse. How can this be?

Put simply, the experts remain wedded to a psychological explanation of chronic fatigue, while those afflicted by it know only too well that it is due to a devastating disturbance of brain function.

They are offered a glimmer of hope by drugs such as sertraline, which boost the level of the neurotransmitter serotonin and are used for the treatment of depression.

Again the "experts" claim the evidence is "equivocal", but the experience of those with chronic fatigue would suggest otherwise – as many have written to inform me. I would be pleased to pass on the details to any sufferers who wish to know more.

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