‘From harmful ‘therapies’ to social services referrals, the notion that this illness is psychosomatic is having devastating effects‘
It’s the greatest medical scandal of the 21st century. For decades, patients with ME/CFS (myalgic encephalomyelitis/chronic fatigue syndrome) have been told they can make themselves better by changing their attitudes. This devastating condition, which afflicts about 250,000 people in the UK, was psychologised by many doctors and scientists, adding to the burden of a terrible physiological illness. Long after this approach was debunked in scientific literature, clinicians who championed it have refused to let go. They continue to influence healthcare systems, governments and health insurers. And patients still suffer as a result.
by George Monbiot, The Guardian
Article extracts
ME/CFS saps sufferers of energy and basic physical and cognitive functions, confining many to their homes or even their beds, often shutting down their working lives, social lives and family lives. The extreme seriousness of this condition, and the fact that there is neither a diagnostic test nor a validated treatment, places a special duty of rigour on doctors and researchers. But patient care has been compromised, and useful research inhibited, by the lingering conviction of many practitioners that ME/CFS is “psychosocial”: driven by patients’ beliefs and behaviour…
You can trace the origins of this model to a paper published in 1970. Without assessing a single patient or interviewing a single doctor, it blamed an earlier outbreak of post-viral ME/CFS on “mass hysteria” based on case notes alone. The reasoning included the fact that the outbreak affected more women than men. For centuries, doctors have been readier to classify women’s illnesses as hysterical or psychosomatic than they have men’s. ME/CFS, like long Covid, hits women harder, so, the thinking goes, it must be all in the mind.
The NICE Guideline
In 2007 this belief system became official guidance: the National Institute for Health and Care Excellence (NICE) advocated two treatments arising from the biopsychosocial model of the disease: graded exercise therapy (GET) and cognitive behavioural therapy (CBT). In 2011, a major study, the Pace trial, part-funded by the Department for Work and Pensions, claimed to show that GET and CBT were effective in treating ME/CFS. The study later turned out to be biased and profoundly flawed…
We now know that patients were right to resist interventions that have proved to be both useless and harmful. The impacts were often horrific. A study in Switzerland found that the most powerful factor contributing to suicidal thoughts among people with ME/CFS was “being told the disease was only psychosomatic”…
In 2020, an independent review by NICE found that the quality of all the research promoting GET and CBT was either “low” or – mostly – “very low”. A paper reported that the thresholds in the 2011 PACE study at which patients were deemed to have recovered had been altered after the trial began. Several studies concluded that GET was actively harmful , as the exercise regime it promoted could worsen patients’ symptoms, causing post-exertional malaise. One paper reported that it was detrimental to the health of at least 50% of patients.
As a result, in 2021 NICE concluded that GET and CBT should not be used to treat ME/CFS (though more conventional CBT can help patients with the psychological impacts of the illness). Similar shifts had already happened in the United States and the Netherlands. The condition is now correctly recognised as a physiological illness. Last month, a paper in the journal Nature Communications proposed a possible physiological mechanism for the condition.
But some people never give up. Despite an overwhelming weight of evidence, the old believers, including Sharpe and Wessely, have continued to try to justify their model, obliging NICE recently to publish a strong refutation. Protected by powerful friends in the media, they could breathe life into their hypothesis long after it had been debunked. The new evidence-led thinking has yet to penetrate parts of the health system: some patients are still being mistreated.
This is not how science should work. Beliefs should be based on evidence. In medicine, there is a double duty: respect the evidence and listen to patients. There is a psychological intervention that could improve the lives of people with ME/CFS: an apology and recognition of the harms they have suffered.