Peter White, Trudie Chalder, and Michael Sharpe respond to an article written by George Monbiot that featured in the Guardian on the 18th of October. The letter in response to this article is entitled: ‘A dualistic view of illness doesn’t help those with ME/CFS‘.
Please note: The second letter from Dr Jake Hollis is not defending the use of CBT and GET
Extracts
We agree with George Monbiot that the death of Maeve Boothby O’Neill was tragic and should have been avoided. Unfortunately, Monbiot draws generalisations from her sad death that are based on a view of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) that is itself outdated
Monbiot suggests such illnesses are generally thought of as either physiological or psychological. This is an outdated dualistic view of any illness, let alone ME/CFS. It has been shown that many such illnesses are the result of a dynamic interaction between biological, psychological and social mechanisms. Just one example of our own research showed the important role of certain viruses in triggering the illness.
Monbiot goes on to reject rehabilitative treatments, such as cognitive behavioural therapy and graded exercise therapy, based on research that he suggests was flawed. Yes, this research, some of which we led, has been criticised by some, but it remains valid; no relevant paper has been withdrawn and many systematic reviews and meta-analyses have found the approaches to be beneficial. Remarkably, the National Institute for Health and Care Excellence (Nice) has indeed rescinded its previous support for these treatments, leaving patients with no evidence-based ways of getting better.
MEA Comment
This is a predictable response in the first letter to the Guardian from three people who are clearly very unhappy that the new NICE guideline on ME/CFS no longer recommends the use of graded exercise therapy (GET) as a treatment for ME/CFS.
This decision was made on a very thorough examination by the NICE guideline committee of all the clinical trials involving GET (which failed to demonstrate any significant benefits) and a substantial amount of evidence from people with ME/CFS who had been harmed by GET.
Fortunately, I don't think there is any possibility that this important and very welcome decision will be reversed.
Dr Charles Shepherd,
Trustee and Hon. Medical Adviser to the ME Association,
Member of the 2018-2021 NICE guideline on ME/CFS committee,
Member of the 2002 Chief Medical Officer's Working Group on ME/CFS
Update: Further Letter from Dr Jake Hollis – 27th October 2024
Dr Jake Hollis has written an additional letter to The Guardian, published on the 27th October 2024, further clarifying that he does not defend the use of CBT or GET for ME/CFS.