Intended for healthcare professionals


Diagnose and be damned

BMJ 2000; 320 doi: (Published 08 April 2000) Cite this as: BMJ 2000;320:1004

Corroboration is important when children's illnesses are diagnosed

  1. Derek Pheby, director (
  1. Unit of Applied Epidemiology, University of the West of England, Bristol BS16 1QY
  2. 6 Melville Court, Clayton, Newcastle-under-Lyme, Staffordshire ST5 4HJ
  3. 4 Rawden Place, Riverside, Cardiff CF11 6LF
  4. King's College Hospital, London SE5 8AF

    EDITOR—Marcovitch's arguments about treatment of the chronic fatigue syndrome (myalgic encephalomyelitis) in children are illogical.1 He writes of the “hatchet job” performed by Panorama in the programme of 8 November and refers to the Washington Post's policy that news requires corroboration.

    One of the responses to his article, by Wessely [published here, p 1005], states, “contrary to the message of the programme, the management of chronic fatigue syndrome in children is not contentious.”2 In referring to a case reported by Panorama Marcovitch states that “parents' views and those of the local medical team were in conflict.” Yet the programme made clear that the dispute was between the parents supported by their own medical advisers and the local medical team, so perhaps there is greater disagreement than has been asserted.

    Marcovitch discussed at length Munchausen's syndrome by proxy; Panorama labelled one of the cases of myalgic encephalitis as being a case of this syndrome. No one likes receiving emotional, intemperate outbursts, even from people who think they have been wrongly accused. But what is sauce for the goose is surely sauce for the gander. Even doctors sometimes make mistakes, yet Marcovitch disregards the possibility that parents, knowing themselves innocent, may feel themselves to have been receiving exactly the same type of vituperative attack that he objects to when doctors are on the receiving end. Such allegations turn on fact rather than clinical opinion so should be subject to Marcovitch's own test of corroboration.

    Innocent people are made angry by accusations that, if made without justification in any other context, could end in High Court actions for defamation. They often react vigorously to them, to give paramount importance to the interests of their children and to preserve the integrity of their families. Clinical opinion may be highly speculative in nature. …

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