Commentary: Heading for a therapeutic stalemate

In late May I went with an open mind to the sixth Invest in ME conference in London to listen to research presentations and take part, on behalf of the BMJ, in a concluding panel discussion. Although I was aware of Invest in ME’s stance against the recent PACE trial1 and other research on non-biological approaches, I was heartened by the conference theme: “The Way Forward for ME—A Case for Clinical Trials.” I knew that laboratory science had not yet yielded biological evidence that would lead to large scale clinical trials, so I hoped to hear about trials of health services and supportive interventions to improve patients’ experiences and lives.

I heard about just one clinical trial at the conference, however. Oncologists Oystein Fluge and Olav Mella, from the University of Bergen, talked about their recent placebo controlled trial of the monoclonal antibody rituximab in 30 patients with chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). They had found positive results for some secondary outcomes, but not for the primary outcome (self reported symptoms and quality of life at three months2), so …