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Pressure grows on Lancet to review “flawed” PACE trial

BMJ 2018; 362 doi: (Published 22 August 2018) Cite this as: BMJ 2018;362:k3621

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Mitochondrial dysfunction in ME/CFS needs testing and treating Re: Pressure grows on Lancet to review “flawed” PACE trial

John McLaren-Howard, Sarah Myhill and Norman Booth have shown that myocardial dysfunction is an important diagnosable and treatable cause of myalgic encephalitis or chronic fatigue syndrome. It is not sensible to expect patients with severe mitochondrial dysfunction to exercise before the underlying causes of mitochondrial dysfunction have been diagnosed and treated. These usually include important essential nutrient deficiencies and toxic metals like nickel, cadmium, or dental mercury amalgams.1-3

Carolyn Wilshire and colleagues have raised serious concerns about the robustness of the claims made in the PACE trial that a fifth of patients with chronic fatigue syndrome recovered with the use of cognitive behaviour therapy (CBT) and graded exercise therapy (GET). They showed that modest treatment effects obtained on self-report measures in the PACE trial did not exceed what could be reasonably accounted for by participant reporting biases.4,5

Mitochondrial dysfunction in ME/CFS needs testing and treating and four women are affected for every one man. In my experience this is because most have taken progestogens and/or oestrogens for contraception or HRT. Hormone use lowers zinc, increases copper levels, lowers copper stores and increases toxic DNA adducts.6

It is to be hoped that mitochondrial dysfunction and essential nutrient testing will become more widely available.

1 Myhill S, Booth NE, McLaren-Howard J. Targeting mitochondrial dysfunction in the treatment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) - a clinical audit.
Int J Clin Exp Med. 2013;6(1):1-15. Epub 2012 Nov 20.

2 Booth NE, Myhill S, McLaren-Howard J. Mitochondrial dysfunction and the pathophysiology of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS).Int J Clin Exp Med. 2012;5(3):208-20.

3 Myhill S, Booth NE, McLaren-Howard J. Chronic fatigue syndrome and mitochondrial dysfunction.Int J Clin Exp Med. 2009;2(1):1-16. Epub 2009 Jan 15.

5 Wilshire CE, Kindlon T, Courtney R, Matthees A, Tuller D, Geraghty K, Levin B. Rethinking the treatment of chronic fatigue syndrome—a reanalysis and evaluation of findings from a recent major trial of graded exercise and CBT. BMC Psychol 2018;6(1):6. doi: 10.1186/s40359-018-0218-3.

5 White PD, Goldsmith KA, Johnson AL, Potts L, et al. Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial. Lancet. 2011;377(9768):823–836. doi: 10.1016/S0140-6736(11)60096-2.

6 Howard JM. The detection of DNA adducts (risk factors for DNA damage. A method for genomic DNA, the results and some effects of nutritional intervention, J Nutr Environ Med 2002;12:19-31

Competing interests: No competing interests

23 August 2018
Ellen C G Grant
Physician and medical gynaecologist
Kingston-upon-Thames. Surrey