Intended for healthcare professionals

Feature Medical Research

Dangers of research into chronic fatigue syndrome

BMJ 2011; 342 doi: https://doi.org/10.1136/bmj.d3780 (Published 22 June 2011) Cite this as: BMJ 2011;342:d3780

The use of objective measures and studies designed to disprove beliefs will ensure scientific progress.

I'm sure that Peter White and Simon Wesselly must
be at least as disappointed with the PACE results as anyone. The
improvement in self perceived levels of fatigue, though modest, appears
genuine enough. They must have been bitterly disappointed that the
patients showed no objective improvements despite such a rigorous
application of CBT. I would submit however that this would not appear to
be the fault of Simon Wesselly or Peter White. It seems clear that the
original protocol was changed and the initial objective end points
removed. This is clearly unsatisfactory for both psychiatrists and
patients, as the inclusion of these end points would have settled the
debate once and for all.

The problem appears to be reflective of a much wider phenomenan which
has developed in Psychiatry and the sciences since the second world war.
There appears to have been a virtual breakdown in communication between
the two philosophical school. Psychiatry has not imported any discoveries
from neuroscience and the latter discipline rejects the proposals of
psychiatry. A classic example was the interaction between the deputy
editor of the BMJ and the panel of scientists in the recent Invest in ME
conference in London. The lady, who was obviously committed to her cause,
volunteered to help the scientists design studies using statistical
methodology favoured by the BMJ. She was obviously not aware that
scientists had been using such methodology before such practices entered
the field of medicine. It would be such a shame if such a genuine offer
to help was intrepreted as an insult. I feel she was undeservedly
lampooned for this perceived gaff. The response of the panel however must
be applauded. Instead of ascribing the worst possible intentions to the
lady's words, they sat smiling and displayed the tolerant attitude that
promises much for future collaboration. When she attends next year to
discuss the adoption of scientific methodology, which can (given time and
willingness) lead to a cure for this devastating illness, let us hope that
mutual tolerance and open communication prevails.

I feel that sufferers of ME/cfs would be wiser to focus on
deficiencies in study methodology than on personalities. If psychiatrists
wish to avoid criticisms then they would be wise to adopt the scientific
method in its entirety. They would then be immune from accusations of
bias. The use of objective measurements and designing studies to attempt
to disprove their belief, that the cause of the illness is a psychological
one, would quickly dispel anger and suspicion within the patient
community.

Competing interests: No competing interests

27 June 2011
David Nash
Patient Adovocate
UK