For the past several years, it has seemed as though physicians in the U.S. and the U.K. have been speaking different languages about Chronic Fatigue Syndrome (also known as Myalgic Encephalomyelitis or ME/CFS). The British medical establishment has remained firmly in the grip of the PACE school, which insists that ME/CFS symptoms are primarily the psychosocial manifestations of "unhelpful cognitions" and “dysfunctional illness beliefs,” which can be “reversed” by means of Cognitive Behavior Therapy (CBT) and graded exercise therapy (GET). American researchers, however, have increasingly rejected the CBT/GET theory – and the discredited PACE trial on which it is based – in favor a biomedical model.
Significant advances in identifying biomarkers – as the first step toward an effective medical therapy – have been made in major laboratories at Columbia, Stanford, Cornell, and other leading universities. In 2015, the National Academy of Medicine (then called the Institute of Medicine) issued an important report concluding that ME/CFS is a biological illness, but it seemed to have almost no impact on the other side of the Atlantic, where psychiatrists continued to dominate ME/CFS treatment and research.
It now appears, however, that the situation may finally be about to change, with the issuance of a new “Best Practice Guide” from the influential BMJ Publishing Group. (BMJ originally stood for British Medical Journal, one of the two leading medical journals in the U.K.) The new report, authored by Dr. James Baraniuk of Georgetown University, rejects the CBT/GET theory and comes down firmly in favor of the biomedical model:
[T]he prospect that CBT can change the illness beliefs of a patient, and that graded activity can reverse or cure CFS, is not supported by post-intervention outcome data.
The publication of this report in the U.K. may well be an inflection point in ME/CFS treatment and research, as it basically demolishes the reigning British paradigm of the illness and specifically points out the ineffectiveness, and the potential harm, of CBT and GET.
The estimable and invaluable David Tuller and I have posted an analysis of the Baraniuk Report on the Virology Blog. Here is the gist:
Something has changed.
That’s the only explanation for the recent publication of a “Best Practice” guide for “chronic fatigue syndrome” (behind a paywall, unfortunately) from the BMJ Publishing Group. This thing is good. It’s very good, in fact. One bottom line at this stage for any treatment guide is the following: Would it lead a clinician to prescribe cognitive behavior therapy or graded exercise therapy for patients with ME, as opposed to those suffering from a vague fatiguing illness? The answer here is an unequivocal no.
The guide doesn’t refute the PACE trial by name. It doesn’t have to. With its strong emphasis on the many physiological dysfunctions that characterize the illness, the guide represents a refutation not only of PACE itself but of the deconditioning/fear-of-exercise hypothesis—the foundational myth of the CBT/GET cult. It is hard to imagine that any organization associated with the British medical and academic establishment would have published this document just two years ago, before patients’ concerns about the PACE trial mushroomed into an international scientific scandal. Someone over at BMJ obviously understands that the field has moved beyond the simplistic and unproven claims of the biopsychosocial field.
You can read the full post here.
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