As David Tuller and I explain in a new article on STAT, there is finally some good news from the U.K. on ME/CFS. The influential National Institute for Health and Care Excellence (NICE) has issued a new draft guideline, rescinding it previous recommendation of graded exercise therapy (GET) and cognitive behavior therapy (CBT). This change is a repudiation of the psychiatric school that has been pushing these therapies for decades, on the theory that ME/CFS symptoms are caused by "unhelpful illness beliefs." Most U.S. medical authorities -- including the CDC and Mayo Clinic -- have already stopped recommending GET and CBT, so the NICE draft is an important step toward bringing British medicine up to date, and making it more humane toward ME/CFS patients.
Here is the gist of our STAT article:
In a draft of new ME/CFS clinical guidelines released last week, a key British agency has not only explicitly rejected graded exercise therapy and cognitive behavior therapy as treatments for this condition but also the rationales behind them. The draft from the National Institute for Health and Care Excellence (NICE) acknowledges that there is “no therapy based on physical activity or exercise that is effective as a treatment or cure for ME/CFS” — just what patients have argued for years. Moreover, notes the draft, “CBT is not a cure for ME/CFS and should not be offered as such,” although the therapy may help patients “manage their symptoms.” The new guidelines will replace a 2007 version that promoted the two interventions.
Medicine can be both wondrously innovative and stubbornly resistant to change. In 1847, the Hungarian physician Ignaz Semmelweis could not convince his fellow doctors in Vienna to wash their hands before delivering babies as a way to prevent often fatal cases of puerperal fever in new mothers. It would be another 30 years before Joseph Lister gained widespread acceptance for his approach to sterilization and aseptic surgery.
Things are better these days, with an average time lag of only 17 years before research evidence reaches clinical practice. The British psychiatrists and others still pushing graded exercise therapy and cognitive behavioral therapy for ME/CFS have done their part to keep the median delay as high as it is.
Clinical guidelines developed by NICE are influential in medical practice around the world, including in the U.S. Its new draft on ME/CFS is a long-overdue and much-needed corrective to years of misguided and potentially harmful recommendations.
You can read the entire article here.
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