Dear Dr. Horton,
Thank you for asking the Dr. Speedy Network of Clinical Excellence for help to improve the quality of your PACE trial editorials because you wanted to engage in a proper scientific debate with the critics of this trial. We are delighted to use our ME expertise gained by being bedridden with this disease for many many years, and help you and the Lancet out in the name of medicine.
One can quickly review the PACE trial when one knows what the basis of the trial is and what their hypothesis is. The answer to these two questions can be found in the following quotes from the PACE trial.
“CBT was done on the basis of the fear avoidance theory of chronic fatigue syndrome. This theory regards chronic fatigue syndrome as being reversible and that cognitive responses (fear of engaging in activity) and behavioural responses (avoidance of activity) are linked and interact with physiological processes to perpetuate fatigue.”
“GET was done on the basis of deconditioning and exercise intolerance theories of chronic fatigue syndrome. These theories assume that the syndrome is perpetuated by reversible physiological changes of deconditioning and avoidance of activity. These changes result in the deconditioning being maintained and an increased perception of effort, leading to further inactivity.”
So basically they are saying that CBT and GET reverse Chronic Fatigue Syndrome. In plain English that would be, CBT and GET cure Chronic Fatigue Syndrome, the name the PACE trial Psychiatrists like to use for ME.
So the question any reviewer should then ask is pretty simple. How many people were in fact cured by CBT and GET according to the PACE trial?
And the answer is nobody, absolutely nobody.
The conclusion from any doctor or reviewer is then pretty simple. The Pace trial shows that CBT and GET, which were supposed to cure people with ME/CFS, are in fact completely useless for ME/CFS.
And we agree with you that the editor of the Lancet would then conclude that the PACE trial has clearly demonstrated that there is no place for CBT psychiatry in ME/CFS, and that it is time to redirect all our efforts away from psychiatry and use them to find the cause/virus and a cure for this disabling, infectious neurological disease as classified by the WHO since 1969.
It was a pleasure Dr. Horton to help you out with your editorials. Please feel free to ask again,