Secret picture of the peer review process of the PACE trial ...

ME made worse by Rituximab ? You might actually have seronegative borreliosis and not ME

Was your ME/CFS made worse by Rituximab? Well you might actually have seronegative borreliosis and not ME/CFS


  CASE 1:
  @ PubMed:

  van Dop WA, Kersten MJ, de Wever B, Hovius JW. BMJ Case Rep. 2013 Feb 14;2013. pii: bcr2012007627. doi: 10.1136/bcr-2012-007627. Seronegative lyme neuroborreliosis in a patient using rituximab.

  Abstract
  A 66-year-old woman presented with severe shooting pains throughout her back and legs, followed by progressive deafness, weight loss and headache. She had a history of marginal zone B-cell lymphoma stage IV-B, for which she was successfully treated with immunochemotherapy and rituximab maintenance therapy.

  A relapse was suspected, but chemotherapy was not administered, since, despite elaborate investigations, malignancy could not be proven.

  Because of a history of tick bites she was tested for antibodies against Borrelia burgdorferi in serum and cerebrospinal fluid (CSF), which were negative.

  However, a B burgdorferi PCR on CSF came back positive. The patient was treated for seronegative Lyme neuroborreliosis with ceftriaxone intravenously and dramatically improved.

  This case presentation demonstrates that, in immunocompromised patients, it is important not to solely rely on antibody testing and to use additional diagnostic tests to avoid missing or delaying the diagnosis.

 

  CASE 2:
  @ PubMed:

  Harrer T, Geissdörfer W, Schoerner C, Lang E, Helm G., Infection. 2007 Apr;35(2):110-3. Seronegative Lyme neuroborreliosis in a patient on treatment for chronic lymphatic leukemia.

  Abstract
  We report on a patient who developed seronegative Lyme neuroborreliosis complicating chemotherapy for chronic lymphatic leukemia. After the fifth cycle of chemotherapy (FCR: fludarabine, cyclophosphamide, rituximab and prednisone) the 63-year-old patient developed night sweat, arthralgia in elbows, wrists, proximal interphalangeal joints (PIPs) and strong neuropathic pain in both legs, followed by paresthesia and hypesthesia in the feet, arms and face.

  Laboratory analysis revealed an elevated C-reactive protein (CRP), a slight elevation of liver enzymes and decreased IgG levels. Cerebrospinal fluid (CSF) analysis showed a lymphomononuclear pleocytosis and an elevation of protein.

  A broad diagnostic work-up was negative including a negative Borrelia IgG and IgM ELISA.

  The patient did not remember recent tick bites, but after specific questioning he recollected a transient erythema on his leg developing just before the start of the last cycle of chemotherapy.

  As the combination of neuropathic pain and arthralgia, the transient erythema and the lymphomononuclear pleocytosis raised the suspicion of Lyme neuroborreliosis, the patient was treated for 3 weeks with ceftriaxone. On therapy all symptoms resolved and CRP normalized. Retrospective PCR analysis of a CSF sample confirmed the clinical diagnosis by detecting Borrelia garinii DNA.

  This case demonstrates that in immunosuppressed patients borrelial serology may be negative and that additional diagnostic approaches (including tests for direct Borrelia detection) may be needed to demonstrate borrelial infection.

Remembering the Outbreak of ME in the Royal Free Hospital on the 13th of July 1955

  @ pugilator.com:

  Sixty years ago on this very day, July 13th 1955, a resident doctor and a ward sister became ill in the Royal Free Hospital. It was the start of the outbreak of a mysterious disease, which would become known as the Royal Free Disease, one of the most famous and well-documented outbreaks of Myalgic Encephalomyelitis(ME).

  What follows is an excerpt from the book “Myalgic Encephalomyelitis and Postviral Fatigue States – The saga of Royal Free Disease” by Melvin Ramsay.

  On July 13th 1955 a resident doctor and a ward sister on the staff of the Royal Free Hospital were admitted to the wards with an obscure illness.

  By July 25th more than 70 members of the staff were similarly affected and it was plain that there was in the hospital an epidemic of a highly infectious nature producing, among other things, manifestations in the central nervous system. Because of the threat to the health of patients, and because of the large number of nurses involved, the hospital closed on that date and remained closed until October 5th. By that time the epidemic was almost over although sporadic cases appeared up to November 24th.

  Between July 13th and November 24th, 292 members of the medical, nursing, auxiliary medical, ancillary and administrative staff were affected by the illness and of these, 255 were admitted to hospital; 37 nurses were looked after at home or admitted to other hospitals from their home.

  It is remarkable that, although the hospital was full at the time of the epidemic, only 12 patients who were already there developed the disease.

 

STAGGERING: the ridiculous mumbo jumbo by Van der Meer still being paraded as science in Britain's leading medical journal

Stephen A Hawkins, 08 May 2015:

Re: The long wait for a breakthrough in chronic fatigue syndrome

I am generally quite impressed with BMJ output, but I find it hard to believe that there are still people in this country that are so wilfully ignorant of the real nature of ME and the dreadful predicament those who suffer it are in.

This editorial is so misinformed that I could not do justice to a full rebuttal without filling the whole magazine, so I will just say why your blinkered adherence to the doctrine of exercise for everything is utterly absurd to anyone who really has ME.

ME 'research' very rarely includes anyone who is seriously affected. Recommendations coming from something like PACE are as relevant as cancer drug trials that only included people who had no tumours.

The most ludicrous irony of the whole dogma is that I, in common with many sufferers, i'm sure, ONLY WENT TO THE DOCTOR IN THE FIRST PLACE BECAUSE I COULDN'T EXERCISE!

For my persistence in wanting to get better i was merely branded a hypochondriac, and, eventually, just left at home to rot in bed.

The ignorance of the medical profession as exemplified in your piece, has destroyed my life, and made me spend most of the last 30y both having to fight a serious illness, and be treated worse than a criminal by most of society at the same time.

In the US, the medical authorities seem to, at last, be coming to their senses, and are trying to address this illness seriously. In light of this, it is quite staggering to read the ridiculous and easily falsifiable mumbo jumbo still being paraded as science in Britain's leading medical journal.

Competing interests: No competing interests

08 May 2015
Stephen A Hawkins
patient
none
Luton

PACE trial authors admit in the BMJ, fear of exercise in CFS is not irrational

By Trudie Chalder Professor,
Kimberley Goldsmith, Peter White, Michael Sharpe, Andrew Pickles King's College London, Department of Psychological Medicine, King's College London, Weston Education Centre, Cutcombe Road, London, SE5 9RJ,

  in the BMJ, 29 January 2015:

  "We found that fear avoidance beliefs mediated both CBT and GET. This does not mean that these beliefs cause the illness.

  We would like to clarify that we did not say that fear avoidance was the cause of CFS [3,4]. We did not state that the illness was psychological or an exercise phobia. Nor did we say that fear of exercise in CFS was “irrational”. Rather, in an illness where exercise increases symptoms, we believe that being cautious about engaging in activity is understandable [4]."

Prof Edwards: an unblinded trial such as PACE simply does not provide useful information

@BMJ: Re: Tackling fears about exercise is important for ME treatment:

I am a retired academic physician and biomedical scientist who has become involved in advising on research directed at ME/CFS because of specific relevant expertise in therapeutic trials. This condition presents particularly severe methodological issues in trials because the desired primary endpoint is subjective and even supportive secondary endpoints are not as objective as one would wish. In this context, an unblinded trial such as PACE is simply uninterpretable. It does not provide useful information on which to base clinical protocols.

There appear to have been a number of additional methodological problems with the trial, but those aside, the basic design does not allow of sufficient scientific rigour. A large number of patients are concerned that the trial should be used as a basis for recommending treatment and I think they are right to be concerned.

As far as I can see all that the PACE trial can tell us about is apparent changes in patients' beliefs about their illness. The trial appears to be based on the supposition that these may be unrealistic beliefs, so it is hard to see why a shift in these beliefs should be considered even relevant unless there is some way of establishing that they become more realistic - which there is not. (Other measures suggest that any change was unwarranted.) We cannot even be sure that these are patients' beliefs since an important part of the 'placebo' phenomenon (that demands blinded controls which are here impossible) is likely to be a response designed to please a therapist, perhaps because of fear of being discharged from care if not perceived as grateful. The fact that perceptions can modify behaviour seems to be acknowledged by the aims and design of the present study.

I do not treat people with this illness and have no other personal interest other than feeling that I may be of use in encouraging useful research. Apart from anything else I am saddened to see poor data of this sort being used in a way that will perpetuate the lack of trust between patients and their carers. The patients are very aware of the weaknesses of the study and I am surprised that those designing the study are not equally aware. Competing interests: No competing interests

18 January 2015 Jonathan CW Edwards Professor of Medicine, Emeritus University College London Gower St, London WC1

ME patient MP Brynmor John KILLED by graded exercise therapy (GET)

@ wikipedia.org::

Brynmor Thomas John (18 April 1934 – 13 December 1988) was a British Labour politician.

John was Member of Parliament forPontypridd in South Wales from 1970 until he died in 1988 at the age of 54. During the Labour government of 1974 to 1979, he was a junior Defence minister for the Royal Air Force (RAF) (1974–1976) and a Home Office minister (1976–1979).

The circumstances of his later life and premature death are cited by physicians who believe the overwhelming evidence for the biological etiology of chronic fatigue syndrome.

Brynmor John had been diagnosed with the illness, and died suddenly immediately after exiting the House of Commons gym. He had been following an exercise regime based on what is argued to be unfounded and unethical medical advice: that sufferers may exercise their way toward a cure for the illness.

Ban the use of the new somatic symptom disorder in the DSM-5 before it devastates Millions of people

The new somatic symptom disorder in DSM-5 risks mislabeling many people as mentally ill

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f1580 (Published 19 March 2013)

Cite this as: BMJ 2013;346:f1580

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1. Allen Frances, chair of the DSM-IV task force

Author Affiliations

1. allenfrances@vzw.blackberry.net

This new condition suggested in the bible of mental health diagnoses lacks specificity, says Allen Frances

The fuzzy boundary between psychiatry and general medicine is about to experience a seismic shift. The next edition of the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM) is scheduled for release this May amid controversy about many of its new disorders. Among these, DSM-5 introduces a poorly tested diagnosis—somatic symptom disorder—which risks mislabeling a sizeable proportion of the population as mentally ill.

The relation between psychiatry and the rest of medicine has been difficult to manage both for mental health practitioners and for primary care doctors, and this is even more problematic for patients caught in-between. The boundary has never been clear cut or static but has shifted back and forth depending on new findings and fashions. The realm of psychiatry would shrink, and that of medicine would expand, whenever advancing science discovered a cause for a previously poorly understood presentation. The classic example of this is “general paresis of the insane,” which went from psychiatry to neurology as soon as the spirochete was identified as the causal agent.

In DSM-5, “somatic symptom disorder” appears in a new section, “Somatic symptoms and related disorders,” which replaces the “Somatoform disorders” section found in DSM-IV. This new category will extend the scope of mental disorder classification by eliminating the requirement that somatic symptoms must be “medically unexplained.” In DSM-5, the focus shifts to “excessive” responses to distressing, chronic, somatic symptoms with associated “dysfunctional thoughts, feelings, or behaviors.”

The overinclusiveness of this diagnosis is suggested by the results of the DSM-5 field trial study reported by the somatic symptom disorder work group at the 2012 annual meeting of the American Psychiatric Association. Somatic symptom disorder captured 15% of patients with cancer or heart disease and 26% with irritable bowel syndrome or fibromyalgia, and it had a high false positive rate of 7% among healthy people in the general population.1 The rate of psychiatric disorder among medically ill patients is unknown, but these rates seem high, and the burden of proof before introducing any new diagnosis is that it has a favourable risk to benefit ratio. Yet the proposed diagnosis is unsupported by any substantial evidence on its likely validity and safety and was strongly opposed by patients, families, caregivers, and advocacy organizations.2

The DSM-5 definition of somatic symptom disorder is loose. It requires only one bodily symptom that is distressing or disruptive to daily life, which lasts at least six months. It also requires one of the following psychological or behavioral responses: disproportionate thoughts about the seriousness of symptom(s); persistently high level of anxiety about symptom(s); or excessive time and energy spent on health concerns.3 This is far looser than the (rarely used) definition of somatization disorder in DSM-IV. This required a history of many medically unexplained symptoms before the age of 30 years that occurred over several years and which resulted in treatment being sought or psychosocial impairment. A total of eight or more medically unexplained symptoms were needed from four specified symptom groups, with at least four pain and two gastrointestinal symptoms.4
Previous DSM criteria have always included reminders to clinicians to rule out other explanations before concluding that any mental disorder is present. I suggested to the working group that similar reminders should be included this time and that before somatic symptom disorder is diagnosed clinicians should consider whether the health concerns are completely unrealistic or whether an underlying medical disorder might account for them. I also suggested that clinicians should consider whether symptoms might be caused by one of several mental disorders that often present with physical problems (such as depression, generalized anxiety, or panic disorder). 

The DSM-5 working group reviewed these suggestions and rejected them.

Misapplication of these catch-all criteria, especially in harried primary care practice, may result in inappropriate diagnoses of mental disorder and inappropriate medical decision making.5 Millions of people could be mislabeled, with the burden falling disproportionately on women, because they are more likely to be casually dismissed as “catastrophizers” when presenting with physical symptoms.

A false positive diagnosis of somatic symptom disorder harms patients because it may result in any underlying medical causes being missed. It also subjects patients to stigma, inappropriate drugs, psychotherapy, and iatrogenic disease; disadvantages them in decisions relating to employment, education, and healthcare entitlements; skews their self perceptions and those of family and friends; and places parents of children with chronic illness at risk of accusation of “overinvolvement” or of maintaining “sick role behavior.”

Every diagnostic decision is a delicate balancing act between definitions that will result in too much versus too little diagnosis—the DSM-5 work group chose a remarkably sensitive definition that is also remarkably non-specific. This reflected a consistent bias throughout DSM-5 to expand the boundaries of psychiatric diagnosis with what I believe was insufficient attention to the risks of the ensuing false positive mislabeling.

The DSM-5 diagnosis of somatic symptom disorder is based on subjective and difficult to measure cognitions that will enable a “bolt-on” diagnosis of mental disorder to be applied to all medical conditions, irrespective of cause. ICD-11 (International Classification of Diseases, 11th revision) is now being prepared by some of the same people who worked on DSM-5.6 7 Unless ICD-11 applies a higher standard of evidence and risk benefit analysis, it may repeat the mistake of casually mislabeling the physically ill as also mentally disordered.8

The late Thomas Szasz once said: “In the days of the Malleus, if the physician could find no evidence of natural illness, he was expected to find evidence of witchcraft: today, if he cannot diagnose organic illness, he is expected to diagnose mental illness.”9 Szasz’s general critique of psychiatry was too broad, but he was correct when it comes to the loosely defined somatic symptom disorder in DSM-5. Clinicians are best advised to ignore this new category. When a psychiatric diagnosis is needed for someone who is overly worried about medical problems the more benign and accurate diagnosis is adjustment disorder.

Notes

Cite this as: BMJ 2013;346:f1580

Footnotes

• I thank Suzy Chapman, patient advocate, Poole, UK, of Dx Revision Watch, for valuable comments and suggestions.
• Competing interests: I have read and understood the BMJ Group policy on declaration of interests and declare the following interests: I will publish two books that include references to DSM-5 (Saving Normal and Essentials of Psychiatric Diagnosis) and I chaired the DSM-IV task force.
• Provenance and peer review: Not commissioned; externally peer reviewed.

References

1. ↵
   Dimsdale JE. Presentation: DSM-5 proposals for somatic symptom disorders. American Psychiatric Association 165th Annual Meeting, Philadelphia, May 2012.
2. ↵
   Brauser D. DSM-5 task force ponders round 2 of public feedback. Medscape Medical News 2011. www.medscape.com/viewarticle/748835.
3. ↵
   American Psychiatric Association. DSM-5 development. DSM-5 Draft criteria: J00 somatic symptom disorder. Third review, 2012. www.dsm5.org/Lists/ProposedRevision/DispForm.aspx?ID=368.
4. ↵
   Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Text revision. American Psychiatric Association, 2000.
5. ↵
   Dimsdale JE. Medically unexplained symptoms: a treacherous foundation for somatoform disorders? Psychiatr Clin North Am2011;34:511-3.

   CrossRefMedline
6. ↵
   WHO. ICD11 beta draft—morbidity linearization. Bodily distress disorders. http://apps.who.int/classifications/icd11/browse/l-m/en#/http%3a%2f%2fwho.int%2ficd%23F45.
7. ↵
   Creed F, Gureje O. Emerging themes in the revision of the classification of somatoform disorders. Int Rev Psychiatry2012;24:556-67.

   CrossRefMedlineWeb of Science
8. ↵
   Goldberg DP. Comparison between ICD and DSM diagnostic systems for mental disorders. In: Sorel E, ed. 21st century global mental health. Jones & Bartlett Learning, 2012:37-53.
9. ↵
   Szasz TS. The manufacture of madness: a comparative study of the inquisition and the mental health movement. Syracuse University Press, 1997.

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Source: http://www.bmj.com/content/346/bmj.f1580

Professor Hooper in the BMJ: Professor Wessely, Peter White et al do not study ME; they use their own Oxford criteria to select people with psychiatric disorders as classic ME is too burdensome for them

Re:History of prejudice
Malcolm Hooper, Emeritus Professor of Medicinal Chemistry
University of Sunderland
Re: Ending the stalemate over CFS/ME. Godlee 342:doi:10.1136/bmj.d3956

The editor of the BMJ refers to the "unproductive standoff" in relation to the long-running disagreement about the nature of ME between the evidence-based biomedical school dating back to at least 1956 (with the WHO classifying ME as a neurological disorder in 1969) versus the ideology of the "psychosocial" school, whose vested interests in maintaining their idiosyncratic categorisation of ME as a mental disorder are a matter of public record 1.

That standoff includes the psychosocial school directing in 1992 that in patients with ME, the first duty of the doctor is to avoid legitimisation of symptoms2; in 1994 ME was described by them as merely "a belief"3; in 1996 they recommended that no investigations should be performed to confirm the diagnosis4; in 1997 they referred to ME as a "pseudo-disease diagnosis" 5, and in 1999 they said about ME patients: "Those who cannot be fitted into a scheme of objective bodily illness yet refuse to be placed into and accept the stigma of mental illness remain the undeserving sick of our society and our health service" 6.

In his letter to the BMJ7 Peter White et al dismiss key symptomatology of ME including ataxia, palpitations with cardiac arrhythmias and loss of thermostatic stability as being of dubious validity, yet those symptoms are specifically required for a diagnosis of ME as stipulated by 26 international experts from 13 countries who between them have 400 years experience of diagnosing over 50,000 patients8.

These experts base their latest criteria on biomedical research and clinical experience of widespread inflammation and multisystemic neuropathology found in ME.
Although claiming to do so, Peter White et al do not study ME; they use their own Oxford criteria that select people with psychiatric disorders in which chronic fatigue is a feature9 .



White says their own criteria are easier to use and insists that they do not exclude those with ME simply because he believes ME to be a mental disorder.
Furthermore, in his letter to the BMJ Peter White complains that the criteria which define people with classic ME are too burdensome for doctors to use.
When did the careful assessment of sick people stop being part of the practice of medicine, especially when the disorder in question is known to be a complex multi-system disorder?
References
1. http://erythos.com/gibsonenquiry/Docs/ME_Inquiry_Report.pdf
2. Medical Research Council Highlights of the CIBA Foundation Symposium on CFS, 12-14th May 1992, reference S 1528/1 (section entitled "The Treatment Process"), now held in the MRC secret files on ME at the National Archive, Kew, and closed not for the customary 30 years but for the unusually lengthy period of 73 years
3. "Microbes, Mental Illness, The Media and ME - The Construction of Disease". Simon Wessely; 9th Eliot Slater Memorial Lecture, Institute of Psychiatry, 12th May 1994 (transcript and Wessely's own working notes)
4. Chronic Fatigue Syndrome. Report of a Joint Working Group of the Royal Colleges of Physicians, Psychiatrists and General Practitioners; Royal Society of Medicine (CR54), October 1996
5. "Chronic Fatigue Syndrome and Occupational Health"; A Mountstephen & M Sharpe; Occupational Medicine 1997:47:4:217-227
6. "ME. What do we know - real physical illness or all in the mind?" Lecture given in October 1999 by Michael Sharpe, hosted by the University of Strathclyde (transcript)
7. BMJ 2011:343:d4589
8. Journal of Internal Medicine: Accepted Article: doi:10.1111/j.1365- 2796.2011.02428.x
9. JRSM 1991:84:118-121
Competing interests: I am a long term advocate for people with ME and have published and lectured extensively on their plight and the injustices they and their carers have suffered as a conseqence of the deeply flawed ideological views of some psychiatrists and the Government agencies that have persistently denied or ignored the massive volume of peer-reviewed, published biomedical evidence.

See also: The main characteristic of ME is an abnormally delayed muscle recovery after doing trivial things, if you don't have that, you don't have ME

The PACE trial: almost £5 million spent on, well, nothing, you couldn't make it up!

Posted by nmj:

The current chaos of criteria is why we have people all over the Internet claiming to have recovered from ME, touting nonsense about how 'believing they can get better, got them better'.

It's because of hopelessly flawed criteria that these people have been told they have ME in the first place, or more worryingly may have diagnosed themselves.

This is why we are so angry about the PACE trial, almost £5 million being spent on, well, nothing. (PACE used the Oxford criteria, devised by UK psychiatrists, which actually exclude neurological disorders, so that people who are a bit fed up and deconditioned can actually be diagnosed with ME. Yes, you couldn't make it up!)
Dr Esther Crawley and others have revived the recent BMJ thread on ME and posed the question: Will adopting the Canadian criteria improve the diagnosis of chronic fatigue syndrome? The answer is, of course it will! Dr Crawley and her colleagues are - unsurprisingly - dragging their heels ... Read more>>

Is ignoring clinical evidence The Way Ahead for the RCGP and Prof Christopher Ward ?

One of the hot items of the last few years is revalidation of doctors. And supposedly the RCGP is leading the way.
With this in mind, it is astonishing that Prof Ward and the RCGP are leading the way in ignoring tons of clinical evidence that ME/CFS is a severely disabling physical disease. But as this comes from the RCGP, aka The Mrs Simon Wessely College, this actually doesn't come as a big surprise as the CBT psychiatrists have been ignoring clinical evidence for decades.

First, they have used the Oxford criteria, i.e. tired all the time, for decades in their so called ME research, which has no relevance to ME/CFS as one can see in the picture below. If a patient comes to the surgery, saying he is tired all the time, then you know straight away that he doesn't have a broken leg, just as you know straight away that he does not have ME, the abbreviation for Myalgic Encephalomyelitis.



Using the Oxford criteria is a fantastic Houdini trick but ignoring the fact that this illness comes in clusters, and as you know, any disease that comes in cluster outbreaks is an infectious disease, is another masterstroke of ignoring clinical evidence. We've had 50 to 60 outbreaks over the years, one was witnessed by Dr. Peter Snow, a GP in New Zealand, who noticed that people who fell ill with this disease, where young and fit patients who never came to see him in his single-handed GP practice. He also noticed that it took quite a while before these patients presented to him after falling ill in this outbreak, because they were so used to dealing with their own problems. They only started to come in, because of the severity of the problems and because the problems didn't go away.

For your information, Dr. Peter Snow, later not only became the president of the New Zealand College of General Practitioners, who had witnessed first-hand what a severely disabling neurological/infectious disease ME is but he also started to educate GPs and young doctors on the severity of this disease.

As we are into ignoring clinical evidence please let us ignore the fact that Australian researchers, after one of the ME/CFS outbreaks, were able to transfer the putative agent to monkeys. Further proof that this disease doesn't exist, wouldn't you say professor Ward. I almost started to like this ignoring clinical evidence principle, but my years of proper medical training interfered and said no-no, any proper doctor would say that this is further evidence that this is an infectious disease.

Another thing I would advise you to ignore is the fact that almost 5% of patients became ill with ME/CFS after a blood transfusion. So ME/CFS can be transferred via a blood transfusion, but again, let us not tell the general public and our doctors this because there is no purpose for doctors to know the facts about a disease. And we don't want another infectious disease out there on the loose, with no one doing anything about it, do we, Prof Ward, so I agree, it is better to ignore this fact as well and fob patients, with an infectious disease, off with psychotherapy to deny they have a severely disabling disease and blame the patient for not getting better.

Oh, and then there is the highly increased incidence of lymphomas in ME/ CFS, but no we don't want doctors to know this as well and use the thinking part of their brain because they might start to realise that ME/CFS is not all in the mind of the patient and that it is in fact caused by an oncogenic or cancer-causing virus.

The other thing I would ignore is the fact that the University of New Jersey has just shown that if you do a lumbar puncture, and analyse the proteins in the spinal fluid from patients with ME/CFS, chronic Lyme disease and healthy controls that you can easily distinguish the three groups.

I would also ignore the fact that Prof Newton has just shown that the lactic acid production in muscles of ME/CFS patients after exercise is 50 times higher than in healthy controls and that this doesn't improve with regular exercise.

I would definitely ignore the fact that the Harvard Medical School has shown that if you do a special form of EEGs, you can easily distinguish between healthy controls, depression and ME/CFS patients, because this fact directly contravenes the vested interests of the old boy network.

I would also advise to continue to ignore the fact that even Prof White, one of the main CBT fanatics has demonstrated that exercise causes immunological damage in ME/CFS. Did he use this in his Pace trial, obviously not, because using it would directly contravene the principle of ignoring clinical excellence.

Now let's have a look at the following remarks from Prof Ward, "It is important to remember that people with CFS want to be taken seriously, so show that you believe them." i.e. you don't but you want your patients to believe you do.

Now, you might say I am biased because I am writing this article, so I would suggest to ask the following three ladies, Allison, Annabel and Sofia, for advice. The problem is, you can not do that, as all three of these lovely ladies were bedridden with severe ME for many years, and then all three of them died of ME.

Yes you heard it right, their official cause of death was ME. But again, it is better to ignore this, so please continue to treat us with great hostility, ignore all clinical evidence that this is a severely disabling physical disease, which has nothing to do with being tired all the time, even though the CBT psychiatrist want you to believe it has, and then what happens, you fall ill with this disease yourself. The problem is, it is not only an infectious disease, it is also known that doctors, especially those who come into contact with lots of infections, for example, paediatricians and GPs, are at a much higher risk to develop this disease. When that happens, you will not only realise what a lot of psycho blah blah we have been reading about this disease in the BMJ and the Lancet, the official CBT fan club magazines, but also that we have wasted decades and millions of pounds to make sure that no one does any research to find the virus that causes this disease and to find a cure and proper treatment.

If you still think, just like Prof Ward wants you to believe that CBT and exercise are the two treatments for this disease, then just have a look at the recent reviews, including the CBT-is best Pace trial, which showed that CBT and exercise for ME/CFS do not cure anybody, and all the other recent reviews which showed that these two so-called treatments make us actually a lot worse. Which is what ME patients have been saying for decades, but who wants to listen to someone who is faking a severely disabling infectious disease, only to be subjected to ridicule, aggression and immense hostility by doctors and many others?

Prof Ward and the RCGP should have known all of this and more if they had studied some of the more than 4000 medical research articles which show that ME is a physical disease, with lots of muscle and immune abnormalities, but reading some of these articles would have required to turn on their computers to access this information which is readily available on the Internet and obviously on my site, and who wants to do that if he is into ignoring clinical excellence.

So, on behalf of the Dr. Speedy Network of Clinical Evidence, I would like to thank Prof Ward and the RCGP for ignoring shed loads of clinical evidence. Amazing, if you think that one is a professor and the other one calls itself a royal college which wants to lead the way in revalidation which supposedly is all about keeping up-to-date as a doctor by reading clinical evidence. And that in the 21st-century with the Internet and easily accessible clinical evidence available at the click of your mouse.

Prof Ward, if you and the RCGP would include your delightful article in your revalidation folder, the assessor could only come up with one conclusion and that is that both of you have miserably failed your revalidation and that you would have to do it all over again. When you rewrite your article, which has ignored all clinical evidence, then please use the above information. Maybe you could even include the exercise testing done by the Pacific fatigue laboratory, which easily showed the difference between healthy controls, lazy couch potatoes and ME/CFS patients who are desperate to get better, go back to the work we love and participate in all sorts of social events including my beloved sports.

Have a nice day reading up on all the clinical evidence,
Dr. Speedy

See also: July 2011: RCGP, a.k.a. the Mrs Simon Wessely College tries to reclassify ME/CFS again

Research finds that BMJ refuses to publish biological ME/CFS research

By Craig Maupin:

Editors at BMJ have long been criticized for bias regarding their portrayal of CFS.

According to ME/CFS advocate Tom Kindlon, most "people with ME who have been around a few years would have had a jaundiced view of the British Medical Journal, before any of the XMRV coverage."

Kindlon stated that "basically, no new biological research has been published in the last 15 years in the BMJ," and the "only people asked to write editorials are those who believe CBT (cognitive behavioral therapy) and GET (graded exercise) are all patients need."

In a 2000 published review of articles on CFS in BMJ (Journal of Chronic Fatigue Syndrome 12:4 2004), several researchers found that "the journal has consistently ignored non-psychiatric professional views on CFS and were unable to find sufficient scientific reason to justify this stance.”

BMJ and Brian Deer left High and Dry Over their Fraud Claims

By John Stone, UK Editor for Age of Autism, April 22, 2011:

“The case we presented against Andrew Wakefield that the 1998 Lancet paper was intended to mislead is not critically reliant on GP records.” So wrote Fiona Godlee (Editor-in-Chief, BMJ) in February, in effect conceding that Brian Deer’s scrutiny of GP notes which had apparently formed the main s basis of his and BMJ’s fraud allegations could not be used to support such a claim.

Back in February Age of Autism and its readers scored a great victory with it letter writing campaign, forcing editor-in-chief of British Medical Journal, Fiona Godlee, to respond to our criticisms both in our columns (HERE) and in the on-line columns of BMJ itself (HERE ). Remarkable though this was we have perhaps not analysed carefully enough how desperate the defence she presented was.

In both versions of her response we find the sentence:

“The case we presented against Andrew Wakefield that the 1998 Lancet paper was intended to mislead is not critically reliant on GP records.”

So, in fact she conceded then and there that a fraud claim could not be based on GP notes, as originally pointed out by ChildHealthSafety (HERE ) as Andrew Wakefield and the other authors of the paper simply did not have access to them. While, we continue to contend that the data in the notes is entirely reconcilable with data in the paper (as Martin Hewitt began demonstrating yesterday HERE ) it was simply not possible for anyone to alter data from material they could not see.

As we have seen Deer responded with seething contempt on the BBC radio programme ‘Science Betrayed’, broadcast in late March, to the cogent explanation that the records referred to in the paper were the Personal Child Health Records of the children (or so-called red books) (HERE ), but by that stage Godlee – who also had a cameo appearance on the programme - had already admitted as much.

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Meanwhile, BMJ have ducked out of publishing my recent letter which bore on several relevant issues including the shifting opinions of doctor-journalist Ben Goldacre, the anomalous and unexplained fusion by Deer and the GMC of the Lancet paper with a protocol for a Legal Aid Board funded study, and the offensive misrepresentation of myself and this matter by Brian Deer in a comment on Orac’s ‘Respectful Insolence’ blog, which I append for interest: Read more>>