Prestigious BMJ promotes ME/CFS misinformation

This post was updated on 16 July 2023 to say that many of the authors of the JNNP article are psychiatrists – the original version incorrectly stated that all of them are.

The prestigious British Medical Journal (BMJ) has published an article which profoundly misrepresents the state of scientific knowledge on ME/CFS.

The article, ME/CFS: Researchers question credibility of NICE guidance, highlights the views of a group of forty-nine psychiatrists who believe that NICE’s guidance on ME/CFS is flawed. The NICE guidance warns that exercise can be harmful to people with ME/CFS. However the group argue that this does not accurately represent the best scientific evidence.

The psychiatrists authored a review article which was published in the Journal of Neurology, Neurosurgery and Psychiatry (JNNP). The review comes with an unusually long list of competing interests; many of its authors have built their careers on the notion that treatment for ME/CFS should be rehabilitative, consisting of physiotherapy, exercise and counseling. These authors receive payments either for providing exercise and counseling ‘treatments’, or for advising government departments or insurance companies that such treatments should be provided. For some reason, the BMJ article makes no mention of these obvious conflicts.

The BMJ misleadingly describes these authors as ‘international specialists’. In fact many of them are psychiatrists, and ME/CFS is not a psychiatric condition. They are specialists only in the sense that their colleagues who, in the past, treated people with multiple sclerosis for ‘hysteria’ were specialists – i.e., not at all.

NICE (the National Institute for Health and Care Excellence) is the institution responsible for developing evidence-based medical standards in the UK. It is known and respected internationally for its thorough and impartial evidence reviews. While the BMJ article seems to imply that NICE is swimming against the scientific mainstream with its guidance on ME/CFS, in fact the opposite is true. The NIH and CDC in the US officially signed up to the scientific consensus that ME/CFS is a serious, chronic, multi-system illness in which exertion can provoke a relapse in 2015, following the publication of a report by the Institute of Medicine (now the National Academy of Medicine). When NICE finally published their updated guidance on ME/CFS in 2021, they were in fact lagging behind the scientific curve.

The psychiatrists’ viewpoint relies on a series of logical fallacies, which have been explained by psychologist Brian Hughes.

In reality the scientific debate over rehabilitative approaches to ME/CFS is over. A search for the most-cited papers on ME/CFS in the past five years turns up research on the condition’s prevalence, symptoms and presentation, and pathophysiology, often with comparisons showing a similarity to long Covid. None of these papers mention exercise, except as an older treatment which has been abandoned because of its tendency to provoke symptom flares and its association with a worsening of disease severity. The science has moved on.

Meanwhile, patient groups have long demanded that clinical treatment follow the scientific evidence. The 2021 NICE guidance was welcomed by all the UK ME/CFS charities and organisations, and the JNNP article has been strongly refuted by the ME Association and MEAction.

It’s almost understandable that a group of researchers and clinicians who have built their careers on rehabilitative approaches to ME/CFS should struggle to accept the new scientific reality. But the BMJ should not have given space to what is essentially an opinion piece coming from a group of heavily biased authors. The BMJ’s readers are doctors, who trust the usually authoritative journal to provide accurate, up-to-date medical information. It is these doctors’ patients who will suffer.

The BMJ was contacted for comment, but they replied that they do not give comments on their articles.