Trial By Error: The Psychosomatic Conference’s Pathetic Response

By David Tuller, DrPH

After I posted yesterday’s blog about Per Fink’s upcoming appearance at the fourth annual Columbia Psychosomatic Conference being held this weekend, I received the following e-mail from Columbia’s Alla Landa. She is an assistant professor of “clinical psychology in psychiatry”–whatever that means–and director of the conference.

I found her note unsatisfactory on multiple fronts, and responded accordingly. My e-mail to her follows below.

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Dear Mr. Tuller,

Thank you for sharing with us you concerns about these important matters. I can assure you that the conference committee and I received your email and are taking what you expressed to us very seriously.

As a clinician and researcher, I am aware that Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS) brings severe suffering to millions of people around the world, and truly hope that biomedical research will help find cures for this condition. I also want to share that the Organizing Committee of the 4th Psychosomatics Conference and the Columbia University Department of Psychiatry affirm our support for the ME/CFS community and state unequivocally that we agree that ME/CFS is a serious multi-system disease associated with neurological, immunological, and energy metabolism impairment. We also support our colleagues at Columbia University’s Center of Infection and Immunity who are using the latest precision-medicine approaches to study the underlying pathophysiology for ME/CFS, with the goal of developing new treatments.

The 4th annual Psychosomatics Conference hosted by the New York State Psychiatric Institute and Columbia University Irving Medical Center will not focus on ME/CFS. This conference will address how multidisciplinary approaches in medicine can help patients with persistent somatic symptoms by bringing together clinical researchers with expertise in brain-body interaction in the fields of psychosomatic medicine, gastroenterology, cardiology, and neuropsychiatry.

Unfortunately, we are unable to answer emails about this matter on an individual basis and to, therefore, address in detail all the points you have raised.

I am hopeful that recent biomedical research initiatives will move the field forward and lead to the development of new treatments for ME/CFS.

Sincerely,
Alla Landa

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Dear Alla Landa–

Thank you for your e-mail, but I’m not sure why I’m getting this message. I did not “share” my concerns with you–I wrote a post on Virology Blog, a site hosted by one of your Columbia colleagues. Perhaps someone else decided to send my post to you.

In any event, it is clear that you and the other organizers have created a public relations disaster for Columbia, New York mental health officials, and the field of psychosomatic medicine. Your generic e-mail to me does nothing to address the specifics of this situation, since it is non-responsive to the particular concerns raised about Per Fink.

I’m glad you agree that ME/CFS has an “underlying pathophysiology.” But to say that the conference does not “focus” on this illness is obviously not the same as saying it won’t be discussed. For reasons known only to you and the other organizers, you have decided to invite to your gathering a man involved in what can only be called the kidnapping and torture of a vulnerable young Danish woman diagnosed with the illness you have just indicated is a serious organic disease. This kidnapping and torture, conducted with the full authority of the state, was considered justified based on the sorts of claims about functional somatic disorders being presented at Columbia this weekend.

If you and the other organizers were aware of these actions and decided to invite Fink anyway, shame on you. If you and the other organizers were not aware of these actions, that would suggest that none of you engaged in sufficient due diligence to vet those being invited. Neither explanation reflects well on you and your colleagues. The invitation would also seem to violate some key principles of developing CME activities, according to the guidelines promulgated by the Accreditation Council for Continuing Medical Education.

Here’s what those guidelines say about “dealing with controversial topics”:

To protect the integrity of accredited CME and of the clinician/patient relationship, all patient care recommendations must be based on evidence that is accepted within the profession of medicine and all scientific research used to support patient care recommendations must conform to generally accepted standards of experimental design, data connection, and analysis.

Thus, CME providers need to develop activities that encourage free and rigorous scientific discourse — while ensuring that faculty do not advocate or promote unscientific treatments and that clinical care recommendations are based on established scientific consensus. When a CME activity includes information about an approach to diagnosis or treatment that is not generally accepted, it is allowable to facilitate debate and discussion about the approach, but it is not allowable to advocate for the test or treatment, or teach clinicians how or when to use it.

It goes without saying that the kidnapping and torture of Karina Hansen was not grounded in “evidence that is accepted within the profession of medicine” or on “established scientific consensus”–nor are Fink’s treatment recommendations for this illness overall. As the international scientific community has now recognized, describing ME/CFS as a functional somatic disorder or an example of so-called “bodily distress syndrome” is neither appropriate nor acceptable. This framing of the illness rests on flawed research that cannot in any way be claimed to “conform to generally accepted standards of experimental design, data connection and analysis.” Your invitation to Fink is a disgrace–an insult to millions of patients around the world confronted daily with the sort of nonsense he and his collaborators in the UK and elsewhere have promulgated for many, many years.

I see nothing in the schedule that suggests the presentations at issue here will be balanced by any effort “to facilitate debate and discussion” about the advocated approach to treatment. It is immaterial that ME/CFS is not the “focus” of these presentations. As you must understand, those in the audience will certainly be likely to apply the recommended “treatments” to ME/CFS patients, regardless of whether that particular illness is even mentioned. So you cannot alleviate yourself and the other organizers of responsibility for this debacle by vaguely suggesting that the gathering is somehow irrelevant to the concerns of those who plan to attend the Saturday protest organized by ME Action New York or the more than 9,000 people who have signed the online petition.

All that is apart from the larger questions of whether these purported disorders or syndromes or the categories of “medically unexplained symptoms” or “persistent physical symptoms” should be construed as discrete illnesses rather than somewhat useful descriptive phrases. The evidence for such claims seems to reside in the absence of current pathophysiological explanations for the symptoms, not in any scientific proof that these purported diagnoses represent actual clinical entities. But perhaps that is a discussion for another day.

Best–David

David Tuller, DrPH
Senior Fellow in Public Health and Journalism
Center for Global Public Health
School of Public Health
University of California, Berkeley

{ 34 comments… add one }
  • Lady Shambles 17 October 2018, 6:02 am

    Excellent! Said with feeling.

  • Karin Alvtegen 17 October 2018, 6:22 am

    Thank you David for taking the fight for us who no longer are able to fight for ourselves.

  • Anil van der Zee 17 October 2018, 6:26 am

    Wow. That email is just perfect David!

    Shame on this department of Columbia University. What a lame response from them. Is that all they’ve got to say?!

    Thank you for standing up for us this way!!

  • Barry 17 October 2018, 7:47 am

    Right on the nail David. Many thanks.

  • Peter Trewhitt 17 October 2018, 7:50 am

    Even clearer and to the point, if that is possible, than your blog post that precipitated Alla Landa’s response.

  • Scott Simpson 17 October 2018, 8:01 am

    Good work, as always David – keep tightening those screws…on their screw-loose thinking.

  • Lisa 17 October 2018, 8:09 am

    I hope this gets shared widely. I’ll certainly circulate it. Thanks, David.

  • Wendy Boutilier 17 October 2018, 8:45 am

    This letter of defense is unacceptable because it’s nowhere near the level it should be at when you consider there is no scientific fact that proves Per Fink and his enablers are OK to practice pseudoscience on the vulnerable. It’s wide spread malpractice that destroys as much as any other weapon of mass destruction. The use of Munchausen Syndrome, to facilitate a legal tool to forcibly remove patients from their family because a psychiatrist’s ego needs to be fed is highly suspect. The excuse that Per Fink is invited to discuss something other than ME/CFS at the same time the CDC and the UK NICE are trying to redefine their own definitions is no excuse. In fact, it ties in too neatly.

  • Elle See 17 October 2018, 9:18 am

    Thanks, David, for telling it like it is! Your help is very much appreciated. So grateful.
    #ScienceOverStigma

  • Graham McPhee 17 October 2018, 9:35 am

    Interesting how, at such a supposedly high level of education, intellect and accuracy, Alla Landa believed that you had contacted her by email. If this is a measure of competence, it does not inspire me.

  • Joan Byrne 17 October 2018, 9:39 am

    Well done David. Once again your integrity throws an uncomfortable spotlight on the most blatant obfuscation. Columbia should be given no wriggle room on this. That man, Per Fink, destroyed Karina Hansen and her family. She will never recover from the damage he and his colleagues inflicted upon her. He is nothing short of a human rights abuser and should be given no succour in a place like Columbia. Shame on them. Keep up the pressure

  • Brenda Vreeswijk 17 October 2018, 9:49 am

    Here here David, it always amazes me that people want to hide behind this nonsense and therefore wave goodbye to their responsibilities.
    Inviting a person that is responsible for kidnapping, incarcerating and forcing a treatment on a patient after stripping her from her human rights, is a disgrace.
    Not only that but the threats doctors received when they wanted to wean her of forced drugs prescribed by Fink.
    His pushing thru a diagnoses that was rejected by the WHO and his attitude against Karina’s parents are despicable.
    Now let’s see if you get a replay on this mail

  • Terri Wilder 17 October 2018, 12:06 pm

    Unfortunately, she is sending the same “sample email” to everyone. I let her know that it was unacceptable.

  • Mennette 17 October 2018, 1:52 pm

    Great response to Dr. Landa! I received the exact same email (complete with typo in the first sentence) on Monday night (10/15) in response to a long email I wrote on 9/22, objecting not only to the presence of Per Fink but to the entire field of somatic disorders/ psychosomatic illnesses (“It’s all in your head”) that advocates the psychological treatment of “unexplainable pain” rather than looking more closely for actual biological causes. I also suggested that they might ask their colleagues in the Center for Infection and Immunity at the Mailman School of Public Health, Dr. Lipkin and Dr. Hornig, for more information about the reality of ME/CFS. The only thing this generic email tells me is that Dr. Landa knows they triggered a nerve in the international ME/CFS community — which is good.

  • Erik Johnson 17 October 2018, 2:13 pm

    Absolutely totally completely AWESOME.

  • Janet Comerford 17 October 2018, 2:14 pm

    Thank you once again David. Your relentless work to expose the evil nonsense perpetrated by the likes of Per Fink give me hope that one day, this illness will be recognised for the life destroying disease that it is.

  • Sandra 17 October 2018, 2:28 pm

    Powerfully speaking TRUTH to power. Thank you, David. These psychologists need to open their eyes and face the harm their theoretical musings (not based in reality and patient experience) and their subsequent practices are doing to vulnerable people. Sometimes I feel like we are just their playthings. An easy way to get a PhD, conjure up theories, publish papers, build careers. It doesn’t matter that their actions really do not benefit patients, but in fact inflict harm. What matters is their reputations, careers, and egos. They have so much to answer for.

  • Sonnenkalb 17 October 2018, 2:51 pm

    wow merci

  • Rachel Riggs 17 October 2018, 4:56 pm

    I don’t think anybody could have said it better – we are so grateful for your efforts, David!

  • Dave Olson 17 October 2018, 5:18 pm

    I received the very same boilerplate, and was speechless for a moment, before the anger set in.. how they can be so insensitive to the sufferers and their caregivers goes beyond belief.. Thank you David for expressing, so well, what we all feel.

  • Lisa 17 October 2018, 5:18 pm

    It’s also worth noting that Peter Henningsen (Germany) is also on the program and was in previous years as well. He co-edited, with Fink, the book Medically Unexplained Symptoms, Somatisation and Bodily Distress: Developing Better Clinical Services (Cambridge Medicine)

    “Product description

    Medically unexplained symptoms and somatisation are the fifth most common reason for visits to doctors in the USA, and form one of the most expensive diagnostic categories in Europe. The range of disorders involved includes irritable bowel syndrome, chronic widespread pain and chronic fatigue syndrome. This book reviews the current literature, clarifies and disseminates clear information about the size and scope of the problem, and discusses current and future national and international guidelines. It also identifies barriers to progress and makes evidence-based recommendations for the management of medically unexplained symptoms and somatisation. Written and edited by leading experts in the field, this authoritative text defines international best practice and is an important resource for psychiatrists, clinical psychologists, primary care doctors and those responsible for establishing health policy.”

    It seems reasonable to assume that the above gives a pretty clear sense of what they’ll present at Columbia. Interesting that it claims to be about “future” guidelines!

  • Janelle 17 October 2018, 5:30 pm

    You spelled it out very plainly. There shouldn’t be any confusion. Hope they can get into a listening frame of mind!

  • JaimeS 17 October 2018, 5:36 pm

    I happen to know someone who was issued the exact same reply, word-for-word. This advocate’s reply was also disgust at the apparent boilerplate, bloodless reply.

    This woman replied that it was most certainly NOT boilerplate and she’d considered her response incredibly carefully.

    …and then copied and pasted, I guess.

    Apparently she’s unaware patients might talk to one another sometimes.

  • Simas 17 October 2018, 5:46 pm

    Great response, David. The problem is, I think, that if they “gave up” ME/CFS it would basically destroy the whole persistent somatic symptom idea, because I’m wiling to bet that ME/CFS, fibromyalgia and possibly mast cell disorders form the vast majority of patient population that they consider as functional/persistent somatic symptoms (or whatever the name they like to use on a particular day).

    They have no way to get out of this, other then to say, OK, we’ve been terribly wrong, game over.

    Is it gonna happen? Someday it will, but doctors from other fields have to start standing up and protesting this nonsense, otherwise psychology/psychiatry is free to do whatever they want, which they gladly do. They can’t take care of their own field. No way.

  • geoffrey keith Brown 17 October 2018, 7:31 pm

    in other words, STUFF YOU FINK that girl will never recover from your abuse
    all Psychiatrists are detrimental to the well being of genuine Myalgic Encephalomyelitis sufferers I speak from personal experience
    28 ect’s -years of 120 mg of Lovan only to be told we are sorry MR Brown MRI tests have confirmed your problem is viral, not mental health

  • Ulrika 18 October 2018, 4:15 pm

    Thank you, David!

  • Donna Lutz 18 October 2018, 8:47 pm

    Thank you David for your intelligent response for so many of us who aren’t capable because of the cognitive dysfunction caused my ME. It’s unethical and should be criminal what Per Fink imposed on Karina. And how many other patients, especially pediatric, who are tortured in this manner.

  • Julie Mason 19 October 2018, 10:02 pm

    Thank you David for writing with specific details and stories and implications! We are proud of you and thankful for you and others like you who can communicate on a professional level to those “powers that be” at other univerisities. Thank you for holding Columbia accountable! We also appreciate those who will protest Mr. Fink’s presence!

  • lo kee 20 October 2018, 2:47 pm

    Awesome!

    I remember long ago when patients would push back like this – we’d be chastised from every side for “disrespect”, resulting in us having to defend ourselves, resulting in months of PEM/PENE (completely knocked out of advocating for ourselves). It is SO COOL to have a healthy, quick-witted journalist like David on our side, whose critical thinking skills are intact and fast as lightening on the comeback!

  • ixchelkali 23 October 2018, 6:24 pm

    !!!! Thank you, sincerely. You said what I would have like to, if my brain were fully functioning.

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