By David Tuller, DrPH
*Please see note at end of post
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.
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.
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 egregious mistreatment* [see note at end of post] of a vulnerable young Danish woman diagnosed with the illness you have just indicated is a serious organic disease. This mistreatment*, 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 mistreatment* 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.
David Tuller, DrPH
Senior Fellow in Public Health and Journalism
Center for Global Public Health
School of Public Health
University of California, Berkeley
*In three places in my response, I referred to the treatment received by Karina Hansen in language that, in retrospect, I should have avoided in this context. I have changed the first mention to “serious mistreatment” and the second and third to “mistreatment.” I apologize for any distress the previous language might have caused.