By David Tuller, DrPH
A recent Wall Street Journal opinion piece accused an apparently powerful “queer feminist wellness collective” of causing an international wave of mental illness, which is being expressed as reports of persistent disabling symptoms after an acute bout of COVID-19. The article was written by a psychiatry resident at Canada’s McMaster University in Canada. Given the arguments advanced by the resident, my friend and colleague decided to check in with the university’s psychiatry department.
Here’s his report.
Can McMaster University Medical School Psychiatrists Be Trusted to Treat ME/CFS Patients?
By Steven Lubet
There were many problems with Dr. Jeremy Devineâ€™s disturbing oped in the Wall Street Journal, as I have detailed here. In addition to gaslighting Long Covid patients and disparaging patient advocacy groups, Devine asserted that the PACE trialâ€™s psychogenic theory of ME/CFS is â€œthe prevailing view among medical practitioners.â€ As readers of this site know, that has not been true since at least 2015, when the U.S. Institute of Medicine (now the National Academy of Medicine) reported its finding that ME/CFS is a â€œserious, chronic, complex, systemic diseaseâ€â€” not a psychiatric or psychological disorder.
Devine is a 2017 University of Toronto medical school graduate and currently a psychiatry resident at the McMaster University Faculty of Health Sciences in Hamilton, Ontario. As a doctor-in-training, he obviously must have obtained at least some of his misinformation from his supervising senior physicians. This raises the troubling likelihood that McMaster psychiatry residents are still being taught that ME/CFS is, as Devine put it, â€œan underlying mental-health issue,â€ presumably treatable with cognitive behavior therapy and graded exercise therapy per the PACE trial (which Devine linked in his oped).
Because prospective ME/CFS patients have a right to know about the quality of care they can expect from McMaster physicians, I sent an inquiry to Drs. Nick Kates and Karen Saperson, respectively the chair and vice chair of McMasterâ€™s Department of Psychiatry and Behavioural Neuroscience, recognizing of course that Devine is entitled to his own opinions about Long Covid:
Dr. Devine also wrote that the â€œprevailing view among medical practitionersâ€ is that ME/CFS is a symptom of â€œan underlying mental-health issue,â€ linking to the UKâ€™s 2011 PACE trial. That was more than a statement of his opinion, and it seriously misrepresented the actual state of current medical practice.
The US Institute of Medicine (now the National Academy of Medicine) issued a report in 2015 finding that ME/CFS is a â€œserious, chronic, complex, systemic diseaseâ€â€” not a psychiatric or psychological disorder. The PACE trialâ€™s recommended treatments of Graded Exercise Therapy (GET) and Cognitive Behaviour Therapy (CBT) have since been discontinued by the U.S. National Institutes of Health and Centers for Disease Control. Likewise, the UKâ€™s National Institute for Health and Care Excellence (NICE) issued a revised draft of its clinical guidelines, dropping both CBT and GET as treatments for ME/CFS, and strongly advising against the latter. Promising biomedical research on ME/CFS is now underway at major U.S. Universities, including Stanford, Columbia, and Cornell.
It is simply untrue to maintain that the â€œprevailing view among medical practitionersâ€ is that ME/CFS is mental-health disorder.
Consequently, I am writing to ask whether Dr. Devineâ€™s understanding of the â€œprevailing viewâ€ is taught in the McMaster psychiatry program. Does your department continue to follow the recommendations of the PACE trial (which the NICE draft called a â€œlow qualityâ€ study)? Are your patients advised to engage in Graded Exercise Therapy? Are your residents made aware of post-2015 developments in the U.S.?
It appears to me that Dr. Devineâ€™s outdated views of ME/CFS may reflect poorly on the quality of training and care provided by your program. Kindly let me know if I am mistaken.
Jeremy Devine, who you refer to, is a medical resident in the Department of Psychiatry and Behavioural Neurosciences at McMaster University. The views he expressed, in an opinion piece, were his own and he does not speak on behalf of our department or the university.
As a Department we do not have a â€œprevailing viewâ€ on this topic, but leave such decisions up to each individual practitioner.
Katesâ€™s answer strongly suggests that some psychiatrists at McMaster do indeed adhere to the outmoded recommendations of the PACE trial, but I wanted to make sure. My followup was therefore quite specific:
Can you please identify for me any â€œindividual practitionersâ€ at McMaster who regard ME/CFS as a â€œmental-health disorderâ€ or recommend CBT or GET as treatments, so that I may request their views directly.
Finally, what is your own view, or Dr. Sapersonâ€™s, of ME/CFS? Do you consider it a mental-health disorder? Do you consider the PACE recommendations valid? Do you approve of CBT or GET as treatments for ME/CFS?
Kates declined to answer, stating only â€œI have nothing else to add.â€ I also wrote to Dr. JoAnn Corey, the director of postgraduate education, who did not reply to repeated inquiries.
This is bad news for prospective ME/CFS patients in Ontario. Given Katesâ€™s evasiveness, and the absence of a clear denial, it seems certain that some McMaster psychiatrists â€“ perhaps many or most, and even Kates and other department leaders â€“ continue to push CBT and GET as ME/CFS treatments, even though the latter has been recognized as contraindicated by the NICE draft guidelines. I have identified at least one McMaster faculty member who apparently endorses GET, but he is a chiropractor who was somehow appointed in the department of anesthesiology.
Young Dr. Devine appears to have been following the lead of his seniors in mischaracterizing ME/CFS and possibly providing mistreatments. Prospective patients should therefore approach the McMaster psychiatry department warily, if at all.
NOTE: Canada follows British spelling conventions such as â€œbehavioural.â€ As a half-Canadian and dual citizen, I did the same in Canadian proper nouns and in my emails to the McMaster physicians, but not otherwise in the body of this post.