By David Tuller, DrPH
It is not often that a major news organization fact-checks BMJ, a leading medical publisher, in real time. But thatâ€™s what happened last week when The Times pushed back against biased BMJ reporting about the committee charged by the UKâ€™s National Institute for Health and Care Excellence (NICE) with developing a new clinical guidance for ME/CFS. This isnâ€™t the first time The Times has seen through the propaganda campaign emanating from those with financial and reputational interests in maintaining the GET/CBT approach despite widespread rejection of its theoretical and scientific underpinnings.
As I noted previously, the BMJ article, published August 3rd, presented quite a stupid line of argumentationâ€”namely, that the draft NICE guidance published last November was developed without sufficient reliance on the available evidence. Sean Oâ€™Neill, a Times reporter whose previous work has demonstrated a more nuanced appreciation of ME/CFS issues than is common among his peers, countered such claims in a piece published the next day. The final version of the guidance is scheduled to be released next week. Perhaps other members of the UK press will follow the Times‘ lead and stop believing everything they read about ME/CFS in major medical journals and in press releases from the likes of London’s Science Media Centre.
Here are two key paragraphs from Oâ€™Neillâ€™s article:
â€œThe BMJ, which first reported the resignations, said there was â€˜an unusually high number of patient representatives [on the NICE committee] prompting suggestions this may have led to more weight being place [sic] on patient views than on published scientific evidence.â€™
However, only five of the 21 committee members were patient representatives, and the lengthy draft report showed clinical research advocating the use of exercise therapy and CBT had been subjected to intensive review and was judged to be of â€˜lowâ€™ or â€˜very lowâ€™ quality.â€
Given the contrast between the coverage from BMJ and The Times, I thought it was worth writing to Dr Fiona Godlee, the editorial director of BMJ and editor-in-chief of The BMJ. (The BMJ is the flagship journal of BMJ, a publishing company with many titles.) Yesterday, I sent her the following letter, cc-ing Sean Oâ€™Neill.
Dear Dr Godleeâ€”
As I wrote a couple of years ago in an opinion piece for STAT, I have admired many of the initiatives fostered under your leadership of BMJ. Thatâ€™s why I have been dismayed over the years by BMJâ€™s problematic approach to ME/CFS, which as you know has triggered previous communications from me. This bias was demonstrated most recently with an â€œexclusiveâ€ news article (published Aug 3) about the three people who have resigned from the committee that has been charged with developing new clinical guidance for the illness.
The National Institute for Health and Care Excellence (NICE) first issued a clinical guidance for what was then referred to as CFS/ME in 2007. That initial committee was weighted in favor of supporters of the so-called biopsychosocial approach, and the published guidance recommended graded exercise therapy (GET) and cognitive behavior therapy (CBT). In contrast, a draft of the new ME/CFS guidance, which was published last November, specifically recommended against offering either of these therapies as curative interventions or treatments for the underlying disorder. After a period for public comment and revision, NICE is releasing the final version on August 18th.
The BMJ article about the committee members who have stepped down reads as if it could have been dictated by the quitters themselves or by other GET/CBT advocates. The reporter apparently believes that the presence of â€œsignificant changesâ€ in the draft recommendations from the 2007 guidance represents grounds for immediate suspicion. Perhaps she and her editors are unaware that 14 years is a long time in medical practice, and that “significant changes” should therefore not be viewed as unusual. Or perhaps they believe that an updated guidance should always reaffirm the previous iteration.
The BMJ article further suggests that, given the 2007 recommendations, it is â€œunclearâ€ how the evidence base â€œbecame unsupportiveâ€ of the standard interventions. This declaration is quite odd. The reasons for the current NICE committeeâ€™s decisions should not be remotely “unclear” to anyone who has read the draft guidance and the extensive research review upon which it was based. In assessing the available studies, NICE rated all the evidence for GET and CBT as being either â€œvery lowâ€ or merely â€œlowâ€ quality. Instead of asking how the evidence â€œbecame unsupportive,â€ the reporter and her editors should ask why anyone found the evidence to be supportive of these therapies in the first place.
Luckily, The Times subsequently published a more accurate account of the NICE committee kerfuffle, including a welcome mention of the possible implications of the new ME/CFS guidance for Long COVID patients. The Times reporter, Sean O’Neill (cc’d here), countered some questionable claims in the BMJ article, including that the committee had excessive patient representation and that it made decisions not grounded in legitimate data. It is heartening that some members of the mainstream UK press no longer accept at face value the various assertions involving ME/CFS promulgated by leading medical journals.
Wittingly or not, this BMJ article appears to be part of a public relations campaign being waged by those who have lost the scientific argument and now seek to cast doubt preemptively on the new ME/CFS guidance, as well as on the process for developing it. As the publication date for this critical NICE document nears, it is unfortunate that BMJ is disseminating GET/CBT campaign propaganda in the guise of “news.”
David Tuller, DrPH
Senior Fellow in Public Health and Journalism
Center for Global Public Health
School of Public Health
University of California, Berkeley