David Tuller

Trial By Error: Game-Changing Articles in The Guardian and The New York Times

24 January 2021 by David Tuller

By David Tuller, DrPH

The relationship between what is being called long-Covid and ME/CFS (and its variants) is complex. The conditions overlap in ways that are poorly understood, and the mechanisms through which they produce such significant disabilities remain elusive. As the coronavirus pandemic enters its second year, many tens or hundreds of thousands of people around the world are suffering from long-term medical symptoms after an acute bout of Covid-19. It remains to be seen how long their complaints will persist.

Trial By Error: New Study Reports First-Hand Accounts of 1955 Hospital Outbreak

15 January 2021 by David Tuller

By David Tuller, DrPH

The name myalgic encephalomyelitis is inextricably linked with an outbreak of what appeared by all accounts to be a viral illness at London’s Royal Free Hospital in the second half of 1955. More than 200 people, most of them female staff and students, fell ill. Some reported long-term complications. Although no pathogen was ever identified, key investigators at the time believed it was possibly or likely an enterovirus.

Trial By Error: Tack’s Take on 2020 Studies; Professor Edwards’ Statement to NICE

13 January 2021 by David Tuller

By David Tuller, DrPH

I have been laying low during the recent holiday and coup season. Today I’m watching the impeachment hearings. And I might find it challenging to get back up to full speed until after New Year’s–which for me will be January 20^th, or whichever day the White House is finally de-Trumped. For now, here are a couple of things worth reading on topics of direct interest to our main theme.

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Trial By Error: Psych Issues Do Not Predict ME/CFS, New Chicago Study Shows

30 December 2020 by David Tuller

By David Tuller, DrPH

For decades, investigators have argued over the causes of the illness or cluster of illnesses variously called myalgic encephalomyelitis (ME), chronic fatigue syndrome (CFS), ME/CFS, CFS/ME and other names. In the absence of an adequate explanation for the debilitating symptoms, a flawed approach to intervention based on the perceived need for psychological and behavioral rehabilitation has been relentlessly promoted by a committed band of professional campaigners at high levels in UK medicine and academia; their favored treatments are cognitive behavior therapy (CBT) and graded exercise therapy (GET).

Trial By Error: Swedish ME Patient Fears Forced Psychiatric Treatment

30 December 2020 by David Tuller

By David Tuller, DrPH

Holger Klintenberg, a 35-year-old from the southern Swedish city of Jonkoping, has severe ME. His illness began after a bout of mononucleosis (or glandular fever) when he was 19. He has recently experienced difficult interactions with the health care system. His family fears he could be forced into psychiatric care against his and their wishes. They are concerned that the medical professionals overseeing Holger’s care do not understand ME and, in particular, the role of post-exertional malaise, or PEM.

Trial By Error: A Letter to BMJ From Prof Hughes, Prof Racaniello and Me

21 December 2020 by David Tuller

By David Tuller, DrPH

I have sent the following letter to Fiona Godlee, editorial director of BMJ and editor-in-chief of The BMJ, on behalf of Professors Brian Hughes and Vincent Racaniello as well as me. We were responding to the recent editorial regarding the new draft of ME/CFS clinical guidelines from the National Institute for Health and Care Excellence–as others have already done through BMJ’s rapid response function.

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Dear Dr Godlee:

The recent editorial from Professors Turner-Stokes and Wade about the new draft of clinical guidelines for ME/CFS from the National Institute for Health and Care Excellence (NICE) is problematic on multiple fronts. [1]

Trial By Error: BMJ Pushes Back Against New NICE Draft

21 December 2020 by David Tuller

By David Tuller, DrPH

The BMJ has published an online “editorial” slamming the new draft of clinical guidelines for ME/CFS from the National Institute for Health and Care Excellence. The position expressed is an interesting one: Non-pharmacological treatments for “complex conditions” cannot be adequately measured by randomized trials, according to the two authors. It is, of course, noteworthy that The BMJ is mounting this argument only after an authoritative review commissioned by NICE found the evidence for CBT and GET was mostly of “very low” quality– although some was just of “low” quality.

Trial By Error: Professors Chalder and Crawley Join Forces to Push CBT for Kids

16 December 2020 by David Tuller

By David Tuller, DrPH

On November 10^th, the National Institute of Health and Care Excellence published a draft of new clinical guidelines for ME/CFS. The draft represented a blunt rejection of the argument that the combination of “unhelpful cognitions” and deconditioning drives the illness. Under this once-hegemonic framework, indicated therapies include cognitive behavior therapy to overcome the unhelpful cognitions and graded exercise therapy to reverse the deconditioning. A review of the literature published along with the NICE draft assessed the quality of evidence from dozens of CBT and GET studies as “low” or “very low.”

Trial By Error: Letter to Author of Removed GET/CBT Training Program for GPs

10 December 2020 by David Tuller

By David Tuller, DrPH

Earlier today, I posted a blog about the decision by the Royal College of General Practice to remove from its site a training program called METRIC, which promoted the GET/CBT approach. I then sent the following letter to Carolyn Chew-Graham, a professor of general practice research at Keele University in Staffordshire and the main author of the training program.

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Trial By Error: GP Group Removes Online GET/CBT Medical Training Program

10 December 2020 by David Tuller

By David Tuller, DrPH

In early 2019, I wrote about an awful online training course for general practitioners on recognizing and caring for patients diagnosed with what was referred to as CFS/ME. The module, called METRIC, promised to provide “GPs and other primary care practitioners with an overview of the presentation, diagnosis, assessment and ongoing management” of the illness. It was based on the discredited PACE trial and a related effort called the FINE trial.

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