‘The Lightning Process’ and chronic fatigue syndrome/myalgic encephalomyelitis, 2022, Vallings

Andy

Andy

Retired committee member
As Medical Advisor to the NZ ME Association (ANZMES) and having worked in this area of medicine for 40 years, I am concerned that recent GP educational events have promoted ‘The Lightning Process’,1,2 predominantly used for treatment of chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME). I do not consider that this is a treatment that GPs should be advocating for use in people with CFS/ME.

Open access, https://www.publish.csiro.au/hc/Fulltext/HC22078#R1
 
Good to see Vallings warning against LP for ME/CFS in the New Zealand GP's journal.

A pity she gives it any credit at all for being able to help anything and refers to it as 'a treatment offering psychological management and potential ‘cure’'.
And says 'While I acknowledge that psychologically-based therapies such as the Lightning Process can have benefit for some patients with any illness, ...'

It's not a treatment it's a brainwashing training program by unqualified quacks that causes serious long term harm.
 
Vallings said:
And says 'While I acknowledge that psychologically-based therapies such as the Lightning Process can have benefit for some patients with any illness, ...'
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Well, no. Obviously. What a weird thing to say. The widespread belief that any kind of psychological anything MUST have some sort of benefit is just plain bizarre. Never privilege a lie. Mental healthcare is decades away from having a viable product, is frankly basically at the level where medicine was at the time of the Humors. Just because they're selling an unviable product doesn't change that.
 
Vallings said:
While I acknowledge that psychologically-based therapies such as the Lightning Process can have benefit for some patients with any illness, ‘curing’ a serious illness such as ME/CFS is unlikely.
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This part looks to me like a misguided attempt at "balance", a bit like journalists giving two sides equal airtime irrespective of the strengths of the respective arguments.

As far as I know there's no solid evidence for the LP being useful for any condition though there are some poorly done studies claiming to provide evidence in for example pain, and selected bits of the LP may well help anxiety. But it would have been better to not mention other conditions at all, they're irrelevant in this context. Though it's conceivable Dr Vallings had to insert this bit to get the article published at all.

I don't know Dr Vallings' thoughts but I rather suspect the main intention behind this article was to give patients and patient organisations in NZ something published against the LP to point to. It may work, I certainly hope so, though it's difficult to know how people not deeply familiar with the ME debates read and interpret an article like this. Given Dr Vallings clearly, and rightly, states her association with ANZMES, do readers unfamiliar with the ME debates interpret her arguments as biased or do they on the contrary take her experience with ME patients as authoritative expertise?

We do have a huge problem with the LP in NZ with believers firmly ensconced in key positions of authority in the health and medical education systems. Some are passive obstacles to progress, which is quite bad enough, but others use their power to promote LP and mind-body ideas in general, including CBT/GET, and to obstruct counter views. As 'evidence' they like to present the Crawley paper and, for good measure, to 'prove' mind-body ideas, also papers by the likes of Fink and Wyller. Nuff said.

So I hope Dr Vallings' article can be a small counter to all that. We also need some solid published literature documenting the harmful effects of LP. Currently we're stuck with your anecdote of recovery against my anecdote of harm. Time to step up to playing your published paper against my published paper but we're currently behind on that score. So if anyone is able to get something written and published, please please pretty please...
 
The Lightning Process is a treatment offering psychological management and potential ‘cure’ for an illness with disordered immunological and biochemical parameters. There is strong evidence, in particular research by Prof Warren Tate (Otago) and Prof Sonya Marshall Gradisnik (Queensland) confirming immunological changes. The Otago research has shown that a SWATH-MS analysis of ME/CFS peripheral blood mononuclear cell proteomes reveals mitochondrial dysfunction.3 This supports a model of deficient ATP production in ME/CFS, compensated for by upregulation of immediate pathways upstream of Complex V that would suggest an elevation of oxidative stress. There were 20–30 times higher unstable genetic codes. A second study has shown evidence of neuroinflammatory changes.4

The Queensland research which looked at transient receptor potential (TRP) pathology found that in ME/CFS patients’ natural killer cells there are fewer functioning TRPM3 receptors and some are defective.5 TRPM3 receptors control movement of calcium in and out of cells. Damaged single-nucleotide polymorphism leads to decrease in the TRPM3 receptors causing changed function leading to decreased intracellular calcium in cells and impaired lysis. These abnormalities affect many systems throughout the body, leading to multiple symptomatology.
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I feel very ambivalent about statements like these being used to counter the Lightning Process. Yes, they might persuade some doctors to treat ME/CFS seriously, and yes, there might turn out to be some valid findings in amongst the ME/CFS publications of Tate and Gradisnik. But the sample size of the research in both of these people's labs is tiny, definitely at the level of preliminary research.

And so what if people with ME/CFS have fewer TRPM3 receptors on the natural killer cells and neuroinflammation? There are plenty of people who believe that CBT can fix inflammation. Professor Tate's recent hypothesis papers are quite similar to the BPS vicious circle diagrams involving stress. The existence of physical problems is no barrier to the belief that the powerful mind can fix things, indeed, theories of somatisation embrace physical symptoms as evidence of the effects of a faulty mind.

The article concludes:
I would therefore recommend extreme caution in promoting this expensive treatment modality without careful evaluation of its suitability.
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So, it's ok to promote it if you do do a careful evaluation of its suitability?

Dr Vallings went on NZ national radio a couple of years back and did not dismiss the Lightning Process when given the opportunity - she said that it is useful for patients who have psychological issues. It's mentioned on the NZ news thread somewhere. Possibly this latest statement is better than nothing, possibly it just brings the Lightning Process to the attention of more possible customers and doctor advocates.
 
Bruce Arroll, head of the Goodfellow Unit, Auckland University and LP supporter (training in it from what I understand) and Jenny Oliver, LP practitioner, were given the opportunity to respond to Dr Vallings article in the Journal. However, Dr Vallings was not given the chance to respond to Arroll, as would be normal practice.

https://www.publish.csiro.au/hc/Fulltext/HC22105

We are concerned that this letter seems to be part of an attempt to stop discussion about the Lightning Process. We suggest Dr Vallings and her supporters look at the actual evidence such as the very well-conducted trial by the Bristol Clinical Trials Unit which found a benefit for teenagers with Chronic Fatigue Syndrome (CFS) from the Lightning Process in 2017.1 The cost-effectiveness of the Lightning Process was UK pounds 1474 per QALY (2017 currency). Dr Vallings’ preferred Pacing Therapy is the least cost-effective at UK pounds 127 047 in 2013 UK pounds.2 CBT is UK pound 18 374 and graded exercise 55 235. This would suggest that Pacing is a modestly effective treatment that is expensive.

The NICE guidelines are quoted for the safety/harm of the Lightning Process. The claimed harms come from a qualitative study (not a cohort) where possibly two people claimed they were harmed (there were no harms in the Bristol Study). Clearly, something bizarre happened at the NICE Guideline on CFS as four people resigned, prompting a group of Scandinavian Psychologists to write an article in the Lancet saying that there was ideological capture of the Guideline group.3,4 We agree, having examined the NICE Guideline.
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CBT is UK pound 18 374 and graded exercise 55 235.
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That's actually pretty poor. I perceive that BPS doctors consider their interventions curative or at least powerful. Those figures make the effectiveness seem minimal, even when flawed studies are taken at face value. If GET was actually curative, it would be stupid simple to implement. It could even be done on a self-help basis with an exercise bike. You'd just ride for 10 minutes, then 12, 14, 16 and so on. If it actually worked your PEM threshold would gradually rise until you stopped experiencing it.

Now I'm starting to wish GET worked :). This is starting to sound easy. I feel like doctors misunderstand this point. I'm not against GET because I have some unjustified condition my illness is physical. I'm against it because it's an unproven therapy that harms people. It's scientific, not ideological.
 
Hutan said:
Possibly this latest statement is better than nothing, possibly it just brings the Lightning Process to the attention of more possible customers and doctor advocates.
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Looks very much like the latter then.

Dr Vallings’ preferred Pacing Therapy is the least cost-effective at UK pounds 127 047 in 2013 UK pounds.2 CBT is UK pound 18 374 and graded exercise 55 235. This would suggest that Pacing is a modestly effective treatment that is expensive.
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I don't think pacing is a therapy. And, wow, that's quite the twisting of the outcomes. A 127,047 UK pounds cost for a benefit from pacing. Given pacing is just finding ways to cope with a reduced capacity for activity, nearly every participant in PACE was surely already doing some version of it before and during the trial, even the ones trying to adjust their daily activity to fit GET into their life. It is therefore to be expected that the trial does not demonstrate any additional benefit from pacing.
 
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RoseE said:
Bruce Arroll, head of the Goodfellow Unit, Auckland University and LP supporter (training in it from what I understand) and Jenny Oliver, LP practitioner, were given the opportunity to respond to Dr Vallings article in the Journal. However, Dr Vallings was not given the chance to respond to Arroll, as would be normal practice.

https://www.publish.csiro.au/hc/Fulltext/HC22105
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None of the numbers they cite here are even real. They mean absolutely nothing. What nonsense.
 
RedFox said:
CBT is UK pound 18 374 and graded exercise 55 235.
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That's actually pretty poor. I perceive that BPS doctors consider their interventions curative or at least powerful. Those figures make the effectiveness seem minimal, even when flawed studies are taken at face value. If GET was actually curative, it would be stupid simple to implement. It could even be done on a self-help basis with an exercise bike. You'd just ride for 10 minutes, then 12, 14, 16 and so on. If it actually worked your PEM threshold would gradually rise until you stopped experiencing it.

Now I'm starting to wish GET worked :). This is starting to sound easy. I feel like doctors misunderstand this point. I'm not against GET because I have some unjustified condition my illness is physical. I'm against it because it's an unproven therapy that harms people. It's scientific, not ideological.
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I don't understand what you've quoted there. The phrase "CBT is UK pound" doesn't appear in the article being discussed.
 
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