Anomalies in the review process and interpretation of the evidence in the NICE guideline for (CFS & ME), 2023, White et al

BMJ, behind a paywall so far as I can tell. Interesting this wouldn't be deemed worthy of open publishing.

Mods--if anything needs to be reformatted, my apologies, by all means change/edit/reformat, if necessary.

I'm not copying the 'competing interests' section. It's so long it might break the forum. And my computer.

But then if I could read this I might break my computer anyway.
I note that this journal takes e-letters:
https://jnnp.bmj.com/content/early/2023/07/09/jnnp-2022-330463.responses

Such e-letters don't have to be perfect but best to do them in scientific format with numbered references underneath. Even just one or two references underneath might be sufficient. One easy one is
1. White P, Abbey S, Angus B, et al. Anomalies in the review process and interpretation of the evidence in the NICE guideline for chronic fatigue syndrome and myalgic encephalomyelitisJournal of Neurology, Neurosurgery & Psychiatry Published Online First: 10 July 2023. doi: 10.1136/jnnp-2022-330463


Not sure whether it publishes any letters formally: there is no mention here of any guidance on this topic:
https://jnnp.bmj.com/pages/authors/#submission_guidelines
One e-letter that has been submitted.
 
Not sure it's fair to blame Charles Shepherd for this. He's not their media person, he's their medical advisor, and his responses to articles like this are usually very good. I agree the MEA need to get their media act together. I am not impressed by their long term chairman's efforts.

I don't mean to blame Charles—he is a very valued member of the community. And it's probably not his job to do social media comms. But I hope he recognises that their strategy does a disservice to his commentary.
 
We were meant to have ForwardME now as a unified voice (when I was in MERC PAG and was involved with their meetings, we spoke about their being more proactive and quicker off the mark). Now they've gone silent again and their subpar website hasn't been updated for the best part of a year.
Makes one wonder about the motivation of the person who took on being the chair of ForwardME when the Countess of Mar retired. But that's probably for another thread. United Kingdom: News from Forward-ME Group
 
Makes one wonder about the motivation of the person who took on being the chair of ForwardME when the Countess of Mar retired. But that's probably for another thread. United Kingdom: News from Forward-ME Group

Yes, don't want to go too far off topic, but one more comment: We tried to get them to use Slack to coordinate advocacy and the type of response you'd want to see today. We failed miserably.
 
White et al. are being misleading when they say graded exercise therapy is symptom dependent.

Here are some extracts from the PACE Trial manual Peter White wrote himself:

This contrasts with the protocol in the PACE Trial [4] where what participants are asked to do is determined by “their planned physical activity, and not their symptoms” (p.20); similarly, “a central concept of GET is to MAINTAIN exercise as much as possible during a CFS/ME setback” (p.51) and “if the participant reports an increase in fatigue as a response to a new level of exercise, they should be encouraged to remain at the same level for an extra week or more” (p.66). The approach in the PACE Trial could be described as inflexible and prescriptive, attributes which Gladwell et al. describe as lowering quality [1].

(taken from a published letter of mine: https://www.researchgate.net/public..._in_CFSME_The_need_for_further_investigations)

 
Yahoo article at 12.22 pm includes Dr Shepherds statements. But the article relies on the NHS pages for describing ME symptoms 'The NHS describes CFS or ME as a long-term illness with a wide range of symptoms, the most common of which is extreme tiredness' Journalists and others will continue quoting "extreme tiredness" until the NHS ME/CFS pages are changed. It's regressive for anyone, especially journalists, to use the name 'Chronic Fatigue Syndrome'.



‘Shortcomings’ identified in chronic fatigue syndrome guidance'
Ella Pickover, PA Health Correspondent
Tue, 11 July 2023 at 12:22 pm BST


https://uk.style.yahoo.com/shortcomings-identified-chronic-fatigue-syndrome-112238436.html
Also published in the Evening Standard and The Independent.

--

Another article but by a different author, Helen McArdle:
'Flawed and harmful': Scientists blast ban on exercise therapy for chronic fatigue
 
So we are back to ME being called Chronic Fatigue Syndrome all over the national press. And the PACE researchers and all their colleagues/propagandists calling the shots in the national press, controlling the narrative. These articles are harmful, damaging us. What the hell has changed. This may as well be 1996 (Joint Colleges Report), or 2002 (CMOs Working Group Report) or 2011 (PACE) ..... misinformation about our disease all over the UK press.
 
So we are back to ME being called Chronic Fatigue Syndrome all over the national press. And the PACE researchers and all their colleagues/propagandists calling the shots in the national press, controlling the narrative. These articles are
harmful, damaging us. What the hell has changed. This may as well be 1996 (Joint Colleges Report), or 2002 (CMOs Working Group Report) or 2011 (PACE) ..... misinformation about our disease all over the UK press.

Utterly heartbreaking.
It's hard to find the energy to begin the fight back yet again. Thanks to those who are planning to do this. Would Sean O'Neill be a possible contact? I see he attended a Forward ME meeting fairly recently. I'll try to add a link to this.

edit: https://www.meresearch.org.uk/wp-co...-ME-Minutes-Meeting-09-September-02.10.20.pdf

"2. Sean O’Neill, Chief Reporter to the Times was also welcomed. He explained that he was going to talk about the media in general, how he thought it worked and the best way to use it.
l People tend to make the mistake of seeing the media as one monolithic organisation. The reality was that, although it had many common features, it is driven and riven by competition. Everybody wanted their own story, seeking something new, unusual, shocking, powerful human story or preferably a scandal!
l Entry into the media was not just about transmitting a message that was important, expecting it to be picked up and responded to. It very rarely worked. Engagement with the journalist with an interest in the subject was essential. Contacts and personal initiative and connections in order to find the right person to take on the story were necessary.
l The right timing was also important. Timing could be upset by events, such as a major disaster which would prevent other news items from being reported. He suggested that there should be a plan but there should also be a plans B and C"

edit 2: there was a later discussion with Sean on how to handle the SMC. He felt they could be ignored because their influence was diminishing.
It's hard to see that today.
 
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It would be good if someone could compare the snippets from the draft version of this paper with the final piece. Should give us an indication of what the reviewers thought. @dave30th
It is interesting to see that the title was changed from “Eight major errors (…)” to merely “Anomalies (…)”.

It is also worth noting that Peter White wrote the paper alone and the other authors only chipped in with comments (which I doubt were more than simple approval):
Contributors: PW drafted the manuscript. All authors have contributed equally and have commented on iterative drafts and agreed the final version.

Peer review took more than 7 months:
Received September 25, 2022
Accepted May 3, 2023
First published July 10, 2023.
 
So we are back to ME being called Chronic Fatigue Syndrome all over the national press. And the PACE researchers and all their colleagues/propagandists calling the shots in the national press, controlling the narrative. These articles are harmful, damaging us. What the hell has changed. This may as well be 1996 (Joint Colleges Report), or 2002 (CMOs Working Group Report) or 2011 (PACE) ..... misinformation about our disease all over the UK press.

They have too much to lose. Im hoping there will be responses from reputable sources, though i’m not incredibly optimistic
 
It is interesting to see that the title was changed from “Eight major errors (…)” to merely “Anomalies (…)”.

It is also worth noting that Peter White wrote the paper alone and the other authors only chipped in with comments (which I doubt were more than simple approval):

I would speculate this is especially true for the FND sycophants, who I highly doubt were pouring over the literature.
 
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