David Tuller: Trial By Error: Carol Monaghan Scores Another Parliamentary Debate

I expect that the PACE lot will do their best to present this as being dangerous political interference in science, like climate change deniers. In some ways, I wonder if it could have been better if the motion had been a bit more cautious, or focussed on a specific like the PACE recovery claims.

It will be hugely humiliating for the UK Establishment to acknowledge that they were wrong about all this, and a lot of people will want to fight back. The same is true with the UK science media. To our advantage, I think that we're now at the point where a lot of important people realise that they're on thin-ice with PACE/CBT/GET, but it's still up in the air how the good/harm from this debate will balance out in the medium term. Hopefully it will encourage more people to look at the evidence and realise that we were right to be raising concern... but people hate admitting that they've got things wrong.

 

I suspect the MPs who wrote the motion are well aware of this possibility (probability? certainty?) and that it informed their decision not to be more specific or demanding in terms of what they were asking for.

• Increased funding for biomedical research is relatively uncontentious - the Chief Medical Officer's report called for the Government to provide this back in 2002 but it demonstrably hasn't materialised to date.
  
• The call for the 'suspension' of CBT and GET suggests only a temporary stoppage - and as NICE has decided the evidence base for these therapies has been called into question, there's a strong argument to be made that the NHS should stop recommending them until the guideline review has been completed.
  
• It'd be awkward for the SMC to argue that GP training on diagnosis and management *shouldn't* reflect the international consensus...
  
• ...and they'd have to be mad to try and defend families being subjected unnecessarily to child protection proceedings.

These are all reasonable and modest requests. It'll be hard for the SMC to successfully portray this as undesirable political interference in the scientific process - although I'm sure they'll give it a try.

 

This argument is used often and it's absurd on its face. This is not about basic science. The researchers themselves admit that they make no claims about cause, pathology or even imply that it's psychosomatic (which they do, they just keep that opinion out of those papers and the resulting guidelines). They are specifically doing trials aimed at treatment options with the intent of becoming widely accepted clinical guidelines in practice, delivered to millions.

Sharpe, Wessely, White, Chalder, Fink, Lloyd and the rest have spent considerable effort pushing their ideology into practice, to be used in a clinical setting, in some instances with force of law. This kind of work normally cannot be detached from patient experience and input. Not a single element of this research has advanced understanding of the disease and their promoters themselves recognize that, arguing that they are merely offering a treatment option where none otherwise exists.

It says a lot that this argument is taken seriously, thanks in part to the SMC. In the climate change argument, this would not be about what is the nature of climate change or if it exists but rather about which specific solutions would work to address it. The psychosocial model basically amounts to nuking the sun, it's that detached from reality. It's incredibly dishonest and shows how little confidence they have in their beliefs, that they need to make up strawman arguments to defend against legitimate criticism.

 

Even more so when they have a legal obligation to rely on objective evidence and real-world patient input and data, which they have purposefully chosen to disregard. The legitimate objections from patient advocates are on public record. They form a damn long and voluminous record of failure. For many it's embarrassment. For some it is serious, career-ending, legal liability.