I think there are issues that go beyond the treatments a theory proposes. Suppose that doctors believed in the psychosocial theory of ME/CFS, namely that the disability of ME/CFS patients endures because they have false illness beliefs and unhelpful behaviors. And suppose that those doctors somehow agreed that GET and CBT do not work. In my opinion, there would still be a major problem. Spreading misinformation about perfectionist tendencies, catastrophizing, kinesiophobia and somatic attributions in ME/CFS patients is harmful because it changes how doctors look at ME/CFS patients and how they interpret their symptoms. Doctors might be more willing to challenge the patient's experience for example by suggesting the patient doesn't really need those sunglasses, that wheelchair or that many hours of sleep. In fact, I would go one step further. Even if there was a psychosomatic theory on ME/CFS that somehow would not lead to such inappropriate management advice, but instead would result in doctors taking the patient seriously, I think there would still be a problem. Most ME/CFS patients experience their illness as a biomedical pathology that is mostly unrelated to their thoughts or behavior. If their doctor believes otherwise, that will be a source of frustration and stigma. So that's a major flaw that is inherent in psychosomatic theories and unrelated to their predictions regarding treatment and management. So even if ME/CFS patients had a doctor who took their symptoms seriously and offered correct treatment advice, the fact that he believes in an etiology that is contrary to the patients' experience, is still problematic. I think one could argue that it is unethical to promote an etiology that challenges the patient experience, without providing the necessary evidence to do so. I agree that this isn't much of a problem in the NICE guideline which doesn't speculate much about etiology. But there was a Belgian government website on ME/CFS that provided pretty much this info. The website was restrained in offering GET/CBT but emphasized that CFS patients have a lot of psychosocial problems and that they have difficulties managing their activity pattern etc. A problem that does bother me in the NICE guidelines and that goes beyond GET/CBT, are their diagnostic criteria. Although the Canadian criteria were available at the time, they made up their own case definition, one that focuses mostly on the symptom of fatigue and only requirs 4 instead of 6 months of duration. If a guideline says that ME/CFS is unexplained fatigue accompanied by some other symptoms, that will probably result in doctors not taking this condition seriously because fatigue is everywhere and always poorly understood. The NICE criteria also probably resulted in overdiagnosis. This Chalder study, for example, looked at 200 patients who satisfied the NICE criteria. Of those, only 52,6% satisfied the Fukuda criteria. So if a guideline defines a condition differently which results in an increase of the prevalence, without offering any good reason (either data or expert opinion) to do so, that is a major problem and ethical issue. So I think I might be taking a middle ground in this discussion. On the one hand, I don't think everything is going to be alright when GET and CBT are off the table. There are other major problems with the psychosocial theory and the way ME/CFS is defined. On the other hand, I doubt that these issues are best articulated using the biomedical/psychosomatic divide terminology. In my opinion the crux of the matter isn't really about having access to biomedical care.