Trial By Error: My Letter to Professor Chalder about the PRINCE Trial

Andy

Andy

Retired committee member
In its efforts to save money, the National Health Service has been expanding the program known as Improving Access to Psychological Therapies (IAPT) by encouraging physicians to refer over all those with so-called “medically unexplained symptoms” (MUS). Under IAPT, the illness referred to as “chronic fatigue syndrome” falls into the MUS category. The program essentially provides CBT and related “rehabilitative” interventions.

Key PACE investigators have been among the leaders in the MUS field, and their trial served as scientific “evidence” to justify the IAPT expansion. Although citing PACE in any kind of authoritative way has become much more problematic in the last couple of years, that hasn’t stopped people like Professor Trudie Chalder from conducting additional problematic trials. The PRINCE trial proposes to investigate whether trained GPs can provide an effective rehabilitative approach to “persistent physical symptoms” (PPS), another term used to describe the phenomenon under examination.
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http://www.virology.ws/2019/09/16/t...-to-professor-chalder-about-the-prince-trial/
 


This morning I sent the following letter to Adrian Aldcroft, editor-in-chief of BMJ Open. The subject line was: "The factual error in the first paragraph of the PRINCE protocol"

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Dear Mr Aldcroft--

Last week, I sent a letter to Professor Trudie Chalder on which I cc'd you and several others. That letter concerned a major factual error in the first paragraph of the PRINCE trial protocol, which BMJ Open published in July. Specifically, the protocol falsely claimed that the estimated costs of treating so-called "medically unexplained symptoms" among the English working-age population accounted for around 10% of the total National Health Service budget. Instead, according to the cited study, Bermingham et al, these estimated costs accounted for around 10% of the amount the NHS spent on that specific age group.

I have not heard back as of yet from Professor Chalder. I am appealing to you directly, as editor-in-chief of BMJ Open, to ask how long it will take to correct this substantive error. Bermingham et al is not ambiguous. After I raised questions earlier this year with the British Journal of General Practice about the exact same untrue assertion in a 2017 editorial on MUS, the journal corrected it. This BJGP correction was posted before publication of the PRINCE protocol.

It is somewhat perplexing that none of the 13 protocol authors, nor any of those who reviewed it, noticed this prominent mistake. After all, Bermingham et al is a seminal study in the field, so one might expect those who present themselves as experts in MUS to be familiar with the core findings. Such an elemental misreading of key data should certainly raise concerns for you, as an editor, that perhaps the PRINCE investigators have made other protocol claims that are also not reliably based on the research being cited.

Mr Aldcroft, you are the editor-in-chief of BMJ Open. Ensuring that documented mistakes are corrected in a timely manner falls squarely within the scope of your responsibilities as a guardian of the integrity and accuracy of the medical literature. This factual error is not a matter for "letters to the editor" or for debate with the authors in published correspondence. To be blunt, you need to do your job and fix the problem, with or without the assent and participation of Professor Chalder and her colleagues. .

I have cc'd Professor Chalder and Sarah Bermingham, the lead author of Bermingham et al, as well as Dr Fiona Godlee, editorial director of BMJ. Given the implications of MUS research on the treatment available to patients diagnosed with CFS, CFS/ME, ME/CFS or ME, I am cc-ing as well other individuals cc-d on my letter to Professor Chalder--several involved with the NICE committee investigating new ME/CFS guidelines and three members of Parliament concerned about the poor quality of research into the illness. I am also cc-ing Professor Chris Ponting, vice-chair of the CFS/ME Research Collaborative.

I look forward to your quick response.

Best--David

David Tuller, DrPH
Senior Fellow in Public Health and Journalism
Center for Global Public Health
School of Public Health
University of California, Berkeley
 
And now again with BMJ Open. I have written many, many posts about my efforts to get this supposedly reputable journal to acknowledge the issues with Professor Crawley’s school absence study. I won’t recap that unfortunate matter in this post, except to note that I am still waiting for the results from a Bristol University investigation of that and a number of other papers from Professor Crawley’s team.

In any event, last week I sent Professor Trudie Chalder a letter about a mistake in the PRINCE trial protocol, which BMJ Open published in July. Today I sent a follow-up letter to Adrian Aldcroft, the editor-in-chief of the journal.
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http://www.virology.ws/2019/09/18/trial-by-error-my-letter-to-bmj-open-about-false-mus-claim/
 
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