A Review of BMJ Best Practice Document on Chronic Fatigue Syndrome by Professor James Baraniuk

Professor Hooper’s peer-review comments were written to indicate the accurate situation that now obtains concerning the PACE trial raw data. People can judge for themselves if his comments were accepted by the BMJ by looking at their updated version of “Best Practice on CFS” released in September 2018. ( https://bestpractice.bmj.com/topics/en-gb/277/ )


http://www.margaretwilliams.me/2018/hooper-review-bmj-best-practice-on-cfs.pdf

A Review of BMJ Best Practice Document on Chronic Fatigue Syndrome by Professor James Baraniuk

Professor Malcolm Hooper 24th June 2018

NOTE: I was asked by the BMJ Section Editor (BMJ Best Practice and BMJ Learning) to provide a peer review of Professor James Baraniuk’s document on “CFS”, to which I agreed. My comments below relate to the version sent to me. In my opinion, it indicated how dangerous the medical education programme about ME/CFS is in the UK. This was borne out by my face-to-face discussion with Professor Baraniuk himself on 1st June 2018 in London: he confirmed to me that his original report had already been sent by the BMJ to other referees and that he had received 156 comments which he was instructed had to be incorporated in his report. It was plainly obvious that those comments had been included in the version sent to me. Professor Baraniuk assured me that I should go ahead and respond as I wished, so it seems he knew his report was not as he intended it to be. In telephone discussions with the BMJ Section Editor, it was stressed to me that the BMJ had to have (quote) “equality”.

 

Cracking critique!

 

This needs to be widely disseminated.
I am considering sending to my GP.

 

Much as I appreciate the effort that clearly went into this, I think that at 18 pages, this is only likely to be read by the ultra-keen and therefore not the ideal advocacy document.

 

7 pages (of actual review material) of an extremely well thought through review, shows just what a mess it was that he had to review.

Now that is as succinct and legible a summing up of that aspect you could hope for I think.

Excellent review!

 

His review comments continue in what I now see is a long appendix but anyone faced with this is going to think they've got to read a review 18 pages long. I think a brief contents list with page numbers would help.

 

Under "peer reviewers" there are Disclosures. Of course, only Hooper has disclosures...

 

In skim-only mode, but just saw that on the BMJ Best Practice website presenting Baraniuk's summary both the IOM Report (2015) and the CDC‘s recommendations on "Symptoms and Diagnosis" are linked as "guidelines" on the right side. In the category "resources" the guideline section is only accessible with subscription, though.

Also, the "patients‘ leaflets" linked on the right side, one on "Chronic Fatigue Syndrome" and one on "Depression in Adults", are only accessible with subscription.

Could anyone who has access to "BMJ Best Practice" give us some information about the guidelines, patient leaflets and "evidence" presented as "resources" for "Best Practice" for "CFS/ME"? (documents' titles, authors?)

Edit: Just realized that this thread's topic is Hooper's review, not the BMJ Best Practice content per se, so I'll copy my post on the thread "Sources of online information for medical professionals".

Edit 2: correct link to the other thread

 

Last reviewed: 16 Dec 2023
Last updated: 09 Jan 2024
https://bestpractice.bmj.com/topics/en-gb/277

 

Dr Charles Shepherd has written to the BMJ in response to the update.

https://meassociation.org.uk/2024/0...=BMJ Best Practice:,lasting at least 6 months.

 

Notwithstanding Charles Shepherd's comments I think this is pretty good on a moderately quick skim through the PDF. It's a fairly long document, though about half are references. That probably means it's only going to be read by a professional invested in the area. I doubt most GPs would get far through it, but I may be wrong.

The sections on possible causes etc seem fine — lots of biological findings and theories, but we don't yet know. I enclose one subsection in treatments —

The section on CBT skates the line a bit, but seems adequately NICE-compliant in terms of being supportive not curative.

 

it blurs over how in the strong difference of opinion, what clinicians and patients “now” agree on is that patients and their advocates/ most charities were right all along. The word harm is used without acknowledgement that that “harm” extends to accounting for why many of the patients who are house and bedbound are so.

 

It's also a bit slippery, because 'activities' really means entire existence.

It's good that professionals are now using activity where they'd once have used exercise, but in a sentence like this, it still manages to convey a sense of voluntary activity. It wouldn't make anyone think that planning might involve not eating fresh salad because you haven't the energy to chew it.