Michael Sharpe: Mind, Medicine and Morals: A Tale of Two Illnesses (2019) BMJ blog - and published responses

I actually thought it was well-written until halfway through the article where they write:

That very much gave me the impression that Sharpe thinks there is no disease to be found in ME/CFS. And apparently, I should overcome my "long-standing ‘bifurcated’ habits of thought" and see that illness is "an abstraction from the totality of what is real"...

Anyway, I think it's best not to reply to this argument (which probably has some truth to it) because it is meant to distract from the flawed theory and questionable research practices of Sharpe and colleagues which form the real reason why GET/CBT are controversial in the field of ME/CFS.

 

I would like to think there might be a useful response to this article. However, it is so bad it is hard to see what one can say. The philosophy is appallingly bad - they gt the views of almost all the philosophers they quote wrong. The analysis is a complete dog's breakfast.

And even if one was charitable and suggested that the improvement seen in PACE was a genuine affect of CBT and GET look how tiny it was! A difference of 3 points in a scale that goes up to 30 at least and probably more. The obvious answer is that patients are dissatisfied with the treatment because, even if it does work, the effect is so tiny as to be a complete waste of time. And of course there is no reason to think it is more than expectation bias. It isn't even as good as the placebo response in other trials.

 

If they genuinely believed that a placebo is good for patients, they should not be giving CBT and GET but some fake biomedical treatment because that will produce stronger placebo responses.

As usual their position is incoherent. Their real goals are keeping CFS in the mental health domain as purely subjective and unexplained condition and selling CBT and GET. Nothing else matters.

 

You can keep an eye on the download article metrics and the demographic for Twitter shares for this Sharpe, Greco commentary here:

https://mh.bmj.com/content/early/2019/06/18/medhum-2018-011598.altmetrics

Twitter demographic

https://bmj.altmetric.com/details/62366783

 

Here is one of the studies on cancer-related fatigue - interesting that it was done by one of their Dutch colleagues, as are most of the studies on this topic: CBT for fatigued cancer survivors - Gielissen et al.

The subjective fatigue scale used here is the CIS (Checklist Individual Strength), which was developed for CFS (see appendix of this pdf).
The 8 questions (7-pt Likert scale) are: "I feel tired", "Physically I feel exhausted", "I feel fit", "I feel weak", "I feel rested", "Physically I feel I am in a bad condition", "I get tired very quickly", "Physically I feel in a good shape"

Lots of issues with the follow-up in this study.

 

Quite interesting that the imporovement in fatigue in the study looks much more dramatic than in PACE. In PACE the score drops from 28 to 21, with controls dropping to 24 (roughly). In this study the fatigue score almost halves.

Sharpe seems to have forgotten that recently he has only been claiming that CBT makes teeny bit of difference to fatigue in ME/CFS.

 

He is right in that patients with invisible illnesses are treated as second or third class citizens.

The irony is that he himself is such a big part of the problem: if you insist that unblinded studies are good enough evidence and switch outcomes, then you're effectively saying that ME/CFS patients do not deserve reliable science, and that is an instance of patients being treated like second or third class citizens.

The real purpose of this article is just to try and cover up the fact that his science is rubbish and that the critics are right.

 

perhaps he knows something we dont't

 

The scales used are completely different. CIS is a measure of relative fatigue. CFQ measures *change* of fatigue since first becoming ill. Neither of the measures are comparable between individuals. And they are certainly not comparable between the two different scales.

 

So the claim of comparable benefit in the two conditions is not actually substantiated?

 

Well, no. And if the results of this long-term follow up are anything to go by, it looks like they are running into difficulties that their UK friends are not acknowledging... https://www.ncbi.nlm.nih.gov/pubmed/28606498

 

https://twitter.com/user/status/1134232641702715393


Sorry about interrupting the academic debate but I just saw this on twitter and figured we could do with the laugh!

 

https://twitter.com/user/status/1141363038001467394

 

I really cannot work out what they think they are trying to say. They want to separate illness as symptoms from disease as physical process. But later they laugh at Locke for making a distinction between subjective experiences like colours and the physical processes that give rise to these experiences.

I don't even think that a humanity journal would accept this piece. It only gets into BMJ humanities because the editor knows nothing about either medicine or humanities.