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

Estherbot

Estherbot

Senior Member (Voting Rights)
Michael Sharpe breaks his retirement promise on ME/CFS and returns with this monstrosity, a blog for the BMJ (British Medical Journal)

He says ME/CFS is an illness but not a disease...

Mind, Medicine and Morals: A Tale of Two Illnesses

https://blogs.bmj.com/medical-human...c&utm_medium=twitter&utm_source=socialnetwork

In this piece, we explore the controversy concerning the treatment of the illness called Chronic Fatigue Syndrome or CFS, which is sometimes also called ME (Myalgic Encephalomyelitis). Specifically we ask why are the apparently benign psychological and behavioural treatments for fatigue—cognitive behaviour therapy (CBT) and graded exercise therapy (GET)—so very controversial.

We suggest that it is helpful to consider this controversy in terms of the modern medical concepts of illness and disease: illness refers to a person’s subjective experience of symptoms; disease refers to objective bodily pathology. Chronic disabling fatigue is a common symptom of many illnesses. For some of these illnesses like CFS there is no generally accepted associated disease. For other illness like cancer-related fatigue, there is. In both cases disease-focussed treatment is commonly ineffective in relieving the fatigue, whereas, illness focussed treatments such as CBT and GET, can be. However, whilst such treatments are readily accepted by patients with cancer-related fatigue, they may be strongly rejected by people with CFS; why is this?
Click to expand...
 
Last edited:
I think the department of medicine at UCLH formed a fairly good idea of why these treatments are so controversial today. They seemed to readily accept the answer that the treatments have not been shown to work and probably do not work very well if at all.

The authors here are perspicacious enough to see that the treatments are also insulting to patients but that isn't the point.
 
It is insulting to suggest that patients cannot tell the difference between deconditioning and chronic illness, or that they erroneously think to be ill, and other similar things.

It is also flawed logic, as it's ultimately based on the idea that absence of evidence is evidence of absence.
 
Last edited:
One wonders if he believes in empirical evidence. Probably before Michael Sharpe had ever heard of ME, and certainly before CFS was ever imagined, my doctors were aware that exercise could be harmful for my condition. Why did he not listen to anyone who tried to tell him about that as a general point, instead of just repeating the boom and bust mantra? The suspicion is that he takes everyone else for fools.
 
The real problem is that medicine is generally bad at handling patients with unexplained illness. They think unexplained means somatizing, and that their job is to manage the somatizing patient by being nice or deceptive, but they have not shown that somatization is a real thing or is occurring in any particular case, or that doing this to patients is even good. Since it's not possible to demonstrate any benefit from this approach with clinical trials that eliminate bias they have never progressed past them.

What is lost here is first trust in medicine, and second the opportunity to actually understand what is wrong with patients. Pseudo explanations only get in the way of understanding what is really happening.
 
I knew Greco rang a bell, as I said previously:

Monica Greco seems to do lots of uninteresting thoughtless work with long words on MUS. It's possibly worth reading her work to see how some people think about these things?
Click to expand...

https://www.s4me.info/threads/monic...ty-and-‘medically-unexplained-symptoms’.2978/

Pretty loathesome to ask "ask why are the apparently benign psychological and behavioural treatments for fatigue—cognitive behaviour therapy (CBT) and graded exercise therapy (GET)—so very controversial" and produce an answer that fails to acknowledge any of the problems with the research in this area. The problem seems to be down to the insecurities of patients? How very embarrassing for us.
 
Can we stop pretending these goons don't deny that ME is a serious disease now?

As if "there is no disease" used in the "rousing reassurance" model of the FINE trial was not clear enough, considering it is the basis of NHS training for GPs. Hosting the Cochrane reviews in the common mental disorders is also kind of a big tell, implausible deniability.

Some people act in bad faith. Some medical professionals are reckless and unethical. It happens.

edit: derp
 
Last edited:
Jonathan Edwards said:
I think the department of medicine at UCLH formed a fairly good idea of why these treatments are so controversial today. They seemed to readily accept the answer that the treatments have not been shown to work and probably do not work very well if at all.
Click to expand...
Added to which, GET especially can harm some pwME, with no way of knowing beforehand who those people will be, so becomes a form of Russian roulette.
 
Why do I get the impression MS is trying to reframe how psychiatrists such as himself are perceived (including by his peers), and trying to exit from the hole they have dug. As Prof. Ola D. Saugstad said at Norway's Mission Millions event:
Several of the leaders of the psychosomatic wing are now jumping off the ME train with the reason that they’re bullied by the patients. This claim was examined in England, and no grounds for such accusations were found. The truth is rather that many of them realise they’re on a sinking ship and are trying to find an excuse to leave it before it goes down.
Click to expand...
 
Several of the leaders of the psychosomatic wing are now jumping off the ME train with the reason that they’re bullied by the patients. This claim was examined in England, and no grounds for such accusations were found. The truth is rather that many of them realise they’re on a sinking ship and are trying to find an excuse to leave it before it goes down.

There was certainly nobody feeling like handing out lifejackets in my department this lunchtime.
 
You must log in or register to reply here.
Back
Top Bottom