Michael Sharpe skewered by @JohntheJack on Twitter

I wish that I knew exactly what were the qualifications of Wessely, David, Butler and Chalder in 1989. It has always seemed to me that they were all much too junior and with too little experience to have such an influence. There views at the time seemed at variance with reality, and I think that is largely what led to the prejudice that they must have been seeing an entirely different patient population. It may just have been that they did not speak much to colleagues.

Reviewer 2 gave the game away about the modus operandi.

 

Seems perfectly consistent and logical to me. What she's saying is that ME sufferers should always listen to experts but never be allowed to listen to themselves.

 

Dr Davis and Dr Klimas are experts, should we listen to them?

 

Have they co-authored a paper with Chalder?

 

You can ask MS that one, if he says yes i will donate an extra $10 to David Tuller next year

 

The ability to blag their way into areas of science and society they have no right nor competence to be.

 

Excellent spot. Here's a little word substitution to make it quite clear what she is saying:

Now, where are the objective studies measuring this fear of exercise that we supposedly have? Where are the studies measuring the fight or flight response in patients? Where are the comparison studies with other debilitating psychological fear based conditions?

This is why I feel it important to point out their exercise avoidance phobia theory. Even a GP in the office would be able to measure at least some of the fight or flight response by taking pulse readings and observing things like sweating, respiration rate, pupil dilation etc. You don't even have to have the object of the patients' fear in the office, just a picture or short video, to measure this.

Here's a list of things to measure:

• Acceleration of heart and lung action
• Paling or flushing, or alternating between both
• Inhibition of stomach and upper-intestinal action to the point where digestion slows down or stops
• General effect on the sphincters of the body
• Constriction of blood vessels in many parts of the body
• Liberation of metabolic energy sources (particularly fat and glycogen) for muscular action
• Dilation of blood vessels for muscles
• Inhibition of the lacrimal gland (responsible for tear production) and salivation
• Dilation of pupil (mydriasis)
• Relaxation of bladder
• Inhibition of erection
• Auditory exclusion (loss of hearing)
• Tunnel vision (loss of peripheral vision)
• Disinhibition of spinal reflexes
• Shaking.

That's a lot of things that can be objectively measured during a test.

 

This made me recall something in Sharpe's 1993 paper.

"Inactivity produces a range of physical and mental changes similar to those suffered by people with CFS. These include muscle wasting, changes in the cardiovascular response to exertion, depressed mood, postural hypotension and impaired thermoregulation (Sharpe and Bass 1992). THESE EFFECTS CAN BE REVERSED WITH GRADUAL INCREASES IN ACTIVITY, ALTHOUGH THIS WILL COMMONLY RESULT IN A TRANSIENT AND PHYSIOLOGICALLY UNDERSTANDABLE, EXACERBATION OF SYMPTOMS, PARTICULARLY MUSCLE PAIN (EWARDS 1986).

The full ref for that paper is
Edwards RHT 1986 Muscle fatigue and pain. Acta Med Scan Suppl 711:179-188

It would therefore appear that Edwards is implicated in the formulation of these ideas.

 

Sharpe seems to have relied on

Sensky T 1990 Patients reactions to illness. Br Med J 300:622-623
but I rather doubt that it will provide the answers you seek.

 

He published a great deal more than that. A 1993 paper of his which I am looking at lists 8 more, not including the one above.

Sorry for any confusion about the names. I was assuming that we all knew who we were talking about.

 

And experts will listen to ME sufferers when they say CBT works, but not when they say it doesn’t.

 

The bit these wallies seem to overlook is that the above only applies if the physical capabilities to exercise exist! It's akin to applying false-illness-belief psychotherapy to someone in a coma!

 

Post Death Psychosis - The false belief syndrome in which people die and then think they can not engage in real life. If they could be made to exercise then they would show increased functional capacity. With CBT we can train them to overcome their false beliefs and fully engage in life. Its not helpful to speak of the undead or zombies because this is a false dichotomy, and BPZ theory clearly explains how this is not important.

 

Yes, I think Edwards was a major influence on the construction of the Wessely-Chalder speculation. Edwards was de facto head of Medicine at UCL around 1982-4 because the official head bowed out of any administrative function. He worked on muscle physiology in the context of training. I think he misapplied findings relating to vigorous training of healthy muscle to the situation in ME. In fact if you are deconditioned from an illness like EBV or major surgery all you need to do is gradually get back to normal activities - no need to deliberately exercise unless you want to do competitive sport. And it does not hurt or make you fell ill.

 

Referring to PACE,
https://twitter.com/user/status/989293666446458880

https://twitter.com/user/status/990132392550653952

https://twitter.com/user/status/1000831757711806464

If I'm reading this correctly, MS is now stating that the PACE patients did not have ME, but were misdiagnosed - some just happened to meet one set of ME criteria as well as having chronic fatigue.

 

They've pulled this before - was it White who said they weren't studying ME?

Maybe someone should now ask him what, in his opinion, the difference between ME and CFS is?