Michael Sharpe skewered by @JohntheJack on Twitter

Jonathan Edwards said:
Well he jumped between two universes in a single paragraph in the 1989 paper, so he is pretty consistent. He was justifying something, I forget what. His first reason was the dangers of not exercising - causing deconditioning. And his fifth reason was that PWME are not deconditioned. He didn't seem to notice his reasons cancelled out. This is the level of intellect we are dealing with.
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It reminds me of Trudie Chalder totaly contradicting herself on 2 points in a Guardian article:

Patients’ fear that exercise or activity will make chronic fatigue syndrome worse can significantly hinder treatment of the debilitating condition, according to researchers.
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She said fear was understandable given the nature of the condition but that people with ME often did too much on days when they felt the symptoms less, hence the importance of experts guiding them through a gradual increase in activity.
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https://www.theguardian.com/society...ients-fear-exercise-hinder-treatment-study-me

So
- a phobia in which you have to prevent patients from doing the dreaded thing.
- this phobia is both irrational and reasonable.

This is the point that makes me really angry. Their theories are so illogical and intelectually indigent. It is just so easy to see it, but it seems not a lot of people have been worried by this, this crap is the only thing we deserve for a lot of people.
 
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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.
 
Cheshire said:
It reminds me of Trudie Chalder totaly contradicting herself on 2 points in a Guardian article:
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Patients’ fear that exercise or activity will make chronic fatigue syndrome worse can significantly hinder treatment of the debilitating condition, according to researchers.
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She said fear was understandable given the nature of the condition but that people with ME often did too much on days when they felt the symptoms less, hence the importance of experts guiding them through a gradual increase in activity.
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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.
 
chrisb said:
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.
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I have wondered that too. I do remember reading somewhere that Simon Wessely was a trainee psychiatrist and was given the fatigued patients at the clinic because none of the other psychs wanted to deal with them, so he decided that would be his specialism.

Given that they were being referred to a psych clinic it seems likely that at least some of them were suffering from depression, not ME, and were misdiagnosed because their presenting symptoms were expressed as physical - tiredness, lethargy, aching etc are common symptoms of depression, so for a trainee I can see that was an easy mistake to make. To build a career on such a misapprehension based on a small sample including some misdiagnosed patients and stick to that for 30 years is, in my opinion, unforgivable.

Chalder was a mental health nurse who switched to psychological therapist. So she had little or no background in biomedical medicine - I suspect she simply went along with Wessely's theories and saw it as a good career path.
 
Cheshire said:
It reminds me of Trudie Chalder totaly contradicting herself on 2 points in a Guardian article:

Patients’ fear that exercise or activity will make chronic fatigue syndrome worse can significantly hinder treatment of the debilitating condition, according to researchers.
Click to expand...

She said fear was understandable given the nature of the condition but that people with ME often did too much on days when they felt the symptoms less, hence the importance of experts guiding them through a gradual increase in activity.
Click to expand...

https://www.theguardian.com/society...ients-fear-exercise-hinder-treatment-study-me

So
- a phobia in which you have to prevent patients from doing the dreaded thing.
- this phobia is both irrational and reasonable.

This is the point that makes me really angry. Their theories are so illogical and intelectually indigent. It is just so easy to see it, but it seems not a lot of people have been worried by this, this crap is the only thing we deserve for a lot of people.
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Excellent spot. Here's a little word substitution to make it quite clear what she is saying:

Patients’ fear that going into restricted spaces will make claustrophobia worse can significantly hinder treatment of the debilitating condition, according to researchers.

She said fear was understandable given the nature of the condition but that people with claustrophobia often did too much potholing on days when they felt the symptoms less, hence the importance of experts guiding them through a gradual increase in caving activity.
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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.
 
Jonathan Edwards said:
Except of course that the Weasel himself said in 1989 that there is clear evidence that PWME are not deconditioned. Their muscles have been tested and they work fine (by Andrew Lloyd and Richard Edwards). So PWME do not need to exercise. Somebody seems to have forgotten this along the way!
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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.
 
Luther Blissett said:
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?
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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.
 
Adrian said:
Just to point out that this is an Edwards who worked at Liverpool hospital and seems to only have published 2 papers. Not Jonathan Edwards.
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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.
 
chrisb said:
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
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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!
 
Barry said:
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!
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:wtf: 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. :confused:
 
chrisb said:
It would therefore appear that Edwards is implicated in the formulation of these ideas.
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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.
 
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