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A preliminary prospective study of nutritional, psychological and combined therapies for me/cfs

Firestormm

Senior Member
Messages
5,055
Location
Cornwall England
Do NOT shoot the messenger :)

OHC Research Published in British Medical Journal Open

We are extremely proud to announce that we have just had published a research study investigating the OHC approach in the British Medical Journal Open!
Founder and CEO Alex Howard says:

“We are hugely proud of everyone that has been involved with making this study happen. For a privately funded clinic we have made an unprecedented investment in research over recent years and it is very heartening to see this continue to come to fruition. We are now working on plans for a randomized controlled trial (RCT), and look forward to inviting support to make this possible over coming months.”

http://freedomfromme.co.uk/blog/2012/11/19/ohc-research-published-in-british-medical-journal-open/

  • Complementary medicine

A preliminary prospective study of nutritional, psychological and combined therapies for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) in a private care setting

  1. Megan Anne Arroll,
  2. Alex Howard
19 November 2012: http://bmjopen.bmj.com/content/2/6/e001079.full

Abstract

Background Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a condition characterised by severe and persistent fatigue, neurological disturbances, autonomic and endocrine dysfunctions and sleep difficulties that have a pronounced and significant impact on individuals’ lives. Current National Institute for Health and Clinical Excellence guidelines within the UK suggest that this condition should be treated with cognitive behavioural therapy and/or graded exercise therapy, where appropriate. There is currently a lack of an evidence base concerning alternative techniques that may be beneficial to those with ME/CFS.

Objectives This study aimed to investigate whether three modalities of psychology, nutrition and combined treatment influenced symptom report measures in those with ME/CFS over a 3-month time period and whether there were significant differences in these changes between groups.

Design and setting This is a preliminary prospective study with one follow-up point conducted at a private secondary healthcare facility in London, UK.

Participants 138 individuals (110 females, 79.7%; 42 participants in psychology, 44 in nutrition and 52 in combined) participated at baseline and 72 participants completed the battery of measures at follow-up (52.17% response rate; 14, 27 and 31 participants in each group, respectively).

Outcome measures Self-reported measures of ME/CFS symptoms, functional ability, multidimensional fatigue and perceived control.

Results Baseline comparisons showed those in the combined group had higher levels of fatigue. At follow-up, all groups saw improvements in fatigue, functional ability and symptomatology; those within the psychology group also experienced a shift in perceived control over time.

Conclusions This study provides early evidence that psychological, nutritional and combined techniques for the treatment of ME/CFS may influence symptomatology, fatigue, function and perceived control. However, these results must be viewed with caution as the allocation to groups was not randomised, there was no control group and the study suffered from high drop-out rates.
 

Enid

Senior Member
Messages
3,309
Location
UK
The best bit is "these results must be viewed with caution". Where are the docs - my own though not understanding ME most certainly medically aided certain symptoms as they progressed (without psychology, CBT and GET - useless for the bedbound having seizures). Only considering the "message" Firestormm.
 

Sasha

Fine, thank you
Messages
17,863
Location
UK
"However, these results must be viewed with caution as the allocation to groups was not randomised, there was no control group and the study suffered from high drop-out rates."

Messenger duly not shot... :)
 

maryb

iherb code TAK122
Messages
3,602
Location
UK
However, these results must be viewed with caution as the allocation to groups was not randomised, there was no control group and the study suffered from high drop-out rates.

So can I say WTH is the BMJ doing publishing it? Could it be that it suits the medical establishments view?
Firestormm - not good for a monday morning - my finger is itching, lucky for you its only a starter pistol!!!
 

Valentijn

Senior Member
Messages
15,786
My own new study: "67% of ME/CFS patients receiving stand-alone psychological treatment drop out of studies prior to completion."

Participants 138 individuals (110 females, 79.7%; 42 participants in psychology, 44 in nutrition and 52 in combined) participated at baseline and 72 participants completed the battery of measures at follow-up (52.17% response rate; 14, 27 and 31 participants in each group, respectively).

14/42 psych patients made it to the end. (33%)
27/44 nutrition patients made it to the end. (61%)
31/52 combined patients made it to the end. (60%)

Pro-CBT spin: "Add in as many non-psychological services as possible to get the CFS patients to stick around long enough to be scarred for life by the CBT."
 

Jenny

Senior Member
Messages
1,388
Location
Dorset
Interesting that one can see the referees' comments at different stages of the reviewing process. Only two of them.

Big problem in that we have no idea what these patients were suffering from since there was no description of how they were diagnosed. Many are likely to have chronic fatigue, not ME, as this clinic specialises in what they call 'burn out'. The paper should have been rejected on this basis alone.

Does anyone understand the reports of percentiles in the Results tables?

Jenny
 
Messages
32
In a video on OHC’s website Dr Arrol states:
http://www.freedomfromme.co.uk/research-overview/ (Accessed April 20th 2012)
“when I was about 14 I had a bout of glandular fever and this developed into M.E. I was very severely affected for 2 years. I was housebound. Very sensitive to light and noise and so was very much sort of kept in a darkened room. Gradually recovered and then was able then to pursue a degree in psychology. This was followed by my masters…”

The OHC website also states: (Accessed April 20th 2012)
http://www.freedomfromme.co.uk/medical-and-research-team/
“Meg was diagnosed with ME at the age of 14 and was severely affected for a number of years. Once recovered, she pursued an academic path and completed a bachelor’s degree in Psychology…”

IMO the above implies that Arroll HAD M.E. but has recovered. Yet to M.E. patients and patient groups Dr Arroll claims to still have M.E. Why?

It would perhaps be understandable that a business flogging 'treatments' for M.E. would not want it generally known if their staff were actually ill with it - that might not be good for business. But if a researcher cannot decide whether or not they actually have an illness, or they consider it shameful to admit having an illness, or pretend to have an illness, how can they judge, or even trust participant's claims and opinions in subjective data? It makes a complete mockery of research.
 

ukxmrv

Senior Member
Messages
4,413
Location
London
From her description it sounds as if Dr Arrol had glandular fever, was severely affected by glandular fever and then luckily recovered.

My impression from having dealings with her group in the past is that they fail to see any difference between ME, CFS and CF
 

Valentijn

Senior Member
Messages
15,786
Big problem in that we have no idea what these patients were suffering from since there was no description of how they were diagnosed. Many are likely to have chronic fatigue, not ME, as this clinic specialises in what they call 'burn out'.

Based on my own experiences at a burn-out clinic pretending to also treat ME: they would have included virtually no ME patients, since the ME patients would have left due to 1) not tolerating the BS, and/or 2) getting sick too often as a result of attending and the "therapy", and/or 3) getting un-diagnosed with "fatigue" by the clinic after the clinic realizes they can't cure them.

I saw dozens of different patients while in the waiting rooms, and only two of them definitely had ME. The vast majority were wearing make-up, carrying their babies around, smartly dressed, fidgeting, and trotting up and down the stairs like it was nothing.
 
Messages
43
I was very annoyed by this paper - there was no screening to see if the people they were treating actually had ME/CFS - yet this paper promotes the idea thats its treating ME/CFS - the reviewers didnt pick up on this, not surprising given it was Dr. Crawley of Bristol and Dr. Price and Psychiatrist from Oxford - both fans of the psycho-approach to ME/CFS treatment. From what I see papers liked this get published easily while conflicting papers are blocked.

I am inspired to set up my own research centre to offer an alternative perspective.
 
Messages
43
This paper explored treatment of his patients at his private clinic - 138 people and the results are shocking. The study claims to show that ME/CFS can be treated after just 90 days of therapy and nutritional advice.

I have written to the BMJ Open to Express my concerns.

Looking at the study the first thing that strikes you is "how do we know he was treating ME/CFS patients and not just members of the general public"? - so I looked at the Reviewers comments to see if they asked this - but no. I found Dr. Price (Psychiatry at Oxford and Dr. Crawley proponent of CBT and the Ligthening Process) as reviewers.

Here is an extract from the first review by Dr. Price in which he discussed the limitations of the data in this study and states that:

"we have no data for two thirds of the psychological intervention group, who *might* have worsened, however unlikely this might seem to those of us who are 'prejudiced' in favour of such interventions."

Yes Dr Price does say he is Prejudiced to Psycho Interventions for treatment of ME/CFS.

If you read on over the course of 3 rounds of reviews what you see is that reviewers steering the authors to change their claims and the wording used to make it less contoversial - ie steering them towards getting paper published.

Its not often you see the most blantant 'prejudice' and bias in peer review open for all to see - but we can here:

Anyone interested in looking at the Study will see some of the glaring problems with this study - I pick out a few
:
Of the 138 paying clients who started the treatment almost 48% dropped out of the study, a study that only lasted 90 Days (3 months).
The idea that ME/CFS can be cured or treated in 90 days with talk therapy and nutritional support is sheer psudeo science.
We can not ascertain if even a single person (n-138 in this study has/had/have ME/CFS. We have to assume they do because they attend this clinic, which is the most fundamental flaw.
The Psych Group receive neuro-linguistic programming (NLP), emotional freedom technique (EFT), life coaching and hypnotherapy/self-hypnosis.
- Over the 90 days of the study, some of the participants received either 13 hours of therapy, or the second group received 4 hours of therapy and another group received only 3 hours of therapy (we have no idea who received what – but it is possible some people only received 3 hours of therapy in 3 months). Possibly 1 hour of therapy per month
In the Nutrition Group therapy consisted of as little as 2 x 1 Hour Sessions (a total of 2 hours advice on nutrition).
The Nutrition group states Mineral and Vitamin Status examined – how was this done, no blood tests to measure vitamin or mineral standing were performed on participants, so how was this measured?
In the Combined Group – we don’t really know what therapy was given, we are left to assume half nutrition and half psychology – which from above might be 1.5 hours of pscy and 1 hour of nutrition.
I could go on and get into the statistics on changes over the course of the 3 months however this is fruitless and pointless as this study is comprehensively flawed, biased, poorly thought out, poorly designed, and an example of pseudo science at it’s best, or perhaps at it’s worse.
 
Messages
43
I found flaws in the stats too - but I decided it wasnt worth my attention showing that up as the study is flawed from the get go - Dr Arroll wasnt even at the clinic when collected was first collected, study only lasts 3 months, paid for by Alex Howard, who charges patients for treatments - trying to validate his product to in essence make more money down the road promoting his products. They shouldnt of even been allowed to claim this was a study of ME/CFS. Price and Crawley basically steered them throught making word changes and then article was published in BMJ Open - which strikes me as a weak money making outlet for publishing studies.
 

Jenny

Senior Member
Messages
1,388
Location
Dorset
For those who use Facebook, might be worth putting a comment on the Optimum Health's Clinic Facebook page.

Jenny
 

Enid

Senior Member
Messages
3,309
Location
UK
There was a time I sympathised with Crawley who apparantly ties to aid her juvenile patients - leaps at possibles so easily - does not understand underlying pathologies - now here's is a thing my brother (Prof Neurolgy) has ME and though ill seeks causes.
 
Messages
1,446
A complaint sent to the British Charity Commission about Alex Howard's Optimum Health CLINIC a few years ago (2009:

Reference number 4043436.




Dear Mr Bxxxxx,


This is a basic overview of the problems:


1. Evidence to show that the Director has invented spurious medical-sounding subtypes of a specific WHO Classified physical Neurological disease; the Clinic has produced no evidence for such subtypes and has the end result of imposing spurious re-definitions and terminology from pop psychology onto medically ill clients.


The Clinics' spurious re-definitions of other disorders as ME, and invented disease 'subtypes' appear to ignore the large quantity of high quality evidence about the disease ME from medical research; in addition the invented 'subtypes' appear to overule the World Health Organisation International Classification of Diseases (WHO ICD 10), the spurious 'subtypes' (which are not based on any objective or science evidence) also appear to undermine the WHO ICD 10 G93.3 Neurological/Physical Classification of ME (WHO classified since 1969) that has been officially confirmed by the British Parliament and the NHS (evidence from Hansard).

The OHC also says that it uses the term ME (for simplicity) on its site when referring to Fibromyalgia, which is a separate disorder to ME and is WHO classified under muscular-skeletal.




2. That the Optimum Health Clinic claims a 'Psychology Department' with a 'Director of Psychology' and a team of 'Visionary Psychology Practitioners'. Apart from the Clinic Director Alex Howard who has a BSc in Psychology, the other staff, including the Director of the Psychology Department, do not appear to actually have any degrees in Psychology or any of the training or qualifications to practice as Psychologists. Neither do any of the staff appear to be registered with the Health Professionals Council (HPC), or registered with the BPS, the British Psychological Society, (confirmed by phone calls to both of those institutions last week). What the 'Psychology Department' does offer is sessions and courses in NLP, Hypnotherapy, Coaching and Emotional Freedom Technique ('tapping for health' etc).


The title ‘Inspirational Psychology Practitioner’ the OHC uses to describe the staff of the Psychology Department is a meaningless term which has no qualification or national standard at all, but it does give the impression of being an officially recognised title; it is not recognised by the BPS or the HPC.



The Clinic Directors not only give the strong impression that they are Psychologists, but also that they are world experts on the WHO classified Neurological disease ME that the clinic aims its products and services at. But it would appear that their qualifications are only at the level of BSc, BA and a Diploma level qualification in Nutrition (ION). The Director of Nutrition has taught Aerobics and Yoga. The other qualifications are in NLP and Hypnotherapy and Coaching although the staff do not say where they gained the qualifications.




3. The clinic appears to be using NLP marketing tactics and step-by-step behavioural marketing models to sell high cost NLP courses to physically sick patients. Such NLP techniques as Anchoring, Voice Anchoring, and the Milton Method and many other NLP persuasion techniques are evident in the Clinics marketing literature and promotional marketing videos and DVDs.

Also the clinic appears to be aiming its advertising at ill people who are looking for nutritional advice and testing for toxicity, and offering that (using tests and protocols developed by reputable doctors and proper BioMedical researchers).


But the clinic has added on a 'psychological' component to the organic disease ME, and Alex Howard says that they "Classify on the Psychological side"; what that appears to mean is doing ‘Enneagram’ type personality typing and offering NLP courses and products to treat a serious organic disease according to the personality 'typing'.

That tactic leads the client (physically sick people) step by step to buying a 'Home Study Psychology Course' to help support the persons recoveryfrom ME, according to the OHC. The 'Psychology' course turns out to be an NLP and Hypnotherapy and Coaching course, which then leads the client, step by step, to buying a Professional Training Course in Hypnotherapy NLP and Coaching at high cost. The clinic also holds out a carrot to suggest that the client with ME could end up being employed by the clinic.




4. Calling Optimum Health Clinic approach 'Integrated' is rather disingenuous as it is the OHC that insists on the spurious psychological 'subtyping' (which it has invented) and on 'classifying on the psychological side' apparently to promote NLP courses.

Integral is the new buzz word in holism and therapy world, as well as the name of a system designed by Ken Wilbur. But one suspects that for the Optimum Health Clinic, using the word integral means they can sell NLP courses alongside with the testing for toxicity and nutrition advice. There are far too much of emphasising buzz words and using NLP devices for persuasion to buy in the OHC's marketing.


I am not sure that the Optimum Health Clinic should be claiming to classify ME, or any other disease or disorder at all. Or is it the clients that are classified "on the psychological side" as Alex Howard puts it.


ME has a Neurological classification from the WHO. The Optimum Health Clinic appears to have diluted the diagnostic criteria definition of ME, and moulded their description of the serious organic multisystem, multiorgan, neuro immune, cardiac, WHO classified disease ME (Myalgic Encephalomyelitis, WHO ICD 10 G9393. Physical Neurological) to include all kinds of states of tiredness, anxiety, stress, fatigue, burnout, even 'naughty lifestyle syndrome', and common psychiatric conditions which have fatigue as a symptom, but which are not relevant to the WHO classified Neurological disorder ME that the Clinic claims it specialises in.



By using the terms fatigue, chronic fatigue (the common symptom of many disorders including post operative and some common psychiatric disorders), 'Chronic Fatigue' the mental health disorder (WHO ICD F48 Neurasthenia, Psychiatric), and confusing them with Chronic Fatigue Syndrome (WHO ICD G93.3 Neurological Physical) and with ME (WHO ICD G93.3 Neurological Physical); by using those terms interchangeably and by claiming to classify "on the psychological side", the Clinic attracts a much broader, bigger range of clients suffering from fatigue from diverse and completely different causes, to buy products and services and courses.


Fatigue is not a defining symptom of ME, the Neurological, immunological, Neuroendocrine and PEM are the distinguishing criteria according to the International Canadian Definitions Diagnostic Criteria (Carruthers et al. 2003) and the Nightingale Criteria (Hyde). PEM is the hallmark delayed exhaustion that is typical of ME and is biochemically distinct from fatigue from other causes. PEM has the distinctive delayed effect and the harm from activity with PEM is accumulative and the dangers are well backed by international biomedical research.




The Optimum Health Clinic appears to systematically muddy the water and ends up describing an organic physical disease (ME) that causes brain inflammation and can be fatal, as a condition that the clinic classifies by ENNEAGRAM personality type, and as a 'life problem' with fatigue or tiredness. Then the Clinic suggests that the redefined 'life problem' needs nutritional advice, detox, AND definitely needs NLP courses and Anthony Robbins style motivation to cure it. The world biomedical ME experts, and researchers do not agree with that. In fact world ME experts (Professors of Medicine, Harvard etc) have stated explicitly that the idea of any 'psychological' factors in ME should have been dispensed with and left behind 20 years ago, and were never relevant to the diagnostic entity they study and treat.



The Optimum Health Clinic may have success in treating tiredness and fatigue that is not caused by ME. The OHC site does claim that its "team of eight practitioners have given 8,000 fatigue related consultations", No doubt they have, but the Clinic also leads the reader to believe (through promotional literature and videos) that fatigue and tiredness and ME are synonymous, when they are not.




The Linguistic Confusion that arises from using the term 'chronic fatigue' as a shortened form of 'Chronic Fatigue Syndrome' also leads to the problem of diseases and disorders and conditions that are not ME, being diagnosed as ME on the presence of ‘fatigue’ as one of the symptoms.


The confusion between ME (WHO ICD G93.3), Chronic Fatigue Syndrome (ICD G 93.3), and Chronic Fatigue (WHO ICD F48) can also lead to wrongful classification of ME as a mental health disorder, with wrong assessment and wrong and harmful treatments.






5. The clinic Director of the OHC, Alex Howard, has written a book about his experience with the disease, a disease which he ends up describing as his 'Journey' to find out 'who he is'. That should ring alarm bells. Alex Howard describes visiting a ‘channeler’ at age 18 and says things such as:

Edwin essentially confirms what I was already starting to believe, that I had chosen my illness before I was born as a way to wake me up to my true self”
(Page 71, ‘WHY ME?’, 2003, Alex Howard, Roximillion Publishing) http://www.cherryred.co.uk/other/roximillion/index.htm



The influence of Roximillion publisher Iain McNay, Alex Howards uncle, on Alex's ideas about spiritual life 'Journeys' and on Alex's quest to discover 'who he is', is very evident from the book 'Why ME?'.

Iain's own beliefs, "Journey" and influence on Alex's development and interest in things spiritual and personal growth based are very evident from some of the interviews on concioustv as well. Iain McNay is entitled to believe and practice anything he wants to of course, but certain theories and world views appear to be attached to the OHC programs for recovering from a serious organic neuro disease ME. Clients of the Optimum health Clinic could well get much more than they bargained for when they contact the OHC for advice on nutrition!




From the book by Alex Howard, ('Why ME?') and other (OHC linked) sources it would appear that the OHC Director is also promoting a particular world view through his clinic, site, book, and his videos DVDs etc which clients (ill people with ME) are encouraged to read and watch. The world view is based on a phrase that Alex Howard uses a lot, "Life Changing Seminars", ie personal growth Transformational Seminars, Inspirational Seminars, Motivational Seminars, 'Healing Journeys', 'Life Journeys' and certain spiritual values (often quite hackneyed pop spirituality) that the OHC clients (people with a serious neuro immune cardiac disease) may not share to begin with, but could be lead into buying into (at a price) at a vulnerable time in their lives, and when worn down by illness.


As one of the things the clinic sells is 'Inspiration', it could be very easy to get drawn into the feelgood factor and buy more courses and products. Inspirational Stories can be bought by signing up to join the Optimum Health Clinic community and receiving ‘Inspirational Stories’ every month for a monthly fee of £15-18, for example.


The three Clinic Directors also describe themselves as a kind of ‘adoptive family’ to each other, and subtly invite and lead the clients to join that ‘family’ by signing up for courses with the clinic.



From making inquiries about Nutritional advice and testing through the Optimum Health Clinic, one is lead step by step to links inside the OHC site, to literature outlining some of the most extreme (and notorious) therapies and practices, and wildest experiments, that have taken place in the Human Potential Movement and new Spirituality movement of the last 40 years; under the banner of 'inspirational stories', 'life stories' and 'growth narratives', some very definite, and extreme life philosophies and concepts of reality, and morality, emerge.

The OHC connection with the video channel concioustv through which the clinics services are described and promoted via inteviews with the clinic staff, and which is owned by Alex Howard's uncle Iain McNay, also leads the clinics clients into a new world of some quite far out beliefs and theories.




My viewpoint on this matter of the Optimum Health Clinic and its practices and marketing methods is one of concern that the very competitive commercial values that have developed in the holistic, personal growth, transformational seminars, and therapy industries, put severely ill people (and those who may be more vulnerable at the time for other reasons, stress, divorce, bereavement) under pressure to buy spurious treatments, and also to 'buy into' beliefs that they did not have before, at points in their life when they are much more vulnerable because of illness etc. However subtle and 'caring' the selling techniques appear to be, they are still selling techniques, and increasingly clever NLP hard-sell marketing and persuasion techniques are becoming increasingly evident in the NLP and Brief Therapy industry, but also the spiritual services and seminars industry..

My viewpoint is not religious, by the way; my reasons for being concerned about the 'pop therapy' and the more extreme 'new spirituality' ideas and practices around now, are not on theological grounds.



Yours sincerely

XXXX

.
 
Messages
1,446
Alex Hward's ME 'Subtypes' from his Optimum Health Clinic Website in 2009

Optimum Health Clinic
Treatment protocols page 5:
http://tinyurl.com/ybrmzc5


Stage 1: ME Predisposing factors.

Our experience has shown that there are a number of predisposing factors to
ME/CFS/Fibromyalgia, but internal and external. ..Here is a basic explanation
of the internal factors (subtypes)


Physical subtypes:

Immune System types: have preexisting genetics or constitutionally weak immune
systems or have exposed to excessive stressors on their immune systems….."

Detox Types: have problems with toxins, caused by preexisting genetic or
constitutional weakness at detoxifying or tolerating them……early signs incude
sensitivity to chemicals in paint, petrol or perfumes…. "

Structural Types: may have been born with a spinal imbalance, which has lead to
poor lynmph drainage, and a back up of toxins in the system. Once ill patients
can also become structurally imbalanced, leading to detoxification problems…."



Psychological subtypes:

Achiever Types: constantly push them selves to do and be more that they are
currently capable of. Characterized by an inability to `be in the moment' and
enjoy `what is', and instead, always focusing on how they cam be and do more.
This can also show up as perfectionism and always trying to `get it right.

Helper Types: constantly places the needs and want s of others above their own.
They value themselves by their helping and supporting of others, and although in
the eyes of society might be perceived a `good person', are often actually
giving from a place of inner lacking and neediness'.

Trauma Types: trauma can either be a major event such as a natural disaster, or
some kind of mental emotional or sexual abuse, or what is known as
`Developmental Trauma' where there is no single event, but happens to someone
who has grown up in an `unheld and unsupported environment' – these kinds of
trauma are not generally digested without professional assistance, and therefore
take a long term toll on the body when nothealthily worked through'


'''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''''




Typical personal growth/ pop psychology stuff.



.
 
Messages
43
Something I find really doggy about Alex Howard is his used of Ex patients. I believe his website was set up by an ex patient, recently a doctor who claims to have had ME/CFS is not a medial Director, his Psychology Director also may have been an ex patient, and the list just keeps going on an on.

Now - The Optimum Health Clinic is Listed as a Dormant Organisation at Companies House --- yet on Alex Howard's website he says that in 2011 he decided that research was the future and he would give 50% of all research from the OHC to research in ME - wow you might say how generous of the man, but if the clinic is dormant and makes £1 per year according to the accounts, that would be £1 / 50% = 50p to research per year.

Ah - see its Alex Howard and Associates LtD that actually makes the money but Alex Howard is just a consultant to the OHC, as are most of his staff.

So how then could a clinic which is a dormant organisation have 1. a Psychology Department and Director, 2. a Research Department and Director, 3. an Internship Program, 4. a Scholarship program for its training courses -- the marketing mickery goes on and on and on. The World Recognised Clinic strikes me as particularly worrying use to language and in 35 countries -

Alex Howard has used his psychology degree to line his pockets on the back of sick and tired people - with his patients being the ones that do most of the work.

**** If anyone on here would like to assist me Id be happy to write up an complaint to the BMJ Open, the Reviewers of the Journal, and The Advertising Standards Agency, and may the British Psychological Society and anyone esle who might be interested in this.