CFS: is the biopsychosocial model responsible for patient dissatisfaction and harm? (eLetter)

[Effi]

http://bjgp.org/content/66/651/511.2
eLetter to British Journal of General Practice by Peter Campion
DOI: 10.3399/bjgp16X687229 Published 1 October 2016

Geraghty and Esmail have done well to draw attention to the substantial biomedical literature now extant around chronic fatigue syndrome (CFS).1 They are right to point out that the dominant model has been a biopsychosocial (BPS) one, and that this has led to persistent disagreement between doctors and patients. What is particularly salutary is the absence of any advance in therapy, so that they recommend, for example, cognitive behavioural therapy (CBT), but with the caveat that it might not be helpful in individual cases. CFS continues to challenge GPs by its resilience to treatment, but colleagues will be well advised to take on board the changing evidence for pathophysiology set out in this article. Many of the cited papers are accessible and worth reading, such as the authors’ reference 8,2 and in that paper, reference 38.3

The bottom line for me is respect for the patient, and humility in the face of lack of knowledge about the precise causes of CFS, which is clearly anyway a heterogeneous group of conditions.

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(ETA: thread on the article by Geraghty and Esmail here.)

 

[Effi]

Next to that eLetter is another eLetter, by our very own @nasim marie jafry

I was pleased to see this article highlight the potential harms of graded exercise therapy (GET) and CBT for patients with myalgic encephalopathy (ME).1 I myself was diagnosed with ME as a 20-year-old student in early 1984 by a consultant neurologist in Glasgow. My illness was triggered by Coxsackie B4 virus — there was an outbreak of Coxsackie in the West of Scotland at this time. Since my own diagnosis with this poorly understood illness, I have been baffled — and shocked — to see the criteria of ME diluted in the early 1990s and the consequent conflation with unexplained ‘chronic fatigue’. Moreover, the adoption of the biopsychosocial model of ‘ME/ CFS’ has certainly not been beneficial to my own experience of illness. I am hopeful that, with the dedicated international biomedical researchers we now have, there will be effective therapies in my lifetime. There are many, many people who truly suffer with this dreadful illness.

Nasim Marie Jafry,
ME sufferer, author of The State of Me (HarperCollins, 2008).

 

[Glycon]

They are right to point out that the dominant model has been a biopsychosocial (BPS) one, and that this has led to persistent disagreement between doctors and patients. What is particularly salutary is the absence of any advance in therapy, so that they recommend, for example, cognitive behavioural therapy (CBT), but with the caveat that it might not be helpful in individual cases.

(1) For some time now, BPS has been the dominant model only in SOME countries.

(2) It's not BPS, but the unhelpful and dangerous clinical guidelines and disability policies, which BPS is used to justify, that have led to disagreement between doctors and patients.

(3) "What is particularly salutary is the absence of any advance in therapy, so that they recommend..." I'm assuming there is a typo here, otherwise the whole sentence is completely incoherent.

(4) Instead of the caveat that CBT might NOT be helpful in individual cases, they should have said that it MIGHT be helpful, but ONLY in a relatively small percentage of cases.

Aside from (1)-(4), a great letter!