12 MARCH 2018
By David Tuller, DrPH
And now some potentially good news from the Netherlands.
Two years ago, the Dutch parliament asked the Health Council—an independent scientific advisory body—to review the state of evidence related to the illness generally called chronic fatigue syndrome in the Netherlands. That review was to include the evidence for rehabilitative treatments like cognitive behavior therapy and graded exercise therapy. The Netherlands, of course, has its own chapter of the CBT/GET ideological brigades. These researchers, like their close colleagues the PACE authors, have published
methodologically problematic studies that have appeared to affirm the efficacy of CBT and GET.
I have seen a copy of the committee’s draft report (in Dutch), which was distributed to stakeholders in November for comment. The final report based on that draft is scheduled to be released next week. Despite concerns expressed at the beginning of the process that the biopsychosocial forces might dominate the proceedings, the draft report significantly downgraded the current recommendations for rehabilitative therapies, so here’s hoping few or no changes were made in the final version.
The draft stated flatly that, based on the evidence, “the committee sees no reason” for GET to be used in the Netherlands. As for CBT, the draft noted that “a small majority” of committee members believed it could be helpful for some patients. But those in this group also acknowledged that patients also reported having been harmed by the approach, and they suggested that the treatment should be pursued with care. The other committee members objected to any use of the kind of CBT designed for ME/CFS, in part given the therapy’s reliance on the theory of misguided illness beliefs. In any event, this split decision was hardly a full-throated endorsement of CBT.
