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What Peter White is teaching Medical Students on CFS via a chapter in a medical textbook

Discussion in 'General ME/CFS News' started by Dolphin, Jan 3, 2014.

  1. Dolphin

    Dolphin Senior Member

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    There's a thread on Peter White and some of his views and writings on CFS here: http://forums.phoenixrising.me/inde...ice-guidelines-insight-into-their-views.1239/ . However, I thought I'd give this its own thread

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    One can read what trainee doctors are learning about Chronic Fatigue Syndrome in the 8th edition of the Kumar & Clark textbook, "Clinical Medicine", here:

    Peter D. White was responsible for this chapter.

    Sample extract:

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    Comment: This doesn't mention that of those that got specialist medical care alone, due to the broad post hoc definition of improvement used in the PACE Trial, 45% improved. Peter White is well aware of what this study (the PACE Trial) found as he was the chief Principal Investigator.

    And a little bit of (largely subjective) improvement shouldn't necessarily be covered under "prognosis".
  2. biophile

    biophile Places I'd rather be.

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    Would it be safe to assume that, as usual, talk about subjective improvement failed to include mention of no corresponding improvements in objective measures? Important omission on the issue of prognosis. Patients become disabled and under-employed with reduced activity, then tend to stay that way regardless of subjective improvements and (cough) "recoveries" from "active rehabilitative treatments" which are not actually rehabilitating patients in the usual sense of the word.
    Last edited: Jan 4, 2014
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  3. jeffrez

    jeffrez Senior Member

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    What a bunch of a**holes. Sorry, but there's really not much else you can say at this point. With so much legitimate scientific evidence of immune/metabolic dysfunction in ME/CFS, not to mention severe disability, these obstinate and arrogant naysayers who ignore the science are really starting to deserve no more respect than the climate change deniers. Engaging them just legitimizes them. I'm starting to believe the proper response now is simply to dismiss them as the cranks they are and not engage. Of course it's terrible that they're officially brainwashing students, but let's face it - most of the doctors end up brainwashed anyway, even without a textbook. I'm afraid the prognosis for clear, rigorous and scientific thinking in the mainstream medical community remains very poor.
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  4. alex3619

    alex3619 Senior Member

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    No more respect? Less respect than the climate deniers.

    Doctors are crammed with facts and procedures. They are typically not trained in formal reasoning. Its a flaw in their education, but with so much being crammed in its not surprising. Some doctors with classical training though are very competent at reasoning, and more learn on their own. There are really good books on this.
  5. leela

    leela Slow But Hopeful

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    Spot on!
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  6. jeffrez

    jeffrez Senior Member

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    Haha, possibly. I just didn't think it was possible to get less than zero. ;-)
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  7. Bob

    Bob

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    Last edited: Jan 10, 2014
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  8. Dolphin

    Dolphin Senior Member

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    Thanks Bob.

    Message to any mods/admins: I can't edit the original message now so if anybody can put https://www.inkling.com/read/kumar-...ne-8th/chapter-23/functional-or-psychosomatic after "here" in the first message, it'd be great.
    Bob likes this.
  9. taniaaust1

    taniaaust1 Senior Member

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    If we thou just leave them training others into thinking the same and the situation will just go and and on as they know they can get away with it .. it means the attitudes towards us wont change. We should be taking a very strong stance about wrong info being put out out there esp anything which we can prove.

    We should be doing things like making sure any future updates of books wrong stuff, that the wrong stuff will be removed before reprinting so future copies will be carrying the same info. (surely there is places one could use to try to get wrong medical info being given out removed?).

    If very wrong medical info was being given out about AIDS or cancer.. I have no doubt it would be stopped!! The ME/CFS community needs to be working out how to get this done... how is this usually done with other things? What dept stops things like this?

    Could Peter White be taken to court due to purposely misleading data which is causing harm to patients? If so stuff like this is direct evidence of misleading data purposely being put out.. we/ME/CFS community/one of our orgs or something, needs to be taken this guy to court. Not just to stop him but to also stop the others out there who believe they can get away with this kind of thing. We take one of these to court and it will make others stop and think a bit more before they think they can get away with this.

    There could also be a snowball affect.. when it has been shown false info has been given in this area and proven (with striking off one well known falsifying data doctor in this field).. this would make others wonder just how much more of the CBT and GET info done by the other doctors pushing this too has been misrepresented. It could cause a field of doubt over the whole CBT and GET thing (a ripple affect against GET/CBT among the medical population) which is exactly what we need.
    Last edited: Jan 10, 2014
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  10. taniaaust1

    taniaaust1 Senior Member

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    How does one unbrainwash a dr? By giving him the spectacle of seeing/knowing that his previously respected peer was dragged throu courts or discrediated for giving out false info.
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  11. Bob

    Bob

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    Last edited: Jan 10, 2014
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  12. Bob

    Bob

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    This textbook explanation of CFS is possibly the most sordid, one-sided, polemical, twisted, distorted, selective, truthless, destructive, harmful and depressing descriptions of the illness that I've ever read, especially considering its context.

    I don't know why a small number of biased and compromised/conflicted (i.e. with vested interests and conflicts of interest) researchers are allowed to write a whole section of the book, and allowed to describe their (debunked) hypothetical model of illness as fact. It's more of a polemic rather than a piece of science or medicine. The WHO (and the UK government) describe ME/CFS as neurological disorder, not a functional disorder. Since when was CFS factually known to be a functional disorder?

    I wonder if letters of complaint to the editors (perhaps even from patient organisations like the ME Association) might be productive.
    Last edited: Jan 10, 2014
  13. Dolphin

    Dolphin Senior Member

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    I think this may have come out before the recovery paper was published? They had the Knoop et al. (incl. White) (2007) which gave 23% for "full recovery". He has said around 1/4 recover after CBT/GET for quite a few years. This might have motivated him to broaden the recovery definition in the PACE Trial.
  14. Esther12

    Esther12 Senior Member

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    He knew what percentage of patients would recover from CBT/GET, so this helped him choose how to define recovery!
    Last edited: Jan 10, 2014
  15. Dolphin

    Dolphin Senior Member

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    And, of course, the protocol had a definition of recovery already (that he had chosen or agreed to).
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  16. Firestormm

    Firestormm Senior Member

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    What do you make of the following (in bold):

    Thanks for the link Bob. I had been trying to find it myself for a while.
  17. Valentijn

    Valentijn Activity Level: 3

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    Or complaints to any universities using these books.
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  18. Dolphin

    Dolphin Senior Member

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    I don't believe there is much evidence for interoception in CFS.
    It's just a theory Peter White has (an insulting theory, I think): we notice normal bodily symptoms more than other people (and hence we think we have an abnormal response to exercise).
    There is plenty of evidence that what happens in CFS e.g. after exercise, isn't normal.
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  19. biophile

    biophile Places I'd rather be.

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    I wanted to make a joke about wanker's cramp in medical writers, but I did not know how to frame it.

    [​IMG]

    I would not get too excited about White's statement. It is probably a combination of reasonable foresight and CYA, with a slight hint of mea culpa. White once organized a conference because he was concerned that the biomedical approach was akin to travelling up a blind alley in medicine's attempt to help patients improve their health and function. I doubt much has changed. White probably thinks that there is more to CFS than the current understanding of functional illness, but I doubt he means that CFS is going to be reclassified as an organic disease. Consider his opening paragraph for context:

    In other papers he states that CFS is a mind-body illness which is both psychological and physical. His reference to neuroscience and his ideas on the involvement of the physical component in CFS are not about organic pathologies, but some form of philosophical physicalism i.e. the mind is a function of the brain and the brain interacts with the rest of the body, while functional non-organic bodily disturbances are also physical in an ontological sense.

    Such a grey area is an interesting subject and may in fact exist, but the associated claims and concepts are usually so entangled in spin and questionable research that nothing can be taken at face value. Look at how White continues to claim or allude that an effective treatment for CFS is an increase in activity despite post-exertional symptoms. This is not 20 years ago when the research was relatively new and speculation was more acceptable in the face of the unknown. The evidence is largely already in and as a result we know that the response to exercise is abnormal and is not explained by deconditioning, and that there are no sustained significant increases in total activity levels after so-called "rehabilitative" therapies.

    If quackery is defined as the over-promotion of treatment, then perhaps Peter White is guilty of quackery. I do not want to use disparaging terms, but he continues to promote falsehoods which the research does not demonstrate and has been repeatedly shown to be false. Proponents of CBT/GET for CFS seem generally disinterested in getting to the bottom of the nature of the reported improvements. Instead they appear to be happy perpetuating the myths which helped their careers.

    The claimed role of cognitive-behavioural factors is generally based on poor or unconvincing and contradictory evidence, with a misunderstanding about certain symptoms (e.g. conflating post-exertional symptomatology with abnormal avoidance behaviours and deconditioning). The associated therapies are based around distorted presumptions about the nature of the illness, and induce only small to moderate subjective improvements in a minority of patients without corresponding objective improvements, which can be explained just as well as the methodological artifact of superficial changes to questionnaire-answering behaviour after given encouragement and optimism about improvements.

    How long must it continue until it becomes a form of pathological science? I think legal action here is unrealistic (taniaaust1), particularly when harm would be difficult to demonstrate in court. Spin and misleading citations seems to be a common problem in academia, so I doubt that White's actions would even raise an eyebrow right now.

    I am disillusioned and disheartened by it all. I do not know what the answer is, but I just plod away on analyzing the research when I can, in order to keep myself informed. I started out believing CFS was mostly a mind-body illness and sought evidence for it, but I ended up falling down this rabbit hole and re-assessing my beliefs. The house of cards is going to collapse eventually. The relevant authorities have been sleeping at the wheel, but over the last several years there has been positive signs that awareness is increasing about the dubious quality of science in psychology and psychiatry in general.
    Last edited: Jan 11, 2014
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  20. Firestormm

    Firestormm Senior Member

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