A reasonable sounding start.
SW: Physical and psychological symptoms are closely linked. A study of 40,000 people at Camberwell measured the incidence of chronic fatigue and GHQ (a common depression or anxiety). It found a very close relationship. Further, the greater the number of symptoms, the more likely the patient was to develop a mood or anxiety disorder. These symptoms may be just non-specific markers for distress.
Chronic fatigue is a common symptom of depression and anxiety (and countless other medical diseases and psychiatric diagnoses), so finding such an association between the two is unsurprising. Extrapolating this to all chronic fatigue is inappropriate, but guilt by association and disingenuous discussion of physical factors is Wessely's typical style for CFS discussion. As usual though, no mention of Kisely's work finding the association between number of physical symptoms and prevalence of psychiatric comorbidity exists regardless whether symptoms are either organic or "unexplained".
SW: CFS is a multi-factorial illness. A person can be at increased risk because of genetics, or because of previous depression, for example.
Hasn't the large premorbid depression studies been exposed as flawed? Not that I would reject it out of hand, or find it surprising for broadly defined CFS which is problematically conflated with symptoms of depression and hence the call from some researchers for better criteria to avoid epidemiological artifacts. Perhaps Dolphin can remind me about the national cohort studies.
SW: Various infections, including the Epstein Barr virus, definitely precipitate this condition. Yet to understand why some people do not get better as the months and years go by, one has to look at behavioural and psychological factors. The illness is then a complicated mixture of predisposition, precipitation and perpetuation.
Back to the blanket hyperbole about abnormal illness beliefs and deconditioning.
SW (on the PACE Trial): For those who appreciate these things, the trial is a thing of beauty, and the results confirm previous smaller studies and follow ups.
Ah, another comment from Wessely about how "beautiful" the PACE Trial is. I have to agree with him for different reasons, because it was a more robust design for a microcosm of the macrocosm of nearly everything wrong with CBT/GET research which does make it an item of beauty for exampling.
Excessive reliance on the patients' subjective perception which authors previously deemed as distorted/unreliable, ignoring the contamination of questionnaires by reactivity bias, exaggerated effect sizes of subjectively reported improvements which are refuted by objective measurements, authors' fear-avoidance of actigraphy which would have embarrassed them, strawmanning the rival therapy ie pacing, obscuring safety data in between ineffectiveness and persistent severe declines ie CBT/GET is "safe" because it is deemed OK to suffer a 20/100 point reduction in function for up to 4 weeks at a time and/or patients don't have to increase activity as presumed in a somewhat similar sense that a toxic drug is also safe when patients don't have to take it if they don't want to, et cetera.
SW: Patient groups rejected the trial out of hand, and the internet was abuzz with abuse and allegations. The main reason for this depressing reaction was the stigma that attaches to disorders perceived (rightly or wrongly) to be psychiatric in origin, whatever that means.
So it isn't because of the biopsychosocialists' poor track record, nor because the patients these organizations represent commonly report adverse effects in real world applications of CBT and GET, nor it is the dozen or so problems identified with the PACE Trial (some before it was published because of the protocol); wise Simon says the answer is, it was simply rejected out of hand mainly because of the stigma of mental illness!? Where did Wessely gain this impression from anyway; relying on his own prejudices, or reading biased newspaper coverage on the issue, or browsing the comments and forum posts? The internet was also "abuzz" with legitimate criticisms which exposed flaws in his pet therapies that he built his reputation on. Wessely's own research shows the stereotype of ME/CFS patients as anti-psychiatry is inaccurate, so I guess he is referring to an unspecified small group of people rather than the entire ME/CFS community?
SW: If one obtained identical results to the PACE trial, but this time with anti-viral drugs, the reaction would have been totally different. This is exactly what did happen when a very small trial of a drug that modulates the immune system (and which has some nasty side effects) was greeted with acclaim from the same sources that tried to discredit the PACE trial, which tested interventions with an impeccable safety record.
Wait a minute, wasn't the effect of Rituximab significantly stronger than the effect of CBT/GET, and unlike the PACE Trial, blinded or placebo controlled? So no, the comparison is not about "identical results". And didn't the Rituximab study show that it was safe anyway? I assume the "same sources" Wessely refers to are patient organizations and internet buzz? I can't speak for other patients but I do have serious concerns about the safety of any drug for CFS because I've become sensitive to them in general.
I can't deny that more skepticism was applied to PACE than Rituximab, when generalizing the responses from the online ME/CFS community. However the Rituximab researchers aren't coming from a background of decades of double speak and spin doctoring and misleading promotion of their treatments, all which make it harder for patients to trust the results of CBT/GET. Further, the Rituximab researchers are from a more mainstream field, they aren't coming from the academically-incestuous fields of psychology and psychiatry where there is a darkly colourful history which is both long in general and recent when it comes to ME/CFS in particular.
The patient community welcomed the Rituximab study not just because of the apparent benefits of the drug but also because it provided clues about actual disease mechanisms which could advance the field, compared to the disputed assumptions about the role of abnormal illness beliefs and deconditioning which are mostly hot air from professional psychobabblers that has stagnated the field. We are desperate for promising leads, not a consolidation of gyroscopic spin and suffocating influence.
PACE itself is a good example of why the erosion of trust continues. Researchers who greatly widen up the outcome goalposts after seeing the worse than expected data from the FINE sister trial don't attract the trust of patients. Researchers who claim that 60/100 points in physical function (PF/SF-36) is "significant/severe disability" for the purposes of CFS diagnosis and trial entry but somehow "normal" for the purposes of a successful outcome (while in the real world about 84% of healthy people of similar age are scoring 80/100 or more and usually 95/100), do not deserve trust or even respect on the issue. CBT proponents who claim full recoveries are routinely occurring, while ignoring 6MWD and actigraphical data which suggest no improvements whatsoever, do not inspire confidence in their therapies.