Dr David Tuller: NICE on Exercise and Post-Covid Syndrome


Senior Member

Trial By Error: NICE on Exercise and Post-Covid Syndrome
15 JULY 2020

By David Tuller, DrPH

As post-covid syndrome has emerged as a major public health concern, so has the likelihood that members of the biopsychosocial ideological brigades will roll out their typical interventions for the “long-haulers”–patients suffering from profound exhaustion and other symptoms for many weeks and months after getting infected with the coronavirus. The situation has created an unforeseen dilemma for UK’s National Institute of Health and Care Excellence, which is currently in the process of revising its misguided 2007 guidance for what it then called chronic fatigue syndrome/myalgic encephalomyelitis and now calls ME/CFS.

The panel that created the 2007 document was dominated by cognitive behavior therapy and graded exercise therapy proponents, so those interventions ended up as core treatment recommendations. Three years ago, NICE conducted a perfunctory review and decided that the guidance did not need updating. An onslaught of negative public comment followed, along with the revelation (on Virology Blog, via a freedom of information request) that the expert review panel was remarkably free of diverse voices. NICE reversed itself and launched a full-scale revision process.

The new ME/CFS guidance was supposed to be issued later this year but the pandemic has understandably disrupted the schedule. It is now scheduled to be released next April. The stakes are high, and not just for the patient community. Careers have been built on touting the benefits of these interventions, despite the failures of trials like PACE and FINE and others of their ilk. If the new NICE guidance rejects this approach, it could have a huge negative impact on their reputations and their ability to obtain further funding to pursue wrong-headed ideas.