There were many problems with Dr. Jeremy Devine’s
disturbing oped in the Wall Street Journal, as I have detailed
here. In addition to gaslighting Long Covid patients and disparaging patient advocacy groups, Devine asserted that the PACE trial’s psychogenic theory of ME/CFS is “the prevailing view among medical practitioners.” As readers of this site know, that has not been true since at least 2015, when the U.S. Institute of Medicine (now the National Academy of Medicine) reported its finding that ME/CFS is a “serious, chronic, complex, systemic disease”— not a psychiatric or psychological disorder.
Devine is a 2017 University of Toronto medical school graduate and currently a psychiatry resident at the McMaster University Faculty of Health Sciences in Hamilton, Ontario. As a doctor-in-training, he obviously must have obtained at least some of his misinformation from his supervising senior physicians. This raises the troubling likelihood that McMaster psychiatry residents are still being taught that ME/CFS is, as Devine put it, “an underlying mental-health issue,” presumably treatable with cognitive behavior therapy and graded exercise therapy per the PACE trial (which Devine linked in his oped).
Because prospective ME/CFS patients have a right to know about the quality of care they can expect from McMaster physicians, I sent an inquiry to Drs. Nick Kates and Karen Saperson,
respectively the chair and vice chair of McMaster’s Department of Psychiatry and Behavioural Neuroscience, recognizing of course that Devine is entitled to his own opinions about Long Covid:
Dr. Devine also wrote that the “prevailing view among medical practitioners” is that ME/CFS is a symptom of “an underlying mental-health issue,” linking to the UK’s 2011 PACE trial. That was more than a statement of his opinion, and it seriously misrepresented the actual state of current medical practice.
The US Institute of Medicine (now the National Academy of Medicine) issued a report in 2015 finding that ME/CFS is a “serious, chronic, complex, systemic disease”— not a psychiatric or psychological disorder. The PACE trial’s recommended treatments of Graded Exercise Therapy (GET) and Cognitive Behaviour Therapy (CBT) have since been discontinued by the U.S. National Institutes of Health and Centers for Disease Control. Likewise, the UK’s National Institute for Health and Care Excellence (NICE) issued a revised draft of its clinical guidelines, dropping both CBT and GET as treatments for ME/CFS, and strongly advising against the latter. Promising biomedical research on ME/CFS is now underway at major U.S. Universities, including Stanford, Columbia, and Cornell.
It is simply untrue to maintain that the “prevailing view among medical practitioners” is that ME/CFS is mental-health disorder.
Consequently, I am writing to ask whether Dr. Devine’s understanding of the “prevailing view” is taught in the McMaster psychiatry program. Does your department continue to follow the recommendations of the PACE trial (which the NICE draft called a “low quality” study)? Are your patients advised to engage in Graded Exercise Therapy? Are your residents made aware of post-2015 developments in the U.S.?
It appears to me that Dr. Devine’s outdated views of ME/CFS may reflect poorly on the quality of training and care provided by your program. Kindly let me know if I am mistaken.
Kates replied:.....................
