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Dr David Tuller: Professor Chew-Graham’s Apparent Shift in Position on GET/CBT


Senior Member

Trial By Error: Professor Chew-Graham’s Apparent Shift in Position on GET/CBT
21 OCTOBER 2020
By David Tuller, DrPH

*October is crowdfunding month at Berkeley. I conduct this project as a senior fellow in public health and journalism and the university’s Center for Global Public Health. If you would like to support the project, here’s the place: https://crowdfund.berkeley.edu/project/22602
Carolyn Chew-Graham, a professor of general practice research at Keele University in Staffordshire , is a longtime proponent of psycho-behavioral interventions for so-called “medically unexplained symptoms,” or MUS—a category in which she and her colleagues include the illness they call chronic fatigue syndrome/myalgic encephalomyelitis. She and other members of the biopsychosocial ideological brigades have long recommended cognitive behavior therapy and/or graded exercise therapy for CFS/ME, and frowned on “pacing” as a strategy.

Professor Chew-Graham is the main author of METRIC, an online medical training program that promotes the effectiveness of the CBT/GET treatment paradigm. Since METRIC is based on the discredited PACE trial and its smaller “sister trial” FINE, the operating theory of illness is that patients’s ongoing symptoms arise from the combination of deconditioning and unhelpful illness beliefs. (Professor Chew-Graham was a co-author of FINE, which reported null results for its two primary outcomes of physical function and fatigue at 12 months.)
Professor Chew-Graham is also an architect of the successful push to include MUS in the National Health Service’s metastasizing Improving Access to Psychological Therapies program. The strategy is designed to shunt these patients away from further medical investigation and towards psycho-behavioral interventions on the presumption that organic dysfunctions are not causing the symptoms. Professor Chew-Graham has more than once mis-cited a seminal study in the MUS field, despite her purported expertise. The study was about the cost to the NHS of patients with MUS, and Professor Chew-Graham’s embarrassing misreading had the effect of more than tripling the apparent expenditures–an error that would likely have the tendency to increase support for expanding MUS services.

Now she has published a major qualitative study about the experiences of so-called “long-haulers”—patients who had presumed or confirmed acute Covid-19 and subsequently developed persistent symptoms. Some of these symptoms appear to be caused by specific organ damage. Others—profound fatigue, head-spinning, cognitive challenges—are often non-specific and harder or impossible at this point to attribute to identified pathophysiological dysfunctions. In other words, these symptoms could easily fall into the MUS category and/or lead to diagnoses of CFS/ME (or ME, or ME/CFS).

Professor Chew-Graham recently described the results from this study during an online webinar on long-Covid organized by the Royal Society of Medicine. As I noted on Virology Blog, she came across as sincere and genuinely concerned about what she’d heard from 24 patients. She strongly supported pacing—in contrast to fellow webinar panel member Alastair Miller, a Liverpool infectious disease expert who hailed the purported evidence base for CBT and GET. He failed to mention that the National Institute for Health and Care Excellence issued a warning months ago against assuming GET was indicated for long-Covid.
Some questions for Professor Chew-Graham

The problem isn’t that I disagree with what Professor Chew-Graham writes about listening to and believing patients. It is that the advice she offers GPs now is rather different from the approach to CFS/ME she has advocated for years and outlined in the METRIC training program. She appears to have a genuine understanding of these long-haulers’ fears and anxieties, and the quotes from study participants are compelling. Given her own long involvement in conveying a different message, perhaps she could provide some sort of explanation for what appears to be a shift in her thinking, if not a complete about-face.

Here are a few of my questions for Professor Chew-Graham:

Do you still believe that CFS/ME is best treated by CBT and GET, per PACE and METRIC?

(One might almost be tempted to think that the subject of the article is struggling with Long Covid as rumour suggests. )