A report revealing why the UK government buried ME.
"In the Expectation of Recovery"
MISLEADING MEDICAL RESEARCH AND WELFARE REFORM
by George Faulkner
Back in 1995 a Unum report on CFS stated that they could "lose millions if we do
not move quickly to address this increasing problem". It was argued that CFS claims
should be managed "more aggressively and in a proactive rather than a reactive fashion"
while attempting to present CFS as "neurosis with a new banner". Emphasising the
importance of psychosocial factors and classing CFS as a mental health problem could
bring immediate financial benefits to insurance companies when policies limit payouts
for mental health problems. One of the PACE trial's principal investigators gave a
presentation on the results of the PACE trial to Swiss Re insurance. Swiss Re's report of
his talk detailed the potential use of mental health exclusions to cut payments, while a
2013 Swiss Re presentation on their approaches to mental health problems describes their
use of specific exclusions for CFS and ME.
In 2002 all three of the PACE trial's principal investigators, along with Aylward,
Waddell and Wessely, contributed to a conference and book which promoted the use
of the biopsychosocial model. The book was made up of conference papers and
transcripts of discussions, and includes Waddell explaining how the biopsychosocial
model was gaining political influence:
"It is all about money. The main thing was to persuade the treasury that there
was an opportunity for keeping costs down, particularly over the longer term."
In response to another participant saying "if you go to Gordon Brown (UK Chancellor)
and say, 'We can prove to you that if we address this issue, we can save £2 billion', then
you will have his full attention", Mansel Aylward replied: "That is the approach that has
been taken, but not in such a robust fashion."
Their discussions explained how, within government, the antipathy caused by the
view that the biopsychosocial model lacked a hard evidence base had been overcome
by the softer evidence of "authoritative and expert opinion". Unfortunately, those
selected for their authoritative and expert opinions may not have risen to positions of
influence because of their moral integrity and intellectual rigour. Systematic reviews were
also described as being important for changing the views of key opinion makers, yet
systematic reviews may merely combine results from a number of different non-blinded
trials, putting aside problems with bias and making potentially misleading results appear
more reliable than they truly are. 
If politicians are not willing and able to engage critically with the scientific and medical
evidence presented to them they could easily be manipulated.
Gordon Waddell pointed out that evidence may not even be what is needed to change
"To take this a stage further, I am not sure that evidence is what convinces people.
We do need an evidence base, but it is ideas that really influence people. People
go to war for ideas, not for evidence. When you look at changing practice, it is
really about ideas rather than evidence."
The biopsychosocial approach to disability was an appealing idea (to some) lacking a
solid evidence base. It has now been used to present cuts to the incomes of sick and
disabled people as a caring intervention in their lives.
The power of the 'evidence-based' label
In 2006 a Parliamentary All Party Group inquiry into CFS/ME claimed that:
"There have been numerous cases where advisors to the DWP have also had
consultancy roles in medical insurance companies. Particularly the company
UNUM Provident. Given the vested interest private medical insurance companies
have in ensuring CFS/ME remain classified as a psychosocial illness there is
blatant conflict of interest here. The Group find this to be an area for serious
concern and recommends a full investigation of this possibility by the appropriate
"It is difficult to get a man to understand something, when his salary depends
upon his not understanding it!"