Mark Vink: The Updated NICE Guidance Exposed the Serious Flaws in CBT and Graded Exercise Therapy Trials for ME/CFS


Senior Member

(This makes for very satisfying reading.............unless you are one of the psychiatric cabal))

The Updated NICE Guidance Exposed the Serious Flaws in CBT and Graded Exercise Therapy Trials for ME/CFS

The Updated NICE Guidance Exposed the Serious Flaws in
CBT and Graded Exercise Therapy Trials for ME/CFS
Mark Vink 1,* and Alexandra Vink‐Niese 2
1 Independent Researcher, 1096 HZ Amsterdam, The Netherlands
2 Independent Researcher, 30159 Hannover, Germany;
* Correspondence:
Abstract: The British National Institute for Health and Care Excellence (NICE) recently published its updated guidelines for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). NICE concluded, after an extensive review of the literature, that graded exercise therapy (GET) is harmful and should not be used, and that cognitive behavioural therapy (CBT) is only an adjunctive and not a curative treatment. Leading proponents of the cognitive behavioural model (CBmodel) find it difficult to accept this paradigm shift. In, for example, an article in The Lancet, they try to argue that the new NICE guideline is based on ideology instead of science.

In this article we reviewed the evidence they used to support their claims. Our analysis shows that the trials they used in support suffered from serious flaws which included badly designed control groups, relying on subjective primary outcomes in non‐blinded studies, including patients in their trials who didn’t have the disease under investigation or had a self‐limiting disease, selective reporting, outcome switching and making extensive endpoint changes, which created an overlap in entry and recovery criteria, using a post‐hoc definition of recovery which included the severely ill, not publishing results that contradict their own conclusion, ignoring their own (objective) null effect, etc. The flaws in these trials all created a bias in favour of the interventions. Despite all these flaws, treatments that are said to lead to recovery in reality do not lead to objective improvement. Therefore, these studies do not support the claim that CBT and GET are effective treatments. Moreover, the arguments that are used to claim that NICE was wrong, in reality, highlight the absence of evidence for the safety and efficacy of CBT and GET and strengthen the decision by NICE to drop CBT and GET as curative treatments for ME/CFS.
Keywords: CFS; chronic fatigue syndrome; eminence‐based medicine; evidence‐based medicine;
ME; NICE; post‐infectious disease

Finally, Flottorp et al. [5] emphasise the need to listen to patients, yet they continue
to ignore that patients have been saying for a long time that CBT and GET are neither safe nor effective. As noted by psychologist professor Kunst, the following “can’t be stressed enough: The reason why we lack treatments for #LongCovid is that patients of similarpost‐viral conditions have been gaslit and disbelieved for decades (i.e., #MECFS). The long‐term effects of viruses are nothing new—it is just that nobody seemed to care” [94].

Rufous McKinney

Senior Member
from Discussion Section of the paper above:

"First of all, the basis of the CBmodel as an explanation for ME/CFS is that patients interpret their symptoms incorrectly. It is illogical and unscientific to then rely on patients interpreting their symptoms by using subjective outcomes because that would imply that patients are interpreting their symptoms wrongly but at the same time they are also interpreting the same symptoms rightly."