An ideological wolf in skeptical clothing?
When talking about his treatments causing harm, Wessely seems to be talking about drugs rather than therapy, and justifies them because overall they result in more good than harm. It was his later statements which I found more interesting, when he discussed how Western medicine changes according to evidence rather than dogma, which is generally true but with some notable exceptions. He mentioned a few trials which demonstrated previous treatments used among the medical profession turned out to do more harm than good (ie killed patients), and stated "
we thought it worked, it didn't, we changed".
The political aspect of medical practice obscures the validity of more discrete and less lethal paradigms in the grey area between medicine and psychiatry (although psychiatry is also considered a field of medicine), areas which he appears to thrive in. Notions of functional psychosomatic illness were around long before Wessely came along, he is merely carrying on the tradition in refined modern terms with the cognitive behavioural model. Over the last century, biomedical science has frequently delivered humiliating smackdowns to psychosomatic ideologies regarding medically unexplained conditions, yet it is still the default attitude. So much for "we thought it worked, it didn't, we changed". ME/CFS inherited these notions as soon as it was considered to be "medically unexplained" and involving the mind.
One wonders how Wessely will or has responded as the basis for and efficacy-safety of CBT/GET continue to be called into question. Fortunately for Wessely, it is difficult to control for the placebo effect and the impact that therapy-based wishful thinking has on subjective questionnaires. CFS is diagnosed subjectively but we know patients have deficits in objective measures of activity, which aren't improving even after CBT/GET despite reported improvements to subjective measures. So he can train a patient to perceive themselves as "better" who will subsequently record lower fatigue scores on subjective questionnaires, while in reality the patient is basically just as disabled as before. That's what seems to be happening here, so Esther12's question about deception is valid. Is the patient being deceived and is this deception OK if it supposedly helps the patient feel a bit better?
I remember from somewhere that Wessely claims his approach is "pragmatic" (ie practical) so he would probably argue that the theoretical details don't really matter as long as patients were getting better or at least feeling better. Think of the infamous BMJ podcast quote about how even if he found XMRV he wouldn't do anything about it because he is in the business of rehabilitation? So much for Myra McClure's recent claim on TWIV that finding XMRV would have revolutionised how Wessely treated his patients! Wessely might find himself suddenly losing patients to antiretrovirals. Who needs to be “rehabilitated” if you can feel better from actual treatment and regain your life successfully on your own? He may discourage HGRV testing but I would be surprised if he actively deny his HGRV-positive patients access to ARV's as a part of overall treatment if they were proven to be effective and relatively safe.
Another obviously pressing question is whether CBT/GET is actually doing more harm than good. All those patient surveys documenting the suffering caused by CBT/GET, he would probably dismiss these as misapplied therapy and/or non-scientific anecdotes and/or nocebo effect, in the same way the alleged success of alternative medicine is dismissed as anecdotes that have simply arisen from the placebo effect and various forms of cognitive bias which misinterpret the natural course of illness. Meanwhile he and his colleagues appear to think they are immune from
such cognitive biases because they employ a few "scientific methods". Similarly, he would also argue that the published literature on CBT/GET shows no evidence of harm, just like he argues in the video that the published literature on an alternative medicine (I forgot which) for rheumatoid arthritis shows no evidence of efficacy. Keep in mind that systematic reviews on CBT/GET for CFS do note poor reporting of adverse effects.
I'm not really a fan of alternative medicine. I don't think of Wessely as a charlatan or a fraud but I am unsure if he qualifies as a quack.
Quackwatch.org states: "
Quackery can be broadly defined as 'anything involving overpromotion in the field of health.' This definition would include questionable ideas as well as questionable products and services, regardless of the sincerity of their promoters." Common medical attitudes and practices towards ME/CFS may therefore qualify as quackery, particularly the "overpromotion" component, including many psychological and biological approaches alike. Regardless of his sincerity and intent, people like Wessely remind me of polished versions of their stereotyped opponents in alternative medicine but have learnt to adapt themselves to the prevailing accepted practice of the era and therefore appear more credible than most CAM proponents. In today's world this means constructing clinical trials to get the desired result of “evidence” for your hypothesis, which would be easier for the "soft" sciences where the standards are different and perhaps also the risk of bias going unnoticed. I don't mean outright scientific fraud but frankly I wouldn't be surprised if something questionable is going on in the psychosocial fanclub in a similar manner as drug trials conducted by pharmaceutical companies.
What we need is someone "to go all James Randi on his ass", but many self-professed skeptics seem more interested in easy targets such as desperate patients using CAM for "subjective health complaints" than they are in bringing down someone like Professor Wessely who is on "their side" regarding alternative medicine and supports much of the same psychosomatic ideology that skeptics rely on to explain away the reported benefits of CAM. While rational skepticism is very useful and necessary, the double standards and hubris mean that I would be somewhat as embarrassed to call myself a "skeptic" as I would be admitting I am a "CFS patient", both labels are cringe-worthy to differing degrees.
I think at the end of the day in the face of criticism, Wessely's main argument will be: clinical trials show that using CBT/GET to "manage" CFS does more good than harm, even if its only making the patient perceive themselves as feeling improved, which is better than nothing. Of course, views like Wessely's have contributed, perhaps inadvertently, to the fact that there is "nothing" else. I am reluctant to call Wessely an ivory tower academic, because he does work with patients, but Esther12 makes some good points. Wessely appears to be largely oblivious to the implications of his work and generally nonchalant towards the alleged misinterpretations and overstating of the evidence. Apart from the recent bizarre outburst about how “insulted” he was at the idea that his patients in the XMRV study were psychiatric patients, his main issue with other psychologisers appears to be that they don't accept CFS as a valid diagnosis or they believe it purely mental rather than psychosomatic (ie affecting both the mind and body in "functional" terms).
In my experience many "mind over body" proponents, who may or may not be skeptics, are prone to justifying discrepancies in their claims in a similar way that some spiritual types (no pun intended) may rely on God or some esoteric element to justify logical uncertainties in their beliefs, exactly what alternative practitioners are accused of in the above video! The psyche-soma connection has been the medical equivalent of the "
god of the gaps" in philosophy and is a constant issue in discussions about ME/CFS.
