ME / Chronic fatigue syndromeLettersPros and cons of ME therapy
Prof Philip Graham and Dr John Cookson on what works best in cases of those with myalgic encephalomyelitis
It is surprising the National Institute for Health and Care Excellence (Nice) should even be considering stopping advising doctors to administer graded exercise therapy (GET) and cognitive behaviour therapy (CBT) in cases of myalgic encephalomyelitis (UK health standards body delays new ME guidance in therapy row, 17 August). Those who object to these treatments do so on the grounds that the condition is not psychological and so should not be treated by psychological methods. In fact, ME is caused by a combination of physical and psychological factors, the relative importance of each varying between sufferers.
In any case, the principles of GET and CBT are used in undoubtedly physical conditions, as in recovery from heart disease and stroke. It is true that the use of these therapies sometimes makes things worse in ME, but this is the case for many established treatments. In this case, though the evidence is not conclusive (it never is), controlled trials indicate that benefit outweighs risk. In the absence of strong evidence of harm, public bodies should not intervene to stop particular treatments but leave clinicians and patients to negotiate together if and how to use them.
Prof Philip Graham
Emeritus professor of child psychiatry, University College London
My younger daughter was diagnosed with ME at 14 years of age and is still ill. She is now 42. My late wife was diagnosed with it some months later and suffered badly until her death in 2019. Because the condition is inadequately characterised, it has been a happy hunting ground for people offering “cures”. None of them work. My wife, a psychologist and statistician, said those who were well enough to engage with CBT were probably on the road to recovery anyway. GET therapy is the last thing people with ME need.
My wife and daughter, when they overexerted themselves, faced severe and rapid deterioration. To her astonishment, while my wife was undergoing chemotherapy, the ME disappeared. It would be difficult to argue that cytotoxic drugs would have any influence on an allegedly psychosomatic illness. A more likely hypothesis is that the immune system is fundamentally involved in the disease. In that case, therapies like GET or CBT are unlikely to be of any value, or even possibly damaging, which seems to be the rational conclusion of Nice.
Dr John Cookson
Bournemouth
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