What is happening to the British press? To be more precise, why don't they seem to care about accuracy in relation to health matters?

Take the example of a letter in the Daily Mail (28.7.00) which referred to ME and post traumatic stress disorder (PTSD). Reader Richard Hornsby wrote that these conditions were nothing more than anxiety and depression; that ME can be greatly helped by psychiatric treatment (he meant CBT/graded exercise) and that we didn't need these separate diagnoses.  

This is nonsense, so I wrote to the Mail noting that PTSD is a recognised psychiatric condition listed in DSM-IV (Code 309.81). I also explained that the term refers to significant distress following events that "involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others"... Then I pointed out that ME (myalgic encephalopathy) is currently classified as a physical disease (ICD-10, Code G93.3); that it's a disorder of the brain and the immune system and that the rates of anxiety and depression in these patients are no higher than those documented in cancer and MS. In other words, these diagnoses exist, they are a reality and while laypeople might not think we need them, that's probably because they don't know what the disorders are.  

I also clarified that ME is not the same as chronic fatigue syndrome as the latter covers a number of disorders, not just ME.  Moreover, the psychiatric treatment which Mr. Hornsby was thinking of only benefits patients with general fatigue, depression and a phobia of activity. "There have been no successful trials of that particular therapy on patients with post-viral syndrome and ME but three unsuccessful ones."

For some strange reason, the Mail refused to publish my letter. This angered me, not because I'm desperate to see my name in the papers, but because people cannot make decisions based on out-of-date and misleading information. They need facts, which will help them understand the issues, not more myths and half-truths. And errors should be corrected. However, the Mail were not to be swayed. They didn't care. 

PTSD is not a joke. It's what some people developed after being in a concentration camp, or witnessing the traumatic events like the King's Cross fire. It's a horrible condition. Why do the papers like the Mail not act when it becomes clear that they have published something which trivialises or misrepresents such an illness?  Reclassifying PTSD and ME as normal anxiety or depression, which Mr Hornsby (and many others) want us to do, won't make either of them go away. It just makes the treatment less specific and effective. What if we reclassified migraines as a headache and gave all the sufferers the same treatment (paracetamol?). We can do better than that.

Everyone is entitled to an opinion. If the papers want to publish a letter claiming that Auschwitz never existed, let them. If they want to print that blacks have a lower IQ than whites, let them. However, you can only have freedom of speech if you also publish responses pointing out that the aforementioned aren't true. Freedom of speech doesn't mean freedom to deceive.

To ignore falsehoods and refuse to correct errors amounts to  deliberately misinforming people. In terms of ME and PTSD, it contributes to the stigmatisation of these conditions and reinforces prejudice. Who gains from that?

The laypress were not the only ones misleading their readers. Here's an example from the yellow comic, aka the British Journal of Psychiatry.

In June, it published a study by Scottish researchers MacHale and colleagues (2000, 176, 550-556). The subjects were 30 patients with CFS and ME "who were not depressed". Two measures plus a detailed interview all showed they did not suffer from depression. There was no sign of depression anywhere. However, when it came to discussing the results, I was surprised to read that the main limitation of the study was that their subjects "had high levels of depression; almost half were on psychotropic medication and five had a previous history of depression". According to the authors, the second part of the sentence justifies the first. Does it?   

Just for your information, 10 of the 30 patients were on antidepressants, and five of them had a history of depression. (Four others were on tranquillisers, I believe.) Thus, a maximum of 10 out of 30 had at one time had depression or were on drugs for depression. When I was young, that wasn't a majority and wouldn't support generalisations about a whole group. So, would you have passed the sentence claiming that the subjects "had" high levels of depression?

I've written before about the failure of the peer review system in British medical journals and this is another example where those involved just didn't care. Why is this sloppiness permitted? If this had been a study on women with breast cancer, the editors wouldn't have passed that sentence.

It was a strange paper for other reasons too. For instance, the authors speculated that the increased blood flow in the thalamus was related to increased attention to motor and cognitive tasks. (That links CFS with depression). Let's look at the evidence. Yes, they had evidence. They had just published a report in another journal detailing the results of cognitive tests on these very same patients. Other scientists would have taken the results of those tests to see if they correlated with the blood flow in the thalamus, as predicted. I challenged the authors in my letter to the journal to let us have the data but in the proofs which I was sent, they refused. One wonders why? Perhaps speculating is more rewarding?  Incidentally, a previous study by another team found no abnormalities in the thalamus. It may just have been a chance finding, of no clinical significance.

The failure of the journal to insist that the authors substantiate their claims is important because that is what we often criticise complementary therapists for. If we now allow this mad speculation in well known medical publications, why do we give people like Eileen Drewery such a hard time? After all, she didn't spend six years training, she didn't get a generous grant from the government to study 30 patients, and she almost certainly hasn't got a statistician in her team. She and the other practitioners may not always justify their claims but they have an excuse. MacHale and her colleagues don't. They had the training, the data, the money and the resources. Who were they trying to kid and why?

Having seen this nonsense from Edinburgh, all l can say is that the study was a waste of the patients' time and energy, a waste of money (e.g. from the Scottish Health Dept.) and a waste of trees. It also reduces British psychiatry to the level of the untrained practitioners, who just make wild claims about patients, often in spite of the evidence. It wouldn't be acceptable in gynaecology or rheumatology. I don't understand why it's acceptable in relation to chronic fatigue. 

Take care,

Ellen Goudsmit