What follows is the text of the article entitled "The Views of Dr Simon Wessely on M.E. : Scientific Misconduct in the selection and Presentation of Available Evidence" by Eileen Marshall and Margaret Williams, published in the Spring 1994 issue of The CFIDS Chronicle.
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It is widely acknowledged in the peer-reviewed medical literature that patients with myalgic encephalomyelitis (M.E.), otherwise known as chronic fatigue and immune dysfunction syndrome (CFIDS) or chronic fatigue syndrome (CFS), suffer from an organic illness which is not psychological or psychiatric in origin. Persons with M.E. are particularly vehement on this point because they know from experience that selective symptoms which point to an organic etiology are simply ignored by many in the medical community because of ignorance or bias. One of the prime offenders in this category is British psychiatrist Dr Simon Wessely.
It is very distressful that Wessely appears to be quite unstoppable in his blind determination to claim that ME/CFIDS is nothing more than a primary psychiatric disturbance.The only United Kingdom government-funded research on ME/CFIDS has been a small grant to the Medical Research Council, which went towards Wessely's research into the psychiatric aspects of ME/CFIDS. In addition, Wessely has a seemingly unassailable influence on the UK Department of Health and the Department of Social Security, and the misinformation he is propagating is causing immeasurable risk and hardship
to sufferers of ME/CFIDS.
His influence does not stop at the UK border, however. Wessely has recently been in the United States doing his utmost to alter the Centers for Disease Control and Prevention (CDC) criteria for CFS by trying to get the case definition turned wholly away from an organic etiology.
All ME/CFIDS patients should be adequately informed about the nature and extent of the damage Wessely has done to them and the public perception of this condition by his many publications in the medical literature. We know that the accuracy of his quotations is not an issue, as all have been published by Wessely and his close associates.
"Maladaptive Coping Strategies"
Despite his claim that he does not want to get into the 'organic' versus 'functional' argument [Wessley, S. - Editorial, 'Chronic Fatugue Syndrome', Journal of Neurology, Neurosurgery and Psychiatry 1991;54:669-671] Wessely has done perhaps more than anyone else to fan this particular flame. He believes that M.E. (or CFS as he prefers to call this disease) is merely one end of a continuum of 'tiredness' as experienced by everyone at some stage in their lives, and that the prognosis of those who succumb to ME may "depend on...maladaptive coping strategies." [Wessely, S - 'The Psychological Basis for the Treatment of CFS', Pulse of Medicine, Dec 14th 1991; 58.] In other words, Wessely seems to be saying that ME is nothing more than an attitude problem experienced by suggestible people who are poor copers and see ME as an easy escape route from life's problems. Wessely compares ME with Neurasthenia, the late 19th century psychiatric disorder. He writes that neurasthenia "provided the most respectable label... one which conferred many of the benefits ... and fewest of the liabilities associated with illness. ... There is little change in the current era [of ME] " [Wessely,S.-'Old Wine in New Bottles', Psychological Medicine, 1990;20:35-53.]
Unfortunately, and probably due to the input of doctors like Wessely, ME definitions have recently centred on the symptom of fatigue instead of the original definition of Ramsay, which focussed on the rapid muscle fatigue after minimal exertion. Fatigue is too vague and common a symptom on which to base any definition, but it fits the aims of psychiatrists like Wessely who want to link ME with depression.
Wessely's Scientific Methods
Wessely is a most prolific author, and to support his own views on the nature of ME, he relies heavily on his own opinions; for instance, in his chapter in a recent neurological textbook ['Recent Advances in Clinical Neurology No.6', edited by C.Kennard, Churchill-Livingstone,1990] he uses no less than 31 self-references. Most mainstream medical journals will permit no more than two self-references in an article.The extrapolations which Wessely makes from his own research findings simply do not carry the weight to support his conclusions. For the most part it seems he has reached his conclusions before generating his data. One of his studies included only 47 patients, yet from this small sample Wessely's major conclusion is that "an alternative hypothesis is that all cases of CFS can be explained by disorder of mood" [Wessely,S, Powell,R - "Fatigue Syndromes: a comparison of chronic 'postviral' fatigue with neuromuscular and affective disorders", Journal of Neurology, Neurosurgery and Psychiatry 1989;52.] In truth, this trial is too small to be of any practical use and, by his own admission, his methodology was flawed. Therefore his conclusions are baseless and arbitrary. Even so, this study continues to be quoted by Wessely as a paper of substance in the ME/CFS literature, as it was published in the prestigious Journal of Neurology, Neurosurgery and Psychiatry. This would undoubtedly convey considerable aumen if one of his colleagues had not let it be known that Wessely himself is the referee on ME for this journal (although he would not have been permitted to review his own work). We understand that he also holds this position for the British Medical Journal, The Lancet, and various other peer-reviewed journals.
The Referee's Role
Normally, the identity of referees who perform peer-reviews is never revealed, but there has been such concern over the abuse of the referee's power to wield undue influence that Professor Sleight, head of cardiology at the John Radcliffe Hospital in Oxford stated "Perr review is 50 per cent garbage, 50 per cent malice and 10% good advice" at a recent Royal Society of Medicine meeting. [Feinmann, J - 'Can GP's trust what they see in academic journals?' GP, 5th Nov 1993;53.] Professor Sleight went on to claim that "many [referees] actually steal data and hold up publication while they publish it as their own research."
The role of referee on any particular subject carries enormous responsibility, because he or she decides what gets published and what gets rejected. If the journals are flooded with enough articles which reinforce concepts of a particular disease, and when many of the articles have been written by a single author, then two things happen. One is that the ideas and conclusions repeatedly put forth gradually become accepted as facts; the other is that the prolific author becomes thought of as an 'expert' merely by virtue of the sheer volume of his or her published works. It would then be natural for such a prolific author to be sought out as the expert of choice by lawyers, for instance. Professor Sleight told the Royal Society of Medicine meeting that for his part, he prefers writing his own detailed press releases rather than relying on the discredited peer-review system.
Railroading the Opposition
Of more importance than his own personal views about ME is Wessely's treatment of other people's genuine research into ME : he repeatedly ignores, dismisses or trivializes any evidence which does not accord with his own views. When he reviews the ME literature factual errors (which lend support to his own theories) and he distorts other people's accounts. For example, in one article [Wessley, S - 'Mass Hysteria : Two Syndromes ?' Psychological Medicine 1987:17:109-120] Wessely reduced the duration of the 1955 Royal Free Hospital epidemic from the actual three months by claiming that it lasted from one day to one month. He bases one argument on a 1970 review of this epidemic [McEverdy CP & Beard, AW: 'Royal Free spidemic of 1955: a reconsideration.' British Medical Journal, 3rd January 1970;1:7-11, one of the most discredited papers in the history of medicine -DK] which claimed that this outbreak was simply mass hysteria, even though they had only reviewed old case notes and failed to interview a single patient. Wessely states that McEverdy & Beard felt that the use of the name 'benign myalgic encephalomyelitis' in this epidemic served to reinforce the outbreak. However, that name was not even coined until 1956, well after the end of the outbreak [the infectious phase - DK] , so it is unlikely that it could have influenced the course of the epidemic. Further, there is no such reference by the original authors in the McEverdy & Beard paper.
More recently, when discussing the persistence of viruses, Wessely writes that even if a virus manages to evade the host response, "the immune system still responds in such a fashion as to indicate the presence of the virus. Evidence of any of these processes has not been provided in CFS." [Wessely,
S - 'The Neuropsychiatry of chronic fatigue syndromes', in Bock and Whelan (eds) 'Chronic Fatigue Syndrome', Wiley & Sons / CIBA Foundation, 1993]. The fact that Wessely chose to ignore the extensive evidence found by..........................
Landsay AL, Jessop C, Lenette ET, Levy JA - 'Chronic Fatigue Syndrome: a clinical condition associated with immune activation', The Lancet, 1991;338:707-712.
Klimas NG, Salvato FR, Morgan R, Fletcher MA - 'Immunological Abnormalities in Chronic Fatigue Syndrome', Journal of Clinical Microbiology 1990;28:1430-1410.
Morrison LJA, Behan WMH, Behan PO - 'Changes in natural killer cell phenotype in patients with post-viral fatigue syndrome', Clinical and Experimental Immunopathology 1991;83:441-446.
Chao CC, DeLahunt M, Hu S, Close K, Peterson PK - 'Immunologically mediated fatigue - a murine model', Clinical Immunology and Immunopathology, 1992;64:2:161-166.
Jones JF, Ray CG, Minnich L, Hicks MJ, Kibler R, Lucas DO - ' Evidence for Activated EBV Infection in patients with persistent, unexplained illnesses: elevated anti-early antigen antibodies', Annals of Internal Medicine, 1985;102:1-7.
Buchwald D, Cheney PR, Peterson DL, et al : 'A chronic illness characterized by fatigue, neurologic and immunologic disorders and active human herpesvirus type 6 infection', Annals of Internal Medicine, 1992;116:2:103-113.
......................... does not mean that there is none [!] - it only means that Wessely, as usual, restricts his references to a biased and personal selection of the evidence which is available.

The rest of the article will appear in next month's Newsletter