Journal of IiME Volume 5 Issue 1 (May 2011) The Involvement of the PACE Trial Principal Investigators and the Director of the Clinical Trials Unit with the Department for Work and Pensions continued training programme for DWP assessors. The Guidelines for DWP assessors state that anhedonia (loss of any pleasure/interest in life) is commonly present in CFS, which is erroneous, as it is not present in ME/CFS. In 1991, John Wiley & Sons published “Post-Viral Fatigue Syndrome” edited by Professors Rachel Jenkins and James Mowbray; in her own contribution, Professor Jenkins, a Principal Medical Officer at the Department of Health and Director of the WHO Collaborating Centre for Mental Health at the Institute of Psychiatry, made it clear on page 242 that there is no anhedonia in ME. The DWP Training Guidelines on CFS continue: “At one end of the scale are the (uncommon) cases where there is a very clear history of the sudden onset of fatigue after a proven viral infection, such as Epstein Barr virus; at the other, cases strongly associated with current or pre-existing psychiatric disorder. In fact, most patients with CFS will also meet the criteria for a current psychiatric disorder” (citing Simon Wessely and Trudie Chalder). “From the point of view of the disability analyst, by the time an individual has reached the stage of requiring a functional assessment the diagnosis is likely to have been in place for some time and behaviour patterns firmly established in the minds of the claimant and his medical attendant”. The claimant‟s medical attendant may be entirely correct in his/her management, but this implied criticism has long been a feature of the Wessely School‟s dismissal of “naive” clinicians who do not subscribe to their own beliefs about ME/CFS: for example: “Suggestible patients with a tendency to somatise will continue to be found among sufferers from diseases with ill-defined symptomatology until doctors learn to deal with them more effectively….It has been shown (by whom?) that some patients have always preferred to receive, and well-meaning Invest in ME (Charity Nr. 1114035) doctors to give, a physical rather than a psychological explanation…such uncritical diagnoses may reinforce maladaptive behaviour” (Old wine in new bottles: neurasthenia and ME. Simon Wessely. Psychological Medicine 1990:20:35-53) and “The prognosis may depend on maladaptive coping strategies and the attitude of the medical profession” (The psychological basis for the treatment of CFS. Wessely S. Pulse of Medicine, 14 December 1991:58). The DWP Guidelines continue: “It will almost always be appropriate to assess the claimant‟s mental state, and in the case of IB PCA (Incapacity Benefit Personal Capability Assessment) and ESA (Employment and Support Allowance), to complete a mental health/function assessment”. “The combination of cognitive behavioural therapy (citing Wessely and Chalder) and graduated exercise (citing Peter White) is at present the mainstay of treatment”, “treatments” which have been shown to be ineffective in numerous international reports and in surveys carried out by ME/CFS charities, as well as in the UK FINE and PACE Trials themselves. The Training Programme then instructs DWP assessors to read only a heavily psychiatrically biased reading list (with no mention of any of the biomedical evidence on ME/CFS), including “Occupational aspects of the management of Chronic Fatigue Syndrome: A National Guideline” (2006) in which Professors White, Sharpe and Chalder were instrumental; the NICE Guideline CG53 (2007) which recommends only CBT/GET as the primary intervention, and the 1996 report on CFS of the DWP Chief Medical Adviser‟s “Expert Group” which included Dr John LoCascio (Medical Director of UNUMProvident insurance company), Professor Anthony Pinching, Dr Peter White, and Dr Charles Shepherd, (Medical Adviser, ME Association). Continued page 37 www.investinme.org Page 36/58
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