Dr Phil Hammond’s latest column in Private Eye is called ‘Trial on Trial’. You may remember he wrote quite a helpful column about ME just recently. This time he writes in response to criticism from a doctor who got in touch to say:
“Every illness has a physical, psychological and social component, and limiting diagnosis or treatment to only one aspect of someone’s illness is likely to lead to a much poorer outcome. This ‘triple diagnosis’ applies to any complaint you care to consider, although obviously in varying proportions. The one exception seems to be CFS/ME, where any suggestion that there might be a psychological or social component leads to criticism. That CBT is the only treatment which has repeatedly been shown to have any benefit is conveniently ignored.”
It does become tiresome having to deal with such ‘arguments’ time and time again. Once upon a time it was ‘yuppie flu’ that popped up in every article about ME. Now, at long last, that is slowly fading away. Yet now we have to deal with this endlessly repeated idea that ME patients have an unreasonable and unsubstantiated resistance to any suggestion that there might be a psychological component to our illness. People with cancer are happy enough to go for CBT, we are told. So what’s our objection? Continue reading “Spreading the Word”
Well, in my previous post (a few hours ago), I did say to take a closer look at the MEGA site in case there was something I’d missed – and too right I was. I had failed to read the new MEGA blog post, thinking that it was just about the change of deadline for applications to join the patient advisory group. I hadn’t realised that it also provides a schedule for subsequent weeks. Here it is:
- 9am 13 December 2016 – Deadline for applications to join the MEGA Patient Advisory Group
- 13-14 December – Applicants contacted and group members confirmed
- w/c 19 December – Papers and key information sent out to Patient Advisory Group members
- 29 or 30 December – Patient Advisory Group teleconference and/or e-group meeting held
- 4 January 2017 – Back-up call for Patient Advisory Group if needed, to address outstanding issues from December meeting.
So patients are to be given a maximum of eleven days to read the ‘papers and key information’ before discussing it and -presumably – suggesting possible alterations in a teleconference or e-group meeting over the Christmas period! So not only are they expected to do this over Christmas, but the twelve days of Christmas has been shortened to a maximum of eleven. Notice the w/c in there – not meaning ‘toilet’ in this instance (although some might think this an appropriate place to sling the schedule) but ‘week-commencing’, so the papers could theoretically arrive any time that week, which might be as little as six days before the conference.
At least they accept the possible need for a backup call ‘to address outstanding issues’ and also feel that some explanation is due. They say:
The reason that the timescale is so short is because the mainstream funder to whom we want to apply for MEGA funding has an application deadline in early January 2017. This deadline was only recently announced and was different to the timings we expected.
If we miss the deadline for this funder, we will not be able to apply again until 2018.
Even so, to use an old joke from Have I Got News For You, the words piss-up and brewery spring to mind. And of course many will say that they’ve carefully planned it like this to deliberately discourage and marginalise patient involvement. I can fully understand that point of view. If MEGA really want to win back the trust of the patient community, they are not going the right way about it.
Does this make an difference to my decision to apply for the patient advisory group? I’m still processing that one. But I’m getting more and more annoyed. Three more words have sprung to mind: ‘taking the’ and ‘piss’. And it’s not us that’s doing it…
(My normal pristine standard of vocabulary will be resumed in the next post.)
See also this OMEGA post which I should have read yesterday, including pertinent comments by Peter T.
Regular readers will know that I recently received a response from Professor Holgate to our 200-plus-signature email expressing concerns about the proposed MEGA study. “We are very appreciative of the enthusiasm being shown to pursue an exciting ‘omics-based research project in the field of M.E…” he said, with no mention of the various pressing concerns we raised in our email. You can read the whole of his message in this previous post.
Here’s my latest response in the ongoing dialogue with Professor Holgate, CMRC Chair, about the proposed MEGA study:
Dear Professor Holgate
Thank you for your response
to our email. I have not been able to consult with all the 218 people who signed the original communication but those whom I have been in touch with have expressed considerable disappointment that you did not attempt to address the specific issues we raised in our letter
However, I await the new website with interest and hope that the FAQ section will at least deal with the two main issues we mentioned in relation to MEGA:
- the recruitment of a representative sample of patients (including the severely affected) who have the cardinal ME symptom of post-exertional malaise, and
- the suitability of Professor Crawley to take charge of such recruitment given the highly imprecise nature of her previous work in this field
Many people who signed the previous letter also left relevant comments Continue reading “FITNET Fiction”
Many patients and carers left additional comments for Professor Holgate of MEGA when they signed our recent letter. I wasn’t able to carry these over when I transferred the post to its permanent home, so I’m reprinting some of them here. Sorry I haven’t included them all but I am grateful for all your comments and signatures nevertheless. I shall link to this post when I send the follow-up letter to Prof Holgate (which I hope till be tomorrow). I will post the follow-up letter here on the blog as well.
Here are the comments: Continue reading “More Voices”
Well, here’s Professor Holgate’s response to our recent email. Do I feel heard? No. What about you?
Dear Spoonseeker (I am not sure whether this is the correct title but I hope this reaches you all),
Thank you for your email. We all recognise the concerns that are held about the MEGA Project and value your input. We are very appreciative of the enthusiasm being shown to pursue an exciting ‘omics-based research project in the field of M.E. and the issues that you have raised. We are soon (next week I hope) will be issuing a description of what MEGA comprises on a new website and will also have a frequently asked questions (FAQ) page which will be regularly updated. The latter is aimed at addressing the majority of questions that have been raised in your and other emails through the FAQs. Involvement of people with M.E. at the core of MEGA will be essential through an Advisory Group of people with M.E. and their carers.
As yet the first grant outline has not yet been submitted. We will do our very best to create the most competitive application, but even with this there is certainly no guarantee of funding. Please be assured that we will definitely involve the M.E. community in the proposal. As you will have noted I have brought the very best scientists from across the UK to assemble this application. It will be a real team effort. We need everyone’s support to help with this otherwise it will fail at the first hurdle.
Thank you again for expressing so much interest in our endeavour. Finally, I should add that I am not a CFS/M.E. researcher myself but someone who has realised we must make inroads into the causes of this (these) distressing and serious disorders.
Professor Stephen T Holgate CBE, FMedSci
MRC Clinical Professor of Immunopharmacology
This email has been sent to Professor Holgate of MEGA. Many thanks to all those who signed. (Whoops! missed a few… Total signatures now updated to 221)
((Please note that we are not the organisers of the OMEGA petition.))
Dear Professor Holgate – We comprise a number of M.E. patients and carers, 218 in all. Please see our signatures at the end of this email..
We are writing because we notice your suggestion in your letter to Professor Jonathan Edwards that OMEGA (the petition opposing the MEGA study) has attracted so many signatures due to the support of Invest In ME. We are writing to assure you that we patients and carers are able to look at the evidence and make up our own minds on such issues.
Here are some of the grave concerns that we have about the MEGA study as it has been proposed. It seems likely that you have heard many of them before but in view of your professed perplexity about the OMEGA petition, we want to make sure you are aware of the issues. For the same reason, we are copying this to the other members of the MEGA team and to those you copied in to your letter to Professor Edwards. We are also sending a copy to Professor Edwards himself, and the email will be posted online at the Spoonseeker blog.
Our concerns about MEGA include the following:
Patients from the NHS CFS/ME clinics (apparently the intended source for MEGA) will not yield a representative sample of people with M.E. The reasons for this include:
- Most severely affected patients cannot access the clinics and so will not be included in the study.
- There will be an inevitable selection bias towards the mildly affected because
- the clinics will tend to select such patients as those most likely to respond to the behavioural therapies on offer, and
- the more severely affected patients will be more likely to reject such therapies – and hence the clinics – as inappropriate.
- Other more severely affected patients will no longer be on the clinic’s system
- either because they have not responded well to the therapies, dropped out, and not been followed up (as feedback suggests is often the case) or
- they are among the long term sick who are no longer on the system because treatment is time-restricted
There has been a suggestion, following representations from patients, Continue reading “The OMEGA Petition – Email to Professor Holgate”
Following on from the previous post about Prof Esther Crawley’s broadcast on BBC Radio Bristol, Dr Phil Hammond has left a response to my letter and I in turn – along with some other correspondents – have replied.
Meanwhile, there has been excellent news from the ME Association who have launched an appeal for a metabolomics study using samples from the existing British biobank, which will include the severely affected. Psychiatrists will not be among the researchers…
You can find more information and details of how to donate here.
Following last Saturday’s interview with Prof Esther Crawley on BBC Radio Bristol, I sent the following letter to Dr Phil Hammond who hosted the programme. I think it explains a large part of the reason why patients with M.E. have problems with Dr Crawley and why we don’t want her involved with the proposed MEGA study:
Dear Dr Hammond
Thank you for putting the concerns of ME/CFS patients to Prof Esther Crawley in your interview on Radio Bristol last Saturday. Unfortunately, as I have tried to explain as briefly as possible below, her responses were largely factually incorrect. I wonder if next time you have her on your programme, you could also invite the investigative journalist David Tuller whose original in-depth analysis brought the many and in some cases outrageous defects of the PACE Trial to wider attention. This led to numerous condemnations of PACE from eminent researchers in the field of ME/CFS. Here are just two of them:
Prof. Ronald Davis of Stanford University said: “I’m shocked that the Lancet published it…The PACE study has so many flaws and there are so many questions you’d want to ask about it that I don’t understand how it got through any kind of peer review.”
Prof. Jonathan Edwards of University College London said: “It’s a mass of un-interpretability to me…All the issues with the trial are extremely worrying, making interpretation of the clinical significance of the findings more or less impossible.”
PACE’s recommendations for the use of CBT and graded exercise therapy (GET) for ME/CFS have frequently been reported by the British media but the important work of Mr Tuller has been ignored, so grossly distorting the information which has been made available to the British public. It would be an invaluable service if your programme could help to redress this imbalance.
When asked about the recent PACE reanalysis on your programme, Prof Crawley replied as follows: Continue reading “Letter to Dr Phil Hammond”
This post comes mainly courtesy (again) of the astute Steve Hawkins, who responded to my concerns in the Getting Airborne post about the possible dangers of a MEGA Biobank. Over to Steve:
On the ‘big data’ front, I think that all genuine physical measurements will be useful if used in the right way. The danger comes from any extraction/filtering that uses diagnosis as the reference field. If they do that – and I’m sure Crawley and Co would, because they think they can diagnose without biomarkers – the results would be garbage, as there would be many conditions given the wrong name but appearing together.
On the other hand, filtering on key concrete signs like PEM, POTS, bedbound, etc. would pull up useful groupings whatever the ostensible diagnosis.
In the wider scheme of things, there are now a number of entrepreneuring projects aiming to collect ALL big medical data, and link all medical databases together. I read a good piece on this recently by one bioinformatician who is setting up a giant server, but I don’t seem to have bookmarked it. Here is a conference on getting all genomic information into ‘the cloud’ for free searching and filtering: And one from The Lancet, on the astronomical amount of data that is about to flow from mobile phones whose apps have turned into our version of Star Trek’s ‘tricorder’. All this info will go into ‘the cloud’:
So we’re getting to the stage where all data is useful: so long as it is faithfully produced. Sadly, we know from PACE that data will have to be graded by association with researcher, and those who cannot be trusted will have their data discarded. There is nothing they can do about this: if their name is on their shoddy work, it will go nowhere, and all the data they collected will be wasted.
There lies the danger of MEGA: not that it will pollute the big data, but that any good data it contains will be at risk of being discarded by everyone but Crawley and her associates. That is why patients should NOT let their data be associated with MEGA while Crawley is involved.
I think Steve has nailed it there, and as it seems unlikely that Prof Crawley will be willing to part company with MEGA, I still believe that we should sign the OMEGA (Opposing MEGA) petition to demonstrate our strength of feeling against the proposal as it stands. The original pro-MEGA petition has now been closed – perhaps because they realised that more people were taking their signatures off than were putting them on – but the OMEGA team are still promoting their counter petition. Here is their latest blog. Scroll to the end for the link to their petition or just click here.