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Review

The Updated NICE Guidance Exposed the Serious Flaws in CBT and Graded Exercise Therapy Trials for ME/CFS

1
Independent Researcher, 1096 HZ Amsterdam, The Netherlands
2
Independent Researcher, 30159 Hannover, Germany
*
Author to whom correspondence should be addressed.
Academic Editors: Raphael B. Stricker and Derek F. H. Pheby
Healthcare 2022, 10(5), 898; https://doi.org/10.3390/healthcare10050898
Received: 26 March 2022 / Revised: 27 April 2022 / Accepted: 9 May 2022 / Published: 12 May 2022
The British National Institute for Health and Care Excellence (NICE) recently published its updated guidelines for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). NICE concluded, after an extensive review of the literature, that graded exercise therapy (GET) is harmful and should not be used, and that cognitive behavioural therapy (CBT) is only an adjunctive and not a curative treatment. Leading proponents of the cognitive behavioural model (CBmodel) find it difficult to accept this paradigm shift. In, for example, an article in The Lancet, they try to argue that the new NICE guideline is based on ideology instead of science. In this article we reviewed the evidence they used to support their claims. Our analysis shows that the trials they used in support suffered from serious flaws which included badly designed control groups, relying on subjective primary outcomes in non-blinded studies, including patients in their trials who didn’t have the disease under investigation or had a self-limiting disease, selective reporting, outcome switching and making extensive endpoint changes, which created an overlap in entry and recovery criteria, using a post-hoc definition of recovery which included the severely ill, not publishing results that contradict their own conclusion, ignoring their own (objective) null effect, etc. The flaws in these trials all created a bias in favour of the interventions. Despite all these flaws, treatments that are said to lead to recovery in reality do not lead to objective improvement. Therefore, these studies do not support the claim that CBT and GET are effective treatments. Moreover, the arguments that are used to claim that NICE was wrong, in reality, highlight the absence of evidence for the safety and efficacy of CBT and GET and strengthen the decision by NICE to drop CBT and GET as curative treatments for ME/CFS. View Full-Text
Keywords: CFS; chronic fatigue syndrome; eminence-based medicine; evidence-based medicine; ME; NICE; post-infectious disease CFS; chronic fatigue syndrome; eminence-based medicine; evidence-based medicine; ME; NICE; post-infectious disease
MDPI and ACS Style

Vink, M.; Vink-Niese, A. The Updated NICE Guidance Exposed the Serious Flaws in CBT and Graded Exercise Therapy Trials for ME/CFS. Healthcare 2022, 10, 898. https://doi.org/10.3390/healthcare10050898

AMA Style

Vink M, Vink-Niese A. The Updated NICE Guidance Exposed the Serious Flaws in CBT and Graded Exercise Therapy Trials for ME/CFS. Healthcare. 2022; 10(5):898. https://doi.org/10.3390/healthcare10050898

Chicago/Turabian Style

Vink, Mark, and Alexandra Vink-Niese. 2022. "The Updated NICE Guidance Exposed the Serious Flaws in CBT and Graded Exercise Therapy Trials for ME/CFS" Healthcare 10, no. 5: 898. https://doi.org/10.3390/healthcare10050898

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