Times article by Sean O'Neill 4/8/21

This is the text of the article "Experts quit over call to drop exercise as treatment for ME":

Bitter divisions in the medical profession over the debilitating condition myalgic encephalomyelitis (ME) have been laid bare by a spate of departures from the body reviewing its future treatment.

Four members of the National Institute for Health and Care Excellence (Nice) committee producing the treatment guidelines left just two weeks before publication of the document. Nice is expected to conclude that the NHS should no longer recommend a controversial exercise therapy for ME after patients said that exertion made their illness worse.

The conclusions have potential implications for the treatment of long Covid, which has similar symptoms to those associated with ME. Sufferers complain that they too are being told to follow exercise programmes that cause relapses.

The charity Action for ME said that its helpline was being inundated with long Covid patients seeking advice. It called for urgent biomedical research into the overlap between the conditions to avert a long-term public health crisis.

In draft guidance last year Nice said that graded exercise therapy should not be offered for ME, also known as chronic fatigue syndrome. It had been recommended in Nice guidance issued in 2007.

Nice also emphasised that another previously recommended treatment, cognitive behavioural therapy (CBT), should be seen as a supportive tool and “not a treatment or cure”.

Consultation on the draft guidance attracted 4,000 responses — an unusually high figure. Despite strong lobbying, it is expected the new guidance will advise against the use of graded exercise.

The BMJ, which first reported the resignations, said there was “an unusually high number of patient representatives [on the Nice committee] prompting suggestions this may have led to more weight being place on patient views than on published scientific evidence”.

However, only five of the 21 committee members were patient representatives, and the lengthy draft report showed clinical research advocating the use of exercise therapy and CBT had been subjected to intensive review and was judged to be of “low” or “very low” quality.

Three of those who left the committee — Michael Beadsworth, an infectious diseases consultant; Gabrielle Murphy, a former ME clinic leader; and Joanne Bond-Kendall, a senior physiotherapist — are understood to be concerned at the exclusion of exercise therapy as a treatment option.

The fourth resignation was that of Charles Shepherd, medical adviser to the ME Association, who was required to stand down after being accused of a conflict of interest by continuing to advise against exercise therapy.

One source said that the resignations were surprising because debate at the committee, while sometimes difficult, had been amicable and conducted without the need for votes.

“The review of the evidence has been very thorough with give and take on both sides of the debate, so the resignations are something of a shock,” said the source.