Professor Trudie Chalder of King’s College London, co-author of widely debunked PACE trial and Director of the Persistent Physical Symptom Service at South London and Maudsley NHS Trust, gives dangerous advice, ignorant of pertinent clinical knowledge, and presents trial findings in a misleading manner in a webinar on Long Covid that is now removed from medical education websites
Doctors with M.E. support Health Education England’s intervention and scientific rigour to protect Long Covid patients by removing a medical education video promoting biased and outdated psychological theories. We also recognise the British Thoracic Society’s foresight in removing the link to this erroneous material.
In November 2020 the PHOSP-COVID Study group hosted a training event on Long Covid. The webinar was subsequently made available on Health Education England’s training platform eLearning for Health (eLfH), a source of continuing professional development for health care professionals, as well as the British Thoracic Society’s website. This has now been removed from both sites following a letter led by Doctors with M.E. Associate and Long Covid sufferer Dr. Shaun Peter Qureshi, and signed by a large group of doctors with Long Covid as well as other health care professionals who were concerned by its content. The general public had also become aware of this webinar and patients with Long Covid were expressing their distress at its offensive content on social media.
…a patient’s deterioration in health and decline in function was dismissed as “an extreme behavioural response” linked to health anxiety.
The webinar showcased clear case examples of patients with Long Covid experiencing Post Exertional Malaise (PEM) / Post Exertional Symptom Exacerbation (PESE). This important hallmark symptom was not recognised. Instead, a patient’s deterioration in health and decline in function was dismissed as “an extreme behavioural response” linked to health anxiety, rather than an exacerbation of illness as a result of physical effort. Exercise was promoted as a beneficial intervention, even for a woman who had suffered two weeks in bed after undertaking a short walking test.
The webinar featured Prof. Trudie Chalder, Professor of Cognitive Behavioural Psychotherapy at the Institute of Psychiatry Psychology & Neuroscience, King’s College London, and principal investigator in the widely debunked PACE trial. She is also Director of the Persistent Physical Symptom Service at South London and Maudsley NHS trust, and a longstanding proponent of belief systems that insist upon psychological treatments such as CBT and graded exercise for certain long-term conditions including ME/CFS.
Prof. Chalder was asked to offer insights into a Long Covid patient’s severe relapse after an exercise test. The Professor’s focus was not on the disease but on “what was going on in her life around the onset of the pandemic,” the patient’s expectations of herself and whether there was any history of somatic symptoms or anxiety. She surmised that the patient had “probably got quite a lot on at home with the children”, commented that “it sounds like she’s very, very health anxious,” and suggested addressing the patient’s fears along with increasing the amount of exercise that she undertook every week. She failed to offer any information on the well recognised symptom of Post Exertional Malaise or objective research on repeat cardiopulmonary exercise testing.
Worryingly, the patient’s deterioration after exercise testing was not deemed an adverse reaction, and Prof. Chalder went on to recommend Graded Exercise Therapy (GET).
This hallmark worsening of symptoms after physical or mental effort characterises ME/CFS and may also play a significant role in Long Covid. It is commonly ignored by proponents of belief systems that Prof. Chalder and her colleagues promote. Worryingly, the patient’s deterioration after exercise testing was not deemed an adverse reaction, and Prof. Chalder went on to recommend Graded Exercise Therapy (GET), even in the face of these adverse reactions to both the exercise test and the patient attempting to walk with her family. The Professor stated that exercise is “not damaging,” with no acknowledgement that patients can be temporarily or permanently harmed.
Prof. Chalder omitted the fact that at 12 months follow up, there was no statistically significant difference in fatigue between the two groups.
In addition, Prof. Chalder presented her research results in an incomplete and misleading manner. From the Candy et al (2004) study, which investigated the effect of a psycho-educational intervention on fatigue for patients recovering from infectious mononucleosis, she presented that at six months follow up, the intervention group was significantly less fatigued than the control group of usual care. The intervention centred on “a personalised strategy of graded time-targeted activity”. Prof. Chalder omitted the fact that at 12 months follow up, there was no statistically significant difference in fatigue between the two groups.
The removal of Prof. Chalder’s webinar from medical education websites reflects growing recognition by the international medical and scientific professions that patients with post-viral illnesses who experience Post Exertional Malaise, including ME/CFS and a subset of Long Covid patients, should not risk deterioration in their symptoms by exceeding their energy limits. Researchers in ME/CFS have long warned of the risks of over-exertion, having quantified a range of physiological abnormalities in this condition. In recognition of the large body of evidence demonstrating the dangers and harms of exercise in ME/CFS and post-viral illnesses with Post Exertional Malaise, the Mayo Clinic, NICE, the U.S. ME/CFS Clinician Coalition and the European Network on Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (EUROMENE) have all removed Graded Exercise Therapy (GET) as a recommended treatment for ME/CFS.
Doctors with M.E. are pleased by the response of Health Education England and the British Thoracic Society in removing this webinar. We hope this marks the first of many positive interventions to update medical education on ME/CFS.