From Tony Waldron, University College London
Charles Shepherd asks for an objective position to be taken on the aetiology of myalgic encephalomyelitis (ME) (4 April, p 22). Why are those who support ME reluctant to accept a psychological basis in some cases?
In my experience, the response from a patient to such a suggestion is either to say “I’m not making it up”, or to make a quick exit from the consulting room. Most of those who treat ME accept that symptoms can result from a number of different causes, including depression.
It is likely that in the survey Shepherd mentions, respondents are biased towards those who have not benefited from treatment. Shepherd makes much of the fact that more than half the respondents had found that cognitive behavioural therapy and graded exercise was either unhelpful or made them worse. It would be interesting to know what proportion were made worse rather than simply not helped. Is it not worthwhile that the other half of the respondents might have been made better? There is, after all, no other treatment that has any effect.
London, UK
