Trial By Error: My One-Sided Correspondence with Professor Crawley

By David Tuller, DrPH

Well, last week was certainly exciting! As I wrote on Wednesday, I was planning to post about Professor Esther Crawley’s SMILE trial. However, that plan changed when Sue Paterson, the University of Bristol’s director of legal services, e-mailed me what I guess was supposed to be a scary letter.

The letter pointedly cited the “close and valued collaborative relationship” between Bristol and Berkeley, which is of no concern to me and has zero relevance to the current situation. Then, in referencing “private and confidential communication” at “a senior level,” Ms. Paterson appeared to be making ominous insinuations about potential professional payback for my actions and behaviour toward Bristol personnel involved in ME/CFS research. (That would presumably be Professor Crawley.)

After receiving the letter, I decided it would be a good idea to review all my blog posts, as well as the various e-mails I had sent to Professor Crawley seeking her response to my concerns. My blog posts are available for anyone to read; I stand by all of them. As for my e-mails, I thought it would be a useful exercise in transparency and a helpful addition to the discussion to publish my entire correspondence with Professor Crawley so that others can adequately assess my actions and behaviour. (Correspondence implies an actual exchange, so the word is really a misnomer here. No matter how many times I tried to solicit Professor Crawley’s comments and explanations, she never replied.)

It is true that I have sometimes used sharp, snarky or sarcastic rhetoric to advance my case, in both my posts and my e-mails. I was under the impression that such approaches to argumentation were not yet outlawed in the U.K. If I am wrong, I am sure my good friends at Bristol will let me know. (Perhaps Ms. Paterson and Professor Crawley are unfamiliar with the wide range of verbal strategies available to experienced practitioners of the English language. If so, I suggest they read Jonathan Swift’s A Modest Proposal to acquaint themselves with the great British tradition of satire.)

First, however, let me once again repeat the offers I have made in multiple e-mails and blog posts. Although I have been falsely accused of egregious misconduct, I nonetheless renew my invitation to Professor Crawley to send me her evidence that anything I have written is libellous, that is, inaccurate. If she can document mistakes, I am happy to correct them. (In contrast, I will not correct my fact-based opinions, no matter how distasteful they are to Professor Crawley.) I also once again urge Professor Crawley to send me her comments about my criticisms, at whatever length, and I will post them on Virology Blog, the same venue where I purportedly libeled her.

I remain perplexed as to why she has consistently refused these offers. The only logical conclusion is that Professor Crawley is incapable of defending her methodological and ethical missteps in a robust debate. I am also at a loss as to why Bristol believes it is acceptable for faculty members to accuse other academics, or anyone–of libel and then refuse to provide any information that would support such a serious allegation.

A person accused of libel–in this instance, me–deserves an opportunity to correct any proven errors, undo any damage as much as possible, and apologize. Professor Crawley and Bristol have denied me that right. Instead, for reasons that escape me, Ms. Paterson appears to believe that sending me a threatening letter might be an effective way to shut me up. If that is indeed what she thinks, she is mistaken. Whatever her motives, her letter is way beyond the pale. I now find myself in the unusual position of having to point out the obvious: This is a very serious scientific and academic dispute, not an episode of The Sopranos.


Now let’s review the record. Unless I’ve overlooked something, I have sent ten e-mails to Professor Crawley. All of them are quoted in full below.

I first critiqued Professor Crawley’s research when I wrote a post about FITNET-NHS on November 22nd of last year. Among other points, I noted that the FITNET-NHS protocol seemed to disappear the NICE requirement that a diagnosis of the illness required the presence of post-exertional malaise as a core element of the fatigue itself. After my post appeared, in fact, Professor Crawley revised her protocol to explicitly include this NICE requirement. So perhaps she agreed that the proposal, as written, was inadequate and unclear. I received no credit from Professor Crawley for pointing out this major issue. (FITNET-NHS remains problematic for a multitude of other reasons.)

In any event, on November 23rd, I sent an e-mail to Professor Crawley inviting her to respond to the previous day’s post. (I referred to her at that time as Dr. Crawley. In the U.S., professor and doctor are titles that can often be used interchangeably, so it is not considered insulting to call someone doctor instead of professor. As I have since learned, that is not the practice in the U.K.)

Here is what I wrote:

Dear Dr. Crawley–I’m a lecturer in public health and journalism at Berkeley, and the academic coordinator of the university’s joint masters program in public health and journalism.

Since last fall, I’ve written extensively about the PACE trial, mostly for Virology Blog, a science site hosted by my colleague Vincent Racaniello, a microbiologist at Columbia. (I’ve cc’d Dr. Racaniello here.)

Yesterday, Virology Blog posted my critique of FITNET-NHS, along with the recent Pediatrics paper on prevalence of CFS and the Dutch FITNET trial. Here’s a link to my analysis:

Trial By Error, Continued: The New FITNET Trial for Kids

Given that I’ve expressed some serious concerns, it seems fair to offer you a chance to respond. If you wish to, you can send your response to Dr. Racaniello, and he’ll be happy to post it, along with my response to your response.

Best–David T.

It goes without saying that I did not hear back from Professor Crawley.


Over the next couple of weeks, I wrote two more posts that included critical commentary about Professor Crawley’s research and her unwarranted claims. On December 4th, I sent her another e-mail, again inviting her to respond:

Dear Dr. Crawley–Since I wrote you last, Virology Blog has posted two more blogs about your research and the Dutch research. 

I have continued to make serious charges about your work–including questioning why you have not published the data from the 2014 CMRC poster, which appears to provide substantive information about spontaneous “recovery” omitted from your Pediatrics paper, FITNET-NHS protocol, and other work. Why would you decide these data are not relevant to the argument you are making for more CBT and GET?

As usual, I checked my concerns with academic colleagues–biostats and epi folks, in particular. They uniformly agree with me about the poor quality of your research. However, I recognize that you and your colleagues undoubtedly feel differently.

That’s why I am again offering you the chance to respond on Virology Blog. In case you haven’t seen the two additional blogs, here they are:

Trial By Error, Continued: A Follow-Up Post on FITNET-NHS

Trial By Error, Continued: The Dutch Studies (Again!), and an Esther Crawley Bonus

Should you decide you want to respond, simply send your response to Dr. Racaniello. He will then give me a chance to respond, and will post both your response and my response to it.

Please don’t accuse me of being “vexatious” or something similar, as your PACE colleagues have done repeatedly when people have legitimately questioned their methodology and asked very reasonable questions. I am not a vexatious person. I just believe in honest science.

Best, David

Again, I received no response.


In mid-December of last year, I came to the U.K. for a month to continue my investigation. Despite Professor Crawley’s refusal to respond to my earlier e-mails, I was interested in interviewing her in person. I wanted to talk about the reanalyses of the PACE data. These reanalyses definitively demonstrated that PACE was not, in fact, a great, great study, as she had claimed in an interview. I also wanted to ask her about the issue of parents being threatened with custody proceedings if they refused to let their sick children be forced to exercise.

On December 19th, I sent Professor Crawley an e-mail with the following subject line: “comment for stories?” Here’s what I wrote:

Dear Dr. Crawley–I’m writing a short piece for Undark, an MIT-based magazine, about the reanalysis of the PACE recovery data that was published last week. The paper, as you likely know, documents how the authors’ decision to weaken all four of the outcome criteria allowed them to maximize their purported “recovery” rates.

The reanalysis, of course, showed that they had null findings per their own original “recovery” definition, which they changed with no approval from the various PACE oversight committees and without the required sensitivity analyses to demonstrate the impact of the dramatic changes.

As you know, I don’t think much of the trial, or any of the other studies focused on CBT and GET, including yours. However, in fairness, it would be good to quote someone–anyone–in defense of the trial. The PACE authors have never been willing to answer any of my questions directly–their answers are evasive and non-responsive to the concerns raised, despite their repeated claims of having answered all in full. Since you apparently continue to believe that PACE is a “great, great trial,” despite all the evidence to the contrary, I thought you might want to defend the 2013 “recovery” paper.

If you send me a quote in defense of the dramatic outcome-switching and the decision to not include sensitivity analyses and why these actions do not disqualify their recovery paper, I will try to make room for it, although no guarantees. Perhaps you can also defend how it’s possible to be “recovered” (or “within normal range”) and on the two primary outcomes at baseline, before any treatment at all. Frankly, I continue to be perplexed at how a “great, great trial” can have outcome measures representing worse health than entry criteria. But maybe that’s just because of my cynical and snarky American attitude. (I do, by the way, apologize for the horrible president-elect my country has now inflicted on you and the rest of the world.)

I’m also working on a piece about families threatened with child custody proceedings because they won’t allow their children to be “exercised” and “CBT’d,” since they know that GET can make their kids much worse. As the UK’s leading pediatric voice on ME/CFS and a proponent of this approach, your name often pops up in my interviews, so of course I’d like to speak with you about this issue. I am currently in the UK until Jan 12th to do my reporting and also avoid for a period my own country’s political disaster, so please advise if there’s a time for us to talk and/or meet.

Of course, I’d be happy to come to Bristol to hear your explanation of why PACE remains a “great, great trial.” I’m also interested in hearing how studies in which the comparison group is “waiting list”–a specialty of your Dutch FITNET colleagues–can be taken as proof of the effectiveness of CBT. And of course, I’m very interested in why you have not published the data included in the poster from the CMRC 2014 gathering, why you believe reports of “chronic fatigue” can lead to a diagnosis of chronic fatigue syndrome, and why you misrepresented the results of the reanalyses in your BBC interview, as I explained in one of the blog posts I sent you.

Thanks much!

Best, David

Once again, no response. (Actually, I received an auto-response indicating that Professor Crawley would be away till January 3rd, 2017. But that doesn’t count.)


Early in 2017, the CMRC’s MEGA project, spearheaded by Professor Crawley, failed in its bid to obtain funding from Wellcome. I planned to write about this, so on April 5th I sent Professor Crawley the following e-mail:

Dear Dr. Crawley–I’m going to include information about Wellcome’s rejection of the MEGA grant application in an upcoming post on Virology Blog. I have a few questions: 

Why do you think they turned down the MEGA proposal? Do you think the reviewers thought it might be replicating what the UK biobank group has been doing for years, without sufficient justification? Or do you think reviewers might have become aware of the international controversy over the indefensible flaws of the PACE trial, raising concerns about continued claims that it is “a great, great trial”? Or do you think there might be another reason?

Let me know if there’s a good time to talk, or feel free to e-mail any responses. And good luck with future grant applications!–

Best, David

I received another auto-response, this one with the following message: “I am away until Thursday the 6th of April and there will therefore be a delay in answering your emails.” The message did not suggest that the delay would be permanent.


After that, I had no further plans to contact Professor Crawley, since it was obviously a waste of my time. Then she decided to slander me in public. I was flabbergasted when I first saw the slide in which she indicated that my post about FITNET-NHS was a libellous blog, especially since she had rejected my invitation to respond and outline any issues she had. The slide went public after it was live-tweeted during her talk to a nephrology conference. (Later, it turned out that she had also used the slide during what was likely one of the high points of her career to date–her inaugural lecture at Bristol.)

Before I posted a response to her false claim, I sent an e-mail on April 29th with the following subject line: your silly accusation that I am writing ‘libellous blogs.’

Here’s what I wrote:

Dear Dr. Crawley–

I was surprised to find myself accused of writing libelous blogs, and my colleague Dr. Racaniello at Columbia, who hosts Virology Blog, of publishing libelous material. This is the post that appeared in the slide you presented at the renal society conference:

Trial By Error, Continued: The New FITNET Trial for Kids

I am currently writing a Virology Blog post refuting your claim. I am happy to offer you the opportunity to write a statement explaining why that post, or any of my posts about your research, are libelous. I will post it as you send it. I will respond to it, of course, but I won’t cut it or edit it down. If you identify factual inaccuracies, of course I will correct any such errors.

Libel, of course, involves inaccuracies, not opinions you dislike. If something is accurate, it is not libel. There is nothing inaccurate in my description of your Pediatrics paper, your FITNET-NHS protocol, or the Dutch research. The PACE authors made the same claim–that I was purveying “misinformation.” It turned out they just didn’t like my interpretation, as a UC Berkeley public health professional, of the facts I had documented. The same applies here.

I certainly can understand why you hate my conclusions and interpretations and my manner of expressing my opinions. I can also understand that it is upsetting to have many dozens of top scientists and clinicians from Berkeley, Harvard, Columbia, Stanford and elsewhere publicly slam in harsh terms the study you have recently endorsed as “a great, great trial.”

But none of that justifies calling my work “libelous.” –You should be more careful about flinging such serious charges at other scientists and researchers. Is everyone who signed the open letters also libelous?

Please respond by Monday if you would like me to include a comment from you.–

Best, David


That e-mail elicited yet another auto-response, indicating that Professor Crawley would be away until May 2nd. I also learned that Monday, May 1st, was a bank holiday in the U.K. So on April 30th I sent a follow-up, offering to delay posting my blog about her libel accusation in order to give her more time to respond:

Dear Dr. Crawley–Since I wrote my previous e-mail, I have been apprised of the bank holiday in U.K. I’ll plan to post my response to your charge that my blogs are libelous on Wednesday instead of Tuesday, in case you want to send in a statement or explanation for your accusation that Dr. Racaniello and I have libeled you.–

Best, David

No response. (For some reason, I do not seem to have received the auto-response about her short-term absence; if I did, I can’t find it now.)


At that point, I also began sending e-mails to members of the executive committee of the CFS/ME Research Collaborative, asking them to take a position on Professor Crawley’s libel accusation, since she served as deputy chair of the group. Given the lack of response from either Professor Crawley or anyone else on the CMRC executive committee, I decided to write a follow-up post. Before doing so, I wrote to Professor Crawley on May 6th, once again inviting her to explain her position.

Dear Dr. Crawley–

Since I didn’t hear from you about any documented inaccuracies in my blog post about FITNET, or other blog posts, I am interpreting that as your acknowledgement that there were no inaccuracies to correct. As a corollary of that, I am also taking it as your acknowledgement that the charge of libel was false, and that the opinions I have expressed, while unpleasant to you, were fair comment and not libelous.

I have no reason to think that this was the first time you have used that slide in public. I assume it’s just the first time you were live-tweeted, so everyone. But since I have no evidence that you have used it in public previously, I am going to pretend to believe that it is the first time. I do expect it to be the last.

Although making false claims of libel is obviously defamatory and possibly actionable, I have decided not to pursue legal action, as I told the CMRC board. I do think a public apology is in order, given that you have made a false and reckless charge that impugns my professional integrity and reputation.

In addition to the CMRC board, I have written to the British Renal Society, complaining about the decision to provide you with a platform to libel me. I will also be complaining to your university, when I get around to it.

Others have noted that you also apparently lifted a photo of a young woman without her permission, and appear to have advised medical professionals how to use alleged “vexatiousness” as a way to avoid their legal responsibilities to comply with FOI requests. You seem not to have noticed that the most recent decision, last year’s First-Tier Tribunal ruling, dismissed in scathing terms the claim that the request was vexatious.

The “vexatious” meme is very 2015. It worked for your PACE colleagues for a number of years, but it doesn’t work anymore. Now that it’s clear the PACE trial had disastrous results for “improvement” and “recovery” before the investigators engaged in rampant outcome-switching, people see past the charge of “vexatiousness” and know that it’s nonsense–at least, the court did, which is what matters. Invoking the argument just makes you look like you’re fighting a desperate rear-guard action–which I guess you essentially are.

I am writing a follow-up blog post about this incident, and the responsibility for the CMRC to address this whole mess as well. It should be posted early next week. I would still welcome either documented evidence of my libelous statements, or an explanation and apology for your false accusation. As I previously mentioned, I will post whatever you send, without edits or trims.-

Best, David

No response.


That follow-up blog post bore the following headline: An Open Letter to the Board of the CFS/ME Research Collaborative. After I posted it, I sent the link to Professor Crawley on May 8th. Here’s that e-mail:

Dear Dr. Crawley–

Although I’m now aware that you follow Virology Blog, I wanted to make sure you saw this latest post, as a courtesy. I have of course also sent it to your colleagues on the CMRC board:

Trial By Error, Continued: An Open Letter to the Board of the CFS/ME Research Collaborative

Best, David

No response.


I continued my efforts to elicit a comment from the CMRC’s executive committee about Professor Crawley’s libel accusation. Finally, Professor Stephen Holgate, the CMRC chair, issued a full-throated statement of support for Professor Crawley. I wrote a blog post about that, and on May 15th I sent the link to Professor Crawley. Once again, I invited her to point out any errors and offered to post her full response on Virology Blog.

Here’s what I wrote:

Dear Dr. Crawley–

This is my response to Dr. Holgate’s note expressing the “full support” of the board for your role with CMRC. Of course, I find his response inadequate and take it as an endorsement of your accusation of libel.

Trial By Error, Continued: The CMRC Affirms Full Support for Libelous Esther

Dr. Racaniello and I are still willing to post on Virology Blog your explanation for the accusation, any documentation or evidence you care to provide, or your apology for falsely making such a charge.

It must be upsetting to you that this talk was live-tweeted. I’m curious, of course, how many other times you have used that slide and accused me of libeling you at public events. Can you provide me with a number?


No response.


On May 18th, Professor Crawley gave a talk at a conference in Devon whose title jokingly referred to children suffering from “medically unexplained physical, psychological symptoms” as muppets. In the U.K., that word is considered a slur that means, according to the BBC, someone who’s stupid, gullible and incapable of independent thought. (In the U.S., the term generally refers only to Miss Piggy and her various puppet-friends; it is not considered an insult, as far as I know.)

By this point, I had complained to Ms. Paterson at Bristol University about Professor Crawley’s libel accusation. In my letter, which I posted on Virology Blog, I let Ms. Paterson know that I expected Professor Crawley to retire the offending slide. To reinforce the point that I would be very unhappy to learn that she had repeated her libel accusation in more presentations, I sent Professor Crawley an e-mail on May 19th. The subject line referenced the previous day’s talk at the muppets event. I again invited her to back up her libel complaint and provide a statement for posting on Virology Blog:

Dear Dr. Crawley–

I trust that in this new presentation the defamatory slide suggesting that I have written “libelous blogs” was not used, and that is has been retired permanently. — Of course, use of the term “muppets” was probably not the best idea, whoever thought of it.

I am working on a blog post about the responses of Action for ME and ME Research UK to the controversy around CMRC. Do you have any comments you’d like to offer on the situation? I’m still waiting for your explanation of the accusation of libel, documentation of your evidence, or an apology. I assume I will be waiting for a long, long time.

Best, David

That was the last time I e-mailed Professor Crawley. I had done my job in seeking her response. There was no point in further efforts to extract an explanation.


Now let’s take a look at other actions and behaviour that involved Professor Crawley, apart from my posts and my e-mails. I can think of two events to which Ms. Paterson might have been alluding.

The first was my talk at the Invest in ME conference on June 1st of this year. The video of that talk is readily available. During the talk, I tore up two PACE papers and one by Professor Crawley. That was her Pediatrics prevalence paper, which asserted that around two percent of 16-year-olds in the U.K. suffered from chronic fatigue syndrome. The paper clearly uses chronic fatigue as a proxy for chronic fatigue syndrome, without legitimate or adequate justification. Although the estimate is wildly inflated, Professor Crawley continues to cite this figure as authoritative.

Tearing up papers written by esteemed researchers might be unorthodox for an academic and offensive to Professor Crawley. But my action was certainly within bounds by recognizable standards of public comment, especially since my poor assessment of her work is backed by leading pediatricians and ME/CFS experts not affiliated with the CBT/GET ideological brigades.

The other behaviour to which Ms. Paterson might be referring was my appearance at Professor Crawley’s public talk at the University of Exeter on Nov 17th. Our exchange at the end of her remarks was captured on video. She interrupted me when I tried to ask a question and then attacked my work as defamatory, again without documenting any errors or mistakes. She also invoked the notion of consulting the police, suggesting to an academic audience that I had engaged in activities that posed a physical threat to her person and safety.

Understandably, I found these remarks to be unfair. However, the video of the exchange is very clear. I asked my question politely. When the moderator requested that I leave the room, I complied without any fuss or protest. I have no idea how Professor Crawey described our exchange to Bristol’s legal department. Ms. Paterson’s thuggish letter about my actions and behaviour suggests that the university might try to characterize my demeanor at this lecture, or perhaps even the fact that I showed up in the first place–as belligerent and aggressive. As the video clearly documents, such an interpretation would be at odds with the facts.

Given the length of this post, I will end here. If it seems warranted, I might also soon post my full correspondence with the CMRC about what I consider to be Professor Crawley’s own unacceptable actions and behaviour. Like my messages to Professor Crawley, these e-mails effectively demolish any claim that my response to being slandered in public has been inappropriate and beyond the bounds of acceptable discourse, no matter what Professor Crawley and her august institution maintain.

Your honor, the defense rests€¦at least until the next post.

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