By David Tuller, DrPH
Update: Not long after I posted this, I sent the following short follow-up note to Dr Jones and the others I’d cc-d:
Dear Dr Jones–
In re-reading my response to you, I noticed that I made an error in the third paragraph when I referred to the “Improving Access for Psychological Therapies” program. The proper name, of course, is “Improving Access to Psychological Therapies.” I apologize for the error. Although I doubt most people would have noticed this mistake, I felt I should be scrupulous in acknowledging and correcting it–especially since I am asking the British Journal of General Practice and Professor Chew-Graham to do the same.
As I have reported, I recently sent a letter to the editor of the British Journal of General Practice. To my surprise, when I woke up this morning I had an e-mail from him. Below is that e-mail, followed by my response.
Dear Dr Tuller
If you are certain that a correction would be of any value €“ the data are a decade old now – please let me have one or two short sentences that you would like us to publish, for consideration.
Professor Roger Jones MA DM FRCP FRCGP FMedSci
Editor, British Journal of General Practice
Emeritus Professor of General Practice, King’s College, London
Dear Dr Jones–
Thank you for your quick response and for what I interpret as confirmation that my concerns about misinformation in the 2017 editorial by Professor Chew-Graham and co-authors are justified.
I am frankly surprised you would imply that a correction might not be warranted based on the age of the misquoted data. The British Journal of General Practice, which clinicians rely on for accurate information, published a self-evidently false statement that should have triggered questions from peer-reviewers and editors. While the data cited are ten years old, as you note, the editorial was published in 2017 and has the potential to impact health policy in the present–especially because Professor Chew-Graham and some of her colleagues in this field have repeated this flagrantly untrue claim in multiple publications and venues.
In the process, the fake meme that MUS accounts for around a tenth of the entire National Health Service budget has been transformed it into some sort of conventional wisdom. Most disturbingly, this “fact” has been consistently cited by those promoting the purported need to expand the National Health Service program called Improving Access for Psychological Therapies.
I presume you would agree that it is generally not optimal to base important public policy decisions on dramatically inflated cost estimates–especially public policy decisions involving access to health. So why would the British Journal of General Practice consider not ensuring accuracy in the published literature by correcting a false statement that it has disseminated, especially given the magnitude of the error and its implications for current public health policy? I find it a touch alarming that someone in your position of authority appears to be advancing the notion that corrections might not be warranted if data are ten years old. Can I therefore assume that the British Journal of General Practice observes a statute of limitations on errors related to the age of cited data and/or believes that old but inaccurate data is best left as is, even if recently cited?
As you know, the normal procedure for corrections would be for the journal, Professor Chew-Graham, and her co-authors to agree on a transparent and accurate statement that includes an explanation for how this error occurred and an apology for having made it. Have you consulted with Professor Chew-Graham on this matter? Although I cc-d her on the letter I sent to you, she has not responded to me. I have no idea if she and her co-authors even acknowledge their mistake. To be clear, I am not seeking to engage in published correspondence with Professor Chew-Graham, which is my interpretation of what you are suggesting in asking me to write one or two short sentences “for consideration.” I have no need to have a letter be “considered for” publication in the British Journal of General Practice. I am not interested in participating in a process in which I write a letter, the journal publishes it, and the authors respond while the paper itself remains uncorrected.
Therefore, I want you–and the authors, if they concur–to remove the false information and replace it with the actual figures from the cited study. As I noted, if the authors don’t concur, you must do this yourself. I also want the fact that this correction was made to be prominently highlighted, so anyone reading the editorial knows what was changed and when. You’re the editor of the British Journal of General Practice. I’m asking you to do your job. Clean up the mess your journal created when it published a false statement with potentially major public health policy implications.
What should the correction say?
First, the correction should obviously acknowledge that the published statement is false–that the amount spent on health care for members of the working-age population in England believed to have MUS, identified as £2.89 billion, did not represent around 11% of “total NHS spend.” Then it should provide the proper characterization of the salient data from Bermingham et al.
Second, the correction should provide some explanation for how this misreading of Bermingham et al occurred and why it was not noticed by anyone involved in the peer-review and publication process. The NHS budget in 2008/2009 was in the £100 billion range rather than the £30 billion range, so the discrepancy would have been discovered had anyone bothered to check.
Third, the correction should include an explanation for why Professor Chew-Graham did not respond to this issue when I wrote her in January and informed her that I planned to seek a correction from the journal. Her failure to take action at that point certainly raises some troubling questions.
Fourth, the correction should include an apology for this misstatement of the reported economic impact of so-called MUS, given the potential public health policy implications.
Since your journal has actively propagated false but possibly impactful public health information, I would also urge you to invite a guest editorial–from me and/or others–exploring how and why Professor Chew-Graham and others regarded as leaders in this domain of medicine have been so consistently wrong in their readings of Bermingham et al. These eminent physicians and researchers apparently have a hard time interpreting financial data from a seminal study about an issue–MUS–on which they claim to have special expertise. Given this demonstrated incompetence in the domain of scientific literacy, these “experts” need to provide convincing reasons for why, going forward, anyone should trust or pay attention to their perspectives on major health policy issues–such as the declared importance of expanding the Improving Access to Psychological Therapies program.
Because Professor Chew-Graham and her colleagues have routinely disseminated misinformation while promoting their preferred policy prescriptions, I believe this matter needs to be addressed as publicly as possible to ensure accountability. As with my initial letter to you, I am therefore cc-ing my response to the physicians involved with the development of the new guidance for ME/CFS at the National Institute for Health and Care Excellence, along with the primary author of Bermingham et al. These individuals do not seem to have been cc-d on your e-mail to me.
I am adding in three member of Parliament who have been especially concerned about the low quality of the research in the domain of ME/CFS; I am also cc-ing a couple of parliamentary aides. Given the claimed linkages between MUS and ME/CFS by those promoting the Improving Access to Psychological Therapies program, it is important that key policy-makers understand how proponents have made distorted economic claims in the British Journal of General Practice as well as many other venues.
Thanks again for your prompt response. I look forward to further details about how you, Professor Chew-Graham and her co-authors plan to quickly correct the false statement about MUS costs in the 2017 editorial in British Journal of General Practice.
David Tuller, DrPH
Senior Fellow in Public Health and Journalism
Center for Global Public Health
School of Public Health
University of California, Berkeley