Trial By Error: My Letter to BMJ Open about False MUS Claim

By David Tuller, DrPH

And now again with BMJ Open. I have written many, many posts about my efforts to get this supposedly reputable journal to acknowledge the issues with Professor Crawley’s school absence study. I won’t recap that unfortunate matter in this post, except to note that I am still waiting for the results from a Bristol University investigation of that and a number of other papers from Professor Crawley’s team.

In any event, last week I sent Professor Trudie Chalder a letter about a mistake in the PRINCE trial protocol, which BMJ Open published in July. Today I sent a follow-up letter to Adrian Aldcroft, the editor-in-chief of the journal.


Dear Mr Aldcroft–

Last week, I sent a letter to Professor Trudie Chalder on which I cc’d you and several others. That letter concerned a major factual error in the first paragraph of the PRINCE trial protocol, which BMJ Open published in July. Specifically, the protocol falsely claimed that the estimated costs of treating so-called “medically unexplained symptoms” among the English working-age population accounted for around 10% of the total National Health Service budget. Instead, according to the cited study, Bermingham et al, these estimated costs accounted for around 10% of the amount the NHS spent on that specific age group.

I have not heard back as of yet from Professor Chalder. I am appealing to you directly, as editor-in-chief of BMJ Open, to ask how long it will take to correct this substantive error. Bermingham et al is not ambiguous. After I raised questions earlier this year with the British Journal of General Practice about the exact same untrue assertion in a 2017 editorial on MUS, the journal corrected it. This BJGP correction was posted before publication of the PRINCE protocol.

It is somewhat perplexing that none of the 13 protocol authors, nor any of those who reviewed it, noticed this prominent mistake. After all, Bermingham et al is a seminal study in the field, so one might expect those who present themselves as experts in MUS to be familiar with the core findings. Such an elemental misreading of key data should certainly raise concerns for you, as an editor, that perhaps the PRINCE investigators have made other protocol claims that are also not reliably based on the research being cited.

Mr Aldcroft, you are the editor-in-chief of BMJ Open. Ensuring that documented mistakes are corrected in a timely manner falls squarely within the scope of your responsibilities as a guardian of the integrity and accuracy of the medical literature. This factual error is not a matter for “letters to the editor” or for debate with the authors in published correspondence. To be blunt, you need to do your job and fix the problem, with or without the assent and participation of Professor Chalder and her colleagues. .

I have cc’d Professor Chalder and Sarah Bermingham, the lead author of Bermingham et al, as well as Dr Fiona Godlee, editorial director of BMJ. Given the implications of MUS research on the treatment available to patients diagnosed with CFS, CFS/ME, ME/CFS or ME, I am cc-ing as well other individuals cc-d on my letter to Professor Chalder–several involved with the NICE committee investigating new ME/CFS guidelines and three members of Parliament concerned about the poor quality of research into the illness. I am also cc-ing Professor Chris Ponting, vice-chair of the CFS/ME Research Collaborative.

I look forward to your quick response.


David Tuller, DrPH
Senior Fellow in Public Health and Journalism
Center for Global Public Health
School of Public Health
University of California, Berkeley

9 thoughts on “Trial By Error: My Letter to BMJ Open about False MUS Claim”

  1. Margaret Laverick

    Thank you for your persistence, it’s hard to believe how and why this continues. Do these people believe they are untouchable? Will they eventually be made to pay for the harm they have done?

  2. A quick response would be good, a slow response quite damning I think.

    But how did all 13 authors fail to pick this up? Did they read their own paper? And don’t they know what the total NHS budget is? What about Paul Mc Crone, Professor of Health Economics at KCL and Director of King’s Health Economics (KHE) ? Doesn’t he know?

  3. David, it’s such a ridiculous figure I assume it was intended to see what you can get away with in the BMJ. Perhaps for the next paper MUS will be 50% or 100% of the NHS budget. For context the annual drugs bill in the UK is about 14% of the NHS budget. It reminds me of the PACE trial SF 36 score saga. Thank you for calling them out as it’s clear no one at the BMJ is likely to do so.

  4. Just for the record, co-author Muj Husain managed to get it right in his March 2017 presentation about Persistent Physical Symptoms (PPS) and the PRINCE Trials (see page 140 of 184 of pdf of presentations entitled ‘Mind and body healthcare: delivering the vision’ from King’s Heath Partners).

  5. Thanks DW. Delivering the vision, huh? Well….I can see (more) clearly now Husain was wrong, (in the published protocol paper), and perhaps we can see at least some of the obstacles in our way? LOL.

  6. Apparently I’ve broken some social media convention in not making clear I was changing from ‘Couch Turnip’ to ‘CT’ above. I thought it was fairly obvious since I’ve been referred to as ‘CT’ in a reply or replies by other people before. But to make it abundantly clear, ‘Couch Turnip’ will now be commenting as ‘CT’. I heard that some people weren’t comfortable with the name ‘Couch Turnip’ and I don’t wish to offend anyone, but I will always be ‘Couch Turnip’ in my head, throwing the despicable opinions that the BPS lot appear to have of patients with ‘MUS’ back in their faces. (‘Turnip’ came from this inane paper by Stone and Carson -

  7. Dear BMJ,

    No matter how many times you close your eyes, tap your heels together, and chant “There’s no place like home”, you will not wake up in a land without ME patients and advocates calling you out for the harm you are causing.

    Get used to it: We. Are. Not. Going. Away.

  8. “Persistent Physical Symptoms (PPS) and the PRINCE Trials (see page 140 of 184 of pdf ”

    I would imagine the poor souls who had to listen to that 184 page presentation had PPS by the end: rigor mortis! Good grief these people don’t half milk it! :/

  9. Husain was apparently aware of what the Bermingham et al study had found, and yet he co-authored a paper with this misleading error on the key issue of the cost of MUS. Does he have a very poor memory? Did he not read or check over the paper before it as submitted? But he’s not the first to do this – Carolyn Chew-Graham and Simon Heyland got the information right in the JCPMH MUS guidance that they co-chaired/co-wrote (published February 2017) but wrong in the BJGP paper entitled “Medically unexplained symptoms: continuing challenges for primary care” published in March 2017. ‘Continuing challenges’, yep, I’d go along with that. Marta Buszewicz, who co-authored the BJGP paper, was part of the expert reference group for the JCPMH MUS guidance and also co-authored a paper entitled “How do hospital doctors manage patients with medically unexplained symptoms: a qualitative study of physicians” (published before the BJGP paper). Both of these relayed the information correctly, so why didn’t she flag up the error (in the BJGP article) to her co-authors?

    When I as at uni (quite a long time ago), professors were considered experts in their fields and were expected to know the detail of the related literature inside out. By my count, 4 of the co-authors of the PRINCE protocol are professors. I mentioned Paul McCrone, Professor of Health Economics at KCL and Director of King’s Health Economics, in my comment above. For several years ending 2016, Professor Moss-Morris was National Clinical Advisor to NHS England for IAPT for people with long-term and medically unexplained conditions’ (LTC and MUS), so she had plenty of time to get her head around the contents of the Bermingham et al paper. As well as being Professor of General Hospital Psychiatry at the IoPPN, Professor Hotopf is also Director of the South London and Maudsley NHS Foundation Trust National Institute of Health Research (NIHR) Biomedical Research Centre (BRC) . You’d have thought that he’d have been more thorough/careful. Professor Chalder is Professor of Cognitive Behavioural Therapy at KCL. What can I say? Is this was CBT does to you?

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