Trial By Error: A Letter to Psychological Medicine about Error in MUS Paper from Sir Simon and Colleagues

By David Tuller, DrPH

I have previously documented that some of the leading experts in €œmedically unexplained symptoms€ (MUS) have regularly misstated a core finding from a seminal study in their field. The study, “The cost of somatisation among the working-age population in England for the year 2008€“2009€, was published in 2010 in the journal Mental Health in Family Practice.

The same mistake has been repeated in journal after journal, and at least a couple of these instances have been corrected. It has recently been brought to my attention by a shrewd observer that the venerable journal Psychological Medicine published one such study two years ago, with Professor Sir Simon Wessely as a co-author.

Psychological Medicine is the journal that, in 2013, published the infamous PACE trial €œrecovery€ paper, in which participants could get worse on the two primary measures and still be counted as €œrecovered.€ At that time, the journal’s editors-in-chief, Professor Robin Murray from King’s College London, and Professor Kenneth Kendler at Virginia Commonwealth University–refused to acknowledge the paper’s methodological and ethical lapses.

In March of 2017, Virology Blog sent an open letter to the journal requesting retraction of the paper. More than 100 scientists, clinicians, and other experts signed the letter. The journal ignored it. Perhaps relevant to that decision was the fact that PACE lead investigator Professor Michael Sharpe is on the journal’s editorial board. For that matter, so is Sir Simon, who is also a King’s College London colleague of one of the journal’s two top editors, Professor Murray.

Given these links, and judging by the problematic results, it is easy to believe that the Psychological Medicine peer review process for papers from authors viewed as eminent is less than rigorous. Anyway, below is the letter I sent yesterday to Psychological Medicine.


Dear Professors Murray and Kendler:

There is a serious factual error in a 2020 paper (epub 2019) published by Psychological Medicine called “Characteristics of patients with motor functional neurological disorder in a large UK mental health service: a case-control study.” The authors are O’Connell, Nicholson, Wessely, & David. 

In their introduction, the authors misstated the core finding of Bermingham et al, a seminal study in their field. They included this sentence: “Bermingham et al. (2010) reported that the incremental cost incurred by somatising patients is £3 billion per year, accounting for 10% of total NHS expenditure.”

This is definitely not what Bermingham et al reported. In fact, Bermingham et al reported that the costs of treating working-age patients assessed to be “somatising” accounted for 10% of NHS expenditures for people of working age–not for the overall populatio. For the year studied in Bermingham et al, total NHS expenditures were around £!00 billion–not the £30 billion implied by O’Connell et al in declaring that £3 billion represented 10% of the total. The statement in O’Connell et al had the obvious but unfortunate effect of more than tripling the apparent impact of the costs of these patients to the NHS.

Other experts in “medically unexplained symptoms” (MUS) have similarly cited Bermingham et al inaccurately. Both the British Journal of General Practice and BMJ Open have acceded to requests that the exact same error in papers they published be corrected (see here and here). That some of the most eminent scholars in the MUS field have made this significant mistake in multiple publications over the course of a decade is rather perplexing, as is the repeated failure of the peer review process at multiple journals to catch it.

I am writing to you directly because this does not seem to be a matter for correspondence or for an exchange of views with the authors. The statement about Bermingham et al is false and needs to be corrected. 

I have cc’d the corresponding author on this message. I have also cc’d the primary author of the mis-quoted study, Bermingham et al, in case there is any confusion over the meaning of the data.

Thank you for your prompt attention to this matter. 


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

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