Trial By Error: My Letter to Professor Anthony David Asks Why MUS Experts Keep Misquoting a Major Study

By David Tuller, DrPH

Earlier this week, I wrote to the journal Psychological Medicine about a significant mistake in a paper on functional neurological disorders. The mistake involved a misquotation of Bermingham et al, a key 2010 analysis of the National Health Service costs associated with care for working-age people found to be “somatising.” One of Psychological Medicine‘s two editors-in-chief, Professor Robin Murray of King’s College London, responded promptly and indicated that he was checking with the authors about the matter.

I subsequently followed up with Professor Murray to point out that the senior author of the paper was also co-author of another paper that had been corrected for the same mistake in October, 2019. He again responded promptly and indicated that he would check on it.

In the meantime, today I sent the following to Professor Anthony David, a neuropsychiatrist and the senior author of the Psychological Medicine paper. He previously was at KCL, along with Professor Murray and a co-author of the paper in question, Professor Sir Simon Wessely. Professor David is now at University College London.


Dear Professor David–

As you are likely aware, I have approached Psychological Medicine about a mistake in O’Connell et al, an article for which you are the senior author. (Other co-authors are Professor Tim Nicholson and Professor Sir Simon Wessely.)

The article is called “Characteristics of patients with motor functional neurological disorder in a large UK mental health service: a case-control study.”  In communicating with the journal, I also noted that another paper on which you were a co-author was corrected for the exact same mistake 18 months ago.

In addition to seeking the correction, I am reporting on the issue for Virology Blog, so I am reaching out to you directly to see if you would like to offer any comments about what happened. (I have cc’d my colleague Vincent Racaniello, Higgins Professor of Microbiology at Columbia, who hosts Virology Blog.)

In brief: In 2010, Bermingham et al reported that the costs of care for working-age people who were purportedly “somatising” accounted for 10% of National Health Service spending for working-age people. Many subsequent papers about so-called “medically unexplained symptoms” (MUS) or “persistent physical symptoms” (PPS) have garbled that statistic, declaring instead that these costs represent 10% of total NHS spending. In fact, they represented about 3% of total NHS spending in the year covered in Bermingham et al.

Any data point about NHS costs has possible policy implications–even more so when a mistake has the effect of tripling the apparent impact, as this mistake does. Certainly the false budgetary claim would seem to bolster an argument for the expansion of specialized services supposedly effective in treating MUS/PPS (i.e. cognitive behavior therapy and related approaches). That is generally the position of those disseminating the false claim in the first place.  

Here are my questions:

Were you aware that another paper you co-authored was corrected for this same misrepresentation of Bermingham et al in October, 2019? If not, why not? 

If so, why didn’t you move to correct O’Connell et al? In the forthcoming correction, will you take responsibility for this 18-month delay since the same false claim was corrected in your other paper? 

Why do you think so many investigators in the MUS field have repeated this false claim in paper after paper across a decade? If thought leaders in this domain can spend years collectively misquoting a seminal paper in their area of expertise, should that raise concerns about their overall scientific literacy and about whether they are basing other assertions about MUS on similarly distorted, misunderstood or biased data? 

Thanks very much. I will of course include any comment or explanation you choose to offer, at any length, in a post on Virology Blog. In the meantime, I also look forward to hearing back from Professor Murray about the timing of the correction itself.


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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