Trial By Error: Professor David’s Third Mis-Citation of Seminal Study of “Medically Unexplained Symptoms”

By David Tuller, DrPH

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I have recently blogged about the multiple mis-citations of a seminal study involving so-called “medically unexplained symptoms” (MUS). The 2010 study, Bermingham et al, found that the amount spent by the National Health Service on working-age people who were assessed as “somatising” accounted for around 10% of what was spent on that population. Since the study was published more than a decade ago, experts in MUS have routinely misrepresented it by asserting that these costs accounted for 10% of total NHS expenditures, in effect more than tripling their apparent financial impact.

The costs of addressing MUS have been cited regularly as a reason to increase psychological services for patients identified with the conditions that qualify for such a diagnosis. Under its current framework, the NHS’ Improving Access to Psychological Therapies program considers anyone with ME/CFS, irritable bowel syndrome and other ailments without a clear etiology to be suffering from MUS. That makes them all eligible to be shunted immediately from primary care to IAPT interventions, which are mostly variations on cognitive behavior therapy.

On April 17th, I wrote to Professor Anthony David, a neuroscientist at University College London. I was seeking information about why he hasn’t yet corrected this mistake in a paper of which he is the senior author–even though another paper he co-authored was corrected for the same mistake 18 months ago.

Professor David, an expert in the MUS field, was formerly at King’s College London, home to some of the leaders of the biopsychosocial ideological brigades. KCL luminary Professor Sir Simon Wessely is a co-author on the un-corrected paper. Another KCL scholar, Professor Trudie Chalder, was the senior author of the paper co-authored by Professor David and corrected in October, 2019, after I wrote to her and BMJ Open, the journal that published it.

Two days ago, I sent a follow-up note to Professor David after I was alerted by a smart observer to yet another paper of which he is the senior author that includes the same mis-citation. (This one also featured a misspelling–“Birmingham” instead of “Bermingham.”)  For Professor David, that’s three separate mis-citations of Bermingham et al–or at least that’s the number we know of.

I have not heard back from Professor David. Whether he responds or not, I do hope he follows through with quick corrections of the two uncorrected papers. And if he made the same mistake elsewhere, I hope he corrects those instances as well so I don’t have to bother pointing them out.

To be clear: I’m not suggesting that Professor David or anyone mis-cited Bermingham et al deliberately. I assume it happened unintentionally and, over the course of a decade, the false “fact” self-replicated in the literature because no one bothered to double-check it–or noticed that it was wrong if they did double-check it. And why would that be? Perhaps because the higher cost meshed nicely with the interests and perceptions of those mis-citing it in the first place. Confirmation bias at play.

This rote repetition of untrue information happens routinely in journalism. In this case, the dissemination of the inaccurate data point has the potential to impact public health policy, and perhaps it already has. Given the significance of the error, it seems fair to ask those who have made it to explain how it happened and why other claims they make should be taken at face value. Yet when asked that kind of question and others suggesting problems with their data or argumentation, members of this cohort of investigators have seemed to prefer to utter words like “harassment” than to provide reasonable and credible responses.

Below is my second letter to Professor David.


Dear Professor David–

I have noticed that a 2016 paper on which you were the senior author contains the same misstatement about Bermingham et al as the two more recent papers that I have already highlighted. The 2016 paper, “Medically unexplained visual loss in a specialist clinic: a retrospective case–control comparison,” was published in the Journal of the Neurological Sciences. I have cc’d the corresponding author on this e-mail, and again Vincent Racaniello, Columbia’s Higgins Professor of Microbiology and host of Virology Blog. (Incidentally, in the paper “Bermingham” is misspelled as “Birmingham.”)

The 2016 paper includes this sentence: “In estimation of the associated health costs of medically unexplained symptoms, Birmingham [sic] & colleagues propose that healthcare utilisation amounts to £3billion per annum, or 10% of total NHS expenditure.” Clearly, this needs to be corrected, since the figure actually represented 10% of NHS expenditures for the working-age population and only about 3% of “total” NHS expenditures. 

For what it’s worth, the title of Bermingham et al itself specifies the age parameters of the study population, so the repetition of this false information across a decade continues to mystify me. Any explanation you might offer to help me understand this phenomenon would be much appreciated.

Thanks for your quick attention to this matter. I look forward to seeing the corrections in both this paper and the more recent one in Psychological Medicine


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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