Trial By Error: More Letters about Professor Anthony David’s Mis-Citations of Key Study on Costs of MUS

By David Tuller, DrPH

I have been in correspondence with the journal Psychological Medicine in my efforts to get it to correct an undisputed factual era related to the cost of so-called “medically unexplained symptoms” (MUS). After three weeks, the journal’s co-editor-in-chief, Professor Robin Murray, finally alerted me on May 4th that the authors “have agreed” to a correction–as if they were making a concession to me rather than ensuring the accuracy of the medical literature.

I responded to Professor Murray, and also followed up with Professor Anthony David, the senior author of the Psychological Medicine paper. I had already written to Professor Anthony to let him know I had seen the same exact mistake in another paper of which he was the senior author, this one published in 2016 by the Journal of the Neurological Sciences. In my follow-up to him, I reminded him about this additional problem and asked him to alert me as to whether he had initiated the same correction in that journal as well. Since I hadn’t heard back by this morning, I have written to editors at the Journal of the Neurological Sciences to inform them that Professor David’s 2016 study needs to be corrected.

I have posted all these letters below.


Psychological Medicine’s letter to me (May 4th)

Dear Mr Tuller,

The authors have agreed to publish a correction of this sentence.

Sir Robin Murray, FRS
Professor of Psychiatric Research
Institute of Psychiatry, Psychology and Neuroscience
King’s College
De Crespigny Park
London SE5 8AF
Consultant Psychiatrist
Psychosis Unit
South London and Maudsley NHS Trust


My letter to Psychological Medicine (May 4th)

Dear Robin–

Thanks for the update. It is perplexing that it took three weeks for the authors to decide what to do about a sentence that clearly included a false statement about the cost of “somatising” patients to the National Health Service. The discussion should have taken a few minutes at most. In any event. I’m glad they came to the right decision after their lengthy deliberations.

I hope Professor David also plans to correct this error in the other paper for which he was a senior author. Perhaps now he and his colleagues will be more careful when citing Bermingham et al, given the impact such inflated figures can have on core policy-making activities. The proliferation of this false claim about the costs of somatization in papers written by experts in the field is an excellent example of how “fake news” becomes perceived as true when people in authority keep repeating it. That this has continued for a decade indicates a rather breathtaking degree of carelessness among the self-styled leaders in this domain, including the authors of this paper.


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


My letter to Professor Anthony David (May 4th)

Dear Professor David–

I was pleased to hear from Professor Murray that after lengthy deliberations you and your colleagues have agreed to correct the false statement in the paper published in Psychological Medicine. I’m not sure why it took three weeks to reach this inevitable decision given the obviousness of the untruthfulness of the claim, but that’s a mystery for another day. 

Can you also confirm that you have initiated the same correction in the other paper for which you are senior author? As a reminder, that is the 2016 paper on medically unexplained visual loss that appeared in the Journal of the Neurological Sciences. If you would prefer, I can write to the editor directly, as I did with Professor Murray, and initiate the correction that way. Please advise how you would prefer to proceed. If I don’t hear back that this correction is in process, I will assume it is not and will contact the editor of the journal myself, cc-ing you and your co-authors.


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


My letter to editors at the Journal of the Neurological Sciences (May 11th)

Dear Professor England and Professor Villemarette-Pittman– 

I am a public health academic and investigative journalist at UC Berkeley. For the last few years, I have looked into some of the research on ME/CFS as well as so-called “medically unexplained symptoms” (MUS). Much of my work is published on Virology Blog, a science site hosted by Columbia University’s Vincent Racaniello, Higgins Professor of Microbiology.

In relation to MUS, a 2016 paper in the Journal of the Neurological Sciences“Medically unexplained visual loss in a specialist clinic: a retrospective case–control comparison”–features a significant mis-citation of Bermingham et al, a 2010 study. The article in your journal 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 [National Health Service] expenditure.” 

In reality, Bermingham et al reported that the costs of care for working-age people who were purportedly “somatising” accounted for 10% of NHS spending on care for working-age people. Many subsequent articles about MUS have mangled and inflated that statistic, declaring instead that these costs represent 10% of overall NHS spending. In fact, they represented about 3% of overall NHS spending in the year covered in Bermingham et al. 

(The analysis and discussion in Bermingham et al are specifically about the costs to the English arm of the NHS; many of the references also fail to make that clear, but that is a separate issue.)

In Professor David’s case, a previous paper that he co-authored and that included the exact same mistake was corrected more than 18 months ago. Just last week, Psychological Medicine agreed to correct the mistake in another of Professor David’s papers after I brought the issue to the journal’s attention. 

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

During the course of my correspondence with Psychological Medicine, I came across the medically unexplained visual loss study in your journal–a third example of the same mistake in Professor David’s output. Last week, I alerted Professor David to the problem with this paper, requesting him to assure me that he had already contacted the journal to initiate a correction, or planned to. 

Since Professor David has not responded, I decided to contact the journal directly about the need for a correction. I have cc’d Professor David as well as Professor Racaniello. (For transparency, I will also post this letter on Virology Blog and social media.)

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

8 thoughts on “Trial By Error: More Letters about Professor Anthony David’s Mis-Citations of Key Study on Costs of MUS”

  1. I think I’ve lost the plot. How can there be cost estimates for “somatising” when there is no reliable evidence of its existence? I’m thinking that proving it exists would be the first step.

    It’s supposed to be caused by thinking the wrong thoughts, right? So far as we know, learned professors with long titles have failed to think the wrong thoughts and give themselves an illness. Meanwhile they insist that us ignorant patients do this all the time without even trying.

    Does that make our brains more powerful than learned professors’ brains?

  2. Perhaps the letter from Sir Robin Murray is indicative of what it takes to be a FRS these days? The lack of gratitude speaks volumes – to me it smacks of arrogance and pomposity.

    Jimells: I agree that this is all nonsense, but unfortunately it seems that a lot of people have already been persuaded that ‘somatizing’ exists, probably with as poor ‘evidence’ that has been used for everything else. It’s helpful, I think, to point out that, for whatever reason, the BPS crew don’t even manage to correctly relay the ‘evidence’ that their mates have concocted. This blog - – (see point 3), along with David’s previous blog -, look at the Bermingham et al paper more closely. The first one – the blog – notes that Wessely appears to have been scathing of the DSM and yet he seems happy to cite the Bermingham et al estimate that employed some prevalence rates in its calculation that had been determined using DSM definitions.

    David’s previous blog
    – is well worth reading on the subject of somatization. It is critical of the conflation of somatization with medically unexplained symptoms in the Bermingham et al paper:

    “In Bermingham et al, distinctions between the concepts of MUS and “somatisation” have essentially been erased. The first paragraph of the abstract addresses the prevalence and burden of “medically unexplained symptoms.” By the abstract’s second paragraph, the focus has switched, without explanation or comment, to the economic costs of what it refers to as somatisation. The paper notes that the unexplained symptoms “are thought to represent a somatic manifestation of psychological distress, or abnormal activation of sensory pathways.” This quick elision between MUS and somatisation is unwarranted.”

  3. What needs to be asked is why did Anthony David cite the Bermingham et al paper at all in a paper that was about a functional neurological disorder (FND)?

    His paper “Characteristics of patients with motor functional neurological disorder in a large UK mental health service: A case-control study” was clearly about motor functional neurological disorder. Anthony David is a member of the Medical Advisory Board of FND Action - Their website makes it clear that functional neurological symptoms should not be lumped in with medically unexplained symptoms (MUS) or referred to as MUS – see here - and here - . FND Action describes in the first link how harmful it can be for patients with FND to be placed in the MUS category. But the Bermingham et al paper (in conflating MUS and somatization) purports to be about the costs of MUS, not FND. So in the paper on motor functional neurological disorder, Anthony David appears to be doing exactly what the FND Action warns against – i.e. conflating FND with MUS. Either they’re the same thing or they’re not. If they’re not then surely any supposed costs of MUS shouldn’t apply to FND?

  4. Lady Shambles

    CT: ” Either they’re the same thing or they’re not. ” The trouble with lies is remembering them isn’t it? Keeping track of the misinformation as well as the disparate members of the BPS cabal, some of whom don’t seem to have received the latest memo, (letting cats out of all sorts of bags – CPL wouldn’t be impressed 😉 ), must be a complicated job to do. The naked emperor hasn’t quite got the control he used to have I’d argue. That’s a perilous position to be in when this devilish detail is being exposed.

    CT: your important point that they shouldn’t be conflating FND with MUS has also been made here
    - in relation to a video by Mark Edwards who is also on the Medical Advisory Board of the FND Action charity. What a confused bunch of people they appear to be!

  5. Lady Shambles: Thanks for pointing out that Mark Edwards appears to have done the same/fallen into the same self-made trap. With all due respect to you – what a shambles! This must be something to make all patients aware of on ME Awareness Day, especially those who’ve received a FND diagnosis or have had their ME diagnosis converted into a FND one having been given the impression that their doctors don’t think it’s all in their head! If Anthony David and Mark Edwards can reference the Bermingham et al paper in relation to functional neurological disorders then can we assume now that they DO believe that FND=MUS=somatization but that they’re not making this clear to their neurology patients?

  6. Lady Shambles

    CT- “If Anthony David and Mark Edwards can reference the Bermingham et al paper in relation to functional neurological disorders then can we assume now that they DO believe that FND=MUS=somatization but that they’re not making this clear to their neurology patients?” Well argued.

    Wrt the deceptive way these diagnoses are handed out, only recently have I witnessed a bizarre conversation on a social media platform where people with ME had been handed the ‘FND’ diagnosis, either instead of their ME diagnosis or in combination with it, and who rejected utterly the notion that this is essentially a diagnosis of a ‘psychosomatic’ disorder.
    Like you CT, I think it’s clear from the evidence trail produced by some of those neurologists who didn’t receive the “for heaven’s sake don’t publicly admit that FND is the same as ‘psychosomatic ” memo that your equation is very likely to be accurate. Which means that patients are being lied to. This is ‘grooming’ and this is ‘abuse’ in my opinion. It is completely dishonest.

    And yes it is a shambles.

  7. Lady Shambles: I don’t think it’s that they didn’t receive that meme. I think it’s that they need to relate FND to the Bermingham et al estimate to try to make their case for more funding – like in this 2017/18 UK parliamentary petition - that was seemingly set up by the FND Hope charity. The Bermingham et al estimate also featured in this UK parliamentary petition - that was apparently set up by FND Hope / FND Hope International in 2018 (see -

    Perhaps FND Action (that insists that MUS and FND mustn’t be conflated) and FND Hope are at odds with each other over this, but if that’s the case then Mark Edwards, Tim Nicholson and Jon Stone must presumably be at odds with themselves, since they appear to be on the medical advisory boards of both charities.

    I think an explanation is due from these charities and these ‘FND experts’.

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