Trial By Error: If Professor Crawley’s ACT Study Was Peer Reviewed, Where Are the Peer Reviews?

By David Tuller, DrPH

Yesterday, I wrote a blog about a just-published but already out-dated conference abstract from a team led by Professor Esther Crawley, Bristol University’s methodologically and ethically challenged pediatrician and grant magnet. After I tweeted about it, I heard from Naomi Harvey, a zoologist, who said she’d written to BJPsychOpen about the abstract’s flaws. Hopefully, she—and any others who alerted the journal–will receive an adequate response.

My exchange with Dr Harvey prompted me to look again at the 2021 study (Clery et al) from which the conference abstract seems to have been drawn. Clery et al, published by BMJ Paediatrics Open, was called “Qualitative study of the acceptability and feasibility of acceptance and commitment therapy for adolescents with chronic fatigue syndrome.” (BMJ Paediatrics Open describes itself as “an official journal of the Royal College of Paediatrics and Child Health.” Just to be clear; the RCPCH is a trade union that, like any trade union, promotes and protects the financial, political and professional interests of its members.)

The timing of the publication of Clery et al is curious.  It was posted in early October of last year. The article’s second reference is to a 2007 NICE guidance on what the agency then called CFS/ME. The link for the 2007 guidance, according to the reference, was accessed in March, 2021. That was after NICE published the draft of the new ME/CFS guidance, which happened in November, 2020.

At the time it published the draft version, NICE was planning to release the final document in April, 2021. But publication was delayed twice amid controversy and an onslaught of public comment and media debate on the draft. Meanwhile, BMJ Paediatrics Open received the Cleary et al manuscript on April 20, accepted it on July 17 and posted it online October 1. NICE ended up publishing the final ME/CFS guidance at the end of October.

BMJ Paediatrics Open has a policy of posting links to the peer reviews of research articles, along with investigators’ responses, on an article’s “article info” page. These links are referred to as “previous versions” and “review history” and are listed under the heading “Publication History.” But the “article info” page for Clery et al does not feature such links under Publication History—just the dates the article was received, accepted and published.

Curious and curiouser. So “Qualitative study of the acceptability and feasibility of acceptance and commitment therapy for adolescents with chronic fatigue syndrome” wasn’t peer-reviewed? If that’s the case, what is BMJ Paediatrics Open’s policy for exempting research from peer review? Or was the article in fact peer reviewed, and the peer reviews haven’t been posted because of oversight lapses, technological glitches, or some other reason?

Professor Crawley has been a prolific producer of articles for BMJ journals, among others. But she has been asked to correct more than 10 papers, including several in major BMJ journals, because of ethical and methodological violation in her work.

The crown jewel of Professor Crawley’s impressive collection of corrections is the one appended to her 2017 (first online publication) study of the Lightning Process, published by BMJ’s Archives of Disease in Childhood. This correction is really long—it ran to 3,000 words. That’s like the War and Peace of corrections. An accompanying 1,000-word editor’s note provided a tortured justification for republishing the study rather than retracting it.

In fact, the conduct and reporting of the Lightning Process research were clear examples of serious research misconduct at best, and a lot worse at worst—in my opinion. So who knows what kinds of errors or missteps might appear in other work from Professor Crawley?

Which brings us back to the initial point. Was this study in BMJ Paediatrics Open peer reviewed? If so, where is the peer review history? If it wasn’t peer reviewed, why wasn’t it?

Given the past, it would seem wise for journals to subject any article in which Professor Crawley has played any role to the most rigorous level of vetting. At the very least, an outside reviewer might have suggested that an article submitted to BMJ Paediatrics Open about ME/CFS during this particular time frame should have included a mention of the draft NICE review and its possible implications for the research under discussion.

Whatever. To me, it’s all a bit cringe-inducing–everyone involved in the publication of this paper seems to be operating in an alternate scientific reality. I’m embarrassed for them.