Trial By Error: Claim that CBT Is Safe Is “Misleading,” Says Dutch Ad Group

By David Tuller, DrPH

In a recent decision, the Advertising Code Foundation in the Netherlands has criticized as “misleading” a statement on the website of the Knowledge Center for Chronic Fatigue (NKCV) touting its treatment approach as “not harmful.” The decision is something of a slap at the NKCV and its co-leader, Professor Hans Knoop, a psychologist and a member of the Dutch wing of the CBT/GET ideological brigades.

Professor Knoop is a long-time colleague of the authors of the now-discredited PACE trial. In a 2011 Lancet commentary accompanying the publication of the PACE results, he and a colleague declared that many patients had met “a strict criterion for recovery”—a ridiculous and untrue claim. In a recent post, I critiqued a recent study from Professor Knoop and colleagues that investigated CBT for long Covid. The study was full of the usual flaws marring his brand of research and yielded predictably positive results in its subjective outcomes that were essentially meaningless.

The Advertising Code Foundation (Stichting Reclame Code, or SRC) describes itself this way: “The Advertising Code Foundation (SRC) has been the body in the field of advertising self-regulation for over 55 years. The SRC promotes responsible advertising with the aim of ensuring the reliability and credibility of advertising.”

The SRC investigates complaints from consumers, commercial interests, and others about advertising they believe is deceptive or otherwise problematic. After a decision is rendered, the SRC monitors whether the advertiser has complied with the recommendation. However, compliance is voluntary.

In this case, the agency received a complaint about information on NKCV’s website regarding its psycho-behavioral treatment approach, which includes elements of both CBT and GET. The decision, dated May 3^rd, described the complaint: “It concerns an expression in the frequently asked questions about treatment for CVS (chronic fatigue syndrome) on the website of the Dutch Knowledge Center for Chronic Fatigue (NKCV). The statement reads: ‘Can the treatment be harmful? The treatment is not harmful. We have investigated this. Here [hyperlink] you will find the research.’”

The whole report is well worth a read. It includes a summary of the complainant’s concerns, followed by NKCV’s response, and then rebuttals from each side. The complainant, who remains unidentified, had the better side of the argument, at least according to the decision.

Of apparent significance was a 2022 paper from Vink and Vink-Niese, “Is It Useful to Question the Recovery Behavior of Patients with ME/CFS or Long COVID?” This analysis was cited both by the complainant and by the chairperson in the final decision. The latter quoted Vink and Vink’s finding that their review “highlights the fact that both treatments [CBT and GET] are unsafe for patients with ME/CFS.”

The SRC found, first of all, that the NKCV website falls under the definition of “advertising,” as outlined in the Dutch Advertising Code. The agency further found that the claim of safety violated the code’s article #7 in, which states the following:

“Advertising must not be unfair. Advertising is unfair when it conflicts with the requirements of professional diligence and substantially distorts or is likely to distort the economic behavior of the average consumer it reaches or is directed to in relation to the product. Deceptive advertising and aggressive advertising are in any case unfair.”

So was the ad in question “unfair”? After weighing the submissions from both parties, the report determined that it was:

“It must be concluded that (the safety of) the treatment of CFS with CBT is under scientific discussion. This does not mean that NKCV may not advertise the CBT treatments it offers on its website at all. However, in view of the above-mentioned difference of opinion with regard to the existence of scientific evidence for its safety, the necessary care and restraint should be exercised when promoting it to ensure that the average consumer is presented with a sufficiently nuanced picture. information about (the possibilities of) the treatment of CFS with CBT…The contested statement does not meet that requirement. After all, it is stated without any reservation ‘The treatment is not harmful’…

“Due to the certainty of the statement, which lacks any nuance, the average consumer is given an incorrect impression about the risks and the results that can be expected from the touted treatment of CFS…Since this consumer may be led to take a decision about a transaction – treatment with CBT by NKCV – that he would not have taken otherwise, the statement is misleading and therefore unfair within the meaning of article 7 NRC.”

As of today, the “frequently asked questions” page of the NKCV’s website still includes the following “misleading” statement: “The treatment is not harmful.”