#paul-garner — Public Fediverse posts
Live and recent posts from across the Fediverse tagged #paul-garner, aggregated by home.social.
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News Bits–“Frail & Furious” for #Millions Missing; Usual Suspects at Psych Confab; Long COVID Advocates Channel ACT UP
By David Tuller, DrPH *This is a crowdfunding month at UC Berkeley. If you’d like to support my work, the link is here. ********** “Frail and Furious” on May 12th Each year on May 12th, an international day of ME awareness, #MillionsMissing protests are held in cities across the world and draw significant media attention. This month’s #MillionsMissing campaign has the tagline “Frail & Furious,” according to the page for the event on #MEAction’s site. The organization launched the campaign ten years ago. Why specifically “frail”? (“Furious” is easy to understand.) Here’s why, per #MEAction: “In the U.S., new Medicaid rules will force people with ME and Long COVID to work 80 hours per month or lose their government health insurance, unless they can prove they have a “serious or complex medical condition” in order to get a “medically frail” exemption. “We know that both are true for the majority of our community but, once again, we are having to fight to prove this to our health leaders. When ME is overlooked, people are denied the protections, services, and support that medically frail patients are supposed to receive.” Here’s some more information from the site: “Government and healthcare systems around the world fail to classify myalgic encephalomyelitis (ME) as a serious, complex medical condition, leading to significant neglect in medical care and social services. Diagnoses are often delayed for years, disability qualifications are complicated, and our health care is at risk. ME receives far less funding for research relative to disease burden (only 3-7% of comparable illnesses), despite massive economic costs. Over and over again, people with ME and Long COVID are asked to prove their medical frailty – how sick we really are. “This #MillionsMissing, we are Frail and Furious! This May, we will come together to show the world how devastating this … -
Claims Built on Fraudulent Trials Should Be Ignored
By David Tuller, DrPH When researchers cite fraudulent studies in support of their claims, it is best not to take anything they write at face value. That is certainly the case with a recent paper titled “Persistent physical symptoms not explained by structural abnormalities or disease processes: a primary care approach to promote recovery,” published earlier this month in the Scandinavian Journal of Primary Health Care. (I use “fraudulent” here not in the legal sense but in the sense of “deceptive” or “deceitful.”) As evidence of something or other, the paper’s references include both the fraudulent PACE trial, whose reported findings have been discredited and rejected by leading medical authorities, and a fraudulent pediatric trial of the Lightning Process, in which the investigators violated core methodological principles of scientific research. (The Lightning Process, a woo-woo “brain retraining” program, was created by osteopath and former spiritual healer Phil Parker, who once claimed to be able to diagnose people’s ailments by stepping into their bodies for a look-see.) The Scandinavian Journal of Primary Health Care has emerged as something of a house organ for members of the biopsychosocial ideological brigades, including prominent non-Nordic fellow travelers like Professor Paul Garner and Professor Trudie Chalder. (The former is the corresponding author of this paper; the latter is one of multiple co-authors.) Both were also co-authors of a similarly misguided document published by the same journal In 2023–a manifesto from the self-styled Oslo Chronic Fatigue Consortium called “Chronic fatigue syndromes: real illnesses that people can recover from.” The new paper’s goal is to offer primary care physicians a short summary of “contemporary theories of PPS” along with purported “evidence-informed pathways” for treating patients. The research involved a “narrative literature review and consensus development with experienced practitioners.” In other words, the paper presents the beliefs, opinions and …https://trialbyerror.org/2026/04/01/claims-built-on-fraudulent-trials-should-be-ignored/
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BMJ’s “Commissioned” Propaganda Piece Hijacked Death of Maeve Boothby O’Neill; Boothby O’Neill’s Mum Responds
By David Tuller, DrPH
Under the editorial leadership of Kamran Abbasi, The BMJ and other journals in BMJ Group have become, at times, mouthpieces for members of the biopsychosocial ideological brigades. That hasn’t been surprising, given his actions during his previous tenure as editor of the Journal of the Royal Society of Medicine.
Under his stewardship, the journal published a piece of crap co-authored by Professor Sir Simon Wessely, a former president of the royal society, and his King’s College London’s colleague Trudie Chalder, the factually and mathematically challenged professor cognitive behavior therapy and one of the lead PACE authors. The 2020 article, Cognitive behavioural therapy for chronic fatigue and chronic fatigue syndrome: outcomes from a specialist clinic in the UK, made causal statements even as it declared that its single-cohort study design did not allow for making causal statements.
When my friend and colleague Brian Hughes, a psychology professor at the University of Galway, and I pointed this out and presented other irrefutable evidence of error, Abbasi declined to take action to correct the public record. We published our critique as a separate article in the Journal of Health Psychology.
Since Abbasi’s ascent as editor in chief of The BMJ, BMJ journals have published some egregious work on ME/CFS and Long COVID. (Not that they were good before.) Most recently, in May, The BMJ, the flagship journal, published what I called “a commissioned propaganda piece” from die-hard biopsychosocial-ists. The commentary, which is called “Patients with severe ME/CFS need hope and expert multidisciplinary care,” touted so-called multi-disciplinary treatment approaches that have no legitimate evidence of effectiveness.
The first author of The BMJ’s invited opinion piece is infectious diseases specialist Alastair Miller, a longtime proponent of graded exercise therapy and cognitive behavior therapy as curative treatments and formerly associated with what was called the Liverpool Chronic Fatigue Syndrome Service. Last summer, during the inquest into the death of 27-year-old Maeve Boothby O’Neill from ME-related complications in Exeter in 2021, The Observer published an offensive and stupid opinion piece by Professor Miller. In the piece, he attempted to hijack the tragedy of Boothby O’Neill’s death to promote his persistent ideological beliefs about purportedly successful rehabilitative strategies.
Another author of the new BMJ article is Paul Garner, also an infectious diseases physician, who has now spent years presenting his N=1 case of recovery from post-viral symptoms as evidence of the power of his strong manly cognitions to cure Long COVID. Per Garner’s claim, this medical turnaround occurred immediately after a phone consultation with someone who sounded very much like a practitioner of the Lightning Process—whether or not that is actually the case.
Like Professor Miller’s piece last summer, the new commentary includes, perhaps not surprisingly, a reference to Boothy O’Neill’s death, in the following sentence: “However, functional impairment may lead to malnutrition and dehydration—described as the cause of death of Maeve Boothby O’Neill, who died in 2021 at age 27.” To be clear: the claim that Maeve’s “impairment” was “functional” rather than driven by ME-related pathophysiological dysfunctions is an unproven theory and contradicts the coroner’s report. The “functional” claim is this lot’s security blanket. But believing in the tooth fairy does not mean the tooth fairy exists.
This desperate plea for relevance from a group of misguided partisans prompted a flurry of rapid responses. So far, 21 have been publicly posted. Sarah Boothby, Maeve’s mother, twice submitted a rapid response. However, it has not appeared. I have posted her comment below. (A version is also posted on Boothby’s LinkedIn page)
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Dear Editor in Chief, Kamran Abbasi
I submitted the following through the BMJ Latest rapid response portal twice, the second time with a request for acknowledgment. As the BMJ has neither published my corrections and criticism nor acknowledged my communication I am writing to you formally for an explanation. Please explain why the BMJ is commissioning and publishing misinformation specifically on Myalgic Encephalomyelitis?
“In commissioning and publishing the opinion piece by Miller et al (BMJ 2025;389:r977) the BMJ failed to fact check and consequently misled its readership on the risk of death from very severe Myalgic Encephalomyelitis (ME). Those interested in medical ethics should note:
Maeve Boothby O’Neill died from ME shortly after her twenty-seventh birthday. She was not the first and has not been the last to die from this devastating illness yet the BMJ made no correction to the claim that Maeve died from malnutrition and dehydration. Dehydration and malnutrition are both easily treatable conditions in Britain. The inquest into Maeve’s death took three years investigating how a preventable death could have been permitted to a young woman who did not want to die, had been actively taking medical advice since the onset of symptoms in 2008, and had consented to three hospital admissions in the seven months prior her premature death in 2021.
It took four years of extensive tests and investigations before Maeve was diagnosed with Chronic Fatigue Syndrome (CFS), by which time she had obtained A* results in Russian, Biology, English and Chemistry at A Level. Such results are not possible without the ability to understand instructions and take advice. Once diagnosed she was under specialist CFS services for eight years, including the Centre of Excellence in Bristol. She meticulously followed the instructions and advice they gave. Maeve never believed she would not recover; she learnt from the bitterest experience how the disease progresses from mild to very severe.
Maeve’s health deteriorated following a mild viral infection from which she (and the rest of her family) appeared to have fully recovered when Maeve was thirteen. Her symptoms steadily progressed to being serious enough that her PE teachers stopped her from joining their lessons; the risk of her being injured was too high.
The facts of Maeve’s death disqualified Miller as an Expert Witness at her inquest. By the end of the three-year inquiry, HMA Coroner was mildly better informed about ME than before the inquest opened. In the process of establishing the facts she confirmed that there are no inpatient services for people with ME anywhere in the UK, either in private or publicly owned hospitals. If the opinions of Miller et al had any efficacy in cases of ME, Maeve would still be alive today.
The Prevention of Future Deaths (PFD) report mentions six national institutions responsible for failing to prevent Maeve’s premature death. These include the National Health Service (NHS), the Medical Research Council (MRC) and the Department for Health and Social Care (DHSC). Failure on this scale can only be remedied by systemic change, which must involve leadership at the highest level.
If a provincial inquest can establish these facts about ME, the BMJ should have little difficulty in doing similar. Failure to correct its editorial stance on this disease, when the international consensus is prioritising patient safety, casts doubt on both the reliability and ethics of opinions from the British medical establishment.”
A shortened version can be found featured in my LinkedIn profile here.
Sincerely
Sarah Boothby
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Suzanne O’Sullivan’s “Psychosomatic” Mis-Diagnoses
By David Tuller, DrPH
*This is a crowdfunding month at University of California, Berkeley. If you appreciate my work and would like to make a donation (tax-deductible to US taxpayers) to the university in support of my position, here’s the link: https://crowdfund.berkeley.edu/project/46120
Neurologist Suzanne O’Sullivan has been conducting a media blitz for her new book, “The Age of Diagnosis: How Our Obsession with Medical Labels Is Making Us Sicker.” The Guardian ran a lengthy excerpt in early March. O’Sullivan appeared on the popular podcast Freakonomics. Multiple publications have published profiles of her, with credulous assessments of her work.
O’Sullivan has long been a major promotor of psycho-behavioral explanations for complex illnesses. Her previous books in this vein–including It’s All in Your Head: True Stories of Imaginary Illness, and The Sleeping Beauties: And Other Stories of Mystery Illness—were bestsellers. In the SARS-CoV-2 era, it should not be surprising that she has now scooped up Long Covid and incorporated it into her expansive worldview. “As no one saw doctors during the pandemic, it’s inescapable that the period was a melting pot for psychosomatic conditions,” she explained in one recent interview.
The new book’s release has coincided with a public discussion in the UK of labor shortages, which have been blamed in part on the numbers currently designated as unable to work because of illness—often because of Long Covid. This discussion is itself linked to the government’s push to reduce unemployment and/or disability benefits and its assertion that many of those currently not working should in fact be working. O’Sullivan’s framework seems likely to provide perceived confirmation of the arguments for cutting social welfare payments as well as political cover for those seeking to promote that strategy.
Similar discussions regarding which people should be considered deserving of publicly funded benefits are occurring in Australia, where I just spent four weeks, and the US. Understandably, this debate has not been received well among many people with disabilities, including those with ME, ME/CFS, Long Covid, and other debilitating conditions whose underlying mechanisms remain unclear.
While “The Age of Diagnoses” has received some positive reviews for O’Sullivan’s storytelling abilities, the praise has not been universal. In one telling example, BJGP Life, an online offshoot of the British Journal of General Practice (BJGP), has published a refreshingly critical perspective. Elke Hausmann, a GP in Derby who has herself experienced prolonged postural orthostatic tachycardia syndrome and other symptoms after COVID-19, pushed back vigorously against O’Sullivan’s “curious characterisation of Long Covid as a psychosomatic condition.”
Here’s a compelling selection from Hausmann’s review:
“O’Sullivan suggests that people don’t like to be told that their physical symptoms might have an underlying psychological explanation. Her idea is that we simply ignore this possibility because mental health conditions are still stigmatised in society, and we don’t want to be seen through the lens of that stigma. Proponents of the psychosomatic explanation of Long Covid (and the same goes for ME), always make out as if we were really the ones stigmatising patients with mental health disorders, by inferring that mental health conditions are somehow lesser, when we represent our illness as ‘physical’…In fact, rather than being resistant to psychological explanations and therapeutic interventions for Long Covid, we generally tend to be quite open to them. Until, that is, experience shows us that this route to a cure is a dead end.”
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Guardian excerpt highlights Paul Garner as “poster patient”
I have read The Guardian’s excerpt from “The Age of Diagnosis.” (I haven’t read the book itself.) O’Sullivan’s thesis is that we that we are being swamped by a tsunami of “over-diagnosis”–as if all those once dubbed the “worried well” have now received specific medical labels for their assorted complaints, aches and pains. In this view, people become so fixated on these labels that they keep themselves chronically sick as a way of affirming and sustaining their illness identity.
The problem with this thesis isn’t that what O’Sullivan describes doesn’t ever happen. Every time a diagnosis relies on symptoms rather than accurate biomarkers, some people with something else or nothing at all will nonetheless be deemed to have the illness. That’s unavoidable. The problem, or one problem, is that she seems to apply her thesis indiscriminately to broad disease categories as well as to the individuals whose cases she examines in detail. Nonetheless, I take little issue with some of Dr O’Sullivan’s general assertions—like the following:
“It could be that borderline medical problems are becoming iron-clad diagnoses and normal differences are being pathologised. These statistics [indicating increased numbers of diagnoses] could indicate that ordinary life experiences, bodily imperfections, sadness and social anxiety are being subsumed into the category of medical disorder.”
O’Sullivan is right. It “could be” that some of what she suggests is, in fact, happening. It could be, as she writes, that the increase in diagnoses means that, at least in part, “we are attributing more to sickness.” But if we are indeed attributing more illness to sickness, the question then is: How much more? And is that necessarily a bad thing, as O’Sullivan believes?
O’Sullivan blames much of the “over-diagnosis” on the metastasizing Diagnostic and Statistical Manual (DSM) of Mental Disorders, the so-called psychiatric Bible. The DSM has grown dramatically from its first edition in 1952 to its most recent, DSM-5, published in 2013, with a proliferating number of disorders. As O’Sullivan accurately notes, the categorizations of various conditions have shifted and expanded significantly, with boundaries that are in many respects porous and arbitrary. No argument with her on that score.
In its discussion of Long Covid, however, the excerpt includes a section presenting Paul Garner as the “poster patient” for demonstrating that the illness is largely or in many cases a result of fear, anxiety, and related emotional or psychological states–and therefore amenable to self-cure. To anyone who has followed the Garner saga since its inception in 2020, O’Sullivan’s decision to highlight his “recovery” narrative exposes deep flaws in her storytelling methods and destroys her credibility. It also exhibits her own case of confirmation bias. A review of Garner’s public statements about his condition documents the following: He experienced a nasty bout of post-viral illness that appears to have self-resolved within six months of his SARS-CoV-2 infection.
After Garner got better, he attributed his recovery to an intervention that sounded very much like the Lightning Process–and, in particular, to the role played by his powerful manly cognitions. He also went out of his way to trash members of the ME community for having offered him advice about pacing, post-exertional malaise, and the like, during his prior months of suffering. In reality, it doesn’t appear that he was suffering from ME or ME/CFS, and certainly not the kind of Long Covid that persists for years. The evidence is that he was already back to a regular hiking schedule by the time he received the advice that he later claimed led to his cure.
Garner has since established himself as an evangelist for so-called “mind-body” solutions to Long Covid and other major illnesses. In this mode, he has suggested that others who fail to recover with his proposed self-empowerment approach have themselves and their negative outlooks to blame. Medical colleagues, like O’Sullivan, have contributed to the hype by disseminating his story and endowing it with unwarranted professional authority.
O’Sullivan transmits Garner’s self-serving interpretation of events without an iota of skepticism or critical thinking. Here’s her account:
“Viruses cause fatigue in order to make people rest, which promotes recovery. But, in Garner’s case, his recovery had gone awry because he inadvertently conditioned his body to stay tired. Garner realised he had to retrain his brain to react differently to the fatigue if he was to get better.
“‘I suddenly believed I would recover completely,’ he writes. ‘I stopped my constant monitoring of symptoms. I avoided reading stories about illness and discussing symptoms, research or treatments by dropping off the Facebook groups with other patients. I spent time seeking joy, happiness … and overcame my fear of exercise.’ By the end of 2020 he had made a full recovery.”
Come on. How does O’Sullivan know that Garner failed to recover because he “inadvertently conditioned his body to stay tired”? That’s Garner’s argument–but what evidence is there for it? Or for the staterment that he recovered because he learned to “retrain his brain”? None. But O’Sullivan buys it without question.
O’Sullivan’s gullibility when confronted with this self-mythologizing tale indicates that she suffers from impaired judgment and limited psychological insight–at least when someone’s story aligns with her own prejudices and inclinations. A large part of O’Sullivan’s narrative strategy involves offering similarly detailed, and generally readable, accounts of people’s hard-to-diagnose illnesses. Given her pre-existing psychosomatic template, however, these individual portraits cannot be taken at face value. Nor do they add up to proof of the book’s larger and frequently misguided thesis regarding mass psychosomatic illness.
In short, O’Sullivan knows how to tell compelling stories–and, it seems, compelling fairy tales as well.
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GET Ideologues Try to Rebut Muscle Abnormality Study–and Fail
By David Tuller, DrPH
It is a pleasure to read a pointed and effective smack-down of an ill-informed argument, especially when the argument is pushing the graded exercise therapy/cognitive behavior therapy (GET/CBT) paradigm for ME/CFS, Long Covid and related illnesses. That’s how I felt about the excellent rebuttal this week to a letter from some of the usual GET/CBT ideologues criticizing a study published last year in Nature Communications. That study reported a link between post-exertional malaise (PEM) and muscle abnormalities in people with Long Covid.
(I interviewed Rob Wüst, the study’s senior author, last year. He also discussed his work in a talk with Solve M.E., which supported the research.)
Among the signers of the critical letter were two of the lead PACE authors: Trudie Chalder, King’s College London’s methodologically and factually challenged professor of cognitive behavior therapy, and psychiatrist Michael Sharpe, an Oxford don and self-proclaimed scientific martyr. Another was Per Fink, the Danish psychiatrist under whose authority a young female ME patient was held against her and her family’s consent. And, not surprisingly, Paul Garner, an infectious diseases physician at the Liverpool School of Tropical Medicine, who claimed to have cured his Long Covid with his powerful and manly thoughts, also added his name.
Professor Garner promoted the letter on social media and parroted its bogus assertion that the participants with PEM in the Wüst study were “deconditioned,” among other unwarranted statements. As he and his colleagues write:
“Appelman and colleagues report on muscle damage following a maximal effort physical exercise test in patients with PEM with the COVID-19 condition, and these results are interpreted as showing that exercise damages the tissues of people with PEM and should therefore be avoided. However, we believe the data reported do not support this interpretation, as the patients were substantially deconditioned; the physical activity was extreme and biological changes would be expected in anyone; and there were no control patients with a post-COVID-19 condition without PEM.”
The “erroneous interpretation of these data,” Professor Garner and his colleagues fret, could lead patients to avoid activity out of fear of PEM and reject “rehabilitation strategies” that could purportedly help them. These rehabilitation strategies obviously include CBT, GET and the many various permutations thereof.
When authors include indisputably untrue factual claims in their writings, it is reasonable to wonder about the accuracy of their other assertions—especially when the misstatements appear to bolster whatever case they are making. In this instance, Professor Garner and buddies refer to a high-profile U.S. National Institutes of Health’s publication as “a recent study on chronic fatigue conditions, including ME/CFS.” The problem is that the study is explicitly not about “chronic fatigue conditions” in general, given that it is called “Deep phenotyping of post-infectious myalgic encephalomyelitis/chronic fatigue syndrome.”
I suppose this could be a sloppy mistake, but that seems unlikely. I’m assuming it’s an intentional misrepresentation, or what is normally called a lie. It seems to be a very clumsy effort to boost the NIH study’s relevance to their argument, given that the Wüst study involves Long Covid and not specifically ME/CFS. But whether this untruth is an actual error or a lie, it serves to undermine the overall credibility of this group of malcontents.
So does another peculiar detail. In citing a controversial Cochrane review of exercise therapy for what was being called “CFS,” the letter references a 2017 version rather than the 2019 version that superseded it. The 2019 version included amendments that watered down the interpretation of the findings, highlighted the uncertainty of the evidence, and noted the lack of sufficient data about potential harms. For investigators to cite an outdated version that has been replaced just because it better suits their arguments is unacceptable.
The response from Dr Wüst and his colleagues was polite but firm:
“We refute that our findings are due to deconditioning, as Long COVID-related skeletal muscle differ fundamentally from those caused by deconditioning. We demonstrated significant physiological differences in Long COVID patients with post-exertional malaise (PEM) compared to healthy controls, even at matched physical activity levels. PEM encompasses a variety of symptoms and not only muscle soreness. Our study did not address the efficacy of exercise training, and we reject misinterpretations that all forms of exercise cause PEM.”
Their response calmly dismantles each plank of the critics’ position. They also suggest that some of the remarks are not only inaccurate but simply off-point and irrelevant to the published paper:
“Ranque et al. [the letter’s first author is Brigitte Ranque, a French physician] state that our ‘findings have been widely interpreted in the media as indicating that exercise in people with Long COVID causes muscle damage and implying that people with Long COVID should not exercise’, but simultaneously agree ‘that intense exercise, such as the one tested in the study, is not recommended’, albeit without providing argumentation. While we speculate that PEM could result in fear of exercising at intensities above the PEM threshold, this was not the focus of our research, and feel this critique does not pertain to our publication.”
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Disclosure: My academic position at the University of California, Berkeley, is largely supported by donations to the university via the campus crowdfunding platform from people with ME/CFS, Long Covid, and related disorders.