By David Tuller, DrPH
In early 2019, I wrote about an awful online training course for general practitioners on recognizing and caring for patients diagnosed with what was referred to as CFS/ME. The module, called METRIC, promised to provide “GPs and other primary care practitioners with an overview of the presentation, diagnosis, assessment and ongoing management” of the illness. It was based on the discredited PACE trial and a related effort called the FINE trial.
PACE was a methodological and ethical disaster, and FINE produced null results for its primary outcomes. (The FINE authors have made unwarranted claims of success in fatigue reduction because a post-hoc change in scoring methods made the results appear somewhat better. This post-hoc analysis does not alter the fact that the trial had null results for its pre-designated measures.) Given these failures, It is certainly problematic that this research should have been used for medical education. But that didn’t stop the Royal College of General Practitioners from developing and hyping METRIC, which promotes the treatment paradigm focused on graded exercise therapy and cognitive behavior therapy.
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