Monday, 20 February 2017

Absence of Evidence


Margaret Williams       18th February 2017

Introduction

As is widely known, Professor Sir Simon Wessely is President of the Royal College of Psychiatrists and is President-elect of The Royal Society of Medicine; his GP wife Dr Clare Gerada, now Lady Wessely, was Chair of the Council of the Royal College of General Practitioners. 

A “Joint Commissioning Panel for Mental Health” from these two Royal Colleges has just produced a 24 page document entitled “Guidance for Commissioners of services for people with medically unexplained symptoms – practical mental health commissioning” in which they include myalgic encephalomyelitis/chronic fatigue syndrome as a functional somatic syndrome ie. as a mental disorder (http://www.jcpmh.info/wp-content/uploads/jcpmh-mus-guide.pdf).

The document is intended for, amongst others, Commissioners of NHS services, Directors of Adult Social Services, the Royal College of Nursing and the Clinical Commissioning Groups that are run mostly by GPs who commission local health care. 

This could sound the death knell for people with ME/CFS who currently receive care packages funded by their Local Authority because there is abundant evidence that cash-strapped Local Authorities spend next to nothing on mental health.

For decades, the proponents of the now-infamous PACE Trial -- particularly Professors Simon Wessely and Peter White -- have maintained that without hard evidence of organic pathology, they will not accept the WHO classification of ME/CS as an organic disorder and they insist that it is a functional somatic syndrome (FSS). 

In other words, ignoring the existing evidence-base of pathoaetiology, since there is not as yet a definitive test for ME/CFS, they believe that absence of evidence really is evidence of absence, so they continue to categorise ME/CFS as a behavioural disorder that can be “cured” by cognitive behavioural therapy (CBT) and graded exercise therapy (GET) and they advise Departments of State that these interventions are both effective and cost-effective.

In their own insular world of psychiatry, however, they appear to have convinced themselves that absence of evidence is not evidence of absence when it comes to the clinical and cost-effective benefit of CBT/GET for people with ME/CFS.

The PACE Trial was funded because it was acknowledged that previous trials of CBT and GET were insufficiently robust. As is now undeniable, the PACE Trial failed, so not only is there no evidence that ME/CFS is a functional somatic syndrome but there is no credible evidence that CBT/GET are effective interventions for its management.

Lack of evidence of both clinical benefit and cost effectiveness

1. In 2001 the York Centre for Reviews and Dissemination reviewed the available evidence for the clinical effectiveness of CBT/GET in ME/CFS; the review team’s negative comments referred to methodological inadequacy; study withdrawal; drop-out rates for CBT; drop-put rates for GET; the unacceptability of treatments; reported improvements may be illusory (“the modest gains may be transient and even illusory”); there was no objective evidence of improvement and there was little lasting benefit from CBT (Interventions for the treatment and management of chronic fatigue syndrome: a systematic review.  Whiting P, Bagnall AM et al: JAMA 2001: Sept 19:286(11):1360-1368).

2. In 2005, Bagnall AM et al from the same Centres for Review and Dissemination produced the 488-page “York Review” of the “evidence” of the effectiveness of CBT/GET from the same studies they had reviewed in 2001 (The diagnosis, treatment and management of chronic fatigue syndrome (CFS) / myalgic encephalomyelitis (ME) in adults and children – Work to support the NICE Guidelines).  

Notably, given that the same RCTs were scrutinised, all previous negative comment from 2001 had disappeared from the 2005 version, but in both the 2001 and 2005 versions, two important issues were not mentioned: (i) corrupted data and (ii) follow-up data revealed relapse, but the 2005 version was the “evidence” upon which the NICE Guideline was predicated.

3. In August 2007 NICE duly produced its Guideline on “CFS/ME” in which it acknowledged the lack of adequate research evidence whilst simultaneously asserting:  “The guideline provides recommendations for good practice that are based on the best available evidence of clinical and cost effectiveness”.  

In his CV, Professor Sir Simon Wessely states about the NICE Guideline: “My work has significantly influenced the management of chronic fatigue syndrome, reflected in the 2007 NICE Guidelines”.

Not only did NICE rely on “illusory” clinical benefit, it manufactured its own evidence on the cost-effectiveness of CBT and found no convincing evidence of the cost-effectiveness of GET.

There were numerous basic arithmetical errors in the Guideline (conceded by Professor Peter Littlejohns, Clinical and Public Health Director of NICE, in his Witness Statement for the High Court Judicial Review) but, importantly, NICE’s own cost-effectiveness search found that out of 60 papers reviewed, only three were considered suitable.

One was a study by Wessely et al which showed no benefit from CBT (BJGP 2001:51:15-18).

Another was the Severens et al paper  (Severens JL et al, Q J Med 2004:97:153-161), which in turn relied on the flawed Prins et al study (Lancet 2001:357:841-847), a study about which in his evidence for the Judicial Review, Martin Bland, Professor of Health Statistics, University of York, presented convincing evidence showing why “the entire Prins trial” was “invalidated”.

NICE, however, decided that the Severens et al paper upon which its entire costing analysis  had to rely had under-reported the benefit because the timescale used was insufficient to show long-term benefit (its timescale being only 14 months in total and not the desired five years).

NICE therefore decided to “extend” the Severens timescale to fit its own requirements to show long-term cost benefit of CBT.  

Since there was no evidence of long-term cost-effectiveness in the Severens et al paper, NICE decided to use the 2001 study by Deale et al which was a five-year follow-up of their 1997 paper (Long-term Outcome of Cognitive Behavioural Therapy Versus Relaxation Therapy for Chronic Fatigue Syndrome: A 5-Year Follow-Up Study.  Alicia Deale, Trudie Chalder, Simon Wessely et al.  Am J Psychiat 2001:158:2038-2042). 

To obtain the “evidence” it needed, ignoring the fact that the two trials used different cohorts and different criteria, NICE extrapolated Deale et al’s 2001 results published in the American Journal of Psychiatry and projected those results into the Severens et al’s 2004 paper to produce what NICE thought might have been Severens’ results in five years’ time. 

Of importance is the fact that this sole 5-year follow-up study by Deale et al suffered from corrupt data: the authors themselves acknowledged that: “56% of the patients undergoing CBT reported receiving further treatments for their chronic fatigue symptoms; other treatments used were antidepressants, counselling, physiotherapy and complementary medicine”, and over the course of the five year follow-up, treatment of many patients had deviated from the trial protocol, rendering the outcome measures meaningless.  

This did not deter NICE from using the corrupted data from the Deale et al study to create its own cost effective “best evidence” in relation to CBT for ME/CFS. 

It is difficult to understand how NICE could get away with creating “evidence” which did not exist and relying on the “evidence” it had created to underpin a national Guideline that claimed to set out best practice.

In the key (Severens) paper upon which NICE relied as “evidence” of the cost-effectiveness of CBT, the Guideline Development Group did not have access to the source data (conceded on page 209 of the Full Guideline). When it subsequently became available, the objective actometer data showed no statistically significant difference between cohort and controls. 

This means that NICE produced a Guideline with a potential catchment of 240,000 sick people based on a flawed analysis that failed to consider objective data which showed no benefit from CBT. 

With regard to GET, the single study which attempted to examine the relative cost-effectiveness of CBT and GET found that the cost-effectiveness of CBT and GET were similar but the study was limited by its small size and by “the use of a non-randomized comparison” (McCrone P et al: Psychological Medicine 2004:34:991-999).

Given that both clinical benefit and cost-effectiveness were based on very limited and poor quality evidence, the development of the Guideline was hardly a scientific approach, let alone one that was “excellent” by the-then titled National Institute for Health and Clinical Excellence.

In his CV, Professor Wessely states about the NICE Guideline: “My work has significantly influenced the management of chronic fatigue syndrome, reflected in the 2007 NICE Guidelines”.

4. In 2008 the Cochrane Systematic Review of CBT/GET found that costing was under-researched and that there was a pronounced lack of research into the likely costs to the NHS of CBT/GET for patients with ME/CFS.  Importantly, Cochrane regarded CBT and GET as integral: “For the treatment of CFS, CBT combines a rehabilitative approach of a graded increase in activity with a psychological approach addressing thoughts and beliefs about CFS that may impair recovery”, hence the Cochrane comments on costing applied to both CBT and to GET.

5. On 6th January 2011 Frances Rawle PhD, Head of Corporate Governance and Policy at the Medical Research Council, wrote to Professor Malcolm Hooper confirming about CBT/GET that, prior to the PACE Trial: “there was insufficiently strong evidence from randomised controlled trials to support their effectiveness”.  This was a surprising admission, because the NICE Guideline that advocated CBT/GET was published four years before the initial results of the PACE Trial appeared.

6. In 2012 McCrone et al published their cost-effectiveness results of CBT/GET based on the PACE Trial data (Adaptive Pacing, Cognitive Behaviour Therapy, Graded Exercise, and Specialist Medical Care for Chronic Fatigue Syndrome: A Cost-Effectiveness Analysis.   Paul McCrone, Michael Sharpe, Trudie Chalder, Martin Knapp, Anthony L. Johnson, Kimberley A. Goldsmith, Peter D. White  Published: August 1, 2012 http://dx.doi.org/10.1371/journal.pone.0040808). 

Over three years later, despite legitimate efforts by Professor James Coyne to gain access to the data so that he could independently verify McCrone et al’s economic analysis, since 11th December 2015 his request has been refused as a “Vexatious Request” by King’s College, London: “The university considers that there is a lack of value or serious purpose to your request. The university also considers that there is improper motive behind the request. The university considers that this request has caused and could further cause harassment and distress to staff”, hence there has been no independent scrutiny of McCrone et al’s claim of cost-effectiveness for CBT/GET in ME/CFS.

The PACE Investigators refuse to accept that their favoured interventions of CBT and GET are neither clinically beneficial nor cost-effective so, as Professor Jonathan Edwards notes on Phoenix Rising about their latest attempt to save face (http://forums.phoenixrising.me/index.php?threads/do-more-people-recover-from-chronic-fatigue-syndrome-with-cbt-or-get-than-with-other-treatments.49331/#post-813558): “We seem to live in a world full of people digging holes for themselves”.

Perhaps the best summary of what has become a farcical situation is provided by “Sean” who wrote on Phoenix Rising: “So let me get this straight: PACE was justified on the grounds that the existing literature was insufficiently robust and needed proper ‘definitive’ testing. 

“But when the results from PACE did not support the results from previous studies, nor hence the underlying theoretical model, the numbers were simply fiddled until they did, and this was justified by saying the new numbers now agree with those previous studies, the same ones that were insufficiently robust enough that they provided the justification and necessity for the "definitive" PACE in the first place. 

“So the previous results being tested by PACE, because they were not robust enough, became the standard by which the results from PACE were determined to be robust or not. 

“Circularity City, or what”.

Whilst the clinical benefit and the cost-effectiveness of CBT/GET may both be illusory, the Report for Commissioners from the two Wessely family-influenced Royal Colleges is anything but an illusion.

By categorising ME/CFS as a mental disorder, it intentionally disregards the mandatory use of the ICD-10 classification codes throughout England as required by NICE.  

This is a serious and dangerous situation: patients with the profoundly disabling neuro-immune disease ME/CFS are now likely to be subject to even more iatrogenic harm. 

Documented iatrogenic harm includes not only lack of medical care, where patients’ symptoms are ignored, dismissed and denied, but also abuse and ridicule. 

Sufferers may yet again be bullied into undertaking harmful management interventions and if they do not comply, their State and insurance benefits are likely to be reduced or withdrawn, putting their very survival at risk.


Thursday, 9 February 2017

Three New Items On The Margaret Williams Website

The Cost of Collusion? (8 February 2017)
Margaret Williams

The Power Of Propaganda? (4 February 2017)
Compiled by Margaret Williams

Letter to the Countess of Mar from the Public Accounts Committee Chair (1 February 2017)
Meg Hiller MP

Saturday, 4 February 2017

Opposing MEGA: Our Covering Letter to Mainstream Research Funders


The OMEGA petition organisers wish to thank all supporters who have added their names to the OMEGA Petition as well as heartfelt comments about the way in which they as the service recipients of ‘ME’ research wish to see that research being carried out in their name. We would like to think the OMEGA Petition can stand as a documented challenge to ‘MEGA’ illustrating that those who support ‘MEGA’ do not have the mandate they claim. The following letter has been sent to many researchers and interested parties so that they cannot claim to be ignorant of this challenge.  We will only update if or when a significant change occurs which relates to this petition. The petition therefore remains open for the time being. We invite everyone to continue to share and sign the petition in support – https://www.change.org/p/opposing-mega-a-vote-of-no-confidence-in-mega-research-for-me-cfs

Letter to Mainstream Research Funders

FAO: All persons with responsibility for research grant applications

CC: Any persons with an interest in the above

NB: This is a serious matter of public interest so please acknowledge receipt of this letter and note that correspondence will be in the public domain

To whom it may concern,

This letter is to inform you that a majority of people reject calls by the M.E./CFS Epidemiology and Genomics Alliance (a project of the UK CFS/ME Research Collaborative) to support their forthcoming submissions for funding for their research proposals.

MEGA created a petition addressed to ‘mainstream research funders’ on a public petition site and this petition was publicised on internet sites of CMRC member charities representing ME patients, from 28th September 2016.

A number of valid concerns about this call for funding were not allayed by subsequent correspondence with members of the board of CMRC. Thus a counter-petition was posted on 19th October on the same petition site as used by MEGA to provide an option to register rejection of calls for mainstream funding of their study proposals.

Supporters of the counter-petition were described by a charity representative member of the CMRC Board as ‘a vocal minority’ and the Chairman of the board wrote that they were ‘baffled’ by opposition to the MEGA proposals, in spite of having read carefully considered and in some cases, quite detailed explanations of the various concerns.

The ‘MEGA’ petition was open for 35 days. It closed on the evening of 2nd November and has 2,542 signatures. The counter-petition ‘Opposing MEGA’ had 2,912 signatures at 35 days (currently over 3,000). This shows that more people rejected the call by MEGA for mainstream research funding than supported it within the same amount of time.

It is understood that the MEGA petition was a means to demonstrate the weight of support from patients for forthcoming grant applications. In that respect it has not succeeded as it is now a matter of public record that the majority of patients have cast a vote of no confidence in MEGA and reject calls for mainstream research funding applications by an alliance formed by the CMRC.

It will not suffice for MEGA or CMRC to reassure research funders that patients are represented on their steering and monitoring committees and advisory groups or that patient concerns will be taken on board. Such measures have not served the best interests of ME/CFS patients over decades past and there is no reason to suppose there will be any change in this position going forward. Indeed great harm has been caused to many ME/CFS patients with the same establishment charities involved as are currently represented in the CMRC.

In addition we are informed that the children and young persons representation will be taken from an existing group working within the University of Bristol. We must assume that this group of young people will already be involved in other trials being conducted by MEGA applicant, Professor Esther Crawley – MAGENTA and FITNET-NHS – both of which are already embroiled in controversy. These young people will, therefore, be already subjected to bias and influence.

Dr. David Tuller, academic coordinator of the concurrent masters degree program in public health and journalism at the University of California, Berkeley, explained:

“Dr. Crawley is a professor of child health at the University of Bristol. She is also currently recruiting for the MAGENTA study of graded exercise therapy for children with the illness. She is a lead player in the U.K. CFS/ME Research Collaborative, an umbrella organization that is sponsoring an ambitious Big Data effort called MEGA, now in the planning stages. While patients and advocates are desperate for the kind of top-notch biomedical and genetic research being proposed, many oppose MEGA precisely because of the involvement of Dr. Crawley and Peter White, the lead PACE investigator. (Dr. White is reportedly no longer involved in MEGA; Dr. Crawley still definitely is.)”

The PACE trial has been debunked internationally by leading clinicians and scientists, and 42 experts signed an open letter to The Lancet, condemning its egregious flaws and noting that they “have no place in published research.” The PACE trial has even been presented as a case study of bad science in graduate epidemiology seminars and at major scientific gatherings. MAGENTA relies on the PACE trial as evidence of efficacy of graded exercise therapy in adults. The PACE trial results have been shown to have been grossly exaggerated to claim positive effects of psycho-behavioural therapies, and in any case, had shown null effect at long-term follow-up. FITNET-NHS relies on a Dutch study, with methodologcal flaws, and which showed null effect of the treatment trial at long-term follow-up. As the MEGA team have consistently refused to answer all questions about PACE, and are even relying on it for funding of current treatment trials, we submit that the MEGA applicants are attempting to build a research project on crumbling foundations and should receive no further funding under any guise.

We would draw your attention to a number of parliamentary questions raised by Kelvin Hopkins MP regarding matters of conduct, policy, and funding, as these relate to individuals and organisations, including patient charities, involved in the MEGA proposal and on the board of the CMRC, and reflect the central concerns raised in the Opposing MEGA petition and the conclusion that we have no confidence in MEGA.

It is imperative that research funders are aware of the majority view in response to the request by MEGA for support of their proposals and the legitimate concerns behind this majority view. This is, of course, particularly important where those funds are from the public purse and when better value for money can be gleaned by using existing resources.

As Prof Jonathan Edwards, Emeritus Professor of Connective Tissue Medicine, stated on the Phoenix Rising Forum:

“Of course it would be nice to have a big study of lots of things in lots of patients but it needs to be done carefully and it will cost a vast amount of money to do that. I think it likely that the money would be better spent in other ways. We already have a Biobank resource and a method for recruiting cohorts – which could be improved but is a good start. I strongly suspect that several metabolomic and genetic and other projects are already being set up with reasonable sized samples elsewhere in the UK”.

The international scientific and clinical community is on the verge of establishing biomarkers for accurate diagnosis of this complex disease, known for research purposes as ME/CFS, and it would be foolhardy to fund a fishing expedition at this stage. However, we must emphasise that our petition is not primarily concerned with the details of the protocol, but rather with the insurmountable and serious matters of research conduct and integrity.

Patients and professionals alike were misled over the PACE trial from its inception to the present day. Children are among the patients suffering daily from the consequences. We cannot afford as a civilised society to repeat nor perpetuate this mistake.

Thus, we submit this letter and Opposing MEGA petition, along with its comments, as an outright rejection of calls by CMRC/MEGA for mainstream research funding and request that you ensure this letter and content is brought to the attention of all personnel in your organisation with responsibility for research funding applications.

We are willing to provide you with further information upon request. We would strongly recommend that you take note of the comments on the petition, the various updates posted and the Opposing Mega website

Yours faithfully,

A. Kirby

on behalf of

Organisers and signatories to the Opposing MEGA counter-petition –

Opposing MEGA rejects this petition by MEGA to mainstream research funders –


Wednesday, 1 February 2017

Hope Deferred But Not Denied


“Hope deferred maketh the heart sick” says the Scripture (Proverbs 13:12). We have all known some hoped-for thing come to nothing. Just when it looked like it would happen, it did not. The disappointment is hard to bear. And when a “false dawn” comes several times it can make us sick at heart.

It was like this for Joseph. The following verses record three times when his hopes were raised, then dashed.

Genesis 37:28 “Then there passed by Midianites merchantmen; and they drew and lifted up Joseph out of the pit, and sold Joseph to the Ishmeelites for twenty pieces of silver: and they brought Joseph into Egypt.”

Genesis 39:20 “And Joseph’s master took him, and put him into the prison, a place where the king’s prisoners were bound: and he was there in the prison.”

Genesis 40:23 “Yet did not the chief butler remember Joseph, but forgat him.”

Hardest

Of all the trials Joseph had, he must have found this element among the hardest to bear. They happened at three key points in his life and brought bitterness into his soul. It afterwards become clear, however, that they were necessary to the Lord fulfilling His purposes for Joseph, and through him for others too. Let us look at this more closely.

Joseph’s two dreams (Genesis 37:5-7; 9-11) were a divine forecast of events to come. He would be high over his brothers, and they would bow to him, signifying their dependence upon him. This was fulfilled when he became Egypt’s Prime Minister. In charge of storing grain during the plentiful years, Joseph sold it in the years of famine – including to his subservient brothers! The fulfilment is recorded in Genesis 42:6 (cf verse 9); 43:26,28; 44:14; and 50:18.

To make this happen, though, God in providence brought Joseph through raised – and dashed – hopes those three times. Painfully disappointing though these were, it was how Joseph came to that blessed place where he could look back and see that it all was meant for good. In the end, his disappointed hopes were fulfilled beyond what he imagined.

The same for us

And in principle it is the same for us. Has 2016 been a year of “hope deferred” for you? Are you tempted to think that the New Year will be no different? Resist the temptation to be disillusioned – even cynical. Considering what happened to Joseph – and the wonderful way all led to God’s expected end (Jeremiah 29:11) – can help us have renewed confidence in the God whose way is perfect, and who makes our way perfect (Psalm 18:30,32).

Let us look at the three occasions when the Lord led Joseph to expect deliverance and renewed blessing, only to see these hopes fail. We can then see that such debacles happen for a purpose, and that they fit into God’s unfolding purpose for our lives. It is not that He has failed us, or that the devil has prevailed, or that we are at the mercy of people and circumstances. It might seem like all of these, but it is all in the providence of God, for our greater good and His revealed glory.

1. The Hope Of Being Spared

Genesis 37:28 “and they lifted up Joseph out of the pit … and sold Joseph to the Ishmeelites for twenty pieces of silver: and they brought Joseph into Egypt.”

1] Here, Joseph is in danger and anguish.
The jealousy and anger of his brothers culminate in their plotting his murder. Approaching them in Dothan, they determine to frustrate his dream-prophecies, “Come now therefore, and let us slay him, and cast him into some pit … and we shall see what will become of his dreams (37:20). They would see what became of his dreams, but in a different way from what they thought! They “imagined a vain thing” (Psalm 2:1), for “the counsel of the LORD, that shall stand” (Proverbs 19:21).

Then on second thoughts they decide to put Joseph into a pit, presumably to leave him there to die (verses 23,24). They heartlessly had their meal before moving on (verse 25a). This shows how stifled their conscience was, able to eat their food and ignore his pleadings (Genesis 42:21). To Joseph it must have seemed the end of everything.

2] Then came hope.
“They drew and lifted up Joseph out of the pit” (verse 28). Eating, they saw in the distance approaching traders, en route to Egypt with their goods. An idea occurs: instead of killing their brother, they would sell him to these men. They would then not be guilty of murder, and be better off financially as well! Sometimes it seems that wickedness prospers at the expense of the righteous – but not for always!

Joseph, not knowing this new scheme, must have felt great relief. His hateful brothers have relented, and they are sparing him! As they lifted him out of that pit he could look forward to going home again. However, imagine the horror: “they drew and lifted up Joseph out of the pit, and sold Joseph to the Ishmeelites for twenty pieces of silver” (verse 28)! What a cruel and crushing disappointment!

3] It had to be.
The extra detail says it: “and they (the Ishmeelites) brought Joseph into Egypt” (verse 28b). Egypt is where Joseph’s future lay: where his dream-forecasts must be fulfilled, and where he was going to be made a blessing to his family and the world. The Lord was working, even by the callousness of his brothers, and the mercenariness of the Ishmaelites. Who would have thought? One day he would look back and see it. God often works like this. As John Flavel observed: “Some providences, like Hebrew letters, must be read backwards.”

Remember: hope deferred is not hope denied.

2. The Hope Of Things Improving

Genesis 39:20 “And Joseph’s master took him, and put him into the prison, etc.”

If his brothers thought that Joseph would vanish and be forgotten in Egypt they were mistaken. Not reckoning on the providential overruling of their wickedness, they were God’s servants to send Joseph there (45:4,5). And there the Lord had another instrument ready: Potiphar. He “just happened” to need another household servant, and was at the market when Joseph was there. Bought by Potiphar, Joseph finds himself in palatial surroundings – very different from Hebron and its fields and flocks.

His great comfort is: “And the LORD was with Joseph” (39:2). The fruit of the Lord’s present help was that Joseph could submit to his new circumstances and serve the Lord in them. This was grace, as James Smith wrote: “Religion is intended to make men happy, not by changing their circumstances, but by changing the disposition of their minds. A deeply-taught child of God, thoroughly sanctified by the Holy Spirit, could be happy anywhere, but another man could not.”

And Joseph found that Psalm 1:3 was fulfilled to him: “whatsoever he doeth shall prosper.” As time went by things improved because “he was a prosperous man … the LORD made all that he did to prosper in his hand” (39: 2,3). Moreover, “And his master … made him overseer over his house, and all that he had he put into his hand” (39:3,4).

1] Things had become bearable for Joseph.
If he must be far from home in a foreign land, this is not so bad. Perhaps in time, having so pleased his master, he could ask for a “leave of absence” and visit home and assure his father all is well. Meanwhile, he is blessed in the Lord, and in his upward mobility. Maybe he thought this was how he was going to rise even higher, eventually to the fulfilment of those dream-prophecies.

2] But, alas!
We find all Joseph’s hopes collapse in unexpected disappointment. From 39:7 we read that Potiphar’s wife tried to seduce the handsome young Joseph. He repeatedly rejects her advances in the gracious fear of the Lord. Deeply scorned, she hatches the plot that brings him down: to her husband she falsely accuses Joseph of these advances, producing his coat as fabricated evidence.

Not for the first time has the innocent been falsely accused by the guilty. And now Joseph exchanges his high position in Potiphar’s house for a low place of punishment in his prison (39:20). This second debacle must have been hard for Joseph to bear.

a] He has done what is right, and yet has unjustly suffered for it.
And where is “them that honour me I will honour” (1 Samuel 2:30) now? He had reasoned, in Matthew Henry’s words, “Better to lose a good coat than a good conscience.” But now he has lost his liberty as well.

b] He is in prison, surely to the shutting up of all his hopes.
Joseph has no way of knowing if he will ever be released. And even if he were, there could be no going back to Potiphar’s house.

c] This was real suffering for Joseph.
An extra detail comes in Psa.105:18 “Whose feet they hurt with fetters: he was laid in iron.” Yet, the physical suffering was not so intense as the sufferings of his heart.

3] This was the Lord’s way.
The grievous turn of events meant that Joseph met in prison the two servants of Pharaoh (40:3,4). It connected with the king of Egypt through his butler. The day will come when his memory divinely-jogged, he will mention Joseph to Pharaoh, who will only be too keen to meet him (41:14). And it will be the beginning of Joseph’s real rise.

For now, though, Joseph must walk by faith, and trust in the Lord who is with him (Proverbs 3:5,6). If he could have seen the outcome, the prison would have afforded more joy and light than his freedom. But faith is “the substance of things hoped for, the evidence of things not seen” (Hebrews 11:1). As Matthew Henry wrote, “God designed to pave the way to his enlargement.

Remember, hope deferred is not hope denied.

3. The Hope Of Deliverance

40:23 “Yet did not the chief butler remember Joseph, but forgat him.”

1] In prison, Joseph discovers what the Lord can be to him.
As in Potiphar’s house, he finds that no place shuts him away from God. Before long, he rises in trust and responsibility in the prison (40:21-23). The Lord makes up to Joseph his loss of liberty (Psalm 69:3) so that he becomes virtually the prison Governor. Here is comfort for all Christians imprisoned unjustly for the gospel’s sake, because they can do good wherever they are. In the story of Eric Liddell, life in the Weihsien Japanese internment camp was lifted immeasurably by his cheerful organising of things for the children, helping the elderly, and keeping up a good spirit among his fellow-internees.

2] There came encouragement.
Joseph is afterwards joined by two of Pharaoh’s important servants: the chief butler, and the chief baker (40:3,4). His quick mind sees significance in this: they have dreams that forecast their future! This must have made him think of his dreams and their meaning. Moreover, the Lord enables him to correctly interpret both men’s dreams, leading to the butler being restored to his position of service to Pharaoh (40:13).

Here, surely, is hope raised again! Joseph sees his opportunity, and asks the butler, when restored, to mention his case to Pharaoh, explaining the injustice of all that has happened to him (40:13-15).

Some have questioned the rightness of what Joseph does here. That by his resorting to this device, he is not trusting the Lord but looking to man. However, it can as easily be understood as Joseph using lawful means to help bring about the answer to his prayers. In providence, it is usually the rule that if there are lawful means to be used, they are themselves providential and can be the way the Lord takes to answer prayer (e.g. 2 Samuel 15:31-34). When this is so, to overlook means is presumptuous.

3] However, once again Joseph is disappointed.
The fulfilment of the two men’s dreams were as Joseph had said: Pharaoh restored the chief butler and hanged the chief baker. However, as the days passed and no one came to Joseph’s cell, no enquiry was made into his case – Joseph finally realised, “Yet did not the chief butler remember Joseph, but forgat him” (41:23). This was a crushing blow, yet again. Perhaps Joseph’s last hope is now gone. And this lasted for two years (41:1).

Perhaps this is familiar. Someone you looked to for help has let you down. Maybe a good friend has turned against you. It may even be someone in the family has grievously disappointed you. We all know that sinking feeling as our heart is made sick. We are not alone. Joseph, one of the best men in the Bible, experienced more of this than we are likely to know. And God’s choicest saints must come this way. Be encouraged now as we consider the sequel.

4] It all ended wonderfully well.
After the two years – “two full years” – for God is never too early or too late – something happened. God visits Pharaoh with similar dreams to Joseph’s and the butler’s and baker’s, because they are divine forecasts of the future. The dreams deeply perplex Pharaoh because he cannot understand what they predict. None of his so-called magicians can tell him its meaning. He desperately needs someone to interpret – and that jogs the butler’s memory (41:9ff).

Now Pharaoh sends for Joseph. Before, Joseph has hoped that he might send to Pharaoh for help. When God’s time comes, Pharaoh sends for him: “they brought him hastily out of the dungeon … and came in unto Pharaoh” (41:14). The word for “hastily” is in the margin: “made him run.” Not one moment longer is Joseph left a disappointed man. When God’s time comes, there is no delay (cf Luke 18:8 “he will avenge them speedily”). We know the rest of the story. Joseph interprets Pharaoh’s dreams and thus his own eminent future, which soon unfolds.

Joseph’s brothers – the very ones who tried to thwart his future – are now brought to Egypt to be part of that future. The whole family come to Egypt to be “nourished” by Joseph. And so, another stage in the unfolding drama of redemption takes place. Ahead will be the sufferings in Egypt, the exodus, entrance to Canaan, the kings – all the way to “the fullness of the time” when, of that nation of Israel our blessed Lord will come.

Joseph little knew what great things were bound up in his three disappointments. But he lived to see that God “hath made every thing beautiful in his time” (Ecclesiastes 3:11), and so will we. Dear reader: hope in God, and from the depths of disappointed hopes still look to Him. His guiding Hand is on your life, and your minutest circumstances are subject to His care. Your times are in His hand and He will bring you through to that place where you can see all the way He has led you, and He has done all things well. Learn these lessons,

a] Our disappointments are His appointments.
In order that He might bring us to our desired haven of blessing.

b] Negative providences are still providences.
He reserves the right to close doors as well as open them.

c] Be thankful for everything that has not happened.
They would have gratified your desires for a while, but you would have missed God’s best.

Thy ways, O Lord, with wise design
Are framed upon Thy throne above,
And every dark and bending line
Meets in the centre of Thy love.

With feeble light and half obscure
Poor mortals Thine arrangements view,
Not knowing that the least are sure
And the mysterious just and true.

Thy flock, Thine own peculiar care,
Though now they seem to roam uneyed,
Are led or driven only where
They best and safest may abide.

They neither know nor trace the way;
But whilst they trust Thy guardian eye,
Their feet shall ne’er to ruin stray,
Nor shall the weakest fail or die.

My favoured soul shall meekly learn
To lay her reason at Thy throne;
Too weak Thy secrets to discern,
I’ll trust Thee for my Guide alone.

(Ambrose Serle, 1742-1812)

by Rev. John Thackway, Pastor of Holywell Evangelical Church

Used with kind permission of the author


Tuesday, 24 January 2017

Children with ME need relevant science, not pressure to do more, more, more


By Jenny Horner on 24th January, 2017

An advocate and campaigner living with ME explains why she opposes Bristol University’s trials on children with the condition.

In November, Bristol University made national headlines for a £1m trial attempting to treat child ME sufferers using a specific form of cognitive behaviour therapy (CBT) over the internet. In chronic conditions, talking therapies can be useful support for the uncertainty and loss caused by illness. However, CBT is being used differently in ME with a strong agenda to increase activity, without treating the underlying disease. Bristol is also trialling a controversial ‘graded exercise therapy’ (MAGENTA).  As an ME sufferer myself, I am deeply troubled to see the continued use of approaches to treat ME that can harm sick children instead of helping them.

The hallmark of ME is an exacerbation of symptoms following physical or cognitive exertion. The repercussions are usually delayed by a day or two and sometimes a relapse can be indefinite. One day I was out walking my dog on the Downs, the next day I was struggling to sit up in bed. Biological findings into ME (myalgic encephalomyelitis) involve the immune system, metabolism and mitochondria. There seems to me no logical explanation for how this could be reversed by CBT or graded exercise.

At the 2016 conference for the International Association for Chronic Fatigue Syndrome/ME, the only CBT-focused study (larger than Bristol’s FITNET-NHS one) concluded that “findings suggest that individuals do not reduce activity level due to illness beliefs, as proposed by the cognitive behavioural theory of CFS… exercise-based interventions lack empirical justification”. The nature of patient opposition to the Bristol trial also includes similar studies failing to report differences at long-term follow-up, poor definition of ME/CFS and reliance on subjective measures.

Graded exercise therapy is more controversial still and reports more harm than benefit in patient surveys. In one ME Association survey 74% reported harm, including starting to need a wheelchair and becoming bed/housebound. Patients aren’t made aware of these risks and if you become severely affected there is no antidote or effective treatment available.

Child studies usually need to be justified by beneficial adult evidence. MAGENTA is based on an infamous £5m study (known as the ‘PACE trial’), which is cited as an example of bad science. In this study patients could get worse yet be classed as ‘recovered’. It is no basis for an ethical trial on children.

Exciting developments, such as appropriating cancer drugs, are showing good results for ME. Patients in this country want to see what little research money there is focused on well-designed biomedical studies, not another £1m of public money targeted at repetitive psychosocial trials.

Adults with ME feel that our views on these issues are usually ignored or caricatured. Children with ME have even less of a voice.

Find out more about the issues and petition Parliament about graded exercise therapy: www.stopGET.org


Wednesday, 18 January 2017

A Travesty Of Science And A Tragedy For Patients: Quotable Quotes Continued 2006 – 2016

This is a long document, so I have just posted the first section. To download and read the whole document, please go to –


A Travesty Of Science And A Tragedy For Patients: Quotable Quotes Continued 2006 – 2016

This document is in 4 sections: Professors Wessely, White, Sharpe and the PACE Trial

Compiled by Margaret Williams

17th December 2016

To assist the reader, as this document is quite lengthy, notable sentences have been highlighted in yellow.

In his power-point presentation on 29th June 2011 about the PACE Trial for the “Forward ME” meeting at The House of Lords, Professor Malcolm Hooper referred to the ME situation in the UK as: “The 3 Ts – Travesty of Science; Tragedy for Patients and Tantamount to Fraud”.

The tragedy for ME patients in the UK existed long before the PACE Trial: it has existed for the last three decades. Can it be attributed to the zealous proselytizing by certain psychiatrists – all of whom are involved with the medical insurance industry and who deem themselves “experts” on ME/CFS - to convert non-believers to their own beliefs about the nature of it?

As in “Quotable Quotes Updated” (which provided examples of unhelpful comments about people with ME/CFS from 1988 to 2005 emanating from psychiatrists Professors Simon Wessely, Peter Denton White and Michael Sharpe and can be accessed at www.margaretwilliams.me), this continuation provides more illustrations of their published views on ME/CFS from 2006 to 2016. It is not comprehensive but merely representative.

In order to understand the effect on patients with ME of the Wessely School’s beliefs and their total disregard of the mainstream biomedical evidence-base that has been shown to underpin the disorder (evidence which vitiates their beliefs), it is essential to be aware of that evidence-base, particularly of the widespread inflammation and the proven immunological, cardiovascular, endocrine, gastrointestinal and musculoskeletal dysfunction, summaries of which can be accessed at www.margaretwilliams.me

One would have expected that these psychiatrists would have kept up-to-date (which doctors are required to do) but their views have remained intransigent (ie. They continue to insist that ME/CFS is a behavioural disorder and that patients who believe they suffer from a physical disease perpetuate their own “perceived” ill-health).

Although some of these quotations are from ten years ago, they were published during the planning/execution of the PACE trial, whose interventions of CBT and GET were predicated on these psychiatrists’ beliefs. 

To continue reading the document, go to 



Saturday, 14 January 2017

A psychosomatic diagnosis is a doctor’s way of saying, “I don’t have a clue”


Written By Jamison Hill

For the last six years, I have fought to legitimize an illness widely—and erroneously—believed to be “all in your head.”

I have myalgic encephalomyelitis, a debilitating multi-system disease that the Centers for Disease Control and Prevention conservatively estimates afflicts more than one million Americans. It is commonly known as chronic fatigue syndrome, a truly trivializing name that belittles what I and other sufferers live with. (Though it is preferable to the condescending term “yuppie flu.”) Doctors have told many people with the disease—including myself—that there is no treatment, and more often, that what we are experiencing is merely a manifestation of the mind.

The latter is the basis for psychosomatic theory, which is the idea that the mind can produce diseases. Diseases commonly thought to be psychosomatic—such as irritable bowel syndrome and Crohn’s disease—can pummel a healthy, thriving member of society without any indication of how. This theory became popular in the US in the early 20th century; Sigmund Freud is the most well-known name associated with it, who maintained that “hysteria” could cause any number of physical illnesses.

Similar theoretical concepts like somatoform disorder suggest that the body can only cope with a finite amount of mental factors before physical symptoms, like headaches, begin to show. But there is a substantial difference between an acute problem like a stress-related headache and claiming that a serious chronic illness is psychosomatic. With the exception of chronic migraines, a headache is generally considered to be an acute symptom, not a chronic illness.

The theory of psychosomatic illness is flawed. Many serious illnesses are initially tagged as psychosomatic because they are too complex for doctors to offer a singular explanation or because the patients have no physical symptoms. There may be a connection between the body and mind—the brain is, after all, an anatomical feature of the body—but this does not mean that physiological diseases can be manifested through mental factors. For example, a 2007 commentary published in the Journal of the American Medical Association concluded that while stress can be a factor in some diseases, “a causal relationship” could not be found.

Dr. Dale Peterson, former president of the Oklahoma Academy of Family Physicians, is even more adamant that physiological disease cannot be caused by mental factors. “Psychological and sociological dynamics may predispose an individual to illness or cause an illness to be much more severe, but other factors must be present to trigger the condition,” he says.

The idea that a disease can be generated from the mind not only lacks scientific evidence—it is belittling to those who suffer from physical illnesses. As Dr. Peterson explains, for someone in the medical field to say a physiological illness is psychosomatic is merely “a professional way of saying I don’t have a clue!”

I contracted myalgic encephalomyelitis after a bad case of mononucleosis in 2010 (an illness often jokingly referred to as the “kissing bug”). Within the first year, my condition had deteriorated to the point where I could no longer take care of myself; I had become bedridden, and eventually lost my ability to speak, eat, tolerate light, or lift my head off the pillow. Through a daily regimen of oral anti-viral medication and IV treatments, my health eventually started to improve. I can now speak polysyllabic words, chew soft food, and sit up in bed to see the sunlight streaming across my room.

But these improvements have had nothing to do with changes in my mental state; I did not will them to happen. Instead, my body was given the proper medicine to improve its physiological impairment.

Regardless, many doctors still disregard my ailments as some form of psychosomatic illness. But sometimes technology just isn’t advanced enough in order to reveal the true underlying physical symptoms behind a disease. For example, until the invention of the MRI in the 1970s, multiple sclerosis was believed to be a form of “hysterical paralysis.” Likewise, some forms of autism, particularly in children, were once thought by some psychologists to be due to a lack of maternal nurturing. Similarly, until inflammation could be measured, asthma was also commonly blamed on overbearing mothers. We all now know that these three diseases have true, physiological causes—not mental ones.

While these illnesses have largely overcome psychogenic theories, other physiological illnesses still face similar stigmas: Inflammatory conditions like Crohn’s disease, stomach ulcers, and irritable bowel syndrome (IBS) still carry psychosomatic overtones—usually stress-related—even though they have been proven to have physiological origins. Researchers at the University of Edinburgh, for instance, have compiled an overview of studies that link Crohn’s disease to factors such as genetics, immune function, and gut bacteria, not psychogenesis.

A lot of this misinformation has spread widely throughout popular culture despite being proven scientifically unsound. For example, a study published in 2011 in the Lancet, a prestigious UK medical journal, used psychosomatic theory to claim that cognitive behavioral therapy (CBT) substantially benefited people with myalgic encephalomyelitis. The study, known as the PACE trial, was eventually debunked and proved to be the product of bad science—but not before it had influenced public-health services to adopt treatment models, many of which actively harmed patients by prescribing exercise to severely ill patients based on psychogenic models.

There is hope, however. After all, multiple sclerosis and autism have managed to transcend the stigma of outmoded psychosomatic theory. But until the government and medical establishment realizes that psychosomatic theory has no place in modern medicine, diseases like mine will continue to be stigmatized, trivialized, and dismissed.