Esther Crawley

From MEpedia, a crowd-sourced encyclopedia of ME and CFS science and history
Revision as of 16:09, February 5, 2018 by Canary (talk | contribs) (edit)
200p

Esther Crawley is Professor in Child Health at the University of Bristol in the United Kingdom. She is a proponent of Cognitive Behavioural Therapy (CBT) and Graded Exercise Therapy (GET) as treatments for paediatric and adult Chronic Fatigue Syndrome.

She is vice-chair of the UK CFS/ME Research Collaborative (CMRC) and leads the paediatric centre for children and young people with ME/CFS at the Royal United Hospital in Bath. (Previously at the Royal National Hospital for Rheumatic Diseases in Bath). Her work has been funded by the National Institute for Health Research (NIHR) and Action for ME.[1].

She was on the guideline development group for the NICE guidelines published in August 2007 and the Medical Research Council CFS/ME expert working group (2009-2010).

She has published studies in the Journal of Psychosomatic Research [2] and collaborates with Peter White of Queen Mary University of London.

Since 2006, Prof Crawley has been awarded £2.3 million in grants by various bodies to study CFS/ME and is the second highest funded researcher in the UK .[3].

Qualifications

BA(Hons), BMBCh(Oxon) Bachelor of Medicine, PhD(UCLond)


Notable studies[edit | edit source]

Esther Crawley is involved with a number of research projects all of which have come in for heavy criticism from individual patients, charities, patient groups, members of the medical profession and scientists.

SMILE trial

SMILE was a pilot trial on children with ME/CFS and involved comparing the effects of standard medical treatment (SMC) against that of the Lightning Process & SMC.[4] The initial budget was £164,000 funded by the Linbury Trust and the Ashden Trust.[5]

Children aged 12 to 18 were drawn from the Bristol & Bath areas, with those too unwell to attend hospital appointments excluded. The charity Association of Young People with ME (AYME) was a participant in the trial[6] and gave evidence in support during the trial ethics procedure.

A Freedom of Information request asking for the cost of the trial and payments to Phil Parker were turned down as they university states the "information is held by the University but is exempt from disclosure under section 22(1) of the Freedom of Information Act as it is information intended for future publication."[7]

MAGENTA trial

Prof Crawley is studying GET in children.[8]. The protocol[9] and peer review history[10] have been published.

The trial started in September 2015 and studies 100 paediatric patients aged 8-17 in centres in Bath, Newcastle and Cambridge who randomly receive graded exercise therapy or activity management. It aimed to be completed in August 2016.

FITNET

This is a major study led by Dr Crawley funded by the NIHR which began in May 2016 and is due to be completed by May 2022.[11] The projected cost is £994,430 and participants include UMC Utrecht and Radboud University Medical Centre in the Netherlands. The charity AYME and the Science Media Centre are also involved to "help us inform patients".

The study aim is to test FITNET-NHS (specialist CBT for paediatric CFS/ME delivered on-line) compared with Activity Management in terms of cost-effectiveness and clinical success.

David Tuller who exposed the PACE trial scandal in his Trial by Error series of investigations wrote about FITNET in November 2016. On 21 Nov, 21016 he wrote Trial By Error, Continued: The New FITNET Trial for Kids and on 28 November 2016 he wrote Trial By Error, Continued: A Follow-Up Post on FITNET-NHS.

There was severe criticism by patients including on the Bristol university student newspaper Backlash for ‘landmark’ University research trials.

MEGA

Esther Crawley was one of the authors in a paper on Pervasive Refusal Syndrome (PRS) presenting with Chronic Fatigue Syndrome: avoiding the pitfall of a wrong diagnosis in which Patients with PRS were similar to those with CFS/ME in terms of age, gender, presence of anxiety or depressive symptoms, time to assessment and pain. They were more disabled than CFS patients and had higher levels of fatigue. It is not clear how PRS is distinguished from severe ME/CFS as the description of PRS matches that of severe/profound ME/CFS. The study suggests that clinicians should think about PRS in patients with refusal symptoms affecting, eating, social interaction, self-care, mobility and treatment. Patients have extremely high levels of fatigue and/or disability. Post-exertional fatigue and disrupted sleep occur but patients are less likely to have characteristic symptoms of CFS/ME such as unrefreshing sleep. Of major concern is that the treatment for PRS is admittance to a psychiatric ward and coercion to do more activity i.e. the exact opposite of the needs of a child with profound ME/CFS. A clinical case that describes a child with pervasive refusal disorder (3) is consistent with a description of profound ME/CFS, and the description of what works to help the child is also consistent with what helps a child with profound ME/CFS, "Treatment must involve tender loving care. The carers must be very patient and sensitive. It takes a long time for the patients to recover, and pressuring them makes their condition worse. It typically takes a few months of treatment before it becomes possible to implement a very gradual rehabilitation programme. Therapeutic enthusiasm in the early stages is almost always counterproductive [11]." Ironically the authors did not appear to collect any physiological data such as the child's temperature (despite her complaints of being cold, or her heart rate, and blood pressure.[12]

Article in Archives of Disease in Childhood 99(Suppl 1):A70-A70 · April 2014 with 246 Reads DOI: 10.1136/archdischild-2014-306237.168

(2) Eur Child Adolesc Psychiatry. 2009 Nov; 18(11): 645–651. Published online 2009 May 21. doi: 10.1007/s00787-009-0027-6 PMCID: PMC2762526 Pervasive refusal syndrome as part of the refusal–withdrawal–regression spectrum: critical review of the literature illustrated by a case report Tine Jaspers,corresponding author1,2 G. M. J. Hanssen,3 Judith A. van der Valk,3 Johann H. Hanekom,4 Gijs Th. J. van Well,5 and Jan N. M. Schieveld1

(3) Pervasive refusal syndrome as part of the refusal–withdrawal–regression spectrum: critical review of the literature illustrated by a case report Tine Jaspers,corresponding author1,2 G. M. J. Hanssen,3 Judith A. van der Valk,3 Johann H. Hanekom,4 Gijs Th. J. van Well,5 and Jan N. M. Schieveld1


Controversies and Criticism[edit | edit source]

GMC Complaints and claims of abuse and death Threats

Dr Crawley has been the subject of complaints to the General Medical Council (GMC)[13] and claimed to have received death threats[14]

No evidence was provided of such abuse claims.

Canadian Consensus Criteria

In an reply to an Editorial in the British Medical Journal by Fiona Goodle, Crawley (with Peter White and Alastair Miller) rejected using the Canadian Consensus Criteria to diagnose patients, labeling it as "not practical", although conceding post-exertional malaise (which is part of the criteria) "may need incorporating in future definitions to help differentiate CFS from more general fatigue."[15][16]

Prevalence at Age 16

In a study[17] published in 2016 using data from almost 6000 children in the Children of the 90s Project[18], Crawley and her team concluded that the prevalence of CFS at age 16 was 1.8%. However, the children were included as having CFS on the basis of questionnaires, no doctors were involved in the diagnosis, and there was no attempt to exclude other fatigue-related conditions except depression. If children reporting depressive thoughts were excluded, the prevalence was reduced to 0.6%, but the 1.8% figure was highlighted in the media. BBC Radio 4 coverage[19] described the condition studied as ‘ME also known as chronic fatigue syndrome’. Dr Charles Shepherd of the ME Association wrote to express concerns about the methodology used but the journal did not publish his letter[20]

NICE Guidelines

Esther Crawley was on the Guideline Development Group (GDG) for the controversial NICE guidelines CG53 which were published in 2007.

Science Media Centre Expert on PACE trial

Crawley was on of the experts chosen by the Science Media Centre to comment on the PACE trial publications in February 2011 and January 2013. She said “All children with chronic fatigue syndrome and their parents are desperate for new research to understand how to treat this condition. The next step is to do a study like this for children to find out if these treatments work.”[21][22]

She also stated in a BBC interview that the PACE trial was “a great, great study.” [23]

Smearing critics as "anti-science" and unauthorised use of personal photos

Esther Crawley presented at a conference in April 2017which she accused all critics of her work being "anti-science' and being harassed. She smeared patient groups, scientists and Dr David Tuller. She inferred about patients being drug users, criminals, with financial and relationship problems. She also defamed a US college student whose picture she took without any permission and used in her presentation [24] [25] .

MUPPETS conference

Esther Crawley presented at a conference called 'A day with the MUPP(ET)S on 18 May 2017 [26]. The term Muppets is a derogatory word meaning stupid person. ME patients and charities condemned the title of the muppets talk. The Tymes Trust issued condemnation [27]. The offensive name of the talk was reported in local media [28].

Continued gaslighting of all ME patients & advocates in science conferences

Crawley continued her smear campaign and theme of portraying sick and disabled ME patients and advocates and other scientists of criticising her flawed science as harassment and abusive and militants at a 'Better Science Better Data' conference in October 2017[29]. She provided no actual evidence of her claims of harassment and instead made numerous unfounded statements to smear all disabled ME patients and advocates who advocate for biomedical research as "fake news" [30].

Freedom of Information Request showed zero evidence of harassment

The Tymes Trust was concerned about the repeated accusations of harassment by Crawley the PACE trial authors and submitted a Freedom of Information Act (FOI) request to Bristol University who are Crawley's employers. Bristol University was followed up for the request and including with escalation to the Information Commissioner who instructed the university to comply with the request. Bristol University eventually responded "We have received no official reports of harassment of University staff by a third party between September 2010 and June 2015.". Therefore there was no evidence of any harassment despite the campaign in the media and science conferences. [31].

An article was published 'Esther Crawley claims harassment, university has no record' examining the Freedom of Information request and the alleged claims of widespread threats and harassment to Esther Crawley and stated "a Freedom of Information request to her own institution by The Tymes Trust, revealed that no such incidents had been reported to them." The article examined a number of alleged claims of harassment and threats and that they had been rejected by the courts in the PACE trial tribunal. Also that some threats and repeated by Crawley in a number of live talks which she said were sent to her were false as it transpired it was actually an artists illustration used in a magazine article cover.

Subsequently the University of Bristol published a confusing statement on their website and stated that it was aware "Professor Crawley in particular has experienced significant harassment and personal abuse over several years". This was inconsistent with the actual official FOI response. It explained that "The University does not have a process for 'official recording' of harassment by third parties of our members of staff hence the response to this FOI request" Voices from the Shadows commented on the controversy in their article 'Bristol University both denies and supports Prof Crawley in her career enhancing “heroic victim” narrative' . They stated of the inconsistency "However, this is seriously at odds with their website, which now echoes the accusations Prof Esther Crawley has been making very publicly at several lectures this year." and "If this really is true, then the University has given a fraudulent response to the Freedom of Information requests."

Open letter to TEDxBristol regarding Crawley's talk "Disrupting Your View of ME"

Esther Crawley continued with her talks and presented at a TEDxBristol talk called "Disrupting Your View of ME" on 2 November 2017 [32] in which she claimed she was disrupting the views of the illness and was the voice of patients. TEDx are not the official TED conferences but TEDx are independent TED-like events, which can be organized by anyone who obtains a free license from TED [33]. This was at the same time during the Unrest film campaign in which Jennifer Brea promoted the film in the UK media for the launch. On the 15th December 2017, Carly Maryhew, one of the co-authors of the PACE trial data re-analysis, sent a letter, a copy of which is available on the Science for ME forum [34] to TEDxBristol, explaining, in part, "the contents of that talk did not seem to comply with the standards of TEDx, as described in the TEDx Content Guidelines.[1] While that might be sufficient to result in the video merely being displayed with a warning regarding the contents, there are other portions of Professor Crawley's presentation which are highly offensive" The letter stated "Not only is she promoting blatant pseudoscience and making false accusations against the patients who oppose her work, she goes so far as to brazenly suggest that she should be our voice....All Professor Crawley needs to do is to stop attempting to silence us."

The TedxBristol talk was recorded and is available on-line [35].

Jennifer Brea tried to avoid singling out a single researcher but finally wrote 26 tweets on twitter about Esther Crawley's behaviour stating that "You do not need to "provide our voice." and that disabled ME sufferers have voices which they use daily and the full thread is available on thread reader [36].

Criticism of Crawley by scientific community

Dr David Tuller has criticised Crawley's approach to science and challenged her on her accusations that he was engaging in libellous blogging [37]. She did not respond to attempts at discussion and contact.

Tuller then attended a talk by Esther Crawley called “What is new in paediatric CFS/ME research” at the University of Exeter’s Mood Disorders Centre [38]. Crawley again repeated her accusation of harassment in the talk but did not specifically mention Virology blog as libellous. She refused to answer the questions and stopped the talk. Tuller also concluded that "I believe that Professor Crawley wants to bully those who raise concerns about her work into silence rather than engaging in robust debate about the very real methodological and ethical problems with her studies."

Crawley stated that a "cease and desist letter" had been sent in the talk and that she also mentioned the notion of consulting with the police over the matter. Dr Tuller did not receive any cease and desist letter and wrote to the University of Bristol legal department to enquire about whether such a letter had been written and what he was supposed to cease and desist from [39].

Her university did not respond so Tuller pursued the matter further and posted another article examining the issue and then a response was sent in which the legal department stated "If by a ‘cease and desist’ letter you mean a letter threatening legal action if the recipient does not stop a specified activity or behaviour, then I can confirm that the University of Bristol has not sent you or your institution such a letter" [40]. Crawley had again made a false statement over the sending of a cease and desist letter.

Dr Tuller has since published all his attempts at contact with Esther Crawley to discuss and attempt to resolve matters in his post 'Trial By Error: My One-Sided Correspondence with Professor Crawley' in which she failed to respond to any of his emails.


Buzzfeed investigation

Buzzfeed reported on the controversy and issues surrounding Esther Crawley and the SMILE trial and other related controversies in their article A Controversial Therapy For ME Has Led To Claims Of Death Threats, Harassment, And Pseudoscience. Buzzfeed investigated the issues and for balance spoke to both Dr David Tuller and Dr Esther Crawley. Dr Crawley responded to some issues but the article stated "Crawley declined to talk about the issue when asked by BuzzFeed News" in relation to her allegations about libel and harassment. Bristol University responded to some issues but on the point about serious issues about probity raised by Prof Edwards, "Bristol said it didn’t feel it was appropriate to comment on this."

Dr Tuller commented on Crawley's attempts to justify her methodological choices in the article 'Professor Crawley's Bogus Buzzfeed claims'.

Freedom of information requests[edit | edit source]

A number of Freedom of Information requests have been made to Dr Crawley about her work. One request revealed records were not kept of patients subsequently re-diagnosed with another illness at Dr Crawley's paediatric clinic.[41]

Media coverage & interviews[edit | edit source]

Other publications[edit | edit source]

  • 2016: Taylor, A, Loades, M, Brigden, A, Collin, S & Crawley, E, 2016, ‘“It’s personal to me”: A qualitative study of depression in young people with CFS/ME’. Clinical Child Psychology and Psychiatry.
  • 2016: Brigden, A, Beasant, L, Hollingworth, W, Metcalfe, C, Gaunt, D, Mills, N, Jago, R & Crawley, E, 2016, ‘Managed Activity Graded Exercise iN Teenagers and pre-Adolescents (MAGENTA) feasibility randomised controlled trial: study protocol’. BMJ Open, vol 6.
  • 2016: Norris, T, Hawton, K, Hamilton-Shield, J & Crawley, E, 2016, ‘Obesity in adolescents with chronic fatigue syndrome: an observational study’. Archives of disease in childhood.
  • 2016: Parslow, R, Harris, S, Broughton, J, Alattas, A, Crawley, E, Hayward, K & Shaw, ARG, 2016, ‘Children’s experiences of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME): A systematic review and meta-ethnography of qualitative studies’. BMJ Open.
  • 2016: Norris, T, Collin, S, Tilling, K, Nuevo, R, Stansfeld, S, Sterne, J, Heron, J & Crawley, E, 2016, ‘Natural course of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis in adolescents’. Archives of Disease in Childhood.
  • 2016: Loades, M, Sheils, E & Crawley, E, 2016, ‘Treatment for paediatric chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME) and comorbid depression: a systematic review’. BMJ Open. Harris, S, Gilbert, M, Beasant, L, Broughton, J & Crawley, E, 2016, ‘A qualitative investigation of eating difficulties in adolescents with chronic fatigue syndrome/myalgic encephalomyelitis’.
  • 2016: Stoll, S, Loades, M & Crawley, E, 2016, ‘Anxiety in paediatric Chronic Fatigue Syndrome (CFS/ME): A Systematic Review’.
  • 2016: Crawley, E, 2016, ‘Trials and tribulations’. New Scientist, vol 232., pp. 20-21
  • 2015: Collin, SM, Tilling, K, Joinson, C, Rimes, KA, Pearson, RM, Hughes, RA, Sterne, JAC & Crawley, E, 2015, ‘Maternal and childhood psychological factors predict chronic disabling fatigue at age 13 years’. Journal of Adolescent Health, vol 56., pp. 181-187

Online presence[edit | edit source]

Directorships and Shareholdings[edit | edit source]

Esther Madeleine Crawley has 1 total appointment.

See also[edit | edit source]

References[edit | edit source]

  1. ↑ Action for ME announces grant for Esther Crawley on incidence Severe Paediatric ME
  2. ↑ Chronic Fatigue Syndrome (CFS) symptom-based phenotypes in two clinical cohorts of adult patients in the UK and The Netherlands
  3. ↑ ME/CFS Research Funding - CMRC (Sept 2016)
  4. ↑ Crawley, Esther; Mills, Nicola; Beasant, Lucy; Johnson, Debbie; Collin, Simon M; Deans, Zuzana; White, Kate; Montgomery, Alan (2013), "The feasibility and acceptability of conducting a trial of specialist medical care and the Lightning Process in children with chronic fatigue syndrome: feasibility randomized controlled trial (SMILE study)", Trials, 14 (415), doi:10.1186/1745-6215-14-415
  5. ↑ £164,000 grant for study into the Lightning Process and children with ME - ME Association (March 2010)
  6. ↑ SMILE Protocol documents: Bristol University December 2013
  7. ↑ Refusal of Information request by Bristol Uiversity - James Coyne (Oct 2016)
  8. ↑ The MAGENTA trial: can we investigate the effectiveness and cost effectiveness of managed activity compared to graded exercise in teenagers and pre-adolescents
  9. ↑ Managed Activity Graded Exercise iN Teenagers and pre-Adolescents (MAGENTA) feasibility randomised controlled trial: study protocol
  10. ↑ Peer Review History for MAGENTA trial
  11. ↑ FITNET to treat Paediatric CFS/ME (NIHR)
  12. ↑ The treatment for pervasive refusal syndrome as described here for PRS, is exactly the same as the protocols used by patients worldwide, experienced clinicians, Dr. Nigel Speight.G160(P) Case series of Pervasive Refusal Syndrome presenting with Chronic Fatigue Syndrome: avoiding the pitfall of a wrong diagnosis
  13. ↑ GMC complaint - Dr Esther Crawley
  14. ↑ Transcription BBC Radio 4 interview with Esther Crawley and Charles Shepherd
  15. ↑ Ending the stalemate over CFS/ME: British Medical Journal
  16. ↑ Use of the Canadian criteria to diagnose CFS: ME Association
  17. ↑ Chronic Fatigue Syndrome At Age 16 Years: Pediatrics (Jan 2016)
  18. ↑ Children Of The 90s Project: Avon Longitudinal Study Of Parents And Children
  19. ↑ BBC Radio Four Womans Hour Interview with Esther Crawley: Jan 2016
  20. ↑ Phoenix Rising copy of unpublished letter from Charles Shepherd to Pediatrics: Feb 2016
  21. ↑ expert reaction to Lancet study looking at treatments for Chronic Fatigue Syndrome/ME - Science Media Centre Feb. 17, 2011
  22. ↑ expert reaction to new research into therapies for Chronic Fatigue Syndrome/ME - Science Media Centre Jan. 31, 2013
  23. ↑ http://forums.phoenixrising.me/index.php?threads/radio-on-me-cfs-sat-5th-nov-9-10amgmt.47759/#post-783344]
  24. ↑ http://forums.phoenixrising.me/index.php?threads/crawley-how-to-deal-with-anti-science-brs2017.51066/page-3#post-842717
  25. ↑ http://forums.phoenixrising.me/index.php?threads/crawley-how-to-deal-with-anti-science-brs2017.51066/page-3#post-842718
  26. ↑ https://web.archive.org/web/20170518090923/http://www.swpc.org.uk/meetings.htm
  27. ↑ https://m.facebook.com/story.php?story_fbid=1973008186317647&substory_index=0&id=1482582732026864
  28. ↑ http://forums.phoenixrising.me/index.php?threads/esther-crawley-18th-may-2017-a-day-with-the-mupp-ets-and-more.51518/page-8#post-851208
  29. ↑ https://web.archive.org/web/20170818062008/https://www.eventbrite.co.uk/e/better-science-through-better-data-2017-scidata17-tickets-32719974324
  30. ↑ https://www.facebook.com/scientificdata/videos/1410989405696093/
  31. ↑ http://www.tymestrust.org/pdfs/noharassmentbristol.pdf
  32. ↑ https://tedxbristol.com/speakers
  33. ↑ https://en.wikipedia.org/wiki/TED_(conference)#TEDx
  34. ↑ https://www.s4me.info/index.php?threads/open-letter-to-tedxbristol-regarding-esther-crawleys-presentation-on-2-november-2017.1532/
  35. ↑ https://pwme.uk/EC/Crawley%20TEDx.mp4
  36. ↑ https://threadreaderapp.com/thread/947170518825758720.html#
  37. ↑ http://www.virology.ws/2017/05/03/trial-by-error-continued-my-libelous-blogging-on-virology-blog/
  38. ↑ http://www.virology.ws/2017/11/20/trial-by-error-my-brief-encounter-with-professor-crawley/
  39. ↑ http://www.virology.ws/2017/11/22/trial-by-error-hey-bristol-where-is-my-cease-and-desist-letter/
  40. ↑ http://www.virology.ws/2017/11/29/trial-by-error-the-crawley-chronicles-continued/
  41. ↑ Number of children re-diagnosed with a psychological or psychiatric illness, by Dr Esther Crawley or any team led by Dr Crawley, or any team where Dr Crawley has worked/advised/trained

cognitive behavioral therapy (CBT) - A type of psychotherapy geared toward modifying alleged unhealthy thinking, behaviors or illness beliefs. One of the treatment arms used in the controversial PACE trial.

graded exercise therapy (GET) - A gradual increase in exercise or activity, according to a pre-defined plan. Focuses on overcoming the patient's alleged unhelpful illness beliefs that exertion can exacerbate symptoms, rather than on reversing physical deconditioning. Considered controversial, and possibly harmful, in the treatment or management of ME. One of the treatment arms of the controversial PACE trial.

UK CFS/ME Research Collaborative (CMRC) - A UK group of researchers and ME/CFS patient groups led by Professor Stephen Holgate. Its launch in 2013 was covered by the Science Media Centre. Since 2014, the collaborative sponsors the CFS/ME Research Collaborative Conference.

NICE guidelines Clinical guidelines used in the UK.

somatic symptom disorder A psychiatric term to describe an alleged condition whereby a person's thoughts somehow cause physical symptoms. The actual existence of such a condition is highly controversial, due to a lack of scientific evidence. It is related to other psychiatric terms, such as "psychosomatic", "neurasthenia", and "hysteria". Older terms include "somatization", "somatoform disorder", and "conversion disorder". Such terms refer to a scientifically-unsupported theory that claims that a wide range of physical symptoms can be created by the human mind, a theory which has been criticized as "mind over matter" parapsychology, a pseudoscience.

Association of Young People with ME (AYME) - AYME was a UK national charity supporting children and young people affected by ME/CFS with members under 25. It's lead medical advisor was Doctor Esther Crawley. In April 2017 the charity merged with Action for ME, forming its Children's Services department run by Mary-Jane Willows.

projection 1. In psychology, a defense mechanism involves attribution unpleasant feelings to another person. May be abusive, e.g., a person accusing someone else of something that they themselves are doing or feeling. Often linked to gaslighting.
2. Estimate or forecast based on trends.
3. Something that extends out from something else.
4. How something is presented. (Learn more: www.forbes.com)

physiological Concerning living organisms, such as cells or the human body.  Physio logical (as in physio) is not to be confused with psych ological (emotional stress).

heart rate (HR) - the number of times the heart beats within a certain time period, usually a minute

Canadian Consensus Criteria (CCC) - A set of diagnostic criteria used to diagnose ME/CFS, developed by a group of practicing ME/CFS clinicians in 2003. The CCC is often considered to be the most complex criteria, but possibly the most accurate, with the lowest number of patients meeting the criteria. Led to the development of the International Consensus Criteria (ICC) in 2011.

BMJ The BMJ (previously the British Medical Journal) is a weekly peer-reviewed medical journal.

NICE guidelines Clinical guidelines used in the UK.

PACE trial A controversial study which claimed that CBT and GET were effective in treating "CFS/ME", despite the fact that its own data did not support this conclusion. Its results and methodology were widely disputed by patients, scientists, and the peer-reviewed scientific literature.

biomedical research basic medical research on organisms, such as humans or other living things, that helps increase medical knowledge. (Learn more: me-pedia.org)

randomized controlled trial (RCT) - A trial in which participants are randomly assigned to two groups, with one group receiving the treatment being studied and a control or comparison group receiving a sham treatment, placebo, or comparison treatment.

BMJ The BMJ (previously the British Medical Journal) is a weekly peer-reviewed medical journal.

myalgic encephalomyelitis (M.E.) - A disease often marked by neurological symptoms, but fatigue is sometimes a symptom as well. Some diagnostic criteria distinguish it from chronic fatigue syndrome, while other diagnostic criteria consider it to be a synonym for chronic fatigue syndrome. A defining characteristic of ME is post-exertional malaise (PEM), or post-exertional neuroimmune exhaustion (PENE), which is a notable exacerbation of symptoms brought on by small exertions. PEM can last for days or weeks. Symptoms can include cognitive impairments, muscle pain (myalgia), trouble remaining upright (orthostatic intolerance), sleep abnormalities, and gastro-intestinal impairments, among others. An estimated 25% of those suffering from ME are housebound or bedbound. The World Health Organization (WHO) classifies ME as a neurological disease.

Retrieved from "https://me-pedia.org/w/index.php?title=Esther_Crawley&oldid=27757"