Andrew Lloyd

Prof. Andrew Lloyd based at Univeristy of New South Wales

Article on Health Rising about Lloyd: https://www.healthrising.org/blog/2015/05/16/the-decline-and-fall-of-an-mecfs-researcher-the-case-of-andrew-lloyd/ Quotes from article: The AHRQ reports provide another “gold-standard” of analysis. The recent AHRQ report Diagnosis and Treatment of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome hardly provided a strong endorsement of either CBT or GET. Contrast the “solid evidence” and “clearly positive” outcomes Lloyd asserts CBT has in ME/CFS, with the “moderate” confidence the AHRQ had that CBT is able to reduce fatigue and provide “global improvement”. Or the low confidence they had, that CBT is able to improve/enhance quality of life, or any kind of important functional measure (overall functioning, increase working hours, or reduce work impairment.) As Lloyd was citing one report stating there was little evidence of harm in GET the AHRQ report was acknowledging the dangers associated with poorly managed exercise and GET programs. They noted that harms were not well reported in GET studies and that several factors, including high degree of harms in one trial, high dropout rates in another, and higher withdrawal rates whenever the arms of trials included exercise, indicated they could be significant. The AHRQ also reported that several studies find that exercise worsens symptoms, and that an ME Association survey reported that GET had higher rates of symptom exacerbation than other treatments. Nor did Lloyd note the confounding factors that the Oxford definition – commonly used in both types of studies – may introduce. The AHRQ report warned that studies containing the Oxford definition, “in particular”, might not contain any ME/CFS patients. The IOM report simply recommended that the Oxford definition be consigned to the dustbin of history. Consider that nowhere are CBT/GET presented as producing other than moderate benefits in a few areas. Then consider how easily those moderate benefits might disappear if more rigorous cohorts were used, or if smaller trials were done. Lloyd’s clearly positive outcomes and strong evidence seem to be an overreach when other citations are referenced. Poor Fitness

Lloyd does present an enlightened viewpoint of why GET may be helpful. Instead of placing the “blame” on overly worried patients he suggests that nervous system sensitisation that takes place during exercise is placing patients in pain causing them to avoid exercise or to go for broke and suffer the consequences in a crash-burn pattern. He also adds the important note that GET programs should be personalized. Lloyd sticks his head in the sand, though, when he states “..there is little evidence for loss of aerobic fitness in patients with chronic fatigue syndrome, and limited evidence for improved physical performance after successful graded exercise therapy.” Lloyd, then, accounts for the rather disturbing fact for GET proponents that there’s no evidence indicating that it improves physical functioning by asserting there simply is no problem with physical functioning; i.e., the aerobic pathways are functioning fine in ME/CFS. By doing so he negates several studies showing declines in energy production during a two-day exercise testing regime as well as other studies documenting problems with energy production pathways in ME/CFS. I don’t think anyone believes the aerobic energy production situation in ME/CFS is resolved (the studies tend to be small), but the evidence is trending strongly in one direction – and Lloyd is trending in another.

Lloyd, thankfully, notes that criteria for recovery in the Pace trial were skewed and that its estimates for recovery (25%) were overly generous. Even mentioning the word recovery, however, in this ceiling afflicted, functionally impaired (no valid assessments of functioning) trial with its geriatric results on the walk test is problematic. In the end Lloyd counts as significant progress two therapies neither of which have “convincingly” been shown to increase functionality at all in an illness that is significantly more functionally impairing than congestive heart failure, type II diabetes mellitus, acute myocardial infarction, multiple sclerosis, and depression. This in an illness that Bill Reeves of the CDC stated is also as functionally impairing as people with AIDS, breast cancer and chronic obstructive pulmonary disease”.

The big surprise regarding Lloyd in this op-ed is not that he’s controversial – he’s always been controversial – but that his op-ed lacks so much rigor. The researcher who with some joy in his heart loved to poke holes in other researchers findings, is not being rigorous himself. He’s become more of an advocate rather than a trusted resource. He’s the wrong man for the job, anyway. It’s understandable for Peter White to publicly support CBT and GET: his work depends on CBT/GET funding, but why is Andrew Lloyd doing that? It’s clear why BMJ would want him; he’s a respected researcher with no CBT work in his past. He’s not tooting his own horn. So why is he doing it? Why did he feel the already CBT/GET saturated Brits needed an op-ed asserting the primacy of CBT/GET? I have no idea.