Esther Crawley

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

She 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 previously by Action for ME.

Crawley served as vice-chair of the UK CFS/ME Research Collaborative (CMRC) until 2018.

She was on the guideline development group (GDG) for the controversial 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 and collaborates with Peter White of Queen Mary University of London.

Since 2006, Professor 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.

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

Notable research
Esther Crawley is involved with a number of research projects that have drawn 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 with SMC. The initial budget was £164,000 funded by the Linbury Trust and the Ashden Trust.

Children aged 12 to 18 were drawn from the Bristol and 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 and gave evidence in support during the trial ethics procedure.

A Freedom of Information Act 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."

MAGENTA trial
In the MAGENTA trial, Professor Crawley is studying graded exercise therapy in children. The protocol Managed Activity Graded Exercise iN Teenagers and pre-Adolescents (MAGENTA) feasibility randomised controlled trial: study protocol was published in 2017.* 2016, Managed Activity Graded Exercise iN Teenagers and pre-Adolescents (MAGENTA) feasibility randomised controlled trial: study protocol

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. The feasibility study was due to be published in 2017 and is now several years overdue.

FITNET Trial
FITNET-NHS 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. 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 a follow-up post.

There was severe criticism by patients, including in the Bristol University student newspaper.

MEGA
MEGA, the controversial ME/CFS Epidemiology and Genomics Alliance, is a group of 15 UK researchers including Professor Crawley, who have submitted requests for large amounts of research funding for ME/CFS studies. This has been supported by some ME/CFS patients and charities, but strongly opposed by others, including the Opposing MEGA group. The MEGA research was turned down for funding.

Pervasive Refusal Syndrome
Crawley was one of the authors of a paper describing several children with the proposed psychological disorder Pervasive Refusal Syndrome (PRS) who "presented as" having chronic fatigue syndrome; 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/very severe 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 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]." 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.

GMC Complaint
Dr Crawley was the subject of a complaint in 2011 to the UK's General Medical Council (GMC), relating to the SMILE trial. The GMC did not uphold the complaint, and closed the case.

NICE Guidelines Review Panel
Esther Crawley, along with Action for ME's medical advisor and others, were part of the Guideline Development Group (GDG) for the controversial CFS/ME NICE guidelines CG53, which were published in 2007. The guidelines recommended cognitive behavioral therapy and graded exercise therapy as the only main treatments for ME/CFS in the UK. The were heavily criticized, with significant rates of harm reported by patents. In 2019, a survey on behalf of NICE found significant rates of harm caused by both treatments.

PACE trial support and Science Media Centre
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.”

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

Allegations of harassment and vexatious tactics from critics
Esther Crawley presented at a conference in April 2017 in which she characterized critics of her work as being "anti-science" and engaging in harassment. She alleged that people engaged in tactics such as vexatious Freedom of Information requests, spread fake news, and instigated vexatious investigations.

Claims of harassment
Prof. Crawley has claimed to have been subject to harassment.

The Young ME Sufferers Trust submitted a Freedom of Information Act (FOIA) request to her employer, the University of Bristol. The request to the university was followed up, then escalated to the UK's Information Commissioner, who instructed the university to comply with the request. The University of Bristol eventually responded "We have received no official reports of harassment of University staff by a third party between September 2010 and June 2015."

An article was published in Vada Magazine examining the Freedom of Information request and the alleged threats and harassment of Esther Crawley, which 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 wrote that the PACE trial tribunal had found claims of harassment relating to the PACE trial were "grossly exaggerated". The article also reported that a claimed threat that Crawley showed in talks was actually an artist's illustration used in a Sunday Times magazine article cover, where it was used to illustrate a phone call to different person.

Subsequently the University of Bristol published a statement on their website and stated that it was aware "Professor Crawley in particular has experienced significant harassment and personal abuse over several years". 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."

MUPPETS conference
Esther Crawley presented at a conference advertised as A day with the MUPP(ET)S on May 18, 2017. The term Muppets is a derogatory word meaning stupid person, but MUPP is also a term used for medically unexplained persistent physical symptoms, also known as medically unexplained physical symptoms (MUPS). ME patients and charities condemned the title of the muppets talk. The Tymes Trust issued condemnation. The offensive name of the talk was reported in local media, and was changed prior to the event. It is not known who chose the name of the event.

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 Prof 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'.

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 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. 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 an open letter 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.

ME advocate Jennifer Brea tried to avoid singling out a single researcher but finally wrote 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.

Criticism of Crawley by scientific community and alleged attempts to suppress criticism
Dr David Tuller has criticised Crawley's approach to science and challenged her on her accusations that he was engaging in libellous blogging. 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. Crawley 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 stated 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."

According to Tuller, 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 said he 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.

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." Based on this, Crawley appeared to have 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 in which she failed to respond to any of his emails. It later transpired that Esther Crawley and Bristol university did send a letter to Tuller's employer, the University of Berkeley the contents of which was unclear, but which were presumed to be an attempt to make Berkeley discipline Tuller. However, according to Tuller, the University of Berkeley reviewed the matter and confirmed that he did nothing wrong, and affirmed his right as a public health journalist to continue his work.

SMILE Trial: Editorial correction and calls for retraction
Dr. Nick Brown, Editor-in-Chief Archives of Disease in Childhood, BMJ, added an Editor's Note to the trial article 'Clinical and cost-effectiveness of the Lightning Process in addition to specialist medical care for paediatric chronic fatigue syndrome: randomized controlled trial'. Despite considerable well-founded criticism, the journal chose not to retract the publication.

Editor's note
 * This study was published online in Archives of Disease in Childhood after peer review in September 2017. The trial tested the effectiveness of a neurolinguistic programming intervention (used widely but never formally tested) in children and young people with chronic fatigue recruited between 2010 and 2013. Though the number of participants was small, analysis suggested a benefit in terms of physical function (measured by the standard SF 36 scale) at both 6 and 12 months after intervention.


 * Since publication, the study has been criticised for failing to meet ICMJE and BMJ policy on trial registration and for not fully adhering to CONSORT guidance on trial reporting. The journal has been criticised for not detecting these issues during editorial and peer review. We have acknowledged these comments and reviewed our processes in relation to this paper and relating to EQUATOR guidance in general. In addition, we have received clarifications from the authors which are under editorial consideration.

Ethics investigation by University of Bristol
In 2019, University of Bristol announced it was investigating Professor Esther Crawley for research ethics violations, after being informed that she had published eleven ME/CFS articles using a research exemption obtained for an unrelated "school absence" study. These publications included a systematic review of ME/CFS treatment outcomes in adults, using data from the United Kingdom National Outcome Database. David Tuller, a public health researcher who had raised the issue with the NHS Health Research Authority, expressed uncertainty about the independence of this investigation. The final report concluded that the publications were research rather than not service evaluations, but that research ethics approval was not necessary since the patient data was anonymised. The report outlined a number of steps that Professor Crawley needed to take, including having corrections to some paper published, but that no disciplinary action was necessary Professor Crawley.

In 2022, more than three years after the research ethics investigation, David Tuller contacted both the University of Bristol and the Health Research Authority to ask why seven of the eleven the research publications by Esther Crawley still had not been corrected, as had been required by the 2019 investigation report. The University of Bristol replied that the journals had been contacted, but that they were unable to explain why corrections had not been made and were unable to produce a copy of the requests for corrections sent by Prof. Crawley, something David Tuller referred to as Did the Dog Eat Professor Crawley's Seven Missing Corrections?

BBC Complaint
Prof. Esther Crawley was interviewed on the BBC's Victoria Derbyshire show in 2016, along with Jane Colby of the Tymes Trust, about the launch of the FITNET-NHS trial involving cognitive behavioral therapy for children and young people with chronic fatigue syndrome. The BBC used briefing information from the Science Media Centre in both the Victoria Derbyshire show the BBC news online article, both of which were subject to a complaint, with the BBC Trust supporting several elements of the complaint, including that the Dutch FITNET study's results were "overstated". The BBC online article was amended as a result of the complaint.

Statements and research on severe ME
Despite the well-recognized fact that 25% of patients with ME have severe ME, with the UK charity for severe ME being called the 25% ME Group, Prof. Crawley has claimed the true figure is just 10% severely ill. Prof. Crawley has been carrying out a number of different studies about the prevalence of ME/CFS in the UK using data from either schools or GPs, however many severely ill patients are housebound and don't have any medical professionals involved in their care due to a refusal to do home visits, and/or a refusal to accept that ME/CFS can be severe, or even life threatening.

Action for ME funding
Action for ME, the UK's largest charity for ME/CFS, has funded a number of research studies that Esther Crawley was principle investigator for. In 2016, Action for ME announced funding for a severe ME/CFS pediatric prevalence study led by Prof. Crawley using money donated by a donor who wanted the funding to benefit children with ME. This study and the choice of Prof. Crawley to lead it were criticized by ME sufferers in forums and letters to the Action for ME chief executive; some ME sufferers reported that Action for ME had removed their posts for being "defamatory". In 2018, Action for ME announced that AfME would not be funding that research, but did not provide a full explanation of the sources of the money and the reasons for doing so.

Freedom of information requests
A number of Freedom of Information Act 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.

Rejection of Canadian Consensus Criteria for ME/CFS
In an reply to an Editorial in the British Medical Journal by Fiona Godlee, 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."

Prevalence at Age 16
In a study published in 2016 using data from almost 6000 children in the Children of the 90s Project, 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 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.

Media coverage and interviews

 * 2015, ME parents’ fury at child abuse claims "HUNDREDS of parents whose children suffer from a crippling illness that leaves them permanently exhausted have been falsely accused of child abuse." (See comments section.)
 * 2016, New Scientist: Time to end the damagaging battle over Chronic Fatigue Syndrome (account needed). Also available via Phoenix Rising discussion
 * 2016, BBC News:Landmark chronic fatigue trial could treat two-thirds (about FITNET-NHS) - BBC Complaint
 * 2016, BBC News: Chronic fatigue syndrome on rise among 16-year-olds
 * 2016, BBC Radio 4: Women's Hour (27 Jan 2016): Talks about teenage girls and chronic fatigue syndrome

Interviews, talks and blogs

 * 2017, Doing what is right in a controversial field - National Institute for Health Research
 * 2016, Trials and tribulations - New Scientist
 * 2016, Anxiety in paediatric Chronic Fatigue Syndrome (CFS/ME): A Systematic Review - BACME conference

Notable studies

 * 2011, The impact of CFS/ME on employment and productivity in the UK: a cross-sectional study based on the CFS/ME national outcomes database - (Full text)


 * 2013, Treatment outcome in adults with chronic fatigue syndrome: a prospective study in England based on the CFS/ME National Outcomes Database - (Full text)


 * 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) - (Full text)


 * 2013, Comparing specialist medical care with specialist medical care plus the Lightning Process® for chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME): study protocol for a randomised controlled trial (SMILE Trial) - (Full text)


 * 2013, Depression in paediatric chronic fatigue syndrome - (Full text) - partly funded by Action for ME
 * 2014, G160(P) Case series of Pervasive Refusal Syndrome presenting Chronic Fatigue: avoiding the pitfall of a wrong diagnosis - (Full text)


 * 2015, Maternal and childhood psychological factors predict chronic disabling fatigue at age 13 years’. Journal of Adolescent Health - (Full text)
 * 2016, Chronic fatigue syndrome (CFS) symptom-based phenotypes in two clinical cohorts of adult patients in the UK and The Netherlands - (Full text)


 * 2016, "It’s personal to me": A qualitative study of depression in young people with CFS/ME - (Full text)


 * 2016, Managed Activity Graded Exercise iN Teenagers and pre-Adolescents (MAGENTA) feasibility randomised controlled trial: study protocol - (Full text)


 * 2016, Obesity in adolescents with chronic fatigue syndrome: an observational study’. Archives of disease in childhood - (Full text)


 * 2016, Children’s experiences of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (CFS/ME): A systematic review and meta-ethnography of qualitative studies - (Abstract)


 * 2016, Treatment for paediatric chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME) and comorbid depression: a systematic review - (Full text)


 * 2017, A qualitative investigation of eating difficulties in adolescents with chronic fatigue syndrome/myalgic encephalomyelitis - (Full text)


 * 2017, Natural course of Chronic Fatigue Syndrome/Myalgic Encephalomyelitis in adolescents - (Full text)


 * 2017, Chronic Fatigue Syndrome and Chronic Widespread Pain in Adolescence: Population Birth Cohort Study - (Full text)


 * 2017, Trends in the incidence of chronic fatigue syndrome and fibromyalgia in the UK, 2001–2013: a Clinical Practice Research Datalink study - (Full Text)


 * 2017, Adult patients’ experiences of NHS specialist services for chronic fatigue syndrome (CFS/ME): a qualitative study in England


 * 2017, (SMILE trial: before editorial correction) - Clinical and cost-effectiveness of the Lightning Process in addition to specialist medical care for paediatric chronic fatigue syndrome: randomised controlled trial (Full text)


 * 2018, Adolescent’s descriptions of fatigue, fluctuation and payback in chronic fatigue syndrome/myalgic encephalopathy (CFS/ME): interviews with adolescents and parents - (Full text)
 * 2018, Childhood sleep and adolescent chronic fatigue syndrome (CFS/ME): evidence of associations in a UK birth cohort - (Full Text)
 * 2018, Defining the minimally clinically important difference of the SF-36 physical function subscale for paediatric CFS/ME: triangulation using three different methods - (Full text)


 * 2018, The International Collaborative on Fatigue Following Infection (COFFI) - (Full text)


 * 2019, (SMILE trial: Editorial correction) - Editor's Note on Correction to Crawley et al. 2018 - (Full text)


 * 2020, Development of a conceptual framework to underpin a health-related quality of life outcome measure in paediatric chronic fatigue syndrome/myalgic encephalopathy (CFS/ME): prioritisation through card ranking - (Full text)
 * 2020, “The child’s got a complete circle around him ”. The care of younger children (5–11 years) with CFS/ME. A qualitative study comparing families’, teachers’ and clinicians’ perspectives’ - (Full text)

Online presence

 * Royal United Bath Hospitals: Fatigue Management, Children
 * Esther Crawley's PubMed history
 * University of Bristol - Esther Crawley
 * School of Social and Community Medicine at Bristol University
 * University of Bristol: Esther Crawley's research publications

Directorships and Shareholdings
Esther Madeleine Crawley has 1 total appointment.

Learn more

 * Ethics investigation report 2019