Keith Geraghty

Dr. Keith Geraghty, B.Sc., B.Sc., M.Dip., M.P.H., Ph.D., is a Honorary Research  Fellow  at  the  University  of  Manchester (UK) in the Centre for Primary Care. His main research interests are patient safety and harms, doctor-patient relations, medically unexplained illness and myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). He holds a Ph.D. in Health Management, a Master of Public Health (Merit with award of Distinction in Dissertation) and a Master Postgraduate Diploma in Research Methodology. In addition to being a ME/CFS researcher, Dr. Geraghty lives with ME/CFS.

In 2012, Geraghty became the Founder Director of The ME/CFS Research Group, whose goal is to bring together researchers and clinicians to undertake innovative studies of ME/CFS.

2017

 * 14 June 2017 - Editorial - "Further Commentary on the PACE Trial: Biased Methods and Unreliable Outcomes" by Keith Geraghty in Journal of Health Psychology"Abstract: Geraghty in the year 2016, outlines a range of controversies surrounding publication of results from the PACE trial and discusses a freedom of information case brought by a patient refused access to data from the trial. The PACE authors offer a response, writing ‘Dr Geraghty’s views are based on misunderstandings and misrepresentations of the PACE trial’. This article draws on expert commentaries to further detail the critical methodological failures and biases identified in the PACE trial, which undermine the reliability and credibility of the major findings to emerge from this trial."

2016

 * 6 Dec 2016, "Mind the Gap: Ethical Failures in the Treatment of Chronic Fatigue Syndrome" by Charlotte Blease & Keith Geraghty in Journal of Medical Ethics blog "Excerpt: In our paper, we find widespread evidence (in the literature) that ME/CFS patient testimony is devalued. Forms of exclusionary deflation may be unintentional but include ignoring patients’ views, undermining their testimony, and offering alternative explanations for their suffering (e.g. pain not being biological but somatised). We also find that exclusion is expressed as negative stereotyping (“heartsinky patients”), and by pernicious ways of psychologising patients’ worries and complaints (even labelling patients as “illness seeking”). Indeed, it is because of the incomplete knowledge of CFS/ME that patients may be especially vulnerable to insidious and harmful forms of ‘expert’ gap-filling."
 * 5 Dec 2016, "Epistemic injustice in healthcare encounters: evidence from chronic fatigue syndrome" by Blease C, Carel H. & Geraghty K. in Journal of Medical Ethics "Abstract: Chronic fatigue syndrome or myalgic encephalomyelitis (CFS/ME) remains a controversial illness category. This paper surveys the state of knowledge and attitudes about this illness and proposes that epistemic concerns about the testimonial credibility of patients can be articulated using Miranda Fricker's concept of epistemic injustice. While there is consensus within mainstream medical guidelines that there is no known cause of CFS/ME, there is continued debate about how best to conceive of CFS/ME, including disagreement about how to interpret clinical studies of treatments. Against this background, robust qualitative and quantitative research from a range of countries has found that many doctors (and medical students) display uncertainty about whether CFS/ME is real, which may result in delays in diagnosis and treatment for patients. Strikingly, qualitative research evinces that patients with CFS/ME often experience suspicion by healthcare professionals, and many patients vocally oppose the effectiveness, and the conceptualisation, of their illness as psychologically treatable. We address the intersection of these issues and healthcare ethics, and claim that this state of affairs can be explained as a case of epistemic injustice (2007). We find evidence that healthcare consultations are fora where patients with CFS/ME may be particularly vulnerable to epistemic injustice. We argue that the (often unintentional) marginalisation of many patients is a professional failure that may lead to further ethical and practical consequences both for progressive research into CFS/ME, and for ethical care and delivery of current treatments among individuals suffering from this debilitating illness."
 * 23 Sept 2016, Editorial - "'PACE-Gate': When clinical trial evidence meets open data access" "Abstract: Science is not always plain sailing and sometimes the voyage is across an angry sea. A recent clinical trial of treatments for chronic fatigue syndrome (the PACE trial) has whipped up a storm of controversy. Patients claim the lead authors over-stated the effectiveness of cognitive behavioural therapy and graded exercise therapy by lowering the thresholds they used to determine improvement. In this extraordinary case, patients discovered that the treatments tested had much lower efficacy after an information tribunal ordered the release of data from the PACE trial to a patient who had requested access using a freedom of information request."
 * 15 Sept 2016, "Cognitive behavioural therapy in the treatment of chronic fatigue syndrome: A narrative review on efficacy and informed consent" Abstract: Cognitive behavioural therapy is increasingly promoted as a treatment for chronic fatigue syndrome. There is limited research on informed consent using cognitive behavioural therapy in chronic fatigue syndrome. We undertook a narrative review to explore efficacy and to identify the salient information that should be disclosed to patients. We found a complex theoretical model underlying the rationale for psychotherapy in chronic fatigue syndrome. Cognitive behavioural therapy may bring about changes in self-reported fatigue for some patients in the short term, however there is a lack of evidence for long-term benefit or for improving physical function and cognitive behavioural therapy may cause distress if inappropriately prescribed. Therapist effects and placebo effects are important outcome factors.
 * 1 Aug 2016, "Chronic fatigue syndrome: is the biopsychosocial model responsible for patient dissatisfaction and harm?" in British Journal of General Practice"Abstract: In 1977 George Engel wrote about the need for an ‘integrated approach’ in medicine that moved the focus beyond biological mechanisms of disease to include all pertinent aspects of illness presentation, setting out a ‘biopsychosocial model’.1 Around the same time, McEvedy and Beard asserted that the disease ‘benign myalgic encephalomyelitis’, described by Ramsay at the Royal Free Hospital, London, was nothing more than a case of ‘mass hysteria’.2 In the 1980s, doctors combined theories of neurasthenia, hysteria, and somatoform illness, to reconstitute ME as ‘chronic fatigue syndrome’. Psychiatrists argued that CFS was best understood using a biopsychosocial (BPS) framework, being perhaps triggered by viral illness (biology), but maintained by certain personality traits (psychology) and social conditions (sociology).3 Although the BPS model holds much utility in understanding ‘illness’ in a wider context, many sufferers of CFS reject the notion that their illness is psychologically or socially derived. Significant numbers of patients report difficult interactions with doctors that leave them feeling dissatisfied, disbelieved, and distressed. In this article, we question whether or not the BPS model generates ‘harms’ for CFS patients, and we ask if other, alternative approaches might be more preferable to both patients and GPs."
 * 27 Jun 2016, "The ‘all in the mind’ myth of myalgic encephalomyelitis/chronic fatigue syndrome" in Nursing in Practice"Abstract: Health professionals should be made aware that ME/CFS is not a psychological illness and in order to improve patient care, nurses need to better understand this illness and its impact on patients. Nurses often witness close-up the impact of acute and chronic illness on patients. Myalgic encephalomyelitis (ME)/chronic fatigue syndrome (CFS) is one illness that nurses may encounter that causes profound life changes for many sufferers. This controversial illness is sometimes presented as a psychosomatic disorder that requires psychological treatment. However, there is no compelling evidence that ME/CFS is a mental health condition and increasing evidence shows it is a biological disease with a range of complex symptoms. This article discusses how the ‘all in the mind’ myth of ME/CFS has permeated both medical discourse and popular culture, with negative consequences for patients living with this poorly understood condition."
 * 1 May 2016, "Doing Research in Chronic Fatigue Syndrome with Chronic Fatigue." 12th [[International IACFS/ME Research and Clinical Conference] Conference paper. Geraghty, K. ]
 * 2016, "Chronic Fatigue Syndrome and the Biopsychosocial Model: Accounting for Harm in the Medical Encounter" Conference paper by Geraghty, K., & Esmail, A.

2015

 * 7 Nov 2015, "Deviant cellular and physiological responses to exercise in Myalgic Encephalomyelitis and chronic fatigue syndrome" by Geraghty, K., & Twisk, F. in Jacobs Journal of Physiology "Abstract: Post-exertional “malaise” is a hallmark symptom of Myalgic Encephalomyelitis (ME) and Chronic Fatigue Syndrome (CFS). Various abnormalities, including abnormal physiological responses to exertion, can account for post-exertional “malaise” and “exercise avoidance”. Since these abnormalities are not observed in sedentary healthy controls, the abnormalities and deviant responses cannot be explained by “exercise avoidance” and subsequent deconditioning, nor by psychogenic factors."

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 * May 2016 IACFSME Newsletter - Doing Research in Chronic Fatigue Syndrome with Chronic Fatigue Syndrome – Dr. Keith Geraghty