Alastair Miller

Dr. Alastair Miller, is a semi-retired infectious diseases physician. He was a founding member of the British Association for CFS/ME (BACME) and served as Principal Medical Adviser from 2010-2015 for Action for ME. His main clinical interests are blood borne viruses, bone and joint infection and CFS/ME.

During his career he was:

• Consultant Physician in the Tropical & Infectious Disease Unit at the Royal Liverpool University Hospital
• Honorary Fellow at the Liverpool School of Tropical Medicine 2005 until May 2014.
• Honorary Senior Lecturer at The Institute of Infection and Global Health at Liverpool University
• Consultant in the West Midlands and Honorary Senior Lecturer in Infectious Disease at Birmingham University, prior to Liverpool University
• Worked with the Royal Marines in Kurdistan after the first Gulf War and was a consultant and Professor of Medicine in the Royal Navy, where he established a multidisciplinary team for CFS management. He left the Navy as a Surgeon Commander in 1995.
• clinical lead for CFS and ran a diagnostic clinic and a therapy service in collaboration with therapy and psychology colleagues, in Merseyside

In his practice, Dr. Miller saw an average of 100 ME/CFS patients a year. While working in the Royal Navy, he had found it affected all ranks.

At a talk given to the Forward-ME Group on 20 January 2015, he stated that: "he did not think that ME was a 'diagnosis of exclusion'. You could make a very positive diagnosis from observing the patient’s condition and history – things like payback (post-exertional malaise), brain fog etc. It was a different fatigue from that experienced with cancer and other chronic conditions, and there was a massive difference between “chronic fatigue” and ME/CFS."

Controversy related to the use of CBT and GET (as recommended by the PACE trial)

For treatment, Dr. Miller believes that drugs can ameliorate some of the symptoms such as pain, depression, nausea, etc., but dissension arose from the patient community because he, also, recommended cognitive behavioral therapy (CBT) or graded exercise therapy (GET). He acknowledged that these treatments were controversial approaches, but since CBT was employed in many other chronic conditions such as cancer and rheumatoid arthritis, he felt it was logical to try it for CFS/ME. His recommendation was based on the belief at the time that CBT and GET were "evidence based" as reported by the PACE trial and The Lancet article.

In a 2008 message to the 25 Percent ME Group, regarding the group's complaint about the Royal Society of Medicine Conference on CFS endorsement of CBT and GET, Dr. Miller responded: "The reality right now is that we do not have any evidenced based approaches other than CBT and GET to help our patients and these techniques are helpful to many of our patients – not everyone and I do accept that in some cases they may worsen the situation but that is true of many conditions and many therapeutic interventions."

In a Science Media Centre press release in 2011, Dr Miller reaffirmed his belief in CBT and GET by stating: "It is clearly vital to continue our research into biological mechanisms for ME/CFS but recent 'false dawns' for example, over the role of retroviruses (XMRV) have shown how difficult this can be. In the current absence of a biomedical model for the causation and the absence of any pharmacological intervention, we have a pragmatic approach to therapy that works and we should use it." This endorsement lead to a petition drive for his resignation from Action for ME, along with others who supported funding of the Pace trial. The petition failed.

No comments by Dr. Miller are available at this time regarding the released PACE trial data and if he would still recommend these treatments in light of the discrepancy between the data collected and the data and conclusions published.

Education

• MAMB - Master of Applied Molecular Biology
• MBChB -Bachelor of Medicine and Bachelor of Surgery, St John’s College, Cambridge and Westminster Medical School
• FRCP - Fellow of the Royal College of Physicians
• DTM&H - Diploma in Tropical Medicine and Hygiene

Talks and interviews

• 2015, ME/Chronic Fatigue Syndrome: Not Just Tired All The Time! - Dr Alistair Miller
• 2015, Transcript of Myalgic Encephalomyelitis/ Chronic Fatigue Syndrome: Not Just Tired All The Time!
• 2015, Minutes of talk given to Forward ME Group

Learn more

• North Cumberland University Hospital webpage for Dr. Miller
• Phoenix rising forum devoted to Dr. Miller
• Article about Dr. Miller

See ME/CFS.

See chronic fatigue syndrome.

See myalgic encephalomyelitis.

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.

See cognitive behavioral therapy.

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.

See Graded exercise therapy.

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.