Friday, 25 December 2015

Christmas Day

A Very Happy Christmas to readers of my blog, your families and friends.

From the Bible –

Isaiah 9 v 6For unto us a Child is born, unto us a Son is given: and the government shall be upon is shoulder: and His name shall be called Wonderful, Counsellor, The mighty God, The everlasting Father, The Prince of Peace.

1 John 4 v 14: And we have seen and do testify that the Father sent the Son to be the Saviour of the world.


Mum’s Christmas Poem 2015 –

The Saviour Comes

Into this darkened world the Saviour came,
Leaving His rightful place of heavenly fame,
In love He stooped to lowly stable birth:
To save His people, Christ came down to earth.

An angel told some shepherds He had come,
They left their sheep and came to Bethl’em’s home.
Wise men from far came bringing precious things
To give in worship to this King of kings.

How could this Babe rebellious man restore
To fellowship with God lost long before?
Only by taking human form could He
Lay down His life to pay sin’s penalty.

This penalty, declared in Adam’s day,
Was death for all who God’s law disobey,
Yet both the Father and the Son agreed
To help poor sinners in their fearful need.

So God the Son died in the sinner’s place
So that salvation could be all of grace.
Eternal life is freely given to all
Who trusting Christ, answer the Gospel’s call.

© JHS 2015  



Matthew 1:21 - " And she shall bring forth a son, and thou shalt call His name JESUS: for He shall save His people from their sins."

What, shall we not remember the birth of our Jesus? Shall we yearly celebrate the birth of our temporal king, and shall that of the King of kings be quite forgotten? Shall that only, which ought to be had chiefly in remembrance, be quite forgotten? God forbid! No, my dear brethren, let us celebrate and keep this festival of our church, with joy in our hearts: let the birth of a Redeemer, which redeemed us from sin, from wrath, from death, from hell, be always remembered; may this Saviour's love never be forgotten! But may we sing forth all his love and glory as long as life shall last here, and through an endless eternity in the world above! May we chant forth the wonders of redeeming love, and the riches of free grace, amidst angels and archangels, cherubim and seraphim, without intermission, for ever and ever! And as, my brethren, the time for keeping this festival is approaching, let us consider our duty in the true observation thereof, of the right way for the glory of God, and the good of immortal souls, to celebrate the birth of our Lord Jesus Christ; an event which ought to be had in eternal remembrance.

Thursday, 17 December 2015

Defending the Faith in the United Kingdom: An Interview with John Blanchard



Tabletalk: What were the circumstances surrounding your conversion to Christ, and how did you become a Christian?

John Blanchard: Returning to my native Channel Island of Guernsey at the end of World War II, following my evacuation to the Hebrides, off the west coast of Scotland, I soon became a card-carrying religious hypocrite. At my newly acquired stepmother’s invitation, I joined Holy Trinity Church and got involved not only in its regular services, but in the choir, the Sunday school and the Young People’s Fellowship, of which I became leader.

After leaving school in 1948, I joined the Guernsey Civil Service and was eventually transferred to the staff of the Law Officers of the Crown. It was there that I met a lovely young lady, who in October 1954 invited me to an evangelistic campaign led by the American evangelist Paul Cantelon. I tried everything I knew to avoid accepting, but the offer to join her proved irresistible. On the first night, I found the program disturbingly different from familiar Church of England services, but God’s Word swept away my prejudices and concerns, and a few nights later God graciously replaced my religion and feelings with repentance and faith, and drew me to trust the Lord Jesus Christ as my Savior. (Three years later, I married the young lady.)

TT: How did you get involved with Christian apologetics?

JB: In 1962, my young family and I left Guernsey for England, where I became an evangelist on the staff of the National Young Life Campaign. Later, I joined the Movement for World Evangelization, and in 1980, I cofounded the organization Christian Ministries. Some twenty years later, when my ministry had broadened to include Bible teaching and conference ministry, I began to realize that in its ongoing evangelism, the church in the United Kingdom was virtually neglecting robust Christian apologetics, while atheism and agnosticism were rapidly gaining ground. I began to speak frequently on “the problems of being an atheist,” and in 1980 I wrote Does God Believe inAtheists?, which traced the roots and rise of atheism, pinpointed the fallacies in atheistic thinking, and presented the case for biblical theism and the Christian faith. To my surprise, it became an instant best seller and was named the U.K.’s Christian Book of the Year.

TT: How did you come to develop the popular Christian Apologetics project, and what are its goals?

JB: I began by speaking on “Does God Believe in Atheists?” in every county in the United Kingdom, and then I began to release DVDs and CDs covering various of its themes. Since then, I have authored another fteen evangelistic titles, each addressing questions unbelievers ask and pointing them to Christ. Along with Ultimate Questions, which was first published in 1987, these have some eighteen million copies in print in more than sixty languages. I also conduct Popular Christian Apologetics tours, largely in the U.K., and in hundreds of events I have tackled subjects chosen by inviting churches. The goals of the project are perfectly straightforward: to challenge unbelievers and to equip Christians to evangelize.

TT: What are the three most important things Christians can do to prepare themselves to defend the Christian faith?

JB: First, deepen their relationship with the Lord, so that their personal evangelism is the natural outcome of spiritual income. When Peter and John were hauled before the Sanhedrin, they were rated “uneducated, common men,” but the clarity and boldness of their testimony was put down to the fact that “they had been with Jesus” (Acts 4:13). Second, master the Bible’s major doctrines. Get a grasp of the big picture and let this be the canvas on which everything else is painted. This begins with God’s aseity (His uncaused self-existence and independence) and includes His absolute sovereignty, in the exercise of which He “works all things according to the counsel of his will” (Eph. 1:11). Third, be alert to current cultural thinking and determine how best to counter it with biblical truth. In all of this, 1 Peter 3:15 is a good template.

TT: What is the most common objection to the Christian faith you hear from atheists, and how do you answer it?

JB: The theory of evolution, and science in general, have often been thrown at me as reasons for rejecting the Christian faith, and one must develop ways of dealing with these. It can easily be shown that evolutionary ideas have no explanation for human dignity, rationality, or morality, while science’s limitations can be pinpointed just as easily. For example, Richard Dawkins’ claim that “truth means scientific truth” is not even a scientific statement. On its own terms, it can’t be true; it is no more than a silly sound bite.

Yet the most common objection to the Christian faith is usually framed in the question, “Where is God when things go wrong?” On Popular Christian Apologetics tours, I am asked to speak on this subject more often than on all the other options combined. People are puzzled, skeptical, or simply angry that a sovereign, loving God could allow atrocities, wickedness, injustice, and hideous evil to take place on His watch. It is impossible in a few sentences even to summarize how I answer these concerns, but I often begin by positing the case if there were no God. This would reduce 9/11 to a spectacular, noisy, colorful rearrangement of atoms of molecules; it would turn solemn services of mourning for national tragedies into pointless pantomimes; it would make it futile for anyone who is suffering from physical, mental, or psychological pain, or trauma of any kind to seek supernatural help.

Most people have never thought this through, and when I sense that this is the case, I point them to a loving Creator, the violation of whose law is the root cause (though obviously not always the immediate cause) of all suffering. The next steps (though there is no rigid formula here) are to show from Scripture the immeasurable depth of God’s love, His amazing grace, the staggering sacrifice of His Son in the place of sinners, and His willingness to rescue us from our sins and to have us live with Him forever in the new heavens and the new earth (Rev. 21:4).

TT: What is the most significant apologetics issue of our day, and why?

JB: The 2001 Census for England and Wales revealed that 72 percent of the population identified themselves as Christian, but ten years later, this figure had dropped to 59 percent, while during the same time the proportion of those claiming no religion jumped from 15 percent to 25 percent. We can assume that “Christian” can be interpreted very loosely, but so can “no religion.” Both hide the fact that we live in an age permeated by religious pluralism. Even if we set atheists aside, huge swaths of people reject “God talk” as prejudiced radicalism and reduce quotations from the Bible as carrying no more authority than those from other religious books. Religious pluralism has inevitably spawned rampant relativism, which even claims that truth itself has been ripped from its roots. Yet archatheist Richard Dawkins’ statement that “all truth is relative” is a claim to absolute truth, so on its own terms it is false.

This points to the question of ultimate authority as the most significant apologetics issue of our day. The Christian apologist needs to face this head on. B.B. Warfield claimed, “If God be a person, it follows by stringent necessity that he can be known only as far as he reveals or expresses himself.” The Christian apologist must convey with conviction and clarity that He has done so.

TT: How can the church best prepare young people to proclaim and defend the gospel?

JB: The best preparation is to do everything possible to help them “grow in the grace and knowledge of our Lord and Savior Jesus Christ” (2 Peter 3:18). Courses designed to deepen their understanding of themes directly related to apologetics have their place, but there is no substitute for falling ever more deeply in love with Jesus. As someone the Lord has graciously (and very recently) led into a late-in-life marriage to a wonderful Christian lady, I can assure you that a training course is not necessary for me to tell others about her—only hearers are needed. The same is true of the gospel.

TT: What is the greatest apologetic for the Christian faith, and why?

JB: When I am asked which of my books I would like to outlast all the others, my reply is always the same: Meet the Real Jesus. This is because every other book ends by unveiling Him and confronting readers with His identity, work, and claims. It has been said that while apologetics can get people from A to Y, only the gospel can get them from Y to Z. I understand what this is saying, but I would prefer to go one step further and say that the Lord Jesus Christ, in all the glory of His deity, birth, life, death, resurrection, return, and everlasting reign, is the ultimate apologetic.

John Blanchard is an internationally known apologist and teacher. Dr. Blanchard is the director of Popular Christian Apologetics, a project committed to defending the Christian faith through broadcasting, writing, and teaching resources. His book Does God Believe in Atheists? was published in 2000 and voted “Best Christian Book” in the 2001 U.K. Christian Book Awards. He has written more than thirty books, including Right with God, Ultimate Questions, and Truth for Life. In addition, he is on the board of governors of Highland Theological College in Scotland and is a trustee and life vice president of Young Life.



Saturday, 12 December 2015

It’s time for doctors to apologise to their ME patients


For too long the medical community has dismissed 'Chronic Fatigue Syndrome' as a mental illness which can be cured with therapy and exercise

By Dr Charles Shepherd
9:35AM GMT 07 Dec 2015

Back in 1955, a mysterious polio-like illness affected 262 doctors and nurses at London’s Royal Free Hospital. The hospital had to close for just over three months.

The outbreak was written up in The Lancet and a new neurological disease entered medical language: myalgic encephalomyelitis, or ME, as it still remains in the WHO Classification of Diseases. "Myalgic" referred to the muscle symptoms; "encephalomyelitis" referred to the various neurological symptoms.

Others were not convinced that ME was a neurological disease, and two decades later two psychiatrists, without interviewing any of the patients, wrote a paper for the British Medical Journal where they concluded that the Royal Free outbreak was due to mass hysteria.

The mud from the BMJ stuck. Like most doctors at the time, I left medical school believing that ME was not a real disease and I would probably never see a case. I was wrong.

Ignored or dismissed by doctors, people with ME went undiagnosed or misdiagnosed for long periods of time, often combined with harmful management advice – as is still the case. I can confirm this after developing classic ME following chickenpox, caught from one of my hospital patients. Some developed severe ME, becoming housebound or bed-bound with no medical help. Some never recovered.

During the 1980s, ME was redefined and given a dreadful new name: chronic fatigue syndrome (CFS). The term CFS trivialised a serious medical condition – the equivalent of trivialising dementia by calling it a chronic forgetfulness syndrome – and shifted the focus from a "disease" to a single symptom, "chronic fatigue".

CFS also brought in a much wider group of people suffering from chronic undiagnosed fatigue. A powerful body of psychiatric opinion convinced the medical profession that CFS was basically a mental health problem whereby people became trapped in a vicious circle of abnormal illness beliefs and behaviours, inactivity and deconditioning. In other words, there was no "disease" present.

The CFS model of causation resulted in two controversial forms of behavioural management – cognitive behaviour therapy (CBT) and graded exercise therapy (GET) – being recommended by NICE as the main form of treatment.

Now we have the PACE trial – the largest and most recent assessment of CBT and GET, which has cost the taxpayer almost £5 million. At long term follow-up, and contrary to what was reported in the press, the PACE trial found no significant difference between CBT, GET, adaptive pacing and specialised medical care.

Public reaction to the spin that has been put on the PACE trial results for CBT and GET has resulted in over 10,000 people signing a petition calling for claims relating to so-called recovery to be retracted and six academic researchers calling for an independent review of the study.

By contrast, in evidence collected from 1,428 people with ME by the ME Association, for which I am medical adviser, 73 per cent reported that CBT had no effect on symptoms while 74 per cent said reported that GET had made their condition worse. The MEA has therefore recommended that NICE withdraws their advice relating to GET.

On the progressive side of this medical divide are physicians and researchers who, like the patient community, believe that ME is a serious multi-system disease, often triggered by infection, but maintained by abnormalities involving, neurology, muscle, and the immune system.

In the UK, a research collaborative with a strong emphasis on the biomedical research has been established. And a major report from the prestigious US Institute of Medicine has recently concluded that ME is a "serious, chronic, complex, systemic disease that can profoundly affect the lives of patients". ME is not a psychological problem.

Biomedical research into ME is revealing abnormalities in the way that muscle creates energy, along with evidence of an ongoing overactive immune system response. New types of brain imaging are demonstrating low-level inflammation in several specific parts of the brain.

At the same time, a large multi-centre clinical trial is taking place to assess the use of Rituximab – a drug that depletes immune system B cells and which is normally used to treat a form of cancer called lymphoma.

The argument here is not with mental illness, which is just as real and horrible as physical illness. As with any long-term illness, some people will develop mental health problems where talking therapies can clearly be of help.

The argument is with a simplistic and seriously flawed model of causation that patients know is wrong and which has seriously delayed progress in understanding the underlying cause of ME and developing effective forms of treatment.

Opening the 2015 research collaborative section of neuropathology, Jose Montoya, professor of medicine at the University of Stanford, said: “I have a wish and a dream that medical and scientific societies will apologise to their ME patients.

I agree – the time has come for doctors and scientists to apologise for the very neglectful way in which ME has been researched and treated over the past 60 years. Doctors need to start listening to their patients and there must now be increased investment in biomedical research to gain a better understanding of the disease process and to develop treatments that these patients desperately need.

Dr Charles Shepherd is medical adviser to the ME Association

Thursday, 3 December 2015

Huddersfield woman Nathalie Wright talks about the misery of living with ME


In this thought provoking first person feature Huddersfield 22-year-old Nathalie Wright reveals how her life has been devastated by the crippling illness ME. Nathalie grew up in Pole Moor above Slaithwaite, went to Wilberlee Primary School, Crossley Heath School in Halifax and then Greenhead College. Day and night became indistinguishable

I lost my life as I knew it on November 1, 2013.

For many ME sufferers there is a date etched onto their deepest memory, the traumatic day they became ill with an often life-long disease. At my worst I suffered months of being completely bed-bound and was too weak to even clean up my own sick from the floor beside me. I only had the strength to shower every few weeks (sitting down.) I was 22.

Day and night were indistinguishable because most of the time I was not fully conscious in the way a healthy person is. I could simply pass out at any point.

When the crushing fog around my brain cleared even a little it only allowed me to be more aware of the relentless pain in my thighs and chest accompanied by a constant vice-like grip on my skull. A myriad of other symptoms danced round my body to a rhythm I couldn’t understand. Take away from this piece one fact about ME – it severely limits the patient’s capacity to function as a human being. I was reduced to a body on a bed in the prime of my life (yet in the grand scheme of ME suffering, I consider myself to have got off relatively lightly.)

My ME story began, as is very common, with a fever. I was a final year student studying English at Oxford University and was happy and fulfilled, looking forward to the future. When the fever hit I was working on some coursework and so asked for an extension as I just did not seem to be getting better. My request was denied.

The subsequent weeks were a blurred mix of confusion and helplessness as I felt myself slip further and further into the nadir of the disease. Why couldn’t I move? Why couldn’t I eat? Why could no doctors help me? You may think that with such a serious disease I would have been offered extensive medical support, but the opposite was true. Several GPs brushed me aside as being ‘a little stressed.’ When I asked another how long I could expect to be so severely ill she simply replied: “How long’s a piece of string?” Not only was I condemned to this tortuous illness, but my sentence was indefinite. I was forced to suspend my studies.

Months later when I finally got a referral to hospital (all the while languishing in a house I shared with strangers where I could barely cope to look after myself at all), I was finally officially diagnosed. “You’ll be back up and running in no time” grinned the specialist. I wanted badly to believe him but his words did not reflect reality.

As so often happens with poorly understood illnesses, attempts were made to psychologise my ME. I reluctantly saw a hospital psychologist who seemed determined to find a cause in my immediate environment. After 40 minutes of desperate floundering it seemed he’d hit the jackpot.

“Where did you go to school?” he asked. I told him, Huddersfield. Nodding sagely and narrowing his eyes he asked: “Are you having a hard time with the posh boys at Oxford?”

That was all the NHS had to offer me.

The relentless avalanche of ME symptoms completely took away my life and such a profoundly disturbing change in physical health is enough to drive anyone to despair.

I remember thinking, often, ‘I both feel like I’m dying and want to die so that I can stop feeling like I’m dying.’

Yet I think the worst consequence of such a disease is the sheer loneliness of it. I saved and treasured my scarce grains of energy to be able to have human interaction, often spending more energy on masking my symptoms and trying to appear as well as possible – I was so ashamed of my ME.

It seemed impossible to make friends and family understand exactly what was happening. Common responses included: “You’re just depressed” or even “this is just an ‘illness behaviour’ and not a real disease.”

However, often complete silence is the most hurtful response. As is common when a young women is in any kind of distress I felt I was dismissed and disbelieved while at the same time I was also blamed for it. It must have been that I was working too hard; it must have been that I only did four hours of exercise a week instead of six; it must have been that I was doing too much exercise. This added up to me eventually doubting every aspect of my being and sense of self – something I’m still trying to recover from.

Oxford University is often a terrible place to be sick. Determined to finish my degree I struggled on a year later under what is an enormous workload for anyone. As is usually the case at Oxford, even though I had suspended purely on medical grounds I was asked to sit nine hours of exams (including my extra time) to be ‘allowed’ back on my course. My protestations that that would make me extremely ill were all but ignored, although I managed to battle my way to just one penal exam with my tutor’s admonishment to ‘toughen up’ ringing in my ears.

I want to end this piece by saying that my ME is currently extremely life limiting, but nevertheless, I have improved a lot and am much better than thousands of severe sufferers around the world who literally can’t speak and are often ignored even when they break their backs to utter a cry of pain.

There are in-person ME support groups but it is a recurring joke in my head that people with ME are always too ill to attend them anyway – sometimes black humour gets you through a bad day. I stumbled across one such voice online which is where the ME community thrives and is an incredibly supportive environment. This voice was so ill and in such pain that it was simply asking others how best it could kill itself.

ME was my gateway to the world of the sick and often the barrier between the two worlds seems unsurmountable. How can you verbalise your body? How can the healthy understand sensations that no body should feel? This is why, when sick people speak it is of utmost importance that we are listened to, and listened to without judgement.

For ME, more biomedical research is needed urgently. In the meantime, the skills of listening and empathy are free.

I, along with millions of other sufferers around the world, want help and we want answers. Oxford University recently published follow-up data to its 2011 trial undertaken in partnership with Queen Mary and Kings College universities. The trial aimed to prove that the best treatment for ME (which they call ‘CFS/ME’) is cognitive behavioural therapy (CBT) and graded exercise therapy (GET).

However, the trial, known as the PACE trial, has been highly criticised internationally and in the UK. Dr Ronald Davis of Stanford University commented: “I’m shocked that the Lancet published it. The PACE study has so many flaws and there are so many questions you’d want to ask about it that I don’t understand how it got through any kind of peer review.”

Indeed, according to the trial’s definitions, ME patients were deemed ‘recovered’ even if they had physical function similar to someone with congestive heart failure. For me, the impact of such misleading claims not only increase the stigma I experience but is actively dangerous. GET was found to make over 70% of patients worse, according to a study conducted by the ME association.

The reason why this is so makes complete sense to any ME sufferer. The defining feature of ME is something called PEM or post exertional malaise (if one thing, ME has honed my acronym skills). This means if I exert myself physically or even mentally I will experience a worsening of all my symptoms, possibly for days or even weeks. If I walk too far at once (say 100m rather than 50m) I will feel sick and faint. Several times I have passed out in public or had to sit of the floor if a queue in a shop is too long. It’s humiliating, but I have thick skin now. I used to be a cross country runner.

The UK trial is contradicted by a landmark report made by the American Institute of Medicine this year which examined all the current evidence and came to the conclusion that ‘ME/CFS is an acquired, chronic multi-systemic disease characterised by significant relapse after physical, cognitive, or emotional exertion of any sort.’ In contrast to the PACE trial which selected patients solely on the basis that they experienced ‘fatigue’ for at least six months, the IOM report states that: ‘The disease includes immune, neurological and cognitive impairment, sleep abnormalities and autonomic dysfunction, resulting in significant functional impairment accompanied by a pathological level of fatigue.’

The report found that ME patients are more functionally impaired than those with type 2 diabetes mellitus, congestive heart failure, hypertension, depression, multiple sclerosis and end-stage renal disease.


Tuesday, 1 December 2015

While shepherds watched their flocks by night

A traditional carol for the start of December 

While shepherds watched their flocks by night,
All seated on the ground,
The angel of the Lord came down,
And glory shone around.

‘Fear not,’ said he, for mighty dread
Had seized their troubled mind;
‘Glad tidings of great joy I bring
To you and all mankind.

‘To you, in David’s town, this day,
Is born, of David’s line,
A Saviour, Who is Christ the Lord;
And this shall be the sign:

‘The heavenly Babe you there shall find
To human view displayed,
All meanly wrapped in swaddling bands,
And in a manger laid.’

Thus spake the seraph; and forthwith
Appeared a shining throng
Of angels, praising God, who thus
Addressed their joyful song:

‘All glory be to God on high,
And on the earth be peace;
Goodwill henceforth from Heaven to men
Begin and never cease.’

Nahum Tate, 1652-1715

Monday, 16 November 2015

PACE Trial Key Dates and Chronology of Complaint


Professor Malcolm Hooper     14th November 2015

Background

24th October 2002:  Professor Peter White’s initial application to the West Midland Multi-centre Research Ethics Committee (MREC), which was approved subject to clarifications

22nd April 2004: first meeting of the PACE Trial Steering Committee (TSC)

27th September 2004: joint meeting of the TSC and the Data Monitoring and Ethics Committee (DMEC)

March 2005:  study opens to recruitment

1st February 2006: unabridged Final Protocol Version 5.0 completed but not published (there were subsequent versions up to 5.2)

9th February 2006: Substantial Amendment 5.1 -- Professor White applies to MREC requesting permission to increase the SF-36 entry threshold from 60 to 65 and the “categorical positive outcome” from 70 to 75 (which he asserted would have the “advantage” of bringing the sibling FINE and PACE trials “into line”)

14th July 2006: Substantial Amendment 5.6 – due to recruitment difficulties, Professor White applies to MREC requesting permission “to advertise the trial to GPs”.  His proposed letter to GPs said:  “If you have a patient with definite or probable CFS/ME, whose main complaint is fatigue (or a synonym), whom you think might be interested and suitable for the study, please consider referring them to XXXXXX CFS/ME clinic at XXXXXX (one of the PACE trial centres)” (http://www.meactionuk.org.uk/White-letter-to-MREC-re-synonym.pdf ).

8th March 2007: abridged trial protocol published online: BMC Neurology 2007:7:6

18th February 2011:  selective results of the PACE Trial published by The Lancet online

5th March 2011: selective result of the PACE Trial published in The Lancet.

Chronology of formal complaint to The Lancet by Professor Malcolm Hooper

(For ease of understanding, it is written in the third person).

Professor Hooper was so concerned at what he read that he requested the article be retracted.

21st March 2011:  Margaret Williams spoke at length to Dr Stuart Spencer, listed on The Lancet Editorial Board as an Executive Editor; it was he who was responsible for publishing the PACE Trial article.  He confirmed to her that Professor White had insisted the article be fast-tracked.  He was informed that a formal complaint was being submitted by Professor Malcolm Hooper.

28th March 2011: Professor Hooper’s formal complaint and accompanying letter were sent to Dr Stuart Spencer at The Lancet. Both the letter and the formal complaint asked for the PACE article to be retracted pending further review (http://www.meactionuk.org.uk/COMPLAINT-to-Lancet-re-PACE.htm  and http://www.meactionuk.org.uk/Lancet-complaint-LETTER-final.htm ).

The two documents provided illustrations that by publishing selective results of the PACE Trial, The Lancet was in apparent breach not only of its own Elsevier publication policy but was also in breach of the WAME publication policy (World Association of Medical Editors), of which The Lancet is a member.

The Elsevier Ethical Guidance policy is unambiguous: “Authors of reports of original research should present an accurate account of the work performed as well as an objective discussion of its significance. Underlying data should be presented accurately in the paper. Fraudulent or knowingly inaccurate statements constitute unethical behaviour and are unacceptable. Review and professional publication articles should also be accurate and objective”.

The Elsevier Publishing Ethics Resource Kit (PERK) is also unambiguous; Research Error and Fraud (PERK 5) stipulates:  “Fraud is publishing data or conclusions that were not generated by experiments or observations, but by data manipulation or invention.  Changing the data measurements to conveniently fit the desired end result is fraud, but excluding inconvenient results is deliberate research error, which, in effect, is the same result – fraud”.

WAME is equally clear: Falsification of data ranges from fabrication to deceptive selective reporting of findings and omission of conflicting data, or wilful suppression and/or distortion of data…. Journals have an obligation to readers and patients to ensure that their published research is both accurate and adheres to the highest ethical standard….If a published paper is subsequently found to have errors or major flaws, the Editor should take responsibility for promptly correcting the written record in the journal” (http://www.wame.org/resources/publication-ethics-policies-for-medical-journals#study ).

In addition, all Elsevier journals are members of the Committee on Publication Ethics (COPE) which provides resources to support the investigation of and response to possible breaches in research and publication ethics.

29th March 2011:  Margaret Williams spoke again to Dr Stuart Spencer; this time Spencer was very angry.  Margaret Williams was (verbatim quote) “warned” and was threatened (verbatim quote): “You’d better be damned sure that you’re right or The Lancet’s lawyers will be on to you if it (the formal complaint) goes into the public domain”.  Having regained his temper, Spencer then confirmed that it was very likely that the PACE article would go for re-review; he also confirmed that he had passed on the complaint to Richard Horton, The Lancet’s Editor-in-Chief.  He then repeated that it would be (verbatim quote) “not wise” to put the complaint in the public domain.  He further said (verbatim quote): “We have to take it (ie. what Professor White said) on trust.  We don’t get statisticians to go round and check every calculation that’s been done”.  He also confirmed that Richard Horton had instructed him to notify Professor White about the complaint and that he (Spencer) had sent White an email advising him that a complaint was coming. Spencer then confirmed to Margaret Williams that Professor White had replied to him by email saying he was not surprised and that (quote) “We’ll deal with it”.

31st March 2011:  Margaret Williams spoke to Dr David McNamee, an Executive Editor at The Lancet, who contradicted what his colleague Dr Stuart Spencer had said: David McNamee was adamant that all studies go for statistical review before publication by The Lancet, saying that this requirement had been set up by him in 1990.  He asked if the allegation was one of scientific misconduct, saying that there was a formal procedure for dealing with such an allegation.  Margaret Williams informed Dr McNamee that a copy of the formal complaint and accompanying letter had been sent to Erik Engstrom (Chief Executive Officer, Reed Elsevier).  For the avoidance of doubt, no acknowledgement or response was ever received from Erik Engstrom, despite a chasing telephone call on 14th April 2011 to Patrick Kerr (Deputy Director, Corporate Communications, Reed Elsevier Group), who dismissively said of Engstrom’s failure to reply that (verbatim quote) “He’s got a £6 billion company to run”.

Also on 31st March 2011 Margaret Williams received an email from Dr Stuart Spencer: “We have asked Professor White to respond to the criticisms made by Professor Hooper.  In view of the length of the document we have asked for a response within 2 weeks.  I hope we shall then be in a position to decide on our next steps”.

1st April 2011: Margaret Williams received an email from Dr David McNamee in which he said that The Lancet’s Editorial meeting that morning “did not go further than to say we need now to wait until we hear back from the authors of the PACE paper”.

On 13th April 2011 Dr Stuart Spencer sent Margaret Williams an email saying they were still awaiting a written response from Professor White.

On 18th April 2011  Stuart Spencer sent Margaret Williams an email in which he said: “The (sic) will be a further delay to the response to Professor Hooper.  This is because we have now forwarded other letters to the authors and we will want to deal with just one response to all the comments.  It would not be right to favour one correspondent over others”.

Also on 18th April 2011 Richard Horton spoke on Australian ABC radio about the PACE trial; interviewed by Dr Norman Swan, Horton was openly contemptuous about Professor Hooper’s complaint: “the paper went through peer review very successfully, it’s been through endless rounds of peer review and ethical review so it was a very easy paper for us to publish. It was only at the point of publication and just after that we have had this extraordinary negative reaction….We have been deluged with dozens of letters raising serious objections to the conduct and interpretation of the study.  Most recently a 43 page diatribe (Professor Hooper’s formal complaint) calling for the paper to be retracted based upon the fact that it is entirely invalid and unethical….Pretty much every aspect of the study you can think of has been impugned….I think the criticisms about this study are a mirage, they obscure the fact that what the investigators did scrupulously was to look at chronic fatigue syndrome from an utterly impartial perspective….The accusations that are being made about (the investigators) is that they have behaved unethically, breached international standards of ethics…. One sees a fairly small, but highly organised, very vocal and very damaging group of individuals who have I would say actually hijacked this agenda and distorted the debate so that it actually harms the overwhelming majority of patients”

On 17th May 2011  Zoe Mullan (listed on The Lancet Editorial Board as a Senior Editor) sent an email to Professor Hooper and Margaret Williams in which she said: “We asked the authors of the PACE trial to respond to your concerns, which they have duly done.  Your complaint and their response were discussed at the highest management level and this group of executive editors was fully satisfied that there were no grounds whatsoever on which to take further action.  We attach the response provided to us here. From an editorial perspective, the case is now closed.  If you believe the editors have acted inappropriately, you could approach our independent ombudsman”.   For clarification, The Lancet’s “independent” ombudsman was Professor Charles Warlow who in 2005 had co-authored the Scottish Neurological Symptoms study (that was dismissive of the neurological manifestations of ME) with Professor Michael Sharpe, one of the PACE Trial’s Principal Investigators, so he was already conflicted.

In his undated letter to Richard Horton sent to Margaret Williams on 17th May 2011, Professor White stated something remarkable: “The PACE trial paper refers to chronic fatigue syndrome (CFS) which is operationally defined; it does not purport to be studying CFS/ME but CFS defined simply as a principal complaint of fatigue…(Oxford criteria)”  (http://www.meactionuk.org.uk/whitereply.htm ).

On 18th May 2011 Professor Hooper provided his initial response to Professor White’s letter to Richard Horton

On  28th May 2011 Professor Hooper provided his detailed response to Professor White’s letter to Richard Horton

On 1st June 2011 a University of Edinburgh zoology graduate, James Campbell, wrote to Zoe Mullan: “I am writing concerning the PACE Trial article…and The Lancet’s astonishingly inadequate response to the valid concerns which have been raised by many people.  I would like to draw your attention to Professor Hooper’s response to Professor White’s letter to Dr Horton.  As you can see, Professor Hooper has drawn attention to the fact that Professor White failed to address many of the valid concerns raised by himself and numerous other researchers. In addition, Professor White’s response contains many factual inaccuracies, errors and inconsistencies.  For example, Professor White now claims that the PACE trial did ‘not purport to be studying CFS/ME’, an astonishing claim with serious implications.  It is surely incumbent on The Lancet, under its own guidelines, to take this matter further and require the authors of the PACE trial to fully address the very significant problems with their response”.

On 3rd June 2011 Zoe Mullan replied: “We were perfectly satisfied with Prof White and colleagues’ response to Prof Hooper’s complaint. If Prof Hooper has any further concerns we would welcome his contacting us about it”.

On 5th June 21011 James Campbell replied to Zoe Mullan: “Speaking frankly, I cannot understand how any science journal could say they ‘were perfectly satisfied with Prof White and colleagues’ response to Prof Hooper’s complaint’. Anyone with any background in science can see that there are serious questions to be answered about the PACE paper and that Prof White did not fully address these concerns.  This whole business reflects very badly on The Lancet”.

On 6th June 2011 Margaret Williams sent the following email to Zoe Mullan:

“Dear Ms Mullan

An email which you sent to Mr James Campbell on 3rd June 2011 has been forwarded to Professor Hooper (and hence to me).  Professor Hooper has asked me to contact you on his behalf.

In that email you say you are perfectly satisfied with Professor White and colleagues’ response to Professor Hooper’s complaint (as indeed you said to us in your email of 17th May 2011), but you also say that if Professor Hooper has any further concerns, you would welcome his contacting you about them.

He does have further concerns, but believed that as you advised him that from an editorial perspective the case was closed, there was no point in sending you a copy of his response.

It is not clear if you have read it, so for convenience a Word copy is attached.

In the light of your email to Mr Campbell, Professor Hooper asks you to accept his response as being a due part of the Elsevier formal complaints procedure.

As requested, he will let you have his further concerns as soon as possible.

I hope you will accept that Professor Hooper bears no personal animosity towards Professors White, Sharpe and Chalder, nor indeed towards Professor Wessely or other members of the Wessely School, but he does have the greatest condemnation of what is internationally accepted to be their cavalier and idiosyncractic attitude towards people with ME/CFS, their dismissal of patients’ intense physical suffering as aberrant beliefs and their unshakable assertion that it is a somatoform disorder (SD) amenable to CBT and GET, when chemokine, cytokine and genetic profiling, as well as proteomics, have identified critical features which make it incontrovertible that it is not an SD and cannot be managed as such.

Professor Hooper’s overriding concern is for the welfare of – and justice for – very sick people who are suffering not from an aberrant illness belief and deconditioning (the premise upon which the PACE Trial was predicated) but from a chronic, complex, multi-system neuroimmune vascular inflammatory disorder in which incremental aerobic exercise is contra-indicated and has been shown by various ME charities to be at best unhelpful and at worst actively damaging in 50% to 95% of patients.

In the light of this, Professor Hooper has asked me to attach another Word document containing extracts from Witness Statements provided by international experts in the disorder for the Judicial Review of the NICE Clinical Guideline on CFS/ME (CG53), electronically available at http://www.meactionuk.org.uk/Statements-of-concern-for-High-Court.htm from which you will see how firmly these experts reject the notion that CBT and GET are the management options of choice for people with classic ME/CFS as distinct from those who suffer from chronic fatigue. Busy though you undoubtedly are, I would ask you to read it with attention.  Perhaps I should explain that for reasons of professional misconduct by the Claimants’ own lawyers, these Witness Statements were not put before the Court.

In the meantime, there is a major problem with the Comment by Bleijenberg and Knoop which The Lancet editorial team has so far failed to address, namely their claim of a 30% recovery rate with CBT and GET for PACE participants.

It cannot be argued that this is merely a matter of semantics (Bleijenberg & Knoop state: “The answer depends on one’s definition of recovery”): those authors have unequivocally misrepresented the findings of the published paper.

The PIs do not report the number of participants who recovered, only those who fell within their own much criticised definition of “normal range” for fatigue and physical function.

It cannot be acceptable for The Lancet to allow Bleijenberg and Knoop to claim that 30% of participants recovered after CBT or GET when the definition of “recovered” on which they rely has been set artificially low by White et al – so low in fact that a participant described by them as recovered could still be sufficiently disabled to meet the trial’s entry criteria.

This surely represents a significant failure of both the peer review process and editorial oversight.

Anyone reading Bleijenberg and Knoop’s Comment will be left with a grossly incorrect understanding of the results of the PACE Trial.

As mentioned in his response to Peter White, Professor Hooper quoted medical statistician Professor Martin Bland: “Potentially incorrect conclusions, based on faulty analysis, should not be allowed to remain in the literature to be cited uncritically by others” (BMJ: 19th February 2000:320:515-516).

In view of this, Professor Hooper once again formally requests that The Lancet either retracts or corrects the Bleijenberg & Knoop Comment and he would appreciate being informed of your editorial decision about this important issue.

If you require further information or clarification, please do not hesitate to contact me and, as mentioned, Professor Hooper will let you have his further comments as soon as possible”.

On 8th June 2011 Zoe Mullan replied to Margaret Williams: “Thank you for your email and the attachments, which I will read.  In the meantime, yes I do think we should correct the Bleijenberg and Knoop Comment, since White et al explicitly state that recovery will be reported in a separate report.  I will let you know when we have done this”.

On 9th June 2011 Professor Hooper provided an update on the PACE Trial results

On 24th June 2011 Professor Hooper provided his further concerns about the PACE results published in The Lancet which were sent to Zoe Mullan on 25th June 2011 (http://www.meactionuk.org.uk/Normal-fatigue.htm ).

On  29th June 2011 Zoe Mullan acknowledged its receipt.

On 12th July 2011  Margaret Williams sent an email to Zoe Mullan asking when to expect the promised correction of the Bleijenberg and Knoop Comment.

On 15th July 2011 Zoe Mullan replied to Margaret Williams: “We are awaiting the outcome of some investigations before making a final decision about publishing a correction to the Bleijenberg and Knoop Comment.  I will keep you posted”.

Despite chaser emails sent on 24th July 2011 and on 11th August 2011, nothing further was heard from Zoe Mullan.

On 10th December 2012 the Countess of Mar submitted a formal complaint to the Press Complaints Commission about The Lancet’s failure to correct the Bleijenberg and Knoop Comment.

On 26th February 2013 in her correspondence with the PCC, Dr Astrid James, Deputy Editor of The Lancet, wrote: “I can confirm that our editor of our Correspondence section, Zoe Mullan, did offer her personal opinion at the time, in which she said that she thought we should correct the comment.  Zoe made a mistake in not discussing this approach with a more senior member of our editorial team.  Now, however, we have discussed this case at length with all members of The Lancet’s senior editorial team, and with Zoe, and we do not agree that there is a need to publish a correction”.

It was not until 13th November 2015 that, following a series of articles by David Tuller exposing the fundamental flaws and inadequacies of the PACE Trial (http://www.virology.ws/2015/10/21/trial-by-error-i/ ) that six renowned scientists (Ronald W. Davis PhD, Professor of Biochemistry and Genetics, Stanford University; Jonathan C.W. Edwards MD, Emeritus Professor of Medicine, University College London; Leonard A. Jason PhD, Professor of Psychology, DePaul University; Bruce Levin PhD, Professor of Biostatistics, Columbia University; Vincent R. Racaniello PhD, Professor of Microbiology and Immunology, Columbia University and Arthur L. Reingold MD
Professor of Epidemiology, University of California, Berkeley) wrote an open letter to Richard Horton and The Lancet.  They called for a truly independent examination and re-analysis of the raw data from the PACE Trial, with the appropriate sensitivity analyses by highly respected reviewers with extensive expertise in statistics and study design.  The reviewers should be from outside the UK and outside the domains of psychiatry and psychological medicine; they should also be completely independent of, and have no conflicts of interest with, the PACE investigators and the funders of the trial (http://www.virology.ws/2015/11/13/an-open-letter-to-dr-richard-horton-and-the-lancet/ ).

The refusal by The Lancet to even countenance the call for retraction by Professor Hooper clearly shows the unwillingness of The Lancet’s editors to recognise the many significant flaws that were brought to their attention and raises the question of the integrity of all publications in The Lancet.

The renewed call for retraction of the PACE paper by such eminent signatories leaves the Lancet editors open to charges of ideological bias if they refuse to comply.