In her capacity as Managing Director of an online training company about Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (M.E/C.F.S), our M.D. Sally Callow complained to various organisations including the General Medical Council about a BBC Breakfast segment on Long Covid on 2nd February 2020, specifically about the false information on recovery through exercise and ‘positive thinking’ for patients with post-viral illness.
Both interviewees were stated as being ‘experts’ by BBC presenter Charlie Stayt ‘You are both, in a way, experts. One a GP and the other an epidemiologist’. Their comments were given in the guise of being medical ‘experts’ on post-viral illness, not purely as patients. However, their comments directly contradict the NICE guidance review (first draft) published in November 2020 where it clearly states that exercise should not be recommended as a treatment or cure. NICE also warns against promoting psychological interventions, CBT, and neurolinguistic programming as treatments or cures for M.E/C.F.S.
Why does this matter in relation to Long Covid?
It has become clear over the past 6 months that a subset of Long Covid patients is experiencing Post Exertion Malaise (P.E.M). Post Exertion Malaise is the key defining characteristic of M.E/C.F.S and is the reason why increased activity/exercise should not be recommended for M.E/C.F.S patients. Yet, there are a large number of medical professionals who believe exercise will help these patients recover from Covid19. Recommendations to exercise are currently included in the Your Covid Recovery programme.
Whilst we agree that exercise may help some patients recover, to see medical ‘experts’ recommending exercise/increased activity to patients who may be additionally harmed by ‘increased activity’ is worrying. Dr. Gerada stated this in the BBC Breakfast interview–
‘There is nothing that isn’t made better through exercise. OK? Nothing. No matter what age, what condition, exercise will always improve it, but in moderation’.
This statement is untrue, for the reasons already stated above. This is why we contacted the GMC to complain about the unprofessional behaviour of Dr. Gerada. We believe her comments stigmatise, and could potentially harm, Long Covid patients who are already battling against medics who are telling them that their symptoms are ‘all in their head’, the Long Covid patient experience is mirroring that of the M.E/C.F.S patient community. As is made clear in Long Covid advocacy group Body Politic’s statement of 16th February 2020 –
‘Both Long COVID patients and others with chronic and acute illnesses have reported being psychologized by clinicians and denied care as a result. This phenomenon fits into a much larger history of medical providers prescribing positive thinking and exercise therapies as cures for chronically ill and disabled patients. Such suggestions place blame on those suffering and are rooted in ableism. In the United Kingdom, people with ME/CFS have often been prescribed Graded Exercise Therapy (GET) along with Cognitive Behavioral Therapy (CBT), despite evidence that contradicts these recommendations and patients’ testimonies that these therapies worsen symptoms. To broadly claim that GET or “brain training” can cure Long COVID puts those living with Long COVID at risk. It also ignores the history of those living with other chronic illnesses.’
On their website, the GMC state:
We have five core organisational values underpinning everything we do.
- Integrity – We are honest and share what we see. We listen to our partners, but remain independent.
- Excellence – We are a learning organisation, committed to achieving high standards.
- Collaboration – We work with others to support safe, high-quality care.
- Fairness – We respect people and treat them without prejudice.
- Transparency – We are open and account for our actions.
These values form the basis on which we operate.
Here is the GMC’s response to our complaint.
Thank you for contacting us and taking the time to raise your concerns.
We have carefully considered your complaint, and while we appreciate your reasons for writing to us, we don’t feel that these are issues that would warrant further GMC action being taken. We are sorry if this is not the outcome that you were hoping for.
Our role is directly related to the registration of doctors. Our responsibilities are all connected to keeping the Medical Register. We oversee medical education; we give entry to the Register for those suitably qualified; we advise on good medical practice while registered; and we remove or restrict registration in response to fitness to practise concerns where there may be a risk to patient safety.
An investigation can only be opened if the concerns raised are so serious that the doctor’s fitness to practise medicine is called into question to such an extent that action may be required to stop or restrict the way in which they can work to protect future patient safety.
The purpose of an investigation is to determine if or to what extent we need to restrict the doctor from working. We are not a general complaints body and we have no legal powers to intervene in or resolve matters for patients.
n Dr Clare Gerada
In your complaint, you raised concerns about Dr Gerada’s comments made in an interview on BBC Breakfast.
You have told us Dr Gerada has wrongly said that all patients would benefit from exercise. You have said that this goes against the recently revised draft NICE guidelines on ME/CFS treatment. Which is changing from recommending GET (graded exercise therapy) and CBT, to advising against a programme of fixed incremental increases in exercise, and instead highlighting the importance of people remaining in their “energy envelope”.
You have said that Dr Gerada’s comments about exercise have implications for new patients with “Long Covid” which has similar symptoms to ME/CFS and that she is giving them harmful advice and stigmatising them for not being able to exercise.
We note that the guidance is in the draft stages and going through a consultation process. We also note there is no indication Dr Gerada is forcing patients to exercise when not appropriate or saying that patients should exercise outside their specific energy envelope.
We appreciate why you are unhappy about these comments, however we do not consider that this incident is sufficiently serious to meet our threshold for opening an investigation into Dr Gerada’s fitness to practise medicine. We cannot in general determine what a doctor can and cannot say by way of an opinion on TV/social media, and this would only meet out criteria for investigation in circumstances where we decide the doctor’s ‘s fitness to practise may be impaired to the degree we may need to place some kind of restriction. Usually this is where there is a serious risk to patient safety. In this instance we do not consider this threshold is met.
The GMC is not supporting or condoning Dr Gerada’s comments. We recognise in the current climate there are bound to be disagreements between parties about what constitutes ‘good’ advice. However, it is not for the GMC to comment on policy decisions, or settle scientific debate about best practice with ME/CFS or Long Covid treatment, that would be for scientific research and the relevant clinical bodies. In the absence of clear information that Dr Gerada has acted in a way as to call into question her fitness to practise these are not matters for GMC action.
If you continue to have concerns about Dr Gerada’s comments, you may wish to consider complaining to the BBC, and/or the Royal College of GPs.
You have also mentioned similar concerns about Dr Paul Garner. You have said that he claimed to have had Coronavirus and recovered through exercise and positive thinking.
We have no information that Dr Garner has lied about being ill with the virus and the fact that he related positive thinking with helping him would not raise fitness to practise concerns. There is no indication Dr Garner is recommending patients positive thinking over medical treatment in accordance with national guidelines. As with Dr Gerada while we appreciate you disagree with Dr Gerada’s opinion and advice, this would not be something which would meet our threshold for opening an investigation.
To get a clearer view of Dr. Garner’s ‘Long Covid recovery’, readers of this blog should read his BMJ article. It is highly likely that Dr. Garner had Post Viral Fatigue Syndrome, as many thousands of others did, and so he would have naturally recovered over a longer period of time irrespective of exercise or positive thinking. However, the advice the M.E/C.F.S community gave him to stop, rest, and pace in the first few months after his acute infection will have greatly improved his chances of recovery and reduced the chances of him developing M.E/C.F.S. Dr. Garner incorrectly and prematurely self-diagnosed himself with M.E/C.F.S. Neither exercise nor positive thinking is an effective treatment or cure for M.E/C.F.S.
To be clear, our Managing Director complained to the GMC as there was no option available to complain to the Royal College of General Practitioners. M.D. Sally also complained to the BBC but as yet has not received a response.
The complaint was to highlight a poor knowledgebase on post-viral illness and also to question whether either Dr. Gerada or Dr. Garner should be permitted to go on national television as ‘experts’ (in a medical capacity) to recommend potentially harmful ‘treatments’ to the viewing public.