Question of CFS/ME diagnosis

In addition, the 15% advantage over standard care for patients in CBT and GET can be further questioned given that at least 1/3 of all patients did not meet the strict international criteria for CFS (Table 1 in study)—the diagnostic protocol most often used in published studies. Strict criteria for CFS are linked to poor prognosis and conversely, subjects who don’t meet strict criteria for CFS have better outcomes.  So the PACE trial folded in a significant number of subjects who do not have CFS according to standard criteria.  Again this dilutes the significance of their findings as it makes it more difficult to generalize to the population of people who do have CFS.

To put behavioral approaches in context—they can be quite helpful, but they hardly meet the standard of clinical significance that would elevate them to curative interventions.   If this had been made clear in the study, it would have provoked far less controversy and debate.