Saturday, 6 March 2010

Letter to The Guardian and GMC

Well - after three days and the co-option of two people who have 'non-ME brain' the letter is done and sent:

Dear Ms Butterworth
My purpose in writing to you is to highlight a number of concerns relating to articles written for The Guardian under the “Dr. Crippen” pseudonym. These relate: to significant and disturbing misleading of readers over the status of some medical conditions which raises questions as to his suitability to continue to write such a column; to the opinions expressed in the column; and to the manner in which he uses The Guardian column to seed (and attract attention to) far more vitriolic posts in his blog that reflect very poorly upon such a respected publication as The Guardian.
Firstly I would like to deal with the matter of misleading readers, with specific reference to his stated position and comments on the legitimacy of Fibromyalgia and M.E.
I turn first to the article Doctors must stop playing along with this whiplash charade
I would like to draw your attention also to ‘Dr Crippen’s subsequent blog entry titled Fibromyalgia: “whatever that is”
which cites the article. I wonder whether you are aware that ‘Dr Crippen’ has a blog and that in it he makes much of his status as a Guardian columnist? I wonder also whether you are aware that the opinions which he airs in his blog are far more inflammatory than those in his column?
‘Dr Crippen’ uses his Guardian column to stir up trouble in an apparently cynical bid to gain ‘hits’ for his blog and thus gain notoriety and advertising revenue. It does seem very clear that the seeds for the fibromyalgia-bashing blog entry were deliberately sown by him in that ‘throwaway’ comment in his Guardian column ostensibly on the subject of whiplash. It also seems this is a tactic he has employed on previous occasions. He plays on his ‘respectable status’ as a Guardian writer to lend undue authority to a blog which appears to have scant regard for modern medical knowledge, patients and on occasion, the truth – and one which without said connection to The Guardian would just be a sad little blog where an ignorant man vents his spiteful and archaic views and revels in baiting the sick. At the same time, he triggers ‘controversies’ over comments in his Guardian column which he then exploits on the blog.
He opens the blog entry in question with:
“Oh! Dear. I just happened to mention in The Guardian today* that I do not know what "fibromyalgia" is. They did not teach me about it at medical school. It is not a diagnosis I have ever made and, not knowing what the condition is, I shall not be making it in the future. Truth is, I rather doubt it exists at all.”
*he links to The Guardian site here
So he begins by revelling in his ignorance, makes it clear he has no intention of bringing his knowledge up-to-date and gets right on with the business of baiting the sick. I’m sure you’ll agree this seems an odd attitude for a doctor: ‘I don’t know what that is; I don’t intend to inform myself; any patient of mine unfortunate enough to suffer from it can therefore whistle for informed help”. Do I really have to list the number of diseases that we didn’t know about once but managed to learn about in the course of history? Need I mention that (to name a few) MS, asthma, epilepsy and Parkinson's Disease were once considered 'mental disorders' and referred to very much in the way 'Dr Crippen' now refers to fibromyalgia and ME? Perhaps it would be sufficient to point out that the GMC’s guidelines to ‘good medical practice’ require a doctor to ‘keep your professional skills and knowledge up to date’?
As for ‘just happened to mention’ – oh, indeed. Just happened to quite deliberately use in the column a respectable newspaper (for reasons I cannot comprehend) pays him to write, another ‘red rag’ term that will provoke exactly the outraged reaction he desires, so that he can then write all about it on his blog in far more offensive terms, thus drawing more complaints - every one of which counts as a ‘hit’ for his blog, making it seem popular and making him money from the advertisers featured thereon. Advertisers don’t care if most of your hits are complaints or visits by concerned and angry people Or, indeed, ignorant and hateful comments. They just care about numbers. What does The Guardian care about?
Naturally, ‘Dr Crippen’ is careful to mention The Guardian right up front, as well as linking to it, because this conveys the dishonest impression that said blog, as well as his Guardian column, is written under the cloak of The Guardian’s approval and respectability. (It also links his blog and The Guardian firmly on search engines.) Is this really a use you are proud of for The Guardian name and reputation?
‘Dr Crippen’ writes sarcastically on the subject of knowledge:
“There is so much knowledge to be gleaned from newspapers and on the internet, especially if you read enough self-opinionated, self-indulgent blogs.”
By this, he is referring to patients who, although suffering, make the attempt to inform themselves about their condition and possible things that could help them. Of course, this should be the job of their doctors – but with doctors like ‘Crippen’ around, who can blame these people for spending their precious energy on their own research?
Anyone who wishes to see a truly ‘self-opinionated, self-indulgent blog’ need indeed look no further than Dr Crippen’s own. I do urge his paymasters at The Guardian to spend some time reading his blog, since as I say he goes out of his way to plug his association with your paper there – your ‘doctor’ gives vent to his real contempt for sick people (whereas in his Guardian column he is rather more careful to dress up his views as concern for the sick, while sprinkling it with asides such as ‘fibromyalgia – whatever that is’ which he can be sure will successfully provoke the fuss he wishes, and which he then takes advantage of to make a blog entry abusing sick people.) Charming comments from his conveniently-anonymous fans which have been posted there recently include:
“Fibromyalgia is yet another diagnosis of exclusion for a set of completely vague and waffling signs and symptoms.

In english it is a load of bullshit, just like ME.”
And the delightful:
“Why do you keep winding the ME/fibromyalgia brigade up?

Oh yeah, I remember, it's called sport!

Keep up the good work.”
Are these really the kind of people you are trying to attract as Guardian readers?
Even more worrying is ‘Dr Crippen’s’ apparent disregard for truth where untruth will serve him better in his mockery.
In response to a poster protesting about the ‘whatever that is’ remark, Dr Crippen wrote:
“I know little about fibromyalgia. I wonder why it is not taught at medical school? Are the whole medical profession wrong? “
This is simply untrue. (I will return to his apparent claim to speak for 'the whole medical profession later). Of course, fibromyalgia is taught about at medical school, though it may not have been 20 years ago. But how many people will read from your columnist the untruth that fibromyalgia is not taught and conclude that it is a ‘fake’ illness? Perhaps you might want to consider employing someone with more up-to-date knowledge to write a medical column for you? Someone who has an interest in keeping his or her knowledge and training up-to-date? Does it not worry you at all that this supposed doctor goes on to say he tried to broaden his knowledge by consulting Wikipedia? Presumably this is the lamentable standard of ‘research’ that informs his column in your paper. He might as easily and to much better end have consulted a medically-verifiable source such as ‘NHS Evidence’ via the NICE Guidelines site which would have provided him very quickly with evidence-based guidelines (such as those from EULAR) on the nature and treatment of fibromyalgia. But that would have been far less ‘amusing’, I suppose.
I will now look at the way in which he has treated the subject of ME – a subject that I am sure you are aware has been much in the news over the last few months.
With regard to the slighting reference in his previous column
to "the many who march under the ME banner but who have nothing wrong with them other than an inability to cope with life" I would suggest that ME seems to be a favourite (and easy) target. I might laugh at the irony of using the term ‘march’ of a group of people who often find themselves housebound – except that it is very, very far from funny. I am an ME patient. My ‘nothing but an inability to cope with life’ includes the following: going in a matter of weeks from someone who trekked 100km across Iceland to raise money for Macmillan Cancer Research to someone who cannot always manage to walk up and down stairs; the most infuriating reduction of cognitive functions; daily pain; the loss of a job I loved due to physical inability to perform it, and the loss of the chance to start a much-desired family. I was, in fact, coping fine with life until ME came along and blasted it into tiny pieces.
For ‘Dr Crippen’ to keep using phrases like this in the face of all the evidence to the contrary passes beyond ignorance into deliberate malice – the contemptible use of an attack on sick people to get himself attention. After the widely-reported deaths of Sophia Mirza and Lynn Gilderdale, how can a respectable newspaper countenance this? Ignorance is no longer an excuse!
As for the assertion that
"Some people with ME are even more blinkered than the medical professionals. Patients with chronic illnesses such as cancer or heart disease sometimes get depressed and are helped by psychiatric treatment. You cannot suggest this to a militant ME sufferer"
I appreciate the suggestion that medical professionals and patients can be blinkered, but I suspect that if you suggested to a cancer patient who had become depressed that they had nothing wrong with them but depression - which is what is suggested to ME sufferers - they too would find that somewhat offensive.
Unfortunately, the suggestion that ME is ‘all in the mind’ is made far more often than it should be - in spite of the fact that ME has been classified by the World Health Organisation as a neurological disorder since 1969 (ICD-8: Vol I: code 323, page 158; Vol II (Code Index) page 173) - and is a suggestion which affects crucially the way ME sufferers are treated by the NHS and our Government services. It is therefore with either deliberate malice or lamentable ignorance unbecoming a doctor that ‘Dr Crippen’ makes such button-pushing assertions as that quoted above. The reaction is all he could wish for, I'm sure. I am surprised that The Guardian would wish to lend its name to such cruel games, or gain a reputation for supporting such ignorance.
The statements made by ‘Dr. Crippen’ in these blog posts cited above are in direct conflict with official published information from WHO and NICE - which does lead me to the question of quite how ‘Dr Crippen’ qualifies as your voice of ‘what’s really happening in the NHS’. I would be most reassured if you could provide me with more details about the anonymous ‘Dr Crippen’ and his qualifications for writing this column.
The Guardian gives as his by-line "Dr Crippen is the pseudonym for a long-serving GP. Every week he brings us a first-hand account of what's really happening in the NHS." (my emphasis). In other words, he is presented to readers as an authoritative and authentic ‘voice of truth’.
All I have been able to find in his own words is:
“spent six years at medical school with four years post-graduate training and then another twenty years in practice, so obviously he cannot be expected to know everything.”
The fact that his training was so long ago and that he mentions no further training since does help explain why his expressed views are so out of date and his ignorance so startling. GPs do have an annual appraisal (and will soon be subject to revalidation/ reaccredidation). However, the content is “learner lead”… if a doctor does not recognise (or accept?) a learning need, they do not have to demonstrate they have met that need! It would appear ‘Dr Crippen’ thinks he has nothing to learn – in fact, both his out-of-date knowledge and ignorance would seem to be considered by him things on which to pride himself.
Perhaps as he writes on medical matters for you, though, you might care to check up on how much effort he makes to stay up to date (as doctors are expected to do by good medical practice, and which will soon be compulsory thanks to reaccreditation)? I would have thought this must affect rather critically his ability to write for you with any real authority on matters medical? I am reluctant to believe that you are, for some bizarre reason, giving him a column where the deliberate aim seems to be to glorify reactionary views and ignorance, but what he writes can scarcely qualify as educational or informative, or ‘what’s really happening’. What purpose, then, is his column intended to serve?
In a recent response to a comment on his blog, ‘Dr Crippen’ assures his readers that he speaks for the majority of doctors:
“What you have to realise is that I am merely saying in public what most doctors only whisper in private. Most doctors do not believe that fibromyalgia is a genuine condition. Maybe they are wrong. Prove it to me. “
I should like to see the statistical data to back up such an easy assertion to make (and to test).
When your paper describes his column as
“a first-hand account of what's really happening in the NHS."
you seem to accord him rather exalted status as an informed 'voice of truth'.
Interestingly a GP (name and address supplied on request) whom I asked to take a look at the column and blog, reacted as follows on the subject of ‘Dr Crippen’s’ authority: “I am sure the GMC would take a poor view of any GP revelling in their ignorance of any subject, rather than accepting it as a failing and doing something about it. Unfortunately, I am sure a reaction is what he is all about. I read one or two similar medical blogs and found them really quite tiresome in their clich├ęd and often quite vitriolic content….so I never bothered again.”
I doubt many people visiting ‘Dr Crippen’s’ blog would ‘bother again’ did he not possess the cachet of being a Guardian writer, and can only wonder why you consider his views important and authoritative enough to be widely distributed by your paper.
Unfortunately, since ‘Dr Crippen’ hides behind anonymity, it is impossible to complain to the GMC about him under his real name (though I do intend to send a copy of this letter to them) – even though his writings must surely raise genuine concerns that he may be putting at risk the health of anyone unfortunate enough to be a patient of his through his arrogance and ignorance, as well as breaching good practice guidelines on the treatment of patients. These guidelines (which you may peruse at include such duties as:-
  • · Keep your professional knowledge and skills up to date.
  • · Treat patients politely and considerately.
  • · Never abuse your patients' trust in you or the public's trust in the profession.
  • · Work in partnership with patients.
I see evidence of none of the above reflected in either his Guardian column or his blog.
Given the wide readership of The Guardian it is clearly imperative that ‘Dr Crippen’s’ at best misleading comments on the subject of fibromyalgia and ME are clarified with all possible haste. I am sure The Guardian has no wish to aid the dissemination of untruth. It is also disturbing that someone who purports to be describing ‘what’s really happening in the NHS’ should be so apparently ignorant about the topics on which he writes – so much so as to raise serious questions over his suitability to write such a column.
To my mind of equal concern to these errors and the general tone he adopts in relation to these conditions in The Guardian column, are the far more vitriolic comments he posts on his blog.
Clearly The Guardian is not responsible for these posts - however as ‘Dr Crippen’ goes to great lengths to emphasise his status as a Guardian columnist and to link to his columns there, these posts do inevitably reflect back upon The Guardian - and in a manner that is extremely negative.
Even had he not made serious errors in his column, the very nature of his blog (which he seeks with considerable success to inextricably link with his Guardian column in readers’ minds) must raise serious questions over the merit of continuing your relationship with him (or her) – the consequences in terms of damage to The Guardian’s reputation as a trustworthy and balanced publication seem serious and undesirable.
May I therefore in closing request a specific, published, apology for the unscientific inference in his Guardian column that fibromyalgia (which ruins many lives) does not exist? Fibromyalgia is included in the Tenth Revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10) published by WHO in 1992 as follows:
· M79 Other soft tissue disorders, not elsewhere classified
M79.0 Rheumatism, unspecified
I would also urge very strongly that The Guardian reconsider its relationship with ‘Dr Crippen’ as I feel he does nothing but damage to the reputation of your paper. I appreciate that you are not responsible for what he writes on his personal blog, but feel you should consider that he uses his connection with your paper to cloak said blog in faux authority and acceptability – and how desirable it is that you enable this to go on.
Jane Winter


  1. *listening*

    A most excellent composition. I truly hope it brings results.

  2. Hi Jane, May I copy you some (too long for your character restrictions) of an email that I have just sent to someone else:

    I’m flummoxed by the vitriolic response to the statement “fibromyalgia – whatever that it”. Like may doctors, I’m in doubt as to the meaning of the word. I’m only saying openly what other doctors are saying in secret. My unease about the meaning of fibromyalgia does not mean that I don’t think there is a group of people with a debilitating and painful condition who are often not getting appropriate treatment. Many doctors’ minds are closed to the diagnosis.

    Some of the emails I have received have been abusive and, incredibly, I have even had death threats. We get nowhere by being abusive. We need an open debate. If you would like to send me an article I will publish it EXACTLY as you send it on NHS BLOG DOCTOR

    Over the last four years, I have had similar correspondence with people who have ME and Chronic Lyme disease. There are similarities between these conditions and fibromyalgia in that there is a lack of tests, a lot of intolerant doctors and a lot of angry patients. I used to have email discussions with "K", an ME sufferer. Very ill, very intelligent and very patient. During this correspondence I wrote the following:

    Myalgic enecphalomyelits is not even recognised in the USA and yet in Australia it is both recognised as a diagnosis and as an acceptable cause of death for death certificate purposes. What are we to make of those two extremes? Why are most doctors so resistant to ME and Lyme Disease?

    Doctors are problem solvers. They believe that all medical problems can be solved, that a diagnosis can always be made. A collection of signs and symptoms allows for that diagnosis, and the diagnosis gives a prognosis and a treatment plan. When doctors meet a patient with a multiplicity of symptoms that cannot be explained it is clear to them that the patient is mad. For, of course, “mad” is a diagnosis and therefore an explanation. The patient cannot win. Doctors feel threatened if they cannot do some tests. There is no known definitive test for ME. There are tests for Lyme disease, but their value is uncertain, and the ones that are commonly done are inaccurate.

    Some ME/CFS/Lyme patients are mad. Of that I have no doubt. Some ME/CFS/Lyme patients are not mad. Of that I have no doubt either. The patients who are not mad, and not militant, have to struggle with doctors whose minds are closed. Worse, they have to struggle with the lunatic fringe of their fellow sufferers. And it is that lunatic fringe that gives all the sufferers a bad name. Such patients have closed minds and even reject medical advice from sympathetic doctors who, whilst they may not have a definitive answer, are trying to help. This is a receipe for disaster.

    “K” said:

    'I have ME/CFS. I am worried that maybe I have Lyme disease instead. I have lost a great deal of my life. I cannot diagnose myself, I cannot treat myself. I cannot take care of myself. I cannot prepare my own meals regularly, I cannot regularly leave the house without help. Am I to be left to rot? I have been ill all my adult life. I beg any doctors reading this to consider going to the ME/CFS conference in London in May...'

    I have read the many knowledgeable comments K has made under the various articles I have written on ME and I do not think he is mad. Or not as in mad mad. He may, on the other hand, be “mad” as in “mad as hell” at the lack of interest the medical profession has taken in ME and CFS and Lyme Disease. Or whichever label you chose. The labels do not matter. The patients do.

    We need a TEMPERATE discussion


  3. Sir, I very much appreciate you taking the trouble to drop by - welcome to Wood of Thorns. I will definitely respond to you properly, but it may take a while due to uncooperative energy levels. In the meantime, I just want to remind everyone that any posts should be polite and constructive, please. J.