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== Controversies == === The PACE trial === Peter White was the lead investigator of the PACE trial, a 5 million pound study that investigated the effectiveness of cognitive behavioral therapy (CBT), graded exercise therapy (GET) and adaptive pacing therapy (APT) in a sample of more than 600 CFS patients.<ref name=":19" /> While the reported findings indicated that CBT and GET were effective treatments for CFS, the authors have been criticized for misrepresenting the trials’ results.<ref name="Wilshire2018" /><ref name="Tuller20151021">{{Cite web|url=http://www.virology.ws/2015/10/21/trial-by-error-i/| title = TRIAL BY ERROR: The Troubling Case of the PACE Chronic Fatigue Syndrome Study|website=[[Virology blog]]|access-date=2019-08-19}}</ref><ref name=":21">{{Cite journal | last = Geraghty | first = Keith J. | date = Aug 2017| title = 'PACE-Gate': When clinical trial evidence meets open data access|url=https://www.ncbi.nlm.nih.gov/pubmed/27807258|journal=Journal of Health Psychology|volume=22|issue=9|pages=1106–1112|doi=10.1177/1359105316675213|issn=1461-7277|pmid=27807258}}</ref><ref name="Williams2016PW" /> The PACE authors deviated from the methods specified in their protocol, without explaining these changes in full in their publications or how the changes impacted the reported findings.<ref name="Tuller20151021" /><ref name=":21" /> Following inconsistencies in the economic analysis of the PACE trial, health psychologist James Coyne filed a request to the journal PLOS ONE to access the data of the trial, a request that was dismissed as vexatious by Kings College London.<ref>{{Cite web|url=https://web.archive.org/web/20160314024024/https://dl.dropboxusercontent.com/u/23608059/PACE%20F325-15%20-%20Prof.%20James%20Coyne%20-%20Response-2.pdf| title = Request for information under the Freedom of Information Act 2000 ("the Act") | date = 2016-03-14 | website = web.archive.org|access-date=2019-08-19}}</ref> PLOS ONE has since issued an expression of concern about the publication in question.<ref>{{Cite journal | last = White | first = Peter D. | last2 = Goldsmith | first2 = Kimberley A. | last3 = Johnson | first3 = Anthony L. | last4 = Knapp | first4 = Martin | last5 = Chalder | first5 = Trudie | last6 = Sharpe | first6 = Michael | last7 = McCrone | first7 = Paul | date = 2012-08-01| title = Adaptive Pacing, Cognitive Behaviour Therapy, Graded Exercise, and Specialist Medical Care for Chronic Fatigue Syndrome: A Cost-Effectiveness Analysis|url=https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0040808|journal=PLOS ONE|language=en|volume=7|issue=8| pages = e40808|doi=10.1371/journal.pone.0040808|issn=1932-6203|pmc=3411573|pmid=22870204}}</ref> The PACE authors have refused to share the trial's data for independent reanalysis due to concerns that “patients might be personally identified by releasing their data.”<ref name=":22">{{Cite journal | last = White | first = Peter D | last2 = Chalder | first2 = Trudie | last3 = Sharpe | first3 = Michael | last4 = Angus | first4 = Brian J | last5 = Baber | first5 = Hannah L | last6 = Bavinton | first6 = Jessica | last7 = Burgess | first7 = Mary | last8 = Clark | first8 = Lucy V | last9 = Cox | first9 = Diane L | date = 2017-01-24| title = Response to the editorial by Dr Geraghty|url=https://journals.sagepub.com/doi/10.1177/1359105316688953|journal=Journal of Health Psychology|language=en-US|volume=22|issue=9|pages=1113–1117|doi=10.1177/1359105316688953|issn=1359-1053}}</ref> Peter White has also criticized the "All Trials campaign" as it encourages authors to share their datasets publicly.<ref>{{Cite journal | last = White | first = Peter D. | date = 2013-05-28| title = Is sharing data from clinical trials always a good idea?|url=https://www.bmj.com/content/346/bmj.f3379|journal=BMJ|language=en|volume=346|pages=f3379|doi=10.1136/bmj.f3379|issn=1756-1833|pmid=23714258}}</ref> During a 2015 first tribunal hearing on the release of the PACE trial data, Professor Ross Anderson defended the PACE authors’ decision by making “wild speculations” about “young men, borderline sociopathic or psychopathic” being attached to criticism of the PACE trial.<ref name=":23">{{Cite web|url=https://www.meaction.net/2016/08/16/tribunal-orders-release-of-pace-data/| title = Tribunal orders release of PACE data | date = 2016-08-16 | website = #MEAction|language=en-US|access-date=2019-08-19}}</ref> The tribunal considered these claims to be unfounded and ordered the release of some of the anonymized data of the trial.<ref name=":23" /> An independent reanalysis showed that the PACE authors had inflated improvement and recovery rates threefold.<ref name="Wilshire2018" /> An open letter signed by more than 100 prominent ME/CFS experts including researchers, clinicians, and MPs has called for “an independent re-analysis of the individual-level trial data, with appropriate sensitivity analyses.<ref>{{Cite web|url=http://www.virology.ws/2018/08/13/trial-by-error-open-letter-to-the-lancet-version-3-0/| title = Trial By Error: Open Letter to The Lancet, version 3.0 | website = [[Virology blog]]|language=en-US|access-date=2019-08-19}}</ref> In a letter to Richard Horton, editor of the Lancet journal, Peter White et al stated: “The PACE trial paper refers to chronic fatigue syndrome (CFS) which is operationally defined; it does not purport to be studying CFS/ME”;<ref>{{Cite web|url=https://www.nice.org.uk/guidance/cg53/evidence/appendix-c-stakeholder-consultation-comments-table-pdf-4602203536| title = CG53 Evidence - Appendix C: Stakeholder Comments | last = NICE | first = | authorlink = National Institute for Health and Care Excellence | date = | website = | page = 43|archive-url=|archive-date=|access-date=Aug 22, 2019}}</ref> however the authors separately stated their results had also been validated against a modified version of the [[London criteria|London criteria for ME]]. According to White et al. criticism of the PACE trial is based on “misunderstandings and misrepresentations”<ref name=":22" />. In 2016 article in the Guardian newspaper, White wrote that "If my team’s research on ME is rejected, the patients will suffer.”<ref>{{Cite news | url=https://www.theguardian.com/commentisfree/2016/sep/30/me-chronic-fatigue-syndrome-patients-suffer-put-off-treatments-our-research| title = If my team’s research on ME is rejected, the patients will suffer {{!}} Peter White | last = White | first = Peter | date = 2016-09-30|work=The Guardian|access-date=2019-08-19|language=en-GB|issn=0261-3077}}</ref> === An adverse effect of the label ME === In one of their studies using the GPRD, White and colleagues reported that the prognosis of patients diagnosed with ME was worse than those diagnosed with CFS or post-viral fatigue syndrome.<ref name=":24">{{Cite journal | last = White | first = Peter D. | last2 = Thomas | first2 = Janice M. | last3 = Gallagher | first3 = Arlene M. | last4 = Hamilton | first4 = William T. | date = 2005-08-01| title = The prognosis of different fatigue diagnostic labels: a longitudinal survey|url=https://academic.oup.com/fampra/article/22/4/383/662673|journal=Family Practice|language=en|volume=22|issue=4|pages=383–388|doi=10.1093/fampra/cmi021|issn=0263-2136}}</ref> The authors considered it unlikely that there was a difference in the underlying condition which the GP’s could accurately differentiate. They speculated that the poorer prognosis of ME was due to the label itself. “It is possible”, the authors wrote, “that the label ME with its suggestion of an untreatable pathological process may somehow render the patient less able to combat their symptoms and disability than other labels.”<ref name=":24" /> === Resigning from the CMO working group === White was one of the members of the Chief Medical Officer’s (CMO) Working Group for ME/CFS, a position from which he resigned due to disagreements about the final report.<ref name=":25" /><ref name="Williams2016PW" /> White and other members who resigned found that the report played down the psychological and social aspects of the condition and concentrates on a medical model.<ref name=":25" /> In an Editorial, White explained that criticism of the report included the “dangers of both over-medicalisation of chronic fatigue and the iatrogenic damage consequent upon that.”<ref name=":27">{{Cite journal | last = White | first = P. D. | date = Aug 2002| title = Chronic unexplained fatigue|url=https://www.ncbi.nlm.nih.gov/pubmed/12185213|journal=Postgraduate Medical Journal|volume=78|issue=922 | pages = 445–446|doi=10.1136/pmj.78.922.445|issn=0032-5473|pmc=1742445|pmid=12185213}}</ref> White also disagreed with the inclusion of pacing as a recommended treatment advice, writing that “the theoretical risk of pacing is that the patient remains trapped by their symptoms in the envelope of ill health.”<ref name=":27" /> === Comments on 2007 NICE guideline === During the development of the 2007 guidelines form the National Institute for Health and Care Excellence (NICE), several controversial comments were made to the draft version of the report, by St Bartholomew’s Hospital Chronic Fatigue Services, which at the time was headed by Peter White.<ref name=":28">{{Cite web|url=https://meagenda.wordpress.com/2007/09/06/a-selection-of-points-the-barts-cf-service-made-during-the-nice-guidelines-for-cfs-me-tom-kindlon/| title = A Selection of points the Barts CF Service made during the NICE Guidelines for CFS / ME: Tom Kindlon | last = meagenda | date = 2007-09-06 | website = ME agenda|language=en|access-date=2019-08-19}}</ref> The comments criticized the provision of equipment and adaptations (for example, a wheelchair,blue badge or stairlift) to allow individuals to improve their independence. St Bartholomew’s provided the following feedback: <blockquote>“Where is the warning about dependence being encouraged and expectation of recovery being damaged by the message that is given in this intervention? We are in no doubt that it is a powerful message for a therapist of any sort to provide such aids. Our view is that such aids should only be considered by a multi-disciplinary therapeutic team as a whole, and usually in the context of providing a temporary means for a patient to increase their activity levels.”<ref name=":28" /> </blockquote>Regarding multiple chemical sensitivites (MCS), Bartholomew’s commented that “MCS is a potentially remediable condition through a graded exposure programme on the basis that the underlying pathophysiology is a conditioned response. It should not be considered as a part of CFS/ME.”<ref name=":28" /> === WHO classification === White has repeatedly stated that there are multiple ways of classifying CFS using the World Health Organization's (WHO) International Classification of Diseases, version 10 ([[ICD-10]]).<ref name=":2" /><ref name=":29">{{Cite journal | last = White | first = P. D. | last2 = Rickards | first2 = H. | last3 = Zeman | first3 = A. Z.J. | date = 2012-05-24| title = Time to end the distinction between mental and neurological illnesses|url=https://www.ncbi.nlm.nih.gov/pubmed/22628005|journal=BMJ (Clinical research ed.)|volume=344| pages = e3454|doi=10.1136/bmj.e3454|issn=1756-1833|pmid=22628005}}</ref><ref name=":26" /> He has claimed for example that “chronic fatigue syndrome may be classified as myalgic encephalomyelitis (ME) within the neurology chapter (G93.3) of ICD-10, or as neurasthenia, a psychiatric disorder (F 48.0).”<ref name=":29" /> The WHO however classifies ME, CFS and post-viral fatigue syndrome (PVFS) under code G93.3 in Chapter VI Diseases of the nervous system of ICD-10, and has made clear that it “is not permitted for the same condition to be classified to more than one rubric”.<ref>{{Cite web|url=https://dxrevisionwatch.com/icd-11-me-cfs/| title = ICD-10: ME, CFS | date = 2009-12-26 | website = dx revision watch|language=en|access-date=2019-08-19}}</ref> ICD-10 explicitly excludes code G93.3 (PVFS, ME and CFS) from the neurasthenia diagnosis F48.0.<ref>{{Cite web|url=https://icd.who.int/browse10/2010/en#/F48.0| title = ICD-10 Version:2010 | website = icd.who.int|access-date=2019-08-19}}</ref> White has also stated incorrectly that CFS can be classified under "R53.82 Chronic fatigue, unspecified, which includes chronic fatigue syndrome NOS."<ref name=":2" /> There is however no such code in the ICD,<ref name="ICD10"/> only in the U.S.'s clinical modification, the [[ICD-10-CM]].<ref name="ICD-10-CM">{{citation |url=https://icd10cmtool.cdc.gov/?fy=FY2022&query=fatigue |website=National Center for Health Statistics| title = R53 Malaise and fatigue {{!}} General symptoms and signs (R50-R69) {{!}} ICD-10-CM Index and Tabular | date = 2007 | access-date=2022-09-21}}</ref><ref name=":30">{{Cite web|url=https://www.twitlonger.com/show/n_1sqvhh3| title = TwitLonger — When you talk too much for Twitter|website=twitlonger.com|language=en|access-date=2019-08-19}}</ref> White has also written that "Fink's concept of body distress syndrome" was recently incorporated into [[ICD-11]]<ref name=":2" />, which is incorrect. For the core ICD-11, WHO has approved the differently conceptualized, "Bodily distress disorder (BDD) which is distinct from Fink's concept of Bodily Distress Syndrome.<ref name=":30" />{{citation needed}} In a lecture for the re-insurance company Swiss RE, White emphasized that a diagnosis of CFS makes it easier than a diagnosis of ME to use a mental health exclusion in insurance policies.<ref name="peter-white-and-swiss-re">{{Cite web|url=http://www.virology.ws/2017/08/07/trial-by-error-retired-pace-investigator-peter-white-and-swiss-re/| title = Trial by Error: Retired PACE Investigator Peter White and Swiss Re|website=[[Virology blog]]|access-date=2019-08-19}}</ref> He argued that “a diagnosis of Myalgic Encephalomyelitis or ME (a term often used colloquially instead of CFS) is considered a neurological condition according to the arrangement of the International Classification of Diseases (ICD) diagnostic codes whereas CFS can alternatively be defined as neurasthenia which is in the mental health chapter of ICD10.”<ref>{{Cite web|url=http://www.freezepage.com/1374761286EFCHIYENBE| title = FreezePage|website=freezepage.com|access-date=2019-08-19}}</ref> === Conflict of interests === ====Disability benefits work==== Peter White has performed paid and unpaid work for the United Kingdom's [[Department for Work and Pensions]] (DWP)<ref name=":19" /><ref>Williams M. [http://www.investinme.org/Article405%20DWP%20&%20PACE.htm The involvement of the PACE Trial Principal Investigators and the Director of the Clinical Trials Unit with the Department for Work and Pensions.] March 2011.</ref>, which is the government department responsible for administering and reforming the assessment of sickness and disability payments, including the controversial Employment Support Allowance (ESA)<ref>{{Cite news | url=https://www.bbc.com/news/uk-37899305| title = UK accused of disability rights violations | last = BBC news | first = | date = 2016-11-07|work=|access-date=2019-08-22|archive-url=|archive-date=|language=en-GB|quote= | author-link = BBC}}</ref> and Personal Independence Payments (PIP)<ref name="Briefing2019">{{Citation | last = Clark | first = Adam | author-link = | last2 = Bellis | first2 = Alexander | authorlink2 = | last3 = O'Donnell | first3 = Michael | author-link3 = | last4 = Jap | first4 = Bess | author-link4 = | last5 = McInnes | first5 = Roderick | authorlink5 = | last6 = Mackley | first6 = Andrew | authorlink6 = | last7 = Kennedy | first7 = Steven | last8 = | first8 = | date = 2019-04-18| title = Ten years of the work capability assessment in relation to employment support allowance and universal credit {{!}} Debate pack | url =https://researchbriefings.parliament.uk/ResearchBriefing/Summary/CDP-2019-0092 | website = House of Commons Library {{!}} Parliament UK|access-date=Sep 14, 2022|quote=|via=}}</ref> for people of working age. White helped draft the DWP's initial ''disability assessment guidelines for CFS'' from 2005 - 2007, which were rejected by all UK ME charities as "unfit for purpose".<ref>{{Cite web|url=https://www.meassociation.org.uk/2007/07/mea-responds-to-version-10-of-the-dwp-medical-guidance/| title = MEA responds to Version 10 of the DWP medical guidance | last = ME Association | first = | authorlink = ME Association | date = Jul 2007 | website = |language=en-GB|archive-url=|archive-date=|access-date=2019-08-23|quote="For the past two years we have been in negotiation with the Department of Work and Pensions (DWP) in order to try produce new medical guidance that will be free from psychiatric bias and will properly reflect the spectrum of ill health and disability that is experienced by people with moderate or severe ME/CFS"}}</ref><ref name="ParliamentUnum" /> In 2017, the United Nations released a report that was highly critical of the benefits, and of the UK treatment of disabled people.<ref name="Briefing2019" /><ref>{{Cite web|url=https://www.huffingtonpost.co.uk/amp/entry/dwp-overhaul-of-disability-assessments_uk_5c8a3113e4b038892f4aa755/| title = Ministers Plan Multi-Billion Pound Overhaul of 'Demeaning' Disability Benefit Assessments {{!}} HuffPost UK|website=huffingtonpost.co.uk|access-date=2019-08-22}}</ref> White is member of the Independent Medical Experts Group, which advises the UK's Ministry of Defence regarding its Armed Forces Compensation Scheme and provides paid consultancy to re‐insurance companies.<ref name=":2" /> White did not disclose his financial conflicts of interest to the participants of the PACE Trial, of which he was the lead investigator. According to Journalist David Tuller, The PACE authors “promised in their protocol to adhere to this foundational human rights document, among other ethical codes. Despite this promise, they did not tell prospective participants about their financial and consulting links with insurance companies, including those in the disability sector. That ethical breach raises serious concerns about whether the “informed consent” they obtained from all 641 of their trial participants was truly ‘informed,’ and therefore legitimate.”<ref>{{Cite web|url=http://www.virology.ws/2017/08/07/trial-by-error-retired-pace-investigator-peter-white-and-swiss-re/| title = Trial by Error: Retired PACE Investigator Peter White and Swiss Re|website=[[Virology blog]]|access-date=2019-08-19}}</ref> ====Health insurance and reinsurance industry links ==== Peter White provides paid consultancy to re‐insurance companies,<ref name=":19" /> including both UnumProvident<ref name="ParliamentUnum">{{Cite web|url=https://publications.parliament.uk/pa/cm200607/cmselect/cmhealth/503/503we79.htm| title = House of Commons - Health - Written Evidence | last = Hooper | first = Malcolm | authorlink=Malcolm Hooper | date = 2007 | website = publications.parliament.uk|at=Para 12|archive-url=|archive-date=|access-date=2019-08-23}}</ref> and Re-Swiss.<ref name="ReSwissMalingering">{{Cite web|url=https://twitter.com/johnthejack/status/1052919934697783296?s=20| title = Attendance at Oxford meeting funded by insurance company. Can upload PACE trial COIs, should you wish which were made before publication of paper but not prior to trial. One Health by TC and PW. Briefing to Swiss Re by PW.pic.twitter.com/LsKkQnMx0E | last = Peters | first = John | date = 2018-10-18 | website = @johnthejack|language=en|access-date=2019-08-23}}</ref><ref name="peter-white-and-swiss-re" /><ref name="Tuller20151117" /> <ref name="SwissRe2011" /> ==== Directorships and Shareholdings ==== Peter White was a director of OneHealth (Company number 04364122) from 2002 to 2010.<ref>{{Cite web|url=https://www.companieslondon.com/uk/04364122/one-health| title = One Health | last = London | first = Companies|website=Companies London|language=en|access-date=2019-08-19}}</ref> The memorandum of association states that the purpose is to promote the biopsychosocial model of illness.<ref>{{Cite web|url=http://companycheck.co.uk/company/04364122/ONE-HEALTH/companies-house-data | title = ONE HEALTH. Free business summary taken from official companies house information. Free alerts. Registered as 04364122 | last = ltd | first = company check|website=Company Check|language=en|access-date=2019-08-19}}</ref> From 1999 to the present, White has been a director of Added Value Advisory Services (Company number 03764154), a company that focuses on “management consultancy activities other than financial management.”<ref>{{Cite web|url=https://beta.companieshouse.gov.uk/company/03764154| title = ADDED VALUE ADVISORY SERVICES LIMITED - Overview (free company information from Companies House)|website=beta.companieshouse.gov.uk|language=en|access-date=2019-08-19}}</ref> Since November 2018 White is also director of PDW Medical Limited, a company that focuses on specialists medical practice activities.<ref>{{Cite web|url=https://beta.companieshouse.gov.uk/company/11702078| title = PDW MEDICAL LIMITED - Overview (free company information from Companies House)|website=beta.companieshouse.gov.uk|language=en|access-date=2019-08-19}}</ref><ref name="Williams2016PW" />
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