Having spent years casting their critics as angry anti-science activists, some of our favourite panjandrums have now entered Phase 3 in their own year-long campaign of (a) getting angry, (b) engaging in activism, and, yes, (c) throwing science-based medicine under the bus.
However, this recommendation appears to dismiss all graded exercise therapy (GET), any programme to address deconditioning and any programme based on principles of osteopathy, life coaching or neurolinguistic processing (such as the Lightning Process (LP)). Our experts note that the decision on LP is particularly arbitrary…it has been banned solely on the basis of qualitative data, which seemed to be mixed. (pp. 759-760)
As you might guess from its silly name, the Lightning Process is not a standard medical intervention. Rather, it is a commercially marketed, trademarked, three-day personal development seminar, first developed in the UK by an osteopath back in the 1990s. It combines elements of osteopathy (an alternative medicine), life coaching (part of the self-empowerment movement) and neurolinguistic programming (a pseudoscience). Unsurprisingly, it enjoys no scientific basis, no biological plausibility, and no reliable evidence base.
As with many complementary treatments, the Lightning Process is heavily reliant on anecdotal testimony and marketing. But not all has been plain sailing. In 2012, the Advertising Standards Authority ruled that claims made on the official LP website were “likely to mislead” and should be taken down. Another red flag is the guru-like status of LP’s founder, whose name is so personally associated with the “official” form of the therapy that the British Medical Journal described the LP movement as “secretive” and as having a “cultish quality”.
Of considerable concern is the fact that the Lightning Process draws heavily on neurolinguistic programming, or NLP. NLP is a highly controversial pseudotherapy that first emerged in the 1970s. Its advocates claim to be able to help people change their lives by re-programming their brains. Although claiming to be a “neuro” discipline, NLP has no basis in neurology and its metaphors of brain function have long been dismissed as nonsense by mainstream neuroscientists. NLP is also unrelated to linguistics, and has nothing to do with programming either. Its jargon-heavy title reflects branding, not science. NLP has no standing in mainstream psychology or academia, except when it is studied as a quasi-religion, part of the New Age movement, or as a form of folk magic.
This is the “neurolinguistic processing” that is being referred to by those who recommend the Lightning Process.
All told, it is very notable that anyone should stand up for such nonsense when making an official submission to NICE. It tells us much about where they really stand on science-based medicine.
So I repeat: this lobbying on behalf of pseudoscience was submitted by THE ROYAL COLLEGE OF PHYSICIANS.
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In their submission to NICE, the Royal College of Psychiatrists are more careful in presenting their point. They open with this:
The College has no experience of Lightning Therapy [sic], and it is not an approach that as far as we know is used by our members. (p. 1215)
But then they quickly escalate to this:
But we are troubled by the decision to reject it. It is supported by a single controlled trial…The trial results were favourable to Lightning Therapy [sic]…We do not think that this decision was reasonable, and that the decision to drop Lightning Therapy [sic] was disproportionate [sic] to the evidence. (p. 1216)
(I’m sure that they meant to say “proportionate” there, as their meaning is pretty clear.)
Once again we have a Royal College speaking up for the Lightning Process, despite not having any experience of it (and not knowing its name). One would have hoped that the members of such an esteemed institution would, dare I say, read the literature on LP before commenting.
To re-cap, LP practitioners purport to cure people’s illnesses by getting them into a hotel for three half-days, charging them the guts of a thousand pounds, and teaching them how to re-programme their brains. The one randomised study to appear in the literature (in thirty years) is hopelessly flawed. LP is not science-based medicine, it is antiscience-based medicine.
Worth mentioning again: this lobbying on behalf of pseudoscience was submitted by THE ROYAL COLLEGE OF PSYCHIATRISTS.
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For their part, the Royal College of General Practitioners also spoke up for the Lightning Process, submitting this to NICE:
We note that the committee has decided to make a recommendation against the use of the Lightning Process as a psychological/behavioural intervention. There has been a recent systematic review of the Lightning Process, published in August 2020…It concluded, however, that all studies evidenced a level of benefit from the intervention, commonly for the majority of participants…Based on the review, it is unclear whether NICE has sufficiently considered this evidence. (pp. 657-658)
These comments are extremely misleading with regard to points of fact. Firstly, the “systematic review” mentioned was not a systematic review. Secondly, the “review” was not conducted by an independent investigator, but was compiled by none other than the inventor of the Lightning Process himself (who, as trademark owner, makes money every time someone uses LP). Thirdly, of the four empirical studies included in this so-called review, three of them were unpublished (and thus never themselves peer-reviewed). The remaining study was extremely flawed but, contrary to what was intimated by the Royal College of General Practitioners, was in fact included in NICE’s evidence review.
In short, this submission tried to defend a bogus pseudotherapy by castigating NICE for failing to take account of a bogus review paper.
Again worth specifying: this lobbying on behalf of pseudoscience was submitted by THE ROYAL COLLEGE OF GENERAL PRACTITIONERS.
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All the above quotes come from documents released by NICE when it published its new guideline for ME/CFS last week. In total, NICE released details of all submissions received from registered stakeholders during the consultation process, material comprising nearly 2,500 pages.
NICE also released the minutes from its stakeholder roundtable event, where the Royal Medical Colleges were invited to explain their concerns. As has been widely reported, no substantive concerns were raised at the roundtable. Instead, the Colleges chose to release a controversial joint statement criticising NICE after the guideline was published.
It is somewhat peculiar that a group of self-styled “medical leaders” should claim to champion science-based medicine, while simultaneously lobbying NICE to allow patients to be treated using such practices as the Lightning Process.
The minutes of that stakeholder roundtable event might help us to understand this anomaly. They help show precisely how NICE’s decision to delist unsubstantiated treatments was greeted in some quarters. While the Lightning Process was not mentioned, attention did focus on graded exercise therapy (GET) and cognitive behavioural therapy (CBT), both now discarded by NICE as curative treatments because of a lack of evidence.
Here’s what was said about each (emphases added):
There was conversation about the definition of GET, how it is delivered in practice and the fact that the term GET is understood to
have different meanings by different people…The group discussed the potential impact of the guideline on commissioning and delivery of services…
The roundtable discussed the positioning of CBT as ‘not curative’ or as a ‘treatment’ with concerns that this may have a negative impact on commissioning of services.
Note that treatment outcomes, per se, did not appear to be the main concern. What seemed to be causing most consternation was this whole issue of “commissioning of services.” In other words, the new guideline was creating anxiety among providers because they felt that some of their services — CBT, GET, and anything else the new guideline dispensed with — might no longer be wanted.
I guess that must be what they mean by “medical leadership.”