In the first two posts in this series you have taken part of  Bateman Horne Center (BHC) recommendation of braintraining in their new clinical guide for healthcare professionals and the communication I have had with them regarding this.

I have also broadly told you about my previous texts on this theme and that I consider a recommendation to be problematic based on the information I have about these methods.

Denna serie finns även på svenska. Du hittar den första delen via [denna länk].

I shared my communication with BHC with a friend who in turn logged it in ChatGPT and asked for a critical analysis. In my eyes AI in this case does a perfect analysis of BHC’s contradictory reasoning and I therefore choose to share it in it’s enterity (with a few minor factual corrections) in this part.

🔍 Critical analysis of BHC’s answer:

🔹1. Sources and evidence base

They say:

“While studies specific to ME/CFS are limited…”

“…we’re following this space closely and have noted several ongoing trials…”

The problem:

  •  No real references to ME-specific evidence, despite the question being specifically about ME and not fibromyalgia or generalized dysautonomia.
  • Referring to “emerging” or “exploratory” research without specifying which research undermines the scientific basis for the recommendation.
  • They mention De Ridder 2011 och Sanabria-Mazo 2020, but these are about neuroplasticity broadly and not ME/CFS with PEM.

👉 Conclusion: The recommendation lack direct support in ME-specific research and is based on extrapolation – which is very risky considering the unique physiology of PEM.

(My addition: [Link] to Wikipedias explanation of the concept extrapolation)

🔹2. Clinical observations

They say:

“Our providers do not deliver neuroplasticity programs themselves…”

“…observations of select patients benefiting…”

The problem:

  • There is no methodology: How are these observations collected? Are they documented, systematized, or merely anecdotal?
  • If BHC does not administer these programs themselves, how do they know which patients are improving, by how much, and why?

👉 Conclusion: References to clinical experience are vague and unsystematic. Such anecdotal evidence carries little weight, especially in relation to a disease with a high risk of deterioration.

🔹3. Definition of “PEM stability”

They say:

“Improved PEM stability” = better understanding, fewer crashes, ability to tolerate light cognitive activity.

The problem:

  • This is a vague definition. For many ME patients, even light cognitive activity is a trigger for PEM.
  • Requiring “ability to engage in light cognitive activity without deterioration” as a criterion—while recommending an hour-long daily cognitive program—is a logical contradiction.

👉 Conclusion: PEM is an objective, physiological response to stress. Recommending DNRS risks misleading patients into believing that it is “safe enough,” which it often is not.

🔹4. Risk analysis

They say:

“We recognise and share your concern… particularly those that deny the legitimacy of PEM.”

The problem:

  • They admit that certain programmes (e.g. Lightning Process, LP) can be harmful, but still make a positive reference to DNRS earlier in the communication.
  • They warn while allowing – which makes the communication ambiguous and potentially misleading for patients and clinicians.

👉 Conclusion: Simultaneously warning against and including an intervention is not compatible with clear medical communication – especially for vulnerable groups.

🔹5. Ethical contradiction: Recommendation despite lack of transparency

They say:

“We support the NICE committee’s recommendation against the Lightning Process…”

But:

  • NICE and many patient organisations clearly point out the problems with LP, but DNRS has a lot in common with LP (structure, theory, commercialisation, push-through thinking).
  • Despite this, BHC tries to distinguish between them without explaining how – which is scientifically dishonest unless methodological differences are presented.

👉 Conclusion: Their attempt to distance themselves from LP while still opening the door to similar programmes is contradictory and potentially misleading.

🔹6. Financial vulnerability

They say:

“We do not endorse any particular programme and do not receive financial benefit…”

But:

  • It matters little whether BHC itself makes money – it legitimises commercial actors by mentioning them in its clinical guidelines.
  • Patients with ME are often desperate, vulnerable and under financial pressure. Legitimising non-evidence-based methods in this context is unethical – even if it is done “carefully”.

👉 Conclusion: Good medical practice requires protecting patients from unfounded and expensive treatments, especially when there is no consensus in the research.

In conclusion

I have a couple of final thoughts regarding BHC’s response to me.

I don’t really understand why BHC insists on talking about ‘programmes’. If they had been content to talk about strategies for managing stress, about how mindfulness, affirmations and breathing exercises under individual supervision can benefit these patients, it would have been different. When you talk about following a programme, it becomes difficult by definition to tailor it to be individual. And thus contradictory.

I think it is this inconsistency that can be dangerous. It becomes extremely confusing when they are so clear about PEM in their other material but suddenly talk about PEM stability in their recommendation for brain training without explaining what it actually means.

I will delve deeper into this in the next section.

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