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The concept of ‘illness without disease’ impedes understanding of chronic fatigue syndrome: a response to Sharpe and Greco
  1. Steven Lubet1,
  2. David Tuller2
  1. 1 Law, Northwestern University, Chicago, Illinois, USA
  2. 2 University of California Berkeley School of Public Health, Berkeley, California, USA
  1. Correspondence to Professor Steven Lubet, Law, Northwestern University, Chicago, IL 60201, USA; slubet{at}


In a recent article in Medical Humanities, Sharpe and Greco characterise myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) as an ‘illness without disease’, citing the absence of identified diagnostic markers. They attribute patients’ rejection of psychological and behavioural interventions, such as cognitive–behavioural therapy (CBT) and graded exercise therapy (GET), to a ‘paradox’ resulting from a supposed failure to acknowledge that ‘there is no good objective evidence of bodily disease’. In response, we explain that understandings about the causes of and treatments for medical complaints have shifted across centuries, and that conditions once thought to be ‘psychosomatic’ have later been determined to have physiological causes. We also note that Sharpe and Greco do not disclose that leading scientists and physicians believe that ME/CFS is a biomedical disease, and that numerous experts, not just patients, have rejected the research underlying the CBT/GET treatment approach. In conclusion, we remind investigators that medical classifications are always subject to revision based on subsequent research, and we therefore call for more humility before declaring categorically that patients are experiencing ‘illness without disease’.

  • health policy
  • public health
  • medical humanities

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  • Contributors Both coauthors meet all four criteria.

  • Funding Support for DT's position at the Center for Global Public Health is crowdfunded through donations to the University of California, Berkeley, many of them from patients with ME/CFS. SL received no outside funding for this project.

  • Competing interests Both SL and DT have written previous critiques of Dr Sharpe’s work on ME/CFS (DT more pointedly and extensively so). DT’s work on ME/CFS has been supported by crowdfunded contributions to the University of California, Berkeley. SL was diagnosed with ME/CFS in 2006.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.