New NICE guideline on chronic fatigue syndrome: more ideology than science?

The National Institute for Health and Care Excellence (NICE) in the UK published a new chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) guideline in October, 2021. 1 National Institute for Health and Care ExcellenceMyalgic encephalomyelitis (or encephalopathy)/chronic fatigue syndrome: diagnosis and management. NICE guideline [NG206]. https://www.nice.org.uk/guidance/ng206Date: Oct 29, 2021 Date accessed: January 13, 2022 Google Scholar The previous NICE 2007 guideline recommended cognitive behavioural therapy (CBT) and graded exercise therapy (GET) for people with mild or moderate CFS/ME based on evidence from randomised trials. 2 Baker R Shaw EJ Diagnosis and management of chronic fatigue syndrome or myalgic encephalomyelitis (or encephalopathy): summary of NICE guidance. BMJ. 2007; 335: 446-448 Crossref PubMed Scopus (79) Google Scholar Since then, more randomised trials and systematic reviews have provided additional evidence supporting these recommendations. 3 Price JR Mitchell E Tidy E Hunot V Cognitive behaviour therapy for chronic fatigue syndrome in adults. Cochrane Database Syst Rev. 2008; 3CD001027 Google Scholar , 4 Larun L Brurberg KG Odgaard-Jensen J Price JR Exercise therapy for chronic fatigue syndrome. Cochrane Database Syst Rev. 2019; 10CD003200 PubMed Google Scholar , 5 Castell BD Kazantzis N Moss-Morris R Cognitive behavioral therapy and graded exercise for chronic fatigue syndrome: a meta-analysis. Clin Psychol Sci Pract. 2011; 18: 311-324 Crossref Scopus (133) Google Scholar , 6 White PD Goldsmith KA Johnson AL et al. Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial. Lancet. 2011; 377: 823-836 Summary Full Text Full Text PDF PubMed Scopus (622) Google Scholar , 7 Nijhof SL Bleijenberg G Uiterwaal CS et al. Effectiveness of internet-based cognitive behavioural treatment for adolescents with chronic fatigue syndrome (FITNET): a randomised controlled trial. Lancet. 2012; 379: 1412-1418 Summary Full Text Full Text PDF PubMed Scopus (153) Google Scholar , 8 Gotaas ME Stiles TC Bjørngaard JH Borchgrevink PC Fors EA Cognitive behavioral therapy improves physical function and fatigue in mild and moderate chronic fatigue syndrome: a consecutive randomized controlled trial of standard and short interventions. Front Psychiatry. 2021; 12580924 Crossref PubMed Scopus (6) Google Scholar No new or more effective interventions have been identified. Although we applaud guideline efforts, it is remarkable that recommendations in the 2021 NICE guideline differ substantially from the previous one, and do not include CBT and GET as means to treat CFS/ME. The new guideline presents strengthened evidence, but a major shift in interpretation. How could this happen?