Fight fire with fire - why not slam PACE academically?

[Dr Speedy]

but I don't see how PACE proved that ME/CFS is a physical disease.

if you read the review it clearly shows their discovery and explains that

 

[Esther12]

if you read the review it clearly shows their discovery and explains that

The paper pointed to the GET arms 6mwt and fitness results to support this point, but I don't think that these necessarily do tell us much about the nature of CFS. Most of those in the GET arm chose 'walking' as the exercise they were going to gradually increase. At 1 year follow up they showed a small improvement in 6 minute walking test results, but no improvement in fitness. That could just mean that these people had devoted more time and energy to walking, as a part of their GET programme, but had reduced other activities elsewhere, so showed no improvement in fitness. PACE's results were not good for those who wanted to claim GET is an effective treatment but I'm not sure they let us claim much about the nature of CFS. To the extent that people argue the 'success' of GET shows GET is, at least partly, a psychological problem, I think that PACE helps undermine that argument, but the 6mwt and fitness results are only really able to provide us information about the impact of the treatments being assessed.

 

[Dr Speedy]

The paper pointed to the GET arms 6mwt and fitness results to support this point, but I don't think that these necessarily do tell us much about the nature of CFS. Most of those in the GET arm chose 'walking' as the exercise they were going to gradually increase. At 1 year follow up they showed a small improvement in 6 minute walking test results, but no improvement in fitness. That could just mean that these people had devoted more time and energy to walking, as a part of their GET programme, but had reduced other activities elsewhere, so showed no improvement in fitness. PACE's results were not good for those who wanted to claim GET is an effective treatment but I'm not sure they let us claim much about the nature of CFS. To the extent that people argue the 'success' of GET shows GET is, at least partly, a psychological problem, I think that PACE helps undermine that argument, but the 6mwt and fitness results are only really able to provide us information about the impact of the treatments being assessed.

That's a perfect example of unjust criticism I mentioned earlier. The paper did not point to the GET arms 6mwt and fitness results to support this point at all. It used a discovery by the PACEtrial which proves again that ME/CFS is a physical disease; which also proves again that the biopsychosocial model is incorrect and proves again that ME/CFS is not MUS.

 

[Esther12]

That's a perfect example of unjust criticism I mentioned earlier. The paper did not point to the GET arms 6mwt and fitness results to support this point at all. It used a discovery by the PACEtrial which proves again that ME/CFS is a physical disease; which also proves again that the biopsychosocial model is incorrect and proves again that ME/CFS is not MUS.

It's hard for me to know what exactly you're referring to. I thought you were referring to bits like these:

The discovery that an increase in exercise tolerance did not lead to an increase in fitness means that an underlying physical problem prevented this; validates that ME/CFS is a physical disease and that none of the treatments studied addressed this issue.

Yet according to the secondary mediation analysis, “Exercise tolerance as measured by the number of metres walked in a fixed time was a strong mediator of GET alone” [43]. However in the supplementary material for the secondary mediation analysis, the significance of the 6MWT was deemphasized [57], because the researchers noted an “increase in exercise tolerance (walking distance) without an increase in exercise capacity (fitness)” [43] which means that the patients had optimized their walking distance without increasing their fitness, despite engaging in “physical exercise five times a week” [43], because the therapies used did not address the underlying metabolic problem preventing improvements in fitness.

The discovery that an increase in exercise tolerance did not lead to an increase in fitness [43], as observed in healthy people, shows that there is an underlying physical problem preventing this, which means that none of the 4 treatments in the trial addressed this issue and validates that ME/CFS is a physical disease.

What were your referring to?

I feel like I'm dumping on this paper now, which had a lot of good stuff in it, but I do think it's worth clarifying these points.

 

[barbc56]

My take is that the paper only deals with the question of whether or not cbt/get is a more effective treatment than standard care. But the study is not testing if me/cfs is a physical or mental condition.

The interpretation and implications of the study are a different matter. If you go by the Wesleyan results of the paper, that get/cbt are more effective for treating me/cfs, it is far too often perceived that this absolutely proves we have a a mental health condition. However, it's really more complicated than that. It takes more than one paper touting the success or failure of these treatments to be able to scientifically conclude, one way or another whether a condition is mental or physical. It's simply not a sufficient amount of evidence to prove this either way. The definition of having a mental or physical condition is not that cbt/get works or not. I'm not sure if it is even related to mental health.

Unfortunately, that subtlety is often missed by the public as well as the scientific community.

I'm not saying PACE is in any way valid as there are many shortcomings with the methodology. Certainly, the interpretation isn't valid. What I am saying is that even if it were a perfect paper, whatever the outcome, you can't really draw a conclusion either way that me/cfs is a mental or physical health condition.

I'm not sure I'm being clear. If someone can say this better, please do!

 

[Dr Speedy]

What were your referring to? I feeling like I'm dumping on this paper now, which had a lot of good stuff in it, but I do think it's worth clarifying these points.

barbc56 the following quoted by Esther12 speaks for itself:
"The discovery that an increase in exercise tolerance did not lead to an increase in fitness [43], as observed in healthy people, shows that there is an underlying physical problem preventing this, which means that none of the 4 treatments in the trial addressed this issue and validates that ME/CFS is a physical disease."

 

[Esther12]

barbc56 the following quoted by Esther12 speaks for itself:

'Exercise tolerance' was just the 6mwt results though, so my earlier comments were relevant:

Most of those in the GET arm chose 'walking' as the exercise they were going to gradually increase. At 1 year follow up they showed a small improvement in 6 minute walking test results, but no improvement in fitness. That could just mean that these people had devoted more time and energy to walking, as a part of their GET programme, but had reduced other activities elsewhere, so showed no improvement in fitness. PACE's results were not good for those who wanted to claim GET is an effective treatment but I'm not sure they let us claim much about the nature of CFS. To the extent that people argue the 'success' of GET shows GET is, at least partly, a psychological problem, I think that PACE helps undermine that argument, but the 6mwt and fitness results are only really able to provide us information about the impact of the treatments being assessed.

 

[Dr Speedy]

'Exercise tolerance' was just the 6mwt results though, so my earlier comments were relevant:

No they were not

 

[Esther12]

No they were not

From the paper:

Yet according to the secondary mediation analysis, “Exercise tolerance as measured by the number of metres walked in a fixed time was a strong mediator of GET alone” [43].

What are you saying exercise tolerance was?