Invest in ME Conference 12: First Class in Every Way
OverTheHills wraps up our series of articles on this year's 12th Invest in ME International Conference (IIMEC12) in London with some reflections on her experience as a patient attending the conference for the first time.
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"CBT & exercise in Chronic Fatigue Syndrome have no evidence" (Translation of Swedish pretty good)

Discussion in 'General ME/CFS News' started by Dolphin, Aug 31, 2015.

  1. Dolphin

    Dolphin Senior Member

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    https://translate.google.ie/transla...d-kronisk-trotthet-saknar-evident/&edit-text=

    Alternative link: http://www.twitlonger.com/show/n_1snca05
    Twitter link: https://twitter.com/TomKindlon/status/638397479181021184

    (Some automated translations are not that good but this one seems pretty good)

    CBT and exercise in chronic fatigue syndrome have no evidence

     
    Debbie23, eafw, adreno and 18 others like this.
  2. Dolphin

    Dolphin Senior Member

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    Original in Swedish:
    http://lakartidningen.se/Opinion/Debatt/2015/06/KBT-och-traning-vid-kronisk-trotthet-saknar-evident/


     
    deleder2k, Helen, Valentijn and 2 others like this.
  3. Esther12

    Esther12 Senior Member

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    Some discussion with Mats Reimer underneath. He doesn't seem up to it, and the responses from the authors are better than is needed. Fun to read.

    "A meta-analysis reduces the sampling error in the material, but does not convert subjective outcomes to objective."

    Mats seems to want to avoid discussing the evidence, and instead just defer to authority.
     
    Valentijn, Snow Leopard, SOC and 5 others like this.
  4. Jonathan Edwards

    Jonathan Edwards "Gibberish"

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    Interesting piece. What sort of journal/newspaper is this, Dolphin?
     
  5. anciendaze

    anciendaze Senior Member

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    This is not a matter of lack of evidence. The PACE trial showed that a year of CBT had no measurable effect on physical performance.

    On the GET arm of the study there were numbers indicating a very modest increase in distance walked in six minutes. The argument that this is significant confuses clinical and statistical significance. This alleged improvement would not be considered clinically significant in very serious illnesses like congestive heart failure where we know gains are very difficult. Improvement in the control arm of the study was virtually ignored. If this was a true control, why did that group gain 22 meters distance?

    The statistical significance also rests on very dodgy assumptions. If the distribution is not normal, the p values are meaningless. The original distribution was definitely not normal (Gaussian), which means the distributions in the different arms can only be normal because sampling that distribution was truly independent. The fact that authors changed criteria in the middle of the study strongly suggests sampling was not blind and independent of previous results.

    Even if you believe those distributions in different arms really were normal the fact that 1/3 of all patients declined to participate in one or more of the walk tests would reduce a measure like Cohen's d to meaninglessness. The values you get from the people you did measure depend on assumptions about the people you did not measure, and there were enough of these to alter outcomes. With the very plausible assumption that those who had reduced capacity to exercise after therapy were more likely to decline an optional test the entire gain vanishes.

    Finally, the separate "step test" of physical condition confirmed a complete lack of measurable improvement -- even in the GET arm.

    The evidence is there, for those who are willing to see it.
     
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  6. Bob

    Bob

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    England (south coast)
    Great stuff! And well researched.
     
    Wildcat likes this.
  7. deleder2k

    deleder2k Senior Member

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    Wiki: Läkartidningen is a Swedishmedical journal which was first published in 1965 by the Sveriges Läkarförbund (Swedish Medical Association), an organisation founded in 1904.

    More:
     
    Last edited: Aug 31, 2015
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  8. Jonathan Edwards

    Jonathan Edwards "Gibberish"

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    Sounds like a sort of Swedish BMJ. The article could be punchier but it seems clear and to the point.
     
  9. worldbackwards

    worldbackwards A unique snowflake

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    Earth
    From Wiki:
     
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  10. anciendaze

    anciendaze Senior Member

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    Perhaps I came across as too negative above. I actually believe a rigorous psychological study would show that doctors are significantly happier after patients complete a year of therapy. ;)
     
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  11. Wildcat

    Wildcat

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    Doctors are happy if patients complete a year of therapy? What about the patients. After 2 sessions of so called CBT I refused to be shut in a room with the CBT lunatic ever again. So much of what is now called CBT, isn't. CBT used to be the province of clinical psychologists, who at least understood what CBT is, and many of them are not impressed with the bargain basement, poor training CBT that is being perpetuated in the NHS currently. Now any old garbled dogma or advice is called CBT.
     
    Last edited: Aug 31, 2015
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  12. Wildcat

    Wildcat

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    Last edited: Aug 31, 2015
  13. Helen

    Helen Senior Member

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    Just wanted to bump this still actual thread and article also with a good reference list. The writers are Drs. of Technology resp. Medicine. Yes, it was published in the Swedish equivalent to BMJ (British Medical Journal).
     
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  14. eafw

    eafw Senior Member

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    Thanks for the bump, interesting article given current debates. Shows that there are people out there who understand the problems with CBT/GET, and yet these articles never get a mass audience (of course because they don't have the full force of the BPS/SMC propaganda-machine behind them)
     
    Helen likes this.
  15. Helen

    Helen Senior Member

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    In fact this article reached most Swedish doctors as it was published in their monthly journal, but you are right, the article deserves a lot more readers. About propaganda machine, I think results from ME research, that will be presented in a not too far future, will change a lot for us to the better - but not for Dr. Wessely.
     
    Last edited: Nov 4, 2015
    Valentijn likes this.

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