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Controversy over exercise therapy for chronic fatigue syndrome: continuing the debate

Discussion in 'Latest ME/CFS Research' started by Dolphin, Sep 4, 2017.

  1. Dolphin

    Dolphin Senior Member

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    http://apt.rcpsych.org/content/23/5/288

     
  2. Dolphin

    Dolphin Senior Member

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  3. Esther12

    Esther12 Senior Member

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    Thanks.

    That was a bit frustrating. I felt like White & co left themselves open to a strong response with their comment, which seemed less carefully phrased than their usual work. The Mitchell reply was pretty weak though. I enjoyed reading the White piece more.

    edit: Actually, White was the middle author. Maybe he didn't play a leading role now he's retired, and that's why it was less good? I expect he'd still have been heavily involved though.
     
    Luther Blissett likes this.
  4. Cheshire

    Cheshire Senior Member

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    When recovery is defined as a matter of "assumptions", you know there is a big problem.

    I also like the way they imply Wilshire and al. choosed their recovery thresholds, putting under the carpet that they used their initial protocol criteria.

    Thank you so much AfME.
     
    Last edited: Sep 5, 2017
  5. alex3619

    alex3619 Senior Member

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    If I had the assumption these investigators don't know what they are doing, where would that lead us? Assumptions are bad news in science. You always have to make some, but you consider that problematic if you are doing good science, and always want to prove or disprove assumptions.
     
  6. Sean

    Sean Senior Member

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    Leaving aside the obvious rebuttal that Wilshire et al only used the protocol originally committed to (and subsequently discarded) by White et al, it is clear that some thresholds are more realistic than others, they are not completely arbitrary.

    The general standard for recovery must be either the age-matched healthy population, or patients' pre-illness capacity, or some combination of those two.

    A score on the 6MWT equal to Class III heart failure patients, with a maximum net gain in any arm of just 35m, after 12 months of treatment, is not healthy by any standard.

    Science is essentially the process of systematically identifying and eliminating assumptions (i.e. preconceptions, prejudices, biases, etc).
     
    Last edited: Sep 6, 2017
    MEMum, Dolphin, AndyPR and 8 others like this.
  7. Valentijn

    Valentijn The Diabolic Logic

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    They're blatantly dishonest, and they're so ethically void that they think dishonesty is okay if you just imply it instead of lying outright.
     
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  8. alex3619

    alex3619 Senior Member

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    Yes, in part, in critical rationalism, the foundation for modern scientific philosophy. It wasn't prior to the mid twentieth century. Guess where this stuff is still sitting on the timeline? In fact I would argue they largely pursue nineteenth century scientific underpinnings for the most part. Most of the modern stuff is just window dressing. That shows when they cannot even do valid statistical analysis.
     
  9. Mohawk1995

    Mohawk1995 Senior Member

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    The real issue is that this is Psychiatrists performing research on the effects of Exercise on CFS/ME. They would be qualified to do research on how the patients feel after having gone through the program (terrible I suspect if there was honesty and integrity involved). They are not Exercise Physiologists, Kinesiologists or Physical Therapists. Not that many of these can agree on this matter either, but at least they have an understanding of what occurs in the body during exercise. Psychiatry on the other hand could only truly assess the "feeling" one gets by exercising. That is a completely incompetent manner in which to approach a disease so severe as this. They could be part of a team researching this subject, but in no way should they be the lead investigators.

    As for Exercise "therapy" for CFS/ME. If you are to exert one's body in the absence of the ability of that body to produce energy, you face a vicious cycle of resource attrition predictably ending in "crashing" the system. In order for a "training response" to occur the body must have the ability to replenish the needed resources. Exercise has its place, but in the case of moderate to severe CFS/ME it is a losing proposition.
     
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  10. Countrygirl

    Countrygirl ME is not MUS

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    Has anyone got access to this new defence of PACE please?



     
  11. Woolie

    Woolie Senior Member

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  12. Wolfiness

    Wolfiness Activity Level 0

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    Please can someone create a program that autogenerates PACE defences like the one that creates postmodernist essays?
    www.elsewhere.org/pomo/
     
    Last edited: Sep 6, 2017
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  13. Wolfiness

    Wolfiness Activity Level 0

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    I stand corrected. This is special:
     
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  14. Valentijn

    Valentijn The Diabolic Logic

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    Agreed. The exercise physiologist at the quack fatigue center I went to was the only one who understood and respected my limitations.

    But the problem is that these psychiatrists and other quacks think that there is no biomedical problem with exertion, and the ones developing GET for ME/CFS think the amount of exercise used in GET is too small to have a biomedical impact. They've stated that it's not capable of increasing physical fitness. GET was developed as a psychological therapy, intended to desensitize an assumed exercise phobia.

    So GET is really just a form of CBT where you attempt to show the patient that they're not really sick instead of telling them that they're not really sick. Deconditioning is just the explanation that they made up to sell the therapy to patients, doctors, and the general public. Ergo they see no need to involve exercise therapists in a treatment which they view as being psychological. And this conveniently avoids the problem of treatments being delivered by those who might take awkward precautions, such as using a heart rate monitor.
     
    Last edited: Sep 6, 2017
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  15. Philipp

    Philipp

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    Are they referring to how they showed that psychiatry has been doing most of the basic things wrong for an entire century and how their standard toolset doesn't do anything for most of the situations they are selling it for? Because anything else would be pretty silly at this point.
     
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  16. Solstice

    Solstice Senior Member

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  17. Dolphin

    Dolphin Senior Member

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    Small point:
    The effect sizes weren't reported in the Lancet paper at least not using the standard measures of effect size.
     
  18. Dolphin

    Dolphin Senior Member

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    This makes it sound like the specific request for data by Matthees was looked at by an ethics committee and it was ruled not to be acceptable. I don't believe any evidence that occurred has been released which makes me think it never happened.
     
    Last edited: Sep 7, 2017
  19. Dolphin

    Dolphin Senior Member

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  20. Dolphin

    Dolphin Senior Member

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