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PACE Trial and the criteria for M.E. used

Discussion in 'Latest ME/CFS Research' started by Dolphin, Jun 2, 2011.

  1. Dolphin

    Dolphin Senior Member

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    I know that people like Angela Kennedy have been complaining about the use of the London criteria in the PACE Trial for many years so I don't claim I am saying anything novel; however, I just thought I'd post my thoughts/observations for what they are worth.
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    PACE Trial - 97% of the participants who didn't have a psychiatric disorder satisfied the definition of M.E. used

    In the Lancet paper on the PACE Trial (by White et al (2011)), it said:
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    I was not 100% sure what "no primary depressive or anxiety disorder (interpreted as an absence of any such disorder)" meant in relation to the percentage we were given for "any psychiatric disorder" i.e. could there be an overlap.

    The following is an extract of a letter that clarifies it (see underlined bit in bold) - the letter was written by PD White, KA Goldsmith, AL Johnson, R Walwyn, HL Baber, T Chalder, M Sharpe, on behalf of all the co-authors (of the PACE Trial)

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    (source: http://www.meactionuk.org.uk/whitereply.htm )

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    The figures from the paper (Table 1) show that, of the 640 participants, 300
    (46.9%) had "any psychiatric disorder" and 51.4% (329) satisfied the London criteria*.

    This means that of the 340 patients in the trial (i.e. who satisfied the Oxford criteria**, with a principal symptom of fatigue, who did not have a psychiatric disorder), 329 (96.8%) satisfied the London criteria for M.E., the definition of M.E. used in the trial!

    This is an amazingly high figure for a definition of M.E. given the "looseness" of the Oxford criteria e.g. unlike the Fukuda CFS criteria or Carruthers ME/CFS criteria, it doesn't require other symptoms apart from fatigue.

    It seems to me the definition for M.E., at least as it was used in this trial, is very suspect. And hence it is questionable what can read into how people with M.E. responded in the trial.

    ---

    *One can how the London Criteria were used here:
    [​IMG]

    **
    One can how the Oxford Criteria were used here:
    [​IMG]

    Annex 1:
    We already cannot be sure if the participants are representative of patients in the community based on who refused to take part, were excluded, etc.
     
  2. wdb

    wdb Senior Member

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    London
    It seem a bit sneaky that they state
    But then if you look at the London ME criteria the instructions are that only criteria 1 to 4 must be met, ie 5) primary depressive or anxiety disorder - can be present
     
  3. oceanblue

    oceanblue Guest

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    Agreed, and I also find the fact that 67% of Oxford Criteria patients met International criteria very surprising too. something doesn't quite add up here.
     
  4. Dolphin

    Dolphin Senior Member

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    That made me less confident about what was said initially. But it appears that if a person had any psychiatric disorder presumably assessed using the SCID (separately) they weren't included.
     
  5. Dolphin

    Dolphin Senior Member

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    Yes, I'm guessing if somebody clicked "present a little" that it was counted as having the symptom:
    [​IMG]
     
  6. Angela Kennedy

    Angela Kennedy

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    Yes, thanks for this Dolphin.

    There are certainly some discrepancies in White's account in his letter to Hooper, and the actual 'London criteria' used in the PACE trial protocol, which seems to have been mangled. and their relationship to the first wave of exclusions rendered by the Oxford Criteria. I haven't had a chance to look at the letter in full yet, but isn't White claiming something like 'someone else' gave him a version of the 'London' to use?

    This gets more and more discrepant the deeper I'm looking, certainly.
     
  7. Angela Kennedy

    Angela Kennedy

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    This constitutes another thread of course, and a lot of the work I was doing previously on the cohorts are on theose other threads. I tried to keep threads to a minimum but you all know how it gets sometimes with different people starting up new threads- it's an occupational hazard we all face!

    But related to this thread, there's another thread here:

    http://forums.aboutmecfs.org/showthread.php?10219-PACE-study-and-oxford-criteria/page3

    in which I made some comments on post #28 which I think may be relevant to this thread specifically:

     

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