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PACE trial authors continue to ignore their own null effect - JHP by Mark Vink

Discussion in 'Latest ME/CFS Research' started by Yogi, Apr 27, 2017.

  1. Yogi

    Yogi Senior Member

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    Please RT the editor of JHP



    http://journals.sagepub.com/doi/abs/10.1177/1359105317703785?journalCode=hpqa#.WQHuLNbj4f4.twitter
     
  2. trishrhymes

    trishrhymes Save PR. Sack the President of the Board.

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    I gather from MEA facebook page that this and David Tuller's article, both just published, should soon be available on open access like all the other PACE commentaries recently published.
     
  3. RogerBlack

    RogerBlack Senior Member

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    A similarly trivially obvious work to the Tuller paper published yesterday. It's just a pity the obviousness is not clear to everyone.
    Perhaps it needs an "Explain like I'm five" section.
     
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  4. Dolphin

    Dolphin Senior Member

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  5. Dolphin

    Dolphin Senior Member

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  6. Dolphin

    Dolphin Senior Member

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    I'm grateful for all the work that Mark Vink has put into writing this paper and other papers he has written. It is a real heroic effort given the severity of his illness. Also I admire him for writing in a language which is not his first language.

    I think he makes a lot of good points in his papers but sometimes he makes points I disagree with and/or think are wrong and I'm going to highlight some regarding this paper now.
     
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  7. Dolphin

    Dolphin Senior Member

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    Small points about this:
    The CBT group had a median (not average) of 14 sessions of CBT +3 sessions of specialist medical care
    The GET group had a median (not average) of 13 sessions of GET +3 sessions of specialist medical care
     
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  8. Dolphin

    Dolphin Senior Member

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    The last sentence could theoretically be true but I don't think is in the PACE trial given the data we have. The people who satisfied ME criteria were almost exactly the same as all those who didn't have a psychiatric disorder (they made up 97% of this group) yet the SF-36 physical functioning and Chalder Fatigue Scale scores for the ME group were similar to the Oxford criteria group.
     
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  9. Dolphin

    Dolphin Senior Member

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    The last part is incorrect. They did not change the entry criteria regarding the Likert fatigue scale. It was always six or more on the bimodal scale.
     
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  10. Dolphin

    Dolphin Senior Member

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    No, it equates to a Likert score of 6-17

    No, it equates to a Likert score of 8-19

    Not really. To enter the trial you needed a bimodal score of six which translates to a minimum of 12 on the Likert scale.
     
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  11. Dolphin

    Dolphin Senior Member

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    I agree with all this
     
  12. Dolphin

    Dolphin Senior Member

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  13. Dolphin

    Dolphin Senior Member

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    I agree with all this
     
  14. Barry53

    Barry53 Senior Member

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    UK
    Many of the people who "the obviousness is not clear to" are very normal decent people who don't have medical science pouring out of their ears, yet are the very people who need enlightening and convincing, if public opinion is ever going to change.
     
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  15. Dolphin

    Dolphin Senior Member

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    Yes indeed. I'm attaching the survey results. See table 6.
     

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  16. Jonathan Edwards

    Jonathan Edwards "Gibberish"

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    I think it is important and useful that this sort of friendly critique goes on amongst those who see PACE as valueless. It does not seem to occur within the PACE fraternity! I agree with your general analysis and salute your attention to detail.

    What I think all this may demonstrate is that understanding how to design valid trials, or how to recognise flaws in those designed by others or oneself is not straightforward. My own experience certainly suggests that. When designing a trial you can spend two days in a meeting thinking you have perfected the design only to realise the second afternoon that you have sunk the whole structure by introducing a flaw. You need people with a wide angle view and you need people who focus on detail.

    The difference with PACE, though, is that it is bit like one of those newspaper puzzles where you have to find 17 different words you can make out of another word. It is not that you cannot find words that sink the ship, it is just quite hard to get all 17! It really would serve very well as an extended exam question in how to to do a trial.
     
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  17. trishrhymes

    trishrhymes Save PR. Sack the President of the Board.

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    I'm not sure I understand your point here. Do we have any analysis of the difference in outcomes for patients with comorbid depression compared with those without in each treatment group? l don't recall seeing any.
     
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  18. Dolphin

    Dolphin Senior Member

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    I'm not sure what I can say except repeat it in a little more detail.

    Here are the figures that showed that 97% of those who satisfied the Oxford criteria in this study who did not have a psychiatric disorder satisfied to ME criteria: https://listserv.nodak.edu/cgi-bin/...CO-CURE&P=R2764&I=-3&d=No Match;Match;Matches

    Thus the results for those who don't have a psychiatric disorder would be very similar to those who satisfied the London ME criteria in the study. Those who satisfied the London ME criteria were found to have similar results overall to the full Oxford criteria group. This then suggests that those who did not satisfy the London criteria also had similar results to the full Oxford criteria group. Those who did not satisfy the London criteria are almost exactly the same as those who have a psychiatric disorder in this study. Thus it would appear that those who had a psychiatric disorder had similar results as those who did not have a psychiatric disorder.
     
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  19. trishrhymes

    trishrhymes Save PR. Sack the President of the Board.

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    Thanks, @Dolphin for the extra information. I hadn't come across before the idea that because the London criteria exclude psych disorder, therefore the majority of the non London ones did have a psych disorder.

    So, if I understand the figures correctly, of the 640 participants:

    300 have 'any psychiatric disorder' ( some of whom may have ME including PEM under a different definition.

    329 satisfy London criteria, ie no psych disorder

    11 have no psych disorder and do not satisfy London criteria

    I remember the claim that they analysed according to the different definitions and found no significant difference. I can't remember whether they actually gave figures for this. Given their propensity for twisting the truth, I'd want to see the figures before I believed this statement.
     
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  20. Dolphin

    Dolphin Senior Member

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    This is theoretically true. Another alternative is that 0% of those with ME might have been negatively affected by CBT and GET. There is quite a range of possibilities.

    One can see the data he is referring to and my comments on it here:
    http://forums.phoenixrising.me/inde...bt-and-get-are-ineffective.48764/#post-803812
     
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