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PACE trial claims of recovery are not justified by the data: A Rejoinder to Sharpe et al.

Discussion in 'Latest ME/CFS Research' started by Tom Kindlon, Mar 21, 2017.

  1. Tom Kindlon

    Tom Kindlon Senior Member

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    In press, Fatigue: Biomedicine, Health and Behaviour

    https://www.researchgate.net/public...arpe_Chalder_Johnson_Goldsmith_and_White_2017
     
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  2. Tom Kindlon

    Tom Kindlon Senior Member

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  3. Jan

    Jan Senior Member

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    Devon UK
  4. Tom Kindlon

    Tom Kindlon Senior Member

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  5. Esther12

    Esther12 Senior Member

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    The data from the PACE trial is so damn helpful. It just shows how valuable data sharing is for furthering scientific debate. (I spent some time coming up with an anaology of a card game where one side gets the whole deck, but then selects cards that can be used by either side... it was not as illuminating as I'd hoped).

    Both my favourite parts of this response stem from taking Sharpe's points seriously and then saying 'well lets look at the data then...'


    Lovely.
     
    Last edited: Mar 22, 2017
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  6. adreno

    adreno PR activist

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    Fantastic job, again!
     
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  7. trishrhymes

    trishrhymes Senior Member

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    Really excellent. I love the way you are able to provide evidence and reasoned argument to yet again demolish their pathetic attempts to defend the indefensible.
     
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  8. char47

    char47

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    WELL DONE. a well reasoned & thoroughly competent scientific demolishing of their claptrap. The facts simply do not support their arguments. Reading that was a very good way to start my day :) Thank you
     
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  9. RogerBlack

    RogerBlack Senior Member

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    A paper that did not need to be written in any sane universe.
    Alas none of the various stages of approvals or reviews caught it before publication of the original, so here we are.

    Thanks.
     
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  10. Solstice

    Solstice Senior Member

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    Rekt.
     
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  11. Sidereal

    Sidereal Senior Member

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    Just brilliant.
     
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  12. trishrhymes

    trishrhymes Senior Member

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    :confused:

    You've lost me...
     
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  13. AndyPR

    AndyPR Cookies for Tired Sam

     
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  14. A.B.

    A.B. Senior Member

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    Nice article. Did you consider pointing out that the subjective "improvement", which is all that's left in favor of the treatment, is comparable to the strength of a psychological placebo intervention as found by Wessely et. al. in a review on the topic?

    So this treatment really appears to be completely useless. It's ironic that Wessely himself would provide the proverbial final nail in the coffin.

    If you considered pointing this out, can you explain why it was ultimately not done? Is it because ultimately it boils down to belief (in whether a placebo effect is useful or useless despite not leading to objective improvement)?
     
    Last edited: Mar 22, 2017
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  15. suseq

    suseq

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    This really is an excellent response, and so good to see all the incredible advocacy on twitter. With huge thanks to all involved.
     
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  16. Tom Kindlon

    Tom Kindlon Senior Member

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    The original paper and this rejoinder are on recovery. One of the reviewers directed us away from talking about efficacy in general.

    However our original recovery paper does talk about subjective and objective measures.

    It was argued that this rejoinder should be short or it wouldn't be read so it doesn't include all the possible points.
     
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  17. dangermouse

    dangermouse Senior Member

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    Thank you :thumbsup:
     
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  18. anciendaze

    anciendaze Senior Member

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    This is a question for those who have gone through the entire bulk of PACE literature repeatedly, something I no longer have the stomach to do. Did the protocol used at the time the PACE trial was funded make any mention of possible discordant results between subjective data collected by questionnaire and objective data on physical performance, aside from making objective data secondary so it could be ignored if inconvenient?

    There should now be no question that such a result took place w.r.t. CBT, where neither the "step test" nor the six-minute walk test showed any improvement. This alone implies that either the hypothesis of psychological causation was falsified, or that CBT was completely ineffective w.r.t. improving objective performance.

    When it comes to GET and the six-minute walk test there is a problem with the data because about 1/3 of people counted as participants declined to participate in that test either before or after treatment. Dropping those who did not fully participant is not an acceptable correction because it introduces a new post facto selection effect in a study which already shows a huge prior selection in the reduction from 3158 to 640. That raises questions about the applicability of any claimed benefits to the public health problem for which the study was funded. We seem to be arguing about whether anyone in a cohort of 3158 referred by NHS GP/PCP doctors might benefit from CBT or GET, with no data at all on the effect of the recommended combination CBT+GET. This is a clear indication of the triumph of authors opinion over data.

    Rather than arguing over what they actually demonstrated I'd like to know what on Earth they believe you demonstrate by showing that a few people out of a huge cohort might or might not benefit from the favored interventions -- in the opinion of certain authors. We are literally at the level of anecdotal evidence following a substantial expenditure in a field where research funding is tight.

    No such problem exists with "step test" data, which conclusively shows no improvement over standard medical care. This is a discordant result, and so far as I can tell, the authors went to some lengths to ignore it.

    Most respectable scientific research considers discordant results especially important in the discussion section. Often it leads to modification of the initial hypothesis. These authors seem incapable of changing their own beliefs because of data.
     
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  19. Sean

    Sean Senior Member

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    Nice work. :)
     
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  20. Tom Kindlon

    Tom Kindlon Senior Member

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