Discussion in 'Other Health News and Research' started by Dolphin, Jul 25, 2016.
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I have just one word......PACE....
One can argue that this is important/relevant for ME/CFS where therapies based on dubious premises (CBT, GET, etc.) have been tested in RCTs.
Identifying “researcher degrees of freedom.”
Similarly with claims about CBT and GET for ME/CFS.
But it is important to say that running an RCT doesn't necessarily give support for a treatment with PACE the preferred treatments will tend to be supported by the measurement systems (in that treatments change perceptions of illness and measurements get perceived fatigue and physical function).
So we really should never accept that and RCT is necessarily going to produce evidence.
The section "Ceteris Paribus: A Science-Based Heuristic for Evaluating CAM Research" explains the theory and gives an example.
You can't get any better than David Gorski and Steve Novella!
Okay, I didn't get further than that. I am so backlogged with interesting things to read and now you've added more!
It comes down to this. Psychology, and also psychiatry, need to decide if they are science or unscientific. For far too long they have wanted to be both, especially psychiatry. I think psychiatry needs to be broken up, based on methodology, and evidence based claims should be rethought accordingly.
I have two more: Lightning Process.
And a big thanks to Esther Crawley for opening the door to that shite being inflicted upon patients, especially children.
I don't know - one of the problems I have with 'Science Based Medicine' is that it seems to give great power to those in positions of authority who get to decide what is 'plausible'. The consensus view within medicine over the last decades seems to have been that CBT/GET are plausible treatments for CFS, but homeopathy is not. So while there is no good evidence that CBT/GET are more effective than homeopathy, they are still viewed as 'mainstream' medicine, not quacky CAM.
I think I prefer simpler Evidence Based Medicine, but with lessons learned from the way utterly implausible CAM can gain 'positive' results in poorly designed trials. Allowing SBM to just dismiss positive CAM trials, but then endorse similarly designed trials that happen to fit in better with the current medical consensus sounds pretty unscientific to me. If implausible treatments are consistently gaining positive results in trials, the problem is with the trials, not the treatment's implausibility.
The CBT and GET assume that the symptoms can be explained by deconditioning.
If one can show that a similar symptom pattern is not present in those who are deconditioned or something similar, then the CBT and GET models are not plausible and so trials supposedly showing their effectiveness should be treated with scepticism.
But it seems they can always come up with a new 'plausible' explanation (or concoction of various explanations, to be selected from and adapted to the particular patient in a holistic manner). More and more people giving up on deconditioning as an explanation of symptoms in CFS hasn't done much to slow the promotion of CBT/GET as effective treatments.
We often read or hear something in the media and then later hear what seems to be contradictory information.
A lot of that has to do with the media reporting preliminary studies, studies on animals yet are presented in such a way that it sounds like they are definitive studies. It makes good news. Also the press releases put out by the universities, labs, where the studies are conducted do the same thing. Sometimes without the researchers knowing or editing the announcement and the person writing it does not have a science background. See here.
In the long run science should be changing as new things are discovered.
A priori is a bit different than just relying on the plausibility of the hypothesis. Even though plausibility is important the meaning is a bit different than how it's usually used, so it's easily misinterpreted. A prori also includes the type of stastics used. Baysian stastics definition of proof vs only using the P value as the holy grail of proof. That's just the beginning.
It's easily mispreceived, even by scientists. I know I had a problem not only understanding this concept but how it's put to use when I first learned about it.
SBM is part of EBM but a bit more refined. It's EBM that actually relies more on authority and many studies on alternative medicine fall in this category.
I have a hugh file on SBM in my computer and when I have more time, hopefully tomorrow, I will post here.
The above references are also helpful but sometimes hard to plow through as it's a lot of information, sometimes made more confusing because of some of the articles overreliance on hyperlinks which the authors assume readers will click, to substitute information that might be more understandable if it was simply put in the text. A product of our times which has advantages and disadvantages.
If anything I have said seems inaccurate, please let me know as this is my interpretation and still in the process of learning.
Isn't a lot of that to do with ust competently engaging in EBM, rather than reason to insert prior assumptions about plausibility?
EBM is often done badly, and it's always good to be pushing to raise standards, but I'm just uncomfortable with the way some in SBM seem to think that that can put implausible CAM in a separate category to things like CBT, GET, other 'plausible' behavioral interventions. I think that of similarly designed trials are showing similar evidence of efficacy for these sorts of interventions we should be equally sceptical/accepting.
I could have misunderstood something. I am largely going off debates I've read in the comment sections of blogs.
Agree. If ME patients are going to start talking about "well established knowledge" regarding treatments, they're simply going to find themselves up against "well, look int the textbooks". And I believe we all know what's in the textbooks.
Even if we can't convince everyone else that the basis for some therapies are not justified, we could still use it to argue why we ourselves are sceptical i.e. it isn't simply based on prejudice about mental health or whatever.
You can also try a Google Site Search
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