Bob
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Due to ongoing questions about the PACE Trial, the principle investigators (White, Sharpe, Chalder) have issued a response which the moderator is now referring people to whenever similar questions are asked on a thread:
http://www.talkhealthpartnership.com/online_clinics/PACE_TRIAL_info.php
Enjoy.
I could say a lot about their statement, but I'll just pick up on some of the blindingly misleading information...
White et al said:About six out of ten patients made a clinically useful improvement in both fatigue and functioning after CBT or GET.
That is written ambiguously and it's misleading. It suggests that 60% of patients improved as a result of treatment with CBT or GET.
In fact an extra 16% of patients made a clinically useful improvement in both fatigue and functioning, when CBT or GET were added to SMC.
White et al said:CBT and GET were also more effective in improving: general ability to do things
Except for objectively measured physical disability (six minute walk test), for which there was no improvement when CBT was added to SMC, and possibly no clinically useful improvement when GET was added to SMC.
This statement also doesn't apply for employment, for which there were no improvements after CBT and GET were added to SMC.
White et al said:We disagree with those people who are concerned that these improvements are somehow less valid since they relied on the subjective reports of patients rather than objective measures; we believe that the patient is the best judge of how unwell they are.
Hold on, wasn't the basis of CBT, in the PACE Trial, that patients have 'false' illness beliefs, and so their judgement can't be trusted?
That was the whole point of CBT in the PACE trial. It was designed to address false illness beliefs.
So at what point does CFS/ME patients' judgement about their symptoms suddenly become valid? When they are very ill, moderately ill, or very well?
If CFS/ME patients are the "best judge of how unwell they are" (as the authors claim) when they are very ill, then on what basis is CBT prescribed? What is the point of it? Why would they want to change illness beliefs?
Anyway, after a year of training patients to think differently about their symptoms, and of training patients to interpret their symptoms in a different way, it is perverse that the authors are then only interested in testing patients' views about their illness, rather than assessing actual changes in physical disability. Such an approach only assesses how successfully the patients have been trained to interpret their symptoms differently, and it fails to assess what effect the therapies actual had on the illness.
By all objectively measured outcomes, CBT failed to make any difference.