Prof Coyne's new blog Undisclosed conflicts of interest in a systematic review protocol of intervent

[Countrygirl]

https://jcoynester.wordpress.com/20...rventions-for-medically-unexplained-symptoms/

Hey, PROSPERO, we’ve got a problem.

Vincent Price as Prince Prospero

A protocol for a systematic review of the treatment of medically unexplained symptoms (MUS) that is posted and downloadable at York University’s PROSPERO site has blatant but undeclared conflicts of interest. Yet, the review has the potential to change health policies in the UK and elsewhere.

Joanna Leaviss, Glenys Parry, Matt Stevenson, Andrew Booth, Alison Scope, Sarah Davis, Shije Ren, Anthea Sutton, Peter White, Rona Moss-Morris, Marta Buszewicz. Medically unexplained symptoms(MUS): primary care intervention. PROSPERO 2015:CRD42015025520 Available here.

The review is funded by £206,000 (US$304,087 ) from the UK National Institute for Health Research.

• A key purpose of systematic reviews is to evaluate the relevance of the scientific literature for health policy with a buffer against the agenda and self-interests of the researchers who conducted the original individual studies.

• There is strong evidence of an undeclared agenda in these authors conducting this systematic review, based on the authors’ disclosures of conflicts of interest elsewhere and their strong public and professional advocacy of a particular viewpoint.

• The circumstances of this systematic review highlight a serious blurring of lines between advocacy and what should be independent assessment of the claims of investigators in systematic reviews, as well as the media.

• The serious conflicts of interest of Peter White

One of the authors listed on the PROSPERO protocol with no conflicts of interest declared is Peter White....

Is Peter White the man you would want to be involved in evaluating the literature concerning treatments for MUS?...

 

[Chrisb]

One cannot help thinking that the money would be better spent on trying to medically explain the symptoms.

 

[Invisible Woman]

This lot make bankers look like Sunday school teachers.

 

[sarah darwins]

This lot make bankers look like Sunday school teachers.

Snap. I was thinking about bankers as I read the above. If you're shameless enough you can get away with anything. Never apologise, never explain.

Incidentally, today is a special day in Britain, that magical day when the pay of executives at FTSE 100 corporations goes past the average annual salary mark for the UK. This year is took them less than five days. It's the most wonderful time ... of the year ....

 

[leela]

One cannot help thinking that the money would be better spent on trying to medically explain the symptoms.

One cannot help but wonder why this exquisitely plain logic has not been doggedly applied whenever and wherever BPSers try to blame the patient.

 

[duncan]

Insurance and state disability interests?

 

[Invisible Woman]

Insurance and state disability interests?

I agree that this is where the pressure is to keep this house of cards standing but when you look at the long term it just doesn't stack up here either. Put the money into research and provide a cure or at least effective treatment and you would have productive people going about their lives earning money and paying tax. Hopefully, if the treatment is good enough, it eventually ceases to qualify for insurance payouts too.

It's pure short term logic that this way of carrying on saves money.

 

[worldbackwards]

Amused by the quote from Moss-Morris:

The authors concluded GET and CBT were moderately effective treatments for CFS. Now, moderately effective may not sound all that impressive until you consider that many of our commonly used pharmaceuticals for medical conditions have similar moderate treatment effects. When using pharmaceuticals as treatment, maintaining these effects may mean taking ongoing medicines. This study shows that even two years or more after treatment has completed, patients receiving GET and CBT sustain their clinical benefits. A small percentage of these patients accessed some further treatment, but even so, these sustained effects are impressive.

Sustained effects that were no better than doing nothing? Can she hear herself?

Jim's comment is very much to the point:

I wonder if we are witnessing a new phenomenon: Zombie Research. No matter how many times we drive a stake into the heart of PACE, it just will not die. The PACE people admit their creation is dead in the long-term follow-up paper, and even that admission barely slows down the monster.

 

[adreno]

I think it's better to just link to the blog, and give him the traffic, rather than posting the entire blog post here.

 

[Sasha]

I think it's better to just link to the blog, and give him the traffic, rather than posting the entire blog post here.

The actual blog is a lot longer but I agree it might be good to post something a bit shorter, @Countrygirl, to make sure he gets lots of traffic over there.

 

[Dolphin]

I think this has some nice quotes by Coyne and others that I think I may use in future when talking about conflicts of interest

 

[Bob]

Jim's comment is very much to the point:

I wonder if we are witnessing a new phenomenon: Zombie Research. No matter how many times we drive a stake into the heart of PACE, it just will not die. The PACE people admit their creation is dead in the long-term follow-up paper, and even that admission barely slows down the monster.

@jimells, that's a hilarious comment! The PACE zombie! (Well, it would be hilarious if it wasn't such a serious subject.) (Here's a direct link to your comment in case anyone wants to read it in full.)

 

[Bob]

Sustained effects that were no better than doing nothing?

I must remember that line! A simple but devastating counter-argument to the spin!

 

[worldbackwards]

I must remember that line! A simple but devastating counter-argument to the spin!

I aim to please.

 

[alex3619]

@worldbackwards, I have blogged on Zombie Science. Its rampant, and occurs when financial or political interests drive the research. See for example:

http://forums.phoenixrising.me/index.php?entries/the-zombie-age-part-a.1333/
http://forums.phoenixrising.me/index.php?entries/the-zombie-age-part-b.1334/

 

[Sean]

Sustained non-effects. Now 50% more, 30% sooner, and only at 17% more cost!

Water proof to 2 metres, rechargeable, comes in a wide range of colours, fits in your pocket, and is safe for kiddies and pets.

Be the envy of your neighbours. Impress your work colleagues. Feel sexier and more important.

Yes, sustained non-effects. The latest marketing miracle brought to you by Modern Medicine Inc.

Because we care.

Coming soon to a quack near you.

Individual benefits may vary. Not suitable for ducks under the age of 6 weeks.

 

[jimells]

@worldbackwards, I have blogged on Zombie Science. Its rampant, and occurs when financial or political interests drive the research. See for example:

http://forums.phoenixrising.me/index.php?entries/the-zombie-age-part-a.1333/
http://forums.phoenixrising.me/index.php?entries/the-zombie-age-part-b.1334/

This is probably where I got the idea from.

 

[A.B.]

Zombie research? How about "fake it till you make it research"?

(but what if you never make it, then it's just all fake?)

 

[Yogi]

PDW has now disclosed his conflicts after being outed by Dr James Coyne.

http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42015025520

Conflicts of interest
PDW has undertaken consultancy work for a re-insurance firm. He has also undertaken voluntary consultancy for the Departments of Health, Work and Pensions and is a member of the Independent Medical Experts Group, a non-Governmental organisation which advises the Ministry of Defence regarding their Armed Forces Compensation Fund.

He did this 2 days after Dr James Coyne's blog.

DISGRACEFUL BEHAVIOUR.

 

[Countrygirl]

PDW has now disclosed his conflicts after being outed by Dr James Coyne.

http://www.crd.york.ac.uk/PROSPERO/display_record.asp?ID=CRD42015025520

Conflicts of interest
PDW has undertaken consultancy work for a re-insurance firm. He has also undertaken voluntary consultancy for the Departments of Health, Work and Pensions and is a member of the Independent Medical Experts Group, a non-Governmental organisation which advises the Ministry of Defence regarding their Armed Forces Compensation Fund.

He did this 2 days after Dr James Coyne's blog.

DISGRACEFUL BEHAVIOUR.

Medically unexplained symptoms(MUS): primary care intervention

Here's the rogues' gallery

Joanna Leaviss, Glenys Parry, Matt Stevenson, Andrew Booth, Alison Scope, Sarah Davis, Shije Ren, Anthea Sutton, Peter White, Rona Moss-Morris, Marta Buszewicz

Here is Prof White's plans for us! He also, he states, will create links and engage with our ME charities! I hope we can put a stop to that.

Review question(s)
What is the clinical, cost-effectiveness and acceptability of behavioural modification interventions for Medically Unexplained Symptoms in primary care or community-based settings?

Types of study to be included
Relevant systematic reviews, RCTs and economic evaluations will be extracted in the first instance and assessed for quality. In addition, qualitative research concerning barriers/facilitators of the effectiveness of behavioural modification interventions from the perspective of both patients and service providers will be retrieved. In the absence of RCT data, data from non-randomised comparative studies, pseudo-experimental studies, quasi-experiments and case report/series will be considered.

Qualitative studies:

(1) Studies reporting qualitative research or qualitative data elicited via a survey or a mixed-methods study to include qualitative data on the perspectives and attitudes of patients who have received behaviour modification interventions in a primary care or community based setting.

(2) Qualitative data, embedded in trial reports or in accompanying process evaluations, which can inform an understanding of how issues of acceptability are likely to affect the clinical effectiveness of interventions;

(3) Qualitative data, either from separately conceived research or embedded within quantitative study reports, reporting the acceptability of interventions to health care practitioners.

Participants/ population
Studies of populations meeting the diagnostic criteria for MUS, MUPS, and somatoform disorders will be included.

Populations with FSS will be included, e.g. IBS, CFS, fibromyalgia

Intervention(s), exposure(s)
Behavioural modification interventions. We will include interventions that aim to modify behaviour. These include CBT, behaviour therapy, and GET.

Interventions may therefore include but will not be exclusive to a range of psychotherapies, for example CBT, behavioural therapy, psychodynamic therapy, mindfulness, reattribution therapy. Interventions may also include other physical therapies, but only where behaviour change is a specified primary outcome or treatment mechanism. Interventions with multiple components will be included where one of the components can be considered a behavioural modification technique as defined by the above criteria. Individual and group interventions will be treated as separate interventions.

Analysis of subgroups or subsets
i) recognised FSS, for example fibromyalgia, irritable bowel syndrome and chronic fatigue syndrome, and ‘somatoform disorders’ ii) who delivers the therapy, for example GP; specialist iii) number of sessions of intervention; iv) number of symptoms; v) duration of MUS

Dissemination plans
We will create links and engage with patient support groups that currently exist for syndromes such as CFS, Fibromyalgia, and Irritable Bowel Syndrome (IBS) in order to publicise the on-going work, as well as link in with professional bodies.

Findings from the review will be presented at relevant professional forums, i.e. societies for behavioural medicine, health economics, primary care, psychiatry and psychology and their associated conferences.

We will disseminate findings of the project to the academic community. The final project report will detail the background, methods and results of the quantitative and qualitative reviews, with statistical syntheses and cost-effectiveness evaluation providing conclusions and recommendations. The decision-analytic model will continue to be available for further analyses as the evidence base develops. We intend to disseminate the findings by publishing the systematic reviews and cost-effectiveness models in high quality journals. We will present the findings at national and international conferences.

Contact details for further information
Dr Leaviss

Organisational affiliation of the review
University of Sheffield

www.sheffield.ac.uk

Review team
Dr Joanna Leaviss, University of Sheffield
Professor Glenys Parry, University of Sheffield
Professor Matt Stevenson, University of Sheffield
Dr Andrew Booth, University of Sheffield
Dr Alison Scope, University of Sheffield
Dr Sarah Davis, University of Sheffield
Dr Shije Ren, University of Sheffield
Miss Anthea Sutton, University of Sheffield
Professor Peter White, Queen Mary University of London
Professor Rona Moss-Morris, King's College London
Dr Marta Buszewicz, University College London

Anticipated or actual start date
01 September 2015

Anticipated completion date
28 February 2017

Funding sources/sponsors
NIHR HTA project 14/26/08

Conflicts of interest
PDW has undertaken consultancy work for a re-insurance firm. He has also undertaken voluntary consultancy for the Departments of Health, Work and Pensions and is a member of the Independent Medical Experts Group, a non-Governmental organisation which advises the Ministry of Defence regarding their Armed Forces Compensation Fund.