Coyne demolishes Per Fink's trial of CBT for medically unexplained symptoms

[BurnA]

Andreas Schröder
http://www.functionaldisorders.dk/
December 8, 2016 at 7:36 pm
0000-0001-5211-4702

one of the authors of the paper discussed replies to Coyne's blog at

http://blogs.plos.org/mindthebrain/...y-for-whatever-ails-your-physician-about-you/

And Coyne replies to that too.

 

[Dx Revision Watch]

Coyne has been asked by Prof Allen Frances, four times, now, to fix the misattribution in the text of his blog.

Coyne has repeatedly refused to comply with Prof Frances' request.

In his response to the lengthy comment from researcher, Andreas Schröder, Coyne writes:

"Welcome to the era of post-publication peer review."

If Coyne is offering his analysis as "post-publication peer review", then I suggest he apply the same standards as would be expected had he submitted a Letter to the Editor - that he correctly attribute the extracts he has used in support of his analysis to their rightful author.

It appears that in his case, political agenda outweighs academic integrity.

 

[Esther12]

Coyne has been asked by Prof Allen Frances, four times, now, to fix the misattribution in the text of his blog.

Coyne has repeatedly refused to comply with Prof Frances' request.

Sounds bad. Hopefully it will get sorted soon.

 

[Dx Revision Watch]

Sounds bad. Hopefully it will get sorted soon.

In the light of Coyne's responses, I have little confidence that he will cease his ridiculous posturing and make the correction he has now been asked four times to make.

Unfortunately, PLOS don't have editorial control over the blogs hosted on their platform.

 

[Esther12]

In the light of Coyne's responses, I have little confidence that he will cease his ridiculous posturing and make the correction he has now been asked four times to make.

It certainly seems he can get things like thins wrong in ways that is totally inexplicable to me. Annoying stuff.

I thought the exchange with Schröder was interesting.

Others are relevant issues regarding psychotherapy trials in general, such as lack of blinding. I will not discuss these issues here.

There is this culture around these sorts of interventions that assumes that as all the 'experts' making money from CBT etc have decided to ignore this problem, it's not a problem that needs to be addressed.

In the scientific world, I live in, scientific studies are discussed within the scientific community in the scientific literature, not on random blogs. Why is this critique not put forward as a letter to the Editor? And why comes it now, years after the publication of our trial?

I can forget that this attitude is still a part of science as it's so utterly rejected by everyone I respect. I don't really know which view of post-publication criticism is the more mainstream one.

This bit on COI completely avoids the point:

5. James Coyle accuses us for conflicts of interests regarding our clinic. The Danish Health system is tax financed, and neither the authors of the trial report nor our employees have any financial interests in this work. We try to help patients, based on the best evidence available. I do not know who James Coyle is trying to help with his blog.

 

[Woolie]

Yea, I thought the blog raised some interesting issues, and would rather see us discuss these than go off on a rant about James Coyne and his various transgressions. That doesn't serve any of our interests. And it doesn't make us look good as a community.

Its especially interesting to see how Schroder defends himself. He uses a few strategies we've seen used by the PACE authors:
- claims that their work must be watertight because it got though peer review
- claims that only "official channels" should be used to enter into debate. Especially, the publishing journal, which (it always turns out) is highly sympathetic to the BPS point of view.
- the claim that "we are only trying to help patients" and that critics are therefore working against patients' best interests
- the claim that the model isn't psychological (its a "complex interplay between psychological and biological factors"). Even though the evidence that their model is primarily psychological is staring us in the face - its in the nature of the intervention! Don't you just love that one!

There's also the outraged tone in Schroder's letter that suggests he comes form a culture where direct criticism of other people's work is rare. He is affronted by the blog (perhaps understandably so, the tone was harsh and overly rhetorical), but he doesn't rise to the challenge and counter the criticisms.

A couple of Schroder's points were fair though. Coyne did have the thing about deterioration wrong, and although there was outcome switching, the results for the original measure were also presented, and it was clear that the change did not impact on the results.

However, even considering the rhetoric, hyperbole and errors, I think Coyne has made a useful contribution here, in terms of highlighting the weaknesses in this type of research.

 

[Woolie]

PS Its unsettling how Schroder and other BPS advocates seem to so faithfully believe in what they do. That makes it all much more dangerous in my view.

(I'm reminded of a certain Nazi leader who also believed wholeheartedly in what he was doing, and we know how that turned out. But people have told me that if you mention that name or Nazis in general, you automatically lose the argument!)

 

[Esther12]

Coyne did have the thing about deterioration wrong

I've not read the paper, but didn't really follow the points being made on that. Any chance I could get a 'for dummies' version?

 

[Esther12]

But people have told me that if you mention that name or Nazis in general, you automatically lose the argument!

That's how I win arguments. I do everything I can to sound like a Nazi, and then when the comparison is made, BINGO!

 

[Wildcat]

.
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@Woolie wrote : 'I ... would rather see us discuss these than go off on a rant about James Coyne and his various transgressions. That doesn't serve any of our interests. And it doesn't make us look good as a community.'



Err? What? ' A rant' ? 'Doesn't make us look good as a community' ...???

.

Coyne has blatantly misquoted from Allen Frances's Blog. It is clear that Coyne has misattributed his quotes, wrongly attributed them to Allen Francis , when its clear that the statements were written by Suzy Chapman/Dx Revision Watch, who has been writing on DSM 5 for many years, a very great many years before Coyne expressed any interest.

At present Coyne is stubbornly refusing to correct his misattributions on his Blog, despite his error being brought to his attention.

Requesting that Coyne corrects his misattributions is reasonable and normal in academic circles.

Coyne's refusal to do so is bizarre and frankly offensive, considering the extensive work done by Suzy Chapman/DS Revision Watch over the years on DSM5, on Per Finks input, and other DSM5 material ...

Coyne has never before expressed any interest in the DSM5 issues .... It very much looks like he has based his blog on other people's work ... and gone further, in refusing to credit the work of those he quotes.


Is it really the case that Coyne's so-called 'transgressions' should be perpetually ignored by the ME community?

We have already lost several long term ME advocates due to Coynes abusive behaviour, and the refusal of sections of the ME community to accept that Coyne's behaviour is beyond the pale.
.
.

 

[Woolie]

Okay, it was a pre-registered trial with two groups. 55 people received a group-based intervention - called StreSS - and the other 66 got nothing (told to go back to their GP and s/he would manage them from now on - this was amusingly called "enhanced care").

The StreSS intervention was the standard stuff - first acknowledging their suffering, then challenging patients' "inflexible symptom attributions", identifying "perpetuating thoughts and behaviours", improving "emotional awareness" etc, etc.

The primary outcome measure was based on the SF36, a self-report questionnaire that asks questions about your physical abilities, mental health and overall functioning. They were going to use the PCS score form this scale, which adds up all all the subscales that relate to physical health (vitality, physical functioning, bodily pain, physical role functioning etc), but they changed this after registration to a measure which only include three of the most important physical subscales: physical functioning, bodily pain and vitality.

The StreSS group showed a significantly greater improvement on the primary, self-report measure than the control group. The change to the primary outcome measure didn't make any difference to the results (they presented data for both measures). Most of the secondary measures were mental health measures, and most didn't show significant improvements.

(Edit: forgot to say that the scores on the primary outcome measure declined slightly int he control group over time - so Coyne was right about that part - but conversely, scores in the StreSS group did actually increase over time, indicating some overall improvement. So its not true that the group differences were entirely driven by deterioration in the control group).

Its interesting to note that they used intention-to-treat, which actually worked in their favour, because more people dropped out in the control group, so had no chance whatsoever of showing even a random improvement.

This is funny:

This treatment provides patients with a positive and evidence-based understanding of their
illness that aims to transcend the mind–body dualism inherent in the current diagnostic classifications,and that contrasts with the usual approach to management, which tends to suggest either physical or mental disease.

This treatment was of course based on a heavily dualistic model in which their "minds" were seen as responsible for their physical symptomatoloy.

 

[Woolie]

We have already lost several long term ME advocates due to Coynes abusive behaviour, and the refusal of sections of the ME community to accept that Coyne's behaviour is beyond the pale.

I'm sorry, @Wildcat. I didn't want to downplay your concerns. Or imply that anyone was out of place to mention these things. Just wanted to steer the discussion back to the key issues raised by the blog.

 

[Wildcat]

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Well, how can we take the blog seriously ... as Coyne has brazenly misattributed certain quotes .... how can we trust the accuracy of anything else he has written on it .... as he clearly has not done his homework...
.

 

[TiredSam]

Yea, I thought the blog raised some interesting issues, and would rather see us discuss these than go off on a rant about James Coyne and his various transgressions. That doesn't serve any of our interests.

I think watching Coyne like a hawk is vital to our interests. I personally have given up ranting about him (for the time being), but if someone has been wronged by him and brings it to our attention I think that's important.

And it doesn't make us look good as a community.

Being worried about looking good shouldn't be bothering us at all - we'll still get labelled with all kinds of names by the BPS crowd, fortunately independent observers (FOI tribunal judge, scientists, journalist and commentators who have come on board lately) have shown that they aren't as blinded by it as the petty name-callers hoped. If you are worried about looking good, you need to keep a constant eye on how Coyne might make us look as a community. His interests are only sometimes the same as ours, and when they aren't he can be a barking liability.

 

[Dx Revision Watch]

Yea, I thought the blog raised some interesting issues, and would rather see us discuss these than go off on a rant about James Coyne and his various transgressions. That doesn't serve any of our interests. And it doesn't make us look good as a community.

No "rant" Woolie and I object to the legitimate concerns of myself and Prof Allen Frances being framed as such.

The only person who doesn't look good, here, is Prof Coyne, himself.

He has been asked to correct his misattribution, not by me, but by Prof Allen Frances, who chaired the DSM-IV Task Force. Prof Frances wants it corrected as much as I do.

Coyne has now refused four times to do so.

That doesn't serve anybody's interests and adds one more bloody minded action to the others that have piled up in the last 12 months.

The commentary on Prof Frances' Psychology Today blog was one of a series of three that we worked on together in the run up to the release of DSM-5. The post has had many thousands of views, was reposted on over 70 other sites and was widely Tweeted and linked to on Facebook. It has received over 500 comments since late 2012. The version on Huffington Post received nearly 300 comments. It was also published at Psychiatric Times.

When quoting from that post, as an academic, Coyne has a duty to strive for accuracy and academic integrity. His choosing to flout this is his failing - not mine.

If Prof Frances and me are now misquoted elsewhere, as a result of Coyne's bloody mindedness, one of us is going to need to spend more time sorting that out.

It is simply not acceptable.

 

[Woolie]

No "rant" Woolie and I object to the very legitimate concerns of myself and Prof Allen Frances being framed as such.

Sorry, @Dx Revision Watch, if I implied there was anything wrong with mentioning these things. Not at all, it was useful information. I was just frustrated that we were getting sidetracked from the content issues raised. But it was wrong of me to use the word "rant", way too judgmental. I'm sorry.

 

[Dx Revision Watch]

Sorry, @Dx Revision Watch, if I implied there was anything wrong with mentioning these things. Not at all, it was useful information. I was just frustrated that we were getting sidetracked from the content issues raised. But it was wrong of me to use the word "rant", way too judgmental. I'm sorry.

Thank you.

As a result of Coyne's arrogance and bloody mindedness I too have been sidetracked - from spending time on work I need to be doing around ICD-11.

 

[Dx Revision Watch]

(Since Coyne touched, briefly, on DSM-5's SSD and included quotes from me, Allen Frances and SSD work group chair, Joel E Dimsdale, within his post.)


The APA has launched a new portal to field proposals for changes, additions and updates to the DSM.

On December 12, Michael B. First reported at STAT News:

"Individuals or groups making proposals must provide supportive information such as reasons for the change, data documenting improvements in validity, evidence of reliability and clinical utility, and a discussion of potentially harmful consequences associated with the proposed change. Proposals must also include a thorough review of the relevant literature and any secondary data analyses the proposers have conducted."​

The APA has appointed a steering committee to oversee proposals for revisions.

Michael B. First writes:

"...APA has defined four types of proposals: revising an existing diagnostic criteria set, adding a new diagnostic category, deleting an existing category, and correcting errors or inconsistencies."​

According to First, APA anticipate that most submissions will come from psychiatric researchers and clinicians, from organizations such as psychiatric subspecialty groups or advocacy organizations.


Michael B. First has also co-authored a paper here:

November 16, 2016
The Future of the DSM Implementing a Continuous Improvement Model
Michael B. First, MD1,2; Kenneth S. Kendler, MD3,4; Ellen Leibenluft, MD5

http://jamanetwork.com/journals/jamapsychiatry/article-abstract/2584711

In which the authors expand on the update process and what is required to support submissions. The first page is viewable.


I don't recall Prof Coyne commenting on the progress of the SSD work group between 2008 and the publication of DSM-5, in May 2013, or whether he submitted comment in the three draft review exercises in 2010, 2011 and 2012.

But there is now an opportunity for all professional stakeholders to submit proposals for updates in a structured manner.


Edited to add:

SSD and the US specific ICD-10-CM:

When the DSM-5 was published in May 2013, the APA had already agreed with NCHS on the cross walk codes between DSM-5 and ICD-9, and ICD-10-CM.

(An ICD code is required for reimbursement purposes.)

DSM-5's new Somatic symptom disorder (SSD) was assigned to ICD-10-CM F45.1 Undifferentiated somatoform disorder

In October 2016, when the partial code freeze lifted, Somatic symptom disorder was approved by NCHS for addition to the ICD-10-CM, following a proposal by APA (in September 2013) for its addition as an inclusion term.

SSD was added to ICD-10-CM as an Inclusion term under ICD-10-CM

F45.1 Undifferentiated somatoform disorder

SSD has not been assigned a unique ICD code within ICD-10-CM and does not replace any existing codes. It does mean that SSD can be coded for under both DSM and ICD-10-CM.

 

[Dx Revision Watch]

https://www.ncbi.nlm.nih.gov/pubmed/27717252#cm27717252_34357

World Psychiatry. 2016 Oct;15(3):291-292. doi: 10.1002/wps.20353.
Bodily distress disorder in ICD-11: problems and prospects.
Gureje O1, Reed GM2.
PMID: 27717252

Comment to the authors of the above paper:

https://www.ncbi.nlm.nih.gov/pubmed/27717252#comments

• Suzy Chapman2016 Dec 17 09:58 a.m.
  
  Firstly, it is to be welcomed that authors Gureje and Reed have published this progress report on the work of the ICD-11 Somatic Distress and Dissociative Disorders Working Group (S3DWG) in an open access journal. The revision of ICD cannot be described as a "transparent and inclusive" process when ICD revision Topic Advisory Groups and sub working groups publish progress reports and rationales for their proposals behind paywalls.
  
  I note the paper discusses the S3DWG's rationale for not including the word "somatic" in the name it proposes for its prototype disorder.
  
  There is, however, no discussion within the paper of the sub working group's rationale for proposing to use the disorder term "Bodily distress disorder (BDD)" when this term is already being used interchangeably in the literature [1-4] with "Bodily distress syndrome (BDS)" - a divergent construct and criteria set already operationalized in Denmark, in clinical and research settings [5].
  
  Omission of consideration within this paper of the potential impact for maintaining construct integrity within and beyond ICD-11 is troubling.
  
  The S3DWG's "Bodily distress disorder" construct, as defined for the ICD-11 core version, has strong conceptual congruency and characterization alignment with DSM-5's "Somatic symptom disorder (SSD)" and poor conceptual and characterization alignment with Fink et al (2010) "Bodily distress syndrome."
  
  It is noted that "Somatic symptom disorder" is also inserted into the ICD-11 Beta draft under Synonyms for BDD.
  
  In sum:
  
  ICD-11's proposed BDD is more closely aligned with DSM-5's SSD (Gureje and Reed, 2016).
  
  The term "BDD" is already used interchangeably in the field for the operationalized "BDS" disorder construct [1-4].
  
  That DSM-5's SSD and Fink et al's (2010) BDS are "very different" concepts, with different criteria sets, capturing different patient populations has been acknowledged by SSD work group chair, Joel E Dimsdale, and by Per Fink, Peter Henningsen and Francis Creed [6][7].
  
  The unsoundness of introducing into ICD a new disorder category that proposes to use terminology that is already closely associated with a different (and already operationalized) construct/criteria set and the potential for conflation between the two has yet to be acknowledged or addressed by the sub working group responsible for this recommendation.
  
  The S3DWG's choice of nomenclature needs referral back to the ICD-11 Revision Steering Group (RSG) and Joint Task Force (JTF) for urgent consideration of the implications of this proposed name for disorder integrity.
  
  References:
  
  1 An introduction to "medically unexplained" persistent physical symptoms, Presentation, Professor Trudie Chalder, Department of Psychological Medicine, King’s Health Partners, 2014, Slide #3 http://www.kcl.ac.uk/ioppn/depts/pm...nar-Slides/Seminar-7/Trudie-Chalder-intro.pdf
  
  2 Rief W, Isaac M. The future of somatoform disorders: somatic symptom disorder, bodily distress disorder or functional syndromes? Curr Opin Psychiatry September 2014 - Volume 27 - Issue 5 - p 315–319 Rief W, 2014
  
  3 Ivbijaro G, Goldberg D. Bodily distress syndrome (BDS): the evolution from medically unexplained symptoms (MUS). Ment Health Fam Med. 2013 Jun;10(2):63-4. Ivbijaro G, 2013
  
  4 Fink P, Toft T, Hansen MS, Ornbol E, Olesen F. Symptoms and syndromes of bodily distress: an exploratory study of 978 internal medical, neurological, and primary care patients. Psychosom Med. 2007 Jan;69(1):30-9. Fink P, 2007
  
  5 Fink P, Schröder A. One single diagnosis, bodily distress syndrome, succeeded to capture 10 diagnostic categories of functional somatic syndromes and somatoform disorders. J Psychosom Res. 2010 May;68(5):415-26. Fink P, 2010
  
  6 Medically Unexplained Symptoms, Somatisation and Bodily Distress: Developing Better Clinical Services, Francis Creed, Peter Henningsen, Per Fink (Eds), Cambridge University Press, 2011
  
  7 Francis Creed and Per Fink. Presentations, Research Clinic for Functional Disorders Symposium, Aarhus University Hospital, May 15, 2014.

Edited to add: As much as I would prefer not to see an SSD like concept and criteria set introduced into ICD-11 core edition to replace all the ICD-10 Somatoform disorders under F45.0 (with the exception of F45.2 Hypochondriasis), I do not consider there is very much likelihood of an SSD-like concept and criteria set not being approved by the RSG/JTF.

I therefore focus on the issue of nomenclature and the obtaining of Exclusions.

Note that in order to leave comments on PubMed listed papers, you need to have had a paper or article published in a journal that is listed by PubMed in order to register for an account.

 

[Woolie]

Just looking at the Schroder study again, there is one artefact not talked about that could have at least magnified the apparent benefit of the StreSS treatment:

Patients in the usual care treatment group are more likely to have stopped coming to their doctor if their symptoms improved, whereas this is less likely to have happened in the treatment group (there were fewer dropouts overall in this group). Since drop outs counted as failures, this could have been the cause of the reported decline in scores in the control group, which served to exaggerate the apparent benefit of the treatment.