Coyne: Wessely’s muddled views of the good psychotherapy trial: I. Misunderstanding control groups

[Ysabelle-S]

This was posted today:

"Sir Simon Wessely is apparently still hawking cruises on a wrecked ship that can’t be salvaged. I urge refunds.

After a long career, Wessely is in the twilight of his influence and relevance. His tired defense of the design of the PACE trial suggests that he is out of touch with contemporary thinking about psychotherapy trials and risks to their validity. But his still inclined to chastise those who disagree with his assessment of the PACE trial.

I invite readers to read and decide…."

The rest here:

https://jcoynester.wordpress.com/20...rapy-trial-i-misunderstanding-control-groups/

He talks about Julie Rehmeyer's article and Wessely's remarks posted below. Then later says:

"This blog post is the first in a series. I will respond to some of Wessely’s odd pronouncements about evaluating clinical trials and his dismissive defense of the PACE trial."

Near the bottom of the post he says: "In my next blog post, I will take a critical look in a second comment on Julie’s article at Simon Wessely’s endorsement of outcomes switching as an admirable feature of the interpretation of clinical trials."

 

[anciendaze]

When are we going to get to the real meat of the matter: the way PACE was structured it was impossible to show any negative effects of treatment if the authors didn't believe it could have a negative effect.

Was there an increase or decrease in overall activity during or after the trial? We don't know.

Were patients who felt worse after treatment more likely to decline the walk test? We don't know.

Did the change in criteria for adverse responses eliminate evidence of PEM? We don't know.

Was there anything except the authors' opinions behind research on adverse events, even if these involved hospitalization? We don't know.

When you can't answer serious questions like these after carefully studying published results of a study claimed to show safety it is unlikely to be an accident.

Unfortunately, until you show that an intervention could even sometimes result in harm it is always possible to claim random variations as benefits, as happens with anecdotal evidence. These authors will not go away unless such evidence of harm comes to light.

 

[Dolphin]

I agree with James Coyne that CONSORT isn't the be-all-and-end-all. It encourages researchers to report what they have done including any changes they have made but that isn't everything.

It's a bit like how CBT and GET studies can appear successful in evidence-based medicine if you are happy to just go by subjective outcomes in nonblinded trials, where the therapies themselves may influence responses.

Adhering to the tools of evidence-based medicine and good reporting is important but it isn't everything.

 

[Esther12]

Wessely has been handing out quotes that make it easy to show what an arse he is recently.

I feel like it's confused my ability to remember the best of them. There are just too many!

 

[Justin30]

This trial and everything this man has said showcases just how little these authors looked at the physical symptoms themselves:

Heres some examples:

Faciculations why do those all of a sudden happen

Myclonus jerks why do those start to happen

Muscle atrophy and extreme weight loss why does that happen

Nystigmus why is that all of a sudden happening

Why all of sudden cant sleep and the tests show this

Why all of a sudden people cant think

This are just a handful of things that happen and how could you not seeing that the nervouse system has been affected in some way?

It just blows my mind that they even considered these treatments when people are being tormented by symptoms.

 

[Glycon]

Sir Simon, my man Vaas would like to have a word with you. He looks irritated. It is not good to get Vaas irritated.

EDIT: Yes, I posted this before. But it is just such a perfect speech to give to the supporters of PACE.