IMEG (UK) Report on Infectious diseases & sequelae in recent deployed service with focus on CFS(PDW)

[Dolphin]

Peter Denton White was part of a small committee involved with this report it seems.

There is no mention of the employment outcome measures from the PACE Trial which cost £5m of UK taxpayers' money, yet the subjective outcomes are mentioned.

https://www.gov.uk/government/uploa...fectious-diseases-imeg-20-Sept_2013-clean.pdf

27 September 2013

IMEG Report on Infectious diseases and sequelae in recent deployed service

1. Following several claims for deployment related febrile illness and their sequelae, IMEG was asked by Minister to investigate and report on the AFCS approach to these disorders, with a particular focus on Q fever and post Q fever fatigue syndrome (QFS).

This short report was informed by literature search and discussion with relevant military and civilian experts.

[..]

14. A variety of treatments ranging from steroids to anti-infective treatment has been provided for fatiguing illness following infection. In general, for all types of persistent fatigue state, optimal management is based on: i) accurate diagnosis of all disorders including co-morbid sleep problems, depression and pain; ii) treatment of co-morbid conditions; iii) focus on the fatiguing illness with active rehabilitation.

Research findings show that individually (not group) delivered Cognitive Behavioural Therapy (CBT) and Graded Exercise Therapy ( GET) as compared to specialist medical care alone are moderately effective (effect sizes 0.5 to 0.8) when added to specialist medical care and delivered in courses of suitable intensity and duration by well qualified and trained therapists (14).

15. The published literature on the natural course, duration, prognosis and effective interventions for fatiguing illness of all types is limited.

Disability, functional outcomes and employability have not been a major focus of studies and comparison of studies and interpretation is hindered by different case definitions and whether patients are drawn from primary or specialist care settings, the latter usually being the more severe cases. The prognosis for patients receiving specialist care for persisting fatiguing illness (spontaneous and post infective) without specific treatment is poor.

A 2005 meta-analysis of 14 studies, of sample sizes between 20 to 3201, with defined entry criteria, published between 1991 and 2002 and followed for between 5 and 10 years showed untreated, a median full recovery rate of 5% (with a range across the studies of 0-31%) while there was symptomatic improvement at follow-up in a median of 39.5% cases ( range 8-63%).

Better outcomes were associated with less severe fatigue at the onset, patients having a sense of control over symptoms and not attributing illness to a physical cause (15).

 

[Dolphin]

Here's some information somebody posted on a mailing list when posting the info. The point of this, the person who posted this said to me, was after the PACE Trial, the ethics committee decided investigators should have to declare competing interests (such as the work Peter White does for government agencies and insurance companies) in the participant information sheet.

http://www.hra.nhs.uk/about-the-hra...y-groups/nreap-guidance/#sthash.nrxudAXc.dpuf

http://www.hra.nhs.uk/documents/201...ch-ethics-advisors-panel-13-february-2012.pdf

NATIONAL RESEARCH ETHICS ADVISORS’ PANEL

Guidelines 13/02/2012

Conflict of Interests/Competing Interest

What proposals could a REC make?

The following steps might be taken in order to mitigate the competing interest (N.B. these measures should be applied in a proportionate manner in accordance with the seriousness of the competing interest ):


The investigator's financial interests/ other competing interests should be publically declared and described in the participant information sheet

Independent (or shared) management of the research. Responsibility for participant recruitment and enrolment, the informed- consent process, analysis of the study data, and the subsequent reporting to the sponsor could be devolved to an independent third party

Independent (or shared) monitoring of the research

Encourage researchers to make their research datasets publically available to allow independent validation of results

Where the source of the researcher‘s competing interests derives solely from their relationship with a particular research site then consideration might be given to changing the research site(s) involved the study

Divestiture of significant financial interests

Ending of relationships that create actual or potential conflicts

Disqualification of the researcher from part, or all, of the research project

https://www.gov.uk/government/people/peter-white

Professor Peter White BSc, MBBS, MD, FRCP, FRCPsych, OBE

https://www.gov.uk/government/organisations/independent-medical-expert-group/about/membership

Membership

Chairman of IMEG

Prof Sir Anthony Newman Taylor

Medical members

Professor Linda Luxon

Emeritus Professor of Audiological Medicine at the University College of London, Honorary Consultant Audiological Physician at Great Ormond Street Hospital and Consultant Physician in Neuro-otology at the National Hospital for Neurology and Neurosurgery.

Professor James Ryan

Emeritus Professor in Conflict Recovery at St George’s University of London and erstwhile Professor of Military Surgery at the Royal Army Medical College.

Dr John Scadding

Honorary Consultant Neurologist at the National Hospital for Neurology and Neurosurgery.

Dr David Snashall

Professor of Occupational Medicine at King’s College London and Clinical Director of the Department of Occupational Health and Safety at Guy’s & St Thomas’s NHS Foundation Trust.

Professor Peter White

Professor of Psychological Medicine at Queen Mary University London and Honorary Consultant in Liaison Psychiatry at St Bartholomew’s Hospital.

Lay member

Lt Col (Retd) Jerome Church MBE
Ex officio members

Representative of the Armed Services (Colonel John Ridge)
Chief of Defence Personnel Medical Adviser (Dr Anne Braidwood)
Injured serving person (Maj Steve McCulley RM)

Observer

HQ Surgeon General (Brig Hugh Williamson)


Independent Medical Expert Group

What we do

The Independent Medical Expert Group advises the Minister for Defence Personnel, Welfare and Veterans on medical and scientific aspects of Armed Forces Compensation Scheme (AFCS) and related matters.

IMEG is an advisory non-departmental public body, sponsored by the Ministry of Defence.

IMEG Secretariat

06.M.06
MOD Main Building
Whitehall
London
SW1A 2HB

 

[biophile]

Research findings show that individually (not group) delivered Cognitive Behavioural Therapy (CBT) and Graded Exercise Therapy ( GET) as compared to specialist medical care alone are moderately effective (effect sizes 0.5 to 0.8) when added to specialist medical care and delivered in courses of suitable intensity and duration by well qualified and trained therapists (14).

This looks like cherry picking from individual studies?

The meta-analysis by Castell et al (2011) which included the mighty PACE Trial:

GET (n = 5) and CBT (n = 16) randomized controlled trials were meta-analyzed. Overall effect sizes suggested that GET (g = 0.28) and CBT (g = 0.33) were equally efficacious.

http://onlinelibrary.wiley.com/doi/10.1111/j.1468-2850.2011.01262.x/abstract

A 2005 meta-analysis of 14 studies, of sample sizes between 20 to 3201, with defined entry criteria, published between 1991 and 2002 and followed for between 5 and 10 years showed untreated, a median full recovery rate of 5% (with a range across the studies of 0-31%) while there was symptomatic improvement at follow-up in a median of 39.5% cases ( range 8-63%).

And what would the full recovery rate be if the original definition of such was used in the PACE Trial?