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Problems caused when non-pharmacological interventions don't live up to their hype

Discussion in 'Other Health News and Research' started by Dolphin, Feb 6, 2015.

  1. Dolphin

    Dolphin Senior Member

    This is from:
    I thought that similar issues could arise with non-pharmacological interventions being claimed to be curative in ME/CFS and the effect this might have on people who weren't cured.

    The rest of the piece discusses a meta-analysis. I found it informative as I like to read/learn about research methodology but may be too academic for many people's tastes.
    Cheshire, Sean, Woolie and 9 others like this.
  2. Roy S

    Roy S former DC ME/CFS lobbyist

    Illinois, USA
    funny --
    "I surveyed the positive psychology literature to get some preliminary impressions, forcing myself to read the Journal of Positive Psychology and even the Journal of Happiness Studies. I sometimes had to take breaks and go see dark movies as an antidote, such as A Most Wanted Man and The Drop, both of which I heartily recommend."
    and one of the comments --
    "James, I put your idea about ignoring unwelcome ideas and data to the test and posted your (and Linda Bolier’s) conclusion in two linkedIn groups about positive psychology. I must admit that it was the first time that such a post did not spark one comment…"
  3. Woolie

    Woolie Senior Member

    Interesting. James Coyne is one of a few voices who is calling for higher quality and reporting standards in psychotherapeutic/behavioural research. This has enormous relevance to studies of CBT/GET interventions in ME/CFS.

    Here are some of his comments from another recent blog:

    ".... As it now stands, the psychotherapy literature does not provide a dependable guide to policy makers, clinicians, and consumers attempting to assess the relative costs and benefits of choosing a particular therapy over others. If such stakeholders uncritically depend upon the psychotherapy literature to evaluate the evidence-supported status of treatments, they will be confused or misled.

    Psychotherapy research is scandalously bad.

    "Many RCTs are underpowered, yet consistently obtain positive results by redefining the primary outcomes after results are known. The typical RCT is a small, methodologically flawed study conducted by investigators with strong allegiances to one of the treatments being evaluated. Which treatment is preferred by investigators is a better predictor of the outcome of the trial than the specific treatment being evaluated.

    "Many positive findings are created by spinning a combination of confirmatory bias, flexible rules of design, data analysis and reporting and significance chasing. Many studies considered positive, including those that become highly cited, are basically null trials for which results for the primary outcome are ignored, and post-hoc analysis of secondary outcomes and subgroup analyses are emphasized.

    "The bulk of psychotherapy RCTs involve comparisons between a single active treatment and an inactive or neutral control group such as wait list, no treatment, or “routine care” which is typically left undefined but in which exposure to treatment of adequate quality and intensity is not assured. At best these studies can tell us whether a treatment is better than doing nothing at all or than patients expecting treatment because they have enrolled in a trial and not getting it (nocebo).

    Designations of Treatments as Evidence-Supported

    "There are low thresholds for professional groups such as the American Psychological Association Division 12 or governmental organizations such as the US Substance Abuse and Mental Health Services Administration (SAMHSA) declaring treatments to be “evidence-supported.” Seldom are any treatments deemed ineffective or harmful by these groups."

    "Departures from preregistered protocols in published reports of RCTs are common, and there is little checking of discrepancies in abstracts from results that were actually obtained or promised in preregistration by authors. There is inconsistent and incomplete adherence to these requirements. There is little likelihood that noncompliant authors will held accountable and a high incentive to report positive findings.."

    Does that remind anyone of a particularly high profile behavioural intervention study of ME/CFS?
    Valentijn, Bob, Sean and 4 others like this.
  4. Woolie

    Woolie Senior Member

    And on a lighter note, this is a hilarious parody of the usual "Courageous in the battle against illness" media story:


    Loved Ones Recall Local Man's Cowardly Battle With Cancer

    "On Jan. 26, just four days after visiting the doctor for what he thought was severe indigestion or maybe an ulcer, Russ Kunkel got the dreaded news: A malignant, fist-sized tumor had metastasized between his stomach and liver. It was cancer. Right then and there, faced with the prospect of a life-threatening disease, the 34-year-old Florissant, MO, husband and father of three drew a deep breath and made a firm resolution to himself: I am not going to fight this. I am a dead man.

    "On Feb. 20, less than a month after he was first diagnosed, Kunkel died following a brief, cowardly battle with stomach cancer.

    "Most people, when they find out they've got something terrible like this, dig deep down inside and tap into some tremendous well of courage and strength they never knew they had," said Judith Kunkel, Russ' wife of 11 years. "Not Russ. The moment he found out he had cancer, he curled up into a fetal ball and sobbed uncontrollably for three straight weeks.
    ... " (click link above for more)

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