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BMJ: Reanalysis of PACE trial reignites row over chronic fatigue treatment (September 29)

A.B.

Senior Member
Messages
3,780
Jacqui Wise
Jacqui Wise works as a freelance medical journalist. In this capacity she has been paid, and continues to be paid, by a range of organisations. These include publishers including the BMJ group, the Lancet group, Ocean Media Group, the WHO Bulletin, and others and communications agencies including Interaction PR. She has no stock options or shares in any pharmaceutical or healthcare companies.
 

mfairma

Senior Member
Messages
205
"[White] said that the more conservative thresholds had made a difference to the results. 'However, it made no difference to our conclusion that cognitive behaviour therapy and graded exercise therapy are safe and moderately effective in improving outcomes for chronic fatigue syndrome.'"

How surprising . . .
 

worldbackwards

Senior Member
Messages
2,051
"[White] said that the more conservative thresholds had made a difference to the results. 'However, it made no difference to our conclusion that cognitive behaviour therapy and graded exercise therapy are safe and moderately effective in improving outcomes for chronic fatigue syndrome.'"

How surprising . . .
Everyone dropping dead and being reanimated as flesh eating creatures of the night would make no difference to that conclusion.
 

TiredSam

The wise nematode hibernates
Messages
2,677
Location
Germany
I can't read the article, but the title doesn't bode well - I would have preferred "uncovers truth" to "reignites row", which makes us sound, what's the word ... vexatious?

'However, it made no difference to our conclusion that cognitive behaviour therapy and graded exercise therapy are safe and moderately effective in improving outcomes for chronic fatigue syndrome.'

That's the problem. It should have done. Look up "statistically insignificant".
 

worldbackwards

Senior Member
Messages
2,051
Everyone dropping dead and being reanimated as flesh eating creatures of the night would make no difference to that conclusion.
"At long term follow up, the patients in the CBT and GET arms had formed into packs which hunted down prey in the streets, ripped their heads from their shoulders and feasted on their exposed organs and intestines. The only way in which they could be repelled was with a bullet to the head or a stake driven directly through the heart.

The authors feel that this conclusively proves that the treatments are both safe and effective and fulfil all criteria for recovery as it would be understood by the general population..."
 
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Cheesus

Senior Member
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1,292
Location
UK
I don't understand. Either the patients improved or they didn't. The criteria for recovery shouldn't make a difference to that.

What has happened here that means one person reads the results as an improvement whereas another reads the results as no improvement? What was the difference between the two analyses?
 
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13,774
I don't understand. Either the patients improved or they didn't. The criteria for recovery shouldn't make a difference to that.

What has happened here that means one person reads the results as an improvement whereas another reads the results as no improvement? What was the difference between the two analyses?

CBT/GET were associated with some minor improvement in self-report outcomes that look likely to have been the result of nothing more than bias... these results were then spun to allow researchers to make bold claims about recovery that depended in a very weak definition of 'recovery'.


I can't read the article, but the title doesn't bode well - I would have preferred "uncovers truth" to "reignites row", which makes us sound, what's the word ... vexatious?

or "reveals the BMJ have been talking bullshit".
 

Cheesus

Senior Member
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1,292
Location
UK
CBT/GET were associated with some minor improvement in self-report outcomes that look likely to have been the result of nothing more than bias... these results were then spun to allow researchers to make bold claims about recovery that depended in a very weak definition of 'recovery'.

So the very minor improvements were amplified because of PW's methodology?
 

A.B.

Senior Member
Messages
3,780
So the very minor improvements were amplified because of PW's methodology?

It hasn't been demonstrated that there really was improvement. The minor improvement on questionnaires probably reflects a transient placebo effect (no diff. between groups at followup).

The walking test shows no clinically significant improvement but about 25% of patients (30% in GET group) didn't actually do this test at 52 weeks, and they would probably have brought these results down further because worse health is a likely explanation for refusing this test.

PACE is even worse than what the reanalysis shows. This is important to keep in mind.
 

Cheesus

Senior Member
Messages
1,292
Location
UK
Along with other problems too. Going through the specific criteria used is probably the best way of understanding things. I can't think what the best summary is now. Maybe parts 1-3 of Tuller's work?

Thanks i will check it out.
 

A.B.

Senior Member
Messages
3,780
White et. al. feel justified in claiming the treatment works because transient improvement on questionnaires seems to be accepted as evidence of an effective treatment in this branch of psychiatry. It's bad science though.
 

Cheesus

Senior Member
Messages
1,292
Location
UK
White et. al. feel justified in claiming the treatment works because transient improvement on questionnaires seems to be accepted as evidence of an effective treatment in this branch of psychiatry. It's bad science though.

Speaking of bad science, I wish Ben Goldacre would have some input, but having just searched his name on the forum I see he is chums with Wessley.
 

IreneF

Senior Member
Messages
1,552
Location
San Francisco
One of the hallmarks of a "placebo effect" is that patients say they feel better in some way, but objective tests reveal no improvement. Placebo seems to work solely on a subjective level. You might think, "what's the harm," but "feeling better" can actually be detrimental:
https://www.nih.gov/news-events/nih...bo-improves-asthma-symptoms-not-lung-function

Because people respond to attention, one way to encourage a positive outcome is to pay lots of attention to study subjects and rely on questionnaires instead of tests of physical function. See the Hawthorne effect for an example of how people respond:
https://en.m.wikipedia.org/wiki/Hawthorne_effect

Of course, if you define the condition under study as psychological, "feeling better" becomes a desirable outcome.