I have slammed a recent Dutch study, Kuut et al, that investigated CBT for fatigue after an acute bout of COVID-19. The study, “Efficacy of Cognitive-Behavioral Therapy Targeting Severe Fatigue Following Coronavirus Disease 2019: Results of a Randomized Controlled Trial,” nicknamed ReCOVer, was published in Clinical Infectious Diseases, a well-regarded journal, and proclaimed itself a success. The intervention, called Fit after COVID, was based on the premise that dysfunctional beliefs about illness and problematic behavior—that is, remaining sedentary because of a purportedly irrational fear of activity and related cognitions—prevent patients from getting better. (I have written about this study here, here, and here.)
Among other flaws, the unblinded study relied solely on subjective outcomes for its claims that CBT is efficacious—a set-up guaranteed to generate an unknown amount of response bias. In a disturbing omission, the study did not mention that the one objective measure—how much people moved, as assessed by actigraphy—yielded null results. In my view, this disturbing omission is a clear example of research misconduct, and arguably qualifies the study as fraudulent. All standard ethics guidelines include provisions barring researchers from withholding salient data that would undermine the reported conclusions.
Such provisions are obviously relevant to this case. Yet the investigators advanced ridiculous justifications for their problematic decision—what I referred to in a previous post as “dog-ate-my-date” excuses. The most laughable was the argument that levels of physical activity are completely unrelated to fatigue. Huh?? As I previously reported, this self-serving argument has been contradicted in previous research by none other than Professor Hans Knoop, the senior author of Kuut et al. It is astonishing that leading investigators would stoop to this level of double-talk—or it would be astonishing if Professor Knoop and his colleagues hadn’t pulled similar stunts in previous research.
I engaged in a spirited exchange on this issue with Professor Chantal Rovers, a physician and infectious disease expert as well as a co-author of the study, on X, the social media platform formerly known as Twitter. I wrote that the arguments in support of witchcraft in Arthur Miller’s classic The Crucible, which I’d just seen in a terrific London production, were more convincing than the explanations offered for the decision to not include the null objective findings in the paper. (I don’t think she appreciated that comparison.)
