Dr David Tuller: Professor Chalder’s PRINCE Has Arrived

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https://www.virology.ws/2020/10/14/...ElBxUddK_WEHtauBd3oPZ5PXiD5p4fRlsmMayEbGGLq8I

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Trial By Error: Professor Chalder’s PRINCE Has Arrived
14 OCTOBER 2020

By David Tuller, DrPH

*October is crowdfunding month at Berkeley. I conduct this project as a senior fellow in public health and journalism and the university’s Center for Global Public Health. If you would like to support the project, here’s the place: https://crowdfund.berkeley.edu/project/22602
So here’s yet another paper with Professor Trudie Chalder of King’s College London as the senior author. That usually means there’s a lot to dig into! In this case, the journal is BMC Family Practice and the paper is titled “Integrated GP care for patients with persistent physical symptoms: feasibility cluster randomized trial.” Professor Chalder’s co-investigators include her KCL colleague, Professor Rona Ross-Morris, and other leading members of the biopsychosocial ideological brigades.

The study is part of this group’s larger project to promote their favorite psycho-behavioral interventions for the category of conditions they refer to as “persistent physical symptoms” (PPS) or “medically unexplained symptoms” (MUS). That would all be fine if their science could withstand serious scrutiny. But most of it is based on unproven hypotheses and relies on tarting up unimpressive results to look better than they are.
These investigators are also prone to embarrassing mistakes—as happened in the first paragraph of the published protocol for this feasibility study. In that first paragraph, the investigators mis-cited a seminal study that sought to calculate the cost to the National Health Service of treating patients with MUS. The effect of the mistake was to more than triple this apparent cost—which bolstered their claim that addressing the issue would lead to NHS savings.

The published protocol now carries a prominent correction.
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A 90-Minute Training Session

The new study, dubbed PRINCE Primary, is premised on the notion that GPs can learn in a 90-minute session how to redirect the cognitive processes of patients with PPS. For the study, 18 GP practices, each including multiple physicians, were randomized to receive the training or not—eight received it, and ten did not. Patients registered with the practices receiving the training were given resources, like self-help materials, that presented information about the development and treatment of PPS, per the notions of the investigators. In addition to the intervention, the patients in these practices received standard treatment, known as “treatment as usual.” The patients in the other practices were offered only treatment as usual.

The underlying hypothesis is essentially the same hypothesis underlying the approach of the ideological brigades to conditions with no identified organic etiology, including irritable bowel syndrome, ME/CFS, and others. As usual, the investigators trot out their triple-P schema of “predisposing,” “precipitating,” and “perpetuating” factors for these chronic illnesses, with perpetuating factors including such constructs as fear of engaging in activity and an excessive focus on symptoms. Per the hypothesis, changing those cognitions and/or behaviors will help patients find a path toward resumption of normal activities.

In this paper, the investigators once again base their argument on the prevalence of PPS. Here is their first paragraph:

Medically unexplained symptoms (MUS), otherwise referred to as persistent physical symptoms (PPS), cannot be explained by organic pathology after medical examinations. The prevalence of PPS in primary care is high, ranging between approximately 11 and 65%.

Let’s stop right there. The first sentence demonstrates the unproven assumptions driving this field of research. The fact is that patients relegated to these categories have conditions that have not been explained to date by organic pathology after medical examination by one or more clinicians. To say they “cannot be explained” by such pathology implies that no organic explanation exists and that those who conducted the medical examinations knew enough to exhaust all possibilities.