Generally psychogenic criteria have major failings, which in part is unique to psychogenic medicine, and in part is related to psychiatry in general.
Psychiatric diagnoses, such as those in the DSM, have no validated scientific basis.
They are not science. I have been looking into this for the last two years, and I have a long long way to go, but essentially all psychiatric diagnoses used in the DSM are derived by a consensus process. They use the existing evidence base. Hmmmmm...... what does that tell us?
Psychogenic medicine has been resoundingly criticized since at least 1922, and I think it goes back to the 19th century though I lack documentation on this. It has defied all evidence and reason though, and operates more like a cult than science. Either you are a believer or you are not. This why it has been variously called nonscience, pseudoscience and psychobabble. It runs afoul of multiple logical fallacies, and it is planned to be a big part of my book writing about this, though that is not expected to be done in the medium term but the long term. My best guess is I am still a full decade from completing that, though I was hoping to get some version out in maybe 2015 or so, but this is now on indefinite hold until I get more cognitive capacity back.
Essentially the Gold Standard is the benchmark in treatment. It is the prior but existing best treatment. In other words, its what EBM has determined to be the best in the past. Now its often used to rubber stamp the current favoured treatment, even if that is not evidence based.
In theory EBM should take into account methodology etc in rating papers. Often this does not happen, especially in psychiatry. The Cochrane review on CBT/GET for CFS did not look at flaws in the methodology. They mainly focused on amalgating data and trying to get more reliable results .In other words, its post processing without validating the input. Its often presumed that peer reviewed published papers are acceptable, just statistically unreliable due to size and bias. To some extent its presumed bias is study by study specific. They do not take into account systemic bias in the whole field of study.
Now a review committee, which is what the IOM panel will be, do not have time, resources or mandate to tease the various studies apart, come to conclusions, then run trials testing their conclusions. They will instead have to take studies on face value. There is simply not the time or resources to do otherwise. There is too much material to cover, and too many entrenched problems in psychiatry and psychogenic psychiatry in particular.
The IOM process is not scientifically validated, just as EBM is not. In doing something like creating evidence based definitions on problematic areas with limited research, I think they should have focused on doing maybe a decade worth of well funded research on how to best do such diagnostic criteria. Instead we face them leaping in and learning on the job. They already stuffed up GWI, sorry I mean CMI. No, actually, I don't.
So the IOM is an attempt to use a consensus process (not science) to create a definition that will not be extensively tested before they pass it out to the public. Of course they will argue that is all Holmes, Fukuda, CCC and ICC are. That is another argument for another post.
I guess we could argue they have to look at the quality of the definition since they think the redefinition of ME is so important, you can only look at EBM to inform it, then you clearly need to look at whether the definitions used in the studies you are considering were themselves formed on the basis of good evidence. And obviously, common sense dictates that the case definition is the foundation of the study and if the definition is invalid, the study is invalid regardless of whether it was a RCT or not.
This is what
should happen. Its not what I am so far seeing in EBM. If this approach were taken to any part of psycho-psychiatry, it would all be dismissed as low grade evidence.
Which brings up another point. EBM does not made final conclusions.
It rates evidence. It amalgamates evidence. It translates scientific evidence, and I would argue nonscientific evidence, into clinical practice, by making
recommendations. So evidence can be upgraded or downgraded based on assessment of strength, risk, outcomes etc. Once this gets transitioned into medical management however, the tentative medical conclusions often become management dogma. Insurance companies often use EBM results to determine what is and what is not allowed.
The more I think about it, the more I think this article will take years to write to an academic standard. Its not simple, and there are large numbers of papers to take into account. I am working on this anyway, but super slowly, and I will release more detailed and referenced articles when I am able, as stepping stones to something with more careful analysis and investigation.
More in part 3 soon. I hope. I need a break for a few hours, and some more sleep.