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I think in the end we sink or swim through good analysis - I think that is what has happened with PACE and why they are finding it harder to be influential. Its hard to even try to have any form of control on twitter and I think one issue is the number of people who want their say - but I was...

Something I don't get is why down weight evidence which is of high risk of bias. This is still considering it and giving it weight even though it is crap and if there is nothing else it starts to look good. Would an approach where we represented evidence in terms of bounds be better where...

Sometimes the equipment doesn't tell them the result that they know is right through 'clinical experience'

If the experts judging are those producing the evidence then that doesn't work. At least if that happens if it isn't a fatal flaw then it is up to the others to give a coherent case as to why the argument is wrong. If they were engineers looking at say a bridge design they would have multiple...

Basically they don't understand what it means to measure something and then how to treat the accuracy of a measurement (which is related to the way measures work and the associated noise). Something engineers learn.

I think the big thing with requiring PEM is the IoM guidelines which came from an independant well respected body as part of their review process.

If he had access to the final docs (with responses and comments) or even read the draft + all the evidence review pieces I suspect that could take quite a few days.

I thought NICE had already redone some stuff in response to some of their spurious claims (and I think that was around criteria and PEM) wasn't that a previous delay. There argument doesn't seem very strong to me and they know the trial evidence is weak and so are relying on assertions that...

I'm not sure he is defending PACE but putting arguments given to him. I wonder if this is a useful article in that it might help us understand the arguments they are making (and they are not strong arguments)

I think it was ignored in some reassessments as a trial arm as its not a real therapy. Perhaps the claim is that it makes PACE more than a trial with a wait list or treatment as usual but APT sets very different expectations and ways to think about symptoms from GET/CBT in their models so it was...

It didn't work for me. I had a couple of goes but the send button didn't work

I suspect something also gets lost in translation as patients probably are saying that it is important to consult them on what outcomes matter and this gets converged into subjective measures. It sounds like bad science in terms of allowing bad outcomes. It is important to listen to patients in...

They said that subjective pain measures were welcomed as patient centered they didn't actually claim patients welcomed them. [edit] It could be researchers who want to use them claiming they are patient centred.

I also think many more people have some background in stats as it comes up in so many different subjects and that helps. For example, my background is as a computer scientist including doing machine learning and some stats modelling (and looking at some cognitive science in that context). Where...

Given his previous article talked about this he may have felt it necessary to mention and I think the way it did helped defuse the argument and hence its use against patients as a whole - the SMC narative is around an undeserving patient group etc.

I seem to remember the IOM report was really important as it came from a highly respected org.

It is interesting to see the confusion but certainty in what he is saying. If he represents a typical doctor then we have real issues.

Particularly in children's clinics where they need support with schools and child protection can be threatened

I think he would have done better to keep quiet I'm more convinced he doesn't have a clue.

If it is an attempt at humour its very poor - but that doesn't surprise me. Perhaps one of the issues of communicating over twitter (although he did write an whole article which really said very little but I'm interpreting it as yes publish the guidelines but doctors should continue doing...