2025: The 2019/24 Cochrane Larun review Exercise Therapy for CFS - including IAG, campaign, petition, comments and articles

But the reason the data cannot be trusted is a mater of human nature - expectation bias.
For robots or Vulcans like Mr Spock from Star Trek you wouldn't need blinded trials.

Statisticians tend to miss that point!

 

That would be mine too.

 

Sure, but if people don't have common sense there is no point in trying to replace it with rules created by eminent people. The rules will always be misinterpreted and distorted, even if they were any good to start with. rule like GRADE and RoB2 are hopelessly flawed.

So there isn't an awful lot of point in further training. You have to rely on someone with common sense at some point pointing out that the method of a particular trial will not do.

 

Judging from comments made by physicians about this problem, it seems that there is a widespread acceptance for lower standards in clinical psychology simply because it can't meet those standards and therefore they would not be able to do the bulk of their work, which is to run clinical studies.

As in, yes, everyone in medicine agrees that this is the case for drug trials and serious procedures about 'real' problems, but since clinical psychology trials can't possibly meet those standards then they simply shouldn't bother. Thus follows Cochrane's business model, which is to take such studies and give them a few rounds of numerical waterboarding, assigning fake numbers to arbitrary shapes, and make this all appear to be just as reliable as drug trials.

It's because of the exemptions. Everyone understands those problems, it's simply accepted that it must be exempted here because it would invalidate almost everything in evidence-based medicine. Not because it has to, but because of decades of accepting garbage standards leaves no other choice. Specifically it would invalidate the top of the absurd pyramid of evidence, systematic reviews and clinical trials, even though the whole thing is several kilometers underground compared to literally all other professional standards. As you said, no other profession even looks at garbage evidence like this, let alone makes use of it.

But here it's all they have and it has been used to influence hundreds of millions of lives. It warrants closing the whole thing down, but it just runs into a wall of embarrassment that the industry isn't ready to jump over yet. Possibly never, not voluntarily anyway.

 

A bad negotiation tactic too.
To set the bar so low.

 

That seems very backwards to me. I might be too foggy to understand this now, but I still don’t get it.

If you have a group of people with CF, and you don’t know if they have PEM or not, how can the results be generalized to everyone with PEM? You can’t prove that anyone had PEM, and you can’t check how that subset in particular responded.

PACE might have accounted for PEM (I have not spent energy on reading it), but many GET/CBT studies don’t.

To take it to the extreme: Say you do a study on humans, monkeys, pigs, and rats, but you don’t write down the species. So you don’t know how many humans that was involved, if any.

Based on that study, surely you can’t say anything in general about humans?

I understand that if humans were involved, and they responded differently than the other animals, then that will be reflected in the CI, etc. But what if they were not involved? That’s what I’m stuck on.

 

Alignment of interests doesn't require any conspiracy. They genuinely think it's fine. They don't look.

It isn't much different from a market crash, where if everyone behaved differently it could be avoided. People just follow the flow.

 

Yes, we hear that all the time, but it is a contradiction. You only need rules if you don't understand how to work out if something is reliable yourself. If you don't you won't know when the rules are not appropriate to a situation in the way they might seem. You can only achieve the best answer by understanding the problems yourself.

My students were always encouraged to think for themselves right from the start. My trainees were told not to use rules but to understand what the problem is. I agree that this may not be what happens elsewhere but there is never a justification for following rules provided by eminences in science.

 

I’m not a native english speaker. Could someone explain “reverse ferreting for your life”?

 

I agree, but I strongly suspect that the difficulty in meeting standards is almost entirely a reflection of the fact that the treatments don't work.

If psychotherapy really worked there would also be a replicable dose response effect. It might be that benefit rose sharply going from 3 to 4 to 5 sessions but by ten the effect was a plateau. With drugs you see that clear as day. If CBT worked you would see it clear as day. So you could assess efficacy using a dose response study, which would almost entirely remove the problem of expectation bias because nobody would have any specific expectations for the optimum dose.

 

I think we can go a level deeper: Cochrane is them, and they are Cochrane.

Cochrane has a non-pharmaceutical fetish. This is the most fertile land for psychobehavioral woowoo.

 

I am sorry about that but this is basic probability theory applied to sets. I have been through all the relevant arguments. I may not have expressed them well but as far as I am aware they are what they are.

Because they all have CF and if you found a property of the CF set then the highest probability is that it will apply to subsets with PEM.

Yes, but none of the other studies even begin to figure in terms of reliable evidence. PACE was the only study that NICE even had to deliberate over because nothing else scored the minimum. The same should have applied to the Cochrane review.

 

You can say that the most likely interpretation is that the result applies to humans as much as rats or monkeys and if it applies to humans it applies in general to them.

If you are not going to go with the most likely you need to have evidence to support there being a reason for a differential.

 

https://en.wikipedia.org/wiki/Reverse_ferret

I had never heard of it.

 

A ferret is a small mammalian carnivore and it goes after its prey with an extreme ferocity.


Maximum back pedalling
Because TG has been pretty cosy with them lot and pretty frosty with us lot to put it mildly.

 

An editor once kindly pointed out to me when I used this term that I meant

Back pedalling
not
Back peddling
!

 

I’m gonna have to rectify this unfortunate typo immediately…


Update: I did it with great difficulty because every time I spoke the word it wrote peddling again….Whats going on?

 

I am a native speaker but was embarrassed to ask! I'm looking forward to an explanation of it, though, because I really like it, whatever it means, and intend to add it to my vocabulary.

 

It's called a spellf**ker.