A systematic literature review of randomized controlled trials evaluating prognosis following treatment for adults with CFS, 2022, Chalder

T

Tom Kindlon

Senior Member (Voting Rights)
Forthcoming
https://kclpure.kcl.ac.uk/portal/en...me(bbffadae-b24f-4ef4-8739-c3fdbc036429).html

A systematic literature review of randomized controlled trials evaluating prognosis following treatment for adults with chronic fatigue syndrome


Tom Ingman, Abigail Smakowski, Kimberley Goldsmith, Trudie Chalder
https://kclpure.kcl.ac.uk/portal/trudie.chalder.html
Original language English
Journal Psychological medicine
Accepted/In press 18 Jul 2022
King's Authors
Abstract
This systematic review investigated randomized controlled trials evaluating cognitive behavior therapy (CBT) and graded exercise therapy (GET) for adults with chronic fatigue syndrome (CFS). The objective was to determine prognosis following treatment. Studies were eligible if they were peer-reviewed and investigated treatment at least 12 weeks in duration. Studies were excluded if they used co-morbid diagnoses as entry criteria or if they did not measure fatigue, disability, or functioning. Literature published between 1988 and 2021 was searched for using MEDLINE, EMBASE, PsycINFO, and Web of Science. Study quality was assessed using the Effective Public Health Practice Project assessment tool. Outcomes were synthesized when three or more studies reported outcomes obtained from the same validated measurement tool. The review included 15 publications comprising 1,990 participants. Following CBT, and at short to medium-term follow-up, 44% considered themselves better and 11% considered themselves worse. Following GET, and at post-treatment to short-term follow-up, 43% considered themselves better and 14% considered themselves worse. These outcomes were 8-26% more favorable compared to control conditions. Two thirds of studies were of moderate quality and the remainder were of weak quality. Limitations of this review relate to the clinical heterogeneity of studies and that most outcomes were self-reported. Results suggest some support for the positive effects of CBT and GET at short to medium-term follow-up although this requires further investigation given the inconsistent findings of previous reviews. Findings may not be generalizable to severe CFS. This review was registered with PROSPERO (CRD42018086002) and did not receive funding.


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This appears to have been done by a research student supervised by Chalder. He's decribed as Mr Tom Ingman, former student. It looks like this article was completed back in October 2019, so it seems to have taken a long time to find a journal stupid enough to publish it.

The thing that shouts out to me, (apart from the whole garbage in garbage out nature of the data used), is the use of the word 'prognosis' in the title of the article.

Definition - Prognosis: The forecast of the probable outcome or course of a disease; the patient's chance of 'recovery'.
Examples given include the 5 year cancer survival prognosis.

In this case he looked at data for 'at least 12 weeks', and only looked at subjective outcome measures, even though he could have looked at the objective outcomes for PACE.

This is not research, it's marketing. Cherry pick the data that suits your prejudices and product, exaggerate by misusing terms like 'prognosis' for short term subjective feedback, and avoid comparison with alternative 'products'. And avoid mention of large scale customer surveys that show your product is harmful.
 
I was referred to Dr Chalder in Autumn 2020 and throughout the entire 1 hour interview she never asked about my symptoms, the entire thing was attempting to find some childhood trauma that was responsible for my illness. I had wised up by this point and already knew what ME/CFS was after my GP had exercised me into severe condition. Suffice to say everything people say about this person is spot on accurate, she is dangerous to ME/CFS patients and should never receive NHS money.
 
Trish said:
This appears to have been done by a research student supervised by Chalder. He's decribed as Mr Tom Ingman, former student. It looks like this article was completed back in October 2019, so it seems to have taken a long time to find a journal stupid enough to publish it.

The thing that shouts out to me, (apart from the whole garbage in garbage out nature of the data used), is the use of the word 'prognosis' in the title of the article.

Definition - Prognosis: The forecast of the probable outcome or course of a disease; the patient's chance of 'recovery'.
Examples given include the 5 year cancer survival prognosis.

In this case he looked at data for 'at least 12 weeks', and only looked at subjective outcome measures, even though he could have looked at the objective outcomes for PACE.

This is not research, it's marketing. Cherry pick the data that suits your prejudices and product, exaggerate by misusing terms like 'prognosis' for short term subjective feedback, and avoid comparison with alternative 'products'. And avoid mention of large scale customer surveys that show your product is harmful.
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In most areas it also isn't marketing anymore - CMA guidelines would require them to evidence and be able to reference any claims made (and so they would have to be in pretty specific to what the data actually tested words)
 
https://www.virology.ws/2022/08/09/...-discredited-cbt-get-deconditioning-paradigm/

Glad they got around to King's and Chalder. Will be interesting to see how this plays out since Chalder has been in open revolt on the new guidelines since she signed the open letter to NICE rejecting them. I can't imagine like the other departments she accepts this willingly so I expect some fireworks. They ought to fire her and any who refuse to comply with the guidance, just due to the cost in negligence payouts they will have to make if she carries on hurting people knowingly and intentionally.
 
Aside from the absurdity of Chalder being involved in essentially grading several of her own homework, what's the reason for this review only including 15 trials when there are hundreds, over 300+ in the NICE guidelines evaluation? Especially as it seems like they used looser criteria, Oxford only is OK, so there should be even more than that.

And then there's stuff like this:
Studies were excluded if they: (1) included participants <18 years old; (2) used idiopathic chronic fatigue
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2) is Oxford criteria. So they included Oxford, but also excluded it. Good stuff.

Because this one went wide, from 1988 to 2021. And they selected 15.
Study quality and risk of bias said:
Study quality was assessed using the Effective Public Health Practice Project (EPHPP) quality assessment tool for quantitative studies
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Not, uh, can't remember the name for the Cochrane thingy. Anyway they're not using it.
Description of included studies said:
After removing duplicates, 3817 studies were identified. After screening, 3767 (99%) were excluded, resulting in 50 full texts. Reasons for exclusion and references to excluded studies can be found in online Supplementary eAppendix 3. Reviewing full texts led to further exclusion of 35 studies, resulting in 15 included publications.
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Reading appendix 3 does not explain how 3767 were excluded. Only the 35 mentioned are excluded for various reasons that seem arbitrary. And there's this:
One study was excluded as it did not report original data (Wilshire, Kindlon, Matthees, & McGrath, 2017).
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The data being held is of course the PACE data, which Chalder is involved in keeping secret. Which is obviously absurd as they have access to the data and PACE did not report its original data.

They seem to report the various PACE papers as different studies, so several of the 15 are actually PACE. They seem to be using the PACE results as originally published with the downgraded protocol, having excluded the reanalysis study. Says "20% recovered".

Basically a joke compared to the exhaustive process NICE went through. The only conclusion is that evidence-based medicine is a terrible, terrible, truly awful process that yields no useful information.

Because from this mediocrity derives the idea that it "proves" that "chronic fatigue" is a psychological disorder. Millions of lives ruined for this. Truly awful.

Also:
Ethical standards said:
The authors assert that all procedures contributing to this work comply with the ethical standards of the relevant national and institutional committees on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008.
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Ethical whitewashing. PACE did not comply with Helsinki. There is nothing to report to participants in a systematic review since there are no participants involved.
 
Trial By Error: Another CBT/GET Marketing Document Masquerading as Research from Professor Chalder

It’s another month, and here’s another worthless paper from Trudie Chalder, King’s College London’s factually and statistically challenged professor of cognitive behavior therapy (CBT). In her desperate effort to prove that the treatment paradigm for ME/CFS combining CBT and graded exercise therapy (GET) is evidence-based, she has now published a paper called “A systematic review of randomized controlled trials evaluating prognosis following treatment for adults with chronic fatigue syndrome.”
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https://www.virology.ws/2022/09/07/...querading-as-research-from-professor-chalder/

eta:
Chalder and her colleagues acknowledge the reliance on subjective outcomes as a limitation that “may have increased the risk of observer or detection bias.” In response, they recommend that “future trials should obtain a range of outcome measures and investigate potential discrepancies between them” and “should report objective outcomes, in addition to self-report measures.”

It is ironic and hypocritical–laughable, really–that Professor Chalder should raise these points. The PACE trial included four different objective outcomes—a 6-minute walking test, a step-test for fitness, employment status, and whether or not the participant was receiving social benefits. All four failed to match the positive reports of success. Yet rather than “investigate potential discrepancies” between their own objective and subjective outcomes, the PACE team dismissed the objectivity of their failed objective measures.
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Just noting here that despite cherry-picking a small fraction of the studies published in a span of 34 years, they still say that it's promising. Even though it technically dates back even further than that, this belief system dates back to the 19th freaking century.

Nothing can have existed for 34 years and be "promising". Even for a human, 34 is past the point at which if someone is still a screw-up with nothing to show for it then that's all there is. It's literally the current standard, used everywhere in LC without even bothering to test anything on the back of this mediocre nonsense, but also it's "promising" and needs more research.

It's the complete lack of oversight and accountability that breaks this discipline. They seem fully content with mediocrity, with absolute failure even. Nothing can actually improve in those conditions, where something becomes immovable simply by being popular enough that no one actually cares whether it's any good.
 
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Trial By Error: My Letter to Psych Medicine About Professor Chalder’s Flawed Systematic Review

"Earlier this week, I wrote about the bogus systematic review of treatment trials for “chronic fatigue syndrome” published this month by Professor Trudie Chalder in Psychological Medicine. In many respects, as I noted, this journal functions a an in-house marketing or public relations organ for members of the CBT/GET ideological brigades, of which Professor Chalder is a charter member. (Professors Michael Sharpe and Simon Wessely are on the Psychological Medicine editorial board. Enough said.)

In addition to formally submitting the article through the journal’s online portal, I also posted it on a pre-print server and sent it directly to the two co-editors of the journal. Here it is."

https://www.virology.ws/2022/09/09/...-professor-chalders-flawed-systematic-review/
 
Thank you @dave30th. So sad that years on from when you started helping us with your articles and letters that this sort of junk by Chalder is still being published. I'm grateful you haven't given up. I just wish Chalder et al would give up and go away. They should be ashamed of publishing this travesty of research.
 
Honestly, they only need to take one look at what happened with Eysenck and not feel bothered by the worst case scenario. Nothing happens, typically. Even discredited ideas, the mantra that a positive outlook makes a huge difference in cancer, is still around, still taught at some universities, still repeated without reservation or shame in public.

I don't think anything bad happened to the many scientists and physicians paid by tobacco companies, and it killed hundreds of millions and continues to kill millions. And that includes Eysenck. They can feel confident that in the very worst case nothing bad will ever happen to them, just like nothing bad actually happened to them for their entire career. Only criticism they could ignore with a sneer. Full pension, lots of friends and colleagues who will still love their work and courage for standing for their beliefs.
 
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