Articles on NICE guidelines 'pause'

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Peter Trewhitt said:
This article also seems to be breaching the press embargo: “Nice last issued recommendations on ME in 2007. New final guidance, seen by the Guardian and roughly in line with a draft report published last November, would have abandoned the GET recommendation and also advised that CBT – a talking therapy commonly used to treat anxiety and depression – is not curative for ME.”
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Once an embargo has been broken, it is broken. The Guardian would no longer be bound, I think, given that The Times already reported the same thing.
 
Graham said:
Most of the feedback seems to have been where the therapist chats to the patient on the final session, or hands them a form to fill in before they go. The whole thing depends on the "thank you very much doctor, I'm sure you have been a great help" syndrome.
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Ah, but the Thetan-measuring machine doesn't reach the red line so that means that it works! I'm sorry I mean the anxiety-rating machine. Wait no that doesn't exist, I mean the anxiety questionnaire thingy says maybe, and that's just what medicine is all about, isn't it? Artificial success on artificial ratings of no importance or relevance? S C I E N C E.
 
Thank you @FMMM1

I was thinking about a government pause here in Canada, which some question is a roll back, and not a pause. Of course, that's one of the main concerns right now with the NICE pause.

Good points @Brian Hughes

If logistical reasons includes monetary issues then that's what I wanted to add about income.

There are of course layers of liability protection for health care practitioners. If they were wrong in prescribing GET and CBT for ME, they were just following the 2007 NICE guidelines. I'm assuming they would not be liable for any harms, or for prescribing these non-evidenced based "treatments".

I don't know for sure, but can imagine some practitioners might be concerned about negative consequences from patients. Patients who went through this highly recommended therapy, who did not improve, or were harmed.

If the guidelines indicate this treatment is of little to no merit, then at the doctor's office level there may be some problems.
 
DokaGirl said:
Thank you @FMMM1

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There are of course layers of liability protection for health care practitioners. If they were wrong in prescribing GET and CBT for ME, they were just following the 2007 NICE guidelines. I'm assuming they would not be liable for any harms, or for prescribing these non-evidenced based "treatments".

I don't know for sure, but can imagine some practitioners might be concerned about negative consequences from patients. Patients who went through this highly recommended therapy, who did not improve, or were harmed.

If the guidelines indicate this treatment is of little to no merit, then at the doctor's office level there may be some problems.
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I suspect it would be difficult to use the 2007 Guidelines now i.e. since the evidence no longer supports the intervention (CBT/GET). If a health care provider is sued for damages, re treatment provided after the draft Guidelines were published [November 2020], then they'd have to demonstrate that they acted reasonably in light of the available evidence - including the evidence that PACE etc. are low quality. That's one of the reasons I think the draft Guidelines cannot be undone i.e. those providing care [physiotherapists, psychologists--] have to be able to demonstrate a reasonable expectation of benefit - currently there's no evidence of benefit so all someone has to show is injury/loss as a result of the unevidenced treatment. I think this whole mess can only be resolved by adopting the draft Guidelines --- there may have to be something that allows the Royal College of Physicians to climb down --- if it were any other "trade union" the Government would steam roller them as a badge of honour!

I'm not a lawyer!
 
I'm guessing a good lawyer/barrister makes sure a discussion focuses on material which benefits their case - if that is the case then are the Royal College of Physicians out on a limb here? See @Jonathan Edwards comments here* it seems that the Royal College of Physicians is focusing attention on material which will inevitably demonstrate that they are supporting unevidenced treatments. Presumably other folks in the Royal College of Physicians will tell them to wise up and stop defending the L T-Stokes folks ---- SURPRISING WOULD BE AN UNDERSTATEMENT.


*"So now we know that the College of Physicians is involved.
That is disappointing but at least it means that the debate will reach people who understand trials.
I guess by their experts they may mean L T-Stokes."
 
FMMM1 said:
I suspect it would be difficult to use the 2007 Guidelines now i.e. since the evidence no longer supports the intervention (CBT/GET). If a health care provider is sued for damages, re treatment provided after the draft Guidelines were published [November 2020], then they'd have to demonstrate that they acted reasonably in light of the available evidence - including the evidence that PACE etc. are low quality. That's one of the reasons I think the draft Guidelines cannot be undone i.e. those providing care [physiotherapists, psychologists--] have to be able to demonstrate a reasonable expectation of benefit - currently there's no evidence of benefit so all someone has to show is injury/loss as a result of the unevidenced treatment. I think this whole mess can only be resolved by adopting the draft Guidelines --- there may have to be something that allows the Royal College of Physicians to climb down --- if it were any other "trade union" the Government would steam roller them as a badge of honour!

I'm not a lawyer!
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Me neither!

Interesting point, with the draft guidelines out there, indicating the facts that GET and CBT therapies are low quality for ME, then it's sort of a done deal, but also not a done deal. The proof of low quality/very low quality is out there, but the final step, in this case acceptance of the final draft has not happened.

I don't know, not being a lawyer, but in my opinion, I would question physicians' being able to successfully prove they were acting reasonably in prescribing GET/CBT to pwME, post draft guidelines. But then again, I'm not a lawyer.

Another puzzler is NICE saying they have to consider comments made pre final draft. Presumably that was already done, given their attention to detail.
 
Barry said:
So, right there, is very good reason Miller would not want this to go through, because attention would then become more sharply focussed on why the safety of these treatments, including worsening of symptoms, was not more stringently monitored, recorded and assessed. I suspect there are significant players very scared about potential litigation fallout down the line, amongst plenty of other things of course.
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Litigation fall out, does seem a possibility. However, governments will often back the establishment. Despite this potential David and Goliath situation, I think litigation may be plan, once the dust settles one way or the other.....
 
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