BBC: Chronic fatigue trial results 'not robust', new study says

For some reason I have an image of his head popping up in the toilet bowl and being impossible to flush.

 

Good job they didn't get Stefanie Marsh to do it.
She's the journalist who did this interview with SW in 2011:
http://www.meassociation.org.uk/201...fessor-simon-wessely-the-times-6-august-2011/
(more recently she interviewed Tom Stranger, Google it).

I'd like to see some kind of apology from the Times at some point.

But at least her article made it clear who we have to thank for CBT/GET:
"
He has written more than 600 research papers on the condition. With colleagues at the psychiatric unit at King’s College London, he helped to develop a rehabilitation strategy and later set up the first NHS programme designed to treat those who had been left incapacitated by the illness. He discovered that by combining cognitive behavioural therapy and light exercise a third of patients make a full recovery.

Before his work, the standard treatment for ME was rest, with the result that many patients were left incapacitated. Many health professionals agree that he has done more for the sufferers of ME than any other individual, not just in Britain but worldwide."

(sorry, I'm on a bit of a Wessely bender at the moment)

 

Well, in a different sense to what the journalist intended, that is very true about SW, and hopefully one day he will have to answer for that.

 

You must be ill!!!!!!!!!!11111111oneoneone

 

When I was looking for something else, Wessely's book on clinical trials came up, and I thought that this section could be of interest to people. I know @Jonathan Edwards mentioned being curious about what the book said about blinding.

 

Thanks,it reveals that he has no clue about the difference between what is done and what is adequate. He has no power of critical thinking.

 

"Blinding removes the possibility of a placebo effect creating an artefactual response in the treatment group."

I really don't think he knows what he is talking about here. This doesn't make sense. Blinding doesn't remove placebo effects per se, and how would a placebo effect be creating a response in a treatment group, unless the treatment were a placebo? But I guess he's dealing with psychiatry, so probably most of their "treatments" are at least part placebo. *cough*

fwiw - my go-to book on clinical trials is the one written by my tutor at LSHTM - Stuart Pocock's Clinical Trials, A Practical Approach. Because he actually explains *why* these things are important, and doesn't just say, "do this, and you'll get that".

 

I think that is right - the idea that blinding removes the possibility of a placebo effect is just garble. Although if by 'placebo effect' we include all the factors that give overoptimistic assessments of responses in trials, including what is often called the reverse placebo effect where it is the doctor or assessor who is pleased rather than the patient, then it vaguely makes sense. Even then it does not remove the possibility, it just reduces the range of sources of bias.

I think it is generally accepted that active treatments have placebo effects as well as effects based on specific modes of action. That is why people use the rough and ready method of subtracting the response to the dummy (assumed to be pure placebo) from that of the test agent to get an idea of the specific effect of the test agent. In fact the maths should be more subtle but the built in uncertainties make it unproductive to try to do more subtle maths in most cases. What also gets forgotten is that effect sizes are derived from populations. A drug with a specific effect on 40% of subjects may also have a placebo effect on another 40% for whom it has no specific effect. That might mean that 16% of subjects get both effects (40% of 40%) but nobody really knows when one gets to that sort of analysis or whether they sum arithmetically or whatever - presumably depending on the linearity etc of the measure used, and so on.

 

Indeed. The concerning thing is that behind all this is the notion that as long as they have been seen to have followed the rules and ticked all the right boxes, then whatever they do is fine, when actually the most important thing is to understand *why* they are doing these things, and that limiting bias is not eliminating bias.