Cochrane ME/CFS GET review temporarily withdrawn

Ah I was hoping this was Cochrane giving Larun every opportunity to answer critiques so that when they they have no come back. A pathetic response to the critiques on the record or a victim rant with the new submission leading to full retraction would be a great Xmas present.

 

Looks like Cochrane have given in to the external pressure. I'd be amazed if they don't now roll-over for Larun in November.

If that review had gone, PACE would have fallen, and a huge number of important people would be left looking very bad indeed. Not surprising that they pushed back hard, but still disappointing that Cochrane folded.

edit: I am sleep deprived at the moment - maybe that is making things seem even worse, but it's all looking so corrupt right now.

 

It's disgusting.

 

How can the community exert more counter-pressure? Heighten the stakes? How to ensure that Cochrane will lose far, far more if they don't pull the paper?

David T has the support of a whole whack of respected scientists. How can we build on that?

 

We're not really able to apply pressure here - Wessely and his mates are.

We can draw attention to the problems with Larun's work and behaviour, and hope that more people in academia who may have some influence start to care, and recognise how fucked up this is, but that's about it. For lots of really important people, the stakes are already as high as they get, and they'll do all they can to prevent the withdrawal of this review. We need to be careful to go on being cautious and accurate in all the criticism we make to try to undermine that 'militants fighting against an all-in-the-mind implication of GET' smear, which the PACE-lot still clearly think is their strongest card.

 

I think the difference is that the core of psychology is methodology. That's the bulk of a psychologist's body of knowledge and also their training. So there have always been those in the area who've been interested in critiquing and advancing methodology (this doesn't mean psychologists don't get it wrong a lot, but there's just always some interested in critiquing work when it does seem wrong).

The core of psychiatry is precedent, belief and technique. The bulk of a psychiatrist's training is in theory (and what the evidence currently supports) and in practicing techniques. They learn methodology only briefly, and generally use it only as a means to an end. There's also a greater deference to authority in psychiatry. e.g. in their written work, they will happily mention that an idea was Freud's. This looks weird to a psychologist - who cares who said it? The culture in psychology is to put the idea first, and it proponent second.

Not to say there aren't great psychiatrists out there who really question their evidence base. I just think they have to be rather special, as they start that race with such a handicap.

 

Yet even if that were true, which it patently is not, Cochrane should be looking only at the quality of the science, nothing else. Anything else are distractions that Cochrane should have the integrity and competence to not factor into their decision.

 

Wessely?

 

Larun is employed by the Norwegian Institute of Public Health - NIPH (the translation they use themselfs). So is Kjetil Brurberg, the other norwegian author. I read that mostly as throwing in the name, trying to add weight to the statement. NIPH have massive trust in Norway.

If others are involved is hard to tell, but sometimes also Signe Flottorp have taken part in discussions. Another senior researcher there.

Also, Cochrane Norway is located at NIPH (as part of the Norwegian Knowledge Center for the Health Services). But I can't figure out any names responsible.

https://www.cochrane.no/welcome

 

I'm not sure that is the right way to think about it. It seems to me, the reviews are seen as "owned" by the authors. So they would in charge of their own review, and have the responsibility to keep it up to date.

But the editors are responsible for overseeing this, but decisions are usually made togheter with authors. As when Tovey asked them to agree with a temporily withdraw. That was probably his last push on them, if they haven't responded for a long time.

So I think the authors will be given every chance to amend their work, if they are willing to try and correct things. And if the authors insist on doing that, the editors might be obliged to let them write up a new version before making any final decisions - even if they are the ones with the last word.

I'm no expert though, this is just my understanding of how things work

 

That sounds like a reasonable scenario. I wonder how long they will manage to drag it all out.
If they do respond, it will make for an interesting read. I imagine that they will not be able to make any significant points and so they will just hope to stave off the inevitable for another day.

 

That's right.

The oft cited zebras/horses quote applies more to Freud/psychology/psychiatry than to any other domain. A dream about a train going into a tunnel. Most likely, that's actually about a train going into a tunnel. It not some kind of repressed sexual desire. Its just a plain old garden variety horse, not a zebra.

 

Also this, Cochrane Norway beeing located at NIPH, (probably) beeing the same people - have been part of the problem in Norway. Trying to criticise the Cochrane reviews, you would be taking on both these entitites with deep rooted trust at the same time.

 

Absolutely, in my view (and this is my area of expertise), 99% of our mental operations are unconscious. That remaining 1% that you are aware of is the tip of the iceberg.

Unfortunately, however, those unconscious operations are not the exciting suppressed desires and deep resentments that Freud believed them to be. There's just things we can compute pretty efficiently without the need to bring the operations into conscious awareness. Things like reading and extracting the meaning from a sentence. Or recognising a face in a crowd, one we haven't seen for years. Things like judging when to slow down in the car when you see a few pedestrians around. Actually, all those really sophisticated things you do in a car, while happily talking to your passenger.

 

The following comes from a sleep-deprived and grumpy brain:

Courtney's comments were submitted in 2016. Larun got away with BS responses then. Two years later when Cochrane tried to to withdraw her seriously flawed work to stop it causing more harm Larun chose to take part in a smear campaign against the patients who noted problems with her work. Because she has a lot of powerful allies in this Cochrane crumbled and decided that she should now just let her submit a minor update to her work.

Now she's going to be able to make some minor changes to remove the most obvious technical problems with her work and more effectively hide her own biases, while continuing to ignore (or downplay the problems with) the fundamental problem of relying on subjective self-report outcomes for nonblinded trials of an intervention like GET. Cochrane have already shown that they'll let her get away with behaving appallingly.

IMO: The most likely outcome is that in a month or twos time we're going to have a load more publicity about how rigorous research by the respect Cochrane Collaboration shows how unreasonable patient critics of GET were.

 

Yes, this is what I'm worried about too, I see that scenario as very likely

But if that happens, we would still have the US and dutch pulling cbt/get from their recommendations? Could really Tovey/Cochrane live with beeing the odd one out? And wouldn't there be an outcry amongst our steadily growing numbers of academic critics?

Mostly trying to comfort myself...

 

Funny that, when I had sexual desire dreams I always thought the true meaning was that I wanted to go through a tunnel on an actual train.

 

Why can’t we lawyer up too?

 

A large part of me agrees with you and thinks this is what's most likely to happen. Cochrane have let this run and run and run and there's no reason to believe they're suddenly going to grow a pair (if you'll excuse the vernacular).

But then a tiny part of me wonders if Larun and co haven't overstepped the line by 'going public' in the way they did. Cochrane tried to resolve the issues quietly, in a manner that was respectful to the authors. For their pains they found themselves unfairly smeared in a Reuters hatchet job. If I was in Tovey's shoes right now I'd be thinking "Right. I'll be reasonable - and more importantly, I'll be seen to be reasonable - by allowing you to address the criticisms without the need to withdraw the review. But if you can't address all the outstanding issues to our satisfaction I no longer have any reason to cut you any further slack".

Additionally the joint letter that @dave30th published on Virology shows Tovey that there's a growing number of scientists, researchers and academics who strongly feel that Cochrane can't allow the GET review to stand. He must realise that he and Cochrane are going to come in for some intense criticism if he doesn't take this opportunity to withdraw it. I haven't seen much in the way of a public outcry from the scientific community following the Reuters article (although obviously there's no way of knowing what sorts of pressure - if any - have been applied behind the scenes). But given the apparently muted response so far it could be that Tovey concludes that the SMC's bark is worse than its bite, and that withdrawing the review is by far the easier course of action.

 

And we'd be holding that mirror up. In public. We aren't going away, the review doesn't magically start looking sound so there is only one eventual outcome.