Cochrane ME/CFS GET review temporarily withdrawn

Faith in Cochrane lost. There is nothing defensible about the claims that CBT and GET work.

All they're doing is giving endless benefit of doubt to people who have already demonstrated to be incompetent or dishonest.

 

Yes. "I'm afraid the rules we've written for ourselves stop us doing the decent thing" is a rubbish excuse.

 

Interesting wording, logically it implies that at the moment it shouldn't be used to inform health care decision making to my mind.

 

Yup, it says to me "it shouldn't be used to inform health care decision making but we will find a way to keep the core concepts by rewording the conclusion." I mean it sounds like they are saying we won't review it properly, but we will find a way to make the treatments fit, probably by tailoring the limitations of CBT/GET.

Isn't the point of a review that you don't know what conclusions you will find before you start?

 

Yet they have given a hard deadline (admittedly another one!) which they surely cannot extend further. And they can surely never really meet the criterion "ensuring that the conclusions are fully defensible". So will it be fix it or fudge?

 

I don't know . . . is gambling allowed on this forum?

 

My reading is that somebody in the system is admitting failure. That may not change anything but someone has broken ranks. I also think that specifically naming Bob is relevant.

 

Well they could ... if they changed the conclusion to say there is no reliable evidence of efficacy. But I am dreaming, aren't I?

 

A very valid point.

 

The note does seem to lay it on the line pretty firmly to the authors; they may have agreed but I very much doubt it was with wholehearted enthusiasm.

"in which time the author team will amend the review"

" improving the quality of reporting"

"ensuring that the conclusions are fully defensible and valid"

"will also address concerns raised in feedback since the Robert Courtney complaint"

To my mind the above statements almost amount to a dressing down, and a challenge to the authors.

This one puzzles me a bit ...

"The amendment will not include a full update, but a decision about this will made subsequently."

... what exactly is it saying? What decision about what exactly? Or am I just being a bit fick?

 

This is indefensible. It has been up for years. It is heavily cited as a strong authority source. A review of something that deserves to remain a recommendation should not take this long. If there are such significant problems that it takes so much effort to get it right, there was something clearly wrong with the initial process and it needs to be retracted prompto.

They really don't appreciate the impact this is having, to recommend harmful guidelines that do not meet the most basic requirements. Completely irresponsible and reckless playing with people's lives.

 

So now they are aligning Tovey leaving ( end of May) and the (next) date for the review amendment.

Significance?

It is a disgraceful failure to take responsibility.


ETA: completion of the word responsibility which failed to print

 

Is a wildly over-optimistic interpretation possible? For example someone is ensuring that at a later date the authors cannot complain about not having been given every possible chance?

 

The dates Robert Courtney submitted his comments:

1. Query re use of post-hoc unpublished outcome data: Scoring system for the Chalder fatigue scale, Wearden 2010.
Robert Courtney
16th April 2016
https://sites.google.com/site/mecfs...-fatigue-syndrome/fine-trial-unpublished-data

2. Assessment of Selective Reporting Bias in White 2011.
Robert Courtney
1st May 2016
https://sites.google.com/site/mecfs...-syndrome/pace-trial-selective-reporting-bias

3. A query regarding the way outcomes for physical function and overall health have been described in the abstract, conclusion and discussions of the review.
Robert Courtney
12th May 2016
https://sites.google.com/site/mecfs...isreporting-of-outcomes-for-physical-function

4. Concerns regarding the use of unplanned primary outcomes in the Cochrane review.
Robert Courtney
3rd June 2016

They've already had well over two years. I think that most people would see that as long enough.

Also, their initial responses to those comments show that their judgements just cannot be trusted.

 

If they're not doing a "full update" (meaning they're not examining new studies), why does it take 6 months just to make a few modest changes!?!

 

I just keep hoping that, after the review authors forced this move to withdraw into the open, Cochrane has pivoted to a very visible display of their 'reasonableness' whilst leaving the authors no place left to stand. But I have been able to follow this story only sparsely.

 

I agree.

"The amendment will not include a full update, but a decision about this will made subsequently."

This is about giving the current review team a very, very last chance to make amendment to the current review - and there are strongly worded critisismen aimed at the review team, for the lack of quality of the current review. I'm sure there are some very not much happy people in Oslo now.

They are not committing to posting the amendet version - but still leave it open if a full update should take place.

" aimed at improving the quality of reporting of the review and ensuring that the conclusions are fully defensible and valid to inform health care decision making. "


There isn't anything new here, other than more open critic aimed at the reviewers - and pushing the date to may. Since they already had made the statement about "soon as possible", they had to post another statement.

This isn't Cochrane not taking the issues seriously, as this reads to me, but the authour team dragging their heels about letting go - while the editor is slapping them over the head.