Cochrane ME/CFS GET review temporarily withdrawn

https://twitter.com/user/status/1104164804569243648

 

The one thing you can be sure of, is that it has naff all to do with good science. Far more to do with mucky political networking is my thinking.

The encouragement I take is that despite the machiavellian coercion that must inevitably be in full swing (I mean, really, what are the odds that that is not happening!), Cochrane have made this quite forceful statement. I would like to think it might be signalling - and intended to be seen as signalling, given its timing - a new broom sweeping clean. I'll allow myself to daydream for a while.

 

They've had 2 years to respond to undeniable flaws that discredit the entire review. Meanwhile a flawed review continues to harm patients around the world, something that will be deserving of serious lawsuits in the future as they have shown to be aware of the issues for a long time and have elected to maintain their recommendations.

Cochrane are absolutely not taking seriously the impact having flawed medical guidelines has on patients suffering from a highly disabling disease. The concerns and reputation of a review's authors are being held above the patients' well-being. This is reckless and irresponsible.

 

I thought the previous note was more critical of Larun et al. (not approved publication of the re‐submission. The review is also substantially out of date and in need of updating) than this one. An amendment by the authors will not do, if the conclusions are still based on subjective outcomes only.

Interesting choice of wording also: it seems that Cochrane is more interested in making a flawed review "defensible", rather than writing a good review. I get the impression that the problem for them is criticism of their brand, rather than a flawed review causing harm to patients.

 

'How much can we let Larun get away with without them completely embarrassing us?!'

 

I don’t think there needs to be a contract. As I understand, the legal requirement is for there to be a duty of care, for that duty to have been breached, and for that breach to have caused injury or loss.

If someone could prove that they had suffered injury or loss as direct consequence of Cochrane’s failure to take adequate measures in response to known problems with the review, then I think they could sue for negligence. The difficulty would be in proving that the injury or loss was caused by Cochrane’s actions (or inaction).

Disclaimer: I have no legal expertise.

 

I think that is right. Cochrane produce reviews knowing that they will be used for guidelines. They have given themselves a duty of care. If it could be shown that NICE guidelines were critically influenced by a Cochrane review that was known to be defective then I think there would be a legal case against Cochrane. It would probably never get anywhere but there would be a legal case. The difficult bit would be proving that NICE had been critically influenced by Cochrane I think.

 

Nailed it.

 

https://twitter.com/user/status/1118040833469685760

 

Alarm bells ringing already, if the GET review isn't withdrawn by the end of May it may never be.

 

Not necessarily, she has involved in drug trials and systematic reviews for a wide range of conditions.

For her reviews of CBT, the studies have been rated as low/very low quality. For "Psychosocial interventions for the prevention of relapse in bipolar disorder", the conclusion was "Cognitive-behavioural therapy, group psychoeducation and possibly family therapy may be beneficial as adjuncts to pharmacological maintenance treatments."

 

Did she say anything about CBT for schizophrenia? If she can see the problems in that area, she should also see them in ME/CFS.

 

https://twitter.com/user/status/1093895988253769729

https://twitter.com/user/status/1084779921090772992

 

It is the phrase evidence-based health care that always makes my heart sink, as usually in relation to ME it is code for bad and misleading evidence. Let's hope Dr Soares-Weiser has a better understanding of reliable evidence than her predecessor. Given her previous role in Cochrane she can not but be aware of the controversy around their reviews in relation to ME/CFS, so I guess we will find out fairly soon what her stand on is in relation to the 'evidence' supporting the use of GET/CBT and as to which group should host ME.

[added - There is the risk that given she is an internal appointment she will pursue Tovey's policy of putting protection of the brand and avoiding controversy above scientific objectivity, but let's hope not.]

 

Apart from the above, this also rang my alarm bell:

I can't pretend I know exactly what it means, but I know it makes me feel uneasy.

 

As she is a psychiatrist there's a risk that she was an "external appointment", especially with Toveys sudden departure announcement.

 

She was Deputy Editor in Chief of the Cochrane Library before this appointment, so it's more a promotion.