Cochrane ME/CFS GET review temporarily withdrawn

Snow Leopard said:
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!?!
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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.
TiredSam said:
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?
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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.
 
inox said:
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.
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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.
 
Andy said:
Interesting wording, logically it implies that at the moment it shouldn't be used to inform health care decision making to my mind.
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Yet it is still there and the warning is small. I wonder what the legal position is in that there comment suggests they know the work isn't up to standard but they are keeping the work published anyway. If someone were to rely on the review I wonder if they could be held liable for any issues or even the money spent on GET when the outcomes are less certain than they claim. However, I suspect since no one has a contract with Cochrane that there cannot be a case for liability?
 
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.
 
Michiel Tack said:
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.
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'How much can we let Larun get away with without them completely embarrassing us?!'
 
Adrian said:
However, I suspect since no one has a contract with Cochrane that there cannot be a case for liability?
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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.
 
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Robert 1973 said:
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.
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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.
 
More information from Cochrane:
https://www.cochrane.org/news/appointment-new-editor-chief-cochrane-library
The Governing Board is delighted to announce that, with effect from 1 June 2019, Dr. Karla Soares-Weiser will become the new Editor in Chief of the Cochrane Library. Karla will replace current Editor in Chief Dr. David Tovey, who is stepping down from the role at the end of May following ten years of distinguished service.

Karla Soares-Weiser was born in Brazil and now lives in Israel. She is a trained psychiatrist, holds a Master's degree in epidemiology, and a Ph.D. in evidence-based healthcare from the University of São Paulo. She has been working in evidence-based health care since 1997 and is an author of over 60 Systematic Reviews, including 33 Cochrane Reviews. She has held numerous positions in Cochrane Groups, including as a Visiting Fellow at the IberoAmerican and UK Cochrane Centres, where she provided training in systematic review production.

Outside Cochrane she has held Assistant Professor posts in Brazil and Israel, and established her own consultancy business providing evidence synthesis services to government agencies and not-for-profit organizations. She was instrumental in the development of Cochrane Response, the organization’s evidence consultancy service; and in 2015 was appointed Cochrane's first Deputy Editor in Chief. Since 2016 she has been leading the transformation programme of Cochrane Review Groups into Networks, and in 2017 became Acting Editor in Chief for four months during David Tovey’s leave on health grounds.
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more at link.
 
John Mac said:
Alarm bells ringing already, if the GET review isn't withdrawn by the end of May it may never be.
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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."
 
Trish said:
She is a trained psychiatrist, holds a Master's degree in epidemiology, and a Ph.D. in evidence-based healthcare from the University of São Paulo. She has been working in evidence-based health care since 1997 and is an author of over 60 Systematic Reviews, including 33 Cochrane Reviews.
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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.]
 
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