Cochrane review and the PACE trial

Yes it does, so why is it presented by prof. Gundersen as brand new? I think Larun et al are working on a new publication, so am expecting one soon, but this can't be it, can it?

 

Gundersen doesn't seem like someone overly concerned about getting the details right.

 

Also worth drawing attention to the problems identified with this review, and the authors' failure to address them: https://sites.google.com/site/mecfs...exercise-therapy-for-chronic-fatigue-syndrome

 

This looks like the old review. Maybe Gundersen is unaware that a more recent attempt at a review including the PACE authors was written but as far as I know has not yet appeared. I advised Cochrane that it had no business to appear and that this previous review was also unfounded. It is conceivable that this is a new version just from Larun and Brurberg.

 

Just to broaden the perspective: Not only the Cochrane "Common Mental Disorders Group" but also the Cochrane "Multiple Sclerosis and Rare Diseases of the CNS Group" appears to have questionable standards of assessing research quality:

Heine M, van de Port I, Rietberg MB, van Wegen EE, Kwakkel G. Exercise therapy for fatigue in multiple sclerosis. Cochrane Database Syst Rev (2015) 9:1.10.1002/14651858.CD009956.pub2

http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD009956.pub2/full

Quality of the evidence

Yet I cannot comprehend how that can be interpreted as "moderate quality" which is the second highest rating by Cochrane -- meaning:

"Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate", yet seems to be sufficient to recommend the reviewed treatment.

I find the shortcomings described by the authors contradictory to their overall rating of the evidence and their conclusion:

Potential biases in the review process

vs. Conclusion

[Edited: title of the Cochrane review]
[Edited 2: sorted my comments from the quotations. It's about time to rest again. ]

 

It certainly looks as if the neurorehabilitationists have joined forces with the liaison psychiatrists on this. In the UK pals of Sharpe like Stone and MacLeod appear to take this peculiar approach to evidence quality.

 

Only last week on the BBC news they were claiming exercise therapy for people with cancer even when having chemo was safe and effective. They are already claiming its a treatment for Parkinsons also.

Same old non descriptive claims, no defining of the difference between exertion and planned exercise and how they measured the effect on activities of daily living.

I think we can close down all labs, medical research and scientific development and just put up posters on every street corner saying, "an apple a day keeps the doctor away".

 

You may not remember the Speak Your Weight machines on the underground. I thought that maybe the answer to osteoporosis was to have machines on platforms where old ladies can put in twenty pence and it jiggles them about for a minute. They might be quite fun.

 

Do rehabilitationists in general use their imagination much to think of other forms of rehabilitation than exercise?
Yet, are the authors of this review actually rehabilitationists?

 

Clicking on each name reveals that they all work in Rehabilitation units.
Essentially we have the equivalent of psychotherapists: physiotherapists. It looks as if Cochrane is happy for the relevant therapists, and their overlords, to review therapist-delivered treatments. I think this is probably something which should come to a stop. Therapists are different from doctors in that they ARE the treatment. So their ability to be disinterested is much less. Doctors are bad enough. Doctors whose work specifically consists of herding around therapists to do the work are pretty much like the therapists.

Having communicated with Iain Chalmers about the GET review situation I have come to realise that there is a political agenda behind Cochrane that is essentially anti-drug, and as part of this pro-therapy.

 

Thank you, @Jonathan Edwards. Not very encouraging, but good to know.

Is this Iain Chalmers' stance in particular, and how influential is he for Cochrane in general at present?
(He appears to have a very one-sided political agenda in other social areas, too, so I thought that could affect his overall trustworthiness).

In any case, I think we need strong allies outside Cochrane and outside the ME field.
I started looking for such allies in the MS research field (see https://www.s4me.info/threads/objec...tiguability-lurija-institute.4241/#post-91599 )

But I lack medical expertise to assess the quality of this research.

Perhaps neuropsychiatrists / neuropsychologists might be supportive of criticizing Cochrane? [eta: ] I think there is also a lack of evidence for treatments in this area ("brain jogging" and the like, yet also drugs).

 

What does Cochrane hope to achieve with an anti-drug stance? And does this apply only to ME/CFS or everything?

 

I don't think it is a matter of hoping to achieve. I just sense that many of these organisations, whether Cochrane, Sense About Science or whatever tend to be set up by people with some sort of political agenda. A very popular political agenda is anti-drug, anti-'biomedical model' etc. Chalmers seems to have left Cochrane per se but I think there may be people still there who have a similar emotional bent under the surface. One may be Paul Glasziou, who was a co-author on the recent Larun, White, Sharpe, Uncle Tom Cobblers and all effort.

 

Dont forget that they are trying to move the model on to "self help" online or DVD "courses" instead of more costly "therapies". On top of that they have already shown their hand by promoting private treatments like the LP and pushing for as many "MUS add ons" as possible.

There are vultures flying around desperately trying to destroy the NHS and turn everything private. The model they will employ if that happens is maximum insurance premiums, with minimum treatments and maximum disqualifications.

We keep hearing "we cant afford the NHS anymore", which is a nonsense statement as the alternative per capita cots will be much higher in a private system once you add a profit motive on top.

Obvious then that they have to get everyone used to next to no treatment first, lower the expectations with a fake political narrative then slice up a bloody big cake of high premiums, minimal payouts and zero hour contracts for as many healthcare workers as possible as well as excluding them from sick and holiday pay as a consequence.

 

@large donner Don't forget banning more and more medications and treatments. E.g. need your tonsils out? Forget it. For women with massive breasts that give them permanent back and neck ache? They have to pay for breast reduction. The NHS can say these procedures weren't banned, but in effect they will be. It's already happened to people who need T3 for thyroid problems. More and more people who are already on it are having it removed from prescription, and new patients are being turned down for it. Officially, it hasn't been banned!

And they are succeeding. The pace of change is accelerating as far as I can tell.

I remember when I first worked a few decades ago that the basic rate of income tax was 33%. Now it is 20%. I don't know enough about taxation to know if it is a fair comparison. But surely tax could go up by 1% without there being riots in the streets?

 

@Jonathan Edwards , apologies, I just realized that in this regard we already have at least one strong, very important and higly appreciated medical professor ally who came from outside the ME field. So we just need some clones of you...Any ideas how to produce them?

 

To rich (and maybe mostly "important") people?

 

I found the following juxtapositions of excerpts of the (I think) latest Cochrane review (http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD003200.pub7/full) in my draft folder and just leave this here in case it might be of interest for anyone.

(I thought it showed some contradictory rhetoric regarding the level of evidence for the reviewers' conclusions.)

The authors conclude in their abstract of the review:

The conclusion at the end of the review also is rather vague:

source: http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD003200.pub7/full

Compare this to the proposed questions they claim to be able to answer...

http://www.cochrane.org/CD003200/DEPRESSN_exercise-treatment-patients-chronic-fatigue-syndrome

...and how they answer these questions:

https://www.cochrane.org/CD003200/DEPRESSN_exercise-treatment-patients-chronic-fatigue-syndrome