Cochrane Review: 'Exercise therapy for chronic fatigue syndrome' 2017, Larun et al. - Recent developments, 2018-19

I don't think this is good news. I'm afraid they'll just tweak it a little and that the main flaw (a focus on subjective outcomes in unblinded trials with inadequate controls) isn't going to be changed.

 

It looks like it's confirmation that Cochrane is as bad as they always looked to be.

 

Has the new editor in chief made any statements about this? Where is she based? I think the job advert said it didn’t necessarily have to be London.

 

https://twitter.com/user/status/1140990514935803906

 

Sadly, it looks like we are heavily affected by an issue that is so much bigger than just ME/CFS.

Cochrane acknowledging that non-blinded studies that rely entirely on subjective outcome measures are problematic would have disastrous consequences for their entire brand. Since they would have to accept the fact that many of their reviews are entirely useless, which doesn't exactly play well with their reputation of being the gold-standard of medicine.

 

Isn't there a level of irony in that we now have our own meta-thread, drawing together the various threads about Cochrane desperately trying to avoid withdrawing their biased meta-review.

 

They could save face by moving ME/CFS into some other category where the scientific standards are higher. So the elephant in the room doesn't have to be acknowledged.

 

We were explicitly told that this would happen about a year ago. Clearly it is not going to happen. This looks like a very transparent retrograde step. When the revision appears we will have to address the situation again.

One slightly positive aspect of this is that the more I see of shenanigans the more I will be in. a position to say to the NICE committee that the whole thing is a shambles. And moreover, that there is clearly a problem with peer review and involvement of people with conflicts of interest.

 

How do you think should this be addressed? Can we make an infographic that explains how lack of blinding leads to nonsensical conclusions? We can show results from that one asthma study and the open label Rituximab study. What the Cochrane review does (as far as I remember) is that it treats these studies as reliable, concludes the treatment works and then just has a small disclaimer like paragraph somewhere that says maybe they are actually unreliable. The conclusion of the review should be we have no idea if they really work.

 

I expected nothing and I'm still disappointed. Disappointed at the reckless indifference to the human lives they are hurting. Disappointed that medicine can be so massively incompetent and cruel even in the face of overwhelming evidence. Disappointed at the sheer inhumanity of the process, one that so casually chucks millions of desperately ill down a cliff, not even looking back.

There will be many lawsuits over this. Cochrane will not survive it. It may be years, but this will ruin it whole.

 

I see no reason to be so optimistic.

They are protecting institutions, they are an institution, they will be protected.

 

This isn't about evidence. It's politics. Too much has been invested in the psychosocial model. Over the years there have been thousands of consistent complaints, forcing its promoters to reaffirm constantly that they stand behind it, based on gut feeling and spurious logic and despite all evidence that it is clearly harmful and wholly misguided. They were asked again and again "are you sure?" and yes, they are sure that they want to keep pulling the metaphorical trigger.

Those responsible are choosing to save face and putting their career above withdrawing clearly harmful medical advice. They are willfully sacrificing lives by the millions in order to avoid the consequences of having done so deliberately in the first place, through well-documented and cogent evidence that their advice is based on fiction and fraud.

The only thing we can do is making it clear to them that this is what they are doing. They know, of course, but this is the only way to have them face consequences in the future, to put them on record so that when people ask "how did people not know?", there will be decades and hundreds of thousands of legitimate complaints over this, all dismissed with prejudice and with casual indifference to the outcome. And this here will be one more, again pleading for sanity in the face of bullying and wanton cruelty.

It has to be clear. Cochrane: you are hurting people. There is the overwhelming evidence for it. You know it. We all know it. You merely choose to dismiss it and cherry-pick an alternative fiction, will be judged by it and you will be ruined by your own hand.

 

Cochrane cares about their image and brand. Showing how biased, incompetent and anti-patient welfare the reviewers and management is will hurt their image and brand.

 

This from Wiki is of concern, and could account for quite a lot:


Wikipedia[edit]
Wikipedia and Cochrane collaborate to increase the incorporation of Cochrane research into Wikipedia articles and provide Wikipedia editors with resources for interpreting medical data.[40] Cochrane and John Wiley and Sons, publisher of Cochrane reviews, make one hundred free Cochrane accounts available to Wikipedia medical editors—the financial value of which has been estimated by Cochrane at between thirty thousand and eighty thousand dollars per annum—and pay a nominal stipend and travel expenses to support a Wikipedian in Residence at Cochrane.[41]

 

I am not so sure. I have a nasty feeling that what matters for brand image these days is showing you can bullshit your way out of any situation where you appear to be dead in the water. We are seeing it all the time in general politics. It seems now to be taking over medical politics. What people now look for in a brand is 'buyability' - evidence that for a reasonable price you can get the answer you want.

 

Is there any realistic chance that we get our own special report on Cochrane?