Cognitive behavioural therapy for adults with dissociative seizures (CODES): a ... multicentre, randomised controlled trial (2020) Goldstein, Chalder

Well, in the protocol they only said to interpret with caution. It would seem like maybe one of the peer reviewers said, "Hey, what about correcting for multiple comparisons?" So they mention it in the abstract and add a paragraph because they have to, but otherwise ignore it. However, it doesn't seem like they obeyed their own idea to interpret secondary outcomes with caution.

 

This was my response on the 2nd of June to Dr Marsh regarding rejecting my letter re Dr Perez's commentary:

Dear Dr Marsh,

Thank you for your swift response to my letter.

I am heartened that The Lancet Psychiatry is normally open to debate such as that raised in my correspondence. I was rather startled by your reasoning for not engaging in such a debate now.

Whilst we are in difficult and new medical territory with potential uncharted times ahead of us, it makes it more relevant than ever to ensure that the possible neurological and psychiatric consequences of COVID-19 are debated openly. There is, for example, the possibility that post-COVID-19 may well develop into poorly understood post-viral, ME/CFS type conditions in some people. Much debate and criticism has been levelled at similar type of research to the CODES trial in recent years, including the PACE trial. This highlighted the importance of the need for objective, measurable outcome measures, otherwise non-blinded trials may well produce misleading results. Moreover, it is not beyond reason to suggest that other poorly understood conditions such as dissociative seizures may also increase post COVID-19. Now is a good and effective time to be debating and discussing how the medical, neurology and psychiatry professions cope with medical uncertainty, ambiguity and chronicity in patients that they currently struggle to help.

I have reviewed the contents of the June 2020 edition and note that COVID-19 is covered in detail in the Editorial and Position Paper sections; COVID-19 is completely absent from the Insight, Articles and Review sections and forms 25% of Comment and just over a third of Correspondence sections. It appears to be being covered thoroughly with ample room for other debates and discussions. For example, under a third of Online First section is dedicated to COVID-19 with plenty of other material covering a wide range of psychiatry topics including: schizophrenia, the built environment, spirituality, treatment for depression, medical notes, leadership in Africa and Aboriginal/Australian issues.

As debate is a cornerstone of good science and how patients are managed emotionally and psychologically during times of uncertainty, engaging in a debate including with leaders in the field such as Dr Perez, could not be more timely.

I would ask you to review your decision regarding my correspondence. I make sound and clear points that are of interest to your readers and will generate debate which can clearly be included in future editions of the journal as other non-specific COVID-19 related topics have been covered well in 2020.

I look forward to a positive response from you soon.

Regards,


Joan Crawford
Chartered Counselling Psychologist
===

Her reply to me on the 4th of June (just found it in my junk folder):

Dear Dr Crawford,

We have discussed your appeal and our decision stands.

Regards,
Joan

==

So, that's that? or is it?

I can see so a lot wrong with the CODES trial that needs challenging. So many similar mistakes to the PACE et al trials.

I'm listing the issues I think need challenging and I'm going to ponder, seek feedback form colleagues and submit a further letter about the trial itself. This kinda poor quality RCT takes up a lot of resources and needs to be challenged firmly at design/conception level and through the peer review process. The lack of critical review is staggering. And the belief that all that the (medical profession) doesn't understand must somehow then be a 'problem' that resides within the patient - i.e. dissociation due to previous psychological trauma or symptoms develop and are maintained via autopoetic process (i.e derived from within oneself - as per MUS) is all speculation. Makes no sense to patients - no face validity. But it is believed wholeheartedly by proponents.

 

I don't think PubMed commons works anymore. Does anyone know? I'm up to my eyeballs today....

 

But you literally provided them evidence that their decision was bogus, providing receipts.

And our BPS overlords scream "WE ARE BEING SILENCED" and are actually taken seriously while this is what actual silencing looks like. What a sick joke. This is politicized science.

Maybe CBT watch would be interested? The exchange, or its details anyway, deserves to be discussed openly, this is not the proper process of scientific debate. Lancet is not behaving as a neutral arbiter here.

 

I'm speaking to Mike Scott on Thursday. I'll discuss with him then

 

I expect I'll write a post about it as well.

 

And you did.

Trial By Error: A King’s College London Press Release Hides the Bad News
https://www.virology.ws/2020/06/11/...lege-london-press-release-hides-the-bad-news/

 

https://twitter.com/user/status/1271400265414062081

https://twitter.com/user/status/1271399035560230912

https://twitter.com/user/status/1271392286585376779

 

This is mathematically impossible. Unless they mean both arms, if there was an actual reduction, since there was no difference in the arms. So that invalidates the alleged effect of the CBT. And frankly there is way too much hand-waving over "standardized medical care". There is no such thing. Medicine is not generic, not everyone receives the same care, even with the same condition, this is beyond absurd. I don't know how this is supposed to make any credible sense.

Let's be honest here, had there been a demonstrated effect, it would be hailed as proving the hypothesis of psychogenic origin. But failure does not mean evidence against the hypothesis, in fact it's literally presented as a success despite past insistence that only the primary outcome was significant. This is a level of dishonesty that is off the charts. They are destroying the credibility of science and it will have serious repercussions, a gift to quacks and charlatans, especially anti-vaccine zealots.

Hailing failure as a success, amplifying the effectiveness of what is effectively useless are hallmarks of pseudoscience. Coming from authoritative sources this is disastrous with huge implications on the credibility of all medical evidence.

This is a PR exercise, not proper reporting on a scientific study. The SMC is a complete failure in its stated role.

 

The quotation marks around "stress" are very weird. As if "we're saying that but don't quote us on it". What a cheap cop-out. Like Sharpe pretending he does not mean ME is psychological even though he literally does.

 

https://twitter.com/user/status/1271742287601688576

 

Neurologists’ experiences of participating in the CODES study—A multicentre randomised controlled trial comparing cognitive behavioural therapy vs standardised medical care for dissociative seizures

https://www.sciencedirect.com/science/article/pii/S1059131119301876

High degree of satisfaction for clinicians in a trial that has null results is just peak BPS. Rating patients' satisfaction by asking the clinicians is just meta peak BPS.

 

https://www.virology.ws/2020/06/15/trial-by-error-another-letter-to-kcl-another-letter-to-bmj/

 

Trial by Error by David Tuller:
More Questions About CODES Trial of CBT for Seizures

Post-CODES, it should no longer be possible to assert that CBT is a treatment for dissociative seizures. At best, it appears to be an intervention that can provide some patients with the kinds of psychosocial relief that would be expected from a course of CBT—and no more. The CODES protocol promised that care would be taken “when interpreting the numerous secondary outcomes.” Given the efforts to promote the trial as a success based on a handful of modest findings in some secondary outcomes, that promise seems to have been breached.

 

Wow. The more you look the worse it gets. Thank you David for being on top of this.

The treatment arm actually did worse. Of course it's likely a statistical artifact that was further affected by a different interpretation of what qualifies as a seizure, it's hard to otherwise explain a comparable drop in both arms. But this is failure. They should acknowledge failure. Failure in research is normal and good. This treatment is useless. They should not have been making claims of effectiveness for a decade but that does not change that their definitive test shows this treatment is useless.

So this is fraud. I'm sorry but this is pure fraud. The results do not support the claims. The grandiose claims of massive benefits are absolutely fraudulent. As usual. Why is fraud tolerated in medicine and how the hell do we speak to the manager because this is bullshit?

 

https://www.virology.ws/2020/06/25/...ics-project-my-letter-to-codes-investigators/

 

It's seriously disappointing how few people pick on this blatant fraud. So much for the "professional skeptics" and a self-corrective process. Then again, the self-corrective part is the scientific method and EBM has basically morphed into a blank check to sidesteps all scientific requirements, ethical and otherwise. A veritable platform for fraud and charlatanism.

But the point has been reached past which medicine has no place to criticize alternative medicine anymore. Not without cleaning house first. Medicine loves quackery just as much as anyone, it just loves the single one, though, but it loves it to death.