Evidence-based psychological interventions for adults with chronic pain: precision, control, quality, and equipoise, 2021, Williams, Eccleston et al.

Sly Saint

Sly Saint

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Jonathan Edwards said:
Silly me, someone is marketing CBT of course, but why would Cochrane employ a marketing executive who believes in 'pushing' treatments?

You can't make it up.
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In embracing the belief that it's all just a messaging problem, that the evidence is infallible and it's just a matter of getting the message out, it seems perfectly natural, especially for Cochrane, who seem to have adopted this approach, along with the whole of the EBM effort.

What do you do when you have a safe and effective treatment that would work for millions if only they understood... I guess the usual sales pitch is "the relationship between the mind and the body, or whatever"? You sell them the idea better than ever, of course. Fitting that the golden age of psychosomatics would also happen along with the era of MBA medicine, right there with artificial targets that completely replace the original goal and become the whole point. Dog wagging its tail is now also chasing its own tail, and wagging it more in response, so chasing it harder than ever on and on.
 
Caroline Struthers said:
He was my first boss at Cochrane. We didn't get on terribly well...
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oh sorry - he is last author . But I worked with Amanda Williams too as she is an senior editor of the Cochrane Pain Group. She seemed very nice. But I recently commented on a Cochrane review on managing chronic pain with psychological therapies. I don't think she got my point about subjective outcomes any more than anyone at Cochrane ever does. https://www.evidentlycochrane.net/chronic-pain-psychological-therapies/#comments
 
Caroline Struthers said:
I worked with Amanda Williams too as she is an senior editor of the Cochrane Pain Group
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Caroline Struthers said:
. But I recently commented on a Cochrane review on managing chronic pain with psychological therapies.
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I think her reply is interesting. Also interetsting that she didn't feel the need to reply again to your reply and Andrew Kewley's comment.

Did you see she co-authored a comment in the Lancet on the NICE guideline on chronic pain after she had resigned from the committee for that guideline?

https://www.s4me.info/threads/new-d...ture-over-medication.16182/page-9#post-378328

(Which all seems a bit weird to me, since with regard to that guideline, criticism I think was justified -- didn't read her comments though, so no idea whether her/their criticism made sense in that case.)

(Edited to add a line about the exchange between Caroline, Amanda and Andrew about the Cochrane review.)
 
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MSEsperanza said:
Did you see she co-authored a comment in the Lancet on the NICE guideline on chronic pain after she had resigned from the committee for that guideline?

https://www.s4me.info/threads/new-d...ture-over-medication.16182/page-9#post-378328

(Which all seems a bit weird to me, since with regard to that guideline, criticism I think was justified -- didn't read her comments though, so no idea whether her/their criticism made sense in that case.)
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ah yes, I had forgotten that. Will have a look at that
 
Arnie Pye said:
Off-topic, sorry.



I realised ages ago that there is some significance to the order in which authors are listed on any research paper or article, but I have never seen an explanation of what that significance is. Can anyone enlighten me?
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This is not gospel, but what I think is the case from working alongside health researchers since 2008. The last author is usually the most senior. The one that adds gravitas to the whole endeavour. The one who holds the grant funding if there is any. etc. They may not have done much (or any) of the hands on research themselves. But they should have read the paper and take responsibility for the content, along with the other authors. Having said that, I have just had a paper accepted for publication where that is not the case...because my boss had no part in the research at all. And there was no specific funding for the research.
 
Arnie Pye said:
Off-topic, sorry.

I realised ages ago that there is some significance to the order in which authors are listed on any research paper or article, but I have never seen an explanation of what that significance is. Can anyone enlighten me?
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Simplified: The first one or two people did most of the work, the people in the middle chipped in and the one or few people at the end secured the research funding or provided a supervisory role.
 
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Arnie Pye said:
Off-topic, sorry.

I realised ages ago that there is some significance to the order in which authors are listed on any research paper or article, but I have never seen an explanation of what that significance is. Can anyone enlighten me?
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It varies across fields, but in medicine and related fields, what @Snow Leopard and @Caroline Struthers say is usually the case:

First author: did the work

Last author: paid for the work, hosted it in their lab, may or may not have done any actual work on it.

Middle authors: a mix of people, some might have done some real work, others may be getting their names on it as a part of a quid pro quo agreement (author name sharing is a common practice in medicine "I'll add your name to my paper if you do the same for me". It is an easy way to inflate he research productivity of every researcher in your group or institution.)
 
The paper was published in Pain:
https://journals.lww.com/pain/Citat..._based_psychological_interventions_for.1.aspx
https://discovery.ucl.ac.uk/id/eprint/10128908/7/Williams_PAIN-D-20-01527_R1.pdf

1. Introduction
Psychological interventions for adults with chronic pain are common and desirable treatment options in multidisciplinary pain treatment centers operating in high resource countries. Evidence for the efficacy and safety of psychological treatments, typically from randomized controlled studies, has been repeatedly summarized in systematic reviews and metaanalyses over the last 40 years.

Our group has maintained the Cochrane Library review on ‘Psychological interventions for adults with chronic pain (excluding headache)’ since its inception in 1999, updating it with the latest evidence, most recently in August 2020 [7,22,29,30]. In the 1999 review, we included 25 randomized controlled trials (RCTs); in 2009, 40; in 2012 (with stricter inclusion criteria), 35; and, in 2020, 75. The main findings of the 2020 review are summarized in Table 1.

Our aim in this topical review is to draw attention to key features of RCTs from which we draw our evidence base of psychological treatments, including design, conduct and reporting of trials. We do not address here other valuable methodologies, such as single case and process studies.

If we are to produce trusted, highquality evidence that is useful, then we must attend to issues that can potentially undermine that trust, issues that add to uncertainty around the evidence. These include, but are not limited to, the precision of our effect estimates as a function of trial size; the quality of treatment content; control over therapy content in the use of comparator treatments; and the degree of equipoise in how questions are asked and answered. We conclude with recommendations for the future direction of the field.
 
Trish said:
If we are to produce trusted, highquality evidence that is useful, then we must attend to issues that can potentially undermine that trust, issues that add to uncertainty around the evidence. These include, but are not limited to, the precision of our effect estimates as a function of trial size; the quality of treatment content; control over therapy content in the use of comparator treatments; and the degree of equipoise in how questions are asked and answered. We conclude with recommendations for the future direction of the field.
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We know how Cochrane deals with that. They defend it as they find it all very... desirable. Whatever that is as a standard. Which sounds a lot like a recognition that this is a "if it worked" thing without having the courage to actually say it.

Problem is that the fix has to work both ways: it's garbage in, and also garbage out. It's not just garbage out because what goes in is garbage, the process itself is garbage and essentially unreliable. Even if what goes in improved, it's still a fully arbitrary process that amounts to a popularity contest depending on who is in the room doing the arbitration. It says nothing about the quality, validity or applicability of the evidence. All it says is that it's common and... desirable. In the end it's always the same issue: bias, bias everywhere. Wanting to help more than caring to find whether it did.

Medicine doesn't use feedback loops. Instead they use this Rube-Goldberg process that is actually more costly and inefficient than doing full quality-control across every single thing they do. This is what happens when you don't use feedback loops, the only way to learn from mistakes.
 
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