Insanity is doing the same thing over and over and expecting a different result, Einstein (allegedly), a rant about psychobehavioural research
by me.
This morning I skimmed a zillionth research report of a clinical trial comparing two versions of essentially the same psychobehavioural intervention. You know the pattern, I don't need to spell it out, a few buzz words will serve - kinesophobia, catastrophising, fear avoidance of exercise, baseline, individualised, small incremental increases, symptom focusing, sleep hygiene, yada yada blah blah.
The shiny new version will have some variation of face to face, online, group, individual, number of weeks, number of sessions, types and timing of exercises, multitudes of questionnaires, and so on, but it's essentially exactly the same every time.
In today's case it was for very broadly defined Long Covid, but it could equally have been for ME/CFS, MUS, enduring symptoms, somatic symptom disorder, functional disorder, conversion disorder, persistent physical symptoms, and for all I know not-eating-enough-pancakes disorder and staring-at-sparrows syndrome.
The premise is the same, regardless of syndrome category: healthy people stay healthy if they exercise, have a regular sleep and daily activity patttern that accords with current cultural norms, they don't catastrophise about every little symptom and they think positive thoughts.
The logic continues - people with symptoms that we, the superior all-knowing clinicians, don't understand, must therefore be behaving wrongly or thinking wrong thoughts. Doctors deal with real diseases and traumas that we understand, so we must not let these non conforming psychobehavioural miscreants contaminate real medicine, we must get some low status therapists to deal with them.
The next step in logic - these low status therapists must find new ways to repeat the same strategy we've been using for at least 35 years, so we can pretend we are purveyors of the latest cutting edge treatment for the miscreants so they will get back to work or at least have the decency to stop bothering doctors.
And so, for the gazillionth time, funding is provided for a clinical trial, and another batch of victims is invited to partiipate in the farce.
It's groundhog day, corporate amnesia, a system problem, stepping on the same rake a gazillion times, ....
In fact it is INSANITY.
Does it occur to clinicians, clinicians organisations, research funders and health care funders that there is no other treatment for any condition that has been subjected to so many clinical trials over so many years? What drug company would expect their drugs to have dozens of clinical trials funded ever year for 35 years for the same drug?
Do the funders even realise the trials they are funding are the same as hundreds of others? Can you imagine the MRC, NIHR, NIH and all the other major funders in the world agreeing to fund hundreds of trials of the same drug that has already been shown to be ineffective or only weakly, subjectively and temporarily statistically but not clinincally effective every year for decades?
What the f--k is going on?
Can someone with better creative writing skills than me turn this rant into a publishable in mainstream media and medical journals article that will wake people with power up to this insanity?
by me.
This morning I skimmed a zillionth research report of a clinical trial comparing two versions of essentially the same psychobehavioural intervention. You know the pattern, I don't need to spell it out, a few buzz words will serve - kinesophobia, catastrophising, fear avoidance of exercise, baseline, individualised, small incremental increases, symptom focusing, sleep hygiene, yada yada blah blah.
The shiny new version will have some variation of face to face, online, group, individual, number of weeks, number of sessions, types and timing of exercises, multitudes of questionnaires, and so on, but it's essentially exactly the same every time.
In today's case it was for very broadly defined Long Covid, but it could equally have been for ME/CFS, MUS, enduring symptoms, somatic symptom disorder, functional disorder, conversion disorder, persistent physical symptoms, and for all I know not-eating-enough-pancakes disorder and staring-at-sparrows syndrome.
The premise is the same, regardless of syndrome category: healthy people stay healthy if they exercise, have a regular sleep and daily activity patttern that accords with current cultural norms, they don't catastrophise about every little symptom and they think positive thoughts.
The logic continues - people with symptoms that we, the superior all-knowing clinicians, don't understand, must therefore be behaving wrongly or thinking wrong thoughts. Doctors deal with real diseases and traumas that we understand, so we must not let these non conforming psychobehavioural miscreants contaminate real medicine, we must get some low status therapists to deal with them.
The next step in logic - these low status therapists must find new ways to repeat the same strategy we've been using for at least 35 years, so we can pretend we are purveyors of the latest cutting edge treatment for the miscreants so they will get back to work or at least have the decency to stop bothering doctors.
And so, for the gazillionth time, funding is provided for a clinical trial, and another batch of victims is invited to partiipate in the farce.
It's groundhog day, corporate amnesia, a system problem, stepping on the same rake a gazillion times, ....
In fact it is INSANITY.
Does it occur to clinicians, clinicians organisations, research funders and health care funders that there is no other treatment for any condition that has been subjected to so many clinical trials over so many years? What drug company would expect their drugs to have dozens of clinical trials funded ever year for 35 years for the same drug?
Do the funders even realise the trials they are funding are the same as hundreds of others? Can you imagine the MRC, NIHR, NIH and all the other major funders in the world agreeing to fund hundreds of trials of the same drug that has already been shown to be ineffective or only weakly, subjectively and temporarily statistically but not clinincally effective every year for decades?
What the f--k is going on?
Can someone with better creative writing skills than me turn this rant into a publishable in mainstream media and medical journals article that will wake people with power up to this insanity?
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