NICE Clinical Knowledge Summaries: Tiredness/Fatigue in adults (includes CFS).

I received this about NICE and 'The Summary' issue as H has now joined S4ME and drew my attention to the conundrum initially.

'Thanks for alert to this- it needs attending to, pleased that Caroline Struthers is taking it up with NICE.

I really don’t see how NICE can hold the line that "the CKS do not represent formal NICE guidance.”

Thre is a link to CKS from the NICE home page: www.nice.org.uk which takes you to:
https://cks.nice.org.uk Not only does this web address clearly imply that CKS are purveyed by NICE, but there is no blurb on the page to advise otherwise.
Yes, some other org puts them together (though the webpage doesn’t tell you that either). But it’s pretty clear that this is being purveyed as official NICE info.

They can’t have it both ways. Either take responsibility for info on their webstie that is presented as such or abnegate responsibility and clearly state on the website that NICE are not responsible for the CKSs.

I have just signed up for an S4ME account but I dont’ know my way around that well so please feel free to post this yourself if it would help.'
 
Suffolkres said:
I received this about NICE and 'The Summary' issue as H has now joined S4ME and drew my attention to the conundrum initially.

'Thanks for alert to this- it needs attending to, pleased that Caroline Struthers is taking it up with NICE.

I really don’t see how NICE can hold the line that "the CKS do not represent formal NICE guidance.”

Thre is a link to CKS from the NICE home page: www.nice.org.uk which takes you to:
https://cks.nice.org.uk Not only does this web address clearly imply that CKS are purveyed by NICE, but there is no blurb on the page to advise otherwise.
Yes, some other org puts them together (though the webpage doesn’t tell you that either). But it’s pretty clear that this is being purveyed as official NICE info.

They can’t have it both ways. Either take responsibility for info on their webstie that is presented as such or abnegate responsibility and clearly state on the website that NICE are not responsible for the CKSs.

I have just signed up for an S4ME account but I dont’ know my way around that well so please feel free to post this yourself if it would help.'
Click to expand...
Janet has just written back to say....

"I have asked the publishers of the CKS to consider your feedback and will contact you again as soon as I receive a response"

I didn't have the heart to point out that NICE are the publishers of the CKS. Presumably she means Clarity...? Who knows?
 
NICE Clare has also spoken, after a chivvy. And now we have Janet's last name - exciting! I might give myself a little break before replying....

Dear Caroline,

Apologies for the delay in responding.

As you rightly note, NICE has recently developed a guideline support document that aims to facilitate collaborative working and increase the use of Cochrane reviews in NICE guideline development. This document is going through final sign-off processes before being circulated to all NICE developers, as such it was not in operation when the ME/CFS guideline was in development. Going forward the rationale for not including a relevant Cochrane review in a NICE guideline will be communicated to the CRG (via the Managing Editor), the Network Associate Editor and the Deputy Editor in Chief (Toby).

With regards to the process for excluded studies more generally, they are detailed in the relevant appendix of the NICE evidence review with the reason(s) for exclusion documented.

I am aware that my colleague, Janet Fahie, is in contact with you re your concerns about NICE Clinical Knowledge Summary for tiredness in adults.

I hope this addresses your queries, please do get in touch should you require further information.

Best wishes,

Clare

Clare Wohlgemuth

Senior Technical Analyst, Centre for Guidelines
 
Suffolkres said:
This was paid for and reviewed in March 2020!

So, why does it not carry a health warning like the NICE web page for ME?
When will it carry a health warning like the NICE guideline web page?

I think the NICE ME Guideline lead Rupert F needs to answer this question ...!
Is it conspiracy or cock up .. or both?
Click to expand...

It could be hard for NICE to hold the line that "the CKS do not represent formal NICE guidance.”

CKS are prominently listed on the NICE home page: www.nice.org.uk
Link takes you to: https://cks.nice.org.uk
This web address clearly implies that CKS are being purveyed by NICE. There is no blurb on either the CKS or NICE webpages to advise otherwise.
The work of putting together may be contracted out, but doctors and other profs will be left with at the very minimum a strong impression this is being purveyed as official NICE info.

NICE can’t have it both ways. Either take responsibility for this 'information' or abnegate responsibility and clearly state on the website that NICE are not responsible for the CKSs.

Incidentally, a search for 'chronic fatigue syndrome' on the 'Evidence Search' box on NICE home page produces a list of 2288 results:
1. The interactive flow chart based on CG53
2. The home page for CG53
3. Information for medics on the 'patientuk' site (last I looked this was not good)
4. The CKS on when to suspect CFS if person has chronic fatigue (which goes to show that if you can get people asking the wrong questions you don't need to worry too much about the answers; same 4 top results if you search on 'chronic fatigue', by the way)
 
Caroline Struthers said:
NICE Clare has also spoken, after a chivvy. And now we have Janet's last name - exciting! I might give myself a little break before replying....

Dear Caroline,

Apologies for the delay in responding.

As you rightly note, NICE has recently developed a guideline support document that aims to facilitate collaborative working and increase the use of Cochrane reviews in NICE guideline development. This document is going through final sign-off processes before being circulated to all NICE developers, as such it was not in operation when the ME/CFS guideline was in development. Going forward the rationale for not including a relevant Cochrane review in a NICE guideline will be communicated to the CRG (via the Managing Editor), the Network Associate Editor and the Deputy Editor in Chief (Toby).

With regards to the process for excluded studies more generally, they are detailed in the relevant appendix of the NICE evidence review with the reason(s) for exclusion documented.

I am aware that my colleague, Janet Fahie, is in contact with you re your concerns about NICE Clinical Knowledge Summary for tiredness in adults.

I hope this addresses your queries, please do get in touch should you require further information.

Best wishes,

Clare

Clare Wohlgemuth

Senior Technical Analyst, Centre for Guidelines
Click to expand...

After a little break, I replied to NICE Clare yesterday

Dear Clare

Thanks for your message. I was not aware the guideline support document was not yet in action – I must have missed that rather crucial bit of your presentation!

You didn’t address my question about feedback to authors of excluded primary and secondary review studies and to their funders? Is this included in the guideline support document? Do you agree that it would be a useful service to explicitly inform funders such as the NIHR and the MRC that studies they have funded in the past cannot be used to support recommendations because they are irrelevant and/or of low quality? If you are not in a position to answer, please could you pass this question on, or let me know who I should address it to?

Janet has replied to me saying that Clarity will not make any updates to the CKS until August. I have asked them to remove a reference to a Cochrane review supporting the management guidance which Cochrane themselves say should not be used. I am not sure why they can’t do this immediately, and have asked Janet to put me in touch with whoever is responsible for the Clarity content on the NICE website.

With best wishes

Caroline
 
Suffolkres said:
Tiredness/fatigue in adults: Changes
Last revised in March 2020

Changes
February to March 2020 — reviewed. A literature search was conducted in February 2020 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of the topic. The topic has undergone minor restructuring. Recommendations have been updated in line with current evidence. The section on Red flags in the Diagnosis section has been deleted and the content incorporated into the Assessment node. No major changes to the recommendations have been made.

Previous changes
January to February 2015 — reviewed. A literature search was conducted in January 2015 to identify evidence-based guidelines, UK policy, systematic reviews, and key randomized controlled trials published since the last revision of this topic. No major changes to the recommendations have been made.

July to October 2009 — this is a new CKS topic. The evidence base has been reviewed in detail, and recommendations are clearly justified and transparently linked to the supporting evidence.
Click to expand...
The topic 'tiredness/fatigue in adults' may well have been introduced as a new topic back in 2009. However it is all but certain that 'CFS' used to exist a topic in it's own right. I know because I have an account of the CKS coverage from the Danum ME newsletter Spring 2011. This refers to CFS throughout and is not pitched at 'when does chronic fatigue become CFS?' [correct answer - it doesn't, this illness is not about fatigue]. I have tried uploading the file for info but apparently file size too large. Anyway, Baroness Scott's PQs have not been answered.
 
Caroline Struthers said:
Do you agree that it would be a useful service to explicitly inform funders such as the NIHR and the MRC that studies they have funded in the past cannot be used to support recommendations because they are irrelevant and/or of low quality?
Click to expand...
More of this, please. This is significant and critical to stop the flow of junk. It amounts to a DDOS attack on reality. Funding obviously useless junk must have consequences.
 
rvallee said:
More of this, please. This is significant and critical to stop the flow of junk. It amounts to a DDOS attack on reality. Funding obviously useless junk must have consequences.
Click to expand...
Plan next to write to Professor Fiona Watt (to question the 2018 defence of PACE and unfulfilled promise to make data available https://webarchive.nationalarchives....org/news/browse/criticism-of-the-pace-trial/) and to Ken Stein at NIHR who is directly responsible for the funding of Cochrane's UK review groups and central infrastructure
 
HMB said:
The topic 'tiredness/fatigue in adults' may well have been introduced as a new topic back in 2009. However it is all but certain that 'CFS' used to exist a topic in it's own right. I know because I have an account of the CKS coverage from the Danum ME newsletter Spring 2011. This refers to CFS throughout and is not pitched at 'when does chronic fatigue become CFS?' [correct answer - it doesn't, this illness is not about fatigue]. I have tried uploading the file for info but apparently file size too large. Anyway, Baroness Scott's PQs have not been answered.
Click to expand...


HMB,
you said today in a private email that this 2018 letter of complaint to NICE might be helpful in attempts to steer NICE in the right direction?
 

Attachments

Suffolkres said:
HMB,
you said today in a private email that this 2018 letter of complaint to NICE might be helpful in attempts to steer NICE in the right direction?
Click to expand...
Yes, I came across hard copy yesterday and read it in full. Purpose of letter was to raise concerns abut the composition of the guideline committee, couched in terms of what the guideline needs to achieve against backdrop of current problems in NHS approach. A rich resource even now when there is cause to be concerned about the evidence reviews
 
Caroline Struthers said:
After a little break, I replied to NICE Clare yesterday

Dear Clare

Thanks for your message. I was not aware the guideline support document was not yet in action – I must have missed that rather crucial bit of your presentation!

You didn’t address my question about feedback to authors of excluded primary and secondary review studies and to their funders? Is this included in the guideline support document? Do you agree that it would be a useful service to explicitly inform funders such as the NIHR and the MRC that studies they have funded in the past cannot be used to support recommendations because they are irrelevant and/or of low quality? If you are not in a position to answer, please could you pass this question on, or let me know who I should address it to?

Janet has replied to me saying that Clarity will not make any updates to the CKS until August. I have asked them to remove a reference to a Cochrane review supporting the management guidance which Cochrane themselves say should not be used. I am not sure why they can’t do this immediately, and have asked Janet to put me in touch with whoever is responsible for the Clarity content on the NICE website.

With best wishes

Caroline
Click to expand...
I noticed just today that an NHS evidence search on 'chronic fatigue syndrome' produces a prominent steer to the Cochrane Reviews of CBT (item 7 of 2291) and 'exercise therapy' (item 10). See https://www.evidence.nhs.uk/search?q=chronic-fatigue-syndrome. (However searching on 'myalgic encephalomyelitis' produces a somewhat different list, which has the CKS much further down and does not appear to include either of the Cochrane Reviews in the top 50: https://www.evidence.nhs.uk/search?q=myalgic encephalomyelitis. There are 23,063 results for ME which at first I thought was good till I started trawling down and found that publications with 'me' as in 'me, myself' are included. Honestly! There are some other interesting peculiarities about the two lists - suggest worth a quick look.) Hope this is helpful
 
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