NICE Statement about graded exercise therapy in the context of COVID-19

Lots being written about a statement that was not actually made. Nowhere in the NICE statement are there words to the effect that GET is not recommended or does not apply, let alone a warning that it is inappropriate or potentially harmful. We know for a fact that it already is recommended by GPs, precisely because of the NICE guidelines.

I don't get it. It won't even work as legal cover since it's a non-statement. Portraying it as saying something it does not say is somehow very fitting for a field of "research" that routinely says things that aren't found in the actual sources.

Frankly bizarre.

 

There is now a correction to the article in BMJ.

The correction states:
We have replaced the word “advises” with “cautions” in the title of this news story (BMJ 2020;370:m2912, doi:10.1136/bmj.m2912) to make it clearer that the advice was not formal guidance.

 

When you make a symbolic statement and somehow manage to actually make it even less meaningful. Basically equivalent to sending thoughts and prayers then adding, "but I don't really mean it, though".

Although this is more reflective of the non-statement so it's actually a necessary correction. NICE should definitely act but choose not to despite having been aware of issues for well over a decade.

"Excellence"

 

amazingly quick response by BMJ; just shows it can be done.
Shame that NICE couldn't put the same 'caution' on the current guidelines.

 

Don't we need to be "cautious" before attributing too much credit to the BMJ? Is the full sequence of events clear? One can see that NICE could decide to be more "cautious" before "advising" people to potentially breach its own guidance.

 

I wondered who reached out the the BMJ on this? No responses on the article. Shows that they can be quick to make changes on some things.

I get the impression that the author of this piece tries to be fair, which seems rare at the BMJ.

 

Not only are people going to be very annoyed about the guidelines, I think they're going to get a shock when they realize just how much we've done to try to get them changed.

The fact that nothing had been done for so long and the harms have been wilfully ignored despite our efforts is going to show the BPS crew and NICE is quite a poor light.

Soon it's going to be obvious to people that the very patient community they're looking to for support has been subject to the same neglect and abuse for decades and nobody gave a .......

That's going to be a very scary prospect for them.

 

My view (learned cynicism) is that when they say individualised person centric care it is to be deliberately unclear.

It makes it sound as though the care is tailored to the individual and treatment/drugs will be given or changed depending on how the person reacts. That sounds like a good thing.

However, it is also a means of avoiding being specific as to what treatments are on offer and any relevant underlying philosophy. That impedes the ability to make informed consent.

For example, my gynaecologist gave me individualized person centric care. All of my options were very clearly laid out along the way and an open discussion of the pros and cons of each were discussed. The specifics were discussed the fact it was individualised and person centric was assumed.

All treatment should be individualised and person centric & that should go without needing to be said, unless you're being slippery while trying to appear open. Adjusting the dose of a medication, switching from one med to another that might suit better and so on is all based in the individual 's response.

When marketing tactics are used to describe the clinical offerings it tells you all you really need to know.

 

So if they want to correct, they can do it immediately. If they don't want to, they can take forever. Of course, fixing peer-reviewed studies is a bit different than a news story, which they treat more as journalism.

 

https://twitter.com/user/status/1288438360848175104


https://twitter.com/user/status/1288437626815614979

 

I'm sorry on behalf of my fellow GPs.
I have advised this in the past. We didn't know.
When we don't know we follow guidelines and
the guidelines as it turns out were wrong.

This is everything that is wrong about the GP system. GPs should be intelligent enough to have known perfectly well that the previous advice was incantation of drivel left over from the era of evidence-less physical therapy. And if they didn't know or understand they should have referred to someone who did.

The only tough bit is when the only people you have to refer to are idiots - which is what I found taxing in this area!

 

If only they had listened to their patients, then they would have known...
I'm glad there is a change happening though.

 

You can't just believe the patients ,you know. They have dysfunctional cognitions...not to mention maladaptive behaviour.

 

On the subject of questionnaires, and following on from a chat I had with my wife the other day.

Whatever ailment you are suffering from, wherever there are subjective symptoms involved, there are really two components to them:

1. The symptom itself, be it pain, fatigue, feeling like sh*t, etc.
2. How well you are coping with '1'.

But when you are coping better with a symptom, you do not really think "the symptom is still just as bad but I'm coping better with it" ... that's not how coping works. Coping better somehow takes the edge off such subjective symptoms, so more likely to report that the symptoms seem less severe. Hence 'subjective'.

 

That is the difference between feeling better and being better and why objective measures are needed in research.

 

https://twitter.com/user/status/1288458262657015809

https://twitter.com/user/status/1288458717588066304


(I'm not getting into the argument of which is the 'best' diagnostic criteria. But Drs should at least be aware of (and have read) the ICC as there are many symptoms coming up with 'long-covid' that are in there which are not being recognised as potential symptoms of ME.)

 

the use of 'better' is also problematic as it is intended as a comparative but is frequently used as a 'final state' ie 'recovered'.