Paul Garner on Long Covid and ME/CFS - BMJ articles and other media.

Multiplying up the per capita liabilities that could occur, this is a 'brave' move, relative harming public health in less populous countries ("sarcasm mode, off")

 

Yea it would require them to own up that while there was an aspiration the (delivered) reality was crap - @Jonathan Edwards comments, re whether you could ever develop a metric (like Cochrane) to evaluate research, come to mind. So they won't climb down and say this was all rubbish.

 

https://twitter.com/user/status/1427624238513631236


good to see PG is keeping up to date with research

 

Garner had SARS-Cov-2, he went to bed for at least 3 moths, then started getting better. That kind of start is not what a typical ME-patient have. That’s the majority of patients. And yes some patients are in fact extremely severely ill and totally incapacitated from the absolute get-go. Most ME-patients are not in that category, but patients just don’t go to bed. Most have done the total opposite of you, Mr. Garner. There are different reasons for a bad start, long time to diagnose, the “just carry on”, own personal strength to carry on, a lot of things in play. Unfortunately data and experiences tells us that is not a optimal start, not a start that is helpful in the long run, very often the contrary.

So Garner, please stop spreading lies and misinformation about ME-patients and approach. It was you who went to bed, had that “luxury” to a optimal start, who gave your body a fair chance to recover. You should be very grateful. That’s worth thinking over when going back to 1947 for all eternity and not even looking at the facts and data.

 

He is unable to accept the fact that he never had ME. Digging in the archives now to try and prove his point is just embarrassing for someone in his position.

 

He has his own particular knack doesn't he.

 

He 's been deep diving into the literature. I think that if he looks about forty years later he might find what the discussion was about.

 

I was hoping that his relative media and twitter silence meant he'd realised what a fool he's making of himself.

 

Evidence synthesis ... surely that cannot be as bad as it sounds?

Took a quick look on Paul Garner's twitter page ...

https://twitter.com/paulgarnerwoof?lang=en

And noticed this ...


Which then led me to here ...

https://www.lstmed.ac.uk/centre-for-evidence-synthesis-in-global-health

And when I then searched a bit more on the notion of evidence synthesis I found ...

https://royalsociety.org/topics-policy/projects/evidence-synthesis/

Which says ...

Am I missing something here? It comes across as saying collect some good quality bits of evidence, then chat about them it and mash it all together, so you can then assume that what you end up is another new piece of evidence that has never itself really been tested.

But do note I'm coming to this completely cold, and have read very little, so hopefully I am completely wrong on this. It may just be very bad naming of something very legitimate - it would be wrong to be assume the worst just because it has Garner's name associated with it.

ETA: Maybe I'm misunderstanding use of the word 'synthesis' in this context? Does it just mean 'collate' in this usage?

 

Evidence Synthesis is what cochrane does, ie. systematic reviews: https://www.cochrane.org/news/evidence-synthesis-what-it-and-why-do-we-need-it. Garner is co-ordinating editor of the cochrane infectious disease group

 

Yes...but what is the epistemological value of it?

 

Maybe my fears have some grounding then ...

 

The idea behind systematic reviews is essentially using systematic methods, such as GRADE and those outlined in the cochrane handbook of systematic reviews to analyse and assess the quality of evidence. The idea is that since the methods are systematic, that eliminates bias, and because they assess all the evidence on a particular topic, that means they show the best and most evidence based overall view of the evidence for something.

https://en.wikipedia.org/wiki/Systematic_review

 

I think that there may be a belief that introducing the word "systematic" into the assessment persuades people of the value. Do those doing the evaluation read the full papers, reassess the statistics, or do they just accept the authors' word. I have seen papers which would seem capable of bearing conclusions other than those reached by the authors.

EDIT punctuation. sorry my posts often appear very different to what I thought I typed.

 

There is a problem evaluating complex interventions in real life situations where it may be impossible to control for all the many variables involved both in the inputs and in the outcomes. When I was an undergraduate there was discussion of the need for convergent evidence in some situations. That you needed a variety of evidence from very different approaches all pointing to the same answer to compensate for the fact that the answers from individual experiments were too narrowly focused to answer more general questions.

To over simplify, for example in the sixties experimental psychology had the idea that you could create perfect focused experiments in highly controlled situations such as running rats in mazes, which would give us the basic building blocks to then construct explanations of more complex real life behaviours. Unfortunately as the decades moved on all these rat psychologists could really do was wonder at the complexity and sophistication of their rats, with even very basic questions remaining unanswered. So an alternative approach was required. To produce adequate explanations of human behaviour, though each individual source of evidence did not necessitate a final conclusion, when all the different sources, the animal studies, the drug studies, the normal physiology and behaviour, the abnormal physiology and abnormal behaviour became congruent then perhaps a reasonably certain answer was possible.

For me a big problem of the GET/CBT research is that it has never seriously attempted to look at other sources of evidence other than their one preferred experimental design. To propose a treatment for deconditioning and false cognition without ever looking at whether deconditioning and false cognitions are actually present, without asking is there evidence that this is not a distinct biological condition but just part of the normal continuum, is in itself problematic especially when you choose an experimental design that maximises your uncertainty.

I suspect there is overlap with this idea of convergent evidence and talk of ‘synthesis’ in this context. However it is important to remember that each component being synthesised into your answer still carries its original uncertainty, and though the idea of congruence or convergence is intended to reduce the uncertainty of your ultimate conclusion, your synthesis could just end up multiplying the uncertainty of the final conclusion. I think this multiplication of uncertainty is inevitable when you adopt this approach not as part of a serious attempt to find a real answer, but rather as a response to the failure of your current defences of the status quo.

[added - Freud when attempting to understand and critique the neuropsychology of his day confronted head major problems in interpreting its evidence sources, his monograph ‘On Aphasia’ is a major work of genius, with some of his questions about applying the scientific method to human behaviour still needing answers today. But unfortunately he threw the baby out with the bath water and decided the way forward was to totally rely on his own personal interpretation or synthesis, replacing science with literary creativity. It seems to me in the current attacks on NICE we are seeing parts of medical science at a similar cross roads. The attackers of NICE’s analysis in relation to CBT are simultaneous trying to shaw up the cracks in their own science through denial and distraction while also attempting to justify going beyond their problems by suggesting a new approach which boils down to literary creativity and ultimately fiction.]

 

He says 'synthesis' I say interpretation. And interpretation by the least qualified due to a plethora of preconceptions.

 

I think PG definition of 'evidence synthesis' is his own selective narrative on his Twitter platform.