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

How much influence do you all suppose Garner wields? In the US, he seems a relatively nondescript figure, but that could just be my misinterpretation or wishful thinking.

 

"Learning to feel tired"

I dont feel tired



<sigh>

<despair>

 

I wonder what he is doing behind the scenes, in collaboration with people in Norway and The Netherlands in particular. I suspect he's trying to influence guidline updates and related exercises.

 

Well, at least it's exposing just how much of a clown show the EBM industry is, nothing but cherry-picking with a few extra steps. Basically 3 logical fallacies and 2 biases in a suit.

In a sense this is good, the mask has been taken off and the quackery is becoming loud, there's no longer any embarrassment about it. The same people who pretend that RCTs and systematic reviews are the best evidence around, and they still obsess on exploratory opinion-based narratives to support their beliefs.

Really this has to be emphasized: the whole discipline of EBM is about a hierarchy of evidence, with anecdotes at the very bottom. Even though the discipline is obviously A-OK with individual anecdotes being emphasized above population studies and surveys, showing how they don't even care about their own standards, where convenient, it's cherry-picking all the way down. This is what Garner is doing, his own biased personal anecdote. His specialty is clinical evidence. And this dude is basically going "yeah so the preacher swung his jacket and I was healed, HEALED!" and he is still respected. Somehow. Incredible.

But beyond that, at the top of the pyramid sit systematic reviews that basically consist of selecting a mix of trials and studies, stripping all details from them (so that hundreds of CBT trials are essentially 100s of times the same thing, all their substance is removed from that process, it becomes fully generic CBT, effectively the same as creating a supercategory for "drugs", which drugs? any drug, any dosage) and doing a bunch of opinions and statistical analysis on them to pretend to make it a rigorous process.

And still exploratory narratives, poorly articulated sophistry, individual anecdotes and other forms of evidence that are supposed to be ignored as insignificant in EBM are constantly emphasized to support the narrative. As Garner is doing here. A co-founder of the organization most-known around the world, synonymous with evidence-based medicine.

This is a similar issue to where many studies tried to pick apart why we disliked psychiatry or rejected psychological explanations as a matter of principle, found it was not the case and kept on saying anyway. By Wessely's own admission one of the highlights of his career was thinking ME was depression, whining that he couldn't tell the difference, than finding it wasn't. Even though he is obviously aware that most physicians think this is the case, based on his work, and would never correct anyone saying so.

Which comes down to this simple fact: they don't even believe in their own process or results, even in their own studies, because they understand that it's not a valid process, that all it does is support conclusions without any attempt at validity. They cherry-pick their own work. The people at the top of this discipline literally don't swallow their own medicine, they know it's junk. And no one cares, because it's a free-for-all jobs-for-life with zero accountability or oversight.

And actually Garner using anecdotes here is even worse than usual, because it's one thing to point to anecdotes, but it's a whole other thing to assert that it must be universal. It's not just saying that this or that anecdote suggests a treatment for some, they are framed as being universal. Not only is it possible to use this as a treatment, it is 100% guaranteed.

The very best that can be said of the "best" evidence (PACE) is that at most it "can be of benefit to some", somewhere on the order of 1/7 in the intention-to-treat, show differences on questionnaires but not in real-life outcomes. And out of this and anecdotes come "this works 100% of the time", which is completely absurd. This is even beyond magical thinking, it's clearly irrational fanaticism.

 

Can you imagine the sheer stupidity of people who think "learning to feel tired" is a good way of thinking about a life-destroying illness?

Not to mention that we have a pretty good idea how "unlearning the illness" works as treatment approach because that's very similar to the CBT/GET approach. They probably wrote the article because they thought the validity of CBT/GET had been proven.

 

Yep. The area would sit as a subject under the super-subject of marketing rather than medicine based purely on what those doing it spend all their time doing and their aim/what they are trying to achieve.

Except even marketing wouldn't touch it because it isn't orienting to customer needs but sellers needs, has methodological issues that business would have no truck with, and marketing has legislation and regulation meaning that it has to be accurate and not misrepresent

So I don't get which part of what they are doing they think is science, or even grants them jobs in academia or the real world? The whole existence of it and the people inside it seem to always lead me to think they just sit inside a few massive loopholes that haven't somehow been closed,like a fifth dimension

 

particularly as he seems to be adopting the same behaviour on twitter as the others down the hole
"Who can reply?
People @PaulGarnerWoof follows or mentioned can reply"

eta:
and of course there is this
"
Advisory boards

• Chair of the Consumer Advisory Group, The Collaborative on Fatigue Following Infection 2020- (COFFI)
• Member of the Strategic Advisory Group for the COVID-19 Longitudinal Health and Wellbeing National Core Study (link is external)(opens in a new tab) and the National Convalescence Core Study 2020-
• Member of the READ-It Advisory Group (August 2022-)
  
  

Continuing academic external positions

• Consultant in Public Health with Public Health England (academic honorary contract)
• Fellow, Faculty of Public Health Medicine
• Senior Research Fellow, WINDREF, St George’s Medical School, Grenada
• Extraordinary Professor in Epidemiology and Biostatistics, Stellenbosch University
  
  https://www.lstmed.ac.uk/about/people/professor-paul-garner

 

I don't think Garner has any real influence. Doctors may listen to him but probably only those who think that way anyway. I don't think his claims for the validity of trials will carry any weight.

I find his persistence with this pretty peculiar, as if he is losing his judgment more generally. It is completely ridiculous that anyone involved in evidence assessment should regard these trials as robust. Maybe that is just the Cochrane counterculture that was always hiding in plain sight but I doubt many other Cochranites would make claims like Garner's on Twitter.

 

Brain fog can affect judgement, and make me insistent that a conclusion based on faulty cognition and memory is correct.

It has, in the past, also led to behaviours like he is showing, trying to correct, or minimise those who don't share the same point of view, due to having functioning brains.

It can take away any ability to re-evaluate.

So possibly not as 'cured' as he thinks he is .

 

Do we? Do we have any evidence he even read the old Cochrane review?

From what I've seen, it seems he can make some quite bold claims more on the basis of his instinctive thinking than anything more substantive. I'm not sure that's terribly unusual for academics. I would be far from confident he even read the Cochrane review before being critical of it.

I think that it's a mistake to try to think that we can understand what happened with Garner, as a lot will be uncertain and unknown.

My impression is that he is personally connected in a way that makes someone influential in the EBM community, and that those sorts of personal connections are very important. IMO the poorly explained and overly critical response to Garner by some people was really destructive.

 

He did go off calling the Cochrane GET review BS at some point, outrageous.

Hard to say what happened and if he carefully read it, but he sure trashed it publicly until he reversed.

 

Agree but for the last bit. I haven’t read responses referred to etc so can’t agree with that being destructive etc

 

I think he is just an empty echo chamber.

I had never heard of the guy before all this, and I doubt any one else had much.
Cochrane cronies are not eminent. They are largely regarded as retentive nerds outside their own sphere.
The people that have influence are presidents of colleges and special government advisors, some of whom we know of.

 

What is so absurd about the 'learning to be tired' thing (other than the fact i dont feel tired of course), is that even if they understood the illness of which they claim to speak, they seem to have no understanding that the majority of us, during out initial viral recovery, did EXACTLY what they now recommend. We believed we were fine, couldnt understand why we kept getting these symptoms, didnt link them with activity or stop to rest because of the delay in PEM kicking in after the exertion. So certainly didnt avoid activity or overly rest until we literally could no longer stand up

We werent remotely anxious about our symptoms simply kept up the positive belief that we were fine & carried on with our lives.

When many of us became ill there was no medical advice, there was no internet or support groups, there was nowhere to be advised to rest or to pace or anything else. There was no 'amazon' to find abook about it, there was nothing in the local library, there was no research you could do as a patient.

I told myself i was well, believed i was well, behaved as if i was well. I assumed every massive (what-i-now-know-to-be-PEM) crash was a new virus, & I carried on as normal. Living my life, as normal. Until one day, about 18mnths after the initial virus/infection, it all came crashing down & i ended up in hospital with what they initially thought was a brain tumour.
There was no 'learning' anything. There was no cognitive or behavioural, or indeed emotional response prior to that collapse, other than completely ignoring & dismissing any & all symptoms.

 

These people forever seem to get the notion of science @rse about face. It is not about cherry picking all the things you think will support your biased opinions and ego, without regard to objective evidence. It is about having a real passion for truth and objectivity, and following the evidence wherever it takes you no matter what; for a real scientist, I would think any ego will be reliant upon being able to look in the mirror and to know that is what you strive for.

And yet again - "chronic fatigue". The main chronic fatigue I get is from listening to this kind of cr@p over and over again. Chronic cr@p fatigue. What has it to do with ME/CFS Mr. Garner!

 

Would be interesting to know if his observations then would be undermining the rubbish he spouts now.