Rethinking the treatment of CFS — a reanalysis and evaluation of findings from a recent major trial of GET and CBT (2018) Wilshire et al.

Free full text:
https://bmcpsychology.biomedcentral.com/articles/10.1186/s40359-018-0218-3

 

Some links if you want to share it:
https://twitter.com/user/status/976624589760548864

https://twitter.com/user/status/976624613873594369

 

https://twitter.com/user/status/976630319439851520

https://twitter.com/user/status/976631683561807877

https://twitter.com/user/status/976633489368985600

 

Congratulations to all the authors for this excellent analysis, and for getting it published. Today’s release of the SMC’s “alternative facts” sheet suggests they are on the back foot and getting desperate.

Well done!

 

https://twitter.com/user/status/976636317923758080

 

And particular congratulations for managing to get some coverage of this in the UK press. Great work everyone involved!

 

https://twitter.com/user/status/976639695315664897

https://twitter.com/user/status/976641389927829504

 

https://twitter.com/user/status/976643946695872513

 

From the BBC article, quoting neurologist Dr. Jon Stone:

This seems to be the fallback position. Keep recommending GET/CBT, because it's better than nothing.

 

Really, the question is 'does anyone capable of having a realistic discussion of its pros and cons of CBT/GET with patients want to work as a CFS CBT/GET therapist?' The answer seems to be 'no'.

 

Firstly very well done to the authors for the paper and for getting media attention. The articles might help to soften the strong hold of the idea of behavioural intervention and rehabilitation as remedy for CFS

However if the news went to the smc who've already released a fixed contrary position who then release it to the media through their filter, it is problematic. Both BBC and the times use chronic fatigue in the headline, which is hugely trivialising and I suspect came from the smc presentation if there was one.

I have not read the times in full so this is on BBC, one can only imagine how Miriam tucker would have made this a fully rounded, in context story - such as IOM report, biomedical research , severity , cost to economy, concern over NHS care, bias of funding, other countries dropping cbt get etc - rather then this study now says this, but they still say that on one study. The charities were not used much as comment so nothing robust with language such as call for retraction, scandal, grossly inflated claims, risk of harm from get, unhelpful media promotion , waste of time and money, how did this hype happen , challenging the Cochrane suppprtive evidence was said.

The BBC article gave the bare facts of the reanalysing paPer which is very good to have out there. However it was quite minimally covered and it's not coincidence surely that right next to this on BBC health is a longer story on tai chi as effective mind body treatment for FM.​

Jon stone suggesting that we might need other rehabilitation therapies is astonishing.

It's less boat rocking than it could have been but I guess that's inevitable with BBC smc. If NHS England analyse the paper in depth and discuss it, it might have greatest Impact, on health professionals. Look forward to reading the times which might be less establishment .

The smc put up JS and CP as experts. I'm not sure on CP here, it's either good for being fully negative with some pointed personal critique, in contrast to JS, or weak for mainly just quoting the authors of the paper rather than personal comment, in contrast with JS.

 

There are 2 audiences for this 1) Expert health professionals/ scientists who drive research and 2) The public and the medical profession who cast a glancing eye over these types of stories.

Don't underestimate the power of planting a seed of doubt over GET/CBT. We know how damaging headlines saying ME patients can exercise themselves out of it have been, even when people don't read the story. The way this paper has been presented by the BBC and The Times is good from that perspective. Easy bite sized pieces we can share with the uninitiated who don't want to wade through scientific sounding papers or even read the story.

 

With no acknowledgement of the risk of harm involved in undertaking GET and the fact that no-one can tell you if you're going to end up in a wheelchair or not (or more importantly actually informs you of the risks).

 

From Michael Sharpe:

Is he trying to be funny? He's not seriously trying to imply that the authors were unduly selective in the choice of data to include in their analyses is he?

Words almost fail me. It's not as if the authors wouldn't have gladly used the whole trial dataset, but somebody blew 250k of somebody else's money making sure they couldn't.

 

Also this one:

The PACE authors only wrote their paper with the original protocol because they knew once they had to give up the data that it was going to be revealed

 

To be fair to Michael Sharpe, his description of Alem's original FOI request as vexatious - causing frustration, annoyance and worry - is looking increasingly prescient.

 

Congratulations to the authors!

The BBC piece is disappointing - they've swallowed the SMC line whole and are regurgitating it. I can't read the Times piece because it's paywalled but it certainly sounds more accurate, given its headline.

http://www.sciencemediacentre.org/e...-for-chronic-fatigue-syndrome-cfs-treatments/

Yes, that is indeed a conflict of interest.

 

Well done and thank you to all who worked on this.