Submission to the Scottish Parliament by Jonathan Edwards

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For no particular reason I am posting here a document that will be made public by the Scottish Parliament in support of @Emsho's petition.

 

Jo, not sure if you've submitted it yet but I found the sentence, "The reason why we have placebo-controlled trials (not just dummy-controlled) and normally blind both patient and investigator to which treatment is which is that unless you do this, if you use subjective outcomes you get uninterpretable results." difficult to parse.

Personally I would have probably written it as "The reason why we have placebo-controlled trials, not just dummy-controlled, and, normally, blind both patient and investigator to which treatment is which is that, unless you do this, if you use subjective outcomes you get uninterpretable results.".

Not claiming my version is perfect Queens English in anyway, just as a lay-person I find it easier to read.

 

Excellent document, thank you very much @Jonathan Edwards. I would just add to @Andy's observation my own, which is that on p.3 you refer to the "Increasing Access to Psychological Therapies" programme, where in fact it is called "Improving Access to Psychological Therapies". It's a tiny gripe.

 

Oh, I am rather glad I could not even remember their proper name. It wouldn't be improving anyway would it? I think it is what is called a Freudian slip.

 

It's probably a bit like not knowing who the Kardashians are.

 

Well that makes it even more difficult to parse! And I think Scottish MPs should do a bit of tricky parsing now and agin - keeps them their McToes.

 

Who are they?

 

Excellent document - just one thing aside from the above observations, struck me as maybe needing rephrasing: "The patient community has been publicly vilified by the trial authors and colleagues but they have turned out to be right." It reads as not clear as to whether it was the patient community or the trial authors that have turned out to be right, ha ha. Great otherwise.

 

I wish I didn't know.

 

Good letter...I like how it simply captures the key points without getting too complicated

 

But there are a couple of what look like stray words in there (probably left over from an edit) that mean that the sentence can't be parsed:

The reason why we have placebo-controlled trials (not just dummy-controlled) and normally blind both patient and investigator to which treatment is which is that unless you do this, if you use subjective outcomes you get uninterpretable results.​

Also, what's the difference between placebo-controlled and dummy-controlled? Will the SMPs know?

Is it unhelpful of us to suggest edits at this stage?

Either way, thanks very much for doing this - it's a strong and clear and simple explanation of how we ended up in this ridiculous and awful situation.

 

They are not stray words, @Sasha. You are not parsing it right. There could be some more commas in there but I have deliberately avoided lots of commas to make it sound a bit more conversational and direct. It is a matter of which treatment is which. I have also deliberately made this sentence a bit complicated to make sure the reader does not skim through thinking it is all very straightforward - which it is not. I have said reasonably easy to explain.

The difference between a placebo control and a dummy control is crucial. A placebo control is intended to mimic all the non-specific factors in the treatment arm that might give spurious positive results. A dummy is just a dud control. I agree that dummy tends to imply acting as placebo but to try to explain the inadequacy of the two comparator arms in more detail within the attention span of expected readers is not likely to be practical. I suspect the SMPs will not know, but I would hope they would get the gist if they know placebos are supposed to mimic spurious positive results, which most people do.

When writing this I was very aware that it was going to sound like an off-the-top-of-the-head response rather than a meticulous critique and I thought that was likely to be more telling here. I realised that there are statements that could be challenged by the BPS advocates as misrepresenting their position. But that seemed to me all to the good because the more the BPS people respond the more inconsistent they make themselves seem. Even if I am being a bit sloppy in my statements I am standing on granite. they are standing on quicksand.

 

And none of you have spotted the real non-sequitur in the text, which is where I refer to the other two arms of PACE without saying I am talking about PACE!

But it is all part of the decoy strategy (ahem).

 

Clearly this must become my new justification.

 

Oops - yes, you're right - it's taken me about a dozen re-readings to get it, though...

 

They wrote the PACE trial.

 

Quote from JE document re CBT/GET/lightning type research:

"If you are not able to obtain reliable evidence you cannot obtain unreliable evidence and treat it as reliable."

Well that just about says it all, spot on!

 

I would be so disappointed if you were not completely out of touch with popular culture. It would seriously undermine your credibility as an expert witness.

 

Oh, but the problems *do* arise from lack of understanding of statistics and trial structure, because so much is reliant on psychology!