The Updated NICE Guidance Exposed the Serious Flaws in CBT and Graded Exercise Therapy Trials for ME/CFS, 2022, Vink and Vink-Niese

Abstract

The British National Institute for Health and Care Excellence (NICE) recently published its updated guidelines for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). NICE concluded, after an extensive review of the literature, that graded exercise therapy (GET) is harmful and should not be used, and that cognitive behavioural therapy (CBT) is only an adjunctive and not a curative treatment. Leading proponents of the cognitive behavioural model (CBmodel) find it difficult to accept this paradigm shift. In, for example, an article in The Lancet, they try to argue that the new NICE guideline is based on ideology instead of science.

In this article we reviewed the evidence they used to support their claims. Our analysis shows that the trials they used in support suffered from serious flaws which included badly designed control groups, relying on subjective primary outcomes in non-blinded studies, including patients in their trials who didn’t have the disease under investigation or had a self-limiting disease, selective reporting, outcome switching and making extensive endpoint changes, which created an overlap in entry and recovery criteria, using a post-hoc definition of recovery which included the severely ill, not publishing results that contradict their own conclusion, ignoring their own (objective) null effect, etc. The flaws in these trials all created a bias in favour of the interventions. Despite all these flaws, treatments that are said to lead to recovery in reality do not lead to objective improvement. Therefore, these studies do not support the claim that CBT and GET are effective treatments. Moreover, the arguments that are used to claim that NICE was wrong, in reality, highlight the absence of evidence for the safety and efficacy of CBT and GET and strengthen the decision by NICE to drop CBT and GET as curative treatments for ME/CFS.

Open access, https://www.mdpi.com/2227-9032/10/5/898

 

Very good and important to have this paper at hand during the development of guidelines, including the one from the Netherlands that will be based on the NICE guidelines.

 

This paper seems to be in response to this

https://www.s4me.info/threads/new-n...ology-than-science-2022-flottorp-et-al.24548/

 

Yes, that’s correct

 

Excellent!

[my bold]

Why do these BPS-ites never get this: If you can only ever claim that an intervention could help someone, without being able to claim with certainty that it will help them, then you are implicitly acknowledging that the intervention could harm them, unless you can provide hard evidence to the contrary. If you have no evidence that people can not be harmed by an intervention, then you have no right to expose people to such risks, or to promote such interventions. Not unless the risks are very well understood and can be well managed.

Even if an intervention might be beneficial in some cases, if it can also be very harmful in other cases, and you have no way of knowing which it will be in any particular case until after any damage has been done, then what right have you to blindly administer the intervention? The risks cannot possibly be well managed.

 

exactly

but they’re also claiming in an indirect way that patients are not motivated to get better because they don’t want to use a treatment that will help them instead of acknowledging that their treatment is useless

 

Yes, understood. Treatment by gaslight.