Why Bother With Medical Journals and Whether They Are Honest? By Richard Smith, former editor of the BMJ

https://www.crossfit.com/health/the-trouble-with-medical-journals-section-2

 

What I want to know is why are we still here:

This is the usual misunderstanding of the central issue. And it allows for everything else that is said to seem valid to an outside reader. If all illnesses have a psychological component than our insistence on the purely physical is irrational.

But all of this brief statement needs to be examined further. Pulling out the details of what is meant by psychological component and how that is applied is rather important.

There has never been (as far as I'm aware) any BPS adherent willing to discuss this beyond the vague and misleading; there's a 'psychological component'.

If they were correct about about their supposition regarding what they mean by this there would be no 'war' because we would all be well and grateful for the treatment that gave us back our lives. It's unfortunate that they can't see that it is not some kind of perverse resistance on our part or a psychological need to be right about this being fulfilled. It is simply that we have discovered (to our own surprise often) that the treatment based on their BPS theoretical model has left us more ill than when we began.

That indisputable fact renders all of their various writing on the subject completely ignorant blathering.

ETA: the people who self-identify as adhering to the BSP model for understanding illness continue to ignore real social factors that contribute to getting ill and quality of life after illness onset. Somehow this escapes their notice.

I find that rather peculiar. Although another word for it could be convenient.

 

It seems that Dr Smith does not keep himself up to date.

We took the best research that we could get and asked people who were recognized experts to write and review for us.

There's never an excuse for an editor letting poor quality stuff through. The editor has a responsibility to know who is a real expert and who is a 'recognised expert'. That last term says it all.

 

If they were interested in clarifying whether ME or any other condition is a disease or not, they would present the two different points of view.

My impression is that "high profile" journals have no interest in such scientific debate but side with the majority view of their subscribers. A large portion of doctors want it to be a non-disease because that means they don't have to care for patients. Whether there are any sensible arguments for it not being a real disease is not something that really interests them. Essentially the medical community has handled the problem of an untreatable disease by agreeing that it is not a disease and therefore not their responsibility. I'm generalizing here and there are exceptions.

That is presumably also the true purpose of the CBT/GET model. It's a justification for what the healthcare system wants to do with us patients, and that's why nobody has a problem with the model making no sense whatsoever on closer examination.

 

My emphasis :

I wonder where the psychological aspect is in, for example, suffering from appendicitis? The only place I can imagine psychology getting involved is after surgery and discovering that the diagnosis was wrong, or being diagnosed so late that sepsis sets in. The psychological aspect in both those cases would be in being absolutely furious after the event.

 

This is where it gets fuzzy. Because when the BPS people talk they use examples that are less acute than this. But if pressed I think the line would be about the psychology around healing from the broken leg or the appendix surgery.

Generally, when these health crises are addressed with medicine psychology doesn't need to be invoked as the moment of discovering the problem and fixing it is generally pretty immediate.

So how the patient got there is often not too relevant. And if healing isn't complicated then also no need for any intervention. But they can nevertheless invoke the general principle of body-mind (where the emphasis is on body) as important without explanation and nobody really challenges what this means to patient care because it's all good--medicine has done it's job. It's as if it's a revealed truth that doesn't need justifying.

But the only reason the BPS can have any legitimacy in the way it advertises it's importance is because of MUS. And here invoking mind-body changes to make mind the concept of primary importance in the illness. There are no quick fixes or answers there. So they swoop into that void. And then they invoke conditions like cancer which is in between the acute care of an appendix and the chronic care of MUS.

 

It was first published in 2000.

Still very annoying, but less so than if it had been written for 2020.

 

the only interest that journals have is profit and if publishing garbage generates an income the will continue to do so regardless of harms caused because we live in a society were the law does nothing to prevent or punish fraudulent research papers.

 

Editorial Misconduct, Freedom and Accountability: Amateurs at Work
ByRichard Smith, former editor of the BMJJuly 28, 2020
Found in:200717,200729,Health,Journals and Publications

https://www.crossfit.com/health/editorial-misconduct-freedom-and-accountability

(haven't checked to see when this was first published)

 

The funny thing about bias is that people having it can be totally unaware of this fact. To them it can be the norm.

I don't doubt that the BMJ selected the best papers on CFS. I just think they were neck deep in their own biases when deciding what made these papers the best.

I doubt they would consider unblinded homeopathy clinical trials as "the best". When the treatment is psychotherapy and exercise for ME, then any papers on this are apparently suddenly amazing no matter how flawed.

 

TL;DR: everyone is biased but me.

Jerk.

 

It's NOT an issue of people with ME devaluing any psychological contribution. This is a false argument.

The BPS cabal position is that after the initial infection any long term symptoms must be viewed as amenable to primarily (or even exclusively) treatable with psychological therapies.

These 'treatments' only work theoretically on paper. In reality people with ME or MUS continue to be either worse off or not recovered -- in it's most useful definition, as pre-illness functioning.

This is all further made fuzzy be the moving target of what they (the cabal) mean when they talk about 'psych contribution' and so many other vague terms that seem to morph into some other meaning as the previous meaning becomes insupportable.

An example would be that first it was just incorrect illness beliefs that needed CBT now it's that our HPA axis is dysfunctional and that too can be treated with CBT.

The one constant in all this is that THEIR therapy is ALWAYS the answer. Period. It will always be so whatever the findings. It will simple morph into a shiny new concept to account for CBT being the solution.

 

Just in case there are people who do not understand the antipathy towards the BMJ, and the suggestions of bias, I thought I would drop in this little reminder from 1989.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1836497/pdf/bmj00231-0039.pdf

For Debate Myalgic encephalomyelitis, Princess Aurora, and the wandering womb Caroline Richmond

It is not entirely clear whether the journal wished to promote debate or start a fist fight.

 

It's notable that in the exerpts, particularly the one that @Trish posted, Richard Smith seems to be arguing that medical journals are not purveyors of truth, but rather should simply reflect the standards of medical science orthodoxy at the time.

This perspective arises as one looks back at the prevailing views and scientific standards published in medical journals in the past. We can choose to look back in scorn, or simply accept that scientists and medical doctors had greater ignorance (and poorer funding) than they do now.

It's amazing how pervasive this myth is. We are not distressed by the implication that our illness may have a psychological component. We are frustrated that all we are offered are psychological therapies that offer little functional benefit.

The claim about perpetuating stigma is more baffling, as no one has that retort when someone states that MS or cancer is not a psychological condition.

As an aside, also note that Richard repeatedly refers to "randomised trials" not "randomised controlled trials", which is somewhat revealing about how he perceives quality and reveals the double standard he has between pharmacological trials and other therapeutic trials.