A Normative Pragmatic Inquiry into the Volatility of Norms in Argumentation, 2026, Jackson

Dolphin

Dolphin

Senior Member (Voting Rights)
[This has over 20 pages on ME/CFS! They are easier to read than the abstract]

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A Normative Pragmatic Inquiry into the Volatility of Norms in Argumentation - Argumentation

Twentieth century innovations in reasoning about health and medicine (randomized clinical trials, systematic reviews, and a growing list of other inventions) have dramatically changed what counts as good argumentation within this domain. Though these new forms are often highly specialized and...
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A Normative Pragmatic Inquiry into the Volatility of Norms in Argumentation​



Abstract​

Twentieth century innovations in reasoning about health and medicine (randomized clinical trials, systematic reviews, and a growing list of other inventions) have dramatically changed what counts as good argumentation within this domain.

Though these new forms are often highly specialized and highly technical, they are gradually becoming “norms of public argumentation” (Zenker, et al., 2024), spreading from esoteric discussion among medical scientists into other discourses (including interpersonal exchanges between doctors and patients).

This pattern is not limited to health and medicine but affects so many domains that it has become ubiquitous in contemporary argumentative discourse.

But innovations aimed at improving reasonableness, when successful, can disrupt preexisting normative frameworks.

They can undermine and supplant prior bases for inference, abruptly change standards for argument criticism, and require adoption of different rules for argumentative engagement.

The study reported here concerns the volatility that surrounds these innovations in a case study of debate over a controversial treatment for a controversial disease.

Close examination of the debate from a normative pragmatic perspective shows much greater normative complexity than has been acknowledged within contemporary argumentation theory, including unexpected volatility in norms that arguers themselves must somehow manage.
 
I selected a long but temporally-bounded body of discourse surrounding a Cochrane review, related to one isolable issue in the broader controversy over ME/CFS (Jackson 2024). The debate itself is structured by a design that Cochrane has tweaked over several decades to support the rise of evidence-based medical practice. The Cochrane review (first published as Larun et al. 2015) has been revised and republished several times, and each version has been extensively criticized in comments posted online with the review. All versions of the review have been published within the Cochrane Database of Systematic Reviews.
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Skipping to 4.5 might be good if you moslty care about the arguments about methodology.

This about sums it up: Cochrane prioritised itself over the interests of the people they ultimately claim they serve - the patients:
Notice that Cochrane’s interest in maintaining the trust of deliberative bodies is about getting its products used (helping to justify whatever funding it receives from whatever source). Its interest in maintaining the trust of the scientific community is about being able to attract reviewers. Both of these fit Gilbert’s conception of ethos, having to do with maintenance of two rather different relationships.
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Though the author refers to some of the internal Cochrane machinations leading up to the decision to switch from withdrawing completely the CFS exercise review to publishing the Larun et al 2019 redraft, including the unpublished advice by an invited expert, this evaluation, perhaps understandably, confines itself to the material published by the Cochrane Library within the archive associated with the review and a small number of other articles/sources primarily referenced by commenters within this archive.

It is good that we have a clear exposition of the time line and some evidencing of Cochrane’s inconsistency, however I would love to see a more journalistic companion piece that set out more of the political shenanigans, what little we know about the internal and external pressure to preserve the advice that people with ME/CFS should exercise regardless of the actual science, details of the survey evidence, the flaws in the pro exercise campaign groups’ (such as the Oslo Consortium) arguments, links to publicly available discussions such as Hilda’s blog, @dave30th ’s Trial by Error series on the Virology Blog, our threads here and particularly our petition page.
 
Other publications from this author:
Dolphin

Opinion Thread 'Health Controversies: Long-Term Disagreement Management Challenges, 2024, Jackson'

[Based on the footnotes and references, this is an in-depth paper on ME/CFS]

https://www.tandfonline.com/doi/full/10.1080/10810730.2024.2369810

Research Article
Health Controversies: Long-Term Disagreement Management Challenges
Sally Jackson
Published online: 23 Jun 2024
Health controversies involve complex exchanges of disagreements over health and medicine.

They unfold differently in different parts of the world, and they often extend over long periods of time.

In...
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T

Thread 'Online Health Communities in Controversy over ME/CFS and Long Covid, 2023, Jackson'

Free fulltext:
https://ejhc.org/article/view/3559

Online Health Communities in Controversy over ME/CFS and Long Covid
Authors

Sally Jackson
Department of Communication, University of Illinois at Urbana-Champaign, United States of America https://orcid.org/0000-0001-6000-4191

DOI:
https://doi.org/10.47368/ejhc.2023.203

Keywords:
argumentation, controversy, chronic fatigue syndrome, myalgic encephalomyelitis, Long Covid

Abstract

The condition known variously...
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I selected a long but temporally-bounded body of discourse surrounding a Cochrane review, related to one isolable issue in the broader controversy over ME/CFS
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This is a major weakness. This issue is not isolated to ME/CFS, not even close. It infects everything broadly labelled as biopsychosocial, basically everything medicine doesn't have a firm biological/pathological understanding, as well as standard practices in clinical trials and psychological studies. It's precisely because it's not an isolated incident that it's so problematic in the case of ME/CFS, largely a function of how disabling it is, but it's general flaws and institutional failure that are responsible here.

Also in framing this as temporally-bounded I imagine the author means that the issue started with Cochrane and is now closed. Except it isn't, it's ongoing and actually long predates our clashing with Cochrane. In fact it's entirely open-ended, it's easy to find the exact same failure more than a century ago, and it's not about to stop, in fact it keeps getting worse.

The Lancet behaved exactly the same way with the MMR paper, and with the PACE paper it published. And so have a lot of commentators who have sided with the bullying parties. In the UK it actually involves most of the main professional organizations in some way. Guaranteed that things are a lot worse in secret, behind closed doors.

Cochrane isn't behaving any differently. In fact it's exactly how typical their "cede no ground" behavior has been that is notable. They are representing their own interests, the idea that they somehow serve patients is frankly laughable. Those institutions only ever value their own survival and influence, and within them the people who control the institutions only serve their own influence and the promotion of their beliefs and opinions within them. They should serve our interests, but they explicitly choose not to, mainly because nothing and no one can compel them to.

To treat it as an isolated case is like focusing on a single burnt tree husk in an ash forest. Yes, this tree was burned down, along with all the others. And the fire is still burning while the firefighters are clearing it a path to keep on burning.
 
It does include more of the discussion and context, although there are a few incorrect assumptions such as:
It is not the value of exercise in general that is disputed but whether ME/CFS patients in particular should be urged to combat their profound fatigue by exercising
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None of this was ever about the value of exercise in general. Exercise is great in general, most of us would love to be able to enjoy it without consequences. It's not medicine, though. Even though this is becoming a dogmatic mantra within the profession. The evidence that exercise is a treatment to illnesses, that it can treat symptoms as broadly and effectively as it's argued to, simply does not exist. It is generally beneficial to many measures of health, but in reality its application as a medical treatment is basically 90% hype.

Our problems are with the quality of evidence. The problem there is just as appalling with us as it is with fatigue in general, depression, chronic pain and many other issues medicine can't effectively treat, all amplified in the manipulative bias and power imbalance of psychobehavioral models. The claims are mostly false and massively overhyped while all conflicting evidence is systematically ignored, dismissed or suppressed. The problems are far wider than just us.

For example the paper mentions how Larun argues that the randomized trials they picked all seem to favor exercise, without considering that while there is significant bias in favor exercise as a treatment, there is none against, and so this only reflects the biases inherent in the models, and in general about the magical healing powers of exercise as a medical treatment.

The case of LC exemplifies this with the warnings over "yeah it's great but not with PEM", when actually it clearly makes very little difference, almost all trials have seen comparable outcomes in control arms despite everyone involved in those trials being biased in favor of exercise (however much they might pretend otherwise).
Despite the positive findings of RCTs, ME/CFS patient organizations began promoting resistance to exercise therapy
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The trials were crap, and they didn't even support the model, in fact they were mostly clearly bust but this was always a narrative-making process. The latest trials are also crap. They are so bad that any alternative medicine you can think of would produce the same results. The patient organizations did not promote resistance to exercise, they objected to and pointed out how the evidence is awful and unreliable, and it still is to this day because they keep doing the same thing in a loop.

In general a pretty good summary of the situation. It's very hard to get a good broad view of what happened without knowing which rugs have been used to sweep under, but it's a decent attempt at it.
 
Peter T said:
It is good that we have a clear exposition of the time line and some evidencing of Cochrane’s inconsistency, however I would love to see a more journalistic companion piece that set out more of the political shenanigans, what little we know about the internal and external pressure to preserve the advice that people with ME/CFS should exercise regardless of the actual science, details of the survey evidence, the flaws in the pro exercise campaign groups’ (such as the Oslo Consortium) arguments, links to publicly available discussions such as Hilda’s blog, @dave30th ’s Trial by Error series on the Virology Blog, our threads here and particularly our petition page.
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Never going to happen but I'd like to see this as well, specifically what happened behind the scenes after we submitted the final draft in Feb 2023. Prior to that, Cochrane's staff were actively engaged on the author panel and Central Editorial Service reviewed and provided feedback on the developing draft 3 times which we incorporated before submitting the final draft. So who made the decision to disband the review after all that time and why?
 
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