Article: 'Is standing up for expertise a fool’s errand?' - Simon Wessely still being portrayed as the 'victim'

Time for some satire:

I've come up with a fantastically effective treatment.

It involves threatening a person with 20 lashes from a whip if they don't immediately feel better.

I believe it works by acting on the brain. The threat of physical harm appears to instantly shift the brain into a healthier state. I've seen this so may times, it is impossible to be a coincidence.

The exact mechanisms will require further research. I believe booster sessions will be required to maintain the effect. High drop out rates are also a problem and we are planning to take patient preferences into account to ensure everyone receives individualized threatment.
 
Kalliope said:
An interview from 2009 with Simon Wessely just resurfaced in my Facebook newsfeed. This might not be the best thread for it, but I wanted to share it anyway as some of his arguments are still being used by doctors here to this very day. He sets a tone where it's acceptable to talk down ME patients as a group. That had huge consequences for us.

The interview is from a big information site about health and both patients and health care personnel are using it.

Wessely says he has had it with nonsense from activists. That he has examined and treated over 3 000 ME patients. Then the article lists all his credentials.

He further says that 99% of doctors looks at this as a combination of psychological and physiological phenomena. That doctors aren't very good at dealing with patients with symptoms lacking an explanation, but psychiatrists and GPs on the other hand are used to this.

"Unfortunately there is a small number - and that is a small number - patients who won't accept this." He says this is because patients think it's the same as people believing they are simulating, hysterical or just imagining things. That's an insult to everyone who has illnesses as depression, panic disorders etc. But Wessely is afraid the stigmatisation of psychological illnesses is still strong.

He says mononucleosis is like a hit and run accident, but that three years afterwards it's no longer the car that's the problem. It's then about secondary handicaps which are treatable. For instance depression. With exception of some few fanatics (sic), most people don't have any problem with this.

He also critiques WHO's classification of ME as neurological and says that 98% of the description of post viral chronic fatigue syndrome is identical with the description of neurasthenia.

NHI.no: Mektig lei
google translation: Has had it
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As usual no substantive argument. Just appeal to authority and name-calling people who disagree as bigots and extremists. An organism perfectly adapted for our political moment.
 
JohnTheJack said:
The point remains, though, that for subjective symptoms, a placebo is legitimate. If you can help someone feel less pain by giving them sugar pills, then give them sugar pills.
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Unusually, I’m not sure I agree with you on this, John. I agree that a placebo would be legitimate if it could help someone feel less pain, but I’m not aware of any reliable evidence than it can. We know that placebos can be very effective at making people report that they are feeling less pain (or fatigue) but that is not the same. To assess whether placebos actually reduce people’s pain levels rather than simply influencing people to report that they are experiencing less pain, subjective reports need to be backed up by objective outcome measures.

An interesting example is the use of hypnosis for pain relief in labour. Various studies report that hypnosis can be effective for labour pain (https://www.ncbi.nlm.nih.gov/pubmed/21762655). However, they all seem to suffer from familiar methodological flaws. When a much better study was conducted using an objective outcome measure (intra-partum epidural analgesia use) hypnosis was found to be of no benefit in reducing pain (see:
https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/1471-0528.13433).

Snow Leopard said:
But are they actually feeling less pain?
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Exactly.

It’s worth reading this article on the Myth of the Placebo Effect in The New Atlantis:
https://www.thenewatlantis.com/publications/the-myth-of-the-placebo-effect
 
I am not convinced that placebos help with pain. I am friends with quite a few people who have done trials and they match what I felt answering questions. When they are asked if the treatment worked they say "a little bit" because no one wants to squash some thing that might be useful. This is especially likely when the treatment has done nothing, no harm, no good.

When the results are revealed "a little bit better" is taken as placebo helped with pain.
 
Jonathan Edwards said:
I think this is a misconception, John.

The problem with placebos is that they tend to work in contrived artificial situations like trials in a way that they do not outside trials. And most of the time what is called a placebo effect is some other spurious reason for improvement. The key problem is that it is almost impossible to tease all these out in trials.

Using a placebo is always an act of bad faith because it involves conning the patient into thinking the benefit was due to a treatment when it was just due to thinking it was. Placebos may be legitimate treatments for illnesses that are merely in themselves false beliefs (if such exist) but I don't see them as legitimate for pain etc.

The use of placebos is also highly dangerous because it is so often a way to avoid making the right diagnosis.
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Fair enough. I do accept that there are problems in working out whether something genuinely is having an effect or not. And there is a problem of definition.

My point though is that for addressing the feeling of something, a subjective outcome is sufficient. If it can be shown an intervention helps someone feel eg less pain, then that is enough. There is no requirement to show what if any active ingredient is involved.

The paper Robert links to says 'Hypnosis is effective for some patients with chronic pain'. I didn't investigate the links, but that would seem to me not to involve anything other than 'mental tricks'.
 
Barry said:
Quite so. If you ignore the pain from a fracture bone and just "push through" it anyway ... you may well do exactly that.
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That does of course apply to all forms of pain relief. And is an issue with sports people, particularly for those where a team may want to give painkillers to a major player for a big competition.
 
Robert 1973 said:
Unusually, I’m not sure I agree with you on this, John. I agree that a placebo would be legitimate if it could help someone feel less pain, but I’m not aware of any reliable evidence than it can.
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Then we agree. I am not saying that it does, only that if it does.

Robert 1973 said:
When a much better study was conducted using an objective outcome measure (intra-partum epidural analgesia use) hypnosis was found to be of no benefit in reducing pain (see:
https://obgyn.onlinelibrary.wiley.com/doi/full/10.1111/1471-0528.13433).
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Though interestingly in that study the subjective reaction to pain matched the objective: neither rates of epidural analgesia nor experience of pain in labour or clinical outcomes varied.
 
Just to clarify my position again. I responded to this:

Wessely appears to be implying that placebos are an acceptable treatment for "subjective" conditions
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.

I think they are an acceptable treatment for subjective conditions, if they can be shown to be effective.

I'm not saying they are effective. I'm certainly not saying that ME is a subjective condition.
 
Jonathan Edwards said:
The problem with placebos is that they tend to work in contrived artificial situations like trials in a way that they do not outside trials. And most of the time what is called a placebo effect is some other spurious reason for improvement. The key problem is that it is almost impossible to tease all these out in trials.
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I presume that if a placebo is administered in a way that is truly 100% blinded, then there is going to be no effect. And in cases where it is claimed to have had some effect, then it is virtually certain the blinding was flawed or partial, and therefore prone to some form of expectation bias etc? Potentially simply the expectation that taking the tablet could be helpful.
 
Snow Leopard said:
Is it though? The counter argument is that it is not what patients transiently report on a subjective 'symptom' questionnaire (or report to a medical practitioner at a consultation) that is important, but the real-world impact on their actual day to day lives.
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Yeah to me fatigue has nothing to do with how I feel, it's about how much I can do compared to normal. I don't care how I feel about it, it's the real life impact that is important. In consults I always report the basic facts as they impact my life, I couldn't care less about how it makes me feel, I don't have any particular feelings about it.
 
strategist said:
I think it would be possible to come up with a clinical trial design that largely eliminates the problem of biased self-reporting.
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The original PACE protocol did that. Reanalysis provided the evidence the effect is merely because of biased questionnaires. When subjective evidence and objective evidence disagree, always bet on the objective evidence.

Which is why they massively deviated from and dropped all objective reporting. This is as simple as it gets and why I consider PACE to be willfully fraudulent. I don't doubt they fully understand they proved themselves wrong either but simply had too much invested in it, had made grandiose claims and promises that they could not deliver so they chose the easy way out of it by lying their ass off for years since.

This group should never have been allowed to run PACE. Designing it, sure, whatever. But running it set everything on the path to defraud, as they have too much lose by what they actually confirmed was already obvious.
 
In a way I almost feel sorry for SW. On reflection, and rereading the article, it looks as though he has done little to stir this up again. It would be interesting to know the origins of the article. There looks to have been heavy involvement of Fox and the SMC. The article looks to be an expansion of the journalist's interests. Perhaps the SMC needs new blood now that everyone knows where Reuters is coming from.

And what is "scientific truth"? Is it ever more than a rebuttable presumption? What's the use of a rebuttable presumption if it cannot withstand attempts at rebuttal?

And what is the defence of science? Is it the defence of a methodology and means of knowledge acquisition, or is it defence of a particular body of work?
 
The placebo is one of the most powerful interventions we have

So why doesn't it cure cancer or MS or Parkinsons or [insert serious disease of choice here]?

Or make any measurable difference at all to them?

Bastard patients just don't want to get better?
 
JohnTheJack said:
My point though is that for addressing the feeling of something, a subjective outcome is sufficient. If it can be shown an intervention helps someone feel eg less pain, then that is enough.
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It is not sufficient evidence in an unblinded clinical trial. It is evidence of participant(s) reporting less pain, which is not the same as experiencing less pain.
 
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