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Behavioural modification interventions for medically unexplained symptoms in primary care: systematic reviews & economic evaluation, 2020, White et al

Discussion in 'PsychoSocial ME/CFS Research' started by Sly Saint, Jul 27, 2019.

  1. rvallee

    rvallee Senior Member (Voting Rights)

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    That's what I meant. I'm not blaming the participants. It just reads too much like testimonials for LP where the participants are told their success depends on believing in it and their words reflecting that need to be positive. Pure tokenism in this case.

    There's a trend I noticed in clinical psychology: there is no criticism on substance. None whatsoever, other perhaps than James Coyne and a handful more. Whenever someone publishes a paper or a report the replies pile up, almost all saying variations of: "brilliant", "wonderful!", "genius!!11!". The comments read like people who were with the team as friendly like-minded observers, not critical stakeholders. Patient involvement requires independence and, frankly, hard-ass criticism. This isn't the time and place for niceties, certainly not for testimonials that read like a corporate brochure.
     
  2. Woolie

    Woolie Committee member

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    The lack of spin in these conclusions is frankly, surprising. I've seen these guys put a far rosier glow on much weaker results. Do you think perhaps they are happy for people to conclude that mere GPs are not equipped to deal with such important matters?
     
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  3. Amw66

    Amw66 Senior Member (Voting Rights)

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    Exactly this - we are always told that CBT/GET dosn't work when experts do not deliver it
    The king is dead .......
     
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  4. rvallee

    rvallee Senior Member (Voting Rights)

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    And now to know where all that PACE money went. The last few years, some of the BPS gang have basically made the case that online versions of their stuff has the same outcomes as the most intensive highly-trained in-person versions. That outcome is null but still, same outcome. And the claim for PACE's massive budget was in part all that training. There is nothing to explain where 90% of that money went to. This is serious fiduciary mismanagement.

    People who waste millions for no reason should not continue to get millions in funding. This claim about expert delivery has been used for so long and now it's basically, "nevermind, no difference in outcome between a 'highly-trained' expert and a cheap app". Which also destroys all the claims of personalized treatment, since the one thing that makes the app delivery cheaper is that everything is standardized, nothing is specific to the individual. And anyway large-scale delivery always required things to be standardized as it made no economic sense whatsoever.

    Basically all the myths have been busted by COVID or time:
    • Nobody seeks the ME/CFS label, it is soundly rejected
    • Viruses clearly do cause ME/CFS, likely also bacteria but clearly viruses
    • "Expert delivery" of the behavioral model is irrelevant, a standardize cheap app / pamphlet does the same, the same obviously being nothing
    • Severity of initial illness may play a factor but ME/CFS does occur even following nearly asymptomatic cases of acute infectious illness so this is nothing like the early fantasies described by Wessely about a severe illness causing seemingly life-threatening terror
    • Deconditioning cannot explain the symptoms, it happens far too quickly and is highly fluctuating, which is obviously not a feature of actual deconditioning
    • The PTSD excuse also makes no sense, many who were completely oblivious to the pandemic, only had mild symptoms early on and pushed through the symptoms, doing their normal thing, also developed some of the same symptoms as those with severe acute illness
    • The bastards definitely do want to get better, most people naturally try the exact rehabilitation approach marketed by the BPS/FND/MUS model, it's just common sense and we are not fragile idiots
    • It is definitely not just fatigue, the illness cannot be reduced to this one symptom, even allowing for the absurdity of a symptom having not only its own sub-symptoms but full-on sub-co-morbidities like dysautonomia, and fatigue is actually optional, bit awkward after having put everything on fatigue despite being warned that it was flawed
    • The 'anxiety' symptoms are clearly mostly dysautonomia
    • Viruses can and do cause many other common diseases and symptoms that fall smack in the MUS bin
    • The vast majority of people absolutely, resolutely, hate the "sick role"
    • There is no such thing as "secondary benefits"
    Probably many more but at this point I think that all the early assumptions have been fully debunked. And still, no change. Because the facts don't matter in belief systems and that is the fundamental issue here: why was an actual belief system, an ideology devoid of evidence or logical consistency, put into clinical use despite widespread failure and harm for decades without any oversight or accountability?
     
  5. Sean

    Sean Senior Member (Voting Rights)

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    But how else will they get all those wonderful secondary benefits if they don't seek that label?

    Yep. One of the reasons I am so dismissive of the deconditioning claim is that I know from my own direct experience that it could not possibly be true. I was far too active at onset and for a long time immediately after it (when I shouldn't have been, it turns out,), for that explanation to even be vaguely plausible.

    And I know too many other patients with a similar story.

    Add in a complete lack of due diligence by those arguing for the deconditioning angle in even checking if it is actually happening, especially in the mild-moderate patients, and it is clearly a fraud of an 'explanation'.
     
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  6. Sly Saint

    Sly Saint Senior Member (Voting Rights)

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    full blog here:
    http://www.cbtwatch.com/number-theatre-and-routine-mental-health/


    see also previous blog
    The Mismatch Between Clients Global Judgements and Changes on Psychometric Test
    http://www.cbtwatch.com/the-mismatc...-judgements-and-changes-on-psychometric-test/
     
  7. rvallee

    rvallee Senior Member (Voting Rights)

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    Honestly this whole thing may be the most incredible example of lies, damned lies and statistics ever. It will live in infamy, used for decades as an example of how to abuse mathemagics in order to fabricate evidence for a teleological ideology. Politicians and governments, business also, lie with statistics all the time. But here it's experts. They are clearly and knowingly lying. They just think they'll be proven right but they are pushing the damned lies and statistics to an almost absurd level.

    It's also a lesson in lack of oversight and accountability. This is what happens when you explicitly dismantle all oversight and accountability in order to push through something that cannot pass any level of scrutiny. This is what happens when you give people unaccountable power. Even medical doctors succumb to hubris, even when it maims and kills those they pretend to help, even when they know it and simply choose to dismiss any conflicting evidence, maintaining dogmatic ruthlessness in achieving an ends justify the means mindset.
     
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