Beyond total treatment effects in randomised controlled trials: Baseline measurement of intermediate outcomes needed to reduce.., 2018, Dunn et al

One for our more technically minded members I think. They are coming up with different ways to analyse trial results and they apply them to the FINE trial, which is why I've posted it.

Open access at http://journals.sagepub.com/doi/10.1177/1740774518760300

 

Saw they thank PACE's Kimberly Goldsmith:

 

It would help if they wrote something comprehensible. I cannot understand what they are wanting to say.

I think they may struggling to say that a convincing inference of how something works tends to require lots of points on a line so that you can see the shape clearly.

 

Perhaps the BPS brigade are getting fed up with patients, advocates & other non-supportive scientists like yourself understanding their work seemingly better than they do themselves & critiquing it in a 'vexatious' manner. So they decided to make it incomprehensible to anyone but those in the BPS clique in an attempt to make everyone think they're clever than they are and shut up.

 

I think this is an old trick and I think it has more to do with the people within the clique wanting to reassure each other how clever they are rather than being at all bothered with outsiders understanding or not.

But the BPS lot might be right to get fed up with us understanding them better than they do. I suddenly realised yesterday that PACE actually disproves the BPS model in a remarkably elegant way. It was not such bad science after all because it managed to refute its own hypothesis - which is what you are supposed to do.

 

Yes, but I found a new argument that makes it clear that PACE actually proves the opposite of the BPS theory, not just fails to corroborate it. Or at least it would if PACE did not, through a similar argument, ensure it did not test the theory on those to whom it was supposed to apply.

I will explain in due course but not just yet.

 

Nope nope nope nope nope nope!

When your entire mediation analysis is based on a non-absolute measure (like CFQ), then there really is no point at all. It's not going to tell you anything.

First rule of stats is to understand your variables, and to understand what they are doing, what they measure, how they behave, are they measuring what you think they are measuring. If this hasn't been done, then anything else is completely pointless and meaningless.

 

I confess I'm really not on top of mediation analysis, and their explanation is very poor. But, from what I understand, the underlying assumptions are fairly crucial, and they seem to have made quite a lot of them that are unlikely to be true.

 

It's always seemed to me a bit ironic that the PACE team crow about the success of the trial since, taking their own reported results at face value, they have shown that they can in fact influence behaviour and psychology to the extent of making people think they are better, but that merely thinking it was so had no significant impact on the actual physical health and functional capability of the participants.

Thus changing the mind did not change the body, ME was not reversed using successfully applied BPS treatments, which is not only the opposite of what they set out to prove regarding ME, but also undermines the whole BPS hypothesis.

Will be interested to hear your new argument @Jonathan Edwards

 

It's a very 'interesting' world you've stumbled into isn't it?

Maybe we could start selling s4me foam desk/wall protectors for the poor independent readers of these type of papers.

 

Yes, the really bad science was the authors' refusal to acknowledge their trial showed their hypothesis to be wrong, and then basically cheated to make it look like their trial had successfully proved them right. I think down the line the PACE trial will be taught not just as an example of bad science, but as an example of deeply flawed scientists ... so flawed they do not deserve to be called scientists.

Edit: Though as I read further down the thread, I realise I've jumped the gun a bit, as you are looking into something more with PACE .

 

Yes, as straw clutching goes .

 

That's the gist but the twist is to rephrase 'changing the mind' in their very own terms so that you can walk round the circular argument in strict bps speak without slipping into any dreadful Cartesian dualism - ahem!

 

But of course in their eyes it was only the mind that needed changing, and any proofs to the contrary they suppressed/ignored.

 

Oh no, you cannot separate the mind from the body like that Barry, that would be entirely against the BPS approach. You really need to go to some of Dr Chalder's lectures to get this right.

 

I'll play:

The BPS model predicts that any illness with an absence of underlying pathology can be reversed or cured through the therapeutic alteration of the dysfunctional cognitions and behaviours of the patient, which are mooted to be the true cause and/or perpetuating factors of the disability.

ME/CFS is considered to be the example par excellence of this type of health condition, being an illness believed in this model to be characterised by fatigue with no ongoing biological cause, but where "the symptoms and disability of CFS are perpetuated predominantly by dysfunctional illness beliefs and coping behaviours. These beliefs and behaviours interact with the patient's emotional and physiological state and interpersonal situation to form self-perpetuating vicious circles of fatigue and disability... The patient is encouraged to think of the illness as 'real but reversible by his or her own efforts' rather than (as many patients do) as a fixed unalterable disease" (Wessley).

Hence the PACE trial, which sought to test whether the disability associated with ME/CFS could be reversed by means of the standard treatments recommended by the BPS model, specifically CBT and GET...

The results clearly show that the patients' disabling cognitions (and behaviours?) were successfully altered in the direction of health and even, for 20%, recovery (as defined in the trial protocol). However, the levels of physical disability and social exclusion experienced by the patients remained unchanged (as per...the various measures). Thus, correcting the dysfunctional beliefs and other maladaptive psychological aspects associated with the condition did not result in an increase in functional capacity, indicating that the biological element of the illness was unaffected - unimproved - by the psychological and behavioural interventions. The study hypothesis is thus disproven, with significant implications for the underlying BPS model...

 

Fair enough. Pretty close!
I did catch one 'physical' though!