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

Discussion in 'Health News and Research unrelated to ME/CFS' started by Andy, Mar 24, 2018.

  1. Andy

    Andy Committee Member (& Outreach when energy allows)

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    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
     
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  2. Esther12

    Esther12 Senior Member (Voting Rights)

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    Saw they thank PACE's Kimberly Goldsmith:

     
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  3. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

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    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.
     
  4. JemPD

    JemPD Senior Member (Voting Rights)

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    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.
     
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  5. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

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    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.
     
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  6. Trish

    Trish Moderator Staff Member

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    That's the only plus side I've been able to see about PACE. Not only did it demonstrate conclusively that GET and CBT are useless for people with ME/CFS, it also demonstrated that they are useless for the much broader category of patients with Oxford defined 'six months unexplained fatigue', which covers pretty much anyone with so called 'Medically Unexplained Symptoms', since most of those lumped into that category have 'unexplained' fatigue as one of their main symptoms. If the treatments based on the BPS model fail, the model fails too.

    And since MUS is the broad category that Sharpe, Chalder et al are now pushing hard to apply the BPS model and treatments to with their roll out of MUS IAPT clinics, it pulls the rug from under the whole thing. Similarly it pulls the rug from under the BPS based approach of the DWP and health insurance industry supported by Wessely, Aylward, White et al.

    I have not been at all surprised that these individuals along with the SMC have been so determined to try to block data release and to undermine any paper based on that data that demonstrates their model has failed.

    It also explains why they so determinedly bury the null results of the FINE trial, which was run in parallel with PACE to cover the more severely affected, home bound patients to demonstrate (they thought) that the BPS model applied across all severity levels.

    In fact what they have inadvertently done is dump the whole branch of psychiatry - psychosomatic medicine which is based on BPS - in the dustbin.

    The fact that they are now clinging to ridiculous justifications like the impact factor of the journals they published PACE in, demonstrates how desperate they are.

    I'm not sure whether that's what you meant, @Jonathan Edwards. Do elucidate if I've gone off on a different track from what you meant.
     
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  7. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

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    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.
     
  8. Trish

    Trish Moderator Staff Member

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    I love your tantalising hints...
     
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  9. Lucibee

    Lucibee Senior Member (Voting Rights)

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    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.
     
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  10. Trish

    Trish Moderator Staff Member

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    Thanks so much @Lucibee. I had a feeling when I read the abstract that they were playing clever clever statistician games without understanding the data they were inputting into their analysis. It's great to have a medical statistician here who can see just what nonsense this is.
     
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  11. Lucibee

    Lucibee Senior Member (Voting Rights)

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    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.
     
    Last edited: Mar 25, 2018
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  12. Indigophoton

    Indigophoton Senior Member (Voting Rights)

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    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
     
  13. Luther Blissett

    Luther Blissett Senior Member (Voting Rights)

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    :hug: 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.
     
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  14. Barry

    Barry Senior Member (Voting Rights)

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    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 :).
     
    Last edited: Mar 25, 2018
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  15. Barry

    Barry Senior Member (Voting Rights)

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    Yes, as straw clutching goes :rolleyes:.
     
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  16. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

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    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!
     
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  17. Barry

    Barry Senior Member (Voting Rights)

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

    Jonathan Edwards Senior Member (Voting Rights)

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    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.
     
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  19. Indigophoton

    Indigophoton Senior Member (Voting Rights)

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    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...
     
  20. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

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

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