BMJ editorial: Updated NICE Guideline on chronic fatigue syndrome, 2020, Stokes and Wade

Split from:
NICE ME/CFS guideline - draft published for consultation - 10th November 2020


Updated NICE guidance on chronic fatigue syndrome

https://www.bmj.com/content/371/bmj.m4774.full

 

Authors,

1. Lynne Turner-Stokes, Northwick Park professor of rehabilitation,
2. Derick T Wade, professor of neurological rehabilitation

 

It's the BMJ editorial by Lynne Turner-Stokes & Derick T Wade.

I have been expecting that some people will try to do a detailed critique of the evaluation applied by NICE and am curious to know what their arguments are.

Unfortunately, it's paywalled and the preview just ends there.

Also I think it would be interesting to know whether / how the evaluation methods differed this time compared to the previous assessment. Or were the methods just applied more thoroughly?

 

It never seemed to bother them that CFS was a heterogeneous condition when the recommended treatment was CBT and GET.

 

Lynne Turner Stokes has revealed her inability to grasp the issue of evidence quality. She once had good critical skills but critical skills tend to suffer when the topic is close to home. There is no evidence that NICE downgraded evidence because of the very obvious shortcomings of GRADE. More likely it found the evidence to be inadequate in rigorous terms. Nothing to do with a 'small number of service users'.

The arguments Lynne provides for being more lenient in chronic conditions are transparently invalid - as I pointed out in my expert witness testimony. She says:

Above all, it is time to recognise that person centred rehabilitation, delivered over an appropriate period, is much more likely to provide tangible benefits than the piecemeal, disjointed efforts that continue to be fostered by the current NICE guideline methods.

But where is there a scrap of evidence for this? Randomised trials show that the effect is close to zero, especially when the y axis is displayed properly.

 

As I have said before, I do sometimes wish I tweeted, but then remember why I don't. But I don't mind being quoted.

 

I think @dave30th ought to have something to say about this. It looks like serious political interference with the work of NICE by a 'small number of service providers' with vested interests!

 

Lynne Turner Stokes previously produced this slide:
https://twitter.com/user/status/1317884385094414336

 

What an impertinent, insulting thing to publish by BMJ. By someone who is not even party to any of this, with a ridiculous conflict of interest being a rehabilitation specialist whining that an invalid rehabilitation paradigm has been discredited.

More than anything this editorial is a whiny rant about the fact that their work cannot meet the standards of science and that this is unfair. It isn't. You are required to prove your claims in science. You cannot and never did. End of story. Being able to push it into practice without evidence means nothing. With time, reality always asserts itself and it finally did.

Everything is about them, their little person, how it affects them. They cannot possibly think of the larger consequences of their navel-gazing. They take no consideration for the enormous harm they leave behind.

Ignorant, impertinent and insulting. All normal things to publish in a medical journal. All very normal things by professionals.

 

Interestingly, LTS echoes Keith Geraghty's suggestion (as I did) that standard randminised controlled trials may not be the best way to asses therapist-delivered treatments. Unfortunately, what she suggests instead would be completely invalid.

 

Editorials
Updated NICE guidance on chronic fatigue syndrome
BMJ 2020; 371
https://www.bmj.com/content/371/bmj.m4774

References for the "overall positive results of randomised evidence published since 2007". [3, 4, 5]

[3] = Cochrane review

[4] = A systematic review from 2015 I havn't heard of before, published by Clinical Psychology Review

[5] = PACE trial

(Strange -- when I browsed the BMJ website for the complete issue, I somehow managed to see the editorial's full text, but when I now copy the corresponding link, it takes me to the paywalled version: https://www.bmj.com/content/371/bmj.m4774 )

Edited for clarity.

 

Maybe you should. Put the cat among the pigeons .

 

Should tweet or should be quoted?
If I tweeted I think I would be sucked in by a Dementor for ever.

 

Yes, I think you could be right.

 

There are always outliers that frauds and quacks use to try and prove a general case. Which itself shows how little they comprehend.

ETA: By this I mean that there will always be a small % of people who are not ill and seek to work the system, and if LTS and the like focus on people like this to try and "prove" a supposed point, it's just plain weird.

 

Yes, service providers who services are relatively cheap, and thereby politically favoured, pushing clinical effectiveness much further down the priority list.

 

An interesting thing about Turner Stokes's piece is that it contradicts itself.

Firstly it says that there is evidence for the value of rehabilitative treatments.

Then it points out that the methods used- randomised controlled trials - are not much use for conditions like ME/CFS.

So there isn't any good evidence.

Since NICE is supposed to recommend on the basis of good evidence it must have got things right.