Caroline Struthers' correspondence and blog on the Cochrane Review: 'Exercise therapy for chronic fatigue syndrome, 2017 and 2019, Larun et al.

andypants said:
Still not holding my breath...
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Presumably the only potentially hopeful sign was that Larun felt there was a need to leak to the Reuter's journalist that Cochrane were considering withdrawing in some fashion this review, and to brief against them with the false 'bullying patients' narrative.

Presumably Larun and the BPS crew were feeling threatened in some way, given putting this all in the public domain was not without risk to them.
 
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Peter Trewhitt said:
"The review author team have advised us that a resubmission is imminent. A decision on the status of this review will be made once this resubmission has been through editorial process, which we anticipate will be towards the end of November 2018."
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This could be based on Cochrane deciding to take at face value the authors' estimate of when the imminent resubmission would be made. If so this leaves plenty of scope for footdragging and Cochrane being surprised that the resubmission is taking longer than the authors' initially estimated.
 
Looks like the review was updated today, after 5:30 -

Date

Event

Description

30 November 2018

Amended

Addition of new published note 'The author team has re‐submitted a revised version of this review following the complaint by Robert Courtney. The Editor in Chief and colleagues recognise that the author team has sought to address the criticisms made by Mr Courtney but judge that further work is needed to ensure that the review meets the quality standards required, and as a result have not approved publication of the re‐submission. The review is also substantially out of date and in need of updating.

Cochrane recognises the importance of this review and is committed to providing a high quality review that reflects the best current evidence to inform decisions.

The Editor in Chief is currently holding discussions with colleagues and the author team to determine a series of steps that will lead to a full update of this review. These discussions will be concluded as soon as possible'.
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https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD003200.pub7/information#history
 
Tijs said:
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I'm sure this is the kind of reassuring talk people want to hear from a medical review organisation. That will go down well with their policy that it's perfectly fine for researchers to review their own work and grade it as flawless and perfect and there's nothing wrong with that.

Found a new slogan for Cochrane: objectivity is overrated. Alternatively: because it feels true.

Literally centuries of scientific lessons flushed down the toilet. Make phrenology great again?
 
I think we need to work on how to convince people of the how flawed it is to combine subjective outcomes with unblinded trials. There is clearly a good deal of convincing still to do. I seem to recall @Jonathan Edwards saying some time back on PR that quite a few people took a lot of convincing initially when he raised the point. Coming to all this from scratch, once pointed out it seemed terribly obvious to me and still does. But I think there is a lot of inertia in establishment mind set that really doesn't see otherwise. How to change that. For psych therapies aimed at genuine psych conditions, the notion may hold some water, but when targeted toward physical conditions with objective outcomes available, it's junk. Something for 2019.
 
I received a response to my complaint to the Governing Board and to the Cochrane Library Oversight Committee about the Exercise for CFS review from David Tovey. I should have submitted my complaint to the Cochrane Library Oversight Committee (CLOC) first, but has never been clear how to do this. The only information about them is here and here. They were “between chairs” for quite a while and I had actually forgotten they existed until I had already made the complaint to the Board. I also tried approaching the Cochrane Council (who are supposed to represent the membership of Cochrane, including patients and the public), but they weren’t interested. Then, in desperation, I submitted a complaint to the Governing Board at the end of November. I was informed on 17th December that as it was an “editorial content issue”, David Tovey would deal with it. As my complaint included references to my previous interactions with David on the matter, and was essentially a complaint about him and his management of this review, this seems unfair both on him and me. Anyway, I was asked to keep people informed of the complaint, so below is the response (in italic). My original complaint is in bold.
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https://healthycontrolblog.wordpres...iew-of-exercise-for-chronic-fatigue-syndrome/
 
I think the comment about Cochrane not being responsible for what use is made of their reviews is somewhat disingenuous. What is the point of doing a review if it is not to inform clinical policy and practice which in turn inevitably influences policy and practice on financial support through occupational or social security benefits.
 
My quick thoughts:

1) Tovey confirms that Cochrane planned to temporarily withdraw the Larun et al. GET review because the authors did not adequately respond to criticism in time. This was what the Reuters article was about. "A subsequent meeting with two of the authors” made the Cochrane editors change course.

Yet Toveys reponse suggests that personal reasons were involved in the authors failure to respond in time and he says that Cochrane only wanted to withdraw the review temporarily, "to give them time without pressure to address the issues raised fully." I suppose it's possible that one of the authors had personal reasons (sickness or deceased family member or something like that) that made it difficult to respond in time and that the Cochrane editors underestimated this.

2) Tovey says that currently the process of re-submitting, reassessment and peer review is pending, but it is not clear what this means as the authors have already offered a re-submission that was deemed unfit. To me it seems that the authors are allowed to make lots of mistakes and do-overs. Are they now doing a re-re-submission? Is there going to be a re-re-resubmission?

3) The most controversial point in Tovey’s response concerns the issue of “using only subjective outcomes in unblindable trials”. “To describe this as ‘terrible methodology’ is simply an opinion”, Tovey says, “and it is not shared by independent methodologists who we consulted". Weird.

Tovey also claims that “objective measures such as resource use were reported when they were identified.” That doesn’t seem right. As Vink showed objective outcomes mostly showed null results and were not considered in the Cochrane assessment of GET. https://journals.sagepub.com/doi/full/10.1177/2055102918805187
 
Surely the point about subjective trials is that there is HIGH BIAS in them, and the Cochrane review says it's low bias. Do the independent methodologists consider it low or high?
What is the current thinking on bias in subjective trials among psychologists @Brian Hughes ?
 
NelliePledge said:
I think the comment about Cochrane not being responsible for what use is made of their reviews is somewhat disingenuous. What is the point of doing a review if it is not to inform clinical policy and practice which in turn inevitably influences policy and practice on financial support through occupational or social security benefits.
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Haven't been able to read the blogpost yet - but this is more or less exactly what is the current mission statement (or something like that) for Cochrane now.
 
It seems to me that the response to point 3 regarding subjective measures in unblinded trials focussed only on the subjective measures and did not consider the consequences of combining that with lack of blinding. I think this is the strongest point with the weakest response. It should be made again but stronger with references to eliminate the "it's just an opinion" rebuttal.
 
Low reading ability-day today, so still haven't read the bofpost, just some tweets. But really surprised that Tovey would actually put that bit about - "saying that reporting only subjective outcomes in unblindable trials is "terrible methodology" is just an opinion" - in writing. And referencing to some un-named "methodology expert".

To Struthers?

I'm glad he did though, even if it makes me nervous about the fate of the ME exercise reviews. Because this will be so obvious wrong (or so I'm hoping....), that it's getting the attention of others.

 
inox said:
it makes me nervous about the fate of the ME exercise reviews.
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Yeah, this response makes me think that Cochrane is even worse than I'd feared and leaves me dreading whatever they're going to do next. So many annoying and misguided things about it. I'm going to have to re-read it with lowered expectations so I can avoid being distracted by my eyes rolling back into my head.
 
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