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

inox said:
She was also one of the founding members of Cochrane, I think?
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Indeed. Her bio on PLOS reads:
Hilda has a habit of being a “founding member” of things. They include the Consumers’ Health Forum of Australia,’s first board and some of its parts, and the Cochrane Collaboration and its Consumers and Communication Review Group.
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This is nice.
 
Have only read once David Tovey's response to Caroline Struthers' complaint about the Cochrane Exercise Review, so far, and find it very confusing if not contradictory need to read it again when my brain is functioning better.

My feeling is that he is trying to keep everyone happy and defend everyone's reputation, which is fundamentally impossible. One wonders if some one else has told him he has to take the complaints seriously, but that he has failed to understand the nature of the complaints.

I had understood from their previous announcement on the 30th of November that Cochrane had decided that the current review was no longer appropriate and would ultimately completely remove or replace it, whereas Tovey now seems to be saying that the current authors may still be allowed to further rewrite it.

Does Caroline Struthers' blog post containing Tovey's response on behalf of Cochrane warrant a new thread of its own? https://healthycontrolblog.wordpres...iew-of-exercise-for-chronic-fatigue-syndrome/
 
rvallee said:
Literally centuries of scientific lessons flushed down the toilet.
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This is what the fight will come down to.

They are claiming the right to completely dismiss the bedrock of the scientific method, which is how to eliminate or control for the subjective element in our perceptions and reasoning.

That doesn't mean the subjective is unimportant. It means you have to figure out how to differentiate it from, and how it relates to, objective truth.
 
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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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Ye this is whats called just shutting up shop. Cant pass the buck, cant admit any personal liability, play the legal advice route, protect your own interests and if the buck isn't passed onto someone else be ready to team up and blow with the wind with anyone who will protect their own interests and yours.

If doing the right thing could have any comebacks on yourself be prepared to shit on the weakest and go into denial mode.
 
Michiel Tack said:
Hilda Bastian is a well respected skeptic who has a blog on Plos One about science and research methodology. Would be great if she got involved as well.
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She does seem to have been defending Cochrane a lot recently. I can't claim to have a good understanding of all the heated politics around Cochrane at the moment, but I do wonder if she might want to avoid being as critical of Cochrane's handling of this case as I think people should be. Maybe it's unfair of me to think that would be an issue, but I increasingly get a sense that researchers' judgements on academic disputes can be heavily influenced by personal connections/alliances/etc.

edit: Having said that, I think that a lot of what I've read from her on the issue seemed reasonable. It just seems impossible for us outsiders to know what's going on. This has engendered a bit of a 'trust no-one' attitude in me.
 
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Esther12 said:
She does seem to have been defending Cochrane a lot recently. I can't claim to have a good understanding of all the heated politics around Cochrane at the moment, but I do wonder if she might want to avoid being as critical of Cochrane's handling of this case as I think people should be. Maybe it's unfair of me to think that would be an issue, but I increasingly get a sense that researchers' judgements on academic disputes can be heavily influenced by personal connections/alliances/etc.
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I am beginning to think that the qualification which would be of most use to scientists would be an A level in English literature, or equivalent.

The role of the "unreliable narrator" seems almost fundamental to all the issues which we consider.
 
Michiel Tack said:
My quick thoughts:

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.
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To use the argument it is simply a matter of opinion is appalling.

If Cochrane wants to be taken seriously, they should be standing for the highest levels of scientific methodology.

How independent were the methodologists and were they perhaps psychiatric/psychological methodologists for whom such methodological sleight of hand is the norm, is acceptable, is the basis of their careers?
 
Daisymay said:
To use the argument it is simply a matter of opinion is appalling.
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When they say 'opinion' what they really mean is 'hypothesis', and the way to resolve which hypothesis is the best fit is via careful experiment/observation.

I am actually quite surprised and disappointed that Tovey played this card. It is unprofessional, unscientific, and completely unacceptable.

Just another example of how deep this methodological and ethical rot has penetrated into the medical science establishment. Wessely and his shitty little cult have a lot to answer for.
 
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JohnTheJack said:
Excellent blog on this by @Lucibee

Why use of subjective measures in clinical trials can be problematic
https://lucibee.wordpress.com/2019/...asures-in-clinical-trials-can-be-problematic/
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The problem with subjective methods is that they are particularly susceptible to human biases, expectation on the part of both patient and clinician, recall bias, etc.

The one bias that is rarely discussed though is that they are also susceptible to modification by the intervention itself, in that the intervention may affect the measurement without affecting the underlying condition, even if the measure is a good proxy for the condition under normal circumstances. It may well be the case that a subjective measure may be a reliable indicator of a patient’s state of health. But that only persists while that measure is not affected by external factors or the intervention itself (by which I mean that the measure is affected, but not the underlying thing it is measuring).
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Thanks @Lucibee
Great article!
 
Barry said:
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.
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This sentiment is already widespread. The problem is that ME lives on the medical blacklist and exceptions are carved out to justify not applying those universal standards. This kind of research would never be considered credible in diseases that aren't discriminated. There are good reasons for the double-blinded placebo-controlled standard. Everyone in medicine understands the need for it, way too many mistakes were made in the past. They just don't think it applies here because they see it as a behavioral problem and thus not their problem.

The problem isn't an understanding of what good practices are, it's to break the disbelief that makes medical professionals think it doesn't apply here. Our situation is comparable to being declared non-citizens and being shut out of legal protections are a result. Fundamental rights and protections do not apply to non-citizens/patients and the normal concerns over ethics and professionalism don't apply because of those exceptions.

This is what's behind ME being in the common mental disorders group. Tovey's statement that this shouldn't be interpreted to imply that they consider ME to be a mental disorder is totally absurd. Of course they do. That's literally the point and Tovey understands that. From his responses, it's clear that politics and ideology are the only factor at play here and the science is irrelevant to their decision-making process because the outcome has been predetermined.
 
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