CBT combined with music therapy for chronic fatigue following Epstein-Barr virus infection in adolescents: a feasibility study, 2020, Wyller et al

I read this as the editor, probably with input from editorial board (which includes Esther Crawley), seeing this as a convenient face-saving way of not upsetting any of their contributors. An editorial mistake is just a slight oversight. It does not put any pressure on any authors or on any referees who might have provided muddled opinions - or indeed suggested an idea to the authors that on reflection wasn't so hot.

It's the same essentially as with Crawley's LP study--the journal has twisted itself into pretzels to not call out the researchers. It is really disgraceful. I'm putting together another letter to the journal and Dr Godlee and hopefully Jo and the others will join me again.
 
Does anyone know whether ""exploratory randomized trial" is an established term in trial methodology?

I do not think it is an established term. There is no particular reason why a trial should not be exploratory and randomised but exploratory is a pretty meaningless term unless you state what it is you are exploring. Phase 1 and 2 studies may be considered exploratory but normally it is made clear that you are exploring the tolerability of the treatment or dose range.

What I think is the con here is the idea that has grown up that it is legitimate to do a trial to explore how feasible it is to do a trial - i.e. a 'feasibility study'.

My impression is that it is reasonably clear that this trial was not originally exploratory. It was a randomised trial designed to test efficacy.
 
A quick comparison at the two versions and this is not even close to be OK. Complete white-wash, including the fact that reading the new version does not show there has been a retraction, or any problem. Just a minimal rewrite that addresses nothing at all. This infinite tolerance for failure is beyond ridiculous.

If anything BMJ is showing how thoroughly the process is corrupt, this has nothing to do with science. Obviously betting on the fact that almost nobody cares what happens to us and when in doubt people will simply side against the vexatious bothersome activists. They may be right, for now, but wow will this look bad if and when the suspension of disbelief lifts that we are, in fact, actual human beings worthy of basic respect.

Because this is extremely disrespectful, wrong on the facts, wrong on basic ethics and the rule and letter of what scientific research is even about. But of course this isn't scientific research, this is "evidence-based medicine", where everything goes as long as this is what most people want.
 
I posted this over on the ME/CFS NICE guidelines thread;
https://www.s4me.info/threads/nice-...ates-and-delays-2020.12690/page-5#post-287751
I don't know how it would fit in, but I think, particularly with recent goings on with long-covid patients, that the whole issue of clarifying the difference between ME/CFS and 'chronic fatigue' needs to be raised.
If NICE are now saying they are not the same (something the ME community have been trying to get across ever since the adoption of CFS) then this needs to be made absolutely crystal clear in the guidelines. It should also follow that any research that relates to 'chronic fatigue' or any other variation of it (eg Crawleys CDF) should no longer be considered automatically relevent to ME/CFS.

this paper is another prime example
 
A news site about research in Norway wrote a rather good article about the study back in June. The article has now gotten a clearly visible update stating the following:

This study is retracted - The journal BMJ Pediatric Open has retracted the study we're writing about in this story. The article has been replaced with a new version where the conclusions have been scaled down. You can read more about the process at Retraction Watch

(hastily translated by me)

They published the article in English as well, but that version has not yet had an update on the retraction.
 
It's the same essentially as with Crawley's LP study--the journal has twisted itself into pretzels to not call out the researchers. It is really disgraceful. I'm putting together another letter to the journal and Dr Godlee and hopefully Jo and the others will join me again.
Really highlights the massive conflict of interests these publishers have, and how that, instead of rising above it as they should do, it's almost as if conceding to those COI forms an integral part of their business model. It's quite revolting.
 
It’s a rather unbalanced situation: if the intervention shows large effect sizes then it’s effective. When it doesn’t a full-scale trial is urgently needed. There’s no risk of your hypothesis being disproven.

Sounds like heads you win (get grant funding) and tails you win --- Pity about the mugs who pay for this (PACE was funded by UK Tax payers) and those who suffer the resulting flawed Government policy (inappropriate treatments).
 
Nina E. Steinkopf has read the new publication and shares her analysis:

Is it considered good research practice to retract an article, change the title, the results and conclusion, and then re-publish it with a completely new ID-number? The criticism still stands and the article should be retracted.

Enligish version: The music therapy study was retracted, amended and re-published: The results are worse than first reported
Norwegian version: Musikkterapi-studien er trukket tilbake, endret og re-publisert: Resultatene er verre enn først rapportert
 
steps-per-day.jpg

It was originally reported that the intervention group went from 8,000 steps per day at baseline to 7,165 at 15 months follow-up. The alterations reveal that the number of steps per day was reduced to 5,680. This shows that objectively measured activity level was reduced by 29%.

This also shows that the difference between the groups at 15 months was 1,908 steps, and not 874 as originally reported. Nevertheless, the authors write that the primary endpoint did not differ significantly between the intervention group and the control group.
 
Nina E. Steinkopf has read the new publication and shares her analysis:

Is it considered good research practice to retract an article, change the title, the results and conclusion, and then re-publish it with a completely new ID-number? The criticism still stands and the article should be retracted.

Enligish version: The music therapy study was retracted, amended and re-published: The results are worse than first reported
Norwegian version: Musikkterapi-studien er trukket tilbake, endret og re-publisert: Resultatene er verre enn først rapportert
Good analysis. Many of the figures changed, best I can tell is because of this:
All analyses in the intention to treat columns are based on imputation of missing values based on the ‘last observation carried forward’ principle.
Is not found in the update (below table 3), which would explain how some values like steps/day changed by quite a lot. I have no idea how this "principle" is valid, specially in a disease known to have wild fluctuations and sudden massive deterioration (and no sudden massive improvement).

Setting aside that 7k steps/day is at best mild idiopathic fatigue and in no way representative of ME/CFS, obviously. None of this is valid, everyone involved in this should be ashamed of themselves.
 
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Participants and their parents were told that personality, thoughts and feelings influence the development of the disease. The «situation», which was a long-term fatigue after an infection, is described by the research team as negative illness behavior, disease attribution and «avoidance».

The article defines «recovered» as a certain fall in subjectively reported fatigue. The results show that 8 participants in the intervention group were «recovered» – against 7 in the control group. At the same time, participants in the same group became more depressed, more fatigued, had more pain and a lower level of function. 8 of the 21 participants in the intervention group withdrew along the way.

It's a shame the authors seem unable to accept what the data is telling them. Seems obvious that this is not a good intervention and quite possibly is harmful.
 
The article defines «recovered» as a certain fall in subjectively reported fatigue. The results show that 8 participants in the intervention group were «recovered» – against 7 in the control group. At the same time, participants in the same group became more depressed, more fatigued, had more pain and a lower level of function. 8 of the 21 participants in the intervention group withdrew along the way.

It's a shame the authors seem unable to accept what the data is telling them. Seems obvious that this is not a good intervention and quite possibly is harmful.

I can't remember the details now, but a few months ago I remember thinking that Steinkopf had made a mistake with claiming that the CBT group was "more depressed, more fatigued, had more pain and a lower level of function". Maybe I was wrong, and I don't have time to check now, but I thought I'd mention that now so people can double-check before assuming that was all right. edit: This was with the first paper, I've not properly read the new one yet and have no idea what that says.
 
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I can't remember the details now, but a few months ago I remember thinking that Steinkopf had made a mistake with claiming that the CBT group was "more depressed, more fatigued, had more pain and a lower level of function". Maybe I was wrong, and I don't have time to check now, but I thought I'd mention that now so people can double-check before assuming that was all right. edit: This was with the first paper, I've not properly read the new one yet and have no idea what that says.

Looking at the table of results, there are hardly any differences between the groups. The only difference that stands out is some of the daily steps measurements. Maybe I'm missing something but I find it strangely difficult to motivate myself to care enough to look more closely.
 
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I think this result shows what pwME have been trying to tell them for years: The symptoms of ME/CFS correlate strongly with physical activity, and that there is a causal relationship - too much activity will lead to worsening symptoms. I think the authors' "surprise" may be because they simply don't get this. Given their approach does not have GET or incremental exercising in it, then maybe - without them even realising it - their patients have simply been learning to pace themselves better, learning to listen to their bodies and back off when they need to. Maybe something about their intervention was fostering that, even though that was not the authors' intention. Maybe unwittingly the authors have demonstrated what pwME have been trying to tell them all this time. Maybe, like PACE, they have proved something useful ... just not what they presumed they were going to prove.
Most CBT treatment protocols for CF and CFS encompass an element of increased physical activity over time,5 6 and graded exercise therapy (GET) in itself is shown to have beneficial effects in CFS.36 37 Our mental training programme did not contain this element, which may explain why physical activity to our surprise actually tended to decline in the intervention group during the treatment period. Interestingly, we observed a concurrent tendency of improvement of many symptom scores, including fatigue and postexertional malaise, in the intervention group.
[my bold]
upload_2020-10-23_23-25-46.png
 
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Looking at the table of results, there are hardly any differences between the groups. The only difference that stands out is some of the daily steps measurements. Maybe I'm missing something but I find it strangely difficult to motivate myself to care enough to look more closely.

The graph from indicates that for 'fatigue' the treatment group did not do worse than then control group.


@Kalliope - might it be worth a Norwegian querying this with Steinkopf?
 
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I think this result shows what pwME have been trying to tell them for years: The symptoms of ME/CFS correlate strongly with physical activity, and that there is a causal relationship - too much activity will lead to worsening symptoms. I think the authors' "surprise" may be because they simply don't get this. Given their approach does not have GET or incremental exercising in it, then maybe - without them even realising it - their patients have simply been learning to pace themselves better, learning to listen to their bodies and back off when they need to. Maybe something about their intervention was fostering that, even though that was not the authors' intention. Maybe unwittingly the authors have demonstrated what pwME have been trying to tell them all this time. Maybe, like PACE, they have proved something useful ... just not what they presumed they were going to prove.

[my bold]
View attachment 12278
My problem with this is that they don't discuss the possibility that the tendencies of improved secondary goals is related to the reduced step-count. I mean, they have thrown PEM into the mix so they should be aware of the possibility (although I don't feel their PEM question covers what PEM is so those results are meaningless to me).
 
I think this result shows what pwME have been trying to tell them for years: The symptoms of ME/CFS correlate strongly with physical activity, and that there is a causal relationship - too much activity will lead to worsening symptoms.

One can read these results as the intervention harming patients, or as helping patients to pace themselves better. But which one is the correct interpretation? And what does the intervention actually consist of? Even after reading the description it's not clear. They say there was no fixed plan to increase activity but maybe that just means patients were told to increase activity levels on their own judgment.

That steps per day is the only meaningful difference between the groups suggests I think the possibility of harm is more likely. Either way the treatment is useless and it shows how grossly the authors misunderstand the problem they're trying to treat.
 
It’s a rather unbalanced situation: if the intervention shows large effect sizes then it’s effective. When it doesn’t a full-scale trial is urgently needed. There’s no risk of your hypothesis being disproven.

Well, it is not as if regularly finding contrary evidence in his studies has ever led Wyller to drop his theory about "sustained arousal" either...
 
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