CEP Guest blog: NICE depression guideline – cautious optimism?

Conclusions

Some may take the view that ‘interfering’ in NICE guideline development is antithetical to the nature of our UK guideline body. Indeed NICE was established to be free from political interference and lobbying from pharmaceutical companies. In a commentary in the British Journal of Psychiatry, Prof Sunkin QC (Hon) and I argued that the stakeholder consultation process is a critical element of quality assurance in NICE guidelines (McPherson & Sunkin, 2019). We suggest that stakeholder consultation can only serve as a robust quality assurance process if legitimate methodological concerns raised by stakeholders during this process are taken into account and not brushed off as minor inconveniences. Moreover, as a public body, NICE is bound by English law to consult in good faith and not to have made decisions prior to the consultation. It is therefore appropriate that NICE appear to have taken on board a set of methodological concerns expressed by a wide section of the patient and professional stakeholder community. The next revision of the guideline will inevitably take some time given the amount of new work now to be done but there appears to be reason for some cautious optimism along with some remaining concerns about the next draft which will be put out for stakeholder consultation in due course.
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The bolding of 'appear' is mine.
 
I had a quick look around this website for the Council for Evidence-based Psychiatry, seems their sole mission is to campaign against the use of psychiatric drugs, nowhere though does it say what they think psychiatrists should be doing. They rightfully point out manipulation and burying of drug trial data but if they think that is bad they should see the trials for non-pharmaceutical treatments.
 
These were that patient experience research had been omitted; as had long-term follow-up data; chronic forms of depression had been inappropriately separated into chronic, treatment-resistant and complex depression; that depression severity in trials and subsequent interpretations of ‘recovery’ had been misrepresented; that an experimental and ‘confounded’ network meta-analysis (NMA) had been used as a primary rather than supplementary basis for recommendations; that quality of life outcomes had been left out.
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So... everything? Yeah, sounds about right. Literally all the things that matter are omitted. This is a chronic problem, caused largely by unhelpful beliefs about illness. Irony.

Patient engagement remains aspirational fiction, something medical authorities reject out of hand. The process almost seems incapable of producing useful things without being forced to and even then barely manages to put the effort.
An analysis of long-term outcomes for the trials of treatments for long-term depression included in the guideline review illustrated how and why NICE should do so too (McPherson & Hengartner, 2019). Although long-term evidence from RCTs is limited in volume, the findings from this set of data (that psychological therapies are superior to antidepressants in the long-term) is supported by a range of systematic reviews of other forms of evidence including naturalistic cohort studies and discontinuation trials.
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This could be significant for us. The entire clinical paradigm is based on a bunch of cherry-picked and misleading trials and rejects all real-life outcomes since then as being significant, despite using the same outcome measures of patient self-reports, prefering the misleading cleanliness of experiments that fabricate an outcome over the messy reality of outcomes completely failing to live up to the conclusions made by these trials, and instead aligning with the underlying data often showing an utterly useless and fictitious paradigm.
Moreover, as a public body, NICE is bound by English law to consult in good faith and not to have made decisions prior to the consultation.
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Haha. Good one. It's nice to dream but it's better to treat reality the way it is, not the way it should be. There are several members of the ME NICE committee who have publicly asserted they support the current BPS paradigm and nothing else. Hell, NICE is even conflicted in our case for having waived the entire process in 2017 and having decided their outcome.

I'm not sure how "good" the news of managing to shame NICE into at least pretending to do the work they have to do rather than the ideology they prefer to fabricate. It shows the entire process to be so dysfunctional that it should be broken up entirely and remade from scratch. The whole point of experts is that they should not have to be shamed into working with reality instead of focusing exclusively on things they like.

When you have to work against the "experts" to solve a problem, you now have two problems to solve. Honestly the lack of progress in this field is clearly revealing that it is the field itself that is responsible for most of that failure. It's all beliefs, opinions, assumptions, biases and logical fallacies, none of which care about patient experience or outcomes. The solution is the problem to the solution to the problem.
 
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