Cochrane Review: 'Exercise therapy for chronic fatigue syndrome' 2017, Larun et al. - Recent developments, 2018-19

Anyone interested in this role?
https://uk.cochrane.org/news/apply-...champion’?mc_cid=ff3a57209f&mc_eid=a63e0523d5
Apply to be a ‘Cochrane UK Consumer Champion’
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We are inviting applications from people who would like to be ‘Cochrane UK Consumer Champions’.
What will the role involve?
The role will be very flexible. You will be able to focus on tasks that you have a particular interest in to ensure you can use your expertise to support the aims of the initiative. Some of the tasks that may be involved are:

  • promoting opportunities for consumers to get involved in Cochrane’s work;
  • supporting consumers with getting involved in Cochrane’s work (e.g. identifying relevant resources and contacts within the organisations);
  • advising Cochrane on consumer needs and priorities within their community;
  • supporting Cochrane with the dissemination of Cochrane work relevant to the consumer communities;
  • providing support to Cochrane Groups in finding relevant consumers to help support their work.
https://uk.cochrane.org/news/apply-...champion’?mc_cid=ff3a57209f&mc_eid=a63e0523d5
 
MEMarge said:
How can one part of Cochrane leave the Larun Exercise review on their site, without clear warning, when they are producing blogs "To help you question health advice" including the following!


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Ideology. BPS/psychosocial/FND/MUS/conversion disorder is a belief system. Personal beliefs are fine. This here is a great example why ideology is incompatible with science and expertise, where even in the most favorable circumstances they still manage to inflict harm and corrupt an entire profession built on science and helping people.

They simply believe in the magical psychological illness thing and nothing can dispel that belief, even when it entirely contradicts their rules and standards. I still vividly remember BMJ's response to one of Crawley's papers, acknowledging it violated an explicit zero-tolerance policy but deciding that it was not a problem.

Evidence-based medicine is like a grand canyon-sized loophole for ideology. It would be easy to rectify but ideology makes it impossible for people to see things for what they are.

Great catch on this article, though, but there's only one catch that applies to us. It's quite a catch, that catch-22.
 
I am tempted to write a comment but I am not sure I can summon the energy. If I did it would something like:

Dear Selena,

It is good to see public education about the potential harms of treatments but I think for Cochrane to put out such advice carries an irony. There is a standing Cochrane review on exercise treatments for chronic fatigue syndrome that fails on just about all the issues you raise. And people at Cochrane know that it is seriously flawed but do nothing about it because of a strange rule that means reviews cannot be withdrawn if the authors do not want to. The interests of Cochrane contributors come above transparency.

What is even more worrying is that this review is only up because an even more problematic review was withdrawn. That one was co-authored by a prominent figure in Cochrane who writes major review articles on quality of evidence.

I personally have no competing interest in this area, being simply a retired physician who writes philosophy and goes birdwatching, but who also has a sense of what is ethical and what is not.

The whole problem boils down to vested interest. Cochrane gives the impression of being King Solomon but in reality was set up by people with a very clear agenda based towards the interest of low tech primary care based medicine. High tech gets the Cochrane workover. Low tech, like therapist-based treatments, is let through on the nod. I asked Iain Chalmers if he was not concerned about vested interest with regard to therapists writing reviews about treatments that provide their livelihood. He seemed to think raising vested interest was an insult. Yet surely the whole point of Cochrane was to address vested interest? The playing field does not seem to be level.

In your position I would be concerned that I was being used as a squeaky clean window dressing for an organisation that is not quite what it presents itself as. Cochrane is just a group of people with opinions, and those opinions are far from unbiased. I used to think otherwise (or it never crossed my mind) but various recent events have made it clear that it is much like any other organisation that makes money out of providing opinions people want to hear.

Yours faithfully

Jonathan Edwards
Professor Emeritus
 
Sly Saint said:
She has a psychology degree from the University of Bath
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There is a lesson here I think - about coincidences. They are uncommon.

I was talking to my wife about this Cochrane business and it came to me again that although the exercise for CFS review might be seen as some trivial backwater in the affairs of Cochrane only of interest to a few nutters with axes to grind, it isn't, it is right in the middle.

In general Cochrane does not have any impact in specialities where evidence is clear. I never even thought of consulting a Cochrane review for RA. Cochrane comes in to play when things are a bit iffy - breast screening, vaccination, chronic fatigue - all areas where the sound of axe grinding can be heard from over the hill.
 
Jonathan Edwards said:
Who would have thought it.
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also has a lot to do with Students for Best Evidence
https://www.students4bestevidence.net/blog/2016/10/05/students-4-best-evidence/

Suggested blog topics
What does ‘no evidence of effect’/ ‘evidence of no effect’ mean and how do they differ? (a useful reference paper for this is: “Claims of ‘no difference’ or ‘no effect’ in Cochrane and other systematic reviews“. (Draft blog in progress)

How do patients values and beliefs get taken into account when practising evidence-based healthcare?

  • What is ‘data dredging’ or a ‘fishing trip’?
  • What do trialists do about participants who are ‘lost to follow-up’?
  • What do we do when we can’t randomize?
  • What are composite endpoints and their possible strengths and weaknesses?
  • What is a cross-over trial and what are the strengths and weaknesses of this study design? (Draft blog in progress)
  • What are ‘adverse events’ and why is it so important that they are recorded and reported in studies?
    What are the principles of data management and presentation in health research? How to present data effectively?
Issues and debates within evidence-based healthcare
  • The seamier side of academia; lying, cheating and occasionally stealing. Retractions (withdrawals) of journal articles are increasing (more than the publication rate of articles is increasing). Moreover, misconduct accounts for the majority of retracted scientific publications. But how do some researchers get away with malpractice for so long and what is being done to tackle the issue? (See retractionwatch.com – a website keeping track of the authors who have had the highest number of retractions (e.g. for falsifying data)).
  • What evidence-based healthcare currently is vs. what it should be (in an ideal, but not necessarily unrealistic, world).
  • Communicating risk: how figures can be (mis)used and the difference between absolute and relative risk.

    The perverse incentives (publication, funding, promotion) in academia to produce positive results
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https://www.students4bestevidence.net/blog/2020/07/15/suggested-blog-topics/
 
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