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EBM and chronic illnesses

Discussion in 'Health News and Research unrelated to ME/CFS' started by Amw66, Sep 1, 2018.

  1. Amw66

    Amw66 Senior Member (Voting Rights)

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  2. Trish

    Trish Moderator Staff Member

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    A quick read through tells me the author is questioning whether evidence based medicine which requires large randomised controlled trials may not be the best way forward for MUS such as ME because everyone is different, so we need to each be treated individually.
    Here's the concluding section:
     
  3. Amw66

    Amw66 Senior Member (Voting Rights)

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    Thanks Trish. On train and have not mastered selective cut and paste .
     
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  4. Trish

    Trish Moderator Staff Member

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    I note also that it's a blog, but a longer version has been published in Philosophers' Magazine. Paywalled. No idea whether the author is medical or philosophical in background.
     
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  5. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

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    It sounds like a psychotherapist using pseudo-philosophy to advertise their mumbo jumbo. The philosophical content is all rubbish. The basic argument is that although evidence is nice if things are complicated it is better to make things up as you go along.
     
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  6. Trish

    Trish Moderator Staff Member

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    That was my conclusion too, @Jonathan Edwards. It didn't seem a particularly helpful contribution to understanding what to do with MUS.
     
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  7. Peter Trewhitt

    Peter Trewhitt Senior Member (Voting Rights)

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    Is considering everyone as individuals in this context an excuse for not addressing the very dangerous untested theoretical underpinning of MUS?

    Without explicitly stating it the proponents are effectively creating an MUS syndrome that consists of a group of people believed not to have any organic basis for their medical symptoms which are the result of faulty cognitions, and is diagnosed on the basis of clinical option, ideally without any diagnostic tests and without seeing any specialists, because such reinforces the patient's false beliefs. [added, ie a new psychiatric diagnosis of MUS syndrome.]

    We get into very dangerous circular thinking that says the only way to diagnose this is by the beliefs of the GP, as any formal medical investigations or intervention will reinforce the false beliefs of the patient. Hardly surprising that the conditions lumped together under MUS disproportionately effect women, indicating medical bias.
     
  8. Peter Trewhitt

    Peter Trewhitt Senior Member (Voting Rights)

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    Reading through the article a second time it seems the basis of the arguement parallels that of Freud's rejection of neuropsychological modelling in favour of what became psychoanalysis.

    Freud's critique of the little box approach to neurological models of behaviour, outlined in such as "On Aphasia" was brilliant and raised philosophical problems that have still not been full answered today. Unfortunately Freud's conclusion was to abandon objective scientific investigation and replace it with his own personal fancies that tell us more about the psychology of Freud and the cultural hang ups of nineteenth century Vienna than the functioning of the human brain in general.

    The creation of an MUS syndrome without any objective evidence base is as much about contemporary culture and the prejudices of a group of researchers and clinicians than it is about medical science. As the research justification relying on exceptionally bad science such as PACE becomes untenable, we are now seeing an attempt to take these beliefs and assertions outside the context of objective verification or potential falsification.
     
  9. Jonathan Edwards

    Jonathan Edwards Senior Member (Voting Rights)

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    Looking at links it seems that this comes from CauseHealth, which is associated with someone called Nancy Cartwright and involves philosophers (the author seems to be a philosopher) and also with a university called NMBU in Nrway. As I suspected this has links with the organisation that Iain Chalmers and Paul Glasziou are linked to. Iain Chalmers is the founder of Cochrane. Glasziou writes articles on how to do trials with Chalmers but was also an author on the exercise Cochrane review with Larun and the PACE authors. This seems to be part of some deep religious network maybe with an anti-pharma bias. Norway seems to be the link and Cochrane seems to be up to its eyes in it.
     
  10. Esther12

    Esther12 Senior Member (Voting Rights)

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    I've not been impressed by Rani Lill Anjum's project. I think they got a huge amount of money for this philosophical examination of MUS and have come up with nothing interesting despite it running during the whole PACE drama. Who could fail to find anything interesting to say about that?
     
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  11. Trish

    Trish Moderator Staff Member

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    Where did they get the money from?
     
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  12. Esther12

    Esther12 Senior Member (Voting Rights)

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    They say: "CauseHealth is a 4 year research project, funded by the FRIPRO scheme for independent projects of the Research Council of Norway and hosted by the School of Economics and Business at the Norwegian University of Life Sciences (NMBU)."

    I see Henrik Vogt is one of their collaborators: https://causehealthblog.wordpress.com/causehealth-collaborators/

    Actually, it looks like they were only given a million... I thought it was even more than that:

    http://www.bournemouthecho.co.uk/ne...ng_study_into_unexplained_medical_conditions/
     
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  13. MSEsperanza

    MSEsperanza Senior Member (Voting Rights)

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    I once landed on the CauseHealth blog when I had the idea that Trish Greenhalgh ( https://www.phc.ox.ac.uk/team/trish-greenhalgh ) might be an ally in a more sensible and less hubristc understanding of the BPS approach to chronical illnesses and googled her, finding her there: https://causehealthblog.wordpress.com/the-guidelines-challenge-a-causehealth-event/

    I was soon disillusioned of finding possible allies in Trish Greenhalgh and the CauseHealth people when I read what their alternative, individualized BPS approach looked like: https://causehealthblog.wordpress.com/project-description/

    Interesting that they seem to be linked to the founder of Cochrane.
     
    Last edited: Sep 1, 2018
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