Michael Sharpe skewered by @JohntheJack on Twitter

What I find strange is that Dr Sharpe seems not to understand very basic concepts like conflict of interest. There is no conflict of interest in raising money to be able to put a point of view if you openly indicate that you are raising money to put that point of view.

A CONFLICT of interest is when obtaining money for services might be expected to lead to biasing some other activity that you undertake, like research.

On Sharpe's definition all journalism is a conflict of interest, including the BBC funded by a licence fee - it makes no sense.

And he seems to fail to understand that whether or not he thinks he would hold the same views irrespective of being paid by people with an interest in those views is of no consequence. What matters is whether or not it is reasonable for others to think that things might be otherwise in the light of what we know about human nature. The same would apply to journalists but in their case their is no CONFLICT because they are not doing anything else that might be biased by this.

The most extraordinary thing about the behaviour of psychological medicine people is that they seem to have so little understanding of human nature (otherwise known as psychology).

And there is no 'level playing field' needed between bad BPS research and bad biological research because the biological research is not being forced on the general public in the form of government guidelines. Nobody needs to worry about the bad biological research because nobody is being forced, or even encouraged, to suffer the treatments proposed.

 

From his point of view his work is being defamed so my guess is he is in survival mode, he is used to being on the offensive not defensive (until now).
I suspect he is looking for any angle because his house of cards is in serious danger if he does nothing since it can't stand on its merits now that people are demonstrating the emperor has no clothes and gaining traction. This type of defensive behaviour is not uncommon for anyone from politicians, celebrities or anyone else high profile who is drowning in the situation they created. Sometimes they can save themselves especially when they have a carrot to go with their stick (works better in politics then medicine, usually).

 

Let's also remember this quote from Professor Sharpe in his 2011 interview with Norman Swan on the ABC network in Australia not long after The Lancet published the first results: “We have a number needed to treat; I think it's about seven to get a clinically important treatment benefit with CBT and GET. What this trial isn't able to answer is how much better are these treatments than really not having very much treatment at all.”

One in seven is about 15%. That would be the difference between their claimed "improvement" rates and the "improvement" rates in the comparison groups. It's also the difference between the "recovery" rate of 22 % and those in the other two groups. If a treatment only helps one in seven, why should everyone with the illness be required to pursue this in order to obtain benefits? Moreover, his second sentence suggests that the study did not prove what it set out to prove. If the trial can't answer whether these treatments are better than no treatment, that means the authors know that the therapies have not been proven to be effective. This statement meets the best definition of a "gaffe"--a true thing that a person has accidentally admitted in public.

 

Indeed, sounds like a Kinsley Gaffe to me.
I'm very confused (perhaps better stated as mad), a 1 in 7 treatment rate is pathetic, not to mention they used recruitment criteria that may have treated who knows how many non ME/CFS patients as if they had the disease inflating their numbers. At such a low arbitrary rate how can they defend locking people up or for failure to recover or denying benefits when by his own words 6 in 7 won't benefit. And in what disease is 1 in 7 improved a successful treatment anyways. You can't be hitting a disease mechanism if over 85% see no benefit or get worse from a treatment.
Interesting that they don't want to talk about the 6 in 7 they won't even admit outside this quote they "know" won't benefit, hoping the gaffe will disappear into the abyss.
By this measure Rituximab is an unqualified success, at 30% in the second trial its double the effectiveness using better recruitment criteria

Sorry i'm just ranting

 

He has illustrated this perfectly by showing that he doesn't understand the conflict of interests between his foot and his mouth on twitter.

 

Why won't Prof Sharpe answer my question? He keeps saying, "It's just a trial, it's just a trial"

https://twitter.com/user/status/982971681818992641

 

i suspect he’s trying to farm vexatious comments ? He can then feign mock outrage and paint this as further evidence on an attack...he’s clearly still hopeful ...but sadly deluded.

He’s actually probably not worth engaging with...it’s not like it’s a productive or stimulating conversation...just a bit bizarre?

 

He's still going...
https://twitter.com/user/status/985438466103300096

 

Similar to the point Jonathan Edwards made, PACE receives focus for two reasons, its effect on government health policy and its share of research funding. It never ceases to baffle me how you could spend that much money trialling a treatment when a) we still need a ton of research on the cause and if necessary, phenotyping of the disease and b) it seems infinitely more sensible that small scale high objective data trials should of commenced before a trial like PACE. As we've learned from the recent release of notes from the trial, finding appropriate and accurate ways to measure efficacy is a challenge all by itself.

To me, the name 'PACE Trial' has always seemed aggressive. It's no secret Pacing has been the preferred illness management strategy of patients. It makes one wonder, are the patients on trial? Is Pacing on trial? It's supposed to be a treatment comparison.

 

Sharpe is in a sense making a valid point. PACE was just a trial. The psychological relationships within a trial are completely different from outside trials. The treatments being tested were based on psychological relationships. So there is no reason to extrapolate the results to real life. In real life people do not feel sorry for therapists wanting their trial to work.

 

Yes I think that's right and that's why it feels uncomfortable to read, not bizarre, well thought out and trying to bait a vexatious response.

 

Indeedy. So where did Horton get the notion that it was more than that?

 

My understanding is that it was a deliberate sop to AfME who were very disappointed when the trial they thought was deigned to prove pacing works turned out to be designed to show it didn't work. The letter from Moira Henderson of the DWP reveals the doubletalk going on.

 

Hey, you are supposed to be the fons et origo here!
I couldn't possibly comment.

 

hey indeed; don't know about the other fella (origo)

 

I'd love to know who the real fons et origo of that notion is though. Probably not Sharpe, but you never know...

 

They always avoid the difficult questions.

 

Sure, but there’s a difference between a funding source which funds only because they want to particular outcome, and a funding source which is at least in theory paying for science and discovery.

With someone like sharpe, the appearance is that they are part of a team effort to promote a particular viewpoint under a cloak of science, rather than people pursuing science who may also advise and advocate regarding the results of that science.

Even the advocacy role is problematic; imahinr you are researching heart disease and also advocate for the consumption of say, s ‘miracle fruit’ which you have discovered reduces the incidence of heart attack. Once you are hired by a company or agency which is tied to that miracle fruit, you will find it hard to be objective about further research. It may be that the expertise you have the expertise the miracle fruit company needs her perfect match, and so it makes sense to work with them. While there is nothing nefarious about that, the result is a conflict of interest damaging to the science you pursue.

My feeling here is that the conflict is not so innocent.

 

I have a hard time understanding this notion of vexatious comments, and why anyone would give significance anonymous posts on the Internet short of credible threats of death or rape. It’s the Internet, which brings out all manner of people saying outragous things. Look at the comments about the Charlie Gard case, where random people said that the parents should have shot the doctors and hospital staff, and then ran off with the child. The same people in real life would be afraid to cut in line at the supermarket.

Here in the United States if you go on the political site, any view which is associated strongly with either right or left will draw comments from people expressing wish for you to die in a fire, or specifically offering to arrange said dramatic demise. Some of the people who post that would actually do so if they had a bit more courage. The other 99.997% of such comments are just halitosis in printed form.
We really don’t worry much about people saying the equivalent of “I don’t like you, you probably smell bad, and I hope space aliens bite off your head”.