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Notes on Flaws of the Biopsychosocial Model for Treating Myalgic Encephalomyelitis

Discussion in 'PsychoSocial ME/CFS News' started by Awol, Mar 22, 2018.

  1. Awol

    Awol Senior Member (Voting Rights)

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    Woolie, Jan, Invisible Woman and 7 others like this.
  2. Hutan

    Hutan Moderator Staff Member

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    I think this document could be really useful with a few tweaks. It focuses on the PACE trial. But I know from my attempts to change treatment guidelines in my part if the world that suggesting PACE was flawed doesn't help. The response is 'well the Cochrane report reviewed a number of studies, not just PACE, and found that GET works'.

    I think there has to be a mention of what is wrong with all the BPS based studies (notably, unblinded treatments with subjective measures, coupled with a treatment that convinces people to report more positively than they might otherwise.).

    I also think that something should be said about the studies finding differences in energy metabolism and metabolites etc.
     
    Woolie, Jan, Sly Saint and 11 others like this.
  3. Sly Saint

    Sly Saint Senior Member (Voting Rights)

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    Have any of these other papers been reanalysed?
     
    Last edited: Mar 23, 2018
    Jan, EzzieD, Skycloud and 4 others like this.
  4. Awol

    Awol Senior Member (Voting Rights)

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    Those are good suggestions and I'm sure they'll update those notes when they have time.

    Yes, the BPS lobby is always ahead of the game, bearing in mind they've been playing it for 30 years or so, and NICE is using the argument that their treatment recommendations don't rely on the PACE trial, but as you say, the basic flaw in all these trials is the unreliability of unblinded trials relying on subjective outcome measures of treatments based on improving patient self-report of symptoms. So hopefully, it won't be too hard to downgrade these trials as evidence, and Cochrane is next on the list to remove this safety net for the BPS lobby.

    In January 2018, Mark Baker replied to Kathleen MCall..

    "As you are, I’m sure, aware the NICE guideline on ME/CFS was published before the PACE trial was seriously under way. Our recommendations were based on a body of research which preceded the PACE study. In our most recent review of the guideline, and cognisant of the controversies regarding the interpretation of the PACE results and methods, we assessed the evidence with, and without, the PACE results and the trial made no difference to the conclusions. Therefore, I cannot accept at this stage that reports of flaws in one study invalidate the results of all the studies in this area."

    http://www.investinme.org/IIMER-Newslet-1801-01.shtml#MBaker-reply

    @Hutan I'm not sure of your neck of the woods, but another rationale for downgrading of evidence for CBT and GET in USA was by discounting studies using the Oxford CFS criteria, refs. 12, 13, 14 in the pdf (but again perhaps could be spelt out in the bullet points) so could that be used to counter the argument about the other studies reviewed by Cochrane?
     
    Cheshire, Woolie, Solstice and 7 others like this.
  5. Hutan

    Hutan Moderator Staff Member

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    Yes.
    Lots of good reasons to try again for change.
     
    Solstice, Awol, Jan and 2 others like this.
  6. Woolie

    Woolie Senior Member

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