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Observer and/or Researcher Placebo?

Discussion in 'Trial design including bias, placebo effect' started by Unable, Dec 28, 2018.

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  1. Unable

    Unable Senior Member (Voting Rights)

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    If certain researchers have a tendency to discount patient testimony, does that mean these researchers have the same problem as vets in discerning when a patient has been harmed or helped?

    I came across this article from Sceptic Vet, through a convoluted web-surf that started with me reading about harnesses for dogs, but it got me thinking.

    If researchers following the behavioural approach to treating ME discount patient testimony by claiming that part of our problem is an over sensitisation to symptoms, then there is surely a similar problem to the dilemma vets have ie - that the vet, or in our case the behavioural researcher, is likely to experience observer bias?

    If ME patients cannot effectively communicate how they feel (due to researcher discounting) then are we literally seen in the same light as animals? And are we experiencing outcomes of an elaborate researcher placebo effect?

    Anyway food for thought.

    http://skeptvet.com/Blog/2012/11/ca...-ineffective-therapy-is-working-when-it-isnt/

    Edit to add: Real message is that objective measures are best. But we knew that. ;)
     
    Last edited: Dec 28, 2018
  2. Peter Trewhitt

    Peter Trewhitt Senior Member (Voting Rights)

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    Presumably here the pet owners and vets demonstrating the caregiver placebo effect were relying on their own informal observation rather than attempting to measure any outcomes. Also they were only wrong arround 50% of the time compared to independent objective measures.

    Obviously, as @Unable suggests, there are potential parallels to the behaviour of some researchers. However our 'beloved' BPS researchers are perhaps not a clear parallel because they do attempt to measure outcomes.

    They do nevertheless disregard objective measures, even though on the rare occasions they are used the most frequent outcome is a null result, but prefer subjective self reported measures which are unfailingly interpreted as positive even when it requires torturing the statistics with such as outcome switching to get positive results. And further they do ignore any null effects in the subjective outcomes, such as at long term follow ups.

    With this preference for subjective self reported measures they employ an internal logical contradiction in that they argue that the subjects have false beliefs about the negative effects of their condition but assume they are accurate in their ability to report any improvement. This assumption of researchers that subjects are to be believed when reporting the positive and disbelieved when they report the negative presumably explains the lack of any adverse treatment reactions reported by such studies.

    In general in interpreting the results of entire studies the researchers are wrong 100% of the time. So I would argue that we are observing something much more complex in the BPS researchers than a carer placebo effect. Perhaps it does illustrate that in common with pet owners and vets, the BPS researchers are in fact relying on their own informal observations and beliefs rather than any formal evaluation, but it is clear they are also actively manipulating their formal observations to protect those beliefs.

    So the carer placebo effect may explain how the researchers coming from a clinical background initially came to their beliefs but can not explain why they distort their research to maintain those beliefs.

    I suspect, in the example of treating arthritis in dogs, the owners and the vets wanted the dogs to improve and also were disposed to believe that they would not engage in a course of treatment that would not work. I suspect we are more likely to see a clearer parallel with the individual therapists providing GET and PACE-type CBT. Patients are discharged as having successfully undertaken the treatment courses even though studies looking at such as getting back to work or levels of benefits claimed in people being treated in the UK by CFS services demonstrate little or no improvement (sorry I can't remember the reference/references).

    So I would suggest it requires more than the carer placebo effect to explain the BPS research, but wonder if it is a significant factor in the maintenance of the UK CFS services given they have such poor objective outcomes.

    [edited to correct typos and for clarity]
     
    Last edited: Dec 28, 2018
  3. Unable

    Unable Senior Member (Voting Rights)

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    THIS!!
     
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  4. Unable

    Unable Senior Member (Voting Rights)

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    Yes @Peter Trewhitt You are of course right there is much more going on with BPS research, beyond just this inability to listen. It was the passing thought that our BPS researchers treat our comments as though they can’t understand what we say - or put another way as if we are animals - that got me.

    I agree with all of your post though. ;)
     
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  5. Peter Trewhitt

    Peter Trewhitt Senior Member (Voting Rights)

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    Yes, I understand you point. A disrespect for the patient is inherent in the BPS approach to ME/CFS and their development of the concept of MUS as a covert psychiatric diagnosis. However I wonder if this disrespect comes from a disdain or even moral judgement that is different to how we regard animals.

    I agree the animal carer placebo effect is an interesting and darkly amusing parallel for how the BPS cult approach ME/CFS and more widely MUS, but unfortunately it is likely that those researching and promoting policy have more worryingly complex motivations.

    [Added - It might even be that we would be better off if we were treated by vets basing our treatment on nonverbal communication.]
     
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  6. Unable

    Unable Senior Member (Voting Rights)

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    @Peter Trewhitt

    “Distain” & “Moral Judgement” - Yes, but mostly “distain” it seems :(
     
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  7. chrisb

    chrisb Senior Member (Voting Rights)

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    Yes. Publication tomorrow of the New Years Honours List is awaited with keen anticipation.
     
  8. Peter Trewhitt

    Peter Trewhitt Senior Member (Voting Rights)

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    Are you starting 'a book' on this?

    What odds do you give on a Lord Wessely or a Dame Crawley?

    [Added - perhaps we should be contacting our local Lord Lieutenants or writing to the Prime Minister's office with our own nominations.]
     
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  9. Trish

    Trish Moderator Staff Member

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    Both seem possible :arghh:, but Lords done by a separate process I think, not part of the 'honours' system.
     

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