Persistent physical symptoms not explained by structural abnormalities or disease processes: a primary care approach [..] recovery, 2026, Abrahamsen+

Nightsong said:
If you are an LP quacktitioner and make money from conducting LP courses then being involved in a study about LP is an obvious conflict of interest because you stand to gain directly & financially from a positive outcome. That is self-evident.
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That is not self-evident to me. No more than a CBT therapist being involved in a CBT study. I don't see the difference. In both cases, they are practitioners--or quacktitioners, if you will--doing their work. But if licensing fees paid hither and yon are involved, that certainly seems to raise the stakes in terms of making it a conflict of interest.
 
Jonathan Edwards said:
I think CBT therapists would be in the same ballpark as Landmark
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Ah, that's the rub. That makes things clearer. That's where we disagree. Under your theory, I think, anyone offering medical services and also conducting investigations into the interventions they favor would have a commercial interest that requires disclosure, even if they're on salary--the ongoing success of their position depends on the success of trials of the intervention. But I agree if there are licensing fees she gets in some way from other people, that makes a difference. I don't think just offering services to gullible people meets the bar.
 
Utsikt said:
really struggle to understand how it’s only a COI if a third party benefits, but not if you benefit yourself.
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But again, every clinician involved in research benefits from positive findings of the interventions they like--even if they're on salary, since their position might be based on their expertise in that intervention. Jo apparently thinks the same COI rules would apply to CBT therapists researching CBT, even if they're just getting $$ from clients. I don't agree.
 
dave30th said:
the ongoing success of their position depends on the success of trials of the intervention.
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Not for a salaried NHS physician. Trials can fail and you still need the physician to make diagnoses and advise. I was never paid to provide treatments. I was paid to give the best advice I could. Someone else got paid for the treatments. In the US I suspect nothing like this occurs because everything is seen through a commercial lens. A CBT therapist is paid to provide treatment.
 
Jonathan Edwards said:
Not for a salaried NHS physician.
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Sorry, Jo--the NHS is not how things necessarily work elsewhere, so I don't see it as undermining my argument. An expert in a particular intefvention in a health care system in the US would have big problems if their research showed the intervention was a bust.
 
dave30th said:
how does that work, exactly? Is she just getting money from patients? Who is she receiving royalties from? Does she get royalties from other practitioners, or do they just pay her to train them? The journals guidelines say "a conflict of interest can occur when you, or your employer, or sponsor have a financial, commercial, legal, or professional relationship with other organizations." What is the other organization, besides herself, that she has a relationship with? That's what I'm not clear on. The fact that she offers a "treatment" and gets paid for offering it doesn't seem to be enough.
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The LP coaches get all the proceeds from the courses they arrange, except for a share of 15 % that’s paid to Parker. It’s essentially a franchise.

LP is not a general healthcare activity, it’s a purely commercial product.

This is a far more direct conflict of interest than a private psychologist, even though I think that still constitutes a COI. You’d never pass a competence/disqualification check for that in a public office in a country with sane laws.
dave30th said:
Selling them to practitioners? That's a different issue and involves third parties, as opposed to her just offering LP to clients. Can you point to where this is made explicit? That she is receiving royalties?
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I must have misspoken if that’s what I said. I have no info about if Landmark receives a commission for recruiting other coaches. I think the training of the coaches is done centrally by Parker.

From Taylor:

Some examples of financial conflicts of interests include:​

  • Employment or voluntary involvement
  • Collaborations with advocacy groups relating to the content of the article
  • Grants from an entity, paid to the author or organization
  • Personal fees received by the authors as honoraria, royalties, consulting fees, lecture fees, or testimonies
  • Patents held or pending by the authors, their institutions, funding organizations, or licensed to an entity, whether earning royalties or not
  • Royalties being received by the authors or their institutions
  • Stock or share ownership
  • Benefits related to the development of products as an outcome of the work
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Examples of non-financial conflicts of interests:​

  • Receipt of drugs, specialist equipment, tools, computer programs, or digital applications
  • Access to data repositories, archival resources, museum collections, by an entity that might benefit, or be at a disadvantage financially or reputationally from the published findings
  • Holding a position on the boards of industry bodies or private companies that might benefit, or be at a disadvantage financially or reputationally from the published findings
  • Writing assistance or administrative support from a person or organization that might benefit, or be at a disadvantage from the published findings
  • Personal, political, religious, ideological, academic and intellectual competing interests which are perceived to be relevant to the published content
  • Involvement in legal action related to the work
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I think the specific financial questions are the most important thing here but I just want to emphasize how generic a thing CBT is compared to the lightning process. LP is trademarked and associated with a specific guy, while CBT is public domain and has a zillion resources and books on it. Any therapist you ask will be familiar with CBT and, at least based on therapists near me in the US, most of them will list it as one of the techniques they actively use. CBT (and its off-shoots like DBT) are everywhere in therapy.

CBT is so generic that studies of CBT are criticized on the basis that we don't know what they actually did. Wiki has a decent summary:
Use of the term CBT may refer to different interventions, including self-instructions (e.g. distraction, imagery, motivational self-talk), relaxation and/or biofeedback, development of adaptive coping strategies (e.g. minimizing negative or self-defeating thoughts), changing maladaptive beliefs about pain, and goal setting.
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Because CBT is so widespread, I don't think we see therapists building a business around it the same way people do with LP. You're not going to stand out and attract clients just by saying you offer CBT. It's like store brand vitamin C, versus LP would be one of those boutique overpriced combo supplements that only sells through naturopaths.

(Not saying CBT is any more scientific than LP, just more popular).
 
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Nightsong said:
If each quacktitioner is paying him a flat yearly fee + 15% of LP course fees that's surely a significant disclosable commercial relationship, no?
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Yes, for Phil Parker. I'm not sure why that would be a disclosable COI for Landmark. Unless it's a pyramid scheme and she's getting royalties from some people.
 
  • Employment or voluntary involvement
  • Collaborations with advocacy groups relating to the content of the article
  • Grants from an entity, paid to the author or organization
  • Personal fees received by the authors as honoraria, royalties, consulting fees, lecture fees, or testimonies
  • Patents held or pending by the authors, their institutions, funding organizations, or licensed to an entity, whether earning royalties or not
  • Royalties being received by the authors or their institutions
  • Stock or share ownership
  • Benefits related to the development of products as an outcome of the work
Which of these apply to Landmark?? Doesn't seem to me that any of them do. If she receives honoraria, royalties, consulting fees, lecture fees or testimonies, she would have to declare them. But in all the comments here, no one has argued that she is doing any of these things. Presumably she pays royalties to Parker, but that's Parker's COI if he were an author--no one has argued that she's receiving royalties or licensing fees. No one has pointed out any money she's received from anyone other than people who pay her for her LP trainings. Phil Parker has the trademark (comparable to a patent)--she does not. So I don't know that the fact that it's a trademarked thing makes a difference. Just because she's awful doesn't mean she should have a higher burden for declaring COIs.

However, I'd like to discuss this with some ethics experts. Perhaps they will see something there that I don't.
 
Nightsong said:
To my mind, if you build an academic career around one type of intervention or category of interventions - whether that is art therapy or CBT or exercise therapy - then you have a personal interest in its success as surely as if you were being paid as a commercial practitioner; but universities and ethics committees don't see it that way. It's an intriguing double standard.
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I agree the same standard should apply. That's why I don't see a difference between a Chalder and a Landmark on this specific question. It might be better if someone like Chalder had to declare practicing CBT or the fact that her whole career is CBT as a conflict--but she doesn't. She only has to declare royalties from books, being an expert witness, or whatever. And so in my view the same standard should apply to Landmark.
 
Turtle said:
Do the two posts 21 and 22 sound like a conflict of interest @dave30th ?
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Did NAV paid her to do it? Then yes, that would represent an outside financial interest that she would have to report. Otherwise, I think it's a stretch. The fact that someone else decided to declare previous work as a conflict of interest doesn't mean it's required in this instance if her income is solely from giving the trainings to clients.
 
dave30th said:
Yes, for Phil Parker. I'm not sure why that would be a disclosable COI for Landmark. Unless it's a pyramid scheme and she's getting royalties from some people.
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I think that's a narrow reading of what should ethically be disclosed. It points to an ongoing, significant commercial relationship of (presumably) mutual benefit to the parties. A successful trial result - or a supportive opinion piece - is of commercial benefit to both individual practitioners and the LP enterprise as a whole. Having the LP promoted as if it were a viable treatment for ME/CFS means more clients, which is to the direct financial benefit of both individual practitioners and the LP HQ. The success of the LP organisation, in turn, is a success for the individual practitioners - more credibility, more publicity, more clients, more money.

The LP organisation is not 'neutrally' providing LP training, either - it has engaged in advocacy around ME/CFS, e.g. with its responses to the NICE consultation draft; it sought to shape national guidelines in its own interests.

Regardless of whether it falls under this or that journal's particular rules I think it's manifestly a conflict of interest & should, ethically, be disclosed. I'd be interested to hear what the ethicists say, though.

CBT also has an elasticity that LP does not in that it is practiced in disparate ways.
 
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Nightsong said:
I think that's a narrow reading of what should ethically be disclosed. It points to an ongoing, significant commercial relationship of (presumably) mutual benefit to the parties. A successful trial result - or a supportive opinion piece - is of commercial benefit to both individual practitioners and the LP enterprise as a whole.
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The same could be said of Chalder or other therapists who specialize, and of studies of CBT or whatever modality they pursue. Why do you think they committed research misconduct with PACE? Had they reported the results, it would have ruined their financial prospects going forward--no more advising insurers, no more advising goverment, no more books about how great CBT is, etc. The entire enterprise would have suffered.

But as you noted, therapists doing therapy is not required as a reportable COI. Perhaps it should be--that's a different question--but it's not. Absent any evidence that Landmark receives money from something other than doing the LP training, I don't see it.

Also, all therapy is a "commercial product" if there's an exchange of money between client (or their health insurer) and the therapist. Now maybe the ethics experts would say that because the LP is trademarked, it's different than non-trademarked interventions and anyone who does it needs to declare it, regardless of whether or not they get other moneys through royalties and such like. I kind of doubt it, but I don't know for sure. My gut is still that this is an overreach in this situation.
 
I think the bottom line here is that a conflict of interest is not defined by a list of examples, it is defined by a conflict of interest. We all know what that is - potential benefit accruing to the individual influenced by the writing of an article or, in particular, the way it is written.

It is a bit like the validity of a finding relating to disease causation. There is a truth of the matter. It may be difficult to ascertain that truth and it may be impossible to define a precise statistical measure that indicates the truth but there is a truth.

Landmark has a conflict of interest in writing an article that promotes a view, and crucially a view that is not likely to be based on truth, although that may not be ascertainable without doubt, in such a way that benefit is more likely to accrue to her, since she makes a living out of selling a therapy.

Much the same applies to Chalder. The only difference is that her views are more protected by an establishment narrative. But Chalder gets fees for courses on CBT so she is in the same boat in that respect.
 
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