Petition: S4ME 2023 - Cochrane: Withdraw the harmful 2019 Exercise therapy for CFS review

Cochrane said:
Our procedures can involve referring complaints within the organization, for example, to our conflicts of interest panel. This depends on the matters raised within the complaints, not on who made the complaint.
I assume this is a response to this section of our letter of 20th November
We have read Hilda Bastian's November update in which she outlines some reasons for the lengthy delay in work on the new review, including Cochrane dealing with some complaints. Cochrane's demonstrated willingness to entertain a complaint arguing against the 2019 Larun et al review being replaced, presumably from a relatively small group of people with vested interests in the recommended treatment, by investigating for over a year and involving multiple committees while ignoring a complaint from patient representatives increases the reputational risk even more.
So they are telling us that the complaint from the BPS people that led to over a year of meetings was at least in part based around their perception of conflicts of interest in the IAG. The fact that Hilda says the new IAG member to be appointed in the new year is for 'balance' and is to be a 'medical practitioner working with people with ME/CFS', suggests to me that they objected to there being 3 patient reps and only 2 clinicians on the IAG.

Cochrane said:
The Cochrane Governing Board is informed about developments relating to this review. I recognize that this email does not address the concerns and complaints you have sent in previous correspondence. However, the other matters you have raised are under review, and we will get back to you in due course.
And this is telling us our assumption in our letter that our complaints are not being considered is wrong. Since we were making that assumption on the basis of the very confusing message in the previous letter from Cochrane, it is good at least to have confirmation that our complaints are being considered.
 
Hi to all

following a flurry of signatures by Swiss PwME in the last couple of weeks the petition total now stands at 9780.

if you have social media accounts or a blog it would be great if you could do a seasonal share of the link to the petition, possibly after Christmas or in the new year

the open letter and petition will continue to be open to new supporters for as long as needed

NP x
 
The Schweizerische Gesellschaft fur ME said they would cover the petition in their December newsletter

Yes, we covered it in the December 16 newsletter. We will also post it on social media at the beginning of the year.

Don't know whether iframe is possible here, but if so, you can read it below. Otherwise, with this link: https://a2ws3.r.sp1-brevo.net/mk/mr/sh/OycXxko2a8zXNWXitvBvW9TR/m9j4vRiOEKoc#GET


Code:
<iframe src="https://a2ws3.r.sp1-brevo.net/mk/mr/sh/OycXxko2a8zXNWXitvBvW9TR/m9j4vRiOEKoc#GET" width="100%" height="300" style="border:1px solid black;">
</iframe>
 
Yes, we covered it in the December 16 newsletter. We will also post it on social media at the beginning of the year.

Don't know whether iframe is possible here, but if so, you can read it below. Otherwise, with this link: https://a2ws3.r.sp1-brevo.net/mk/mr/sh/OycXxko2a8zXNWXitvBvW9TR/m9j4vRiOEKoc#GET


Code:
<iframe src="https://a2ws3.r.sp1-brevo.net/mk/mr/sh/OycXxko2a8zXNWXitvBvW9TR/m9j4vRiOEKoc#GET" width="100%" height="300" style="border:1px solid black;">
</iframe>
Thanks Jonas:thumbup:
 
Merck Manual: Chronic Fatigue Syndrome (Professional version)

By Stephen Gluckman , MD, Perelman School of Medicine at The University of Pennsylvania
Reviewed/Revised Jul 2023

Under "Treatment of Chronic Fatigue Syndrome"
  • Acknowledgment of patient's symptoms

  • Sometimes cognitive-behavioral therapy

  • Sometimes graded exercise, limited to avoid a setback

  • Medications for depression, sleep, or pain if indicated
To provide effective care to patients with CFS, physicians must acknowledge and accept the validity of patients' symptoms. Whatever the underlying cause, these patients are not malingerers but are suffering and strongly desire a return to their previous state of health. For successful management patients need to accept and accommodate their disability, focusing on what they can still do instead of lamenting what they cannot do.

Cognitive-behavioral therapy and a graded exercise program have been helpful in some studies but not in others (1, 2). They should be considered for patients who are willing to try them and have access to the appropriate services. Depression is common and expected in any patient with a disability. This should be treated with antidepressants and/or psychiatric referral. Sleep disturbances should be aggressively managed with relaxation techniques and improved sleep hygiene (see table fibromyalgia) can be treated using a number of medications such as pregabalin, duloxetine, amitriptyline, or gabapentin. Physical therapy is also often helpful. Treatment for orthostatic hypotension may also be helpful.

Unproven or disproven treatments, such as antivirals, immunosuppressants, elimination diets, and amalgam extractions, should be avoided.

Treatment references
  • 1. Vink M, Vink-Niese A: Graded exercise therapy for myalgic encephalomyelitis/chronic fatigue syndrome is not effective and unsafe. Re-analysis of a Cochrane review. Health Psychol Open 5(2):2055102918805187, 2018. doi:10.1177/2055102918805187

  • 2. Larun L, Brurberg KG, et al: Exercise therapy for chronic fatigue syndrome. Cochrane Database of Systematic Reviews Issue 10. Art. No.: CD003200, 2019. doi: 10.1002/14651858.CD003200.pub8

This post has been copled and discussion moved to
MSD Manual (US): Chronic fatigue syndrome - updated Apr 2020 and Sept. 2021
 
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We're in a bit of a lull with this at the moment, but work on it hasn't stopped altogether.

From my point of view, we're waiting for a long list of things to happen:

The IAG (Independent Advisory Group to the new review process)

1. Hilda's next update on progress of the IAG and review.
IAG Update | Thread

2. Hilda's promised explanation of her statement on her Talk page set up for communication between pwME and the IAG where she said on 11th November: “I don’t believe lobbying could get the Larun et al 2019 removed from The Cochrane Library, as I understand the current arguments and the Cochrane policy.”
Talk page
| Thread

3. Hilda's promised public consultation on a document the IAG prepared some time ago (a consultation first planned for autumn 2021)
"We also plan to get the IAG’s first consultation underway in the early weeks of the new year. That is a consultation on a paper summarising past critiques of the Cochrane review – see my last report for more details."
Hilda's December update

4. The planned revised editorial note the IAG are working on suggestions for, but that Cochrane editors will have the final say on.
"As discussed in my last report, the editorial note on the current review on exercise and ME/CFS will be revised. The IAG has been considering the practice of editorial notes on Cochrane reviews, and discussing possible contents for the revised editorial note."
Hilda's December update

5. News of the appointment of another member for the IAG
The December 2023 report from Hilda says
"There is one final vacant position on the IAG. A primary consideration in filling this position will be addressing concerns expressed about a perception of bias in the makeup of the IAG." This is expected to be filled by "a medical practitioner working with patients with ME/CFS." Nominations to be sent to Hilda by the end of January.
Cochrane IAG Update | Thread

I think the choice of appointee will tell us a lot about the level of influence of the BPS people on the process, especially as this appointment seems to have been instigated by the prolonged and delaying process of Cochrane considering a complaint that wanted the old review to stay and the new review process closed down. Hilda has clarified that the new person must be a doctor who deals with ME patients. She is avoiding answering questions on what is meant by the aim of the appointment being to provide balance.
"I realize the wording about the perception of bias is vague. I’m sorry about this, but I’m not going to expand on that – quite a bit of discussion went into alternatives before I decided vagueness was preferable."
Talk page | Thread

6. News on the timetable for public consultation on the protocol.
_______________________


Complaints

We await news on progress and outcome of Cochrane's handling of S4ME's five formal complaints submitted on 30th October 2023.
The 5 complaints are:
Complaint A: A failure of process - non removal of an outdated and incorrect review in the timescale promised.
Complaint B:
A failure of process - failure to follow normal procedure on a critical comment (this refers to Michiel Tack's comment posted by Cochrane with an editorial reply saying it would be dealt with in the new review process which is 'a priority'.)
Complaint C: A failure of process - failure to take effective action for over two years by the Editor-in-Chief on the stalled new review process.
Complaint D: A failure of process - the Editor-in-Chief's failure to address serious concerns from the public, and passing them, inappropriately, to the IAG that has no power to act on our requests, and has a non functioning email address.
Complaint E: An important policy misjudgement - making the withdrawal of the 2019 review contingent on the publication of a new review.

(We highlighted here the evidence of ineffectiveness from NICE and the CDC, and evidence of harms)
Complaint letter

On 19th December the S4ME committee received a response to our letter of a month earlier in which we assumed on the basis of previous correspondence that our complaints were not being considered. In this letter, Jordi Pardo Pardo, Interim Chair. Cochrane Governing Board clarifies the position. He says that some of the points we have raised had been considered already after complaints in 2020. And concludes his letter:
"However, the other matters you have raised are under review, and we will get back to you in due course."
Thread with letter

It appears from this reply that they are standing by their decision of 2020 not to withdraw the 2019 review in reponse to one or more complaints we were not aware of. I'm guessing they aren't willing to re-open that decision despite developments since 2020. So I'm guessing they are just going to do a fudged consideration of our more minor complaints of the editor not responding adequately initially to our letters.

From Hilda's latest update:
Complaints and communication
As a result of the complex internal restructuring Cochrane began in 2021, the organisation had a new communications team. Early in December I asked for a meeting with the people involved with managing complaints, to discuss issues with recent complaints and how responsiveness could be improved.

Complaints and questions are being sent to multiple individuals and addresses across Cochrane and the IAG, so coordination is critical to ensure that issues and concerns don’t fall through the cracks. Our meeting was very useful for clarifying our respective roles and expectations.

We agreed on pathways for referring complaints, along with continuing liaison. This should improve responsiveness in future. The Cochrane team had been working on several system improvements for some time, too, so there will be more to report on this soon.

Hilda's December update
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S4ME committee actions

There is a lull in activity on this by the committee, as progress now largely depends on Cochrane, and all we can do is wait. We also have very limited capacity among committee members at the moment.

We still intend to formally submit the petition to Cochrane sometime soon and to consider any further action we can take.

One committee member has started work again on contacting more organisations to invite their support.

Another (me) is trying to write an article to submit to Cochrane through their comments system focusing specifically on harms, a subject they have completely avoided in all their communications in relation to the review, and with us and via Hilda, despite us specifically raising it in our letters and other comments received by Cochrane over the years addressing it.
Progress on my article is glacially slow, as I find myself cognitively very limited at the moment. Just keeping up with the other forum stuff I do is using up most of my cognitive capacity. So don't expect anything soon.
 
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Don't forget the kitchen sink!

And I mean really this is literally all the issues raised from the start. They haven't addressed or delivered a single thing, they just let them pile up, even the complaints about throwing out the complaints about them just letting it all pile up.

Cochrane's approach to so-called evidence-based medicine embodies the worst aspects of a corrupt planned economy bureaucracy and crass capitalism working on the equivalent of snake oil NFTs. It's just excessive in all aspects, and none of the excesses are in the right direction. Truly impressive stuff, they are giving a masterclass that will be studied for centuries as a model of failure.
 
In creating Cochrane, they have somehow managed to create a beaurocratic monster that swallows up anything important in endless meetings, and red tape rule books that don't allow them to actually make sensible decisions for the good of people's health.

It appears that somewhere in their monster reorganisation process that's taken several years and seems to be still ongoing, they have managed to lose sight of whatever complaints process they had set up. From what Hilda says that I quoted above, they had no structure in place to deal with our letters or complaints.
 
The committee received the following email from Cochrane on Tuesday 19th December, posted on the open letter thread, and also here for comments:
______________

Dear Trish Davis and the Committee of Science for ME international forum,


Thank you for your correspondence, which has been referred to me.


We are committed to taking complaints seriously, and to following Cochrane's established processes and procedures. [1] For example, as we note on our website, [2] previous complaints on some of the issues you have raised were also made in 2020. Those were investigated by a sub-group of Cochrane’s Editorial Board and a Cochrane Coordinating Editor, who agreed that the published review did not warrant withdrawal based on those complaints.

Our procedures can involve referring complaints within the organization, for example, to our conflicts of interest panel. This depends on the matters raised within the complaints, not on who made the complaint.

We regret the lengthy delays to this project. As indicated in Hilda Bastian’s November report, [3] the next steps for this review are currently in planning. When there is a timetable and further details, this will be included in public updates. As also reported, since the review process will take some time, Cochrane will be working with the Independent Advisory Group on a revised editorial note with the aim of reducing the chances of misinterpreting the current review.

The Cochrane Governing Board is informed about developments relating to this review. I recognize that this email does not address the concerns and complaints you have sent in previous correspondence. However, the other matters you have raised are under review, and we will get back to you in due course.


Kind regards,

Jordi Pardo Pardo

Interim Chair. Cochrane Governing Board.
________________
Do you have his JPP's email address? I may try writing directly to him as he has always been very reasonable when I've contacted him before about this...in around 2018!
 
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