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

What now? Any suggestions?
I don't have a specific suggestion as to how and can't help much but perhaps contacting the Long Covid groups and getting them to sign on. Not all of them see the overlap with them, or want anything to do with ME/CFS, but it should not take much of a leap to understand that clinicians definitely do and that this flawed review plays a big role in why GET continues to be the main recommendation for LC, ignoring PEM.

The LC community definitely knows about PEM. Whether they agree or not that they have anything to do with ME/CFS, or think that they can continue keeping their heads in the sand about it, most definitely know and understand that PEM is a major problem and that recommendations to exercise don't make sense to them anymore than they do for us. All they need to understand from there is the importance of this review.

The bigger problem is that the LC community isn't well organized yet, it's still mostly ad hoc. There must be a list somewhere, though.
 
Oh, and contacting the IAG members. Some questions to ask them have been put forward in another thread, the Bastian talk page I think. Cochrane and Bastian haven't told us anything in years. That only leaves the IAG members, and the time has long passed to pretend that this process is anything but a sham. I don't think there's any value in them remaining on board, though that's their decision, but it'd be useful to know what is going on with them. If anything.
 
I don't have a specific suggestion as to how and can't help much but perhaps contacting the Long Covid groups and getting them to sign on. Not all of them see the overlap with them, or want anything to do with ME/CFS, but it should not take much of a leap to understand that clinicians definitely do and that this flawed review plays a big role in why GET continues to be the main recommendation for LC, ignoring PEM.

The LC community definitely knows about PEM. Whether they agree or not that they have anything to do with ME/CFS, or think that they can continue keeping their heads in the sand about it, most definitely know and understand that PEM is a major problem and that recommendations to exercise don't make sense to them anymore than they do for us. All they need to understand from there is the importance of this review.

The bigger problem is that the LC community isn't well organized yet, it's still mostly ad hoc. There must be a list somewhere, though.

Are there any M.E. specific or friendly journalists who could do a good job of getting out the story in a few different angles

something like ‘it’s been x amount of time, just stonewalled and no withdrawal’ and then nail really getting across why this matters and the significance

I'd also like the clear message (seeing the same thing from the Oslo thing), given the timing, underlining how these old people have been using the trick of causing damage with the treatments and then selling the need for more based on non-sequitur pitches claiming we 'are a cost' (or should be given our debility, but we ask for and get no treatment) and so then they suggest they are giving more money for doing the same thing. Again. And how this revolving tactic has built how kingdoms that offer little worth or use. Siphoning off funding that would have been for resources that were much needed by all including pwme. Telling those left short-staffed they are overworked because of us the very people they'd be barring from entry for so long anyway.

Because now it's been so long it shows that those involved with keeping that up there or ignoring the Nice stuff, well it's not about not knowing or not knowing how to help, it's not about not having the science or analysis or there ever being a debate now all that crud over decades has been analysed to 'surely you've proved your null based on how much you can manipulate your research and still get nothing'.

SO it's about how even when a subject and infrastructure claiming to be based on science, and to have safeguards and to be about 'helping' or safety, doesn't get the answer that 'works' for certain interested parties - well how all those claims count for nothing and something will make sure it will never go over the line. Or is it just the 'instincts' of these systems, to automatically delay, defer etc?

It feels about as soon as they realised the truth isn't going to be what works for them it's stalling for time looking for new ways to crop up that it can be manipulated back.

After 5yrs of having done nothing other than play patients a review flagged as flawed finally just needs to be withdrawn.

And the issue with it needs to be so well written-up by some good journalists that can unbundle the significance of this that they show that Cochrane can't both keep this, and keep playing this game and survive. Because it is clear by now that unless it comes down they are keeping up something that is absolutely against everything they claim to stand for - so which are they? You can't be both propaganda and conflicted and claim to be some overview on science.

And just navigate that by ignoring withdrawing something harmful and wrong pretending that's 'just a grey area' - 5 years. And no proper intention at all. And the new patient-led review didn't need the old one not withdrawn in order to proceed anyway!
 
Oh, and contacting the IAG members. Some questions to ask them have been put forward in another thread, the Bastian talk page I think. Cochrane and Bastian haven't told us anything in years. That only leaves the IAG members, and the time has long passed to pretend that this process is anything but a sham. I don't think there's any value in them remaining on board, though that's their decision, but it'd be useful to know what is going on with them. If anything.
I have heard from one IAG member who said they wanted to clarify something regarding the confidentiality rules (there is no NDA). They got one response but then wanted further clarification and have not heard back yet.
 
The only things I can think of that would put pressure on an organisation stonewalling are publicity and funding. So as others have suggested trying to get journalists involved, or contacting their funding and partner organisations, which given the predominance of government funding from the UK, Denmark, US and Germany probably means people from those countries contacting relevant elected officials.
 
Given Hilda’s personal Blog page on this is obviously failing as a meaningful channel of communication, with no indication that information there is passed to Cochrane or the IAG, this reinforces others’ comments that we need to address the issue with Cochrane’s funding sources, relevant regulatory bodies and the media.

I have submitted another comment to Hilda’s Blog without any optimism. I have reproduced it on the members only thread but agree with @Trish ’s suggestion that we discuss the issues more publicly now, so am also copying it here.

Peter T
September 25, 2024 at 11:18 pm
Your comment is awaiting moderation.

To repeat myself “Previously on the 27th of May you said ‘I hope to have another report in the next few weeks’. Is it possible you could use less ambiguous timing references?”

You responded to this comment without any concrete information on your timescale and yet more months have passed. I understand others have also commented here fairly recently but those comments seem to have disappeared into your moderation process. If this is meant to be part of a radical new approach by Cochrane to consultation, given the entire process is now years behind schedule, the repeated failure to report or explain delays is totally unacceptable.

The current ME/CFS exercise review like its predecessors fails to address harms and is almost universally reviled by the patient community as harming not only people with ME/CFS but also now those Long Covid patients also displaying Post Exertional Malaise who meet the diagnostic criteria for ME/CFS. If Cochrane had designed a process to divert and ignore genuine evidence based concerns and retain as long as possible their flawed exercise review they could not have done better.

I do not expect this to pass moderation any time soon, so I will also copy it to the S4ME forum.
 
Thanks @Peter Trewhitt. I have just come to this thread to do the same with my recent post on the Talkpage which still awaits moderation, and email to the IAG address.


trishrhymes
September 12, 2024 at 2:06 am
Your comment is awaiting moderation.

Dear Hilda,

I don’t know whether the following is within your Talk page rules, I accept that it’s up to you whether to publish it. Your page, your rules. I hope you will see that what I am saying here needs to be said, and said publicly.

_____________

I don’t wish to apportion blame to named individuals, since I have no knowledge of where blame lies, though clearly the editor-in-chief bears some responsibility.

I don’t want to hear more excuses about Covid, or funding cuts and reorganisation, or other priorities, I don’t want more flannel from Cochrane about new and better complaints procedures, I don’t want any more letters from Cochrane that don’t address any of our questions, I don’t want more assurances from you that you are making ‘steady progress’.

Cochrane has shown, with its actions and inactions where its priorities lie, and it’s crystal clear its priorities do not lie with scientific evidence, or the health of millions of people.

Cochrane’s priorities clearly lie with propping up failed paradigms favoured by their friends. They have known since Tom Kindlon’s publication on harms in 2010 that GET should not be recommended for ME/CFS, they have known since Kindlon and Robert Courtney pointed out flaws in the research that made it unsound that GET is not clinically useful.

They have known since Michiel Tack’s detailed analysis published on the Cochrane website in 2020 that the 2019 Larun paper should never have been published, and should be withdrawn.

The picture coming from Cochrane is of amateurish incompetence and lack of scientific understanding.

We at S4ME have tried, for over a year, and others have been trying for much longer, to make Cochrane take the problems with the Larun review seriously, supported by over 11 thousand petition signatories and over 70 organisations. People with ME/CFS and many clinicians and scientists agree that the Larun review causes harm and should be withdrawn. Cochrane editors have been given links to peer reviewed papers on harms, and large survey data, as well as some harrowing examples of harms.

Not once, in any of our correspondence with Cochrane, have they even acknowledged that they need to take harms evidence seriously, or indeed take any notice of it at all.

Cochrane is a disgrace, shaming its charitiable status, and apparently so tied in knots by its administrative processes and procedures that the editors can’t see the wood for the trees. The only alternative to that conclusion is that they have no intention of putting matters right, being in the pockets of proponents of exercise therapy, regardless of evidence.

There is no reason to keep the Larun 2019 review currently published with Cochrane’s name. Nobody with ME/CFS wants it, it helps nobody, and it is being used to perpetuate harm to who knows how many people.

I lie in bed today feeling angry and helpless, distressed beyond measure that we are so disregarded, treated as trash, unworthy of anyone’s efforts to set things right.

I don’t want your sympathy, Hilda, I want action, and I don’t mean another ‘monthly report’ telling us you are making progress in this or that small way.

I want you to contact the most senior people at Cochrane and tell them in no uncertain terms that this charade has to stop. They must withdraw the Larun review, and make a public and unreserved apology for the harm it has caused for years. And they must do so by October 2nd 2024, 5 years after they promised a new review in two years.

Will you act now? Please?

Trish Davis.

Copy of email sent on 18th September 2024 to cochrane.iag@gmail.com
I have only received the standard automated reply.

Dear Hilda,

I hope all is well with you.

I expect you will have seen my latest comment on your talkpage. I tried to stay within your rules by not naming any individuals, but found it hard to restrain my anger and despair. As I said, it's up to you whether you allow it.

I am considering a next move, including complaints to COPE and the Charity Commission, and going to the media. I have been holding on to hope that this effort won't be necessary, but that hope is fading fast.

The Larun review was published a few days before my 70th birthday. I am now rapidly approaching 75, and wondering whether I will live to see the Larun review gone in my lifetime. I fear leaving my daughter with severe ME to fight for medical care alone in a world where doctors turn to Cochrane for evidence based advice, and find the Larun review that failed to review harms evidence, leaving her, and millions like her extremely vulnerable.

Please can you help?

I feel like all our efforts and those of others are falling into a black hole. Why won't Cochrane act with some respect and humanity, instead of leaving us all in the dark for months and years on end?

In sadness,

Trish Davis
 
A reminder of a few dates:

In one week's time it will be 5 years since the review was published on 2nd October 2019. On the same day the editor in chief Karla Soares Weisser announced that the new review process would be set up early in 2020. It was expected to take about two years, with the new review publshed in early 2022.

Hilda Bastian was appointed to lead the IAG (independent advisory group), including appointing its members and advising Cochrane on suitable people to be on the review writing group. She was also tasked with providing regular updates on the Cochrane website.

The only so-called 'monthly updates' published so far were:

Listed here, with introduction and FAQ's updated November 2023
Stakeholder engagement in high-profile reviews pilot

The latest information on Hilda's talkpage in answer to some posts from me is the following:
June 27th 2024
"action on this project is a priority again"

July 29th 2024
"Making steady progress, and getting closer to having a report to publish."
 
A reminder of a few dates:

In one week's time it will be 5 years since the review was published on 2nd October 2019. On the same day the editor in chief Karla Soares Weisser announced that the new review process would be set up early in 2020. It was expected to take about two years, with the new review publshed in early 2022.

Hilda Bastian was appointed to lead the IAG (independent advisory group), including appointing its members and advising Cochrane on suitable people to be on the review writing group. She was also tasked with providing regular updates on the Cochrane website.

The only so-called 'monthly updates' published so far were:

Listed here, with introduction and FAQ's updated November 2023
Stakeholder engagement in high-profile reviews pilot

The latest information on Hilda's talkpage in answer to some posts from me is the following:
June 27th 2024
"action on this project is a priority again"

July 29th 2024
"Making steady progress, and getting closer to having a report to publish."

Do we know when the ‘writing group’ submitted their draft ‘protocol’ to Cochrane in preparation for consultation?

Given the writing group were relatively punctual is the subsequent inaction a deliberate choice by Cochrane or the failure of the IAG for whatever reasons, be it Cochrane’s influence or Hilda’s choice?
 
Do we know when the ‘writing group’ submitted their draft ‘protocol’ to Cochrane in preparation for consultation?
Early 2023.
According to the November 2023 update, there are multiple stages for the protocol to go through:
https://community.cochrane.org/orga...older-engagement-high-profile-reviews-pilot-3
The first draft of the protocol is currently with the Cochrane Editorial Unit, and the editors are planning the next steps for the project. Once they sign off on a protocol, the IAG will be reviewing it. Then it will go to peer reviewers, some of whom will be proposed by the IAG. Responses to peer review will also be considered by the IAG.

It will be the version after all that review that will be released as a preprint. We will use our experience with the first consultation to seek, analyse, and report on feedback to the protocol. The consultation period is currently planned to be six weeks after the preprint of the protocol is released.

Given the writing group were relatively punctual is the subsequent inaction a deliberate choice by Cochrane or the failure of the IAG for whatever reasons, be it Cochrane’s influence or Hilda’s choice?
I understand the IAG were told to stop work from some time in 2021 to August 2023. This was for multiple reasons including deprioritising the review while Cochrane dealt with its major restructuring, and lengthy complaints procedures.
The IAG resumed work last August for a few months, but then stopped again while Hilda sorted out being paid and Cochrane finally got around to reprioritising the review it seems, around the middle of this year.

I have no idea which of the multiple stages the protocol has reached.
 
And some sort of temporary editorial note on the review that we were told would happen some time but we have never heard anything about since.

Has the note been written? Waiting on Cochrane for approval? Waiting on the IAG for review? Waiting on Cochrane for publication? Has any work been done at all? Do bears poop in woods?! We don't know, they haven't shared anything of substance about anything yet.
 
And some sort of temporary editorial note on the review that we were told would happen some time but we have never heard anything about since.

Has the note been written? Waiting on Cochrane for approval? Waiting on the IAG for review? Waiting on Cochrane for publication? Has any work been done at all? Do bears poop in woods?! We don't know, they haven't shared anything of substance about anything yet.
What was the date the note was promised ‘to keep things safer in the interim , given without it then it’s wrong’ because apparently proper action would take too long?

is it a year? I mean that’s inexcusable if it has gif to that. Interim emergency measures have no excuse given there is the correspondence saying there is no / low effect at medium significance or vice versa ie no effect and yet the ‘interpretation’ ie sold conclusion infers something different and wrong - so you just put a note saying that was wrong and ‘this is correct’ - they had an independent arbiter after all , because the honest conclusion wasn’t wanted but when that was honest too it got rewritten so how many times can something be changed from truth and honesty so quickly then claimed it takes years to write a note saying ‘oh yeah actually it’s this’ at least where there is mis-selling on the abstract/front of the box that is causing harm.
 
What was the date the note was promised ‘to keep things safer in the interim , given without it then it’s wrong’ because apparently proper action would take too long?

At least by the November 2023 update - link. I don't remember seeing anything earlier
"As completing the review will take time, the joint Cochrane/IAG meeting discussed a proposal from a member of the IAG for adding a revised editorial note. Some uses of the Cochrane review do not reflect critical nuance and limitations in its conclusions, and the goal of a note would be to try to reduce such misinterpretation. There was unanimous agreement to this step, and the IAG has begun drafting a proposal for the editors’ consideration."
 
At least by the November 2023 update - link. I don't remember seeing anything earlier
"As completing the review will take time, the joint Cochrane/IAG meeting discussed a proposal from a member of the IAG for adding a revised editorial note. Some uses of the Cochrane review do not reflect critical nuance and limitations in its conclusions, and the goal of a note would be to try to reduce such misinterpretation. There was unanimous agreement to this step, and the IAG has begun drafting a proposal for the editors’ consideration."
Ok guven ut was suggested by the IAG member, and then the IAG unanimously agreed I imagine they drafted it swiftly and that has been sat with’the editors’ or if there is some other invented stage in Cochrane for all that time - 10months.

it’s important to name someone for accountability and responsibility starting to be held by individuals so i will make it as ‘the editors’ and I’m sure if they signed it off snd passed it in swiftly to someone else they can tell us and show us the proof.

similarly if the IAG weren’t allowed to pass their completed statement to the editors directly and it is an individual (s) in the middle holding into it that has been creating that not happening/obstructing they can confirm that if it’s not them.

so even when spoon fed something they can do immediately and could have done by Dec it has been chosen not to? Ie they chose the delay /not to sign that off - and given all the independent arbiter and assessment of what the results mean that note had written itself in meaning before anyone wrote it and ‘tone’ isn’t 10months important

so whoever chose to delay it for that time leading to the harm we see happening horrendously to pwme in hospitals and the GET / ‘pacing up’ lying rebrand of it being sold by gladwell etc in the meantime and so on being fervously opportunitistically built on dishonest statements eg by people like coffi- the longer they can hold it off whilst they churn out a few more sales pitches and seal a few more contracts etc? It seems like.
 
Just the other day, I saw a paper reference an earlier version of the review, not the 2019 version, but maybe a 2016 version. I forget where I saw that, it was a new paper. And the citation does link through to the older version still hosted in the Cochrane Library. There is a banner at the top of the version saying that it isn't the most recent version, but it's not big and could be missed. Unlike the 2019 version, there is no link to the page with the note from the editor saying that the 2019 version will be updated. So, the warnings on that earlier version are actually weaker than on the 2019 version.

2016 version
2017 version

It seems to me that, for an organisation providing medical advice, this management of obsolete reviews is really dangerous. It could be worth having a look around the Cochrane Library to see how reviews that have later been shown to be wrong have been dealt with. I know the review of Traditional Chinese Medicine approaches for CFS was withdrawn. But, it seems that earlier versions of the Larun review are not actually withdrawn.

It looks as though even if one day there was a new Cochrane hosted exercise therapy review, authors of papers could still choose to cite the 2019 version, just as some are choosing to cite the 2016 one. So, I think it makes it all the more important to get that Larun et al review formally withdrawn. A new review doesn't seem to automatically make all the ones that have gone before ineffectual.
 
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That is really sloppy work from their web team
Yes, I guess a question is, is the web team generally sloppy, and outdated reviews of all sorts hang around like a bad smell? Or is it just with CFS, and with influential review authors who think there was nothing wrong with their first versions, that old reviews are still so accessible and poorly identified?
 
Just the other day, I saw a paper reference an earlier version of the review, not the 2019 version, but maybe a 2016 version. I forget where I saw that, it was a new paper. And the citation does link through to the older version still hosted in the Cochrane Library. There is a banner at the top saying that it isn't the most recent version, but it's not big and could be missed. Unlike the 2019 version, there is no link to the page with the note from the editor saying that the 2019 version will be updated. So, the warnings on that earlier version are actually weaker than on the 2019 version.

2016 version
2017 version

It seems to me that, for an organisation providing medical advice, this management of obsolete reviews is really dangerous. It could be worth having a look around the Cochrane Library to see how reviews that have later been shown to be wrong have been dealt with. I know the review of Traditional Chinese Medicine approaches for CFS was withdrawn. But, it seems that earlier versions of the Larun review are not actually withdrawn.

It looks as though even if one day there was a new Cochrane hosted exercise therapy review, authors of papers could still choose to cite the 2019 version, just as some are choosing to cite the 2016 one. So, I think it makes it all the more important to get that Larun et al review formally withdrawn. A new review doesn't seem to automatically make all the ones that have gone before ineffectual.
Agreed. And given whatever ‘compromise’ they’ve insisted on doing instead have now been evidenced by time passed as being hollow delay tactics I think they simply add weight to what that underlying action required needs to be :
complete removal and withdrawal with all the various notes , old copies and so on cleaned out.

and informing of publications and organisations who have cited or based judgements on it . It is still being used in a circular way as the main evidence gif other reviews and so on

the conclusion was written on the wall it needed to be withdrawn by 2019 with huge issues before that.

the fact all the delaying promises failed since - that were never sufficient anyway always need to be circled back only to emphasise’more if those compromises’ being suggested instead of withdrawal are clearly just delaying tactics

and it’s time it came down
 
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