Who said: don't bother testing patients?

JaimeS said:
From my post waaaaay back here: https://www.s4me.info/threads/who-said-dont-bother-testing-patients.6532/page-5#post-119654
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Found it: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2539651/

Oh oh oh oh oh - I see Martin Bland (Stats Prof) has found it too... https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1127546/

Editor---Although this paper by Pawlikowska et al is nearly six years old, I read it only two months ago.1 I am surprised that there seem to be no letters or articles referring to it to point out that the analysis is flawed.
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ETA: I've now found my previous post about this: https://www.s4me.info/threads/who-said-dont-bother-testing-patients.6532/page-6#post-119882

And I'll just add that in Wessely's reply, he (correctly) points out that this flaw doesn't change the conclusions of their study. OK. But it does indicate that if they are so sloppy with their stats, how many other mistakes might they have made? They also ignore all the other points that Martin Bland made.
There are several more subtle statistical problems: the histograms with unequal interval sizes shown as the same length on the graph; the statement that with such large numbers the distributions of responses to the fatigue and the general health questionnaires follow a normal distribution (the shape of the distribution is not related to the sample size); the ignoring of the cluster sampling; the use of two different scoring systems for the questionnaires. But the quoting of impossible means should be enough to show that this paper is flawed. Why has nobody noticed, in refereeing, editing, reading the paper (several authors have cited it but seem to accept it uncritically)?
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Lucibee said:
he (correctly) points out that this flaw doesn't change the conclusions of their study.
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Although maybe this isn't so true either. Their conclusion is that "fatigue is closely associated with psychological morbidity" - but that's only true if you can assume that the GHQ is a good measure of psychological morbidity, which only a few posts ago, we saw is not necessarily true either. Again, it is the strong reliance on self-reported subjective questionnaires, and the assumption that they will accurately tell you whatever you want them to mean in all circumstances.
 
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Oh this just keeps getting stranger and stranger. Someone found the original manuscript: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1127330/

Seems there were Gremlins at the BMJ - but Bland's other points still haven't been addressed.

...and it's clear that Anthony Pelosi was one of the referees!

(and his explanation is completely different from the other referee...)
 
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Lucibee said:
Oh this just keeps getting stranger and stranger. Someone found the original manuscript: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1127330/

Seems there were Gremlins at the BMJ - but Bland's other points still haven't been addressed.

...and it's clear that Anthony Pelosi was one of the referees!

(and his explanation is completely different from the other referee...)
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Makes you wonder why the actual authors didn't bother to read it to make sure there were no errors in the publication.
 
Nasim Marie Jafry said:
Behan also diagnosed Charles Shepherd, medical advisor to MEA
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Do you think this quote from Wessely Archive Ref1 is a direct reference to CS?:
The humiliation perceived in the attachment of a psychiatric "label" reflects poorly not just on these doctors but on psychiatrists, who have failed to influence such attitudes in both their colleagues and the public. This is ironic given that medical professionals are overrepresented among cases of the disorder. ... In addition, we believe that understanding of the postviral fatigue syndrome has been hindered by doctors who suffer from the condition also researching it. Though medical training affords insight into the subjective effects of illness, it is axiomatic that objectivity is not similarly enhanced.
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and back to the "it's just depression" thing that @EzzieD mentioned, I found this in the very same reference:
When the somatic symptoms of depression are compared with those of the postviral fatigue syndrome not only are they similar (including fatigue, headache, chest pain, dyspnoea, dizziness, dysuria, and gastrointestinal disturbance) but the frequency with which they occur is also remarkably concordant. ... This does not prove that postviral fatigue is primarily a psychiatric condition but does emphasise the influence that disturbances of affect may have on physical symptoms.
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He's laying down the tracks without having to take responsibility for where they end up.
 
chrisb said:
Given that the paper was dated March 1988 , did CS publish anything before that date? I would have thought not. Would it have been Dr Anne Mcintyre?
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I had a look - but AM doesn't appear in publication record until 1991. CS was publishing in 1989 at least, so may have encountered SW at conferences and asked a few awkward questions?
 
Lucibee said:
I had a look - but AM doesn't appear in publication record until 1991. CS was publishing in 1989 at least, so may have encountered SW at conferences and asked a few awkward questions?
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I think AM was associated with the MEA by 1987. I had a feeling that there was something in SW's book that made me think it was her. I will look.
 
Lucibee said:
Oh oh oh oh oh - I see Martin Bland (Stats Prof) has found it too... https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1127546/
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From that:

I think the authors should be asked to explain this and, if necessary, carry out a reanalysis, with competent statistical advice. Potentially incorrect conclusions, based on faulty analysis, should not be allowed to remain in the literature to be cited uncritically by others.
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Sounds familiar.

Lucibee said:
Seems there were Gremlins at the BMJ - but Bland's other points still haven't been addressed.
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Sorry, maybe I'm brain fogged. Is he saying his copy of the paper had the values that were published at first? Or that his paper had the correct values?
 
JaimeS said:
Sorry, maybe I'm brain fogged. Is he saying his copy of the paper had the values that were published at first? Or that his paper had the correct values?
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He (reviewer 1) is saying that his copy has the correct values that SW put in his reply to Bland. But I would say that the precision of the estimates is suspicious (and slightly meaningless) given that the data are clearly skewed (not normally distributed), which MB also picked up on.
 
So I take from this that Wessley's papers have always kind of slid by somewhat inexplicably, even when they don't make sense.

I'd say he has a lot of friends in high places, but what kind of 'friend' would let you make a mistake this public? I just have to conclude that peer review is pretty crap.

Edited to add:

I always have to remind myself that there are people who really are okay with lying or cheating if they mean they get ahead. I wonder how many researchers wildly skew their data, knowing that getting caught is vanishingly rare -- and that if they get caught they can always apologize and correct. Meanwhile, they've gotten invitations to speak at conferences, their uni is happy with them, their job is secure -- and everyone remembers what they said first anyway, unless a huge stink is raised, a la PACE.

I am pretty relentlessly moral, and it's my knee-jerk reflex to think other people see this "but would never do it".

But, I mean, taking morality out of the equation, why not? They never truly 'get in trouble' for it. PACE and Wakefield are outliers. And clearly there are people in the world to whom the right and wrong means very little, so long as they push their agenda and/or get their money.
 
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chrisb said:
I think AM was associated with the MEA by 1987. I had a feeling that there was something in SW's book that made me think it was her. I will look.
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Sorry @JaimeS I know this is off topic but it is an issue worth clearing up, and I do not wish to initiate broader discussion. In the chapter Social History of a 20th Century Illness in the book Chronic Fatigue and its Syndromes by Wessely Hotopf and Sharpe, the authors appear to display their irritation with Macintyre. Her views must have been clear by 1987 and were no doubt those of the MEA, with which there seemed to be perpetual annoyance.

Another reason for the vehement rejection of psychiatry is because it is perceived as dealing only with the insane: "psychiatrists decided ME is a psychiatric disorder-i.e. we are mad." (Macintyre A , ME Postviral Fatigue Syndrome. How to live with it 1989) Again this too is becoming an increasingly accurate perception of modern psychiatry. Many of the recent trends in psychiatry are consistent with that observation. For those rejected by medicine, and who are clearly not suffering from a major mental disorder such as psychosis, modern psychiatry is not an attractive home. Whilst we bitterly regret this, there is little denying its accuracy.

One wishes that he gave more frequent reasons, suchas this, to sympathise with his plight.
 
Lucibee said:
and back to the "it's just depression" thing that @EzzieD mentioned, I found this in the very same reference:

When the somatic symptoms of depression are compared with those of the postviral fatigue syndrome not only are they similar (including fatigue, headache, chest pain, dyspnoea, dizziness, dysuria, and gastrointestinal disturbance) but the frequency with which they occur is also remarkably concordant. ... This does not prove that postviral fatigue is primarily a psychiatric condition but does emphasise the influence that disturbances of affect may have on physical symptoms.

He's laying down the tracks without having to take responsibility for where they end up.
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postviral fatigue - similar to - depression
concludes: postviral fatigue may be a psychiatric condition

could have also concluded:
depression (psychiatric condition) may be postviral disorder
 
To take this back to where it all started, "who said, 'don't bother testing patients,'" I think it comes down to this...

There is an expectation nowadays that medicine should have all the answers, and that there should be a test for everything. That there isn't is clear. And I can sort of see the point that endlessly testing for things for which there isn't a *definitive* test might be harmful.

However, some enterprising characters (who happen to be psychiatrists) have sought to capitalise on this by offering their own "solutions", and by categorising the whole field of conditions that medicine cannot explain (or more importantly, cannot effectively treat) they can ensure that their dying field is rejuvenated, particularly as increasing numbers of psychiatric disorders are explained by biological processes.

Personally, I think this is a misuse of their "talents", and that they should be focussing their efforts on helping people to live with chronic illnesses (and all the 'psychosocial' issues that entails) until such a time that a viable treatment comes along. They certainly should not be standing in the way of elucidating the causes or developing those treatments - but that's what they have ended up doing. And they need to understand that that's why so many of us are upset with them.
 
Lucibee said:
However, some enterprising characters (who happen to be psychiatrists) have sought to capitalise on this by offering their own "solutions", and by categorising the whole field of conditions that medicine cannot explain (or more importantly, cannot effectively treat) they can ensure that their dying field is rejuvenated
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But their field isn't dying - there's a crisis in Mental Health care in UK. Children who are suicidal are having to wait 8 weeks for help (I may be wrong on exact time, saw it on TV the other night and can't maintain figures in memory, but it was quite a long time in terms of suicidal child). Adults have to wait for much longer, over a year in some cases I think. So why don't the so and sos FO and deal with REAL mental health problems and leave us alone!
 
ladycatlover said:
But their field isn't dying - there's a crisis in Mental Health care in UK.
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Arguably, that's precisely why there's a crisis. They are struggling to recruit enough professionals into their field, and their profession is inadequately equipped (scientifically and practically) to deal with the problems that folks with mental health conditions face because they refuse to remove their feet, brains and ideology from the 19th century.
 
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