Thread by @TomKindlon

[Thread]
"No More Mr NICE Guy…" by Brian Hughes, a professor of psychology

thesciencebit.net/2020/11/21/no-…

An incisive blog that covers the NICE ME/#CFS guidelines, issues regarding trials of nonpharmacological interventions in general, appeals to authority, etc.

#MEcfs #MyalgicE
1/n

2/n

"The new [NICE] guidelines not only repudiate a heretofore favoured treatment approach for a particular illness, they also threaten to discredit an entire (albeit quirky) branch of medicine — and, for good measure, to cast clouds over significant swathes of psychology too"

3/n
"Here is an extract from expert testimony provided by Jonathan Edwards, professor emeritus of clinical medicine at University College London" [on the #PACETrial authors trying to justify their use of post-hoc criteria rather than their original criteria]

#MEcfs #CFS #CBT

4/n
"key shift in NICE’s approach to ME rests on their new&improved attitude to evidence quality. As Prof Edwards argues in drug trials poor quality evidence is automatically discarded as it's recognised as having no value.Bad evidence is seen as equivalent to no evidence at all"

5/n
"However, when it comes to treatments for ME, the psychologically-oriented professions have seemed entirely happy to rely heavily on bad evidence, on the basis that it is the only evidence they have."

#MyalgicEncephalomyelitis #ChronicFatigueSyndrome #MEcfs #CFS #MyalgicE

6/n
"This domineering posture has long been employed by the coterie of establishment figures who have promoted the psychological treatment of ME, particularly in the UK. The new stance from NICE suggests their influence is now waning. Argument from authority no longer holds sway"

7/n
"Overall, across no fewer than 172 #CBT studies, NICE graded 153 (89%) as “VERY LOW” quality and the remaining 19 (11%) as “LOW” on quality. Not a single study was found to have exceeded that abysmal threshold."

#MyalgicEncephalomyelitis #ChronicFatigueSyndrome #MEcfs #CFS

8/n
"A similar bloodbath befell studies of #gradedexercisetherapy (#GET). Of a total of 64 studies of GET, NICE determined 52 (81%) to be “VERY LOW” quality and 12 (19%) to be “LOW” quality. Again, not a single study was any better than “LOW” quality."

#MEcfs #CFS #MyalgicE

9/n
"The most common methodological problem identified in all these [#CBT & #GET] studies was “risk of bias.” We all know the reasons for this — dodgy control groups, absurd blinding, shameless goalpost-shifting, and the entire unseemly smorgasbord of #PACE-style strategies"

10/n
"In every single case, each of these so-called experts describes #CBT and #GET as “evidence-based” despite the fact that NICE has exposed the purported evidence to be of such low quality as to be meaningless. The “evidence” they refer to is not evidence at all"

#MEcfs #CFS

11/n
"NICE’s verdict on psychosocial treatments for ME amounts to nothing less than an utter repudiation. That it comes from an authoritative agency & is based on a thorough empirical review is extremely significant."

#MyalgicEncephalomyelitis #ChronicFatigueSyndrome #MEcfs #CFS

12/n
"This is not just a turning point for people with ME, #CFS, and related conditions — it is a high-profile exposure of exactly how, for years, entire subfields of the psychological sciences have been willing to overlook, if not embrace, shoddy standards."

#MyalgicE

13/n
"In all respects, this public shaming [of proponents of cognitive behaviour therapy and graded exercise therapy for ME/CFS] is long overdue.

It is richly deserved."

#MyalgicEncephalomyelitis #ChronicFatigueSyndrome #MEcfs #CFS #PwME #MyE #EBM #EvidenceBasedMedicine

/end

14/n
An image created by Horace Reid based on extracts from "No More Mr NICE Guy…" by Prof. Brian Hughes
thesciencebit.net/2020/11/21/no-…

#MyalgicEncephalomyelitis #ChronicFatigueSyndrome #MEcfs #CFS #MyalgicE #GradedExerciseTherapy #GET #cognitivebehaviouraltherapy #CBT #PwME #MyE

15/n
Another extract from "No More Mr NICE Guy…" by Brian Hughes (a professor of psychology) which I highly recommend

thesciencebit.net/2020/11/21/no-…

#MyalgicEncephalomyelitis #ChronicFatigueSyndrome #MEcfs #CFS #MyalgicE #GradedExerciseTherapy #GET #cognitivebehaviouraltherapy #CBT