A Personal Comment on:
'A controversial consensus - comment'. Professor Van der Meer and =
Professor Lloyd. Online.
http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2796.2011.02468.x/full
My interest is aroused by the author's reference to the PACE Trial.
Van der Meer and Lloyd remark: '.the PACE trial published in the Lancet =
[2], which provided evidence for effectiveness of elements of =
cognitive-behavioural therapy (CBT) and graded exercise therapy (GET) =
for patients with CFS.'
The above statement is questionable. In the PACE Trial, GET and CBT =
resulted in improvement for only 15% of participants over and above the =
Control Group. Therefore the 'effectiveness' was for a small minority. =
Furthermore, the researchers themselves stated that their interventions =
were 'moderately' effective. Furthermore, the research only relates to =
'mild' and 'moderate' CFS; and provides no information about 'severe' or =
'very severe' CFS (which probably account for at least 25%).
Reading the Lancet with an 'open mind' reveals these facts and makes Van =
der Meer and Lloyd's later remark about: ".accounting in a balanced =
fashion for the strength of the evidence is an essential element", =
appear self-contradictory.
The only qualification the authors give appears to be the use of the =
word 'elements'; i.e. 'evidence for effectiveness of elements'. I don't =
know what this means. I've read the PACE Trial Protocol several times =
and the only mention of 'elements' refers to components of the CBT =
therapy all of which are necessary for a coherent treatment. Are Van =
der Meer and Lloyd suggesting that one or some components worked but =
others didn't? I do not believe the Lancet publication made this claim. =
But if it did, a reference is required.
By making inaccurate or unqualified or unreferenced statements Van der =
Meer and Lloyd betray a preference for their opinions over the =
scientific 'strength of the evidence'.
This is further confirmed in paragraph 3, where the authors state: =
'Quite a bit of mediocre research has been carried out in relation to =
CFS - featuring poorly defined subject groups.' In view of this =
appreciation of the shortcomings of using a 'poorly defined subject =
groups', it is odd that the authors should claim that the PACE Trial =
'provided evidence', in view of the fact that this research recruited =
participants using the flimsiest CFS criteria in existence and that the =
lead researcher - Professor Peter White, has compounded this weakness by =
claiming that the research did not even investigate CFS/ME:
"The PACE trial paper refers to chronic fatigue syndrome (CFS) which is =
operationally defined; it does not purport to be studying CFS/ME". And =
added that the PACE Trial studied: "CFS defined simply as a principal =
complaint of fatigue that is disabling, having lasted six months, with =
no alternative medical explanation (Oxford criteria)" =
[http://www.meactionuk.org.uk/Hoopers-initial-response-to-PDW-letter.htm]=
It is also notable that the Lancet and others have praised the PACE =
Trial for its scientific design and rigorous execution. If they thought =
it so good, then why didn't they read it as Van der Meer and Lloyd =
suggest; in a "systematic and unbiased fashion"? Had they done so they =
would have seen that the results clearly demonstrate that psychological =
and rehabilitative interventions are of little benefit to most people =
diagnosed with CFS. If this obvious and evidence based result of the =
PACE Trial was recognised by the scientific and medical communities, =
then the research might have been =A35 million well spent. =
Unfortunately, it seems that many, including Van der Meer and Lloyd =
themselves, need to read the Lancet paper again - in a "systematic and =
unbiased fashion".
Peter Kemp
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