In een commentaar op een artikel van Julie Rehmeyer n.a.v. recente heranalyses van de PACE-trial
herbevestigt Simon Wessely opnieuw dat hij nimmer zijn (onhoudbare) standpunten zal veranderen.
Wessely, of iemand die zich voor hem uitgeeft, stelt, ondanks alle feiten die het tegendeel aantonen,
dat PACE een schoolvoorbeeld is van hoe een trial van dit soort uitgevoerd moeten worden
(alle procedures zijn netjes opgevolgd, over het aanpassen van procedures praten we maar niet),
dat CGT en GET 'superieure' en veilige behandelingen zijn om de ziekte te 'managen', en
dat de PACE-trial studie nooit teruggetrokken zal worden mdat daar geen reden voor is.
September 23, 2016 AT 5:38 AM
Sorry to spoil the party but some cold facts are necessary [typo corrected, FT]
- The PACE trial remains an excellent trial and a model of
how to deliver a complex intervention RCT.
Read the 2012 Lancet paper again.
Check it against the CONSORT statement.
You will see it is 100% compliant.
- Nothing at all has emerged to alter or contradict its key findings.
These are that two treatments (CBT and GET) are superior
to two others (pacing and standard medical treatment).
All four approaches are safe.
The effects of CBT and GET are modest but still,
worthwhile especially as at moment and
for the last 25 years there has been nothing better.
- As others note this does not speak to the causes of CFS but only to management.
For avoidance of doubt all
the serious clinicians and academics who work in this area
know this is genuine condition
ihat causes much misery to patients, friends and family.
- Clearly we need better treatments but until and unless we do,
doctors can safely recommend CBT and GET to patients.
Indeed they could and did before PACE –
it's findings were entirely congruent with the previous literature,
just that PACE was larger.
In my country (UK) there was already sufficient evidence
to recommend both therapies in our NICE guidelines before PACE was published.
PACE will not be retracted
because there is no reason to do so,
it is fully CONSORT compliant and so on,
but if it had not happened the guidelines would remain the same.
I have written a commentary here on the main PACE paper
outlining the basic principles of a sound RCT and
why PACE more than adheres to them:
I realise that this will not be a popular post. That's sad.
But I think people need to know there is another story here and
one that might explain
why it is that people continue to cite the Lancet paper and
why it's results whilst not earth shattering are sound.
Finally I should add that
I played a part in early days of developing CBT as a management approach to CFS,
carried out one of the early RCTs and so on, and
know personally all the PACE authors.
I am not therefore neutral on this topic, and
I continue to recommend CBT to my patients with CFS if they want it.
I was not however an author on the PACE study.