The analysis of the 2017 Cochrane review reveals flaws, which means that contrary to its findings... more The analysis of the 2017 Cochrane review reveals flaws, which means that contrary to its findings, there is no evidence that graded exercise therapy is effective. Because of the failure to report harms adequately in the trials covered by the review, it cannot be said that graded exercise therapy is safe. The analysis of the objective outcomes in the trials provides sufficient evidence to conclude that graded exercise therapy is an ineffective treatment for myalgic encephalomyelitis/ chronic fatigue syndrome.
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
The FatiGo trial concluded that multidisciplinary rehabilitation treatment is more effective for ... more The FatiGo trial concluded that multidisciplinary rehabilitation treatment is more effective for chronic fatigue syndrome/ myalgic encephalomyelitis in the long term than cognitive behaviour therapy and that multidisciplinary rehabilitation treatment is more cost-effective for fatigue and cognitive behaviour therapy for quality of life. However, FatiGo suffered from a number of serious methodological flaws. Moreover, it ignored the results of the activity metre, its only objective outcome. This jeopardizes the validity of FatiGo. Its analysis shows that there was no statistically significant difference between multidisciplinary rehabilitation treatment and cognitive behaviour therapy and neither are (cost-)effective. FatiGo's claims of efficacy of multidisciplinary rehabilitation treatment and cognitive behaviour therapy for chronic fatigue syndrome/myalgic encephalomyelitis are misleading and not justified by their results.
The draft updated NICE guidance for ME/CFS highlights the unreliability of subjective outcome measures in non-blinded trials
Journal of Health Psychology, Jan 28, 2021
The National Institute for Health and Care Excellence (NICE) recently published its draft updated... more The National Institute for Health and Care Excellence (NICE) recently published its draft updated guideline on the diagnosis and management of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). NICE concluded that ME/CFS is a complex multisystem chronic medical condition for which graded exercise therapy should not be used and cognitive behavioural therapy is only a supportive therapy and not a treatment or cure. The draft guidance also highlighted the unreliability of subjective outcome measures in non-blinded trials. High quality randomised controlled ME/CFS trials are now needed to find pharmacological treatments that lead to substantial objective improvement and restore the ability to work.
Analysis of the 2008 Cochrane review of cognitive behavioural therapy for chronic fatigue syndrom... more Analysis of the 2008 Cochrane review of cognitive behavioural therapy for chronic fatigue syndrome shows that seven patients with mild chronic fatigue syndrome need to be treated for one to report a small, short-lived subjective improvement of fatigue. This is not matched by an objective improvement of physical fitness or employment and illness benefit status. Most studies in the Cochrane review failed to report on safety or adverse reactions. Patient evidence suggests adverse outcomes in 20 per cent of cases. If a trial of a drug or surgical procedure uncovered a similar high rate, it would be unlikely to be accepted as safe. It is time to downgrade cognitive behavioural therapy to an adjunct supportlevel therapy, rather than a treatment for chronic fatigue syndrome.
This article is an open access article distributed under the terms and conditions of the Creative... more This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY
Introducing bias into the trial In defending their work against Dr Geraghty's (2016) criticism, t... more Introducing bias into the trial In defending their work against Dr Geraghty's (2016) criticism, the PACE (Pacing, graded Activity, and Cognitive behaviour therapy: a randomised Evaluation) trial authors state that "The protocol was published some 3 years before the analysis began, and 4 years before the first outcome paper was published" (White et al., 2017). However, the protocol's "Final version 5.0" was submitted to the ISRCTN on
Myalgic encephalomyelitis/chronic fatigue (ME/CFS) is a post-infectious, chronic disease that can... more Myalgic encephalomyelitis/chronic fatigue (ME/CFS) is a post-infectious, chronic disease that can lead to severe impairment and, even, total disability. Although the disease has been known for a long time, and has been coded in the ICD since 1969 (G93.3), medical research has not yet been able to reach a consensus regarding its physiological basis and how best to treat it. Against the background of these shortcomings, psychosomatic disease models have been developed and psychotherapeutic treatments have been derived from them, but their empirical testing has led to sobering results. According to the current state of research, psychotherapy and psychosomatic rehabilitation have no curative effect in the treatment of ME/CFS. Nevertheless, we see numerous patients in practices and outpatient clinics who suffer severely as a result of their illness and whose mental well-being and coping strategies would benefit from psychotherapeutic help. In this article, we outline a psychotherapeutic...
Treating Long Covid as a functional disorder contradicts the evidence and is unhelpful to patients. Response to Saunders et al
Instead of treating Long Covid as a functional disorder without any evidence to back up that clai... more Instead of treating Long Covid as a functional disorder without any evidence to back up that claim, first and foremost we should step up our efforts to find out what the exact underlying pathophysiological mechanisms are to be able to find effective treatments for millions of patients. This will enable them to go back to work and solve the labour shortage which is the next crisis the world is facing as a consequence of the current pandemic.
The German Institute for Quality and Efficiency in Healthcare (IQWiG) recently published its draf... more The German Institute for Quality and Efficiency in Healthcare (IQWiG) recently published its draft report to the government about myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). The IQWiG concluded that graded exercise therapy (GET) and cognitive behavioral therapy (CBT) should be recommended in the treatment for mild and moderate ME/CFS based on two CBT and two GET studies. In this article, we reviewed the evidence used by IQWiG to support their claims, because their conclusion is diametrically opposed to the conclusion by the British National Institute for Health and Care Excellence (NICE) in its recently updated ME/CFS guidelines. Our analysis shows that the trials IQWiG used in support suffered from serious flaws, which included badly designed control groups; relying on subjective primary outcomes in non-blinded studies; alliance and response shift bias, including patients in their trials who did not have the disease under investigation, selective reporting, making ...
The British National Institute for Health and Care Excellence (NICE) recently published its updat... more The British National Institute for Health and Care Excellence (NICE) recently published its updated guidelines for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). NICE concluded, after an extensive review of the literature, that graded exercise therapy (GET) is harmful and should not be used, and that cognitive behavioural therapy (CBT) is only an adjunctive and not a curative treatment. Leading proponents of the cognitive behavioural model (CBmodel) find it difficult to accept this paradigm shift. In, for example, an article in The Lancet, they try to argue that the new NICE guideline is based on ideology instead of science. In this article we reviewed the evidence they used to support their claims. Our analysis shows that the trials they used in support suffered from serious flaws which included badly designed control groups, relying on subjective primary outcomes in non-blinded studies, including patients in their trials who didn’t have the disease under investigatio...
Supplemental material, Supplemental_material for Cognitive behavioural therapy for myalgic enceph... more Supplemental material, Supplemental_material for Cognitive behavioural therapy for myalgic encephalomyelitis/chronic fatigue syndrome is not effective. Re-analysis of a Cochrane review by Mark Vink and Alexandra Vink-Niese in Health Psychology Open
Supplemental_material – Supplemental material for Biohybrid nanofibers containing manganese oxide–forming fungi for heavy metal removal from water
Supplemental material, Supplemental_material for Biohybrid nanofibers containing manganese oxide–... more Supplemental material, Supplemental_material for Biohybrid nanofibers containing manganese oxide–forming fungi for heavy metal removal from water by Yaewon Park, Shuang Liu, Terrence Gardner, Drake Johnson, Aaron Keeler, Nathalia Ortiz, Ghada Rabah and Ericka Ford in Journal of Engineered Fibers and Fabrics
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