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Hoe een studie naar CVS vervalst werd, leidend tot meer pijn en stigma
How a study about Chronic Fatigue Syndrome was doctored, adding to pain and stigma
Steven Lubet, Northwestern University
(THE CONVERSATION) The public relies on scientists to report their findings accurately and completely, but that does not always happen. Too often, researchers announce only their most favorable outcomes, while keeping more disappointing results well out of sight.
This phenomenon, first identified by the psychologist Robert Rosenthal in 1979, is called the “file drawer problem.” Although it is widely recognized – affecting drug trials, psychology experiments and most other fields – it has seldom been documented, for obvious reasons. Suppressed results are, well, suppressed, and they are usually discovered only by chance.
It was therefore almost unprecedented when a group of patients, at the end of last year, successfully unmasked the skewed data behind an influential British study, first published in Lancet in 2011, of the devastating disease known as Chronic Fatigue Syndrome (sometimes called myalgic encephalomyelitis or ME/CFS).
My interest in this issue is both professional and personal. As a law professor, I have devoted much of my career to the study of judicial ethics, including the problem of implicit biases that can undermine the reliability of both court trials and clinical trials.
I have also been living with ME/CFS for over a decade, so I am acutely attuned to the need for responsible and transparent research on the illness. Unfortunately, the most extensive study of ME/CFS – called the PACE trial – was deeply flawed from its inception, in ways that the principal investigators have yet to acknowledge.
‘Dysfunctional’ beliefs all too real for those in pain
The story began in 2005, when a group of psychiatrists set out to test their theory that ME/CFS is primarily a psychosocial illness, characterized by patients’ “unhelpful cognitions” and their “dysfunctional” beliefs that their symptoms are caused by an organic disease.
Under this assumption, they recruited over 600 ME/CFS patients for the PACE trial and randomly divided them into four categories. One group was treated with cognitive behavior therapy (CBT), a form of psychotherapy that addresses patients’ “false perceptions” of their illness, and a second group received graded exercise therapy (GET), which consisted of supervised increases in their activity levels. The other two groups were essentially controls, receiving neither of the treatments under study.
In a 2013 article in Psychological Medicine, the PACE team announced its most striking results. This follow-up article claimed that the therapy arms of the study – CBT and GET – had achieved impressive 22 percent recovery rates – not just improvement rates – as opposed to only seven or eight percent in the control arms.
The result was enthusiastically promoted in the press, but many patients were suspicious, especially of the GET outcomes, which contradicted their experience of debilitating crashes following the simple movements of daily life.
ME/CFS patients have consistently explained that exertion exacerbates their worst symptoms. For many, even moderate exercise can result in a days-long crash, in which they are nearly immobilized by muscle weakness and joint pain. In the U.S., post-exertional relapse has been recognized as the defining characteristic of the illness by the Centers for Disease Control, the National Institutes of Health and the Institute of Medicine.
For the PACE investigators, however, the announced recovery results validated their conviction that psychotherapy and exercise provided the key to reversing ME/CFS.
There was just one problem. A subsequent investigation found that the PACE investigators had changed the standard for recovery midstream, weakening one of the key criteria to the point that a subject could actually have gotten worse in the course of the trial and yet still count as “recovered” following supervised GET.
Unraveling the mystery
Here is how it worked, as shown by the investigation: At the outset of the trial, patients were recruited who scored at 65 or lower on a measure called the physical function score, and recovery was defined as achieving a subsequent score of 85 or higher, which indicates a relatively healthy person.
Before the unblinded trial was completed, however, the definition of recovery was reduced to a score of 60, which was below the level that qualified research subjects in the first place.
It was the change in this outcome measure (and several others) that allowed the PACE researchers to declare their favorable outcome for GET. The unimpressive results under the original protocol went unpublished, as though they had been stuck in a a figurative file drawer.
When the Psychological Medicine article was published in 2013, members of the patient community immediately pointed out the discrepancy. Because the study had been publicly funded, they sought the underlying data under the U.K.’s Freedom of Information law. The PACE investigators refused to release any of the raw results.
In October 2015, David Tuller of the University of California at Berkeley published a lengthy expose of the PACE trial, pointing out the jiggered outcome measure, as detailed above, and many other flaws. His report attracted the attention of numerous American scientists who joined an open letter seeking an independent review of the PACE data.
Finally, in summer 2016, a British Freedom of Information tribunal ordered the PACE team to unlock the file drawer and disclose their raw data. A revelation followed.
Exaggerated recovery claims
A group of patients and scholars reanalyzed the PACE data according to the original determinants and, as suspected, the “recoveries” under CBT and GET all but disappeared. As they reported last December in a peer-reviewed medical journal, the recovery rate for CBT fell to seven percent and the rate for GET fell to four percent, which were statistically indistinguishable from the three percent rate for the untreated controls.
Thus, the PACE investigators proved nothing more than a familiar adage among statisticians: If you torture the data, they will confess anything.
Researchers in the U.S. and Australia have recently made great progress toward identifying biomarkers for ME/CFS, which may lead to an effective medical intervention. Over 100 prominent researchers, clinicians and organizations have called on Psychological Medicine to retract the PACE article, although the journal has not yet publicly responded.
Thanks to the original PACE announcement, however, graded exercise is still routinely prescribed throughout the U.S. and the U.K. despite reports that the treatments can cause intolerable pain and relapse. Those who question GET are often told that they must simply exercise more, no matter how badly they crash afterward.
It is bad enough to torture the data, but it is indefensible to torture patients based on manipulated results.
This article was originally published on The Conversation. Read the original article here: http://theconversation.co(...)ain-and-stigma-74890.
Bron: http://bigstory.ap.org/ar(...)yndrome-was-doctored
De resultaten van de grootste studie naar CGT(cognitieve gedragstherapie) en GET(graded exercise therapie) voor M.E./CVS zijn zo vervalst dat ze van een insignificant resultaat naar een recovery rate van 22% zijn gegaan. Deze studie vormde en vormt nog steeds in Nederland de heilige graal voor het behandelen van patiënten.
Een van de belangrijkste symptomen van CVS is dat wanneer je over je grenzen gaat je daar soms zelfs weken tot maanden voor moet lijden. Patiënten die CGT en GET krijgen voorgeschreven wordt dit echter continu gevraagd. Dit heeft voor enorm veel lijden onder patiënten gezorgd. Uit patiëntensurveys blijkt dat meer dan 50% van de mensen die een GET programma gevolgd hebben daar slechter tot veel slechter van zijn geworden. Sommigen tot huis- of bed-gebonden toe.
Uit persoonlijke ervaring kan ik het ook elke patiënt afraden.
Steven Lubet, Northwestern University
(THE CONVERSATION) The public relies on scientists to report their findings accurately and completely, but that does not always happen. Too often, researchers announce only their most favorable outcomes, while keeping more disappointing results well out of sight.
This phenomenon, first identified by the psychologist Robert Rosenthal in 1979, is called the “file drawer problem.” Although it is widely recognized – affecting drug trials, psychology experiments and most other fields – it has seldom been documented, for obvious reasons. Suppressed results are, well, suppressed, and they are usually discovered only by chance.
It was therefore almost unprecedented when a group of patients, at the end of last year, successfully unmasked the skewed data behind an influential British study, first published in Lancet in 2011, of the devastating disease known as Chronic Fatigue Syndrome (sometimes called myalgic encephalomyelitis or ME/CFS).
My interest in this issue is both professional and personal. As a law professor, I have devoted much of my career to the study of judicial ethics, including the problem of implicit biases that can undermine the reliability of both court trials and clinical trials.
I have also been living with ME/CFS for over a decade, so I am acutely attuned to the need for responsible and transparent research on the illness. Unfortunately, the most extensive study of ME/CFS – called the PACE trial – was deeply flawed from its inception, in ways that the principal investigators have yet to acknowledge.
‘Dysfunctional’ beliefs all too real for those in pain
The story began in 2005, when a group of psychiatrists set out to test their theory that ME/CFS is primarily a psychosocial illness, characterized by patients’ “unhelpful cognitions” and their “dysfunctional” beliefs that their symptoms are caused by an organic disease.
Under this assumption, they recruited over 600 ME/CFS patients for the PACE trial and randomly divided them into four categories. One group was treated with cognitive behavior therapy (CBT), a form of psychotherapy that addresses patients’ “false perceptions” of their illness, and a second group received graded exercise therapy (GET), which consisted of supervised increases in their activity levels. The other two groups were essentially controls, receiving neither of the treatments under study.
In a 2013 article in Psychological Medicine, the PACE team announced its most striking results. This follow-up article claimed that the therapy arms of the study – CBT and GET – had achieved impressive 22 percent recovery rates – not just improvement rates – as opposed to only seven or eight percent in the control arms.
The result was enthusiastically promoted in the press, but many patients were suspicious, especially of the GET outcomes, which contradicted their experience of debilitating crashes following the simple movements of daily life.
ME/CFS patients have consistently explained that exertion exacerbates their worst symptoms. For many, even moderate exercise can result in a days-long crash, in which they are nearly immobilized by muscle weakness and joint pain. In the U.S., post-exertional relapse has been recognized as the defining characteristic of the illness by the Centers for Disease Control, the National Institutes of Health and the Institute of Medicine.
For the PACE investigators, however, the announced recovery results validated their conviction that psychotherapy and exercise provided the key to reversing ME/CFS.
There was just one problem. A subsequent investigation found that the PACE investigators had changed the standard for recovery midstream, weakening one of the key criteria to the point that a subject could actually have gotten worse in the course of the trial and yet still count as “recovered” following supervised GET.
Unraveling the mystery
Here is how it worked, as shown by the investigation: At the outset of the trial, patients were recruited who scored at 65 or lower on a measure called the physical function score, and recovery was defined as achieving a subsequent score of 85 or higher, which indicates a relatively healthy person.
Before the unblinded trial was completed, however, the definition of recovery was reduced to a score of 60, which was below the level that qualified research subjects in the first place.
It was the change in this outcome measure (and several others) that allowed the PACE researchers to declare their favorable outcome for GET. The unimpressive results under the original protocol went unpublished, as though they had been stuck in a a figurative file drawer.
When the Psychological Medicine article was published in 2013, members of the patient community immediately pointed out the discrepancy. Because the study had been publicly funded, they sought the underlying data under the U.K.’s Freedom of Information law. The PACE investigators refused to release any of the raw results.
In October 2015, David Tuller of the University of California at Berkeley published a lengthy expose of the PACE trial, pointing out the jiggered outcome measure, as detailed above, and many other flaws. His report attracted the attention of numerous American scientists who joined an open letter seeking an independent review of the PACE data.
Finally, in summer 2016, a British Freedom of Information tribunal ordered the PACE team to unlock the file drawer and disclose their raw data. A revelation followed.
Exaggerated recovery claims
A group of patients and scholars reanalyzed the PACE data according to the original determinants and, as suspected, the “recoveries” under CBT and GET all but disappeared. As they reported last December in a peer-reviewed medical journal, the recovery rate for CBT fell to seven percent and the rate for GET fell to four percent, which were statistically indistinguishable from the three percent rate for the untreated controls.
Thus, the PACE investigators proved nothing more than a familiar adage among statisticians: If you torture the data, they will confess anything.
Researchers in the U.S. and Australia have recently made great progress toward identifying biomarkers for ME/CFS, which may lead to an effective medical intervention. Over 100 prominent researchers, clinicians and organizations have called on Psychological Medicine to retract the PACE article, although the journal has not yet publicly responded.
Thanks to the original PACE announcement, however, graded exercise is still routinely prescribed throughout the U.S. and the U.K. despite reports that the treatments can cause intolerable pain and relapse. Those who question GET are often told that they must simply exercise more, no matter how badly they crash afterward.
It is bad enough to torture the data, but it is indefensible to torture patients based on manipulated results.
This article was originally published on The Conversation. Read the original article here: http://theconversation.co(...)ain-and-stigma-74890.
Bron: http://bigstory.ap.org/ar(...)yndrome-was-doctored
De resultaten van de grootste studie naar CGT(cognitieve gedragstherapie) en GET(graded exercise therapie) voor M.E./CVS zijn zo vervalst dat ze van een insignificant resultaat naar een recovery rate van 22% zijn gegaan. Deze studie vormde en vormt nog steeds in Nederland de heilige graal voor het behandelen van patiënten.
Een van de belangrijkste symptomen van CVS is dat wanneer je over je grenzen gaat je daar soms zelfs weken tot maanden voor moet lijden. Patiënten die CGT en GET krijgen voorgeschreven wordt dit echter continu gevraagd. Dit heeft voor enorm veel lijden onder patiënten gezorgd. Uit patiëntensurveys blijkt dat meer dan 50% van de mensen die een GET programma gevolgd hebben daar slechter tot veel slechter van zijn geworden. Sommigen tot huis- of bed-gebonden toe.
Uit persoonlijke ervaring kan ik het ook elke patiënt afraden.
Fraude is in de wetenschap helaas wijdverbreid. Ik heb zelf helaas geen kennis van dit onderwerp en kan er dan ook inhoudelijk verder geen commentaar opgeven.
Doubts over the validity of the PACE hypothesis
http://thelancet.com/journals/lanpsy/article/PIIS2215-0366(15)00054-1/fulltext
http://thelancet.com/journals/lanpsy/article/PIIS2215-0366(15)00054-1/fulltext
Ich glaube, dass es manchmal nicht genügend Steine gibt und
Ich bin mir sicher, dass auch schöne Augen weinen
Ich bin mir sicher, dass auch schöne Augen weinen
In Nederland is trouwens hetzelfde gebeurt met de Fitnet trial.
The open-label FITNET trial [4, 5] did indeed report a 63 % ‘recovery’ rate at 6 months. However, the trial used a post hoc definition of ‘recovery’ which has been criticised for not being stringent enough [1, 8]. Furthermore, the follow-up paper concluded that receiving CBT ‘did not significantly influence recovery rates’ at long-term follow-up (LTFU), as there was no significant difference between CBT and the ‘usual care’ control group.
Juking the stats! 60% hersteld claimen terwijl het werkelijke resultaat statistisch zo goed als niet bestaand is.
The open-label FITNET trial [4, 5] did indeed report a 63 % ‘recovery’ rate at 6 months. However, the trial used a post hoc definition of ‘recovery’ which has been criticised for not being stringent enough [1, 8]. Furthermore, the follow-up paper concluded that receiving CBT ‘did not significantly influence recovery rates’ at long-term follow-up (LTFU), as there was no significant difference between CBT and the ‘usual care’ control group.
Juking the stats! 60% hersteld claimen terwijl het werkelijke resultaat statistisch zo goed als niet bestaand is.
De self-reporting scores waren dus alsnog beter, al waren ze mogelijk gebiased. De studie is dus niet goed uitgevoerd, maar dat betekent niet dat de resultaten perse niet kloppen, zoals TS stelt. Opnieuw doen, maar dan goed dus.
quote:Op zondag 26 maart 2017 17:38 schreef MevrouwPuff het volgende:
De self-reporting scores waren dus alsnog beter, al waren ze mogelijk gebiased. De studie is dus niet goed uitgevoerd, maar dat betekent niet dat de resultaten perse niet kloppen, zoals TS stelt. Opnieuw doen, maar dan goed dus.
Statistisch insignifacte verbeterings-scores op subjectieve meetinstrumenten.quote:Applying a definition of recovery that was almost identical to the protocol-specified one, we found that recovery rates dropped from 22% to 7% in the CBT treatment group, from 22% to 4% for the GET treatment group, and from 7% to 3% for the Control (no therapy) group. The complete analysis may be found in Matthees et al. [26 Matthees A, Kindlon T, Maryhew C, et al. A preliminary analysis of ‘recovery’ from chronic fatigue syndrome in the PACE trial using individual participant data. 2016 Available from:
http://www.virology.ws/20(...)l-new-analysis-finds
[Google Scholar]
]. The rates for the CBT and GET groups were not significantly higher than those for the Control group (p-values for Fisher’s exact test were 0.199 and 0.770 for the 2 pairwise comparisons, respectively).55. The publicly available data provides only one case definition of CFS – the Oxford definition – so we counted any person who failed to meet that definition as having met this criterion for recovery. This approach may provide a slightly generous estimate of the proportion recovered according to the original criteria: it is hypothetically possible that some of the people classified as recovered may still have met one of the other case definitions, and therefore may not have been defined as recovered according to the original criterion.
View all notes
Consequently, it can be seen that the changes the authors made to the definition of recovery dramatically increased the overall proportion of patients that could be counted as ‘recovered’, and also enabled them to report statistically significant group differences, which would not have been possible using the original definition.
Geen enkel resultaat op de objectieve toetsen.quote:The PACE trial included several such objective measures. These included a six-minute walking test and a step fitness test [2 White PD, Goldsmith KA, Johnson AL, et al. Comparison of adaptive pacing therapy, cognitive behaviour therapy, graded exercise therapy, and specialist medical care for chronic fatigue syndrome (PACE): a randomised trial. Lancet. 2011;377(9768):823–836 doi: 10.1016/S0140-6736(11)60096-2
[CrossRef], [PubMed], [Web of Science ®], [Google Scholar]
,38 Chalder T, Goldsmith KA, White PD, et al. Rehabilitative therapies for chronic fatigue syndrome: a secondary mediation analysis of the PACE trial. Lancet Psychiatry. 2015;2(2):141–152. doi: 10.1016/S2215-0366(14)00069-8
[CrossRef], [PubMed], [Web of Science ®], [Google Scholar]
]. The researchers also recorded work days lost to illness in the period prior to, and in the 12 months following, treatment allocation [39 McCrone P, Sharpe M, Chalder T, et al. Adaptive pacing, cognitive behaviour therapy, graded exercise, and specialist medical care for chronic fatigue syndrome: a cost-effectiveness analysis. PLoS One. 2012;7:e40808. doi: 10.1371/journal.pone.0040808
[CrossRef], [PubMed], [Web of Science ®], [Google Scholar]
]. Data for one of these measures was recently made publicly available: distance walked on the six-minute walking test. PACE’s CBT programme encouraged patients to overcome their fear of activity, and to also experiment with gradual increases in activity, so patients who recovered after CBT would be expected to score within the normal range on this test, especially after the passage of an entire year. The same would be expected for the GET programme, which set a goal of five exercise sessions a week, with walking being the most popular choice of exercise. We can estimate the normal range for this test from recently published norms based on a comparable version of this task (like PACE, it used a 10 m track length) [40 Beekman E, Mesters I, Gosselink R, et al. The first reference equations for the 6-minute walk distance over a 10 m course. Thorax. 2014;69(9):867. doi: 10.1136/thoraxjnl-2014-205228
[CrossRef], [PubMed], [Web of Science ®], [Google Scholar]
]. Taking into account the PACE participants’ gender composition, average age and body mass index, and adopting the formula derived from the published norms, the lower bound of normal for this test is 589 m. None of the patients in the CBT, GET or Control groups who qualified as ‘recovered’ achieved a walking distance that approached this lower bound, even after a whole year – irrespective of whether the protocol-specified or the revised definition of recovery is used.
Dan moet je hier nog eens bij rekenen dat er verder niet gekeken is naar of er schade aangericht is bij participanten. Terwijl in een serie onafhankelijke surveys 50% of meer van de patiënten die GET moeten ondergaan wel zeggen dat ze er slechter of veel slechter van zijn geworden. Voor CGT is dit percentage lager maar op basis van de cijfers is het nog steeds niet aan te raden.
http://www.tandfonline.com/doi/full/10.1080/21641846.2017.1259724
Het hele artikel waar ik zojuist quotes uit plaatste.
http://www.prohealth.com/library/showarticle.cfm?libid=19041
Survey naar de effecten van verschillende behandelingen. In deze survey geeft 2/3de van de patiënten die GET gevolgd heeft aan er slechter van geworden te zijn.
Ben trouwens zelf ook van werkend naar huisgebonden gegaan met CGT/GET.
Survey naar de effecten van verschillende behandelingen. In deze survey geeft 2/3de van de patiënten die GET gevolgd heeft aan er slechter van geworden te zijn.
Ben trouwens zelf ook van werkend naar huisgebonden gegaan met CGT/GET.
De belangen en corruptie zijn groot.
Helaas is dat de laatste 10 jaar er niet beter op geworden.
Men gebruikt falende methoden vanuit 'marktwerking' overweging.
Helaas is dat de laatste 10 jaar er niet beter op geworden.
Men gebruikt falende methoden vanuit 'marktwerking' overweging.
Deuger & Gutmensch
"Conservatism consists of exactly one proposition, to wit: There must be in-groups whom the law protects but does not bind, alongside out-groups whom the law binds but does not protect."
"Conservatism consists of exactly one proposition, to wit: There must be in-groups whom the law protects but does not bind, alongside out-groups whom the law binds but does not protect."
Graded exercise therapy. Zo ongeveer het slechtste wat je voorgeschreven kan worden als je een ziekte hebt waar de hoofdcomponent post exertionele malaise(PEM) is. Zijn heel veel mensen een hoop zieker van geworden.quote:
Het houdt eigenlijk in dat je je activiteiten elke dag/week een stukje opbouwt. Wat echter gebeurt met M.E./CVS patiënten als ze over hun grenzen gaan is dat ze een enorme terugval krijgen en daar in extreme gevallen maanden/jaren last van houden. Wat GET doet is je continu over je grens heen duwen, voor veel patiënten heeft dat enorme fysieke gevolgen.
http://www.ncf-net.org/library/Reporting%20of%20Harms.pdf
In de link meer daarover.
[ Bericht 16% gewijzigd door Solstice1 op 27-03-2017 10:36:47 ]
quote:
https://www.healthrising.(...)rug-for-me-cfs.5004/quote:Last month Hanson reported finding evidence of a hypometabolic state in ME/CFS, and now Fluge and Mella have apparently found it as well. The metabolites they've found suggest to them that low energy production is a central feature of this disease.
Van Robert Naviaux.quote:Metabolomics showed that chronic fatigue syndrome is a highly concerted hypometabolic response to environmental stress that traces to mitochondria and was similar to the classically studied developmental state of dauer. This discovery opens a fresh path for the rational development of new therapeutics and identifies metabolomics as a powerful tool to identify the chemical differences that contribute to health and disease.
http://www.pnas.org/content/113/37/E5472.full
In Japan loopt nu ook een replicatie-studie en ik geloof dat ze daar in Australië ook mee bezig zijn.
Al die onderzoeken maken het ook wel duidelijk waarom M.E./CVS patiënten geen bloed mogen geven trouwens. Als normaal functionerende mitochondriën(geven energie aan cellen) in bloed van patiënten wordt geplaatst stoppen ze met werken.
http://www.meassociation.org.uk/2015/05/23959/
Pacing is dat je leert om je dagtaken in delen op te breken en niet over je grenzen te gaan.
Pacing is dat je leert om je dagtaken in delen op te breken en niet over je grenzen te gaan.
Ik heb het ook gehad. Pas helemaal overgegaan met glutenvrij eten. Dan ga je geweldig goed en diep slapen. Gevolg: overdag meer energie. Oftewel ik denk dat het vanuit je darmen komt.
Veel patiënten hebben baat bij een dieet inderdaad, hoeft niet per se glutenvrij te zijn. Genezen doet bijna niemand door een dieet alleen. Ik word zelf op het moment behandelt aan een dysbiose in de darmen waar een overgroei van streptokokken en bacteroides zat.quote:
Ik heb het ook gehad. Pas helemaal overgegaan met glutenvrij eten. Dan ga je geweldig goed en diep slapen. Gevolg: overdag meer energie. Oftewel ik denk dat het vanuit je darmen komt.
In Noorwegen lijken goede resultaten gehaald te worden met rituximab een kankermedicijn dat B-cellen doodt. Definitieve resultaten moeten nog binnenkomen dus dat is best spannend. Dezelfde groep test ook cyclophosphamide.
[ Bericht 11% gewijzigd door Solstice1 op 27-03-2017 11:17:31 ]
Tja aan de ene kant is het kwalijk dat ze later een definitie voor herstel hebben gemaakt. Maar als ze die definitie goed aan hebben gegeven in het artikel en vervolgens niet liegen over die waarden dan is dat toch een kloppend onderzoek. Het is misschien geen heel goed onderzoek maar wel juiste data.quote:
In Nederland is trouwens hetzelfde gebeurt met de Fitnet trial.
The open-label FITNET trial [4, 5] did indeed report a 63 % ‘recovery’ rate at 6 months. However, the trial used a post hoc definition of ‘recovery’ which has been criticised for not being stringent enough [1, 8]. Furthermore, the follow-up paper concluded that receiving CBT ‘did not significantly influence recovery rates’ at long-term follow-up (LTFU), as there was no significant difference between CBT and the ‘usual care’ control group.
Juking the stats! 60% hersteld claimen terwijl het werkelijke resultaat statistisch zo goed als niet bestaand is.
De implicatie van het onderzoek is vraag twee, het is aan de lezer om te kijken of hij/zij het eens is met de definitie die gehanteerd is voor recovery. En zo niet dan moet de data gewoon zo zijn opgeschreven dan er uit te vinden is wat er zou gebeuren met een andere definitie voor recovery.
En mochten we vallen dan is het omhoog. - Krang (uit: Pantani)
My favourite music is the music I haven't yet heard - John Cage
Water: ijskoud de hardste - Gehenna
My favourite music is the music I haven't yet heard - John Cage
Water: ijskoud de hardste - Gehenna
Zijn ze zelf helaas niet zo duidelijk over:quote:Op maandag 27 maart 2017 13:39 schreef Bosbeetle het volgende:
[..]
Tja aan de ene kant is het kwalijk dat ze later een definitie voor herstel hebben gemaakt. Maar als ze die definitie goed aan hebben gegeven in het artikel en vervolgens niet liegen over die waarden dan is dat toch een kloppend onderzoek. Het is misschien geen heel goed onderzoek maar wel juiste data.
De implicatie van het onderzoek is vraag twee, het is aan de lezer om te kijken of hij/zij het eens is met de definitie die gehanteerd is voor recovery. En zo niet dan moet de data gewoon zo zijn opgeschreven dan er uit te vinden is wat er zou gebeuren met een andere definitie voor recovery.
https://www.cyberpoli.nl/cvs/interviews/sannecvsquote:Zes maanden na de FITNET-behandeling bleek 63% van de jongeren hersteld, vergeleken met 8% in de controlegroep. Dit herstel bleef behouden op de langere termijn, enkele jaren na het staken van de FITNET-behandeling.
Mijn proefschrift beschrijft daarnaast hoe vaak CVS voorkomt bij jongeren in huisartsen- en kinderartsenpraktijken. Ook hebben we onderzocht wat de invloed van IQ en van cortisol (stresshormoon) is op herstel van CVS.
Terwijl er van een positief resultaat uit de studies dus geen sprake is.
http://www.virology.ws/20(...)tnet-trial-for-kids/
The 2012 study, a Dutch version of FITNET, was published in The Lancet. (Why is The Lancet always involved?) In a subsequent paper published in Pediatrics in 2013, the Dutch team reported no differences among their trial participants at long-term follow-up. In other words, as with the PACE trial itself, any apparent advantages conferred by the investigators’ preferred treatment disappeared after the study was over. (More on the Dutch study below.)
Voor veel meer over Fitnet, check de link.
The 2012 study, a Dutch version of FITNET, was published in The Lancet. (Why is The Lancet always involved?) In a subsequent paper published in Pediatrics in 2013, the Dutch team reported no differences among their trial participants at long-term follow-up. In other words, as with the PACE trial itself, any apparent advantages conferred by the investigators’ preferred treatment disappeared after the study was over. (More on the Dutch study below.)
Voor veel meer over Fitnet, check de link.
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Hoe een studie naar CVS vervalst werd, leidend tot meer pijn en stigma
