Because some people like “taking” the drugs that their body produces at the doses they are produced at when shown such films. QMUL are appealing. Mind is not brain. https://clinicaltrials.gov/ct2/show/record/NCT02229942?term=fluge+rituximab&rank=1, I’ve just realised that my second twitter link was to the wrong Horton attack on PACE critics – above he was criticising the ME Association, complaining that they “object to rigorous research findings because they challenge fixed assumptions? So time after time the psychogenic explanation has been shown to be wrong. I had the same idea. 13. Kings Coll, London, rejected it as ‘vexatious’. A double-blind and placebo-controlled study. Again, if it’s that bad, how did it stand for so long? ““talk therapy” and other forms of “mental health treatment” not involving drugs” are indeed “very effective in solving important problems in portions of the population.”, and that those portions are substantial proportions of the populations having the problems in question; 2. Many requests have been dismissed as vexatious, upheld by the FOI commissioner. Apparently I have not got Lupus although I have many of the symptoms. In particular, the essence of all the stuff I’ve been yammering on about above is: “you certainly cannot get away with claiming that mental origins of bodily conditions have no scientific basis”. P.S. So not only does ME/CFS have a unique symptom, it is one which has been verified in objective manner. Historically this perspective was grounded in morality and specifically in religious morality, though it is not limited to religion. We’re called anti-science, when all were really asking for is good science. I totally agree that “psychosomatic” illness has been abused, but I also think that there are conditions where things done to the “mind” (ie. Psychiatry needs to get its act together. Although their diet plan is intended for all … Look, I promise you I can consistently induce significant measurable physical changes in people by purely sensory (visual, audio, smell) means, just find a few 18 year old males and show them pictures of naked women, or find a population of 18 year old females and have them listen to the audiobook version of some romance novel, or get the two populations in the same room and waft the smell of bacon into the room. If you can’t propose a mechanism, you had better show REALLY robust evidence that this “mind/body” link actually affects bodily systems in this way. Meanwhile any sensible discussion around these issues, or someone claiming some success from psychological intervention is ran off any forum or threads locked. And yet you seem to argue that this is a remarkable leap of faith. Third, there is no evidence that the virus link is post-hoc. There are economic and political influences here too. https://www.researchgate.net/publication/283476227_Psychogenic_explanations_of_physical_illness_Time_to_examine_the_evidence I don’t think I could — indeed, I often don’t see “subtle issues that should be addressed” on first reading. 5 million pounds (UK). For anybody who has ME, here’s a link – http://www.hummingbird.com. I suspect part of the problem is doctors are too busy to read papers critically. http://www.meassociation.org.uk/how-you-can-help/fundraising-support/. Are there methodological problems with some of these studies? Either way, the reviewer must have approved the change. But that’s my point. that’s it. J Psychosom Res. (CBT/LP/similar which is designed to induce denial doesn’t improve coping.). Yes. The NHS does not want people to be diagnosed due to the repercussions financially. . Its this sort of irrational post-hoc logic that makes people question psychosomatic theories as a whole. This ‘strict criterion for recovery’ in fact only required that patients report and SF36-PF score of 60 or more, and a likert Chalder fatigue score of 18 or less. The way to go is to destigmatize the mental as a source of suffering (see e.g. See all Pro-Science sources. On the other hand, reputations change. If reviewers are too busy let the Journals figure out a better way to compensate them for their time. At some point we have to stop this cycle and ask for proof outside of vague handwaving, word-games and Charcot/Freud based theory. Brains can cause or contribute to bodily symptoms. The afflicted MUST be made to share responsibility for their own illness. Yet clinicians and policy-makers are frequently treating psychosomatic disease as a proven fact. Psychogenic cannot be used as a default diagnosis. It’s more complicated. Lancet is a well known very respectable medical journal. I speculatively suggested alliances between certain larger universities to make the branding of quality of their output credible (given cross-review between them). It is a barn door issue of a trial that is methodologically a non-starter. Medical imaging is often a neglected topic in global oncology guidelines, but is crucial in cancer care, since imaging is essential to diagnose—or exclude—both adult and childhood cancers, … I think we agree more than disagree. The calculation would be very different. Did you check that link on Soderling. https://aeon.co/opinions/bad-thoughts-can-t-make-you-sick-that-s-just-magical-thinking, I agree with you, and elsewhere I mention two “types” of situations, 1) where doctors can’t figure out what is wrong and “blame psych”. The role of stress in symptom exacerbation among IBS patients. So that’s where the abstraction matters & that’s what we are fighting about. It seems likely that physical restrictions in the sinuses combined with exposure to allergens and/or respiratory viruses leads to treatment of a small number of acute sinus infections with antibiotics. I cant think, process information, remember; I am hormonal; I feel the cold and am sensitive to noise. That includes things like anorexia and bulemia, PTSD, drug addiction, depression, etc. Existing crappy measures of biota content (basically “culturing”) fail to detect this condition. It is not implausible that the brain can get stuck in this “sickness” state. Basically my prior is kind of broad. ack, stupid blog and its eating less than signs. I haven’t managed to read all the comments yet so I’m sure the point has been made that one reason the PACE paper was so readily accepted and widely (mis)reported is that it is the only medical research to be part-funded by the UK government’s Department of Work and Pensions. Some of them being mere patients seems particularly galling. Publication is a random process. The false labeling of conditions which are not understood as ‘psychogenic’ has served only to divert attention from medical ignorance. The Lancet editor is using his journal’s reputation to defend the controversial study. Patients talk about disease because it’s shorter than the alternatives. Indeed, I have had two papers accepted for publication that had errors. OTOH, yes, I’d be more than a bit annoyed if you really do recommend publication after not even 15 mins of reading. Yes I’m sure, medicine is full of methodology problems. there’s this study and then there was that Iraq deaths paper from a few years back. No, reviewers must not catch *every* problem: They only have to catch *one* (non-trivial) problem and that ought to be enough to send a paper back. By the same logic I could argue that ice-cream consumption causes shark attacks (they both increase in the summer and this is a famous example of the correlation/causation mistake where on a graph they can be made exactly correlated). Then you need to defend your modelling methods, and defend the use of QALYs. The world is really really interesting and complicated! I have huge glaring white lights, imagine looking at a jagged hole in the ice on a pond, but instead of water the hole is filled up with glaring white light and you cannot see. The trials for cancer patients are very promising but applicability is potentially much broader: https://news.usc.edu/63669/fasting-triggers-stem-cell-regeneration-of-damaged-old-immune-system/. The patients, in addition to suffering from the symptoms, also suffer from the stigma that such an attitude creates: they are treated as if their condition is questionable, maybe just imagined; as if it springs from a weakness of character and they’re to blame for it. If we drop pre-publication review entirely, it’s not clear how many of the hours that currently go into pre-publication review, will instead go into post-publication review. How they apply existing science to solve problems (or, in the case of engineers, to build things) can involve incredibly clever feats of mental prowess, but it is nonetheless a very different process than doing science to produce new scientific knowledge. (The long-term follow-up study showed that there was NO significant difference between the different interventions studied in the trial, even on subjective measures!). For example, my prior on “panic attack” in the absence of recreational, prescription, or OTC drug use is that it’s caused by “mental processes” related to stressors in the environment such as relationships, money, career, etc, and NOT viruses, bacteria, food allergies, etc. stupid simplistic models are just that… stupid and simplistic. I really don’t like the current model of terse 3-page Science/Nature papers focused on grabby graphs and statistical significance. The US and European governments already have most of the IT infrastructure in place in the form of PubMed and Europe PubMed. What part of a ton of posts did I say that “psychosomatic disease exists”?? For the avoidance of doubt, when on 29th March 2011 the executive editor responsible for the publication of the PACE Trial articles was asked how The Lancet’s statisticians could have let such conflicting interpretation of the data be published in a journal of its reputation, he confirmed that he had taken Peter White on trust, saying (verbatim): “We can only do what we can do. Results were anticipated by NICE when forming their guideline for CFS/ME long before the trial had finished and was used as a reason for not updating the guideline when review was due. Medical school is very much more like a trade school, in which students are taught how to take care of patients, than a school teaching how to do science. Why not focus on building a good fence? More on that at Prof Coyne’s blog here https://jcoynester.wordpress.com/. The campaign against this study was virulently anti-science, adding £750K to the costs. But, as the study becomes more and more disparaged, the sharing of reputation goes the other way. And so you have the basis of a repeated game where faction can coordinate and gate keep. It is only now, 6 years on, when we get researchers from other areas to look at the evidence, that the problem is beginning to be recognized. First, the fact that doctors resort to “psychogenic” when no physical cause is known does not mean that mental origins of diseases do not exist. Another major issue that seems to have escaped the Lancet is that this was an open label-trial, without a placebo control arm, that relied purely on self-report primary outcomes in a trial of interventions that aimed to change patients’ interpretation of their symptoms. And I get from your last posts that you are not really going to bat for psychosomatic theories. Allergy. “Yeah, I mean adaptive pacing therapy essentially believes that chronic fatigue is an organic disease which is not reversible by changes in behaviour. Then there are the dreadful consequences of parents accused of factitious disorder by proxy on the assumption that there is no underlying organic disease process causing chronicity. It is time we learned from history and put a stop to it before any more patients suffer. It is an opinion piece. 7. And, I argue, ultimately contrary to the reputation of the Lancet as well. I’m asking that we not perpetuate the myth that there exists a separate incorporeal “mind” and that therefore because the “mind” is incorporeal that it therefore can’t affect the body. Many have mentioned the PACE trial in Britain and this is a subject which will require very careful and detailed analysis and scrutiny. the range of the mean plus (or minus) one standard You’re simply assuming that a panic attack is caused by the mind. Presumably the reviewers know this. PEM, on the other hand, results in ME/CFS patients getting very sick starting approximately 24 hours after normal or even trivial amounts of exertion. If it is now acknowledged that this ‘virulent anti-science campaign’ was actually a result of honest, reasonable and diligent patients spotting real problems with the quality of the research which was profoundly affecting their lives, then this will be more than a little embarrassing for Horton and the Lancet. . In this case, the “fence” is the requirement that a research paper overcome a series of hurdles: there should be a statistically significant p-value, ideally there should be some random sampling or random assignment, there should be publication in a top journal. From a scientific & medical perspective and legal perspective, the following needs to be scrutinised by many independent parties in the scientific and medical communities, and analysis communicated to all doctors and medical professionals. or be a contributing factor to improvements in other diseases (cancer? and as yet this doesn’t seem to have happened. And this ancient Greek view of a duality of spirit and body needs to stop so that we can get respect for a potentially important medical tool (but NOT the only tool!). Do you reject those states as “mental disorders?” I’m happy enough with “thinking about stuff” can “cause things to happen in the brain” which can “cause things to happen in the body” and it is POSSIBLE and sufficiently plausible that it is deserving of study that “thinking about things” can cause relatively permanent or severe somatic disorders. As if the problem is criticsm, not bad science. For example, running a gel and finding that all the lanes have some band… but they didn’t run a negative control! And no one has been able to. https://twitter.com/richardhorton1/status/38371958055772160. should work.” I disagree because, even in theory, refereeing is only an imperfect screen. Why? If they want me or someone else to replicate the analysis, look at it from all angles, evaluate all the claims in the paper, etc., they’re gonna have to pay me or motivate me in some other way. If you want to go further and say “mental -> physical” is a category of explanation that has been overrun with charlatans and that this background should give us low prior probability for believing the model in most cases… I probably would be fine with that, lots of medicine seems to be overrun with charlatans (see Tamiflu discussion recently) ;-). How do we create a system where pre-publication reviewers are motivated to do a good job? Dismissing this line of inquiry because (1) is so prevalent is unwarranted. which sources? There exist stricter case definitions used in research. Speaking of immune dysfunction, many patients are looking at this trial to hopefully provide answers and a treatment. These kind of examples from which one is supposed to deduce that psychogenic disease must surely exist just demonstrate that proponents of psychogenic illness have no evidence that the mind can cause disease. It’s the constant awful brain fog, massively impaired cognitive functioning and being ‘hormonal’ which are my major symptoms. And the referee might say, I only looked at it for a few minutes and I didn’t notice that flaw. If the topic is important, others can analyze the data too, so that puts less of a burden on the original data analysts, indeed it allows for a separation of hypothesis generation, study design, data collection, data analysis, and policy recommendations. Topics include, but are not limited to: Anti-infective therapy, Bacterial infections, Gastrointestinal infections, HIV/AIDS, Malaria. It looks like pre-registration can supply reviewers with some information of use at least in the area of the Garden of Forking Paths or phacking. So, again, how did it stay afloat for so long. consider asking questions about this issue to be “vexatious”, so we may never know what happened. Or claims that CBT is as effective as antipsychotic drugs in treating schizophrenia. Long term Psychological stress such as financial stress and relationship stress etc can make people produce various hormones that suppress the immune system, which then leads to them getting more and more frequent viruses and/or bacterial infections, alters inflammation response, can cause changes in the biota of the gut or other areas, and can be associated with things like irritable bowel disorder or higher risk of heart attack. But I think how much evidence is required will vary a lot based on reasonable priors for the effect. I think that Horton saw his publication and defence of the PACE trial as a brave stand against militant, anti-science patient pressure groups. I think it is also worth saying that since publication the Lancet has been vigorously defending the PACE trial. I did not mean to sound like that joke “if you want to get there, you shouldn’t be starting out from here” and there are (always have been) folks who take the high road. For your arguments to be convincing, you need to be able to point to high quality studies that give convincing evidence that: 1. Why are you so averse to *improving* the review process itself? Yes you can. The mind is a metaphysical concept outside of the realm of science. Coyne suggests that maybe UK studies should have overseas reviewers and says (if memory serves) that getting overseas reviewers is the norm in some countries. After all, people do this all the time after even the worst deconditioning caused by other illnesses, injury, etc. It makes the psychogenic theories and treatments for the disease especially ridiculous. I think it should happen more often. First, it’s worth pointing out that we do not know that all patients diagnosed with ME have the same illness. And more importantly, designing experiments that fail to actually rule out other obvious possibilities so that at the end of an expensive experiment you know very little more than you did going in. It is certainly possible that psychosomatic disease exists. Point taken. For that you need: 1) A definite specific model of how this would work in the particular disease on the biochemical level. The larger issue was discussed before on this blog, its not clear/settled on who should or would step up (provide resources) to take responsibility for quality control management of academic output: Not the journals as not in the immediate/intermediate interests (though Andrew argues it is in the longer term interests), not the universities as public relations is booming and being seen as of exponentially increasing importance, not funding agencies as they don’t want their funding decisions subject to such stringent review (who does), maybe governments (Obama admin has made some moves). So might as well select them at Columbia. It’s very difficult to be published in The Lancet. No validated mechanisms exist. What PACE did not show in the slightest was the kind of result you would expect if people who were merely ill because they “believed” they were ill and were just deconditioned and fearful. The reviewer should definitely try to catch problems. I’m not sure it’s that simple. Further I assume practically none of the patients would have heard of ME / CFS at the point in time where the self report the “first onset” date post hoc? It is simply an acknowledgement of what most medicine is. What’s that all about? In the second case, a colleague pointed the error out to me before publication — and it was a serious error that I was not able to correct. I also added an item on the PACE study to the “Controversy” section of the page. And then again M.E. Until then, only the small, specialized group of researchers involved in the area were the ones who handled any criticisms and they refused to reveal any further details. Yes old people might complain about chest pain when watching a horror movie because their hearts can’t handle the increased heart rate.

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