Fatigued by scales as outcome measures

2 04 2016

[Updated: 4 May 2016]

In March (2016), Rebecca Goldin wrote an excellent article for Sense about Statistics USA on the shortcomings of the PACE trial.

Prof Goldin devotes a lot of attention to the issue of fatigue, and the way in which it was measured and used in the trial, both as an entry criterion, outcome and recovery measure. Much is made of the overlap between entry criteria and recovery because of the conversion between bimodal and Likert scales. She also discusses the ceiling effect, whereby there is no way to record worsening outcomes. And this is the thing that bothers me the most, in that this scale doesn’t provide an absolute measure of fatigue, but only measures a change in fatigue. It’s a little like trying to measure speed by only recording acceleration.

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Engel and the biopsychosocial model

15 03 2016

In my last post, I briefly mentioned the biopsychosocial model and cited a criticism of it. However, having done a bit more digging, I’ve discovered that it seems to be woefully misunderstood in modern practice, both for physical and mental disorders.

Models of care adopted by medical professionals can often make it difficult for them to see the whole picture. Equally, professionals trained to offer psychosocial therapies are reluctant to consider biological causes of mental health conditions (and, regrettably, some physical conditions), mainly because they cannot offer solutions in those areas. The definition of disease has been largely driven by professional boundaries rather than reality. Read the rest of this entry »

My thoughts about the PACE trial

27 01 2016

First of all, why am I interested in this? Well, I have friends who are affected by this horrid condition (ME – myalgic encephalomyelitis), so this trial has a bearing on how they might be treated (or not), and I used to work as an editor at The Lancet, the journal that published the trial. I then trained as a medical statistician, and worked in research for a couple of years.

I know I’m a little late to this party, but I did read the paper when it was first published in 2011, and made some notes about it at the time. So I’ve updated them here.


The PACE trial was a hugely ambitious and complicated study of several interventions in patients with chronic fatigue syndrome (CFS). The interventions – graded exercise therapy (GET), cognitive behavioural therapy (CBT), and adaptive pacing therapy (APT) – involved a large number of sessions, with multiple measures, multiple centres, substantial patient involvement and input, and all these factors must have made it very difficult to ensure that everyone was being treated the same. The participant manuals for the interventions were huge (100+ pages each), and the demands on all those involved would have been substantial. Trials tend to work best when the interventions are kept simple. This was not a simple trial. Read the rest of this entry »

Food fair fantasies

3 03 2015

Last week, Joanna Blythman published an article in The Guardian entitled Inside the food industry: the surprising truth about what you eat, featuring extracts from her new book, Swallow This, which alleges to uncover the “darkest secrets” of the food industry. I was therefore intrigued to find out what these dark secrets were.

I found myself in the dark, eerie, indoor expanses of Frankfurt’s Blade Runner-like Festhalle Messe.

I immediately pictured a futuristic mash-up of Los Angeles and Shanghai in 2019 (or 1992 if you prefer book to film), with replicants lurking in the shadows and robotic sheep around every corner. However, this was no SciFi convention; instead it was a food ingredients fair. Determined to enhance the scare factor, she likens it to an arms fair, but I guess an arms fair is just a trade fair that exists to sell weaponry, just as a food ingredients fair exists to sell, err, food ingredients. Nothing sinister so far.

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100-day cough on the increase

5 01 2012

Today, the HPA issued a press release about the increase in whooping cough cases in the UK. However, I suspect that this disease is still being severely underreported.

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Cool It and other stuff

3 06 2011

Every year at the Hay Festival, I go to hear the latest darlings of the environmental movement talking about how they are going to save the planet, and this year was no exception.

My Hay 2011 started off in a windy tent with Mark Lynas talking about his new book “The God Species” and how optimistic he was that we could adapt and mitigate our way into the future.

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Straw men and hair splitting

7 11 2010

I was very much looking forward to the airing of “What the Green Movement Got Wrong” on Channel 4 on Thursday November 4th. This programme presented the views of Stewart Brand and Mark Lynas that the Green Movement has become far too entrenched in its position on several issues, including genetic engineering and nuclear power, and that maintaining those positions is damaging not only to the Green Movement itself, but also, ironically, to the environment.

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