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Petition update: The 'Independent Advisory Group' breaks their two year silence, but there will be no withdrawal of the inaccurate and harmful review 'Exercise therapy for chronic fatigue syndrome’, and those two years saw little, if any, progress.
Change.orgNews from Cochrane, or rather from the Independent Advisory GroupSilence has been broken after a hiatus of more than two years in the promised monthly updates from Hilda Bastian, leader of the Independent Advisory Group (IAG) for the process to develop a review to replace the 2019 Larun et al Review.
You can read the IAG November 2023 update here.It includes a new way of making public comments moderated by Hilda Bastian - link here.
Assessing progress against the requests we made in August 2023:
1. The immediate withdrawal or retraction of the 2019 Cochrane review 'Exercise therapy for chronic fatigue syndrome’ by Larun et al. and all earlier versions.
There is no indication that this will happen. Instead, the IAG is drafting a note to be added to the review to reduce 'misinterpretation' and better 'reflect critical nuance and limitations in its conclusions'.
We are concerned that this description of the problem misses the point that the review is fundamentally flawed. The problem is not just 'nuances' or with readers misinterpreting what the 2019 review says. The authors failed to understand the substantial bias created by the research methodology of the included studies. The most fundamental flaw that makes the review's conclusions unsound is that small improvements in self-reported assessments of symptoms in unblinded trials of treatments that specifically aim to make people downplay their symptoms are not evidence of the treatment working.
Also describing the problem with the review as being the 'limited applicability' of its conclusions misses the point that when conclusions are not based on good evidence they should not be applied to any patients. Restricting the use of the review to a particular subset of people does not fix the problem.
A note that says anything less clear than "This review is fundamentally flawed. Do not use it for clinical guidance" in large letters will not fix the problems with the review.
2. An immediate restart of regular monthly updates on the new review process, with clearly stated timelines for completion of the review to publication within one year from now OR Abandonment of the new review process.
We welcome the November 2023 update and thank those who are working towards an accurate review. However, 'one swallow does not make a summer'; one update does not make a functioning process that will produce an accurate review in a timely way. There is, as yet, no evidence that Cochrane understands the key problem with the 2019 review, and therefore no evidence that any replacement review will adequately address it. There is no evidence that Cochrane appreciates the urgency of the need for change.
It is also clear that people in favour of the old review are vigorously opposing change. Explanations for the two year silence include a lengthy process of dealing confidentially with several complaints, none of which were upheld. One complaint from supporters of exercise therapy for ME/CFS opposing the new review process seems to have taken around a year and the consideration of multiple committees within Cochrane to address. ________________
So, four years after a process to replace the 2019 review started, it remains in place, and any replacement review is still some way off. More scarce health resources have been wasted delivering treatments that do not work and more people have been harmed. Crucially, more research with the same fundamental flaws that are ignored in the 2019 review - some on CFS, some on Long Covid and some on various "functional" diagnoses - has been funded and done, with the results going on to mis-inform clinical approaches around the world.
We therefore continue this campaign.Thank you to all who have signed the petition. Please do keep spreading the word.
Cochrane have now acknowledged receipt of our October complaint about the 2019 review; we expect a response soon.