Why I am signing the petition to oppose MEGA

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MEGA has many facets: is it a thing of beauty or are its flaws too great?

MEGA is a proposed study into ME/CFS. There are good and bad aspects to it, so reaching a conclusion on whether to support it, or not, is not straightforward. But after careful consideration I have decided I am going to sign the petition opposing the study.

The MEGA alliance asked patients to endorse their study by signing a petition in support of them gaining funding to take the project forward (yes, there are two separate petitions). In the bit at the bottom were details about who was involved which includes the principal investigator of the PACE trial, and another researcher who has spoken highly of PACE and is running a trial similar to PACE in kids. Both promote a biopsychosocial (BPS) model of the disease.After some debate, someone launched a counter petition opposing the study. Right now what we have is a binary choice:

– Support the petition endorsing the study

OR

– Support the petition in opposition to the study.

You can of course do nothing but then you get no say at all, stuff just happens to you.

There are lots of potential problems with MEGA and these have been discussed on Facebook pages, blogs and forums such as Phoenix Rising. But these are the things that for me mean that I cannot support MEGA:

* Peter White’s involvement – he led the PACE trial. He promotes a BPS model of the disease that his own research does not support.

* Esther Crawley’s involvement – she ran a treatment trial of the Lightning Process on children with ME. She is now doing a graded exercise therapy trial on children despite there being concerns over the safety of the treatment.

* AYME involvement – Esther Crawley is an adviser for this organization so there is a clear conflict of interest. In my view AYME does a bad job of representing the interests of patients, one recent example I wrote about on my blog this spring.

I also have concerns over the definition that will be used to pick patients for the study, though I believe this may be something that those involved in the study may be willing to change, so it is not currently a reason why I am signing the petition. I don’t see any realistic prospect of them resolving the three issues above though, hence I will be signing the petition to oppose MEGA.

Some have pointed out that there are some good people involved in this study too, and I agree that is the case. There are researchers involved who have a track record of carrying out good quality science and I hope these people will do research into ME/CFS in some form. I want to find myself in a position where I can support them wholeheartedly.

I would like to specifically state that every patient I have interacted with wants these new researchers involved. The concerns are solely with certain individuals and organizations that I feel have let patients down over the years.

It has also been pointed out that as well as mental health questionnaires for 12,000 patients we will also get some omics data, and I think if genuine patients are picked this will be very interesting. The problem though is that patients are being asked if they want this study as it is and we are not being given a one or the other option. We are being told we get the good bits but must also accept the bad bits.

Given the new researchers involved are not considered experts in ME/CFS the study will be dependent on the advice of the so called experts White and Crawley. This could limit the good side of what we could potentially get out of this study and given its size and cost, if this study is not done properly it will set in stone an omics view of the disease forever. No one is going to be given funding to do something similar on this scale again if this study fails to show compelling evidence of something going on in omics. So the stakes are high.

Additionally, omics research takes time, a lot more time than it takes for mental health questionnaire and chalder fatigue scale results from the same study to be published and start being applied to all of us. If lots of people without ME/CFS but with mental health problems are entered into the study (highly likely based on the definition they tell us they will use) then a lot of those 12,000 study participants will demonstrate mental health dysfunction and not have ME/CFS.

It would probably seem quite reasonable to add these questionnaires to the study (it’s not hugely expensive). But off the back of the biggest ever study of mental health in ME/CFS (even though that is not the primary aim of the study) White, Crawley and other researchers who promote behavioral models of the disease will use this data to further research in that area rather than biological models.

So the question is, are you willing to take the risk of endorsing the bad as part of the deal to potentially get something good? Right now, as it stands, I cannot support it.

Some people who I like and respect a lot are in support of MEGA. I understand their reasons, and I too would love to support large-scale biomedical research into ME/CFS from some of the names involved in this project. I have found it very tempting to ignore the major problems I’ve raised, because of my desire for some of the big names involved in this project to have a crack at the disease. But I simply can’t do so under the present circumstances, I feel the downsides are currently too significant.

It was also very tempting to sit on the fence. This is not the same situation as PACE, for instance. This is not PACE 2. PACE was 100% bad, there were no redeeming features. MEGA, in contrast has both good and bad features. But I felt it was my responsibility to reach a conclusion and to voice it and my conclusion is that there is too much bad wrapped up with the good.

Also, as you can remove your signature from these petitions if you change your mind, if the issues blocking my support of MEGA are resolved — and I hope they are — I will happily withdraw my signature and support the study. That gives me the confidence to make a decision based on the information I have right now.

I welcome comment on my blog from both sides of the debate, it’s not something that patients should fight over, it’s OK to disagree on such important matters. There is no clear right or wrong, and even if we disagree on this I am sure we will continue to agree on a great deal else.

PACE and the interests of trial participants

disabled courtA tribunal has recently ruled that anonymous data from the controversial PACE trial must be released, rejecting an appeal from Queen Mary University of London (QMUL).

The data in question has been discussed on this blog before and you can read here to understand exactly what data we are talking about. It includes no personal identifiers.

The release of this data would allow for a reanalysis of the primary outcome measures according to the thresholds pre-specified in the researcher’s own published protocol. The recovery analysis in their published papers diverged from their own protocol, and included them lowering the recovery thresholds – this had the effect that more patients appeared to “recover” than if they had stuck to the planned thresholds for recovery. It’s possible that against the original recovery thresholds PACE may fail to demonstrate any significant recovery in patients – which would make the trial a failure.

QMUL can potentially appeal the tribunal’s decision and try again to block the release of the data that would allow this analysis. QMUL have already spent over £200,000 on legal fees on this tribunal case alone, which seems extraordinary considering they are a public institution. Following the tribunal’s decision they released this statement on their website: Disclosure of PACE trial data under the Freedom of Information Act

Prior to the tribunal, QMUL released a similar statement in which they said they were “seeking…the advice of patients”: Release of individual patient data from the PACE trial which led me to write to ME/CFS charities asking them to speak on behalf of patients. I asked patients to do the same, and you did! The effort was a success with 29 charities across the globe writing to QMUL on the request of patients to call on them to release the data and drop their appeal. This was submitted to the tribunal as evidence of the public interest in the data being released. Regarding the clear public interest in the release of the data, the tribunal stated:

“There can be no doubt about the Public Interest in the subject matter which is evident throughout the course of this appeal, and beyond, and we are grateful for the assistance that has been given to us in this regard.”

It was surprising that QMUL chose to ignore such strong public interest in the release of the data, which included thousands of patients, patient organizations, and academics. It appears they were not sincere in their wish to take account of the advice of patients, after all and I note that in their most recent statement, this time they do not invite the views of patients. But their most recent statement does say this (my emphasis added):

“We are studying the decision carefully and considering our response, taking into account the interests of trial participants and the research community.”

Perhaps QMUL will be consulting with participants then. QMUL surely do not mean to decide what is in the interests of participants without consulting them? To not consult participants would seem quite remarkable to me, but for all I know QMUL have been keeping participants informed and are seeking their views following the tribunal decision.

Given the Judge has ruled that they “…are satisfied that the risk of identification has been anonymised to the extent that the risk of identification is remote”, and that there is “…a strong public interest in releasing the data…” it is hard to see how QMUL could claim the interests of participants could be furthered by another appeal.

It must never be forgotten that trial participants are also patients, and members of the public too. However, this has not stopped QMUL in its various submissions from making a number of accusations of harassment from patients. In a separate FOI case, under a section they entitled “Harassment,” QMUL have pointed to the 12,000 strong petition calling for PACE claims to be retracted – most of those signatures are patients and some may be from patient participants in the PACE trial.

QMUL has accused patients in their “further skeleton” submission to the tribunal, where they claim “’highly critical’ and ‘vitriolic’ patient/activist groups” have tried to discredit the research.

One such activist group, according to QMUL, is the patient forum Phoenix Rising. Professor Jonathan Edwards, a member of the Phoenix Rising Board of Directors, appears to have been displeased with this accusation, as evidenced by his submission to the tribunal, referred to in the tribunal’s decision:

“Professor Edwards takes issue with the assertions that Phoenix Rising is allowing inappropriate behaviour, and further takes issue with the  term  ‘activist’ being used for its audience. He distinguishes highly motivated data requesters from those acting inappropriately or unreasonably. He accepts that certain individuals have expressed their frustrations with the misinterpretation of the PACE trial on the website in abusive terms, but this pales  in  comparison with four years of “intelligent and measured critique” provided by the other patients. Rather, the campaign to discredit or hijack the issue has come from the PACE authors and their colleagues in a series of attacks in review articles in the national press, online and in public presentations.”

The tribunal decision notice shows that one of QMUL’s arguments against disclosure of the anonymous PACE data was that “It would cause unwarranted distress to participants and open them to criticism or harassment.”

One document submitted by Alem Matthees as part of the evidence to the tribunal was a document collating the publicly available comments from PACE trial participants who had voluntarily come forward to express their views in public. A copy can be found here. It was submitted to dispute the claims of QMUL that patient participants were in danger of being harassed, and shows that in all cases where patient participants have come forward they have not been harassed, but rather have been praised, thanked and supported. This is no surprise, as we are all patients and we all just want to get better.

The Judge, considering this, and other evidence, found QMUL’s assessment of activist behaviour to be “grossly exaggerated” and QMUL were forced to admit at the hearing that “no threats have been made either to researchers or participants.”

But understandably, patients – including patient who are participants in the PACE trial – may feel rather upset with QMUL about their negative stereotyping of patients.

The tribunal decision includes a sentence about the responsibility of QMUL to participants when it comes to information about the anonymous data, the Information Commissioner pointing out that ” It would be up to QMUL to explain to participants that their data has been anonymised so that they could not be identified from it so as to allay fears that they themselves [QMUL] seem to be attempting to stoke up.”

Again, this makes you wonder what QMUL have been telling patient participants, if anything.


 

 

image credit: welsnet
creative commons licence
changes made to original image

PACE Trial’s Forbidden Fruit, Part 3: Charities Must Echo Patient Calls For Data Release

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I recently wrote about the Freedom of Information (FOI) request that the Information Commissioner upheld, ordering Queen Mary University of London (QMUL) to release the data requested from the PACE trial. I provided an example of exactly what data was requested to demonstrate that the release would not include any personal identifiers of patients from the trial. I also highlighted the scaremongering of the PACE authors and their institutions that is misleading people into thinking the data is personal data when it is not. Before that, I wrote about why we must be allowed to see the data.

QMUL released a statement about the case, stating that they were seeking advice of patients, but they have not explained how this advice is going to be sought or under what conditions.

Many ME/CFS patients will obviously want to have their opinions taken into account. It is clearly a matter that patients feel strongly about. A recent petition concerning the PACE trial, signed by over 11,000 people (mostly, it is reasonable to assume, patients) included a call for:

“the study authors… to give independent researchers full access to the raw data (anonymised by removing trial identifiers and all other data superfluous to the calculation, such as age, sex or location)”

My suspicion is that QMUL and the PACE authors will seek the support of ME/CFS charities who have supported them in the past. But our charities should neither support the withholding of the data nor passively wait to be contacted: they should be all over this issue. Patients rightly expect the charities to speak up on their behalf, to earn the donations and membership fees we give them. The charities must ensure that the PACE authors can’t just cherry-pick the advice from patients that suits them.

Previously, some of the charities have done a good job of challenging the flaws in the PACE trial and others have fallen short. Some past statements suggest that some ME/CFS charities may not understand the problems with the trial. However, this is too important for the charities to fail to inform themselves of all the facts. There is now plenty of well written information about the problems with PACE. Whereas patients may be too sick to do the necessary reading and thinking, our charities have a duty to study the facts. They must not allow themselves to be be misled by the PACE authors or sit on the fence through ignorance; either will be unacceptable to patients, who will not forgive such a failure on this key topic. Charities representing patients, particularly, but not exclusively in the UK, can have an important impact and I am calling on them to stand up for patients on this crucial issue.

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I encourage readers to contact ME/CFS charities and ask them to contact QMUL to tell them that patients want the data released. Crucially, not just the charities that have been supportive of patients already but also those that some may feel have let them down on this issue before. Judge each charity by its subsequent actions. Below are the contact details of a list of the larger UK charities which you may wish to contact.

I will be writing to ME/CFS charities who represent UK patients in two week’s time to ask what their official stance is, and what they are doing about it. I hope that they will publish their letters to QMUL on their own websites so that I can link to it. If you also want to post a copy of your email/letter/the gist of your phone-call, then feel free to do that here – I think it would be good to have the views of patients on the public record.

Here is what I will be sending to each of the below charities. Feel free to copy the text – adapting it if you like – to save yourself some time.

I believe this is really important. We have limited energy, but if we don’t spend it to do this then QMUL will find it easier to present a one-sided view of what patients want that will not represent us well.

My email:

I am writing, as an ME/CFS patient/member of your charity, to express my concern about the PACE trial and Queen Mary University of London’s (QMUL’s) actions to deny release of trial data that the Information Commissioner has ordered them to release. I understand that QMUL are seeking the “advice of patients” which I assume may include contacting you for a statement or evidence of what patients’ advice on the matter is. Even if they do not contact you I think you should contact them so that patients’ views are accurately conveyed.

Patients’ views have been expressed in an 11,000-signature petition hosted by the ME patient-advocacy organisation #MEAction, which included a call for “the study authors… to give independent researchers full access to the raw data (anonymised by removing trial identifiers and all other data superfluous to the calculation, such as age, sex or location)”.

I believe that it is crucial that our UK ME/CFS charities stand up for patients and for transparency in the science that affects our lives: patients expect no less of our charities at this crucial time. The Information Commissioner has already concluded in his ruling that the data release poses no risk to trial patients being identified.

In common with the petition signatories, my view is that the PACE trial was flawed and the de-identified data must be released to the public at once. I believe QMUL should drop their appeal before the tribunal hearing and comply with the Information Commissioner’s decision. I hope that you will contact QMUL and express to them that this is a widely held view among patients, and one that you support.

I hope that you will post any letter that you send to QMUL on your website. I have written a blog post on this topic and will link to any public statements that you make on this issue.

Sincerely,

Contact details for the larger UK ME/CFS charities:

The charities are listed in alphabetical order. While some informed themselves early about the problems with PACE and have, to their great credit, actively campaigned to protect patients from the misinformation that surrounds it, others have not. The latter charities in particular now need to realise that they must act in a way that reflects reality and patients’ needs before they lose their reputations for good: and all charities now need to come together and speak with one voice. Please write and tell them!

Action for ME
AYME
Invest in ME
ME Association
ME Research UK
Tymes Trust

25% ME Group (added to list 09 Feb 2016)

 

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PACE Trial’s Forbidden Fruit: Is The Data Really Poisonous?

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A Mock strawberry: No it’s not poisonous, despite what you may have heard. Just tasteless.

A freedom of information (FOI) request was submitted to Queen Mary University London (QMUL) in 2014 for a small portion of the PACE trial data (below I go into detail about precisely what data has been requested, and you can skip ahead if you want to). QMUL refused this request. The case went to the ICO who agreed with the requester and ordered QMUL to release the data. QMUL have appealed this decision and the tribunal will take place in 2016 with the court deciding whether QMUL have to release the data, or not. The outcome is impossible to predict, but it’s important. I wrote previously about why we must be allowed to see the data.

Here is my opinion: For ME/CFS, this tribunal case is one of the most important things that will happen in the whole of 2016. It’s outcome will affect millions of us for years to come. So I consider this important. Very important.

I’m not sure all ME/CFS patients realise how much PACE affects their lives. PACE is the cornerstone of the behavioural model that dominates how ME/CFS is perceived by government agencies including the NHS, the media and the public. It dominates how the disease is treated, not only in the UK but in many other countries around the world. It dominates how research money is spent (more behavioural studies rather than biomedical studies that might actually lead somewhere). It dominates social security policy that ultimately affects whether you get the support you need to live when you are crippled by the disease.

If you think that as PACE was studying those diagnosed with the Oxford criteria and therefore it doesn’t affect you, think again. The authors use the term myalgic encephalomyelitis in their protocol, their paper, and media statements, alongside chronic fatigue syndrome, and this important limitation to the study (uselessly broad criteria that mean people with other diseases are included in the study) has not held it back from being used to blight the lives of those with ME or CFS defined by a stricter set of criteria. So this matters to all of us no matter what we think of the names, or whether more than one disease is represented by these labels.

The study has been fraught with problems, the design was a shocker, there have been concerns over safety, reporting of results and misrepresentation of data, and the hiding of data that does not support the authors pet-theory of a behavioural model of disease. Without visibility of the data the authors conclusions cannot be put to test and undergo normal scientific scrutiny. So it is essential that we get to see the de-identified data.

In relation to this case, QMUL have said that they are “seeking….advice of patients…” No details are given of how QMUL is seeking this advice of patients. We have not been told how patients are being selected, how QMUL are presenting their request and what information they are providing the patients with, or how patients wanting to provide advice (me, for instance) can do so. This concerns me greatly as the authors of the PACE trial have repeatedly attempted to set themselves up as an unofficial mouthpiece for patients; they tell government agencies and the public what we apparently want and think, they have huge influence in this area, and yet none of them, to my knowledge actually formally represent any patient organizations – and given their research positions it would be inappropriate if they did. These are researchers who give treatment in clinics and in trials to patients. They do not formally speak for patients. And it’s just as well, as they make all kinds of statements without foundation:

QMUL and the PACE authors have repeatedly misled and propogated misinformation with regard to FOI requests for data from the trial, painting a picture of requesters are harassers and of individual patient’s personal data being at risk (click here for a list of examples that I have just started putting together – please leave a comment there if you have spotted others), but this is nothing more than a tactic designed to avoid transparency. Even if we trusted them to follow a transparent and appropriate process when contacting patients for advice, the statements they have already made are highly likely to have biased much of that patient feedback already.

I think it essential to ensure everyone knows exactly what data was requested. These are the data points, below – and only this data – that will be released should the tribunal reject QMUL’s appeal.

• Total SF-36 physical function scores at baseline and 52 weeks. Patients filled in a 10-item questionnaire and their answers were summed to give a total score between 0 and 100 points: it’s this total score that has been requested.

• Total Chalder Fatigue Questionnaire Likert scores at baseline and 52 weeks. Patients filled in an 11-item questionnaire and ‘Likert’ scoring yields a total score between 0 and 33 points.

• Total Chalder Fatigue Questionnaire bimodal scores at baseline and 52 weeks. The “bimodal” method of scoring this questionnaire yields a total score between 0 and 11 points.

• Whether the participant met the Oxford definition of CFS at 52 weeks (yes/no).

• Participant-rated Clinical Global Impression score. This is a rating from 1 to 7 of how the participant saw their health as having changed at 52 weeks, ranging from “very much worse” (7) to “very much better” (1).

• Doctor-rated Clinical Global Impression scores. As above, but rated by the doctor, not the patient.

• Meters walked in six minutes (the “six-minute walking test“) at baseline and 52 weeks.

• The group to which each participant was randomly allocated (i.e. APT, CBT, GET, or SMC).

As you can see, the data being talked about contains no personal information whatsoever. Personal details of participants such as name, gender, age, locality, will NOT be disclosed.

For more detail on these questionnaires, HERE is an excellent detailed explanation

A spreadsheet containing only the above data would be released. Here is a made up example of what a few rows of that data might look like with each row being the de-identified results from each patient:

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Click here for a larger image in a new window. As you can see this is data is handy if you want to analyse whether or not the PACE treatments were as effective as its authors claimed, it is entirely useless if you wanted to track down the patients from the trial (not that there is any evidence anyone would want to do that anyway).

If you have read, or been told, that the data is more than this, then you have been lied to. If you have been told that patients who took part in the trial can be identified from this information then you have also been lied to. It is patently ridiculous to suggest that anyone could be identified from this set of data, as there are no personal details whatsoever. With over 600 patients having taken part in the trial there is simply no way to pick anybody out, even if someone knew who had been in the PACE trial; and with over 250,000 CFS patients in the UK, there’s no way of picking out PACE trial patients with the sort of data that has been requested.

Something QMUL and the PACE authors have never explained is why anyone would want to identify and track down the patients from the trial. Without a suggested motive, it’s hard to see why the PACE data should be higher out of reach than other studies which release their de-identified data (quickly becoming the norm nowadays). What has been the experience of patients from the PACE trial who have chosen to reveal that they took part in the trial, I wonder?

I have seen several patients who took part in the PACE trials say so on social media and I have never seen anyone respond negatively at all. Rather, I have seen fellow patients thank them for taking part in research, I have seen fellow patients offer support if they are still sick, and I have seen fellow patients respect their privacy unless they want to talk about it more. The most common response I have seen is a “Like” on Facebook with many patients from the PACE trial who reported their participation getting double figure “Likes”. We are all patients who share this diabolical disease, and I think it is very unethical of the PACE authors to manufacture the illusion of some kind of wedge between us when there is not one.

To reinforce the point that the release of the PACE trial data would not lead to any patients being harassed, I want to remind everyone that the PACE trial had a sister trial called FINE that was conducted at the same time. Whereas the PACE trial was for mild to moderate patients, the FINE trial was intended for severe patients and those who could not get to their local ME/CFS clinic due to distance, but similar data was collected. The FINE trial failed just as badly as the PACE trial did, but unlike the PACE trial, the authors of FINE, to their credit, released several pieces of data equivalent the  data requested of PACE. In fact they released a whole bunch of other de-identified fields as well, and did so without even being asked and anyone can go access it without any problems. No patients who participated in the FINE trial have been identified, no one has even tried. What would possibly be the motive to do so? I’ve noticed that QMUL and the PACE authors sometimes like to say things which lack any logical foundation to justify them, and that seems to reflect their overall effort to simply hide the PACE study from scrutiny at all costs.

I hope patients, including those who took part in the study, are not fooled by this scaremongering, but I understand some will be. It is not their fault if they are, they should be able to trust the people running the trial, but clearly if you question what they are saying you can see they are misleading patients. I hope this article adds a little clarity to what data is really being asked for and leads people to think about the true motives behind QMUL’s extreme attempts to deny release of the annonymized trial data.  If you want to follow this topic as it progresses over the coming months I suggest following James Coyne, David Tuller, and myself and keeping an eye on our blogs.

Within the next week I will be publishing another blog post focusing on how ME/CFS charities are responding to the PACE trial scandal and this specific appeal case, and what patients might be able to do to ensure their views are heard.

 

PACE Trial’s Forbidden Fruit: Why We Must Be Allowed A Look Inside

Take my word for it, it's an apple...

Take my word for it, it’s an apple…

If you have any interest in science, open data, bioethics, freedom of information or ME/CFS then the rejection by King’s College London of Professor James Coyne’s request for data relating to their PACE trial will not have escaped your notice. Indeed, many in the science community seem to have noticed ME/CFS for the first time as a direct result, as some of the tweets later in this article may suggest.

First, do take a look at the letter from KCL. It’s short on pages, and long in absurd statements.

The university focused a lot on the damage to reputation and potential criticism of the authors, however if the data is sound, if it supports their assertions about PACE as they have published then there should be no anxiety over this whatsoever. Indeed, if the authors scientific method is sound then release of the data would vindicate them, and would surely enhance their reputations. If the serious allegation of “improper motives” as they put it, has any validity be it by those who wish for openness or those arguing for concealment, the only way to determine this is to release the data. At present we have a claim the evidence is compelling but a contradictory argument that it must be accepted in blind faith. The brief glimpses we have been allowed so far have already shown that the PACE authors have repeatedly misrepresented PACE by telling everyone it is an apple when it is not. When is an apple not an apple? When it is an orange. 

First there was the ‘recovery’ paper where they redefined the word recovery to mean someone who is still so disabled at the end of the trial (average age, 38) that they are on a par with those suffering from Class II heart failure, and may even be worse off at the end of the study than when they started. Recovery to the authors means someone who has scored only 60 out of 100 on a physical function score, even though you could enter the study with a better physical function of 65. (Yep, you could actually get worse in this study according to the trial’s two primary outcomes and they would still count you as recovered – a success).  See David Tuller’s blog for more on this.

Then they claimed follow up showed CBT and GET were effective when in fact the underlying data showed a null result. No more effective than standard medical care. See James Coyne’s blog for more on this.

Now they are labelling legitimate request for data as vexatious, of no value, as having improper motives. They will say anything to avoid releasing the data. They want you to see an apple when in fact it is an orange. And from a distance it may really look like an apple. If you only look at the title of their paper and don’t read it objectively you can easily be fooled. But what they don’t want you to do, what they can’t allow you to do, is bite into the apple. If you do so you will discover that it’s not an apple at all. It is an orange. It was always an orange. They consider PACE to be a forbidden fruit; you may only look, you cannot touch, you certainly cannot bite into it, for they you would have true knowledge, and knowledge can be a dangerous thing.

I promised you some choice tweets, and here they are, people from the scientific community who are most disturbed by KCL’s rejection of Professor Coyne’s request. I am not aware of these people having shown an interest in ME/CFS before (though I apologise to any of them if I am wrong about that):

The university states that it believes it is “entitled to take into account the wider dealings and publicity surrounding the project when considering the motive behind this request”. I would say that you can’t have your cake and eat it (I don’t feel the need to stretch the apple/orange analogy any further). If we are going to consider the wider publicity surrounding the project then we must also consider how the rest of the scientific community feel about this, as well as the patients – that’s what this is all about, I’ll happily remind you; patients are sick with this dreadful disease, they live with it night and day and they deserve to be heard also. More than 11,000 people have signed a petition for misleading PACE claims to be retracted, so there is a clear public interest in this data being made available. It was heavily funded by the public purse and has been highly influential in determining the treatment that patients with ME/CFS get, both under the NHS in the UK and also in many other countries across the world. This really matters because there is a lot of money being wasted if the PACE treatments don’t actually work, and to make matters worse there is strong reason to suspect the treatments make many patients worse. A survey of 1,428 patients by the ME Association found that 74 per cent reported that graded exercise therapy (GET) made their condition worse. I can speak from personal experience of the harm GET causes, it made me much more ill but the NHS clinic that gave me it were totally disinterested when this happened – you can read a short page about my experience on MEAction.net

The final part of the letter that I will highlight is the claim that Professor Coyne’s request is vexatious and may lead to harassment of the authors. It seems that no PACE author’s mouth ever opens without the word harassment or vexatious or some other slur on patients being voiced. There are around a quarter million patients with this disease in the UK, which includes many children, as well as adults (to put that into perspective there are around 100,000 with multiple sclerosis, so ME/CFS is a very common disease). Worldwide we are talking about millions. Even if these claims of harassment were true – and I have not seen evidence that they are – it would still be unethical to smear all patients by voicing such claims ad nauseum. The truth though is far more disturbing: these comments come out over and over again because it is very effective at stealing the voice of patients who have been raising concerns about the quality of the PACE trial and the harms of GET. What Professor Coyne and the science community are experiencing now, is exactly the same as patients have had to put up with for years now.

Sadly, with all the bad press that PACE has been getting lately, I am sure these claims of harassment, or abuse, and vaguely described bad behaviour will be voiced loudly in the very near future. Probably in a national newspaper. I would be surprised if we didn’t hear these slurs in the next week, or two at most. Patients are used to this. As if living with this horrid disease weren’t enough, we get collectively slagged off on a very regular basis. It is cruel. I lost my life age 27, and I am hurt by this, but I can’t tell you how bad I feel for children who have to put up with this as well. It is a great injustice, and in my opinion everyone has a responsibility to study these PACE papers carefully, to listen to the criticisms being raised and to reason this through in their minds. And if a certain conclusion cannot be reached without seeing the data the PACE studies are based on then people must insist that the data is released. I am grateful to Professor Coyne and a number of others who have done this, and I hope others join them.


 

UPDATE:

It didn’t take long. An hour or two after publication, we got a troll smearing ME/CFS patients (for avoidance of doubt, I am not referring to the first tweet below but the reply by AS):

Professor Coyne, of course, has bitten the fruit of the ME/CFS world and knows this for what it is. I encourage others to do so. ME/CFS patients are not “nut cases” they don’t send “death threats” “letter bombs” and you don’t need police protection from us. We are, like you, just normal people. I have a family, and friends and I consider myself a nice guy. Before I was ill I worked in quality management for an international software firm. I was very good at it. I just got randomly unlucky and got this disease. I was young and thought I would never get ill. Even my grandparents are healthy in their 90s so I just didn’t think this could happen to me.  People like this guy want you to believe I am a terrorist though. Why is that?

I will continue to call people out who attack patients in this way and make unethical smears against a population that is undeserving of it. We actually deserve your compassion and support.