I'm going to be a bit controversial here and use The Sackett model to support Simon Wessely's stance on MECFS. I'm teasing it out as I write so let's see if it stands up to my scrutiny in the framework of Sacket's model.
"The best research evidence is usually found in clinically relevant research that has been conducted using sound methodology." (Sackett D, 2002)
Treatment for any condition is based on evidence, and one of Sackett's three circles says ... 'BEST RESEARCH EVIDENCE'. We can look back and criticise the management of ME in the 80s, 90s and noughties but was treatment at the time not based on the most up-to-date research? It was! This is why, as outlined, in my previous blog many patients are disappointed (is that a strong enough word?) that all but psychologists wanted to win the MECFS game of pass the parcel. Because all or at least most of the research became psychological.
Using Sacket's model to look at it:
- the research was up-to-date
- the research was seemingly relevant
- there was no other contemporary research to lean on.
So that became the 'best research' that contributed to the evidence base.
Two words jump out at me from Sackett's quote above: 'sound methodology'. Did anyone question or call for transparency in the methodology of psychological research in the past three decades (pre PACE). There was no big outcry from the science world that I am aware of.
So. It's all sound!
So, MECFS practitioners in the UK whoever they might have been during these decades based their treatment on this sound, unchallenged research and I would suggest cannot be criticised for doing so because it was the most up-to-date, professionally well-thought-of research of the time in the UK.
But if I bring Sackett's third circle in here we can start to question how the research went on unchallenged for so long. The third circle that Sackett says is an integral part of forming an evidence base for any treatment is 'CLIENT VALUES AND PREFERENCES'. MECFS 'clients' can certainly not be accused of staying silent over the decades but can be accused of being unheard, and even worse, at times, silenced when repeatedly giving opinion that the illness is physical.
In looking for the evidence base for past MECFS treatments, it is clear now that Sackett's 'EXPERTISE ' circle and his 'BEST RESEARCH' circle were both crammed full of psychologist and his 'CLIENT VIEWS AND PREFERENCES' one was filled to bursting point with clients/patients shouting their views into a vacuum.
So, if I'm right in teasing this out, Wessley and other psychology researchers can look at one Sackett circle and justify that their research was all that there was to form an evidence base for MECFS treatment. However, overlap the three circles and patient voices should have been influencing the way that research went. This was never allowed. Patients were vexatious, militant, fitted their Wessleyan psychological profile if their opinion was voiced.
Imagine Evidence Based Practice as a three legged stool, Sacket's model has 'client voices and preferences' as one of the legs. Without them the stool topples.
Using Sacket's model to look at it:
- the research was up-to-date
- the research was seemingly relevant
- there was no other contemporary research to lean on.
So that became the 'best research' that contributed to the evidence base.
Two words jump out at me from Sackett's quote above: 'sound methodology'. Did anyone question or call for transparency in the methodology of psychological research in the past three decades (pre PACE). There was no big outcry from the science world that I am aware of.
So. It's all sound!
So, MECFS practitioners in the UK whoever they might have been during these decades based their treatment on this sound, unchallenged research and I would suggest cannot be criticised for doing so because it was the most up-to-date, professionally well-thought-of research of the time in the UK.
But if I bring Sackett's third circle in here we can start to question how the research went on unchallenged for so long. The third circle that Sackett says is an integral part of forming an evidence base for any treatment is 'CLIENT VALUES AND PREFERENCES'. MECFS 'clients' can certainly not be accused of staying silent over the decades but can be accused of being unheard, and even worse, at times, silenced when repeatedly giving opinion that the illness is physical.
In looking for the evidence base for past MECFS treatments, it is clear now that Sackett's 'EXPERTISE ' circle and his 'BEST RESEARCH' circle were both crammed full of psychologist and his 'CLIENT VIEWS AND PREFERENCES' one was filled to bursting point with clients/patients shouting their views into a vacuum.
So, if I'm right in teasing this out, Wessley and other psychology researchers can look at one Sackett circle and justify that their research was all that there was to form an evidence base for MECFS treatment. However, overlap the three circles and patient voices should have been influencing the way that research went. This was never allowed. Patients were vexatious, militant, fitted their Wessleyan psychological profile if their opinion was voiced.
Imagine Evidence Based Practice as a three legged stool, Sacket's model has 'client voices and preferences' as one of the legs. Without them the stool topples.
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