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Pressure grows on Lancet to review “flawed” PACE trial

BMJ 2018; 362 doi: https://doi.org/10.1136/bmj.k3621 (Published 22 August 2018) Cite this as: BMJ 2018;362:k3621

Inaccurate remarks by Professor Sharpe

I feel I need to respond to inaccurate remarks from Professor Sharpe.

The only thing unwelcome about PACE was the interpretation, which was unfounded, not the findings. More specifically, none of the authors of the letter to the Lancet has ever expressed a desire to stop research into treatment of ME/CFS. This allegation is untrue. The authors have expressed their desire to see research of an adequate standard. None of the authors of the letter to the Lancet, as far as I am aware, has any objection to the study of psychological or exercise therapies if competently performed. The implication that for some reason the type of research was unwelcome to them is a fabrication.

Professor Sharpe says that the PACE trial had extensive review before publishing. This remark may be misleading. It is a quotation from Richard Horton. It transpires that the trial was indeed subject to multiple peer review during planning. However, Horton also made clear that the publication of the results and interpretation was fast tracked. My information is that fast-tracking includes giving the authors an opportunity to choose at least one sympathetic referee. So it seems fairly certain that the publication may not have received extensive peer review.

Professor Sharpe says that all further reviews of the trial have found its conclusions to be sound. This is not the case. An entire volume of the Journal of Health Psychology (August 2017) was devoted to reviewing the trial and the majority of papers found it totally unsatisfactory. These papers also pointed out that the 'other studies' noted by Dr Sharpe had similar flaws. As indicated in my previous comment, it was the patient scientists who brought the problems of PACE to the attention of academics outside the field of liaison psychiatry, where peer review appears to fall below standard. Unblinded trials of therapist-delivered treatments with subjective outcomes are not considered valid evidence in any other field as far as I am aware.

Competing interests: No competing interests

23 August 2018
Jonathan CW Edwards
Professor in Medicine, Emeritus
UCL
Rayne Institute, 5, University Street, London WC1