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PACE chronic fatigue trial was properly conducted, says UK research watchdog

BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l639 (Published 07 February 2019) Cite this as: BMJ 2019;364:l639

Re: PACE chronic fatigue trial was properly conducted, says UK research watchdog

Nigel Hawkes makes some interesting rhetorical moves in presenting this news report.

Firstly, whilst PACE supporters are quoted giving their full academic credentials e.g. Professor Sharpe of U of Oxford, Prof Evans of LSHTM, the major PACE critic mentioned is (in contrast) introduced as 'a US Activist', without noting his doctorate in public health or his academic position at UC Berkeley.

More subtly, Mr Hawkes interprets Prof. Montgomery's as providing a completely clean bill of health to the PACE study.

Hawkes reports "In any case, there are no grounds for considering PACE to be of poor quality, he says."[1]. In fact Prof Montgomery’s letter is far more balanced, carefully deflecting questions of scientific robustness to other agencies and detecting both: “indications that the science is sound, as well as evidence of concern”[2]. He recommends that “The range of views suggests that the debate needs to be continued …”[ibid]. I do not understand how Hawkes translates this to Montgomery saying there are “no grounds” for concern.

For those who are not familiar with this debate, it might help if Hawkes had mentioned any of the primary scientific criticisms of PACE, for example: that it was (ultimately) an unblinded trial using subjective outcome measures as the primary endpoint, and thus wide open to placebo effects; or that the very broad recruitment criteria could result in quite diverse responses to any treatment from different patient subgroups. It is not surprising that so many patients, advocates (or ‘campaigners’ in Hawkes’s vocabulary) and concerned scientists/clinicians argue that the PACE trial is inadequate as a basis for clinical recommendations, even if the HRA concludes that the ethical oversight was satisfactory.

Science journalists have an important role in summarising research and sharing knowledge. Their words can have a significant impact on clinical decisions and policy development. It is disappointing to see such an important story apparently being mis-reported in your pages.

Yours

Andy Dearden

References
[1] Health Research Authority. Letter from the HRA to Norman Lamb MP, 29 January 2019. https://www.parliament.uk/documents/commons-committees/science-technolog....
[2] Hawkes, N. PACE chronic fatigue trial was properly conducted, says UK research watchdog. BMJ, 2019; 364:l639. https://doi.org/10.1136/bmj.l639

Competing interests: I have a relative who would meet the inclusion criteria of the PACE trial.

08 February 2019
Andy Dearden
Professor of Interactive Systems Design
Sheffield Hallam University
Communication and Computing Research Institute, Sheffield Hallam University