Friday, January 8, 2010

Contrasting speeds that it takes to publish two studies by Simon Wessely

Contrasting speeds that it takes to publish two
studies by Simon Wessely and Anthony Cleare


I thought some people might be interested in the following observation.

The KCL have recently published research on XMRV which they clearly got
published very quickly (most likely it was all done in the second half of
2009 or perhaps even the last three months).

This contrasts sharply with another study which found that those who did not respond to CBT had low cortisol.  [Ed. Note: i.e., those patients had ME/CFS and not depression misdiagnosed as CFS.]

These results were known in early 2003 (or before) as Anthony Cleare
presented them in Feb 2003 http://www.cdc.gov/cfs/meetings/2003_02.htm  :

"Cleare [27] found that those responders to CBT (43% of the sample at end
of treatment) had baseline urine cortisol levels close to normal whereas
those who did not respond had baseline levels below normal.
This indicates that those who were most impaired on hypothalamic-pituitary-adrenal (HPA) functioning might have been the least able to improve with graded activity interventions.
Clearly, a better understanding of subtypes is needed to determine why only
certain patients benefit from these non-pharmacologic interventions."

[27] Cleare AJ. What psychopharmacology tells us about the
pathophysiology of medically unexplained fatigue. Paper
presented at the meeting towards understanding the cellular
and molecular mechanisms of medically unexplained fatigue;
2003; Cold Spring Harbor Laboratory, NY: The
Bradury Center.

[Quote taken from: Jason LA, Torres-Harding S, Brown M, Sorenson M, Julie
D, Corradi K, Maher K, Fletcher MA (2008).  Predictors of change following
participation in non-pharmacologic interventions for CFS. Tropical Medicine
and Health 36, 23-32]

However, this finding which could have for example influenced clinical
practice (e.g. the NICE guidelines), was not published till the middle of
2009:

Does hypocortisolism predict a poor response to cognitive behavioural
therapy in chronic fatigue syndrome? Roberts AD, Charler ML, Papadopoulos
A, Wessely S, Chalder T, Cleare AJ. Psychol Med. 2009 Jul 17:1-8. [Epub
ahead of print] PMID: 19607750 [PubMed - as supplied by publisher]

This is despite the fact that another part of this study (it is referenced
in the Roberts (2009) paper as giving further details on the study) was
published back in 2004:

Roberts ADL, Wessely S, Chalder T, Papadopoulos A, Cleare AJ (2004).
Salivary cortisol response to awakening in chronic fatigue syndrome.
British Journal of Psychiatry 184, 136-141.

As some people will be aware, people promoting CBT for CFS in the UK have
not been particularly interested in subgroups.  CBT is "sold" as being
suitable for all.
If the results that efficacy of CBT might depend on cortisol readings,
clinical practice might be very different now and indeed research might
have moved in a different direction to investigate the different sorts of
patients.

[I explore the issue of predictors in non-pharmacological interventions for
CFS in a letter I have had pubished,  Letter to the Editor: Stratification
using biological factors should be performed in more CFS studies. Kindlon
T. Psychol Med. 2009 Oct 12:1. [Epub ahead of print] No abstract available.
PMID: 19818203]

Tom

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