By David Tuller, DrPH
Earlier this week, Dr Fiona Godlee, editorial director of BMJ, e-mailed me in response to concerns expressed about the study of the Lightning Process published in Archives of Disease in Childhood, one of the journals under her purview. Those concerns were expressed in an open letter to her signed by 72 scientists, clinicians and other experts, along with more than 60 patient and advocacy organizations.
I sent that letter to Dr Godlee in late November. I had previously sent her the letter, with fewer signatories, in July. She had not previously responded.
Dr Godlee’s letter to me is below. It is disappointing, if not particularly surprising. In this case, BMJ’s abdication of its editorial obligations continues.
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Dear Dr Tuller,
I am writing in response to your emails dated 28 August and 25 November. I recognize that it has taken me some time to reply.
I have reviewed the issues raised in your complaint and have discussed the matter at length with my editorial colleagues and our statistical advisors. While acknowledging that mistakes were made in the initial peer review and publication of this article, I am satisfied with the process and outcome of the post-publication review.
I believe that the correction and the detailed editor€™s note present a robust account of events and that the level of uncertainty and caution now expressed by the authors is appropriate. In my view, readers and guideline bodies are now equipped to reach their own conclusions on the quality of the evidence in support of this therapy.
Thank you again for bringing the issues to my attention.
With best wishes.
Fiona Godlee
“In my view, readers and guideline bodies are now equipped to reach their own conclusions on the quality of the evidence in support of this therapy.”
We, as readers, are also equipped to reach our own conclusions wrt BMJ group publications. Many of us, myself included, probably view them in a very bad light and can only presume that ‘research’ presented within these journals can never be guaranteed to be properly peer reviewed and as such are at risk of being ethically dubious, statistically lacking in quality and consequently being meaningless in their conclusions. As it’s impossible for readers to drill down into the bad practice of BMJ publications for each and every article they publish then it might be that we, as readers, can only come to the conclusion that all papers are suspect given the lack of rigour Ms Godlee continues to endorse.
I wonder how those who might have had first class work published feel about having their own work muddied by association?
At this point in the proceedings, one now has to question the motives behind this blatant disregard of child protection. The BMJ would appear to have more to lose than gain by retracting this study. What possible motives could drive a decision which has the very real potential of putting children in harms way? Our children deserve the highest standards in child safety and the standards exhibited by the BMJ are shamefully inadequate.
Being satisfied with the process is exactly the problem. Any process that allowed this to happen is demonstrably broken, being satisfied with it is the problem. Clearing blatant violations once more guarantees they will happen again. This isn’t even Crawley’s first violations, she has a pattern of doing this, the exact same way and with the same intent of turning null results into false positives.
This is abdication of the basic responsibilities of the job, like a judge saying it’s not their duty to pass judgment. It’s literally the whole point of scientific publishing, not “reader beware”. If the process of scientific publication is so broken as to allow nonsense like to be published it puts in peril the entire scientific process. How can that process be trusted at all when it allows this?
How much of published research is garbage given this is given the thumbs up? Richard Horton says up to half. Not his work, though. Only others make that mistake. Nevermind his arguments with PACE are roughly the same as with the Wakefield paper. Now let’s lower the bar a few notches down at Cochrane and that will fix the problem. By making it worse. Somehow that makes sense to some people.
This will destroy the reputation of BMJ and rightfully so, as it’s clear the editorial board stands for overt charlatanism. For what? A tarot-healing quack and propping up the failed BPS model? To feed the IAPT monster that is evidently drowning in its own BS? Circumstances are showing that medical research needs massive system-wide top-down reform and that sick people need genuine protections from self-serving ideologues and predatory researchers.
This Lightening Process study ought to be the reductio ad absurdum of the entire bio psychosocial approach to ME. Many of the design flaws, indeed even research malpractice, present in the current study are also present in such as the PACE study.
But further this methodology underpins a substantial body of work used in the over hype of CBT, and the newer ideologically motivated flavour of the month MUS draws heavily on PACE and copycat studies. There are lot of careers invested into these bandwagons.
Is Dr Godlee’s ethical and intellectual failure to deal with these issues influenced by this political climate?
“have discussed the matter at length with my editorial colleagues and our statistical advisors.”
How about legal advisors and ethical advisors? Or did they all quit in disgust?
I agree with all the comments expressed so far
I can never trust BMJ again
I have a question for Dr Godlee:
If a child who has been put through this secret ‘Lightning Process’ develops appendicitis or meningitis or suffers a head injury then what should they do? Should they remember what they’ve been taught in their secret sessions and stand in a circle and tell their symptoms to ‘stop’ or whatever other rubbish they’ve been told to do that we don’t know about because it’s all so secret? Or should they seek medical help? Because children who’ve learnt this ‘process’ are likely to put it to use for other problems/symptoms, aren’t they?
Godlee’s right in saying ‘that mistakes were made in the initial peer review and publication of this article’ – the mistake in publishing this study is stark staringly obvious – but an even bigger mistake has now been made in passing up this excellent opportunity to retract it.
Spot on Joan Byrne and CT. The indifference to child protection by both researchers and journal is terrifying. But then, the reign of BPS psychiatrists over the NHS has been built and enforced at costs to ordinary citizens that regularly involve severe abuse of children. Let’s be clear; the frequent taking into “care” of children with M.E. –because their parents have dared to state that the child is ill and needs care, not the tortures of forced exercising and cruel brain-washing — amounts to a cult of abuse no less terrifying than the sexual exploitation of children by priests. It deprives children of love, safety and health, while the state’s “carers” sometimes can turn out to be sexual predators or plain vicious.
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Deboruth, what I find so alarming too is the apparent conflation now of ME/CFS with ‘medically unexplained symptoms’, ‘medically unexplained symptoms’ with FII (fabricated or induced illness) in paediatrics, and that doctors are told that it’s mothers who are most likely to be guilty of the latter. As well as that, they’re taught that women are far more likely to suffer from ‘MUS’, and that women who have ‘MUS’ themselves are more likely to be guilty of FII. So basically women and mothers are under suspicion from the moment they have contact with health services. This is blatant institutional sexism.
There have been several cases in the UK news lately where children have died because their mothers’ cries for help over clearly serious symptoms that warranted emergency care have been ignored by doctors. It used to be (many decades ago) that medical students were taught that they should always listen to the mother, because the mother knows their child the best. What has happened to change this?
On secrecy: in 2012 the BMJ launched their Tamiflu campaign – https://www.bmj.com/content/345/bmj.e7303 and https://www.bmj.com/tamiflu – to get companies to release their clinical trial data. So doesn’t Dr Godlee think that readers of the BMJ deserve to know what the secretive ‘Lightning Process’ is about? Would she be happy to publish a paper about a secret drug where nobody’s told the formula? Doesn’t she understand that psychological techniques can be as dangerous as any drug and that secrecy is a red flag for abuse? BMJ should have refused to publish this study unless the full details of the process were disclosed. So much for openness and transparency, so much for child protection.
Crawley and BMJ are making trash faster than the trash truck can lug it away:
“This study aims to explore perceptions of recovery held by paediatric patients with CFS/ME and their parents.”
https://bmjpaedsopen.bmj.com/content/3/1/e000525.full
Finding treatments that actually work is too hard, so let’s study perceptions instead.
It won’t help patients but they are an unavoidable nuisance. Getting more grant money is all about convincing funders that hand-waving contributes to the scientific knowledge base. In today’s university research systems, actual new knowledge is more of a happy side effect, since the overriding concern has to be, how do we keep the lights on?
Crawley and BMJ are doing awful work, but they are just cogs in a much bigger machine that is rotten to the core. When the number of actually useful and trustworthy scientific papers drops from “a few” to “zero”, will anyone even notice?
Health services have all been duped by ‘normalisation’ of types of research that are inappropriate for determining what are practicable treatments, or even cures.
When editors need to be ‘satisfied’ that work based on statistics is ‘robust’ (where else do we encounter this word but in getting dodgy stats accepted?), they are just joining in an industry lobby technique designed to favour one company’s almost useless drug, over another co’s almost useless drug.
When a drug or treatment actually works, it doesn’t need fancy statistics to gaslight gullible health service budgetary offices with: the patients will be better and back at work.
We really need to campaign to get the stats out of clinical commissioning. Stats are useful for scientists to help tell if they are on the right track, but, otherwise, they are nearly all just trying to make silk purses out of sow’s ears.
(You’ll often see columns of figures with standard deviations that are bigger than the average, for example. If you’d had to calculate that manually, you’d have given it up as obvious nonsense, but a computer stats package will just spew it out to order, and nobody knows enough to notice how daft it is. 🙁 )
I would like to clarify/correct my comment above where I wrote that doctors are taught that “women who have ‘MUS’ themselves are more likely to be guilty of FII”. I was asked whether I had evidence of this, so I went through quite a lot of stuff to check. It is clear from articles and presentations that doctors are told that *perpetrators of FII are likely or highly likely to have somatoform or somatization disorders themselves* (so sort of the reverse of what I wrote, and subtly different I think). I would therefore like to correct my previous comment and replace the phrase I used with the phrase given above (between *-*) . However, I found one reference – this 2011 article – “Psychopathology of perpetrators of fabricated or induced illness in children: case series” by Christopher Bass and David Jones – where the authors conclude that psychiatrists who work with women with somatoform disorders should be on the lookout for the consequent impacts of these disorders on the womens’ children. Given the context of the paper, I believe that what they were saying to readers here WAS quite similar to, or strongly implied, what I wrote. I don’t believe they were right to conclude that from their study, but I assume it got through peer review. As always, it’s worth reading the whole paper to get a fuller picture and reach your own conclusions!