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==More cleanup issues == *I don't really understand what "cleave at the joints" means - I think those words should be removed. I think he's saying that there is symptom overlap but that's already explained underneath ''Please don't remove this sentence: do not “cleave nature at the joints” has become a characteristic phrase to describe what Wessely & Sharpe meant in this article, namely that the different diagnostic label does not reflect underlying pathologies but the way medicine is organized in specialities.'' :[[User:Sisyphus]] - if you think it's important then fine, I think it needs explaining if you want to add that. It's not a phrase I'm familiar with [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 15:38, August 10, 2019 (EDT) *'''environmental threats''' - I'm still finding it hard to follow what this means, does it means ''environmental factors'' (environmental toxins/chemicals, viruses), or everyday stress / fast pace of life (and how is that a threat and to who) - and I'm not sure what unwelcome features means compared to the threats - is this from the Old wine in new bottles paper. Here's the sentence: ''Within the CFS label, ill health can be blamed on environmental threats and unwelcome features of modern life.'' ''With environmental threats, he means toxins, chemicals, radiation and viruses so perhaps we could add that if it isn't clear. Unwelcome features of contemporary life is a phrase he uses in the Huibers & Wessely, 2006 study and in Wessely S. (1995). The social and cultural aspects of CFS where he highlights the similarities with neurasthenia. I thinks he means stress, difficulties of modern, (post-) industrialized life etc.'' ::Thanks for the expanded quote. Does he give examples of what he calls environmental threats? I did re-read Old wine, New bottles but couldn't find that (do you have a paper number & which paragraph?) I saw a similar phrase in his Pros and Cons of diagnosis article but it didn't explain environmental stuff. I also checked Google books, Google scholar, searched Old wine New bottles and the internet on general, although not everything comes up. If that's including things like chemical exposure, viruses, or toxins that's highly relevant and I'd like to include it. Also if he's just linking it to fears about those things, that would also be relevant. Or maybe he means job security, the economy or something. Alternatively we could just take "environmental threats" out but keep the modern life part in. I don't want to make a lot of work for you, and please understand I'm just wanting to understand Wessely's words rather than trying to check the verify of the quote. [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 15:02, August 9, 2019 (EDT) :::Great, that's exactly what I wanted to know, and if anxiety or the things theistic are the cause. We have pages on many of these topics [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 15:38, August 10, 2019 (EDT) * Epidemiology - Selection bias - I can't understand what is considered selection bias. Are we talking about researchers only selecting some of those at tertiary centers (researchers bias), or accidental effects because patients choosing tertiary centers are more upper class (which would be a very odd claim to make in a public health system where nobody pays) - I don't think Wessely's one-off criticism of other studies is worth mentioning here - I would rather use the space to say it was the first large UK Epidemiology study ''Selection bias means that different patients are seen in primary versus specialist care. This was most evident in US studies where there's a large economic barrier to see specialists, but Wessely research suggested this was true in the UK as well, perhaps for other reasons. You can find more info about this in Euba et al. (1996). A Comparison of the Characteristics of Chronic Fatigue Syndrome in Primary and Tertiary Care. Here Wessely and colleagues write: "We confirmed the considerable excess of social class 1 among the hospital cases This did represent a considerable difference from primary care."'' [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 14:35, August 8, 2019 (EDT) ::I'm sorry for my mistake on Huibers & Wessely. With the '''CBT Deale 1997''' study I do think it reads like everyone reported positive outcomes, and while not citing the significant opposition to this, avoiding mentioning that findings are now considered mixed I feel would wrong. The [[FINE trial]] - PACE's sister trial - reported a null result as did most studies not using the Oxford criteria. Stating others found similar implies there is a consensus when CBT of being withdrawn due to concerns about harm and ineffectiveness (issues I chose not to raise since this isn't the CBT page). The [[http://www.investinme.org/Documents/PDFdocuments/CanadianDefinitionME-CFS.pdf#page=10 Canadian Consensus Criteria p47-49] points to mixed evidence on CBT. The Cochrane CBT report - co-written by one of Michael Sharpe's colleagues is phrased more cautiously " Currently there is a lack of available evidence on the effectiveness of CBT as a stand‐alone intervention or in combination with other interventions compared with usual care or other types of treatment (including immunological therapies, pharmacological therapies, exercise, complementary/alternative therapies and nutritional supplements) for CFS." [https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001027.pub2/full#CD001027-sec1-0006 see here]. *I think it would be more accurate if it stated the percentage improved in Deale and Wessely rather than just "positive effect". (Even the initial PACE trial stated only "moderately effective" so I feel we are overstating). ''I don't get this. This isn't a page about CBT. All I wrote was: "Wessely’s research team conducted a randomized controlled trial which indicated that CBT is more effective in relieving CFS symptoms than relaxation therapy.[57] Other researchers have reported similar findings[58] and CBT has been recommended as an evidence-based treatment for CFS by several health authorities." All that is factually correct and an adequate and brief description of what happened. It is relevant to the Wessely page. Why do you insist on mentioning other studies or the 5 year follow up study which you haven't even read yourself. It seems that you want to use to page to make the argument that not all studies have reported positive effects for CBT. This isn't an appropriate place to do that IMHO. I had already included plenty of references questioning the effectiveness of CBT. A more general remark: this discussion is costing a lot of energy and to be honest I don't think we are making much progress. You've made some helpful suggestions and I appreciate your efforts in trying to improve the page but unfortunately, I do not get the feeling that you are actually checking the information I wrote. You seem more focused on adding criticism of Wessely's view, trying to discredit it and give readers the impression that his research is unsound. Most of the 'corrections' or additions you suggested - about Wessely's contradicting himself on Gulf War Illness, Wessely suggesting CFS patients are malingering, Wessely denying underlying the underlying pathology of CFS, the WHO recognizing CFS as a neurological disease not just an illness, Wessely not deserving credit for developing the CBT model and Chalder Fatigue Scale, The BMJ poll, the five-year follow up study Deale et al. 2001, the Huibers quotes, selection bias etc. have turned out to be incomplete or incorrect. And it all seems intended on criticising Wessely and his research. There's some irony in that the page now includes a warning that the information is not neutral, while in fact, it is. I get a feeling that this is your main problem with the page as it stands: that it presents Wessely's career and research neutrally instead of using the page as a resource for criticism of Wessely and the many mistakes he has made. A similar conflict arises on other pages, for example on the PACE trial page. There is the goal of writing a brief but comprehensive overview of the subject, much like a Wikipedia article. Then there's another goal of storing as much information and resources on the topic. Both goals conflict with each other. Perhaps one should consider making two pages on subjects where there is such a disagreement in goals: an extensive resource page where as much information is stored and a normal page where a presentable summary and overview is written. The resource page doesn't have to be comprehensive or neutral, just a place to store information so that readers highly interested in the topic can found more information. The normal page has to be shorter and have balance and neutrality as it is intended as an encyclopedia article for readers unfamiliar with the topic. - Sisyphus''. ::[[User:Sisyphus]] I apologize for my mistake on the 5 year follow up. I did read it, and added the reference to the full article, I think perhaps I mixed up the content with another article read on the same day. I am happy to admit mistakes or misunderstandings but I certainly don't add references unread. The WHO as I proved via the link classes ME, CFS & PVFS under "Diseases of the nervous system" - section G - and they have also said it can only be classified in one place (under one rubric) - the neurological disease is often referred to be patient groups and there has been direct communication with the World Health Organization over the fact ME & CFS can only be classified in one place in the ICD-10. Wessely is not the sole creator of the CBT model - that was all I pointed out - Vercoulen's also got a joint paper on that (separate team) - Wessely has done far more to promote it however. When Jason and Song tried to confirm if the cognitive behavioral model fit the data they actually stating their aim was to Vercoulen's rather than Wessely's. *An option would be to leave out mentioning other studies (it's a page about Wessely afterall) or to rephrase so we aren't suggesting CBT always gives positive results. Gordon, Whitehead, Jason, Lloyd and Wearden's FINE trial were all no clinically significant improvement. See [https://www.researchgate.net/profile/Nikolaos_Kazantzis/publication/263342654_Cognitive_Behavioral_Therapy_and_Graded_Exercise_for_Chronic_Fatigue_Syndrome_A_Meta-Analysis/links/5a2b1525a6fdccfbbf8523f8/Cognitive-Behavioral-Therapy-and-Graded-Exercise-for-Chronic-Fatigue-Syndrome-A-Meta-Analysis.pdf Meta Analysis p5] I do need to look again at the 5 year follow up of Deale and Wessely since I only checked the abstract and conclusion there. (Now done & edit sorted) ::[[User:Sisyphus]] I re-read the follow up and have now changed it to say "with improvements sustained over the long term, although they did not consider it a ‟cure”." - and no criticism. If you happy feel free to rephrase. [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 15:38, August 10, 2019 (EDT) *CDC and CBT & GET - I think this is important to mention, along with the more recent change of policy, since shows the huge influence of Wessely's studies outside the UK (most of the page is written about in the Izk) ::This is also costing my a lot of energy, some days feels like no progress - other days (like today) several important issues are resolved. I can't comment on the '''PACE trial''' page - I haven't had much input. If you feel it's not neutral you can tag that and outline the issues. ::I re-read the point of view info in the guidelines here and on Wikipedia. Looking back, the page was previously in need of a POV cleanup. If you notice similar it would be helpful to tag. Major changes should also be addressed via the talk page first to see what input others have, rather than a total rewrite from a single editor. What I would like to do is a few tasks: * Selection bias in the Epidemiology study - will check out and most likely add in the new the you suggested, if not I will leave alone. * Add back in the criticisms under Criticism and Controversy, possibly with some combined or shortened eg the Gremlins one * Illnesses without disease heading since it's been a major theme, possibly under Criticism or controversy * Iatrogenesis / iatrogenic - I'm going to add to the [[Terminology]] page then there will be an underline for those who want to look them up * Add images to break up the page - graphics / charts depending on copyright, or some uncontroversial quotes, possibly about the impact of the illness - suggestions welcome * Science media center - might add a heading and expand since it's broken several key stories, Infernon alpha study, harassment of researchers etc *Wessely's claim about the Iraq war not harming veterans is disputed, will think on phrasing this. On Gulf War he denies the role of a drug that's involved but that belongs under Criticism heading instead. I am removing the POV tag. [[User:Notjusttired|notjusttired]] ([[User talk:Notjusttired|talk]]) 15:38, August 10, 2019 (EDT) ===Re: More cleanup issues -- ~~~~=== : Replace this text with your reply
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