Arthur Reingold

Professor Arthur L. Reingold, MD, is Division Head of Epidemiology at the University of California, Berkeley, School of Public Health. He has criticized the scientific validity of the PACE trial. He was also one of the 42 signatories of the Open letter to the Lancet calling for the PACE trial data to be independently reanalysed.

Infectious disease epidemiology in the 21st century

Reingold published an influential paper in 2000, titled "Infectious disease epidemiology in the 21st century: will it be eradicated or will it reemerge?". This paper examined why fewer diseases were being examined for infectious disease associations. Reingold pointed out that the field of epidemiology originally referred to the study of infectious epidemics, but that an "epidemiologic transition" occurred by the early 1970's:

This "epidemiologic transition" left many in the scientific and medical community believing that infectious diseases were (or soon would be) a problem of the past and that we were free to concentrate our future research and prevention efforts on "chronic diseases" such as cancer, diabetes mellitus, stroke, and cardiovascular disease.

As part of this "epidemiologic transition", Reingold explains, the field of "chronic disease" epidemiology rapidly expanded, while the field of infectious disease epidemiology shrank dramatically. To illustrate his point, Reingold documents how the percentage of infectious disease papers published in two prominent epidemiology journals dropped from over 80% in the 1920's to less than 20% in the year 2000, despite the many new infectious diseases discovered in the late 20th century. He concludes:

In retrospect, medical history was somewhat premature in crossing off classic "infectious diseases" from its list. [...] We now know, with a fair degree of certainty, that the rigid distinction between "infectious diseases" and "chronic diseases," [...] which dominated the thinking of generations of epidemiologists, is at best simplistic and misleading. [...] Moreover, various epidemiologic and laboratory observations provide tantalizing suggestions that infectious agents may be involved in the pathogenesis of diverse other "chronic diseases," including juvenile onset diabetes mellitus, schizophrenia, multiple sclerosis, selected types of arthritis, inflammatory bowel disease, and sarcoidosis, among others.

Criticism of the PACE trial

David Tuller detailed Arthur Reingold's criticism of the PACE trial in his report Trial by Error:

"Arthur Reingold, the head of epidemiology at the University of California, Berkeley, School of Public Health (and a colleague of mine), has reviewed innumerable clinical trials and observational studies in his decades of work and research with state, national and international public health agencies. He said he had never before seen a case in which researchers themselves had disseminated, mid-trial, such testimonials and statements promoting therapies under investigation. The situation raised concerns about the overall integrity of the study findings, he said.

Although specific interventions weren’t named, he added, the testimonials could still have biased responses in all of the arms toward the positive, or exerted some other unpredictable effect—especially since the primary outcomes were self-reported. (He’d also never seen a trial in which participants could be disabled enough for entry and “recovered” on an indicator simultaneously.)

“Given the subjective nature of the primary outcomes, broadcasting testimonials from those who had received interventions under study would seem to violate a basic tenet of research design, and potentially introduce substantial reporting and information bias,” said Reingold. “I am hard-pressed to recall a precedent for such an approach in other therapeutic trials. Under the circumstances, an independent review of the trial conducted by experts not involved in the design or conduct of the study would seem to be very much in order.” "

PACE trial A controversial study which claimed that CBT and GET were effective in treating "CFS/ME", despite the fact that its own data did not support this conclusion. Its results and methodology were widely disputed by patients, scientists, and the peer-reviewed scientific literature.

chronic disease a disease or condition that usually lasts for 3 months or longer and may get worse over time. Chronic diseases are long-term (typically incurable and requiring long-term management) but are not necessarily severe.

a disease or condition that usually lasts for 3 months or longer and may get worse over time. Chronic diseases are long-term (typically incurable and requiring long-term management) but are not necessarily severe.

chronic disease a disease or condition that usually lasts for 3 months or longer and may get worse over time. Chronic diseases are long-term (typically incurable and requiring long-term management) but are not necessarily severe.

bias Bias in research is "a systematic deviation of an observation from the true clinical state". (Learn more: me-pedia.org)

Bias in research is "a systematic deviation of an observation from the true clinical state". (Learn more: me-pedia.org)

bias Bias in research is "a systematic deviation of an observation from the true clinical state". (Learn more: me-pedia.org)