A “Moral equivalent of war” and the PACE chronic fatigue trial

My hastily arranged Skeptic in the Pub talk received wide distribution, first through SlideShare  and then with the first of a number of videos posted on YouTube. Many thanks to all those who made the pub talk happen and then disseminated it, especially Barbara Collier.

Some of slides became a source of comments in social media. I especially liked the blog post from #ME Action that was headlined

I declare moral equivalent of war


I have received permission to re-post it here in its entirety. I introduce it with some comments about just what a moral equivalent of war (MEOW) means in this context. I realize that MEOW is more commonly used in the United States and might be subject to misunderstanding elsewhere.

What is a moral equivalent of war?

William_James_b1842cThe term originates with American philosopher and psychologist, William James. It comes from the title of his 1910 talk  in which he called for a “war against war” [that was] going to be no holiday excursion or camping party.”

A more recent reference is a 1977 speech by US President Jimmy Carter  in which he compared the energy crisis with the “moral equivalent of war”. Echoing William James, his speech was intended as a “rallying cry for service in the interests of the individual and the nation.” For better or worse, Carter’s speech and energy recommendations became known as MEOW.

meow1Something becomes the moral equivalent of war in the sense that other peacetime activities and priorities are harmonized and focused in pursuit of a goal as they would be in a war.

My war, of course, is against practices and assumptions that guide them, not people.

Here is the #ME Action blog post in its entirety.

James Coyne gives a public talk on PACE Trial

In a public talk in Edinburgh on Monday, psychologist Professor James Coyne declared the “moral equivalent of war” on the practices and assumptions that, he said, have allowed the “bad science” of the PACE trial to go unchallenged by scientists and the media.

The authors of the UK’s £5 million PACE trial have claimed that it showed that cognitive behavioural therapy and graded exercise therapy were beneficial for patients with chronic fatigue syndrome. Patients have criticised the trial’s methodology since its publication but criticisms have been dismissed by the study authors as reflecting “the apparent campaign to bring the robust findings of the trial into question.”

Professor Coyne’s attention was drawn to PACE by the authors’ latest claims, made in a recent Lancet Psychiatry paper, that long-term follow-up of patients confirmed these benefits. Coyne published a detailed blog post condemning the paper as “uninterpretable” and as having used “voodoo statistics” in a failed attempt to correct for “fatal flaws.”

The problems, Professor Coyne said, are “obvious to anyone who looks carefully. That virtually no one else picked them up reflects badly on the editing and peer review at Lancet Psychiatry… and media portrayals of this trial.”

PACE’s results were, Professor Coyne said, “being badly misrepresented by the investigators,” “going unchallenged” and being “uncritically passed on by journalists and the media, with clear harm to patients.” There were, he said, “murky politics about who can speak and who is silenced.”

In a move that will delight many patients, Professor Coyne stated that he was now refocusing his existing goals and activities on exposing more of the “questionable research practices” of PACE; establishing the culpability of journal editors and reviewers; and educating the media and journalists on “responsibilities they have not exercised” in reporting the trial.

He would also, he said, expand his focus to include questionable research and publication practices that “have maintained [the] illusion that there is validity to [the] psychosomatic model for [the] treatment of ME, CFS, and [post-viral syndrome]”. He added that he would “validate and legitimize what patients have been saying all along and bring them into [the] conversation as credible citizen-scientists” and would “identify and dismantle [the] structure by which PACE investigators bullied and neutralized critics.”

Professor Coyne,  Emeritus Professor of Psychology in Psychiatry at the University of Pennsylvania , is one of the world’s most cited psychologists and is well known for his work in debunking false scientific claims, including that having a positive attitude can help cancer survival. He said in his talk that “the story of PACE will be rewritten to underscore [the] necessity of [a] strong patient voice in [the] design and conduct of clinical trials” and that it would mark a “turning point in [the] use of language indicating greater respect for patient activism, healthy assertiveness, and self-determination.”

Slides from Professor Coyne’s talk have been posted online and received over 4,500 views in less than two days. A video recording of the first part of his talk is now on YouTube.

I've had it