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Our response to that controversial study on CBT outcomes in chronic fatigue has now been formally published

As you read here in February, David Tuller and I attempted to respond to an alarming research paper that appeared in a recent issue of the Journal of the Royal Society of Medicine.

The paper they had published had purported to show evidence that cognitive behavioural therapy leads to symptom improvements in patients with chronic fatigue. We wrote a response detailing the study’s serious methodological flaws and the highly misleading way in which its results had been presented. We even showed that key statistical statements in the paper’s Abstract were factually inaccurate. Despite this, the Journal of the Royal Society of Medicine saw fit to reject our submission without providing any reason. Even though our manuscript met all the journal’s guidelines, the editor chose to not even allow it be reviewed for publication.

Undeterred, we proceeded to submit to another journal, the Journal of Health Psychology. There it underwent formal review, arising from which we were required to make some changes. Ultimately our revisions were deemed satisfactory and our paper was accepted.

Today it has been officially published. It is Open Access, so you can read it for free at the JHP website.

This is our new Abstract:

In a paper published in the Journal of the Royal Society of Medicine, Adamson et al. (2020) interpret data as showing that cognitive behavioural therapy leads to improvement in patients with chronic fatigue syndrome and chronic fatigue. Their research is undermined by several methodological limitations, including: (a) sampling ambiguity; (b) weak measurement; (c) survivor bias; (d) missing data and (e) lack of a control group. Unacknowledged sample attrition renders statements in the published Abstract misleading with regard to points of fact. That the paper was approved by peer reviewers and editors illustrates how non-rigorous editorial processes contribute to systematic publication bias.

You may have read our earlier draft back in February. However, the published version contains a very important update.

In a new section in our Conclusion, we describe some specific problems with how the JRSM arranged for the original CBT study to be peer-reviewed. We go into detail on the specific peer reviewers they approached, critiquing their qualifications and — crucially — exposing some troubling conflict-of-interest issues.

Here is a flavour:

More notably, the fourth peer reviewer is a psychiatry trainee on the Maudsley Training Programme. This programme is operated in partnership with the Institute of Psychiatry, Psychology and Neuroscience at King’s College London and the South London and Maudsley NHS Foundation Trust. All five co-authors of the Adamson et al. paper list one or both of these institutions as their academic affiliation(s). Two of the co-authors (…) hold senior positions at the Institute of Psychiatry at King’s. Another co-author (…) serves as a College Tutor and Clinical Skills Programme Co-ordinator on the Maudsley Training Programme itself. Ordinarily, being affiliated to the same institution(s) as a manuscript co-author would disqualify a person from serving as peer reviewer. Being affiliated not only to the same institution, but to the same academic units as all five co-authors would certainly appear to present significant issues concerning potential conflicts of interest. That the peer reviewer in question is a trainee of the co-authors’ institutions further compounds the problem. In our view, to ask a student to serve as peer reviewer for a paper produced by senior professors of their own college places them in an impossible position, and is highly inappropriate.

Do go take a look.