Balance Scales (ca. 1940) by William

“A science that does not allow opposing opinions abolishes knowledge.” Er, kind of

Colleagues and I have responded to a paper in Der Nervenarzt, the leading German neurology journal, pointing out various reasons why its “overview” of evidence-based approaches to ME/CFS treatment lacked, well, evidence.

Our critique can be read in full in English via the following Tweet (kudos to @AnilvanderZee):

In summary, our critique is as follows:

  1. While it is true that exact causes are unknown for sure, the authors of the paper that was published in Der Nervenarzt omitted to describe how several biological pathways have been strongly implicated in the pathogenesis of ME/CFS.
  2. The authors omitted to mention PEM (post-exertional malaise) and its implications for adverse outcomes following exercise therapies.
  3. The authors tenuously claimed that ME/CFS prognosis is “good” by citing a highly questionable (and cherry-picked) study, while ignoring the preponderance of research on this topic which shows that prognosis is, in fact, very poor.
  4. The authors attempted to criticise the new (2021) NICE guideline for ME/CFS by citing studies that NICE themselves already identified as being of such poor quality as to be unreliable.
  5. The authors argued that comorbidity implies causality, a clear (and rather silly) example of the correlation fallacy.
  6. The authors incorrectly stated that there are no objective markers of outcomes in ME/CFS.
  7. The authors ignored the scale of incapacitation in ME/CFS, which has been recorded at around 25%.

[I note that several of these points, if not all of them, are among the various “myths” I discussed in my lecture on ME/CFS Awareness Day earlier this year.]

Courtesy of Der Nervenarzt, the original authors were invited to write a reply to our reply. It wasn’t particularly good, or relevant. The authors repeat many of their various postions as though the criticisms didn’t happen. They shift their positions on some issues (e.g., by acknowledging that physiological causal pathways probably exist), but not so as to deter them from their psychogenic premise.

They make a rather preposterous point about psychoneuroimmunology (PNI), a field of research that they describe as a “currently growing” (“aktuell wachsende“) and a source of “new explanations” (“neuen Erklärungsansätzen“). I remember PNI being described as “current” and “new” back in the 1990s when I was a student. Spoiler alert: it turns out that PNI is not the answer to all of our questions. Big words are impressive (maybe less so in German, but nonetheless) but throwing them about like this should fool nobody. Jargon is not an argument.

Secondly, PNI is just a simple psychophysiological model. I should know, I’m a psychophysiologist. All PNI proposes is that the various systems of the human body are interrelated, and that this includes the brain and nervous systems. It follows that mental processes are intertwined as well. But PNI certainly does not propose that all medical conditions therefore must have causes that are partly or fully psychological. I draw your attention, once more, to that classic medical condition: the broken leg. Broken bones feel painful, but they are rarely caused by mental anguish and psychotherapy is not going to fix them.

The authors go on to refer to the new NICE guideline in disparaging terms, falsely implying that it was based on poor science and scuppered by non-specialist reviewers. Once again, you can review the reasons why these aspersions are entirely spurious by watching my myth-busting lecture.

And finally, in order to try to make us look bad, the authors choose to respond to our criticisms by mentioning a selected bunch of other people’s criticisms that were directed to them on social media. (Peer-review for the win!)

They end their response with the statement that “A science that does not allow opposing opinions abolishes knowledge” (“Eine Wissenschaft, die gegenteilige Meinungen nicht zulässt, schafft Wissen ab“). This is a ridiculously pompous example of epistemological over-reach. Science does not trade in opinions. Hypotheses, perhaps, but not opinions. And science rejects hypotheses once they have been falsified.

Overall, I would rate the quality of argument in the authors’ response as POOR or VERY POOR.

* * *

And yet the authors’ response just sits there, proudly published on the journal’s website. I guess that means it meets the editorial standards of Der Nervenarzt.

It seems that editors are increasingly sitting on the sidelines these days, ever keen to stir up content (and clicks) for their journals by contriving these types of tit-for-tat exchanges. Affecting a wish for neutrality, they claim, editors choose not to take sides.

However, juxtaposing critiques alongside tenuous (and even factually erroneous) rebuttals unhelpfully implies an equality of authority between positions. Weak arguments are given the same airtime as strong ones, all in the interest of “balance”. This practice skews scholarship. It creates false equivalences between creationists and biologists, between global warming denialists and climatologists, between crystal therapists and cancer specialists, and between flat earthers and people who paid attention in primary school.

That can’t be good.

Academics like to think of themselves as value-neutral professional experts, engaged in an apolitical craft. However, refusing to arbitrate between evidentiary positions, and choosing instead to frame all commentary as somehow deserving of an equivalent platform, is exactly what creates our modern era of misinformation and polarisation.

It happens again and again and again, and is rather dispiriting.

Editors should edit.

Otherwise we should replace them with AI.

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