On 2 June 2020 I made a comment on the Cognitive behaviour therapy for chronic fatigue syndrome in adults review asking for it to be withdrawn because it is 12 years out of date but still informs two guidelines. The rules on withdrawal changed in August 2019, so the response to my request was to place an inconspicuous note on the review saying “This review was last updated in 2008 and is no longer current. The author team is no longer available to maintain the review.”
In June I also noticed that there were references to two non-existent Cochrane reviews in the background section of the review, so I decided to write another comment.
In the section “Why it is important to do this review” it states that: –
“This review is central in a programme of Cochrane reviews for CFS, which also cover exercise therapy (Edmonds 2004), pharmacological treatments (Rawson 2007) and complementary approaches, including acupuncture (Zhang 2006) and traditional Chinese herbal medicine (Adams 2007).”
Two of the reviews mentioned in this programme have disappeared: the review of pharmacological treatments Rawson 2007 [Rawson KM, Rickards H, Haque S, Ward C. Pharmacological treatments for chronic fatigue syndrome. Cochrane Database of Systematic Reviews 2007, Issue 4. [DOI: 10.1002/14651858.CD006813] and acupuncture Zhang 2007 [Zhang W, Liu ZS, Wu Taixiang, Peng WN. Acupuncture for chronic fatigue syndrome. Cochrane Database of Systematic Reviews 2006, Issue 2. [DOI: 10.1002/14651858.CD006010]. How can two review documents published in the Cochrane Library with a DOI disappear without trace?
In the section “How the intervention might work” it states that: –
“For the treatment of CFS, CBT combines a rehabilitative approach of a graded increase in activity with a psychological approach addressing thoughts and beliefs about CFS that may impair recovery. A gradual increase in activity, negotiated and agreed with the patient, can be used as a ‘behavioural experiment’, in which core beliefs, such as about the link between increased activity and worsened physical symptoms, can be tested”
This biopsychosocial approach to the treatment of ME/CFS has been discredited. It is likely it has led to the recommendation of treatments that are at best ineffective and at worst harmful to people with ME/CFS. Yet still this hypothesis about how CBT might work appears in an out-of-date Cochrane review giving the theory continued credibility. There is no caveat in the review, or prospect that the review will be updated to reflect any progress in understanding of the disease, or acknowledgement of possible harm done by some treatments.
A review of pharmacological treatments would have been (and still would be) very useful to enable comparison between alternative hypotheses about what may cause and perpetuate the condition, and what may or may not help patients. As you won’t withdraw this dangerously out-of-date review because your withdrawal policy has changed, please can you revise the background of the review to: –
- acknowledge that the biopsychosocial approach to explain how treatments such as CBT might work has been justifiably challenged
- explain why the two reviews on pharmacological treatments and acupuncture were never published, and why the protocols have disappeared.