ME/CFS and CBT – a basic error

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For more than three decades, the Wessely School has searched for empirical support for its psychosomatic approach to CFS. That search has been in vain. I show here, here and here that the theoretical assumptions of the Wessely approach lack support and have fallen.

The drive to show CBT and GET are effective treatments has been a key part of the failure, e.g. the PACE trial. An independent review by NICE suggests that GET is unsafe and CBT can only be weakly supported and, quite likely, is only a placebo effect.

In facing the mountain of invalidation that the Wessely School is having to endure, it has made the most basic error for any scientist: converting an inconclusive association into a conclusion of causation.

Correlation does not equal causation

Everybody knows it. It is drummed into people’s heads from the very beginning.

Yet, as a journal editor I have discovered that it is the most basic and common error by authors in psychology and healthcare, no matter how experienced the investigator. This common mistake can throw a mantle of doubt over a publication or even an entire research programme.

The fundamental distinction between correlation and causation is legendary. It is taught in first year medical and psychology classes all over the world.  Yet, the distinction can allude even the most seasoned researchers in Psychology, Psychiatry and kindred fields.

An introduction to the topic for 14-216 year old students studying Health is here.

A video for Biology GCSE students about the topic is available below.

An often cited example of the correlation=causation mistake concerns the polio epidemics in the US and Europe during the 1940s and 50s in the pre-vaccination period. Polio was crippling thousands of people, mostly children (and still is in some parts of the world). Polio epidemics occurred during summer and autumn. People eat more ice cream during summer and autumn. So for a while, children were warned not to eat ice cream or they would get polio.

Correlation is an association between two variables. In the late 1940s the polio rate (Y) and ice cream sales (X) could show a close correlation but eating ice creams did not cause polio:

X (ice cream eating) -/> Y (polio rate increase)

Causation is a cause and effect relationship between two variables. In 1949 in the US hot weather (Z) led to more people using public swimming pools and to more people eating ice creams (X) so both were caused by hotter weather (Z), which led to higher rates of polio (people swam in non-chlorinated pools more frequently) and to more ice cream eating:

The same kind of erroneous logic occur everyday in science, even among some of the most experienced researchers who are often strongly influenced by confirmation bias.

Z (hotter weather)-> X (ice cream eating)

and

Z (hotter weather) -> Y (polio rate increase)

Adamson, Ali,  Santhouse, Wessely & Chalder (2020)

In October 2020, Adamson, Ali,  Santhouse, Wessely and Chalder published a study in the Journal of the Royal Society of Medicine that purported to demonstrate that CBT ‘led to’ significant improvements in CFS patients.  The authors had reached the conclusion that CBT caused improvements but the evidence warranted no such thing. What exactly did the authors do in their study?

Objectives

The authors’ aim was to examine the effectiveness of CBT for CFS in a naturalistic setting and examine what factors, if any, predicted outcome. Note that ME is not mentioned because patients with ME were not included in the study. Nor should they have been because CBT could not possibly have helped them.

Design

They analysed patients’ self-reported ‘symptomology’ over the course of treatment and at three-month follow-up. They also explored baseline factors associated with improvement at follow-up.

Setting and Participants

Data were available for 995 patients receiving CBT for CFS at an outpatient, specialist clinic in the UK.

Main outcome measures

Patients were assessed throughout their treatment using self-report measures including the Chalder Fatigue Scale, 36-item Short Form Health Survey, Hospital Anxiety and Depression Scale and Global Improvement and Satisfaction. Note, these are all self-reported, subjective outcome measures.

Results

“Patients’ fatigue, physical functioning and social adjustment scores significantly improved over the duration of treatment with medium to large effect sizes (|d| = 0.45–0.91). Furthermore, 85% of patients self-reported that they felt an improvement in their fatigue at follow-up and 90% were satisfied with their treatment. None of the regression models convincingly predicted improvement in outcomes with the best model being (R2 = 0.137).”

Conclusion

As stated in the Abstract the Conclusion implies, but not does categorically state, a causal role for the CBT intervention. However, inside the main body of the article the authors state the conclusion that makes the CBT treatment causal in a manner that is unwarranted. They make the fundamental correlation equals causation error.

Enter stage left:

Brian Hughes and David Tuller (2021)

In a well-argued paper, Brian Hughes and David Tuller (2021) demonstrate that Adamson et al.’s (2020) conclusions are “misplaced and unwarranted.” They had submitted their critique to the Journal of the Royal Society of Medicine but the Editor did not accept it. Hughes and Tuller made a preprint available online and submitted it to the Journal of Health Psychology where it was reviewed and accepted and will shortly appear online. Here I quote from the Abstract:

“[Adamson et al.] interpret their data as revealing significant improvements following cognitive behavioural therapy in a large sample of patients with chronic fatigue syndrome and chronic fatigue. Overall, the research is hampered by several fundamental methodological limitations that are not acknowledged sufficiently, or at all, by the authors. These include: (a) sampling ambiguity; (b) weak measurement; (c) survivor bias; (d) missing data; and (e) lack of a control group. In particular, the study is critically hampered by sample attrition, rendering the presentation of statements in the Abstract misleading with regard to points of fact, and, in our view, urgently requiring a formal published correction. In light of the fact that the paper was approved by multiple peer-reviewers and editors, we reflect on what its publication can teach us about the nature of contemporary scientific publication practices.”

 A Few Details

In their paper, Tuller and Hughes point out that the Adamson et al. study and paper:

“are both problematic in several critical respects. For example, the Abstract – the section of the paper most likely to be read by clinicians – contains a crucial error in the way the data are described, and requires urgent correction.” They point out that a conspicuous controversy is overlooked. Adamson et al. write that the intervention is “based on a model which assumes that certain triggers such as a virus and/or stress trigger symptoms of fatigue. Subsequently symptoms are perpetuated inadvertently by unhelpful cognitive and behavioural responses” (p. 396). Treatment involves, among other elements, “addressing unhelpful beliefs which may be interfering with helpful changes” (p. 396).

The theory of unhelpful beliefs was laid out in a 1989 paper by the Wessely team that included two of the Adamson et al. paper’s authors (Wessely and Chalder). Recent posts here, here, and here show that the theory is lacking in any scientific support leaving the theory totally broken.

This fact was brushed under the carpet and simply not mentioned in the Adamson et al. paper.

Tuller and Hughes report that Adamson et al. are similarly selective in their discussion of the literature on CBT. After scrutiny of 172 CBT outcomes, the redrafted NICE guidance makes it perfectly clear that all of the research is of either “low” or “very low” quality. According to NICE, not one claim for CBT efficacy was supported by any evidence exceeding the “low quality” threshold.

To quote Hughes and Tuller, the research reviewed by Adamson et al.:

“is hampered by several fundamental methodological limitations that are not acknowledged sufficiently, or at all, by the authors. These include: (a) sampling ambiguity; (b) weak measurement; (c) survivor bias; (d) missing data; and (e) lack of a control group. Given these issues, in our view, the findings reported by Adamson et al. are unreliable because they are very seriously inflated.”

I consider here the last point only for its relevance to cause and effect.

Lack of a control group

Causality can never be established without a control group or a control condition. Adamson et al. did not include a control group and so their data cannot possibly support an inference about causality.

Period.

Yet Adamson et al. write:

“The cognitive behavioural therapy intervention led to significant improvements in patients’ self-reported fatigue, physical functioning and social adjustment” (p. 400).  

This direct statement of causality is unjustifiable and, most likely, plain wrong.

The authors realise this – or were made to realise it by the editor or reviewers – because they state:

the lack of a control condition limits us from drawing any causal inferences, as we cannot be certain that the improvements seen are due to cognitive behavioural therapy alone and not any other extraneous variables” (p. 401).

As Brian Hughes and David Tuller (2021) point out, this statement includes another assertion of causality which is also self-contradictory: “In one sentence, therefore, the authors draw a causal inference while denying the possibility of being able to do just that given their study design.”  

Ironically, this kind of assertion is what some psychiatrists used to call ‘schizophrogenic’. Not a bad descriptor in this case. It is also a little piece of ‘doublethink‘ in which the reader is expected to simultaneously accept two mutually contradictory beliefs as correct.

Implications

  1. The Adamson et al. study does not and will never warrant the conclusion that CBT “led to” improvements in CFS symptoms.
  2. The draft NICE guidance establishes that the evidence in support of CBT for pwCFS is marginal. It is likely to be nothing more than a placebo effect.
  3. To quote Tuller and Hughes, “the authors have provided a partial dataset suggesting that some of their participants self-reported modest increases in subjective assessments of well-being …These changes in scores might well have happened whether or not CBT had been administered.”
  4. The flight of Adamson et al. into the illegitimate correlation-equals-causation error is possibly a sign of desperation. When nothing is working, there is little option but to make it up as you go along.
  5. The house of cards that is the Wessely School is fast tumbling down, and not before time.

ME/CFS and the Lightning Process

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Here I review research by the Wessely School on the Lightning Process (LP). LP is a pseudoscientific cult founded by Phil Parker, a Tarot reader, specialist in auras and spiritual guides, and an osteopath. It has triggered a spate of shoddy evidence and false claims that brings a new low level to the checkered history of ME/CFS research and care, and takes the Wessely School with it to rock bottom.

Phil Parker’s qualification as a trainer/therapist have been described by him as follows:

Phil Parker is already known to many as an inspirational teacher, therapist, healer and author. His personal healing journey began when, whilst working with his patients as an osteopath. He discovered that their bodies would suddenly tell him important bits of information about them and their past, which to his surprise turned out to be factually correct! He further developed this ability to step into other people’s bodies over the years to assist them in their healing with amazing results. After working as a healer for 20 years, Phil Parker has developed a powerful and magical program to help you unlock your natural healing abilities. If you feel drawn to these courses then you are probably ready to join.”

I, for one, am pleased that I do not feel drawn to Phil Parker’s courses. I had the chance. They were running above my local grocers in Crouch End, London. I would have happily run a mile to avoid them.

What is the Lightning Process?

The LP is described as “a neuro-physiological training programme based on self-coaching, concepts from Positive Psychology, Osteopathy and Neuro Linguistic Programming” (Parker, Aston & Finch, 2018).

The developer of LP Phil Parker describes it in these words: LP “Is a training programme that teaches you to change the way your nervous system controls your body.Its empowering tools involve gentle movement, meditation-like techniques and mental exercises.With practice you’ll learn how to switch on pathways which promote health and switch off ones which aren’t so good for you….With practise you can use them to change the way your nervous system works, switching on pathways which promote health and switching off ones which aren’t so good for you.” 

LP has attracted a following in the UK, Norway, and other countries. LP practitioners are trained to promote it as a treatment for many serious medical conditions including ME/CFS. The approach can be easily identified as pseudo-science.

Participants are told to ‘Believe that the Lightning Process will heal you’.

· Tell everyone that you have been healed.

· Perform magical rituals such as standing in circles drawn on paper with positive keywords inscribed.

· Learn to render short rhymes when you feel the symptoms, no matter where you are, as many times as necessary for the symptoms to go away.

· Speak only in positive terms and think only positive thoughts .

· If symptoms or negative thoughts occur, extend your arms with the palm of your hand pointing outwards and shout “ Stop! «.

· You are responsible for having ME. You choose to have ME yourself. But you are free to choose a life without ME if you want to.

· If the method does not work, you are doing something wrong.

What the Experts Say

David Tuller, DrPH, Senior Fellow in Public Health and Journalism, Center for Global Public Health, School of Public Health, University of California, Berkeley has commented: “The Lightning Process is the woo-woo pseudo-nonsense that trains people to reject their illness and engage in positive affirmations, among other strategies.”

Brian Hughes, PhD, Professor in Psychology, University of Galway, Ireland, points out that LP “comprises a number of modalities that are normally classified as pseudosciences. It is based largely on NLP, which is a completely discredited practice…All told, there is nothing to suggest that the ‘Lightning Process’ is a promising clinical modality. It has no scientific plausibility; it exists because commercially-minded providers of pseudoscientific treatments have successfully identified a market for it. In that regard, it occupies the same space as, say, crystal therapy.”

Edzard Ernst MD, PhD, FMedSci, FRSB, FRCP, FRCPEd, Emeritus Professor at the University of Exeter, has commented: “So, what do we call a therapy for which numerous, far-reaching claims are being made, which is based on implausible assumptions, which is unproven, and for which people have to pay dearly? The last time I looked, it was called quackery.”

Lightning Process and the Wessely School

In 1989, Professor Wessely wrote about alternative therapies as follows: “Almost all patients referred to hospital with CFS will have tried a variety of ‘alternative’ therapies… The patients’ faith in treatments which may be beneficial to specific individuals should not be undermined but not all such therapies can be given approval…It is a doctor’s duty to protect the patient from such exploitation, which may be medically and financially harmful. The willingness to try such untested treatments should be viewed as a reflection of the patients desperate need for help” (Wessely, et al. 1989).

Things have changed. Research on one particular alternative therapy, LP, which they call a ‘training’, has become an active research topic at the Wessely School with two publications to date:

Silje Endresen Reme (Harvard University), Nicola Archer (King’s College London) and Trudie Chalder (King’s College London):

Experiences of young people who have undergone the Lightning Process to treat chronic fatigue syndrome/myalgic encephalomyelitis–a qualitative study (2012)

Phil Parker (London Metropolitan University), J Aston (King’s College London) and Lisa de Rijk ((King’s College London):

A systematic review of the evidence base for the Lightning Process (2020)

Author Lisa de Rijk, is a visiting research fellow at King’s College London as well as a Neurolinguistic Programming “master trainer,” change consultant, and applied psychologist, according to her Linked In profile.  The other author has a KCL degree but does not appear to have a current affiliation.

Parker and his two KCL-affiliated co-authors describe the 14 studies they found after a search of the literature. The study has been eloquently reviewed by David Tuller. Six studies were identified as surveys, three as qualitative studies, two as (non-survey) quantitative studies, one as a case report, one as a “proof-of-concept” study, and one as a randomized clinical trial. Six of them were identified as having been peer-reviewed.

According to the conclusions, the review “identified an emerging body of evidence supporting the efficacy of the LP for many participants with fatigue, physical function, pain, anxiety and depression. It concludes that there is a need for more randomised controlled trials to evaluate if these positive outcomes can be replicated and generalised to larger populations.”

The evidence of purported efficacy is not at all convincing and there are reports of bullying and unethical behaviour. According to the Norwegian ME association ME Foreningen in (2012), Lightning Process is one of the treatments that has done the most harm to patients. LP resulted in 50% of the ME patients reporting that LP had made their condition worse, 25% seriously worse. 30% reported that LP had no effect on symptoms.

Yet, ‘experts’ affiliated to the Wessely School have been swarming like flies to applaud a recent LP study, including Michael Sharpe. But more on this later.

Implications 

  1. By lending credibility to the pseudoscientific cult that is the Lightning Process, the Wessely School has finally reached rock bottom.
  2. Following the exposure of a King’s College London grandee, Hans Eysenck, and the scandal of the PACE trial, the Wessely School is about to take another major hit.
  3. The LP ‘training process’ dares not to describe itself as a therapy for fear of recriminations.
  4. LP training has been rejected by NICE and sinks to the bottom to join the Wessely School and other forms of quack medicine.

Thanks to Tom Kindlon for his feedback on an earlier version of this post.

ME/CFS and the PACE trial

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Here I review the disastrous trial known as the ‘PACE trial’. This updates a post from several years ago.

Readers may also be interested in seeing the Special Issue on the PACE trial in the Journal of Health Psychology (2017).

Review of the evidence indicates that none of the Wessely School’s hypotheses about the causes of ME/CFS are supported by the science (see here, here and here). Under these circumstances it would be scientifically impossible for ME/CFS treatments based on these incorrect principles to actually work. Only if there is a ‘fix’ and evidence is craftily manipulated by scientific sleight-of-hand could the therapies be made to look effective.

Which is exactly what has happened.

ME/CFS patients have known the truth for donkey’s years. Only the perpetrators of the ‘CBT/GET Illusion’ have claimed otherwise.

I review here the PACE trial and present a few details of an exposure by Carolyn Wilshire, Tom Kindlon, Alem Matthees and Simon McGrath (2017), which reveals the true null effect.

What was the PACE Trial?

Rarely in the history of clinical medicine have doctors and patients been placed so bitterly at loggerheads. The dispute had been a long time coming. Thirty years ago, a few psychiatrists and psychologists offered a hypothesis based on a Psychological Theory in which ME/CFS is constructed as a psychosocial illness. According to the Wessely School, ME/CFS patients have “dysfunctional beliefs” that their symptoms are caused by an organic disease. The ‘Dysfunctional Belief Theory’ (DBT) assumes that no underlying pathology is causing the symptoms; patients are simply being ‘hypervigilant to normal bodily sensations‘ (Wessely et al., 1989; Wessely et al., 1991).

The Wessely School Theory assumes that the physical symptoms of ME/CFS are the result of ‘deconditioning’ or ‘dysregulation’ caused by sedentary behaviour, accompanied by disrupted sleep cycles and stress. Counteracting deconditioning involves normalising sleep cycles, reducing anxiety levels and increasing physical exertion.  Attentional biases also divert the patients towards their symptoms.

To put it bluntly, the DBT asserts that ME/CFS is ‘all in the mind’.  Small wonder that patient groups have been expressing anger and resentment in their droves.

Top-Down Research

‘Top-down research’ uses a hierarchy of personnel, duties and skill-sets. The person at the top sets the agenda and the underlings do the work. The structure is a bit like the social hierarchy of ancient Egypt. Unless carefully managed, this top-down approach risks creating a self-fulfilling prophecy from confirmation biases at multiple levels. At the top of the research pyramid sits the ‘Pharaoh’, Regius Professor Sir Simon Wessely KB, MA, BM BCh, MSc, MD, FRCP, FRCPsych, F Med Sci, FKC, Knight of the Realm, king-pin and originator of the Wessely School. The principal investigators (PIs) for the PACE Trial were Professors White, Chalder and Sharpe, the ‘Inner Circle’ of the Wessely School. Another Inner Circle member, Sir Mansel Aylward, then at the Department for Work and Pensions, was a funder of the trial. The PIs all have or had connections both to the Department for Work and Pensions and to insurance companies.

The investigators obtained close to £5,000,000 of tax payers’ money to run the PACE trial.

The objective of the trial was to demonstrate that two treatments based on the DBT, cognitive behavioural therapy (CBT) and graded exercise therapy (GET), help ME/CFS patients to recover. 

There was a zero chance the PACE researchers would fail to obtain the results they wanted. As the PACE ship left port, it went directly towards its destination. Only when it struck that unfortunate iceberg called “Null Result” did things begin to go seriously wrong.

Groupthink, Conflicts and Manipulation

The PACE trial team were operating within a closed system or groupthink in which they ‘know’ their theory is correct. With every twist and turn, no matter what the actual data show, the investigators are able to confirm their theory. The process is well-known in Psychology. It is a self-indulgent processes of subjective validation and confirmation bias.  Groupthink occurs when a group makes faulty decisions because group pressures lead to a deterioration of “mental efficiency, reality testing, and moral judgment” (Janis, 1972). Given this context, we can see reasons to question the investigators’ impartiality with many potential conflicts of interest (Lubet, 2017). Furthermore, critical analysis suggests that the PACE investigators involved themselves in manipulating protocols midway through the trial, selecting confirming data and omitting disconfirming data, and publishing biased reports of findings which created a catalogue of errors.

‘Travesty of Science’

The PACE Trial has been termed a ‘travesty of science’ while sufferers of ME/CFS continue to be offered unhelpful or harmful treatments and are basically being told to ‘pull themselves together’. One commentator has asserted that the situation for ME patients in the UK is: “The 3 Ts – Travesty of Science; Tragedy for Patients and Tantamount to Fraud” (Professor Malcolm Hooper, quoted by Williams, 2017). Serious errors in the design, the protocol and procedures of the PACE Trial are evident. The catalogue of errors is summarised below. The PACE Trial was loaded towards finding significant treatment effects.

When Disaster Strikes

The claimed benefits of GET and CBT for patient recovery are entirely spurious. The explanation lies in a sequence of serious errors in the design, the changed protocol and procedures of the PACE Trial. The investigators neglected or bypassed accepted scientific procedures for a RCT, as follows:

ErrorCategory of errorDescription of error
1Ethical issue: Applying for ethical approval and funding for a long-term trial when the PIs knew already knew CBT effects on ME/CFS were short-lived.On 3rd November 2000, Sharpe confirmed: “There is a tendency for the difference between those receiving CBT and those receiving the comparison treatment to diminish with time due to a tendency to relapse in the former” (www.cfs.inform/dk). Wessely stated in 2001 that CBT is “not remotely curative” and that: “These interventions are not the answer to CFS” (Editorial: JAMA 19th September 2001:286:11) (Williams, 2016).
2Ethical issue: Failure to declare conflicts of interest to Joint Trial Steering Committee.Undeclared conflicts of interest by the three PIs in the Minutes of the Joint Trial Steering Committee and Data Monitoring Committee held on 27th September 2004.
3Ethical issue: Failure to obtain fully informed consent after non-disclosure of conflicts of interest.Failing to declare their vested financial interests to PACE participants, in particular, that they worked for the PHI industry, advising claims handlers that no payments should be made until applicants had undergone CBT and GET.
4Use of their own discredited “Oxford” criteria for entry to the trial.Patients with ME would have been screened out of the PACE Trial even though ME/CFS has been classified by the WHO as a neurological disease since 1969 (ICD-10 G93.3).
5Inadequate outcome measures.Using only subjective outcome measures.The original protocol included the collection of actigraphy data as an objective outcome measure. However, after the Trial started, the decision was taken that no post-intervention actigraphy data should be obtained.
6Changing the primary outcomes of the trial after receiving the raw data.Altering outcome measures mid-trial in a manner which gave improved outcomes.
7Changing entry criteria midway through the trial.Altering the inclusion criteria for trial entry after the main outcome measures were lowered so that some participants (13%) met recovery criteria at the trial entry point.
8The statistical analysis plan was published two years after selective results had been published.The Re-definition of “recovery” was not specified in the statistical analysis plan.
9Inadequate controlSending participants newsletters promoting one treatment arm over another, thus contaminating the trial.
10Inadequate controlLack of comparable placebo/control groups with inexperienced occupational therapists providing a control treatment and experienced therapists provided CBT.
11Inadequate controlRepeatedly informing participants in the GET and CBT groups that the therapies could help them get better.
12Inadequate controlGiving patients in the CBT and GET arms having more sessions than in the control group.
13Inadequate controlAllowing therapists from different arms to communicate with each other about how patients were doing.
14Lack of transparencyBlocking release of the raw data for five years preventing independent analysis by external experts.

Credit where credit is due

A significant amount of investigation about the PACE trial was carried out in 2015 by David Tuller.

Please see:

Tuller D (2015) TRIAL BY ERROR: The Troubling Case of the PACE Chronic Fatigue Syndrome Study. http://www.virology.ws/2015/10/21/trial-by-error-i/

Tuller D (2015) TRIAL BY ERROR: The Troubling Case of the PACE Chronic Fatigue Syndrome Study (second installment). http://www.virology.ws/2015/10/22/trial-by-error-ii/

Tuller D (2015) TRIAL BY ERROR: The Troubling Case of the PACE Chronic Fatigue (final installment) http://www.virology.ws/2015/10/23/trial-by-error-iii/

Tuller (2016) http://www.virology.ws/2016/02/01/trial-by-error-continued-a-few-words-about-harassment/

Other significant pieces of exposure were:

Goldin R. PACE: The research that sparked a patient rebellion and challenged medicine. www.stats.org/pace-research-sparked-patient-rebellion-challenged-medicine

This paper by Dr Mark Vink was described in a letter to the Editor of Lancet from Professor Malcolm Hooper as “The final coup de grace“:

The PACE Trial Invalidates the Use of Cognitive Behavioral and Graded Exercise Therapy in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Review. J Neurol Neurobiol 2(3).

PACE-Gate: the Cover-Up

Blocking release of the raw data for five years and preventing independent analysis by external experts was tantamount to a cover-up of the true findings. An editorial by Keith Geraghty (2016) was entitled ‘PACE-Gate’. ME/CFS patient associations were rightly suspicious of the recovery claims concerning the GET arm of the trial because of their own experiences of intense fatigue after ordinary levels of activity which were inconsistent with the recovery claims of the PACE Trial reports. For many sufferers, even moderate exercise results in long ‘wipe-outs’ in which they are almost immobilized by muscle weakness and joint pain. In the US, post-exertional relapse has been recognized as the defining criterion of the illness by the Centers for Disease Control, the National Institutes of Health and the Institute of Medicine. For the PACE investigators, however, the announced recovery results validated their conviction that psychotherapy and exercise provided the key to reversing ME/CFS.

Alem Matthees Obtains Data Release

When Alem Matthees, a ME/CFS patient, sought the original data under the Freedom of Information Act and a British Freedom of Information tribunal ordered the PACE team to disclose their raw data, some of the data were re-analysed according to the original protocols. The legal costs of the tribunal at which QMUL were forced to release the data, against their strenuous objections, was over £245,000. The re-analysis of the PACE Trial data revealed that the so-called “recovery” under CBT and GET all but disappeared (Carolyn Wilshire, Tom Kindlon, Alem Matthees and Simon McGrath, 2016). The recovery rate for CBT fell to seven percent and the rate for GET fell to four percent, which were statistically indistinguishable from the three percent rate for the untreated controls. 

Graded exercise and CBT are still being routinely prescribed for ME/CFS in the UK despite patient reports that the treatments can cause intolerable pain and relapse. The analysis of the PACE Trial by independent critics has revealed a catalogue of errors and provides an object lesson in how not to conduct a scientific trial. The trial can be useful to instructors in research design and methodology for that purpose.

Following the re-analyses of the PACE Trial, the DBT is dead in the water. There is an urgent need for new theoretical approaches and scientifically-based treatments for ME/CFS patients. Meanwhile, there is repair work to be done to rebuild patient trust in the medical profession.

The Final Sinking

Caroline Wilshire, Tom Kindlon, Alem Matthees and Simon McGrath asked a very simple question:

Can patients with chronic fatigue syndrome really recover after graded exercise or cognitive behavioural therapy?

These authors gave a critical commentary and preliminary re-analysis of the PACE
trial. I quote their Abstract:

BACKGROUND: Publications from the PACE trial reported that 22%
of chronic fatigue syndrome patients recovered following graded
exercise therapy (GET), and 22% following a specialised form of
CBT. Only 7% recovered in a control, no-therapy group. These
figures were based on a definition of recovery that differed
markedly from that specified in the trial protocol.
PURPOSE: To evaluate whether these recovery claims are justified
by the evidence.
METHODS: Drawing on relevant normative data and other research,
we critically examine the researchers’ definition of recovery, and
whether the late changes they made to this definition were
justified. Finally, we calculate recovery rates based on the original
protocol-specified definition.
RESULTS: None of the changes made to PACE recovery criteria were
adequately justified. Further, the final definition was so lax that on
some criteria, it was possible to score below the level required for
trial entry, yet still be counted as ‘recovered’. When recovery was
defined according to the original protocol, recovery rates in the
GET and CBT groups were low and not significantly higher than in
the control group (4%, 7% and 3%, respectively).
CONCLUSIONS: The claim that patients can recover as a result of
CBT and GET is not justified by the data, and is highly misleading

Implications

  1. The PACE trial is/was/and always will be an unmitigated disaster. I use it in my textbook as an example of how not to do a trial.
  2. The authors and sponsors have done a disservice to science and to patients that will be hard to forget.
  3. An apology is the least that the principal investigators can do to make amends for this dreadful piece of pseudo-science.
  4. The universities involved should return the public funds that were wasted on the PACE trial project.
  5. A government enquiry is necessary to investigate the full facts in relation to the connections between the investigators, the insurance industry and the UK Department of Work and Pensions.

Note: This post is dedicated to Alem Matthees who has dedicated his life to the search for the truth about ME/CFS and was responsible for obtaining the release of the PACE trial data.

Reference:

David F Marks et al. (2020) Health Psychology. Theory, Research & Practice (6th ed.) SAGE Publications Ltd.

A New Book with a New Approach to the Investigation of the Paranormal

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From the Preface

[An ESP experiment] “immediately appeals to his [or her] unconscious readiness to witness a miracle, and to the hope, latent in all [people], that such a thing may yet be possible. Primitive superstition lies just below the surface of even the most tough-minded individuals, and it is precisely those who most fight…” 

C.G. Jung, 1952.

It is of natural science to investigate nature, impartially and without prejudice.

J.R. Smythies, 1967.

Anomaly

  • something that defies explanation – adds spice. Beyond spice, anomaly offers hope, the hope that something – whatever it may be – exists beyond the everyday. We humans live in hope eternally. But what exactly is an ‘anomaly’? I do not mean the kind of oddness or peculiarity in human behaviour that is everywhere to be seen. I am referring to things that really should not be so, the weird, the spooky, the face in the mirror that isn’t you. Anomalistic experiences are curious, strange, ‘funny peculiar’.  As we engage with the experience itself, we freely ruminate and craving to understand, we dig to discover something new. The goal here is to do precisely that, to dig below the surface of anomalistic experience, to take a close look at the psychology of the paranormal, to put psi ‘under the microscope’.  One should not be surprised if all is not as it seems and we can expect surprises aplenty here.

I approached the writing of this book with anticipation

wondering where the adventure might lead. I hoped it would lead towards new insights, explanatory theory and nuggets of new knowledge.

In the end, I reached an altogether unexpected conclusion…

How, you may well ask, can that be?  Surely, an ‘expert’ about psychology and the paranormal should already have reached an opinion one way or the other, a strong point of view?

Not so.

I genuinely have no idea where this new investigation will lead.I write as a zetetic.[1] I have a map and a set of place names[2],  but what exists at each place is uncertain. I last visited this field 20 years ago. Now, with ‘new eyes’ and new evidence, one’s understanding could be significantly different compared to 20 years ago.  Unlike previous visits, I am giving the psi hypothesis an initial probability of being a real, authentic and valid experience of 50%.

Please take a minute to consider your own current degree of belief in ESP.  Indicate your current belief with an arrow on the Belief Barometer below.[3]

My objective

is to cut a path through the vast, tangled jungle of publications with a machete that is sharp and decisive. With each new claim, one must reads, reflect, question, reflect some more, and ultimately decide at one particular moment the degree of plausibility that each specific claim possesses. Belief Barometers will be used to mark your and my degree of belief for each individual claim. The amount of variation in one’s degree of belief indicates a sensitivity to evidence.  If somebody simply says ‘0%’’ or ‘100%’ to absolutely everything, that surely indicates intransigence and intolerance of ambiguity.

One cannot profess definite explanations in advance because that would be blinkered. If we already KNEW the answers, we would cease to investigate, I would not be writing, and you would not be reading. The truth would already be out and we would be picking at the flesh of dead learning like vultures at a dead elephant.

No true zetetic starts from a fixed position. She/he suspends judgement while seeking and exploring with an open mind. In any science, all ideas are provisional, pending further investigation. Those who assert a fixed point of view before looking at the evidence break the ‘Golden Rule of Science’, which is to let conclusions follow the evidence.

Anomalistic psychology

includes the entire spectrum of conscious experience in all of its glorious splendour. By examining in-depth the evidence both pro and con any particular claim, one gains an entitlement to offer conclusions. Even then, the conclusions are tentative, pending further investigation by independent investigators. I am also minded to recall Heraclitus’ well-known dictum, “You cannot step into the same river twice, for other waters are continually flowing on.”  Having stepped into the paranormal river on a few occasions, it was each time a different river.

It is impossible here to include everything in Anomalistic Psychology. The selected exemplify phenomena that have received significant attention from researchers over the last 50 years.  Fun though they may be: Big Foot, the Loch Ness Monster, Clever Hans, mediums, Ouija boards, and stage mentalists didn’t make the cut. See them in the ‘red tops’ and on YouTube.

Returning to the world of psi

after a 20-year respite, I am curious to see what has changed. Anomalistic Psychology is now the battle-ground of psi (Luke, 2011) and there is a growing stockpile of sophisticated methods and findings that can be considered to be supportive of paranormal interpretation.

My return to the field is not without some amount of trepidation, for now I risk being the target for pot-shots from both sides!

However, a strongly partisan view is unhelpful to making any progress in this, or any other part, of science.  Progress requires a dialogue between advocates of differing positions. I wish to put down a marker that says: “Peace. Nobody won. Stop fighting.” That’s not to say there won’t be criticism; there must be, otherwise there can never be progress.

To establish a dialogue, I invited seven *stars* of the field to respond to my criticisms and questions: Daryl Bem, Susan Blackmore, Stanley Krippner, Dean Radin, Hal Puthoff, Rupert Sheldrake, and Adrian Parker. Warm thanks to one and all.

Evidence, critique, new theories

In this book, I present evidence, critique, and new theories. Whenever possible, I use verbatim quotations of advocates concerning specific claims. Nobody can ever legitimately say that a claim has been ‘disproved’; if the truth of a claim is undecided, it is only possible to say that it is neither confirmed nor disconfirmed.

Whatever one thinks, the world is always independent of how we might wish it to be. There is nothing wrong about believing in psi if one chooses to, and scientists have no place disparaging such beliefs. Belief in the paranormal is normal.

Sociologist Andrew Greeley (1991) put it this way:

“The paranormal is normal. Psychic and mystic experiences are frequent even in modern urban industrial society. The majority of the population has had some such experience, a substantial minority has had more than just an occasional experience, and a respectable proportion of the population has such experiences frequently. Any phenomenon with incidence as widespread as the paranormal deserves more careful and intensive research than it has received up to now….People who have paranormal experiences, even frequent such experiences, are not kooks. They are not sick, they are not deviants, they are not social misfits, they are not schizophrenics. In fact, they may be more emotionally healthy than those who do not have such experiences.” (Greeley 1975: 7)

Scientists should be agnostic about the ontological status of paranormal experience and examine the circumstances that constrain or facilitate exceptional experiences.  In approaching each claim, I maintain a zetetic viewpoint, neither believing nor disbelieving,  attending to the evidence. Only after one has completed a thorough survey of evidence is one entitled to an informed opinion. A zetetic must not be naïve, however.

Master zetetic, Marcello Truzzi (1987):

Marcellotruzzi

“The ground rules of science are conservative, and in so far as these place the burden of proof on the claimants and require stronger evidence the more extraordinary the claim, they are not neutral. But, we also need to remember, evidence always varies by degree, and inadequate evidence requires a tolerant reply which requests better evidence, not a dogmatic denial that behaves as though inadequate evidence were no evidence” (p. 73).

Astronomer, Carl Sagan (1995) also offers wise advice:

260px-Carl_Sagan_Planetary_Society

“It seems to me what is called for is an exquisite balance between two conflicting needs: the most skeptical scrutiny of all hypotheses that are served up to us and at the same time a great openness to new ideas. Obviously those two modes of thought are in some tension. But if you are able to exercise only one of these modes, whichever one it is, you’re in deep trouble.If you are only skeptical, then no new ideas make it through to you. You never learn anything new. You become a crotchety old person convinced that nonsense is ruling the world. (There is, of course, much data to support you.) But every now and then, maybe once in a hundred cases, a new idea turns out to be on the mark, valid and wonderful. If you are too much in the habit of being skeptical about everything, you are going to miss or resent it, and either way you will be standing in the way of understanding and progress. On the other hand, if you are open to the point of gullibility and have not an ounce of skeptical sense in you, then you cannot distinguish the useful as from the worthless ones.” (Sagan, 1995, p 25).

The first 20 years of the 21st century

brought many astonishing scientific discoveries: the first draft of the Human Genome, graphene, grid cells in the brain, the first self-replicating, synthetic bacterial cells, the Higgs boson, liquid water on Mars and gravitational waves. Not bad going in such a short time!  During this same period, Anomalistic Psychology has grown at an enormous pace with increased numbers of investigators and publications (Figure P2).  Disappointingly, however, new discoveries or theories are few and far between. If there has been one discovery, it might be stated thus: The science of anomalistic experience is more complex and obscure then most psychologists ever imagined. When we are at the beginning of new venture like this, we must not be deterred by having no real answer to two of the hardest questions in science: What is consciousness and what is it for? [5]

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One of the greatest scientific minds of the last century, Stephen Hawking, stated:

Stephen_Hawking.StarChild

“Science is beautiful when it makes simple explanations of phenomena or connections between different observations” (Sample, 2011).

It has also been said that advances in science come not from empiricism but from new theories.

Parapsychology, like its ‘big sister’ Psychology, has always been heavily empirical and short on theory. The rapid growth is indexed by multitudes of empirical studies in the absence of notable theoretical developments.

By becoming more theory-driven, the field of ‘Psychology + Parapsychology’ as an integrated whole seems likely to make faster progress.

It seems counterproductive to treat Parapsychology and Psychology as separate fields.

Bringing the ‘Para’ part back into mainstream Psychology helps to integrate the discipline. This book takes a step in that direction. Parapsychology and Psychology contain myriads of variables, A,B,C…N…X,Y,Z.  An established strategy for developing new research in Psychology and Parapsychology is for the investigator to identity ‘gaps’ in the field and to set about filling those gaps with correlational and experimental studies with almost every possible permutation and combination of variables.  The gap filling approach is one strategy for keeping productivity high but, often, it is at the expense of developing new theories. As already noted, the academic world is based on quantitative measures of performance[6] and the number of publications a researcher can claim matters. This drive towards publications leads to what I call ‘Polyfilla Science’.

Polyfilla Science

For every ‘hole’ investigators can fill, they are almost guaranteed a peer-reviewed publication. ‘Polyfilla Science’ exists on an industrial scale, keeping hundreds of thousands of scientists busily occupied in hot competition. The ‘winners’ of the Polyfilla competition are the ones who tick the highest number of boxes and harvest the most citations.[7]

‘Polyfilla Science’ can be represented as a multidimensional matrix of cells where the task of science is viewed as filling every last cell in the matrix (Figure P3).  This method of doing science is more akin to a fairground shooting gallery than to theory-driven science.  In the absence of theory, many researchers use a Polyfilla ‘shotgun’ by testing a dozen or more “hypotheses” in one shot. Popular though it is, ‘Polyfilla Science’ isn’t the only game in town, and a theory-driven approach is also available.  Theory is used to identify the principles behind questions that need answering in a process of confirmation and disconfirmation of predictions. When one considers the fact that there are one hundred thousand psychology majors in the US alone, all needing a research project, it is no wonder the Polyfilla approach is so popular.[8]

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The book is geared towards the needs of teachers, researchers and students interested in Anomalistic Experience, Parapsychology and Consciousness Studies.

In comparison to the scientific discoveries in other fields, Psychology or Parapsychology have made no world-changing discoveries in the last 50 years. By this, I mean discoveries that are worth telling your grandchildren. In my opinion, the lack of significant theoretical developments, and the Polyfilla Approach, are two of the main reasons for this lack of progress.  All this needs to change.

Avoiding the drunkard’s search

One must beware – and avoid – the drunkard’s search principle – searching only where it is easiest to look. You probably already know the parable:

A policeman sees a drunk man searching for something under a streetlight and asks what the drunk has lost. He says he lost his wallet and they both look under the streetlight together. After a few minutes the policeman asks if he is sure he lost it here, and the drunk replies, no, and that he lost it in the park. The policeman asks why he is searching here, and the drunk replies, “this is where the light is”.

lost_in_the_dark

We must look wherever psi could be found, not only where it is easiest to look.

The search for psi is a complex, winding trail of traps and pitfalls. When we observe evidence, we must not,  a priori, rule it out as subjective validation or confirmation bias. An openness to being wrong may cause uncomfortable feelings, but knowledge and truth are never givens. When we are lucky enough to discover something new, this is hard-won treasure.

I present here new theories in the spirit of open inquiry. There’s a saying that ‘today’s theories make tomorrow’s fish-n-chip paper’. Possibly, probably, these theories are wrong.  So be it. If possible, falsify my theories, throw them out, and develop better ones. By testing and falsifying existing theories, newer, better theories can be obtained and so on indefinitely. As I share thoughts and conclusions, the reader will be able to contest and challenge  and contrary evidence.

We’ve walked on the Moon and are heading to Mars, but we still don’t yet know the function of consciousness. One of the starting points must be to separate fact from fiction in anomalistic psychology.

Notes

[1] Zetetic from the Greek zçtçtikos, from zçteô [ζητέω (zéteó) — to seek] “to seek to proceed by inquiry”.

[2] [2] Tópos, the Greek name for “place” (τόπος); ‘topic’ in English.

[3] Belief Barometers appear throughout this book.

[4] The majority of so-called ‘skeptics’ are disbelievers and/or deniers who have adopted the label ‘skeptic’ for its more temperate connotations. The late Marcello Truzzi was one of two co-founding chairman of the leading US skeptical organisation CSICOP (the Committee for the Scientific Investigation of Claims of the Paranormal). Truzzi became disillusioned with the organization, saying they “tend to block honest inquiry, in my opinion… Most of them are not agnostic toward claims of the paranormal; they are out to knock them.” Using the title of ‘skeptic’, Truzzi claimed that this association of debunkers could claim an authority to which they were not entitled: “critics who take the negative rather than an agnostic position but still call themselves ‘skeptics’ are actually pseudo-skeptics and have, I believed, gained a false advantage by usurping that label.” Genuine or ‘classical’ skepticism is the zetetic view to suspend judgement and enter into a genuine inquiry that assumes any claim requires justification. Maintaining a zetetic position of open inquiry requires a steady hand and a critical mind. There is no room for naivety but a touch of Socratic irony may at times be helpful. A protracted correspondence between Martin Gardner and Marcello Truzzi , indicating their two contrasting viewpoints, has been published by Richards (2017).

[5] Nagel (2013) and Strawson (2006), among others, argue for the ancient philosophy of pan-psychism, in which all physical objects from atoms to the cosmos all have conscious experience.  Elsewhere, I have described Consciousness  as “a direct emergent property of cerebral activity” (Marks, 2019)..

[6] Numbers of publications, citations, grant monies, prizes, promotions and awards.

[7] One of the world’s most published and ambitious ‘Polyfilla’ psychologists told me a self-effacing story about the occasion he went for an interview at the University of Oxford. A member of the panel asked: “Dr X, you have a huge number of publications. But what does it all mean?” He didn’t know the answer and got rejected for the post.

[8] Polycell Multi-Purpose Polyfilla Ready Mixed, 1 Kg, i#1 best seller on Amazon.co.uk, 16 May 2019.

[9] The history of the field is adequately reviewed by others e.g. John Beloff (1993) or Caroline Watt (2017).

Human Needs in COVID-19 Isolation

Featured

A Perfect Storm

These are extraordinary times. Throughout history there have been plenty of pandemics but the human response to COVID-19 is unprecedented. The world will never be the same again. It is estimated that close to four billion people are living in social isolation during this mother of all pandemics (Sandford, 2020). Unless there is a revolt, policies of social isolation in one form or another are expected to continue until a vaccine is available 6, 12 or 24 months from now.  The cumulative impacts of social distancing will be truly profound.

COVID-19 lockdown has created a perfect storm’ of vulnerabilities that huge numbers of people, and services, are ill-prepared to manage. This post reviews the science of human needs as they are expected to play out over a prolonged period of domestic confinement.

The COVID-19 pandemic involves a novel coronavirus characterized by a respiratory illness that results from a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (Centers of Disease Control and Prevention, 2020). The disease was first reported in Wuhan, China, in December 2019 and symptomatic patients frequently present with a dry cough, fever and shortness of breath within 2 to 14 days after exposure. The coronavirus disease (COVID-19) pandemic is receiving intensive interest at all levels: political, economic, social, scientific and in health care.  The epicenter of the COVID-19 outbreak moved from China to Europe and a few weeks later to the US. As of 22 April 2020, there were 2,564,038 confirmed cases and 177,424 deaths reported worldwide, affecting at least 201 countries, areas or territories (Johns Hopkins University, 2020). Most cases are in the USA (823,786 cases), followed by Spain (204,178) and Italy (183,957) (Johns Hopkins University, 2020).

Isolation

Owing to the absence of a vaccine, official control measures have been implemented to reduce the spread of COVID-19, such as restrictions on people’s movements, including social distancing, closing of gyms and parks, travel restrictions, quarantines and stayathome guidance. The policy of confinement has significant health, economic, environmental and social consequences. In the psychological sphere, recent evidence shows that similar pandemics increased the prevalence of symptoms of post-traumatic stress disorder, as well as confusion, feeling of loneliness, boredom and anger during and after quarantine (Brooks, Webster, Smith, Woodland, Wessely, Greenberg, et al. 2020). 

Stressors during this critical period include fear of infection, fear of death, uncertainty, loss of social contacts, confinement, inadequate information, conflicting advice, loss of outdoor activities, disconnection from nature, loneliness, depression, helplessness, anger, low self-esteem, financial loss and obstacles to supplies of food and water (Brooks et al., 2020; Jiménez-Pavón, Carbonell-Baeza & Lavie, et al., 2020; Xiang, Yang, Li, Zhang, Zhang, Cheung, et al., 2020). A survey in China during the initial outbreak of COVID-19 found that 54% of respondents rated the psychological impact of the outbreak as moderate or severe; 17% reported moderate to severe depressive symptoms; 29% reported moderate to severe anxiety symptoms, and 8% reported moderate to severe stress levels (Wang, Pan, Wan, Tan, Xu, Ho et al., 2020). Given that a significant proportion of the population live alone or are vulnerable to mental health problems, the impacts of the COVID-19 pandemic on mental wellbeing are only now just beginning to be felt.  

 

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In light of these issues, systematic psychological self-care must be given a high priority in coping with the detrimental impacts of COVID-19 and social distancing. Here we discuss one of the most fundamental tools of self-care for health enhancement: increased physical activity. Governmental recognition of the benefits of exercise is evidenced by permitting exercise outdoors during social isolation for indefinite periods of weeks or months. Yet rarely is the issue adequately addressed; an International Task Force of experts to review and advise on psychological and physical self-care would be a welcome initiative.

During the COVID-19 pandemic special attention to systematic psychological health care is required (Zaka, Shamloo, Fiorente & Tafuri, 2020; Zandifar and Badrfam, 2020). Interventions to deal with the pressing psychological needs of individuals during the pandemic are being investigated but in most parts of the world seriously lacking (Xiang et al., 2020; Wang, Zhao, Fen, Liu, Yao, & Shi, et al., 2020). 

One example is physical exercise, which is one of the most important tools to prevent mental illness and improve well-being (Mandolesi, Polverino, Montuori, Foti, Ferraioli, Sorrentino et al., 2018). However, few public health guidelines include daily physical exercise routines for people living in varying degrees of isolation during the pandemic (Chen et al., 2020; Jiménez-Pavón et al., 2020).  The role of physical exercise in psychological wellbeing during the pandemic is discussed in a later post.

Here I introduce concepts that help to enable effective self-care measures for COVID-19 isolation. These concepts are part of A General Theory of Behaviour.

 Psychological Homeostasis

At every level of existence, from the cell to the organism, from the individual to the population, and from the local ecosystem to the entire planet, homeostasis is a drive towards stability, security and adaptation to change.  In a general theory of behaviour claims that striving for balance and equilibrium is a primary guiding force in all that we do, think and feel.  A behavioural type of homeostasis has been given the descriptive term: “Reset Equilibrium Function” (or ‘REF; Marks, 2018). The REF is thought to be omnipresent, whatever we are doing and wherever we are doing it, which includes the monotony of COVID-19 isolation. When we are in isolation, the REF stays with us, considers how to restore equilibrium and reduce feelings of unrest. The REF’s monitoring is not normally attended to, but the REF’s products are: feelings of distress, boredom, loneliness and instability can all be a focus for concern. Competing drives, conflicts, and inconsistencies all pull the flow of thought and feeling ‘off balance’, triggering an innate striving to restore equilibrium. Individuals resort to a variety of methods to restore a sense of balance and equilibrium.

Body and mind continuously regulate and control many domains and levels simultaneously, with multiple adjustments to voluntary and involuntary behaviour guided by two types of homeostasis: Type I – inwardly striving or physiological homeostasis, H[Φ], and Type II – outwardly striving or psychological homeostasis, H[Ψ]. Physiological regulation involves drives such as hunger, thirst, sex, elimination and sleep. The ‘Reset Equilibrium Function’ (REF) operates across all behavioural systems that are investigated by psychological science. 

The Reset Equilibrium Function is a general control function that automatically restores psychological processes to equilibrium and stability. The REF is triggered when any processes within a system strays outside of its set range. The REF is innate and exists in conscious organisms, which all have Type I and II homeostasis. The two types of homeostasis work in synergy. Psychological and physiological processes operate in tandem to maximize equilibrium for each particular set of functions. 

These include cognition, affect, chronic stress, and subjective well-being, and also out-of-control conditions such as isolation, boredom, addiction or insomnia that are in need of self-care. When there is goal to make a behavior change, conscious awareness of the goal and full engagement of one’s personal resources are necessary preconditions for purposeful striving, e.g. the need to reduce boredom and instability in COVID-19 isolation.

The Needs Hierarchy

Human experience is controlled by needs and behaviours to satisfy needs. A general theory of behaviour includes Maslow’s (1943) influential statement about human needs(with a few minor modifications). It is assumed that needs occupy a hierarchy of seven overlapping levels (Figure 1). Like any hierarchical structure, the stability of the system relies on the strength of its foundation level.  The first level  Immediate Physiological Needs  incorporates physiological homeostasis (Type I) and the sustenance of all physiological needs.  Higher level needs from level 2 upwards are served by psychological homeostasis (Type II). There is a progression in developmental priority as the individual matures.  The motivational hierarchy reflects evolutionary function, developmental sequencing, and current cognitive priority. Individuals who are unable to meet their immediate physiological needs at level 1 are at a disadvantage in meeting higher-level needs. Think of a building with seven storeys. If level 1 of the building is not strong, then the higher levels will be vulnerable to collapse.

NEW Needs Pyramid 

Figure 1. The Hierarchy of Human Needs. Homeostasis operates at all seven levels. Physiological, or Type I homeostasis operates at level 1. Psychological, Type II, homeostasis operates at level 2 (Self-protection) and above. Reproductive goals are in the order they are likely to appear developmentally. Later developing needs are overlapping with earlier developing needs. Once a need develops, its activation is triggered whenever relevant environmental cues are salient. Adapted from Kenrick, Griskevicius, Neuberg and Schaller (2010) with permission.

 

I consider next the likely impact of COVID-19 social distancing in light of the needs hierarchy. Four needs most directly impacted by social distancing at levels 1 to 4 are discussed in turn.

Immediate Physiological Needs (Level 1)

Physiological regulation involves the drives of hunger, thirst, sex, elimination and sleep. Level 1 is a bedrock for all higher levels. We consider first food, drink and other necessary products, which have been an issue from the very start of the pandemic with panic buying and stockpiling reported everywhere causing supermarkets and stores to run out of supplies. In the UK, in packaged food and beverages, the highest growth has been evident in cereals (38%), vegetables (37%), cocoa (25%), rice (22%) and pasta (19%). There has also been an increase in bottled water and indulgence foods, such as chocolate (23%), olives (68%) and beer (20%) (Kantar, 2020).Comfort eating and drinking is a common strategy of individuals seeking ways to ameliorate anxiety and distress associated with lockdown. Comfort eating and drinking is associated with weight gain and the development of obesity and eating disorders, especially in conditions of isolation and boredom (Crockett, Myhre & Rokke, 2015; Marks, 2015; Figure 2). Sadly, there is likely to be an acceleration in the already high prevalence of obesity over the lockdown period. As the lockdown period is indefinitely extended, with increasing joblessness and poverty, food insecurity is likely to become a major concern for many people. 

 

FIG 2

 

Figure 2.  Panel A shows the homeostasis system linking low self-esteem with negative affect, comfort eating and overweight. Intervention to alter the dynamics of the system towards that shown in Panel B replaces comfort eating with exercise designed to increase self-esteem and control weight gain (Marks, 2015).

 

A well-known and, to many, surprising COVID-19 phenomenon has been the prevalence of toilet-tissue stockpiling (TTS). In the UK, for the week ending 8 March 2020 the sales of toilet tissues rose by 60% year-on-year (Kantar, 2020). Why should this be?  In fact, this behaviour is perfectly logical and in line with the needs hierarchy where utmost priority is given to needs at level 1. TTS provides long-term hygienic support to the necessary act of elimination, which, during isolation, is more frequent at home because people are unable to do itat the workplace. Thus, TTS is consistent with level 1 of the hierarchy of needs.

 

Level 1 needs are automatically more complex in cases of addiction to drugs, alcohol, tobacco and other substances. If any of these addictions are present, the entire needs structure can be placed in jeopardy. In any case, disruption of sleep patterns is one prevalent consequence of pandemic distress. A European task force concluded: “In the current global home confinement situation due to the COVID-19 outbreak, most individuals are exposed to an unprecedented stressful situation of unknown duration. This may not only increase daytime stress, anxiety and depression levels but also disrupt sleep. Importantly, because of the fundamental role that sleep plays in emotion regulation, sleep disturbance can have direct consequences upon next day emotional functioning Managing sleep problems as best as possible during home confinement can limit stress and possibly prevent disruptions of social relationships” (Altena, Baglioni, Espie, Ellis, Gavriloff, Holzinger, et al., 2020, p. 1). It has been established that physical exercise improves sleep for people of all ages (Flausino, Da Silva Prado, de Queiroz, Tufik, & de Mello, 2012; Reid, Baron, Lu, Naylor, Wolfe & Zee, 2010;  Yang, Ho, Chen, & Chien, 2012). We return to this later.  

Need for Self-Protection (Level 2)

Self-protection needs during the COVID-19 pandemic are paramount. The World Health Organisation (WHO, 2020) and national governments have required a lockdown of the population with social distancing and ‘stay-at-home’ isolation. These policies have stoked fear of death and infection while incentivizing individuals to carry out frequent handwashing, wearing masks along with social isolation. The advice to stay at home has been the main topic of messaging from health authorities during the pandemic.  

An individual’s responses to COVID-19 lockdown is shown in Figure 3. In lockdown, unmet self-protection needs become ‘normal’ and individuals experience systematic frustration of a deep-seated need to ensure protection of self and their family. This high level of frustration causes fear, anxiety and distress as individuals feel incompetent to guarantee the safety and protection of loved ones, family and self. Fear, anxiety and distress are also associated with insomnia, irritability and aggression. Especially if an  individual uses alcohol or drugs to assuage their fears, aggression may turn into physical violence to family members, women, children and pets(Peterman, Potts, O’Donnell, Thompson, Shah, Oertelt-Prigione, et al., 2020). There are increases in the incidence of  homicides and suicides (e.g. Campbell, 2020).

 

FIG 3

 

Figure 3. Behavioural systems at level 2 of the needs hierarchy in COVID-19 lockdown. In panel A, fear and frustration are accompanied by heightened surveillance of the external environment via TV news channels and social media. In panel B, fear and frustration are replaced by self-compassion and empathy and surveillance is replaced by reaching out to others.

Need for Affiliation (Level 3)

The almost total cessation of full frontal face-to-face affiliation outside of one’s domestic bubble is mandated by policies of home confinement and “social distancing”. Connecting with others normally helps individuals to regulate their emotions, cope with stress, and remain resilient (Williams, Morelli, Ong & Zaki, 2018).  Loneliness and social isolation, on the other hand, worsen the burden of stress, and often produce deleterious effects on mental, cardiovascular, and immune health (Haslam, Jetten, Cruwys, Dingle, & Haslam, 2018). Older adults, at the greatest risk of severe symptoms from COVID-19, are also most susceptible to isolation (Luo, Hawkley, Waite, & Cacioppo, 2012). Intergenerational social support, self-esteem, and loneliness are all strongly associated with subjective well-being (Tian, 2016). 

 

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These effects are not peculiar to older people. Even among adolescents, loneliness  is associated with physical inactivity (Pinto, Oppong Asante, Puga Barbosa, Nahas, Dias and Pelegrini, 2019). Thus distancing threatens to aggravate feelings of loneliness that likely will produce negative long-term health consequences in many vulnerable people. During the COVID-19 pandemic, the population of people at risk is enormous. After the lockdown period ceases, sadly mental health services are expected to be overwhelmed.

People with unmet needs for affiliation at level 3 are also at risk of failing to meet needs for status and self-esteem at level 4.

Need for Status/Self-esteem (Level 4)

As noted, status and self-esteem needs are vulnerable if needs at levels 1 – 3 are unmet. Failure at levels 1-3 accumulates with larger knock-on effects as cumulative failure develops. Furthermore, the pandemic is producing huge increases in  unemployment and poverty, vulnerability factors for lowered self-esteem and social status (e.g. Goldsmith, Veum & Darity, 1997). Self‐esteem is associated with responses to success and failure (Baumeister & Tice, 1985). Low self-esteem also creates a vulnerability to depression (Sowislo & Orth, 2013) and to drinking alcohol (Hull & Young, 1983)  if affordable. Self-esteem moderates the associations between body-related self-esteem, conscious emotions and depressive symptoms (Brunet, Pila, Solomon-Krakus, Sabiston & O’Loughlin, 2019).  Self-esteem also appears to be an important antecedent of the development of self-compassion (Dona, Parker, Sahdra, Marshall, & Guo, 2018).  

 

Conclusion

COVID-19 lockdown has created a perfect storm’ of vulnerabilities that huge numbers of people, and services, are ill-prepared to manage. The success of social isolation policies will depend on minimizing long term depreciation of mental health. 

 

References

Altena, E., Baglioni, C., Espie, C. A., Ellis, J., Gavriloff, D., Holzinger, B., … & Riemann, D. (2020). Dealing with sleep problems during home confinement due to the COVID‐19 outbreak: practical recommendations from a task force of the European CBT‐I Academy. Journal of Sleep Research.

Awick, E. A., Ehlers, D., Fanning, J., Phillips, S. M., Wójcicki, T., Mackenzie, M. J., … & McAuley, E. (2017). Effects of a home-based DVD-delivered physical activity program on self-esteem in older adults: Results from a randomized controlled trial. Psychosomatic medicine79(1), 71.

Baumeister, R. F. & Leary, M. R. (1995). The need to belong: Desire for interpersonal attachments as a fundamental human motivation. Psychological bulletin, 117, 497–529.

Baumeister, R. F., & Tice, D. M. (1985). Self‐esteem and responses to success and failure: Subsequent performance and intrinsic motivation. Journal of personality53(3), 450-467.

Brooks, S.K., Webster, R.K., Smith, L.E., Woodland, L, Wessely, S., Greenberg, N., et al. (2020). The psychological impact of quarantine and how to reduce it: rapid review of the evidence. The Lancet 395:912–20.

Brunet, J., Pila, E., Solomon-Krakus, S., Sabiston, C. M., & O’Loughlin, J. (2019). Self-esteem moderates the associations between body-related self-conscious emotions and depressive symptoms. Journal of health psychology24(6), 833-843.

Campbell, A. M. (2020). An Increasing Risk of Family Violence during the Covid-19 Pandemic: Strengthening Community Collaborations to Save Lives. Forensic Science International: Reports, 100089.

Campbell, J.P., & Turner, J.E. (2018). Debunking the myth of exercise-induced immune suppression: redefining the impact of exercise on immunological health across the lifespan. Frontiers in immunology 9:648.

Carver, C. S., & Scheier, M. F. (1982). Control theory: A useful conceptual framework for personality–social, clinical, and health Psychology.  Psychological bulletin92(1), 111.

Centers for Disease Control and Prevention (2020). Coronavirus (COVID-19).

https://www.cdc.gov/coronavirus/2019-nCoV/index.html

Chekroud, S. R., Gueorguieva, R., Zheutlin, A. B., Paulus, M., Krumholz, H. M., Krystal, J. H., & Chekroud, A. M. (2018). Association between physical exercise and mental health in 1· 2 million individuals in the USA between 2011 and 2015: a cross-sectional study. The Lancet Psychiatry5(9), 739-746.

Chelsey, L., Holden, P., Rollins, M., Gonzalez, M. (2020). Does how you treat yourself affect your health? The relationship between health-promoting behaviors and self-compassion among a community sample. Journal of health psychology, 359105320912448.

Chen, P., Mao, L., Nassis, G.P., Harmer, P., Ainsworth, B.E., & Li, F. (2020). Wuhan coronavirus (2019-nCoV): The need to maintain regular physical activity while taking precautions. Journal of sport and health Science 9:103.

Coronavirus COVID-19 Global Cases by the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University (2020). Available at: https://gisanddata.maps.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6

Crockett, A. C., Myhre, S. K., & Rokke, P. D. (2015). Boredom proneness and emotion regulation predict emotional eating. Journal of health psychology20(5), 670-680.

Deci, E.L., & Flaste, R. (1995). Why we do what we do: The dynamics of personal autonomy. GP Putnam’s Sons.

Donald, J. N., Ciarrochi, J., Parker, P. D., Sahdra, B. K., Marshall, S. L., & Guo, J. (2018). A worthy self is a caring self: Examining the developmental relations between self‐esteem and self‐compassion in adolescents. Journal of personality86(4), 619-630.

Eyre, H., & Baune, B.T. (2012). Neuroimmunological effects of physical exercise in depression. Brain, behavior, and immunity 26:251-66.

Flausino, N. H., Da Silva Prado, J. M., de Queiroz, S. S., Tufik, S., & de Mello, M. T. (2012). Physical exercise performed before bedtime improves the sleep pattern of healthy young good sleepers. Psychophysiology49(2), 186-192.

Geraghty, K., Hann, M., & Kurtev, S. (2019). Myalgic encephalomyelitis/chronic fatigue syndrome patients’ reports of symptom changes following cognitive behavioural therapy, graded exercise therapy and pacing treatments: Analysis of a primary survey compared with secondary surveys. Journal of health psychology24(10), 1318-1333.

Goldsmith, A. H., Veum, J. R., & Darity Jr, W. (1997). Unemployment, joblessness, psychological well-being and self-esteem: Theory and evidence. The Journal of Socio-Economics26(2), 133-158.

Goldstein, E., Topitzes, J., Brown, R.L., & Barrett, B (2018). Mediational pathways of meditation and exercise on mental health and perceived stress: A randomized controlled trial. Journal of health psychology, 1359105318772608.

HAN University of Applied Sciences (2020). Quarantrain. Stay fit during COVID-19 Available at: https://quarantrain.org/

Haslam, C., Jetten, J., Cruwys, T., Dingle, G., & Haslam, S. A. (2018). The new psychology of health: Unlocking the social cure. Routledge.

Holden, C. L., Rollins, P., & Gonzalez, M. (2020). Does how you treat yourself affect your health? The relationship between health-promoting behaviors and self-compassion among a community sample. Journal of Health Psychology, 1359105320912448.

Hull, J. G., & Young, R. D. (1983). Self-consciousness, self-esteem, and success–failure as determinants of alcohol consumption in male social drinkers. Journal of Personality and Social Psychology44(6), 1097.

Jiménez-Pavón, D., Carbonell-Baeza, A., & Lavie, C.J. (2020). Physical exercise as therapy to fight against the mental and physical consequences of COVID-19 quarantine: Special focus in older people. Progress in cardiovascular diseases. In press.

Joseph, R.P., Royse, K.E., Benitez, T.J., & Pekmezi, D.W. (2014). Physical activity and quality of life among university students: exploring self-efficacy, self-esteem, and affect as potential mediators. Quality of life research, 23(2), 659-667.

Kantar (2020). Accidental stockpilers driving shelf shortages.24/03/2020. Available at: https://www.kantarworldpanel.com/global/News

Kenrick, D. T., Griskevicius, V., Neuberg, S. L., & Schaller, M. (2010). Renovating the pyramid of needs: Contemporary extensions built upon ancient foundations. Perspectives on psychological science5(3), 292-314.

Keteyian, S. J., Patel, M., Kraus, W. E., Brawner, C. A., McConnell, T. R., Piña, I. L., … & Chase, P. J. (2016). Variables measured during cardiopulmonary exercise testing as predictors of mortality in chronic systolic heart failure. Journal of the american college of cardiology67(7), 780-789.

Kraemer, M.U., Yang, C-H., Gutierrez, B., Wu, C-H., Klein, B., Pigott, D.M., et al. (2020). The effect of human mobility and control measures on the COVID-19 epidemic in China. medRxiv.

Kwasnicka, D., Dombrowski, S.U., White, M., Sniehotta, F. (2016). Theoretical explanations for maintenance of behaviour change: A systematic review of behaviour theories. Health psychology review, 10(3), 277–296.

Lin, T-W., & Kuo, Y-M. (2013). Exercise benefits brain function: the monoamine connection. Brain sciences 3:39-53.

Lopresti, A.L., Hood, S.D., & Drummond, P.D. (2013). A review of lifestyle factors that contribute to important pathways associated with major depression: diet, sleep and exercise. Journal of affective disorders 148:12-27.

Lubans, D.R., Lonsdale, C., Cohen, K., & Eather, N. (2017). Framework for the design and delivery of organized physical activity sessions for children and adolescents: Rationale and description of the ‘SAAFE’ teaching principles. International Journal of Behavioral Nutrition and Physical Activity, 14.

Luo, Y., Hawkley, L. C., Waite, L. J., & Cacioppo, J. T. (2012). Loneliness, health, and mortality in old age: A national longitudinal study. Social science & medicine74(6), 907-914.

Mandolesi, L., Polverino, A., Montuori, S., Foti, F., Ferraioli, G., Sorrentino, P., et al (2018). Effects of physical exercise on cognitive functioning and wellbeing: biological and psychological benefits. Frontiers in psychology 9:509.

Marks, D. F. (2015). Homeostatic theory of obesity. Health psychology open2(1), 2055102915590692.

Marks, D. F. (2018). A general theory of behaviour. London: SAGE Publications.

Mikkelsen, K., Stojanovska, L., Polenakovic, M., Bosevski, M., & Apostolopoulos, V. (2017). Exercise and mental health. Maturitas, 106, 48-56.

Mandolesi, L., Polverino, A., Montuori, S., Foti, F., Ferraioli, G., Sorrentino, P., & Sorrentino, G. (2018). Effects of physical exercise on cognitive functioning and wellbeing: biological and psychological benefits. Frontiers in psychology9, 509.

Peterman, A., Potts, A., O’Donnell, M., Thompson, K., Shah, N., Oertelt-Prigione, S., & van Gelder, N. (2020). Pandemics and Violence Against Women and Children. Center for Global Development Working Paper (in press).

Pinto, A. D. A., Oppong Asante, K., Puga Barbosa, R. M. D. S., Nahas, M. V., Dias, D. T., & Pelegrini, A. (2019). Association between loneliness, physical activity, and participation in physical education among adolescents in Amazonas, Brazil. Journal of health psychology, 1359105319833741.

Reid, K. J., Baron, K. G., Lu, B., Naylor, E., Wolfe, L., & Zee, P. C. (2010). Aerobic exercise improves self-reported sleep and quality of life in older adults with insomnia. Sleep medicine11(9), 934-940.

Rodrigues, F., Teixeira, D. S., Cid, L., & Monteiro, D. (2019). Have you been exercising lately? Testing the role of past behavior on exercise adherence. Journal of health psychology, 1359105319878243.

Ryan, R.M., & Deci, E.L. (2017). Self-determination theory: Basic psychological needs in motivation, development, and well-ness. New York, NY: Guilford Press.

Sandford, A. (2020). Coronavirus: Half of humanity now on lockdown as 90 countries call for confinement. Accessed on 14/04/20 at:

https://www.euronews.com/2020/04/02/coronavirus-in-europe-spain-s-death-toll-hits-10-000-after-record-950-new-deaths-in-24-hou

Semenchuk, B.N., Strachan, S.M., & Fortier, M. (2018). Self-compassion and the self-regulation of exercise: Reactions to recalled exercise setbacks. Journal of Sport and Exercise Psychology40(1), 31-39.

Simpson, R.J., Campbell, J.P., Gleeson, M., Krüger, K., Nieman, D.C., Pyne, D.B., et al. (2020). Can exercise affect immune function to increase susceptibility to infection?. Exercise Immunology Review26, 8-22.

Sowislo, J. F., & Orth, U. (2013). Does low self-esteem predict depression and anxiety? A meta-analysis of longitudinal studies. Psychological bulletin139(1), 213.

Sperandei, S., Vieira, M.C., & Reis, A.C. (2016) Adherence to physical activity in an unsupervised setting: Explanatory variables for high attrition rates among fitness center members. Journal of science and medicine in sport, 19(11), 916-920.

Standage, M., & Ryan, R.M. (2012). Self-determination theory and exercise motivation: Facilitating self-regulatory processes to support and maintain health and well-being. In G. C. Roberts & D. C. Treasure (Eds.), Advances in motivation in sport and exercise. (pp. 233-270) Champaign, IL: Human Kinetics.

Tay, L., & Diener, E. (2011). Needs and subjective well-being around the world. Journal of personality & social psychology101(2), 354.

Tian, Q. (2016). Intergeneration social support affects the subjective well-being of the elderly: Mediator roles of self-esteem and loneliness. Journal of health psychology21(6), 1137-1144.

Tiggemann, M., & Zaccardo, M. (2018). ‘Strong is the new skinny’: A content analysis of# fitspiration images on Instagram. Journal of health psychology23(8), 1003-1011.

US Centers for Disease Control and Prevention. Coronavirus disease 2019 (COVID-19): situation summary (2020). Available at: https://www.cdc.gov/coronavirus/2019-ncov/cases-updates/summary.html?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fsummary.html

Yang, P. Y., Ho, K. H., Chen, H. C., & Chien, M. Y. (2012). Exercise training improves sleep quality in middle-aged and older adults with sleep problems: a systematic review. Journal of physiotherapy58(3), 157-163.

Wang, C., Pan, R., Wan, X., Tan, Y., Xu, L., Ho C.S., et al. (2020). Immediate psychological responses and associated factors during the initial stage of the 2019 coronavirus disease (COVID-19) epidemic among the general population in China. Int J Environ Res Public Health, 17:1729.

Wang, Y., Zhao, X., Fen, Q., Liu, L., Yao, Y., & Shi, J. (2020). Psychological assistance during the coronavirus disease 2019 outbreak in China. Journal of health psychology.

White, K., Kendrick, T., & Yardley, L. (2009). Change in self-esteem, self-efficacy and the mood dimensions of depression as potential mediators of the physical activity and depression relationship: Exploring the temporal relation of change. Mental Health and Physical Activity 2:44-52.

Williams, D.M. (2008). Exercise, affect, and adherence: an integrated model and a case for self-paced exercise. Journal of Sport and Exercise Psychology 30: 471-96.

Williams, W. C., Morelli, S. A., Ong, D. C. & Zaki, J. (2018). Interpersonal emotion regulation: Implications for affiliation, perceived support, relationships, and wellbeing. J. Pers. Soc. Psychol. 115, 224–254.

World Health Organisation (2020). Coronavirus disease (COVID-19) advice for the public. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public

Xiang, Y-T., Yang, Y., Li W., Zhang, L., Zhang, Q., Cheung, T., et al. (2020). Timely mental health care for the 2019 novel coronavirus outbreak is urgently needed. The Lancet Psychiatry 7:228-9.

Zaka, A., Shamloo, S.E., Fiorente, P., & Tafuri, A. (2020). COVID-19 pandemic as a watershed in health care: A call for systematic psychological health care for frontline medical staff. Journal of Health Psychology (in press).

Zandifar, A., & Badrfam, R. (2020). Iranian mental health during the COVID-19 epidemic. Asian Journal of Psychiatry 51:101990.

 

 

 

 

 

Scientific Fraud at London University

The University of London (UL) is a complex, federal institution including University College London (UCL) the LSE, King’s College London and the London Business School. The University is the world’s oldest provider of academic awards through distance and flexible learning, dating back to 1858. The UL website proudly announces that it: “has been shortlisted for the International Impact Award at the 2018 Times Higher Education Awards, known as the ‘Oscars’ for higher education.

The academic context of an institution of the size and complexity of the UL is one of intense external and internal competition. These colleges compete fiercely for resources on a national and international stage. Many of them do exceedingly well. They are obsessed by their positions in various public league tables.  For example, the Times Higher Education (2018) World University Rankings for 2019 place Imperial College, UCL, LSE and King’s at 9th, 14th, 26th and 38th places respectively in a table of 1250 universities. These rankings matter and the only game in town is to move up the table. Oxford and Cambridge are in first and second place, with Stanford, MIT, CalTech and the Ivy League universities not far behind.

Within UL itself, there is intense rivalry between the member colleges,  the Medical Schools, the Schools and departments within those colleges, research groups and units within departments, and finally, between individual academics. The  white heat of competition needs to be directly observed or experienced to be believed. Academics at every level are under huge and intense pressure to obtain research funding and to publish peer-reviewed papers in high-impact journals to raise the perceived status of their schools and departments, and to secure funding in the form of research grants and to do all of these things as quickly as possible. As a consequence, simply to stay in the race, each and every method that produces the most outstanding results will be tested and tried. Unfortunately, from time to time, this inevitably means that academics resort to fraudulent practices.

This always does harm; it harms patients, biomedicine and science.  It also harms the reputations of the individuals concerned and their institutions. For this reason, information about scientific misconduct seldom finds its way into public arenas, yet it is a notable part of ‘behind the scenes’ academic history. In “Scientific misconduct and the myth of self-correction in science”, Stroebe, Postmes and Spears (2012) discuss 40 cases of fraud that occurred between 1974 and 2012. The majority occurred in Biomedicine and the only two UK cases were at UL. Academic institutions prefer to keep scientific fraud committed by their employees behind closed doors. Then with the inevitable leaks, news of ‘scandals’ creates headlines in the mainstream media. This means that academic responses  to fraud are driven by scandals. To quote Richard Smith (2006): “They accumulate to a point where the scientific community can no longer ignore them and `something has to be done’. Usually this process is excruciatingly slow.”

There have been several examples of proven scientific misconduct involving fabrication and fraud at several esteemed colleges within London University. London University has been blighted with a high proportion of ‘celebrity’ fraud cases, a few of which are summarised below.

UNIVERSITY COLLEGE LONDON – BURT SCANDAL

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Sir Cyril Burt at University College London claimed a child’s intelligence is mainly inherited and social circumstances play only a minor role. Burt was a eugenicist and he fabricated data in a manner that suggested the genetic theories of intelligence were confirmed.   Burt’s research formed the basis of education policy from the 1920s until Burt died in 1971. Soon afterwards evidence of fraud began to seep out, as if from a leaky bucket.

Notable exposures were by Leon Kamin (1974) in his book, The science and politics of IQ and Oliver Gillie (1976, October 24) who claimed that “Crucial data was faked by eminent psychologist” in the Sunday Times 

Burt was alleged to have invented results, assistants and authors to fit his theory that intelligence has primarily a genetic basis.  It is widely accepted today that Burt was a fraudster although he still has defenders.

ROYAL FREE HOSPITAL – WAKEFIELD SCANDAL

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A fraudulent article in The Lancet falsely linked the MMR vaccine to autism. The publicity about this scared large numbers of parents.  Dr. Andrew J Wakefield and a team (1998) at the Royal Free Hospital and School of Medicine, UL,  falsified their findings. This resulted in a substantial drop in vaccinations causing unnecessary deaths among thousands of unprotected children (e.g., Braunstein, 2012; Deere, 2012). In spite of significant public and scientific concerns, the Wakefield paper was not retracted until February 2010,  12 years after the original publication.  The paper received 1330 citations in the 12-year period prior to retraction and 1260 citations since the retraction. The false evidence that MMR vaccine causes autism is widely cited to the present day, and the paper forms the backbone of an international anti-vaxxing campaign which Wakefield leads from Austin, Texas (Glenza, 2018).

ST GEORGE’S MEDICAL SCHOOL – PEARCE SCANDAL

Dr. Malcolm Pearce of St George’s Medical School, LU, claimed that a 29-year-old woman had given birth to a healthy baby after he had successfully relocated a five-week-old ectopic foetus into her womb (Pearce et al., 1994).  The report excited worldwide interest and hope to thousands of women who are prone to pregnancies that start outside the uterus and end in miscarriage. However, Dr Pearce’s patient records had been tampered with, colleagues knew nothing of this astonishing procedure, and the mother could not be tracked down. Pearce had falsified his evidence. The GMC ruled that fraud had happened and struck off his name from the register. His fraud actually ended two careers.

BIRKBECK COLLEGE AND UCL SCANDAL

Turner (2018) describes a “a major research scandal, after an inquiry found that scientific papers were doctored over an eleven year period.” Professor David Latchman, Master of Birkbeck College and one of the country’s top geneticists, was accused of “recklessness” by allowing research fraud to take place at UCL’s Institute of Child Health. The report states that UCL launched a formal investigation after a whistleblower alleged fraud in dozens papers published by the Institute.

It is alleged that a panel of experts  found that two scientists, Dr Anastasis Stephanou and Dr Tiziano Scarabelli, were guilty of research misconduct by manipulating images in seven published papers. Professor Latchman, a former Dean of the Institute, is cited as an author on all seven of the papers.  In a paper published in the Journal of the American College of Cardiology, the panel said there was “clear evidence” of cloning, where parts of an image were copied and pasted elsewhere.

KING’S COLLEGE LONDON – PETERS AND BANERJEE SCANDAL

Another college in UL tainted by fraud is King’s College. According to the King’s College’s website (https://www.kcl.ac.uk/lsm/about/history/index.aspx) the College was founded in 1829 as a university college “in the tradition of the Church of England”. The first King’s Professor to gain prominence as a fraudster was Professor Timothy Peters, professor of clinical biochemistry at King’s College School of Medicine and Dentistry, who was found guilty of serious professional misconduct in 2001. He was given a severe reprimand by the General Medical Council (GMC) for failing to take action over falsified research published by a junior doctor he was supervising (Dyer, 2001).

Professor Peters had been the research supervisor of Dr Anjan Banerjee, a junior doctor at King’s College Hospital between 1988 and 1991. Dr Banerjee, aged 41, was suspended from practice by the GMC for 12 months in December 2000 for publishing fraudulent research (BMJ 2000;321:1429). When the GMC suspended him, he had already been suspended from his job as consultant surgeon at the Royal Halifax Infirmary as a result of unconnected allegations concerning financial fraud, and he resigned after the GMC suspension. In spite of everything, Dr Banerjee was awarded fellowships at three Royal Colleges and also the MBE!  Nice work, if you can get it.

KING’S COLLEGE LONDON –  HANS J EYSENCK AND R GROSSARTH-MATICEK SCANDAL

A recent publication in the Journal of Health Psychology, ‘Personality and fatal diseases: Revisiting a scientific scandal’ by Anthony Pelosi and editorial, ‘The Hans Eysenck affair: Time to correct the scientific record’ have triggered an investigation into 61 publications by the late Professor H J Eysenck and R Grossarth-Maticek.

Hans Eysenck did his doctorate at UCL under the supervision of Cyril Burt (see section above about the Burt Scandal).

My Open Letter to the President of King’s College, London, Professor David Byrne, draws attention to the 30-year old scandal concerning the dodgy data, impossible claims and dirty tobacco money that are the foundation of multiple dubious publications by Professor H J Eysenck and R Grossarth-Maticek’s.  An investigation by KCL of these events is long overdue and a report of a review by KCL is currently awaited. Watch this space…

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<Prof Hans J Eysenck                                                                          Roland Grossarth-Maticek>

UNIVERSITY COLLEGE LONDON – AHLUWALIA  SCANDAL

The Ahluwalia scandal is described in detail by Dr Geoff. It involved multiple acts of fraud. Jatinder Ahluwalia was obviously a very shrewd operator. In spite of getting found out on more than one occasion, Ahluwalia was able to gain employment in several prestigious institutions including Cambridge University,  Imperial College London, UCL and the University of East London.

These cases indicate the relative ease with which the academic fraudster can accomplish fame and fortune at some of the most prestigious institutions in the land.  The extremely poor record of the authorities at colleges in London University in discovering and calling out fraud is something to behold.

To be continued…

Psychology and the Paranormal

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“There are more things in heaven and earth, Horatio, than are dreamt of in your philosophy.”

Thanks for the visit!

I approach this blog site with a sense of anticipation, wondering where it may lead…

I hope it might lead towards light, new treasure, in the form of new knowledge and theory.  

How can that be, you might well ask ?  Surely, a so-called ‘expert’ must already have an opinion one way or the other about the paranormal? Wrong!

The truth is that I have no fixed ideas about which direction the evidence will lead. 

One thing I do know – it is necessary to step beyond old assumptions, seek new objects of knowledge. 

If we already KNOW the answer, the TRUTH, why would we bother to read, write or even THINK for that matter, because the truth must already be determined, already out there, written by somebody, somewhere and all that would be left to do would be to pick up dead learning.

Believers vs. Disbelievers

It is quickly apparent to any observer that the paranormal field is heavily divided between two armies of believers (so-called ‘sheep’) and skeptics (so-called ‘goats’ who are actually dis-believers) battling it out with no holds barred.

The stakes are high. The fight is not about empirical studies, observations and anecdotes.  The very nature of science, life and reality are being contested.  

There are ‘dead bodies’ and ‘unexploded land mines’ all over the place and one would be lucky to leave the field in one piece. One can surmise that there can only be losers, never winners, in this futile type of war. In the end every soldier in the affray is a loser. It’s an intellectual version of World War I with permanent trenches and barbed wire fences that has been waging for over a century.  

I know this because I have been there on the battle field.  I entered the field and did several tours of duty. Then, battle-weary with the affray, I walked away.

Recently I returned to see if anything has changed.

As I stuck my head over the trench top waving a white flag of peace, a few warning shots were fired. The same old battle is raging but with the difference that many new foot soldiers have been recruited and there have been scores of  new studies over the last 20 years. These studies have been weaponised to provide increased power, precision and impact.

The army of non-believers now possesses a stockpile of findings consistent with scientific explanations of the paranormal. The believer army, meanwhile, has accrued an equally large stockpile supportive of paranormal interpretations.  

White Flag of Neutrality

Offering the white flag of peace and neutrality causes no small amount of trepidation.  Am I now to be a target for both sides – because, in the battle of the paranormal, nobody is permitted to be neutral?  It’s a ‘do or die’ scenario like no other in science.

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The blog posts here are written from a dispassionate point of view. If I am passionate about anything, it is about the importance of neutrality. My purpose is to create a balanced and even-handed review based on the best contemporary evidence on paranormal claims in science and medicine.

I present here the evidence, both pro and con, explain the relevant psychological processes, present scientific arguments, and produce a final balance sheet at the end.

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Out soon:

“Psychology and the Paranormal

Exploring Anomalous Experience”


June 2020 | 400 pages | SAGE Publications Ltd

 

 

 

Cochrane Catastrophe

Peter Gøtzsche’s Expulsion Triggers Mass Resignation

The Board of a prestigious scientific organisation, The Cochrane Collaboration,  recently suffered a mass resignation.  This post documents the reasons why, using the words of the organisation itself. The board has been reduced from 13 to 6 members, following a vote to expel a founding member  for the first time in its 25-year existence.

On 14 September, Peter Gøtzsche, director of the Cochrane’s Nordic Centre and a member of its governing board, posted a statement on the centre’s website. This announced that he had been expelled as a member of the Cochrane Collaboration, after a vote by 6 of 13 of the board’s members.

A further four elected members of the board — which also has appointed members — stepped down in protest. To maintain a balance between appointed and elected members, the board also asked two appointed members to resign.

Gøtzsche claims no justification was given for his expulsion except that he was accused by the board of bringing the organization into “disrepute”. The organization — which carries out systematic reviews of health-care interventions — told Nature it had received “numerous complaints” about Gøtzsche after the publication earlier this year of a critique he co-authored, entitled ‘The Cochrane HPV vaccine review was incomplete and ignored important evidence of bias’ and published in the BMJ Evidence-Based Medicine.

Who or What is Cochrane?

I quote from the Cochrane website:

“Cochrane is for anyone interested in using high-quality information to make health decisions. Whether you are a doctor or nurse, patient or carer, researcher or funder, Cochrane evidence provides a powerful tool to enhance your healthcare knowledge and decision making.

Cochrane’s 11,000 members and over 35,000 supporters come from more than 130 countries, worldwide. Our volunteers and contributors are researchers, health professionals, patients, carers, and people passionate about improving health outcomes for everyone, everywhere. Our global independent network gathers and summarizes the best evidence from research to help you make informed choices about treatment and we have been doing this for 25 years.

We do not accept commercial or conflicted funding. This is vital for us to generate authoritative and reliable information, working freely, unconstrained by commercial and financial interests.

Our Strategy to 2020 aims to put Cochrane evidence at the heart of health decision-making all over the world.”

The Strategy to 2020 has hit a stumbling block. GOAL 4 is or was: “Building an effective sustainable organization.”

“To be a diverse, inclusive, and transparent international organization that effectively harnesses the enthusiasm and skills of our contributors, is guided by our principles, governed accountably, managed efficiently, and makes optimal use of its resources.”

In light of the torpedo the shambolic Governing Board has fired at its own organisation, the expulsion of Peter Gøtzsche, Goal 4 of the Strategy now reads like an ill-timed joke. The statement that spells the end of Cochrane is quoted below.

Bizarre Situation

The Cochrane website is currently as bizarre as can be. A Screen Shot taken this morning 2018-09-27 at 07.05.55 shows an announcement of Peter Gøtzsche’s expulsion immediately followed by the announcement of the 25th Anniversary event to celebrate Peter’s Nordic Cochrane Centre and the foundation of the Cochrane Collaboration:

Screen Shot 2018-09-27 at 07.05.55

Statement from Cochrane’s Governing Board

Statement made by the Governing Board at Cochrane’s 2018 Annual General Meeting, 17th September, at the Edinburgh Cochrane Colloquium

“Dear Cochrane members,

These are extraordinary times and we find ourselves in an extraordinary situation. Your Board is always happy to answer questions about our decisions, and today is no different. We want to explain how we got here today. This wasn’t our original plan because we wanted to behave fairly and with integrity, in a process that respected the privacy of an individual, whilst taking place over a number of days. Days, which unfortunately span this special Colloquium.

This is about the behaviour of one individual. There has been a lengthy investigation into repeated bad behaviour over many years. It is exceptionally unusual for a Board to have to do such an investigation.

Last Thursday, the Board took a decision which divided the Board. Subsequently, four Board members chose to resign. At the same time, others contributed to a public and media campaign of misinformation.

We recognize that the last 24 hours have been exceptionally difficult and as a result, we as a Board have decided to share with you information about the decision that was made, the process by which it was made, and where we are now, in order to act in the best interests of Cochrane.

We now want to put before you as much evidence as we can, so you know what is going on. We cannot tell you everything. All of you will understand why individuals have a right to privacy and confidentiality. We ask that you all respect this, because we may not be able to tell you everything, for legal reasons and reasons of privacy.

By way of background, we are a global organization which operates under British law because we were founded as a UK charity. Our mission is to benefit the public. We are governed by our Articles of Association.

As the Board, we are in fact the employers of the Cochrane staff. All our staff, and our members, have the right to do their work without harassment and personal attacks. We are living in a world where behaviours that cause pain and misery to people, are being ‘called out’. This Board wants to be clear that while we are Trustees of this organization, we will have a “zero tolerance” policy for repeated, seriously bad behaviour. There is a critical need for ALL organizations to look after their staff and members; once repeated, seriously bad behaviour had been recognized, doing nothing was NOT an option.

So, here are the facts as we are able to report them. We may be able to tell you more later, we may not. Time will tell.

This Board decision is not about freedom of speech.
It is not about scientific debate.
It is not about tolerance of dissent.
It is not about someone being unable to criticize a Cochrane Review.

It is about a long-term pattern of behaviour that we say is totally, and utterly, at variance with the principles and governance of the Cochrane Collaboration. This is about integrity, accountability and leadership.

In March this year, we received three complaints about an individual. These were not the first complaints that had ever been received. In fact, the earliest recorded goes back to 2003. Many have been dealt with over the years. Many disputes have arisen. Formal letters have been exchanged. Promises have been made. And broken. Some disputes have been resolved, some have not.

It was clear to the Co-Chairs that the Board had to reach a decision about these most recent complaints. The individual then made serious allegations against one of the Senior Management Team and shared those with the Board. We seemed to be in an impossible situation. How could the Board now reach a decision about the complaints in a fair way? How could we fulfil our responsibilities as employers of the Senior Management Team? Or alternatively, act to admonish that member of the Senior Management Team if they had done wrong?

With guidance from a Trustee with extensive experience of complaints, we proposed asking a totally independent person to undertake a review. The report was to be confidential to the Board.

After failing to get agreement from the individual to an independent review, we then sought legal advice on behalf of Cochrane. We asked the lawyers, what should a Charity such as Cochrane do in this situation? We were advised that various legal consequences flowed from the events – the complaints and the accusations – and that Cochrane should take them seriously.

We asked the lawyers to take particular note of Cochrane’s commitment to transparency. They noted that, but also stressed the importance of confidentiality.

They advised that an independent review was both a sensible and proportionate response.

At the Governing Board Teleconference on 13th June 2018, all Board members read the letter from our lawyers. The lawyers stated that given the serious legal concerns about this matter they strongly recommended an independent review by a very senior lawyer. The Board approved a motion to accept the lawyer’s advice and establish the independent review.

Our lawyers identified a senior independent lawyer (QC) and he was instructed on 2nd July 2018. As part of the process, he invited written submissions from both individuals concerned. He invited both to be interviewed. The lawyer was asked to work to a deadline of the Board Meeting on Thursday last week, 13th September. And, we did in fact receive his preliminary report in time for that meeting. The report completely exonerated the member of the Senior Management Team but did not exonerate the other individual.

Whilst the review was underway, and as a completely separate matter, a paper was published in the journal BMJ-EBM co-authored by the individual concerned on July 27th 2018. The publication of this paper has proved controversial. As a result, the Board received a number of letters of complaint. Each was sent to the individual to allow a written response. In order to avoid any misunderstanding, the Board want you to be clear that this was a matter that arrived very late in this whole process.

So, at the Board Meeting on Thursday September 13th, the trustees reviewed the lawyer’s report of his independent review, and all the material related to the recently published paper. After they had reviewed and discussed this at length, the Trustees exercised their judgement, and looking across a broad range of behaviours, the Board came to a decision to invoke Article 5.2.1. relating to termination of membership. This was not unanimous.

As a result, Article 5.3 was triggered, and the member has been invited to make a written response within seven days.

At this point in time, this person remains a member of the Cochrane Collaboration. We are waiting for the process to be completed. We will report back to you about the outcome as soon as we are able to.

Let us repeat, this is an extremely rare and unusual thing to do. We hope never to have to do this again.

Cochrane Governing Board
Edited (without prejudice): 19th September 2018

Wednesday, September 19, 2018″