Phoenix Rising tells QMUL: release the PACE trial data
Mark Berry, Acting CEO of Phoenix Rising, presents the Board of Directors’ open letter to Queen Mary University of London (QMUL) urging them to release the PACE trial data, and hopes that other non-UK organisations will join British charities in the same request…
On 1 February, ME/CFS patient Clark Ellis wrote an open letter to seven major British ME/CFS charities to ask them to contact QMUL.
He wanted them to write their own open letters to request QMUL to abandon its appeal against the Information Commissioner’s decision that it must release PACE trial data to a patient who had requested it for independent analysis. All other attempts over the years to obtain this key data have failed.
Although Phoenix Rising is a US-based non-profit, we think it important that all charities act to support the release of the data so that the controversy over the PACE trial can be resolved and patients can base their treatment decisions on sound information.
Those groups without the time or resources to draw up their own letter are encouraged to write to QMUL, endorsing any of the other letters already published online by other organisations. Groups joining the growing list of organisations calling on QMUL to release the data are asked to publish their action on their websites, and to contact Clark Ellis to let him know that they have done so.
Below is the text of the letter that we sent to QMUL on Monday 8th March, to the Records and Information Compliance Manager and to Professor Simon Gaskell, the Principal of QMUL.
Dear Sir/Madam,Re: Freedom of Information Act request to QMUL for release of PACE trial data
According to a public statement made by the PACE investigators on 18 December on QMUL’s website:
“We are currently seeking further ethical and scientific advice, as well as the advice of patients, on how best to provide independent decisions about appropriate access to relevant data in a way that balances the rights of trial participants, and future progress of the trial analysis and follow up, with the public interest in releasing trial data.”
Phoenix Rising is a patient-led non-profit that provides the world’s largest internet forum for patients with ME/CFS. We have over 14,000 members and are therefore well placed to contribute to the “advice of patients” that you and the investigators are seeking in relation to the trial.
In this capacity, we strongly advise you to immediately release the anonymised PACE trial data to the independent investigators who have requested it and to abandon your appeal against the Information Commissioner’s decision that you should release it to Mr Alem Matthees.
You will be aware of the serious problems with the PACE investigators’ handling of the study’s data analysis. These problems include abandoning protocol-specified main outcome analyses partway through the trial when the trend towards the eventual poor overall outcome could already have been apparent. The replacement analyses included “normal ranges” for fatigue and physical function with such low thresholds that patients could worsen during the trial and yet be in the “normal ranges” for these measures. The threshold for patients’ “recovery” of physical function on the SF-36 scale was dropped from a score of 85/100 to 60/100: that is, below the threshold for trial entry (65/100) and close to the mean score for patients with Class II congestive heart failure (57/100). These changes will inevitably have produced inflated and misleading estimates of clinical effectiveness and recovery, making it impossible for patients and clinicians to make informed decisions about treatment.
Such flaws, and the PACE authors’ failure to adequately address them, have caused a catastrophic loss of confidence in the trial among patients worldwide. This loss of confidence is now shared by an increasing number of scientists as the failure to release the data gains public attention. The scale of this loss is demonstrated by open calls for the release of the data to independent investigators, in sources including:
commentary by Dr Richard Smith, former editor of the BMJ, on the BMJ’s blog; and on PLOS’s blog by Professor James Coyne, who himself has requested and been denied anonymised PACE data.
There is no risk to trial participants that their rights to privacy will be infringed by release of the requested anonymised data, as the Information Commissioner has already ruled. The PACE investigators have had over five years to analyse and publish on the basis of the trial data and it is long since time that they allowed other researchers access. The International Committee of Medical Journal Editors now propose a new norm — that study authors must share the anonymised individual patient data underlying their published results within 6 months of publication — and they base that proposal on “an ethical obligation to responsibly share data generated by interventional clinical trials because participants have put themselves at risk”. We agree. We do not believe that patients risked their health in the PACE trial so that its authors could evade scrutiny of their questionable analyses by preventing other researchers from reanalysing the data.
The PACE trial cost £5 million of public money and the controversy surrounding it can only be resolved by releasing the data. As Dr Richard Smith said, concerning the failure to release the PACE data so far: “QMUL and King’s are making a mistake… the inevitable conclusion is that they have something to hide.” It is clearly and overwhelmingly in the public interest, the interest of patients, and the interest of QMUL’s own reputation that you now release the data. We urge you to do so without further delay.