Thursday, April 21, 2016

Reductio ad Absurdum: A Webinar with Dr. Avi Nath

On April 21, Solve ME/CFS Initiative hosted a webinar with Dr. Avindra Nath, NINDS intramural clinical director, and the lead investigator of NIH's ME/CFS study. (For those who missed it, the webinar is available on the Solve CFS Youtube channel.)

The first half hour of the talk centered on the NIH study: how it will be structured, how patients will be selected, and how they will be tested. (This information has been presented elsewhere on this blog, so I will not summarize it here.)

In the second half hour, Dr. Nath responded to questions from the listeners, which Dr. Zaher Nahle, Solve ME/CFS Initiative's Vice President for Research and Scientific Programs, was kind enough to deliver.

The first question put to Dr. Nath concerned bias among people involved in the NIH study. The answer was "I can't give a litmus test to every researcher."

There was clearly a misunderstanding about the scope of the question, so Dr. Nahle rephrased the question to ask specifically about bias among the NIH staff. Once again, Dr. Nath responded by reducing the question to absurd proportions, claiming that he didn't have time for "psychological games."

Neither did Dr. Nath have time to talk to Drs. Fluge and Mella. "I can't talk to everyone who has done a study," is how he answered that question. Of course, Fluge and Mella aren't "everyone." The third phase of the NIH study will involve testing immunomodulatory drugs, one of which may be rituximab. Nobody knows more about the effects of rituximab on ME/CFS than Fluge and Mella, so one would think that a consultation would be prudent.

There was not much time for further questions, but I have no doubt that Dr. Nath would have sidestepped those as well.

Reductio ad Absurdum

In rhetoric, the device known as reductio ad absurdum is employed to avoid addressing an opponent's argument. By reducing an argument to absurd proportions, not only is a pall cast over the opponent's point, the discussion effectively comes to a halt.

Dr. Nath has demonstrated this technique on prior occasions.

During the NIH telebriefing, Charmian Proskauer, President of the Mass CFIDS/ME/FM Association asked if 40 patients were too few for the study. Dr. Nath replied "If you need to have a thousand patients to find something, it probably isn't worth finding." There are numbers, perfectly reasonable numbers, between 40 and 1000. One hundred, for example, is a reasonable number. But, by exaggerating Ms. Proskauer's argument, Dr. Nath neatly sidestepped the question of whether we really needed another pilot study.

In like fashion, "I can't talk to everybody" sidesteps the question of whether Dr. Nath will confer with two researchers involved in the only current large-scale study on a drug that has shown promise for ME/CFS patients.

As for the question of bias, "I can't do a litmus test on everybody," "I can't read minds to see who is biased," and "I don't have time for psychological games," are reductio ad absurdum arguments as well. Nobody has asked Dr. Nath to read anyone's mind. We have simply questioned the appropriateness of three (only three) staff members, two of whom are in key positions.

The true intent of reductio ad absurdum responses is to belittle the opponent. When this type of rhetorical strategy is employed, the person using it is not only seeking to avoid replying to a point, but to diminish the person making it. (Reductio ad absurdum is only one step removed from ad hominem attacks, which belittle the person directly. Both are considered logical fallacies.)

The questions posed to Dr. Nath today were phrased respectfully. They addressed concerns that should be taken seriously by anyone conducting a study at public expense. Public scrutiny is to be expected under these circumstances, and yet Dr. Nath appears to believe that we should not be looking at who performs the study, or examining the protocol, or, in fact, asking any questions at all.

Our tax dollars are paying for this study. It is not only our right to know what the federal government is spending our money on, it is an ethical duty on the part of the government to make full disclosure. Above all, a clinical trial should never be conducted in secrecy, for obvious reasons. And a trial that has even a remote possibility of bias or mismanagement should receive even more scrutiny. That is how good science is conducted.

Researchers who maintain an attitude of scorn towards the subjects of their studies rarely produce good research. And researchers who do not bother to thoroughly investigate prior as well as current research uniformly produce bad research. While Dr. Walitt has been open about his bias (even while denying that he has one), it is becoming increasingly clear that Dr. Nath's dismissive "I can't be bothered" attitude will be equally problematic in this study.


  1. He doesn't have to mind read or do a Litmus test. They have openly expressed their bias and ignorance.

  2. Dr. Nath's comment about the "anxiety" of the ME/CFS community regarding the Reeves definition was all I needed to hear.
    Either he is completely ignorant of the sordid history of Reeves involvement, or is choosing to sidestep the issue by blaming the patient community for an unreasonable emotional behavior.

  3. Thanks Erica for highlighting the absurd tactics used by Dr Nath to deflect legitimate questions and cast aspersions on those who dared question him. He obviously bristled when he felt his authority and expertise were slighted. Does he really appreciate input from the patient community or was his participation in the webinar just a token gesture?

  4. Erica, has anyone considered lodging a complaint with the Inspector General, since this is being publicly funded?

  5. My late wife and I were so abused by numerous doctors from India that we developed PTSD. I will never be willingly treated again by a doctor from India.
    Char killed herself over the 20 years of suffering she endured at the hands of these people.

    1. According to Dr. Nancy Klimas, patients with ME or CFS in the US that she sees have already been so abused by doctors (of any background) that they could be diagnosed with PTSD. So it might be the prejudice all doctors and researchers have against our disease, not something to do with his background.

      Dharam Ablashi, the co-discoverer of HHV-6A, has been wonderful to my family. He is Pakistani. I don't think good and bad come in national labels when it comes to this disease.

    2. I'm sorry - I forgot to say that I AM sorry for your loss.

    3. We spent nearly 5 years in an RV coast-to-coast while I was still consulting and Char had seen many many doctors before encountering these doctors from India. Our favorite Primary Care physician was from Lebanon. We were far from prejudice but these doctors from India were so terrible that Char publicly acknowledged our new found prejudice on her blog. It's not something we were proud to admit.

  6. My late wife and I were so abused by numerous doctors from India that we developed PTSD. I will never be willingly treated again by a doctor from India.
    Char killed herself over the 20 years of suffering she endured at the hands of these people.

  7. Thank you for expressing my own concerns so clearly. All I get from other patients is criticism - they don't understand the composition of the data set is all-important, and even more so with only 40 patients! [I cannot believe that Nath does not know the rule of thumb for statistical research is 50 in the data set + the number of variables you want to use.] The problem is magnified by the heterogeneous nature of this disease.

    To some extent, the problems with Walitt and Saligan fall more within the disciplines of social science than the hard sciences. The very idea of prejudice isn't scientific - and it sounds insulting. But Walitt (who is on record as of last year saying that CFS and fibromyalgia are classic examples of somatoform disorders) and Saligan (who sees CFS as a "behavioral" disorder) both will be bringing preconceptions into their work, preconceptions that we just do not deserve, at best. At worst, they may influence who ends up in the very small set of 40 patients.

    I have been told that they are not going to have input into patient selection; they're just going to WORK with the patients. Again, the patients deserve better than that - better someone with NO preconceptions than someone with insulting preconceptions.

    I'm also told "they know what they are doing" about the way patients are going to be selected. How hard is it to reassure us that they aren't prescreening patients using the CDC questionnaires (aka the Reeves questionnaires aka the Reeves definition aka Reeves' "operationalized Fukuda definition" - same bad questionnaires, called different things for expediency).

    Patients do not understand that the study's validity is dependent on the data set. You won't learn much about cancer if you only study patients who have diabetes.

    If we just "wait and see what happens," it will be too late. I wish there was some way he would just LISTEN.

    1. Spot on Mary. This project was meant to fill the empty hole that was the NIH effort on ME/CFS and give sustenance to long-suffering patients. However it looks like we are being fed a dog's breakfast of a study design with a unclear selection criteria, too many comparisons from too few subjects, a study leader who appears to lack expertise in the topic, and some biased investigators. We'd be better off if they did nothing.


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