Saturday, September 13, 2008

No evidence-based treatment for anorexia?

According to this study, which is an overview of 40 years of eating disorders treatments, there are still no evidence-based treatments for anorexia nervosa. "A specific form of family therapy (based on the Maudsley model) appears promising," write the study's authors.

Appears promising? Actually, FBT, or the Maudsley approach, has been shown to be successful (85 to 90 percent long-term recovery rates) for treating both anorexia and bulimia. In the last 10 years there have been several good studies on FBT, including this one, this one, and this one.

And yet some of the top researchers in the field are still saying that there is no evidence-based treatment for anorexia, and that the Maudsley approach "appears promising." Which is rather like saying that there appears to be a link between smoking and lung cancer.

After 40 years with no other good treatments, you'd think researchers would jump on this one. So why the damning with faint praise?

Come on, you guys. You're the ones who can get the word out to parents best. You have a moral obligation to spread the word about FBT--the ONLY evidence-based treatment we've got at the moment for treating anorexia. I'll be thrilled if we turn up more treatments that are effective. In the meantime, though, let's use what we've got.

11 comments:

Anonymous said...

The article was published in the Nordic Journal of Psychiatry. With all apologies to our Norse friends, I wouldn't consider that as authoritative as being published in one of the more well-known journals.

marcella said...

I agree - use what we've got. But it is the job of the researchers to keep researching and developing better treatments. This article (yes, I KNOW it's 3 years old, lets hope things are progressing fast) http://www3.interscience.wiley.com/cgi-bin/fulltext/110472689/PDFSTART
gives the evidence as "barely" there, because, in scientific terms, it is. Maudsley has proved VERY successful within those teams who have systematically used it with adolescents. It hasn't yet been tried properly with adults and with those with longer duration of illness.

Harriet said...

Marcella,
Since the vast majority of ED casse start in adolescence, any treatment with a 90% success rate in adolescents is going to change the face of the disease.You know and I know that once anorexia becomes chronic it's devilishly difficult to treat. It's much easier to treat in adolescence. To say that Maudsley is not a valid evidence- based treatment because it hasn't been tried yet with adults is like saying, I don't know, that treatments for juvenile diabetes aren't valid unless they work for adult onset diabetes too.

In terms of Maudsley being "barely" there--while the studies are relatively recent, the treatment has been used with great success in the UK for 20+ years. I know that your family did not benefit from Maudsley treatment, and I am sorry. I hope researchers continue to develop new treatments and to study these wretched illnesses.

But I want to make it clear that there IS a successful evidence-based treatment for anorexia and now bulimia in adolescents and young adults.

marcella said...

Maybe the Nordic Journal is guilty only of repeating somewhat older findings like that of Prof Fairbairn in 2005 which I quoted above. Here's more evidence on the side of Maudsley http://www.informaworld.com/smpp/content~content=a792183737~db=all~jumptype=rss
which specifically states "At this time, the evidence base is strongest for the Maudsley model of family therapy for anorexia nervosa".
Harriet I'm not wishing to argue against your point that FBT is evidence based and should be used as the first line of defence everywhere. ALL clinicians need to be up to date on the latest research and offering the best we have available immediately to all their clients, and, to date, that's FBT.
However I don't think it's the job of researchers to get that word out, it's their job to research and that will, by its very essence, involve argument and testing to the limits because that's the only way of proving anything scientifically.
It's the job of clinicians and health care managers to look at the evidence and educate patients and carers about it - and as parents we have a responsibility to use our brains (and google!) too.

Harriet said...

I agree that researchers should focus on research and not on publicizing treatments. :-) In this case, the researchers misspoke in a serious way, and I wanted to help set the record straight.

Parents have the responsibility to research, but when your child is diagnosed with an ED, you're so often in crisis with little time to think clearly. The more people know about their options, the better for everyone.

marcella said...

Another link for you http://amhi-treatingpreventing.oup.com/anbrg/private/content/mentalhealth/9780195173642/p093.html and then I really will stop googling for the afternoon and start doing something more immediately useful

Anonymous said...

Why the "damning with faint praise"?

Probably, lack of studies replicating results at multi-center trials that have a nurses-study stretch of data. At this time, with the research in hand and the time under our belt, this method looks promising so far ... but we haven't seen these kids' *full* lifetime course of wellness or illness, recovery or relapse.

More than one generation, for an illness like anorexia, is probably necessary to establish true, replicable, standardized treatment protocols and expected outcomes.

And many of the families using home-based care aren't documented in the ways science likes to track things. Because they're often at home and not in hospital units. And some parents eschew the ED professional establishment in favor of PCPs and a supportive network of non-"expert" providers. It's probably too loose a connection of factors to conclusively say in journal-speak that we can and should put most of our eggs in this basket, especially considering the age and staging limitations at this time,

I don't think the wording discounts the promise or validity of Maudsley models.

Carrie Arnold said...

Another part of the reason may be in the nature of language in scientific journals. Researchers are always going to say things like this in the most conservative manner possible. Making exaggerated claims is one of the quickest ways to be pilloried in the scientific community.

Comparatively, the research on Maudsley treatment isn't nearly as robust as is on many other illnesses. It's hard to study anyway, and the numbers of sufferers are fairly low. Trials are long and costly, and criteria for recovery are hard to measure. It's been in limited use in the UK for 20 years, but most of the Brits I know with EDs aren't receiving anything close to FBT. The treatment is in name only.

I agree that Maudsley is the best treatment out there. And I disagree with the authors' phrasing. But, as a scientist, I do understand it.

Anonymous said...

Hi, sorry this isn't totally relevant, I just wanted to be sure people saw this chillingly dead-on Jezebel post:

http://jezebel.com/5049949/do-not-forget-this-eating-disorders-and-the-long-road-to-recovery

marcella said...

Carrie - you've said just what I wanted to say, but being both a scientist and a writer, you've said it so so much better.

mary said...

Perhaps as more and more families, including those who SWITCH to a family based approach after too many years of failed attempts, the numbers will rise and the voices will begin to be heard. I doubt my daughter ever got "counted" as a home based recovery! Researchers are limited to the studies they use and that can be a narrow group, IMO.
How nice it would be if there was a way around the work! A magic pill that blocks the negative voice. Perhaps they are getting closer. Nutrients are as magical as we can get. Omega 3 oils and b complex are also mighty good mind healers along with certain other valuable chemicals needed to keep the mind well. Still, when we work our lives, ED's or any other issues, and we invest in ourselves and help ourselves, we can come out stronger. This may be why home based recovery is best regardless of the "family" that's used. (it might not have to be mom and dad)
I have great respect for the different paths people take but how I wish I could send the strength to those who freeze in fear when a disease hits the family. And send help to those with stubborn and rebellious kids!