“We can’t tell you what proportion recover, we can only tell you what proportion clinically significantly improve”

This is the bizarre mantra from NHS Talking Therapies digital partner, SilverCloud. The latter platform is based in Ireland and until recently it boasted ‘up to a 70% clinical recovery rate’. I protested to the Irish Advertising Standards that this was fraudulent, and Silver Cloud have since withdrawn any claim as to recovery. I explained to the ISAA that recovery has a clear meaning to a member of the public, as back to their old self or best functioning. As SiverCloud studies have never demonstrated achievement of this metric, it was highly misleading. Its’ new vanguard claim is ‘up to 65% of users achieve clinically significant improvement’. But I wouldn’t change my internet provider if the would be provider claimed an ‘up to particular speed’, I would smell a rat. 

The term ‘clinically significant improvement’ only has meaning if the population being addressed is clearly specified. The mnemonic PICOT is recommended by the NHS and NICE to establish the credibility of an intervention. The ‘P’ stands for population, established with a ‘gold standard’ procedure. But in none of the studies cited by SilverCloud has the ‘population’ been crystallised using a standardised diagnostic interview  nor has outcome , the “O” been determined by a blind independent assessor using a ‘gold standard’ interview. The cited SilverCloud studies lack any credibility. 

It is disingenuous of SilverCloud to now claim ‘up to 80% of participants show improvement in depression and anxiety symptoms’. Once again we have the advertising gimmick of ‘up to’. With no specification of who the ‘participants’ are with regards to the P of PICOT. The platform has not used a credible attention placebo to determine whether any identified changes are any more than regression to the mean. Similarly stating ‘93% users satisfaction’   is no more compelling than restaurant owners saying 93% of customers said they were satisfied when asked, leaving the premises. 

Why does NHS Talking Therapies associate itself with SilverCloud? It offers the alluring prospect of wide dissemination of a service at minimal cost. Quite simply it is fixated on a fantasy, such a state of mind is a recipe for abuse. The time is long overdue for NHS Talking Therapies and NHS Managers to be properly regulated.

Dr Mike Scott