Blog: "The patient voice: a biased or valuable source of information?"

I disagree. In the context that the PhD student was meaning this is exactly what we want.

I am pretty sure the student was forced to listen to some drivel put on by the department to illustrate the emotional story of someone cured by CBT. That ought to put anyone off, oughtn't it?

What's more the student was disparaged as 'biomedical'. That isn't a category based on speciality it is a category based on prejudice and contempt.

 

The guy who is quoted on the blog (Casper Schoemaker) is paediatric rheumatologist like Esther Crawley. He is heavily in to patient choice and apparently critical of evidence evaluation by things like GRADE - reminiscent of Turner Stokes I guess. Clearly very much up in the Gordon Guyaltt controversy about evidence standards. Presumably he thinks being 'biomedical' is a Cartesian fallacy and all that stuff. Doesn't;t think bias is too important.

Don't be fooled!

 

I think i've missed a thread... ?

Who are clarity?

 

Just to pick up on the n=1 point – as a mathematician, finding a single counter-example destroys a hypothesis. Now of course that isn't appropriate in fuzzy real life, but n=1 accounts should at least challenge assumptions.

 

This is moronic on a basic level.

Has this person ever been to the doctor? You don't just walk in and sit there silently, hoping that the doctor somehow divines your issue. You say that this hurts or that itches or that one thing is not working very well anymore.

I agree that you have to be highly caught up in some sort of weird indoctrination and ideological medical politics to be able to generate this piece of writing. If you are looking at the world with anything close to a sensible lens none of this verbiage would ever occur to you.

 

I also found this bizarre and disturbing. What is a "biomedical" PhD student? Do people really talk like this? Worrying.

 

This piece is sufficiently vague and fluffy that it acts as a bit of a rorschach test for what people want to get annoyed about. Although that doesn't necessarily make it totally bad.

This sort of vague philosophical-type thinking seems to be pretty popular amongst some medical professionals. And I never really get the impression they're that good at it - a lot of assertions without proper evidence, muddling similar but different concepts together. Basically just talking vaguely and broadly about concepts in a way that seems clever at a distance, but if you look closer is confused and lacking in substance. There does seem to be a lot of that sort of thinking amongst BPS type theories and thinking about things like functional and somatization disorders.

Anyway so I struggle to see the exact point this piece is making. Maybe he's just saying people should have more empathy for patients and listen to them more? Or maybe it's an argument for N=1 trials becoming the gold standard? There's really a lot of room for interpretation, although I think it's more likely to be the former.

I feel like people are being a bit harsh on this guy for writing a pretty benign piece though. Some things he wrote in a paper he authored do seem to indicate he holds a fairly BPS view of disease but I don't know if that's worth discussing.

 

We use the term biomedical in the way that people are forced to use the artificial term 'allopathic', invented by the homeopaths, to describe real medicine. I don't know who coined 'biomedical' but I suspect the touchy-feely BPS people - as in 'over-medicalisation'. I have never much liked the 'biomedical' term but it has a fairly easy to grasp meaning.

But the key point here is that we use biomedical not to define a person belonging to a speciality - like a gynaecological or rheumatological - but to define a way of thinking about causation. The author in the piece refers to the PhDs as biomedical. That must be a comment about way of thinking. It is like saying 'all these allopathic PhDs' which of course nobody who believed in real medicine (as opposed to homeopathy) would say.

 

Yes, but I think to be realistic we have to assume that if a PhD student really said this about n=1 rather than doctor Schoemaker dreaming it up they would have assumed that it was in the context of experiments about causation and specifically trials where in general single exceptions - i.e. non-responders - do not tend to refute relevant hypotheses.

I would bet my bottom dollar that the PhD student raised this concern because the invited patient was talking about something that was supposed to bear on causation using an n=1approach - very likely because Schoemaker and his friends have a bee in their bonnet about this being valid after all - just like Garner and Turner-Stokes.

 

To be clear, there are two people involved. One is Casper Shoemaker, who is a reasonably ancient paediatric rheumatologist. His gossip is being given blog space by a young NIHR research fellow interested in ethics.

 

If you look at his publication list you can see it is the latter dressed up as the former. It is also the new received wisdom for the multidisciplinary team brigade all the way from Guyatt, Glasziou and Garner to Turner-Stokes and the Bristol psychology team. It is a very specific form of double-think.

 

Biomedical science is a thing. My eldest daughter did a degree in this at Queen’s University Belfast. A quick Google shows that other Universities also offer such degree courses.

https://www.qub.ac.uk/courses/undergraduate/biomedical-science-bsc-b940/

My youngest daughter did Bioveterinary Science. So it seems adding “bio” means there is no confusion regarding the end destination of the students. My daughters are scientists not doctors or vets.

 

What the 'patient-centre' educationalists of today may forget is that in theban old days of the 1970s patient's stories were the centrepiece of an educational session - in those days the Grand Round. The first half of a presentation was the patient's account. This was normally formalised by the presenter but it was considered bad form not to have the patient present (for an audience of maybe 200) to answer questions about details.

 

That is a point. It has another meaning in that context - science teaching relevant to medicine rather than nuclear physics or botany.

It might be that the author is referring to Biomedical Science PhDs but I think not because Biomedical Science in the curriculum sense is only an undergraduate course - as you say specifically designed to indicate that it is not part of a clinical course. Moreover I think the author would have capitalised if there really were Biomedical PhD courses. Certainly at UCL PhDs come under the discipline - Immunology, Physiology, whatever.

So actually I am not sure that biomedical science is a thing. Biomedical Science courses are things just as we used to have a Clinical course as a second stage of a medical degree.

 

Thinking about it I think there is a further division of meanings. The BPS people consider biomedical to be a way of thinking. On here we use biomedical to refer to items of research that tackle biomedical rather than psychosocial questions. The BPS people would of course say that focus on these is narrow minded but even they would have to say measuring cytokines is biomedical research in a way that asking about childhood trauma is not.