Can psychiatry make medicine better? Michael Sharpe, 29 Nov 2022

In the lecture, entitled ‘Can psychiatry make medicine better: a tale of three trials’, he will summarise several decades of research he has led into the contribution psychiatry can make to medical care including three major clinical trials.
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i wonder which trials he will be discussing....?
 
Sly Saint said:
he's very established in the US on this; see post here
https://www.s4me.info/threads/light...roval-february-2022.14876/page-14#post-263595
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It's established despite zero evidence of usefulness.

One of Sharpe's paper: https://www.s4me.info/threads/the-e...mized-trials-2021-toynbee-sharpe-et-al.20568/
Study conclusion said:
Whilst we found no evidence that any of the inpatient C-L Psychiatry service models evaluated is effective, the sparseness of the literature and its methodological limitations preclude strong conclusions
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And since evidence is required for something, not against, then clearly this mumbojumbo has been established without any actual evidence. In fact the only conclusion is that it's not useful, but somehow in medical research aspirational marketing is OK.

Of course "working", "effective" or "useful" are just a matter of perception. It has certainly worked very well for people like Sharpe, is effective at creating careers that accomplish nothing and get rewarded for clearly political reasons.

So very much in the biopsychosocial tradition: useless to patients, beloved by professionals. Which really shows how disconnected from reality modern healthcare is. Perception matters more than reality.
 
NelliePledge said:
I note it says he will be making the Adolf Meyer memorial lecture in San Francisco in May.
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Studies Showing Psychiatry's Value to Medically Ill Patients Needed, Says Award Lecturer

The skills that psychiatrists bring to the care of medically ill patients can “make medicine better” by improving patient outcomes, said Michael Sharpe, M.D., emeritus professor of psychological medicine at Oxford University.

Sharpe delivered the 2023 Adolf Meyer Award Lecture on Sunday at APA’s Annual Meeting. The award honors an individual for lifetime achievement in psychiatric research.

Sharpe said this integration of psychiatry and medicine was championed by Meyer, who was an early proponent of “whole patient care” and developed the concept of “psychobiology.” This notion was picked up by later psychiatrists, most notably George Engel, M.D., who conceptualized the biopsychosocial model.
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But the historical separation of psychiatry from the rest of medicine has made that integration challenging, and Sharpe said psychiatry needs to define specifically what it can bring to the care of medically ill patients and prove its value in robust clinical trials.

As examples, he presented clinical trials focused on three problem areas of medical care: management of chronic fatigue syndrome, depression care for people with cancer, and long hospital stays in elderly patients.

In patients with chronic fatigue syndrome (sometimes called myalgic encephalomyelitis), Sharpe described a “vicious circle” of fatigue, fear of fatigue, avoidance of activity, disability, and physiological changes leading to more fatigue. A study published in the British Medical Journal in 1996 compared four interventions designed to gradually reduce avoidance of activity: cognitive-behavioral therapy (CBT), graded exercise therapy, adaptive pacing therapy, and standard medical care.

Patients receiving CBT had the lowest scores on fatigue (standard medical care had the highest) and the highest scores on physical function. “Cognitive-behavioral therapy was both acceptable and more effective than medical care alone in improving patients’ day-to-day functioning in the medium term,” wrote Sharpe and colleagues. “It was also more effective in helping patients to feel better.”
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https://www.psychnews.org/alert_AM2023_3k.html


eta:


"robust clinical trials" hah.
 
This clicks perfectly into my research, thank you @Sly Saint.

If anyone gets a hold on the full lecture (text or video), please DM me. I'd be very grateful.

I'll keep an eye on this thread of course, but am currently trying to recover from overload and worsening health, so not keeping up.
 
strategist said:
PACE is one of the best examples they could find? That says volumes.
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The study cited above:

In patients with chronic fatigue syndrome (sometimes called myalgic encephalomyelitis), Sharpe described a “vicious circle” of fatigue, fear of fatigue, avoidance of activity, disability, and physiological changes leading to more fatigue. A study published in the British Medical Journal in 1996 compared four interventions designed to gradually reduce avoidance of activity: cognitive-behavioral therapy (CBT), graded exercise therapy, adaptive pacing therapy, and standard medical care.
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is not the PACE trial which was first published in 2011. Interesting that Sharpe should cite an earlier and smaller study.
 
He seems to be conflating the earlier study which only compared CBT with standard medical care, and PACE which included the 4 groups he describes.
The earlier study used Oxford criteria, the control group were just given their diagnosis and advised to keep increasing their activity, then nothing. The treatment group seemed to be focused largely on persuading them to change their illness beliefs and they had weekly one hour sessions for 5 months.

Edit: To be fair, it may be the person who wrote the article about the lecture who has conflated the two trials.
 
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The award honors an individual for lifetime achievement in psychiatric research.
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Yikes. If that's all it takes. Dude just described what he hoped to achieve as if it actually achieved it, and that's good for them.

If psychiatry could make medicine better, I think it had more than enough time to prove it. There is no "if" anymore. Especially when the award cites the cycle of formulaic BS trials as an achievement, when it's only a matter of time before the paradigm is retired entirely.
 
rvallee said:
Yikes. If that's all it takes.
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It gets even better - when Sly Saint posted the notice in February, I looked up the specifics of the award (I wanted to know its origin) and noticed the criteria for nomination:

"Self-nominations and nominations by a colleague are accepted."

I have no idea who nominated him, but I could totally see Sharpe nominating himself, and I amuse myself with the thought. :laugh:
 
I felt a chill in the air over the weekend of the APA meeting in San Francisco. Luckily, I managed not to see Professor Sharpe's talk--costs $$ to get into the conference. I assumed that was likely the reporter's mistake. Sharpe is proud of PACE and no reason from his perspective not to cite it favorably.
 
I would like to know what the BPS definition of "activity" is.

Do they use a narrow definition? Is it just about going to the gym, and vigorous exercise such as jogging, cycling, swimming etc.? In other words, having a sporty lifestyle.

Many pwME do activities, out of necessity, and maybe for enjoyment as well. Someone has to wash those dishes. Light housework is an activity some pwME do. Someone has to do it, and circumstances may dictate it is the pwME.

If we were all afraid of, and didn't engage in
"activities", there might be less crashes/Post Exertional Malaise.

I know for myself, I have to engage in activities that may, or will cause PEM, but often there is no choice but to do them. And, even pacing will not eliminate the PEM.

I am tired of the BPS'ers thinking we don't know what's best for us. They don't understand ME at all.
 
The president bit feels a bit like that time in high school where we got to elect members of the student board of the school. 6 applicants for 5 spots and 9 people turned out to vote. Yes you're governing the student board, but it isn't really an accomplishment I'd boast about.
 
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