Government and Insurance companies - establishing the BPS model

The shame isn't that they're trying to classify ME as a mental illness to avoid paying out past 24 months, the real shame is that they can get away with discriminating against mental illnesses like this and those who should be calling them out on this, are not doing so.
 
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I have reported to the Financial Conduct Authority that companies are still including ME in mental health exclusions which goes against all the guidelines set by insurance bodies. As I didnt have a complaint specific to me they weren't that interested - will try and chase them on it.

I had some good news this week - my claim that has been going on for the last 18 months was decided on last week and they approved it !!!!

I had a mental health exclusion as I had depression when I took out the policy. They tried to refuse it saying that ME was a mental condition, then went through everything else they could - hadn't been ill for long enough (9yrs!), had been active in that time, could go back to work if I had more treatments (mindfulness, cbt and get give good results as shown in PACE trial), would not be permanent etc.

I had to fight against each argument and even with reports from my consultant they just ignored them. Reports from their CMO fabricated information, I had to go through long SAR process to get these reports which they tried to withhold. Also had to have exam by their independent expert. I was expecting them to still refuse after this and had been to see my own indpendent expert as well. Hadnt even had this other report yet but i had sent another letter to them before they made decision, where I criticised their expert and his exam.

Not sure whether this made the difference or if they just got fed up of me. The policy wasn't for a huge amount and they must have spent a lot working on it. I will get the rest of the notes from them under the SAR so hopefully will find out.

I will put everything together so others can use but it will take a while as I am exhausted and body has crashed after the shock (not too bad but enough that i need a rest)

Thank you to everyone that helped me on this with comments and answers to the questions I needed evidence for. Each letter I wrote seemed to be like a mini thesis especially with all the research I had to do in getting all of the information to throw at them. I never thought we would get to the end and get a positive decision without having to go through the ombudsman. It shows it's worth pursuing even against huge odds.

Moderator note: post has been copied to the thread set up by Sly Saint (as noted in the post below)
 
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There was an enormous rise in the reported incidence of Myalgic Encephalomyelitis in the late 1970s and 1980s, alarming medical insurance companies in the US. So it was at this time that certain psychiatrists and others involved in the medical insurance industry (on both sides of the Atlantic) began their campaign to reclassify the severely incapacitating and discrete neurological disorder known as Myalgic Encephalomyelitis as a psychological or ‗personality‘ disorder, in order to side-step the financial responsibility of so many new claims (Marshall & Williams 2005a, [Online]). As Professor Malcolm Hooper explains:
In the 1980s in the US (where there is no NHS and most of the costs of health care are borne by insurance companies), the incidence of ME escalated rapidly, so a political decision was taken to rename M.E. as ―chronic fatigue syndrome‖, the cardinal feature of which was to be chronic or on going ―fatigue‖, a symptom so universal that any insurance claim based on ―tiredness‖ could be expediently denied. The new case definition bore little relation to M.E.: objections were raised by experienced international clinicians and medical scientists, but all objections were ignored… To the serious disadvantage of patients, these psychiatrists have propagated untruths and falsehoods about the disorder to the medical, legal, insurance and media communities, as well as to government Ministers and to Members of Parliament, resulting in the withdrawal and erosion of both social and financial support [for M.E. patients]. Influenced by these psychiatrists, government bodies around the world have continued to propagate the same falsehoods with the result that patients are left without any hope of understanding or of health service provision or delivery. As a consequence, government funding into the biomedical aspects of the disorder is non-existent. (2003a, [Online]) (2001, [Online])
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The psychiatrist Simon Wessely – arguably the most powerful and prolific author of papers which claim that M.E. is merely a psychological problem of ‗fatigue‘ – began his rise to prominence in the UK at the same time the first CFS definition was being created in the USA (1988). Wessely, and his like-minded colleagues – a small group made up mostly but not exclusively of psychiatrists (colloquially known as the ‗Wessely School‘) has gained dominance in the field of M.E. in the UK (and increasingly around the world) by producing vast numbers of papers which purport to be about M.E.
Wessely claims to specialise in M.E. but uses the term interchangeably with chronic fatigue, fatigue or tiredness plus terms such as neurasthenia, CFS and ‗CFS/ME‘ (a confusing and misleading term he created himself). He claims that psychiatric states of ongoing fatigue and the distinct neurological disorder M.E. are synonymous. Despite all the existing contradictory evidence, Wessely (and members of the Wessely School) assert that M.E. is a behavioural disorder (with no physical signs of illness or abnormalities on testing) that is perpetuated by ‗aberrant illness beliefs‘ and by ‗the misattribution of normal bodily sensations‘ and that patients ‗seek and obtain secondary gain by adopting the sick role‘ (Hooper & Marshall 2005a, [Online]).

The Wessely School and collaborators has assiduously attempted to obliterate recorded medical history of Myalgic Encephalomyelitis even though the existing evidence and studies were published in prestigious peer-reviewed journals and span over 70 years. Wessely‘s claims (and those of his colleagues around the world) have flooded the UK (and worldwide) literature to the extent that medical journals rarely contain any factual and unbiased information on M.E. Thus most clinicians are effectively being deprived of the opportunity to obtain even the most basic facts about the illness.

For at least a decade, serious questions have been raised in international medical journals about possible scientific misconduct and flawed methodology in the work of Wessely and his colleagues. It is only relatively recently however that his long-term involvement as medical adviser – and board member – to a number of commercial bodies having a vested interest in how M.E. is managed have been exposed.
The government funded research produced by this group continues to be rigorously criticised on the grounds that it is methodologically flawed and biased and that it relies on a highly selective and misrepresentative choice of references, and too often cites their own studies as the sole or primary references. Despite this, and the fact that this coterie of psychiatrists has a number of outrageous conflicts of interest and proven affiliations with corporate industry they have managed to assiduously infiltrate all the major institutions – including government – directing funding for M.E. research into an exclusively psychiatric model of the illness; and which involves studying ‗fatigue‘ sufferers instead of those with M.E. All under the ‗anything-goes‘ banner of ‗CFS‘ (Mar 2004, [Online]) (Hooper 2003, [Online]) (Hooper et al. 2001, [Online]).
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Among his 53, largely undeclared, conflicting interests Wessely is a member of the supervisory board of a company named PRISMA. This same company is being paid many millions of pounds to supply ‗rehabilitation‘ programs (such as CBT and GET) to the NHS for use on ‗CFS‘ patients (Mar 2004, [Online]). Wessely is also an officer of the insurance giant UNUM.

The facts on Wessely‘s colleagues are equally disturbing. Other members of the Wessely school with similar indisputable long-term commitments to the medical insurance industry are Michael Sharpe, Professor Mansel Aylward, Anthony Cleare, John Locasio and Peter White – Wessely‘s closest colleagues. Peter White is one of the chief medical officers for insurance company Swiss Re and their other ―CFS experts‖ are Michael Sharpe and Simon Wessely, and they also use psychiatrist Anthony Cleare (a frequent co-author with Wessely).

LoCascio of UNUM advised the UK DWP (Welfare Office) on welfare reform while Professor Aylward was in charge of UK DWP and then director of UNUM‘s research establishment at Cardiff University (Hooper 2003, [Online]) (Hooper et al. 2001, [Online]) (Williams 2007, [Online]). The list goes on. In the US in 2004 Commissioner John Garamendi described UnumProvident as ‗an outlaw company‘ and also stated that, ‗It is a company that for years has operated in an illegal fashion‘ (Rutherford 2007, [Online]).

Other insurers involved include: Swiss Life, Canada Life, Norwich Union, Allied Dunbar, Sun Alliance, Skandia, Zurich Life and Permanent Insurance, and as Re-insurers, the massive Swiss Re. The goal of these groups has clearly been to prevent insurance cover for M.E. patients (those with a psychiatric label are denied medical insurance cover), to prevent disability payments to them and to prevent successful liability lawsuits and maintain the supremacy of their industries (Hooper 2003, [Online]) (Hooper et al. 2001, [Online]) (Williams 2007, [Online]) (Rutherford 2007, [Online]).

This group has also driven government policy on M.E. in the UK to an overwhelming extent. Wessely is adviser to the UK government and his wife (a GP and psychiatrist) is Senior Policy Adviser to the Department of Health.

Wessely was also recently reprimanded by the World Health Organisation (WHO) for attempting to subvert the ICD definition of Myalgic Encephalomyelitis due to the fact that he did not, as he claimed, have the authority to issue a WHO definition (Hooper 2003a, [Online]) (Hooper et al. 2001, [Online]) (Marshall & Williams 2005a, [Online]).

"Given that what Wessely promotes is contrary to the established scientific evidence, how does he manage to maintain such power and control? Many knowledgeable people believe he maintains it by singing the desired political tune; by scientific misconduct; by manipulation of other people‘s published work; by flawed methodology; by deception and by the circularity of self-references. Substantial evidence clearly reveals that in pursuit of his personal ideology or, alternatively, that of his corporate masters, Wessely abuses the scientific process. The implementation of his personal philosophy is not based on medical science and has had devastating consequences, not just for sufferers of M.E. but for their families as well."

www.hfme.org
 
Sly Saint said:
Wessely is a member of the supervisory board of a company named PRISMA
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"
PRISMA stands for “Providing Innovative Service Models and Assessments”.

It is based in Germany and is a multi-national healthcare company working with medical insurance companies.
It arranges “rehabilitation” programmes and its recommended management is CBT. PRISMA claims to be especially concerned with long-term disability from the perspective of government, service providers and insurance companies.
It claims to have developed a “unique treatment programme” for “hopeless” cases (it specifically includes those with CFS), claiming that such patients “avoid physical exercise and social activities, as they fear these may trigger new bouts of complaints”.

In the PRISMA Company Information, Professor Simon Wessely is listed as a Corporate Officer. He is a member of the Supervisory Board. In order of seniority, he is higher than the Board of Management.
He is listed as a “world expert” in the field of “medically unexplained illnesses including Chronic Fatigue Syndrome” (PRISMA Company Information, 2001).
Concern has been repeatedly raised that Wessely is recommending an NHS management programme for people with ME/CFS that is known to be potentially harmful but which is provided by a company of whose Supervisory Board he is a member."

https://livingfoods.co.uk/cognitive-behavioural-therapy-does-not-help-with-m-e-c-f-s/

see also:
Regius Professor Sir Simon Wessely
January 7, 2018 Margaret Williams
The incalculable contribution to medical science of Regius Professor Sir Simon Wessely: a thirty year retrospective. Margaret Williams 28th December 2017
http://www.margaretwilliams.me/2017/thirty-year-retrospective.pdf

https://artzstudios1.wixsite.com/globaladvocatesmeicc/blog/author/Margaret-Williams
 
One question which has intrigued me, and we I have got no closer to resolving concerns the National Employers Life Assurance Holdings which, according to Wiki, was the UK's largest disability insurer, and acquired by UNUM in 1990. One wonders what names might have been associated with that company in a medical advisory capacity.
 
Mansel Aylward:

Article in Independent from 1998:
"Top doctor in job for wife row

THE chief medical adviser to the Department of Social Security, Dr Mansel Aylward, was behind the setting up of a company that enables civil servant doctors to process health insurance claims.

The company, Mediprobe, which puts doctors in contact with major health insurance companies, has Dr Aylward's wife, Angela, listed as director.


It has also emerged that Mediprobe, which is totally independent of the DSS, has paid Dr Aylward for work done on its behalf, even though he was advised he could not be involved in the establishment of the company."

https://www.independent.co.uk/news/top-doctor-in-job-for-wife-row-1153041.html
 
Redacted letter to Mansel Aylward Public Health Wales
"
Furthermore, detailed research (Stewart 2016) identified the fact that the original BPS model was the creation of George Engel (Engel 1997), who used it in a very different context, and UnumProvident Insurance distorted the original BPS model for financial gain.

Your DWP commissioned research (SCBIB 2005) was created at the Centre for Psychosocial and Disability Research, which was initially funded with £1.6million by UnumProvident Insurance (Rutherford 2007), later re-named UNUM Insurance, who were identified in 2008 by the American Association of Justice as the second worst insurance company in America (AAJ 2008).

Most recently, the academic excellence of Professor Tom Shakespeare and colleagues (Shakespeare et al 2016), who were not commissioned by the DWP or funded by an American corporate giant,
produced the paper “ Blaming the victim all over again: Waddell and Aylward’s biopsychosocial (BPS) model of disability”



eta:
https: //www.scribd.com/document/368592854/Redacted-Letter-to-Mansel-Aylward-Public-Health-Wales

I had to put some spaces in because the link gets 'converted'.
 
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