Is it true that more than half of medical consultations are for MUS? A look at the evidence.

[Hutan]

This thread has been temporarily closed for moderation.

 

[Daisybell]

Moderator note:
A number of posts on this thread were in breach of Rule 1 - no personal attacks or public accusations.
Accordingly, some posts have been edited and several have been deleted as they were responding to now deleted material.
Please can everyone be mindful of our rules going forward and focus on the topic of the thread. Thank you.

 

[TiredSam]

The title of this thread is:

Is it true that more than half of medical consultations are for MUS? A look at the evidence.

If members want to examine whether a given statistic is true or not, what's the problem?

Ah, I see now. The reason that Up to Date states "over 50% of patients are not suffering from a medical condition" is that this has been received opinion for decades, particularly in health policy. There is a ton of research over many decades that established this picture. Try looking up Barsky in the 1980s. (That stuff will really make your hair stand on end.)

In my opinion it's not possible to dispute this picture by quoting research. It's too entrenched, and there are literally thousands of papers that support it. In any case, it's actually useful for the ME cause to accept that half of symptoms are undiagnosed. It shows that half of the time doctors don't actually have answers. Then it's easy to show that there's never been a safe, scientific approach to handling that reality.

The title of this thread is whether the statistic is true or not. It may be entrenched, but so what? It may be useful for the ME cause, but again, so what? Some members may have ethical concerns about quoting a statistic that is known to be dodgy just because it is thought to be useful. That's the kind of attitude we are used to from the BPS activists. The papers that have demolished PACE have stuck to what is known to be true, so they can't be argued against.

You good people are very trusting, and I think you don't know what an attack looks like in the language of professional discourse.

I may or may not be good, I am not trusting, I am a professional. Not sure what purpose categorising S4ME members serves. For the purposes of this thread I'm just someone who's interested in the subject of the thread title, ie is the 50% figure true? I don't feel I have to justify or defend such an interest. It's just something I'm interesting in knowing more about.

I mean, genuinely, that the people on s4me are good, well meaning people. You're also highly intelligent, articulate and very well informed.

Members of S4ME are a mixed bunch, are you sure that in the brief time you've been here you're in a position to characterise everybody as a group, and are you sure it's necessary? "Well-meaning" implies naive or misguided to me, but let's not get into that, I'd rather stick to the subject in the title of the thread.

 

[Trish]

Hi Diane, I have gone back through this thread trying to get my head around just what you are saying about the 50% figure. I'm sorry this post is rather long. I am trying to sort out your point about the statistics and in what way they can be challenged. I now have a copy of the Kroenke paper and will address it in my next post.

Finally, to be very clear, the paper certainly does not accept that 50% of patients have MUS. It says this is a typical understanding, and then it goes on to consider in great detail what's actually happening with that portion of the patient population. All of what it says there supports your cause.

my bolding.

But you do seem to accept the idea that the stats you quote are correct in reporting the proportions of patients whose symptoms are unexplained. You refer here to 'that portion of the patient population'. That seems to imply that half the population have a problem with getting a diagnosis.

Your paper starts with these sentences:

Biomedical diagnostic science is a great deal less successful than we’ve been willing to acknowledge in bioethics, and this fact has far-reaching ethical implications. In this article I consider the surprising prevalence of medically unexplained symptoms, and the term’s ambiguous meaning.

And your introduction starts:

Biomedical diagnostic science is a great deal less successful than we’ve been willing to acknowledge in bioethics.

And the part of your paper relevant to the discussion starts with this.

PRELIMINARY INFORMATION
Prevalence and Terminological Ambiguity
By some estimates, medically unexplained symptoms are significantly more common in outpatient settings, or at least in general practice, than symptoms that are medically explained – and this idea really should shake the foundations of clinical ethics as we’ve come to understand the field. One well-known study (Kroenke and Mangelsdorf 1989) offers the astonishing finding that 86% of symptoms for which patients seek biological medical care remain medically unexplained in an internal medicine setting. Findings at that high end have been echoed by several additional studies (Korber et al. 2011; Steinbrecher et al. 2011), though there are equally many that embrace far lower estimates (Swanson, Hamilton and Feldman 2010). A recent review article suggests that MUS “account for 10-15% of all general practice consultations” (Johansena and Riser 2016, 647). In everyday practice at this time, and at the level of policy, estimates for outpatient practice generally seem to fall between these two extremes, so that the prevalence of MUS is understood as roughly equivalent to the prevalence of medically explained symptoms.

My bolding.
I will address the point I have highlighted in my next post.

You then go on to quote the Up to Date use of 'more than 50% and the UK guideline us of the Wessely et al. 52% figure. I don't dispute that they use these figures.

Thanks Trish for your questions. You're absolutely right that some research focuses on number of symptoms, while other research focuses on number of patients. Researchers generally fail to note that difference in comparisons and that's really a huge problem. Research on MUS is very unscientific - in large part that is the point of my article.

I'm not sure it's useful to run through all these figures in detail. That's not going to change the big picture. The very extensive process of review and critique for the article did not find any reason to challenge the 50% figure as representative of current understanding among professionals who work with MUS. I think that means you can trust that this is what they generally believe.

I think they're right that roughly 50% of outpatients' symptoms are unexplained, as in, undiagnosed. It's just that they equate this with psychosomatic diagnosis - and there's a serious problem with that. The last part of the paper shows why it's both unscientific and unethical to equate diagnostic uncertainty with psychosomatic diagnosis. That's the part that really matters.

my bolding

This is where I have a problem with your analysis of the situation. You correctly state that the 50% figure is being used in policy documents relating to that area of 'medicine' and is commonly accepted in the MUS field. That doesn't make it correct. You acknowledge that there are problems with the research. We are in agreement there.

The place where I part company with you is the final paragraph of this post. Why on earth do you believe that 50% of outpatient symptoms are unexplained. Or as you seemed to imply in the post I quoted at the top of this post, that 50% of patients aren't getting a diagnosis. Can you provide any evidence to support either of these statistics?

It's a good question, Trish. It might help to know that the higher estimate in Kroenke and Mangelsdorf (in the body of the paper) was incredibly influential. That's a big part of this - it's not just what the papers say. It's also a matter of knowing which ones are really influential and which are peripheral. On this point, note that the JCPMH estimate is not just another research paper. It's a policy document - so no matter what the research says, this is the figure that drives UK health policy.

What I'm saying is that half of symptoms are undiagnosed in outpatient settings. Then I say (in the article) that research typically equates undiagnosed symptoms with psychosomatic symptoms. The article is then devoted to showing how it's unscientific, and unethical, to assume that undiagnosed symptoms are psychosomatic. See?

my bolding

... you are so right that there's conflation of proportion of symptoms and proportion of patients. And you're right about how important this is to the statistical picture! The research on this stuff is so bad that they have not reckoned with this problem. That's what I'm saying. You're not going to find an answer to this question in research because they're not that careful. It's appalling. Very deeply confused on so many levels. That's a big part of what I do - I show all the ways that this stuff is unscientific.

I agree that it's important to point out, as from my understanding you are doing in your paper, that there are ethical problems in conflating a symptom being medically unexplained, and that symptom belonging in the field of psychosomatic disorders, somatisation etc.

But do you also challenge the unethical inflation of statistics by these MUS 'experts' to support their case, and the inaccuracies in the 50% figure used in policy documents? As far as I can see your paper does not challenge the numbers, and you have repeated in this discussion that you believe the 50% figure to be accurate. Your whole paper is built on the premise that 50% of outpatient appointments don't lead to a biomedical diagnosis and/or that 50% of symptoms presented at such clinics are unexplained. That claim is what I'm trying to get to the bottom of.

 

[Trish]

A closer look at the Kroenke and Mangelsdorff paper referred to in my previous post and discussed in post #2 of this thread.
Common symptoms in ambulatory care: Incidence, evaluation, therapy, and outcome, Kroenke and Mangelsdorf 1989

Diane has helpfully pointed out that there are too many papers on the prevalence of MUS for me to try to tackle them all, but that this paper has been particularly influential in MUS policy making.

This is borne out by it being singled out from all the papers to quote (or misquote) by Wessely et al in their paper that is used as the source paper for the 52% claim in the NHS MUS guidance document (see post #1)

I have now obtained a copy of the full paper and read it.

Before I go into the detail of what Kroenke actually found, I remind you of the way it has been quoted:

Wessely et al:

Previous studies have suggested this in individual clinics, for example, only 16% of one clinics new outpatient attendees to a US internal medicine clinic was a definite biomedical cause identified for symptoms. [Kroenke et al]

Diane O’Leary:

One well-known study (Kroenke and Mangelsdorf 1989) offers the astonishing finding that 86% of symptoms for which patients seek biological medical care remain medically unexplained in an internal medicine setting.

Now let me look at what the paper actually says:

In the abstract:

A retrospective study of the medical records of 1000 patients of one internal medicine outpatient clinic over a 3 year period were examined for new reports of 14 pre-selected symptoms.

A total of 567 new complaints of chest pain, fatigue, dizziness, headache, edema, back pain, dyspnea, insomnia, abdominal pain, numbness, impotence, weight loss, cough, and constipation were noted, with 38 percent of the patients reporting at least one symptom. Although diagnostic testing was performed in more than two thirds of the cases, an organic etiology was demonstrated in only 16 percent.

In the full paper this is clarified:

38% had 1 or more of the listed symptoms, made up of:
24% 1 symptom; 9% 2 symptoms; 3% 3 symptoms, 2% 4 or more symptoms.

Total symptoms from the list = 567
Organic cause diagnosed = 84 (14.8%)
Psychological cause diagnosed = 58 (10.2%)
No cause found = 425 (75%)

Treatment recommendations were recorded for 311 of the 567 symptoms.
There is also an interesting discussion of follow up, improvement and treatment outcomes for the different subsets.

My notes

This is an internal medicine clinic and they say most of their work is with patients with chronic organic disorders such as hypertension, diabetes, cardiopulmonary disorders and arthritis, and they say the majority of visits are for these known conditions.

We have no information about the diagnostic pathway of 62% of the patients who didn’t report symptoms on the list, nor about other well understood organic symptoms reported by the 38% group.

So both the percentage of patient visits, and the percentage of symptoms that were undiagnosed must logically be far smaller than the figures quoted by Wessely et al. and O’Leary.

Returning to those statements:
Wessely et al.

Previous studies have suggested this in individual clinics, for example, only 16% of one clinics new outpatient attendees to a US internal medicine clinic was a definite biomedical cause identified for symptoms. [Kroenke et al]

This statement is clearly very misleading nonsense. It was not a study of new outpatient attendees, it was a 3 year retrospective study of all consultations by 1000 patients. Since we have no information about whether the 62% of patients studied had any problems getting their symptoms diagnosed, nor whether other symptoms of the 38% were diagnosed. We only have information about whether a particular subset of the 38% group’s symptoms were diagnosed, nothing about whatever other symptoms they reported.

O'Leary:

One well-known study (Kroenke and Mangelsdorf 1989) offers the astonishing finding that 86% of symptoms for which patients seek biological medical care remain medically unexplained in an internal medicine setting.

This statement is also inaccurate. She does at least refer to symptoms, not patients, but there must have been lots of symptoms that weren’t include in the study, since 62% of patients did not have their symptoms included at all. The 14 symptoms were selected by the researchers precisely because they are symptoms, such as constipation and headache, for which there usually is no known organic cause.
.......................

In both cases, this misuse of statistics bolsters the misinformation conveyed in the papers. While the purpose for doing so is very different - in Wessely’s case to support his psychosomatic approach; and in O’Leary’s case to try to support patients by challenging the psychosomatic approach - the fact remains that both are helping to perpetuate a myth.

 

[Roy S]

I've recently collaborated with Keith Geraghty on a chapter about MUS for the Oxford Handbook of Ethics and Psychotherapy, and there we use the 50% figure. (That chapter is still under review.)

Keith Geraghty has some relevant recent tweets-

https://twitter.com/keithgeraghty

 

[large donner]

My point is much simpler - where did the 50% figure come from?

It may not be important to your central ethical argument, but it is important if it means our government in the UK is spending billions on MUS 'services' on the basis of a vastly inflated figure. That matters to me.

The point of the term MUS in the UK is to save billions not to spend it so in all likely hood the 50% figure came from lies and was deliberately presented to stupid policy makers.

 

[Diane O'Leary]

Hi Diane, I have gone back through this thread trying to get my head around just what you are saying about the 50% figure. I'm sorry this post is rather long. I am trying to sort out your point about the statistics and in what way they can be challenged. I now have a copy of the Kroenke paper and will address it in my next post.


my bolding.

But you do seem to accept the idea that the stats you quote are correct in reporting the proportions of patients whose symptoms are unexplained. You refer here to 'that portion of the patient population'. That seems to imply that half the population have a problem with getting a diagnosis.

Your paper starts with these sentences:


And your introduction starts:

And the part of your paper relevant to the discussion starts with this.

My bolding.
I will address the point I have highlighted in my next post.

You then go on to quote the Up to Date use of 'more than 50% and the UK guideline us of the Wessely et al. 52% figure. I don't dispute that they use these figures.


my bolding

This is where I have a problem with your analysis of the situation. You correctly state that the 50% figure is being used in policy documents relating to that area of 'medicine' and is commonly accepted in the MUS field. That doesn't make it correct. You acknowledge that there are problems with the research. We are in agreement there.

The place where I part company with you is the final paragraph of this post. Why on earth do you believe that 50% of outpatient symptoms are unexplained. Or as you seemed to imply in the post I quoted at the top of this post, that 50% of patients aren't getting a diagnosis. Can you provide any evidence to support either of these statistics?




my bolding


I agree that it's important to point out, as from my understanding you are doing in your paper, that there are ethical problems in conflating a symptom being medically unexplained, and that symptom belonging in the field of psychosomatic disorders, somatisation etc.

But do you also challenge the unethical inflation of statistics by these MUS 'experts' to support their case, and the inaccuracies in the 50% figure used in policy documents? As far as I can see your paper does not challenge the numbers, and you have repeated in this discussion that you believe the 50% figure to be accurate. Your whole paper is built on the premise that 50% of outpatient appointments don't lead to a biomedical diagnosis and/or that 50% of symptoms presented at such clinics are unexplained. That claim is what I'm trying to get to the bottom of.

The paper's arguments do not depend on the 50% figure - that's not accurate. I suppose it will feel more or less important as a problem depending on how many patients you think are undiagnosed.

You are correct that I am not challenging the idea that roughly half the time outpatients do not get a diagnosis. I believe that the general sense of diagnostic success has been greatly inflated in everyday culture for many years.

The 50% figure makes sense if you think about it. The vast majority of Sx that people take into a medical appointment are benign and self-resolving. And diagnostic science is just not that advanced. Think about the difference between now and a hundred years ago - then imagine what more we will know about diagnosing disease in a hundred years.

What, exactly, leads you to think that diagnostic science is usually successful?

It's important that there is a great deal of research on rates of unexplained symptoms outside of the BPS camp, and it's important that this is not about the UK - so even if you find what you think is evidence of inflated figures in the UK, that's not going to matter because this is a globally accepted picture. My sense is that it's a standard point of health policy - so health budgets have been designed around it for a long while.

I don't think your government has inflated the rate of undiagnosed Sx. But your government is the worst that I know of when it comes to the assumption that all undiagnosed symptoms have psychological causes. There is very clear evidence that your government has studied the cost of undiagnosed Sx, and studied the savings with psychological management - so there's very clear evidence that diagnostic practice has not been guided by what's best for patients. It's been guided by what's best for the budget. My opinion is that this is the heart of the problem, and we can address it.

 

[Diane O'Leary]

The point of MUS in the UK is to save billions not to spend it so it all likely hood the 50% figure came from lies and was deliberately presented to stupid policy makers.

That's just not tenable. There is far, far too much research to support it, and this research is global. The Up To Date system, for example, is the global leader in research review and summary (made in the US), and they use the 50% figure.

Keep in mind that it's 50% undiagnosed patients - not 50% psychosomatic patients. It's the leap to psychosomatic that's a lie, and that problem is particularly serious in the UK.

 

[Diane O'Leary]

A closer look at the Kroenke and Mangelsdorff paper referred to in my previous post and discussed in post #2 of this thread.
Common symptoms in ambulatory care: Incidence, evaluation, therapy, and outcome, Kroenke and Mangelsdorf 1989

Diane has helpfully pointed out that there are too many papers on the prevalence of MUS for me to try to tackle them all, but that this paper has been particularly influential in MUS policy making.

This is borne out by it being singled out from all the papers to quote (or misquote) by Wessely et al in their paper that is used as the source paper for the 52% claim in the NHS MUS guidance document (see post #1)

I have now obtained a copy of the full paper and read it.

Before I go into the detail of what Kroenke actually found, I remind you of the way it has been quoted:

Wessely et al:



Diane O’Leary:



Now let me look at what the paper actually says:

In the abstract:

A retrospective study of the medical records of 1000 patients of one internal medicine outpatient clinic over a 3 year period were examined for new reports of 14 pre-selected symptoms.


In the full paper this is clarified:

38% had 1 or more of the listed symptoms, made up of:
24% 1 symptom; 9% 2 symptoms; 3% 3 symptoms, 2% 4 or more symptoms.

Total symptoms from the list = 567
Organic cause diagnosed = 84 (14.8%)
Psychological cause diagnosed = 58 (10.2%)
No cause found = 425 (75%)

Treatment recommendations were recorded for 311 of the 567 symptoms.
There is also an interesting discussion of follow up, improvement and treatment outcomes for the different subsets.

My notes

This is an internal medicine clinic and they say most of their work is with patients with chronic organic disorders such as hypertension, diabetes, cardiopulmonary disorders and arthritis, and they say the majority of visits are for these known conditions.

We have no information about the diagnostic pathway of 62% of the patients who didn’t report symptoms on the list, nor about other well understood organic symptoms reported by the 38% group.

So both the percentage of patient visits, and the percentage of symptoms that were undiagnosed must logically be far smaller than the figures quoted by Wessely et al. and O’Leary.

Returning to those statements:
Wessely et al.

This statement is clearly very misleading nonsense. It was not a study of new outpatient attendees, it was a 3 year retrospective study of all consultations by 1000 patients. Since we have no information about whether the 62% of patients studied had any problems getting their symptoms diagnosed, nor whether other symptoms of the 38% were diagnosed. We only have information about whether a particular subset of the 38% group’s symptoms were diagnosed, nothing about whatever other symptoms they reported.

O'Leary:

This statement is also inaccurate. She does at least refer to symptoms, not patients, but there must have been lots of symptoms that weren’t include in the study, since 62% of patients did not have their symptoms included at all. The 14 symptoms were selected by the researchers precisely because they are symptoms, such as constipation and headache, for which there usually is no known organic cause.
.......................

In both cases, this misuse of statistics bolsters the misinformation conveyed in the papers. While the purpose for doing so is very different - in Wessely’s case to support his psychosomatic approach; and in O’Leary’s case to try to support patients by challenging the psychosomatic approach - the fact remains that both are helping to perpetuate a myth.

I sure appreciate your diligence and your clarity, Trish. I think it's important that the 50% figure does not directly support the Wessely approach. The Wessely approach is one way of managing the 50% problem that's extremely cost effective - but that doesn't mean the Wessely approach is the source of the problem. That's confused reasoning.

I'm afraid I'm not seeing the point of all the effort with this paper. The Up to Date system provides global access to concise summaries of current research and consensus on every condition. That system notes that more than 50% of patients are not suffering from a medical condition. Even if this one paper is utterly unscientific, even if Wessely inflated it and I inflated it and you can prove all of that beyond all doubt, what then? It's a drop of rain in the sea. You cannot possibly make progress on disputing the 50% picture by finding fault with this paper or interpretations of it. (Well, you can find research to support any figure you happen to prefer - but the range is wide enough to make 50% reasonable. I think that's how people see it.)

But think about what Up to Date is actually saying there! 50% of patients are not suffering from a medical condition?

The thing to be concerned about there is not the idea that diagnostic science fails half the time. The idea that half of patients cannot possibly be suffering from illness - that is absolutely tragic. It is utterly outrageous, at a level that's immediately obvious to everyone outside of psychiatry.

When I do public lectures on MUS all I have to do to establish that there's a serious problem with this area of medicine is to put that Up to Date statement up on a powerpoint slide. Medicine manages uncertainty in a way that's blatantly unscientific. This is not a subtle problem. It's not about the UK, it's not about ME, and it's not about any one paper. It's a flashing red light of human threat - and there is not one patient, adult or child, conscious or unconscious, injured or ill, who is not directly threatened by it.

 

[Esther12]

I get the impression people are talking at cross-purposes a bit. A lot of people here will ask 'is there any good evidence for that' with any claim being made by an authoritative source, regardless of the impact of the claim. A lot of the probing of research is more about intellectual curiosity than the pragmatic pursuit of any particular end. Maybe this partly reflects peoples experiences, where 'pragmatism' has often been used as a justification for the promotion of misinformation relating to ME/CFS that ends up harming patients in ways researchers have failed to account for.

 

[Jonathan Edwards]

Thanks for the clarification, @Trish. It is interesting to see just how much Wessely has misrepresented data, not just his own but other people's.

 

[large donner]

That's just not tenable. There is far, far too much research to support it, and this research is global. The Up To Date system, for example, is the global leader in research review and summary (made in the US), and they use the 50% figure.

Keep in mind that it's 50% undiagnosed patients - not 50% psychosomatic patients. It's the leap to psychosomatic that's a lie, and that problem is particularly serious in the UK.

So Up to Date Collates the info and uses a 50% figure? Does that tell you the source of any potential meme that leads to the eventual figures for the diagnostic label MUS?

If we look back over the life of the term MUS is it on an upward curve or a downward one or has it remained steady?

When I stated the issue of the term MUS suiting the UK medical establishment I wasn't being exclusive. I am pretty sure overstating of such a diagnostic label could exist equally all around the world and would conveniently suit who ever picked up the bill for medical care be it in a socialised system or a private insurance based one.

There is also the issue of empire building and even if the figure is claimed to be the same all around the world that doesn't exclude potential deliberate marketing of the term to make it take on a life of its own via policy and education.

One only has to look at the US DSM as one example to understand how this could work.

Things can take on a life of their own built on poor foundations. If a figure is similar all around the world for a certain claim it doesn't tell you automatically what the motive was or wasn't for that.

Would you comment on the US DSM in terms of its categorisation of "illnesses" and the potential implications that could have in meme building and how it could affect the ability to collect accurate information on categorisation of diseases/diagnsotic labels etc?

Or perhaps comment on the US medical insurance industry?

 

[JohnTheJack]

A closer look at the Kroenke and Mangelsdorff paper referred to in my previous post and discussed in post #2 of this thread.
Common symptoms in ambulatory care: Incidence, evaluation, therapy, and outcome, Kroenke and Mangelsdorf 1989

Diane has helpfully pointed out that there are too many papers on the prevalence of MUS for me to try to tackle them all, but that this paper has been particularly influential in MUS policy making.

This is borne out by it being singled out from all the papers to quote (or misquote) by Wessely et al in their paper that is used as the source paper for the 52% claim in the NHS MUS guidance document (see post #1)

I have now obtained a copy of the full paper and read it.

Before I go into the detail of what Kroenke actually found, I remind you of the way it has been quoted:

Wessely et al:



Diane O’Leary:



Now let me look at what the paper actually says:

In the abstract:

A retrospective study of the medical records of 1000 patients of one internal medicine outpatient clinic over a 3 year period were examined for new reports of 14 pre-selected symptoms.


In the full paper this is clarified:

38% had 1 or more of the listed symptoms, made up of:
24% 1 symptom; 9% 2 symptoms; 3% 3 symptoms, 2% 4 or more symptoms.

Total symptoms from the list = 567
Organic cause diagnosed = 84 (14.8%)
Psychological cause diagnosed = 58 (10.2%)
No cause found = 425 (75%)

Treatment recommendations were recorded for 311 of the 567 symptoms.
There is also an interesting discussion of follow up, improvement and treatment outcomes for the different subsets.

My notes

This is an internal medicine clinic and they say most of their work is with patients with chronic organic disorders such as hypertension, diabetes, cardiopulmonary disorders and arthritis, and they say the majority of visits are for these known conditions.

We have no information about the diagnostic pathway of 62% of the patients who didn’t report symptoms on the list, nor about other well understood organic symptoms reported by the 38% group.

So both the percentage of patient visits, and the percentage of symptoms that were undiagnosed must logically be far smaller than the figures quoted by Wessely et al. and O’Leary.

Returning to those statements:
Wessely et al.

This statement is clearly very misleading nonsense. It was not a study of new outpatient attendees, it was a 3 year retrospective study of all consultations by 1000 patients. Since we have no information about whether the 62% of patients studied had any problems getting their symptoms diagnosed, nor whether other symptoms of the 38% were diagnosed. We only have information about whether a particular subset of the 38% group’s symptoms were diagnosed, nothing about whatever other symptoms they reported.

O'Leary:

This statement is also inaccurate. She does at least refer to symptoms, not patients, but there must have been lots of symptoms that weren’t include in the study, since 62% of patients did not have their symptoms included at all. The 14 symptoms were selected by the researchers precisely because they are symptoms, such as constipation and headache, for which there usually is no known organic cause.
.......................

In both cases, this misuse of statistics bolsters the misinformation conveyed in the papers. While the purpose for doing so is very different - in Wessely’s case to support his psychosomatic approach; and in O’Leary’s case to try to support patients by challenging the psychosomatic approach - the fact remains that both are helping to perpetuate a myth.

Very interesting post. Thanks for your hard work on it @Trish and for your clear analysis.

 

[ME/CFS Skeptic]

So 30 years ago Kroenke and colleagues went to an Internal Medicine Clinic for military personnel in Texas and they looked at the charts. They searched for 14 common symptoms that often remain unexplained such as fatigue, dizziness, cough, numbness, constipation etc. Of the 1,000 patient charts studied, only 38% had one of those 14 symptoms. The other 62% of patients are left out of the analysis. Data were dependent upon what physicians had documented in the records. So if a doctor didn’t note fatigue in a patient with MS, Kroenke and colleagues would have no idea the symptom was there. Furthermore: for some reason, chronic complaints were excluded.

So that’s the data the famous Kroenke et al. paper is based on…

Very revealing.

Thanks for pointing this out @Trish !

 

[Hoopoe]

It's rather hard to do a sensible analysis of problems whose only common denominator is being unexplained.

 

[Jonathan Edwards]

I guess relevant that this was a military personnel cohort. That would be totally unrepresentative of the general population. Probably few women!!

 

[Daisybell]

Am I being stupid about this - if this study was a retrospective search for specific symptoms, surely these symptoms might have been recorded coincidentally at the time of the appointments? What I mean is that there is no way of knowing that people reported them due to asking the doctor about the symptom or because the doctor asked them if they had any other symptoms e.g. constipation? Like a general health check...
Which means the whole figure is even more completely bogus - if that’s possible!

 

[Jonathan Edwards]

Which means the whole figure is even more completely bogus - if that’s possible!

Indeed, 120% bogus. Maybe 520% bogus. The only people who could possibly think it worth taking these figures seriously would be people who have a vested interest in taking them seriously.

 

[Trish]

I guess relevant that this was a military personnel cohort. That would be totally unrepresentative of the general population. Probably few women!!

It was a military hospital that served the military, their families and retired military. They claim the demographics were pretty representative of the population.