The Triumph of Eminence-Based Medicine - Brian Hughes

Thanks @Brian Hughes

 

I've thought about this a lot. The psychological/physical dichotomy keeps getting used against patients either way, so I'm not sure it's something we should focus on (I don't think most people know what BPS means either). I've recently decided the the best way to frame this, for me, I

I think it was the BACME response to NICE that said only 8,000 ME patients use the NHS clinics. That's only 3.2% of the estimated 250,000 ME patients nationwide (or 6.4% if the number was actually only 125,000, which is the lower estimate).

Either way, it seems like patients aren't using these services. It may also be that those who do use the services are those most likely to want to do CBT or GET. It also probably means we have GPs treating most patients, rather than specialist clinics.

So whether it's public or private healthcare, patients probably are voting with their feet.

Moderator note
The latter part of this post has been copied to a new thread and posts discussing it have been moved across:
UK - Discussion of how many patients use NHS ME/CFS clinics

 

I have posted a sort of summary here:
https://www.s4me.info/posts/118699/

and will shortly post the full transcript I have done.

It would be good to have the slides if possible(?)

 

I hope wikipedia is a reliable source in that case...

Indeed, the per individual cost in the US is higher than in Germany or UK. In US, 46,2% of the costs are paid by the state. In Germany, it is 77%.

I think the US health system is more expensive for the individual due to privatization: insurance companies, doctors and some hospitals profit. In the US, the only "real" insurance is the private insurance. That's a bit like in Switzerland, but they have more regulation.

In Germany, statutory health insurances want to save money just as private insurances in order to maximize profit. (Which is interesting, because to my knowledge, statutory insurances aren't supposed to make profit?) I don't know the exact links, but statutory insurances and government/state are linked with each other via the health ministry; that's not the case with private insurers; well, theoretically...

In Germany, roughly 10% have a private insurance. In the US, it is 87,4%. It's a completely different market.

So in the US, profit maximization is "easier", and the system wants that people pay more. In Germany - which wants a development in that direction, I think - that's mostly not the case, and the state wants to reduce costs.

USA want that, too, but there's a conflict between private interests and cost reduction, and it is known that private interests win. I think a person that takes diagnostics and treatments brings more money than a round of CBT/GET. But CBT/GET is more cost-efficient in a health system like that in German or UK.

Just my opinion.

 

I think so too, @Inara. And there's something else, something linked to the differences in social/political values between the US and Europe. A value that seems to be paramount in US society is freedom and respect for individual choice, whereas European society places greater value on caring for everyone in society and this can lead to a more paternalistic attitude to health and safety.

 

@Brian Hughes

I'd like to use this marvellous except in my S4ME signature.... would that be ok?

So it would read
"We should not see ME/CFS as resulting from mass cognitive hysteria among a quarter of a million UK citizens. Rather, we could see the biopsychosocial theory of ME/CFS as a grand sanctimonious delusion shared by a professional clique who, for circumstantial reasons, find themselves dominant in British behavioural healthcare." Brian Hughes

 

It seems more related to how strong belief in psychosomatic medicine is within the culture of medical professionals.

In Canada and France, both with single-payer, there is simply nothing. No clinics, no "fatigue specialists", nothing. My GP mentioned CBT and a referral to a physical therapist but only to stave off sedentary deconditioning and did not bother pushing and I'm pretty sure it would have been standard CBT, rather than the gaslighting kind created by the psychosocial ideologues.

I think that's also the case in many other European countries like Belgium and Italy. They don't recommend anything, don't bother much beyond "nothing wrong with this patient".

And we know many private health care providers in the US recommend them, they just don't bother much if the patient doesn't want them.

 

Absolutely fine with me, @JemPD. I'm glad you find it helpful...

 

Analysis BBC radio 4 Monday 12th November is about the replication crisis in psychology.

 

Is your date right @Trish?

 

@Brian Hughes . Just out of interest, how did your lecture in Wexford go down and how interested are psychologists in improving their research.? Thanks

 

See new thread https://www.s4me.info/threads/analysis-the-replication-crisis-psychology-in-question.6662/

 

Hi @obeat. The feedback on my lecture in Wexford was very positive, actually. I was struck by how many psychologists came to tell me they appreciated my approach and were glad I was raising these issues. Overall it was a positive experience for me, and very encouraging. I do think psychologists are a lot more conscious of the need to improve research than we often realise. And while there is (in my view) a strong generational factor -- with newly trained psychs most keen to acknowledge and fix the problems -- there are also many more experienced psychologists who are frustrated by the fact that these problems have been around for such a long time. But of course, the subset of psychologists who attend such a conference are not necessarily representative of the profession as a whole.

Next year I will likely give a similar lecture at a similar event in the UK. It will be interesting to compare the reaction.

 

Solve ME/CFS Initiative sharing the article.

Code:

https://www.facebook.com/SolveMECFSInitiative/posts/10155845632037108

 

On reading books on problems with DSM, I think psychiatrists are too but the culture inhibits change.

PS Do you discuss in your book the prior literature on Zombie Science, which includes financial and political bias, in addition to prestige bias, all supporting research together?

 

BMJ
Editorial

Redefining the ‘E’ in EBM

https://ebm.bmj.com/content/23/2/46