The Triumph of Eminence-Based Medicine - Brian Hughes

James Morris-Lent said:
'Eminence based medicine' is very apt!

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One criticism:
I think this passage:

is implying that there are a great deal of firmly established physiological findings, when there aren't many - I'm not sure there are any at all, although there may be some promising leads at this time.

I think this problem results from falling a bit into the psychological-physical dichotomy trap. Although you've set it up as psychogenic-organic. When trying to show that ME is not psychogenic, one naturally then wants to show positive 'organic'-sounding evidence.

I would keep the word 'psychogenic' since it is central to the BPS thesis, but I think the proper opposite of it is just 'not psychogenic'. ('Organic'/'Physical'/'Biological'/'Physiological' are not useful categories because they contain every disease, condition, and syndrome, unless we wish to believe in 'metaphysical illness', which we certainly shouldn't!)

The other useful dichotomy that comes to mind is 'responds to psychological intervention' vs 'doesn't respond to psychological intervention'.

So it's enough to argue against BPS by simply showing that the psychogenic etiology thesis is unsubstantiated at best, implausible, and contradicted by the results of PACE; and showing that there is no good evidence for benefit from CBT or GET regardless of what theory they stem from.

I think overstating positive physiological evidence weakens the position of advocacy. We need the standard of argument to be high to invalidate BPS BS. And it may compromise the standard of future biomedical research, which can itself contain loads of junk, and which we need to be of the highest quality possible.
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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
Dolphin said:
Yes, I agree.

I think that it would be hard for people such as Peter White and Trudie Chalder/Simon Wessely to set up bases like they did in Barts and King's in a health system where there are co-pays where consumers pay some or all of the costs. Too many patients would have voted with their feet/money not to attend such services and other competing services would be set up. Once Peter White and Simon Wessely had such solid bases, it allowed them to have little empires with research and the like, be seen as experts, etc.

[A reminder of some of the things Peter White and the Barts service said on draft NICE guidelines:
https://meagenda.wordpress.com/2007...g-the-nice-guidelines-for-cfs-me-tom-kindlon/ Such comments would damage the reputation of a service competing for a patient's "business".]

Accepting this doesn't mean that overall, one thinks that the NHS and similar systems aren't the best system(s). To me it's like being somebody thinking a particular drug or procedure is good or the best in a particular situation, but then going on to deny it has any side-effects.
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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
 
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Brian Hughes said:
Many thanks. That would be fine with me. Let me know if you get to do this. In due course I want to superimpose my slides onto the video, so that viewers can better follow what I'm saying. When I get the time...... ;)
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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(?)
 
Jonathan Edwards said:
But that is the crazy thing. The state does pay more. Nobody realises that the US socialised healthcare system is more expensive than ours per person.
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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.
 
Inara said:
Personally, I believe this is linked to the kind of health system of a country. In USA, there is no "general" health insurance (even Obama care doesn't come close to what we have in UK, Germany, France etc.), it's private. The social system isn't very good, so costs remain relatively low. (US citizens, please correct me where needed.) And USA are the first to accept ME. The other countries want to reduce costs of the health system, and the BPS teaching "it's up to the individual to get healthy" is most welcome.
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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
 
Woolie said:
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.
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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.
 
JemPD said:
@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
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Absolutely fine with me, @JemPD. I'm glad you find it helpful... :emoji_thumbsup:
 
obeat said:
Analysis BBC radio 4 Monday 12th November is about the replication crisis in psychology.
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Monday 12th November, 30 minute program at 2030
The Replication Crisis
Analysis
Many key findings in psychological research are under question, as the results of some of its most well-known experiments – such as the marshmallow effect, ego depletion, stereotype threat and the Zimbardo Stanford Prison Experiment – have proved difficult or impossible to reproduce. This has affected numerous careers and led to bitter recriminations in the academic community. So can the insights of academic psychology be trusted and what are the implications for us all? Featuring contributions from John Bargh, Susan Fiske, John Ioannidis, Brian Nosek, Stephen Reicher, Diederik Stapel and Simine Vazire.

Presenter: David Edmonds
Producer: Ben Cooper
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obeat said:
@Brian Hughes . Just out of interest, how did your lecture in Wexford go down and how interested are psychologists in improving their research.? Thanks
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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.
 
Brian Hughes said:
I do think psychologists are a lot more conscious of the need to improve research than we often realise.
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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
So, should we ignore evidence from journal articles? If steps are not taken urgently to address the situation, then ‘probably’ would be our answer. By the law of Garbage In Garbage Out, whatever we produce in our reviews will be systematically assembled and synthesised garbage with a nice Cochrane logo on it. One major problem is our ignorance of the presence of garbage, as its invisibility makes its distortions credible and impossible to check. This is how some of us happily signed off a Cochrane review with findings which had been completely and invisibly subverted18 by reporting bias.
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Ethics and Evidence both begin with ‘E’.
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https://ebm.bmj.com/content/23/2/46
 
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