Trial By Error: Why Have Experts in MUS Spent Ten Years Mis-Citing a Study about Costs to the NHS? David Tuller

[Sly Saint]

What does it mean that the top investigators in a field of research have collectively and consistently misrepresented a seminal figure in their purported domain of expertise? I’m talking about all those who present themselves as authorities on the topic of so-called “medically unexplained symptoms” (MUS) but have found it difficult to accurately cite a study that examined the purported costs of these conditions to the National Health Service. (This phenomenon was initially pointed out to me by an observant sleuth; I first wrote about it here.)

The study in question, Bermingham et al, is called “The cost of somatisation among the working-age population in England for the year 2008-2009.” It was published in 2010 in the journal Mental Health in Family Medicine. As one of its core findings, it estimated something very specific: NHS costs for patients of working age identified as “somatising” to even a minor extent accounted for around 10% of the total costs for that demographic category. In paper after paper, “experts” in MUS have translated that straightforward data point this way: Patients with MUS accounted for 10% of total NHS costs. The effect of that error is to more than triple the apparent impact of MUS on the NHS budget.

https://www.virology.ws/2021/04/23/...rs-mis-citing-a-study-about-costs-to-the-nhs/

 

[rvallee]

I cannot accept at this point that this is a mistake. It's clearly disinformation, they know they are lying, they are lying for their self-benefit and they get away with it because the system is not built to guard against this, it encourages groupthink and deals harshly with anyone who rocks the boat against political wants.

Not that at this point is new, ever since the first time Tuller had to basically explain to an editor why and how a basic factual mistake in their journal should be corrected it was obviously intentional deceit. But they do it again because they are encouraged to lie for their self-benefit, because others benefit from it too.

Similar to how our BPS ideologues keep lying that there is nothing but a small vindictive activist minority objecting to their stuff and none of it is substantial. They know it's false. Among many other lies they repeat. But they lie anyway. When lying is encouraged, you get a LOT of it. And lies replicate, one lie leads to another and another, always bigger, always committing more people to it.

If there's any doubt, I am calling these people liars. They lie about medical and public health matters in full awareness and intent. And it's immoral and wrong.

 

[Starlight]

I don't think they care about lies or morals or conscience..and people like that are probably considered to be sociopaths. They don't consider the damage they have done and they have an ardent desire to continue on the same path. I like the way David Tuller goes after them lie by lie , oh ! of course I meant line by line.
..

 

[Graham]

I have thought a lot about this over the years, especially with Sharpe, Wessely, White, Chalder and Crawley. I don't know any of them, have never met them, so it would be wrong of me to leap to conclusions, but to my mind there are only three possibilities.

Stupidity – a complete inability to understand the scientific, statistical and logical methods, no matter how well it is explained to you.

Deep seated belief – an unshakeable, almost religious belief, that their interpretation is correct, and that the texts they follow are the chosen words on the matter, and that they have been chosen to heal the sick.

Sociopaths – simply playing the game for self-interests.

I think it would be easy to assume they are all sociopaths, but actually I have the feeling that we have all three in the group.

 

[dave30th]

My feeling about Bermingham et al is that it really was likely unintentional and then just kept being repeated as a commonly accepted "fact" that no one had to bother to double-check. I don't think all the misquotations were intentional. However, because they all believed the same thing, it was easy for them to collectively mis-read the study and repeat the misinterpretation. Now, at this point, delaying correcting it or creating obstacles to correcting it is obviously intentional. Not immediately initiating corrections is intentional. This morning I sent Professor David another e-mail:

Dear Professor David--

I have noticed that a 2016 paper on which you were the senior author contains the same misstatement about Bermingham et al as the two more recent papers that I have already highlighted. The 2016 paper, "Medically unexplained visual loss in a specialist clinic: a retrospective case–control comparison," was published in the Journal of the Neurological Sciences. I have cc'd the corresponding author on this e-mail, and again Vincent Racaniello, Columbia's Higgins Professor of Microbiology and host of Virology Blog. (Incidentally, in the paper "Bermingham" is misspelled as "Birmingham.")

The 2016 paper includes this sentence: "In estimation of the associated health costs of medically unexplained symptoms, Birmingham [sic] & colleagues propose that healthcare utilisation amounts to £3billion per annum, or 10% of total NHS expenditure." Clearly, this needs to be corrected, since the figure actually represented 10% of NHS expenditures for the working-age population and only about 3% of "total" NHS expenditures.

For what it's worth, the title of Bermingham et al itself specifies the age parameters of the study population, so the repetition of this false information across a decade continues to mystify me. Any explanation you might offer to help me understand this phenomenon would be much appreciated.

Thanks for your quick attention to this matter. I look forward to seeing the corrections in both this paper and the more recent one in Psychological Medicine.

Best--David

David Tuller, DrPH
Senior Fellow in Public Health and Journalism
Center for Global Public Health
School of Public Health
University of California, Berkeley

 

[rvallee]

I have thought a lot about this over the years, especially with Sharpe, Wessely, White, Chalder and Crawley. I don't know any of them, have never met them, so it would be wrong of me to leap to conclusions, but to my mind there are only three possibilities.

Stupidity – a complete inability to understand the scientific, statistical and logical methods, no matter how well it is explained to you.

Deep seated belief – an unshakeable, almost religious belief, that their interpretation is correct, and that the texts they follow are the chosen words on the matter, and that they have been chosen to heal the sick.

Sociopaths – simply playing the game for self-interests.

I think it would be easy to assume they are all sociopaths, but actually I have the feeling that we have all three in the group.

Ultimately, all things that should be irrelevant under a functioning system of accountability.

I do place significant personal blame on those responsible, but they are being encouraged and rewarded every step of the way. Regardless of the reasons for pursuing this, their immediate environment is telling to go for it and never look back. So perverse incentives and a broken system are frankly more to blame than whatever personal flaws they carry.

It's very similar to the scientists who helped the tobacco companies kill people for profit. Did they believe it? Nobody knows, but what we do know is that those people had a pretty good life, provided for their family and probably retired with a very comfortable pension and savings. The world was rewarding them handsomely, until it didn't. But when it stopped doing that, nobody seems to have blamed them. Does anyone even know the names of the scientists who did that dirty work? Probably not, aside from a handful of historians.

In the end we all respond to our immediate social context. If that context is encouraging and rewarding bullying behavior that ultimately destroys life, frankly most people do not have the awareness or capacity to know any better. Humans are social animals and if that society is telling someone that they're doing great maximizing the productivity of a human sacrifice process, how are they really to know any better when it gives them access to luxurious housing, material wealth and respect/fear?

It's easy to forget that well over 90% of human history happened while living in small tribes of hunter-gatherers, where immediate social approval was everything. I think that's the flaw we carry over and explains everyone's behavior. So much of human behavior can be boiled down to the old Watergate saying of: The truth is, these are not very bright guys, and things got out of hand.

Which places the fault in the system. But the system is run by people who respond to social cues and rewards. And what's happening to some of the prominent ones, say Richard Horton or Fiona Godlee? Doing pretty good. Basically we're still just a bunch of primitive apes who kid ourselves we're doing great because what else is there to do anyway? Our BPS overlords have no idea how our lives are or what they leave behind, all they know is they're having major success destroying our lives, an outcome they never actually have to face.

 

[Sean]

Ultimately, all things that should be irrelevant under a functioning system of accountability.

I do place significant personal blame on those responsible, but they are being encouraged and rewarded every step of the way. Regardless of the reasons for pursuing this, their immediate environment is telling to go for it and never look back. So perverse incentives and a broken system are frankly more to blame than whatever personal flaws they carry.

It is the combination of a broken (or inadequate) oversight system, and individuals happy to exploit that.

 

[Sly Saint]

Trial By Error: Professor David’s Third Mis-Citation of Seminal Study of “Medically Unexplained Symptoms”

I have recently blogged about the multiple mis-citations of a seminal study involving so-called “medically unexplained symptoms” (MUS). The 2010 study, Bermingham et al, found that the amount spent by the National Health Service on working-age people who were assessed as “somatising” accounted for around 10% of what was spent on that population. Since the study was published more than a decade ago, experts in MUS have routinely misrepresented it by asserting that these costs accounted for 10% of total NHS expenditures—in effect more than tripling their apparent financial impact.

https://www.virology.ws/2021/04/26/...inal-study-of-medically-unexplained-symptoms/

 

[Andy]

Trial By Error: Neurology Journal Fixes False Claim in MUS Paper–But Fails to Publish a Correction Notice

"I’ve recently bugged two separate journals to correct the same error—a mis-citation of a study concerning the estimated costs to the UK’s National Health Service of so-called “medically unexplained symptoms” (MUS). One of the journals, Psychological Medicine, has corrected the mistake and has also published a standard notice called a corrigendum that alerts readers to the fact that a change has been made.

In contrast, Journal of the Neurological Sciences has corrected the error in the text of the paper in question but has not published a corresponding corrigendum—or at least not one that I can find on the site of this Elsevier publication. Perhaps one is coming, although the offending sentence was fixed weeks ago, according to my communications with the journal. It is not acceptable for a journal to make a substantive correction and not indicate that this has happened."

https://www.virology.ws/2021/07/31/...per-but-fails-to-publish-a-correction-notice/

 

[rvallee]

The authors apologise for this error

And the editors, who did not do their one job? And the peer reviewers, who seemingly did not put any effort? Did they not read beyond the authors' names? What kind of BS process do they have there?

 

[Invisible Woman]

And the editors, who did not do their one job? And the peer reviewers, who seemingly did not put any effort? Did they not read beyond the authors' names? What kind of BS process do they have there?

Too right. If the peer reviewers and editors can't bring themselves to.apologize maybe they should put their hands in their pockets at David Tuller's next crowd funding as he has had to do part of their job for them?

 

[Forbin]

The erroneous use of this statistic might be labeled "Low Accuracy" but "High Precision."
It's "high precision" because everyone is making the same mistake, but "low accuracy" because it's just plain wrong.
This kind of thing usually represents some kind of "systemic error." [I know. Shocking, isn't it?]

 

[Sly Saint]

paper from 2018;
another example?

Prevalence of medically unexplained symptoms in adults who are high users of health care services: a systematic review and meta-analysis protocol

It is estimated that MUS accounts for approximately 20% of new consultations in primary care,4 5 52% of new referrals in secondary care6 and 20%–25% of all frequent attenders at medical clinics.7 8 Patients with MUS are commonly referred for multiple investigations and assessments with little benefit, so are needlessly costly for healthcare systems9–11 and account for approximately 10% of the total National Health Service (NHS) expenditure for the working-age adult population in England. The annual cost attributable to MUS due to lost productivity and decreased quality of life is over £14 billion to the UK economy.12 However, there is no satisfactory review of the available literature to support such estimations.

https://bmjopen.bmj.com/content/9/7/e027922#ref-9