PROOF POSITIVE? ME/CFS (UK)

Discussion in 'Fibromyalgia Main Forum' started by tansy, Sep 13, 2005.

  1. tansy

    tansy New Member

    PROOF POSITIVE?

    Evidence of the deliberate creation via social constructionism of
    "psychosocial" illness by cult indoctrination of State agencies, and the
    impact of this on social and welfare policy

    Eileen Marshall Margaret Williams

    30th August 2005

    The ME community has for years urged UK Government bodies to fund research
    into both the epidemiology and the biomedical abnormalities that are known
    to exist in myalgic encephalomyelitis (ME, also listed as Chronic Fatigue
    Syndrome by the World Health Organisation in the International
    Classification of Diseases as Chronic Fatigue Syndrome (CFS) as a disorder
    of the nervous system), almost always to no avail, to the extent that the ME
    community realised that there were powerful vested interests at stake which
    were known to involve a group of psychiatrists known as the "Wessely School".
    Now, it seems, there is hard evidence of the reason for the Establishment's
    apparent resistance to acknowledge ME/CFS as an organic disorder and, as
    previously realised, it does indeed involve psychiatrists of the "Wessely
    School".

    The evidence is contained in a book entitled "Biopsychosocial Medicine: An
    integrated approach to understanding illness" edited by psychiatrist Peter
    White, Professor of Psychological Medicine at St Bartholomew's and the
    London, Queen Mary School of Medicine recently published by Oxford
    University Press (2005).

    This provides a most illuminating exposition of what had long been
    suspected; the list of contributors is itself equally confirmatory.

    The book arose out of a two-day conference held at the (pharmaceutical)
    Novartis Foundation in London on 31st October and 1st November 2002, being a
    joint venture between the Novartis Foundation and a body called One-Health,
    said to be a not-for-profit company that (quote) "was established in order
    to promote a system of healthcare based on the biopsychosocial model of
    ill-health". Peter White is Chairman of One-Health and his fellow Directors
    include Trudie Chalder, a former Registered Mental Nurse who is now
    Professor of Cognitive Behavioural Psychotherapy at the Institute of
    Psychiatry and Guy's, King's and St Thomas' School of Medicine. The Patron
    of One-Health is Greville Mitchell, described as "an influential and
    far-sighted philanthropist". One-Health is supported by the Andrew Mitchell
    Christian Charitable Trust, based at The Grange, St Peter Port, Guernsey.

    In his Preface, Peter White claims that because the biopsychosocial approach
    is better established in psychiatry and in the provision of healthcare for
    what are described as "medically unexplained symptoms", the conference
    concentrated on examining the relevance of the biopsychosocial approach to
    such chronic "medically unexplained" symptoms which -- inevitably, given
    the known beliefs of the contributors -- included Chronic Fatigue Syndrome.

    Peter White states that the book was written because "some people believe
    that medicine is currently travelling up a 'blind alley' (and) this 'blind
    alley' is the biomedical approach to healthcare. The biomedical model
    assumes that ill-health and disability is directly caused by diseases and
    their pathological processes (but) there is an alternative approach...the
    biopsychosocial approach is one that incorporates thoughts, feelings,
    behaviour, their social context and their interactions with pathophysiology".

    Twenty eight "international experts in the field" were invited; twelve talks
    were given, followed by an equal time spent in discussion. The book
    includes those (edited) talks and discussions.

    Some of the invited noblesse "in the field" are already known to the ME
    community: apart from front-runners such as Professor Simon Wessely, who
    chaired the entire conference, Professor Michael Sharpe and Professor Trudie
    Chalder, others who have featured in the fate of those with ME include
    Professor Mansel Aylward, formerly of the Department of Works and Pensions
    (which will ring bells for those with ME/CFS who have had to appear before
    DWP Tribunals in order to obtain or retain their State benefits) and who is
    now at Cardiff as Professor and Director of Psychosocial Disability and
    Research at a new Centre funded by UnumProvident, the medical insurance
    giant that has a lengthy and disturbing track record of refusing to pay
    legitimate claims, especially to those with ME/CFS, to the extent that
    punitive damages have been awarded against it.

    Another of the "international experts in the field" is Professor Jos
    Kleijnen, Director of the Centre for Reviews and Dissemination at the
    University of York, the same Centre that carried out the systematic review
    of the literature that sought to show the efficacy of cognitive behavioural
    therapy for the Chief Medical Officer's "independent" Working Group on
    "CFS/ME" (to which Wessely donated his personal database of over 3,000
    papers), a review which concluded that cognitive behavioural therapy was the
    management regime of choice for those with "CFS/ME". It is the same
    Professor Kleijnen who, during that systematic review of the literature,
    failed to acknowledge or answer correspondence that drew attention to the
    published peer-reviewed evidence of the organic basis of ME/CFS and of the
    biomedical abnormalities that have been demonstrated to exist in the
    disorder.

    Yet another "international expert in the field" is Dr Michael Fitzpatrick, a
    general practitioner at Barton House Health Centre, 233 Albion Road, London
    N16 9JT, better known for his association with the on-line magazine "spiked"
    and for his public attack on the CMO when the latter stood up in support of
    ME as being on a par with multiple sclerosis and motor neurone disease (for
    information about "spiked" and its background, and the efforts of Dr
    Fitzpatrick to dismiss the validity of ME/CFS, see
    http://www.meactionuk.org.uk/SELECT_CTTEE_FINAL_VERSION.htm ).

    Another "international expert in the field" is Professor Adrian Furnham,
    Professor of Psychology at University College, London; this is the same
    Professor Furnham who became famous for publishing some highly derogatory
    comments about people with ME: in the Daily Telegraph on 18th February 1999
    he wrote an article that implied that some people might use "ME" as an
    excuse for professional under-achievement and lack of success and he implied
    that such illnesses were no more than a product of a "psychobabble industry
    based on medicalising mediocrity" and were not real. The ME Association's
    medical adviser, Dr Charles Shepherd, lodged a formal complaint about
    Professor Furnham with the disciplinary committee of the British
    Psychological Society (BPS), claiming that Furnham had broken the Society's
    Code of Conduct by expressing views that were unbalanced and insulting to
    those suffering from ME, and that Furnham's view that ME/CFS was nothing
    more than a fashionable excuse for people who are otherwise lazy, mediocre
    or incompetent was totally inconsistent with the published scientific
    findings. After four months, the BPS concluded that Furnham had not
    committed any form of professional misconduct and rejected the complaint,
    whereupon Shepherd asked the BPS to explain how Furnham's article could be
    acceptable, given that its own Code of Conduct makes it clear that its
    members "shall value and have respect for scientific evidence when making
    public statements".

    It is perhaps worth pointing out that this is the same BPS that, after an
    inquiry lasting nine months, has very recently rejected another ME-related
    complaint about one of its members, in the course of which the BPS itself
    was shown to be in clear breach of its own Rules of Procedure. That
    particular complaint was submitted by Professor Malcolm Hooper about an
    Associate Fellow of the BPS who had on several occasions publicly and
    maliciously defamed him and who had repeatedly publicly implied clinical
    expertise that she did not have, yet the BPS rejected the confirmatory
    evidence that was submitted. The BPS seems to have an interesting history:
    there will be those who recall that a Dr Meg Barker, a speaker at the BPS
    annual conference held in April 2005 in Manchester, advocated "polyamory",
    or free love and multiple relationships: "polyamory" was described by Dr
    Barker as "the belief that it is acceptable or even ideal to have more than
    one sexual partner, with an emphasis on the recognition of multiple
    important relationships" (see: "Free love is fine". Celia Hall. Daily
    Telegraph, 4th April 2005).

    Another "international expert in the field" of note to the ME community is
    Professor Peter Salmon, Professor of Clinical Psychology at Liverpool, known
    for his view that "CFS/ME" is somatisation of mental illness, whose
    Editorial in the May 2002 issue of the British Journal of General Practice
    (Doctors and social epidemics: the problem of persistent unexplained
    physical symptoms, including chronic fatigue) included the following:
    "Opinion has been divided about the validity of chronic fatigue syndrome or
    myalgic encephalopathy (CFS/ME) as an illness. Now, in a report to the Chief
    Medical Officer (CMO), an expert group has concluded that the condition is
    indeed a chronic illness meriting significant NHS resources, including the
    unreserved attention of the medical profession. The approach adopted by the
    group became dominated by the perspective of sufferers and led to the
    conclusion that the scale and severity of the condition establish its
    authenticity and dictate the need for NHS provision. The group's
    recognition of CFS/ME as a distinct syndrome runs counter to trends in
    recent research (citing Wessely, Lancet 1999:354:936-939). It is likely
    that the "reality" of syndromes such as CFS/ME reflect bias in the referral
    and selection processes inherent in medical specialisation. Patients with
    persistent unexplained physical symptoms (PUPS) believe themselves to be ill
    (and) seek support from fellow sufferers via the agency of syndrome-specific
    support groups and treatment from complementary practitioners. Thus, in
    contrast to the trend in recent research to view PUPS as a generic problem,
    both clinical practice and the activities of pressure groups are tending to
    perpetuate syndromes such as CFS/ME. The prevailing view in UK primary care
    has been that somatisation of mental illness is the basic problem.
    Approaches to care which focus on changing the way patients and doctors
    communicate about the illness and, in particular, incorporate and modify
    patients' beliefs within an agreed management strategy, are gaining ground
    (and) a number of authors have pointed to the primacy of cultural and social
    factors in creating ill-defined syndromes, suggesting that they are akin to
    other types of 'social epidemic'. The fundamental criticism of the CMO's
    group is that by adopting an approach that allowed consumerism in health
    care to define an illness, it surrendered a role reserved for the profession's
    established scientific methods. The uncritical diversion of NHS resources,
    and particularly medical man-power, will not diminish the problem, for
    unless the medical profession clearly understands its role in the management
    of illness beliefs and behaviour in the absence of demonstrable pathology,
    it risks becoming both an intellectual casualty and a potent vector of this
    and other social epidemics".

    In a submitted response (unpublished) to the BJGP, Hooper et al noted that
    Salmon seemed to resent the CMO's acknowledgement that ME/CFS is a "real"
    disease and that Salmon made not a single mention of any of the mounting
    number of biomarkers of organic pathology, nor --- even though admittedly
    writing in a British journal--- did he attempt to explain how his so-called
    "social epidemics" of physical symptoms have come to affect hundreds of
    thousands of people worldwide who manifest exactly the same physical
    symptoms when such patients do not speak or understand the same language,
    for example, those in Russia, Sierra Leone, Papua New Guinea, China and
    Japan. Perhaps the most telling matter is that for one of his allegedly
    supportive references, he relied on the surmising of a much-criticised
    American Assistant Professor of English, the notorious Elaine Showalter
    (author of Hystories: hysterical epidemics and modern culture [London,
    Picador, 1998] who equates ME/CFS and Gulf War Syndrome with abduction by
    aliens) as evidence to support his own theories, from which it could be
    surmised that, as a psychologist, he must be at something of a loss in the
    complex field of neuro-endocrine-immunology and vascular biology that
    defines ME/CFS.

    Another "international expert in the field" is Francis Creed, Professor of
    Psychological Medicine at the School of Psychiatry and Behavioural Sciences
    at the University of Manchester; he is Director of Research and Development
    for the Manchester Mental Health and Social Care Trust and is also Editor of
    the Journal of Psychosomatic Research. One of his research areas is the
    treatment of somatisation. Creed has failed to acknowledge or respond to
    letters written to him as Editor asking that the Journal present a more
    balanced and less biased portrayal of ME/CFS.

    Other "international experts in the field" include Professor Edward Shorter,
    holder of the Hannah Chair in the History of Medicine at the University of
    Toronto, Canada, whose views are so beloved by Elaine Showalter, such views
    being that the creation of disorders such as ME are ' a spiral of suggestion'.
    According to Shorter, "Patients are exposed to a diagnosis and assured by a
    sensation-hungry media that it represents the explanation of their problems
    (and) they are reassured that doctors do not know what they are talking
    about. This is a recipe for the disintegration of medical authority and a
    psycho-circus of suggestion" (I am a Duvet woman: why are 85 per cent of ME
    sufferers women? Elaine Showalter. Independent on Sunday, 25th January
    1988).

    So much for the already-known beliefs of the contributors, but what are they
    saying in this book? The following extracts provide the answer, but what
    they do not provide is the answer as to how attempts to alter the way a
    person thinks about such a serious disorder can address or assist how ill a
    person feels (and actually is), nor how the favoured psychiatric 'management
    regimes' can improve understanding of the pathological processes that result
    in end-organ failure that cause patients to feel (and to be) so sick and
    disabled.

    Unless the disease itself is robustly investigated and understood -- and
    ultimately treated -- no amount of psychosocial 'management' will have
    worthwhile or lasting effects, either upon the hapless sufferer trying to
    cope without medical support with serious and destructive organic pathology
    or upon the cash-strapped and rapidly sinking NHS.

    The whole concept of "biopsychosocial" intervention would seem to be a short
    sighted 'quick-fix' that is doomed to pass into oblivion once the biomedical
    evidence falls into place: to disregard the need for (and the importance of)
    the biomedical aspects that are already known to underlie ME/CFS and to
    place such undue emphasis and funding only on the biopsychosocial aspects
    has, through the auspices of members of the One-Health company, come to
    dominate UK Government policy and service provision, but it may soon turn
    out to be the company's own death sentence because there is now so much
    credible biomedical evidence of serious organic pathology in ME/CFS that the
    beliefs of members of the One-Health company look increasingly
    scientifically naïve and ill-founded.

    No-one disputes that supportive understanding can help patients to cope with
    the suffering inherent in many diseases, including cancer and heart disease:
    where things are different in ME/CFS is that the very reality and nature of
    the disorder are denied by this One-Health group, who claim it is a mental
    disorder and who seem consistently unable to comprehend how the imposition
    of such erroneous beliefs can be psychologically injurious to sufferers and
    that this amounts to iatrogenic damage.

    From the Foreword by Simon Wessely: 'The greatest benefit to mankind'.

    Before quoting from Wessely's words, it may be worthwhile reflecting on his
    choice of quotation and what he hoped to convey by its use: in the book "The
    Greatest Benefit to Mankind" [Harper Collins, London, 1997] the late Roy
    Porter noted that it was the biomedical model (not the psychosocial model)
    that has provided advances in the understanding -- and thus in the
    treatment and prevention -- of disease processes.

    Wessely's Foreword states: "I seem to have spent much of the last decade
    sitting on grant-giving bodies...cognitive behaviour therapy has transformed
    the management of many chronic symptomatic conditions. That psychological
    and social factors contribute to disease is clear (but) no-one in their
    right minds, not even government, would dream of tackling these issues
    without firming anchoring policy and intervention in the social sphere. No
    argument there. Psychological issues matter, and matter greatly. The
    Whitehall studies that (Sir Michael Marmot, Professor of Epidemiology and
    Public Health, University College, London, another of the "international
    experts in the field") has guided are seminal. What they have shown is how
    social differentials, both at work and at home, are major determinants of
    disease outcome. I have always felt that trying to influence psychological
    and social outcomes is a very good and satisfying career for a doctor, even
    if in the public eye people like myself will never achieve the respect,
    acclaim and rewards given to our more glamorous colleagues". Having asked:
    "What role does the psycho and social play in the bio?", Wessely actually
    concedes that "Perhaps in their choice of participants and Chairman (for the
    conference) the organizers had loaded the dice (in favour of the
    biopsychosocial approach).

    At the end of his Foreword, Wessely makes one of his convoluted
    pronouncements: "Medical care remains dualistic, perhaps more so than ever.
    In the clinic, but not the conference hall or laboratory, we seem best able
    to tackle the social and psychological only when we have solved the physical
    first". This could be interpreted as meaning that in the clinic, Wessely
    School adherents (ie. proponents of the biopsychosocial paradigm of disease)
    will continue to patronise ME sufferers by assuring them that their symptoms
    really are "physical" in order to get their trust, whilst in the conference
    hall and laboratory (where the "real" issues are addressed), the social and
    psychological will continue to be the key issues.
    From the Discussion after Professor Kate Lorig's presentation (chapter 12:
    "What are the barriers to healthcare systems using a biopsychosocial
    approach and how might they be overcome?")
    Professor Kate Lorig from the Stanford Patient Education Research Centre at
    Stanford School of Medicine provided some telling answers. When asked by
    Professor Mansel Aylward how did she recruit people into the biopsychosocial
    model, she replied: "I'd put real marketing experts onto it. The programme
    is now being used in about 14 countries and the Australians found out that
    the way to recruit is via symptoms. Are they tired? If so, come along. We
    have been running the same programme with monolingual Spanish speakers. We
    run it in churches and community halls. This past Easter I went to mass
    twice, and I'm Jewish. The place to find Spanish speakers in the USA is
    mass on Easter Sunday. Between myself and the staff we covered 17 masses.
    We just take their names and addresses and then call them later. The system
    has to go to them, you don't ask them to go to the system. We have not
    focused on diseases, but on symptoms. This is what they respond to".

    Peter White then asked Professor Lorig: "Have you seen a differential effect
    in outcome by diagnosis or diagnostic group? I ask this because work done
    in the UK under the aegis of the Department of Health suggested that a
    particular diagnostic group, chronic fatigue syndrome, did not do at all
    well (but that) patients with CFS did better when they did the programme
    with patients with arthritis". Lorig replied that they were currently doing
    studies to see whether it makes much difference if people are in a
    disease-specific group, but that their initial results did not show a great
    deal of difference.

    Professor Francis Creed asked Lorig: "We were discussing some of the
    organizational barriers to instituting the biopsychosocial model more widely
    (but) it sounds like you have been very successful in overcoming them. What
    are the most telling things that have made a difference?", to which Lorig
    replied: "We have proselytised..the 'innovators' leap out in front and try
    everything new. These were not the people we want to reach. Instead, we
    wanted to target the next group, the 'early adopters' (of the regime). These
    are the people that need to be successful. If they are, the rest of the
    world will eventually come along".

    Professor Michael von Korff (Senior Investigator from the Centre for Health
    Studies in Seattle) then said: "Kate Lorig outlined sources of resistance.
    If we want to make the biopsychosocial model work, we need to start
    addressing some different fields than the primary care visit and medical
    care".

    Mike Fitzpatrick said: "It is interesting to contrast the approach Kate
    Lorig is talking about with what we are familiar with about patient
    campaigns, which often have a very activist feel to them, such as the ME
    campaign. There are vast numbers of these self-help groups. What Kate has
    described has a strongly top-down character (and) the nature of the training
    seems didactic, with master trainers. How does this sit with the existing
    self-help campaigns?"

    Lorig replied: "The two master trainers in the UK both came from patient
    groups...we have had virtually no resistance from patient groups".

    Wessely asked: "What would happen if (a) group started to challenge these
    particular treatment ideologies and said they wanted to know how to get more
    benefits from the state? You are going to come to some bits where some
    people in the room might say 'I tried that and it didn't work for me: in
    fact it made me worse' ", to which Lorig's reply was: "I'd say, ' You know,
    then I really think you shouldn't do it' ".

    Trudie Chalder said to Kate Lorig: "It is clear that you are a very
    effective cognitive behavioural psychotherapist and I want to congratulate
    you on your programme. It sounds marvellous". Lorig replied: "If you are
    interested in it, I would suggest seeing it in action. Bob Lewin has done
    this".
    Professor Robert Lewin (from the Department of Health Sciences at the
    University of York) said: "I went along because I got involved through the
    Department of Health. They wanted some disease-specific modules. I though
    this was going to be done by people who had been taught by rote how to do
    this from a set of flip charts. Goal setting is completely different when it
    is done by lay people. I had to be careful as a fairly experienced
    therapist to forget the part of me that wanted to guide the process. I
    wonder if patient-generated goals last longer. As we all know, CBT gains
    tend to fade over time".
    Wessely said: "My immediate reaction is to wonder about the slightly false
    dichotomy you set up between orthodox and alternative medicine. I am
    extremely sceptical about complementary medicine. The question you address
    is whether the biopsychosocial model is the same as the model of alternative
    medicine. I am absolutely certain it can't possibly be, or otherwise I
    wouldn't so criticize it. In the field we work in, the alternative views on
    chronic fatigue syndrome are unbelievably reductionist. There is a group of
    people who consult alternative practitioners because they want the most
    biological explanations about allergies and so on. They see them in a
    political framework: it's all the fault of governments and industry. In
    those models there is no room for any psychosocial element".

    Mansel Aylward said: "Today we have hit on what I think are the crucial
    issues. These aspects of the biopsychosocial model have had the greatest
    impact in developing social and welfare policy in the UK. These techniques
    are simply described and one can communicate them to our colleagues, and
    even to our politicians, who sometime find it difficult to grasp these
    issues. This sort of work will strongly influence how social policy and
    rehabilitation will develop over the next year or so. Importantly, we
    should consider the work by Buchbinder in Australia. This showed the
    utility of a multi-media educational programme. We hope we will be able to
    repeat some of this here".

    Michael Von Korff said: "If you take interventions that individually are
    modest in their effects and you have the healthcare system and the social
    welfare system using these approaches consistently, you end up with a larger
    effect. This is a very important aspect".

    Peter White said: "There are two ways to change beliefs. You can change
    beliefs first using cognitive behavioural therapy, which leads to behaviour
    changes (or you can) change the behaviour first, which then changes the
    cognition. Exposure is needed to the particularly avoided behaviour, which
    is exercise or physical activity in chronic fatigue syndrome. Perhaps we
    need to look carefully at how an intervention programme is delivered for
    each disease".

    Robert Lewin observed: "You may have delivered the exercise programme in a
    far more psychological way, but purely physical exercise programmes do not
    have very much effect".

    Wessely said: "We are talking about barriers. The people we see just don't
    believe us".

    Michael Von Korff said: "If we start with the assumption that all chronic
    pain patients are motivated largely by secondary gain and are difficult and
    demanding individuals, then we will miss the broader opportunity to
    fundamentally change the way (such patients) are managed in the healthcare
    and social welfare systems".

    Kate Lorig said: "This is where we have to develop key messages, which the
    healthcare system gives consistently".

    Simon Wessely said: "We accept that. This is what we do in treatment
    programmes. But we also know that even getting patients to see us is a
    challenge because of their fear-avoidance beliefs".

    Michael Sharpe said: "I'd like to get the word iatrogenesis on the table;
    doctors do cause harm by their psychological interventions: people often do
    not get consistent messages from their various medical attendants. In fact,
    in the UK at least, there are substantial numbers of doctors who give people
    exactly the opposite advice in terms of this evidence. When Simon Wessely
    is trying to tell his patients one thing, they can read something entirely
    different on the internet or see someone else who will tell him or her
    exactly the opposite. That inconsistency of apparently authoritative
    information is an important part of the problem".

    Peter White said: "The biopsychosocial approach is import in addressing
    disability associated with all chronic ill-health, whatever its provenance
    (but) there is an overwhelming amount of evidence for the utility of the
    biopsychosocial approach in both understanding and helping patients with
    mental ill-health and physical symptoms for which no explanation is
    apparent. The latter includes common disorders such as chronic fatigue
    syndrome. How can barriers to making the biopsychosocial approach routine
    for chronic ill-health be removed? Barriers to implementing this approach
    exist within patients, professionals, and health-care systems. Health-care
    systems will routinely incorporate the biopsychosocial approach when
    convinced of its economic advantages. But a more convincing case may mean
    considering economic costs across the whole of society, not just the
    health-care system".

    Discussing professional education and training in relation to the
    biopsychosocial approach, White said: "Teaching the skills necessary for
    professionals to feel confident that they can address the problems thrown up
    by a biopsychosocial approach is more important than persuading them to ask
    the appropriate questions".

    White went on: "Because many patients now use the internet for information
    on their health, we should make greater use of this medium to get the right
    message across".

    He then said: "Above all, patients need to know that the biopsychosocial
    approach is simply an extension of the biomedical approach (and) because
    patients, health-care systems, and benefits providers have most to gain, it
    is probably they who will drive the agenda forward, unless we take the lead
    ourselves".

    The one dissenting voice at the conference was that of George Davey Smith,
    Professor of Clinical Epidemiology, Department of Social Medicine,
    University of Bristol, who in a presentation called "The biopsychosocial
    approach: a note of caution" carried the torch for intellectual integrity.
    His contribution showed that bias can generate spurious findings and that
    when interventional studies to examine the efficacy of a psychosocial
    approach have been used, the results have been disappointing.

    To quote from Davey Smith's contribution: "Over the past 50 years many
    psychosocial factors have been proposed and accepted as important
    aetiological agents for particular diseases and then they have quietly been
    dropped from consideration and discussion". The illustrations he cited
    included cholera, pellagra, asthma and peptic ulcer. He went on to quote
    Susan Sontag's well-known dictum: "Theories that diseases are caused by
    mental state and can be cured by willpower are always an index of how much
    is not understood about the physical basis of the disease" (Illness as a
    metaphor. New York: Random House; 1978).

    Davey Smith's reasoned warning to brought to mind the validity of Susan
    Haark's chapter "Concern for Truth: What it means, Why it matters" in "The
    Flight from Science and Reason". (Eds) Paul R Gross, Norman Levitt and
    Martin W Lewis (New York Academy of Sciences, 1996; pp57-63), which finds
    that those who know only their own side of a case know very little of that,
    and that "sham reasoning" attempts not to get to the truth, but to make a
    case for the truth of some proposition to which one is already committed, a
    familiar phenomenon in contemporary academic life. "Sham reasoning" in the
    form of research bought and paid for by bodies with an interest in its
    turning out in a desired way, or motivated by political conviction, and
    "fake reasoning", in the form of 'scholarship' that is in reality
    self-promotion, are all too common. Could this possibly apply to members of
    One-Health company?
    In the discussion that followed Davey Smith's presentation, Wessely appeared
    to be apoplectic: "That was a powerful and uncomfortable paper. There will
    undoubtedly be many people, including those who one might call CFS
    activists, who would have loved every word you were saying. There is a
    popular and seductive view of medical history in which we move implicitly
    from unknown diseases which are thought to be psychiatric, and as we become
    better, brighter scientists, they are finally accepted in the pantheon of
    real diseases. You should remember that there is an opposite trend as well,
    which you didn't mention".

    Davey Smith's response was succinct: he believed there is a need to
    distinguish association from actual causation: "My main point was about
    disease aetiology. As a disease epidemiologist I want to get the right
    answers about this. In my view, susceptibility has been overplayed and
    exposure has been under-appreciated in social epidemiology".

    The distinguishing between association and causation is a key issue: Wessely's
    confusion, especially in relation to ME/CFS, of association with causality
    is a criticism that has long been directed at him and he has been reminded
    again and again that correlation is not the same as causation, and that he
    should not over-interpret results as having more practical importance than
    those results warrant. To do so is not only methodologically flawed, but
    contributes to the continued mis-perception of the disorder.

    Nevertheless, and perhaps unsurprisingly, Professor Sir Michael Marmot
    sprang to support Wessely: "I would emphasize Simon Wessely's point. It is
    easy to look back and say, 'Gosh, how silly they were in the past to think
    all these silly thoughts; aren't we clever now!'. Research has advanced
    beyond the examples you cite because there have been many advances in
    conceptualisation and measurement of psychosocial factors", to which Davey
    Smith replied: "We can get more robust evidence from observational studies,
    but these approaches have not really been utilized in the psychosocial
    field".
    Illuminating as these extracts have been, it is the final discussion ("How
    to overcome the barriers") that strikes the most chilling resonance because
    it seems to embody the social construction of their own version of reality
    by these influential and determined social constructivists: this is alarming
    because there are parallels in comparatively recent history that are
    forgotten at humanity's peril.

    In the final discussion, Peter White thought it would be useful to outline
    the barriers identified in their discussion and to explore ways round those
    barriers. He said: "I think we have agreed that the aetiological work is
    not immediately relevant to the biopsychosocial model in the healthcare
    system at the moment. Therefore what we need to concentrate on
    pragmatically is the use of the biopsychosocial model in healthcare".

    This would seem to be the clearest indication that the causation (and thus
    the accurate nature) of disease is of no relevance to One-Health social
    constructionists.

    Douglas Drossman (Professor of Medicine and Psychiatry, University of North
    Carolina, USA) said: Is there a way to communicate these ideas to the people
    involved with running medical schools? Often, the problem is in changing
    the behaviours of physicians at practice who are 50 years old. It may be
    much easier to start with new medical students. We want to begin with them".

    At this point, Trudie Chalder made a truly disturbing contribution: "Rather
    than start with the physicians, which might be quite a difficult task, we
    could make a start with youngster in schools. My experience is that they
    are much easier to educate. The only barrier is the parents. Once we have
    the child on our side we are in a very good position".

    Kate Lorig then said: "I'd like to suggest something a little more radical.
    I think we need some patients to look at how healthcare is delivered. It
    would be easy to put the biopsychosocial model into this setting".
    Wessely said: "Mansel Aylward, you are involved with policy definitions.
    What have you heard here that might influence your Secretary of State?"

    Aylward said: "I have been given a lot of information that reinforces some
    of the messages that I have passed on to decision makers. We had some great
    difficulty last year persuading certain people that the way forward in the
    more effective assessment of disability and its management in people on
    State benefits lay more with a biopsychosocial approach. There seems to be
    an antipathy in some parts of Government towards anything without a hard
    evidence base. If the biopsychosocial approach is perceived in (such a)
    way, it is very difficult to get the Department of Health, amongst others in
    Government, to favour interventions and rehabilitation adopting the
    biopsychosocial approach. But in recent months I'm beginning to see a
    change".

    Wessely: "What made some of the policy makers change their views?"

    Aylward: "Systematic reviews of the literature garnering evidence to support
    the biopsychosocial concept.
    Recent meetings of focus groups of key opinion makers (now) support ---with
    authoritative and expert opinion --- the value of biopsychosocial
    approaches. There are going to be some developments soon. The key aspect
    has been effectively communicating this in a far more robust and
    authoritative way".

    It is noted here that Aylward used the words expert "opinion", not expert
    "evidence".

    Professor Gordon Waddell (Centre for Psychosocial and Disability Research,
    Cardiff) said: "It may actually be easier to change patients and the public,
    and they will then force the professionals to change. Some decision makers
    were very jaundiced. It is all about money. The main thing was to persuade
    the Treasury that there was an opportunity for keeping costs down".

    Professor Robert Lewin said: "One of the things that Greville Mitchell is
    helping us do through One-Health is an analysis that will look at the lost
    opportunity costs from not using cognitive behavioural therapy approaches.
    We are doing this in collaboration with Jos Kleijnen".

    Greville Mitchell said: "If you go to Gordon Brown (UK Chancellor of the
    Exchequer) and say, 'We can prove to you that if we address this issue, we
    can save £2 billion, then you have his full attention".
    Mansel Aylward said: "That is the approach that has been taken".

    Helge Malmgren, Professor of Theoretical Philosophy, Goteborg University,
    Sweden, said: "Considering that so many people go to alternative and
    complementary medicine practitioners, perhaps we should not only confront
    alternative medicine, but also try to make alliances. In particular, we
    could try this with practitioners who use brands of alternative medicine
    that we think have some plausibility".

    Wessely said: "In many levels this is happening. We discussed whether we
    should call this business 'integrated healthcare'. Unfortunately, Prince
    Charles has taken this name".

    Dr Brian Marien of the Health Psychology Unit, King Edward VII Hospital,
    Midhurst, West Sussex, said: "I like Gordon (Waddell's) idea of changing
    patients, because I don't think we are going to change the professions. We
    have seen from Kate Lorig how there is a huge resistance to changing
    practice".
    Mike Fitzpatrick said: "The line from the ME Association is that if you, as
    a GP, say you are sceptical about the ME label, the Chief Medical Officer
    has stipulated how this must be dealt with. This reflects the endorsement
    at the highest level of policy of a disease label that is not supported by
    the evidence --- it is a completely irrational formulation".

    Mansel Aylward's response was: "It doesn't follow that all of that report is
    supported by everyone in Government service. The Department of Work and
    Pensions doesn't necessarily endorse all that is in the Working Party's
    report to the Chief Medical Officer. I am also mindful of the views of
    those who, as members of that group, distanced themselves from some aspects
    of the report".

    Fitzpatrick said: "Nonetheless, this is the line and it is very much
    promulgated that GPs should follow this. It is a consensus forged by
    excluding many of the people in this room who have been involved in this
    area. This illustrates a big problem: the Government are linking up with
    patient activist groups in relation to this very significant area of medical
    practice to dictate a line of approach which is not actually going to be
    beneficial to patients".

    Wessely's reply was: "This is a problem that would need five separate
    conferences to address".
    Professor Michael von Korff said: "If this (biopsychosocial) field doesn't
    start to do definitive trials and strengthening of the research base, we are
    dead in the long run", to which Wessely replied: "There is no dispute about
    that. Some of the evidence doesn't translate into policy as quickly as we
    would like, but without evidence, I am quite sure that there would be no
    changes. Evidence alone is not enough".

    Wessely then said to Greville Mitchell: "I think you should have the last
    word".

    Greville Mitchell said: "The question in the title of this meeting was
    whether the biopsychosocial model is a necessity or a luxury. To me, the
    answer from this meeting is that it is clearly a necessity. It has been a
    brilliant meeting".

    It may have been a "brilliant" meeting as far as most of the participants
    were concerned but a glaring question remains unanswered: during the
    meeting, Professor Robert Lewin from the Department of Health Sciences at
    York stated: "As we all know, cognitive behavioural therapy gains tend to
    fade over time"; this being so (and quite apart from any consideration of
    the appropriateness or efficacy of CBT from the outset), how can the
    psychosocial model that depends on CBT be sold as being so attractive to the
    Chancellor of the Exchequer? Is the Chancellor being deceived about the
    "lost opportunity costs from not using the cognitive behavioural therapy
    approaches"? If CBT has no lasting benefit, how can it be cost-effective?
    Is this self-delusion on the part of One-Health company members?

    A further point that seems to remain unaddressed relates to Peter White's
    claim that the biopsychosocial model is "simply an extension of the
    biomedical model". This claim is not supported by the published views of
    One-Health company members, who without question have denied the validity of
    the biomedical model specifically in relation to ME/CFS and have sought to
    substitute their own biopsychosocial model, not to use it as an adjunct. If
    the biopsychosocial approach worked in cases of authentic ME, patients would
    be clamouring for it, not refusing it, but it clearly does not work in
    ME/CFS and graded exercise may even be life-threatening for the most
    severely affected. As Wessely himself said: "The people we see just don't
    believe us".

    Is it not a little ironic that Mike Sharpe voiced his concern about
    iatrogenesis: "doctors do cause harm by their psychological interventions"
    (presumably he is referring to non-psychiatrists) without apparently being
    able to comprehend the iatrogenesis inflicted upon those with ME/CFS by him
    and his colleagues through their own psychological interventions?

    In essence, the meeting seems to have exemplified an exercise in
    self-promotion rather than an enlightening exercise.

    Overall, the meeting seems to have crystalised One-Health company members'
    clear intention to exert an unchallenged stranglehold over defenceless sick
    people who suffer from what One-Health company members deem to be "medically
    unexplained symptoms", in that the best interests of such sufferers are to
    be sacrificed on the pecuniary altar of the State.

    Indeed, there is now hard evidence that a cabal of social constructionists
    are bent on indoctrinating politicians and Government agencies worldwide -
    and in the UK are not averse to publicly side-lining even the Chief Medical
    Officer - and on imposing their own ideology onto an unwitting public and an
    unconvinced medical profession. This is to be done by means of programmed
    brain-washing that the cabal intends to be implemented not only by the
    Government agencies they have groomed but also by multi-media "educational"
    campaigns as well as by using the internet, starting with the indoctrination
    of children at school (ie. before their critical faculties are sufficiently
    developed to enable them to be discriminating, which seems particularly
    morally repugnant).

    Such determination to change people's beliefs may result not only in the
    removal of a person's right to receive appropriate medical care but may
    further distort the social structure of what was once a decent British
    society in which respect was afforded to the sick as of right, because the
    nature of the State seems to be being changed by social constructionists
    from democracy to autocracy (ie. tyrannical control of the individual).

    Such behaviour is not dissimilar to that of a cult, whose members in this
    case have a great deal invested in their own beliefs.

    However, by seeking to impose their cult ideology, this group has probably
    done more than most to prolong the artificial mind-body dualism they claim
    to despise, because people will see them for what they
    are -self-promotionists par excellence.

    In her review of "Biopsychosocial Medicine", US research journalist Kate
    Duprey hits the nail exactly on the head: "For the past two decades
    medicine has been engulfed in an ideological firestorm that is less about
    actual patients and their well-being than it is about professional promotion
    and a backlash against a medical model that does not give psychiatrists a
    starring role in healthcare. This book gives a good overview of the
    thinking on one side of the raging battle (but) I didn't find it to be
    balanced. How such polarization is helpful to patients is not adequately
    addressed, possibly because the well-being of patients is not the real
    focus. When something is controversial, balance is presenting both sides,
    yet little or no attention was given to the large bodies of scientific
    research objectively refuting the stated views of the contributors. (The
    book) essentially remains a book of self-promotion"

    ( see Controversial for a reason. August 5, 2005,
    http://www.amazon.com/exec/obidos/tg/detail/-/0198530331/qid=1125670603/sr=8-2/ref=sr_8_xs_ap_i2_xgl14/103-3052351-3936630?v=glance&s=books&n=507846 )
    .

    It was also interesting to read the review of "Biopsychosocial Medicine" by
    Aziz Sheikh in the current Journal of the Royal Society of Medicine, where
    it was promoted as book of the month (JRSM 2005:98:431-432), because Sheikh
    summed it up thus: "How does "Biopsychosocial Medicine" move the subject
    on? Despite valiant attempts by Simon Wessely and Peter White to draw
    practical messages, I have to say not greatly".

    It may not have moved the subject on but it has done nothing to provide
    those who suffer from the savage disease ME/CFS with even a modicum of hope.



  2. tansy

    tansy New Member

    Eileen Marshall Margaret Williams

    4th September 2005

    The response to our recent document “Proof Positive?” (CO-CURE ACT: 2nd
    September 2005) has been astonishing by any standards.

    There is clearly an undercurrent of deep unrest within the ME community that
    indicates the powerful strength of feeling against the repeated failure of
    the relevant UK Government policy-makers to heed the significant amount of
    international scientific evidence of organic pathology that has already been
    demonstrated and instead to rely on the unproven beliefs of the proponents
    of the biopsychosocial model of the disorder who, on their own admission,
    are targeting and indoctrinating these policy-makers.

    Further, there is strong resistance by those with authentic ME to the
    proclaimed intention of “Wessely School” adherents to make it compulsory for
    sufferers of ME/CFS – on pain of loss of State benefits -- to submit to
    programmes of brain-washing techniques that are designed to “modify” their
    thoughts and behaviour so that they accept that their physical symptoms are
    not caused by any organic disease but are simply somatisation of mental
    distress.

    Some of the points raised need emphasising: as was pointed out by a
    correspondent in Northern Ireland, the biopsychosocial model of ME/CFS
    regards it as a comprehensively somatisation disorder (in other words, as a
    psychiatric disorder): how does this sit with the fact that in the 1996
    Joint Royal Colleges’ Report on CFS (CR54: RCP Publications), it was the
    same psychiatrists themselves (Simon Wessely and Peter White) who warned
    members of the three Royal Colleges that:

    (i) 25 – 40% of ME/CFS patients do not fulfil the criteria for psychological
    disorders (chapter 4 / Summary)

    (ii) nearly all studies find that between one-quarter to one-third of those
    who fulfil criteria for CFS do not fulfil any criteria for psychiatric
    disorder and that (quote): “Any simple equation of CFS with psychiatric
    disorder is thus erroneous” (chapter 7: 7.6).

    Where is the published research since 1996 that enables the same
    psychiatrists now to claim that apparently 100% of ME/CFS patients suffer
    from a psychiatric disorder? To make a diagnosis means making a formal
    determining description to identify a disease: most people with authentic ME
    have never ever seen a psychiatrist, yet all seem now to have been
    generically diagnosed as suffering from somatisation. Surely clinicians,
    including psychiatrists, have no right to make mass diagnoses about people
    they have never seen, especially when the appropriate and necessary
    investigations have not been carried out? For such diagnoses to be regarded
    as factual is not only ludicrous but also destroys the medical ethos and
    degrades the medical profession.

    A correspondent in Shropshire commented that Wessely and White place much
    emphasis on “selling” their programme but seem to have overlooked the
    important point that when healthcare became an industry, patients became
    customers, with Government pushing the idea of consumer choice. The result
    is that patients are increasingly applying Trading Standards criteria to
    what is on offer.

    Does it work?

    Is it safe?

    Is it cost effective?

    It should be noted that these are the very criteria applied by the NHS to
    complementary medicine, which must mean that it is reasonable for the same
    criteria to be applied by patients to orthodox treatments of all kinds.

    As this wise correspondent remarked: “Empire building on shifting sands is
    not to be recommended”.

    Perhaps Professors Wessely and White would care to comment.
  3. Mikie

    Mikie Moderator

    I'm too fatigued to read all this right now, but just from what I did read, I think I got the idea.

    Just hearing a term like "psychosocial" puts me in alarm mode.

    Love, Mikie