General thread on functional disorders in Denmark

I thought it might be of use to collect news regarding functional disorders in one place, to help keeping an overview of the lobbyism taking place.

In June 2020 you can sign up in Denmark to a seminar that will prepare you to become an "ambassador" in your municipality for functional disorders!

The aim of the seminar is to qualify you to support sharing of information about functional disorders to your municipality and to collaborating partners. You will also be invited to take part in the ambassador network, which for now has 80 members.

The teachers are a psychologist and a social worker, as well as a project leader.

Funktionelle lidelser - bliv klædt på til en ambassadørposition i jeres kommune
google translation: Functional disorders - get ready for an ambassador position in your municipality

 

The Norwegian newssite for research; Forskningno, shared today an article from their Danish sister site, Videnskabdk about functional disorders.

Flere unge danske med funksjonelle lidelser: - Ingen sykdommer kommer som lyn fra klar himmel
google translation: Increasing number of young Danes with functional disorders: - No illnesses appear out of nowhere

Patients with so-called functional disorders typically have pain in various parts of the body, they are constantly exhausted, dizzy or nauseous. Some suffer from diseases known by the name of fibromyalgia, chronic fatigue syndrome (ME) or irritable bowel.

- There are also examples of symptoms such as seizures, paralysis and sudden blindness, explains Rask.

Functional disorders are most likely the body's response to various stresses: Frequent infections, illness or prolonged dissatisfaction, for example due to bullying or divorce, the research literature states.

 

The article also tells about the ongoing study DanFunD (the Danish study of Functional Disorders), which has a presentation in English here
https://www.frederiksberghospital.dk/ckff/sektioner/SBE/danfund/Sider/DanFunD-engelsk.aspx

In the DanFunD study, the functional disorders are represented by irritable bowel syndrome, fibromyalgia, chronic fatigue syndrome, whiplash associated disorders and multiple chemical sensitivity. However, data will likewise be used to study other conditions, such as cardiovascular disease, diabetes, respiratory diseases, allergy and asthma.

 

Two articles on ME in the current edition of the Danish Medical Journal - Ugeskriftet.
They are both paywalled, but the titles and ingresses give a hint as to where they're heading.


Title: Harsh ME debate "It's like punching a duvet"
Phones hacked, threatening videos, abuse on social media have all been part of the debate surrounding chronic fatigue (CFS/ME). The anger is often intense, and harassment can scare doctors away, according to international experience. But the patients are still there, and they are in need for more help than they're getting today.
https://ugeskriftet.dk/nyhed/me-debat-slider-det-foles-som-sla-i-en-dyne

Title: They make fun of you and present you as a doctor that hates his patients
It can be very challenging to work in a field filled with so much conflict as chronic fatigue. Psychiatrist Andreas Schröder has experienced to be denounced online and publicly shamed. Yet he still carries on - and after having gone down with stress and depression, has become more direct and brave.
https://ugeskriftet.dk/nyhed/de-lat...tiller-dig-som-en-laege-der-hader-patienterne

 

Mhmm.

"Medically unexplained symptom management"
Andreas Schröder Michael Sharpe Per Fink
https://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(15)00233-3/fulltext

 

I never cease to find it amazing that so many members of the medical profession manage to make a living out of being useless diagnosticians. Not only do they make an excellent living out of being so useless they manage to blame the damn patients for the uselessness of the doctors as well. Hallelujah, Praise the Lord, It's a Miracle!

 

I want to read them... I don't want to read them.

 

Just noticed this article in a Danish journal for medicine and health about a large sum which was allocated to optimise treatment opportunities for patients with hypothyroidism. In March this year some of this money got redistributed to include treatments of functional disorders. So if any endocrinological departments want to apply for this money, they have to agree to cooperate with departments for functional disorders. The regional centres for functional disorders were alerted of these funds one week before the endocrinological departments.

Endocrinologists, patients and politicians are now protesting against conflating hypothyroidism with functional disorders. This is the response they receive:

The National Board of Health appears to fully support the placement of the small group of metabolic patients under functional disorders centers. We have received the following response from Lotte Klitfod, who is a consultant and section manager in the Planning Department:

"At the National Board of Health we naturally recognize that low metabolism is a somatic disease and that the disease belongs to the endocrinological specialty. Unfortunately, there is a group of patients who, despite proper endocrinological medical treatment, and whose medical test cannot identify another cause of their symptoms, have low metabolic symptoms. These patients today lack a good treatment. Patients with persistent symptoms, regardless of diagnosis, can benefit from helping manage their illness. In this way, patients can achieve a higher level of function and a higher quality of life. The Centers for Functional Disorders have extensive experience in helping patients with better disease management, and we believe, therefore,that the centers in collaboration with the endocrinological departments may be very relevant in the treatment of patients with persistent symptoms of low metabolism. It is thus our hope that the pool will help more patients get a good treatment. ”

Sundhedspolitisk Tidsskrift: Endokrinologer, patienter og politikere i oprør: "Lavt stoffskifte skal ikke behandles som en funktionel lidelse"
google translation: Endocrinologists, patients and politicians revolting: "Low metabolism should not be treated as a functional disorder"

 

I saw someone else claim that an example Andreas Schröder gave somewhere of on-line abuse was a blog from Coyne, presumably this one: https://www.coyneoftherealm.com/201...y-for-whatever-ails-your-physician-about-you/

I don't know if this is right or not and have trouble even accessing a lot of these articles, but I'd forgotten Coyne had even blogged on Schröder's work.

This piece of Schröder's makes him sound very ill informed, or worse. He seems to rely on Cochrane and Kelland to present critics of research as unreasonable, citing a PACE response to Wilshire, but not the Wilshire paper, or the response to the response: https://ugeskriftet.dk/files/vpled_70687_-_fuld_litteraturliste_-_bilag.pdf

 

I hadn't noticed this til just now, but Schröder replied to Coyne's blog, and Coyne then replied to him. Schröder doesn't seem to think on-line criticism of science is a good thing: "In the scientific world, I live in, scientific studies are discussed within the scientific community in the scientific literature, not on random blogs."

In addition to his reply in that thread, Coyne also posted his reply as a blog here: https://www.coyneoftherealm.com/201...t-of-cbt-for-an-unrecognized-mental-disorder/

 

It is notable that they never contest the fundamental methodological issues directly.

 

Ridiculous. Waaaaay too much politics in medicine. This is getting out of control, it's a complete regression away from decades of painful lessons.

At some point too many people will simply write medicine off entirely, when there's barely any difference between blatant quacks and other blatant quacks. This is how you further a crisis of legitimacy. This is why people don't trust medicine, because there's far too much turf wars and empire building based on blatant lies. In a freaking pandemic no less. Bravo.

They seriously can't see the consequences of doing this? That basically merging quackery straight into medicine does not improve medicine, in fact destroys its very credibility? The detachment from real-life consequences is unsustainable.

 

How is it even possible to deal with people who are either delusional or pathological liars? I don't even know anymore which is the most likely. They only argue in sophistry, logical fallacies or blatant lies. This kind of argument makes me think of old alchemists talking about how complex and smart their recipes are and how such rigorous care must mean the outcome is good. They never even check the damn outcome of their work! They refuse the premises of patients thinking they're out of their minds and denouncing this blatant quackery.

I think it's the complete lack of accountability. The entire field of psychiatry has been afforded the luxury of zero accountability for anything they do for decades. It created a dogmatic culture that sees any criticism as a personal attack, they simply cannot deal with it, are only comfortable within their mutual admiration society where everything is groundbreaking and people marvel at the distance they have traveled... in a circle.

This isn't 1998. What kind of petty argument is that? Medical journals are proving every day that they are unable to provide the basis for scientific publishing so discussions have to move out of this gated old boys club.

 

Bolding mine. Beautifully put!

 

In fairness it is mostly Consultation Liaison psychiatry that is at fault here. It's grand plan for world domination is ongoing.

See: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4967779/
(Michael Sharpe 2016)

The final line of text brings the kind of dread that I'd feel if I found myself in proximity to a Borg cube waiting to be assimilated.

We will resist.

 

Maybe this thread is a sensible place for this Fink presentation to Swiss Re in case anyone's interested?

I didn't find it that interesting, but it beats reading a magazine.

'Somatoform disorders,
Functional somatic syndromes and disorders
Bodily distress syndrome
Concept, consequences and treatment'

https://www.swissre.com/dam/jcr:777ad3de-d97c-4de6-9554-01a99ebf161c/Presentation+Per+Fink.pdf

 

Only did a quick scroll through but found some interesting verbal gymnastics on slide 52 worth being aware of, in a know your enemy sort of way.

Fink clearly knows the common patient objections to BDS and is trying to position BDS as a genuine physical problem, not the patients' fault, and a condition that can be treated effectively by the caring physician (cost-effectiveness features prominently on other slides). Who could possibly object? All very slippery.

I still can't get over how you can just invent a syndrome and then present it to all and sundry as an established fact. And presumably be paid for giving nice presentations on it to insurance companies.

 

That sounds painful!
(sorry if this in inappropriate, but it is funny!)

Seriously though, Fink is trying to claim that prolonged pain/injury after motor vehicle collisions is mostly due to psycho-social factors and whiplash-associated-disorder doesn't exist (it's literally crossed out and BDS put in it's place).

 

Here's a link to a PDF about this from the Danish Health Authority titled "Model for interdisciplinary treatment course for patients with diffuse persistent symptoms of low metabolism" (my translation of the title, the PDF is in Danish)

 

The way this seems to work is this:

These companies need to back up their discriminatory policies with research. People like Fink and White produce this research and get rewarded for it.

Reality doesn't matter, it just has to look credible enough to broader society to make it difficult for patients to contest this.