Hausotter about CFS/ME

[Inara]

I came across another German BPS proponent, Dr. Wolfgang Hausotter.

Mr. Hausotter has written several "guidelines" for assessments, including CFS. Here is an abstract of one of these "guidelines", published in the Versicherungszeitschrift (insurance journal):
https://www.talentplus.de/foerderung/sonderfoerderprogramme/index.html?infobox=/infobox1.html&serviceCounter=1&wsdb=LIT&connectdb=veroeffentlichungen_detail&referenznr=R/ZS0083/0005&from=1&anzahl=20&detailCounter=3&maplength=20&suche=index.html?autor="Hausotter,+Wolfgang*"&intlink=true

Chronic fatigue or chronic fatigue syndrome (CFS) is not a new disease, yet in recent years it has become increasingly important as an evaluation problem. It coincides with the well-known clinical picture of neurasthenia, shows extensive overlap with symptoms of depression and, finally, to the current concept of 'burnout'. Regarding the etiology there is fierce controversy between the representatives of a somatic and a psychological etiology. As reviewers you will be guided by the assessment criteria for somatoform disorders, especially because objectified findings are lacking. CFS can be independently encoded as neurological diagnosis G.93.3 according to ICD-10, although never objectified neurological deficits were detected, as well as neurasthenia F 48.0 or accompanying physical symptoms as somatization disorder F 45.0.

Here's an "article" about CFS: https://www.google.de/url?sa=t&source=web&rct=j&url=http://www.ralf-kollinger.de/wp/wp-content/uploads/2014/01/Bericht-Begutachtung-des-chronischen-Ersch%C3%B6pfungs-Syndroms-HAUSOTTER-Vers.Med_.-2015-MCS.pdf&ved=2ahUKEwiTpZS3po3cAhVPr6QKHR2OB_sQFjAAegQIBRAB&usg=AOvVaw37iw7V_0pMgWJLnbRV8wgz

It seems he is/was working for private insurance companies (which I'm gonna check further), and he is doing medical assessments for authorities (e.g. DRV = DWP, MdK = medical Service of the state health insurance; it should be noted that MdK and state insurances seem to form a "cartell"). I also want to check if there is any direct connection to Wessely&Co (in the sense of collaboration e.g.).

His written reports have nearly the same content as his articles. It seems others cite him, partly word by word.

These are the main points:

- CFS doesn't exist; it's not a real disease.

- CFS is Neurasthenia. It can also be diagnosed as somatoform disorder. Amongst others, he cites Beard from 1869 and a quote by Trimble (even in his written reports): "There is no better example of old somatized wine in new bottles than this revived version of the nineteenth-century neurasthenia."

- The BPS model is a medical standard that must be applied in making diagnoses (this sounds like a rule). Everything else is bad practice.

- CFS is just a popular diagnosis.

- He mentions the Canadian Consensus criteria, too, but it seems he can't speak English and/or can't read, because these are not the CCC I know (NO mention of PEM/PENE at all). Furthermore, the CCC are mayhem (here he cites the old Degam guideline "Tiredness": iatrogenic mayhem potential!)

- There are many similarities to the Burnout syndrome.

- "According to current knowledge, the postinfectious etiology of CFS can be considered as refuted" (reference 30, but the references are not given in the article).

- Changes in neurotransmitters, the immune and endocrinological system that are found in CFS are also found in other illnesses of the soul.

- As all people with somatoform disorders, people with CFS have no motivation for somatoform therapies.

- He highly critisizes patient organizations and self help groups.

- The WHO falsely categorize CFS as G93.3; it should be F48.0 and this can be used.

He loves exclamation marks.

I want to attack this stuff with facts, science and reality. But I could need some help with some of the points. I would be very thankful for anything, especially that tackles the claim that ME is not real, that ME is the same as Neurasthenia and that the BPS model is a must in medical care (and widely accepted as "gold standard").

I cannot go into specifics at this point, but I probably will use this in the future.

 

[Hoopoe]

- As all people with somatoform disorders, people with CFS have no motivation for somatoform therapies.

Proponents of somatoform disorders are making progress impossible for themselves if they are unwilling to accept the honest patient feedback that the therapy is misguided and useless.

 

[adambeyoncelowe]

The WHO expressly forbids dual labelling and BME/PVFS (G93.3) is excluded from neurasthenia (F48.0) and vice versa. The WHO coding is binding here, and should be there too. So he probably loses on a legal technicality.

 

[Inara]

thank you both, both is very helpful!

Mr. Hausotter obviously doesn't work professionally after reading some of his stuff. The problem is: He is viewed as an expert on assessments, including CFS assessments. Other doctors copy him. He obviously lacks knowledge and probably something else, but still this needs to be addressed with facts and science. I hope that third parties will be convinced by this. I hope there will be some logic.

He is a problem for many people in Germany, including ME/CFS and "MUS" people, fibromyalgia and so forth. In his article from above he even complains about the Bundesrat who decided to not categorize ME/CFS, Fibro & Co. under somatoform disorder anymore.

It's clear he's presenting his opinion as fact and reality. It could be powerful to counter this with the real facts.

 

[MSEsperanza]

Still being crashed, just dropping by because the name "Hausotter" alerted me.

Found him mentioned as a medical expert witness in a legal case about disability pension (his opinion , along with other "expert" opinions, in favor of the insurance company was invalidated).

All three medical expert witnesses engaged by the insurance company have something in common, which my ultra-PEM-brain is not able to translate into English ATM. Google translates it with a sense of humor, though:

"Also Dr. Hausotter - also graduate of the 2004 vintage [!] of the GenRe expert academy and specialized in so-called file reports - confirmed as expected the opinion of his colleague Niessner."

(in German: "Auch Herr Dr. Hausotter –ebenfalls Absolvent des Jahrgangs 2004 der GenRe Gutachterakademie und spezialisiert auf sog. Aktengutachten – bestätigte erwartungsgemäß das Gutachten seines Kollegen Niessner."
http://www.ra-buechner.de/newsarchi...nd-fuer-sechs-jahre-zahlen-versicherungs.html

For Gen Re see: https://en.wikipedia.org/wiki/Gen_Re

Good night.

 

[Snowdrop]

@Inara

It's great that you are researching and finding this info for German ME people.
It does make me think that perhaps it's time we find some healthy/semi-healthy people who might do some translating of (for example) the David Tuller blogs on Virology and other info.

I don't know if this is on the radar as something that needs doing for ME Action but maybe we can consider it here and help counter the disinformation that seems to exist everywhere.

 

[Hoopoe]

It's clear he's presenting his opinion as fact and reality. It could be powerful to counter this with the real facts.

If his job depends on dismissing patients, then this is a bit like trying to convince Coca Cola that sugar drinks are unhealthy. It's other people that can be convinced.

 

[Inara]

If his job depends on dismissing patients, then this is a bit like trying to convince Coca Cola that sugar drinks are unhealthy. It's other people that can be convinced.

I don't want to convince him, I want to show to others that his statements have nothing to do with reality. He's doing reports that are used by authorities, by insurers, by medical services, in court...

Thank you @MSEsperanza! Very helpful information.

It does make me think that perhaps it's time we find some healthy/semi-healthy people who might do some translating of (for example) the David Tuller blogs on Virology and other info.

Quite a good idea. Have you specific ideas?

I don't know if this is on the radar as something that needs doing for ME Action but maybe we can consider it here and help counter the disinformation that seems to exist everywhere.

This would be great!

 

[Hoopoe]

I don't want to convince him, I want to show to others that his statements have nothing to do with reality. He's doing reports that are used by authorities, by insurers, by medical services, in court...

The IOM report is good for this purpose.

 

[Snowdrop]

Quite a good idea. Have you specific ideas?

Will have to think about it.

It may take a while. My brain has decided to work on dial up modem mode while even the slightest sign of thinking on my part sends it into overload.

 

[adambeyoncelowe]

The other thing to bear in mind is that even CFS is indexed to BME/PVFS (G93.3) in the WHO coding. The only way he could possibly be right is if the patient has long-term 'fatigue syndrome', which is different, and is F48.0. But why would his new diagnosis override the diagnosis of public health clinicians? I don't think it would.

Over here, if an insurer's doctor tried claiming several staff in the NHS had applied the wrong label consistently to a patient, and that the label he prefers should be applied instead, I'd like to think that the judge would side with the NHS if this point were to be highlighted. It should be obvious what the insurer's doctor is doing.

 

[Inara]

But why would his new diagnosis override the diagnosis of public health clinicians?

Because he says so.

One argument is that the psych. diagnoses are carefully done (by psychiatrists) whereas the ME diagnosis is the result of a one time appointment, where the BPS model is ignored.

I see "Fatigue syndrome" F48.0 is the same as Neurasthenia, at least they seem to have the same ICD code.

Now, you have someone who is viewed as "expert". A judge for instance won't question what an "expert" says, unless he receives different information from another expert or reliable source.

So what needs to be done is to show that Hausotter is no expert at all which would most probably lead to not listening to his "expert opinion".

You're right, in case of UK it is far more difficult today to relabel CFS as Neurasthenia or somatoform disorder, although Wessely&Co tried it. Here one sees Hausotter lives in the past. Even Wessely&Co view ME/CFS as a real disease, and they don't mention Neurasthenia=CFS=ME today, or do they?

Concerning "Fatigue syndrome" and CFS: How will you show they're different? If Oxford criteria are applied - and they are by most, at least here in Germany - then F48.0 and G93.3 are indeed equal.
So here, an argument is needed.

 

[James Morris-Lent]

Regarding neurasthenia: I always find it particularly daft when someone references 19th century understandings of neurasthenia as somehow trustworthy or remotely authoritative. Quite possibly some people diagnosed with neurasthenia had the entity we refer to as CFS, but it's all shrouded in the mists of time, not to mention Freudian quackery. We can get a much clearer clinical and biochemical picture today and we can use that to judge explanations on their merits.

 

[Inara]

@James Morris-Lent, I agree with you and I feel the same. That somebody who earnestly equates a mid 19th century "diagnosis" with a today's disease can be taken seriously and viewed as an "expert" is beyond me. It's like equating MS with "hysteric paralysis" or tuberculosis with a "psychological illness" of people with a certain personality.

It's difficult to jump into a discussion with someone who obviously lacks some degree of understanding and thinking, but who seems to be very convinced about himself. Since others seem to listen to him as an "expert" it needs to be done and we need facts to invalidate him.

He has written several books about assessments, especially with a focus on private insurers assessments. He is the author of the chapter "Symptom complexes and selected questions" of the DRV book "Social medical assessment for the statutory pension insurance",
https://www.springer.com/de/book/9783642102493#aboutAuthors.
One could hypothesize if it's his success that "CFS" is standardly assessed by psychiatrists in the DRV (= DWP in UK) who then standardly check for psychosomatic disorders.

So unfortunately it's not enough to say he is a quack, although to us - who are well-informed about the on-goings in the "ME-world" - this is obvious. We need to show why he is a quack.

 

[adambeyoncelowe]

According to Wikipedia, at least, it 'is no longer included as a diagnosis in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders'.

If even psychiatrists aren't using the diagnosis any more, it seems a stretch to assume this is anyone's 'true' diagnosis over another, better defined one (or one that at least has a body of recent research behind it).

Anxiety and depression appear to be key symptoms, so you could disprove neurasthenia by the absence of these.

Using the Freudian model, where 'he believed this condition to be due to "non-completed coitus" or the non-completion of the higher cultural correlate thereof, or to "infrequency of emissions" or the infrequent practice of the higher cultural correlate thereof' (again, from Wikipedia), you could at least claim to be getting bonked often enough to dismiss that model too.

But, as Inara suggests, you'd only want to point out these things to illustrate the sheer ridiculousness, and Victorian understanding of science, of such a diagnosis. Comparing the Freudian model of neurasthenia to the Freudian model of Parkinson's, which was equally suspect, probably helps too.

A reasonable judge would patently see this diagnosis for what it is. There's a reason it's no longer being used.

 

[MSEsperanza]

According to Wikipedia, at least, it 'is no longer included as a diagnosis in the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders'.

Neurasthenia still exsists as one of the WHO codes, both in the American and in the German version.
http://apps.who.int/classifications/icd10/browse/2016/en#/F48.0

Anxiety and depression appear to be key symptoms, so you could disprove neurasthenia by the absence of these.

A psychiatrist who wants to see depression, will diagnose depression. It's almost impossible to prove absence of depression. Same with anxiety.

 

[diwa]

my official `reha-bericht`(deutsche-rentenversicherung) from nov. 2016 names f.48.0 and (!) g.93.3;
i don`t have anxiety nor depression. but lots of physical pain...

they always forget to look at biochemical evidence as for example:

atp (very low), gluthation (low), oxidative stress, nitro-stress, low-grade inflammation,...

 

[Inara]

F48.0 is Neurasthenia.

A psychiatrist who wants to see depression, will diagnose depression. It's almost impossible to prove absence of depression. Same with anxiety.

Exactly this. It is very difficult to argue against psychiatric diagnoses. It's not enough to just say it's unscientific. One needs to point out exactly where and why.

Now, in Hausotter's case he's contradicting himself by saying that G93.3 is only diagnosed via a subjective symptom list (which is correct), but at the same time stressing the correctness of Neurasthenia and psychosomatic disorders - which are highly subjective and regardless of nearly 200 years of "research" there's still no objective proof. (Which again reminds me of Thomas Insel.)

I daresay every clearly or logically thinking person will see this incoherence and discard this "expert". But it's not happening because authorities - including courts - stick together, and they simply don't want that ME becomes an established disease.

But I won't loose hope that facts will someday break through. That's why I'm collecting them in case of Hausotter.

Anxiety and depression appear to be key symptoms, so you could disprove neurasthenia by the absence of these.

No matter what you say, you won't be believed. If a psychiatrist - with his almighty wisfom and knowledge - says you feel depressed and anxious, you do. End of discussion.

Comparing the Freudian model of neurasthenia to the Freudian model of Parkinson's, which was equally suspect, probably helps too.

I think this could be another angle. I slightly remember that the Freudian beliefs are critisized inside of psychology - and the BPS model is more widely applied. Does anyone know more by chance?

Also, how can you tackle the claim that every "good" physician today uses the BPS model and that it is (nearly in a legal sense) malpractice if a doctor does not?

A reasonable judge would patently see this diagnosis for what it is.

I hope so.