Illness Behaviour - a multidisciplinary approach McHugh and Vallis (EDIT)1986

Just in case it's of interest, I just saw that the 2003 book (ABC OF PSYCHOLOGICAL MEDICINE) he co-edited with Sharpe and Carlson is freely available here: https://management.usmf.md/sites/default/files/inline-files/ABC of Psychological Medicine_0.pdf

 

@Esther12 thanks for that link. It is most informative, but rather depressing. I'm sure that there will be a treatment for that.

What I find significant is the suslicion that much of this can be traced through Shepherd. I am sure that he said that a major influence on him was Gilbert Ryle. It is therefore surprising that I have a sneaking suspicion that the work is full of category errors.

 

You're going deeper into the history than I ever have. I think that these things are important but it's hard to know how much difference it will make now. Someone needs to write a book.

 

That's an... interesting... font choice. My eyes, they hurt.

Skimming through, though, this book could have been written at any point in the last century, it does not feature any modern or relevant information, it is not informed by reality or scientific evidence. It's what some people do that they happen to think is relevant. Most of it is just their opinion and mostly wrong.

What a mess.

 

I agree that there is some importance in this. It cuts off lines of retreat and should leave no position to which to fall back.

I think it helps to show that the problem is much wider than thought and how subjects may be related.

It does puzzle me that I don't recall any connection being made in Oslers Web. One would have thought that Cheney, Peterson and Komarof would have been aware of the potential influenceswhen they were being fobbed off with psychosomatic explanatons. More work is needed. But it will not be I who writes the book.

 

Interesting question, @chrisb. Maybe cynical but did the 1978 international symposium held at the Royal Society of Medicine bring attention and potential legitimization that generated interest in an interest in alternative, less expensive approaches of managing? This symposium followed a stead incidence of outbreaks from 1934 through the 1970s.

Link to the lead article is here and the full proceedings are here

 

@Medfeb There are a number of papers in the 1980/84 period expressing concern over the impact of health costs. From memory Cluff and Eisenberg wrote on the subject but I think I have lost the references. There was certainly concern over the possibility of three potential or actual epidemics.

I have not seen any reference to the 1978 symposium being taken seriously in the US. Indeed the only US representative (EDIT Shelokov) there complained of his unpopularity with his US colleagues because of the perception of his earlier involvement in biowarfare research. He said he was involved only in defensive vaccine capability.

 

A couple of (fairly) interesting points arise from rereading the Preface. It seems that some texts were not included in the book. One was by Dr J Ware of the Rand Corporation. Googling suggests he might have been involved in creation or development of the SF 36. Presumably aspects of commercial confidentiality and copyright were involved in the decision to exclude. Let us not assume that he was just too dull.

The other is that "A special mention is deserved for Drs Arthur Kleinman and David Mechanic who provided much advice and encouragement in the planning ...". And there they were again at CIBA.

@Medfeb on the other thread you questioned when Straus changed tack and you mentioned his 1988 paper on the acyclovir trial ending in 1986. I had put his change of mind at 1985. The time lines around here are compressed but interesting. There are a number of significant papers published in early 1988 - the Holmes Criteria, the Strauss paper, the Eisenberg lecture and the David, Wessely Pelosi paper. These all derive from a short period in 1987. I think the CDC conference was in March. The Eisenberg Oxford lecture was in May. The Wessely paper was accepted for publication in late summer, I think it was about September, and the relevant Straus paper was based on a lecture delivered in early Fall. It is hard to know what to make of it all.

In any event the Toronto Conference took place on August 14-16 1985. The book was published in 1986. As there are 416 pages of it one might reasonably expect that it would have been late 1986.

 

The discovery about Dr Ware led me to look into the other three referred to who did not make it into the print edition. They were drr D Meichenbaum of University of Waterloo and Dr V Neufeld of McMaster, about whom I could see nothing which might concern us. However Dr Allan Detsky of Toronto is clearly too dull for us. According to Allan S. Detsky - Wikipedia

Detsky posed many probing questions into the reality of cost effective medicine, and his 1990 contribution A clinician's guide to cost-effectiveness analysis is considered to be a user manual into cost-effectiveness analysis. He followed this with an article on How to use a clinical decision analysis as part of the JAMA Users Guides to the Medical Literature series [1

 

Ware appears to have also been involved in development of the Mental Health Inventory-38 (MHI-38) published in 1983.
mental_health_inventory.pdf (amhocn.org)

 

You may be right about the 1978 conference. But Shelekov (of NIH, NIAID) had done work in this field. Together with and Henderson (of CDC), he published this 1959 paper in the New England Journal of Medicine on a series of epidemics from 1934 up to 1958. At the time, they referred to it as epidemic neuromyasthenia.

In an international conference held in the late 80s or early 90s, Henderson described his and Shekelov's work as a recurrent interest but said it was one few others shared. And Henderson's boss directed him to shift onto smallpox eradication.

 

Yes. I knew about Shelokov and Henderson, but all seemed to go quiet after 1959 when the Imboden , Canter,9 Cluff model seemed to become dominant.

 

Interesting. Thanks for highlighting. I'll have to dig into that work further.

 

There seems to be a general failure to attribute or cite sources. The reason is unclear. In the UK we know about the influence of Gordon Waddell on the BPS school, with his ideas influencing Aylward. Exercise is good for lower back pain. And seemingly for everything else too. From memory Waddell idea goes back to 1986. I will have to check that.

It does appear unfortunate that this was discussed at some length in Arthur Cott's paper under the sub-heading "contraindications: "hurt" versus "harm". This seems to be the root problem with the interventions for ME. The assumption is that they cause hurt but not harm. I recommend the section at page 88. If this had been made clear in 1989 much confusion could have been avoided.

 

@Medfeb you expressed interest in any financial imperative to this new approach. The conclusion to Cott's paper is perhaps enlightening.

This chapter has attempted to illustrate three main points. First, that illness, as opposed to disease, is a significant health-care problem and that often illness remains even following optimal medical therapy. Second, the disease-illness distinction model provides for an optimal interdisciplinary intervention process for complex (and simple) cases involving both disease and illness. Finally there exists a significant potential for a group educative focus for such interdisciplinary intervention and represents a powerful cost- effective mode of health-care delivery.

it is a pity we did not get to see the papers presented by the cost benefit analysis specialist and the expert on SF36.

 

In the book there is a rather interesting footnote to Arthur Cott's paper on p85.

The model, procedures and data presented in this paper were developed and collected over a ten year period at the Behavioural Medicine Unit, St Joseph's Hospital, Hamilton, Ontario, Canada. During this time, we have had the unique opportunity of developing a true interdisciplinary clinical research unit within a Department of Medicine in a teaching hospital of a university medical school-McMaster University. The effort evolved from an initial research project involving experimental behavioural psychology, psychiatry, and general internal medicine into a major service, research and educational facility. In addition to formal experimental studies, we have collected detailed data including a wide variety of treatment, non treatment, demographic, and outcome variables on over 500 complex disability cases. An operational model for simultaneous interdisciplinary intervention and the management of complex disability cases based on the disease-illness model was developed and refined. The formal set of procedures for integrating and co-ordinating the interdisciplinary activities of medical and behavioural sciences in the treatment of complex disability cases developed is outlined in detail in this paper.

More research is required. It does seem odd that we seem not to have encountered this before, especially when use of their work has been made by so many.