Is it true that more than half of medical consultations are for MUS? A look at the evidence.

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The title of this thread is:

If members want to examine whether a given statistic is true or not, what's the problem?

The title of this thread is whether the statistic is true or not. It may be entrenched, but so what? It may be useful for the ME cause, but again, so what? Some members may have ethical concerns about quoting a statistic that is known to be dodgy just because it is thought to be useful. That's the kind of attitude we are used to from the BPS activists. The papers that have demolished PACE have stuck to what is known to be true, so they can't be argued against.

I may or may not be good, I am not trusting, I am a professional. Not sure what purpose categorising S4ME members serves. For the purposes of this thread I'm just someone who's interested in the subject of the thread title, ie is the 50% figure true? I don't feel I have to justify or defend such an interest. It's just something I'm interesting in knowing more about.

Members of S4ME are a mixed bunch, are you sure that in the brief time you've been here you're in a position to characterise everybody as a group, and are you sure it's necessary? "Well-meaning" implies naive or misguided to me, but let's not get into that, I'd rather stick to the subject in the title of the thread.

 

Keith Geraghty has some relevant recent tweets-

https://twitter.com/keithgeraghty

 

The point of the term MUS in the UK is to save billions not to spend it so in all likely hood the 50% figure came from lies and was deliberately presented to stupid policy makers.

 

The paper's arguments do not depend on the 50% figure - that's not accurate. I suppose it will feel more or less important as a problem depending on how many patients you think are undiagnosed.

You are correct that I am not challenging the idea that roughly half the time outpatients do not get a diagnosis. I believe that the general sense of diagnostic success has been greatly inflated in everyday culture for many years.

The 50% figure makes sense if you think about it. The vast majority of Sx that people take into a medical appointment are benign and self-resolving. And diagnostic science is just not that advanced. Think about the difference between now and a hundred years ago - then imagine what more we will know about diagnosing disease in a hundred years.

What, exactly, leads you to think that diagnostic science is usually successful?

It's important that there is a great deal of research on rates of unexplained symptoms outside of the BPS camp, and it's important that this is not about the UK - so even if you find what you think is evidence of inflated figures in the UK, that's not going to matter because this is a globally accepted picture. My sense is that it's a standard point of health policy - so health budgets have been designed around it for a long while.

I don't think your government has inflated the rate of undiagnosed Sx. But your government is the worst that I know of when it comes to the assumption that all undiagnosed symptoms have psychological causes. There is very clear evidence that your government has studied the cost of undiagnosed Sx, and studied the savings with psychological management - so there's very clear evidence that diagnostic practice has not been guided by what's best for patients. It's been guided by what's best for the budget. My opinion is that this is the heart of the problem, and we can address it.

 

That's just not tenable. There is far, far too much research to support it, and this research is global. The Up To Date system, for example, is the global leader in research review and summary (made in the US), and they use the 50% figure.

Keep in mind that it's 50% undiagnosed patients - not 50% psychosomatic patients. It's the leap to psychosomatic that's a lie, and that problem is particularly serious in the UK.

 

I sure appreciate your diligence and your clarity, Trish. I think it's important that the 50% figure does not directly support the Wessely approach. The Wessely approach is one way of managing the 50% problem that's extremely cost effective - but that doesn't mean the Wessely approach is the source of the problem. That's confused reasoning.

I'm afraid I'm not seeing the point of all the effort with this paper. The Up to Date system provides global access to concise summaries of current research and consensus on every condition. That system notes that more than 50% of patients are not suffering from a medical condition. Even if this one paper is utterly unscientific, even if Wessely inflated it and I inflated it and you can prove all of that beyond all doubt, what then? It's a drop of rain in the sea. You cannot possibly make progress on disputing the 50% picture by finding fault with this paper or interpretations of it. (Well, you can find research to support any figure you happen to prefer - but the range is wide enough to make 50% reasonable. I think that's how people see it.)

But think about what Up to Date is actually saying there! 50% of patients are not suffering from a medical condition?

The thing to be concerned about there is not the idea that diagnostic science fails half the time. The idea that half of patients cannot possibly be suffering from illness - that is absolutely tragic. It is utterly outrageous, at a level that's immediately obvious to everyone outside of psychiatry.

When I do public lectures on MUS all I have to do to establish that there's a serious problem with this area of medicine is to put that Up to Date statement up on a powerpoint slide. Medicine manages uncertainty in a way that's blatantly unscientific. This is not a subtle problem. It's not about the UK, it's not about ME, and it's not about any one paper. It's a flashing red light of human threat - and there is not one patient, adult or child, conscious or unconscious, injured or ill, who is not directly threatened by it.

 

I get the impression people are talking at cross-purposes a bit. A lot of people here will ask 'is there any good evidence for that' with any claim being made by an authoritative source, regardless of the impact of the claim. A lot of the probing of research is more about intellectual curiosity than the pragmatic pursuit of any particular end. Maybe this partly reflects peoples experiences, where 'pragmatism' has often been used as a justification for the promotion of misinformation relating to ME/CFS that ends up harming patients in ways researchers have failed to account for.

 

Thanks for the clarification, @Trish. It is interesting to see just how much Wessely has misrepresented data, not just his own but other people's.

 

So Up to Date Collates the info and uses a 50% figure? Does that tell you the source of any potential meme that leads to the eventual figures for the diagnostic label MUS?

If we look back over the life of the term MUS is it on an upward curve or a downward one or has it remained steady?

When I stated the issue of the term MUS suiting the UK medical establishment I wasn't being exclusive. I am pretty sure overstating of such a diagnostic label could exist equally all around the world and would conveniently suit who ever picked up the bill for medical care be it in a socialised system or a private insurance based one.

There is also the issue of empire building and even if the figure is claimed to be the same all around the world that doesn't exclude potential deliberate marketing of the term to make it take on a life of its own via policy and education.

One only has to look at the US DSM as one example to understand how this could work.

Things can take on a life of their own built on poor foundations. If a figure is similar all around the world for a certain claim it doesn't tell you automatically what the motive was or wasn't for that.

Would you comment on the US DSM in terms of its categorisation of "illnesses" and the potential implications that could have in meme building and how it could affect the ability to collect accurate information on categorisation of diseases/diagnsotic labels etc?

Or perhaps comment on the US medical insurance industry?

 

So 30 years ago Kroenke and colleagues went to an Internal Medicine Clinic for military personnel in Texas and they looked at the charts. They searched for 14 common symptoms that often remain unexplained such as fatigue, dizziness, cough, numbness, constipation etc. Of the 1,000 patient charts studied, only 38% had one of those 14 symptoms. The other 62% of patients are left out of the analysis. Data were dependent upon what physicians had documented in the records. So if a doctor didn’t note fatigue in a patient with MS, Kroenke and colleagues would have no idea the symptom was there. Furthermore: for some reason, chronic complaints were excluded.

So that’s the data the famous Kroenke et al. paper is based on…

Very revealing.

Thanks for pointing this out @Trish !

 

It's rather hard to do a sensible analysis of problems whose only common denominator is being unexplained.

 

I guess relevant that this was a military personnel cohort. That would be totally unrepresentative of the general population. Probably few women!!

 

Am I being stupid about this - if this study was a retrospective search for specific symptoms, surely these symptoms might have been recorded coincidentally at the time of the appointments? What I mean is that there is no way of knowing that people reported them due to asking the doctor about the symptom or because the doctor asked them if they had any other symptoms e.g. constipation? Like a general health check...
Which means the whole figure is even more completely bogus - if that’s possible!

 

Indeed, 120% bogus. Maybe 520% bogus. The only people who could possibly think it worth taking these figures seriously would be people who have a vested interest in taking them seriously.