Michael Sharpe skewered by @JohntheJack on Twitter

alex3619 said:
The original paper is viewed as a treatise on psychosomatic medicine, but given a new label.
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Regarding 'psychosomatic', there are two meanings I take from that. One is, like 'biopsychosocial', a truism when taken at face value. The other is a euphemism for conversion disorder, asserting psychogenic causation for mental / non-'organic' illness.

I just plowed through the paper [text here for those interested]. I think people taking it as the latter (endorsement of 'conversion disorder' paradigm) have made a full-course dinner out of it. That said, it's understandable how they would get there because the paper injudiciously encourages medical professionals to break free of the 'biomedical' model without providing an actual rigorous (scientific) framework to replace it - just a suggestion to be more sensitive to psychosocial aspects of disease.

This can be taken in any direction, so there's a vacuum to be filled by whatever people will tend to come up with. It seems that any time there is any sort of vacuum, it gets filled in by psychogenic explanation. (Because of this I have to question the premise that 'biomedical' really was as oppressive and hegemonic as Engel paints it. Was there really a time when people did not tend to dismiss 'mental' or 'unexplained' syndromes as psychogenic or something like it?)

In any case, today's proponents of BPS would do well to go back to this paper. It emphasizes the strengths of the 'biomedical model'. It points out that issues with the biomedical model often arise from correctable misapplication of it, rather than fundamental flaws in the model itself. It does not advocate 'psychiatry of the gaps' - assertions of psychogenic causation of unexplained syndromes. They might realize that what they're doing is simply creating new problems in medical practice without even addressing the issues of concern in Engel's paper.

Let me know if you see differently.
 
Other material by Engels, as reviewed by Ghaemi in my blog on Phoenix Rising makes it very clear its about psychosomatic medicine in the main meaning of the word, in which mental issues cause physical symptoms. The earlier versions on which BPS was founded are perhaps less clear. This goes back to the 30s, but did not start gathering momentum till mid century. I probably should reread the paper though, its been years.

The original philosophy (decades before the 77 paper) behind BPS is semi-OK, with potential, what has almost universally been done with it is not sound. I think many of the bipsers are well aware of the original issues but its a primary driving force behind psychosomatic medicine now, and in the waffly sense.

Part one of my old blog is here - https://forums.phoenixrising.me/ind...e-and-fall-of-the-biopsychosocial-model.1075/
 
Indigophoton said:
A friend of Wessely's, previously unaware, wants to know about PACE. Wessely only tweeted him the link to the original work, although he is also interested in the dispute. Anyone feel like tweeting links to the special issue of J Health Psych, the Wilshire reanalysis and Tuller's blog to the guy? @dave30th?
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+1
Also someone might want to point out that they used Oxford criteria which has been shown to include patients without ME/CFS at all and even with those patients who would raise the treatment curve they still needed to resort to changing the recovery standard.
 
alex3619 said:
Actually that is a misapplication of CBT. We should not confuse the really bad CBT with the classical CBT. CBT is not about getting rid of anything, its about giving you tools to manage symptoms a bit better. When applied as curative its a nonsense.
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I've been though many rounds of CBT for depression. They mean well, but they miss the point. This is one of the many reasons i have delved into this topic in excruciating ( :cry: ) detail.

alex3619 said:
But if the unscientific mismash is not published, most of their papers will disappear and never see the light of day.
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It would be nice if anything unscientific was not published but unfortunately those people who publish it are just going to publish something else in its place. Many people will commit fraud for gain and i wish we had a solid method for preventing this.

alex3619 said:
On this we are going to disagree. How the brain works must be understood if you are to figure out how its broken.
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Yes and no, we know that vegetables are good for humans, we know in some ways why and in many ways we don't (how much do they increase longevity, how much do they reduce the risk of cancer, how much and what diseases do they reduce, all good questions that have research but no bullet proof answers). We have not even identified all the nutrients humans need though we have made great strides in the last few centuries.
Often general concepts such as this come from population studies or large scale multi variable studies (such as the Rotterdam study), where correlation hopefully equals causation even if we don't understand why.
Conversely sometimes we find accidents we can't explain, lowering cholesterol does not lower the risk of heart attacks, though for years it was believed it did. However statins do lower the risk of heart attack even though by design they lower cholesterol which in itself does not reduce the risk of heart attack. Two wrongs seem to have made a right, and the predominating theory is they somehow stabilize arterial plaque. So they are vastly prescribed because they work, we don't know why and its not by the mechanism they were designed for which is now debunked.

All that said i like to know exactly why and how something works but we don't always have that luxury


alex3619 said:
Its really just a mnemonic, to remind doctors to think outside of a narrow box. Its clinical. Its research basis is highly dubious, aside from direct clinical application, where the ideas have been shoved into small psychosomatic boxes.
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I understand that your position is that psychological doesn't matter. We could argue this till we both collapse form PEM and we would not convince each other.
 
Alvin said:
I understand that your position is that psychological doesn't matter. We could argue this till we both collapse form PEM and we would not convince each other.
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That is not actually my position. My position is that psychopsychiatry is largely theoretical, and hence unproven and much of it will be wrong. I cannot a priori identify what is right or what is wrong, we need the science, and it does not exist. Further I do not doubt psychology has an impact on disease and coping mechanisms. My arguments lie elsewhere. I do however point out that the notion that mind causes disease, not impacting or modifying but causing, has a history of utter failure in the scientific literature.

One particular point is that we need to separate scientific psychiatry from non-scientific psychiatry and from pseudoscience. Right now its a terrible mismash. Science is the main method we advance knowledge about complex causal issues, and even so it has a real problem with dealing complex networks of inter-relating things. Only sort-of applying science leads to pseudoscience.

Right now there is abysmal pseudoscience being passed off as sound science. That is creating a lot of issues we see in ME.

I would be happier to see psychiatry split into neurology, psychology, sociology, and alternative medicine. Its a confused mismash of these four right now. Even much of biopsychiatry is flawed because the diagnostic categories are mostly theoretical and unstable. Just look how they keep changing. They lack biomarkers or indeed any definitive markers at all. How can you do good science when you are unsure just what problems you are really looking at?
 
alex3619 said:
That is not actually my position. My position is that psychopsychiatry is largely theoretical, and hence unproven and much of it will be wrong. I cannot a priori identify what is right or what is wrong, we need the science, and it does not exist.
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I agree that psycopsychiatry is largely theoretical but in a different direction then you, treating negative emotions with sanctioned drugs is not very different then using unsanctioned ones.

alex3619 said:
My arguments lie elsewhere. I do however point out that the notion that mind causes disease, not impacting or modifying but causing, has a history of utter failure in the scientific literature.
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alex3619 said:
Right now there is abysmal pseudoscience being passed off as sound science. That is creating a lot of issues we see in ME.
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As for diseases being caused by psychosomatic causes i agree with you, its their attempt to treat everyone who is not diagnosed with a known disease or even tested properly as hysterical or MUS. Its a condescending way to get rid of patients and convince themselves they are offering excellent medicine.

alex3619 said:
I would be happier to see psychiatry split into neurology, psychology, sociology, and alternative medicine. Its a confused mismash of these four right now. Even much of biopsychiatry is flawed because the diagnostic categories are mostly theoretical and unstable. Just look how they keep changing. They lack biomarkers or indeed any definitive markers at all. How can you do good science when you are unsure just what problems you are really looking at?
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To be honest i would rather see it dissolved almost completely.
Neurology is a different discipline, people with real diseases like Alzehimers, Parkinsons, traumatic brain injury, stroke and the like have real diseases that need treatments targeted for those disorders.

Amw66 said:
Statins share the same issues with raw data and data manipulation that we are all painfully familiar with.

I' m not sure anyone could confidently make claims as to their efficacy.

http://bjsm.bmj.com/content/early/2018/01/16/bjsports-2017-098497
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I agree that they are more dangerous then let on, in some cases they may be causing dementia and even their plaque stabilizing is not excellent, actual plaque removing drugs are whats needed and prevention is possible (Vitamin K2).
 
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SW refers to Mike Godwin as a "school friend" in his original tweet.

Cyber Rights: Defending Free speech in the Digital Age
Mike Godwin
MIT Press
Revised Updated Edition: 2003
ISBN-13: 978-0262571685

Synopsis:

"Lawyer and writer Mike Godwin has been at the forefront of the struggle to preserve freedom of speech on the Internet. In Cyber Rights he recounts the major cases and issues in which he has been involved and offers his views on free speech and other constitutional rights in the digital age. Godwin shows how the law and the Constitution apply, or should apply, in cyberspace and defends the Net against those who would damage it for their own purposes. Godwin details events and phenomena that have shaped our understanding of rights in cyberspace - including early antihacker fears that colored law enforcement activities in the early 1990s, the struggle between the Church of Scientology and its critics on the Net, disputes about protecting copyrighted works on the Net, and what he calls "the great cyberporn panic." That panic, he shows, laid bare the plans of those hoping to use our children in an effort to impose a new censorship regime on what otherwise could be the most liberating communications medium the world has seen.

"Most important, Godwin shows how anyone - not just lawyers, journalists, policy-makers, and the rich and well connected - can use the Net to hold media and political institutions accountable and to ensure that the truth is known."
 
Indigophoton said:


A friend of Wessely's, previously unaware, wants to know about PACE. Wessely only tweeted him the link to the original work, although he is also interested in the dispute. Anyone feel like tweeting links to the special issue of J Health Psych, the Wilshire reanalysis and Tuller's blog to the guy? @dave30th?

No harm in letting as many people as possible know what's going on, especially if they then retweet. Mike Godwin is an attorney and author based in Washington DC with over 17k twitter followers.
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He's had such a robust response, I worry that if he gets any more responses, that may end up confirming SW's worst caricatures of us (which I'm sure he's shared with the guy in private).
 
alex3619 said:
I would be happier to see psychiatry split into neurology, psychology, sociology, and alternative medicine. Its a confused mismash of these four right now
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What you're actually saying is that its superfluous to neurology, psychology, sociology and alternative medicine ;)

I saw that article in the Guardian trying to recruit more psychiatry registrars - there are apparently unfilled places in the UK every year. So I get the feeling the medical fraternity as a whole do not think much of the specialty either.

In the UK, there's a few psychiatrists I'm familiar with (excluding the BPS ones), and many of them seem to fit a pattern. They're people who always preferred the humanities/social sciences, but they were persuaded to do medicine because its a good living. Then they discovered psychiatry as a way they could revisit their love of speculation, philosophising, ponitification and big words. The looseness and freedom of it all.

To be fair, some of these folks end up in neurology too, and they write books about how the brain-damaged patient can offer insights into human nature.
 
How marvellous to see Simon Wessely wading in to try and stop his mate Michael Sharpe making a complete fool of himself, only to shoot himself in the foot even more spectacularly when his smug remarks end up ensuring that criticism of PACE is given more publicity, including to his old friends who haven't read it.
 
And perhaps a critique of that - especially the one which pointed that it's a revealing choice of anology because with scientific trials you are not supposed to predetermined the destination and make adjustments in the steering to make sure it gets there. Can't remember who wrote it, but it was excellent.
 
Woolie said:
He's had such a robust response, I worry that if he gets any more responses, that may end up confirming SW's worst caricatures of us (which I'm sure he's shared with the guy in private).
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Maybe SW is just working on a smug assumption that Godwin will agree with him and he thinks everyone is terribly impressed that he knows Godwin - basically couldn’t resist trying to get one over on those pesky patients and weirdo researchers by name dropping Godwin. But it could turn out to be Russian Roulette if Godwin reads the info he’s been sent and actually says he agrees PACE is dodgy.
 
Does Mr Godwin have relevant expertise? If not he may find it difficult to understand why PACE is flawed and tend to trust authority and friends over random strangers on the internet. I think Wessely would be careful who he invites into the debate.
 
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