Questioning Biomedicine’s Privileging of Disease and Measurability, 2021, Kroll

Abstract

Within biomedicine, the diagnosis of disease is often privileged over a patient’s experience of illness. Yet up to 30% of primary care visits might be attributable to persistent illness without a diagnosed disease, including functional somatic syndromes like fibromyalgia and chronic fatigue syndrome. When clinicians are unable to diagnose disease or correlate symptoms with measurable changes in biomarkers, patients experiencing such an illness are at increased risk for suspicion, misplaced questioning, or having their motives misinterpreted through damaging social and cultural narratives about gender, race, ethnicity, socioeconomic status, or disability. Adhering strictly to a biomedical model of thinking about disease and diagnosis can prevent clinicians from empathically engaging with patients and helping them navigate their illness experiences.

Open access, https://journalofethics.ama-assn.or...privileging-disease-and-measurability/2021-07

 

Who says that your model has anything to do with the ability to empathise? In my experience those of my colleagues who witter on about psychological and social factors are the least empathising. They think they know the answers rather than being humble with the patient and admitting there are limits to what we understand.

The whole thing is a straw man argument.

 

If the BPS brigade had any concept of real empathy, rather than the faux-empathy they so arrogantly dispense, then they would not have caused so much distress to so many people over all these decades. The responses these people have provided down the years seems to demonstrate a total inability to empathise - full stop.

 

This abstract indicates the author is imposing their own, potentially controversial, definition of what is a diagnosable disease. Such creates a purely circular logic that is as dangerous as it is insulting to the patient.

In nearly thirty years every consultant, GP and specialist clinician I have seen, other than one occupational health physician who said I ‘must either be an alcoholic or have AIDS’ has been perfectly happy with me having a diagnosis of ME or CFS or ME/CFS as per their personal preference. If an individual is to reject the WHO, NICE and many physicians’ understanding of ME and a number of other conditions, they could at least present some evidence that supports their position.

Why do researchers and others advocating a BPS understanding of an arbitrarily chosen grouping of conditions feel empowered to assert their personal opinions as fact on the basis of little or no evidence and in contradiction to a considerable pool of evidence indicating the contrary.

I certainly respect a clinician more for saying they do not know, rather than those that assert an unevidenced and poorly defined hypothesis as fact.

 

Those are all psychosocial risks amplified by the biopsychosocial ideology. But "biomedicine", aka medicine, is the model to blame. Sure. Why not? It's your fault I hit you. This is a completely circular argument because it is created by refusing to do the necessary medical research and effort in the first place and fanatically adhering to Freud's dumb ideas.

This reeks of "we can't allow a [wrong ideology] government to form therefore we will overthrow your democracy, you know, for your own good, and also access to your natural resources but whatever that's just a happy coincidence".

This person can't even imagine that medicine isn't complete? How? How does that even happen? How can anyone be this ignorant and foolish and work in this profession at all?

And as Barry said take your fake empathy and shove it.

 

I don't know if it is because I'm female or if this is common to men as well...

There have been some occasions throughout my life where I've been diagnosed with "Disease A", been investigated for the disease, and then been dismissed because no evidence for Disease A can be found. As a result of the dismissal I've had lots of black marks recorded on my medical records suggesting I'm, at the very least, a drug-seeker, a hypochondriac, an attention-seeker, depressed, anxious etc.

But in the cases I can recall it has turned out that "Disease A" was a misdiagnosis in the first place and what I actually had was Disease B or Disease C or Disease D... But once those flags and insults have appeared on a patient's records they can't be removed even with a pneumatic drill and dynamite. And the existence of those flags means that the patient is far more likely to be assumed NOT to be suffering from anything biomedical right from an initial visit to a doctor and must be suffering instead from something that the BPS crew thinks is in their remit.

 

That's a nice start.

Yeah, no. Try talking to some patients first, before saying such misleading things about our reasons for refusing treatments or our needs.

What patients what is treatments that work to help them recover their functioning, so that they can better meet their human needs. Now in reply, some may say, yes, that is what treatments like CBT or GET or whatever seek to achieve. But the problem is, those treatments don't have little to no effect* for most patients and the quality of evidence in the literature is of poor quality compared to what would be expected for pharmacological or surgical treatments, so claims that they are evidence-based are not terribly convincing to educated patients. Patients reject these treatments because they don't work, not because of a stigma or hypothesised bias against mental illness.
*(on objective measures of functioning - they are very good at inducing response biases on questionnaires.)

Lastly, the concept of "illness without disease" is inherently dualistic. Anyone who uses this phrase (unless they are criticising it) is a body-mind dualist, despite any claims they make to the contrary.

 

Aside: a more personal article by the author:

https://hekint.org/2021/06/07/seeking-medicalization-chronic-illness-without-diagnosed-disease/

 

My initial reading of that sentence was:

"“Probably the most replicated risk marker for a functional somatic syndrome (FSS) is that having one is strongly associated with having another twenty."

 

Another twenty diagnoses, maybe!?!

Okay, I cleaned up the references to avoid confusion...

 

(quote is from the abstract)
But the alternative is ... biopsychosocial medicine? Strict biomedical, evidence based, stringent science, and understanding the limitations, are much more likely in my view to help than biopsychosocial views. That starts with an understanding that medicine has advanced a great deal but is still incomplete and often wrong or limited. I have been saying for maybe a decade now, the best thing we can hear from doctors most often is "I don't know" followed by "but I will try to help".

Government and insurance disease categories are part of the problem, together with the limitations in treatments and invesitigations that follow with a specific diagnosis. We must not lose sight of the issue that often medical limitations are imposed upon doctors. Its not entirely a failure in doctor education or culture.

Our heroes still should be biomedical scientists many of whom are doctors. That is where breakthroughs will come from.

Our villains are still those with entrenched dogma and ignorance of the science, and this goes far beyond medical doctors.

Much of the rest of the medical profession has limitations imposed on it including limitations on informations systems informing doctors. Evidence based medicine as it currently stands is often failing to provide the evidence doctors need.

The single biggest mistake I see being made in our community is thinking this is entirely an issue of reason or science. The less reliable areas in medicine are drenched in medical politics. This is part of the reason why strictly rational or scientific debunking of biopsychosocial over-reach often fails to do very much. The politics is not addressed. I really don't know how to advance this much, its not really what our doctors and researchers do routinely. Mobilzing advocates, organizing them, and addressing the medical politics of ME is very much a necessity. We have done some of that. We need much more, and with all the allies we can find.

 

Got inspired by a tweet...


Diseases eradicated by biomedical science: too many to count.
Diseases eradicated by the biopsychosocial model: hahahahahahahahaha
Diseases made manageable by biomedical science: even more too many to count
Diseases made manageable by the biopsychosocial model: hahahahahahahaha are you still here with this junk? still zero, buddy

 

It is however a method for convincing people via political rhetoric, and a basis for advertising.

 

This gave me a laugh
"Surgical scars and the expansion of narrative possibilities. By Camille Kroll."
Reminds me of Zen and the Art of Motorcycle Maintenance - but without the enjoyment/insight.
I didn't stick with this article beyond the first paragraph - there may be some hidden gems in there.

 

No doubt the BPS folk remain convinced that a course of CBT and a generous helping of empathy would have done the trick

 

So I developed diabetes. I was tested seen by a diabetes nurse who considered my diet (very good) exercise (impossible), alcohol consumption (huh!) and did I smoke? She then asked if I had any mental health issues or was worried about the diagnosis and accepted when I said no.

I was given drugs which helped and every 3 then 6 months I go back to see her. I have bloods taken, urine sample checked for kidney function, my weight and feet assessed. I can ask about anything worrying me.

Once a year I have my eyes checked.

All biomedical, no psychology in sight and my health checked to find problems early when they are treatable.

Similarly, my husband gets his blood checked for thyroid hormone level every few years, no psychology involved.

Mental health treatment for mental health problems. It's not as if there is not enough work for them in that.

 

It's as if the BPS gang have this insatiable craving to constantly justify their existence, and in the process totally undermine their own efforts.

 

"Illness without disease" seems like a bizarre concept in the context of ME/CFS. What we have here is just pathological processes that aren't understood yet. To assert as a fact, that the pathological processes don't exist, just because they're not described yet, is beyond absurd.

By this logic one could have argued that any form of cancer was "illness without disease" before the pathology of it was described. When you go far back in medical history, doctors could only observe the consequences of the disease, but not the disease process in itself. That doesn't mean that it didn't exist.

In the concept of "illness without disease" there's a lack of recognition of the fact that medical knowledge is currently incomplete and that breakthroughs will turn some of today's truths into tomorrow's pseudoscience.

 

That is the history of psychobabble and medical science right there.

The idea that ME does not have pathology is also currently absurd. We don't have proof of a univeral core pathology, but there are lots of things objectively wrong with us.