The HANDI Working Group

[Amw66]

Thread split from
“Graded exercise therapy: Chronic fatigue syndrome” by The HANDI Working Group (2019)


Who comprise the HANDI group and what are their interests.
Interesting re timing of this piece

 

[MSEsperanza]

Who comprise the HANDI group and what are their interests.
Interesting re timing of this piece

Their interests:
"A committment to promoting effective non-drug treatments"

HANDI is an online formulary of non-drug interventions in health care, which have solid evidence of their effectiveness.

Based on the idea of modern pharmacopoeias, each HANDI entry includes indications, contraindications and ‘dosing’. The aim is to make ‘prescribing’ a non-drug therapy almost as easy as writing a prescription for a drug.

HANDI enables clinicians to offer a greater choice of interventions to a patient, who may wish to avoid pharmacotherapy and the risks and life style changes often associated with drug treatment regimes.

Advances in non-drug treatments in the past few decades have been substantial and diverse: exercise for heart failure and COPD, the Epley manoeuvre for benign paroxysmal positional vertigo, knee taping for osteoarthritis, cognitive therapy for depression, ‘bibliotherapy’ (specific guided self-help books for some conditions), to name just a few.

Nearly half the thousands of clinical trials conducted each year are for non-drug treatments. However, the effective non-drug methods are less well known, less well promoted, and less well used than their pharmaceutical cousins.

https://www.racgp.org.au/clinical-r...(handi)/about-handi/what-is-the-handi-project

The authors:
https://www.racgp.org.au/clinical-r...entions-(handi)/about-handi/about-the-authors

(The website is announced to be down later today and tomorrow for two hours, due to maintenance activities.)

 

[Jonathan Edwards]

In addition, I was thinking it could be helpful to know a few studies on treatments like exercise, physiotherapeutic or psychological interventions that do comply with standards for drug interventions, i.e., randomized, adequately controlled, and blinded and, especially when blinding is not possible, measuring objective outcomes. Ideally, this should be studies on illnesses for which objective outcomes seem difficult at a first glance, too.

Comparing the ME GET and CBT studies to such 'best practice' studies could be an argument against the idea that 'we' just don't like exercise and psychotherapies or, to the more rationally arguing PACE & Cochrane defenders, that it is not possible to measure objective outcomes in some illnesses like ME.

As far as physiotherapy goes I thin thee are very few. When I was a rheumatologist in the 1970s and 1980s physiotherapy was used for almost everything but without any basis. I remember one quite good Dutch study of flexion versus extension versus do what yo like exercise for back pain that showed that doing what you like is slightly better. But maybe the authors wanted to get that result.

There is clearly a major problem with 'evidence-based' experts being biased towards non-drug treatments. It is a form of evangelism in reality.

 

[Jonathan Edwards]

Their interests:
"A committment to promoting effective non-drug treatments"

That is interesting, evangelists they are. The evidence that knee taping is any use is pretty thin I think.

What I think may be reasonably sound is the evidence for level of exercise protecting against cardiovascular disease, but that is not about therapy, it is based on epidemiological studies if I remember rightly.

 

[Sean]

There is clearly a major problem with 'evidence-based' experts being biased towards non-drug treatments. It is a form of evangelism in reality.

The backlash against reductionist psychopharmacology, while understandable, and perhaps even necessary in part, has clearly gone way too far. It is deep into cult territory now, and doing serious damage across the health system and society.

If the psycho-social advocates were serious about that aspect of health then a central pillar of their agenda would be advocating for an adequate minimum level of material and social living standards. I bet that alone would be the single most effective 'treatment' possible for the bulk of psycho-social 'disorders'.

DokaGirl said: ↑
"However, this finding is believed to be due to inappropriately planned or progressed exercise programmes, possibly undertaken independently or under supervision from a person without appropriate experience."

"believed" and "possibly" are not facts, they are of course suppositions or assumptions.

I think we should start making a list of all the "conclusions" which include these sorts of words. I was as guilty as anyone of not noticing them but thanks to this forum they now stand out for me. It is quite astounding how much of the BPS facts have these qualifiers.

believed, possibly, may, might, could, seems likely, has the potential to, etc.

This kind of sophistry has been a characteristic feature of their rhetoric for decades. In particular, sliding back and forth between indefinite and definite terminology, between qualified and absolute statements.

IIRC, Ellen Goudsmit was pointing out this crap 20 years ago.

Their act hasn't changed one bit since they first got started on us in the late 1980s.

 

[Snowdrop]

If the psycho-social advocates were serious about that aspect of health then a central pillar of their agenda would be advocating for an adequate minimum level of material and social living standards.

Whenever and wherever the BPS advocates publicly proclaim their psychological 'fix' for all and sundry health issues they should be confronted with the above quote.

 

[Snow Leopard]

The backlash against reductionist psychopharmacology, while understandable, and perhaps even necessary in part, has clearly gone way too far. It is deep into cult territory now, and doing serious damage across the health system and society.

The main problem with pharmacological treatments is their efficacy was overstated. Obviously the solution is to more realistically appraise the efficacy of pharmacological treatments, not to overstate the efficacy of non-pharmacological/surgical treatments.

 

[Sean]

Obviously the solution is to more realistically appraise the efficacy of pharmacological treatments, not to overstate the efficacy of non-pharmacological/surgical treatments.

Any hype you can hype I can hype higher,
I can hype any hype higher than you.

 

[rvallee]

The backlash against reductionist psychopharmacology, while understandable, and perhaps even necessary in part, has clearly gone way too far. It is deep into cult territory now, and doing serious damage across the health system and society.

Way I see it is like starting to demonize all food because too many people eat too much fast-food.

Yes, there are excesses and mistakes with drugs. No, there is no better way to deliver chemicals. Life is a series of chemical processes. Food is chemicals. Water is a necessary chemical solvent. We need molecular oxygen to function, more chemical reactions. Our very thoughts require chemical reactions, as do movement and procreation.

It's about balance. Neither is better or worse at anything. You can influence some internal chemical processes without drugs. Others you can't, because the body can't produce them. This extremist approach is reaching comical levels when you consider the accusations of "boom and bust" and "all-or-nothing personalities" crap we have been branded with. Now this here is actual unhelpful illness beliefs with genuine psychosocial consequences.

If the psycho-social advocates were serious about that aspect of health then a central pillar of their agenda would be advocating for an adequate minimum level of material and social living standards. I bet that alone would be the single most effective 'treatment' possible for the bulk of psycho-social 'disorders'.

100% this. But for the actual psychosocial problems, which most psychosocial proponents cannot tell apart from the products of their own imagination.

 

[Caroline Struthers]

Post copied and subsequent posts moved from Independent advisory group for the full update of the Cochrane review on exercise therapy and ME/CFS (2020), led by Hilda Bastian

This thread is also relevant: “Graded exercise therapy: Chronic fatigue syndrome” by The HANDI Working Group (2019)

I will write to Cochrane again - copying in Hilda Bastian. Paul Glaziou, Hilda's PhD supervisor, and advisor on the Exercise review, I think has something to do with Handi. Will check that out. It's a clear conflict of interest even if Hilda says she has not spoken to Paul about the review.

Yes, Glasziou is a founder/committee member of Handi https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6355298/

 

[MEMarge]

Copied post

I sincerely hope not!

I only asked because of this mention in the linked article:

"In an exciting new development, the Royal College of General Practitioners (RCGP) is partnering with the RACGP to provide access to HANDI for UK GPs. This is a free resource so why not take a look?1 In addition, the RCGP will be contributing ideas for treatments to be included, helping with the review process, and linking RCGP resources to HANDI and creating UK-focused versions of HANDI advice."

 

[Jonathan Edwards]

"In an exciting new development, the Royal College of General Practitioners (RCGP) is partnering with the RACGP to provide access to HANDI for UK GPs. This is a free resource so why not take a look?1 In addition, the RCGP will be contributing ideas for treatments to be included, helping with the review process, and linking RCGP resources to HANDI and creating UK-focused versions of HANDI advice."

They may have trouble getting anything funded without NICE approval but this looks like a disaster in line with so many others. They want to create the RCIQP (Royal College of Independent Quack Practitioners). Judging by how miserable they sounded in Pulse maybe they should just look for another job and stop troubling the public.

 

[Jonathan Edwards]

I only asked because of this mention in the linked article:

@MEMarge,

The article by a UK RCGP person and Glasziou on HANDI is 2019. So presumably GPs have had access to this for a while.

When you say 'linked article' which one did you mean? Is there some new reference to HANDI from RCGP?

The examples given in the cited article by Simon and Glasziou are truly appalling. CBT and exercise for everything, including toothache it seems.

 

[FMMM1]

I'm late to the party as usual - this is pretty shocking

"The Handbook of Non-Drug Interventions — HANDI — project was launched by the Royal Australian College of General Practitioners (RACGP) in 2013 to promote effective non-drug treatments. HANDI is an online formulary of non-drug interventions for use in primary care that have solid evidence of their effectiveness. The aim is to make ‘prescribing’ a non-drug therapy almost as easy as writing a prescription for a drug. Box 1 lists some common GP consultations and examples of HANDI resources that might help."
https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC6355298/

Charlatans, homeopaths ---- step this way. You can kind of hear the cha-ching ---- stop prescribing treatments which impact on your bottom line ---- here's the manual ---"The Handbook of Non-Drug Interventions — HANDI"
---- do those folks, you can't actually help, get you down ---- cha-ching ---- here's the free way to get them out of our surgery ----"The Handbook of Non-Drug Interventions — HANDI"

There's probably a GP in the UK who'll promote this ---"The Handbook of Non-Drug Interventions — HANDI"

 

[rvallee]

I'm late to the party as usual - this is pretty shocking

"The Handbook of Non-Drug Interventions — HANDI — project was launched by the Royal Australian College of General Practitioners (RACGP) in 2013 to promote effective non-drug treatments. HANDI is an online formulary of non-drug interventions for use in primary care that have solid evidence of their effectiveness. The aim is to make ‘prescribing’ a non-drug therapy almost as easy as writing a prescription for a drug. Box 1 lists some common GP consultations and examples of HANDI resources that might help."
https://www.ncbi.nlm.nih.gov/labs/pmc/articles/PMC6355298/

Charlatans, homeopaths ---- step this way. You can kind of hear the cha-ching ---- stop prescribing treatments which impact on your bottom line ---- here's the manual ---"The Handbook of Non-Drug Interventions — HANDI"
---- do those folks, you can't actually help, get you down ---- cha-ching ---- here's the free way to get them out of our surgery ----"The Handbook of Non-Drug Interventions — HANDI"

There's probably a GP in the UK who'll promote this ---"The Handbook of Non-Drug Interventions — HANDI"

A few days ago, one annoying Norwegian (or Swedish?) physician, who is constantly insulting and demeaning us for some reason, was expressing outrage that osteopaths were now accepted medical practitioners in his country (or something like that), how it opened the door to charlatans. A door that can pass through pseudoscience, like the one he loves, can let through any pseudoscience. Aw, the law of unintended consequences.

He's a big fan of the LP (and everything BPS/psychosomatic) and is especially bullyish at pushing it. He's probably not aware that Parker is an osteopath. Then again, there's a whole lot he's not aware of, but that people like him, pushing charlatanism and quackery, don't understand what comes after voting for the face-eating leopards party is something to behold.

No doubt he sees no connection, but I'm frankly surprised at how slow the alternative medicine industry is at taking advantage of those gigantic loopholes. The BPS playbook would work just as well for homeopathy, acupuncture or any other sham out there. The only difference is the culture of medicine, but that's also changing for the worse as quackery increasingly becomes standard practice. Once it becomes OK to "prescribe" going to a museum and other silliness, is it really silly to prescribe anything for any reason? The shark has already been thoroughly jumped.

 

[MSEsperanza]

Once it becomes OK to "prescribe" going to a museum and other silliness,

I think many people would benefit from going to a museum and similar activities, and accessibility should be improved, but it's not a treatment for illnesses, and prescribing such activities is neither an apt way to deal with economic deprivation due to chronic illness, nor a means to make cultural institutions and social activities more accessible.

Edit: The Handi recommendations until now don't include 'social prescribing', they are focused on exercise and psychotherapy/mindfulness and also on preventive medicine (or non-medicine)

A few days ago, one annoying Norwegian (or Swedish?) physician, who is constantly insulting and demeaning us for some reason, was expressing outrage that osteopaths were now accepted medical practitioners in his country (or something like that), how it opened the door to charlatans.

https://twitter.com/KristianGunder/status/1492181901410459649

https://twitter.com/KristianGunder/status/1501513881663033346?cxt=HHwWhMC-3fC6udYpAAAA

deepl translate:

"Osteopathy, naprapathy and manual therapy are similar to chiropractic and lack a scientific basis. The Parliament has now opened the way for even more groups to have straws in the health care basket without offering health care."

 

[Sean]

The aim is to make ‘prescribing’ a non-drug therapy almost as easy as writing a prescription for a drug.

And what happens if the patient declines the prescription?

Become tagged as a 'difficult patient' on their medical files?

 

[FMMM1]

A few days ago, one annoying Norwegian (or Swedish?) physician, who is constantly insulting and demeaning us for some reason, was expressing outrage that osteopaths were now accepted medical practitioners in his country (or something like that), how it opened the door to charlatans.

Yea there seem to be a few of those high profile folks around --- they may be disproportionately represented --- by their own loudness --- many much better Doctors probably are frustrated that they cannot help ---- which is where lobbying - for research, centres of excellence (specialist clinics) etc. might be a way to move things on.

No doubt he sees no connection, but I'm frankly surprised at how slow the alternative medicine industry is at taking advantage of those gigantic loopholes. The BPS playbook would work just as well for homeopathy, acupuncture or any other sham out there.

Yea probably based on lack of knowledge, but the lightning process etc. seems to be a way to join the mega rich --- and without the risk of a criminal sentence associated with other scams.

See Crawley has patents for non-treatments --- supplied to the NHS no less --- how are they doing that following the new NICE guidance?

 

[Jonathan Edwards]

The aim is to make ‘prescribing’ a non-drug therapy almost as easy as writing a prescription for a drug.

So you can now say - well I've done my job, I have prescribed treatment, so now you can go out of the door. And I don't even have to find the dose for a drug.

 

[MEMarge]

@MEMarge,

The article by a UK RCGP person and Glasziou on HANDI is 2019. So presumably GPs have had access to this for a while.

When you say 'linked article' which one did you mean? Is there some new reference to HANDI from RCGP?

The examples given in the cited article by Simon and Glasziou are truly appalling. CBT and exercise for everything, including toothache it seems.

Apologies, the ref was to the Simon and Glasziou 2019 paper. This was more obvious on the original thread.