Trial By Error: The Cost of MUS

Andy

Andy

Retired committee member
In January, I wrote about the problematic online training course developed by the Royal College of General Practitioners and touted by Steve Brine MP as addressing the “misconceptions” about ME (or CFS/ME, as the online course calls the illness). The lead author of the course was Carolyn Chew-Graham, a professor of general practice research at Keele University in Staffordshire. Rather than addressing any “misconceptions,” the course repeats various bogus claims that the GET/CBT ideological brigades have been pushing all along.

Like the PACE authors and those in their orbit, Professor Chew-Graham is a leading proponent of psychological and rehabilitative treatments for patients identified as having “medically unexplained symptoms,” or MUS. (Journalist Maya Dusenbery and I discussed some of the problems around the MUS construct in this Q–and-A last year for BerkeleyWellness.com.) In fact, Professor Chew-Graham has represented the Royal College of General Practitioners as co-chair of a joint effort with the Royal College of Psychiatrists to develop commissioning guidelines for MUS services.
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http://www.virology.ws/2019/02/25/trial-by-error-the-cost-of-mus/
 
chrisb said:
It is astonishing that a professor would not seek to address such criticism at the earliest opportunity either by acknowledging and correcting statements, or refuting the allegations.
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I think I now would be more shocked by a proffessor, advocating a BPS approach to ME/CFS and/or the catch all psychiatric pseudo non diagnosis of MUS, that did acknowledge a valid criticism and corrected their work. It definitely feels there is something rotten in this area of medicine/academia.
 
Alvin said:
I posted a reply but its awaiting moderation.
Is it because i added links?
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With the new system for comments with the Virology Blog, my experience is longer comments sometimes go into moderation but eventually reappear unlike the old DISQUS system where comments under moderation just seemed to disappear.
 
Peter Trewhitt said:
With the new system for comments with the Virology Blog, my experience is longer comments sometimes go into moderation but eventually reappear unlike the old DISQUS system where comments under moderation just seemed to disappear.
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Cool.
I don't often comment right on the articles but this time it seemed important, if someone reading the article reads the comments they need to know this is not a new thing nor can you sweep it under the rug
 
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Really worthwhile article, and excellent as always. Same pattern as ever: Make a serious mistake that has massive implications for patients (and major issues for NHS economics as it happens), but the damage could be limited if readily corrected when first spotted. To me the real crime is in not setting things to rights when the mistake becomes clear, because at that moment things are at a tipping point: the consequences of not doing the right thing are potentially horrendous, and if the chance to do the right thing is passed by, then the situation will rapidly get worse, and more entrenched. The difference in numbers is major, and the idea that NHS economic policy is being set based on such misinformation ... is just mind boggling.
 
Barry said:
Just reading now, but with "The promise of this idea rests on two assumptions:", did you mean to say "premise" @dave30th?
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No, I meant the promise that this idea, if implemented, would produce savings. but it's obviously clunky phrasing. I actually myself kept thinking of premise was right. But then it would have had to be "this premise rests on..." I think rather than "the premise of this idea rests on..."
 
@dave30th - I was going to post this on Virology Blog, but I couldn't work out how to add a link...

The Department of Health's 2008 Departmental Report gave the NHS financial settlement for 2008/9 as being £97.1 billion (Page 148, Figure 9.5). So £2.89bn would be less than 3% (2.98% to be more precise) of the total NHS budget for that year. The 10% figure that Professor Chew-Graham is so fond of is more than a threefold exaggeration of the actual spending on MUS as a percentage of the total NHS budget for that year.

(And of course, this is not to say that you should estimate current spending on MUS as being 2.98% of current NHS expenditure either - a lot could have changed in the decade since the Bermingham study...)
 
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What I find really interesting is this. This 10%/11% figure (more than 3x greater than the reality) has likely been used to influence major decisions on NHS spending, possibly even influence government thinking on its resource allocation to the NHS. So how different might those decisions have been if the correct figure had been used? Not necessarily just financial decisions either. More of a rhetorical question really, given how impossible it likely is to ascertain what might have been.
 
Barry said:
What I find really interesting is this. This 10%/11% figure (more than 3x greater than the reality) has likely been used to influence major decisions on NHS spending, possibly even influence government thinking on its resource allocation to the NHS.
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That is probably the point.
In my experience those who spout lies to support their lies are interested in ideologies and not the truth.
 
Barry said:
What I find really interesting is this. This 10%/11% figure (more than 3x greater than the reality) has likely been used to influence major decisions on NHS spending, possibly even influence government thinking on its resource allocation to the NHS. So how different might those decisions have been if the correct figure had been used? Not necessarily just financial decisions either. More of a rhetorical question really, given how impossible it likely is to ascertain what might have been.
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The whole business about trying to make health care 100% efficient is worth some thought. We know that 100% bed occupancy in hospital sis dangerous but I suspect people do not realise just how essential 'inefficiency' is to good health care.

The idea of a doctor is someone who is likely to know whether or not you are really ill when you, as a lay person may not. Recognising signs of disease is an art that takes 10 years training. So it is reasonable to assume that the lay person will be looking after their health properly if they go to the doctor three times as often as they have serious disease. So we want a system that is 75% 'inefficient' in terms of there being something seriously wrong every time someone goes to the doctor.

Those 75% of times may often be for symptoms with no medical explanation of importance. So in a sense we are expecting 75% of resources at least in diagnostic terms to be 'wasted' if we want adequate health care. And of course that does not in any way imply that these unexplained symptoms then need to be dealt with by some mumbo-jumbo therapists. The person just needs to be told that nothing serious has been found.

What I find most worrying is that the RCGP has bought in to this 'efficiency' approach wholesale.
 
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