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.
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.
it was "unapproved" so I "approved" it. Who knows why the system had unapproved it? probably because of the length. but others that are long sometimes get through.
Thanks No worries, i just didn't want it to be forgotten, on some websites they sit in purgatory indefinitely.
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.
Just reading now, but with "The promise of this idea rests on two assumptions:", did you mean to say "premise" @dave30th?
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
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.
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...)
Thanks, Stewart--someone else pointed that out. I can use that in follow-up posts. And then in some references it got changed to 11%. Not sure how that happened.
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.
That is probably the point. In my experience those who spout lies to support their lies are interested in ideologies and not the truth.
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.
