UK Dr Anna Chellamuthu, GP and Lightning Process practitioner, and her article in a GP journal

Phew, a close shave......
Just as well the 'Anngate' LooPy article was pulled...... as it could have been put forward for a prize.......mayby by 'CG' eminent GP ( Just like the Maddox Prize- Aka SW!)
The Prize is awarded each year by The Tamar Faculty of the Royal College of General Practitioners.



https://bjgplife.com/kieran-sweeney-prize-2021/
The Kieran Sweeney Prize 2021: A national UK prize for medical writing by GPs
The Article

The article must be previously unpublished and have been written solely by the entrant.
Ideas from disciplines outside medicine such as the arts, business, philosophy, literature, or political and social science will be especially welcome. .....
The piece should be written in prose at a level that an interested member of the public will understand, under the title “What does the future hold for the relationship between a patient and their GP in the UK?”

 

You're right - I think I misread something:

https://bjgplife.com/contribute/

 

The fact that they decided to unpublish it suggests they didn't take a close look at it when they published it. And that's a a bit strange because LP is strongly discouraged in the NICE guideline.

 

I suspect the editor thought it was a good piece of NICE-bashing and standing up for GP rights.

I think they may have unpublished it when I raised the ethical issues over treatment of children. Stepping outside NICE guidelines is not necessarily something reprehensible but when it comes to encouraging brainwashing treatment for children things get a bit different.

 

Especially 10 year olds......

 

This LP thing is really starting to give very strong Scientology for physicians vibes, even weird infiltration in places that exist to guard against nonsense like this. Ghosts of aliens past. Conversion disorder is basically some "ghost in the machine". Same coin with two identical sides. They're both narrative-driven, though only one has an action sci-fi movie (Battlefield Earth).

 

Too true. This is the key bit on the issue with the LP (and I can see other things under similar veins that are growing up in the area of 'therapies' of various types - it is so scary to watch). This lady herself is 'caught up' underneath powerful characters with very strong messaging for those on the 'inside' even compared to what they put out to the 'outside'.

The fact a GP has become so involved they are now doing what they are doing is testament to how mindbending the overall situation is really. Although I'd be interested and think it is incredibly important for this case to be fully investigated to check whether there were other influences beyond the direct LP set-up also involved with telling her that this was a good/safe idea for her career and life etc.

As you say, this set-up like many others you sadly see over the years perhaps isn't really about 'the treatment' necessarily when you look at it for a few minutes.

In most other industries the equivalent of what she has done would have huge, irreparable consequences - just because the profession seems to not always do this doesn't make the fact someone has 'gone there' any less serious or extraordinary. Particularly when you consider that losing her license would put all sorts in jeopardy including her LP business (given she has branded herself that way). So whatever has been involved in creating this state is obviously strong and probably more forces (aka Porters 'forces analysis') than a story explains.

Someone doesn't become that unable to see the consequences and big picture overnight, or alternatively, that emboldened and under the impression that the potential consequences wouldn't happen - or both - and it is vital for the profession to analyse and get to the bottom of how many directions she has been pushed or encouraged from etc.

I'd have 'some' sympathy in some ways for someone caught up in this (she herself was the mother of a poorly kid one day and clearly found all these friends, comfort, distraction in this at a time of just having moved across the country) if it weren't for the parasitic aspect where things like this encourage them to drag others into where they are, and in this 'pyramidy set-up' might find there is incentive driving things rather than 'chasing losses' compared those who are the vulnerable, broke, sick persons who seem to be being marketed to and the impact would be even more problematic for.

The whole thing needs to be unpicked - because as I say it certainly isn't the only one in the only area and is a real huge issue that needs to start being understood in order to make the most vulnerable safe via regulations. And these won't be effective if those involved aren't identified to ensure that said regulations etc aren't involving those who might have conflicts or reasons they personally might want to encourage it etc. in deciding the what and how ie on the decision boards.

As they say in research 'past behaviour is the best predictor of future behaviour' certainly more so than the weakest measure which is asking people their 'intentions' on behaviour (always pretty useless in any survey). So getting to the bottom of these things might help to identify the pattern of influences and issues underlying.

And the idea that it is 'the wonder treatment's amazingness' that is the reason for all this is something anyone would and should be rightfully cynical of. Even if that is what they all want to claim. That, to me, seems a distraction.

 

Spot on

 

The interesting part of the response is the tiny amount of the article that the editor was trying to pick out in order to state how it 'met the aims of this new debate-focused section'. It 'seems' from memory that her article was a medley of the story she already had on her website with (someone elses/her?) scathing attack on the guideline with various bit of 'research'. But with an incidental one-liner about never having worked outside the guideline before, and then sending her own child off to LP and getting qualified in it herself.

It's not really an experience of being 'a GP working outside guidance' at all.

In fact the other 'bits' he suggests, which 'just about' tick the box for the sections claimed aims I think were similarly 'incidental' and 'minor' parts within the whole advertorial?

 

The editor mentioned that he had consulted with members of the editorial board. That I:

EDITORIAL BOARD
Dr Luke Allen, Department of Clinical Research, London School of Hygiene & Tropical Medicine
Prof. Carolyn Chew-Graham, School of Primary, Community and Social Care, Keele University
Dr Hajira Dambha-Miller, Department of Population Health and Primary Care, University of Southampton
Dr Graham Easton, Clinical and Communication Skills Unit, Queen Mary, University of London
Dr Adam Firth, Bracondale Medical Centre, Stockport
Dr Benedict Hayhoe, Department of Primary Care and Public Health, Imperial College London
Dr Jennifer Johnston, Centre for Medical Education, Queen’s University Belfast
Dr Peter Murchie, Academic Primary Care Research Group, Institute of Applied Health Sciences, University of Aberdeen

Only one name I recognise there.
It would have been interesting to have been a fly on the wall.

 

wow, I hadn't read up on this before. Does anyone have a copy of the original article? Now that it's taken down, I"d like to read it.

 

It's your classic nasty sales ploy: anyone who doesn't buy this and then act normal and say they are better are 'insert whatever nasty name-call'. Man not ball strategy to a tee.

Like anyone selling something that doesn't work saying things like 'haters gonna hate' to complainers or resorting to personal slights in attempt to invalidate them.

The pathetic thing is the people who suck this up and the ignorant and unforgivable is the bystanders who read these transparent and poisonous things and don't (as they must see it) just say out loud this is tosh and so it becomes a useless strategy but allow it to continue. I always find looking to the sidelines to see if there those who are keeping their hands clean from being directly involved whilst happily providing encouragement whilst being thoroughly prepared to leave anyone who gets caught out standing as a patsy is often interesting in this sort of thing too.

This transparent thing hasn't been allowed to take off and last so long for no reason so there are 'red flags' around environment that allowed this to prosper to this point.

 

Esther12 posted a copy in this post, https://www.s4me.info/threads/uk-dr...icle-in-a-gp-journal.24850/page-3#post-408386

 

Someone elsewhere mentioned that 'functional doctors' was what we needed in order to help us. The way that was talked about it sounded like internal medicine/actual docs with a more 'get to the bottom of it' approach so I looked up for one in interest. Then I got confused as there was also 'integrated functional medicine'. A lot more came up via google with that one and it started to be to whole practices that were naturopath and dietician as well as qualified GPs but running very different kinds of places - all seemed private ie not NHS.

Anyway I did not quite a few of those seemed to be involved with this sort of thing too (as you look through wondering whether it is a good or bad thing etc you are studying for red flags).

Does anyone know more about functional medicine, integrated functional medicine - there seems to be a whole 'school' in it, and all these various other areas and how big they are now?

 

I wondered whether this was filling a pretty specific demographic. Very much a laypersons view but.. being a GP is a tough job, lots of them are salaried ones slogging their way through the appts. Unless they have a career plan to go in this direction I can't imagine their 'powerless to change things' position and personal spare time and finance situation (many are likely to be younger, perhaps have kids at home etc) would mean they are buying these magazines and then reading past any official article they need for the personal development.

I don't know what his business model is nor the marketplace issues and competition at various positioning points.

Those who want to navel gaze on these 'debates' and can should surely be possible to demographically define. And the worry is that as the way forums work is that those who thinks this type/level of 'debate' (as they call it - but it is hardly fixing the hard issues of medicine or GP set-up) is tosh aren't going to stay on the forum disagreeing with it - they'll just go elsewhere and leave those that do to it. It's doubly more important given the career impacts we suspect are involved for medical profession etc.

This editor might want to be quite careful as he develops his new flagship section to at this point make the clear decision about whether he wants/needs the short-term trumpist-type Unique User catching stuff, or actually wants something more 'worthy' on the debate front. The thing is that these things won't be 'unique' as articles and will drop down the google search with lots of other articles giving the same stuff quite quickly - so the usefulness of said articles for that purpose is shorter.

A good article on a topic someone would 'google through time' will last and grow as a traffic generator and indeed in helping his SEO(Search Engine Optimisation/types of data the ever changing google algorithms use to decide who/what comes up where on a search page). It also won't become obsolete in all the stuff that pops up when someone puts in LP, but will appear when someone googles whatever unique-ish and more specific question they might type in. I note if he is kidding himself with the one-liner about 'never gone against a guideline before' means it will come top for 'working outside the guideline' according to algorithms he needs to get an expert in.

Reputation (takes time to build but a minute to knock down) vs perceived popularity - and probably also feeds into SEO based on which 'bracket' you are landing in ie are your online readers those who also read the publications you'd like to be seen as in a category with. Like in all walks of life, who you choose to hang around with and what they think of you is something most implicitly know says a lot about you. The power of 'Source of Origin' in marketing is hugely important too (is he wanting to target readers who might also want to be LP practitioners). But maybe, sadly, these individuals are the decision-makers he wants, which says a lot.

There almost undoubtedly would be some really important stuff totally beyond this that could be being raised as proper debates in such a section that could actually be a force for good and getting solutions with the right people. His marketing plan might want to look at who he wants reading his journal in 5yrs time and where he wants his brand to be with what audience. Because these types of additions are important but can be a major part of positioning (not just SEO marketing to get new users in if that is something he needs for advertising or revenue purposes).

 

I partly wonder whether some of the issues with these things having had the 'support' they have (I'm guessing there must be some allied to professions somewhere who mightn't believe in it but can see its use agenda-wise so allow it to exist) is because ME and its PEM has represented a 'glitch in the matrix' for a medicine that wants to move to assuming most illness is tackled by telling people to exercise and eat healthily.

Funnily, I suspect it really isn't the only illness that has PEM, or certainly some of the systemic issues meaning that the 'treat the symptoms' behavioural depts are actually an expensive as well as in/less effective way of going about too many illnesses and structure. Imagine if they treated heart problems as something that sent people off to the meditation dept back in the day, dietician, and then maybe exercise based on the assumption that their not being able to do so without symptoms was cart before horse etc.

But to the outside it seems like historically there was one 'year' when any illness/medical area that hadn't already scraped in under the bar suddenly got treated in this paradigm.

And that is rather supply-led. I can't help but wonder when an area is supply-led you end up with people who can cherry-pick jobs and their preferred part of it. I worked in a different area, but this is common everywhere and you see people turn up trying to palm off involvement in the core of their role and simply twist whatever their post is into/by doing their fave bit. Every job has more interesting or indeed less arduous (or whatever the issue is) parts to it and every organisation has some roles than some see as 'cushy numbers' by their own preferences/needs (fortunately these tend to even out across people with different things they want out of a job).

And of course all the symptom addressing stuff is based on generic heterogenous, therefore lowest-common denominator studies - they are therefore aiming to 'make people average' in all these things - because the nature of their inference-based stuff inc. reference ranges is that these don't represent what is 'best' health-wise but normal-distribution. If most of the population is ill then effectively research based on this would be perpetuating treatments to make people who were less ill more 'average and therefore less well'. Or who you define or pick as your cohort defines it another way.

I diverge into philosophical but the lack of 'deduction' as part of the scientific process in medicine is a blatant issue - it isn't science technically without this. I also don't understand how a whole area has iterated in the same spot for decades to the point one could describe it as 'stuttering' (or spluttering). It sort of makes the case for the declared reason for why the academic research/literature process - with debate back and forth to the end etc and it moves things forward not working in itself. If there is no override or jumpstart mechanism for when quits are called on a rut.

Add in the fact there is no scientific plan or strategy behind what is funded for research and not, you have teh same supply-led issue on those who sign off and those who sign up to do studies.

I can sort of see how the issue you've mentioned, which is fair, marries into this context/environment. I forgot to add: because it solves the cognitive dissonance that the 'beliefs and set-up' needing to not change vs the challenge that ME provides to that with PEM is causing.

 

12 Nov 2021 — Chew-Graham is Professor of General Practice Research at Keele University, Honorary Professor of Primary Care Mental Health at Midlands