The rise of an out-dated healthcare model in Government decision making

UPDATE: 25/12/2012

Nassir Ghaemi has replied to my email saying that he will take some time to explore these links and then pass on some thoughts. He added:

“My initial impression is that this is quite an unwarranted vulgarization [sic.] of  an already out of date and oversimplified medical theory.”

ORIGINAL POST:

I came across an editorial by Nassir Ghaemi MD MPH for BJPsych, “The rise and fall of the biopsychosocial model”, and read with great interest. [“The biopsychosocial model was valuable in its day as a reaction to biomedical reductionism, but its historical role has played out.”]

Let me try to give the background and explain my interest in the Biopsychosocial model, and why I contacted Nassir for his expert opinion on these matters. (This is an edited version of the email I sent him.)

I have been suffering with quite sever ME/CFS, together with fibromyalgia and depression, since 2005. Although it stopped my teaching career back then, it hasn’t stopped my determination to carry on living and learning.

There has been a long running saga in the UK over welfare reform, ‘work capability assessments’, the company ATOS, and welfare to work schemes. My research has turned up some interesting developments and evidence in these areas over the last 10-20 years.

Let me introduce you to the controversy surrounding the US Tennessee-based insurance company Unum, who are advocates of the Biopsychosocial (BPS) model. Due to a major class action, It admitted unfair business practices, investigations, and fines, and was called an “Outlaw Company” by the former California Insurance Commissioner, John Garamendi. [Gosselin, Peter G. (3 October 2005). “State Fines Insurer, Orders Reforms in Disability Cases”. Los Angeles Times. Tribune Company. Retrieved 27 December 2009. “‘UnumProvident is an outlaw company. It is a company that for years has operated in an illegal fashion,’ said California Insurance Commissioner John Garamendi.“]

Unum has been advising the UK government since 1994, and has been involved with the UK’s Welfare to Work Bill. [ http://www.corporatewatch.org.uk/?lid=2940 ] In 2003, the government brought in Atos Origin to conduct incapacity assessments, and in 2005 they started using a computer system they call ‘LiMA’ – ‘Logic Integrated Medical Assessment’. The Full Facts website [ http://thefullfacts.com/esa/forum/viewtopic.php?f=22&t=330 ] lucidly explains how the system works, and the issues and controversy surrounding it. It is in essence a ‘tick box’ automated assessment, and having seen the training manuals and comments from many surrounding this ‘training’, can attest to the computer programme being predominantly involved in the decision making, reducing the role of the health care professional doing the assessment merely to the status of ‘computer operator’. There is evidence that the system is fully based around the BPS model. The Black Triangle Disability Campaign have been at the forefront of the struggle against Atos and successfully lobbied  Scottish GPs  to denounce the testing regime, a move soon followed by the UK wide BMA.

The BPS model was recommended by Dame Carol Black in her report ‘Working for a Healthier Tomorrow’ (2008). [ http://www.dwp.gov.uk/docs/hwwb-working-for-a-healthier-tomorrow.pdf ] This report was commissioned by the DWP and used as justification for the Work Capability Assessment.  Lord Freud, the minister for state in charge of welfare to reform (who is also the Great-grandson of Sigmund Freud) made it plain that he wanted to implement this report in full, and that he fully supports the BPS model.

However, with Unum’s involvement as advisors to the government in these matters, it has concerned many that the BPS model has achieved such traction in government policy with regard to all illness, conditions and disabilities. ‘Disabled People Against Cuts’ are among many groups that believe that BPS intervention has been imported from a discredited background and become the defacto ideology behind the welfare reforms and back to work policies for disable and sick people. [ http://www.dpac.uk.net/tag/bio-psychosocial-model/ ] This constantly reaffirmed by ministers and government with a completely unqualified mantra of “work is good for you”.

With regards to my condition, I have been positively diagnosed twice by a consultant  in neurology and by a consultant in rheumatology, both saying very similar things about my condition. However, currently, the government allows psychiatrists to give the majority of advice for ME/CFS although there are more than 5000 research papers showing ME to be physical, not psychological. Advice on ME needs to be given by experts specialising in areas of the disease pathology, such as neurology and immunology.This is the subject of a petition to the government currently, calling for the government to get “Advice on ME needs to be given by experts specialising in areas of the disease pathology, such as neurology and immunology… [and not from] psychiatrists, psychologists, or anyone working in an unrelated area” [ http://epetitions.direct.gov.uk/petitions/37117 ].

Are we right to be worried by the prevalence of the BPS model at the heart of government decision making, what are the true motivations behind these decisions, and ultimately is the BPS model is of any value whatsoever?

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