Month: March 2019

A friend has asked me to post this and I thoroughly agree that this is an important issue affecting women in particular. People with M.E. may remember that one of the reasons given by McEvedy and Beard for the ‘hysterical’ nature of M.E. in their 1955 report on the Royal Free outbreak was ‘the high attack rate in females compared to males’. This post has some interesting info on the role played in this issue more recently by Professor Sir Simon Wessely.

On International Women’s Day, let’s remember that thousands of UK patients, especially women, are being diagnosed with medically unexplained symptoms or ‘MUS ‘, denied biomedical care and shipped off to psychological therapies instead.  Those who wind up in the ‘Improving Access to Psychological Therapies’ or ‘IAPT ‘ programme will all be coded with ‘somatization disorder’.

The 2017 JCPMH Guidance for commissioners of services for people with MUS that promotes IAPT states that: “the risks or associated factors for MUS include being female” but the 1999 study cited for this statement reports that “physical symptoms were slightly more common in women, but this difference was not significant.”

Another study (2001) cited in the Guidance puts gynaecology at the top of the table for the rate of MUS in outpatient clinics.  Except a different study reported in a presentation entitled  “Complex patients” by Dr Alan Cohen FRCGP  puts gynaecology in the middle of the table for MUS rates, with gastroenterology at the top. 

A 2002 study, also cited in the JCPMH Guidance, reveals that there was no greater risk of MUS in women and comments that: “the absence of a female excess in the somatising patients was unexpected given that this is a near-universal finding in studies of medically unexplained symptoms. This highlights the role that higher consultations rates in females may have as a confounding variable in such studies.”

All 3 studies (1999, 2001, 2002) include Simon Wessely and Matthew Hotopf as their authors.  Wessely was President of the Royal College of Psychiatrists (RCPsych) when the RCPsych acted as joint partner with the RCGP in the production of the 2017 JCPMH Guidance. 

In 2003, Simon Wessely co-authored an article in the Journal of the Royal Society of Medicine entitled “Medically unexplained symptoms: exacerbating factors in the doctor–patient encounter” which said: “Factors predisposing to MUS are female gender…….”

Two of his own previous studies, including one published the year before, had shown that not to be the case.

So in 2017, as President of the RCPsych, was it not possible for Professor Sir Simon Wessely to prevent the publication of the misleading/discriminatory information regarding risks of MUS in the guidance for NHS commissioners? 

References

• Joint Commissioning Panel for Mental Health (2017) Guidance for commissioners of services for people with medically unexplained symptoms (JCPMH), http://www.jcpmh.info/good-services/medically-unexplained-symptoms/

• Hotopf, M., Mayou, R., Wadsworth, M., et al (1999) Childhood Risk Factors for adult Medically Unexplained Symptoms: results from a national birth cohort study. American Journal of Psychiatry, 156, 1796-1800.

https://ajp.psychiatryonline.org/doi/10.1176/ajp.156.11.1796

• Nimnuan, C, Hotopf, M, Wessely, S. Medically unexplained symptoms: an epidemiological study in seven specialities. J Psychosom Res 2001; 51: 361–367.

https://www.ncbi.nlm.nih.gov/pubmed/11448704

• Alan Cohen presentation – [PDF] Complex Patients

•  Page LA, Wessely S. Medically unexplained symptoms: exacerbating factors in the doctor-patient encounter. J R Soc Med. 2003;96(5):223-7.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC539474/