This post (in response to a new paper promoting the use of CBT for IBS) is by my colleague Couch Turnip and originally appeared as a comment here: http://www.virology.ws/2019/04/15/trial-by-error-crowdfunding-week-2-and-more-sharpe-and-chalder/ (with some changes by the author)
For those who are new to this issue and may be unfamiliar with some of the acronyms,
MUS – Medically Unexplained Symptoms
BPS – Biopsychosocial
IAPT – Improving Access to Psychological Therapies
This MUS cult is so dangerous. It’s flavour of the decade because, apart from being a whacky belief system, it is also an economic management model that has been built on the management model for ME/CFS. The BPS cabal have succeeded in depriving ME/CFS patients of care, proper investigation, research and the chance of effective treatment for far too long, and now they’re extending the same model to everyone else, and especially to those who have unexplained symptoms. (That’s just about everyone who goes to a GP before they get diagnosed.) What better way is there for governments, health services and insurance companies to save money than to tell people that their symptoms are due to psychological problems and deny them biomedical care on that basis from the outset?
The risks should be obvious (well you’d think). The differential diagnosis for IBS includes – inflammatory bowel disease (IBD), endometriosis, GI tract cancer, ischaemic colitis, giardiasis and coeliac disease. On the basis of a rushed 8 minute consult GPs are to send their patients off for telephone CBT / IAPT instead of referring them to secondary care. The UK already has a poor track record of diagnosing cancers at an early stage, with patients often having to go back to their GPs many times before the correct action is taken, so an additional delay for CBT could well be catastrophic. And IBD is often misdiagnosed as IBS. Speaking from recent experience, if gastroenterology consultants are incapable of diagnosing IBD from a patient’s history then what are the chances that GPs will get it right? This is shoddy science leading to dangerous medicine, and unfortunately this model is taking off across the globe.
What started out looking like a cruel vendetta against ME/CFS sufferers has morphed into an economic strategy with global reach. But this has been in the planning for a long time. It is not an underestimate to say that millions are now at risk.
spoonseekerdotcom 
Couldn’t agree more. The machinations tearing up the NHS are rather frightening to those who are in any part aware of what’s going on. Of course most healthy people outside the service will have no idea until they fall foul of these new systems which are designed to limit access to proper care and diagnosis. Anyone of any age or background is at risk …. only the few who live long , healthy, lives can avoid finding out the hard way, and of course having a ‘long and healthy life’ is one of things only measurable in hindsight. In other words, everyone should be very afraid at how the NHS has decided to deal with its creaking structure and inability to balance the books.
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It’s hard to believe that the practice of medicine itself would be manipulated and used as a tool to cut costs, but that is unfortunately where we’re at now.
I had an experience last summer that will stick in my memory. The attitude of hospital staff towards someone I was accompanying seemed to change dramatically with their perception of the situation. When the (young adult) attendee was clearly unable to walk and was struggling to stand up then staff behaved in an exemplary manner towards them – they appeared caring and sympathetic, rushing to help and locating a wheelchair in a hospital where such basic equipment seemed in very short supply. But on wheeling the patient into a different department about 10 metres away, the attitude of the staff was noticeably different. Here the patient, now marginally less compromised on account of the wheelchair, was treated as if they were catastrophizing their situation and I, as the wheelchair pusher, was their facilitator or accomplice in this. When they were struggling to get out of the wheelchair for an examination/investigation, I was told to get them to hurry up and move. When I slightly raised my voice in indignation, security appeared at the door. How can 10metres and a wheelchair make so much difference?
Whatever happened to real compassionate care? What happened to believing the patient and taking their symptoms and situation at face value rather than reading all sorts of pseudo-psychology into it? What exactly are they teaching medical staff about patient management these days? I shudder to think.
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50% of the people enrolled in the USA NIH comprehensive research trial had an undiagnosed rare disease. In the UK 100% of these people would be told that they have MUS and referred for telephone counselling. When did the UK’s medical system become that of a third world country for anyone with a disease that is not on the “common diseases list” ?
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Answer – in my opinion – When a group of questionable individuals came along (1970s and ’80s onwards) and joined up with economists (2003 onwards) to persuade Government that identifying patients as mentally ill was a very effective way to deny them medical care and reduce the NHS budget.
Then all it took was for supposedly good and intelligent people to do nothing – for doctors to take the easy option and go along with prejudging and blaming patients instead of standing up to the oppressive and unsafe regime being imposed upon them. Of course, there’s nothing particularly new in them blaming the patient, we all know they’ve been using derogatory terms to insult their patients (especially female ones) for a very long time. But with ‘MUS’ they’re now given free rein to discriminate as much or as little as they choose.
Stan, do you know how many of those 50% with previously undiagnosed rare diseases were women? I ask because the BPS lot in the UK seem to see no problem with one study yielding a 52% female predominance for MUS and another reporting 79%. To anyone with half a brain, that should ring very loud alarm bells.
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Wouldn’t it be possible for women living in one place to be way more stressed than men? So that would rise to a higher gender ratio than one from a study conducted where men’s and women’s stress levels were similar.
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Correction, I meant 57%, not 52% as the female predominance in the MUS study I mentioned above.
In answer to your question, Spoonseeker, both studies I mentioned were conducted in London, so I don’t think the big difference in the female MUS predominance (57% versus 79% women) can really be explained by women in one of the studies being way more stressed than men because of their location. The 57% female predominance figure came from a secondary care study (published in 2001) by Wessely and his colleagues. It involved two South East London general hospitals, and Wessely helpfully explained in another paper that he co-authored (see previous https://spoonseeker.com/2019/03/08/mus-international-womens-day/ article) why there might be an apparent (but not real) female predominance in MUS. The 79% figure was from a primary care study involving 6 GP practices – 2 in Inner North East London, 2 in South East London, and 2 in South West London. Wessely’s study was therefore slap bang in the middle of the larger area covered by the GP-based study.
So if the geographical area can’t explain this remarkable difference, what can? Some possible explanations:
1. GPs are generally more prejudiced against women than secondary care doctors are.
2. There was a gap of more than 10 years between the 2 studies. Perhaps over that time women in London became far more psychologically stressed than men and therefore suffered far more from MUS than they had done in the past. Or maybe at the turn of the millennium London men discovered a fantastic new way to chill out?
3. In the period between the studies, doctors were taught to expect women to have MUS more often than men and so diagnosed them with MUS more frequently – i.e. a self-fulfilling prophecy.
Who knows, but I’m inclined to believe Wessely on this one, and say that any apparent female predominance isn’t real, leaving us with 1 and 3 as the most plausible explanations.
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