PACE als voorbeeld van
met het (bio)psychosociale model
In een uitgebreide analyse beschrijft George Faulkner hoe het (bio)psychosociale model
gebruikt wordt als rechtvaardiging voor "politieke hervormingen" (lees: besparingen) en
de invoering van "de omgekeerde bewijslast": patiŽnten kunnen beter worden, maar moeten wel willen.
Het boekwerkje gaat in op de claims die op basis van de PACE trial-studies gemaakt werden.
Aan de hand van een gedegen analyse van de cijfers en definities in studies en andere documenten
toont Faulkner aan dat er van de claims van de auteurs weinig tot niets overblijft.
de PACE-trial uitkomsten laten zien dat CGT en GET niet effectief zijn en mogelijk zelfs schadelijk.
Voor de PACE trial-analyse van Faulkner, klik op onderstaande afbeelding:
Misleading medical research underpins disability cuts
A new report from the Centre for Welfare Reform explains
how a current scientific controversy relates to
the debate surrounding welfare reform and cuts to disability benefits.
The 'biopsychosocial' model of disability
has played an important role in shaping recent reforms to disability benefits,
yet important claims about the value of biopsychosocial approaches
have been founded upon evidence
which was always potentially misleading, and
can be shown to have been exaggerated and
distorted in ways that
further misrepresent the reality of living with ill health and disability.
The biopsychosocial model has been used
to create new obligations for those suffering from common health problems,
the responsibility to "recognize that the sick role is temporary, in the expectation of recovery."
However it is not clear that these new obligations are reasonable.
There is a danger that the belief
that it is acceptable to encourage 'positive' views of
ill health, disability and the efficacy of treatments
have affected the design and reporting of medical research,
encouraging unreasonable expectations of recovery.
A large and expensive assessment of biopsychosocial interventions, PACE,
the only such trial to have received funding from the Department of Work and Pensions (DWP),
provides a clear example of the problems
which can affect academic research and
distort our understanding of important issues.
This report explains
how problems with the design of this trial, and
the presentation of its results,
led to seriously misleading claims about patients' recovery rates.
In a Lancet commentary, reviewed and approved by the trial's researchers,
patients were classed as having fulfilled a "strict criterion for recovery"
even though the criterion used was in fact so loose
that patients could have reported a worsening of all their symptoms and
yet still have been classed as recovered.
Despite the problems identified with the presentation of results
the trial's team continue to fight against
releasing important data from this publicly funded research,
with pre-specified primary outcomes remaining unreported.
There have even been attempts
to portray Freedom of Information requests about this trial
as a form of harassment and
stigmatise patients' concerns
about the way in which
the efficacy of potential treatments are being misrepresented to them.
With growing numbers of the international scientific community
speaking out about the problems surrounding this trial,
the Information Commissioner ruled that
data which could correct many of the misleading claims made about the trial's results
should be released.
The trial's researchers and their institutions are appealing against this ruling, and
an information tribunal is now due to take place on 20-22 April.
Dubious claims of biopsychosocial expertise
have been used to serve the interests of influential institutions and individuals
in government, medical research and the insurance industry,
where concerns about money and reputation
will inevitably compete with concerns about public health and patients' rights.
While there is a growing popular awareness of
the problems with nonblinded or poorly controlled trials
being used to make unjustified claims about the value of alternative medicine,
there is also a widespread failure to acknowledge that
more mainstream rehabilitative approaches
can be built upon a similarly poor evidence base.
Greater honesty about this is needed,
especially as attempts to cut welfare spending lead politicians
to turn to rehabilitation as a key part of their policies on disability, and
as something which may become compulsory for those claiming disability benefits.
This report, written by George Faulkner,
shows the need for more critical engagement with biopsychosocial medical research.
There is a danger that
the lives of millions of people have been damaged
by judgments based upon inaccurate and misleading claims,
shifting power away from those suffering with ill health and disability
by presenting policies which reduce their options and income
as benevolent and empowering interventions.
There are several published articles already
which draw attention to the serious flaws in this research.
Dr Simon Duffy, Director of the Centre for Welfare Reform said:
Misleading medical research is particularly dangerous
when politicians are looking to blame social problems on minority groups,
as they have with disabled people.
While it is encouraging that
some of the academic community is beginning to challenge this problem,
it is sad that so many continue to fight to protect their own interests, and
we are particularly grateful to George Faulkner for carrying out this important research.
The report is available to read online and download as a pdf here:
Onder dankzegging aan Manja.