For those of you who have been following anciendaze's blogs on Moral Hazards, or who have an interest in systems theory, most of the issues on biopsychosocial models can be explained by local rewarding of activity, but not rewarding based on global outcomes. There is risk of this problem in any very distributed research or delivery system, but most individuals involved are not culpable in the real sense, they are only doing what they are taught to do and rewarded for.
There is a way to present this, based on very simplistic argument, not at all dealing with the complexity of the real issue, but retaining the basic lesson.
For this argument, people are basically analogous to puppies. (By the way this argument can be applied to ME activism in a very unflattering way, but that is another story.)
When a research puppy (biopsychosocial or otherwise) presents a paper that shows a potential cheap solution to the problem, in this case the biopsychosocial approach to ME, they are thrown a doggy treat. Lets call the puppies who treat them this way their masters. When the researcher produces another paper, they are thrown a bunch of doggy treats. This continues as long as they perform good tricks. The researchers are so happy to get doggy treats (grants, awards, accolades) that they keep going. They reason that if they were doing anything wrong they would not get so many doggy treats.
Their masters on the other paw, have their own packs (insurance companies, government) they answer to. These masters reduce costs or risk based on how they have been handing out doggy treats. So in turn their packs give them their own doggy treats. This reinforces the worth of what they are doing, and ensures they keep passing out doggy treats to researchers who produce research they agree with. (I think this was once called zombie science, science by funding favourable outcomes rather than by funding rigorous results.) These masters are very happy with themselves because they have made sure their packs get more doggy treats.
The packs on the third paw (insurance shareholders, government et cetera) get doggy treats from their own members for being so cool that they don't have to waste resources on doggy treats. See, they say, we have more doggy treats because we are so cool.
Sick MEmbers of the pack who can't make their own doggy treats are being denied doggy treats in the interest of the good of the pack. The pack says they want to look after these MEmbers, but the pack is rewarded by looking after the pile of doggy treats, so they are reluctant to help. They bark a good bark, but they don't go walkies the way they should.
Meanwhile more and more pack MEmbers are getting sick, and chewing up more and more doggy treats. The pack tries to compensate by denying even more doggy treats. It is exceptionally rare that they use any doggy treats to reward those looking to cure the pack MEmbers, and so make them productive. Instead, they say they will give more doggy treats to those pack MEmbers who somehow get better. This appeals to the pack, but is very unpopular with the sick MEmbers. The numbers of sick MEmbers continues to grow.
So the number of doggy treats used up by all this grows and grows, but at each step the accounting methods say that doggy treats have been saved, and puppies who do this are rewarded with more doggy treats accordingly.
Doggy treats are of course cash, status, and praise, particularly cash.
Each step in the system is rewarded based on simplistic local measures. At no point is there an overall assessment of effectiveness across the system. I assert again that trying to treat growing disability issues by cost cutting is equivalent to borrowing more money to pay for things that don't work. It allows the books to be balanced but increases the long term debt. Only research into cures, and not just palliative treatments, has a long term benefit.
I hope George reads this blog.
The Doggy Treat Model of Why It Is So
Blog entry posted by alex3619, Aug 20, 2011.
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About the Author
I am a long term ME patient with many complications. While I have pushed research advocacy since 1993, I became political around 2009. My current project is a book called "Embracing Uncertainty". Uncertainty in medical science seems anathema to too many doctors. "I do not know" is something more doctors should be honest about.