Swiss Re insurance: advice re CFS/ME from Peter White: Diagnosis & Treatment

[Bob]

1. “If the policy refers to functional somatic syndromes in addition to mental health, then CFS may fall within the exclusion.If the policy doesn’t refer to functional somatic syndromes as well as mental health then it would be difficult to apply.”
2. “The point made is that a diagnosis of Myalgic Encephalomyelitis or ME (a term often used colloquially instead of CFS) is considered a neurological condition according to the arrangement of the International Classification of Diseases (ICD) diagnostic codes whereas CFS can alternatively be defined as neurasthenia which is in the mental health chapter of ICD10.”

Observations

• These 2 points appear to be inconsistent with the WHO ICD classifications.
• Point 1 seems to be inconsistent with point 2. In point 1 it states that CFS could not fall under the mental health exclusion but in point 2 it states it could be defined as neurasthenia (mental health).

...

Yes, it does seem contradictory, doesn't it. First they say that it would be 'difficult' to claim that CFS is a mental health condition, and then they say that "CFS can alternatively be defined as neurasthenia", which is categorised as mental health in ICD-10.

But, according to the ICD-10, CFS is not alternatively named as neurasthenia. 'Fatigue Syndrome' is listed under neurasthenia, but not CFS. In the index of the ICD-10, CFS links to ME.

And 'Postviral fatigue syndrome' (under which ME is categorised) is excluded from the 'neurasthenia' category in the ICD-10.

I'd like to see their justification for claiming that CFS is equivalent to neurasthenia. I wouldn't have thought that it would stand up in a court, if an insurance company refused payment by trying to claim that CFS is neurasthenia. Especially in the UK, where the NHS uses the name 'CFS/ME'.

It's interesting to see evidence of (small 'p') politics at play, and why names and categorisations make a big difference for financial vested interests.

 

[Valentijn]

I'd like to see their justification for claiming that CFS is equivalent to neurasthenia. I wouldn't have thought that it would stand up in a court, if an insurance company refused payment by trying to claim that CFS is neurasthenia. Especially in the UK, where the NHS uses the name 'CFS/ME'.

Wessely's done quite a few non-research essays comparing CFS to neurasthenia, and basically saying they're the same thing. Is he involved with the insurance industry?

 

[Bob]

Is he involved with the insurance industry?

He seems to claim that he has not worked for the insurance industry, apart for roughly a year at PRISMA in 1999, and I don't know if there is any evidence that he has received personal income from the insurance industry. But whether he is 'involved' in the insurance industry is another matter.

 

[biophile]

In the meantime, what can insurers and reinsurers do to assist the recovery and return to work of CFS claimants?

• Check that the diagnosis of CFS is correct. Misdiagnosis is not uncommon; one London CFS clinic reported that 50% of patients referred to them with a provisional or definite diagnosis of CFS, did not have CFS. If you have concerns, question the diagnosis and refer to an expert.

• It is likely that input will be required to change a claimant’s beliefs about his or her condition and the effectiveness of active rehabilitation. Funding for these CFS treatments is not expensive (in the UK, around £2,000) so insurers may well want to consider funding this for the right claimants. It may be important to establish that there are no significant obstacles to recovery before embarking on this approach.

• Check that private practitioners are delivering active rehabilitation therapies, such as those described in this article, as opposed to sick role adaptation. Don’t assume that the private provision of services is necessarily of any better quality than the public-funded health service.

Look at data on rates of return to work, and give up on CBT and GET?

Yes, it is quite ironic* that after speaking to the lead author of the PACE Trial about the results, the same trial which debunked the notion that CBT/GET made any significant difference to employment losses and insurance payouts, Swiss Re then proceeds in recommending CBT/GET "to assist the [...] return to work of CFS claimants".

* Not really, when considering the history of exaggerated and misleading claims in the promotion of CBT/GET.

To be fair, the following sentence suggests the article was written in 2012 or earlier, possibly before the relevant data was released in August 2012: "There will be more web-based training offerings from the Swiss Re team in 2012."

The article is still on their website however, so it reminds me of this recent humour article:
5 Outrageous Lies Companies Are Legally Allowed to Tell You
http://www.cracked.com/article_1948...ompanies-are-legally-allowed-to-tell-you.html

I wanted to add: "#6 Insurance companies allowed to mislead about the efficacy of CBT/GET", but then I saw:

"#2. Products Are Still Claiming Bullsh*t Health Benefits."

Meh, close enough.

 

[Valentijn]

Does anyone know when Peter White first worked for insurance companies? The earliest date I've found is 1999.

 

[Yogi]

Here is Peter White on video misleading other clinicians.

Thanks to maxwhd for this.

https://twitter.com/maxwhd/status/663694419359612929

 

[Glycon]

Awww!