That's very interesting. Do you have any useable quotes from that source?
From around page 218 for a couple of pages, here:
http://books.google.co.uk/books?id=chwtWAt76JoC&pg=PA250&dq=shorter wessely aylward biopsychosocial&hl=en&sa=X&ei=wpvMT8KhA6f80QWHg6moAQ&redir_esc=y#v=onepage&q=money&f=false
I can't copy and paste! I didn't re-read it all, but it looks like it says pretty much what I remembered. They also mention the importance of systematic reviews, and as we know, they can easily be skewed one way or the other. This could explain why so many seemingly pointless ones get pumped out.
Hi Esther12, I am not sure its this clear cut. Like the ideological divide between right and left wings of politics, I think there is a divide in medical attitudes. I suspect that many of these people do indeed think they are doing the right thing - but because they are ideologically and not factually driven they are dangerously unaware of the consequences.
I didn't mean to say it was clear cut, and agree that many of the proponents of BPS probably thought that they were doing a good thing which would help patients. I just think that lots of people doing bad things are motivated by a desire to do good.
I think the idea of BPS is fine. I think the implementation of that idea, current practice, is dangerously flawed. The driving force seems to be fear. Medical and political thinking based on fear (and its cousin hatred) underlies many of the worst periods in history.
How is this about fear? In politics its about fear of the rising social costs. Add rising resource costs that are expected and the economies of these countries are going to be heavily burdoned. In the case of the psychiatrists its fear that those who practice psychosomatic medicine are a dying breed. They are losing relevance. This is their attempt at a comeback. They are failing, and one day this will be seen for what it is.
I see what you're saying, but when the idea itself is so tied up to pragmatism and claims about results, I think that it's hard to say it's a good idea implemented poorly. I also do not see any way that it could be implemented well within our current social structures, or without some dramatic improvement in our ability to train and regulate our medical staff. A BPS approach seems doomed to fail, and doomed to continue to fail for the foreseeable future.
I know what you mean about some of the things said as part of the BPS approach to disability sounding good in an abstract kind-of way, but one can say that communism is a good idea in principle, or some other benevolent form of authoritarianism... but they're only good ideas if we assume that people in positions of power and authority are less self-interested, prejudiced and stupid than they really are. In reality, they're bad ideas... and that's where ideas should be judged imo.
Edit: I wasn't able to get it all, but this is part of the section from Peter White's BPS book OB asked about:
from page 218 of Biopsychosocial Medicine: An Integrated Approach to Understanding Illness, edited by Peter White.
Wessely: Mansel Aylward, you are involved with policy definitions. What have you heard here that might influence your secretary of state?
Aylward: I have been given a lot of information that reinforces some of the messages that I have passed on to decision makers. I haven't heard anything startlingly new, but I am happy to have my views confirmed. We have made some significant progress. We had some great difficulty last year persuading certain people that the way forward in the more effective assessment of disability and its management in people on state benefits lay more with a BPS approach to rehabilitation, job retention and recovery, than a focus on economic disincentives or wielding the stick approach. There seems to be an antipathy in some part of Government towards anything that is perceived as fuzzy or nebulous, without a hard evidence base. If the BPS approach is perceived in this way and is competing for investment with hard policies focusing on bed occupancy and delivery of acute services, it is very difficult to get the Department of Health, among others in Government, to favour health-focused interventions and rehabilitation adopting the BPS approach. But in recent month I'm beginning to see a change. The Department for Work and Pensions may now have been persuaded to invest in initiating pilot studies in various areas of the country, in particular involving benefit recipients with back pain and fatigue, to see if all the talk about the BPS approach has any basis in improving outcomes.
Wessely: What made some of the policy makers change their views?
Aylward: Systematic reviews of the literature garnering evidence to support the BPS concept. Identifications of best practices in using BPS approaches that improve function and rates of return to work, particularly in people with disability caused by back pain. Recent meeting in the form of focus groups of key oppinions makers support with authorative and expert opinion the value of BPS approaches. There are going to be some developments soon.
Wessely: What kind of evidence caused change?
Aylward: The evidence which has been there all along. The key aspect has been effectively communicating the evidence in a far more robust and authoritative way. We also ran a series of workshops where we discussed and evaluated various approaches to facilitate return to work and to address the rising numbers of people in receipt of incapacity benefits. Some £25 billion per year is being spent on state benefits resting either directly or indirectly on a medical basis. The prospect of effective interventions that might reduce that expenditure are powerful catalysts for change.
Waddell: To take this a stage further, I am not sure that evidence is what convinces people. We do need an evidence base, but it is ideas that really influence people. People go to war for ideas, not for evidence. When you look at changing practice, it is really about ideas rather than evidence. My hesitation about what was said earlier is that everything seem to show the the behaviour of health professionals is difficult to change. But there are some suggestions from the Australian education campaign, Kate Lorig's work, and our work in Scotland, that it may actually be easier to change patients and the public and they will then force the professionals to change. The information from Australia has helped tremendously [1,2]. Some decision makers were very jaundiced, but this has played a role in convincing them that there is something in that and that it will save money. It's all about money. The main thing was to persuade the treasury that there was an opportunity for keeping costs down, particularly over the longer term.
Drossman: One of the efforts in the USA that has had some influence on Congress is the burden of illness study carried out be the American Gastroenterology Assocations. They identified the costs in terms of direct and indirect costs. Direct costs refer to the costs related to the healthcare, such as medication and physician visits and indirect costs are other way in which the illness impacts on the economy, for example, loss of work productivity or wages due to illness. Using irritable bowel syndrome (IBS) as an example the prevalence is 15 million in the USA. When you multiply this by the number of dollars spent in terms of physician visits and prescriptions, it exceeds the cost burden of inflammatory bowel disease (IBD). Thus the higher prevalence (about 100 times great) for IBS offsets the high cost per patient of IBD, yielding greater cost to society. The cost to the economy is about US$2 billion of direct and US$20 billion of indirect costs. This had some inflence on Congress. It is not proving that you can treat it that matters but proving that the economic burden is there and that effort must be placed on finding better treatments.
Wessely: I once tried to add up the cost burden of a range of conditions and it comes to more than the gross national product of the entire western world!
Lorig: Particularly for morbidity.
Lewin: One of the other things that Greville Mitchell is helping us do through One Health is an analysis that will look at the lost opportunity costs from not using cognitive behavioural therapy (CBT) approaches. We are doing this in collaboration with Jos Kleijnen. This is a complicated procedure because we haven't even got an agreed definition of CBT. We'd be delighted to have any suggestions for how we might do this.
Wessely: Can I clarify? Is Jos also doing a review of more direct psychosocial interventions in this area?
Lewin: Yes. The study is looking at the possible costs savings. What would the Government gain if they were to spend more on these areas?
Mitchell: People are pretty limited in viewing government future budgets. They will escalate: That is a fact of life. Therefore, if you are going to add to this bill you won't catch the government's attention, even if you