The power and pitfalls of omics part 2: epigenomics, transcriptomics and ME/CFS
Simon McGrath concludes his blog about the remarkable Prof George Davey Smith's smart ideas for understanding diseases, which may soon be applied to ME/CFS.
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*Having read the full IoM report*, do you think it was written to help allow insurers avoid paying?

Discussion in 'Institute of Medicine (IOM) Government Contract' started by Dolphin, Feb 22, 2015.

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*Having read the full IoM report*, do you think it was written to help allow insurers avoid paying?

  1. I strongly believe it was written the way it was to help allow insurers avoid paying

    1 vote(s)
    3.1%
  2. I believe it was written the way it was to help allow insurers avoid paying

    1 vote(s)
    3.1%
  3. I don't know whether it was written the way it was to help allow insurers avoid paying

    1 vote(s)
    3.1%
  4. I do not believe it was written the way it was to help allow insurers avoid paying

    13 vote(s)
    40.6%
  5. I strongly do not believe it was written the way it was to help allow insurers avoid paying

    16 vote(s)
    50.0%
  1. Dolphin

    Dolphin Senior Member

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    I thought it might be useful to have a separate thread to look at this issue.

    I thought it could be useful to restrict the poll to people who have actually read the full report as people who have not read the full report are presumably relying on other people's opinions when they may not have come to the same conclusion if they had read the full report themselves.
     
  2. Dolphin

    Dolphin Senior Member

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    I have seen at least two people suggest the report was written to help enable insurers avoid paying.

    I do not find this at all convincing.

    The people who wrote the report included two patients and one parent of a severe patient as well as several ME/CFS experts. I am not at all convinced these people would spend a lot of time and effort to help design a document to help insurance companies.

    And I think if one wanted to help health and disability insurers, it would have been written differently, more denigrating the illness and the evidence and blaming the patient.

    Also, from insurers' point of view, I can't see why "systemic exertion intolerance disease" would be better than "chronic fatigue syndrome".
     
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  3. A.B.

    A.B. Senior Member

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    I don't believe it was because they wrote this on page 216:

    The tone and content of the IOM report also don't fit with this. I think that anyone who has actually read it will agree.

    One need only contrast the report with what Wessely has written over the years and they're almost polar opposites.
     
    Last edited: Feb 22, 2015
    SOC, beaker, Valentijn and 9 others like this.
  4. Bob

    Bob

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    In my opinion, the full report is the opposite of what you'd expect from something designed/influenced by the insurance lobby.
     
    Last edited: Feb 22, 2015
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  5. Sasha

    Sasha Fine, thank you

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    Pretty extraordinary idea, in my opinion.

    I think it's good to take the temperature of opinion with these single-issue polls.

    Good thinking, @Dolphin. :thumbsup:
     
  6. Wally

    Wally Senior Member

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    @Dolphin,
    I don't believe that the Report was "written" to help insurance companies avoid paying claims. In other words, I don't believe there was an "intention" of any member on the I.O.M. ME/CFS Committee to write a report that would help insurance companies avoid paying claims.

    However, I and I believe others in the ME/CFS community have concerns that if certain recommendations within the Report are implemented by the HHS that there is a possibility that it could impact payment of insurance claims in the U.S.

    Because insurance coverage and claim payment is a complicated (thorny) area for people to often fully understand, it is possible that some of these issues may not have been foreseen by the Committee when preparing the Final Draft of the Report. In the United States, insurance companies are regulated by individual states not by the Federal Government except for issues related to the Affordable Care Act, claims that fall within ERISA (Employees Retirement Security Income Act), or other specific carve outs. In the U.S., there is also insurance coverage available from private insurers and from the Federal Government through Medicare and Social Security. Many layers to this onion and not a simple task to wade through all the nuances.
     
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  7. Dolphin

    Dolphin Senior Member

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    I see the latter as a separate issue from what is being discussed in this thread.
     
    Valentijn, Kati and barbc56 like this.
  8. Nielk

    Nielk

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    No one can know the intentions of anyone. One can only look at the facts.

    Fact:

    The IOM report recommends that GPs diagnose and care for patients. Does that mean that insurance will not pay for appointment with specialist if they are diagnosed with SEID?

    Fact:

    They do not recommend any medical tests for SEID. Does that mean that insurers will not pay for blood tests that look for nk cell function, viral titers and others. The IOM report does not recommend sleep studies. Does that mean that insurers will not pay for those tests with a SEID diagnostic code?

    Fact:

    the IOM criteria does not exclude psychiatric conditions. Will long term disability insurers then deny long term coverage based on the fact that the patent with SEID diagnosis might be suffering from a psych condition?
     
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  9. Dolphin

    Dolphin Senior Member

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    One may not be able to be 100% accurate, but one can get impressions from how something is written. This is a long document and I believe one does get a feel for where it is coming from. Add this to our knowledge of the authors and one can make estimates. To me it seems like a wild conspiracy theory that this report was written to help insurance companies.
     
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  10. Nielk

    Nielk

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    Who made those statements. I have not seen them.
     
  11. Dolphin

    Dolphin Senior Member

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    I'm not sure how useful it is to mention specific people as that could personalise the discussion.
    However, given you yourself asked, you said something along those lines in this post:
    http://forums.phoenixrising.me/index.php?threads/iom-and-the-name-game.35696/#post-561060
     
  12. Nielk

    Nielk

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  13. Dolphin

    Dolphin Senior Member

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    You post was a reply to a post of mine about the report and the claim that the HHS had paid the IoM $1 million to get the name.
     
  14. Nielk

    Nielk

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    Yes. It was HHS' action in redefining ME/CFS into something different than ME.

    I stand by that statement.
     
  15. Dolphin

    Dolphin Senior Member

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    In
    http://thoughtsaboutme.com/2015/02/...-ltd-benefits-hello-diluted-research-cohorts/

    In a post called:
    IOM’s Redefinition of ME: Farewell LTD Benefits, Hello Diluted Research Cohorts

     
  16. Dolphin

    Dolphin Senior Member

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    The independent IoM panel wrote the report not the HHS.
     
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  17. Nielk

    Nielk

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    It is not up to the government to create or sponsor for setting criteria for disease.

    Have you read Osler's Web?
     
  18. lnester7

    lnester7 Seven

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    When it comes to written documentation, Stop thinking who wrote it, what was the intention is a simple matter of the words and how can they be interpreted. If a word is vague and there is room for misinterpretation. It will happen. PERIOD.

    Lawyers make a living every day on this. Is the nature of the beast, you cannot foresee every case in the future so one has to be vigilant.

    We have to point out the things that can hurt us later. It really does not matter if people intended for it to be that way. Just be vigilant of holes like this and patch them.
     
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  19. Dolphin

    Dolphin Senior Member

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    You may not find the discussion of interest. No one is forcing you to read it. I think it is worth discussing whether the report was deliberately written to help insurance companies or not. I think it is a wild conspiracy theory that makes us look bad. We sometimes have to make claims that authorities let us down/etc but we might not be taken seriously if we have already made claims that are incorrect.

    I also think the report and its authors are being unfairly maligned. I think people who haven't read the report aren't being given the full picture. I think and thought that most people who have read the full report wouldn't think it was written to help insurers and so the poll shows at the moment.
     
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  20. Nielk

    Nielk

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    Reality will speak for itself. If the IOM criteria will be adopted, we will see what the eventual insurance ramifications will be.
     

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