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Sounds like a new paper found BPS approach to whiplash to be of no value

Discussion in 'Other Health News and Research' started by Esther12, Dec 18, 2012.

  1. Esther12

    Esther12 Senior Member

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    http://www.bbc.co.uk/news/health-20756398

    Lancet paper: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61304-X/abstract

    Sorry for the post and run, but I'm just heading out somewhere.

    I'm quite interested in the whiplash stuff, and thought others might be interested in this too.

     
  2. Esther12

    Esther12 Senior Member

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    I've still not had a chance to look at this (something for another day), but it sounds like the guy writing the Lancet's editorial thinks that this failure of biopsychosocial management shows the importance of managing biopsychosocial aspects of whiplash:

    I think that the BPS stuff around whiplash is interesting, because it seems clear that fraud does play a role in whiplash claims, and the way in which they try to medicalise that is often amusing.

    It seems far less clear that whiplash cannot cause people long-term problems regardless of psychosocial factors... and the trouble is that if it's acknowledged that some people suffer problems that should receive compensation from insurance companies, and that there are not clear objective tests which allow these problems to be identified, then it becomes difficult to justly restrict those payouts in order to avoid allowing fraud. It's also fun to compare and contrast with BPS approaches to CFS.

    The editorial is behind a pay-wall here: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(12)61416-0/fulltext
     
  3. Esther12

    Esther12 Senior Member

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    This story was from last week:

    http://www.guardian.co.uk/money/2012/dec/11/government-plans-cut-whiplash-claims

     
  4. ukxmrv

    ukxmrv Senior Member

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    I think that this is an action by the Insurance industy and they are using all the tools at their disposal to limit claims for whiplash. Started to see the building for a few years now. The insurance company has had a huge campaign on whiplash.
     
  5. alex3619

    alex3619 Senior Member

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    Medical insurance industries have a conflict of interest. They are not beholden to people who buy policies except to the exact letter of the contract. They are answerable to shareholders, their board etc. They also have to obey the law. If there is a legal way for them to obviate paying more, then they actually have a duty to take it. Its a failing in the current system. Free market principles do not apply. So they have a duty, and its in their financial best interest, to promote findings, research and conclusions which mean they pay out less and so make more profit. This makes it hard for them to be moral instruments, though they can be ethical (by current ethical standards). Its also the basis behind zombie science, although that term applies equally to government administration conflicts.

    Services which are monopolistic in nature, or tend to be, and are essential for the wider public interest, need to be closely government regulated at the very least. Failure to do so is a failure of government, and alas this is all too common.

    Biopsychosocial is becoming a buzzword for costcutting. Its not moving much in the direction of improving results. Its becoming a means to save money. Evidence based medicine has similar conflicts. I hope to blog on this next year or the year after, I have loads more research to do.

    This is not, I emphasize, corporations or government necessarily doing the wrong thing. Its a case of the system promoting the wrong thing ... without appropriate checks and balances.

    I know someone who had a whiplash injury. Only one doctor noted thyroid damage, the rest either didn't or didn't care. Nothing wrong, go home. Then she got a thyroid storm, followed by Hashimotos thyroiditis, and coming out of that qualifies for fibromyalgia. She also has had several acute adrenal crises. There are lots of other cases. A lot of the research supporting the status quo simply reaffirms the obvious without looking into the things that don't fit.

    What is encouraging though is that at least some BPS claims are being tested.

    Bye, Alex
     
  6. Esther12

    Esther12 Senior Member

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    It's also interesting to watch insurance companies fund and promote research which argues that private insurance should play a greater role, and social insurance should be rolled back. The justifications for doing this seem really embarrassingly poor... but they've got capital on their side, so that doesn't seem to matter.
     
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  7. alex3619

    alex3619 Senior Member

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    Which they have a statutory obligation to do if they can. Its how the system works. There are supposed to be conterveiling checks and balances ... but where are they? The decline of the fourth estate (media) is a huge issue. Investigative journalism is critical to democracy, and becoming more so. Its also in decline.

    Private insurance promotes private insurance. The fact that over emphasis on private medical insurance is associated with massive cost blowouts in the US, and continued insurance premium rises, and mounting insurance company profits, needs to be independently investigated. Every investigation I am aware of, and its only a couple so far, shows that a single insurer system in teh US would result in an immediate 25% cut in costs to the public for the same services.

    Either public or private though, there is a tendency to use accounting principles to decide on services. Not science, not proven medical results, but prudent accounting. Evidence based medicine is becoming evidence based management, where the primary outcome of concern is cutting costs.
     

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