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Vid of Wessely in a debate about alternative medicine and quackery.

Discussion in 'General ME/CFS News' started by Esther12, Sep 26, 2010.

  1. Esther12

    Esther12 Senior Member

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    In case anyone's interested (Simon's opposed to quackery this time):

    http://www.spike.com/video/alternative-medicine/3439367

    He talks about the importance of being honest with patients, yet to me it seems that the version of CBT he and Chalder promotes is rather sly and manipulative. Certainly that was my experience of it, and that training video we have of Chalder has her encouraging GPs to be evasive and avoid clarity of communication with patients.

    He talks about the importance of randomised control trials for working out the impact of treatments and says:

    "I know my treatments do harm... but do they do more harm than good? Is overall the benefit greater than the risk?"

    I've always been amused by the emphasis he places upon psycho-social factors in maintaining CFS combined with a disinterest in the way in which his work has affected the psycho-social settings for CFS patients. By focusing only upon patients directly in receipt of his treatments and in trials he isolates himself from the impact his work has indirectly on patients - and it is here that it does the most damage imo: legitimising the prejudices many have about CFS, even if he does not intend it to.

    I'd also be very interested to hear him say what damage he thinks his CFS treatments do: again, there seems to be a desire to spin them as positively as possible to patients in a way that rather undermines his professed commitment to treating patients honestly. If he was urgently fighting to have those who claimed that any CFS patient who followed a GET program would fully recover stripped of their medical license (and ideally pension) it would be easier to take him seriously - but this sort of thing doesn't seem to bother him, despite the evidence showing that it is not true.

    (Started rambling there... off to bed).
  2. guest

    guest Guest

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    The problem with children like Wessely is that they are way too stupid in order to understand complex science. It's much easier for them to make up their pseudo-scientific world and talk crap all day while real scientists have to work in the laboratory, have to educate themselves and base their results on science rather than ideology. Getting struck by CFS would be the only way for Wessely to understand what really is happening here. Unfortunately always the wrong people get ill.
  3. biophile

    biophile Places I'd rather be.

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    An ideological wolf in skeptical clothing?

    When talking about his treatments causing harm, Wessely seems to be talking about drugs rather than therapy, and justifies them because overall they result in more good than harm. It was his later statements which I found more interesting, when he discussed how Western medicine changes according to evidence rather than dogma, which is generally true but with some notable exceptions. He mentioned a few trials which demonstrated previous treatments used among the medical profession turned out to do more harm than good (ie killed patients), and stated "we thought it worked, it didn't, we changed".

    The political aspect of medical practice obscures the validity of more discrete and less lethal paradigms in the grey area between medicine and psychiatry (although psychiatry is also considered a field of medicine), areas which he appears to thrive in. Notions of functional psychosomatic illness were around long before Wessely came along, he is merely carrying on the tradition in refined modern terms with the cognitive behavioural model. Over the last century, biomedical science has frequently delivered humiliating smackdowns to psychosomatic ideologies regarding medically unexplained conditions, yet it is still the default attitude. So much for "we thought it worked, it didn't, we changed". ME/CFS inherited these notions as soon as it was considered to be "medically unexplained" and involving the mind.

    One wonders how Wessely will or has responded as the basis for and efficacy-safety of CBT/GET continue to be called into question. Fortunately for Wessely, it is difficult to control for the placebo effect and the impact that therapy-based wishful thinking has on subjective questionnaires. CFS is diagnosed subjectively but we know patients have deficits in objective measures of activity, which aren't improving even after CBT/GET despite reported improvements to subjective measures. So he can train a patient to perceive themselves as "better" who will subsequently record lower fatigue scores on subjective questionnaires, while in reality the patient is basically just as disabled as before. That's what seems to be happening here, so Esther12's question about deception is valid. Is the patient being deceived and is this deception OK if it supposedly helps the patient feel a bit better?

    I remember from somewhere that Wessely claims his approach is "pragmatic" (ie practical) so he would probably argue that the theoretical details don't really matter as long as patients were getting better or at least feeling better. Think of the infamous BMJ podcast quote about how even if he found XMRV he wouldn't do anything about it because he is in the business of rehabilitation? So much for Myra McClure's recent claim on TWIV that finding XMRV would have revolutionised how Wessely treated his patients! Wessely might find himself suddenly losing patients to antiretrovirals. Who needs to be “rehabilitated” if you can feel better from actual treatment and regain your life successfully on your own? He may discourage HGRV testing but I would be surprised if he actively deny his HGRV-positive patients access to ARV's as a part of overall treatment if they were proven to be effective and relatively safe.

    Another obviously pressing question is whether CBT/GET is actually doing more harm than good. All those patient surveys documenting the suffering caused by CBT/GET, he would probably dismiss these as misapplied therapy and/or non-scientific anecdotes and/or nocebo effect, in the same way the alleged success of alternative medicine is dismissed as anecdotes that have simply arisen from the placebo effect and various forms of cognitive bias which misinterpret the natural course of illness. Meanwhile he and his colleagues appear to think they are immune from such cognitive biases because they employ a few "scientific methods". Similarly, he would also argue that the published literature on CBT/GET shows no evidence of harm, just like he argues in the video that the published literature on an alternative medicine (I forgot which) for rheumatoid arthritis shows no evidence of efficacy. Keep in mind that systematic reviews on CBT/GET for CFS do note poor reporting of adverse effects.

    I'm not really a fan of alternative medicine. I don't think of Wessely as a charlatan or a fraud but I am unsure if he qualifies as a quack. Quackwatch.org states: "Quackery can be broadly defined as 'anything involving overpromotion in the field of health.' This definition would include questionable ideas as well as questionable products and services, regardless of the sincerity of their promoters." Common medical attitudes and practices towards ME/CFS may therefore qualify as quackery, particularly the "overpromotion" component, including many psychological and biological approaches alike. Regardless of his sincerity and intent, people like Wessely remind me of polished versions of their stereotyped opponents in alternative medicine but have learnt to adapt themselves to the prevailing accepted practice of the era and therefore appear more credible than most CAM proponents. In today's world this means constructing clinical trials to get the desired result of “evidence” for your hypothesis, which would be easier for the "soft" sciences where the standards are different and perhaps also the risk of bias going unnoticed. I don't mean outright scientific fraud but frankly I wouldn't be surprised if something questionable is going on in the psychosocial fanclub in a similar manner as drug trials conducted by pharmaceutical companies.

    What we need is someone "to go all James Randi on his ass", but many self-professed skeptics seem more interested in easy targets such as desperate patients using CAM for "subjective health complaints" than they are in bringing down someone like Professor Wessely who is on "their side" regarding alternative medicine and supports much of the same psychosomatic ideology that skeptics rely on to explain away the reported benefits of CAM. While rational skepticism is very useful and necessary, the double standards and hubris mean that I would be somewhat as embarrassed to call myself a "skeptic" as I would be admitting I am a "CFS patient", both labels are cringe-worthy to differing degrees.

    I think at the end of the day in the face of criticism, Wessely's main argument will be: clinical trials show that using CBT/GET to "manage" CFS does more good than harm, even if its only making the patient perceive themselves as feeling improved, which is better than nothing. Of course, views like Wessely's have contributed, perhaps inadvertently, to the fact that there is "nothing" else. I am reluctant to call Wessely an ivory tower academic, because he does work with patients, but Esther12 makes some good points. Wessely appears to be largely oblivious to the implications of his work and generally nonchalant towards the alleged misinterpretations and overstating of the evidence. Apart from the recent bizarre outburst about how “insulted” he was at the idea that his patients in the XMRV study were psychiatric patients, his main issue with other psychologisers appears to be that they don't accept CFS as a valid diagnosis or they believe it purely mental rather than psychosomatic (ie affecting both the mind and body in "functional" terms).

    In my experience many "mind over body" proponents, who may or may not be skeptics, are prone to justifying discrepancies in their claims in a similar way that some spiritual types (no pun intended) may rely on God or some esoteric element to justify logical uncertainties in their beliefs, exactly what alternative practitioners are accused of in the above video! The psyche-soma connection has been the medical equivalent of the "god of the gaps" in philosophy and is a constant issue in discussions about ME/CFS.
  4. Esther12

    Esther12 Senior Member

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    I agree with most of what you say biophile.

    That's true, but no doubt Wessely would warn you off slipping into dangerous dualism there! Both drugs and psychological interventions can be used to treat depression, and both serve to alter the patient's brain chemistry. Why would only drugs cause harm? Given how little we understand about the affects CBT/GET has upon patients surely it would be rather quacky to just presume that their are no side-affects to these treatments.

    I'm not keen on most philosophical conceptions of pragmatism, and I think the way CFS is treated serves ass a good illustration as to the dangers of this approach towards reality. I also think that those who endorse a limited form of pragmatism often end up going further, and in a more self0serving manner, than they really intend to.

    I really didn't know which side Wessely would be on. I know he's very anti-alternative medicine, but I thought he could end up taking a subtle position which argued for only a very limited definition of quackery, and gave alternative practitioners room to practice legitimately if only for pragmatic reasons. The lady who spoke before him used many of the arguments in defense of alternative medicine that you hear used to defend the psychological approach to CFS.

    It would have been nice if some of the people at the debate had been aware of Wessely's work.
  5. guest

    guest Guest

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    I didn't know it was called God of the Gaps but I agree to 100%. Perfect comment!
  6. Angela Kennedy

    Angela Kennedy *****

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    Thank you very much indeed Biophile for this very useful exposition.

    "God of the gaps". WOW that's interesting!
  7. HowToEscape?

    HowToEscape? Senior Member

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    Wessely does not believe aluminum sulphate in concentrations sufficient to kill fish and livestock is harmful to humans. He did not volunteer to test this himself while declaring that dumping 20 tons into the water supply of Camelford, UK was a non-event. Stupid? Not at all; he is smart about working the system and creating a rather nice perch for himself.
  8. Angela Kennedy

    Angela Kennedy *****

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    I think you've picked up on some key problems in Wessely's (and colleagues) approach here Esther.

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