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

[Esther12]

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.

Intensive whiplash treatment is no better than standard care, a study suggests.
The study, in the Lancet looked at the treatment of more than 2,700 people with mild to moderate whiplash.
No additional benefits were seen in those who had more intensive care - which included suggesting a rapid return to normal activities.
A Canadian expert said the study showed the lack of benefit from "unnecessary treatments".
Whiplash injuries cost the UK economy about £3.1bn a year, mainly due to the expense of treating those with chronic symptoms (between 30-50%) and their subsequent need to take time off work.
Long-term problems can include pain from even the smallest movement, difficulty sleeping and even being unable to work.
Compensation claims for whiplash injury have risen, with about 1,500 made every day in the UK, even though there has been a fall of about 20% in road accidents since 2006.
Earlier this year, the government promised to take action to reduce the number of claims.
Positive messages
There has been debate since the 1980s about how best to deal with whiplash injury, but little research to support any specific approach.
Some researchers have suggested that training A&E staff to provide more intensive treatment - with more positive messages about recovery and specific advice on beneficial exercises as well as advising an early return to work and normal activities - could help people recover more quickly.

 

[Esther12]

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:

Writing in the Lancet, Robert Ferrari, from the University of Alberta in Canada, said: "The challenge now is to change societal expectations about whiplash injury.
"Legislative changes could reduce the extent to which expectations can be met - less contact with lawyers, insurers, and the treatment industry could reduce the encouragement of these expectations and the behaviour that follows.
"Not prescribing unnecessary treatment might also help to change beliefs about the nature of the injury, and thus studies like that of Lamb and colleagues are needed.
"At the very least, to reduce health-care costs, Lamb and colleagues have shown that the emergency departments are providing evidence-based and cost-effective treatment when they do less, not more."

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

 

[Esther12]

This story was from last week:

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

Government plans to cut whiplash injury claims

Justice secretary Chris Grayling set to launch consultation on creating independent medical panels to improve diagnosis
The government will unveil plans to reduce the huge number of whiplash claims which have been pushing up insurance premiums.
Justice secretary, Chris Grayling, will on Tuesday launch a consultation on creating new independent medical panels to improve diagnosis of whiplash injuries.
This aims to ensure that genuine claims can still go ahead, but exaggerated, misrepresented or fraudulent claims are robustly challenged.
It will also consult on options to allow more whiplash cases to be challenged in the small claims court and to change the current position where it can be cheaper for insurance companies to accept questionable claims than to contest them.
"For too long honest drivers have been bearing the price of a system that has been open to abuse and it is time for that to change," Grayling said.
"We are proposing action to support effective whiplash diagnosis by medical experts and to simplify procedures which will help bring speculative or fraudulent claims before a judge – so genuine claims can still be settled but fraudsters are left in no doubt there will be no more easy paydays."
The government said it has taken action after figures showed there had been a 60% rise in personal injury claims related to road accidents since 2006, despite vehicles becoming safer and a 20% reduction in the number of reported accidents over the same period.
It estimated that whiplash claims cost £2bn in 2010 or £90 for each policy.
This is the latest stage of a series of significant civil justice reforms by the government, designed to reduce legal costs and stop the growth of compensation culture in England and Wales.
Tuesday's consultation complements law changes which will come into effect in April 2013.
They will include rebalancing no-win no-fee deals so losing defendants will no longer have to pay a success fee or legal insurance premium to the claimant's lawyer.
It will also include banning "referral fees" where companies can profit from selling on someone's personal injury claim and stopping claims management companies from offering money or goods as an inducement to make a claim through them.
The insurance industry has committed to passing on savings to consumers made from the reforms to civil litigation costs, the government said.
James Dalton, head of motor and liability at the Association of British Insurers, said: "We are pleased that the government recognises that tough action is needed to protect honest motorists from the UK's whiplash epidemic. For too long, whiplash has been seen as the "fraud of choice".
"Our roads are safer, yet every day over 1,500 whiplash claims are made. These claims add an extra £90 a year to the average motor insurance premium.
"More effective diagnosis of whiplash will help genuine claimants get paid out quickly and reduce the scope for fraud, so helping to ensure that honest motorists do not end up footing the bill for the cheats through higher insurance premiums."

 

[ukxmrv]

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.

 

[alex3619]

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

 

[Esther12]

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.

 

[alex3619]

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.

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.