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Swiss Re insurance: advice re CFS/ME from Peter White: Diagnosis & Treatment

Bob

Senior Member
Messages
16,455
Location
England (south coast)
Swiss Re
Managing claims for chronic fatigue the active way
http://www.swissre.com/clients/newsletters/Managing_claims_for_chronic_fatigue_the_active_way.html

Interesting & revealing extract:

"A final point specific to claims assessment, and a question we’re often asked, is whether CFS would fall within a mental health exclusion, if one applies to a policy. The answer to this lies within the precise exclusion wording. If the policy refers to functional somatic syndromes in addition to mental health, then CFS may fall within the exclusion. If the policy doesn’t refer to functional somatic syndromes as well as mental health then it would be difficult to apply. The point made is that a diagnosis of Myalgic Encephalomyelitis or ME (a term often used colloquially instead of CFS) is considered a neurological condition according to the arrangement of the International Classification of Diseases (ICD) diagnostic codes whereas CFS can alternatively be defined as neurasthenia which is in the mental health chapter of ICD10."
 

Bob

Senior Member
Messages
16,455
Location
England (south coast)
I've copied the web page for future reference, and attached it as a PDF file to this post.
(I've attached two PDF files which both include the same info, but with slightly different formatting.)
 

Attachments

  • www_swissre_com-clients-newsletters-Managing_claims_for_chronic_fatigue_the_acti.pdf
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  • swissre.com-Managing_claims_for_chronic_fatigue_the_active_way.pdf
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user9876

Senior Member
Messages
4,556
Results for those in the group that received “pacing” with SMC were no different than for those receiving SMC alone, which surprised the research team.
Weren't they surprised by the lack of performance of CBT and GET. I thought the original protocol suggested they thought they would get much better results.

It is thought that behavioural activation helps to treat the illness itself, whereas “pacing” (staying within limits imposed by the illness) only results in adaptation to the illness

I suspect that they are being told by white that CBT and GET are cures.

The key message is that pushing the limits in a therapeutic setting using well described treatment modalities is more effective in alleviating fatigue and dysfunction than staying within the limits imposed by the illness traditionally advocated by “pacing”.

The pushing the limits statement is very worrying isn't it pushing people too far that causes serious relapses with CBT and GET.
 
Messages
13,774
Looks like they're already conflating Adaptive Pacing Therapy, with it's '70% rule', with 'pacing' as a response to illness:

  • CBT addresses unhelpful thoughts and behaviours in relation to a fear or avoidance of engaging in activity and symptoms by collaborating with a therapist in a series of experiments with increasing physical and mental demands.
  • GET engages people in a therapeutic programme to incrementally increase their participation in physical activity so as to reverse physiological deconditioning and exercise intolerance that has occurred as a result of avoiding activity.
  • Pacing advocates that people adapt to the illness, by planning and pacing activity with rest so as to avoid exacerbations and restrict participation in activity to well within their energy limitations.
  • SMC consisted of an explanation of CFS, generic advice such as avoiding extremes of activity and rest, advice on self-help, and medication directed at specific symptoms. Given that this was care offered to patients in secondary medical care, it does not equate with the usual care and advice provided by family doctors.

No mention of the fact that CBT and GET were not found to lead to an increase in employment rates, or a decline in insurance payouts.

If a CFS patient does not gradually increase their activity, supported by an appropriate therapist, then their recovery will be slower.

lol at this. Any evidence that CBT or GET allowed patients to increase their activity levels over any sustained period of time? The only evidence we have on this is the CBT trials which showed that CBT led to no increase in activity levels. Also - their inevitable recovery will be slower? What an odious quack.


In the meantime, what can insurers and reinsurers do to assist the recovery and return to work of CFS claimants?

Look at data on rates of return to work, and give up on CBT and GET?

Or...

It is likely that input will be required to change a claimant’s beliefs about his or her condition and the effectiveness of active rehabilitation. Funding for these CFS treatments is not expensive (in the UK, around £2,000) so insurers may well want to consider funding this for the right claimants. It may be important to establish that there are no significant obstacles to recovery before embarking on this approach.

Check that private practitioners are delivering active rehabilitation therapies, such as those described in this article, as opposed to sick role adaptation. Don’t assume that the private provision of services is necessarily of any better quality than the public-funded health service.
Someone needs to have their beliefs challenged.

What utter scum. Thanks for this feeling of burning hatred Bob, it would be a shame to have missed out on some more Peter White entertainment.
 

Firestormm

Senior Member
Messages
5,055
Location
Cornwall England
I posted this on another thread and concluded it must have originated at around the time of the publication, say 2011/12 also Esther12. Worth it's own thread though. Not sure how this thinking stretches across the industry - White does express a conflict of interest if I recall correctly about being an insurance advisor. Be interested to hear from Graham when he has had his chat. I think Invest in ME flagged this up again the other day - presumably in response to the published letters we were discussing.
 

Sean

Senior Member
Messages
7,378
Weren't they surprised by the lack of performance of CBT and GET. I thought the original protocol suggested they thought they would get much better results.

Their amazingly wrong predictions of the outcomes is one of the most telling points of all in The Great PACE Debacle. They were not just a bit wrong, they were waaaaaaay off the mark.

I suspect that they are being told by white that CBT and GET are cures.

If White is proven to have made that claim on the record, in any formal capacity, then he is in serious trouble. That would be evidence enough to go for his scientific and professional throat.

The pushing the limits statement is very worrying isn't it pushing people too far that causes serious relapses with CBT and GET.

Another claim that could be serious trouble for whomever tries to make it.
 

MeSci

ME/CFS since 1995; activity level 6?
Messages
8,231
Location
Cornwall, UK
Swiss Re
Managing claims for chronic fatigue the active way
http://www.swissre.com/clients/newsletters/Managing_claims_for_chronic_fatigue_the_active_way.html

Interesting & revealing extract:

"A final point specific to claims assessment, and a question we’re often asked, is whether CFS would fall within a mental health exclusion, if one applies to a policy. The answer to this lies within the precise exclusion wording. If the policy refers to functional somatic syndromes in addition to mental health, then CFS may fall within the exclusion. If the policy doesn’t refer to functional somatic syndromes as well as mental health then it would be difficult to apply. The point made is that a diagnosis of Myalgic Encephalomyelitis or ME (a term often used colloquially instead of CFS) is considered a neurological condition according to the arrangement of the International Classification of Diseases (ICD) diagnostic codes whereas CFS can alternatively be defined as neurasthenia which is in the mental health chapter of ICD10."

There is a kind of collective insanity going on - can you have orchestrated insanity? If so, this is it. Or institutionalised insanity, systemic insanity...?

I know that governments think in the short term - to be more specific - the likely length of their own terms before the blame for the consequences can be passed on to another party, but clearly giving the wrong treatment to people is not cost-effective in anything but the VERY short term.

I'm trying to work out what is happening but can't quite figure out who are the chickens and who are the eggs.

  • Governments want to save money on benefits (at least during the time that they could be blamed for any overspend).
  • Governments task agencies, etc., with reducing benefit costs.
  • Agencies, etc., hire people with the perceived ability to provide 'expert' backing for ways to reduce benefit costs.
  • Those 'experts', eager to earn more status and money, fall over each other to twist science to suit the client's purposes.
And at some point one of them gets a knighthood...

:aghhh:

Can someone beam me up to a sane planet, please? This one is doing my head in. :alien:
 

MeSci

ME/CFS since 1995; activity level 6?
Messages
8,231
Location
Cornwall, UK
Their amazingly wrong predictions of the outcomes is one of the most telling points of all in The Great PACE Debacle. They were not just a bit wrong, they were waaaaaaay off the mark.

If White is proven to have made that claim on the record, in any formal capacity, then he is in serious trouble. That would be evidence enough to go for his scientific and professional throat.

Another claim that could be serious trouble for whomever tries to make it.

I so hope you are right. But so often, people with power get away with murder. And that word 'murder' is not necessarily inappropriate. It's serial homicide/culpable manslaughter and GBH at the very least.
 

alex3619

Senior Member
Messages
13,810
Location
Logan, Queensland, Australia
Badly failed predictions is stock in trade for psychobabble. Yet they have never stopped. Its an insular crowd, peer reviewing their own papers, read by mostly people who are believers, and not answerable to the "rest" of the scientific community in practice. I have never counted how many times they have been debunked, but I read about it a lot. Start with the long long long list of diseases now considered physical that they claimed as psychological.

The wider medical community needs to step in and not leave them be, and the scientific community beyond that, and the academic community, and finally the rest of the people. Enough is enough.

I do think there is widespread institutionalized rationalization, where evidence (of often dubious quality) is assembled to support political, economic, or other agendas and ideologies. BPS fits right in with that. Its called Zombie Science for a reason, but the same thing happens in the business world with economic theory.
 

Firestormm

Senior Member
Messages
5,055
Location
Cornwall England
alex3619 :nerd: :lol: Out of interest, how many of those now 'physical diseases' simply did not have enough known about them at the time? I mean how much is it a process of a discipline thinking it can help before or until another discipline determines an actual cause and/or better treatment? :ninja: :snigger:
 

alex3619

Senior Member
Messages
13,810
Location
Logan, Queensland, Australia
Hi Firestormm , every single one I know of did not have enough known about them at the time, though even after things were learnt there was huge resistance in at least some cases (eg. peptic ulcers). In many cases the technology did not even exist to learn anything, not for decades. Charcot rightly pointed this out in (I think) the 1860s. Hysteria, in his early writings, was due to brain damage that could not yet be identified as the technology did not exist. Now we recognize most of his cases of "hysteria" as epilepsy. Technology changes what can be found. So do the research questions being asked. If you look for the wrong things don't be surprised if you find nothing useful.

I would have less of a problem with babble if in practice they considered the hypotheses tentative and unproven, and did not claim medical privilege in testimony by over-claiming certainty in legal cases or when someone is sectioned, or when writing advice for government policy.

Alex.
 

Sean

Senior Member
Messages
7,378
The wider medical community needs to step in and not leave them be, and the scientific community beyond that, and the academic community, and finally the rest of the people. Enough is enough.

There is a clear and compelling – and increasingly urgent – case for the broad scientific community to demand that psych 'science' submit to a comprehensive external review of its basic methods and claims by a panel of internationally renowned, top level scientists from a range of disciplines.

If psych are going to claim to be science based, then the rest of science have a right, and a responsibility, to require them to actually be so, and not take their name in vain.

I would love to see a really sharp physicist put them under the intellectual blow torch, in full public view. It would be a bloodbath. :)
 

MeSci

ME/CFS since 1995; activity level 6?
Messages
8,231
Location
Cornwall, UK
There is a clear and compelling – and increasingly urgent – case for the broad scientific community to demand that psych 'science' submit to a comprehensive external review of its basic methods and claims by a panel of internationally renowned, top level scientists from a range of disciplines.

If psych are going to claim to be science based, then the rest of science have a right, and a responsibility, to require them to actually be so, and not take their name in vain.

I would love to see a really sharp physicist put them under the intellectual blow torch, in full public view. It would be a bloodbath. :)

I would pay for tickets to see this!:)
 

alex3619

Senior Member
Messages
13,810
Location
Logan, Queensland, Australia
There is a clear and compelling – and increasingly urgent – case for the broad scientific community to demand that psych 'science' submit to a comprehensive external review of its basic methods and claims by a panel of internationally renowned, top level scientists from a range of disciplines.

If psych are going to claim to be science based, then the rest of science have a right, and a responsibility, to require them to actually be so, and not take their name in vain.

I would love to see a really sharp physicist put them under the intellectual blow torch, in full public view. It would be a bloodbath. :)

I clicked like but it doesn't seem strong enough .. we need a super-like button! Scientists do indeed need to get involved, and claims to evidence based medicine need to be thoroughly scrutinized. A claim is not enough.
 

biophile

Places I'd rather be.
Messages
8,977
It will likely take time before the general public and some medical professionals accept the findings of this research given that on average it takes seventeen years for research findings to influence clinical practice (Agency for Healthcare Research and Quality, 2011).

Until now I never realized that there was a benefit to such a delay. It is 2013, and when CFS patients go to doctors today it certainly does feel like 1996 or even 1986. I imagine that by 2030 it will be widely accepted that the PACE Trial was basically a white elephant, to put it politely. Let us pray that in 2030 general practitioners and specialists alike are not enthusiastically embracing the results of the PACE Trial as if it is a common gold standard in medical care for CFS.

However, the NHS "specialist" CFS/ME" centers already largely embrace CBT and GET, based on older research. I hope that in 17 years time, the main progress is more than merely updating the protocols used to deliver it.
 

Firestormm

Senior Member
Messages
5,055
Location
Cornwall England
Until now I never realized that there was a benefit to such a delay. It is 2013, and when CFS patients go to doctors today it certainly does feel like 1996 or even 1986. I imagine that by 2030 it will be widely accepted that the PACE Trial was basically a white elephant, to put it politely. Let us pray that in 2030 general practitioners and specialists alike are not enthusiastically embracing the results of the PACE Trial as if it is a common gold standard in medical care for CFS.

However, the NHS "specialist" CFS/ME" centers already largely embrace CBT and GET, based on older research. I hope that in 17 years time, the main progress is more than merely updating the protocols used to deliver it.

I hope that a treatment comes along that treats the underlying disease in some, most or many of us, Bio. Only then - perhaps - will you see a reduction in the onslaught of management approaches. But some will still need help to manage their condition - unless the underlying disease can be identified quickly and treatment of it results in sustained remission.
 

Yogi

Senior Member
Messages
1,132
Interesting & revealing extract:

"A final point specific to claims assessment, and a question we’re often asked, is whether CFS would fall within a mental health exclusion, if one applies to a policy. The answer to this lies within the precise exclusion wording. If the policy refers to functional somatic syndromes in addition to mental health, then CFS may fall within the exclusion. If the policy doesn’t refer to functional somatic syndromes as well as mental health then it would be difficult to apply. The point made is that a diagnosis of Myalgic Encephalomyelitis or ME (a term often used colloquially instead of CFS) is considered a neurological condition according to the arrangement of the International Classification of Diseases (ICD) diagnostic codes whereas CFS can alternatively be defined as neurasthenia which is in the mental health chapter of ICD10."


Good find Bob!

This is completely wrong and should be challenged. These false statements I believe have been challenged by Professor Hooper and the Countess of Mar on numerous occasions.
Have these statements not been shown to be wrong before and why is Peter white still wrongly able to provide such false statements such as these?


  1. If the policy refers to functional somatic syndromes in addition to mental health, then CFS may fall within the exclusion.If the policy doesn’t refer to functional somatic syndromes as well as mental health then it would be difficult to apply.”
  2. The point made is that a diagnosis of Myalgic Encephalomyelitis or ME (a term often used colloquially instead of CFS) is considered a neurological condition according to the arrangement of the International Classification of Diseases (ICD) diagnostic codes whereas CFS can alternatively be defined as neurasthenia which is in the mental health chapter of ICD10.”

Observations
  • These 2 points appear to be inconsistent with the WHO ICD classifications.
  • Point 1 seems to be inconsistent with point 2. In point 1 it states that CFS could not fall under the mental health exclusion but in point 2 it states it could be defined as neurasthenia (mental health).
  • CFS and ME are not just considered neurological by the WHO's ICD but by the UK government Department of Health and Ministers of Parliament.
  • I believe the 2 points regarding classifying CFS as functional somatic syndromes and (somatisation) and neurasthenia have been challenged successfully before by the wonderful Countess of Mar and could undoubtedly be able to be challenged again.
  • However Swiss Re may be difficult to challenge as they are a reinsurer and the person with ME would have a contract the insurer rather than the reinsurer. It appears that Peter White is intentionally giving wrong facts to Swiss Re and they would in turn provide these wrong facts to the insurer


Would love to hear what other forum members make of these 2 points above and the observations.