Peter White gets set to speak at Swiss Re Insurance Medicine Summit 2017

[Valentijn]

From memory, POTS is defined as marked increase in heart rate when the patient stands up. How are they going to psychologize something like that?

It's already been happening for a while, on the HADS depression and anxiety questionnaire, for example, as well as in diagnosis. The symptoms of OI and anxiety are quite similar, aside from the first requiring a change in position, and the 2nd requiring anxiety. So they excuse the lack of acknowledged anxiety based on it resulting in supposedly psychosomatic symptoms instead, probably due to OI psychosomatic anxiety patients hating psychiatry.

The orthostatic component will be largely ignored, as many ME symptoms are. It might be vaguely explained by deconditioning and fear of doing activities that require being upright, such as boring chores and leaving the house. Indoor fitness video gaming at home will no doubt be one cure

To avoid doctors diagnosing OI instead of anxiety, Tilt Table Testing (TTT) will be discouraged, as it might cause the obviously psychosomatic patients to think they're really ill. If they're really lucky and have the right friends at NICE, the quacks will even get the TTT put on the "Do Not Do" list, because what better way to protect their model than by forbidding the exploration of other models?

This is why all of the psychosomatic quacks need to go down, not just the fatigue ones.

 

[Barry53]

It looks like he has been a chief medical officer for a long time. See:
http://forums.moneysavingexpert.com/showthread.php?t=2356683

And that was in Mar 2010.

In which case, quite aside from PACE, surely it is a clear COI (could it even be malparactice of some kind?) to be heading a department that is treating a specific patient for a disease, whilst advising a medical insurance company to not pay out to that same person, until further treatment (as administered by your department) has been accepted by that same patient, as administered by that same department. It all stinks to high heaven. Would be a good question for him to answer at the upcoming Swiss Re summit.

Edit: It feels almost akin to blackmailing of patients, or something along those lines.

 

[Barry53]

It looks like these "insurance" companies may have not understood what the word insurance means?

Ultimately their primary objective is to insure themselves.

 

[user9876]

I used to assume that it was in the interest of insurance companies to keep health care costs down so that they could make bigger profits but I was disabused of this by a friend who works in part as a gatekeeper for insurance claims. In fact it is in the insurance companies' interest for health care costs to be as high as the public will tolerate. The higher the cost th more likely people are to feel they need insurance. The higher the costs the higher the value the companies can add a percentage to when charging premiums.

No doubt insurance companies have to keep rogue physicians under control who charge out of line fees but it is in there interest for the approved fee to be as high as people will pay. Apparently, within the medical travel insurance area there is major behind the scenes collusion between big insurers and rip-off private clinics. Gatekeepers have to learn that certain 'friends' are allowed to slip their invoices through. And threatening phone calls are not uncommon. All good John Le Carré stuff by the sound of it.

Talking with people in the insurance industry (but not those at the frontend or medical) the thing insurance needs is predictable risks. They charge a premium and as long as they know they will payout only a certain % of the premiums they are happy. They basically price based on having an understanding of what risks will happen and how often. They may have a bad year but it evens out over time. So the asbestos claims on LLoyds were very bad because they were not predicted and hence not priced into the premiums that had previously been charged.

Different insurance products have different profiles so car insurance is pretty steady but things like building/infrastructure insurance can suffer from catastrophes. So an insurer generally needs a balanced profile.

 

[Sbag]

I used to assume that it was in the interest of insurance companies to keep health care costs down so that they could make bigger profits but I was disabused of this by a friend who works in part as a gatekeeper for insurance claims. In fact it is in the insurance companies' interest for health care costs to be as high as the public will tolerate. The higher the cost th more likely people are to feel they need insurance. The higher the costs the higher the value the companies can add a percentage to when charging premiums.

No doubt insurance companies have to keep rogue physicians under control who charge out of line fees but it is in there interest for the approved fee to be as high as people will pay. Apparently, within the medical travel insurance area there is major behind the scenes collusion between big insurers and rip-off private clinics. Gatekeepers have to learn that certain 'friends' are allowed to slip their invoices through. And threatening phone calls are not uncommon. All good John Le Carré stuff by the sound of it.

Can we get your friend to attend the meeting for us

 

[dangermouse]

To no-one's surprise!

Still find it unbelievable though, I just can't help it

 

[Sbag]

This post details what Prof Peter White said at a previous speaking event at Swiss Re: in that event, White is basically explaining to these insurers how they can exploit the differences in the ICD disease classification of ME and CFS, in order to escape having to provide ME/CFS patients with disability support, which saves these insurers a lot of money, but leaves ME/CFS patients high and dry.

The unscrupulous trick used by these insurers is the mental health exclusion: CFS — but not ME — can be considered a mental health condition according to the ICD classification of CFS, and I understand that disability insurance rules usually stipulate that they do not have to provide long term disability payments for mental health disorders. So unscrupulously and erroneously making ME/CFS look like a mental health condition is the get out trick used by insurers.


This is why the creation of the CFS disease category by the CDC in 1988 may well have been done in collusion with the disability insurance companies. In the 1980s, there was an apparent 5 to 8-fold increase in ME/CFS incidence (this data comes from several sources, including the disability insurer UNUM, who reported that claims for disability caused by ME/CFS had increased 500% from 1989 to 1993).

So the insurance companies at that time were desperate to figure out an underhand way to avoid having to make disability payouts to all these new ME/CFS patients. The creation of the new disease category of CFS appeared to be the answer to their prayers, but a disaster for ME/CFS patients.

More info on this here: Fivefold to eightfold increase in the incidence of ME from 1980 to 1989, and also in this post.

I am currently in the process of a critical illness claim and have posted in other threads. Have been doing research on it as I have always been told I cannot claim when I have rung up before. This time I asked them to send me details of why I was being refused, how they classify ME and how they classify "functional nervous disorder" which I have an exclusion for in my policy due to having depression when I took it out. A couple of weeks later they came back to me and said they actually needed more information and could I fill out a claim form. In the meantime I had been looking into it all in preparation for my complaint.
I found the following wording is currently being included in critical illness policies being drawn up this year:


In addition my consultant told me that he has been involved in a number of cases for patients and when going to court he had been chatting to the insurers, They told him that they will keep declining claims as most people don't challenge them. Even if they get taken to court 50% of people won't turn up so the insurers win. If the claimant does turn up then they actually go outside and settle with them on the steps. They are just playing the system as only a small percentage of people actually go through with the whole thing (probably because they are too sick and brain fogged) so they win the majority of the time.

I spoke to the person handling my claim last week and asked some general questions again about how they classify things. After much ducking and diving he eventually said that they don't have an internal written definition of ME but they do have it as an illness "of unknown cause". Functional nervous would mean "of unknown cause / medically unexplained" whereas functional neurological would have a biological explanation.

In the relevant insurers booklet on "understanding underwriting" which is for financial advisor use only and not approved for use with customers, they actually then classify mental disorders under two headings:
- Organic - These disorders are caused by, or associated with, disease of the brain tissue. An example of an organic disorder is a tumour.
- Functional - There is no clear physical cause for these disorders. They can result from an individual's inability to adapt to his/her environment.
In their sections on tumours there is no mention of any mental disorders and they class a tumour as an abnormal mass of tissue which grows at a different rate from the surrounding normal tissue.
Obviously they are trying to cover off all possible options for declining claims - but I find it astonishing the inconsistency of what they use internally with what the medical profession uses in terms of what diseases are classified as.

If every WW organisation classifies ME as a neurological condition (before anyone says NICE class it as a mental health issue they don't actually say that - they say that "WHO classes is as neurological and some members of the Guideline Development Group (GDG) felt that, until research further identifies its aetiology and pathogenesis, the guideline should recognise this classification. Others felt that to do so did not reflect the nature of the illness, and risked restricting research into the causes, mechanisms and future treatments for CFS/ME." So they actually sidestep the issue and don't make a definite statement as far as I can see but they definitely don't say that it is a mental disorder but they imply it with their treatment options by calling them treatment rather than symptom relief.) then how can insurers get away with putting ME in the "mental health disorder" categorisation that they put in their current policies. Surely this must be against some laws? I tried to get information from the insurance governing bodies about what insurance companies must do but they wouldn't provide it to a member of the public.

I am fully expecting to have my claim turned down but I will carry on through the process. I would love to think that it might be possible to expose the current classification that the insurers use and do something about it but I have no idea how to take this any further. If anyone has any ideas do let me know.

 

[msf]

The full-text of Wessely's article can be read here:
http://simonwessely.com/Downloads/Other/OldWine.pdf

Let's be honest, their titles don't sound like those of intelligent people, do they? I guess they could be dumbing down for their audience. I´ve also noticed that Wessely likes to reference outdated medical ideas from past centuries to show how up-to-date his thinking is. There was one title with a reference to the four humours, or something equally stupid and antiquated.

I suggest this title for all subsequent talks by White: ´second-millennium ideas from a corporate shill.´ Of course, that would put him about two millennia ahead of Wessely, which doesn´t seem quite fair when Wessely probably taught him everything he doesn´t know.

 

[Daisymay]

View attachment 22928

And that was in Mar 2010.

In which case, quite aside from PACE, surely it is a clear COI (could it even be malparactice of some kind?) to be heading a department that is treating a specific patient for a disease, whilst advising a medical insurance company to not pay out to that same person, until further treatment (as administered by your department) has been accepted by that same patient, as administered by that same department. It all stinks to high heaven. Would be a good question for him to answer at the upcoming Swiss Re summit.

Edit: It feels almost akin to blackmailing of patients, or something along those lines.

Well Professor White was certainly chief medical officer for Swiss Re as far back as 2003.

Here is an article from Margaret Williams, dated June 2003, stating that White was CMO of Swiss re back then:

http://www.margaretwilliams.me/2003/notes-on-insurance-issue-in-me.pdf

Notes on the involvement of Wessely et al with the Insurance Industry and how they deal with ME/CFS claims

Margaret Williams 17th June 2003


"These insurance companies all seem to be involved in RE-INSURANCE; for example, Norwich Union uses Swiss Re and psychiatrist Peter White is one of the Chief Medical Officers for Swiss Re. Their other “CFS experts” are Michael Sharpe and Simon Wessely, and they also use psychiatrist Anthony Cleare (a frequent coauthor with Wessely who works in the same department) for the insurers. "



The PACE trial was registered by White on 22nd May 2003, when he was CMO of Swiss Re.

http://www.isrctn.com/ISRCTN54285094

 

[Hip]

how can insurers get away with putting ME in the "mental health disorder" categorisation that they put in their current policies. Surely this must be against some laws?

Insurers do not put myalgic encephalomyelitis (ME) in the mental health disorder category, as ME is classified as a neurological disease, and ME comes under ICD-10 Section G — Diseases of the Nervous System.

The ICD-10 code for ME is:

G93.3 Postviral fatigue syndrome / Benign myalgic encephalomyelitis


However, insurers may make use of related ICD-10 disease classifications to slip patients with ME/CFS into, such as the disease:

F48.0 Neurasthenia

Neurasthenia comes under ICD-10 Section F — Mental and Behavioural Disorders.


There is also the ICD-10 condition of:

R53 Malaise and fatigue

Malaise and fatigue comes under ICD-10 Section R — Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified. I don't think this can be used for chronic fatigue syndrome or myalgic encephalomyelitis.


In the ICD-10-CM, which is the United States localization of the ICD-10, there is also:

R53.82 Chronic fatigue, unspecified

R53.82 Chronic fatigue, unspecified is considered a synonym for chronic fatigue syndrome (but not for myalgic encephalomyelitis), and comes under Section R — Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified.


This is what Peter White gets paid for: to explain to disability insurers what ICD disease codes are available, and how these insurers can slip ME/CFS patients into disease categories such as Section F — Mental and Behavioural Disorders, in order to avoid making disability payouts.

In the post I linked to before, Peter White explains to insurer Swiss Re:

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.

 

[msf]

Yeah, seems like an ethical guy - I have no doubts about his latest study now.

 

[Barry53]

Insurers do not put myalgic encephalomyelitis (ME) in the mental health disorder category, as ME is classified as a neurological disease, and ME comes under ICD-10 Section G — Diseases of the Nervous System.

@Sbag's attachment suggests otherwise ...

 

[Sbag]

Insurers do not put myalgic encephalomyelitis (ME) in the mental health disorder category, as ME is classified as a neurological disease, and ME comes under ICD-10 Section G — Diseases of the Nervous System.

The ICD-10 code for ME is:

G93.3 Postviral fatigue syndrome / Benign myalgic encephalomyelitis

Rather, insurers may make use of other similar ICD-10 disease classifications to slip patients with ME/CFS into, such as the disease:

F48.0 Neurasthenia

Neurasthenia comes under ICD-10 Section F — Mental and Behavioural Disorders.

There is also the ICD-10 condition of:

R53 Malaise and fatigue

Malaise and fatigue comes under ICD-10 Section R — Symptoms, signs and abnormal clinical and laboratory findings, not elsewhere classified.



In the ICD-10-CM, which is the United States localization of the ICD-10, there is also:

R53.82 Chronic fatigue, unspecified



This is what Peter White gets paid for: to explain to disability insurers what ICD disease codes are available, and how these insurers can slip ME/CFS patients into disease categories such as Section F — Mental and Behavioural Disorders, in order to avoid making disability payouts.

In the post I linked to before, Peter White explains to insurer Swiss Re:

I don't think the picture that i included showed up in the thread itself - please take a look at the attachment which I included which comes from a current insurance company critical illness policy. In case it doesn't show up this is what it says:
- any mental health disorder, including but not limited to anxiety disorders, depression, stress, fatigue. exhaustion, drug or alcohol abuse, psychiatric complications of physical disorders, chronic fatigue syndrome, myalgic encephalomyelitis, post viral fatigue syndrome, behavioural disorders, fibromyalgia, physical disorders related or attributable to stress, any other mental or functional nervous disorder or treatment/complications of any such mental health disorders.

If I have interpreted this incorrectly then please let me knw but to me it looks like it is listed as one.

 

[Sbag]

@Sbag's attachment suggests otherwise ...

View attachment 22937

Thanks Barry - obviously as we suffer from delusions I then sometimes have to doubt what I read and how I interpret it. Having been digging around this it seems that the insurers include it in policies taken out in their mental health exclusion bit. Most people wouldn't think to question it as they won't have ME or be thinking about claiming for it when they take out a critical illness policy. If you then develop it then as it is not listed as a specific disease in their list they pay out for you have to claim under permanent disability. But then they say that you aren't covered because it was in your policy as a mental illness.

This issue has come up in various cases including one for ME. In 2000 the policy said that “No benefit shall be payable for incapacity arising from any mental, nervous or functional disorder, including chronic fatigue syndrome or Myalgic Encephalomyelitis.” In 2002 the person tried to claim for ME and FM. Insurers said his policy specifically excluded ME and other functional disorders. Person took insurers to adjudication who sided with the insurers. Person then took insurers to ombudsman quoting physical neurological disease etc. Originally he had queried the policy terms and agreed that if he was incapacitated by something which had no physical origin then he would agree to that condition. In the end the ombudsman went with the insurers because they had listed it originally - the fact that it was not properly listed was glossed over. If you want to read the piece you can see it here http://www.ombudsman-decisions.org.uk/viewPDF.aspx?FileID=40225

 

[Hip]

I don't think the picture that i included showed up in the thread itself - please take a look at the attachment which I included which comes from a current insurance company critical illness policy. In case it doesn't show up this is what it says:
- any mental health disorder, including but not limited to anxiety disorders, depression, stress, fatigue. exhaustion, drug or alcohol abuse, psychiatric complications of physical disorders, chronic fatigue syndrome, myalgic encephalomyelitis, post viral fatigue syndrome, behavioural disorders, fibromyalgia, physical disorders related or attributable to stress, any other mental or functional nervous disorder or treatment/complications of any such mental health disorders.

As far as I can see, either these insurers have got it wrong to include ME under mental health disorders (because ME is defined as a neurological disease); or else they might be including ME as a physical disorder that can have psychiatric complications (in their list they mention "psychiatric complications of physical disorders").

It would be interesting to write to the insurance company in question, and ask them why they have placed ME, which comes under ICD-10 Section G — Diseases of the Nervous System, as a mental health condition.

 

[jaybird1]

This post details what Prof Peter White said at a previous speaking event at Swiss Re: in that event, White is basically explaining to these insurers how they can exploit the differences in the ICD disease classification of ME and CFS, in order to escape having to provide ME/CFS patients with disability support, which saves these insurers a lot of money, but leaves ME/CFS patients high and dry.

The unscrupulous trick used by these insurers is the mental health exclusion: CFS — but not ME — can be considered a mental health condition according to the ICD classification of CFS, and I understand that disability insurance rules usually stipulate that they do not have to provide long term disability payments for mental health disorders. So unscrupulously and erroneously making ME/CFS look like a mental health condition is the get out trick used by insurers.


This is why the creation of the CFS disease category by the CDC in 1988 may well have been done in collusion with the disability insurance companies. In the 1980s, there was an apparent 5 to 8-fold increase in ME/CFS incidence (this data comes from several sources, including the disability insurer UNUM, who reported that claims for disability caused by ME/CFS had increased 500% from 1989 to 1993).

So the insurance companies at that time were desperate to figure out an underhand way to avoid having to make disability payouts to all these new ME/CFS patients. The creation of the new disease category of CFS appeared to be the answer to their prayers, but a disaster for ME/CFS patients.

More info on this here: Fivefold to eightfold increase in the incidence of ME from 1980 to 1989, and also in this post.

I can confirm that is exactly right. I was working for the National Trust when I became ill. Through the pension scheme I was offered treatment for my CFS paid for by Aviva. This was GET with a bit of CBT tagged on. I was promised I'd be back in 12 weeks; 23 weeks of GET later I was told that the funding for treatment had stopped and I was told to get myself back to work as I had received all the information I needed to recover - so long as I worked at least 15 hours per week I would receive an insurance payment on top of the hourly rate I worked. The 15 hours was set because that's what the physio said I should be able to work with the extent of symptoms I had (that would be the same condition the CFS clinic saw me in and were shocked at how ill I was...). Save to say after 5 months of trying and getting worse I was ill-health dismissed and not able to receive any insurance payments afterwards nor have access to the pension or it's benefits. Some would say I'd been had......

 

[Barry53]

... or else they might be including ME as a physical disorder that can have psychiatric complications (in their list they mention "psychiatric complications of physical disorders").

But ME is not a "psychiatric complication" of ME, it is the underlying physical condition itself. So if it was someone with cancer, they would be excluding any psychiatric complications of the person's cancer, but not the cancer itself. And the wording is very clear on that.

 

[jimells]

Spot-on. IMO, that's where the 'phobic' model of exercise came from. Rise in epi & norepi on standing, HR increases, adrenaline shakes? Clearly you have a deep-seated fear of being vertical.

And successful treatment of hyperadrenergic POTS with anti-histamines is simply a "placebo response" and further proof of the "Power of Mind over Matter and Common Sense".

Studies such as "Hyperadrenergic postural tachycardia syndrome in mast cell activation disorders" obviously have serious methodological problems that only the brilliant Regius Professor Sir Simon Wessely and his loyal sidekick P.D. White can uncover.

In response to the new wave of attacks by doubting academics and hordes of patients who refuse to accept their assigned station, they will soon be receiving more well-deserved titles, honorifics, and awards, and lavishly complimented on their fine new clothes.

 

[Hip]

But ME is not a "psychiatric complication" of ME, it is the underlying physical condition itself. So if it was someone with cancer, they would be excluding any psychiatric complications of the person's cancer, but not the cancer itself. And the wording is very clear on that.

It is not too clear what rationale this particular insurance company (@Sbag did not mention their name) uses to define mental health disorders, but going by their list, even fatigue is classed as a mental disorder, so perhaps that is why they may be categorizing ME as a mental disorder.

I am not entirely sure if insurance companies are required by law to abide by the ICD disease classification (in which ME is defined as a neurological disorder, not a mental one), or whether these companies are free to make their own classifications. If the latter, then I guess there is not much we can do about it.

It's possible that these days, some insurance policies may automatically exclude myalgic encephalomyelitis from coverage. But back in the 1980's, when there was this explosion of new ME/CFS cases, I guess the insurance industry were focused on figuring out how to get out of paying pre-existing policies that had already been taken out by clients, and I think the creation of CFS may have been their solution in the 1980s.

 

[Cheshire]

Trial by Error: Retired PACE Investigator Peter White and Swiss Re
http://www.virology.ws/2017/08/07/trial-by-error-retired-pace-investigator-peter-white-and-swiss-re/

Thread: http://forums.phoenixrising.me/inde...-investigator-peter-white-and-swiss-re.53324/