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DNS - ‘Biopsychosocial’ basis for benefit cuts is ‘cavalier, unevidenced and misleading’

worldbackwards

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Further evidence of an academic rearguard action against the DWP. Took their bloody time.

A new article by Professor Tom Shakespeare and Professor Nicholas Watson, and fellow academic Ola Abu Alghaib, concludes that the biopsychosocial model of health (BPS) “does not represent evidence-based policy”.

The BPS under-pinned Labour’s out-of-work disability benefit employment and support allowance (ESA) and the work capability assessment (WCA), which has since been linked repeatedly to relapses, episodes of self-harm, and even suicides and other deaths, among those who have been assessed and found fit for work.

BPS has also “played a key role” in the tightening of eligibility criteria for ESA and other disability benefits by the subsequent coalition and Tory governments, including the new personal independence payment and universal credit, even though there is “no coherent theory or evidence” behind it, say the three authors.
http://www.disabilitynewsservice.co...-cuts-is-cavalier-unevidenced-and-misleading/
 

Bob

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Bob

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Disability News Service said:
The article is the first academic examination of the BPS, and particularly of two key publicationsby Aylward and Waddell: The Scientific and Conceptual Basis of Incapacity Benefits (2005) and Models of Sickness and Disability: Applied to Common Health Problems (2010).
Disability News Service said:
Shakespeare, Watson and Abu Alghaib say they have “carefully reviewed claims” made in the two publications, which they say reveals “a cavalier approach to scientific evidence”.

They point to “inconsistencies” and “misleading statements”, and they say that the authors “rely on unevidenced assertions throughout their work”.

They add: “Waddell and Aylward slide between general statements that are scientifically valid andspecific statements that are matters of opinion or political prejudice.

“They also tend to cite their own, non-peer reviewed papers extensively.”
Disability News Service said:
A DWP spokeswoman said the department was not previously aware of the article before it was contacted by DNS, but she added: “We work with experts on disability issues and look at a wide range of evidence when developing policies that will affect disabled people, including the work and health green paper, and we will consider the points raised in this article.”
Disability News Service said:
Alyward left DWP to head Cardiff University’s Centre for Psychosocial and Disability Research, which for four years was sponsored by the US disability insurance giant Unum, a company that once bragged that UK government policy on incapacity benefit reform was “being driven by our thinking”.
Disability News Service said:
Alyward had declined to comment on the article by noon today (9 June), while DNS has so far been unable to contact Waddell.
 

Bob

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The Disability News Service article discussed above, links to the following article from 2013, which i found interesting...

Unum bragged about ‘driving government thinking’ on incapacity benefit reform.

Disability News Service.
15th Feb 2013
http://www.disabilitynewsservice.co...rnment-thinking-on-incapacity-benefit-reform/

An insurance company set to make huge financial gains from incapacity benefit (IB) reform bragged about “driving” the government towards those reforms, evidence obtained by Disability News Service (DNS) has revealed.

The US insurance giant Unum has repeatedly denied attempting to influence IB reform over the last two decades, despite mounting evidence that it has done so.

Unum is the largest provider of “income protection insurance” (IPI) in the UK, and tougher welfare rules – including replacing incapacity benefit with employment and support allowance (ESA) – are likely to persuade more people to take out IPI, boosting the company’s profits.
 
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SilverbladeTE

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UNUM executives should have been arrested for conspiracy to defraud and murder, for their "Hungry Vulture Award" criminality which the corporation got *caught* doing 20 years ago

the fact they got away with it, and doing similar crap in UK recently, proves the company is inherently evil to it's core and should be raided by FBI and UK's National Crime Agency, and others.
then forcibly dissolved by our governments.

this proves that "corporate" law and existence is inherently contrary to the basic point and need of justice: people being held personally responsible for their acts
corporations always hide behind dozens of expensive lawyers and absolutely perverse laws that they have been allowed to put in place by bribing corrupt politicians and bureaucrats over the past 150+ years
Corporations are inimical to Humanity's interests, they destroy the entire concept and support of the justice and financial systems
Corporations are not "Capitalist", they are parasitic threats, they are not normal "businesses" which can be held to account and have reasonable law, responsibility and taxation (actually if corporations were banned out of existence, broken up into small/medium businesses, they could then be properly taxed and thus with proper revenue income lower the entire tax demand on business since tax evasion by corporations is absolutely massive).
 

chipmunk1

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The Biopsychosocial model by Engel, who happened to be a Psychoanalyst is based on (surprise) Psychoanalysis.

How can freudian medicine ever be evidence-based and scientific? It is the result of doing too much cocaine.

It criticises the willingness of a succession of politicians, such as the welfare reform minister Lord Freud – who has described it in parliament as a “coherent theory” – to base their policies on the BPS
 
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Extraordinary stuff:
The article is the first academic examination of the BPS, and particularly of two key publications by Aylward and Waddell: The Scientific and Conceptual Basis of Incapacity Benefits (2005) and Models of Sickness and Disability: Applied to Common Health Problems (2010).

Following the article’s publication, Watson – professor of disability research at the University of Glasgow, and director of the Centre for Disability Research – called for DWP to review the evidence used to drive its policies on out-of-work disability benefits.

He told Disability News Service (DNS) that the BPS had “been used to drive the WCA”, and that the government now needs to examine “the evidence that they used to create their policies”.

He added: “I would question very much the foundations that they are built on.”

He pointed out that none of the articles they analyse in their article had been published in peer-reviewed publications – as theirs was – but instead had been self-published or published by “obscure publishing houses”.

He said: “If they really wanted to make their case, they would submit their work to peer review.”
Full story
‘Biopsychosocial’ basis for benefit cuts is ‘cavalier, unevidenced and misleading’
 

Esther12

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Interesting stuff. Quite a lot of interesting references in there too.

eg the parliamentary office of science and technology summary of the ESA WCA controversy: http://www.parliament.uk/briefing-papers/POST-PN-413.pdf

They don't provide the details of the ESA criteria, when that's a pretty important part of the controversy!

The reforms didn't work... we need more of them:

The current reforms
The government has announced that it will phase out
Incapacity Benefit by March 2014. 1.5 million claimants will
be reassessed for Employment and Support Allowance
(ESA) using the Work Capability Assessment (WCA). These
were introduced in 2008 by the previous government for
new claims. The current government agrees with the
principle, but finds it inefficient in its current form because:
 Expenditure on Incapacity Benefit and ESA remain high.
 It has not resulted in claimants moving from these
benefits into employment. For example, in a recent
survey only a quarter rejoined the workforce.1
The reform is primarily intended to help people off benefit
and into work, reducing welfare dependency. However, it
may also potentially target resources at those who need
them most and reduce overall expenditure on social
security.
DWP claims that the decision making process for ESA as a whole is based on the biopsychosocial model. It suggests that between them, the face-to-face assessment and a claimant’s evidence covers the full range of biological, social and psychological factors. Disability groups are sceptical about the extent to which psychological and social factors are being taken into account.
This is their summary of the BPS model:

Biopsychosocial model Developed by psychiatrists in the 1970s, this model argues that biological, psychological and social problems all have to be taken into account to manage the health of an individual, and provide an effective treatment. The current United Nations model of disability, the International Classification of Functioning (ICF), describes the interaction of these factors along with a person’s health to explain how and where people might be disabled.
 

Dolphin

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They contend that whilst the social model may be relevant to those with severe conditions and permanent impairment, it is not appropriate for ‘common conditions’. ‘Common health problems’ refers to musculo-skeletal; cardio-respiratory; and mental health conditions, which together account for two-thirds of sickness absence, early retirement and incapacity benefit claims (Waddell and Aylward 2010, 6). These common conditions, it is argued, are ‘similar in nature and sometimes even in degree to the bodily and mental symptoms experienced at times by most adults of working age’ (Waddell and Aylward 2010, 6). Further, it is claimed that the associated non-specific diagnoses are ‘often “nominal”, existing in name only, not real or actual’, although ‘these symptoms are very real, justify healthcare, and may cause temporary restrictions.’(Waddell and Aylward 2010, 7) As with low back pain, so with these other common conditions, a return to work is advised: ‘These people have what should be manageable health problems. Provided that they are given proper advice and support, recovery is normally to be expected and long-term incapacity is not inevitable.’ (Waddell and Aylward, 2010, 8).
One can see where "chronic fatigue syndrome" where the fatigue is seen as not pathological could be seen as a good example of something that would fit into their model.
 

Dolphin

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Rather than bringing together biological, psychological and social factors in a holistic account of disability, the Waddell-Aylward BPS is in actuality a causal explanation of sickness absence, with advocacy for a particular approach to disability management. By saying that the social model is not relevant to this population, and by differentiating ‘common conditions’ from ‘severe conditions’, advocates of the Waddell-Aylward BPS are advancing a distinction between ‘real’ incapacity benefit claimants, with long-term and incurable health conditions, and ‘fake’ benefit claimants, with short-term illness: ‘Common health problems are very different from the severe medical conditions and permanent impairments for which sickness and disability benefits were originally designed’ (Waddell and Aylward, 2010, 8). Given the uses to which the WaddellAylward BPS has been put in recent UK government welfare reform, it seems apt to suggest that this distinction maps closely onto the historical social policy division between the deserving and the undeserving poor (Stone 1984). It also drives media coverage and popular attitudes to disabled people (Brient et al 2013).
 

Dolphin

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Challenging the Waddell-Aylward BPS

Here we will explore the elisions and exaggerations that we believe render the WaddellAylward BPS approach conceptually and empirically invalid. Conceptually, Waddell and Aylward slide from generally well-accepted statements about the role of psychological factors in health, to their BPS model, which is a specific and highly contested account of the role of psychological factors in health (Waddell and Aylward, 2010, 37). For example: ‘The biopsychosocial model recognizes that biological, psychological and social factors, and the interaction between them, can influence the course and outcome of any illness’ (Waddell and Aylward, 2010, 22). Whilst most commentators would accept that disability is multifactorial, it is a bigger and more contentious claim to state that each of these factors influences any disease or disability. However, by using the word ‘illness’, which medical sociologists have always applied to the social experience of disease (Field 1976), Waddell and Aylward are muddling the picture. What they are actually trying to do is to emphasise psychological factors in the common health conditions that often generate incapacity benefit claims.
 

Dolphin

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Both the International Classification of Functioning (ICF) and the Waddell-Aylward BPS use similar terms: for example both talk about ‘performance’ and ‘capacity’. However in the ICF such terms have defined technical meanings: ‘performance’ refers to what an individual does in their everyday context whilst ‘capacity’ refers to their ability to execute a task or action in a uniform or standard environment. Gaps between performance and capacity highlight the role of disabling or enabling factors (Bostan et al 2014). Because of social and environmental barriers, performance is usually lower than capacity (Almansa et al 2011). In the Waddell-Aylward BPS, the same terminology is used, but in a misleadingly different way: ‘As an oversimplification, capacity may be limited by a health condition, but performance is limited by how the person thinks and feels about their health condition’. (Waddell and Aylward, 2010, 20). In other words, the difference between ‘performance’ and ‘capacity’ for the BPS is all about individual attitudes and motivation, not about environmental factors: again reinforcing the psycho over the social.
 

Dolphin

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It is interesting to note that the American College of Physicians/American Pain Society review of acute lower back pain (Chou et al 2007) is disparaging of Waddell et al’s 1996 recommendations to start exercise after 2 to 6 weeks, because they were based on poor quality evidence. A Cochrane Review of behavioural interventions for local back pain found moderate quality evidence that behavioural therapy is more effective than usual care for pain relief in the short term, and found that there was little or no difference between behavioural therapy and group exercises in the intermediate-to-long term (Henschke et al 2010). In the physiotherapy field, Hancock et al (2011) argue that the bio has been forgotten in the biopsychosocial, and call for research on the biological component
Reminds me of what the CBT/GET/BPS have been researching in the ME/CFS field and the types of research they are calling for.
 

Dolphin

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More importantly however, having claimed credit for their BPS model in changing approaches to back pain, Waddell and Aylward extrapolate from the changed clinical approach to lower back pain to make a different and wider assertion, that conditions such as mental health conditions and cardio-respiratory disorders can be similarly transformed with a psychologically-based approach.
 

Dolphin

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Waddell and Aylward seem to make misleading statements. For example, they write that: ‘symptoms are subjective bodily or mental sensations’ (2010, 3), from which you might infer that symptoms lack reality. Symptoms are indeed a feature of a disease which is noticed by the patient, whereas a sign is noticed or measured by other people, for example blood pressure. But this does not mean that symptoms are all in the mind. Taking a subjective history is an important part of diagnosis. Symptoms include aspects such as pulse or respiratory rate, assessed by reliable, clinical measures. The combination of symptoms, signs and laboratory tests together generate the medical diagnosis of health conditions. Subjective does not mean ‘unreal’.
 

Dolphin

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Most importantly, given that the BPS is intended as a contribution to policy formation, and that contentious claims are often made, it might be expected that a robust evidence base would be provided. Yet the authors rely on un-evidenced assertions throughout their work. For example, they state ‘the more non-specific and subjective the health condition, the more important the role of personal and psychological factors’ (2010, 7): this may or may not be true, but when no evidence is provided, it is hard to know either way. To take another example, work and return to work are presented as a good thing, and as being generally good for health (2010, 33). Yet evidence for positive impact of interventions that aim to encourage return to work following illness or injury on quality-of-life outcomes is weak (Franche et al, 2005).
Chronic fatigue syndrome could be seen as very non-specific and subjective and hence that the role of personal and psychological factors to be very very important if one believes their model.
 

Dolphin

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The failure to include both macro socio-economic factors, and the meso and micro disabling factors means that a BPS approach can only blame victims for their plight: ‘For most people with common health problems, decisions about being (un)fit for working, taking sickness absence or claiming benefits are conscious and rational decisions, free choices with full awareness and intent, for which they must take responsibility.’ (Waddell and Aylward, 2010, 22). In other words, they should be perceived as scroungers.