By David Tuller, DrPH
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Last week, Guardian columnist George Monbiot wrote another scathing piece about the failure of the UK health care system to address the plight of people diagnosed with ME/CFS. (Monbiot’s previous column on the issue appeared in March; our interview about it is here.) The new column was pegged to the case of 27-year-old Maeve Boothby O’Neill, whose death in 2021 from complications of severe disease has received extensive media coverage in the UK (if not, unfortunately, in the US).
But Monbiot’s main focus in this column was the sorry history of London’s Science Media Centre in promoting egregiously flawed studies about the illness. The SMC, a PR agency masquerading as a purportedly neutral arbiter of scientific research, has been on Monbiot’s radar for decades. Yesterday, Monbiot and I discussed some of the issues he addressed in the column, including what he has referred to as the “cruel and bizarre cult” that has controlled it since its inception. (Because of a time lag on the zoom call, in a couple of places we seem to be talking over each other.)
This really needs to get out there. But I hope David and George will also consider doing a reverse-direction interview with David explaining all about the situation with UK medicine that goes way further than just ME and Long Covid into functional and MUS land. So many patients being refused investigations and proper treatment across so many specialties now to make reductions to the NHS physical health budget. Up to half of all secondary care referrals being viewed as related to MUS. Psych staff being taken on to deliver psychotherapy instead of physical investigations and care. Women’s health at greatest risk. So many of same themes apply – gullible doctors instead of gullible journalists who have little choice but to believe what they’re told because of their own time constraints….and the neoliberal model of every man and woman for themselves that is, to my mind, now so much in evidence under the guise of not overmedicalizing, “too much medicine” and prevention rather than cure being the way forward for the NHS.
Please, pretty please?
An article about the strange story of the Science Media Centre’s parent group, showing how a far-left group ended up on the far-right .
The URL didn’t show up in my previous post, it is this: https://weeklyworker.co.uk/worker/1416/follow-the-leader/
George mentioned this -https://www.monbiot.com/2003/12/09/invasion-of-the-entryists/
George suggested that journalists belong to a profession that perhaps surpasses all others when it comes to being gullible or vulnerable to persuasion but I’d say that doctors do too, for similar reasons – they also don’t have enough time to investigate claims thoroughly or to even consider that they might be dodgy. Like journalists, doctors are now dependent on others to know what to think and do; like journalists they may not have the capacity to decide for themselves. Some may even lack the intellectual capacity, it having been drummed into them from medical school to believe what they’re taught. (That is maybe where they differ from journalists whose job it is to objectively search for the truth. To an extent, doctors have to accept that what they are taught is true.) While, going by George, journalists have perhaps come to take and rely on organizations like the SMC as the ‘voice of God’, I’d say that medics appear to be in the thrall of their medical hierarchy and peer-reviewed journal output instead, such that even when it is obvious that peer review has failed to deliver correct and safe information, they don’t seem to be able to take that further to question the rest of what they’ve been taught on that subject. Let me give an example.
In comments under David’s most recent blogs, I’ve flagged up a 2021 paper by Rogers et al about functional cardiac symptoms -https://www.sciencedirect.com/science/article/pii/S1470211824033694 that, to my mind, really deserves our attention. Why? Because it synonymized cardiac syndrome X – a heart condition more prevalent in women that I believe had previously been regarded as a psychosomatic/functional problem – with non-cardiac chest pain. It wasn’t as if the recognition of cardiac syndrome X (now commonly known as ‘microvascular angina’) as an ‘organic’/physiological condition was new, it looks like it had happened years before. I imagine it’s a bit like people still claiming peptic ulcer disease to be functional/psychosomatic years after Helicobactor pylori was acknowledged to be the main culprit. Except this paper’s to do with the heart. It’s not just me suggesting that this paper was problematic, concerns were raised by 2 cardiology consultants and a medical trainee – see letter available here -https://www.researchgate.net/publication/350368994_A_further_explanation_for_chest_pain_without_visible_coronary_artery_disease. But despite raising serious concerns about the paper, the authors of the letter including the cardiologists don’t appear to challenge their own belief – what they’ve likely been taught – that functional syndromes are highly prevalent. I can’t know for sure, but I suspect that they’ve taken this information on trust and haven’t questioned prevalence figures supplied to them via peer-reviewed articles, CPD sessions or whatever. Indeed, the Rogers et al paper notes reported estimates of medically unexplained symptoms (MUS) in cardiology clinics of between 30% and 40% of presentations. In their letter the cardiologists don’t challenge this. The first reference given by Rogers et al to support these figures is this 2001 paper -https://www.sciencedirect.com/science/article/abs/pii/S0022399901002239 by Nimnuan et al where the MUS prevalence rate for cardiology was actually a whopping 53% (so the 30 to 40% figure in the paper’s text was conservative). Are the cardiologists aware though that in this study by Nimnuan et al around 38% of patients who were initially diagnosed with MUS were later found to have a medical explanation for their symptoms and that the high prevalence rate found was likely due to the lower level of expertise of the doctors in charge of the clinics? Have they looked at all the studies claiming high MUS rates to see if they stand up to scrutiny? I doubt it. Perhaps they genuinely don’t have time to or maybe they’d rather have a handy box that they can place patients with unexplained symptoms in than trawl through all the evidence themselves to see if it’s trustworthy?