Monday, January 21, 2013

"Vanishingly Small"

Michael Sharpe: The first thing is it’s a big problem, it’s a big problem in primary care and primary care chooses who they send to secondary care and it is across medical specialities about a quarter to a third of the patients seen fall into this category, so it’s a big problem. The second question is, do these people all go on to have [sic] disease that to have the symptoms explained if you just wait. And again the evidence is and our studies in neurology suggest even after a year very, very few people once they’ve been assessed by a neurologist turn out [sic] to have a disease. So it isn’t that if you wait the disease will always become clear, it usually doesn’t.

Norman Swan: And if you go and see a better neurologist?

Michael Sharpe: And if you go and see a better neurologist, people of course do end up doing this, they go and see multiple doctors in the hope that one of them will find a symptom [sic], but once you’ve seen a competent specialist doctor the chance of a second [specialist] finding something becomes vanishingly small.
Hear hear!
In the United States, a disease is defined as “rare” if it affects fewer than 200,000 individuals, or roughly one in 1500. Rare diseases are often poorly understood, with symptoms that can be difficult to diagnose, and can be life-threatening. Around 6,800 rare diseases have been identified and the large majority of them — up to 80% — are thought to have a genetic origin. Most rare diseases can’t be cured and many lack effective treatments because research on rare conditions is often hampered by a scarcity of study participants and poor funding.

If you add up all the rare diseases it turns out that about 30 million Americans suffer from a rare disease. That’s nearly 10% of the populationsuddenly rare is not so rare!
I would say no doctor knows all of these 6,800 identified rare disease – the chances that any doctor misses a disease in a patient are very high if it is something the doctor does not deal with everyday. Given a patient with a random rare disease, every doctor will fail to make proper diagnosis, even if he is specialized in neurology. The only chance the patient has is to find the doctor who knows the disease.

And then there are the not so rare diseases (mediums diseases? well done diseases?), where I seriously doubt that most specialists know all diseases. Some doctors don't even know Behçet’s, for crying out loud!

To dismiss the utter importance of a proper differential diagnosis for supposedly "medically unexplained" symptoms is not acceptable behaviour for any doctor.

Plus, on average it takes 2 years for a patient with a chronic disease to receive a diagnosis (without any guarantee whatsoever that it is the correct diagnosis). The long tail is made up of people who have a disease that could be identified with current medical knowledge, however the medical profession is unable to deliver them a diagnosis in an acceptable time-frame. So equalling "Patient has no diagnosis after 1 year" with "Patient has no disease" is a highly unethical shell game by the good doctor – these fucking clueless butchers malicious psychoquacks very fine disciples of the Wessely school always try to move the pea when you are not looking carefully.

Leaving behind what is currently known, there are people who have diseases that are – gasp! – currently unknown to medical science. Who here would stand up and claim that every disease and every disease mechanism has been identified, that medical science knows it all, has all tests needed to identify diseases in a patient, and that there is nothing new to learn for medical science any more? If you are standing now, you are an idiot.

I will not dignify the rest of the bullshit that Michael Sharpe bloviates, except to remark that Sharpe is throwing lots of sand in everybody's eyes – including his own in his confirmation bias frenzy – to intentionally blur many medical concepts, psychological concepts and appealing to what he presents as some sort of "common sense" to push the psycho-woo of the Wessely School. If Sharpe were really interested in the reality of diseases with their peripheral fatigue and peripheral pain (and not his make-believe confirmation-bias psychological-woo "It's the brain who makes the symptom"), he would heed to look at the scientific work of people like Alan Light or Christopher Snell. Sharpe works very hard so patients with demonstrable physical disease should receive treatment by psychologist, and by psychologists alone – that this may be in his financial interest, but not in the medical interest of his patients, that he is unable to realize. Alas, as Thomas Kuhn and Max Planck have remarked before, we have to wait until they have died of old age and a new generation not entangled in idealistic BS has replaced these jokers.

To finish, I would say the chances that Michael Sharpe is a competent doctor, who acts in the interest of his patients, these chances are vanishingly small. However the chances that he is a psychoquack look more like on the order of being 1.0 (p<0.0000001).

My personal advise: Stay away from psychoquacks. First of all they feel harassed if you demand attention for your medical problems – medical problems are not their department, after all. And secondly it it might be bad for your health.

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