Archive for the ‘Professor Mansel Aylward’ Category
Professor Wessely: Knocking the Docs & Overstepping the Mark
I feel that my last post ended on a somewhat cryptic note regarding Professor Wessely, and that I need to support the claim I made about the undermining of physical medical authority within his ‘doctrine’. This I feel I have previously done to an certain degree with regard to Professor Aylward and his colleagues (here and here), though the potential certainly exists for more to be highlighted.
An insight into what could be termed the ‘under-the-radar‘ approach to undermining the integrity of medical personnel, such as GPs, is provided by Professor Wessely’s article for Unum’s Annual Chief Medical Officer’s Report 2007 entitled “Why and When do Doctors Collude With Patients?” (The CMO for this publication was Michael O’Donnell, now occupying the same role with Atos Healthcare.)
Subtle But Significant
This notion may seem to be introduced with apparent goodwill, even humour, but the important fact is that it is introduced at all. The question should always be asked about corporately financed material “Who is set to benefit from the dissemination of these ideas?”. Is there anything to gain on the part of the Insurance firm Unum who produced the report? – Such as carving a first chink in the hitherto resilient armour of the authority of physical medicine, perhaps. This, by suggesting that doctors can be psychologically ‘vulnerable’ to forms of ‘collusion’ with those in their care in ways which might work against the patient’s welfare.
Might it not in fact be an attempt to first, construct such a thing as this type of ‘psychological failing‘ of a doctor, and second, draw it into the classification of ‘iatrogenesis‘, a term historically limited to the adverse effects on patients of drugs, medical error, or negligence through decisions taken by medical personnel. Note should be taken of Professor Wessely’s reference to the naivety of ‘ethically pure’ young doctors, new to practice, who will come to the realisation that “in real life things are not neat and simple, but grey and ambiguous”, ultimately, presumably, succumbing to this ‘necessary collusion’. Some of the reasons for colluding that Wessely lists give anything but a favourable impression of our medical practioners, including as it does such things as financial reward, lack of time and fear of complaint.
Poor NHS. Also deluded.
Just prior to introducing Professor Wessely’s article Michael O’Donnell bemoans the way that “our NHS managers [are] fixated on providing those treatments which can be measured” such as operations and injections. As opposed perhaps to psychological interventions which rest solely on, and the success of which is evaluated only by, certain ‘experts’ in that field. He then states that “until return to work is included as the objective and final measure of success, it seems likely that the NHS will continue to miss the point.” This is of course an ‘objective’ perspective, and nothing whatsoever to do with the fact that it serves insurers such as Unum’s best interests (and saves them money) to get the sick back to work.
Wessely’s ‘Previous’
If what I’m claiming seems a little exaggerated, or ‘conspiracy theory-ish’ perhaps you should also take a look at this paper by Professor Wessely from 2003. The main thrust of of which is that doctors who accept the possibility that their patients suffering from (ahem) ‘Medically Unexplained Symptoms’ (MUS) may actually be physically ill are in danger of committing an ‘iatrogenic’ offence against them. He does this by arguing that patients with ‘MUS’ conditions (an important and expensive group he alleges) are in effect made worse by doctors taking their illnesses seriously and organising physical investigations and treatments. There are, Wessely concludes, “points within the doctor-patient encounter where MUS may be iatrogenically maintained“. In simple terms, doctors need to stop ‘colluding’ with these patients because it is doing them harm.
Note: Professor Wessely’s list of MUS illnesses in the paper (detailed below) correlates very closely with those listed by fellow psychiatrist Dr Christopher Bass at the 2004 Atos Conference referenced in my earlier post. (Though he omits chronic back pain in favour of irritable bowel syndrome)
Non-cardiac chest pain
Fibromyalgia
Chronic fatigue syndrome
Repetitive strain injury
Caution: Unbridled Arrogance Ahead.
An unexpected interjection to the article under the sub-heading ‘Social’ is yet more evidence of just how entitled proponents of the Biopsychosocial model perceive themselves to be in stepping out of their own field and usurping theories from Sociology to twist into their arguments. Aylward from his ‘Medical’ expertise, and Wessely from Psychiatry. It is very telling indeed that there are no qualifed Sociologists involved in the Biopsychosocial lobby. A small matter of ethics, perhaps.
Wessely’s A Sociologist Now?
In this instance Wessely attempts to appropriate Ivan Illich’s notion of ‘Social Iatrogenesis‘ and ‘invent’ his own version for his own purposes.
Illich explains the meaning of his term as referring to the “impairments to health that are due precisely to those socio-economic transformations which have been made attractive, possible, or necessary by the institutional shape health care has taken“. Note the use of the word ‘institutional’ here.
Illich’s main concern is that autonomy has been removed from the people, and he speaks about the danger of ‘radical monopolies’ such as is expressed in the idea that “When cities are built around vehicles, they devalue human feet“.
Illich asserts that “Ordinary monopolies corner the market; radical monopolies disable people from doing or making things on their own”. Disregarding this core idea, Wessely feels entitled to put his own spin on ‘Social Iatrogenesis’. Describing it as “a term for illness caused or prolonged by wider sociopolitical inputs” he uses it to discredit ‘Patient Support Groups, no less! It would be quite one thing were he a qualified Sociologist to make that assertion, and accordingly be ethically required to back it up with a full argument as to why that could be a reasonable (though inexplicably contradictory) interpretation of Illich’s theory. It is quite an extraordinary presumption to appropriate that theory towards the opposite aim of its originator. Patient Support Groups are nothing if not an attempt to restore a measure of autonomy to ‘the people’ within what has become an ever more bureaucratised, institutionalised healthcare system. This is nothing short of abominable arrogance on Wessely’s part, but oh so very symptomatic of this group of ‘experts’ including Aylward et al.
Could He Possibly Be More Wrong?
Wessely just couldn’t be more wrong in citing Illich in this context, when the latter complains that the spread of medicine “turns mutual care and self-medication into misdemeanors or felonies”. Please compare against Wessely’s rubbishing in the Unum Report of any steps that that an individual may take outside of traditional medicine to ‘self-medicate’. These potential treatments he disparages as ‘”cod-immunology [mixed with] pseudo radiation science interspersed with New Age homilies” directing us towards that reknowed ‘quack-busting’ site ‘BadScience.com’. Hardly comments or sentiments in line with Illich’s philosophy is it? No, it’s quite the opposite. Perhaps Professor needs to sign up for a beginner’s course in Sociology, or better still refrain from playing with concepts that he doesn’t understand.
I’ll leave the final word to Illich on “nosology” (the system of classification of diseases, which he notes “changes with history”)
In our society nosology is almost totally medicalized; ill-health that is not labeled by the physician is written off either as malingering or as illusion.
Oh deary me, Professor Wessely, oh deary me…
My Response to Professor Aylward’s statements to BT and DPAC
A response to Professor Aylward’s statement to Black Triangle and DPAC outside the IFDM2012 conference, on 11th September 2012.
“Few people have been involved in as many return to work or rehabilitation initiatives as Professor Mansel Aylward” [1]
I was, quite frankly, staggered to read Professor Aylward’s response to the questions posed to him about his usage of the Bio-Psycho-Social (BPS) Model and his apparent denial that his ideas have been deliberately used in the way that I and others have asserted; which is to establish a process, the Work Capability Assessment (WCA) by which the majority of the sick can be illegitimately found fit for work.
In my article on the subject [2] I believe I argue convincingly quite the opposite to Professor Aylward’s current assertions, providing examples that indicate how this has been achieved. It is an ideas trail which leads directly back to the esteemed professor and his (and his various colleagues), efforts, (in concert with the insurance firm, Unum), to revolutionise the way in which our health related benefits are administered – with its overwhelming emphasis on ‘proving’, in the words of Chris Grayling, almost everyone capable of ‘some work’. What the WCA most certainly is not, contrary to claims otherwise, is a fair, impartial and objective method of assessing someone’s capacity for work. And one who must take a large part of the responsibility for that situation having arisen is Professor Aylward himself.
Ruthless promotion of the BPS model
Examining Professor Aylward’s recent defence of his position on BPS, and the links that have been made between his work and the rearrangement of our welfare system, it would seem that he is now claiming to have had no influence upon the changes which have been wrought. This is an astonishing claim in light of the manner in which he and others of his cohort have ruthlessly promoted and applied some very specific ideas about illness. These academics, including Professor Aylward, within what I have previously termed the ‘BPS lobby’, have consistently and persistently pushed their ‘new’ notions about illness and disability until they, first successfully penetrated, and then became the sole authoritative discourse within official literature in this area.
They were able to do so through drawing on their privileged positions as leaders of medical and scientific authoritative discourse and doctrine. We should remind ourselves too that welfare policy is to all intents and purposes a form of law, which in the case of welfare benefits is very strenuously applied. Results of failure to comply are severe, and punished mercilessly by the modern system. Those stigmatised as ‘scroungers’ or ‘malingerers’ are afforded zero tolerance and enthusiastically chased to ground and pilloried in our contemporary society. All the more reason, then, for the ideas which have fed into those administrative instruments by which people’s health is assessed to be above criticism, and fair and just, avoiding adding to any stigmatisation of illness and disability.
On 11th September Professor Aylward claimed to ‘sympathise’ with the ‘grievances’ raised by the disabled community. He hints that the address he had just given about the BPS model contained criticism of its current application with respect to disabled people; that he now finds it ‘unsatisfactory’, because it “no longer addresses the exclusion of disabled people from society“. When did it ever, professor? It is not the BPS model itself that people are outraged by, sir, but the uses to which it has been put. And that has been to further ‘exclude’ sick and disabled people from society by further disabling them through adding demonisation to their stigmatisation, and financial penury to their already disadvantaged economic situation. And all this has been accomplished via the Atos administered WCA, built as it was on ideas about ‘illness’ culled from your literature, and that of the insurance firm Unum, whose processes have been aptly described as ‘disability denial factories’.
Meaning of the ‘social’
Professor Aylward wishes that people would believe that he had never taken any other view than that “the social element has been neglected” in the application of ideas from BPS.
But what exactly has been the professor’s use of the ‘social’? That he proposes that this has been neglected in the application of BPS is something I agree with wholeheartedly. The potentially hazardous effects of that most ‘social’ activity of work have been elided, quite deliberately, by he and his colleagues. In fact Professor Aylward has gone to extreme lengths to persuade both medical practitioners and the wider public alike that we all have the wrong idea about work posing possible hazards to health. The positive benefits of work have been hammered home regularly in the publications and research conclusions at every possible opportunity. Not only that but Professor Aylward has decreed that all dialogue about work should be changed, all those ‘erroneous’ ideas that work contributes to poor health must be reclassified as ‘myths’, and work reconstituted in our minds as an essential component of recovery from illness; for everyone, no matter what degree of illness they suffer. [3]
Considering the strong emphasis on ‘work’ in that aspect of his literature, is this the form of the ‘social’ that Professor Aylward is drawing upon? It appears not. On the release of his co-authored scientific book ‘The Power of Belief’ [4] Professor Aylward gave a presentation around its themes to a joint meeting of the British Psychological Society and Association of British Psychologists. In a graphic which describes the three elements of BPS the ‘social’ is defined by three keywords. Beneath the vague, undetermined ‘culture‘ and ‘social interaction’ we find: ‘the sick role’. [5.,Slide 18] For anyone unaware of this concept, it promotes, among other things, the notion that a sick person has much to gain from ‘playing’ the sick role. Patients are portrayed as accruing certain advantages from being ill (or merely claiming to be so). These are so-called secondary gains such as ‘exemption from ‘performing’ in society, and from social responsibilities, as well as receiving attention and help that those who do not claim sickness cannot. Those are the ‘rights’ that sick people enjoy. On the other side is the obligation to do everything a person possibly can to get better and participate fully in society. The problem around this, of course, is the assumption that illness can always be recovered from, that the sick will always heal. This is a notion which is not only unhelpful, but is positively harmful when the sick role is attached to the long-term, chronically ill. This, however, is the very aspect of ‘the social’ which Professor Aylward evidently gives priority to in his theories. And it is exactly that idea which is incorporated within the WCA, whereby chronically sick people, with progressive and sometimes terminal illnesses are being forced into a perpetual round of reassessment, the black magic roundabout administered by Atos, just in case they have magically become ‘well’. When we have a situation of someone with Down’s syndrome being asked at their WCA how long they have had that ‘condition’, it is not hard to visualise that she too will be continually reassessed to see if her ‘condition’ improves over time.
Atos, too, endorse concept of ‘secondary gains’ when assessing illness
This idea of the ‘sick role’ is mirrored in an Atos publication of 2004. [6] If any doubt remains about the way in which Atos regards those who are subjected to its formulaic tick box assessment process then this publication will dispel them. A side panel of the document authored by Dr Christopher Bass is entitled familiarly “Symptoms that defy explanation” and includes a helpful list of conditions that fall within this category, including
Chronic Fatigue Syndrome
Fibromyalgia
Chronic back pain
Repetitive Strain Injury
Non-cardiac chest pain
Dr Bass then proceeds to make much of this concept of ‘secondary gains’ that presumably accrue from claims to these particular types of ‘common’ illnesses, describing them thus:
“Work absence as a reward for years of struggle; turning a socially unacceptable disability into a more acceptable ‘organic’ disability caused by injury or disease beyond their control. They can blame their failures on the illness; elicit care, sympathy and concern from family and friends; avoid work or even sex; and there are financial rewards associated with disability“.
I don’t think I’ve ever seen this defamatory notion expressed quite so blatantly towards the members of the sick and disabled community. But then again, this is Atos, who have proven themselves to be Teflon against all legitimate complaints that have been made against them.
I can’t help but wonder how many of these sufferers from ‘unexplained illnesses’ have spent their final months in desperate circumstances after being denied their benefits by Atos.
We think therefore we are…
That ‘version’ of the ‘social’ aside, in practically all Professor Aylward’s work there seems to be nothing but the remorseless application of the psychological, at the expense of any consideration of the social.
“The Power of Belief” [4], was published at the time of the Unum funding of the Centre at Cardiff University under his directorship. An illustrative chapter title from this collection is “Explaining unexplained symptoms: The role of beliefs in clinical management’. This volume is a multiple contributor work which centres solely on the idea that how people regard their illness is the most important factor in determining the course of it. Not their physical limitations; their pain; the barriers their condition puts up between them and everyday social functioning; the distress arising from having an impaired physical (or mental) interface with which to negotiate a society which caters only to the able-bodied. No, none of these have as much validity or significance in a sick person’s life than what they ‘think‘ about the state of their bodies. This one notion makes it possible to place the blame for someone’s inability to function successfully in the world squarely on their own shoulders, and has made possible, too, the idea that people can ‘recover’ if they only adopt a positive attitude towards that end. This latter idea too, not only holds a special significance within both the professor’s personal ideology and his literature, but is highly implicit in the justifications for the increasing numbers forced off Employment Support Allowance who are portrayed as needing to have ‘tough love’ applied by their government, lest they ‘fester’ on benefits.
An interesting reference is made within the book’s introduction to the rise in ‘symptom based conditions‘ and, as I will cover in a follow up to this piece, this is a concept which has been treated by Professor Aylward in two totally contradictory ways, at different points in time, an action which can only seriously call into question his motives for doing so.
Medicine is the ultimate authority, except when it doesn’t concur…
I have previously written [2] about the inconsistency of the way ideas from the BPS model are used by Professor Aylward and his colleagues -that they are inevitably used in a plastic way, and opportunistically. When the argument calls for ‘authority’ to substantiate their ideas, such as suggestions that some illnesses lack validity, medical aspects are drawn upon, as is implied in their reference to ‘medically unexplained’ conditions. In all other cases the ‘medical’ model or ‘bio’ aspect is disparaged or minimised, as, too, are medical personnel. GPs and specialists, are robbed of their authority; and their capacity to determine a person’s capability to function is questioned. In fact doctors must now be themselves ‘indoctrinated’ to some extent into the ‘new paradigm’ [7.]. This, to date, they are apparently resistant to, committed to their self-identification as patient advocates. This taken-for-granted factor, though, is seen as only one influence on them, since many are accused of being of weak character or of ignorance, through ‘fear’ of repercussions from patients should they deny the requested sick note [8], or through their lack of awareness of the positive part that work supposedly plays in recovery for their patients They are denied, within BPS ideology, the capacity to exert any form of judgement in any given patient’s situation over whether work would be a help or a hindrance to getting well. Their reticence to wholeheartedly swallow this new paradigm is constructed as a (misdirected) stubborn commitment to an irrelevant ‘medical’ perspective on sickness and disability. It is difficult to perceive this as anything other than an attempt to downplay medical authority when it does not suit the ideology or the ends that the Professor Aylward and his BPS lobby are seeking.
SNORB – Indoctrination for the doctors
What is SNORB? The acronym stands for ‘Sick Note or Bust’, a slogan whose meaning is difficult to grasp. Perhaps it makes more sense to GPs, who are its intended targets. Could it perhaps be meant to represent the attitude of patients who are determined to ‘get signed off’ at all costs? Regardless, SNORB is an initiative created by Professor Aylward’s Cardiff Centre and is part of a campaign to ‘turn around’ GPs’ thinking and change their behaviour around the issuing of sick notes to their patients. Its existence came to the fore through examination of yet another presentation given by Professor Aylward, containing the inevitable repeated themes which seek to link work and health as mutually beneficial partners. This time it was at a ‘Rehabilitation Workshop’ – for insurers, with a panel composed of representatives from the major insurance companies, NFU Mutual, Legal and General and Axa. It’s title is ‘Health and Work: The Moral Obligation’ [9]. As indicated the themes consist of ‘Work is the main (only?) route to wellbeing’, and ‘The most significant obstacle to recovery is found within the psyche, in people’s beliefs about illness’, and so on ad nauseum. The BPS lobby pave the way for a later discrediting, or minimising, of that which they intend to disparage by framing it in terms of a ‘mystery’ or ‘paradox’ or as a set of ‘myths’. Thus (in this presentation, slide 8) an alleged ‘Health paradox’ of improvements asserted to have been made in health outcomes versus increased insurance claims is constructed. As pointed out also in my article [2.], conclusions made about health by these academics are demonstrably flawed, relying on interpretation of data which favours simplistic over-generalisations that overlook such things as unequal distribution of illness across classes, or hierarchical levels of employment, or indeed geographical location. Once, however, the seed of doubt has been planted, and a shroud of mystery has been cast, it is a small matter to finish the job of delegitimisation, to render invalid commonly understood notions about illness or disability through proposing a ‘solution’ which by contrast appears clear, pragmatic and founded in comparative rationality.
SNORB is introduced to this insurance fraternity following the heading ‘Why GPs don’t want to know’, under suggestions for the removal of ‘barriers’. A description of SNORB ‘training’ materials for GPs would not do it justice and a visit to the website [10.] is necessary to fully appreciate the manner in which our doctors are being encouraged to conduct their dialogue with patients about work. I do not use the term ‘indoctrination’ lightly in this instance.
‘Objectivity’ sometimes vital, sometimes not – Two contradictory presentations.
The BPS lobby take a similar attitude to ‘objectivity’, the cornerstone of any professed scientific method, as they do to ‘medical authority’. When it suits the professor’s desired aims to emphasise the importance of ‘objectivity‘, for example in order to diminish the validity of certain conditions, those categorised in his account as ‘subjective‘ or ‘symptom based’ (ie depend largely on personal accounts of pain, discomfort and distress), then this is done. But when the desired effect is to inject some doubt into existing ways of assessing capacity in illness, (ie via the ‘medical model’) Professor Aylward depicts ‘objectivity’ as far less reliable or even achievable.
At one end of this scale a presentation which the professor gave in Amsterdam in 2007 for occupational and insurance physicians, ‘The Assessment of Work Capacity in the United Kingdom’, [11.] begins with the astonishing claim that “The assessment of Work Capacity is frustrated by the meaningless pursuit for objectivity“. The presentation ends with a call to “Abandon the forlorn pursuit of objectivity” and “Embrace the bio-psycho-social paradigm shift”. The cult-like appearance of these last two phrases comes as no real surprise since their objective is to bring about a kind of brainwashing effect into a new ‘way of thinking’. Revealingly, a note attached to the presentation declares that incapacity benefits are a “big area of reform” by which the employment rates of sick and disabled people may be increased. Are we really expected to believe that the professor has not had continuing involvement, indeed influence, in these reforms?
Contrarily, Professor Aylward’s presentation at a Sydney conference three years later, entitled ‘Realising the Health Benefits of Work’ [12.] to ‘leaders’ from Australian government and industry depicts ‘objectivity’ quite differently. Here it is presented as a taken for granted final arbiter of fact. In this case it is used, as it so often is by the BPS lobby, to undermine the validity of a range of health conditions, including mental health, musculo-skeletal and cardio-respiratory conditions. Such illnesses are minimised by alleging that they show “Limited objective evidence of disease”.
WCA – an ‘objective’ tool for assessing ‘Work Capacity’
It is disconcerting, when the professor is so particularly adamant about so many of his
assertions to see how flexible a concept ‘objectivity’ becomes in his hands, being capable of being raised or dismissed at will, apparently dependant on which underlying agenda he intends to fulfil. Considering that the major claim to legitimacy of the WCA is that it is impartial, through being built upon objective scientific principles, if as he asserts ‘objectivity’ in the assessment of Work Capacity is unattainable, then this completely undermines it as an authoritative instrument, and proves it to be a fraud. A fraud with devastating consequences for tens of thousands of innocent sick and disabled who are being denied support on its basis.
It may seem like splitting hairs to draw attention this way to the use of words. But when words are used to convince governments to undertake policy changes which aim to remove support from an estimated million people there really had better be clear, robust and consistent arguments to support them. If I were to challenge the government on an issue, and let’s imagine for a moment that it bothered to give me a reasonable reply, it would take a familiar form. Statistics would be quoted, plausible arguments raised. I would be pointed in the direction of those who had produced the research and whose credentials I should trust to have produced honest, impartial, and yes, objective work.
This cannot be said to be the case with the WCA. What we have instead is a process whose intellectual origins are worse than dubious, permeated (and therefore tainted) with vested interests of one type or another, and the academic substance of which is wanting and inconsistent at best, seriously biased and compromised at worst, contaminated by an association with private profits. As a result of it the government is pushing people off benefits faster than Disney threw lemmings off a cliff. This is Professor Aylward’s legacy, and he is clearly attempting to extricate himself from his indisputable and powerfully influential involvement in facilitating it.
Refuted connections
One of the ways that Professor Aylward is now attempting to distance himself (which in my follow up to this piece I will show is not a first for him) from what is becoming incontrovertible proof that the WCA is a fraud perpetrated upon the vulnerable, is through claims that his input into the development of this process has been minimal, and connected only vaguely to work on assessments he did while in previous service at the DSS.
Why then does he display the acronym ‘DDAM’ among his string of qualifications [13.], since ‘DDAM’ is the Diploma in Disability Assessment Medicine, a qualification specifically developed for HCPs administering the WCA – the training and accreditation for which is delivered solely by Atos Origin [14]. The primary academic reference for those studying for this qualification is the Disability Handbook [15], co-edited by Professor Aylward together with his ex-DSS colleague Peter Dewis [16.]
Both these doctors left government service to work for insurance firm UNUM, albeit for Professor Aylward it was under the umbrella of academic ‘funding’ provided by that company, though he must have necessarily been involved in negotiations with that company prior to leaving his government post in order to put that in place. Further, a third co-editor of that book, Dr Moira Henderson went on to hold the post of Chief Examiner for the DDAM from 2003 until 2012 [17.]
Dr Dewis’ involvement with the WCA is substantial. UNUM have described him as having “been instrumental in the setting up of the diploma of Disability Assessment Medicine of the Faculty of Occupational Medicine of the Royal College of Physicians” confirming that he “continues to work as an examiner for that diploma“. The 2005 UNUM page which attests to this has been removed, but Zoominfo has links to a cached version of it here: [18.]
A further reference on that page refers to the ‘leading role’ that Dr Dewis has played in the “development of disability assessment medicine”.
The ‘Disability Handbook’ is quite obviously the authoritative work on which the WCA was built and from which disability assessment has been sourced, and to which all who deal with disability in a general sense refer, bearing as it does the authoritative stamp of the UK government. Does Professor Aylward wish us to believe that although his co-editors of such an influential work have gone on to become further embedded within the Atos process, that despite being by far the most senior, influential, member of the group, and despite he himself holding the DDAM qualification, he has had nothing further to do with it?
This, while he has continued to work closely with his Unum employed colleague, Dr Dewis [19.], who now holds a Directorship with that company following an initial tenure as Chief Medical Officer ?[18] Is it really credible that he would be so uninformed about Atos and the WCA?
This information about Peter Dewis, by the way, is all the confirmation that anyone should need as proof of the direct connections between Unum and Atos, since he quite obviously works for both simultaneously. That, and the fact that Michael O’Donnell, now Chief Medical Officer since 2011 with Atos, held that exact same role for ten years with Unum. Though this is quite openly public knowledge, it is evidently not regarded as any conflict of interest by our government, despite Unum’s quite blatant attempt to capitalise on the increased precarity caused by these ‘reforms’ with their ‘Income Protection Insurance’.
Integrity – when one finds that the boot is on the other foot
Conscious perhaps of the emerging exposure of the profoundly influential role he has played in the WCA, and evidently experiencing a feeling of vulnerability concerning his reputation, Professor Aylward makes the plea of professing himself to be “a man of integrity”. Whether indeed he carries out his implied promise to ‘speak out’ if he ‘finds the WCA is not proper’ will demonstrate whether this is the case. What cannot be overlooked is the fact of the, now hundreds of thousands of sick and disabled people who have already had their integrity spuriously attacked via the humiliating, fraudulent ordeal that is the WCA, the repercussions from which have damaged far, far more than their reputations. And the root of which is without any shadow of a doubt Professor Aylward’s work.
Gill Thorburn 18th September 2012.
References
As some of the material referred to is in the form of pdfs and powerpoints I have made them available through my dropbox account. The rest are weblinks.
[1.] Professor Mansel Aylward – The Interventionist https://dl.dropbox.com/u/32109159/Aylward/01.AylwardTheInterventionist-PostOnline2009.pdf
[2.] https://dl.dropboxusercontent.com/u/32109159/Illness%20as%20Deviance.pdf
[3.] https://dl.dropbox.com/u/32109159/Aylward/03.Waddell.WorkIsGood.ppt
[4.] http://www.amazon.co.uk/The-Power-Belief-Psychosocial-disability/dp/0198530110
[5] https://dl.dropbox.com/u/32109159/Aylward/05.Sept20BPSCardiff.pdf
[6] https://dl.dropbox.com/u/32109159/Aylward/06.AtosConference2004.pdf
[7] https://dl.dropbox.com/u/32109159/Aylward/07.DWPForDoctorsWorkIsGood.pdf
[8] https://dl.dropbox.com/u/32109159/Aylward/08.Aylward.GPs.pdf
[9] https://dl.dropbox.com/u/32109159/Aylward/09.RehabilitationWorkshopForInsurers.pdf
[10] http://www.healthyworkinguk.co.uk/uploads/decision_aid/resource/snorb/
[11] https://dl.dropbox.com/u/32109159/Aylward/11.Aylward.AssessmentOfWorkCapacity.ppt
[12] https://dl.dropbox.com/u/32109159/Aylward/12.Aylward.RealisingHealthBenefitsWork.pdf
[13] http://www.debretts.com/people/biographies/browse/a/25041/Mansel+AYLWARD.aspx
[14] http://www.fom.ac.uk/education/non-specialist-qualifications-and-training/diplomas/ddam
[15] http://www.fom.ac.uk/wp-content/uploads/ddamread1.pdf
[16] http://www.wharfside.org.uk/events/disability_handbook.pdf
[17] http://www.fom.ac.uk/general-news/new-chief-examiner-diploma-disability-assessment-medicine-ddam
[18] http://www.zoominfo.com/#!search/profile/person?personId=508408589&targetid=profile.
[19] https://dl.dropbox.com/u/32109159/Aylward/18.Aylward.Unum.Cardiff.Issue1.pdf
The Problem of ‘Scientifically Unfounded Attitudes’: A BioPsychoSocial Analysis
A small, but select, number of individuals in our society can be seen to be suffering from the mysterious problem of “Scientifically Unfounded Attitudes“. This is a significant issue for society as a whole since those afflicted tend to hold high status, influential positions in the academic, state and corporate medical community, and have been complicit in cobbling together a rag bag of ideas (under the guise of a theory) which has had profoundly negative effects on many people’s lives, economically, socially and personally. This is also true of its effects on taxpayers money, a great deal of which has been wasted on spurious processes whose only objective, it seems, is to channel vast amounts of money into the pockets of private companies.
So how has this situation arisen? A biopsychosocial model is very helpful in the analysis of these individuals:
First it is necessary to address the ‘bio-medical’ element (in order to get it out of the way, which is the usual concern of these adherents). Exhaustive medical data is not available for this group, but considering their fairly advanced average age, and the fact that they are still furiously active, and able to travel extensively around the world touting their ‘theories’ suggests that they belong to a privileged sector of the health spectrum. That is, they are those in whom illness is relatively absent. This is confirmed visibly by the absence of any ‘aids’ in their conduct of work. It can be reasonably assumed, then, that they have been in the main favoured with good health.
Further, and here we introduce a social aspect into the analysis, a singular feature which connects all these individuals is their tenancy of high profile positions within state, academic or corporate agencies. Occupying, as they do, the top strata of the employment scale, which attracts to it a slew of benefits extra to the significantly high salaries these positions command, they are comfortably placed should they ever find the spectre of ill-health casting a shadow across their lives. This ‘social’ lens, then helps to explain how their distorted perspective on illness may have been reinforced by their privileged social location. The protection of affluence provides an impenetrable buffer against physical or mental affliction.
And it is the second of these, the mental, which perhaps offers the greatest insight into the behaviour and attitudes of this group. The psychological element of this model is able to highlight the source of shared distortions in beliefs that manifest within this sector of the population. Significantly this group place an excessive value upon psychological explanations of illness. Perhaps this is an instinctive acknowledgement of the fact that they, themselves, suffer from psychologically deluded ideas about the sources of illness (for reasons not unconnected to their own bio and social circumstances). Many of them, some explicitly, some tacitly, derive their understanding of illness from what is termed ‘positive’ psychology (or the rather more respectable ‘cognitive behavioural’ theory). The ideas underpinning this minority field of the discipline is that it is not the circumstances of people’s lives which determine the outcomes for them but their ‘attitude of mind‘. More rational people consider this ‘wishful thinking’, or when applied to the dire circumstances of some people’s lives by an outside agent, abuse. Other psychological dysfunctions are also visible among this group, particularly that of the persecution complex which is evidenced in ‘knee-jerk’ responses to any legitimate criticism that those actually suffering from illness have the temerity to raise.
This has been a brief analysis of this afflicted group, but it has also been a demonstration of just how widely it is possible to apply the BPS model. I believe it has been put to a far more realistic use here than it has by the group in question, who stretch one or two ideas to breaking point in their attempt to legitimise their theories, with their notably unbalanced emphasis on the (out-dated) psychological at the expense of those accompanying elements of the model. Interestingly this analysis too has found more significance of the ‘psycho‘ aspect in revealing underlying attitudes and distorted beliefs surrounding an issue. Perhaps that ultimately is this model’s failing, in that under the aegis of a purported ‘scientific’ paradigm it is able to provide a platform for the legitimisation of any, or all, biased attitudes.
Hopefully this small exercise will have enlightened people as to the uses to which the BPS model can be put. Anyone who wishes to give an apparent scientific gloss to their biased propositions need only to remember to quickly dispense with the ‘bio’ and the ‘social’ and focus excessively on the ‘psycho’ where, given its controversial history, psychology is certain to furnish them with something with which to underpin their claims.
The Whole Sorry Story
http://www.lwbooks.co.uk/journals/articles/rutherford07.html
Here I am, trying to track down Unum’s involvement with the policy making of our government(s) and their dominant influence on the ‘academic’ work that supports the prevailing perspective on illness and work, and I find that Jonathan Rutherford had the complete history nailed (in 2007). It’s quite shocking. The public haven’t a clue that a private company, an insurance company at that, has been directing our government’s hand in its welfare policy. A discredited Insurance company, sued in the U.S. and warned to act legally in future, but whom many suspect to be carrying on with dubious practices (denying disability) still.
HIDDEN AGENDA
If it isn’t apparent what value it might have for Unum to manipulate British Welfare Policy in this way, perhaps you need to take a look at this, a little glimpse into the future:
http://www.demos.co.uk/files/Mutual_benefit_-_web.pdf?1299256527
The keyword is INCOME PROTECTION. This is going to be a word that will start to gain currency in welfare and media discourse, as the public is conditioned towards the idea that ‘Hey, National Insurance is crap’, its inadequate, its not going to protect hard working people when they fall ill. Stories will start to appear that highlight this, Poor old Mr & Mrs Squeezed Middle find themselves in unfortunate circumstances and, shockingly, there is nothing there to support them in the standard to which they’ve become accustomed. When its only the ‘scroungers’ and ‘malingerers’ that are being made destitute that’s one thing, but this ‘report’ points out that it could happen to YOU, the honest and conscientious worker! The responsible citizen takes extra steps towards saving themselves. And your government will be very involved with the Insurance industry in developing this ‘new national insurance’. As it has been since Unum first got into bed with them in 1994.
A Very Tangled Web
http://hackneyunemployedworkers.files.wordpress.com/2010/06/privatisation-and-welfare-reform.pdf
Well, well. This one has it all really. Aylward, Unum’s influence on the DWP.
Mansel Aylward.
In 2005 he was elected to the new Health Honors Committee,
designed to make the system more transparent. Given the much publicised
emphasis on the need for “transparency” within all Government departments,“One again has to ask how it can be acceptable for a “policymaker”
at the head of a Government Department clearly to have had such close involvement with an insurance company like UNUM whilst he was advising Government and formulating policy,”
More than this, we can see the future of Mansel Aylward’s preferred delivery service, as in his own words,
“By incorporating the Biopsychosocial Model into disability
assessment, we can identify critically important information on
obstacles to recovery, which in many cases can be tackled by an
integrated package of support such as that offered in the Pathways to
Work pilots and as provided by UnumProvident’s Claims
Management and Rehabilitation Services.”
johnny foreigner: So many fingers, so many pies.
johnny foreigner: So many fingers, so many pies..
More about Professor Aylward.
I shall choose some choice quotes once I have a chance to read it all. Breakfast calls!
ATOS and the surprising bounce
A FOI response from the DWP to a Ms Blair-Jordan dated 5th November 2010 stated the following:
“The clinical examination results are structured according to the findings of evidence based medical research carried out by Atos Healthcare to determine the functional consequences of specific clinical signs.”
This paragraph followed the defense of the phrases used to construct a medical history of the claimant, detailing the ways in which they had been ‘quality assured’ and deemed relevant. They claim to have subjected the material to accredited panels and that it was agreed in consultation with what was formerly Corporate Medical Group (now DWP Health & Benefits Division). Mansel Aylward was leader of the Corporate Medical Group, a post he seems to have left to take up the UNUM funded post at Cardiff.
Mansel Aylward
“led the Corporate Medical Group on the UK Government’s Welfare Reform initiatives and made a major contribution in establishing the new postgraduate diploma for doctors in Disability Assessment Medicine.”
As I would very much like to examine this primary research I emailed ATOS Healthcare on 22nd July to request identification of it. I imagine such an important piece of research must have been widely disseminated and peer reviewed considering the bearing it has on people’s wellbeing.
My email:
Dear Atos Healthcare,
In a FOI response to a request for information regarding the Work Capability Assessment it states that the structure underpinning it is derived from “evidence based medical research carried out by Atos Healthcare to determine the functional consequences of specific clinical signs”. I assume that this research has been subject to the usual academic rigours and has been published widely, being such an important work. Can you therefore provide the context in which this has been done, point towards editions of journals etc containing these findings, in which peer review and scrutiny took place.With thanks,
Their response:
Thank you for your e-mail below. I can confirm that I have forwarded your Freedom of Information Act request to the appropriate Freedom of Information Officer who is
Commercial Management of Medical Services
Department for Work and Pensions
Room 306
Block 3, Norcross
Norcross Road
Blackpool
FY5 3TAAny further communication regarding this request should be sent to them.
Yours sincerely
Gemma Bowes
Customer Relations Manager
Now this is interesting on two points. First it was not a FOI request, though I reference one. I was requesting info about medical research, you know stuff that is published in medical journals, at conferences etc, material that should be available academically. I have academic access at the moment and would like to scrutinise it.
Secondly when I received my second letter from the Correspondence Team in response to my letters to Iain Duncan Smith and Chris Grayling I was advised to contact ATOS Healthcare with my concerns (and not ministers presumably). Their full response, along with my letter to Grayling, is in the ‘Talking to thisgov section of my blog.
So, it seems I have been ‘bounced’. The gov have bounced me over to ATOS, ATOS have bounced me over to the gov. Like a hot potato.
I will, of course be writing a follow-up email to ATOS highlighting their misunderstanding of the purpose of my request, which concerned material generated independantly by their company and which had nothing to do with the DWP. It is claimed to be medical research and I want to know who carried it out and where it was published. I may be surprised and the ‘Commercial Management of Medical Services’ at the DWP may provide this. We’ll see.
Update:
My follow-up email to ATOS, sent today 23rd July:
Thank-you for your response. I feel, however that you have been misled somewhat by my reference to FOI. What I in fact was requesting was information about your company: ATOS Healthcare’s, evidence-based medical research which underpins the Work Capability Assessment.
The DWP state, and I quote:
“The clinical examination results are structured according to the findings of evidence based medical research carried out by Atos Healthcare to determine the functional consequences of specific clinical signs. “
Therefore there exists, whether in journal form or reports from conferences or other material a body of published medical research carried out by ATOS, accessible through academic access, if not publicly. Especially in such an important area as Public Health research must be impartial and withstand academic scrutiny. I wish to be informed of what this research consists, researchers involved, methods, conclusions drawn etc. The research was conducted by ATOS and has nothing to do with the DWP. It is a very straightforward request. If the research exists please direct me towards it, or explain why it is unavailable.
Update:
Their response, 25th July 2011:
Thank you for your enquiry. Further to the action taken by my colleague, Gemma Bowes, I can confirm that any enquiry related to an area of Atos Healthcare’s Business is a FOI. Under the terms of our contract with the DWP, CMMS (Commercial Management of Medical Services) are responsible for dealing with such requests.
regards
Lesley Hemingway
Customer Relations Team
I am only seeing muddy waters over this, and can only think that this is what happens when the corporate is mingled with the public/state. Why should the fact that a company has a contract with the DWP prevent it from releasing the sources of its research? Why does it fall to the DWP to release these sources of research through FOI? It seems as if ATOS have had written into its contract that they should be shielded from any analysis of their practices.
Update:
http://www.whatdotheyknow.com/request/identification_of_medical_resear#incoming-197479
Decided not to wait for Atos’ forwarded FOI request to the DWP – did it myself ^
We’ll see how that pans out by no later than 26th August. I am so looking forward to getting to grips with Atos’ research and seeing how they link underlying medical pathology with functional capabilities! This must be some huuuuuge body of work to cover all those conditions, physical and mental, providing evidence for all the precise differentiation of categories, the strengths of the various ‘capacities’ within them and the subtle nuancing required for interlinking between condition and functionality. Some body of research that, like.
downwithallthat 