Posts Tagged ‘Biopsychosocial Theory’

George Berger on Gordon Waddell and the Origins of the Work Capability Test

February 9, 2015

A few weeks ago I blogged about a piece on Mike’s site, Vox Political, by Mo Stewart describing Unum’s role in formulating the fitness for work test. This is the prize piece of pseudoscience used by the DWP and Atos to deny people welfare benefits on the grounds that, no matter how ill or disabled they are, they are still somehow ‘fit for work’. In the most extreme cases, this has resulted in terminally ill people having their disability benefit removed and blandly informed that they will have to be reassessed. Just in case, you understand, that they get better.

One of the commenters on the piece was George Berger, who kindly informed me of his piece on the DPAC website tracing the origins of the fitness for work test in the bizarre theories of Gordon Waddell. Mr Berger commented:

It seems that the historical source is Waddell’s work on back pain and non-organic signs. That was imaginatively extended to “invisible illnesses.” The back pain work was heavily criticised by medical people in his specialism, yet he seems to have been protected by Aylward and maybe others. I did not know about the purely medical critique when I wrote this.

http://dpac.uk.net/2014/09/gordon-waddells-biopsychosocial-attack-on-disabled-people/

As you can see from the link, it’s entitled Gordon Waddell’s Biophysical Attack on Disabled People.

Gordon Waddell was a highly respected orthopaedic surgeon, who drew on George Engels’ holistic theories of the origin of disease. Engels believed that for patients to be made better, the healer should address all aspects of their condition, including its social and psychological components. Waddell, however, perverted this into the current government policy that sees patients as essentially malingerers. In his papers ‘Nonorganic Physical Signs in Low-Back Pain’ (Spine, volume 5, number 7, 117-125); and ‘A New Clinical Model for the Treatment of Low-Back Pain’ (Spine, volume12 number 7, 632-644), published in 1980 and 1987, Waddell stated that there were symptoms in lower back pain that had no physical cause. He believed these were entirely psychological in origin. These non-organic symptoms in turn produced depression, a feeling that treatment hadn’t worked, and encouraged the patient to adopt a ‘sick role’. Mr Berger quotes from Waddell’s 1998 book, The Back Pain Revolution, ‘that illness behaviour quite often ‘focuses on money and implies malingering,’ and that it ‘may depend more on… psychologic events than on the underlying physical problem’ (1998: 216, 227).’

George Berger states that Waddell’s scientific methodology is simply wrong, and that it was strongly influenced by Skinner’s Behaviourism, which in turn has been categorically demolished by none other than that great American radical, Noam Chomsky, amongst others.

Despite its falsity, it has been seized upon by New Labour and Tory governments determined to cut the welfare bill. Waddell’s ideas on pain and malingering were taken up by Atos at a conference in 2004. Another doctor, Christopher Bass, used his biopsychosocial theories to explain chronic fatigue syndrome, fibromyalgia, chronic low-back pain, repetitive strain injury and non-cardiac chest pain, as all essentially psychological malingering. Waddell’s ideas were taken up by UnumProvident, the American insurance fraudster, whose head, John LoCascio, attended a conference at Oxford on malingering and illness deception. The corporation then set up the UnumProvident Centre for Psychosocial and Disability Research at Cardiff University. Finally, in 2006 Waddell and A. Kim Burton wrote that ‘Work is generally good for health and well-being’, a line now repeated ad nauseam by the cretins now stuffing the DWP under Esther McVile and Iain ‘Tosser’ Duncan Smith.

There’s far more over in George Berger’s original article, and it’s definitely worth reading for anyone interested in a very scholarly destruction of this pernicious piece of pseudoscience.

Mo Stewart on Government, Quackery and Fraud by Unum Provident

January 21, 2015

Quack Tractors Caricature

Vox Political has a fascinating guest piece by Mo Steward, a long-time friend of the site. This describes the malign influence on the British government’s welfare policies towards the disabled by the American medical fraudster, Unum, and their pet academics, Gordon Waddell and Manzel Aylward. Waddell and Aylward were professors at a Cardiff University department, funded and explicitly named after Unum, who applied the biopsychosocial model of disease. This was used by Unum as the basis for refusing to pay out on its insurance claims in America. Stewart details how the scientific basis of Unum’s policies has been discredited, and the insurance giant named as the second biggest fraudulent insurance provider in America by the federal authorities. Waddell and Aylward’s report, which has formed the basis for subsequent government attempts to reform and remove benefit payments for the disabled, is also comprehensively discredited. It is more or less entirely self-referential, which means that basically its arguments are unsupported by anyone else.

It is rubbish.

This hasn’t stopped it influencing the British government since a conference on reforming welfare by New Labour in 2001, where the emphasis was on the perceived idea that people claiming disability benefits were malingering. This has shown to be untrue, not least in America, where Unum was branded a ‘disability denier’ by the federal authorities. Nevertheless, Unum’s role in government policy has persisted, not least because one of the New Labour politicos at the conference was the appalling Lord Freud, who subsequently defected to the Tories. The result has been that over ten thousand people have died, despite being described as fit for work by Atos. Mo Stewart gives the precise figures. The DWP has been so shamed by these figures, that they have refused to publish them for succeeding years. The policy has also been responsible for the rise in hate crime towards the disabled, who are now generally perceived by the public as malingering spongers.

Stewart’s article’s entitled: The influence of private insurance on UK welfare reforms – Mo Stewart. It begins

Here’s a timely article by Vox Political‘s friend Mo Stewart.

At a time when the main focus of attention appears to be on Maximus, the company taking over Work Capability Assessments, Mo says she hopes this will encourage people to deal with the real villains – UNUM Insurance.

Now let’s go over to Mo for further information about UNUM:

Much has been written about the Work Capability Assessment (WCA), including the fact that it was recently deemed as being fatally flawed by the Work and Pensions Select Committee1 (WPSC): ‘The flaws in the Employment and Support Allowance (ESA) system are so grave that simply “rebranding” the assessment used to determine eligibility for ESA (the Work Capability Assessment WCA) by appointing a new contractor will not solve the problems, says the Work and Pensions Committee in a report published today.’1,2,3

The WCA was introduced by the New Labour government in 2008 and is exclusively conducted by Atos Healthcare until March 2015. The assessment is mandatory for recipients of Incapacity Benefit being migrated to the Employment and Support Allowance (ESA) and for all new ESA applicants. Following much controversy, Atos Healthcare announced that they are to withdraw early from the Department for Work and Pensions (DWP) contract to conduct the WCA.

The plan to ‘dismantle the welfare state’ was first suggested by the 1982 Thatcher government4 and has been relentlessly pursued by successive United Kingdom (UK) governments. Hence, in the Coalition government’s response to the select committee’s evidence,5 the Minister for Disabled People, Mike Penning MP, disregarded the very detailed information provided by the WPSC report3 that clearly listed the many serious problems still faced by those who must endure the WCA to access the ESA benefit.

It’s extensively footnoted, so you can see that it is very definitely factually accurate. Unlike the rubbish spouted by Freud, Waddell and Aylward.

It’s at http://voxpoliticalonline.com/2015/01/20/the-influence-of-private-insurance-on-uk-welfare-reforms-mo-stewart/ Please read it and get informed about the influence of this bunch of malign quacks on government policy.

This illustration at the top of this post is an etching by Charles Williams from 1802, The Tractors, satirising one particular brand of late 18th – early 19th century quacks. The beams coming from the woman’s mouth read ‘Half-Hints’, ‘Malignity’, ‘Destruction’, ‘Scandal’, ‘Envy’ ‘Hypocrisy’ and ‘Innuendoes’, all terms that could fairly be applied to the malign influence Unum, Waddell and Aylward have had on British government, and the way their fraudulent pseudoscience has destroyed the lives and dignity of the disabled.

The 18th and 19th century was the heyday of some of the most brilliant satirists and caricaturists wielding pen and ink. These men mercilessly skewered medical quacks and pompous, grasping and incompetent doctors, as well as other topics like the royal family and corrupt, mendacious and incompetent politicians. One can only guess what Gilray and Cruikshank would have done to Waddell and Aylward.

From 2012: Private Eye on Bad Atos Decisions and Flawed Government Reports

January 20, 2015

In their 27th January – 9th February 2012 issue, Private Eye reported the case of Keith Tilbury, a man who had suffered severe physical and psychological harm after being accidentally shot by a police firearms instructor. Despite the severity of his injuries, Mr Tilbury was nevertheless judged fit for work by Atos. The same article also criticised the government report which forms the basis for the government’s replacement of the Disability Living Allowance with the Personal Independence Payment. It ran:

Fit-For-Work Tests
Shits in the Dark

In the Eye’s growing post-bag of appalling decisions made by French service company Atos in assessing sick and disabled people as being ~”fit for work~”, one of the most shocking concerns Keith Tilbury.

Mr Tilbury spent 13 days in a coma fighting for his life after he was accidentally shot in the stomach by a police firearms officer. The bullet smashed a rib, damaged his sternum and put a hole in his liver. He had to have part of a kidney removed and lost part of his bowel. He had massive entry and exit wounds, muscle and other extensive soft tissue damage.

Since that disaster in 2007, Mr Tilbury has suffered two heart attacks, two while undergoing surgery, a quadruple coronary bypass, two transient ischemic attacks (mini-strokes), one full-blown stroke resulting in reduced vision 9in his eyes, post-operative complications – and post-traumatic stress disorder.

Mr Tilbury, 60, says: ” I have had many hours of cognitive behaviour therapy with a psychotherapist trying to work out why a Thames Valley Police firearms instructor would fire Dirty Harry’s weapon of choice – a.44 magnum – in a seminar room.”

Given his well-documented health records, Mr Tilbury, who had been a civilian emergency call centre operator, is trying to establish how on earth the Atos nurse or doctor – he is not sure which – could decide that he is fit to work without “dropping down dead” when there has been no improvement in his health since his last assessment.

Like thousands of others, Mr Tilbury is having to go through the ordeal of appealing against the decision. He sees the box-ticking Atos test – drawn up with the help of US insurance giant Unum, which was fined millions in the US for cheating its clients – as no more than a government tool to slash the benefits of people who through no fault of their own can no longer work.

As the Eye has extensively reported (see issues 874, 1300, 1301 and 1302), Unum has been helping both Tory and Labour government with so-called welfare reform, going right back to Peter Lilley’s 1994 social security “Incapacity for Work” shake-up.

Atos, which boasts that its contract with the current government is worth “approximately 100m a year”, happened to be the only other private company sitting alongside Unum on the then Labour government’s panel which reviewed and came up with the hated “work capability test” which is now failing Mr Tilbury and thousands like him.

Companies like Atos and Unum (which markets its insurance on the back of welfare reform) now stand to make even more millions, however, as the coalition presses ahead with its plans for similar assessments for those receiving disability living allowance (DLA). By replacing DLA with a personal independence payment which is subject to regular review and face-to-face assessments, the government says it can save £1bn because it claims many people no longer require the support.

But a recent detailed study, Responsible Reform, accuses the government of consistently using inaccurate figures to exaggerate the rise in DLA claimants, while concealing the overwhelming opposition to its latest reform. The detailed 40-page study – dubbed the Spartacus report and written and funded by disabled people receiving DLA, excluding those with mental health conditions, had remained remarkably stable.

One of the authors, Kaliya Franklin, said: “cutting spending on DLA will increase the burden on local authorities, the NHS and community services at the very time they seeking to find savings by reducing eligibility, particularly for social care support.”

There is no point in subjecting people with permanent disability to regular assessments and those whose conditions do improve would welcome reform – and indeed assessments – if they were simplified and considered robust, fair and transparent. But as Mr Tilbury and so many like him have found, the government’s work capability test, delivered by Atos, is none of those things.

PS: After the shooting incident in which Mr Tilbury was injured, Thames Valley police was fined £40,000 with £25,000 costs and the PC fired the weapon, David Micklethwaite, £8,000 and £8,000 costs, for breaching health and safety regulations.

Although Atos have now pulled out of administering the test, the same deep flaws remain. The test itself, as reported by many bloggers such as Johnny Void, and Mike over at Vox Political, is based on discredited pseudoscience, the biopsychosocial model of illness. Johnny Void has also blogged the other day about how the new contractors for the test, Maximus, will pursue exactly the same policies and recruit many of the same personnel. The only difference is that they’re better at PR, and are seeking to conceal their involvement behind a front company. And Unum are still pressing for further contracts and the dismantlement of the welfare state.

As for the discontinuation of the DLA and its replacement with PIP, many bloggers, including Mr Void and Mike have criticised this. Bloggers like Glynis Millward and the people at DPAC also posted on the findings of the Responsible Reform report.

The Work Capability Assessment is rubbish, and has been shown repeatedly to be rubbish. But as Johnny Void has reported, some Labour shadow ministers continue to think that the system only needs to be reformed.

It doesn’t. It needs to be scrapped completely, along with the parasitic and malign companies, Unum and Maximus, that formulated and administer it.