From The Guardian 19th July 2011:
"Healthier behaviour plans are nudge in the wrong direction, say peers: House of Lords committee criticises attempts to curb junk food and alcohol consumption through voluntary agreements"
This article relates to a House of Lords science and technology committee report which questioned ministers use of what is known as the nudge theory.
Nudge theory is described in the book by Thaler and Sunstein entitled "Nudge: Improving decisions about health, wealth and happiness". Nudge theory advocates influencing behaviour by altering the context or environment in which people choose.
Here are a couple of quotes from the book:
"Nudges count as such and qualify as libertarian paternalism only if any costs are low"
"By properly deploying both incentives and nudges, we can improve our ability to improve peoples lives"
Nudge theory is relevant to social policy; it is not a tool to be used at the individual level. For instance, to pry into peoples personal habits is not a nudge, it's a poke in the ribs and a health consultant should not do it.
Infact, often people find themselves tossed precariously on stormy waters; a little nudge from government in such a situation is not going to have much influence. In such a situation, the Health Consultant would wish to support and assist you until you feel yourself rocking gently on those waves.
Stevie Smith - Not Waving But Drowning
Nobody heard him, the dead man,
But still he lay moaning:
I was much further out than you thought
And not waving but drowning.
Poor chap, he always loved larking
And now he's dead
It must have been too cold for him his heart gave way,
They said.
Oh, no no no, it was too cold always
(Still the dead one lay moaning)
I was much too far out all my life
And not waving but drowning.
Friday, 22 July 2011
Friday, 15 July 2011
Making Headway
Ending the stalemate over CFS/ME
Fiona Godlee
BMJ 2011;342:doi:10.1136/bmj.d3956 (Published 22 June 2011)
The very term CFS/ME indicates the separation and disagreement that exists over this condition. It seems a sensible approach not to argue over terminology, whether it's CFS or ME, and use the term CFS/ME. Diagnostic classifications, causation and treatments are all still hotly disputed. What would the Health Consultants position be?
The Health Consultant does not treat illness. Really?
Enhancing health is quite distinct from treating illness. Illness and its multitude consequences will inevitably drain health and vitality and it is the role of the Health Consultant to help restore this. If you were looking for somebody to execute a cure to your illness you would need to look elsewhere.
The Health Consultant helps the person; a constructive approach to enabling health would be possible without the client even mentioning any diagnostic labels. Such labels result in certain judgements being made; not always a bad thing if information is properly deliberated to avoid it being misjudged.
When working with the Health Consultant it should be apparent to you that you are engaged in a confidential dialogue, that is open-minded, impartial and focused on positive outcomes.
Fiona Godlee
BMJ 2011;342:doi:10.1136/bmj.d3956 (Published 22 June 2011)
The very term CFS/ME indicates the separation and disagreement that exists over this condition. It seems a sensible approach not to argue over terminology, whether it's CFS or ME, and use the term CFS/ME. Diagnostic classifications, causation and treatments are all still hotly disputed. What would the Health Consultants position be?
The Health Consultant does not treat illness. Really?
Enhancing health is quite distinct from treating illness. Illness and its multitude consequences will inevitably drain health and vitality and it is the role of the Health Consultant to help restore this. If you were looking for somebody to execute a cure to your illness you would need to look elsewhere.
The Health Consultant helps the person; a constructive approach to enabling health would be possible without the client even mentioning any diagnostic labels. Such labels result in certain judgements being made; not always a bad thing if information is properly deliberated to avoid it being misjudged.
When working with the Health Consultant it should be apparent to you that you are engaged in a confidential dialogue, that is open-minded, impartial and focused on positive outcomes.
Tuesday, 5 July 2011
Acupuncture
Acupuncture for ‘frequent attenders’ with medically unexplained symptoms: a randomised controlled trial (CACTUS study) Paterson et al. The British Journal of General Practice June 2011
The introduction to this paper states:
"People who have persistent physical symptoms that cannot be explained by current medical knowledge (‘medically unexplained physical symptoms’ [MUPS]) make up 11–19% of UK GP consultations and up to 50% of new referrals to outpatient clinics."
A large proportion of patients in the NHS are being lumped into the box labelled "MUPS". The result of this is expressed well in the same paper:
"In addition to their physical symptoms, such patients, and their doctors, are distressed and frustrated by the lack of explanation, credibility, and acceptable treatment options."
The CACTUS study concluded:
"The addition of 12 sessions of five-element acupuncture to usual care resulted in improved health status and wellbeing that was sustained for 12 months."
"The factor for which least evidence was found was the sharing of acceptable and empowering explanations"
It should be noted that this study used practitioners fully trained in traditional 5-element acupuncture rather than the minimally trained western medical practitioners within the NHS who adhere to conventional western neurophysiological principles. The findings show very clear benefits to the patients. It is suggested that further work is needed regarding explanations that patients find "acceptable and empowering". It would be interesting to see the difference it makes if the gap between western medical explanations and alternative theories is bridged to allow greater health enablement; this is what the Health Consultant aims to do.
The introduction to this paper states:
"People who have persistent physical symptoms that cannot be explained by current medical knowledge (‘medically unexplained physical symptoms’ [MUPS]) make up 11–19% of UK GP consultations and up to 50% of new referrals to outpatient clinics."
A large proportion of patients in the NHS are being lumped into the box labelled "MUPS". The result of this is expressed well in the same paper:
"In addition to their physical symptoms, such patients, and their doctors, are distressed and frustrated by the lack of explanation, credibility, and acceptable treatment options."
The CACTUS study concluded:
"The addition of 12 sessions of five-element acupuncture to usual care resulted in improved health status and wellbeing that was sustained for 12 months."
"The factor for which least evidence was found was the sharing of acceptable and empowering explanations"
It should be noted that this study used practitioners fully trained in traditional 5-element acupuncture rather than the minimally trained western medical practitioners within the NHS who adhere to conventional western neurophysiological principles. The findings show very clear benefits to the patients. It is suggested that further work is needed regarding explanations that patients find "acceptable and empowering". It would be interesting to see the difference it makes if the gap between western medical explanations and alternative theories is bridged to allow greater health enablement; this is what the Health Consultant aims to do.
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