Reattribution Study

Thanks to Tom K for this one:

[UK£459,707 = US$911,339 = EUR634,812]

This (unsuccessful) study on reattribution

["Reattribution is frequently taught to general practitioners (GPs) as a
structured consultation that provides a psychological explanation for
medically unexplained symptoms"]

was included in the list Professor Colin Blakemore (Chief Executive, Medical
Research Council (at the time)) supplied to Invest in ME for his article on
MRC funding of "CFS/ME" (see page 24): "Annex 2 - Current MRC support for
CFS/ME research" in Journal 1 http://tinyurl.com/2mvnzs i.e.
<http://www.investinme.org/Documents/Journals/Journal%20of%20IiME%20Vol%201%
20Issue%201.pdf>.

When the study was happening it was also mentioned (although not by name) on
the "CFS/ME" page of the MRC http://tinyurl.com/32yy4z e.g.
<http://web.archive.org/web/20051111122423/www.mrc.ac.uk/index/public-intere
st/public-topical_issues/public-cfs.htm>
"Indirect support through two trials exploring the management of patients
with persistent unexplained symptoms."
[It isn't mentioned on the current page
http://www.mrc.ac.uk/YourHealth/HealthArticles/CFS-ME/index.htm as it's
finished "Indirect support through one trial exploring the management of
patients with persistent unexplained symptoms" refers to a trial involving
Michael Sharpe (a well-known psychiatrist of the CBT School of Thought].

The MRC awarded ***£459,707*** for this study on 10th July, 2003:
[ref: http://tinyurl.com/2mjg3v i.e.
http://www.nrr.nhs.uk/2006AnnualReports/ProgrammeSameIDRecords.asp?Code=RW4&
Title=Mental+Health+in+the+Community ]

Four of the people involved in the study are involved with the FINE Trial on
CFS (cost over £1.1m paid for by the MRC and the NHS).

Incidentally, one of the authors of this study, Dr Chris Dowrick, (who is
one of the people involved in the PACE trial) is giving a talk "Assessment:
physician's approach" at the RSM Conference on CFS, April 2008
http://www.rsm.ac.uk/academ/cfs.php .

To the best of my knowledge, no project headed by somebody not from the CBT
school of Thought wrt CFS (e.g. Sharpe, Chalder, Wearden, Wessely, White,
Morriss, Creed, etc) has ever through the (UK) MRC's grant approval process.

Tom (Kindlon)

---------------

1: Br J Psychiatry. 2007 Dec;191:536-42.

Cluster randomised controlled trial of training practices in reattribution
for medically unexplained symptoms.

Morriss R, Dowrick C, Salmon P, Peters S, Dunn G, Rogers A, Lewis B,
Charles-Jones H, Hogg J, Clifford R, Rigby C, Gask L.

Division of Psychiatry, School of Community Health Sciences, University of
Nottingham, South Block, A Floor, Queen's Medical School, Nottingham, NG7
2UH, UK. richard.morriss@nottingham.ac.uk.

BACKGROUND: Reattribution is frequently taught to general practitioners
(GPs) as a structured consultation that provides a psychological explanation
for medically unexplained symptoms.

AIMS: To determine if practice-based training of GPs in reattribution
changes doctor-patient communication, thereby improving outcomes in patients
with medically unexplained symptoms of 3 months' duration.

METHOD: Cluster randomised controlled trial in 16 practices, 74 GPs and 141
patients with medically unexplained symptoms of 6 hours of reattribution
training v. treatment as usual.

RESULTS: With training, the proportion of consultations mostly consistent
with reattribution increased (31 v. 2%, P=0.002). Training was associated
with decreased quality of life (health thermometer difference -0.9, 95% CI
-1.6 to -0.1; P=0.027) with no other effects on patient outcome or health
contacts.

CONCLUSIONS: Practice-based training in reattribution changed doctor-patient communication without improving outcome of patients with medically unexplained symptoms.

PMID: 18055958 [PubMed - in process]

* * *

As Dr. Starlanyl points out, "if all tests are normal, the right tests haven't been done yet".  There's no such thing as a medically unexplained symptom, only doctors who haven't delved deeply enough looking for the cause.

Dr. Katrina Berne observes that doctors should "Avoid the labels "somatizer", "hypochondriac", "neurotic" and "crock". All symptoms have origins and should be taken seriously."

Re-attributing post-viral problems to psychology accomplishes nothing except guaranteeing that the patient will not receive the proper treatment to get well.  The doctors then, like mine, accuse the patient of not wanting to get wellwhen, in fact, the patient would very much like to get well, if only the doctors would prescribe the correct medication instead of trying to coax the patient to try harder to do what the patient finds physically impossible.