>>>independent/computer_page 66 abrown(42)16sep93 9:51 Richardd's piece on RSI is in tomorrow.. >>>independent/computer_page 67 richardd(99)16sep93 22:00 c66 ... and it has a brief mention of Cix's RSI conference (j rsi for details) [end of plug] Richard >>>independent/computer_page 68 jfletcher(702)17sep93 10:42 c67 As a quack I have a bit of a problem with the concept of Repetitive Strain Injury - isn't this just a fancy name for the stiff neck you get if you sit in one position for a prolonged period? Also, why has the condition only just been recognised? OK, computers have only recently become part of people's daily lives, but typewriters have been around for over 100 years. In fact, ISTM that the typewriter posture should cause even more problems than the computer position, because when you use a typewriter your head is flexed (to look at the paper on the platen) whereas with a computer monitor, you look straight ahead. Isn't RSI simply a product of the 'compensation culture'. jeremy >>>independent/computer_page 69 tchannon(823)17sep93 13:52 c68*m :-) Typing came in many forms (sic) as does using a computer keyboard. RSI seems to be more to do with joint/nerve problems, and other intensive things such as playing musical instruments can cause problems. (personally the former causes me no problem, the latter does but I have to option of not doing it or switching instruments) What would you suggest as the cause and treatment for things like tennis elbow and is this practical for a working person? (hope I am guessing correctly) I suspect that we agree on the nebulous nature of rsi. OTOH I do not think that people should be forced to work for long periods making similar movements and yet this seems to be acceptable in many businesses. Long term, technology will remove most irritations (pun intended) eg. work in clearing houses will be completely automated. >>>independent/computer_page 71 jfletcher(656)17sep93 19:41 c69 >>What would you suggest as the cause and treatment for things like tennis elbow... Sure, I take your point - tennis elbow is unquestionably a 'real' entity with an organic basis, but it is a very precise complaint viz. pain and tenderness over a specific point of muscle insertion on the outside of the elbow, which can be related to particular forms of repeated movement at the joint. OTOH, RSI seems to be a much more nebulous concept altogether and has the potential to be expanded to include virtually any of the myriad aches and pains to which the human frame is heir. I agree with everything you say in your final paragraph. jeremy >>>independent/computer_page 70 richardd(4315)17sep93 13:57 c68* Sorry about the length of this message, there is a lot to respond to .... > As a quack I have a bit of a problem with the concept of Repetitive > Strain Injury - isn't this just a fancy name for the stiff neck you get > if you sit in one position for a prolonged period? The name is just a convenient term for a number of disorders, some of which have been recognised by medical science (e.g. carpal tunnel syndrome, tenosynovitis) and some of which are not recognised but undoubtedly cause real pain for people. Personally, I would not include a stiff neck as an RSI, though this is a common precursor and is often associated with it. The pain experienced is enough that some RSI sufferers cannot use their hands for anything, even such tasks as cooking, opening doors, and carrying shopping can cause intense pain. I know one woman who had to be fed for three months due to the pain of feeding herself. So this is not just a fancy name for a stiff neck :-) The name is not helpful since it suggests a single disorder, perhaps work related upper limb disorders (WRULDs, note plural) is a better term, since this does not masquerade as a medical term. > Also, why has the > condition only just been recognised? OK, computers have only recently > become part of people's daily lives, but typewriters have been around > for over 100 years. In fact, ISTM that the typewriter posture should > cause even more problems than the computer position, because when you > use a typewriter your head is flexed (to look at the paper on the > platen) whereas with a computer monitor, you look straight ahead. Carpal tunnel syndrome has been recognised for a long time, and the essential characteristics of RSI were recognised by Bernardini Ramazzini in the 1700s. RSI has afflicted eighteenth century seamstresses and continues to afflict production line workers. Typewriters have been around a long time, and they DO cause RSI - I know people who used manual typewriters who got RSI that way. You are absolutely right about typewriter posture - unfortunately that posture is very similar to that used in about 90 per cent of the work stations that I see as a computer consultant. If correctly set up with monitor near eye level, the risk of RSI due to neck problems is somewhat reduced, but increased keying rates and lack of natural breaks (see below) may result in a higher overall risk of RSI from computers, relative to typewriter usage. The current increased awareness of RSI may be due to a number of factors: - journalists and professionals have started getting it - the number of cases has grown at approx 30 per cent per annum in the US, perhaps due to the increase in use of computers for work in the US from approx 670,000 in 1976 to about 45 million in 1990 (from memory). - the incidence amongst keyboard users may well have increased due to the fact that electronic keyboards, word processing and better computer technology reduce the number of natural breaks to feed new paper, use Tippex, wait for computer operations, etc. - jobs are becoming more knowledge intensive, and unfair dismissal is more often challenged in industrial tribunals or courts - so employers find it more costly to dismiss someone with RSI and train a replacement. > > Isn't RSI simply a product of the 'compensation culture'. This is presumably a reference to the RSI epidemic in Australia, where some claims were apparently due to the availability of compensation. In the UK, there is practically no compensation for RSI - you have to prove you are 14 per cent disabled to get invalidity benefit, which is very hard even if you are in great pain due to a medically unrecognised condition! The Government has tightened up a lot on invalidity benefit claims, too, resulting in genuine RSI sufferers often getting nothing more than unemployment benefit. Lack of compensation means that there is no incentive to get RSI, there are lots of disincentives. This kind of comment is deeply unhelpful to people who are in more or less constant pain - doctors such as yourself should inform themselves a bit more about current research which shows that the forms of RSI not recognised currently by medical science do in fact lead to measurable changes in nerve transmission, and are not simply compensationitis. Richard >>>independent/computer_page 72 jfletcher(2172)17sep93 19:41 c70 Wow! Where do I start? First - a general point. There are clearly, embedded within the term 'RSI', conditions such as carpal tunnel syndrome, ulnar nerve palsy, tennis and golfer's elbows, and writer's cramp, which are well-defined entities of presumed organic origin which are caused by repetitive actions of occupational or other origin. The problem is that there is a risk that a lot of more nebulous complaints have been smuggled into this portmanteau term. Why not dump the term altogether and use the specific names (for example those listed above) for the appropriate conditions? >>... perhaps work related upper limb disorders (WRULDs, note plural) is >>a better term, since this does not masquerade as a medical term. That's even worse! Sounds exactly like a medical term! >>- journalists and professionals have started getting it I like the distinction between journalists and professionals! ;-) >>- the number of cases has grown at approx 30 per cent per annum in >>the US, perhaps due to the increase in use of computers for work... Or the increase in compensation payments? >>This is presumably a reference to the RSI epidemic in Australia... No - I hadn't heard about that. >>Lack of compensation means that there is no incentive to get RSI, >>there are lots of disincentives. Oh no - 'illness behaviour' has lots of incentives and rewards (apart from the potential for compensation): people have written doctoral theses on the subject. >>This kind of comment is deeply unhelpful to people who are in more or >>less constant pain - doctors such as yourself should inform themselves >>a bit more about current research which shows that the forms of RSI >>not recognised currently by medical science do in fact lead to >>measurable changes in nerve transmission, and are not simply >>compensationitis. Well I'm sorry you're upset, but doctors are pretty hard-headed people who like to see solid evidence before accepting the existence of a new condition. I would be interested if you have references to medical research on the subject, but only those published in journals listed in Index Medicus please. jeremy >>>independent/computer_page 73 richardd(7539)17sep93 22:33 c72 Another long message ... if anyone wants this to continue in the rsi conference, we can move it there. > Wow! Where do I start? > That's funny, that was my reaction to your original message :-) > Why not dump the term altogether and use the specific > names (for example those listed above) for the appropriate conditions? This may be medically precise but it then leaves those with non-specific RSI, if I can call it that, with no term to describe their condition. Whether this is a wholly physical, compensation-driven or psychological condition, there should be a term to describe it, in my opinion. I understand the reason why medical science tends to reject anything that does not fit into the current model, but this often leaves sufferers from unrecognised diseases with no effective treatment, unless you call it treatment when a doctor says "it is all in your mind". Let me use an analogy from computer support - if a customer has an intermittent and complex failure in their computer system that has never been seen before, a computer support provider will not say 'sorry, we do not have that problem listed in our knowledge base of all conceivable problems, we cannot help you'. It will try to find out if the problem is really a non-problem caused by user error, or if the user is making it up, but it will not just say "you must have imagined it". Clearly humans are a lot more complicated than computers (!) but why is the medical profession not more customer focused in trying to treat people who are in pain, even to the point of referring patients to complementary therapy practitioners? I think the difference is that doctors are very reluctant to say they do not know how to treat a disease - it is simpler to deny that it exists than to admit that their long and arduous training has not equipped them to deal with this disorder. > >>- the number of cases has grown at approx 30 per cent per annum in > >>the US, perhaps due to the increase in use of computers for work... > > Or the increase in compensation payments? There is little in the way of compensation for RSI sufferers there either. I cannot see the common sense in denying the connection between use of keyboards and RSI - the compensationitis response smacks of a cover-up for the fact that medical science has little idea about what RSI is and how to treat it. Lyme disease is an example of a real disease whose existence was denied for years before it was recognised. I believe RSI will similarly be discovered to be 'real' - after all, it is treatable with physiotherapy, other bodywork, and relaxation/meditation, rather than psychological treatment. > >>Lack of compensation means that there is no incentive to get RSI, > >>there are lots of disincentives. > > Oh no - 'illness behaviour' has lots of incentives and rewards (apart > from the potential for compensation): people have written doctoral > theses on the subject. Earlier on you said it was directly linked to compensation payments, which are largely unavailable since it is not a recognised disease. Are you now saying that it is nothing to do with compensation payments? Maybe some people are driven for psychological reasons to manifest illness behaviour in the absence of illness - my problem with this is that the existence of what I think is a small group of such people prevents the early recognition and treatment of unrecognised diseases. Would you like to explain your thinking to a group of RSI sufferers who are not receiving any financial compensation, and precious few psychological compensations (unless you count being unemployed and depressed due to the pain). > Well I'm sorry you're upset, I am largely recovered now, so I am not as upset as people who hear this kind of stuff from their GPs while they are still in pain.... People with RSI do not usually type such long messages :-) > but doctors are pretty hard-headed people > who like to see solid evidence before accepting the existence of a new > condition. I would be interested if you have references to medical > research on the subject, but only those published in journals listed in > Index Medicus please. Doctors should see evidence before treating a condition, but the problem comes for people who are 'early sufferers' from a new disease - how are they going to be treated other than by dismissing their problems as imaginary? Unless the medical profession manages to process (i.e. investigate and recognise/reject) the large number of new complaints (e.g. sick building syndrome, eye problems from virtual reality headsets) with much greater rapidity, I do not see how it is going to cope and provide good 'customer service'. The medical profession reminds me of a traditional hierarchical company, in its inability to respond quickly enough to these changes in the 'market' of symptoms presenting themselves. I do not have exact references to the studies that show a physical component to RSI, but I can give you some details of one Australian study done at the University of Melbourne, which showed physiological disturbance of the nerve pain pathways in people with RSI, consistent with the presence of chronic pain in other situations. Psychological tests also showed that the terms used to describe pain by those with RSI did not correlate with the diffuse language used by psychologically disturbed patients or those whose pain is of psychiatric origin. The study was directed by Professor Richard Helme, and I saw the report in January 93, which should enable you to find this at a medical library. The following references should cover the debate on psychosomatic/iatrogenic vs. physical causes of RSI. I can binmail you a more complete list if you like. Armstrong, T.J., & Silverstein, B.A. (1987). Upper extremity pain in the workplace - Role of usage in causality. In N.M. Hadler (ed.), Clinical Concepts in Regional Musculoskeletal Illness (pp. 333-354), Orlando: Grune & Stratton, Inc. Dimberg, L., Olafsson, A., Stefansson, E., Aagaard, H., Oden, A., Andersson, G.B.J., Hansson, T., & Hagert, C.G. (1989). The correlation between work environment and the occurrence of cervicobrachial symptoms. Journal of Occupational Medicine, 31 (5), 447-453. Feldman, R.G., Goldman, R., & Keyserling, W.M. (1983). Peripheral nerve entrapment syndromes. American Journal of Industrial Medicine, 4, 661-668. Ferguson, D.A. (1987). "RSI": Putting the epidemic to rest. The Medical Journal of Australia, 147, 213-214. Hadler, N.M. (1990). Cumulative trauma disorders: An iatrogenic concept. Journal of Occupational Medicine, 32 (1), 38-41. Hagberg, M., & Wegman, D.H. (1987). Prevalence rates and odds ratios of shoulder-neck diseases in different occupational groups. British Journal of Industrial Medicine, 44, 602-610. Herberts, P., & Kadefors, R. (1976). A study of painful shoulders in welders. Acta Orthopaedica Scandinavica, 47, 381-387. Hocking, B. (1987). Epidemiological aspects of "repetitive strain injury" in Telecom Australia. The Medical Journal of Australia, 147, 218-222. Linton, S.J., & Kamwendo, K. (1989). Risk factors in the psychosocial work environment for neck and shoulder pain in secretaries. Journal of Occupational Medicine, 31 (7), 609-613. Seeing these references makes me realise that the 'central research department' of Medical Profession plc knows things that are not communicated to the 'support engineers' on the ground :-) Richard >>>independent/computer_page 74 jfletcher(4292)18sep93 0:42 c73 >>...if anyone wants this to continue in the rsi conference, we can move >>it there. Don't worry, I'm the mod here, so carry on (but feel free to copy any of my ravings across!). >>This may be medically precise but it then leaves those with >>non-specific RSI, if I can call it that, with no term to describe >>their condition. Whether this is a wholly physical, compensation- >>driven or psychological condition, there should be a term to describe >>it, in my opinion. This is a fair point, but I think that medically accepted conditions like carpal tunnel syndrome etc. should be excluded from the term 'RSI' which should instead be restricted to the less clearly defined complaints (pending a resolution of their cause and treatment). >>I understand the reason why medical science tends to reject anything >>that does not fit into the current model... Medical science tends to put things into three (not two) categories - 'accepted', 'rejected' and 'case not proved'. RSI is in the third category I would say. >>...why is the medical profession not more customer focused in trying >>to treat people who are in pain, even to the point of referring >>patients to complementary therapy practitioners? I hope that we do try to treat people in pain - the problem is that we need to know what constitutes an effective treatment. This requires a clear definition of the disease process and carefully controlled clinical trials to prove (or disprove) the effectiveness of particular therapies. I would personally have no problem with sending patients to complementary practitioners *provided* that I were satisfied that their treatment is effective. >>I think the difference is that doctors are very reluctant to say they >>do not know how to treat a disease - it is simpler to deny that it >>exists than to admit that their long and arduous training has not >>equipped them to deal with this disorder. There's a lot of truth in that statement. >>There is little in the way of compensation for RSI sufferers there >>either. I didn't know that - I thought that the concept of RSI was accepted by the courts there. >>I believe RSI will similarly be discovered to be 'real' - after all, >>it is treatable with physiotherapy, other bodywork, and relaxation/ >>meditation, rather than psychological treatment. I believe that RSI is 'real' in the sense that the patients have a genuine complaint - the question is 'what is the cause'? I would regard relaxation and meditation as largely psychological treatments, and physiotherapy also has an important psychological component. >>Earlier on you said it was directly linked to compensation payments, >>which are largely unavailable since it is not a recognised disease. >>Are you now saying that it is nothing to do with compensation >>payments? Richard, I don't know what the cause of non-specific RSI is. I didn't say that it was compensation-related - I raised the possibility (note the question mark after >>or the increase in compensation payments<<). >>Would you like to explain your thinking to a group of RSI sufferers >>who are not receiving any financial compensation, and precious few >>psychological compensations... Once again, Richard, I don't have any preconceived ideas about the causation of non-specific RSI, I'm simply exercising the healthy scepticism of the scientist. >>...but the problem comes for people who are 'early sufferers' from a >>new disease... I think early sufferers from a new disease (or newly-recognised disease) are always going to be in a very unfortunate position cf. AIDS in the early 80's. >>Unless the medical profession manages to process...the large number of >>new complaints...with much greater rapidity, I do not see how it is >>going to cope and provide good 'customer service'. This is the domain of medical research and I agree that non-life- threatening conditions often don't get the attention they deserve from medical researchers. Of course, if funds are provided for research in a particular area, then you'll usually find no shortage of medics willing to look into the problem for you! Perhaps this should be the focus of concern in the RSI community? Thanks for the references - I'll look them up. jeremy >>>independent/computer_page 75 richardd(4219)18sep93 14:01 c74* >... I think that medically accepted conditions > like carpal tunnel syndrome etc. should be excluded from the term 'RSI' > which should instead be restricted to the less clearly defined > complaints (pending a resolution of their cause and treatment). I would be happy with this, but some portmanteau term such as WRULDs would surely be useful as well - otherwise every article has to list every possible disorder, which runs into the tens AFAIK. > Medical science tends to put things into three (not two) categories - > 'accepted', 'rejected' and 'case not proved'. RSI is in the third > category I would say. I would agree. I am less concerened about the classification than about the effects of this classification on how individuals are treated. > I would personally have no problem with sending patients to > complementary practitioners *provided* that I were satisfied that their > treatment is effective. I am glad to hear this - some GPs, however, seem to dole out painkillers and do not refer people to competent complementary practitioners when orthodox medicine has drawn a blank. > > >>There is little in the way of compensation for RSI sufferers there > >>either. > > I didn't know that - I thought that the concept of RSI was accepted by > the courts there. Some people have been successful in the courts, others have settled out of court, many have not been successful. I really meant compensation without going to court - after all, if a wall falls on me at work, leading to permanent disability, I would have little trouble claiming invalidity benefit. Someone with severe RSI that does not respond significantly to treatment should also get invalidity benefit but often there are great problems in obtaining this. > > I believe that RSI is 'real' in the sense that the patients have a > genuine complaint - the question is 'what is the cause'? I would regard > relaxation and meditation as largely psychological treatments, and > physiotherapy also has an important psychological component. Few would deny that there is a psychological component to RSI and some treatments for it - however, some doctors go further than this to say that it is wholly psychological *and therefore not really a problem*. It is only the last step in this argument that causes me real problems. I do not believe that it is wholly psychological, and there is some hard evidence that it has a physical component. Even if it is psychogenic the physical symptoms (tight muscles, limited mobility) are easy to observe. > ... I don't have any preconceived ideas about the > causation of non-specific RSI, I'm simply exercising the healthy > scepticism of the scientist. Scientific scepticism is very valuable, of course, in unveiling charlatans and pseudo-science in general. I find it harder to accept it when this scepticism leads to a 'real' condition being dismissed and therefore left untreated. Scientific scepticism is fine when applied to problems that are remote from people, but it can have damaging effects when placed in a social milieu such as the medical community. > I think early sufferers from a new disease (or newly-recognised disease) > are always going to be in a very unfortunate position cf. AIDS in the > early 80's. They have always been in an unfortunate position, but is there no way of improving their medical care even in the absence of hard facts? Perhaps treatments that were agreed to be of low downside risk (e.g. massage) could be prescribed even so. > This is the domain of medical research and I agree that non-life- > threatening conditions often don't get the attention they deserve from > medical researchers. Of course, if funds are provided for research in a > particular area, then you'll usually find no shortage of medics willing > to look into the problem for you! Perhaps this should be the focus of > concern in the RSI community? Certainly funding would help, but I think the sheer volume of scepticism about RSI, which has been variously labelled as being 'manufactured by doctors', 'hysteria', and 'non-existent', would tend to put off many researchers from even researching this topic. Richard >>>independent/computer_page 76 jfletcher(1659)18sep93 17:35 c75* >>...some GPs, however, seem to dole out painkillers and do not refer >>people to competent complementary practitioners when orthodox medicine >>has drawn a blank. But why should GPs use public funds to send patients to practitioners whose treatments have not been shown to be beneficial? If patients want to try unproven treatments, they should do so on a private basis IMHO. >>Someone with severe RSI that does not respond significantly to >>treatment should also get invalidity benefit but often there are great >>problems in obtaining this. I think the state has a right to insist that a new (or newly recognised) condition be properly validated by medical science before it is expected to hand out public funds to sufferers. >>Scientific scepticism is fine when applied to problems that are remote >>from people, but it can have damaging effects when placed in a social >>milieu such as the medical community. I think that the lack of a scientific approach has historically been one of the main (if not *the* main) obstacles to medical progress. >> Perhaps treatments that were agreed to be of low downside risk (e.g. >>massage) could be prescribed even so. I think that it is very unlikely that treatments of this sort are going to be made generally available within the NHS - there is scarcely sufficient money to deal with life-threatening disorders. >>...I think the sheer volume of scepticism about RSI...would tend to >>put off many researchers from even researching this topic. Possibly, but I think that well-conducted research is the only way you're going to counter medical scepticism about this subject. jeremy >>>independent/computer_page 77 digbyj(539)18sep93 21:20 c76* >I think that the lack of a scientific approach has historically >been one of the main (if not *the* main) obstacles to medical progress. Not only medical progress. People easily go off onto tangents, or miss the point entirely of what they've discovered. Fleming and penecillin was an example of this. He thought he'd found a wonderful new way of analysing germs, instead of a way to kill them off! It was Florey and Chain (+A.N. Other who I've forgotten) who really made the advance with pencillin some years later. Digby James >>>independent/computer_page 78 jfletcher(144)18sep93 23:36 c77 I didn't know there was a 'fourth man' in the penicillin story. Fleming, Florey and Chain shared the Nobel prize for the discovery. jeremy >>>independent/computer_page 86 digbyj(155)19sep93 23:41 c78 Ah! That's was it. I'd confused Florey and Chain with the three Nobel Prize winners, and thought the third was a collaborator, not Fleming. Digby James >>>independent/computer_page 79 richardd(1853)19sep93 14:23 c76 > > But why should GPs use public funds to send patients to practitioners > whose treatments have not been shown to be beneficial? If patients want > to try unproven treatments, they should do so on a private basis IMHO. Maybe I should turn this around - given that the medical treatment I had was more or less useless in treating my RSI (even the painkillers were less effective than relaxation, etc.), whereas complementary therapies have helped me recover (as well as giving short term pain relief/muscle relaxation), why on earth should the medical profession be the only 'therapist grouping' to benefit from my contributions to the NHS? I am not really bothered if some treatments do not work for everybody - if they work for some people and are low-risk, that is enough for me. Those who are not helped by certain treatments for RSI can very often find other treatments that work better. > I think the state has a right to insist that a new (or newly recognised) > condition be properly validated by medical science before it is expected > to hand out public funds to sufferers. The problem is that medical science is no longer the only game in town - and it is less effective than other treatments in my own, limited experience of treatment (and in some other people's experiences, too). In any case, I understand that GPs can already refer patients for complementary treatment using NHS funds. > I think that it is very unlikely that treatments of this sort are going > to be made generally available within the NHS - there is scarcely > sufficient money to deal with life-threatening disorders. Even if these treatments result in lower cost and better results than medical treatments? This would help the NHS's budget by freeing up money for those cases where medical science is best equipped to cope. Richard >>>independent/computer_page 80 jfletcher(1199)19sep93 16:53 c79m >>... the medical treatment I had was more or less useless in treating >>my RSI...whereas complementary therapies have helped me recover... I'm pleased that complementary therapy appeared to help your symptoms, but I'm afraid your experience is simply an anecdote, and not a properly controlled clinical trial, which is the only thing that can ultimately prove or disprove the value of a particular therapy. >>... I understand that GPs can already refer patients for complementary >>treatment using NHS funds. I'm not a GP. so I don't know whether this is true or not - it's difficult to believe that it is true because neither the GP nor the health district would be likely to hold a contract with the practitioner, so there would be no mechanism for making payments to him/her. Perhaps somebody else knows. >>Even if these treatments result in lower cost and better results than medical treatments? In that case, there would be a financial case for providing the treatments, but therapies that involve a person's time (e.g. physiotherapist, speech therapist, complementary practitioner etc.) are almost invariably going to be more expensive than simple analgesics. jeremy >>>independent/computer_page 82 richardd(2743)19sep93 20:54 c80 > I'm pleased that complementary therapy appeared to help your symptoms, > but I'm afraid your experience is simply an anecdote, and not a properly > controlled clinical trial, which is the only thing that can ultimately > prove or disprove the value of a particular therapy. From where I am sitting, complementary therapy has not just removed the symptoms, it has treated some of the root causes, such as muscle tension. I do not get any significant recurrence of symptoms even when typing 8 hours a day, which compares with immediate severe recurrence of symptoms after twenty minutes when my RSI was at its worst. I am aware that this is anecdotal, but until people start doing controlled studies of complementary therapies for RSI, anyone with RSI is best advised to investigate such therapies, in addition to conventional treatment, unless they want to persevere with RSI for a few years until medical research catches up. A bunch of anecdotes is worth more than zero controlled studies in my book. As for GPs being allowed to refer patients to complementary therapists, the source for this was a Daily Telegraph survey (if I can mention a competitor here!) published on 6th April 1993. This asked, amongst other things, whether the respondent was aware that: - GPs are allowed to 'delegate' patients to be treated by alternative therapists - budget holding GPs may purchase alternative therapy treatment - non-budget holding GPs may apply to the Family Health Service Administrationto employ or fund alternative therapists A minority of respondents (who included patients and GPs) were aware of these facts. Fifteen per cent of respondents had in fact been referred to a (complementary) therapist. > ,,, therapies that involve a person's time (e.g. > physiotherapist, speech therapist, complementary practitioner etc.) are > almost invariably going to be more expensive than simple analgesics. If simple analgesics work, this is of course true since the complementary therapy will normally involve more treatments and more time per treatment. However, for bad backs, RSI and other musculoskeletal problems analgesics are often just palliatives and do not treat the real problem. If a complementary therapy is effective in a few treatments it will be much cheaper than continued visits to and prescriptions from a GP for analgesics etc. In the survey mentioned above, 52 per cent of people started using an alternative therapy because orthodox treatment was not working, and 77 per cent rated it very helpful. This is not a controlled study, of course, but it indicates at least some customer satisfaction, which the medical profession should perhaps consider including in its performance targets. Richard >>>independent/computer_page 84 jfletcher(627)19sep93 22:48 c82 >>... until people start doing controlled studies of complementary therapies for RSI... AFAIK there's nothing to stop the alternative therapists from doing these trials themselves. >>- budget holding GPs may purchase alternative therapy treatment - non-budget holding GPs may apply to the Family Health Service Administrationto employ or fund alternative therapists Well, well, I didn't know that. It seems rather appalling to me that just when medicine has started to have some serious scientific foundation, patients seem to be opting for witchcraft instead, but I guess we live in anti-science times! jeremy >>>independent/computer_page 90 richardd(1107)20sep93 23:19 c84 > > AFAIK there's nothing to stop the alternative therapists from doing > these trials themselves. Except funding... > ... It seems rather appalling to me that > just when medicine has started to have some serious scientific > foundation, patients seem to be opting for witchcraft instead, but I > guess we live in anti-science times! Maybe you should consider why people are anti-science? Oh, of course, it must be their fault not medicine's, the patient is always wrong :-) Not everyone who opts for alternative therapy is devoid of a scientific background (I did some science in my degree) - only the results have convinced me that some of these therapies are useful. The medical profession's reaction to the switch to alternative therapies reminds me of many established paradigms just before the rules changed - the existing paradigms stop being so useful but the only reaction is to ridicule alternatives. Similar reactions could no doubt have been observed in Detroit while the Japanese were taking over the Californian car market with smaller, higher quality cars :-) Richard >>>independent/computer_page 93 jfletcher(721)21sep93 8:05 c90 >>Except funding... Fair point, but if sufferers band together, form a charitable organisation to support research into RSI, raise funds, and then offer grants to researchers, things should take off. This is a well tried and successful approach that has been followed for many other disorders - diabetes, multiple sclerosis, cancer etc. Charity is an important source of medical research funding in this country and around the world, and fills many of the gaps left by state funding. >>...the existing paradigms stop being so useful... Well the medical 'paradigm' in this context is the controlled (preferably double-blind) clinical trial, and I think there's still life in that old dog. Cheers. jeremy >>>independent/computer_page 87 pjacks(138)20sep93 1:21 c80 Yes, it is true that referrals to homeopathic hospitals (I think there are three or so?), osteopaths and suchlike can be arranged by GPS. >>>independent/computer_page 81 tchannon(488)19sep93 17:46 c79 I think there is a simple but good example with Osteopathy where there has been an apparent refusal by GPs to even suggest that they or the practice are not qualified to treat. Some of the best Osteopaths are also GPs but that leads on to a further matter; it is difficult to impossible for a layperson to get impartial information about the treatments available and the efficatiousness of the medics in question. Why is it that the best advice on this is likely to come from laypeople? >>>independent/computer_page 83 richardd(77)19sep93 20:54 c81 The phrase 'vested interests' springs to mind, I don't know why ... Richard >>>independent/computer_page 85 jfletcher(186)19sep93 22:48 c83m No, from a personal point of view, I have no objection if patients with RSI take their complaints to alternative practitioners - I get paid by the hour not per consultation. jeremy >>>independent/computer_page 91 richardd(208)20sep93 23:19 c85 This was not a personal comment - but would all doctors be happy if they made as much money while seeing alternative therapists take some of the kudos and respect that derives from healing people? Richard >>>independent/computer_page 94 jfletcher(206)21sep93 8:05 c91 Good question, and I'm not sure of the answer. I suspect that if the techniques involved were scientifically established as beneficial, they would absorb them into mainstream medical practice. jeremy >>>independent/computer_page 88 tchannon(4)20sep93 2:59 c83 :-) >>>independent/computer_page 89 t_c(646)20sep93 13:47 c73 > Let me use an analogy from computer support - if a customer has an > intermittent and complex failure in their computer system that has > never been seen before, a computer support provider will not say > 'sorry, we do not have that problem listed in our knowledge base of > all conceivable problems, we cannot help you'. It will try to > find out if the problem is really a non-problem caused by user error, > or if the user is making it up, but it will not just say "you must > have imagined it". ROFL! Sorry, but I just couldn't resist this. > "you must have imagined it" Oh yes they do, oh yes oh yes oh yes. :-) Regards, Tony C. >>>independent/computer_page 92 richardd(547)20sep93 23:19 c89 Well, I suppose they do sometimes, but they will hopefully go out of business if they try this too much, because competing support providers are usually available at similar costs. In the medical world, there are difficulties in going to an alternative care provider (to use the US terminology), at least in the NHS, since alternative therapists are only paid for by your GP if they are sympathetic to your case. Unfortunately, the Catch 22 is that the GPs who say you are imagining it are unlike to be pro alternative therapies. Richard