WINZ accept people on to a sickness benefit when they are given a valid medical certificate by a doctor. Unless there is some very obvious reason why this certificate can be called into question, WINZ has little choice but to accept this state of affairs. Typically, someone has to report the person to WINZ before they will investigate. So it is very unfair to blame WINZ for this situation.

It is also unfair to blame the doctor for issuing the certificate. Since it takes a great deal less physical strength and stamina to be a drug dealer than an minimum wage labourer, it is perfectly feasible that a doctor could issue a perfectly legitimate WINZ certificate without ever suspecting the beneficiary’s extracurricular activities.

In addition, a patient may have an illness that provides little or no physical signs to prove that the illness is genuine. The doctor in this case has no real option but to accept the patient’s word that he is genuinely incapacitated. Good examples of this would be chronic back pain, depression and chronic fatigue syndrome. None of these have easily obtainable objective signs or investigations that definitively verify the disease. It is relatively easy for a patient to become knowledgeable enough to fake his/her symptoms. As the majority of  patients with these sorts of illness are completely genuine, it would be both counterproductive and extremely unfair to expect them to provide some sort of “proof” of their illness. One has to take them at their word.

It is perfectly feasible that some people genuinely become incapacitated at a very physical occupation, go on to sickness benefit, then find that they can make a very decent living dealing in drugs. It is not very likely that they will then say to WINZ “thanks, but I don’t need a benefit any more because I’m a successful drug dealer”. I am certain that there are dozens of sickness beneficiaries who are exactly like Mr. Szeto – drawing a benefit becomes a form of cover for them (not a very good one when they buy expensive cars!).

And before anyone frenzies in the comments, the vast majority of sickness beneficiaries are just as honest as you and I. They have genuine illnesses which prevent them from working and they don’t deal in drugs. Of course, a fair number of long-term beneficiaries could retrain themselves into a new career more rapidly and with greater enthusiasm than they do, but that is an entirely different story. Very few beneficiaries are out and out crooks or even particularly lazy (the common right-wing meme). Most (of the long-term ones, at any rate) have absolutely appalling self-esteem which holds them where they are. For this we can thank our socialist-leaning friends in Labour who have convinced most long-term beneficiaries that they are helpless without welfare.

Related posts:

1. The Sick, the Lame and the Lazy
2. Paying For Their Sins
3. Entitled

But the senior author of the study, Judy Mikovits, director of research at the Whittemore Peterson Institute in Reno, Nevada, said further blood tests have revealed that more than 95 per cent of patients with the syndrome have antibodies to the virus – indicating they have been infected with XMRV, which can lie dormant within a patient’s DNA.

“With those numbers, I would say, yes, we’ve found the cause of chronic fatigue syndrome. We also have data showing that the virus attacks the human immune system,” said Dr Mikovits. She is testing a further 500 blood samples gathered from chronic fatigue patients diagnosed in London.

“The same percentages are holding up,” she said.

This evidence puts paid to the common belief amongst many in the medical fraternity that CFS is a psychiatric diagnosis, rather than a physical one. If it can be verified further, it represents an exciting breakthrough in the management of this debilitating disease. CFS is extremely difficult to treat and the prospect of a possible antiretroviral drug or a vaccine in enticing, even if it is still quite far in the future. Many CFS sufferers will simply be happy that the disease has been shown not to be “all in their head”. Detection of XMRV antibodies will also make the diagnosis of CFS much easier, as it is easily confused with other diagnoses such as fibromyalgia and depression.

Almost certainly, there are trigger factors that cause XMRV to manifest as CFS. As 3.7% of the normal population carry this virus, it is imperative we find these trigger factors, as tens of millions of people may be at risk of developing the disease.

The other famous retroviral syndrome, AIDS, may condemn people to a slow death; CFS condemns people to a ghost-like existence. It is hard to tell which is worse.

Related posts:

1. It’s All in Your Head!
2. No Magic Bullet
3. Stable Swine

I am reminded of the attitude of doctors to Myalgic Encephalomyelitis, the scientific name for Chronic Fatigue Syndrome or so-called “Yuppie ‘Flu” or “Tapanui ‘Flu”. Even now, years after most authorities concede there is indeed such a disease, there are many doctors who still believe it is “malingering” or just another presentation of depression (Note to such doctors: You can find ME in the ICD10 classification of diseases, but NOT in the DSM4 classification of psychiatric ones).

In my various stints in general practice, I have treated many of these people. The attitudes of their bosses, their co-workers and even their relatives and spouses are often quite intolerant. Victims are often treated as if they were simply making up symptoms. They are treated with a disdain that we would hardly use on sufferers of similarly debilitating diseases such as rheumatoid arthritis.

What I find hard to understand, is how we manage to maintain these attitudes in the face of thousands of sufferers. CFS has a prevalence of about 4:1000 which translates to about 20,000 sufferers. The chances are high that you know at least one. Gulf War Syndrome effected about 200,000 US soldiers. This doesn’t strike me as a few malingerers trying to get off work, or opt out of life. These are people with a genuine problem who need our help and understanding. I am saddened that they often cannot find this in their family doctor.

We doctors often attempt to produce an aura of all-knowing infallibility. Patients prefer us to have all the answers – they find it reassuring. We are disturbed when it becomes apparent that there are many things we do not know and cannot explain. People find new ways to fall sick and new diseases arrive. People react in wildly differing ways to the same illness or the same drug. Medicine is, in fact, inherently unpredictable.

Doctors who ignore this uncertainty in their work do their patients a grave disservice. The entire Gulf War Syndrome episode illustrates this well. 200,000 people were denied medical assistance because their doctors had decided that their problem was “all in their heads” – that they had PTSD and needed psychotherapy. Their doctors walked down the path of established knowledge where they felt comfortable and refused to look at their own fallibility, refused to ask “have we got this wrong?”.

By no means do I think that doctors have a monopoly on blinkered arrogance. I just think that such a mindset in medicine leads to consequences that are both unpleasant and tragic. More than in any other area of life, a closed mind in a doctor is a recipe for disaster. 

Our only protection is a good dose of humility. One spoonful as needed, before opening mouth.

Related posts:

1. Chronic Fatigue Syndrome
2. Head Case
3. Drug Dealing