Artificially generated Confusion about the ICD-10 concerning MCS
In an international newsgroup for activists and scientists which looks into the topic of environmental related diseases, toxic caused illnesses and chemical sensitivity, a posting about the ICD-10 concerning MCS was issued by a German activist (see appendix). She presented a written answer from the DIMDI, which she received in response to a question she wrote. She misinterpreted the answer of the DIMDI, in parts she mistakenly translated from German to English, and furthermore left out important points.
E.g. the term “quality assurance” mentioned in the letter of the DIMDI was left out. But the importance of it is essential, as only quality assurance by the means of proper clinical diagnostics after international recognized criteria can lead to an adequate therapy. In the context of “QM” (quality management) the German Medicine focuses on this. So the readers who could not read the original German letter were totally confused and misinformed about the importance of the ICD-10 for MCS in Germany.
Dr. Tino Merz, legal expert for Environmental issues gives his view:
PART I - Artificial Confusion about the ICD-10
It is fascinating to watch all the possibilities of misinterpretation again and again. In order to avoid all incorrect interpretations, we published the “Information’s for Physicians”. The ICD-10 Classification of the WHO and the diagnosis criteria for MCS, CFS, FM and TE can be found in it, without much comment. But as shown, even that can be confuscated.
ICD 10 – List of Diagnosis
Thus and because it is not the first time that wrong conclusions were drawn from wrong ideas, in absolute clear words: the international classification of diseases, 10th edition (since 1992) is a list of about 70.000 diagnosis, which are divided into 22 chapters. The diagnosis to be included are recognized and, due to that, legal diagnosis. That’s important for jurisprudence. The medical Definitions (e.g. diagnostic criteria) are not listed there.
Talking the ICD-10 to Death: Off Topic
Because of this, we included both in the information’s for physicians. The diagnostic criteria are for matters of diagnose, the ICD-10 term is for the legal classification. “T78.4… allergy, unspecified” lists MCS under external injuries, namely as acquired immune deficiency in the characteristic of an unspecified allergy or hypersensitivity. Already earlier an activist lady supposed this to be insufficient. She provided scientific arguments to justify it. Well, that’s off topic. The ICD-10 is a formal [schematic] classification. The phrase “T78.4 does not recognize “MCS” as a medical diagnosis.” is entirely wrong. The ICD-10 list does exactly this: It recognizes MCS as a defined diagnose.
Self-made artificially produced Confusion causes Damage
Since it is this way, in coincidence with the classification as physical and external injury, the attempts don’t stop, which want to relativize what has been scientifically decided for a about a decade. The reinterpretation as “IEI” was rejected by the WHO in 1996. The psychogenic thesis was not phrased until the international discourse was resolved just with the ICD-10 entry. The trick applied is genial. As chemicals harm the mental functions, exactly this is turned against the harmed. The psychogenic thesis swaps cause and effect. This allows to misinterpret any study as wrong as desired. This has nothing to do with science (see blog entry: Erlanger Fake (German only). Nevertheless this allows to create confusion. It is combined with loudness and intimidation. The apodosis from the DIMDI shows that the official tried to avoid trouble. The activist made the classic mistake: “Never ask something, if you don’t know the answer in detail”. Now the asking activist also wrongly judges: she suggests a new finding (“eye-opening”) to be that the ICD-10 does not list recognized diagnosis. What else then? This is the genuine purpose of the ICD. Even those who propagate the psychogenic thesis don’t dare something like this. Therefore, such nonsense is extremely helpful, but only for confusion and to cause damage to the afflicted.
No Question: Environmental related Diseases are recognized long ago
Nobody can deny seriously that environmental related diseases have been recognized long ago. But it is possible to achieve nearly everything with half-truths and prevarications if the afflicted don’t inform themselves. So the others get them where they want them to be.
As legal expert I often have to experience lawsuits that fail, because clients decide wrong, following their view, as they do not know the legal background and the legal interpretation of the scientific knowledge and ignore the advice.
Author: Dr. Tino Merz for CSN – Chemical Sensitivity Network, January 29, 2009
Additional information’s (German only):
- www.dr-merz.com
- Strategy Paper for MCS (pdf)
- Information for physicians about MCS, CFS, EMS, TE (pdf)
–
APPENDIX:
The activist’s newsgroups posting from early January:
The German ICD-10 Coding Guidelines have taken on an important role in Germany since 2002. Because of the cross mapping from the German payment system (known as the Fallpauschale [FP] and Sonderentgelt [SE]) for the hospital inpatient billing requirements to the implementation of the German DRG (G-DRG) payment system, an increasing awareness for the necessity of correct coding could be seen. As of August 15, 2003, Germany named the ICD-10 version ICD-10-GM (German Modification). Usage of the ICD-10-GM: In Germany, the practicing physician is legally responsible for documenting and coding patient charts that are seen in his/her office, and the hospital physician is legally responsible for documentation and coding of the hospital inpatient/outpatient admissions.
Multiple Chemical Sensitivity (MCS) has been formally registered as a physical illness by the German Institute of Medicine, Documentation and Information, and is classified within the German version of the World Health Organization (WHO) International Classification of Diseases ICD-10-GM, Code T 78.4… allergy, unspecified.
For clarification whether MCS has been recognized as a physical illness or not, I wrote to Dr. Ursula Kueppers at the DIMDI. On December 22, 2009 she sent the below reply. An eye-opener to me are the last sentences of her e-mail:
“The ICD-10 can only partly be helpful in deciding the obviously unsolved controversy whether a disease like MCS is to be listed under physical illnesses or mental (psychogenetic, psychiatric) disorders. The facts of this issue have to be discussed by medical experts and can only be answered by them.”
The essence of her statement is that ICD-10-GM, code T78.4 does not recognize “MCS” as a medical diagnosis. The German government simply put “MCS” into the index of the German ICD-10-GM for different purposes (statistics, payment, etc.) in the National Health Care System.
Best to everyone,
xxx
Cited written reply from the DIMDI*
Dear Ms. XXXX
I apologize for not answering your question earlier.
The ICD-10-GM serves in the Germany Federal Republic for different purposes in the public health (amongst others for the billing system, quality assurance, statistics). The ICD-10-GM is based on the ICD-10 edition of the World Health Organization (WHO).
Normally, the ICD-10 (-GM) does not define diseases, but classifies illnesses in Chapters and Groups etc. considering specified criteria. This structure of the ICD-10 (-GM) has its roots in history. You can read more about that in Volume 2 (Instruction Manual) of the WHO’s ICD-10 edition. [English WHO version ]
As to MCS the status quo is that MCS is actually coded in the ICD-10-GM under “T78.4… allergy, unspecified” and thus it is not assigned to Chapter V – Mental and behavioral disorders. From my point of view the explanation text there provides a good reason for the coding under T78.4. “This category is to be used as the primary code to identify the effects, not elsewhere classifiable, of unknown, undetermined or ill-defined causes. For multiple coding purposes this category may be used as an additional code to identify the effects of conditions classified elsewhere.”
For the final judgment of the obviously not cleared matter of dispute, whether such a disease like MCS has to be seen as a physical or mental illness, the ICD-10 help is limited. This question has to be discussed on its merit by medical experts and only they can answer it.
Yours sincerely,
p.p.
Dr. Ursula Kueppers
DIMDI – German Institute for Medicinal Documentation and Information
Medical Classifications
The DIMDI is an Institute of the German Federal Ministry of Health’s (BMG) Portfolio.
* (Translated by BrunO)
PART II - Update: Emotionality and Misinformation do damage to MCS sufferers
In his previous blog post Dr. Merz wrote how activists and support groups generate artificial confusion about the code for MCS in the ICD-10. For about three years some patient “advocates” apply to put this diagnostic-key forcefully into question or even deny its existence, which describes MCS as an organic disease. Though CSN has spread a non-ambiguous letter from the DIMDI, these attacks don’t stop. And actually, there is no comprehension. The circulation of misinformation organized by an activist even on national and international levels continues. For weeks she is posting falsifying information’s about the ICD-10 concerning MCS in various newsgroups. She tries to morally legitimate her behavior which is harmful to all MCS suffers in one of the recent posts by mentioning her own failed lawsuit.
The Opinion about the MCS ICD-10, spread by an Activist Lady:
According to Dr. Kueppers at the DIMDI (German Institute of Medicine, Documentation and Information – medical classifications), the purpose of the ICD-10-GM classification system is only medical billing, statistics. She wrote that the ICD-10 (-GM) does not as a rule define illnesses.
Despite the ICD-10-GM classification system, code 78.4… allergy, unspecified, MDs, psychiatrists, psychologists, medical experts still can assign the dx “mental”, “psychogenetic”, “psychosomatic” disorder for our illness, if they want to do so.
To offer evidence for this sad truth, I would like to inform you on my own experience with the German legal system. In April 2002 I went to court. In a lawsuit at the regional court Bonn, the expert witness, a respected professor and director of the university hospital in Cologne stated the below in evidence, though he had to be familiar with the ICD-10 classification system:
>> As to conventional (orthodox, traditional) medicine, a clinical syndrome such as “MCS” is not known and recognized. “Multiple Chemical Sensitivities” as the plaintiff translates the term for the illness do not have any influence on the therapeutic procedure within the limitations of conventional medical treatment. “MCS” is a matter of non-medical practitioners (homeopaths, and others).>>
This lawsuit caused a kind of “PTSD” in me. So if I stumble across articles “GERMANY IS THE FIRST COUNTRY TO RECOGNIZE MULTIPLE CHEMICAL SENSITIVITY ( MCS) AS A PHYSICAL DISEASE”, for instance, the one by Christiane Tourtet it still hurts, and I swallow my anger about the experienced injustice.
Best from Germany,
XX
*Note: DIMDI’s name in not translated correctly. DIMDI means “German Institute for Medicinal Documentation and Information”. It is not an Institute for Medicine; it is not called “German Institute of Medicine, Documentation and Information”.
–
Dr. Tino Merz about the restated Misinterpretations of the Activist:
You have to start reading the text of the activist from the end. The writer is hurt and annoyed about an expert opinion, which says MCS does not at all exist in traditional medicine. Instead of figuring out how to counteract such nonsense effectively – if the professor does not know the ICD, he may be incompetent or prejudiced – she swallows her anger.
Well, she is unable and unwilling to believe what Dr. Kueppers wrote in her precise letter to Silvia Mueller. Probably she asked if it really was true. That’s the old truth: “If you ask long enough …”. Meanwhile pressure was put on Ms. Dr. Kueppers. So she backpaddles and our writer presents her the opportunity to buckle.
At last, our writer teaches the world and proclaims the sad truth, that there are no diagnoses in the ICD and the physicians do not have to pay any regard to it.
This activity shows how those, which – knowing the truth – deny the state of science, succeed to turn an immense whole scientific literature into garbage, as seen by presenting their pseudo science as new scientific finding (Erlanger Fake Method: swap cause and effect), apostrophizing it as traditional medicine correctness and demanding above all, to accept it as “serious”. Obviously they succeed in making many support groups to accept it. I point to a quote in my strategy paper about “the belief in science”. An activist lady states in it non-acceptance of MCS is due to journalists and politicians belief in science. Thus the activist accepts MCS is scientifically unexplained. In consequence, the sad truth is that such support groups assist to dig their own grave.
Author: Dr. Tino Merz for CSN – Chemical Sensitivity Network, February 5, 2009
Translation: BrunO with help of John. Thank you to both of them!
