BPS attempts at psychologizing Long Covid

This claim is technically correct, but completely ignores the underlying reasons why evidence is ranked. In every ranking I have seen, anecdotal evidence is the lowest form of evidence. Its frequently wrong or misleading. This level of evidence covers doctor experience I think. Dealing with these issues is a big fail for EBM in my view. The underlying theory appears sound, but how its used in practice, and misused (including deliberately), is far from sound.

 

But this is very much the BPS façade. We take everything seriously and of course do not dismiss anything as psychological because mind and brain work together in complicated ways and we have learned to be nice to people (even if a bit late in one case).

 

Trial by Error by David Tuller: More on that WSJ Opinion Piece; and Q-and-A with Author of this Week's WJS Rebuttal

Quote:
Did you already feel this way or did your own experiences change your mind?

My own experiences played a large role. There is a lot of skepticism in medicine, and much of that permeates into the way things like chronic Lyme or fibromyalgia are addressed in medical school. I think I only learned about chronic fatigue syndrome once I developed Long COVID myself. My own experience made me more sensitive to the patient experience, and in particular the psychological effects of being dismissed by a provider. While there is an innate empathy in most who choose psychiatry as a profession, becoming a patient yourself has a special way of increasing empathy for other patients.

ETA: Both WSJ opinion pieces were paywalled, but Eric Topol has shared them on Twitter:

 

I don't think you're giving him enough credit, actually. He's young and working through his thoughts about how his field is addressing these issues and pushing back against stupidity. I mean, I like Stilton cheese and many blue cheeses!

 

There's a paywalled editorial by the infamous Hanne Kjöller in Sweden's largest morning paper today. I don't have access, but I suspect the headline says it all...

"Specialist clinics for cultural illnesses function as early ill health retirement factories."



Specialistkliniker för kultursjukdomar fungerar som förtidspensioneringsfabriker
https://www.dn.se/ledare/hanne-kjol...ar-fungerar-som-fortidspensioneringsfabriker/

ETA: The framing/narrative she's using is so called "cultural illnesses" (psychological/emotional/existential/social threats are supposedly "internalised" and expressed as physical symptoms), referring to Karin Johannisson's earlier works. For more info on the psychosomatic concept "cultural illnesses" see posts here and here.

 

Reply by Kjell Rautio, investigator of welfare, health insurance and social politics.

Rautio then gives several examples of when Kjöller has previously seriously misrepresented the facts in her published work.

En viss ”kultursjukdom” sprider sig på DNs ledarsida igen…
https://loblog.lo.se/2021/04/en-viss-kultursjukdom-sprider-sig-pa-dns-ledarsida-igen/

Google Translate, English

https://twitter.com/user/status/1378081031237070848


(Edited to correct spelling mistakes.)

 

Comment on Twitter to this interview with Garner from Jonas R. Kunst, a professor in psychology at Oslo University

 

Continued:

 

Where is the evidence that neurons are firing false fatigue alarms? What could cause them to do that? Has anyone shown that any fatigue is caused by neurons firing alarms?

If it is true, why are the neurons sending false signals? Something must be wrong further down the chain of causation what could it be? It is another soundbite that sounds reasonable till you try to pin down what it means.

If all that about neurons actually is what is causing longcovid how does positive thinking change them. How does the signal travel from your thoughts to the neuron?

Now, maybe positive thoughts make you breath more deeply and take in more oxygen, maybe exercise increases your mitochondrial numbers, maybe cortisol levels drop or your heart rate goes down or POTS gets better.

It is possible and necessary to formulate theories into testable hypotheses and then report the results with as little jargon as you can before these extraordinary claims can be made. Even a thought experiment or a clear description of what you theory involves would be useful as it could be tested for plausibility. We do not know the exact causes of many diseases but things like migraines are not spoken of so dogmatically.

 

They are interested in reaching out to others also

 

A paywalled reply by Adam Svanell, editor at Svenska Dagbladet (Sweden's third largest morning paper).

Unfortunately I don't have access, but it still feels good just knowing that people are openly expressing criticism of Kjöller's harmful, ridiculous opinions.

Kjöller kallar tusentals svenskar inbillningssjuka
https://www.svd.se/kjoller-kallar-tusentals-svenskar-inbillningssjuka

https://twitter.com/user/status/1379423619059712001

 

I was curious about the date the thread started, and found it somewhat amusing seeing it started with Henrik Vogt arguing with Greenhalgh over something... that she agrees with today, in fact has been indirectly promoting the LP based on Garner's account, and would be more likely to be on a panel agreeing with Vogt about most of what he says.

Although they did start agreeing that ME patients are horrible people who deserve to be neglected so there was always some common ground. But she didn't know at the time that they are more or less the same. That became kind of awkward.

 

I've read it now, someone sent me a copy. It's a good article.

ME is mentioned briefly:

 

Trial By Error: Northwestern Law Professor Steve Lubet’s View of that Wall Street Journal Editorial

https://www.virology.ws/2021/04/06/...s-view-of-that-wall-street-journal-editorial/

 

The Swedish newspaper Aftonbladet has an article today about quarrel between doctors about what Long Covid is.
The article is also covered in the Norwegian newspaper Dagbladet.

Aftonbladet: Läkarstrid om postcovid: "Det har blivit ett ställningskrig"
google translation: Long-term illnesses are the subject of heated debate among doctors: "It has become a position war"

quote:

The condition, which mainly affects women, is a complication of covid-19. Symptoms include fatigue, cough, shortness of breath, fever and neurological disorders. Aftonbladet has previously written about several patients affected by the syndrome and studies have indicated that as many as 1 in 20 may have long-term problems.

But now the diagnosis is being questioned.

"Too careless"
- We have used the term far too carelessly. Everything that can go wrong is attributed to covid-19, says Anders Ekbom, professor of epidemiology at Karolinska Institutet .

The criticism also applies to how patients have been cared for in care.

Nowadays, many long-term patients are referred to a special clinic in Stockholm, something that some experts consider to be a waste of resources.

 

https://sunnybrook.ca/media/item.asp?c=2&i=1315&f=learning-while-teaching

Old ( 2015) but an interesting insight into this year 3 post gard student wannabee journalist... 'gentleman'! ( my emphasis)


‘……With only a few weeks left before the start of a new school year, Devine is driven to get as much done as he can. After a full day’s work, he often returns to the lab after dinner to check the results of his latest programming experiment and to set up a new experiment to run overnight. He admits that he can be a bit obsessive about his science projects. “They’re almost all consuming,” he says. “I think about them all the time.”

Despite the long hours and what he calls “the transient sense of hopelessness that comes with a failed experiment or a terrible result”, this experience has been a good one for Devine.

“One reason why I’m so happy in this lab right now is the freedom,” he says. “I don’t feel like there’s a hawk over my shoulder. I feel like I can make mistakes and learn my way.”
And when he’s learning, his computer is learning too.
Jeremy Devine received a D+H Summer Studentship Award.

 

Another reply, this time an editorial i Dagens Nyheter (Sweden's largest morning paper), by people at Karolinska University Hospital's postcovid clinic and others.

Postcovid är ingen kultursjukdom
https://www.dn.se/ledare/replik-postcovid-ar-ingen-kultursjukdom/

Google Translate, English

 

Nina E. Steinkopf has written a good comment to this article, and also to the interview with Paul Garner which was in the same newspaper.

Can positive thinking cure Long Covid?

Quote:
Physicians and researchers have an ethical responsibility in the way they disseminate medical information. When the impression is given that Long Covid is in fact fear of illness, those who in turn also claim to have the solution to the problem have a duty to inform about intellectual conflicts of interest. There will be power and prestige, and also big money involved when the Long Covid patients are enrolled in research projects, when treatment methods are recommended, and when NAV can finally demand courses in LP as a condition for financial support.

 

https://twitter.com/user/status/1381510314332581889