BPS attempts at psychologizing Long Covid

Their main argument seems to be that so many patients with long covid have negative antibody tests.

• They refer for example to the survey by Hannah Davis and colleagues were more than 2000 respondents said to have had an antibody test (IgG, IgM, or both) but only 18.2% had positive results.

• In a different study, 77 long covid patients reported they had antibody tests but only 30 (39%) were positive.

• Thirdly they refer to this preprint on 1560 students where there was no difference in symptoms between the 188 (12%) that were seropositive and the 1365 (88%) that were seronegative for covid antibodies.

The authors of the NYT article argue that "Antibody testing has some level of false negatives, and antibody levels can wane; however, most people with a prior infection have antibodies for some time, so such testing remains informative overall."

 

This is the kind of stuff that shows that the problem is fundamental to medicine and cannot be resolved without massive system-wide change. Gaffney is an annoying contrarian but Berger otherwise seems to generally get it, is clearly well-intentioned and I've seen many of this tweets showing that he understands the political and economic issues at play in medical outcomes. But then he signs his name to this garbage, and it shows that individuals, even well-meaning ones, cannot work with a broken system. This is the intersection of well-intentioned but misguided that has lead us to disaster, now being used to amplify the very same disaster, using the disaster as a guide. Mercy.

And their solution is the same as always: science won't have the answers, a prediction so foolish it's hard to believe. And it's true, as long as science is stifled and blocked. It won't have the answers until the work is actually done. The only difference between scientific medicine and alternative medicine is science, without it the results are the exact same: nothing. And we know that this pseudoscientific alternative medicine doesn't work, but since it doesn't work, it can't be evaluated, as it is used to assess itself. Psychosocial models are used to assess psychosocial outcomes, which is the same as calibrating a thermometer with a broken one. And just like a broken clock, a broken thermometer is accurate a certain % of the time.

Medicine in its current form is unable to handle this kind of complex issue, it's impossible to ignore this at this point. The golden age of psychosomatics has completely destroyed medicine's ability for further progress outside of very pointed areas, all scientific and biomedical. The BPS model has managed exact zero success in decades, and yet the general mindset in medicine seems to be that science is pointless now that they know everything and that alternative medicine is just as good as long as it has the weight and coercive, and silencing, power of scientific medicine, despite having none of its competence or quality.

It's even always the same tired arguments that have been used for centuries by now. It's genuinely insane that medicine is paralyzed by old baggage like this. Even more insane that the system cannot be changed from the outside, it is impervious to anything outside of its limited frame of reference. Like an old dictatorship resisting the need for democratic reform, it will never vote itself out of power, even for the greater good.

 

Honestly I don't care about the answer, it will be the usual argle-bargle, but it's good to see that long haulers are starting to see the urgency of medicine being completely out of its depth here, and that politics will have to overrule system paralysis.

https://twitter.com/user/status/1428384827028475914

 

Gaffney's tiresome refrain doubting that long Covid could result from a SARS-CoV-2 infection always comes back to his favorite (and seemingly only) evidence, studies that show patients with and without SARS-CoV-2 antibodies reported the same level of symptoms. Therefore, he says, the most plausible explanation must just be stress of the pandemic! (Can he even trust that the immunosuppressed who develop no antibodies after vaccination even got vaccinated in the first place??)

Equally inaccurate and condescending is his implication that patients seek a physical explanation for their symptoms because of the stigma around mental health and that “compassionate” and “validating” clinicians will do more to address patient suffering than a pharmaceutical treatment. (Here I would have liked more quantitative data on how "validation" was provided to patients and how it has reduced symptoms or improved their quality of life.)

 

Not about Long Covid, but it's highlighted by Henrik Vogt as a study that documents that expectations of illness will make symptoms worse and he draws parallels to an opinion piece he wrote last year on Long Covid and how medical information can lead to prolonging symptoms.

Scandinavian Journal of Public Health Experiencing COVID-19 symptoms without the disease: The role of nocebo in reporting of symptoms by Daniali and Flaten

Conclusions:
Believing to be infected with COVID-19, along with anxiety, can enhance the severity of COVID-like symptoms. Thus, the nocebo effect was due to both cognitive and emotional factors and was higher in females.

 

Isn't this just evidence of increased response bias associated with those factors? Too many researchers assume that symptoms as reported on a scale is the same as an experienced symptom. They are not the same and they never have been. Scales place one or more levels of abstraction between an experience of an symptom and their reporting.

 

another famous writer of drivel wonder which insurance companies pay him to deny benefits .

 

Says it all really.

 

This is so absurd when you look out there at the real world with most people having long given caring and just want this all to be over. You'd only need to read long haulers accounts to see that most of them thought nothing of it.

As usual, people like Vogt generalize their personal experience, basically have no theory of self. They think about this stuff so they assume everyone does, they can't imagine that other people have other life experiences than their own. They have weird beliefs about illness and so everyone must have them too.

I especially love how the other common argument for those symptoms is that it's basically normal, if you poll random people you will find "common symptoms" regardless, which completely undercuts whatever it is they're trying to argue here. But consistency is obviously not their thing.

 

If your questionnaire asks "Do you have trouble finding the right word?" and "Do you forget things?" it is inevitable that the controls will seem to have the same results as the patients.

In 1985 a friend said he saw a poster about ME at his GPs and he had all the symptoms they mentioned even though it was quite a good one. It is the intensity of our symptoms and the consequences that are important in distinguishing that we are sick.

Consider a similar questionnaire about MS

"Do you drop things?"
"Do you trip over your own feet?"
"Do you have fatigue?"
"Do you have trouble getting out of a chair?"
"Do you get a sudden urge to empty your bladder?"

 

NHI is an official site for information about diseases and clinical care. It is used as a trusted source by both health care workers and general public in Norway.

They've just published an article about prolonged symptoms after Covid-19 with a clear "biosychosocial" approach.

The article says it's known that some can have long term symptoms following some long lasting infections, as Epstein Barr virus.
Among theories that may explain the condition are immune response, anti body response or re-infection. Then they add: It is also discussed whether the cause is composed of biological, psychological and social conditions. It could also be a consequence of restrictions during the pandemic.

When listing symptoms, they've added increased weakness after exertion, which I assume is supposed to describe PEM.

Regarding treatments there's not enough knowledge yet, but there is good reason to believe that things that are effective in other conditions with similar symptoms, can have affect in this condition as well. Therefore they recommend graded physical activity (but have added that you should reduce the intensity if you deteriorate), breathing exercises and online cognitive therapy.


NHI.NO Covid-19, langvarige symptomer
google translation: Covid-19, prolonged symptoms

 

https://sciencenorway.no/covid19-jo...ovid-are-sensationalized-by-the-media/1901927

 

Wow. The argument boils down to:

Funny how that works, uh? If you don't provide a service for something, you can say that there is no service provided for this. How that circles back to meaning there is no need for it is something that requires advanced mental gymnastics.

There have been hundreds such headlines, most of the articles were completely uncritical. Whether this means they didn't notice, or want even more of those is unclear, but they have no issues with uncritical reporting, and the reasons for those are obvious, with the symptoms of LC being miscategorized as mental health, again uncritically.

Be careful what you wish for:

How mad would these people get if they were asked critical questions? Especially about their so-called evidence for an increase in mental illness, which they make in this article, without evidence. Very.

It turns out that no lessons were learned from the AIDS crisis. The exact same failures are still around, unchanged.

 

no lessons are ever learned because there are no consequences for what imo is medical fraud .

 

Saw this post on Reddit and thought it was worth re-posting here:

 

I agree its cruel but doubt that it is exceptional. Consider the inquisition, holocaust, pogroms, Serbia, Rwanda, Uighur, slavery.

It is human nature to inhabit a self-righteous identity and construct stereotyped perspectives on other humans justifying inhuman treatment.

This is how tribal and dominance instincts manifest in some people.

Too many psychologists of limited conscience do not understand what they themselves are doing, nor will they admit it, as it is a means to power over others and they are caught up in defensive self interest. They have to be lead and governed, overpowered as it were from within their group identity as psychologists, by the more enlightened who claim a stake in the same profession.

"We" on the other hand need to be careful we do not do the same ourselves as hypocrisy is another of the more dubious gifts of the human psyche.

 

I am always aware of the way we are a self selected group who echo each other's viewpoint so it is worth stopping to think occasionally if we are missing important points through a sort of blindness.

Then I realise that there is no world in which I would think that putting children through LP is a good idea. Taking a step back and trying to see the other side just makes it clear how self serving they are.

I do admit to liking some research evidence which backs my own view of ME better than that which doesn't but I just hug it to myself

 

Socks hurt my feet because of the neuropathy They obviously need CBT!