Chapter 1 - Fads and Fallacies in Science, Medicine, and Psychology Published online by Cambridge University Press: 16 March 2023

[Sly Saint]

Summary
This chapter defines fads and fallacies, and relates them to cognitive errors. It discusses broader problems with determining causality in science, and the reasons for the replication crisis in research. Examples of medical and surgical fads, namely chronic fatigue syndrome, chronic pain, and non-evidence-based surgical procedures, are examined. The chapter also discusses the role of the pharmaceutical industry in medical fallacies. It concludes by explaining how fads can be understood in the context of the challenges of chronicity in medicine.

By and large, medical fads arise when practitioners have good intentions but lack knowledge. For reasons of training, idealism, and professional pride, physicians passionately want to help their patients. Although they often succeed, most are less comfortable with chronic illness than with acute disease. Managing chronicity requires patience and an acceptance of limitations.

we should be cautious about the expert consensus that lies behind formal treatment guidelines, even the most high-quality recommendations. In my opinion, the guidelines published by the National Institute for Health and Care Excellence (NICE) in the UK are more reliable than anything produced in North America. (This could be because British culture has historically, at least until recently, valued empiricism and common sense over hype.) The other major contribution of British medical experts (in collaboration with Canadian ones) has been a series of Cochrane reports that are considered to be a gold standard for evaluating treatment. But Cochrane is so rigorous that it typically concludes that not enough research is available to lead to strong conclusions. Moreover, although NICE guidelines and Cochrane reports represent the best we can do at any given time, they have to be regularly updated to serve as a guide to practice. Many of them become dated within a decade or so.

Chronic fatigue syndrome (CFS) has been the subject of intensive research and serious controversy for decades, and the diagnosis remains controversial (Holgate et al., Reference Holgate, Komaroff, Mangan and Wessley2011). As defined by the Centers for Disease Control and Prevention in the USA, CFS is characterized by persisting or relapsing fatigue for at least 6 months, cannot be explained in other ways, and is associated with four other symptoms from a list that includes post-exertional malaise, impaired memory or concentration, unrefreshing sleep, muscle pain, multi-joint pain without redness or swelling, tender cervical or axillary lymph nodes, sore throat, and headache.

Attempts to define CFS in other ways, such as by the term “myalgic encephalopathy (ME),” assume that a specific biological etiology has been found. But these claims have never been proven or replicated. Viral infection need not be the main cause of the syndrome, although it seems to be a trigger. Holgate et al. (Reference Holgate, Komaroff, Mangan and Wessley2011) concluded that post-viral fatigue ends up being chronic, either because of psychosocial stressors or due to other unknown factors. Thus chronic fatigue is not an infectious disease, as claimed by some patient advocates who want to legitimize their suffering, but an abnormal response of the immune system to infection, leading to a failure to recover.

No evidence-based treatment for CFS has ever been established. This is not surprising, given that the syndrome is quite heterogeneous. For a time, the idea that fatigue might be due to low blood sugar, even in the absence of diabetes, affected practice (Bennion, Reference Bennion1983). Later, Abbey and Garfinkel (Reference Abbey and Garfinkel1991) concluded that CFS includes cases with unknown organic causes, and others that represent depression, or what nineteenth-century psychiatry called “neurasthenia” (Shorter, Reference Shorter1993), as well as what DSM-5-TR now calls “somatic symptom disorders” (American Psychiatric Association, 2022).

Another patient symptom that physicians struggle with, namely chronic pain, can take many forms. Today fibromyalgia is a common diagnosis in primary care. This syndrome has a specific definition (Chakrabarty and Zoroob, Reference Chakrabarty and Zoroob2007): the presence of widespread pain for a period of at least 3 months, as well as tender points at 11 out of 18 specific anatomic sites. However, no lesions can be found at the tender points, and there is no evidence of any etiological factor—or of any consistently effective evidence-based method of treatment. Like chronic fatigue, fibromyalgia overlaps with somatic disorders (Shorter, Reference Shorter1993), with the important difference that it is more widely accepted within the medical profession. Even so, the concept remains controversial. Like many mental disorders, it presents with symptoms but without signs, and is not associated with biological markers or organic changes. It remains possible that fibromyalgia will eventually go down in history as a medical fad.

https://www.cambridge.org/core/book...d-psychology/E0F368DDCFB42B36530D3E19A423DEA7

 

[Andy]

Author is Joel Paris, Emeritus Professor of Psychiatry, McGill University, Canada.

 

[Trish]

By and large, medical fads arise when practitioners have good intentions but lack knowledge.

If you're going to use references and definitions from Shorter and Wessely from the 1990's you can hardly justify accusing others of lacking knowledge.
Where are the references from post 2015, and where is the current consensus that ME/CFS must include PEM?

 

[Wyva]

If you're going to use references and definitions from Shorter and Wessely from the 1990's you can hardly justify accusing others of lacking knowledge.
Where are the references from post 2015, and where is the current consensus that ME/CFS must include PEM?

Those probably don't count as institutions like IOM, NICE or WHO are now clearly just puppets of the extremely powerful ME/CFS patient organizations, also commonly known as "some patients".

 

[rvallee]

There's something unique about reading medical philosophy, it's like a peer into the past, pre-science, even pre-expertise. They're just old ideas without any substance throwing rocks from a glass tower while screaming "I'M THE KING OF THE WORLD!". Freud himself would find nothing incomprehensible in any of this. The ideas are so generic, so ignorant and devoid of any actual meaning, of any effort at being valid.

Every bit of criticism they have for what they consider fads, and obviously "fads" don't last for decades this is just silly, applies far more to the main factor at fault here in the psychosomatic ideology. But they can't ever turn criticism inward. Their job is to throw rocks and their glass throne is just super comfortable.

How do you even get past calling chronic pain, literally one of biggest health problems, a fad? One common factor to psychosomatic ideologues and anyone who espouses those beliefs is a complete inability to imagine any experience other than their own. They are so full of themselves while blowing nothing but hot air. Even where equal criticism applies, they tip it entirely as being blameless, even perfect.

And they just basically trade praise and awards for one another in a ridiculously incestuous system:

But Cochrane is so rigorous that it typically concludes that not enough research is available to lead to strong conclusions

In itself this is laughable, but the author just made zero effort outside of supporting their conclusion that they seem unaware that Cochrane actually does that without any problem, since they straight up don't care about their own principles when it's necessary to push the ideology. Evidence-based medicine is a corrupt industry and they are the most representative institution of this decay.

And I'm really tired of nonsense like this:

By and large, medical fads arise when practitioners have good intentions but lack knowledge. For reasons of training, idealism, and professional pride, physicians passionately want to help their patients. Although they often succeed, most are less comfortable with chronic illness than with acute disease. Managing chronicity requires patience and an acceptance of limitations.

Physicians aren't elves, FFS. They're ordinary people who are often out of their depth, working in a dysfunctional system within a profession that carries the slogan "first do no harm", but has done far more harm than good until the turn of the last century. This is as detached from reality as any system of nobility or aristocracy, bestowing superiority on the basis of status alone, as having magical special blood, or whatever.

The contrast with other expert professions is just shocking. Medicine has been moving so slowly over the last few decades that every other expert profession has passed them by. And they're essentially slowing down even further, betting everything on delusional nonsense that is somehow praised, while the actual serious hypotheses and models are ridiculed. It's just baffling how lazy, even nihilistic, this all is. They're becoming Nero, fiddling with themselves while the rest of us burns.

It's actually weird that it talks about the crisis of replicability, when it is mostly contained in areas that use psychological methods. It's psychology that is this crisis, and medicine by extension everywhere they adopted the same methodologies, for the same purpose that psychology does: it allows them to "find" anything they want and simply argue their opinion as if factual. The real crisis of replicability is this stubborn inability to actually self-criticize. There's just none of that in medicine, they can never actually look at where they are failing, in fact seem to double down every single time their beliefs are challenged or the horrible outcomes they create are pointed out.

 

[shak8]

FM as "...medical fad" except that it was characterized since 1904 (as fibrositis).

 

[Sean]

Like many mental disorders,

Cart before horse much?