Effectiveness of a symptom-clinic intervention ... multiple and persistent physical symptoms, 2024, Burton, Deary et al

It makes sense when we just believe that when they say they think there is nothing wrong with our bodies, that's what they mean. It's like telling a child that they know there is no monster under the bed, you just checked and it's safe to sleep.

No matter how they try to frame it as "yes, but believing in a monster can truly bring symptoms" makes no difference to the fact that in this scenario, there are never monsters under the bed. Straight up never have, never will be. They know what they're doing, they're just basically executing code that falls within a if(false) statement.

It's all completely monstrous, pun intended, but it makes sense as long as you agree with a premise that is false. This is the nature of beliefs, why they can be so dangerous, why they usually hurt others far more than they hurt the believers themselves. It's their beliefs that makes this all so harmful, but the nature of beliefs makes the believers unaware of it, to them it's just logical, rational, common sense, it's not just true, it's Truth.

 

Just to confirm, the Fryer et al. paper does outline in much more detail what the intervention involved, by way of describing the training of the 5 GPs who gave the intervention to patients in the Burton trial.

The following section describes what techniques were taught to patients:

It's such a shame that this is being used as a way to avoid further tests and diagnosis, rather than as a way to help patients cope either while they wait for those things, or in the situation where there genuinely isn't anything else the medical profession can offer.

 

It seems like a mind-boggling expensive way of teaching someone to relax and breathe

One session with an OT would be as helpful (for those patients who didn't feel patronised....).

And only after a medical professional has levelled with them honestly to simply state, 'we dunno' what is causing your symptoms, we sadly currently have no effect treatments and in the meantime looking after yourself and so forth is the best that can be done.... And patients are unlikely to stop seeking tests and so forth until they believe that all possible treatable issues have been assessed. So by trying via opaque methods to essentially persuade a patient to do x or y, I suspect in time they are perhaps more likely to seek further medical input and be less trusting of doctors.

 

Letter in the Lancet by David Tuller & Joan Crawford, with a reply from the authors:

https://www.thelancet.com/pdfs/journals/lancet/PIIS0140-6736(25)00329-0.pdf

 

Thanks! And I just posted about it here. What a non-responsive response!! They don't mention the main point--their primary outcome findings were clinically insignificant.

 

Given what we know about gaslighting, we should continue to gaslight the patients and the readers to further our own agenda.

 

The link is broken. I'm curious what their response is. Great comment from Tuller and Crawford.

 

It works for me. It takes you to a pdf. Their response is also at the bottom of the virology post.

 

OK, got it, from David's article.

Tuller & Crawford: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)00329-0/fulltext.

Authors' non-response: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)00330-7/fulltext.

 

Uh. It worked the 2nd time I clicked it. First time gave me an error. Ah well.

 

They are too insulated in their ideological bubble. If they ever listened to patients, just once, they'd easily know that we want real explanations, not fake-but-hopeful ones. And this has nothing to do with some obviously perfectionist demand over perfect knowledge. There are very few diseases that have perfect knowledge. What we need is good enough knowledge, and their stuff isn't it at all.

Patient forums are filled with frustration at this very thing, begging physicians, in frustration, to admit when they don't know something, how fake explanations are self-defeating because it obviously encourages them to stop looking. It makes them lose respect in physicians, in medicine itself. They can easily know this, and they probably do. But they still prefer to hold on to their fantasies.

This is a "let them eat cake" justification, one that completely ignores the issues raised in the comment. Awful. I don't even know why editors accepted the non-answer, it completely ignored what was said.

 

Encouraging health professionals to proclaim “we do not know what is causing symptoms” in response to persistent physical symptoms, as Crawford and Tuller recommend, underestimates the explanatory power of recent symptom science and is likely to perpetuate the frustration and hopelessness of both clinicians and patients, which is all too common in this field.

The frustration and hopelessness of clinicians is largely due to their own incompetence.
That also leads to frustration and incompetence on the part of the patients.

The crux of that incompetence is the inability to recognise its existence.

 

Come on! It's based on the explanatory power of recent symptom science.

 

I interpret it as meaning, "It's a convincing-sounding idea, but we have no evidence for it."

 

You might have given the best description of BPS here.