Review Interventions for the management of long covid post-covid condition: living systematic review, 2024, Zeraatkar, Flottorp, Garner, Busse+

I'm away from home an with limited WiFi so not has opportunity to read.

I'm wondering if they referred to the ReCover trial?

I had the following critical letter published. Kuut et al 2023.

"Issues with Expectation Bias, Absence of Data Relating to Objective Trial Outcome Measures, the Use of Low Quality Trial Design Methods and Choice of Flawed Psychological Model in ReCOVer Trial for Prolonged Fatigue Post Covid-19 Infection"

I'm guessing the authors didn't reference me......

 

It's interesting that these authors conclude that there's no compelling evidence for HBOT as a treatment for LC. Another systematic review that was just published came to the opposite conclusion:

Most studies found that HBOT can improve quality of life, fatigue, cognition, neuropsychiatric symptoms, and cardiopulmonary function. Although HBOT has shown some benefits for long COVID symptoms, further rigorous large-scale RCTs are required to establish precise indications, protocols, and post-treatment evaluations.

https://www.mdpi.com/2075-1729/14/4/438

 

For those not familiar with Young, he has quite a high media profile in the UK but he is not someone whose views are taken seriously by those who care about the truth. He and Garner are a good match.

See Controversies: https://en.m.wikipedia.org/wiki/Toby_Young

 

Reading about him it makes perfect sense that he and Paul Garner found each other. The subheading of "Covid 19 pandemic" under Controversies is especially enlightening.

 

Yes according to their standards, this should have at least the same certainty of evidence. But they downgraded it twice, once for selective reporting and the second time because the reviewers believed there is no plausible mechanism:

 

Exactly what happened with PACE. This has always been the process: the lies amplified, massively overhyped, on page A1, the slow gradual debunking that simply gets ignored nowhere to be found, even years down the line. The asymmetry of bullshit in action.

It's really like an amplification process. Nowhere is there any evidence suggesting this treats anything, but out come loud assertions that this is a 100% safe and effective cure. Nothing's changed, this is how this scam industry thrives.

 

Oh the overlap between both grifter groups is obvious. It comes from a deep-rooted disdain for disabled people that is very popular in these political circles. No surprise there.

We're seeing the same thing with the more general pandemic deniers that will dominate US medicine in the next few years. They are all deeply associated with, and often funded by, corporate groups pushing far right politics.

It's stuff that would be super popular on platformed BS like Joe Rogan. It plays very well with the conspiracy crowds, so this is where they get the warmest reception. They understand where the politics of this stand, and where the money is coming from.

 

Interesting, that one can do that in a systematic review, i.e. use a system such as GRADE, but then also move outside of said system and judge certain studies according to your own criteria without specifying what these criteria even are, since "plausibility assessment" wouldn't seem to be part of the bias 2.0 tool.

 

There's also Hyperbaric oxygen effectively addresses the pathophysiology of long COVID: clinical review (2024, Frontiers in Medicine) which came out around the same time as the review you quoted. I haven't got round to reading any of these yet, but this review concluded —

And just recently is Is there a rationale for hyperbaric oxygen therapy in the patients with Post COVID syndrome? (2024, European Archives of Psychiatry and Clinical Neuroscience) with abstract concluding —

Hyperbaric oxygen for treatment of long COVID-19 syndrome HOT-LoCO: protocol for a randomised, placebo-controlled, double-blind, phase II clinical trial (2022, BMJ Open) appears to have completed in June 24 but not yet reported. See https://www.clinicaltrials.gov/study/NCT04842448

 

It's truly the perfect method to greenlight fashionable establishment pseudoscience while still gatekeeping, correctly, other forms of perfectly equivalent pseudoscience. Basically it's almost entirely arbitrary, but it has the pretense of being somewhat scientific. Exactly the definition and process of pseudoscience: using the tools and language of science to sanewash beliefs and opinions lacking any credible evidence.

They're even showing the perfect application in pushing establishment pseudoscience by performing a more rigorous application of bias concerns for pharmaceutical/supplement treatments while arbitrarily upgrading the reliability rating of behavioral interventions, despite being subject to far more inherent bias. It couldn't be more blatant, but put this in front of 100 so-called skeptics, even professional ones, and all 100 will say this is a great review.

IMO it's the most extreme example of how expertise can fail, and it's precisely because experts see nothing wrong with it that it's so extreme. The death of expertise. Why they are delivering less and less over time, and losing trust and credibility while being oblivious that it's almost entirely self-inflicted.

 

These references are:

The Komaroff-Lipkin paper does not seem to suggest that graduated physical activity and CBT have been found effective, the Larun review is supposed to be being replaced, and the abstract of the Kim et al paper states that while a number of interventions reached statistical significance "there was no definitely effective intervention with coherence and reproducibility".

I'm puzzled about some of the determinations they have made. They use the broad WHO definition but exclude anosmia/hyposmia trials. Moderate certainty classifications are assigned even when trials don't seem to warrant it. They also don't seem to say how the TRACT flagged issues were addressed? (I don't think there's a specific cutoff/threshold score for TRACT but it would have been useful to have more detail on this; the per-trial determinations can be found in the spreadsheet).

While it is true that there is no plausible mechanism of action for "synbiotics" I wonder what the authors would say if someone did a GRADE-style review and downgraded all of the CBT studies on the grounds that they did not find the cognitive-behavioural model at all plausible? Tools like GRADE are surely just useless if the authors of reviews can simply substitute their own judgment on a selective basis?

Don't have the energy to look at this further but hope someone does.

 

They've done the same ignore the high risk of bias and rate it as "moderate strength" evidence anyway trick seen in the Cochrane review...

 

One more point - the authors say of PEM that:

Ref 43 is a New Scientist article; ref 44 is a Dave Tuller blog and ref 45 is the Vink paper "Could Cognitive Behavioural Therapy Be an Effective Treatment for Long COVID and Post COVID-19 Fatigue Syndrome?". On this basis they define PEM as "worsening fatigue after physical or mental exertion", which proves that they don't understand what it is at all; the references they cite also don't define PEM in this way.

 

They use those same references in the discussion/implications section.

 

Print article in the Telegraph — complete with a terribly misquoted pull quote stating:“The effectiveness of CBT and rehabilitation implies that long COVID is not real but psychological.”

I guess this is the icing on the cake. Can't see Garner and co being in any rush to call the Telegraph.

 

Noticed that the protocol says this about conflicts of interest (my bolding):

 

I wouldn’t be at all surprised to see a letter from them protesting that psychological illnesses like LC and ME/CFS are real. PR manipulation at its best/worst.

SW and co will no doubt be raising a cheer – a truly dreadful piece of research, which doesn’t provide any reliable evidence in support of its claims about CBT and rehab, has passed peer-review and been published in the BMJ. Now the Telegraph is using it to write headlines which are not even supported by the false claims in the BMJ paper.

“War is peace, freedom is slavery, ignorance is strength.”