Long COVID – Can we deny a diagnosis without denying a person’s reality?, 2024, Little et al.

Fantastic how they go from Objective to Conclusions without all those annoying steps of Methods and Results. Sums up BPS perfectly.

 

There are two journals put out by the RANZCP - this is the lesser one, does not require scientific research or clinical experience and is often used as a way to get published. It is a vehicle for members of the college to express opinions on all sorts of things that interest them (but also new initiatives they are trying in the mental health service (not ME or Long Covid just general psychiatry).

I am not sure what their roles are in the mental health service in Wellington. Although the article comes under Consultation Liaison Psychiatry but I don't know if they work there. I would be very disappointed if they do and hold these views.

I am not sure how other psychiatrists would be influenced by this paper. To me, it is farcical and outdated and also seems a bit sensationalist eg. by listing various "psychogenic" outbreaks. They elude to ME/CFS researchers only doing research because they know someone with ME/CFS. What's that got to do with anything? does that affect the validity of their research?

So much of this paper is cherry picking a few references from the psychosocial and psychosomatic schools of thought and lacks any rigour or scientific review of the literature.

They feel uneasy writing it....then why did you? I have been pondering this. It is like they are trying to say "hey everyone - why aren't you talking about what is so obvious to us". I am afraid this is not the first time doctors have written saying Long Covid (and ME/CFS and every other illness with multiple symptoms and unclear pathophysiology) is basically neurasthenia. So many articles have been written and discussed here when the illness was becoming more prevalent and reported on but these authors haven't spent much time looking at all the scientific research going on into Long Covid and ME/CFS. All this research seems pretty inconvenient to their view.

There appears to be a lot of discussion on freedom of speech in the latest Australasian Psychiatry (during my brief look at the most recent issues). They have another article in the most recent issue titled "Silent reflections remain unheard"

 

I wouldn't bother, it would just encourage the buggers. Next there'll be an article saying "felt an uneasiness in writing an article equating CFS/ME and Long Covid with neurasthenia and hysteria - and received hysterical emails from hysterical females, point proven". Or something in that vein. You can't reason with true believers

From what I hear not many in the profession take those incoherent ramblings seriously - I really hope my informant is correct on this - so a better strategy and use of energy would be to ignore this and instead try and encourage more sensible people to publish more sensible pieces (not that I know how to go about this, lacking the necessary personal contacts)

 

We do not know what causes ME, we do not have specific mechanisms. What we have is multiple triggers and lots of hypotheses.

We know what triggers LC for probably the majority of cases, though a small percentage might have had multiple potential triggers at the same time. We do not have specific causal mechanisms. We are testing hypotheses in current global research.

What these kinds of papers miss is that we have literally thousands of known biochemical and physiological abnormalities. We do not understand them, but they are measurable. At least one, or several if you prefer, relate to how people with ME or LC respond to exercise, and some of that is measurable on the repeat CPET.

We have objective physical evidence that something physical is wrong. There does not appear to be any concrete evidence of substantial cognitive causality. Its functional in the sense of biochemical and physiological abnormalities, not abnormalities of thoughts and behaviours, according to hard evidence. There are cognitive processing issues, but nothing to show they are cause and not consequence.

Its time psychiatry stopped accepting explanations that are grounded in 19th century scientific methods. Its absurd. Its time these people started reading the existing science.

 

So articles ‘discussing’ whether hate, human rights and coercive care for the disabled need to be ‘balanced with clinicians judgement’. And then an article suggesting a clinicians judgment should be able to be more independent of clinical trials?

Is this the same one whose main area is Electro convulsive therapy?

This seems like a list of red flags. I’m sure all those ‘normal’ patients who ‘have nothing to worry about’ would be queuing up to see this doctor if they ever got really ill once they’d read this list ?

yep there is a right to free speech. But there shouldn’t be a right in a profession to keep a job title and powers if you have red flags regarding whether you use misinformation to back up ideology you sell. You can’t have both. Otherwise it isn’t ‘speech’ it’s ideology you are implementing?

A random man can get a soap box and stand in a park saying this. Or someone can be a doctor eg with niche religious beliefs but still confirm to their medical oath and responsibilities in who they treat and how being based on science. But they don’t get to write the policies on who’s welcome and how other doctors should deal with groups they think are hysterics or don’t like?

you can’t start using a title which doesn’t confer expertise along with non facts to sell dislike of individuals and expect someone not to question whether that means you shouldn’t / can’t have responsibility that would assume you ‘don’t bring that discrimination to work’?

just like someone cracking xenophobic jokes would expect as a doctor to have their past outcomes analysed and maybe feedback sought from patients to check they can leave it at the door. At least surely? But at least they aren’t writing in journals to other medics inferring knowledge and suggesting different ways to treat them with at best cherry-picked non-scientific snippets to try and sell those statements

 

I am not totally convinced that these explanations are even ‘grounded in 19th century scientific methods’. My knowledge of Freud and psychoanalysis is limited but my understanding is that he abandoned contemporary neurology/neuropsychology because it felt too limiting and, though perhaps charactering his approach a little unfairly, he essentially replaced it with an intuitive sense of what felt right in the light of his clinical experience and his personal beliefs.

This is exactly what we are seeing with the BPS approach to evidenced based medicine, where they allow themselves major leeway to move away from the scientific method because to them the conclusions they want to confirm are self evident truths.

 

Yeah honestly the best technique might just be to let this guy go on and “study” some other stuff without reminding him/making him think more about Long Covid/ME.

 

Pretty sure the authors will be open to suggestions from patients to improve their research!

 

At that time a lot of medicine, and softer science, was about showing they are right, and its up to others to show if they are wrong. It was about confirmation, not testing. This is pre-Popper and the notion of falsifiability, or even trying to break hypotheses. There is a specific name for this in the literature but I forget what it is. If I recall correctly Popper first called this non-science. Psychiatry is the branch of medicine that has mostly not grown out of this. Some biological psychiatry has moved beyond this, but that often has other biases if money is involved.

 

True but also part of nineteenth century ‘science’ was natural history, detailed thorough observation. However the BPS advocates are not even doing good natural history, they observe only what they want to see and some even consciously exclude observations that don’t fit in with what they already believe.

 

Most baffling thing in this op-ed, as is tradition, is the notion that this is all promising, full of potential and never-before-tried, but it's also solidly tested and so on. Same old nonsense about central sensitization and other crap. The same old script, always new and promising, but also effective based on years of clinical implementation. They talk about hope for long haulers, and it's literally the thing that's been tried from the start and millions have been subjected to. There is zero effort at making sense here.

Small lies are bad enough. Big lies, though, how do professionals not understand that big lies are never legitimate? That none of this can be real simply because of this? There is no such thing as lying to the truth, all it leads to is more lies, and here, being health care, massive needless suffering and death. What garbage.