His lecture for students at the medical faculty at the university of Bergen was good too
Glad at least some health care providers get decent information.
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ME/CFS and Long Covid - Digging Deeper 7-8 May 2025 | Stavanger | Norway
- Thread starter Jaybee00
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Glad at least some health care providers get decent information.A couple of questions from Scheibenbogens talk.
1. If this improvement from immunoadsorbtion is genuine, why would it not be an appropriate therapy for the severe or very severe in the absence of better drugs?
2. She says that she has seen very good improvement from CD19 depleting drugs in trials at Charite. Does anyone know what she is referring to?
I think many here will feel she overstates the evidence in her talk about mechinisms. Nevertheless it is good to see clinical trials happening.
Utsikt
Senior Member (Voting Rights)
I don’t quite buy this. Biomedicine was already taking into account all factors, but it only viewed it through the lense of the physical reality.
BPS says that there exists something more, something not already covered by the physical reality. But there is nothing more.
rvallee
Senior Member (Voting Rights)
I'm not sure that biopsychosocial can be pinned down as any one thing. It's too vague and generic. In practice it's mostly useless or horrible. In principle it's hard to judge because it doesn't really say anything, which allows anyone to basically say anything about everything.
What matters more than anything is that what it is, in practice, has nothing to do with what is claimed in principle, and that it adds nothing of value.
It's not much difference from political parties with completely different philosophies and policies all claiming to be for justice and order. It means different things to different people, and that's what makes it useless, it's a shapeless void. It's the same as the questionnaires they use: every single answer to their questions can be answered the same way by different people but for completely different reasons, or differently but for the same reasons. It reduces complex matters down to simple numbers, like compressing information and losing 99% of it.
Having read/skimmed hundreds of biopsychosocial papers, presentations, assertions and the like over the last few years, I haven't seen anything at all in there that is worth a damn. And I am 100% certain that over time, nothing at all out of the current ideas will hold up. It's the health care equivalent of thoughts and prayers. In themselves they can be framed as well-intentioned and harmless, but the second they are elevated above a simple complementary set of good intentions, when they are operationalized with fake formality they can't live up to, they only cause harm for zero meaningful benefit.
What matters more than anything is that what it is, in practice, has nothing to do with what is claimed in principle, and that it adds nothing of value.
It's not much difference from political parties with completely different philosophies and policies all claiming to be for justice and order. It means different things to different people, and that's what makes it useless, it's a shapeless void. It's the same as the questionnaires they use: every single answer to their questions can be answered the same way by different people but for completely different reasons, or differently but for the same reasons. It reduces complex matters down to simple numbers, like compressing information and losing 99% of it.
Having read/skimmed hundreds of biopsychosocial papers, presentations, assertions and the like over the last few years, I haven't seen anything at all in there that is worth a damn. And I am 100% certain that over time, nothing at all out of the current ideas will hold up. It's the health care equivalent of thoughts and prayers. In themselves they can be framed as well-intentioned and harmless, but the second they are elevated above a simple complementary set of good intentions, when they are operationalized with fake formality they can't live up to, they only cause harm for zero meaningful benefit.
Jonathan Edwards
Senior Member (Voting Rights)
But if we ever to get anywhere and maintain any sense in medicine we need to stop muddling concepts. The BPS theory is a theory of causation. That has nothing to do with supporting patients three ways (there isn't much you can do socially). Whether an illness has a partly psychological cause or not need have nothing to do with whether psychological treatment or support is likely to be justified. Very often it is the people with 'physical' causes for their illness, like cancer, who need psychological support. People with psychiatric disease may be better off with drug therapy.
So I agree with Trish that in terms of therapy there is no 'BPS approach'.
Not sure that is correct.
(Not a criticism of biomedicine, as such. More a comment on them never being given a solid run at doing so.)
Snow Leopard
Senior Member (Voting Rights)
I suggest re-reading Engel. Bio-psycho-social was *explicitly* a practise based approach rather than a causative theory. Some may have tried to twist it towards the latter in the years since but the evidence has never been there.
Ravn
Senior Member (Voting Rights)
I don’t disagree. The BPS model of causation is neither coherent nor helpful and the sooner we get rid of it the better. I just don’t think a short video like this is the place to take that fight. This video has a few minutes to convince doctors practicing right now to not do stupid things like send their ME patients off to GET and CBT but instead to support them with whatever practical, financial or symptom relief they may need and are able to access
I don’t know about the Norwegian context that this video is responding to but I suspect it’s similar to NZ. Here the situation is that BPS is effectively the official stance of the entire health system at all levels
I’ve discussed BPS with a handful of health professionals and none of them cared one hoot about what Grinker or Engel might have meant or whether it stacks up as a model. As far as they’re concerned today’s BPS is about looking at the whole person in their environment. What that means in practice is vague and seems to depend on whatever the individual health professional wants it to mean. Some do have an undercurrent of psychosomatic thinking, others are all about socioeconomic factors or about family support. But whatever it means to them, they’re quite passionate about it
Which is why I think it’s unrealistic to expect any positive change from attacking BPS head-on right now. In the short term we’re more likely to get helpful behaviour from health professionals if we encourage them in some of the more useful beliefs they already have, i.e. the ones around practical support for patients, and let them call it BPS if they want to
In the long term the hope is that either the term BPS simply goes out of fashion or that people will completely forget what it originally stood for and everyone applies and understands it to mean that patients should be supported in whatever way is best for the individual. That would be language change in action. Unfortunately the process of language change tends to be a messy and confusing affair with unpredictable outcomes. Currently I see at least two opposing tendencies. On the one hand the term BPS is being applied to a pragmatic approach - not a model proper - to addressing economic, cultural and other barriers to healthcare. On the other hand the wellness fad is pulling the term back to meaning something vaguely psychosomatic - also not a model. Anyone’s guess which trend will win out
I don’t know if there’s a way to speed up a change in fashion, linguistic or conceptual, but if there is it has to be at a higher level in the system than a video like the one sparking this discussion
There’s a valid case to be made for not mentioning the term BPS at all in videos like this. It’s usually best to not remind people of any unhelpful notions they may hold. However, that argument only holds if the other side doesn’t bring the topic up themselves. And in Norway the other side very much brings it up at every opportunity, I suspect that’s why it was included in the video
Irrespective of changing terminology, the BPS model itself will, I fear, keep popping up in new disguises for as long as there are humans inclined to magical thinking. The best we can hope for is relegating it to the fringe. For that we need some robust research breakthroughs
Utsikt
Senior Member (Voting Rights)
Which factors did it not take into account? Or probably more importantly, were there any known factors that they ignored due to reasons other than resource limitations?
Utsikt
Senior Member (Voting Rights)
BPS is very much the go-to in Norway for all kinds of things, and especially ME/CFS. The Norwegian cancer association even supported Reme’s study on pre-op hypnosis of breast cancer patients..
rvallee
Senior Member (Voting Rights)
Hmm, that's something I missed, and it's really disturbing when you consider it. It really has nothing to do with supporting patients in any way, because all it is is some assertive flowcharts about the causes of illness behavior.
That's why I never saw a single useful thing out of its evidence base, because all it does is make assertions and work through the implications of how it could help. If it were true, which it isn't. Hence: "imagine a world"-based medicine.
Even the most generous interpretation of this model misses the point entirely, which is that it has no point. It's just an alternative model, identical in its intent and purpose as the homeopathic model, or the chiropractic model, or any of the other quack models. All of which have the same killer flaw: if it were true, it could be of some use, but it isn't, and there is no point bothering beyond that.
rvallee
Senior Member (Voting Rights)
It would be more fair to say: to the degree at which it's realistic to do so. Medicine also can't take into account socioeconomic determinants of health, and they mostly don't bother with that, even though it would have 100x the impact of this psychobehavioral junk. So instead of "prescribing" safe housing, which would be wise, but is at a policy level, they end up prescribing nonsense like walks in the park, which is foolish, but can be done in the confine of a 1:1 consult, mostly because it has zero implications one way or another.
It's not realistic to take all this psychobehavioral mumbo jumbo into account when it comes to medicine, so they didn't bother, because it doesn't matter any more than astrological... projections or whatever.
What this BPS model is create the fiction that they are taking into account more than they used to, when in reality they take far less into account because they distract themselves by jiggling keys in front of our faces.
rvallee
Senior Member (Voting Rights)
I keep seeing this, but it's pure fiction. Health care is not biopsychosocial, has never been, and never will be. When someone has cancer, they go to oncology clinics where they receive treatment based on known biology. The rest is either complementary, ultimately matters very little, or alternative, usually actively harmful, or at least a wasteful distraction.
So this opens up the awkward question of why all the pretense, when medicine is 99% about biology, with a few specks here and there of other factors, all of which still relate to biology. Diabetics aren't advised about the importance of diet because eating well is biopsychosocially good. They're advised about this stuff because it directly impacts on the biological problem, on their inability to metabolize sugar.
Deep down medicine retains this weird obsession with it, if it were true and worked, it's their philosopher's stone, but no one thinks psychobehavioral first, as it would be very silly to do so. The pretense is there, but it's all theater. It's really absurd that it has attainted this mythical "everything we do is biopsychosocial" when it's a bunch of total nonsense.