Side-effect expectations are associated with disability, physical fitness, and somatic symptoms 3 months after post-COVID... 2024 Salzmann et al

[Ash]

In all seriousness As it is German research team I really hope someone is going to flag it up to the late night comedian guy

Who’s this?
Would I need to speak German to follow it or would English subtitles (if anyone did them) give me the general impression?

 

[NelliePledge]

Who’s this?
Would I need to speak German to follow it or would English subtitles (if anyone did them) give me the general impression?

On the Germany thread I think, it has subtitles

 

[forestglip]

Who’s this?
Would I need to speak German to follow it or would English subtitles (if anyone did them) give me the general impression?

The German late night talk show ZDF Magazin Royal hosted by Jan Böhmermann did a full episode on long COVID and ME/CFS.



Some quotes from an AI translation:











So in the Jon vs John race to cover ME on their show, amazingly the winner is Jan.

 

[Chandelier]

Tweet by Dr. Habets from December 2025 about an article by Dr. Berwanger:

In a publication in the Hessisches Ärzteblatt, Dr. Berwanger, Chief Physician at Hardtwaldklinik in Zwesten, discusses neurorehabilitation. Unfortunately, he once again cites the notorious KleinSchnitz study, which has no real evidential value because post-exertional malaise (PEM) is not even mentioned as a symptom.

One might think that hardly anyone reads the Hessisches Ärzteblatt. That would be a serious mistake. Physicians do, in fact, read publications like this. This is yet another typical example of what I consider the neurologists' insidious approach. The damage they cause is substantial, because those who are already skeptical simply have their skepticism reinforced by publications of this kind.

There is not a single word about the work of Babel, Scheibenbogen, or Hohberger. This publication demonstrates what I see as the neurologists' extraordinary arrogance in feeling confident enough to publish something like this.

Article (German) | Google Translate

Excerpts:

Explanatory Models

The pathophysiological mechanisms underlying PCS remain unclear despite numerous laboratory and imaging findings. The following processes are currently considered to be the most relevant: [3]

• Viral persistence and/or reactivation
• Autoimmune processes
• Endothelial dysfunction
• Mitochondrial dysfunction
• Alterations of the (intestinal) microbiome
• Autonomic dysregulation

Furthermore, it remains an open question to what extent these findings represent truly meaningful evidence supporting a broadly accepted scientific hypothesis of PCS, or whether they should instead be regarded merely as epiphenomena.

A carefully conducted study involving 171 patients with PCS found abnormal findings in only 1.7% of cases based on clinical neurological examination, comprehensive neurophysiological testing, cranial MRI, and cerebrospinal fluid (CSF) analysis. However, the study provided evidence of significant psychiatric comorbidity and high levels of somatization. [4]

The role of psychosomatic factors in the predisposition to, triggering of, and maintenance of PCS remains the subject of considerable debate, both within the scientific community and—perhaps even more so—among the general public. The challenging overlap between the symptomatology of PCS and that of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is discussed further below.

Rehabilitative Approaches​

Since pharmacological and device-based interventions—such as hyperbaric oxygen therapy, transcranial direct current stimulation (tDCS), and plasma exchange [5]—have demonstrated virtually no clinically relevant therapeutic effects, as confirmed by a recent systematic review [6], rehabilitative interventions have inevitably become the primary focus of treatment.

One of the strengths of the rehabilitation system commonly practiced in Germany is its comprehensive biopsychosocial approach. [7] However, a major challenge is that many individuals with PCS do not accept the psychological component of this approach and consistently reject any possibility that psychological factors may contribute to their symptomatology. Instead, PCS is frequently regarded as closely related to myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS)—a condition whose etiology remains controversial but whose syndrome is widely recognized—and therapeutic concepts developed for ME/CFS are consequently applied to PCS.

There is now compelling evidence that neurorehabilitation is an effective treatment for PCS. Our own study [14] demonstrated that patients' expectations can have a decisive influence on rehabilitation outcomes. All members of the rehabilitation team—but especially the medical staff—should be aware of this powerful influencing factor and provide patients with appropriate information regarding the content, objectives, and expected outcomes of rehabilitation.

Unrealistically high expectations should be addressed through clear and realistic patient education in order to prevent disappointment during the rehabilitation process. Communicating with patients in this balanced and appropriate manner may help to maximize placebo effects while minimizing the detrimental influence of nocebo effects.

A significant challenge for rehabilitation centers providing post-COVID rehabilitation is that patients with PCS—primarily because of fatigue—require a substantially lower therapy intensity, particularly during the initial phase of rehabilitation. Within the quality assurance framework of the German Pension Insurance (DRV), this reduced therapy density may result in lower quality ratings and, consequently, reduced patient referrals to the treating institution. This represents an important structural issue that requires urgent clarification.

 

[Axel]

"this reduced therapy density may result in lower quality ratings and, consequently, reduced patient referrals to the treating institution. This represents an important structural issue that requires urgent clarification"

Well, yes, insurance companies aren’t going to pay for density if patients need, above all, ‘less density’ (basic cares staff instead of rehabilitation placebo specialists - not the same salaries).
Good point.
The system is under threat.
It's a subvertive illness.

As for the rating, it is simply a matter of acknowledging that the product does not fit this type of condition. Honor can be saved, if windfall of patients can't. But I don’t see that it’s a concern for them.

 

[Chandelier]

"this reduced therapy density may result in lower quality ratings and, consequently, reduced patient referrals to the treating institution. This represents an important structural issue that requires urgent clarification

It doesn’t seem to matter to them that their treatment doesn’t work or that it makes patients even worse.
They only start to feel a need for urgency when their finances are at risk.

Is the medical arena the wrong place to initiate the downfall of rehabilitation in ME/CFS?
Could this be achieved so much easier by some small legislative rulings?

 

[NelliePledge]

Rehabilitation is definitely effective it’s just that patients have unrealistic expectations……..

 

[rvallee]

I'm not really sure what they're complaining about when this is the entire point of the ideology: reduce health care costs by kicking people out. It doesn't benefit the insurance industry, which very much likes the mental health exception, to spend money on useless treatments when their objective with using this exception is to spend zero money on it.

They're getting exactly what this was built to accomplish, but it seems they have a very warped idea of it because there is always a little bit of money out of research or health care system to prop it up. Ironically, this is one of the strengths of a private insurance industry, as public health care systems just keep paying no matter the outcomes.

 

[Utsikt]

It doesn't benefit the insurance industry, which very much likes the mental health exception, to spend money on useless treatments when their objective with using this exception is to spend zero money on it.

Sure it does. They get people to pay for insurance and then deny claims because it’s psychosomatic or only approve a few hours with a psychologist. Or they just remove the coverage of certain conditions altogether: A major insurance company in Norway recently removed ME/CFS from their disability coverage because they got too many claims.