BMJ: Chronic fatigue syndrome and Long Covid, moving beyond the controversy, 2021, Newman

[rvallee]

Oof. Those responses are terrible and completely misunderstand the problems. Why do so many people who have nothing useful to say feel the need to say those things anyway?

 

[Jonathan Edwards]

clinicians individualise cases with a high degree of detail... but what exactly does that mean?

It used to be called palmistry.

 

[Keela Too]

And the bit before that quote talking about how clinicians individualise cases with a high degree of detail... but what exactly does that mean? Is there any good evidence it benefits patients to have these specialised teams do this?

Another angle.

If there are certain types of clinicians who can work out what is needed in individual cases “with a high degree of detail” then I wonder how closely their detailed recommendations would match?

It is surely important that there is consistency about what different clinicians would offer to one specific individual.

It would be interesting to ask a multitude of such clinicians to each evaluate the same case to ascertain the consistency of what they each say. (Leaving out for now how useful their recommendations might be, just find out if they can all say the same thing about the same patient?).

There is little point in measuring something to a high degree of precision, if the measuring tools used are comparable to an elastic measuring tape. The numbers on said elastic tape could still be given in very precise, but obviously meaningless, terms!

 

[Jonathan Edwards]

A cunning ruse, @Keela Too .

 

[alex3619]

It would be interesting to ask a multitude of such clinicians to each evaluate the same case to ascertain the consistency of what they each say.

This is what some diagnostic criteria in the DSM (3?4?) had as validity testing. All it really tells you is they are on the same page, its not really testing validity. There is no way to ensure they are not ALL wrong or misguided. If there is bias all it shows is consisent bias.

 

[Jonathan Edwards]

All it really tells you is they are on the same page, its not really testing validity.

That's so. But to validate the concept of individualisation it is pretty neat.

 

[dave30th]

This is what some diagnostic criteria in the DSM (3?4?) had as validity testing. All it really tells you is they are on the same page, its not really testing validity. There is no way to ensure they are not ALL wrong or misguided. If there is bias all it shows is consisent bias.

Right but I would assume in this case most of these individualized treatment plans for the same individual would vary from clinician to clinician.

 

[rvallee]

As good a place as any to leave this, considering it exemplifies the controversy, unwittingly, no less. Imagine having clear double standards while mocking the idea of having double standards in the same thread you are applying obvious double standards. Peak Dunning-Kruger right here. Or maybe just simple bias. Regardless, if these people didn't have double standards they wouldn't have any.

 

[TiredSam]

Gotta take my hat off to Russell Malcolm for taking the BPS scam one step further. Use an empathic and holistic psychosocial survey to identify perpertuating factors for which there are no objective data, then treat them with homeopathy. It's brilliant - cure a fictional cause with a fictional treatment. Treat a made-up diagnosis with magic water. Can't blame a homeopath for taking the BPS con-trick and running with it.

It is surely important that there is consistency about what different clinicians would offer to one specific individual.

Nope, sorry. A part of the individualised holistic survey includes the relationship and interaction between the individual patient and the individual homeopath, so it would be perfectly valid for one empathic clinician to offer a different individualised path forward from another for the same individual patient, and for both to be equally valid.

 

[Keela Too]

Nope, sorry. A part of the individualised holistic survey includes the relationship and interaction between the individual patient and the individual homeopath, so it would be perfectly valid for one empathic clinician to offer a different individualised path forward from another for the same individual patient, and for both to be equally valid.

That almost sounds convincing!
Almost!

 

[Amw66]

Another angle.

If there are certain types of clinicians who can work out what is needed in individual cases “with a high degree of detail” then I wonder how closely their detailed recommendations would match?

It is surely important that there is consistency about what different clinicians would offer to one specific individual.

It would be interesting to ask a multitude of such clinicians to each evaluate the same case to ascertain the consistency of what they each say. (Leaving out for now how useful their recommendations might be, just find out if they can all say the same thing about the same patient?).

There is little point in measuring something to a high degree of precision, if the measuring tools used are comparable to an elastic measuring tape. The numbers on said elastic tape could still be given in very precise, but obviously meaningless, terms!

Sounds a bit like GRADE.
Process but potentially zilch consistency

 

[TiredSam]

That almost sounds convincing!
Almost!

I teach English to a psychotherapist. It's how she explained to me her objections to the amount of statistics psychology students have to learn these days. She genuinely believes that psychotherapy should be exempt from the rigours of the scientific method because statistical studies don't incorporate the crucial factor of the relationship between the individual therapist and patient.

"So two therapists could offer completely different treatments, and both would be equally valid?" I asked her. "Yes", she agreed enthusiastically.

I suspect many more therapists than openly admit it, consider having to subject their art to the scientific method as an afront.

 

[Sean]

In the absence of objective data,

Let that sink in.

In the absence of objective data, anything goes. Which is why the 'subjectively defined' claim is so prominent in the psychosocial arguments. It is their get out of jail free card.

 

[FMMM1]

Gotta take my hat off to Russell Malcolm for taking the BPS scam one step further. Use an empathic and holistic psychosocial survey to identify perpertuating factors for which there are no objective data, then treat them with homeopathy. It's brilliant - cure a fictional cause with a fictional treatment. Treat a made-up diagnosis with magic water. Can't blame a homeopath for taking the BPS con-trick and running with it.


Nope, sorry. A part of the individualised holistic survey includes the relationship and interaction between the individual patient and the individual homeopath, so it would be perfectly valid for one empathic clinician to offer a different individualised path forward from another for the same individual patient, and for both to be equally valid.

That shows up what a scam it is - one Doctor can prescribe X and it works and another Doctor can prescribe Y [for the same disease] and it works - if you're going down that route then why not give the patients the money [as suggested by @Snow Leopard ] and let them use it to improve their quality of life - rather than the "Doctors" quality of life!

 

[FMMM1]

I teach English to a psychotherapist. It's how she explained to me her objections to the amount of statistics psychology students have to learn these days. She genuinely believes that psychotherapy should be exempt from the rigours of the scientific method because statistical studies don't incorporate the crucial factor of the relationship between the individual therapist and patient.

"So two therapists could offer completely different treatments, and both would be equally valid?" I asked her. "Yes", she agreed enthusiastically.

I suspect many more therapists than openly admit it, consider having to subject their art to the scientific method as an afront.

Wouldn't it be better to simply put an actimeter on the patient, check whether they've been able to return to work ---- something objective to measure improvement?

 

[TiredSam]

It's interesting to see where a homeopath goes when they're looking to expand their business. Hardly an advert for the BPS brigade - being what homeopaths do next.

 

[Invisible Woman]

In the absence of objective data,

Let that sink in.

In the absence of objective data, anything goes. Which is why the 'subjectively defined' claim is so prominent in the psychosocial arguments. It is their get out of jail free card.

But only when the subjective data tells them what they want to hear or can assume.

When the subjective data is the patient pointing out that the treatment has harmed them.....

Suddenly there are GRADEs of subjective data because it doesn't all appear to be equal.

 

[Barry]

https://uk.linkedin.com/in/russell-malcolm-647a841a

I found the language in his letter pretty interesting.

Specialised teams, such as the fatigue clinic at the Royal London Hospital for Integrated Medicine, routinely individualise chronic fatigue syndrome cases to a high level of detail. In the absence of objective data, the use of advanced and holistic history taking can explore the factors that perpetuate the clinical state.

The “forensic” part of the inquiry searches for the symptomatic features of pathophysiological change, hypothalamic dysregulation, or ongoing immunological disturbance. The physical and functional inquiry is then contextualised by an empathic and holistic psychosocial survey.

To me it comes across as word salad for making it up as you go along.

 

[Mithriel]

We do not need anymore individualised treatment than a disease like MS. "The factors that perpetuate the clinical state" are the same for all of us - we have ME.

Just like MS it will express itself differently in different people but with the current knowledge a simple explanation of why we should no exceed our limits and how to recognise when we do, symptomatic relief, financial support, aids and a suitable care package would be of great benefit.

A designated ME nurse who was well versed in the biomedical symptoms of ME would be a great step forward.

What they are talking about is just a different set of words to say we do not have a physical disease.

 

[Michelle]

I teach English to a psychotherapist. It's how she explained to me her objections to the amount of statistics psychology students have to learn these days.

I've always thought that psychotherapy is far closer to literary analysis than it is medicine. Now, I do enjoy me some good lit crit--both intellectually and emotionally/spiritually--as I have good therapy (and I actually have had good CBT). But it ain't science and should never be the basis for prescriptive policy.