BMJ editorial: Long covid clinics should be run as research hubs

[rvallee]

https://www.bmj.com/content/374/bmj.n1996

Clinical services, often including multidisciplinary teams, are being set up to treat patients with ongoing symptoms from covid-19. They have been generally welcomed, but critical evaluation is important to ensure they serve patients well. Multidisciplinary care is not magically beneficial, is resource intensive, and can exclude patients from decisions. Timely use of the skills and knowledge of different specialist professionals is helpful, but improved decisions require an evidence base showing meaningful benefit for patients and cost effectiveness.

Without this evidence, there is the potential for harm through routine imaging and associated overdiagnosis, ineffective or harmful treatment, and wastage of resources through duplication of effort.14 Inconsistent advice is also a danger: without evidence based interventions people attending new clinics may be no better off, and may be worse off.​

 

[Peter T]

https://www.bmj.com/content/374/bmj.n1996

Clinical services, often including multidisciplinary teams, are being set up to treat patients with ongoing symptoms from covid-19. They have been generally welcomed, but critical evaluation is important to ensure they serve patients well. Multidisciplinary care is not magically beneficial, is resource intensive, and can exclude patients from decisions. Timely use of the skills and knowledge of different specialist professionals is helpful, but improved decisions require an evidence base showing meaningful benefit for patients and cost effectiveness.

Without this evidence, there is the potential for harm through routine imaging and associated overdiagnosis, ineffective or harmful treatment, and wastage of resources through duplication of effort.14 Inconsistent advice is also a danger: without evidence based interventions people attending new clinics may be no better off, and may be worse off.​

Wish this had been taken into account when the specialist ME services were set up.

 

[Graham]

I wish they took the same attitude when printing some of the editorials about ME.

 

[Ariel]

I wish they took the same attitude when printing some of the editorials about ME.

Yes, it was surreal to read this in the BMJ!

 

[Jonathan Edwards]

Let the infighting begin!

 

[JemPD]

Yes, it was surreal to read this in the BMJ!

I agree! wow it was indeed surreal to read that. Do they hear themselves?
What a staggering lack of self awareness.

 

[Hoopoe]

Clinics that provide care, develop knowledge and facilitate research should be the default approach to serious, unexplained chronic illness. It's the logical answer to effective care being held back by a lack of knowledge.

 

[Amw66]

Is this what happens when so many medics are affected?

 

[NelliePledge]

Clinics that provide care, develop knowledge and facilitate research should be the default approach to serious, unexplained chronic illness. It's the logical answer to effective care being held back by a lack of knowledge.

This

 

[Wonko]

Problem is, we've all seen what happened last time.

So my trust is a little lacking when such lofty ideas are pronounced.

 

[alktipping]

"harm through routine imaging and associated overdiagnosis, ineffective or harmful treatment, and wastage of resources through duplication of effort.14 Inconsistent advice is also a danger:" isn't this the ruse that was used to deny proper investigation and treatment to people with m e or f m .

 

[chrisb]

"harm through routine imaging and associated overdiagnosis, ineffective or harmful treatment, and wastage of resources through duplication of effort.14 Inconsistent advice is also a danger:" isn't this the ruse that was used to deny proper investigation and treatment to people with m e or f m .

This could have come from Arthur Cott in 1985. It probably did. He proposed multidisciplinary teams to deal with illness behaviour. And the potential harm of overtesting. I'm sure this has been known in some circles all along. They just never mentioned it.

 

[Arvo]

Problematic piece. Some of its arguing mirrors the arguments made by Wessely and Sharpe in the early stages of BPS takeover. E.g. Calling it something already familiar while downplaying and vaguely generalising it, using phrases like "unclear aetiology" while ignoring a shit-ton of concrete pathophysiological finds that explain symptoms, pointing at a somehow changed ability to "withstand stressors" as a cause (this one is also known from 50s psychosomatic Tuberculosis nonsense), and repeatedly discourageing investigation as a bad thing (which stems from hysteria/hypochondria theory and helps to keep everything vague and unknown. Plus it's cheap.)

Rather than seeing long covid as a new disease or set of syndromes, we could consider it in the context of problems seen routinely in general practice after infections or trauma—disrupting our ability to withstand stressors in an undifferentiated way, with unclear aetiology or prognosis, but nevertheless likely to resolve spontaneously. The value of investigation or drug treatment remains unclear and is likely to be limited.

Timely use of the skills and knowledge of different specialist professionals is helpful, but improved decisions require an evidence base showing meaningful benefit for patients and cost effectiveness.

Without this evidence, there is the potential for harm through routine imaging and associated overdiagnosis, ineffective or harmful treatment, and wastage of resources through duplication of effort.14 Inconsistent advice is also a danger: without evidence based interventions people attending new clinics may be no better off, and may be worse off.

Assumptions about the benefit of new clinics, rather than critical evaluation and in-practice research, is likely to lead to poorer quality interventions and poorer information and support for a worried public.

The piece as a whole sounds ok, but only if you don't look too hard at it. I am reminded of the dutch model of creating cf "expertise centres" by the dutch branch of the BPS crew where everything revolves around CBT and physical 'research" is done that is no threat to that approach, or which confirms it. Keeps them at the center of things and blocks other research.
(And maybe I'm mistaken, but wasn't there something about the CFS centre data from the BPS crew in the lobby protest against the NICE guideline publication? Like the centre data were somehow more important then the careful analysis of a large volume of CBT studies? I'm worried about a similar setup for LC clinics: BPS CBT centres that position themselves as the expert hubs, hoovering up all the funding and with those producing the neccesary "research" to stay in business as such.)

While in theory I agree with the last quote, I find its tone and the use of the phrase "a worried public" in this context also a possible red flag. It fits the nonsense bps narrative that people are too worked up about LC and that stress and anxiety is the actual cause of illness.