Doctors’ attitudes toward specific medical conditions, Scoles, 2022 (includes ME/CFS)

Bolding mine:

This study uses machine learning and natural language processing tools to examine the language used by healthcare professionals on a global online forum. It contributes to an underdeveloped area of knowledge, that of physician attitudes toward their patients.

Using comments left by physicians on Reddit’s ”Medicine” subreddit (r/medicine), we test if the language from online discussions can reveal doctors’ attitudes toward specific medical conditions. We focus on a set of chronic conditions that usually are more stigmatized and compare them to ones well accepted by the medical community.

We discovered that when comparing diseases with similar traits, doctors discussed some conditions with more negative attitudes. These results show bias does not occur only along the dimensions traditionally analyzed in the economics literature of gender and race, but also along the dimension of disease type. This is meaningful because the emotions associated with beliefs impact physicians’ decision making, prescribing behavior, and quality of care.

First, we run a binomial LASSO-logistic regression to compare a range of 21 diseases against myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), depression, and the autoimmune diseases multiple sclerosis and rheumatoid arthritis. Next, we use dictionary methods to compare five more chronic diseases: Lyme disease, Ehlers-Danlos syndrome (EDS), Alzheimer’s disease, osteoporosis, and lupus.

The results show physicians discuss ME/CFS, depression, and Lyme disease with more negative language than the other diseases in the set. The results for ME/CFS included over four times more negative words than the results for depression.

https://www.sciencedirect.com/science/article/pii/S016726812200347X

 

https://twitter.com/user/status/1586080125904424961

 

huh feels like someone took my complaints about the /r/medicine threads and turned it into science!

So the stigmatising words most associated with ME/CFS in order:

skeptic, unproductive, morgellons, scoff, somatized, elude, madeup, disprove, psychosomatic, nothingness, worldview, accuse, conspiracy, dismiss, observations, degrade, vague, agenda, unprofessional, laziness

psychological wasn't highlighted as its not a usual stigma word but in our case I think it should be. I was also surprised not to see illfluencers here at all, it was a word I learnt in that subreddit and I have seen it in every post about Long Covid/ME/CFS/FIBRO/EDS et el but since its a made up word potentially the system doesn't recognise it and when the researchers were finding associated words they didn't know to look for this and classify it.

This is pretty damning in the conclusion bringing it back to the massive funding and research gap that ME/CFS has

 

Really not surprised about the attitudes about depression, still as bad as ever for the most part. Says a lot, the whole pretense about how medicine has changed, when all that's changed is they throw more psychoactive drugs at it, but keep the underlying negative attitudes.

It's also notable that the nasty attitudes are directly tied to how much is known about a condition. Attitudes about RA used to be as revolting as this. So basically they are nasty to everything they don't understand, in proportion to how little they understand it, and that nastiness leads to no progress, which keeps the ignorance locked in place.

Amazing system they got there.

 

I'm shocked that depression is the second most-stigmatized condition. We like to believe doctors take it seriously nowadays. My healthcare team always seemed to. How can you hate people for being depressed? That's horrifying.

Also, how did fibro lose to depression in this sordid race?

 

IDK man, I just love the secondary gains. Living on 20% of what I'd be making if I wasn't disabled is super fun /s

 

Reddit skews young - not teens, but 20-somethings. Maybe youthful doctors, hale and hearty, are more likely to believe that their training has taught them all they need to know, but after a decade or so of professional and life experience they learn how often illnesses defy explanation. Also, perhaps Reddit attracts people who are simply nastier than average - r/juniordoctorsuk in particular.

 

Looks like a useful study.

I suspect the data comes from this master's thesis:
https://www.s4me.info/threads/maste...-medical-conditions-2020-brooke-scoles.15726/

 

Do /r/juniordoctorsuk next! Alas too few posts for a similar analysis to be done, but its far nastier when they do go on rants about particular diseases.

 

Yes it's not 'doctors' is it, it's "Reddit users engaging in medic related communication on a platform that predominantly appeals to males under 30".

Also no acknowledgement of compartmentalism - we all use language differently depending on context - obscenities that are a source of humour amongst friends, may be aggressive and demeaning in other contexts, using denigration language amongst close colleagues outside of work may have nuance wholly absent in the work place, etc. The relative negativity is interesting but I'm not sure it tells us very much even if the use of the technology is very clever.

 

Some doctors still don't understand that depression is a physical illness.

 

Everything I see suggests otherwise. Medicine is dominated by the tyranny of lab results. There are no lab results for depression and the current model is for all intents and purposes the exact same model as ME: hand-wavy BS about psychosocial stuff. So it's not surprising given that they are the same model, the same as psychosomatics.

Now there is a lot of theater pretending otherwise, but most (definitely not all) physicians who take depression seriously do it similarly to how our BPS overlords take their made-up stuff seriously. It's all mind-body BS nowadays.

Medicine has no place for wishy-washy BPS stuff, if there isn't a piece of technology validating that it's the correct answer, it's not taken seriously. Frankly I think that this has been a development for the worst, you end up with the worst-case scenario where it's not taken seriously, and of course it's vague and undefined BPS woo, but everyone pretends to, which keeps the failure locked firmly in place.

Seriously this needs to be said again: the modern model of depression is basically the same model as for "chronic fatigue", to most it basically is, it's complete generic and vague anyway so it doesn't matter, can't prove it wrong. Of course it's not taken seriously, not as long as medicine treats lab results, rather than people. Long Covid shows none of this has changed, the underlying attitudes have not changed.

 

You're exactly right here. In the distant past, nothing was medically explained. We just gave people herbs to balance their humors (or whatever) and hoped for the best. Then we began attacking disease more scientifically and began discovering causative agents and biomarkers. The diseases we could unravel became privileged, and the ones we couldn't often received received stigma rather than efforts to bring our knowledge to the same level.

We've seen this play out time and time again. MS and RA were frequently psychologized, and a few fringe people dared do it with cancer and AIDS. Autism was discovered in the 1940s but it took until the 70s for it be accepted as a neurodevelopmental condition. And the famous story of stomach ulcers.

 

I can see why doctors prefer/have less bad attitudes to illnesses that can be objectively measured. I’m not sure we are going to change that.

So I think we need to adapt and work to ensure there are tests that can be used in the clinical setting. And I think the best way of bringing this about is not having a one-dimensional strategy of calling/lobbying for more research. I think more of the millions/tens of millions affected and their tens or hundreds of millions of loved ones needs to focus more on raising money for biomedical research by donating and fund-raising.

 

The lead author has posted some comments with a new account:

Also on the BMJ non-diseases poll, for what it is worth:

 

The ironic thing about the guy talking about context is that it's always worse in context and the more context you add the worst it is. It's about outcomes and outcomes are simply disastrous, there's no polishing that turd.

In the end, all of this falls under: it's not a lie if you believe it. So calling people "frequent fliers", or "worried well", is endearing and devoid of any real-life consequences because it feels true, and is said to be true, and is taught to be true, even though it's clearly false or negative. As long as no one ever checks the consequences of that. Which is the current state, circular QED.

Hence things like the report in (Denmark? Norway?) basically describing how healthcare treats pwME as abuse, and the ministry simply responds with: we disagree. Facts aren't social constructs, but their use is. Racists use the same approach: it's not racist if it's/feels true.

 

That's absolutely true. The study revealed a dumpster fire, but when you zoom out, you realize the whole city is burning. It's not just doctors ranting on the Internet. Intolerant doctors psychologized ME, which caused neglect from science and medicine, and the awful outcomes resulting from a lack of therapies. All the awful things we're intimately familiar with.

 

And /r/medicine has now picked up on the paper.