Long covid—an update for primary care, the BMJ, 2022, Trisha Greenhalgh

WTH does substance abuse have to do with Long Covid? Those responses have nothing to do with the issue being discussed, this is agenda-pushing.
Many of the complaints we see in primary care are of a functional nature primarily and there is often a large functional component to physical illness like COPD and asthma, heart disease and musculoskeletal pains.
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This is where the whole "a functional overlay" is heading, this pseudoscience is creeping everywhere. It will ruin everything.

Evidence is irrelevant to evidence-based medicine:
Greenhalgh said:
Multidisciplinary rehabilitation is an effective approach even in so-called ‘functional’ or ‘medical unexplained’ conditions [4,5]. Using terms such as ‘psychological’ or ‘functional’ is unlikely to be helpful in engaging patients in treatment plans.
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It is not effective. This is just pushing an agenda on the back of LC. And the issue is not with the terms. It never was with the terms. The issue is that this is pseudoscience and it's a failure. Greenhalgh is doing nothing but pushing her own agenda here. Gross.
 
Here is the Greenhalgh response to the 'functional' letter,

"The terms ‘organic’ and ‘functional’ are misleading. They imply a clear (Cartesian) split between illnesses of the body and those of the mind [1]. Long covid symptoms have been shown to be associated with various structural abnormalities in different organs and derangement of physiological function [2,3]. Like any other medical condition, long covid also includes an element of mental processing of symptoms and emotional and psychological reaction to the illness and the limitations it confers. We did not ignore these aspects of long covid; we included them as key elements of a whole-person condition that requires whole-person management.

The patient’s symptoms may be many, varied and fluctuating; no single biomarker exists to confirm or exclude long covid. Rather than label this pattern as ‘functional’, we need to listen carefully to the patient’s story, do a physical examination and relevant investigations, exclude alternative diagnoses, make and record the diagnosis of long covid, and direct the patient to self-management resources, support groups, and professionals with appropriate expertise.

Multidisciplinary rehabilitation is an effective approach even in so-called ‘functional’ or ‘medical unexplained’ conditions [4,5]. Using terms such as ‘psychological’ or ‘functional’ is unlikely to be helpful in engaging patients in treatment plans.

Rather than polarizing around outdated taxonomies, we should all acknowledge that prompt assessment and holistic management of the whole patient is what patients deserve and what the health service should be offering for long covid."

Replace "long covid" with "ME/CFS" and almost all of this could very well have been something written by numerous ME charities and advocates over the years.
 
That's a little strawmanny. Nobody really believes there's a cartesian split between mind/body illness, or that "mental processing of symptoms and emotional and psychological reaction to the illness and the limitations it confers" doesn't exist. We don't deny the mind-body connection. We believe it works in different ways, and we avoid claiming it has magical powers.

For example, both BPS and biomed proponents see the connection between behavior and symptoms as important, but in essentially opposite ways. BPS people think pwME are too sensitive to symptoms and thus don't exert themselves enough. (Much summarizing here.) PwME believe that paying close attention to your symptoms, espeically PEM, allows you to manage your illness through pacing.

BPS people might assert that the cognitive impairment from ME is due to emotional disturbance. (Loosely, mind->body) Biomed people say the cognitive impairment and emotional disturbances are due to the effects of the illness on one's coping mechanisms, as well as the brain.
 
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