MedWatch: "We see a radicalization of the scientific debate"

ME/CFS Skeptic

ME/CFS Skeptic

Senior Member (Voting Rights)
This interview with Professor of psychiatry Martin Walter also discusses ME/CFS and the IQWiG draft report in Germany. The title and quotes below are translated with Google Translate.

At Jena University Hospital, Martin Walter, head of the Department of Psychiatry and Psychotherapy there, organised the first Long Covid Congress on 18/19 November – the great response surprised him. In the MedWatch interview, Walter criticizes the lack of funds for research, the stigmatization of those affected and "radicalization tendencies" in science.

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Link to the article:
https://medwatch.de/erkrankungen/lo...dikalisierung-der-wissenschaftlichen-debatte/
 
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MedWatch: As a professor of psychiatry, how do you view the causes of Long Covid and ME/CFS?

Walter: 15 years ago, I would probably have classified fatigue as psychosomatic. With today's knowledge, however, we can see that there are a high probability of organic causes. A majority of studies report inflammatory processes, changes in the bloodstream and nervous system. However, the physical and psychological dimensions are more closely linked than is often seen. However, we must also distinguish between the causal consideration and the therapeutic consequence.

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MedWatch: In its preliminary report on chronic fatigue syndrome, the Institute for Quality and Efficiency in Health Care (IQWiG) recommends graded exercise therapy (GET), which is used in psychosomatics and psychiatry. Affected associations, on the other hand, speak of a mass mistreatment, because GET relies on movement and ignores stress intolerance as a leading symptom of fatigue. At the congress, research also indicated that the therapy could cause harm. What do you think?

Walter: As physicians, we must demand that recommendations be evidence-based. Where this is not the case, we must demand corrections. Those affected have an important point here when they say: The harmful side effects of this therapy were underestimated, the reports about a possible benefit were overestimated and the study situation was not analyzed critically enough. The IQWiG report is therefore not as cautious as the uncertain data situation and the indications of a harmful effect would require. In an activating therapy, we have to orient ourselves very strongly to the individual load limits. There is no single treatment for one diagnosis.
 
An important point re: mental illness - often difficult for ME/CFS advocacy to get to grips with. Neither ME/CFS nor PASC is prophylactic against Mental Illness:

"With ME/CFS, the situation is very complex. FWith ME/CFS, the situation is very complex. For years, doctors have projected their own insecurities onto patients. They were generally referred to psychiatric care, and their physical symptoms were not recognized. Those affected resisted this – and put the focus on the purely organic. This is understandable, but was not only good for the therapeutic consequences: we must not confuse de-stigmatization with de-psychiatrization. After all, about a fifth of the patients with Long Covid have mental impairments. We can alleviate that.. ."
 
ME/CFS Skeptic said:
15 years ago, I would probably have classified fatigue as psychosomatic. With today's knowledge, however, we can see that there are a high probability of organic causes
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Ironic. Since the facts have not changed since then. Showing the issue is all about perception and perception alone. It's a people problem, with the problematic people being the medical profession. There is radicalization, but it exclusively comes from medicine, from EBM zealots and BPS ideologues. These people are true radicals, espousing an "ends justify the means" approach to everything they do.

Can't really talk of the radicalization of scientific debate when the debate over chronic illness is unfortunately almost never scientific. Because debates are for entertainment. The patients talk about science, even demand it. It's always rejected. The physicians debate their perception. That has nothing to do with science, it's rejection of science that is the very issue here.

Almost every report about Long Covid recommends patient involvement. It's necessary. And yet the outcome of involving patients is always rejected unless the entire process is controlled by medical professionals and the patient involvement is reduced to performative tokenism. Even though it's clear at this point that we were right all along. About everything.
 
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ME/CFS Skeptic said:
Walter: 15 years ago, I would probably have classified fatigue as psychosomatic. With today's knowledge, however, we can see that there are a high probability of organic causes. A majority of studies report inflammatory processes, changes in the bloodstream and nervous system.
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In fact the vast majority of findings are negative. A majority of studies may mention some particular finding that looks a bit positive but usually it is not confirmed.

So yes, nothing has changed except perception.

And with the other comments it is not so clear that that has changed much either!
 
Jonathan Edwards said:
In fact the vast majority of findings are negative. A majority of studies may mention some particular finding that looks a bit positive but usually it is not confirmed.

So yes, nothing has changed except perception.

And with the other comments it is not so clear that that has changed much either!
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I doubt perception has even changed that much, just that it's now unfeasible for a lot of people to keep justifying their position on their treatment of choice. What I'm reading from this guy is that yes there are biological underpinnings but there are those with mental impairments that we can still treat so keep us around, pretty please.

The immediate reaction with the NICE guidelines seemed to be, let us help you pace then if we can't offer CBT and GET anymore. From some people I even get where they are coming from and that they're actually wanting to help, others can't claim innocence so much.
 
Solstice said:
What I'm reading from this guy is that yes there are biological underpinnings but there are those with mental impairments that we can still treat so keep us around, pretty please.
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But biological issues can lead to mental problems. So, fix the biological problems and mental problems would disappear. I'll bang the drum, yet again, for nutrient deficiencies causing anxiety and depression, for example.

If psychologists/psychiatrists try and "fix" a low nutrient problem with anti-depressants it won't work. Take it from someone who was put on several different kinds of anti-depressants during the 1990s when the real problem was low iron. Prior to that (in the 70s) my doctor at the time thought valium might "fix me". It didn't. But I bet I was low in iron then too.
 
FMMM1 said:
Maybe someone should contact the journalist.

He may be taking one side based on limited/poor understanding - let's face it my understand is largely based on more knowledgeable/informed sources here ---.
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The journalist is doing fine, google translate is falling short a bit. It translates Belastungsintoleranz as stress intolerance for example which isn't correct. Belastung means something else in this context, more towards exercise, I'm struggling to find the right word atm because I'm juggling between three languages. But it isn't stress intolerance it has to do with intolerance to exertion.

Other than that the journalist is being pretty direct and critical and the interviewee is using a lot of weasel words and language that we're all to familiar with from English-language interviews. There are a lot of organic dysfunctions but psychology most definitely plays a role. It basically turns back around to that all the time. We can't claim that the disease is psychogenic but we sure as hell should have a place in helping.

The journalist might have pushed a bit more on evidence and on how correlation and causation are different, but I think he did a good job tbh. He didn't really take any side but he did ask critical questions and is obviously familiar with how the system failed us and tried to press on that.

There's also a bit about activism and extremism that makes it difficult for scientists to look into long-covid etc. from the guy being interviewed. It's a critical interview where the answers eventually circle back to the default BPS position.
 
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