Opinion. BMJ: Long covid: research must guide future management, 2021, David

Moved post

Long covid: research must guide future management by Anthony S David, UCL

"Will the new long-covid multidisciplinary teams be the setting of a never-ending journey round in circles or will they have the courage to accept uncertainty? Increasing evidence shows organ damage and pathological changes post covid, and we must be aware of many patients who have severe and debilitating fatigue and have not been believed or offered much help at all. But we must also remain open minded that some multi-symptom presentations may not be due to hitherto unidentified multi-system pathologies (with negative investigations), but a singular mechanism of heightened awareness of bodily sensations and objective malfunctions.7 It is a hypothesis and therefore provisional, but if articulated well in a clinical setting, with humility yet optimism, can lead to agreed new ways forward, which may be beneficial.

The injection of funding into this area will hopefully help guide future management of a large number of people with long covid-19 and, with luck, might even help many more with the broad range of post-viral conditions."

https://www.bmj.com/content/375/bmj.n3109

 

And so it goes on .
Am I reading this wrongly but it sounds like
ACT / CBT on false illness beliefs ( again)

 

Unless you can tell us what this singular mechanism is and how to confirm it - no.

 

It would sure be nice to see an honest attempt at decoupling the effects of negotiation tactics from the actual interventions in these trials. Decision-making is (arguably) one of the more robust disciples within psychology in terms of the potential of setting up actual testable hypotheses, but I rarely see it mentioned.

 

Moved post

Anthony David, who wrote an article with Simon Wessely setting the stage for the decades of failure dealing with post-infectious chronic illness has things to say. They represent very well the complete detachment from reality that operates in this space, how our lives are just abstract distant things to them. It isn't just that decades were lost to this nonsense, it's that millions of lives were sacrificed in the process, with absolutely nothing to show for it, which David leaves unsaid but clearly true.

And what does David concludes from it? That we should still respect their failure and keep trying anyway. Or something like this. Rage-inducing coming from someone looking smugly at the disaster he caused and liking it way too much. Lip service to research is just that, lip service. Hollow, self-serving.

The main argument seems to be that if a common diagnosis is found, it should be detached from its cause. That is if thrombosis is found, it should be categorized as thrombosis, without a link to having been caused by Covid. So you leave almost nothing connected to its cause, erasing it in the process. Which is the whole problem with inventing CFS in the first place. So as usual pushing the problem as the solution to itself.

Also: management? WTH? Still with the mindset that all this is is managing complaints.


Long covid: research must guide future management
https://www.bmj.com/content/375/bmj.n3109

In 1988, colleagues and I published an article in The BMJ called “Post viral fatigue: time for a new approach.”2 This was an attempt by young researchers to make the case that viewing the syndrome through a more unified mental-physical health lens and epidemiological orientation might counteract the increasingly polarised debate between patients with post-viral fatigue or myalgic encephalomyelitis (ME) and their doctors. We called for a clearer operational case definition, a biopsychosocial approach, and an end to emotive language all round. A generation later and our calls remain current.
...
We must not fall into the trap set by all “unexplained” symptoms: endless investigation by clinicians who then impart the “good news” that the test was normal. Because there is no accompanying positive explanation for the symptoms, this is perceived as implying, “it’s not real” or somehow worse, that “it’s all in your mind.”​

Imagine the hubris of saying the above after having spent decades saying exactly this, pushing this, forcing this down our throats and attacking is for begging for this nightmare to end.

But we must also remain open minded that some multi-symptom presentations may not be due to hitherto unidentified multi-system pathologies (with negative investigations), but a singular mechanism of heightened awareness of bodily sensations and objective malfunctions.7 It is a hypothesis and therefore provisional, but if articulated well in a clinical setting, with humility yet optimism, can lead to agreed new ways forward, which may be beneficial.​

This article is the polar opposite of humility, it's the height of hubris. David would do well to disappear in the sunset instead of showing just how gigantic his hubris is, we already know, and Wessely's.

I will be responding to this article. I hope many others do. The stream of lies has to end.

 

Interesting to see what some of the more articulate long haulers make of it.

 

Merged thread

Long covid: research must guide future management

Anthony S David. Professor of Mental Health

Back in February 2021, the UK government announced that £18.5m is being invested into clinical research into long covid by UK Research and Innovation (UKRI).1 In light of public and medical concern about the long term effects of covid-19 infection, this is welcome.

In 1988, colleagues and I published an article in The BMJ called “Post viral fatigue: time for a new approach.”2 This was an attempt by young researchers to make the case that viewing the syndrome through a more unified mental-physical health lens and epidemiological orientation might counteract the increasingly polarised debate between patients with post-viral fatigue or myalgic encephalomyelitis (ME) and their doctors. We called for a clearer operational case definition, a biopsychosocial approach, and an end to emotive language all round. A generation later and our calls remain current.

Bodies including the National Institute for Health and Clinical Excellence (NICE), the Scottish Intercollegiate guidelines network (SIGN), the Royal College of General Practitioners (RCGP) and the Centres for Disease Control and Prevention (CDC) in the US have all attempted to operationally define persistent symptoms and disability after acute covid-19 illness.3 I think the term used by NICE—post-covid-19 syndrome—is a reasonable starting point. NICE’s definition includes the phrase “not attributable to alternative diagnoses.” This seems obvious, and yet is critical, as this should not be a catch-all category where any disorder with unexplained symptoms can be attached. For example, if a patient recovers from the acute respiratory illness, but remains short of breath and is found to have pulmonary fibrosis or pericarditis by accepted criteria, or, experiences brain fog and mental slowing, later linked to microvascular infarcts on MRI—can they be removed from the post-covid-19 cohort? I would say yes. Their condition may be unusual, and it may be serious, but it is not mysterious. These conditions add to the tally of morbidity caused by covid-19, but not to post-covid-19 syndrome. This, however, depends on patients getting access to the right assessments and investigations and there have been many calls from long covid patients to ensure that they have proper medical assessment of their symptoms.

More at link (opinion piece no abstract) https://www.bmj.com/content/375/bmj.n3109

 

Comment from Dr Keith Geraghty
https://twitter.com/user/status/1473694199853768713

 

Basically, this is like putting one of those insulating bibs (forgot the name, they have those for beer cans) on the same bottle of the same wine and pretending it's brand new. And not just that but actually raising the price.

Or crippling amnesia.

https://twitter.com/user/status/1473736838707875847

 

Like MUS perhaps? It's yet another meaningless diagnosis that is so useful to doctors when they want to blame the patient.

 

I felt the urge to write my uncensored thoughts on the idea of "heightened body awareness" supposedly causing symptoms.

I find this idea implausible and the authors come across as very confused.

The idea is described vaguely, so we have to guess what exactly the proponents have in mind which suggests that what they have in mind is not defensible or that they are not able to even clearly fomulate their thoughts.

I'm sure we all know the phenomenon of thinking of something that caused unpleasant sensations in the body and then reliving that feeling (like hearing a mosquito causes one to have heightened awareness of sensations consistent with mosquito bites, and this can make one feel a little itchy in some places. My guess is that the authors propose that this kind of mechanism is the basis for symptoms. The experience of chronic illness bears no resemblance to this. One would suspect that this explanation is being proposed because the person is confused about what having the illness is actually like. The symptoms I experience do not depend on my thoughts or awareness. If they did it would be obvious just like in the mosquito bite scenario. The symptoms would be predictable but they are frustratingly unpredictable. The symptoms would be very mild and transient but they are severe and chronic (there is a huge discrepancy between what heightened awareness is able to cause and what is being experienced). I do not believe that heightened awareness can cause more than very mild symptoms, and I think it can cause only a limited range of symptoms.

My instinctive response to annoying chronic symptoms is also to ignore them for a while. This seems to be a very common response which contradicts the proposed heightened awareness mechanism.

There also seems to be a conceptual confusion between "having symptoms and noticing them more when paying attention to them" and "making symptoms appear out of nowhere via some vague cognitive mechanism". They seem to take the first phenomeon as evidence for the second one while this is not a valid conclusion.

Finally, this idea seems to lacks a scientific basis and it's disturbing that these ideas are being applied in healthcare when there doesn't actually seem to be any evidence. By lack a scientific basis I mean that there doesn't seem to be any experiment showing that "heightened awareness" could cause anything resembling chronic illness.

Common sense also tells me that if thoughts or cognition in general were the main cause of a chronic illness, speaking with the affected person would make it quickly very clear to anyone that these thoughts and cognitions were extremely abnormal (not just questionable or probably incorrect like the many cures or ideas about the cause of the illness that circulate).

 

It's also strange that the authors seem to believe that their approach is a solution to patients not being believed, when they are essentially saying that patients are imagining a problem and that this act of imagination creates symptoms. These people cause the problem they think they're solving.

 

Be fair.He does admit that they were young researchers. There would be no point in saying that if he were not considering the possibility that with hindsight they might have done things differently. I think they owe it to us to say how.

 

More from KG:
https://twitter.com/user/status/1474837318372675584

 

Young Researcher

He says they were “young researchers”, which is what you might say if about to recant your previous ideology, or at the very least to tell an amusing anecdote about something you were wrong about.

It really doesn’t work if you’re then gonna explain that as an elderly researcher you stand by everything “young researcher” you promoted as an inexperienced newbie.

So you learned nothing significant over your 30year career?

You are also very proud to of learned nothing much?

Perhaps you weren’t trying to make discovery or …..?


No matter how “young” a researcher you were when you began, it’s not relevant. Not if you’re still the same corporate/ government propagandist you were at the beginning at -what, we can all hope and pray is soon to be -the end.

Not when those who were sick at the beginning of your reign are as just as sick at the end.
Not when in over 30 year the prognosis is no better. There are no treatments. Not when thanks to you, those getting sick today have if anything worse treatment from their HCP than when you began.


You were never “young” you were always a vampire.


Draining the life out of us. Wanna know why we are all so unusually tired?

It is you. Sucking with the unrelenting vigour of your kind upon our life’s essence.

You and your ancient mates.

 

They do cause the problem, indeed they do. You lay out how they do this very starkly.

Id add, I don’t think there is a reason to think that they actually think that they are solving it.

We have what this researcher says about themselves, that a problem they were trying to address was doctors disbelief of their patients reports.

We would then need to assume that this researcher meant that he aimed to reduce the doctors disbelief in patients. But we have no reason to make this assumption.

No reason at all to take this researchers account of his own intent seriously. On any level. The evidence so conclusively points to other and opposing motivations.

Such as smoothing the path for doctors to convey their contempt and disbelief in a far more disciplined way. A superficial layer of varnish to make doctors existing prejudice appear to be simply an extension of medical knowledge. Rather than personally and politically harmful beliefs and actions on doctors part. A way to make rejection of the patients fundamental right to healthcare, more acceptable to the general public. A new language and terminology of plausible-ish sounding rational for denial of care. A development that would make it ever harder for patients to challenge, a unified front. The pseudoscientific model for denial of care and the protection of certain economic interests.

If the researcher wishes to reduce a doctors skepticism or hostility regarding a certain group of patients, the researcher simply does not go about doing all in his power to enhance the division.

If at first he meant to heal and yet he was incompetent and instead caused harm?

We all make mistakes. As a person with ME I make mistakes every single day multiple times a day. I have difficulty understanding words and numbers and that means I get confused and can’t work stuff out. It’s terrifying. It is very serious. I cannot find away to look after my own interests when my competency is so reduced.

However that is not what is happening here. The researcher is not confused. He is sewing confusion. This requires effort.

To accomplish your own goals while misleading others you must remain crystal clear on what these actually are. On what is at stake.

The researcher doesn’t at any time demonstrate credible scientific reasoning. He may or may not possess the skills to do so if called upon, we will never know. Scientific endeavour is not the task he has taken on.

He has had 30years to course correct. If the results he gained were not those he intended. He has not done so.

A whole life’s work built on the betrayal of your own humanity. A willing recruit. An ancient bargain. Comfortable living and accolades. Gained at the direct expense of those made expendable, sick and poor. Taking up the role of the enforcer. To exclude the non-wealthy well most of your fellow people, from access healthcare. All this on behalf and to the enrichment of the already unimaginably wealthy. This is hard to justify.

Why not look back and imagine you were once a ‘young gun’ bravely applying your intellect to a ‘new’ problem?

 

I did not expect responses to be approved quickly given the holidays, but it's been long enough. I don't know if I'm the only one who submitted one, but at this point I assume it was rejected. No responses published, which is disappointing given how central these people have been in the debacle that lead to Long Covid, and how ridiculous it is for David to publish the exact same rhetoric as 3+ decades ago as if they were new.

BMJ continues to be a bad influence on medical science, it's sad to see. Probably derives from the BMA being just as bad, pushing the damn BPS model like it's a religion. With iconic institutions like this, no wonder medicine is struggling so badly.

 

Can you quote tweet this in response ?

 

I'm not sure I understand. Do you mean reply with this response to the BMJ where they tweeted the David letter? It's a bit long for a tweet thread. Actually kind of long for a response but there was much to say. But I could link to the rejected letter.