Opinion Pragmatism in the fray: Constructing futures for ‘medically unexplained symptoms’, 2024, Greco

Forthcoming in Schermer, M. and Binney, N. (eds) (2024) A New Pragmatic Approach to the Conceptualisation of Health and Disease. Springer.

https://d1wqtxts1xzle7.cloudfront.n...VX~vdPdf2A__&Key-Pair-Id=APKAJLOHF5GGSLRBV4ZA

Pragmatism in the fray: Constructing futures for ‘medically unexplained symptoms’

Monica Greco
Goldsmiths, University of London

Abstract

The expression ‘medically unexplained symptoms’ is still widely used to indicate physical symptoms that are not attributable to any known conventionally defined disease.

It is discursively related to several other concepts including somatisation, somatic symptom disorder (DSM 5), and functional somatic syndromes, which include the diagnoses of fibromyalgia, chronic fatigue syndrome, multiple chemical sensitivity, and irritable bowel syndrome, among others.

Some of these conditions are currently the object of controversies and political battles.

This chapter examines what it can mean to approach this group of conditions ‘pragmatically’ by contrasting two different versions of pragmatism.

One version, exemplified in social research that aligns itself with arguments proposed by some patient movements, is consistent with Rorty’s ‘epistemological behaviourism’.

Another version, exemplified by a novel clinical intervention (the Symptoms Clinic) is consistent with William James’ ‘radical empiricism’.

It is argued that these different approaches yield significantly different consequences.

The first affords legitimacy to patients on an immediate and piecemeal basis at the expense of reinforcing a bifurcated mode of thought.

This, it is argued, is a factor in (re)producing the experience of ‘medically unexplained symptoms’.

The second is premised on the assumption of a relational continuity between social structure, embodied experience, and physiology.

 

What's the academic term for 'medicine is really stupid sometimes'?

Because that's the third version of pragmatism. It wins the pragmatism contest because you can describe the entire theory in phone emojis.

 

Curious as to what the "novel clinical intervention" might be I googled "Symptoms Clinic" and this was the top hit, from 2012 (don't know if relevant to the OP as haven't read either, note the authors though)

Burton C, Weller D, Marsden W, Worth A, Sharpe M
A primary care Symptoms Clinic for patients with medically unexplained symptoms: pilot randomised trial
BMJ Open 2012;2:e000513. doi: 10.1136/bmjopen-2011-000513

 

Hot take: these long philosophical discourses on medically unexplained symptoms are medical narcissism.

It's easier to engage in these discourses than to admit that we don't know. It's easier to blame the patients than admit one's own powerlessness to help.

The accusation of dualism is made by people who couldn't get over the fact that their cherished pet theory was rejected by patients. By refusing to accept this as legitimate feedback, they also stop themselves from moving on and coming up with new better ideas.

I don't know if dualism features here but bifurcated mode of thought sounds like it's some variant of the same idea.

 

Booooooring

Yeah, you don't say? Maybe stop making stuff up to fuel the wrong side of a battle that doesn't even need to happen and has only caused massive suffering?

Also, taking from the Oxford dictionary:

Please stop misusing words. Nothing these quacks say or do has anything to do with pragmatism. They embody bureaucratic failure and intellectual masturbation like no one else has managed to in decades, stuck with their old belief systems. Millions of people have no future because ideologues can't let go of the past. What a dumb waste of lives and resources.

 

At least there can be no doubt as to what Greco thinks, according to her patients are "(re)producing the experience of ‘medically unexplained symptoms’" but fear not, there's a "novel clinical intervention" (novel?! just how many decades can you continue to call something 'novel'?)

Seeing how closely Greco has worked with some of the people behind the organised pushback against the NICE ME/CFS guidelines (think the Oslo consortium, Anomalies paper, etc), a pushback which includes the strategy of building a body of published work that's intended to lend an illusion of weight to their argumentsopinions I can only see two possible scenarios.

Either Greco is in cahoots with them and this upcoming chapter is part of that organised strategy.

Or Greco herself is not directly involved and is acting in good faith, in which case it's still highly likely she's being 'encouraged' by the people behind the organised strategy, and it's more than highly likely they'll use her work to support their own ambitions

Either way it's not helping patients

 

In her domain of science, this is what they believe. I have very little doubt she is completely sincere in her beliefs--no matter how wrong, illogical or stupid those beliefs are.

 

What the author seems to be unaware of is that Chris Burtons' love of pragmatism is purely based on the idea of muddling along without doing any rigorous science. It bears no relation to the pragmatism of William James in metaphysics.

This is really just moving words around on a Scrabble board.

 

Except that it isn't really. Both Rorty and James had well-defined arguments for particular metaphysical approaches. James was also genuinely a scientist. This sort of stuff isn't even academic, even if it claims to be. It is more akin to agony aunt columns in Sunday newspapers.

 

Symptom clinics already exist.

 

The link to the article does not work for me but I noticed that the chapter is also uploaded here:
(PDF) Pragmatism in the fray: Constructing futures for 'medically unexplained symptoms' | Monica Greco - Academia.edu

 

Ha, good point! but I was referring to their branch of pseudo-whatever (science? philosophy?) relating to the "MUS" construct.

 

Oh wow that sounds like they need to do some *checks notes* reality testing.

 

I had a conversation at the NICE committee with Burton over the fact that pragmatic trials of this sort by definition cannot provide evidence of efficacy. (That is how pragmatic trails are defined - they sacrifice the rigour needed to establish cause and effect relations in order to answer practical questions such as ease of delivery.) Burton clearly had no understanding of the problem.

It is perhaps of interest that Burton did not sign White's 'Anomalies..." paper. Presumably he couldn't having been a committee member and signed up to the conclusions - that trials that did actually try to be designed to get an answer were still of too poor quality to get one.

 

She cites Kate Kelland's piece of trash "journalism" about so-called "harassment" of Professor Sharpe as evidence of something or other. She also fails to grapple with the abysmal quality of the PACE trial and all the other research in this domain. Perhaps all that doesn't matter in her epistemological view of the "iatragenic vortex of somatisation."

 

I have had a brilliant idea for an MRC research grant.

I gather that it is known that women and men have different sensitivity of their sense of smell such that, for instance, women can tell Brut from Chanel No. 5 but people like me have no idea.

I think we should have a study of the ability to smell bullshit. It clearly does not fall quite in line with other olfactory traits. Quite a lot of women seem to be unable to detect bullshit emanating from under orange or yellow hair for instance.

Perhaps specific genes are involved. Maybe it needs a GWAS study of bullshit sniffers and non-bullshit sniffers. It would need to be carefully set up interns of recruitment though. Too many people from Chalfont St Giles and Tunbridge Wells (or maybe Miami) could skew things badly.

We might even discover that there is a separate organ for detecting bullshit, supplied by the vagus nerve and situated in the earlobe region. Having one's ears pierced might reduce the sensitivity significantly, as might face-lifts.

I was thinking of around a £5M grant over ten years.