Extremely cringe. All pompous style and zero substance.
It's not. The clinics are famously useless and widely criticized for it. That's all there is to say about it. But the paper mindlessly accepts the notion that it must be effective, effectively contrasts only a tiny subset of the research efforts as if they're equivalent. Rehabilitation has long been fully explored here, there has been nothing to research for years. It's a tiny corner that was fully explored quickly decades ago, and has been stuck in a loop ever since. The biology on the other hand is gigantic and could be researched for decades and never come close to fully map it.
This paper is basically the usual science vs fantasy struggle, like when early science started to explore some of the wide areas and it was contrasted with traditional faith-based cultural approaches. It may as well be about the introduction of germ theory of disease and how it clashes with the ideas at the time, putting them not even on equal footing, but choosing a tiny subset of it and declaring that in comparison, it's too early to tell which is better.
There is so much stereotyping and mindless reductionism, strictly for effect. It actually reminds me of Edison killing an elephant with DC current, as if it somehow proves any other point than that he was an asshole willing to kill an elephant to fail to prove a point.
You can't talk about knowledge when there is no actual knowledge. This word salad is a perfect reflection of the complete disconnect with reality that the biopsychosocial model suffers from. The clinics are a massive failure, but you would never know this reading it. They never developed any real knowledge precisely because they take the wrong approach, while the proper approach, science, is an arduous and difficult process.
The best comparison is probably with Mother Theresa and her network of 'clinics'. They weren't really clinics, none of them did any medical care. They were religious places where the dying could suffer in communion with God, according to the faith model she held. When she herself got ill, she was flown on private jets to expensive private clinics in the US. Here this paper would contrast them as equally valid, despite the fact that every single person involved would obviously choose the medical approach, but they don't know that, because they're not suffering right now. They have zero perspective on this.
Specifically, they drew from the failed rehabilitation models pushed onto ME/CFS for years. Which Greenhalgh knows, and yet chooses to omit. A model that has always affirmed that there is nothing biologically wrong here, that it has nothing to do with infections, and has never shown any effectiveness.
This looks to me exactly like misnaming someone on purpose. Can't even get the name right? Why the quotes?
Contrast this, "characterised by profound fatigue", with the definition of LC she chose, somehow with a citation to one of her papers, as if she had anything to do with this definition:
This is the proper definition of ME/CFS, and yet she contrasts this with "‘MECFS’" as being different. Incredible display of ignorance.
It does not. This is false. Many clinics are even closing precisely because they don't have any treatments and rehabilitation doesn't work, and for those still open it's commonly said that there is no need to do anything beyond basic diagnostic work-up for the same reason. Many GPs refuse to refer patients for the same reason. There are regular articles and studies showing the complete ineptitude of this model.
The growth of pseudoscience in medicine is one of the biggest scandals of our time. It's become a de facto standard. And this paper is nothing but self-serving pompous nonsense. As usual with TG.
