By David Tuller, DrPH
Last week, The Wall Street Journal published a passionate but clueless opinion piece from a psychiatric resident at McMaster University in Ontario, Canada. The author, Jeremy Devine, portrayed the entire category now being referred to as Long COVID as a fiction foisted on the world by a committed commando of deluded and illness-obsessed queer feminists (or maybe queers and feminists–I’m not sure). And patients, no less! The column’s mean-spirited tone made it difficult to read. Repellent, actually. I wrote about it here.
Devine presented snark instead of viable evidence for his argument, which appeared to emerge from his own deficit of compassion and empathy for patients. He showed no interest in the views of those experiencing the debilitating symptoms he was glibly interpreting as psychosomatic. Instead, he dismissed survey data based on his negative attitudes toward the researchers’ status–whether as patients, queers, feminists or members of wellness collectives seeking to identify links between discriminatory social structures and health inequities. His anger and dismay at their unwillingness to acknowledge the psychosomatic nature of their symptoms and submit to his diagnostic authority were palpable.
Poor guy! He really seemed to be struggling with some stuff.
Devine also accused experts who are taking these prolonged symptoms seriously of being bamboozled. In his view, this powerful queer-feminist coven has brewed pseudoscientific spells and cast them upon the decision-makers at the National Institutes of Health, in the process enchanting them into offering more than $1 billion for nefarious patient-influenced research projects. (The article made no mention of whether potions from frog entrails, elephant dung, and the menstrual blood of queer feminist patients were used.)
In laying out his case, Devine chose to link to the PACE trial as the epitome of medical wisdom on the issue of the purported psychogenic origins of post-viral symptoms. If he can spare a few minutes, I can tell him a story about the PACE trial in about 15,000 words.
Lots of people–not just young and arrogant psychiatry residents at McMaster University–say stupid things. Luckily, most people don’t say their stupid things in The Wall Street Journal. It would be interesting to know how Devine ended up being the sucker to take responsibility for this disaster. Was it commissioned, or was it a submission out-of-the-blue, or is Devine a friend of someone who knows someone on the opinion page? In any event, it would have been better for all involved had a wise editor prevented this frightened young man from making a public spectacle of himself. Well, too late for that!
Anyway, I was glad to see The Wall Street Journal follow up this week with a cogent rebuttal to the Devine mess. Even better, it was from a peer of Devine’s, another psychiatric resident, Yochai Re’em, who is at New York-Presbyterian Hospital, Weill Cornell Medicine. Re’em acknowledged in the opening lines of his piece that he himself had contracted COVID-19 and subsequently experienced persistent symptoms. His perspective is very different than Devine’s.
My Q-and-A with Yochai Re’em
I reached out on twitter yesterday to Yochai Re’em, the author of the second Wall Street Journal piece. In addition to his psychiatric work, Re’em, is also a researcher with Body Politic’s Patient-Led Research Collaborative. (That’s the same group dissed by Devine for having a queer and feminist orientation–or something like that, anyway.) I sent Re’em a few questions. Here’s our exchange:
What was your reaction when you saw Devine’s piece?
I wasn’t surprised a piece like that was written, but I was a little surprised it managed to pass through WSJ given the gross inaccuracies and sweeping generalizations with insufficient citations. In retrospect, I may have been a little naÃ¯ve. The further I read, the more it became clear the piece was a result of an emotional reaction about the Long COVID community, lazily invoking €œmainstream medicine’s€ views despite these points being far from mainstream. My initial surprise gave way to disappointment as I realized the author is a fellow psychiatric resident. Arguments were presented in order to substantiate his thesis that Long COVID is a psychogenic phenomenon with patient-led organizations fueling the fire.
Unfortunately, these arguments were narrow pieces of the puzzle, omitting much of the picture, and placed out of context. The general tone – referencing patient advocacy groups as though the nature of their involvement alone would prove their untrustworthiness- is not the psychiatry I know. I was also somewhat shocked that it seemed he was trying to diagnose an entire group of individuals with a psychiatric disorder without examining them (there was no mention of him encountering Long Covid patients in his clinical practice). This left me feeling disappointed and feeling that psychiatry was misrepresented in the piece.
I will not deny that the current state of Long COVID research leaves much to be desired (after all, it’s been only a year since the pandemic started). I am still confused, though, by why so many people seem so hellbent on critiquing the existing evidence and using that critique as proof that Long covid doesn’t exist or is psychogenic (criticizing the current evidence is hardly proof of that), instead of running adequate trials to try to better understand it.
How did your piece come about and how did it end up in the WSJ?
Early in the pandemic, there were many reports among long-haulers of patients being told that their symptoms were all due to anxiety and/or depression. Some of these patients had a history of anxiety/depression and were able to identify this was not consistent with their own experience–which goes against Devine’s point that this is due to societal bias against mental health disorders. Some were psychiatrists themselves.
I began thinking about why doctors tell patients their symptoms are due to psychological issues, often without backing it up with evidence, and often as a diagnosis of exclusion. Many of the reasons may be due to psychological factors in the doctors themselves, which I tried to outline in my piece. I had been working on this and attempting to get it in a medical journal when Devine’s piece came out. I reached out to an editor at WSJ to see if it may be possible for me to respond to this piece via an opinion piece myself, and sent a draft of what I had been working on. I received significant support from fellow Body Politic members who read through my draft, offered feedback, guidance, and edits.
Did you already feel this way or did your own experiences change your mind?
My own experiences played a large role. There is a lot of skepticism in medicine, and much of that permeates into the way things like chronic Lyme or fibromyalgia are addressed in medical school. I think I only learned about chronic fatigue syndrome once I developed Long COVID myself. My own experience made me more sensitive to the patient experience, and in particular the psychological effects of being dismissed by a provider. While there is an innate empathy in most who choose psychiatry as a profession, becoming a patient yourself has a special way of increasing empathy for other patients.