By David Tuller, DrPH
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In a remarkable display of–well, I’m not even sure what to call it–Professor Michael Sharpe has blamed Guardian columnist George Monbiot and Long COVID support groups, among others, for the wave of people reporting prolonged symptoms after acute bouts of COVID-19. And during the same February presentation in which he made those observations, Professor Sharpe warned viewers of “poor quality research” while still citing his beloved but discredited PACE trial as if it offered meaningful evidence. The event was an “Expert Forum on secondary COVID-19 impacts” organized by Swiss Re, a major reinsurance company.
Monbiot himself has experienced what he has referred to as a mild case of Long COVID. He has expressed empathy and support for those who have been whacked by this much, much worse than he has. And the situation has brought to his attention the years-long neglect of the ME/CFS patient community. Here’s part of what he wrote in January in a compelling column:
“In some cases, long COVID could mean lifelong COVID. The effects can be horrible. Among them are lung damage, heart damage and brain damage that can cause memory loss and brain fog, kidney damage, severe headaches, muscle and joint pain, loss of taste and smell, anxiety, depression and, above all, fatigue. We should all fear the lasting consequences of this pandemic.”
That passage apparently didn’t sit well with Professor Sharpe. In his presentation, he cited it–if I understand his argument–as the sort of thing likely to trigger other people into reporting exaggerated or imagined symptoms they insist are manifestations of Long COVID. This assertion is the same argument he and his comrades in the biopsychosocial ideological brigades have made for decades about the purportedly pernicious social influences that convince ME/CFS patients that they’re ME/CFS patients.
Here’s what seems to be Professor Sharpe’s basic point: We wouldn’t be hearing from all these anxiety-ridden, depressed, hysterical and deluded people (mostly women) if they weren’t being convinced that there’s a thing called Long COVID by patient disinformation and fearmongers like George Monbiot.
That’s the argument. That’s it. Really. Sharpe allowed in his presentation that some post-COVID patients might need medical investigation. But he also noted that seeking medical attention is a coping mechanism for the psychological distress that patients experience as physical symptoms. So he likes having it both ways.
For months, Professor Sharpe and his colleagues have been deploying the Long COVID phenomenon in a campaign to shore up their cherished but collapsing CBT/GET approach to ME/CFS and related conditions. Accompanying this campaign has been an effort to rehabilitate the credibility and authority of the PACE trial itself. In his presentation, Professor Sharpe included a slide of the purportedly positive results for the trial’s fatigue and physical function outcomes. In a Long COVID webinar sponsored by the Royal Society of Medicine in September, one panelist suggested that PACE merely suffered from poor public relations; he was of course overlooking the methodological and ethical lapses that likely qualify the study as an example of research misconduct, at least according to standard definitions.
And now the PACE rehabilitation project has jumped across the Atlantic onto The Wall Street Journal’s opinion page. Two weeks ago, the news organization published a piece that described both Long COVID and ME/CFS as manifestations of mental illness and linked to the PACE trial as representative of the “prevailing view” in the medical profession. Luckily, the case against PACE is well documented, so the notion of restoring it to its glory days is a non-starter. It is and will always be a piece of crap.
There’s a lot more nonsense from Professor Sharpe’s presentation. My friend and colleague Brian Hughes, a psychology professor at National University Ireland Galway, took aim at it earlier, so I’ll leave the rest to him. You can read his analysis here.
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Is it possible not to see sexism in Sharpe’s presentation?
The medical/healthcare system has been told that up to 3 or 4 times as many women as men suffer from ‘medically unexplained symptoms’ (read ‘psychogenic illness’) eg here -https://kirkleesiapt.co.uk/wp-content/uploads/2018/05/medically-unexplained-symptoms-positive-practice-guide-1.pdf – (page 8) – and yet few healthcare practitioners seem to question whether the BPS model encourages sexism, the gaslighting of women and the creation of a self-fulfilling prophecy. There don’t actually have to be more women than men suffering with MUS for more women than men to end up being shipped off to psychological therapies and put on inappropriate psych medications. All you need is for doctors to be told that that is the case, for presentation slides and pictures to depict women, not men, with MUS. Like this one -https://www.kingsfund.org.uk/sites/default/files/esther-gathogo-charlotte-benjamin-pilot-enhanced-gp-management-medically-unexplained-sympthoms-kingsfund-may12.pdf maybe? And even when a paper on MUS co-authored by Wessely indicated that there was no significant gender prevalence, he seemed to quickly forget that important result, subsequently telling his readers that being female predisposed people to MUS (https://spoonseeker.com/2019/03/08/mus-international-womens-day/). To my mind, the BPS model gives doctors free rein to be as prejudiced and discriminatory as they wish, and so many disadvantaged and vulnerable people may fall foul as a result (see -https://opposingmega.wordpress.com/2020/08/19/so-what-if-23-get-worse-2/). Of course, some illnesses may actually affect women more than men, so to dismiss them as being of psychological origin and to pour money into psychological rather than biomedical research is discriminatory too. This discrimination must end.
I have been suffering with quite sever ME/CFS, together with fibromyalgia and depression, since 2005. Although it stopped my teaching career back then, it hasn’t stopped my determination to carry on living and learning.
I came across an editorial by Nassir Ghaemi MD MPH for BJPsych, “The rise and fall of the biopsychosocial modelâ€, and read with great interest. [“The biopsychosocial model was valuable in its day as a reaction to biomedical reductionism, but its historical role has played out.â€]
I contacted The author explaining how the uk was using BPS to inform not only medical treatment but the entire welfare system which trolls and gaslights people applying for sickness and disability benefits using the most spurious reasons to constantly deny people support. I asked him: are we right to be worried by the prevalence of the BPS model at the heart of government decision making, what are the true motivations behind these decisions, and ultimately is the BPS model is of any value whatsoever?
He replied to my email saying that he will take some time to explore this issue. He added:
“My initial impression is that this is quite an unwarranted vulgarization [sic.] of an already out of date and oversimplified medical theory.â€
I agree with CT in the comments above. In fact, Professor Sharpe’s use of the word “hysterical” is inherently sexist in the first place, having its root in the Greek word for a womb “hystera”. It’s a word that is never applied to men.
I’d like to add to my first comment: “hysterical” was a word coined to dismiss and derogate the mental health of women. Professor Sharpe’s derogatory use of it here is disgusting but indicative that his opinion belongs in the 19th century, not the 21st
Sure, didn’t Thomas Szasz say there was no such thing as mental illness? The foundations of modern western medicine are discriminatory to women and there will not be proper health care until it is all swept away. As I understand it, in the Navajo nation there is a medicine man and a medicine woman 2-methods of healing, different but equally respected and you as an individual get to choose who you consult. As Elaine Morgan wrote back in the 1970’s the male of the species is treated like the archetypal horse whereas the female is the donkey. Extraction orthodontics on girls because their mouths are too small is tantamount to Chinese foot binding and leads to neurological damage later in life that no amount of talking therapies can cure.
I have just heard from the lady who runs our Fibromyalgia monthly lunch meetings here in Oxfordshire that Simon Wesseley was the guest on BBC Radio 4 Desert Island disks on 28th March. I told her I would be avoiding it.
After being an early covid patient in February 2020 I experienced symptoms for 9 months. These were distinctly physical, and included: bouts of fever, persistent dry cough, bouts of glandular swelling (in different sites – don’t ask!), muscular pains (ditto), and (for 7 months) facial neuralgia. These were not debilitating, but they were enough to convince me that such after-effects are real.
With every outbreak of anything there will be a few people who develop symptoms which are essentially psychological, and probably anxiety-related. That is no reason to dismiss the physical symptoms of many. Nor to relapse into Victorian stereotypes of hysterical females.
But “ah”, I imagine some BPS proponents might say, “we must have parity of esteem for mental health. MUS is a mental health problem, therefore not to treat all those women who have it would be depriving them of mental health care. That would be discrimination.” Except a study that has been cited (eg in this paper by Sharpe and colleagues -https://jnnp.bmj.com/content/jnnp/74/7/897.full.pdf) to inform doctors that the misdiagnosis of psychogenic symptoms as ‘organic’ is a greater problem than the reverse – Nimnuan et al 2000 – https://academic.oup.com/qjmed/article/93/1/21/1588375 – “Medically unexplained symptoms: how often and why are they missed?” – revealed unacceptably high MUS misdiagnosis rates as explained here -https://opposingmega.wordpress.com/2020/05/01/untangling-the-mus-web/ . And those who have cited that Nimnuan et al 2000 paper were presumably aware of these unacceptably high MUS misdiagnosis rates if they’d read the paper properly, but that doesn’t appear to have stopped some of them referencing the same study’s ‘sister’ paper – Nimnuan et al 2001 -https://pubmed.ncbi.nlm.nih.gov/11448704/ – to persuade readers that MUS/functional symptoms are highly prevalent – see here -https://opposingmega.wordpress.com/2020/06/06/who-else-knew/ – without warning them of the high MUS misdiagnosis risk.
Also, we mustn’t forget that in 2005 Sharpe, Stone, Carson and Warlow seemingly tried their best to debunk “Eliot Slater’s myth of the non-existence of hysteria” -https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1299341/ , giving the impression that misdiagnosis rates for MUS/conversion symptoms have been quite low (averaging 4%) since 1970. This was on the basis of their own 2005 systematic review that they’ve admitted was of questionable quality -see 2nd paragraph here -https://academic.oup.com/brain/article/132/10/2878/333395 . But at least one of them knew (unless he somehow forgot) that the MUS misdiagnosis rates uncovered in the Nimnuan et al study (that collected data from 1995 to 1997), that wasn’t included in their systematic review, were much higher.
A few observations:
i) “This assertion is the same argument he and his comrades in the biopsychosocial ideological brigades have made for decades about the purportedly pernicious social influences that convince ME/CFS patients that they’re ME/CFS patients.” Huh! That old trope. I, and many of my long-timer ME comrades, have had ME for multiple decades… enough decades to predate any social influence. Ironically I first became ill in the very year Beard and McEvedy were creating their fraudulent bit of nonsense re-framing ME as hysteria. In 1970 I was far too young to be aware of this paper and to be aware of the Royal Free outbreak that had occurred 5 years before I was even an oocyte! I did not grow up in a medical household and no one had heard of the disease until the mid 1980s. Colleagues, knowing I had periods of time when I was very unwell, wondered if I could have ME, but they knew as well as I did that the ‘number one symptom’ being touted by the media and supposedly associated with the disease as per Mid 1980’s coverage did not apply to me: I was not depressed, at all, in any way (imagine those last word are underlined). So I rejected the notion on the basis of the erroneous way the disease was being manipulated in the press at the time, it didn’t reflect my presentation. It wasn’t until 20 years after first becoming ill that the diagnosis was suggested to me in a medical context. It seemed to fit but I know from my subsequent experience that it was being used (exactly as the BPS wanted it used) as a dustbin diagnosis. All in all I’ve had 4 different doctors give me this diagnosis and only one of them had any remote idea what authentic ME actually was. I keep my paperwork so I can interrogate this observation using my contemporaneous evidence.
As things go, my diagnosis as per the ICC seems about right, but I have not sat on my laurels assuming that a diagnosis which presently has no definitive diagnostic test is necessarily correct. After all we have examples of stalwart ME advocates who have themselves discovered a good way down the line that they have something else entirely. The ‘wastebasket-ness’ of the ME diagnosis leads, as an MUS diagnosis now also leads, to a strangulation of further testing opportunities. (See here: -https://www.bmj.com/content/329/7472/928/rr/702858- )
The influence of ‘media’ causing either ME or Long Covid is yet another silly BPS trope and one which needs strangling itself.
ii) In October 2019, I was told by a neurologist that “people like you” don’t return positive test results for small fibre poly neuropathy. What did *he* mean by “people like you”? Did he mean ME sufferers, or women, or both perhaps? In Spring 2020 I had a skin punch biopsy done privately (via a different neurologist) that revealed that I do indeed have small fibre poly neuropathy. It cost me thousands of £s to access this test. My neuropathic pain and sensations had been ignored by the NHS for 10 years. Ten years of torture but no NHS specialist care bar a one off ‘Pain Clinic’ appointment in the summer of 2019 in which I was offered only ‘mindfulness’. Nothing else, just mindfulness. Ten years of neglect. That’s what the monstrous BPS model has done to me. What do Sharpe and Swiss Re have to say about that I wonder?
iii) @ Peter Nicholls: very interesting. I hope your contact follows this through.
I do believe the word ‘hysterical’ is Dr Tuller.
“I do believe the word ‘hysterical’ is Dr Tuller.”
I’m guessing this isn’t *the* Michael Sharpe’ .. it sounds a bit hysterical in itself doesn’t it? After all if it were then we have a Professor of Psychological Medicine from the University of Oxford pronouncing on a diagnosis of mental illness without a proper consultation. It’s ok for those of us without such qualifications to make amateurish and colloquial observations but it could never be ok for a Professional to veer so outlandishly from their professional ethical code.
I wonder which wag has infiltrated Virology Blog as Sharpe’s alter ego? It gave me a chuckle at the very least.
The video of Sharpe’s presentation has also been posted on YouTube:
https://www.youtube.com/watch?v=7-pgbM0FHBE
and it contains many more highly contentious statements than his slides.
(By the way, Dr Tuller, your email address on the Berkeley Journalism website – https://journalism.berkeley.edu/person/david_tuller/ – is wrong, it points to berkeley.com rather than berkeley.edu.)
Twenty years of ME has convinced me that the psychobabble brigade are equal opportunity haters. They despise all patients, especially the sick ones.
Actually all of medicine now despises sick people. The whole system is designed to sell stuff like vaccines and cancer tests to the worried mostly-well who have health insurance. People with serious chronic illness can just get stuffed. They are waaay too much trouble.
It has been very informative to talk to the hospice nurses that are looking after me. They uniformly report that physicians are failing to do their job of actually diagnosing illness and attempting to treat them. They are afraid to prescribe medicine, at least in part due to fear of DEA (federal narcs) scrutiny.
There are numerous reports suggesting NHS has a serious personnel crisis due to workers quitting and/or too sick to work regular hours. It is likely similar in the US but the fragmented system here makes it hard to tell what is going on.
I recall writing comments a year ago stating the first priority of the medical machine has to be to take care of their workers and support the families. Like all other aspects of managing the corona crisis, medical machine leaders have completely failed to look after their people.
Now almost no one can get competent and effective medical care for any illness. Does Professor Sharpe have anything to say about that?
I had another little chuckle apropos of the comment from ‘Michael Sharpe’ above:
The (presumably real) Michael Sharpe has, on his Twitter page, re-tweeted** a diagrammatic explanation of ‘ “The hierarchy of disagreement from “How to Disagree” ‘ by Paul Graham. It can be found in pyramid form where sensible and intelligent disagreement is headed by ‘refuting the central point’ right down through 7 steps to the presumably undesirable practices & the baseness of ‘ad hominem’ and ‘name calling’ at the bottom.
Let’s hope it wasn’t the real Michael Sharpe (above) making an ‘ass hat’ of himself then? 😉
** easy to find on his Twitter page, and screen grabbed…of course!
By stating his misguided opinions about ME/CFS and Long Covid, Prof Sharpe exposes his flawed logic to a wider field of public scrutiny. This may backfire on him and ultimately help raise awareness of bad science in ME/CFS.
Professor Sharpe, Likes to destroy his own career little by little, taking unprofessional swipes at others. The last laugh will be on you though, as biomarkers for long Covid are already being found i.e. Autoantibodies to beta-adrenergic and muscarinic cholinergic receptors, even autoantibodies targeting cytokines and chemokines themselves .
Diverse Functional Autoantibodies in Patients with COVID-19 | medRxiv
https://www.medrxiv.org/content/10.1101/2020.12.10.20247205v4
Where it gets interesting is a subgroup of ME/CFS patients have autoantibodies to beta-adrenergic and muscarinic cholinergic receptors too.
‘Autoantibodies to beta-adrenergic and muscarinic cholinergic receptors in Myalgic Encephalomyelitis (ME) patients – A validation study in plasma and cerebrospinal fluid from two Swedish cohorts – ScienceDirect’
https://www.sciencedirect.com/science/article/pii/S2666354620300727
——-
To date ME/CFS has never been tested for autoantibodies for cytokines or chemokines due to lack of funding. But that’s because people like you Sharpe, took millions of dollars of funding to make it appear ME/CFS is a mental disorder with that now discredited PACE trial (remember how you appallingly shifted the goal posts ‘DURING’ the trial) that caused funding for biological research to dry up, and you are still a huge part of that road block now.
Did you know Stanford School of Medicine found a different blood biomarker for ME/CFS in recent times too. Sadly that had to be funded by donations.
Biomarker for ME/CFS identified | News Center | Stanford Medicine
https://med.stanford.edu/news/all-news/2019/04/biomarker-for-chronic-fatigue-syndrome-identified.html
——-
As for calling people names like ‘hysterical‘ you are stooping almost as low as the PACE trial. Grow up, Come back with actual evidence that millions of sick people globally are somehow all ‘hysterical‘ because of what a couple of people said in a few articles. Dear lord how are you actually a professor in the sciences?
By the way the Long Covid support groups were set up prior to the media reports. Explain that too?
You are lashing out like a child because you know your game is soon going to be up, with the new massive funding directed at actual biological research on Long Covid. Research we all know will also show more biomarkers for ME/CFS. And that Professor Sharpe will leave egg on your face, and your career in utter tatters.
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I do believe the word “sociopathic†is Michael Sharpe.
To Peter Nicholls:
Very interesting post; it would be great if you could share any outcome from this.
Is it possible for you to post a link to the BJPsych editorial?
Thanks!
“We wouldn’t be hearing from all these anxiety-ridden, depressed, hysterical and deluded people (mostly women) if they weren’t being convinced that there’s a thing called Long COVID by patient disinformation and fearmongers like George Monbiot.”
I find this statement by Professor Michael Sharpe nonsensical. To imply there is no possibility of any viral infection leading to long-term post viral illness defies belief.
Personally, interaction with medical professionals who continue to deny Myalgic Encephalomyelitis (ME/CFS) is a physiological illness is but one difficult aspect of decades lived experience of severely debilitating illness. This denial flies in the face of ME being classified as a neurological disorder by WHO.
Understanding of pathophysiological disease can only come about through open minds keeping pace with latest scientific evidence-based research.
Professor Michael Sharpe; Know we have names. Know our lived experience matters. Know we patients’ desire nothing less than resuming active, healthy lives. Know I am a woman who finds your words obnoxious and irrelevant to the subject. Know scientific fact matters. Know your words matter.
https://www.mdpi.com/2075-4418/9/3/70/htm?fbclid=IwAR1vuV7ZBXpKUTFBvhTHIBdAoTG25g6k-bqxveFxXS9p8O9NnZ0AH9__HMw
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