By David Tuller, DrPH
On Tuesday, I gave a presentation at the Kirby Institute, a renowned research center at the University of New South Wales in Sydney, along with my friend and colleague Dr David Joffe, a respiratory medicine specialist. David spoke about the pathophysiology of Long Covid as well as the enormous economic burden of the disease. I spoke about the problems with the clinical trials of psycho-behavioral interventions—specifically, the infamous PACE trial for ME/CFS and the recent REGAIN trial for Long Covid.
Time was short, and we both only had 20 minutes, so I had to rush through the last part of my talk. But I think overall it went pretty well. Although I get agitated every time I talk about this body of crap research, I managed to restrain myself from referring to PACE as “this fucking trial.” Nor did I repeat my signature act of academic performance art—ripping up a copy of the PACE trial into shreds and tossing them in the air. Still, I think my perspective came through pretty clearly.
Thank you to both the speakers. I’ve three questions in response to Dr Joffe’s talk:
1) The coincidence in the spikes in case numbers across pathogens following the covid pandemic is striking. Has anything similar across several or many pathogens ever been seen before, perhaps to a lesser degree after epidemics?
2) Has anyone looked into whether Long Covid patients are more likely to succumb to these pathogens than those who recovered well from covid?
3) Is there evidence that would point towards vaccination against these pathogens (where available) being a sensible way to go for Long Covid patients?
A powerful presentation by the David duo, thank you.
Joffe offered links to the studies on cell function. Where May I find these please?
Dr Donohoe tested these values for me a number of years ago and they were depleted. I have Myalgic Encephalomyelitis, acute post viral 2012. My interest is in how the science may have shifted to utilise results of such tests further? Also, if functional testing has progressed?
I’d like to point out that the rise in economic inactivity due to ill-health in the UK (see video at 21 mins) started increasing considerably before the covid pandemic -see Figure 6 here -https://www.bankofengland.co.uk/speech/2022/may/michael-saunders-speech-at-the-resolution-foundation-event . It appears, from that figure, that the rates of such inactivity for men and women fell hand-in-hand from the mid to late 1990s up until about 2013/2014, but they have risen dramatically since and far more in women than in men. While I’ve no doubt that covid and long covid is playing a substantial part in that, the rise before covid goes unexplained. I think we need to consider why levels of sickness might have been rising in women before the pandemic – what had happened to UK medicine around that time that put women at a health disadvantage to men? To my mind, an obvious contender for this rise is the medically unexplained symptoms (MUS) doctrine/strategy for cost-cutting that was taught to doctors across the UK, particularly during the 2014 to 2017 period when the Royal College of Psychiatrists (RCPsych) seemed to me to be pushing teaching on MUS, (for example with the 2017 JCPMH “Guidance for Commissioners of Services for People with Medically Unexplained Services” that was jointly produced by the Royal College of General Practitioners and the Royal College of Psychiatrists), and that’s still being embraced in the NHS. Persuading doctors that MUS mostly afflicts women, is caused by psychological/psychiatric/psychosomatic mental health problems, is highly prevalent (around 50% of secondary care outpatient referrals) so a substantial drain on already stretched NHS resources, and that MUS misdiagnosis rates are low and that to further investigate patients and pay them medical attention will probably cause them iatrogenic harm instead of helping, is, in my opinion, likely to lead to many many patients, and far more women than men, not having their physical problems adequately addressed. They’ll likely end up sicker and unable to work, and may well receive inappropriate and potentially harmful mental health treatment instead of the physical care that they desperately need. (For just one example of harms see here -https://www.cam.ac.uk/research/news/chronic-diseases-misdiagnosed-as-psychosomatic-can-lead-to-long-term-damage .)
OK, I admit that there could be other explanations for the rise and the greater rise in women. Perhaps the increase in prescriptions for antidepressants in the UK is reflective of poorer mental health in general (see figure 1 here -https://bjgp.org/content/72/720/e511 ) although that wouldn’t explain the fall up to 2013/14 and the rise thereafter? (NB Women are more likely than men to be taking antidepressants and other mood-altering drugs –
https://www.gov.scot/publications/short-life-working-group-prescription-medicine-dependence-withdrawal-consultation-draft-recommendations/pages/11/ – see figure 1.3). Alternatively, if more women were being made depressed by contraceptives/hormonal treatments that they’re told can’t make them depressed (and that they can’t just stop taking because implants or whatever need to be removed), maybe that could lead to higher rates of economic inactivity due to ill health in women? I imagine too that if doctors (perhaps influenced by a misleading MUS education programme) failed to recognize physical side effects/withdrawal effects caused by antidepressants and instead consigned the symptoms and accompanying patients to their MUS pile, then that could potentially contribute to a rise in economic inactivity due to ill health by creating a cycle of symptoms and psych-drug treatment that patients couldn’t find a way out of.
Rather than looking into all these things, and waking up to the possibility that the MUS strategy and other healthcare failings could now be seriously harming the nation’s health and the UK economy to boot, it seems to me that the UK government has chosen instead to suggest that UK citizens – young people especially – have lost their Blighty backbone and are now regarding the feelings and struggles generated by life’s difficulties as mental health problems that need treating, (see here -https://www.youtube.com/watch?v=pV5Hx7XXiQg ). Could it possibly be that the same medical ‘experts’ who have pushed the MUS ‘it’s all in their heads’ line to help reduce the NHS’s physical healthcare costs by diverting patients towards cheap mental health therapies and treatments, (often claiming that these patients ARE really ill, but mentally rather than physically), may now be doubling down by making out that a resultant rise in mental health problems in the UK – an indicator, I’d suggest, of that strategy’s failure – is due to nothing more than self-indulgent navel-gazing/catastrophizing and/or woke wimpery (if that’s a word) by people who need to get a grip?
The UK Government’s answer appears to be more ‘support’ from job coaches to get all these sick economically inactive people back to work, but I haven’t heard anyone explain yet what form that ‘support’ might take. If only that support was doctors taking their patients’ unexplained physical symptoms far more seriously. If only it was doctors taking their patients’ mental health problems far more seriously.