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• W4361217494 abstract "Upon reading Chloe Saunders and colleagues’ Comment,1Saunders C Sperling S Bendstrup E A new paradigm is needed to explain long COVID.Lancet Respir Med. 2023; 11: e12-e13Summary Full Text Full Text PDF PubMed Scopus (10) Google Scholar it is striking how this new paradigm is essentially the old paradigm for medically unexplained symptoms and contested illnesses.2Hughes B Tuller D Lubet S Paradigm lost: lessons for long COVID-19 from a changing approach to chronic fatigue syndrome.https://www.healthaffairs.org/do/10.1377/forefront.20210514.425704/Date accessed: January 8, 2023Google Scholar The authors advance an alleged philosophical problem they call “taboos based on a dualistic understanding of physical versus mental illness”. They assert such “Poorly integrated explanatory models contribute to poor care and stigma for people who are ill in these specific ways.” For the sake of argument, let us consult the lemma dualism: “In the philosophy of mind, dualism is the theory that the mental and the physical—or mind and body or mind and brain—are, in some sense, radically different kinds of things. Because common sense tells us that there are physical bodies, and because there is intellectual pressure towards producing a unified view of the world, one could say that materialist monism is the ‘default option’.”3Robinson H Dualism.in: Zalta EN Nodelman U Stanford Encyclopedia of Philosophy Archive: Spring 2023 Edition. Metaphysics Research Lab, Stanford, CA2023Google Scholar If monism is the default option, pushback against implicitly systemic “dualistic understanding”1Saunders C Sperling S Bendstrup E A new paradigm is needed to explain long COVID.Lancet Respir Med. 2023; 11: e12-e13Summary Full Text Full Text PDF PubMed Scopus (10) Google Scholar is a non sequitur. In actuality, what Saunders and colleagues seem to oppose is divergence of care pathways across the salient care needs of patients. Although their explanatory model is agnostic on this point, the authors assert some patients “are ill in these specific ways” that demand integrated care—specifically, “effective treatments and rehabilitation approaches for functional disorders”. In effect, this routes patients who are ill in these specific (ie, non-specific) ways along a specific care pathway to specific clinical services and obscures their care needs. This paradigm promotes “a non-dualistic approach” to justify special pleading for patients who are allegedly ill in these ontologically distinct but vague ways4O'Leary D Why bioethics should be concerned with medically unexplained symptoms.Am J Bioeth. 2018; 18: 6-15Crossref PubMed Scopus (29) Google Scholar (unlike patients well served by “a dualistic understanding”1Saunders C Sperling S Bendstrup E A new paradigm is needed to explain long COVID.Lancet Respir Med. 2023; 11: e12-e13Summary Full Text Full Text PDF PubMed Scopus (10) Google Scholar). When the authors argue an explanatory model of long COVID (also known as post-COVID-19 condition) cannot succeed “on an individual pathophysiological basis alone” but necessitates “social, experiential, and psychological factors”, they ostensibly subscribe to a pluralistic understanding. However, treatment provision is narrowly defined according to their fixed understanding. An integrated model of post-COVID-19 condition that a priori rejects “simple, causative relationships between pathophysiology and symptoms”, insistent on analysing it as a multifactorial clinical entity with non-linear causal processes, flouts basic principles of parsimony, saliency,5Geraghty K Jason L Sunnquist M Tuller D Blease C Adeniji C The ‘cognitive behavioural model’ of chronic fatigue syndrome: critique of a flawed model.Health Psychol Open. 2019; 6 (2055102919838907)Crossref Scopus (22) Google Scholar and incommensurability. Successful integration of epistemically distinct domains, by a single field (of functional disorders), no less, is an extraordinary claim. The authors seem content to endorse an evidence base that has historically failed to deliver on that claim. I declare no competing interests. Concerns regarding a suggested long COVID paradigm – Authors' replyWe thank the authors of these three helpful responses to our previously published Comment.1 We welcome Fabian Schwendinger and colleagues highlighting some important factors related to the ongoing immune response that we did not expand upon and for introducing the microbiome. Knowing which factors are necessary and sufficient to understand and treat long COVID (also known as post-COVID-19 condition) across the spectrum is an important goal of a research programme. An exploratory model is needed as the starting point of such a research programme, but scientific models are updated as research progresses. Full-Text PDF Concerns regarding a suggested long COVID paradigmWe read with great interest the Comment by Chloe Saunders and colleagues1 that suggested a new paradigm to explain long COVID (also known as post-COVID-19 condition) as an embodied condition with heterogeneous biological, psychological, and social factors that might be interrelated. Full-Text PDF Concerns regarding a suggested long COVID paradigmIn Chloe Saunders and colleagues’ Comment,1 they recommend a model (which they term new) in which biological, social, experiential, and psychological factors interact to cause long COVID (also known as post-COVID-19 condition). To us—public health scholars with lived experience of post-COVID-19 condition—the model appears indistinguishable from old biopsychosocial models. For decades, such models have been misused to inaccurately characterise similar conditions, such as myalgic encephalomyelitis (also known as chronic fatigue syndrome), as rooted in patients’ own maladaptive psychological processes. Full-Text PDF A new paradigm is needed to explain long COVIDWe now have adequate data to describe the core symptoms, course, and prevalence of long COVID. Core symptoms include breathing difficulties, muscle pain, anosmia, tingling extremities, and general tiredness. Many of these symptoms are non-specific, but are seen at higher rates in people with long COVID than would be expected in the general population.1 Full-Text PDF" @default.
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• W4361217494 date "2023-04-01" @default.
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• W4361217494 title "Concerns regarding a suggested long COVID paradigm" @default.
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