By David Tuller, DrPH
Update, Feb 3rd:
After less than 24 hours, our letter was rejected by the journal. Here’s the message I received:
Dear Dr Tuller,
Thank you for your recent submission to The Lancet Respiratory Medicine. We have now had time to consider your manuscript and unfortunately, on this occasion, we have decided not to publish it because we have limited space in the journal and cannot give your paper priority over other letters we have in the pipeline.
Although this decision has not been a positive one, I thank you for your interest in the journal and hope it does not deter you from considering us again in the future.
Dr. Emma Grainger
Editor-in-Chief, The Lancet Respiratory Medicine
Last month, The Lancet Respiratory Medicine published a comment called “A new paradigm is needed to explain long COVID.” Not surprisingly, this “new paradigm” is the same old paradigm that has been applied to ME and CFS patients for decades. That paradigm, of course, has been debunked and discredited–even though many people seem not to have come to terms with that reality yet.
The journal has already rejected a couple of letters responding to the comment. I just submitted another, on behalf of myself and Sarah Tyson, a professor of rehabilitation in the Division of Nursing, Midwifery & Social Work at the University of Manchester. I have also posted it on a pre-print server, and am sharing it below.
To the editor:
The authors of “A new paradigm is needed to explain Long COVID” suggest that Long Covid is largely a “functional” disorder attributable to pandemic-related stress, anxiety, depression and a host of additional factors unrelated to pathophysiological processes. It goes without saying that psychological states and social and environmental conditions can have a major impact on health status and exacerbate underlying health conditions. Moreover, mental health disorders are often associated with somatic complaints like fatigue and pain. But that’s very different from arguing—without legitimate or valid evidence–that millions of people with devastating and prolonged disabilities are experiencing what the authors call “functional” complaints triggered mainly by mood disorders. Rather than these disorders being the cause of the global wave of life-altering symptoms, they are more plausibly viewed as a frequent consequence of the experience of having a poorly understood and often belittled illness.
Long Covid is a heterogeneous phenomenon involving multiple symptoms produced through a range of physiological pathways, as has become evident from the emerging research.  It would be unwarranted to expect a single unifying explanation to account for long Covid’s many manifestations. However, in supporting their position, the authors cite the lack of “an all-encompassing pathophysiological mechanism.” This is a straw-person argument. No reasonable investigators have proposed the existence of “an all-encompassing, pathophysiological mechanism” that is responsible for generating the entire spectrum of long Covid symptoms.
The authors dismiss efforts to seek pathophysiological explanations for patients’ physical symptoms with the tired charge that this approach represents “dualistic” thinking. As an alternative, they are proposing grand theories regarding “functional” etiologies and apparently expecting others to embrace these unproven speculations—an expectation that suggests a certain level of arrogance. It is simply too soon for investigators to have obtained authoritative answers to a phenomenon as complex and varied as the long-term impacts of coronavirus infection and acute COVID-19. Perhaps if the field of post-viral illness had not been neglected for decades, and patients with ME/CFS and related conditions had not been ignored and mistreated, we would understand a lot more now about the medical challenges confronting long Covid patients.
Senior Fellow in Public Health and Journalism
Center for Global Public Health
School of Public Health
University of California, Berkeley Sarah Tyson
Professor of Rehabilitation
Division of Nursing, Midwifery & Social Work
School of Health Sciences
University of Manchester
 Saunders C, Sperling S, Bendstrup E. A new paradigm is needed to explain long COVID. Lancet Respiratory Medicine 2023;11; 2:e12. DOI: 10.1016/S2213-2600(22)00501-X
 Davis HE, McCorkell L, Vogel JM, Topol EJ. Long COVID: major findings, mechanisms and recommendations. Nature Reviews Microbiology 2023; Jan 13:1-14. DOI: 10.1038/s41579-022-00846-2
Thanks David and Sarah. I can’t see any reason why the journal would reject this letter, other than not wanting to take part in scientific debate.
As for “a new paradigm”, could that be the new paradigm being talked about here -https://www.youtube.com/watch?v=DqDTAHUMnq4 . Chilling, I think, especially in the context of the NHS. Watch out all you patients who up to now have felt safe in the knowledge that your chronic debilitating illness has a firmly established biomedical cause because it looks to me like you could be robbed of that security if this particular school of thought has its way. If you’re not under threat of quite imminent death, will your symptoms be put down to somatization or psychological causes instead now?
And that was from before the pandemic when the UK economy was in better shape….not good shape, but better than it is now. I suspect that UK psychiatry, sensing it’s been on shaky ground in terms of funding, has, (especially since the economic crash), been desperately trying to find a way to ensure its longevity and has managed to convince the powers that be that it can help to drastically reduce NHS spending on ‘physical’ health by diverting patients to psychiatric treatment and psychological therapies instead. (That’s ‘psychiatry’ by the way, the word in itself appears exclusive and therefore dualistic so why hasn’t that gone?) It’s hardly holistic medicine to pit ‘physical’ health spending against ‘mental’ health spending, but that’s what we’ve seen in NHS, with applicants for funding for psychological therapies being asked to describe their savings assumptions with respect to reducing (physical health) outpatient appointments, investigations and length of stay. Dualism, yes, I’d call that dualism, and a very dangerous dualism at that – pistols at dawn, almost.
Like they can’t make space for scientific debate? I’d call that stodge, not science.
And I’m kind of reminded of this -https://www.theguardian.com/commentisfree/2022/aug/25/bbc-agent-tory-party-bias-news-media-emily-maitlis-mactaggart-lecture
Since when did good science crouch?
Peter Trewhitt says
It seems in addition to those letters apparently lined up for publications, a fair few more like David and Sarah Tyson’s have been rejected.
At least this flush of letters demonstrating the logical and scientific shortcomings of those claiming Long Covid is a functional and/or psychosomatic condition gives the lie to those regurgitating the tired meme of anti-science patients objecting to psychiatric diagnoses.
What is ironic is that those claiming Long Covid is a psychiatric condition, despite their assertions of original thinking, are rather regurgitating the ideas and unscientific/even anti-science methodologies of Sigmund Freud from the 1890s.
Thank you for keeping banging at that door!
monkey mart says
Thank you for continuing to pound on the door!
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