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Beware the COVID-sceptic doctors

It turns out that not all medical doctors are infallible. Who knew?

Some of them, it seems, dally at the margins of pseudoscience. Take for example the latest BMJ Op-Ed from the doctor who cured himself of long COVID. He says he did so through positive thinking. Go him!

Pseudoscience’ is a frequently used term, but one that is widely misunderstood. It is often used as a synonym for ‘quackery’ or ‘bunkum’ or ‘general nonsense’. But not all quackery, bunkum, or nonsense actually constitutes ‘pseudoscience.’ 

‘Pseudoscience’ does not simply refer to something that is factually wrong. There is more to the term than that. 

‘Pseudoscience’ refers to an activity that falls short of the quality standards required by the scientific method, but which claims to be scientific nonetheless.

In other words, ‘pseudoscience’ is pretend-science. It is a sham version of real science. It uses the appearance of science to exploit the gullibility of non-specialist audiences. “Look at me, I’m a scientist!” is its message. “See my white coat, call me ‘Doctor’!” If pseudoscience had a hashtag, it would be #sciencenotscience.

But the most important thing about pseudoscience is that it is often hidden in plain sight.

So-called scientists can be pseudoscientists too.

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I’ve been writing about pseudoscience for a very long time. As with many psychologists — especially those who, like me, take an early interest in research methods — I first became curious about the way so many human beings believe claims about UFOs, astrology, ghosts, and other peculiarities.   

But then I began to twig that many practices in mainstream science and academia themselves fall short of rigorous standards. Do these practices constitute pseudoscience as well? 

Well, if they claim to be scientific but actually are not, then the answer to that question is, unambiguously, ‘Yes’.

In fact, it is a fairly common point in undergraduate philosophy classes that many major historical scientific figures were themselves prone to pseudoscience. They were inclined to believe in all manner of nonsense, especially when that nonsense fell outside their areas of expertise. 

The recurring theme here is a problem I call “runaway competence bias”, the tendency to attribute greater weight to the opinion of an expert, regardless of whether or not that person has proven expertise in the subject about which they are opining.

In short, just because a person is an expert in one area, does not make them an expert in another area. And it certainly doesn’t make them an expert in all other areas.

* * *

We encounter this problem a lot in psychology. During COVID, I have simply lost track of the number of medical specialists in the media who see themselves as capable experts in the science of human behaviour — the cardiologists who to tell us how to promote mask-wearing, or the respiratory doctors who pontificate about the behaviour of people in crowded places, or the microbiologists who tell us all when and where people can be relied upon to keep 2 meters apart. 

And now we have the healed-thyself physician who claims to have recovered from long COVID because it was caused by, er, Pavlovian conditioning:

I feel that I have looked down the barrel of the ME/CFS gun and disarmed it. I believe that we can unwittingly reinforce, as Pavlov has shown, the dysfunctional autonomic tracks in the brain set up by a virus long gone. 

I write this to my fellow covid-19 long haulers whose tissues have healed. I have recovered. I did this by listening to people that have recovered from CFS/ME, not people that are still unwell; and by understanding that our unconscious normal thoughts and feelings influence the symptoms we experience.

There it is in all its glory: #sciencenotscience.

Our unconscious normal thoughts and feelings influence the symptoms we experience”? Well yes, kind of. Except the problem is that statements like this mean everything and nothing. It is a truism to state that our “thoughts and feelings” influence our “experience” of symptoms. But what causes those symptoms?

Well, it depends. What we do know — and this has nothing to do with Pavlov — is that people with long COVID and ME/CFS manifest a range of physiological symptoms that extends far beyond what cognition could ever induce. 

Pavlovian processes — more correctly termed respondent conditional reflexes — require the pairing, over time, of biologically potent unconditioned stimuli with reflexive physiological responses: bells, dogs, drooling, and all that. Such processes are very far removed from the neuro-immune manifestations of ME/CFS, in which oxidative and nitrosamine stress are believed to contribute to progressive cell and metabolic dysfunction in a way that produces hypometabolic states in sufferers. No researcher in the field of psychoneuroimmunology would ever suggest that the type of antibody-mediated dysregulation of the immune system sometimes seen in ME/CFS could be responsive to macro-level classical conditioning.

In other words, the good doctor’s theory of his own recovery is so out there as to be nonsensical even to imagine. It is so erroneous as to be not even wrong.

And let’s not forget, despite his constant reference to the disease, this doctor never actually had “ME/CFS”. There are similarities, yes, but long COVID and ME/CFS are still different conditions. He seems to be using the label as a kind of shorthand or, possibly, as yet another gratuitous dig by a medical professional directed at the ME/CFS community. Either way, it is pretty offensive for any doctor to tell a patient group that he has experienced their disease and, well, it wasn’t really that bad in the end.

But equally concerning is the level of scientific reasoning on display. From a scientific perspective, we all know (and by “we” I mean those of us who have ever taken an undergraduate or high-school class in basic research methodology) that a single case of recovery cannot tell us anything about recovery in general.

Nor will “listening to people that have recovered from CFS/ME, not people that are still unwell”. In fact this is the opposite of what the scientific method demands. Science requires that conclusions take account of “people that are still unwell” because only then will we be able to test our predictions against competing alternatives. That’s what we call falsification. It has been a basic tenet of scientific epistemology for well over a century. 

Just because a writer is an authority in infectious diseases — or even just because he contracted COVID himself — does not suddenly make him an expert in psychobiology, cognitive neuroscience, or epistemology. These are actual areas of study of interest to actual experts. 

Armchair speculation does not an expert make.

* * *

In short, sometimes what you read in medical journals is wrong. The authors there are not always as qualified as you think they are (assuming you agree that status, privilege, and in-group membership are not, in and of themselves, qualifications). Nor indeed are they always as qualified as they think they are.

We can all say something bizarre if we want to. Only some of us, however, are ever given a high-profile platform from which to publish it to the world. Self-belief in one’s own omnicompetence is a common affliction, especially so in the opinion pages of medical journals. We should all be wary of such knee-jerk expertise.

Tom Hanks got COVID as well. Should we ask him for his theory too? 

How about it, BMJ? Another one of your “commisioned, non-externally peer-reviewed” guest editorials, perhaps…