Paradigm Lost: Lessons for Long COVID

David Tuller (University of California, Berkeley), Steven Lubet (Northwestern University), and I have written an opinion piece over at Health Affairs. It’s on the implications of recent developments in ME and chronic fatigue syndrome for the treatment of Long COVID.

We argue that the paradigm shift signalled by the UK’s new (draft) guidance on the relevant psychological and behavioural therapies amounts to what the philosopher Thomas Kuhn would have described as a scientific revolution.

Here’s a flavour:

Processes of change in medicine and other disciplines, during which the authority of die-hard practitioners is supplanted by new insights, are frequently referred to as “paradigm shifts,” in reference to Thomas Kuhn’s classic analysis of scientific revolutions. By the time the coronavirus pandemic arrived last year, a paradigm shift in the ME/CFS field was already well underway, with the psychogenic view having steadily lost ground in the debate.

We provide a blow-by-blow account of how the new draft treatment guidance — enthusiastically welcomed by patient groups and other health advocates — has provoked a bitter backlash from a rump of UK-based therapy providers (including some eminent academics) who see the proposals as an attack on their long-held monopoly of influence:

Any paradigm shift creates winners and losers. In Kuhnian terms, the losers are usually those who persist with a flawed model despite the emergence of empirical reasons to doubt it. The shifting of the ME/CFS paradigm significantly undercuts those prominent psychiatrists, psychologists, and other health professionals who chose to invest significant reputational capital, over multiple decades, in what is a now a collapsing theoretical construct. And so accordingly, we have entered the Kuhnian stage of crisis.

Confronted with the unpleasant prospect of NICE withdrawing its approval for their work—and no doubt alarmed at the implications these developments have for resource allocation, training courses, and other practicalities of service delivery in their domains—proponents of the dissolving paradigm immediately sought to strike back…

…the emergence of Long COVID has thrown a new controversy into the mix. Undaunted by NICE’s verdict on the state of the evidence, some proponents of the psychogenic view of ME/CFS have promoted what to them is a logical inference—namely, that symptoms of Long COVID resembling ME/CFS must be psychogenic too. Long COVID patients without identifiable organ damage continue to report that physicians are attributing their complaints to mental health factors, advising them to increase their exercise levels or seek psychotherapy.

We take the view that change in science is seldom smooth, and that there is no absolute guarantee good ideas will supplant bad ones. Scientific vanity is real. History has shown that many scientists, even prominent ones, would rather cling to the status quo than allow their theories be debunked by data.

Long COVID could end up affecting millions of people around the world. Its treatment requires robust science rather than intellectual conservatism. The paradigm needs to be shifted, not lost.

Do go read the entire piece here.

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