Thread by @Loretta_Torrago

This Long Covid study's reliance on serology derails its claim to have a control goup. What's more, it treats beliefs as *inventors of reality* while overlooking that typically beliefs are *reflections of* reality.
Laypeople call this "gaslighting".🧵
jamanetwork.com/journals/jamai…

1. An Out of Control Control Group

In this study, participants are given serology tests.

Participants are notified of the results and asked if they believe they had Covid, a question that just as well could be phrased as: Do you believe the test results?

Not everyone does. The study found 1,091 positives. Somewhat more than ½ the positives (638) did not believe the results. A fair assumption is they were asymptomatic.

The 453 remaining positives (“positive believers”) agreed with the results. Amongst the negatives, most agreed with the results but 461 (the “negative believers") believed they had Covid anyway.

The 461 negative believers are the study’s control group and the persistence of their symptoms is compared with those of the positives.

Since persistent symptoms are most associated with believers (some of who were -), the authors conclude persistent symptoms have more to do with beliving one had Covid than with Covid infection itself.

Unsurprisingly, the study has been welcomed by LC skeptics & drawn the ire of LC sufferers & activists. But the study relies on contrasting sero+s with (sero) negative believers.

However, serology testing’s propensity for false –‘s, suggests some negative believers were right about having had Covid. One issue is, not everyone infected seroconverts (produces antibodies).

https://twitter.com/chrischirp/status/1457813397777625089

https://twitter.com/nataliesurely/status/1458133803772354566

Further, even under normal circumstances, antibodies wane (boosters, anyone?) and this may be a particular problem for the assay used.

https://twitter.com/AtomsksSanakan/status/1458052539962773505

What’s more, producing low levels of antibodies that fade to undetectable levels can be, not evidence of infection’s absence, but of Long Covid’s presence.

https://twitter.com/DavidSteadson/status/1458218907060383746

Still, this only suggests that there are actual Covid cases amongst the believers who were negative. We don’t know how many, though we have clues: prior to the study, 656 believers had their Covid confirmed.

This is 203 more than the 453 + believers the study found. Where did these 203 believers wind up? Apparently, in with the 461 negative believers which, as it happens, is the not just the CONTROL GROUP, but somewhat less than half of it.

That some formerly +s are, months later (at the time of the study’s testing period) sero-negative is predictable.

If you’re like me, you are wondering why, given this predictability & the prior confirmation, the authors are at all surprised believers have a lot in common. Most conspicuously of all, what they have in common is: having had Covid.

2. Conceptual Issues and a Conclusion that Isn’t

The implication that symptoms are most associated with belief is not lost on anyone with the study being reported as showing LC is “in the head” or that belief is causing symptoms.

But the study shows no such thing. First, an association between belief and symptoms does not itself establish causality and, even if the association were causal, which is the direction of the causal arrow?

The data itself is indifferent between belief causing symptoms & symptoms causing belief. Yet the authors, tipping their hands by putting LC in quotes, ignore the chicken or the egg problem by inviting the conclusion that belief drives symptoms.

But how would it work for belief to drive symptoms?
Are we to suppose that, one fine day, for no reason whatsoever, based on no symptoms, someone comes to believe they had Covid?
If beliefs are so dislodged from reason in this way, why don’t more of us believe we can fly?

The authors’ view of belief as symptom creators is made more curious because not all the believers even attributed their symptoms to Covid.

In grad school, I had a friend who insisted he was having a heart attack. He also insisted he had chest pain & that the pain was attributable to the heart attack. Yet, in the authors’ telling, the scenario is even more unhinged than that.

In their scenario, there is a free-floating belief in illness (not caused by symptoms) that causes symptoms which the believer may or may not attribute to the believed illness they don’t have.
What if we tried assuming, instead, that people aren’t crazy?

We could begin w/this chart of symptoms & the differences btw the antibody +s & the -s (which, recall, include actual Covid). In fact, we might notice that, whether + or -, whether believers or doubters, a lot of people feel persistently unwell.
Is it all in everyone’s head?

LC minimizers have a strategy. Shades of it are in this paper. The strategy starts with the observation that symptoms of LC can be found in the general population. The conclusion is LC doesn’t define a unique condition or “isn’t real”.

If you aren’t seeing LC, the problem might be you lack a key question like: To what extent does this or that symptom interfere with your daily activities?
That would be my question, were I truly interested in finding the LC sufferers.
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