I agree that I’m more likely to be concerned about in-fact-psychosomatic things than average, and on the outside view, thus probably biased in that direction in interpreting evidence. Sorry if that colors the set of considerations that seem interesting to me. (I didn’t mean to claim that this was an unbiased list, sorry if I implied it. )
Some points regarding the object level:
The scenario I described was to illustrate a logical point (that the initially tempting inference from that study wasn’t valid). So I wouldn’t want to take the numbers from that hypothetical scenario and apply them across the board to interpreting other data. I haven’t thought through what range of possible numbers is really implied, or whether there are other ways to make sense of these prima facie weird findings (especially re lack of connection between having covid and thinking you have covid). If I put a lot of stock in that study, I agree there is some adjustment to be made to other numbers (and probably anyway—surely some amount of misattribution is going on, and even some amount of psychosomatic illness).
My description was actually of how you would get those results if approximately none of the illness was psychosomatic but a lot of it was other illnesses (the description would work with psychosomatic illnesses too, but I worry that you misread my point, since you are saying that in that world most things are psychosomatic, and my point was that you can’t infer that anything was psychosomatic).
If the scenario I described was correct, the rates of misattribution implied would be specific to that population and their total ignorance about whether they had covid, rather than a fact intrinsic to covid in general, and applicable to all times and places. I do find it very hard to believe that in general there is not some decently strong association between having covid and thinking you have covid, even if also a lot of errors.
It’s a single study, and single studies find all kinds of things. I don’t recall seeing other evidence supporting it. In such a case, I’m inclined to treat it as worthy of adding some uncertainty, but not worthy of a huge update about everything.
If this consideration reduced real long covid cases by a factor of two, it doesn’t feel like that changes the story very much (there’s a lot of factor-of-two-level uncertainty all over the place, especially in guessing what the rate is for a specific demographic), so I guess it doesn’t seem cruxy enough to give a lot of attention to.
I agree that mostly it isn’t salient to me that some fraction of cases are misattributions, and that maybe I should keep it in mind more, and say things like ‘it looks like many people who think they had covid can no longer do their jobs’ instead of taking things at face value. Though in my defense, this was a list of considerations, so I’m also not flagging all of the other corrections one might want to make to numbers throughout, as I might if I were doing a careful calculation.
It’s true that I don’t really believe that half of the bad cases at least are misattributions or psychosomatic—the psychosomatic story seems particularly far-fetched (particularly for the bad cases). Perhaps I’m mis-imagining what this would look like. Is there other evidence for this that you are moved by?
I put a lot more trust in a single study with ground-truth data than in a giant pile of studies with data which is confounded in various ways. So, I trust the study with the antibody tests more than I’d trust basically-any number of studies relying on self-reports. (A different-but-similar application of this principle: I trust the Boston wastewater data on covid prevalence more than I trust all of the data from test results combined.)
I probably do have relatively high prior (compared to other people) on health-issues-in-general being psychosomatic. The effectiveness of placebos (though debatable) is one relevant piece of evidence here, though a lot of my belief is driven by less legible evidence than that.
I expect some combination of misattribution, psychosomaticity, selection effects (e.g. looking at people hospitalized and thereby accidentally selecting for elderly people), and maybe similar issues which I’m not thinking of at the moment to account for an awful lot of the “long covid” from self-report survey studies. I’m thinking less like 50% of it, and more like 90%+. Basically, when someone runs a survey and publishes data from it, I expect the results to mostly measure things other than what the authors think they’re measuring, most of the time, especially when an attribution of causality is involved.
Even if long covid is entirely psychosomatic, it’s worth avoiding those psychosomatic effects. One way to avoid them is to debunk (potentially at the gut intuition level, which is harder to reliably do) non-psychosomatic causes of it. Another way is to avoid covid in the first place. I expect the most effective strategy will include some combination of these.
I see “psychosomatic” often used as a semantic stopsign. Once something is called “psychosomatic”, people typically stop trying to figure out a way to solve the problem. I don’t know of any reliable and credible ways to resolve psychosomatic issues, it’s mostly meditation guys and alternative medicine quacks who even try.
If it’s really true that a large amount of health-issues-in-general are psychosomatic, then that’s a really huge problem which we don’t have an adequate solution for! (I expect that you agree with this, I just am trying to push against the weight of the semantic stopsign that people have around this concept.)
Psychosomatic is a word that’s gets often used as if that would mean that illnesses aren’t real.
If you tell someone with an allergy to cats to imagine that they are stocking a cat, that can be enough to trigger the allergy symptoms. The fact that an imagined cat is good enough to trigger the allergy shows quite clearly that the allergy is partly psychosomatic as it can be triggered psychologically.
The underlying mechanisms of such an immune response are however deep. One model of long COVID is, that it’s partly about autoimmune issues. Those might be as psychosomatic as the above example of cat allergy. There’s a neuronal pattern that gets the body to trigger defenses in a misaligned way.
I agree that I’m more likely to be concerned about in-fact-psychosomatic things than average, and on the outside view, thus probably biased in that direction in interpreting evidence. Sorry if that colors the set of considerations that seem interesting to me. (I didn’t mean to claim that this was an unbiased list, sorry if I implied it. )
Some points regarding the object level:
The scenario I described was to illustrate a logical point (that the initially tempting inference from that study wasn’t valid). So I wouldn’t want to take the numbers from that hypothetical scenario and apply them across the board to interpreting other data. I haven’t thought through what range of possible numbers is really implied, or whether there are other ways to make sense of these prima facie weird findings (especially re lack of connection between having covid and thinking you have covid). If I put a lot of stock in that study, I agree there is some adjustment to be made to other numbers (and probably anyway—surely some amount of misattribution is going on, and even some amount of psychosomatic illness).
My description was actually of how you would get those results if approximately none of the illness was psychosomatic but a lot of it was other illnesses (the description would work with psychosomatic illnesses too, but I worry that you misread my point, since you are saying that in that world most things are psychosomatic, and my point was that you can’t infer that anything was psychosomatic).
If the scenario I described was correct, the rates of misattribution implied would be specific to that population and their total ignorance about whether they had covid, rather than a fact intrinsic to covid in general, and applicable to all times and places. I do find it very hard to believe that in general there is not some decently strong association between having covid and thinking you have covid, even if also a lot of errors.
It’s a single study, and single studies find all kinds of things. I don’t recall seeing other evidence supporting it. In such a case, I’m inclined to treat it as worthy of adding some uncertainty, but not worthy of a huge update about everything.
If this consideration reduced real long covid cases by a factor of two, it doesn’t feel like that changes the story very much (there’s a lot of factor-of-two-level uncertainty all over the place, especially in guessing what the rate is for a specific demographic), so I guess it doesn’t seem cruxy enough to give a lot of attention to.
I agree that mostly it isn’t salient to me that some fraction of cases are misattributions, and that maybe I should keep it in mind more, and say things like ‘it looks like many people who think they had covid can no longer do their jobs’ instead of taking things at face value. Though in my defense, this was a list of considerations, so I’m also not flagging all of the other corrections one might want to make to numbers throughout, as I might if I were doing a careful calculation.
It’s true that I don’t really believe that half of the bad cases at least are misattributions or psychosomatic—the psychosomatic story seems particularly far-fetched (particularly for the bad cases). Perhaps I’m mis-imagining what this would look like. Is there other evidence for this that you are moved by?
Good points. Some responses:
I put a lot more trust in a single study with ground-truth data than in a giant pile of studies with data which is confounded in various ways. So, I trust the study with the antibody tests more than I’d trust basically-any number of studies relying on self-reports. (A different-but-similar application of this principle: I trust the Boston wastewater data on covid prevalence more than I trust all of the data from test results combined.)
I probably do have relatively high prior (compared to other people) on health-issues-in-general being psychosomatic. The effectiveness of placebos (though debatable) is one relevant piece of evidence here, though a lot of my belief is driven by less legible evidence than that.
I expect some combination of misattribution, psychosomaticity, selection effects (e.g. looking at people hospitalized and thereby accidentally selecting for elderly people), and maybe similar issues which I’m not thinking of at the moment to account for an awful lot of the “long covid” from self-report survey studies. I’m thinking less like 50% of it, and more like 90%+. Basically, when someone runs a survey and publishes data from it, I expect the results to mostly measure things other than what the authors think they’re measuring, most of the time, especially when an attribution of causality is involved.
Even if long covid is entirely psychosomatic, it’s worth avoiding those psychosomatic effects. One way to avoid them is to debunk (potentially at the gut intuition level, which is harder to reliably do) non-psychosomatic causes of it. Another way is to avoid covid in the first place. I expect the most effective strategy will include some combination of these.
I see “psychosomatic” often used as a semantic stopsign. Once something is called “psychosomatic”, people typically stop trying to figure out a way to solve the problem. I don’t know of any reliable and credible ways to resolve psychosomatic issues, it’s mostly meditation guys and alternative medicine quacks who even try.
If it’s really true that a large amount of health-issues-in-general are psychosomatic, then that’s a really huge problem which we don’t have an adequate solution for! (I expect that you agree with this, I just am trying to push against the weight of the semantic stopsign that people have around this concept.)
Psychosomatic is a word that’s gets often used as if that would mean that illnesses aren’t real.
If you tell someone with an allergy to cats to imagine that they are stocking a cat, that can be enough to trigger the allergy symptoms. The fact that an imagined cat is good enough to trigger the allergy shows quite clearly that the allergy is partly psychosomatic as it can be triggered psychologically.
The underlying mechanisms of such an immune response are however deep. One model of long COVID is, that it’s partly about autoimmune issues. Those might be as psychosomatic as the above example of cat allergy. There’s a neuronal pattern that gets the body to trigger defenses in a misaligned way.