* fatigue is something everyone feels sometimes and the answer is to push through it for most people
* it’s impossible to observe fatigue objectively, it just appears people are lazy or low energy
* there’s no known (or at least there wasn’t last time I researched it) bio markers for CFS
* there’s no known evidence of viruses causes CFS, just speculation
Etc
Things have changed a lot over the last 30 years. I think most people including doctors accept CFS is real whereas that wasn’t the case in the past.
The case for the cause of CFS is still very much open, and I think it’s probably naive to say CFS is caused by viral infections. It’s probably the case that some CFS is caused by viral infections, but again, it’s hard to differentiate, it’s hard to prove, and even if you did, so what? CFS probably also has autoimmune causes, which themselves are diffuse in their root causes and mechanisms, and even psychosomatic roots in burnout and other extreme stress syndrome. Finally, when the causes are psychosomatic, that isn’t code for “fake,” it is literally a real issue it’s just not caused by an extrinsic agent. The health impact of extreme prolonged stress is not a joke, and it’s not the persons “fault.” There seems to be a real need for people to pin their CFS and other health issues on some external factor and not the abuse they’ve (or others have) subjected their psychology and by proxy their body to.
> I think most people including doctors accept CFS is real whereas that wasn’t the case in the past.
I think most doctors accept that CFS is real, but I also think most doctors would not call a somatic illness fake. See for instance these researchers [0] who are research somatic causes yet all agree there is a physical/hereditary component. Anxiety disorders also have a hereditary component and they aren't fake.
My girlfriend's sister suffers from Long Covid for going on 2yrs now.
Some of the problems she had early on is that most doctors wrote her off as either lying or anxiety. More than one ER doc said there's no way that Covid could ever cause lasting symptoms other than lung damage, which she didn't have, so it's likely just anxiety. There was one DO she saw, during an admit for tachycardia, who said that he believed that she has a post-viral syndrome and knew of others with other post-Covid issues. The problem would be trying to convince his colleagues to believe it would be an uphill battle, so he hoped it was temporary for her. I know things have changed now but some doctors can be extremely arrogant and dismissive of patients (female patients more than male).
> but trying to get his colleagues to believe it would be an uphill battle
You have to go through a lot of education to become a doctor, so people naturally expect doctor's to be wise, but the truth is they are just good a memorizing things. They aren't necessarily smarter than any other person and have just as many blindspots.
* Source: My dad and uncle are doctors. My brother in law is a doctor. I have a friend who is a doctor. And I've known a lot of other doctors through them.
I dated a med school student for all of medschool and some rotations. Thus I have countless doctor friends now from those years. Everytime I bring up the reality of what most doctors are like, I get downvoted on HN for some reason.
The doctor I dated for years never drank water. She loved diet coke. She ate mcdonalds constantly but avoided the bun. She was skinny though. I had to teach her how to pump gas because her dad did it for her until she was 22. She loved cocaine and moly. Currently cycles Adderall and Ritalin (or something very similar) so she doesnt get too used to one or the other. I could list 20 other 'wtf?' type of things about her. Most others are similarly weird, careless, unhealthy, confused and logicless.
> Everytime I bring up the reality of what most doctors are like
Is your insight that doctors are regular educated humans suffering from the same flaws and vices as other regular educated humans?
> She loved cocaine and moly. Currently cycles Adderall and Ritalin (or something very similar) so she doesn’t get too used to one or the other.
Not sure what this is supposed to imply. I expect the same can also be said for at least 20% of doctors, dentists, SV, Big Law, Wall Street and Main Street in the 20-29 age range.
Drug abuse, alcohol abuse, no knowledge of anything real world other than your job, are not qualities of "regular educated people".
They are modern qualities of the loud morality failed majority these days. Just because it's common for celebrities and kids of rich people to do drugs and screw around, doesn't mean that's what my parents expect from their doctors.
> Drug abuse, alcohol abuse, no knowledge of anything real world other than your job, are not qualities of "regular educated people".
Actually they are, your statement applies to any one of the examples I gave you of what society considers successful/prestigious careers. Silicon Valley is the poster child for stimulant and hallucinogen use/abuse, are they not similarly regular educated people?
> Just because it's common for celebrities and kids of rich people to do drugs and screw around
Where are you getting the idea that it's only common amongst celebrities and kids of rich people?
> They are modern qualities of the loud morality failed majority these days.
I don't even know what "loud morality failed majority" means but morality (particularly your personal definition of it) =/= professional competency.
The disconnect here seems to be your expectations (and definition of morality but that's a separate point). Your parents, and you, seem to be unaware of how common stimulant, alcohol and drug use is amongst white-collar professionals.
Sorry to disappoint but as a group physicians are no different. This has no relevance on professional competency. Fun fact for you the "fathers of modern medicine" who have all the diseases named after them and designed the residency education system were all overt cocaine addicts, thats part of why the hours are so long.
Jesus man. I understand that degenerate behavior is common in today's doctors. That was my entire point of the original post. Otherwise what would I really be saying? That I knew ONE almost drug addict doctor that looks forward to her next festival? Obviously one of everything exists.
My point about celebrities and rich famous people was that they normalized it, to the point that you aren't even surprised doctors are druggies in their free time.
No one cars that some Uber programmer is on speed. More people would care to know that their doctor that recommends heart pressure medication is a druggy, because they'd know this personal doesn't really care about potential kidney damage in themselves, so of course they'll recommend you take kidney damaging heart medication without really explaining that that's what is happening.
If you left the SV and internet bubble, you'd learn that drug use and alcohol use is not liked by most in their higher level professionals.
Women in particular get a lot of 'mental' diagnoses for actual physical ailments. Endometriosis seems to be one of those terrible things that women are told to suffer with, then later if they have exploratory surgery they find terrible lesions inside their body.
She is now, but was infected with the virus before she got the vaccine. The vaccine was available but unfortunately she was hesitant about getting it due to all of the noise online and in the news. She was vaccinated about 4mo after being infected and had already been experiencing Long Covid symptoms.
If she was vaccinated after infection, she probably has enough level of antibodies. (1,2) I hope she consult that with her doctor rather than online noise as you think.
Because of long covid and the millions suffering with it, we are revealing many new findings of a category that has largely been ignored for centuries. Darwin for example was thought to had CFS through his health journals, but nobody knew or cared about it.
When those new findings challenge our current understanding, we get smarter as a species and work to alleviate the suffering by investing more money and time into these matters.
Points aside, your third point is largely concerning.
Some investigation revealed though that is has become more difficult for GPs to ignore the pressure put on them by insurers to send patients back to work.
There is still no identified viral mechanism for CFS. So yes, you will continue to find many doctors that deny that there is convincing evidence for viral causes of CFS because that is the reality of the current situation.
But: absence of evidence is not necessarily evidence of absence. The fact that we still haven't found convincing evidence (with the caveat that 'millions of people complain about certain symptoms' in my book counts as overwhelming evidence) doesn't mean that such a mechanism doesn't exist. It may merely mean that we are looking in the wrong places, may not be looking in the right way and in general still have a poor understanding of how our bodies really work.
Is linked to post viral or post bacterial infections, and even though here too there is a lack of complete understanding at least the symptoms are so clear (up to complete paralysis) that denying it seems pointless. It's also super rare, so there is no incentive to deny it.
But if COVID ends up putting a sizeable percentage of the workforce out of action that may well have serious implications for how we deal with chronic disease and post viral infections. Incidentally: this is one of the possible futures that various experts warned about during the early days of the pandemic, that it would be a decade or more before we would fully understand the impact and that by assuming the post infection consequences would be mild that we may have made a grave mistake.
Fortunately some of the more outrageous possibilities have so far not surfaced, this is one that we can deal with.
Doctors are not medical forensics. It shouldn't matter that the mechanism behind CFS isn't known, there's ample evidence that the condition is real. So I reject that casual dismissal.
However, there is no known way to treat CFS. That problem is a much more valid excuse for a doctor to do nothing. But a doctor that refuses to acknowledge a patient's troubles because they don't know how to treat it is a bad doctor.
If I had to make guesses, my take is a viral+immune system interaction. You get the virus which causes your own immune system to respond. In that response we get a 'partial match' to something inside of our own system. This leads to a low level inflammatory attack against your own system.
In type 1 diabetics there is some evidence of a post viral auto-immune cause in some cases.
Because I've been running from doctor to doctor for years without results - because they won't test for anything other than the regular stuff, like blood tests, heart issues, etc. My boss doesn't believe me since CFS or burnout couldn't possibly exist, you just need to focus on your work more. Everytime I say I can't go out since I'm too tired I get made fun of or have eyes rolled at me.
It's like denying someone has a broken arm and gets ridiculed for not wanting to play tennis.
I think it's simply because no normal human wants to know that they're permanently damaged. It's a real tough pill to swallow. You have to be very comfortable with your own mortality.
Viruses can cause organ tissue damages, that's enough for me to believe a virus can cause all sort of "syndromes"
I'm not on the denier side but harass me with fear, threats, and free movement mandates and I will deny that syndromes even exist.