Intended for healthcare professionals

Editor's Choice

Long covid and apheresis: a miracle cure sold on a hypothesis of hope

BMJ 2022; 378 doi: (Published 14 July 2022) Cite this as: BMJ 2022;378:o1733
  1. Kamran Abbasi, editor in chief
  1. The BMJ
  1. kabbasi{at}
    Follow Kamran on Twitter @KamranAbbasi

In desperate times, even in good times, we all need hope. Hope is essential and helps us seek solutions. Yet hope can be a dangerous weapon. Boris Johnson’s greatest attribute was to sell hope, although Martin McKee argues that Johnson’s empty promises, including those on health, leave him well placed in the race to be the UK’s worst prime minister (doi:10.1136/bmj.o1707).1

One of those hopes was that the covid pandemic was “over” in February (,2 a political gambit to lift all restrictions that defied hard evidence and cold logic (doi:10.1136/bmj.o1, doi:10.1136/bmj.o1555, doi:10.1136/bmj-2021-069881).345 SARS-CoV-2 never went away, even if its impact was dulled, and it is now most definitely back, sending people to hospital and intensive care (doi:10.1136/bmj.o1702).6 Hospitals are reintroducing masking for staff (doi:10.1136/bmj.o1712),7 although the general public seems blissfully ignorant of the latest omicron variant. By invoking the Dunning-Kruger effect, David Oliver calls on experts to speak up, in plain language and accessible formats, to counter the “false belief systems that are over-confidently asserted by inexpert people” (doi:10.1136/bmj.o1701).8

One answer is to keep going and caring, even when it’s hard (doi:10.1136/bmj.o1689).9 Another, and not mutually exclusive, is to seek hope in a new health secretary’s desire to cut through commercial determinants, although any hope that he will stop listening to industry, and start “listening to public health experts and GPs” (doi:10.1136/bmj.o1704),10 seems a forlorn one (doi:10.1136/bmj.o1687).11 The many deep rooted problems of population health, as highlighted by the NHS Race and Health Observatory’s inaugural conference on racism in health and medicine last week (doi:10.1136/bmj.o1699, doi:10.1136/bmj.o1715, doi:10.1136/bmj.o1710),121314 are beyond the quick fix of a structural reorganisation of the health system (doi:10.1136/bmj.o1682).15

Other than the covid misadventures of rich countries, a major reason why covid is still troubling us is our collective inability to deliver vaccines to poor countries and increase vaccine uptake. The challenge extends beyond vaccine hesitancy and includes supply restrictions and distribution challenges, especially to remote rural populations (doi:10.1136/bmj-2021-069596).16 Canada is destroying 14 million covid vaccine doses, not because it was unwilling to donate them but because of “distribution and absorption” challenges in recipient countries (doi:10.1136/bmj.o1700).17

Another reason why covid still troubles us is that—as with climate change, poverty, and war—it’s easy to downplay the effects if you’ve never experienced it. The same applies to vaccination. If you haven’t experienced myocarditis or pericarditis after vaccination, you might be reassured by data on its low incidence and its mild and self limiting nature (doi:10.1136/bmj-2021-069445).18 Even though these risks don’t outweigh the benefits of vaccination (doi:10.1136/bmj.o1554),19 the risks loom larger if you’ve been affected by them.

Equally, it’s easier to argue against covid restrictions if you haven’t experienced long covid. Many people living with it are desperate for a return to “normal,” so much so that they are turning to unproved experimental therapies. A new BMJ investigation with ITN News finds that people are spending their life savings on apheresis, a treatment that claims to clear microthrombi from blood (doi:10.1136/bmj.o1671).20 There are no trials, only hypotheses. There is no research evidence of benefit, only anecdotal reports and the blind faith of vulnerable people seeking a miracle cure. We all need hope, but hope can sometimes be a dangerous thing.

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