Welcome to the world of mass tort lawsuits against pharmaceutical manufacturers based on adverse event reporting. Some patients report having extremely common symptoms after taking the drug, then everyone taking the drug starts looking for it, and pretty soon a disproportionate number of patients on the drug have reported the symptoms. Buckraking plaintiff lawyers get involved and pay experts with prestigious credentials to give opinions that amount to nothing more than "consistent with". FDA request new studies from the manufacturers which are inconclusive or take years, and a "consistent with" caution gets added to the drug labeling which further fuels the litigation. Some judges let the case go to the jury, some juries buy the theory and award large damages and hundreds of millions or billions are paid in settlements without regard to whether there is persuasive evidence of causation in general or in the specific cases. Often the matter is only resolved years later when enough people have taken the drug that it's possible to run epidemiology studies that are large enough to have sufficient statistical power to be persuasive. That system has made many lawyers rich, but that's about all there is to commend it.
When Matt said you were going to do a guest post, I was super excited. I have been reading your work on Havana Syndrome for a while. I was skeptical about it when I first heard about it.
My skepticism came from a... why would anyone want to do this. The risk of being caught can't in anyway justify some obscure benefit from this sort of attack. I was not at all surprised when the evidence for it failed to materialize.
I am curious as to the demographics of the Havana Syndrome patients? Age and gender?
Now for the controversial opinion. For a while, I have believed that a certain (perhaps the majority) of long covid cases, or people that have complained about long covid were suffering from "mass sociogenic illness"
Now, I know that people that have severe symptoms that end up in the Hospital have documented organ damage, but this is the sort of thing that can easily be detected.
However, there are a large number of "long covid" sufferers who complain about many of the same symptoms as Havana Syndrome. Headaches, fatigue, brain fog, neurological symptoms. Etc...
Additionally, there were many of these long covid patients who said that their symptoms mysteriously improved after getting vaccinated, of which there is no clear medical reason as to why.
Additionally, several months ago there was a study of long covid sufferers that showed that many of them had no detectable antibodies to covid and had no record of positive covid tests.
Acknowledging "mass sociogenic illness" is a thing is one of those things that people tend to be very careful about, especially in the media. It's sort of the equivalent of calling someone "crazy". Something that isn't polite.
If you talk with Doctors, they will quietly acknowledge that psychosomatic symptoms are quite common. The mind is a powerful organ.
Note: I am not saying that all mysterious symptoms are psychosomatic. There are clearly cases of medical issues that Doctors just haven't figured out. The body is complex. Between the brain, nervous system and immune system, there are plenty of ways for the body to suffer.
However, that does not mean that mass sociogenic illness doesn't exist, and that we should carefully consider it when making policy decisions.
To push back on those saying all chronic illness is psychosomatic (chronic Lyme, long COVID, etc) - there's a long history in the medical profession of claiming that anything they don't understand must be due to mental defects of their patients. One example (that won a Nobel prize) is the peptic ulcer, thought for 50+ years to be due to lifestyle choices, or even bad mothers. Then it turned out it was actually caused by a bacterium.
Doctors would rather tell a patient "you're crazy" than "we don't know what's wrong and we don't know how to help you". It's entirely biologically plausible that a viral or bacterial infection causes long term symptoms - we know, for example, that flu infection increases stroke and heart disease risk (possibly also true of COVID).
Seems like an overly strong thesis. I agree that Havana Syndrome very much could be a mass psychogenic illness, but I would also put 'directed microwave weapon' at like a nonzero possibility. As the excellent comment by Neva Durand below me notes, there's a long history of doctors calling chronic illnesses psychosomatic- the peptic ulcer is a pretty wild example!
Shure here marshals a bunch of disconnected facts for the overly strong thesis that it
"is very likely" a psychogenic illness, ignorant of the irony that she's basically doing the same thing as the microwave weapon crowd. There's like the same level of evidence either way! Maximum irony points. Or, it could be a non-weapon but totally real cause such as a new type of illness or bug. (Perhaps it affects other, regular people in other countries who receive less media & medical attention than State Department officials).
We should continue to cautiously study Havana Syndrome, and not make overly strong, evidence-weak assertions either way- whether a new weapon or mass hysteria. This piece doesn't help. I suspect this kind of thinking is popular among the Greenwald/Taibbi 'everything bad about Russia is a hoax' crowd
Thanks for spelling out what has always seemed to me the most plausible explanation for this problem. It's generally impossible to prove a negative, but the claims that diabolical weapons underlie the syndrome has always seemed far-fetched.
When I worked in Afghanistan it was common for schoolgirls to collapse from what were believed to be poison gas attacks by the Taliban. These happened often enough that the government ended up arresting some people and torturing them into confessing. But nobody ever found any physical evidence for poison gas.
If the Afghans had read this New Yorker article from 1978, they'd have realized what was actually happening:
I think that an issue here is that nobody wants to admit the possibility that their illness was psychogenic because it would mean they were "crazy" or that their very real suffering was somehow fake or invalid. It's not! Just because the primary cause of your symptoms was your own brain doesn't make it under your control, nor does it invalidate your experience.
I came down with a viral infection (never confirmed to be covid) in mid-March 2020 right when pandemic fears were at their peak. I'd say that I didn't really feel 100% physically again until August 2020 or so, and even now my exercise capacity seems limited (confounded by the fact that I've been much less active). It certainly didn't FEEL psychogenic, but I have to admit that I was extremely stressed and anxious the whole time--about my illness, about the uncertainty of how bad the pandemic would be, about my job, and about never seeing my friends anymore. Obviously if there's something physically wrong that's concerning in the long term it would be good to know (and doctors have been unable to find any issues), but I'm not super bothered by the prospect of it having been psychogenic--bodies and brains can be stupid sometime, it wouldn't be my fault.
So Havana, Lyme disease, long covid--it seems like sometimes the assertions that these are psychogenic are phrased in such a way that provokes defensiveness in the sufferers. I think in order to make progress in finding the real causes, psychogenic or not, it would be very helpful to destigmatize the psychogenic hypothesis so that people don't feel crazy or stupid if they did suffer from something that was "all in their head."
More of this, please. I appreciate this type of well-reasoned and well-researched post.
Not sure why everyone is conflating this with Lyme or Long COVID (both of which are diseases with an actual cause and exhibit symptoms similar to ME/CFS). The better analogy is to the lab leak hypothesis! Lots of media noise around shady evidence with nothing concrete to refute the overwhelming likelihood of natural origin.
I don’t think comparing Havana syndrome to Lyme disease is correct. One has evidence that is specific. A tick bite with a bulls eye . A Specific bacterial infection. And a source, deer. The symptoms of Lyme seem to lend them selves to many common maladies but a blood test can confirm it. I would agree that some folks are misdiagnosed and many self diagnose incorrectly… but it’s not the same as Havana syndrome
“ without the noise, there is nothing beyond the brute fact that medical science unfortunately lacks adequate explanations for many symptoms experienced by many people.”
This is key for me when I read about medical things. Doctors know a lot and they are always learning more. But there are still plenty of gaps for even common things, and given the placebo effect is a thing and people can apparently also trick themselves into being sick(er) - or merely conflating a few common symptoms into one big, scary, underlying diagnosis - I tend to read all such stories with heavy skepticism.
I haven’t read Douthat’s book on Lyme disease, for example, nor have I dug into Long COVID, but I generally enter those topics with my priors against it being a thing.
I highly recommend this podcast about Havana Syndrome. It's with an expert on functional illness and at one point she mentions that during the pandemic she would sometimes experience symptoms of Covid, which she knew were psychological in nature. This is something that happens to people when we're under stress.
This article conflates two questions: (1) is there an identifiable syndrome, ie are foreign federal officials experiencing certain symptoms at higher rates than the general population and (2) if so what is its cause. Shure points out that the individual symptoms are common, but she but doesn’t really argue, much less prove, that there is no syndrome to be explained. As a result, she’s ultimately left arguing that among the unknown causes of this syndrome, one speculative possibility (mass sociogenic illness) is probably true while all other speculative possibilities are probably false. I’m not convinced. To be clear, I have no idea what’s causing this and have always been skeptical that it’s the Russians. But I’d need a lot more evidence to move from general skepticism of conspiracy theories to a specific belief that the cause is more likely mass sociogenic illness than something else . Once it’s conceded that there’s a syndrome with an unknown cause, the answer is that the cause is unknown.
I’m willing to go for some ray guns. I want to believe. Just give me some kind of proof of concept. They are acting like this technology came fully formed (maybe Russia trades with the aliens?), or they point to a couple of failed technologies Russia used decades ago as the precursors. This is supposedly a portable weapon that targets well from long range and leaves no trace. That’s a pretty advanced product! Maybe we could produce something that’s immobile, uses way too much power, causes electrical interference or targets poorly but gives a similar result? Just give me something.
Welcome to the world of mass tort lawsuits against pharmaceutical manufacturers based on adverse event reporting. Some patients report having extremely common symptoms after taking the drug, then everyone taking the drug starts looking for it, and pretty soon a disproportionate number of patients on the drug have reported the symptoms. Buckraking plaintiff lawyers get involved and pay experts with prestigious credentials to give opinions that amount to nothing more than "consistent with". FDA request new studies from the manufacturers which are inconclusive or take years, and a "consistent with" caution gets added to the drug labeling which further fuels the litigation. Some judges let the case go to the jury, some juries buy the theory and award large damages and hundreds of millions or billions are paid in settlements without regard to whether there is persuasive evidence of causation in general or in the specific cases. Often the matter is only resolved years later when enough people have taken the drug that it's possible to run epidemiology studies that are large enough to have sufficient statistical power to be persuasive. That system has made many lawyers rich, but that's about all there is to commend it.
Thanks, Ms. Shure. I sympathize with your exasperation. Your views line up with those of Cheryl Rofer, whom I also respect.
I am a great hater of the Putin regime, and I am sure that he would be happy to directly attack our embassy personnel if he could.
But there's no good proposal for a mechanism of injury here. And when I ask my more credulous friends for hard evidence, all I hear is... *crickets*.
When Matt said you were going to do a guest post, I was super excited. I have been reading your work on Havana Syndrome for a while. I was skeptical about it when I first heard about it.
My skepticism came from a... why would anyone want to do this. The risk of being caught can't in anyway justify some obscure benefit from this sort of attack. I was not at all surprised when the evidence for it failed to materialize.
I am curious as to the demographics of the Havana Syndrome patients? Age and gender?
Now for the controversial opinion. For a while, I have believed that a certain (perhaps the majority) of long covid cases, or people that have complained about long covid were suffering from "mass sociogenic illness"
Now, I know that people that have severe symptoms that end up in the Hospital have documented organ damage, but this is the sort of thing that can easily be detected.
However, there are a large number of "long covid" sufferers who complain about many of the same symptoms as Havana Syndrome. Headaches, fatigue, brain fog, neurological symptoms. Etc...
Additionally, there were many of these long covid patients who said that their symptoms mysteriously improved after getting vaccinated, of which there is no clear medical reason as to why.
Additionally, several months ago there was a study of long covid sufferers that showed that many of them had no detectable antibodies to covid and had no record of positive covid tests.
Acknowledging "mass sociogenic illness" is a thing is one of those things that people tend to be very careful about, especially in the media. It's sort of the equivalent of calling someone "crazy". Something that isn't polite.
If you talk with Doctors, they will quietly acknowledge that psychosomatic symptoms are quite common. The mind is a powerful organ.
Note: I am not saying that all mysterious symptoms are psychosomatic. There are clearly cases of medical issues that Doctors just haven't figured out. The body is complex. Between the brain, nervous system and immune system, there are plenty of ways for the body to suffer.
However, that does not mean that mass sociogenic illness doesn't exist, and that we should carefully consider it when making policy decisions.
To push back on those saying all chronic illness is psychosomatic (chronic Lyme, long COVID, etc) - there's a long history in the medical profession of claiming that anything they don't understand must be due to mental defects of their patients. One example (that won a Nobel prize) is the peptic ulcer, thought for 50+ years to be due to lifestyle choices, or even bad mothers. Then it turned out it was actually caused by a bacterium.
https://www.news-medical.net/health/Peptic-Ulcer-History.aspx
Doctors would rather tell a patient "you're crazy" than "we don't know what's wrong and we don't know how to help you". It's entirely biologically plausible that a viral or bacterial infection causes long term symptoms - we know, for example, that flu infection increases stroke and heart disease risk (possibly also true of COVID).
Seems like an overly strong thesis. I agree that Havana Syndrome very much could be a mass psychogenic illness, but I would also put 'directed microwave weapon' at like a nonzero possibility. As the excellent comment by Neva Durand below me notes, there's a long history of doctors calling chronic illnesses psychosomatic- the peptic ulcer is a pretty wild example!
Shure here marshals a bunch of disconnected facts for the overly strong thesis that it
"is very likely" a psychogenic illness, ignorant of the irony that she's basically doing the same thing as the microwave weapon crowd. There's like the same level of evidence either way! Maximum irony points. Or, it could be a non-weapon but totally real cause such as a new type of illness or bug. (Perhaps it affects other, regular people in other countries who receive less media & medical attention than State Department officials).
We should continue to cautiously study Havana Syndrome, and not make overly strong, evidence-weak assertions either way- whether a new weapon or mass hysteria. This piece doesn't help. I suspect this kind of thinking is popular among the Greenwald/Taibbi 'everything bad about Russia is a hoax' crowd
Thanks for spelling out what has always seemed to me the most plausible explanation for this problem. It's generally impossible to prove a negative, but the claims that diabolical weapons underlie the syndrome has always seemed far-fetched.
Yup yup yup.
When I worked in Afghanistan it was common for schoolgirls to collapse from what were believed to be poison gas attacks by the Taliban. These happened often enough that the government ended up arresting some people and torturing them into confessing. But nobody ever found any physical evidence for poison gas.
If the Afghans had read this New Yorker article from 1978, they'd have realized what was actually happening:
https://www.newyorker.com/magazine/1978/08/21/sandy
I think that an issue here is that nobody wants to admit the possibility that their illness was psychogenic because it would mean they were "crazy" or that their very real suffering was somehow fake or invalid. It's not! Just because the primary cause of your symptoms was your own brain doesn't make it under your control, nor does it invalidate your experience.
I came down with a viral infection (never confirmed to be covid) in mid-March 2020 right when pandemic fears were at their peak. I'd say that I didn't really feel 100% physically again until August 2020 or so, and even now my exercise capacity seems limited (confounded by the fact that I've been much less active). It certainly didn't FEEL psychogenic, but I have to admit that I was extremely stressed and anxious the whole time--about my illness, about the uncertainty of how bad the pandemic would be, about my job, and about never seeing my friends anymore. Obviously if there's something physically wrong that's concerning in the long term it would be good to know (and doctors have been unable to find any issues), but I'm not super bothered by the prospect of it having been psychogenic--bodies and brains can be stupid sometime, it wouldn't be my fault.
So Havana, Lyme disease, long covid--it seems like sometimes the assertions that these are psychogenic are phrased in such a way that provokes defensiveness in the sufferers. I think in order to make progress in finding the real causes, psychogenic or not, it would be very helpful to destigmatize the psychogenic hypothesis so that people don't feel crazy or stupid if they did suffer from something that was "all in their head."
More of this, please. I appreciate this type of well-reasoned and well-researched post.
Not sure why everyone is conflating this with Lyme or Long COVID (both of which are diseases with an actual cause and exhibit symptoms similar to ME/CFS). The better analogy is to the lab leak hypothesis! Lots of media noise around shady evidence with nothing concrete to refute the overwhelming likelihood of natural origin.
I don’t think comparing Havana syndrome to Lyme disease is correct. One has evidence that is specific. A tick bite with a bulls eye . A Specific bacterial infection. And a source, deer. The symptoms of Lyme seem to lend them selves to many common maladies but a blood test can confirm it. I would agree that some folks are misdiagnosed and many self diagnose incorrectly… but it’s not the same as Havana syndrome
“ without the noise, there is nothing beyond the brute fact that medical science unfortunately lacks adequate explanations for many symptoms experienced by many people.”
This is key for me when I read about medical things. Doctors know a lot and they are always learning more. But there are still plenty of gaps for even common things, and given the placebo effect is a thing and people can apparently also trick themselves into being sick(er) - or merely conflating a few common symptoms into one big, scary, underlying diagnosis - I tend to read all such stories with heavy skepticism.
I haven’t read Douthat’s book on Lyme disease, for example, nor have I dug into Long COVID, but I generally enter those topics with my priors against it being a thing.
I highly recommend this podcast about Havana Syndrome. It's with an expert on functional illness and at one point she mentions that during the pandemic she would sometimes experience symptoms of Covid, which she knew were psychological in nature. This is something that happens to people when we're under stress.
https://podcasts.apple.com/us/podcast/45-havana-syndrome-a-disease-of-body-or-mind/id1545378409?i=1000540133170
Russia using this secret weapon in Beijing is the most implausible thing to me. Why would they risk China getting the tech?
This article conflates two questions: (1) is there an identifiable syndrome, ie are foreign federal officials experiencing certain symptoms at higher rates than the general population and (2) if so what is its cause. Shure points out that the individual symptoms are common, but she but doesn’t really argue, much less prove, that there is no syndrome to be explained. As a result, she’s ultimately left arguing that among the unknown causes of this syndrome, one speculative possibility (mass sociogenic illness) is probably true while all other speculative possibilities are probably false. I’m not convinced. To be clear, I have no idea what’s causing this and have always been skeptical that it’s the Russians. But I’d need a lot more evidence to move from general skepticism of conspiracy theories to a specific belief that the cause is more likely mass sociogenic illness than something else . Once it’s conceded that there’s a syndrome with an unknown cause, the answer is that the cause is unknown.
So you present this information to the conspiracy theorists and what do you get? Crickets.
I’m willing to go for some ray guns. I want to believe. Just give me some kind of proof of concept. They are acting like this technology came fully formed (maybe Russia trades with the aliens?), or they point to a couple of failed technologies Russia used decades ago as the precursors. This is supposedly a portable weapon that targets well from long range and leaves no trace. That’s a pretty advanced product! Maybe we could produce something that’s immobile, uses way too much power, causes electrical interference or targets poorly but gives a similar result? Just give me something.