MFOHome About Commentary Discussions Funds The Best Resources Support Us!

Howdy, Stranger!

It looks like you're new here. If you want to get involved, click one of these buttons!

Sign In Register

Categories

In this Discussion

Here's a statement of the obvious: The opinions expressed here are those of the participants, not those of the Mutual Fund Observer. We cannot vouch for the accuracy or appropriateness of any of it, though we do encourage civility and good humor.

    Support MFO

  • Donate through PayPal

The K-Shaped Economy

Observant1
edited November 2025 in Other Investing 
 Key Points

• Wages for the top 25% of the U.S. workforce are rising by 4.6% annually,
  while the lowest quarter sees only 3.6% annual gains.

• Financial stress is increasing for lower-income households, 
  with 29% living paycheck to paycheck and a record 6.7% of subprime auto loans delinquent.

• The economy’s growth is increasingly reliant on affluent households, 
  as lower-income consumers face rising costs and reduced spending capacity.
https://www.msn.com/en-us/money/economy/what-is-the-k-shaped-economy-and-why-is-it-a-problem/ar-AA1QpHuF

Comments

  • DrVenture
    Taken from a similar thread:

    https://www.morningbrew.com/stories/2025/11/03/evidence-of-k-shaped-economy-popping-up-everywhere

    -The affluent doing very well along with the booming stock market and the appreciation of their homes in the inventory-crunched real estate market.

    -Nearly everyone else faltering due to a shaky job market, high interest rates, and/or inflation.

    Auto: In September, the cost of a new vehicle passed the $50,000 mark for the first time, according to Cox Automotive’s Kelley Blue Book. And repossession volume passing through Manheim, the auction group owned by Cox, was up 12% through the end of September on an annualized basis, according to the Wall Street Journal’s deep-dive into the rise of auto repos.

    Airlines: Delta Air Lines CEO Ed Bastian said that sales of premium seats would exceed those of coach seats for at least one or two quarters in 2026.

    Food & bev: Coca-Cola CEO James Quincey told CNBC that sales of its premium brands, like Smartwater, Topo Chico, and Fairlife, are juicing the company’s sales, while Coke demand is up at dollar stores, as well as at amusement parks frequented by higher spenders.

    Consumer goods: Apple grew by double digits last quarter, thanks to strong sales of the $799 iPhone 17. And while economist Leo Feler told Marketplace that “everyone has kept buying health and personal care items,” how and when they buy them has changed. Wealthier shoppers are making hauls at Costco, while budget-constrained shoppers use up everything at home before going shopping.

    Zoom out: Economic trends suggest that the gap will widen rather than narrow. Economist Betsey Stevenson of the University of Michigan told Marketplace, “The real risk to a K-shaped economy is social and political instability."
  • hank
    edited February 18
    Off topic - But one wonders how the popularity of online gaming of every sort (dice rolls, roulette wheels, sports events) is affecting the finances of these lower income workers?
  • gman57
    edited November 2025
    Yes, the recent busts of basketball and baseball players shows how bad it could get. They lost/made peanuts (to them) but probably cost them their million dollar careers. Almost every commercial on ESPN is gambling related. You can bet on EVERYTHING. I bet $100 the 2nd basemen ties his shoe at the start of the third inning. What could go wrong?
  • DrVenture
    edited February 15
    Recent article on K-shaped economy. Is it still "...the economy, stupid!" ?

    How will this severely weakened consumer impact markets? Job growth appears to be key here. But, we know that all of 2025 was revised severely downward. And the January 2026 job numbers, besides being very hard to calculate, have a lot of economists very skeptical.

    https://www.cnbc.com/2026/02/13/k-shaped-economy-middle-class-spending.html

    •The National Foundation for Credit Counseling predicts financial stress will reach an all-time high in the first quarter of this year.

    •While spending growth for higher-income Americans remained stable over the last year, growth slowed for lower- and middle-income households, according to the Bank of America Institute.

    •The expected boost in tax refunds this year may help prop up consumer spending. (But, is expected to be short-lived)

    "The NFCC’s quarterly forecast projects that financial stress will reach an all-time high in the first quarter of this year, based on consumer behavior data from its national network of financial counseling agencies that serve more than 1 million clients."

    "Financial stress is affecting more middle-income consumers ages 45 to 60, who can no longer borrow to fund their lifestyle, Croxson said. They would take on more credit to keep this spending going, but they can’t access it,” he said. “They have reached their capacity.”

  • DrVenture
    edited February 15
    What might trigger a correction, or a severe downturn? A weak consumer? Can wealthy consumers keep it all elevated? IDK

    The recent numbers are unsettling. In addition to what the above article cites about the consumer, slower than expected economic growth appears to be upon us. Jobs revised down, existing home sales very much down, inflation still running a bit high. The U.S. markets are lagging a decent bond fund YTD.

    We have durable goods orders coming this week, they are expected to be weak. Was spending pulled up pre-tariff? It's what I did! Fourth quarter 2025 GDP is estimated +2.8%. Not bad, but likely buoyed by massive AI spending. Which means that it might be misleading about broader economic health. Recent holiday retail numbers were underwhelming.

    We all know that markets can remain irrational for long periods. Then, they tend to correct hard and fast. So, what should drive one's allocations? FOMO or just plain fear? I am not making predictions, just asking questions.
  • a2z

    hard to make more of these things other than (yet another) fragility indicator.
    what happens when tech infrastructure capex no longer makes up for consumer spending in gdp?
    same or more consumer spending by the wealthy, for things they certainly dont need at the prices they transact, is risky and not easy to re-balance. i see some structural changes for this far outlasting the next several verdicts on gop running the country.
    likewise, i see automated flows into american index funds with similar apprehension.

    one thing i always try to look for is whether trump has knocked america off its ~15 yr re-industrialization trend.
    the result so far says 'maybe no' for basic goods, and 'certainly yes' for complex goods (those requiring more than ~6 significant production steps).
    no luck in finding reliable sites tracking this...jpm is trying.
  • Observant1
    edited February 15
    "What might trigger a correction, or a severe downturn?
    A weak consumer?
    Can wealthy consumers keep it all elevated?"

    I've read that the "wealthy" have been responsible for much of the recent consumer spending.
    Many of these folks are feeling flush due to significant equity appreciation from 2023-2025.
    If U.S. equities experience a sharp correction—which can occur at any time for no particular reason—
    the "wealthy" may subsequently curtail their spending.
    This could create a nasty feedback loop which further propels stock markets downward.
  • Old_JoeOld_Joe
    @a2z- If you are at all interested in the current state of AI, try installing the current FREE version of Anthropic's "Claude", and ask it to find you those sites. If they exist, Claude will find them.
  • JD_co
    edited February 15
    The wealthy (top 5%?) carry the US economy while the middle class wilts and most of us suffer the effects of inflation and lack of job security/wage growth. "K" shaped economy.

    Look, we could already be in a recession. I have a hard time seeing where we would be INFORMED that we are. It's not that difficult to fudge the numbers or just continue to delay the reports (already happening).

    You know its coming.
  • Old_JoeOld_Joe
    @a2z- So I thought that I'd forward your question to 'Claude', and here is the response:

    =================
    Claude: I'll help you find reliable sites tracking America's re-industrialization trend. Let me search for sources that focus on this topic. (Searched the web)
    =================

    America reindustrialization trend tracking data
    10 results

    
    What Is Reindustrialization For? - American Compass
    americancompass.org
    
    Reindustrialization of Europe and US 2025 - Capgemini USA
    www.capgemini.com
    
    Reindustrialization - Wikipedia
    en.wikipedia.org

    How Reindustrialization Is Boosting U.S. Manufacturing – and Challenging Utilities - EPRI Journal | EPRI Journal
    eprijournal.com
    
    Manufacturing resilience: Reindustrialization in the United States - Capgemini USA
    www.capgemini.com
    
    Infographic: Manufacturing reindustrialization trends 2024
    www.capgemini.com
    
    US Reindustrialization: A True Industrial Revolution – Analysis
    www.eurasiareview.com
    
    DelMorgan & Co.’s Analysis of the U.S. Manufacturing Rebuild: Reindustrialization, Onshoring and the CHIPS Act - DelMorgan & Co.
    delmorganco.com
    
    American Reindustrialization: Empty Promises vs Massive Opportunities | by Jonathan Healy | Cathay Innovation | Medium
    medium.com
    
    The New Economic Geography of Reindustrialization
    thephiladelphiacitizen.org

    manufacturing construction spending tracking database
    10 results

    
    Total Construction Spending: Manufacturing in the United States (TLMFGCONS) | FRED | St. Louis Fed
    fred.stlouisfed.org
    
    Total Construction Spending: Manufacturing in the United States (TLMFGCON) | FRED | St. Louis Fed
    fred.stlouisfed.org
    
    US Manufacturing Construction Spending (Monthly) - United S…
    ycharts.com
    
    Manufacturing Construction Spending Declines Under Trump - FactCheck.org
    www.factcheck.org
    
    Construction Spending
    www.census.gov
    
    Total Construction Spending: Total Construction in the United States (TTLCONS) | FRED | St. Louis Fed
    fred.stlouisfed.org
    
    Monthly Subnational Construction Spending: Private Manufacturing
    www.census.gov
    
    Total Private Construction Spending: Manufacturing in the United States (PRMFGCON) | FRED | St. Louis Fed
    fred.stlouisfed.org
    
    MONTHLY CONSTRUCTION SPENDING, AUGUST 2025
    www.census.gov
    
    Total Construction Spending: Manufacturing in the United States | FRED | St. Louis Fed
    fred.stlouisfed.org

    Done
    =================
    Let me search for a few more specific tracking sources and databases. (Searched the web)

    Bureau Economic Analysis manufacturing reshoring tracker
    10 results

    
    Where Could Reshoring Manufacturers Find Workers?
    www.clevelandfed.org
    
    Reshoring Initiative 2024 Annual Report, Plus 1Q2025 1
    reshorenow.org
    
    Reshoring Initiative 2022 Data Report 1
    reshorenow.org
    
    1 Fifth Third Bank Executive Insights on the U.S. Manufacturing Resurgence
    www.53.com
    
    Proven trusted talent acquisition 2025 Reshoring Survey Report Harry Moser
    reshorenow.org
    
    Reshoring American Manufacturing: Why It May Not Be Possible—or Even Desirable | ThinkSet | BRG
    www.thinkbrg.com
    
    Construction & Manufacturing Reshoring Trends in the U.S.
    institute.bankofamerica.com
    
    A shrinking workforce may thwart US manufacturing ambitions
    www.deloitte.com
    
    Reshoring Initiative 2023 Annual Report 1
    reshorenow.org
    
    Reshoring Report Shows Progress, and Risks | Reshoring Initiative | American Machinist
    www.americanmachinist.com

    Done
    =================
    Based on my search, I've found several reliable sites that track America's reindustrialization trend. Here are the key sources:

    Government Data Sources
    1. FRED (Federal Reserve Economic Data) - St. Louis Fed
    • Tracks manufacturing construction spending monthly from 2002 to present FRED
    • Free, public access with downloadable data
    • URL: fred.stlouisfed.org/series/TLMFGCONS

    2. U.S. Census Bureau
    • Publishes monthly construction spending reports
    • Launched experimental Monthly Subnational Construction Spending data at the division level in 2023 U.S. Census Bureau
    • URL: census.gov/construction/c30/c30index.html
    Industry Research & Tracking Organizations

    3. Reshoring Initiative
    • The most comprehensive tracker specifically for reshoring/reindustrialization
    • Has tracked 1.7 million new jobs from reshoring and FDI since 2010 American Machinist
    • Publishes annual reports with detailed job announcements, industry breakdowns, and state-level data
    • URL: reshorenow.org

    4. Capgemini Research Institute
    • Surveys 1,400+ senior executives annually across 13 sectors and 11 countries Capgemini
    • Tracks reindustrialization investment trends (projected $4.7 trillion over next 3 years)
    • URL: capgemini.com/insights/research-library/

    5. American Compass
    • Conducts surveys on public attitudes toward reindustrialization American Compass
    • Focuses on policy and workforce implications
    • URL: americancompass.org

    Before I provide more details, I have a few questions to help point you to the most useful sources:

    =================
    My response: Thank you- a person on MFO asked that question, and I thought that I'd confer with you about it. I'll forward your response, and if he needs additional info I'll get back with you.
    =================
    Claude:
    You're welcome! I'm glad I could help. That's a good collection of reliable sources that should give them a solid starting point for tracking the reindustrialization trend—from government data (FRED, Census Bureau) to specialized industry trackers (Reshoring Initiative) and research organizations.

    If they come back with follow-up questions or need more specific sources based on their particular focus area, feel free to reach out. I can dig deeper into sector-specific data, regional breakdowns, or other specialized tracking resources as needed.
    =================
  • beebee
    edited February 16
    @Cluade, Welcome to MFO.

    @Old_Joe thanks for that introduction to Claude.

    Here's Claude using Microsoft Excel to help you find savings by analyzing your budget:

    https://youtube.com/watch?v=YAv0Efy3TGs
  • sma3
    I used Claude to find all of the Randomized Controlled Trials for Long Covid and Chronic Fatigue Syndrome. The first pass it identified a study and told me of the criticisms that have been published about this study, but did not find a newer one by the same authors. When I asked about the latter it thanked me for the reference, and could calculate that in fact the two studies had different patients because of the methods.

    I asked it to list the references, links to studies that were free to access. It took it over 30 minutes, but it did produce what I asked for.

    I then asked for a summary of the criticisms I mentioned above and it produced a decent list with references

    It can only access data and article that are not behind a paywall, so that leaves out a lot of the medical literature, but It took 30 minutes to do what it would have taken me at least a full day or longer.

    I am pretty impressed. It might even be worth $17 a month



  • Old_JoeOld_Joe
    @a2z apparently wasn't impressed with the result's from Claude, but since he didn't respond, we have no understanding of why.
  • WABACWABAC
    sma3 said:

    I used Claude to find all of the Randomized Controlled Trials for Long Covid and Chronic Fatigue Syndrome. The first pass it identified a study and told me of the criticisms that have been published about this study, but did not find a newer one by the same authors. When I asked about the latter it thanked me for the reference, and could calculate that in fact the two studies had different patients because of the methods.

    I asked it to list the references, links to studies that were free to access. It took it over 30 minutes, but it did produce what I asked for.

    I then asked for a summary of the criticisms I mentioned above and it produced a decent list with references

    It can only access data and article that are not behind a paywall, so that leaves out a lot of the medical literature, but It took 30 minutes to do what it would have taken me at least a full day or longer.

    I am pretty impressed. It might even be worth $17 a month



    This is how perplexity answered your question for free: https://www.perplexity.ai/search/find-all-of-the-randomized-con-qwRZeo7cRi6gWKXo3tKdmg#0

    TLDR: When asked for the time it described how to make a watch.
  • Old_JoeOld_Joe
    edited February 17
    OK, here's what I just got from Claude. The subject matter is well above my pay grade, and the response is VERY detailed, so it's going to take a lot of space and multiple sections. Stand by:

    My question-
    Is it possible for you to find all of the Randomized Controlled Trials for Long Covid and Chronic Fatigue Syndrome? Or if not all, as many as possible?
    7:20 PM
    That's a broad and important research area! Before I dive in, let me clarify a few things to make sure I find what's most useful for you.

    While you answer those, a few important notes on what's feasible:

    What I can do well: Search PubMed, ClinicalTrials.gov, and other databases to find a large number of relevant RCTs, covering both conditions. I can compile them into a structured list with titles, interventions, outcomes, and links.

    Honest limitations: A truly exhaustive systematic review would normally require a librarian-designed search strategy across 10+ databases with deduplication — that's the gold standard. What I can produce is a comprehensive but not guaranteed-complete list, suitable for a strong overview.

    Scope note: Long Covid and ME/CFS (Myalgic Encephalomyelitis/Chronic Fatigue Syndrome) overlap but are distinct. Some trials address both, some only one. I'll clarify which is which as I find them.

    Once you answer the questions above, I'll start searching!

    Q: What type of RCTs are you most interested in? (Select all that apply)
    A: All of the above

    Q: What's your goal with this information?
    A: Academic/research review

    Q: What status of trials do you want included? (Select all that apply)
    A: All statuses

    7:21 PM
    Searched the web

    Now I have enough information to compile a comprehensive document. Let me put this together.

    RCTs in Long COVID & ME/CFS: A Comprehensive Research Compendium
    Document
    Here is your comprehensive compendium. A few important things to know about what I've put together:

    What's included:

    The document is organized into four main sections — Long COVID pharmacological RCTs, Long COVID non-pharmacological RCTs, ME/CFS RCTs (which have a 30+ year history), and a combined section for trials addressing both conditions. I've covered trials ranging from antivirals (STOP-PASC, PAX LC, COVID-OUT), immunomodulators (rituximab, baricitinib, BC007), cognitive/neurological agents (vortioxetine, donepezil, amantadine), rehabilitation/exercise (51+ trials in the July 2025 meta-analysis alone), olfactory training, HBOT, neuromodulation, and more.

    Key numbers to know:

    Long COVID published RCTs (treatment): approximately 51 per the most recent meta-analysis (July 2025), with 100+ registered across all statuses
    ME/CFS RCTs: approximately 60 identified in the most recent systematic review (to Jan 2024), with a historical total approaching 80–100+
    Honest caveats for academic use:

    This is a research-quality overview, not a formally conducted systematic review. The gold standard would require a librarian-designed search across 8–10 databases with blinded deduplication. The document flags the best resources to serve as your foundation — particularly the Zeraatkar et al. BMJ 2024 living systematic review (updated regularly), the eClinicalMedicine/Lancet 2025 meta-analysis (51 RCTs), and the Kim et al. J Translational Medicine 2024 review (60 ME/CFS RCTs).

    One important contextual note: the ME/CFS section includes a flag about the PACE trial controversy — the debate over GET/CBT and the CDC's subsequent reversal of those recommendations is significant for any serious academic review of the field.

    Would you like me to dig deeper into any specific intervention category, condition, or time period?
    I'll get back to you if I have a further inquiry later.Thanks very much.
    7:26 PM
    You're very welcome! This is a rich and fast-moving research area, so whenever you come back there may well be new trials to add — especially with the RECOVER-TLC program expanding and several ongoing Phase II/III results expected in 2026–2027.

    Good luck with your research!
    The following four sections are a poorly formatted text reproduction of the complete report. The division into the four sections is arbitrary- simply tried to get as much into a section as the MFO limits will allow.

    The text formatting on the original Claude reply was much, much better than what is reproduced here. The original is neatly arranged in columns, nicely spaced, with various text fonts and font emphasis used where needed.

    So here we go:
  • Old_JoeOld_Joe
    edited February 17
    1)

    RCTs in Long COVID & ME/CFS: A Comprehensive Research Compendium
    Compiled: February 2026
Scope: Treatment, prevention, and diagnostic/mechanistic RCTs; all statuses (completed, ongoing, published)
Purpose: Academic/research review
    Methodological note: This compendium draws on systematic reviews, meta-analyses, and individual trial records identified via PubMed, ClinicalTrials.gov, and curated databases (MSK Library COVID Impacts Guide, Health Rising, FNIH RECOVER-TLC). It is comprehensive but not formally exhaustive — a gold-standard systematic review would require multi-database searching with a librarian-developed strategy and deduplication. For a complete registry-based list, searches on ClinicalTrials.gov (terms: "long COVID" OR "post-acute sequelae" OR "PASC" OR "ME/CFS" AND "randomized") and WHO ICTRP are recommended.

    KEY UMBRELLA RESOURCES
    Before the individual trials, these are the highest-value secondary sources that aggregate RCT evidence:
    Resource
    Description
    Zeraatkar et al., BMJ 2024
    Living systematic review of Long COVID RCTs (searched to Dec 2023; 24 RCTs included)
    Chee YJ et al., J Med Virol 2023
    Systematic review of pharmacological Long COVID RCTs
    Ivlev I et al., J Gen Intern Med 2025
    Narrative review; 26 Long COVID RCTs synthesized
    eClinicalMedicine / Lancet 2025
    Meta-analysis of 51 Long COVID RCTs (searched to July 2025)
    Kim JH et al., J Transl Med 2024
    Systematic review: 60 ME/CFS RCTs (searched to Jan 2024)
    Kim SY et al., J Transl Med 2020
    Systematic review: 56 ME/CFS RCTs (searched to April 2019)
    Seton KA et al., J Clin Med 2024
    Overview of clinical trials in ME/CFS
    CDC Systematic Review 2023 (Federal Register)
    U.S. government evidence review for ME/CFS diagnosis & treatment

    PART I: LONG COVID RCTs
    A. PHARMACOLOGICAL INTERVENTIONS
    Antivirals (Treatment of Established Long COVID)
    Trial / Study
    Intervention
    N
    Status
    Key Finding
    Reference
    STOP-PASC
    Nirmatrelvir/ritonavir (Paxlovid) 15-day vs. placebo
    ~155
    Completed 2024
    No significant improvement in PROMIS-29 Physical Health at day 28
    Geng et al., JAMA Intern Med 2024;184(9):1024
    PAX LC
    Nirmatrelvir/ritonavir 15-day vs. placebo/ritonavir (Phase 2, decentralized)
    ~119 screened
    Completed 2025
    Did not significantly improve outcomes vs placebo
    Sawano et al., Lancet Infect Dis 2025;25(8):936
    Antivirals / Immunomodulators (Prevention of Long COVID — given in acute phase)
    Trial / Study
    Intervention
    N
    Status
    Key Finding
    Reference
    COVID-OUT
    Metformin, ivermectin, fluvoxamine (factorial design, Phase 3)
    1,431
    Completed 2023
    Metformin reduced long COVID incidence by ~41% (HR 0.59); no effect for ivermectin or fluvoxamine
    Bramante et al., Lancet Infect Dis 2023;23(10):1119
    ACTIV-6 (metformin arm)
    Metformin vs. placebo in acute COVID, 6-month PASC follow-up
    2,983
    Completed 2025
    Results published 2025 (PASC outcomes); primary results pending full publication
    medRxiv 2025 preprint
    Immunomodulators (Treatment of Established Long COVID)
    Trial / Study
    Intervention
    N
    Status
    Key Finding
    Reference
    BC007 Phase II
    BC007 (aptamer targeting autoantibodies vs. GPCRs)
    —
    Completed/Terminated
    Did not demonstrate superiority over placebo; trial suspended
    IDSOCIETY.org 2025 update
    REVERSE-LC / RECOVER-TLC baricitinib expansion
    Baricitinib (JAK inhibitor) for neurocognitive & cardiopulmonary Long COVID
    Large (multi-site)
    Enrolling from early 2026
    Ongoing; results expected ~2027
    FNIH RECOVER-TLC 2025
    Sipavibart (monoclonal antibody)
    Anti-spike monoclonal antibody vs. placebo (Schmidt Initiative/SILC-funded)
    —
    Enrolling 2025
    Ongoing
    NSU Newsroom 2025
    AER002
    Long-acting human IgG1 mAb neutralizing SARS-CoV-2 spike
    —
    Ongoing
    —
    Zhang et al., Infect Dis Immun 2025
    Neuropsychiatric / Cognitive Agents
    Trial / Study
    Intervention
    N
    Status
    Key Finding
    Reference
    McIntyre et al.
    Vortioxetine (antidepressant/pro-cognitive) vs. placebo
    —
    Completed
    Positive cognitive outcomes reported
    McIntyre et al., Brain 2024;147(3):849
    Nakamura et al.
    Donepezil (acetylcholinesterase inhibitor) for fatigue & psychological symptoms
    —
    Completed 2025
    Published JAMA Netw Open 2025;8(3):e250728
    Nakamura et al., JAMA Netw Open 2025
    Harandi et al.
    Amantadine for post-COVID fatigue (open-label RCT)
    —
    Completed
    Significant fatigue reduction
    Sci Rep 2024;14:1343
    Kuut et al.
    Cognitive Behavioural Therapy (CBT) for severe fatigue, 1:1 vs. care as usual
    114
    Completed 2023
    Fatigue reduction with CBT
    Lancet EClinMed 2023
    RECOVER-TLC low-dose naltrexone (LDN) arm
    LDN for Long COVID fatigue (ages 6-25)
    Large
    Protocol finalized 2025; not yet enrolling
    —
    FNIH RECOVER-TLC 2025
  • Old_JoeOld_Joe
    edited February 17
    2)

    Metabolic / Anti-inflammatory
    Trial / Study
    Intervention
    N
    Status
    Key Finding
    Reference
    Hansen et al.
    Coenzyme Q10 (high-dose) vs. placebo, crossover
    —
    Completed 2023
    No significant benefit
    Lancet Reg Health Eur 2023;24:100539
    Lau et al.
    SIM01 synbiotic (probiotics + prebiotics) for PACS
    —
    Completed 2023
    Significant improvement in fatigue, memory, cognition, GI
    Lancet Infect Dis 2023
    Antifibrotics (Pulmonary Long COVID)
    Trial / Study
    Intervention
    N
    Status
    Key Finding
    Reference
    Pirfenidone Phase II
    Pirfenidone for post-COVID pulmonary fibrosis
    —
    Ongoing/completed
    —
    RECOVER call to action 2023
    PINCER
    Nintedanib vs. pirfenidone for post-COVID pulmonary fibrosis
    —
    Ongoing
    —
    RECOVER call to action 2023
    Deupirfenidone (LYT-100)
    For post-COVID respiratory complications
    168
    Completed July 2022
    Results expected 2023
    RECOVER call to action 2023
    Other Pharmacological
    Trial / Study
    Intervention
    N
    Status
    Key Finding
    Reference
    RECOVER-TLC GLP-1 agonist arm
    GLP-1 receptor agonist for Long COVID
    Large
    Not yet enrolling (2025)
    —
    FNIH RECOVER-TLC 2025
    Vericiguat Phase II
    Guanylate cyclase inhibitor (licensed for heart failure) for post-COVID & post-COVID ME/CFS
    —
    Ongoing
    —
    Frontiers in Medicine 2023
    RECOVER-TLC stellate ganglion block arm
    Nerve block intervention
    Large
    Not yet enrolling (2025)
    —
    FNIH RECOVER-TLC 2025

    B. NON-PHARMACOLOGICAL / REHABILITATIVE INTERVENTIONS
    Hyperbaric Oxygen Therapy (HBOT)
    Trial / Study
    Intervention
    N
    Status
    Key Finding
    Reference
    Efrati et al. (Israel)
    HBOT vs. sham in post-COVID condition
    73
    Completed
    Improved neurocognition, sleep, pain
    Sci Rep 2022 (original); longitudinal follow-up Sci Rep 2024;14:3604
    HOT-LoCO (Sweden)
    HBOT for Long COVID, Phase II RCT
    —
    Ongoing (interim safety report 2023)
    Safety acceptable; efficacy results pending
    BMC Infect Dis 2023;23:33
    Neuromodulation / Brain Stimulation
    Trial / Study
    Intervention
    N
    Status
    Key Finding
    Reference
    tDCS trials (multiple)
    Transcranial direct current stimulation (multiple NCT#s: NCT05780450, NCT05092516)
    Small
    Ongoing/completed
    Mixed small RCTs
    Zhang et al.; Frontiers 2023
    Vagus nerve stimulation
    NCT05918965
    —
    Registered
    —
    Zhang et al., Infect Dis Immun 2025
    Stellate ganglion block
    NCT06055270
    —
    Registered; RECOVER expanding
    Promising; awaits pivotal trial
    FNIH RECOVER-TLC 2025
    Exercise / Rehabilitation
    Trial / Study
    Intervention
    N
    Status
    Key Finding
    Reference
    Romanet et al.
    Exercise training for Long COVID dyspnoea, multicentre RCT
    —
    Completed
    Improved dyspnea
    Ann Phys Rehabil Med 2023;66:101765
    Pehlivan et al.
    Tele-COVID: Post-discharge telerehabilitation RCT
    —
    Completed
    Positive
    Ann Thorac Med 2022;17:110
    Okan et al.
    Breathing exercises via telemedicine, RCT
    —
    Completed
    Positive
    Clin Nurs Res 2022;31:771
    Rodriguez-Blanco et al.
    Telerehabilitation therapeutic exercise 14-day, post-COVID
    —
    Completed
    Effective
    J Clin Med 2023;12
    Rodriguez-Blanco et al.
    Breathing vs. strength exercises via telerehabilitation, acute phase RCT
    —
    Completed
    Both arms effective
    Clin Rehabil 2022;36:486
    Samper-Pardo et al.
    ReCOVery APP telerehabilitation, 3-month RCT
    —
    Completed
    Positive
    Sci Rep 2023;13:7943
    Cardiopulmonary telerehabilitation (functional exercises)
    Post-COVID hospital discharge RCT
    —
    Completed 2025
    Positive
    J Telemed Telecare 2025;31:311
    Multiple additional exercise RCTs
    (51 total exercise RCTs in July 2025 meta-analysis)
    4,026 total
    Various
    Meta-analysis: exercise, respiratory muscle training, telerehab all show cardiopulmonary benefit
    eClinicalMedicine/Lancet 2025
  • Old_JoeOld_Joe
    edited February 17
    3)

    Trial / Study
    Intervention
    N
    Status
    Key Finding
    Reference
    Romanet et al.
    Exercise training for Long COVID dyspnoea, multicentre RCT
    —
    Completed
    Improved dyspnea
    Ann Phys Rehabil Med 2023;66:101765
    Pehlivan et al.
    Tele-COVID: Post-discharge telerehabilitation RCT
    —
    Completed
    Positive
    Ann Thorac Med 2022;17:110
    Okan et al.
    Breathing exercises via telemedicine, RCT
    —
    Completed
    Positive
    Clin Nurs Res 2022;31:771
    Rodriguez-Blanco et al.
    Telerehabilitation therapeutic exercise 14-day, post-COVID
    —
    Completed
    Effective
    J Clin Med 2023;12
    Rodriguez-Blanco et al.
    Breathing vs. strength exercises via telerehabilitation, acute phase RCT
    —
    Completed
    Both arms effective
    Clin Rehabil 2022;36:486
    Samper-Pardo et al.
    ReCOVery APP telerehabilitation, 3-month RCT
    —
    Completed
    Positive
    Sci Rep 2023;13:7943
    Cardiopulmonary telerehabilitation (functional exercises)
    Post-COVID hospital discharge RCT
    —
    Completed 2025
    Positive
    J Telemed Telecare 2025;31:311
    Multiple additional exercise RCTs
    (51 total exercise RCTs in July 2025 meta-analysis)
    4,026 total
    Various
    Meta-analysis: exercise, respiratory muscle training, telerehab all show cardiopulmonary benefit
    eClinicalMedicine/Lancet 2025
    Olfactory Rehabilitation
    Trial / Study
    Intervention
    N
    Status
    Key Finding
    Reference
    D'Ascanio et al.
    Olfactory training vs. PEA-LUT (palmitoylethanolamide + luteolin)
    —
    Completed
    Preliminary benefit with PEA-LUT
    Eur Rev Med Pharmacol Sci 2021;25:4156
    Di Stadio et al.
    Olfactory training + PEA-LUT vs. placebo, multicentre double-blind RCT
    —
    Completed
    Improved olfactory function
    Curr Neuropharmacol 2022;20:2001
    Di Stadio et al.
    Parosmia: olfactory training + ultramicronized PEA-LUT
    —
    Completed 2023
    Positive
    Biomedicines 2023;11
    Steroid sprays (nasal)
    For Long COVID olfactory dysfunction
    —
    Multiple small RCTs
    Modest benefit
    Meta-analysis 2025
    Acupuncture
    NCT#
    Intervention
    Status
    NCT06633666
    Acupuncture for Long COVID
    Registered
    NCT06476496
    Acupuncture for Long COVID
    Registered
    NCT05890508
    Acupuncture
    Registered
    NCT05212688
    Acupuncture
    Registered

    PART II: ME/CFS RCTs
    Note: ME/CFS has a 30+ year history of RCTs. The following covers major categories. For a complete list, see the CDC/AHRQ systematic review (2023) and Kim SY et al. (2020), which identified 56 eligible RCTs through April 2019, and Kim JH et al. (2024), which identified 60 RCTs through January 2024.
    A. IMMUNE-BASED INTERVENTIONS
    Trial / Study
    Intervention
    N
    Status
    Key Finding
    Reference
    Fluge et al. (Phase II)
    Rituximab (anti-CD20 B-cell depletion) vs. placebo
    30
    Completed
    Delayed symptom improvement vs. placebo at 6–10 months (not statistically significant at 3 months)
    PLoS One 2011
    RituxME (Phase III, Norway)
    Rituximab multiple infusions vs. placebo
    151
    Completed
    No clinical improvement; increased serious AEs
    Fluge et al., Ann Intern Med 2019;171(1):22
    Rintatolimod Phase II (AMP-501)
    Rintatolimod (Ampligen; TLR3 agonist) IV vs. placebo
    ~92
    Completed
    Statistically significant improvement in exercise tolerance
    Strayer et al.
    Rintatolimod Phase III (AMP-516)
    Rintatolimod IV twice weekly vs. placebo, multi-site
    234
    Completed
    Significant improvement in exercise tolerance in 2–8 year illness subgroup (51.2% improved by ≥25%)
    PLoS One 2020
    Vericiguat Phase II
    Guanylate cyclase inhibitor for ME/CFS & post-COVID ME/CFS
    —
    Ongoing
    —
    Frontiers in Medicine 2023
    BC007
    Aptamer for GPCR autoantibodies — case report/small; Phase II in Long COVID failed
    Small
    Terminated in LC
    Under investigation in ME/CFS subgroups
    Seton et al. 2024
    B. ANTIVIRAL INTERVENTIONS
    Trial / Study
    Intervention
    N
    Status
    Key Finding
    Reference
    Valganciclovir RCT
    Valganciclovir (for HHV-6/EBV-associated ME/CFS)
    Small
    Completed
    Some benefit in biomarker-confirmed HHV-6+ cases
    Montoya et al.
    Valacyclovir (VACV) / artesunate
    Antiviral RCTs
    Small
    Completed
    Promising preliminary results
    Seton et al., J Clin Med 2024
    C. PHARMACOLOGICAL — NEUROMODULATORS
    Trial / Study
    Intervention
    N
    Status
    Key Finding
    Reference
    Galama et al. 1996
    Fluoxetine (SSRI) vs. placebo
    —
    Completed
    No significant benefit
    Lancet 1996;347:858
    Valdizán Usón & Idiazábal 2008
    Methylphenidate (immediate-release)
    —
    Completed
    Some improvement in cognition/fatigue
    Published
    Blockmans & Persoons 2016
    Methylphenidate long-term in CFS
    —
    Completed
    Some benefit
    Acta Clin Belg 2016;71:407
    Sildenafil pilot RCT
    Sildenafil (PDE5 inhibitor) for ME/CFS fatigue
    11 (5 treated, 6 placebo)
    Completed (NCT00598585)
    Significant fatigue improvement
    Small pilot
    Fampridine RCT
    Potassium channel blocker (approved for MS)
    —
    Ongoing
    —
    Frontiers in Medicine 2023
    Dexamphetamine
    Stimulant; first evidence for efficacy
    —
    Early-stage RCT
    Promising
    Frontiers in Medicine 2023
    Lithium
    Anti-inflammatory/antidepressant
    —
    Ongoing RCT
    —
    Frontiers in Medicine 2023
    Galantamine
    Acetylcholinesterase inhibitor
    —
    Registered
    —
  • Old_JoeOld_Joe
    4)

    D. METABOLIC / DIETARY SUPPLEMENTS
    Trial / Study
    Intervention
    N
    Status
    Key Finding
    Reference
    Multiple RCTs
    NADH alone or with CoQ10
    —
    Completed (multiple)
    Modest fatigue improvement in some
    Seton et al. 2024
    Multiple RCTs
    Coenzyme Q10
    —
    Completed
    Mixed results
    Systematic reviews
    Multiple RCTs
    L-carnitine
    —
    Completed
    Limited evidence
    —
    Multiple RCTs
    Vitamins C, D, B12, magnesium
    —
    Various
    Small trials
    —
    Network meta-analysis 2025 (47 RCTs)
    Interventions for depression/depressive symptoms in CFS (47 RCTs, 4,028 participants)
    4,028
    Published 2025
    Diet therapy most effective for depressive symptoms; followed by moxibustion
    medRxiv / published preprint 2025
    E. PSYCHOLOGICAL / BEHAVIOURAL INTERVENTIONS
    Trial / Study
    Intervention
    N
    Status
    Key Finding
    Reference
    PACE Trial (UK)
    Graded Exercise Therapy (GET) and Cognitive Behavioural Therapy (CBT) vs. adaptive pacing and specialist medical care
    641
    Completed 2011
    Controversial: modest self-reported improvement; criticised for protocol changes and outcome measure shifts
    White et al., Lancet 2011
    FINE Trial
    Pragmatic rehabilitation vs. supportive listening
    296
    Completed 2010
    No significant benefit at 70 weeks
    Wearden et al., Lancet 2010
    Multiple CBT and GET RCTs
    Various psychological/behavioural
    Various
    Completed
    Overall: limited and contested evidence; patient groups report harms from GET

    CDC Systematic Review 2023
    ⚠️ Important context: The PACE trial's findings and methodology have been extensively debated in the ME/CFS community. The CDC no longer recommends GET or CBT as primary treatments following its 2023 systematic review, which found insufficient evidence.
    F. NON-PHARMACOLOGICAL
    Trial / Study
    Intervention
    N
    Status
    Key Finding
    Reference
    Dietary interventions (multiple RCTs)
    Various dietary approaches
    —
    Various
    Diet therapy shows promise for depressive symptoms
    Network meta-analysis 2025
    Acupuncture + moxibustion RCTs
    Traditional Chinese medicine
    Multiple small RCTs
    Various
    Limited evidence; ongoing interest

    Low Dose Naltrexone (LDN) for ME/CFS
    LDN (registered ACTRN12624001162505)
    —
    Ongoing/registered 2024
    Pre-post data positive; no RCT published yet as of 2025
    Polo et al. 2019; systematic review 2025
    Probiotics
    Various probiotic formulations
    Multiple small RCTs
    Various
    Some preliminary benefit
    Seton et al. 2024

    PART III: OVERLAPPING LONG COVID / ME/CFS RCTs
    Trial / Study
    Intervention
    Conditions
    Status
    ACTRN12624001162505
    Low-dose naltrexone
    ME/CFS + Long COVID
    Ongoing 2024
    Vericiguat Phase II
    Guanylate cyclase inhibitor
    Post-COVID ME/CFS
    Ongoing
    RECOVER-TLC LDN arm
    LDN (ages 6-25)
    Long COVID (overlapping with ME/CFS phenotype)
    Protocol 2025
    BC007
    Autoantibody aptamer
    Both
    Terminated in LC; under investigation

    PART IV: ONGOING / REGISTERED TRIALS — LONG COVID (Selected from ClinicalTrials.gov / WHO ICTRP)
    NCT# / Trial
    Intervention
    Status (as of Feb 2026)
    NCT05780450
    tDCS (brain stimulation) for Long COVID
    Ongoing
    NCT05092516
    tDCS
    Ongoing
    NCT05918965
    Vagus nerve stimulation
    Ongoing
    NCT06055270
    Stellate ganglion block
    Ongoing
    NCT06633666, NCT06476496, NCT05890508, NCT05212688
    Acupuncture
    Ongoing
    NCT05668091
    PAX LC (Nirmatrelvir/ritonavir) — now closed
    Completed
    REVERSE-LC (Wes Ely, Vanderbilt)
    Baricitinib for neurocognitive/cardiopulmonary LC
    Enrolling 2026 via RECOVER expansion
    NCT06147050
    Metformin for reducing fatigue in Long COVID
    Registered
    Sipavibart (SILC-funded)
    Anti-spike monoclonal antibody
    Enrolling 2025
    AER002
    Anti-SARS-CoV-2 IgG1 mAb
    Ongoing
    GLP-1 agonist (RECOVER-TLC)
    Semaglutide or similar
    Protocol stage 2025

    SUMMARY STATISTICS
    Domain
    Approximate number of RCTs identified
    Long COVID (treatment RCTs, completed/published, to 2025)
    ~51 (per eClinicalMedicine 2025 meta-analysis); ~26 (per J Gen Intern Med 2025 narrative review)
    Long COVID (all statuses including ongoing/registered)
    100+ per WHO ICTRP systematic reviews
    ME/CFS (RCTs to 2024)
    ~60 (Kim et al. 2024); ~56 (Kim et al. 2020)
    ME/CFS (historical total)
    ~80–100+ across all interventions per CDC 2023 review

    RECOMMENDED NEXT STEPS FOR SYSTEMATIC SEARCHING
    For a truly exhaustive review, the following search strategy is recommended:
    1 Databases: PubMed, Cochrane CENTRAL, Embase, CINAHL, PsycINFO, Web of Science, WHO ICTRP, ClinicalTrials.gov
    2 Key search terms: ("long COVID" OR "post-acute sequelae" OR "PASC" OR "post-COVID-19") AND "randomized controlled trial"; ("myalgic encephalomyelitis" OR "chronic fatigue syndrome" OR "ME/CFS") AND "randomized controlled trial"
    3 Date range: Inception to present
    4 Key living sources to monitor:
    ◦ Zeraatkar et al. BMJ Living Systematic Review (updated regularly)
    ◦ Cochrane COVID-19 Register
    ◦ MSK Library COVID Impacts Guide (libguides.mskcc.org/CovidImpacts/LCtreatment)
    ◦ RECOVER-TLC (fnih.org)
    ◦ Health Rising (healthrising.org) for ME/CFS and Long COVID trial tracking


  • Old_JoeOld_Joe
    @WABAC-

    The text formatting on the original Claude reply was much, much better than what is reproduced here. The original is neatly arranged in columns, nicely spaced, with various text fonts and font emphasis used where needed. The various sections are nicely separated by horizontal lines of various thickness.

    Generally, very readable.
    OJ

  • WABACWABAC
    That's pretty hard to evaluate @Old_Joe.

    I'm not inclined to pay for it when I can get it for free, or just do it the old-fashioned way digging through pubmed or google scholar.

    I suppose I should consider myself lucky that there's just not near as much published material on the topics of interest to me.;-)
  • Old_JoeOld_Joe
    The version of Claude that I'm using is free.
  • a2z
    edited February 18
    back to relevancy to original topic, i had already seen about half the sources from claude, and unsure how much benefit i gain by examining more.

    my main takeaway on re-industrialization is this :
    are we on track for correct prioritization AND implementation regarding american re-industrialization? (including canada+mexico , as i think that can be salvaged post-trump)

    roughly, we have 2 main groups:
    *basic industry , such as chemicals, and most items needing less than ~6 separate\dislocated processing and finishing steps. (this is the ed conway foundational view)

    *high value-add industry, where we do not remain permanent hostage to the total supply chain (e.g., rare earths). this is usually where capital is most apt to flow; vehicles, electronics, etc...

    the best i can tell no one in the gop has even mentioned this dilemma, in huge contrast to raiding hyundai plants and other such brilliant strategy.

    by the way, no matter how many sources AI cites, it ignores different sources that appear to have conflicting data. this is all on the reader regarding likely forward prospects.
    as an example of such, american industrial construction seems on trend, but industrial construction productivity is way down, and currently at the bottom of all sectors. i can take a guess at the likely outcome since being at the very beginning of massive re-industrialization where global trade continues to fracture.

  • Old_JoeOld_Joe
    On the contrary: In some of my traffic Claude has in fact advised that there is conflicting information. Claude could certainly handle an additional request to examine and compare all of that.
  • equalizer
    If you ask the FDA these research questions, you could end up with this answer:

    Why do you want to know? The DOW is almost 50K.
    We liberated 2,600 FDA positions, so no one left to answer science questions.
  • Old_JoeOld_Joe
    Seems fair enough.
Sign In or Register to comment.