MD, PhD, FMedSci, FSB, FRCP, FRCPEd

On this blog, I have repeatedly pleaded for a change of the 2010 NICE guidelines for low back pain (LBP). My reason was that it had become quite clear that their recommendation to use spinal manipulation and acupuncture for recurrent LBP was no longer supported by sound evidence.

Two years ago, a systematic review (authored by a chiropractor and published in a chiro-journal) concluded that “there is no conclusive evidence that clearly favours spinal manipulation or exercise as more effective in treatment of CLBP.” A the time, I wrote a blog explaining that “whenever two treatments are equally effective (or, in this case, perhaps equally ineffective?), we must consider other important criteria such as safety and cost. Regular chiropractic care (chiropractors use spinal manipulation on almost every patient, while osteopaths and physiotherapists employ it less frequently)  is neither cheap nor free of serious adverse effects such as strokes; regular exercise has none of these disadvantages. In view of these undeniable facts, it is hard not to come up with anything other than the following recommendation: until new and compelling evidence becomes available, exercise ought to be preferred over spinal manipulation as a treatment of chronic LBP – and consequently consulting a chiropractor should not be the first choice for chronic LBP patients.”

Three years ago, a systematic review of acupuncture for LBP (published in a TCM-journal) concluded that the effect of acupuncture “is likely to be produced by the nonspecific effects of manipulation.” At that time I concluded my blog-post with this question: Should NICE be recommending placebo-treatments and have the tax payer foot the bill? Now NICE have provided an answer.

The new draft guideline by NICE recommends various forms of exercise as the first step in managing low back pain. Massage and manipulation by a physiotherapist should only be used alongside exercise; there is not enough evidence to show they are of benefit when used alone. Moreover, patients should be encouraged to continue with normal activities as far as possible. Crucially, the draft guideline no longer recommends acupuncture for treating low back pain.

NICE concluded that the evidence shows that acupuncture is not better than sham treatment. Paracetamol on its own is no longer recommended either, instead non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or aspirin should be tried first. Talking therapies are recommended in combination with physical therapies for patients who had no improvement on previous treatments or who have significant psychological and social barriers to recovery.

Professor Mark Baker, clinical practice director for NICE, was quoted stating “Regrettably there is a lack of convincing evidence of effectiveness for some widely used treatments. For example acupuncture is no longer recommended for managing low back pain with or without sciatica. This is because there is not enough evidence to show that it is more effective than sham treatment.”

Good news for us all, I would say:

  • good news for patients who now hear from an accepted authority what to do when they suffer from LBP,
  • good news for society who does no longer need to spend vast amounts of money on questionable therapies,
  • good news for responsible clinicians who now have clear guidance which they can show and explain to their patients.

Not so good news, I admit, for acupuncturists, chiropractors and osteopaths who just had a major source of their income scrapped. I have tried to find some first reactions from these groups but, for the moment, they seemed to be stunned into silence – nobody seems to have yet objected to the new guideline. Instead, I found a very recent website where chiropractic is not just recommended for LBP therapy but where patients are instructed that, even in the absence of pain, they need to see their chiropractor regularly: “Maintenance chiropractic care is well supported in studies for controlling chronic LBP.”

NEVER LET THE TRUTH GET IN THE WAY OF YOUR CASH-FLOW…they seem to conclude.

302 Responses to NICE no longer recommends acupuncture, chiropractic or osteopathy for low back pain

  • This is great news indeed! I doubt that all the criticism in the world will ever stop the charlatans from doing what they do, but removing NHS referrals is an important step away from the nonsensical “integrative” agenda and marks, I think, an important step towards re-establishing the vital role of evidence in treatment choices made within the NHS.

    I wonder if there are any doctors who also practice chiropractic? I know a lot of physios use acupuncture and of course some GPs use homeopathy. It’s not clear how this recommendation will affect patients referred to practitioners who use bullshit alongside reality-based techniques.

    • I don’t know a single medic who elected to become a chiro

      • That’s not a surprise, it’s baffling that a doctor would adopt any whole-cloth alternative-to-medicine system, I guess homeopathy is an exception here.

      • Whereas there are many doctors in the UK who have trained as osteopaths and some who have made that their primary way of working.

        I’m sure you are also aware of the educational and healthcare position of osteopathy in the US.

        • “many” ???
          care to give us a figure?

          • London College of Osteopathic Medicine is a college of osteopathy specifically for the post graduate training of doctors. They have been in existence at least as long as I have been aware of this field (1980s) I’m sure they can give you the precise numbers

            http://www.lcom.org.uk

          • Ah, so you’re guessing. This “many” of which you speak – the British Homeopathic Association claims something like 400-odd members, which they no doubt think of as “many”, but it amounts to less than 0.2% of all registered doctors. Obviously there is a distinction between reality-based osteopaths and those who believe in “cranial osteopathy” and other such twaddle, but the US experience shows a number of examples such as Sherri Tenpenny who have drunk deeply of the kool-aid. Tenpenny is anti-vaccine and even promotes the chemtrail conspiracy theory.

        • Yes, in the US the osteopaths ditched the pseudoscience of chiropractic and now have training that is largely indistinguishable from that of an MD. I am not aware that the UK has similar parity between MD and DO. Feel free to provide links to back this claim.

          • I’m not sure osteopaths anywhere would lay claim to chiropractic philosophy. Historically/chronologically it was the other way round and the concepts were always different, beyond the basics. I am not familiar with the detail of the US curricula so I don’t know how much osteopathic and manual therapy training basic DO graduates receive. It is a relatively small proportion who go on to practice manual, musculoskeletal osteopathy akin to that practiced elsewhere in the world (10% was mentioned to me many years ago). Point is some do. And since, as you say, the training is indistinguishable from the MD training in the US there is a whole crowd who have moved from ‘doctor’ to ‘osteopath’ as we know them , which was the original point I was making. Of course, uK osteopathic training is not the same as UK medics training. If rhat is the ‘claim’ you are asking for links to support, please more it is not a.claim I made and I haven’t seen anyone else make it. It nonetheless grates when it’s quality and the understanding of the profession is rubbished by those who know nothing about it. The training is relevant to the requirements of the job.

          • You stated:

            Whereas there are many doctors in the UK who have trained as osteopaths and some who have made that their primary way of working.

            That gets a {{citation needed}} from me. It seems to cover the US status, but not that in the UK, at least not with the assertion of “many”.

          • Guy, I refer you back to post above regarding London College of Osteopathic Medicine which was established in 1946. I don’t have a figure but I’m sure they could let you know. If they only graduated 5 students a year that’s 350. I am aware of a handful of doctors who have trained in osteopathy at other uk colleges so I expect there are a few more from those institutions too.

      • Actually, I’m a medic who plans on going to chiro school in a few years.

        • @ Brett on Friday 01 April 2016 at 01:10

          “Actually, I’m a medic who plans on going to chiro school in a few years.”

          Why would anyone plan on doing something so incomprehensibly stupid and delve into witchcraft, coming from a scientific background? Is real medicine too hard and you prefer to faff around with people’s backs with very few risks?

      • I DO NOT KNOW OF A SINGLE DOCTOR OF MEDECINE WHO ELECTED TO BECOME A PHYSIOTHERAPIST?

    • The Royal College of Chiropractors were quick to jump on it, with this statement:

      24 March 2016: NICE revised (draft) guidance recommends package of care typically provided by chiropractors

      For low back pain, with or without sciatica, NICE revised (draft) guidance recommends risk stratification and a multimodal treatment package comprising exercise alongside at least one of:

      – Self management
      – Manual therapy [manipulation, mobilisation or soft tissue techniques (for example, massage)]
      – Psychological therapy (for example, cognitive behavioural therapy)

      It is noted that mobilisation and soft tissue techniques are performed by a wide variety of practitioners; whereas manipulation is usually performed by chiropractors or osteopaths, and by doctors or physiotherapists who have undergone additional training in manipulation. Manual therapists often combine a range of techniques in their approach and may also include exercise interventions and advice about self-management.

      • I’m no apologist for chiropractic but that is a perfectly valid and reasonable statement, so …..

        • I’ve not read all 891 pages of the guidance yet, but (even ignoring the spin) it’s what that doesn’t say that’s perhaps more interesting.

          • NICE have been clear that they have looked at the evidence for treatments rather than Professions. They have not recommended any profession in the draft guideline but instead have recognised that a range of professions could deliver care including physiotherapists, chiropractors and osteopaths. This was the same in the previous guideline so Professor Ernst is wrong to say that these NICE no longer recommend chiropractic and osteopathy as it never did, but rather NICE recognises that these professions can provide evidence based treatments.

            So whilst acupuncture has been removed this guideline once again recommend manipulation, with the caveat that it is part of a multi-modal package. Therefore two NICE guidelines have looked at the evidence and support the option of manipulation. This may not sit well with the Professor but this is what these other experts tell us.

          • “Professor Ernst is wrong to say that these NICE no longer recommend chiropractic and osteopathy”
            No, I use these terms not to describe professions but sets of modalities [the respective professions would be chiropractors and osteopaths] – just as I used ‘acupuncture’ in the same sentence.

          • Indeed, so equally, what the blog and newspaper articles quoting prof Ernst don’t say is just as interesting. Ref use of osteopathy and chiropractic vs osteopaths and chiropractors that is a valid point. Would I be right or just naive to accept that as coming from a genuine place and an honest heart. It is perhaps naive to assume ones readers and media interpreters and their readers will understand the nuance. Or It may be a very deliberate way of presenting an opinion which will serve an agenda in the full knowledge that the nuance will not be understood by most.

      • Ah yes, the evidence-based Royal College of Chiropractors.

        Anyone want their baby/child/animal manipulated?

        http://rcc-uk.org/wp-content/uploads/2014/11/Competencies-for-specialism.pdf

    • Hello! Guy,

      I wish for you to define or interpret what is meant by your comments: ”evidence in treatment”? Can you explain this in standard English language? If not, and you are using a codified English language would you state that clearly in your reply?

      I also wish for you to define or interpret the other thing you wrote on this forum: ”use bullshit alongside reality-based techniques”? If your definition/interpretation could be written in standard English language. If not, and you are using a codified English language would you state that clearly in your reply?

      • Robin
        As they say-What exactly didn’t you understand?
        I’ll leave it to the feller Chapman to clarify his own comment for you, but I’m surprised any clarification were needed. Unless of course he and I are speaking the same kind of codified English and hadn’t realised that others were struggling to understand it.

      • The phrase was actually the role of evidence in treatment choices. In other words, are treatment choices based on evidence or dogma. Medicine has a lot of history with dogma-based treatment, but current practice strives to defer always to evidence. SCAM treatments such as homeopathy and chiropractic, have only dogma. They cannot defer to evidence as it would mean they had to accept evidence that they are wrong.

      • I certainly look forward to reading the Chiropractic guff, especially the stunning news of the ‘New Law of Biophysics;’. The fact that it’s published by a ‘college’ trading under the banner of Palmer doesn’t augur well though.

      • Just a reminder to the ‘acupuncture is total quackery’ fanatics, that it arose during a period when Chinese science and technology was so far advanced of our own as to make us look like a different species. And it is practised and enjoyed daily by tens of millions of East Asians for whom it is unrelated to anything ‘new age’ and is just part of their traditional medicine. In the arrogant contempt you demonstrate, you are not just targeting your imagined concept of the flakey new ager into crystal healing and reiki but millions of committed, highly trained and hardworking doctors throughout the world. Such widespread use of a medicine over two millennia doesn’t of course prove its efficacy, but it might induce a rather more open-minded questioning on your part than the closed-minded – and actually unscientific – certainty you model.

        • Finally a truth from this commentator: “widespread use of a medicine over two millennia doesn’t of course prove its efficacy”
          “open minded questioning” … that’s what I have been doing for the last 20 years by trying to assess acupuncture rigorously.

          • Very enlightening tread and exciting opportunity to interact with two of the most influential thinkers on my daily practice as a medical acupuncturist and pain specialist working with cancer patients.

            When you (Edzard and Deadman) refer to acupuncture, does that include “dry needling” or “ashi point needling”? In my own limited experience, this procedure seems to be quite effective when adequately indicated (active trigger points eliciting the referred pain).

            Isn’t this “acupuncture doesn’t work” a bit to generic? I mean, there are different types of needling after all

          • those who claim ACUPUNCTURE DOES WORK should show us the evidence on which type of acupuncture works.

          • I thought ‘needling’ was the province of pricks. [Warning: generalized ad hominem intended purely for light relief!]

      • @Jens Anders Kjerson

        Your comments are your website. A website is not a comment!

        My comments on your website are as follows.

        1. You expect people to sign up in order to be able to read any article. Ridiculous! If you have something to say don’t hide behind Facebook and Google logins.

        2. Articles with titles such as “The Art of Palpation: Sensing Inflammations through a Wooden Stick” and “Clinical Procedure for an Anatomical Spirit Level: The Pelvic Angle Indicator (PAI)” suggest you have a poor grip on the real world, but that’s not surprising since you’re an alumnus of the Palmer School of Chiropractic.

        Comments are welcomed by readers of this blog, but your crass attempt at self-publicity leads me to a recommendation in your case: go practise autogenesis.

  • What’s happening? Is the World having a fit of sanity? First the Spanish Universities drop Homeopathy courses, then Tribeca drops Andrew Wakefield’s ‘documentary’, and now this.

  • Prof Ernst wrote: “The new draft guideline [press release cited*] by NICE recommends various forms of exercise as the first step in managing low back pain. Massage and manipulation by a physiotherapist should only be used alongside exercise”
    * https://www.nice.org.uk/news/press-and-media/exercise-not-acupuncture-for-people-with-low-back-pain-says-nice-in-draft-guidance

    Re NICE’s press release specifying “manipulation by a physiotherapist”: according to an academic physiotherapist, who was one of the members of the NICE back pain/sciatica Guideline Development Group, “that’s just a quirk of the press release”. He says that the evidence was assessed for interventions, not professions. Ergo, although the draft guideline doesn’t *recommend* manipulations by physiotherapists, chiropractors, or osteopaths, it doesn’t dismiss them either. In other words, it’s silent on the matter. See here:
    https://twitter.com/NeilOConnell/status/712972301046837248

    However, let’s hope that NICE will be specific – and sensible – on the subject of providers when the final guideline is published in September 2016 – i.e. that it will recommend manipulation by physiotherapists only (for obvious reasons).

    • I would appreciate having the “obvious” explained to me.

      • @ C Bury

        Osteopathy quackery aside https://skepticbarista.wordpress.com/category/osteopathy/ chiropractors, in particular, should be put under the microscope by NICE. I fear that it is overlooking the fact that hundreds of vitalistic, subluxation-based chiropractors in the UK will focus on the necks of their back pain patients:

        Quote
        “Chiropractors view the spine as an entity. Where they diagnose ‘subluxations’, they will normally manipulate and ‘adjust’ them (11). And ‘subluxations’ will be diagnosed in the upper spine, even if the patient suffers from back pain. Thus many, if not most back pain patients receive upper spinal manipulations. It follows that the risks of this treatment should be included in any adequate risk assessment.”

        Ref: Spinal manipulation for the early management of persistent non-specific low back pain — a critique of the recent NICE guidelines, Edzard Ernst, Int J Clin Pract (18th August 2009)

        Reference (11) is Ernst E. Chiropractic: a critical evaluation. J Pain Sympt Man 2008; 35: 544–62. Page 6 of the paper mentions a report that indicates that only 11% of all cervical manipulations are “appropriate” and gives the reference Coulter I, Hurwitz E, Adams A, et al. The appropriateness of manipulation and mobilization of the cervical spine. Santa Monica, CA: RAND, 1996:18e43.

        Yet, apparently the chiropractor regulator, the General Chiropractic Council, doesn’t see the above as a public health concern:
        http://tinyurl.com/d74ogje

        For further ‘obvious reasons’ see here:

        http://edzardernst.com/category/chiropractic/

        and here http://www.ebm-first.com/chiropractic.html

        and here http://www.ebm-first.com/chiropractic/uk-chiropractic-issues.html

        and here https://www.sciencebasedmedicine.org/the-bait-and-switch-of-unscientific-medicine/

        • Thank you for taking the time to post those links. I will take a look at them although I am thus far unimpressed by the term osteopathy quackery and the link you provide in association. Having spent a few minutes there, more here and on some other posts on this site I am getting a flavour I do not like. I am comfortable with science and what it tells us. Other agendas, rudeness, dismissive and belittling language, bias and closed minds. Not really a place I want to inhabit (from either side of an argument). I shall probably take what’s useful with gratitude and not outstay my welcome.

          • C Bury- I find myself a little confused -as I have on previous occasions -by your complaints of ‘rudeness, dismissive and belittling language, bias and closed minds’.
            Add to this list vitriolic anger, accusations of being in the pay of ‘Big Pharma’, lies, and cherry-picking of data, and you’ll start to get an idea of what opponents of quack medicine have to put up with all the time. A little dilute rudeness isn’t half of it.
            I’ve been accused many times of being in the pay of drug companies – no evidence provided, of course- and currently Mike Adams – admittedly a world class lunatic -on his Natural News website is asking who ‘got at’ Robert de Niro in order for him to pull the Wakefield film from the Tribeca Festival, with hints that he and his family have possibly been threatened by mysterious dark forces, and silly links between the Festival, Nazism, and attempts to collude in mass murder by injecting children.
            To be honest, given all the above and more, I’m quite impressed by the temperate and considered nature of the vast majority of posts on this site and others. If you taste ‘flavours you do not like’, I would suggest the later stages especially of Edzard Ernst’s book, and perhaps most particularly the vile and malign influence of Prince Charles and his fawning court. THERE’s unplesant flavours.
            I don’t know if you thought this site would be a gentle back-stroking group, where people could exchange ideas about various ‘therapies’ with no fear of contradiction, even of the loonier reaches of homeopathy, as has happened here and on other sites like Quackometer. It would seem to be a misunderstanding.

        • No, indeed, I do not need my back stroked (was that a deliberate reference, given the topic under discussion? Very good! )

          I think I was pretty clear that I simply prefer good science and good thinking so I may be closer to certain others within these walls despite also being a ‘quack’. I’m just not keen on dogma from either side, and don’t see a debate being furthered by those unhelpful tactics and behaviours I mentioned and certainly not by those you listed. I have seen it from both sides elsewhere and it is inexcusable but appears to be a nasty side of human nature which the internet magnifies. The big pharma accusations and more from the conspiracy theorists rub me up the wrong way too. I am under no illusion that the pharmaceutical industry are a powerful lobby and that capitalism and money wield great power, probably way beyond what we generally see, but I am not paranoid enough to see it’s influence in everyone who disagrees with me. So, I know this thread is mild. I’m not feeling overly threatened or upset, though maybe I am a sensitive soul who will choose to be elsewhere at a whiff of less than polite discussion. I certainly have a much lower threshold than those who enjoy dishing out or swiping back at vitriol. I would already be gone if I thought that was a line which had been crossed already. I’m sorry for the fact that you and your pals have been subjected to that elsewhere. You all have a choice: to play that game with those you oppose or stick to the science and reasoned discussion. I see some claiming to be doing that here but actually crossing the line, if in small degree. Perhaps they don’t realise!

          • C Bury –
            A few points.
            ‘Pals’ is a slimy epithet, often used by CAMists, with its insinuation that we -including 2 pharmacists and a high-ranking doctor I know-form some sort of shadowy clique in league with Big Pharma.
            I should have thought the word ‘dogma’ to be more relevant to quacks who cannot -or will not- provide evidence for their beliefs, but say they’re right because they’re right, rather than to people who reason with logic and easily available scientific evidence.
            As to the huge amounts of money involved in real medicine – what about the huge profits in quackery? Why do you think Boiron is so worried by the recent Spanish universities’ decision? What about the so-called ‘supplements’ industry? How do you think charlatans like Holford and ‘Dr’ McKeith became so rich?
            Part of the problem here is that-as you point out-so many homeopaths and supporters of other quackery are indeed sensitive souls, or at least pretend to be so, and perceive any argument against them as ‘rude’, ‘bad-mannered’, ‘dogmatic’ or ‘aggressive’. I’d be interested in your evidence of these on this blog. But then I’d also be interested in evidence that quackery works, so I shan’t be holding my breath. I’ll be needing that in case I ever decide to give ‘breatharianism’ a go.

          • Barrie,

            I will add ‘pals’ to the list of old English words best avoided whose meaning has been distorted, at least here. No slur was intended, nor crossed my mind. (First recorded in English in the second half of the 1700s, pal was borrowed from a Romani word meaning “brother, comrade,” which occurs as phal in the Romani spoken in England and phral in the Romani spoken in continental Europe.)

            Already told you I am not swayed by the ‘Big Pharma’ accusations. You seem to be trying to pick a fight with someone who is not actually in disagreement with you.

            I think dogma is a relevant word wherever it is found and that is not exclusive to one group or another (which is another way of saying exactly what I said before but you also appear to be trying to distort).

            Thought I’d better be clear what we are discussing so looked it up. “Quackery is the promotion of fraudulent or ignorant medical practices. A quack is a “fraudulent or ignorant pretender to medical skill” or “a person who pretends, professionally or publicly, to have skill, knowledge, or qualifications he or she does not possess; a charlatan”. I quite like this one: “Simple Definition of quackery
            : the methods and treatments used by unskillful doctors or by people who pretend to be doctors”. So I have no evidence that quackery works but if it provides a living for someone (by the second definition a doctor or someone pretending to be a doctor, thus excluding the practitioners I expect you mostly have your sights set on) then it is self evidently working for them. However, by the first definition it does not include genuine, properly-trained practitioners of many disciplines who understand what they do and understand the limits of their understanding and the limitations of their chosen practice.

            Are you assuming that because I can see that the pharmaceutical industry deals in large sums of money I have some sympathy with the supplement industry (which, of course, the same companies have their fingers in) or with the other people and money making ventures you list? You’d be wrong…about me and in implying some comradery between those like me and the likes of Holford and McKeith. That said, I doubt their riches match the multinational organisations manufacturing drugs.

            Well, evidence of the things I noticed on this blog. Dismissive and belittling were two words I used. Well “quackery” is, correct me if I’m wrong, intended to belittle and dismiss and you and others, correct me if I’m wrong, use it in this thread to refer to various manual therapies which are the topic of this thread. Speaks for itself. “I’ll be needing that if I ever decide to give breatharianism a go”. What is that anyway? But I take that, correct me if I’m wrong, as a comment designed to belittle it and to associate it with other therapies under discussion here and therefore belittle them. Am I being sensitive or correctly identifying a dismissive tone which I think it not unreasonable to also therefore find rude and slightly aggressive.

            As I said, you and your associates (is that better than pals?) might be surprised that a “quack” like me shares much more in common with your thinking than you realise and much more than with those exhibiting the thinking you describe as dogma.

            I appreciate your time to comment and engage. I said I might leave these shores and unless I find more energy for this mildly entertaining banter I think I am done arguing with someone with whom I probably agree about more than I disagree.

          • C Bury-
            ‘Pal’ is an excellent, if currently unfashionable, word. The reason it irks me is that it’s often used in a sneering, dismissive, patronising manner by fans of CAM as an underhand way of implying that I, and people such as I, are working as a secret cabal along with Big Pharma.
            As to quackery- I, and I think most others on this site, use it to mean the belief and practice of completely unproven, and often completely bogus, ‘therapies’ either from ignorance -correct useage intended here- or wiful ignorance, or malevolence. Gerson Therapy for instance. Or ‘ Blood type diets’.
            Maybe I misunderstood your point about the validity of something as long as it’s making money for someone, so I’ll leave that one for the moment.
            Again, if I seem to appear dismissive about certain therapies and ideas, it’s because I’m being-well- dismissive. Gerson Therapy is murderous. Homeopathy has had 200 years to provide evidence as to its efficacy, and the occasional cultist who claims to have evidence of a successful trial of such somewhere among his papers is usually never heard from again. Though why after all this time there would be only one successful demonstration escapes me. Even that should surely have opened the floodgates and washed away all known Science.
            As to ‘breatharianism’, I suggest you look it up. It’s the belief that we can train ourselves to live on nothing but air and sunshine, as -surprise, surprise-the ancients did. There’s some magnificent stuff on the Internet about, for instance, its main Australian proponent, real name Ellen Grieve, who now goes under some daft Indian nonsense, and was found ordering a vegetarian meal on an airline flight, and nearly killed herself trying to prove this nonsense on television. There have indeed been documented deaths, including one in Scotland a few years back.
            Or try Wiley Brooks, the main American quack, who was caught coming out of a hotel with a chicken pie.
            Anyway-off to improve my fatigue, whatever that means, as recommended by Alex Yuen of Balham. And if he’s not a ‘pal’ of Pooter, he ought to be.
            Pip pip!

    • Thanks for clearing up the NICE typo Blue!

      I am reading my way through the documents and the appendices A-G here may be helpful.

      https://www.nice.org.uk/guidance/indevelopment/gid-cgwave0681/documents

      Look at page 40 onwards for specific approaches investigated and also around page 50 for manual techniques,  SMT and Maitland, so still generic.

      SMT + exercise better than either on own and multimodal approach recommended. Both of these have been standard in my practice and the majority of chiro practices for decades! Traction not recommended so the physio’s will not be happy! Dry Needling that is the latest love child of chiro’s and physio’s will not be happy with the acupuncture statement.

      Like you I await the full guidelines!

    • @ Blue Wode

      it seems the press release you have referred to has been updated to state

      “Massage and manipulation by a therapist should only be used alongside exercise because there is not enough evidence to show they are of benefit when used alone.”

      Therefore, Prof Ernst should edit his text to reflect the current press release which is ambiguous to which profession is providing the manipulation. In addition he should also change his title as manipulation can be a chiropractic, osteopathy or physiotherapy modality.

      • AN Other wrote: “it seems the press release you have referred to has been updated to state “Massage and manipulation by a therapist should only be used alongside exercise because there is not enough evidence to show they are of benefit when used alone”.”

        You are correct. It has:
        https://www.nice.org.uk/news/press-and-media/exercise-not-acupuncture-for-people-with-low-back-pain-says-nice-in-draft-guidance

        AN Other wrote: “Therefore, Prof Ernst…should [also] change his title as manipulation can be a chiropractic, osteopathy or physiotherapy modality.”

        The title of Prof Ernst’s blog post is ‘NICE no longer recommends acupuncture, chiropractic or osteopathy for low back pain’. As explained above, NICE previously recommended chiropractic, osteopathy and physiotherapy…

        QUOTE
        “Consider offering a course of manual therapy, including spinal manipulation, spinal mobilisation and massage. *Treatment may be provided by* a range of health professionals including chiropractors, osteopaths, manipulative physiotherapists or doctors who have had specialist training.”

        Ref: https://www.nice.org.uk/guidance/cg88/documents/press-releases2

        Here, once again, is the definition of ‘recommend’:

        ‘Put forward (someone or something) with approval as being suitable for a particular purpose or role’

        Ref:http://www.oxforddictionaries.com/definition/english/recommend

        So, Prof Ernst is correct. NICE *no longer* *recommends* chiropractic and osteopathy (or physiotherapy for that matter, but as he’s an Emeritus Professor of CAM, chiropractic and osteopathy are his main subjects here).

        • @BW
          Neil O’Connell was clear in his tweet!
          “The guideline does not specify by provider of therapy/ rehab that’s just a quirk of the press release”
          https://twitter.com/NeilOConnell/status/712972301046837248
          I think that as you have suggested we wait until September. Then the arguments about what is the best multimodal approach including which branch of the exercise religion we should subscribe/include will be very entertaining!
          Damn, I’ve been on this blog with you guys tooooooo long! I’m becoming way too cynical!

  • What is also interesting is that the previous guidance that recommended acupuncture and spinal manipulation on its own was a mere 219 pages long: the new draft guidance is 891 pages.

  • The overwhelming amount or research and data out there supports chiropractic as the most cost effective form of treatment for back pain. This information is totally misguiding the public. The medical profession was convicted of antitrust against the chiropractic profession having deliberately lied an misguided the public. Sadly here is another attempt to distribute disinformation. DB

  • Shouldn’t it be ‘woad’ not ‘wode’?

  • Andy wrote on 29 March 2016 at 13:22: “NICE have been clear that they have looked at the evidence for treatments rather than Professions. They have not recommended any profession in the draft guideline but instead have recognised that a range of professions could deliver care including physiotherapists, chiropractors and osteopaths. This was the same in the previous guideline so Professor Ernst is wrong to say that these NICE no longer recommend chiropractic and osteopathy as it never did, but rather NICE recognises that these professions can provide evidence based treatments.”

    @ Andy

    The previous guideline implied the recommendation:

    QUOTE
    “Consider offering a course of manual therapy, including spinal manipulation, spinal mobilisation and massage. Treatment may be provided by a range of health professionals including chiropractors, osteopaths, manipulative physiotherapists or doctors who have had specialist training.”

    Ref: https://www.nice.org.uk/guidance/cg88/documents/press-releases2

    • so, he is twice wrong in a short comment – WELL-DONE!

      • @ Ernst

        In stating that chiropractic and osteopathy are modalities – can you explain how they differ from spinal manipulative therapy provided by a physiotherapist or doctor?

        Also what is the difference between acupuncture and dry needling?

        • ” chiropractic and osteopathy are modalities” OH DEAR!
          I DIDN’T SAY THAT
          I SAID “I use these terms not to describe professions but sets of modalities [the respective professions would be chiropractors and osteopaths] – just as I used ‘acupuncture’ in the same sentence.”

          • @ Edzard

            So are you saying that chiropractic and osteopathy are sets of modalities?

          • AGAIN:
            I use these terms not to describe professions but sets of modalities [the respective professions would be chiropractors and osteopaths] – just as I used ‘acupuncture’ in the same sentence.

          • @ Edzard

            A yes or no would be more helpful instead of repeating yourself.

            Also you never answered my additional questions!

  • I think you are clutching at straws, the draft guideline still recommends the option of manipulation and states that

    “It is noted that mobilisation and soft tissue techniques are performed by a wide variety of practitioners; whereas manipulation is usually performed by chiropractors or osteopaths, and by doctors or physiotherapists who have undergone additional training in manipulation. Manual therapists often combine a range of techniques in their approach and may also include exercise interventions and advice about self-management.”

    If you believe that the previous guidelines implied that it recommended chiropractic and osteopathy (which i don’t) then the same can be said for the new draft guideline. It was not the intention of NICE to recommend professions but to look at treatments.

    More importantly the evidence review in the draft guidelines supports the option of manipulation and other manual therapy when delivered as part of a multi-modal approach which, in my experience, is the way that most (not all) UK physiotherapists, chiropractors and osteopaths work.

    • Andy wrote: “…the draft guideline still recommends the option of manipulation…”

      True (with exercise).

      Andy wrote: “…and states that “It is noted that mobilisation and soft tissue techniques are performed by a wide variety of practitioners; whereas *manipulation is usually performed by* chiropractors or osteopaths, and by doctors or physiotherapists who have undergone additional training in manipulation. Manual therapists often combine a range of techniques in their approach and may also include exercise interventions and advice about self-management”. If you believe that the previous guidelines implied that it recommended chiropractic and osteopathy (which i don’t) then the same can be said for the new draft guideline.”

      No it can’t. Pay attention to the asterisks. The previous guidelines said:

      QUOTE
      “Consider offering a course of manual therapy, including spinal manipulation, spinal mobilisation and massage. *Treatment may be provided by* a range of health professionals including chiropractors, osteopaths, manipulative physiotherapists or doctors who have had specialist training.”

      Ref: https://www.nice.org.uk/guidance/cg88/documents/press-releases2

      Here is the definition of ‘recommend’:

      ‘Put forward (someone or something) with approval as being suitable for a particular purpose or role’

      Ref:http://www.oxforddictionaries.com/definition/english/recommend

      • So can we agree that the guideline recommends manipulation (with exercise, self-management advise) as an option for low back pain and now sciatica?

        It recommends treatments not professions? Therefore it does not specifically recommend chiropractors, osteopaths or physiotherapists but signposts these manual therapy professions as being able to provide this care.

        This seems quite straightforward to me.

        • Andy wrote: “So can we agree that the guideline recommends manipulation (with exercise, self-management advise) as an option for low back pain and now sciatica?”

          Surprisingly, yes. It says:

          QUOTE
          “Consider manipulation, mobilisation or soft tissue techniques (for example, massage) for managing non- specific low back pain with or without sciatica, but only as part of multi-modal treatment packages.”

          Ref: https://www.nice.org.uk/guidance/GID-CGWAVE0681/documents/draft-guideline (p.15)

          Andy wrote: “It recommends treatments not professions?”

          Yes.

          Andy wrote: “Therefore it does not specifically recommend chiropractors, osteopaths or physiotherapists but signposts these manual therapy professions as being able to provide this care.”

          Signposts? Maybe, but it’s certainly not explicit.

          Andy wrote: “This seems quite straightforward to me.”

          No, it’s not. As I said previously, it requires clarification. With the guidelines being at draft stage, hopefully that will happen.

          BTW, even the previous guideline wasn’t as clear as it could have been. In saying “Consider offering a course of manual therapy, including spinal manipulation, spinal mobilisation and massage. Treatment may be provided by a range of health professionals including chiropractors, osteopaths, manipulative physiotherapists or doctors who have had specialist training” … https://www.nice.org.uk/guidance/cg88/documents/press-releases2

          …it failed to guard against the treatment delivery being made by very dubious manual therapists such as:

          ‘Spinologists’
          http://www.spinology.co.uk/faq.htm

          ‘Osteomyologists’
          http://osteomyology.co.uk/

          And ‘spine specialists’
          https://www.thebureauinvestigates.com/2011/11/14/struck-off-chiropractor-still-working-as-spine-specialist/

          • Dear BW I am pleased that we are able to agree on the points I mentioned.

            Your last point is not really valid however, as spinologists, osteomyologists and spine specialists are not statutorily regulated health care professions in the UK and thus would not be fall into the NICE definition that you cite.

            I note that you are surprised that manipulation was recommended in this draft guideline. I seem to remember with the previous guideline it was suggested by some that the guideline group was biased. Do you think this is the case with the current guideline group?

  • Back pain is called non-specific because scans, tests and examinations reveal no physical damage.

    The body is made up of over 200 types of specialised cells. Cells are being damaged or weakened all the time but you would not normally notice any symptoms because cells are designed to rejuvenate through sleep, to maintain themselves, to repair damaged cells and to reproduce to replace dead cells. These and other cell functions are the natural processes that keep the body healthy.

    Non-specific lower back pain occurs when you allow your muscle cells in the lower back region to become too weak to rejuvenate and to maintain themselves. Cells can be damaged or weakened by a large number of factors including injury, trauma, overexertion, and prolonged lack of basic needs like proper food, exercise, relaxation and, most important of all, sleep.

    Prolonged lack of restorative sleep leads to energy deficiency which causes organs, body parts and systems to weaken and dysfunction, resulting in many health problems including nutritional deficiency, accumulation of toxins, low immunity, stagnation and insufficient pumping action of the heart which weaken and damage cells. Bad circulation is known as the silent killer because it weakens, damages, and destroys cells in the absence of any other cause.

    Lower back pain is your body’s way of telling you that your muscles cells are tired and weak, unable to repair and replenish themselves. Symptoms of stiffness, aches and pain are your body’s way of forcing you to slow down so that it can have a chance to rest and recuperate. This is why symptoms typically improve and disappear naturally when the body has a chance to bounce back.

    However, no treatment can produce sustainable benefits as long as regular poor sleep and energy deficiency are allowed to persist.

    If exercise or any one treatment can improve or prevent non-specific low back pain as some people suggest, no one needs to suffer and this condition cannot be said to be incurable.

    Acupuncture is effective for lower back pain because it releases tension to help tired muscles relax and rejuvenate. Acupuncture is the most effective way of improving circulation. Better circulation improves blood flow which gives tired cells the nourishment they need.

    Nevertheless, the only way to produce sustainable benefits or to prevent non-specific lower back pain is to give the body the energy it needs to resume its normal self-repairing and self-maintaining functions. This can be achieved by restoring restorative sleep.

    NICE and conventional medicine obviously do not understand lower back pain. It’s like the blind leading the blind, arguing which star is brighter when no one can see. Arrogance, lack of knowledge and skill are the reasons why millions of patients are suffering needlessly.

    Everyone should know that symptoms of lower back pain usually improve and disappear even without treatment because there is no physical damage. Doctors and therapists (including acupuncturists) who cannot improve symptoms that improve and disappear naturally should be utterly ashamed. They are the reason why millions of people suffer needlessly.

    Medicine must be evidence based. The Chinese Clinic gives everyone a money back guarantee to improve, cure and prevent not only non-specific lower back pain and fatigue, but also a wide variety of incurable conditions simultaneously, without side effects, just by restoring restorative sleep

    It is silly to argue what is effective for lower back pain when a small clinic in Balham, southwest London, gives everyone a money-back guarantee to improve not only this condition but also a large number of incurable conditions simultaneously, just by restoring restorative sleep which gives the body the energy it needs to repair and heal itself.

    Do not suffer needlessly.

    • yes, ‘medicine must be evidence-based’ !
      very little of what you state falls into that category.

      • Lower Back Pain is said to cost the UK £12bn a year, in the 21st century. Does this not tell you something.

        You are barking up the wrong tree. Acupuncturists, chiropractors and other therapists are not the problem. Conventional medicine that cannot even understand lower back pain in the 21st century is the cause of endless suffering.

        If you consider how symptoms of back pain improve and disappear naturally, without treatment, you will soon understand how we guarantee to improve non-specific lower back pain, with a success rate of 100%.

        Would you not agree that only fools cannot improve a condition that improves and disappears by itself?

        The money back guarantee we offer is guarantee by law. If you are really interested in truth, in improving NHS services, and in advancing science, send us 10 people with chronic non-specific lower back pain and see for yourself how quickly they recover to regain control of their life.

        • what on earth are you talking about?
          we all know that ~90% of LBP improves without treatment.
          that does not mean that alt med is fine as a treatment of LBP.
          can you please make a relevant and clear point?

          • The point is why the best brains in the world cannot improve lower back pain that improves and disappear naturally?

            Alt med is a red herring. The real problem is conventional med that cannot improve so many conditions, such as lower back pain, headaches, eczema, tinnitus, sarcoidosis, fibroids, cystitis, herpes, arthritis and MS etc. etc, symptoms of which usually improve and disappear even without treatment.

            Work this out and you deserve the Nobel prize. It is easy, we give everyone a money back guarantee to improve their sleep and energy, and we guarantee that when sleep and energy improve, these and many other incurable conditions improve and disappear naturally.

            I told you you are learned and talented. We have done the hard work. All you need to do to advance science and medicine is to present the evidence we produce every day.

          • the real problem, it seems to me, is your way of thinking which is not very logical.

          • Alex Yuen-
            Like so many others, you’re making a false argument.
            No one is saying that proper medicine knows everything. But quackery knows NOTHING.
            I’ve quoted the Dara O’ Briain sketch before, where he says-to paraphrase- ‘Science doesn’t know everything. Scientists don’t claim to know everything. If they did, they’d stop. But that doesn’t give people the right to plug the gaps with any passing fairytale that takes their fancy’.

          • Alt med is a red herring. The real problem is conventional med that cannot improve so many conditions, such as lower back pain, headaches, eczema, tinnitus, sarcoidosis, fibroids, cystitis, herpes, arthritis and MS etc. etc, symptoms of which usually improve and disappear even without treatment.

            Nice example of the distraction fallacy. Problems with medicine validate quackery in precisely the same way that plane crashes validate magic carpets.

            Medicine does not promise to cure these things, but where it cannot cure, then symptomatic relief is often possible. Alternatives-to-medicine make bold claims of profound wisdom and “cures”, which are simply fraudulent. Some alternatives-to-medicine also provide temporary symptomatic relief (e.g. by distraction), but practitioners are not honest about this.

          • Anyone can learn to cure LBP by observing the changes people make for the condition to improve and disappear.

          • The logic is simple. Given the fact that LBP improves and disappears in 90% of cases without treatment, this is good evidence that LBP can be improved, cured and prevented by the body itself. If the body is not capable of improving, curing or preventing LBP, symptoms would persist and everyone would suffer endlessly.

            The question is what does the body need to improve, cure and prevent LBP?

            Given the fact that conventional medicine cannot improve LBP, the answer can come only from alt med.
            You suggest that exercise and other lifestyle changes are helpful. We work on the same principle.

            Energy is the life force that underpins all functions. Food is a key source of energy but sleep is by far the stronger basic need. Most people can function for 20 days or more without food and water but no one can function without sleep. Sleep rejuvenates, recharges batteries. Restorative sleep gives you a full tank of energy and a fresh brain, sleep that is not sufficiently restorative gives you a small tank of energy and brain fog.

            Short of energy, organs, body parts and systems weaken and dysfunction, or behave abnormally, giving rise to a wide variety of symptoms conventional medicine call illness.

            These symptoms are manifestations of energy deficiency and can therefore be improved, cured, and prevented easily by giving the body the energy it needs. We achieve this by restoring restorative sleep.

            We help people make lifestyle changes that are necessary for restorative sleep to recur. We discovered 5 years ago that by restoring restorative sleep, which gives the body the energy it needs to resume normal functions to heal itself, LBP as well as a large number of incurable conditions also improve and disappeared simultaneously.

            LBP is easy to improve because it improves itself. When you work out why the best brains in the world cannot improve so many conditions that improve naturally, you’ll understand that conventional medicine is fundamentally flawed.

            We guarantee to improve conditions like arthritis, fibromyalgia, sarcoidosis, MS and a lot more on the same principle. Symptoms that improve and disappear naturally suggest that the condition can be improved by the body itself. We improve all these conditions simultaneously, without side effects, just by restoring restorative sleep, providing that you have not left it too late.

            Focus not on why LBP occurs but on how symptoms improve and disappear naturally and LBP is easily curable. You are most welcome to see for yourself how we improve LBP and many other chronic conditions, just by helping people sleep restoratively.

            Unless you can find someone who can restore restorative sleep and guarantee to improve energy, we are the only people on earth who can improve sleep and energy on a money back guarantee. Our expertise in restoring restorative is ground-breaking. It is for experts such as yourselves to take our contribution forward to deliver life-changing and life-saving benefits to people all over the world.

            Conventional medicine is fundamentally flawed because energy does not feature in medical text books. Conventional medicine’s belief that organs, body parts and systems can function without energy, or blood can flow by itself, is the reason why doctors are wasting billions of pounds on treatment that makes people suffer and die needlessly.

          • “Given the fact that conventional medicine cannot improve LBP, the answer can come only from alt med.”
            Sorry, but this is not logic, it is wishful thinking.

          • Nice use of bait and switch. You are missing one important fact: Minchin’s Law. By definition, alternative medicine either hasn’t been proven to work, or has been proven not to work. The idea that alt-med is appropriate (let alone uniquely so) for conditions with cyclical symptoms is to engage in the alt-meddler’s fantasy of supporting the body’s own processes. There is no evidence that this is true – indeed many alt-med systems have such a fundamentally wrong view of disease processes that it is laughable.

            As one familiar with sci-fi franchises, I can readily identify the technique alt-meddlers are using when they start suborning valid scientific findings as “explanations” of their nonsensical views, replacing or excusing obvious nonsense. We call it “retconning” – as in retroactive continuity. Orwell illustrated it best, in Nineteen Eighty-Four: “We’ve always been at war with Eastasia”. The simple truth is that “ancient wisdom” has no insight into cyclical symptoms, all forms of medicine prior to the scientific era were about amusing the patient while nature took its course, with a very few accidental exceptions such as chewing willow bark to releive toothache.

          • Given the fact the best brains in conventional medicine in the 21st century cannot give you the answer, logic dictates that the answer can come from the only other possibility, which is alt med.

            This is why the Swiss Government recognises alt med to give its citizens a chance. The Health Secretary gives Britons no chance. This is why 75,000 diabetic patients die every year, including 24,000 deaths that are completely avoidable.

            http://www.bbc.co.uk/news/health-16147731

            Even if you do not care about people suffering and dying needlessly on a massive scale, you should care about the £23.7bn conventional medicine costs the UK in diabetes alone every year. We all have to pay for this one way or another.

            Why do you keep on arguing about LBP when it is really insignificant. We give everyone a money back guarantee and succeeds in every case so no one needs to suffer. In any case, you know that symptoms improve and disappear in 90% of cases without treatment so there is really nothing to talk about.

            Why do you not talk about the 7,000 diabetic patients who lose their limbs to amputations every year? or the 75,000 deaths each year that can be prevented just by giving everyone cost-effective treatment to help them sleep restoratively?

            http://www.nhs.uk/Livewell/tiredness-and-fatigue/Pages/lack-of-sleep-health-risks.aspx

            Why do you talk about logic while you and your supporters let the Health Secretary and the doctors who kill so many patients get away with murder scot-free?

          • “logic dictates”… NO IT DOESN’T. LEARN TO THINK STRAIGHT!

          • It is a fact, not fairytale that our success rate in improving non-specific LBP is 100%. It is also a fact, not fairytale, that we give everyone a money back guarantee to improve not only LBP, but also a large number of incurable conditions simultaneously, just by restoring restorative sleep.

            http://www.thechineseclinic.co.uk/#/back-pain-cures-itself/4568082095

            In any case, LBP is easy to improve because, as Prof Edzard highlighted, symptoms improve and disappear without treatment in 90% of cases.

            Is it not true that only fools cannot improve symptoms that improve and disappear naturally?

            You use words like quackery and knowing nothing to conceal your lack of sensitivity, care or substance. Acupuncture, Chinese medicine and other alt med are not the problem. The problem you don’t want to know or talk about is the £23.7bn conventional medicine costs the UK in diabetes alone which results in 75,000 Britons dying every year, including 24,000 deaths that are completely avoidable.

            http://www.bbc.co.uk/news/health-16147731

            http://www.nhs.uk/news/2012/04april/Pages/nhs-diabetes-costs-cases-rising.aspx

            I can’t and I don’t speak for anyone else but we give a money back guarantee to improve diabetes, providing you have not left it too late.

            In any case, NHS Choices tells you that diabetes, obesity, heart disease and other incurable conditions can be improved, cured, and prevented, just by restoring restorative sleep, which is exactly what we do.

            http://www.nhs.uk/Livewell/tiredness-and-fatigue/Pages/lack-of-sleep-health-risks.aspx

            There is nothing quackery about restoring restorative sleep. Unless you can find someone else who can restore restorative sleep and energy consistently on a money back guarantee, we are the only people on earth with this skill.

            Medicine must be evidence based. The evidence you should publicise is the fact that so many people die needlessly every year from diabetes alone. 73,000 people die each year from heart disease, which can also be prevented easily by regular good sleep.

            Unscrupulous doctors and NHS managers, starting from the Health Secretary, are the people you ought to hold to account. Sarah Ellemore suffered needlessly for 20 years to end up being left to waste away in a wheelchair. We guarantee to improve MS, with a success rate of 100%. She has written to the
            Health Secretary to ask him to resign. A Health Secretary that permits the NHS to cost the UK £23.7bn a year to make 75,000 people die needlessly every year should be sent to prison. Hold the Health Secretary to account is the best way to help the NHS focus the mind

            http://www.thechineseclinic.co.uk/#/complaint-to-health-secretary/4592052578

            Conventional medicine is going through a vital phase of transformation because the costs of failure are no longer sustainable.

            Five years ago we discovered that many incurable conditions can be improved, cured and prevented simultaneously, without side effects, just by restoring restorative sleep as NHS Choices recommends.

            We are therefore at the forefront of this transformation process. You can help us improve NHS services to deliver life-changing and life-saving benefits to everyone in the UK and all over the world, or you can continue to argue about quackery while world medicine moves into the 21 century.

            It is easy to improve health, prevent illness, and safeguard life expectancy. All you need to learn is how restorative sleep and energy can be restored.

            http://www.thechineseclinic.co.uk/#/chronic-fatigue-syndrome/4543845831

            Use you talents wisely.

  • Andy wrote 29 ‎March ‎2016 at ‏‎22:04:46: “Your last point is not really valid however, as spinologists, osteomyologists and spine specialists are not statutorily regulated health care professions in the UK and thus would not be fall into the NICE definition that you cite.”

    My point is valid. The previous guideline said “Treatment may be provided by *a range* of health professionals including chiropractors, osteopaths, manipulative physiotherapists or doctors who have had specialist training”.

    Where does NICE list all of its approved providers? Remember, some spinologists, osteomyologists and spine specialists, have had specialist training (i.e. they are former chiropractors, osteopaths, or physiotherapists).

    As for these dubious providers not being statutorily regulated, that is irrelevant. Chiropractors and osteopaths are regulated by statute, but both professions are still mired in quackery, especially chiropractors. See here:
    http://www.dcscience.net/2009/05/25/nice-falls-for-bait-and-switch-by-acupuncturists-and-chiropractors-it-has-let-down-the-public-and-itself/

    Andy wrote: “I note that you are surprised that manipulation was recommended in this draft guideline. I seem to remember with the previous guideline it was suggested by some that the guideline group was biased. Do you think this is the case with the current guideline group?”

    Yes, I think so. Remember, there was an osteopath on the draft Guideline Development Group. See p.11 here:
    https://www.nice.org.uk/guidance/GID-CGWAVE0681/documents/draft-guideline

    However, that’s an improvement on the previous Guideline Development Group which included a chiropractor.

    Looking to the future, in five or six years’ time when the guideline is next up for review, I suspect that spinal manipulation, like acupuncture this time round, will be dropped. IOW, we’re probably witnessing the death throes of spinal manipulation.

    On another matter, I note that on p.21 of the Draft Guideline, it says the following:

    22 a draft guideline is produced after the group assesses the available evidence and makes recommendations

    23 there is a consultation on the draft guideline

    24 the final guideline is produced

    Ref: https://www.nice.org.uk/guidance/GID-CGWAVE0681/documents/draft-guideline

    Re item 23, does anyone have details about the consultation on the draft guideline? How would one go about submitting comments to it?

  • Sigh. What a mess.

    The *draft* guidelines recommend manipulation and/or massage plus exercise.

    Everything else written here is speculation and bias.

    • As Prof Edzard says, 90% of LBP improves without treatment. The right question to ask is why the best brains in the world in the 21 century cannot improve a condition that improves and disappears by itself?

      Conventional medicine is fundamentally flawed because energy does not feature in text books, as though organs, body parts and systems can function without energy.

      Alt med succeeds by giving the body the energy it needs, albeit that some therapies are more successful than others.

      NICE does not understand the body needs energy to function. Therefore, its recommendations will always remain second class at best where energy is involved. It’s like three blind mice, each telling the other two the way forward.

      Many conditions are incurable because they are manifestations of severe energy deficiency. We improve, cure and prevent these conditions simply by restoring restorative sleep which gives the body the energy it needs to resume normal functions, thus healing itself.

      NHS Choices tells you unambiguously that regular poor sleep puts you at risk of serious medical conditions and it shortens your life expectancy.

      http://www.nhs.uk/Livewell/tiredness-and-fatigue/Pages/lack-of-sleep-health-risks.aspx

      This means that, as long as the NHS allows insomnia to persist, no sustainable improvident is possible because no treatment can prevent regular poor sleep from weakening the body progressively for serious medical conditions to develop to shorten life expectancy.

      LBP is one of body’s ways of forcing you to change, to slow down so that both the brain and the body can have a chance to calm down, to relax enough to sleep restoratively.

      We improve, cure and prevent LBP and many other incurable conditions simultaneously, just by restoring restorative sleep to give the body the energy it needs.

      Conventional medicine is world class in treating many conditions, to change and save lives. However, it is also true that conventional medicine is immensely harmful for many common conditions because it is designed to sell drugs not to help the body heal itself. This fundamental conflict of interest means that people will always be made to suffer needlessly.

      A medicine that does not recognise energy and has no way of improving sleep and energy levels does not belong to the 21st century.

      Medicine must be evidence based. It must be realised that people suffer and die needlessly only because conventional medicine is historically ineffective and harmful.

      If conventional medicine is effective and safe, no one will suffer or die needlessly.

      The Chinese Clinic guarantees to improve LBP, with a success rate of 100%. We use a combination of therapies including acupuncture in every case. In light of the outcomes we consistently produce every day, NICE’ proposal to discontinue acupuncture is obviously wrong.

      What NICE and everyone is talking about is guesswork and speculation. What we talk about is hard evidence, backed up by a money-back guarantee which is recognised by every Court in the land.

      http://www.thechineseclinic.co.uk/#/curing-back-pain/4543846463

      Don’t waste time arguing how to improve LBP which is a waste of time since the best brains in medicine cannot understand this condition.

      Find out how we improve LBP in every case and you can explain to NICE, and the best brains in the world, how easily LBP can be improved, cured and prevented, just by restoring restorative sleep as NHS Choices recommends. Everyone is welcome to see how we produce outcomes that no one else in the world at this moment can produce.

      • “Conventional medicine is fundamentally flawed because energy does not feature in text books, as though organs, body parts and systems can function without energy. ”
        this is nonsense!!!

        • Alex Yuen-
          You are an utterly magnificent example of someone doing as much damage to his own case as any opponent could.
          ‘Energy’ doesn’t feature in text books for exactly the same reason that ‘phlostigon’ doesn’t.
          For pity’s sake man, the hole’s deep enough. Stop digging!

          • You obviously do not know what you are talking about. Please enlighten the world and tell us which book teaches doctors to improve energy?

            Have you heard of the term fatigue, which means extreme tiredness?

            Please talk evidence, not hot air.

          • Alek Yuen-Your comments are now becoming incomprehensible.

        • How do doctors improve energy? TATT – tired all the time is one of the most common complaints that doctors get. If a treatment to improve energy exists, no one would suffer fatigue!

          We guarantee to improve energy and our success rate is at least 98%. Please explain how conventional medicine improves energy.

          • your claims are nuts! are you too?

          • Edzard- I understand and respect your request for politeness on this site, but I have to say I bust a gut laughing at your last reply to the feller Yuen. I think by now he’s lost any right he might previously have had not to be subjected to sarcasm. I think he’s lucky it’s only sarcasm.

          • Are you saying the TATT cannot be improved or are your saying that our success rate in improving energy is not at least 98%.

          • SORRY – I have run out of time to discuss with you. you are quite hopeless in my view.

        • NHS Choices reveals that fatigue is the most common symptom which 9 out of 10 people with MS find most troublesome. Our success rate in improving fatigue as well as in MS is 100%.

          Please explain what treatment conventional medicine provides that can improve fatigue.

          • no, no no! you make a claim (Our success rate in improving fatigue as well as in MS is 100%.) and YOU have to prove it.

          • Edzard-re Mr Yuen
            It gets funnier and funnier.
            I googled ‘Chinese Clinic, Balham High Road’, and it comes up as ‘Chinese Clinic, Car Dealers’.
            The photo shows a bog standard shopfront, and the 2 reviews are pretty scathing, citing aggression, bullying, 80 pound charges per repeat visit, and downright nastiness when anyone tries to get the much-vaunted ‘Money Back’. One poor gullible sap claims to have lost 4,000 pounds. Time to drop the Balham Chinese Clinic from the blog I think, unless people are really desperate to ‘improve their fatigue’.

          • Alex Yuen
            I may not reply for a while, as I’m going to go and improve my fatigue-i.e. find a better quality of fatigue. Or like whatever.

          • Barrie Lee Thorpe

            I thought only intelligent and fair-minded people come on to this site. What kind of a person would blame us for being described by a silly website as a car dealer? How low can one get?

            If you had even basic knowledge of law or business, you would know that a money-back guarantee is an essential part of a contract, a legal commitment, which is recognised by and enforceable in any Court.

            Every high school leaver would know that, If the guarantor does not refund a valid claim fully and promptly, the Court will award the claimant not only a full refund but also compensation for any harm or inconvenience caused, plus lawyer fees plus court charges to punish the guarantor for being deceitful and for wasting court time. Your suggestion that we or anyone can get away with not honouring a money-back guarantee is really quite silly.

            The police will explain to you that to offer a money-back guarantee that you do not honour is a serious criminal offense called obtaining money by deception or fraud.

            Do you really believe that someone would waste time complaining on the internet and not try to get £4,000 back by calling the police or the local Trading Standards Office?

            Don’t you know that all you have to do to get a full refund plus compensation plus legal fees is to make a simple claim through the small claim court?

            In any case, I am surprised that you actually believe that any man would pay £4,000 for 100 sessions of acupuncture – to have needles stuck into him 100 times if he finds the treatment useless or disagreeable in any way?

            Only an idiot would do that. Only a real idiot would believe this a story! Everyone now knows how trusting you are.

            You must calm down and try not to confuse yourself. The question asked is whether conventional medicine can improve fatigue. Some of your supporters argue that it can, and some say the notion that fatigue can be improved is absurd.

            Please clarify whether you believe that energy can be improved or not. If yes, please explain how?

            In any case, we improve energy on a money-back guarantee. Our success rate is at least 98%. This means that, if your energy levels do not improve, you get a full refund, even if we have improved all the conditions you complained about, including LBP.

            Have you got the point now? You talk a lot and offer nothing. You help no one accept to feed one another’s ego and arrogance.

            We give everyone a money back guarantee to improve their health, sleep, energy, productivity and quality of life.

            We have done the hard work to make tomorrow better for anyone who wants it. What have you done?

            You cannot recognise truth even when it is staring you in the face!

            75,000 Britons die every year needlessly from diabetes alone and you say nothing.

            What kind of a person would do nothing to preventing another 75,000 fellow citizens from dying needlessly this year and every year, then criticise someone for giving everyone a money back guarantee to help them get well?

            Everyone now knows you are that kind of a person.

          • Alex Yuen
            Bugger off.
            Oh-before you do- please explain the phrase ‘improve fatigue’.
            Surely – even in your fantasy world – people don’t want their fatigue to be ‘improved’. This is nonsensical.
            Also- you keep throwing around percentage figures that don’t mean anything.
            Assuming you’re not making these figures up -HAH! – how do you calculate them?
            Also-I can’t he;p noticing that you still haven’t shown how people are fatigued today in a way they hadn’t been previously.
            ‘Toxins’ I expect.
            Pip pip!

          • To Alex Yuen
            Alex, dear boy! I rather think you’ve been rumbled!
            Unless it’s all a conspiracy by Big Pharma!
            Come in Number Yuen-your time is up!

          • To Alex Yuen
            Alex, dear boy! I rather think you’ve been rumbled!
            Unless it’s all a conspiracy by Big Pharma!
            Come in Number Yuen-your time is up!

          • Perhaps readers would like to see what the Advertising Standards Authority thought of your guarantee?

            02 December 2015: Chinese Clinics (Balham) Ltd t/a The Chinese Clinic

            …and your claims about MS?

            23 October 2013: ASA Ruling on Chinese Clinics (Balham) Ltd – Advertising Standards Authority

        • What is nonsense? Are doctors taught to improve energy. If doctors or medication, or food or supplements of any treatment can improve energy, why are so many people suffering from fatigue?

          • Alex Yuen
            I’m intrigued by your question ‘Why are so many people suffering from fatigue?’
            Compared with when? Was there a time when people didn’t suffer from fatigue so much? How do we prove this?
            What are your measurement criteria?
            Perhaps you have medical/historical evidence?
            Or is this along the lines of statements like ‘People are sillier now than they were in the 1950s’? Or ‘People aren’t quite as good-looking as they were last year’?
            Or is that a bit too close to the ‘sarcasm’ that quacks complain they have to endure on sites like this?

          • Alex Yuen

            I am suffering from intellectual fatigue reading your centuries old view of life. It dates back to vitalism. How can you improve energy?! Your ridiculous view of ‘energy’ flies in the face of physics, chemistry and biology.

      • “Alt med succeeds by giving the body the energy it needs, albeit that some therapies are more successful than others.”

        If bullshit was energy we could power the UK on yours alone.

  • Frank Odds

    Are you saying that energy cannot be improved? Please explain what you mean by saying that my view of ‘energy’ flies in the face of physics, chemistry and biology.

    • Go treat yourself to an elementary science textbook.

      • Alex Yuens -YOU are the one making the claim that energy can be ‘improved’. This is just drivel. It is NOT the job of intelligent people to make sense of such meaninglessness. YOU are the one making the claim, silly as it is. YOU are the one who should be tasked with making sense of it.

  • Dear Professor Ernst,

    Thank you for agreeing to answer some of my questions about your take on the NICE Guidelines.

    First question: you seem to argue that it’s good that acupuncture was removed from the guidelines due to lack of efficacy and yet you support NICE recommendations of other treatments that demonstrated no efficacy. Can you explain why you support some treatments without efficacy and not others?

    Second question: it turns out that the conclusion that acupuncture did not outperform sham for short-term pain reduction was arrived at due to errors from sloppy data entry. Using the corrected data, acupuncture does outperform sham for reduction in pain. Does this new information impact your view of the guidelines and their recommendation regarding acupuncture? Or do you feel that acupuncture should not be recommended by the guidelines regardless of what the corrected data shows?

    Third question: you have argued many times that acupuncture works solely through placebo and non-specific effects. The NICE data showed that, compared to usual care, acupuncture was just about the most effective treatment for pain reduction reviewed by the committee – it was more effective than exercise, yoga, massage, manipulation and a combined intervention that involved both cognitive therapy and exercise. Can you provide a biologically plausible explanation for how this physical intervention works through solely non-specific effects, with outcomes greater than interventions that have both specific and non-specific effects? And why that explanation is more likely than acupuncture working through a combination of non-speceific and specific effects, characterised by its well-documented local and systemic mechanisms?

    Fourth question: you seem to rest your argument that acupuncture works through non-specific effects on studies that compare acupuncture to sham acupuncture. However, practically all investigations of sham acupuncture demonstrate that sham is not biologically inert and that it controls for some of the specific needling effects of acupuncture. Can you provide any evidence to the contrary? That sham acupuncture only controls for placebo and non-specific effects and does not itself provide any of the same physiological effects as the acupuncture treatment itself?

    Thanks in advance.

    • “you support NICE recommendations of other treatments that demonstrated no efficacy”
      WHICH THERAPIES ARE THESE AND WHERE DID I OFFER MY SUPPORT?
      “Does this new information impact your view of the guidelines and their recommendation regarding acupuncture?”
      MOST LIKELY, BUT I WOULD HAVE TO SEE THE REVISED GUIDELINES, OF COURSE.
      “you have argued many times that acupuncture works solely through placebo and non-specific effects”
      I HAVE STATED THAT THE EVIDENCE SUPPORTS THIS HYPOTHESIS WHEN IT DID; THAT’S DIFFERENT, I THINK.
      “The NICE data showed that, compared to usual care, acupuncture was just about the most effective treatment for pain reduction reviewed by the committee.”
      ARE YOU REFERRING TO THE REVISED VERSION OF THE GUIDELINE?
      ” Can you provide a biologically plausible explanation for how this physical intervention works through solely non-specific effects, with outcomes greater than interventions that have both specific and non-specific effects?”
      ” practically all investigations of sham acupuncture demonstrate that sham is not biologically inert and that it controls for some of the specific needling effects of acupuncture.”
      THIS IS NOT MY INTERPRETATION OF THE PUBLISHED LITERATURE.
      ONE NEEDS TO ACCOUNT FOR OTHER FACTORS AS WELL, E. G. METHODOLOGICAL QUALITY OF THE STUDIES.
      NO

      • Thank you for your prompt reply.

        1) “WHICH THERAPIES ARE THESE AND WHERE DID I OFFER MY SUPPORT?”
        Referring to the new NICE draft, you wrote:
        “good news for patients who now hear from an accepted authority what to do when they suffer from LBP,
        good news for society who does no longer need to spend vast amounts of money on questionable therapies,
        good news for responsible clinicians who now have clear guidance which they can show and explain to their patients.” I took this to mean that you support NICE’s recommendations.

        However, exercise, manual therapy, psychological therapy, opioids and self-management are all recommended by the guidelines and yet lack demonstrated efficacy according to NICEs review. Indeed, psychological therapy + exercise didn’t even outperform waitlist control (Appendix K p901).

        2) “MOST LIKELY, BUT I WOULD HAVE TO SEE THE REVISED GUIDELINES, OF COURSE.” I’m happy to hear that you remain open-minded. But why wait for NICE to correct their data when you can see it for yourself in the original studies? As a researcher, aren’t you well positioned to evaluate whether or not the recommendations of the guidelines are appropriate based upon the available research? I’d be happy to show you exactly where the errors are and send you copies of the original studies. Will you publicise the errors as vociferously as you publiced your initial support of the guidelines?

        3) “I HAVE STATED THAT THE EVIDENCE SUPPORTS THIS HYPOTHESIS WHEN IT DID; THAT’S DIFFERENT, I THINK.”

        I agree, there’s a distinction to be made there. But could you point me to evidence that sham acupuncture does not control for some of the needling effects of acupuncture? I have presented a referenced case on my blog for why sham acupuncture clearly does do some of the same things as acupuncture and you even presented a review of laser acupuncture (a treatment that can actually be double-blinded and adequately controlled) showing its superiority to sham. Obviously, you can understand that misinterpreting sham acupuncture as a biologically inert control when it’s not has serious implications in how sham-controlled acupuncture research is interpreted. So could you point me to some “evidence that supports this hypothesis” and evaluate it in the context of sham acupuncture research as a whole? Acupuncture, like all therapies and interventions, exerts placebo and non-specific effects. What I haven’t seen is evidence that sham acupuncture does not produce acupuncture needling effects and this is a very important distinction.

        “ARE YOU REFERRING TO THE REVISED VERSION OF THE GUIDELINE?” Nope, according to NICE’s own data table (Appendix K, p158), which included 1,334 subjects, showed that acupuncture had an effect size of -1.61 for short-term reduction in VAS while the majority of recommended treatments didn’t even have a clinically meaningful difference from usual care for short-term pain reduction.

        Can you give me a compelling reason that NICE should recommend against an effective treatment due to presumed lack of efficacy when it recommended treatments that demonstrated neither efficacy nor effectiveness (e.g. psychological therapies)?

        4) “THIS IS NOT MY INTERPRETATION OF THE PUBLISHED LITERATURE. ONE NEEDS TO ACCOUNT FOR OTHER FACTORS AS WELL, E. G. METHODOLOGICAL QUALITY OF THE STUDIES.” Ok, can you give some evidence that demonstrates that sham acupuncture is biologically inert? You’re talking about “interpretation” of literature when I’m not aware of any studies that examined this hypothesis and found that sham acupuncture did not control for needling effects. As stated above, this is a very important point. Incorrectly assuming that sham is biologically inert when it actually provides acupuncture needling effects is fundamentally flawed.

        According to NICEs data (both original and corrected), acupuncture is literally one of the most effective treatments for low back pain and your post demonstrates support for guidelines that deny this to patients while recommending treatments that lack both efficacy and effectiveness on the unlikely hypothesis that sham acupuncture only controls for placebo and non-specific effects.

        Thanks for your time, I look forward to your reply.

        • OK, so you assume based on rather paranoid looking conjecture that Prof. Ernst supports other non-evidenced therapies, despite the fact that he spends most of his time critiquing non-evidenced therapies.

          The question now is, why would this be relevant? After all, we have seen may proponents of outright nonsense (e.g. homeopathy) asserting that one must not oppose homeopathy unless one also opposes $RANDOMOTHERTHING, which usually involves a double fallacy: false equivalency (few things are as bogus as homeopathy, after all) and false dilemma.

          There is nothing wrong with celebrating the removal of bullshit from NICE guidelines. The removal of ALL bullshit would be wonderful, but the removal of ANY bullshit is cause for celebration isn’t it?

          • Guy, Have you ever actually had acupuncture? More specifically acupuncture for back pain?
            I have. I was completely immobilized due to my disks collapsing in my lower back and after a mere TWO acupuncture sessions by an experienced Traditional Chinese Acupuncturist I could not only walk again, I have never experienced more than an occasional niggle in my back which I don’t even have to take painkillers for. I will also just let you know that due to the severity in my back pain I was recommended an operation to fuse my L3, L4 and L5 vertebrae to my sacrum, an operation that the specialist decided not to do as acupuncture had removed the pain allowing me to lead a very normal life on no medication.

            It is unacceptable to remove something that SO CLEARLY WORKS on people, allowing them to avoid operations and medications that ARE PROVEN to have dangerous side effects.

        • 1) do you feel like apologising for trying to put words into my mouth?
          2) if you don’t mind, I wait until I have seen the revised guideline.
          3) I am glad we agree on this
          4) I have no intention to do a systematic review on this question; all I will do therefore is to refer you to my own paper: http://www.ncbi.nlm.nih.gov/pubmed/12512790

          • 1) I said “you support NICE recommendations of other treatments that demonstrated no efficacy” because you expressed clear and repeated support for the guidelines as a whole. Are you now saying that you don’t support the new NICE draft?
            2) Your prerogative, but a rather weak and indefensible decision for a self-chosen commentator on the accuracy and value of the guidelines.
            3) You didn’t answer my question. I’ll repeat it: “Can you give me a compelling reason that NICE should recommend against an effective treatment due to presumed lack of efficacy when it recommended treatments that demonstrated neither efficacy nor effectiveness (e.g. psychological therapies)?”
            4) I didn’t ask you to do a systematic review, I asked you to provide “some evidence that demonstrates that sham acupuncture is biologically inert.” Your study didn’t measure whether sham acupuncture was biologically inert, it measured whether or not it was judged to elicit de qi, used as a surrogate of activity. In order to judge whether or not a control is biologically inert, you first have to understand some of the biological responses it is eliciting to achieve its effect and then confirm that your control does not elicit similar responses. For example, a sugar pill is a biologically inert control in a statin trial but not at all biologically inert in a trial evaluating a treatment for hypoglycemia.

            It’s rather endearing that you consider ‘de qi’ to be a biological marker, but what the question requires is evaluation of whether or not sham acupuncture elicits any of the same biochemical changes through its specific physiological action as acupuncture does. No systematic review required, just some evidence, which I’m sure you’ll have no trouble providing. Thanks.

          • enough!

          • I am new to this site and have found it interesting and at times amusing to read the various comments, however I was dismayed, Edzard to see that you declined to answer the questions that Mel has raised. I too am a lover of science and evidence, hence it strikes me as surprising and somewhat disingenuous for you to ignore the points that Mel raises and the questions that she poses to you. Surely, as an advocate of reliable evidence and, presumably, transparency (I have attributed the latter to you based on what I have learned about you rather than as a direct quote of any comment that you have made – I am not putting words in to your mouth and will withdraw any suggestion that you are an advocate of transparency if such a suggestion offends you) you would want to check out for yourself any potential flaws in the evidence that was considered and relied upon in producing the revised NICE guidelines. Having been a member of another NICE programme development group charged with reviewing evidence and producing appropriate evidence-based guidance, I understand the level of scrutiny involved but also the potential for mistakes to sometimes happen. Is it not possible that there has been a mistake in terms of how the evidence for the effectiveness of acupuncture was interpreted? Are you not interested in clarifying whether there has indeed been a mistake? I would have thought that efficacy of evidence was of the utmost importance to you given that you risk your reputation by endorsing recommendations made on it. If there is any possibility that the evidence, the reliability of the evidence, the interpretation of the evidence or recommendations made on the strength of it are flawed then I would appreciate your further examination of the issues and questions raised by Mel and look forward to your informed response.

          • I do not answer the questions to people who try to trip me up, and do not apologise when found out. Moreover, this is largely about NICE guidelines which seem to be in the process of being re-written. I prefer to wait until the new and final version is available. I am likely to comment then.

          • Dear Edzard,Nice is still opening to hear from public. Tomorrow they have a public hearing meeting in Peterborough PE7 8FD. After discussion all of those points over last two months can you tell Nice you have no objection to remove acupuncture from recommendation ? We will let Nice know. Or can you please tell us what you have some comments on this. Many thanks.

          • Dear Professor Ernst,
            The scientific community are eagerly awaiting your reply to Mel’s four key questions.

            To refer back to the original source of where this debate stems from (the draft NICE Guidelines: “I prefer to wait until the new and final version is available”) suggests that you are deferring judgement to the NICE committee rather than your expertise.

            Given the international reach of NICE recommendations and the impact on health policy, funding and research world-wide. It would be valuable to have an expert like yourself contribute to the discussion of the studies that were submitted for inclusion by the review committee.

            Can you please reconsider your position and answer these questions.

            Thank you
            Kath

          • Edward Ernst, I always thought you were a bully and a fraud. You’re very macho when it comes to slapping down people who may have experiential reasons for supporting acupuncture and other therapies but don’t have the skill to challenge you on the clinical evidence. Now as soon as somebody does, you back off, cry ‘enough’, say you can’t possibly comment till some undetermined future date and generally act like a wuss. I say put up or shut up. I’d prefer the former because it would be good to see you eat crow but I lean towards the latter because of the substantial harm you are causing and the beautiful silence that would ensue if you did indeed go quiet.

          • and you cannot even spell my name correctly [after that your comment deteriorated sharply] thank you for proving my theory correct: http://edzardernst.com/2012/12/ad-hominem-attacks-are-signs-of-victories-of-reason-over-unreason/

          • Dear Edzard, I am extremely worried, that someone of your academic ilk, backs off so quickly, when challenged by a critic, who has sound arguments. You appear as weak in your arguments, as some pendulum swinging, new age dowser, who vainly holds sticks to their guns, not because they can back their position up with scientific evidence, but because it is what they “believe”. Please answer the questions that have been presented to you.

          • I find it interesting to note that this thread was deteriorating into the usual brainless slanging match until the comments made by Mel. It is unfortunate that Mr Ernst has not shown himself able to respond effectively to her questions. I wonder whether this is because he is unwilling to or simply unable to? I find it somewhat worrying that many individuals and, apparently, a certain sector of the media are prepared to give credence to the views of a so-called academic who is apparently unable to back up his opinions with clear reference to published research, as is the accepted norm. I too await an intelligent, well evidenced response from Mr Ernst. Until this is forthcoming I shall find it impossible not to view him as an unfortunate creature too keen on the sound of his own voice.

          • you do realise that I did respond to 2 rounds of questions from Mel, and you do realise that the last few comments came from acupuncturists, don’t you? so can you answer me a question, please: why do you think acupuncturists defend acupuncture, and why do you think ‘SO CALLED ACADEMICS’ as you kindly call me are not convinced?

          • As and acupuncturist, I will refrain from making any defense or statement as to the efficacy as Mr. Edzard had stated he is unconcerned with my opinion in this matter. As a conscientious reader, I believe he is being disingenuous when he clams that Mel has attempted to “trip him up” (how so?) or that he has answered her questions. Overall, his response has been rather disappointing in it’s lack of thoughtful dialog…and rather long on dismissive excuses.

          • Acupuncture done by Edzard Ernst MD, PhD, FMedSci, FSB, FRCP, FRCPEd SHOULD NOT be recommended by NICE guidelines for low back pain (LBP) — unless he changes his attitude and first GOES and takes 3 or 4 years degree level training that would allow him to be recognized by Acupuncture professional bodies in the U.K.
            http://admissions.acupuncture.org.uk/index.php?option=com_k2&view=item&layout=item&id=5&Itemid=119
            http://www.atcm.co.uk/membership/how-to-apply

            Why I chose him as an example? As he just released a blog with a tile that: NICE no longer recommends acupuncture, chiropractic or osteopathy for low back pain
            http://edzardernst.com/2016/03/nice-no-longer-recommends-acupuncture-chiropractic-or-osteopathy-for-low-back-pain/?replytocom=77254#respond

            Acupuncture done by FULLY QUALIFIED Professional Acupuncturists, such as myself, and thousands of others. We ARE FULL MEMBERS of the British Acupuncture Council (BAcC), The Association of Traditional Chinese Medicine (ATCM) and other such professional bodies…… Acupuncture DONE by FULLY QUALIFIED PROFESSIONALS SHOULD BE recommended by NICE guidelines for low back pain (LBP) for the best interest of public, health care, and government in the U.K.

            Why not ask the thousands of FULLY QUALIFIED Acupuncture practitioners cross the UK for EVIDENCE of whether acupuncture works or not for LBP?

            Thousands of us and tens of thousands of the public are satisfied with Acupuncture results for LBP AND WE are ready to prove to you the REAL EVIDENCES THAT ACUPUNCTURE WORKS FOR LBP!

            … from Mr Sheenette on Tuesday 17 May 2016 at 11:20:

            “Guy, Have you ever actually had acupuncture? More specifically acupuncture for back pain?
            I have. I was completely immobilized due to my disks collapsing in my lower back and after a mere TWO acupuncture sessions by an experienced Traditional Chinese Acupuncturist I could not only walk again, I have never experienced more than an occasional niggle in my back which I don’t even have to take painkillers for. I will also just let you know that due to the severity in my back pain I was recommended an operation to fuse my L3, L4 and L5 vertebrae to my sacrum, an operation that the specialist decided not to do as acupuncture had removed the pain allowing me to lead a very normal life on no medication.
            It is unacceptable to remove something that SO CLEARLY WORKS on people, allowing them to avoid operations and medications that ARE PROVEN to have dangerous side effects.”

            Please remember that you should respect others as talented as yourself, if anyone like this Edzard wants to claim that thousands people like Mr Sheenette are foolish to waste hard earned Money to receive Acupuncture for their LBP, then more thousands of us — including some GPs, Nurses, physiotherapist who are practicing Acupuncture are all FOOLS too! — many who have spent a life-time working hard to prove the effectiveness of Acupuncture!

            Please stop choosing to be blind about all of this in the real world includes the U.K. but only selectively use some “Journal papers” to play. By the way, there are millions papers about how Acupunctures works! You Don’t know Acupuncture and you never bother to study all these papers!

            Ten of thousands of the UK public have been SUCCESFULLY using acupuncture services and continue to pay for it privately before any guidelines — until today. Both the PUBLIC and Acupuncturists in the UK have been keeping our patience whilst we wait for the GOV to release a stationary regulating in the UK to stop people like Edzard to practice acupuncture which may bring no results and even danger, and then for him to sit back and celebrate the wrong guidelines about acupuncture does not work which makes him completely blind about how many reality —

            In the last week in my clinic alone I have successfully treated 8 clients with acupuncture for LBP! They all wrote references to support me and willing to stand with me side by side to prove we are not foolish and Acupuncture WORKED and HELPED their LBP. They are the ordinary public: Opera Singer, Housewife/Mother, Solicitor, Diver, Football Player, Designer, Nurse student, and Doctor!

            Please stop underestimating the effectiveness of Acupuncture in treating LBP and underestimating public and FULLY QUALIFIED Professional Acupuncturists.

            Let me repeat that please open your eyes and look:

            The effectiveness of Acupuncture in treating LBP can be proved by thousands of FULLY QUALIFIED Professional Acupuncturists and ten of thousands of the UK public who have been SUCCESFULLY using acupuncture services of LBP!

            The effectiveness of Acupuncture in treating LBP can be proved by thousands of FULLY QUALIFIED Professional Acupuncturists and ten of thousands of the UK public who have been SUCCESFULLY using acupuncture services of LBP!

            The effectiveness of Acupuncture in treating LBP can be proved by thousands of FULLY QUALIFIED Professional Acupuncturists and ten of thousands of the UK public who have been SUCCESFULLY using acupuncture services of LBP!

            Caroline

            I have to apologise in advance that I will not reply to any replay here as I no longer interest to read any his blog anymore.

            Also I am going to the NICE meeting tomorrow in Peterborough to read the above to NICE board if I could get a chance. 🙂

            such a nice evening in London, wish you all enjoy!

          • Today Nice meeting, We should invite Edzard to come. He is Professior for CAM but he makes absolutely hypothesis to De Qi from what we have. For us DeQi is very Simple observation or feeling for our practitioners but not patients who receive the acupuncture . Different practitioners at different time or at different acuponits can induced many different feelings to define whether the needle is entered right position. That is de qi. That is not biological response but experiences from clinical practice. However the Professor is misleading his team and his world to believe his thought De Qi is biological response from patients. That is not thought . That is his therory and his criteria to define real or sham acupuncture by his fellowers. Indeed, 30 papers of Nice this time (almost 70% )treating making DeQi is real acupuncture and otherwise is sham, Can I ask Prof question :you has spent millions pounds to do CAM research. Can you give the biological evidence for De Qi? I am sure Palcebo should not be account . Perhaps to correct the professor is To define what is professor.? To my thought it is depending publications . The real one has thousand papers. Otherwise is sham. …. Clearly. Professor should come to join with us today and to learn from what it is de qi and explains what is sham.

          • “Not good news for acupuncturists who’ve had a major source of their income scrapped”

            I doubt that very much.

            These guidelines don’t do much for the outward appearance of our profession granted, which is why we want to fight for the correct messages, but in terms of driving business NICE is a dead duck. Its about as far removed from the real world as its possible to get. The NHS is buckling under the pressure of service provision and locally CAM practitioners have a valuable role to play in receiving this pressure. Mainstream health providers and patients get this so whilst the arguments over who is right academically/evidentially rages on I am confident people will still look for acupuncture, osteo and whatever else they feel works for them.

            The NICE guidelines probably represent less than 1% of my income. This would increase if I took on NHS work but frankly I wouldn’t work for the NHS if you paid me a kings ransom. NICE guidelines could endorse every condition under the sun and I’d still have absolutely no interest because I’d be driven to distraction by their bureaucracy.

            Mr Ernst I cannot knock your passion commitment and vigour in spite of the fact that I frequently feel you unfairly assault my profession. I do respect the affirmation with which you approach your work but I would be a little concerned at the perception you appear to portray that CAM practitioners are all a bunch of con artists. There are good and bad in any profession and no doubt acupuncture have their share of cash cows out to make money at any cost. On the whole however I would offer to reassure you that the overwhelming majority of my colleagues are genuine and caring people with the same passion and belief in their profession as you have in yours. We don’t mis inform people or milk them for cash. We are driven by positive clinical outcomes, not riches. You will find no mansion in my name with a Bentley on the drive.

            The more I read these high velocity arguments the less convinced I am that they achieve anything for anyone. To that end, I’d would happily extend to you an invitation to come and chat to me about what I do, what my personal values are and how I operate. A civilised conversation between 2 committed individuals who hold an opposing position but a similar passion and commitment to their work. Im sure you would find that I’m not a deluded, uneducated thief but a normal bloke, trying to do his best for people and make a modest living in the process.

          • Dear Professor Ernst PhD,
            You have stated clearly, several times that you have answered Mel’s questions, but from the thread above it does not look as though you have answered them with the same enthusiasm that came across in your opening statement for this thread. For example, take this question:

            “Second question: it turns out that the conclusion that acupuncture did not outperform sham for short-term pain reduction was arrived at due to errors from sloppy data entry. Using the corrected data, acupuncture does outperform sham for reduction in pain. Does this new information impact your view of the guidelines and their recommendation regarding acupuncture? Or do you feel that acupuncture should not be recommended by the guidelines regardless of what the corrected data shows?”

            Your original answer to this was:
            “MOST LIKELY, BUT I WOULD HAVE TO SEE THE REVISED GUIDELINES, OF COURSE.”

            following the thread of this question, Mel then went on to seek a bit more of an explanation about your stance:

            “I’m happy to hear that you remain open-minded. But why wait for NICE to correct their data when you can see it for yourself in the original studies? As a researcher, aren’t you well positioned to evaluate whether or not the recommendations of the guidelines are appropriate based upon the available research? I’d be happy to show you exactly where the errors are and send you copies of the original studies. Will you publicise the errors as vociferously as you publiced your initial support of the guidelines?”

            In this exchange Mel was clearly offering to send you the data she has which has helped her to formulate her position, to you would be able to examine the data for yourself and draw your own conclusions. Your response was as follows:

            “if you don’t mind, I wait until I have seen the revised guideline.”

            At the very beginning of this thread you wrote:

            “On this blog, I have repeatedly pleaded for a change of the 2010 NICE guidelines for low back pain (LBP). My reason was that it had become quite clear that their recommendation to use spinal manipulation and acupuncture for recurrent LBP was no longer supported by sound evidence.”

            It is probably reasonable to assume that you made the statement above based on your own interpretation of the evidence, so it would seem logical that you would be interested in any data which contradicts your current understanding of the evidence.
            I have used the above to indicate that although you feel you have answered Mel’s questions and are happy to wait for a revision to the guidelines before making further comment, you should expect to exasperate people when you seem so willing to make bold statements to refute the evidence supporting the use of acupuncture for LBP, but not so willing to take a second look to see whether Mel’s information would change your stance.

          • This is another standard SCAM ploy. The preponderance of evidence says that X is bullshit but the X Association has this study that says otherwise, so that clearly wins.

            What NICE did was to assess *all* the evidence. That will have included the evidence you and Mel like. What you are doing is akin to taking the average of all values, then asserting that the true value us the average of that and the value you want. A moment’s thought shows the problem: You can repeat that forever and it will asymptotically approach the value you want. Fine if you’re selling the bullshit, not so fine if you are looking for objective fact.

          • Fascinating. Can you provide us with some specific numerical results from the NICE forest plots to better illustrate your point? Seems to contradict what the results actually showed, but if you could be specific, perhaps we’d better understand.

          • I lean in all directions at times..
            What I find interesting is that in the UK, those who study and then practice any form of Alt-Medicine, MUST learn western science during their studies and at least try to communicate with the anti-Alt-Med people in their own language.

            Conversely, those who oppose Alt-Med I can honestly say, I have never come across one who actually studied the subject they are opposing. Its like the majority of English people who go to other countries but never bother to learn the language. It must be like talking to a frog who lives in a well about the seas and oceans which he will never visit.
            Without you actually studying what you are opposing, in terms of evidencing your own knowledge and understanding makes your whole argument empty – saying that, even a muppet gets it right ‘sometimes’.

            It has a dirty similarity to how condescending rich people might speak to or about poor working class people or anyone different to themselves… Trump comes to mind!

          • To address two obvious glaring errors:

            There is no such thing as “Western science”, it’s just science. Scientific knowledge is the body of knowledge established by inquiry following the scientific method. SCAM does not follow this method, it does not have some alternative form of science, it has non-science.

            And: UK SCAM practitioners have absolutely no minimum standard of knowledge of any kind. There is no requirement for training or qualifications, and what training there is generally has no objective merit. Homeopath wannabes can study at the feet of germ theory denialists for example.

          • Dear Mr. Ernst,

            This is the first I have heard of you so checked your credentials. I looked at your publications and see that you are very accomplished in a particular area of knowledge.

            I believe, there are a host of incorrect assumptions being made in this Nasty discussion thread by those supporting Mr. Ernst’s position:

            1. Evidence based science must follow the gold standard of double blind or a particular study design. This is not true. Because of the nature of acupuncture, finding a homogenous population, using a standard point protocol plus placebo and actual affects of sham is problematic for standard design methods. Innovative designs are required but are they necessary? Did you know that historically the larger body of data (in time and volume) pointing to something being true was always considered the BEST Evidence?

            2. You can control all the variables in whole animal or human studies. This is not true. That is why we have theories and results pointing to possibilities that do not become “fact” for a very long time. Do you know you can find a host of flaws in almost every study involving whole animals/humans?

            3. Outcomes of studies provide facts and poor studies, or those with flaws, must be thrown out. This is not true. Science is about examining studies and gleaning insight. All studies provide information. A narrow view will make it very difficult to see the answers. Do you know how important it is for learning and to keep an open mind?

            3. Academics know better than Acupuncturists. This is not true. Academic researchers operate within a range of specialized knowledge. Do you know that you cannot properly judge or design studies with acupuncture unless you know both research methodology AND traditional Chinese medicine?

            Mr. Ernst, I may not be celebrated like you in a particular area of expertise, however, I was highly involved in science research for over 20 years, was sought after for my skills in study design and analysis, am published, have worked beside some of the worlds best researchers (I once received a standing ovation for my work at an international meeting) AND I now am a qualified Acupuncturist. I can sit confidently on both sides of this discussion.

            When I look at your area of knowledge and credentials, I believe you are not qualified to stand in judgement of studies involving acupuncture. It also appears that you are not open to learning from those that do know and have used a few flaws in studies to support a pre-existing bias.

            My colleagues and I have been highly insulted and I am very disappointed in the ignorance I have witnessed here in this thread. I am very concerned about the damage you have done to a profession that practices true healthcare, that I believe, will be the saviour of our failing western medical system and become the gold standard of modern medicine to come.

            I have great respect for acupuncture based in TCM and was very humbled by it when I switched careers. I believe if you and those on your NICE panel had the expertise and perspective I have had the joy to learn, you would never remove this from the guidelines for treating LBP.

          • There has long been a serious disconnect between conclusions at the culmination of research into various forms of CAM and the results obtained during said research. I provide three papers, discussing acupuncture, as examples to demonstrate my point. In each case I quote a statement of great import in the abstract, followed by the “conclusion”.

            Am J Chin Med. 2013;41(1):1-19. doi: 10.1142/S0192415X13500018.
            Acupuncture for chronic low back pain in long-term follow-up: a meta-analysis of 13 randomized controlled trials.
            Xu M1, Yan S, Yin X, Li X, Gao S, Han R, Wei L, Luo W, Lei G.

            “”2678 patients were identified from thirteen randomized controlled trials….Clinical outcomes were evaluated by pain intensity, disability, spinal flexion, and quality of life. Compared with no treatment, acupuncture achieved better outcomes in terms of pain relief, disability recovery and better quality of life, but these effects were not observed when compared to sham acupuncture..””

            Conclusion “”..No publication bias was detected. Acupuncture is an effective treatment for chronic low back pain, but this effect is likely to be produced by the nonspecific effects of manipulation..””

            The disconnect here is that having ascertained that 2678 people, in 13 RCTs, obtained better outcomes in essential areas with, and not without, acupuncture those excellent results are clouded by reference to “sham acupuncture”, the existence of which has never been proven, nor any valid such alternative modality.

            Clin J Pain. 2013 Feb;29(2):172-85. doi: 10.1097/AJP.0b013e31824909f9.
            Acupuncture for acute low back pain: a systematic review.
            Lee JH1, Choi TY, Lee MS, Lee H, Shin BC, Lee H.

            “”11 randomized-controlled trials (n=1139) were included. Compared with nonsteroidal anti-inflammatory drugs…..acupuncture may more effectively improve symptoms of acute LBP (5 studies; risk ratio, 1.11; 95% confidence interval: 1.06, 1.16). For pain, there exists inconsistent evidence that acupuncture is more effective than medication. Compared..

            Conclusion “”The current evidence is encouraging in that acupuncture may be more effective than medication for symptom improvement or relieve pain better than sham acupuncture in acute LBP. The present findings should be confirmed by future studies that overcome the methodological limitations of the studies evaluated in our review..””

            The disconnect being that positive results gained in 11 trials of over 1000 patients, far better than using NSAIDS, are clouded by a conclusion which suggests “methodological limitations”, rather than the relief gained by >1000 grateful participants, should be the focus.

            Perhaps a more honest and reliable, in terms of conclusion reflecting results, statement follows this paper:-

            Clin J Pain. 2007 Feb;23(2):128-35.
            Acupuncture for chronic low back pain in routine care: a multicenter observational study.
            Weidenhammer W1, Linde K, Streng A, Hoppe A, Melchart D.

            “”A total of 2564 patients (mean age 57.7+/-14.0 y, 78.7% female), who were treated by 1607 physicians, were included in the main analysis…. After 6 months (6-mo follow-up), 45.5% of patients demonstrated clinically significant improvements in their functional ability scores..””

            Conclusion “”Acupuncture treatment is associated with clinically relevant improvements in patients suffering from cLBP of varying degrees of chronification and/or severity.””

            When did science find itself restrained purely by the prose of “Reviewers” seemingly incapable of extracting true obvious value from acupuncture-based treatments they described?

          • alright, alright, alright!
            It was sweet of you Mel to say ‘sorry’, albeit not for trying to trip me up; but then you wrote “I honestly had no intention of misrepresenting you”, and that’s almost an excuse. I am most impressed with the PR you are able to create [ ~2000 hits on this blog in just a few hours] and obliged for the popularisation of my blog. this was great fun to observe!
            therefore, I will try to answer the above questions after all – but no further questions [I do have other, more important things to do – you rightly say that, with this blog, I want to provide objective information; but I did not mean to offer answering endless series of questions; there is a difference, you know]
            1) I am waiting for the final version, as you seem to think that there are serious mistakes in the draft, it will be fascinating to see what the final version makes of it.
            2) I don’t see a question here.
            3) No
            4) I thought ‘de qi’ is a biological response of acupuncture, in fact the most important and obvious one. but you probably know better?!
            Now, can I ask you a question: I looked you up, and somewhere they/you stated that you have published quite a bit on the subject; I couldn’t find anything on Medline. could you please provide the links to your most important pieces of research?
            many thanks, edzard

          • James Brown said:

            in the UK, those who study and then practice any form of Alt-Medicine, MUST learn western science during their studies and at least try to communicate with the anti-Alt-Med people in their own language.

            What science MUST, say, a homeopath learn during their studies and why do you believe they have to try to communicate with ‘anti-Alt-med people’?

            Conversely, those who oppose Alt-Med I can honestly say, I have never come across one who actually studied the subject they are opposing.

            What leads you to that conclusion? Have you spotted something that someone here who opposes altmed has got wrong?

          • he is trying to say that acupuncturists understand more about science than I, for instance, understand about acupuncture.
            wrong, but a nice try anyway.

          • James Brown-
            Git down, y’all.
            You’ve misunderstood the argument, as so many altmeds do.
            I’ve said it before, but I’ll have another stab at it.
            It is not necessary for one to study homeopathy, or any other foolishness, in order to have an opinion on it.
            All that’s required is to understand the basic illogic upon which it’s constructed, the cherry-picking of data, the lying, the obfuscation, the sheer wilful ignorance about Science, the maniacal claims about its efficacy.
            To use my previous analogy – it’s like if I have two people offering to mend my TV. Or, currently as it happens, my pool.
            If one turns up with a box of TV or pool repair tools, and the other arrives with a pound of sausages, I don’t have to know how a TV or a pump works in order to work out that the guy who thinks he can do it with sausage is probably wrong at best, an idiot at worst. Otherwise the World would be half full of people studying homeopathy, half of them because they believe in it and the other half because they’re feverishly trying to become ‘default homeopaths’ simply so they’ll be granted the right to an opinion. There’s lots of things I’ve never studied in detail, such as Breatharianism or child pornography. I don’t intend that to stop my having an opinion.

          • Apologies, I am short on time to be able to commit fully to this discussion.

            All BSc level subjects in the UK must have a western scientific underpinning otherwise they would not have made it into a degree course. I don’t know specifically what homeopaths learn, but know that acupuncturists must study western anatomy, physiology, pathology, differential diagnosis etc.. as well as learning the Chinese methods and how they compare. I am not saying that not studying the ‘other side’ should stop you from having an opinion, but it clearly undermines that opinion especially when combined with the nastier more closed minded people who get involved in these discussions.

            Consolidating the various paradigms whilst speaking different languages does not appear possible.
            The Chinese for example have a completely different construct of thought and language which is nearly impossible to appreciate unless you actually go and try to learn Chinese.

          • Beautiful, Barrie. That post deserves a bookmark!

          • Dear Gwen Willams,

            I am sure you are a very nice, well meaning person, but your post just might attract some unpleasant responses. I will try not to be unpleasant.

            You say you were “highly involved in science research for over 20 years, was sought after for my skills in study design and analysis, am published, have worked beside some of the worlds best researchers (I once received a standing ovation for my work at an international meeting) AND I now am a qualified Acupuncturist. I can sit confidently on both sides of this discussion.” Yet your comments betray, let’s say, confusion about the nature of scientific investigation.

            “Outcomes of studies provide facts and poor studies, or those with flaws, must be thrown out. This is not true. Science is about examining studies and gleaning insight. All studies provide information.” But surely, poorly designed and executed studies only provide misinformation? Spontaneous generation was held to be the origin of microbial life for many years. Lots of papers were published to support the idea. Then Louis Pasteur came along with a well designed experiment that disproved the concept. The erroneous studies were never unprinted but they surely don’t provide information. In the same way, obviously poorly designed clinical trials are just not worth consideration.

            “You can control all the variables in whole animal or human studies. This is not true.” Agreed; but I’ve never seen anyone claim on this blog that you can control all the variables. The prospective, randomized, double-blind clinical trial has often been described as the ‘least worst’ attempt to bring the norms of scientific experimentation into the clinical arena.

            “Evidence based science must follow the gold standard of double blind or a particular study design. This is not true.” I beg to disagree (and I personally dislike the expression ‘gold standard’). The design of clinical trials needs to be as good as it can be. In a lab experiment you’d be laughed off the bench if you omitted to include proper controls. With clinical trials — see previous paragraph — we’re looking at the variability between patients and that’s a confounder, but that’s no excuse for accepting entirely uncontrolled trials as part of the body of knowledge: they’re just anecdotal rubbish. Controlled trials of low quality are also of little use.

            Now, with your chosen form of witchcraft, acupuncture, I accept that controlling for the effects of needling is less easy than providing controls for other forms of Big Snakeoil, but just look at the history of acupuncture trials. The first attempts at controls assumed the job was easy. Acupuncture is based on meridians, qi and specific acupuncture points, right? So stick in the needles away from the acupuncture points and you’ve got a control. But trials with controls needled in ‘incorrect’ points showed no difference between experimental and control groups, so acupuncturists claimed these controls were inadequate. The theory on which acupuncture was based was quietly forgotten.

            So various forms of sham acupuncture were introduced as controls. None of these is scientifically perfect, but they represent the ‘least worst’, rather than ideal controls. Most well-designed studies based on sham acupuncture controls show no difference in effect between experimental and control groups. By now, an open-minded observer might think that sticking an acupuncture needle anywhere in the body probably has some sort of effect (what we know of the human body would support that). The question that remains unanswered is “does this effect have anything therapeutic to offer for disease?”

            You wrote “Did you know that historically the larger body of data (in time and volume) pointing to something being true was always considered the BEST Evidence?” I’ll suppress the expletive response this patronising question provokes. This a variant of the argument from popularity, and it’s just plain wrong.

            I shan’t go on. On your website you display a quote from Thomas Edison (well known as an inventor, but way out of his depth in other fields of experience): “The doctor of the future will give no medicine, but will interest her or his patients in the care of the human frame, in a proper diet, and in the cause and prevention of disease”. Try telling that to a patient with acute bacterial meningitis, or prostate cancer, or hypertension, or any of the thousands of conditions that have visibly benefitted from medical progress. Witchcraft remains witchcraft; the beauty of it lies in its strong appeal to uncritical, trusting human beings.

          • Hello Mr. Odds,

            You might be a nice person too. The only Frank Odds I found online was a mycologist, not sure if that is you. Perhaps if you stated your qualifications in this matter that would help your arguments.

            My hope is to soften the legalistic and almost religious zeal surrounding research I see here that frankly you see with younger less mature scientists. There is more to science that what we can explain in our little labs. To paraphrase a famous surgeon I worked with (performed first heart transplant in our province – common now) and a world class award winning Anaesthesiologist/Researcher that I also worked with, they both said “The more you know and learn through science, the more you realize how much you don’t know”.

            I am not confused about the nature of the scientific method. Is not misinformation still information? It remains that the observer looks at the data objectively in context with the flaws of the design. Poorly designed studies still tell us what not to do.

            Of course you need proper controls etc. That is a given. All researchers know what you are trying to point out. This is obvious. But if you do not thoroughly understand the modality you are testing, you cannot appropriately design the trials. In the case of acupuncture, most often, the controls are wrong because the researchers do not understand the traditional medical theories on which acupuncture is based.

            Acupuncturists do not dismiss the need for western interventions, antibiotics etc. These are important to save people’s lives. We are not anti-western medicine. It has its place of importance but it also has limitations. The medicine on which acupuncture is based is the missing piece and can successfully treat conditions that western medicine cannot.

            Calling it “witchcraft” is what people did in the dark ages to scientists because it was something they did not understand. Now people like you and Mr. Ernst call what we do “witchcraft” because you don’t understand it and I believe you fear it. It truly is a superior medicine in many ways. Combined with western medicine or allopathic medicine or whatever you want to call it, they make a great team. I know because I have studied both.

            It is simple as this: You and Mr. Ernst do not know because you have not studied acupuncture and TCM for a minimum of three full time years (the minimum training – includes many of the same courses MDs take with foundations in microbiology, anatomy, physiology etc….). You cannot judge the efficacy or the outcomes of trials or the appropriateness of a trial design involving acupuncture. All I am suggesting is that you please refrain from publicly speaking about things you do not know or understand. Please take the time to learn and listen to those like my self and colleagues that do know.

          • you are hilarious, really!
            apart from the facts that
            1) I don’t think I ever characterised acupuncture as witchcraft
            2) that I am not Mr but [to you] Prof Ernst
            you seem to claim that one needs to be fully trained for 3 years full time to be able to judge the effectiveness of acupuncture. there are at least 3 problems with this assumption
            1) anyone can call themselves ‘an acupuncturist’ in many countries,
            2) many articles about acupuncture that you find ok because they are positive are authored by people who have not such a schooling,
            3) anyone who undergoes such schooling will come out as a true believer – which means essentially you are saying only true believers are allowed to comment on acupuncture. all others are incompetent to do so.
            I raise my hat! this is what I call logic!!!

          • Hello “Professor” Edzard,

            I was responding to Mr. Odds in regard to the comments about “witchcraft”.

            The Professor title does not have any meaning to me. It is a job position at a university but if you insist…

            True, many acupuncturists do not have the qualified training in places where our profession is not regulated.

            You do not know what I think or believe. This is just your opinion.

            The fact is, I am a qualified acupuncturist who was also a scientist with 2 decades of research experience and publication.

            My point, I want to make is: What about the gap in your credentials? If you do not study BOTH acupuncture in the framework of TCM for a minimum of 3 years AND be trained and experienced as a research scientist in clinical trials, you are not qualified to judge and design studies involving acupuncture.

            It is my opinion, that you are operating and speaking outside your area of expertise in this matter.

            I suspect this is why your response to me was to call me “hilarious” and thus you have resorted to AD HOMINEM ATTACKS AGAINST ME which is off topic BTW.

          • Gwen Williams said:

            Hello Mr. Odds,

            You might be a nice person too. The only Frank Odds I found online was a mycologist, not sure if that is you. Perhaps if you stated your qualifications in this matter that would help your arguments.

            What difference do you believe that would make to the validity of his arguments?

          • Hello Alan,

            I was responding to Mr. Odds who replied to my comment but the same holds true for Mr. Ernst. The reason why I asked for credentials is this:

            If you do not study BOTH acupuncture in the framework of TCM for a minimum of 3 years AND be trained and experienced as a research scientist in clinical trials, you are not qualified to judge and design studies involving acupuncture.

            Most studies I read are not designed properly because the people on the team do not understand the medical theories that frame acupuncture or understand how acupuncture works. They try to use the standard approaches to clinical trials that do not fit for this reason:

            1. Picking a homogeneous population is key. To use western diagnosis is inadequate. You need to also diagnose in Chinese medicine (e.g western medicine has headaches and migraines – Chinese medicine has 9 types of headaches with underlying root causal factors)

            2. Picking the appropriate point prescription or protocol is problematic. Acupuncture treats the person not a “disease” and to pick one protocol for every subject (which you have to do in the study design) means you are forced to use sub-standard treatment protocols.

            3. Sham acupuncture as a control is problematic. The primary channels branch out to divergent, lou-connecting and sinew channels which covers most of the surface of the body. How does one pick a place where there will not be some biological activity that will lessen the significance between the control and treatment response?

            4. If you don’t know the theories of TCM you cannot choose the right data to collect to measure outcomes appropriately. A positive outcome to measure in acupuncture may be a gradual change in the pulses, showing a underlying change in a root causal factor that will improve the organ function of one organ system that controls another… Outcomes are far different than taking a pill and seeing an immediate change.

            Those of you who are acupuncturists know some of what I am talking about. Those who know research methodology will get my drift but will think this is rubbish, because they ack a significant knowledge base.

            Unfortunately people have resorted to AD HOMINEM ATTACKS because of the underlying assumption that acupuncturists are not as educated as scientists. This is not true and has led to disrespectful behavior on both sides.

          • Gwen Williams seems to be a master of the argument from authority. If someone comes along claiming 5 years of training in acupuncture, presumably they’d trump Ms Williams.

            Edzard Ernst and Alan Henness have already said almost all I would say in response. I will refer Gwen Williams to Barrie Lee Thorpe’s comment earlier in this thread here. Perhaps that will give this highly qualified and trained lady some insight into the basics of reasoning. I think reference to Dunning and Kruger is also appropriate.

            By the way, Ms Williams: “My hope is to soften the legalistic and almost religious zeal surrounding research I see here that frankly you see with younger less mature scientists.” Thank you for characterizing me this way by implication. As a senior citizen I am very flattered.

          • @ Frank Odds on Friday 20 May 2016 at 18:12

            “Gwen Williams seems to be a master of the argument from authority. If someone comes along claiming 5 years of training in acupuncture, presumably they’d trump Ms Williams.”

            I think she did post-grad in Logical Fallacies.

            @ Gwen Williams on Friday 20 May 2016 at 16:04

            Acupuncture has, supposedly, been around for a long time, discarded in 20th century China as witchcraft and resurrected by mass-murderer Mao to appease a disquieted populace. In all that time, has there been a shred of supportive evidence?

            Really, don’t you think the dead horse being flogged is deceased long enough not to be revived?

            “By the way, Ms Williams: “My hope is to soften the legalistic and almost religious zeal surrounding research I see here that frankly you see with younger less mature scientists.” Thank you for characterizing me this way by implication. As a senior citizen I am very flattered.”

            Flattered you may be, however, you may be well junior to Gwen;
            http://www.acupuncture-halifax-dartmouth.ca/about-gwen

          • Gwen Williams said:

            I was responding to Mr. Odds who replied to my comment but the same holds true for Mr. Ernst. The reason why I asked for credentials is this:

            If you do not study BOTH acupuncture in the framework of TCM for a minimum of 3 years AND be trained and experienced as a research scientist in clinical trials, you are not qualified to judge and design studies involving acupuncture.

            Unfortunately, you’ve not answered the question I asked:

            What difference do you believe that would make to the validity of his arguments?

            However, another question for you: what – specifically – is it that Prof Ernst get’s wrong about the evidence that a properly trained acupuncturist (whatever that is) wouldn’t?

          • Hello Alan, Mr. Edzard’s lack of training causes him and some of you to be able to correctly analyze or understand what is happening in studies involving acupuncture. You cannot take the “conclusions” in any paper at face value. There are tons of junk peer-reviewed research papers. If you can ask the right questions, you will get erroneous answers. The couple of studies I saw Me. Edzard’s name was attached to involving acupuncture were poorly designed and useless. Therefore:

            Your questions:

            “What difference do you believe that would make to the validity of his arguments?” and

            “However, another question for you: what – specifically – is it that Prof Ernst get’s wrong about the evidence that a properly trained acupuncturist (whatever that is) wouldn’t?”

            In a nutshell: Mr. Edzard’s reasoning and logic is wrong, as are his conclusions about acupuncture. And the opinions of you folks those who don’t have the proper training in either research or acupuncture is of no value to the discussion. Your comments against my colleagues and against acupuncture are irrelevant.

          • I disagree.
            our studies were NEVER done, planned, designed or executed by me alone. I always had very experienced acupuncturists at my side. so, even if your argument were correct [which it is not], it would fall down like a house of cards. the suspicion is that you, as most acupuncturists, do not like rigorous studies because they fail to confirm what you believe.

          • Gwen Williams said:

            In a nutshell:

            I didn’t ask you for some kind of overall summary: I asked you what – specifically – is it that Prof Ernst get’s wrong about the evidence that a properly trained acupuncturist (whatever that is) wouldn’t? All you’ve done so far is proclaim he’s biased and waved your hands about a lot. Can you do better than that?

          • @Gwen Williams

            You should join forces with Len Thomas (reiki threads). He always claims only a few people have the right insights to criticize his chosen branch of woo.

            I’ve a simple question for you. How do you feel about homeopathy, reiki, chiropractic, aromatherapy, gua sha, reflexology and the rest? As with acupuncture, all of these claim to be able to heal many forms of illness, all by quite different methods and with entirely different underlying mechanisms. Do you regard these as valid forms of medicine, or is only acupuncture truly beneficial (in the hands of someone who has undergone your extensive training, of course)? Or do you sit in the fence and have no opinion because you haven’t undergone the appropriate training?

          • I’ve been told on this site-many of us have- that no one who hasn’t spent three years or more ‘studying’ these subjects -although Dog knows how those three years would be filled – has the right to an opinion. And then of course the problem of ‘ad hominem’ attacks -sometimes justifiably, sometimes not – rears its head.
            First-how can any human being afford three years to ‘study’ each and every one of these maniacal fluffinesses before being allowed to comment?
            Second-as to the ‘ad hominem’ point-a few years ago there was a Tory Peer who wasted the population’s time and money by spouting on, in the House of Lords, about his notion that the cloud cover at the North and South poles was there to hide the holes from which UFOs emerged.
            I can’t help being tempted to the position-as with Mr Yuan and his idiotic acupuncture claims from a few weeks back-of thinking that some people’s beliefs are so time-wastingly stupid that the ‘ad hominem’ route just cuts through the nonsense, and saves time. And yes, I have already spotted the slight fault lines in my own argument, so don’t try to patronise me. It’s just that I think my fault lines are not anywhere so big as the chasms of the fruitcakes.

          • James Brown said:

            All BSc level subjects in the UK must have a western scientific underpinning otherwise they would not have made it into a degree course.

            Where is that mandated?

          • it’s not only not mandated but, to the best of my knowledge, untrue.

          • Edzard said:

            it’s not only not mandated but, to the best of my knowledge, untrue.

            I’m sure you’re right, but perhaps James Brown can provide evidence for his assertion?

  • Hi Edzard, I think the points Mel raises are valid. I eagerly await your response to her questions.

    • Dear Professor Ernst,

      “I do not answer the questions to people who try to trip me up, and do not apologise when found out.”

      I’m very sorry to hear that you do not want to answer questions about your statements or your viewpoints. I thought the purpose of this blog was to educate people about evidence-based medicine. You say that your goal “is to provide objective evidence and reliable information” on your About page. I honestly had no intention of misrepresenting you. Given the content of the blog post above and your quotes to the Guardian, you seemed to be expressing support for the guidelines and having reread what you expressed I still can’t see anything to contradict this … if you find these questions tricky, all I can surmise is that you were completely unfamiliar with the contents of NICEs review or the data they based their results on before publicly commenting in favour of their conclusions. If that’s the case, then you really owe us (your readers and the public) an apology. If there’s another explanation, please share.

      You seem to feel that I’ve misrepresented your stance on the guidelines – please, clarify your views so that we can understand more accurately. I honestly have no intention of misrepresenting you.

      “Moreover, this is largely about NICE guidelines which seem to be in the process of being re-written. I prefer to wait until the new and final version is available. I am likely to comment then.” If you prefer to wait for the final version before commenting, then why write a blog post, continually tweet about it and give an interview to an internationally syndicated paper about it? You’ve chosen to provide expert opinion on the subject so it should be easy and desirable for you to support your viewpoints.

      But no, this is about basic interpretation of research evidence for acupuncture, which is highlighted by NICEs appraisal but goes deeper. You begin this post by saying “I have repeatedly pleaded for a change of the 2010 NICE guidelines for low back pain (LBP). My reason was that it had become quite clear that their recommendation to use spinal manipulation and acupuncture for recurrent LBP was no longer supported by sound evidence.” Answering some simple questions about how you arrived at this conclusion using specific references to support your view is something you should be happy to do. You have endorsed guidelines that recommend against one of the only effective treatments that they evaluated. I think it’s reasonable to ask you to support this stance. If you don’t have evidence, then it’s reasonable for you to explain that.

      I do hope you’ll answer my questions above and I also have a few more.

      NICEs guidance on how to develop guidelines clearly states that they should use effectiveness, not efficacy, to determine recommendations. And yet this group directly contradicted those instructions. Do you feel that the recommendations should be based on NICEs official policy of using comparative effectiveness? Or based on efficacy? Why?

      The criteria used to evaluate acupuncture was different than that used to evaluate every other treatment. Most of the recommended treatments do not meet the criteria used for acupuncture. So do you think that those treatments also shouldn’t be recommended? Or that acupuncture should be judged by the pre-stated criteria used for the rest of the treatments? Or do you agree with using a completely different set of criteria for one treatment during post-hoc analysis? Why?

      Of the treatments they do recommend, which recommendations do you agree with and which ones do you disagree with? Why?

      The Chair of the committee that determined these guidelines was in direct violation of NICEs conflict of interest policy – he had a direct financial conflict of interest that precluded him from the role, which he continued to perform in spite of this clear violation. Do you think this influenced the results? How do you think NICE should handle this?

      I do hope you’ll continue to keep the channel of communication open. It’s only through these discussions that we can truly understand the “objective evidence and reliable information” you have to share. Thank you for your time.

      • Dear Professor Ernst,

        Thanks for responding briefly to my questions.

        “I looked you up, and somewhere they/you stated that you have published quite a bit on the subject; I couldn’t find anything on Medline. could you please provide the links to your most important pieces of research?”

        Well, I obviously can’t comment on what “they” said “somewhere.” But, I can tell you my most surreal experience in the so called peer-review realm was writing an oped piece for a little CAM journal. It was replying to this ridiculous review about acupuncture that somehow made it past peer review but, get this, this CAM journal is actually a publication of . . . wait for it . . . the Royal Pharmaceutical Society!! I’m not kidding! Ironically, the journal’s called “FACT” – you couldn’t make it up, could you? I guess it’s not indexed by Medline, which is just as well.

        And thanks for agreeing that, no, there is no compelling reason that NICE should recommend against an effective treatment due to presumed lack of efficacy when it recommended treatments that demonstrated neither efficacy nor effectiveness.

        Let me break this down. NICE was asked to answer the question: is acupuncture effective? And to that question, they answered “yes.” On that basis alone, if they were doing their jobs, they should have continued to recommend acupuncture.

        However, they decided to create a hurdle for acupuncture in post hoc analysis that they did not apply to a single other treatment. They said it needed to demonstrate clinically meaningful benefits beyond sham, using this as a control for placebo and non-specific effects. You are a professor of complementary medicine and have been researching acupuncture for decades. You have not been able to provide me with a single piece of evidence that sham acupuncture is a biologically inert control. “De qi” has its place in the clinic and in the lab but it is not a proxy for all physiological effects and research using objectively measured biomarkers demonstrates that sham is an active control. Sham acupuncture is more effective than usual care and many other treatments, so the most reasonable hypothesis is that it is providing physiological needling effects and this has been confirmed in many studies, including fMRI. Comparing acupuncture to sham acupuncture does not tell you the difference above and beyond non-specific and placebo, it tells you the difference between two different acupuncture-like interventions. And I repeat, NICE agrees that acupuncture is effective. I also repeat, both of these are more effective than usual care.

        Even before the corrected data is used and even though acupuncture was compared to an active control, acupuncture STILL outperformed other treatments that were recommended in terms of efficacy.

        So, Professor Ernst, I understand that you are a man of science and not of dogma. In a long and illustrious career we’d be surprised if you didn’t change your mind once in a while. Indeed, it would be cause for concern! So, based on a fuller understanding of what NICEs literature review found, their remit, and the overall evidence of all recommended treatments, do you still agree with your earlier assertions that NICEs decision to remove their recommendation of acupuncture was appropriate and evidence based?

  • Edzard, I am a little unclear from your response whether you are referring to me or to Mel with your comment that you do not answer questions to people who are trying to trip you up. If it is to me then I am disappointed if you have read that motive into my post and the questions that I posed to you – it certainly wasn’t my intention to try to trip you up.

    Quite the opposite in fact – I am simply trying to clarify exactly what your current opinion is with regards to the draft guidelines – has your opinion changed in light of the information that Mel presented to you? Are you now concerned about the efficacy of the interpretation of the evidence considered during the NICE PDG? Given the importance of the NICE guidelines and the impact that they will have, is it not better for you to share your opinions and any concerns that you have BEFORE the final guidelines are published? After all, it will be too late if you don’t speak up now and to be fair, to date you have been fairly opinionated about the draft guidelines.
    From reading your earlier comments when the draft guidelines were published, it seems reasonable to assume that you were in support of them and satisfied that acupuncture should be removed as a recommended treatment. Now that Mel seems to be casting some doubt on the accuracy of the evidence which contributed to that opinion, I am interested to understand why you would continue to rely on something that may not be all that it seems. Surely a blind belief in evidence that could be flawed is not good science.
    Your refusal to properly respond to the questions and concerns that Mel raised with you does make me doubt whether you really care about the efficacy of the evidence that NICE considered but I hope that is a mistake or misunderstanding on my part rather than any real reflection on you. Surely, a man of your standing who has been so vociferous in his support of the draft NICE guidelines would not want them being made final UNLESS he was satisfied that they were based on sound evidence. Surely you would not choose to ignore any contrary opinion that is supported by evidence just because you don’t like what it might mean? It is ok to change your mind you know. That is what intelligent and learned people do when they are presented with new or additional evidence. Remaining entrenched in an opinion that might well be based on flawed evidence is not what I expected from a serious scientist.
    There were no intended tricks in either this or my earlier post. I am not trying to trip you up. I am simply looking for transparency and clarity and would appreciate it if you would respond in a fuller and more considered way to the questions, issues and concerns that Mel raised with you.

  • Edzard (apologies that was an autocorrect), I made an ad hominem response because your blog is all about you as a person. You are constantly rude to others and bypass or ignore responses that you don’t like. It’s you who makes it hominem.

    • “constantly rude”
      SURELY NOT!
      “ignore responses that you don’t like”
      NOT TRUE! I HAVE SOME 20 OO0 RESPONSES ON MY BLOG, TO ANSWER EVEN A SMALL PROPORTION OF THEM IS QUITE A JOB; I THEREFORE ANSWER ONLY SPORADICALLY AND HOPE READERS MOSTLY DISCUSS AMONGST THEMSELVES, WICH THEY DO VERY WELL, I THINK. NEVERTHELESS, I ANSWER MANY REPONSES THAT I DON’T LIKE BUT FAR, FAR FEWER OF THOSE THAT I DO LIKE.

      • There is a massive contradiction in your whole approach and your own personality is at the heart of it. Part of you wants to promote a cool, unbiased, look-at-the-evidence stance (which I wholeheartedly support) but you yourself model the exact opposite. You are hyper-emotional, extremely biased, hostile and contemptuous of anyone you think ‘beneath you’. You gloat over people’s real or imagined inconsistencies and generally come across as a nasty piece of work. It’s not too late to change though. A true scientist is willing to give up everything they believe in and hold to in the light of evidence that it is no longer viable. I would say that your approach is no longer viable and to continue with it will cement you as a bitter and cantankerous person, increasingly given to loud and hostile statements to hang in there in the public eye (a kind of Ken Livingstone if you will). Whereas you could change and be a beacon for cool and reasoned argument that nevertheless has a human heart at the centre of it – a heart, I would say, that many of the people you rubbish have a lot of. And I’m sure you will agree that both heart and head are key in the practice of medicine.

        • ..and you know my personality?
          how clever of you!

          • Everyone knows your personality, and you are famous for your personality. I’m really sorry to say so, but it’s the truth. Wake up please, don’t live in your own dreams!

          • Time for Ernst’s Law:

            “If you are researching complementary and alternative medicine (CAM) and you are not hated by the CAM world, you’re not doing it right.”

            http://rationalwiki.org/wiki/Edzard_Ernst#Ernst.27s_Law

          • FYI I just posted this on The Journal of Chinese Medicine’s Facebook page:

            So, a development in the Edzard Ernst story. Remember he is Emeritus Professor of Complementary Medicine at the Peninsula School of Medicine, University of Exeter. In a response to a comment of mine on his blog, he just spelled out Ernst’s Law: “If you are researching complementary and alternative medicine (CAM) and you are not hated by the CAM world, you’re not doing it right.” How can such a childish provocateur remain in his post. It demeans the University and it’s time they let him go.

          • Didn’t really want to get back into this but can’t help it! Blue Wode: what a strange rule you quote. I would have thought that if you are doing research and unbiased commentary right you would gain respect from the intelligent and reasonable from all quarters …and we do exist within ‘CAM’ as well, although I realise the intelligent and reasonable do not have a monopoly anywhere. So, it seems odd to me to have a stated goal of annoying or antagonising a whole heterogenous group of people.

          • Peter Deadman said:

            “So, a development in the Edzard Ernst story. Remember he is Emeritus Professor of Complementary Medicine at the Peninsula School of Medicine, University of Exeter. In a response to a comment of mine on his blog, he just spelled out Ernst’s Law: “If you are researching complementary and alternative medicine (CAM) and you are not hated by the CAM world, you’re not doing it right.””

            Now just where did Prof Ernst say that?

          • yes, they are very quick at turning the words in your mouth; that’s why this gets so very tedious and unproductive.

          • How does he know your personality? Don’t be silly, Professor Edzard, every word on your blog displays flagrant psychopathology; you don’t think it’s transparent ? If you have access to a mirror, go and look in it.

            Especially egregious is how unpleasant, patronising and facetious you were to Gwen Williams, who, whether she is right or wrong, was consistently courteous. You rudely and sarcastically demanded she address you as Professor. Not all professors are created equal, Edzard, and you are no Einstein.

        • Peter Deadman-Reasoning-
          Are we even reading the same blog?

        • Nice one Peter. He needs to be brought down a few pegs. I have always found it somewhat ironic that someone who puts themselves forward as a “professor” of CAM always seems to be putting all the modalities down. What is he a professor of actually? has anyone interrogated his credentials? He always appears in his comments to be a rather sad and angry chap who is not looking for the good in things but quite the contrary, I always see him criticising, never praising or expressing approval of CAM.

          • Edzard Ernst-
            You have to admit, Andy Sordyl has a point. You ARE always criticising CAM ‘modalities’, and never praising them.
            I wonder whether there’s the vaguest possibility that Andy might be able to work out why that would be.
            What is it that so confuses the wandering brain -dead that they think that sites like this and Quackometer exist simply to massage their ‘modalities’? Do they visit car repair sites and complain that there’s no information there on moths or French cheeses?

          • @Andy Sordyl

            I find it amazing how many people make comments like this and can’t be bothered to read the About” tab at the head of the blog. Edzard Ernst was appointed as Chair of Complementary Medicine at Exeter, but, as he states in the “About” section: “Unlike most of my colleagues, I do not aim to promote this or that therapy, my goal is to provide objective evidence and reliable information. It is fair to say that this ambition did not endear me to many quasi-religious believers in alternative medicine.”

            In his academic position he approached CAM with an open mind, did excellent (and abundant) research, and found there was little or no robust evidence to support any brach of CAM. Not surprising, really. As pointed out by one comment in this thread , if somebody turns up to fix your TV armed with a string of sausages you don’t need deep intelligence to figure out the sausages ain’t gonna fix the TV.

            The theoretical bases of all branches of the witchcraft known as CAM are the medical equivalent of the string of sausages. No anecdotes, arguments from popularity or arguments from authority are going to alter that. When they appear to work for an individual, they’re doing it by the placebo effect, or the symptoms resolve spontaneously anyway. Like the research conducted with grants from the National Center for Complementary and Integrative Health set up quite a few years ago in the USA, Edzard Ernst’s research revealed that, whtn properly investigated, the many branches of CAM are the medical equivalent of the emperor’s new clothes. They just don’t stand up to scientific scrutiny. (They wouldn’t be alternative if they did.)

          • @Andy Sordyl

            What an immature comment
            You could have spared yourself the embarrassment of revealing your intellectual shortcomings and naivety if you had checked simple, readily available facts. You could for example have simply read the “About” section in the header above.

            I always see him criticising, never praising or expressing approval of CAM.

            That is actually the purpose of this blog. By definition CAM that can be approved is no longer CAM but medicine. Professor Ernst spent many years trying to find such CAM and give it established approval. He and his team found a few such, very few. The same is with NCCIH, which is spending billions on this task, with very little success. Certainly nothing of what you offer has been found to work for real.

          • It is interesting that some people post a link and in the case of this clown, oops Andy Sordyl, it gives a chance to see what they do and believe.

            Sordyl is the full wu (http://sordyl.co.uk/3/Biography.html);
            “Andrew Sordyl DAc Lic OHM Clin.Ac(Nanjing) MBAcC MRCHM.

            Andrew Sordyl is a well respected, highly qualified and experienced exponent of his profession. After three years Diploma study at the London School of Acupuncture and Traditional Chinese Medicine, he completed a two year post-graduate Licentiate in Oriental Herbal Medicine at the London College of Traditional Acupuncture and Oriental Medicine.

            He has completed post-graduate clinical training at the second affiliated hospital in Nanjing, China, and in the Colombo general hospital in Sri Lanka.

            He has trained in, and mastered, all the disciplines of Traditional Chinese Medicine (TCM) including Acupuncture, Herbal Medicine, Tuina, nutrition, meditation, Qi Gong, as well as Shiatsu, Yoga and western massage. He has a background in Homeopathy and is a Master Practitioner of Neuro Linguistic Programming (NLP) and Emotional Freedom Technique (EFT), which he uses in Life Coaching. He is a member of the Register of Chinese Herbal Medicine (MRCHM) and Member or the British Acupuncture Council (MBAcC).

            He isn’t cheap (http://sordyl.co.uk/13/Charges.html);
            “Charges
            New patient (80 minute appointment): £80.00
            Subsequent treatment (40 minute appointment): £40.00
            Herbs on average will cost (per week) : £5.00 – £10.00
            Fertility treatment for couples: £120”

            He makes ridiculous claims (http://sordyl.co.uk/11/Fertility-Acupuncture.html);
            “Fertility Acupuncture
            Acupuncture has a long and successful history in reproductive medicine. It can be used to help boost natural fertility, to help improve the chances of IVF success, and to prepare the body for conception and pregnancy generally.”

            And, despite his claims (http://sordyl.co.uk/3/Biography.html);
            “Because of his former extensive experience in business, and as a family man, he brings great insight and empathy to his work.
            His passion is the detailed knowledge and understanding of the human body and mind, and thus regular Continuing Professional Development (CPD) is directed towards detail anatomical studies and development of human interaction skills.”,
            he seems to be a particularly nasty b@st@rd.

            How many of his treatments withstand even cursory scrutiny?

  • Quite suddenly, the whole tenor of the discussion has taken on a new heat. Thanks to – I’m not going to pretend to be neutral here – the anger and vitriol of many of the homeopaths and acupuncturists, who aren’t doing their own side’s argument much good with their sneering, wild accusations. Something that I very recently had experience of on Facebook when a woman I’d encountered on a Crete ex-pats’ website, and with whom I’d been having a pretty civilised discussion about quackery -albeit that she’s a believer – said that it was pointless for me to send her any links to websites and reports as she wasn’t going to bother reading any of them – she knew what she believed and that, as far as she was concerned, was that.
    I then posted on my site a mention of an item about 10 Cancer Myths being debunked -available on, among others, the Cancer Research UK site. She spotted it, asked for a link. By which time, as I told her, I told her I’d done a bit of thinking and decided I found her attitude to this whole subject a trifle extreme and religious, and therefore while I was happy to continue on a somewhat more superficial, jokey level, I had decided to back out of that particular discussion since, as I put it, her view was the Daily Mail’s ‘I already know what I think, don’t confuse me with the facts’, and therefore I saw no point in wasting my time.
    At which point she became unhinged, and started shouting in capital letters and calling me a LIAR with weird views who LIED in order to satisfy my main obsession, which as she saw it was ‘winning arguments’. And then saw no other option but to Unfriend me.
    I’ll live.

    • Yes it has and it’s rude, mean spirited, inappropriate and reflects badly on everybody involved. That said these acupuncturists are having their careers negatively affected by the NICE guidelines issue, so you can understand a level of frustration.

      • thank you for pointing that out: THEY HAVE A SIGNIFICANT CONFLICT OF INTEREST!!!

        • Of course we do Edzard, we as evidence-based acupuncture practitioners are pretty sick and tired (and on some levels deeply bemused and even amused) of having to direct ‘experts’ such as yourself to examine the real evidence, as presented by Mel. One of the first things I learned during my Science degree was about bias, and you, kind Sir, with your rhetoric and tantrums, are exhibiting a prime example of confirmation bias.

          “It is error only, and not truth, that shrinks from inquiry.” Thomas Paine

          • @ Kylee Junghans

            Isn’t ‘evidence-based acupuncture practitioner’ an oxymoron in view of the data that are in?

            The following was apparent in 2013…

            QUOTE

            “…after decades of research and more than 3000 trials, acupuncture researchers have failed to reject the null hypothesis, and any remaining possible specific effect from acupuncture is so tiny as to be clinically insignificant. In layman’s terms, acupuncture does not work – for anything.”

            Ref: https://www.sciencebasedmedicine.org/acupuncture-doesnt-work/

            However, I don’t expect you to agree with the above. As Upton Sinclair said, “it is difficult to get a man to understand something, when his salary depends on his not understanding it”.

          • “it is also difficult to get a man to read something, when he is foaming from his mouth”.

          • if evidence-based practitioner is an oxymoron, then all those pesky trials showing efficacy and effectiveness, and silly old fMRI scans showing responses that I use to guide my practice must mean I am so dumb for actually doing a research degree and wasting years of my life studying and interpreting evidence. Now if only I could fake an fMRI scan for personal financial gain mwah ha ha

          • @ Kylee Junghans

            if evidence-based practitioner is an oxymoron, then all those pesky trials showing efficacy and effectiveness, …

            Yes, you’re right there. The one’s that show efficacy and effectiveness are certainly pesky. If you cherry-pick them only you may come to the wrong conclusion that evidence shows acupuncture works.

            …and silly old fMRI scans showing responses that I use to guide my practice must mean I am so dumb for actually doing a research degree and wasting years of my life studying and interpreting evidence. …

            You said it. If it is at all true you did a research degree, which I doubt in light of your apparent lack of rationality and comprehension, it certainly seems to have been wasted. I could find no trace of your name in several main databases of research publications. Not even Google found any mention of your name in relation to research, except an empty Academia.edu page with your name and “research interest acupuncture” that said you had not uploaded any papers yet.
            Yes, certainly wasted years.

            Now if only I could fake an fMRI scan for personal financial gain mwah ha ha

            It’s already been demonstrated how easy they are to fake or fumble. Take a look at the fMRI of a dead salmon that some guys made. It demonstrates how easy it is to tweak such a study to show what you wish for.

          • Hi Bjorn, you’ll just have to take my word for it that I did a research degree (and a health science degree). That you couldn’t find me online is awesome… means my privacy settings are just right! Lets put the ad hominem attacks aside and move onto ad nauseam responses instead…

            If someone claims to be an expert in a field (which, by the way, I have never claimed to be), and uses their public profile (and SHOUTY CAPS) to expound on a topic that, at the heart of the matter, concerns ALL (yes, shouty) genuine practitioners in health care, (that is the appropriate provision of care for patients), then shouldn’t said expert be held to the same level of scrutiny that said ‘expert’ applies to the available evidence?

            It is reasonable to question EVERYTHING (sorry for the shouty, but I kinda like it), and if gaps in reporting & findings/conflicts of interest/questionable methodology are discovered and pointed out (in Mel’s case, very clearly and respectfully…I might have used SHOUTY CAPS), then it is also reasonable to expect the ‘expert’ to respond in kind, rather than brush off SERIOUS FLAWS (loving it) in the (ok, i’m going to say it… the NICE guidelines) evidence?

            You’re right Bjorn, there are many flawed and poorly designed acupuncture studies, but there are also many, many well designed and executed studies that show acupuncture to be effective. Look them up. A man as learned as yourself would have no trouble finding them and applying an appropriate level of scrutiny to them.

            The question remains… why would and ‘expert’ refuse to acknowledge the flaws in this document when they are so bloody OBVIOUS (couldn’t resist, one last shouty time)? I can’t wait to see Edzard’s response to the amended guidelines.

          • @ Björn Geir on Monday 23 May 2016 at 23:24

            This is Dr Kylee, from http://www.danielwillischiropractic.com.au/about-warragul-chiropractors.html ;

            **************************************************************************
            DR. KYLEE JUNGHANS BHSC(ACUPUNCTURE), MPH

            Kylee is a registered Acupuncturist, who has recently relocated with her family to the Gippsland area from the Gold Coast.

            Qualifications include a Bachelor of Health Science and a Master’s Degree in Public Health from Griffith University School of Medicine.

            With thousands of hours of clinical experience and a strong interest in research and evidence-based medicine, Kylee is able to provide acupuncture treatments that are tailored to your specific health needs.

            Acupuncture is a painless, safe and effective treatment option for a wide variety of symptoms and conditions for both adults and children, including:

            Musculoskeletal pain & injuries
            Fibromyalgia
            Women’s health & gynaecological issues
            Fertility
            Anxiety & Depression
            Insomnia
            Dizziness/Vertigo & Tinnitus
            Skin disorders
            Gastrointestinal disorders
            *************************************************************************

            She works in a chiropractic clinic in Warragul (Victoria, Australia) and is the full wu. Have a look at the web site (http://www.danielwillischiropractic.com.au/spinal-conditions.html) to see what a broad range of diseases can be treated. And I won’t keep you waiting; this chiro is a subluxationist.

            So, for all of Kylee’s bravado about research and other blatherings, she works with a chiro who has been disowned by most chiro organisations who disavow the subluxation.

            Poor Kylee, so self-affectionate and forthright, but putting her lot in with a chiro who even chiros disown.

          • You are a DOUCHE! AD HOMINEN AND SHOUTING

          • @ Kylee Junghans on Wednesday 25 May 2016 at 10:50

            “You are a DOUCHE! AD HOMINEN AND SHOUTING”

            Oh my, such anger. So much so, you use an American term when you are an Australian and this sort of language only seems to impinge on the feeble-minded, those incapable of holding their own language traditions separate from the assault from American grossness.

            Didn’t you say this, “with your rhetoric and tantrums”, as a form of pejorative for those who were not able to pursue a matter rationally? So much for rationality. The facade could only continue for as long as you weren’t exposed for the nonsense world you inhabit.

            (That is “Hominem”.)

      • The thing is that Ernst and his cohorts have waged a prolonged and steady war in the name of science against CAM in general and Chinese medicine in particular. They have worked to discourage Universities from offering courses and engaging in research on the grounds that it is tainted work. This results in reduced availability of meaningful treatments to patients, hinders valuable research and the raising of academic standards, and impacts on practitioners’ livelihoods. Ernst would regard these as successes. He professes a scholarly detachment, a commitment to evidence and an open mind, but in fact is deeply biased and, as we see from this discussion, when there is compelling evidence against his stance, he backs off, claims not to have the time to respond or read the evidence, and resorts to SHOUTING in capital letters. In the discussion above, he proclaims Ernst’s Law: “If you are researching complementary and alternative medicine (CAM) and you are not hated by the CAM world, you’re not doing it right.” He clearly loves his childish provocative stance and is as far from a disinterested observer as it’s possible to be. I wouldn’t waste my time or breath on him if he didn’t have an influence that far exceeds his worth.

        • The thing is that Ernst and his cohorts have waged a prolonged and steady war in the name of science against CAM in general and Chinese medicine in particular. They have worked to discourage Universities from offering courses and engaging in research on the grounds that it is tainted work. This results in reduced availability of meaningful treatments to patients, hinders valuable research and the raising of academic standards, and impacts on practitioners’ livelihoods.

          Your fallacy is: begging the question. What meaningful treatments? The entire reason why people have opposed “integrative” nonsense is precisely due to the lack of evidence that the treatments are meaningful. And this work does not prevent good scientific study, rather, it deters practice based on dogma and usually absolutely terrible science.

          In fact, the telling point is the last one: practitioners’ livelihoods. That seems to eb all the integrative crowd really care about.

          • “In fact, the telling point is the last one: practitioners’ livelihoods. That seems to eb [sic] all the integrative crowd really care about.”

            What an asinine, reductive nonsense.

    • Your comment that this is not doing the case of acupuncturists any good, is quite fair and reasonable. I have to say as a practising acupuncturist, willing to question the efficacy of my actions, I have encountered similar hostility. My own opinion is that it is the role of the acupuncture profession to provide evidence and to engage with challenges to research. Something that needs to be taken more seriously.

  • Er… yeah.

    • Or more there isn’t much conflict, they’re angry.

      • yes, I noticed.

        • As a neutral observer in this spat about acupuncture I see anger and irrational statements from some acupuncturists. I see provocative and childish gloating on the other side. Neither are helpful, at least not in debating the issue at hand. I can see the value to parties with an established bias and position in poking the acupuncturists with a stick so that those with a short fuse and poor or no understanding of research and the hierarchy of evidence crawl out and make a lot of noise, doing their cause no favours. That must be satisfying if you have an agenda other than the one at hand, but it does not further the discussion, it simply exposes that there are some acupuncturists who are not research literate. There clearly are others who are. Mel’s posts appear the most reasoned and rational here yet have been cursorily dismissed and his/her points and position not addressed.

          • I thought I did answer her questions; please look again.

          • Perfect contribution. And the venerable Professor certainly did NOT answer her questions, whether he “thought” so or not. He misdirected. Repeatedly.

        • I have followed this discussion with interest. Some of the rudest and most discourteous posts I can see are from Mr Ernst himself. But I get that, I imagine you seek to maintain a bold and authoritative tone simply by dismissing others. Being a bit controversial in your discourse has obviously served you well in that you have built a media profile on it.

          I have a great idea… why don’t you be really controversial and answer some of the questions that have been asked? If you really wanted to silence the world of CAM you could stun them all with your incisive and insightful answers. All I can see are flippant retorts and sarcasm.

          Just maybe we could all make some progress on this, instead of digging heels in. Evidenced Based Medicine is at the heart of what you do, and at the heart of this debate. Look at the evidence base. Then debate. Surely you have a professional and moral obligation to do so. That is what Mel has respectfully suggested and it seems reasonable.

          • show me where I have been rude or ruder than my opponents in this discussion, please.
            you obviously did not notice, but I did answer questions.

          • Again dodging the point which is this – you have a professional obligation to investigate the evidence at the heart of this, and answer the original questions posed by Mel.

            You would earn some respect from your readers if you did so. This may not be comfortable territory but it can only help your cause to demonstrate you have read and understood the evidence base behind the Draft NICE guidelines. You might be surprised by some of the data?

          • I did answer her questions

          • Nice example of tone trolling there.

            Now a question for you: why should anyone display defence towards SCAM practitioners? They adopt practices which are, by definition, not based on evidence, they engage in “research” which is carefully designed to avoid falsifying their beliefs, they discount all evidence that contradicts with their beliefs, and they accuse anybody who does not share their beliefs of being closed-minded. What part of that qualifies for anything other than mockery?

            I refer you to Minchin’s Law: the name for alternative medicine that has been proven to work is: medicine. Only in the fantasy world of SCAM does a practitioner demand to be allowed to sell a treatment until others prove, to the SCAM-peddler’s satisfaction, that it is bogus. The entire field is founded on a reversal of the burden of evidence and repudiation of the approach which finally ended two millennia of bloodletting and purging.

          • the “gentleman” in question, suffers from an extraordinary lack of self-awareness. My diagnosis: Narcissistic Personality Disorder. “Lack of insight is one of the most challenging aspects of treating personality disorders. Such patients are notoriously unaware of their impact on others or the consequences of their behaviour for themselves”

          • @ wu ming on Tuesday 24 May 2016 at 01:22

            “the “gentleman” in question, suffers from an extraordinary lack of self-awareness. My diagnosis: Narcissistic Personality Disorder. “Lack of insight is one of the most challenging aspects of treating personality disorders. Such patients are notoriously unaware of their impact on others or the consequences of their behaviour for themselves””

            Despite it being obvious, your comment has been posted on the prof’s blog. Do you think someone with NPD would do that?

            Not only do you show complete daftness, you display an extraordinary lack of awareness and self-awareness.

  • @ Chris

    Re Ernst’s Law, it is not, as you claim, a strange rule at all. The number of ad hominems (e.g. ‘Mr’ Ernst) levelled at Professor Ernst PhD in the comments above are fairly typical of adherents of alternative medicine when they start to sense that their beliefs and livelihoods are under serious threat.

    Here’s Professor Ernst’s own view of Ernst’s Law:

    “If a scientist were to instil scientific, critical, progressive thought in a field like neurology, thus overthrowing current concepts and assumptions, they would be greeted with open arms among many like-minded researchers who all pursue the aim of advancing their field and contributing to the knowledge base by overturning wrong assumptions and discovering new truths. If researchers were to spend their time trying to analyse the concepts or treatments of alternative medicine, thus overthrowing current concepts and assumptions, they would not only not be appreciated by the majority of the experts working in this field, they would be castigated for their actions.
    If a scientist dedicated decades of hard work to the rigorous assessment of alternative medicine, that person would become a thorn in the flesh of believers. Instead of welcoming him with open arms, some disappointed enthusiasts of alternative treatments might even pay for defaming them.
    On the other hand, if a researcher merely misused the tools of science to confirm the implausible assumptions of alternative medicine, he would quickly become the celebrated ‘heroes’ of this field.
    This is the bizarre phenomenon that ‘Ernst’s law’ seems to capture quite well – and this is why I believe the ‘law’ is worth more than a laugh and a chuckle. In fact, ‘Ernst’s law’ might even describe the depressing reality of retrograde thinking in alternative medicine more accurately than most of us care to admit.”

    Ref: http://edzardernst.com/2013/11/ernsts-law/

    • @Blue Wode

      That fleshed it out a bit and is more reasonable and reasoned. I am not in significant disagreement with the sentiment there. But the suggestion or pretence that because Prof Ernst identifies a reaction to his work amongst some in ‘CAM’ (and, yes, it is apparent here amongst some who choose to engage and react) it follows that this represents the thinking of an entire profession, supposed group of professions or all individuals within those groups is not correct, honest or ‘good’ thinking.

  • and why wouldn’t we be angry? As Peter Deadman points out, your stance, not based on scientific evidence, is being taken as gospel by many people, who either can’t interpret research correctly, or can’t be bothered to as they have made up their mind about acupuncture. It is frustrating. Why not just answer the questions posed and if you find anything Mel has written to be factually incorrect (rather than just going against your beliefs), be brave and admit you are wrong to suggest acupuncture should not be included as a recommended modality for care and management of LBP. The more you put yourself forward in this instance, the sillier your stance becomes.

    • I have answered Mel’s questions, did you not notice?

      • Edzard

        I wrote two posts yesterday and you didn’t answer any of the questions that I posed to you or even acknowledge what I had written – I was unsure whether one of your posts was directed to me or Mel. With regard to your responses to the questions and issues raised by Mel, they did not give the impression of being considered or complete.

        You will note from my posts from yesterday that I have not sought to defend or promote acupuncture, rather I am interested in good science and fairness. I am keen to establish clarity and transparency about your current position regarding the draft NICE guidelines given that there seems to be some doubt over the reliability over the evidence used/not used to support them. Would you please do me the courtesy of replying to my questions from yesterday?

        • I thought I had made my position clear several times: if Mel’s interpretation is correct [a big IF in my view], I will comment once we have the final version from NICE. anything else would be premature or even irresponsible, in my view.

          • Mel’s questions clearly relate to the current document and evidence base used in making that document. You have no need to wait for another version if you are doing your job which is to read the current documentation and evidence base used.

            It’s as simple as that. It is indisputably far more irresponsible to not be undertaking a detailed analysis of the evidence base used, as Mel has sought to engage you in.

          • I have explained my position; if you cannot or do not want to understand it, I am unable to help you.

      • She didn’t notice, since you didn’t answer. Are you hallucinating?

  • Tony wrote on Wednesday 18th May at 11:25 : “I’d would happily extend to you [Professor Ernst] an invitation to come and chat to me about what I do, what my personal values are and how I operate. A civilised conversation between 2 committed individuals who hold an opposing position but a similar passion and commitment to their work. Im sure you would find that I’m not a deluded, uneducated thief but a normal bloke, trying to do his best for people and make a modest living in the process.”

    Were such an encounter to happen, I suspect that Professor Ernst would be left with impressions very similar to those he had following a visit to the Anglo European College of Chiropractic just over a year ago:

    QUOTE

    “My own impression of the day is that some of my messages were not really understood, that some of the questions, including some from the tutors, seemed like coming from a different planet, and that people were more out to teach me than to learn from my talk. One overall impression that I took home from that day is that, even in this college which prides itself of being open to scientific evidence and unimpressed by chiropractic fundamentalism, students are strangely different from other health care professionals.”

    Ref: http://edzardernst.com/2015/01/my-visit-to-the-anglo-european-college-of-chiropractic/

    BTW, it’s worth remembering that Professor Ernst has had hands-on training in acupuncture:
    http://edzardernst.com/about/

  • What a uncouth cavalcade of concerted heckling. Wonder who dealt out the tomatoes and rotten eggs?

    Why don’t these people who are so convinced of the greatness of their “art” spare the energy for providing positive proof of acupuncture’s superiority. Should be easy with such miraculous results.

    From what these people are saying, acupuncture is such a fantastic method of getting even the most impossible cases of hopeless double disc herniations and whatnot miraculously out of bed in no time, not to speak of all the simple lumbago cases.
    Then how come that in my part of the world, where medicine is socially funded, practitioners of this wonderful miracle are few and far between?
    There should be at least one well-salaried acupuncturist on every block.
    You see, back problems are very costly for society. Insurance companies and governments would hire acupuncturists in troves because back problems are one of the most common and most expensive cause of absence from work. And anything that would raise productivity is certain to get the attention of big money – but acupuncture, for some peculiar reason has failed miserably tp get the attention of those who pay to keep the society rolling and production going.

    How come the Nordic countries for example, with their socially funded medical services, aren’t educating and employing troves of needling experts to lower this enormous cost for society? How come american insurance companies aren’t shoveling money into the cash registers of acupuncturists?
    How come hundreds of millions of back pain sufferers are using other methods and usually just getting better anyway after some days, even if they never get to feel the sharp end of an acupuncture needle??

    How come all these eminent (in their own view at least?) acupuncturists so indignantly expressing their dissatisfaction with our criticism of their “art”, are even bothering with this puny argument instead of working on the studies and writing up the fantastic results – or just enjoying an umbrella drink at the poolside?

    Now let’s hear from the back row, if they can put down the rotten eggs for a second, why acupuncture is having such a hard time despite its fantastic potential?

    • Cheers for that, Bjorn.
      Unless you’d missed it, there are quite a lot of us making a living doing this, a lot of people find it helps.
      Notably insurance companies who routinely pay for my clients treatment.
      The tone you’re using really doesn’t elevate the debate. Does it?

      • Bob Dobbs
        So precisely have you undermined your own argument that, should you be unable to work out how, I shall not waste any of my time explaining. Took just three and a bit short sentences as well. Is that a record?

      • Nice try Bob, but your arguments only illustrate your limited outlook and inability to understand the point i am making. Let’s try feeding it to you with a spoon:

        Back pain is very expensive for the society because it causes severe productivity loss and absence of work. Consequently, if acupuncture was the fantastic miracle for back pain and spinal problems, not only would it be fantastically more common, acupuncturists/acupuncture would be a normal part of the health care systems all over the world, which it is not.

        Even if you perceive your own little patch as containing several of your own species, and they manage to make a living by sticking people with needles for ailments that get better anyway, the real world is bigger than your horizon.
        On a global scale, acupuncturists are relatively few and far between, which only proves how they have generally failed to demonstrate their worth for more than entertaining the worried well and fool those who will believe anything that seems unconventional.
        Acupuncture just isn’t supported by solid, independent evidence. When the totality of it is examined, which NICE has been doing along with lots of other institutions and organisations, it does not show a real effect over that of wishful thinking and suggestion (~ placebo effect).
        The results of such reviews (of the totality of evidence) is why NICE are planning to remove acupuncture from their recommendations.
        If acupuncture was at all effective, it would have been demonstrated long ago on a massive scale but all they can come up with is incredible anecdotes like we have seen above and can have many different explanations as Barry Beyerstein explained with clarity in his classic essay.

        In North America there are of course the odd insurance companies that can be lured to pay for make believe medicine but that does not prove the worth of acupuncture, chiro-adjustments, reiki, reflexology or any of the hundreds of different alternative medical”miracles” that are all effective in the eyes of those who profit from them – not any more than votes for Donald Drumpf’s prove that he is an able candidate for president.
        The world is bigger than North America and in many countries, government institutions and organizations independent from vested interests, search actively for solutions to expensive health problems like back pain.

        Instead of complaining about my tone, which I consider quite adequate in the context above, why don’t you explain why acupuncture isn´t subsidized by governments and health care systems all over the world if it is so effective for back pain?

        • Logical wrong. Populazation of medicine or benefit from medicine is received by public of people which by mouth not by policy. To save money or working for other purpose such as politics or someone own ideal like Edzard thought a government will like to use policy or regulationt to push or turndown . Nice this time is making U turn . That is not thinking for public people but for saving money for NHS , This is definitely correct because Nice is paid by the Government. But no government in this world represents medicine, doctors, patients and people. As long as you are employed by the agent or institute your personal moral is limited. You can’t tell other people truth. Yesterday Chair of Nice told audiences he worked NHS 30 years as GP many patients thought he is a great doctor but he knows most time he was giving placebo. Do you believe he was doing that everyday cheating his patients over last 30 years and then no one blames him and he is even promoted as Chair to decide how to treat or cheat the nation. Again definitely that is not case. My personal feeling he must have been a very good doctor and definitely healed a great number of his patients when he was GP . As GP his personal moral was not limited. He must have tried best to relief any symptoms for his individual patients even he knew some treatment might not cure the problem . He must believe some placebo is essential to relief pain such as aspirin and later people could have chance to cure. That is before his Chair. However since he is Chair and not doctor he becomes politician who is always tell one side story to benefit one side. Edzard might be slightly different from the Chair and he does not pretent as politician to say good words. He makes very clear that CAm is not working such herbs and acupuncture. We should respect his points and majority of population under NHS might be also agree with him. But that does not suggest they are right and CAm is useless. If we accept you logic the Biggest placebo organisation in the world is NHS not acupuncture.

        • Thanks for your redoubtable efforts at schooling me.
          Isn’t what we’re arguing about on this thread, that acupuncture was recommended for back pain by NICE, then it wasn’t but actually it should have been, because it was better than NSAIDs, exercise, etc when you looked carefully at the figures?
          I don’t recall mentioning ‘miracles’, ‘must have been you.

        • Bjorn, using the NICE as a justification against acupuncture as a LBP treatment is probably not a good argument in your favour lol

    • You should find a girlfriend, you’re a very angry little man. It’s not good for your health.

      • You should find some decorum, you presumptuous knob.

        Whether the prof wants, needs, or otherwise thinks about a “girlfriend” is the worst kind of judgemental ad hominem. It reflects your standards in all forms. Likewise, reference to a person’s height is pathetic. At 189 cm, is it acceptable for me to ridicule because you are shorter than me. Truly a refuge of the intellectually bereft.

        Given the dubious nature of your qualifications, you are one of the last people the prof is likely to advice from.

  • A friend who has a place in France-where of course belief in wingwang is high – and not a fellow prone to practical japery informs me that there is available a homeopathic pill called ‘Homophobiol’, which is meant to combat homophobia. Whether he has been duped, or whether the French have invented a top joke, I know not. I leave it with you.

  • many thanks to wu ming and all the others who used this forum for ad hominem attacks and thus demonstrating yet again that such attacks are a VICTORY OF REASON OVER UNREASON [http://edzardernst.com/2012/12/ad-hominem-attacks-are-signs-of-victories-of-reason-over-unreason/] + [http://edzardernst.com/2012/12/ad-hominem-attacks-are-signs-of-victories-of-reason-over-unreason/] + [http://edzardernst.com/2016/05/acupuncturists-defeated-by-their-very-own-display-of-unreason/].
    THANKS BOYS AND GIRLS!!!

    • Some of the Quackers’ ‘ad hominem’ comments are now becoming puerile and deranged to a quite disturbing extent. But then if they had the ability to take a step back and realise that, they’d equality have the ability to stand back and see the immaturity of their silly Wngwang religion.

    • So what you’re saying is because some people, presumably acupuncturists, can’t avoid behaving rudely that means they must be wrong?

    • Edzard, you need to see a doctor. I feel sorry for you. That is not ad hominem – that is compassion (by the way, stay off the Latin, you are not good at it)

  • BSc – Bachelor of Science… The requirement for western science learning – the clue is in the name! The best of your knowledge appears to be not quite enough in this case.
    If a course had no westerns science, it would have likely been considered an arts degree.

    • I have been in charge of a BSc in Exeter! read my memoir…science learning? minimal

    • @James Brown

      You said

      If a course had no westerns science, it would have likely been considered an arts degree.

      First of all, there is only science, no ‘western’ science. Scientists all over the planet follow the same methods, read Nature and Science, and increase our knowledge base of reality.

      If you think courses in witchcraft would be considered as arts degrees, you’re dead wrong. Take a look here, and here, and here, and here. All BSc courses in branches of SCAM.

      Sadly, universities nowadays are merely businesses. Their objective is to coin in cash. At the bottom of the barrel are institutions that don’t seem to care where the cash comes from.

      • Seems Frank decided to post four links to courses (well the first three I looked at – does that count as cherry picking) in acupuncture whose details clearly demonstrate a grounding in medical sciences and BSc level research and statistics, rather undermining his intended point I think.

        • @ Chris Bury on Tuesday 24 May 2016 at 18:23

          “Seems Frank decided to post four links to courses (well the first three I looked at – does that count as cherry picking) in acupuncture whose details clearly demonstrate a grounding in medical sciences and BSc level research and statistics, rather undermining his intended point I think.”

          I looked and couldn’t see what you claim. The curriculum isn’t defined, so the unit titles could encompass anything. Wishful thinking, at its finest.

          However, this would come as no surprise from someone who is an osteopath and can treat an incredible range of conditions, including cranial osteopathy and those affecting babies and children.

          He and his business partner have an amazing array of “skills” (my favourite is lymphatic drainage because the human body does this ever so poorly);

          “Qualified Practitioners in

          • Acupuncture
          • Aromatherapy
          • Chinese Herbal Medicine
          • Counselling
          • Emotional Freedom Techniques
          • Healing
          • Herbal Medicine
          • Homeopathy
          • Manual Lymphatic Drainage
          • Massage
          • Osteopathy
          • Physiotherapy
          • Reflexology
          • Cranial Osteopathy

          http://www.creditoncomplementaryhealthcentre.co.uk/

          The obvious question is then; how can a person who believes so much nonsense able to make any judgement about the “science and medicine” involved in any course of study?

          The BS meter went full off scale.

  • You’re saying that their resort to ad hominem attacks is actually a strategy to cover the paucity of their argument. They use of it is simply a means to the end of covering their lack a coherent arguments regarding the efficacy of acupuncture as a treatment modality. In essence they’re rude because they have nothing better to bring to the table. Is this correct?

    • Yep.

      • Apart from the fact that studies that suggest that the control used on many acupuncture trails isn’t an appropriate control. And that acupuncture should have been advised for patients with back pain because it was quite good.

        • @ Bob Dobbs on Thursday 26 May 2016 at 08:52

          “Apart from the fact that studies that suggest that the control used on many acupuncture trails isn’t an appropriate control.”

          It seems that alt-meds want to agree with the type of control before a study and disagree afterwards when it shows nothing positive for their brand of witchery. James Randi stuck this constantly with his $1 million dollar challenge.

          “And that acupuncture should have been advised for patients with back pain because it was quite good.”

          Isn’t that the point of a study or studies. Begging the question does nothing, unless you are an alt-med.

          • The one simple question to ask quacks like the fellow Dobbs, of course – and which they’re completely at a loss to answer except with aggressive fuff – is why there isn’t a homeopath strutting around the place with 1 million dollars sticking out of his pockets, puffing a cigar like a Beano toff, having claimed Randi’s prize and made him -and the whole of Science – look utterly backward and foolish.
            I must admit that he is -if nothing else -possessed of great nerve, if he seriously expects people not to laugh in his face when he demands special rules for Quackery testing.
            Who knows? If Rotherham United had been allowed such leeway, they could have won promotion to the Premier League instead of battling all season against relegation. Some of what what this old narrow-minded world fussily called ‘defeats’ could have been analysed differently, using a different ‘modality’ -let’s call it lying – and magically turned into ‘wins’. Bingo! Promotion!

  • Does anyone know of a medical practitioner who wanted to become a physiotherapist?

  • “The new draft guideline by NICE recommends various forms of exercise as the first step in managing low back pain. Massage and manipulation by a physiotherapist should only be used alongside exercise; there is not enough evidence to show they are of benefit when used alone.”

    Interesting, since the latest Job Analysis I read reports that in 2009:

    96.8% of chiropractors report they do corrective and therapeutic exercise.
    92.3 % of chiropractors report they do rehabilitation exercise.

    And physical fitness and exercise promotion is done on a daily basis.

    Yet the title of the blog is, “NICE no longer recommends acupuncture, chiropractic or osteopathy for low back pain”

    Perhaps another example of EE confusing a profession with a modality?

    • no, most definitions of chiropractic define it as the ‘practic’ not the ‘practor’

      • The title of this blog is misleading (and I’m being nice) as it does not appear to represent the report.

        In fact, it appears that this report said that SMT could be considered as an adjunct to exercise, two approaches which are already used by most chiropractors on most of their patients most of the time.

        So for the title to say NICE no longer recommends chiropractic…tsk, tsk.

        • @Doc Dale

          The question has been posed many many times, by several commenters, with many dissembling responses from chiros. What, assuming you don’t hold with subluxations, vitalism and all the Palmer stuff, is chiropractic? I’ll try to put it another way: what distinguishes chiropratic from physiotherapy? Or spinal manipulative therapy? Why do you (and others, they know who they are) feel you need to call yourself a chiropractor?

    • I do sports massage and Acupuncture for low back pain .sciatica .it does help with the problem .help the problem first then do exercises it works I’ve worked from my doctors for 8 years they refered for it

  • Another interesting little finding…

    “It was also very interesting to note that the vast majority of our sample (89.5%) agreed or strongly agreed with the statement “I am interested in learning or improving the skills necessary to incorporate EBP into my practice”.”

    http://chiromt.biomedcentral.com/articles/10.1186/s12998-015-0060-0

  • Lets start by saying the link of NICE Guidelines below strictly states acupuncture is not an effective method for chronic lower back pain. There is no mention of Physiotherapists, Osteopaths or chiropractors. It says exercise should be the first point of action “I agree” however says on the second sentence down “massage and manipulation by a THERAPIST” they are using the word therapist in a broad sense to include the practice of Physiotherapy, Osteopathy and Chiropractic. Remove or correct this inaccurate post by changing Physiotherapist to Therapists and removing any mention of Physiotherapy, Osteopathy or Chiropractic. An yes im aware he mentions one Journal of a chiropractor, dont cherry pick one thing and claim it as fact.

    Ok so I have read the link to his NICE Guidelines (apologies for some reason it made spelling mistakes when i copied and pasted it) click his link and see what i mean anyway, the errors present makes no difference anyway. Here it is:

    The draft guideline recommends exercise, in all its forms (for example, stretching, strengthening, aerobic or yoga), as the first step in managing low back pain.

    Massage and manipulation by a therapist should only be used alongside exercise because there is not enough evidence to show they are of benefit when used alone.

    The draft guideline also recommends encouraging people to continue with normal activities as far as possible.

    The draft guideline no longer recommends acupuncture for treating low back pain because evidence shows it is not better than sham treatment i. Paracetamol on its own is no longer the first option for managing low back pain. Instead, the draft guideline recommends that non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or aspirin should be tried first. Weak opioids, such as codeine, are now only recommended for acute back pain when NSAIDs haven’t worked or aren’t suitable.

    Combined physical and psychological treatments (talking therapies) are recommended for people who have not seen an improvement in their pain on previous treatments or who have significant psychological and social barriers to recovery.

    The updated draft guideline has been expanded to include people with sciatica, a painful condition typically caused by irritation or compression of the nerves which run from the lower back, through the legs and down to the feet.

    Unlike the previous guideline, which only covered the management of low back pain that had lasted between 6 weeks and 12 months, the updated guideline covers people with low back pain or sciatica irrespective of how long they have had the condition

    Professor Mark Baker, clinical practice director for NICE, said: “Millions of people are affected every year by these often debilitating and distressing conditions. For most their symptoms improve in days or weeks. However for some, the pain can be distressing and persist for a long time.

    “Regrettably there is a lack of convincing evidence of effectiveness for some widely used treatments. For example acupuncture is no longer recommended for managing low back pain with or without sciatica. This is because there is not enough evidence to show that it is more effective than sham treatment.”

    Professor Baker continued: “It is possible to reduce the impact that low back pain and sciatica can have on people’s lives. The draft guideline continues to recommend a stepped care approach and means people whose pain or function are not improving despite initial treatment should have access to a choice of further therapies.

    “Our aim with this draft guideline is to give clarity and set out the most clinical and cost effective ways to treat low back pain and sciatica based on the best available evidence. We now want to hear from all those who provide care for people with these conditions in the NHS, as well as from people with the conditions and their carers, to ensure all relevant views are considered for the final guideline.”

    According to musculoskeletal physician and GP Dr Ian Bernstein*, who is on the group developing the guideline: “The diagnosis of back pain includes a variety of patterns of symptoms. This means that one approach to treatment doesn’t fit all. Therefore the draft guidance promotes combinations of treatments such as exercise with manual therapy or combining physical and psychological treatments. The draft guideline also promotes flexibility about the content and duration of treatments, and the choices made should take into account people’s preferences as well as clinical considerations.”

    A recent studyii found that lower back pain caused more disability than any other condition, affecting 1 in 10 people and becoming more common with increasing age.

    In the UK it is estimated that low back pain is responsible for 37% of all chronic pain in men and 44% in womeniii and the total cost of low back pain to the UK economy is reckoned to be over £12 billion per yeariv.

    Sciatica is also a relatively common condition, with estimates suggesting that as many as 40% of people will experience it at some point in their lives.

    Ends

  • A fairly recent and decent overview of systematic reviews of acupuncunture for LBP by Liu et al.

    http://www.ncbi.nlm.nih.gov/pubmed/25821485

    Decent except for their conclusion, which stretches the evidence too far, IMO.

    My own conclusion:

    Consistent results of systematic reviews show that acupuncture is no better than sham for acute/subacute LBP, either for short term pain relief or functional improvement.

    Conflicting results of systematic reviews mean it is unclear whether acupuncture is effective for short term pain relief for chronic LBP; however, consistent results show no functional benefit.

  • I just found a summary of the very complex evidence that, I think, is solid and fair (http://www.dynamed.com/topics/dmp~AN~T906249/Acupuncture-for-chronic-low-back-pain#sec-Efficacy):
    Evidence synthesis All 4 trials found a clinically significant improvement in pain and function was more likely with acupuncture than with usual care.
    In comparing acupuncture to sham acupuncture, 2 high quality larger trials found no difference in likelihood of clinically significant improvement, while the other 2 smaller trials reported that clinically significant improvement was more likely with acupuncture than with sham.
    Systematic reviews reported comparable findings (consistent benefit compared to usual care, inconsistent results suggesting no difference compared to sham) but were limited by use of mean scores rather than responder rates.

    Clinical perspective: Guidelines are inconsistent with one recommending acupuncture, one recommending against acupuncture, and one not making a recommendation for or against acupuncture. Across many potential interventions for chronic low back pain, doing something is more effective than doing nothing, and doing something appears as effective as doing something else. Acupuncture can seem effective whether real or sham. Some clinicians may consider any efficacy a placebo effect, and find suggesting acupuncture unwarranted. Despite not having proof that a specific (or any) technique is involved in patients feeling better with using acupuncture, it still could be a reasonable option based on relative safety compared to other active interventions for patients with chronic low back pain who are looking for a different therapeutic option.
    Contributors: Alan Ehrlich, Brian Alper, Ashvin Shah, James LaRue, Eric Manheimer

  • I live in Jacksonville and got accident few years back . Injuries are healed but my pain was there for a long period . Someone told me to see a near car accident chiropractor .
    I visited a chiropractor and i dont believe i was feeling well .

  • final guidance by NICE was just published:
    https://www.nice.org.uk/guidance/NG59/chapter/Recommendations#non-invasive-treatments-for-low-back-pain-and-sciatica
    “Acupuncture
    1.2.8
    Do not offer acupuncture for managing low back pain with or without sciatica.”

  • Much of the effect of the therapies (I am long term Physio in the NHS) with back pain is in reassurance and managing expectations. Illness behaviour in all its guises is complex and a lot of back pain , particularly ongoing back pain is embedded in suffering and often a complex narrative of iatrogenic disability which is perpetuated by all and sundry. The hands on approaches are akin to the fish biologists talk on radio four the other morning –strokes to facilitate bonding and perhaps reduction in threat , stress physiology. Everything else is theatre in addressing these aims . Some people are more prone to sensitisation and others for a whole complex raft of reasons .Many patients (particularly in pain clinics ) have complex whole system problems where a ‘healing response’ through talk/touch/exercise probably needs to be addressed –the back pain often therefore is the tip of the iceberg and no amount of evidence RCT trial evidence helps much in the clinic. However onto this topic, its good that modality type thinking is being challenged as the techniques and interventions are probably an attempt to imitate biomedical techniques when they are likely more ‘hypnotic’ in action …Advising exercises and logical approaches is sane and rational but many just wont buy into this and will follow the latest novel fashions espoused by Gwynneth and any other social media guru . Medical fashions are just the same and much of the interventions such as facet blocks and the like are no better in effect than needling someones tense back muscles but the medical interventions are facilitated by the white coat and the bigger bill –esp in private practice . All in all as Waddell suggested in the back pain revolution back pain intervention has been an unmitigated disaster and will probably always will be …The latest guidelines are encouraging but doubt if they will change much in the clinic environment for a while . Probably needs TV programmes and much more general education approaches starting at school level ….??

    • Excellent comment, Ian. This same discourse is current in osteopathic circles regardless of the narrow inaccurate view of our profession demonstrated by some ill-informed commentators

  • This is interesting…

    QUOTE
    “…let’s look at what the NICE guidelines say about exercise:

    ‘Consider a group exercise programme (biomechanical, aerobic, mind–body or a combination of approaches) within the NHS for people with a specific episode or flare-up of low back pain with or without sciatica. Take people’s specific needs, preferences and capabilities into account when choosing the type of exercise.’

    One important point from this guidance is that NICE recommends a “group exercise programme”. This presents something of a problem for pure manual therapists such as osteopaths and chiropractors as they don’t normally have access to a group exercise programme for their patients. I have already highlighted the fact that osteopathy and chiropractic are no longer first line treatment choices for low back pain and sciatica. NICE have made it clear in their own press release that exercise is the “first step in managing the condition”. The right person to deliver an exercise programme is of course a physiotherapist.

    The new NICE guidelines are something of a problem for osteopaths and chiropractors as their treatments are no longer first line choices and they are not well placed to offer a suitable exercise programme. Some of them may opt to continue treating patients the way the always have and not take the NICE guidelines into account. However, that is a potentially risky strategy for two reasons:

    It doesn’t seem to be in the best interest of their patients
    They risk being found in breach of their “Practice Standards” which could result in formal complaints to either the GOsC or GCC.”

    Ref: https://complementaryandalternative.wordpress.com/2016/12/06/nice-guidelines-for-low-back-pain-and-sciatica-a-clarification/

  • this is from a BMJ article with the summary of the final guideline:

    Consider manual therapy (manipulation, mobilisation, or soft tissue techniques such as massage) or psychological therapies using a cognitive behavioural approach, or both, for managing low back pain with or without sciatica, but only as part of a treatment package including exercise. [Based on high to very low quality evidence from randomised controlled trials and the experience and opinion of the GDG]

  • people with chronic lbp just need some pain killers and to running it off, no need for physical therapists

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