MD, PhD, FMedSci, FSB, FRCP, FRCPEd

Ad hominem attacks, I have previously pointed out, are victories of reason over unreason. And they are used frequently by supporters of alternative medicine!

If you doubt it, see for yourself.

I recently posted a comment on new Nice guidelines. It generated lots of comments, and mostly they were rational discussions of the issues involved. This changed abruptly when, on 16 May, Mel’s comment started a new, concerted wave of discussion at a time when the usual debate had already subsided. In the course of this new and heated debate, I was repeatedly accused of being rude.

As I have stated repeatedly on this blog, I try to keep rudeness out of the comments as much as I can. Therefore, the claim surprised me and today I reviewed the entire comment section selecting all potential ad hominem attacks. Here are the results:

ACTUAL OR POTENTIAL AD HOMINEM ATTACKS AGAINST ME

Peter Deadman on Tuesday 17 May 2016 at 12:55 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.

tonto on Tuesday 17 May 2016 at 13:19 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”.

Jill Onyett on Tuesday 17 May 2016 at 14:29 …an unfortunate creature too keen on the sound of his own voice.

Tracey Phillips on Tuesday 17 May 2016 at 13:16 …to date you have been fairly opinionated …

Peter Deadman on Tuesday 17 May 2016 at 16:34  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.

Peter Deadman on Tuesday 17 May 2016 at 16:52 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.

Peter Deadman on Tuesday 17 May 2016 at 19:30 How can such a childish provocateur remain in his post. It demeans the University and it’s time they let him go.

Kylee Junghans on Wednesday 18 May 2016 at 08:42 …you, kind Sir, with your rhetoric and tantrums, are exhibiting a prime example of confirmation bias.

Peter Deadman on Wednesday 18 May 2016 at 08:48 [Ernst] professes a scholarly detachment, a commitment to evidence and an open mind, but in fact is deeply biased… 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.

Carol Cooke on Wednesday 18 May 2016 at 09:27 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.

ACTUAL OR POTENTIAL AD HOMINEM ATTACKS BY MYSELF

Edzard on Wednesday 18 May 2016 at 09:18 “it is also difficult to get a man to read something, when he is foaming from his mouth”.

I know, this is not really ‘ad hominem’ but I could not find anything more dramatic. Surely, some will disagree this me here, and I do invite them to cite my rudeness from this threat, if they spot it. You are more than welcome!

CONCLUSION

You may think this is a bit trivial, but I disagree. The main reason I did this little exercise is to demonstrate a point which I think is important and carries a relevant lesson for future comments and discussions:

  • WHEN I OR ANYONE ELSE DEFENDING RATIONALITY GET AGGRESSED, WE NATURALLY TEND TO RESPOND SLIGHTLY MORE FORCEFULLY.
  • SUBSEQUENTLY, THE OTHER SIDE OFTEN REACTS BY ATTACKING US PERSONALLY.
  • THIS OFTEN LEADS TO AN ESCALATION OF TONE.
  • EVENTUALLY THE OTHER SIDE CLAIMS WITH INDIGNATION THAT WE ARE THE ONES DOING THE PERSONAL ATTACKS.
  • IT IS A TACTIC THAT IS EFFECTIVE BUT DISHONEST, IN MY VIEW.
  • THE LESSON IS SIMPLE: DO NOT LET YOURSELF GET PROVOKED INTO ISSUING AD HOMINEM ATTACKS, BE POLITE AND PATIENT.

I know this sounds simpler than it is, and I am far from being immune to the problem, but we owe it to reason to give it a try.

 

64 Responses to Acupuncturists defeated by their very own display of unreason

  • Dear Professor Ernst,

    I am so sorry to hear about the pain you must be feeling after so many personal attacks. I for one, think you are a beautiful human being, just misunderstood.

    I just wanted to question your analysis about the “defeat” part of the conversation. You have said numerous times that you have answered my questions. But that’s not the same thing as actually answering the questions. Perhaps you could troll through your comments section again? I have asked one question in particular perhaps 3 or 4 times now and I will try it again. If you have already answered it, feel free to copy and paste your previous response:

    “I will ask again: where is your evidence that sham acupuncture is biologically inert? I have provided strong evidence that it is not. This question goes to the very heart of your argument. You can call me all the names in the book, I’m sure your readers find it a hoot, but I think we’d all still appreciate an answer to this foundational question on which your entire argument about the nature of acupuncture rests.”

    If sham acupuncture is not biologically inert then your opinion that acupuncture’s effectiveness compared to usual care being due to solely non-specific effects is completely unfounded unless you have some other evidence, which we’d all be very interested to hear about. Thanks, Professor Ernst, we look forward to learning from you.

    • and I think you are a much more beautiful human being than I !!!
      anyway, about the ‘de qi’ [it’s off topic here, you know but I do make exceptions for such beautiful beings]. don’t you agree that, in case you insist that sham acupuncture is not inert, you are saying that all that stuff about meridians and acupoints etc. is pure flimflam?
      and another question: do you agree that the comments I refer to are ad hominem and a display of unreason.
      last question: why do you insist on me answering your questions, while you hardly ever answer mine? [could be construed as rude, you know, if I didn’t know you were such a beautiful human being, of course]

      • touched by your concern about pain!
        yet I must tell you I don’t feel pain, I feel amused; see here: http://edzardernst.com/2013/12/ad-hominem-attacks-my-life-would-be-so-dull-without-them/
        thanks for facilitating this so very skilfully.

      • Dear Professor Ernst,

        “don’t you agree that, in case you insist that sham acupuncture is not inert, you are saying that all that stuff about meridians and acupoints etc. is pure flimflam?” Fantastic question, welcome back to the conversation. The answer is no, and here’s why.

        Assuming that we want to test whether there are points on the body that when needled are better at resolving clinical issues than other points and that these points are based on Chinese Medical theory, to test that hypothesis we still need to understand whether or not our comparator is biologically inert. If it is, then the difference between the two types of needling is the specific effect of the acupuncture intervention. If sham acupuncture is not biologically inert, that does not invalidate acupuncture theory. It means that you are comparing your acupuncture treatment to an ACTIVE control, which means you need to recruit more patients when you design your study and interpret the results appropriately based on this reality.

        Adequately powered sham control studies demonstrate the superiority of acupuncture over sham. As far as I’m aware, the best attempt skeptics have had to critique these results was to say that the difference was small. And the point that I will continue repeating is that that’s fine, because the difference is not the effect of acupuncture over and above non-specific/placebo, it’s over and above an active comparator, which itself is superior to usual care. I really don’t think this is a complicated concept, but I’m certainly happy to continue to answer questions about this.

        “do you agree that the comments I refer to are ad hominem and a display of unreason.” I find this part of the conversation rather boring if I’m honest because it distracts from the actual research conversation, which is why I thought we were here. But no, not all of these are good examples of ad hominem attacks. When Kylee said that you were demonstrating confirmation bias, that wasn’t a personal attack, but rather an observation. And if I may, ad hominem attacks are directed against the person rather than the point they are making. But you have had so little to say in support of your point. Perhaps you could focus your attention there?

        “why do you insist on me answering your questions, while you hardly ever answer mine? [could be construed as rude, you know, if I didn’t know you were such a beautiful human being, of course]” Professor E, you could make a girl blush! You asked me about recent research publications and I answered. Did I miss any other questions?

        • Actually, thinking a bit more about ad hominem, you know all the times that you say we’re biased and irrational because we’re acupuncturists but you totally avoid commenting on the substance of the arguments we’re making?

          THAT’S textbook ad hominem. You point to the motive for the argument, rather than respond to the argument itself.

          Does this mean you’re going to stop doing that?

          • can you please cite the exact quotes?

          • Sure, here are a few. Feel free to add them to your post:

            Edzard on Tuesday 17 May 2016 at 14:48

            “why do you think acupuncturists defend acupuncture?”

            Edzard on Thursday 19 May 2016 at 18:32

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

            Edzard on Wednesday 18 May 2016 at 08:17:
            Regarding acupuncturists:
            “thank you for pointing that out: THEY HAVE A SIGNIFICANT CONFLICT OF INTEREST!!!”

            These are all fine examples of ad hominem, what you call “displays of unreason.” They are about arguer, not the argument.

          • I disagree: these were statements made as a reaction to direct attacks not to arguments.
            and even if you classified this as ad hominem, there is a degree of severity and the attacks on me are quite a bit stronger, wouldn’t you agree?

          • Professor Ernst, your comments are still ad hominem attacks. You seem to be offering the “well, they started it!” defense. Somewhat weak given the subject of your post. Furthermore, if you’re saying that ad hominem attacks really aren’t ad hominem if they are “statements made as a reaction to direct attacks not to arguments” (which isn’t true, by the way) then you need to demonstrate that all of the comments you cite above were in response to arguments. You haven’t actually made many (any?) arguments so it would be interesting to see if you could demonstrate this. But what you seem to be arguing (rather than admit that perhaps your own ad hominem attacks may have perhaps contributed to people calling you rude) is that context matters, so I might ask you why you’ve pasted these quotes without providing any context?

            “even if you classified this as ad hominem, there is a degree of severity and the attacks on me are quite a bit stronger, “wouldn’t you agree?”

            Ah, so you’re saying that you yourself demonstrated unreason but you judge this level of unreason to be less than the other side? And then you end your proselytism by admonishing your readers: “DO NOT LET YOURSELF GET PROVOKED INTO ISSUING AD HOMINEM ATTACKS, BE POLITE AND PATIENT,” even though by your own admission, you yourself weren’t able to successfully follow this advice?

            Sorry, what’s your point exactly?

          • no not ‘weak’ – it’s the whole point of my post!
            remember what I wrote:
            “The main reason I did this little exercise is to demonstrate a point which I think is important and carries a relevant lesson for future comments and discussions:
            WHEN I OR ANYONE ELSE DEFENDING RATIONALITY GET AGGRESSED, WE NATURALLY TEND TO RESPOND SLIGHTLY MORE FORCEFULLY.
            SUBSEQUENTLY, THE OTHER SIDE OFTEN REACTS BY ATTACKING US PERSONALLY.
            THIS OFTEN LEADS TO AN ESCALATION OF TONE.
            EVENTUALLY THE OTHER SIDE CLAIMS WITH INDIGNATION THAT WE ARE THE ONES DOING THE PERSONAL ATTACKS.
            IT IS A TACTIC THAT IS EFFECTIVE BUT DISHONEST, IN MY VIEW.
            THE LESSON IS SIMPLE: DO NOT LET YOURSELF GET PROVOKED INTO ISSUING AD HOMINEM ATTACKS, BE POLITE AND PATIENT.

            I know this sounds simpler than it is, and I am far from being immune to the problem, but we owe it to reason to give it a try.”
            END OF QUOTE
            and I even admit here that I am not innocent – at least I am trying! and at least I am contributing a lot of things other than insults to the debates, would you not agree?

          • “you say we’re biased and irrational because we’re acupuncturists”
            this is not true!
            I may have stated that this or that argument is biased or irrational but never because you are acupuncturists. when I say such things, I do so because I feel the argument is biased or irrational. can you show me quotes that support your statement?

          • Dr. Ernst,

            A couple more examples:
            In response to Alex Yuen, Wednesday 30 March 2016 at 16:05, he was making a point which may have been inaccurate, but was definitely not ad hominem, Dr. E: “your claims are nuts! are you too?” Followed short by another, “SORRY – I have run out of time to discuss with you. you are quite hopeless in my view.”
            In response to Yawye’s very confusing, however, non offensive comment, Dr. E: “what drugs have you been taking?”

            I find it funny that you would even post an article like this. This is what I believe to be, how you so eloquently phrase, EFFECTIVE BUT DISHONEST. You write articles riddled with incendiary language (cult/quack/charlatan) and when you get angry responses you act as if you are just delivering facts. You can produce your research and demonstrate your points without name-calling. This article is intended to proclaim your innocence and show that you always take the higher road. This is a cheap tactic and entirely inaccurate.

          • Derry Merbles=
            The thing is, though, that the feller Ernst wasn’t saying that Alex Yuen was a nutcase, and that therefore any point he made was invalid. As with Eccles in the Telegoons, even a nutcase can get the time right twice a day, simply by writing it down on a piece of paper.
            He was merely enquiring as to the possibility.
            And since Yuen’s claims were so fantastical and even legally improper, and had been shown to be so by the ASA, I think the question valid. In other words, while accepting that Yuen’s opinions were not invalid simply because they may have been voiced by a nutcase, the apparent nutcasery of Yuen, as evidenced by his further reasoning, might give a person evidence to doubt his-let’s say-grasp on reality. And might therefore lead a rational person towards the stance of, if not dismissing, then at least having cause to doubt the basis of any further statement by Yuen.

          • @Barrie

            Your point would have been more persuasive if it did not require such rigorous phraseology. However, I will confess, I am impressed by your attempt.

            You act as if this was simply a question and not intended to persuade other readers into thinking that Yuen is “nuts.” I find it hard to imagine that you actually believe this. If this point is true, how would you suggest Yuen respond? “Yes, I am nuts! Now let us continue our conversation.” No matter how you attempt to justify Dr. Ernst’s actions, this is a rude way to determine the sanity of an individual.

            All of this would be typical of his blog and therefore “OK” if he did not act as if he was the victim of wrong-doing and somehow claim this to be a “victory of reason over unreason.”

          • @ Derry Merbles.
            Thank you.

        • “Adequately powered sham control studies demonstrate the superiority of acupuncture over sham”.
          not quite! here is an example to the opposite: http://www.ncbi.nlm.nih.gov/pubmed/16186474

          • Fascinating study! I couldn’t find the power calculation though. What formula did you use to determine that this study is adequately powered? Looks tiny to me but I’d be interested to hear how you calculated it.

          • it’s in the methods section; and yes, the study lacked power. it is an example only and there are many others. show me the studies with sufficient power, or better, a meta-analysis of the pooled data.

          • Me: “Adequately powered sham control studies demonstrate the superiority of acupuncture over sham”
            Professor Ernst: “not quite! here is an example to the opposite”
            Me: “looks tiny”
            Professor Ernst: “yes, the study lacked power. it is an example only and there are many others.”

            Does this exchange even require commentary? Professor Ernst, studies that lack power, such as the one you reference, clearly provide support FOR my argument and AGAINST your argument. I agree, there are many examples like this, as you say.

          • good try – however, you ‘forgot’ to quote my last piece of script accurately. this is what I actually stated: “yes, the study lacked power. it is an example only and there are many others. show me the studies with sufficient power, or better, a meta-analysis of the pooled data.”
            when there are several studies that lack power [‘tiny’ is hardly the word for a study of > 80 patients], the best approach to approach the truth is to pool them in a meta-analysis [did they not teach you that in your science course?]. that’s why I suggest a meta-analysis; and somehow I doubt that it might show what you hope it would.

          • “that’s why I suggest a meta-analysis; and somehow I doubt that it might show what you hope it would.”

            And here we come full circle. On 16 May, I wrote:
            “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.”

            Let me clarify this. With the data errors, NICE found that acupuncture outperformed sham with an effect size of -0.80 [-1.36, -0.25]. You’ll note that this is statistically significant and does not support the conclusion that acupuncture did not outperform sham. Some of the treatments that they DID recommend did not have a statistically significant difference from sham AT ALL (sorry for the caps, don’t know how to italicise here, not trying to shout 😉

            However, by a show of hands, they decided that in order for the difference over sham to be considered “clinically significant,” which is a meaningless categorisation when an active comparator is used, that the effect size on a VAS scale had to be at least -.1. Again, many of the treatments that they recommended did not pass this test, but they recommended them anyways.

            However, using the correct numbers from the included studies, which surely you’ll agree is what we should be using, the effect size of acupuncture over sham is -1.03 [-1.53, -.54], a result that meets NICEs arbitrary definition of ‘clinical significance.’

            So now you have high quality evidence from an adequately powered analysis demonstrating strong evidence that acupuncture is superior to sham.

          • off topic!
            but I’ll answer: a meta-analysis would need to
            1) include all data, not just those on pain
            2) be done according to formal, transparent criteria
            3) be published and peer-reviewed.

          • “a meta-analysis would need to
            1) include all data, not just those on pain
            2) be done according to formal, transparent criteria
            3) be published and peer-reviewed.”

            It would need to meet your criteria in order to do what? The NICE meta-analysis constitutes “high quality evidence from an adequately powered analysis demonstrating strong evidence that acupuncture is superior to sham.” Your first criteria is demonstrably incorrect, meta-analyses can be performed on any predetermined single outcome measure, if that’s what the study protocol indicates. However, in this case, the NICE meta-analysis also demonstrated that acupuncture was significantly superior to sham in improving quality of life and improving function.

            Number 2 is a basic attribute of any properly performed meta-analysis. The NICE meta-analysis easily meets this criteria.

            Number 3 is patently false. Unpublished studies that have not gone through peer review only yields a potential or hypothetical issue with quality. After all, your peer-reviewed published paper on Cochrane reviews of acupuncture shows that these criteria do not guarantee quality or accuracy.

            Examining the methods and results of such a review will demonstrate whether or not the results are accurate. The actual problem with this review was that the data was extracted incorrectly. I’ll add that because the reviewers were clearly attempting to demonstrate that acupuncture doesn’t work, they excluded two studies that had been included in the previous guideline meta-analysis and had been included by Cochrane, claiming that the sham control did not meet their criteria. These studies were highly favourable for acupuncture. So more unbiased reviews of the same area demonstrate stronger results for acupuncture – these positive results represent a conservative estimate of efficacy.

            I’ll add that NICE guidelines are peer-reviewed, in a manner comparable to Cochrane Reviews, with the additional step of a consultation period where reviewer comments are published and commented on.

            If you are saying that the NICE draft meta-analysis does not constitute strong evidence of acupuncture’s efficacy and you want to maintain the appearance that the reason for this is other than the fact that, despite strong evidence to the contrary, you are still trying to argue that acupuncture lacks efficacy, then you really need to explain where the NICE meta-analysis introduced bias that would provide results different from a more accurate analysis. I could only find examples of bias that provided a more conservative measure of acupuncture’s effect. That it is not yet published is not evidence that the result is wrong; it doesn’t remotely suggest that. If you have specific issues with their methods or have reasons to believe that the result is incorrect, we’d love to hear them.

          • could it be possible that I might be able to teach others a thing or two about systematic reviews/meta-analyses? [http://www.ncbi.nlm.nih.gov/pubmed/19622511]

          • Professor Ernst, is there anything in particular in the PRISMA statement that you wanted to bring our attention to?

          • Dear Mr. Ernst and Mel,

            RE: This study “Adequately powered sham control studies demonstrate the superiority of acupuncture over sham”. http://www.ncbi.nlm.nih.gov/pubmed/16186474

            Please provide the original paper. I also can’t find the links to the original papers that NICE used to base its decision to remove acupuncture from the list of recommended treatments for LBP. Thanks

            From what I see in the abstract of the paper (link above), there is no way to evaluate the key things you need to look for in a study. But from what I see:

            First of all 116 test subjects is way too small.

            What was the inclusion and exclusion criteria to determine what kind of stoke and what kind? In Chinese medicine there are more than 1 kind of stroke with different root causes. How were these people chosen and were they selected based on western or Chinese diagnosis? It looks like the NIH scale was used which is not sufficient for the purposes of a study on acupuncture.

            Meta-analysis of many studies is useless unless the population for all combined studies is homogeneous (as per paragraph above).

            How were people selected for each group (control and test) and was there an analysis done to be sure that each treatment group (post-selection) was homogeneous as per above.

            Secondly, what points were chosen for treatment of acupuncture and application of sham? It may be that the point protocol was not appropriate for the treatment group. If using a western diagnosis this would be true. If the sham points were placed close by, they too could stimulate the same meridian even without needle penetration. (acupressure & light for example can stimulate the points)

            Third. Are the measurements taken blinded or biased. Scales like the Barthel are subjective and has been reported to be inconsistent in its usage in stroke studies (see wikipedia).

            The P values used are not appropriate for determining significance in this kind of study, in my opinion.

            Personally, I don`t believe this study adds much value so why argue about it?

            There is tons of peer reviewed published work out there that is bad research. Anyone can pick a handful of studies to make a case for whatever opinion they want to support.

            The true test is the cream that surfaces to the top over time. Eventually NICE will add acupuncture back on their list for LBP and many other ailments.

            I spent more than 20 years in science and medical research before switching to acupuncture.

            Thank you Mel for asking good questions. Of course the sham acupuncture will create a response and is not inert.

            Mr. Ernst, I see you get great pleasure in finding ways to increase the activity on your site. Great marketing scheme. I had never heard of you until a few days ago.

      • Dear Professor Ernst

        Why can’t you just answer Mel’s question: “where is your evidence that sham acupuncture is biologically inert?” I think a more appropriate title for this post might be “Edzard Ernst defeated by his own inability to answer simple questions”

        Instead of answering her question, you cherry-pick topics like “all that stuff about meridians and acupoints” and call it flimflam and then complain about ad hominem attacks and that your questions aren’t being answered.

        Could you please explain how saying that sham acupuncture is not inert means that one doesn’t believe in channel theory or acupuncture points?

  • I think the shouting, all caps “ENOUGH” was the start lol

    • I know!
      it’s magic that a single word can set off such a display of unreason on the acupuncturists’ side, isn’t it?
      AND IT WASN’T EVEN IN CAPITAL LETTERS, THAT’S YOUR FANTASY PLAYING TRICKS WITH YOU AGAIN?

  • The ENOUGH was, and that was ENOUGH

  • I repectfully suggest that your response to clearly articulated and valid questions re efficacy and efficiency AND the inertness of sham are silly

  • “Sham acupuncture is biologically inert”
    I agree, because I know of no plausible evidence to the contrary.
    Sham acupuncture has no bio-chemical or physico-chemical interaction with any biological structure that I know of.

    If other folks have evidence of bio-physico-chemical interactions produced by fake needles, not inserted into a biological system (a human, say), but merely pressed (without undue pressue) against the exterior of that biological system – then let us hear what that evidence is.

    It does not matter the slightest whether or not the proponent of a particular idea is a wonderful human being, or quite the opposite. What matters is the idea.
    Which is why ad hominem attacks are so foolish, waste everyone’s time and are boring.

    Of course, sometimes one has to consider whence cometh the idea, who devised the idea, and what motives they have for promulgating the idea. (Usually to secure a ‘career’ they would not otherwise have).
    So a consideration of the ‘hominem’ comes into a full critical analysis – but not an attack on the hominem’s argument which is based on the person of the hominem.

    The idea that fine needles can affect non-existant meridians and ‘points’ and thereby affect pathological processes is so inherently unlikely that the very greatest care should be taken in adopting such ideas.

    Those who do adopt such ideas, and urge others to adopt them, should offer more rational reasons why they hold to their faith that “It seems to work better than effects reasonably termed ‘placebo'”.

    Mel’s ‘evidence’ is strong enough for her, but does she not see that it is simply not strong enough for most of us who are engaged with these issues in an unbiased way?
    (Spoiler alert – I am biased, but only on the grounds of scientifically valid evidence and plausible theories).

    It is very irritating and exasperating when the simplest of ideas (there should be plausible evidence to support any proposed ‘scientific’ theory) is constantly bitched about.
    Those who accept acupuncuture is a faith should go about their way – but should not attack persons who are of a different faith or (more likely), none.

    Thank you.

    • Me: “where is your evidence that sham acupuncture is biologically inert?”
      Richard Rawlins: “‘“Sham acupuncture is biologically inert”
      I agree, because I know of no plausible evidence to the contrary.”

      If I were a skeptic, I might point out that this is an example of creating a strawman argument through the fallacy of quoting out of context, also known as “contextomy.” Since I’m not, I’ll just say, that it’s a shame that you felt the need to open your arguments so dishonestly, it rather weakens your credibility.

      “Mel’s ‘evidence’ is strong enough for her, but does she not see that it is simply not strong enough for most of us who are engaged with these issues in an unbiased way?” It’s not my evidence, it’s just evidence. The data for the NICE guidelines for low back pain is a great way to examine evidence as an example because it’s a head to head comparison of dozens of interventions for the same indication.

      Your abstract soliloquy about ‘ideas’ and ‘beliefs’ not withstanding, if we get down to the specifics of the data, acupuncture was about the most effective intervention in the reduction of pain in low back pain – this is compared to drugs, which themselves were demonstrated to work better than placebo, and also compared to therapy, exercise, yoga, and a combination of therapy and exercise.

      So the simple idea you offer is: “there should be plausible evidence to support any proposed ‘scientific’ theory.” The ‘theory’ that I am proposing is that acupuncture is effective in the treatment of low back pain. My plausible evidence is a systematic review of randomised clinical trials conducted by NICE evaluating the effectiveness of acupuncture that demonstrate that it has a clinically significant effect. To put icing on the cake, this effect is greater than other treatments that were also studied, making the placebo argument vanishingly unlikely.

      So if you would like to argue against this specific theory, where is your evidence?

      • this is the last off topic comment that I will allow on this thread. if you want to discuss acupuncture-related stuff, go to the other posts.

    • Dear Mr. Rawlins,

      Not all of us accept acupuncture by faith.

      I was in science and medical research for 20 years before switching to acupuncture and TCM and always look at it from both a scientific and evidence based perspective. I also have 2 colleagues and former students of mine who were anesthetists and who saw the value of acupuncture and TCM enough to also switch careers to become registered acupuncturists.

      TCM is a very complex medicine and unless you have studied it at great lengths you cannot understand why sham may indeed create a biological response. It can, if you understand that the primary meridians include the attached divergent, lou connecting and sinew channels that span out over wide surfaces of the body. It would be difficult to choose points that did not link to the primary channels. Plus the points are stimulated by light and pressure.

      Nothing is as simple as it seems. It is only simple if you are working with a limited knowledge base.

      It is sad that people of science are sometimes so close minded. Your assumption that people in alternative medicine do not have much scientific training is incorrect and has resulted in a disrespectful position that has insulted my colleagues.

      My advice to you and Mr. Ernst is to take time the time to study TCM and acupuncture for 3-4 years before passing judgement on my colleagues or on any research involving acupuncture.

      • It is” sad” and unscrupulous that “people of ” pseudoscience and non science are always so closed minded to reality. History proves the fanatics of some religions, voodoo, faith healers, witch doctors, and the mix of current Alternative fake health practices cannot be convinced of their ingrained misinformation. You sound evangelical in your beliefs even after convincing evidence to the contrary. The earth is round and human physiology and anatomy are real. There are no “energies” or meridians. Reality and science are not based on beliefs no matter how convincingly one is brainwashed.

    • “Acupuncturists defeated by their very own display of unreason”
      Dear Mr Rawlings, out of interest in theory I acknowledge your point regarding “Sham” acupuncture. However, to what extent have you searched, analysed, evaluated and reviewed the literature concerning the application and type of “Sham” acupuncture? It is irritating when assumptions are made without such concerting effort. Similar to Edzard, where he applies no critical thought, nor does he appraise the NICE guidelines before making (a favourable positional) comment. The simplest idea is there should be plausible evidence when asserting an all for one theory of “Sham”, when in reality there are various types of Sham, and in fairness other issues worthy of exploration. For example the nature and effectiveness of the designed interventions, the similarity or differences between them, thresholds of importance and actual research design and methodology. It is evident that you exercise a ‘display of unreason’ failing to acknowledge pertinent issues as such around the debate. Further, you fail to describe, and discuss issues surrounding your own profession. Lack of critical thinking and motivation leads to inert conclusions and recommendations and unreason. This behaviour and activity also does nothing for health and social science advancement.

  • can I please ask all commentators to stay on topic. the topic here is the strategy of some to first provoke and subsequently claim that they have been aggressed.

  • Re the argument about ‘ad hominem’ attacks, and what indeed constitutes them.
    I’m probably giving away my own position on this when I say that I’m more than convinced that the vast majority of ‘ad hominem’ attacks come from the Quackside.
    Some of the more hysterical, belligerent ones almost-but, as yet, not quite – approach the shrieking insanity of the anti- James Randi nutjobs.
    My experience of this was when I and others attacked, on Amazon, the latest ranting book by the extreme right wing ‘Feminist’ Gail Dines.
    We were accused in one reply of making ‘ad hominem’ comments.
    My reply – I’d be interested in others’ views – was that she had previously said that there was no argument, or study, or evidence that would persuade her, and other ‘Feminists’ like her, to change their minds on the subject of ‘Pornography’. And so I had concluded that she had entwined herself so fanatically, and resolutely, with her deranged views that she should not be surprised if she were personally criticised along with those views.

    • “Hysterical, belligerent, shrieking insanity, nutjobs, deranged views” Do I detect an ad hominem argument?

      • ad hominem means to the person – not his/her views.

        • My studies of Latin did include “ad hominem” as did my studies of logic. When emotive descriptions of other parties replace logical argument, this is indeed ad hominem argument. Incidentally ad hominem argument can hardly be described as “a victory of reason over unreason”. Firstly there is no victory in ad hominem argument only distraction, and secondly ad hominem argument is not reasonable.
          I do find the lack of any attempt to provide evidence for sweeping statements made in the course of this discussion very disappointing. The mediators, receptors and signalling pathways involved in both the anti-inflammatory and analgesic effects of acupuncture have been investigated as well as extensive studies of brain and brain stem activations and brain connectivity patterns. The differences between sham and verum acupuncture have also been characterised and include fMRI studies showing the common and different patterns of activation and deactivation in BOLD signal, as well as different effects on mu opioid receptor potential binding. Whilst there are still many questions regarding the underlying physiological mechanisms of acupuncture, a significant amount of research has been completed and much is already known. In addition almost 8,000 randomised controlled trials of acupuncture have been published to date, and while some of these studies are or poor quality, there is a body of high quality research which will not magically disappear when a pseudoskeptic waves his/her magic wand and solemnly intones the magic words “pre-scientific gobbledigook”. Incidentally there are also many studies of acupressure which do in fact show physiological effects from pressure on the skin. From example, in a study presented at Harvard Medical School in the Society for Acupuncture Research’s conference last October, by Zick and Harris it was found that different protocols of acupressure points produced quite different patterns of modulation of glutamate/glutamine and creatine/phosphocreatine in the posterior insula of patients with cancer-related fatigue.
          Yes, anatomy is real, modulations of TRPV1 receptor and substance P in allergic rhinitis in response to acupuncture are real, the production and release of endogeneous opioids (including enkephalins, endorphins, dynorphins, endomorphins and nocistatin) in acupuncture analgesia are real.
          None of this information is difficult to locate with a simple PubMed search. It would be refreshing to see some real science on this page.

          • did they forget to tell you about cherry-picking when you did your PhD?

          • @Dr John Macdonald, PhD

            “From example, in a study presented at Harvard Medical School in the Society for Acupuncture Research’s conference last October, by Zick and Harris.” Shame on you! You can present anything at a conference (and write it in a conference abstract). Peer review has its problems, to put it mildly, but your entire comment lacks credibility if you imagine conference presentations provide robust evidence.

            By the way, fMRI is now very weak as evidence. Seems to be able to show almost anything, depending on who’s interpreting it.

          • A quick point to refresh our memories re. fMRI:
            Studies using functional magnetic resonance imaging are frequently referenced to support claims of acupuncture efficacy. Both living and dead brains react to stimuli and it matters little whether you drop a coffee mug on a toe or stick a thin needle in the Conception vessel – 1 (apparently useful in the resuscitation of drowning persons), it will result in areas lighting up in the brain in one way or another. The problem with such studies is apparently that the instruments can be tweaked to show almost anything you wish for, as demonstrated in an fMRI study of a deceased Atlantic Salmon.
            The design, performance and interpretation of fMRI studies is wide open for the influence of wishful thinking and other bias as well as mistakes and adultery.
            That areas of the brain light up or endorphines or other substances are released by sticking needles, scraping skin or other stimuli says nothing of its medical efficacy or efficiency.

  • Complaining about being attacked by others with ad hominem arguments sounds suspiciously like a litany of ad hominem arguments. The main purpose of ad hominem argument is to distract the debate away from the substantive issues. The very important issue here is that a NICE review has been conducted in a manner which does not accurately reflect the evidence about the effectiveness of acupuncture for low back pain. The numerous serious flaws in this process have been clearly articulated and communicated to NICE in formal feedback. A network meta- analysis on interventions for sciatica by Lewis et al 2015 found that acupuncture was the second best intervention in terms of global effect and pain intensity and rated many ranks above exercise. How then can exercise be recommended when acupuncture is not? NICE is on notice and the world is watching for their response.

  • The author, Karla McLaren, who was a leader in the New Age culture for 32 years before undergoing a transition to skepticism, wrote an essay on how scientific and critical thinking communication could be made more effective. In particular she mentioned the following:

    “I think I’ve finally discovered the central issue that makes communication so difficult…that skeptical information is absolutely threatening and unwanted. What I didn’t understand until recently is that when you start questioning these beliefs, there’s a domino effect that eventually smacks into your whole house of cards—and nothing remains standing.”

    Ref: http://www.csicop.org/si/show/bridging_the_chasm_between_two_cultures

    In view of the above, I think that Professor Ernst is showing great understanding in advising all commentators to try to be as polite and as patient as possible in discussions.

    • That’s a really interesting link, but doesn’t have much bearing on the source of the contretemps which is that the methodological basis of control in acupuncture studies is questionable, and that acupuncture was an effective intervention in the treatment of back pain despite being excluded from the NICE guidelines, for whatever reason. Nobody on the acupuncture side is experiencing an ontological crisis over this. Quite the reverse, in fact.

  • If I had not been aware of cherry-picking when I did my PhD (which I was) then this forum could provide a salutary tutorial in the art. My comments have related to a large body of both efficacy/effectiveness and mechanism trials, yet responders have chosen to cherry-pick fMRI studies and make criticisms (without any evidence) of that technology. When I referred to a conference presentation as an example, only that example was attacked with the apparent misconception that I was suggesting that that study alone (which was quoted as a conference paper because the peer-reviewed journal publication has not yet occurred as it was new research) was robust data to support acupuncture mechanism. A large body of robust data on both the efficacy and effectiveness of acupuncture for a range of conditions will not go away by wishing it so because it does not align with strongly-held beliefs. While some aspects of acupuncture remain unexplored, there is a significant body of evidence for the mediators, receptors and signalling pathways involved in both acupuncture’s anti-inflammatory effects and it’s analgesic effects (as already mentioned). Yes ad hominem argument and cherry-picking can sometimes be effective distractions to avoid engaging with evidence – all the evidence – however they do not do much to advance the cause of science.

    • bravo!
      so you know about cherry-picking.
      then you also know that talking about ‘a large amount of evidence’ is cherry picking.
      and you also know that you must show us systematic reviews and meta-analyses that support each of your theories.

      • Cherry-picking is the selective use of only the evidence which supports a predetermined position (as has been done in the NICE review on low back pain). Referring to 8,000 RCTs as “a large amount of evidence” is a simple statement of fact. I have proposed no theories, hence I have no obligation to provide you with a reading list to support them. The facts on acupuncture are available, as previously indicated, to anyone who wishes to conduct a simple PubMed search. I do not expect to do the homework of any student to whom I teach research literature critical analysis, nor do I intend to compile reading lists for those who are perfectly capable of informing themselves by actually searching and reading the research literature. I have noticed that very little of the discussion on this page actually manages to support any assertions (which tend to expressed in rather emotive tones which are hardly appropriate to a discussion of science) with actual evidence.

        • you haven’t listened during your science course: even citing 16 000 RCTs as evidence is wrong if they have been cherry-picked. the best way to avoid cherry-picking is to conduct a systematic review.

          • Professor Ernst, I couldn’t agree more that systematic reviews, especially when performed well, reduce bias and constitute a source of high quality research.

            Incidentally, I’m not sure if you’ll remember this, but I recently pointed out to you that the systematic review conducted by NICE demonstrated that acupuncture demonstrates a clinically meaningful effect over sham acupuncture in the reduction of back pain. You raised a number of theoretical and unsupported objections to this systematic review, which I countered. You then provided a link to the PRISMA guidelines on reporting systematic reviews, without making any specific point, which was, if I’m honest, a bit weird.

            The systematic review conducted by NICE demonstrates high quality evidence of acupuncture’s efficacy over sham for pain reduction in low back pain. It only differs from other high quality reviews in that it excludes two high quality studies because the committee opined that the sham did not meet their criteria. These were both positive studies, so NICEs results constitute a conservative result.

            If you have any specific comments on how this review was methodologically flawed and thus these results are not accurate, please share. All of the information you need in order to make such a discernment is available to you. If you cannot find any specific weaknesses or flaws to reasonably indicate that they have not come to the correct result, then please concede that this review provides high quality evidence of efficacy for this clinical condition, as you have indicated that on numerous occasions that it fits such criteria.

          • PRISMA: I seem to remember that you wanted to teach me about SR methodology, and I cited PRISMA to point out that I am one of its authors. did you miss that?
            NICE conducts HTAs not SRs, if I am not mistaken.

          • Dear Professor Ernst,

            I saw that you were a collaborator on PRISMA but I didn’t imagine that you were actually giving an Argument from Authority rather than answer my questions.

            “NICE conducts HTAs not SRs, if I am not mistaken.”

            You are mistaken. NICE conducts HTAs (STAs, MTAs), which is totally different than the systematic reviews that they conduct during guideline development, of which I have clearly provided an example.

            I repeat, either tell us of a specific methodological issue with this systematic review or admit that it constitutes high quality evidence of acupuncture’s efficacy. Anything else is a clear demonstration of confirmation bias.

          • you all seem to confuse this blog with a police interview.
            you ask questions, I answer.
            you ask more questions, I answer again.
            I ask questions, you rarely answer.
            you find my answers unsatisfactory – well tough!
            I have stated this in various forms many times: I prefer to wait until we have a reaction from NICE about your criticisms. then I might respond. why is that so difficult to comprehend?

          • Since you were not present during any of my studies, it is remarkable that you are able to comment on whether or not I was listening – or perhaps you were just being patronising again. Citing a number of RCTs is not “wrong” and no I have not cherry-picked at any point. Systematic reviews can reduce bias if they are conducted well, especially if the basis for inclusion of studies is rational and appropriate and does not involve cherry-picking. Now that the distractions about ad hominem arguments and cherry-picking have been dealt with, perhaps it is time to return to the real issues which were being discussed, namely the serious flaws in the NICE review process which you have not yet addressed. Many questions (above) remained unanswered and crying “ENOUGH” is neither a mature nor a satisfactory response for one who aspires to take the moral high ground of a scientist.

          • you all repeat this, just like a broken record!
            I have answered the questions as far as I could or wanted to answer them. don’t tell me you mean to say I HAVE to respond to your interrogations. This is a blog not a police interview [and even there one has the right to remain silent, I believe]. anyway, the NICE guideline may or may not be defective; I think it is up to NICE to sort this out. I will respond to any revision they may publish. I stated this ad nauseam – but the acupuncture horde does not want to understand this. is that perhaps my fault too?
            how about answering some of my requests, then?
            where are the systematic reviews that support the many claims you have been making?
            BTW: I just found your trial which you are so proud of in social media; I might blog about it tomorrow. something to look forward to!

  • Poor Professor Ernst, being hounded by all these people who want him to provide evidence to support his position. Can’t a skeptic write unsubstantiated opinions in peace?

    You asked for a systematic review and I provided a recent systematic review that demonstrates acupuncture’s efficacy.

    You said it had to be peer-reviewed. It is.
    You said it needed to measure multiple outcomes, even though that’s not true and you just made that up. But it does.
    You then, oddly, questioned whether or not the systematic review is a systematic review, phenomenally peculiar for someone who just drew attention to his role in the development of Prisma (pretty low bar over at Prisma, eh?). Yes, the systematic review is indeed a systemic review.
    You then say, even though you have access to this review, you have no inclination to look at it. You will wait until September until others have reviewed it and commented on it.

    Professor Ernst, you absolutely positively have the right to remain silent. The next time the Guardian ask you for an expert opinion on a document that you either lack the inclination or skill to critically review, it may be an idea to refrain from commenting.

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