MD, PhD, FMedSci, FRSB, FRCP, FRCPEd

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    by jm - Sunday 18 February 2018 16:00
    Bjorn, You say "I know for a fact that the Gua Sha did not help him (your appendicitis patient)”. I would agree with you on that one - appendicitis isn’t something anyone would use gua sha for. I was hoping that Howard would reply to you - I’m curious if he’s ever heard of gua sha as a choice of treatments for appendicitis. I doubt it, but you never know. See - look at that. Four years later, and we’ve found common ground. Since I’ve described to you many times how simple and straightforward gua sha is, I'm curious about the “tales of magic and mystery” though. Sounds intriguing! As does the “easy money” part - I think Howard has explained to you (as have I) how gua sha isn’t a very good choice if easy money is what your goal is. Or "respect", for that matter - as a general rule, gua sha is mainly thought of as lowly 'folk' medicine. It’s not an “exotic” treatment - it’s a pretty common household tool. Which makes it a bit strange to see it as a topic on a skeptic blog…too many people will see right through the "bike accident” ruse and assume this wasn’t a serious discussion about gua sha. Which would be a pretty accurate assumption.

by James - Sunday 18 February 2018 14:17
A small overview of some of the authors' scientific research yield (in terms of papers) and background reveals a relative lack of insight into "alternative medicine". The head of the department's Wikipedia page has a weird statement at the top: This article may have been created or edited in return for undisclosed payments, a violation of Wikipedia's terms of use. It may require cleanup to comply with Wikipedia's content policies. Furthermore, the "stellvertretende" Leiter (Keilani M.) is a bit of a mystery, only source of information is on Pubmed publication records. The Department's webpage does not expose much info about the staff. Taking a look at their publications in general, all in all, they don't seem to make a distinction between what is and what isn't alternative medicine. It is quite probable that they are genuinely studying all types of interventions, in which case they need to be made aware of the limitations of their subject of study. In other words, they seem to be honest in their approach, but they are unaware that they have stepped in woo-territory. On the other hand, comparing two interventions of doubtful efficacy to each other is a rather lame mistake to make and these mistakes cost considerable amounts of money, but the authors state inside the paper, in the acknowledgements section: We would like to thank the patients and the medical staff who collaborated on this study There is no financial or material support to report for the present study. Most evidence points to the direction of an honest mistake. I think they should be made aware of this limitation. The peer-review process has failed yet again, unfortunately. I am beginning to think that peer-reviewers have adopted a compassionate mentality towards the effort and resource spending related to research and are behaving far more leniently in their duties. That, or they are "hired"/hand-picked for the job, I can't find any other explanation for letting such obviously flawed work get published. Another interesting note to be made is that the paper was actually accepted and published in 2016, and the Journal of the American Osteopathic Association has already had a chance to comment on it, I assume positively, although I cannot access their commentary to be totally certain. Finally, although it will take a considerable amount of effort and time to calculate preliminary Ernst numbers from whatever raw data is available in aggregate structures, something that I plan to carry out in the not-so-distant future (I hope before the end of this year, I will keep you updated), judging by the type of research of the authors of this paper, and their history, it is unlikely that they have a finite Ernst number, i.e. they have probably not collaborated with anyone that has a finite co-authorship path to Dr. Ernst. This is indeed a bad paper overall...

by Osteopathie Praxis im Klinikum Karlsruhe - Sunday 18 February 2018 11:35
As I went for some osteopathic trainings to Vienna long ago it was interesting that in those times the concept of CRAFTA from the Netherlands started and the osteopaths tried to take the knowledge over anf to make their own courses out of this. The CRAFTA books were sold in the Osteopathic school of Vienna. Later the Osteopathic School of Vienna started to work together with the Dungl Center in Graz and both started their new program for a M.Sc. (ost) with a minimum of credit points with the private University of Krems. So you might find other studies about manual therapy in cranio mandibular dysfunctions in the CRAFTA webpages. It is interesting to compare the CRAFTA concept with this study here.. CRAFTA claims to be evidence based ... really?? https://crafta.net/blog-section/about_crafta/artikelen

by Leigh Jackson - Saturday 17 February 2018 17:31
It's possible that there was no peer review - it appears that peer reviewed editions of the journal may be the exception and not the rule. True enough, the results reported in this paper are meaningless - in scientific terms. If the real purpose was to test for treatment effectiveness then the authors should go back to square one. They haven't got a clue. Was that the real purpose? Was the purpose simply to get a paper published with their names on it? The paper is potentially useful to true believers and practitioners. Perhaps they are just that. Their Ernst numbers must surely be off the scale? Shame on Vienna University for facilitating junk science.

by Viktor Weisshäupl - Saturday 17 February 2018 17:24
http://www.tandfonline.com/doi/abs/10.1080/09638288.2016.1269368 to save your effort to find the paper.

by Lenny - Saturday 17 February 2018 14:53
I couldn’t do a decent critical appraisal of a paper if it ran up and bit me on the arse, but even I can see this for the utter garbage it is. Not worth the paper it is printed on.

by Edzard - Saturday 17 February 2018 14:01
quite agree!

by Edzard - Saturday 17 February 2018 13:59
you are too kind [and just made my day!]

by James - Saturday 17 February 2018 12:36
This post makes me sad, not so much the uselessness of the trial, rather your disappointment, Dr. Ernst. Imparting rationality in a field such as research in medicine is a very difficult effort of a beneficence. Oftentimes, it appears as if there would be no hope. I would like to ease your embarrassment a bit, by saying that the footprint of your positive influence extends far beyond what you would even hope for. Your Department may slip one or two travesties but whoever comes across your work cannot help but put up a fight, either against his own preconceptions, or against his prior illusions that this world is ruled by reason. In the rare occasion, where somebody has already had an idea of how much chaos exists in the minds of the general population with respect to the mechanisms that govern this world, an encounter with your work reminds them of how important it is to never let the guard down and think that everybody's got what they deserve. Although I, personally, was very well aware of how much bullshit runs around all over our world, your efforts always remind me that a robust conclusion is not the ending point of proper research, it is the beginning point of the tough endeavour of proper dissemination. Do not feel embarrassed, Dr. Ernst, a series of butterfly effects, both older and more recent, is already beginning to have a strong impact in medical research. With all due respect, Dr. Ernst, you may or may not be here to witness the magnitude of the impact of your intervention in the world of medical research when it's full-blown due, but let me reassure you that it is going to be greater than any present situation or state of things might illustrate. I hope, of course, you are here with us for a very long time and keep disappointing all sorts of promoters of implausible claims in this world. Finally, not being sure as to whether this has been proposed in the past, I believe that Dr. Ernst's influence on alternative medicine research has accummulated the critical mass to be considered sensational. I propose we should set forth the concept of the Ernst number in Alternative Medicine, in the same way that the Erdős number is defined in Mathematics: To be assigned an Erdős number, someone must be a coauthor of a research paper with another person who has a finite Erdős number. Paul Erdős has an Erdős number of zero. Anybody else's Erdős number is k + 1 where k is the lowest Erdős number of any coauthor. Ernst number: To be assigned an Ernst number, someone must be a coauthor of a research paper with another person who has a finite Ernst number. Edzard Ernst himself has an Ernst number of zero. Anybody else's Ernst number is k + 1, where k is the lowest Ernst number of any coauthor. So, Ernst's immediate coauthors have an Ernst number of 1, etc. Extravagant, some may say? I say, it is not so much for the Ernst numbers themselves, which I still find utterly interesting, as there is to the recognition coming forth from establishing a formal metric, which will ultimately show, in my opinion, in due course, how much confidence we can have in the results of various alternative medicine writings, judging by the Ernst number of the various authors. In my modest experience, the time for this kind of recognition is due. Other folks in here will have, of course, both much more experience than myself to judge whether it is this "high-time", and much more authority than myself to achieve the formal establishment of that metric, should they agree with the idea. Whatever the case, I will always be intrigued by the thought of acquiring a finite Ernst number, and this should be enough by itself to demonstrate to you, Dr. Ernst, that you should not be embarrassed, your efforts are recognized and acknowledged, it just takes time and there are natural fluctuations.

by compandalt - Saturday 17 February 2018 11:19
It would appear that the authors of this study don't have the faintest idea how to conduct research to test treatment effectiveness. It's also very concerning that the peer reviewers failed to detect the many flaws in this study and reject it for publication. Neither the authors nor the peer reviewers have considered the possibility that both of these treatments are equally ineffective for temporomandibular disorders. Given what we know about the lack effectiveness of both manipulative osteopathy and cranial osteopathy for most conditions (as well as the lack of plausability of cranial osteopathy) that seems by far and away the most likely outcome. When I see papers as truly awful as this getting published, I worry about the future of research.

by Pinkrose - Sunday 18 February 2018 11:18
Hello Phil we would like to try a mistletoe injection for my sister with stage 4 thyroid cancer agressive and fast growing. It spread on different parts of her body. It metastesis in her brain and the doctor told is that she has a tumor in her head. She doesn't recognize us we are so upset. We don't have any option we want to inject rhe mistletoe without consent of her doctor but we want to try because the doctors want us to have a chemo therapy but we think my sister can't survive in chemo she is so weak.she taking lot of pills and antibiotic. I'm not sure if any other side effects injecting mistletoe while taking medicine pr antibiotics? Base in your experience. I hope you can help us regarding in this matter. Thank you.

by Edzard - Sunday 18 February 2018 07:37
to summarise the failings of the AACMA so far: 1 no apology 2 no direct response to me 3 they wrongly imply that i formerly had an undeclared link to the pharmaceutical industry 4 they provide a website that does not exist 5 they misunderstand what the BPS is NOT BAD FOR SUCH A SHORT STATEMENT

by Alan Henness - Saturday 17 February 2018 16:00
The RLHIM have also just removed the following from list of services: Complementary cancer care clinic Complementary cancer care service – children adolescents and young adults Skin Clinic Weight Loss Clinic

by Alan Henness - Saturday 17 February 2018 15:36
The RLHIM has finally announced this on their web pages rather than hidden in their leaflets:RLHIM Pharmacy Important information From 3rd April 2018, The Royal London Hospital for Integrated Medicine (RLHIM) will no longer be providing NHS-funded homeopathic remedies, Iscador and herbal medicines for any patients as part of their routine care. This is in line with the funding policy of Camden Clinical Commissioning Groups, the local NHS body that plans and pays for healthcare services in this area. Should you choose you will be able to purchase these medicines from the RLHIM pharmacy, while other homeopathic pharmacies may also be able to supply the medicines. You can speak to your clinician or the RLHIM pharmacy at your next visit about this.

by Iqbal Krishna - Saturday 17 February 2018 05:43
Edzard I am aware of your new found love for the Indians(1 Indian killed by Epsom salt finds mention in your post) and the scorn you have started showing for the British (billions of scarce resources being wasted and no helpful advise from you). What has changed?

by Edzard - Friday 16 February 2018 10:24
OR ALTERNATIVELY: go yonder and multiply

by James - Friday 16 February 2018 10:10
You can write yourself, fellow Iqbal, spare yourself the time of copy-pasting.. Nobody checks the completely irrelevant pieces you paste anyway. You could try talking yourself a bit, for a change. Write all you wish as you wish it were. No conventional medicine, an entire world of unprotected patients and an entire market of toy medicine juat for you. Type all your dreams-come-true!

by Edzard - Friday 16 February 2018 08:39
too stupid a comment to merit a response

by Iqbal Krishna - Friday 16 February 2018 08:05
Edzard "Clearly, the big news here is that the RLHIM has been forced to stop providing NHS-funded homeopathic. This could be indicative of what might soon happen throughout NHS England." It is no good to share part of the information. The real update is that NHS is moving into bankruptcy. And the reason: "Seven leaders including Niall Dickson, chief executive of the NHS Confederation, warned justice secretary David Gauke that the rising cost of clinical negligence claims was having a significant impact on the health service. The health and social care secretary, Jeremy Hunt, was also copied into the letter, which was sent on Monday. The group, which includes the chairs of the British Medical Association and the Academy of Medical Royal colleges, said the NHS spent £1.7bn on negligence claims last year and the annual cost has doubled since 2010/11. They added that the estimated total liabilities, which is the cost if all current claims are successful, stands at £65bn, up from £29bn in 2014-15." "The group said: “We fully accept there must be reasonable compensation for patients harmed through clinical negligence but this needs to be balanced against society’s ability to pay." Very impressive: "Payouts given to NHS patients who have been victims of negligence should be reduced because they are unsustainable”, health service leaders have told the justice secretary." https://www.theguardian.com/society/2018/feb/02/nhs-compensation-payouts-unsustainable-say-health-leaders Negligence will continue. That is NOT unsustainable. Imagine the outcome when high value scientific medical interventions are stopped. The fun begins.

by Richard Rawlins - Friday 16 February 2018 07:24
'Royal London Hospital' - obviously. Yes, there will be confusion with one of the same name in Whiitechapel, but when RLHfIM first came up with its new title and started their marketing, I wrote to the Whitechapel RLH CEO and pointed this out - they were not bothered and not prepared to take the issue up with the Privy Council whose responsibility it is to regulate use of 'Royal' titles. I if HM does not mind the confusion, it would be impertinent for her subjects to do so.

by Alan Henness - Friday 16 February 2018 00:42
For the record, the leaflets the RLHIM have so far changed to state that they will no longer be providing homeopathy or herbal products are: Womens Service Childrens Service General Medicine Service Rheumatology service Podiatry and Chiropody Western Herbal Medicine Service

by jrkrideau - Thursday 15 February 2018 21:41
Royal London Water and Sugar Dispensary?

by Renaud DEFRANCE - Saturday 17 February 2018 14:19
Thank you a lot for your timely and informative reply! Regarding your 4° I'm a bit surprised you say I broke the rule you recall, as I thought precisely being applying this very one when letting open the initial question in my conclusion because part of the evidence was lacking (1°). Anyway thanks again, specially for the link to sciencebasedmedicine. Cheers

by Alan Henness - Saturday 17 February 2018 11:59
ROFL! And spot on.

by Mojo - Friday 16 February 2018 18:59
He took my pulse and was able to determine when and why and how I first became ill. There is a term for that capacity, and I’m am sure you know what it is. Cold reading?

by Michael Kenny - Friday 16 February 2018 13:22
Yes pulse-diagnosis is a REAL science, as is Chiropractic, Scientology, pick-up-sticks, and seduction. The term for that in case Tom can’t pull it from his ass, is fraud. My analogy was not only coherent but perspicacious, as my secretary (just as your acupuncturist) were intent on screwing us.....mine literally yours figuratively. Perhaps it’s you that has gone off the deep end and come up with the bends?

by Lori Santulli - Friday 16 February 2018 06:27
Why do you say that you think something is interesting when in fact, it's sounds like the entire field is out of your depth (no pun intended!) ... as well as your ability to make coherent analogies! Pulse diagnosis is a science as well as an art. Tom, Help! what's the term so as to convince our fellow traveler?

by Alex Smithers - Saturday 17 February 2018 00:45
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2998502/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1475939/

by Edzard - Friday 16 February 2018 16:52
a new article on Gerson therapy: https://babe.net/2018/02/14/a-youtuber-who-claimed-being-vegan-cured-her-cancer-has-died-from-cancer-35318?utm_content=buffere89ba&utm_medium=social&utm_source=facebook.com&utm_campaign=buffer

by David Colquhoun - Friday 16 February 2018 12:58
Aha it's that BMC journal for nonsensical medicine. It seems curious that the two normal deviates (z values) mentioned in the abstract are identical to 5 significant figures,

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