MD, PhD, MAE, FMedSci, FRSB, FRCP, FRCPEd.

The New Year is a good occasion to thank all commentators for their participation. Your contributions are essential and much appreciated. Sadly, the tone used by several of us (me included) has deteriorated in recent months. Therefore, I would like to take this opportunity to update the rules for contributing to this blog and let you know that I plan to enforce them.

I do like clearly and concisely expressed views and am often as outspoken as politeness allows. I hope that commentators will do the same, no matter whether they agree or disagree with me. However, I will now insist that we all observe a minimum of courtesy towards each other.

Twelve simple rules must be observed when commenting on my blog.

  1. All posts should be in understandable English; with rare exceptions, I will not post comments that I find incomprehensible.
  2. Libellous statements will not be posted.
  3. Personal insults will not be posted.
  4. People who keep insulting others will be permanently banned from posting on my blog.
  5. Comments must be on-topic.
  6. Nothing published here must be taken as medical advice.
  7. All my statements are comments in a legal sense.
  8. Conflicts of interest should always be disclosed.
  9. I will stop discussions on any particular topic if I feel that enough has been said and things are getting boring or repetitive.
  10. I will not post comments which are overtly nonsensical.
  11. I will prevent commentators from monopolizing the discussion.
  12. Please use the same name you’ve used before when commenting — it doesn’t have to be your real name, but it helps others who are trying to follow the discussions.

Please do let me know if you feel that I or someone else has broken any of these rules.

21 Responses to Revised rules for commenting on this blog

  • Your blog, I understand. I lost interest honestly, you are too one-way in politics. Wish politics were left out as well, turns me off, surprisingly that was not mentioned in new rules. Most science based sites have a direct correlation to a certain political leaning and label sceptics on other side rudely, when we believe in same thing.

    • Most science based sites have a direct correlation to a certain political leaning …

      Could you explain this a bit further? Or perhaps give some examples? AFAICT, politics only pop up in this blog and other blogs when it is relevant, i.e. when politicians say or do things that are anti-scientific (or fail to do things when science indicates that they should).
      I see no consistent political bias in any of those blogs, other than that some political groups appear to be more anti-scientific than others – which of course leads to certain politicians being the subject of discussion more often than others.

      … and label sceptics on other side rudely, when we believe in same thing.

      Again, this is not fully clear, maybe because we have differing views on what ‘sceptic’ means. In my opinion, a sceptic is someone who does not take any information or claim on face value, but wishes to see some acceptable scientific evidence before accepting it for a fact. However, some people who call themselves ‘sceptics’ unfortunately exclusively apply their scepticism to information from mainstream science, while judging their own favoured areas (e.g. SCAM) by far more lax standards.

      In general, I find that well-intended(!) discussions often derail because of a lack of understanding of what the other person means exactly, or sometimes even because people differ about what the basic facts are. Therefore I think it is important to ask what someone means if things aren’t perfectly clear.

    • If you sincerely believe that science and medicine operate completely independent of politics and government then you are extraordinarily naive, if not downright gullible. We regularly see political interference occurring in science and medicine, and while all political sides may be guilty of it some are massively more guilty than others.

      So if you find yourself more offended by political interference being called out than by the interference itself, perhaps you should reflect on your current political allegiances and how well those really align now with your ostensible scientific ideals.

      As to which you should choose, well there’s no point us stating the obvious; if you wish to lie to yourself then that’s up to you. Good science is not in the business of coddling your delicate feels. It is brutally, unflinchingly, honest—anything less is not science at all.

      • The scientific process has nothing to do with politics. The reason CAM isn’t accepted as mainstream isn’t because of politics, it’s because it doesn’t work when subject to proper scrutiny. CAM’s success depends on promotion by ego-driven personalities who have a vested interest in it working and are unprepared to seriously question whether it does in an impartial way.

        I’m glad to hear Prof Baum is making a good recovery, the world needs a little good news right now. Happy new year to everyone!

        Niall

        • “The reason CAM isn’t accepted as mainstream isn’t because of politics, it’s because it doesn’t work when subject to proper scrutiny.”

          Most of CAM has low quality research (often pointed out here) thus we dont really know if it works or not.

          • 1) “Most of CAM has low quality research (often pointed out here) thus we dont really know if it works or not.”
            2) The more rigorous studies fail to show efficacy.
            3) Thus it is either unproven or disproven.
            4) Therefore, it would be wrong to use it in clinical routine.

          • Most of CAM has low quality research (often pointed out here) thus we dont really know if it works or not.

            That is the very definition of CAM, and a good reason to conduct proper research rather than go on using it.

            Though perhaps we need a different word for those charlatans who know very well that their treatment doesn’t work and are simply motivated by profit.

        • @Niall: I was replying to jim, who was whining about Prof Ernst’s sometimes mentions of politics.

          Of course, jim’s complaint fails anyway since this is Prof Ernst’s blog where he can talk about anything he damn well likes. Still, as one of the few CAM researchers who does apply scientific rigor to the process, I’m sure Prof Ernst is familiar with political interferences to undermine the science, from Orin Hatch’s “Get Out Of Jail Free” card to the US Supplements Industry and the NCCIH, through Prince Chuckles malicious destruction of his own research department at Exeter, to President Trump shilling worthless HCQ just to evade admitting he doesn’t have all the answers on COVID.

          Thus Prof Ernst’s political commentaries are both timely and aposite, and if jim only wants to hear what jim only wants to hear then I’m sure we can all agree he is free to go start his own blog instead.

  • Dear Edzard,
    Happy and healthy New Year. I salute you for taking this stand and endorse everything you say. The quotation with the picture is very apposite but you don’t say who this humane philosopher is. Can you tell me about him please.
    I have just survived a existential crisis. In. the period between boxing day and New Year’s Eve I was admitted to the Royal Free Hospital following a heart attack. This was at the apogee of the worst pandemic in our living memory. I having nothing but praise for all the NHS staff who cared for me 90% of whom were either immigrants or the son’s and daughters of immigrants. I was awake but sedated as they carried out my angiogram, identified the stenosis and dilated it up and added a stent. This was all done so efficiently as to minimise the damage to my myocardium. I marvelled at the way a cannula was navigated up my radial artery and manoeuvred into the coronary arteries on a big screen of magnified digital images. In my imagination I saw a long line of scientists from William Harvey at the time of King Charles II, via Marie Curie at the turn of the 20th C, to Francis Mouyen who first described digital radiology in 1987, smiling down on me. Once unblocked the beautiful fractal geometry of my coronary arterial system was displayed and my fear was expunged. Scientific medicine is beautiful, the giants of this science are our greatest heroes. The external and internal structures of the human body are sublime and the role of scientific medicine, aided by bio-technology of near magical proportions, restores our bodies to functional perfection that has emerged over millions of years through the process of evolution.
    One last word, I nearly forgot, my procedure was carried out in the hospital with the highest burden of COVID-19 in London. Yet I felt safe thanks to the scientific geniuses who developed and tested a vaccine in less than one year and I was one of the lucky ones to have had the first dose of the Pfizer vaccine because I was considered old and vulnerable.
    Having got that of my chest I have made of New Year Resolution to withdraw from Twitter for the very reasons you describe.
    God bless the NHS and for atheists amongst us thank God for science.
    Mike

  • People who keep insulting others will be permanently banned from posting on my blog.

    Remember that calling Dana a bloviating tit isn’t an insult but an item of evidence-based fact.

  • I endorse best wishes to Michael.
    A major stimulus to the cause of rational medicine.
    Not least his piece in the BMJ, which bears a read:
    Not ‘off topic’ – but an exemplar of good sense and pointed commentary on the heart of this blog’s concerns.

    BMJ. 2004 Jul 10; 329(7457): 118.
    PMCID: PMC449836
    Personal View
    An open letter to the Prince of Wales: with respect, your highness, you’ve got it wrong.

    Michael Baum , professor emeritus of surgery and visiting professor of medical humanities.

    “Twenty years ago, on the 150th anniversary of the BMA, you were appointed its president and used your position to admonish my profession for its complacency. You also used this platform to promote “alternative” medicine. Shortly after that I had the privilege of meeting you at a series of colloquia organised to debate the role of complementary and alternative medicine (CAM). Of course, you won’t remember me but the event is indelible in my memory. I was the only one of my colleagues unequivocally to register dissent.

    A few days later you had a four-page supplement in the London Evening Standard, promoting unproven cures for cancer, and the paper invited me to respond. I requested the same space but was only allowed one page, which at the last minute was cut by a quarter to make space for an advert for a new release by Frankie Goes to Hollywood. Furthermore, the subeditors embarrassed me with the banner headline, “With respect your Highness, you’ve got it wrong” (13 August 1984). As I have nothing more to lose I’m happy for that headline to grace the BMJ today.

    Over the past 20 years I have treated thousands of patients with cancer and lost some dear friends and relatives along the way to this dreaded disease. I guess that for most of my patients their first meeting with me was as momentous and memorable as mine was with you.

    The power of my authority comes with a knowledge built on 40 years of study and 25 years of active involvement in cancer research. I’m sensitive to the danger of abusing this power and, as a last resort, I know that the General Medical Council (GMC) is watching over my shoulder to ensure I respect a code of conduct with a duty of care that respects patients’ dignity and privacy and reminds me that my personal beliefs should not prejudice my advice.

    Your power and authority rest on an accident of birth. Furthermore, your public utterances are worthy of four pages, whereas, if lucky, I might warrant one. I don’t begrudge you that authority and we probably share many opinions about art and architecture, but I do beg you to exercise your power with extreme caution when advising patients with life threatening diseases to embrace unproven therapies. There is no equivalent of the GMC for the monarchy, so it is left either to sensational journalism or, more rarely, to the quiet voice of loyal subjects such as myself to warn you that you may have overstepped the mark. It is in the nature of your world to be surrounded by sycophants (including members of the medical establishment hungry for their mention in the Queen’s birthday honours list) who constantly reinforce what they assume are your prejudices. Sir, they patronise you! Allow me this chastisement.

    Last week I had a sense of déjà vu, when the Observer (27 June) and Daily Express (28 June) newspapers reported you promoting coffee enemas and carrot juice for cancer. However, much has changed since you shocked us out of our complacency 20 years ago. The GMC is reformed and, as part of this revolution, so has our undergraduate teaching. Students are taught the importance of the spiritual domain but also study the epistemology of medicine or, in simpler words, the nature of proof.

    Many lay people have an impressionistic notion of science as a cloak for bigotry. Nothing could be further from the truth. The scientific method is based on the deductive process that starts with the humble assumption that your hypothesis might be wrong and is then subjected to experiments that carry the risk of falsification. This approach works. For example in my own specialism, breast cancer, we have witnessed a 30% fall in mortality since 1984, resulting from a worldwide collaboration in clinical trials, accompanied by improvements in quality of life as measured by psychometric instruments.

    You promote the Gerson diet whose only support comes from inductive logic—that is, anecdote. What is wrong with anecdote, you may ask? After all, these are real human interest stories. The problems are manifold but start with the assumption that cancer has a predictable natural history. “The patient was only given six months to live, tried the diet, and lived for years.” This is an urban myth. With advanced breast cancer the median expectation of life might be 18 months, but many of my patients live for many years longer, with or without treatment.

    I have always advocated the scientific evaluation of CAM using controlled trials. If “alternative” therapies pass these rigorous tests of so called “orthodox” medicine, then they will cease to be alternative and join our armamentarium. If their proponents lack the courage of their convictions to have their pet remedies subjected to the hazards of refutation then they are the bigots who will forever be condemned to practise on the fringe.

    I have much time for complementary therapy that offers improvements in quality of life or spiritual solace, providing that it is truly integrated with modern medicine, but I have no time at all for “alternative” therapy that places itself above the laws of evidence and practises in a metaphysical domain that harks back to the dark days of Galen.

    Many postmodern philosophers would have us believe that all knowledge is relative and that the dominance of one belief system is determined by the power of its proponents. However, perhaps we should all remain cognisant of the words of the Nobel laureate Jacques Monod: “Personal self-satisfaction is the death of the scientist. Collective self-satisfaction is the death of the research. It is restlessness, anxiety, dissatisfaction, agony of mind that nourish science.

    Please, your royal highness, help us nourish medical science by sharing our agony.”

    I infract Prof Ernst’s admonition not to stray off-topic, yet I am sure he will be of too generous a spirit to edit my copying of Michael Baum’s admonishment to one of the UK’s foremost promoters of SCAM (and that is the topic here!).
    HRH TPoW has had Covid-19 and presumably doe not need the vaccine. His mother’s status is not declared, but, being enraptured by homeopathy, she has probably not had a jab. I know the Faculty of Homeopathy endorse vaccines, but most homeopaths do not – and HM still helps Ainsworth’s with their marketing of homeopathic remedies by granting them her warrant.

    This is no different from Miss Markle promoting a brand of coffee – except that, being younger, on trend, and American, Miss Markle does it more effectively. Yet MM gets castigated – HM does not.
    Ain’t life unfair.
    (A statement, not a question.)

    Press on Michael.
    Richard

    • “dark days of Galen”

      QFTW.

    • “…Personal self-satisfaction is the death of the scientist. Collective self-satisfaction is the death of the research. It is restlessness, anxiety, dissatisfaction, agony of mind that nourish science.”

      “…Please, your royal highness, help us nourish medical science by sharing our agony.”

      This sentiment is inherently contradictory: how can the subject achieve perfect agony without some microscopic feeling of satisfaction?

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