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

malpractice

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Guest post by Kevin Smith

A family member of my household has been aghast to receive in the post yesterday a letter suggesting that, if they develop symptoms of coronavirus, they should take homeopathic remedies.

If this had been from some quack pharmacy doing a random mailshot, it would have been bad enough. But, astonishingly, it has come from the NHS! The letter is not on headed notepaper and is unsigned (it is in the format of a ‘factsheet’), thus is doesn’t contain the sender’s address; however, the envelope’s address label displays both my family member’s NHS number and the name of their GP practice. Moreover, the franking refers to a PO Box number that is owned by the NHS teaching hospital in our area. So it has certainly come from the NHS.

I believe that the family member who received it has been targeted because, in the past, a GP referral had been made for them to consult an NHS homeopath at this hospital.

Yes, very sadly, homeopaths have managed to exist within the NHS in the local area. I had assumed that, with the NHS recently cracking down on homeopathy, such quacks would have been excised – but this looks not to be the case, given the sending of this letter.

Here’s the text of the letter. Read it and see if you are as astonished – indeed as enraged – as I certainly am, and as is the family member to whom it was sent.

Guidance on Coronavirus (updated)

Prevention:

Daily probiotics, Regular handwashing, Stat dose of Covid-19 nosode 200c if it becomes available, Vit C & Zinc supplementation

Stress avoidance (Constitutional homeopathic prescribing & lifestyle)

Avoid incidental paracetamol use (ie no symptomatics for stress headaches etc)

Contact:

Add Ecchinacea, tincture 5 drops in water, twice daily, for no more than 4 consecutive days

Prodromal (ie before symptoms emerge):

Avoidance of incidental paracetamol use.

Stop work. Rest. Isolation. (+ Gelsemium 2 hourly, and/or Covid-19 nosode if it becomes available)

If you develop symptoms of Coronavirus: then avoid Paracetamol, Ibuprofen or Aspirin and take one of the following every hour, sucked in the mouth:

Camphora 30c (tablets or pillules) chills, cough, changeable fever

Bryonia 30c (tablets or pillules) fever, painful dry cough

Arsenicum album 30c (tablets or pillules) washed out feeling, chilliness, restless or agitated

Veratrum album 30c (diarrhoea, chills and fatigue)

Bryonia and Camphora are the most commonly indicated for Covid-19 from experience so far. Order them directly from one of the UK Homeopathic Pharmacies listed.

7 grammes / 8 grammes = 60 tablets or pillules

14 grammes / 15 grammes = 120 tablets or pillules

That’s the front page of the letter. Overleaf, it lists 11 homeopathic suppliers (across the UK), complete with contact details.

Additionally, the letter was accompanied by a pink slip, containing the following text:

If you find that you need to use any of the treatments outlined here, it is very important that you provide detailed feedback to us, so that we can adapt and improve our advice to others if necessary. Email (feedback only) [email protected]

What to make of this communication? Remember, this was from the NHS! What to do about it? COMMENTS WELCOME!

During the last 30 years, I must have read a few thousand studies of so-called alternative medicine (SCAM). Some made me angry because of their methodological flaws or wrong conclusions. A few impressed me. Many made me giggle. But none has ever caused me to laugh out so long as this one entitled ‘A STUDY ON THE PROPHYLACTIC EFFICACY OF HOMOEOPATHIC PREVENTIVE’.

Here is its abstract:

Homoeopathy has established its supremacy in the control of infectious viral diseases. The widespread acclaim in this regard is now supported by this study. The study was conducted in the Chikungunya fever hit areas of Kerala. The genus epidemicus was selected after detailed analysis of the first cases of Chikungunya. This preventive medicine was widely distributed in the disease prevalent areas. A survey was conducted for the evaluation of prophylactic efficacy. The study showed a very high significant effect of Homeopathic medicine in the prevention of Chikungunya fever.

You are, of course, correct to defend the Indian authors: it is unfair to judge a study purely on its abstract. So, let’s have a look at the rest. After a lengthy introduction, the heart of the full paper discloses the amazing details of the study.

Here I present the unabridged text of the study; the only part I have omitted is the introduction:

Aims and Objectives

1. To assess the efficacy of Homoeopathic medicine in the prevention of Chikungunya.
2. To determine the magnitude of incidence, clinical features, mortality , social & economic impact of the Chikungunya epidemic.

Conclusion

The Homoeopathic preventive medicine distributed for Chikungunya epidemic was highly effective.

THAT’S ALL!

As so often in the realm of so-called alternative medicine (SCAM), the Australians are setting an example. The Australian Health Practitioner Regulation Agency (Ahpra) is the national organisation responsible for implementing the National Registration and Accreditation Scheme (the National Scheme) across Australia. Yesterday, the Ahpra have issued an important press-release. Here is an excerpt:

… While the vast majority of health practitioners are responding professionally to the COVID-19 emergency and focusing on providing safe care, Ahpra and National Boards are seeing some examples of false and misleading advertising on COVID-19.

During these challenging times, it is vital that health practitioners only provide information about COVID-19 that is scientifically accurate and from authoritative sources, such as a state, territory or Commonwealth health department or the World Health Organization (WHO). According to these authoritative sources, there is currently no cure or evidence-based treatment or therapy which prevents infection by COVID-19 and work is currently underway on a vaccine.

Other than sharing health information from authoritative sources, registered health practitioners should not make advertising claims on preventing or protecting patients and health consumers from contracting COVID-19 or accelerating recovery from COVID-19. To do so involves risk to public safety and may be unlawful advertising. For example, we are seeing some advertising claims that spinal adjustment/manipulation, acupuncture and some products confer or boost immunity or enhance recovery from COVID-19 when there is no acceptable evidence in support.

Advertisers must be able to provide acceptable evidence of any claims made about treatments that benefit patients/health consumers. We will consider taking action against anyone found to be making false or misleading claims about COVID-19 in advertising. If the advertiser is a registered health practitioner, breaching advertising obligations is also a professional conduct matter which may result in disciplinary action, especially where advertising is clearly false, misleading or exploitative. There are also significant penalties for false and misleading advertising claims about therapeutic products under the Therapeutic Goods Act 1989.

Patients and health consumers should treat any advertising claims about COVID-19 cautiously and check authoritative sources for health information about COVID-19, such as state, territory and Commonwealth health departments.

As always, patients and health consumers should ask their practitioner for information to support any advertising claims before making decisions about treatment. Patients and health consumers should receive accurate and truthful messages so they can make the right choices about their health.

Many of my posts during the last weeks have dealt with this problem. The sad truth is that charlatans of all types are trying to exploit the fear of consumers during the current crisis for making a fast buck. This is despicable, unethical, unprofessional and possibly criminal.I do hope that the authorities of other countries follow the Australian example.

The objective of this trial, just published in the BMJ, was to assess the efficacy of manual acupuncture as prophylactic treatment for acupuncture naive patients with episodic migraine without aura. The study was designed as a multi-centre, randomised, controlled clinical trial with blinded participants, outcome assessment, and statistician. It was conducted in 7 hospitals in China with 150 acupuncture naive patients with episodic migraine without aura.

They were given the following treatments:

  • 20 sessions of manual acupuncture at true acupuncture points plus usual care,
  • 20 sessions of non-penetrating sham acupuncture at heterosegmental non-acupuncture points plus usual care,
  • usual care alone over 8 weeks.

The main outcome measures  were change in migraine days and migraine attacks per 4 weeks during weeks 1-20 after randomisation compared with baseline (4 weeks before randomisation).

A total of 147 were included in the final analyses. Compared with sham acupuncture, manual acupuncture resulted in a significantly greater reduction in migraine days at weeks 13 to 20 and a significantly greater reduction in migraine attacks at weeks 17 to 20. The reduction in mean number of migraine days was 3.5 (SD 2.5) for manual versus 2.4 (3.4) for sham at weeks 13 to 16 and 3.9 (3.0) for manual versus 2.2 (3.2) for sham at weeks 17 to 20. At weeks 17 to 20, the reduction in mean number of attacks was 2.3 (1.7) for manual versus 1.6 (2.5) for sham. No severe adverse events were reported. No significant difference was seen in the proportion of patients perceiving needle penetration between manual acupuncture and sham acupuncture (79% v 75%).

The authors concluded that twenty sessions of manual acupuncture was superior to sham acupuncture and usual care for the prophylaxis of episodic migraine without aura. These results support the use of manual acupuncture in patients who are reluctant to use prophylactic drugs or when prophylactic drugs are ineffective, and it should be considered in future guidelines.

Considering the many flaws in most acupuncture studies discussed ad nauseam on this blog, this is a relatively rigorous trial. Yet, before we accept the conclusions, we ought to evaluate it critically.

The first thing that struck me was the very last sentence of its abstract. I do not think that a single trial can ever be a sufficient reason for changing existing guidelines. The current Cochrance review concludes that the available evidence suggests that adding acupuncture to symptomatic treatment of attacks reduces the frequency of headaches. Thus, one could perhaps argue that, together with the existing data, this new study might strengthen its conclusion.

In the methods section, the authors state that at the end of the study, we determined the maintenance of blinding of patients by asking them whether they thought the needles had penetrated the skin. And in the results section, they report that they found no significant difference between the manual acupuncture and sham acupuncture groups for patients’ ability to correctly guess their allocation status.

I find this puzzling, since the authors also state that they tried to elicit acupuncture de-qi sensation by the manual manipulation of needles. They fail to report data on this but this attempt is usually successful in the majority of patients. In the control group, where non-penetrating needles were used, no de-qi could be generated. This means that the two groups must have been at least partly de-blinded. Yet, we learn from the paper that patients were not able to guess to which group they were randomised. Which statement is correct?

This may sound like a trivial matter, but I fear it is not.

Like this new study, acupuncture trials frequently originate from China. We and others have shown that Chinese trials of acupuncture hardly ever produce a negative finding. If that is so, one does not need to read the paper, one already knows that it is positive before one has even seen it. Neither do the researchers need to conduct the study, one already knows the result before the trial has started.

You don’t believe the findings of my research nor those of others?

Excellent! It’s always good to be sceptical!

But in this case, do you believe Chinese researchers?

In this systematic review, all RCTs of acupuncture published in Chinese journals were identified by a team of Chinese scientists. An impressive total of 840 trials were found. Among them, 838 studies (99.8%) reported positive results from primary outcomes and two trials (0.2%) reported negative results. The authors concluded that publication bias might be major issue in RCTs on acupuncture published in Chinese journals reported, which is related to high risk of bias. We suggest that all trials should be prospectively registered in international trial registry in future.

So, at least three independent reviews have found that Chinese acupuncture trials report virtually nothing but positive findings. Is that enough evidence to distrust Chinese TCM studies?

Perhaps not!

But there are  even more compelling reasons for taking evidence from China with a pinch of salt:

A survey of clinical trials in China has revealed fraudulent practice on a massive scale. China’s food and drug regulator carried out a one-year review of clinical trials. They concluded that more than 80 percent of clinical data is “fabricated“. The review evaluated data from 1,622 clinical trial programs of new pharmaceutical drugs awaiting regulator approval for mass production. According to the report, much of the data gathered in clinical trials are incomplete, failed to meet analysis requirements or were untraceable. Some companies were suspected of deliberately hiding or deleting records of adverse effects, and tampering with data that did not meet expectations. “Clinical data fabrication was an open secret even before the inspection,” the paper quoted an unnamed hospital chief as saying. Chinese research organisations seem have become “accomplices in data fabrication due to cutthroat competition and economic motivation.”

So, am I claiming the new acupuncture study just published in the BMJ is a fake?

No!

Am I saying that it would be wise to be sceptical?

Yes.

Sadly, my scepticism is not shared by the BMJ’s editorial writer who concludes that the new study helps to move acupuncture from having an unproven status in complementary medicine to an acceptable evidence based treatment.

Call me a sceptic, but that statement is, in my view, hard to justify!

 

The ‘Corona-Virus Quackery Club’ (CVQC) is getting positively crowded. You may remember, its members include:

Today we are admitting the herbalists. The reason is obvious: many of them have jumped on the corona band-wagon by trying to improve their cash-flow on the back of the pandemic-related anxiety of consumers. If you go on the Internet you will find many examples, I am sure. I have chosen this website for explaining the situation.

Herbs That Can Stop Coronavirus Reproduction

CoV multiplies fast in the lungs and the stomach and intestines. The more virus, the sicker you get. The herbs are in their scientific names and common names.

    1. Cibotium barometz – golden chicken fern or woolly fern grows in China and Southeast Asia.

      Cibotium Barometz

    2. Gentiana scabra – known as Korean gentian or Japanese gentian seen in the United States and Japan.

      Japanese Gentian

    3. Dioscorea batatas or Chinese Yam grows in China and East Asia

      Chinese Yam

    4. Cassia tora or Foetid cassia, The Sickle Senna, Wild Senna – grows in India and Central America

      Cassia Tora

    5. Taxillus Chinensis – Mulberry Mistletoe

Lectin Plants that Have Anti Coronavirus Properties

Plant Lectins with Antiviral activity Against Coronavirus

From the table above, all have anti coronavirus activity except for garlic. One plant that is effective but not listed is Stinging nettle.

Yes, very nice pictures – but sadly utterly unreliable messages. My advice is that, in case you have concerns about corona (or any other health problem for that matter), please do not ask a herbalist.

WELCOME TO THE CVQC, HERBALISTS!

[If you do not like black humour or sarcasm, please do NOT read this post!!!]

Donald Trump just announced that, at Easter, he wants to see churches packed, his way of saying the lock-down is over because it is damaging the economy. Many others have put forward similar arguments and have pointed out that caring for the vulnerable, sick, old, etc. creates an economic burden that might eventually kill more people than it saves (see for instance ‘Economic crash could cost more lives than coronavirus, study warns‘).

Many people have also argued that homeopathy is unjustly vilified because it is truly a wholesome and safe medicine that should be used routinely. The notion here is that, alright, the evidence is not brilliant, but 200 years of experience and millions of fans cannot be ignored.

I have been wondering whether these two lines of thinking could not be profitably combined. Here is my suggestion based on the following two axioms.

  1. The economy is important for all our well-being.
  2. Homeopaths have a point in that the value of experience must not be ignored.

What follows is surprisingly simple: in view of the over-riding importance of the economy, let’s prioritise it over health. As it would look bad to deny those poor corona victims all forms of healthcare, let’s treat them homeopathically. This would make lots of people happy:

  • those who think the economy must take precedent,
  • those who fear the huge costs of saving corona patients (homeopathy is very cheap),
  • those who argued for decades that we never gave homeopathy a fighting chance to show its worth.

There is a downside, of course. There would be a most lamentable mortality rate. But, to paraphrase Dominic Cummings, if a few oldies have to snuff it, so be it!

Once we get used to this innovative approach – I suggest we call it integrative medicine – we might even consider adopting it for other critical situations. When we realise, for instance, that the pension pots are empty, we could officially declare that homeopathy is the ideal medicine for anybody over 60.

What do you think?

 

I have been alerted to the fact that the latest issue of ‘Homeopathy 4 Everyone’ is packed with what I might call the criminal promotion of homeopathy for coronavirus. Here are a list of and links to the articles in question:

The editorial is by Alan Schmuckler. Here are a few excerpts:

… homeopathy has a proven track record of preventing disease, whether it be bacterial or viral. It has protected people from polio, smallpox, diphtheria, scarlet fever, meningococcal meningitis, leptospirosis and various influenzas.  Homeopathic remedies have successfully treated virtually every epidemic disease that occurred over the last 200 years, including the 1918 influenza pandemic. Treating this disease will require keen observation but if we remain calm, and work as a community, we will be able to reason it through. Most importantly, we will have a means of prevention that will become clear as more cases are evaluated.

There will be the usual critics, but they are simply misinformed. The bottom line is, homeopathy is effective, safe and cheap and doesn’t interfere with other treatments.  In a situation where there is no other proven alternative, it is illogical not to use it.

To those in the Pharmaceutical industry, who know homeopathy works and have been trying to sabotage it, this is a good time to rethink your plan. If you could put away your greed and support homeopathy, you might save your own life and your loved ones, along with countless millions…

The degree of delusion which becomes evident in these lines is frightening. And the actions of these homeopaths are, in my view, criminal.

I have almost got used to seeing that any health crisis brings the worst out of charlatans. In the present pandemic, this has been true for SCAM merchants such as the:

homeopaths,

colloidal silver crooks,

TCM practitioners,

orthomolecular quacks,

Unani-salesmen

and, of course, the chiropractors.

Perhaps one can even forgive such behaviour on an individual level – sadly, it seems to be a human trait to turn every misery into a business opportunity. But when professional organisations behave in this manner, I have less understanding.

In that context, this press release by the INTERNATIONAL CHIROPRACTORS ASSOCIATION seems revealing:

March 16, 2020 (Falls Church, VA) In these challenging times associated with the COVID-19 Pandemic, the International Chiropractors Association (ICA) is issuing a statement reaffirming chiropractic as an essential healthcare service. Everyone is under extraordinary levels of stress.

Chiropractic Services represent an essential and necessary component of the health care program of millions of patients of all ages and all walks of life in the United States and worldwide. Timely and consistent access to chiropractic care is essential to the maintenance of the health and wellbeing of this patient population, particularly during times of stress.

The association encourages jurisdictions at all levels to acknowledge and respect that chiropractic is an essential healthcare service even during a pandemic.

It is important to recognize that as of mid-March 2020, there are no recognized cures in conventional medicine or alternative health approaches for COVID-19. There are no vaccines, no drugs, no natural remedies, no alternative therapies that have been tested and the outcomes peer reviewed to meet any evidence-based standard. The public has the right to seek their own pathway to health and well-being. For millions of Americans, that pathway includes regular chiropractic care. For individuals such as those recovering from injury or suffering back pain, chiropractic care is essential on their road to recovery.

ICA President, Stephen P. Welsh, DC, FICA stated, “While Coronavirus-19 has everyone’s attention, it cannot be forgotten that health promotion and non-opioid pain management through chiropractic adjustments of the subluxation is essential and should not be curtailed or restricted because of this pandemic. With churches, schools, restaurants, museums being closed, the ICA reminds authorities that the offices of doctors of chiropractic should be treated no differently than the offices of medical doctors – as an essential health care service.”

Did I state that I have less understanding for this? To be honest, I feel slightly sick reading the press release!

The ICA state that one of their objectives is to ‘promote the highest professional, technical, and ethical standards for the doctor of chiropractic while safeguarding the professional welfare of its members and the public.’ I highly recommend that the ICA take a step back and inform themselves what professionalism and ethics really mean.

Some homeopaths are so deluded that I am tempted to characterise them as criminally stupid. This does, in my view, apply to those homeopaths who continue to advise their patients to treat or prevent coronavirus infections homeopathically. This website is only one example of many:

So what homeopathic remedy should I take for Coronavirus?

If you are living in an area which is not yet affected by Coronavirus, you should not be taking any remedy for now.

Based on the analysis above, I believe Bryonia alba 6CH or 30CH, can serve as a prophylactic.

It can be given (only to affected population) once a day, till days become warmer and the epidemic subsides (hopefully). People are mobile in endemic or epidemic areas should take the medicine daily. People who are in self quarantine and not having social contact, can take it for 3-5 days and then take it if and when they venture out. If a patient has flu-like symptoms, you can take the same remedy in 6 or 30 potency, 6 hourly. If the vitality is very low, more freuent repetition may be required. Also consider Camphora in such a case.

If a patient develops tightness in chest and shortness of breath, Lycopodium 30CH is likely to help.

The remedy suggestions are based on the available data. Homeopathy needs much deeper individualization, and clinical experience of treating Coronavirus Covid-19 patients with homeopathy, may bring up a different group of remedies.

Some recent data from Iran shows that many patients are showing sudden collapse. Dr. Rajan Sakaran as well as Dr. Sunirmal Sarkar have suggested that Camphora be considered as a medicine and prophylactic there. So if Covid-19 patients in your country are showing signs of sudden collapse with respiratory distress, vertigo and cold sweat, you may consider Camphora.

I do not recommend self-medication. You can show this article to your homeopath for a better clinical judgment that he/she will make for you.

If you suspect yourself to have Corona virus infection, please consult the concerned medical authorities in your country immediately.

If you have a flu-like illness and wish to take homeopathic treatment, please consult a qualified homeopathy doctor in person.

As I already stated: there are many websites with similarly barmy information. If you don’t believe me, see for yourself and run a quick google search.

Some people will say that this is not so bad – if it does not help, it cannot harm!

I would disagree.

Harm is being done by these charlatans in several ways. Firstly, the truth is a most valuable asset, and we must not allow homeopaths to vandalise it. Secondly, if patients believe in these bogus claims, they might take effective preventative measures less seriously and thus increase the danger for us all. Thirdly, anyone following the idiotic advice of homeopaths would have to forge out money for their service, and that money could be put to better use elsewhere.

My conclusion is that these homeopaths try to profit from the panic of vulnerable people. They are therefore crooks of the worst kind.

The ‘Corona-Virus Quackery Club’ (CVQC) is enjoying a fast-growing membership. As mentioned in previous posts, it consists of:

homeopaths,

colloidal silver crooks,

TCM practitioners,

orthomolecular quacks,

Unani-salesmen.

Chiropractors have been keen to join since weeks. They have a long tradition of claiming that their ‘adjustments’ boost the immune system, and therefore it was to be expected that they also jump on the corona-bandwagon.

Some chiropractors seem to believe that the corona-virus pandemic is a fine business opportunity or, as one put it, the perfect opportunity to have a heart to heart with patients about their immune and nervous systems! Remember, if germs automatically caused disease, the human race wouldn’t be around to debate the issue. Many forget that Louis Pasteur, the father of the germ theory recanted his belief. On his deathbed he observed, “It’s the soil, not the seed.” In other words, without the right environment, germs can do little harm.

Chiropractors and other health care workers are at greater risk due to patient or client interactions and are encouraged to take extra precautions when it comes to cleaning and disinfecting surfaces and skin or close contact.

“Every chiropractic practice has been touched by coronavirus [fears],” says Bill Esteb, DC, who has created and is circulating a coronavirus and chiropractic guide on how to avoid contracting the virus.

“We wanted to create a tool that chiropractors could use as a conversation springboard. Chiropractors need to remind their patients that germs don’t automatically cause disease. And that ‘catching’ the coronavirus, or anything else, requires a hospitable environment.”

The only way to catch anything, says Esteb, is to become a hospitable host. Flipping the message, Esteb in his coronavirus and chiropractic guide says here is “How to Catch the Coronavirus”:

  • Eat a Poor Diet — Make sure your body lacks the vitamins, minerals, enzymes and micronutrients needed to keep itself in good repair.
  • Avoid Adequate Rest — Stay up late and use sugar, tobacco, coffee and energy drinks as needed.
  • Become Dehydrated — Reduce the effectiveness of your natural defense mechanisms by shunning adequate water.
  • Stop Exercising — Reduce the efficiency of your lymphatic system, which requires movement to circulate this important germ-fighting fluid.
  • Think Negative Thoughts — Worry that you’ll be a victim. Closely monitor news reports about outbreaks, fearing the advancing pandemic.
  • Rarely Wash Your Hands — Use your dirty hands and fingers to rub your eyes, pick your nose or wipe your lips.
  • Skip Your Chiropractic Adjustments — Handicap your nervous system, the master system that controls your entire body. Wait until symptoms are clearly present.

“Following these suggestions is the way to become a suitable host for any number of germs or microbes,” Esteb says. “The tongue-in-check approach keeps the subject light. It stimulates more instructive patient conversations. It helps reduce appointment cancellations.

“Most people have an inappropriate fear of germs. And while this poster and patient handout won’t eliminate it, use it to explore the value of ongoing chiropractic care as a preventive strategy.”

——–

The Internet is full with messages of this type. Here is just one example: The best defense for the Corona Virus is to be healthy when you are exposed to the virus. Get adjusted to boost your immune system. Check out this video blog on what you can do to be healthy and prepare your body to fight off the corona virus.

——–

Perhaps the worst excesses can be found on Twitter:

James Langford 
@JamesLangford15·

Did you know that a properly aligned body supports and activates our immune system. During this time of concern from the corona virus, making sure your body is healthy is the best way to combat this illness. #health #immunesystem
Oxford Chiropractic
@OxfordChiropra1·

Scared of the corona virus? Practice a little preventative care like mama always used to tell you and get your spine adjusted!!! It’s boosts your immune by 200%!!!!! Why aren’t we talking… instagram.com/p/B9pjMqdATmBn
——–
So, considering this concerted effort, I am happy to announce that, from today, my friends the chiros are official members of the CVQC.
CONGRATULATIONS GUYS!
PS
Whether Boris Johnson will be allowed in, depends on future announcements; so far, his chances are not bad.
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