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

religion

Conversion therapy has been banned last week in Canada. These therapies – also known as sexual orientation change effort (SOCE), reparative therapy, reintegrative therapy, reorientation therapy, ex-gay therapy, and gay cure – rely on the assumption that sexual orientation can be changed, an idea long discredited by major medical associations in the US, the UK, France, and elsewhere. The new law makes “providing, promoting, or advertising conversion therapy” a criminal offense. It will also be an offense to profit from the provision of conversion therapy. In addition, the bill states a person cannot remove a “child from Canada with the intention that the child undergo conversion therapy outside Canada.” Prime Minister Justin Trudeau hailed the law’s Royal Assent: “It’s official: Our government’s legislation banning the despicable and degrading practice of conversion therapy has received Royal Assent — meaning it is now law.”

Conversion therapy is the attempt to change an individual’s sexual or gender identity by psychological, medical, or surgical interventions. Often, informed consent is insufficient or lacking. In conventional medicine, numerous treatments have been tried for this purpose, some of them dangerous and all of them ineffective. In alternative medicine, approaches that have been advocated include:

  • Homeopathy (see below),
  • Hypnotherapy,
  • Spiritual healing,
  • Prayer,
  • Eye Movement Desensitization,
  • Rebirthing,
  • and others.
Survey data imply that conversion therapy is still disturbingly popular, often leads to undesirable outcomes, and is most frequently practiced by:
  • Faith-based organizations or leaders
  • Licensed healthcare professionals
  • Unlicensed healthcare professionals

As previously reported, the German ‘Association of Catholic Doctors’ claimed that homeopathic remedies can cure homosexuality. Specifically, they advised that ‘…the working group ‘HOMEOPATHY’ of the Association notes homeopathic therapy options for homosexual tendencies…repertories contain special rubrics pointing to characteristic signs of homosexual behavior, including sexual peculiarities such as anal intercourse. And a homeopathic remedy called ‘Dr. Reckeweg R20 Glandular Drops for Women’ was claimed to treat “lesbian tendencies.” The product is “derived and potentised from fetal tissues.”

Several countries are now in the process of banning conversion therapy. France has already banned it and so has Germany. The UK government intends to introduce a legislative ban on the practice of conversion therapy. The consultation on how to best do this is open until 4 February 2022.

In 2013, Zuckerman et al. conducted a meta-analysis of 63 studies that showed a negative intelligence-religiosity relation (IRR). Now a new meta-analysis with an updated data set of 83 studies has re-addressed the issue.

The new analysis showed that the correlation between intelligence and religious beliefs in college and non-college samples ranged from -.20 to -.23. There was no support for mediation of the IRR by education but there was support for partial mediation by analytic cognitive style.

In 2012, Canadian scientists tested the hypothesis that an analytic cognitive style is associated with a history of questioning, altering, and rejecting (i.e., unbelieving) supernatural claims, both religious and paranormal. In two studies, they examined associations of God beliefs, religious engagement (attendance at religious services, praying, etc.), conventional religious beliefs (heaven, miracles, etc.), and paranormal beliefs (extrasensory perception, levitation, etc.) with performance measures of cognitive ability and analytic cognitive style. An analytic cognitive style negatively predicted both religious and paranormal beliefs when controlling for cognitive ability as well as religious engagement, sex, age, political ideology, and education. Participants more willing to engage in analytic reasoning were less likely to endorse supernatural beliefs. Further, an association between analytic cognitive style and religious engagement was mediated by religious beliefs, suggesting that an analytic cognitive style negatively affects religious engagement via lower acceptance of conventional religious beliefs.

Some time ago, I reported about a study concluding that a higher religiousness/spirituality is associated with a more frequent use of supplements or additional therapies in individuals with endocrinopathies or metabolic diseases. As so-called alternative medicine (SCAM) has been shown to be associated with worse outcome, addressing religiousness/spirituality which stresses the responsibility of the person for his life might offer an additional resource and should be further studied.

On this blog, we have discussed many times, that advocacy of SCAM is associated with vaccination hesitancy; see, for instance here, here, and here)

Finally, the findings of a recent study suggest that beliefs in an engaged God were associated with greater mistrust in the COVID-19 vaccine. This association was amplified for Hispanic and lower-educated Americans. The authors argued that beliefs in an engaged God may promote distrust of science, reduce motivation to get vaccinated, and derive comfort and strength by placing control over one’s life in the hands of a loving, involved deity.

There are, of course, other factors involved in the complex relationships between intelligence, religiosity, SCAM, and vaccination hesitancy. Yet, it seems clear that such links do exist. I agree that it is well worth investigating them in more detail.

The purpose of this qualitative research was to explore whether pilgrims visiting Lourdes, France had transcendent experiences and to examine their nature.

For this purpose, the researchers traveled to Lourdes and spoke with 67 pilgrims including assisted pilgrims, young volunteers, and medical staff. About two in five reported a transcendent experience: some felt they had communicated or had close contact with a divine presence, while others reported a powerful experience of something intangible and otherworldly.

The authors concluded that visiting Lourdes can have a powerful effect on a pilgrim and may include an “out of the ordinary” transcendent experience, involving a sense of relationship with the divine, or experiences of something otherworldly and intangible. There is a growing focus on Lourdes as a place with therapeutic benefits rather that cures: our analysis suggests that transcendent experiences can be central to this therapeutic effect. Such experiences can result in powerful emotional responses, which themselves may contribute to long term well-being. Our participants described a range of transcendent experiences, from the prosaic and mildly pleasant, to intense experiences that affected pilgrims’ lives. The place itself is crucially important, above all the Grotto, as a space where pilgrims perceive that the divine can break through into normal life, enabling closer connections with the divine, with nature and with the self.

Some people can have powerful effects when they expect something powerful. So what?

To make any sense out of this, we need a controlled experiment. I am glad to tell you that Austrian psychologists recently published a controlled study of this type. They tested the effects of tap water labeled as Lourdes water versus tap water labeled as tap water found that placebos in the context of religious beliefs and practices can change the experience of emotional salience and cognitive control which is accompanied by connectivity changes in the associated brain networks. They concluded that the findings of the present study allow us to draw preliminary conclusions about the placebo effect in the context of religious beliefs and practices. We found that this type of placebo can enhance emotional-somatic well-being, and can lead to changes in rsFC in cognitive control/emotional salience networks of the brain. Future research is warranted to replicate the results. Moreover, future research should investigate whether the observed effects generalize across different religious affiliations. The idea of “holy water” (or blessed water) is common in several religions, from Christianity, Islam, Buddhism to Sikhism.

Placebo can enhance emotional-somatic well-being. Expectation can play all sorts of tricks on us. This makes sense to me – much to the contrary to the ‘qualitative study’ suggesting that transcendental experiences can be central to this therapeutic effect experienced by believers in Lourdes.

While working on yesterday’s post, I discovered another recent and remarkable article co-authored by Prof Harald Walach. It would surely be unforgivable not to show you the abstract:

The aim of this study is to explore experiences and perceived effects of the Rosary on issues around health and well-being, as well as on spirituality and religiosity. A qualitative study was conducted interviewing ten Roman Catholic German adults who regularly practiced the Rosary prayer. As a result of using a tangible prayer cord and from the rhythmic repetition of prayers, the participants described experiencing stability, peace and a contemplative connection with the Divine, with Mary as a guide and mediator before God. Praying the Rosary was described as helpful in coping with critical life events and in fostering an attitude of acceptance, humbleness and devotion.

The article impressed me so much that it prompted me to design a virtual study for which I borrowed Walach’s abstract. Here it is:

The aim of this study is to explore experiences and perceived effects of train-spotting on issues around health and well-being, as well as on spirituality. A qualitative study was conducted interviewing ten British adults who regularly practiced the art of train-spotting. As a result of using a tangible train-spotter diary and from the rhythmic repetition of the passing trains, the participants described experiencing stability, peace, and a contemplative connection with the Divine, with Mary as a guide and mediator before the almighty train-spotter in the sky. Train-spotting was described as helpful in coping with critical life events and in fostering an attitude of acceptance, humbleness, and devotion.

These virtual results are encouraging and encourage me to propose the hypothesis that Rosary use and train-spotting might be combined to create a new wellness program generating a maximum holistic effect. We are grateful to Walach et al for the inspiration and are currently applying for research funds to test our hypothesis in a controlled clinical trial.

 

Just as I read that the right-wing preacher Lance Wallnau once claimed he had cured Rush Limbaugh of his lung cancer – Limbaugh died yesterday of that cancer – I found this paper in the bizarre journal ‘EXPLORE’ reporting a much more successful (or should I say ‘tall’?) tale of healing by prayer.

This case report describes an 18-year-old female who lost the majority of her central vision over the course of three months in 1959. Medical records from 1960 indicate visual acuities (VA) of less than 20/400 for both eyes corresponding to legal blindness. On fundus examination of the eye, there were dense yellowish-white areas of atrophy in each fovea and the individual was diagnosed with juvenile macular degeneration (JMD).

In 1971, another examination recorded her uncorrected VA as finger counting on the right and hand motion on the left. She was diagnosed with macular degeneration (MD) and declared legally blind. In 1972, having been blind for over 12 years, the patient reportedly regained her vision instantaneously after receiving proximal-intercessory-prayer (PIP). Subsequent medical records document repeated substantial improvement; including uncorrected VA of 20/100 in each eye in 1974 and corrected VAs of 20/30 to 20/40 were recorded from 2001 to 2017.

To date, her eyesight has remained intact for forty-seven years, according to the authors of this paper.

The course of these events is summarised in the graph below.

And here is what the patients was reported stating:

“What people need to understand is ‘I was blind’, totally blind and attended the School for the Blind. I read Braille and walked with a white cane. Never had I seen my husband or daughters face. I was blind when my husband prayed for me- then just like that- in a moment, after years of darkness I could see perfectly! It was miraculous! My daughter’s picture was on the dresser. I could see what my little girl and husband looked like, I could see the floor, the steps. Within seconds, my life had drastically changed. I could see, I could see!”

This report originates from the GLOBAL MEDICAL RESEARCH INSTITUTE. Their website claims that our mission is to investigate the effects of prayer in the resolution of conditions where the prognosis is typically poor, even with medical intervention. We are also developing randomized, controlled clinical trials of healing prayer effects.

Three questions came to my mind while reading all this:

  1. Are RCTs in prayer really needed? The believers already ‘know’ and will not trust the findings of the research, if they are not positive.
  2. Who do they try to convince the public with a case report that dates back 47 years?
  3. What do they think of Carl Sagan’s bon mot, ‘EXTRAORDINARY CLAIMS REQUIRE EXTRAORDINARY EVIDENCE’?

Many people have pointed out that the US election was disappointing because, after Trump’s four years in office, people must have realised that he is a vile and dangerous president. Yet, a very large proportion of Americans voted for him. Some commentators even speak of a cult-like movement supporting Trump.

Many people have also pointed out that some forms of so-called alternative medicine (SCAM) are irrational and even harmful. Yet, a sizable proportion of the population continue to use them. Some experts even speak of a cult-like movement supporting SCAM.

WHY?

Why do so many people make irrational choices?

Are they all stupid?

I don’t think so!

The way I see it, a key here must be critical thinking. Critical thinking means making decisions and judgements based on (often confusing) evidence. According to the ‘National Council for Excellence in Critical Thinking’ it is the intellectually disciplined process of actively and skilfully conceptualizing, applying, analysing, synthesizing, and/or evaluating information gathered from, or generated by, observation, experience, reflection, reasoning, or communication, as a guide to belief and action.

Critical thinking is not something one is born with; but most people can learn this skill. In one study, researchers measured the relationship between student’s religion, gender, and propensity for fantasy thinking with the change in belief for paranormal and pseudoscientific subjects following a science and critical thinking course. Following the course, overall beliefs in paranormal and pseudo-scientific subcategories were lower by 6.8–28.9%.

Though easily confused with intelligence, critical thinking has little to do with it. Critical thinking is a collection of cognitive skills that allow us to rationalise. Critical thinkers are flexible thinkers who require evidence to support their beliefs and recognize fallacious attempts to mislead them. Critical thinking is the skill of minimising cognitive biases.

If I am correct, those people who voted for Trump in the US (or similar politicians, such as Boris Johnson in the UK) and those consumers who spend their money on bogus SCAMs both are deficient in their ability to think critically. This does not mean that they are the same individuals. I merely suggest they have one characteristic in common.

It is crucial, I think, to realise that critical thinking can be improved with education. In the final analysis, disappointing results of any election in which (far too many) people voted for a dishonest, corrupt politician, and the disappointingly high usage of bogus SCAMs have, I believe, their roots in poor education. This means that, if we want to reduce the risk of the Trump disaster repeating itself, we need to invest effectively and generously in better educating our children (and adults). And if we want to minimise the risk of consumers wasting their money or damaging their health with bogus SCAMs, we need to make sure the public has a sufficient understanding of logic, reason, evidence and science.

As the world is waiting for the drawn-out process of vote-counting in the US to end, and as Trump has already declared himself to be the winner, it is easy to get emotional about the harm the current POTUS has done (and might do in future) to his country and the world. One comment I read this morning:

Christians have feared the arrival of the Anti-Christ for 2 000 years. And as soon as he appears, they vote for him.

I have to admit that I find it amazing that close to 50% of the US citizens, after observing Trump in action, are not wiser than to vote for him – amazing and frightening!

Yet, we must remain rational.

He might still be voted out!

To remind myself why I, as a scientist, find Donald Trump so deeply objectionable, I have collected a few of his quotes on science. I hope you see my point:

  • Not only are wind farms disgusting looking, but even worse they are bad for people’s health
  • Remember, new “environment friendly” lightbulbs can cause cancer. Be careful– the idiots who came up with this stuff don’t care.
  • Healthy young child goes to doctor, gets pumped with massive shot of many vaccines, doesn’t feel good and changes – AUTISM. Many such cases!
  • The concept of global warming was created by and for the Chinese in order to make U.S. manufacturing non-competitive.
  • So, supposing we hit the body with a tremendous — whether it’s ultraviolet or just very powerful light — and I think you said that that hasn’t been checked, but you’re going to test it. And then I said, supposing you brought the light inside the body, which you can do either through the skin or in some other way, and I think you said you’re going to test that too. It sounds interesting…
  • And then I see the disinfectant, where it knocks it out in a minute. One minute. And is there a way we can do something like that, by injection inside or almost a cleaning. Because you see it gets in the lungs and it does a tremendous number on the lungs. So it would be interesting to check that. So, that, you’re going to have to use medical doctors with. But it sounds — it sounds interesting to me.
  • People are surprised that I understand it [science]. Every one of these doctors said, ‘How do you know so much about this?’ Maybe I have a natural ability. Maybe I should have done that instead of running for President.
  • Some say that and some say differently [global warming]. I mean, you have scientists on both sides of it. My uncle was a great professor at MIT for many years. Dr. John Trump. And I didn’t talk to him about this particular subject, but I have a natural instinct for science, and I will say that you have scientists on both sides of the picture.
  • And when you’re talking about an atmosphere, oceans are very small. And it blows over and it sails over.
  • I’m speaking with myself, number one, because I have a very good brain and I’ve said a lot of things.
  • What do I know about it? All I know is what’s on the internet

To this picture, we evidently have to add

NO UNDERSTANDING OF OR RESPECT FOR SCIENCE.

The objective of this survey was to assess the prevalence and types of so-called alternative medicine (SCAM) usage as well as the participants’ spirituality/religiousness in an outpatient department for endocrinology and metabolic diseases. All individuals visiting the outpatient department at a German university hospital from April to June 2009 were offered a standardized questionnaire on the use of dietary supplements and other SCAMs as well as their religiousness/spirituality. Demographic and clinical data of 428 respondents were taken from the electronic health record.

Of the respondents, 16.4% (n = 66) classified themselves to be religious/spiritual and 67.9% (n = 273) as not religious/spiritual. The results show that:

  • 41.4% of the respondents used supplements and 27.4% additional therapies;
  • the use of supplements and other SCAMs was more frequent in people with higher religiousness/spirituality (p = 0.005 and p = 0.01,resp.);
  • there were no associations between religiousness/spirituality and the number of consultations, costs for drugs, appraisal of the physicians treatment methods, the perceived effectiveness of prescribed drugs, fear of late complications or of side effects.

The authors concluded that a higher religiousness/spirituality is associated with a more frequent use of supplements or additional therapies in individuals with endocrinopathies or metabolic diseases. As SCAM has been shown to be associated with worse outcome, addressing religiousness/spirituality which stresses the responsibility of the person for his life might offer an additional resource and should be further studied.

This survey has a dismal sample size and even worse response rate and must therefore be taken with more than a pinch of salt. Yet vaguely similar associations have been shown before. For instance, analysing data from the 1995-1996 National Survey of Midlife Development in the United States (n=3032), researchers examined the correlations between four aspects of spirituality/religiousness-i.e., spiritual only, religious only, both spiritual and religious, and neither spiritual nor religious-and six measures of SCAM. Compared with spiritual only persons, the odds of using energy therapies were 86% lower for spiritual and religious persons, 65% lower for religious only persons, and 52% lower for neither spiritual nor religious persons. Compared to spiritual only persons, spiritual and religious individuals were 43% more likely to use body-mind therapies in general; however, when this category did not contain prayer, meditation, or spiritual healing, they were 44% less likely. Religious only individuals were disinclined toward SCAM use.

There might be considerable cultural and national differences, of course, but if it is true that religiousness/spirituality is associated with a more frequent use of SCAM, we ought to ask what the nature of the link between the two might be. There are, as far as I can see, three possibilities:

  1. religiousness/spirituality causes SCAM use;
  2. SCAM use causes religiousness/spirituality;
  3. the two are related via one or several other factors.

I see no reason why 1 or 2 should be true. More likely there is a common denominator. The obvious one might be that both religiousness/spirituality and SCAM use are somewhat irrational, more a matter of belief than evidence, and revealing a lack of scepticism or critical thinking. In this case, religiousness/spirituality and SCAM use would simply be two different expressions of the same frame of mind.

What do you think?

 

 

Am I the only one who is tired of hearing that, in India, homeopathy is doing wonders for the current pandemic? All of the reports that I have seen are based on little more than hearsay, anecdotes or pseudo-science. If anyone really wanted to find out whether homeopathy works, they would need more than that; in fact, they would need to conduct a clinical trial.

But wait!

As it happens, there are already ~500 clinical trials of homeopathy. Many show positive effects, but the reliable ones usually don’t. Crucially, the totality of the evidence fails to be positive. So, running further studies is hardly a promising exercise. In fact, considering how utterly implausible homeopathy is, it even seems like an unethical waste of resources.

But many homeopaths disagree, particularly those in India. And it has been reported that several trials have been given the go-ahead in India and are now up and running. This regrettable fact is being heavily exploited for swaying public opinion in favour of homeopathy. The way I see it, the situation is roughly this:

  • a few trials of homeopathy are being set up;
  • they are designed by enthusiasts of homeopathy who lack research expertise;
  • therefore their methodology is weak and biased towards generating a false-positive result;
  • while this is going on, the homeopathic propaganda machine is running overtime;
  • when the results will finally emerge, they will get published in a 3rd rate journal;
  • homeopaths worldwide will celebrate them as a triumph for homeopathy;
  • critical thinkers will be dismayed at their quality and will declare that the conclusions drawn by over-enthusiastic homeopaths are not valid;
  • in the end, we will be exactly where we were before: quasi-religious believers in homeopathy will feel vexed because their findings are not accepted in science, and everyone else will be baffled by the waste of time, opportunity and resources as well as by the tenacity of homeopaths to make fools of themselves.

But criticising is easy; doing it properly is often more difficult.

So, how should it be done?

The way I see it, one should do the following:

  • carefully consider the implausibility of homeopathy;
  • thoroughly study the existing evidence on homeopathy;
  • abandon all plans to study homeopathy in the light of the above.

But this hardly is inconceivable considering the current situation in India. If further studies of homeopathy are unavoidable, the following procedure might therefore be reasonable:

  1. assemble a team of experts including trial methodologists, statisticians, epidemiologists and homeopaths;
  2. ask them to design a rigorous protocol of one or two studies that would provide a definitive answer to the research question posed;
  3. make sure that, once everyone is happy with the protocol, all parties commit to abiding by the findings that will emerge from these trials;
  4. conduct the studies under adequately strict supervision;
  5. evaluate the results according to the protocol;
  6. publish them in a top journal;
  7. do the usual press-releases, interviews etc.

In India, it seems that the last point in this agenda came far too early. This is because, in this and several other countries, homeopathy has become more a belief system than a medicine. And because it is about belief, the believers will avert any truly meaningful and rigorous test of homeopathy’s efficacy.

 

 

This was essentially the question raised in a correspondence with a sceptic friend. His suspicion was that statistical methods might produce false-positive overall findings, if the research is done by enthusiasts of the so-called alternative medicine (SCAM) in question (or other areas of inquiry which I will omit because they are outside my area of expertise). Consciously or inadvertently, such researchers might introduce a pro-SCAM bias into their work. As the research is done mostly by such enthusiasts; the totality of the evidence would turn out to be heavily skewed in favour of the SCAM under investigation. The end-result would then be a false-positive overall impression about the SCAM which is less based on reality than on the wishful thinking of the investigators.

How can one deal with this problem?

How to minimise the risk of being overwhelmed by false-positive research?

Today, we have several mechanisms and initiatives that are at least partly aimed at achieving just this. For instance, there are guidelines on how to conduct the primary research so that bias is minimised. The CONSORT statements are an example. As many studies pre-date CONSORT, we need a different approach for reviews of clinical trials. The PRISMA guideline or the COCHRANE handbook are attempts to make sure systematic reviews are transparent and rigorous. These methods can work quite well in finding the truth, but one needs to be aware, of course, that some researchers do their very best to obscure it. I have also tried to go one step further and shown that the direction of the conclusion correlates with the rigour of the study (btw: this was the paper that prompted Prof Hahn’s criticism and slander of my work and person).

So, problem sorted?

Not quite!

The trouble is that over-enthusiastic researchers may not always adhere to these guidelines, they may pretend to adhere but cut corners, or they may be dishonest and cheat. And what makes this even more tricky is the possibility that they do all this inadvertently; their enthusiasm could get the better of them, and they are doing research not to TEST WHETHER a treatment works but to PROVE THAT it works.

In the realm of SCAM we have a lot of this – trust me, I have seen it often with my own eyes, regrettably sometimes even within my own team of co-workers. The reason for this is that SCAM is loaded with emotion and quasi-religious beliefs; and these provide a much stronger conflict of interest than money could ever do, in my experience.

And how might we tackle this thorny issue?

After thinking long and hard about it, I came up in 2012 with my TRUSTWORTHYNESS INDEX:

If we calculated the percentage of a researcher’s papers arriving at positive conclusions and divided this by the percentage of his papers drawing negative conclusions, we might have a useful measure. A realistic example might be the case of a clinical researcher who has published a total of 100 original articles. If 50% had positive and 50% negative conclusions about the efficacy of the therapy tested, his TI would be 1.

Depending on what area of clinical medicine this person is working in, 1 might be a figure that is just about acceptable in terms of the trustworthiness of the author. If the TI goes beyond 1, we might get concerned; if it reaches 4 or more, we should get worried.

An example would be a researcher who has published 100 papers of which 80 are positive and 20 arrive at negative conclusions. His TI would consequently amount to 4. Most of us equipped with a healthy scepticism would consider this figure highly suspect.

Of course, this is all a bit simplistic, and, like all other citation metrics, my TI provides us not with any level of proof; it merely is a vague indicator that something might be amiss. And, as stressed already, the cut-off point for any scientist’s TI very much depends on the area of clinical research we are dealing with. The lower the plausibility and the higher the uncertainty associated with the efficacy of the experimental treatments, the lower the point where the TI might suggest  something  to be fishy.

Based on this concept, I later created the ALTERNATIVE MEDICINE HALL OF FAME. This is a list of researchers who manage to go through life researching their particular SCAM without ever publishing a negative conclusion about it. In terms of TI, these people have astronomically high values. The current list is not yet long, but it is growing:

John Weeks (editor of JCAM)

Deepak Chopra (US entrepreneur)

Cheryl Hawk (US chiropractor)

David Peters (osteopathy, homeopathy, UK)

Nicola Robinson (TCM, UK)

Peter Fisher (homeopathy, UK)

Simon Mills (herbal medicine, UK)

Gustav Dobos (various, Germany)

Claudia Witt (homeopathy, Germany and Switzerland)

George Lewith (acupuncture, UK)

John Licciardone (osteopathy, US)

The logical consequence of a high TI would be that researchers of that nature are banned from obtaining research funds and publishing papers, because their contribution is merely to confuse us and make science less reliable.

I am sure there are other ways of addressing the problem of being mislead by false-positive research. If you can think of one, I’d be pleased to hear about it.

 

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