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

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    by Edzard - Thursday 20 September 2018 10:53
    "Brian Deer – well known for his stance against Andrew Wakefield..." ARE YOU FOR REAL? he is the investigative journalist who uncovered the fraud committed by the ex-doctor Wakefield!

    by Angela - Thursday 20 September 2018 10:23
    Richard Rawlins - ‘last night Newsnight covered anti-vax - critically’. Really? I saw it too and it was biased (but to be expected from Mainstream media) I thought it was desperate : Brian Deer - well known for his stance against Andrew Wakefield (I won’t elaborate more on him) and three other participants talking about conspiracy etc etc. In fairness a nurse did say we need all the information on vaccines to deliver to parents - I hope that becomes a reality.

    by Richard Rawlins - Thursday 20 September 2018 06:31
    Last night Newsnight covered Anti-Vax. - critically. Press on, we won’t ‘win’ because the faith centre is so deep in the hypothalamus - but we might stem the tide and must continue to press for folks to have all relevant information, and to think critically.

    by chris - Wednesday 19 September 2018 13:04
    You make a good and reasonable point Prof. Ernst. The problem as I see it is that a synonym for "Bollocksology" might be Religion as both are based on a faith based belief system. Good luck changing someones religion. As Niall stated above , in the veterinary profession no amount of evidence seems to be able to turn the tide and growth of quackery. That is why places like this : http://www.tcvm.com/ continue to grow and expand globally into new markets. Especially concerning is the integration and embracing of pseudoscience in our professional schools. What was once a fringe market, something medical professionals found themselves exploring after graduating is becoming part of the curriculum. https://smallanimal.vethospital.ufl.edu/clinical-services/integrative-medicine-services/ https://healthypets.mercola.com/sites/healthypets/archive/2013/03/13/building-veterinary-schools.aspx

    by Niall Taylor - Wednesday 19 September 2018 11:32
    What a brilliant piece! I liked 'Appraisal is bunk' and 'we shouldn't aim to "raise awareness" but to improve knowledge'. There is an insidius vagueness and timidity creeping into medical terminology these days, no one seems to be able to say it like it is any more, possibly for fear of giving offence or the daft belief that it is not the done thing to suggest a health professional might actually know more about medicine than other people, including patients. And calling out bollocksology is just as difficult and unpopular in the veterinary profession. Most vets would rather allow animals to be treated for cancer with water and sugar tablets than risk giving offence to a 'fellow professional' (most of whom stopped being 'professional' the moment they started practicing homeopathy IMHO). Niall

by Frank Odds - Thursday 20 September 2018 10:53
@Bjorn Geir I regret I had overlooked Candy Champion's earlier comment. When someone posts a comment such as this one, full of aggression and accusations of lying, I tend to respond with a similar level of aggression when I find that the comment is based on a total misreading of tabulated data. FWIW: earlier this year I too was diagnosed with a colorectal adenocarcinoma. I'm currently undergoing medical and surgical treatment and am cautiously optimistic that, as a result, I'll be declared cancer-free by the end of the year. The treatments, particularly chemotherapy, are not pleasant, but I'm impressed by the many measures that have been developed to prevent or reduce the severity of the side-effects. I am prepared to suffer a little for the longer-term good. I find it easy to understand why some people elect not to undergo orthodox medical treatments; it's entirely their own business. But when that choice is apparently taken on the basis of serious misinformation or failure to comprehend statistics, and the person concerned feels abusive towards medical orthodoxy, then something, somewhere, has gone seriously amiss. I'd recommend anyone newly diagnosed with cancer and thinking of refusing orthodox medical treatments to read the many empathetic, erudite comments on this blog from the oncologist Julian Money-Kyrie. Good examples are this one and this one. Dr Money-Kyrie has also addressed the issue of Googling as 'research' in the hands of people with no background education in biology or medicine (here).

by Stephen Cox - Wednesday 19 September 2018 22:59
Thank you for the excellent comments based on your personal vast experience and expertise Dr. Money-Kyrle. It is astonishing and frustrating that so many non physicians and non scientists become convinced in Voodoo magic perpetrated by con artists. It reminds me of the book by Dr. Paul offit,"Do You Believe in Magic?" All patients should read this, since it conveys and compares reality and truth to nonsense with fact based discussions and references.

by Björn Geir - Wednesday 19 September 2018 19:59
It seems that Ms. Champion's reading of cancer statistics like the devil reads the bible has an extremely sad background. If I read this post from her@ 14:14 today correctly, she is desperately trying to justify her ill advised decision not to accept proper treatment for her own adenocarcinoma disease.

by Candy Champion - Wednesday 19 September 2018 19:37
That is cancer statistics for 66 years from SEERcancer.gov it's a table but didn't transfer over as one. You can copy it into a table or simply go to their site and see it.

by Björn Geir - Thursday 20 September 2018 10:01
@Caca No it did not help. Most fetuses in breech position (bottom first instead of head first) spontaneously turn into cephalic position (head first) before labour starts. Breech position is common in early pregnancy. About 90% of fetuses are in the correct position already at 32 weeks and 25% of fetuses in breech positions at 36 weeks have turned spontaneously at birth. Spontaneous version may occur at any time before labour starts, even after 40 weeks. Only 3-5% of babies are born (vaginally or by cesarean section) in breech position. What makes you think that it was your mother burning herbs on your pinky-toe that did something that nature almost always takes care of?

by caca - Thursday 20 September 2018 08:27
it did worked for me. i had a breech presentation on my 4th pregnancy. actually, it was all my own fault. i did experimenting puncturing hegu and sanyinjiao to stimulate birth, and that night something happened, my baby change her presentation. when i did the check up to OG, USG reeal that she was in diagonal breech presentation. my OG doc suggest me to undergo a C section. but i said let's wait a few more days who know she will turn back to the normal presentation. i was so desperate and ask my mom to help me doing moxibation on BL67 for about 30 minutes each side. i also try the knee chest position (knee chest position only rarely succeed for i was already in 40th week of pregnancy). walhamdulillah, in the morning, i went to the OG n ultrasount reveal she was back to normal position. i proceed to the normal labour. happy ending.

by Simon Cummings - Thursday 20 September 2018 07:41
OK, GibleyGibley it is. I don't need to justify exercise as a treatment for lbp because, at no stage, did I state that exercise is an effective treatment for lbp! You left this out of my response to your previous comment: "I didn’t discuss the tx of lbp, acute or otherwise."

by GibleyGibley - Wednesday 19 September 2018 20:52
Simon, you wrote......"Hi Mike, It’s Accredited Exercise Physiologist and, in the main, we stick to exercise as a treatment modality." I asked you why do you use a form of care, "exercise", that has been proven to be ineffective? I am not picking a fight, I am asking you to justify your rationale for treatment. Anonymity because I, like many other people on this post prefer it. e.g. D.C., Blue Wode and the "Franks"

by Lenny - Thursday 20 September 2018 07:38
Not me, Dana. I'm just commenting on what all the chemists and scientists who have recognised the paper for the nonsense it is and have hence ignored its findings have said. Keep yelling your rubbish into the evidencial and factual void, Dana. Your foolish yabbering continues to amuse.

by Dana Ullman - Wednesday 19 September 2018 15:44
Yeah...those photos of nanoparticles of the 6 different metals can be considered "noise" OR they can be consider nanoparticles of the original 6 metals. Your denial of facts is a classic in showing non-acceptance of reality. And further, I'm impressed that YOU are somehow more informed than the reviewers at LANGMUIR which is published by the American Chemistry Society. You must be very very smart or simply complete full of bowel particles...we know which.

by Edzard - Thursday 20 September 2018 06:49
I doubt it

by Dc - Wednesday 19 September 2018 23:42
Change the question to get the answer you want. Got it.

by Edzard - Wednesday 19 September 2018 13:19
no, the usefulness of a method depends on the question you want to answer. if your question is 'does this therapy have a specific effect?', the design is useless. if my question is 'how useless is the addition of A to B?', it can generate a useful answer. [I say 'my question', because it was not the one the authors had in mind; they aimed at the 1st question and had chosen a useless study design to answer it. but, as things turned out, not all was lost]

by DC - Wednesday 19 September 2018 13:02
so the answer to my question would be “yes”.

by Edzard - Wednesday 19 September 2018 07:26
if A+B does not show a benefit over B, the result is far less inconclusive that in the case where it does and the finding is interpreted as a specific effect of A. I think this is common sense, don't you?

by Leigh Jackson - Wednesday 19 September 2018 21:59
Given the proclamation by China's leader that TCM is a national treasure to be given equal status with western medicine I believe that the default position of reputable publishers outside China should be that papers originating from within China have a serious risk of bias in favour of TCM. Accordingly reviewers should be alert to and capable of bringing all such biases to light. When acupuncture is claimed to be more effective than drugs for chronic constipation, red lights and alarm bells should be flashing and ringing in any scientifically minded brain.

by Les Rose - Wednesday 19 September 2018 17:28
Respected people such as Tricia Greenhalgh are asking for open peer review. There was a total failure of peer review here, as the errors are many and obvious. The usual formula was applied - quack papers are reviewed by other quacks. Frankly though the errors were so glaring that the editors should not even have invited reviewers. Maybe we should move beyond peer review and try something different, such as: 1. Screen submissions for obvious flaws, but this will cost money for editorial staff. 2. Publish in draft and invite critique. 3. Authors to rework paper in response to critiques. 4. Each paper goes through a version control system until all points of criticism are addressed. Any draft can be cited but is prominently flagged as draft and may have errors. 5. Final version published after a set number of versions. Some online journals are doing something like this. There are problems with it, such as malicious rivals deliberately delaying finalisation of a paper they don't like. Right now we often have flawed papers that have been reworked, but other authors commonly cite the earlier flawed version because it suits their beliefs. The only solution to this is retraction - but retracted papers still get cited and reviewers often miss this! Whatever the solution, traditional peer review is not fit for purpose.

by Edzard - Wednesday 19 September 2018 12:29
good points! when I was still at Exeter, I used to do about 3 reviews/week on average. but I had lots of support from secretaries and co-workers. now that I have none of this, I reject almost all invitations to review journal submissions - it's a lot of work when done properly, and not responsible to do it superficially.

by Edzard - Wednesday 19 September 2018 12:24
YOU ARE RIGHT! the journal editors must take the responsibility. the problem is, I think, that they usually do not have the funds that would be needed to do so.

by Edzard - Wednesday 19 September 2018 12:21
good idea! one problem is that critical assessment skills need a lot of training and reviewers are usually paid NOTHING.

by Ariane - Wednesday 19 September 2018 12:15
What about working on opening positions for medical post-grad students with a good mastering of both English and Chinese, like, for instance, Chinese students in England and the US? I'm not sure what form this kind of appointment would take, but I understand that there are quite a bit of Chinese studying abroad, without reckoning with Anglo-Saxon students from Chinese families. Maybe, there might be a way to build a network of such students who could share the work and also get deeper insight in critical thinking about the scientific method. But being completely outside the institutional world of medical studies and researches, I don't know how that could work.

by jrkrideau - Wednesday 19 September 2018 11:56
It strikes me as irresponsiblity on the part of editors to submit papers to a reviewer if the reviewer does not read the language in which most of the articles cited are written, or in this case, included in the corpus of the meta-analysis. My experience has been that what the cited paper says and what the author of the paper who cited it thinks it said are sometimes completely at odds. Sometimes what the reported data says and the conclusions drawn are completely at odds within the paper.

by Frank Odds - Wednesday 19 September 2018 11:49
The Wikipedia article on academic publishing in China makes interesting reading in the context of this post. See also this piece about how much Chinese scientists are paid cash if their work is published in prestigious Western journals — a sure-fire recipe for dishonesty in science. I would add to your three criteria for ideal peer reviewers "...has plenty of time to devote to the review". The reality is that it takes longer to assemble the detailed arguments — supported by appropriate citations — for rejecting a paper than it does to recommend acceptance. The combined impact of an ever-growing list of scientific publications with ever-decreasing numbers of support staff in universities makes the most critical and knowledgeable peer reviewers so busy they're more likely than ever to refuse to referee a paper that looks even a little bit dodgy from the abstract.

by Frank Odds - Wednesday 19 September 2018 16:10
"yes homeopathy is a very old medical invention like Ayurveda" Ayurveda: developed more than 3000 years ago in India. Homeopathy: a theory developed by S. Hahnemann in the 1790s. Yep, equally old (for the arithmetically challenged).

by S. Koduri - Wednesday 19 September 2018 15:32
Truly. amazing....yes homeopathy is a very old medical invention like Ayurveda...now a days there is huge demand for homeopathic doctors especially in cases where western medicine has huge side effects..your reply is very interesting....sir

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