Why should anyone believe what Professor Edzard Ernst says, after he put his name to a BBC programme, he now describes as “deception”.

March 31, 2011
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image001Simon Singh was in Kingston on Monday night speaking to the Kingston Humanist Society. As all the skeptics I have challenged refuse to debate me in public, I thought I would go down and give a clinicians explanation of Evidence Based Medicine to a physics scientist. (more of that in my next blog post)

What really surprised me was Simons explanation of how he got together with Edzard Ernst “The first Professor of Complementary medicine in the UK, “who according to Simon knows everything there is to know about CAM”.

In January 2006 The BBC aired a programme on acupuncture presented by Professor Kathy Sykes. Simon Sing showed a clip from the programme which opens with a woman having open heart surgery, apparently using just acupuncture to supress the pain.  The presenter tells the viewer “as the surgeon begins, the success of the operation depends not just on his skill, but on the power of acupuncture”. Here’s a link to the relevant segment of the programme: http://www.youtube.com/watch?v=t-dWMpuYnwQ

According to Simon Singh the open heart surgery was in fact performed with anaesthetic, the patient was receiving three powerful conventional sedatives — midazolam, droperidol and fentanyl — along with large volumes of local anaesthetic injected into her chest, all of which rendered the acupuncture merely cosmetic. This is what Simon Singh and Edzard Ernst have to say about the procedure in the book they wrote  “Trick or treatment”, they state; “the patient had received a sufficiently large dose of conventional drugs to mean that the acupuncture needles were a red herring , probably playing nothing more than a cosmetic or psychological role. They described demonstration as “a deception” on the viewers.

What shocked me was the nonchalant manner in which Simon informed us  that professor Edzard Ernst was in fact  an advisor to the programme makers on this “deception”. This was of course before they began working together on Trick or Treatment.

It is a few years since I read “Trick or Treatment” promising us the “truth about acupuncture” and other CAM, but I didnt recall reading about this error of judgment on Ernst part in the book, which for me brings his credibility into question. Nor have I been able to find reference to his involvement  in a book  claiming to be seeking the truth about complementary medicine.

The programme was aired on January 20 2006, yet it was March 25 before Ernst made his apparent concerns public, possibly  in the light of much criticism of the BBC series on alternative medicine and Simon Singh having approached him.

On March 25 Ernst states, Having seen the finished programme, he wishes he had not had his name attached to it. Remember this is two months after the programme had been aired. Ernst refuses to answer whether he was paid to advise on this programme. Simon told us that Ernst assured him that he considered jumping ship but decided it was better to remain part of the project and be able to “reel in the excesses” of the BBC production team and presumably get paid for his efforts.

Below is part of Simon Singh’s original response to the programme in the Telegraph:

A BBC series on unorthodox therapies was devoid of scepticism and rigour, says Simon Singh

“Scotland’s Herald television reviewer, Ian Bell, was stunned when he saw “a 21-year-old Shanghai factory worker undergoing open-heart surgery with only the needles to control her pain”. It seemed to be one of the most amazing bits of television this year, but did he really witness the amazing power of acupuncture or was he, like the rest of us, misled?

The three-part BBC series Alternative Medicine, presented by Kathy Sykes, was supposed to be a rigorous scientific examination of the claims of alternative therapies. Although the second programme was indeed a rational look at the placebo effect, the other two episodes were little more than rose-tinted ads for the alternative medicine industry.

For example, the scene showing a patient punctured with needles and undergoing heart surgery left viewers with the strong impression that acupuncture was providing immense pain relief. In fact, in addition to acupuncture, the patient had a combination of three very powerful sedatives (midazolam, droperidol, fentanyl) and large volumes of local anaesthetic injected into the chest.

With such a cocktail of chemicals, the needles were merely cosmetic. In short, this memorable bit of television was emotionally powerful, but scientifically meaningless in building a case for acupuncture. I have spoken to several experts who say that the procedure was neither shocking nor impressive, but it was unconventional because the Chinese surgeons seemed to have used a higher level of local anaesthetic to compensate for the lack of general anaesthetic.

When I put this to Professor Sykes, she replied: “The suggestion that the operation could have taken place without the acupuncture and it would have been fine is an interesting idea and might possibly be the case.”

Even though the television commentary was technically accurate, by omission and emphasis, viewers were left with a false impression. Everyone I have spoken to, including Ian Bell, believed they had witnessed acupuncture providing major pain relief, so they felt misled when I explained what was really going on.

Of course, recent scientific studies have hinted at tentative evidence that acupuncture might provide limited pain relief, but this is still far from proved and many other studies have shown that acupuncture is nothing more than a placebo. However, the programme makers seemed to have focused on whatever positive evidence was available and then added a dollop of impressively irrelevant heart surgery to cast acupuncture in the best light”.

On March 25th Edzard Ernst’s explained his involvement which were published by Simon Singh in the Guardian.

Edzard Ernst, professor of complementary medicine at Exeter University, was dismayed by the shortage of hard evidence. The main consultant for the series says: “The BBC decided to do disturbingly simple storylines with disturbingly happy endings. But none of these stories is as simple as they presented, nor do they have such happy endings. Even when the evidence was outright negative, they somehow bent over backwards to create another happy ending.

“I feel that they abused me in a way. It was as if they had instructions from higher up that this had to be a happy story about complementary medicine without any complexity, and they used me to give a veneer of respectability.”

Rationality

Prof Ernst, an experienced TV consultant, was disappointed by several sections of the series. The low point for him came last November, when he complained three times about the programme on faith healing, which he felt was creating a false impression. Having been ignored, he wrote to Martin Wilson, the series producer: “With any other subject this would simply be a false impression and an orgy in pseudo science, but with healing this cuts much deeper. Here we are touching on a very fundamental issue of rationality. If your programme undermines rationality in that unfortunate way, it does an enormous disfavour far beyond healthcare and promotes US-style anti-science.”

Having seen the finished programme, he wishes he had not had his name attached to it.

According to Prof Ernst, the fundamental problem was the production team’s lack of expertise and unwillingness to listen: “I would have expected that journalists doing a medical programme would be able to deal with medical evidence. But they were at a complete loss to understand the difference between an anecdote and real evidence. You need somebody on the team who is a scientist, particularly in the area that the programme is about. Also, there is no point having expert advisers if nobody is going to take on board what they say.”

Despite the criticisms, the BBC is understood to be considering commissioning a second series. A spokesman said yesterday: “We take these allegations very seriously and we strongly refute them. We used two scientific consultants for the series, Prof Ernst and Dr Jack Tinker, dean emeritus of the Royal Society of Medicine, both of whom signed off the programme scripts. It seems extremely unusual that Prof Ernst should make these comments so long after the series has aired.”

Simon Singh did not ask why Ernst did not insist on having his name removed from the programme and why his “mea culpa” was two months after the programme had been aired.The BBC never commissioned a second series, soon after Ernst and Simon Sing wrote their best selling book claiming to seek “the truth” about alternative medicine

I asked Edzard Ernst on Twitter on Tuesday why he had allowed his name to be associated with this TV Programme. He has been tweeting, but has not answered my question and presumably got Simon Singh to respond on his behalf: “Richard You already know why Edzard was associated with the acupuncture programme, I explained yesterday”

I then asked Ernst if he received money for consulting on this programme? Again Simon responded on Ernst’s behalf: “Richard trust me when I say, “Edzard Ernst is a man of integrity who was pragmatic about the best way to serve viewers”

I checked the book could not find a mention of Ernsts involvement with the programme in the chapter on acupuncture, or how he was exploited by the BBC. Perhaps it might be mentioned in chapter 6 “Does Truth Matter”There is a heading “Placebos – little white lies of fraudulent falsehoods”? Perhaps its mentioned there. No!

Perhaps its in “The top ten culprits in the promotion of unproven and disproven medicine”. 1Celebrities: Professor Ernst and his colleague Max H Pittler looked for articles published in 2005 – 2006 which involved well known people using alternative medicine. Yes this patient was a factory worker, so its unlikely to be under celebrity, but I thought Ernst might consider himself a bit of a “celebrity” who was anti CAM and might have included it. 2 Medical Researchers according to the book “There have been only a few shining examples of academics who have gone out of their way to highlight the contradictions, exaggerated claims and falsehoods within much of alternative medicine. It gives an example of such a person; Edzard Ernst, but no mention of the “deception”. 3Universities: No!

4 The Media: must be in there According to Ernst and Singh the media “tend to present an overly positive and simplistic view of alternative medicine. The way that alternative medicine is presented in newspapers, all to often flies in the face of the evidence” They even mention the “Misleading sequence that implied that acupuncture could act as a powerful anaesthetic for open heart surgery” again no mention of “Ernsts involvement or the way “he was taken advantage of”. I did not bother checking who the other culprits were, it is obviously something Ernst is not keen to talk about. You will have to read the book yourself to find that out if Ernst admits his failing in those sections.

Its a shame so few chiropractors have bothered to read this book which shows little understanding of the principles of “Evidence Based Medicine” as outlined by the likes of Archie Cochrane and David Sackett. This will be my next posting as part of a series of postings which finish on April the 12th when I turn this blog over to others as I move away from chiropractic and into Woo.

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  • william

    Oh do shut up. He has quite correctly criticized an interfering unqualified Royal. Do not apologize for this Cambridge 2:2! Just look at the academic qualifications that Professor Ernst holds first!

  • Pingback: Ad hominem attacks are signs of victories of reason over unreason | Edzard Ernst

  • Liam Mulvany

    A great comment here from seireinfalls to Ernst most loyal follower blue wode.

    “You can learn more about the faulty logic of CAM proponents hereI am not a CAM proponent I am a scientist who bases his claims on what I can or cannot prove, its a little thing I like to call the scientific method. Ask a question, develop an experiment to test the question, hopeful find an answer, but more often than not find more questions.Professor Ernst has proved his points through highlighting and referencing the weaknesses in chiropractors’ reasoning. It is up to chiropractors to produce the required robust data to support their claimsI am yet to read anything that cannot be criticise for poor mythology or low sample size but again I have only read what Enst has written on the subject (and done a quick none exhaustive search)and as I have repeatedly said he seems to report poorly and cherry pick that which suits his purpose. If he improves I shall stop, is that not fair?Yes, and that’s a two-way street. Solid data on harms are more important than dubious data on benefits.Agreed but again the evidence just is not up to scratch on either side.It seems to me that you are the one who’s being emotiveI shall concede that I am passionate about good science and it being reported in positive and unbiased way. All too often that which claims to be science is just personal opinion and it is this that has given science such bad press over recent years.The problem is that many chiropractic students don’t seem to adequately research the field of chiropractic before entering itAh does anyone, I can think of at least one Homeopath that must be regretting a big portion of their life;-) However I hope you are not suggesting that the University’s offering these courses are up to no good?No I have no agenda against Ernst, I have an agenda of reporting of what is essentially a personally held belief in the same way that if a Chiropractor was saying lots of positive things in the Guardian web pages I would be holding them to the same standard of evidence that I shall hold to Ernst and myself. In many ways I am paying the good Dr. a complement by spending so much time urging him to report better and do the research that is so badly needed.At the end of the day my credibility lies in the fact that I hold myself to the highest standards of evidence and when I make a claim I either state it as opinion or present good peer reviewed evidence of a high quality. Now I understand that all evidence can be critiqued for this and that but as long as you have good methodology and a good pool of data you have done the best you can do.The problem with this subject is that (and again I have not done an exhaustive search) there seem little evidence either way and whilst I accept that from an ethical point of view you would always want to take the most precautionary view this is not always practicable. So it does and indeed has become a shouting match between two paradigm and both sides seem either unwilling or unable to conduct research to sort it out, and that is the worst possible place for any science to find itself.As a final question are you honestly saying that Ernst is not biased? His diatribes on this subject have led me to come to the conclusion that he is a bit bitter and there is just a wif of a suspicion that he would very much like to be sued by someone to get into the lime light, however this is opinion and I offer no solid evidence.”

  • Fedup

    I think this comment by Blue wode basically sums up the total bias and blinkered outlook of this individual.
    “The evidence base for primary care is around 80% whereas the evidence base for CAM, according to Edzard Ernst, is around 7%. ”

    Blue wode will happily forget about about tye 20% that is not EBM, happily forget about all the previous treatments available as ebm but since been disproved, happily ignore ALL other evidence put forward for CAM but base a judgement of 7% because Prof Ernst has said so???? Where is the critical thinking in that? Its pathetic blind faith in a man who has as much bias as blue wode. The great one has spoken and must be beleived!!!!

  • Richard

    An interesting exchange on the Guardian website between someone called “sereinfalls” and Edzard Ernst, I wonder how many skeletons Ernst has in his closet. Ernst likes Twitter as long as his followers dont ask questions. He has blocked me, and as i dont thing anything he has to say is very important, I accept his decision happily. I mean a second rate researcher, who spends his time reviewing second rate research for the internet. You figure?  http://www.guardian.co.uk/science/blog/2012/may/22/alternative-medicine-long-arm-law?commentpage=all#start-of-commentssereinfalls22 May 2012 10:41AMWhilst I generally agree with the points put forward in this article I think it is a bit brave of Ernst to speak of abiding by the rules when he essential lost his professorship for breaking the rules:The Lancet editor Richard Horton criticised Ernst in a letter to The Times saying “Ernst seems to have broken every professional code of scientific behaviour by disclosing correspondence referring to a document that is in the process of being reviewed and revised prior to publication. This breach of confidence is to be deplored.”I think its about time the Guardian found someone with a little bit more credibility to speak on these matters and stop giving Ernst a sense of professionalism he clearly does not deserve.Please note that he gave up his professorship and as such this title should no longer be used, the url you have posted is Ernst reasoning, of which I am in no doubt makes sense to him but on a web site that I could have built to make my own point.The fact remains that The Lancet editor Richard Horton criticised Ernst and to the best of my knowledge never took back his comments and I am in full agreement. Ernst was in a position of trust and abused that trust before the article in question was published so my point remains that he is a poor choice to speak on these matters where there are scientists with intact reputations whom are better positioned to comment.What is the point of having a system where we respect scientists because of their ethics and behaviour and then continue to listen to those who have been shown wanting. Also its not as if his research (when he did actual research) was earth shattering in its detail or scope and from what I can tell, from a quick rather than exhaustive trawl, when he held his seat this final 8 years were doing reviews of other poor research, where is the point in that? If your going to create an evidence base (either for or against) and you conclude the that previous research is poor what do you do:A: Spend ages reviewing poor research (the choice that Ernst made)B: Conduct better research learning from mistakes madeI would choose B but then again I did a science degree which taught me to do that. I could very easily do a lit review of Ernst research and tear it to pieces if that was what I was about, but I see his research flaws just as he sees the flaws of research he reviews but I choose to learn from that lesson and not continue to criticise that which has been critiqued to death already.For me Ernst needs putting in the trash can of bitter old scientists that tried to make a name for his ego rather than to peruse experiments to prove/disprove his chosen field.edzardernst22 May 2012 2:13PMResponse to sereinfalls, 22 May 2012 1:10PMLet me correct your allegations: I have not given up my professorship and am still in post. When I do retire I will be emeritus professor. During the last 19 years,we did ~ 35 clinical studies and I think it is difficult to do more. Horton’s criticism amounts to nothing; he did not know the facts and later took it back to avoid litigation presumably. And who is Horton anyway? Is he beyond fail? What about his involvement in the Wakefield affair?There was a proper and rather hostile official investigation which found me not guilty. What more can anyone want?If you feel like reviewing my publications,please do so.Your comment is nothing but an ill-informed,shoddy and rather clumsy ad hominem attack. Try harder next time!sereinfalls22 May 2012 4:07PMResponse to edzardernst, 22 May 2012 2:13PMIf this is Edzard Ernst your grammar is shocking.I did say a quick trawl and not an extensive search and I was also speaking about the last few years when you seem mainly to do lit reviews.As to trying harder how much harder do I need to try when you have responded

  • richardlanigan

    He is really desperate for anti chiropractic material having to rehash what he wrote for the Guardian. Unfortunately the chiropractic profession lets him get away with it. Does anyone know what he had to say to the GCC, he claims to have done another presentation there. 

  • Liam
  • Richard

    Had my 8 of 12 chemo session today, feel like shite only professor Ernst can get me off my sick bed, and comment on another of his polemics in “Pulse”. Not one of my legitamate resons were discussed in this article. Its like a religion and people should have faith and not question the vaccination gospel, hardly being skeptical.  http://www.pulsetoday.co.uk/comment-blogs/-/blogs/13460869/twelve-reasons-people-take-an-anti-vaccine-stance

  • Fedup

    Even better.
    PROFESSOR EDZARD ERNST: MASTER TRICKSTER
    OF EVIDENCE-BASED MEDICINE?http://www.anh-europe.org/files/071115-Edzard-Ernst-exposee_final.pdf

  • Fedup

    I do like this, check out the comments and replies to said comments.
    http://www.anh-europe.org/news/edzard-ernst-on-the-self-promotion-trail

  • Fedup

    Here are some of the recents tweets by the unbiased so called professor Ernst.
    “if homeopathy is the air-guitar of medicine,chiropractic must be the bag-pipes in a string-quartet”
    “apparently quacks are also weasels – isn’t nature marvellous?”
     ”it’s more that quacks weasel ,not vice versa”
    “if you want to FEEL well,some alt med might do.if you want to BE well,alt med rarely suffices”
    “chiropractic is full of empty platitudes and overt bull..”

    How can anybody really beleive this guys research let alone his opinions are based on anything but his bias. He is not an opened minded skeptic, hes tilted further than the Costa cruise ship.

  • Liam Mulvany

    I really am quite dissapointed. All these so called Skeptics with their moaning about science and libel laws wanting the freedom to say what they want etc etc. I was on twitter for a while, trying to show Blue wode a thing or two about chiro. Guess what, he blocked me. This so called skeptic who likes to make his/her opinion known to the world blocked a source of information that actually went against his beleifs, did he argue the point? No he just went LALALALALALALALA I’m not listening. I have also had several discussions with Prof Ernst on Pulse regarding his biased research, I found it quite entertaining. In fact his latest blog about Germany shows he is scraping the bottom so to speak. Here is my reply to Ernst’s blog on Pulse because for some reason I am not allowed to post on his blog any more!!!!!!
    “What a surprise that you should totally ignore the positive outcomes, same as always.The interesting parts of this study are that in 1997 “only a minority had implemented these into their medical schools.” But in 2004 “(34%) indicated that CAM therapies had already been integrated into the curriculum at their medical schools”, I wonder what the numbers are now?I think this study also shows Prof Ernst blog, outlook, views and research for what it is. An individulas biased opinion. Heres why.”The results of a survey of decision makers (directors of clinical departments, along with research and education institutes)” not your average Joe who could be fooled by some slick marketing,”The majority of respondents favoured the integration of CAM into the medical system (research 85%, teaching 84% and treatment 60%).”Prof Ernst wants the end of CAM full stop. Luckily he is not in the majority. “

  • Fedup

    Hi Richard, hope things are going OK. The good news is Ernst has less followers than I have active patients, and I’d bet at least a quarter of his followers are like you and me. A picture was put up of the skeptics in the pub meeting where Ernst was giving a talk recently. To say it’s busier at my local on a wednsday night would be about right.

  • http://www.chiropracticlive.com Richard Lanigan

    I had not been on Twitter for a while, and the first thing I saw was all anti chiropractic rhetoric just pouring out of Ernst this morning, I asked him if he thought todays Tweets were a bit biased, he did not answer. Thats why Twitter works so well for him he just tweets the stuff that supports his point of view and his followers take it as gospel. While most chiropractors are still hiding under their beds rejoicing that the GCC will only charge them £800 this year

  • Fedup

    So here we go again, the total unbiased (cough) Prof Ernst has been tweeting. here are a list of his last few tweets, see if you can find the common theme.

    http://www.ncbi.nlm.nih.gov/pubmed/22014869 if you have arrythmia,for heaven sake do not go to a chirohttp://www.ncbi.nlm.nih.gov/pubmed/22014911 suckers believe that chiro improves sucklinghttp://www.ncbi.nlm.nih.gov/pubmed/22025741 chiro neck manipulation can killhttp://www.ncbi.nlm.nih.gov/pubmed/22027032 another example suggesting chiros have little idea about designing a decent research projecthttp://www.ncbi.nlm.nih.gov/pubmed/22027034 chiro does not cure insomnia but causes it when you receive the chiro’s billhttp://www.ncbi.nlm.nih.gov/pubmed/22027037 did you know that chiros can improvr your reading ability?no kiddinghttp://www.ncbi.nlm.nih.gov/pubmed/22027203 this is akin to asking people in macdonalds whether they like hamburgers!research?no!Right shall we have a look at these and again try and fight through the bias of EE1- The first is a case study following a patients visit to a chiropractor, here is the main points. “The purpose of this article is to describe a case report and discuss a possible anatomical explanation of the occurrence of arrhythmias in patients with thoracic outlet syndrome (TOS).CLINICAL FEATURES: A 60-year-old man experienced arrhythmia when he turned his head to the left and had these symptoms for 7 years. The patient attributed his symptoms to TOS. The arrhythmia was triggered while performing an Adson test during the clinical evaluation.INTERVENTION AND OUTCOME: The Grostic procedure as a measure of analysis of the biomechanical relationship of C1 to C0 and the lower cervical spine was performed. According to this analysis, the patient had a right laterality malposition of the atlas. High-velocity, low-amplitude manipulations (adjustments) were applied. The patient’s symptoms improved after one visit and demonstrated resolution upon evaluation at the third visit. In the year following the initial presentation, he has had minor recurrent short-lived episodes of arrhythmia that abated with the atlas manipulation/adjustment.CONCLUSION: There is a paucity of published reports describing the management of patients with arrhythmias through manipulative methods. This appears to be the first case that describes the successful amelioration of an arrhythmia associated with TOS using chiropractic adjustment of the atlas vertebra as the sole intervention.”Prof Ernst please read this bit out loud. “that describes the successful amelioration of an arrhythmia associated with TOS using chiropractic adjustment “  have a look back at what Ernst actually tweeted. “for heavens sake” LOL nice from a skeptic using biblical phrases. So in this case you are wrong Ernst, if there is a negative outcome with arrythmia following chiro where is your evidence? If you have no evidence of negative outcomes but you are given positive outcomes in the form of a case study how can you possibly, as a scientist, dismiss it? Blue wode, would you like to answer that?2 again a case study. “CONCLUSION: The results of this case suggest that neuromusculoskeletal dysfunction may influence the ability of an infant to suckle successfully and that intervention via chiropractic adjustments may result in improving the infant’s ability to suckle efficiently.” Again Prof Ernst said “suckers believe that chiro improves suckling” bias? Suckers? Prof Ernst do you have case studies or evidence to the contrary? or is it your personal opinion. Ad Hominem? very scientific.3- “This case report describes a 50-year-old man who developed neurological symptoms a few hours after manipulation (high velocity low amplitude [HVLA] technique) of the cervical spine.”Ernst tweets chiro can kill. No mention of death on this study, an injury yes but death? Could you point us in the right direction Edzard? or are you making your own conclusion? Again skeptic and scientist you are not.4-”OBJECTIVE: Inflammatory markers interleukin-6 (IL-6) and C-reactive protein (CRP) have not been evaluated in response to a short course of lumbar spinal manipulation. The purpose of this study is to observe the responses of inflammatory markers (IL-6 and CRP) after a series of 9 chiropractic spinal manipulations.”"CONCLUSION: A total of 9 chiropractic lower back manipulations caused the mediators of inflammation to present a normalization response in individuals suffering from chronic low back pain.”Ernst tweets, “chiros have little idea about designing a decent research project” Laughable, these guys are actually DOING research rather than cherry picking studies done and coming to your own conclusions(like somebody we know). The good thing is this can be repeated. Prof Ernst why don’t you repaet this study and see if you can get a different outcome with inflammatery markers, Do some real research. 5-”CONCLUSION: Some studies have noted improvement in insomnia following manual therapy; however, based on clinical trials, there is minimal evidence of support for chiropractic in insomnia. Further studies with high methodological scores need to be conducted.”Can’t argue with that conclusion, good bit of research. BUT thats not good enough for Ernst he has to go that extra mile and make a comment like “chiro does not cure insomnia but causes it when you receive the chiro’s bill” Pathetic, resoting to low level play ground tactics. My dads bigger than yours.6-”CONCLUSION: The care provided to this patient seemed to help resolve his chronic musculoskeletal dysfunction and pain and improve his academic performance.”  Had several students, a medical student this morning, comment on the difficulty they have studying while in pain. Surprised? 7-”RESULTS: The chiropractic providers collected 275 chiropractic patient questionnaires. The number of patient questionnaires collected by each of the 4 participating chiropractors ranged from 35 to 100. The patients primarily sought care for the management and treatment of pain (98.5%), and 57.5% considered that their chiropractors were “primary care providers.” Eighty-five percent preferred that their chiropractor be qualified to prescribe medications and provide hands-on treatment, whereas 97.5% perceived their chiropractors to be chiropractic physicians.CONCLUSIONS: This small group of chiropractic patients from 4 offices in New Mexico perceived that their doctors of chiropractic were physicians and primary care providers, and 85% preferred that their chiropractor treat patients with limited prescriptive authority when appropriately trained.”Ernst tries to belittle this study but it actually is quite important, I like the McDonalds analagy though it sucks.”The patients primarily sought care for the management and treatment of pain (98.5%),” This is what we do, all these people may well have already visited their Medical practitioner ( most have already seen their GP before they see me) and then had chiropractic treatment for their pain, that question should have been included in the study. If that is the case then the analagy would have to include a visit to first KFC to see which they preferred.

  • Fedup
  • Fedup

    If you are reading this Blue Wode surely you can see Prof Ernst Bias, I have said this for some time. No matter what the research conclusion Ernst will only talk or tweet about the negative, even when positive outcomes stare him in the face he steadfastly refuses to acknowledge them. Thats not normal for a sceptic or scientist. is it?

  • Fedup

    LOL blue wode has just asked Prof Ernst for a response to my last post,” it doesn’t merit a response” LOL as usual when he is wrong he decides to butt out. Check every post I’ve put here Blue wode and ask Ernst to reply. He won’t because he can’t. They all show him for what he is.

  • Fedup

    If anybody was actually questioning the Bias of edzard ernst have a look a this.
    This is what he tweeted. http://www.ncbi.nlm.nih.gov/pubmed/21974915 31% of patients experience side-effects after chiro for neck pain [5%"intense"]

    If you check the study out it actually paints a very positive picture of chiro for neck pain.
    RESULTS:
    A total of 1,090 patients completed the study having 4,920 (4.5 per patient) office visits requiring 2,653 (2.4 per patient) upper cervical adjustments over 17 days. Three hundred thirty- eight (31.0%) patients had SRs meeting the accepted definition. Intense SR (NRS [greater than or equal to]8) occurred in 56 patients (5.1%). Outcome assessments were significantly improved for neck pain and disability, headache, mid-back pain, as well as lower back pain and disability (p 5 million career upper cervical adjustments without a reported incidence of serious adverse event.
    CONCLUSIONS:
    Upper cervical chiropractic care may have a fairly common occurrence of mild intensity SRs short in duration (<24 hours), and rarely severe in intensity; however, outcome assessments were significantly improved with less than 3 weeks of care with a high level of patient satisfaction. Although our findings need to be confirmed in subsequent randomized studies for definitive risk-benefit assessment, the preliminary data shows that the benefits of upper cervical chiropractic care may outweigh the potential risks. Key Indexing Terms: Chiropractic; Adverse Effects; Symptomatic Reactions; Manipulation; Upper Cervical.

    Check out the patient satisfaction and the last sentence, "the preliminary data shows that the benefits of upper cervical chiropractic care may outweigh the potential risks."
    That will surely get EE where it hurts.

  • http://www.chiropractorswarwick.co.uk Stefaan A.L.P. Vossen

    Yes, but the attention was drawn to Ernst primarily via the route of chiropractors making claims. As such I would state that the value of Ernst’s work is over-inflated rather than wrong. The errors exist in the assumptions that are being made based on his work, and he takes great care not to be noted as making any such claims. The bias arises from the observation he just implies the claims and facilitates others to make those claims. Rather foolishly but effectively.
    Stefaan

  • Fedup

    “Belief can alter observation; human confirmation bias is a heuristic that leads a person with a particular belief to see things as reinforcing their belief, even if another observer might disagree. Researchers have often noted that first observations are often somewhat imprecise, whereas the second and third were “adjusted to the facts”.

    Sounds like prof Ernst work, somebody reproduce!!!

    “This is one of the reasons (mistake, confusion, inadequate instruments, etc. are others) why scientific methodology directs that hypotheses be tested in controlled conditions which can be reproduced by others. The scientific community’s pursuit of experimental control and reproducibility, diminishes the effects of cognitive biases.”

    Bias, bias and more bias, sorry but without somebody reproducing Ernst work it holds no weight as so called evidence just reinforces the fact that his work is based on his own beleifs.

    “A linearized, pragmatic scheme of the four points above is sometimes offered as a guideline for proceeding:[49]
    Define a question Gather information and resources (observe) Form an explanatory hypothesis Test the hypothesis by performing an experiment and collecting data in a reproducible manner Analyze the data Interpret the data and draw conclusions that serve as a starting point for new hypothesis Publish results Retest (frequently done by other scientists) ”
    Funny how all of prof ernst work misses out on that last bit, it just becomes skeptic reality over night.

  • Fedup

    Edzard Ernst research is all a load of bias nothing travelling faster than the speed of light. It cannot be deemed as evidence or science, so all the skeptics that think by quoting ernst so called research papers are getting it very wrong. Why.
    heres why,
    “Scientific researchers propose hypotheses as explanations of phenomena, and design experimental studies to test these hypotheses via predictions which can be derived from them. These steps must be repeatable, to guard against mistake or confusion in any particular experimenter.”

    Now can any so called skeptics out there show me a piece of research done by EE that has been repeated by another scientist? Not even one?

    Again Prof Ernst fails on basic research principals.

    “Scientific inquiry is generally intended to be as objective as possible, to reduce biased interpretations of results. Another basic expectation is to document, archive and share all data and methodology so they are available for careful scrutiny by other scientists, giving them the opportunity to verify results by attempting to reproduce them.”

    Has ANY of Ernst’s work been verified and reproduced? No didn’t think so. Bias pops up time and time again when the research is not reproduced or verified, much like all of Prof ernst work.

  • Fedup

    Just viewed a pic of the crowd at Plymouth skeptics in the pub meeting while the great Edzard Ernst was giving a talk. LOL my waiting room has more people in it!!!!!!!

  • Fedup

    I love this, i was worried for a bit that Ernst would do nothing but appoint one of his lap dogs to take his place but it looks like that is not going to happen.
    “How much freedom do you have in choosing a candidate? Can you choose/decide freely?Sadly, I was only involved in drafting the job description. Everything else is out of my hands. I offered my further assistance but the offer was so far not accepted.”

    LOL why can’t Ernst see he has to leave because he is the problem, poor research constant bias etc, why the hell would they want him to help pick a successor.

  • Fedup

    I like this quote, especially as there is a consensus in the skeptic ranks (fuelled mainly by the er.. Scientist Edzard Ernst) that all CAM is useless.
    “In the words of the late late Michael Crichton,”Historically, the claim of consensus has been the first refuge of scoundrels. It is a way to avoid debate by claiming that the matter is already settled. The great scientists in history are great precisely because they broke with consensus.”
    Probably why EE will never be described as great.

  • Fedup
  • http://www.chiropractorswarwick.co.uk Stefaan A.L.P. Vossen

    Hey Nick, if you go onto http://www.tcpn.co.uk there is a link there “ask a question” wher you can mail me with your email address or send me the content you refer to. Many kind regards and best wishes,
    Stefaan

  • Fedup

    This story has appeared online at chiroeco.com.
    Edzard Ernst forced to step down

    August 2, 2011 — The American Chiropractic Association (ACA) has previously reported on the efforts of Edzard Ernst, whose work has been noted as being damaging to complementary and alternative medicine practitioners around the world.
    On Monday, Ernst announced that he would be leaving his role

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    at Exeter University following pressure from the government to shut down Ernst’s entire department unless he stepped down as head of the unit. Exeter University will begin looking for Ernst’s replacement in the beginning of next week.

    Prof Ernst reply on twitter.

    “EdzardErnstEdzard Ernsthttp://t.co/Tbltquzchiros cannot even get the simplest facts right which are available to everyone with a brain3 Aug”Now can somebody explain this too me, like I’m a 6 year old, in the words of a great film.Prof Ernst was told his unit would close, he blamed his fall out with HRH and evrybody else at his Uni. A new Dean took over and has said the unit can stay open IF Ernst leaves. Now I think that Prof Ernst is in denial, he has done nothing but provide poor research and used this in attracting as much media attention as possible, so he had to go. I wil shout so he may hear. ITS YOU PROF ERNST THAT IS THE PROBLEM NOT YOUR UNIT NOT ANYBODY ELSE ITS YOU AND THAT IS WHY YOU HAD TO GO. YOU ARE NOT GOOD AT WHAT YOU DO AND HAVE DRAGGED YOUR UNIT SO DEEPLY INTO THE MUD THAT IF YOU CONTINUED THEY WOULD HAVE TO CLOSE IT!!!!!

  • Nick

    Hey Stefaan, when you get a moment can you email me. I have some info that may be of interest to you with relation to this point. I assume as an admin you can get my email from the forum?

    Cheers

    Nick

  • http://www.chiropractorswarwick.co.uk Stefaan A.L.P. Vossen

    @EdzardErnst is nothing short of a hypocrite with a naive audience. In fact I cannot really blame Ernst’s self-deluded stance as his supporters know how heavily the punches rain down when you say something that is not to his liking and hence are not likely to vocalise their criticism…

  • Fedup

    This why prof Ernst should not be allowed to be the only author.

    Cochrane Handbook for Systematic Reviews of Interventions
    14. Adverse effects
    14.6. Assessing Risk of Bias for Adverse Effects
    14.6.3. Case Reports
    14.6.3.2. Determining Causality
    There is usually uncertainty as to whether the adverse event was caused by the intervention (particularly in patients who are taking a wide variety of treatments). Review authors must decide on the likelihood of the intervention having a causative role, or whether the occurrence of the adverse event during the intervention period was simply a coincidence. However, two independent review authors might not reach the same judgement from the same case report. Several studies have evaluated the responses of review authors who were asked to appraise reports of adverse event. In one study, complete agreement was obtained only 35% of the time between two observers who used causality criteria in an algorithm for assessing suspected adverse reactions (Lanctot 1995* ). In another study, three clinical pharmacologists, who evaluated 500 reports of suspected reactions, failed to agree on the culprit drug in 36% of the cases (Koch-Weser 1977*).

  • Fedup

    Prof Ernst constantly breaks the rules with regard to his so called unbiased research. This from the cochrane hand book.

    A common mistake when there is inconclusive evidence is to confuse ‘no evidence of an effect’ with ‘evidence of no effect’. When there is inconclusive evidence, it is wrong to claim that it shows that an intervention has ‘no effect’ or is ‘no different’ from the control intervention. It is safer to report the data, with a confidence interval, as being compatible with either a reduction or an increase in the outcome. When there is a ‘positive’ but statistically non-significant trend authors commonly describe this as ‘promising’, whereas a ‘negative’ effect of the same magnitude is not commonly described as a ‘warning sign’; such language may be harmful.
    Another mistake is to frame the conclusion in wishful terms. For example, authors might write “the included studies were too small to detect a reduction in mortality” when the included studies showed a reduction or even increase in mortality that failed to reach conventional levels of statistical significance. One way of avoiding errors such as these is to consider the results blinded; i.e. consider how the results would be presented and framed in the conclusions had the direction of the results been reversed. If the confidence interval for the estimate of the difference in the effects of the interventions overlaps the null value, the analysis is compatible with both a true beneficial effect and a true harmful effect. If one of the possibilities is mentioned in the conclusion, the other possibility should be mentioned as well.
    Another common mistake is to reach conclusions that go beyond the evidence. Often this is done implicitly, without referring to the additional information or judgements that are used in reaching conclusions about the implications of a review for practice. Even when additional information and explicit judgements support conclusions about the implications of a review for practice, review authors rarely conduct systematic reviews of the additional information. Furthermore, implications for practice are often dependent on specific circumstances and values that must be taken into consideration. As we have noted, authors should always be cautious when drawing conclusions about implications for practice and they should not make recommendations. ”

    Prof Ernst constantly makes these mistakes.

  • Fedup

    This from Ernst on the guardian website.

    While Ernst will still take early retirement, the department will remain open under plans drawn up by Professor Steve Thornton, who took over as Dean at Exeter in May. The university plans to advertise for a replacement for Ernst next week.
    “The whole thing would backfire in my view tremendously if we found a promoter of alternative medicine and not a good scientist,” Ernst said, adding: “It looked as though I had to go and that was the price for the unit to continue.”

    LOL I don’t think it will backfire if we find a scientist who is impartial and not a bigot who has steadfastly backed up his own biased opinions over the years.
    This is the best bit though “It looked as though I had to go and that was the price for the unit to continue.” The unit could not continue with Ernst at the helm as it obviously was producing research that was based more on Ernst biased ego than actually looking at the facts. The unit could be a very important rescource for CAM therapies if the Professor in charge of it was not somebody with an agenda, a REAL scientist who does not formulate or exagerate negative research no matter what the data says.
    Goodbye edzard and good riddance, I’m really looking forward to the research done by the new prof of CAM at the least we won’t see crap headlines from “the worlds only professor of complememtary medicine.”

  • Fedup

    Ernst has just been on a phone in on BBc wales, I only caught the last few minutes, which was about homeopathy, but I really enjoyed it. a homeopath was trying to explain how homeopathy works and basically admitted he didn’t know, he couldn’t explain it, yet. A skeptic, don’t know who it was, then said “so the homeopath is saying it’s magic?” The presenter responded with ” he didn’t say that he said he couldn’t explain it” Slap The skeptic then went on to talk about placebo as this was obviously the case for homeopathy. That was followed by a call from a sheep farmer who said (think of this being spoken in a welsh accent) “I use it all the time when me sheep get(cant remember the name of the disease), its a serious disease and homeopathy works 100% of the time” Slap.

    Wish I had heard all of it as the skeptics have been twittering about it.
    This is what zeno had to say about a ladies experience with CAM following cancer treatment 9 years ago, she feels the CAM helped her survive not only the chemo but has kept her healthy since.
    “@david_colquhoun Good grief! Quack: “you’ve got to have an open mind…”And just to show how arrogant these skeptics are, this from david colquhoun.” Idiotic phone in on Radio Wales, Edzard Ernst tries to stem the tide of delusional callers”Twat. 

  • Dr Phil

    Yup I get this, but what good does bickering with the man do? Side step him, have Steffan write some of his beautiful prose and get him published. Write a book. He’s almost done anyway, retired and out of fresh ideas. The public don’t care about facts, they care about feeling and hope. Chiropractic brings hope to many people, that’s what they pay for. It’s not the product it’s the feeling. Some people are non-feeling robots who only deal in absolutes. They are inflexible, obstinent and insular, overly analytical and take satisfaction in winding others up to service their own egos. That’s their deal. It would be better to be umoved by their attempts, Fedup says he hates Ernst. I don’t feel anything for Ernst one way or another. I don’t even think about him.

  • Fedup

    Great article on Pulse, please join and read it. I like the comments<Andy Lewis(skeptic) getting lambasted by a GP.
    http://www.pulsetoday.co.uk/comment-blogs/-/blogs/12427208/it-s-time-to-take-a-reality-check-on-evidence-from-clinical-trials

    And a good article here.

    http://www.bmj.com/content/342/bmj.d3004.extract

    "For many of us, the move towards an evidence based approach to medicine has largely been a welcome one. We have learnt to evaluate therapies rigorously and be highly sceptical of expert enthusiasm for them. Perhaps most importantly, we now try to turn routinely to summaries of the evidence rather than rely on single studies. For what we assumed were good reasons, systematic reviews and meta-analyses have become gold standards, whether we are a politician, a physician, or simply a citizen. But is it fool’s gold?"

  • http://www.chiropracticlive.com Richard Lanigan

    Its difficult to ignore when he has such good acess to the media and they believe he is an authority on what I do and how I do it. He is like most academics you meet, the chiropractic profession has many like Ernst, not very succesfull in practice so they devote their lives to explaining this lack of sucess to their families and friends.

    Ernst can say what he likes to his followers on Twitter and they lap it up. Not so convincing when a few more words are included in the discussion http://www.timeshighereducation.co.uk/story.asp?storycode=416567#.TgnqOI4Q-64.facebook

  • Dr Phil

    If you don’t like the man, and don’t have any respect for his work, then why bother to read it?

  • Fedup

    OK I’m just going to say it, I F***KIN hate Mr Ernst, he talks so much bollox that I am starting to detest the man.
    Why you may ask, well this just shows the absolute bigot that he is.
    This is the conclusion of a study done on chiropractic students regarding EBM.
    “Conclusions
    Although it is feasible to conduct an international web survey of chiropractic students, significant stakeholder participation is important to improve response rates. Students had relatively positive attitudes toward EBP. However, participants felt they needed more training in EBP and based on the knowledge questions they may need further training about basic research concepts.”
     Infact “76% of respondents found it easy to understand research evidence and 81% had some level of confidence assessing the general worth of research articles, 71% felt they needed more training in EBP to be able to apply evidence in chiropractic care.” So a large percentage understand the evidence and a larger percentage were confident in assessing the worth of research(basically they can see all of EE’s research for what it is), but they still feel they need more traing to help them, nothing wrong with that, they are students after all.
    This is how Edzard Ernst tweeted this.
    “http://t.co/afhDzgJchiropractic is still in the dark ages of healthcare”
    tosser.

  • Fedup

     Great post here about Mr Ernst and his lakys.

    Brian Kaplan4 July, 2011
    Ernst writes here: “homeopaths like kaplan only accept research that confirms their prior belief”First of all I am a fully qualified medical doctor who happens to use homeopathic medicine as one of the tools in my practice but generally subscribe to the ethics and values of my peers in conventional medicine. I do accept research and but don’t accept that research has ‘refuted’ homeopathy. I also consider it significant that it is the subjective experience fo hundreds of millions of people that homeopathy worked for them and consider this an important fact from a democratic as well as a health-orientated point of view.How does Ernst know what I believe? What EVIDENCE does he have to say that I believe the nonsense he has written here about me? I have heard him claim (on the radio) that the Government decision to retain NHS homeopathy was influenced by the meddling of Prince Charles. Presumably he has EVIDENCE for this rather outrageous claim. If so where is it? Or is EVIDENCE something he demands from other people?As far as EVIDENCE and EBM are concerned, I subscribe to the BMJ handbook of Clinical Evidence which shows that of commonly used CONVENTIONAL approaches11% are definitely beneficial23% are likely to be beneficial7% trade off between harm and good51% unknown effect5% unlikely to be beneficial3% likely to be ineffective or harmfulErnst and the detractors of CAM hate the simple chart showing these figures which can be seen here: http://clinicalevidence.bmj.com/ceweb/about/knowledge.jspThe reason they hate this chart is that it shows that huge swathes of orthodox medicine are NOT evidence based. (Much of the use of anti-depressants falls into this category but I digress)This is very unhelpful to their cause as their attack on CAM is very much based on the accusation of ‘lack of evidence’ of CAM which disingenuously implies that conventional medicine on the NHS MUST obviously all be evidence based.I have called on Ernst many times simply to state the LEVEL OF EVIDENCE that he considers ALL interventions should attain before being included on the NHS but apparently this is ‘not his job’ – even though he was happy to make an embarrassing testimony to the Science and Technology Committee at the House of Commons and call for the abolition of NHS homeopathy on the grounds of ‘lack of evidence’. Double standards? You bet! Fortunately the Government kicked ALL the (anti-NHS homeopathy) recommendations of this generally discredited committee (signed by only 3 MPs) into touch. This political decision was taken very badly by Ernst and particularly badly by his fellow anti-homeopath (Prof Michael Baum) who wrote a ranting letter steaming with rage at how democracy prevailed against his views to the BMJ very soon after writing a letter (in answer to a letter from me about an article written by himself and Edzard Ernst in which I claimed to be misquoted) to the American Journal of Medicine calling for this debate on homeopathy to go ‘back into the realm of polite disputation’ (http://goo.gl/T8yjg) :-)Edzard Ernst made a name for himself by being the Professor of Complementary Medicine who attacked CAM and particularly homeopathy. He was successful in this attack with regard to the media and writing a book but fortunately, despite his efforts, democracy was dignified enough to protect NHS homeopathy and state that doctors ie GPs and local health authorities were in a better position to make clinical decisions about THEIR patients than Edzard Ernst of Exeter.

    http://www.timeshighereducation.co.uk/story.asp?storycode=416567#.TgyEuSIJ6MU.twitter

  • Fedup

    Edzard Ernst made this statement on pub med a few years ago.

    Chiropractic maintenance treatment, a useful preventative approach?
    Ernst E.
    SourceComplementary Medicine, Peninsula Medical School, Universities of Exeter and Plymouth, 25 Victoria Park Road, Exeter EX2 4NT, UK. Edzard.Ernst@pms.ac.uk
    AbstractMost chiropractors advise patients to have regular maintenance treatments with spinal manipulation, even in the absence of any symptoms or diseases. This article evaluates the evidence for or against this approach. No compelling evidence was found to indicate that chiropractic maintenance therapy effectively prevents symptoms or diseases. As spinal manipulation has repeatedly been associated with considerable harm, the risk benefit balance of chiropractic maintenance care is not demonstrably positive. Therefore there are no good reasons to recommend it.
    PMID:19465044[PubMed - indexed for MEDLINE] He then went on to write on his blog at Pulse.Professor Edzard ErnstDoes chiropractic maintenance therapy work?17 Jun 11Do we all really need regular chiropractic manipulations from the cradle to the grave? A new study suggests not, writes Professor Edzard ErnstMost chiropractors earn a sizable proportion of their money by advocating that, in order to stay healthy, virtually every human being must receive spinal adjustments on a regular basis. According to this view, regular chiropractic manipulations are needed by all of us virtually from cradle to grave.They call this approach ‘maintenance treatment’. Even though it is popular, not a single proper trial has ever tested its value.Not until recently, that is. Canadian chiropractors randomised 98 back pain patients to regularly receive for 10 months either spinal manipulation or spinal manipulation and a home exercise programme or no such treatments.The results show no preventative effect whatsoever. The authors’ conclusions were thus fairly straight forward: ‘This study hypothesised that participants in the combined intervention group would have less pain and disability and better function than participants from the two other groups during the preventive phase of the trial.”This hypothesis was not supported by the study results. Lack of a treatment-specific effect is discussed in relation to the placebo and patient provider interactions in manual therapies.”Further research is needed to delineate the specific and non-specific effects of treatment modalities to prevent unnecessary disability and to minimise morbidity related to non-specific chronic neck pain (NCNP). Additional investigation is also required to identify the best strategies for secondary and tertiary prevention of NCNP.’ 1It would be interesting to monitor how many chiropractors now stop claiming that maintenance therapy is worthwhile. Personally, I am not pinning my hopes too high!So you would think he has just proved his point wouldn’t you.The problem is Mr ernst has been shown 2 further studies that show maintenance can be beneficial.http://www.ncbi.nlm.nih.gov/pubmed/15510094with its conclusion,CONCLUSIONS: Intensive spinal manipulation is effective for the treatment of chronic low back pain. This experiment suggests that maintenance spinal manipulations after intensive manipulative care may be beneficial to patients to maintain subjective postintensive treatment disability levels. and here,http://www.ncbi.nlm.nih.gov/pubmed?term=Does%20maintained%20Spinal%20manipulation%20therapy%20for%20chronic%20non-specific%20low%20back%20pain%20result%20in%20better%20long%20term%20outcome%3Fwith its conclusion,Conclusion. SMT is effective for the treatment of chronic non specific LBP. To obtain long-term benefit, this study suggests maintenance spinal manipulations after the initial intensive manipulative therapySo would think Mr ernst, the unbiased prof who only wants evidence and data , when provided with some, may change his opinion, after all thats what sceptics are supposed to do when handed evidence and data that proves then wrong. No such luck, he replies with this.”i repeat:i cite the only study of chiropractic maintenance therapy that was available”and to cap it all he then says,”I now had time to look up the 3 references cited above. Two refer to the same study and none of the 2 trials relate to chiropractic maintenance treatment.”Ok he is right the 2 studies refer to spinal manipulation, BUT guess what thats exactly what the study he championed was about, here is its title,”A randomised controlled trial of preventive spinal manipulation with and without a home exercise program for patients with chronic neck pain.”You can lead a biased prof to the fountain of truth but you can’t make him drink.

  • Fedup

    http://www.acupuncturetoday.com/mpacms/at/article.php?id=32422

    What a surprise Mr E Ernst research methods called into question here.

  • http://www.chiropracticlive.com Richard Lanigan

    Hi Fed up,

    I am fine thanks, just finished chemo and radiation, have the surgery next month. I tend to put more information about my health on Face Book. I am starting to wonder myself about Twitter is it about a free flow of information, or massaging ones ego by having lots of sychophantic followers who hang onto your every word.

    I have questioned Ernst on a number of things, I have never called him names as he has me. But he no longer wants to share his drivel with me for some reason. Ernst does not bug me, its those in our own profession who wnat to follow his path. This very debate is opening up in medicine around the Colleg of Medicine. RCTs will only be applicaple if we standardise the chiropractic intevention and the people delivering the intervention, its not going to happen.

     Do you notice many of the “scientists” promoting EBM are not clinicians, and they only speak about papers as evidence. They seem to think you can see a patient but their presenting symptoms into a computer which will throw up a treatment based on the evidence

  • Fedup

    A good debate and I think one that most researchers and scientists I see would agree with, that RCT are not the best form of research for some interventions.

    Weiwen ng
    “I have a masters in public health, and I can tell you that even for allopathic medicine, we need a more flexible standard of evidence than the randomized trial. Some therapies simply don’t lend themselves to assessment by RCT. Social interventions even more so, and yet they can have a very powerful impact on population health. I am skeptical of many of the claims of CAM practitioners, but I can tell you that massage therapy and chiropractic care have done me a lot of good for some musculoskeletal complaints that really dogged me. Allopathic medicine doesn’t have the answer to everything, and there are suggestions that certain CAM therapies can help, so I say we go for it.”

    David Colquhoun.
    “@Weiwen Ng  You say “the author’s observation that the decline of the U.S. is linked to its increasing reliance on CAM seems vastly overstated”. I couldn’t agree more, but of course I didn’t say that at all.  I di find it a bit worrying though, that a masters in public health should talk about “more flexible standards of evidence”. Of course it’s easier to publish papers if you aren’t too fussy about the standards of evidence, but the nub of the question, whether it is a pill. a diet or a social intervention is causality/  If the effects you see are not causal then you can may well give advice that harms patients, as in the case of HRT for example.  randomisation is the only way to be certain about causality and that is why it is so very important.  You should be advocating more randomised tests of social interventions, not more flexible standards of evidence. ”
    Weiwen ng
    “If you want to get specific, well designed and preferably large case control studies and cohort studies are acceptable, especially when they produce consistent evidence in favor of an intervention. Now, for pharmacological interventions, RCTs can and should be the backbone of evidence. However, as I mentioned, not all interventions (especially social ones) are as amenable to RCTs. And for that matter, RCTs aren’t perfect, because they’ll only tell you about your intervention in comparison to the placebo (and another intervention(s), if applicable) – and because they’re expensive, you only have so many RCTs.

    “I’m surprised and dismayed that you instantly interpreted my comment as saying that we should throw the evidence out. Sometimes you have to live with evidence that’s less definite – in policy and in business, we do this all the time, for better and for worse. But that doesn’t mean that once we get outside the pharmacological space, you suddenly can’t make decisions because you don’t have RCTs. “http://www.theatlantic.com/life/archive/2011/06/america-land-of-the-health-hucksters/240809/

  • Fedup

    Hi Richard, how you doing email me as I’ve deleted my twitter account to much “bum kissing look at my blog, I know what I’m talking about cause ernst says so” crap.

    I agree with you totally, last week I talked to a surgeon I’m treating, hes big on EBM but of course agreed that you can follow certain methods that have been shown to work with trials BUT when it comes down to the individual person having their very individual operation it comes down to the surgeons skill and experience, especially if things don’t go to plan.

    It just bugs me that EE can blatantly by so biased and his lap dogs just can’t see, though even sceptics who don’t beleive CAM has any more effect than placebo are starting to see what these Skeptics are really about.

    http://www.theatlantic.com/life/archive/2011/06/whats-eating-the-small-loud-band-of-alt-med-critics/240860/

  • http://www.chiropracticlive.com Richard Lanigan

    Hi Fed up, Comparing studies is like guys worrying if there
    penis is big enough. Its experience that matters most when the intervention is completely
    dependent on the skill of the practitioner delivering it.
     
    Below is what I wrote on Ernst’s latest drivel in Pulse. I have not been on
    Twitter for a while and he has kindly stopped his feed into my account
    presumably he only wants his sycophants reading his conclusions.

    My
    response to Ernsts latest in Pulse.

    These
    researchers concluded that “Further research is needed to delineate the
    specific and non-specific effects of treatment modalities”. Fair enough this
    study done by chiropractors was not positive. It seems the only chiropractic studies
    that Professor Ernst champions are the ones that confirm his own bias. If the
    results of this study had been positive how much would any scientist draw from
    a study of 98 subjects. Professor Ernst does extrapolate much from  such a small sample.

    In doing
    so he would seem to conclude, that synovial joint dysfunction does not benefit
    from treatment. That restricting joint motion will have no effect on joint
    function and will not lead to adhesions in the capsule and joint degeneration.
    I am sure these researchers recognise that these physiological changes happen and
    why they recommend  the need for further
    research, to possibly examine confounders like the interventions used by the
    chiropractors in this study,  many
    different techniques are used by chiropractors and manual therapists to “maintain
    joint function.

    It is
    laughable for a serious scientist to extrapolate so much from so little. A
    study it would appear he has not even read properly. It is now the professors
    opinion that thousands of chiropractors, osteopaths and physiotherapists should
    ignore years of experience and declare “maintenance therapy is no longer worthwhile”.
    Its just as ridiculous as chiropractors claiming to cure conditions based on
    positive results from equally small samples.

  • Fedup
  • Fedup

    Prof ernst is going, BUT he will help find his replacement. DOH

    http://www.timeshighereducation.co.uk/story.asp?sectioncode=26&storycode=416567&c=1

  • Fedup

    Great article here.

    http://www.theatlantic.com/life/archive/2011/06/whats-eating-the-small-loud-band-of-alt-med-critics/240860/

    Love this bit.

    “Now, with Colquhoun (who’s a respected researcher, but not a physician) weighing in, we’ve got almost all the usual suspects in the world of full-out, well-credentialed alternative-medicine haters rounded up to express their displeasure.”

  • Fedup

    Just to really show how biased the prof is, I found another positive piece of research, easy really if you ACTUALLY are interested in the truth.

    Efficacy of preventive spinal manipulation for chronic low-back pain and related disabilities: a preliminary study.
    Descarreaux M, Blouin JS, Drolet M, Papadimitriou S, Teasdale N.
    SourceLaval University, Kinesiology Division and Quebec University in Trois-Rivières, Chiropractic Department, Quebec, Canada. Martin_descarreaux@uqtr.ca
    AbstractOBJECTIVE: To document the potential role of maintenance chiropractic spinal manipulation to reduce overall pain and disability levels associated with chronic low-back conditions after an initial phase of intensive chiropractic treatments.METHODS: Thirty patients with chronic nonspecific low-back pain were separated into 2 groups. The first group received 12 treatments in an intensive 1-month period but received no treatment in a subsequent 9-month period. For this group, a 4-week period preceding the initial phase of treatment was used as a control period to examine the sole effect of time on pain and disability levels. The second group received 12 treatments in an intensive 1-month period and also received maintenance spinal manipulation every 3 weeks for a 9-month follow-up period. Pain and disability levels were evaluated with a visual analog scale and a modified Oswestry questionnaire, respectively.RESULTS: The 1-month control period did not modify the pain and disability levels. For both groups, the pain and disability levels decreased after the intensive phase of treatments. Both groups maintained their pain scores at levels similar to the postintensive treatments throughout the follow-up period. For the disability scores, however, only the group that was given spinal manipulations during the follow-up period maintained their postintensive treatment scores. The disability scores of the other group went back to their pretreatment levels.CONCLUSIONS: Intensive spinal manipulation is effective for the treatment of chronic low back pain. This experiment suggests that maintenance spinal manipulations after intensive manipulative care may be beneficial to patients to maintain subjective postintensive treatment disability levels. Future studies, however, are needed to confirm the finding in a larger group of patients with chronic low-back pain.

  • Fedup

    As usual the great Prof E has shown his bias but cherry picking research. On his Pulse blog he writes,
    “Does chiropractic maintenance therapy work?”
    “They call this approach ‘maintenance treatment’. Even though it is popular, not a single proper trial has ever tested its value.
    Not until recently, that is.
    Canadian chiropractors randomised 98 back pain patients to regularly receive for 10 months either spinal manipulation or spinal manipulation and a home exercise programme or no such treatments.

    bust = Math.floor(1000000*Math.random());
    document.write(”);

    The results show no preventative effect whatsoever. ”

    He then goes on to do his usual chiro bashing by showing his true colours.

    “It would be interesting to monitor how many chiropractors now stop claiming that maintenance therapy is worthwhile. Personally, I am not pinning my hopes too high!”

    So when a chiropractor point him to study that shows that maintenance treatment does has some benefits you would maybe expect him to alter his opinion or at least take a sceptical stand point? No Chance.

    On twitter he was shown this research.

    “Does maintained Spinal manipulation therapy for chronic non-specific low back pain result in better long term outcome?
    Senna MK, Machaly SA.
    SourceRheumatology and Rehabilitation Department, Mansoura Faculty of Medicine, Mansoura University.
    AbstractABSTRACT:: Study Design. A prospective single blinded placebo controlled study was conducted.Objective. to assess the effectiveness of spinal manipulation therapy (SMT) for the management of chronic non-specific low back pain (LBP) and to determine the effectiveness of maintenance SMT in long-term reduction of pain and disability levels associated with chronic low-back conditions after an initial phase of treatments.Summary of background. SMT is a common treatment option for low back pain. Numerous clinical trials have attempted to evaluate its effectiveness for different subgroups of acute and chronic LBP but the efficacy of maintenance SMT in chronic non-specific LBP has not been studied.Subjects and Methods. 60 patients with chronic, nonspecific LBP lasting at least 6 months were randomized to receive either (1) 12 treatments of sham SMT over a one-month period, (2) 12 treatments, consisting of SMT over a one-month period, but no treatments for the subsequent nine months, or (3) 12 treatments over a one-month period, along with “maintenance spinal manipulation” every two weeks for the following nine months. To determine any difference among therapies, we measured pain and disability scores, generic health status, and back-specific patient satisfaction at baseline and at 1-month, 4-month, 7-month and 10-month intervals.Results: Patients in second and third groups experienced significantly lower pain and disability scores than first group at the end of 1-month period (P = 0.0027 and 0.0029 respectively). However, only the third group that was given spinal manipulations during the follow-up period showed more improvement in pain and disability scores at the 10-month evaluation. In the no maintained SMT group, however, the mean pain and disability scores returned back near to their pretreatment level.Conclusion. SMT is effective for the treatment of chronic non specific LBP. To obtain long-term benefit, this study suggests maintenance spinal manipulations after the initial intensive manipulative therapy.”Read the conclusion because Ernst hasn’t. This was his reply.”no good evidence that “maintenance”is effective”So to re cap, even though the great prof is shown two pieces of research, one for maintenance treatment and one against his opinion is negative, not very sceptical, very very biased and pretty boring. Get over it Prof. Just try not to be so biased you never know you may actually learn something.

  • Fedup

    As usual the great Prof E has shown his bias but cherry picking research. On his Pulse blog he writes,
    “Does chiropractic maintenance therapy work?”
    “They call this approach ‘maintenance treatment’. Even though it is popular, not a single proper trial has ever tested its value.
    Not until recently, that is.
    Canadian chiropractors randomised 98 back pain patients to regularly receive for 10 months either spinal manipulation or spinal manipulation and a home exercise programme or no such treatments.

    bust = Math.floor(1000000*Math.random());
    document.write(”);

    The results show no preventative effect whatsoever. ”

    He then goes on to do his usual chiro bashing by showing his true colours.

    “It would be interesting to monitor how many chiropractors now stop claiming that maintenance therapy is worthwhile. Personally, I am not pinning my hopes too high!”

    So when a chiropractor point him to study that shows that maintenance treatment does has some benefits you would maybe expect him to alter his opinion or at least take a sceptical stand point? No Chance.

    On twitter he was shown this research.

    “Does maintained Spinal manipulation therapy for chronic non-specific low back pain result in better long term outcome?
    Senna MK, Machaly SA.
    SourceRheumatology and Rehabilitation Department, Mansoura Faculty of Medicine, Mansoura University.
    AbstractABSTRACT:: Study Design. A prospective single blinded placebo controlled study was conducted.Objective. to assess the effectiveness of spinal manipulation therapy (SMT) for the management of chronic non-specific low back pain (LBP) and to determine the effectiveness of maintenance SMT in long-term reduction of pain and disability levels associated with chronic low-back conditions after an initial phase of treatments.Summary of background. SMT is a common treatment option for low back pain. Numerous clinical trials have attempted to evaluate its effectiveness for different subgroups of acute and chronic LBP but the efficacy of maintenance SMT in chronic non-specific LBP has not been studied.Subjects and Methods. 60 patients with chronic, nonspecific LBP lasting at least 6 months were randomized to receive either (1) 12 treatments of sham SMT over a one-month period, (2) 12 treatments, consisting of SMT over a one-month period, but no treatments for the subsequent nine months, or (3) 12 treatments over a one-month period, along with “maintenance spinal manipulation” every two weeks for the following nine months. To determine any difference among therapies, we measured pain and disability scores, generic health status, and back-specific patient satisfaction at baseline and at 1-month, 4-month, 7-month and 10-month intervals.Results: Patients in second and third groups experienced significantly lower pain and disability scores than first group at the end of 1-month period (P = 0.0027 and 0.0029 respectively). However, only the third group that was given spinal manipulations during the follow-up period showed more improvement in pain and disability scores at the 10-month evaluation. In the no maintained SMT group, however, the mean pain and disability scores returned back near to their pretreatment level.Conclusion. SMT is effective for the treatment of chronic non specific LBP. To obtain long-term benefit, this study suggests maintenance spinal manipulations after the initial intensive manipulative therapy.”Read the conclusion because Ernst hasn’t. This was his reply.”no good evidence that “maintenance”is effective”So to re cap, even though the great prof is shown two pieces of research, one for maintenance treatment and one against his opinion is negative, not very sceptical, very very biased and pretty boring. Get over it Prof. Just try not to be so biased you never know you may actually learn something.

  • Fedup

    As usual the great Prof E has shown his bias but cherry picking research. On his Pulse blog he writes,
    “Does chiropractic maintenance therapy work?”
    “They call this approach ‘maintenance treatment’. Even though it is popular, not a single proper trial has ever tested its value.
    Not until recently, that is.
    Canadian chiropractors randomised 98 back pain patients to regularly receive for 10 months either spinal manipulation or spinal manipulation and a home exercise programme or no such treatments.

    bust = Math.floor(1000000*Math.random());
    document.write(”);

    The results show no preventative effect whatsoever. ”

    He then goes on to do his usual chiro bashing by showing his true colours.

    “It would be interesting to monitor how many chiropractors now stop claiming that maintenance therapy is worthwhile. Personally, I am not pinning my hopes too high!”

    So when a chiropractor point him to study that shows that maintenance treatment does has some benefits you would maybe expect him to alter his opinion or at least take a sceptical stand point? No Chance.

    On twitter he was shown this research.

    “Does maintained Spinal manipulation therapy for chronic non-specific low back pain result in better long term outcome?
    Senna MK, Machaly SA.
    SourceRheumatology and Rehabilitation Department, Mansoura Faculty of Medicine, Mansoura University.
    AbstractABSTRACT:: Study Design. A prospective single blinded placebo controlled study was conducted.Objective. to assess the effectiveness of spinal manipulation therapy (SMT) for the management of chronic non-specific low back pain (LBP) and to determine the effectiveness of maintenance SMT in long-term reduction of pain and disability levels associated with chronic low-back conditions after an initial phase of treatments.Summary of background. SMT is a common treatment option for low back pain. Numerous clinical trials have attempted to evaluate its effectiveness for different subgroups of acute and chronic LBP but the efficacy of maintenance SMT in chronic non-specific LBP has not been studied.Subjects and Methods. 60 patients with chronic, nonspecific LBP lasting at least 6 months were randomized to receive either (1) 12 treatments of sham SMT over a one-month period, (2) 12 treatments, consisting of SMT over a one-month period, but no treatments for the subsequent nine months, or (3) 12 treatments over a one-month period, along with “maintenance spinal manipulation” every two weeks for the following nine months. To determine any difference among therapies, we measured pain and disability scores, generic health status, and back-specific patient satisfaction at baseline and at 1-month, 4-month, 7-month and 10-month intervals.Results: Patients in second and third groups experienced significantly lower pain and disability scores than first group at the end of 1-month period (P = 0.0027 and 0.0029 respectively). However, only the third group that was given spinal manipulations during the follow-up period showed more improvement in pain and disability scores at the 10-month evaluation. In the no maintained SMT group, however, the mean pain and disability scores returned back near to their pretreatment level.Conclusion. SMT is effective for the treatment of chronic non specific LBP. To obtain long-term benefit, this study suggests maintenance spinal manipulations after the initial intensive manipulative therapy.”Read the conclusion because Ernst hasn’t. This was his reply.”no good evidence that “maintenance”is effective”So to re cap, even though the great prof is shown two pieces of research, one for maintenance treatment and one against his opinion is negative, not very sceptical, very very biased and pretty boring. Get over it Prof. Just try not to be so biased you never know you may actually learn something.

  • Fedup

    As usual the great Prof E has shown his bias but cherry picking research. On his Pulse blog he writes,
    “Does chiropractic maintenance therapy work?”
    “They call this approach ‘maintenance treatment’. Even though it is popular, not a single proper trial has ever tested its value.
    Not until recently, that is.
    Canadian chiropractors randomised 98 back pain patients to regularly receive for 10 months either spinal manipulation or spinal manipulation and a home exercise programme or no such treatments.

    bust = Math.floor(1000000*Math.random());
    document.write(”);

    The results show no preventative effect whatsoever. ”

    He then goes on to do his usual chiro bashing by showing his true colours.

    “It would be interesting to monitor how many chiropractors now stop claiming that maintenance therapy is worthwhile. Personally, I am not pinning my hopes too high!”

    So when a chiropractor point him to study that shows that maintenance treatment does has some benefits you would maybe expect him to alter his opinion or at least take a sceptical stand point? No Chance.

    On twitter he was shown this research.

    “Does maintained Spinal manipulation therapy for chronic non-specific low back pain result in better long term outcome?
    Senna MK, Machaly SA.
    SourceRheumatology and Rehabilitation Department, Mansoura Faculty of Medicine, Mansoura University.
    AbstractABSTRACT:: Study Design. A prospective single blinded placebo controlled study was conducted.Objective. to assess the effectiveness of spinal manipulation therapy (SMT) for the management of chronic non-specific low back pain (LBP) and to determine the effectiveness of maintenance SMT in long-term reduction of pain and disability levels associated with chronic low-back conditions after an initial phase of treatments.Summary of background. SMT is a common treatment option for low back pain. Numerous clinical trials have attempted to evaluate its effectiveness for different subgroups of acute and chronic LBP but the efficacy of maintenance SMT in chronic non-specific LBP has not been studied.Subjects and Methods. 60 patients with chronic, nonspecific LBP lasting at least 6 months were randomized to receive either (1) 12 treatments of sham SMT over a one-month period, (2) 12 treatments, consisting of SMT over a one-month period, but no treatments for the subsequent nine months, or (3) 12 treatments over a one-month period, along with “maintenance spinal manipulation” every two weeks for the following nine months. To determine any difference among therapies, we measured pain and disability scores, generic health status, and back-specific patient satisfaction at baseline and at 1-month, 4-month, 7-month and 10-month intervals.Results: Patients in second and third groups experienced significantly lower pain and disability scores than first group at the end of 1-month period (P = 0.0027 and 0.0029 respectively). However, only the third group that was given spinal manipulations during the follow-up period showed more improvement in pain and disability scores at the 10-month evaluation. In the no maintained SMT group, however, the mean pain and disability scores returned back near to their pretreatment level.Conclusion. SMT is effective for the treatment of chronic non specific LBP. To obtain long-term benefit, this study suggests maintenance spinal manipulations after the initial intensive manipulative therapy.”Read the conclusion because Ernst hasn’t. This was his reply.”no good evidence that “maintenance”is effective”So to re cap, even though the great prof is shown two pieces of research, one for maintenance treatment and one against his opinion is negative, not very sceptical, very very biased and pretty boring. Get over it Prof. Just try not to be so biased you never know you may actually learn something.

  • Fedup

    As usual the great Prof E has shown his bias but cherry picking research. On his Pulse blog he writes,
    “Does chiropractic maintenance therapy work?”
    “They call this approach ‘maintenance treatment’. Even though it is popular, not a single proper trial has ever tested its value.
    Not until recently, that is.
    Canadian chiropractors randomised 98 back pain patients to regularly receive for 10 months either spinal manipulation or spinal manipulation and a home exercise programme or no such treatments.

    bust = Math.floor(1000000*Math.random());
    document.write(”);

    The results show no preventative effect whatsoever. ”

    He then goes on to do his usual chiro bashing by showing his true colours.

    “It would be interesting to monitor how many chiropractors now stop claiming that maintenance therapy is worthwhile. Personally, I am not pinning my hopes too high!”

    So when a chiropractor point him to study that shows that maintenance treatment does has some benefits you would maybe expect him to alter his opinion or at least take a sceptical stand point? No Chance.

    On twitter he was shown this research.

    “Does maintained Spinal manipulation therapy for chronic non-specific low back pain result in better long term outcome?
    Senna MK, Machaly SA.
    SourceRheumatology and Rehabilitation Department, Mansoura Faculty of Medicine, Mansoura University.
    AbstractABSTRACT:: Study Design. A prospective single blinded placebo controlled study was conducted.Objective. to assess the effectiveness of spinal manipulation therapy (SMT) for the management of chronic non-specific low back pain (LBP) and to determine the effectiveness of maintenance SMT in long-term reduction of pain and disability levels associated with chronic low-back conditions after an initial phase of treatments.Summary of background. SMT is a common treatment option for low back pain. Numerous clinical trials have attempted to evaluate its effectiveness for different subgroups of acute and chronic LBP but the efficacy of maintenance SMT in chronic non-specific LBP has not been studied.Subjects and Methods. 60 patients with chronic, nonspecific LBP lasting at least 6 months were randomized to receive either (1) 12 treatments of sham SMT over a one-month period, (2) 12 treatments, consisting of SMT over a one-month period, but no treatments for the subsequent nine months, or (3) 12 treatments over a one-month period, along with “maintenance spinal manipulation” every two weeks for the following nine months. To determine any difference among therapies, we measured pain and disability scores, generic health status, and back-specific patient satisfaction at baseline and at 1-month, 4-month, 7-month and 10-month intervals.Results: Patients in second and third groups experienced significantly lower pain and disability scores than first group at the end of 1-month period (P = 0.0027 and 0.0029 respectively). However, only the third group that was given spinal manipulations during the follow-up period showed more improvement in pain and disability scores at the 10-month evaluation. In the no maintained SMT group, however, the mean pain and disability scores returned back near to their pretreatment level.Conclusion. SMT is effective for the treatment of chronic non specific LBP. To obtain long-term benefit, this study suggests maintenance spinal manipulations after the initial intensive manipulative therapy.”Read the conclusion because Ernst hasn’t. This was his reply.”no good evidence that “maintenance”is effective”So to re cap, even though the great prof is shown two pieces of research, one for maintenance treatment and one against his opinion is negative, not very sceptical, very very biased and pretty boring. Get over it Prof. Just try not to be so biased you never know you may actually learn something.

  • Fedup

    Just stay in bed!!!

    AUTHORS’ CONCLUSIONS:
    Moderate quality evidence shows that patients with acute LBP may experience small benefits in pain relief and functional improvement from advice to stay active compared to advice to rest in bed; patients with sciatica experience little or no difference between the two approaches. Low quality evidence suggests little or no difference between those who received advice to stay active, exercises or physiotherapy.

  • Fedup
  • Fedup

    One of the things that really gets up my nose about skeptics arguments against chiro, especially Blue Wode, is that we are only in it for the money. bait and switch, you charge too much, financially bad etc etc,

    What then after this bit of research, (which involves manipulation) should the skeptics be saying about private physios? Are all the private physios cowboys who rip the public off when the public could easily get the same treatments for free on the NHS?

    The Access Randomised Clinical Trial of Public versus Private Physiotherapy for Low Back Pain.
    Casserley-Feeney SN, Daly L, Hurley DA.
    Source*School of Public Health, Physiotherapy & Population Science, University College Dublin, Ireland.
    AbstractSTRUCTURED ABSTRACT: Study Design: Pragmatic randomised clinical trial.Objective: This study investigated differences in the clinical outcomes of public versus private physiotherapy for general practitioner referred patients with acute and chronic low back pain (LBP).Summary of Background Data: Health care setting (i.e. public or private) has been found to influence the course and clinical outcome of common diseases. Despite the international burden of LBP, the effect of healthcare setting on clinical outcomes has not been investigated in this population.Methods: 160 consenting patients, who were referred for physiotherapy for LBP by their general practitioner completed the Roland Morris Disability Questionnaire (primary outcome), Short-Form 36 v2, Fear Avoidance Beliefs Questionnaire, Back Beliefs Questionnaire, EuroQol EQ5D and Patient Satisfaction Questionnaires, were stratified (Acute LBP: ≤ 3 months, n = 55; Chronic LBP: > 3 months, n = 105), and randomly allocated to receive public PT (n = 3 hospitals) or private PT (n = 12 clinics), and followed up at 3, 6 and 12 months post randomisation by post.Results: Repeated measures ANOVA showed significant improvement over time for nine predominantly biomedical outcomes i.e. (i) Roland Morris Disability Questionnaire at 3 and 6-months (ii) Short Form-36 v2 Physical Component Score, Bodily Pain, Role Physical, General Health, Vitality, EQ5D visual analogue scale and weighted health index scores at 3-months, and (iii) the Back Beliefs Questionnaire at 6-months; while the remaining seven biopsychosocial outcomes showed no change over time, and the ‘between within’ repeated measures ANOVA showed no significant differences between groups over time for any outcome measures (p>0.05). Independent samples t-tests found no significant differences between groups in the mean changes in outcome measures from baseline at 12 months, apart from SF-36 v2 Role Physical [mean difference, 95% CI = 5.64 (0.860 to 10.428); t = 2.337; p = 0.021] in favour of the private PT group. There were significantly higher levels of satisfaction with outcome of treatment in the private PT group (Median (IQR): public PT: 5.0 (2.0); private PT: 6.0 (2.0); Mann Whitney U test = 1324.50; p = 0.020), but no differences in satisfaction with treatment or global perceived improvement (p>0.05). The private PT group had a significantly shorter waiting time (mean difference = 39.79 days; 95% CI: 26.88 to 52.69; t = 6.121; p<0.001), and treatment duration (mean difference: 23.48 days; 95% CI: 7.43 to 39.52; t = 2.909; p = 0.005) than public PT. Participants in both groups were treated with advice/education, manipulative therapy and exercise therapy, with minimal use of cognitive behavioural approaches in either group. Physiotherapists in the private PT group had significantly more experience and more postgraduate qualifications than the public PT group (p< 0.005).Conclusion: Despite differences between public and private PT regarding waiting times for treatment and therapist experience, there were no significant differences between groups in the majority of clinical outcome measure scores at follow-up, apart from SF-36 Role Physical and satisfaction with treatment outcome in favour of the private PT group.

  • Fedup

    My God this is a positive bit of research of acupuncture from Peninsula, this can’t be surely!! Hold on no wonder there is no E.Ernst listed in the authors. But there is a Cummings M who I think is Mike Cummings a very well qualified GP, who I think spent time in the Army, and uses acupuncture in his surgery. One fellow who would def take no shit from EE.

    Acupuncture treatment for chronic knee pain: a systematic review.
    White A, Foster NE, Cummings M, Barlas P.
    SourcePeninsula Medical School, Universities of Exeter and Plymouth, Plymouth, UK. adrian.white@pms.ac.uk
    AbstractOBJECTIVES: To evaluate the effects of acupuncture on pain and function in patients with chronic knee pain.METHODS: Systematic review and meta-analysis of randomized controlled trials of adequate acupuncture. Computerized databases and reference lists of articles were searched in June 2006. Studies were selected in which adults with chronic knee pain or osteoarthritis of the knee were randomized to receive either acupuncture treatment or a control consisting of sham (placebo) acupuncture, other sham treatments, no additional intervention (usual care), or an active intervention. The main outcome measures were short-term pain and function, and study validity was assessed using a modification of a previously published instrument.RESULTS: Thirteen RCTs were included, of which eight used adequate acupuncture and provided WOMAC outcomes, so were combined in meta-analyses. Six of these had validity scores of more than 50%. Combining five studies in 1334 patients, acupuncture was superior to sham acupuncture for both pain (weighted mean difference in WOMAC pain subscale score = 2.0, 95% CI 0.57-3.40) and for WOMAC function subscale (4.32, 0.60-8.05). The differences were still significant at long-term follow-up. Acupuncture was also significantly superior to no additional intervention. There were insufficient studies to compare acupuncture with other sham or active interventions.CONCLUSIONS: Acupuncture that meets criteria for adequate treatment is significantly superior to sham acupuncture and to no additional intervention in improving pain and function in patients with chronic knee pain. Due to the heterogeneity in the results, however, further research is required to confirm these findings and provide more information on long-term effects.
    PMID:17215263[PubMed - indexed for MEDLINE]

  • Fedup

    http://www.ncbi.nlm.nih.gov/pubmed/21296268

    This contains some key phrases.

    Abstract
    BACKGROUND AND OBJECTIVE:
    Complementary and alternative medicine (CAM) is frequently used in patients in industrialised countries. Despite this popularity, there remains a considerable deficit of discourse and cooperation between physicians practicing CAM and conventional medicine. The aim is to present the methodology and results of the first international case conference on integrative medicine (IM) dealing with a patient with low back pain. In this paper the methodological tool “case conference on IM” is also described.
    METHODS:
    The interactive case conference took place on November 20th, 2009 as part of the “2nd European Congress of IM” in Berlin, Germany. An experienced expert panel from both conventional medicine and CAM developed integrative medical diagnoses and therapeutic strategies using as their starting point an individual patient case on chronic low back pain (LBP). The case was selected because LBP is a common diagnosis with considerable economic impact and a problem which is often treated with CAM.
    RESULTS:
    In this case conference, the expert panel agreed on a diagnosis of “chronic non-specific LBP with somatic and psychological factors” and proposed multi-modal short- and long-term treatment including of CAM. The importance of the patient-physician-relationship and the consultation process with appropriate consultation time for treatment success was highlighted. There was consensus that the diagnostic process and resulting treatment plan should be individualised and focussed on the patient as a complete person, identifying the significance the disease has for the patient and not just on the disease for itself. Considerable differences were found amongst the experts regarding the first steps of treatment and each expert saw possibilities of “effective and adequate treatment” being met by their own individual treatment method.
    CONCLUSION:
    The case conference on integrative medicine stimulated an intensive exchange between the approaches used by conventional medicine and CAM clarifying different treatment possibilities for low back pain. Therefore, case conferences on integrative medicine could serve as a model for evaluating similar activities in academic hospitals and establishing such approaches in routine medical care. This strategy has the potential to improve patient centred care.

    This is what our great Prof. E had to say about it.

    “every quack treats back pain differently”

    Nothing about “This strategy has the potential to improve patient centred care.”

  • eugene

    Wow the evidence shows that rotational neck adjusting causes VAD and chiro’s adjust necks too much. Has he read Cyriax’s stuff rotate extend and pull! (He was a physio). Great perhaps Blue Wode can give us a lecture on the “right amount” of neck manipulation.

    Lets look at the “safe” option of swimming, based on evidence something of which Blue Wode should understand.

    From the BMJ: Drowning and sudden cardiac death
    D Kenny, R Martin
    + Author Affiliations
    Bristol Congenital Heart Centre, Bristol Royal Hospital for Children, Bristol, UK
    Correspondence to Dr Robin Martin, Consultant Paediatric Cardiologist, Department of Congenital Heart Disease, Bristol Royal Hospital for Children, Upper Maudlin Street, Bristol BS2 8BJ, UK; rob.martin@uhbristol.nhs.uk
    Accepted 12 April 2010 Published Online First 28 June 2010
    Drowning is one of the leading causes of accidental death in children. Some apparent drownings may be related to sudden cardiac death, in particular to unidentified channelopathies, which are known to precipitate fatal arrhythmias during swimming-related events. In this article, the authors examine the likely incidence of such events, the impact of these events on the community, the cardiac defects involved and whether realistic and reliable measures are available to identify those at risk. In developed countries, drowning is the third leading cause of accidental childhood death with a mortality in the UK of 0.7/100 000 children <15 years. 1 The death rate is higher in countries such as the USA and Australia where warmer climates lend themselves to more water exposure and higher numbers of domestic pools. 1 2 Data from national agencies in the UK and Australia indicate that 40% of these drownings occur in swimming pools 3 4 while reports from the USA demonstrate that 19% of drowning deaths in children occur in public pools with certified lifeguards present. 5 There is less information concerning morbidity, but it is estimated that for each drowning death, there are up to four non-fatal drowning events requiring hospitalisation. 1 In almost all cases, these events are considered accidental; thus, extensive efforts have been made to reduce the potential for unsupervised and unsafe exposure of young children to water. Drowning rates have consequently declined over recent years predominantly due to these preventive efforts. 6 However, despite these efforts, one report has recently highlighted that up to 50% of drownings occur in 5–19-year-olds who were are least moderate swimmers.

    Heart attacks at the Gym, safe!!!  Everything carries a risk Wodes lack of abilty to assess it is embarresing.

    Blue Wode is clearly unable to understand the meaning of risk. Even by Ernst's dogy "ask a neurosurgeon what he remembers" anecdote from which he gats data!! we are safer than drowning. I could only find drowning data for kids but 50% could swim so I would imagine rates are similar for adults.

    Biased biased morons. Despite the risks of course we should use the gym of course we should exercise and of course we should consider using a chiropractor for headaches.

  • http://www.chiropracticlive.com Richard Lanigan

    I have a soft spot for Blue Wode. Perhaps because we both
    like Dave Allen and have little time for organised religion.

    Its Ernst like many of our own “academics” who were hopeless in clinical
    practice, that get up my nose.  Sanctimonious
    wallys, who  maintain their self esteem by telling clinical practitioners
    their experience counts for little unless it is supported by “evidence”,
    published and subjected to “peer” review. Would Alex Ferguson have
    been so successful if he had waited for evidence or did the scientists take  inspiration from him, and base their research
    on his success and does he care about their findings?

    I was looking  at one
    of our journal  ”peer review” panels
    the other day and was  amazed at how many
    “arse holes” were in there. Is it a requirement for peer review, to
    lack personality and clinical proficiency.

    Check out the exchange with Ernst and a chiropractor who
    asks a serious question and wants to engage with him http://www.pulsetoday.co.uk/story.asp?sectioncode=20&storycode=4129528&c=2  Ernst is a serious scientis all right and I got a chemistry set when I was 10.

  • Fedupc

    Hi Eugene, blue wode will never change his/her mind no matter what the evidence. On twitter i started a conversation with him/her, he said the evidence shows chiros adjust the neck to often, I then tweeted evry patient for the next few day, no neck adj, no neck adj. the bait and switch is how chiros work, so I sent him a tweet whenever I didn’t treat somebody and sent them away with no charge.  The evidence shows rotational neck adj can cause vad, I told him I don’t use rotational neck adjustments does that mean I’m excempt? He then said reserch shows chiros x ray too much, I again told him I’m a chiro and I don’t x ray. He said exercise and pain killers where the best way to manage lbp, I and steffaan asked him what should all the people do if this doesn’t work for them? He said it was a safer option so I drew his attention to research about all the deaths fron nsaids. He said excercise and swimming where a safer free option, I asked if his swimming pool and gym were free? he said I was twisting things and blocked me on twitter!!!!

  • eugene

    Took this from the post Ernst had a link to on Fox news.

    “The most recent review of studies by the Cochrane Collaboration, an international organization that evaluates medical research, found that spinal manipulation “was no more or less effective than medication for pain, physical therapy, exercises, back school or the care given by a general practitioner.”

    Still, given the lack of quality evidence supporting spinal manipulation for headaches due to neck strain, “patients should be advised to use other therapies,” Ernst said.
    Read more: http://www.foxnews.com/health/2011/06/16/can-spinal-manipulation-help-people-with-headaches/#ixzz1PXSgJn57

    This is fabulous, we are just as good as long term medication known to cause ulcers, liver and kidney disease with chronic use, incidence of which is far higher than post manipulation stroke, (if this is even cause and effect which has never been shown as its so rare).

    You would think a Skeptics logical thought would be you pays your money and takes your choice, if Physio doesnt work try chiro, if that doesnt work try exercise or diet, if that doesnt work try medication, or perhaps as we see in most patients a combination of all the above as patients rarely say I will only do one or the other that would be stupid, do what is effective for you.

    I also wonder how the researchers classified cervicogenic headache as normally there are a myriad of factors, hormonal, stress / anxiety, diet, sleep pattern, etc. If I suggest a patient try the mini pill from the GP for a cyclic headache I consider chiropractic care has worked (if it works) because I am a chiropractor and I suggested it. If I adjust C1 and no headache I will take the credit too. If I suggest regular sleep pattern, reduce NSAID’s because of rebound headaches again another chiropractic success. To suggest to seek other therapies (and that we perform manipulation regardless) is just stupid and once again demonstrates self-opinionated bias.

    Perhaps once EE retires we might actually get a collaberative approach to research with the Chiropractic profession / educ ational establishments as I like having unbiased evidence regardless of the source, but without the self opinionated biased conclusions. 

  • eugene

    I dont think it corroberates the beleifs of a profession but it does corroberate our outcomes that we find in daily practice. There is a big difference. It is evidence what we do works not how it works. It all adds to the melting pot.

    Spine is such a namby pamby chiropractic only journal of course (sarcasm) any rubbish research gets in there… Blue Wode has nailed his colours to the mast. I wonder if he is worried about looking foolish, or if he is really taking an impartial view on all the evidence… I wonder. 

  • Fedup

    A great bit of research here.

    Two research studies generated by the medical profession this year add evidence in support of the value of chiropractic maintenance care.  The first study published in January 2011 in Spine concluded that “SMT is effective for the treatment of chronic non specific LBP. To obtain long-term benefit, this study suggests maintenance spinal manipulations after the initial intensive manipulative therapy.”  The second study in April 2011, published in the Journal of Occupational and Environmental Medicine, provides additional support for the value of chiropractic maintenance care for post injury low back pain patients.  The study followed 894 injured workers for a period of one year.  During that year there were four different types of therapy available to the workers:  medical management, physical therapy, chiropractic, and no therapy.  Episodes of repeat disability were recorded during the year following the initial injury.  Physical therapy had the highest percentage of reinjured workers followed by those receiving medical management or no treatment at all.  The lowest incidence of repeat injury was found among those workers who had received chiropractic maintenance care.  The results of published surveys given to chiropractors have documented the profession’s belief in the value of maintenance care.  Furthermore, during the last decade there have been a dozen peer reviewed papers on the subject.  There are far more questions to be answered, but it is heartening to see medical research corroborate the studies and beliefs of the chiropractic profession.

    But of course Blue Wode thinks the 2 pieces of evidence are rubbish, what a surprise, just goes to show no matter how much evidence you show an individual who claims to be a skeptic (but is really just a biased chiropractic hater) they won’t change their minds.

  • http://www.chiropracticlive.com Richard Lanigan

    Ernst must be the fast food of EBM http://www.ncbi.nlm.nih.gov/pubmed?term=%22Ernst%20E%22%5BAuthor%5D his students are very productive. 

    The thing about “spinal manipulation” there are many in the profession who see it as one of their tools as part of a”package” for the treatment of musculoskeletal  pain syndromes and until the profession defines chiropractic properly, people like Ernst can say thats chiropractic.

  • Fedup

    Well Mr Ernst just gets more and more desperate. Here is his tweet. EdzardErnst Edzard Ernst by zeno001 http://www.ncbi.nlm.nih.gov/pubmed/21649656 CHIRO for headaches:the best evidence is negativeHere is the paper and more importantly what it ACTUALLY says.”All randomized trials which investigated spinal manipulations performed by any type of healthcare professional for treating cervicogenic headaches in human subjects were considered.”Manipulations performed by ANY TYPE of healthcare.”Six RCTs suggested that spinal manipulation is more effective than physical therapy, gentle massage, drug therapy, or no intervention.”"The results are mixed and the only trial accounting for placebo effects fails to be positive. Therefore, the therapeutic value of this approach remains uncertain.”Can anybody see the word chiro there? anywhere? So why does EE say chiro evidence is negative? when HIS OWN conclusion states “remains uncertain”As usual a bit of reserach done by EE is as one sided as a sinking ship. Sums it up nicely.

  • andrew_gibberish

    Reminds me of the old adage. Never argue with a fool, they will bring you down to their level and beat you with experience. Edzer may well enjoy his retirement, with the occasional speaking engagement at skeptic in the pub. I would be curious to see a general survey of public perception of medical care. My suspicion is that medical providers would be seen as out of touch and out of date. Their aloof attitude to anything non-medical is ego driven, not patient driven and is a reminder as to why morbidity is on the increase in Western society despite the continual over intervention of an insatiable medical establishment. Goodbye Edzer, thanks for you grand contribution of………um, er, congratulations on leaving your mark on………..er…..you will be remembered as the……….em, sod it. Give the man a copper carriage clock and “NEXT”!

  • http://www.chiropracticlive.com Richard Lanigan

    It is embarrassing to to think how the chiropractic profession let a man with such a limited understanding of  the practice of evidence based medicine discredit chiropractic by debating with chiropractors representatives with equally  limited understanding of EBM. Its made the profession look so foolish This is how foolish chiropractors try to convince professor Edzard Ernst that they are the chosen ones http://www.pulsetoday.co.uk/story.asp?storycode=4129401Then there is how you deal with Ernst, and people who limit their way of practicing to whats in the Journlas and ignore experience and patient values  http://www.pulsetoday.co.uk/story.asp?sectioncode=20&storycode=4129709&c=2  I would love to debate Ernst on a public forum or those  chiropractors who point the finger at everyone but themselves. 

  • Fedup

    This tweet from edzard ernst shows how he is an impartial un biased researcher of CAM.

    “just giving lectures to docs;amazing how little interest they have in alt med.if they knew about it,quacks would have less of a chance.pity”Goodbye EE.

  • Fedup

    A very good post here http://www.bmj.com/content/342/bmj.c7153.full which nicely shows E ernst research is flawed, but even more interesting is the actual research here. http://www.bmj.com/content/342/bmj.c7153.full

    I espaecially like this bit from obviously unbaised, nothing to hide researchers,.

    “One hundred and sixty one of the 268 respective investigators acknowledged receipt of our email, of whom 31 (19%) declined our invitation. For those authors who did not respond to emails, we were unable to ascertain whether this was because of incorrect or invalid contact information and hence non-receipt of our invitation. We were unable to obtain contact details for chief investigators or lead authors for 19 (7%) trials; however, we established contact with coauthors for eight of these.
    Thirty one trialists (including six coauthors) declined to be interviewed. The majority (17 trialists) gave no reason for doing so. Those who did provide reasons for declining cited personal circumstances (five trialists), work commitments (four trialists), and difficulty in recalling the trial (three trialists). One trialist did not wish to be interviewed by telephone, preferring email or written contact only. One trialist requested a copy of the ORBIT protocol, and subsequently declined to be interviewed.
    Overall, 130 (81%) trialists initially agreed to be interviewed (113 chief investigators or lead authors; 17 coauthors), but further attempts to establish contact and request their trial protocols proved unsuccessful for 30 of these. A further 35 trialists were unable to provide a copy of their trial protocol and so were not interviewed: 15 were unable to locate a copy, 13 were unable to disclose details of their protocol because of restrictions imposed by funding bodies (funded solely by industry), five had protocols that were not written in English, and two trialists were unwilling to share their protocol with us, both stipulating that it was a confidential document. Six further trialists agreed to be interviewed and provided a copy of their protocol, but did not respond to any further email contact. ”

    and this

    “A higher proportion of trialists who did not agree to interview were funded by industry.”

  • Paulm123

    Holy Shit – All the Best Richard!

  • CDC

    Best of luck RL! Be strong and know you are in the thoughts of many people.

  • Jackofkent

    Ha ha :-)

  • ExMcStudent

    Hugs for you and your family at this scary time. Hang in there Richard.

    ExMcStudent

  • http://www.chiropracticlive.com Richard Lanigan

    Turns out Jack of Kents comment was an April Fools day “joke”. What I find fasinating is that this tounge in cheek “joke” is spot on. Whether the adulation of his position in the skeptic movement has clouded his judment remains to be seem.

  • http://www.chiropracticlive.com Richard Lanigan

    Jack of Kent was spot on about the Simon Singh case and he is spot on about this.

    However I do not include our own resident skeptic Colin in that characterisation. I look forward to interesting discussions with him as I embrace the Woo approach to heath and wellbeing on Twitter.

  • Fedup

    I know, but many a true word spoken in jest.

  • QueCee

    …or an April Fools?

    more importantly, best of luck Richard

  • http://welshandgrumpy.blogspot.com/ Colin Jenkins

    Good luck…

  • Fedup
  • http://www.chiropracticlive.com Richard Lanigan

    Hi Colin,
    I was not going to engage with anyone on this, (got to remove all stress from my life) but your comment made me laugh, thanks.

    I have had lots of e-mails and texts about Coats going and I wanted to say, I dont give a fuck!

    Four weeks ago I went to me GP because there was some blood in my poo. Referred to a consultant and had a colonoscopy and a tumour was found in my colon. Biopsy was positive and this morning I have an MRI scan, Moday a CT Scan. Then they will know if has spread and I will get a prognosis.

    If its good news statistically I will be in the group that have a 90% survival rate, but if I am one of the 10%, with a good statistical prognosis I would be fucked. I could have bad news and be told I have only 10% survival rate. The point I am making is nobody knows and thats the worst part. The NHS has been fantastic and I will go down the medical route.

    On Monday waching Simon mock the homeopaths I was sitting there thinking of Popeye the Sailor man who is helping me deal with this. No evidence to support the efficacy of Popeye for helping people deal with cancer.

  • http://welshandgrumpy.blogspot.com/ Colin Jenkins

    RL: “…I turn this blog over to others as I move away from chiropractic and into Woo.”

    Far too much or a coincidence (sic) – you and Coats are teaming up aren’t you…

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