Please see Part 1 of this series to get a view on what Cranial Osteopathy is and the reliability of the available evidence.
This post will cover:
* How common is Cranial Osteopathy
* Advertising advice & guidance!
* What answers has the GOsC given?
* And finally!
How common is Cranial Osteopathy?
It is worth looking to see how often Cranial Osteopathy it is used and who is most likely to be offered the treatment. For this I will turn to information in the GOsC’s Standardised Data Collection (SDC) report released in June 2010. Available here in pdf format. This covers the whole of the UK Osteopathic profession, Cranial Osteopathy is mentioned regularly throughout the document but for now I am only interested in the figures that show how common this treatment is.
Page 157 covers the ‘Profile of Osteopathic Care’. This show that osteopaths predominantly treat musculoskeletal conditions, typically over 40% of patients will have symptoms relating to lower back problems. Conditions where Cranial Osteopathy is more likely (but not exclusively) to be recommended are headaches (7%), conditions suffered by infants & children (8.5%) and ‘clinically diagnosed co-morbidity’ where more than one condition is present (13%).
Figure 2 on page 158 shows that regardless of symptoms or conditions presented, Cranial techniques are used as a treatment given during the first appointment in 25.8% of all cases and the sub-note to this figure states that:
‘The type of treatment given at second and subsequent appointments showed a similar distribution’
Page 175 of the report mentions a proposal that a version of the SDC tool, specifically for capturing data related to the treatment of children, is being considered :
“The development of a version of the SDC tool for infants and children is proposed, in collaboration with the osteopathic organisations specialising in this area of practice e.g. the Foundation for Paediatric Osteopathy, the Sutherland Cranial College, and representatives from the children’s clinics within Osteopathic Educational Institutions.”
This was also confirmed in a GOsC email from Dec 2010. So it is clear to see that although Cranial Osteopathy is some way from being the most popular treatment offered by Osteopaths and although not all osteopaths use cranial techniques, is certainly not uncommon – particularly for children and the elderly. I do wonder if the reason it is so popular for infants and babies is that regular osteopathy may be unsuitable – so providing a ‘gentle’ treatment option adds another revenue stream!
Advertising advice & guidance!
The statutory regulator for Osteopathy within the UK is the General Osteopathic Council (GOsC). The GOsC are talking to me via email (at least for the moment – but they’ve yet to read this!), so they are most certainly aware that there are questions surrounding the evidence for Cranial Osteopathy, but they were certainly aware of the issue well before I asked any questions. The minutes of their committee meeting in July 2010 contains the following statement:
“9. Osteopaths’ advertising. The GOsC was actively monitoring discussion of osteopaths’ advertising by members of the public in the blogosphere. There were claims by bloggers that osteopaths were making unverifiable claims for the treatments they offered and it appeared that cranial osteopaths’ websites were particularly under scrutiny.”
I should point out that it is ONLY Cranial Osteopaths that I have looked at!
“In addition to this monitoring, the GOsC continued to advise the provision in editions of the Osteopath and in the newly launched Fitness to Practise e-bulletin, that they should check their publicity for compliance with the Code of Practice and the Advertising Standards Authority Code. Osteopaths’ attention had also been drawn to up to date research published by the General Chiropractic Council – The Effectiveness of Manual Therapies – the UK evidence report , which could be used to check any claims being made in publicity. The help of the BOA in re-enforcing the advice to osteopaths on this issue was acknowledged.”
Rather than releasing evidence or a clear statement to counter the view that these claims are unverifiable, they choose to draw Osteopaths attention to their own Code of Practice, the ASA/CAP codes and the information in the UK Evidence Report. Is it not perfectly reasonable to assume that if they held reliable evidence, they would release it when asked and in doing so counter any claims being made in the ‘blogosphere‘! The UK Evidence Report was coverd in Part 1 of this topic.
The GOsC have certainly issued clear, unambiguous advice to their members and as the following examples show, they have been issuing this advice for well over a year.
The Osteopath Oct / Nov 09 edition (Page 9)
<-- Read this text then look at the image!
This is just the opening statement of a full page article called ‘Does Your Advertising Comply With The Rules‘. The article links advertising claims to their Code of Practice Clause 92, 122 and 123 and it goes a step further and asks their members to consider the following question:
“can you provide evidence that osteopathy in general,and the treatment you are offering in particular, is effective for the conditions you are claiming to treat?”
EVIDENCE that a treatment is EFFECTIVE – Is this not the same thing I’ve been asking the GOsC & NCOR!
The Osteopath Oct / Nov 10 edition (Page 16)
A year later another full page article called ‘Advertising Regulator To Look At Website Copy‘ said:
“All osteopaths must comply with the ASA’s requirements on healthcare advertising, as set out in the CAP Code, and you should therefore ensure that the claims made in your publicity material – both in print and online – can be verified by robust clinical evidence.”
And also …
“The change means that complaints regarding website content will now be considered by the ASA rather than trading standards officers, as is currently the case. Any complaints against an osteopath’s website could also be made directly to the GOsC, which we will be required to investigate.”
And more recently ….. The Osteopath Dec 09 / Jan 11 edition (page 22)
This is another full page article called ‘Advertising Guidelines Changed To Reflect Osteopathic Practice‘. This is an interesting one, not only does it tell osteopaths that they need to conform to the ASA/CAP guidelines and where to obtain advice. It shows that the British Osteopathic Association have been talking to the ASA on this matter, also it actually tells osteopaths where to find a list of conditions that will require evidence to support them.
“The full list of conditions that osteopaths can refer to in their publicity material is contained in the Help Note on Health, Beauty and Slimming Marketing Communications that Refer to Medical Conditions.”
This list applies to more than just Osteopaths. Anybody making (or challenging) health, beauty or slimming claims should read it. You need to register (free) to gain access to this list, but states that evidence may be required to support claims for colic, bed wetting and many, many more. It also states that suitably qualified medical advice should be sought for conditions such as Asthma, Ear Disorders and Learning Difficulties …. ALL conditions that Cranial Osteopaths offer to treat!
The Osteopath also provides a good deal of coverage on The Effectiveness of Manual Therapies – the UK evidence report and have devoted a number of full page articles to the findings of this report. These articles also contain references to ASA/CAP guidelines and advice on implementing the findings of the report. As this report has been covered elsewhere I will simply provide links.
The Osteopath Jun / Jul 10 edition (page 14) This gives an initial evaluation of the report by NCOR.
The Osteopath Aug / Sep 10 edition (pages 14-16) This provides a more detailed breakdown of the conditions covered and the quality of the evidence reported. Colic, Asthma and Ear Infections are all reported as Inconclusive.
What answers has the GOsC given?
Whilst it is true to say that the GOsC have not provided any research evidence to answer my questions and the only real action they have taken is to issue advertising guidance, they have made a number of statements on the subject and some of these are worth commenting on. Back in May 2010 I asked the GOsC if they could point me in the direction of suitable evidence to support the use of Osteopathy as a treatment for a range of non-musculoskeletal conditions.
I have covered the majority of these comments in earlier posts:
18 Apr 2010: Osteopaths: Talking a good game..
23 May 2010: Osteopathy: More words, Some actions, No evidence!
However since then I have had further contact with the GOsC and they have made a few interesting comments.
Dated 21/12/2010:
“You have asked us to provide details of current clinical evidence supporting osteopathic practice. The role of the GOsC – and indeed any healthcare profession regulator – is to regulate the professional conduct of individuals who are on its register; it is outside the scope of our role to collect evidence of the efficacy of particular treatments.”
They claim that collecting evidence is not a part of their role as a regulators, but they do have the services of NCOR to perform that task and that task has been done.
The GOsC are very aware of the claims being made and also of the poor quality of research evidence there is to support those claims. They undoubtedly recognise that this could constitute a breach of their Code of Practice (item 122) otherwise there would be no reason to issue all the advertising guidance. What they have said is:
“As you are probably aware, research development within UK Osteopathy is in its formative stages”
This may be a fact, but it is certainly not an excuse that would allow claims to be made without reliable evidence. The British School of Osteopathy was founded in 1917, the GOsC was established under the Osteopaths Act 1993. Osteopathic research should be well beyond its ‘formative stages’.
“Currently, as part of our work on improving the quality of information provided by registrants, we are focusing on the content of practice websites because of the growing public reliance on web-based information. Along with actively advising osteopaths to assess the accuracy of the information they provide in this way, we are also in the process of reviewing registrants’ practice websites, in order that we can advise them individually and more specifically on good advertising practice.”
Here is an acknowledgement that the content of a website is increasingly important to the public when seeking healthcare advice, therefore it is increasingly important that those claims are based on reliable evidence.
The GOsC are focusing on the content of their members websites and actively advising osteopaths to check their accuracy … The GOsC have a statutory duty to protect the public, yet these websites and claims are still common place – Why!
And if the GOsC are looking at their members websites, shouldn’t they at least have a view on the evidence ….. something they claim is outside of their remit!
To summarise what I’ve been told when asking for evidence – these comments are taken from a series of emails – sadly none contained any evidence!
“Anecdotal evidence in any healthcare field is not to be dismissed out of hand as it is often the precursor of controlled trials. In addition, lack of evidence is not in itself evidence of lack of efficacy.“
Anecdotes do not count as evidence!
“That said, the paucity of quality data relating to osteopathic practice is a deficit that must be addressed”.
I appreciate the acknowledgement that the is a lack of quality evidence – but this has so far not been addressed
“the treatment of non-musculoskeletal conditions has yet to be properly explored in terms of efficacy and safety, and in terms of what both the patient and the clinician believe to be the purpose of the osteopathic intervention.”
If the efficacy and safety have not been explored – Osteopaths should not be treating anybody ….. let alone babies! Why is this even remotely acceptable. Websites regularly say how safe and gentle the treatment is.
“To take the examples of colic and asthma – it is likely that neither expects a cure from the osteopath, but both parties are hoping to enhance the management (rather than the treatment) of the condition”
I totally disagree – When Osteopaths advertise a treatment for colic, I would believe paying customers are expecting something more positive. I think ‘it is unlikely‘ this is based on actually asking patients or parents, just personal opinion.
“In addition to the right to be informed where there is no evidence of positive effect the GOsC considers it essential that patients are also alerted to any identified risks associated with osteopathic care”
Patients have a right to be informed …….. I agree, but nobody is doing it!
“Notwithstanding the points above, your observations regarding osteopathic websites indicate that the GOsC must be more targeted in our guidance to practitioners.”
I will accept that a reasonable amount of clear guidance has been issued ……. but it is being ignored. So GOsC need to take further action.
“Your additional queries relating to “cranial osteopathy” highlight another area where information could be fuller in the public interest.”
What information has been made public. There certainly doesn’t seem to be anything on the GOsC website to inform the public.
It is difficult to avoid the similarities between this and the General Chiropractic Councils regulation of chiropractic!
And finally!
I firmly believe that there is insufficient evidence to support the claims being publicly made by Cranial Osteopaths. I believe that making these claims constitutes a breach of the Osteopaths Code of Practice and also of the ASA/CAP advertising guidelines. What is more the Osteopaths regulator within the UK is aware of this and seems content to simply issue advertising guidance – something that is clearly being ignored!
I am absolutely certain that there are people out there who will strongly disagree with what I have said. The majority of the comments on the quality of the evidence have been drawn from sources within the Osteopathic profession. If they disagree with that assessment, then they need to be able to provide robust evidence to show otherwise.
My own views on Cranial Osteopathy have been formed by looking at the information that is available and given what I have found, I believe I can justify those views.
What is more, I am not alone in thinking this and the criticisms come not just from Skeptics but from UK Osteopaths.
This division is recognised by the GOsC and the NCOR evidence summary contains the following message:
“Dissenting voices
Cranial osteopathy is not without its critics who question its scientific plausibility, its place within osteopathic medicine, and its lack of evidence of effectiveness. The growth of good quality clinic trials and scientific investigation will attempt to act as a rebuttal to such critics.”
I would point out here that it is equally valid (and more likely) that good quality evidence will support the views of critics!
Since my last post on the subject, I have had comments from UK Osteopaths some wishing me ‘good luck’ and others going somewhat further:
“Unfortunately cranial osteopathy is becoming increasingly popular, I think the celebrity woo endorsement has a lot to answer for… Believe it or not your campaign will have tacit support amongst many osteopaths.”
If true then that would be good. And also …
“I would say from personal experience that while the “philosophy” underpinning cranial practice is wrong and much of belief systems that have grown up around it are flawed, there is much to be said for simple touch and a friendly face. I have had cranial treatment done on me by colleagues And I felt it to be a pleasant and relaxing experience. This however does not justify the grand claims being made by some practitioners.”
I have no problem with the notion that a friendly face and time spent with a patient is of benefit and agree that this can be lacking in many doctors surgeries, although doctors may spend more time with you if you pay them £30-£40 per session (typically 30 mins & 1 hour). I can also understand how it may be pleasant and relaxing (even if only temporarily) and I agree with the comment that this is not a license to practice nonsense!
“However there is a large epistemological variance between what I claim to be able to do and some of my colleagues are claiming. I find this extremely worrying and to be honest feel that this needs to be addressed..”
I can understand many Osteopaths being reluctant to be openly critical of their peers, but they need to recognise that to the public ……… you are all Osteopaths!
Criticism of Cranial Osteopathy is nothing new, as this (2004) article from Ben Goldacre shows. Bad Science – Cranial Osteopathy
I will do an update once the results of the NCOR literature review have been published and am interested in seeing if it comes to a difference conclusion and on what research it is based upon. (I’ll try to make it shorter!)
Until then, it is very clear that the evidence for Cranial Osteopathy is extremely weak and has been openly criticised by many with the Osteopathic profession.
Bruce
February 24, 2011
Andrew
Actually a good review but I didn’t notice any mention of subluxation anywhere, nor in fact, osteopathic lesion.
It is my understanding that chiropractors carry out the greater proportion of manipulation worldwide by far and as it has been accepted to be beneficial, I do not fully understand the intolerent, bigoted and biased stance of the S.K.E.P.T.I.C.s nor in fact your interpretaion of the information, that you offer. Once again a pick and mix process to try and prove your point. Failing miserably of course, as usual.
What is interesting is the comment:
Ernst and Assendelft’s review of the risks of manipulation is particularly biased. I would like to repeat the last two words taken from the piece you offered: PARTICULARLY BIASED lol
Ah see no real surprise there then. I go back to a former statement, you guys are progressively being seen by the wider population of scientists and clinicians for exactly what you are.
The good news is every circus needs it clowns.
Keeping tooting that horn old bean.
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This was recovered from the spam bin!
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Tzspence
February 24, 2011
Here it is again accusations if bias from Professor Ernst, this time from the paper listed above by Andrew.
‘Ernst and Assendelft’s review of the risks of manipulation is particularly biased.’
What is going on, is this accurate or a joke?
Tzspence
February 24, 2011
Well spotted TZ. Not sure what side of the fence you sit or how aware you are of what is going on but bias, is bias, is bias.
Andrews synopsis of the above paper is Andrews synopsis of the above paper. No mention of subluxation in the paper anywhere just pro manipulation ( the vast majority worldwide of which is carried out bu chiropractors) and ‘ can learn a lot from chiropractic’ type statements.
Yip the author has it right ‘ PARTICULARLY BIASED’ says it all lol
Bruce
February 24, 2011
Tzspence
Supporting ourselves now are we. Your not benj are you?
Bruce
February 24, 2011
You gays are a bit off to left field, however I agree with your last post. I get the impression you are not a Zeno- phobe. Not sure what you are but if you are, it’s an own goal mate ( like the lol) sheesh
Bruce
February 24, 2011
Genuinely sorry, should have been ‘guys’
Blue Wode
February 24, 2011
Hello @ A N Other
Can you confirm that Gordon Waddell factored in the RAND (Research and Development) organisation’s published review of the literature on cervical spine manipulation and mobilization in 1996 in which it concluded that only about 11.1% of reported indications for cervical spine manipulation were appropriate?
A N Other wrote: “…there are other professions (physiotherapy), who would treat the neck when a patient presents with low back pain!”
True, nevertheless….
Quote:
“Since about 90% of manipulation in the United States is done by chiropractors who use spinal manipulation as a primary treatment for a variety of health problems, neck manipulation is more problematic among chiropractors than among physical therapists and other practitioners who use manipulation only occasionally in the treatment of selected musculoskeletal problems”
http://tinyurl.com/6x9lu7r
Blue Wode
February 24, 2011
A N Other wrote: “One final point, Ernst, in your quotation, talks about spinal manipulation. Your Bottom line conclusion says chiropractic manipulation. What is the difference?”
The head of the Connecticut Chiropractic Council (a trade group) tries to explain during testimony before the Connecticut State Board of Chiropractic Examiners on 19th January 2010:
(Chiropractic Leader Refuses to Answer Easy Questions – approx. 3 mins)
Andrew Gilbey
February 24, 2011
Goodness me – that was painful to watch! It was also very reminiscent of the NZ enquiry into chiropractic.
Bruce
February 25, 2011
Blue woad
Can you say Professor Waddell did not incorporate the Rand review?
Surely your point with regards manipulation isn’t simply: if more of something is done by one group over any other by a huge margin, the shock would be any outcomes/side effects would be greater for that group.
That’s like saying it’s a great surprise that medicine kills more people than any other prescribing group. Really! Don’t be silly BW. Weak argument, but then what’s new.
Also the figures you guys, especially you BW, quote come from ERNST, yet AGilbeys balanced critique from an orthopaedic surgeon states categorically that his review was PARTICULARLY BIASED and this time, not by a chiropractic academic. Of course that is not the first time his critique has been criticised for bias, is it.
You guys seem to read the bits that want to, critique the bits in your own fashion that you want to and ignore the rest.
But you do make us laugh.
Interesting, as Andrew Gilbey brought up risk, the serious risk of a stroke, Heart Attack or fatality (excluding other more ‘minor’ problems) while having and angioplasty is 1:100 and an angiogram 1:300. Good odds eh, and do all people really need them, I am sure we all have our stories lol
PS
appreciating this is all about Osteopaths and the evidence therein and non Osteopaths have jumped to their defence: they seem very thin on the ground here, fighting there own corner. I wonder why that is lol
Or maybe they have got it right. Just ignore you guys?
Blue Wode
February 25, 2011
Bruce wrote: “You guys seem to read the bits that want to, critique the bits in your own fashion that you want to and ignore the rest.”
Wrong. Unlike some others, we like to apply the precautionary principle in the interests of patient safety.
It’s not a laughing matter.
Bruce
February 25, 2011
Blue Woad
Please don’t get all sanctimonious on a Friday. This has nothing to do with patient safety, if it was the same critique protocol would be used across the healthcare board and it is obviously not. It’s about agenda, and in some cases it would seem, maybe even paying the bills?
A N Other
February 25, 2011
@ Bruce
Just to make it clear for yourself, i posted the balanced review by Gordon Waddell not Andrew Gilbey!
@ Blue Wode
Can YOU explain in your own words the difference between spinal manipulation and chiropractic spinal manipulation?
Also to quote from Gordon Waddell:
“Ernst and Assendelft’s review of the risks of manipulation is particularly biased. Although the subject of this editorial is low back pain, they concentrate on the admittedly higher risks of cervical manipulation. Even then, orthodox medicine has a long way to go to reduce the rate of serious complications of most of our investigations and treatments to the order of 1:0.2-1 million. The adverse reactions to which the authors refer are temporary aggravations of symptoms or minor subjective reactions; in a personal series, that rate is comparable to figures for every other orthodox treatment for back pain. What matters is the balance of effectiveness versus risk, and that is strongly in favour of manipulation”
He seems to be happy with the risks associated with spinal manipulation and feels the benefits outweigh the risks. So, a world renowned orthopaedic surgeon is happy with patient safety in relation to the use of spinal manipulation, would you think it is OK?
Finally, in a previous discussion with you, you had the opinion that low back pain was self-limiting. Therefore, under that train of logic would you agree that the prescription of NSAIDs for low back pain is not applying the precautionary principle in the interests of patient safety becuase of the known risk factors?
Blue Wode
February 25, 2011
A N Other wrote: “Can YOU explain in your own words the difference between spinal manipulation and chiropractic spinal manipulation?”
Most chiropractors claim they ‘adjust’ the spine which is apparently more specific than manipulation. As Samuel Homola, DC, explains:
Quote
“The reasons for use of manipulation/mobilization by an evidence-based manual therapist are not the same as the reason for use of adjustment/manipulation by most chiropractors.”
More:
http://jmmtonline.com/documents/HomolaV14N2E.pdf
Blue Wode
February 25, 2011
A N Other wrote: “So, a world renowned orthopaedic surgeon is happy with patient safety in relation to the use of spinal manipulation, would you think it is OK?”
No. The risk is still there. It boils down to *individual* informed consent.
A N Other wrote: “…would you agree that the prescription of NSAIDs for low back pain is not applying the precautionary principle in the interests of patient safety becuase of the known risk factors?”
No. IMO, it is applying the precautionary principle. NSAID products are invariably accompanied by Patient Information Leaflets. You can find a more detailed defence of them here:
http://www.zenosblog.com/2010/11/where-the-evidence-leads/comment-page-3/#comment-24111
Bruce
February 25, 2011
Blue woad
Can you say Professor Waddell did not incorporate the Rand review?
Surely your point with regards manipulation isn’t simply: if more of something is done by one group over any other by a huge margin, the shock would be any outcomes/side effects would be greater for that group.
That’s like saying it’s a great surprise that medicine kills more people than any other prescribing group. Really! Don’t be silly BW. Weak argument, but then what’s new.
Also the figures you guys, especially you BW, quote come from ERNST, yet AGilbeys balanced critique from an orthopaedic surgeon states categorically that his review was PARTICULARLY BIASED and this time, not by a chiropractic academic. Of course that is not the first time his critique has been criticised for bias, is it.
You guys seem to read the bits that want to, critique the bits in your own fashion that you want to and ignore the rest.
But you do make us laugh.
Interesting, as Andrew Gilbey brought up risk, the serious risk of a stroke, Heart Attack or fatality (excluding other more ‘minor’ problems) while having and angioplasty is 1:100 and an angiogram 1:300. Good odds eh, and do all people really need them, I am sure we all have our stories lol
PS
appreciating this is all about Osteopaths and the evidence therein and non Osteopaths have jumped to their defence: they seem very thin on the ground here, fighting there own corner. I wonder why that is lol
Or maybe they have got it right. Just ignore you guys?
A N Other
February 25, 2011
@ Blue Wode,
Yes the risk is still there, but the benefit otuweighs the risk according to Mr Waddell. So if the patient was fully informed of the risk, would you still be against the use of spinal maipulation.
Also, patient information leaflets have to be read, are there any forms of evidence which proves that all patients read the patient information leaflet and hence have informed consent before taking a medication?
Please answer the question in its full context and not selectively as you have done. There was a preceeding statement that you believe that low back pain is self-limiting and therefore under that train of logic would you agree that the prescription of NSAIDs for low back pain is not applying the precautionary principle in the interests of patient safety because of the known risk factors?
A N Other
February 25, 2011
@ Blue Wode
So, you believe chiropractic manipulation (adjust) is more specific than spinal manipulation. Is there any evidence for that?
Also the quote from Samuel Homola is about the use not the definition of spinal manipulation, which you seem to think is different to chiropractic spinal manipulation
Blue Wode
February 25, 2011
@ Bruce @ A N Other
Bruce wrote: “Can you say Professor Waddell did not incorporate the Rand review?”
No. Obviously neither you, A N Other, or I am able to prove that he did. However, I am not aware of any proof identifying conditions for which neck manipulation is absolutely essential. Indeed, chiropractic’s own reviews of the literature fail to show neck manipulation to be superior to physical modalities having little or no risk of adverse effects. Therefore the trick is using manipulation appropriately in carefully selected cases, with informed consent after weighing benefit against risk.
IMO, it is unconscionable for chiropractors to use neck manipulation as routinely as they appear to, even if they consider the risk small or hypothetical.
BTW, since this thread is about osteopathy, I would remind readers that the most recent systematic review of RCTs of osteopathy for musculoskeletal pain patients concluded the following:
Quote
“Collectively, these data fail to produce compelling evidence for the effectiveness of osteopathy as a treatment of musculoskeletal pain.”
http://www.ncbi.nlm.nih.gov/pubmed/21053038
A N Other
February 25, 2011
@ Blue Wode
Can you please answer the questions above as well!
Also, NSAIDs can help with pain relief, that is proven. However, people who have low back pain can be left with mulitple deficits, such as diminished hip extension and hip internal rotation after the pain has gone i.e. when they are asymptomatic. These deficits can remain for years.
So, NSAIDs are only treating the pain of low back pain and not these persisting deficits, which can be treated by manual therapists (osteopaths, chiropractors, physiotherapists etc.). If, these deficits are not addressed the person can be prone to chronic low back pain and probable increase in the use of NSAIDs or other medication, which will increase the risk factors associated with these medications.
Hence, NSAIDs have their role but they can’t be used on their own.
Bruce
February 25, 2011
Blue woad
As normal you refuse to comment on Ernst obvious bias in his research.
Will you respond?
Blue Wode
February 25, 2011
A N Other wrote: “NSAIDs are only treating the pain of low back pain and not these persisting deficits, which can be treated by manual therapists (osteopaths, chiropractors, physiotherapists etc.). If, these deficits are not addressed the person can be prone to chronic low back pain and probable increase in the use of NSAIDs or other medication, which will increase the risk factors associated with these medications. Hence, NSAIDs have their role but they can’t be used on their own”.
In that case I would venture that paracetamol, physiotherapy, and coping strategies would be preferable *ethical* options. In addition to being much cheaper, they are also less risky – i.e. no chance of the patient being ensnared by quackery which might lead to unnecessary neck manipulations based on outdated ideas.
Blue Wode
February 25, 2011
@ Bruce
I don’t see Ernst’s alleged bias. What I see is an impartial scientist dedicated to patient safety.
A N Other
February 25, 2011
@ Blue Wode,
Who is impartial between Ernst and Waddell in their views on spinal manipulation?
Also, interesting to see you have changed your mind on physiotherapy, because in previous discussions you have said there is no place for any manual therapy in the treatment of low back pain!
So you do agree that in some cases of low back pain that manipulation/mobilisation of the neck is appropriate?
Bruce
February 25, 2011
BLue Woad
No, it is pretty obvious you don’t see Ernst as being biased, but that doesn’t mean he isn’t?
There are obviously others who see that his research is ‘particularly biased’ and are happy to announce it in well respected scientific journals.
Edz’s reputation as in ‘eminent scientist’ continues to slip dramatically, that is if many others out there are to be believed?
Once again it would seem that those skeptics, who ‘claim’ to seek the truth, may actually have problems recognising it when it is placed in front if their noses.
No change there then lol
Blue Wode
February 25, 2011
A N Other wrote: “Who is impartial between Ernst and Waddell in their views on spinal manipulation?”
Ernst. IMO he understands the downside of chiropractic more fully than Waddell.
A N Other wrote: “Also, interesting to see you have changed your mind on physiotherapy, because in previous discussions you have said there is no place for any manual therapy in the treatment of low back pain!”
I recall that the previous discussions were about the Hancock study:
http://www.zenosblog.com/2010/11/where-the-evidence-leads/comment-page-3/#comment-25074
However, if you’re going to introduce deficits – and remember you said “if these deficits are not addressed the person *can be prone* to chronic low back pain” (i.e. it’s far from being a certainty), then physiotherapy might be an option, although it would have to be at an MD’s discretion.
A N Other wrote: “So you do agree that in some cases of low back pain that manipulation/mobilisation of the neck is appropriate?”
As I have already suggested, only with the FULL consent of the patient, and only in very, very rare cases. However, it seems that the exact opposite is occurring at the moment and that is not ethical.
A N Other
February 25, 2011
@ Blue Wode
I will repeat the question – Who is impartial between Ernst and Waddell in their views on spinal manipulation?
This is not about chiropractic it is about spinal manipulation.
In relation to the discussion we had previoulsy (Hancock et al) you took the position of – “As for physiotherapy, as we know, it’s not nearly so mired in quackery, although with regard to low back pain, it possibly has little to offer in view of the Hancock study’s findings”
However, when presented with new evidence (which you seen to be unaware of) your opinion changes to that you would use physiotherapy. It is also a bit condescending to physios that you think that an MD knows best regarding manual therapy, considering some of the leading researchers and clinicians in this field are physios.
Finally, the use of “can be prone” is because there is no certainty within the field of musculoskeletal medicine. Preventing patients from becoming chronic low back pain sufferers is vital, therefore it is more judicious to be proactive (address the deficits) rather than leave it, which has been the problem for musculoskeletal complaints for most of the history of modern medicine.
Please read the article by Karel Lewit in that previous discussion, it will help you understand where musculoskeletal care is going.
Blue Wode
February 25, 2011
A N Other wrote: “I will repeat the question – Who is impartial between Ernst and Waddell in their views on spinal manipulation?”
Ernst.
A N Other wrote: “In relation to the discussion we had previoulsy (Hancock et al) you took the position of – “As for physiotherapy, as we know, it’s not nearly so mired in quackery, although with regard to low back pain, it possibly has little to offer in view of the Hancock study’s findings” However, when presented with new evidence (which you seen to be unaware of) your opinion changes to that you would use physiotherapy.”
Please don’t put words in my mouth. I did not say that I would use it. I ventured* that in those circumstances it would be a preferable ethical option.
[*Venture - an undertaking involving uncertainty as to the outcome]
A N Other wrote: “It is also a bit condescending to physios that you think that an MD knows best regarding manual therapy”
But doesn’t an MD have superior clinical experience of who is likely to get better *without* physiotherapy?
Bruce
February 25, 2011
Come on Blue Wode, do you listen to yourself. How can you honestly expect people to take anything you say seriously. The answer is, they dont. But you knew that.
You honestly think Edzard Ernst is impartial and Gordon Waddell is not. The latter individual really is an eminent scientist and is recognised internationally as such, while the former is loosing credibility as a serious researcher on a daily basis..
A N Other
February 25, 2011
@ Blue Wode,
Explain how Ernst is impartial compared to Waddell?
Regarding “But doesn’t an MD have superior clinical experience of who is likely to get better *without* physiotherapy?”
That may not be true – Chronic musculoskeletal problems and overuse syndromes are particularly baffling to modern medical management. In the esteemed Journal of Bone and Joint Surgery in 2002 Freedman et al wrote that “It is … reasonable to conclude that medical school preparation in musculoskeletal medicine is inadequate.” And, in 2005 Matzkin et al wrote that “training in musculoskeletal medicine is inadequate in both medical school and non-orthopaedic residency training programs.”
Finally i don’t think i put words into your mouth. Quoting your statement “then physiotherapy might be an option, although it would have to be at an MD’s discretion”. The pivotal word to me is “option”. Now the definition of option is the act of “choosing” – choosing means “To select from a number of possible alternatives; decide on and pick out”. So to me i can’t see how you conclude you meant venture from what you wrote. If you meant venture maybe you should be clearer or more careful with the words you use.
Blue Wode
February 25, 2011
@ Bruce @ A N Other
Your lightweight ad homs and nit-picking smack of desperation.
I’ve already linked to the most recent systematic review of RCTs of osteopathy for musculoskeletal pain patients which concluded that the data collectively failed to produce compelling evidence for the effectiveness of osteopathy as a treatment of musculoskeletal pain. However, there’s also another recent systematic review to consider:
Combined chiropractic interventions for low back pain.
CONCLUSION: “Combined chiropractic interventions slightly improved pain and disability in the short-term and pain in the medium-term for acute and subacute LBP. However, there is currently no evidence that supports or refutes that these interventions provide a clinically meaningful difference for pain or disability in people with LBP when compared to other interventions. Future research is very likely to change the estimate of effect and our confidence in the results.”
Walker BF, French SD, Grant W, Green S., Cochrane Database Syst Rev 2010; 4: CD 005427.
That seems to support Simon Singh and Edzard Ernst’s 2008 evaluation of chiropractic:
“WARNING: This treatment carries the risk of stroke or death if spinal manipulation is applied to the neck. Elsewhere on the spine, chiropractic therapy is relatively safe. It has shown some evidence of benefit in the treatment of back pain, but conventional treatments are usually equally effective and much cheaper. In the treatment of all other conditions, chiropractic therapy is ineffective except that it might act as a placebo.”
Ref. ‘Trick or Treatment? Alternative Medicine on Trial’, p.285
IMO, the above strongly suggests not risking one’s time, money, or life with either chiropractic or osteopathy.
A N Other
February 25, 2011
@ Blue Wode
You still have not answered the questions i have put!
Also where is the ad hominem?
I am just clarifying the accusation and answering questions you put to me.
Blue Wode
February 25, 2011
A N Other wrote: “…where is the ad hominem?”
Do you think that Bruce is being polite, objective, and professional? I don’t.
A N Other wrote: “You still have not answered the questions i have put!”
In view of what I wrote in my previous comment above, I think that’s now irrelevant.
A N Other
February 25, 2011
@ Blue Wode
So i didn’t write an ad hominem. Then why say that i did?
I think it is still a relevant question considering you are questioning the impartiality of respected orthopaedic surgeon, who has been involved in research regarding back pain for 20+years. So please explain why you feel Ernst is more impartial than Gordon Waddell regarding spinal manipulation?
Bruce
February 25, 2011
BW
Once again a quantum leap to plug Ernst book.
Sad really
skepticat
February 26, 2011
@A N Other
Don’t worry, it’s obvious to the casual reader that Blue Wode was only accusing you of nitpicking, probably inspired by the last paragraph you addressed to him, which does sound a bit desperate but not as desperate as Bruce, whose entire history of posting on skeptic blogs has been characterised by his liberal use of ad hominem and very little else.
I note the so-called ‘argument’ hasn’t changed over the past year even if the expressions have grown more pompous:
“This has nothing to do with patient safety, if it was the same critique protocol would be used across the healthcare board and it is obviously not. It’s about agenda, and in some cases it would seem, maybe even paying the bills?”
Translated into plain English, this reads as “You big bullies have singled out chiros and that’s not fair, boo-hoo. You must have some sinister self-serving motive.”
In fact, this accusation is demonstrable nonsense. The playing field is perfectly even and anyone who makes misleading claims about any healthcare product in their advertising to the general public should be challenged and many are being challenged, as the ASA’s published adjudications amply demonstrate. Once their digital remit is extended to include websites, we can expect to see many more ajudications on a whole range of therapies and if the practitioners’ regulatory bodies are worth their salt they will be ensuring their members websites don’t tell bare-faced lies like the chiros did.
http://www.nightingale-collaboration.org/
As I said in response to a similar comment on Zeno’s blog, I presume osteos, physios, dentists and all the rest of them could stand in shopping malls haranguing hapless shoppers and have national weeks promoting themselves if they wanted to. I don’t doubt that there are bogus therapies being practised by practictioners of other therapies but I’ve yet to see a single one accost people outside Sainsbury’s to tell them about it.
The point is that chiropractors, more than any other healthcare profession, have drawn attention to the fact that they promote bogus therapies on their websites and elsewhere and that’s why they got the full-frontal assault when they did. I know this, Bruce knows it, everybody knows it, so the constant whining about bias and prejudice is wearing very thin.
By the way, Bruce, peppering your posts with ‘lols’ and happy faces and saying what a great laugh you’re having fools nobody. Spending dozens of hours writing out what is basically the same insult hundreds of times is the internet equivalent of a neon sign telling the world you’re an extremely angry and embittered man and, given the state of play on Planet Chiro, I don’t blame you. What you – and most other chiros that frequent skeptic blogs – don’t seem to realise is how much worse you are making it for yourselves.
Speaking as one who can’t really be arsed to read lots of papers about chiropractic, preferring instead to base my judgement on how chiros themselves behave, I can assure you that it is not Edzard’s research that prevents me from recommending chiropractic to those you think would benefit. (At the moment, that happens to include my son.) I expect healthcare professionals to behave professionally when they are talking about something as important as this and I am mystified as to why you think constantly attacking the character and integrity of those you disagree with is an appropriate and professional way to behave. I invite any bystanders to compare Bruce’s posts with those of Blue Wode, whose posts are concise, straightforward and never include ad homs even when Bruce is unconscionably nasty about him, which Bruce invariably is when he can’t get Blue Wode to see things his own blinkered way.
Finally, your attempt to introduce a new nonsensical term – “zeno-phobes as some are calling them” – is noted, as is the fact that nobody is actually using it except you. Why bother?
A N Other
February 26, 2011
Hello Skepticat,
I don’t think I was nit-picking. I was just clarifying, one the accusation that i put words into Blue Wodes mouth and two the questions he was asking me. I think that is fair and reasonable. If Blue Wode thought i was just nit-picking then that should have been addressed in a seperate post not in the same sentence as the ad hominem.
Can I ask where do I sound a bit desperate?
Blue Wode
February 27, 2011
Edzard Ernst: “…Most who comment on my work are not complimentary because of overt conflicts of interests.”
Enough said.
Bruce
February 28, 2011
Simple question:
Is this man ill, misguided or arrogant?
‘agree with me or be wrong’
Lol
A N Other
February 27, 2011
@ Blue Wode
Please point out the “overt conflict of interests” that relates to Gordon Waddell.
Also, please explain why you feel Ernst is impartial and Gordon Waddell is not in your opinion, regarding spinal manipulation?
Bruce
February 27, 2011
And the swarm arrives to defend their master lol
lol
The last two are fir you sceptical. Bigotry, i think is not skepticism.
You ran away from the questions posed on chiropracticlive where it was obvious that you were, shall we say’ walking slightly off the path of truth with regards the nightingale collaboration When challenged, you stopped posting and now you expect people to take you seriously. Lol
Bruce
February 27, 2011
@ scepticat
Sadly I have never claimed to be a chiropractor or anything else for that matter, looks like you are seeing them everywhere. I believe on top of everything else you seem to have going on, that’s called an obsession. Lol
With regards the nightingale collaboration, it clearly states it will only monitor CAM, not anyone else as you have claimed. If however it did monitor ALL health care using the same critiquing mechanism, you would have universal support, as it stands………well !
skepticat
February 28, 2011
@ Bruce
Thanks for providing yet another perfect illustration of everything I said about you and glad to see you are remembering to post the smiley face through the latest hissy fit.
I see you accuse me of lying but you fail to provide any killer evidence, such as a link to the conversation in question. Here, let me help you:
http://www.chiropracticlive.com/?p=1061#comments
I’m particularly proud of the posts I made in that thread and I do hope you will actually read them. If you do, you will see that, far from running away from any questions, I give a very, very comprehensive response to all of them. Interestingly, in my very comprehensive response on that thread, I quote from a previous comprehensive response to the same question posed by you on the quackometer. Let me refresh your memory on that one too:
http://www.quackometer.net/blog/2010/11/chiropractors-at-war-with-their-regulator-the-gcc.html
So the clearly demonstrable fact of the matter is that the same ‘question’ (i.e. accusation that NC is just about attacking CAM) has been made twice on two different blogs (that I know about) and that I have answered it fully and truthfully on both blogs. And yet here you are on yet another blog falsely claiming that I ran away.
What I actually walked away from, having already given my comprehensive response, was the tirade of abuse your professional colleagues hurled at me. Here’s an example:
“Prick, Dick, Ego self masturbator, usual tosser and possibly on the dole soon.”
But don’t take my word for it, go check the thread. You’ve no excuse not to, now that I’ve provided the link and proven that it is you, not I, who is the liar. Now let’s see if you’re grown up enough to apologise.
The NC will not only “monitor CAM”. The NC is concerned about misleading and dangerous claims made in the promotion of any healthcare therapy in advertising to the public. The overwhelming majority of such claims are made by CAM practitioners. Of course the focus should be on those healthcare therapists who make the most misleading claims to the most people, like the chiros did before your world came crashing down around you. The most important thing that the NC will do, IMO, is highlight the fact that people can challenge misleading claims in healthcare advertising and empower them to do so. I’m glad to see you pledging your support. Though you obviously have nothing to offer in the, shall we say, cerebral sphere, I’m sure a donation will be appreciated. That’s if you’ve any money left, what with all those nameless charities you support.
Yes, I know you haven’t “claimed to have been a chiro”. I’m not accusing you of “claiming to be a chiro. I’m accusing you of being a chiro who pretends not to be one. Given that you post obsessively on the subject and given the content of your posts, that isn’t an unreasonable belief on my part. (The only chiros I am seeing everywhere is you and a handful of your equally embittered mates). I don’t blame you for not ‘fessing up, however. If I were a chiro who behaved like you, I wouldn’t admit to being one either.
=======SB=========
Recovered from the spam bin.
=======SB=========
Bruce
February 28, 2011
Slepticat
You still make me laugh with your posts Maria. My goodness, this has nothing to do with ‘ confessing’, nothing to confess really. It may however highlight your own personal paranoia and prejudices rather than a consideration that an informed member of the public would take such a stance.
Or you could have me banned again, can’t have the sheep knowing about freedom of thought now can we? Censorship is a tool used by many in the past, but never for the benefit of the masses.
Never nice having deficiencies highlighted. I think the reason for censorship on your sure and other has been termed ‘nodding dog syndrome’.
I also find the names you get called offensive, but your own responses/ rantings have been less than ‘ reasonable’ in the past. So when cornered you run yet wear the derogatory statements as a badge of honour on your site when it suits. I understand it’s is easier to throw stones on home ground with your mates around you than venture out the house. eh lol
Bruce
February 28, 2011
@ skepticat
Now the nightingale collaboration, that really is an interesting one.
Set up by you, Henness; you’re life partner if my information is accurate and Singh, and it clearly highlights and pinpoints CAM on it’s website? There is no mention of other groups such as physiotherapy, podiatry, speech therapy, psychotherapy, dentistry or even medicine where the claims/treatments supersede robust evidence? This shows very clear bias and bigotry in your stance unless the site content has changed in the last 3 days? But your get-out clause is to have your own definition of ‘therapies’ which one must assume differs greatly from this:
‘Therapy (in Greek: θεραπεία), or treatment, is the attempted remediation of a health problem, usually following a diagnosis. In the medical field, it is synonymous with the word “treatment”. Among psychologists, the term may refer specifically to psychotherapy or “talk therapy”.’
But then this is simply what you guys do, you try and change the world around you to fit your own ends. Surely fundamentalism is the same wherever you find it?
To be a group that has genuine purpose and respect surely it must look at the whole, it must apply the same robust criteria to all groups if it is to be taken seriously and gain support from the healthcare and the scientific community. That of course is only if evidence and public safety is truly paramount in your purpose rather than the more obvious attempt of genocide on CAM itself? Or is there another, more sinister reason?
Why do you personally think the College of Medicine is putting together it’s own guidelines for evidence? Could thus be because they want to support CAM or possibly because they want to support evidence in all areas if health care in a fair and sensible manner without being seen as fundamentalist, agenda or even financially driven in their approach?
To the lay reader it seems as if you guys are right and by virtue of the same, everyone else is wrong. Let’s see if your response changes peoples minds?
But hey keep smiling but don’t forget those bans and censorship they are important to maintain your ‘credibility’ and ‘side of the argument’. This ones for you .. :-) Lol
skepticat
February 28, 2011
In case anyone’s wondering, Bruce was banned from both Zeno’s blog and mine after posting the same peurile abusive comment about my Zeno 14 times. http://www.skepticat.org/2010/03/the-importance-of-being-ernst-2/#comment-1225
His seven postings on my blog, made nearly a year ago, have not been censored. They are still there serving as testimony to his lack of ability to engage intelligently, much as the posts on this thread (supported by the links I have provided, of course) serve as testimony to his lack of integrity.
His last post on the NC is, frankly, nuts. There really is nothing more I can say about it.
Bruce
February 28, 2011
@ skepticat
Surely, you can do better than this;
‘His last post on the NC is, frankly, nuts. There really is nothing more I can say about it.’
Like trying to answer some of the criticism rather than once again pretending you have the moral high ground. Running shoes on again it seems, always the easy way out!
But hey let’s get back to healthcare and the evidence for mmmm let’s see.
Psychotherapy: one robust paper to support it
Podiatry: conflicting information whether orthotics should be prescribed or even if the the foot should be maintained in neutral.
Physiotherapy: no strong evidence to support it
Medicine: only 22% of all treatments on the NHS have robust evidence to support it.
With this and patient safety and informed consent being paramount, or so you say lol, maybe the nightingale collaboration should stop pretending they are anything other than an agenda driven club organised to destroy all CAM.
Chiropractic: serious risk on cervical manipulation 1:250000 (this figure taken from a paper now accepted by many respected researchers as being a very weak paper) to 1:5.4 million
Colonoscopy: 1:1000 serious risk to patient
Angiogram: 1: 300 serious risk to patient
Angiopasty: 1: 100 serious risk to patient
As soon as you get serious and stop bleating about people throwing stones back the quicker the publics best interest will be served, but if course that’s not really your goal now is it.
skepticbarista
February 28, 2011
Bruce,
“but hey let’s get back to healthcare and the evidence for mmmm let’s see.” ….. How about Cranial Osteopathy – that’s the subject of the blog post!
Bruce
February 28, 2011
Yip happy with that SB, it is getting a bit off track
skepticat
March 1, 2011
Oops, there’s me running away again…in your dreams.
Sorry, I realise from your response that my last post confused you. When I said ‘nuts’, I was referring to your suggestion that I define the word ‘therapy’ differently. You haven’t actually argued this, you’ve just stated it and I’ve no idea where it comes from. As for the “criticisms”, I refer you yet again to the links I helpfully provided to the thread on Lanigan’s blog and to the thread on quackometer where this exact same point – the only point you ever make – received a full response from me. I see no more reason to repeat those responses here than you evidently see any need to be truthful. Nice try, though.
Having refuted your nonsense several times now, Bruce, it’s obvious that it doesn’t matter what I say about the NC, it makes you feel better to believe in the product of your fevered imagination you describe thus:
“maybe the nightingale collaboration should stop pretending they are anything other than an agenda driven club organised to destroy all CAM.”
Your mind, it would seem, is closed tighter than a baboon’s bumhole. Poor you.
“But hey let’s get back to healthcare and the evidence for mmmm let’s see.”
And what seems to be escaping you is that the topic to get back to is not healthcare but the claims made by so-called healthcare practitioners in the promotion of their therapies. You whine about lack of evidence for NHS therapies ad nauseum but offer no suggestion as to what the NC can do about this. Rather than tell us about lack of evidence for all these therapies as if this somthing that should concern us (even if you can’t tell us how), find the misleading claims being made about them in their advertising to the public and challenge them. The NC newly launched website has all the information you need to do so because that’s what the NC is all about: challenging misleading claims.
Good luck with that and I look forward to hearing how you got on. (But I hope people who are genuinely concerned about being scammed by charlatan therapists – rather than the threat to the scammers’ careers – will begin by focussing on the homeopaths, given the countless websites featuring claims to be able to treat everything under the sun, making them a tad more dangerous than the dentists and podiatrists, IMO. But each to their own, as they say.)
Don’t forget the donation!
Here’s the link again:
http://www.nightingale-collaboration.org/
Bruce
March 1, 2011
@skepticat
‘Your mind, it would seem, is closed tighter than a baboon’s bumhole. Poor you.’
Have you sent this to the right person or is it meant for Blue Woad or one if the other members of the swarm, I really don’t recognise the statement?
A donation, it’s always money, money, money now that you have a title eh? Dangerous path to mix: finances, agenda and ego Lol
If the NC (does that mean Nightingale Collaboration or Not Credible not sure) pans out to be all encompassing and fair it will have my full support, until then you need to tin rattle elsewhere my dear. Alternatively, don’t you just love that word, maybe Ernst will donate the proceeds of his book that is always being plugged by you guys?
It must be a real irritation that the ASA’s independent advisors (that excludes Ernst) have supported chiropractic in advertising anything at all and in fact osteopathy more so ( the latter albeit without stringent scientific evaluation of the evidence), and maybe one will find that the same may apply to cranial osteopathy. Who knows. Lol
But let me ask you a simpler question that you may actually choose to answer this time; how does osteopathy compare with chiropractic evidence-wise (appreciating this thread is about osteopathy and evidence) and how do they both compare with physiotherapy and it’s evidence base? This should be easy from a NC Director.
This will help us get back on track re this thread?
A N Other
March 1, 2011
@ Blue Wode and Skepticat
Can you answer my questions too please?
Thanks
Bruce
March 1, 2011
@A N Other
Not a chance of a sensible response from either of these two.. Nike springs to mind.
But wait they really don’t have to answer if past behaviour is anything to go by, they can simply ban or censor. lol
skepticat
March 5, 2011
@A N Other
Sorry, but the only question I can see is your superfluous one,
“Can I ask where do I sound a bit desperate?”
Which you said in response to this:
“it’s obvious to the casual reader that Blue Wode was only accusing you of nitpicking, probably inspired by the last paragraph you addressed to him, which does sound a bit desperate,”.
Bold added.
@ Bruce
Sorry, but you still sound desperate.
I hope one day you will get all the parts of your brain working together as a team long enough to post something that is (a) truthful (b) intelligent and (c) relevant.
And that I’ll live to see a flying pig.
A N Other
March 5, 2011
@ Skepticat
So where in the last paragraph do i sound a bit desperate?
Bruce
March 6, 2011
@skepticat
Sorry Maria,
For desperation use mirror. The nice thing about blogs is others who do not necessarily participate also read them. Your failure to answer even the simplest of questions (in case you missed it, it was in the last paragraph) just shows that responding with substance is not really on your mandate.
Interestingly Andy ( the black duck) responded to one of the poster, not sure if swarm or not yet, by writing this;
‘le canard noir on March 3, 2011 at 1:31 pm
That’s OK and sorry for the terse response.
I guess the reason people get angry about this sort of off topic posting as it is a common tactic for quacks to engage in ‘whataboutery’ – or ‘don’t talk about that, talk about this.’ – Basically, anything to avoid discussing the shortcomings of their own beliefs and actions.’
As the thread is about osteopathy and evidence, my question was related to that. Maybe Andy’s comments should also relate to both yourself and Blue Wide eh. Lol
Andrew Gilbey
March 6, 2011
I can’t imagine that the Skeptics have much reason to be desperate. For them it is just all good debate (and fun). However, for the CAM practitioners, it is their livelihood and prestige as heath ‘professionals’ that is being threatened. They have every reason to sound desperate, given the bloody good kicking their professions have taken over the last year or so.