Medicalisation – don’t take it lying down.

September 29th, 2007 by Ben Goldacre in acupuncture, bad science, medicalisation, placebo | 69 Comments »

Ben Goldacre
The Guardian
Saturday September 29 2007

One thing that always fascinates me, as I tug on my pipe in this armchair, is how reductionist, how mechanical, how sciencey and medical we like our stories about the body to be. This week a major new study was published on acupuncture. Many newspapers said it showed acupuncture performing better than medical treatment: in fact it was 8 million times more interesting than that.

They took 1162 patients who had suffered with back pain for an average of 8 years (so these were patients who had failed with medical treatment anyway) and divided them into 3 groups. The first group simply had some more medical treatment; the second group had full on acupuncture with all the trimmings, the needles all put carefully into the correct “meridiens” in accordance with ancient Chinese stuff, and so on; while the third group just had some bloke pretending to be an acupuncturist, sticking needles in their skin at random. The study set a threshold for “response to treatment”, which was an improvement of 33% on 3 items out of a bigger scale, or 12% on one symptom scale. So this was not “getting better”, or a “cure”.

I’m not carping, I’m just telling you what they measured. And what were the results? Firstly, 27% of the medical treatment group improved: this is an impressive testament to the well known healing power of simply “being in a trial”, since medical treatment hadn’t helped these patients for the preceding 8 years. Meanwhile 47% of the acupuncture group improved, but the sting is this: 44% of the fake acupuncture group improved too. There was no statistically signficant difference between proper, genuine ancient wisdom acupuncture, and fake, “bung a needle in, anywhere you fancy, with a bit of theatrical ceremony” acupuncture.

There are three possible explanations for this finding. One is that sticking needles in your body anywhere at random helps back pain due to some physiological mechanism. The second is that theatrical ceremony, reassurance, the thought of someone doing something useful, and a chat with someone nice helps back pain. (The third option is “a bit of both”).

Now as I have said so many times before, the placebo effect is not about a sugar pill, it’s about the cultural meaning of a treatment, and our expectations: we know from research that two sugar pills are more effective than one, that a salt water injection is better for pain than a sugar pill, that colour and packaging have a beneficial effect, and so on. Interestingly, there has even been a trial on patients with arm pain specifically comparing a placebo pill against a placebo ritual involving a sham medical device, modelled on acupuncture, which found that the elaborate ritual was more effective than the simple sugar pill. “Placebo” is not a unitary phenomenon, there is not “one type of placebo”.

But the most important background information missing from the news reports wasn’t about the details of the study: it was about back pain. Because back pain isnt like epilepsy or tuberculosis. Most of the big risk factors for a niggle turning into chronic longstanding back pain are personal, psychological, and social: things like depression, job dissatisfaction, unavailability of light duty on return to work, and so on.

And the evidence on treatments tells an even more interesting psychosocial story: sure, anti-inflammatory drugs are better than placebo. But more than that, bed rest is actively harmful, specific exercises can be too, and proper trial data shows that simply giving advice to “stay active” speeds recovery, reduces chronic disability, and reduces time off work.

We don’t like stories and solutions like that for our health problems. There are huge industries telling you that your tiredness is due to some “chromium deficiency” (buy the pill); your cloudy headed foggy feeling can be fixed with vitamin pills, pills, and more pills. It is a brave doctor who dares to bring up psychosocial issues for any complaint when a patient has been consistently told it is biomedical by every newspaper, every magazine, and every quack in town.

But in conditions like back pain or fatigue, information alone can make a difference to the suffering of millions. In Australia, a simple public information campaign (“Back Pain: don’t take it lying down”, arf) was shown to reduce back pain significantly in the whole population. Meanwhile journalists, patients, quacks, politicians and editors would all rather talk about magical, technical pills and rituals.


Here is the paper which compares two different placeboes, a placebo pill in one arm, against an elaborate placebo ritual involving a sham medical device modelled on acupuncture:

You can read more about the placebo effect here:

The full academic paper for the acupuncture study can be found in Archives of Internal Medicine Vol. 167 No. 17, September 24, 2007. I asked the American Medical Association to make it freely available, since it has been so heavily promoted and discussed, and is the focus of lots of public interest, and was funded by the public medical insurers in Germany. They refused, and for some slightly odd reasons in my opinion, but that is a story I will write on another day. If you have an academic login you can read the paper here, if you are denied access to this information then I agree, that is wrong:

Here is the real action, an excellent and current review of the literature on back pain from the British Medical Journal, and it’s free to access:

Since back pain is a problem with a lifetime incidence of 50-70%, you might as well read the paper, since you will need to know about it, I’ve extracted a couple of tables below.

The main challenge is the early identification (for example, based on psychosocial risk factors) of patients at risk for chronicity and subsequently preventing the chronicity from occurring.

Table 1 Risk factors for occurrence and chronicity of low back painw10

Risk factors




Age; physical fitness; weakness of back and abdominal muscles; smoking

Obesity; low educational level; high levels of pain and disability


Stress; anxiety; negative mood or emotions; poor cognitive functioning; pain behaviour

Distress; depressive mood; somatisation


Manual material handling; bending and twisting; whole body vibration; job dissatisfaction; monotonous tasks; poor work relationships and social support

Job dissatisfaction; unavailability of light duty on return to work; job requirement of lifting for three quarters of the day


  • Reassure patients (favourable prognosis)
  • Advise patients to stay active
  • Prescribe medication if necessary (preferably at fixed time intervals):
  • Paracetamol
  • Non-steroidal anti-inflammatory drugs
  • Consider muscle relaxants or opioids
  • Discourage bed rest
  • Consider spinal manipulation for pain relief
  • Do not advise back-specific exercises

And here is the paper showing that a simple public health campaign, encouraging people to get back to action as soon as possible, reduced the prevalence of back pain in a population:

The Victorian WorkCover Authority’s statewide media campaign “Back pain — don’t take it lying down”, which commenced in 1997 (Box 1), aimed to provide a new approach through prime-time television advertisements featuring health professionals, and sports and local television celebrities. The messages, all endorsed by the relevant professional healthcare organisations, were simple:

  • back pain is not a serious medical problem;
  • disability can be reduced and even prevented by positive attitudes; and
  • treatment should consist of continuing to perform usual activities, not resting for prolonged periods, exercising and remaining at work.

The campaign counselled individuals with low back pain, their doctors and employers to avoid excessive medicalisation of the problem, and unnecessary diagnostic testing and treatment.

A three-part evaluation of this campaign (evaluating general population attitudes, general practitioners, and the WorkCover Authority claims database) suggests that there has been widespread adoption of these messages (Box 2).13,14 The campaign successfully managed to:

  • “de-medicalise” a public health problem;
  • ease the burden on general practitioners and specialists;
  • empower workers to solve their own health challenges; and
  • save workers’ compensation payments.

The success of the campaign has been attributed to many factors, including the simple, direct language used to convey the messages, and the evidence-based content, both pioneered by the authors of The back book.12 In addition, virtually every professional body with a stake in back pain in Australia supported the campaign.

And Benny’s Final Thought:

There is a fascinating irony here. While the flaky humanities graduate commentators in the media bang on about “scientism” and accuse doctors and scientists of being “reductionist”, while CAM therapists bang on about doctors being in the pocket of big pharma, and praise themselves for being “holistic” and “lifestyle oriented”… doctors seem to be the ones actually dishing out basic, sensible, evidence based non-technical lifestyle advice, and people are strangely resistant to hearing it.

Plus ca change, kids.

If you like what I do, and you want me to do more, you can: buy my books Bad Science and Bad Pharma, give them to your friends, put them on your reading list, employ me to do a talk, or tweet this article to your friends. Thanks! ++++++++++++++++++++++++++++++++++++++++++

69 Responses

  1. doris said,

    September 29, 2007 at 6:36 am

    Early bird;making the most of free internet time.
    Really interesting follow-on to the acupuncture report,which generated so much discussion.
    I would like to know how the prevalence of reported back pain,chronic and acute,specific and non-soecific,varied across the social classes,since I note that obesity,depression,poor social support and low job satisfaction are listed as strong risk factors.
    Categorisation of social class is,in itself,controversial,but I’m wondering whether poverty,poor housing,lousy,badly paid jobs and generally unhealthy habits are associated with a higher incidence of back pain.
    Perhaps a response to intolerable circumstances.
    Do cleaners and shop workers develop back pain more frequently than stockbrokers and company directors?
    The Australian study was very encouraging:what would the Daily Mail have to say?
    I used to get vaguely troubling bouts of discomfort;it disappeared when I got my allotment and started digging and cutting down weed,etc.

  2. jackpt said,

    September 29, 2007 at 2:43 pm

    I wonder if part of the problem with doctors giving lifestyle advice is that many people are confused by the context. There’s a tendancy to see doctors as the man and this can be superficially backed up by the necessary professional restraints placed upon doctor/patient relationships. I wonder if the future is to have ‘lifestyle doctors’ – medically trained doctors who GPs can refer people to but who specifically deal with helping people to make small important changes to their life. Having a Lifestyle-doctor would be easier for people to understand because they would become the new lifestyle gurus, and better, be doing it on an evidence based basis. Plus, such lifestyle doctos could provide the all-needed tea and sympathy bit. It wouldn’t surprise me if the feeling something positive is being done is a placebo in itself. The problem would be with funding and that the move will be criticised by quack ‘lifestyle gurus’ for stealing their customers.

  3. Ben Goldacre said,

    September 29, 2007 at 3:18 pm

    i think that’s an interesting point. people choose where to go with certain problems, and perhaps it’s not so much that doctors are fixated on biomedical solutions and explanations (they’re not) but that often when a person takes their back pain, depression, or fatigue to a doctor, it’s because they are specifically shopping for a biomedical model.

    having said that, i think the great paradox really is that when you go to CAM therapists what you get is the biomedical model writ large, but under a slightly different branding banner: pills and bogus magical blood tests for fatigue, magic machines that change your energy wave pattern to eradicate the nicotine molecule, a magical qlink pendant with electronic components that protect you from the electromagnetic rays that are causing your headaches, etc.

  4. jackpt said,

    September 29, 2007 at 4:09 pm

    I think there is a huge demand for lifestyle advice from doctors. There’s been plenty of excellent TV/radio doctors doing phone-ins and the like. I suspect that people don’t see their own doctor in that context, plus some doctors aren’t equipped with the personality or time needed, and that is where CAM tosspots have stepped in. It helps that CAM tosspots often have more time on their hands than doctors. I think such ground could be regained from the CAM crowd if public perception was shifted to see doctors in a lifestyle advice context, and one way of doing so would be rebranding a small chatty/approachable subset of them to deal with lifestyle, plus giving them time. I think CAM therapists use the biomedical model writ large is in response to market forces.

  5. happeh said,

    September 29, 2007 at 7:34 pm

    I do not like your mocking tone. It is based on ignorance in my opinion. You say you are a scientist, you have a blog set up about science, a blog that shows up at the Guardian occasionally, yet you appear to me to be extremely sloppy in your thinking.
    You say something like “Acupuncture along meridians and sticking needles in anywhere seems to do the job”. What you say is not true. They did not put the needles in anywhere in the story I read. They said they needled the back area. The way your statement reads, it makes people think you could stick a needle just anywhere in the head or chest and it would help back pain. That is not what they did. Your language is sloppy and leads people to think things that are untrue.
    But you want us to trust that you know better.
    You then go on to say that “there are 3 options for what is going on”. You are not a thorough thinker. There are more options. I do not know if you didn’t list them because they would interfere with the point you want to make, or if you really are sloppy and do not see them.
    What effect do the medical people themselves have on the patient? You describe something you call ceremony. I do not mean that. I mean what if the particular medical practictioner did something to the patient?
    How would you know? You wouldn’t, because it is not on the list of 3 possibilities you put up. It would be necessary for the study to separate the medical practitioners on some identifiable basis, to see if the healing was associated with them, whether they needled acupuncture points, needled some area in general, or maybe just read a book to the patient.
    I think you are young. I think you do not have life experience. I think you are not informed enough to be telling the world how things are in particular areas.
    I will prove it.

  6. spk76 said,

    September 29, 2007 at 8:48 pm

    Could it be he?

  7. misterjohn said,

    September 29, 2007 at 11:33 pm

    Happeh, happeh, happeh talk,
    Happeh talk, keep talking happeh talk
    Talk about things you like to do
    You got to have a dream, if you don’t have a dream
    How you gonna have a dream come true?

    I think that says it all.

  8. pv said,

    September 29, 2007 at 11:57 pm

    Ben wrote
    “Now as I have said so many times before, the placebo effect is not about a sugar pill, it’s about the cultural meaning of a treatment, and our expectations: we know from research that two sugar pills are more effective than one…”

    We (I in particular) also know that parents give their children homeopathic remedies for colds, etc., and of course the children say it works. I do know someone, a school teacher in fact, who does this. Well, what do you know, the teacher tells me it must work because her children say it does. Methinks this is a good example of a cultural meaning of the treatment in the relationship between mother and children.
    By the way, this same teacher recommended homeopathic medicine to me for a bad sore throat and hacking cough on the basis that homeopathy is “natural”!

  9. pv said,

    September 30, 2007 at 12:08 am

    happeh said,

    September 29, 2007 at 7:34 pm

    “I do not like your mocking tone.”

    Well, don’t read it then.

    h also said,

    “It is based on ignorance in my opinion.”

    And your ignorance is based on what?

    Definitely this Happeh!

  10. Robert Carnegie said,

    September 30, 2007 at 12:34 am

    The back is big. This experiment seems to dispose of the acupuncture claim that needles stuck in exact sites on human anatomy – not necessarily the site of the pain – have a particular effect. You can put them anywhere and it’s equally convincing.

  11. flange said,

    September 30, 2007 at 4:43 am

    although the average period for being on normal medical treatment was 8 years, the minimum to be eligible was 6 months so i don’t think you can draw any conclusions about anything being down to “an impressive testament to the well known healing power of simply “being in a trial”

  12. doris said,

    September 30, 2007 at 8:52 am

    I’ve just followed pv’s link on Happeh;I’ve never encountered his bon-mots before:apparently,he is a genius;I’m not so no comment.
    However,hot of the sky news press:M and S are going to start selling bacteriocidal pyjamas for men with an germ-busting silver thread incorporated;’every clout(old english),has a silver lining’.
    Perhaps Happeh should have a pair;might help with the masturbatory,conspiracy-based obsessions.
    This has nothing to do with back pain of course.
    What is happeh’s background?
    Is he self-taught?

  13. AitchJay said,

    September 30, 2007 at 1:33 pm

    I love it when people are balls-out unhinged.

  14. spk76 said,

    September 30, 2007 at 8:11 pm

    JLHarris: “You’ve made this statement a couple of times regarding specific exercise for LBP. Do you, or anyone else, have the reference for this?”

    Hayden JA, van Tulder MW, Malmivaara A, et al. Exercise therapy for treatment of non-specific low back pain (Cochrane review). In: The Cochrane Library, Issue 3, 2005. Wiley, Chichester, UK

  15. Fralen said,

    September 30, 2007 at 8:17 pm

    JLHARRIS SAID: “You’ve made this statement a couple of times regarding specific exercise for LBP. Do you, or anyone else, have the reference for this? As someone in a profession that works with back pain daily, I like to think I stay up on the research for LBP, but yet I’ve never seen anything that concluded specific exercise for LBP can be harmful.”

    You obviously havent made that much of an effort if you cant even be bothered to read the BMJ review referenced, recommended, and extensively quoted from in the very post you’re commenting on.

  16. The Master said,

    October 1, 2007 at 12:05 pm


    funnily enough Research published a few years ago did suggest that sugar when given to children has a mild analgesic effect.

  17. doris said,

    October 1, 2007 at 12:32 pm

    I quite agree with you,Captain Kirkham;people feel vindicated if a discrete disease entity can be identified using a suitably impressive biomedical label.
    I believe there was a very percipient comment posted at the tail-end of the previous discussion on acupuncture,identifying accusations of mental illness,and diagnoses of physical illness.
    This takes me back to my earlier comment about reported incidence of back pain within social classes:are the less privileged and more impoverished members of society more likely to feel the need for a biomedical’vindication’of a condition in order that they can gain access to medical help and state support?
    With probably little to fall back on in the way of financial security,such people might be more in need of a culturally acceptable description of their distress.

  18. Confounded kids said,

    October 1, 2007 at 4:09 pm

    A colleague of mine has just said something similar to a comment made by the acupuncturist who appeared opposite Ben on the PM programme. It’s a point I’m not sure Ben’s addressed specifically.

    A lot of people defend CAM approaches against the charge of being placebos (real clinical effect via the power of culturally-informed expectations of dramatic inventions) by recounting instances of children or animals who have had similar effective responses to acupuncture / homeopathy etc. My response was that these are: (a) typically individual cases – anecdotes rather than experiments; and, (b) involve either chronic or self-limiting conditions, in either of which, the outcome of interest (pain, presence of psoriasis) might improve without the intervention. Any further comments for or against?

  19. doris said,

    October 1, 2007 at 4:35 pm

    To your recent post,Confounded kids;in the previous discussion on acupuncture,I gave a brief acccount of my sister’s experience with acupuncture.
    She has but one functioning kidney,having been born with a malformation of the other which eventually required an operation to save her life.
    For the past couple of years,she has been having regular traditional chinese-style acupuncture to ward off the pain and urinary symptoms which she otherwise develops whenever she catches a cold or gets overtired.
    She swears by the efficacy of the treatment and says she knows her own body so well now that she can tell immediately if she is below par.
    There are no clinical data to substantiate her assertions so I don’t know how this fits into the general placebo-or-not debate.
    Obviously she has positive expectations and has developed a close and trusting relationship with the practitioner,but one has to assume,and hope’ that she still has reasonably normal renal function.This could probably be attributed to placebo,therefore.
    I hope,obviously,that her kidney will continue to function normally,but I do wonder how effective the acupuncture would be were she to develop a serious problem.
    In that event,she will be getting one of mine (kidneys,that is).
    Perhaps this account will answer some of the interesting points you raised in your post.

  20. ACH said,

    October 1, 2007 at 6:15 pm

    Counfounded: “A lot of people defend CAM approaches against the charge of being placebos (real clinical effect via the power of culturally-informed expectations of dramatic inventions) by recounting instances of children or animals who have had similar effective responses to acupuncture / homeopathy etc. ”

    Children are particularly sensitive to suggestions -especially from parents – that what they are being given is good for them. The oldest therapy around is MKIB “Mummy’ll kiss it better” and it works miraculously, but I doubt any clinician trying it on a patient would find any results other than being hauled before the GMC for professional misconduct.

    As for animals, most vets will tell you that the perception is nothing to do with the animal, but the owner. Anecdote alert: I read one truly heartrending account from a vet who described the pitiful condition of a dog, I think, whose owner was convinced that it was getting so much betetr since it had started on the sugar pills, despite the vet seeing a very obvious decline in its condition.

  21. Robert Carnegie said,

    October 2, 2007 at 12:29 am

    About rapid revision of best practice – non-complementary healthcare delivery doesn’t always work like that. You get outdated treatments offered, or treatments that never did any good at all. The rollout of latest good practice is uneven – in the worst cases, they fix it in medical school and wait for all the old doctors to die.

    Of course following an entire model of all disease whose theoretical basis has been disproved for about two hundred years puts that in the shade.

  22. ips said,

    October 2, 2007 at 8:24 pm

    Doris said …

    “This takes me back to my earlier comment about reported incidence of back pain within social classes:are the less privileged and more impoverished members of society more likely to feel the need for a biomedical’vindication’of a condition in order that they can gain access to medical help and state support?
    With probably little to fall back on in the way of financial security,such people might be more in need of a culturally acceptable description of their distress’.

    Good points–not specifically related to back pain but relevant to chronic disorders generally –

    Culture affects biology and threat response and tissue sensitivity/perception of pain.The Culture of Pain by David Morris is highly recommended .
    It is hardly suprising that people seek actualisation of their experiences through physical complaints when other explanations are culturally unacceptable.
    I agree with Ben’s comments regarding psycho/ social factors but I also believe ‘somatisation’ is a cause of pain perception too . There is according to many authors a mutual neurobiological basis for emotion and pain -clinically this is common with primary emotional problems being ‘felt’ as physical disorders . This is extremely common in general practice settings.
    Damasio has done a lot of work in this area -its just that we have for many years been die hard dualists .

    We are able to understand a lot more about the role of the brain in ongoing pain and are also understanding more about pain perception and the representation of the body (see here for a recent popular understanding and read the review if interested)
    The benefit of some somatic and ‘alternative’ approaches is that there is accpetance of the role of emotion and bodily pain which a strictly biomedical approach often ignores. Also in chronic problems (without any real obvious cause) –tissue stimulation and talk/education/graded exercise need to be given in a package to stand any chance of success –seldom does one thing ‘work’ in isolation so i can’t personally see how you can compare acupuncture v’s physio/osteopathic / prayer/mung beans or hypnosis .

    The model of injury -pain – intervention-cure is ideal but how come there are so many people reporting inexplicable chronic pain –back pain being a big component of the statistics)

    The difficulties are perhaps at a conceptual level –‘chronic pain is not the same as acute pain lasting longer’ (Melzack of the pain gate theory) . Ongoing problems are also at the bottom in the league in terms of interest and rated ‘importance’ by Drs (latest BMJ) . Seldom is the bio/psycho/social model used in practice and perhaps this is one of the main reason for the difficulties in management of many people with persisiting painful spines ?

  23. PalMD said,

    October 3, 2007 at 3:13 am

    Wow, so much to address–
    First, internists dish out lifestyle advice all the time. Most patients, even those who like the whole “holistic thing” either don’t want to hear it, or can’t overcome their various addictions (to food, drink, sedentariness, tobacco).

    We KNOW that eating less is good in many circumstances, but an obese person with “fibromyalgia” would rather do just about anything else than go on a real diet, despite the fact that losing weight will make their joints feel better.

    Any primary care physician sees this every day.

    Quick fixes do exist–lose weight and your diabetes and blood pressure will improve. It’s true! But you’d rather get reiki and homeopathy…fine, but have fun on dialysis.

  24. RS said,

    October 3, 2007 at 9:09 am

    There’s a lot of truth in that PalMD.

    How many parents give up smoking when told their child’s asthma will be made worse by it? Not many. Yet they’ll still rant and rave at the doctor for not sorting out little Johnny’s symptoms 100% – or oppose the use of steroid inhalers.

  25. emilypk said,

    October 3, 2007 at 2:25 pm

    Lifestyle advice needs to be given a certain way to elicit cooperation. Many doctors aren’t interested learning how to do this especially as it is time consuming or involves giving a referal to a profession they don’t have much respect for.

  26. gadgeezer said,

    October 3, 2007 at 3:35 pm

    In 2003 Avshalom Caspi et al discussed the relationship between the gene, 5-HTT, and childhood maltreatment in causing depression. Current theories say that 5-HTT is crucial for the regulation of serotonin to the brain; and that the proper regulation of serotonin protects us against depression in response to trauma or stress.

    In humans, each 5-HTT gene has two alleles, and each allele occurs in either a short or a long version. Scientists are still figuring out how the short allele affects serotonin delivery, but it seems that people with at least one short 5-HTT allele are more prone to depression. And since depression is associated with unemployment, struggling relationships, poor health and substance abuse, the short allele could contribute to a life going awry. A Question of Resilience New York Times

    Psychiatrist and resilience expert Sir Michael Rutter was interviewed for the same article and said:

    We now have well-replicated findings showing that genes play a major role in influencing people’s responses to adverse environments. But the genes don’t do anything much on their own.

    It seems that the tandem effect of genetics and environment may play a substantial role in development and response to circumstances alongside cultural responses.

  27. sheffield said,

    October 3, 2007 at 4:05 pm


    I am training to be an acupuncturist. I have seen it work and therefore find it unfortunate that you should wish to put down a therapy about which i doubt many of you know anything.

    Did you not know that it has been successfully used for thousands of years in a country that for the entire of history (apart from possibly the last few hundred years) has been technologically and philosophically far more advanced that Western countries?

    It’s worth being open-minded about things in life; a rigid conception will only lead to harm and mocking others will only come back to haunt you.


  28. sheffield said,

    October 3, 2007 at 4:08 pm

    PS. Apologies to some of the more recent and interesting comments i was aimed more at the reactionary types writing at the top of this column

  29. happeh said,

    October 3, 2007 at 4:46 pm

    Anyone notice how the replies to my post are not replies to what I said, but personal attacks?

    I find that odd. I create one post on a blog where no one knows me, and the next post is a character assasination post. Why? What are the chances someone would do that?

    There are people on the internet who follow me around to cause me trouble. Any place I post, they immediately try to poison the atmosphere before people have a chance to find out who I am. The webpage link posted by spk76 is an example of those people.

    The people responsible for that webpage are “scientists” who were unable to defend their position in scientific discussions. When it became apparent that the discussions were going my way, they banned me from the discussion area, and created that webpage because they were angry. Then they sent me personal messages taunting me about what they had done.

    I think it is pretty obvious one of those people has made the post here in this blog pointing to that character assasination website. They follow me everywhere and have been for oh…..3 or 4 years now.

    Maybe I am wrong. I am a good and trusting person by nature. I know that other people are not like me. Maybe I should ask a question first before stating who I think made those posts?

    Do the people reading this blog do an internet search on the nicknames of every person posting in this blog? I have never searched for another person’s name on the internet in 8 years or so. I am not a snoop. If someone wants to tell me about themselves, I let them tell me when they want to. I do not go snooping to find things out about them.

    Am I the only person who respects the privacy of others? Then maybe that link above is not one of the people harassing me on the internet. Maybe it is just a nosy person who searches on all the people’s name they find in every discussion they read?

    PS. just so you troublemakers know, I used the Happeh nick as a test to see if you were still out there. Brought you right to the bait within 1 1/2 hours. I posted and 1 1/2 hours later there is a post with a link to the character assasination site.

  30. emilypk said,

    October 3, 2007 at 5:21 pm

    Happeh, you came in with an attack, calling people ignorant, impuning their status in various personalised ways and saying you would prove it. You received replies in kind.

    I suggest you try a different tack if you really want to be part of the discussion –i.e. stick to the message not the person– and you might receive the same consideration.

  31. pv said,

    October 3, 2007 at 6:05 pm

    emilypk said,

    October 3, 2007 at 2:25 pm

    “Lifestyle advice needs to be given a certain way to elicit cooperation. Many doctors aren’t interested learning how to do this especially as it is time consuming or involves giving a referal to a profession they don’t have much respect for.”

    Most Doctors? Really? Do you know most Doctors?

  32. pv said,

    October 3, 2007 at 6:14 pm

    Happeh, do you have any contribution to make to the topic or are you here merely to be whinge and insult everyone? Really you shouldn’t complain when people are rude to you or about you – it’s exactly what you do.
    Btw, the Internet is not a private place and people are naturally curious – except for you.

  33. pv said,

    October 3, 2007 at 6:15 pm

    emilypk, apologies from me! Poor reading skills translated “many” as “most”. 🙁

  34. ips said,

    October 3, 2007 at 7:01 pm

    Doris — I think your observations are correct, at least my experiences of multiple GP practices and Pain Clinics have led me to believe that you are right!
    You might find this review interesting re nature/nurture.
    I also think gene expression is clearly influenced by early nurturing -
    Perhaps one reaction to this is an instinctive human ‘need’ in times of perceived trouble to seek solace –touch is one way of doing this and perhaps is one of the reasons for the success of ‘manual therapy’ but mostly it has to be couched in the language of mechanics for it to be acceptable..see here
    similar observations here and Dr Campbell teaches acupuncture to health professionals …
    Re lifestlyle there are plenty of institutions that provide good quality and life affirming programmes without selling anything or promoting dogma –Often there is no money or interest to promote this style of care in the nhs –most of the issues are unglamorous and are deemed to be outside the domain of medicine. This is despite the overwhelming evidence that GP clinics are populated by lifestlyle related problems where pharmacology could in many cases be eliminated by things like exercise or stress management approaches . However these are active approaches and as Ilich suggests in Medical Nemesis people have been programmed into having things done to them not doing them for themselves ……

  35. emilypk said,

    October 3, 2007 at 7:27 pm

    In terms of touch as solace, I may be wandering a little far afield but recent research with babies suggests that being held was an effective analgesic during heel lancing, including behavioral and physiological responses. I wonder if touch is for pain what talking is for depression?

  36. ips said,

    October 3, 2007 at 7:54 pm

    I think you are right sometimes you might need both forms of communication as ongoing pain and depression co-exist or influence each other.
    This in parts is excellent and gives you an idea of the sensible integration of science and the humanities which is not at all ‘flakey’…..
    This gives you an idea of how some Physiotherapists are trying to integrate education utilising neuroscience to facilitate behavioural change .The explain book is very good.

  37. jodyaberdein said,

    October 3, 2007 at 8:06 pm

    I wonder if anyone has particular comments regarding lifestyle intervention performed by the medical profession with reference to a very old large trial, the Multiple Risk Factors Intervention Trial (MRFIT)JAMA 248:1465, 1982 ?

  38. emilypk said,

    October 3, 2007 at 9:17 pm

    Depends, I guess, on the GP. I have yet to be sponanteously referred to anyone by a GP although some bowed to a specific request with some critique along the lines of “waste your time and money if you want to.” May admitted limited sample of 8 GPs in 4 countries suggests a suprising uniformity of attitude!

  39. RS said,

    October 3, 2007 at 9:43 pm

    What sort of referrals are we talking about here (if you don’t mind me asking)?

    GPs, and doctors generally, always seem happy to refer to dieticians, nurse specialists, physios, OTs, speech and language therapists, psychologists, counsellors, other medical specialists, and many others. Although, of course, that is just my experience.

  40. pv said,

    October 3, 2007 at 10:05 pm

    MULTIPLE gp practices?

    Many =
    1. Being one of a large indefinite or indeterminate number; numerous: many a child; many another day.
    2. Amounting to or consisting of a large indefinite or indeterminate number: many friends.

    Multiple =
    adj. Having, relating to, or consisting of more than one individual, element, part, or other component; manifold.

    n. A number that may be divided by another number with no remainder: 4, 6, and 12 are multiples of 2.

    They aren’t synonymous in either English or American English. Sorry to be pedantic but the difference might be worth preserving.

    “Multiple years ago I had chicken pox.
    How many spots did I have?
    Multiple! Too multiple to count.”

    I know this usage is catching on but it’s still pretentious and silly.

  41. ips said,

    October 3, 2007 at 10:39 pm

    Yes, I should have said many …..apologise and it will make me read through what I write so thanks for clarifying meaning . I didn’t intend to be pretentious .

    You spent a few paragraphs being pedantic about grammar but made no comment about the overall content.This seems a fairly typical response in these of these kind of discussions.

  42. doris said,

    October 4, 2007 at 11:29 am

    Thank you,ips for the second informative response;I am going to follow up the links,particularly the first one on gene expression and early nurturing;I actually cut out and kept a clipping from a ‘guardian’ article earlier this year about some cutting edge research in this field.
    Secondly,since this is becoming such a very lively and enjoyable discussion: what do those who are taking part think about the many reports about the use of aural acupuncture(less pompously,ear lobe needling),to help recovering addicts kick their various habits?
    At the risk of straying into anecdotal territory again,I have read many accounts of its efficacy.
    I should love to know what other people think/can add.
    Finally,emilypk and pv:brilliant riposts to happeh!

  43. doris said,

    October 4, 2007 at 12:02 pm

    I’ve just followed up gadgeezer’s links on the 5-HTT gene and its polymorphism:this raises many questions about experience of pain and somatisation etc,and links with depression and vulnerability.
    I wonder whether researchers will be able to do some related investigations in the area of chronic pain of no known cause?
    It is possible to see why so many individuals turn to the rather more comforting treatments offered by CAM practitioners.

  44. pv said,

    October 5, 2007 at 2:27 am

    ips said,

    October 3, 2007 at 10:39 pm

    “Yes, I should have said many …..apologise and it will make me read through what I write so thanks for clarifying meaning . I didn’t intend to be pretentious .

    You spent a few paragraphs being pedantic about grammar but made no comment about the overall content.This seems a fairly typical response in these of these kind of discussions”

    Yes I was a bit pedantic, I admit. And one of my many failings sometimes is the difficulty of getting past peculiar language to the substance of what the writer or speaker is trying to convey. My fault I know.
    Anyhow, if this doesn’t sound too easy, I think I pretty much agree with what you say about cultural and lifestyle issues. And now that I know exactly what somatization is I should agree you there too.

  45. ips said,

    October 5, 2007 at 10:13 am

    pv-Thanks for the reply –and also making me aware of the importance of clarifying language -an important point as I am doing a dissertation on placebo.
    This is an interesting biological proposal as to how placebos might ‘work’

    Doris, this is a better link for you and Dr Campbell is extremely generous with her time. Her explanations and thinking are very clear , especially considering the complexities of the subject matter.

  46. Mark said,

    October 5, 2007 at 5:18 pm

    Whatever came of that study reported on BBC2 last year, where MRI was used to show verum acupuncture lighting up parts of the brain (vs sham acupuncture not, though in that case “sham” was superficial needling, rather than ignoring meridians)?

    My meagre search skills mean I’m unable to find any papers published…

  47. happeh said,

    October 5, 2007 at 5:54 pm

    EmilyPK – You feel I came in and attacked people? You do know that the word “ignorant” is a descriptive word don’t you? It means people do not know something. Is ignorant an insult? I guess that depends on the listener doesn’t it? If I don’t know something, I am ignorant of it whether I like someone telling me that or not.

    PV – I have plenty to contribute to the conversation. The conversation must be interesting, and there must be a way for me to enter it.

    Right now, we have people quoting scientific journals at each other and using medical and scientific buzzwords at each other. I have no interest in a contest to see who can quote which scientific journals, or who can use the most scientific buzzwords.

    Doris – Don’t you dare give anyone a kidney. I don’t care who it is. The medical doctors are only telling you part of the story in how people change after kidney surgery.

    According to Chinese medicine, there is hardly anything that will more drastically affect you physically and mentally than having a kidney removed. Maybe having your brain removed might have the same drastic effect on your body as having your kidney removed will.

    Western doctors have no idea of the ramifications of kidney surgery. Or if they do, they do not say it publically. No matter how empathetic you are, would someone you cared for really ask you to become a cripple, in order to help them? What kind of a friend would do that?

  48. pv said,

    October 5, 2007 at 8:47 pm

    “According to Chinese medicine, there is hardly anything that will more drastically affect you physically and mentally than having a kidney removed. “

    Blah, blah, blah.
    What, for aaaa’s sake is so special about Chinese medicine. And what is it with this oriental fetishism?
    Do the Chinese live longer or healthier than anyone else in the world. Not really. In fact it’s significantly worse than some other countries.

  49. ips said,

    October 5, 2007 at 9:50 pm

    Chinese medicine seems to be ‘holistic’ since in theory it adopts an encompassing approach and looks at emotional health as well as purely ‘physical’ problems. The bio/psych/social model should do this in the Western Health model too.

    The ideas of Taoism attract those seeking ‘holistic’ idealisitc notions of ‘balance’ .The metaphors seem to fit with sympathetic/parsympathetic balance which to me is no bad thing. There is ample ‘evidence’ to link
    excsssive ‘autonomic’ imbalance ie stress with numerous ‘western’ and increasingly Chinese maladies. As PV said there is no proof that China is any healthier -obesity rates are catching up with Scotland and that is bad!

    However in days of yore TCM probably killed an awful lot of people with cross infection but so did our health professonals by not washing their hands (its a hard job now in many places i hear

    What is wrong with looking at these issues in a scienfitic way rather than unprovable metaphysical notions of vital forces or energy ? The current state of play is that we can do this and the Dali Lama seems to think it is interesing, subjecting meditation to scrutiny for example . The same is being done with acupuncture and things like manipulation of the body.

    Biomedicine obviously works . The ‘reductionist approach is brilliant for defined disease but has its blind spots . Medicalisation is a big issue and everyone in the present cultural system can have something wrong with them if you look for it–look at psychiatric ‘diagnosis’ and the rise of depression for instance. Focussing on disease often misses the personal issue of suffering and coping and in the ‘atomised’ world we are now in family care is lacking for many–this is the role for ‘alternative medicine and therapy i believe……That is my own experience of working in the NHS –people for whatever reason in all cultures seek help in time of trouble . In former times people had closer families and perhaps religion –now everything is a ‘medical problem’ . Illich can teach us a lot regarding how we are delluded into thinking that medicine holds the answers- its more likely to be found in the culture and environmental adjustments. Currently since we live in a logical ‘scientifically’ influenced world neuroscience is proving that this is the case and this is why I submitted the SEED article on neurogenesis and stress.

    People are attracted to many ‘eastern’ approaches for many reasons i guess . ‘Slower’ , personal , ‘meditative’ approaches may facilitate healing in conditons which may be placebo responsive? The Dylan Evans paper was intended to suggest that there are placebo responsive conditions which can be subjected to experimentation …….TCM etc are adjuncts to allow healing in placebo responsive problems which are probably numerous but narrow in their scope. Examples possibly include certain inflammatory disorders/pain and depression which are defensive time limited biological reactions in ways that kidney failure cleary is not.

    Science at best brilliant since it is exploratory and moves on when it has better answers . Medicine however is not fully scientific as it is often based on vested interests and attempts to influence people who are impossibly complex -however its probably the best model we have .The alternative is a reliance on gurus and metaphysics which prior to antibiotics was probably the state of affairs here !

  50. ips said,

    October 5, 2007 at 11:21 pm

    PV I am not arguing for TCM ,Chinese medicine or whatever else is fashionable ……I offered a few thoughts as to why there might be interest and a lot of cash going in this direction . I thought my reply was reasonable .

    I agree, in the relatively affluent times we are in Gwyneth Paltrow getting jam jars on her back is a good role model to follow .

    Emotional health is more than ‘State of mind’ . I was thinking of things like somatic markers of emotion as an example . (Search on the neurologist Damasio for an idea if you are interested) -hence the relief of sticking pins into people or doing shiatsu or whatever else . Likely to work as these neural inputs via soft touch n fibres enter the insula area of the brain or so I have read .

    I work with GP’s most are great ( as are most people in the NHS) but time pressed and the system is overwhelmed by issues that just don’t fit a biomedical model .
    There are also issues of increasing ‘medicalisation’ but this is another issue.

    Sure there are psychogists (wait a year or watch a computer programme of how to think differentlly in some cases) .
    Many of the issues I see are in the no mans land of medicine . This seems to be where complimentary medicine is useful ?
    I used the word ‘holistic’ in inverted commas as i think it is often pointless .

    Over and out