Working with a complementary therapist

WildBoots

Hi folks,

For any doctors here, what do you think about working alongside a complementary therapist, such as an acupuncturist or a herbalist? Would it be something you would have no problem doing or would you caution your patients to stay well clear? (or actively encourage them) Have you worked alongside people like this in the past and what was your experience like if you have?

SleepDoc

WildBoots wrote: »

Hi folks,

For any doctors here, what do you think about working alongside a complementary therapist, such as an acupuncturist or a herbalist? Would it be something you would have no problem doing or would you caution your patients to stay well clear? (or actively encourage them) Have you worked alongside people like this in the past and what was your experience like if you have?

Would love to work alongside a herbalist that could successfully manage a ruptured AAA, or an acupuncturist that could bang in an epidural.

Failing that, they could help with the crossword.

Vorsprung

SleepDoc wrote: »

Would love to work alongside a herbalist that could successfully manage a ruptured AAA, or an acupuncturist that could bang in an epidural.

Failing that, they could help with the crossword.

That's a bit harsh. How many GPs/physios/OTs/Speechies have successfully managed a AAA? Vascular surgeons are the only ones who can manage a AAA successfully and the survival rates aren't exactly flash.

Haven't been in a position where I've been asked about acupuncture but my mum goes to one every few weeks and swears by it. I think it's all bollocks myself but if people think it does them good, they can knock themselves out.

SleepDoc

Vorsprung wrote: »

That's a bit harsh. How many GPs/physios/OTs/Speechies have successfully managed a AAA? Vascular surgeons are the only ones who can manage a AAA successfully and the survival rates aren't exactly flash.

Haven't been in a position where I've been asked about acupuncture but my mum goes to one every few weeks and swears by it. I think it's all bollocks myself but if people think it does them good, they can knock themselves out.

Well the question was whether a doctor would work alongside one of these complimentary charlatans.

I would not and prefer working alongside people who rely on evidence to guide their clinical practice.

opinion guy

SleepDoc wrote: »

Well the question was whether a doctor would work alongside one of these complimentary charlatans.

I would not and prefer working alongside people who rely on evidence to guide their clinical practice.

There's plenty of evidence to back up acupuncture

Victor

SleepDoc wrote: »

Well the question was whether a doctor would work alongside one of these complimentary charlatans.

Alternative = bad
Complimentary = good

Are you saying you wouldn't refer a stressed person to a massage therapist as part of their treatment? Or a person with inactivity-caused mobility difficulties for yoga?

lonestargirl

I do think that complementary medicine can have a role to play in addition to conventional treatment.

Out of interest I found the following clinical trials investigating the using of complementary medicine in cancer treatments.

Acupuncture for chemo-induced peripheral neuropathy in multiple myeloma and lymphoma patients

Acupuncture for Prevention of Radiation-Induced Xerostomia

Chemotherapy and Mindfulness Relaxation: A Randomized Trial at M.D. Anderson Cancer Center and M.D. Anderson Community Clinical Oncology Program

Effects of Tibetan Yoga on Fatigue and Sleep in Cancer

Evaluation of the Role of Spirituality in Coping With and Surviving Ovarian, Primary Peritoneal or Fallopian Tube Cancer

Music Relaxation Video and Pain Control: A Randomized Controlled Trial for Women Receiving Intracavitary Brachytherapy for Gynecological Cancer

WHEL (Women's Healthy Eating and Living) Survivorship Study

These are the kinds of uses of complementary medicine that I, as a patient, may be open to. The question is, if any of these trials has a postive outcome does it then become evidence-based-medicine and fall out of the complementary domain?

SleepDoc

Victor wrote: »

Alternative = bad
Complimentary = good

Are you saying you wouldn't refer a stressed person to a massage therapist as part of their treatment? Or a person with inactivity-caused mobility difficulties for yoga?

Not in my line of work, no.

GradMed

WildBoots wrote: »

Hi folks,

For any doctors here, what do you think about working alongside a complementary therapist, such as an acupuncturist or a herbalist? Would it be something you would have no problem doing or would you caution your patients to stay well clear? (or actively encourage them) Have you worked alongside people like this in the past and what was your experience like if you have?

"So called integrative medicine should not be used as a way of smuggling alternative practices into rational medicine by way of lowered standards of critical thinking."
http://www.bmj.com/content/341/bmj.c6979.full?sid=399ff70a-c25d-45f9-a875-67d8f83b4ddf


I believe it is inappropriate for medical professionals to work with alternative, complimentary, integrative medical practitioners. To do so confers an air of legitimacy to their practices which are not based on scientific evidence.

opinion guy wrote: »

There's plenty of evidence to back up acupuncture

There is no compelling evidence to suggest that acupuncture is anything other than a placebo.

Victor wrote: »

Alternative = bad
Complimentary = good

Are you saying you wouldn't refer a stressed person to a massage therapist as part of their treatment? Or a person with inactivity-caused mobility difficulties for yoga?

Alternative, complimentary and integrative are terms generally used to describe the same thing, a non scientific based method of medical practice.
Yoga, to me, is just another form of low impact social exercise with an emphasis on relaxation and peaceful contemplation. How is that different to other mobilisation programs suggested by a physiotherapist.

lonestargirl wrote: »

I do think that complementary medicine can have a role to play in addition to conventional treatment.

Out of interest I found the following clinical trials investigating the using of complementary medicine in cancer treatments.

Acupuncture for chemo-induced peripheral neuropathy in multiple myeloma and lymphoma patients

Acupuncture for Prevention of Radiation-Induced Xerostomia

Chemotherapy and Mindfulness Relaxation: A Randomized Trial at M.D. Anderson Cancer Center and M.D. Anderson Community Clinical Oncology Program

Effects of Tibetan Yoga on Fatigue and Sleep in Cancer

Evaluation of the Role of Spirituality in Coping With and Surviving Ovarian, Primary Peritoneal or Fallopian Tube Cancer

Music Relaxation Video and Pain Control: A Randomized Controlled Trial for Women Receiving Intracavitary Brachytherapy for Gynecological Cancer

WHEL (Women's Healthy Eating and Living) Survivorship Study

These are the kinds of uses of complementary medicine that I, as a patient, may be open to. The question is, if any of these trials has a postive outcome does it then become evidence-based-medicine and fall out of the complementary domain?

I don't have time to go through these but the 1st link above is a non randomised pilot study. Information from this could be used in determining whether further investigation of an idea is warranted, nothing more.
The 6th link is dietary related, so to me that's dietetics and nothing alternative medicine at all.

If there is compelling evidence for a treatment then it ceases to be complimentary and becomes medicine. This should not happen on the basis of one trial alone, results from trials should be reproduced.

There is a post on sciencebasedmedicine.org today on a similar topic
http://www.sciencebasedmedicine.org/?p=9030
"A recent study published in the Archives of Opthalmology compare patching of one eye vs acupuncture in the treatment of amblyopia in older children, and finds positive results from acupuncture. The study, and its press, are a good example of the hazards of studying highly implausible modalities."

The site also has an interesting post on whether or not it's good to test implausible health claims
http://www.sciencebasedmedicine.org/?p=8874

lonestargirl

GradMed wrote: »

I don't have time to go through these but the 1st link above is a non randomised pilot study. Information from this could be used in determining whether further investigation of an idea is warranted, nothing more.

True, but you generally (at least in the US) require a pilot study before you can get funding for a randomised control trial. Some of the other ones listed are randomised trials. I specifically picked studies from MD Anderson as it is a large, very well respected research insitute (I found 3100 results for it on clinicltrials.gov) with a rigorous IRB.

GradMed wrote: »

The 6th link is dietary related, so to me that's dietetics and nothing alternative medicine at all.

It's certainly not alternative, but is it complementary? I'm not sure either, that's what I was getting at in my last sentence.

Victor

GradMed wrote: »

There is no compelling evidence to suggest that acupuncture is anything other than a placebo.

Sometimes placebo is useful. Not just with hypochondriacs and terminal cases.

Alternative, complimentary and integrative are terms generally used to describe the same thing, a non scientific based method of medical practice.

Yes, they are mostly the same activities. However, there is a huge philosophical difference between alternative and complimentary - there would be some alternative practitioners / remedies that discourage medical interventation and therefore can't claim to be complimentary. Complimentary practices won't cure many things, but can improve quality of life.

Yoga, to me, is just another form of low impact social exercise with an emphasis on relaxation and peaceful contemplation. How is that different to other mobilisation programs suggested by a physiotherapist.

Indeed, however in certain cases it may be useful to have the social side to encourage the patient to maintain the programme and allow low level supervision.

GradMed

lonestargirl wrote: »

It's certainly not alternative, but is it complementary? I'm not sure either, that's what I was getting at in my last sentence.

Sorry I phased that poorly. I meant that dietetics is a science. It's not alternative or complimentary but a part of standard medical care.

Victor wrote: »

Sometimes placebo is useful. Not just with hypochondriacs and terminal cases.
Yes, they are mostly the same activities. However, there is a huge philosophical difference between alternative and complimentary - there would be some alternative practitioners / remedies that discourage medical interventation and therefore can't claim to be complimentary. Complimentary practices won't cure many things, but can improve quality of life.
Indeed, however in certain cases it may be useful to have the social side to encourage the patient to maintain the programme and allow low level supervision.

Placebos are fascinating
Ben Goldacre discusses the placebo effect here, short video 3-4 min.
http://www.nhs.uk/video/pages/medialibrary.aspx?Page=12&Filter=&Id={362CE1D5-1762-4E28-A65E-312EB2C745A5}&Tag=&Title=NHS+VIDEOS+|+The+placebo+effect&Uri=video%2f2010%2f2.February%2fPages%2fPlaceboeffect.aspx

The problem is, and he covers it, the ethical issues associated with giving a placebo to a patient. Administering placebos generally involve some level of deception and doctors cannot lie to their patients.

There may well be philosophical differences between those that use the terms alternative and complementary but it really makes no difference. If there is evidence to support the treatment modalities then they merit further investigation. If they can be shown to be of benefit then they will become a part of clinical practice. If not they will be discarded.

On your last point, why do you assume that a program suggested by a physiotherapist won't encourage social activity.
During one of my rotations this year the doctors continually emphasized the benefits of a pulmonary rehab course to clinic patients. One of the main benefits they saw was it promoted social activity.

p.s and while typing this there's a man on RTE1 claiming to be a mind reader. Sigh.

WildBoots

Wow.

Some of you guys are incredibly obnoxious. Should have known better.

GradMed

WildBoots wrote: »

Wow.

Some of you guys are incredibly obnoxious. Should have known better.

Would you care to elaborate?

PhysiologyRocks

To be honest, I think calling people obnoxious is far worse than anything else that has gone on in this thread.

Victor

GradMed wrote: »

On your last point, why do you assume that a program suggested by a physiotherapist won't encourage social activity.

In the last two years, I've twice* had a pinched nerve in my right arm. The reaction of the doctor to the suggestion of a physiotherapist was "meh". In both cases, the pain was still at 80% (noting that some painkillers are only really effective for the first while) after 10-14 days when I went to the physioterrorist (these people are trained to inflict pain!). Within 3 days of going to the physio, it was at 20%. However, I found maintaining the physio regime of stretching exercises to be a chore (especially with concussion related memory lapses) and having a "support group" (I overstate this) would have been useful. That support group need not have been a medicalised one.


* First time I had a leg cramp at 3am in bed. I pushed down to straighten the leg and nearly fell out of bed. While I was able to stop myself with my left arm against a box, the right arm went flailing trying to balance myself. The second time I fell on ice and ended up with concussion.

During one of my rotations this year the doctors continually emphasized the benefits of a pulmonary rehab course to clinic patients. One of the main benefits they saw was it promoted social activity.

Fair enough with pulmonary rehab, but with other situations, the same (and in certain case better) results can be achieved with a sub-medical programme, in particular if the person has an adverse personal reaction to a medical intervention.

At one point I was very depressed and did a one week observation course. Only 30 minutes week was with a doctor, 60 minutes individual time with a psychiatric nurse and the balance of the 15 hours was group based with the likes of occupational and complimentary therapists. I'm not about to take up aromatherapy (the bang on the head put paid to that ), it's not everyone's thing, but I did find massage to be very useful.

p.s and while typing this there's a man on RTE1 claiming to be a mind reader. Sigh.

Some people are very good at eliciting information from people and deducing things from that. No they don't literally read people's minds, but they can extract information from unwilling subjects. Some of these people work in law, politics or psychology, others in "entertainment" or crime.

Dr Galen

WildBoots wrote: »

Wow.

Some of you guys are incredibly obnoxious. Should have known better.

What sort of an argument back at anyone is that?

The "should have known better" comment has been typical of many people from the alt/comp health lobby who have come here. Instead of engaging, and debating, we get this sort of thing, making anyone who doesn't agree with the many forms of pseudo-science out there to be ogres.

WildBoots

Dr Galen wrote: »

What sort of an argument back at anyone is that?

The "should have known better" comment has been typical of many people from the alt/comp health lobby who have come here. Instead of engaging, and debating, we get this sort of thing, making anyone who doesn't agree with the many forms of pseudo-science out there to be ogres.

Why does eveything have to be an argument or a debate? I was just looking for people's opinions, nothing more, nothing less. People should be mature and intelligent enough to be able to make a point without resorting to nonsense such as:

"Would love to work alongside a herbalist that could successfully manage a ruptured AAA, or an acupuncturist that could bang in an epidural.

Failing that, they could help with the crossword".

or

"Well the question was whether a doctor would work alongside one of these complimentary charlatans".

I'm not making anyone out to be an ogre. In my opinion, it's in the best interests of the patient that there is communication between different practitioners. Both systems of medicine have something of benefit to offer and it's about time people realised this, it shouldn't be about choosing one over the other.

Have a nice day

Dr Galen

ok, but what benefits do these other systems of medicine have to offer? I mean real benefits, that we can prove exist?

I totally agree that everyone involved in a patients care should be communicating effectively. IMHO that can be one of the biggest failings of the mainstream medical model. A lot of that though is legacy stuff, a hangover from a different time, and has gotten progressively better.

Whether that line of communication should extend to herbalists et al is a good question. Regardless of ones own personal opinion on the validity of one form of treatment over another. If a patient makes the decision to engage with a alt/comp practitioner, in addition to mainstream medical treatment, then really there should be communication between all parties involved. Mostly, so that any potential interactions or issues could be nipped in the bud. That shouldn't be seen as a validation of any other treatments by the physician etc, but more as acting in the overall interests of the patient.

El_Dangeroso

As a side note, re: acupuncture, how would you double blind an acupuncture trial? People tend to know that they are getting needles stuck in them!

And what placebo would be appropriate? If you use nothing then there's an intervention effect to think about, if you use anything else (for example acupressure) how does that not have a possible effect too?

I ask because my main area of interest would be nutrition, an incredibly young science which also suffers from a lack of ability to properly blind (unless you make everything a processed grey sludge, in which case that isn't really analagous to real food)

lonestargirl

WildBoots wrote: »

Both systems of medicine have something of benefit to offer and it's about time people realised this, it shouldn't be about choosing one over the other.

This is your opinion, nothing more nothing less.

I'll evaluate each treatment on it's own, eivdence based, merits.

SleepDoc is correct also, there are whole areas of medicine where complementary medicine really doesn't have potential applications (aneasthetics, surgery, radiology, pathology to name a few). In my opinion most of its applications lie in the qualitative area of supporting people through treatment for long term illnesses.

opinion guy

lonestargirl wrote: »

SleepDoc is correct also, there are whole areas of medicine where complementary medicine really doesn't have potential applications (aneasthetics,

Funny you should mention that - there was a guy in Naas for years doing surgery under hypnosis instead of anaesthesia. Forgotten his name now but I'm sure someone on here will know it.

Dr Galen

El_Dangeroso wrote: »

As a side note, re: acupuncture, how would you double blind an acupuncture trial? People tend to know that they are getting needles stuck in them!

And what placebo would be appropriate? If you use nothing then there's an intervention effect to think about, if you use anything else (for example acupressure) how does that not have a possible effect too?

I ask because my main area of interest would be nutrition, an incredibly young science which also suffers from a lack of ability to properly blind (unless you make everything a processed grey sludge, in which case that isn't really analagous to real food)

Can't remember the reference now, will try, but in one study I read they were able to successfully blind it by altering the puncture points.

There is a "map" of sorts, used by practitioners of acupuncture, to show them were to stick the needles basically. In the study they subjected one set of people to acupuncture using the map as a guide and basically on the other group, made up where they were sticking the needles. The people involved were none the wiser, as you would expect.


Lots of studies use the "sham" acupuncture to blind, here's an interesting enough one from Germany http://archinte.ama-assn.org/cgi/content/full/archinte;167/17/1892 there are plenty more though

El_Dangeroso

Dr Galen wrote: »

Can't remember the reference now, will try, but in one study I read they were able to successfully blind it by altering the puncture points.

There is a "map" of sorts, used by practitioners of acupuncture, to show them were to stick the needles basically. In the study they subjected one set of people to acupuncture using the map as a guide and basically on the other group, made up where they were sticking the needles. The people involved were none the wiser, as you would expect.


Lots of studies use the "sham" acupuncture to blind, here's an interesting enough one from Germany http://archinte.ama-assn.org/cgi/content/full/archinte;167/17/1892 there are plenty more though

Interesting study indeed, even if they did use 'tongue diagnosis' which has been shown again and again to be no better than a guess. I think the most shocking aspect of that study is that even the sham acupuncture was doubly effective than conventional pharmacological treatment! So sticking needles in people does 'something' for sure.

Still not double-blinded though, the practitioners knew who was getting what. That can make a massive difference to the results. That's the problem with these types of studies.

I actually partook in acupuncture a while back, it didn't do much, so I had less than satisfying results given how expensive it is. I'm still open minded that it might have a role to play in chronic conditions though and I look forward to more research before I'd fully make up my mind.

2Scoops

I'm inwardly amused whenever I hear medics, especially young medics, staunchly defending science when, in my experience, most can't interpret papers correctly, if indeed they even try to keep up with the literature. A pity the practise doesn't follow the passion. :pac:

Dr Galen

i think you have a decent point there 2scoops. Probably one for another thread, but when i look back on my training (nursing) research and the like was put across in an awful way, a way that would switch you off totally to it. Its only in the time since finishing and working in the field that i have regained interest in proper critiquing etc.

2Scoops

Dr Galen wrote: »

...Probably one for another thread...

I'd love to start a brand new thread, but it would only consist of young medics agreeing with me and being thankful that they aren't one of these ghastly scientifically illiterate doctors I'm talking about. :pac:

GradMed

2Scoops wrote: »

I'd love to start a brand new thread, but it would only consist of young medics agreeing with me and being thankful that they aren't one of these ghastly scientifically illiterate doctors I'm talking about. :pac:

You should. It could, if people were willing to help, become a useful resource for those wanting to improve their ability to read scientific papers.

2Scoops

GradMed wrote: »

You should. It could, if people were willing to help, become a useful resource for those wanting to improve their ability to read scientific papers.

There's already an entire board [researcher] for such things...

opinion guy

2Scoops wrote: »

I'm inwardly amused whenever I hear medics, especially young medics, staunchly defending science when, in my experience, most can't interpret papers correctly, if indeed they even try to keep up with the literature. A pity the practise doesn't follow the passion. :pac:

You sir, are a genius.
Whilst it is amusing to hear young medics do so, I find it disturbing when older authorative medics engage in this, as they often do

El_Dangeroso

In my course in college (Health Informatics), they quoted the figure that it would take approximately 10,000 hours of reading to keep up with all the latest medical literature that was released each month.

The biggest challenge in evaluating research in my opinion is stats. I've done three courses to date and I'm still nowhere near good enough to tear apart the methods section like the biostats professor that I work with. But I've personally come across a good few that have very elementary errors (using parametric tests on non-normal distributions for example), how these errors get by peer-review is disturbing.

opinion guy

El_Dangeroso wrote: »

In my course in college (Health Informatics), they quoted the figure that it would take approximately 10,000 hours of reading to keep up with all the latest medical literature that was released each month.

Hence the need for specialiation. However we do lose something when everyone becomes a specialists and generalists are very much needed too.

The biggest challenge in evaluating research in my opinion is stats. I've done three courses to date and I'm still nowhere near good enough to tear apart the methods section like the biostats professor that I work with. But I've personally come across a good few that have very elementary errors (using parametric tests on non-normal distributions for example), how these errors get by peer-review is disturbing.

Eh.....yes and no. I agree with you that often times the wrong stats tests are used (in fact most of the time maybe). But soooooooo many papers are fundamentally compromised even before you get to the stats in my opinion. Just basic design of experiment is lacking. Confounding factors are just ignored if they can't be fit into models etc etc etc.

El_Dangeroso

opinion guy wrote: »

Eh.....yes and no. I agree with you that often times the wrong stats tests are used (in fact most of the time maybe). But soooooooo many papers are fundamentally compromised even before you get to the stats in my opinion. Just basic design of experiment is lacking. Confounding factors are just ignored if they can't be fit into models etc etc etc.

Yeah but as you say those design flaws are easily spotted with a little training IMO.

Having worked along side researchers on clinical trials (in an IT support/data management capacity), most of the principal investigators start out with no idea about how to properly power a study, correct procedures on sample selection, randomisation etc. and a scary amount of them come into the statistician at the end of the study with a big dirty pile of data pleading 'Just give me a p-value so I can submit this for publication!'. Now obviously on large multi-centre pharma trials they have a stats guy on board from the get go but that is a minority of trials I would say (arguably even those studies have funny things going on with the numbers too, but that's a whole other conversation!).

Regarding leaving out confounders, I do have sympathy for scientists in that respect as long as they are making a fair effort to include everything, they were never going to have an exhaustive list. I used to be a lot less forgiving before I saw how much work actually goes into an RCT even before you enroll one patient. It's like herding cats.

My main bugbear is taking observational evidence and using it as anything other than a tool to generate a hypothesis. This is rife in nutrition science, pretty much all of the nutrition guidelines are built on deeply faulty science.

lonestargirl

1) Medical students are not taught statistics properly. When I did my MSc in Galway we shared the medical informatics class with the med students. It was basically a class on how to do things in SPSS. There was a broad outline of different tests and a chart on how to pick the most appropriate one depending on whether your data was nominal, ordinal parametric etc. No real discussion on the interpretation of data.

2) In many hospitals in Ireland there is no real cohesive control or oversight of research that is going on there. I worked in one hospital which I felt had a good system, every study went to both ethics and research management even undergrad projects. The purpose of research management was to look at both the impact on the hospital of the research and to evaluate the project. You would have to justify the proposal and explain what statistical tests etc. you were going to use. These meetings weren't excessive formal and were held very regularly so they didn't really impact on the time-line but they did force you to sit down and think about what you were doing.

3) Research is something doctors must do in order to get SpR and consultant positions. Guess what? The qualities that make a good doctor are not always the ones that make you a good researcher. I used to get doctors coming to me for advice who really didn't have a clue what they were doing and had been sent by their consultant to 'go and look at xyz' - I work in radiation oncology and it's a field that is rife with data mining, all some people were looking for was their name on a paper. Obviously, an ability to interpret papers is a must for any doctor but I don't see why they all should have to participate in research. In their defense, many hospitals don't have to resources to aid and teach those who want to get involved in research. How many hospitals have a dedicated statistician?

Following my MSc in worked in both research and clinical areas in Ireland for a few years and I've just started a PhD project in the US. In my 1st semester I had comprehensive courses on biostatistics and research ethics. My research group has weekly journal club where we read and dissect papers relevant to our area. I have to form a candidacy committee to supervise my PhD project which will include my supervisor, a statistician and 2-3 others. They will meet with me every 3 months to go over my work and discuss my project and future directions. About 2.5 years in I have to do a formal PhD candidacy exam, similar to a viva, defending my proposal and methods and demonstrating provisional results. A lot of my program is geared towards teaching me to become an effective researcher.

El_Dangeroso

lonestargirl wrote: »

Obviously, an ability to interpret papers is a must for any doctor but I don't see why they all should have to participate in research.

I'd thank this 10 times if I could. Pushing otherwise utterly brilliant clinicians into carrying out clinical research just to tick a box to further their career is a big mistake. You'll get the odd doctor who is a good scientist but one definitely does not imply the other.

opinion guy

El_Dangeroso wrote: »

I'd thank this 10 times if I could. Pushing otherwise utterly brilliant clinicians into carrying out clinical research just to tick a box to further their career is a big mistake. You'll get the odd doctor who is a good scientist but one definitely does not imply the other.

Oddly enough its about the one point I disagree with. You can't properly interpret the science unless you've done some yourself. You don't understand the limitations of the work without first hand experience in the lab or in the field

El_Dangeroso

opinion guy wrote: »

Oddly enough its about the one point I disagree with. You can't properly interpret the science unless you've done some yourself. You don't understand the limitations of the work without first hand experience in the lab or in the field

Possibly, if your talking about small scale trials or audits, but most research funding requires a clinician as PI, when it's an entirely skill-set that leads to a good study. Might be good for the clinician, but not really good for stemming the tide of flawed science.

I'd disagree that you can never properly evaluate a paper unless you've contributed one of your own. I know I used to far more harshly judge a paper before I ever knew the details of how one was produced.

Dr Galen

could we maybe hive this off into a new thread? veering well OT now but the discussion is good all the same!

El_Dangeroso

Dr Galen wrote: »

could we maybe hive this off into a new thread? veering well OT now but the discussion is good all the same!

Oops, sorry, please do!