annaj

As a medical doctor, having not seen and assessed him myself, I would be unable to make a diagnosis, so I'd advise he see his GP. Nothing that I've said on here has been directly related to Narnia's son and nothing I have said on here implies that anyone should rely on TCM as an alternative to western medicine. All I've said it that I don't think it should be dismissed as "utter nonsense" because it may have some use and validity. No, I don't. Not that it's any of your business or relevant. Please don't imply that I'm trying to patronise you. At no point have I said or implied that you don't or can't understand me, just that you seem to be choosing not to.

Oh, come on, Belle. This sounds a lot like dismissing to me and not much like criticising the industry or calling for regulation. Chinese medicine is harmful at worst, and I have said several times that there needs to be more regulation, but it's a lot more than placebo at best.

Well, thanks for the metaphorical pat on the head, taper, but you've missed the point. If a new treatment for malaria, one of the world's biggest killers and increasingly resistant to exisiting drugs, can be dervied form a herbal remedy, that's a bit more than complementary, don't you think? Am I really the only person that sees a middle ground between "it's all woo" and "it's all true and miraculous"?

Ok, David, I'm going to have one last go at trying to get you to understand what I've been saying all along, because the malaria drug is a perfect example. Ok, so, artemisia annua has been used in chinese medicine, sucessfully, for some time to treat malaria. Western scientists thought "well, now, that's interesting" and researched the herb to find the active ingredient and investigate its potential use. So, yes, western science, but science that wouldn't have happened if those scientists had dismissed all traditional herbal medicine as woo and not bothered to research it. Just to spell it out: I am completely pro-vaccination and have never advocated alternative medicine over vaccination, as well you know. I have never suggested unregulated herbalists should be allowed to give what they want to who they want or make claims they can't substatiate. I have never supported reiki, homeopathy or any other nonsense based on nothing. What I have said, and still say, is that chinese herbal remedies contain active ingredients and have a history of sucessful use that shouldn't be dismissed entirely.

Sorry, just to add, LM, I hadn't seen your post when I posted that, so I realise it must look like I was ignoring a very personal post. I'm really sorry for your loss, suicide is a dreadful thing to have experienced.

Sean, yes, really. Am I not expressing myself well? Because you seem to be completely misunderstanding me. Homeopathy is woo based on nothing. Water doesn't have memory and homeopathic remedies have no active ingredients. Chinese herbal medicines do have active ingredients. Chinese herbal medicine is not evidence-based, but neither is a huge amounts of western medicine. EBM is a new concept and treatments that were standard and proven, by years of experience to work (like n-acetylcycsteine for paracetamol overdose based on a small case series, over 30 years ago) have not been re-tested, because it's difficult to design an ethical trial of something that we know works from experience. Western medicine is also not pure science, even the evidence-based parts. Placebo is there all the time in medicine and we are all susceptible to it, even you, Sean. Bright coloured pills work better. My patients feel better if I'm nice to them while I'm treating them. Placebo effect is also not just about belief or philosphical interest, it has real, important, practical implications. How can we hope to understand or treat conversion or pyschosomatic disorders without understand it better? Don't forget, Goldacre devotees, what his chosen specialty is. As for TCM practioners and advocates not being interested in scientific research, in my experience, and this is something I've looked at both professionally and personally, that's not true and that, as I said in my first post, is the other thing that sets it apart. Maybe not "vast" amounts, but there is work being done to design trials that overcome the inherant difficulties in studying an intervention like acupuncture and there has been at least one RCT published in the Lancet. I think I'm going to bow out though, because with you, antijen and Karter all seemingly misinterpreting me (antijen, sorry nothing personal, but just because I think there might be some merit in investigating TCM, doesn't put us at all on the same side) and D_C ignoring me I think it's rapidly going to become the kind of discussion that's just not worth it.

Don't get excited, Karter, I'm not turning pro-woo. I'm saying if the point of science is to understand our world better, we really can't ignore something as huge and powerful and exciting as our ability to make something work, because we believe it will.

Sean, no, to say the placebo effect is powerful is not at all the same thing as saying ignorance is bliss. It's recognising that, actually, we know very little about the relationship between mind and body and maybe trying to learn more. You know, what with science being about expanding our knowledge an' all.

Umm, Sue may not be, but I am (although the minimun training is five years, not seven, but I have six plus eleven years experience and two post-graduate diplomas, if we're counting) and you seem to have ignored everything I've said. You should, perhaps, read Ben Goldacre's chapter on the tendancy to asign more value to evidence that supports your view and dismissing that which does not. Unregulated and variable teaching and practice is obviously wrong, but that is an argument for better regulation, not for throwing the baby out with the bathwater. And of course I completely agree that teaching that herbs and acupuncture can treat cancer is irresponsible and unethical. But elsewhere in his writing Goldacre also expresses his interest, as a scientist, in further trials of acupuncture and exploring the relationship with placebo. And, yes, there are some herbs that cause renal failure, all of which are banned in the UK. There are also conventional medicines with catastrophic side-effects, such as the highly teratogenic roacutane used for acne, the use of which is tightly controlled. So, again it's question of regulation. I'm not saying it works, I don't know if it does or not, I'm saying as a scientist and a doctor I see enough evidence to think there may be value in it and not dismiss it entirely as woo.

TCM and acupuncture are set apart from other forms of alternative or complementary therapy (or woo) by several things, most of which have been touched upon. First, there is the history. Of course something is not valid just because it's old, but a consistent history of sucessfully treating certain conditions with certain remedies is a type of evidence base. It's not as compelling as a series of well-designed randomised controlled trials, but it has some validity. Second, there is the training. In China, TCM and acupuncture are taught and practiced in major teaching hosptials alongside western medicine. Trainees in TCM study with undergraduates in western medicine at least for the firts few years of their training. So, properly trained and accredited practitioners have far more physiological and anatomical knowledge than, say, a reiki master or homeopath and many are dual qualified. Third, there is a widespread willingness to engage in clinical trials and try to understand the relationship between genuine treatment effect and placebo and TCM and acupuncture practitions tend acknowledge that the way the treatment is conducted is important. There have not, yet, been any definitively positive trials, but there have been some with promising and interesting results. Acupuncture is difficult to test through blinded RCTs, because of it's nature, but the same applies to any number of conventional interventions, testing nebulised drugs against inhaled, for example. Fourth, unlike homeopathy, there are, without doubt, active ingredients in Chinese herbal remedies and many of them are common to Western medicines. TCM has a whole different philosiphy to Western medicine. Instead of focusing on the illness and treating it, TCM looks at the whole system and looks for weaknesses in the system that allow the illness to thrive. The principle is that the doctors job is to keep the body healthy in order to prevent illness, rather than treat illness when it occurs. It's an interesting approach and not without merits. The more we learn about diseases, the more we realise that there occurance and severity is often governed by more than one factor, including the general health of the subject and their lifestyle. I am a firm believer in the value of evidence based medicine, I practice and teach it daily, but I am also aware of it's limits. Passionate advocates of EBM, who state they only believe in research based methods, should be aware of how much western medicine is not evidence based (or is based on so called low-ranking evidence like expert consensus or established practice, which on the hierachy of evidence ranks well below RCTs) because EBM is new and many of our treatments are not. One thing that does have a very good evidence base, Sean, is paracetamol for fever ;-)

This thread title is crying out for a smutty joke..... I just can't quite think of it.....

But you wouldn't know until you got back if they'd cut your hostages ear off...

Smiler, that's so sad, I'm really sorry you didn't enjoy your day. I had a biggish white wedding and loved every minute; it really was one of the happiest days of my life. I enjoyed the planning and the build-up, there were stressful moments, obviously, but for the most part I loved it and missed it when it was over and I love looking back at the pictures. So, obviously, I don't think that big weddings have to be stressful and awful, but I think you either are a big wedding person or you're not. If the very thought of a big wedding leaves you cold, it's probably not for you, so don't do it. As everyone else has said, do whatever feels like the right thing for the two of you. In the end all that matters is that you start the day not married and end the day married to the man you love, whether that's in front of 2 witnesses or everyone you know, or anything in between, is up to you. Good luck.

Huguenot, I stand corrected, humbled and thoroughly ashamed of my foolish suggestion that St Thomas' referred to two saints. I am clearly out of my depth, so I'm going to go back to giggling at katie1997's and SimonM's posts (or should that be katie1997 and SimonMs'? Or katie1997 and SimonM's?) about cheeses.

It's not censorship, Moflo,just keeping the place tidy. You said yourself the moderators would decide and they have. No-one is trying to supress debate on this topic. You can post all you want on this thread, but there's no need to fill the whole page with the same thing. I'm not sure how I feel about the strike, but I saw a group of men trying to obstruct and heckling a fire engine trying to get up Crystal Palace Road, with its blue lights on, earlier and what I am sure of is that, whichever side of the divide you're on, trying to stop a fire engine on the way to a call is irresponsible.

Katie 1997, in answer to Mockney Pier asking if anyone else was annoyed by the use of "cheeses" as the pleural...

Moflo, there are two other threads already going about the strike, there was no need to start a new one. I understand how important it is to the people involved, but this is a community forum for everyone to use and it shouldn't be dominated by one issue or group.

I agree with Rosie that both s' and s's can be correct and would probably go for Charles's Garden, because I would say Charleses. I believe, although can't remember who told me, that St Thomas' has the apostrophe after the s, because it's named after more than one St Thomas.

But Mockney, why would you bring up Snorky when Narnia was talking about huncamunca? Huncamunca is not Snorky. He's been very clear about that. Nope. Definitely not. No similarities at all.

Natch.

Only by a few days, Moos. Quids was really chippy and stroppy at first, but we made him love us (and admit he's middle-class) in the end. ;-)

It's true that one of the pelicans in St James's park doesn't live there, but just visits, I remember my dad telling me years ago (and, obviously, everything my dad says is true). But if "my dad says so" is not evidence enough I've seen it take off from the lake and fly away myself, so, gwod, you daughter may well have spotted a flying pelican...

One of the several ways in which I'm like Monica Geller, the Friends character, is that I can't stand animals dressed as humans. I know plenty people on here think I'm without a sense of humour anyway, so I've nothing to lose by saying, Waynetta, I see nothing funny in a series of pictures of miserable looking, and probably mistreated, animals dressed up for childish entertainment.

I'm in. Should be able to get there for 6.30....

Yes, I think 12th November works for me and The Phoenix sounds good.