The Wrongness of Dr Sarah Myhill

August 5, 2011 at 8:28 pm (Anti-Vaccination) (, , , , , )

Last year, I wrote about some of Sarah Myhill’s incorrect assertions regarding vaccination. Since then, Dr Myhill has substantially amended her website, removing many of the factually incorrect statements. However, some still remain.

It’s odd that Dr Myhill hasn’t taken the time to remove all the dubious statements regarding vaccination, given that the GMC’s Interim Orders Panel considered Dr Myhill’s case (along with others) in March this year. On page four of this PDF, point 8 of the determination states that:

You must continue to ensure in relation to your website, or any website relating to your medical practice, that there are no pages, downloadable content, including documents, forum or discussion board content, or other references or online media relating to the following subjects:

There follows a list of topics that should not be referred to on Dr Myhill’s website or any site referring to her medical practice. Here’s the one that caught my eye:

f. Any immunisation or vaccination.

It seems that Dr Myhill has failed to ensure that there are no references to “any immunisation or vaccination” on her website: Swine Flu: what about a vaccine. The page states that: “Vaccinations are always a two edged sword – they have the ability to switch on the immune system. Ideally, of course, this should be against the virus, but vaccinations can certainly switch on chronic fatigue syndromes, probably allergies and possibly autoimmunity. “

The page on autoimmune diseases has this: “Vaccinations all contain immune adjuvants (without which they do not work!) such as mercury (thiomersal,) aluminium, squalene (a toxic lipid) or whatever. These have the potential to switch on the immune system to trigger allergies and/or autoimmunity. My personal view is that the evidence for benefit of the annual flu vaccination is probably out-weighted by potential damage so I no longer recommend this for my patients. Instead I direct them to Viral infections – good nutrition is highly protective against viral infection.”

Thiomersal is not an adjuvant, it’s a preservative. Squalene (a favourite bugbear of the anti-vaccinationists and said by Dr Myhill to be “a toxic lipid”) is a naturally occurring substance found in plants, animals and humans – and is also found in a variety of foods, cosmetics, over-the-counter medications and health supplements. The evidence suggests that the squalene contained in vaccines poses no risk. Myhill claims that ingredients used in some vaccines may trigger allergies or autoimmunity, and offers her personal opinion that the risks of flu vaccination outweigh the benefits. Here is a paper on the real and presumed side effects of vaccination:

During recent years a scala of diseases or symptoms have been associated with vaccination (presumed side effects). Careful and extensive investigations have shown that such hypotheses could not be supported. Examples are allergic diseases as asthma, diabetes mellitus, multiple sclerosis (after hepatitis B vaccination), autism and inflammatory bowel disease (after MMR vaccination) and sudden infant death syndrome. The total number of cases where at least a possible relation between side effects and vaccination is observed–apart from local reactions and moderate general symptoms–is very rare (about 0.25 per 1000 vaccinations) and does not balance the benefits from vaccination.

There are more references to vaccination on Myhill’s site here, here, and here. Dr Myhill consistently claims that vaccination is linked to CFS (chronic fatigue syndrome), talking of vaccines “switching on chronic fatigue syndrome” and “triggering flares of CFS”. I’m always willing to be proved wrong, but I don’t think there is reliable evidence of an association between vaccination and CFS.

Appel, Chapman and Shoenfeld seem to think it is at least plausible that vaccination could be linked to CFS and call for further research, but state that: “Little is known about this issue. There are some reports on CFS occurring after vaccination, but few prospective and retrospective studies failed to find such an association” and point out that a working group of the Canadian Laboratory Center for Disease Control (LCDC) that was founded in order to examine the suspected association between CFS and vaccinations concluded that there is no evidence that relates CFS to vaccination.

A Norwegian study found “no statistically significant association between vaccination against meningococcal disease in teenagers and occurrence of CFS/ME”, and a double-blind, randomized study of the effects of influenza vaccination on the specific antibody response and clinical course of patients with chronic fatigue syndrome found that “no difference could be detected between immunized and placebo CFS patients in immunization side effects”.

There are two issues here: firstly, the GMC appear to have been insufficiently diligent in ensuring that Dr Myhill’s website is in compliance with their conditions; secondly, the references to vaccination on Myhill’s site contain statements that are unsupported by evidence, misleading, or untrue.

Update, 18th August

A comment below asks “So what if patients read her site and decide not to get a flu jab? So they get the flu? I’m not sure why you believe you should be in charge of that. ” It’s worth remembering that the complications include pneumonia, Reye syndrome, myocarditis, and death (0.5-1 per thousand cases). [PDF] For swine flu in 2009, the mortality rate was found to be lower – 26 per 100,000 (0.26 per thousand cases). Link. Graph of mortality per 100,000 of population from the Public Health Agency of Canada:

flu deaths graph

Update, 22 June 2012

Dr Myhill has apparently threatened to sue one of the people who has reported her to the GMC. See here and here for more.

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306 Comments

  1. Andysnat said,

    We have common ground with Myhill. We agree that the GMC didn’t do a very good job in handling her case.

    Just the FTP hearing left.

  2. Paul said,

    If Dr. Myhill is continuing to make her claims regarding vaccination in spite of the evidence that shows her to be wrong and in spite of GMC instructions to remove these claims, then she should be referred back to the GMC. Serious consideration should be given to suspension or erasure from the Medical Register.

  3. jdc325 said,

    I should point out that, in spite of Dr Myhill’s failure to comply fully with the conditions imposed, the Interim Order was revoked last month. From Dr Myhill’s website:
    “On 26th July 2011 I attended a review hearing in front of the Interim Orders Panel at the GMC in Manchester. As a result of the hearing the Panel decided that the Interim Order, imposed on my registration with the GMC in April 2010, was not necessary. The Panel’s decision revoked the Interim Order.”

    As the GMC don’t seem to be that bothered about the statements on Dr Myhill’s website, I’m not sure it’s actually worth complaining to them. Myhill does write that “I am happy to amend entries given good reason” so perhaps I would be better contacting her rather than the GMC.

  4. jdc325 said,

    I sent an email.

    [/Moss]

  5. KAL said,

    There a few key issues you have skimmed over here:

    It is quite possible that myalgic encephalomyelitis/chronic fatigue syndrome are discrete entities grouped together for the sake of convenience. While they may have core symptoms in common they may have very different etiologies and treatments – just as with arthritis.

    So attenuated vaccinations, which are not recommended for people with immune system abnormalities and many of which are found in people with ME/CFS (Brenu et al 2011, Fletcher et al 2009, Klimas et al 2007 and many more), may cause complications in some cases, but not others. Statistically it is problematic when you have one pie with multiple slices and can lead to incorrect conclusions if these confounding variables are ignored.

    Secondly, although there are potential biomarkers on the horizon for ME/CFS (Schutzer et al 2011) at the present time there are multiple, occasionally mutually exclusive definitions in use. (Sharpe et al 1991, Fukuda et al 1994, Carruthers et al 2003, Reeves et al 2006, Carruthers et al 2011). Many of the definitions are so broad and lacking in specificity and severity of symptoms that anyone and their cousin could be diagnosed with ME/CFS. The problem with mixing people who do not have a disease with patients that do are obvious.

    Without biomarkers, standardized reporting of definitions used, cleaner data sets and subgrouping it is nearly impossible to say one way or the other when you use an umbrella term like CFS.

  6. jdc325 said,

    Thanks KAL.

    “Without biomarkers, standardized reporting of definitions used, cleaner data sets and subgrouping it is nearly impossible to say one way or the other when you use an umbrella term like CFS.”
    If it’s “nearly impossible to say one way or the other”, then it is my view that Dr Myhill should not be asserting on her website that vaccines “switch on chronic fatigue syndrome” and “trigger flares of CFS”.

  7. colmcq said,

    “The evidence suggests that the squalene contained in vaccines poses no risk”

    No: the evidence *clearly indicates* that the squalene contained in vaccines poses no risk.

    You should be more forthright when criticising this kind of dangerous nonsense. Pull no punches JDC!

    col

  8. KAL said,

    @jdc325 If clinicians and researchers waited until there was definitive proof never to change based on new technology, new research, new knowledge nothing would ever be written or said would it now? You and I would be able to play golf every day instead of writing.

    The hypothesis is reasonable based on the issues I outlined. But I too would like to more research using a very narrow definition looking at many of the variables that have not been researched.

  9. jdc325 said,

    “If clinicians and researchers waited until there was definitive proof never to change…”
    But Dr Myhill isn’t even waiting until there is some reliable evidence to support her hunch – as yet there is no research that has found a link between CFS and vaccination. Nobody is suggesting that we wait for “definitive proof” before changing behaviour.

    What I’m suggesting is that, in light of the known efficacy and safety of vaccination and the known dangers of the infectious diseases that immunisation protects us from, it would be unwise to make any recommendation not to immunise – and it would be unwise to report a hunch regarding vaccination and CFS as if it were fact (let’s not forget – it is Dr Myhill who has claimed certainty on this point) without having any evidence to support this hunch.

    I wouldn’t criticise Dr Myhill for calling for further research into the question of whether vaccines might be linked to CFS. I do, though, think it fair to criticise her for making unsupported assertions on her website. Which is exactly what she has done.

    I also think it’s fair to criticise her mischaracterisation of squalene, as well as her unsupported claims that vaccinations may cause allergies and autoimmune disease and that the benefit of the annual flu vaccination “is probably out-weighted by potential damage”.

    I’m not sure whether Dr Myhill should be criticised for failing to adhere to the conditions of the GMC, given that they have failed to ensure compliance and have now even dropped the conditions they set. I think on this point, I’d be inclined to blame the GMC. I’m still puzzled as to why they revoked the interim order when it was quite clear that she had not complied with the conditions of the order.

  10. George said,

    From Myhill camp:

    VERY IMPORTANT NEWS — GMC CAVES IN AGAIN!! The GMC has dropped the scheduled FtP Hearing against Dr Sarah Myhill with no case to answer.

  11. jdc325 said,

    Thanks for the update George.

    An odd decision, but not entirely unexpected given the decision to revoke the interim order.

  12. jdc325 said,

    Having contacted Dr Myhill regarding my concerns over her website content (since posting the above) and having received an unsatisfactory reply, I have now contacted the GMC.

  13. Andysnat said,

    Well done James.

  14. KAL said,

    James – Not sure how to say this without offending, but who died and appointed you Dr. Myhill’s keeper?

    Do you have any actual objective evidence that she has specifically harmed or killed someone? Disagreeing with someone is one thing, but targeting anyone, whether it be Dr. Wessely or Dr. Myhill, because you disagree with their point of view is a little over the top.

    So what if patients read her site and decide not to get a flu jab? So they get the flu? I’m not sure why you believe you should be in charge of that.

    What is your investment in this? Why are you targeting this doctor? Are you targeting all doctors who do something you disagree with or just this one?

    If you don’t have enough to do you should probably also report every country doctor who prescribes antibiotics for a viral infection. That would keep you beyond busy as well.

    Strange.

  15. jdc325 said,

    @KAL – I’m not sure if you’ve read any of the 380+ posts on this blog criticising people other than Dr Sarah Myhill, but perhaps you could tell me why she should be exempt from criticism despite making incorrect assertions regarding medical matters?

    “Do you have any actual objective evidence that she has specifically harmed or killed someone?”
    No – and I don’t need such evidence in order to object to the wrongness on her website.

    “Disagreeing with someone is one thing, but targeting anyone, whether it be Dr. Wessely or Dr. Myhill, because you disagree with their point of view is a little over the top.”
    I’m not sure that a single email to the GMC about a doctor who has published misinformation and speculation about vaccination on their website should be characterised as “targeting”. Perhaps it is “a little over the top”, but my correspondence with Dr Myhill proved fruitless and my options appeared to be (a) do nothing or (b) write to the GMC.

    “So what if patients read her site and decide not to get a flu jab? So they get the flu? I’m not sure why you believe you should be in charge of that.”
    I don’t think I should be “in charge of that” – I think it’s reasonable to expect the written output of doctors (on their own website) to be evidence-based, I think it’s reasonable to expect doctors to comply with conditions set by the GMC, and I think it’s reasonable to expect the GMC to actually ensure that doctors do comply with those conditions. And you seem to be rather casual in your dismissal of flu – the complications include pneumonia, Reye syndrome, myocarditis, and death (0.5-1 per thousand cases).

    “What is your investment in this? Why are you targeting this doctor?”
    She’s wrong on the internet.

    “Are you targeting all doctors who do something you disagree with or just this one?”
    Well, I’ve also written about Dr Richard Halvorsen, Dr Andrew Wakefield, and I’m in the middle of writing a post about an American doctor. How many doctors do you want me to complain about?

    “…you should probably also report every country doctor who prescribes antibiotics for a viral infection”
    Oh. Well, I’m going to find that rather difficult to do. Unless they advertise their bad practice on their own website and make it easy for me…

  16. jdc325 said,

    Forgot a link: http://www.cdc.gov/vaccines/pubs/pinkbook/downloads/flu.pdf (source for complications of flu).

  17. Hammerdoc said,

    KAL,

    What if someone with lung cancer read her site and decided not to seek treatment as a result? Are you OK with that?

    How about her advice on how to put babies to sleep? Are you happy with her advising parents to increase the risk of cot death?

    Her advice on vaccinations is wrong, but her advice on so much else is wrong as well.

    Do you believe that a 12 week old foetus is fully formed, with all the cells it will need for the rest of its’ life? Dr. Myhill does.

    Believe me, the disagreement isn’t about “points of view”, it’s about established facts – facts that a doctor should be expected to know.

    Frankly, the GMC’s decisions have left me deeply suspicious of doctors in general. After all, if someone as clearly deluded as Dr. Myhill is allowed to continue practicing her warped view of “medicine”, how many others are out there?

  18. Hammerdoc said,

    Oh, and let’s not forget that she flogs grossly overpriced, completely unnecessary nutritional supplements – one of the first warning signs of impending quackery…

    http://www.drmyhill.co.uk/wiki/Nutritional_Supplements_-_what_everybody_should_be_taking_all_the_time_even_if_nothing_is_wrong

  19. Neuroskeptic said,

    “So what if patients read her site and decide not to get a flu jab? So they get the flu? I’m not sure why you believe you should be in charge of that.”

    The thing about infectious diseases is they spread. If you choose not to get vaccinated, I might get sick.

    People have a right to deal with their bad back or their ingrowing toenails however they want. That’s their problem. They would be foolish to follow bad medical advice, but that’s not my concern. But as soon as you’re talking about infectious disease, it is my concern.

  20. colmcq said,

    the problem, KAL, was not the manner with which she dealt with her patients, which i have no doubt was very compassionate; it was the information she gave on her website which could have serious implications if followed

  21. jdc325 said,

    Thanks Hammerdoc.

    On supplements:

    It has become increasingly apparent that the long established Recommended Daily Amounts (RDAs) of nutritional supplements are now out-dated. Either the levels have been incorrectly set, or they do not represent levels for optimum health, or they do not permit the necessary latitude for individual biochemical differences or disease states. Increasingly, they are not relevant to people leading modern Western lifestyles and eating Western diets. It is time for a new set of RDAs. [Sarah Myhill]

    The term [RDA] recognises that particular groups of individuals (E.g. infants and those over 60) have different needs and for each group, the intention was to be sufficiently generous to encompass the presumed (but unmeasured) variability in requirement among people. This meant that the value was usually set deliberately high. [Derek Shrimpton]

    I have some other thoughts on food supplements that I’d like to share with you at some point Hammerdoc.

  22. jdc325 said,

    @Neuroskeptic

    Absolutely – when people are uninformed or ill-informed, their poor decisions regarding vaccination negatively affect other people as well as themselves.

    @colmcq

    Yep – I restricted myself to commenting on the advice regarding vaccination, but as Hammerdoc points out there was other potentially dangerous advice on the website.

  23. Hammerdoc said,

    @jdc:

    Scroll down toward the bottom of the page I linked to above.”Myhill’s Magic Minerals” and “Prices of Nutritonal Supplements” certainly seem to suggest she’s flogging supplements, and the rest of the page is basically saying that everyone should be taking them.

    Oh, and I’d like to hear your thoughts on supplements…

  24. jdc325 said,

    I wrote to Dr Myhill regarding my concerns and received a response in which she (a) indicated that she was not inclined to amend her website at this time and (b) referred to Barbara Loe Fisher as an authority on vaccinations. Given the response from Myhill and the fact that the website still contained statements regarding vaccination that were incorrect (and breached the conditions set by the GMC), I decided it would be reasonable to contact the GMC to let them know of my concerns. I have also been considering other ways in which I could attempt to reduce the amount of wrongness on Dr Myhill’s site.

    If there are any further developments, I will update my post on Dr Myhill.

  25. Brendan Brady said,

    Armchair skepticism is much the same as armchair football management: a lot of big opinions with little firsthand experience, unfortunately.

    Ever read: Why Most Published Research Findings Are False?

    http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0020124

    There are also many factors outside scientific rigour determining establishment position – in many countries with a far better standard of healthcare than ours, the thought of injecting or putting mercury in the mouth is seen as beyond crazy. And there are also many chronic conditions which require the intuition and human touch of a devoted doctor rather than a few studies which recommend the blanket prescription of a drug. (Which is many specialists in this country.)

    From what I’ve seen, Myhill is a pragmatist. I’m sure she’s wrong about dozens of things – just as any doctor is and just as many of our establishment positions get proven to be.

    But she seems to be advocating restoring health and seeing what works, rather than fighting any kind of ideological battle. In my opinion, she’s what medicine needs more of these days.

  26. mrsP said,

    Just wanted to question the 0.5-1 per thousand cases of complications after ‘flu. These are deaths aren’t they and in the US? I would have thought in the vulnerable – elderly, chronic sick, kids, the figures for complications- mainly chest infections – would be much higher. Beds are certainly at a premium for medical cases in the winter and occasionally surgery has to be cancelled. These patients may not die, but cause distress and cost a lot of money in care.

    Do not know where to find figures, and deciding whether a person actually has had flu or a simple URTI resulting in a chest infection would be difficult.

    Anyway flu jabs seem to be a good idea, evidenced, and recommended by the WHO and our own dear under threat NHS.

    Good read – thanks,

    Dot

  27. jdc325 said,

    @mrsP

    Yes, you’re right. That figure of 0.5-1 per thousand cases of flu refers specifically to deaths, and not to all complications.

    I probably should have included the rates of other complications to make the sentence less ambiguous. Or just phrased it differently. The PDF I linked to in my following comment is from the CDC’s Pink Book and this is where I got the information from (page 154 / page 4 of 22). I don’t think it gives the rates of other complications but here’s what it does say:

    The most frequent complication of influenza is pneumonia, most commonly secondary bacterial pneumonia (e.g., Streptococcus pneumoniae, Haemophilus influenzae, or Staphylococcus aureus). Primary influenza viral pneumonia is an uncommon complication with a high fatality rate. Reye syndrome is a complication that occurs almost exclusively in children taking aspirin, primarily in association with influenza B (or varicella zoster), and presents with severe vomiting and confusion, which may progress to coma due to
    swelling of the brain. Other complications include myocarditis (inflammation of
    the heart) and worsening of chronic bronchitis and other chronic pulmonary diseases. Death is reported in 0.5–1 per 1,000 cases. The majority of deaths occur among persons 65 years of age and older.

  28. jdc325 said,

    @Brendan Brady:
    “Ever read: Why Most Published Research Findings Are False?
    http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0020124

    Yes, I have. I’m not sure which research findings you think this paper is relevant to though – perhaps you could point to the research I cited in my post that you think may be false? While you’re at it, perhaps you could also point out to me which of the corollaries in the article you linked to apply to this research? (Small sample size, small effect size, etc.)

    There are also many factors outside scientific rigour determining establishment position – in many countries with a far better standard of healthcare than ours, the thought of injecting or putting mercury in the mouth is seen as beyond crazy.

    Which countries have a far better standard of healthcare than ours? (Please name them, and cite reliable evidence to support your claim that their healthcare provision is in fact better than ours.)
    Please explain why you think that the fact that the use of mercury-containing or mercury-releasing compounds is thought by some to be “crazy” is relevant – surely the evidence of the safety and efficacy of the use of these compounds is more important than what people “think”?

    And there are also many chronic conditions which require the intuition and human touch of a devoted doctor rather than a few studies which recommend the blanket prescription of a drug. (Which is many specialists in this country.)

    I’m in no way opposed to intuition and human touch – but these should be complementary to evidence-based treatments, not alternatives. Please cite evidence for your claim that “many specialists in this country” recommend the blanket prescription of a drug. Please cite evidence for your implied claim that “many specialists in this country” lack intuition and the human touch.

    From what I’ve seen, Myhill is a pragmatist. I’m sure she’s wrong about dozens of things – just as any doctor is and just as many of our establishment positions get proven to be.

    But she seems to be advocating restoring health and seeing what works, rather than fighting any kind of ideological battle. In my opinion, she’s what medicine needs more of these days.

    I’m sure she’s wrong about vaccination. The GMC seemed to be sure of the same thing (although they apparently didn’t have the will to enforce their condition that Dr Myhill refrain from discussing vaccination on her website). I’m not sure what’s pragmatic about taking advice from Barbara Loe Fisher and Richard Halvorsen, who are in no way experts on vaccination. I’m not sure what’s pragmatic about ignoring the peer-reviewed, published, replicated evidence regarding vaccination in favour of unreliable anecdotes. I’m not sure what is pragmatic about being obviously and demonstrably wrong about thiomersal and squalene. I’m not sure what’s pragmatic about publishing statements regarding vaccination that are unsupported by evidence, misleading, or untrue in defiance of one’s regulatory body.

    Are you sure that Dr Myhill is a pragmatist?

  29. jdc325 said,

  30. Brendan Brady said,

    Well I’d list Sweden as a shining example. Amongst the highest cancer survival rates in the world, along with some of the lowest rates of hospital-acquired infections. (While the UK is among the worst in Europe in both.) They put a blanket ban on mercury years ago.

    The reason it’s seen as crazy is because mercury is known to be highly toxic and difficult to excrete. We’ve ample evidence of the effects of acute exposure. Chronic exposure is extremely difficult to quantify because we can’t deliberately expose people to mercury over years/decades, and we can’t reliably control environmental exposure. Add to that an individual’s sensitivity to mercury, and their ability to detoxify it, along with any number of contributory factors, and you probably have too many uncontrollable factors to derive meaningful results.

    PMID: 17436982 shows a very slight correlation between the number of amalgams one has and the likelihood of developing MS, but again, with so many uncontrollable environmental and genetic (potential) factors, whatever influence may or may not be there may be virtually obscured by noise. Perhaps in a generation’s time, we’ll be able to look at countries like Sweden and look at the incidence of certain conditions.

    So being able to say “lack of any scientific evidence”, can be misleading. You only have to look at the sheer volume of conflicting studies trying to find a link between cannabis use and schizophrenia. It can be difficult to demonstrate cause and effect outside controlled conditions – the design of the experiment largely determines the result. Look at SSRIs vs placebo.

    Flu statistics can also be extremely sketchy. It’s the whim of the doctor whether a flu complication is recorded as a flu complication or a complication of an underlying condition. As you know with league tables, an asthma or cardiac complication might be more desirable on paper than a flu complication.

    From what I’ve seen, there also seems to be a mass underreporting of statin-induced myopathies. I suppose what I’d say is, in an industry like medicine, good science can be extremely difficult for a multitude of reasons. There’s no replacing a good doctor’s intuition – at present.

    And yes, from what I’ve seen, I’d call Myhill a pragmatist. She only seems interested in what works. She’s specialising in a condition which lacks the interest from major pharmaceuticals (at present) to fund any useful/relevant research for patients.

  31. jdc325 said,

    Here are the points I made and my thoughts on your response to them:

    “I’m not sure which research findings you think this paper is relevant to though – perhaps you could point to the research I cited in my post that you think may be false? While you’re at it, perhaps you could also point out to me which of the corollaries in the article you linked to apply to this research? (Small sample size, small effect size, etc.)”
    Your response to this seems to be missing from your comment.

    “Which countries have a far better standard of healthcare than ours? (Please name them, and cite reliable evidence to support your claim that their healthcare provision is in fact better than ours.)” You’ve named one country and provided no evidence.

    “Please explain why you think that the fact that the use of mercury-containing or mercury-releasing compounds is thought by some to be “crazy” is relevant – surely the evidence of the safety and efficacy of the use of these compounds is more important than what people “think”?”
    Which mercury compounds? In what dose?

  32. jdc325 said,

    “Flu statistics can also be extremely sketchy. It’s the whim of the doctor whether a flu complication is recorded as a flu complication or a complication of an underlying condition. As you know with league tables, an asthma or cardiac complication might be more desirable on paper than a flu complication.”

    Citation needed.

  33. jdc325 said,

    “From what I’ve seen, there also seems to be a mass underreporting of statin-induced myopathies.”
    Well, from what I’ve seen there is no mass underreporting of statin-induced myopathies. Perhaps you’d like to break this impasse by providing some evidence?

  34. jdc325 said,

    “And yes, from what I’ve seen, I’d call Myhill a pragmatist. She only seems interested in what works.”
    Really? And how does Myhill know what works? Gut instinct? Asking a like-minded friend? Taking a dispassionate look at the best available evidence?

  35. deetee said,

    Brendan, what’s mercury got to do with cancer survival rates and hospital acquired infections?

    Next no doubt you’ll be linking the fact that a country has low autism rates with their hospital hand-washing policies.

  36. bs123 said,

    To all those who criticise Sarah Myhill, I will guarantee that if you ever catch ME/CFS you will eventually end up on her doorstep, because most other doctors are completely and utterly useless. Patient testimony is far more important that bigoted opinion and it is virtually unanimous that her approach works better than any

    I followed her cases at the GMC and the transcripts showed up the committee as a bunch of small minded ignoramuses, which so typify every committee I have ever sat on.

    As for vaccination, there are a huge number of concerned voices worldwide, including a great number of doctors. However, any publicly dissenting voices are jumped upon by ‘Big Pharma’, who stifle any debate on the subject because of the billions they make in profits.

  37. Dorothy Paterson said,

    You obviously have not read much of this blog. No one has said Dr Myhill is not kind and caring to her patients.

    The issue is mainly her web site. The fact is that some of it is wrong, some out of date and some comments frankly dangerous. JDC has explained well why her recommendations on flu vaccinations are not good and contrary for example to not only our own NHS but also the World Health Organisation’s policies. Nothing to do with “Big Pharma”.

    Some incorrect pages have been taken down, but some remain. If you have lung cancer it seems you need an MRI scan – not true (X Ray, CT scan and lung biopsy diagnoses lung cancer). It seems if they find a tumour on x ray it is too late. Not true. Admittedly survival rates are not good for lung cancer but some do survive.

    Regarding Big Pharma – I think Dr Myhill too makes some money from selling her magic minerals and other supplements. Actually nothing wrong with doctors or anyone else making money, as it is how you make it that matters. The drugs have to be necessary and with side effects explained if any. Drug Companies have to make money in order to provide drugs we need, to survive in some cases and to live painfree lives in others, and they need money to do further research.

    It is right to criticise them if they not doing their research well, or push drugs that are not entirely necessary, but I think we would all be a tad worse off without them. In fact a good proportion of us over 60s would have died a long time ago, as some of us would without flu vaccination.

    mrsP

  38. jdc325 said,

    Hi bs123,

    I think that your assertion that “most other doctors are completely and utterly useless” is untrue and an unfair characterisation of dedicated, competent and caring doctors.

    With regard to patient testimony being “far more important that bigoted opinion”, I have to ask – where is the ‘bigoted opinion’ to which you refer and what conclusions have been drawn that rely on it? Also, are you aware that patient testimony is not all that reliable? Perceived improvement can be due to a whole host of things, for example:

    Spontaneous improvement, fluctuation of symptoms, regression to the mean, additional treatment, conditional switching of placebo treatment, scaling bias, irrelevant response variables, answers of politeness, experimental subordination, conditioned answers, neurotic or psychotic misjudgment, psychosomatic phenomena, misquotation, etc. [Kienle and Kiene, 1997]

    It seems that neither of us is very impressed with the GMC and their handling of this case, but for different reasons. The GMC’s competence (or lack thereof) has no bearing on the quality of information on Dr Myhill’s website, so I don’t intend to discuss it further here as it is irrelevant to the points you have made.

    I’ll address vaccination in a separate comment.

  39. jdc325 said,

    As for vaccination, there are a huge number of concerned voices worldwide, including a great number of doctors. However, any publicly dissenting voices are jumped upon by ‘Big Pharma’, who stifle any debate on the subject because of the billions they make in profits.

    There are quite a lot of people who have unfounded concerns about vaccination, some of them are doctors. That much is true. If you think that an appeal to popularity or authority will cut it here, though, you are mistaken. Appeal to popularity? The vast majority of people choose to be vaccinated where vaccines are available. Appeal to authority? Some doctors (a minority) do have unfounded concerns regarding vaccination. These doctors include Dr Sarah Myhill and Dr Richard Halvorsen. These doctors are not experts in vaccination. They are not experts in the fields of immunology, epidemiology, or infectious diseases. As appeals to authority go, this one is particularly unconvincing. And if there were evidence to support their concerns, then you wouldn’t need to rely on an appeal to authority – you could link to the large, reliable, well-designed studies that proved them right. There are, on the other hand, large, reliable, well-designed studies that have debunked various myths regarding vaccination. Some examples can be found in the references section of this paper. (See also this on the lack of support for the various hypotheses regarding presumed side-effects of vaccination.)

    With regards your conspiracy theorising (“any publicly dissenting voices are jumped upon by ‘Big Pharma’, who stifle any debate on the subject because of the billions they make in profits”), I can only say this: Dr Halvorsen has been highly critical of vaccination – has he been silenced by Big Pharma? The newspapers have published reams of nonsense on the failed hypotheses regarding alleged side-effects of vaccination – were they silenced by Big Pharma? People have published (small, poor-quality) studies that purport to show links between vaccination and various diseases & symptoms – have they been silenced by Big Pharma? No, no, and no. So I’m afraid that accusations of debate being stifled are not only patently untrue but also a little silly.

  40. phayes said,

    “Response to the Ioannides paper from Loewenstein”

    Oh dear! The last paragraph is spot on but the argument preceding it is a crock.

  41. phayes said,

    And, TBH, it’s really quite shocking if these illogical nonsense statements:

    “Since the subject is a biological system, any external factor is almost sure to have some effect on any medical condition.”

    “the parsimonious assumption is that both of the alternatives, improvement and worsening, are equally likely and therefore the prior of the hypothesis that the external factor is correlated with an improvement of the condition is 0.5.”

    really are sitting there – unchallenged, FFS – in a science journal.

  42. pv said,

    Can I add here that there are attempts to stifle debate, but not by Big Pharma or any real scientists. For the stifling of debate one only has to visit on-line “support group” echo chambers, like those supporting Saint Sarah Myhill, and the ex-Saint Andrew of Wakefield. Try being a dissenting voice there and often as not you are banned. Try Jabs for example.

    The real stiflers of debate are the quacks who have something to sell and lots to hide. The disciples who’ve bought the product and the narrative are rarely happy to have their integrity questioned, so debate is shut down. The resemblance to organised religion is uncanny.

  43. jdc325 said,

    And, TBH, it’s really quite shocking if these illogical nonsense statements:

    “Since the subject is a biological system, any external factor is almost sure to have some effect on any medical condition.”

    “the parsimonious assumption is that both of the alternatives, improvement and worsening, are equally likely and therefore the prior of the hypothesis that the external factor is correlated with an improvement of the condition is 0.5.”

    really are sitting there – unchallenged, FFS – in a science journal.

    I think you should write a response. (Do it while you’re still angry…)

  44. phayes said,

    I would consider writing a response if I thought the probability of it having a positive effect… ;-)

  45. Luke said,

    Dr. Myhill is actually trying to help people, which is more than can be said for the people making petty comments on here and demanding her suspension by the GMC….. is a piece of paper signed by the GMC all you have in life? are you that pathetic, or can you actually think for yourselves?

  46. jdc325 said,

    I’ve previously corresponded with Dr Myhill in an attempt to persuade her to remove or correct statements that are unsupported by evidence, misleading, or untrue. Dr Myhill chose not to remove or correct them. I don’t think that these statements are trivial and I don’t think it’s petty to request that such statements are removed or corrected (or to go further and write to the GMC to complain, as I have done). I don’t dispute that Dr Myhill is trying to help people, but I do dispute the accuracy of her statements regarding vaccination.

  47. Charlotte said,

    I find it surprising, given the frequently monumental failures of the NHS, that so much effort and antagonism is directed at a private GP with a special interest in a very vulnerable group of patients. Dr Myhill is a private doctor. People who follow her advice have chosen her as a private doctor and in particular as a specialist in fatigue problems. It is clear her advice will be more relevant to those in a weaker state than the robustly healthy who are very likely to suffer no ill-effects from vaccination. It seems odd that you don’t see there may be a different argument for vaccination depending on the person taking it. People with fatigue are very unlikely to catch flu in the first place, as they are unlikely to be well enough to leave the house and come into contact with infected people, nor are they likely to have much energy for entertaining at home. I myself became very ill after taking a vaccination and it set my recovery back for a good nine months.

    My personal preference is for a doctor with an opinion and interest, it may not be everyone’s but that is the point of choice. It seems to me your opposition to Dr Myhill is a fight against choice more than anything else. Are you the internet thought police? No alternative views, in case people decide to think for themselves!

    Vaccination is a fraught subject. Why not attack one of the other doctors/hopsitals who also disagree with MMR vaccines, like Breakspear. Oh, that’s right, you’d rather attack a woman on her own whose private care is affordable. Larger institutions like Breakspear, who’s treatments are very expensive are of course beyond reproach, after all they are companies with a healthy interest in profit, not an individual interested in improving the health of very unwell people.

    Dr Myhill is succeeding in helping people, I can confirm this personally as someone who became very ill and was patronised and written off by the NHS and lost years of my life to debilitating illness before finding Dr Myhill and beginning the road to recovery. My experience of vaccination during my lowest period of illness was that it made me a lot worse, did not effectively protect me against flu (which I caught anyway) and set my recovery back by months. But I suppose my experience should be ignored just in case a perfectly healthy person strays onto a website for fatigue sufferers and therefore decides to not take a vaccine with the appalling outcome that they get the flu and have to stay in bed for a week to get over it. I mean, of course that seems like a greater risk than a fatigue sufferer being laid low for 9months, as I was…!!!

  48. jdc325 said,

    Hi Charlotte,

    You’ve launched a spirited defence of Dr Myhill here, seemingly in the belief that because you think she is trying to help people she should not be criticised for making statements that are unsupported by evidence, misleading, or untrue. You’ve also suggested an alternative target in the Breakspear. I’d just like to note that while your comment did read to me like an example of the well-meaning defence, I have taken your comments on board and will soon be publishing my criticisms of the Breakspear.

    Thanks,
    James.

  49. What’s Wrong With The Breakspear Hospital? « Stuff And Nonsense said,

    [...] to Charlotte, for alerting me to the Breakspear’s activities, and to Le Canard Noir, for writing about the [...]

  50. Maureen said,

    Stuff and Nonsense! That is exactly what this website is.
    Sitting in immoral judgement over others. Trouble making at its very lowest.
    There is absolutely nothing written on this website by the so called ‘jcd325′ that shows any emotional intelligence. It is a sad indictment of today’s society that
    These websites are allowed to exist. This isn’t free speech, this is complete lunacy…. Probably undiagnosed Narcisstic Personality…. Wesseley should be able to give you some clear guidelines!

  51. anarchic teapot said,

    Quite a compelling argument, Maureen. Most impressive logic and an astounding array of incontrovertible evidence.

    /sarcasm
    Sorry. Sometimes these idiots bring out my inner dick.

  52. Alan Henness (@zeno001) said,

    Maureen

    Who is this ‘jcd325′ of whom you speak?

  53. Cybertiger said,

    Well said, Maureen … and Charlotte too. You’re right, jcd523 (aka tiresome tic) is the charlatan – along with the ‘anarchic prick’ – and there is nothing borderline about their inner personality disorders … jdc235 and the teapot are one and all the psychopathies rolled into two big, pathetic pricks … the evidence is fully supportive, if not incontrovertible. To**ers!

    PS. The evidence suggests that Mr. Henness is also a psychopathic plo**er

  54. KAL said,

    Sorry to interrupt the name calling here, but I’m going to respond to neuroskeptic from waay baack who stated that patients have the right to choose their own treatment unless it imperils others. He referred specifically to the flu jab. Normally I would agree, but there are two variables that may change the answer.

    Two thoughts:

    1. As I’ve said before, the issue of vaccinations for ME/CFS patients is less about the chemicals than it is about whether the virus is attenuated or not.

    The CDC specifically states that immunocompromised people should not be given such vaccinations. Attenuated vaccinations include the flu, yellow fever and MMR for example. Immune system abnormalities in patients with ME/CFS are well documented in the scientific literature. Ergo, this may be a population where such vaccinations are contraindicated.

    Neuroskeptic also stated that his health would be at stake if patients were to forgo the jab. So how do you determine which takes precedence – the health of patients with a severe neuroimmune disease where attenuated vaccines appear to be contraindicated or a healthy person who will most likely not have complications and will recover easily? Although just to play devil’s advocate, there are a few documented cases of people who contracted a severe flu and then contracted ME/CFS, but the percentage is quite small and there are obviously factors such as genetics and immune system abnormalities at play or everyone who contracts a viral illness would also contract ME/CFS.

    The second point is more practical. How often are you in the home of a patient with ME/CFS? A large portion of patients are homebound or even bed bound. No exposure = no risk. Your argument would be more persuasive if ME/CFS patients were actually part of the general public population.

    I realize this has strayed out of the Sarah Myhill debate so carry on.

  55. jdc325 said,

    Hi KAL,

    Thank you for interrupting the name-calling.

    I just wanted to mention something you touched on in your response to Neuroskeptic: the normal flu vaccine is actually an inactivated vaccine (containing killed virus), rather than being an attenuated vaccine. (An alternative flu vaccine is available as a nasal spray and this alternative vaccine does contain a live, weakened virus.)

    [I'd also point out that there is research that has been conducted into vaccination and CFS/ME and failed to find an association. There is also the research into the flu vaccine that found that “no difference could be detected between immunized and placebo CFS patients in immunization side effects”.]

  56. mrsP said,

    KAL

    As CFS/ME is a “dustbin” diagnosis, you cannot say all are immuno compromised, by any stretch of imagination.. Where is the evidence that the syndrome is “neuroimmune disease”. Do in fact neuroimmune diseases exist and what are they?

    Whether or not someone with any chronic/acute condition should have vaccination is up to the individual on their doctors advice. Blanket advice for someone with a syndrome such as this is inappropriate

    I do not know how many people with CFS/ME are bedbound – I doubt the majority, but would like to know. So many I think are capable of spreading infection.

    mrsP

  57. KAL said,

    mrsP brings up an excellent point.

    Although most definitely not a dustbin diagnosis, CFS has over the years become an umbrella term with multiple definitions which have been shown to select very different patient groups.

    And research shows that some definitions mix in people with affective disorders only with ME/CFS patients or tend to select people only mildly affected. Many experts believe that if the patient does not have post exertional malaise lasting more than 24 hours, unrelieved by rest and upon minimal exertion such as doing the dishes or walking the dog they do not have ME/CFS. Severity and specificity are key as well as the specific pattern of symptoms and signs.

    So, yes when you say “research shows” you do have to look at which definition was used and whether it was modified as well as in this discussion which vaccines and adjuvants were included as well as the size of the cohort. (Part of the problem is there is currently no standardized way of reporting how ME/CFS patient groups were selected and/or defined in studies which tends to confound the literature.)

    The World Health Organization ICD-10 classifies myalgic encephalomyelitis under other disorders of the brain in Chapter 6. The full code is G93.3. Chronic fatigue syndrome and post viral fatigue syndrome are indexed to G93.3.

    So ME/CFS is classified as a neurological disease, however, many of the experts in the field use the term neuroimmune because patients meeting the 1994 Fukuda research criteria and the 2003 Canadian Consensus Criteria and the recently published 2011 International Consensus Criteria have the neurological abnormalities described in the scientific literature. If you are unfamiliar with the PubMed or OVID MEDLINE databases, you should definitely familiarize yourself.

    It is very difficult to determine how many patients are homebound because the epidemiology varies depending on the “looseness” of the definition used. As well, many people are misdiagnosed depending on the familiarity or lack there of, of the clinician with the more restrictive clinical criteria. Many others remain undiagnosed perhaps because of the stigma remaining from when ME/CFS was hypothesized to be psychological or from lack of access to adequate medical care. In the United States the CDC estimates that 25% are permanently disabled although that number only includes those cases that have cleared the SSA ALJ process.

    As for whether ME/CFS patient are infectious, although many of the top experts believe ME/CFS is most likely caused by a virus or viruses, it doesn’t mean other people can “catch it” the way you would a cold or the flu. Many cancers are also caused by viruses, but you can’t “catch” them either.

    (My comments are based on being a professional medical writer who covers conferences, research, government testimony and interviews with the many experts involved in the field of ME/CFS and other related conditions. For the sake of brevity I try not to confuse lay readers with extensive scientific detail or extensive references. Readers who are not lay people are quite capable of finding and reading the scientific literature all on their own – assuming they are so inclined.)

  58. mrsP said,

    I agree with what you say re CFS/ME and it being an umbrella diagnosis, which is what I meant by the term dustbin, sorry if that offended, but being an ex nurse and a medics wife I have rather cynical black humour. No one knows what causes CFS/ME or how many conditions make up this syndrome. There simply is not enough evidence. Like my husband says most people with chronic fatigue present saying it started with a viral infection, but that is just anecdotal and there is still no strong evidence of viral cause, although I believe there is some evidence of a virus being a trigger.

    The term neuroimmune tends to be hijacked by people who believe in illnesses that do not exist, or of which little as yet is known, or conditions which various quacks have pronounced the cause with little evidence. Just google neuroimmune and quackery galore comes up and are usually of the anti vax brigade too.

    Anyway back to Vaccination for ‘flu. Do you not agree that blanket advice NOT to have the flu jab for chronically ill people is bad?

  59. KAL said,

    Actually, there is plenty of scientific evidence that the trigger is viral in many cases. Anecdotal or N=1 studies doesn’t mean the association isn’t true, it simply means researchers haven’t been able to consistently replicate the association. And there are many variables as to why that may be the case. But it is a starting point. Patients aren’t scientists, but they are the expert on their own experience.

    What you have to understand when you read the literature is that many pathogens can cause the same disease or diseases which have core symptoms in common. Many people are stuck in the 19th century and think one pathogen=one disease.

    So what the literature actually shows is that many different pathogens are associated with subgroups. Dr. Ablashi, co-discoverer of HHV-6, states it is about 10-12.

    However, the studies done thus far have been insufficiently powered to show associations with multiple pathogens. Statistically, a study of twenty people is unlikely to be statistically valid if this is the case. As well, if definitions that mix healthy people in with actual patients are used that further confounds the literature because the negative results are to be expected in healthy people and would thus appear to weaken or nullify the association.

    Cutting edge metagenomics work is currently being done by the Center for Infection and Immunity at Columbia University in New York. From choosing the large cohort to matching the controls they are being meticulous. Results should be published in about 18 months.

    Two good longitudinal studies (Taylor et al 2009 and HIckie et al 2006) have been done where a cohort was follow from the acute illness stage to when a small percentage contracted ME/CFS.) The pathogens looked at included EBV (HHV-4), Coxiella burnetii (Q fever) and Ross River virus. What they found was the key wasn’t which pathogen or psychological issues, but rather how severe the initiating illness was.

    As for neuroimmune, I didn’t make the term up, I simply use the term most widely used by the scientists in this field. Neither they nor I have control over who hijacks it. As for quackery, I tend to roll my eyes and ignore it. I enjoy discussing variables and possibilities because these are the engines driving science, but at the end of the day I’m a hard science kinda gal. I don’t think one study makes or breaks a theory. I always want more.

    As for jabs, I simply encourage people to think beyond the end of their nose and consider factors that they may not be aware of. If the CDC says at this time immunocompromised patients shouldn’t receive vaccinations with attenuated viruses that’s good enough for me. As for flu jabs, adjuvants may also be an issue.

    There is work regarding a syndrome called ASIA syndrome. It’s too preliminary to comment, but for example Rosenblum H et al just published correlating the symptoms of ASIA with those of ME/CFS. As well the AISA (autoimmune/inflammatory syndrome induced by adjuvants) syndrome possibly indicate a contribution of adjuvants and vaccines to the development of autoimmunity. Or not. This may or may not apply to ME/CFS, but there is scientific evidence that at least some subsets of patients have an autoimmune condition. If you don’t explore possibilities using rigorous science you will never know.

    I’ll let it ride at this since this has wandered rather off topic.

    My statements should not be taken as support for misstatements contained on Dr. Myhill’s site, but rather an attempt to get people to think issues all the way through and supply knowledge that they may not have.

  60. Cybertiger said,

    @mrsP

    They don’t know the cause of ME/CFS … and they haven’t yet divined the causality behind the autism spectrum disorder … but of one thing these clever scientists are absolutely sure … none of these disorders is caused by vaccines. Quack, quack … quaaaack.

  61. KAL said,

    @cybertiger – you and Dr. Mikovits appear to have something in common – neither of you seem to be able to understand the ME/CFS and autism have nothing in common and are not the same disease at all. This also means that the scientific literature relating to vaccines is not the same.

    Which very clever scientists were you referring to and what are the credentials that make them so very clever? Professionals, and that includes, scientists go by the peer reviewed scientific literature not Donald Duck. While I don’t cover autism, I think I’ve layed out the various variables relating to ME/CFS research in such a way that a layperson can understand the issues.

    Let’s try this again shall we? Specifically, which study or studies are you referring to? Which definition was used? How large was the cohort? Was the study a longitudinal study? How many studies have been done and can a meta-analysis be done given the disparities? Did the studies all come to the same conclusion and if not why not?

    Pretending to be a waterfowl doesn’t give you credibility in the real world.

  62. mrsP said,

    Kal. “If the CDC says at this time immunocompromised patients shouldn’t receive vaccinations with attenuated viruses that’s good enough for me. As for flu jabs, adjuvants may also be an issue.”

    They mean live virus, and there is a chart on the main site as to what vaccines should be used or not according to the particular immunity. The CDC pink book states:-

    Condition: Immunosuppression
    Live: Contraindication
    Inactivated: Vaccinate if indicated

    So as our vaccines in the UK are inactivated as JDC pointed out I think, there is no reason fore someone with CFS/ME not to get the vaccine. In someone chronically ill, vaccination is indicated. The ‘flu in someone incapacitated and de-conditioned to start with could be serious or fatal. Feeling off colour for a short time or a sore arm is no contraindication.

  63. mrsP said,

    Kal

    But adjvants are not an issue. They have been used for over 70 yrs without a problem (CDC), but are not present in the US seasonal flu vaccines anyway. Not sure about the UK, amd vaccines and any side effects are monitored all the time. As adjuvants are there to enhance the vaccine, wouldnt that mean less virus inactivated or not is used? Which is good if in short supply.

    To be clear – in my previous post I am not saying ALL people with CFS/ME should have the flu jab – this should be determined on an individual basis by the doctor and patient concerned according to the patients condition at the time.

  64. Alan said,

    Hi there, where did the graph from Public Health Agency of Canada come from? Could we have a hyperlink or citation please? This would be a great help, thanks!

  65. jdc325 said,

  66. Alan said,

    thankyou!

  67. GMC Complaint Regarding Dr Sarah Myhill « Stuff And Nonsense said,

    [...] site after correspondence with her, I followed up on this in August this year in this post: the wrongness of Dr Sarah Myhill. I noted that Dr Myhill had substantially amended her website, removing many of the factually [...]

  68. anniw said,

    I have M.E, 13 years in total, severely for the last six years (am currently housebound, have been too ill to leave my home now for 18 months as the exertion involved is too much). It’s a hugely life limiting and debillitating condition. However, I have concerns about Dr Myhill. As a patient group, we have been neglected, although things are slowly starting to change, and where you have an illness with no known treatment and also some scepticism that you are suffering an organic physical disease (despite there being many research papers showing abnormalities, especially in the immune system, I believe) doctors like Dr Myhill are seductive. They give you time, listen and offer ‘treatments’.

    My concern with Dr Myhill is I have nothing to compare her treatments with. How do I know they are evidence based? Should i consult with Dr Myhill, from what other people with M.E whom I know have consulted her and her website, she would suggest a battery of tests, stool tests, heavy metal tests, her mitrochrondria tests. These tests are not cheap. The treatments that follow are very restrictive, especially her diet recommendations. She advocates absolutely no sugar. I find it very hard to give up completely sugar and reading her website always makes me feel guilty that I can’t follow her diet recommendations. What I don’t know is whether this guilt is misplaced.

    She uses labs like Biolab and Genova Diagnostics. I am trying to establish whether these labs and their tests would be accepted by mainstream science? She is big on heavy metals, again I don’t know whether the tests she advocates are reliable. Dr Myhill seems very convinced she knows how to treat M.E (although she always refers to fatigue. My symptoms are much more than fatigue) as well as knowing the causes of myriad other diseases and this makes me wary of her.

    Many people with M.e leap to her defence, but i do wonder if it’s misguided…..

  69. mrsP said,

    Hi
    Sorry you are ill. The best places to get advice on getting treatment are you own doctors and NHS websites. NICE guidelines have a section on CFS/ME with a downloadable PDF files on treatment for the condition and one prepared for patients and relatives. This also contains links to other reputable sources I think.

    http://guidance.nice.org.uk/CG53

  70. Dr Sarah Myhill – Yet More Dangerous Advice? « Stuff And Nonsense said,

    [...] written about Dr Myhill several times now. Previously, I’ve pointed out various incorrect assertions and [...]

  71. anniw said,

    Mrs P, thanks for your reply. I would have to say that having had this illness for 13 years I feel some of the NICE guidelines about M.E are unhelfpul, especially the recommendation of graded exercise. I’m sure you are aware that M.E charities and M.E patients have expressed their concern about some of the NICE guidelines. Personal experience and of many others with this devastating condition know that activity must be approached with great caution, as going over’s one personal limits induces a symptom flare and can progress the condition. Nice really do need to reconsider their views on GET and M.E.

    I would suggest you google the ICC guidelines to get the most up to date information on the many bodily systems affected by M.E and keep an open mind that when it comes to the M.E there has been way too much bias of psychological theories and approaches to this physical illness as well as conflating chronic fatigue/idopathic fatigue with M.E.

    However, this bias is slowly starting to change. Today, there was the good news that the MRC have released £1.8 million for (http://www.meassociation.org.uk/?p=9760) five new projects to investigate the mechanisms and underlying biological processes involved in the illness, which could eventually lead to better diagnosis and the development of more effective treatments. £1.8 million isn’t much but it’s a start towards money being directed at bio medical research.

    My GP is supportive, as is my consultant at my local hospital. Both approach it as a physical illness but acknowledge there are no known effective biomedical treatments as yet due to the paucity of bio medical research. Neither, thankfully, recommend graded exercise therapy. They have been able to prescribe meds to help with interrupted sleep and pain meds. Both of which, of course, help with symptom relief but are not treatments.

    In lieu of M.E being recognised as a physical illness for so long, it is not surprising that many people with M.E end up resorting to consulting alternative doctors with dubious treatments.

  72. mrsP said,

    Nice guidelines suggest many different ways of managing the syndrome, depending on the severity. It does not recommend GET for people with severe symptoms. GET is fine for those for whom it is appropriate and research shows this. The guidelines clearly state that symptomatic treatment is geared to each individual patients condition at the time.

    There is no strong evidence as yet as far as I know of the cause of CFS/ME or indeed if it is one condition or several. Whether biopsychosocial or “physical” matters little, finding the cause/s is the important thing.

    Someone with a mental illness or a biopyschosocial illness has “real” illness too. They are just as real as an appendicitis but the treatments are much more complicated.

    Glad you have a good medical support team.

  73. anniw said,

    Testing…

  74. anniw said,

    Ah, I wrote an entry only to lose it.

    Mrs P, there is research to show that graded exercise is inappropriate for people with M.E, moderately affected as well as severely. This is one research paper, http://www.theoneclickgroup.co.uk/documents/ME-CFS_docs/Twisk%20Maes%20CBT.pdf and more recently here, http://www.iacfsme.org/BULLETINFALL2011/Fall2011KindlonHarmsPaperABSTRACT/tabid/501/Default.aspx

    As I said before the problem is that M.E has been conflated with chronic fatigue and there are too many definitions/criteria. For the Oxford criteria one only needs fatigue lasting six months to receive a diagnosis. No post exertional malaise, the key feature of M.E, no neurological symptoms, noise and light sensitivity, no pain and so on.

    Leonard Jason, Phd writes,

    ‘M.E. experts from the U.K., U.S., Canada, Australia and many other countries who have studied this disease have stated that it’s the definitions that determine the diagnosis. The current Consensus Document and most M.E. definitions (Ramsay, Dowsett and historic) require the major criteria of severe muscle fatigue following minimal exertion with prolonged recovery time, and neurological disturbances, especially autonomic, cognitive and sensory functions, and variable involvement of cardiac and other systems, with a prolonged relapsing course. This is a very specific list of criteria, and a major point to note is that the CNS (central nervous system) dysfunction of M.E. can be measured.

    Alternately, CFS definitions present the major criterion of fatigue that lasts 6 months and reduces the level of function by at least 50%. Post-exertional malaise and neurological abnormalities are considered minor and optional criteria. So this broad definition could encompass any of many illnesses in which fatigue plays a role. Fatigue is not only a symptom of numerous illnesses, but it is something experienced by normal, healthy people. And there are no reliable objective ways to measure fatigue’. He also points out that ‘ Myalgic Encephalomyelitis is a clear-cut, definitive diagnosis with tests that can show the effects of M.E. such as: SPECT and PET Scans, Natural Killer Cell Function test, Rnase-L antiviral dysregulation, and Blood Flow. Infectious onset is most commonly observed. Antivirals and immune modulators have shown promise, but funding for clinical trials has been scarce’

    The cause is not known but there have been over 4000 papers that show biological abnormalities in M.E, http://www.meactionuk.org.uk/SUBJECT_INDEX.htm

    The problem with conflating idopathic chronic fatigue with M.E is that cohorts are mixed and studies then claim that graded exercise and CBT can help some when in fact they make people with M.e worse. People with M.E have an activity ceiling beyond which they cannot go without exacerbating the illness and making them worse, sometimes permanently.

  75. anniw said,

    to continue from above,

    As mentioned above, the recent ICC criteria are helpful in detailing the many symptoms and bodily systems affected in classic M.E. http://www.meassociation.org.uk/wp-content/uploads/2011/10/ICC-FOR-ME-October-2011.pdf

    Mrs P, of course mental and biopsychosocial illnesses are illnesses, that is not in dispute, but M.E is a physical illness. You say it does not matter how m.e is labelled, but experience as a sufferer shows it does. Here in the UK, M.E has been mainly approached (although the tide is slowly starting to turn) as a mental or biopsychosocial illness and the research studies have been predominantly on behaviourial studes on patients selected from the way too broad criteria. This has resulted in treatments such as GET and CBT being advocated for patients with M.E despite them making patients worse or achieving nothing as in CBT (i’ve nothing against therapy to help one deal with a life changing physical disablity, but CBT has often not been used in this way for m.,e, rendering it useless, as well as insulting, when applied to change ‘aberrant illness beliefs). Those with just fatigue (for various reasons, including possibly psychiatric) may be helped by graded exercise, but not those patients who fit the more rigourous criteria as mentioned above, icc.

    If you came down with a life changing physical debilitating illness where the only treatments on offer were as much use as a chocolate teapot, and worse can actually make your illness worse, you too would ask that your illness was labelled for what it is, physical, so bio medical research could be done and effective treatments eventually developed.

    I would not have a problem with being diagnosed with a mental illness – and it’s hard not to wonder when you mention mental illness that you are tactitly implying people with M.E do have a problem with this – if that it what i have, but I don’t I have a physical illness and it needs to be treated as such.

    I leave you with three more links in case they may be of interest
    Abnormal Proteins In Spinal Fluid of CFS PAtients http://www.umdnj.edu/cgi-bin/cgiwrap…nth=02&year=11
    Brain Abnormalities In ME http://bjr.birjournals.org/content/e…89091.abstract
    Norwegian Rituximab Study http://translate.google.com/translat…y-3615631.html

  76. anniw said,

    Apologies the last three links do not work. I will try again:

    http://translate.google.com/translat…y-3615631.html http://bjr.birjournals.org/content/e…89091.abstract

    http://www.umdnj.edu/cgi-bin/cgiwrap…nth=02&year=11

  77. anniw said,

    Kal, it is good to see a professional medical writer take an interest in M.e/CFs and be aware of the problems of criteria and mixing up patient groups, as well as acknowledging how debilitating it can be…

  78. mrsP said,

    @ anniw

    We seem to have wandered of the subject of the thread. You can discuss CFS/ME for ever it seems to me, and we will have to await some more research.

    The complaints against Dr Myhill have nothing whatsoever in may way to do with CFS/ME. For whatever reason some people seem to think that people with CFS/ME are being attacked. They are not.

    My personal main complaint was and still is her advice and information on asthma and other chest diseases which I consider incorrect and in some cases were dangerous. Fortunately some page have been taken down, but others remain. As I am now inundated with mince pie making and grandkids, I will wish you a happy Christmas and a healthier New Year.

  79. alistair said,

    Dr Myhill does not purport to know how to treat M.E., only to be doing all she can to learn how to treat patients to best effect – she is not arrogant.
    I suggest you request a vitamin A test from your GP. If s/he follows NICE/NHS guidelines, then you will be refused, since “Vitamin A deficiency is rare” and “vitamin A testing is not cost effective”, yet, in the chronically ill, a vitamin A deficiency is not so unlikely, especially if you do not eat liver.
    Alternatively, you could simply supplement with vitamin A (NOT beta carotene – this may not correct such a deficiency in someone ill, whilst being linked to cancer in some studies), do this for 3 or 4 months, and review your symptom severity from month 2 onwards. If you have any negative artefacts of night vision, review those from month 3 onwards.

    All this talk of ‘evidence’ in relation to NHS medicine finds me frustrated: a friend never got examined by GPs nor by infectious disease consultant – both were content with their seated ‘diagnosis’ of “ME” with recommendations for CBT and GET, this without examining the patient to consider their list of 50+ symptoms… so I should complain to GMC about them? Yes, I should. But it is wrong to focus unduly on Myhill, just because she has an accessible website — I love the idea (Dorothy Paterson: “…some comments frankly dangerous…”) but have not found any of her comments to leap out of the webpage to attack me.
    Most bad medicine is carried out in consulting rooms up and down the land, wherein the well paid GPs and consultants do not get out of their chairs to practise any detailed patient examination towards effective clinical diagnosis… and we should know that patient examination is no longer on the medical students syllabus. Strange, yet true.

    We must remember that evidence based medicine is a statistical business – a patient from the 5% not helped by the ‘proven treatment’ is better with the clinical insight of a good doctor who treats them appropriately – and NICE guidelines are, as they have recently admitted in relation to lyme disease, just that, guidelines. Yet so many doctors and people on this blog seem to think that evidence based medicine applies equally across all patients, under all circumstances – treatment ‘a’ benefits the majority of patients, therefore it should be used on all patients ??? Is clearly hocum, whilst imagining that NICE guidelines should be adhered to strictly is to set down clinical experience and the details of the individual patient in favour of medicine by rote… we are more complicated organisms than this would make sense of.

    Back to my M.E. friend who had lost 10 years of life to debilitating ill health…
    A private doctor spent 15 minutes examining, and 15 minutes reviewing dietary and symptom diaries. They learned more from that half hour consultation than in 15 years of complacent, lazy, NHS failings.
    And, yes, a stool test showed up a negative combination of a few harmful bacteria present and a few good bacteria absent, which the Dr conveyed might explain all manner of the symptoms.

    Yes, friend took a lot of supplements, and after a few months, with improved night vision and various symptoms of infection (drenching sweats at night whilst normally feeling frozen) clearing up, it became clear that vitamin A deficiency had been one key aspect of the pathology.
    Dr Myhills website was an invaluable source of dietary information and motivation to actively pursue better health and to see the connection between poor nutrition and pathology. Her site is, after all, mostly focused upon regaining and maintaining good health through optimum nutrition — she is correct to encourage people to eat healthy diets and consider their holistic good health rather than imagining that a vaccine or antibiotic can protect an unhealthy person, with a terrible diet, against disease; it might temporarily kill an infection, but your immune system is the most important component of long term good health.

    Now, remind me, what is the evidence base for the benefit of nutritional supplements? Have I just waded in to no-man’s land wherein to be mown down by the sharp and unforgiving words of the medically superior evidence wins club – show us your proof – citations needed – witch hunters from previous centuries…
    Did Linus Pauling, double Nobel prize winner for medicine live to 93 years?
    But equally, do remind us, one and all, why we should generally avoid supplements of vitamin E, calcium, beta carotene and iron without medical supervision, and that we should take vitamin A carefully – 2-3 months at 2x RDA is okay (unless you are pregnant), but permanently at this level is unwise.

    Accentuate the positive. Eliminate the negative.
    If only your blog would try this, instead of all that vitriol about people who are nothing like so harmful nor dangerous as the typically lazy, over paid, consultant or GP who cannot see how 4 minutes can possibly be long enough to examine a patient or review their symptom diary / diet diary…
    If everyone had a good diet, per Dr Myhill, any number of cases of illness and life threatening disease might be avoided, so do consider the ‘risks’ of her small comments about vaccines in perspective, won’t you?
    Last: today I met a nice looking young woman with very pale skin. I have to avoid the skin and wear sun block as I get a rash from more than a little sun exposure, she said.
    You do take vitamin D, don’t you? I ask.
    …I get sufficient sun, she stated.
    She leaves and friends then tell me that she has been on leave from studies with ill health…. surprised? No.
    Dr Myhill – I tried to tell her about vitamin D, but she would not listen, and, would you believe it: She is ill and has insufficient knowledge of nutrition and the requirement for sunshine or vitamin D supplementation, even after a year of illness and NHS involvement that she is not likely to get healthy any time soon.
    So, do balance some minor discrepancies between what you deem threatening to the world order and the volume of positive helpful information that Dr Myhill’s website shares. There is a healthy perspective to be garnered here. Guidelines and precise adherence to evidence based medical statistics will not achieve the best health outcome for every patient.

  80. mrsP said,

    @Alistair

    “in the chronically ill, a vitamin A deficiency is not so unlikely, especially if you do not eat liver.”

    What about eggs, milk, yoghurt, cheese, oily fish?

    In general terms, the argument that other doctors practise poor medicine is no argument not to highlight those who offer incorrect advice on a website. The one has nothing to do with the other. Please find a decent argument backed up with some evidence.

    “Have I just waded in to no-man’s land wherein to be mown down by the sharp and unforgiving words of the medically superior evidence wins club – show us your proof – citations needed ”

    Err……. yes

  81. alistair said,

    mrsP you appear to be very powerfully motivated in attacking just one doctor – hatred would not be too strong a word. I attempted with my many words to show you that there is a healthy perspective to be had, between some opinions expressed that you deem dubious or dangerous (a potential to lead to slightly increased deaths) and much else that is beneficial to the health of her readership… improving their health outcomes… but you appear to be fueled by some powerful hatred such that your reply to my comment is very selective.

    So, Dr Myhill wrote something you did not like about asthma and chest diseases – if you are going to make accusations that her comments are or were “dangerous” [is this more New Labour style health and safety speak: Do her words rise up and attack those reading them?] perhaps you would quote them or outline what facet of medicine she got so dangerously wrong?
    Asthma inhalers are all well and good, but if UK citizens in general are deficient in vitamin D, what with its natural anti-inflammatory benefits, it seems that the general thrust of her advocacy towards focusing on good health by getting sufficient nutrition through improved diet and supplements where necessary, would appear to be spot on.

    Are you certain there is no room for a difference of medical opinion? Do you really think that people are so gullible that the first thing they read they believe 100% and that they ignore all further medical opinion, e.g. from their GP ?

    You do not encourage me to report the consultants I mention to the GMC… you do not comment on much that I have said. I fear that your line of sight clouds with a red mist when the name Myhill is present. I’d recommend a chill pill, if you understand this non-medical term turn of phrase.

    My ME comments were intended to be addressed to AnniW – I hope she finds them useful.

  82. mrsP said,

    @alistair

    You are making assumptions that are wrong. I do not hate Dr Myhill, I do not know her. According to her patients she appears to be a caring doctor, I do not make personal attacks but I will take issue and have done with any doctor/therapist/CAM practitioner who make claims I think on evidence are wrong.

    The best available evidence supported by the GMC, was that the asthma pages in question were incorrect and they were taken down. I cannot now read them, so cannot answer your questions, except to say that the only way at the moment to prevent asthma deaths and improve the quality of life of patients is current treatment as described in the guidelines on asthma and as practised by every respiratory consultant in the country. To cast doubts about inhaler treatment is IMO dangerous. I remember many tragic asthma deaths pre modern treatment, including a childhood friend.

    Please supple evidence that providing Vit D will prevent asthma. I have not found any. There is some evidence that a high intake of fruit and vegetables leads to less asthma, but does not mean that pharmaceutical treatment is not necessary and there is no evidence that giving supplements leads to less asthma.

    It is dangerous not to vaccinate children and dangerous to the old not to have flu vaccine. People do die of flu, children do die of measles = the figures are there on Gov and WHO websites.

    It is dangerous to recommend to lie babies on their sides. Cot deaths reduce is babies are laid on their backs, again there is evidence.

    There is room for differences in medical opinion, but any variation in treatment should be evidence based. Obviously with time and research opinions do change and rightly so.

    Health and safety policies are essential and save lives too, which is something david cameron doesn’t seem to know.

    Your posts are long, please deal with one issue at a time.

  83. alistair said,

    mrsP – you are careless in your reading of my words and of Dr Myhills website.
    I did not state that “providing Vit D will prevent asthma” – where did you read that? – however it clearly makes good sense to optimise nutrition, and as regards vitamin D, we know that dietary sources are low, just as sunshine is insufficient in a UK autumn/winter/spring. And we know that vitamin D is naturally anti-inflammatory, hence, in large measure, the relief felt by arthritis sufferers during summer and when taking a sunshine holiday during our rainy seasons.
    My brown steroidal inhalers are a part of my life, but, if I find that supplementing vitamin D, when the sun is low in the sky or I am working indoors, results in my requiring lower doses of steroidal inhalant – being less dependent upon some ugly pharmaceutical interventions, interventions that only manage symptoms, and which carry side effects… then I have to think that vitamin D supplements are a pretty good bet. Don’t you? Meanwhile, my asthma nurse advises me to rinse my mouth after using the steroidal inhaler – to lessen inadvertantly dosing my mouth and throat with steroids.
    Is it okay that I suggest all asthmatics and others with inflammatory conditions likely should take vitamin D supplements, except perhaps during summer or sunshine holidays overseas?

    You state that “the only way at the moment to prevent asthma deaths and improve the quality of life of patients is current treatment as described in the guidelines on asthma and as practised by every respiratory consultant in the country” …but even this is not the whole truth!
    Unless the guidelines suggest that people try to live away from the worst air pollution, and that avoiding taking vigorous exercise during the most polluted time of day/weather conditions, and that asthmatics should avoid smoke inhalation, and their next of kin should avoid smoking in their presence, and that asthmatics should consider avoiding inflammatory substances, such as common food intolerances and artificial additives such as azo dye colorants… well, as you can see, I am writing a common sense list that involves no pharmaceutical drugs nor supplements, but are lifestyle matters that do have an impact on asthmatics health outcomes.

    I’d be happy for you to make my day and find that NICE et al include mention of good nutrition and sensible supplements to take, and mention of behaviour towards avoiding trigger pollutants or pollutants that worsen asthma or make management more difficult.

    Dr Myhill did not state that lying a baby on its side prevents cot deaths… far more interestingly, she outlined how cot deaths are unknown in Japan – how they use fire retardants in their mattresses based upon the rather inert element, Boron, whilst we use all manner of funky brominated chemicals, and when, over time, these chemicals get attacked by fungal growth, especially on reused mattresses that have the secretions of a previous infant upon them, they may release some very toxic chemicals. Hence it is wise to NEVER reuse infant mattresses for 2nd born, etc.
    This, if I remember it, is either a very sound theory or a proven fact… but it is not Dr Myhills opinion, as with much on her site, she is a gatherer of resources and researches, which information she shares for people to consider.

    Now, when you move on to describing that people die of flu and measles, of course you are telling the truth. Although death is the outcome of life for everyone, so one should not forget that everyone has to die of something – not all death is avoidable.
    But you appear not to mention that good nutrition and healthy immune systems can help people to survive and/or recover more quickly from these illnesses. So it is that vitamin A is often mentioned in relation to measles and is recognised by WHO as a most important vitamin correction of the malnourished in the 3rd World. Well, there are malnourished people in the UK too, some through bad diet, others through excess alcohol and its harm to liver and vitamin B levels, and others through faults in their genes, and still others through pre-existing chronic ill health. So, mention of disease killing people and how immunisation can help is just one piece of that conversation – without mention of nutrition the discussion is incomplete. Dr Myhill does not believe that immunisation holds all the answers, which is a perfectly reasonable position to take – she then posits evidence of why people should optimise their diet to the benefit of their health, of a healthy immune system.

    one issue at a time – that would suit you? You love to focus in on one tiny point, and in so doing lose perspective on the whole picture. Anyone that did not know better might read this blog and figure that Dr Myhill is a dangerous doctor, when the reality is that, as with the risky business of using a bicycle in place of driving a car, whilst there is room to consider degrees of risk involved in her advice (or riding a bicycle), the overall effect of health knowledge and improving nutrition, lifestyle and health choices (of taking exercise on a bicycle) is very likely far more beneficial than is the advice ‘dangerous’ – some bicyclists are involved in accidents, some die, but overall they likely benefit from all that exercise, fresh air and cheap efficient transport away from the coughs and sneezes that people inhale on and waiting for buses, in cars, and on trains.
    This is how perspective works – it does not work when one nitpicks details out of context.

  84. FourEcks said,

    Alistair writes: “Dr Myhill does not purport to know how to treat M.E., only to be doing all she can to learn how to treat patients to best effect – she is not arrogant.”

    http://www.drmyhill.co.uk/wiki/Summary_of_my_approach_for_CFS_/_ME_sufferers.

    “I estimate that in my working life I have seen and treated thousands of patients with CFS. I now know that there is a route to get well which entails a whole package of treatment.”

    Sounds pretty damn arrogant to me.

  85. Cybertiger said,

    Well said, Alistair. mrsP is a tiresome little nitpicker: I agree.

    PS. I’ll now tell a story of Vitamin D and the power of those dangerously negligent doctors who still roam the streets of England. It concerns a 16 year old girl with a dark skin who lives in London. She has a baby by her 19 year old, dark skinned boyfriend – who is overjoyed to be a father despite his youth. The girl breast feeds her child. The baby becomes unwell; the couple take him to the GP who refers them to hospital. They go on the bus. The baby is admitted to their local London hospital, deteriorates and is transferred to the intensive care unit at GOSH where he dies. The young parents are not allowed to be with their child because the doctors had diagnosed deliberate abuse by parents. A post-mortem exam revealed rickets.

    Two years later the young couple were up at the Old Bailey defending a murder charge.

    http://www.dailymail.co.uk/news/article-2056290/Jayden-Wray-4-month-old-baby-rickets-shaken-death.html

    There were 60 medical experts present as witnesses. No doctor really knew why the child died, but a jury was expected to decide on murder beyond reasonable doubt, or otherwise. After six weeks the trial was called off. Judge Stephen Kramer QC told the jury: “There is insufficient evidence for you to be asked to continue.” The trial cost the taxpayer around £3 million, though the financial is a small part of the true cost.

    This sort of obscenity has now become routine, despite “the evidence”.

    http://www.telegraph.co.uk/health/healthnews/4632198/Doubt-over-shaken-baby-theory-that-has-sent-dozens-of-parents-to-prison.html

    The so-called “arrogance” of Sarah Myhill sort of pales into insignificance … against the evidence-based obscenity of our medical and justice systems. Society is sick: this recent Old Bailey trial provides proof of sickness beyond any reasonable doubt.

  86. mrsP said,

    Alistair

    Just asthma – I have a meal to cook and bridge to play.

    You said “Asthma inhalers are all well and good, but if UK citizens in general are deficient in vitamin D, what with its natural anti-inflammatory benefits,etc ” So you linked inhalers with deficiency of Vit D. I apologise if you did not mean that Vit D supplements prevents asthma. However you do say that Vit D lessens your usage of a steroid inhaler and I would like to know what evidence you have that it does.

    You may feel better taking Vit D supplement. The reason for this could be many things. You may indeed be short of it or it could be the placebo effect, the normal ups and downs of asthma or it could be regression to the mean, or any number of other things.

    All we can rely on is evidence. The anecdotal evidence of one is not enough nor is the plural of anecdote, data. There are some studies that are suggesting at the moment that more people are short of Vit D than was thought, particularly chronic sick who cannot get out, darker skinned people etc. But nothing in relation to asthma.

    The guidelines clearly state to avoid smoke and pollution. Have you read them? ww.brit-thoracic.org.uk/Portals/0/Guidelines/AsthmaGuidelines/sign101%20Sept%202011.pdf

  87. alistair said,

    Your link did not work for me, but an identically titled page began thus:
    “My aim is to give all CFS sufferers and their therapists the knowledge and the access to information and tests to get themselves on the road to recovery.”
    So that would be “on the road to recovery” but I take your point – what I intended was, that she does not have a stock answer to any one patient – she recognises that there are a whole host of aspects to sufferers regaining good health, and she emphasises the difficulty of this patient group making their journey towards health which likely involves lifestyle changes, etc..
    However, unlike 99% of GPs and the vast majority of consultants, all of whom follow the misformulated Oxford guidelines concocted by a panel that included the late Prof Anthony Clare, (which guidelines replaced much better guidelines…) wherein all patients showing any signs of ME type symptoms get armchair diagnoses without examination or tests or nutritional advice (yes, more than 5 symptoms and doctors sideline their chronically ill customers as mentally unfit. How convenient for them,) …and state they have ME, in other words, they have psychological problems that are best treated (here we go again for the success of evidence based medicine as a mantra rather than as guidance) by CBT and GET… when in fact, someone who has actually examined, tested and treated thousands of ME patients – hats off to Dr Myhill – finds that they are typically profoundly lacking in energy with delayed exertional fatigue and delayed recovery, and that they must pace themselves and avoid over doing exercise in order to get well… this and much else.

    But I insist that your quote nor mine are a sign of any arrogance.
    The arrogance in this field is when a state paid consultant eschews examining their patient in favour of assuming that it is all in the patients mind, even when patients have the most obvious symptoms of uncontained chronic infection and lowered immune health, for instance, regular drenching night sweats, verrucae that have not resolved after ten years, multiple complex skin conditions including rare types of eczema and psoriasis that have skin specialists itching their heads and providing anti-fungal/bacterial ointments that prove of no curative value… Such consultants also ignore CBT specialists when those specialists attest that a patient has no mental problems beyond, perhaps, a little depression at being so horribly, chronically ill.

    Dr Myhill is expressing something wonderful: a profound confidence that those with ME can get well – that there is a path they can travel to regaining good health, if not robust good health, and this is a sign of someone who has seen many successes with this patient group, including those left to rot, sometimes bed bound by fatigue and weakness, by the NHS busy following guidelines as if they are a straight jacket on treating any one individual.

  88. jdc325 said,

    Dr Myhill did not state that lying a baby on its side prevents cot deaths…

    Dr Myhill’s advice to place babies on their sides to sleep is potentially dangerous, as babies placed on their sides to go to sleep are at increased risk of SIDS. Do you not think that this is more important than why Dr Myhill gave such advice? Whatever her motivation for giving such advice, it is dangerous. You’re nitpicking details and ignoring the most imporant point (which is ironic given the last line of your post made at 4:01pm).

    Now, when you move on to describing that people die of flu and measles, of course you are telling the truth. Although death is the outcome of life for everyone, so one should not forget that everyone has to die of something – not all death is avoidable.

    Yes, everyone has to die of something eventually. Frankly, though, I’d prefer it if infants were protected against measles and able to survive infancy. You seem not to share my preference.

    But you appear not to mention that good nutrition and healthy immune systems can help people to survive and/or recover more quickly from these illnesses.

    They might help, but that’s not enough. If measles outbreaks occur, people will die – even with good nutrition and a healthy immune system. Infants and young children are particularly vulnerable. Unless you’re a fan of child mortality or terribly misinformed about vaccination and infectious diseases, you will favour vaccination against measles and oppose baseless scaremongering about the MMR vaccine.

    Anyone that did not know better might read this blog and figure that Dr Myhill is a dangerous doctor…

    Some of the advice on her website is dangerous. Demonstrably so. People who do not know better and read her website might come away with the false impression that vaccination is more dangerous than the infectious diseases that it protects against, or that babies should be put to sleep on their sides, thereby increasing the risk of SIDS. How do you feel about that?

  89. alistair said,

    I am glad to see that you have kept up to speed with the detailed findings of the GMC. The complaint relating to Dr Myhills advice on babies was dismissed – although no reason was given for this, it seems likely that taken in the context of a discussion of the Richardson theory on cot death, and setting the context of the infant having a healthy mattress/sleeping environment, it may well be that the research evidence does not apply so neatly to this healthy situation as you would suggest.
    Myhill goes to the trouble of explaining all about toxic matress fire retardants on her website – do you broadcast this information to benefit others?

    Nitpicking: the difference between a toxic time bomb of a mattress that may cause the death of an infant and a healthy mattress that won’t: now, is that what you call nit picking?
    And by taking it out of context (the context of a healthy mattress per the Richardson theory of cot death) you are missing the very likely validity of her approach and advice.

    You prefer infants to survive infancy, via vaccinations as necessary – so do I;
    I have not expressed an opinion about vaccines – I have not said that I am against them in any circumstances. Your reading of and in to my words is tiresomely inaccurate. I recognise the value of vaccines whilst also recognising that occasionally vaccines have proven to be contaminated and caused major harm, whilst with almost all vaccines there is some small risk of adverse outcomes – but this is just a healthy awareness of risk. Infectious diseases carry a major risk and achieving herd immunity is a pretty good bet towards avoiding outbreaks of disease.

    Yet talk of Dr Myhills vaccine advice is rather out of date now that she has removed most of it. Or should we keep brandishing her arguably controversial opinions against her even though they are now her private opinions? Would that not be rather a negative and vindictive approach?

    However, modern advice would have expectant mothers avoiding all vitamin A – ‘because it can harm the foetus’ – when in fact the mother needs healthy levels of vitamin A, and the new born needs good nutrition… a child needs a disproportionate amount of vitamin A compared to an adult.
    With the NHS virtually silent on the topic of nutrition except to keep saying “don’t do this! and don’t do that! and this, that and the other is bad” – based in part on the fact that nutritional supplements “haven’t had double blind, placebo controlled trials…” – more of the myth that evidence based medicine is required before anyone can operate on established knowledge – that it supposedly carries more weight than approximately known aspects of human biology.

    Earlier, mrsP wrote:
    “It is dangerous not to vaccinate children and dangerous to the old not to have flu vaccine. People do die of flu, children do die of measles = the figures are there on Gov and WHO websites.”
    This is why I mention that some elderly people will die – it is inevitable, not something that can usefully be delayed forever, and some people, at some stage in life, prefer not to prolong with major intervention, their lifetime.
    It appears that a famous Oxford Doctor was responsible for a phrase related to my theme:
    “William Osler, 1849-1919
    Sir William Osler, often called the father of modern medicine, spent much of his life studying pulmonary diseases (diseases of the lungs) and is known for dubbing pneumonia the “old man’s friend.” Ironically, Osler himself died of pneumonia after contracting influenza.”
    Why did some people deem it, and still agree today that, flu and/or pneumonia can be described as “old man’s friend” ?
    Well, I suppose it is because it tends often to rapidly lead to death, and under some circumstances of having a life well lived behind you, and suffering aches, pains, and distress late in life, burdened with modern cultural norms that you have never quite kept up with, and governments that never quite seem to care sufficiently about the oldest in our populations, fearing becoming a burden on others, or missing friends and loved ones who have died before you ….well, some people in this group do decide that a swift exit, when the time comes, is better than a slow lingering one. If only in giving less time to ponder your mortality as you become more frail or suffering more pain.
    So I say again – everyone has to die of something, eventually, and for many, when asked, the most important aspect is not how many days they achieve on this planet, it is the quality of that time and how little they suffer at the end.

    Another reference to SIDS and Dr Myhills baby posture advice which was subject to a complaint to the GMC… which complaint the GMC dropped – so draw your own conclusions about just how ‘dangerous’ the GMC felt this advice was, in its context.

    How do I feel about that…
    I feel that you are over reacting and acting in a vindictive fashion. I feel that you often focus on a phrase rather than a full paragraph – you lose the context in which words are framed, and thus misunderstand the balance of what has been stated. And sometimes you think you have read something even when it has not been written – clearly you are passionate, but this passion is not well controlled, and you are in danger of jumping to inaccurate or inappropriate conclusions and catching hold somewhere near to the wrong end of the stick.
    I sense that you are a rather black and white thinker – that you have little facility to think dispassionately, that you tend to be very fixed in your thinking (I am not clear what if anything might make you alter your understanding or viewpoint, except a new placebo controlled double blind research study that appears statistically to show that the last study was wrong – such evidence is everything to you, even though it shows that not all such evidence lasts the test of time and thus even such evidence is fallible) and thus you are rather prescriptive – tending to pronounce statistical likelihood as carved in stone certainty.

    But you did ask how I feel about your interpretation of a few words out of context that were, anyway, rules okay by the GMC, so there it is.

  90. jdc325 said,

    @Alistair

    I am glad to see that you have kept up to speed with the detailed findings of the GMC. The complaint relating to Dr Myhills advice on babies was dismissed – although no reason was given for this, it seems likely that taken in the context of a discussion of the Richardson theory on cot death, and setting the context of the infant having a healthy mattress/sleeping environment, it may well be that the research evidence does not apply so neatly to this healthy situation as you would suggest.
    Myhill goes to the trouble of explaining all about toxic matress fire retardants on her website – do you broadcast this information to benefit others?

    Whether or not a complaint against Myhill has been dismissed is not necessarily indicative of whether her advice is dangerous. As I wrote here: “with regard to my concerns about the content of Dr Myhill’s website, the GMC told me the following. A doctor is entitled to express their opinion, and the GMC does not have the power to censor this.” At no point did the GMC tell me that Myhill’s advice was “safe”, let alone “supported by reliable evidence”.

    You seem very keen on the Richardson report. (Correct me if I’m wrong, but I think this earlier comment of yours refers to Richardson’s hypothesis: “either a very sound theory or a proven fact… but it is not Dr Myhills opinion”). Perhaps this might be of interest: link.

    Since 1971 sudden infant death syndrome(SIDS) have been recorded. In 1989 B A Richardson publicised his hypothesis that toxic gases were released from cot furnishings. The Turner Committee considered the evidence, and in 1991, concluded that the hypothesis was unfounded. Media attention in 1994 focused on antimony in infant tissues and claimed correlation with Richardson’s earlier work. This Expert Group review the Turner Report and subsequent data on SIDS, then recommended future studies. The work commissioned and executed is described fully. Both hypotheses are considered unfounded. The recommendations advise which information needs to be recorded for future analysis. The advice from the leaflet ‘Reduce the risk of cot death’ is endorsed but professional organisations need continuing assessment and review of new evidence and the advice given. Two annexes and four appendices contain additional information including B A Richardson’s reports. References cited at end of some sections

    Any thoughts?

  91. jdc325 said,

    @Alistair

    I feel that you often focus on a phrase rather than a full paragraph – you lose the context in which words are framed, and thus misunderstand the balance of what has been stated.

    I think my attempting to keep my comments relatively brief and avoid tl;dr posts has led you to believe this. With hindsight, it probably would have been better if I’d quoted you fully on SIDS and addressed your views point-by-point (including the points relating to Richardson’s unfounded hypothesis). I think that, regardless of the Richardson hypothesis, my earlier comments regarding Myhill’s advice on putting babies to sleep were sound – but I can see why you might be unsatisfied by a response that failed to address the Richardson report.

  92. jdc325 said,

    Some useful links re the Richardson hypothesis…

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC120786/?tool=pubmed ["The hypothesis was that flame retardants in mattresses and covers might undergo methylation to toxic gases by the action of S. brevicaulis or other microorganisms"; "The polyurethane inner-foam of crib mattresses might be a site for toxic gas formation of group 15 elements, but determination of the level of Sb, As, P, and Bi in crib mattress foam showed no correlation with the occurrence of SIDS. No volatile forms were detected in the headspace of mixed or monoseptic cultures of anaerobes containing polyurethane foams. There was no evidence for a causal relationship between levels of trimethylantimony or total trimethylantimony forms and SIDS".]

    http://www.ncbi.nlm.nih.gov/pubmed/11291741 ["There was no evidence to suggest that levels of trimethylantimony or total methylantimony forms in cot mattress foams have a causal relation to SIDS."]

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC500741/?page=1 ["...no evidence of the presence of the fungus or the production of gases".]

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1718263/?tool=pubmed ["There is no evidence to support a causal role for antimony in SIDS."]

  93. alistair said,

    A good hypothesis with science struggling to find supporting evidence… now where have we heard that before? (yes, it happens all the time)
    It is all well and good to respect science, but to all those addicted smokers using the lack of proof (some years back) as a reason to continue smoking in spite of the likelihood that it causes cancer and contributes to many other aspects of ill health, I suggest they engage their brains, and stop smoking.

    Risks of passive smoking unproven? I am not sure, but I sure as anything suffer from your smoke at the bus stop, just outside a building when the wind blows it inside… do I need proof to feel such folk are selfish and to want the power to force them to think of my health and comfort? No.

    Science is not always so easy as formulating a hypothesis – the latter only requires that we consider a set of factors and ponder how they might explain outcomes.

    Do you have a better hypothesis about the lack of cot death in Japan where they use inert and harmless chemicals as flame retardants, compared to the situation in the UK where we use a number of significantly unpleasant chemicals – chemicals that in and of themselves are not likely healthy bedfellows to the human species?

    How many years did it take Sir Richard Doll to arrive at sufficient evidence that smoking tobacco causes cancer? Was it about 50 years?

    Many parents in the UK today are opting for sealed mattresses. On balance a likely good choice, yet most adults would not want to sleep on a sweat inducing plastic covered mattress, and babies are terrifically good at generating heat…
    ,,,and there was Dr Myhill talking about babies sleeping arrangements in the context of a particularly special, likely hard to obtain in the UK, type of mattress…
    The context is I think really rather important here.

    As for the GMC explaining how they do not have the power to censure opinion:
    “Whether or not a complaint against Myhill has been dismissed is not necessarily indicative of whether her advice is dangerous. As I wrote here: “with regard to my concerns about the content of Dr Myhill’s website, the GMC told me the following. A doctor is entitled to express their opinion, and the GMC does not have the power to censor this.” At no point did the GMC tell me that Myhill’s advice was “safe”, let alone “supported by reliable evidence”.”
    That is nonsense! If a doctor contradicts science and proposes people take actions which put their health at risk, the GMC is perfectly happy to clip their wings – it has done so to Dr Myhill a couple of times, as you yourself have mentioned in relation to her opinions pertaining to vaccination and asthma. Rightly, or wrongly.
    I think the GMC has serious issues relating to incompetence – failing to follow their own rules, failing to act openly, and still lacking independent supervision of their decisions; they sit in judgement on doctors in a form of kangeroo court with little right of appeal for doctors who may have no case to answer yet be suspended in an instant. All of which can actually harm patients continuity of care and their health outcomes.
    The best recent story was where the GMC condemned Dr Myhill for being involved in midwifery whilst under various GMC sanctions… they had not checked their facts whatsoever!!! Really! If they had taken a look at Dr Myhills own website, they would have found that she helped her pregnant sow during birth of its piglets… Did I say GMC and incompetent in the same sentence, then repeat the trick for good effect? Yes, and previously I said GMC and incompetence in the one sentence.

  94. Cybertiger said,

    Well written, Alistair … again! I agree: ‘GMC competence’ is the oxymoron while ‘jdc523 incompetence’ is not.

  95. mrsP said,

    @alistair

    “Do you have a better hypothesis about the lack of cot death in Japan where they use inert and harmless chemicals as flame retardants,”

    They do not have a lack of cot death in Japan. They had 153 in 2008 I believe, not a huge difference with the UK.

    http://www.sids.gr.jp/english/otherrecents.html

    My other link re asthma guidelines:-

    http://www.sign.ac.uk/pdf/sign101.pdf

    You also say:

    “Risks of passive smoking unproven? I am not sure, but I sure as anything suffer from your smoke at the bus stop, just outside a building when the wind blows it inside… do I need proof to feel such folk are selfish and to want the power to force them to think of my health and comfort? No.”

    No you do not need proof to think such folk are selfish in that blowing smoke into someone elses face which may not be pleasant and to an asthmatic especially. However does not prove it causes you actual harm. For this you do need do need research to provide the evidence in order to persuade governments to bring in legislation restricting smoking in public places.

    JDC – i know i am thick and it will be obvious, but how do you put in the nice quotey things you do?

  96. mrsP said,

    apologies for typos, bad grammar etc. in previous post

  97. alistair said,

    Some people appear obsessed with proof via supposed scientific evidence, failing to recognise that a great deal of statistical calculation is involved, thus even when the science is far from infallible, the calculations likely give reason for care in application or for the keeping of a relatively open mind.

    Did I speak of legislation? No.
    I was attempting to get you to comprehend the nature of real life observation against your obsessive ‘need for proof’

    I myself do not need proof of harm from passive smoking – I experienced that harm personally from childhood onwards — I suffer discomfort ranging from induced coughing through to a need for more inhalant to control symptoms. Smoke gets in my eyes too – no, I’m not immune to that old trick – potential amours please note that I find it unattractive.

    mrsP (how do you pronounce your name?)
    I read your statistics on cot death in Japan with interest. It appears from these statistics that SIDS caused 1/19th of infant mortality in 2009 (?)
    that is 0.14 infant mortalities per 1000 births
    Is this similar to the UK or vastly lower than in the UK? In other words, does it still likely support the theory that a difference in the mattress may play a significant role in the lower rate of cot death in Japan?
    Have you not bothered to propose a hypothesis for the cause of cot deaths?

    I revise my understanding of the topic and of the science, though my mind ponders what factors have been considered… it might still be, perhaps for a varied mix of reasons that, the mattress described by Dr Myhill, as with the historical use of horse hair as mattress filling in this country, may be beneficially ventilated. Meanwhile, I know that there are many organisms that we struggle to test for, such that even a thorough autopsy on a SIDS infant would not likely show every micro-organism present – we do not yet have the full picture of pathology in these unfortunate infants,

    Do you know that strange artefact: when someone is unduly stressed they cannot function as they ought?
    So the classic case is the young woman wanting to have a baby and trying, with partner, her hardest… she may be worried about her age, her career, her relationship, her fertility, … etc.
    Well, she does everything in her power to become a fertility expert, does temperature charts, gauges the exact moment of ovulation, etc. etc. etc.
    She has plans for the turn of child making events for the next 5 years…
    But yet she does not fall pregnant, month after month, season after season…
    At some point you learn the young lady and her fella have revised plans and are just going to take things as they come and get on with other plans….
    The very next month she is pregnant! Voila! It’s a boy/girl!

    My point? Well, Dr Myhill may yet be benefiting some people by talking about child rearing in relaxed healthy terms – good nutrition this, good environment that, sensible planning the other (esp. good nutrition for the mother) … much nutritionally good information, information on more worrying aspects, and mostly reassuring and likely beneficial as a result
    Besides, her comment about lying an infant on its side may have been edited out, so not really worthy of further comment, and the related pages give a lot of helpful information to consider:

    http://www.drmyhill.co.uk/wiki/Category:Women%27s_health,_fertility_and_healthy_babies

  98. mrsP said,

    “Some people appear obsessed with proof via supposed scientific evidence, failing to recognise that a great deal of statistical calculation is involved, thus even when the science is far from infallible, the calculations likely give reason for care in application or for the keeping of a relatively open mind.

    Did I speak of legislation? No.
    I was attempting to get you to comprehend the nature of real life observation against your obsessive ‘need for proof’”

    I am aware that some statistical calculation is involved and that science is fallible. That is precisely why we need evidence that is published, can be peer reviewed and replicated. There can then be a consensus, until such time research improves on that knowledge. I am more inclined to rely on such knowledge than on the opinion of any person, for we all can have unreliable memory, our opinions can be subjective and/or we have conflicts of interest.

    On passive smoking – you may not need evidence or want it but if you want to improve your situation or that of others with asthma, and stop others smoking in your face, you need legislation IMO and that DOES require evidence.

    On cot death there is no definitely known cause. SIDS happened long before fire/flame retardant mattresses. A would have been great aunt was one. Risk factors are prematurity, low birth weight, lying on the front or side, exposure to smoking, high temperature, sleeping with adults, duvets, pillows. (NHS choices, various SIDS organisations) I would not attempt an hypothesis on the cause as I am simply not equiped to provide one. I leave that to experts who have trained and then specialised for years.

    As for your link, I would disagree with much written there. THat will have to be left to another time.

  99. jdc325 said,

    I think the GMC has serious issues relating to incompetence…

    I think you may be right.

    You may also be interested in the comments of the GMC’s former president quoted in this article. I was.

    The former GMC president, Sir Donald Irvine, is deeply concerned at the ease with which poorly performing doctors appear able to move around the NHS and what he says is the GMC’s failure to ensure high standards. Irvine pushed for the introduction of revalidation for doctors after the Bristol babies scandal in the 1990s – poor performance by children’s surgeons at Bristol Royal Infirmary meant babies with heart defects were more likely to die there than if they were under the care of more skilled surgeons at other hospitals. But revalidation – five-yearly recertification that doctors are up to the job, based on annual assessments – is still not in place. Irvine told the health select committee earlier this year that the GMC permits doctors to carry on working who would not pass basic medical exams.

    “As things stand, the bar is far too low,” he said. He is concerned that the bar will not be raised when revalidation is in place, because some GMC panels, which will make the final decision on problem doctors, “incline to give the doctor rather than the doctor’s patients the benefit of the doubt”.

    Another point:

    A good hypothesis with science struggling to find supporting evidence… now where have we heard that before? (yes, it happens all the time)

    And how should someone react when it turns out that the evidence does not support their hypothesis? Should they maintain that the hypothesis is good, therefore the evidence must be wrong? Or should they accept that, however neat their hypothesis was, the evidence against it means that the hypothesis should be dropped? Did you read the links I posted showing that the Richardson hypothesis had been researched and that the evidence showed no causal relationship between the mattresses Richardson complained of and SIDS? They researched the purported link between SIDS and (types of) mattresses, just as they did the purported link between SIDS and sleeping position. They found an association for one hypothesis (ignored by Dr Myhill) and no association for the other (adopted enthusiastically by Dr Myhill).

    [Edited to add text between quotes, in order to make it obvious where the Irvine quote ends and a quote from Alistair's comment begins.]

  100. jdc325 said,

    how do you put in the nice quotey things you do?

    It’s not obvious, but you need to use these tags: [blockquote] and [/blockquote] but with < (less than) and > (more than) symbols instead of [ and ]

    [Edited because WordPress keeps thinking the symbols are part of unclosed tags.]

  101. alistair said,

    JDC325 to answer your question out of context (it was reference what one should determine viz ones neat hypotheses versus scientific evidence or the current lack of it in support…)

    In my opinion it is quite simple what one ought to do…
    Think twice before viciously and routinely attacking, again and again and again, a doctor who would easily pass medical exams if she sat them tomorrow. Tired? She would pass them again the following day and the one after that. Why? Because she knows her medicine and is physically fit and healthy – mentally tough, fit as a fiddle, stamina honed by dealing with the GMC wrongfully threatening her career.

    This is a doctor who routinely examines her patients.
    A routine that reminds me of that I witnessed performed by Dr Daymond prior to his retirement last year – 15 minutes physical examination and 15 minutes of querying a symptom diary (not my own) and time considering food diary too.
    I understand that today doctors have only a few minutes with their patients, yet is it not better that a patient with complicated symptoms has longer with their doctor towards identifying, diagnosing and finding suitable curative treatment (if this is possible) than that same patient visits the surgery repeatedly without suitable medical examination, never getting better, irritating the doctor (who believes that their unexamined patient is an obvious hypochondriac or depressed, or attention seeking, etc.) and using far far more NHS time?

    Dr Myhill, as you well know – if not, read it on her website – has had the very considerable inconvenience of multiple mostly entirely disingenuous/conflicted/unpleasantly motivated/unjustified complaints made against her to the GMC, wherein the GMC has acted unprofessionally, and against the medical/health interests of Dr Myhills patients who were left to suffer whilst Dr Myhill was needlessly suspended. All of this without obvious communication between complainant and Dr Myhill (opportunity to answer the concerns prior to GMC action) and without preliminary discussion with the GMC to address the issues before high handed, careless action was taken.
    Further, all this without one single patient complaint, and without any evidence (you would like that, wouldn’t you?) of harm done and certainly without any thing more than disagreement about the dangers of voicing opinion that contradicts current medical doctrine (howsoever that is supported by the ‘proof’ that is scientific evidence – medical or statistical, primary data analysis or meta analysis of a bunch of research projects that were not designed to test the hypothesis ‘tested’ by the new statistical meta-analysis.)
    By contrast, and for some perspective, other doctors (go ahead – look them up via google search) who have made errors resulting in the death of one or more patients have been allowed to continue practising medicine without significant penalty nor lengthy suspension.

    Dr Myhill is a professional who looks after her own good health just as she does for her patients. She is not some fat, over paid, arrogant, complacent, ‘play complicated medicine by the simple guidelines’ [which ensures that I keep a low profile and don't upset any quangos such as NICE] uncaring consultant, who fears loss of salary far more than s/he worries about the well being of their patients.

    Did you bother to address my critique of the majority of doctors who no longer examine patients, even those presenting multiple symptoms over a prolonged period of time? Doctors who show no professional interest in attempting to comprehend what it is that is wrong with their patient, as a whole, yet willing to send them for varied costly (to the NHS) referrals for specific issues unlikely to comprehend the entirety of their patients pathology. Doctors who may never have had any real interest in examining their patients…
    Did you comment when I mentioned that patient examination is no longer on the UK medical syllabus?
    Did you notice my failure to mention that study of human anatomy has also been dropped from the UK medical syllabus?

    Medicine in the UK is going to get a whole lot worse in the years to come, and not only for lack of limitless funds, but because the focus on identifying the medical problems of the most sick patients has not been prioritised, instead, GP surgeries are now the most superficial place to have medical attention.

    My hypothesis is that Dr Myhill seems to get an entirely disproportionate amount of bile directed at her, perhaps simply because her website is such an accessible source of her views to target… yet up and down the country, in every large town and all cities, there are far less competent doctors going through the motions of their careers, some hating the job, some hating the sick, some struggling to do a professional job… 4 minute appointments, targets, paperwork incentivised with hefty payments, NICE and self-appointed medical experts combining to ‘run out of town’ all doctors who challenge those guidelines with their own lengthy clinical experience. I challenge all readers of this blog to complain to the GMC every time their own GP or consultant fails to act professionally. I challenge any reader of this blog to befriend a very ill person by joining a support group, and support that person by attending their medical consultations, and in finding out how badly some are treated, within hospitals, by top medical staff, to make good on all of this bile within you all, by taking the situation up via complaints to the GMC.

    Now that Myhills website is adjusted following varied inputs, including concerned parties actually talking to her — this small courtesy is only reasonable — is Dr Myhill really such a relevant target for all the bile you can place at her door?

    You won’t improve medicine UK much by attacking her, nor medical outcomes for her patients. There are very very few people actively improving the health of the nations ME (I prefer CFS) sufferers – all GPs seem to believe that such patients are hypochondriacs, malingerers and attention seekers.
    My friend suffered all of this abuse from GPs for many years.
    Well, the NHS and NICE state that testing for vitamin A is not justified / not cost effective. (can you see where this is going yet?)
    The NHS and NICE state that CBT and GET are the appropriate ‘evidence based’ treatments for ME.
    The NHS and NICE don’t test vitamin A levels.
    (can you see where this is going yet?)
    My friends proved to have been seriously deficient in Vitamin A. It was not the only issue to resolve, but the NHS would not discover that a limping ME patient had a broken leg – they are that blindly set upon their mantra of evidence based medicine…
    Does 80% success of a treatment mean that treatment is proven and should be given to all of the relevant patient group?
    NO!
    If 2% are damaged by the 80% treatment, but helped by a different treatment, and you happen to be amongst that 2%, then, for you, that ‘2% effective’ treatment is 100% effective for you. This is why evidence based medicine does not work for a good many patients, and some of them are the most ill.
    If CBT and GET improves your ME/CFS then it is entirely likely that you were a little depressed and too inactive in your couch potato lifestyle.
    If you fit the real symptom set of someone with CFS then CBT may or may not prove interesting, but GET will harm your recovery.

  102. Cybertiger said,

    Well said, Alistair! You’re absolutely spot on … and I should know … I’m a GP … and have been for 25 long years.

  103. anarchic teapot said,

    @alistair
    Just one point, because (a) you endlessly repeat the same claims, despite your arguments being disproven or completely off-topic (b) your ad hominem attacks are hardly going to impress anybody. You say:

    they are that blindly set upon their mantra of evidence based medicine…
    Why would one give medicine without any evidence that it is needed, or is even safe? One should not assume a broken leg because somebody is limping.

    Your assertions are mostly evidence-free, your arguments specious and circular, and you really should learn to differentiate between constructive criticism and smearing. Please try to address these failings.

  104. mrsP said,

    Your challenges are not necessary. We are in fact trying to protect any number of sick/vulnerable/gullible people by pointing out erroneous information on websites/media from any source. No bile, no singling out. The website in question is just one of many.

    Your experience of life appears to be very sad but you should realise that this does not happen to everyone and in my experience with a local charity helping disabled, disadvantaged and elderly people, the vast majority are more than happy with their medical treatment.

  105. Cybertiger said,

    The potty little teapot, nihilistic or otherwise, is not an impressive object. Pisspot!

  106. mrsP said,

    My previous post didn’t come out as I planned – It should have been addressed to Alistair.

  107. Cybertiger said,

    mrsP feebly wittered,

    “I am aware that some statistical calculation is involved and that science is fallible. That is precisely why we need evidence that is published, can be peer reviewed and replicated. There can then be a consensus, until such time research improves on that knowledge. I am more inclined to rely on such knowledge than on the opinion of any person, for we all can have unreliable memory, our opinions can be subjective and/or we have conflicts of interest.”

    mrsP’s ineffectual witterings reminded me of one of the BMJ’s rather more pathetic Christmas offerings (but I’m sure you’ll love it mrsP),

    “When balance is bias”

    http://www.bmj.com/content/343/bmj.d8006?tab=full

    … that underlined the infallibility – and peerless arrogance – of some scientists – particularly Brian Cox, the pretty professor and daydream-believer with a Lancashire accent. Sad, really – I thought our Brian was better than that.

    And talking of the endless fallibility of statistics based medicine; I particularly liked today’s rapid response, “Journalists, mavericks and dissidents”, from James Penston, a consultant gastroenterologist in Scunthorpe, and author of,

    “Stats.con – How we’ve been fooled by statistics-based research in medicine.”

    This is a good read: all those gold standard, peer reviewed RCTs, are nothing but a load of cobblers – apparently.

  108. jdc325 said,

    @alistair,

    Thank you for your comments. Given that they seem to consist mostly of complaints of viciousness, anecdotes, complaints about doctors who aren’t named Myhill, and (bizarrely) complaints about scientific evidence, I’m not persuaded by your arguments.

    Do you dispute that there is misinformation on Dr Myhill’s website?

    Do you dispute that doctors are required, if they publish information about their medical services, to make sure the information is factual and verifiable?

    I think it’s quite clear that there is information published on Dr Myhill’s website that is not “factual and verifiable”. I’ve provided some examples, and others are still available on Dr Myhill’s site. As well as the examples in this post, you can see here the post in which I first mentioned her advice on placing babies to sleep on their sides. I referred to the NHS advice in my post, and a commenter added links to some papers addressing sleeping position and SIDS. I’ve also pointed out in comments above that the Richardson hypothesis on which Myhill relies is unfounded, baseless, not something that should be used to inform clinical judgement.

    This link is from the GMC’s guidance on good medical practice. Here’s what it states:

    60. If you publish information about your medical services, you must make sure the information is factual and verifiable.

  109. Cybertiger said,

    jdc352: you really are a tireless, baseless, spineless, tosspot.

  110. jdc325 said,

    @Cybertiger,

    This is a good read: all those gold standard, peer reviewed RCTs, are nothing but a load of cobblers – apparently.

    As a GP for 25 years, what would you suggest should be the ‘gold standard’ for evidence of efficacy of medical treatments? Enlighten us, Cybertiger. Are you really suggesting that peer-reviewed RCTs are “cobblers”? If so, what do you think would be better than an RCT. How should we decide which treatments work and which don’t?

  111. Matthew said,

    @Alistair,

    This is a doctor [Myhill] who routinely examines her patients.

    Her own testimony to the GMC was that she recommended a patient be given IV magnesium and Vitamin B12 injections. This patient was never seen or spoken to by her; the advice came after the patient had a blood test.
    So why didn’t she examine this patient? Is this only the tip of a large iceberg highlighted through the vigilance of the patient’s GPs? How many other patients does she give remote advice about, or offer prescriptions for without taking histories or examining them?

    The complaint relating to Dr Myhills advice on babies [lying on their sides] was dismissed

    Errr, no it wasn’t dismissed, but only because there never was a complaint to the GMC about this particular idiocy in the first place. Please familiarise yourself with the facts of the case, would you?

    PS It would be good if you directly answered jdc’s questions to you about your opinion on her advice, and whether you feel it is appropriate or based on sound evidence. Please try to do this, and do it succinctly, rather than writing reams of words about how marvellous she is and how terrible other doctors are.

  112. Hammerdoc said,

    @Alistair:

    I just want to take issue with this bit:

    “Dr Myhill did not state that lying a baby on its side prevents cot deaths… far more interestingly, she outlined how cot deaths are unknown in Japan – how they use fire retardants in their mattresses based upon the rather inert element, Boron, whilst we use all manner of funky brominated chemicals, and when, over time, these chemicals get attacked by fungal growth, especially on reused mattresses that have the secretions of a previous infant upon them, they may release some very toxic chemicals. Hence it is wise to NEVER reuse infant mattresses for 2nd born, etc.”

    Japan doesn’t use “the rather inert element, Boron” as a fire retardant. It uses compounds of Boron known as Borates, which are classified as “Substances of Very High Concern” by the EU.

    Dr. Myhill is actually advocating exposing babies to reprotoxins. Nice!

    Your unthinking support of such a dangerous quack speaks volumes.

    Oh, and cot deaths are not unknown in Japan. They are lower than the UK, but still pretty common.

  113. alistair said,

    archaic teapot wrote:
    “they are that blindly set upon their mantra of evidence based medicine… Why would one give medicine without any evidence that it is needed, or is even safe? One should not assume a broken leg because somebody is limping. Your assertions are mostly evidence-free, your arguments specious and circular, and you really should learn to differentiate between constructive criticism and smearing. Please try to address these failings.”

    Oh dear! Oh dear! Oh dear! You really cannot comprehend irony, can you? You are so canalised in your views that any opinion that differs gets your goat every time.

    Evidence based medicine is a mantra, a basis for addressing possible treatments through considering research outcomes, but it is not the answer in all cases: It relies upon statistical analysis of research results to draw conclusions about the most effective treatment, and then, in being translated in to treatment guidelines, has people blithely assuming that one size fits all — that the evidence shows that 100% of patients are helped by the specified treatment. WRONG! Some patients may be killed by the most commonly helpful treatment – their pathology/physiology/genetics may not be addressed by the research study.
    What counts as most effective? Success in 70% of the test group? 60% compared to 2 other treatments that helped 10% each respectively? 50% compared to 4 other treatments that only helped 15% each respectively?
    So, if you are not one of the 70% 60% 50% … the evidence based medicine might be inappropriate, or even harmful … whereas your complicated health problems/genetic disposition might require an entirely different approach, possible one not even considered in any existing research… human health and genetics and pathology are all pretty damned complicated, such that it is unlikely in cases of the most complicated ill health, that one (treatment) size fits all.
    Then there is the response to treatment that occurs only when a doctor begins treating their patient…
    Suppose a doctor begins by addressing an infection with antibiotics prior to dealing with arthritic symptoms… and in so doing, finds that the patients arthritic symptoms improve greatly with the antibiotics. What is the doctor to do? Ignore that improvement and proceed to treat the arthritis with steroids? That would be a little careless don’t you think? It might be that the antibiotic is providing some anti-inflammatory benefit, or that there is some unseen infection causing the infammatory joint symptoms… eg. lyme disease… Doctors are not straight jacketed by guidelines unless they are clueless.
    NICE guidelines are correctly based upon evidence based medicine, but a physician is still free to use their clinical judgement towards best addressing their patients recovery from ill health.
    The GMC cannot censure a doctor for stating an opinion, especially where that opinion has a sound basis in fact / research.

    Limping versus a broken leg.
    I was illustrating what NHS/NICE guidelines have done to health care by making acceptable the presumptive diagnosis on appearances in place of diagnosis based upon patient examination.
    One should not assume that someone with multiple symptoms is: a hypochondriac / an attention seeker / a depressed malingerer – yet this IS the experience of thousands of chronically sick people who have not received any help from the NHS.
    In the limping example, obviously one should not assume that someone limping is pretending or attention seeking or has a broken leg! That would be nuts unless they have a clearly broken bone sticking out of their skin from upper or lower leg… You or I would need to examine that person to establish what was actually causing the limping. Are you with me now? Do you get it?

  114. alistair said,

    You said:
    “Do you dispute that doctors are required, if they publish information about their medical services, to make sure the information is factual and verifiable? I think it’s quite clear that there is information published on Dr Myhill’s website that is not “factual and verifiable”. I’ve provided some examples, and others are still available on Dr Myhill’s site. As well as the examples in this post, you can see here the post in which I first mentioned her advice on placing babies to sleep on their sides. I referred to the NHS advice in my post, and a commenter added links to some papers addressing sleeping position and SIDS. I’ve also pointed out in comments above that the Richardson hypothesis on which Myhill relies is unfounded, baseless, not something that should be used to inform clinical judgement.”

    Dr Myhills publishes her opinions and a discussion of science and research informations. She is a Doctor and does have a practise and does see patients and so on, but her website is not a diagnosis of me, you, them, anybody … and you keep mentioning something she said about babies out of context, and I believe that your out of context requotes are more dangerous than her words in their original context. Someone may google and find your words involving the words babies and sides and draw the opposite conclusion to that which you espouse.

    So, are you advocating a situation where anyone saying anything that does not appear in peer reviewed science research papers as the verified best approach, should be silenced?
    Did you read Big Brother and think it sounded like a Utopian world?
    Are you aware of the serious flaws in our peer review system?
    I guess not.

    As for you (and others) denouncing the Richardson SIDS / cot death hypothesis, I think you are forgetting the well accepted statistical dictum – absence of proof does not equal proof of absence.
    Can you prove that the Richardson hypothesis is wrong?
    Have you quoted any such proof? Nope. You have quoted research that did not agree with his findings. That did not find evidence to support his findings.
    Now, just suppose, that those later studies were funded by vested interests who, for example, have a lot invested in modern fire retardant chemicals… perhaps funded ever so discreetly… and just suppose that peer review of that later research was flawed for the same reason…
    Are you feeling quite so certain that Richardson is DEFINITELY WRONG WRONG WRONG WRONG … now? Speak up! You can’t actually be certain, but you feel pretty sure? What – 60% sure? 90% sure? on what evidence? Is your evidence verifiable?

    The myth of evidence based medicine is in part that it is proven and verifiable… that it ‘works’. Yet, if you are among the minority that were not helped by the researched treatment that happened to help, what, 65% of the study group, does that evidence based treatment work for you? no. What if the research or statistical or meta-statistical analysis on which the scientific facts are demonstrated was flawed? What if the peer review process was flawed?

    In spite of guidelines formulated with highest regard for evidence based medicine, which in any case can only ever be a guide, since a patient may not be alike to those beneficially treated during the research study… much of medicine proceeds as a result of a doctors observation of their patient; if a patient responds well to a treatment, a doctor may choose to continue that treatment, even when this does not happen to neatly coincide with the outcomes statistically analysed of some medical research. If a patient responds negatively to the guideline recommend, evidence based relevant treatment, a Doctor may need to try something else.

    Now, can that treatment be justified? yes, obviously.
    Can that treatment be proven and verified as correct? no. It cannot begin to be verified by the methods of general medical research since that would require 50+ patients (to even begin performing statistical analysis of the results) and double blind trials and suitable controls (who wants to guess what a suitable control might be for this study? Why are they a useful control? Shall we begin be cloning the patient so that we can ACTUALLY compare the outcomes of a variety of treatments? Now that would be a useful control group – 100 identical patients treated dissimilarly! …treatment of an individual at the time they require treatment cannot be verified by modern medical research/statistical analysis and therefore all Doctors are failing to comply with your ‘rules’ in their everyday treatment of every patient.

  115. alistair said,

    A good quote:
    “mrsP feebly wittered, “I am aware that some statistical calculation is involved and that science is fallible. That is precisely why we need evidence that is published, can be peer reviewed and replicated. There can then be a consensus, until such time research improves on that knowledge. I am more inclined to rely on such knowledge than on the opinion of any person, for we all can have unreliable memory, our opinions can be subjective and/or we have conflicts of interest.”

    and reference one of many interesting books on, let us say, the weaknesses and difficulties underlying much evidence based medicine.

    mreP: What is it that you are saying? Do you realise that you contradict yourself to the point that you sound entirely confused.
    … You are aware that some statistical calculation is involved [ie. the outcome could be entirely meaningless or worse the opposite of the truth - statistics get complicated where the test subjects are entirely heterogeneous - as compared to comparing the medical history of identical twins] and that science is fallible [so you accept that any piece of 'evidence based medicine' might be entirely wrong, even harmful].
    Then, quite astonishingly, you go on to say “That is precisely why we need evidence that is published, can be peer reviewed [actually, to get published the peer review has already happened] and replicated. ????
    So in sentence 1 you outline how all of medical research can be entirely flawed, and in sentence 2 you extoll the virtues and importance of medical research… a self-contradiction if ever I saw one.
    This ‘evidence’ that you reference is the result of statistical analysis of medical research – if that research is flawed, there is no reason the resulting ‘evidence’ can be trusted whatsoever. Since most medical research involves heterogenous subjects, with an unquantifiable number of uncontrolled aspects, one might say that much of such research is a matter of judgement rather than scientific provability.
    The peer review you mention is just one part of our science paper publishing environment that has been shown to be subject to intense pressure from vested interests, which may make any paper that you read prone to promote a point of view rather than anything nearly resembling scientific fact.

    So much so, that a Doctor writing their opinions based on their reading/research and their experience in medical practise, may come closer to the truth than the peer reviewed science papers. I doubt that this is only my opinion – likely it is an opinion shared by many others.

  116. Cybertiger said,

    If it’s as blunt as a nail, sharp as a hammer, quacks like a duck, farts like a doc …. then it’s very probably an arsehole.

    Hammerdoc said,

    “Your unthinking support of such a dangerous quack speaks volumes.”

    While there is mention of dangerous quacks, here is recent talk,

    http://bit.ly/wR6q9q

    … of a couple of that most dangerous species of arsehole.

  117. alistair said,

    You wrote:
    “Her own testimony to the GMC was that she recommended a patient be given IV magnesium and Vitamin B12 injections. This patient was never seen or spoken to by her; the advice came after the patient had a blood test. So why didn’t she examine this patient? Is this only the tip of a large iceberg highlighted through the vigilance of the patient’s GPs? How many other patients does she give remote advice about, or offer prescriptions for without taking histories or examining them?”

    Perhaps you are familiar with her testimony?

    http://www.drmyhill.co.uk/wiki/Dr_Myhill_defends_her_case_at_the_General_Medical_Council_Interim_Orders_Panel_hearing

    Here we find that there are all manner of discrepancies in the complainant GPs story, also in the expert witnesses story, and, that the expert witness is by no means an expert.
    Then the transcript provides this exchange:

    “THE CHAIRMAN: Thank you. I have a few questions for you. Relating to the first complaint and the son of Mrs X, who in effect was the patient, is it right that you prescribed without seeing the patient? A My recommendations were to the general practitioner, and I did not prescribe anything to the patient. I merely requested that the GP oversee the provision of B12 and magnesium injections. The GP agreed to do the blood test originally in order that the patient could have the relevant test. I then made the recommendations to the GP to provide the B12 and magnesium injections and show how these should be administered. In the event the patient did not receive any B12 or any magnesium injections from anybody.
    Q Would your normal practice be to prescribe yourself but then inform the GP what you have done? How does it work out— A It depends very much on the circumstances. I use B12 injections and magnesium injections very widely in my practice, I find them very helpful for a range of conditions, and my normal policy is I always inform the GP, I always ask the GP if they would be prepared to oversee these injections and do them. In the event of that GP refusing, and if the patient still wants to go ahead with them, then they have to find a trained professional who can show them how to do the injections, which is often me, and then I supply them with the necessary to do them and again keep the GP informed.”

    Let’s keep this in perspective: The vitamin B12 injection she recommended would quite likely do most anyone some good, and would do no harm to anyone. The magnesium injection likewise.
    So on the basis of risk, after conducting a precise blood test looking at red cell magnesium (something the NHS do not choose to do), Myhill put whom at risk? And is it possible that Myhill risked a patient having an improved health outcome?
    Now, this was referred to the patients GP, and that GP determined that they could not help the patient as they did not understand the science (and had presumably not bothered to read up on it).

    Tip of the iceberg… relevance? If this were the tip of the iceberg and Myhiil is often causing a risk of no harm only of possible benefit, and along the way, might be sharing information about a detailed blood test and the science informing it, that aids a GP to better help their suffering patient… where is the harm? or danger? There is none.
    You are making a molehill out of a worm cast.

    Elsewhere in Blighty, wee find that GPs are not practising patient examination and medical students are not learning about patient examination nor about anatomy — yes, that’s right, future consultants are not getting a grounding in patient examination, and future surgeons are missing out on several years of studying anatomy… is this not more worrying than Dr Myhill recommending harmless but possibly beneficial injections of B12 and Magnesium ??

  118. Cybertiger said,

    @jdc352

    The evidence for the proposition that the RCT is generally a load of old statistical cobblers is to be found in James Penston’s book, ‘Stats.con’, currently £12.99 from Amazon.

    http://amzn.to/xWJUo0

    I’ve read the book and the evidence is compelling.

  119. Matthew said,

    @Alistair

    You miss the point (deliberately?)
    You said Myhill routinely examines her patients.
    I gave an example of where she did not do this, which you accept.

    Accept that your statment was in error, and move on. I am not bothered about whether her advice was appropriate or not. For all I know it may have been brilliant, but the point is she does NOT examine all her patients.

    Second point you failed to address – you claimed her advice to put babies to sleep on their side formed part of the GMC complaint.
    It quite obviously didn’t.

    I mention these 2 small “errors” of yours to show your own grasp of the issues and the evidence here is faulty. Your posts are long, verbose and rather boring, and I haven’t bothered to read much of what you say, so for all I know there are many more errors of fact I haven’t seen.

    Facts matter.
    You can keep your errors of opinion, those you are entitled to.

  120. Matthew said,

    @Alistair,
    Just noticed another one – twice now you have claimed UK medical students are not trained in clinical examination of patients.

    This claim is like saying astronomers are never trained in using telescopes.

    I hope you will provide evidence of your unbelievable claim, preferrably with linked reference to undergraduate medical curricula?

  121. alistair said,

    Matthew
    “You miss the point (deliberately?)”
    A little sensitive? Nothing deliberate – no slight intended.
    “You said Myhill routinely examines her patients.
    I gave an example of where she did not do this, which you accept.”
    The word routinely in this context does not necessarily mean that she examines 100% of her patients – my point is one of perspective: GPs tend not to examine their patients, certainly not those with complex/multiple symptoms, which category are much more likely presumed to be attention seeking hypochondriacs without any examination by GPs and consultants alike, meanwhile, medical students no longer study patient examination – it has been dropped from the syllabus.
    So, by comparison, a doctor that routinely (the vast majority of the time) examines her patients is somewhat of a marvel. Don’t you think so?

    The example given is also somewhat of a moot point: she did examine the patients blood, which, again, is a lot more than many GPs do when guessing at a diagnosis – but she did not prescribe anything, but informed the patients guardian and GP of the results, and gave expert indication of a route of treatment as indicated by that blood test. And, this was no standard NHS blood test, so, if it looked at red cell magnesium levels, it would have given good evidence of likely benefit from magnesium injection per her recommendation.
    Are you missing my point now?

    “Accept that your statment was in error, and move on. I am not bothered about whether her advice was appropriate or not. For all I know it may have been brilliant, but the point is she does NOT examine all her patients.”
    If I said “all” then I was in error, however, she did run a blood test and examine the results.

    “Second point you failed to address – you claimed her advice to put babies to sleep on their side formed part of the GMC complaint.
    It quite obviously didn’t.”
    Apologies. I am certain that I did not use those words “part of the GMC complaint” – there have been several complaints, all almost entirely without foundation. Reading them all again to see whether this additional point, originally mentioned on this blog out of context, was part of a previous GMC complaint was not about to happen. I stand corrected on this minor point of inconsequential fact.

  122. alistair said,

    And one more thing:
    “I am not bothered about whether her advice was appropriate or not. For all I know it may have been brilliant…”
    “Facts matter.
    You can keep your errors of opinion, those you are entitled to.”

    Ironic this considering that the patients mother was obtaining a medical second opinion, and this is what Dr Myhill provided after examining the patients blood with the knowledge and cooperative assistance of his GP.
    Opinions matter, and in medicine a second opinion that shines a light where previously the medical answer is unclear, is a wonderful thing.

  123. Becky Fisseux said,

    @Cybertiger

    You’ve been a GP for 25 years? That’s not entirely true, now is it. Not 25 years uninterrupted, certainly. (As can be seen from this: http://www.bedfordshire-news.co.uk/News/Sacked-GP-hits-out-after-losing-claim.htm )

    A small point, but I feel it’s an important one.

    Kind regards,

    Becky

  124. alistair said,

    “@Alistair, Just noticed another one – twice now you have claimed UK medical students are not trained in clinical examination of patients. This claim is like saying astronomers are never trained in using telescopes. I hope you will provide evidence of your unbelievable claim, preferrably with linked reference to undergraduate medical curricula?”

    Well spotted! I wondered when someone might comment upon this recent change to the medical curriculum, this and the dropping of the study of anatomy.
    So it is current tense, not past tense:
    “medical students are … no longer going to be …trained in clinical examination of patients”
    Although my words, in quoting a well informed, still academically active, retired surgeon, were about “patient examination”. In sad fact, this too, is past tense, as he passed away late last year.

    “This claim is like saying astronomers are never trained in using telescopes.”
    Yes, quite unbelievable, isn’t it?
    Except that it would be more like, “astronomers will no longer be trained in using telescopes”.
    However, to all those patients suffering complicated illness with multiple infections, especially those that appear “ME like”, wherein their GPs never examine them, instead guessing that it is all in their mind and referring them for CBT and GET, which, the well known Dr Myhill points out in quite some scientific detail is categorically the wrong ‘treatment’ for a good many such patients.

    Medical syllabus evidence
    I suggest that someone well informed with access to the current medical syllabus, or to a medical student forum, or to a friendly current 1st year medical student via facebook etc. has it looked up – I have no reason whatsoever to doubt my source, no reason to check his statement, but I sense that this is something that has put your jaw so heavily on the floor, you might need more than a stiff drink or a hefty doubt of anything I state to rectify your faith in the infallibility of Medicine UK.

    Yet GPs up and down the country are already not examining chronically ill patients – more than 2 symptoms and the attention seeking / hypochondriac patient is extracting the pee. Even infectious disease consultants will just sit and tell a patient with all manner of symptoms that they need CBT without so much as taking their pulse or considering differential diagnoses based on the lengthy list of symptoms that include obvious signs of chronic infection.
    So it should not be so much of a surprise that management of medicine UK have determined that there is no need for patient examination during a 3 minute consultation when the guidelines should suffice to steer a GP towards the appropriate conclusions for running a test, prescribing, or referring the patient — the faster all of this happens, so their thinking must run, the more efficient and cost effective the NHS will be!!! Wrong. Oh, so very wrong. Treatment effectiveness is often dependent upon accuracy of clinical diagnosis and that will rely upon those skills of clinical examination.

  125. Cybertiger said,

    Another arsehole, a big prick and yet another fissure-in-ano. A small point, but I feel it’s an important one.

    Eh, Brian?

  126. Cybertiger said,

    PS. Whoops, sorry, I meant, Becky … of course.

  127. mrsP said,

    @alistair

    And you say I am confused!

  128. alistair said,

    @mrsP – “And you say I am confused!”

    Yes, that is correct, you are, or were in the context of what you had said, confused. Or did you intend self-contradiction within 2 short sentences to demonstrate that you are right at the top of your game – that you understand the implication of anything being talked about herein?

  129. mrsP said,

    No alistair I am not confused and I did not contradict myself. Of course the research of science can be flawed and statistics can be done badly, which is why we need the process of research – publication – peer review – replication.

    If the science in this process is shown to be flawed then its back to the drawing board. Strangely enough research that gets through the process can then be used either for further research and in the search for treatment for a disease in the case of medical research.

    This is the way science progresses.

    Oh and you are wrong on peer review – get your facts right.

  130. alistair said,

    Okay @mrsP – So I am wrong, having stated what I believe… would you be so kind as to state what the truth is, since apparently you know?

    “get your facts right” – so, what are the facts?

    You are saying, if I am able to read between the lines, that the peer review process of scientific research is without flaws, is perfect, there are no vested interests muscling in and either preventing publication of science that runs contrary to their interests, or, affirming via positive peer review poor research in order to subvert the science in promotion of their interests?
    Is this what you would have me believe? It is a very naive and disproven notion.

    “Of course the research of science can be flawed and statistics can be done badly, which is why we need the process of research – publication – peer review – replication.”
    Sorry, but you have that somewhat in the wrong order:
    The standard meaning of peer review is the process involving review of research papers prior to their being approved for publication. This route is not infrequently subverted to prevent the publication of good science papers that run contrary to the interests of business or individuals, or to promote as worthy papers that are of lowest quality or even falsified, in order to promote some self-interested untruth.

    The peer review you are talking about is that of professionals being able to read published items. However, this type of peer review does not ordinarily expose the full research data to critique, only the polished prose of the authors – plenty of bad science and flawed data can be concealed. In addition, post publication, the cat is out of the bag, such that no amount of negative reviews from peers will prevent that adverse/wrong information being read and believed, even repeatedly quoted, by a good many.

    Replication is a pretty good bet, but, as I said much earlier, as with the connection between smoking and cancer, one does not always need proof in order to wisely take action, and waiting for that proof can take so long, if ever it arrives, that action is no longer possible nor useful. How long did Richard Doll and Richard Peto look at the cancer link to smoking?

    Where a Doctor is dealing with one very ill patient, on occasion it is possible, even wise, to test by treating – if the patient responds to the treatment you have a better idea what is wrong or what may help [Hugh Laurie as House MD eat your heart out] whereas the wrong test or an inadequate test might tell you nothing.

  131. Cybertiger said,

    Thank you, Alistair, for linking to Sarah Myhill’s page on the testimony she gave to the GMC in April 2010. I had not read it before. I was shocked.

    http://bit.ly/ADbrrD

    I was shocked at the behaviour of the GMC. In fact my reaction to reading her account was one of rage, fury, disgust and utter contempt for the GMC.

    The GMC is a disgrace, pure and simple.

    It’s a matter of supreme embarrassment that I happen to be registered with this pathetic organisation – but I have to be registered to earn a living in the discipline for which I trained and have long experience. Sarah Myhill is quite obviously a remarkable person and I admire her and her resilience against all the odds. Both she and Andrew Wakefield stand head and shoulders above the medical establishment goons who harass them. A plague on the GMC, the BMJ, Brian Deer and Ben Goldacre’s host of miserable little acolytes – useless eaters all!

    Competing interests: I learned today that Andrew Wakefield and Sarah Myhill both qualified in 1981. So did I. Spooky, huh!

  132. mrsP said,

    @ Alistair

    Fair enough I was may be wrong about peer review. A paper would be peer reviewed before publication in a reputable journal. However not all faults may be picked up then, which is why you have to publish so that others can read and criticise and learn of course. And this to me, a lay person, seems like peer review and is vital. Sometimes problems will not arise until attempts to replicate are made.

    You talk about lung cancer – so what do you think of Dr Myhill’s view on that – that if you find it on X ray it is too late? Hope someone with a treatable tumour does not read that bit.

  133. alistair said,

    @mrsP – “A paper would be peer reviewed before publication in a reputable journal. However not all faults may be picked up then, which is why you have to publish so that others can read and criticise and learn of course. And this to me, a lay person, seems like peer review and is vital.”

    Not quite, no. In essence, if a paper fails peer review then it does not get in to the prestigious journals, and it may or may not get published at all. Perhaps it would get in to some minor periodicals, but such might not give any significant platform to your work… when your science/research was unworthy, then this is as it should be, but when you’re trying to publish learnings that would change the world and your target of specialist journals is very small (yours is a specialist subject), and the publishing editor keeps giving your work to the same group of specialists, and unbeknownst to you, some major financial interest is paying one or more specialist to find reason to reject your papers, every one… well, you can see that false rejection of false acceptance could both lead to negative outcomes from peer review. This allegedly happened to a researcher looking at trans-fatty acids role in causing heart disease: I seem to remember that he reckoned to have had his work rejected over a 50year period… all widely accepted today.
    Replication of results from research is one gold standard of validation, particularly of laboratory tests/processes, less so of epidemiological studies. So, of course, that can be important, but failure to replicate results is not always a sign of falsehood in the original research – not where the original research required the highest standards of laboratory procedures (where science meets art – culturing of hard to culture micro-organisms, etc.)

    Lung cancer: “By the time a lung cancer is seen on an X ray, it is too late for curative treatment” – well, we all know that it is very bad news, with low survival rates, and likely, though I have not checked, your prognosis is better if your cancer is caught at the ‘little cough’ stage before it can be seen on an X=Ray, than later when it can.
    Dr Myhill is direct and without false optimism, but then the purpose of her writing here is clearly not to be gentle on these patients, but to be tough with all the complacent folks amongst us who are not taking responsibility for our own good health… and then she suggests how one might live a more healthy life and lower risk of such disease.
    She also says this of cancer more generally: “By the time one waits for lumps or symptoms to develop it is likely to be too late. It is much better to be aware of the risk factors for cancer and target those one is at risk of. Firstly observe all the lifestyle changes to protect against cancer.” before advocating her guidelines to maintain and restore good health.
    I think she does a pretty good job of communicating complicated science, medicine and life choices, with references thrown in, and doing so concisely and without pulling any punches.

    And she does not use the simplistic (ie. misleading) language of the NHS/DOH wherein “five a day” is the message. No, Myhill gives a pretty full coverage of health issues, with few aspects to grumble about, and this as a small practise with but one doctor… There is much to like about her website, and much to like a whole lot more than the NHS websites, where mention of nutrition is a dirty word.

    Did I say, that NICE guidelines have the NHS believing that Vitamin A deficiency is rare, yet, by implication of it not being cost effective, not testing anyone for it? If you are chronically ill, it is a pretty good idea to have a vitamin A test to make sure that you are not deficient.

  134. Matthew said,

    @Alistair,
    As evidence that the medical undergraduate curriculum no longer has clinical examination, you cite a retired, now dead surgeon who incorrectly said it wasn’t???
    1. Anatomy and clinical examination are very different (look them up)
    2. Clinical examination is the core requirement for the curriculum, and continues to be. Exams throughout every year of the clinical undergraduate courses require students to pass OSCEs (go look it up).

    Your ignorance and prejudice on this point is gob-smackingly horrendous, but I see you base it upon hearsay and bias, and tells us lots about how you arrive at your uninformed opinions.

    But I am glad you have refined your claims, and accept that Myhill doesn’t clinically examine all her patients. We are getting somewhere.

    I am interested in your claim that asking for a blood test on a patient is “examining them”. Very good that one. Maybe people like Cybertiddles think that, but no GP I have ever come across. I suspect he avoids getting close to his patients, since they might object to the alcohol smell.

    @Tiddles – I hear bad thinks come in threes. 1981 was obviously not a vintage year for medical graduates – I wonder why so many loopy people got through their finals.

  135. Matthew said,

    @Alistair

    “3 minute consultation” [with a GP]

    Evidence please?
    You taking the piss again, pronouncing on things of which you have no knowledge?

    Show me evidence of one GP who has ever scheduled 3 minute appointments for patients and I’ll buy you a crate of your obviously frequently used favourite tipple.

  136. alistair said,

    @Matthew – Wow! How angry are you? Always you demand evidence! Why the silly accusation that I have no experience of UK GP appointments… do you think I am a foreign visitor to this site? One who lives outside of Britain? What gives you that impression?

    Now. You have not read much that I have written, only a selective part, else you would sense that I have plenty of experience of doctors appointments: This is often the case with good friends of CFS sufferers who benefit from a healthy advocate being with them to try to steer NHS bias in their favour. Actually, it rarely works, but it led me to see a lot of GPs and some consultants.

    Okay. Sure *angrily* I exaggerate about GP appointments, they can be anything from 5 minutes (urgent quickie appointments at many surgeries) to a common 7 or 8 minutes, and, when lucky, in some areas, at some practises, and with the effects of New_Labour receding, you may still get a more traditional 10+ minutes. Almost sufficient time to do useful patient examinations, though scarcely enough to take a good look at those chronically ill people with multiple symptoms.

    But I write of the most sick patients not being examined, yet you do not comment on that. I write of the NHS missing absolutely fundamental signs of immune deficiency which later prove to have involved vitamin A deficiency, yet the NHS don’t test vitamin A levels, and my experience saw GPs and a consultant refute mention of the obvious signs of immune problems – this without examining their patient. They already ‘knew’ without getting out of their chairs that the patient had ME and for this the evidence based treatment was CBT and GET. End of discussion.

    Why do you obsessively demand evidence? Do you think that evidence always makes something true? Do you think that absence of evidence, and of proof, always makes something untrue? I’ll bet that you are wrong on both scores if you do.
    How are you getting along with disproving my comments about the latest medical syllabus in the UK? Or is the onus of proof ALWAYS on the first person to mention something? You can doubt me, openly, but I am modern – I don’t always see why I should have to prove everything: There is nothing to stop someone proving that i am wrong, if indeed I am.

  137. Cybertiger said,

    Alistair is right again – showing that ‘experience’ triumphs over the pathetic “where is the evidence” bleatings of angry, arrogant twerps like Matthew. Of course GPs don’t schedule 3 minute appointments, but that is what the patient will often get – if they’re lucky, in a 10 minute slot. Believe me, or not … there are a lot of lazy, greedy and gamesplaying GPs out there, whose only interest is in money. Ever heard of the QOF? It’s a game GPs play to maximise income: the interests of the patient or the taxpayer is the last thing on the corrupt doctor’s mind.

  138. jdc325 said,

    Lung cancer: “By the time a lung cancer is seen on an X ray, it is too late for curative treatment” – well, we all know that it is very bad news, with low survival rates, and likely, though I have not checked, your prognosis is better if your cancer is caught at the ‘little cough’ stage before it can be seen on an X=Ray, than later when it can.
    Dr Myhill is direct and without false optimism, but then the purpose of her writing here is clearly not to be gentle on these patients, but to be tough with all the complacent folks amongst us who are not taking responsibility for our own good health… and then she suggests how one might live a more healthy life and lower risk of such disease.
    She also says this of cancer more generally: “By the time one waits for lumps or symptoms to develop it is likely to be too late. It is much better to be aware of the risk factors for cancer and target those one is at risk of. Firstly observe all the lifestyle changes to protect against cancer.” before advocating her guidelines to maintain and restore good health.
    I think she does a pretty good job of communicating complicated science, medicine and life choices, with references thrown in, and doing so concisely and without pulling any punches.

    You seem to think that Myhill’s intention in writing “By the time a lung cancer is seen on an X ray, it is too late for curative treatment” is clear and that it is aimed at people who are “complacent” and not “taking responsibility” for their health. I don’t think that is clear at all.

    Nor do I think that Myhill’s purported intention excuses or explains what she has written. What she has written is incorrect (look up the 1, 5, and 10-year survival rates for lung cancer and the first test used to diagnose it). And it’s not just wrong, it’s dangerously wrong – it could mislead someone diagnosed with lung cancer and lead to them falsely believing that it was too late for treatment. You may believe that Dr Myhill’s intention is to avoid giving patients false hope – if it were, then it would have been better for her to phrase her comments in a way that didn’t indicate there was no hope at all. Don’t you agree, alistair?

  139. Cybertiger said,

    @Becky Fisseux (aka sore-ass)

    Yeee hawww … they hang ‘em high … and bury ‘em deep … in Texas. And they shoot deer too.

    http://www.bolenreport.com/Wakefield/briandeer.htm

    Bought a new frock yet, Becky? Check with Fiona so you don’t end up with the same one. Booked your tickets to fly? It’s a long, long way to Texas from South London … and what with your sore arse and all … bless.

  140. Swordfish said,

    Dear Alistair,

    You have repeatedly suggested that examination no longer forms a part of the undergraduate medical student syllabus and asked “There is nothing to stop someone proving that i am wrong, if indeed I am”. I am afraid you are indeed demonstrably wrong. The undergraduate syllabus is contained in the GMC document “Tomorrow’s Doctors 2009″

    http://www.gmc-uk.org/GMC_TD_09__1.11.11.pdf_45377818.pdf

    Outcome 2 (c) requires the graduating student to be able to “perform a full physical examination”.
    Your statement that anatomy is no longer required is equallyincorrect. All of the medical programmes in the UK include anatomy teaching, as can readily be determined from their web sites. For such an extraordinary claim, I think the onus is on you to provide proof in your turn.

    Best Wishes.

    Swordfish

  141. alistair said,

    Swordfish, for the love of god, why do you quote an out of date publication as demonstration that I am wrong? Why do you screw with my careful choice of words? Did I say that “anatomy is no longer required” ? Suffice that I will be keeping my anatomy for so long as is possible, how about you?

    Extraordinary claim?? Really? Now did I say that I was told this be a well informed, active if retired, surgeon? Did I say that? (yes, sadly he is no longer with us – such a nice fellow too)
    Is it so extraordinary that I would trust him to be well informed and to be telling me the truth? A man of integrity, old fashioned integrity, a man well connected with a good number of still working, well connected, highly ranked folk in the field of medicine, both within the UK and abroad.

    I indicated that the teaching of patient examination and the study of anatomy is being removed from the syllabus, perhaps my words might have been careless – perhaps it is not the current 1st year students who will suffer, but those from next years intake, or even, given how slowly some wheels must turn, the intake in 2013. Let us not go back to 2009 to consider whether I might be correct in 2012.
    And, yes, it is a very worrying thing to find oneself saying, since the future surgeons had better have all the practise they can get before holding a knife in surgery and it would be good if standards of patient examination improve such that GPs comprehend that whilst time is limited, their special case patients – those suffering the most symptoms indicative of chronic ill health – do indeed benefit from at least one doctor going to the trouble of taking an over view of their symptoms for the making of stepwise progress towards good health. This is good for patients and good for NHS budgets: Imagine, that in 2011, we are sending charitable monies and resource over seas to fund such as vitamin A shots for malnourished, and yet a doctor guided by NICE et al cannot recognise the possibility of vitamin A deficiency in the UK. It is a crazy situation.

  142. mrsP said,

    @ Alistair

    You claim that Myhill has better advice on diet than the NHS who simply say 5 a day. Not true – the NHS website and an enormous amount os evidenced information. here is just one of the many pages.

    http://www.nhs.uk/chq/pages/Category.aspx?CategoryID=51

    There is no need for Vitamin A levels to be done on request. If you have symptoms of a vitamin deficiency your GP can arrange one. It is dangerous as you have said to take too much vitamin A.

    If someone with a chronic illness can manage a balanced diet with fruit, veg and dairy products it is unlikely they have a Vit A deficiency.

  143. alistair said,

    @Matthew
    “You seem to think that Myhill’s intention in writing “By the time a lung cancer is seen on an X ray, it is too late for curative treatment” is clear and that it is aimed at people who are “complacent” and not “taking responsibility” for their health. I don’t think that is clear at all.”

    Have you read much of her site – not spotted any theme to it in relation to encouraging people to take responsibility for their own health? No? Really?
    So, what do you think her intention is? Do you think she is trying to upset and offend and insult those with cancer? Is that logical?
    Why is it that you are so very happy telling another person that they are wrong, yet you proffer no insights of your own?

    I find this page neatly addresses your misapprehension:

    http://www.drmyhill.co.uk/wiki/Cancer_-_the_principles_of_prevention_and_treatment

    She indicates that the NHS struggles with the fundamentals: surgery, radiotherapy, chemotherapy … but there are other steps that can be taken … by the patient to optimise outcomes.

    “Nor do I think that Myhill’s purported intention excuses or explains what she has written. What she has written is incorrect (look up the 1, 5, and 10-year survival rates for lung cancer and the first test used to diagnose it). And it’s not just wrong, it’s dangerously wrong – it could mislead someone diagnosed with lung cancer and lead to them falsely believing that it was too late for treatment.”

    Are you good at winning bets? Do I see that the 1year survival rates hover short of 20%. Do you find those to be good odds, odds that are stacked in favour of the lung cancer patient? Really?
    I did not talk about the first test, and nor did DrMyhill – I mentioned a small cough, and she observed that once things are clearly visible by X-Ray things are really serious: to someone unsure whether to see their doctor, early stage, nagging doubts … Dr Myhills words, would, I believe, to most people, encourage the patient to do something straight away, before it is too late. But, hey, that is just my perception.

    “You may believe that Dr Myhill’s intention is to avoid giving patients false hope…”
    No, I did not say that [Damn it! What is wrong with your reading skills? I observed that Dr Myhill is direct, a plain speaker, with no false optimism: She would not be one to encourage binge drinking simply because it might not cause any long term harm, so go on! Enjoy yer selves!! She would counsel going easy on alcohol for all the right reasons]

    ” – if it were, then it would have been better for her to phrase her comments in a way that didn’t indicate there was no hope at all. Don’t you agree, alistair?” ”
    No, I don’t agree. What might she have said: “Once lung cancer is visible by X-Ray, your chances of survival are little better than 1% at 1year”. Is that better? Or have you found betting on such cancer survival is a tidy earner? That your bookie is helpfully so pessimistic as Dr Myhill, and that both of them are wrong?
    Perhaps you will find me evidence showing survival rates once lung cancer is visible by X-Ray, as opposed to the generalised cancer survival rates that includes early diagnosed along side late diagnosed ?

  144. alistair said,

    @mrsP
    “You claim that Myhill has better advice on diet than the NHS who simply say 5 a day. Not true – the NHS website and an enormous amount os evidenced information. here is just one of the many pages.
    http://www.nhs.uk/chq/pages/Category.aspx?CategoryID=51

    Taking 2 links at random:
    “…benefits of a mediterranean diet
    A Mediterranean diet is typically:
    • high in legumes (beans, peas)
    • high in cereals
    • high in fruits
    • high in vegetables
    • high in fish
    • a high monounsaturated fat to saturated fat ratio
    • moderate alcohol intake
    • low in meat and meat products
    • low in milk and dairy products”

    — so no mention of sunshine nor of vitamin D in this list nor in the text. Sunshine is a fundamental part of that Mediterranean diet – and Dr Myhill recognises this fact.

    “What is a healthy balanced diet?”
    Guess what: yes – there is no mention of sunshine nor of vitamin D, which factor is an essential ingredient, along with plenty of sleep, of a healthy balanced diet: all these components are necessary for good health.

    “There is no need for Vitamin A levels to be done on request.”
    Yes there is, since NICE guidelines lead many a GP to both think that vitamin A deficiency is rare, and that testing is not cost effective.

    “If you have symptoms of a vitamin deficiency your GP can arrange one.”
    Not if he/she is following the guidelines to the letter as so many do.

    “It is dangerous as you have said to take too much vitamin A.”
    I am not too worried about taking too much – the tolerance over RDA are generous, in the short term, except for expectant mums, where much more caution is recommended. Supplementing for any other adult can be of the order of 2x RDA daily for 3-4 months.

    “If someone with a chronic illness can manage a balanced diet with fruit, veg and dairy products it is unlikely they have a Vit A deficiency.”
    So? My point is, what if someone does have a vitamin A deficiency? Who will recognise it as a possibility? Who will test for it?
    Remember that all those standard blood tests that the NHS run do not include vitamin A, so for a GP faced with a patients exhibiting multiple symptoms, with very limited consulting time, when that blood test comes back, to all intents and purposes, “normal”, they are left in a tight spot. Many succumb to determining that their patients is… as stated previously,,, a malingerer, an attention seeker, a hypochondriac, or combination of these. The diagnostic process is inhibited.
    Back to your patient with chronic illness. They may well be having a healthy diet, but the beta carotene they obtain from all those fresh colourful fruit and veg requires that their biochemistry is working okay, else it will fail to deliver vitamin A … they would need to be eating ~100g of liver per week in order to deliver ~RDA of vitamin A as retinyl ester. Further, people who are chronically ill may not absorb vitamin A so well, nor store it so well. Sometimes a little supplement, to make certain the intake, is a good idea. Not all the time, but sometimes.

  145. jdc325 said,

    @alistair,

    So, what do you think her intention is? Do you think she is trying to upset and offend and insult those with cancer? Is that logical?

    No, I don’t think that was her intention. It doesn’t matter what you or I think her intention might have been. You can be well-meaning and wrong – and my blog posts on Dr Myhill have focussed on whether or not her information is right or wrong, not whether it was written with good intentions. Do you not think that, regardless of Dr Myhill’s intentions, what she writes is incorrect and it would be better if it were corrected?

    Are you good at winning bets? Do I see that the 1year survival rates hover short of 20%. Do you find those to be good odds, odds that are stacked in favour of the lung cancer patient? Really?

    I never said, or even implied, that the odds were stacked in favour of the lung cancer patient. What’s been criticised is the statement by Myhill that “By the time a lung cancer is seen on an X ray, it is too late for curative treatment”. This is an absolute statement. It is inaccurate and misleading. Writing that the odds were stacked against the lung cancer patient would not have been inaccurate and misleading – but that’s not what Dr Myhill wrote was it? And I’m not criticising what Dr Myhill might hypothetically have written instead of what she wrote – I’m criticising what she actually did write.

    The 1, 5, and 10-year survival rates are available here: http://info.cancerresearchuk.org/cancerstats/types/lung/survival/#one

    In England and Wales the latest figures show around 27% of male and 30% of female lung cancer patients are alive one year after diagnosis falling to 7% and 9% respectively at five years. Ten year survival rates are shown in the form of a graph that can be downloaded – the most recent figures on the graph are 5% for both male and female patients.

    What might she have said: “Once lung cancer is visible by X-Ray, your chances of survival are little better than 1% at 1year”. Is that better?

    Can you provide substantiation for the suggested claim that “Once lung cancer is visible by X-Ray, your chances of survival are little better than 1% at 1year”? If it is indeed the case that this is true, then yes – it would have been better than what Dr Myhill did actually write. What she actually wrote was demonstrably wrong. It certainly isn’t “factual and verifiable”.

  146. Cybertiger said,

    Wonderful stuff! jdc352 is the champion nitpicker, beating even mrsP into a cottonpickin, nitpicking hat.

  147. alistair said,

    I asked Matthew, and you ignored that comment, so perhaps I had better ask you:
    Perhaps you will find me evidence showing survival rates once lung cancer is visible by X-Ray, as opposed to the generalised cancer survival rates that includes early diagnosed along side late diagnosed ?
    (Yes, of course I already referred to that linked URL, but it does not show survival from that stage specifically.)

    “my blog posts on Dr Myhill have focussed on whether or not her information is right or wrong”
    Aha! The wonders of all or nothing, black and white, thinking. Edward De Bono, I salute you for steering people away from this type of dismal approach, and towards broader perceptions.
    The good news is that Myhill’s website clearly is not a long list of ‘facts’, but a place where she communicates lots of medical and health information, framed variously around her opinions and turns of phrase, and approximations too – the many things she could tell all interested parties if she had sufficient time, but instead they are able to read her website.

    Show me the evidence (which I will weigh) that lung cancer when visible by X-Ray has survival rates of significance, survival that goes beyond time to tidy lifes affairs, adjust the last will and testament, hand over key passwords, and to say sorry for lifes transgressions…. show me that in support of your “Dr Myhill is incorrect” address – else you are just wagging your finger inaccurately about you.

    For instance:
    “Can you provide substantiation for the suggested claim that “Once lung cancer is visible by X-Ray, your chances of survival are little better than 1% at 1year”? If it is indeed the case that this is true, then yes – it would have been better than what Dr Myhill did actually write. What she actually wrote was demonstrably wrong. It certainly isn’t “factual and verifiable”.

    Hang on a minute! So, Matthew, you don’t actually know what the survival rates are at that stage of lung cancer, do you? You are repeatedly stating that Dr Myhill is wrong, wrong, wrong! without any basis at all, scientific, conscientious objector, Mormon, royal blood, member of Lords cricket club… no basis whatsoever. Incredible. So much bile in you, that it spills from you faster than your brain can engage with the gaps in your own knowledge. You are a vicious anonymous blogger aren’t you? And I don’t intend that euphemistically.

    And I disagree with you yet again: If the rate of survival as described is approximately (it is only ever approximately) 1%, then Myhill is in the clear to describe this as too late – it is odds that no betting guru would recommend unless you have nothing to lose, in which case, Myhills words likely have no adverse impact on anyone: some might take her words and pursue that 1% chance with all their might, and those who are not so driven would likely not be reading a health website – and all sufferers likely would not have the time nor breath to be dallying with such reading.

    Meanwhile, the rest of us, reading those words, will very likely get the idea that we want to maintain our good health and listen up to any knowledge Dr Myhill might share to that end. We might even start to take responsibility for our own good health. And thus Dr Myhills website likely results in nothing but good health outcomes.

    So, have you got any facts ready to justify criticising the world and his dog yet? If you were a dog, what sort of a vicious little biter would you be? Prove it!

  148. jdc325 said,

    “And thus Dr Myhills website likely results in nothing but good health outcomes.”
    Even for babies laid on their sides to go to sleep?

  149. alistair said,

    Do you fool yourself half of the time or all of the time, because you don’t fool me at all.

    Do you insist on looking at those words out of context again and again and again? Is that your standard modus operandi? You pick on a detail rather than answer anything nearly amounting to the bigger picture, and, if there is nothing small to pick on, you take a few words out of context and pick on them… Beyond contempt, sir, you are.

    You always quote just a few words, and always out of context.
    How on earth do you expect to understand what the author intended (which really does matter) if you do not read whole sentences? And later, how do you propose your reader understands the context of your chosen quotes if they arise without the context in which they were written? Riots have been started with little more care than you are showing to your criticisms.

    In case it helps your understanding, take the controversy about the inscriptions on the new Luther King memorial…

    “Inscribed on the Stone of Hope are two statements – one, a direct quote, the other, the paraphrase of his words that is at the center of the present controversy:

    The first, from the “I Have a Dream” speech, is “Out of the Mountain of Despair, a Stone of Hope”-the quotation that serves as the basis for the monument’s design. The words on the other side of the stone read, “I Was a Drum Major for Justice, Peace, and Righteousness,” which is a paraphrased version of a longer quote by King: “If you want to say that I was a drum major, say that I was a drum major for justice. Say that I was a drum major for peace. I was a drum major for righteousness. And all of the other shallow things will not matter.” ‘

    The point being that the paraphrase takes a few words out of context, their meaning is subtly but powerfully different in their original intended context.

  150. Cybertiger said,

    Nice qotes, alistair!

    jdc352 is the drum major for meaningless nitpicking.

  151. Cybertiger said,

    Becky Fisseux/Rebecca Fisher, the dame with the sore bottom, hates Andrew Wakefield and all supporters of the medical research scientist who champions vaccine safety. Becky is the majordomo of jabsloonies,

    http://jabsloonies.blogspot.com/

    … a blatantly hateful website occupying the vile outer edge of the anti-science blogosphere. Compare the output of Becky’s blog with Andrew Wakefield’s recent talk about the safety of vaccines.

    Of course, jdc325 and his nitpicking followers – mrsP, ChrisP, Hammerdoc, Matthew and other assorted bad-science nutters … are with Becky, the foul-mouthed arsehole from South London. Give me strength!

  152. Matthew said,

    Alistair,
    I think you confuse me with someone else – I never commented on the lung cancer entry on the myhill website. If you like, I can give it a go though.

    But I see a trend here- you have made numerous claims, but hardly any of them stand up to scrutiny. You have had to backtrack on several of your vague statments already.

    You are very free with opinion and hearsay, and eschew proper evidence. You dismiss our concerns about your cherrypicked, confirmation-biased world view, and assure us that your “experience” somehow trumps ours, when you haven’t a clue what our experience is. All of us can all be misled and easily fooled, hence our scientific approach to establishing evidence-based, verifiable facts before stating any claims. I just wish you (and cybertiddles) would do the same.

  153. Matthew said,

    @Alistair,

    btw I loved your idea that sunshine exposure forms part of the “mediterranean diet”.
    Classic.

  154. Matthew said,

    I listened to Wakefield’s vaccine/autism talk at the Jamaica conference – thanks for the link.
    Now there are at least 14 people have heard it – the 13 people in his audience, and me.
    Load of bollocks, as usual.

  155. alistair said,

    Matthew “I listened to Wakefield’s vaccine/autism talk at the Jamaica conference – thanks for the link.
    Now there are at least 14 people have heard it – the 13 people in his audience, and me.
    Load of bollocks, as usual.”

    My, how very scientific of you! I suppose you would not like to produce your evidence for that? You are such a weasel. You don’t hold yourself to the same standards that you hold others, now do you? Can you verify that only 14 people have listened to his talk? Oh! So you are allowed irony and a little poetic licence but when others apply the same, you simply cannot ‘get it’ – it does not pass your scientific evidence filters.

    To me you reserve:
    “You have had to backtrack on several of your vague statments already. You are very free with opinion and hearsay, and eschew proper evidence.”

    What are left to do now but ‘backtrack’ in relation to evidence for 14 people hearing the aforementioned talk? So what if you backtrack – so what if you assist your audience to understand an earlier vague statement or one that has gone straight over their heads? It is no big deal.

    Did you appear in the fairy tale about the sleeping Princess? There was a nasty prick in that tale if I remember correctly.

  156. alistair said,

    @Matthew “@Alistair, btw I loved your idea that sunshine exposure forms part of the “mediterranean diet”. Classic.”

    I can see that your nutritional knowledge is weak, but I did not suspect it to be this weak. Are you a medic or a teenage interested party? This paucity of nutrition knowledge from one who criticises others knowledge so readily… would fit with the arrogance of modern guideline based medical folk or with the rudeness of uninformed youth.

    What do you propose to be the vitamin D source in this marvellous Mediterranean diet? A little extra fish? Heavy on the butter? (not much in olive oil)
    And what do you propose to be the vitamin D source of any similar diet in the UK?

    I was emphasising the somewhat important aspect of the Mediterranean diet that is so often ignored during discussion of same, where seemingly even the NHS forgets about vitamin D when talking about and advising on a healthy diet.

  157. alistair said,

    Matthew – I missed this (which I will dissect):
    “@Alistair,
    As evidence that the medical undergraduate curriculum no longer has clinical examination, you cite a retired, now dead surgeon who incorrectly said it wasn’t???
    1. Anatomy and clinical examination are very different (look them up)”

    [No confusion here - except in your misquote - I said that both study of anatomy and patient examination were dropped. I full well know that they are different, you stupid, insulting, PFY. Let's try another difference: your arse and your elbow - is that making sense?]

    2. Clinical examination is the core requirement for the curriculum, and continues to be. Exams throughout every year of the clinical undergraduate courses require students to pass OSCEs (go look it up).

    [or you could quote your source - surely you hold yourself to the same high standards that you constantly demand of others? No? Hypocrite. Which year of medical studies are you in?]

    Your ignorance and prejudice on this point is gob-smackingly horrendous, but I see you base it upon hearsay and bias, and tells us lots about how you arrive at your uninformed opinions.

    ['Ignorance and prejudice'? Do you reel off words for no apparent reasaon? A well informed person, a senior medic, advised me of changes to the medical curriculum... Call it hearsay when you find a source that disproves it, until then, get out of my face you stupid PFY. As for 'bias' - to what are you referring?]

    But I am glad you have refined your claims, and accept that Myhill doesn’t clinically examine all her patients. We are getting somewhere.

    [You obviously did not read what I wrote (looks like a pattern of behaviour) - I observed that most GPs and even consultants do not bother to examine their most chronically ill patients, this with the patient in their consulting room!?! Blood tests are often the nearest they get to considering the health of their patient.
    On this basis, and on the basis that the criticised Dr Myhill did nothing worse that providing an advanced blood test and results/recommendations based on expert consideration of those blood tests to a GP without seeing the patient, I should say that Dr Myhill is performing above the typical standards, wouldn't you? She was not the patients GP merely a 3rd party test provider - a test provider who received blood from the patients GP.

    No! Don't bother replying! You never do - you never take criticism and consider whether you might have been wrong - you and others on here only point their fingers and accuse others... ]

    @Tiddles – I hear bad thinks come in threes. 1981 was obviously not a vintage year for medical graduates – I wonder why so many loopy people got through their finals.”

    ['bad thinks' ??? Are you saying that Dr Wakefield and Dr Myhill are loopy?]

  158. alistair said,

    @Matthew “Alistair,
    I think you confuse me with someone else – I never commented on the lung cancer entry on the myhill website. If you like, I can give it a go though.

    But I see a trend here- you have made numerous claims, but hardly any of them stand up to scrutiny. You have had to backtrack on several of your vague statments already.

    You are very free with opinion and hearsay, and eschew proper evidence. You dismiss our concerns about your cherrypicked, confirmation-biased world view, and assure us that your “experience” somehow trumps ours, when you haven’t a clue what our experience is. All of us can all be misled and easily fooled, hence our scientific approach to establishing evidence-based, verifiable facts before stating any claims. I just wish you (and cybertiddles) would do the same.”

    I did confuse you – your comments and those of jdc are so very similar in failing to read nor comprehend the words of others, in failing to respond to any question asked by another, to attack constantly, to ascribe criticism whether or not that criticism is apt … all negativity, no positivity.
    Most all my comments have stood up to scrutiny – but very few of my questions to those criticising me have returned any answers. That is the biggest trend – no one else allows themselves to be challenged.
    Backtrack? I have clarified my meanings a few times, yes. So what?

    Opinion and hearsay have their place – most of the criticism of Dr Myhill is a matter of opinion not fact. This in spite of the purpose and motivation for this blog. I am unclear as to the reason for this apparently blind cast iron condemnation.
    I do draw on my experience, yes, whenever I feel it might help throw light on something currently misunderstood. So what? This is a constructive trait.
    When did I “assure us that your “experience” somehow trumps ours” – what has upset you?
    When I describe the well publicised experience of a couple of hundred thousand ME/CFS sufferers in relation to the NHS, wherein they do not get examined and instead it is presumed that their problem is a mental one, this in order to show that targeting Dr Myhill so unswervingly seems harsh, inappropriate and disproportionate, then I am pretty sure that only someone like yourself would deem that information arrogant or a put down.
    But yet no comment do I get affirming that such GPs and consultant ought to get more complaints.

    “All of us can all be misled and easily fooled, hence our scientific approach to establishing evidence-based, verifiable facts before stating any claims.”

    All of us can be misled and easily fooled? Prove it. Show me evidence… how does it feel getting the evidence requirement every time you make a statement of opinion?
    So. You are nervous of being wrong or of making a mistake? Poor you, though neither state needs fill you with fear, nor worry you unless you are in a tight spot in a quizz to the death and this is the deciding question…

    I have had no comment on my earlier mentioned dictum, which surprises me, but this is neither a learning blog nor a positive nor friendly blog, simply a pick on and attack Dr Myhill blog. A sad excuse for human activity, especially when she is a rather good doctor compared with the average guideline led crowd most people see, GPs who switch off their clinical knowledge and experience in favour of applying a framework of guidelines that may not apply to any one patient.

    Oh1 This evidence mantra!
    You know that evidence does not prove anything, and nor does a lack of evidence disprove anything. Both may lend weight to a point of view, to a likelihood of something being true/untrue, but not proof. Experience, judgement, and consideration of factors may all help gauge the truth.

  159. Cybertiger said,

    @Matthew

    http://jabsloonies.blogspot.com/

    I agree; Becky’s got bollocks

  160. Matthew said,

    Alistair,

    Regarding my claim that there were only 13 people who heard Wakefield’s talk at the Jamaica conference, I must backtrack, and I owe you an apology I guess.

    You see, I suppose I forgot to count the cameraman/men, who must also have been present. So that makes 10 people in the audience, 3 people sat on the panel adjacent to the podium, and a cameraman or 2 (2 seems likely from the camera angles). It’s in the YouTube video – go and count them if you wish. I must admit the video had 79 “views” when I looked at it, but since we don’t know if these hits consist of anyone who had the fortitude to sit through his 38 minute talk, do we. My (modified) claim still stands – 14 or 15 people heard his talk in person.

  161. Matthew said,

    Alistair,

    Please, please, please enlighten us all on how sunlight is part of a diet. I can see the point of my previous comment went straight over your head last time. I know sunlight boosts Vitamin D levels. But do you know that the term “diet” refers to what you eat, and that sunlight is not food, I hope? What next, are you going to turn into a breatharian? If you want to talk of diet, talk about food, not lifestyle.

    Call me pedantic, or literal, if you will, but it is your loose language and imprecise terminology that troubles me. You remind me of Humpty Dumpty, who said “when I use a word it means just what I choose it to mean”. Reality is not like that I am afraid. Words have precise meanings, and when used in a medical or scientific context that is absolutely crucial. And important or significant statements of fact require confirming evidence.

  162. alistair said,

    Matthew: “I listened to Wakefield’s vaccine/autism talk at the Jamaica conference – thanks for the link.
    Now there are at least 14 people have heard it – the 13 people in his audience, and me.
    Load of bollocks, as usual.”
    Later:
    “You see, I suppose I forgot to count the cameraman/men, who must also have been present. So that makes 10 people in the audience, 3 people sat on the panel adjacent to the podium, and a cameraman or 2 (2 seems likely from the camera angles). It’s in the YouTube video – go and count them if you wish. I must admit the video had 79 “views” when I looked at it, but since we don’t know if these hits consist of anyone who had the fortitude to sit through his 38 minute talk, do we. My (modified) claim still stands – 14 or 15 people heard his talk in person.”

    it! Okay! I understand. You hate Andrew Wakefield. You ‘backtrack’ (your ghastly word not mine) and proceed to fool no one by suggesting that people viewing on YouTube either would not have listened to his talk, or, that since we do not have proof that these were people who heard his entire talk, they do not count… what type of fuckwit are you, just how retentive is your derriere, that you express this level of your need for proof about something so trivial? Bile and more bile – I think you may have a gall bladder problem.

    Finally, as if your weasel credentials were not apparent to any one fool enough to waste time reading the words of you and jdc325, et al, you utter this line of utmost twistery:
    “My (modified) claim still stands – 14 or 15 people heard his talk in person”
    If you have modified your statement, then your original statement no longer stands. You could simply have said that you had intended something slightly different, but oh no! Not you! Mr Perfect with the golden orb stuck where the sun now shines… fallible? You? Yes – you. You are human, are you not? Prone to err? What a dickhead! Pull your head out before that orb burns it, and smell the fresh air. Hypocrite through and through, with a lazy approach to understanding other people, esp. those you disagree with, or those who disagree with you.

  163. Matthew said,

    Alistair,

    Suddenly I see you are getting annoyed by things I have said, and are demanding evidence for them…Perhaps the irony of that is completely lost on you?

    You still deny making incorrect or exaggerated claims. Let’s just count a few which I have summarised/abbreviated:
    1. Myhill routinely examines her patients.
    (demonstably false, as shown by her own GMC testimony. You then tried to say doing a blood test counted as a form of examination, but realised this was nonsense and made you look foolish, so then turned it into a claim that Myhill only conforms to the standards of other GPs – they don’t always examine patients either, so presumably she is just as bad as they are?)

    2. Myhill’s advice to lay babies on their side was one of the complaints to the GMC about her website.
    (accepted by you as false claim on your part)

    3. GPs take 3 minutes to see patients.
    (Admitted by you as exaggerated – in fact the established standard through all GP practices in UK is 10 minutes per appointment. Admittedly, a very simple problem might be dealt with a bit quicker, but that would be unusual, and some patients take longer. 10 minutes is the average.)

    4. Medical students are no longer taught clinical examination or anatomy
    (shown to be false by reference to readily available curricula [also see below], but still denied by you because a doctor who you knew said so, so you’d rather believe him than the evidence. That speaks volumes about your sources of evidence and your confirmation bias.)

    [perhaps you could get an idea of what medical schools teach by looking here:

    http://en.wikipedia.org/wiki/Medical_school_in_the_United_Kingdom

    Alternatively, you could look at a few of the dozens of books produced to help students train for their structured clinical examinations, which form the core of their studies, and reflect upon why, if students don’t do clinical examination, these books are produced or sold.

    http://www.amazon.co.uk/s/?ie=UTF8&keywords=osce+medical+student&tag=googhydr-21&index=aps&hvadid=4940167025&ref=pd_sl_863xb9eioy_b

    Now how about backing up some of the other wild claims based on nothing but prejudice/hearsay/bias. For instance this one:

    “I describe the well publicised experience of a couple of hundred thousand ME/CFS sufferers in relation to the NHS, wherein they do not get examined”

    I appreciate the injection of humour you gave me to kick off my day. Almost as good as the sunshine is food claim.

    Now I have no doubt that for many ME patients their NHS experience is suboptimal, but please provide evidence for the 200,000 figure not being examined by their doctors. Claims by the occasional ME patient who says he was not examined won’t do – let’s see evidence that “a couple of hundred thousand” were not examined please. That claim is quite extraordinary, so as Sagan said, it needs to be backed up by extraordinary evidence.

  164. alistair said,

    Matthew: “Please, please, please enlighten us all on how sunlight is part of a diet. I can see the point of my previous comment went straight over your head last time. I know sunlight boosts Vitamin D levels. But do you know that the term “diet” refers to what you eat, and that sunlight is not food, I hope? What next, are you going to turn into a breatharian? If you want to talk of diet, talk about food, not lifestyle.

    Call me pedantic, or literal, if you will, but it is your loose language and imprecise terminology that troubles me. You remind me of Humpty Dumpty, who said “when I use a word it means just what I choose it to mean”. Reality is not like that I am afraid. Words have precise meanings, and when used in a medical or scientific context that is absolutely crucial. And important or significant statements of fact require confirming evidence.”

    Why don’t you respond to the answers I provided last time your brain imploded at the notion that acquisition of vitamin D is of such importance that the word diet is not fit without mention of sunshine.

    I should say that having a good source of vitamin D is far more crucial to a human life than whether Matthew, or anyone else, is bothered by precise meanings… In the context of what I wrote previously, the difference between a ‘Mediteranean diet’ eaten in the UK and the same eaten near the Mediterranean is obviously the amount and regularity of strong sunshine. And the import of this, is that a Mediterranean diet cannot be discussed within our cloudy shores without encompassing a discussion of sources of vitamin D, for failure to do so would lead you, alike to the NHS, to recommend a marvellous diet that leaves folk lacking vitamin D – and so, unless you can do better, it really is sensible to include sunshine in discussion of a healthy diet and or a Mediterranean diet.
    Making sunshine a component of diet makes sense unless you leap off reality and conclude that the author intends that we all eat some sunshine, which would be a bizarre perception, given how we all know that sunshine arrives as light from the sky, and eating it is not an option.

    Yes, I am stretching the word diet slightly to encompass the absorption of an energy source via which input we garner vitamin D. Are you entirely inflexible Matthew?

    Can you think of a better means to encompass the need for vitamin D in to a discussion of healthy diet? And how to do so to avoid the misconception that we can eat a Mediterranean diet in the UK whilst getting very little quality sun, and be as healthy as a southern European?

    Did you read my earlier response? How about responding to it instead of opening the sluice gates of your tiny bean and revealing the gaping deficiency within? You are all mouth and no trousers.
    Pedantic or literal? I suggest that you are so literal you likely are within the Aspergers spectrum, which would also explain your absolute lack of insight in to your perpetual perceptual inadequacy. Not to mention your lack of insight in to you.

  165. Matthew said,

    Alistair, you said:

    ”Most of the criticism of Dr Myhill is a matter of opinion not fact.”

    No.

    I can see you are upset by criticism of Myhill’s website. This criticism is not based upon opinion. This blog has listed many errors of fact that are on her website, with citations to medical evidence or national guidelines indicating Myhill is wrong or misleading in her advice.

    You have tried to deflect the criticism of Dr Myhill by throwing out numerous criticisms of GPs and the NHS. (That does not make her any less incorrect). These criticisms are largely based upon your impressions, opinion, generalisations, or hearsay. I have demonstrated that they are largely misleading, exaggerated or incorrect.

    Do you not see the difference between JDC’s criticism of Myhill and your criticism of GPs?

  166. alistair said,

    Matthew: You are a total hypocrite, one entirely lacking in insight in to your self-serving inconsistency. You never respond to any query proffered when someone responds to your comment, only come back with more inaccuracy and bile. You are perfectly vile.

    “Alistair,
    Suddenly I see you are getting annoyed by things I have said, and are demanding evidence for them…Perhaps the irony of that is completely lost on you?”
    Hello!??!?! Knock! Knock! Anyone home? (I can see some lights have been left on…)
    The irony is not that I ask you for evidence, it is that you only see a need for evidence / proof from other people, but that standard does not need to apply to yourself. The irony is your total lack of self-awareness and personal insight. That is why I have several times used the word hypocrite. Go look it up. The irony here is lost on you. Fuckwit. Have you seen “Wheres my car dude?” Talking with you reminds me of the scene at the drive through where the chinese staff response is always to say, “…and then?” as if to prompt further orders. For a while it is unclear whether this is a recorded voice repeating in error, and then it becomes clear that it really is just a very annoying person – that this is just a gag in the film – a person who does not acknowledge, never listens, never responds to comments. You are that annoying person. Congratulations! You have won first prize in the biggest tosser contest – Come on down!

    “You still deny making incorrect or exaggerated [ err... later in this piece you make note of my admitting to some exaggeration... what the fuck are you like?! ] claims. Let’s just count a few which I have summarised/abbreviated: [ let me help you, the words you want are, badly paraphrased: ]
    1. Myhill routinely examines her patients.
    (demonstably false, as shown by her own GMC testimony. You then tried to say doing a blood test counted as a form of examination, but realised this was nonsense and made you look foolish, so then turned it into a claim that Myhill only conforms to the standards of other GPs – they don’t always examine patients either, so presumably she is just as bad as they are?)”
    I have responded to this in detail, yet instead of replying to that response, you repeat yourself. You appear to be educationally subnormal. Yes, she routinely examines her patients, but she also provides advanced medical tests and interpretation of same. The case in point was effectively her providing a second opinion to the patients GP. That GP did not understand the medicine involved and did not prescribe the B12 nor Magnesium. Yet this was indeed more careful examination than many GPs provide to complicated clinical presentations… there is a lot of psychological guesswork being justified since the 1991 Oxford definition of ME was introduced.

    “2. Myhill’s advice to lay babies on their side was one of the complaints to the GMC about her website.
    (accepted by you as false claim on your part)”
    No. I did not accept it as a “false claim” you pompous arse! It was simply an error of fact.. the subject remained that of the rights and wrongs in the context (which neither you nor jdc bother with) of that advice.

    “3. GPs take 3 minutes to see patients.
    (Admitted by you as exaggerated [ and there we see how honest I am... case dismissed; you are a fucking moron ] – in fact the established standard through all GP practices in UK is 10 minutes per appointment. Admittedly, a very simple problem might be dealt with a bit quicker, but that would be unusual, and some patients take longer. 10 minutes is the average.)”
    Again, why not respond to what I actually said, instead of paraphrasing it badly and with loss of meaning? Did I give an example earlier of how that can result in altered meaning?
    Matthew, have you been around the country doing a statistically valid sampling of actual doctors appointment length? Has anyone done so?
    Are you being a hypocrite once again by not providing real life evidence / proof?
    I think so. No, the irony is on you, before you ask.

    “4. Medical students are no longer taught clinical examination or anatomy
    (shown to be false by reference to readily available curricula [also see below], but still denied by you because a doctor who you knew said so, so you’d rather believe him than the evidence. That speaks volumes about your sources of evidence and your confirmation bias.)”
    Not shown to be false by a 2009 pdf from the GMC. Did you read my reply? Why not quote it and respond accurately?
    So far I have not seen any evidence that my erstwhile friend was wrong.
    Your failure to disprove it, while showing me varied items that are not up to date, and whilst taking me to task about my “confirmation bias” only makes you look like a total twat.

    And now you are quoting wikipedia at me?!?!?! Quelle irony? And you are talking actively about clinical examination, not patient examination… – which words were my original comment and were the words of my informant…
    “[perhaps you could get an idea of what medical schools teach by looking here:

    http://en.wikipedia.org/wiki/Medical_school_in_the_United_Kingdom

    Alternatively, you could look at a few of the dozens of books produced to help students train for their structured clinical examinations, which form the core of their studies, and reflect upon why, if students don’t do clinical examination, these books are produced or sold.
    http://www.amazon.co.uk/s/?ie=UTF8&keywords=osce+medical+student&tag=googhydr-21&index=aps&hvadid=4940167025&ref=pd_sl_863xb9eioy_b
    Of perhaps you would like to show me evidence that the syllabus is not set to change?

    “Now how about backing up some of the other wild claims based on nothing but prejudice/hearsay/bias. For instance this one:

    “I describe the well publicised experience of a couple of hundred thousand ME/CFS sufferers in relation to the NHS, wherein they do not get examined” ”

    You obviously don’t know any data about ME / CFS in this country. Go look it up. Go join a support charity and read about the daily experiences of ME sufferers. Go read about the ME sufferers forcibly taken from their care providing mothers and incarcerated in state homes where they soon died. Whilst there, go understand why Dr Anthony Clare et al changed the criteria for ME in 1991 at Green College Oxford, and how this was a black day for evidence based medicine – or do you feel there is a wonderful evidence base of guessing that someone presenting with multiple symptoms has mental issues without once examining them? Simon Weasely eat your heart out. That name is underlined – I must have misspelled it.

    “I appreciate the injection of humour you gave me to kick off my day. Almost as good as the sunshine is food claim.”
    You really are a total twat. What is your specialism? because it most certainly is not nutrition.
    What is your source of vitamin D? Have you been for a sunny winter holiday overseas? Or do you take vitamins? Or, do you believe that mention of vitamin D when considering any diet is not relevant?

    “Now I have no doubt that for many ME patients their NHS experience is suboptimal, but please provide evidence for the 200,000 figure not being examined by their doctors. Claims by the occasional ME patient who says he was not examined won’t do – let’s see evidence that “a couple of hundred thousand” were not examined please. That claim is quite extraordinary, so as Sagan said, it needs to be backed up by extraordinary evidence.”

    Here we go again – after making statements without providing evidence you are back to requiring that I provide evidence. Double standard again and again and again… such a fuckwit hypocrite.
    In fact, the claim, given the Oxford definition of ME and the existence of Wesselly, is really not extraordinary. It is surprising. It is saddening, even sickening, that so much money is wasted by doctors failing to take interest in diagnosing complicated symptoms, happy to label such folk with the ME moniker – mental problems – and this without psychology training… just adherence to guidelines telling them that such cases are ME every time, that the treatments are proven, etc.

    Start replying to my actual responses to you – respond to a wider range of things that I raise – maybe then I’ll trouble myself with proving anything. Until then, be happy to set about disproving me – how hard can that be?

    May the god of their choosing help anyone that has you as their doctor. A plague of weasels at your door sir.

  167. Matthew said,

    Alistair,

    To help with your quoting of others, please could you insert some formatting instructions. The easiest is to put before the quote, and at the end of the quote put
    This italicises the contained text and easier to see as different from your own.

    Regarding your claim that sunshine is food you say:

    “Yes, I am stretching the word diet slightly”

    lol.

    PS1. I well know the importance of Vitamin D. That is not in dispute. I was merely pointing out how loose your definitions/claims are and this was a prime example. When someone is so sloppy that they make elementary errors it calls into question the veracity of their entire commentary. If a vicar gave a sermon about the importance of faith in marriage, but didn’t know the definition of the word marriage and said he was just “stretching the word marriage” slightly to incorporate a teenage crush, would you find him credible? If he complained that vicars are now not required to read the bible scriptures, saying he knows that because a priest, now dead, once told him so, would you find him plausible?

  168. alistair said,

    Matthew: “Alistair, you said:
    ”Most of the criticism of Dr Myhill is a matter of opinion not fact.”
    No.
    I can see you are upset by criticism of Myhill’s website. This criticism is not based upon opinion. This blog has listed many errors of fact that are on her website, with citations to medical evidence or national guidelines indicating Myhill is wrong or misleading in her advice.

    You have tried to deflect the criticism of Dr Myhill by throwing out numerous criticisms of GPs and the NHS. (That does not make her any less incorrect). These criticisms are largely based upon your impressions, opinion, generalisations, or hearsay. I have demonstrated that they are largely misleading, exaggerated or incorrect.

    Do you not see the difference between JDC’s criticism of Myhill and your criticism of GPs?”

    Perhaps you could go to the small coutesy of considering what I have written previously, about how you and JDC take a few words out of context and of how the authors intention as framed by that context is a key part of what they have actually said.
    I have suggested that your combined attack on Myhill is disproportionate and that there are better (or worse cases) targets out there… no reply do I get… you are obsessed, for reasons beyond me.

    I have plenty of personal experience of gross wrong doing within the NHS.
    That makes it fact, not impression / opinion, generalisation or hearsay. But there are hundreds of others being treated similarly by their own description.

    National guidelines do not make a doctor wrong. What an awful misunderstanding, but one that is common within the NHS. They are but guidelines and evidence based medicine, whilst occasionally highlighting a treatment that must be withdrawn, and so on, does not always provide an answer that fits all patients – individual patients do not always conform to being average – they are each unique and so a doctor must use clinical judgement.

    “This criticism is not based upon opinion. This blog has listed many errors of fact that are on her website, with citations to medical evidence or national guidelines indicating Myhill is wrong or misleading in her advice.”

    Nope. National guidelines and statistically ‘proven’ medical evidence does not result in an alternative opinion necessarily being untrue nor misleading.

    “I have demonstrated that they are largely misleading, exaggerated or incorrect.”
    You have done no such thing, and you have proven (just one thing) yourself to be a terrible hypocrite. You write it and believe it if that make you feel better, but it is not so.

  169. Matthew said,

    Alistair, you say:

    “Start replying to my actual responses to you”

    Which responses? The ones where you call me the following? “Vile, hypocrite, stupid, suffering from Aspergers, fuckwit, tosser, educationally subnormal, pompous arse, fucking moron, twat, fuckwit”?

    You want invective in return?

  170. alistair said,

    Sloppy you sly little cunt. You are so careful to avoid engaging with what I have said and responding to my questions of you, that you are in danger of sliding up your own edifice (interpret that loosely of tightly as appropriate).

    “When someone is so sloppy that they make elementary errors…”
    It was not an error! it was my choice to use those words, you presumptious shit.

    Are you aware that language acquires new meaning over time?
    Are you unaware that we bend words this way and that, all of the time?
    Are you aware of any other linguistic means to address the need for sunshine towards humans obtaining sufficient vitamin D in relation to their dietary intake?

    Perhaps we can call it the Mediterranean lifestyle? Hey! that involves a certain diet and a certain quality of sun, does it not? But that would confuse the masses when attempting to get them healthier, now wouldn’t it?
    So for good reason we have get stuck on this phrase “Mediterranean diet” and with that, one needs to prevent, yes, I said prevent, confusion, by making clear that this ‘diet’ is significantly so very good because of the climate in which is takes place… the contribution of sunshine is clear.

    As for your priest not reading the scriptures any more…
    How about you get off your lazy complacent arse and go find the proof that I am wrong about changes to the medical syllabus? And, yes, as I stated, those changes might be arising in the intake of 2012 or maybe 2013 … NOT 2009!

  171. alistair said,

    Matthew: ““Start replying to my actual responses to you”

    Which responses? The ones where you call me the following? “Vile, hypocrite, stupid, suffering from Aspergers, fuckwit, tosser, educationally subnormal, pompous arse, fucking moron, twat, fuckwit”?

    You want invective in return?”

    No, the responses I made before getting so utterly frustrated with your hypocrisy that I resorted to venting invective.

    And, by the way, I did not call you “suffering from Aspergers”, that would be a daft name, no, I indicated that my perception and observation of your interactions on this blog make me think that you are likely in the Apergers spectrum.
    However, if you looked at the context of each slice of that invective, and if you combined that with any insight/perception whatsoever, you might just begin to understand things more clearly.

    Did you look up ‘hypocrite’? It is not a name I am calling you, it is an accusation based on your behaviour.
    Oh! Hell! All of that invective is accusation based upon your behaviour.

  172. Swordfish said,

    Dear Alistair,
    I’m afraid you are quite unequivocally wrong about the medical syllabus. “Tomorrow’s Doctors 2009” is not an ‘out of date’ publication: it is the current guidance. It was issued in 2009, and Medical Schools had until 2012 to implement it. It contains a full list of compulsory patient examination requirements. Since the undergraduate programme is normally 5 years in length, it will be in force at least until 2017. There is no likelihood that the GMC will remove patient examination from any revision: on the contrary, they have consistently stepped up the practical requirements in each iteration of their requirements.
    Your source of information is a verbal comment from a deceased friend: mine is that I currently run an U.K. undergraduate medical programme and am currently or recently an External Examiner at another three U.K. Medical Schools, and I provide guidance to the Medical Schools Council and GMC on educational matters. Do you think it possible that your friend’s comments were informal, possibly even hyperbolic for effect, rather than evidence based? Perhaps you have not quite perfectly remembered his words?
    You said that the dropping of anatomy teaching “is current tense, not past tense”. Please provide evidence that any UK medical school has actually dropped ‘anatomy’ teaching, or is planning to do so. Current teaching approaches are available on medical school web sites, so it would be very easy for you to find evidence for your assertion.
    Everyone is mistaken sometimes, as you are here. Given that these points are not absolutely central to your argument, you might wish to take the opportunity to acknowledge this (as a demonstration of your reasonableness in general). Inability to admit that one is wrong in the face of the evidence, conversely, should be seen as casting doubt on one’s ability to conduct a rational discussion. I look forward to your reply.
    Best wishes,
    Swordfish

  173. alistair said,

    Swordfish: You are a funny fish! Fancy not mentioning your professional knowledge and involvement at the first opportunity:
    “I currently run an U.K. undergraduate medical programme and am currently or recently an External Examiner at another three U.K. Medical Schools, and I provide guidance to the Medical Schools Council and GMC on educational matters.”

    Whilst the words guidance and syllabus are not quite the same, ditto “Current teaching approaches”, and “Since the undergraduate programme is normally 5 years in length, it will be in force at least until 2017″ is daft, since there is a new student intake every year, so in terms of items being dropped from the syllabus, this could happen in any year, regardless of the requirements for those midst their studies. I nonetheless recognise that you are likely in a position to know about the syllabus for the coming year.

    I am not clear of the of ‘practical requirements’ as it impacts upon patient examination: “There is no likelihood that the GMC will remove patient examination from any revision: on the contrary, they have consistently stepped up the practical requirements in each iteration of their requirements.” …for instance, does this mean that at first the ability to take pulse and temperature were required, only later were ears and noses added to examination skills required, and testing of widest range of reflexes and their interpretation is unlikely to be added… a semantic flutter.

    Whether my learned friend was aware of some changes on the horizon, coming to a medical school near you within a few years of now … we will see.
    If I am sorry, it was for carelessly indicating any immediate timescale for the changes I had heard about… and clearly they are not with us yet, which fact you appear to have demonstrated.
    So, in relation to my careless choice of words intimating current in place of in due course, I apologise – these words were chosen in error.

    Off the point:
    Thanks Swordfish for engaging with me rather than simply finger pointing, and nay saying, etc…
    Whilst I did not enter words on this blog for its worthy qualities, it is a pity that Matthew and JCS are engaged in such a negative approach and that they do not engage on equal terms with those that disagree or write alternate view points. Most of all it is a pity that no one has broadly accepted that evidence based medicine is no panacea for an individual that would have been an outlier on the original research – someone either not benefiting from the guideline ‘proven’ treatment or, quite possibly, someone harmed by that treatment.

    But EBT is currently a holy cow, and to say anything against the wonders of Evidence Based Medicine is liable to lead you to be harrassed in much the same way that Dr Myhill is harrassed — with dimwits slinging mud based on daft paraphrasaing, words out of context, and backed by the canon of evidence based medicine as proof that any other approach is disproven and harmful. Really, such perception is the most dangerous factor which we need to combat – such thinking limits ones powers to consider and analyse complicated health matters with as much perception as one may.
    Edward de Bono – I salute you.

  174. Matthew said,

    @Alistair,

    Sloppy you sly little cunt. You are so careful to avoid engaging with what I have said and responding to my questions of you, that you are in danger of sliding up your own edifice (interpret that loosely of tightly as appropriate).

    “When someone is so sloppy that they make elementary errors…”
    It was not an error! it was my choice to use those words, you presumptious shit.

    Are you aware that language acquires new meaning over time?

    “sly little cunt”? “presumptious shit”? “sliding up your own edifice”?

    I really don’t know whether to laugh or cry. You admit using the wrong terms/words by choice? And perhaps your gutter language will acquire “new meaning over time”?

    “presumptious”? Is that a neologism?
    “edifice”? I forgive you for this one, since as demonstrated you know little about anatomy or what words actually mean, and use terms randomly/interchangeably. Maybe a medical student who knows anatomy (ie ALL of them) could tell you what an orifice is.

    Re the medical syllabus, perhaps a look at the current entry syllabus and curricula will disavow you of your notion that students will not get trained in anatomy or clinical/patient examination.

    Maybe Liverpool’s will do (chosen at random)

    http://www.liv.ac.uk/media/livacuk/schoolofmedicine/A100_2010.pdf

    Or perhaps Myhills’ alma mater, University College London?

    http://www.ucl.ac.uk/medicalschool/undergraduate/mbbs-programme/prospectus/medicalschoolprospectus2012.pdf

    Now you get off your own lazy “complacent” arse and actually read what studying medicine entails, instead of relying on hearsay.

  175. mrsP said,

    @matthew

    You have the patience of a saint.

  176. mrsP said,

    @alistair

    You say earlier that sunshine was not mentioned on the NHS site – of course it is here on the vitamins and minerals section and in many others also.

  177. Matthew said,

    @Alistair,
    Looking at your contributions here from a more charitable angle, I guess that your core message has become muddled because of your inability to clearly express your thoughts without sloppy language and inability to stick to points of fact rather than opinion.

    Claims that everyone’s viewpoint or opinion is equivalent, because evidence isn’t necessarily everything, is merely an appeal to ignorance. If this was how medical science progressed, they would still be bleeding patients. I would be the first to acknowledge that science is not sacrosanct or inviolable or always correct – indeed it operates from the perspective of always trying to disprove its own assumptions and search for something that more closely approximates the truth.

    But medical matters are not merely random “opinions”, any of which have equal value or validity. Current guidelines are established because medical science has sufficient evidence to suggest that taking that particular course of action will be in the patient’s best interests. Guidelines evolve as new evidence incorporates new evidence.

    A doctor who relies on their own experience may be perfectly competent (if their experience is extensive and appropriately applicable). But one who ignores evidence, ignores national guidelines on disease management is likely to run into trouble, since their patients are not being optimally managed. Myhill has shown she lags behind in terms of knowledge in many areas of current medical practice. Some of her general ideas may be quite acceptable, albeit unorthodox, because these may be opinions/views held by a number of other reasonable and responsible doctors. But if she issues specific advice that conflicts with what the majority of reasonable and responsible doctors would do, she risks running into trouble, since there is likely to be little basis for her actions, and these could be indefensible in medicolegal terms.

    Myhill’s website advice falls into this category. You cannot give harmful advice to the public, and claim that it is ok because “as far as you know no-one has complained or been harmed”, which is her viewpoint, but it is unlikely that anyone suffering harm from her advice would immediately be apparent to her. To put it another way, what would you say if I said: “Don’t use seatbelts while driving, because I have a medical practice that specialises in seeing people who say they were injured in a crash by a seatbelt. That is my “experience”, and so that is my basis for giving this advice, and no-one has complained as far as I know.”

    Whether you agree with this or not, doing what other knowledgeable and responsible doctors do is the appropriate behaviour from a legal standpoint. It makes sense, or else one would have thousands of doctors all “doing their own thing” and getting sucked into a spiral of self fulfilling prophecy thinking their own experience is all that matters, and creating websites full of their own unorthodox advice, much of which may have no basis in fact or evidence.

  178. Matthew said,

    @Mrs P.
    I’m just having a slowish day, and want to play.

  179. Cybertiger said,

    Look at the size of the prick. Matthew loves exposing his bollocks too. He’s the playground flasher. And he’s playing with himself. Ugh! The dickhead’s a danger to the public. The little jerk should be locked up.

  180. jdc325 said,

    I wonder how neutral observers might feel about the comment thread here. In particular, I wonder how persuasive they find Cybertiger’s carefully reasoned arguments.

  181. alistair said,

    Oh JDC325, your concerns are so touching…

    They likely have misgivings not dissimilar to those they feel when reading Matthew talk about evidence based medicine and NICE guidelines as though these are the sum of all medical knowhow — as if doctors must diagnose per, and prescribe treatment that lies within, the NICE or other evidence based medicine formulated guidelines, or else somehow take a chance with …patients lives / their professional reputation / doing something that has not got ‘the weight of medical research findings’ to back it — we can all says things that make no sense from time to time, but this thread, in spite of NICE confirming that guidelines are only guidelines, and every good doctor knowing this, strenuously ducks the question of what a statistically probable ‘best’ treatment means when faced with someone with a slightly different set of symptoms / conditions / pathology … someone who is found to respond well, if unexpectedly, to some unrelated treatment … I just pray that neither Matthew nor your good self are doctors, since ‘painting’ medicine ‘by numbers’ does not seem like a clever idea to me.

    Do we not understand the value of a Doctors clinical experience and judgement more highly, and recognise the fiendish complexity of human ill-health more than this thread would indicate? I do. I think that Cybertiger does too… in fact, I think most right thinking people do…

  182. alistair said,

    @mrsP – “You say earlier that sunshine was not mentioned on the NHS site – of course it is here on the vitamins and minerals section and in many others also.”

    Can you give URLs for this? I gave URLs in relation to something someone else posted, and it talked all about healthy diets but failed to mention significant sources of vitamin D… So, show me the pages – likes I say, Myhill is rather good on nutrition, where the NHS site is cumbersome, and inconsistent.

  183. mrsP said,

    having trouble posting.

  184. Swordfish said,

    Dear Alistair,

    Thank you for your response to my post. If you wish to cling to the notion that patient examination will be dropped from the medical curriculum at some unspecified point in the future, as a fig leave for your assertions, please feel free to do so. As you say, time will indeed tell.

    Next, would you agree that the use of obscene and offensive language weakens the effect of your arguments rather than strengthens it?

    best wishes,

    Swordfish

  185. Matthew said,

    Alistair:

    “ Do we not understand the value of a Doctors clinical experience and judgement more highly”

    Your faith in maverick doctors is touching. Once again you miss my point. It is not that doctors always have to prescribe and “paint by numbers” according to guidelines, it is that doctors must behave in a fashion that other reasonable and responsible doctors would also do, and they must also not expose patients to the risk of harm. If they do not do this, patients may suffer harm and the doctors will expose themselves to the risk of negligence claims which would be indefensible.

    Dr Myhill has admitted she lacks experience in many medical fields. She may be a whizz at managing chronic fatigue, if so good for her. But her website gave advice on medical matters outside her experience. Surely you can understand that this advice cannot then be said to be reliant on experience, when she has none that is relevant?

    An example. Under the section on cancer, she admits she is not an expert on cancer. Yet she gives out wrong information (eg saying that once a lung tuimour is visible on Xray it is too late for treatment). This claim is not justified by her experience, so where does the claim come from? Not from any valid standard source of medical information, I can tell you.

    I know you have tried to fudge this one in your posts above, but the medical reality is that virtually all lung cancers are first diagnosed on plain chest Xray. Overall 1 year survival is about 30%, so this means that for every 10 people reading Sarah Myhill’s website and who accept her “advice” that cancer is untreatable once it is diagnosed on an Xray, there will be a minimum of 3 who die unnecessarily.

    http://info.cancerresearchuk.org/cancerstats/types/lung/survival/

    So instead of seeking conventional and potentially curative approaches to the treatment of their newly diagnosed cancer, patients may be tempted to follow Dr Myhill’s advice about how to treat cancer. This consists of rather specious advice on detoxification using a “far infrared sauna to “boil off the toxic load”, mega doses of Vitamin C or low glycaemic diets.

    Now perhaps you can answer me this. Since Dr Myhill is not a respiratory specialist, or an oncologist, and admits she has no expertise in cancer, why is she giving out this advice? According to you, she is relying on her “experience”, yet she admits she has none in this field of medicine.

    Your faith in doctor’s “experience” needs to be better targetted, I suggest. Let Dr Myhill stick to what she knows and what is shown to be effective, and not delve into advising on matters outside her own expertise, cancer being one prime example. Is that too much to ask?

  186. Matthew said,

    Alistair,

    Let me put this too you more simply, for clarity and so that your response may be quite specific and to the point.

    Imagine you have a chest x ray, and unfortunately it reveals a lung tumour.

    Will you:
    a) Accept what Dr Myhill says on these matters, because of her experience, and realise it is “too late” to do anything, or
    b) See a chest specialist and seek conventional therapy.

    Just answer a) or b) please. There are really no alternative choices.

  187. alistair said,

    Swordfish: “Thank you for your response to my post. If you wish to cling to the notion that patient examination will be dropped from the medical curriculum at some unspecified point in the future, as a fig leave for your assertions, please feel free to do so. As you say, time will indeed tell.

    Next, would you agree that the use of obscene and offensive language weakens the effect of your arguments rather than strengthens it?”

    When told by someone eminently trustworthy, well connected, and that person is not one to gossip nor waste time on small talk – in other words, someone you have very good grounds to trust – it is likely that you maintain an interest or buy in to what they have told you, open-mindedly, until, that is, the arrival of new information that categorically nullifies it.
    You do not seem quite so well connected as he was, that is my inference, and are not able to announce the medical syllabus nor its content trajectory for the next few years… My mind remains open.

    This blog is not a discussion of obscenity, for that we should go elsewhere.
    I have my reasons, right down to use of the word edifice in place of the potentially more widely predicted use of orifice.
    What saddens me is how silent you remain on key topics related to this blog: the theme of evidence based medicine and how doctors who are not ‘mavericks’ should always comply with its dictats ,,, would benefit from some balance by way of an explanation of the limitations of evidence based medicine. But yet you have not commented about evidence based medicine – is it a holy cow in your neck of the professional woods too?
    It is a pity. You obviously know plenty, and likely could wipe the floor with Matthew in straight line reasoning and knowledge, yet his is the … buccal cavity … that reverberates, raspberry-like, too much of the time. And his standards are nothing like so highly refined as your own. For instance, I am about to respond to his provision of evidence that lung cancer has a significant chance of survival once it can be imaged by X-Ray,,, evidence that he was not keen to produce, yet all the time demanding proof from others, and evidence which I had already seen, this prior to JDC325 supplying it, and… well, it does not evidence survival rates from X-Ray visible lung cancer. The standards Matthew demands of himself are at vanishing point.

  188. alistair said,

    Matthew:
    Yet more hypocrisy? Would that you provided evidence for survival rates from lung cancer at the stage it is visible to X-Ray… you have simply provided the same link that JDC325 provided, one which I had already viewed. It does not show relevant data.
    It is generally accepted that advanced lung cancer gives very very poor chances of survival.

    “Your faith in maverick doctors is touching.”
    No, I attest that every good doctor needs to be able to consider the patient before them, how they present, what their individual health/genetic/pathological/nutritional mean towards making a diagnosis and prescribing medicine or guiding their patient. I attest that any doctor too diligently following guidelines based on research attempting to find one-size-fits-all treatments for some observable aspect of ill health is liable to do some very bad medicine.

    “Once again you miss my point.”
    Since you have scarcely responded to my responses to your points, dismissing them whilst attacking me, again and again… no, I don’t miss your point.

    “It is not that doctors always have to prescribe and “paint by numbers” according to guidelines,”
    Actually, in your attacks against Dr Myhill, you will find on rereading that this is mostly implicit and sometimes explicit in what you have said. Repeatedly so.

    “it is that doctors must behave in a fashion that other reasonable and responsible doctors would also do”
    Bull shit. Doctors first priority is not what other doctors think, except by way of obtaining a second opinion, it is the good health of their patient that counts.

    “… and they must also not expose patients to the risk of harm.”
    Okay – so you propose that we cancel all surgical procedures, close hospitals (too many sick patients in one place increase the spreading infection), and withdraw all drugs that might on occasion have an adverse reaction or other harmful side-effect? Bang go Statins in the blink of an eye.

    “If they do not do this, patients may suffer harm”
    There again, without attempting to treat them, some patients will die anyway…

    “… and the doctors will expose themselves to the risk of negligence claims which would be indefensible.”
    Yes!! Their employer might be really annoyed with them for being so careless…. ?!? Hell! You can please some people, some of the time, but you can’t please all of the people all of the time. Are you suggesting that modern medicine should be closed on the grounds of adverse health and safety risk? Good plan! At it boy!

    “Dr Myhill has admitted she lacks experience in many medical fields.”
    Find me a doctor who does not lack experience in many medical fields… so she was being honest? Big deal.

    “She may be a whizz at managing chronic fatigue, if so good for her.”
    Managing, treating, and curing… at least, returning many many patients to a good quality of life where they can live a little, work, play, dance, have fun and not fear becoming bed bound soon… so it is good for her, and bloody marvellous for such patients who have been repeatedly dismissed by GPs based on the nonsensical Oxford definition of ME, with GPs commonly not examining their patient and commonly presuming them to be depressed or attention seeking or hypochondriacal, and pushing them towards CBT to resolve their troubled thought processes.

    “But her website gave advice on medical matters outside her experience.”
    She expressed many opinions, yes. Something that JDC325 mentions (above) the GMC advised him/her/it that they cannot censure doctors for expressing an opinion…

    “Surely you can understand that this advice cannot then be said to be reliant on experience, when she has none that is relevant?”
    Oh! You are such a literal creature. The phrase ‘lacking experience in…’ is not necessarily the same as ‘know nothing about…’

    “An example. Under the section on cancer, she admits she is not an expert on cancer. Yet she gives out wrong information (eg saying that once a lung tuimour is visible on Xray it is too late for treatment). This claim is not justified by her experience, so where does the claim come from? Not from any valid standard source of medical information, I can tell you.”
    Actually, you have yet to provide any source of published information that refutes her statement. So please stop bleating how wrong she is.
    Likely she has met a few people in her lifetime, read medical journals, etc. and has settled on considering that this stage of lung cancer remains a terminal condition.

    “I know you have tried to fudge this one in your posts above, but the medical reality is that virtually all lung cancers are first diagnosed on plain chest Xray.”
    I don’t believe that you have shown that – do you have a reference that shows this to be fact? And, there is some middle ground here – a fuzzy X-Ray indicating that all is not well, may not be quite the same thing as Myhill talking about Lung cancer being visible on X-Ray.

    “Overall 1 year survival is about 30%”
    For young folk, diagnosed at varied stages of cancer.

    “… so this means that for every 10 people reading Sarah Myhill’s website and who accept her “advice” that cancer is untreatable once it is diagnosed on an Xray, there will be a minimum of 3 who die unnecessarily.
    http://info.cancerresearchuk.org/cancerstats/types/lung/survival/
    You are blatantly misinterpreting those graphs. They show no such thing.

    “So instead of seeking conventional and potentially curative approaches to the treatment of their newly diagnosed cancer, patients may be tempted to follow Dr Myhill’s advice about how to treat cancer. This consists of rather specious advice on detoxification using a “far infrared sauna to “boil off the toxic load”, mega doses of Vitamin C or low glycaemic diets.”
    Obviously, faced with death, all who yearn for more life will do everything in their power to cure their illness…. conventional and complementary approaches. Clearly nutrition is complementary.
    I have absolutely no idea why Steve Jobs did not use conventional approaches for his treatable cancer.

    “Now perhaps you can answer me this”
    It would be much less wearing if you would answer anything for me rather than keeping insisting I am wrong without addressing anything I put to you.

    “… Since Dr Myhill is not a respiratory specialist, or an oncologist, and admits she has no expertise in cancer, why is she giving out this advice?”
    Did I already mention the word ‘opinion’. She seems to be beyond reproach from the GMC expressed view, in matters of expressing her opinion. Does she say, “If you have cancer what you should do is…”
    I don’t think so.

    “According to you, she is relying on her “experience”, yet she admits she has none in this field of medicine.”
    No, she said she lacked experience, but this is very comparable to your reliance on medical research in place of going and doing the research yourself. It is perfectly possible that DrMyhill has read rather a lot of medical research papers and medical references, and has developed rather a useful knowledge, don’t you think?

    “Your faith in doctor’s “experience” needs to be better targetted”
    I’d sooner have an experienced doctor who knows what works to resolve most expediently a nasty medical complaint, than have someone freshly qualified reading it off the guidelines… wouldn’t you?

    “… I suggest. Let Dr Myhill stick to what she knows and what is shown to be effective, and not delve into advising on matters outside her own expertise, cancer being one prime example. Is that too much to ask?”

    What works for an individual patient presenting to a doctor, has not been subject to research in a double-blind trial… sure, the doctor can see if the patients symptoms and general health mean that the guidelines usefully apply, and then, if the fit is good, hey presto! they can prescribe usefully according to the guidelines, but this is certainly not always so. In addition, where a doctor happens to recognise that the guidelines are either lagging 18 months behind the science, or, are perversely incorrect, as they are with CFS, and they are with the NHS insistence that testing vitamin A levels in the chronically ill is not cost effective (although, admittedly, trying supplementing with vitamin A over 3-4 months is, likely, more cost effective), then it is good that a doctor has the wits, integrity and moral fortitude to ignore the rot and treat their patient according to the best science research available.
    In short, you are confused. Dr Myhill is free to voice opinion.

    Now, can you show me the survival rates for lung cancere presentations where the cancer is *visible* on X-Rays?
    And, can you show me the stats on route to lung cancer diagnosis?

    Thanks.

  189. alistair said,

    Matthew: “Let me put this too you more simply, for clarity and so that your response may be quite specific and to the point.

    Imagine you have a chest x ray, and unfortunately it reveals a lung tumour.

    Will you:
    a) Accept what Dr Myhill says on these matters, because of her experience, and realise it is “too late” to do anything, or
    b) See a chest specialist and seek conventional therapy.

    Just answer a) or b) please. There are really no alternative choices.”

    [This reminds me of that scene where Steve Martin in the film Roxanne facing down someone ribbing him about his big nose... too easy for words to do better...]

    Fantastic! The reductive thinking / all or nothing analysis approach – bound to get to the nub of the truth, if not the heart of it.
    c) take note of what Myhill has to say, whilst visiting specialist cancer hospital soonest
    d) visit specialist cancer hospital soonest, and research widely on alternative viewpoints and health suggestions (life is precious)
    e) do nothing – we have all got to die some day
    f) meditate
    g) refuse to accept the diagnosis
    h) travel to America for the best treatment available
    i) write to TV doctors for advice on what to do. Then take their advice
    j) have fun taking one last holiday
    k) use time available to put affairs in order, write will, etc.
    On occasion, diagnoses have proven erroneous where medical records/X-Ray images have been mixed with another patients
    l) pray for a miraculous intervention from your god

    There is so much, and so many combinations of what a person can do,
    Oh! Me? I’d probably choose a mixture of d through l, if I was lucky enough to have that sort of time and sufficient breath with which to do so.

    I think choice is so empowering, don’t you?

  190. alistair said,

    Matthew:
    “I really don’t know whether to laugh or cry.”
    Thanks to god on high – you are human! I do believe you might, just might, be getting it… humour is possible, beneficial, indeed vital.

    “You admit using the wrong terms/words by choice?”
    Did Les Dawson play the piano badly? You bet he did.
    Did Ronnie Barker pismonunciate from time to time?
    Did Del Boy sometimes get his words in a muddle?
    Do you need shaking out of your self satisfied pedantically, suffocatingly restrictively, truth evadingly narrow view of everything? Certainly.

    “And perhaps your gutter language will acquire “new meaning over time”?”
    It has plenty of meaning here and now thanks. It was directed at you.

    ““presumptious”? Is that a neologism?”
    Err… i next to u on the keyboard – looks like a typo, don’t you think? Or do you prefer alternative approaches to Ockham’s razor?

    ” “edifice”? I forgive you for this one, since as demonstrated you know little about anatomy or what words actually mean, and use terms randomly/interchangeably. Maybe a medical student who knows anatomy (ie ALL of them) could tell you what an orifice is.” ”

    Interesting that you state that all medical students know anatomy, as though they all have a near equal grasp.

    I think edifice was rather a nice choice, given my use of the word cunt. Given your self-righteousness and hypocritical standards regarding evidence, using a term that can mean school of thought, combined with the notion of slippery, seems all too apt for you.
    However, the word cunt, meaning hole or orifice with flapping lips, is what I had already called you, so I had no desire to repeat nor confuse my meaning.
    I won’t promise to be more direct another time – just try to interpret literally, and some of the time, you won’t be far wrong.

  191. Matthew said,

    Alistair,

    I think that you have ably demonstrated why civil discussions with someone like your GP may have degenerated into an impasse.

    When you resort to calling people cunts and fuckwits because you fail to understand simple medical concepts of risk, benefit and potential for harm, and cannot distinguish between appropriate clinical expertise and quackery, then I can quite see why people like you do not get on well within the system of the NHS and rapidly alienate themselves.

    My attempts to engage you more civilly have unfortunately failed. I suppose I should not have expected any different – the red flags were flapping wildly from the time of your earliest posts.

    Most of your drivel above is not worth responding to, but I would like to know one thing:

    How do you think a possible lung cancer is first diagnosed? As I am sure Swordfish can tell you, it is virtually always first found on chest X ray (and then confirmed by either bronchoscopy and biopsy or CT /PET scanning). Very rarely a primary lung cancer might be found coincidentally while the patient undergoes a different diagnostic procedure – I knew of someone who had a primary kidney tumour, and a staging CT scan was done which revealed a coincidental lung tumour which turned out to be an independent primary – this scenario I gather is extremely rare, and in retrospect the radiologists agreed that his chest X ray did in fact reveal changes that they initially missed)

    But perhaps you think lung cancers are diagnosed by telepathy, or quantum dowsing? I’d love to know. Go on, tell us how they are diagnosed, and then tell us why you think that cancers visible on an X ray are incurable (as Myhill implies).
    ,

  192. Matthew said,

    Another gem from the Myhill website:

    Prion disorders: Alzheimer’s Disease; Parkinson’s Disease; Creutzfeldt-Jacob’s Disease & Motor Neurone Disease.

    She says as her opening gambit: “I have no difficulty with the concept of prion disorders”.

    Of these 4 diseases, only one (CJD) is due to a prion disorder.
    With respect, I suspect Dr Myhill has significant problems with the concept of prion disorders.

  193. Matthew said,

    And someone should point out to her that the spelling of Creutzfeldt-Jakob Disease is wrong. You’d think that someone with the expertise Alistair says she has wouldn’t make an error like that particularly when writing a chapter about it for one’s wikipedia type medical information website.

    But perhaps it isn’t really “wrong” after all, perhaps as Alistair will no doubt suggest, it is only her “opinion”, and is therefore viewable as perfectly “corrr-ect!”.

  194. alistair said,

    Matthew: “My attempts to engage you … failed”

    I am glad to see that you are finally having a laugh.
    For he that holds all the answers, you are miserably failing to provide any evidence for them. You that points the finger and calls everyone wrong, yet fails to provide evidence himself, and fails to answer any point raised towards him… you fail to engage me? What self-deception ./ delusion!

    “Most of your drivel above is not worth responding to, but I would like to know one thing”
    Well, you could just try providing evidence for anything that you have stated yet not so far shown evidence instead of nay saying anything that I say… you could do that if the evidence could be found, but you are not finding it, are you? So instead of admitting that you are not entirely correct, you are on the attack again.

    I say again, get yourself checked viz Aspergers – this is not a criticism, just a perception that might be relevant towards you knowing yourself. You are certainly a handful where it comes to matters of engaging you outside of your obsessive focussed interest and angle. Your straight lines allow no deflection nor time to observe alternate viewpoints.

    I am quite sure that very often an X-Ray shows signs that the lungs are somehow not quite right, but the diagnostic step tends to be a further test in the case of small cell disseminated cancer… am I mostly correct?

    As you yourself say of such diagnostic routes:
    “…confirmed by either bronchoscopy and biopsy or CT /PET scanning”
    so the actual diagnosis is not X-Ray, that merely shows indications of something not quite right, it is the follow up procedures that diagnostically confirm lung cancer.

    If you are talking of large tumours in the lungs, then this is a different and specific scenario, and these will be visible to X-Ray and perhaps operable…

    “When you resort to calling people cunts and fuckwits because you fail to understand simple medical concepts of risk, benefit and potential for harm, and cannot distinguish between appropriate clinical expertise and quackery, then I can quite see why people like you do not get on well within the system of the NHS and rapidly alienate themselves.”
    What? I called you a cunt and fuckwit to attempt to penetrate your incredibly thick hide and see if I could elicit some positive engaged response: all other attempts, at length, have failed. Hence, in no small part, my suspecting, all things considered, that you may well lie in the spectrum of Aspergers – likely very clever and capable, but with some provisos and limitations.

    Your above paragraph does not mention how you have failed to respond to any critique or analysis that I have made of the limitations of evidence based medicine – your holy grail of best medical practise – and has ignored my calling your bluff on the difference between medical advice and medical opinion, and … on any topic and every topic that I have engaged with and responded to any of your comments … it is you, time after time, who has not engaged in debate.

    I picture you to be tall and skinny, like the animated Peperami in the TV adverts — nothing stops you arguing the toss in a fashion that ridiculously ignores the obvious. Yet not so much a ‘bit of an animal’ but certainly a hide bound animal – excepting your slight sensitivity when called a few names.

  195. alistair said,

    Matthew: “Another gem from the Myhill website:

    Prion disorders: Alzheimer’s Disease; Parkinson’s Disease; Creutzfeldt-Jacob’s Disease & Motor Neurone Disease.

    She says as her opening gambit: “I have no difficulty with the concept of prion disorders”.

    Of these 4 diseases, only one (CJD) is due to a prion disorder.
    With respect, I suspect Dr Myhill has significant problems with the concept of prion disorders.”

    She says, under a sub-heading:
    “What are prion disorders?
    I have no difficulty with the concept of prion disorders. …”
    Looks like she is not so confused to anyone but yourself.

    Has Wikipedia got spellings hopelessly wrong again:
    “The disease was first described by German neurologist Hans Gerhard Creutzfeldt in 1920 and shortly afterwards by Alfons Maria Jakob, giving it the name Creutzfeldt–Jakob.”

    How would you like to spell the name of this set of diseases?
    I believe that, as with many foreign origin names, there is more than one acceptable spelling.

    Now, as for the main heading that you quote, much as you believe that she is wrong, do you think it might be more productive to email her or join her forum and ask why it is so titled? Or tell her why it is in error?
    Or is that too much like engaging with a discussion for you, given as they are so wrong and you are so correct?

  196. alistair said,

    Matthew – I’ll say this for you: You really and truly hate being criticised or in any way having your statements doubted. You can only think that your most exacting standards of reasoning and logic and learning result in you providing the perfect answer every time. God it must be hard work being you in the real world, amongst people with their own minds and their own evaluations of the truth and interpretations of the world around them. Too many uncontrolled factors to be comfy for you.

    Now my mental image of you is heading towards the shape of Yosemite Sam… Another ridiculous character.

  197. Cybertiger said,

    The ‘Swordfish’ snootily asked,

    “Next, would you agree that the use of obscene and offensive language weakens the effect of your arguments rather than strengthens it?”

    That particular silly fishy person forgets that jdc253’s alma mater is Ben’s place, the drinking hole of a load mad f*sh and a whole host of other moronic f*ckw*ts,

    http://www.badscience.net/forum/viewforum.php?f=3

    … that includes such f*ckw*tted luminaries as ‘Becky Fisseux’, the gay dame with a boil on his bum and a very sore arse,

    http://jabsloonies.blogspot.com/

    “Hi. My name’s Rebecca, although most people know me as Brian” … and in reality I’m a big c*ck with a very foul mouth and lots of strong argument.

  198. alistair said,

    Cybertiger – is all that true? JDC325 (to me an anonymous alias) is connected with Ben Goldacre?
    Wow! Then all of this disproportionately negative energy being poured towards Dr Myhill suddenly makes sense – got to protect the psychics budgets and their grasp of the budget and their twisting of the truth… ME is all in the mind… yeah right: some people get lethargic then ill from being sad, depressed and losing a healthy mental perspective… but so many more want real medicine… and psychics cannot provide this.

    Next you will say that Swordfish is similarly linked… but seems unlikely: a cut above is the impression I get.

  199. jdc325 said,

    Hi alistair,

    Who has said that “ME is all in the mind…”?

  200. jdc325 said,

    Sorry alistair, I forgot to ask – do you think that posters on the XKCD forum are “connected with Randall Munroe”?

  201. Cybertiger said,

    Yes, the ‘jdc’ thingy is one of the Maharishi Guru Ben’s premier league disciples. jdc532 has recently been elevated to the f*ckw*ts top table as a ‘bad science’ milk monitor and thus able to dispense b*llsh*t awards to the biggest t*ss*rs in Guru Ben’s foul-mouthed world of dismal scientists. Yuk!

  202. matthew said,

    Wikipedia is spot on.

    J A K O B

    If Myhill is going to write an article about a disease, can she not get the name corr-ect?

    As predicted, the paranoid conspiracist Alaster leaps to her defence. I have no doubt if she called it “iaycubv” he would say she is right, and mumble about this being an acceptable variant in esperanto.

  203. Cybertiger said,

    Stupid, arrogant, nitpicking git! Ugh! A typical bad scientist of the Ben Goldacre genre.

  204. alistair said,

    Matthew – were you a late starter: did you take longer than most to stop having tantrums at the smallest thing, and to stop crying and to stop wetting the bed?
    Jakob / Jacob ? For Fuck’s sake get a grip man!
    For an encore you go on to misspell my name. So Fucking what?
    …at any rate, I think you meant me, even if the description was a little uncharitable… (you did tell me to act paranoid, didn’t you?)

    A singularly disproportionate lot of bollocks – infeasibly small would be my guess.

    First a typo has you blabbing, now a name that won’t make the tiniest iota of difference to the trajectory of man and woman kind alike…
    Are you not getting your lithium? Has someone withdrawn your medication?
    Calm down. Your not on Television. This is just some shite blog.

  205. alistair said,

    “jdc325 said, January 17, 2012 at 9:47 pm
    Hi alistair,
    Who has said that “ME is all in the mind…”?”

    Where have you been these last 20 years? If you post entries on any blog cognisant of bad science/Ben Goldacre, surely you must have heard about the evidence based treatment for ME ? Really not? (downgrade blog merit status) Note to party of 2nd part: must pull head out.

  206. alistair said,

    “jdc325 said,
    January 17, 2012 at 9:51 pm
    Sorry alistair, I forgot to ask – do you think that posters on the XKCD forum are “connected with Randall Munroe”?”

    Can you smell smoke? Some fishy kind of smoke?
    …you have never heard of Ben Goldacre? Really?

  207. matthew said,

    Allastir,

    Has it ever occurred to you that doctors do CT scans or lung biopsies because something abnormal is visible on a chest Xray, and not just for fun?

    Sorry you got upset at the name mispelling. I took it that this doesn’t matter, the way you have been defending Myhill’s vagaries in this area.

  208. mrsP said,

    Good quote I missed on Myhill – “pure asthma is always totally reversible and has a cause”

    No it is not and of course it has a cause – however the cause is not fully understand. Genetics, the environment play a part and we know some triggers.

    This IMO is dangerous information. Until the cause is fully understood and perhaps a cure found asthmatics must take the treatments that are shown to work. 1500 people died from asthma each year and failure to take proper treatment if the major factor in this. To lead people to believe that diet, breathing systems etc can reverse asthma is indefensible.

  209. ChrisP said,

    Matthew, what a page you have found! That whole page on prion disorders is full of wrong. Ms Myhill seems to have confused amyloids with prions, and she also promulgates the myth that there is no evidence of a link between BSE and vCJD. The CDC has some really interesting data on CJD. http://www.cdc.gov/ncidod/dvrd/cjd/index.htm

    I see tiddles has uncovered your ugly secret jdc and that has set alistair’s conspiracy theory generator going. Are you going to tell alistair or should I, that tiddles alma mater is JABS? alistair could find conspiracy theories to his heart’s content over there. Perhaps tiddles can show him the ropes?

    One small correction MrsP, that quote about asthma from Ms. Myhill is dangerous misinformation.

  210. alistair said,

    “matthew said, January 17, 2012 at 10:40 pm
    Allastir,
    Has it ever occurred to you that doctors do CT scans or lung biopsies because something abnormal is visible on a chest Xray, and not just for fun?”
    You paraphrase me? To what end? …they see something odd on an X-Ray and use lung biopsies and CT scans to diagnose.

    “Sorry you got upset at the name mispelling. I took it that this doesn’t matter, the way you have been defending Myhill’s vagaries in this area.”
    I got upset at what? Is the English language a mystery to you or did you just lobotomise yourself? You’re ability to read others reminds me of… Aspergers traits.

  211. alistair said,

    “mrsP said,
    January 18, 2012 at 12:51 am
    Good quote I missed on Myhill – “pure asthma is always totally reversible and has a cause”

    No it is not and of course it has a cause – however the cause is not fully understand. Genetics, the environment play a part and we know some triggers.

    This IMO is dangerous information. Until the cause is fully understood and perhaps a cure found asthmatics must take the treatments that are shown to work. 1500 people died from asthma each year and failure to take proper treatment if the major factor in this. To lead people to believe that diet, breathing systems etc can reverse asthma is indefensible.”

    …and yet Dr Myhill never says don’t take your asthma medication, now does she?
    So giving opinion that they may be avenues to explore to cure your asthma is hardly a dangerous thing to do, unless raising hopes is a well known cause of premature death. She does not state that finding the cause is simple nor certain… she is perhaps being rather vague, but nothing like dangerous.

  212. alistair said,

    I understand the idea that finding errors in the writings of another can be interesting, hell, I do it myself, it just seems when picking flaws in Myhill that the critics make so many mistakes themselves, so as to suggest that Myhill is actually much more careless or wrong than she is…

    “ChrisP said,
    January 18, 2012 at 5:36 am
    Matthew, what a page you have found! That whole page on prion disorders is full of wrong.”
    For clarity, did you mean full of errors?

    “…she also promulgates the myth that there is no evidence of a link between BSE and vCJD.”
    No she does not; She does not mention vCJD.

    “I see tiddles has uncovered your ugly secret jdc and that has set alistair’s conspiracy theory generator going.”
    Not at all, but it would surprise me if the jcd with all his peerless acuity had posted on badscience repeatedly without knowing anything about ME, the story of the Oxford criteria, the NICE guidelines that presume mental issues… etc. As for his not being aware of Ben – well, he smokescreens ineffectually – a straight denial would have been more convincing, but beating around the bush? Nah! Not buying it. This is simply termed intuition and/or perception, not “conspiracy theory generation”

    “Are you going to tell alistair or should I, that tiddles alma mater is JABS? alistair could find conspiracy theories to his heart’s content over there. Perhaps tiddles can show him the ropes?”
    Ah! Great! The old boys network in place of openness – no hidden agendas here… Sure.

    “One small correction MrsP, that quote about asthma from Ms. Myhill is dangerous misinformation.”
    And that last sentence is horribly ambiguous. Double negative? More danger – is this self-inflicted danger or danger from Wales?

  213. ChrisP said,

    No alistair, I meant full of wrong. In that just about every sentence on the page is wrong.

    Why would it surprise you if jdc posted on the Bad Science Forum without knowning anything about the Oxford Criteria? Are you expecting everyone to be full bore on the arguments among the CFS community about diagnostic criteria? I think jdc is aware of Ben Goldacre, he does link to his blog and forum on this page. I rather suspect he can’t see the connection in the conspiracy theory. It is hard to have a conspiracy if everybody knows about it?

    Has tiddles let on that he was a long time resident of the JABS forum? They are one of the few places on the internet that don’t point and laugh at poor old tiddles. Hey I got another conspiracy theory for you. Have you noticed how CJD is actually an anagram of jdc? Creepy huh?

    Dangerous misinformation is not a double negative. I love it how when the arguments start tto fall apart, there is all this wrong criticism of grammar. It is as if substance of the argument is not at all important.

  214. alistair said,

    ChrisP – Eat my shorts! This blog of JDCs is about Dr Myhill – if JDC is a freakin’ turd he’d still know about ME / CFS and the Oxford criteria.
    I don’t rate him a stupid turd. Don’t imagine that I am stupid either.

    “I think jdc is aware of Ben Goldacre, he does link to his blog and forum on this page.”
    That was so worthwhile stating. If rather obvious? Yawn.

    “Hey I got another conspiracy theory for you. Have you noticed how CJD is actually an anagram of jdc? Creepy huh?”
    Do I misunderstand the term ‘conspiracy theory’, or is it you? And why the obsession?

    Just because you do not rate the JABS forum does not in itself make the quality of entries on this blog any more accurate.

    “Double negative” was not a criticism of his grammar, and certainly not of his phrase “dangerous misinformation”, it was the lack of clarity of his comment upon mrsPs ‘Dangerous’ warnings… was he accusing mrsP of misinformation, even dangerous misinformation, or was he accusing her of being wrong about there being any dangerous information… was one negative negating another… I suppose that makes me guilty of ambiguity in a sentence accusing others of ambiguity… (gosh! is that what matthew calls irony? You know, I think I get it… removes tongue from cheek [irony? wots that?]) perhaps you did not notice my accusation in that earlier post?
    Take it easy, likely it is not so complicated as you would like.

  215. alistair said,

    ChrisP – I seemed to have missed the obvious comment to a grammarian like yourself: “No alistair, I meant full of wrong.” is not an impressive piece of writing no matter that what you meant was “full of wrong”
    It’s alright dear – you’re not on TV, just this shite blog.

  216. ChrisP said,

    alistair, do your turds freak you out often?

    I am not interested in your shorts, you can keep them to yourself.

    I only became interested in your obsession about conspiracies when you thought there was so much import in the revelation that jdc posted on the Bad Science Forum. Most people I meet who are into conspiracy theories end up in the position of not finding any conpsiracy that they don’t like. (Hey there is a double negative for you. Creepy huh?).

    Don’t tell me you think JABS Forum is quality? Rabbit hole, here we come!

    I see you have trouble reading. Because my sentence went ‘One small correction MrsP, that quote about asthma from Ms. Myhill is dangerous misinformation.’

    I see substance of the argument is not at all important. Let’s all focus on the grammar!

    One last thing, CJD gets used as a generic term that encompasses a group of prion based spongiform encephalopathies, as well as being a specific disease. Just so you know.

  217. alistair said,

    ChrisP
    Who is interested in conspiracy theories here?
    Perhaps you address them on the topic instead of me?

    “Don’t tell me you think JABS Forum is quality? Rabbit hole, here we come!”
    I have made no comment about it to be sure.

    “I see you have trouble reading. Because my sentence went ‘One small correction MrsP, that quote about asthma from Ms. Myhill is dangerous misinformation.’”
    No trouble – I read your sentence with ease.
    Which sentence remains a trifle ambiguous. Are you correcting mrsP in the extent or degree to which the Myhill information is wrong, or admonishing mrsP for creating dangerous information?

    Clarity of writing matters – seemingly for us both – so let us not lose sight of the need for it.

    CJD / vCJD – I had no idea! Thank you for telling me, I’ll make a note of it.
    Well, perhaps you or Matthew had better ask Myhill to be less ambiguous – since she does not differentiate CJD / vCJD, There is little point assuming that she has got herself confused, certainly not without asking her.

  218. ChrisP said,

    alistair, this blog post is about the wrongness on Ms Myhill’s website. Most of which has nothing to do with CFS. The wrongness ranges from incorrect notions about disease, disease progression and treatment to staggering ignorance about biochemistry. If I hadn’t seen the website for myself, I would be hard pressed to accept someone with a biology undergraduate degree at University could believe such nonsense. However, for me the coup de grace is the useless tests and treatments Ms Myhill promotes to patients. It is one thing to publish misinformation, quite another again to rip off vulnerable people.

    I could write to Ms Myhill about the things that are incorrct on her website, but I doubt that would be of much use. From her behaviour towards the GMC, I get the strong impression that Ms Myhill is more interested in being right, rather than being correct.

  219. Cybertiger said,

    @ChrisP with the Pnut brain

    “From her behaviour towards the GMC, I get the strong impression that Ms Myhill is more interested in being right, rather than being correct.”

    What sort of gibberish is that?

  220. Cybertiger said,

    Of course, one of Ben’s flock of turkeys got himself slaughtered for Christmas.

    http://www.meassociation.org.uk/?p=9879

    Ho, ho, ho, twat!

  221. alistair said,

    ChrisP
    Oh, I thought this blog was not so much: ” …about the wrongness on Ms Myhill’s website” as about: “the-wrongness-of-dr-sarah-myhill”

    Most of the NHS promotes useless tests (take your typical GPs interpretation of standard blood tests, where they will interpret magnesium if asked, where this cannot usefully be evaluated from serum, and only shows abnormalities on verge of patients death), so this criticism of Myhill is pretty bland. I suppose that her involvement in research on CFS which resulted in new and useful tests is not something that much interests you.

    You could write to her before publicly and repeatedly declaring that she is wrong about something whereby that error is presumed (she does not mention vCJD but you assume that her use of CJD is in its broad meaning). It would be both polite and the only likely route to you’re learning whether your interpretation is correct. However, in general, where criticism of Myhill on this blog is concerned, much as you deride Myhill in your perception that she “is more interested in being right, rather than being correct”, the criticism herein is not worried about, nor interested in, being tested. Finger pointing of the worst “neighbour from hell” variety, rather than anything too scientific.

    If the treatments that Myhill ‘promotes’ to patients is so useless, how is it that so many folk report her information being the first to get them any health improvement after what is often a matter of years ‘on the scrap heap’ through fatigue, fibromyalgia pain and so on? Are all these ‘victims’ deluded hypochondriacs with mental problems?
    I take it that you nor anyone you care about has suffered from true chronic fatigue? They are a sizeable minority.

    Shall we test some of her science?
    NICE / NHS / et al recently denounced selenium as an additive of no proven (read evidence based medicine) value as a supplement.
    Myhill indicates its involvement in antioxidant biochemistry.
    Is Myhill demonstrating “staggering ignorance of biochemistry”? or is someone with a selenium deficiency liable, in broadest terms, to benefit from correcting this? I’ll assume that we can agree that selenium is not known to be over supplied by a typical UK diet?

  222. alistair said,

    Cybertiger: not exactly slaughtered, no, but doctors lacking humanity are sadly all too common. No, the punishment is unlikely to make any think twice, just as this blog shows little sign of dropping the hypocrisy and being even handed. It is largely a disproportionate and negative attack, not liable to garner the best outcomes for anyone.

  223. Swordfish said,

    Dear Alistair,
    I am glad that you have conceded that patient examination is part of the current teaching of medical students, as opposed to your previous assertions. I am entertained that you believe that your friend is more current with GMC thinking than I am. I think this is implausible since (a) it is my professional responsibility to know such things and (b) he is deceased.

    With regard to obscenity and scatological language, I asked because in my view its use markedly weakens the credibility of your arguments, and you obviously think differently: I am curious as to why.

    We do not recommend ‘holy cows’ in my institution. We prefer medicine based on evidence to medicine not based on evidence. We teach our medical students that the best practice of medicine requires the integration of the best research evidence with our clinical expertise and our patient’s unique values and circumstances.

    By ‘best research evidence’ we mean valid and clinically relevant research, often from the basic sciences of medicine, but especially from patient-centred clinical research into the accuracy of diagnostic tests (including the clinical examination), the power of prognostic markers, and the efficacy and safety of therapeutic, rehabilitative, and preventive regimens.

    By ‘clinical expertise’, we mean the ability to use our clinical skills and past experience to rapidly identify each patient’s unique health state and diagnosis, their individual risks and benefits of potential interventions, and their personal values and expectations.

    By ‘patient values’, we mean the unique preferences, concerns and expectations each patient brings to a clinical encounter and which must be integrated into clinical decisions if they are to serve the patient”.

    We explore this further with qualified doctors up to and including consultants, and with senior doctors in leading roles in the NHS.
    I hope this clarifies the situation.

    Best Wishes,

    Swordfish

  224. Cybertiger said,

    Down on the ranch, hillbilly Ben, scientifically cultivates a particularly ‘vicious’ breed of turkey …

    http://www.meassociation.org.uk/?p=9879#comment-2146

    … peculiarly ‘unsavoury’ creatures all

  225. ChrisP said,

    Ms Myhill’s research on CFS. alistair, are you talking about this research? http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2680051/ If so, it is thoroughly crap. Let me start with the things wrong with it.

    Introduction. This is supposed to provide sufficient background to understand the hypothesis being tested. Instead it is a long rambling piece on basic energy metabolism. There is no evidence presented in it of where CFS is supposed to specifically interfere with metabolism and what the evidence for this is. Instead it says (to paraphrase): ‘Energy is important. You get fatigued if you don’t have sufficient energy. Cells make energy in their mitochondria. Therefore, mitochondrial dysfunction must be the cause of CFS.’

    Methods. Firstly, patients were made to pay for tests. This in medical research always rings alarm bells. It means patients are being exploited by the researcher. There is no ethics approval mentioned. This definitely rings alarm bells. All research involving patients requires an ethics approval to stop the patients being exploited by the researcher. Patient matching was not done. The patients were not matched for sex, age, location, or any other potential confounders. Without this, the data are basically useless. Nothing has been controlled for, so you don’t know if CFS or smoking is producing the difference. A test not fit for the purpose was used. Makes the results useless. No statistical analysis was conducted. So we don’t know if any differences occurred by chance.

    Results. Basically useless. There was no a priori hypothesis tested. The results are declared to be important when CFS patients differed from non-CFS individuals.

    Discussion. This is supposed to put the information gathered into an understanding of the field. Instead it discussed the various diagnosis criteria and made the rather extraordinary statement that if a less selective diagnosis criteria was used, the correlations would not be as good. How on earth would Myhill know? This wasn’t tested.

    If the paper was so bad, how come it got published I hear you ask. (Actually I didn’t, I am using a figure of speech. Actually, I am not sure this is a question you would want to ask anyway, but it is one I want to answer – but I digress). It was published because this is in one of those journals where you pay to get your work published, no matter how bad it is.

    Always happy to help alistair.

  226. alistair said,

    Swordfish.
    I fear that you are too busy to respond accurately to that which I have said.
    Did you read it, or do you prefer to run with the story in your head?

    Your story reads really nicely, just it further emphasises things in ways that are misleading.
    “I am entertained that you believe that your friend is more current with GMC thinking than I am. I think this is implausible since (a) it is my professional responsibility to know such things and (b) he is deceased.”

    Very witty, yet ‘more current’ are your words, not mine.
    It is one thing knowing the current syllabus and historical changes inside out, quite another having knowledge of their direction in the future.

    I was imprecise in my original gossip (that became obvious, right?): tell me, what are the changes to the medical syllabus for the next 5 years? Do you set the syllabus? If not, do you have the confidence of folk directly involved in so doing? …aside from not to mention a word or your job could be on the line ( …which cannot be said of an elderly man), what have they shared with you?

    “With regard to obscenity and scatological language, I asked because in my view its use markedly weakens the credibility of your arguments, and you obviously think differently: I am curious as to why.”
    What I think, remains in my head. I have only commented that I had my reasons.
    So the obviousness of my thinking can only be down to your mind-reading: I suggest you stop guessing at what it is that I am thinking.

    “We do not recommend ‘holy cows’ in my institution. We prefer medicine based on evidence to medicine not based on evidence. We teach our medical students that the best practice of medicine requires the integration of the best research evidence with our clinical expertise and our patient’s unique values and circumstances.

    By ‘best research evidence’ we mean valid and clinically relevant research, often from the basic sciences of medicine, but especially from patient-centred clinical research into the accuracy of diagnostic tests (including the clinical examination), the power of prognostic markers, and the efficacy and safety of therapeutic, rehabilitative, and preventive regimens.

    By ‘clinical expertise’, we mean the ability to use our clinical skills and past experience to rapidly identify each patient’s unique health state and diagnosis, their individual risks and benefits of potential interventions, and their personal values and expectations.

    By ‘patient values’, we mean the unique preferences, concerns and expectations each patient brings to a clinical encounter and which must be integrated into clinical decisions if they are to serve the patient”.

    We explore this further with qualified doctors up to and including consultants, and with senior doctors in leading roles in the NHS.
    I hope this clarifies the situation.”

    Clarification? Well, it does not state your view on the limitations of evidence based medicine as interpreted by NICE et al, no, but it does give pause for thought. Some of it, if it is the official line, sounds like bull.

    This sentence in isolation would be leaning towards naivety concerning evidence based medicine:
    “We prefer medicine based on evidence to medicine not based on evidence.” as I outlined previously with reference to patients who might, if within the evidence finding research, have been outliers on plots of benefit/risk/detriment..

    Why, given these excellent values, do you think the GMC called such inexpert witness at a Myhill hearing, one man who had very little knowledge nor expertise in medicine of nor related to CFS and who did not bother to read the Myhill paper on the topic… Looks like the GMC could benefit from some internal revision – an intensive weeks course should see much of the dust and cobwebs dislodged. Further forays in to worrying about their professional members could likely be shortened.

    By the look of it, considering all that you have said, I should indeed write to the GMC about every GP or consultant who fails to examine a patient complaining of multiple symptoms that cannot be visibly diagnosed from 2metres away. Especially where they are later diagnosed during a brief examination by a competent doctor.

    I still feel dismay at one such miserable GP who turned from patient doubter to entomologist in the space of 30 seconds. Clueless and properly unlikely to help their ill patient.

  227. alistair said,

    ChrisP
    Thank you. I don’t know whether the paper you site is a relevant one.

    If you are always happy to help, and you spot such obvious flaws in the Myhill method, then what of my earlier comments about the common experience for patients, relating to GPs and consultants alike:

    Why is it that GPs (limited consulting time?) and consultants alike, very often do not examine patients that they diagnose with CFS / ‘ME’ ?
    Any symptoms reported by the patient which obviously fall outside of both the Oxford criteria and the previous criteria are dismissed.

    You say of aspects of her ‘research':
    How on earth would Myhill know?

    I say, reference many ‘diagnoses’ of ME by non-examining doctors:
    How on earth would these diagnosing doctors know?
    Patient looks sorry for themselves… whines about pain and tiredness all the time…
    Well, I suppose the Oxford criteria are pretty vague, but yet what excuse do these doctors have?

    Do they all keep Penfold in their pockets saying “Oh, crumbs!” and “Oh, doesn’t that hurt, Chief?” …not that this would aid diagnoses but it might distract them from their professional work.

    Myhill may be bad in your eyes, but she is seen to get beneficial results by many many patients (and she is not the only doctor getting good results in treating chronic fatigue, but they are rare), whereas there are many consultants who just apply the Oxford criteria mantra without taking the trouble to quickly check by examining their patient… instant, effortless, referral karma… tick on list… good stats… little paperwork… a breeze.

    I mention this only in the interests of keeping some perspective on just how awful this blog deems Myhill to be.

  228. Cybertiger said,

    @ChrisP

    Is it because they’re right on, correct, on the nose, unmistaken … and you know it? Is that the reasoning behind the absurd viciousness towards the likes of Sarah Myhill and Andrew Wakefield? I suspect that Christina England is correct and ‘right on the money’ when it comes to the medical root of all this viciousness and absurdity.

    http://bit.ly/woYjuf

  229. Cybertiger said,

    @alistair

    “Looks like the GMC could benefit from some internal revision …”

    Looks to me like the GMC should be closed down as no use or ornament to anyone, let alone the patient. A pox on the GMC.

  230. Cybertiger said,

    Of course, I should have said,

    A pox on them. Looks to me like the GMC should be closed down as no use nor ornament to no one, let alone the patient. Get rid of the buggers!

    Or something like that.

  231. Cybertiger said,

    @alistair, who said,

    “… you have never heard of Ben Goldacre? Really?”

    Quote from the comments on,

    http://bit.ly/woYjuf

    “The psychopaths at the top are imposing a psychopathic culture on the rest of us.”

    Sad, but all too true.

  232. mrsP said,

    @ Chris

    Thanks for the correction.

    @Alistair

    Yes, Dr Myhill does state in her advice that conventional treatment should be used. However this very often is qualified as here in COAD for example:

    “When the cause cannot be found or avoided keep the airways opened up with inhalers: blue ones (bronchodilators).
    Keep inflammation in the lungs down with brown inhalers (steroids).”

    This gives the impression that IF a cause was found or could be avoided inhalers would not be necessary. COAD (usually known as chronic pulmonary airways disease – COPD) is irreversible airways obstruction. i.e.you will always need inhalers whatever the cause.

    Here is another swipe:

    “Because conventional medicine tends to use the same drugs to treat lung problems, doctors have become intellectually lazy and no longer differentiate between the various types of lung disease.” Which is simply not true. It appears to me that treatment of different conditions may involve some of the same drugs because the result of those differing conditions produce the same pathology in the lungs.

    The general picture comes across as – yes take your inhalers, but if you took supplements, breathed properly, found the cause for your asthma/breathing problems you may not need to. This is not current best medical advice and is not evidence based.

    If you have a disease with a safe effective treatment that has strong evidence, what on earth is the point in a single handed non specialist investigating other so called treatments that do not?

    Much research is going on by well qualified specialist doctors and scientists. You can look up a lot of the MRC website.

    Personally I find the NHS website to be very good and is user friendly. Some unevidenced or poorly evidenced stuff on alt med creeps in now and then is my only gripe.

  233. mrsP said,

    corrections – copd chronic obstructive pulmonary disease. and typos.

  234. matthew said,

    Bravo Swordfish!
    You win the internet.

    Thank you for crystallising so coherently the values and practices inherent in the NHS. There will always be those who do not espouse these principles, and when they don’t they should be called out or called to account, certainly.

    My own concern with Dr Myhill is that she seems to be extremely reluctant to consider the notion that some of her advice/practice might be wrong. I guess she has got this way through a combination of confirmation bias and reinforcement from highly selective and positive patient feedback.

    It seems from Dr Myhill’s skirmish with the GMC that she is quite intransigent and reluctant to entertain the notion that some of her behaviour might be inappropriate or wrong.

    This is not a good sign I am afraid. Single handed doctors who work in relative clinical and intellectual isolation (as does Myhill) are always prone to become dogmatic in their approach and less receptive to the infusion of external ideas, modifiers or correcting influences. Unfortunately people like Alistair merely reinforce this, with his adamant defence that everything she says is wonderful and true (even the spelling errors), and no amount of prompting that the majority of other right thinking doctors and national bodies/institutions which are tasked with determining best clinical practice seem to think differently appears to make any impression.

    What is worse is that much of the “wrong” advice we are questioning relates not to her own specialist area of practice (CFS), but to her comments on areas where she has no particular expertise (such as screening for and treatment of cancer, treatment of prion disorders, immunisation and so on). It is clear and was clear from her website that much of the content was outdated and inaccurate, and I assume this means she was either unable to maintain and update her website (in which case she should close it down) or that she genuinely lacks insight into her failings in areas outside her usual expertise. Apparently what is on her website is “OK” because the GMC decided that any advice offered was an “opinion”. My problem is that some of her opinions were/are demonstrably wrong, and they could harm patients who take her advice at its face value. (Publishing plain wrongness of fact doesn’t help either).

  235. Swordfish said,

    Matthew,

    Thank you, but I fear I would not want the Internet, even as a prize. Some of the comments on this blog exemplify the reasons why.

    Alistair;

    Yes, I am responsible for the syllabus (and indeed curriculum) at my institution, under the guidance of the GMC’s ‘Tomorrow’s Doctors 2009’, which has I say, has a full compliance date of 2012, so it is the curriculum for the next 5 years. I do believe that I am in the confidence of the regulator, and that my job is secure, but perhaps I am wrong, and in any case, do not wish to seem to self-praise by expanding on why I believe these notions!

    With regard to your thought processes, you are correct: I cannot fathom them. This is why, observing that you used obscene and scatological language, I asked you about the reasoning behind this phenomenon. I remain curious.

    With regard to your query “with reference to patients who might, if within the evidence finding research, have been outliers on plots of benefit/risk/detriment”, I suspect you may have overlooked the answer in my previous post. It is:

    “By ‘clinical expertise’, we mean the ability to use our clinical skills and past experience to rapidly identify each patient’s unique health state and diagnosis, their individual risks and benefits of potential interventions, and their personal values and expectations”. Hence we “require the integration of the best research evidence with our clinical expertise and our patient’s unique values and circumstances”.

    I hope this helps, and best wishes, as always;

    Swordfish

  236. alistair said,

    Matthew:
    Just because you can form sentences does not make those sentences the accurate truth.
    “Unfortunately people like Alistair merely reinforce this, with his adamant defence that everything she says is wonderful and true (even the spelling errors), and no amount of prompting that the majority of other right thinking doctors and national bodies/institutions which are tasked with determining best clinical practice seem to think differently appears to make any impression. What is worse is that much of the “wrong” advice we are questioning relates not to her own specialist area of practice (CFS), but to her comments on areas where she has no particular expertise (such as screening for and treatment of cancer”

    Wonderful? True? Not my words nor my sentiment.
    I have spoken not in defence of Myhill so much as in defence of a healthy perspective – to ensure that you all don’t get so carried away with the soft target of a published public website that you forget all the hopeless doctors across the nation, including those locums brought in from Abroad whose English skills prevent them doing half of the patient interactive stuff described by Swordfish, who thoroughly deserve being castigated, indeed, run out of medicine. This blog has no healthy perspective.

    You have serious problems that you are still tittering on about one or two spelling errors. More like a child of 12 than an adult. What is your beef?
    I have responded clearly to your spelling worries earlier, yet you choose to make them an issue at this point?

    Remind me, did you get back to me on the limitations of evidence based medicine and of the peer review process? I didn’t think so.

    And, did you actually find any evidence that Myhills comment about lung cancer, for which you vilified her, were actually incorrect? ‘cos if you did, you’ve yet to share it.
    Seeing some unidentifiable fuzziness (or whatever) on an X-Ray that indicates need of a biopsy is NOT in itself a cancer diagnosis. This is not the stage that Myhill referred to in using the word visible.

    People rely everyday on GPs who have no particular expertise. Sure, they get referred some of the time, but those GPs (unless they are very quick at looking things up) have to act on their knowledge day in, day out… and the fact that Myhill is a GP does not mean she cannot express points of view such as that leaving doubts about lung health to chance or delaying seeking help may be the last thing a person does… is not so very likely to encourage people to die without help. Most people don’t want to die. For the rest of us, her words tend to suggest not taking our health for granted, and whilst preventative medicine is somewhat outside of the scope of the NHS (unlike to Austrian healthcare, amongst others), Myhills message is about people looking after their health.

    “right thinking doctors and national bodies/institutions which are tasked with determining best clinical practice…” …do not always get things right – balancing all factors when making their guidance.
    They are not tasked with identifying exactly what a doctor must do with any individual patient – they can only come up with treatment guidelines and treatment funding rules, since health is so complicated any one patient may not present the textbook case that is exactly comparable to the research that has taken place, and the budgets are finite.

    Or, have I missed something fundamental – is human health and medical care really trivially easy unless you are Myhill getting it wrong all the time?

  237. alistair said,

    Swordfish – I was warming to you, but yet you are doing it again, and failing to make the situation clear.

    1. “I am responsible for the syllabus (and indeed curriculum) at my institution”
    You write the course and decide what is on it? Really?
    Can you tell me whether you will be introducing any changes to the study of anatomy when next you revise your courses?

    “…under the guidance of the GMC’s ‘Tomorrow’s Doctors 2009’, which has I say, has a full compliance date of 2012, so it is the curriculum for the next 5 years”…
    So students who begin their studies in 2016 will do exactly the same course as student who begin their studies this year?
    There will be no change in medical science during 5 years?

    I didn’t ask about your relationship to any regulator(s), I asked whom set the medical syllabus in UK medicine.

    “With regard to your thought processes, you are correct: I cannot fathom them.”
    I didn’t ask you to. In fact, did I not ask you to desist from guesswork?

    With regard to your query “with reference to patients who might, if within the evidence finding research, have been outliers on plots of benefit/risk/detriment”, I suspect you may have overlooked the answer in my previous post. It is:
    …OKAY! I get it!
    You are agreeing that evidence based medicine has limitations for the individual patient who does not fit the profile of those benefiting from a treatment shown to usually benefit apparently similar patients during medical research. Guidelines can thus only be guidelines.

    Now, Matthew – how about you? Can you bring your pure scientific self to admit that there are limitations to evidence based medicine – that it is not a panacea for all patient cases?
    …Would you like to put your thumb in the ink and press it on the page where it says “I, Matthew, understand about the limitations of evidence based medicine for the individual patient who, for reasons known or unknown, it proves inappropriate to treat with the standard guideline treatment.
    Or is that really distressingly uncomfortable territory? where you risk being derided by your mates down the bar forum on Friday night for showing weakness?

  238. jdc325 said,

    “jdc325 said, January 17, 2012 at 9:47 pm
    Hi alistair,
    Who has said that “ME is all in the mind…”?”

    Where have you been these last 20 years? If you post entries on any blog cognisant of bad science/Ben Goldacre, surely you must have heard about the evidence based treatment for ME ? Really not? (downgrade blog merit status) Note to party of 2nd part: must pull head out.

    Hi Alistair,

    I asked who has said that ME is all in the mind. You appear to be unable or unwilling to give me an answer to my question. This isn’t a game of answer a question with a question – I’m genuinely interested. You claimed that (unspecified) people have said that ME is “all in the mind” yet you haven’t told us who they are or linked to a relevant quote that demonstrates that they have indeed said this. Is there a relevant quote that you can link to, or is this something that you’ve made up?

  239. jdc325 said,

    “jdc325 said,
    January 17, 2012 at 9:51 pm
    Sorry alistair, I forgot to ask – do you think that posters on the XKCD forum are “connected with Randall Munroe”?”

    Can you smell smoke? Some fishy kind of smoke?
    …you have never heard of Ben Goldacre? Really?

    As the disgraced GP Cybertiger has pointed out, I post on the Bad Science forum (set up by Ben Goldacre). My point was that referring to me being “connected with” Ben Goldacre was analagous to posters on XKCD being “connected with” Randall Munroe on the basis that they posted on a forum he set up. At no point did I claim that I’d “never heard of Ben Goldacre” – or anything like it. If you read my response as meaning that, then I would suggest that you have an impressive ability to invent meanings that were never intended by the author. A bit like when you made up a new meaning for the phrase “By the time a lung cancer is seen on an X ray, it is too late for curative treatment”, really. You thought that meant that people shouldn’t be “complacent” about their health. A quite ridiculous interpretation.

    Do you deliberately ‘misunderstand’ things or do you have trouble with reading comprehension? I only ask, as I’m interested in whether you are dishonest or simply unskilled.

  240. alistair said,

    Whichever it is, is likely better than being a nasty little shit.

    Your meaning was obvious…. oh! Did I not reply to it?
    So, do you know Ben Goldacre?
    (truth or dare… I wonder how honest you really are?)

    Do you understand reverse psychology? Or how people play games? or what gambit people use in communication when seeing what information they can glean… it does not always fit well with making the most sense – sometimes varied types of provocation help.

    Writing on Ben Goldacres forum links you to him. Depending upon how stupidly literally you interpret that last sentence, you will recognise that it is a fact. Ditto your XKCD example. Connected with.. very loose words.

    You read whatever the fuck you like in to all manner of things, at least that is what one might think in reading your responses. I did not interpret hard to arrive at the conclusion that Myhill has something of a mission to encourage people to look after and take responsibility for their own good health… to encourage them that it matters, and how… that interpretation is entirely consistent with her varied writings. If you have not picked up on that, then I must consider you to be suffering with perceptual, reading, or other deficiencies. Cancer can kill! AIDS kills! Always use the green cross code! …staying alive is the message in all of these… there may be other messages, but don’t get excited and talk rot on my account.

    JDC325 – you are provocative, I’ll say that about you to your face.

  241. jdc325 said,

    “So, do you know Ben Goldacre?”

    In the biblical sense? No.

    As a friend? No.

    As a colleague? No.

    In the sense that I post on a forum he set up years ago and no longer frequents? Yes.

    HTH.

  242. alistair said,

    JDC325: This blog is not about getting questions answered: there is very little of that going on. Matthew shits his pants rather than give an answer or face up to anything.
    You are pretty close to the same.
    Yet hypocrisy is what this blog is all about – people who demand evidence then provide none themselves, or repeat questions yet give no answers themselves.

    “I asked who has said that ME is all in the mind. You appear to be unable or unwilling to give me an answer to my question. This isn’t a game of answer a question with a question – I’m genuinely interested. You claimed that (unspecified) people have said that ME is “all in the mind” yet you haven’t told us who they are or linked to a relevant quote that demonstrates that they have indeed said this. Is there a relevant quote that you can link to, or is this something that you’ve made up?”

    Sorry Swordfish, but the correct answer to such a rude prick is Fuck you!
    You sorry excuse for a tosser. Why don’t you crawl back up your hole?

    JDC, dear sir,
    I have not gotten around to giving you an answer. keep your fucking hairpiece on!
    There is no promise from me to answer your every dumb, insulting, provocative, hypocritical question in an instant – far less that anyone gives me a straight answer to anything. If I can be bothered, before answering you, I’ll look out all the questions you have left hanging unanswered. AS if you give a turd.

    Where the fuck do you grab the interpretation that I might be “unable or unwilling” to give you an answer? Out of your tiny mind? From up your bum? Unable to give you an answer?!?!?! That defies belief – do I look like I am short of words or unwilling to produce some? That sun must be bloody painful shining all day long out of your butt, and your halo must be a hellish burden (did you see the irony I laced that one with?).

    ME – those who say it is all in the mind? Most GPs.
    Did you read my mention of doctors entirely failing to consider vitamin A deficiency, absolutely in line with NICE / NHS guidelines and bet earlier on this blog? Did you respond to those entries?
    Go join the ME association and get reading about patient experiences of the NHS.
    Go read the Oxford criteria for ME and how they differ from both the previous criteria and from the much quoted (in this forum) CDC version – in case you are not clued up in this regard.

    Now, having done this tiny piece of homework, what picture is emerging for you? And don’t tell me that you need verbatim quotes, names, dates, locations, etc. in the first instance. Okay? If you do, I’ll throw your rattle out of your pram.

  243. jdc325 said,

    “I did not interpret hard to arrive at the conclusion that Myhill has something of a mission to encourage people to look after and take responsibility for their own good health… to encourage them that it matters, and how… that interpretation is entirely consistent with her varied writings. If you have not picked up on that, then I must consider you to be suffering with perceptual, reading, or other deficiencies.”

    Once again, we’re back to Myhill’s intention – what you see as her mission to encourage people to take responsiblity for their own health.

    If, as part of this mission, Myhill writes things that are not factual and verifiable then I think it’s fair to point out that she’s done so. This is what I have done. Regardless of her intention or her “mission”, there are statements on her website that are unsupported by evidence, misleading, or untrue. Constantly referring back to Myhill’s intentions does not change this. Nor does it in any way excuse it.

  244. Swordfish said,

    Dear Alistair,

    Oh, I think that Matthew will be very relaxed about accepting the definition of Evidence Based Medicine you have just accorded with. It is, after all, the true definition of EBM, and he strikes me as a man who can tell his edifice from his orifice. What one might fairly object to is a doctor who failed to review the evidence at all, or to consider it in a reflective manner. And that, after all, was the point of the original blog post, was it not?

    i will return to your other questions at some point. Just now, a glass of Rioja is claiming my attention in an urgent manner.

    Best wishes,

    Swordfish.

  245. jdc325 said,

    “ME – those who say it is all in the mind? Most GPs.”

    [Citation needed]

  246. jdc325 said,

    “Where the fuck do you grab the interpretation that I might be “unable or unwilling” to give you an answer? Out of your tiny mind? From up your bum? Unable to give you an answer?!?!?!”

    From your decision to post a response without answering the question.

    “That defies belief – do I look like I am short of words or unwilling to produce some?”
    No, you don’t look like you are short of words. Just answers. Oh, and evidence to support the many assertions you have made.

  247. alistair said,

    JCD – HTH ? Looks like more weasel words:
    “jdc325 said,
    January 18, 2012 at 6:02 pm
    “So, do you know Ben Goldacre?”

    In the biblical sense? No.
    As a friend? No.
    As a colleague? No.
    In the sense that I post on a forum he set up years ago and no longer frequents? Yes.”

    No! In the very simplest sense of do you know Ben to speak to? Have you ever been introduced? Would you recognise each other in passing on the street? Might you greet one another? Do you exchange emails?
    …does he know you?
    … personal stuff, but starting to look relevant after all the prevarication you have demonstrated so far.

    Obviously you are not obliged to say, but don’t prevaricate with “in the biblical sense?” type of crap, unless that is genuinely relevant, if too-much-information.

  248. alistair said,

    Give me strength!
    “jdc325 said,
    January 18, 2012 at 6:24 pm
    “ME – those who say it is all in the mind? Most GPs.”

    [Citation needed]”
    Context: “Go do your homework.”
    Has it been raining? Is the sun shining out of your butt?

    Let me tell you: Why don’t you pull your head out and go take a look?
    As I have already suggested: Go join the ME association and find out what response people get from their guideline following GPs when they present with the typically multiple symptoms that go hand in hand with ME/CFS…
    Read the NICE guidelines and the Oxford criteria and the previous criteria and the CDC criteria…
    Then come back to me.

    You are so fucking hypocritical.

    Instead of opening your eyes and doing a little reaeding, you fail to answer me (something you love to accuse me and others of doing) and come straight back at me, with “Citation needed”

    No, it is not. You do your bit, and I will do mine.
    That was my offer. You want something different then do me the courtesy of telling me straight: I don’t want to do my homework, I want you to all the leg work for me so that I can concentrate on my mantras…
    It does not wash with me. Ok?

    I am guessing that you don’t live in Scotland? They wouldn’t put up with your kind of shilly shallying north of the border. Nobody should have to.

  249. jdc325 said,

    If you wanted an answer to a precise question, perhaps you should have asked one sooner Alistair. I see you’ve now asked several.

    We have never been introduced. Nor have we met without an introduction (I know you didn’t ask this question, but I thought I’d answer it anyway – consider it a bonus).

    I reckon I would recognise him in the street, but I don’t know if he’d recognise me. He’s more recognisable than I am. People who have been on TV and use their real name and actual photo on twitter tend to get recognised more than random people on the internet who tend to use pseudonyms and avatars.

    Might we greet one another? I don’t know. I suppose I might go over and introduce myself to him. I doubt he’d greet me. As I say, I don’t know if he’d recognise me. Unless I was wearing a baby chimp mask and eating an apple… or was cunningly disguised as Richard Briers.

    Do we exchange emails? Not normally, no. I emailed him 10 months ago to ask him a question about the placebo effect and he was kind enough to reply and recommend a letter by Kirsch. We don’t normally correspond with each other though. If you are asking whether Ben and I are pen pals, the answer is “no”.

    “…does he know you?”
    Heh, define “know”. I don’t think I should answer any more general questions like this given your hissy fit and outrage about my imagined “prevarication”.

  250. alistair said,

    mrsP: Another point by point refutation starts here…
    [about lung diseases]
    “@Alistair
    Yes, Dr Myhill does state in her advice that conventional treatment should be used.”
    So she is not doing anything especially dangerous here. That is good.

    “However this very often is qualified as here in COAD for example:
    “When the cause cannot be found or avoided keep the airways opened up with inhalers: blue ones (bronchodilators).
    Keep inflammation in the lungs down with brown inhalers (steroids).”

    Sounds like standard advice: the blue inhalers are to be used only when necessary… and if that is more than 5 times per day, then one is on the wrong inhaler and needs a perventative inhaler, such as the steroidal type.
    Equally, if ones breathing improves and remains stable whilst reducing doses of steroidal inhalant, to the point that the steroidal inhalant is not required, then… it is not required. End of.

    Would you have a diabetic continue injecting insulin if their diabetes came under control/in remission?
    Would you recommend those with regular migraines continue taking the tablets even when they have not had a migraine in months and reduced their medication gradually?
    Would you recommend that people take any pharmaceutical (there will be exceptions, I realise this) unnecessarily?!

    “This gives the impression that IF a cause was found or could be avoided inhalers would not be necessary.”
    Correct. That is exactly so. How lucky would such a person be?
    It could happen that their asthma was caused by a trigger, such as house dust or house mould or drinking campari (cochineal) or eating foods coloured with cochineal (cheap crab sticks) … and fixing that trigger made the asthma cease… in which case, they would not be advised to needlessly take the medication.
    On the other hand, they might be wise to carry a blue inhaler as a preventative or treatment, just in case they suffered a sudden attack.

    “COAD (usually known as chronic pulmonary airways disease – COPD) is irreversible airways obstruction. i.e.you will always need inhalers whatever the cause.”
    Nope. Untrue.

    The following looks like Myhill is doing a little generalising…
    “Here is another swipe:
    “Because conventional medicine tends to use the same drugs to treat lung problems, doctors have become intellectually lazy and no longer differentiate between the various types of lung disease.” Which is simply not true. It appears to me that treatment of different conditions may involve some of the same drugs because the result of those differing conditions produce the same pathology in the lungs.”
    Sure, the lung condition may be similar, but Myhill is talking about lack of diagnostic differentiation between different conditions… Did you miss that?

    “The general picture comes across as – yes take your inhalers, but if you took supplements, breathed properly, found the cause for your asthma/breathing problems you may not need to. This is not current best medical advice and is not evidence based.”
    Evidence based???????????????????
    Medical advice? Any sensible doctor encourages their patients to take enough rest, to eat well, to reduce stress in their lives, and so on.
    Any good doctor will encourage patients to try to avoid things that trigger ill health: migraine sufferers to avoid cheese, coffee, alcohol, etc., etc.
    Why would a doctor not suggest that asthma patients try to spot patterns in causation, try to improve their diets, and get enough sleep, and work on taking positive steps to improve their living environment to reduce adverse factors in their lung disease presentation??
    This is, and always has been, best medical advice, short of getting involved in pharmaceutical treatments.
    IF it works in your case, then that is 100% evidenced. It does not matter …who you are and what you do to live, thrive and survive, there’re still some things that makes us all the same… you… me… them… everybody… (to quote a costly film)
    If something works for you, then it works and no amount of research will likely disprove it. This applies to miracle cures no different to cures found by fixing some cofactor or fixing a nutritional deficiency or any of a whole host of possible things… your dog dying and no longer being in your house… the cat moving out, permanently… your teenage smoking son leaving home… your landlord resolving a damp problem… moving home away from gloucestershire… converting the open log fire to an enclosed log burning stove… fitting whole house ventilation… quitting smoking… changing your old mattress and pillow and enclosing all in dust mite impermeable covers… so many possible fixes for people with asthma that has a trigger…
    …shall I go on? And you are telling me that you cannot think of anything that an asthmatic would be well advised to try in order to reduce the rate of progression, and possible to resolve, their asthma?? Do you not have any personal experience of asthma? No knowledge at all except from medical books or NHS websites? That is a shame, ‘cos, ‘lady’ you appear to know nothing.

    “If you have a disease with a safe effective treatment that has strong evidence, what on earth is the point in a single handed non specialist investigating other so called treatments that do not?”
    Because treatments that are deemed safe still have patients reliant upon them, still have patients that are suffering, still have patients whose health may be deteriorating in spite of them (unless those treatment are a curative)… because all treatment tend to have some side-effects (my NHS advice was to rinse my mouth after using steroidal inhaler – that is current best advice… so clearly the steroidal inhalers, and the clue there is in that word ‘steroidal’, are not the greatest bet for suffering no long term side effects.
    Besides, the more reliant you are on a pharmaceutical, the more chance there is that one day you will not be able to control your condition… you’ll be unespectedly trapped in a lift too long, or your condition will be unexpectedly exacerbated to your breaking point…
    Myhill is simply encouraging people that there may be avenues to explore to improve their health of to reduce their symptoms…

    “Much research is going on by well qualified specialist doctors and scientists. You can look up a lot of the MRC website.

    Personally I find the NHS website to be very good and is user friendly. Some unevidenced or poorly evidenced stuff on alt med creeps in now and then is my only gripe.””

    Then let all ill people leave responsibility for their health in the hands of the experts and let no expert be surprised when people taking no responsibility become more obese, eat more sugar, take less exercise, have no idea about environmental hazards, etc. etc. etc.

    am I making any sense to you? Do you still think that what you wrote makes any sense whatsoever?

  251. alistair said,

    JCD
    ““…does he know you?”
    Heh, define “know”. I don’t think I should answer any more general questions like this given your hissy fit and outrage about my imagined “prevarication”.”

    Oh diddums! I’ve impacted on your sense of just being by direct.
    You prevaricated. You started framing things in terms of referencing the ‘to know’ in biblical terms. Just man up: own your behaviour and move on.

    Ben Goldacre: ok – got it – you have corresponded with him, but he does not know you, you have not met, and likely, though he may have seen you previously, he would not recognise you. done.

    As for answering questions – you have answered precious few.

  252. alistair said,

    Swordfish – you are very generous to Matthew:
    “Swordfish said,
    January 18, 2012 at 6:21 pm
    Dear Alistair,
    Oh, I think that Matthew will be very relaxed about accepting the definition of Evidence Based Medicine you have just accorded with. It is, after all, the true definition of EBM, and he strikes me as a man who can tell his edifice from his orifice. What one might fairly object to is a doctor who failed to review the evidence at all, or to consider it in a reflective manner. And that, after all, was the point of the original blog post, was it not?

    i will return to your other questions at some point. Just now, a glass of Rioja is claiming my attention in an urgent manner.
    Best wishes,
    Swordfish.”

    We differ. I doubt very much that Matthew is man enough to be quoted on the limitations of evidence based medicine or any other holy cow discussed on this blog.
    He may be able to tell his edifice from his orifice, even if such figures of speech leave him, well, speachless, but I doubt he can slide up his own vagina (what is a mangina? Or have I watched insufficient of the Might Boosh?)

    The lung cancer hiatus (if I am not muddling diagnoses)
    When Matthew arrives at the evidence to justify his scathing, villifying, condemnatory, criticism of Myhill, stating that seeing lung cancer on X-Ray is too late for survival to be hoped for, then I will talk to you about your Myhill critique “a doctor who failed to review the evidence at all” further.
    I think you have the wrong doctor, that the whole thread is targeted with too much focus on an easy published target, where 10% of GPs would be a much more worthwhile goal… there is a lot of seriously bas medicine in this country, with too few looking at their patients diets nor reminding patients of the critical aspects…
    I won’t swap my shiraz for your Rioja unless yours is really good.
    Sweetness and light from on high, as it was deigned to be,
    Alistair

  253. alistair said,

    JDC:
    “jdc325 said,
    January 18, 2012 at 6:07 pm
    “I did not interpret hard to arrive at the conclusion that Myhill has something of a mission to encourage people to look after and take responsibility for their own good health… to encourage them that it matters, and how… that interpretation is entirely consistent with her varied writings. If you have not picked up on that, then I must consider you to be suffering with perceptual, reading, or other deficiencies.”

    Once again, we’re back to Myhill’s intention – what you see as her mission to encourage people to take responsiblity for their own health.

    If, as part of this mission, Myhill writes things that are not factual and verifiable then I think it’s fair to point out that she’s done so. This is what I have done. Regardless of her intention or her “mission”, there are statements on her website that are unsupported by evidence, misleading, or untrue. Constantly referring back to Myhill’s intentions does not change this. Nor does it in any way excuse it.”

    You point me in the direction of your appreciation of the limitations of evidence based medicine and I may find that you know more than the tabulated outcome of analysed research results.
    How about a different approach: avoid eating liver, avoid eating colourful fruits and veg, avoid eating fish liver oil, avoid eating eggs and dairy and cease taking any vitamin enriched foods, drinks or pills … and in 2 years time, tell me how your health has declined with your vitamin A supplies diminishing. Tell me then that diet does not matter, and that you lack evidence from double blind studies, that you need the evidence in order to evince what is causing your health woes… Myhill has focused much energy and effort across 30 years and does not come out of that with no knowledge of her own. She has seen results from a varied programme of dietary improvements… and has read plenty from other doctors doing similar work…. what more evidence does she need for those aspects of what she does?
    Her website sometimes lacks scientific detail, but I’d rather she were my doctor than a good many GPs I have seen over the years….
    Remind me which guidelines the GMC has seen cause to challenge her on?
    Was it that she did not follow any of the guidelines? (which NICE allow are just guidelines)
    Was it that she put lives at risk?
    Was it that she caused death by professional incompetence or negligence?
    Was it that she failed to maintain confidentiality for her patients? (which, as we know, the GMC failed on miserably)
    …lend me some perspective on Myhill, what are the faults that lead the GMC to withdraw her licence to practise? (of course, they did not do this)

    You could enter any medium sized medical practise near where you live and find a doctor wholly unsuited to practising medicine. disinterested in their patients welfare … going through the motions of guidelines… unmotivated, disinterested, insufficient and disabling: unlikely to give their patients the best medical care and interventions in a timely manner.

  254. ChrisP said,

    alistair, you claimed Ms Myhill did research in CFS. This is the only paper she has ever published. It therefore represents the full sum of her research that is available. By critiquing it, I am suggesting that your claim of Ms Myhill doing research on CFS does not represent a strong appeal to authority and doesn’t impress me one iota.

    You then go on to ask me about doctors and consultants not examining patients that they diagnose with CFS. In the first place, I would like to see the evidence in support of this statement, because it sounds extraordinary to me that doctors and consultants would regularly diagnose patients without ever seeing them (although I do accept that Ms Myhill has done this).

    Secondly, this strikes me as a classic case of whataboutery. Why should this make the selling of dubious tests and unnecessary supplements to vulnerable people by Ms. Myhill correct? Surely both activities are wrong and should be condemned?

  255. Cybertiger said,

    @ChrisP

    You’re another tiresome tic, just like that irritating toad, the jdc thingy.

  256. matthew said,

    Alistair,
    I think we are both agreed the GMC can sometimes be woefully incompetent, not fit for purpose and can fail to look out for the interests of vulnerable patients. Glad to see some common ground between us.

  257. matthew said,

    Alistair:

    And, did you actually find any evidence that Myhills comment about lung cancer, for which you vilified her, were actually incorrect? ‘cos if you did, you’ve yet to share it.
    Seeing some unidentifiable fuzziness (or whatever) on an X-Ray that indicates need of a biopsy is NOT in itself a cancer diagnosis. This is not the stage that Myhill referred to in using the word visible.

    Sigh…. Myhill’s website says this:

    “By the time a lung cancer is seen on an X ray, it is too late for curative treatment.”

    In a country which does not have a programme of proactive screening for lung cancer through regular CT scans (these are merely a detailed series of Xrays involving higher levels of ionising radiation, and therefore risk), lung cancer will be suspected through the clinical setting of someone having presented to a healthcare practitioner and undergoing a plain Xray. This is how the vast majority of lung cancer is diagnosed. In Myhill’s own words, this is when it may be “seen on an Xray”. I am sorry to say it, but this “fuzziness or whatever” (as you like to call it) is exactly what Myhill is talking about. Confirmation of type and staging will require biopsy, but the fact remains that if nothing is seen on an Xray, then cancer will not be suspected, nor will invasive tests take place. Doctors are not in the habit of doing bronchoscopies or biopsies on patients with normal Xrays, as Swordfish will no doubt confirm.

    So we are left with the scenario of a patient who, having been told by his doctor that an Xray shows some “fuzziness or whatever” that looks malignant, possibly taking Myhill’s words at their face value, and doing one of the things you said you might do in a previous post (eg mediate, do nothing, put affairs in order, go on holiday, since we all have to die sometime).

    Patients with lung cancer will die without conventional treatment. If the cancer is one of the 85% of tumours that is classified as non-small cell type on histology, then average survival without therapy is under one year. With treatment, 5year survival for those without metastases outside the lung is between 7 and 73%, dependent upon stage, indicating a substantial cure rate for the better prognostic stages of tumour. (Recall Myhill says that for them it is too late for curative treatment). Even tumours which are >7cm diameter at presentation (you’d have to be pretty defective not to see that on Xray) have a 35% survival at 5years. Following Myhill’s advice will condemn patients who might have survived 5 years or longer, or even been cured, to certain death.

    Small cell cancers tend to be more advanced and be disseminated by the time they are detectable on Xray, so survival is poorer, but even then it is in the order of 1% – 38% at 5 years. Without treatment they die in an average of 4 months. Just about time to squeeze in that brief holiday, if they are lucky!

    The fact that you are prepared to argue against these points until you are blue in the face does you no favours, nor does it point to your having a logical, rational or scientific mind open to the idea that you might be mistaken. Any normal person would say “Hey, OK, the advice seems wrong, maybe Myhill is wrong.”, but no, you both deny she is wrong, and what is more are prepared to deny the clear evidence that lung cancer is survivable.

    Alternatively, you could prove me wrong, and yourself and Myhill right, by pointing me to published data showing 5 year survival of any lung cancer is 0%.

    To make it easy for you, let’s confine that request to just primary lung cancers which are larger than 7cm diameter which would certainly be visible on Xray, even to someone whose eyes are as closed to evidence as yours are. Go on, I dare you.

    Best wishes.

    I end with some references to cancer screening/diagnosis and prognosis for your information – see later (for some reason they will not post.

  258. matthew said,

    perhaps jdc knows why I cannot post links???

  259. mrsP said,

    @ alistair

    The first point – I never said that inhalers should be used when not necessary.

    My point was that Dr Myhill gives the impression that IF a cause could be found for COPD then inhalers would not be necessary. This is not true as COPD is irreversible. Treatment/stopping smoking, avoiding whatever caused your COPD in the first place, can prevent progression of the disease sometimes and alleviate some symptoms but not cure it.

    http://www.nice.org.uk/nicemedia/live/13029/49401/49401.pdf

    “Sure, the lung condition may be similar, but Myhill is talking about lack of diagnostic differentiation between different conditions… Did you miss that?”

    What evidence is there that doctors are not differentiating between various pulmonary diseases? Her assumption is that if the treatment is the same for two different conditions, then the doctor is not differentiating between them. This is not logical as bronchodilators and steroids alleviate the symptoms of both emphysema and asthma for example.

    Of course it helps if you can find what triggers you asthma, however, if it is not immediately apparent, it usually is very difficult to find it. Non pharmacological treatments and prophylaxis asthma are discussed in the guidelines I gave you a link for from the BTS. There is not a lot of evidence that much is effective. There is no evidence that supplements and diet play much part, although we all need a good balanced diet with plenty of fruit and veg.

  260. teacake said,

    Hi Alistair,

    I wonder if you could answer a question on a matter which has been confusing me.

    I think most of the people corresponding here would agree that the GMC has acted very poorly in their dealings with Dr. Myhill, and I personally feel it could certainly be argued that the GMC have demonstrated incompetence in handling this case. You have certainly made this plain in your posts.

    However, on a number of occasions you have used the fact that the GMC dropped its case against Dr. Myhill as proof that the information published on her website must be okay. I’m wondering how you square this – how can you say that the GMC is incompetent, and at the same time use them as support for her? I hope I’m not over-interpreting if I suggest that the premise you’re using here is “If the GMC says it’s okay, it must be okay”, but how can you get over the problem that you’re relying on the opinion of an incompetent organisation?

  261. jdc325 said,

    @alistair

    “I’ve impacted on your sense of just being by direct.”

    I think you may have missed out some words here. And perhaps put some in the wrong order. I sometimes wonder if this kind of muddled writing is indicative of muddled thinking.

  262. jdc325 said,

    @matthew

    “perhaps jdc knows why I cannot post links???”

    I’m afraid I don’t. Are you using html tags or posting the url without html tags? Not sure if it’s WordPress that’s glitchy or something at your end.

  263. alistair said,

    I should keep your theories nice and simple … Ockham’s Razor and all that.
    Can you do 12 things at once? Nor can I. Do you always cope with interruption? I don’t. But I am so glad that your clear thinking always results in your finishing every sentence and leaving no task half-baked.

    I’ve been accused of being a conspiracy theorist several times herein… your guesswork as to my insufficiency in leaving one sentence unfinished will likely furnish you with no truth and leave your world gasping for evidence or proof or both.

  264. jdc325 said,

    “Do you always cope with interruption?”

    No, but I do tend to check comments before I post them. Just in case I’ve accidentally written something nonsensical and rambling.

  265. Cybertiger said,

    @jdc352

    You do seem to write quite a bit of rambling stuff and nonsense, so I guess not much checking goes into it. Twit!

  266. Cybertiger said,

    Ben Goldacre runs a thriving turkey farm with lots of gobble and acres of gobbledegook,

    http://www.badscience.net/forum/viewforum.php?f=3

    And yet Dr Ben cannot understand how his motives can have been so misunderstood, even misunderestimated.

    One of Ben’s prize turkeys recently wrote a blog piece on ‘deflecting criticism for dummies’ – and turkey farmers too – and Ben Goldacre threw in a certain tuppence worth,

    http://bit.ly/AsesUS

    “My 2p worth: I think when people assert that you could only hold a position on a matter of science because you are driven by a political or financial tie, they are simply telling you how they think, how they reason, how they come to conclusions, and how they use data.”

    You ‘av to larf! Poor conflicted Ben! Political and financial conflicts tie all others, those other contorted folk, but not Dr Ben, never this big turkey farmer. But turkey farmers have conflicts too, don’t they? Just different ones from other folk, I guess. We’re all conflicted someway, some ways more than others. I wonder what conflicts Dr Goldacre has? Perhaps his Mum was a non-executive director of Grunenthal or Union Carbide or some such. There will be something. Who knows?

    Competing interests: my Mum was sometime chairman of ACHCEW (Association of Community Health Councils for England and Wales) – for what it’s worth now.

  267. jdc325 said,

    Would you care to point to something I’ve written that is “nonsensical and rambling”, cybertiger?

    Links or it didn’t happen :)

  268. Cybertiger said,

    It happened all right,

    http://jdc325.wordpress.com/

  269. jdc325 said,

    Could you be more precise and actually point to something I’ve written that fits that description? Pick whichever nonsensical and rambling comment takes your fancy, and link to it. If you can.

  270. Cybertiger said,

    @jdc235

    You’re a prize turkey stuffed with sage and nonsense stuffing. I can’t be more precise than that. Twat!

  271. matthew said,

    Hey shabbytiddles!
    I’d keep “mum” about comments on other people’s mothers if I were you.
    Glass houses and all that.

  272. Cybertiger said,

    “Those who live in glass houses should masturbate in the basement”

    Gobbling turkeys – and their minder – should be locked in the dungeons. Pillocks!

  273. teacake said,

    If one applies the same logic that categorises jdc325 as Ben Goldacre’s disciple because jdc has posted on a forum Dr. Goldacre originally set up, both Cybertiger and alistair are presumably jdc325’s disciples.

    Well, you’ve both posted on his blog, haven’t you?

  274. Cybertiger said,

    @teacake

    I’ll bet you’re related to that ‘pottyold teapot’ that comes here from the nutty end of the blogosphere from time to time. I think you ought to change your name to ‘alittlefruitandnutcake’ to disguise the pottiness of your tea-for-two-timing relationship. Plonkers!

    PS. I don’t think you’re very bright … which two-times with the other turkeys down on farmer Ben’s smallholding.

  275. teacake said,

    @Cybertiger

    Do you have anything other than abuse to contribute?

  276. Cybertiger said,

    What contribution has teacake or any of the other turkeys ever made to anything? Mind you, ‘Jonas the Christmas turkey’ gave me a belly full of laughs. W**ker!

  277. mrsP said,

    @ teacake

    Q.E.D

  278. Cybertiger said,

    mrsP waddles in from her bridge class … twaddle, gobble, quack! Forget teapots and teacakes, it’s gin & tonic time … for mrsP. Lemon!

  279. mrsP said,

    Don’t need bridge classes and its a nice malbec or if you can afford it some montalcino or margaux.

  280. teacake said,

    teacake: “Do you have anything other than abuse to contribute?”

    Cybertiger: “What contribution has teacake or any of the other turkeys ever made to anything? Mind you, ‘Jonas the Christmas turkey’ gave me a belly full of laughs. W**ker!”

    You could just have said “No I don’t.” It would have saved time and pixels.

  281. Swordfish said,

    Dear Alistair,

    Sorry about the delay in getting back to you: real life (and the day job…) intervened.
    You asked:
    “You write the course and decide what is on it? Really? Can you tell me whether you will be introducing any changes to the study of anatomy when next you revise your courses?” and “So students who begin their studies in 2016 will do exactly the same course as student who begin their studies this year? There will be no change in medical science during 5 years?”

    Let me describe how it works. The GMC lays out the core curriculum (in Tomorrow’s Doctors 2009), which includes general principles and some specific required outcomes. These will not change over the next 5 years, since the ‘Tomorrow’s Doctors’ has a revision cycle). However, I can decide how I meet these objectives (within limits:see next paragraph!). The GMC ask for extensive written information each year, and carry out on-site inspections every few years, to confirm that I am conforming to the guidance. The GMC also issues explanatory guidance from time to time (and, with others, I contribute to developing this guidance). Physical examination is required and valued within this curriculum.

    However, I do have a number of constraints. I have finite resources, and I work in partnership with other organisations (medical schools and NHS Trusts), so there is a negotiating process involved, Then too, I have a dedicated group of staff, and whenever possible, I like to give them some freedom to be creative in their teaching, within the overall guidance. And there is an evidence base for medical education, to which I pay close attention. So I don’t/can’t just do whatever I feel like. I love my job, though, even with these constraints!

    Several general principles laid down by the GMC can be paraphrased as ‘up-to-dateness’, so if there is a change in medical science, I will incorporate that into the teaching. Since you ask, I have markedly increased the resources for anatomy teaching during my time in post, and am working hard to increase its clinical relevance even further.

    I don’t think I have yet managed to explain EBM to you. Taking account of individual patients is not a weakness of EBM, it is the essence of EBM: it is part of the definition of EBM. If a doctor (a) fails to take account of the evidence or (b) fails to interpret it properly for their individual patient, then they have failed to apply EBM properly. This blog post is about (a).

    Hope this helps, sorry about the length.

    Best Wishes

    Swordfish

  282. Cybertiger said,

    “If a doctor (a) fails to take account of the evidence … This blog post is about (a). Hope this helps, sorry about the length. Best Wishes Swordfish.”

    Yuk!

    More pretentious nonsense from that silly fishy person – the nitpicking, cherry picker, who brings the very idea of medical ‘evidence’ into disrepute. Mad as a fish, and twice as fishy!

  283. Flippant the Dolphin said,

    Wow – so this is where all the frustrated people hang out – I fear for my own health if healthcare “professionals” spend all their time being really quite anal, and not actually contributing in a positive way.

    Don’t get me wrong – I am as keen for misinformation to be quashed as anyone, but the relentless persecution and outpouring of vitriol at one person (who to the average CFS/ME sufferer would seem to be trying her best to help them) seems like a waste of time.

    For many, many years, the NHS has treated CFS/ME sufferers appallingly, and at a time when the treatment still echoes the off-key warblings of the Wessely school (allegedly), some of you ought to be a) ashamed of yourselves, and b) stripped of whatever authority you have. Some of the name calling would be out of place in a school playground, so why not consider the notion of GROWING UP A BIT?

  284. jdc325 said,

    Wow – so this is where all the frustrated people hang out…

    Welcome, Flippant the Dolphin. Glad you could join us.

    I fear for my own health if healthcare “professionals” spend all their time being really quite anal, and not actually contributing in a positive way.

    I don’t think that occasionally commenting on the failings of Dr Myhill and those defending her in this thread can be fairly portrayed as people “spending all their time being really quite anal, and not actually contributing in a positive way”.

    Don’t get me wrong – I am as keen for misinformation to be quashed as anyone…

    Great. You’ll probably enjoy the posts I’ve written about Dr Sarah Myhill then (and you will just love the posts here on the misinformation perpetuated by those who are anti-vaccination or pro-homeopathy – do take a look at them if you have time).

    …but the relentless persecution and outpouring of vitriol at one person (who to the average CFS/ME sufferer would seem to be trying her best to help them) seems like a waste of time.

    I’d question whether writing a handful of blog posts and making a complaint to the GMC about Dr Myhill constitutes “relentless persecution”. I’d also be very interested in seeing this outpouring of vitriol. Please can you point me to the vitriolic comments regarding Dr Myhill? And Myhill might well be trying to help people with CFS/ME – but if she is well-meaning and wrong should she be exempt from criticism merely because she has good intentions? How else, by the way, do you suggest people should spend their free time? Just so we know what would be acceptable to you, like.

    For many, many years, the NHS has treated CFS/ME sufferers appallingly, and at a time when the treatment still echoes the off-key warblings of the Wessely school (allegedly), some of you ought to be a) ashamed of yourselves, and b) stripped of whatever authority you have. Some of the name calling would be out of place in a school playground, so why not consider the notion of GROWING UP A BIT?

    The name-calling is a bit of a tedious distraction from the issues. I’m not sure that your rude, shouty post is particularly helpful though. Seriously – do you think that characterising critics as frustrated, anal and negative is constructive? Do you think that shrieking about vitriol is a useful addition to the debate? You do come across as being a bit shrill and ranty. Perhaps if you wish to claim the moral high ground or raise the tone of the comments section here you might like to try a slightly different approach?

  285. tan norman said,

    I would just like to say (as a normal person, not a health professional) that I thank my lucky start for the likes of Dr Sarah Myhill, Dr Peatfield, and Dr Joseph Chandy, because through their dedication to patients, people like me ( I have hashimotos disease) have managed to fight their way back to health. My GP has not been very helpful at all!

  286. tan norman said,

    I truly believe that I was heading for Alzheimers (B12 has saved me) yet my doctor told me that a serum blood level of 196 was perfectly OK. This was despite suffering from 5 years of numbness in my toes, then numbness in finger tips, and tingling arm. In fact I was crying due to frustration and she just tried to give me………..guess what? ………..antidepressants! sigh

  287. mrsP said,

    @ tan norman

    For the sake of argument, lets assume your GP made a misdiagnosis (and we have no way of knowing this for certain as we do not know all the facts). The fact that one GP does this does not in any way justify the wrong information on Dr Myhiills website. So your story whilst sad and I do not disbelieve you, is not relevant.

    As I think I have said before, Dr Myhill may be kind and caring to her patients. Kind people can be wrong and when they put their wrongness on the internet they are setting themselves up for criticism. Criticism which is justified to protect the vulnerable and the gullible.

  288. Sean said,

    I stumbled across Dr. Myhill’s site a few years ago – but had been following some of the recommendation for diet and supplement regime to treat my arthritis (ankylosing spondilitis) for many years with good success.
    Please do not throw the baby out with the bath-water with your attitude toward Dr. Myhill – I see that there is a lot of good in what she says.

    To add fuel to the fire – I have read Bad Science and it is Bad Journalism and a poor analysis by any measure.

    There is too little reasearch in to ‘unconvential’ medicine – and we all know why don’t we! For example I got banned within a week of joining an arthritis forum (sponsored by major drugs companies) – the moderator said it was dangerous to suggest what had worked for me as it might give other ‘false hope’.

    So to to all you nay-sayers to any of what Dr. Myhill preaches or links to – do you want to be in the throws of the drug company cartels forever or start to unpick the true causes of diseases.

  289. ChrisP said,

    Sean, Myhill promotes a lot of rubbish that will be bad for people. That is what is being complained about. Sometimes she is correct, but far more often she is blinded by her own ideology.

    This is what separates scientists from charlatans. Scientists question everything and if a well loved idea proves ot be wrong they ditch the idea not the evidence.

    Laslt, you should understand that medicine that works is called medicine; that which doesn’t work is called alternative medicine. ALways ask about the strength of the evidence base.

  290. mrsP said,

    Saying things that are right should not prevent people criticising the wrong things you say. Neither does criticism of the wrong imply that the right things you do or say should be thrown out.

    You are entitled to your opinion of Bad Science, however you are wrong when you say that there is little research into “unconventional medicine”. There are thousands of studies into homeopathy and all other forms of alt med and to date they have not come up with evidence that they work. How much money and for how long should people continue to do trials on therapies with no evidence of efficacy above placebo and with no scientific plausibility in the first place?

    If I were you I would also do a little research into the profits of alternative medicine. WHilst major drug companies need regulating and some bad things have happened, we need the treatments they research and supply in order to achieve the life expectancy and quality of life we all want at present.

    Ancedotes of what works for one person is not the basis for recommendation to others. Treatments need to be researched, have scientific plausibility, RCTs, replication and finally a consensus of experts before being brought into use and recommended on line.

  291. mrsP said,

    Saying things that are right should not prevent people criticising the wrong things you say. Neither does criticism of the wrong imply that the right things you do or say should be thrown out.

    You are entitled to your opinion of Bad Science, however you are wrong when you say that there is little research into “unconventional medicine”. There are thousands of studies into homeopathy and all other forms of alt med and to date they have not come up with evidence that they work. How much money and for how long should people continue to do trials on therapies with no evidence of efficacy above placebo and with no scientific plausibility in the first place?

    If I were you I would also do a little research into the profits of alternative medicine. WHilst major drug companies need regulating and some bad things have happened, we need the treatments they research and supply in order to achieve the life expectancy and quality of life we all want at present.

    Ancedotes of what works for one person are not the basis for recommendations to others. Treatments need to be researched, have scientific plausibility, RCTs, replication and finally a consensus of experts before being brought into use and recommended on line.

  292. mrsP said,

    Sorry for the double post – do not know how that happened.

    Also

    “Around 4,700 people die every year in England after getting flu, a Department of Health spokeswoman said. People in at-risk groups are 11 times more likely to die than those outside the category”

    Do you not therefore think it reasonable, Sean, to question Dr Myhill’s statements on her site such as this one ” My personal view is that the evidence for benefit of the annual flu vaccination is probably out-weighted by potential damage so I no longer recommend this for my patients”.

  293. Sean said,

    The term “evidence based” is a clever phrase used by mainstream medicine driven by profit hungry drug companies – I won’t provide links unless you ask but there are also plenty of proper studies that are ignored by mainstream “medicine”.

    So i guess that my success and the dozens of others that visited the alternative practitioner that I first visited 20 years ago – are anecdotes – lets ignore them all. She worked from her living room and sold vitamin and mineral supplements at little to no profit.

    Go to the Kickas.org web site (followers of Dr. Alan Ebringer – low starch diet) and read the 100’s of other anecdotes of followers of that are ignored by medicine.

    I don’t agree with all that Dr. Myhill says (for example i think soya is a dangerous food). I agree that there are snake oil salesmen everywhere on the net but a lot of this blog seems to tarnish all with the same brush.

    On specifics – so Dr. Myhill does not recommend flu jabs for her patients – what are her patient suffering from? Oh – most of them have food allergies due to having messed up immune systems (mostly from gut damage and dysbiosis). I work with perfectly healthy people that step up for their yearly flu jab – perhaps the frail and elderly should take the jab but my view is that there is not enough evidence in to it’s long term safety – batches this year were withdrawn due to tests for safety. Ironically the reason that a lot of people struggle to fight off flu is that there bodies are fighting food allergies or are depleted of vitamins and minerals due to gut damage from there diet – Dr Myhill follows this wisdom of prevention.

    Again specifics – treatments they research – quality of life – Please visit an arthritis forum and see how much success and quality of life is being achieved… Using drugs that they stumbled upon from cancer treatments – we are all guinea pigs – my fathers health was ruined by convential medicine too.

    The only form of alternative treatment I can argue for is diet and supplementation of vitamins and minerals and perhaps more exercise – I make no claims for other alternative and probably have the same view as yourself. Who mentioned homeopathy? Again I probably agree with you on this one.

    We cannot depend constantly on medicine to save us – we in the west are in a downward spiral with our diets and related health – if you are interested and want good reasoned arguments then look no further than the blog of DOGTORJ (John Symes) – another Charlatan – judge for yourself?

    Your having the wrong argument – its not whether we should or should not have the flu jab – it is why are we having to resort to it?

  294. Sean said,

    Sorry – just to add that I am not suggesting that diet cures all either – we do need mainstream medicine.

    You all seem familiar with Dr. Myhills website – so take a quick search for Dr. Terry Wahls – and her own treatment of Multiple Sclerosis – boy I bet those real medicine / drugs companies are clambering to follow up on this one. Can you patent a cabbage smoothie and a gluten free diet!

    Another anecdote you will sing – or a bloody big Black Swan!

  295. Sean said,

    I had another thought about vaccination –
    In the uk there is a debate raging about tuberculosis being spread by badgers – to cattle. Grass fed cattle are immune to tb because there systems fight the infection – grain fed cattle die and need to be culled.

    Now guess what their answer is – vaccinate cows against tb. Mmmmmm – not feed them a diet that makes them healthy!

    Food for thought?

    Doctors “gp’s” – my GP is lovely by the way… are asked to take the Hippocratic oath – yet they only take 2 to 3 seminars on nutrition (drink milk …it’s full of calcium… Right?) – when the father of modern medicine said “let food be thy medicine” he did not mean just roll out the same advice to all – it was a wise recognition that we are all different and that we all respond differently to what we put in our bodies.

  296. ChrisP said,

    Sean, evidence-based means exactly that: based on the best evidence available. And yes your ‘success’ is indeed anecdote. Anecdotes are not ignored, but are afforded the lowest level of evidence because they can be confused by many other factors, not least of which are re-call errors, mistaking correlation with causation, etc. The highest standard evidence is from double blind studies where neither the patient nor the treating physician knows whether the treatment is real or a placebo.

    The fact that Sarah Myhill sold vitamins and minerals from her loungeroom is not evidence of the efficacy or otherwise of her treatment suggestions. In fact it rather suggests an attitude to evidence that is concerning. Most people with a healthy diet do not need vitamin or mineral supplements and evidence suggests too much of these is risky. Unless the patient has been tested to determine what current levels are; vitamin and mineral supplements could be dangerous.

    Like I said before, anecdote is the absolute lowest quality of evidence. Hundreds of anecdotes are still just that: anecdotes. The real question is how many of Erbringer’s patients have not benefitted? Without knowing this it is impossible to put any context around the hundreds of anecdotes. The truth is not decided as a popularity contest.

    Your comments about the flu vaccine are just idle speculation. People die from influenza. How can the vaccine be less safe than death? More than 600 in the UK in 2010/2011 http://www.bbc.co.uk/news/health-13523971

    I find it strange you think we in the west are on a downward spiral. Life expectancy in the UK has increased by some 30 years in the past century http://www.parliament.uk/commons/lib/research/rp99/rp99-111.pdf Hardly evidence of a downward spiral.

    Lastly, you are wrong about bovine tuberculosis. Grazing on grass does not provide any form of protection against the disease. So no thought there.

  297. Sean said,

    Yes – we are all living a long time on average although that average of our grandparents ages is set to drop. Half the population is propped up with medication for diabetes and high blood pressure – we are simply kept alive longer.

    I understand what evidence based is but the term has been hijacked – the National Arthritis Society website (sponsored by drug companies) sum it up well – they suggest that –

    “Some people with AS have told us they have had a good experience with the low starch diet whereas others have found no benefit.

    It is difficult to research into diet. When new medicines are tested the researchers might give one group the new medicine and another group a dummy or placebo medicine. Even the doctors treating the patients in the medical trial might not be told which patients are taking the trial medicine and which the dummy medicine so that this knowledge does not influence the results. This is known as a double blind trial. We know from research that double blind trials, in which neither the patient, nor the observer knows which treatment has been given, is the best way to show if a treatment actually works.

    However, when researchers experiment with diet and try to look at how diet can influence disease, it is impossible to carry out certain research protocols such as using controls or dummy treatments. Neither the person eating the diet nor the person taking measurements after the diet can be blinded as to which diet has been used. It’s also not possible to confirm that someone is sticking rigidly to the diet without any lapses.”

    So medicine is dictating that diet cannot be medicine as it cannot be tested in the same way – one step away from saying that evidence is impossible. So you are right and I am snookered – anecdote is all we have according to you and those that have decided what evidence really is!

    Do your research – animals fed on natural diets have much less disease incidence than being crammed with grain and soya.

  298. Sean said,

    Sarah Myhill was not my alternative health practitioner – I saw someone many years before I saw her website.

  299. mrsP said,

    Sean

    ChrisP has adequately answered your questions. But one more point on flu vaccines and Dr M. Neither I nor you have any idea what the majority of her patients suffer from and to state in another quote from her site “My view is that the nutritional approach is so effective at protecting against viral infection that vaccination against seasonal ‘flu is not necessary ” seems to indicate that the doctor thinks no one should be given the vaccine.

    Regarding safety – the withdrawal of a vaccine proves to me that the systems in place for checking vaccine safety are being followed and are successful.

    People die from flu, and the older or iller you are increasing your chance of dying and no amount of good diet will prevent infection from a virus – they are not choosy. A healthy person on a good diet will have better outcomes, however.

  300. ChrisP said,

    Sean, I think we should look at your claims.

    Diabetes in the UK 4.5% http://www.diabetes.org.uk/Professionals/Publications-reports-and-resources/Reports-statistics-and-case-studies/Reports/Diabetes-prevalence-2011-Oct-2011/

    High blood pressure incidence in the UK 31% http://www.bhf.org.uk/research/statistics/risk-factors/blood-pressure.aspx, but only half are being treated http://www.bloodpressureuk.org/mediacentre/Bloodpressurenews/UKhighbloodpressurerisesbutmorediagnosed.

    So that is about 20%, not half. Once again your claims are shown to be highly inaccurate.

    You still fail to understand the difference between anecdote and evidence. It is possible to do studies into diet http://www.nejm.org/doi/full/10.1056/NEJMc1204792 as a recent example.

    Unlike you, I actually have done research. So much so, I even know the basis of the claim you are making about grass-fed cattle being protected against tuberculosis. I also know the claim is wrong.

  301. Sean said,

    ChrisP

    I thought mrsP said you had answered all my questions – although I am not sure what questions I had asked.

    I have seen the pattern of your responses to others on this Blog – if you and MrsP spent half as much time on the cause of disease – then you might have actually helped as many people as Dr. Myhill. You play the ‘link to a report’ game – we can do that all day as there will be papers contradicting yours.

    I had meant to say for example nearly 50% are on long term medication – and the percentage is higher in the elderly.
    – High blood pressure
    – Diabetes
    – Arthritis
    – Depression
    – Food allergy

    And from your own fantastic research that 20% to 35% (including undiagnosed) have just diabetes or high blood pressure – is that not a lot of the population in itself.

    From official US report –

    “The report also found that life expectancy at rose to 74.5 years for men and 79.9 years for women in 2002. For those turning 65, life expectancy is age 81.6 for men and 84.5 for women.”

    Mmm those figures tell us something… Myself and my wife have grandparents in their 90s they were healthy and well until their 80s – the coming elderly now 50 to 70 ‘are’ being propped up against modern western diseases as listed above with pills and potions.

    I ask you and MsrP a question (there is a question) –

    Do you think that the rise of modern disease is caused by lifestyle and diet? Did doctors spot that smoking causes disease straight away – how many anecdotes and charlatan studies did they ignore over 30 years of denial. Doctors like Sarah Myhill are ahead of the game.

    Alistair and CyberTiger have far more deserving intelligent posts on this blog than your replies give them.

    Do you think that modern medicine would recognise if diet were the cause of many diseases? If 40% of arthritis sufferers were to get better on a gluten free / low starch diet (Research from Dr. Ebringer) then the drug company funded websites like “Arthritis Today” “Arthritis Care and Research” – still just tout “Follow a balanced diet with grains…blah blah”) – my early quote about evidence based came from the NASS Guidelines – they say that doing evidence based trials for people getting better on different diets is not possible to do.

    You reply to others about CFS/ME and Autism – and there being no association – as a autoimmune sufferer myself who has researched autoimmune conditions. I do believe that there is a link that can tie Autism, MS, Arthritis, Asthma and others – 4 words “Diet, bacteria and Molecular, Mimicry” – follow this and you might see that Vaccination where you body is sub-clinicially fighting other things could be an issue.

    Not everyone is allergic to gluten – I am – but is it in any drugs companies interest to do research in to the effects of food on health – there are too many vested interests on the drugs and food lobby sides. I am not a conspiracist it is just something that I have come to accept – apart from Ibruprofen – despite bouts of soreness and stiffness I have never taken an anti-inflammatory, disease modifiers, immunosuppresents.

    Your efforts should be aimed at bigger fish than Dr. Myhill – when you see what is happenning to our / your health service and the role of big drugs companies, property management of our hospitals (you claim to have formally been a nurse) it is no wonder that Dr. Myhill exists in her current role. You critising her is exactly what the medical profession do – treating a symptom and not the cause – which in itself is an elegant circular irony!

    As Alistair said earlier you would have us all put in to the straight-jacket of an evidence based doctrine – we have no common ground!

  302. mrsP said,

    First to make it clear I do not know Chris p and am not married to him. When i said answered you questions that was badly phrased. What I meant was that Chris had replied to your arguments and corrected your misunderstandings about what constitutes evidence.

    Not all disease is caused by lifestyle and diet. Ageing, genes, pathogens, allergens and various other things including the unknown are factors also. Lifestyle and diet can be predisposing factors and diet of course in the form of deficiencies can be a direct cause eg rickets and scurvy. In some cases an overdose of some vitamins can cause illness too.

    The old chestnut re smoking is proof of nothing except that doctors do change their opinions when presented with sound strong evidence. Which is more than be said for the proponents of CAM and the anti vaxers.

    Vaccinations are not an issue your body deals with pathogens 24/7 and the number of antibodies it produces as a result of a vaccine are minuscule in proportion.

  303. ChrisP said,

    Sean, I link to evidence. What it does is show your claims are incorrect. I am not doing this for your benefit, because your mind is made up. I am doing it for casual readers so they do not leave the blog thinking that your version of reality has anything supporting it. The reason for the links is in order for thinking people to check whether what I am writing is correct.

    If you had meant to say that 50% of people are on long-term medication, you should have said so. Although I fail to see how that makes any of your points valid. If you can’t be bothered to be accurate about the little issues, how can anyone trust you with the large ones?

    So Sean, why when I have posted data on UK life expectancy, do you cite US life expectancy? Are you not aware that one is not the other? My grandmother lived to 101 before she fell down stairs. It is an interesting anecdote, but of no relevance to population life expectancy. Just like your anecdotes.

    Cybertiger provides intelligent posts? What like this one: “Another arsehole, a big prick and yet another fissure-in-ano. A small point, but I feel it’s an important one.
    Eh, Brian?”

    If you feel like that is the epitome of internet discussion, you may find cybertiger’s alma mater of JABS to your liking. It rarely gets better than that.

    OK to your questions. The rise of modern diseases is in part the result of lifestyle changes. One of those being greater longevity. As people live longer (as opposed to being killed by childhood diseases like diphtheria, scarlatina, measles, pertussis and so on, they are more likely to get diseases of old age, like arthritis, heart disease and cancer.

    Modern medicine understands well there are impacts of diet on disease. It can find out the links through epidemiological research and then runs intervention trials to test the hypotheses. For my chronic, genetically inherited condition I am advised by my doctor to avoid certain foods. However, what is often written on the internet by promoters of certain diets is unevidenced rubbish they have made up – like Myhill’s stone age diet.

    As a scientific researcher, I find you claim of having done research hard to accept. I think what you really mean is you have sought out stuff on the internet that reinforces ideas you already had. That does not count as research.

  304. Sean said,

    Sorry ChrisP

    Me and others like me don’t have 30 years to wait for the evidence.

    I might be crippled with arthritis or others might be in a wheel chair with MS – whilst modern medicine catches up. Even if I take my medicine.

    All my posts have really been in defence of the existence of holistic health practicioners that exist because the NHS has failed.

    I am not attacking individual doctors – I am just suggesting that the system that promotes modern “medicine” is flawed an needs to be restructured.

    Let’s run an example, an anecdote if you like but cases I see month in and month out where children with JIA (Juvenille form of Arthritis) go to the doctor with sore ankes – or a sore knee and are prescribed very strong drugs without any initial exploration or suggestion that they might want to cut out milk or gluten. GO TO AN ARTHRITIS FORUM WHERE PARENTS ARE CRYING OUT FOR HELP AND ADVICE – The caring supportive advice that they get from other adult sufferers is not balanced against the options for the child at that stage. THIS WEBSITE JUST PLAYS TO DEMONISE DR’s SUCH AS DR. MYHILL who can offer a better initial alternative that normal doctors do not offer.

    Many of these children (and adult sufferers too) have bowel disorders also – like Crohns (a clue me thinks?).

    You will understand my frustration and perhaps see my point that I went from 17 to 25 years old suffering with Ankylosing Spondilitis – there are medicines (which my Father took for the same condition but he still got a fused ribcage, spine and neck) and I use forums today where I see lots of people still suffering on different medicines for arthritis and many of the other posters seem to still get flare ups on top of the side effects from the drugs. I AM 80% better on my diet (and supplement that I have been taking for over 15 years without side effects) – I run half marathons (at 47 years old) – and when I saw Dr. Myhills site I immediately (mostly) thought – there is someone who will make a difference!

    THIS WEBSITE does more potential harm to that child in terms of options that the parent would feel safe to make than Dr. Myhill ever would.

    So you can only do research if your a scientific researcher? I am a business analysis for over 15 years and 11 years in IT before that. I do research (fact finding) and then analysis and draw reasoned conclusion from the analysis – then I offer up recommendations and solutions.

    I will concede on Cybertigers posts but your motivation is strange based on our view of the world.

    This website and some of its posters are like cowardly kids in a playground that is siding with the nasty bully – one day you will realise that you have chosen the wrong side.

    As I say you are expending your efforts attacking the wrong dangers – in the meantime just join the bully behind the bike sheds for a sneaky fag – it must be cool and safe if they are doing it!

  305. ChrisP said,

    Sean, all your posts on this thread have made claims without evidence. Your defence of ‘holistic health practicioners[sic]’ has been without critical thinking. You have defended them regardless of whether their claims are supported by evidence or are totally wrong. It does not seem to matter much to you, so long as the claim is made by someone outside the medical establishment you are happy to accept it. After I show that a claim is not true, by linking to real world data, that doesn’t change your opinion about other claims.

    The reason I am pointing this out id for the casual reader, so they are not bamboozled. I am hoping they realise the need to investigate the evidence base of all medical claims made on the internet, given the errors promulgated by people like yourself and Myhill.

    As far as I can tell from the medical literature, there is no evidence of a connection between gluten or lactose and rheumatoid arthritis. There are however strong links to certain genetic factors. So there is no reason for a GP to suppose that a specific change in diet (other than a reduction in weight if obese) would help. Smoking is one activity that is correlated with a higher incidence of rheumatoid arthritis. So the GP should recommend smokers give up.

    Sadly once rheumatoid arthritis has been diagnosed there is no known cure. The condition is chronic. The best that can be done is to manage the symptoms and try to prevent bone damage. Auto-immune conditions are particularly hard to cure.

    I don’t think I said anywhere that only scientists could do research. The statement was that my scientific training allowed me to see that what you were claiming to do was not research, but searching for affirmation of your existing views. For research, critical appraisal of evidence is required, not acceptance based on appeal.

  306. Eleanor said,

    I am a former State Registered Nurse and lifelong asthmatic. So had always been sceptical about anything other than conventional medicine. However, when I became chronically ill and disabled in my early thirties no-one seemed to think there was anything wrong with me – no diagnosis – no treatment. This is why people seek out alternative therapists – they want to understand what is wrong with them and how to get better. Almost simultaneously I sustained a work related Repetitive Strain Injury (or whatever they call it now) which completely crippled me for years – unable to use hands or arms – and severe chronic fatigue and unwellness, It wasn’t until, after a period of stress following divorce (my husband didn’t want to be saddled to a disabled person for the rest of his life – which I can understand, in hindsight) when I had such violent reactions to anything I ate that I thought it may be allergic related and saw an ‘unconventional’ allergy specialist – a Private Consultant formerly NHS. I was given a diet – and antifungal medication – and it was like a miracle cure – it took a year and psychologically made me feel like a freak. I was not cured and still have to pace myself and am still disabled – but I was healthy – if that makes sense. I know what makes me ill – stuff. Little toxins and that kind of stuff – I take a paracetamol and it knocks me out – I take an expensive paracetamol and it doesn’t knock me out. I take erythromycin and am fine – I take erythromycin with a different red colouring in and I have an asthma attack every time I take it. I have been generally well for years now, within my limitations and with limited use of my upper limbs, but if I have a local anaesthetic at the dentists I am seriously ill for about a year afterwards.

    I now know, after following the diet – that I am ill if I eat anything with yeast in – and I have anaphylaxis if I eat tuna fish. I already knew I was allergic to moulds after skin prick testing at the age of 10, but we all thought that was mildly amusing – how can anyone be allergic to mould? Well eat it and you get ill!

    I have never consulted Dr Myhill – I have looked at the page and wondered if it was taking advantage of people – people on benefits can’t afford private medical care.

    Unfortunately, for people with chronic ill health, the conventional medical world doesn’t have a system for proper diagnosis and treatment – advice is good – but even today I avoid going to see a GP as the scepticisim is demoralising and it is not nice to be treated as neurotic. I am an extremely practical and pragmatic person – approach everything in a business-minded way, having run a business for some years in the past, look at the problem, analyse it and find a solution.

    The problem is, unless your problem and solution are officially accepted and recorded by the NHS you then have serious problems when you are admitted to hospital with any other conventional condition.

    I recently saw a neurogologist who tells me my RSI, Fibromyalgia and all fatigue symptoms and drug reactions are all the same thing as ME and CFS. In other words they’re all weird unknown conditions and you have to get on with it and manage and there is no further treatment. I can accept having to manage and have no further treatment, but it would be nice to be validated as a real patient and not a hypochondriac.

    In my case I am fairly sure it is all related to my life long allergic conditions of asthma, eczema and hayfever and the biggest help anyone gave me was the Private Allergy specialist (sadly now died) who not only put me on the diet and gave me the antifungals, but also explained that you can reduce your body load of allergens. Take away the biggest one and you can handle the smaller ones better. My biggest one being moulds. Whilst on the diet my asthma virtually disappeared, my eczema disappeared completely and I have not had hayfever since – just mildly the odd day every few years. I went from being on oral steroids every summer, to just one puff of inhalers twice a day – and no wheezing. I even came off inhalers completely at one point, but as I now want to have a life and don’t stick to a diet stringently any more, I had to go back on the inhalers.

    So I don’t know about other people with ME or CFS or whatever the terms are now, but I do think moulds and fungus might be a lot to do with it! And any history of allergic condition, which is hereditory in my family.

    But what we really really need right now, from conventional medicine – is alternatives! I do not want to die of rotting teeth thank you. There is no alternative to local anaesthetics at the dentists! They are drugs, they get injected into you and if you have a body that reacts severely to chemicals in your body the treatment can be worse than the cure.

    I had hypnosis (not very successfully) to get a tooth extracted at one point – extremely painful and stressful (I didn’t hypnotise well) but no adverse after effects. A local anaesthetic puts me in hospital overnight and then in bed for 6 weeks, with a year (and counting) to recover.

    I have been to Guy’s hospital allergy clinic and had challenge tests for all local anaesthetics to prove no allergy – but mainly, from my point of view to see how I reacted after a full dose of something. Apart from drowsiness I am fine. But an hour after an injection at the dentist and I am extremely ill with stroke symptoms (which I am now told is a Basilar migraine). And it doesn’t just wear off.

    So what we need is solutions – ok maybe it is not understood, but what can be understood is that some people cannot tolerate chemicals in their system – particularly injected ones, and particularly in certain areas affecting the blood brain barrier. It seems crazy in the 21st century to have to choose between living with acute and chronic infections in your mouth (compromising your immune system and other knock on health problems – I’m not even going to think about heart disease thank you) – and having a quick jab to take a tooth out – why is there no other alternative?

    Dr’s like Dr Myhill may be helping people to learn how to manage their conditions – but we are not looking at the whole picture – lifelong medical care. I am sure some alternative to local anaesthetic could be invented!

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