DOCSLIB.ORG

Letters to the Editor

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Letters to the Editor checklist below (adapted from Jolles and patient require blood products in the myxedema, pyoderma gangrenosum, psori- Hughes4) summarises the general consid- future. asis, and pretibial myxedema. Int erations prior to the commencement of Reassuringly, the incidence of serious Immunopharmacol 2006;6:579–91 5 Brennan VM, Salomé-Bentley NJ, Chapel hdIVIG. reactions to IVIG is low and usually due to HM. Prospective audit of adverse reactions concurrent infection or over-rapid admin- occurring in 459 primary antibody-deficient Physician’s checklist for high dose IVIg: istration. A prospective study of 459 anti- patients receiving intravenous immuno- 1. Liver function, renal function, full body deficient patients established on IVIG globulin. Clin Exp Immunol 2003;133: blood count, and hepatitis screen showed that no serious reactions occurred 247–51 6Munks R, Booth JR, Sokol RJ. A compre- (avoid hdIVIG in rapidly progressive in over 13,000 infusions across twelve cen- hensive IgA service provided by a blood renal disease). tres and using six different IVIG products. transfusion centre. Immunohaematol- 2. Immunoglobulin levels to exclude IgA The rate of milder reactions was 0.8%.5 ogy.1998;14:155–60 deficiency. If no IgA present In the UK, primary immunodeficiency (<0.05g/l), measure anti-IgA patients who infuse at home no longer antibodies. require the automatic prescription of Systematic review of systematic 3. Exclude high titre rheumatoid factor adrenaline auto-injectors even though reviews of acupuncture and cryoglobulinaemia. incidence of complete IgA deficiency with Editor – Derry et al (Clin Med July/August 4. Preferably ensure that a sufficient anti-IgA antibodies is higher in antibody supply of a single product and batch deficient patients (especially IgAD with 2006 pp 381–6) have advanced acupunc- of IVIG is available to expose the IgG subclass deficiency) than the general ture research significantly by their review patient to a minimum number of population. Furthermore a large study of 35 systematic reviews. Since I am an donors and to avoid unnecessary demonstrated that far fewer individuals author of 14 of these articles, I feel I should product changes. with IgAD and anti-IgA antibodies than comment. The analyses by Derry et al 5. Take any baseline specimens, would be expected developed transfusion imply that the authors of many reviews examination findings, or photographs reactions6. were too ‘optimistic’ regarding the value of required in order to later document The diagnosis of IgAD and measurement acupuncture mainly because they often any objective response. of anti-IgA antibodies is therefore useful in based their conclusions on biased data. I 6. Follow manufacturer’s guidelines defining patients at increased risk of reac- think that this may well be true. We need to regarding reconstitution and rate of tions to IVIg but the presence of even high be more, not less, critical when assessing infusion (and maintain good titre anti-IgA antibodies may not preclude complementary/alternative medicine hydration and fluid intake). the use of an IVIg product low in IgA (CAM). Ironically, many CAM enthusiasts 7. Provide patient information regarding where the risk–benefit ratio merits it. believe that the work of my team is already too critical. high-dose IVIG therapy and consent. T EL-SHANAWANY 8. Store a sample of serum so that any Specialist Registrar in Immunology Believers in acupuncture will probably future research questions or matters University Hospital of Wales, Cardiff point towards a range of weaknesses in the analyses by Derry et al. The article has, of relating to transmission of infective WAC SEWELL agents may be addressed. Visiting Professor of Immunology course, several limitations but these should University of Lincoln, Lincoln not distract us from its provocative conclu- If anti-IgA antibodies are detected and SA MISBAH sion: there is ‘no robust evidence that are at high titre it may well still be possible Consultant Immunologist acupuncture works for any indication.’ to use an IVIg product low in IgA (see Table Churchill Hospital, Oxford Using an entirely different approach, which 1: Properties of IVIg preparations currently STEPHEN JOLLES included a review of those trials which con- available in the UK, in our original article) Consultant Immunologist and Allergist trol for placebo effects through the use of starting the infusion at a slow rate and, if University Hospital of Wales, Cardiff the new non-penetrating sham devices, I tolerated, gradually being increased under recently arrived at a strikingly similar the supervision of experienced staff and in a References overall verdict: ‘Acupuncture remains setting where full resuscitation facilities are 1Cunningham-Rundles C. Physiology of IgA steeped in controversy. Some findings are available. The current generation of IVIg and IgA deficiency. J Clin Immunol encouraging but others suggest that its products are generally lower in IgA than has 2001;21:303–9. 2 Lilic D, Sewell WAC. IgA deficiency: what clinical effects mainly depend on a placebo previously been the case. Premedication we should–or should not–be doing. J Clin response.’1 Critical assessment like this of such as antihistamine, paracetamol and Path 2001;54:337–8 Derry et al is a very rare thing in CAM. But hydrocortisone may also be used at initia- 3 Bjorkander J, Hammarstrom L, Smith C et CAM researchers should remember that it tion of IVIg or during change of product. al. Immunoglobulin prophylaxis in patients is mainly this approach which advances This is not generally needed for subsequent with antibody deficiency syndromes and anti-IgA antibodies. J Clin Immunol 1987; healthcare. infusions. Consideration may also be given 7:8–15 EDZARD ERNST to a medic alert bracelet documenting the 4Jolles S, Hughes J. Use of IGIV in the treat- Professor of Complementary Medicine high titre anti-IgA antibodies should the ment of atopic dermatitis, urticaria, sclero- Peninsula Medical School, Exeter 508 Clinical Medicine Vol 6 No 5 September/October 2006 LETTERS TO THE EDITOR Reference Whilst it may well be the case that the resulting as a complication from surgery in 1Ernst E. Acupuncture – a critical analysis. general public’s understanding of this area which the intention is to save life. JInt Med 2006;259:125–37. is inadequate, I firmly believe that they have On his final point, we will simply have to got hold of a truth which many profes- disagree. We hear much about supposed sionals are trying to deny, namely that the human rights, and very little about respon- Assisted dying choice of the time of one’s death is a funda- sibilities. I do not accept that the choice of mental human right and that it is not the the time of one’s death is a fundamental Editor – Though I do not for a moment place of legislators or health professionals to human right, and I would be interested to question his bona fides, I believe that deny that right. know the premise on which this assertion is Stephenson (Clin Med July/August 2006 pp made. If Fisken really believes this, and if 374–7) is profoundly mistaken and, ROGER A FISKEN Consultant Physician this ‘right’ is not to be denied to people by indeed, that he condemns his position with Friarage Hospital legislators and health professionals, then his own arguments. He says that ‘in most Northallerton, North Yorkshire presumably he would advocate that assisted cases [my emphasis] the physical symp- Reference dying be available to anyone who asks, of toms of terminal illness can be relieved’ whatever age and whatever condition of and that even where patients have complex 1Anonymous. A personal view of assisted dying. Clin Med 2006;6:412–7. health? A slippery slope indeed. symptoms ‘they can usually [my emphasis again] be alleviated.’ These statements are JEFFREY STEPHENSON obviously correct but are, frankly, irrele- St Luke’s Hospice, Plymouth In response to Fisken vant: as Stephenson himself agrees, those Reference who advocate the availability of assisted My statements about what can be achieved 1Anonymous. A personal view of assisted dying do so in relation to an ‘extremely by palliative care are hardly irrelevant as it is dying. Clin Med 2006;6:412–7. small proportion [of terminally ill important to establish the benchmark for people]’; however small that proportion what is possible. The appalling care high- may be, the fact is that such people exist, as lighted by the author in the same issue, to Assisted dying is eloquently demonstrated by another whom Fisken refers, although tragically all author in the same issue.1 There are people too common is nonetheless suboptimal.1 Editor – While I share some of Dr Jeffrey who are resistant to opiates or who find Palliative care is certainly not a panacea for Stephenson’s concerns regarding assisted their side effects intolerable and the same all end-of-life ills, but whatever the limita- dying, I feel that several of the points raised goes for the most commonly used anti- tions there is always something that can be need further attention. Firstly, I think it is emetic drugs. What are we going to provide done to bring a measure of relief. presumptive to state that most of us for these people? There will always remain some people working with the terminally ill are strongly No one would suggest that assisted dying who would like the option of assisted against a change in the current law. Those is an easy matter on which to legislate, but dying. However, at what cost to others do physicians working in palliative medicine with sufficient determination it is possible we elevate their autonomy above other who have spoken out on this subject tend to set aside absolutist arguments and to pro- concerns? Fisken’s faith in our legislators is to be strongly against assisted dying.
Load more

Recommended publications
  • JFP 0205 Comm Ernst.Final.REV2
    Family Medicine Forum Second thoughts on integrative medicine Edzard Ernst, MD, PhD, FRCP,FRCPEd Peninsula Medical School, Universities of Exeter and Plymouth, Exeter, UK ntegrative medicine is a new concept of care, we should integrate CAM across all of soci- healthcare.1,2 Confusingly, the term has 2 ety. This line of argument seems logical and well Idefinitions. The first definition is a healthcare intentioned. But is it convincing? system “that selectively incorporates elements of Just because the affluent are the primary complementary and alternative medicine (CAM) recipients of CAM does not necessarily recom- into comprehensive treatment plans….”1 The mend it to everyone. Their lifestyle choices also second definition is an approach that emphasizes put them at greater risk for cancer and gout, and “health and healing rather than disease and treat- they undergo liposuction more often. That the ment. It views patients as whole people with affluent can afford to pay for CAM does not mean minds and spirits as well as bodies….”1 it’s good for them. I would argue that the whole-person concept has always been at the core of good medicine, The evidence for benefits vs risks particularly primary care, and that coining a new The assumption we should really mistrust is that name for an old value is counterproductive. If we satisfaction with CAM services is the same as a can agree that the whole-person concept needs demonstration of efficacy. The missing link in the no other name, we can greatly simplify matters logic of integrated medicine is the evidence that by letting integrative medicine stand for just one CAM does more good than harm.
    [Show full text]
  • EDZARD ERNST — a RESPONSE We, Even in Much Detail
    Digest the publication of Trick or Treatment? EDZARD ERNST — A RESPONSE we, even in much detail. The difference is Alternative Medicine on Trial .2 But here the that we try to apply just one standard while possibility of what might be learned from Trick or Treatment? Alternative Medicine on Swayne uses two. The placebo-effect is CAM about our ability to stimulate self- Trial is not a book against alternative clearly powerful, thankfully we both agree regulating and self-healing mechanisms medicine, it is a book in favour of good on that. Swayne believes this justifies the whose pervasive role in medicine Ernst and evidence and single standards in health routine use of homeopathy and other Singh acknowledge, is tragically neglected. care. Jeremy Swayne admits that ineffective treatments. We point out that Dismissing the results of the Bristol ‘truthfulness is an essential attribute’ but you don’t need to administer a placebo to Homeopathic Hospital clinical outcome study criticizes our book for lack of ‘wisdom and generate a placebo response — effective on the grounds of explanations other than the discernment’, ‘lack of … balance’, treatments do that too and they convey effect of homeopathic medicines (some of neglecting ‘the positives’ and disregarding specific effects as well. The logical which are tendentious and don’t reflect a ‘the power and importance of non-specific conclusion therefore is that, by using pure diligent study of the research paper), they and placebo effects’. He concludes by placebos, we do our patients a grave ignore the core fact that for whatever reason accusing us of ‘scientific tunnel vision’.
    [Show full text]
  • Medical Sociology BLACKWELL COMPANIONS to SOCIOLOGY
    the new blackwell companion to medical sociology BLACKWELL COMPANIONS TO SOCIOLOGY The Blackwell Companions to Sociology provide introductions to emerging topics and theoretical orientations in sociology as well as presenting the scope and quality of the discipline as it is currently confi gured. Essays in the Companions tackle broad themes or central puzzles within the fi eld and are authored by key scholars who have spent considerable time in research and refl ection on the questions and controversies that have activated interest in their area. This author- itative series will interest those studying sociology at advanced undergraduate or graduate level as well as scholars in the social sciences and informed readers in applied disciplines. The Blackwell Companion to Major Classical Social Theorists Edited by George Ritzer The Blackwell Companion to Major Contemporary Social Theorists Edited by George Ritzer The Blackwell Companion to Political Sociology Edited by Kate Nash and Alan Scott The Blackwell Companion to Sociology Edited by Judith R. Blau The Blackwell Companion to Criminology Edited by Colin Sumner The Blackwell Companion to Social Movements Edited by David A. Snow, Sarah A. Soule, and Hanspeter Kriesi The Blackwell Companion to the Sociology of Families Edited by Jacqueline Scott, Judith Treas, and Martin Richards The Blackwell Companion to Law and Society Edited by Austin Sarat The Blackwell Companion to the Sociology of Culture Edited by Mark Jacobs and Nancy Hanrahan The Blackwell Companion to Social Inequalities Edited by Mary Romero and Eric Margolis The New Blackwell Companion to Social Theory Edited by Bryan S. Turner The New Blackwell Companion to Medical Sociology Edited by William C.
    [Show full text]
  • Inside IC Football Club Loses £1,000 and Is Accused of Criminal Damages
    Th e student ‘news’paper of Imperial College London Issue 1,403 felix Friday 16 May 2008 felixonline.co.uk Inside Return of the Singh Pages 10 & 11 Architecture Vs. Fashion Pages 16 & 17 Guns, gorillas & Generals Pages 20 & 21 Hangman – Two bookable Brown love offences? IC Football Club loses £1,000 and is accused of criminal damages and intimidatory behaviour at a Knightsbridge hotel, see page 3 Page 23 2 felix Friday 16 May 2008 News News Editor – Andrew Somerville, News Goblin – Matty Hoban [email protected] NSS rigging undermines MPseudoSci: is Imperial credibility of league tables lending credence to rubbish? Kingston University lecturer caught red-handed trying to influence her institution’s standing in national league tables national league tables, employers will be led to believe students’ degrees are “shit” rendering them essentially unemployable. As a result of this, students are told to artificially inflate the scores for each of the twenty-two questions posed. “... If you think something was a 4, my encouragement would be, give it a 5”, says the Kingston academic to a lec- ture room full of students. In response to national media coverage of the inci- dent, the university’s Vice-Chancellor has called this an “isolated incident” and that the lecturer’s comments were “inappropriate”. Homeopathy in action. Active molecules? 1 in 1060 , if you’re lucky The story was picked up by IC news website, Live! (live.cgcu.net) and subsequently by the BBC, The Daily Kadhim Shubber In the past, the Centre for Homeo- Telegraph and The Times.
    [Show full text]
  • Is Homeopathy a Clinically Valuable Approach?
    Opinion TRENDS in Pharmacological Sciences Vol.26 No.11 November 2005 Is homeopathy a clinically valuable approach? Edzard Ernst Complementary Medicine, Peninsula Medical School, Universities of Exeter & Plymouth, 25 Victoria Park Road, Exeter EX2 4NT, UK Homeopathy is a popular but implausible form of than the disease, the initial success of homeopathy is medicine. Contrary to many claims by homeopaths, understandable; being highly dilute, most homeopathic there is no conclusive evidence that highly dilute remedies are largely free of adverse effects. The recent homeopathic remedies are different from placebos. renaissance of homeopathy is perhaps more puzzling; it The benefits that many patients experience after can be seen in the context of the global boom in all types of homeopathic treatment are therefore most probably alternative medicine [7]. due to nonspecific treatment effects. Contrary to wide- Today, w20% of all GPs and 90% of all veterinarians in spread belief, homeopathy is not entirely devoid of risk. Germany practise homeopathy. In the UK 42% of GPs Thus, the proven benefits of highly dilute homeopathic refer patients to homeopaths and 86% of Scottish GPs are remedies, beyond the beneficial effects of placebos, do said to be in favor of homeopathy. In Holland, 45% of GPs not outweigh the potential for harm that this approach use homeopathy and, in Belgium, this figure is reported to can cause. be 85%. Across Europe approximately a quarter of the population uses homeopathy [8]. A Norwegian observa- The origins of homeopathy tional study suggested recently that 7 out of 10 patients Christian Friedrich Samuel Hahnemann, the ‘father’ of who visited a homoeopath felt improvement in their main homeopathy, was born in 1755, and 2005, 250 years complaint 6 months after the initial consultation [9].
    [Show full text]
  • Homeopathy — a Case in Point Why EBM Is So Important — Or, “The Plural of Anecdote Is Not Data.”303
    5 Homeopathy — a case in point why EBM is so important — or, “the plural of anecdote is not data.”303 Homeopathy — a case in point why EBM is so important 5.1 Alternatives to medicine? EBM is by now the established way to conduct medical research and practice, sometimes more, sometimes less successful and always dependent on the user, both the physician and the patient. And although a lot of the criticism levelled at EBM can be refuted or EBM changed in a way that it is still true to its principles and still patient friendly, many patients are looking for alternatives to EBM and medicine in general. They are either dissatisfied by the way there are treated in hospitals and by conventional GPs, or they are slightly afraid of the treatments which can have side effects and whose ingredients lists contain long and hard-to- understand words. These dissatisfied patients look for other means to treat and cure their ailments and a whole market of ‘alternative’ medicines has sprung up to cater to these patients wants and needs. Foremost of these alternative treatments is homeopathy, closely followed by acupuncture. The treatments claim to be more ‘natural’ in that they do not use any harsh chemicals and that they are more gentle, taking the whole person into account. This chapter will mainly deal with homeop- athy and its methodological problems as a case in point why EBM is so important and why we need modern science to heal and cure. If these ‘alternative’ treatments are effective, they belong in the realm of EBM, and if they are not, they are no alternative to EBM, but should be abandoned.
    [Show full text]
  • Multinational Association of Supportive Care in Cancer
    22nndd GGuuiillddffoorrdd SSuuppppoorrttiivvee CCaarree iinn CCaanncceerr CCoouurrssee 9th-10th November 2016 Royal College of Physicians, London Background The Multinational Association for Supportive Care in Cancer (MASCC) has defined supportive care as “the prevention and management of the adverse effects of cancer and its treatment. This includes management of physical and psychological symptoms and side effects across the continuum of the cancer experience from diagnosis through anticancer treatment to post-treatment care. Enhancing rehabilitation, secondary cancer prevention, survivorship and end of life care are integral to supportive care”. The aim of this two day course is to provide healthcare professionals working in oncology with an up-to-date, evidence-based review of current issues within supportive care. All of the speakers work in oncology, and all of the speakers have an interest in various aspects of supportive care; the speakers include specialists in clinical oncology, medical oncology, palliative medicine, psycho-oncology, oral medicine, gastroenterology, pain medicine, endocrinology and pharmacology. The main focus of this course is metastatic bone disease, and strategies for preventing the development / progression of this problem, and especially strategies for managing this problem: speakers include renowned specialists from the specialties of Oncology, Palliative Medicine, Radiology and Orthopaedic Surgery. The course is organised by the Department of Supportive & Palliative Care at the Royal Surrey County Hospital
    [Show full text]
  • Simile February 2018
    The Faculty of Homeopathy Newsletter February 2018 Anger and protests at RCVS statement on CAM ets, farmers and pet owners have condemnation of the RCVS. “This reacted with anger after the Royal statement has been imposed without VCollege of Veterinary Surgeons’ consultation with clients or any of the (RCVS) ruling council agreed a new vets who use these treatments. We position statement on complementary are deeply disappointed that the RCVS therapies which they say is tantamount would seek to undermine its own to a ban on the use of homeopathy in members whose independence and the treatment of sick animals. livelihoods are at stake.” Although the statement is designed Supporters of veterinary to cover all complementary therapies, homeopathy have also been making it singles out homeopathy. It makes the their views known. An online petition questionable claim the therapy “exists received over 15,000 signatures. without a recognised body of evidence” And in January a group of about 50 and to protect animal welfare it should protestors, many accompanied by their only be used alongside conventional animals, braved gale force winds and treatments and not as an alternative. pouring rain to march on the RCVS’s Furthermore, many homeopathic Vet Geoff Johnson protesting headquarters in London to deliver the veterinary surgeons believe the in London petition. They were met by Professor statement implies a degree of criticism Peter May, the RCVS’s president, who of their clinical competence, in that by used in veterinary practice, as well attempted to clarify the royal college’s using homeopathy they are causing as human medicine, is inconclusive.
    [Show full text]
  • Vol 121 No 1279; ISSN 1175 8716 Page 1 of 125 URL: ©NZMA
    THE NEW ZEALAND MEDICAL JOURNAL Journal of the New Zealand Medical Association CONTENTS This Issue in the Journal 4 A summary of the original articles featured in this issue Editorials 6 Melanoma in New Zealand: a problem that is not going away James H F Shaw 10 Ghosts in the machine: the experiences of M āori in the New Zealand health system Jonathan B Koea 13 Lack of progress in New Zealand’s Cancer Control Strategy Christopher Wynne 16 Defamatory articles or not? Frank A Frizelle Original Articles 18 The incidence and thickness of cutaneous malignant melanoma in New Zealand 1994–2004 Ann Richardson, Lynn Fletcher, Mary Jane Sneyd, Brian Cox, Anthony I Reeder 27 The road we travel: M āori experience of cancer Tai Walker, Louise Signal, Marie Russell, Kirsten Smiler, Rawiri Tuhiwai-Ruru, Otaki Community Health Centre, Te Wakahuia Hauora, Te Aitanga a Hauiti Hauora, Turanga Health 36 Thyroid malignancies: a New Zealand South Island thyroid clinic experience 1995–2006 Bevan Brownlie, Philippa Mercer, John Turner, Robert Allison 46 An audit of colon cancer data on the New Zealand Cancer Registry Ruth Cunningham, Diana Sarfati, Sarah Hill, Diane Kenwright 57 The value of voluntary morbidity and mortality meetings at a New Zealand metropolitan hospital Magdalena Sakowska, Saxon Connor 66 Hospital discharges in New Zealand 1991–2005: changes over time and variation between districts Antony Raymont NZMJ 8 August 2008, Vol 121 No 1279; ISSN 1175 8716 Page 1 of 125 URL: http://www.nzma.org.nz/journal/121-1279/3207/ ©NZMA Viewpoints 75 Mapping
    [Show full text]
  • Vitualis' Medical Rants: Volume 2
    VITUALIS’ MEDICAL RANTS THE MUSINGS OF A JUNIOR DOCTOR… YES, A TORTURED SOUL AND QUITE POSSIBLY A DISTURBED MIND. Volume 2 Collection: July 2005 to December 2005 First Edition Dr. Michael Tam, B. Sc. (med), M.B., B.S. (University of NSW) vitualis’ Medical Rants – Volume 2: July 2005 to December 2005 :: dedication :: To all my readers, many thanks for your support; and to my lovely wife, whose patience made this book possible. ii Published by Lulu.com 2005 © 2005 by vitualis Productions, Michael Tam. Some rights reserved. License Creative Commons Attribution-NonCommercial-NoDerivs 2.5 You are free to copy, distribute, display, and perform the work under the following conditions: Attribution. You must attribute the work in the BY: manner specified by the author or licensor. Noncommercial. You may not use this work for $ commercial purposes. No Derivative Works. You may not alter, = transform, or build upon this work. For any reuse or distribution, you must make clear to others the license terms of this work. Any of these conditions can be waived if you get permission from the copyright holder. Your fair use and other rights are in no way affected by the above. This work is licensed under the Creative Commons Attribution- NonCommercial-NoDerivs License. To view a copy of this license, visit http://creativecommons.org/licenses/by-nc-nd/2.5/ or send a letter to Creative Commons, 559 Nathan Abbott Way, Stanford, California 94305, USA. iii vitualis’ Medical Rants – Volume 2: July 2005 to December 2005 iv Preface n the second half of the year 2005, an evolution in the character of the “vitualis’ Medical Rants” blog took place.
    [Show full text]
  • Hockey Committee Members 'Pressured
    In this week’s issue: an interview with Labour leader Ed Miliband, the plans for the fi rst UKIP society in Wales detailed, and why gair rhyddy we can no longer ignore the housing crisis Monday March 23rd 2015 | freeword | Issue 1049 Hockey committee members ‘pressured’ to resign ‘Severe’ sanctions imposed following streaking incident in Julian Hodge embers of the Cardiff Men’s of confi dence in their ability to However, those responding to pissing on the side of my house.” EXCLUSIVE Hockey committee have fulfi l their roles, explaining that “we the disciplinary action have voiced Journalism, Media and Culture Pictured: Anna Lewis M reportedly been ‘pressured’ feel we have lost the backing of the concerns that the action taken is too undergraduate Sophie Lodge also Hockey players at to resign after team members were chairman and the committee and severe. confi rmed that she had seen “people last year’s varsity recorded ‘streaking’ in the Julian we feel our position has become Former student Chris Houghton streaking” in Talybont North during (Taliesin Hodge Building. untenable.” said: “I think a hockey player’s job is her fi rst year. Coombes) Th e incident, which took place “We feel we did the job to the to play hockey. If anything, all that But talking about the disciplinary in the building’s library and was best of our abilities and feel that his running around with their kit off action, Lodge expressed doubt over recorded on video by a surprised decision is putting the club’s best shows is an intense devotion to their whether the resignations were too onlooker, led to both social interests fi rst.” sport.” harsh an outcome.
    [Show full text]
  • Trick Or Treatment: the Undeniable Facts About Alternative Medicine
    The new england journal of medicine sensus that sexual relationships between thera- pists and patients are never permissible. Gutheil and Brodsky’s book is thus valuable in that it provides great clarity on the importance of strict professionalism and the avoidance of exploitative behavior in clinical practice. Moreover, it offers down-to-earth guidance in an accessible and in- teresting format, making theoretical notions come to life for use in everyday practice. Laura Weiss Roberts, M.D., M.A. Joseph B. Layde, M.D., J.D. Medical College of Wisconsin Milwaukee, WI 53226 [email protected] Trick or Treatment: The Undeniable Facts about Alternative Medicine By Simon Singh and Edzard Ernst. 342 pp., illustrated. New York, W.W. Norton, 2008. $25.95. ISBN 978-0-393-06661-6. Chinese Acupuncture Chart, Undated. he authors of this book state in their Wellcome Library, London. Tintroduction: “Our mission is to reveal the truth about the potions, lotions, pills, needles, woven with accounts of medical quackery as well pummeling and energizing that lie beyond the as descriptions of clinical trials that illustrate sci- realms of conventional medicine.” Their goal is entific methodology. to answer the question of whether alternative In the chapter on acupuncture, for example, therapies provide any benefits — or only a pla- the authors relate the ancient origins of the prac- cebo effect. tice and its recent rise in popularity in the West. Simon Singh is a physicist and science journal- After consideration of the principles of Chinese ist, and his coauthor, Edzard Ernst, is a physician medicine and the concept of meridians, Singh and professor of complementary medicine.
    [Show full text]