Publication Date 01/07/2014         Volume. 6 No. 6   
Information to Pharmacists

Editorial

From the desk of the editor

Welcome to the July 2014 homepage edition of i2P (Information to Pharmacists) E-Magazine.
At the commencement of 2014 i2P focused on the need for the entire profession of pharmacy and its associated industry supports to undergo a renewal and regeneration.
We are now half-way through this year and it is quite apparent that pharmacy leaders do not yet have a cohesive and clear sense of direction.
Maybe the new initiative by Woolworths to deliver clinical service through young pharmacists and nurses may sharpen their focus.
If not, community pharmacy can look forward to losing a substantial and profitable market share of the clinical services market.
Who would you blame when that happens?
But I have to admit there is some effort, even though the results are but meagre.
In this edition of i2P we focus on the need for research about community pharmacy, the lack of activity from practicing pharmacists and when some research is delivered, a disconnect appears in its interpretation and implementation.

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Newsflash Updates for July 2014

Newsflash Updates

Regular weekly updates that supplement the regular monthly homepage edition of i2P. 
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Feature Contribution

Woolworths Pharmacy - Getting One Stage Closer

Neil Johnston

It started with “tablet” computers deployed on shelves inside the retailer Coles, specifically to provide information to consumers relating to pain management and the sale of strong analgesics.
This development was reported in i2P under the title Coles Pharmacy Expansion and the Arid PGA Landscape”
In that article we reported that qualified information was a missing link that had come out of Coles market research as the reason to why it had not succeeded in dominating the pain market.
Of course, Woolworths was working on the same problem at the same time and had come up with a better solution - real people with good information.

Comments: 5

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Intensive Exposition without crossing over with a supermarket

Fiona Sartoretto Verna AIAPP

Editor's Note: The understanding of a pharmacy's presentation through the research that goes into the design of fixtures and fittings that highlight displays, is a never-ending component of pharmacy marketing.
Over the past decade, Australian pharmacy shop presentations have fallen behind in standards of excellence.
It does not take rocket science - you just have to open your eyes.
Recently, our two major supermarkets, Woolworths and Coles, have entered into the field of drug and condition information provision - right into the heartland of Australian Pharmacy.

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The sure way to drive business away

Gerald Quigley

I attended the Pregnancy, Baby and Children’s Expo in Brisbane recently.
What an eye and ear opening event that was!
Young Mums, mature Mums, partners of all ages, grandparents and friends……...many asking about health issues and seeking reassurances that they were doing the right thing.

Comments: 1

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‘Marketing Based Medicine’ – how bad is it?

Baz Bardoe

It should be the scandal of the century.
It potentially affects the health of almost everyone.
Healthcare providers and consumers alike should be up in arms. But apart from coverage in a few credible news sources the problem of ‘Marketing Based Medicine,’ as psychiatrist Dr Peter Parry terms it, hasn’t as yet generated the kind of universal outrage one might expect.

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Community Pharmacy Research - Are You Involved?

Mark Coleman

Government funding is always scarce and restricted.
If you are ever going to be a recipient of government funds you will need to fortify any application with evidence.
From a government perspective, this minimises risk.
I must admit that while I see evidence of research projects being managed by the PGA, I rarely see community pharmacists individually and actively engaged in the type of research that would further their own aims and objectives (and survival).

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Organisational Amnesia and the Lack of a Curator Inhibits Cultural Progress

Neil Johnston

Most of us leave a tremendous impact on pharmacies we work for (as proprietors, managers, contractors or employees)—in ways we’re not even aware of.
But organisational memories are often all too short, and without a central way to record that impact and capture the knowledge and individual contributions, they become lost to time.
It is ironic that technology has provided us with phenomenal tools for communication and connection, but much of it has also sped up our work lives and made knowledge and memory at work much more ephemeral.

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Academics on the payroll: the advertising you don't see

Staff Writer

This article was first published in The Conversation and was written by Wendy Lipworth, University of Sydney and Ian Kerridge, University of Sydney
In the endless drive to get people’s attention, advertising is going ‘native’, creeping in to places formerly reserved for editorial content. In this Native Advertising series we find out what it looks like, if readers can tell the difference, and more importantly, whether they care.
i2P has republished the article as it supports our own independent and ongoing investigations on how drug companies are involved in marketing-based medicine rather than evidence-based medicine.

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I’ve been thinking about admitting wrong.

Mark Neuenschwander

Editor's Note: This is an early article by Mark Neuenschwander we have republished after the soul-searching surrounding a recent Australian dispensing error involving methotrexate.
Hmm. There’s more than one way you could take that, huh? Like Someday when I get around to it (I’m not sure) I may admit that I was wrong about something. Actually, I’ve been thinking about the concept of admitting wrong. So don’t get your hopes up. No juicy confessions this month except that I wish it were easier for me to admit when I have been wrong or made a mistake.
Brian Goldman, an ER physician from Toronto, is host of the award-winning White Coat, Black Art on CBC Radio and slated to deliver the keynote at The unSUMMIT for Bedside Barcoding in Anaheim this May. His TED lecture, entitled, “Doctors make mistakes. Can we talk about it?” had already been viewed by 386,072 others before I watched it last week.

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Dispensing errors – a ripple effect of damage

Kay Dunkley - BPharm, Grad Dip Hosp Pharm, Grad Dip Health Admin, MPS, MSHPA

Most readers will be aware of recent publicity relating to dispensing errors and in particular to deaths caused by methotrexate being incorrectly packed in dose administration aids.
The Pharmacy Board of Australia (PBA), in its Communique of 13 June 2014, described a methotrexate packing error leading to the death of a patient and noted “extra vigilance is required to be exercised by pharmacists with these drugs”.
This same case was reported by A Current Affair (ACA) in its program on Friday 20 June
http://aca.ninemsn.com.au/article/8863098/prescription-drug-warning

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Take a vacation from your vocation

Harvey Mackay

Have you ever had one of those days when all you could think was, “Gosh, do I need a vacation.”
Of course you have – because all work and no play aren’t good for anyone.
A vacation doesn’t have to be two weeks on a tropical island, or even a long weekend at the beach. 
A vacation just means taking a break from your everyday activities. 
A change of pace. 
It doesn’t matter where.
Everyone needs a vacation to rejuvenate mentally and physically. 
But did you also know that you can help boost our economy by taking some days off? 
Call it your personal stimulus package.

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Explainer: what is peer review?

Staff Writer

This article was first published in the Conversation. It caught our eye because "peer review" it is one of the standards for evidence-based medicines that has also been corrupted by global pharma.
The article is republished by i2P as part of its ongoing investigation into scientific fraud and was writtenby Andre Spicer, City University London and Thomas Roulet, University of Oxford
We’ve all heard the phrase “peer review” as giving credence to research and scholarly papers, but what does it actually mean?
How does it work?
Peer review is one of the gold standards of science. It’s a process where scientists (“peers”) evaluate the quality of other scientists' work. By doing this, they aim to ensure the work is rigorous, coherent, uses past research and adds to what we already knew.
Most scientific journals, conferences and grant applications have some sort of peer review system. In most cases it is “double blind” peer review. This means evaluators do not know the author(s), and the author(s) do not know the identity of the evaluators.
The intention behind this system is to ensure evaluation is not biased.
The more prestigious the journal, conference, or grant, the more demanding will be the review process, and the more likely the rejection. This prestige is why these papers tend to be more read and more cited.

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Dentists from the dark side?

Loretta Marron OAM BSc

While dining out with an elderly friend, I noticed that he kept his false tooth plate in his shirt pocket. He had recently had seven amalgam-filled teeth removed, because he believed that their toxins were making him sick; but his new plate was uncomfortable. He had been treated by an 'holistic dentist'. Claiming to offer a "safe and healthier alternative" to conventional dentistry, are they committed to our overall health and wellbeing or are they promoting unjustified fear, unnecessarily extracting teeth and wasting our money?

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Planning for Profit in 2015 – Your key to Business Success

Chris Foster

We are now entering a new financial year and it’s a great time to reflect on last year and highlight those things that went well and those that may have impacted negatively in the pursuit of your goals.
It's also a great to spend some time re-evaluating your personal and business short, medium and long term goals in the light of events over the last year.
The achievement of your goals will in many cases be dependent on setting and aspiring to specific financial targets. It's important that recognise that many of your personal goals will require you to generate sufficient business profits to fund those aspirations

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ReWalk™ Personal Exoskeleton System Cleared by FDA for Home Use

Staff Writer

Exoskeleton leader ReWalk Robotics announced today that the U.S. Food and Drug Administration has cleared the company’s ReWalk Personal System for use at home and in the community.
ReWalk is a wearable robotic exoskeleton that provides powered hip and knee motion to enable individuals with Spinal Cord Injury (SCI) to stand upright and walk.
ReWalk, the only exoskeleton with FDA clearance via clinical studies and extensive performance testing for personal use, is now available throughout the United States.

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Attracting and Retaining Great People

Barry Urquhart

Welcome to the new financial year in Australia.
For many in business the past year has been described as a challenging period.
Adjectives are a key feature of the English language.  In the business lexicon their use can be, and often is evocative and stimulate creative images.  But they can also contribute to inexact, emotional perceptions.
Throughout the financial pages of newspapers and business magazines adjectives abound.
References to “hot” money draw attention and comment.  The recent wave of funds from Chinese investors, keen to remove their wealth from the jurisdiction and control of government regulations is creating a potential property bubble in Australia.

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Updating Your Values - Extending Your Culture

Neil Johnston

Pharmacy culture is dormant.
Being comprised of values, unless each value is continually addressed, updated or deleted, entire organisations can stagnate (or entire professions such as the pharmacy profession).
Good values offer a strong sense of security, knowing that if you operate within the boundaries of your values, you will succeed in your endeavours.

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Evidence-based medicine is broken. Why we need data and technology to fix it

Staff Writer

The following article is reprinted from The Conversation and forms up part of our library collection on evidence-based medicines.
At i2P we also believe that the current model of evidence is so fractured it will never be able to be repaired.
All that can happen is that health professionals should independently test and verify through their own investigations what evidence exists to prescribe a medicine of any potency.
Health professionals that have patients (such as pharmacists) are ideally placed to observe and record the efficacy for medicines.
All else should confine their criticisms to their evidence of the actual evidence published.
If there are holes in it then share that evidence with the rest of the world.
Otherwise, do not be in such a hurry to criticise professions that have good experience and judgement to make a good choice on behalf of their patients, simply because good evidence has not caught up with reality.

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Laropiprant is the Bad One; Niacin is/was/will always be the Good One

Staff Writer

Orthomolecular Medicine News Service, July 25, 2014
Laropiprant is the Bad One; Niacin is/was/will always be the Good One
by W. Todd Penberthy, PhD

(OMNS July 25, 2014) Niacin has been used for over 60 years in tens of thousands of patients with tremendously favorable therapeutic benefit (Carlson 2005).
In the first-person NY Times best seller, "8 Weeks to a Cure for Cholesterol," the author describes his journey from being a walking heart attack time bomb to a becoming a healthy individual.
He hails high-dose niacin as the one treatment that did more to correct his poor lipid profile than any other (Kowalski 2001).

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Culture Drive & Pharmacy Renewal

Neil Johnston

Deep within all of us we have a core set of values and beliefs that create the standards of behaviour that we align with when we set a particular direction in life.
Directions may change many times over a lifetime, but with life experiences and maturity values may increase in number or gain greater depth.
All of this is embraced under one word – “culture”.
When a business is born it will only develop if it has a sound culture, and the values that comprise that culture are initially inherent in the business founder.
A sound business culture equates to a successful business and that success is often expressed in the term “goodwill” which can be eventually translated to a dollar value.

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ReWalk™ Personal Exoskeleton System Cleared by FDA for Home Use

Staff Writer

Exoskeleton leader ReWalk Robotics announced today that the U.S. Food and Drug Administration has cleared the company’s ReWalk Personal System for use at home and in the community.
ReWalk is a wearable robotic exoskeleton that provides powered hip and knee motion to enable individuals with Spinal Cord Injury (SCI) to stand upright and walk.
ReWalk, the only exoskeleton with FDA clearance via clinical studies and extensive performance testing for personal use, is now available throughout the United States.

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Pharmacy 2014 - Pharmacy Management Conference

Neil Johnston

The brave new world of health and wellness is not the enemy of Pharmacy, it is its champion.
Australian futurist, Morris Miselowski, one of the world's leading business visionaries, will present the Opening Keynote address on Pharmacy's Future in the new Health and Wellness Landscape at 2.00pm on Wednesday July 30.
Morris believes the key to better health care could already be in your pocket, with doctors soon set to prescribe iPhone apps, instead of pills.
Technology will revolutionise the health industry - a paradigm shift from healthcare to personal wellness.
Health and wellness applications on smartphones are already big news, and are dramatically changing the way we manage our personal health and everyday wellness.

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Generation and Application of Community Pharmacy Research

Neil Johnston

Editor’s Note: We have had a number of articles in this issue relating to pharmacy research.
The PGA has conducted a number of research initiatives over the years, including one recently reported in Pharmacy News that resulted from an analysis of the QCPP Patient Questionnaire.
Pharmacy Guild president, George Tambassis, appears to have authored the article following, and there also appears to be a disconnect between the survey report and its target audience illustrated by one of the respondent comments published.
I have asked Mark Coleman to follow through, elaborate and comment:

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Friends of Science in Medicine

Neil Johnston

articles by this author...

Neil Johnston is a pharmacist who trained as a management consultant. He was the first consultant to service the pharmacy profession and commenced practice as a full time consultant in 1972, specialising in community pharmacy management, pharmacy systems, preventive medicine and the marketing of professional services. He has owned, or part-owned a total of six pharmacies during his career, and for a decade spent time both as a clinical pharmacist and Chief Pharmacist in the public hospital system. He has been editor of i2P since 2000.

A powerful group (The Friends of Science in Medicine (FSM)) comprised of medical academics and interested professionals has sprung into existence under the guidance of CEO Loretta Marron  (Australian Skeptic of the Year 2011), Professor Alastair MacLennan, Emeritus Professor John Dwyer, Professor Rob Morrison and Professor Marcello Costa and a cast of 400 Australian and international names.
Their full title, academic establishment and contact details are included in the press release that follows, along with a link containing the full list of academics involved.
The aim of this group is to directly challenge those universities that provide education and degrees to support some health disciplines, not deemed to be evidence-based.
This is in effect, a full-frontal confrontation to the universities that appear on the "naughty list (and there are quite a number).
It will also be confrontational to government and the agencies involved with regulating and monitoring the various health disciplines.

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Obviously as the "Friends of Science in Medicine" mobilise and begin to target and shoot down those activities on the "hit list", there will be an opposite reaction as the "targets" also mobilise to protect themselves.
The health disciplines left standing at the end of this attrition will obviously seek to have scarce government funds directed towards their own academic activities and funding that subsidises patient care directed into their specific patient rebates.
Even private health funds will no longer be able to direct their marketing into naturopathy, chiropractic, homeopathy etc if they do not exist any more, even though consumers show a strong preference towards these services, mostly as refugees from the orthodox medical system.
Many health fund members are also in the younger age group because the alternate health systems appeal to them. Disruption of this younger member base has the potential to increase private insurance premiums and make it unaffordable to all but the wealthy.
A budget conscious cash-strapped federal government may be inclined to let go some of these health disciplines based on the need to balance a budget before the next elections, citing the evidence of the FSM.

i2P has the belief that evidence-based medicine is a sound objective for all the health sciences.
How that evidence has been derived is another "can of worms" and there are many holes in the medical system of the conduct of clinical trials and the publishing of the findings, where the heavy hand of Big Pharma is in the background, buying influence at all levels, including universities (the "not-so-naughty" universities are included here as well).
Therefore i2P suggests that in the clean up of the "naughty universities" that the "Friends of Science in Medicine" pay equal attention to the orthodox health disciplines - and that may mean extending the "naughty list" to embrace all universities to guarantee equality of approach.
Otherwise credibility may be prejudiced.
Health service consumers will also need to be strongly represented, for they are the group that is ultimately affected, and their preferences need to be recorded and taken to account,

What the "Friends of Science in Medicine" is trying to achieve is quite impressive and has the potential to clean up a lot of the "wrongs" in health generally. As for any organisation there is the potential for some of its members to hijack the primary agenda and steer it down different pathways.
Funding for this new group will need to be adequate and at the same time remain pristine, because it represents considerable power that needs to be harnessed democratically.
It will be a magnet for every single "power broker" in the health industry.

Loretta Marron

Quack Treatments Duck for Cover
24 January 2012

Some alternative medical treatments, long contested as "quackery" by orthodox medicine, are coming under heavy fire.

Homeopathy may soon be dropped from German and UK medical insurance providers as a cost-saving measure, reports Deutsche Welle, Germany’s International Broadcaster *.

The broadcaster also states that, starting this year, it will no longer be possible to receive a degree from a publicly-funded British university in areas of "alternative medicine," including homeopathy, naturopathy and reflexology.

It is all welcome news to the Friends of Science in Medicine (FSM), an Australian organisation formed in December of 2011, to argue against the inclusion of pseudoscience courses in Australian universities and for their removal from Australian health benefits schedules.

"Friends of Science in Medicine wants to reverse the trend which sees government-funded tertiary institutions offering courses in the health care sciences that are not underpinned by convincing scientific evidence," said Professor John Dwyer AO,  Emeritus Professor of Medicine at the University of New South Wales.

Nineteen of Australia’s thirty-nine Universities currently offer degrees and courses in alternative health care,  identified as courses that are not evidence-based or based upon demonstrably false assumptions. They include Homeopathy, Iridology, Reflexology, Kinesiology, Healing touch therapy, Aromatherapy and 'Energy Medicine'.

Since its formation in December 2011, FSM has attracted close to 400 individual members from Australia and overseas. Concerned academics from two thirds of Australia’s universities have joined it, as have influential international health and medical organisations.

"Courses in alternative medicine are dishonest, they teach things that aren't true, and things that are dangerous to patients in some cases" said David Colquhoun FRS, Professor of Pharmacology at University College London, who has led demands to close the UK programs.

FSM has written to all Australian universities asking them to endorse the principles that science and health courses offered by universities should be evidence-based and conducted according to accepted scientific methodology.

"Our main goal is to have all universities acknowledge this controversy and review their health science teaching to ensure that their courses use scientific principles based on experimental evidence," said Professor Alastair MacLennan, Professor of Obstetrics & Gynaecology at The University of Adelaide.

FSM is also arguing that non evidence-based alternative practices should be ineligible for rebates from Australian medical insurance providers. It wants the government to stop funding non evidence-based courses in universities and providing other endorsements of pseudoscience.

"As one example, the federal government’s establishment of a national registration system for chiropractors, despite there bei ng no definition of an acceptable range of their services, together with permitting them to call themselves "Doctors", have enhanced chiropractors’ credibility," said Professor Marcello Costa, Professor of Neurophysiology at the Flinders University.

* http://www.dw-world.de/dw/article/0,,15673133,00.html
----------------------------------------------------------------------------------------------------------------------------------------------------------
Name             Prof Alastair MacLennan; Professor and Head of the Discipline of Obstetrics & Gynaecology, UofA
Name             Emeritus Prof John Dwyer AO; Founder of the Australian Healthcare Reform Alliance, clinical advisor to and member of the NSW inter-agency committee for the protection of the public from health care fraud, UNSW
Name             Prof Marcello Costa FAA; Professor of Neurophysiology, Flinders University
Name             Loretta Marron, CEO FSM .
Contact through email  scienceinmedicine@bigpond.com

* List of supporters

* Invitation to join FSM

* Global media releases

Return to home

Submitted by Andrew on Tue, 17/07/2012 - 13:33.

During the last two years I was having a problem with a severe pain in my stomach. I visited numerous GPs, surgeons, gastroenterologists with absolutely no help. The only people who actually helped me are naturopaths, including Australian, Chinese and Indian. Thus, friends of the only medicine are representing no science but rather is a bunch of guys who want to get rid of alternative medicine so that doctors would have no competition.
The modern doctors do not treat patients. How is it possible to do this having 10 min for a visit to GP?. Moreover, the modern so called “scientific’ medicine is about money only. Doctors are bribed by pharmaceutical companies to prescribe certain drugs which in many instances are harmful for the body and give no relief whatsoever. Doctors charge you for visits lots of money without caring about resolving of a problem.
Even with a small competition form alternate medicine the so called scientific one behaves horribly, what would happen if there is not competition. Imagine there are only Coles shops around Australia…Luckily we have markets, grocery shops, Safeway and many other options.
Natural medicine was grown for centuries and treated people. In fact, it is the modern medicine which is not scientific as it disregards all good stuff which was inherited by medical practitioners during many generations.
Every medicine has its limitations. Some problems like severe surgical must be treated by doctors, many others are well treated by natural medicine and from the preventative point of view this medicine is MUCH better than chemicals ruining the body. Naturopaths can always find a cause of pain, whereas GPs in lots of instances are giving just panadol or even antidepressant without caring of the actual cause and consequences of destroying the body.
Shame to so called scientific medicine and its current state here in Australia. natural medicine and modern chemical medicine must co-exist but not punch each other, although mainly the second is always punching the first, to make us healthy. In this case the modern chemical medicine doe snot care about us and about our health, it cares about itself.

Submitted by David Weedon on Thu, 10/05/2012 - 07:47.

Dear FOSIM, keep doing what you are doing, it will help drive more and more people to Natural Therapies.

FOSIM = FE (Flat Eathers)

Submitted by Good Reference on Tue, 17/04/2012 - 15:50.

Academic freedom is the belief that the freedom of inquiry by students and faculty members is essential to the mission of the academy, and

that scholars should have freedom to teach or communicate ideas or facts without being targeted for repression, job loss, or imprisonment.For more details about the academic word just check this

site www.n8fan.net and enjoy.

Allan
www.n8fan.net
Good Reference

Submitted by Dr J Cowley on Mon, 06/02/2012 - 12:36.

Good article Neil-members of this group need to start to think what they have signed up to. I don't have strong views on evidence based medicine or alternative medicine. But I do find the recent attempt by these medical academics to influence Universities re alternative medicine degrees quite astounding. It confronts the very basics of freedom of knowledge. And it makes these signatories look like a totalitarian outfit that wants to stop certain knowledge and disciplines of knowledge. They claim they are protecting consumers, because consumers want the right to choose. I have spent 30 years listening to consumers and seeing the changes-and the big reason they go to alternative medicine is they don't trust the medical theorists.
There is a vast amount of criticism of scientific medical research ranging from the statistical analyses, the commercial backing, the "club" that approves Government funded research, fraud in research etc etc. I look at many medical papers and am amazed at the range of variables in human behaviour and history they just don't even take into account as perhaps impacting their results. They don't even ask about some factors that are critical in some studies. The studies wouldn’t get through at the basic level if they were commercial research. And yet the results go into the pot pourri of EBM.
Look at the Internet-a cursory search shows that EBM has major problems.
Its time they got their own houses in order before they pick on other disciplines. The arrogance of saying that the world is only the way they see it is a total affront to what universities stand for.

Submitted by Susan Kirk on Wed, 01/02/2012 - 15:22.

Great article Neil. Your references to the elitist nature of this lobby group are insightful. Your readers may want to support other members of the public who seek to not have their liberties to choose healthcare and education squashed by visiting http://www.change.org/petitions/protect-university-education-in-natural-... and signing the petition along with 1,500 other consumers.

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