I notice in the comments here (mostly the anonymous ones) and alarming tendency to ignore the evidence.
I have every sympathy with doctors. It must be hard to say to patients that there isn't much we can do. Bu I have little sympathy for doctors who solve that problem by offering false hope and ineffective treatments.
Nicholas Cooke sums it up nicely "There isn't a medication for every situation. Sorry."
"Pushes through" seems a very pejorative way to describe one of the most honest bits of NICE guidance. It comes as close as its possible for an official document can to admitting that there is, in most cases, no very effective treatment for non-specific low back pain. Much harm has been done by the pretence that this isn't the case. At least NICE no longer endorses outright quackery like acupuncture. The guidance has resisted the temptation to clutch at straws. That should be welcomed.
I thought the NICE back pain guidance was like a breath of fresh air. At last someone had the courage to say that it's an unsolved problem.
In most cases there is no effective treatment. That should be obvious because if there were an effective treatment, it wouldn't be such a huge problem.
One certainly has to sympathise with GPs who have to tell patients the bad news (or to disguise it, according to taste)/
At least acuquacks are no longer an option.
One despairs when the first comment on a serious problem comes from an anonymous anti-vaccination crank.
To anonymous GP partner.
I don't know why you are so angry with NICE. All the reports says is that there is NO effective treatment for low back pain. That's been known for quite a long time. The only mystery is why it took so long for NICE to say so. http://www.dcscience.net/2016/03/24/nice-rejects-acupuncture-for-low-back-pain/
I fear that some of the comments here illustrate very well why NICE.
The results of more than 3000 trials of acupuncture, some of them well-designed, have consistently shown that it is indistinguishable from various sorts of sham, yet some people still advocate it. The power of myths is indeed strong (especially when there are no good alternatives). The evidence presented in Anesthesia and Analgesia (2013) shows that it simply does not work (-see http://www.dcscience.net/2013/05/30/acupuncture-is-a-theatrical-placebo-the-end-of-a-myth/ ).
In fact not only does it not work, it doesn't even have a very big placebo effect in most cases. Most of the apparent effects are not real placebo effects. Rather they can be explained regression to the mean (and so of no benefit to the patient). See http://www.dcscience.net/2015/12/11/placebo-effects-are-weak-regression-to-the-mean-is-the-main-reason-ineffective-treatments-appear-to-work/
It is very heartening to see the critical assessment of evidence in this guidance (in contrast to the 2009 guidance). The fact is that none of the treatments works very well and that has led to clutching at straws. This guidance provides a welcome debunking of many of the myths.
Not least, it may herald the end of acupuncture provision on the NHS.
I blogged the new guidance this morning, at http://www.dcscience.net/2016/03/24/nice-rejects-acupuncture-for-low-back-pain/
A few simple calculations would have shown that this was inevitable -eg see http://www.dcscience.net/2014/03/10/on-the-hazards-of-significance-testing-part-1-screening/
We are cursed with innumerate politicians.
I think it would help if both NICE and GPs were to be more frank about the only-too-common case where nothing really works well.
For example, nobody has the foggiest idea about what fibromyalgia is or how to treat it effectively. Why not just say so?
Alan Hennes is probably right about the particular question of herbal regulation,
That doesn't mean that the prince is always so ineffective. The fact that the Department of Health thought fit to consult the prince's right hand man, Dr Michael Dixon about the NHS Choices advice about homeopathy would almost certainly have resulted in bad advice being given, if it were not for the fact the the Freedom of Information Act revealed what was going on,
Oh dear, once again we see that "anonymous" hasn't the slightest clue about statistics. But thanks for re-posting the link. I hope that those who are more numerate than "anonymous" seems to be will gain something from it.
He/she is also less than honest. The 11% number was so low because in included a lot of CAM therapies that don't work. If one excludes magic therapies the actual number is nearer to 50%. Of course it should be 100%. I and many of my friends are working on that. Anonymous is working in the opposite direction.
My irony meter is off scale (again), Commenters who haven't the courage to reveal their name (or conflicts of interest) being abusive to people who are not anonymous, You couldn't make it up!
Anonymous. I'd like to remind you that blood-letting "withstood the sterling test of time" for many centuries.. That alone is sufficient to show that it's anything but a sterling test, but more like a triumph of optimism over facts.
One of the anonymous posters says
"David Clqhuon [sic] is not a clinician and has been heavily involved in many anti- homeopathy wheezes over the years whilst ignoring NHS waste of over £200 million a year on SSRI's [sic]."
It's always noticeable that homeopaths fail to check before they shout abuse (anonymously). If you want to know my views on SSRIs it really isn't very hard to find out -for example, try http://www.dcscience.net/2014/04/16/deadly-medicines-and-organised-crime-a-review/
It's a waste of money to test placebos against placebos, Since the dummy homeopathic pill is identical with the placebo pill, it's self evident that all the positive trials are no more than a manifestation of the false discovery rate problem: see http://rsos.royalsocietypublishing.org/content/1/3/140216
One can't blame Hahnemann, He died before a numerical value was known for Avogadro's number. If he had known that, he'd have been the first person to condemn the modern practice of homeopathy.
The problem seems to lie within the Department of Health. Officials there tried to alter the (generally good) advice given by NHS Choices on homeopathy. They seemed to think that the right people to ask about the question were people associated with the Prince's Foundation for integrated Health, in particular they asked the advice of Michael Dixon (I notice that he's now a candidate for president of the RCGP). Read the sorry history at
It's well known (to everybody but NHS England, it seems) that the tests for mild cognitive impairment are quite useless in the sense that they produce vast numbers of false positives e.g.
It would help if NHS England understood evidence better and were less inclined to tug their collective forelocks when ministers come up with daft ideas.
PS it would be advisable toi wait for the revised NICE guidance before renting space to an acupuncturist. The latest information indicates that acupuncture is no more than a theatrical (and not very effective) placebo.
What you shouldn't do is to rely on organisations like the CNHC. When complaints were made to the CNHC about unjustified claims made by "reflexologists" (ie plain old foot massage) the CNHC agreed that the claims were unjustified, but took no action because they said that reflexologists had been taught things that weren't true during their "training". This episode, more than any other, shows the futility of trying to ensure proper training in subjects that are make-believe in the first place. The same applies to acupuncture, chiropractic and just about every form of made-up medicine.
What a tragic waste of a medical education.
Doesn't Dr Borbely understand Avogadro's number? If she relies on the "it works for me" sort of non-evidence, she's endangering patients when she practises regular medicine, even before we get to the make-believe stuff.
Is it possible to say that you don't want your data sold to anyone, but still have it available free for academic use?