I hate to do this to Bora again. I really do. I'm also getting tired of blogging all these crappy acupuncture studies. I really am. However, sometimes a skeptic's gotta do what a skeptic's gotta do, and this is one of those times.
As you may recall, a mere week ago I was disturbed to have discovered the publication of a truly horrifically bad acupuncture study in PLoS ONE. It had all the hallmarks of quackademic medicine: an implausible hypothesis, trying to correlate mystical concepts of meridians and qi to anatomy and failing miserably, and dubious statistical modeling. That PLoS ONE actually published this tripe shows me that, for all its claims of being scientifically rigorous, PLoS ONE has a serious problem when it comes to so-called "complementary and alternative medicine" (sCAM or, if you're a fan, CAM). In fact, PLoS ONE has as its tagline "accelerating the publication of peer-reviewed science." Sadly, the acupuncture study published there a month or two ago made me think that going a bit slower wouldn't necessarily be such a bad thing.
So does this latest atrocity, which comes from the University of New South Wales, and the Prince of Wales Hospital and is entitled The Brain Effects of Laser Acupuncture in Healthy Individuals: An fMRI Investigation. I'll give Im Quah-Smith and crew some credit. Unlike a recent acupuncture study from a month ago, where the authors explicitly tried to hide that they were not actually doing acupuncture at all but rather were running electrical current thorough the needles, at least Smith et al admit up front that they are using "laser acupuncture." Of course, "laser acupuncture" is no more acupuncture than is "electroacpuncture"--unless, of course, the Chinese were more techologically advanced than anyone had previously suspected, having developed electricity and having understood quantum mechanics a couple of millennia before we backward "Western" scientists did. Either that, or the first incarnation of Deepak Chopra was alive and active back then.
Yes, it's just that ridiculous. Before I even discuss the study, I just want to reiterate and reemphasize that "laser" acupuncture is not acupuncture. It is lasers zapping the skin. True, "laser acupuncture" is a much cooler term than "lasers zapping the skin," but that does not make it any more accurate or correct. What is it with woo-meisters and their propensity to take modern technology, graft it onto treatment based on prescientific notions of disease and how the body works, and then "rebrand" it (to put it kindly) into something that sounds cool but goes woo. That's all the "electroacupuncture" study was done, and it's how this "laser acupuncture" study was done.
Smith et al begin:
Despite the remarkable developments in Western Medicine in modern times, public interest in Traditional, Complementary and Alternative Medicine (TCAM), such as acupuncture, remains high [1], [2]. This may be because TCAM is perceived as holistic and relatively free of adverse effects. However, these treatments sit uncomfortably alongside scientific medicine because of strikingly different explanatory systems and the empirical tests applied by each discipline. In order to bridge the gulf between high public acceptability and the lack of empirical evidence for many of these treatments, it is important to reconcile them with modern scientific concepts. Our focus here is on laser acupuncture, and we address the question whether laser acupuncture produces brain effects that are biologically plausible.
Here we go again with the classic argumentum ad populum. Notice that the argument is not that acupuncture works and is scientifically interesting for what it can teach us about the body. Notice that the argument is also not that studies of CAM should be scientifically rigorous because science-based medicine is the best medicine and, if acupuncture can't stand up to rigorous science, we shouldn't use it. Rather, the reason to apply science to acupuncture, according to Smith et al, is to "bride the gulf between high public acceptability and the lack of empirical evidence for many of these treatments. Also notice that Smith et al have set the bar for evidence incredibly low. Heck, they've set it so low that I wonder why they bothered at all. Basically, they are asking whether laser acupuncture causes measurable effects in the brain. Seriously. That's all this study tests. One might as well state the hypothesis as: Shining lasers on the skin will cause changes in the brain. It's such an obvious hypothesis that it's virtually trivial, as this passage slows:
In this study, we examined the blood oxygen level dependant (BOLD) functional magnetic resonance imaging (fMRI) response to laser simulation on the above mentioned acupoints CV14, LR14, LR8 and HT7. We chose laser acupuncture as it permits blinding of application because of the lack of a local sensation at low intensity, together with the previously mentioned increases in practical usage and limited understanding of its mechanisms. We reasoned that if laser acupuncture is altering a person's mental state a neurological effect should be observable. Further, if the effect differs dependent on the site of stimulation, then the neural locus of the activity should also differ.
Well, duh. Why wouldn't the effects in the brain differ dependent on the site of stimulation? This is Neuroscience 101, people. In fact, this is so simple that even a surgeon like me can understand, no need to call in a neuroscientist or a neurologist like Steve Novella. In fact, to me this would be the sort of laboratory exercise that Neuroscience 101 students would do if it weren't for the fact that functional MRI is too complex and expensive. The hypothesis, however, is neither complex nor challenging. So what did Smith et al do?
Basically, they took 10 students (7 men and 3 women) who had no history of depression or psychiatric disorder and had never undergone acupuncture treatments. They then called upon the magical mystical arts of acupuncture to choose the following acupuncture points:
Why were these acupuncture points chosen? Who knows? The mysticism that is traditional Chinese medicine appears to claim that these acupuncture points have relevance for depression, as well as on a small randomized trial of "laser acupuncture" for depression. One problem that lept out at me right away was that this study was only single-blinded. The subjects were blinded to whether they were receiving "real" or "sham" laser acupuncture, the sham laser acupuncture consisting of the laser being turned off. Four acupuncture points were tested against one sham acupuncture point as follows, alternating between "real" laser acupuncture and placebo laser acupuncture (no laser) at each acupuncture point. fMRI images were acquired and duly analyzed. Lots of MRI time was wasted along with subjects time, and one of the simplest and least revealing tables of results I've ever seen. Particularly suspicous to me is that the results were presented in a single table of results and numeric values. No actual images were presented, which would allow readers to get a much better feel for how significant and convincing the reported results are.
Another deficiency in this study is the lack of something that is absolutely critical for any study that involves any form of imaging, be it fMRI or even just simple chest X-rays. What is that something? Blinding. That's what. For any imaging study, it's very important that the radiologists evaluating the images be blinded to the experimenatal group. Even though the images were quantified using computer software, there is still a huge subjective component in analyzing and interpreting fMRI images and identifying the various anatomic areas being examined. Add this to the apparent lack of blinding of the actual acupuncturists doing the "laser acupuncture" and the investigators doing the computer prestidigitation on the fMRI images.
After all that effort, here's what the investigators concluded, after bragging that their study was the "first fMRI study to examine the effects of laser stimulation of a suite of acupoints found to be efficacious in a clinical condition (depression)":
The main finding of our study was that each acupoint or control point resulted in a different pattern of brain activity when contrasted against all the other acupoints or control point. The acupoints we investigated in this study were those that have been used in our previous treatment study for depression [22]. This finding suggests that although these acupoints are all used in the treatment of depression, the neural locus of this effect differs depending upon the site stimulated.
Well, duh, I repeat. Well, duh. Shine laser light on different parts of the body, and you get different reactions in the brain. Who'da thunk it?
Not surprisingly, as nearly all quackademic medical articles do, this study takes utterly uninteresting results and then uses the differences observed in what parts of the brain light up depending upon what acupuncture point has laser light shined on it as evidence that acupuncture--excuse me, laser acupuncture--"works" for depression. Indeed, they even make it explicit. Because shining a laser light on the four acupuncture points cause the fMRI of the brain to light up in areas that are also involved in depression, that must mean that acupunture using these points is a valid treatment for depression. Personally, I see this as confusing correlation with causation combined with the Texas sharpshooter fallacy.
Finally, it's interesting to note who the investigators are. A quick Google search on the first author, Dr Im Quah-Smith, revealed this gem, which declares that "Dr Im Quah-Smith fervently believes acupuncture can relieve depression. And now she's putting that faith to the test." I also found this video:
Now there's some serious quackademic medicine for a serious journal like PLoS ONE.
Having read this study, I found it to be a steaming, stinking pile of fetid dingo kidneys, even by the usual low, low, low standards of typical CAM studies. My guess for what happened is this: The authors knew this study didn't meet the standards for a real neuroscience journal. Neither did they want to relegate it to the scientific ghetto of the CAM literature, where editorial standards are so low that they're subterranean and attempts at actual science are intermingled with the purest woo, like homeopathy and reiki. So what to do? Well, PLoS ONE bills itself as a journal where only the science counts, where the reviewers don't make judgments on the import of the science being presented but rather only assure that it is sound, boasting a 60-70% acceptance rate for manuscripts. I can see how PLoS ONE might be a tempting place for a quactitioner to drop off her latest attempt at quackademic medicine. Unfortunately, somehow these latest bits of tooth fairy science on acupuncture belie the scientific rigor that PLoS ONE claims for itself. Seeing these articles in PLoS ONE make me even more certain than I was before that I no longer wish to submit any manuscripts to PLoS ONE.
After all, if I'm going to risk having my work placed along side a quackademic article, I should at least aim high--higher than PLoS ONE. The New England Journal of Medicine, perhaps?
REFERENCE:
Quah-Smith, I., Sachdev, P., Wen, W., Chen, X., & Williams, M. (2010). The Brain Effects of Laser Acupuncture in Healthy Individuals: An fMRI Investigation PLoS ONE, 5 (9) DOI: 10.1371/journal.pone.0012619
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"Laser acupuncture" strikes me as grasping at straws.
This study pisses me off. All quackery does, but it's only natural that when it deals with an illness that you've had firsthand experience with, it's gonna piss you off a little more than usual. Thanks for writing this thorough thrashing.
So, it appears that they take what is *already* discarded (accupuncture) by SBM and graft another more modern and feasible technology (laser) on to it, hoping for results and possibly, respectability - this leads me to propose an alternative name for alt med ( in addition to "quackademic", "sCAM","CAM", "integrative"," complementary", "woo", etc.): the "Trash Can" School"** of medicine, or if you like, in French: "L'Ecole Poubelle" (?)...** (of course, I'm only referencing, not dissing, John Sloan's "Ash Can School" of art which was more based on reality than this study is.)
I have a hypothesis that a kick in the testicles and a kick in the buttocks will result in different patterns of brain activity. Where's my funding and fMRI time?
Dammit, as someone working on writing a PhD Fellowship application I'm more than a little irritated that someone got money to do this. "...whether laser acupuncture produces brain effects that are biologically plausible." is right up there with "...will further our understanding of [phenomenon]."
I think their colleagues should be sent a copy of the paper - scanner time is scarce enough without it being taken up by this nonsense, and maybe some social pressure would help create actual specific hypotheses next time.
Dude. Homeopathic lasers.
If lasers are just highly concentrated beams of light, and homeopathy is just a highly dilluted active ingredient, that means that my flashlight is a homeopathic laser.
PLoS has mechanisms for commenting on and rating their papers. It's likely worth the effort to express your opinions of the paper there - where the comments become part of the article metadata and are visible to all.
In fact, if skeptical comments and ratings to sCAM studies on PLoS were very common, it might give this type of 'researcher' reason to seek out other venues to publish their drivel. Heck, could even be part of the solution...
N
I am not a neuroscientist, nor do I play one on TV. I find it interesting that having a light ... sorry ... laser shined on your skin stimulates a brain response, even if there is no sensation. This would be a necessary - but not sufficient - condition to proving that "laser acupuncture" does, well, anything.
But the real potential breakthrough they completely ignore is the possibility of using sharks with laser beams on their heads as therapists! They'd be able get acupuncture, acupressure, and "laser acupuncture" benefits all from a single source. Assuming, of course you can train the shark to identify the correct points and not eat the patients.
I found it interesting that this "study" didn't include an "off-target" control to make sure that their laser equipment wasn't causing an effect on the subject or the fMRI imaging.
I was also struck by their claim that the laser stimulation couldn't be felt by the subject. Although they fail to mention the delivered energy in this paper, they do say that the laser set-up was similar to their laughable study on laser acupuncture for depression. Looking up that paper, I find that they delivered 0.5J (500 mJ), which would be 20 sec. of total exposure to their 25 mW laser. Although the authors claim that this was below the level of sensation, they don't mention asking their subjects if they could feel when the laser was "on" and when it was "off". This may be an oversight.
However, the bigger question is how insensible laser light is causing a measurable physiological effect. I have a 5 mW laser pointer - if I point it at the correct "acupunture point" on a student and leave it there for 100 sec. (0.5 J delivered energy), can I make them feel less depressed about a failing grade? I suspect not, but that is what these "researchers" claim to have found.
In reality - as Orac shows - this was a poorly controlled study that shows only that there is (possibly) some brain reaction to sensations that are (possibly) below the conscious perception threshold (although they don't mention asking).
It would be interesting to repeat this study (if it weren't for the horrendous misuse of fMRI time) with a true placebo group that had the laser probe applied but had the actual laser energy delivered into a wet towel next to their body. I suspect, however, that having got the result they wanted, these researchers will never again test their hypothesis.
Prometheus
No, no - a flashlight is far too concentrated. You have to turn the flashlight off and rely on the black body radiation of the cold filament and the memory of light.
Jay Sweet writes:
If lasers are just highly concentrated beams of light, and homeopathy is just a highly dilluted active ingredient, that means that my flashlight is a homeopathic laser.
Be careful where you point that thing!! When the batteries run down and it just produces a dim glow, it could be capable of slicing through solid neutronium like it's gouda cheese!
First of all, totally agree with you that this study is pointless and proves nothing of interest except that the brain lights up when you do stuff. I just had two minor quibbles.
The first regarding running electricity through acupuncture needles -- it might not have existed back in the day, but nowadays electro-acupuncture is the norm for Chinese traditional medicine (being Chinese, I've seen quite a few, and I actually haven't met any acupuncturists who *don't* use electricity). So I'd have no problem with studies that use electroacupuncture. The point is to study acupuncture as it's used now, not as it was used in the Ming dynasty.
Also, regarding blinding in fMRI studies. I must say of clinical fMRI studies I've read, hardly any of them are double blinded. So it's valid to criticize a paper for not being double blinded, but I think that issue extends way beyond quackademic medicine or PLOS One
Having suffered from depression myself, I can say that sharks with laser beams on their heads is pretty effective at cheering you up in the short term, but it's not lasting.
The problem is that electroacupuncture is basically exactly the same thing as a legitimate therapy that is under study, TENS. So while there is no problem with studying "electroacupuncture", calling it electroacupuncture, without at least qualifying that it's basically equivalent to TENS, is misleading.
Isn't Laser Acupuncture completely pointless by definition.
And what's more, since it causes increased activity in parts of brain that are active in patients with chronic pain, we can assume that kick in the testicles is a valid treatment for chronic pain!
All illness can be cured by laser cats. Why won't they fund the studies? Why is the government trying to suppress knowledge?
I guess I never paid much attention to acupuncture before I started reading this blog. I was a bit of a shruggie. Now that I have been enlightened, I am realizing how insane this stuff is. How do they even get away with misappropriating a term like acupuncture and just sticking whatever other modality on to it that they like? Thanks Orac for telling it like it is.
I'm half tempted to pioneer a new therapy called slap acupuncture. I bet some loons would line up for it, get smacked across the face and be dumb enough to come back for seconds.
I do like the Kuna Mola quilt behind the pin cushion guy. It is very lovely. Though I wondered if all the colors and lines would give some folks a headache.
"I'm half tempted to pioneer a new therapy called slap acupuncture. I bet some loons would line up for it, get smacked across the face and be dumb enough to come back for seconds."
Been done: http://www.kadir-buxton.com/
He "cures" people by hitting them hard about the head. I wish I was kidding.
Ugh.
http://healthnews.uc.edu/news/?/11319/
"People want to see clinical trials, but itâs hard to do that because you canât get a good control group,â says Colyer. "For example, how do you fake acupuncture well?"
Well, let's see - beyond the ways that have been done, how about simply doing "real" acupuncture in places totally unrelated to the actual complaint. The patient is diagnosed by one acupuncturist who creates a treatment plan. This is handed to a researcher who randomizes - some get their intended plan, some something else. A second acupuncturist administers the treatment plan with no knowledge of what is being treated.
Mark P @17 - And he has the answer for global warming too. He blithely assumes that a 10,000 m geothermal well would only take 4 times as ling to drill as a 2500 m oil/gas well and only cost 4 times as much. The Dunning Kruger is strong with that one. He would be a good candidate for Friday Dose of woo except giving mentally ill people concussions isn't very funny.
Great insightful commentary by Orac (of course)and some funny shite by MephO'B.
I've just recently discovered this web site, and I'm hooked. I've been in med ed and science for some decades, and we successfully fought off the attempt to incorporate sCAM (AKA TrashCan Med -- love the new term) into the UGME curriculum here. We also kicked sCAM MDs out of the univ hospital clinical arena (but some do still do woo on the sly). Sadly,some med students are naive and embrace the woo, and more than you can imagine "don't believe" in human evolution.
Respectful Insolence rules.
ps -
PLoSONE is shockingly erratic in quality. Pretty darn good stuff to truly dreadful crap is the skewed rule there. I've seen several papers that I reviewed for other journals (and which were rejected) end up published by PLoSONE for no good reason. I've also reviewed papers for them, some of which were accepted, others not, hit or miss.
But it's fast, has an OK impact factor, is media friendly, and does unlimited color. Not free but pretty cheap for authors. Did I mention FAST? And it's not going away. In other words, this won't be the last laughable woosCAM we see in PLoSONE.
It's not so much nonsense as hypnosis.
for what it's worth: 20 years ago, I took a course at Columbia to learn hypnosis...the ability to undergo deep trance could be measure by the amount of white seen in the eye when you looked up.
so the ability to accept suggestions is neurophysiolgical...
On the other hand, during the course, we were told of a Chinese man whose eye roll was zero, and when he tried hypnosis for pain relief, it did not work...he remarked that acupuncture didn't work either.
back in the 1970's , the Chinese were showing "open heart surgery" under acupuncture...and our teacher remarked he couldn't see why they smiled through the surgery that including sawing or pounding one's chest cavity open, so he suspected that was trance, not acupuncture.And indeed, only 20 percent of folks could undergo surgery without other drugs etc. (and 20 percent of the population is highly suggestable).
An MD friend of mine learned how to induce trance from his (witchdoctor/herbalist) grandmom. He used it often during the Nigerian civil war to do surgery when they ran out of drugs. And I've used it to debride burns. It works, but not for everyone and most people have a limited response to hypnosis...makes one wonder if anyone did a cross experiment with acupuncture with a test to measured how easily they could be hypnotized
One wishes for a nice sceptic who knows these facts to debunk the nonsense, but I guess no one wants to check out the research.
tiobang, you might want to check out Steven Novella's blog and podcast (Skeptic's Guide to the Universe, SGU) about those surgeries. Things were not as they seemed... the patients were often given actual anesthetics along with the acupuncture, or told to shut up and endure the pain.
That Kadir-Buxton web page is just too bizarre. Parts of it were highly amusing (he knocked an attacker unconscious and then proceeded to slap him around the buttocks--the attacker upon regaining consciousness then said it was better than sex), but other parts were very disturbing (see how he proposes treating rape victims). Until I read the disturbing parts I thought for sure this is prime material for Orac's Friday Dose of Woo.
Leaving aside any link with depression, can anyone explain how shining a laser on a person's skin can cause changes in their brain, unless the laser is causing enough heating to be felt? To me (as someone with very little knowledge of medicine or human biology) this is a real surprise! Is our skin generally light-sensitive?
I emailed PLoS to ask them why their standards had dropped so low as to allow this lamentable paper to get published. On my site www.leavingthelandofwoo.com I've listed them as a reputable scientific research source and I pointed out that if they publish material like this, I might have to drop them (which I don't want to do). Peter Binfield of PLoS has now replied to me as follows:
"Decisions on individual PLoS ONE papers are always made entirely by the academic editors themselves - PLoS as a publisher imposes no requirements on those editors, and never has. Provided the Editors feel a paper meets our editorial criteria then it is their decision whether or not to accept any given paper. In both of these cases, the Editors presumably felt that the papers met our criteria (and those criteria have not changed since launch).
Therefore, please can I suggest that you or Orac leave comments on these papers (via the Comments tab) - this will perhaps allow the editors who edited them (one of whom is a Section Editor); the reviewers who reviewed them; or the authors themselves to respond to the concerns raised. There is no guarantee of course that they will respond, but they are the people who are qualified to do so."
Perhaps, if enough people leave enough comments, it will be obvious that the paper should never have been published. Nevertheless, the damage is done since it will be cited as peer-reviewed evidence by those promoting acupuncture, which after all was almost certainly the point of the exercise.
I do wonder though whether there are Woo merchants getting in as editors on PLoS, just a thought.
Bah. they aren't even sticking needles in people!
what did they use for control, a sham laser ?
Phoey.
From M&M of the article:
"The second level analysis (ANOVA) used each individual subject's contrast images, which were effectively the statistical parametric maps of the t-statistics for each voxel. The data had a threshold of p <0.001 with a spatial extent of 15 contiguous voxels."
What do you guys think about this image analysis? Maybe I'm being dense here, but it seems to me they didn't apply any multiple testing correction? If so, this paper would suffer from the "dead salmon problem", i.e. a huge multiple testing problem.
Sorry, that should be
"...The data had a threshold of p 0.001 with a spatial extent of 15 contiguous voxels."
To ridicule a poor study is not the same as to prove that a treatment has no value. You are painting all of acupuncture with the same brush, when there have in fact been some well-controlled studies that show results. Admittedly, the data is not strong. Admittedly, the mechanism by which acupuncture might work in depression (for instance) is unclear. But the same is true of antidepressants (read Sharon Begley's summaries for more on this), which pharmaceutical companies peddle for billions and which, unlike acupuncture, involve quality of life diminishing side effects. Your bio states you are a surgeon (so am I); how many quality studies have been done on back surgery? Can you cite any that include your essential double blind? How would that work, anyway? I agree that complementary medicine is overblown and under-proven, but the same is more or less true of much western medicine. Do you propose therapeutic nihilism, whereby we offer no treatments that haven't been unequivocally proven? People go to doctors because they want help; much of the time they know that quick and simple cure is unlikely. But they still want, and need, support. Fine, ridicule away. But have you heard the saying about the pot calling the kettle black?
Will, would the acupuncture that showed toothpicks work just as well qualify as one of those "well-controlled" studies?
I suspect the subjects could sense when the laser was turned on.
@Will M. What do you mean by "western" medicine? I think there is simply medicine. Anyway, the main difference between medicine and acupuncture is that acupuncture is based in pre-scientific ignorance and the best studies of acupuncture show it is no more than an elaborate placebo.
One of the Authors is a PLoS ONE editor:
http://www.maccs.mq.edu.au/members/profile.html?memberID=192
N said,
"PLoS has mechanisms for commenting on and rating their papers. It's likely worth the effort to express your opinions of the paper there - where the comments become part of the article metadata and are visible to all."
This has been the most disappointing part of Orac's treatment of these subjects. PLOS One has a commenting system that allows one to receive criticisms and address them. Such criticisms should be heard by their authors as peer review doesn't end at the journal editors. There is one comment on there now that got a response from the authors, so they seem to be willing to engage.
This morning I gave blood, and noticed a new question that I don't remember being there two months ago (and I did answer "No"):
"In the four months have you had any acupuncture?"
I guess they might to flag a person's blood for hepatitis!
Dear Orac,
I'm a bit late adding to this thread, but as I've just read the article I'll comment. There are various problems with the paper (from my perspective), but despite the lack of a clear rationale for the study, the most obvious interpretation of the results is that they are negative - 3 out of 4 'woo' stimuli gave brain activation, against 1 out of 1 dummy stimuli. That's 75% against 100%. Not really a win for the woo.
I was shocked at the obvious ignorance of this author (and that of the respondants) who is claiming to rationally disparage this research project.
You are ridiculing acupuncture as some sort of mystical medicine when you obviously know nothing about it and have obviously not read any modern literature and research on the topic. If you had you would know about current research, for example, on the fascia soft tissue and how it is being considered as the possible mechanism of acupuncture. This reserach is also showing how non- acupuncture points can provide results but not to the extent of acupuncture points. You might like to look at research by the likes of Langevin and articles by Finando and Finando.
I do not know who you are or if you are in fact scientists. If you are it is a wonder that human kind has made any progress at all with such closed minds and narrow thinking.
Xenja, you must have been really shocked! It took you over a year to think of that evidence free response.
Next time choose a more recent article on acupuncture to become indignant about, and make sure you cite those papers (journal, title and date) of that current research. Be sure to include journal, title and date, the random last names are not enough.
No, not that shocked, only just came across your blog & responded after reading. References are as follows - these are just the tip of the iceberg by the way:
Finando, S. and D. Finando (2011). "Fascia and the mechanism of acupuncture." Journal of Bodywork and Movement Therapies 15(2): 168-176.
Langevin, H. M. (2006). "Connective tissue: A body-wide signaling network?" Medical Hypotheses (66): 1074-1077.
Langevin, H. M., & Yandow, J.A. (2002). "Relationship of Acupuncture Points and Meridians to Connective Tissue Planes." The Anatomical Record (New Anat) 269: 257-265.
Im Quah-Smith is still promoting and spruiking her quac(k)ademia by way of a letter received today by my husband (who is an incredibly fit sports enthusiast) and never seen nor heard of her. She is moving to new premises in Roseville. Well â wooptido. Dream on Ms I Q-S.
The childish, sarcastic tone and content of this critique demonstrates a gross lack of knowledge and defensiveness. This attitude and behaviour is an embarrassment to your profession and deprives you of any respect, credibility and intelligence that you profess to have. I find this in fact alarming. Please focus on the good that you can do rather than the damage you can cause others. Even if you do not agree with the discipline there is no need for personal attacks.This says more about you than the person you are targeting.
So, which specific parts of Orac's critique demonstrate 'a gross lack of knowledge'? The research described in the paper he's critiquing is best described as poor in quality & design - if you think otherwise then please explain why. (Otherwise we might have to conclude that you are tone-trolling...)