tag:blogger.com,1999:blog-5959094372836804855.post7314600092936856610..comments2023-09-04T01:31:11.524-07:00Comments on Adventures in nonsense: Why making large numbers of complaints about chiropractors was the right thing to doSimonhttp://www.blogger.com/profile/14195003492084088327noreply@blogger.comBlogger54125tag:blogger.com,1999:blog-5959094372836804855.post-56594834544601595062009-11-20T13:07:07.688-08:002009-11-20T13:07:07.688-08:00Hi Simon
Well done - I thought I might get a quic...Hi Simon<br /><br />Well done - I thought I might get a quicker response to that post! (Of course, apology accepted)<br /><br />So. Leg replacement drugs. OK. Not worried about, long term side effects, anything like that? I seem to remember something about Thalidamide in your ‘the health of the world depends on it’ letter. An extreme-ly bad example.<br /><br />Interestingly, you seem to be saying that there is a spectrum of conditions for which clinical certainty is variable and the application of RCT’s not always definitive. <br /><br />The question then is how does that spectrum look? What conditions are on it? Where are they on it? Who decides that? Should it be in categories of diagnosis or individual cases? What exactly is short term - 1 week? 12 weeks? 1 year? What is self limiting – 100% resolution? 50%? How long is it acceptable for recovery to take? Who decides that? What if it’s severe but self limiting? What is severe? Who quantifies severity? Who decides when to treat? How to treat? Who decides?<br /><br />I know - I’ll ask the ASA. <br /><br />The problem is that you don’t really know what circumstances evidence other than RCTs might be used, what that evidence might be, or indeed, how it might be applied in practice. That’s fine – it’s an enormously complex area that you clearly (hopefully) don’t work in. However, even though you seem to have a weak understanding of the basic principles of clinical reasoning, you still feel justified in questioning my ethics regarding my rationale for the use of massage. <br /><br />‘Sense about Science’ is great. Fantastic. What you seem to be flying a flag for is ‘Sense about Statistics’ – which is nonsense. The final outcome of such a campaign would be clinicians engaged in recipe management – unwavering adherence to statistically based protocols. In practice, clinical reasoning is not just judgement of facts, it is a judgement of values, attitudes and expectations as well. Either you have a poor understanding of this concept or you’re making a deliberate effort to ignore it because it doesn’t fit with your basic model. <br /><br />KR <br /><br />JackieJackie Whttps://www.blogger.com/profile/10166166772990297333noreply@blogger.comtag:blogger.com,1999:blog-5959094372836804855.post-4411945301387617682009-11-20T08:47:42.204-08:002009-11-20T08:47:42.204-08:00@Jackie
>..taking a week
Actually, I saw sever...@Jackie<br /><br />>..taking a week<br />Actually, I saw several posts identical comments from you come in at once. Thought I'd published one but hadn't, then saw the new ones and didn't know why you were resending them all the time. Then I finally figured out that I hadn't published the first one, sorry.<br /><br />>Delay<br />I've been incredibly busy.<br /><br />>Ethical<br />Your comment said that "empirical evidence for the efficacy of massage is weak". If this is the case, I stand by the statement that it is therefore unethical to sell this service to an uninformed consumer.<br /><br />I stand by the statement that depending on the circumstances, the evidence does not necessarily need to come from RCTs. As an extreme example, if you found a drug that made an amputated leg grow back, I'd be happy with a small number of case studies. At the other end of the spectrum, you definitely need RCTs if you're dealing with a treatment for a short term self-limiting disease.<br /><br />I don't know how much this relates to the specific treatments you are promoting as I have not looked into the specifics.Simonhttps://www.blogger.com/profile/14195003492084088327noreply@blogger.comtag:blogger.com,1999:blog-5959094372836804855.post-68304320444620592222009-11-20T06:01:27.205-08:002009-11-20T06:01:27.205-08:00Hi Simon
...exclusive use of RCT's..??
...i...Hi Simon<br /><br />...exclusive use of RCT's..?? <br /><br />...immoral treatments..?? <br /><br />...self limiting conditions..??<br /><br />The value you place on RCT's underpins your case but you appear not to know how or when they are applied in real world clinical situations.<br /><br />I posted these questions 4 times over the course of a week before they even appeared on the blog & I still have heard nothing back from you.<br /><br />It looks as if I had been congratulating you on a job well done, my post would have appeared more promptly. Perhaps the GCC aren’t the only ones acting as if they have something to hide..?<br /><br />KR<br /><br />JackieJackie Whttps://www.blogger.com/profile/10166166772990297333noreply@blogger.comtag:blogger.com,1999:blog-5959094372836804855.post-78030996929898083082009-11-18T01:34:09.032-08:002009-11-18T01:34:09.032-08:00Hi Simon
You’re right - RCT’s are not the only ev...Hi Simon<br /><br />You’re right - RCT’s are not the only evidence used to make clinical decisions. It isn’t a case of using RCT’s, or case studies, or that’s it. <br /><br />Your answer doesn’t really square with your previous comments about the examples I gave though. <br /><br />If you’re saying that RCT’s are ‘probably not’ exclusively applicable for decision making in a manual therapy, then how can you classify the use of massage as part of a treatment, (or choosing between RCT’s of equal quality for the use of exercises in acute LBP), as immoral? <br /><br />Is it immoral enough for you feel justified in making a complaint against me for using soft tissue work or Mackenzie exercises as part of my management? <br /><br />I think I should also point out that a huge number of conditions presenting to medical practices & to manual therapy clinics of all descriptions will have a favourable natural history ie: will get better by themselves over time. Some conditions presenting to A&E will clear up by themselves. The ubiquitous nature of conditions with a ‘favourable’ natural history means that the simple presence or absence of eventual recovery cannot always be used as the final arbiter for the application of treatment. <br /><br />KR<br /><br />JackieJackie Whttps://www.blogger.com/profile/10166166772990297333noreply@blogger.comtag:blogger.com,1999:blog-5959094372836804855.post-86626246938715269052009-11-10T09:03:20.395-08:002009-11-10T09:03:20.395-08:00@Jackie W
Can it? Depends.
Well I think I repli...@Jackie W<br /><br />Can it? Depends.<br /><br />Well I think I replied to that in my first response:<br /><br />"I think there are cases where we can rely on other evidence. If a disease that shows little history of clearing up by itself suddenly clears up in a good percentage of people after they receive a treatment then we can probably place a certain degree of trust in those case studies, so long as the case studies were tracked from the beginning and not cherry-picked after the disease cleared up."<br /><br />So does this apply to manual therapy? Probably not. If you're treating things that sometimes clear up by themselves, an RCT is required.Simonhttps://www.blogger.com/profile/14195003492084088327noreply@blogger.comtag:blogger.com,1999:blog-5959094372836804855.post-67296556618177539952009-11-09T05:31:50.150-08:002009-11-09T05:31:50.150-08:00Hi Simon
Thanks for taking the examples at face v...Hi Simon<br /><br />Thanks for taking the examples at face value – I have given them in good faith. The ones I have given are all pretty standard stuff but I appreciate that this is a huge area & very difficult to get to grips w/ all the research. <br /><br />I didn’t want to get too bogged down in the examples though – they were purely meant to be illustrations of potential pitfalls in the practical application of the evidence, rather than questions in themselves. <br /><br />I’m really driving at a broader key principle here so I’ll try & frame the original question in a slightly different way – <br /><br />Can clinical decision making in manual therapy be based exclusively on RCT’s? <br /><br />That’s about as clear as I can make it..!<br /><br />KR<br /><br />JackieJackie Whttps://www.blogger.com/profile/10166166772990297333noreply@blogger.comtag:blogger.com,1999:blog-5959094372836804855.post-26162269385587655922009-11-08T07:33:37.770-08:002009-11-08T07:33:37.770-08:00@Jackie W.
I haven't looked into the evidence...@Jackie W.<br /><br />I haven't looked into the evidence for anything that you've told me, this reply is based solely on what you've said.<br /><br />Well, my opinion for (i) is that if there is no evidence for efficacy, it would be immoral to sell the service. <br /><br />For (ii), if the evidence is mixed then I don't think you should be selling the service until the evidence is in. Especially if a Cochrane Review of the evidence recommends against it.<br /><br />For (iii) I think I would need to do a lot more research (which I don't have time for at the mo) to properly answer the question.Simonhttps://www.blogger.com/profile/14195003492084088327noreply@blogger.comtag:blogger.com,1999:blog-5959094372836804855.post-56062194246871305332009-11-06T11:09:11.085-08:002009-11-06T11:09:11.085-08:00Hi Simon –
Sorry it’s taken a few days to get ba...Hi Simon – <br /><br />Sorry it’s taken a few days to get back to you.<br /><br />I’ve actually come up w/ 3 examples – one with a lack of evidence, one with conflicting evidence and one where the quantitative findings raise more questions than answers.<br /><br />Manual Massage is one of the most widely used treatments in Manual therapy – it’s popular with therapists and patients. Galloway & Watt (2004) found that up to 52% of treatment time was spent on massage for athletes at major sporting events. However, empirical evidence for the efficacy of massage is weak and there is very little RCT evidence for all the theoretical physiological benefits, which are often claimed. So – will I stop all soft tissue work in my treatments until there is an RCT that says it works? Personally, no - I have to use clinical reasoning, judgment and experience.<br /><br />An example of conflicting evidence is in giving exercise in cases of acute low back pain. Giving exercise actually goes contrary to the findings of the Cochrane Collaboration Back Review Group (2000), which stated that:<br /><br />“Specific exercises are not recommended for acute lower back pain patients…”<br /><br />Waddell (1996) said much the same sort of thing. On the other hand there are also studies that show exercise prescription in acute low back pain to be effective – notably into the Mackenzie protocols, but also through the work of McGill, Liebenson and others.<br /><br />So there is the thing – the evidence directly conflicts so is impossible to follow. In any given acute low back pain case, I unavoidably ignore at least one set of RCT results depending on whether or not I choose to give an exercise. When someone presents with acute low back pain, I have to make a judgement on the likelihood of an exercise being beneficial for his or her specific situation based on other case-specific variables. Again it comes back to the awareness of RCT’s along with clinical reasoning.<br /><br />Finally - the use of MRI & CT in the diagnosis of disc herniations and nerve root pain (‘Sciatica’). Simple you might think – disc bulges, hits the sciatic nerve & off goes the pain down the course of the nerve– take an MRI or a CT & there it is. However, false positive rates can be as high as 50% - ie the same disc lesions seen on MRI or CT are also present in asymptomatic individuals (Boden 1990, Brandt-Zwadzki 1994 & 1995, + others). That undermines the certainty and clinical relevance of that imaging procedure in that particular context, which in turn reduces the amount of definite information available to make absolute clinical decisions. It also questions what we thought we knew about disc lesions if they are present in so much of the asymptomatic population. <br /><br />As you can see, it all gets very messy indeed, but I hope that helps clarify the question..! <br /><br />Looking forward to hearing your thoughts on this.<br /><br />KR <br /><br />JackieJackie Whttps://www.blogger.com/profile/10166166772990297333noreply@blogger.comtag:blogger.com,1999:blog-5959094372836804855.post-29399793911134754282009-11-03T11:29:49.274-08:002009-11-03T11:29:49.274-08:00Great question - I'll get back to you with a s...Great question - I'll get back to you with a specific example tomorrow..!<br /><br />I would say though, that it will only be a single example from just one of the grey areas in manual therapy and I suppose I'm asking about the broader principles here ie: the possibility that in manual therapy, RCT's alone are incapable of reliably quantifying the entirety of a patient encounter. <br /><br />These types of questions have been a point of conflict between 'scientist' & 'clinician' for many years so this current situation is not new or confined to a single profession.<br /><br />Interestingly, the need to bring the question to a single example is an example of making a problem solving situation easier by giving it clearly defined parameters...<br /><br />KR<br /><br />JackieJackie Whttps://www.blogger.com/profile/10166166772990297333noreply@blogger.comtag:blogger.com,1999:blog-5959094372836804855.post-88928474116526156332009-11-03T09:23:57.252-08:002009-11-03T09:23:57.252-08:00@Jackie W,
Sorry Jackie. I had actually started c...@Jackie W,<br /><br />Sorry Jackie. I had actually started composing a reply and then was not 100% sure of its relevance. I started again and never finished.<br /><br />Quick question to help me out: Can you give me an example of a treatment that you would give without RCT, tell me what you'd give the treatment for and also what evidence you do have that it works.<br /><br />Might be easier to work with a specific example.Simonhttps://www.blogger.com/profile/14195003492084088327noreply@blogger.comtag:blogger.com,1999:blog-5959094372836804855.post-38843384147337325582009-11-03T09:18:23.596-08:002009-11-03T09:18:23.596-08:00Hi Simon
It's been nearly a week now - any v...Hi Simon <br /><br />It's been nearly a week now - any view on the RCT question..?<br /><br />Thanks <br /><br />JackieJackie Whttps://www.blogger.com/profile/10166166772990297333noreply@blogger.comtag:blogger.com,1999:blog-5959094372836804855.post-3562140185218661432009-10-28T08:54:55.059-07:002009-10-28T08:54:55.059-07:00Hi Simon
I confess I have very little experience ...Hi Simon<br /><br />I confess I have very little experience in paediatrics so I don’t really feel in a position to comment on that specific situation but I definitely see your point on the limited use of case studies. However, I still have this nagging doubt that your analysis doesn’t take into account the full gamut of information used in a clinical encounter. <br /><br />Speaking as someone who works well within the definition of evidence based manual therapy, I am on the front line of making clinical decisions but would find it nigh on impossible to rely purely on RCT’s. <br /><br />Many clinical diagnoses are still based on ‘sprains’, ‘strains’ and ‘syndromes’ for which definable absolutes are impossible to establish. The variables involved with individual cases presenting for manual therapy are enormous – even within the same category of diagnosis. The vast array of variation in the individuals presenting & the specific training and direction of the manual therapist themselves, renders a purely statistical analysis fragile when making clinical decisions on the ground. <br /><br />As you quite rightly pointed out, case studies are similarly limited, so in-between there has to be skill, judgement and interpretation - all based on the best information available. Unfortunately, the lack of absolutes dictates that judgement has to play its’ part. The results of many standard orthopaedic tests (and even advanced imaging procedures) also need to be processed and interpreted with care and once you add in judgement and interpretation, pure statistical analysis gets really shaky. <br /><br />Until more clearly definable absolutes are available in manual therapy, the practical reality is that clinical practice has to be more than RCT’s. They are vital and useful yes – but slavish reliance assumes way too much of current knowledge and seems to ignore the subtleties of real world clinical encounters.<br /><br />Do you agree that this lack of absolutes in manual therapy limits the clinical application of RCT’s? <br /><br />Again, that’s just my 2p & I’m curious to hear your thoughts…<br /><br />Thanks<br /><br />JackieJackie Whttps://www.blogger.com/profile/10166166772990297333noreply@blogger.comtag:blogger.com,1999:blog-5959094372836804855.post-23691295132049605252009-10-27T13:22:53.093-07:002009-10-27T13:22:53.093-07:00Jackie W,
Sorry I missed your Q previously.
I t...Jackie W, <br /><br />Sorry I missed your Q previously.<br /><br />I think there are cases where we can rely on other evidence. If a disease that shows little history of clearing up by itself suddenly clears up in a good percentage of people after they receive a treatment then we can probably place a certain degree of trust in those case studies, so long as the case studies were tracked from the beginning and not cherry-picked after the disease cleared up. <br /><br />That’s not the case with the chiropractic/colic case studies though. Colic is something that clears up by itself. Case studies that show colic clears up after chiropractic treatment is, well, bloody useless.<br /><br />Cheers,<br /><br />Simon.Simonhttps://www.blogger.com/profile/14195003492084088327noreply@blogger.comtag:blogger.com,1999:blog-5959094372836804855.post-65823453119803961042009-10-27T07:47:36.881-07:002009-10-27T07:47:36.881-07:00Hi Simon
Way back on 23 Oct (11.06) I made some p...Hi Simon<br /><br />Way back on 23 Oct (11.06) I made some points about the use of RCT's in clinical practice. That was originally one of the questions I wanted to ask you and since then, I seem to have been swept along with the mele. Perhaps it was my fault for not framing the comments specifically as a question. <br /><br />So, with reference to the post on 23 Oct, should mindful clinical practice rely exclusively on RCT's? <br /><br />I would be interested to hear your thoughts on that point before the mele moves on.<br /><br />Thanks<br /><br />JackieJackie Whttps://www.blogger.com/profile/10166166772990297333noreply@blogger.comtag:blogger.com,1999:blog-5959094372836804855.post-1856416640410555902009-10-27T06:03:36.690-07:002009-10-27T06:03:36.690-07:00Simon,
all the best in this needful cause. Good ...Simon, <br /><br />all the best in this needful cause. Good luck to both you and Simon Singh in your endeavours!Cosmic Navel Linthttps://www.blogger.com/profile/07301190881761763414noreply@blogger.comtag:blogger.com,1999:blog-5959094372836804855.post-52022534509807278452009-10-26T14:47:19.167-07:002009-10-26T14:47:19.167-07:00Hi Andrew,
Interesting question. I think the poi...Hi Andrew,<br /><br />Interesting question. I think the point I was making was that if you randomly make up three ideas without any kind of reasoning, they are equally unlikely to be true.<br /><br />If there is one that has been shown to be false with testing, this is even more unlikely to be true.<br /><br />However, the null hypothesis is slightly different. <br /><br />The key point is this: Most things don't work. For every one action that will make your car's engine start, I could name a billion other actions that wouldn't (please don't ask me to).<br /><br />So because I can name a billion things that don't work for every one thing you can name that does, it makes sense to go with the null hypothesis until the evidence is in. <br /><br />That's not to say that you claim "X doesn't work". It's moreover that you claim "X has not yet been shown to work. I'll be open-minded, but assume for now that it doesn't work until you come up with some evidence".<br /><br />SimonSimonhttps://www.blogger.com/profile/14195003492084088327noreply@blogger.comtag:blogger.com,1999:blog-5959094372836804855.post-24768431212730983952009-10-26T14:14:35.027-07:002009-10-26T14:14:35.027-07:00Hi Simon,
This is not a criticism, per se - more ...Hi Simon,<br /><br />This is not a criticism, per se - more a question. Where you say that<br /><br />"If there are three hypotheses, all without evidence for them and one where evidence has been looked for but not found, then that one is clearly the least plausible hypothesis."<br /><br />If you are testing the null hypothesis, then surely a null hypothesis that hasn't been rejected has the same intrinsic value as one that hasn't been tested. It's quite possible that I'm wrong here, so please do say if I'm barking up the wrong tree. (I've learned a lot from blogs such as yours, so that is why I query this.)<br /><br />In the case of infantile colic, I think we should ask, now why would chiropractic work? From my understanding of the way the human body works, I would have to say there is no reason why it would work.<br /><br />Keep up the good work with those complaints! My feeling is that it's the right thing to do if you have a social conscience.<br /><br />Cheers, <br /><br />AndrewAnonymousnoreply@blogger.comtag:blogger.com,1999:blog-5959094372836804855.post-85204943621071755362009-10-25T02:42:42.333-07:002009-10-25T02:42:42.333-07:00'That empty space being the chasm between your...'That empty space being the chasm between your ears'.........echoes in the stadium in the wake of my deatureSilexhttps://www.blogger.com/profile/12429356351173643393noreply@blogger.comtag:blogger.com,1999:blog-5959094372836804855.post-77889324170122195552009-10-25T01:46:02.108-07:002009-10-25T01:46:02.108-07:00@ Jackie W
Thank you for your reply. IMO, Simon&...@ Jackie W<br /><br />Thank you for your reply. IMO, Simon's reasons for making the mass complaints were perfectly obvious without having to spell them out. However, I appreciate now that his post has been worthwhile for some.Blue Wodehttp://www.ebm-first.comnoreply@blogger.comtag:blogger.com,1999:blog-5959094372836804855.post-18982481970086684132009-10-25T01:33:07.535-07:002009-10-25T01:33:07.535-07:00@ Blue Wode
That distinctly Orwellian rationale c...@ Blue Wode<br /><br />That distinctly Orwellian rationale could be used to justify complaints against any profession w/ a regulatory body - a complaint that may be better directed at the regulatory body itself perhaps. If I were to make a mass complaint against anyone I would make sure I could justify it – for myself and to be fair to those I was complaining against. <br /><br />I think Simon is being fair by outlining his reasons & that’s what I’m getting at - fairness.Jackie Whttps://www.blogger.com/profile/10166166772990297333noreply@blogger.comtag:blogger.com,1999:blog-5959094372836804855.post-30033546932884836432009-10-24T13:47:15.425-07:002009-10-24T13:47:15.425-07:00*puff of smoke**puff of smoke*Silexhttps://www.blogger.com/profile/12429356351173643393noreply@blogger.comtag:blogger.com,1999:blog-5959094372836804855.post-87027069651919522212009-10-24T13:11:12.289-07:002009-10-24T13:11:12.289-07:00@ Jackie W
I’m not quite sure what you’re getting...@ Jackie W<br /><br />I’m not quite sure what you’re getting at. If the individuals involved in the mass complaints are confident that they have not breached any of the requirements set out in their Code of Practice, then what is there for them to worry about? On the other hand, if they suspect that they have contravened their Code of Practice, then the consequences of that are deserved.Blue Wodehttp://www.ebm-first.comnoreply@blogger.comtag:blogger.com,1999:blog-5959094372836804855.post-1470005862936068822009-10-24T12:22:13.146-07:002009-10-24T12:22:13.146-07:00Silex - come on now - I thought you said you were ...Silex - come on now - I thought you said you were leaving?<br /><br />You seem to have developed a monologue & the idea of this type of platform is dialogue. You made your point and I have the feeling by now you might be shouting randomly at an empty space. <br /><br />I'd really like to hear back from some other people on the topics raised but it seems you're mostly just being gobby & rude, & as a result, ruining any constructive conversation. <br /><br />By addressing this to you, I really don't mean for you to come back to me on this. In fact please don't -(please don't!)- I get the picture..!Jackie Whttps://www.blogger.com/profile/10166166772990297333noreply@blogger.comtag:blogger.com,1999:blog-5959094372836804855.post-89417425014483869792009-10-24T11:16:03.470-07:002009-10-24T11:16:03.470-07:00Other simon at least had the decency to respond-
...Other simon at least had the decency to respond-<br /><br />Many thanks for your deeply insightful email. Unfortunately, I am currenly busy fighting the legal case, so I don't have time to respond in any detail, but I am sure that you will find lots about my views on various websites.<br /> <br />Thanks again for such a thoughtful contribution to the debate.<br /> <br />Best Wishes,<br />Simon.<br /><br />Ps. I will try to slouch less. Thank<br /><br />If one good thing could come from this....its less slouching. Good on you simon.<br /><br />"Ps. I will try to slouch less. Thanks." Well if one thing good comes from this my friend, I'd be grateful for this. But grateful am I that you took the time to respond, this is more than i can say for many others.<br /><br />You speak to a man who has been in pain, tension and trauma for many years on many fronts battling a diseased spine and had to self learn chiro techniques to sort it out. ever done self manipulation? thats chiropractic for ya. Once you discover that and slowly find that upon correction of vertebrae, that your stomach is able to take in nutrients-those super foods doing nothing before having solved the neural compromise-your brain actually starts computing thoughts again, your heart starts doing its job properly, and slowly you claw your way out of the depths of fatigue. You will know my friend. You would know.<br /><br />Lots of bad chiro's out there. Tell them to all update to non force neurological approach<br />like www.torquerelease.com. Forced manipulation is old school. You gota love those Subluxations straight. Release tension and release compression and the subluxations glide back into place. Gently, easily, no harm done<br /><br />Go after all those bad chiro's doing bad forceful manipulations, cause no good comes from that, your right, no evidence. And get funds for lots of research. throw funds at em to sort themselves out so that they don't need to be sneaky. <br /><br />Just please my man, don't tear down a whole discipline in the name of fear and ignorance. Chiropractic is the only discipline that woke up to look at the spine and be intrigued. Before then, we were all ignorant and stupid. They need help, not more slander.<br /><br />Don't throw the baby out with the bath water.<br /><br />RespectSilexhttps://www.blogger.com/profile/12429356351173643393noreply@blogger.comtag:blogger.com,1999:blog-5959094372836804855.post-36356520803755405262009-10-24T06:07:14.820-07:002009-10-24T06:07:14.820-07:00ok guys. i think my job in this nest here is done....ok guys. i think my job in this nest here is done. i'm sure you will all be happy that i leave you to your comfy lair of stupidity.<br /><br />but before i leave. I must at least sing a song to you, to contrast my spoken word. find your own harmony<br /><br />Endangered species, caged in fright,<br />Shot in cold blood, no chance to fight.<br />The stage is set, now pay the price.<br />An ego boost, dont think twice.<br />Technology, the battles unfair,<br />You pull the hammer without a care.<br />Squeeze the trigger that makes you man,<br />Pseudo-safari, the hunt is canned...<br />The hunt is canned.<br /><br />All are gone, all but one.<br />No contest, nowhere to run.<br />No more left, only one.<br />This is it, this is the countdown to extinction.<br />Tell the truth, you wouldnt dare.<br />The skin and trophy, oh so rare.<br />Silence speaks louder than words.<br />Ignore the guilt, and take your turn.<br />Liars anagram is lairs,<br />Man you were never even there.<br />Killed a few feet from the cages,<br />Point blank, youre so courageous...<br />So courageous.<br /><br />One hour from now,<br />Another species of life form<br />Will disappear off the face of the planet<br />Forever...and the rate is accelerating.<br /><br />I just oh so wish it was you slimy life forms that this song was about.<br /><br />ho ho and and merry fuck youSilexhttps://www.blogger.com/profile/12429356351173643393noreply@blogger.com