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The Quack Full Employment Act

Quacks, charlatans and snake oil salesmen are closely watching “The Colorado Natural Health Consumer Protection Act,” Senate Bill 13-215 (SB 215) as it wends its way through the Colorado Legislature. I imagine a few felons about to be released from prison are keeping tabs on the bill too, for reasons we’ll get to in a minute. SB 215 passed the Senate on Tuesday. It will now go on to the House, where it has the support of Rep. Joann Ginal, the mover and shaker behind a bill giving “naturopathic doctors” a right to practice, House Bill 13-1111 (HB 1111). That bill passed the House and is now parked in the Senate awaiting committee assignment.  Apparently, critical thinking skills have abandoned the state capital. Things are looking grim.

If the “Colorado Natural Health Consumer Protection Act” passes, Colorado will become one of a handful of states where anyone can practice medicine. Of course, these laws don’t come out and say that exactly. In fact, the Colorado bill states that if you don’t have a medical license you cannot practice medicine, which in Colorado is defined to include:

Holding out one’s self to the public within this state as being able to diagnose, treat, prescribe for, palliate, or prevent any human disease, ailment, pain, injury, deformity, or physical or mental condition, whether by the use of drugs, surgery, manipulation, electricity, telemedicine, the interpretation of tests, including primary diagnosis of pathology specimens, images, or photographs, or any physical, mechanical, or other means whatsoever; . . . Suggesting, recommending, prescribing, or administering any form of treatment, operation, or healing for the intended palliation, relief, or cure of any physical or mental disease, ailment, injury, condition, or defect of any person . . .

But, as we shall see, what SB 215 actually does is allow rank amateurs to diagnose and treat just about anyone for any disease or condition with means of no known safety or effectiveness. In other words, they can practice medicine, it’s just quack medicine. At the same time, the bill strips away important consumer protections. And guess who’s supporting it? The Colorado Medical Society, although I suppose we can be disappointed but not surprised. The Colorado Chapter of the American Academy of Pediatrics is remaining neutral. As I said, critical thinking skills have decamped from Denver.

Pay attention folks. Passage of this bill will energize the Health Freedom crowd. They’ll be in your state soon.

Why is the legislature doing this?

Let’s begin at the beginning, with a look at the legislative findings. Such findings are often set forth at the beginning of a bill to explain the legislature’s purported reasons for the law’s necessity. Legislative findings are supposedly based on facts but, in my experience, all too often they are no more than a bit of political theater. True to the tradition, SB 215’s legislative findings are pretty much fact-free.

First, the bill’s draftsmen trot out the shop-worn “complementary and alternative medicine (CAM) is popular” gambit. For this they rely on the 2007 survey by Barnes et al. As we have discussed many times before on SBM, by suddenly transforming such conventional practices as diet, relaxation and exercise into CAM, the survey was able to make it look like CAM use is much greater than it actually is. That is, of course, if anyone could really define “CAM” in the first place. Even the National Center for Complementary and Alternative Medicine (NCCAM), itself cited in the legislative findings, admits it’s hard-pressed to define this amorphous and ever-changing category.

Second, from this survey they extrapolate that 1.5 million Coloradans “currently receive a substantial volume of health care services” from CAM practitioners, a conclusion actually contradicted by the survey they rely upon. The overwhelming majority of health care expenditures for CAM is for self-care, such as buying off-the-shelf products like as fish oil supplements. Less than two percent of consumers use a type of CAM that requires seeing a practitioner currently unlicensed in Colorado.

Third, the bill claims that CAM practitioners “are not regulated by the state.” Again, not true. According to the survey, the most commonly visited CAM practitioners are chiropractors, osteopaths and massage therapists, all of whom are regulated by the State of Colorado. (Of course, this also demonstrates another flaw in the survey — counting all visits to massage therapists and to chiropractors and osteopaths for manipulation as CAM, another error that inflates the numbers.) Acupuncturists are also licensed.

Finally, the legislature finds that CAM “practices do not pose an imminent and discernable [sic] risk of significant harm to public health and safety.” Or, in other words: “What’s the harm?” And whoever drafted this bill should check with the Colorado Attorney General on the extent of the state’s constitutional power to regulate for the health, safety and welfare of its citizens. The risk of harm needn’t rise to “imminent and discernible” for the state to step in and protect the public. And apparently, they didn’t thoroughly review the NCCAM website in cherry-picking their legislative findings. If they had, they would find, in NCCAM’s own words, “the safety and effectiveness of many CAM therapies are uncertain.” Others are actually known to be dangerous or ineffective or both. Or maybe they did review the website but they just don’t care.

What will an unlicensed CAM practitioner be able to do?

Under current law, an unlicensed CAM practitioner is subject to prosecution if they do anything that requires a license to practice medicine. This bill creates a “safe harbor” from prosecution if the unlicensed practitioner follows certain rules. And who is eligible for this protection as an unlicensed practitioner? Pretty much anyone who isn’t a licensed health care practitioner and wants to call himself (or herself) a CAM practitioner, a point we’ll return to shortly. But first, let’s look at what they can do. In other words, how is “CAM” defined in the bill? It is

advice and therapy services . . . within the broad domain of health care and healing arts therapies and methods that are based on complementary and alternative theories of health and wellness. . . [These] include healing practices using food; food extracts; dietary supplements [as defined in DSHEA] including vitamins, herbs, minerals, and enzymes; nutrients; homeopathic remedies and preparations; . . . the physical forces of heat, cold, water, touch, sound, and light; stress reduction healing practices; and mind-body and energetic healing practices.

The CAM practitioner cannot practice massage therapy, but can employ

stroking of the hands, feet, or ears; or . . . the use of touch, words, and directed movement of a health art within the bodywork community, including healing touch, mind-body centering, orthobionomy, reflexology, rolfing, reiki, qigong and practices with the primary purpose of affecting energy systems of the human body.

If the practitioner has “board certification” from the International Association of Colon Hydrotherapy or the National Board for Colon Hydrotherapy he can perform enemas or colonic irrigation.

My interpretation is that this definition permits every form of quackery I’ve ever heard of and some that will be invented.  And one I had never heard of: “ortho-bionomy.” In fact, CAM is limited only by the imagination of anyone who can fit what he dreams up into this broad and fuzzy list. I predict the word “quantum” will be getting a real workout in Colorado. Personally, I would go for the “mind-body and energetic healing practices” category if I were setting out as an unlicensed practitioner. Almost unlimited opportunities there. Of course homeopathy is tempting because you would get to sell little bottles of water at extravagant prices to the unsuspecting public.

What are they prohibited from doing?

Let’s now turn to what unlicensed practitioners are prohibited from doing under SB 215. Then we’ll look to a few hoops they must jump through before they get to do whatever it is they choose to do.

These are the things unlicensed practitioners cannot do:

The CAM practitioner cannot perform surgery and certain other invasive procedures, prescribe or administer drugs or certain medical devices, set fractures, provide chiropractic “adjustments,” practice dentistry, use or prescribe radiation, use spinal anesthetics (topical anesthetics are permitted), or use “invasive” laser devices. The practitioner cannot provide a “conventional medical disease diagnosis” although an “unconventional” diagnosis or diagnosis of a condition other than a disease is apparently permitted. They cannot “recommend the discontinuation of a course of care, including a prescription drug, prescribed by another health care professional.”

But what about ordering lab tests, that reliable means of finding “unconventional” diseases to treat with CAM, such as adrenal fatigue, chronic yeast overgrowth, chronic Lyme disease, toxicities, imagined vitamin and mineral deficiencies and so forth? While the bill doesn’t allow skin puncture, it doesn’t mention other types of tests. In any event, all the practitioner has to do is recommend that the “client” [which is what the bill calls consumers] visit a walk-in lab, such as Any Lab Test Now. There he will find a number of tests whose results might be catnip for quacks, such the “fatigue panel,” the “telomere test,” the “micronutrient test“ and the “saliva hormone test.”

Who can a CAM practitioner treat?

The unlicensed practitioner can see just about anyone who walks in the door. They cannot “directly administer medical protocols to a pregnant woman or to a client  who has cancer.” I thought they couldn’t practice medicine at all, so I’m not sure what this means. In any event, they are apparently free to administer quack protocols to pregnant women and cancer patients.

They cannot treat a child under two without having informed consent of the parent, disclosing they are not licensed physicians, and recommending that the child “have a relationship with” a board-certified pediatrician. Of course, the parent is free to ignore this recommendation. Informed consent is an interesting requirement because it highlights the lack of a key consumer protection. A patient must give informed consent to any treatment by a medical doctor. Except for children under two, no informed consent is required for treatment by an unlicensed practitioner.

What must a CAM practitioner do to avoid prosecution?

There are a few things the unlicensed practitioner must do to avoid prosecution. The practitioner must tell the client the nature of the CAM health care services to be provided, that the practitioner is not licensed, whether he has liability insurance (I’ll wager he doesn’t) and any degrees, training, experience, credentials or other qualifications the practitioner has. The latter is small comfort as the many on-line certificates and do-nothing degrees available can fill the walls of even the most dim-witted practitioner. All of this must be reduced to writing and signed by the client. This statement must advise the client that he should discuss any recommendations made by the CAM practitioner with his PCP or certain other board-certified specialty physicians. (Be prepared for some doozies, you Colorado physicians!)

Who can become a CAM practitioner?

So what are the qualifications for becoming an unlicensed CAM practitioner? Next to none. Just about anyone can do it. The only exceptions are licensed (or registered or certified) health care providers whose licenses are suspended and the mentally incompetent. Also excluded are felons who have “not satisfied the terms of the sentence imposed for the crime.” But as soon as they walk out of prison or complete parole, convicted felons can go straight into practice as a CAM practitioner. This could prove a solution for the seemingly intractable problem of chronic unemployment among convicted felons. Plus, those convicted of financial crimes are often excellent flim-flammers. And how about allowing those convicted of sexual assault and child molestation “to stroke the hands, feet, or ears or . . . the use of touch”? Excellent idea!

Consumer Protection? What consumer protection?

Under current Colorado law, unlicensed practitioners of complementary and alternative health care are subject to prosecution for the unlicensed practice of medicine. This bill provides a “safe harbor” from prosecution if the unlicensed practitioner follows certain rules. Thus, consumer protection is decreased by removing some conduct — no matter how egregious – from the reach of prosecution. For example, if a homeopath did a homeopathic diagnostic workup on a Coloradan and sold her homeopathic remedies as a “cure,” the homeopath has likely engaged in the unlicensed practice of medicine. If this bill becomes law, as long as the homeopath otherwise complies with the rules, the homeopath can diagnose and prescribe homeopathic remedies with impunity. And no matter how much public harm he may be causing, the medical board can do absolutely nothing about it. In addition, the bill also provides that unlicensed practitioners who don’t follow the rules violate the Colorado Consumer Protections Act (CCPA). But the CCPA already protects consumers for most of the conduct permitted by the bill. So here the bill adds nothing the consumer doesn’t already have.

An injured person can still sue a CAM practitioner for negligence if the bill passes. But what exactly would constitute negligence? All persons owe a duty to others to act reasonably in any particular circumstance. In a negligence case, an injured party must show that the person causing harm breached that duty in some manner. So how would the plaintiff show that the CAM practitioner breached this duty of care? For licensed health care practitioners, such as a medical doctor, the duty of care is established by a standard of care, or what a prudent practitioner would do in the same or similar circumstances. If the practitioner falls below that standard, he commits malpractice. But since there is no standard of care for the unlicensed CAM practitioner, how would one establish the breach of duty necessary to succeed in a negligence case?

That would leave the plaintiff with a run-of-the-mill reasonable person standard. But wait – the legislature has specifically said that these CAM practitioners can practice homeopathy and other such nonsense and they have no obligation to provide informed consent and no obligation to refer to a physician (merely “to discuss” the CAM practitioner’s recommendations with one’s physician). They aren’t educated and trained to diagnose medical conditions and, in fact, are forbidden from “conventional” medical diagnoses, so how would they recognize the need to refer in the first place? (In contrast, for example, a chiropractor has a duty to refer to a medical doctor for any disease or condition beyond his scope of practice or ability to treat. He would also have liability insurance to compensate for injuries if he fails to do so. CAM practitioners do not.) Apparently, then, an unlicensed practitioner could get off scot-free for failing to refer a person desperately in need of medical care in any case where a “reasonable person” would not recognize the danger. If you aren’t a licensed health care provider, do you know which headaches signal danger and which ones don’t? How about back pain? Stomach aches? Coughing? Chest pains? No? Well, neither do they.

Just how bad is it?

Let’s put this all together and see just what would happen should this bill become law. Virtually anyone can set up shop without any education or training in health care whatsoever, or a worthless on-line certificate if they prefer, and practice complementary and alternative “health care and healing arts therapies and methods.” They can see anyone who walks in the door, no matter how sick. They can provide any unconventional disease diagnosis they want, including making up diseases and conditions that don’t exist. CAM practitioners can then proceed to practice virtually any “healing arts therapies and methods” they can dream up, including recommending various nostrums that they then sell to the consumer. They have no duty to provide informed consent, no education and training in recognizing the need to refer to a physician and no duty to refer to a physician. And even if the CAM practitioner is injuring his “clients” right and left, the medical board must sit on its hands and do nothing as long as the CAM practitioner complies with a few rules. The board has no authority whatsoever to step in and stop it. Unlike every licensed health care professional in Colorado, who must answer to a regulatory authority, the unlicensed practitioner answers to no one.

The injured clients could sue for negligence. But even if they could overcome the substantial obstacles I’ve already mentioned, CAM practitioners don’t have to carry liability insurance. And, rest assured, few (perhaps no) plaintiff’s attorney is going to take one of these cases unless the practitioner has substantial assets to pay any judgment against him and therefore the attorney’s fees and costs.

Natural Health Care Consumer Protection? Hardly. It’s the Quack Full Employment Act.

Author’s Note: Linda Rosa, RN, and Larry Sarner have worked tirelessly to defeat SB 225 and HB 1111, on their own time and with their own money. Whatever happens in Colorado, we owe them a great deal of gratitude for getting in there and fighting to defend science-based medicine. We could all learn a lesson from their example.

Posted in: Energy Medicine, Health Fraud, Herbs & Supplements, Homeopathy, Legal, Naturopathy, Politics and Regulation

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19 thoughts on “The Quack Full Employment Act

  1. norrisL says:

    As I have mentioned on SBM recently, the Australian Government is preventing people with private health insurance from claiming against quack therapies, although, for some reason known only to the Australian Government, they still allow people to claim for chiropractors
    (Or, as I call them, chiroquacktors) and also for acupuncture.

    In Australia, there is only ONE private health insurer who does not pay out on quackery. The name of that company is: Doctors Choice Health Insurance.

    So at least we are beginning to deal with these quacks, while it sadly seems that in Colorado, the state government there has chosen to go in the opposite direction.

    And this seems to me to be the crux of the matter. We have “governors” who know nothing about medicine, or worse still have already come down on the side of CAM/quackery, and these are the people who make these important decisions. Surely people in government, when they come up against a subject that they do not understand, should be obliged to “do a little research”. Whether you are in Colorado, the UK, Canada or Australia there should be access to people with relevant expertise in the field. Pie in the sky. Probably, but, you know, I have to have a dream.

  2. norrisL: As I have mentioned on SBM recently, the Australian Government is preventing people with private health insurance from claiming against quack therapies

    Oh there is a solution for that – claim it on the Public Health Insurance. You might be interested in signing this petition and join the other 700 concerned citizens:

    http://bit.ly/15i5D0M

  3. Linda Rosa says:

    Many thanks to Jann Bellamy for an astute analysis. I would be remiss to not acknowledge that Maureen Maker and Mark Johnson, MD, have done much of the heavy lifting in Colorado trying to stop these bad bills. It has been a pleasure working with them.

  4. Sastra says:

    Egad. It’s as if they want alternative medicine to be judged using the standards we use when cases are brought against churches or religions. Criminal liability only — doctrine, dogma, and claims regarding divinity are all exempt from state regulation or scrutiny. Every individual must evaluate their worth according to their own standards.

    But unlike salvation or enlightenment, there are tests in reality for “health.” It ‘s not a spiritual concept. It means something beyond opinion and it can be measured. Placebo is not the right remedy for everything.

    Best of luck to Rosen, Maker, Johnson, and anyone else doing some very heavy lifting.

  5. nickmPT says:

    I think this is the end result of a lack of real manufacturing jobs in the U.S. and a decline in scientific thought and education. Also, ‘mainstream’ biomedicine (physicians, physical therapists) has done a piss-poor job with chronic conditions (i.e. pain), which constitute a large, if not the biggest, chunk of health care expenditure.

    The CAM crowd has done a good job of selling the people in pain (and other various maladies) a story, that is most likely scientifically false, but is frankly better than the story we mainstreamers have been selling. And it gets worse.

    Many mainstreamers have accepted this deficiency in their own story and instead of seeking better answers through science, have outsourced it to the CAM crowd in the form of integrative medicine. Hell, some of the mainstreamers have even picked up the CAM ‘therapies’ (i.e. craniosacral, acupuncture) in hopes of adding another ‘tool’ to their ‘toolbox.’

    There are some signs that it may get better (I mostly speak of pain science), however, stories like these continue to show the tough road ahead to keep the 1) public informed on the best science/evidence and 2) provide the most effective and efficient care.

    Cheers,
    Nicholas

  6. annappaa says:

    I wish there were a more organized movement against health fraud and other abuses of science. But, to my knowledge, there is no organization I can join to fight against the practice of alternative medicine without informed consent. Being an advocate of abortion rights and access to contraception was as easy as emailing the local Planned Parenthood to volunteer. But I would also love to devote some of my energy in the fight against quackery.

  7. RobRN says:

    @annappaa: Look around – Most large metropolitan areas have a “Skeptics” society so that could be a place to start.

  8. CommonSenseBoulder says:

    “as a rule, regulation is acquired by the industry and is designed and operated primarily for its benefit”
    -George Stigler (Nobel Prize in Economics): “The Theory of Economic Regulation”
    ( http://web.missouri.edu/~podgurskym/Econ_4345/syl_articles/Stigler_TheTheoryOfEconomicRegulation.pdf )

    That includes the quack industry.

    It is unfortunate this is being done in the name of “Health Freedom”, there are many skeptical libertarians that disagree. If you wish to convince people it is useful to learn to “speak their language”, to argue from the perspective of those with similar views about freedom who disagree with them.

    The argument to make to small government advocates is this isn’t about freedom even if it superficially seems to be. It is really about giving the impression the government considers these things safe, it is “crony capitalism”, a favor for special interest groups. Unfortunately many of these people won’t care about that since it is a special interest they like and they are really only using the word “freedom” as an emotional argument to help get what they want, but if so it is useful to try to highlight that reality.

    These arguments will only work with skeptical libertarians who may have bought into their “freedom” sales pitch, but not the quackery (and there are many skeptical libertarians despite what some here might think based on the “health freedom movement”. Most don’t fall for this quackery. e.g. high profile skeptical libertarians include Michael Shermer, John Stossel, and Penn Jilletee )

    Principled small government advocates feel that *if* the government is doing something (even if they might object to its role in that area) that it needs to do a good job of it. While people trust the government to keep them safe, the government shouldn’t be supporting quacks. Libertarians also oppose fraud, which quacks shouldn’t be allowed to perpetrate. Unfortunately those who don’t accept like we do that these folks are quacks won’t buy into this argument.

    There is a vast difference between bad regulation- where people think the government is keeping them safe but isn’t- and true deregulation where they know they need to look to private consumer protection to do so. Libertarians advocate getting the government entirely out of medicine to allow private competing agencies to certify medical practitioners rather than a 1 size fits all government monopoly approach which can be derailed through what economists like Stigler refer to as “regulatory capture” by special interest groups. Again however, while the government *is* involved in certifying safety, it needs to do a good job.

    A private certification label would compete for the trust of patients, insurers, and hospitals. We would seek out a “science based medicine” certification and avoid quacks. Others would be free to use quacks.. people have a right to make questionable decisions in life even if we try to persuade them not to… we at least wouldn’t be endorsing them by paying for them since we would use insurers who didn’t waste money on quack certifications (since a libertarian government wouldn’t force them to cover it).

    We would argue against quacks, but at least we wouldn’t be funding a government that endorsed them and duped people into thinking they were safe. Their insurance rates would go up to cover the cost of treatments that don’t work (hmm…then again if they die without a long hospital visit, perhaps not). Insurers who were science based would try to win them as customers by arguing against quackery.

    Unfortunately we have nothing remotely like a free market in healthcare now, which many people don’t realize so you can’t argue effectively with those that are aware of the details of this. If you want to try to persuade free market advocates not to back “health freedom”, it is useful to understand why they have the world the worldview they do, whether you agree with them or not. .One page delving into the level of regulatory capture in our healthcare system to grasp why “freedom” motivates many people (from the perspective of a skeptic not into quackery) is here:
    http://www.politicsdebunked.com/article-list/healthcare

    Libertarians realize competition works better than monopolies, even government monopolies that you hope will do a good job because they are in theory supposed to act in the public’s interest. Another nobel laureate economist, James Buchanan founded the “public choice” school of economics which studies how governments actually operate in reality ..rather than simply relying on wishful thinking they operate in the public’s interest. He called it “politics without the romance”.

  9. Linda Rosa says:

    For those wanting to help fight the Naturopath and Health Freedom bills in Colorado, please consider joining Colorado Citizens for Science in Medicine, a private, not-for-profit group of concerned citizens and health care professionals. (Write me via Facebook)

    For those in other states, you might want to start your own such group. CCSM be happy to communicate with such groups.

    To learn about naturopath licensure bills around the country and which legislators need to hear from you, go to Jann Bellamy’s website:

    http://www.no-naturopaths.org/legislative-alerts.html

  10. CommonSenseBoulder says:

    This is strange. I had a post here before that seems to have disappeared. It said it was send off for a moderator’s approval, but then it did appear. I didn’t save the long text of it, which tried to explain to folks here how to argue against this sort of bill by learning to “speak the language” of those who might agree to support this. I know it is doubtful you can reach those who support quacks, but it was meant to explain how to argue with those who advocate small government who might have bought into the “freedom” argument.

    I am hoping someone removed it because it was a bit long (in which case I would have hoped they would have at least contacted me to suggest making it shorter) rather than because they disagreed with the politics which unfortunately I suspect is the real reason it is gone, even though I am a skeptic opposed to this Quack Full Employment Act. If so that is rather shortsighted if you truly value fighting the “health freedom” movement since the best way to fight it is to understand how those most likely to support it think, or at least the ones who might be swayed against it to explain how it isn’t a step in the right direction.

    I would have thought science based medicine folks would value as much information as possible, and dialogue with those on their side, rather than silencing a message someone didn’t like which seems to be all too common a tactic among anti-intellectuals, whether quacks or those in the political realm that push policies based on emotion rather than reason.

  11. CommonSenseBoulder says:

    re: my message above, the hope was they would repost the original message rather than have me waste time trying to redo what I didn’t save, I don’t know if I will bother now given that sort of reaction. I didn’t see a need save it, I was arguing against the bill. I didn’t expect there to be someone here apparently wishing to hide political views they don’t agree with (as quacks try to hide from evidence) since those views were posted to allow people to consider ways to deal with those that might support the “freedom” aspect of this bill, but who don’t support quacks.

  12. David Gorski says:

    No one is trying to “silence” you, and no one deleted your comment. We don’t work that way. Your comment was caught in the spam trap, and, quite frankly, it took me a while to find it. I’ve restored it. No one is continually monitoring the comments on this site; I check in once or twice a day, less over the weekend.

  13. CommonSenseBoulder says:

    Sorry for the confusion, but the post was on this page (it no longer said it was awaiting moderation). Then it disappeared, the most likely conclusion to draw was that it was deleted. If the first messages is left, feel free to delete this response and my prior complaints as no longer relevant.

    I didn’t think this site worked that way, which is why I was surprised, I didn’t know if it was perhaps some atypical politically active sysadmin, I didn’t think it was typical. I have simply observed that sort of behavior on other sites. where people are able to engage in rational discourse on some topics, but then are intolerant of differing views on others. There is a reason discussing politics is considered “taboo” in certain social situations, since it can invite emotional reactions even among those that are dispassionately rational in other areas. Those who are skeptical of status quo approaches to politics often deal with reactions similar to what skeptics of pseudo-science get trying to discuss evidence with those pushing the paranormal. Unfortunately in politics obviously the answers are far less clear cut than even uncertain areas of medical science, but the answer is more thought, not less. There are intelligent people on various sides with evidence and logic (even if in differing ratios, and obviously some of us/them will turn out to be wrong :-) ), but also emotional people on all sides.

  14. Chris says:

    Yes, Moderation Bots work in mysterious ways!

    (there is on another wordpress powered blog where comments randomly just disappear, they do not go into moderation, for no apparent reason just go into a void… the blog owners are working on it)

  15. BillyJoe7 says:

    CSB,

    Comments are never censored here, but the occasional poster is banned…usually for using sock puppets.
    A little bit of advice though. Make your initial postings short and to the point. Nobody is likely to read a long post by someone that are not familiar with. If your initial short succinct posts prove interesting, your longer postings are then more likely to be read.
    Also, if your post lies in moderation, repost it, because no one goes back in the thread to read your post once they’ve read past it, because no one will know it is even there.

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