This article have been used by the anthroposophic hospital as advertisement for the care they sell to the swedish ”NHS”. The criticism against the design and the conclusions of the study, both here in the comments and in social media, has not been properly adressed by the authors.

So I will again state my main issues with this paper and hope that the authors will try to answer my questions. At least I know that the statistician professor Petzold will understand my concerns, since we have already discussed this over the phone.

1. The prescriptions for analgesics seem very low if pain really was the main medical problem for the patients in the study. At baseline only 3-4 daily doses per month, while the amount of psycholeptics was twice as high.
When the use of analgesics was already so low, why was this parameter chosen as the main outcome measured?

2. The use of non-prescribed analgesics sold OCT was not recorded in the study.
How can we then know if the patients’ use of analgesics changed at all?

3. The patients at the anthroposophic hospital usually stay for three weeks of rehabilitation. How long the control patients were admitted to other hospitals is not stated, and might include very short time emergency care.
Can the authors tell us the average and median time in hospital stay for the two groups?

4. Table 4 shows that in the year before the control patients more often had a cancer diagnosis, but less often a psychiatric diagnosis compared to those who received ”integrated care”.
Does this not make the groups too dissimilar for comparison?

5. The amount of prescribed psycholeptics did not change significantly after ”integrated care”. Do the authors have any thoughts about this?

6. Was it recorded how the use of anthroposophic medication (both homeopathic and non-homeopathic) changed in the two groups?

Mats Reimer
Pediatrician
Gothenburg
Sweden