 What got you into infectious disease as a specialty, you know, I did it as a third year medic fourth year medical student The rotation I wanted to do was Filled and I looked I had to do something so I'll try infectious diseases because at the time I was hitting to family practice And I did it and I was hooked I mean it was so much fun and the cases were so cool and the attendings were just the greatest people And they all share a characteristic that all ID doctors have which is a love of the sound of their own voice So I thought this is the field for me and so I never looked back And so it's sort of one of those rare epiphanies where you actually I actually had a life-changing event And I've had a blast ever since almost by accident. Yeah, it was by accident Well, what is it about chiropractic and other alternative medicine modalities that have has you really concerned? basically it depending on the one and depending on what you're talking about most are not based in reality and most don't work and I think that patients and sick people should have therapies that are based in reality and some things like say Homieopathy we're so far from reality that it boggles the mind or reiki And it should be based on things that are shown to be effective because people's lives and health and their um Finances are dependent upon that and so I think we have an obligation to give people medicine that works the financial aspect is one that I I don't think I heard much until listening to you and then also reading my Ed Zard Ernst book trigger treatment and That definitely gave me a different perspective because In chiropractic we talk about oh, you know adjustments are so much cheaper than Being on all of these prescriptions But it really depends on how you look at it an adjustment can you know for 60 bucks a pop oftentimes is what people charge Intended Compared to you know a bottle of ibuprofen or some other painkiller. Oh, yeah, and for serious illnesses I mean I bankrupt people all the time seriously people come in without insurance they have a serious infection that I have to treat and by the time They're done they're permanently bankrupted and you know in the outpatient setting you used we're all used to seeing the results of minor problems, but if minor problems progress they can lead to major problems which Devastate people financially emotionally health healthily But these things are very expensive and they mount out very quickly and you lose track when you're a provider is to just how much This stuff can cost people that they can't afford often Even simple things I remember my brother didn't have insurance for a while and was having some pain in his upper left quadrant Someone's ingested. Maybe it's your spleen. Maybe it's something else and so went to the ER They said no, you just have the flu. Here's Tylenol and the bill came back for like five six hundred dollars. Oh, yeah And just really even that small amount relative relatively small amount really hurt him. Yeah, actually Now you do deal mostly with those more severe cases, right? Yeah, I mostly yeah I'm 99% in patient medicine. I have very little outpatient medicine. So I obviously have a skewed perspective on on health care I only take care of Very sick people in the hospital rarely. I don't have much of an outpatient practice for a variety of reasons How do you think that if that? Excuse your perspective on alternative medicine Oh, yeah, it definitely does because I don't take care of those people who have the problems that no one can figure out And for which there are no therapies. I chronic fatigue syndromes, for example, which um, you know People suffer from I see them occasionally but people with chronic problems that have minimally Effective therapies and especially don't have a cause I don't deal with those and that's a whole realm of medicine That is extremely difficult To know how to treat and what to do. I see the occasional chronic fatigue patient but You know, it's not part of my existence I and then I see about infectious diseases, of course is you find the bug you kill at the patient's better You know, you find bug me kill bug me go home. It's a simple. It's a simple job so it does skew you because I'm used to figuring it out fixing it getting it better and moving on and a lot of outpatient medicine is chronic Illness, which I recognize and I don't deal with that. So my skill set is suboptimal for treating chronic Unremitting undiagnosable diseases And it seems that that's what a lot of Patients that go to alternative medicine therapies are trying to find a cure for So nothing else has worked Yeah, you know, I think there's as many reasons that people use alternative medicines as there are people in some people because they have a Problem that doesn't get better. Some people are just contankerous Contrarians who doesn't want the man to tell them what to do, you know, and so they do it that way or there's fear like anti-vaccine people a Complete misunderstanding of vaccines. So I don't I actually have never figured out why even though I read the literature Why people go seek alternative providers as a general rule I can only speak as to why a patient goes to a given provider. This is pretty pretty variable Yeah, I started them always surprised sometimes at the people who do Are you why is that? I just think you know, they Don't have a problem that needs something, you know, they are on therapy But they add on other things that don't add much but expense, you know They have an infection so they take colloidal silver. That's not gonna help you. It's just gonna turn you blue And so Things like that Now you you spend a lot of time in your podcasts at least addressing chiropractic acupuncture The professions in general yeah are based around alternative medicine in undergrad I had a cold and went to the doctor and I was given by a medical doctor a homeopathic drug That kind of surprised me it was bright In the immortal words of gag health front, you know doctors are just this guy, you know, I don't know if you're a hitchhiker's guide to the galaxy If you ever get a chance download the BBC original television or radio show it's hilarious But doctors are no different and fortunately or fortunately than anybody else So there's prone to all the problems that the non-physician is for alternative medicine Unfortunately medical school training does not teach you how to think it teaches you What to think and you're used to that you're doing your basic science years, right? Mm-hmm. Are you totally inundated with an unbelievable amount of information that there's no way you're gonna stuff it into your brain Yeah, and every time I raise my hand and ask the question well, wait a minute. What about this? There's no time for that right now Yeah, and you know that doesn't end and by the time you're done With your training which is basically stuffing information into your brain and learning how to do your job Then you have your practice which again Very time-consuming and and so people never get time to think critically about stuff. So a doctor uses homiopathy The average physician is no better trained than anyone else for evaluating those things So, yeah, that surprised me that leads me to two questions. First of all, if it's then the doctor That perhaps is uneducated in a certain area. Why why address the profession as a whole? Oh I don't know Yeah, why go after acupuncture or talk about I don't know. It's just I find it The guiding force for virtually every aspect of my life is to do what I find interesting I don't know why I find these things interesting But you know, I tell my kids this figure out what you enjoy and what you like and run with it and You'll be happier long run so I just find the I thought the whole issue of skepticism and how people think badly and how people think and Why people think it's just for me an interesting area and people say why don't you go after a big pharma? Or why don't you talk about I got a recent e-mail about all you should write about? Physical therapy, yeah, you know, it's just it doesn't interest me So I don't know why I just I do the things that I find interesting and I find those issues interesting I get that I agree. I find This idea of evidence-based medicine wherever it may be really fascinating and when I read Trick or treatment as much as it is completely against acupuncture and homeopathy and you know These things that I'm learning a bit about It fascinates me the stories behind how how clinical trials came about and and as you mentioned how we think and how we can be How we can fool ourselves. Oh, yeah, it really is amazing so if you don't okay, so so you just Talking in general terms about chiropractic because that's what's out there rather than talking about specific Practices or specific doctors that do specific treatments that may not have evidence behind them Yeah, and you know, it's in for my mind. I've come to this conclusion over time It's not the person. It's the it's not the sin. It's not the sinner. It's the sin To quote the pope. I think the pope said that I'm not it's not the individual doing something. It's the overall male you that is Changed because it doesn't matter if I make say, you know, dr. Oz suddenly decides that Green coffee beans don't cause weight loss It's the overall environment where people are not thinking critically about medicine or other important issues That's important So I've sort of drifted away from the person over the years. It's more of the concepts that I try and Talk about is it the process of evaluating a treatment? Is that where we think a lot of doctors go wrong? So what is your process? Yeah, and understanding Well, I only you start I like to start at the basics and so, you know, what's the plausibility that something's gonna work? You know, will this give an antibiotic has efficacy in the test tube? So it should work for this weird infection I got, you know And then you look for animal studies and clinical trials that show also efficacy But for a lot of it you like to know that it works at a fundamental level that it makes sense at a fundamental level before you start applying it to people and Some things have make no sense at a fundamental level like acupuncture or homeopathy et cetera, et cetera, et cetera They're not their fundamental basis is fantasy kind of depends on your on your perspective your paradigm because Reiki and I've taken courses in Reiki and I'm I've received my attunement. I do not practice Reiki But for those who believe in Energy believe in this aura believe in this spirit being that can be affected by another person's energy There's plausibility Yeah, but there is no energy and if you could I mean I've always said it's been pointed out by others if we can pick up a the power of a of a refrigerator light bulb, which is what the Voyager spacecraft is transmitting so it's out past Pluto It's giving out energy at the level of a Refrigerator light bulb and we can pick it out now I'm a little biased that way my undergrad degree all back in the last century was physics So I spent my days, you know working on what energy is and I'm nowhere near the knowledge base I had back then but there is no energy and there is no Energy that you or I can alter in each other. It does not exist now. There's always just down to how You know Something works or not and the problem with medicine is that it runs counterintuitive to everything we do every day What's the best burger place in Portland? I haven't found I don't eat very many burgers, but I've been found again. Where do you like to go? Well, I mean I like a little big burger. Okay. Why well cuz I tried a bunch of different burgers over the years And I think it's the best burger. What's your favorite beer? Well, I like ESB's and IPA's I like hobby beers. I'm a Portlander. How do I know because I've tried a bunch of different beers and it works for me And that's how what's for my favorite shoes? I always wear marbles Well, I could have tried a bunch of other shoes and they're the most comfortable for my daily walk And that's how we approach everything every day is what worked for us and what people tell us And what's counterintuitive about all medicine is a cannot use that to determine what works for you And there's so much that goes into fooling yourself that something is effective that You can't trust it and I always say the three most dangerous words in medicine are in my experience When it comes to therapeutic interventions because you can't trust yourself How do we how do we control that or how do we prevent ourselves from fooling ourselves? well first is knowledge and Understanding how you can fool yourself and the other is you know, that's why we have randomized placebo-controlled double-blind trials So you take out all the potential bias that could possibly go into determining if something works I mean, I love the acupuncture stuff is that I think the most compelling For that showing bias because once you remove any knowledge that the patient is Getting acupuncture then it works just as well as real acupuncture So twirling toothpicks on the skin if the patient thinks this acupuncture is the same as acupuncture for relief Of what was it knee pain or back pain? Think the German study was knee pain So twirling toothpicks works just as well as real acupuncture. You know acupuncture does nothing If something is equal to a fake procedure that doesn't work, but the active Interf not interfering. Oh kind of getting old Having a relationship with a patient has innumerable effects beyond just What you do? Here's your prescription. I'll take your appendix out Whatever and I'm very aware of how much those social interactions are very important in changing Perspective as to how you hurt when you tell a patient you have an unusual disease and they're not certain and you just tell them I'm not certain, but it's not cancer. Ah, you should see the relief on their face You know, I mean, I just made right there a huge difference in how they're gonna approach stuff I know it's not cancer if you're having an intervention with someone You will always have lots of effects that are not non-specific effects. They're very important And most of alternative medicine is having those non-specific effects Feeling better and that's a good thing. It's just being done under false pretenses Right, so we're talking about a form of the placebo effect If what if the only benefit you get is the placebo effect So if you're using acupuncture or homeopathy and the patient does get better Maybe it's only because of your interaction and having someone with confidence that makes them feel better Yeah, and that's why they get better. Yeah, is that a bad thing? Well in current medical practice doing something specifically plus for placebo is considered to be unethical So the key one of the key concepts in medical ethics is the patient has to be informed as to what you're doing And the risks and the benefits they're the boss And if you're doing a placebo if if you're doing it for placebo and you're not telling the patient upfront There's no effort. There's no Sorry, there's no there. There's no evidence to show that X works Is it's a worthless therapy? And I'm gonna do it anyway, which nobody ever does Then you're doing placebo ethically, but if you're not doing without informed consent You're not doing it ethically and placebo outside of clinical trials is considered unethical in modern medicine Even if you have to lie better and still justify the means of is that the right one? Uh-huh. Yeah No, because you're not allowed to lie to your patient And by omission or commission I get that and I'm a lousy liar Yeah, so when I think ahead, you know, yeah, I know that this treatment has been Experienced to work has been observed to work. Maybe not in a controlled trial But yeah, a doctor does this and the patients get better. The Latin doctors are really Really nice guy makes their patients feel really comfortable. I have to wonder is that all that's going on and could I Tell the patient, you know This this therapy doesn't have an effect, but I'm gonna do it anyway because you're gonna feel better That would probably be an ethical way to do it Yeah, it would be interesting that they'd want to pay money for that. Yeah Let's say I just spent an hour you're doing something that doesn't work and you're doing it anyway And I'd give you $120. I don't think that's Gonna go But placebo medicine is not considered ethical in this society You're not allowed to lie to your patients ever by omission or commission. Is that a consensus of just a general consensus of Doctors. Yeah, you know, there's if you go and it's the official Guidelines of ethics. I may have it if you go the Wikipedia page on medical ethics They go through the the main points of medical ethics One of which is that the patient is the boss and has to be informed about what you're doing Honestly you got to tell them what you're gonna do and why and there's always I mean you always How you choose to tell people things always Biases them and you have to be careful about that, you know, if you tell them you have a 30% chance of dying they're gonna be a lot worse than if you say a 50% chance of living I mean how you phrase things is very important and you have to do it honestly with people but Those interactions have a lot of power With people and you have to be honest with people and that's the hard part of medicine Getting back to the controlled trials and and sham versus real treatments We try to figure this out a lot in chiropractic. How can you do a sham adjustment? How could you double-blind a chiropractic treatment? I don't know. I haven't read on that one. I haven't read Yeah, that's not something that I have read in or on so I can't answer that Usually clever people can come up with something that fools people, but I don't know if that's ever been invented the best idea I have is to take a full Term of students teach them sham adjustment with them thinking that it's real and then let them go out and practice and see What happens, but I don't think that would go over very well now something similar was done Which I've always found fascinating Was this guy I forget his name He was a palm reader and he got this amazing results with all his palm reading And then he started giving the opposite reading of everything he saw and Got the exact same Effects from the people he talked to Who was that? But I think that's But I thought that was fascinating how you can convince people you say he everything he saw he told the opposite and And he got the same Encouragement from his his Patience victims I don't know whatever word you choose for some of these two palm reader. Yeah, there's an interesting study that we talked about recently on idiopathic effects I think it's idiopathic. No, no, it's a different word idiomotor where Your Consciously you control what you do what you're the Ouija board Yeah, the Ouija board and so there is a doctor and I I want to say it was here in Portland But I'm not sure that did a similar trial and brought people in and showed them The water dowsing rods showed them the You know the the medallion hanging over the palm and if it goes in a circle that's a yes if it goes in a straight line that's a no and These people came up and tried it and it worked. Yes was yes But then you had a whole different cohort come in and said well if it goes in a straight line That's a yes, and if it goes in a circle, that's a no So you flipped it around but the same results. Yeah fascinating stuff really fascinating how that happens Have you ever been to a chiropractor? No Will you ever Consider going to one? I can't think of why yeah, I Don't have back. I don't have back. I did actually had a C-spy disc for about nine months That was miserable, but eventually it got fixed the old-fashioned way with a knife. Oh, really? Yeah, under surgery. Yeah, best day of my life as I woke up without any Cervical Ridiculopathy you cannot imagine I've had a lot of medical problems in my life, but the one I have sympathy for patients more than any other is Nerve root pain. Mm-hmm. It's there all the time It's miserable. It never gets better. I could never take narks for it because I was working Yeah, and it's just I want a doctor house. Yeah, nine months of misery until it got so bad They fixed it and I woke up pain-free But I don't think I never go I don't see a reason why we need to Do you talk much with chiropractors? Have you ever interviewed one or or discussed? How they yes on and off over the years you see us in social situations where you're polite and you don't want to cause a fuss You know, I mean Replace to cause of us. Yeah, it's not mine I mean, you know, like right now we you and I are having a civil conversation and I have no I honestly have no Urged to be an asshole. I mean Okay You can you could be aggressive and belligerent and it serves no useful purpose. It's fun to write that way I mean, you know, there's a great deal of fun and coming up with a Clever way to Say something written, but I'm talking to people. I mean we have a different approach in the world I'm sure and that's fine. I'll be happy to talk with you and I'm always gonna be civil and nice. That's How I tend to try and be you're right is you're writing is very aggressive now You don't pull any punches and just very to the point now And you know if you ask me a direct question, I'll give you a direct answer But I'm gonna be nice about it because I like to get along with people But I've never go to a chiropractor. I don't have a need to and I don't think it would work And if I had low back pain it would probably help But you know, I would probably just do the conservative thing of nothing and lie on my back and take some time Because most get better regression to the mean. Yeah If chiropractic could help with that quicker, would that be enough reason? Yeah, okay. I Don't know if there are any studies that show Show the time frame I haven't read that for a while. It's been a couple years. So it's kind of faded My memory is that it's as good as other modalities for relieving Bet low back pain, but I have to admit I'm my My It's been a while since I've read it and the only stuff I can keep active in my brain is infectious disease stuff Yeah, I mean if I thought I could get me better faster I'd go but I mean I always worry about The very real complications of Someone missing with my spine I mean, it seems to me that things are set up. Okay, relax relax relax There this rupture of a tibial artery now I know that the chiropractic literature denies that that is a problem But my reading of the literature suggests that especially with neck stuff People do get vertebral tears occasionally after this it seems I wouldn't take the risk for What would be marginal benefit for something that would be popping my spine? Is that risk as great as the as the risk of Iotrogenic, you know fatalities in the hospital. I just found another article yesterday. Yeah numbered it at 400,000 a year deaths are Caused by Medical treatment. Oh, yeah. I mean I sit on our quality council and I'm very proud of the work We've done to decrease complications and deaths and in my my hospital system We all since doing a lot of science and evidence-based interventions We estimate in the system. We have prevented over the recent numbers like 250 deaths over the last five years and over a thousand infections By doing all these quality interventions medicine is dangerous and I'm the first to admit that Uh, but also it's always a matter. It's not the absolute risk of the danger But it's the risk versus the benefit you come in with an acute heart attack What we're going to do to you is dangerous and risky and could kill you But it's a hell of a lot better than staying at home with your big heart attack If you come in with a dissecting aneurysm You're in a world of hurt. If you don't treat it, you're dead If you go into the hospital, you can get into serious problems from what we do with you, but the risk Is greater than the benefit If you have alternative modalities that are equal to chiropractic with less risk just go to a physical therapist and having a Massage, um, I go with that even though it's a tiny risk The hospitals are dangerous places Yeah, I try to avoid them as much as I can. Oh, yeah, I'm in them all day. I know what we can do to people Uh, but I also know all the things we do to prevent things from happening Yeah, but it's not just usually it's just not the absolute death. You have to bear in mind It's the benefit you gain from dealing with very Very dangerous medical conditions And I think we're at least in my school we talk about those risks as well But the numbers that are thrown out are one in about a million adjustments circle adjustments caused vertebral artery dissection And Is that a large enough risk? Oh, what's the benefit? I wonder if it depends on on what you're treating Yeah, I mean having seen big strokes In young people And how devastating it is there are things I would not take a one in a million risk for I wouldn't take a brain insult as a one in a million risk You know, it's just doesn't see oh I remember the one I saw as a girl who overstretched in her yoga class And as she was overstretching she tore her vertebral artery. Oh, yeah, it was a devastating devastating Problem if the risk was You know a little headache. Yeah, but strokes man can take care of a couple of those You know, there's there's certain diseases that know that you don't want to ever have to have as a doctor Because you've seen how devastating and brain insults are just not on my to-do list It's not worth the risk the benefit the many chiropractors claim is that upper cervical adjustments can Can correct many different issues from indigestion to allergies to Well, d.d. Palmer Yeah, just did the cervical neck to cure deaf deafness according to the story. Yeah, that's That's uh, interesting story And I don't know how like if you could tell me how adjusting the neck could cure deafness As a basic principles I would be interested I would too. I'm hoping some listeners can can shed some light on that It's like and many of these alternative medicines have very interesting origin stories kind of like, you know comic books and you know Get bit by a radioactive spider or you see that a bird has a broken wing and something an owl And then you see that something in its eye. Oh, look, there's the birth of iridology In ear acupuncture started because somebody's back pain got better after they Uh, uh burned their ear and he came and he came up with ear acupuncture as a consequence Uh, these don't seem to have a lot of basic principles to guide them if you ask me I would love to know how how adjusting the neck could cure deafness Um, or even if that's true. I don't know. Is that really a true story or is that a powerful? You know, it's repeated so often the the only variation that I heard on it Was a version in which Didi Palmer didn't invite the janitor in and and have this hypothesis of if I adjust here Something might change But rather the janitor was a joke teller and he loved Conversing with the other tenants in the building and Didi was reading a big heavy anatomy book and went out and listened to a great joke That uh that the janitor told and as he was laughing Didi slapped him on the back and said that was a That was a good one and that's when the janitor heard a pop In his neck and the next day was able to hear through that ear again. That's the only other version that I've heard Hi, I don't think many people are going to agree with that that's that's true. So there There are a few you know different versions of how that might have come about but yeah, but yeah He was able to hear again It doesn't just it just doesn't seem like the good basis of a medical intervention I kept looking during our my second quarter of anatomy during head and neck Uh for the nerve that goes from cervical vertebrae up to the ear And I couldn't find it. Yeah Well, I've got a couple quick questions for you. Uh infectious disease doctor you uh, I'm sure have studied a lot of microbiology That's what I'm in right now and oh can't wait to get over with it Well here I'll let you know in medical school. I hated microbiology. Yeah, so I'll go figure. I do it for a living kind of So what is your favorite microbe right now? Favorite. Yeah, it's one I can kill Which is happening less and less now. I always say that if I was a superhero my arch enemy would be staph aureus Um, because that's the one I try and kill most and have the most problems with professionally I don't know if you call if you give it's my favorite because it pays my mortgage And and my kids college tuition then staph aureus would be my favorite It's my least favorite because it caused the most pain and suffering and everything if you see If you had to limit yourself to one topic of debate, whether it's homeopathy vaccines reiki chiropractic the existence of aliens If you could only do one, what would you pick? Ah, so just a question It actually would be and probably this is not quite right but All the different cognitive biases Okay, so that's on the on that process of fooling ourselves rather than the outcomes If I had to pick one that has the most impact on That I think people use the most and has the most literature on it. It would be acupuncture It's amazing of all I have all these google and pub med alert set up to send me updates and acupuncture always is heads and tails more than anything I think it's because china a lot of people coming out of china and china is booming with medical and pseudo medical research So I'd probably pick acupuncture As I said, I've been listening to quack cast for quite a while, but you don't only do quack cast You've got you you're an editor for science-based medicine.org. Yeah, you're right for medline You've got medscape medscape. Sorry. You've got the gabatapas blog and Podcast, yeah, and now you've got the society for science-based medicine That you are helping run. Are you the lead on that? I've been doing me and jan. Uh, I've been doing the lion's share of the work I wrote the website and been doing most of the blogging et cetera on it Jan's doing she's a lawyer Uh, uh, jenna bellamy. She has she's been doing the legal aspects of this sort of thing As a student with like 30 hours 30 credit hours of of load right now I have trouble just you know cooking food. How do you manage all of this your whole online enterprise? Uh But you're prolific I mean every week you've got an article coming out and you've got a podcast quite regularly I mean, it'll be a weekend where you release four or five I Have a fair amount of dead time that I always have my p. Uh mac book air with so like I I'm I'm At work when you get a consult you send the resident off to see it the resident works them up and comes to you So I haven't maybe I have an hour to kill while the resident is Seeing a patient. So, um If if I don't have other work to do with the hospital, I'll write something Um, I don't watch tv anymore except for uh blazer games Uh, that's really it. I mean, I don't watch television I had my chair in the living room is sit where I can't see the tv and when the tv is on I just sit there and work and I uh Basically work from when I get up to when I go to sleep Amazing it's fun and I enjoy it, but just I don't have much dead time How much do you sleep per night? I usually go to bed bed 10 30 and get up between six and seven. Oh, that's not bad You're doing better than I am. Oh, you're The older you get the less you can tolerate a lack of sleep I mean, I don't I don't know how I did it when I was in my 20s Because I residency and oh, yeah those people work in 80 hour weeks and double shifts Oh, yeah, I couldn't do that now. So I just keep busy You know, what's your inspiration for a blog post? It's amazing stuff just sort of comes in if you keep it open If you keep your filters open and I have I can say I have uh, uh, google and pub med Um Alerts and then for my infectious disease stuff. It's just what you see every day is mind bogglingly cool I mean, it's it's amazing I've been blogging infects three times a week in infectious diseases Since I think 2008 And I almost never I've very rarely have had to repeat myself that much variety really it's really amazing So you don't you don't ever get bored any thoughts on the uh, this Spread of a polio like Uh disease in california that they've determined not polio or Yeah, I don't know much. I just know about what I read on a medscape. So I haven't heard much about it I'm sure the cdc is all over it, but uh I haven't I don't have an extra. I don't have any special pipelines into knowledge outside of the internet Yeah, that's been interesting. We've discussed that a few times in class Yeah, hopefully they find it Something that isn't coming our way is What was the uh What was the inspiration for fssbm for the society for science-based medicine? Uh basically I think that Well, that's just me, but us and the folks at science-based medicine basically that we're an underrepresented How do you want to say cult? We're an underrepresented cult In the world. I mean if you go to in the in the skeptical world And that stuff there's very little about science-based medicine and there's very few of us who Have an interest in it Compare if you take your average, you know skeptical inquirer There might be an article Harriet Hall writes and in the skeptic magazine You'll see Harriet's but it's you know, bigfoot UFOs and Kennedy conspiracies and all the the big ones and in medicine Most docs are too busy and although the IDSA has a lot of interest in vaccines For example, they don't have a big thing that I've ever found about combating anti-vaccine issues And so I think there's a void in both organization and uh and focus In this area And so I thought we'd start this in an attempt to have better focus on areas of critical thinking as it applies to medicine And it was uh So bringing a group of of skeptics into science-based medicine Yeah, uh more take critical thinking out of our area and into the rest of the world Yes, uh doctors are horrible to organize. So Uh, I thought well, let's just give it a shot and see what happens seems like it's taken off quite a bit Yes, I'm pleased. I'm we figured we get two or three hundred members in the first two years. I think we got 500 Uh, uh people at least 500 on the uh who have registered for the website in a country of 300 million We can go farther, but it's very reassuring. How many followers do you have on twitter? I don't know 600 maybe okay 800 something like that and you you keep track of subscriptions to the podcast No, I am very bad at all those sorts of things I You know, there's a you can have a choice between producing and consuming And I just tend to throw things out there and forget about them, which is not a good way to do stuff Maybe you have try for a relentless self-promotion. Uh, I don't spend I don't twitter enough I I totally do not get facebook Uh facebook tend tattoos Mark me as uh an old geezer because I don't understand either of them Uh, you know, I don't do that. So I tend to produce stuff and throw it out there and just let people do What they want. I don't pay enough attention to that stuff And I should help probably helps keep us sane mind with that and all that stuff Um, I spend a lot of time on on social media probably more than I should especially while I'm in grad school Let me come on But I'm on youtube. I'm reading comments on you know youtube videos about chiropractic and I hear a lot Uh People commenting and saying, you know chiropractic Students or chiropractors Just have to be incredibly stupid or just shockingly ignorant or just devoid of scientifically of scientific thinking To believe in this stuff I mean, would you go that far as to say that they're just Not intelligent No, I think it depends on like all things Is great homo heterogeneity in the field So I there are those like, uh, sam homo. That's how you pronounce his name. Uh, who, um, uh What's nothing to do with sublexations and which energy is it? innate intelligence Yeah, thank you There's so many different terms for these energies. I can't remember them and he's a chiropitalism Yeah, he's a chiropractor and he wants nothing to do with that. Uh, and then there's people who, uh, Are strongly anti-vaccine and will treat your asthma with chiropractic and there's a great variety So I you know, we had a friend whose Boyfriend was a chiropractor and he's a nice guy who did reasonable things and it's variable It's like they're goofy at doctors and they're really good doctors They're all right, you know Was it have you seen doctored the movie that came out a year or two ago? Yeah Yeah I think it's in that one that they have medical doctors talking about, you know vaccines cause autism and homeopathies You know my preferred prescription um, yeah It is I appreciate that you say that it is More of the variety of individuals because when I'm in school and I'm sitting next to classmates They're incredibly educated. They are sharp as can be. I mean I can talk about just anything with you know within the medical field or chiropractic or Whatever it might be and astrophysics, you know pick whatever and they have A pretty solid foundation and knowledge in that and so it's difficult for me to You know to hear that chiropractors in general must be diluted I don't think you can do that's why I said earlier. I don't know why people use alternative medicine you can It's what the individual Given individual I don't think you can speak to chiropractors As a whole as anything Because you versus and I'm sure there's that gullible shit for brains who sits in the back Uh, there's certainly I know them in my world They existed all fields at all times unfortunately Uh, education does not necessarily mean critical thinking and education doesn't necessarily mean you're a good person Education just means you're educated and so You know chiropractors are probably as a group that I would enjoy having did Individuals that I probably have a great time having dinner with and people that I'd want to run away from as fast as I could And that applies to every group of people I know As I said earlier, it's not the person from my mind and I kind of keep this in mind. It's the Concepts it's not the sinner. It's the sin And there's great variability in human beings Is evidence-based chiropractic and oxymoron No, the question is do you act on the evidence? You can have evidence-based uh, I well I probably should have said this at the beginning because Harriet Hall tends to write most of the chiropractic Stuff for science-based medicine and since she's always headed me on that I will tell you I should have told you this up front I don't read that stuff as much as I read other areas Because here it's kind of Harriet's um Bigger area of interest and I can do that for whatever reason have fallen more into acupuncture And I tend to be writing a lot about that lately um Uh, uh, what was the question? So oxymoron Oh, so now now the question is is do you then Act on the evidence? And if you got good studies that show something is not effective Do you abandon it? That tins in the alternative medicine world tends to be resistant to change on the basis of evidence Harriet had an article recently where she took An article from somewhere some chiropractic blog on the 10 best papers from the past year Yeah, I remember that yeah, and she discussed each one of them in detail and And explained how this one may not have had a large a large enough sample size of this one came to a questionable conclusion And I would agree that it's difficult to do quality chiropractic research I mean to get a large sample size to blind patients. That's a challenge Yeah, you don't need to put the word chiropractic in that sense It's difficult to do high quality research And everything yeah any kind of yeah, and so you know, I that's if people care enough. It's amazing what it gets done Um, I just have to be a little obsessed about it. I think quality research is possible In any place that sets their mind to it. I mean the nca am our ncc am Funds alternative medicine research someone comes up in a teaching institution with a good It's there. It's just hard and difficult But it's that way for medicine for anything money's tight and research is hard. That's why I don't do it In the money money, unfortunately I think is one of the big factors and in creating a large quality study And that's what's great about the nc cam I think and my school has a study that's just wrapping up We did one on low back pain. We were currently in the process of doing one on cervicogenic headache I think I've heard you say though that the nc cam should be absolved We shouldn't be putting money into alternative therapy research. Well to date they've spent. Oh, what was the sum? I forget a serious chunk of change and showed no benefit show the and you know their um Mandate by the congressman was to show that these things were effective. What's his name? Um The guy who funded it I'm blanking. I don't know who's behind it harkin Senator harkin he got funding for it with the express purpose that it's supposed to show these things have benefit Not to show whether or not they work but to show they did work and they've not shown anything has worked From a scientific method viewpoint, isn't that biased already to say you have to show that it works? But yeah, that's why it's not a good reason to fund an agency So if they had come out and say let's look at whether or not this works. Yeah, and fund it with that purpose Yeah, he was upset because they haven't shown anything works. Yeah, well because it doesn't work. That's life How long has it been funded to my knowledge has it been that long? less than 10 years I'd have to google that. I don't know How long does it take for positive results to come out Uh, you can do most studies in four or five years If you can get enough patience and write them up Uh, what's her name? Eugenie? uh Mazariac I think her name is She wrote a nice article in skeptical inquirer going through all the funding and results of the nccam in the last year or two unfortunately SIA just never puts their stuff online so people can read it Their old school paper Hard to get a hold of yeah Well, I want to wrap it up. I don't want to take too much of your time I want to give you the chance talk to me talk to other chiropractic students. What would your advice be? I don't know Let's let's let's clear I mean, I I think I know what your advice would be to a student who's considering chiropractic But how about a student that's in chiropractic school right now and you know wants to Do their best to be evidence-based to practice based on the science What do you tell them If I say anything I think this is true not only of chiropractic students of anybody is is to understand How bad you think To really understand the cognitive biases confirmation bias to understand that all those ways that we find um Results were nonexist I mean my favorite article my epiphany on that was an article of the American Journal of Medicine Years ago called spiraling empiricism And it was an article on all the different cognitive problems people make medically in infectious diseases To make them think they're doing something and it's a very it's a classic in my world for bad thinking If I were to tell anybody chiropractic student or naturopathic student or medical student Learn how bad you think and apply it to yourself But most people don't do that. That's the problem that I would hope to fix someday I love it. Thank you. Thank you so much for your time. This isn't really been enjoyable to talk with you No problem