 Let's go to our final presentation today. Keeping with the variety, we have Joanne Benamou, and she is a registered nurse working in clinical research in the area of radiation oncology. She is also, and let me take off this list, executive director of Friends of Science and Medicine on the committee of the Australian Skeptics, administrator of Stop the Antivats Network, and founder of the Facebook group Nursing Skeptically. So of that list, the top of the list, she's gonna talk to us about Friends of Science and Medicine standing up for science in Australia. Please welcome Joanne. And I'm not the executive director of Friends of Science and Medicine, I'm on the executive. So a little bit higher up than I'd intended. Okay, so as Ray said, I'm a registered nurse by profession and I work in clinical trials and radiation oncology. And this morning I'm gonna be talking to you about how a small group of concerned health professionals and scientists have set about standing up for science in Australia in the face of a growing alternative health industry, which is based largely in pseudoscience. A couple of brief disclosures that I've set up on the executive of FSM. I'm also a committee member of the Australian Skeptics Inc. And Australian Skeptics provided an initial startup grant to FSM. So my talk today is about Friends of Science and Medicine in Australia. And it's gonna be divided into two parts. The first part is gonna cover the main streaming of CAM, Complementary Alternative Medicine. And the second part will be about the formation of Friends of Science and Medicine itself. I'm gonna explain why Australian scientists, doctors and allied health professionals see the need for an organization to counter claims and commercial ventures that exploit vulnerable people's need for cure. So what do we mean when we talk about CAM? Many things fall under the CAM umbrella. Some, but very few, have evidence to support the claims made for their use. Under the Complementary umbrella, we can include somewhat innocuous treatments like aromatherapy, meditation, and some vitamins and supplements. But then there are those that seek to act as primary care providers like chiropractic and homeopathy. And these are the ones that we're most concerned about. They're the ones that pose the greatest risk, either because of their intrinsic anti-medicine stance or because the treatments themselves have an unacceptable risk benefit profile. Now the use of CAM in Australia is staggering. Approximately two thirds of the population use at least one form of CAM remedy or intervention. So we're not talking about a mind power cottage industry here, we're talking about billions of dollars annually. In 2006, a study found that almost as many visits were made to CAM practitioners as were made to medical practitioners. And if you have private health insurance in Australia, you can be reimbursed for many of these CAM treatments regardless of efficacy. And of course there's the problem with universities. You can now graduate with a degree in chiropractic or traditional Chinese medicine. So from the industry side of things, historically one major company played a significant role in where we find ourselves today. In 2003, the Therapeutic Goods Administration, the TGA, which is equivalent to the American FDA, ordered a major recall of pan-pharmaceuticals products and suspended their license. This prompted a review of the alternative medicine industry and the review found major weaknesses and potential dangers to the public. They recommended about 49 areas for reform, which were to be implemented by a joint Australia New Zealand authority. However, the head of the company, Soothe TGA, claiming that the TGA had failed to adhere to due process. And in 2008, they received a settlement of 50 million Australian dollars. And this left the regulatory bodies extremely shaken and reluctant to pursue similar action in the future. Sadly, in the previous year, the proposed joint authority collapsed taking with it much of the intended reforms. And this brings us to where we are today. So the TGA is now seen as a toothless tiger. We have a two-tier system whereby your pharmaceutical or more high-risk products like chemotherapy antibiotics and so on fall under the OST-R system, which is the registered products, while the more low-risk products, which most of the can products fall into, go into the OST-L or listed category. Sponsors are simply expected to confirm that their product only has low-risk pre-approved substances. They're expected to hold evidence for the product, but they don't actually have to submit it for review. The TGA's Complaints Resolution Panel is seriously under-resourced and very slow to respond to any complaints. And there have been repeated breaches of the code. In fact, in 2011, a review found that 90% of those products assessed actually breach the code. But there are few, if any, consequences. And those sanctions that are available are even non-punitive or ineffective. And an example of this is one of Australia's major companies, Swiss. They're a huge producer of vitamins and supplements. And in 2013, just in April, actually, they were found to have mislead consumers with a product called the UltiBoost Appetite Suppressant, which Swiss claimed caused weight loss and significantly reduced hunger. So what Swiss did in response to this was to simply rename the product to UltiBoost Hunger Control, relist it and replace it in stores under the new name. Now, incredibly, since its inception, the TGA have not made one single prosecution. So adding to the current situation is a powerful CAM lobby which includes the Complementary Health Care Council of Australia. And they lobby against proposed changes which would strengthen consumer protections. Now, in 2008, there were plans to end the OSTEL listing system and replace it with one which actually assessed the efficacy of products. And the director of the council stated that this flew in the face of sound, efficient and economic risk-based regulatory practice. Now, sadly, the public appear to be either unaware or apathetic to the problem. Our crew is the Australian Health Care Practitioners Regulatory Authority, or Regulatory Agency. I hate the acronyms. And they came about in 2010 at the same time as the health practitioner regulation law came into effect. And what this effectively did is to bring most of our health professions under one regulatory umbrella. The problem is that APRA doesn't evaluate the validity of the theories and treatments which underpin the professions that it regulates. So we have a system now where we have medical practitioners, nurses, psychologists, physiotherapists and so on under the same umbrella with chiropractors, traditional Chinese medicine practitioners and osteopaths. Now, there has been much criticism leveled at APRA in terms of how this process has been carried out and in particular over the issue of the individual professional boards which govern each profession. One of the arguments, of course, by having them there, we are giving the protection to the public, but the counter-icom to that is that we're legitimising pseudoscience. And one of the examples of this is the Chiropractic Board of Australia. The board has been widely criticised for failing to act on a number of very worrying issues. Firstly, chiropractors treating babies and children for a range of diseases. And in addition, chiropractors generally making claims for clinical effectiveness for non-musculoskeletal condition, which I'm sure many of you would know or have heard that the only evidence that exists for chiropractic is for low back pain, which is really not different to physiotherapy for low back pain and so on. The other issue has been their failure to speak out on the use of the controversial subluxation theory as the basis for chiropractic. And it was also found recently that there are a number of continuing professional development courses available for chiropractic, which contained anti-vaccination information. And these were tacitly given endorsement by the board who had farmed out the continued professional development to one of the other chiropractic organisations. Adding to that also is the fact that 70% of the professional membership of the Australian anti-vaccination network are chiropractors. So moving on to the university system, as I mentioned earlier, you can now get a degree in many of these practices and a survey by the Australian Skeptics in 2011 found that out of the 39 tertiary institutions in Australia, 30% offer high level degrees under the Health Sciences Banner, which are based in CAM. And these range from a bachelor's degree all the way up to a PhD in chiropractic. Similarly, there are legitimate academic courses such as nursing, midwifery and pharmacy, which incorporate CAM into their programmes. So for example, although thankfully it's not widespread in nursing, there are some courses which carry a component of therapeutic touch. Or within midwifery and pharmacy, you can complete part of your programme in complementary medicine and integrated medicine. And it's not just about learning what they are, it's about how you can incorporate it into your practice. Sorry, how do I go back? There are also many alternative colleges which offer bachelor degrees in homeopathy and naturopathy. These do sit outside the university system, but they're recognised as legitimate courses by the government, which you can see by the fact that students can actually receive government assistance in the form of student loans. So now for the second part of the talk, I'm going to talk to you about Friends of Science and Medicine itself and a little bit more about the problems with CAM that have led to its formation, how we've gone about creating an effective lobby group, the actions we've taken and achievements thus far and where we plan to go from here. So as I've covered so far, this is an industry that has little government audit or control. Many of the treatments available are either ineffective or potentially dangerous and there's real potential to delay evidence-based diagnosis of treatment. Quality control is a significant issue with many instances of adulteration, contamination, variable dosing and missing ingredients. And there's also widespread misuse of pathology testing. So recognition of these issues led to widespread alarm amongst academics, clinical researchers and laypeople. And in 2011, the current secretary and CEO of FSM, Loretta Marin, compiled a report on a pediatric chiropractic clinic being run out of the Royal Melbourne Institute of Technology, which also runs one of the chiropractic degree programs. This was supported by several of the current FSM executive and it received widespread media coverage. In September of 2011, the co-founders of FSM as well as 29 of our supporters issued a protest to the Central Queensland University regarding their 2012 Bachelor of Science in Chiropractic. And it was these actions that laid the foundations for the new group. In December of 2011, FSM was formally launched and in February of the following year we became an Incorporated Association. In March we launched our website. The founding members form a cross-section of concerned professionals with a history of promotion of good science and medicine. Our president is Professor John Dwyer, Emeritus Professor of Medicine. And we have two vice presidents, Professor Alastair MacLennan, Professor Rob Morrison, our treasurer Professor Marcello Costa, and our very, very busy secretary and CEO Loretta Marin who many of you might come across before. So we've committed ourselves to a number of very important ideals. We'd like to see the removal of pseudoscientific courses from tertiary institutions. We intend engaging regulatory authorities in harm reduction strategies and to publicly challenge the non-scientific principles of many practitioners of CAMHS. Public engagement is incredibly important in order to help clarify the importance of good science for better healthcare, and in particular to educate the public so that they can access evidence-based healthcare and avoid misleading and sometimes dangerous CAMHS. So it's been a very busy couple of years for us. We initially wrote to the vice-chancellors of all of the universities to validate the initial information that the Australian Sceptic's got on the pseudoscientific health courses. We did receive replies, and they varied from the helpful to the ambiguous, and some of them were downright hostile. Some didn't reply at all, and you can see their responses on our website. Very importantly, we met with the Parliamentary Secretary for Health and raised our concerns regarding the lack of oversight of the industry, the pseudoscience and universities, and in particular fundamentalist chiropractors. We've also made several submissions to regulatory bodies, including the TGA, and we've also written an open letter to private health insurers asking them to withdraw the CAMHS rebate for therapies which have no evidence base. We've provided this to anyone who actually wants to submit that letter themselves to their insurer. We've also written to all of the chiropractic organizations regarding the inappropriate treatment of babies and children and also to the university faculties offering chiropractic regarding their position on subluxation theory. Now, at the moment, the government is conducting a review of the rebate for natural therapies with private health insurance, and in May of this year, Professor Dwyer presented at this review. Sadly, FSM was the only voice for science in medicine, and we're still awaiting the results of this review. Now, it was recently discovered that probably the Cormidwifery textbook which is used in every university in Australia is in its section on discussing vaccination with parents is directing students to the Australian vaccination network as a source of non-government information on vaccination. And when we discovered this, we took action and this resulted in pretty good media coverage. We've also been in touch with our state health departments and they've directed the universities to alert the students to the misinformation in the book. In addition, the editors have given reassurance that they will be removing this section of text from the next edition of the book. What we do, people about the last six years of midwives who've been exposed to the textbook in its current form, I'm not so sure. Now, one of our significant achievements has been to simply attract media interest in the issue and this has been very successful indeed. As you can see by just the small selection of the coverage that we've received. And I'd encourage you also if you can to get hold of a program called Catalyst which screened on Thursday night in Australia which gave an excellent expose of pediatric chiropractic and which FSM played a significant role in. Our membership has grown rapidly, attracting a broad range of health professionals, scientists, journalists and consumer advocates. And we've got our first Nobel Prize winner, which we're delighted to welcome Professor Peter Doherty. Now, these are people who in the words of Professor Rob Morrison, are keen to defend not only the good name of health but the good name of science against those who seek spurious scientific respectability while debasing the science that they invoke. Internally, we have established working groups to address specialty areas including pharmacy and nursing. We have a regular column in Australasian science called Bit of Hill which we do accept submission for as well. And we've partnered with Linda Rosa from ISM to form an international discussion group for nurses and we're aiming to collaborate on an international white paper on nursing. We'll also be releasing a position paper later this year on pathology testing which is supported by the Royal College of Pathologists in Australia. We've also expanded our executive recently to include myself and Dr. Sue Yurachi who's a specialist in emergency medicine. So given the wide range of chem modalities, the lack of government oversight and the increasing public buy into the naturalistic fallacy, we unfortunately do face a long road ahead. However, we are now considered a powerful lobby group with a rapidly growing support base. And in the face of an aging population with an increase in burden of disease, it is more important now than ever that our scarce health dollar is not squandered on ineffective and potentially dangerous pseudoscience. Now, you too can offer your support by visiting the FSM website and becoming a named supporter of our objectives. Thank you, Jill and we have time for maybe one or two questions. Do we have any, please come up. So from my perspective in British Columbia and Canada in general, we have extended health has now been extended to chiropractors and other pseudoscientific health ways. My question is, do you feel like you're winning? And if so, can you help us win? Because we're not. I don't think we're winning yet but I think that we are in a position now where we've got enough voices that are trusted by the public that if we can keep getting that message out there then the public will start to realize what an important issue this is. And I think particularly, that main issue that I raised at the end about our scarce health dollar, we endlessly hear about the problems in our public hospitals, about having enough nurses and all of those issues. So I think if you can engage the public on why this is so important in terms of evidence-based healthcare, that is a really important message to get out in terms of why money is being funded away from the important side of healthcare, things like palliative care and aged care and all of those areas which are really missing out. I think that's a really important part of it. But yes, please get in touch and we can see what we can do. Let's thank Joanne one more time. Thank you so much. Thank you.