 I'm back again. This is Dr. Harriet Hall with the last in a series of ten lectures on science-based medicine. Science-based medicine should be a no-brainer, but there are forces working against it. It's being undermined by the media, by politicians, and even by doctors who don't understand it. In this lecture, I want to address some of the trends in our society that are hazardous to our health. Electrons are continually demonstrating that the general public is appallingly ignorant of science. Only 40 percent of Americans accept evolution. Only half of American adults can tell you how long it takes for the earth to travel around the sun. Fifty-three percent of Americans don't know that electrons are smaller than atoms. The age of enlightenment represented a revolution in human thought, turning from superstition to science and reason. David Cahoon refers to the last 30 years as the age of endurkinment, in which truth no longer matters very much, and dogma and irrationality have become respectable. He says, A minor aspect of the endurkinment has been a resurgence in magical and superstitious ideas about medicine. The existence of homeopaths on the high street won't usually do too much harm. Their sugar pills contain nothing, and they won't poison your body. The greater danger is that they'll poison your mind. Carl Sagan said, We live in a society absolutely dependent on science and technology, and yet have cleverly arranged things so that almost no one understands science and technology. That's a clear prescription for disaster. I'll be covering these four topics, the media, politics, licensing of CAM providers, and quackademia. First, the media. According to Mark Twain, if you don't read the newspaper, you're uninformed. If you do read the newspaper, you're misinformed. He said that over a century ago, and things haven't changed. Science reporting in the media is particularly unreliable. Reporters don't know much about science, and things get lost in translation. In this cartoon, the scientist is telling the reporter that they destroyed 10% of the cancer cells on a lab rat's tail. And the headline comes out, Cancer Cured. Quite often a reporter just reads a press release, swallows it whole, and regurgitates it undigested, because he doesn't have the scientific background to understand it or to put it into context for his readers. The purpose of the newspaper is not to inform the public, it's to sell newspapers. Sensationalism and controversy sell. And reporters sometimes spend the news to make it fit their beliefs. Here's an example. I read these news reports in two different news services. New study shows that glucosamine and chondroitin are effective in treating osteoarthritis. New study shows that glucosamine and chondroitin are ineffective for osteoarthritis. It sounds like these were two studies that got opposite results, but they were actually two reports of the same study. How could that be? Well, here's the explanation. The study compared five treatments, glucosamine alone, chondroitin alone, glucosamine and chondroitin together, selicoxib, a non-steroidal anti-inflammatory drug, and an inert placebo. Only the selicoxib did better than placebo. But the patients had been stratified by their level of pain at the beginning of the study, and the researchers wanted to find something positive, so they went back and looked at each of the resulting 10 subgroups. It appeared that the group with moderate to severe pain had responded to the combination of glucosamine and chondroitin better than to placebo, but the group with mild pain didn't. With selicoxib, both the groups with mild and with moderate to severe pain responded. Now, when you measure 10 things, one of them may appear to be positive just by chance. The authors themselves cautioned that the study was not designed or powered to draw any conclusions from subgroup findings like these, and that further studies would have to be done before they could conclude that the combination was effective for moderate to severe pain. Now, I'm skeptical because I can't think of any other treatment that has a greater effect on severe symptoms than on mild ones. Have you ever heard of a painkiller that relieves the severe pain of kidney stones but won't relieve a mild headache? I'm also skeptical because there was a study in Canada where they looked only at patients who were already taking glucosamine and who believed that it was working. They randomized them and left half of them on glucosamine while they switched the other half to a placebo, and the patients couldn't tell the difference. Anyway, it's obvious that the way this story was reported was skewed. Perhaps the writer was biased and wanted to believe that glucosamine worked. Or maybe he just thought that it works would make better headlines than it doesn't work. Reporters are fixated on telling both sides of the story. They try to provide the appearance of balance and not to favor one side over the other. Well, balance may be appropriate for questions of opinion, but not for questions of fact. When there are established facts, you should favor one side over the other. It would be silly to give equal time to people who are out of touch with reality. If you write about astronomy, you shouldn't feel obligated to give equal time to astrology or to the Flat Earth Society. The LA Times recently recognized this. The editor said, simply put, I do my best to keep errors of fact off the letters page. When one does run, a correction is published, saying that there is no sign humans have caused climate change is not stating an opinion. It's asserting a factual inaccuracy. The media allows celebrities to pontificate on subjects they know nothing about. Here are a few examples. Jenny McCarthy frightens patients into rejecting vaccines by saying vaccines will make their children autistic. Suzanne Summers encourages irresponsible self-experimentation with hormones, and she claims to be a cancer expert. Dr. Weil believes that intuition and stone-thinking are better guides to the truth than science. Oprah gave a platform to all kinds of questionable claims. She featured Kim Tinkham on her show. Tinkham read the book The Secret and decided that she could heal herself of breast cancer. She believed that if she simply wanted it badly enough, she could change her reality. She rejected conventional treatment that would almost certainly have cured her, and instead she used Dr. Robert Young's PH Miracle Diet. Oprah's viewers heard how she was empowered by making her own choices. They didn't hear how she died of metastatic cancer, not long after her TV appearance. I wonder how many women rejected surgery and chemotherapy after they watched that show. Dr. Oz has endorsed every kind of charlatan on his show. He even featured a psychic who talks to the dead. He said that this can serve as a kind of psychotherapy. Every week he promotes a new quack treatment or worthless supplement, often for weight loss. He does offer a lot of sound medical information, but he mixes it with errant nonsense, and his viewers have no way of telling which is which. With his huge audience and his prestige, he may have done more to promote quackery than anyone else in America. And then there's the internet. More and more people are turning to Dr. Google for their medical information and health advice. Dr. Google is like Jekyll and Hyde. There's a good Dr. Google and a bad Dr. Google. There's a lot of excellent information available, but naive internet surfers are far more likely to find misinformation. Here are a few of the unreliable websites. There are thousands of unreliable ones, but I'll just list a few of the ones that happened to have particularly annoyed me. Whale.2 is a crank website run by a pig farmer. Mercola.com is run by a D.O. named Joseph Mercola. Natural News is run by the health ranger Mike Adams. The Age of Autism and the Australian Vaccination Network are both anti-vaccine sites. The Weston Price Foundation. Weston Price was a dentist who believed all kinds of weird things about nutrition as well as about dentistry. And the Huffington Post. It has a lot of good articles, but it also has some atrociously bad ones on health subjects. You should assume everything on these websites is false until proven otherwise. And then there's good Dr. Google. There are plenty of trustworthy websites, and I couldn't possibly list them all. But here are a few of the ones that I go to when I'm looking for information. Government sites like the National Institutes of Health and the Centers for Disease Control. Professional medical organizations like the American Academy of Pediatrics, the American Academy of Family Physicians, and the American Congress of Obstetricians and Gynecologists. Organizers like the American Cancer Society. QuackWatch. And there's PubMed and Google Scholar where you can find all the studies that have been published on a given subject. And here are a few of the many blogs that I've found to be consistently trustworthy. Science-Based Medicine, of course. It's a collaborative effort, a multi-author blog with a number of science-based writers. I've been writing an article there every Tuesday since January of 2008, and our searchable archives are a great source of reliable information. Neurologica, Respectful Insolence, Improbable Science, Bad Science, and Ed's Art Earns blog. These are listed in the course guide where I've also listed some recommended books for further reading. QuackWatch maintains a list of non-recommended sources of health advice, as well as questionable products and questionable advertisements. QuackWatch's Dr. Steven Barrett has a rule of thumb. If you eliminate the websites that are selling something, the ones that are left are more likely to be trustworthy. Enough about the media. Now on to the next topic, politics. Our legislators do not understand science. Mark Twain said, suppose you were an idiot and suppose you were a member of Congress, but I repeat myself. Some of our legislators are not only scientific illiterates, but they have made fools of themselves with astoundingly stupid public statements. Here are just a few of the many, many examples. Representative Todd Aiken told us that rape can't cause pregnancy. Representative Michelle Buckman said that the HPV vaccine causes mental retardation. Representative Paul Brown said, all that stuff I was taught about evolution and embryology and the Big Bang Theory, all that is lies straight from the pit of hell. Would you believe Brown is an MD and he's on the House Committee on Science? These people are making our laws. Scary, isn't it? Politicians are interested in getting re-elected. There is much political wheeling and dealing. Political opinions of powerful legislators often count more than scientific or philosophical truth. Reason TV produced this video, The Alternative Medicine Racket, How the Feds Fund Quacks. There's a link to this video in the course guide and it's well worth watching. It only takes 15 minutes. In 1984, a congressional committee reported that con artists selling alternative medicine were swindling the public out of $10 billion a year. Twenty years later, these same con artists were being funded by the government and were infiltrating every level of the medical establishment and preying on the old, the sick, and the desperate. What happened? Why is the government funding quackery? Senator Tom Harkin was partly to blame. He was convinced that his allergies had been cured by bee pollen and he created the Office of Alternative Medicine, not to do scientific studies to find out if alternative medicine worked but to validate his beliefs that it did work. The OAM morphed into the National Center for Complementary and Alternative Health, which was recently renamed the National Center for Complementary and Integrative Health. Dr. Joseph Jacobs was named director of the OAM because he was a Mohawk Indian who had used traditional remedies and they thought he would be sympathetic to cam. But he was also a rigorous scientist. He was unable to do his job because the OAM advisory council was packed with quacks. Under political pressure to validate dubious treatments without scientific evidence, he resigned. He was succeeded by political appointees more willing to do the bidding of their masters. The two biggest mistakes our lawmakers have made are the NCCAM, now the NCCIH, and the DSHEA. Science-based medical doctors would like to see the NCCAM defunded and the DSHEA repealed. The National Center for Complementary and Alternative Medicine was established in 1991 by CAM advocates on both sides of the aisle who believed in CAM or who supported the diet supplement industry and wanted its claims to be scientifically tested. Its agenda has been shaped by politics, not by science. It has studied things like the effects of lavender and lemon oils on wound healing and the benefits of distant prayer for AIDS. It has wasted scarce research money on studies that had no scientific merit and that never would have been funded without political pressure. This was the idea behind NCCAM. All unproven methods should be studied so we can disprove the ones that don't work and discard them once and for all. That sounds like a great idea, but the problem is that nothing ever gets discarded. After spending $2 billion of taxpayer money, NCCAM has never demonstrated that a single CAM treatment is effective and it has never been willing to declare that any CAM treatment is ineffective. That's not much of a track record, is it? When studies of a CAM treatment get negative results, instead of rejecting it, they just recommend further study. And it gives CAM a prestige it doesn't deserve. It allows believers in CAM to say, well, there must be something to it because the government is studying it. The great majority of the studies that have been funded by NCCAM had so little scientific merit that without political pressure, rigorous scientists would not have recommended spending scarce research funds on them. Our Barker-Bassel says, it's become politically correct to investigate nonsense. To make the situation even worse, many of these studies have violated ethical guidelines. The Helsinki Declaration says, medical research involving human subjects must conform to generally accepted scientific principles, be based on thorough knowledge of the scientific literature, other relevant sources of information, and on adequate laboratory and where appropriate animal experimentation. A study must be scientific in order to be ethical. There is nobody of basic science, laboratory, or animal experimentation to support many of the implausible things the NCCAM has studied. And there are other ethical violations. Informed consent is often inadequate. They overstate the value of the treatment, they minimize the likelihood of harm, and they fail to divulge essential information. There's often a lack of medically competent supervision. In a trial of homeopathy for ear infections, the researchers didn't treat the patient's pain or monitor them for complications. There's a lack of clinical equipoise. Clinical equipoise means that if you're going to randomize subjects to two treatment groups, there should be genuine uncertainty as to which treatment is best. If you know one treatment is inferior, you would be harming patients by putting them in that group and denying them effective treatment. That's why we can't do a vaccine study where a controlled group is denied the protection of vaccines. I'm going to tell you about two of the clearly unethical studies the NCCAM has funded. The TACT trial to assess chelation therapy for heart disease, and the Gonzales trial for cancer treatment. Chelation therapy was originally intended to treat mercury and lead poisoning. The chelating agent binds to the metal ions and allows them to be removed from the body. A few doctors hypothesized that chelation might improve cardiovascular disease by detoxifying the body, and they opened chelation clinics and started offering chelation not just for heart disease but for 70 other diseases too. Patients have died because chelation treatment caused fatally low calcium levels. Two of those deaths were in autistic children. There had been several small trials and there was abundant additional evidence from basic science, case studies, and legal documents. We had good evidence that it didn't work and was dangerous. But then an editorial in the American Heart Journal argued that chelation therapy couldn't be ruled out for heart disease because there hadn't been any large randomized control trials. That was a typical party line evidence-based medicine argument. As I explained in lecture one, evidence-based medicine tends to disregard prior probability and evidence from other sources and to rush straight into randomized control trials. That was just the kind of excuse the NCCAM wanted. It funded the TAC trial to assess chelation therapy. Dr. Kimball Atwood headed a group that did a comprehensive review of the TAC trial while it was still ongoing. Among other things, they found there was prior evidence that chelation didn't work and was unsafe. There were no laboratory animal or human phase one or two studies. The trial failed to conform to the Declaration of Helsinki Mandatory Ethical Guidelines. There were deficiencies in the NIH application process. The informed consent was inadequate. It failed to divulge potential adverse effects. There was inappropriate political pressure. The investigators failed to divulge conflicts of interest. They stood to gain financially from the study. Some of the investigators were shady characters with previous misconduct. Dr. Atwood's group concluded, TACT is unethical, dangerous, pointless, and wasteful. It should be abandoned. But it wasn't abandoned. And the results were equivocal. There was no difference in the number of deaths, heart attacks, strokes, heart surgery, or hospitalizations. But there did appear to be an advantage for one subgroup of patients who were diabetic. That was enough for them to claim that the overall combined effect was positive. These results allow proponents of chelation to claim that it works just as they did before the study. And they allow science-based doctors to claim that it doesn't work just as they did based on prior evidence before the study. So we're right back where we started, only $30 million poorer. And there were serious problems with the study. The 95% confidence intervals indicated that if they had repeated the study with a different group of subjects, the results might have been entirely negative. There were a lot of dropouts, and there were more dropouts in the placebo group. One in five subjects withdrew consent partway through the study, suggesting that they might have dropped out because they believed in chelation, and when they found out they weren't getting it, they didn't want to continue with what they thought were useless treatments. There were some other things that looked funny. There was a lot of incomplete data, there was a failure of blinding. 180 subjects died during the study, and two of the deaths were directly attributed to the effects of chelation. Another unethical study was a trial of the Gonzales Protocol for treating advanced pancreatic cancer. I mentioned it before in lecture eight when I talked about coffee enemas. If you'll remember, the protocol requires all of this. Coffee enemas twice a day, freeze-dried pancreatic enzyme, nutritional supplements 130 to 160 doses a day, special diet of organic foods, preparing fresh juices many times a day, skin brushing daily, and liver flushes. The NCCAM study compared the Gonzales Protocol to a conventional oncology treatment for advanced pancreatic cancer, chemotherapy with gymside beam. The Gonzales Protocol is implausible. Just as with the TAC trial, there was no good scientific rationale for doing the study, and there was no body of basic science or animal experimentation to support it. The consent forms they used were inadequate. It was unethical. The trial failed to conform to the Declaration of Helsinki guidelines. The experimental design was inadequate. The study had difficulty attracting patients. Most of the subjects refused to submit to randomization, because only believers in the Gonzales Regiment volunteered for the study, and they insisted on getting the treatment. So they had to change the design of the study to a controlled observational study. There was no blinding. There couldn't be, because patients can tell whether they're getting chemotherapy or doing all of those Gonzales things. The impetus for doing the study was political and not scientific. The Gonzales Protocol was a fraud. No mainstream doctors believed it was anything else, and they were surprised that anyone with education would be on it. Despite all the flaws, the results were unequivocally negative. Good chemotherapy with gym cytobine was far superior to the Gonzales Protocol. The patients on chemotherapy survived for 14 months. The patients on the Gonzales Protocol died after only 4.3 months, and they had a poorer quality of life. Even a newborn baby can see that this was thumbs down for Gonzales. It should have been the death knell for this treatment, but I guarantee it won't be. Dr. Gonzales responded with paranoid whining. He wrote a whole book complaining that he'd been undermined and that the trial had been designed by biased researchers to ensure that it would fail. He and his followers will continue to clamor for more studies. Desperate patients will continue to believe in this treatment because it offers hope, false hope, and the regimen gives them a sense of control and virtuousness. They're taking action and doing some very difficult things to help themselves. Early funded studies of implausible treatments are worse than useless. They're frequently unethical and even dangerous. The results tend to be equivocal. Studies don't convince true believers. They just keep calling for more studies, and evidence-based medicine is happy to agree. There could always be one more study with a different dose, a longer trial, or a change in some other factor. This could go on forever. They're wasting research funds. The fact that they're being officially studied gives them a prestige they don't deserve. Senator Tom Harkin was the driving force behind the creation of the NCCAM. He's a true believer in CAM who's convinced that B. Paulin cured his allergies. This recent quotation from him is very revealing. He said, One of the purposes of this center was to investigate and validate alternative approaches. Quite frankly, I must say publicly that it has fallen short. I think quite frankly that most of its focus has been on disproving things, rather than seeking out and approving. What? It's obvious that he doesn't have the slightest clue about how science is supposed to work. Instead of using good science to find out what works and what doesn't, he wanted the NCCAM to validate the things he believed in. That's a clear perversion of science. The Diet Supplement Health and Education Act of 1994 was as big a mistake as the NCCAM. David Gorski calls it a travesty of a mockery of a sham. DSHEA is based on deception. It created a separate category of diet supplements that can claim to support structure and function, but that can't claim to treat, prevent, or cure any disease. They are sold under the fiction that they are foods to supplement the diet, while everyone knows they are really meant to be used as medicines. Sellers and buyers understand that diet supplements are intended to treat, prevent, and cure, even though they can't legally make those claims. They manage to get the message across in the form of testimonials from customers who clearly imply that they have been treated and cured. The DSHEA weakened the ability of the FDA to protect the public. Diet supplement manufacturers don't have to prove their products are safe or effective before marketing. The burden is on the FDA to prove that a product is unsafe. Under the DSHEA it would be perfectly legal for you to market grass clippings from your lawn. Under the rationale that chlorophyll or some other component is known to help maintain structure or function in the human body in some way, no matter how far-fetched. The clippings could be contaminated with fertilizer, weed killers, rodent droppings, insects, dog poop, or anything else that was on your lawn. You could continue selling it forever, unless the government could prove that it had harmed people. And it's not easy for the FDA to do that. After several people had died from using ephedra supplements, the FDA banned ephedra. But the law was challenged in court by ephedra manufacturers, and it took two years for the ban to be upheld by the U.S. Court of Appeals. Here's another mistake. One of the provisions of the Affordable Care Act, ACA or Obamacare, prohibits health plans and insurance companies from discriminating against any health care provider who is acting within the scope of that provider's license or certification under applicable state law. That means that our tax dollars would be required to pay for any kind of quackery that gets licensed, which brings us to the subject of licensing alternative health care providers. Chiropractors, acupuncturists, naturopaths, and other CAM providers are licensed in some states. Two reasons are given for licensing these alternative practitioners. One to grant privilege, to protect the practitioner from prosecution for practicing medicine without a license. Two to protect the public by ensuring standards of training and performance. But do they protect the public? It can be argued that they do just the opposite, that they endanger the public. Here are some of the arguments against licensing. One, it legalizes fraudulent practices. For instance, when chiropractors tell patients they have subluxations that must be removed. Two, it authorizes mandatory insurance coverage, which we all pay for. Three, CAM providers' education is inadequate for the scope of practice granted. Licensed chiropractors, acupuncturists, and naturopaths can see any patient, regardless of age, with any disease or condition, whether they're trained for it or not. Four, it permits self-regulation. That's a huge problem. It means the foxes guarding the henhouse. The CAM practitioner practice acts usually give the practitioners their own boards, which are usually made up of a majority of CAM practitioners along with a couple of public members. These boards are responsible for enacting the rules governing practice, and they hear disciplinary complaints, just like the medical boards. Licensed regulations can simply incorporate all kinds of quack practices. For instance, in Florida, the acupuncture board specifically permits the use of Curly and Photography, which has zero to do with acupuncture, and it's totally bogus. Five, it makes liability difficult to prove when the practitioners are sued. Six, they can't be prosecuted for practicing medicine without a license, even when they exceed their scope of practice. Seven, it gives them a legitimacy they don't deserve, and it leads to public confusion about who is a doctor. Do we really need separate licensing boards? In some states, acupuncture and physician assistants are regulated by the same medical board that governs MDs, so theoretically scientific standards can be enforced. CAM boards don't set or enforce reliable standards. These set-by-boards ought to define the condition with a set of criteria which any practitioner could see and evaluate, and the diagnosis should be confirmed with a physical examination and confirmatory test, followed by a treatment plan, which could then be objectively assessed with objective criteria of success or failure of the treatment. Naturopathy is a hodgepodge of treatments with no standard approach. And how could you standardize all the different kinds of acupuncture? Needles, electroacupuncture, moxibustion, ear acupuncture, et cetera. How could you set standards for quackery? Boards have a poor track record. They haven't done well in regulating chiropractic acupuncture or naturopathy, where these things have been licensed or legitimized. The Institute for Science and Medicine has spoken out against CAM licensure. Their policy statement says, the world's health care systems need to be rooted in a single science-based standard of care for all practitioners. Effective, reliable care can only be delivered by qualified professionals who practice within a consistent framework of scientific knowledge and standards. Practitioners whose diagnoses, diagnostic methods, and therapies have no plausible basis in the scientific model of medicine should not be licensed by any government, nor should they be allowed to practice under any other regulatory scheme. Any statute permitting such practices should be amended or repealed as necessary to achieve this policy. Unscientific practice in health care should be further targets of aggressive prosecution by regulatory authorities. Here are some specific reasons to oppose licensing of naturopaths. There is practically no public demand. Three-tenths of one percent use naturopaths in 2007. Their claims to have the same education and training as MDs are false. They reject evidence-based medicine as a standard of patient care. They discourage patients from going to a medical doctor for life-saving treatments. They fail to recommend standard public health practices, and they use risky treatments with no evidence of benefit. There are some alarming trends of increased privileges for CAM. Chiropractors can now prescribe medicines in some states and can even inject them intravenously in one state, New Mexico. In other states, they're lobbying to get the right to prescribe drugs. They already do school and sports physicals in some districts. They're trying to reinvent themselves as family doctors. Naturopaths have full prescribing rights, except for narcotics, in two states. In nine states, they've been granted at least some prescription rights. Drugs can be added to their formulary at the discretion of a board made up of naturopaths. They're not trained in conventional pharmacology, and seeking prescription privileges makes a mockery of their claim to be a drugless profession. Recently, they've been lobbying the VA to hire naturopaths to treat veterans for chronic pain. They have no expertise in the area of chronic pain, and they often prescribe marijuana for pain, which is legal in some states, but is still prohibited by federal law, so it couldn't be used in the VA system. This is just a blatant attempt on their part to sneak a foot in the door. Moving on to the last topic, quacademic medicine. Quackery in the form of CAM and integrated medicine is infiltrating our medical schools and institutions. Medical schools were once bastions of science, and now they're beginning to look a bit like Hogwarts. In 1910, the Carnegie Foundation asked Abraham Flexner to report on the state of medical education. What he found was a disaster. There were 155 medical schools in North America. Many were trade schools operated by one or a few doctors, unaffiliated with the university, and run for profit. They typically required only two years of study, lab work and dissection were not required. Many schools taught unscientific methods. Many were run by medical sects. There were 15 homeopathic medical schools, eight eclectic schools, one physiomedical school, and eight osteopathic schools. They admitted students with a high school diploma or less. They were poorly equipped to teach science. They offered inadequate opportunities for clinical experience. They taught dogma based on revelation, and graduates were not equipped to understand the human body into diagnosed diseases. Chicago had 14 medical schools. Flexner called them a disgrace to the state whose laws permit their existence, indescribably foul, the plague spots of the nation. Flexner made these recommendations, higher admission and graduation standards, strict adherence to mainstream science. Schools must drop courses in eclectic medicine, physiomedicalism, naturopathy and homeopathy, or lose their accreditation and their underwriting support. A few schools resisted for a time, but eventually all of them either complied with the report or shut their doors. Today there are no homeopathic or eclectic medical schools. Osteopathic medical schools have joined the mainstream, but unfortunately there are still five schools of naturopathy. There was a time when promoters of quackery would have been laughed out of medical school classrooms, but today they're back because of widespread societal acceptance of CAM. Wally Sampson referred to it as the press wowed and the academics cowed. Today teaching CAM in medical schools is required for accreditation. There are integrative medicine programs in dozens of medical and nursing schools. They fail to conform to evidence-based standards. They advocate a sliding scale of proof where treatments with lower risk would require lower standards of evidence. Some of these programs even teach nonsense like homeopathy and therapeutic touch. The NCCIH is funding curriculum development. It has awarded $76 million to mainstream medical schools and CAM schools to foster the teaching of CAM. Medical education has turned its back on Flexner's warnings and has betrayed its scientific foundation. I think we desperately need another Flexner. How did this betrayal of science happen? Well, here are some of the factors that may have contributed. Money, CAM is profitable. More patients will come to your clinic if you offer it. Distrust of the pharmaceutical industry and of the establishment in general. Political correctness and post-modernism. In post-modernist thought, facts in science are artifacts of social constructions and conventional medicine is exercising political hegemony over other subjugated forms of healing like naturopathy and homeopathy. A scientifically illiterate public is clamoring for help freedom. Essentially the right to try any treatment that appeals to them, even if it's freedom to endanger their health with quackery. Evidence-based medicine has been distorted, causing it to devalue scientific rationale and plausibility in favor of trusting any randomized control trial. The boosters of integrative medicine are well organized and CAM has well-paid lobbyists and the American Medical Student Association is actively advocating CAM. I've been accused of wanting to abolish CAM to make it illegal. I'm not trying to abolish it. I'm not stupid. I know we couldn't abolish it if we tried. I realize CAM and quackery will always be with us as long as humans are human. The human mind prefers stories to science. People want easy answers. They grasp it any straw of hope. They're influenced by others. You can't legislate against human nature. We tried that with prohibition and it didn't work. We can't hope to abolish CAM but we can hope to educate the public. We can hope to crack down on deliberate health fraud. We can hope to regulate false advertising and we can hope to discipline health care providers who make false health claims. I don't have any objection to patients using CAM as long as it's not a treatment that's dangerous, as long as it doesn't entail stopping essential medical treatment and as long as the patients are given enough accurate information to make an informed decision. I only object to patients choosing CAM when they don't understand the pros and cons, when they've been given false information. In that case, they're not informed so they can't make an informed choice. The public has been demanding health freedom, the right to use any treatment they want and that is supported by one of the core principles of medical ethics, patient autonomy. Patients have the right to accept or reject any treatment. Jehovah's Witnesses are free to reject life-saving blood transfusions. A patient can reject surgery even if he understands that he'll die without it. I strongly support their right to do that. I strongly support patient autonomy but I don't think people can exercise true autonomy when they have freedom without information. What should doctors do? They should practice science-based medicine whatever possible. They should not offer untested treatments except as a last resort and with the explicit understanding that they're experimental. They should not recommend treatments that are no better than placebo while implying that they've been proven effective. They should inform patients about the lack of scientific evidence for CAM and then let them decide. And they should support patients who decide to use CAM but without supporting CAM itself. As a doctor, I wouldn't prescribe placebos and I wouldn't recommend CAM but if a patient was already using CAM or wanted to try it, I would explain that it's not supported by scientific evidence and when it appears to work, it's likely due to a placebo effect but it's probably safe. I would tell the patient if you decide to disregard the lack of evidence and try it, either because you believe it might work or just in hopes of getting a placebo effect. I have no objections but please don't discontinue conventional treatment X because it's essential to your health and please follow up with me and let me know how you're doing with the CAM treatments. There are signs of hope. Skeptics in Australia have had some real successes against anti-vaccine activists and after they exposed the power bands on television the company went out of business. They organized the Friends of Science and Medicine to fight against the teaching of CAM in Australian universities. I'm a member of the Friends of Science and Medicine. I really like their name because it has the same initials as the Flying Spaghetti Monster. In the UK, there used to be 45 university degrees in CAM and most of those had been discontinued. In the US, the Institute for Science and Medicine was established in 2009. I'm proud to be one of the founding fellows of that organization. Health Canada now requires warning labels on homeopathic vaccines. The Children's Hospital of Philadelphia has removed diet supplements from its pharmacy. Some celebrities are speaking out to promote vaccination. Dr. Oz was skewered at a congressional hearing and a group of prominent doctors wrote a letter calling for Columbia University to fire him and his ratings dropped 39% this year, the biggest drop of any talk show. And just recently, five of us regular writers from the Science-Based Medicine blog established the Society for Science-Based Medicine under the leadership of Mark Crislop. It's a nonprofit membership organization to support science-based medicine. The board members of the Society for Science-Based Medicine held the first day-long conference on science-based medicine in April 2015 in conjunction with NEXUS, the Northeast Conference on Science and Skepticism. And we hope to present many more conferences like that. Anyone can join the SFSBM. You can too. So I'll end on that note of hope. I hope you've enjoyed these lectures. I hope you've learned something about science-based medicine and have been immunized against pseudoscience and quackery. And I hope you'll remember to question everything you read and to always do what this poster says. Choose science. Everything else is dumb.