 It's Saturday, February 27th and this is For Good Reason. Welcome to For Good Reason, I'm DJ Grothi. For Good Reason is the radio show and the podcast produced in association with the James Randy Educational Foundation, an international nonprofit whose mission is to advance critical thinking about the paranormal, pseudoscience, and the supernatural. I'm happy to have Harriet Hall on the show this week. She's a medical doctor known as the Skeptok. She's a retired family physician who writes about pseudoscience, about questionable medical practices. During a long career as an Air Force physician, she held various positions from flight surgeon to director of base medical services and did everything from delivering babies to taking control of a B-52. She retired with the rank of colonel. She recently published Women Aren't Supposed to Fly, The Memoirs of a Female Flight Surgeon. She's also a regular contributor about medical myths to Oprah's magazine, Oh. Welcome to For Good Reason, Dr. Harriet Hall. Thank you. Harriet, your book and maybe we'll talk about it more later in our discussion is Women Aren't Supposed to Fly, The Memoirs of a Female Flight Surgeon. Let's start off, why don't you tell me how you went from being a female flight surgeon to one of the most prominent skeptic doctors who are speaking out about scientific medicine? It was all quite serendipitous. I was in the Air Force for 20 years and retired as a full colonel. For a while after I retired, I didn't do anything. I read a lot about skeptical issues and I went to conferences and things like that. I didn't actually start doing anything until just a few years ago. I went to the skeptics toolbox that Psychop puts on in Oregon. I got to know Ray Hyman and Wally Sampson and emailing back and forth with them after the conference. Wally Sampson encouraged me to write something for the scientific review of alternative medicine. I'd never written anything in my life and I said, I don't know how to do that. He said, try it. I did. I just kept writing and writing. Wow, and now you have a column on science-based medicine on critical thinking for O Magazine. That's one of the largest, I guess, mouthpieces of any skeptic that I know considering its subscription rates. Yes. I don't know anyone else who has such a wide reach to the general public in another publication like that. Are you getting positive feedback from that column or is skepticism kind of controversial to the women, to the people who read that magazine? Well, it's not really what I would classify as a skeptical column though. It's under tight editorial control. They only allow me 250 words and they want me to write about common health myths, debunking common health myths. Nonetheless, you're able to, well, do some debunking, so it is skepticism in that sense. Yes. Yes. It's not the things that I would particularly choose to write about. Give me some examples of topics you focus on. In Oprah or as a skeptic? Yeah, in O. One of them was about the myth that eating late at night makes you gain weight more than if you eat other times a day. I'm so glad to hear that's a myth. I'll never be scolded again for my late night snacks. And one of them was about you lose most of your body heat through the head, which actually you lose body heat proportionally the same from any part of your skin. Interesting. Okay. You're on the show to talk about scientific medicine as opposed to, say, traditional medicine or what they call complementary or alternative medicine. The implication by calling what you're into, what skeptics promote, scientific medicine is that the other stuff is unscientific. Does it follow that it's always bad to be unscientific or, I mean, just not based on Western models of science, that's not necessarily a bad thing, is it? There is only one science. I don't like calling it Western science because the scientific method is the same everywhere in the world. And the medicine that's not scientific medicine is based on testimonials and on beliefs and it's not tested or verified. And I think it's always wise to put your beliefs to the test and look for evidence. That's the whole basis of all of our skepticism. And the scientific method has proven itself. It's not just that we believe that science works. We've shown that it's a reliable way of approaching the truth and probably the only reliable way. It's the best method we have to keep from fooling ourselves. So you would say that when traditional medicine works, if it does, or complementary alternative medicine, any of those interventions, if they work, they're actually just scientific medicine because if they work, they're scientific. Yes, and that's why I and some of my colleagues really object to the term complementary and alternative medicine because there really is no such thing. There's only one medicine, medicine that's been proven to work. And as soon as something is tested and proven to work by a scientific method, it's adopted into conventional medical practice and is no longer considered alternative. The alternative terminology is really a political ideological thing. It's not a meaningful scientific term. What term do you use for that category of health cures or interventions that you wouldn't accept as working? Well, there is a big spectrum of some of the things that fall under the complementary alternative medicine umbrella are just things that haven't been adequately tested yet and they might work. So we have to keep an open mind about them. Some of the other things are just outright quackery. No, but I guess I'm asking if you don't like the terminology, the term complementary alternative medicine to label that stuff, what term would you use? Well, that's what I was getting at. I don't think there is any one term that really covers everything. Oh, I see. And some of us have called it so-called complementary alternative medicine. We like that because the initials are scams. I love it. A little cheeky, it's like when James Randi calls believers in the supernatural or the paranormal woo-woos. It's a way for us to poke a little fun, although if you're trying to have a serious-minded scientific engagement with these folks to call their worldview a scam from the get-go, it might close doors to that kind of dialogue. If you're looking at all of that and you don't want to use one term to label all of it, but we're talking about what most people would consider complementary alternative medicine treatments, is there one or another of them that really gets your hackles up most? You don't treat all of it with the same sense of moral outrage. No, I guess it depends on what you're looking at because if you're just looking at what harm they do, they all can do harm by getting people to think uncritically and accept things without evidence, and they can all be used instead of life-saving medicines. So they've been known to kill people in that sense. But as far as outrage, I guess the thing that outrages me the most is homeopathy because it's just so totally ridiculous. And just recently, is it in the UK and also in Australia, New Zealand, elsewhere, there's been a lot of activism against homeopathy. And I think in the UK, just recently, a governmental body concluded there's nothing to it. Right. There's been a lot of public interest like that mass suicide, the demonstration that they held recently. Right, what a really smart idea. James Randy had done that for years where on stage, he would do an OD, he'd overdose with a homeopathic sleeping remedy and where it gives a warning on the package, don't take more than X number and he takes the whole bottle and nothing happens. That suggests there's nothing there. Right. There are all sorts of untested claims. You concentrate mostly on this CAM stuff or SCAM, but there are claims about psychics and ghosts and UFOs. When these untested or unsupportable claims are made in the field of medicine and health, they get your attention. Why aren't you equally up in arms about faith healers or psychics or past life regression or that sort of stuff? I am equally up in arms about them, but I don't write about them because medicine is the field that I know about where I have something to contribute. Well, that seems kind of obvious then. Good on me for asking such a good question, right? Right. The point is you concentrate on it because of your expertise. It's not that you think the other stuff is more trivial. Exactly. Medicine is the one place where I feel like I have something special to contribute. Some complementary or alternative medicine interventions work or at least to some extent or am I completely wrong about that? Even the National Academies of Health suggest acupuncture is a very helpful addition to treatment for cancer patients. Massage, other therapies seem to have positive effects. So you don't throw the baby out with the bath water. You don't say all of it's a scam. Well, what do you mean when you say that they work? Because placebo has worked to some extent. And they actually work even if there's no medically efficacious... They work for some things. They work for subjective things like pain and nausea and depression. But they don't work objectively for things like curing cancer and broken bones. What do you think about National Academies of Health commending acupuncture? You think it's just kind of a PR thing or there's some evidence? Or are you like Randy and it just really gets your ire up that they would even suggest something like that? There is some evidence, but it's poor quality evidence. And when you look at all of it objectively, actually there is a book that does that, Snake Oil Science by Arbarker Basel. He's looked at all of the evidence for acupuncture. And he's come to the conclusion that the evidence is compatible with a hypothesis that acupuncture doesn't work better than a placebo. I want to talk about chiropractic. You mentioned homeopathy is something that you think is especially pernicious or possibly harmful. Chiropractic is in that same fuzzy category and I think there's some overlap. Some chiropractors engage in homeopathy or do kind of, you know, they prescribe herbs or other kinds of not traditionally pharmaceutical pills, right? Would you say there are good chiropractors even if there are also probably some chiropractors or are all of them quacks? I guess what I'm asking is, would you claim that no chiropractor actually helps treat patients in a measurable medical sense? No, there are good chiropractors. And if you look on the chirobase website that's affiliated with QuackWatch, they have a statement that they ask chiropractors to sign. And they say, I reject the subluxation myth and I provide short-term care of musculoskeletal problems. And I don't do any of the quackery stuff. So if a chiropractor follows those principles, find because there is evidence that spinal manipulation treatment for low back pain works not better than any other treatment but equivalent to other treatment and possibly with quicker relief. But other people besides chiropractors do that. The doctors of osteopathy do spinal manipulation, physical therapists do. And if you're using spinal manipulation therapy to treat musculoskeletal pain, that's evidence-based. But if you're doing chiropractic manipulations to treat subluxations, that's quackery because there's no such thing as a chiropractic subluxation. There was a paper that just came out recently that I wrote up for the science-based medicine blog where chiropractors had reviewed all of the evidence, all of the published evidence for the subluxation and had concluded that there wasn't any. And chiropractic originally was what founded in the theory, almost a spiritualistic theory. It's not naturalistic like scientific medicine, but the belief that by adjusting the spine, you're getting your spiritual energies kind of more in order. Yes, they call it innate with a capital I. The body's natural wisdom and healing ability. There's basically three parts of the chiropractic theory. One of them is that there are bones out of place in the spine which we've proved with x-ray there aren't. The other thing is that the bony maladjustments interfere with the nervous system and there's absolutely no evidence that that's true. And then the third part is that by doing these adjustments you can allow the innate to do its job better and there's also no evidence for that. It's kind of like the Chinese mystical belief in chi or the spiritual energy chakras, all that stuff. Different terminology, but a very similar kind of faith claim. It could be considered a type of energy medicine. In Canada there are laws protecting senior citizens from the hazards of chiropractic spinal adjustment. You mentioned that there's some evidence that it works maybe not better but at least as well as going to a regular doctor for that sort of stuff. Do you think that there's a chance similar laws could ever be passed in the United States? In other words, to protect senior citizens from strokes or something, my grandmother, no exaggeration, went to her chiropractor of many years and she was just in a lot of pain afterwards for weeks. Of course the justification was that we had to fix you and you have to recover from that because we fixed you whatever it was but there are reports, not anecdotal, that senior citizens can go to a chiropractor for a spinal adjustment and have a stroke after because some of this stuff is rather violent on the body. Yes, in fact strokes from neck manipulation was the issue that first got me started looking into alternative medicine. I didn't know there were any laws against it. I know there have been warnings against it and there's a hearing going on in Connecticut where they're trying to get a state law requiring informed consent for neck manipulation. In order to make sense out of a senior citizen getting neck manipulation? Well, the danger is not just to senior citizens. In fact, there's probably more danger for younger people. There was one study and I think it was published in Neurology where they looked at patients that had a posterior basilar artery stroke and they found that in the patients that were under the age of 45, they were five times as likely to have seen a chiropractor in the preceding week as the control patients. So it's a hazard to anyone and there's no way of telling who's at risk and who's likely to get a stroke. It's rare. We don't know how rare it is because the chiropractors aren't keeping any kind of statistics that would tell us, but there is a real danger and as far as the dangers of alternative medicine, that's the one place where they're actually doing something that can kill people, doing something that can directly result in death. So in that sense, you might say that's the most dangerous part of CAM. Harriet, you mentioned the science-based medicine blog earlier that's really growing to be the online place for people to get what their fix of skepticism about alternative medicine. That's what we're trying to do and serving is a good resource now. People used to write and ask me questions and I'd try to explain things to them. Now I can just say go to the science-based medicine blog and read this article. As we discussed, you're focused on alternative medicine because that's your expertise in medicine. You and other skeptics don't really seem to focus on the harms of conventional or scientific-based medicine. I'm thinking about big pharma, big pharmaceutical companies and how some of their products over the last few years have been shown to actually harm patients, lead to death. You know, recent diabetes pill of Andy or whatever it was was just reading a couple days ago, you know, damaging the heart. There's a long list of big pharma selling stuff that doesn't pass muster. Why aren't skeptics railing against the big pharmaceutical companies like they rail against these alt-med gurus? Well, for one thing, scientific conventional medicine is very good at policing itself. If you read the medical journals, there's articles about Evandian and the studies get discussed in great detail and when we find that something is dangerous or when we find that something isn't working, it gets dropped from the armamentarium of conventional medicine. There's a good self-policing, self-critical system in place and there's nothing like that in alternative medicine. But also, we do criticize things in conventional medicine. Just recently, I wrote an article for science-based medicine about the overuse of osteoporosis drugs and I've written a lot about inappropriate screening. I just wrote one about colonoscopy, which is being overhyped way beyond the evidence. You mean people getting more testing than they actually need? It doesn't show that as much testing as widely tested as people are is actually helping in outcomes? Well, believe it or not, there is actually no evidence that being screened with colonoscopy reduces the death rate from colon cancer. We think it probably does, but the studies haven't been done and the evidence isn't there. I want to get back to Big Pharma. These companies, I don't think this is widely known, they actually own most of the lines of the herbal remedies, the alt-med supplements. So many of the alternative medicine crowd, they think there's the good guys out there who are selling the traditional remedies, the herbs, the supplements, and then there's the chemical peddlers, big pharmaceutical companies, when in fact it's one and the same, it's just that big pharmaceutical companies said, hey, here's a market, let's own all the supplements and sell those too because there's a lot of money in it. That's right, there's a huge amount of money in it and there's not pretty much overhead because you don't have to do all those scientific studies that you have to do to get a new drug approved. But the point is, it's big companies selling this stuff, it's not the little guy versus the big company. Yes, that's true, it's big business and Big Pharma is right in there getting its life. I have friends in upstate New York who are really steeped in alternative medicine and I know a fellow who actually has a storefront, kind of a shop where you get herbs and homeopathic remedies and all that. And in his head, that's like the little guy, right? It's a romantic idea tilting at the windmill of big corporate America when in fact, if you're buying this stuff, you're buying it from corporate America. I just think that's an important point to emphasize that it's not talked about a whole lot. Yes, you're right. I want to talk about the difference between fringe science and pseudoscience. So there are a lot of medical interventions that might be cutting edge, but I think they're probably still worth looking into for my advantage. I don't have a background in medicine. But skeptics, I know many of them anyway who have a kind of knee-jerk rejection of anything that's not consensus science. I'm thinking of some of the radical life extension stuff of Aubrey de Grey or some of the transhumanism stuff. It's not to me smack of cam or woo-woo, but still it isn't yet consensus science because it's so cutting edge. Are you equally alarmed by all of those claims as you are by alternative medicine or do you think some of that stuff's worth being open-minded about because it's fringe science but not pseudoscience? Well, I think it might be better characterized as early science. You start out with small studies and then you do more studies to see if you can replicate the original results and then you compare one thing to another. It's a gradual process and you can never trust the results of one study. It's a consensus that develops based on all of the published evidence and it takes time. And I'm not alarmed by people making those claims. What I'm alarmed about is people prematurely rushing into treatment with things that haven't been tested because experience has shown us that most claims turn out not to be true. Even drugs that the pharmaceutical companies are working on, when they get them to the point of doing human trials on them, only about one out of ten of them pans out. So the probability is that most of these new ideas will not pan out but some of them definitely are worth pursuing and worth doing more studies on. What I object to is when people come out prematurely and say we have proven that this works and start selling products and encouraging people to take things that really have not been tested. So it's an important question whether or not, say, resveratrol aids in life extension. But you would be against people widely popping those pills until more research is done. You don't reject the question as alternative medicine or woo-woo, but you wouldn't go as far as some of the transhumanists who say everyone should be taking these pills in order to live their 200 years. I wrote an article about resveratrol for the science-based medicine blog and there is some interesting evidence in mice and in lab studies and test tube type things, but nobody has done the studies to tell us whether the stuff really benefits the average person in any significant way. You probably feel the same about dramatic calorie restriction to extend life or any of the other possibilities that might be promising. We're just not to the point yet where people should alter their lifestyles to pursue them. I don't think so. The test hasn't been done yet. How optimistic are you about I've called it transhumanism, but I'm talking about the application of technology to radical life extension or to ameliorate kind of natural biological problems we'll all face. I read the stuff of it sounds like science fiction, but I read some transhumanist stuff and consequently transhumanism is one of two topics I'm never allowed to mention at a cocktail party because I end up sounding like I joined a cult. That's how excited I am about it, but my fellow skeptics are like, oh my gosh, well I'll give you a pass, DJ, that's the one area that you're kooky on, but everyone maybe gets one. I'm not sure it's kooky to be excited about these prospects. Well, it's fascinating stuff, but it's basically speculation at this point. Are you optimistic that we will continue to extend life, say, or to the whole host of claims that you could put in the category of transhumanism. Does it excite you at all or are you kind of an open-minded skeptic but you're tabling it for now until more research is out? I'm open-minded, but I'm withholding judgment. I wrote a book review for Skeptic Magazine that compared to three different books about anti-aging treatments and I don't know the closest we've come is the calorie restriction. They have tested that in other mammals and have shown that it prolongs life but we're talking about really serious calorie restriction. It's probably not practical for people. Most people would not be willing to follow that kind of a diet and if they followed it they might not be getting adequate nutrition. Right, even if you did follow it who would want to live longer who wants to be so miserable you want radical life extension but also radical life enhancement at the same time. I'm not really too optimistic about life extension. I'm more optimistic about optimizing the duration of life by preventing diseases and curing illnesses. What do you think about the class of drugs that I think there's not consensus in science regarding the class of drugs called nootropics or whatever cognitive enhancers where you don't pop a pill to change your personality you pop a pill to make you smarter or have better concentration or better memory or something like that. Does that stuff hold water or is it still the stuff of science fiction? I'm skeptical. Well I won't tell you about all the cognitive enhancers I take just joking, just joking I don't take them. If a listener and we could I guess finish up with this Harriet if someone listening is skeptical but also wants to benefit from the best medical treatments out there and doesn't want to be closed-minded doesn't want to reject anything out of hand what's your prescription for them is it just a matter of kind of doing what their doctor says or doing what consensus science says I guess my concern with that is that there are a lot of doctors who are pretty pro-alternative medicine these days. Yes, there are there are doctors who prescribe a lot of belief-based things instead of just evidence-based things. The best advice I could give a skeptical layman is ask for the evidence. If your doctor says resveratrol is something you should take ask him what studies he's going on and look at the details and find out if he's really basing it on evidence or if he's just basing it on well I think it helped some of my patients and I think it sounds like a good idea and also there's a couple of really good resources on the web now one is quackwatch.org and the other is sciencebasedmedicine.org and if you're wondering about any specific treatment one of the first things I recommend is looking at those two websites it sounds like you have a lot of faith in the educated consumer of healthcare so it's not enough to go on just what your doctor says you think people could actually look at published studies and do the research and that's not too much to ask someone who wants a treatment. Well it is too much to ask for someone to evaluate the research studies because most people don't have the knowledge background to do that but everyone can ask their doctor what's the evidence and I think that's the key thing if your doctor recommends something that you're skeptical about ask him why he's recommending it and whether he's basing it on published evidence another good rule of thumb I have is when you hear about something that you're skeptical about ask who disagrees with this and why what are their reasons for disagreeing if you can find that out and find both sides of the story usually it's pretty clear listing to both sides which one makes more sense Harriet Hall thank you for joining me on for good reason appreciated the discussion and I think you offer a really clear roadmap for evaluating these claims even if you're not an expert well you don't need to be you can follow the kind of rules of thumb you just outlined and come to a smarter case about these sorts of claims well thank you for inviting me you've asked some really good questions and I've enjoyed our discussion well thanks much Harriet look forward to the next time we talk and now the honest liar talks about his hobby collecting pseudosciences here's Jamie Ian Swiss what do you call someone who believes in pyramid power I have a hobby I'm a collector of science first some definitions a pseudoscience is a set of ideas presented as scientific when in fact they're not and fails to meet the accepted norms of scientific research science is based on actual provable observation rather than mythology mystical authority sacred text or faith scientific claims are testable repeatable and falsifiable they can not only be proven but they are framed in such a way that it's also possible scientific claims are coherent with the rest of science and further exploration adds to their confirmation a new discovery in chemistry confirms and adds to our further understanding of biology by contrast pseudoscientific claims are invariably not testable not consistent with known scientific principles are supported only with selective evidence are filled with exceptions and special assumptions and are often based on faith mythology or the simple idea that they've been around for a very very long time but just because an idea is old doesn't always make it good or else your HMO would be offering leeches and cupping in order to treat the humors but these facets of pseudoscience while accurate are not why I collect them I collect pseudosciences because so many of them are so damn goofy and because no matter how goofy the claims there is always somebody out there capable of making a buck on it it's a tribute to the folly and the foolishness of the human condition we all know somebody who believes in something in my collection as the humorous Josh Billings once said it's not so much the things we don't know that get us into trouble it's the things we know that just ain't so now my collection is up to over 500 pseudosciences and I haven't got the time to discuss them all today so let's just consider this the first installment of the honest liars pseudoscience collection beginning with quack medicine now quack medicine is a broad pseudoscientific category with a rich history that's filled with both tragedy and it must be admitted hilarity we'll talk about some of both in another episode but for the moment what I really want to point out is that there's also a subset of medical quackery that applies to veterinary medicine that is to say crackpot medicine for pets and what I love about this is the term used to describe a practitioner of quack veterinary medicine to wit an animal quacker I love that yogic flying followers of the cult of transcendental meditation believe that the cult's long time leader Maharishi Mahesh Yogi you know old bearded guy in a bathrobe hung out with the Beatles can actually teach you to fly the magician the late Doug Henning who helped modernize and popularize magic in the 1970s and 80s was actually an enthusiastic believer and sadly gave up his career in pursuit of this kind of real and sensical magic well many years ago James Randy and I along with our skeptic friend and colleague Chip Denman went to observe a day of tea embers taking part in what they called the yogic flying Olympics in Washington DC this consisted of people sitting on mattresses with their legs crossed and bouncing they called it flying we called it bouncing I often consider myself lucky when I find myself touching down on the tarmac celebrating the fact that the professional pilots up front seem never to be confused about the differences between flying and bouncing xenoglossy here I can do no better than quote from the online skeptics dictionary xenoglossy is the alleged speaking or writing in a language previously and entirely unknown to the speaker the probability of this happening is approximately zero the skeptics dictionary can be found at xkepdic.com crystal power like many other ancient crackpot new age beliefs or as I prefer to call it new age as in rhymes with sewage crystal power was particularly big in the 1970s I remember at the time being seated on a plane and noticing the passenger sitting next to me a woman who was obviously uncomfortable with flying she was wearing a crystal pendant which she kept fingering nervously and I couldn't help but think to myself that if this plane goes down in the ocean somewhere there'll be 199 people hanging onto their seat cushions and one person hanging on to a rock channeling channeling was another new age pursuit that while thousands of years old was revived in the 1970s what with naptha or rampa or whatever the name of Shirley McLean's favorite channel or was to me however channeling always seemed just like bad ventriloquism you know they talk funny but their lips move aromatherapy aromatherapy like so many things is as much of a marketing category as it is a pseudoscience so you might say that the science of aromatherapy is based on the principle that stuff you like the way it smells smells really good to you star child a star child is the offspring of an alien and a human being like I don't know Richard Simmons pyramid power pyramid power is the belief that if you have something shaped like a pyramid and put something else under that magic happens razor blades sharpen dead plants come back to life cell phones get better reception so there is your first set of entries in the honest liars collection of pseudosciences score yourself zero for each one you got right because each and every one of them is worth absolutely nothing and oh what do you call a believer in pyramid power a pyramid this is Jamie in swiss and I am the honest liar thank you for listening to this episode of for good reason to get involved with an online conversation about today's show join the discussion at for good reason dot org views expressed on this show aren't necessarily the views of the James Randy educational foundation questions and comments on today's show can be sent to info at for good reason dot org for good reason is produced by Thomas Donnelly and recorded from St. Louis Missouri our music is composed for us by Emmy award nominated Gary Stockdale contributors to today's show included Jamie Ian Swiss and Christina Stephens I'm your host DJ Glophy