 Next up we have a panel discussion on medical cranks and quacks. It's gonna be Moderated by Steven Novella. You all know him is the chief editor of science-based medicine and apparently he has some podcast I don't know whatever He'll introduce the rest of the panel. Here we go. Your haiku is doctor doctor, please. It hurts when I go like that Well, don't go like that. Please welcome Steven Novella Thanks for coming everyone I have a very distinguished panel I don't need to reintroduce everybody the I've Mark Chrislip Harriet Hall David Gorski from science-based medicine blog and Robert Blaskowitz who has already introduced also fighting the medical fakers That's what we all of us do. We all have day jobs and full-time careers, but we spend some of our time Trying to combat those people who are promoting pseudoscience in medicine We have a kind of a running joke of how almost futile the job is we Mark Chrislip thinks that our logo should be Sisyphus pushing a rock up a hill But we figured out it was a little little self-defeatist. So We did we rejected that idea and Sisyphus has it easy. Yeah It was too easy, right? So We all have our those Cranks quacks whatever you want to call them those people who are promoting something less than science-based medicine in the medical field And we have been you know spending years fighting against them trying to protect patients protect the public From their snake oil and their nonsense and we're going to try to you know Give you some of an idea of what we're up against the kinds of people that are out there Why we oppose them and what are the options that we have before us? So let me just throw this out to the panel and have each of you give an answer to this Is there one medical faker out there one person that you feel? Is your nemesis who's the who's the person out there that you would most like to take down or that you have spent time directly opposing mark It's probably somebody who combines regular medicine with whack-a-loon stuff So it's hard to get too upset with real true believers like Dana Ollman and homeopathy when you get someone like dr. Oz who combines legitimate medicine with Borderline medicine and then he starts talking to the dead which I assume is his critical thinking skills Those are the type of people you'd really like to take down because they Justify Quackery by using real medicine and that would be my vote would be the the legit docs Yeah, so they blur the lines. Yes between real medicine and fake medicine, which is the most insidious That's the that's the worst thing that we're fighting against right is that lowering of the lines Although I did you know after I was on the odd show I did have somebody who was a fan of dr. Oz say that oh, yeah I like everything that dr. Oz is except when he gets into that alternative medicine stuff Then I just ignore him so I was I was glad to hear that but that's just one anecdote But I think for most people those blurring of the lines is very dangerous Harriet One of the ones that really annoys me is a dr. William Ray He's in Texas and he treats people who come in with a lot of vague symptoms And he diagnoses them with multiple chemical sensitivities, which is not a recognized diagnosis and To give you an idea His clinic walls are made of ceramic because anything else he could put on the walls his patients would react to He has detoxification saunas in his clinic He has exercise machines that have had all the lubricants removed from them because his patients are Irritated by the lubricants off-gassing They did a feature on him on nightline a few years ago and they interviewed one of his patients She was a medical doctor who'd been diagnosed with depression She'd been she had seen a psychiatrist every day for a year But she finally had to stop going to the psychiatrist's office because of the diesel fumes in the air she couldn't drive and He diagnosed her as sensitive to literally everything in her environment and she moved to an island and she She built a special home that didn't have any dangerous materials in it she takes multiple injections of Sort of supposedly allergy shots, but very unconventional ones every day one of the things she injects into herself is mercury She won't use her telephone because the magnets in it give it or give her headaches And she spends two hours a day inhaling oxygen and at the same time They showed her with her dog and her horse outdoors. She was riding around a dirt arena stirring up all kinds of dirt and None of that bothered her because that's natural, but it's man-made chemicals that are causing all her problems supposedly He takes patients like that and he ruins their lives. He turns them into hypochondriacs and Hermits they're afraid to go out of their house. They're they can't work. He's done a lot of harm to a lot of people The medical board investigated him one of the things that came out in the investigation was that he was injecting jet fuel into patients and He said oh well not really. I'm just injecting a small amount as a Skin test for allergies. Well, you can't be allergic to jet fuel And then later when the board started picking on him he explained well. No. He really wasn't injecting Actual jet fuel. He was injecting the electromagnetic imprint of jet fuel Well the Texas board Charged him with Texas Medical Board They charged him with six different things I'm going to read them to you using pseudoscientific test methods Failing to make accurate diagnoses Providing nonsensical treatments Failing to properly inform patients that his approach is unproven Practicing in areas for which he has not been trained And representing himself as certified by a board that is not recognized by the American board of medical specialties It's pretty serious charges and so basically all of alternative medicine is what you're saying After three years the case was finally resolved with what they call of a mediated agreed order And essentially all he did was say he had to revise his consent form Thank You Texas David is there anyone outside of Texas that you would consider? Your your nemesis or somebody worth going out well I'm torn because you would think after I just gave a 20 minute talk on Stanislav Brzezinski that I would say it would be him but I Really kind of think dr. Oz would be the one because he spreads it to millions like Brzezinski doesn't affect anyone other than the Patients who come to his clinic Dr. Oz's effects Pernicious effects go way beyond that. I agree Robert you're gonna stick with Brzezinski or you want to add anybody to the list? I'm not that type of doctor. Yeah, so But no Brzezinski. He's my Vader. Yeah So there's a long long list obviously we could spend hours just going down the list and you could read about many of them And in the pages of science-based medicine I have a bugaboo about chiropractic neurology because it doesn't exist and it invades my personal specialty but the person that one person that I like to bring up is William Hammersfarr because he's a neurologist practicing medicine in Florida and he decided that he would treat strokes and then a long list of other elements with FDA approved vasodilators drugs that that enlarge the blood vessels Even though the treatment essentially has been shown not to work. This is something that is actually not an idea new to him It's been studied 20 years ago and was found not to work and the concept is not really valid The Florida the state of Florida actually took him to court You know basically challenged His practice saying that what he was doing was substandard medicine because it wasn't based on Scientific principles and they essentially proved their case They proved before a judge that what he was doing was below the standard of care So that what he was doing was it was harmful to patients was not based on evidence, but then he appealed based upon Florida's recent Healthcare freedom law which states that if you're practicing Alternative medicine that you were you could the state can't hold you to the standard of care So in other words you can do whatever you want as long as you inform your patients that it's alternative But they didn't define alternative. So here we have an MD Prescribing FDA approved drugs just doing it wrong and that's alternative and then he won he got out He's slipped away from regular from any regulation because he was protected shielded by this law Which leads me to the next question is what avenues do we have available to us to fight these guys? Obviously, we can write blogs and talk about them and try to educate the public about Why what they're doing is wrong, but it seems like we should be able to shut them down So what's out there for us and why doesn't it work? It never does seem to work because the only thing you can ever nail somebody for is sex abuse and illicit drugs Though I was pleased to see in Washington State, which I hate saying I should just say Washington That someone got their license Put on hold for doing the Marshall protocol That's the first time I've ever seen anybody in the medical boards chastised for using alternative medicine I think it's partly resources people don't have time and then you get logged bogged down in the legal aspects that You know trying to prove it's wacky as it is. It's difficult it's a big problem that there are 50 state medical boards and 50 different sets of laws and What Florida is not the only state with a quote-unquote health freedom law. I believe Colorado just passed one It's about to up to 20 or so and there are and there are states that license naturopathy, which means naturopathy is a legitimate therapeutic, but I think it's like 16 or 17 states now and In those states naturopathy is legit and as I like to say naturopathy is basically a cornucopia of Quackery, I mean basically it's everything almost everything other than science-based It seems maybe there's one or two, you know it thrown in there But most of what they do seems to be just yet whatever is not based on evidence. Yeah, right I mean and in fact one thing I always like to say to show about naturopathy If you want to know how nutty naturopathy is Every naturopathic school requires a course in courses in homeopathy Homeopathy is on the naturopathic board examination. God. I would love to see that examination We've never been able to get a copy of it, but it's basically that you know, it's part and parcel of naturopathy But how are you going to get it? Abandoned when I have I'm from Oregon. We have a chiropractic college right naturopathic college a couple or internal medical colleges All the institutions have integrative medicine programs So it's part and parcel of the medical school is part and parcel of medical care You have reality-based and non-reality-based care together. I don't know how you can say when you have a medical school teaching their residents Ricky yeah, that that's not legit. It's being done at University of whatever It's a problem. You know what I call Ricky, right? It's faith healing because it's faith healing using Eastern mysticism instead of Christianity You're like channeling energy from the quote-unquote universal And My spell checker always makes it our eek y which I think That works. Is that anything like reek? Game of Thrones geek. I'm sorry so Thank you, so Yeah, so it's it's infiltrating our own profession So it's hard for us to it's getting harder to criticize chiropractic naturopathy homeopathy acupuncturists When in fact all of those things have infiltrated our own profession So we're simultaneously trying to clean house actually just trying to hold back what seems like a losing war for now while You know for entire professions that are based up not upon science don't have a culture of science seem to be gaining ground So again like Harriet, where do we go from here? So what do we do to reverse turn this barge around? Our Legislation of course is the final answer, but that's going to be hard and I don't see it better legislation coming anytime soon But one thing that could be done The medical boards have a certain amount of power and if they would just do a good job We could make some progress there But we've got a bunch of bureaucrats and wimps and people without balls that are on the medical boards And they can be intimidated there was a case in Washington state where a doctor was found To be using one of those electro dermal diagnosis machines those machines are illegal and He should have been chastised for using them But his lawyers Wrote personal letters to everybody on the medical board Threatening a lawsuit if they continued to investigate and they promptly dropped it Yeah, one thing that yeah, Brzezinski, right? Yeah, this is gonna be present. Is this you hear that? Okay, much better I Think that we can actually help these medical boards You know there was there was a case A couple of months ago when one of the the physicians Appeared to be Announcing test results on the Brzezinski patient group Facebook page Which would be a major violation of patient confidentiality and a skeptic took a screenshot and sent it to the medical board I mean these are the types of shenanigans where non-experts can intervene and maybe be useful to point this stuff out to them, right? and there It's politics too. For instance, I'm quite convinced that you know Part of the reason Brzezinski is still in operation 36 years later, you know 15 years after the consent agreement is Policy he has political allies He really does I mean Joe Barton as I mentioned before and I'm sure there are a bunch of local politicians that can put pressure on the Texas Medical Board so They're they're afraid of them Yeah, unfortunately, I mean there's a lot of money in in selling fake medicine And so and money equals political connections equals power equals shield the ability to shield themselves So just if I can't just quickly encapsulate there What are the potential mechanisms out there at the federal level? We have the federal trade commission that can prosecute people for false advertising essentially fraud in the marketplace And I don't know about you guys. I found them to be willing Sometimes they have their heart in the right place they try but they're overwhelmed and they just sort of pick and choose what they want to Go after they certainly don't have the will or the ability to go after everything that's out there Have any of you ever dealt directly with the the FTC which is kind of a statement in and of itself So I try to help them out when I can but nothing much comes of that at the federal level Also, there is the FDA so if anything that involves Using a drug outside of it's the legal parameters or using something that's not approved using an unapproved drug That's pretty much the only time you're going to be able to get the FDA involved in shutting down a Charlotte is when they're using an unapproved drug using an approved drug off label. It's fine That's nothing the FDA can concern themselves with Have you and again have any of you guys? Utilize the FDA in terms of you know directly opposing Well, that's interesting because I've known reporters who have tried to get you know to get it to the FDA about Brzezinski. Yeah pretty Tight-lipped. Yeah, one of the weird things, you know, I was reading Ben Goldacre's book about Bad pharma and kind of how the system kind of enables some type of shenanigans And when they said that when you you would file a FOIA request For say a protocol to see what they're what they're doing. You don't get that information because it's proprietary And right and that's exactly what happened when I did that for Brzezinski. They wouldn't give me any information Until the drug is approved. It's considered a trade secret Right, but what I like with DCA David, you've written about that. That's that's an industrial chemical, right? Yeah, the FDA actually did ultimately shut this guy down That's what he's talking about. DCA is dichloroacetic acid, right and it's it you know it is used for diseases of metabolism and A few years ago. It was found in preclinical models mainly rodent models to have potential activity against brain tumors and So it's a simple chemical to make so this this pesticide salesman I kid you not Started selling it and and he did something really interesting. He sold it as quote-unquote pet DCA you buy it for your pet with cancer and you know because the regulations in veterinary medicine are you know not as tight and Everybody everybody knew these people were buying it for themselves But you know this charade worked for a while, but eventually the FDA did shut him down, right? But when drugs aren't involved Or or marketing fraud well, it's all marketing fraud But you know the FTC is unlikely to be helpful and the federal government otherwise is pretty much out of the picture Well, yeah, I mean like again I hate you keep going back to Brazilian but as long as he didn't ship it You know early on as long as he didn't ship it across state lines Yeah, they couldn't really do much and and because it wasn't it technically at the time Wasn't illegal in Texas, right? And they tried very hard to prove he shipped it across state lines But he was actually very careful and as far as they could tell they can never prove that he did right And then otherwise we're at the state level, right? So most people don't realize that the AMA by the way doesn't regulate medicine because what are we doing? It's about the AMA the enemies of is a professional group. They don't regulate anything The states regulate the practice of medicine. They license professionals You know they if you're practicing below the standard of care, whatever That's all on the state and that's what we've been touch Why we keep talking about the Texas state the Florida State Board the boards of health of each state would be the one you would go to with a specific complaint about a practitioner and the the kinds of complaints you go bring it against them One is they're practicing outside their scope Which the scope of practice is based on the parameters that they are licensed to practice or that they're practicing substandard care and that's why the charlatans are trying to one expand their scope and to Eliminate the standard of care with those two barriers gone. It's you know, it's the golden age of cracker There's absolutely nothing to stop them and then no matter even if we have an iron clad case against them There's simply no legal mechanism to shut them down Which again life somebody like presents he can be practicing for decades with without being able to shut him down and and what I can never He's not an oncologist. He's never he'd never train in medical oncology. He's not a board certified oncologist He would be a GP. He's not even board certified in internal medicine, you know He's an indie not a doctor Say that he's an indie not a doctor. Yeah No, he has a he has a legitimate MD, but you know, he's never done any training beyond an internship as far as I know Right, so he's not yeah, not specially trained as an oncologist But that's a good point that when you're licensed by the state you're actually licensed to practice medicine and surgery Right, you can do anything. Yeah, the scope of practice is basically everything So what then regulates the this the ethical scope of practice for physicians who are essentially licensed by the state to do anything? Well, I mean these days it's tends to be getting getting Certified for insurance plans and hospital privileges because most you can't get privileged in a hospital now unless your board certified and a recognized specialty You most of the time can't get on insurance plans unless your board eligible or board certified and You know recognized specialty, right? But so the solution to that is set up your own institute and charge cash Right, which is why this is that's pretty much what they do right you have the Bob's Institute of whatever and Give it an impressive name It should basically charge patients cash, you know And then you've all of all of those problems getting privileges charging insurance companies they go away So every barrier has been systematically removed David you brought up the Colorado law this one goes beyond Just a health care freedom law, you know, yeah, I'm trying to remember the details, but it's basically As far as we say legitimizes quackery it almost anything goes Yeah, essentially, I think Jan Bellamy also writes for SBM called it the quack full employment act Yes Because it essentially says the scope of practice of alternative practitioners is pretty broad I think they only limited them from doing major surgery They I don't think they could prescribe prescription medications Yeah, either but they could pretty much do anything else pretty much anything else So the another way to go against a charlatan is to get them for practicing medicine without a license So that barrier is being systematically removed as well. So no standard of care No insurance coverage, no privileges, no practicing medicine without a license What's left to us, you know in terms of a regulatory option? There really isn't much so I mean essentially they've won They've they've removed every regulatory and legal barrier Get you know that we could use to shut down the practice of fake medicine And they're not they haven't completed that process But they're making steady progress doing that state by state in all of those various ways so again, we're down to Just educating the public and lobbying for you know to reversing this trend to trying to get more rational More rational, you know regulation so Where does that leave us like you know mark Harriet? We what do you think we could go from here in terms of let's say Let's focus on the assuming we can't fix the broken regulations Then so then what do we do to protect our patients protect the public from these quacks? Well, hell you've convinced me I'm changing I'm setting up a clinic. I think going you have to offer is at this point education and trying to reverse the tie I mean all the and the problem is when they have state Regulation and they have societies. It's going to be impossible to get rid of them and I did It's education certain things. I think over time become an embarrassment for people and right now Alternative medicine is not an embarrassment to use if you can make your as someone's belief system Embarrassing as part of a cultural phenomenon people will tend to drift away from it. I think certain evil parts of the Western society Have drifted away because people are embarrassed to be seen as racist or whatever a ridicule ridicule Works to some extent. Yeah, I wonder one of the patients I agree that education is key and that's what we're trying to do We're trying to get good scientific information out there on the internet where people can find it and the other thing I think we ought to be able to do something to improve on enforcing the laws that we do have there were two cases in Washington State of people practicing medicine without a license One of them was a veterinarian who was using one of those Electrodermal diagnostic machines and she was ordered to stop practicing medicine without a license and she moved a few miles over the border into Idaho and started a new clinic and kept right on going and There was a case that I reported were some kind of a spa Totally non-medical people were using one of those diagnostic machines And I reported them to the State Attorney General and I got a nice note back from the investigator saying thank you for reporting this We want to investigate those people, but we're not allowed to do it until somebody like you makes a report Thank you so much, but then he investigated and they said oh well, they're not really practicing medicine Yeah, I mean that's the big thing with state medical boards a lot of them can't do anything until there's a complaint Yeah So that's something that that anybody can do anybody could file a report to the FDA the FTC the state medical board But it sometimes has to be a patient complaint an actual patient He thinks that he's been a victim right and that's one of the things that with the other Brzezinski patient group Since we've been critical and open and vocal people are finding that there are other people who have felt burned too and They often don't know how to report These things so we try to guide them to the right people Yeah, you're right, so you need a victim You know it's a lot of sometimes a legal process doesn't get underway until somebody says I was harmed by this practitioner And those are those people that were amazingly difficult to find because nobody wants to admit that they fell for You know something Fingy like that. Well coming back to Texas again, and this is not about Brzezinski this time I forgot I forgot the Doc's first name, but his last name was Arafilis But does anyone remember the Texas? Nurses and from Winkler, Texas who wanted to report this guy for pushing supplements doing Substandard medicine and in the ER and stuff like that Then this guy was buddies with the sheriff and they found out who made the complaint Texas at the time did have an anonymous A law where you could complain anonymously about a practitioner and they found out about them and they got they were almost put in jail for You know for quote-unquote violating patient confidentiality to send the medical records Even though Texas law says that using medical patient medical records to make a complaint about Substandard care is not a violation of HIPAA, which is the privacy law, but you you can't get a patient complaint if You give the therapy the patient gets better you get credit you give the alternative therapy They don't get better. Well, you didn't come to me soon enough. So they're in a win-win situation Or they're dead and dead people don't file even the worst one kind of a practice all the complications that they get they consider To be part of the therapy It's very convenient so you can't do wrong to have a complaint Right so I mean that part of their shtick is sort of preparing for failure if it doesn't work they have you know lots of things to blame other than themselves and Their patients will probably buy that just like they bought their the original justification for going so again It becomes really hard to find patients who are willing to say I was harmed By this practitioner, but when we do then we have the so another avenue that we have before us that we Haven't discussed we're talking about federal regulation very limited state regulation Political will isn't there and their power even when they have the political will their powers being taken away from them systematically by gullible state Legislatures, but then there's the legal avenue. So suing practitioners for Malpractice for harming patients. This is now is not regulatory. This is civil We don't see a lot of this either and does anyone have on the panel have any ideas about why? Have we failed to explore this avenue adequately or can we support this avenue more or is it just are there things that are Limit are the limitations. I'm not thinking a lot of these practitioners don't carry malpractice insurance So there's no deep pocket that the lawyer is willing to go after Well, the one thing they teach us that malpractice courses is it's not screwing up that gets you sued most of the time It's when you establish a bad relationship with the patient and they feel like they somehow have been Lied to or kept out of the secret, but screwing up won't get you sued because everyone no one's perfect I should phrase that differently But they don't they establish is all about the relationship Yeah, so you're not going to have a dissatisfied relationship with an alternative practitioner because that's at some level all they have to offer That's the only level a case in point I got an email from Someone who had had a stroke after a chiropractic neck manipulation and It sounded like he had done some really inappropriate things and I asked them if they had reported him and they said no in fact they've never even gone back to the treating chiropractor to let him know that the patient had had a stroke and You've got to have a patient complaint to do anything there was a chiropractor in Seattle I think she's still still practicing that I called a no-touch chiropractor. She was doing neck Manipulations of a special type upper cervical chiropractic and she would take one hand over the other and She'd go and make a cracking sound in her own wrists while she was about Now they did a news story on a news magazine and the video was available online And I sent that to the chiropractic board and I said look She's doing a procedure that's not approved There's a list of things that chiropractors can do and no touch chiropractic is not on the list Besides which she's telling these patients that she's giving them upper cervical adjustments and she's not touching them So she's charging them for something that she didn't do and They dithered around and they misinterpreted what the video said and I had to file a second complaint to say go back and look at the video and The upshot of it was They decided they wouldn't do anything because no patient had complained I had a patient once had a long story weird complication from chiropractic and I pulled I pulled the patient I think it's probably from the chiropractic. She's oh, I love Dr. Bob. He's like one of the family I'm not gonna worry about it. Yeah, you're a month-long hospitalization the patient Kathy who was in my talk Who was at the clinic and only later found that she was not gonna get the anti-neoplast and she said well, this was part of my path Part of my path, you know, and I you know, I I believe she's still she's still with us And I sent her a note saying, you know, it's not just you Right. I mean that this there are lots of recurring complaints, you know, make sure this doesn't happen anyone else I read about a family that had had one member with a Stroke due to a chiropractic neck manipulation and they liked the chiropractor so much They kept going back until three family members had had strokes So what can you do there? They have great bedside manners. They spend a lot of time with patients. They're very caring and Patients love them and don't want to sue them Road to hell is paved with good intentions So we have about eight minutes left. I do want to leave some time for questions Is George is there a microphone in the audience? Are you gonna pass that around? So any while George is doing that and people are queuing up any final thoughts before we go to questions? Just one quick thing. Good. There are risks to doing this. Yeah, for instance You know, I showed that just the Twitter stuff was nothing but this here is a letter. I got about a month ago from my state medical board Saying that some time ago an allegation was filed against you with this office after a thorough review of the matter We have determined that a violation of the public health code cannot be established. Accordingly our file has been closed imagine my relief However, I'm pretty sure I know who did this and it's a Brzezinski patient Yeah, so I mean there is some liability on our side, you know, the people She also called my university. Yeah, so something our bosses can get called Complaints can be filed against us because all you know, we're just trying to say what we believe is the truth You know our credentials could be questioned. You know, we do put ourselves out there I mean, fortunately, I don't not familiar with anything really bad happening But we're always always like waiting for the hammer to drop take a first question. Hi. This is Susan Don't forget to mention that Wikipedia has been a major battlefield 23,000 views to the clinic's page this last month also rebutter and web of trust something all of us can be doing joint skeptic action Yep, control the flow of information. What she said Quick plug the JREF is selling the science-based medicine ebooks You can you can download them through the JREF for the noob for the Kindle by them read them love them You can also if you want to get them all on one fell swoop You can get see CDs with all of the books on all the formats at the SGU table out front when it comes to Wikipedia Could I just mention that that that is so effective that? Wikipedia was singled out in the most recent Brzezinski movies as being controlled by evil skeptics. No, seriously No, watch the movie on You have to unleash the evil hordes of skeptics I Have two kind of short questions one is how do I ensure that my position is a science-based physician? And where can I send my friends besides science-based medicine to get more information about the chiropractics that they go to? Before I jump in anybody want to offer an answer the answer to the second question is quack watch. Yeah, absolutely. That's a good. Yeah Now Yeah, it's some of it's a little out of date, but it's still solid by and large Yeah, and there may be plans to update and and there yes. Yeah, leave it at that, but also just Search on that the specific item that you're interested in Comma skeptic. Yeah, and you will get to lots of resources that may not be on those two websites science-based medicine Quack watch those are probably the most dense resources But the other resources are spread throughout the skeptiverse on the online. So just chiropractic skeptic and our hit rate is really good We do actually do very well in terms of page ranking of Skeptical articles because you know, we've been doing it for a long time. They're actually fairly academic. We're well linked So that that search Is effective. What was the other question? How do I know if my physicians a science-based physician? Any any thoughts for the ball if he recommends acupuncture. He probably isn't but Sorry, that was a cheap, you know as as a philosophical approach to medicine I would probably say that 99% of doctors are not science-based We don't have a background of training to think critically in our Consumption of a huge amount of information and trying to synthesize So you'll find that most docs are evidence-based and they follow the protocols and the Cochran reviews and those things but This table is probably pretty much all the science-based medicine docs in the United States Marks our resident nihilist. Well medical school really isn't doesn't teach science per se. It teaches you how to be a doctor like how to treat patients and Somewhat how to evaluate evidence, but it's not the primary Mission. Yeah, but more directly to your question I would say that certainly watch out for red flags. Take them seriously. Don't brush them off You know if they recommend something that sounds quacky it probably is and it does question it You know you could find another resource Even another doctor if you've had something a really critical decision and see if they're they agree with you know With the first opinion So I think just the red flags is probably the most useful way If something doesn't feel or sound right to you don't take it for granted Don't assume it's because they know better than you do Investigate it till you feel satisfied and happy with it and you can judge a doc by the company He keeps if they're in or she if they're in a big clinic associated with a major hospital institution That does not have an integrative medicine program odds are pretty good. You have a good group if it's the University of Minnesota Integrated medicine program. Yeah, you might want to go somewhere See if their name rhymes with dr. Bos too. It's always good Hi, I was just wondering since you Don't hold the highest opinion of some of the standards in the US are there any countries where where you think Just has better standards or that you're looking to integrate or just sort of Something along those lines, I'm not sure I'm knowledgeable enough I mean there's a problem everywhere, but it seems particularly acute here Yeah, well, there's no science-based medicine utopia out there every country has their different problems They may be better when it comes to regulating marketing claims like the but they're worse in other respects like in the UK the Advertising standards Association just came out with a just a devastating critique of homeopathy, which was awesome I would love the FTC or the FDA to come out with that in the United States Which is just not going to happen But they have other problems in the UK that we don't deal with Australia, Canada, you know the countries that I'm familiar with they have they're better in some ways worse than others It's just a mishmash, but there's no perfect country out there. Antarctica Antarctica, yeah, here is pristine Hi, I just recently heard of An organization called merger watch. I don't know if any of you guys have heard it merger watch merger watch It's an organization that's concerned about the when catholic hospitals merge with Merge with sex sexual hospitals and then they try and impose their Religious guidelines On on the hospital that they're merging with so I don't know if you guys have heard of it or That's a whole area we didn't get into I know that can be an issue, but I don't know any details. Yeah, I'm not familiar with I'm sorry I'm not real familiar with that issue We'll do one more question a two more Sorry, just a couple of really really short quick questions and not intellectual or anything. I just didn't catch a couple of things What did you call a cornucopia of quackery? Naturopathy look it up. Okay, and where was it legal? What's that about 20 states of legalize something? Yeah, it's like 18 or 20 states Yeah, and in fact they just introduced the bill in Michigan, but it doesn't appear to be going anywhere But they're constantly pushing to get licensed in every state. Okay. Thank you I just wanted to say regarding the question about different countries and how things are working with their laws One of the things that's actually happened in New South Wales in Australia. Oh, what do you know? Thank you know more about Australia than we do Sure anyhow the in New South Wales up until recently We had a similar problem in that you had to actually a patient had to lodge a complaint in order to Have any action taken against a practitioner? What's happened is since the failure to prosecute the Australian vaccination network for for their actions We've actually successfully had the legislation changed in New South Wales So that you can we can now actually put in these complaints ourselves They don't actually have to have done anything wrong So our health care complaints commission are now expecting a flood of complaints from skeptics Regarding all of the the practices. So I think the main one of the main things is you have to lobby your politicians to change the laws That's a good note to end the panel on that the bottom line of all this again, we're not trying to be nihilistic We're all doing this and we're doing it with with passion is that really the thin line between The rest of the world and just being completely overwhelmed by quackery and nonsense is the skeptical movement We're the last line standing so we do have to to keep pushing to keep fighting the good fight. So thank everyone for coming Congratulations