 So, we're going to talk to you about complementary and alternative medicine. You might imagine that we have a couple of strong opinions about that topic. We'll try to share them with you. I noticed the slide's already gone up there. So that's our colleague, Mark Crislip, who wasn't here. Now, for those of you, he seems to like a little bit of fancy words. So the next slide, just for those who don't know what instantiate means. Okay. All right. So yeah, so we're going to talk about cow pies today. But first, just by way of introduction, Harriet Hall is a retired physician who blogs for us at Science-Based Medicine. David Gorski is a managing editor of Science-Based Medicine Blog, and even for years before that runs his own blog, Respectful Incidents, where he blogs under the name of ORAC. And Rachel Dunlop is very active in the Science-Based Medicine movement or opposing alternative medicine in Australia and internationally. So welcome to my esteemed panel. So we're going to talk to you during, at this panel, about complementary and alternative medicine. We actually try really hard not to let that frame the discussion or frame the debate. That's why we chose the name Science-Based Medicine. We want to be pro or for something. We are promoting a scientific standard in medicine. But complementary and alternative medicine or CAM, which is pretty much what we're going to call it for the rest of the panel just for convenience, is a social cultural phenomenon now, legal even, and it has infiltrated not only into regulation but also into academia. So we have to confront it. We have to confront the concept, the meme, if you will, of what is CAM. So I'm going to start with that question for my panel starting to my left with Harriet. Can you just define in your mind what is CAM? Well, there's no such thing as alternative medicine. It's a myth. And there can be alternatives within medicine, for instance, surgery versus medical treatment for coronary heart disease. And there can be alternatives to medicine, like not treating at all. But there can be no alternative to medicine itself. There's just medicine that's been adequately tested and proven to work and medicine that hasn't. And when it's been proven to work, it becomes part of conventional medicine. That is actually almost a direct quote from Marcia Angel. I don't know if that was intentional from the New England Journal of Medicine from I think 10 years ago or something like that now, maybe eight or nine years ago. There is no alternative. It's either science-based medicine or it's not. Dave, do you want to add something? Obviously, I agree with Harriet, but I would sort of add there are actually three types of medicine, medicine that has been shown to work, medicine that hasn't been shown to work, and medicine that's been shown not to work. And CAM is mostly the latter two, medicine that either hasn't been shown to work or has been shown not to work. And the whole term complementary and alternative medicine is basically more of a marketing buzzword than anything else. Back 20, 30 years ago, it used to be called alternative medicine. And over time, they decided that they didn't like, alternative implied that it was inferior, it was outside the mainstream, which of course it was. And so they came up, I don't know who came up with this term, but complementary and alternative, they're like, okay, it will complement medicine. You use it with regular medicine, which leads to Mark Crystal's quote. Because the latest buzzword is integrative medicine. Integrating can into regular medicine. Or as I say, integrating quackery with real medicine. Right. Rachel? Yeah, I don't really have a lot more to add than what my colleagues have said. But I think many people in this audience would know the famous Tim Minchin line that he's used in Storm, the video, which is alternative medicine that's been shown to work is called medicine. And there's no alternative to that, that's it. Medicine that works is medicine, there's nothing else. So then is the category, complementary and alternative medicine, a legitimate category? Harriet? No. No. No. All right. So then how did the category originate? I don't think it originated from within mainstream medicine as something that, it didn't arise organically out of categorizing different types of treatments or an approach, it had a specific history to it. So we'll start with you, David, actually. Tell us, how did the whole CAM phenomenon begin? Well, I mean, it's one of those things that it was basically, like I said, a more of a marketing vehicle. It complementary an alternative is, but by calling it complementary you're basically saying, well, we're not saying you shouldn't use conventional medicine, but this could complement it. And then complementary and alternative added together. It's a nice little acronym, CAM, easy to remember, easy to sell. Now, of course, interestingly enough, a lot of practitioners who are pushing integrative medicine don't like the term CAM anymore because they don't like the fact that it has all, having something that is complementary to medicine to them implies that it's inferior, which it is, but they don't want, but calling it integrative, they now can sell it as, oh, we're integrating the best of both worlds and it elevates these unscientific methods, you know, at least in the public eye as being co-equal with conventional medicine. And, you know, that more than anything, it's about language. It's about branding and marketing. Right. And I mean, I wrote a post a few months ago because I came across this CAM website where the guy was saying, and CAM should be renamed to the National Center, you know, for integrative medicine, don't use CAM, use integrative medicine. For basically the reasons that, you know, I said, you know, alternative implies inferior, you know. And our colleague, Wally Samson, who's been doing this a lot longer than we have, he comes right out and says, before the term CAM and integrated, before all these new marketing rebranding terms were around, it was called health fraud. Or quackery. Or quackery, which has a legal problem to it. There's a couple of, unfortunately, you know, if I use the term quackery, that you're opening yourself up to libel that some of our colleagues in Europe were successfully sued for calling a quack a quack, which is unfortunate. But just saying it's health fraud, I mean, that was what it was called. But then, say, managed to completely change that around to essentially the promoters of health fraud said, okay, we're going to brand this as alternative and complementary, integrative, whatever. And it, in a way, it worked. Yeah, it did. But isn't that what Mark Chrislip, Mark Chrislip is quite upfront about this, Steve. Doesn't he call it SCAM, Supplementary Complementary Alternative Medicine? Or so-called Complementary Alternative Medicine. Wally Sampson tried to pin down the first usage of the term alternative medicine. I don't think he ever figured out, was trying to find when it was first mentioned in the medical literature, that it wasn't until sometime around 1970 that the term came along. Before that, we call these things quackery and folk medicine and all kinds of other terms. But everything got lumped together under alternative medicine. It includes herbal medicine, which is somewhat plausible, because that's where pharmacology came from. And it includes things like drinking your own urine and sticking candles in your ears. So it put a lot of different things into one bag, very inappropriately. And it wasn't until after 1990 that the terms complementary and integrative medicine came into common use. So it's really a recent phenomenon. Yeah, and that's a very interesting point, Harriet, because we get often asked about CAM. And the category is so broad, it's hard to make sweeping statements about, except for the fact that it's everything that's not science-based medicine. So it's really defined by what it isn't. But David, maybe you could talk a little bit about this, too. What's the spectrum that we see under this broad umbrella of CAM? Oh, you have everything from what Harriet said, drinking your own urine or homeopathy, Reiki, which is, by the way, nothing more than faith healing using Eastern mysticism instead of Christianity as its basis, to supplements and various herbal medicines. Now, we always make the point that herbal medicines and supplements might actually have physiologic effects. They do, after all, often contain drugs. They may be like adulterated, impure drugs with, you know, who knows what their potency is, but, you know, they're drugs and there's some plausibility. And there's a whole field in pharmacology of natural products, you know, natural products, pharmacology, which is science and some of our most important drugs, for instance, in oncology, have come out of it. Like, Taxol comes from the bark, was originally derived from the bark of the Pacific U tree. So you do kind of have to, you know, distinguish the various forms of medicine that fall under CAM. Some of them are somewhat plausible, but those don't need to separate category. Once again, if they test out scientifically, then they just become medicine. Yeah, one of our colleagues, actually I'm forgetting which one, said that the spectrum is from the barely plausible to the demonstrably absurd. That was Kimball. That was Kimball. Yeah, that was great. That pretty much captures it. So, but what's the effect of it being so inclusive? Is that something that works in their favor or in our favor in terms of, you know, the public opinion about CAM? The fact that the category, this false marketing category includes things like homeopathy, which break the laws of science, you know, physics and chemistry, let alone, you know, biology and medicine. Including that with things that are plausible and reasonable, but just need to be studied scientifically, like herbalism, for example. And even beyond that, I would add, they try to, they're constantly trying to include under this umbrella things which are already part of science-based medicine, like nutrition and exercise. And anything to do with physical therapy. Exercise or nutrition. Of course, their version of nutrition only resembles science-based medicine. Science-based nutrition by coincidence sometimes. Well, there's, yeah, there's science-based nutrition and pseudoscientific nutrition, but they try to include the science-based stuff and rebrand it as CAM. So it seems that they're trying to make the whole category legitimate by including legitimate end of the spectrum. Yeah, it's a huge umbrella and people can find something that they believe in and that lends credibility to all the rest of it. So, you know, I believe in X, so all that other stuff. If it's the same category, maybe I should start believing in homeopathy and some of those other things. I call it the Trojan Horse, okay? You have the Trojan Horse is like nutrition, you know, lifestyle interventions, you know, maybe a few plausible herbal medicines. And they pull the Trojan Horse inside academia, which is another top topic entirely, how this is infiltrated academia. And then all the woo comes out, you know, once it's... Well, that's part of the down my list, but since you bring it up, David, and you've written a lot about this, why don't you tell us about how they, how CAM proponents have infiltrated, to what extent and with what strategies have they infiltrated academia? Oh, well, there are now many medical... First off, there are many medical schools that now have either, you know, division, sections, you know, departments of integrative medicine. And these include big names, Harvard, Yale, unfortunately, Stanford, you know, and basically, you know, they've been re... Under this rebranding, they've managed to give the impression of some scientific legitimacy. And there's now, you know, there's a large, you know, we have the National Center for Complimentary and Alternative Medicine, which, you know, is funding grants to study this stuff. We have the Bravewell Consortium, which is funding grants and various programs to promote CAM for one of a better term. So there's a lot of money in it for medical schools. They've basically given money to set up a Center for Complimentary and Alternative Medicine. Yeah, I mean, the same thing is happening in Australia, but to an extent, it's driven mainly by the fact that unis are going broke. Like, we don't have, they don't have a lot of funding anymore. And in our case, there's a lot of money in China that they're throwing at unis to establish traditional Chinese medicine clinics. In fact, only last month, a university in Adelaide set up a facility guided by the Vice Chancellor because they're getting a lot of money thrown at them. But Australian skeptics recently did a very large amount of research looking at the amount of quackery or CAM that's in universities in Australia. And we found that about two-thirds have some sort of alternative medicine. And some of the stuff is just nuts. Like, Tim Mendham, who's our executive officer, is here and Joe Benamue did this research. He found that there was an electrical engineering course that was teaching auras. I mean, okay, that's not a medical course specifically, but also there was a homeopathic midwifery. Not quite as sure how that works. But it went from things like chiropractic. Let's just push a little bit. Unless you push, I don't know. Unless you push, the more effective it is. But, you know, we've started a campaign in Australia that some of you here, I think, are actually signatories to. It's called Friends of Science in Medicine. And that rose out of this research that we did, and it was spearheaded by Loretta Marin. And it's basically just a bunch of people and academics who are concerned about the infiltration of CAM into universities. And we've got something like 400 signatories to this, just saying it's really designed to highlight this and to indicate to vice chancellors and chancellors that this stuff should not be in science-based courses. I mean, one of the things that was particularly bad about this and insidious was there was a chiropractic clinic at the Royal Melbourne Institute of Technology that was specifically treating babies. So they were cracking babies' necks in this clinic. And, of course, there's no evidence that that does anything apart from possibly harm them. And so there was a big campaign created by Australian skeptics about that. And, fortunately, one of the universities has scaled back some of their CAM, but we're up against the fact that there's a lot of money from CAM proponents who are flowing into universities, and this government funding is pulling out. They're in a bind. I found some interesting statistics online. They said that 60% of U.S. medical schools teach some form of CAM. And in Europe, it was 40%. I also found a study of Danish medical students that was kind of scary. They said that, see, 68% of the medical students in Denmark had used some kind of CAM. And most of that, fortunately, was herbal medicine and vitamins and things like that. But what was chilling to me is that 18% of the medical students in Denmark had used reflexology. I actually was thinking, I might be able to top your examples. And sadly, I hate to do it because it's my alma mater. The University of Michigan has a section of anthroposophic medicine. That's Rudolf Steiner. Oh, wow. So this brings up the question of friends of science and medicine as a good example of scientists and science-based physicians banding together and saying, this is wrong. This shouldn't be happening. We need to maintain a standard of science within the field of medicine. But why isn't that happening more? Why isn't the scientific and medical community in an uproar or an outrage over the infiltration of blatant pseudoscience into medicine? David, you want to start with that? He's being a shruggy. Val Jones coined a term a few years back, the shruggy, which basically is... Yeah, they realize it's nonsense, but they just don't care enough to do anything about it. And another thing is most physicians are not really scientists. I hate to say this being one, but I learned that this is true from having done a PhD as well as an MD. They don't necessarily always recognize what's good science and what's not without some help. Yeah, I want to add to that because there was a department in a university that I can't name where they were teaching anatomy to chiropractic students and when the academics went and complained to the vice chancellor, they were told that because they were teaching that course, they were getting tens of thousands of dollars in the kitty, which they could then spend on their research if they didn't have any money. So they were sort of in a bind of, well, if we stop teaching anatomy to chiropractic students, we won't be able to fund our labs, so they just kept doing it. Do you want to add anything here? I just wanted to say that I think some medical doctors don't really understand what the camp people are claiming. They've heard of it, one of their friends used it, it sounded like a good idea, and they don't have the time or the interest to really understand what it's all about. Oh, absolutely. For instance, and I'm sure you've encountered this, most people and a lot of doctors think that homeopathy is just herbal medicine. Yeah, and most pharmacists too, sorry. So when I actually explain it to them, or I give a talk explaining it in gory detail and comparing the dilution to the number of atoms in the known universe and stuff like that, they're like, really? Yeah, I have confronted my colleagues about this a lot, and you hear things like what's the harm, or it's all just faith healing, and it's always going to be this in medicine, so why bother? Or this is just making patients feel better, it's like the touchy-feely, benign intervention, so let them do it, and there is a complete lack of understanding of how the rank pseudoscience that it represents. I mean, yeah, and that part, whenever I hear that I say, so you're basically saying that to have a good bedside manner and make our patients trust and like us and treat them with respect that we have to embrace quackery? Right, but I guess they don't think about it as quackery. Okay, or that we have to abandon science? Right, yeah, we understand that that's what it is, but I find it's just the same in Australia, do you think Rachel? It's amazing how little our colleagues know about pseudoscience. It's like what Jamie was saying yesterday, that there's the consumer protection organizations that don't have the skills and the expertise to understand this stuff, and then there's the scientists who don't have the knowledge about the quackery and the tricks that people can pull on people. So we're the guys in the middle, that it's our obligation to explain this stuff to people, and I work with plenty of scientists, and our job is to critically analyze data and come up with evidence for an effect, and so many of my colleagues don't know that homeopathy is bunk, and I've had people tell me that I should leave people alone to puncture works, and they don't know how, but it works. So within medicine, we have what we like to call a standard of care. You can't just do anything and call it medicine, and the traditional method for determining what the standard of care involves something to do with scientific evidence, we call it a science-based standard of care. In my mind, CAM represents an erosion, if not a full frontal assault on the science-based standard of care. So, Harriet, why don't you discuss that a little bit further? How should we have a standard of care, and how does CAM relate to that? We should have a standard of care, definitely, but the devil is in the details. When you try to define a standard of care and implement it, there is one big problem with that, in that science is constantly changing. So if you try to have a cookbook or a dogmatic standard of care, things are going to change, and there is a chance that somebody could be sued for not following a standard of care when actually he was following better, more recent evidence that just hadn't developed into the standard yet. But we have to have standards. I mean, the lawyers couldn't do their job in malpractice suits if they couldn't say that the doctor had failed to follow the standard of care. Right, so the standard of care is a bit fluid, which is what you're saying. They maybe exploit that in order to work it in around the edges. I think it's worse than that, though. Did you want to talk about that there? Well, no, we have, you know, it's actually a fairly recent phenomenon that's going on, evidence-based guidelines that are being, you know, issued by various professional societies. We have a ton of them in oncology, and we, in particular, where I work, I follow the NCCN guidelines, which is the National Cancer Center Network or something. But it's an organization that puts out these guidelines, and you should see the ones for breast cancer. It's like, you know, pages and pages, and they update them, like, every year or sometimes multiple times a year. Do you think that, this could be Rachel or any of you, do you think that CAM represents a double standard within medicine rather than not only an erosion of the existing standard? Well, I guess it represents a double standard in the sense that they want to be, they want to play with the big boys, if you like. They want to be in the white coats, and they want to have the stethoscopes, and they want to have evidence behind them, but they don't want to follow the rules, you know. So they don't want to have to prove efficacy or safety, they want to be up there with the drugs that have gone through, you know, phase four clinical trials and cost billions of dollars to get to that stage. They want to have that legitimacy without following the rules, and practitioners of CAM do that all the time. They don't want to be regulated, they don't want to be controlled, but they want to play with the big boys. So let's talk about those rules. You're talking about the rules of how scientific evidence relates to the practice of medicine, how we interpret scientific evidence, and that's my experience as well. They don't want to play by the rules of science. David, you talk about the Trojan horse we've written about the bait and switch. Tell us a little bit more about that. Well, I mean, basically, they want to shortcut the whole process and essentially reach approval of their methods or acceptance of their methods in the medical community without doing the hard and dirty work that it takes to get to that stage. You know, to get a treatment to the point where it's accepted in medicine is usually a pretty long process. It can either start with a clinical observation, then it involves lab work, and then, you know, back to the clinic for clinical trials that start out small, like pilot studies, and then work their way up to large phase three studies. And they want to jump straight to the phase three a lot of times, and they tend to do them badly enough that placebo effects can often make it seem as though they have some evidence that their stuff might work. In acupuncture, this is... In fact, you said... Oh, how they go back to lesser trials. Yeah, so there are a certain hierarchy of clinical evidence that we use to decide what works and what doesn't work, what should be part of the standard of care. And when the best studies show that, for example, acupuncture doesn't work, I've found that I've written about this. They do one of two things. They reinterpret the study to say that it does work by essentially rebranding placebo effects as a real effect. Or they say, okay, forget that. We're going to go to less well-controlled, less rigorous trials because they're more pragmatic or a real-world experience. And we're going to use that data. So essentially, trials that were never designed to be efficacy trials, we're going to use them to prove, quote, unquote, or demonstrate efficacy because the efficacy trials are coming out negative. And again, that's definitely a double standard because they're not playing by the rules. Yeah, I had a little fun with a homeopath recently just before I came to TAM. And he's apparently quite famous for trolling in the UK. But I think the panel is familiar with the Shang study from the Lancet. Was it the Lancet, 2005? No, it was published. It was a meta-analyses of where the homeopathy works. And they chose about 12 different studies and looked at the overall body of evidence, which is the best way to determine if there's a real effect. And they found that there was no difference between the homeopathic treatment and placebo. But within those were six studies that were positive. But when you compared them to the rest of the studies that were negative, you got an answer of zero. But this guy was going and picking out the positive studies from that meta-analysis and saying, but look, they're positive, they're for homeopathy worse. He was undoing the meta-analysis. He was undoing the meta-analyses to get a positive effect. And there will always be seemingly positive studies. There's noise in clinical trials. We choose a certain statistical significance level. There will always be false positives. You have to look at the entire body of evidence. What really kills me is when they admit that there is no good evidence to back their message. For instance, there have been acupuncturists that have said, well, yes, their literature doesn't really support it, but we want to keep doing it for the placebo effect. Well, that's obviously a double standard because what if a pharmaceutical company had a new drug? They did a study and compared it to the placebo and found that the placebo and the drug worked equally well. I mean, it would never get on the market. They're not able to sell a drug because it might have a placebo effect. So the double standard is just glaringly obvious there. So that's sort of the scientific double standard. They're trying to have rules just for themselves. They want to write them as they go along to suit the evidence, rebranding placebo effects using the wrong kinds of studies. But there's also a legal double standard that they are very aggressively pushing. In my experience, it's largely under the banner of healthcare freedom. And in fact, there are healthcare freedom laws in many states. Just on the road a couple days ago a little of that. So tell us about that, David. Okay, healthcare freedom. It's basically what I like to call health freedom, freedom for quacks from pesky government interference. Which is basically what it is. But they branded under, well, you should have the right to choose your healthcare. I'm like, okay, you have the right to choose your financial instruments, too. So does that mean Bernie Madoff shouldn't be in jail? So yeah, they branded as consumer freedom, but it's really the freedom of the seller to not be restricted by standards of care. Yeah, there's a current fight going on in Australia with the anti-vaxxers because there's a product that you may have heard of called black salve. And it's basically a paste. And it's caustic. And it's supposed to cure cancer. So obviously David would know about it. Yeah, basically it burns holes in your face. And Quackwatch has written a whole page about it where someone applied it to the side of their nose and ended up with half a nose because it's a caustic paste. And so for that reason it's banned by our regulators. But the Australian Vaccination Network has decided that that is against their health freedom. So they keep going on radio and talking about how we should be able to buy it and use it because it cures cancer. And they keep getting told off by the regulators and they keep saying, but it's our health freedom. I could never understand the black salve as a cancer surgeon. Okay, yeah, you could cure some skin cancers by burning them off. But it'd burn them off in an uncontrolled fashion, leave a horrendous wound instead of cutting them off, which is what we do. But you see what you don't understand is it hasn't innate intelligence apparently, David. So it can choose the cancer cells selectively. It doesn't burn all the... It doesn't just burn your skin. No, no, no, it's smart. It's not like this cancer. That's what I've heard from the health freedom people. Yeah, there's also, I think, an analogy to be made with academic freedom calls, say for creationists, say, it's the same thing. They say we want academic freedom to teach pseudoscience in science classrooms. And again, it's the conflict with the academic standard. So we say there should be some minimal standards in terms of academic legitimacy for science-based medicine. And they are countering that by saying, no, but we want academic freedom, freedom of speech, health care freedom. Want to add to that, Harry? Vaccines tie in here, too, because parents say they don't want the government telling them what to do with their children. They want the freedom to treat their children with their parental wisdom. Yeah, so the parental freedom also comes in. Oh, yeah, it's the same thing. At your debate a couple of days ago, what was the last question? Should vaccines be mandated? Should vaccines be mandated? And that was the one where the audience says, we want to hear your answer to this. When the conversation was getting a little bit away from it, that was the thing they were most interested in. I just want to add one thing, Steve. Freedom of speech and freedom of health doesn't mean that you don't have freedom from responsibility. And I think that's the point here, is that these people want freedom from liability and responsibility. So they're quite happy to go and spruke things like black salve, but they're not under the same regulations and legislation that science-based people are. So if you, David, went and used that on one of your patients, you'd probably be struck off or you'd be disciplined for that. There would be consequences. There would be problems and trouble. Yeah, but these people want freedom from having to apply the laws of science and then freedom from actually having to take the consequences. And in many cases they don't have to, because there's no legislative bodies to crack down on them. And people may remember the homeopath, Francine Scrayon, who was involved in treating a woman who died from untreated colon cancer. Now, that went to the courts and it went through the coroner, and they deemed that she did play a role in that. However, she's still practicing now. And in science-based medicine, that would never happen. And I point out that, again, I said there are actual health care in the United States. And I've personally been involved in cases where we proved in court that a physician was practicing below the standard of care. I mean, significantly enough that what they were doing was malpractice and needed to be disciplined. They were disciplined. And then they appealed on the basis that what they were doing was alternative. And under the state's freshly minted healthcare freedom law, that they were immune to the standard of care. That's the rule. Well, that's one case, but I was also involved in another case. You know what he did? He has a very powerful political organization in North Carolina. He's basically a doctor who practices alternative medicine. And he used to treat cancer. He's big in the autism world because he used chelation therapy and all these other, quote-unquote, biomedical treatments and autism. So basically when the state medical board started coming after him, he managed to get his buddies in the legislature to pass a law that basically was like one of these health freedom laws and he's off the hook. Yeah, can you legalize my crime so I don't get held accountable for it? Thanks, guys. I want to leave some time for questions and answers. I think it's always the most interesting aspect of this topic. I want to ask each of my panelists one final question, and while we're doing that, maybe you could start the process of lining people up for questions. So the final question I'm going to ask of each of you. I'll start, Rachel, with you, is if you were all-powerful dictator of the world, what steps would you take? So if you could just say I want to institute these steps to protect the public of what you take. Yeah, well, I take steps to try to, I guess, delegitimize it, and in many cases, at least in Australia, and it's probably the same in the US, a lot of quackery or CAM is included in private health insurance. So when you sign up to pay to get health cover, you're also paying for things like chirohomyopathy, aromatherapy, crystal therapy. And in fact, there have been moves in Australia very recently in private health because currently the situation is the government supplements the health funds and so in an indirect manner they're paying for that. So that potentially is going to be removed from Australian health funds, which is fantastic news. And then I would also just slap the media around the face and upside the hedge because honestly, anyone who watches current affairs magazine type will and they do so much damage because there's still evidence to show that most of us are exposed to that and a lot of us get our health reporting from watching the mainstream media and they just swallow everything whole and spit it out as if it all works and I think that's where I just go, that's it, slap upside the head, stop it. Okay, David. If you add Dr. Oz to that, I'll... Yes, I'll slap him upside the head. What has to happen is that the various medical boards, in the US each state has its own medical board but other countries have medical boards. It's all done in different ways everywhere but however they do it, the medical boards have to have more actual power, more actual ability to discipline doctors, more actual basis in science. A lot of what medical boards do is not to enforce the standard of care. It's to go after doctors and appropriately so who are like dependent on substance dependence, alcoholism or who are diddling patients or something like that and yes, they need to be that is their priority because those are very easily demonstrable dangers to public health if you let that doctor continue to practice but often there's no energy left to go after these doctors practicing various things that we consider quackery. The first step is the medical boards have to be much strengthened. A lot of them are run on a shoe string budget, overworked, overburdened, dealing with pressing threats that they view like someone who's sexually abusing patients, someone who's drunk in the operating room, someone who's selling prescriptions for narcotics. It's also their mandate to defend the standard of care because they don't have the energy or budget left and also I find the political will to do much about that. I certainly agree with all of that but Cam will always be with us, quackery will always be with us because we have defective brains that evolve to be more like Captain Kirk than Mr. Spock and people make decisions based on irrational and emotional factors and we all do it. I certainly admit to it and I doubt if there's anyone in this room that hasn't made a decision based on one of those things and you got to be careful not to get paternalistic or condescending when you try to protect people from themselves. So what I would like to see ideally is to have a reformed educational system where at every level of education, starting in preschool, we were taught critical thinking skills and and then combine that with ready availability of accurate information and then if people choose to make poor decisions based on emotional and illogical factors it's informed consent. Okay. George will start taking some questions. First question. Alright, you've actually already touched on this a little bit but given the fact that there now seems to be maybe a substantial part of the population that might not seek out conventional treatments without some complementary or integrative medicine. What are the kind of ethical and moral dilemma if any in addressing those patients so that if you're unwilling to use that, that you don't discourage them from getting the conventional treatment that may be necessary to treat. So what are the ethics of just as a physician if your patient asks you should I be taking this complementary alternative medicine? Or I'm going to take it. They're telling us I'm going to a chiropractor I'm taking the supplement. What do we do about that? David? I mean I'm you have to be careful to do this and it is respectful of a way as possible but you have to tell them the truth. You have to tell them that the evidence doesn't support it or the problem is a lot of doctors don't actually know what the evidence is for a lot of these things. So I've had patients come up to me and say they wanted to try a royal rife machine which or various other things for their breast cancer and I mean I basically say you know there's no evidence that that works and a lot of evidence to suggest that it shouldn't work but I mean you can't stop a patient from doing something like that if they're going to do it they're going to do it all you can do is try to give them the information that would help make the decision. Patients have to be honest with their doctors too because I read a statistic that only 38% of CAM users had discussed it with their doctors but the encouraging thing is that of all the people who are seeing CAM practitioners 96% of them are also seeing a conventional doctor. And we should add part of the premise of that question was that it's very popular the popularity is actually way overblown and that's also an artifact of this broad category when you include things like anyone taking vitamins is using CAM that inflates the statistics but if you look at how many people have used like hardcore things like energy medicine, homeopathy, acupuncture it's low single digits. There's a lot smaller phenomenon then they're really making it out to be that's part of the marketing you create this wide umbrella and say look so many people are using it this part of it's legitimate and then you just ride the pseudoscience through the door. My question is there are a number of people who at the grassroots who would like to fight the misleading claims they see particularly in advertising and so forth but they don't know how and I know in the UK they set up the Nightingale collaboration to provide the resources and guidelines for ordinary folks like us to work with the appropriate governmental bodies in order to do that. Do you know of any similar efforts being pursued in the US? Nothing that's similar to the Nightingale operation. How about in the UK Rachel? Friends of science and medicine is mainly about infiltration into academia. There was also a plugin built for crime called Fish Barrel in the UK where you could just plug in a few things very quickly that would very rapidly make a complaint to the regular whoever was the regulation body. That doesn't actually work very well in Australia because our system is a little bit more complicated but there's a lot of people in Australia that just fill out the forms and complain and complain and we get called serial complainers by the camp heaps but you know the thing is if you abide by the rules you won't get into trouble. It's as simple as that. There are a couple of things like in the US that any citizen can do. One is I think the regulatory agency that is really trying their hardest to oppose a lot of the real fraud in the camp is the FTC the Federal Trade Commission because a lot of them actually violate basic rules of commercial fraud. They're making claims that they're not allowed to make false advertising. That's the thing that they're most vulnerable to. You try to get them on the standard of care it's very squirrely and very deliberately squirrely but you get them on commercial fraud and the FTC will absolutely go after them and they're really making an effort to do so so report them to the FTC also get involved politically our politicians are listening to what they think the public is saying which is all being distorted by the camp proponents so make sure your representatives know that you want science based medicine you don't want the NCAM or you don't want laws that are going to water down the standard of care and your state too. Unfortunately this is mainly in the US being fought state by state so you really have to know about what's going on in your state. Well hi I have the same question for this panel that I would have put to many of the speakers whom we have heard at the meeting. Namely in this room we are you are, if you'll pardon the expression preaching to the converted how do you persuade or why is it impossible to persuade the believers that they're wrong? Well because they're convinced by their beliefs you're never going to change the mind of people that are believers because that they have a cognitive dissonance that predicts that they will believe that I'm not trying to target the believers there's no point it's a waste of time I try to target the fen sitters and with respect to anti-vaccination there's an estimation of about 20 to 30% of parents that are undecided there's about 2% in Australia that are absolutely not going to vaccinate that 20 to 30% their minds can be changed by things so that's the people that you target forget about the believers you'll never change the mind because of our defective brains we are very susceptible to testimonials and advertising and to personal experience you you take something for a cold and it's gone in seven days so forever after you've cured your cold so yeah I think it's worth pointing out that the evidence that we do have from surveys etc show that most CAM users are not hardcore true believers that's a very small core of true believers step 5% or so that's part of their world view and they're really dedicated to it most are just open minded to it because they hear about it in the press they hear stories from their friends and they're just grossly misinformed so it actually is an area and I find this with an individual patient with my colleagues with anyone where they don't know what to expect so we're actually confronting misinformation more than true believers with this topic do you guys agree with that? yes go back to the example of homeopathy again most people just think it's herbal medicine right but it really is for most people all you gotta do is really tell them what homeopathy is and that's enough I heard a guy once say you should never use anecdotal evidence I think I heard that same guy I think one of you alluded to this but it seems to me the big elephant in the room are the insurance companies that have either been compelled or allow CAM for patients to use related to that is in this country we have a lot of uninsured people that what is the evidence that many of them are going to do with CAM folks because they can't afford to go to a regular doctor so are the uninsured resorting to CAM because they can't afford medicine I don't know of any statistics on that Donna, to be honest with you I don't know any statistics but I've certainly heard examples of people who couldn't afford medical care and found that CAM was cheaper for instance there's a thing called red yeast rice that lowers cholesterol it's the same ingredient and it is one of the prescription statins but when you buy it as red yeast rice you don't have the guarantees from a pharmaceutical it's not regulated as carefully you're not certain about the dosage so my question was why would anybody choose that over a prescription version because it's natural but also people said well because I can afford it and the drugs cost a lot of money so I asked the doctor to give me the prescription and they got a point the other part of this is that even the insured there's an effort by CAM proponents to try to get insurance companies and yes the government to pay for this stuff and insurance companies sometimes listen because if enough of their customers say we want this covered they might just do it right they'll go for the cheaper thing that's the insurance companies are okay with that they don't care if it works sometimes I've also had very specific rules where insurance companies I was dealing with had to write ridiculous regulations in order to accommodate state mandates about what they're forced to cover and they have to write regulations that affected me in this case because of but the laws were drafted to contain chiropractors that they were forced to cover for something that chiropractors shouldn't have been doing it's a long story but it was that's the insanity that we're dealing with now these ridiculous regulations that are being you know forced upon insurance companies that's the other sort of end of the aspect of this it's another battle line that we're fighting unfortunately I wanted to come back to the question of playing by the rules the idea that a lot of the alternative medicine they don't want to do the hard work of the levels of clinical trials process, safety, purity that farm companies have to go through and I'm wondering if this slide is heard by some of the abuses of the big pharma we'd heard from Carol Tavris yesterday and there's many cases of Archangel that's shown does that part of our problem is that people say well look look what happens in the clinical trials there's all these issues problems and they may not understand what's behind that but then the alternative medicine can use that to say this is why we don't need to go through that process yeah there was a recent case and the big pharma company escapes me now but there was a big expose very recently about some fraud that was going on was it GSK yeah and that was actually they had to pay a three billion dollar fine for something evil that they did and that was actually exposed by partly exposed by scientists and skeptics and so we're very happy to dobb on ourselves and to expose fraud and you know bad behavior when we see it in fact Ben Goldacre is one of the guys who does that all the time the difference is you'll never see that with alternative medicine practitioners even for example the homeopath I mentioned before who was implicated in the death of a woman from colon cancer you didn't see the other homeopath saying that's really bad and what she did was wrong that just doesn't happen does it whereas science based medicine were happy to expose that sort of stuff and say look what we did this is bad let's move on from that now and learn from our mistakes and you know the other thing is you always get the alt med people saying but vioxx but silly to mind yeah we learned from that and we're not going to do that again because science is progressive and moves on from its mistakes and learns and moves forward right but there's also there's a huge false dichotomy implicit in the question which always to me reflects how successful their framing has been oh look at big pharma verses big supplement or verses the cam world but all we're saying is we want one science based standard to cover everything we will criticize and attack the pharmaceutical industry when they abuse science and the you know the camp opponents when they abuse science it's one science based standard and these any dichotomy that's their doing that's their framing and it's specifically for the purpose of again carving out these double standards and they want to play that card just published on the supplement industry which is a big industry with a lot of overlap with big pharma some of these companies are owned by big pharma but who own them through various other companies so it kind of obscures the connection they want to create this marketing image of a mom and pop homegrown supplement friendly natural company but it's big pharma just selling supplements because of the regulations big homeopaths make no money at all they just do it for the love of it and the flowers and the unicorn boron they don't make a lot of money take a couple more questions I feel that the biggest problem here is money obviously universities are turning to camps in order to bring in more money and unfortunately being a pharmacist I've seen it happen in pharmacy we've had a lot of our funds cut we've had to sell ourselves to the devil and have these things in stores and it's not necessarily the pharmacist choice how do you see us going on from here and getting the government to realise that they need to put money in into the right places so that we can actually treat our patients effectively and not give legitimacy to these products I think someone mentioned this the other day was it here or maybe it was in a conversation I had but we need to start making science and medicine and evidence based medicine a political issue so we have to go to the polls where we make an emphasis to our MPs that this is important to us so it becomes an issue where people will vote for it so there are lobby groups that will say if you don't give us more childcare this election we're not going to vote for you actually sorry it's in the geek manifesto it's the UK book by Mark Hampton it's the UK book called the geek manifesto I recommend you read it so I think we just need to coordinate ourselves better and if we go through the political system and make it a voting issue where politicians go I'm going to lose my state if I don't represent these people then we can start to get them to focus more money into these areas because at the moment I guess as you said before David there's too many shruggies that's the problem I'm pessimistic about our politicians because so many of them are strong believers in alternative medicine they funded the NCCAM and the diet supplement health and education act I think we're going to have to change society before we can change the politicians and change the laws one true believer and 100 shruggies that's what we're seeing 100 true believers last question I have noticed the increasing shelf space that the pharmacies have lent to the outright CAM treatments or products that are I strongly suspect are CAM but not sure about one what can somebody do who's standing in the moment looking for a product and they see them suspicious treat products right next to the legitimate ones what should they look for to help them make a better choice and are there any efforts or is there an effort that can be made to try and let the pharmacies know that you don't want to see those iffy products listed in the stores anymore you look straight for the quack Miranda wouldn't you David the quack Miranda this product does not or it does not the claims are not been evaluated by the FDA we do not claim to treat or diagnose any condition any disease so yeah it has that disclaimer they're forced to put that on there because there hasn't been evidence to show that it works of course if it says homeopathic run that's an easy one and some of my friends have actually spoken to the pharmacist about it because in Australia you quite often find ear candles on the counter at the pharmacy and they've spoken to the pharmacist and in some cases the pharmacist have said like Polly said she's a pharmacist in Australia their hands are tight that they're put there by the people that own the pharmacies not by the pharmacist so the front of the shop often is the pharmacy guild that runs the business side and the pharmacist has the back of the shop so it's not there for in some cases the pharmacist says yeah but patients want them and they kind of work it's an uphill battle there's no single effort that you're aware currently a distance to like like a grassroots thing in process because one person saying something to one pharmacist is one thing but you get the ground so is there anything in the works at the moment that someone could join in or nothing organized that I know of I mean obviously the things that individuals can do are as complained to the pharmacist right to the company right to Walgreens or whatever and say you have pseudoscience in your store I'm not going to shop there anymore but enough people do that you'll get their attention I don't know what will happen the UK is doing it with boots in homeopathy in Australia we wrote to the pharmacist of Australia an open letter about three years ago and said this is a joke guys come on and we got a fairly good response we didn't get a lot of stuff being taken out but there are coordinated efforts in the UK and Australia so come on guys you guys have to do something expose and shame we've got a great resource right in this room some of you guys out there get together start a movement alright well thank you very much for your attention everyone a round of applause for our great panel