Science

This is part five of my summary of TAM7, now up to Saturday, July 10. Part 1 is here, part 2 is here, part 3 is here, part 4 is here, and my coverage of the Science-based Medicine conference begins here. Ethics of Deception Panel D.J. Grothe moderated a panel discussion on the role of magic in skepticism and the ethics of deception, featuring Penn Jillette, Teller, Ray Hyman, and Jamy Ian Swiss. D.J. began by asking whether magic teaches critical thinking, to which Jamy Ian Swiss responded yes, and pointed to Danny Hillis hiring a magic tutor for his kids so that they could learn how methods of deception work. Everybody else on the panel disagreed, beginning with Ray Hyman, who observed that there are kooky magicians. Swiss agreed that there are magicians who are gullible and that learning magic doesn’t make you a skeptic, but said that it was useful to him. This brief exchange then occurred: D.J.: Teller, did you have a comment? Teller: No. D.J. Just as we rehearsed.As it turned out, Teller did have a comment–he said that while some magicians think that doing the trick and saying “this is not real” is just as good as explaining it, it isn’t–and “you should explain it.” Ray Hyman seconded the point, saying, “exposing tricks that can be done in multiple ways gives people a false sense of ability to detect fakery.” Faraday’s explanation of spiritualist table-tipping caused Alfred Russell Wallace to become convinced of the existence of spirits when a medium used a different method on him. Hyman said this is what is known as being “half-smart,” which is the card cheat’s term for a guy who knows something about card cheating. The card cheat then asks him what he knows, and then adapts his methods to not use those and not get caught. (Penn Jillette’s recent book, How to Cheat Your Friends at Poker, discusses this very subject.) The topic then turned to mentalism, about which Ray Hyman said, you can teach the methods of cold reading in one day. Mentalists will complain about it, but not magicians. About the Psychic Entertainers Assocation, Jamy Ian Swiss said “they are neither psychic nor entertaining.” Hyman said that psychic entertainers are now mostly people competing with psychotherapists. Penn said that cold reading should be exposed, as it’s being used to deceive people. D.J. asked about the “poor man’s psychotherapist defense” of such “psychic entertainment”–isn’t it similar to Rogerian psychotherapy (named after Carl Rogers)? Ray Hyman pointed out that they can cause harm in many circumstances, such as their inability to recognize suicidal symptoms. Penn went further and said, “lying always does harm and is mmoral, it has no justification”–but then offered “exceptions for loved ones and medical situations.” Hyman pointed out the distinction between lying by commission and lying by omission, and both he and Penn agreed that “lying by omission is also a lie” (quoting Penn). D.J. observed that that’s a very uncompromising position on lying. But Penn then said, “how can you love someone without lying to them,” and suggested that kindness and politeness requires lying of the sort that he made exceptions for in his previous statement. D.J. then brought up mentalists who are also skeptics and who don’t make psychic claims, such as Derren Brown and Banachek (who was at the conference, but unfortunately not part of this panel–I think his viewpoint would have been a very worthwhile addition). D.J. pointed out that Brown claims a “deep understanding of human psychology,” while Banachek will say that he is drawing inferences based on posture or facial expression. He asked the question, “Are they equally unethical?" Teller said that he has argued with Brown, and Brown is moving to a more honest position–his latest book says that he’s doing tricks, and says things like “I have special ways of dealing with information,” which is true. He said that in Penn & Teller shows, they give no hint of the supernatural, so “we get the credit.” Penn said that there are two places in their current show “where I say I’m doing one thing and am actually doing another. I wrestle with the ethical implications. If you admit you’re lying, it’s more like an actor playing a role. But there are two places in the show where I pretend to be speaking earnestly but am not." Ray Hyman said that Jerry Andrus was the most honest guy in the world, but he said that a magician on the stage has a license to lie. It’s theater. (In my notes, I wrote–“But does ‘it’s TV’ suffice?”–a topic that came up shortly.) Jamy Ian Swiss says that he is working to develop some mentalist techniques which present things that are convincing looking, but which obviously cannot be happening. He suggests that the effect will be more impressive if he can give the audience confidence that he cannot do what he then appears to do. Ray Hyman said that a distinction between magic and mentalism is that mentalism is boring, and can only be dragged on (to show length) if people think that it’s real. “If you believe the stuff is real, what’s the appeal of mentalism?” Teller seconded that point–“if you pretend it’s possible, it’s just nature." D.J. brought up the example of Mark Salem, who “claims a well-developed understanding of the human mind,” and asked, “why do we give skeptical mentalists a pass?” Jamy Ian Swiss then criticized Salem. Ray Hyman said that when he performed, he would say that he has no special powers, and “whatever I can do, you can do. There’s nothing abnormal or paranormal about it.” Teller said, “The correct answer to how it’s done is–it’s a trick.” Penn said that if people come up to him after a show and really want to know how it’s done, he’ll tell them. But he gave the example of a very famous magic trick (he didn’t say which one) that fooled everyone who saw it, is protected by a patent, that you can look up. There’s a multi-page description of how it’s done, but few people bother to read past the first few pages. He said, “[Jim] Steinmeyer says magicians are guarding an empty safe. If we explained the bullet catch trick, it would not be interesting. The tricks we expose are the ones where the secret is interesting and clever. In the bullet catch we’re hiding messy ugliness. … Valentino, the masked magician, couldn’t reveal the real good-looking tricks because they don’t have the ‘aha!’ cleverness.” Teller observed that people have accurately described how the bullet catch is done online, but it still looks amazing. Penn pointed out that there are also inaccurate descriptions of the bullet catch on the Internet, so he’d hate to see somebody else try to do it. Teller suggested that Adam Savage put them to the test on Mythbusters. D.J. said that “believers will always be with us–are disclaimers necessary?” (He observed that he was reformulating a quote from Jesus that “the poor will always be with us.”) Ray Hyman suggested that disclaimers create an “invited inference problem,” taking away any reason to challenge or question, and thereby promoting belief. Penn commented that “There was no Jesus, so the quote is wrong." Finally, D.J. turned to the question of using magicians in scientific investigations, as James Randi has long recommended, to which Penn said, “it depends upon the magician.” Ray Hyman said that “scientists do not do tests,” and that “magicians can hurt the process.” He pointed out that Milbourne Christopher was fooled by Uri Geller, and made up a bogus explanation for metal bending in terms of chemicals on his hands that became a parody scientific explanation like “swamp gas” for UFOs. Randi then came up and said that “magicians for parapsychology tests need to have a deep and broad knowledge of magic, not just know how to do a few tricks. Half-smart is not smart at all. Be all-smart or forget it.” He went on to make his common point that Ph.D.s can easily be fooled even though they’re not dumb. Randi also said that there is a place for “white lies,” giving an example that will appear in his biography, being written by Tim Steinberg. He sent a letter to his grandfather shortly before his death at the age of 94, in which he said “I believe you will be with your wife at death,” in order to give comfort in a situation where the lie did no harm. He said that he’s glad to see Derren Brown coming clean, and said that “Uri Geller is trying to come clean, but he’s fucked–he lied to governments and research institutions. … He now says he wants to be known as a ‘mystifier.’” He suggested that the media should ask Geller, “yes or no, have you ever used psychic powers that do not involve trickery,” but when they do, he’ll hang up the phone and refuse to answer the question. In the Q&A, the first question was about Criss Angel, David Blaine, and “street magic,” and in particular the way that the TV audience doesn’t see the same thing that someone there would see. Jamy Ian Swiss said that David Blaine made some early irresponsible claims. Teller said that when you watch TV, “it’s the proscenium,” which seems to me an erroneous comparison that could be used to justify all sorts of misrepresentation in the name of entertainment. Jamy Ian Swiss said that TV specials on magic have a credibility issue because of the possibility of editing and camera tricks, but that street magic was a good idea. Teller said it’s an aesthetic issue rather than a moral issue, and that he sees editing to produce effects OK–that the rules aren’t the same for TV. Penn said he didn’t think David Blaine would entertain, and observed that “reality TV is fake. Lots of people know it, but some think everything on TV is real." Another questioner said she appreciated Penn’s comment on global warming as pseudoscience (which I didn’t note in my notes and don’t recall what he said), to which Penn responded, “Don’t listen to me, I’m the least qualified to talk about” the subject, and said “we won’t do a Bullshit! show on global warming.” He said “If there is global warming, and there probably is, we don’t know if we caused it. But if we caused it, and we probably did, we don’t know if we can stop it. But if we can stop it, and we probably can, we don’t know if socialism is required." (Mark Edward, a skeptic who works as a mentalist who was also at TAM7, was disappointed with this panel and expresses his opinion in a comment at skepticblog.org.) At this point I stepped out for a moment, while Robert Lancaster was given the Skeptical Citizen Award, and returned as a documentary film on Jerry Andrus was being shown. It told a bit about Jerry’s life and his house, the “Castle of Chaos,” filled with his inventions, including puzzles, optical illusions, magical effects, and mechanical and electronic devices of his creation. Stephen Bauer on Jerry Andrus Stephen Bauer, an attorney and member of Oregonians for Rationality, has attended every TAM, but this was his first time as a presenter. He gave the story of how he found skepticism–his mother was a big fan of woo including a believer in the psychic powers of Uri Geller, and to combat his skepticism she gave him a copy of The Magic of Uri Geller without reading it. As this was the original title of James Randi’s debunking of Geller (now known as The Truth About Uri Geller), he found it very persuasive, though said his mother didn’t care much for it when she then looked at it a bit deeper when he told her he thought the book was completely correct. Bauer wrote to James Randi asking for an explanation of how ouija boards work, and he suggested that Bauer talk to Ray Hyman at the University of Oregon about the ideomotor effect. He then joined Oregonians for Rationality and began attending the summer Skeptic’s Toolbox workshops at the University of Oregon, where Jerry Andrus came up and introduced himself. He then told some stories about Jerry Andrus. At Halloween, Andrus would never give candy, only a trick. Sometimes he would answer the door as a floating disembodied head. One year he would open the door, then lean over beyond the point at which he should have fallen, and then straighten back up, then shut the door. Andrus was a magician, a skeptic, and an inventor. He had been visited by film crews from three continents. He never married, had no kids. He lived in the same house for 80 years. He performed every six months at the Magic Castle. His house, an 1891 Victorian home, was known as the “Castle of Chaos” and was filled with things that he had collected, designed, and built, though not a single piece of traditional furniture. He was an artist, photographer, poet, musician, composer, and agnostic. He called Bauer for an estate plan, which ended up being a simple will that left everything to his brother George, who is 93 years old. The Castle of Chaos contained a full printing shop in the attic, which required metal bands to be put around the room to keep it from shaking apart from its operation. Andrus printed his own books. He also had his own photo studio, from which three pickup loads of photo chemicals had to be disposed. After his death, a group of volunteers from Oregonians for Science and Reason worked regularly on his house to catalog its contents, dispose of unsalvageable items, and put items into storage. Bauer spent his sabbatical working 12 hours a day on Andrus’s house. Just the recycled items included 32,000 pounds of scrap metal, 2 cords of scrap wood, 1,000 cubic feet of plastic, and fans, hair dryers, and “air moving devices." The house had a ground-level crawlspace with four entrances, three of which featured a set of amusement park railroad tracks leading under the house, on which Jerry could lie down on a device of his own construction and push himself under the house, where he stored various items. Among those items included gigantic magnets, which he could use to make the planchette on a ouija board in his house spell out things. He had a Hammond organ, heavily customized with his own additions, connected by a spaghetti tangle of wires. And the house contained much that they couldn’t figure out, like the wiring. A black sock hanging in the bathroom was pulled down, setting off a security system–which they didn’t know existed. An electronic rat trap in one room turned out to be a device for launching tennis balls and spoons during simulated seances. He had a slide projector that he made from a motorcycle engine. They found that he had all of the letters he received when he was a soldier in WWII, which will now be donated to a military museum. They collected 120 boxes of materials now being kept in a storage unit, which include 3 dozen boxes of letters, notes, and writings, 20 boxes of mixed media, and 4 volumes (2000 pages) of his daily journal of “Scribulations." Stephen Bauer finished up with some thanks to the late John Lar, who died in 2008, for getting the Castle Chaos project started, and noted that Lar’s wife had cared for Jerry in his final days. He told a little bit about Jerry’s 93-year-old brother George, a musician with a “house of wonders” of his own, who has been making videos of soap bubbles featuring his own music (the linked video also features Jerry). He ended with a quote from Tycho Brahe, who left all of his work to Kepler with the comment, “Let me not seem to have lived in vain, let me not seem to have lived in vain." Hal Bidlack then said, “A man should live his life so that when it comes time for him to die, he has nothing left to do but die. It seems like Mr. Andrus did that." (I remember Jerry Andrus as a quiet and soft-spoken guy who was a regular fixture at all of the Skeptics Society conferences at Caltech. He would usually be found next to his table of his optical illusions, some of which will now always be present at every TAM, which he would be happy to help demonstrate to anyone who stopped by.) Skepticism and the Media Panel This was an unmoderated Q&A panel featuring Penn and Teller, Adam Savage, Bill Prady, and Jennifer Ouellette. A few of the questions and answers I noted (I missed most of them as I was trying to ask a question myself, which I previously tried to ask of the ethics of deception panel). Q. Why can’t the Daily Show or Colbert take down Jenny McCarthy? A. Penn: That’s not the sort of thing they do. Q. What was the biggest media failure of skepticism recently? A. Adam Savage: The NPR ombudsman taking the position that calling waterboarding “torture” is taking sides, and defending it on the basis of having to be balanced. A. Penn: The truth isn’t in the middle. Q. Dave from Phoenix: Any opinion on TBN or Benny Hinn? A. Jennifer Ouellette: I grew up in a fundamentalist household, went to faith healing meetings, etc. It’s fantasy. My parents still beleive they can speak in tongues. Q. The subtext here is on getting facts right and of leaders being of exemplary character. How can we promote character, service to the public, telling the truth, and owning the consequences of your actions? A. Adam Savage: It’s unattainable. There’s a percentage of assholes everywhere. A. Penn: Most people are good; there are 6 billion good people. Disagreement doesn’t make them assholes, but I still call them assholes on my show. Q. What about historical accuracy? The History Channel creating bogus doubt? A. (Savage? Prady?) So what have you done about it? .. Hal took your mike away… A. Savage: We’re one of the few shows that goes back and corrects our mistakes. Wouldn’t it be great if the History Channel came out and said all of their Nostradamus documentaries of the last 20 years were wrong? (Laughter from the audience.) Only skeptics and history teachers laugh at that. Many film crews don’t care about truth. Mythbusters visited hurricane researchers who said they’re always misrepresented. A. Prady: We said on an episode [of “The Big Bang Theory”] that a Van Dyke is a goatee without a mustache. It’s wrong, we will correct it. Q. The ridicule of pseudoscience–what is appropriate, heavy ridicule, no ridicule? A. Penn: I’m not in favor of heavy ridicule. We do it towards ourselves and allies as well as believers. A. Jennifer Ouellette: Humor can be a powerful convincing mechanism. If it’s mean spirited, though, that’s different. A. Penn: The joke of our show is that we’re calling bullshit. The message is pro-science and respect each other, and Pollyanna-ish hippie shit. I love crazy people. I’m in the category of the wack job. When I went on “Politically Incorrect,” a show that always has one nut, I looked around and I didn’t see the nut. I straddle both sides–if a gun were held to my head and asked what are you, a skeptic or a nut, I’m the nut. . A. Prady: “Big Bang Theory” was originally about computer programmers, but it was too hard to photograph [due to reflections from screens]. The message of the show is that everybody thinks other people have life figured out–and nobody does. A. Teller: On the Orgasm episode of Bullshit!, we talk about a guy who has a crazy orgasm machine for a hot tub, and it turns out it’s Penn. (Voiceover for Teller: “And then there’s this asshole…”) (The “Jill-Jet,” U.S. patent #5,920,923.) Q. Richard Saunders: Does anyone on “The Big Bang Theory” do origami? A. Prady: Sheldon knows origami but just doesn’t do it on the show. You only see days something interesting happens. (“Oooh!” from audience.) Sorry, that was cheap. … A. Penn: Bullshit! in Sweden is called skitsnack–“shitcock." … A. Savage: There are partnerships involved here. There is huge strength in push-pull. We drive each other nuts, but the product is better. A. Penn: We hope to get famous enough that only one of us has to show up. Q. (To P&T:) Did you know George Carlin, and why don’t we address comedy more often? A. Penn: Carlin was a hero of mine. I spoke to him on the phone quite a bit. I don’t think comedians, magicians, or skeptics matter–it’s individuals. There are wackjobs in comedy. We shouldn’t celebrate a form, just individuals. A. Savage: I find it interesting that all practitioners say that their field is the only pure one. I knew a package design professor who said that package design is the only pure art form. Hal Bidlack: That was not thinking outside the box. (Big cheer from audience.) Q. Can you offer words to young skeptics held down by the beliefs of their parents? A. Ouellette: Voracious reading. I couldn’t watch “Welcome Back, Kotter.” My parents would burn non-Christian books. I left home at 17 for college. A. Penn: You shouldn’t manipulate, just say what is true. Don’t talk to adolescents differently, just talk to a general audience. Don’t try to “reach” adolescents. Q. What do you think of fake skeptics on shows like “Ghost Hunters”? A. Penn: House, Bones, Num3ers (pronounced “numb-three-ers”), etc. All have atheists. Atheists and skeptics have it good on major shows right now. We’re not martyrs. Hitchens said we have no saints or martyrs. There are minorities being fucked over in this country, and we’re not it. (Though atheists are more mistrusted than other groups.) Q. What’s the role of skepticism in broadcasting? A. Prady: Make them central as characters, and stay on the air, and don’t have a social message, just have fun. A. Savage: We didn’t set out to inspire scientists–if we set out to do that, we’d be pompous, pretentious, and fail. We’ve done our show for 7 years and want to do 5 more. Q. (For Teller, about why he has a bottle of water in front of him despite the Bullshit! show on bottled water.) A. Teller: I filled the bottle using the tap in the men’s room. … A. Ouellette: To reach minds, reach for hearts, from your heart. My question was something like, “The movie ‘Expelled’ received a lot of criticism for the deceptive way in which it obtained interviews from its subjects. Theology professor Paul Maier has made similar charges about his appearance in the Bullshit! episode on The Bible. I was glad to hear on the ethics in deception panel that you agree that lying by omission is wrong. Can you comment?” It turns out I misremembered Maier’s criticism, which was about his views being completely mangled by the editing, not being deceived about what show he was on, though his comments make it seem like he was surprised about the nature of the show. I would have thought the title would be a hint. Penn responded that he didn’t know who Maier was, and didn’t quite get the point of my question. I met up with him in the hallway between sessions, and pointed out that Maier was an actual guest on the show, not just some blogger writing about it, and he laughed at the misunderstanding. He said that the contracts for everyone who appears on the show state that the show is Penn & Teller’s Bullshit!, but that just because he was given that information in the contract and signed it doesn’t mean that he read it and knew it. (Bullshit! writer Michael Goudeau, standing next to Penn, concurred that the contracts name the show.) I offered to point him to Maier’s critique, but he said that he had no interest in reading it and Maier can say whatever he likes. I don’t find that entirely satisfactory given the strong stance against lying that Penn took during the ethics of deception panel. I also discussed this on Friday evening with Michael Shermer, who was previously criticized by a commenter at this blog for his role in that same episode of Bullshit! on the Bible. Shermer pointed out that he had no idea of what Maier said and wasn’t responding specifically to his remarks, but just answering questions asked by the interviewer. He also observed that Penn & Teller don’t write the show, or do much more for any given show than show up to record their scenes and voice overs, though of course they bear some responsibility given that it has their names on it. Phil Plait on Doomsday 2012 The final talk of the day was Phil Plait on “Doomsday 2012,” the idea that the world will be coming to an end on December 12, 2012 based on the end of the Mayan calendar and an alleged Mayan prophecy of the end of the world, a popular topic for questions to NASA. He began by saying that the Mayans were good astronomers and had a good calendar system, and had the largest centralized civilization of their time, but they didn’t predict their own civilization being absorbed into others. The claim of an alleged prophecy of destruction is false–it doesn’t exist–it’s just that their calendar system ends and rolls over. Back in 2003 at TAM1, Plait spoke about Planet X and Nibiru, and warned that this idea would come back, and he was correct. He spent the rest of the talk looking at what could possibly cause the destruction of the earth in 2012, and what’s the evidence. First, perhaps a “Sun of Doom”? Looking at solar flares and sunspots–would that activity peak in 2012? Sunspots will probably peak in 2013, solar flare activity in 2013 or 2014. An asteroid or comet impact? None known to be on a collision path. Next, perhaps a “Galaxy of Doom” or “Milky Way of Doom”? The Milky Way galaxy is 100 billion to 200 billion stars in a flattened disc, which appears to us as a strip, since we’re in it. He talked about the Galactic equator, and that the sun is close to it. As an aside, he remarked that 75% of the American public doesn’t know both that the earth rotates once per day and revolves around the sun once per year, let alone that the earth is at a tilt with the northern axis pointed at Polaris, which is the reason for the seasons. (Note: This stat seems somewhat dubious, since a 1999 Gallup poll found that 79% of Americans correctly answered that the earth revolves around the sun. Would that really drop all the way to 25% just by asking for frequency of revolution and rotation? And if so, how much of that is merely confusion between the terms “revolution” and “rotation”?) He talked about the precession of the equinoxes, caused by the gravity of the sun and moon, which goes through one circle every 24,000 years, and the map position of the sun at the winter solstice crosses the Galactic equator. But that happened in 1998. So some have said that we are “in that era” of the crossing, which takes about 18 years; we’re near the end of that era. What about the idea that there’s a supermassive black hole at the center of the galaxy that will do something? Plait said that, oddly, he hasn’t seen this claim made–oddly because it’s wrong. The sun is closest to the galactic center on December 19, 2010, too late by a week. And a black hole 260 quadrillion km away would have a gravitational force 1.5 trillionth of the sun. The gravity from Mars and the moon is significantly greater. In short, Plait concluded, these claims are all “cosmic colons, full of astronomical crap." JREF Update/Wrapup The day ended with a JREF update, first from Jeff Wagg, noting that this was the first TAM being broadcast via streaming video, with a total of over 18,500 visitors, 850 at a time the last he looked. JREF has done cruises to Alaska, Mexico, the Galapagos, and the Bermuda Triangle, and he took a poll of interest for another cruise next March, for which there was “mild interest." He talked of SkeptiCamp, and the possibility of one occurring at the same time as TAM London, somewhere in the northeastern United States, possibly Boston, and asked those interested to contact him via email. The JREF’s Swift newsletter subscription readership is growing–there are twice as many today as there were in January of this year. There’s a possibility of doing some kind of live video broadcast on a weekly basis. He gave thanks to the JREF forum volunteers, and made another advertisement for the JREF scholarships, “if you’re going to school, we will give you money." Phil Plait said he was blown away by Dr. Joe Albietz’s presentation on vaccination at SkeptiCamp Colorado, and gave an update on the vaccination drive–up to $8,500. A. Kovacs, JREF director of operations, gave thanks to various people including one of the poker game participants who donated all of his winnings to the vaccination drive, and another donor who gave $1,000 but wanted to remain anonymous. Matt Fiore was recognized as the most generous skeptic to the drive, and was given tickets to Lance Burton courtesy of Michael Goudeau. And that wrapped up the regular conference programming for Saturday, July 11. Next up, a summary of the skeptical paper sessions for Sunday, and the Million Dollar Challenge that finished up TAM7.

Continuing the postings of The Arizona Skeptic; you can find volume 1 (1987-1988) here. An index to all issues by title, author, and subject may be found here. The Arizona Skeptic vol. 2, no. 1, July/August 1988: "Lippard Disgraced!" by Ron Harvey "A Visit to the 'Psychic Showcase'" by Jim Lippard "Color it Absurd" by Ken Morse "Handwriting Analysis" by Jim Lippard "Recognizing Destructive and Manipulative Groups" by Al Seckel Upcoming Meetings "Ghost Busters or Lease Breakers" by Ken Morse "June PS Meeting" by Judy Sawyer: speakers Craig Nichols and Lee Earle of Manifestations "July PS Meeting" by Judy Sawyer: speaker Anita O'Riordan of the Arizona Attorney General's Elderly Abuse Project Correction (of omission to "Psychic Detectives" article in previous issue) Editor's Ramblings The Arizona Skeptic vol. 2, no. 2, September/October 1988: "Hype-nosis" by Jim Lippard (title typoed in published copy) "Recipe for Successful Local Group" by Kent Harker "Book Review: Nostradamus and His Prophecies by Edgar Leoni" reviewed by Jim Lippard Upcoming Meetings August PS Meeting: speaker Michael Preston on hypnosis "September meeting" by Mike Stackpole: speaker Gary Mechler on astrology "October meeting" by Judy Sawyer: speaker Janet Lee Mitchell on out-of-body experiences Editor's Ramblings The Arizona Skeptic vol. 2, no. 3, November/December 1988: Predictions for 1989 and Beyond "Psychological Factors Conducive to Paranormal Belief" by Jim Lippard "Book Review: The Art of Deception by Nicholas Capaldi" reviewed by Ted Karren "Book Review: Hypnosis, Imagination, and Human Potentialities by Theodore X. Barber, Nicholas P. Spanos, and John F. Chaves" reviewed by Jim Lippard Upcoming Meetings November PS Meeting: skeptics' predictions "December PS Meeting" by Judy Sawyer: speaker David Alexander on faith healers "TUSKS Lecture" by Ken Morse: speaker Conrad Goeringer on "Bimbos for Satan" Editor's Ramblings The Arizona Skeptic vol. 2, no. 4, January/February 1989: "Let's Be Serious: Defensive Skepticism" by Mike Stackpole "Behaviorism and Consciousness" by Jim Lippard (on January speaker, Erv Theobold) "In Response" by Erv Theobold, Ph.D. "Book Review: Mindspell by Kay Nolte Smith" reviewed by Judy Sawyer "Book Review: Science and Earth History by A. N. Strahler" reviewed by Roger Mann "Book Review: Eyewitness Testimony by Elizabeth Loftus" reviewed by Jim Lippard "Book Review: ESP and Psychokinesis: A Philosophical Examination by Stephen E. Braude" reviewed by Jim Lippard Upcoming Meetings January PS Meeting Editor's Ramblings This volume had only four issues, and marks the end of Ron Harvey's editorship. The next volume picks up in January 1990 with Mike Stackpole as editor.

I’ve begun putting old issues of The Arizona Skeptic online as PDFs, starting with the old Phoenix Skeptics News, edited by Ron Harvey. Volume 2, 1988-1989, is here. An index to all issues by title, author, and subject may be found here. Phoenix Skeptics News vol. 1, no. 1, July/August 1987: Welcome!July MeetingResource Library"Cold Reading" by Jim LippardLocal Radio Talk Show Features PsychicsModem Users Take Note"Foes Turn Up Heat: Fire walking is not so hot, skeptics of seminars say" by Simon Fisher, TribunePostscript by Jim LippardBook ReviewsLocal Conference on Health FraudUpcoming Phoenix Skeptics MeetingsPhoenix Skeptics News vol. 1, no. 2, September/October 1987: August Meeting: Hans Sebald on witchcraftSeptember Meeting: Charles Cazeau on prophecies of NostradamusSurveyor NeededRandi on Faith Healers (interviewed by Jim Lippard and Mike Norton)"Health Fraud isn't 'snake oil' anymore" by Phyllis Gillespie, Arizona Republic"Charlatans can be spotted if you know common clues" (Arizona Republic)"Proper Criticism" by Ray HymanUpcoming MeetingsPhoenix Skeptics News vol. 1, no. 3, November/December 1987: October Meeting: Halloween party at Hans Sebald'sNovember Meeting: James Randi psychic surgery video, Randy Jones on psychic surgeryPapers ignore disclaimer request on astrology columnsFlyers neededPsychic fair"Focus on You" by Jim Lippard"Channeling: Believe It or Not" by Hans Sebald, Ph.D."Book Review: The Faith Healers by James Randi" reviewed by Jim Lippard"On the distinction between nonbelief and disbelief" by Hans Sebald, Ph.D."Book Review: The Psychology of Transcendence by Andrew Neher" reviewed by Jim LippardEditor's RamblingsUpcoming MeetingsPhoenix Skeptics News vol. 1, no. 4, January/February 1988: December Meeting: Jim Speiser and Marge Christenson of MUFONJanuary Meeting: Robert Dietz of ASU on creationismPhilip Klass LectureSkeptics ReorganizedSkeptics subcommittees formed"Peter Popoff Came to Town" by Jim Lippard"Towards a more effective organization" by Bob Guzley"Update on the Radiocarbon Dating of the Shroud of Turin" by Jim LippardNew Phone NumberEditor's RamblingsUpcoming MeetingsPhoenix Skeptics News vol. 1, no. 5, March/April 1988: Important Announcement!February Meeting: Jeff Jacobsen on ScientologyPhilip Klass LectureMarch Meeting: Mike Stackpole on claimed dangers of D&DThe Organization Explained!"Frank Baranowski: Promoter of the Paranormal" by Jim Lippard"Book Review: The New Inquisition by Robert Anton Wilson" reviewed by Jim Lippard"Robert Anton Wilson and the H.E.A.D. Revolution" by Zak WoodruffEditor's RamblingsUpcoming MeetingsPhoenix Skeptics News, vol. 1, no. 6, May/June 1988: April Meeting: James Lowell on Mexican cancer clinicsMay Meeting: Jim Lippard on psychic detectivesPress coverage"Turin Shroud Update" by Jim Lippard"Dr. Stranges Lives Up to His Name" by Mike Stackpole"Near-Death Experiences and TV" by Jim Lippard"An Artistic 'Phenom'" by Ted Karren"Psychic Detectives" by Jim LippardEditor's Ramblings"TUSKS Tips" by Ken MorseUpcoming MeetingsThe last issue of this volume was the first one also distributed to the Tucson Skeptical Society (TUSKS), and prompted a change of name to The Arizona Skeptic beginning with volume 2. This was also about the time I moved to Tucson to attend graduate school at the University of Arizona (August 1988).

Here’s a nice short YouTube video documenting several cases of deception in the documentary “The Great Global Warming Swindle." And on the same subject, I’m rather fond of an exchange between Martin Durkin, the producer of that film, and geneticist Armand Leroi, journalist Ben Goldacre, and science writer Simon Singh, which prompted Durkin to respond, “you’re a big daft cock” after Leroi pointed out that the film had used completely erroneous data that was possibly even faked. (Via the Deltoid blog.) ...

Looks like the chiropractic post has been referenced at a chiropractic forum, which is generating a fair amount of traffic: http://www.chiroweb.com/cgi-bin/ubb/dcs_only/forumdisplay.cgi?action=displayprivate&number=4&topic=014324 And the chronic Lyme disease post has been referenced at a Lyme disease forum: http://www.lymeneteurope.org/forum/viewtopic.php?f=7&t=2623&p=19265 It remains to be seen if this will produce any critical comments, though I noticed that an advocate for chiropractic, “nobs,” showed up in the comments at the Science-Based Medicine blog and made a mistaken inference about the conference content–that it was 25% about chiropractic–because he failed to realize that my conference summary had only covered the first four of the six speakers at the time. Nothing yet from homeopaths that I’ve noticed.

This is the sixth and final part of my summary of the Science-Based Medicine conference at TAM7, which will be followed by a summary of TAM7 itself. Part one, Dr. Steven Novella’s introduction, is here. Part two, Dr. David Gorski on cancer quackery, is here. Part three, Dr. Harriet Hall on chiropractic, is here. Part four, Dr. Kimball Atwood on evidence-based medicine and homeopathy, is here. Part five, Dr. Mark Crislip on chronic Lyme disease, is here. The sixth session speaker was Dr. Val Jones, CEO of BetterHealth, on “Online Health and Social Media: The Good, The Bad, and The Ugly.” In this last post of my SBM conference summary, I’ll cover her talk as well as the Q&A panel that concluded that day’s events. Personal Story Dr. Jones began her talk with her personal history–she was raised in Nova Scotia by hippie parents from New York City and grew up on a farm with cows. She said her parents were “moderately weird”–they would ascribe magical powers to yogurt, but they vaccinated their children. She called herself a “shruggie” with respect to complementary and alternative medicine (CAM)–ambivalent about whether there could be anything to it. She worked with the Ontario March of Dimes, became a doctor, did biophysics and vaccination research at the Mayo Clinic, and earned her M.D. in physical medicine at Columbia. She then worked at Medscape with George Lundberg, editor of JAMA, and created the Clinical Nutrition & Obesity journal there (at Medscape). She was then recruited by RevolutionHealth, an online provider of health information started by Steve Case of America Online. She described it as an “OnStar system for navigating the health care system.” She moved to Washington D.C. to take the job, and, as she put it, “entered the Twilight Zone." Revolution Health She served as an editorial director and medical reviewer with a staff of 100 doctors across the country, and “couldn’t believe the crap that came across [her] desk. Who are these people and why are they so into their colons?" At one point, an article was submitted from a writer for Alternative Medicine magazine that claimed olive oil cures breast cancer. The study behind the story showed that breast cancer cells in a petri dish, exposed to a chemical found in olive oil, made some kind of genetic change–that was transformed into an alleged cure for breast cancer. The company developed a health tracker tool, and developers kept adding trackers based on what they thought would be cool, such as a “hot flash tracker.” She asked, “Why?” The developers answered, “so they can tell the doctor if a hot flash occurred at 2 or at 3 o’clock!” There was no clinical review of the tracking tools. Medicine Chest Another product was developed called Medicine Chest, which allowed people to vote their medicines up or down for how much they like them. “It’s not going to be misinformation, it’s the wisdom of crowds,” the developers said. Not only could users vote on their medicines that were listed, they could add suggestions of their own in free-format text fields. The display of the results on the site didn’t distinguish FDA-approved treatments from what people entered in on their own. The result was that the best treatment for headaches, back pain, strains, etc. was narcotics, followed by marijuana. The best treatment for diabetes (without distinguishing type 1 from type 2) was dog walking. Dr. Jones compared this to the Citizens’ Briefing Book on Obama’s change.gov website, where the general public could vote on what they considered to be the most important issues, with the resulting winner being the legalization of marijuana. Other recommended treatments from the Medicine Chest feature included yogurt for colon cancer, acupuncture for ovarian cysts, herbal treatments for hip fracture, and steroids for cellulitis (which she observed is “very bad and dangerous”). Other similar sites took things to a further extreme, such as Patientslikeme.com, which allowed patients to conduct and report their own clinical trials online. This led to promotion of fish oil to slow the progression of multiple sclerosis and ALS. And beer and dogs as a treatment for lack of motivation. She cited a quote from Poincare: “Science is facts; just as houses are made of stones, so is science made of facts; but a pile of stones is not a house and a collection of facts is not necessarily science." She searched the Internet for help understanding the craziness, and came across Orac’s Respectful Insolence blog, which she followed for several months. The last straw for her at Revolution Health was when it promoted chelation as a treatment for autism, which could kill a child, and she felt violated her Hippocratic Oath. Dr. Jones listed a set of psychological factors which lead people to wrong conclusions, of the sort you might find in Kahnemann & Tversky’s Judgment Under Uncertainty. On the list was the Hawthorne Effect, which purportedly showed that any change made in a business environment temporarily improves productivity. This effect was named after a study of worker productivity based on data collected after changes in lighting and other conditions at the Hawthorne Works between 1924 and 1932, but subsequent studies have failed to replicate the effect. The original data was recently rediscovered and reanalyzed by Steven Levitt (author of Freakonomics) and John List, with the result that “we find that existing descriptions of supposedly remarkable data patterns prove to be entirely fictional. There are, however, hints of more subtle manifestations of a Hawthorne effect in the original data." Miscellaneous Slides She concluded her talk with a few slides with various observations, such as The Onion’s “NSF: Science Hard” article and a quote from Surgeon General Rich Carmona that the average American understands medicine at the 4th to 6th grade level. She pointed out that there’s a cottage industry of quack cancer treatment providers around the M.D. Anderson cancer center, taking advantage of cancer patients. She criticized the 1994 passage of DSHEA and its signing into law by Bill Clinton, which exempted dietary supplements from FDA approval requirements unless they’re found to be harmful. She quoted lots of examples of harm from whatstheharm.net. She recommended Memorial Sloan Kettering’s herbal guide, noting that “doesn’t work” is the conclusion for most descriptions, and recommended ClinicalTrials.gov for accurate information. And she closed with a quote from Hippocrates: “There are two things, science and opinion; the former begets knowledge, the latter ignorance." Q&A There was then a Q&A panel with all speakers. The first questioner came up to note that the CDC of Maine recently sent pediatricians copies of Paul Offit’s book, Autism’s False Prophets. He also noted that humor of the sort in the “That Mitchell and Webb Look” clip about the homeopathic emergency room was effective, and we need more things like that. Steven Novella responded that we need lots of different things, not any one thing, because AltMed has its marketing down pat. Another questioner asked if there was a way for social media to work effectively in medicine, to which Dr. Jones responded that MedHealth “has lifeguards in the pool–physicians to moderate.” In a later comment, she pointed out that MedHealth has 200-300 doctors who answer questions for free, because the referrals they get as a result more than make up for the [opportunity cost]. Someone else said that the book Snake Oil Science needs to be turned into an easily usable website, and complained that Quackwatch is hard to use and too polemical. Dr. Novella agreed that SBM needs to provide more, better, and more usable information. It would be good to have a place where you can find overviews on topics, allow you to dig as deep into technical detail as you want, and provides a list of sentinel references. (This is essentially what the TalkOrigins Archive provides for the creation/evolution debate, in particular with Mark Isaak’s Index of Creationist Claims; the power of providing these kinds of broad and deep archives of reliable material was one of the key points of the talk I gave in June to the American Humanist Association.) Another questioner asked whether there is anything we can do to get rid of the National Center for Complementary and Alternative Medicine. Dr. Novella said that it is becoming more widely known that NCCAM’s Trial to Assess Chelation Therapy, its largest and most expensive trial to date, is loaded with “quacks and criminals” (guilty of insurance fraud and worse) and “totally corrupt,” as has been reported by the Associated Press in several good stories. Bioethicist Art Caplan has pointed out that these are unethical experiments on human subjects that would (should?) never be tolerated by NIH. (NCCAM is part of NIH.) NCCAM has spent $1.2 billion $2.5 billion of taxpayer money to date, and produced zero new treatments. Someone raised the question of what kinds of questions to ask your own doctors to make sure they’re giving good advice. Dr. Jones suggested asking, “Do you use UpToDate?”, which is a service that searches the world medical literature regularly and provides current data reviewed by 300 full-time reviewers. Dr. Gorski suggested asking whether a doctor follows the NCCN guidelines, which are evidence-based cancer treatment recommendations. Dr. Novella observed that just using Google, a “pull approach,” how most people look for medical information online, is highly unreliable because “bad sites are good at looking like good sites.” (I’d suggest that a more specialized search engine is a better way–Tim Farley suggested some ways of creating such capabilities at TAM6 last year.) Dr. Hall said that Stephen Barrett’s rule of thumb for distinguishing good from bad sites is that “if it’s selling something, it’s a bad site.” I’m not sure how effective that rule is, since even good sites are typically selling something. Someone raised a problem for use of prior probability, noting that it could have made us miss out on the discovery of lithium as a treatment for bipolar disorder, since it was originally postulated on rather shaky grounds. He gave a second example as SSRIs, which are effective in treating depression, but the original MAOI hypothesis of their operation has been refuted. Dr. Novella responded by saying that first of all, no known mechanism should imply a neutral prior probability (i.e., 0.5). Second, in deciding what to research, it’s better to err on the side of the implausible–but not for treatment. He further suggested that lack of mechanism should not be equated with implausibility. Dr. Atwood seconded that there is a difference between lack of mechanism and contravention of a physical law, and made reference to the discussion that he and I had during the break. He gave aspirin as another example of a substance where the mechanism was discovered later than its effectiveness, and expressed doubt about the questioner’s story of the discovery of lithium’s usefulness. David Whitlock raised the question of framing, asking why we don’t draw the distinction as science-based vs. faith-based medicine. Dr. Novella responded that this would cause more problems than it would solve, at least in the United States, because of the immunities granted to the free exercise of religion. A questioner wondered whether it might at least stop the government from paying for “faith-based” medicine under single payer. (I don’t think we’re likely to get single payer, and I note that we still have an Office of Faith-Based Programs, so I think this is not a good suggestion.) Dr. Gorski noted that very little CAM is actually religion-based. A questioner asked how corrupt the Cochrane data is, to which Dr. Atwood replied that the contributions on CAM subjects are unreliable, but reviews of substances are good and Cochrane in general is good. Dr. Novella said that he uses Cochrane to get studies and results, but ignores their conclusions, and pays close attention to authorship. Dr. Hall said that when it comes to meta-analysis, if the result is negative, you should believe it, but if the result is positive, you should look further. Dr. Novella noted that the systematic reviews in Cochrane aren’t actually meta-analyses. And that pretty much wrapped up the day for the Science-based Medicine conference. If you’d like to continue on to my summary of The Amazing Meeting 7, it begins here. UPDATE (July 19, 2009): I’ve been reminded that I neglected to mention one of the more interesting questioners, a massage therapist who stood up and said that he was probably the only “woo practitioner” in the room (though the doctors disagreed that massage therapy really counts as “woo”–and see Dr. Atwood’s talk, where he classified massage therapy as having high prior plausibility), who regularly attends CAM conferences. He complimented the speakers and the audience for having a level of displayed intelligence, sophistication, and scientific knowledge that is not seen at those CAM conferences. ...

This is part five of my summary of the Science-Based Medicine conference at TAM7, which will be followed by a summary of TAM7 itself. Part one, Dr. Steven Novella’s introduction, is here. Part two, Dr. David Gorski on cancer quackery, is here. Part three, Dr. Harriet Hall on chiropractic, is here. Part four, Dr. Kimball Atwood on evidence-based medicine and homeopathy, is here. The fifth session speaker was Dr. Mark Crislip, infectious disease specialist and host of the Quackcast podcast, on “Lyme from the IDSA to the ILADS to the ABA." Like several of the other speakers, Dr. Crislip began with a disclosure of potential conflicts of interest, saying that he had “barely any” and “[hasn’t] spoken to a drug rep in 25 years." He started his talk with a description of Lyme disease. It’s caused by a spirochete related to syphilis, that comes in three varieties, European, Asian, and North American. The latter is Borellia burgdorferi, a nasty little organism that lives in ticks, primarily deer ticks. It’s transmitted via a tick bite, requiring 36 hours of attachment for transmission, and has grown in prevalence in the northeastern United States with the growth of the deer population. In the northeastern U.S., most ticks have Lyme, while in the northwestern U.S., only 1.3% of ticks have Lyme, because those ticks feed on the blood of a fence-sitting lizard that contains something that kills the spirochetes. (Here, Dr. Crislip joked that despite the presence of numerous fence-sitting lizards in Washington, D.C., the effect doesn’t work there.) North American Lyme disease goes through three stages: skin rash, arthritisspreads to whole body, causes meningitisresults in encephalomyelitis and neurological symptomsThere are drugs that work well to treat the disease at all three stages. However, there are “also people who think they have Lyme but don’t,” or “post-Lyme disease." Two Camps Dr. Crislip identified two groups that have radically different views about Lyme disease: 1. The Infectious Diseases Society of America (IDSA). 2. The International Lme and Associated Diseases Society (ILADS) The latter says that Lyme is common, hard to diagnose, and “requires infinite antibiotic treatment.” The former says nearly the opposite. The New England Journal of Medicine published a critical appraisal of “chronic Lyme disease” which put the sufferers into four categories: 1. Symptoms of unknown cause, no evidence of B. bergdorferi. 2. Well-defined illness unrelated to B. Bergdorferi (e.g., ringworm). 3. No history of Lyme disease, but blood contains B. Bergdorferi antibodies. 4. Post-Lyme disease syndrome, chronic illness. The study performed controlled trials of those in category four, and concluded that there is no evidence of B. Bergdorferi persisting beyond treatment, the name “chronic Lyme disease” is a misnomer, and there is no justification for continued antibiotic treatment of such persons. Dr. Crislip then stated that the two camps present a false dichotomy, but that the truth is closer to the IDSA position. He asked, “is there asymptomatic Lyme?”, and answered “yes.” 7% of test subjects have asymptomatic seroconversion (show B. Bergdorferi antibodies) in vaccine trial placebo groups. He asked, “can [Lyme be] persistent due to antibiotic resistance?”, and answered that there is no good data of that. He pointed out that Borellia can exist in three forms, the spirochete, a cyst, and an L-shaped form with no cell wall. The cysts appear when the organism is stressed, but isn’t found in humans (and is supported in fewer than 25 references in PubMed) and the L-shaped form can be made in the lab but doesn’t survive in humans. Diagnostic Testing Dr. Crislip said that the standard test for Lyme disease is a two-step process, an ELISA test confirmed with a Western Blot (the same process used for testing for HIV). With classic Lyme disease, this is a very reliable method. It can also be tested with PCR and with antigen assays, and “there is genotypic variation in Lyme that could potentially make the two-step test less sensitive." There are also labs which perform their own unvalidated tests, such as a lab in Texas that he says “almost always yield[s] positive results.” These labs with unvalidated diagnostic tests have caused the CDC and FDA to issue warnings about non-valid Lyme tests. Dr. Crislip posted a list of alleged symptoms of chronic Lyme disease, which was a very long list including “unexplained hair loss” and “feeling as if you are losing your mind,” along with another list of alleged symptoms of chronic candida, and noted that they were quite similar. Using such lists, virtually any symptom is an indicator of these alleged chronic conditions. The ILADS guidelines go even further, and say such things as: The labs are all unreliable, so treat for Lyme even if the test is negative.The primary symptom is that the patient thinks they have the condition.Physical findings are nonspecific and often normal.If the Western blot result is ambiguous, treat it as positive (the opposite of what you do with HIV).A comparison to tuberculosis and leprosy provides justification for long-term antibiotic treatment (even though those diseases are biologically dissimilar to Lyme).In short, the ILADS guidelines provide a nonfalsifiable definition of Lyme disease. The best trials in the NEJM treated Lyme disease patients with a month of cipro (and?) doxycycline. The “chronic Lyme disease” advocates say that the immune system is damaged with antibiotic use, and then Lyme disease increases as the immune response declines–based on no data. If you don’t have the data, sue The state of Connecticut passed a bill “giving doctors immunity for giving infinite supplies of antibiotics” to patients purportedly suffering from “chronic Lyme disease.” Since the IDSA guidelines are against long-term antibiotic use, the Connecticut Attorney General sued the IDSA. They couldn’t afford $250,000 in legal expenses, so they settled the case. Dr. Crislip concluded by pointing out that the cause of this unsubstantiated syndrome will be promoted by a new film coming out, called “Under Our Skin,” which has the tag line “There’s no medicine for someone like you.” Crislip noted that of the two doctors in the film promoting this illness, one lost his license for diagnosing Lyme disease over the telephone. (Part six of my conference summary, on online health and social media, and the final Q&A panel session, is here.) ...

This is part four of my summary of the Science-Based Medicine conference at TAM7, which will be followed by a summary of TAM7 itself. Part one, Dr. Steven Novella’s introduction, is here. Part two, Dr. David Gorski on cancer quackery, is here. Part three, Dr. Harriet Hall on chiropractic, is here. The next session was Dr. Kimball Atwood, an anesthesiologist who is also board-certified in internal medicine and associate editor of the Scientific Review of Alternative Medicine. He spoke on “Why Evidence-Based Medicine is not yet Science-Based Medicine,” or “Do Clinical Studies of Highly Implausible Methods Help or Hinder?" Dr. Atwood’s talk made some points right at the start similar to the critique of evidence-based medicine (EBM) given in Dr. Novella’s introduction–that EBM makes the mistake of devaluing what he called “pre-clinical knowledge.” Unlike Dr. Novella, however, he also stated that random controlled trials (RCTs) “cannot, by themselves, overturn well-established medical principles.” I’m not sure that his talk actually demonstrated that point–as stated, it sounds like “well-established medicalscientific principles” are part of a “hard core” of medical theory (in Imre Lakatos’ sense) that cannot be refuted even if found to be in conflict with empirical results, because they are shielded by the addition of auxiliary hypotheses to salvage it. I don’t think that was his intent, as surely even “well-established medical principles” should be eligible for revision in light of contrary empirical evidence. Instead, what I think he meant by “pre-clinical knowledge” and “well-established medical principles” is really more like a demand for consilience with the rest of scientific knowledge, adherence to logic and mathematical principles, and having a plausible mechanism (or at least not having a purported mechanism in conflict with other known facts). More on that in the “Q&A” section, below. [UPDATE (July 21, 2009): As Dr. Atwood notes in the comments, I incorrectly transcribed what his slide said. Also note his further discussion on what he means by a “plausible mechanism.] He began his talk with an overview of EBM–EBM advocates, to quote EBM pioneer David Sackett, “use of the best available evience, especially from patient-centered clinical research.” It relies on randomized controlled trials and systematic reviews. Dr. Atwood gave two examples of successes of EBM. First was the standard practice of giving heart attack patients anti-arrhythmia drugs post-myocardial infarction, which EBM trials showed causes excess deaths and was an incorrect practice. Second was the Women’s Health Initiative study on hormone replacement theory, which showed that risks exceed benefits for taking estrogen. (I’m no authority, but I am skeptical of this claim based on my understanding of the flaws in that study from conversations with the late Chris Heward, who is co-author on a paper in Fertility and Sterility that challenged the WHI study for methodological flaws which made it unable to detect cardioprotective effects.) The four steps of “pull” EBM are: formulate an answerable questiontrack down the best evidencecritically appraise the evidenceindividualize, based on clinical expertise and patient concernsAtwood stated that those in practice the longest perform the worst, by not keeping up to date with their fields. Cochrane Collaboration Atwood next turned to the Cochrane Collaboration, the organization that maintains a library of EBT results, classified by type of evidence and evaluated with reviews in the form of evidence statements and recommendations. He gave a few examples, such as a statement about the effect of physical activity on dementia: “[There is] insufficient evidence to determine the effectiveness of … physical activity programs in managing or improving … dementia.” And a seemingly equivalent statement about the use of homeopathy for the same purpose: “In view of the absence of evience, it is not possible to comment on the use of … homeopathy in treating dementia.” This, according to Dr. Atwood, is B.S. – Bogus Science. Why don’t they just say that homeopathy doesn’t work? Because there are no sound clinical trials in the database. EBT categorizes evidence into three classes. Class I evidence involves randomized controlled trials (RCTs). Class II involves controlled trials without randomization (or several other forms of case-control studies). Class III involves one or more case studies of a treatment without a control group and is considered insufficient for a treatment to be called “evidence-based medicine.” Within each class there are further divisions, for example, Class I is broken down further, with systematic reviews of RCTs at the top (1a), followed by individual RCTs (1b), and so forth. Atwood objected that this devalues pre-clinical knowledge by making “evidence” synonymous with clinical trials, and that therefore EBM “is not based on all of the evidence.” He provided a few more examples of complementary and alternative medicine (CAM) treatments from Cochrane, described with terms like “Not enough evidence to …,” “little evidence,” and, in the case of laetrile as a cancer treatment, “No studies found that met inclusion criteria.” There was, however, a 1982 New England Journal of Medicine clinical trial on 180 patients which yielded a negative result and the conclusion that the treatment is dangerous, but this constituted a case study at the lowest level of evidence in EBM. Atwood quoted a statement from Edzard Ernst, co-author with Simon Singh on the chiropractic-critical book, Trick or Treatment, to the effect that “a priori plausibility has become less and less important” as a result of EBM (which Ernst advocates). He then continued with more CAM treatments in Cochrane, such as craniosacral therapy, reflexology, Kirlian photography (“may be more reliable than chance”), and therapeutic touch (“remains controversial”). Homeopathy Atwood then described the case of homeopathy in order to make his central argument critical of EBM. Samuel Hahnemann invented homeopathy in 1796, on the basis of two principles. The first principle is “similia similibus curantur,” or “like cures like,” or the “law of similars.” This claims that if you find a substance that gives you symptoms similar to an illness, that’s the substance you use to cure that illness. Hahnemann read in William Cullen’s “A treatise of the materia medica” that cinchona bark could be used to treat malaria (now known to be true because of quinine in the bark). He gave himself a sample of that bark while healthy and observed that he developed symptoms that were similar to malaria. From this single example, he concluded that all medicines produce symptoms in healthy people similar to the symptoms of diseases they effectively treat. The second principle of homeopathy is the “law of infinitesimals.” He reasoned that dosages sufficient to produce overt symptoms were too high, so the substances should be diluted in order to provide an effective treatment, and in fact the more diluted, the more powerful the cure. Homeopathic remedies of 24X (or 12C) are the equivalent of diluting 0.36mL of salt into a volume of water the size of the Atlantic Ocean. Hahnemann most commonly recommended an even greater dilution of 60X (30C). For all intents and purposes, homeopathic remedies of standard dilutions are indistinguishable from the water used to dilute them. Atwood went on to note that homeopaths do not agree on prescriptions for various maladies. On top of that, the outcome of all trials to date have been failures. This is a long list of powerful reasons for rejecting homeopathy, but the last one is the only one EBM considers relevant. There is clearly a very low degree of plausibility for homeopathy independently of such trials, and homeopathy is a clear case in point that “some hypotheses are too implausible to spend time on (or spend more time on)." Prior Probabilities Atwood offered the following set of broad categories of prior probability and types of treatments that fall into them: Prior probability of about zero: homeopathy, neurocranial restructuring (putting balloons up your nose and inflating them). Prior probability significantly lower than («) 1: metabolic therapies for cancer, detoxification, chiropractic for any purpose other than back pain Prior probability very low: acupuncture for pain most popular herbal claims (St. John’s wort, echinacea) Prior probability moderate to high: massage, relaxation techniques for anxiety reduction and chronic pain Prior probability depends on: basic sciencecogency of theoryprevious studiessourceHe then discussed Bayes’ Theorem, which says that the odds of a hypothesis being true given certain evidence is equal to the odds of the hypotheses (prior probability) multiplied by the Bayes factor, which is the probability of the evidence given the hypothesis divided by the probability of the evidence given the null hypothesis. If the prior probability is near zero, then much greater evidence is needed in the Bayes factor to result in a probability of the hypothesis being true. (Note that Atwood gave the theorem partly in terms of odds rather than probability for the purposes of his talk. Odds = probability / (1 - probability).) When Bayes’ Theorem is taken into account, the p-value of a statistical result can become much less impressive. For example, with a p-value of .05, which means that a result would be expected to occur by chance 5 times in 100 with a Bayes factor of 2.7, if the prior probability is only 1%, that result only raises the posterior probability to 3%. If the prior probability is 20%, it raises it to only 40%. With a p-value of .01, a result expected to occur by chance only 1 time in 100, and a Bayes factor of 15, a prior probability of 1% is raised to 13%; a prior probability of 20% raised to 78%. Dr. Atwood provided a table with more detail that went up to p=.001 (result expected by chance 1 in 1000 times). Dr. Atwood advocated that “prior probability ought to be formally considered in EBT,” and gave the further example of a “positive” trial for intercessory prayer in the critical care unit (CCU) with an 11% reduction in some harm with a p-value of .04, and noted that if the prior probability was 1%, this still produces less than 6% odds of a genuine effect. A few other similar examples were given involving acupuncture, homeopathy, and distant healing, the final example of which had Edzard Ernst as a study co-author and concluded that it “warrants further study,” but which he subsequently backed away from after “some positive trials [were] found to be fraudulent." Finally, he noted that pre-trial knowledge is not sufficient, but is necessary for a treatment claim. Q&A I asked Dr. Atwood if, in his final statement, he was saying that you have to have a plausible mechanism for a treatment in order for a treatment to be justified (a positive requirement), or if he only wanted to impose a negative requirement that the proposed mechanism or method did not contradict known facts from other realms. His initial answer was that he thought those would be equivalent, but I observed that we can discover cause-effect relationships without having any knowledge of the underlying mechanism, such as Mendel’s discovery of genetics. At that point, he agreed that he just wanted to require the negative condition. Another audience member then suggested that this might be accomplished by creating a categorization scheme for levels of plausibility that in some way parallels the levels of evidence scheme. Another questioner asked how to standardize assignment of prior probabilities and address bias, to which Dr. Atwood said that you could just pick neutral prior probabilities, since if you do enough studies the posterior probability of each study becomes the prior probability for the next. EXTRA: As appropriate for a talk that touched on homeopathy, prior to Dr. Atwood’s presentation this excerpt from the fourth episode of season three of “That Mitchell and Webb Look” was shown to the audience: (Part five of my conference summary, on chronic Lyme disease, is here. Part six, on online health and social media, and the closing Q&A panel, is here.) ...

This is part three of my summary of the Science-Based Medicine conference at TAM7, which will be followed by a summary of TAM7 itself. Part one, Dr. Steven Novella’s introduction, is here. Part two, Dr. David Gorski on cancer quackery, is here. The next session was Dr. Harriet A. Hall, the “SkepDoc,” a retired family physician and former Air Force flight surgeon, on “A Scientific Critique of Chiropractic." Chiropractic Dr. Hall began her talk by observing that 10% of Americans see a chiropractor some time each year, and said that her talk would address the questions of when you should see a chiropractor, what they really do, is it based on science, and why isn’t it part of regular medicine. Chiropractic, she said, is a pre-scientific system that was discovered on a single day (September 18, 1895) by D. D. Palmer, a grocer and magnetic healer. On that day, he performed a spinal manipulation on a deaf janitor and allegedly cured his hearing, and based on that single case, claimed that he had found the cause of all disease. Hall noted that in 1895, Pasteur had just died, X-rays had just been discovered, and the germ theory of disease was just catching on. For perspective, she noted that 1900 was the first year in which you would have a 50% chance of having a beneficial outcome from a visit to a doctor. Chiropractic theory says that all disease is caused by subluxations, or dislocated joints, causing nerve impairment, thereby impacting the flow of “Innate,” a mystical force that flows through us. There are real subluxations, which are visible on X-rays, but chiropractic subluxations have never been demonstrated to exist. The chiropractic finding of “Boop”–bone out-of-place–can’t be documented on X-rays, and chiropractors have claimed that they are as small as 1/10,000,000 mm. The current chiropractic definition of subluxation (as defined by the American Association of Chiropractic Colleges) has been adjusted to be more vague: “a complex of functional and/or structural and/or pathological articular changes that compromise neural integrity and may influence organ system and general health." Palmer said that 95% of ill health and disease is caused by spinal subluxations, and 5% from misalignments of other bones. Hall suggested that if this were true, invertebrates wouldn’t get sick, though perhaps chiropractors would say that Palmer was only speaking of the causes in humans. She went on to point out that a ruptured disc is an example of a spinal injury which causes pain without subluxation, directly refuting Palmer’s claim. The chiropractic theory of nerve impingement often uses a garden hose analogy, that a kink in the hose causes water to back up on one side of the kink. But this analogy is not correct, because nerve conduction speed is only affected at the point of compression, as seen in carpal tunnel syndrome. While such nerve dysfunctions do exist, they don’t work the way chiropractic says, and they are not the cause of most disease. A further problem for chiropractic is that 12 cranial nerves and 5 sacral nerves are out of reach for chiropractic manipulation. Hall showed a diagram about the flow of “Innate” which showed the doctor’s “Innate” influencing the patient’s “Innate,” but for which there was no described mechanism. There is, of course, no evidence that “Innate” exists, and it’s now rejected by many chiropractors. The audible crack from chiropractic manipulation, Hall said, is just like knuckle cracking, and has no therapeutic effect except perhaps for its psychological impact. She noted that at least one chiropractor cracks her own wrists and doesn’t actually touch her patients! Osteopathy and Chiropractic Hall compared osteopathy to chiropractic with this chart: OsteopathyChiropractic restoring blood flowminimize spinal manipulation therapy (SMT)adopted sciencerestoring nerve flowmaximize SMTnope Spinal manipulation therapy, said Hall, works as well as other treatments in treating back pain, and there is no evidence that it assists in treating anything other than back pain. A problem in testing SMT is that good placebo controls are impossible, because the patient can tell when SMT is occurring or not. Single blinding is impossible, let alone double blinding. There are also many variations of technique possible. Tooth Fairy Science Dr. Hall argued that chiropractic study is something like what she called “tooth fairy science.” You could perform tests of the tooth fairy, by putting lost teeth into baggies vs. facial tissue before putting it under the pillow, comparing the amount of money received for the first lost tooth to the last lost tooth, looking for correlations with parental income, and so forth, but none of this would tell you anything about an entity called the Tooth Fairy. She gave an anecdote of a man suffering from back pain who made an appointment with a chiropractor for the following Monday. Over the weekend, his pain went away–if he had made his appointment for Friday, he would have attributed the pain going away to the chiropractic treatment and perhaps ended up as a believer and regular patient. She compared this to the “blue dot cure,” a treatment by painting a blue dot on your nose (any nonsensical treatment suffices for the illustration). If the patient gets better, that’s evidence that it worked. If the patient stays the same, that’s evidence that the treatment kept him from getting worse. And if the patient gets worse, that’s evidence that the disease was too far advanced, and if only he had come sooner it would have been treatable. (Or, alternatively, it’s evidence that more treatment is required–say, upping the dosage of the remedy or painting a darker blue spot on the patient’s nose.) What chiropractors do well, Hall said, is help with back pain and act as good psychologists. But they’ve gotten thumbs down the New England Journal of Medicine, Consumer Reports, The Medical Newsletter, Canadian neurologists, and many other sources, not just because of claims to be able to treat things that it can’t treat, but because of safety issues. The Big Downside of Chiropractic Chiropractic manipulation of the head and neck turns out to be dangerous. It can compress or tear vertebral arteries, resulting in strokes, perhaps as frequently as in one in a million manipulations, and perhaps 20% of basilar strokes are caused by spinal manipulations. Hall pointed out that mobilization is as effective as manipulation, yet is safe–so there’s no reason to use the riskier method. The Canadian neurologists mentioned above have recommended that signs warning signs be posted in chiropractic offices and that neck manipulation of children be prohibited. Insurance data on payouts for chiropractic malpractice show that about 9% of payouts in 2002 were for “CVA,” or cerebrovascular accident. The numbers are likely under-reported, since there may be some time between a manipulation that causes damage and a stroke. Chiropractors as Quack Magnets A further problem with chiropractic is that practitioners are “quack magnets,” promoting all sorts of bogus diagnostic methods and treatments such as moire contour analysis, use of a “neuroscope” that measures temperature differences and pressure, biofeedback as a form of electrodermal testing, applied kinesiology (pseudoscientific muscle strength testing), unnecessary dietary supplements, homeopathy, and reflexology. Hall also mentioned B.J. Palmer’s (D.D. Palmer’s son) “Atlas Adjustment” technique, or “hole in one” technique, which suggests that manipulation of the Atlas vertebra is sufficient to cause the rest of the spine to fall into alignment. Chiropractors also tend to overuse X-rays, such as taking full-spine X-rays which expose the reproductive organs and inevitably produce overexposed or underexposed areas. Proper X-raying focuses on smaller areas to get the right exposure. Chiropractors offer bad advice, frequently discourage immunizations and other medical treatments, and they frequently miss diagnoses of real illnesses. In one test of chiropractors, patients were sent in to describe classic heart attack symptoms, but none of the chiropractors in the test recognized it or its significance, and none suggested that the patient visit an emergency room. Types of Chiropractor There are three major chiropractic groups. The International Chiropractors Association (ICA), or “straights,” who practice only chiropractic. The American Chiropractic Association (ACA), or “mixers,” who mix chiropractic with other diagnostic and treatment techniques. And the National Association for Chiropractic Medicine (NACM), who are attempting to reform chiropractic by disassociating it from Palmer’s pseudoscience and using only evidence-based scientific medicine. Chiropractic Thinking and Hallmarks of Pseudoscience Hall gave some examples of chiropractic thinking that is blatantly wrong or harmful: If spine is straight, we can’t die.Germs don’t cause disease, or we’d all be dead.Muscle testing to find allergies. (In one case, a patient was tested for job-related stress with applied kinesiology, by pushing down on his arm while he thought of work.)Spinal adjustments as the only treatment for meningitis, resulting in the child’s death–and it was the chiropractor’s own child.A “no-touch” chiropractor (cracking own wrists, mentioned above).And examples of how chiropractic exhibits the hallmarks of pseudoscience: “If science disproved it, I’d still use it."It doesn’t give up ineffective treatments.It’s made no progress over the last century.It doesn’t matter whether it’s true as long as it makes you feel better.Dr. Hall concluded her talk by giving several three examples of concrete harm from chiropractic taken from Tim Farley’s “What’s the Harm” website, which lists 312 specific cases of chiropractic harm: Kristi Bedenbaugh: Suffered a stroke and died. Sandra Nette: Suffered multiple strokes and was left paralyzed with locked-in syndrome. Laurie Jean Mathiason: Fell into a coma and died after receiving 186 neck manipulations in a six-month period. Dr. Hall recommended the Quackwatch site and Chirobase.org as online resources on chiropractic, and the book Inside Chiropractic by chiropractor Samuel Homola and Quackwatch founder Stephen Barrett. Q&A In the Q&A session, Dr. Hall was asked whether chiropractors are required to follow a standard of care and whether informed consent is required. She said that informed consent is not required, it is voluntary, and the informed consent forms that she’s seen are very bad. She was also asked how many chiropractors meet the good and safe criteria, and she made a guess of under 10%. (Part four of my conference summary, on evidence-based medicine and homeopathy, is here. Part five, on chronic Lyme disease, is here. Part six, on online health and social media, and the closing Q&A panel, is here.) ...

This is part two of my summary of the Science-Based Medicine conference at TAM7, which will be followed by a summary of TAM7 itself. Part one is here. David Gorski, surgical oncologist and associate professor of surgery at Wayne State University, perhaps better known as Orac of the Respectful Insolence blog, spoke next on “Case studies in cancer quackery: Testimonials, anecdotes, and pseudoscience.” He began with a disclaimer (he doesn’t speak for his employer) and some disclosures (he receives no pharma funding and isn’t paid to blog). His talk was about misrepresentations by cancer quacks, who use exaggeration and misrepresentation and make false promises. To illustrate exaggeration, he showed a cartoon that described “three approved paths to the graveyard,” “cut” (surgery), “burn” (radiation), and “poison” (chemotherapy) (the exaggeration is in the title rather than the descriptions, which are he admitted were accurate). To illustrate the latter, he showed a series of book covers by Hulda Clark–“The Cure for All Advanced Cancers,” then “The Cure for All Cancers,” and then “The Cure for All Diseases.” She thinks that all cancers and diseases are caused by liver flukes, to be diagnosed with a “Syncrometer,” a device similar to a Scientology E-meter, a galvanometer that measures electrical resistance of the skin, and cured with the “Zapper,” a low voltage electrical device. Some of the frequent claims of cancer quacks are that they are “wholistic” and treat the whole patient rather than a part or a symptom, that “we treat the real cause of cancer,” that their treatment is “natural,” and that “cancer is not the disease, it’s a manifestation of something else” such as psychological conflict. And, of course, the ever-popular generic “toxins.” They also claim that natural cures are being suppressed because Big Pharma can’t make a profit from them. Testimonials Gorski next turned to the role of testimonials in cancer quackery, which he said are being used for several reasons, the first N of which are “to sell a product.” Two other reasons are “to persuade others” and “to attack standard evidence." He gave Gorski’s Laws of Testimonials: 1st Law: When a believer in Alternative-Based Medicine (ABM) uses a combination of both science-based medicine (SBM) and ABM and gets better, it’s always the ABM that gets the credit. 2nd Law: When a believer in ABM uses a combination of both SBM and ABM and dies or gets worse, it’s always SBM that gets the blame. He next described two cases of testimonials, the first of which was an example of a “not cancer” testimonial. This was a testimony of a man who felt a lump on his chest which he claimed to be breast cancer, which was successfully treated by some quack remedy. But this was never diagnosed as cancer, and Gorski noted that from the description it actually sounded like a case of gynecomastia rather than cancer. His second case was that of Daniel Hauser, a 13-year-old boy with Hodgkin’s lymphoma, who went through one round of chemotherapy with good results, but then stopped taking it because he and his mother wanted to use an alternative treatment from “Chief Cloudpiler.” The judge ordered chemotherapy to be continued, and he and his mom took off, though ultimately returned and re-started chemotherapy. During the time chemotherapy stopped, the tumor grew to larger than it was originally, and when it was restarted, it again responded to treatment–but of course his mother gave credit to the alternative treatment. The problems with testimonials are that there may not have been a diagnosis of cancer, there may have been a misunderstanding of the diagnosis (e.g., “I was sent home to die”), there may be important information withheld, the diagnosis may have been done by quack tests with no validity (e.g., the Syncrometer or live blood cell analysis), and there may be a selection bias. As an example of the latter, he noted that dead people don’t give testimonials. Questions for Evaluating Testimonials He provided a modified version of Dr. Moran’s questions to ask in order to evaluate testimonial evidence. These questions include: Was cancer definitely present?Did it go away?Was the advocated treatment the only one used?Was the alternative therapy a replacement for primary or for adjuvant therapy?At this point, he distinguished primary, adjuvant, and neo-adjuvant therapies. The primary therapy for most cancer treatments is surgery, to remove as much of it as possible. Adjuvant therapy is designed to reduce the risk of recurrence, where radiation is used to reduce the risk of local recurrence (cancer in the same place, to make sure you get rid of it all) and chemotherapy is used to reduce the risk of a systemic recurrence (cancer that may have spread to other parts of the body). Neo-adjuvant therapy is designed to shrink a tumor prior to surgery, and may reduce complications and produce better results from surgery. Suzanne Somers To illustrate the importance of these questions and distinctions, he used the case of Suzanne Somers, who was diagnosed with breast cancer at the age of 54, probably at stage I. She had no positive lymph nodes and underwent a lumpectomy, radiation, and a lymph node biopsy, but refused chemotherapy with tamoxifen in favor of mistletoe extract and other supplements. In her case, the answers to the questions were: Was cancer present? Yes.Did it go away? Yes–it was removed by surgery.Was the alternative medicine the only or primary treatment? No.He then examined her probable survival rates with and without chemotherapy, and noted that if the tumor was small, the benefit of chemotherapy for her 10-year survival rate could be as low as 1%. With a larger tumor, her 10-year survival rate improvement could still be as low as 4% (and would already be at 90% prior to chemo). But, Gorski noted, most women say that they would go with chemotherapy even for as little as a 1% increase in survival rate. Surgery cures most cancers that can be cured, up to stage III, and the corresponding benefits of chemo and hormonal therapy increase with more advanced stages of cancer. Gorski then observed that there may be cases where a person is diagnosed with cancer by a biopsy, declines further treatment, and has a good survival rate, where they fail to realize that the biopsy itself has been a surgical primary treatment that has excised all of the cancer–an excisional biopsy may be equivalent to a lumpectomy. He also noted that many people say to go ahead and take out the tumor but don’t touch my lymph nodes, and he agreed that lymphedema, which can be caused by surgical or radiation treatment of the lymph nodes, is “not a fun thing.” But the new standard of care is to use blue dye and a radiotracer procedure to find lymph nodes likely to be positive for cancer (“sentinel lymph nodes”), and treat accordingly. Kim Tinkham Kim Tinkham is a woman who saw The Secret, had stage III breast cancer, and declined all treatment. She now claims the cancer is gone, based on a quack blood test, even though the lump is still present, and has written a book about it. She is a follower of Mormon naturopath Robert O. Young, who claims that acid is the cause of all disease and alkalinization is the cure for everything. He says there is no such thing as a cancer cell, just a healthy cell spoiled by acid. Two years after her initial diagnosis, Tinkham is still alive. Gorski pointed out that for a case like hers, expected survival for five years with treatment could be over 50%, but at ten years it goes way down. Data about untreated cancer comes from 250 cases of “large palpable tumors” from 1805-1933 at Middlesex Hospital in Connecticut. At 10 years, 3% were still alive, and at 15 years, 0.8% were still alive; the median survival rate was 2.87 years. He noted that breast cancer biology is “highly variable in clinical behavior” and in some cases may be “indolent, slow-growing, and slow to metastasize." The answers to the testimonial questions for Tinkham are: Was cancer definitely present? Yes.Did it go away? No.Was the alternative treatment the only one? Yes.Time will no doubt soon tell how (in)effective this alternative treatment has been, unfortunately. Testimonials as Conversion Stories Gorski suggested that these testimonies are really part of “cult medicine” and seem to follow a pattern like religious conversion stories. The specter of death comes like a “bolt out of the blue,” the person repents and says “I brought this upon myself,” they face temptation in the form of standard medical care, they search for enlightenment, and then they find enlightenment in the form of some alternate description of their ailment which they then want to evangelize. Michaela Jakubczyk-Eckert Dr. Gorski concluded his talk with the story of Michaela Jakubczyk-Eckert (warning, graphic images), who was born on November 14, 1964 and died on November 12, 2005, just two days short of her 41st birthday. She had a T4 lesion eating through the skin of her breast, a case of “classic delayed diagnosis.” She received neo-adjuvant chemotherapy treatment which shrank the tumor considerably, but then discovered Ryke Geerd Hamer, the inventor of German New Medicine, who argued that cancer is caused by psychological conflict rather than anything biological. She stopped her chemotherapy, and suffered a horrible relapse. As Gorski put it, she “died a horrible, horrible death” with her final days being subjected to the pain of a rotting-away body of skin and bones–a death far worse than chemotherapy. It was a vivid depiction of the alternative that cancer quacks can cause for their victims. Her husband has put up a website to try to dissuade others from being fooled by Hamer’s theories (see link above to her story). Dr. Gorski has written a blog post at the Science-Based Medicine blog on alternative medicine testimonials that covers some of the above subjects in more detail. (Part three of my conference summary, on chiropractic, is here. Part four, on evidence-based medicine and homeopathy, is here. Part five, on chronic Lyme disease, is here. Part six, on online health and social media, and the closing Q&A panel, is here.) ...