Arizona's homeopathic medical board

Dr. Kimball Atwood's presentation at the Science-based Medicine conference included some observations about the overwhelming evidence against homeopathy being a valid or even remotely plausible treatment for anything. During one of the Q&A sessions at that conference, someone made an observation that Arizona is a terrible state for all kinds of quackery, and even has a State Board of Homeopathic Medical Examiners.

The homeopathy board was created in 1982 by a law written and lobbied for by Dr. Harvey Bigelson, a homeopath who was indicted in 1992 by a federal grand jury on 63 counts of Medicare fraud, 44 counts of mail fraud, and eight counts of obstruction of justice. He plea-bargained his way down to three counts and five years of probation, and lost both his medical and homeopathic licenses, making him one of only two homeopaths to lose their licenses by action of the board. He subsequently opened a cancer clinic in Mexico to continue his quackery.

There was an opportunity for Arizona to dispose of its Homeopathy Board in 2006, when the law that created it would have expired under its sunset provisions, but our legislature foolishly renewed it despite overwhelming evidence that it not only gives an unmerited credence to nonsense, but doesn't even do anything to keep criminals from practicing homeopathy. An October 9, 2005 story in the Arizona Republic pointed out several cases of convicted felons from other states permitted to obtain homeopathic licenses and practice in Arizona. It also pointed out that complaints brought against homeopathy board members for malpractice and sexual harassment were simply dismissed:

The homeopathic board has dismissed at least five complaints against its own members over the past five years, including one in which a patient suffered kidney failure after treatment, as well as an alleged incidence of sexual harassment.

The complaint involving kidney failure was lodged against board member Dr. Annemarie Welch in March 2003. The woman who lodged the complaint fell ill after seeking treatment from Welch for an infected blister on her toe. Welch treated the infection with "vitamin C therapy," according to board meeting minutes.

After the woman suffered "acute renal failure," she filed a complaint against Welch with the Arizona Medical Board, which also licenses Welch.

The homeopathic board argued for primary jurisdiction of the Arizona Medical Board complaint against Welch, arguing that she had primarily used homeopathic procedures. Once the homeopathic board had control of the case, it dismissed the complaint.

According to meeting minutes, board members did not believe there was a correlation between the vitamin C therapy and the patient's kidney failure. They also noted that the patient didn't comply with Welch's treatment recommendations. Welch pointed out the Medical Board also found no wrongdoing in its investigation.

That's crazy--the judgment shouldn't have been whether the vitamin C therapy caused the problem, but whether the LACK of a real treatment of the infection caused by the quack treating her with vitamin C caused the kidney failure. The story goes on:

A Phoenix woman lodged a sexual harassment complaint against board member [Dr. Gary] Gordon in May 2001. The woman said he had spontaneously kissed her on the mouth after she stopped to speak with him at his booth at a medical trade show.

The homeopathic board dismissed the woman's complaint because she did not show up to the May 2001 meeting at which her complaint was scheduled to be heard. She apparently had a family emergency and wrote to the board that she could not make it. Board members questioned Gordon about the allegation, which he denied. The woman did show up at the next board meeting and asked to refile her complaint, but board members voted 2-2 against it.

Nice way to uphold ethical standards, there, homeopathy board. And their permissive behavior with regard to conduct appears to extend beyond members of the board to the licensed homeopaths they're supposed to be regulating:

Troubled physicians licensed by the board include Dr. Charles Crosby, who obtained his Arizona homeopathic license in May 2004 despite revealing to the board that he had been ordered to have counseling for a "perceived loss of social inhibition" in his home state of Florida. It later became known that Crosby had been accused of fondling patients and of having a breast fetish. A report on the case in Florida said Crosby had developed "a special technique of manipulating women's breasts to treat pain in other areas of their body."

The suspension of Crosby's license in Florida triggered a inquiry before the Arizona homeopathic board in July. At the meeting, Schwengel, the board president, said he did not find any specific examples that showed Crosby had acted unprofessionally, according to meeting minutes.

Other members expressed concern about Crosby's behavior, but they did not suspend his license, instead giving him until November to undergo an independent mental evaluation to determine if he is competent to practice here.

Board member Gordon defended this action on the grounds that in the U.S. we assume that doctors in trouble who have "paid their debt to society" have been rehabilitated, and that taking away a license is a severe punishment:

"What we look at is, do we want to try and resurrect a troubled physician and keep them under control, or do we want to throw them away and let them dig ditches?" Gordon said. "Once you take a doctor's license away, they don't really have a particular skill that they're qualified to do."

And what are homeopaths qualified to do in Arizona, besides dispense bottles of overpriced water falsely claimed to be medicine? The board's website gives the answer:

The scope of the license includes the practice of acupuncture, chelation, homeopathy, minor surgery, neuromuscular integration, nutrition, orthomolecular therapy and pharmaceutical medicine (see A.R.S. § 32-2901(22)).

The one that jumps out at me the most is "minor surgery." Yikes!

Here's a list of approved continuing education courses for homeopaths in Arizona:

Learn Oxidative Therapy AHIMA/Westbrook 1/22/09 7 hours
Ethics & Boundaries Dr. Jodi Decker Flexible 3 hours
Professional Ethics Dr. Jodi Decker Flexible 4 hours
Lyme-Autism Connection LIA Foundation/CHOICE 6/25/ - 6/28/09 12 hours

The middle two courses on ethics would seem to me, if taught honestly and accurately, to completely undermine the enterprise. Homeopathy is a bogus practice, and I'd think using bogus practices as medical treatment should be near the top of the list of unethical things that health practitioners should avoid. The other two courses sound like the promotion of quackery; oxidative therapy has been a quack treatment for cancer, and the latter is about a link between two conditions, each of which is already surrounded by rampant nonsense, that is being promoted by the "Lyme-Induced Autism Foundation" in advance of supporting research or data. There was some research being done at Columbia University's Lyme and Tick-Borne Diseases Research Center a few years ago by Dr. Brian Fallon about a possible misdiagnosis of some cases of Lyme disease as autism, but that apparently has not demonstrated any connection and there is nothing about autism currently on their website. About.com compares Fallon's description of his research to a press release from the L.I.A. Foundation:

Fallon:

In our work with children who have developed Lyme disease, we have encountered a few children who had developed autistic-like disorders which were eventually also diagnosed as having Lyme Disease due to other concomitant symptoms; when the child received intensive antibiotic therapy, the autistic syndromes dramatically improved and, in some cases, resolved. We hypothesize: a) that a small subpopulation of children with autism in Lyme endemic areas may have an antibiotic responsive disorder due to a spirochete-induced autistic syndrome...

L.I.A. Foundation press release:

New reports indicate up to 90% of children with autism are infected with Lyme disease. With autism at a staggering 1 out of 166 children, parents are questioning this new finding.

Can you tell which organization is using scientific methodology? The L.I.A. Foundation's list of its own activities puts "awareness" and "education" ahead of "research," which is putting the cart before the horse. (Of course, if they did research as a priority, that could cause problems for their chosen acronym--the L.I.A.R. Foundation probably wouldn't get as many donations.)

It should be noted that Welch and Gordon are not on the state homeopathy board today. But next time we have the opportunity, I suggest we Arizonans get rid of this board completely.

UPDATE (February 9, 2011): I recently came across this April 10, 2008 New Times story that shows how Arizona's homeopathic board certification has effectively been an invitation to doctors who've lost their licenses in other states to come to Arizona and become M.D.h.'s.

Science-based medicine conference, part 4: evidence-based medicine and homeopathy

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:

1. formulate an answerable question
2. track down the best evidence
3. critically appraise the evidence
4. individualize, based on clinical expertise and patient concerns

Atwood 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 science
• cogency of theory
• previous studies
• source

He 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.)

The Amazing Meeting 6 summarized, part two

This is part two of my summary of The Amazing Meeting 6 (intro, part one, part three, part four, part five).

Friday, the conference gets started
More skeptics from around the world began to show up on Friday. Checking in at the registration desk entitled each person to a name badge, a folder of materials, a laser pointer/reading light (which many put to use during the conference, sometimes to the irritation of a speaker or emcee Hal Bidlack), and a copy of An Objectivist Secular Reader, edited by Dr. Edward Hudgins. The book argues for common cause between skeptics and Objectivists "and the often-related libertarian perspective." I happened to sit next to Hudgins through part of the conference, and spoke to him a bit between sessions, and found that we have some common friends and acquaintances. He said that he thinks the libertarian viewpoint does fit well with skepticism, which was a point made later in the conference by Michael Shermer by drawing an analogy between anti-authoritarianism in the religious sphere to anti-authoritarianism in the political sphere--but of course governments actually exist, so the real underlying question is what legitimizes or justifies authority, which is a question also relevant in the scientific sphere. I'll say more about this later when I summarize Shermer's talk.

Hudgins was working on a presentation for an upcoming speaking event which included statistics about changes in U.S. religious demographics over the last several decades, showing a rise in nonbelief. I asked to look at one page that showed a breakdown of U.S. religious adherents by sect, and pointed out the huge growth among Pentecostals (something I've previously written about here). This growth indicates to me that there's more to religion than dogma and doctrine, and that a purely intellectual critique of beliefs and practices that are held for reasons that involve emotion and community is doomed to failure.

I think that one of skepticism's strengths is that it is a method, not a doctrine, and that turning it into dogma or trying to link it to a specific set of conclusions about religion or politics (or science, for that matter) is an enormous mistake that serves only to limit its appeal. Skepticism is at its best when it teaches people to think critically for themselves and at its worst when it tells people what to think. I'll have more to say on this subject when I summarize Sunday's talks, which included one by Don Nyberg railing against "religious pseudoscience."

Friday morning I sat down to breakfast with a young couple from Texas, whose names unfortunately escape me. He had just completed a semester of medical school in Guadalajara, Mexico, and she had finished a degree in neuroscience. We were soon joined by Tony, an Australian who had been living with his partner in Mexico City for the last several years and was now on his way back to Australia by way of a trip around the world. There was a strong international presence at the conference, with dozens of Australians in particular, probably due to the strength of the Australian Skeptics organization.

After breakfast, I went up to the conference room to hear the end of the recording of the Skeptics Guide to the Universe podcast which was being recorded live in the room, but somehow I completely failed to meet Steven Novella, one of the podcast's hosts, through the entire conference. I had hoped to at least say hello and introduce myself, since we were cosigners of a letter to Skeptical Inquirer back in 1999.

Hal Bidlack opens the event
The conference officially kicked off with an introduction by Hal Bidlack, who is running for Congress in Colorado Springs, CO, a part of the country which would be greatly helped by a critically thinking legislator. He mentioned that two prominent skeptics have died since the last conference, Arthur C. Clarke and Jerry Andrus. Andrus was a regular attendee of Skeptics Society conferences and JREF conferences, known for setting up his optical illusions and his willingness to explain them patiently to all.

Randi's welcome
Hal then introduced James Randi, who was looking more frail than the last time I saw him in person, though he said that his health is much better than it has been in the recent past. Randi pointed out that a light, a chair, and a table commemorating Jerry Andrus and his illusions was set up in the back corner of the conference room, and will be set up at future Amazing Meetings as well--while noting that this is for us to remember Jerry.

Randi announced that the JREF library is up to 2282 books, that this conference had about 900 attendees, and that it attracts more women and young people than any other skeptics conference. My impressions supported that conclusion. He also stated that there are UK and Dutch skeptical TV series in the works, and ended by saying that he wanted everyone at the conference to come up, greet him, and shake his hand (which I had already done on Thursday when I ran into him by the registration desk).

Ben Goldacre on homeopathy
The first official conference presentation was by Ben Goldacre, M.D. of www.badscience.net, who spoke about "squabbles about homeopathy." Goldacre described the basic arguments against homeopathy. The main argument against it is that its extreme dilutions are so extreme that a single molecule of a 30C diluted substance would be found in not an Olympic-sized swimming pool, but in ten thousand million million million million pools. A 55C dilution would be equivalent to a universe-sized sphere filled with water with a single molecule of the diluted substance in it. Goldacre observed that a label of a homeopathic remedy that says it is safe because it contains "less than 1 ppm" of the diluted substance is quite an understatement. The homeopaths respond that this is irrelevant; what makes the homeopathic remedy work is that "water has memory," and its structure has somehow changed to reflect being in contact with the diluted substance. But, Goldacre asked, why does it remember the remedy and not, say, having been in Nelson's colon or the Queen's bladder, or in contact with countless other substances? The homeopathic answer to that is that the memory only comes into effect through "succussion," when the remedy is in the water and the container is banged ten times firmly against a wooden striking board (for instance).

As homeopaths do want to present their work as scientific, they have been willing to engage with skeptics. Goldacre reported that his website was given permission to reprint papers from the journal Homeopathy on water memory, which were then critiqued in the JREF Forums, and the critiques assembled into a response which was submitted to and published in the same journal.

But Goldacre points out that the standard anti-homeopathy arguments have been made at least since John Forbes, Queen Victoria's physician, made them in 1846, but they have proven ineffective in persuading homeopaths and users of homeopathic remedies from giving them up. He says the arguments are "irrelevant," because homeopaths are persuaded that their remedies actually work. But that's just not so, he argued. While one might think that homeopathy is like anesthetics where we don't know how it works but it does, with homeopathy we have no good explanation for how it could work and we also have evidence that it doesn't work any better than a placebo.

He then went on to talk about how the placebo effect is a genuinely fascinating scientific anomaly far more worthy of interest than homeopathy. In pain relief, four sugar pills are more effective than two, salt water injection is more effective than sugar pills, and commercial packaging make placebos more effective. He argued that the extent to which homeopathy works is indistinguishable from the placebo effect, as demonstrated by a proper meta-analysis of homeopathic trials, reducing the weight of those which have flaws such as poor randomization and poor blinding.

Keynote by Neil deGrasse Tyson
Neil deGrasse Tyson, who was clearly the rock star of skepticism at the reception on Thursday night, surrounded by adoring fans (perhaps it was his hat, as P.Z. Myers suggests), gave the keynote address to the conference. When he began, many people had been shining their laser pointers on the wall above the stage, and Tyson informed the audience that he would express his "geek dominance." He instructed everyone to point their laser pointers above the door on the opposite side of the room. Once everyone had done so, he pulled out his laser pointer--shining from farther away than anyone else, since he was up on stage--and shined a large green dot that outshone all of the red dots.

Tyson's talk was called either "Adventures in Science Illiteracy" or "Brain Droppings of a Skeptic" (a title cribbed from George Carlin). He began by saying that he had something to do with Pluto's demotion from being a planet, and that anybody who didn't like it should "get over it." The rest of his talk wandered over a large range of topics that have come up in the Q&A sessions of his lectures:

UFO Sightings: When people say they've seen a UFO, be sure to remind them what the "U" stands for. Typically, those who claim they've seen a UFO start by saying it was unidentified, then end up "inventing knowledge of everything" about it being an extraterrestrial spacecraft.

Alien Abductions: Tyson said that eyewitness testimony is the lowest form of evidence in science (though it's certainly not worthless, and even the scientific literature is a form of testimony about the results of experiments). He pulled out his iPhone and said that if he had one of these 10 years ago, he'd have been burned at the stake. If you get abducted by a UFO, you should take something not of this earth in order to prove your alien contact. He showed a slide of a cover of the book "How to Defend Yourself Against Alien Abduction" and said that "I bought it, read it, and heeded its advice--and I have not been abducted."

Inept Aliens: They travel trillions of miles to get here, then crash.

Conspiracy Theory: They tend to tacitly admit insufficient data. If an argument lasts more than five minutes, both sides are wrong.

Astrology: If you read a horoscope to a group of people and ask if it describes them, approximately 2/3 will agree that it fits them. Most Scorpios are actually Ophiuchans.

Birth Rates and Full Moons: Average human gestation is 295 days; the lunar cycle is 29.5 days. Full moon birth = full moon impregnation.

Behavior and Full Moons: The pressure of an extra pillow is a trillion times greater than the tidal force on a cranium.

Surviving Terminal Cancer: If someone gets three diagnoses from physicians giving them 5-7 months to live, then lives for five years, they credit God for their survival, rather than blaming doctors for a poor diagnosis.

Swami Levitation: Tyson suggest 1,000 cans of baked beans would generate sufficient flatulence to become airborne.

Moon Hoax: Modern technology is so advanced that some people can't believe it. But if you learn the rocket equation and look at how much fuel was in the Saturn V, if the launch was fake, what was all that fuel for?

Mars "Virus": In 2003, the Earth was the closest it had been to Mars than in the previous 60,000 years, which led to multiple stories (including in subsequent years) that some virus would jump from Mars to Earth. Tyson pointed to the side and said "Japan is that way." He jumped a few feet to the side in that direction, and then said he is now as much closer to Japan as Mars came to the Earth from its average distance.

Fear of Numbers: 80% of building on Broadway in NYC have no 13th floor, due to an irrational fear of the number 13. (Yet who actually does fear 13?) And why don't we use negative numbers on elevators for subfloors? Or negative numbers in financial ledgers, instead of parentheses? (Actually, I suspect that's to avoid ambiguity with hyphens in dollar ranges, rather than a fear of negative numbers.)

Naming Rights: Tyson pointed out countries that put scientists on their money--Isaac Newton on the English one-pound note, Einstein on Israeli money. The U.S. has only one scientist--Ben Franklin--on money, on the $100 bill, but with no symbolism to represent his scientific work--no kite, no key, no lightning rod. He also pointed to Gauss and the Gaussian distribution on British money as British support of science, but Nassim Nicholas Taleb, in The Black Swan, points out that the financial field goes grossly astray by trying to using Gaussian distributions to describe phenomena that are not Gaussian. Taleb points to Gauss on British money as ironic and inept rather than pro-science.

Tyson also looked at the names of the elements, with slides of the periodic table that showed which ones were discovered when, and by which countries. While the U.S. was not the top country, it has discovered nearly all of the most recent elements. Tyson explained that Sweden has discovered so many elements because Ytterby cave was rich in undiscovered elements, and yielded the names of the elements Yttrium (39, 1795), Terbium (65, 1843), Erbium (68, 1843), Ytterbium (70, 1878), and Scandium (21, 1879).

Jury Duty I: Tyson described being called for jury duty. He was asked what he did, he said that he was an astrophysicist. When asked what he teaches, he said "a course on evaluating evidence and the unreliability of eyewitness testimony," at which point he was promptly dismissed.

Jury Duty II: Tyson was called for jury duty again, and made the first cut of jurors. The facts of the case were described--the defendant was charged with the possession of "2000 mg" of cocaine. When the jurors were asked if they had any questions, Tyson asked, "why did you describe it as 2000 mg instead of 2 g, about the weight of a postage stamp? Aren't you trying to bias the jury by making it sound like a large quantity of drugs?" At which point he was promptly dismissed.

Math?: Tyson pointed out a headline bemoaning the fact that "half the schools in the district are below average." He also pointed out an article that pointed out that 80% of airplane crash survivors had studied the locations of the exit doors upon takeoff as a suggestion that this is a good idea--but it didn't give the percentage of the nonsurvivors that had done the same. If 100% of the nonsurvivors had also studied the exit locations, would that be an argument not to do so?

Tyson responded to the common observation that the lottery is a tax upon the poor, saying that no, it's a tax on the innumerate. Similarly, he pointed to the subprime mortgage mess as a mathematical illiteracy problem.

Bayer ad in Physics Today: Tyson described an advertisement that Bayer placed in Physics Today asking how to get students interested in "why heavy things fall faster than lighter things." The ad was later changed to "why heavy things fall as fast as lighter things."

George W. Bush: Tyson said that he lives closer to Ground Zero in Manhattan than the height of the WTC towers, and showed some photographs he took on September 11. He attended a science medal presentation at the White House since he was on the presidential advisory committee; at that event Bush stated that "Our God is the God who named the stars." However, 2/3 of all stars with names have Arabic names, because from 800-1100 Islam was very supportive of math and science, giving us the names of algebra and algorithm, and the Arabic numerals. But in the 12th century, Imam Hamid al-Ghazali (1058-1111), the St. Augustine of Islam, stated that "manipulating numbers is the work of the devil."

There are 1.2 billion Muslims, yet they've only earned 2 of 579 Nobel prizes (one in physics, one in economics), while Jews, who are 1/80 as numerous, have earned 143 Nobel prizes, and thus have had 6,400 times the impact of Muslims on modern science. He wondered how much more contribution they would have made if it had not been for al-Ghazali's position of influence on Islam.

Intelligent Design: A 2004 SUV ad said, "In the world of SUV's, it's the survival of the fittest." In 2005, it was changed to "Its features are nothing short of a miracle."

Tyson argued that the intelligent design idea--stopping investigation with "God did it"--has historically stopped scientific inquiry. He argued that Newton could have developed Laplace's perturbation theory if he had not stopped his inquiry and appealed to God for the explanation of planetary movements that conflicted with his theory.

Stupid Design: Leukemia, vision loss with age, Alzheimer's, exhaling most oxygen we inhale, our inability to smell CO or CO2, the fact that we eat, drink, and speak through the same opening (vs. dolphin design--dolphins can't die laughing). Tyson also mentioned the 1755 Lisbon earthquake, which killed 70,000 people, mostly Christians who had gathered in churches that Sunday mornings.

Religious People in the U.S.: Tyson observed that most people in the U.S. are religious--about 90% believe in God. When you look at educated people, holding a master's or Ph.D. degree, it drops to about 60%. When you look at scientists, it's about 40%. The most elite scientists--Nobel prizewinners, National Academy of Science members, etc.--it drops to 7%, with physicists and biologists as the least religious. But he pointed out that the 7% is still a substantial number of people--you cannot blame the general public for being religious if we don't understand why 7% of the most educated elite people are religious and pray to a personal God.

Bible in Science Classroom: He observed that there aren't scientists picketing in front of churches demanding equal time for science, referred to Matthew LaClair's confrontation with his history teacher for proselytizing in the classroom (a story broken by this blog), and read his letter to the editor of the New York Times about the case:

To the Editor:

People cited violation of the First Amendment when a New Jersey schoolteacher asserted that evolution and the Big Bang are not scientific and that Noah's ark carried dinosaurs.

This case is not about the need to separate church and state; it's about the need to separate ignorant, scientifically illiterate people from the ranks of teachers.

Neil deGrasse Tyson
New York, Dec. 19, 2006

Albert Einstein and God: Tyson pointed out the content of the recently published 1954 letter from Albert Einstein, and how religious believers who have claimed Einstein as one of their own have been in error.

Cosmic Perspective: Tyson went through a series of numbers with examples to clarify their magnitude: 1, or 10**0, a clear one. 1,000, a thousand, 10**3, kilo. 1,000,000, a million, 10**6, mega. 10**9, a billion, giga. There are 6,000 astrophysicists in 6 billion people, so astrophysicists are one in a million. (But someone observed that there were 3 astrophysicists present among the 900 attendees of the conference.) McDonald's has sold 100 billion hamburgers--which could encircle the globe 52 times, and then be stacked to the moon and back. At age 31, you will have lived for one billion seconds. 10**12, trillion, tera. 10**15, quadrillion, peta. The number of sounds emitted by all human beings who have ever lived. 10**18, quadrillion, exa. The number of grains of sand on an average beach. 10**21, septillion, zetta. The number of stars in the universe.

Tyson then made a list of the most abundant elements in the universe--hydrogen, helium, oxygen, carbon, nitrogen--and observed that, minus helium, these are also the same as the key ingredients of life.

He quoted the Bible's "and the meek shall inherit the earth and live in a world of peace"--and suggested that the correct translation should have been "geek" instead of "meek."

APS Conference in Vegas: Tyson closed by referring to a Las Vegas newspaper headline that said, "Meeting of physicists in town, lowest casino take ever."

Alec Jason on Peter Popoff and criminal forensics
Alec Jason, an independent forensic photographer and investigator, described how he helped James Randi in his investigation of the faith healer and televangelist Peter Popoff, who claimed to use the "word of knowledge" to obtain detailed information from God about the people he was healing. In fact, Popoff's wife Elizabeth was collecting the information from people before the show and transmitting it to Popoff via radio to an earpiece receiver he was wearing. Jason described how he went to Brooks Hall a day prior to the Popoff healing event to determine the normal background radio frequency broadcasts, and then scanned for traffic during the event while posing as a janitor at the facility. The device he used was an early Scanlock device, and although Popoff could have used countermeasures ranging such as frequency hopping, codes, spread spectrum, or encryption, none of these were in use and they quickly picked up the sound of footsteps and then Elizabeth Popoff saying, "Hi, Petey. I hope you can hear me, becasue if you can't, you're in trouble."

Randi exposed Popoff on the Tonight Show, and Popoff's career seemed to have been derailed, though it took months for his followers to get the message. But now Popoff is back--and while he was making $12 million a year before, he's reporting over $24 million a year today. The message was a demoralizing one for skeptics--even the exposure of a blatant fraud like Popoff's is not sufficient to keep him from continuing to take money from the gullible and live a life of luxury.

There were some technical difficulties during the first part of Jason's talk, and I found it mostly to be old hat--I've read Randi's The Faith Healers, seen his Tonight Show appearance, and viewed multiple presentations about the Popoff exposure.

The remainder of Jason's presentation was about his work in some criminal cases. In a case in Africa, a body was found with a SIG Sauer P226 pistol on its chest. The question to resolve was whether this was a suicide or a homicide--after firing, the gun remains cocked and has to be manually decocked. A photo of the crime scene was too fuzzy to see clearly whether the gun was cocked, but Jason was able to compare reflectivity hot spots of a cocked vs. a decocked gun to determine that the gun was decocked. As it turned out, this didn't show that it was a homicide, as the first officer on the scene said that he had picked up the gun and turned on the safety--there is no safety on the pistol, and what he had actually done is decocked it, and thus the gun was shown to have been still cocked when the body was found.

Jason also went into a lot of detail in the Frank Zupan case, where Zupan was found at the scene of a vehicle accident where his wife was behind the wheel of their car and dead with gunshot wounds to the head. Zupan testified that they were driving at 25-30 mph when an oncoming car approached, and he thought rocks came through the window and hit his wife, which he then attributed to gunshots. Jason showed that a gun cannot be shot at faster than 10 rounds per second, and if gunfire came from a car approaching at 20 mph, there would be 3 feet of movement per shot. Since Zupan's wife was shot twice in the head and there was no damage to the front windshield, there's no way Zupan's account made sense.

Penn & Teller Q&A session
Penn and Teller had no prepared material, but simply answered questions from the audience. They talked about a wide-ranging variety of subjects, including Penn's radio show (which may come back in a different form), Teller's short film that appears on George A. Romero's "Diary of the Dead" DVD, and the fact that their show Bullshit! is "fair and extremely biased." In response to a question about what they may be wrong about, Penn said that he has symptoms of a believer with respect to his views on art and his libertarian politics. When asked what's the line between reasonable concern for the environment and environmentalist nuttery, Penn answered "I don't know," and Teller said, "carbon credits are bullshit, modeled on indulgences."

Penn stated that he thinks Obama is very classy and positive, but that he doesn't agree with him about anything.

Teller showed a video made by Jeff Levine about cold reading, called "The Cold Reader," based on a story by Matthew Simmons.

George Hrab's music
George Hrab came onstage briefly to play a couple of songs, one titled "God is Not Great" inspired by Hitchens' book, and another about being a skeptic.

P.Z. Myers on bat wings
P.Z. Myers gave a talk that presented some actual science--he first gave a brief description of his field and his own work, and then a summary of work by Chris Cretekos on the genes that control the development of bat wings, and what happens when they are put into rats. Rather than attempt to summarize this myself, I'll point the interested reader to Stephen Matheson's description of the same work.

Richard Saunders on himself and educational materials for kids
Richard Saunders of the Australian Skeptics, author of 17 books on origami, creator of the origami Pigasus for JREF, founder of the Sydney Skeptics in the Pub group, former president and current VP of the Australian Skeptics, chief spoon bender for the Australian Skeptics, and producer of the TANK vodcast, said that he's about to be the most famous TV skeptic in Australia. He will be the skeptical judge on "The One: The Search for Australia's Most Gifted Psychic" show. After spending a lot of time talking about his past and coming achievements, he did a nice demonstration of a dowsing investigation for use by educators to teach children scientific methods. He had six volunteers from the audience as dowsers to try to find a bottle of water placed under one of six plastic bins. First he found the best dowser at detecting the bottle when it was out in the open, then did trials first blind and then double-blind.

Panel discussion on identifying as a skeptic
The day's events concluded with a panel discussion between James Randi, P.Z. Myers, Michael Shermer, Margaret Downey, Phil Plait, Hal Bidlack, and a member of the NYC Skeptics (I didn't catch the name) about skepticism and identifying as a skeptic. Shermer began by saying that we start by assuming everything is false and require evidence to demonstrate that anything is true. I'm not sure that's actually a sound methodology--it's a lot easier to dig yourself into a philosophically skeptical hole where you doubt the existence of an external world and other minds than it is to get out. Our actual belief methods start out with trust--trust in our own senses and in the testimony of others as we learn language and concepts--not with Cartesian skepticism. In my opinion, something like "trust but verify" and "determine the limits and faults in belief-forming methods, and avoid them" is a better procedure than trying to build up all knowledge from nothing or from indubitable foundational premises. In answer to a question about various kinds of deniers referring to themselves as skeptics, Phil Plait observed that skeptics demand evidence, while deniers deny evidence. Those who deny the Holocaust or that man landed on the moon are not skeptics, they are deniers.

At one point, Margaret Downey made a statement that testimony from individuals who claim remarkable experiences are not relevant because "first-hand reports are just hearsay." But this is a mistake--they may be characterized as hearsay to others, but not to those who are making the reports who have actually had the experiences. Further, reports themselves may be collected and correlated with other objective evidence and used to draw scientific conclusions. I think it's a huge mistake to reject individual experience out of hand in the manner suggested; it's generally possible to take a report of an experience and identify possible explanations for what could cause the experience (or the report of an experience and the false belief in an experience).

There was an excellent audience question about how those of us with limited scientific knowledge can come to conclusions about complex scientific topics where we lack expertise to evaluate the evidence ourselves--aren't we taking results on faith? Randi responded to the question, but I don't think he really got the point. I went and spoke with the questioner afterward, and she agreed that he seemed to be answering a different question. I made the point that in such a case we need to determine who are the reliable experts, the trustworthy authorities, and that we have a number of clues we can use to help identify them.

On to TAM6 summary, part three.