The Amazing Meeting 7: intro, Bidlack/Plait/Randi, Prady

The James Randi Educational Foundation (JREF)'s eighth "The Amazing Meeting," TAM7, took place July 9-12, 2009 at the South Point Hotel and Casino in Las Vegas. (The eighth is number 7 because there was a smaller TAM5.5 event in Fort Lauderdale in January 2008 as the annual event transitioned from occurring in January to occurring in the summer.)

This post begins my summary of The Amazing Meeting 7, which I plan to complete and post in parts over the next week or so, similar to the summary I wrote up of last year's TAM6. Other summaries of TAM7 may be found here:

• By Michael at Young, Hip and Conservative: a skeptical blog.
• In six semi-liveblogged parts at The Atheist Experience blog: Part 1, Part 2, Part 3, Part 4, Part 5, Part 6
• At the Anxiolysis blog: Preamble, Day 1, Day 2, Final day
• By Geeky Atheist.
• By Action Skeptics, with some interesting criticisms: Thursday and Friday, Saturday and Sunday
• At the TAMazing blog (many posts)
• D.J. Grothe's wrap-up of TAM7 at CFI's blog
• antiheroine at the Central Ohioans for Rational Inquiry blog
• Brownian at JREF's Swift blog
  

Photos of TAM7 may be found here:

• Dean Baird's photos.
• Michael's TAM7 photos at Picasa.
• Flickr photos tagged "tam7."
  

This was the first TAM at this location south of the strip, and I was a bit worried about the convenience factor, since there wasn't the diversity of restaurants within walking distance that you get with a hotel on the strip. That concern proved unfounded, as there was a good variety of food available within the hotel, ranging from deli sandwiches to a steakhouse, and I never left the hotel during the conference. Those who did visit the strip were able to catch a bus across the street for a few dollars, if they didn't just bum a ride from somebody with a car. I did hear a few complaints about the food--that the buffet wasn't great, nor was one of the mid-range restaurants, neither of which I visited. There was also some displeasure on the part of vegetarians about the lack of meat-free options for the first day's lunch. I was somewhat disappointed that the morning's continental breakfasts were served in the main conference hall rather than in a separate dining room with round tables more conducive to conversation like last year, but the lunches were served in that manner and I did get to meet a few people that way each day. Overall, I thought the location was excellent and it has already been booked again for next year's TAM8, which will take place from July 8-11, 2010.

This year, rather than attend any of the pre-conference workshops, I attended the excellent Science-Based Medicine conference which was held in conjunction with TAM7. TAM has tended to avoid having a particular theme or focus, and it was nice to have a day that was concentrated in a particular field, and which drew an audience largely of people with expertise in that field. I think this has been one of the strengths of some of the Skeptics Society conferences that have focused on particular subjects, such as its 1996 conference on evolutionary psychology, its 2005 conference on "Mind, Brain, and Consciousness" (which was quite critical of evolutionary psychology), and its 2007 meeting on the "Environmental Wars." At the same time, the diversity of TAM and its audience is also valuable, so having a second conference as an optional complement to TAM strikes me as a good way of getting the best of both worlds.

This year was the first TAM with over 1,000 attendees, of whom 30% were women, the highest percentage of female attendees to date. When the question was asked, "how many are here for the first time?", it appeared to be about half the audience members who raised their hands. The first TAM had about 140 attendees, and last year's TAM6 had just over 900. There seemed to be a pretty good geographic diversity, with large contingents from Canada, the UK, and Australia like last year. It would be nice if attendees could voluntarily allow some information about themselves to be published in an attendee directory, such as name, JREF Forum handle, and home location.

There was a good-sized contingent from Arizona this year, including several participants from SkeptiCamp Phoenix, Phoenix Skeptics in the Pub, the Skeptics of Tucson, and Flagstaff's Northern Arizona Skeptics. The conference kicked off with its usual Thursday evening meet-and-greet with hors d'oeuvres and a cash bar, during which I managed to chat with people from all of those groups, some for the first time. We'll be holding another SkeptiCamp Phoenix next year, and I expect we'll be able to double our participation.

Friday, July 10
The conference formally began on Friday morning with opening remarks from emcee Hal Bidlack. Hal noted the growth in participation at TAM, talked about a ghost tour at the Stanley Hotel (where "The Shining" was NOT filmed), and noted that Uri Geller had appeared on NBC News as a commentator on Michael Jackson's death.

Hal kicked things off by quoting Plutarch ("The mind is not a vessel to be filled, but a fire to be kindled") and noted that skeptics are a family: "Welcome to the Randi family reunion." He remarked on the power of the individual to make change, and singled out for particular note Reed Esau for his part in the origination and expansion of SkeptiCamp, and Robert Lancaster for his stopsylviabrowne.com website.

He noted that there is an audience tradition of "pretending not to like my jokes" and that Randi once accused him of using "homeopathic humor."

And he offered a "cautionary note" that "we aren't cookie cutter, we do have areas of disagreement." By coming together in a group there are "dangers to individualism." This is an inclusive, "large-tent organization," and the topic of religion in particular has been "a source of tension" in previous conferences. Skepticism, he said, is about examining testable claims, and he noted that he, among others, is not an atheist. While I encountered many atheists at the conference, there was little, if anything, in the way of explicitly atheistic material presented (though I don't remember any last year, either, except for some Objectivist material that was handed out to attendees, which was disappointingly both overtly anti-religious and political, though it was not a subject of discussion in any presentation that I noticed).

Phil Plait then offered his first opening remarks as president of JREF, stating that the organization has "reached critical mass" and "become the mainstream skeptics movement of the people." He said that people come to TAM for three reasons--to hear speakers, to see Randi, and to participate in the skeptical community. We don't necessarily agree on all of our positions, but we agree on how we reach conclusions. Like Hal Bidlack, Plait also called out both Reed Esau and Robert Lancaster for their contributions.

Dr. Plait spoke a bit about the Randi $1 million challenge, saying that it had started to become an albatross because of the amount of effort required to deal with potential claimants. It was "hard to determine what the claim is" from many people, let alone how to properly test it and come to an agreement on protocol. So it had been announced that the challenge would be discontinued in order to put the funds to better use and save the effort. But it has also been a useful tool, and he was happy to announce that it will be continued after all, in some form, the details of which are still to be worked out.

James Randi then came up on stage in a red and white striped shirt that he identified as his "happy shirt." He was pleased at the steady growth of TAM. In a more somber note, he commented on "my subdued appearance" and explained why he was unable to shake hands with anyone at TAM this year. He was the recipient of an "unwelcome visitor" (cancer), for which he's had surgery and will be undergoing chemotherapy. He explained that this is why he hasn't made many videos of late.

Randi gave special thanks to Sean McCabe, his personal assistant for the last year, who is now going back home and back to school, and to Brandon K. Thorpe, who will be his new assistant. He went through a long list of people that he thanked, including the JREF staff and volunteers, and various speakers and entertainers whose participation makes TAM a success. He ended by noting that the first TAM to be held outside of the United States, TAM London, to be held on October 3 and 4, was oversubscribed in less than an hour.

Keynote: Bill Prady, creator and executive producer of "The Big Bang Theory"
Bill Prady started by saying that the "keynote sets the tone" for a conference, and that if so, this conference will be "disorganized and ill-prepared." He said he looked at the JREF website's description of his talk for clues as to what he should talk about, and saw that he stated that he "makes sure each episode is full of science" and that in a recent talk at Comic-Con, he had the audience laughing so hard they were rolling in the aisles. After reading that description, he said, "all I can do is disappoint you horribly." With that, he showed a few short clips from "The Big Bang Theory" which he thought would be "of interest to this group," which included a debunking of astrology based on Bertram Forer's work, a reference to intelligent design, some magic tricks, and more references to astrology. The clips were fairly amusing, but my wife and I made an attempt to watch this show after hearing recommendations from friends, but gave up without completing two shows due to the painful laugh track. (A recent Twitter remark from Australian skeptic Richard Saunders suggests a similar experience.)

After the clips, Prady described his own background--that he earned pocket money doing magic shows from about age 12 to 16, and had an International Brotherhood of Magicians pin that he wanted to bring but was unable to find. He said that he read both Linking Ring and Genii, and frequently saw Randi on the covers, and was honored to sit next to him at the conference. He said he was a college dropout, then worked as a computer programmer before getting into television.

He observed that the chicken or egg problem was resolved by evolution--the egg came first--but then posed his own chicken-egg problem: "Do people who think like us become computer programmers, or does computer programming make people think like us?" He stated that there are two qualities common to such people: 1. critical thinking, and 2. lack of judgment about each other. As an example, he gave a friend named Ken, who would not go anywhere he hadn't been before without being shown by someone else, even if it was yards away from somewhere else he had already been. He could do hex-decimal conversions in his head, but when told it's customary to tip between 15% and 20% based on quality of service, he couldn't calculate tips on his own because he didn't know how to measure that. When his friends suggested he just always tip 17.5%, he refused, because then he would be overtipping half the time and undertipping half the time. (And I can't resist noting that this response makes an unwarranted assumption about the distribution of service quality received by an individual diner.)

Prady offered a few remarks about the characters and his show. The character Leonard is based on him. There was a story line about Penny offering herself to him in a distraught moment, with Leonard blowing it because he insisted on making a true statement about an analysis of their situation, which Prady stated was based on a true story. He said he's proud of all the characters on the show, and wanted to depict "other views as complex, not stupid or paper tigers." E.g., Penny's belief in astrology and Sheldon's mother's religious faith. He said that "people's belief systems are the things that get them through the day. ... they're not saying 'oh, please help me abandon the thing that gets me through my illness, my unemployment, my kid who doesn't understand me.' This is the thing that gets them to the night so they can go to sleep so they can get up and do it again. People's beliefs are not a contest. You don't win. You don't win at the end of the day."

His original plan was to have the show about computer programmers, but apparently having the characters in front of computers raised too many difficulties for filming, due to reflections from monitors as well as the difficulty of depicting what they were doing.

He wanted to read some angry letters of complaint received by the show, but was unable to locate any. There was a folder marked "disturbing letters," but these were mostly letters from inmates in love with actress Kaley Cuoco. He called CBS, but they had not received a single angry letter. He took that as offering a bit of assurance for skeptics, that an audience of 12 million people per week could watch a show that begins with the history of the universe in 20 seconds to a Barenaked Ladies song and promotes science and critical thinking without being upset by it.

Prady concluded by saying that when Phil Plait and Adam Savage asked him to speak, he knew his title should be "We Can Continue Telling Women in Bars That Astrology Isn't Real, But We Won't Get To Have Sex." He suggested (presumably addressing only the straight men and lesbian and bisexual women in the audience) that while you're here in Las Vegas and you meet a woman who is very complimentary and interested in you, be skeptical. He also suggested (to the same audience) that if you're enjoying a conversation with a woman who says "I'm a Sagittarius," try performing a study with two different responses. 1. Give a detailed explanation of the time twins study from England as a refutation of astrology, or 2. Say "wow, you have the most incredible eyes," and see which response is more likely to lead to a positive outcome. (These remarks have led to some criticism of Prady for obvious reasons; Prady responds here. The topic is discussed further on the Skeptics Guide to the Universe podcast #211, interview with Skepchick Carrie Iwan (starting at 43:30). Gender and skepticism was also the topic of discussion of the August 7th episode of Skeptically Speaking. The Podblack Cat blog discussed women, science, and skepticism earlier this year.)

In the subsequent Q&A session, Prady said that the science content of the show comes from technical advisors. He said "lots of people think the show mocks people like us--but if you were in the writer's room you'd say it's an idealized picture of who they'd like to be." He recounted how when the character Ross on the show "Friends" went to a paleontology convention (he was supposedly a paleontologist), there was nothing in the dialogue that went beyond 6th grade science. He didn't want his show to be like that. They use David Saltzburg, a UCLA astrophysicist, as a consultant. They asked him, "What's new in physics," to which his answer was "not much in the last 40 years," which they wrote into the script. Saltzburg said "oh, string theorists will get mad at me." He then said something disparaging about string theory (I missed it in my notes), and they put that into the script, too.

In response to a questioner who asked why women are depicted as stereotypically ditzy and scientists as maladjusted, Prady defended his portrayal. He said that Penny is not portrayed as ditzy but as a "pragmatic intelligence--the best character on the show at getting through life and getting things done." He said there will be more female scientists on the show in the future.

The final question was a comment from someone in the audience who has a son that is like the characters on the show. On the show, Sheldon uses a board to fold clothes. The questioner's son looked online to find such a board to use himself, and dubbed the board "Sheldon."

(There's a transcription of Prady's talk here. Randi's opening remarks are transcribed here. Part two of my summary of TAM7, on Dr. Fintan Steele, Phil Plait, and Robert Lancaster, is here.)

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.

Bowl-a-Rama Fundraiser this Thursday

There are just 11 days left to raise money for Bowl-a-Rama. We have one more fundraising event this Thursday, July 23rd at Rosita’s in Tempe or Mesa. Please come out, enjoy a great meal and support RESCUE. 15% of your purchase is donated back to RESCUE!!! Pictured is the flyer for the event (you’ll need it in order for us to receive the proceeds). I can email the flyer to you if you are interested, just ask me in the comments. All are welcome for lunch, dinner, dine in or take out. Jim & I will be at the Tempe location around 6:00pm, please stop by.

Index of Conference Summaries

This is a reverse-chronological list of conference and talk summaries I've written up, either at my blog or elsewhere. Most pertain to skepticism and critical thinking in some way (and I'd like to think that all involve the application of skepticism and critical thinking to the topics at hand), some are political, and some involve information security. I've got a few more of these in print form that are online in the issues of the Arizona Skeptic.

Bruce Wagman on "Many Species of Animal Law," April 7, 2010, Arizona State University's Sandra Day O'Connor College of Law, Tempe, Arizona, Armstrong Hall 116.

Joel Garreau on Radical Evolution, November 18, 2009, Arizona State University, Tempe, Arizona, Coor 5536, CSPO Plausibility Project.

Richard Carrier on "Christianity and Science (Ancient and Modern)," November 8, 2009, Humanist Society of Greater Phoenix, Home Town Buffet, Scottsdale.

Robert B. Laughlin on "The Crime of Reason," November 5, 2009, Arizona State University, Tempe, Arizona, Sandra Day O'Connor School of Law, Great Hall; 2009 Hogan & Hartson Jurimetrics Lecture in Honor of Lee Loevinger.

Roger Pielke Jr. on climate change adaptation, November 5, 2009, Arizona State University, Tempe, Arizona, Decision Theater.

Roger Pielke Jr. on climate change mitigation, November 5, 2009, Arizona State University, Tempe, Arizona, Coor 5536.

Robert Balling on climate change, October 30, 2009, Arizona State University, Tempe, Arizona, Coor L1-74.

Personalized medicine research forum, October 23, 2009, Arizona State University, Tempe, Arizona, The Biodesign Institute.

Atheist Alliance International convention, October 2-4, 2009, Burbank Marriott, Burbank, California. Speakers: P.Z. Myers, Ed Buckner, Lawrence Krauss, Carolyn Porco, Martin Pera, Jerry Coyne, Daniel Dennett, Richard Dawkins, Gerardo Romero, Jonathan Kirsch, Eugenie Scott, Brian Parra.

Marco Iacoboni on imitation and sociality, August 27, 2009, Arizona State University, Tempe, Arizona, psychology department colloquium, MU202.

Joel Garreau on the future of cities, August 26, 2009, Arizona State University, Tempe, Arizona, Consortium for Science, Policy, and Outcomes colloquium, Coor L1-10.

The Amazing Meeting 7, July 9-12, 2009 at the South Point Hotel and Casino, Las Vegas, Nevada.
Part 1: Introduction, Hal Bidlack, Phil Plait, James Randi, Bill Prady keynote.
Part 2: Fintan Steele, Phil Plait, Robert Lancaster.
Part 3: Jamy Ian Swiss/James Randi, Jennifer Ouellette, anti-anti-vax panel (Steven Novella, David Gorski, Joe Albietz, Harriet Hall, Michael Goudeau, Derek Bartholomaus), Joe Nickell.
Part 4: Skeptics Guide to the Universe/Rodrigues-Watson wedding, Michael Shermer, Adam Savage.
Part 5: Panel on ethics of deception (D.J. Grothe, Penn Jillette, Teller, Ray Hyman, Jamy Ian Swiss), Stephen Bauer, panel on skepticism and the media (Penn Jillette, Teller, Adam Savage, Bill Prady, Jennifer Ouellette), Phil Plait.
Part 6: Sunday paper sessions, Million Dollar Challenge with Danish dowser Connie Sonne.

Science-Based Medicine Conference at The Amazing Meeting 7, July 9, 2009 at the South Point Hotel and Casino, Las Vegas, Nevada.
Part 1: Steven Novella on science-based medicine.
Part 2: David Gorski on cancer quackery.
Part 3: Harriet Hall on chiropractic.
Part 4: Kimball Atwood on evidence-based medicine and homeopathy.
Part 5: Mark Crislip on chronic Lyme disease.
Part 6: Val Jones on online health and social media, and Q&A panel.

American Humanist Association annual conference at Tempe Mission Palms Hotel, Tempe, Arizona, June 5-9, 2009.
Sorry, only covered my own talk from the pre-conference workshops and the ArizonaCOR press conference.

Jeff Benedict on the Kelo case and his book Little Pink House, Goldwater Institute, Phoenix, Arizona, April 15, 2009.

SkeptiCamp Phoenix, Arizona State University, Tempe, Arizona, March 28, 2009. Speakers: Tony Barnhart, Abraham Heward, David Jackemeyer, Don Lacey, Jim Lippard, Shannon Rankin, John Lynch, Jack Ray, David Weston, Mike Stackpole, Charlie Cavanaugh Toft, Xarold Trejo.

Daniel Dennett's 2009 Beyond Center Lecture, Galvin Playhouse, Arizona State University, February 18, 2009, on "Darwin's 'Strange Inversion of Reasoning.'"

Bill of Rights celebration event at the Wrigley Mansion, Phoenix, Arizona, December 14, 2008.

The Amazing Meeting 6, June 19-22, 2008 at the Flamingo Hotel and Casino, Las Vegas, Nevada.
Overview and photo link.
Part 1: Banachek memory workshop.
Part 2: Hal Bidlack, James Randi welcome, Ben Goldacre on homeopathy, Neil deGrasse Tyson keynote, Alec Jason on Peter Popoff and criminal forensics, Penn & Teller Q&A, George Hrab musical interlude, P.Z. Myers on bat wings, Richard Saunders on educational materials for kids, panel discussion on identifying as a skeptic (James Randi, P.Z. Myers, Michael Shermer, Margaret Downey, Phil Plait, Hal Bidlack, and a member of the NYC Skeptics whose name I didn't catch).
Part 3: Michael Shermer on the Skeptologists and why people believe weird things, Sharon Begley on creationism and other weird beliefs, Derek and Swoopy on Skepticality and podcasting, Steven Novella on dualism and creationism, Jeff Wagg JREF update, Jim Underdown on the Independent Investigations Group and award to Randi, Randi on patching up relations with CSI (formerly CSICOP), Skeptologists pilot.
Part 4: Phil Plait on astronomy, Adam Savage on his Maltese falcon, Matthew Chapman on creationism and Science Debate 2008, Richard Wiseman on the "colour changing card trick" and mass spoonbending lesson, panel discussion on the limits of skepticism (Goldacre, Daniel Loxton, Radford, Savage, Novella, Hrab, Randi, Banachek, and Saunders), Sunday conference papers: John Janks on Marfa lights, Don Nyberg on pseudoscience, Steve Cuno on myths in marketing, Tracy King on viral video.
Part 5: Lee Graham on artificial creatures and real evolution, Christopher French on anomalistic psychology, Tim Farley on building skeptical tools online, Brian Dunning on The Skeptologists.

Gene Healey on his book The Cult of the Presidency, Goldwater Institute, Phoenix, Arizona, May 1, 2008.

Richard Dawkins 2008 Beyond Center Lecture, Grady Gammage Auditorium, Arizona State University, Tempe, Arizona, March 6, 2008, on "The God Delusion."

New Mexico InfraGard Member Alliance "$-Gard" conference, February 22, 2008, Albuquerque, New Mexico. Speakers: Frank Abagnale on protecting yourself from fraud, Anthony Clark and Danny Quist on malware secrets, Alex Quintana on current trends in malware, Melissa McBee-Anderson on the Internet Crime Complaint Center (IC3).

Ayaan Hirsi Ali at the Phoenician Resort, Goldwater Institute award banquet, Phoenix, Arizona, December 7, 2007.

Screening of "Mr. Conservative" documentary about Barry Goldwater, Goldwater Institute, Phoenix, Arizona, August 16, 2007. Features Barry Goldwater, George Will, Barry Goldwater, Jr., Sandra Day O'Connor, Ben Bradlee, Sally Quinn, Al Franken, Julian Bond, Hillary Clinton, and Jack Valenti.

Ron Paul launches Arizona campaign at private home in Paradise Valley, Arizona, March 30, 2007.
Followed up by Einzige's "Ron Paul, Religious Kook," my "Spammers and criminals for Ron Paul," and "Ron Paul connected to white supremacists?"

Skeptics Society conference on "The Environmental Wars," Caltech, Pasadena, California, June 2006.
Intro and links to other summaries.
Jonathan Adler on federal environmental regulation.

Eugenie Scott on "Creationism and Evolution: Current Perspectives," Robert S. Dietz Memorial Lecture at Arizona State University, Physical Sciences building, February 3, 2006.

National White Collar Crime Center (NW3C) Economic Crime Summit, November 8-9, 2005, downtown Phoenix, Arizona, and Freedom Summit, November 12-13, 2005, Grace Inn Ahwatukee.
Economic Crime Summit and Freedom Summit comparison/contrast/overview--prayer vs. atheism debate, Terry Goddard, Roger Vanderpool, John Vincent, Kevin Robinson, Charles Cohen, George H. Smith, Eric Lounsbery, David Friedman, Chris Heward, Karen Kwiatkowski, Jim Bovard.
Freedom Summit: Stuart Krone on technology and why we're screwed.
Freedom Summit: Steven Greer on aliens and conspiracy.
Freedom Summit: Links to photos and other summaries.

CSICOP Conference on "The Psychology of Belief," Seattle, Washington, June 23-26, 1994.

CSICOP Conference on "Fairness, Fraud, and Feminism: Culture Confronts Science," Dallas, Texas, October 16-18, 1992.
Part 1: Panel on multicultural approaches to science (moderator Eugenie Scott, Diana Marinez, Joseph Dunbar, Bernard Ortiz de Montellano), unofficial session on faith healing with Ole Anthony.
Part 2: Intro remarks by Lee Nisbet, panel on gender issues in science and pseudoscience (moderator James Alcock, Carol Tavris, Susan Blackmore, Steven Goldberg), Richard Dawkins keynote on viruses of the mind.
Part 3: Fraud in science panel (moderator Ray Hyman, Elie Shneour, Paul Friedman, Walter Stewart), Sergei Kapitza and Evry Schatzman on international skepticism, panel on crashed saucer claims (Philip Klass, James McGaha).
Part 4: Robert Young on the Kecksburg meteor, Donald Schmitt on Roswell, awards banquet (Richard Dawkins, Henry Gordon, Andrew Skolnick), entertainment by Steve Shaw (now better known as Banachek), visit to Dealey Plaza.

CSICOP Workshop on UFOs, Ramada Inn Airport Hotel, Tucson, Arizona, November 16-17, 1990. James McGaha, Robert Sheaffer, Robert Baker, and Ronald Story, all on UFOs.

Deception in "The Great Global Warming Swindle"

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.)

DHS still a mess, five years on

One of the main points of the creation of the Department of Homeland Security in 2004 was to centralize oversight over a wide array of agencies with responsibility for the safety and security of the United States and its territories. The 9/11 Commission made 41 specific recommendations to Congress, and one of those was "create a single, principal point of oversight and review for homeland security." But that's one that hasn't been accomplished--DHS oversight by Congress is through 86 separate committees and subcommittees (see chart below, click on it for the full-sized image).

The Center for Public Integrity and the Center for Investigative Reporting have joined forces to investigate the effectiveness of the Department of Homeland Security's efforts since its creation, and will be publishing a series of reports over the next several months which should prove quite interesting.

Science-based medicine conference posts yield new visitors

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.

Science-based medicine conference, part 6: online health and social media, and Q&A

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.

Science-based medicine conference, part 5: chronic lyme disease

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:

1. skin rash, arthritis
2. spreads to whole body, causes meningitis
3. results in encephalomyelitis and neurological symptoms

There 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.)

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.)