I guess, Tom, I played for Colton to get hurt. I guess, how much improvement did you see from him during his rookie year, and maybe what will your message be to him as he attacks off season? I saw a ton of improvement from when he was here in the spring to throughout the season. Just, you know, he kept getting better and better. So it's tough for him. He's starting to make some strides as a receiver as well. Just attack the rehab like he attacked the season, and he'll be fine. What's your message, I guess, to Caleb, who got to keep hitting penalty on Sunday? Yeah, that was tough, because we want to create momentum and field position. We did the opposite. We created it for them. So again, he's just got to be smarter.  We talked to him about that. We drill it. We train it. So I got to do a better job teaching him so he's not in that position, and then we can't do it, because then you give up points. And especially on the road in the division, that's hard to do. Mike seemed to suggest, kind of on Colton's play, there's some inherent danger in the way guys can go at him. Caleb's player, Colton. No, Colton's, in the way he got hurt, that there's some danger to it. Yeah, I mean, that's a tough position. You've got two guys, and they're running over 20 miles per hour, and you've got to change direction, and that's just unfortunate. Mike was talking a little bit about Kyle at the field yesterday, too. And it's tough to get a slot receiver in the game when he's not returning points. Has he continued to work on that, even though he hasn't been able to do it? He's worked every day before practice, catching punts. And when we do the punt team, he's back there catching them and trying to improve. See some progress in that? I know it's hard to simulate game. Yeah, it's hard to simulate when those guys are flying down at you. It's a little bit different catching it, just in the middle field with all the action. We get a few of those reps, but not a ton. I sure hope so. As long as you keep going, it does. Appreciate it. Do you feel any different turning 30 today? I don't. I was expecting gifts. That's what I mean. And there's spots. OK, OK, cool. All right, back, back. Did your teammates say to you, at least? I ain't got no song yet, but no. I'm still expecting gifts from y'all and everybody else, but that haven't popped up yet. So we'll see. What's it like having a birthday and NFL locker room? Do you get jokes? Do you get one-liners? What are you here? Well, Ben Jones is gone, so I feel a little safe. I don't get no shaving cream in my face. The guys are a little nicer, but it's cool. Especially just this time of year. I got family coming in, and it's great for to be able to see another one. We've talked about that number with running backs and how people tend to draw it as a bad line. I imagine you're eager to disprove that. Let's see, we'll see. Stay tuned, we'll see. What's it mean? There aren't too many backs in your age area that are very productive.  Yeah, it's always a good thing to be able to still be productive and be able to make plays and have an impact. And I'm grateful to be able to still be in this position. My body feels good. I feel good and just ready to work and continue that as time goes on. This season hasn't gone the way you or the team probably wanted it to, but how good does it feel to get another pro bowl selection and have that honor? Yeah, it's always a great honor to be to be recognized for your play, which I'm not too proud of this year. But from your peers and everybody voted, I really appreciate it. Very grateful to have my fourth selection. Don't thank for granted at all. And just appreciate everybody who was involved that were able to get me in. Do you have to give yourself a little bit of grace, I guess? You say you're not too proud of your performance this year and the numbers aren't quite where they've been. But clearly your peers and everybody else still say you're one of the best and you're still over 1,000 yards this late in your career. Do you need to be easier on yourself? No, not at all. Sometimes you need to hit a year like this to be able to grow, to be able to learn, to be able to reflect. And I'm definitely going to do that once the season's over. Wasn't fueled before. I'm definitely more fueled now. Definitely more motivated, definitely more hungry and going to all season, attacking it as hard as I can. But at the end of the day, it's about being consistent, but being at playing at a high level. And like I always say, I'm my worst critic. So I'm always going to be hard on myself, regardless. Are there any facts who you saw advice from about playing later in a career and what advice do those guys give you about having long sustained careers after 30? Yeah, I had talked to Barry Sanders. I had the Nike Suite last year at the Super Bowl. I had saw that he ran for 2000 when he was 29 years old. That kind of gave me a little bit more motivation. And I was a big LT fan, so I watched him throughout his career. I really watched almost all the backs. Grew up down the street watching Fred Taylor and Marisha Jones drew when they were a tandem. So got to watch a lot of great backs throughout my years and track their careers. And sometimes I go online and see what they did when they got to this age. And hopefully I can do some great things at this age as well. So you anticipate Sunday being like driving to the stadium, going through your regular motions, but knowing there's at least potential that's the last time you're doing it in the home locker room there? Yeah, yeah, I would just treat it as any other game. I'm not trying to try to get too caught up, get too overwhelmed. And just enjoy the moment, you know, focus on fitting the season strong, going out there playing a good game overall as a team and hopefully getting to win. And then after the game, having talked to Numbida and going straight home. No, I'm kidding, I'm kidding. I'm just kidding, I'm kidding. You think there'll be a moment somewhere along the way? I mean, there's obviously going to be an introduction and some fanfare when you leave the field and stuff like that?  I'll be free agent after this year, been here eight years. So just be grateful to whoever shows up. And I know the fans have come out and hopefully we put on the show, be able to finish strong. But just grateful for the whole process. Do you have family or friends or people in public who ever come up to you and talk to you about free agency? Is that something that ever has to come up? Or is it something you can avoid? Yeah, I'm not really much. I don't really go out in public too much. But no, not really. I think they'll talk about it once the season's over with. But I'm not too much. I'm too focused on what I need to do. You guys have been going at it since, I guess, April towards the season. What's it like knowing that Sunday is the end of it and it's kind of weird that a lot of times you're playing to getting the playoffs into the very end and then there's a sudden end. Now you know the finish line Sunday. What is that like? It's been a short, long season. I would say, but that's just what it is. That's the reality of it. We love the game, but we've got one more. So just focus on finishing it strong. Like I said, we're not happy about how the season went. But it's all about how you finish and hope we can finish it strong. There was this taking care of from both the team perspective and your perspective in the offseason.  I mean, any player will love to play for the organization and finish out their career as long as they can. But like he says, the business side and all those type of things that go on and on. And I understand that. So we'll just see how it shakes out during the offseason. You told me to ask later on a few weeks ago when I asked this, what has been your favorite run or moment since the time you've been here? Just asking me after Sunday. On Sunday. I have an answer again. Still got another thing. Still got another, yeah, so we'll see. We'll see you after Sunday. How are you going to celebrate your birthday? Thank God for another one. Probably get some cupcakes or a birthday cake for my girl. My daughter's already been talking about it since you woke up. And she'll probably blow out the candles. Probably a little spit on there because she's always excited for it. So yeah, just thank God for another one. And spend the time with my girl and my daughter. And wake up tomorrow and see you another day. Thanks, Jack. Is it hard to, you've gotten 22 back there possibly for the last time. Is it hard to keep that out of your thinking for the game at all? No, I mean, our thought process hasn't changed. It's still going to be find a way to go in a game. Find a way to do a good job of playing good football, being physical, controlling the football, and putting our team in the best position possible to go in a football game. So that's really, I know it sounds like coach talk here, but that's really been in the forefront in terms of our focus here and how we're approaching this week. He's handled the responsibility and the execution of that half-back pass so well. Has that made that easier to call kind of as time is going on? Yeah, when you have someone that's played as well as Derek has for such an extended period of time, you trust him with the ball in his hand, whether it's doing that, running the football, whatever it may be. He's proven that any job that we give him, he typically goes out there and does a pretty good job of it. So when you have guys like that that you can trust, you feel comfortable being able to go ahead and maybe think outside the box a little bit. There are a whole lot of running backs that is turning 30 today that are still making a big impact on games. How impressive is that that he's still a productive guy? It's really impressive. And I think it's a testament really to the way he approaches obviously not just how he comes to work every day, but the type of work he does in the offseason, the type of work he does outside the building during the season to not only maintain but to continue to get stronger as the season's going on. And again, the proof is in the put in there. But he does such a great job of maintaining and taking care of his body that's put him in a position to continue to be effective and successful at this point in time. What do you think Taja maybe made his biggest strides this season? Yeah, I know it's probably not a sexy answer, but really like pass protection. He does a great job with the pickups. He does a great job being in tune with everything and understanding that as a puppy coming in here, that was the quickest way for him to be able to go and gain the respect of his teammates is to be able to go and face some people up. And he's done a great job of being able to go and handle that responsibility and doing really anything that we're asking him to do when it comes to being able to go and pass pro. He's dynamic with the ball in his hands, and I think we all knew that when he got here. But his continued attention to detail and effectiveness and pass protection has been impressive. We won't get a shot to talk to you after this game. How do you kind of evaluate how the first season's gone in terms of what you wanted to do offensively? Yeah, we wanted to win more games, wanted to score more points. But at this point in time, luckily, we get one more opportunity to go out there and play consistently for four quarters. Again, here we are talking about it whatever week it is in the season. But we need to do a good job here putting together these last couple of days of practice and then being able to go out there and play consistent, good style of football for four quarters on Sunday. Yeah, they do a good job of moving all those guys around. It's not just him. They've got a multitude of rushers up front that are effective, that have different skill sets. 44 is big and long and strong. 41 does a good job of being able to use his length. And he's got some speed to power. He also has the ability to use some finesse. And then you got 95. So they've got a multitude of guys up front that they do a good job of in their pressure packages. Yeah, a lot.  And there are a couple of things that came up, right? With us being able to go and operate on the road, some different things there. And just, again, as he continues to play the position, just the things that come up organically, every game's a new opportunity for those situations to come up and for him to be able to learn from those opportunities. And so yeah, I think each game presents an opportunity to be able to continue to grow in those different situations. What's the biggest area you would start to land again with a guy who's finishing the season?  Again, we'll have a little bit more time to be able to dive deeper into those evaluations. But again, I only have a limited amount of brain power right now and all that's going towards Jacksonville. The offensive line problems have been pretty well documented throughout the course of the season. What are some of the areas there, though, that you kind of see as positives from that group? Are there very many? Yeah, again, it's a tough position because when you're getting noticed, it's for the wrong reasons, typically. You know what I mean? So they do good things for us. In the run game, I thought we did a better job up front at times being able to get into some of our combinations. And we've continued to see that execution improve. Unfortunately, again, it comes down to there's one run in the goal line where we get four of the five up front are doing a great job, and we have a breakdown at a position. So it's just a matter of us continuing to work out here with the different techniques and fundamentals to make sure they can be more consistent. What kind of things has Skobronsky learned throughout the course of the year? Has he kind of leveled off a little, or is he still getting better? No, I mean, again, he's learned how to play in a new position. I think a lot of times that gets overlooked. That transition outside from tackle to guard is a little different.  You don't have as much space to operate. So he's learned a new position, being able to slide inside the guard. And he's done a good job. Again, you go back and watch last week. There were multiple examples of him being able to go ahead and get movement at the point of attack and just, again, continuing to be more consistent with some of the different stuff that he's seeing, the handling of some of the games, all the different things inside that, again, the entire group and everybody needs to work on. Still in the zone, maybe, especially the last few weeks, has he come on this year and maybe going into the off season, does he potentially carry some momentum at maybe holding down that spot? Yeah, I mean, Dylan's done a good job of doing anything that we've asked him to do. First and foremost, in terms of being a good teammate and really understanding the complexity of the multiple positions that he's played, whether it was left, whether it was right, whether it was guard. And so he's done a really good job of being able to have that responsibility thrown on him and being able to go ahead and go out there and execute. And oftentimes, it wasn't really with a whole lot of heads up. There were a couple of battlefield adjustments there where we had to slide him in or slide him over. He's done a great job there being able to go and function at the multitude of positions on both sides. Is his right tackle as good a fit as any of the spots that he's played for? Yeah, I mean, I think there's, you know, he's had pluses and minuses at every position. So again, we're focused on him being able to go out there this week and giving him the tools to be able to go out and play well against a good front. Has it been healthness throughout the season battling injuries? But he's a veteran and he's been on different teams. How beneficial has that been just to have a little bit of that? Sure. Yeah, I think any time you get a vet that's played a lot of football, you know, that's experienced the highs and lows, it's good, especially when you have a younger room. So he's done a great job in there, you know, taking some of those guys under his wing and being able to kind of show them the ropes a little bit as to what it's like and what it takes to be a successful offense lineman in the league. How nice is it to have Danico and Harold, particularly the way Harold's played here down the stretch as that threat on that line, especially with Jeff out these lines? Yeah, it's been big for us. I think their production has been huge. It's been timely for us. Great to get Harold back to where he's rolling, you know? And you see the effort play showing up, the reverse the other day, chasing it down him and Otis from the other side. So some of those old school Harold plays that we're accustomed to, it's good. But I can't say enough about both those guys and what they do for our defense. It seems like Entree has been overlooked for many years for one reason or another. It was nice to see him at least get an alternate pro bowl. Yeah, he's deserving. He's a pro bowler in my mind, everything he does for us and the impact he has on the game each week. Just happy for him, well-deserved, earned. So hopefully he's able to enjoy it, if he's able to get out there. What do you think has enabled him, though, at his age, being an older player to still kind of be so effective? Yeah, I think his approach, his daily approach, the way he studies, the way he prepares, and then his ability to go out there and be instinctual. Played with instincts, he's got a good feel for how linemen are trying to block them. He's able to use his quickness. I mean, he's got a unique skill set because he's so long. But at the same time, he's so quick, he's able to get on edges in a hurry. He can win a lot of different ways, right? And he understands that, and I think as games progress, he understands how guys are blocking him. He's able to counter it as within the game. What have you seen from Otis Reese in the brief trial he's had inside linebacker? Yeah, I think he's taken steps. I do. You see flashes out there and making plays. I think he's flying around. We knew his physicality a little bit from the preseason and the opportunities he's had there. So he's done a good job of this point. He's just got to continue to be consistent. Don't get complacent. Don't be happy where he's at. Continue to improve and get better.  Can you give you an element of speed on this defense that's maybe been missing in a few spots? I mean, it showed up here these past few weeks. Him running, I think anytime you get those effort plays, you see him open up and run. It's evident. What about Kevan Wallace, who's played a little bit more lately, too? Yeah, it's good to get him back last week. He's battling through some stuff. So he's been good since he's been here. I think he's done a good job for her. So hopefully that continues here this week. When you see the lineup, the starting lineup, you guys have put out there like last several weeks and some of the names just not as recognized as a little bit mind blowing just how different the lineup has been going down a stretch here compared to.  We've got to coach the guys that are available. We've got to get them ready to go and they've got to go play. And hopefully make the most of their opportunity, right? That's our job. So whoever's out there, they've got to go perform. And hopefully we can do a good job as a coaching staff and preparing them to be able to put their best foot forward. This is the most we've seen out of Elijah Mold in terms of playing games because he's had injuries the past few seasons. How do you feel like his growth has been being able to actually build off of that and playing in games? And what would you want to see more from next season with him? Yeah, I think he's done a good job for us. I mean, as a rookie, he had a really good year for us playing inside. So I think just the transition to safety form has been an adjustment. And I mean, hopefully it continues this week. He's going to have an opportunity to go out there again this week and go play. And he's got to continue improve. Like all these guys just continue to improve. We're not going to see you after this game. When things haven't gone well enough for the defense, what in your eyes has been kind of the root of the problem? Yeah, I mean, right now, man, I'm focused on Jacksonville. See if we can find a way to win this thing and end this thing on a good note. And we just got to keep improving. We've got to become more cohesive as a unit. And each week playing and play out, we got to be ready to go. And hopefully this weekend at Jacksonville, we can do that. What's prevented the cohesion you think? I think combination of things. I think that's one thing we strive for all the time, is just the communication, the execution, understanding. Every guy's got a role on every single play, right? And we just got to make sure everybody understands and goes out there and executes and does their job. Christian Kirk-Craft has said, if he can go, how much does he change things? A lot, you know, a lot. He's a really good player. They're talented, right? On the perimeter, they're talented across the board. So we're going to have our hands full if he's available. Zay Jones is available. He'll change his things for sure. Thank you.


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