how to find reliable health information and avoid unreliable health information on the internet and just out there in the universe. I'll be joined by David Gorski and Harriet Hall, colleagues at Science-Based Medicine website, and from down under, all the way from Australia, Rachel Dunlop, who's fighting the fight down there. So welcome everyone. And of course, I'm Stephen Novella. I'm the founding editor of Science-Based Medicine. The title of this talk is Dr. Google, just as a euphemism to talk about the fact that a lot of people these days are finding health information on the internet. In fact, sometime around 2000, searches for health information exceeded pornographic information on the internet. Only took about 20 years for that to happen. I actually took this picture on Tuesday. I was at Google. They invited myself and my colleagues from the Skeptics Guide to the Universe to talk to Google about health information. So we actually reversed the flow a little bit there. So I'm going to cover some basic principles about where do you find health information and how to think about those sources of information and the kind of pitfalls that you'll need to avoid. So number one, of course, a very reliable source of health information is your doctor. Don't be afraid to use that as a resource. Of course, there's a huge spectrum of competence, ability to communicate, worldview, etc. So I always advise people with friends, family, whatever to find a position that they feel comfortable with that you can have access to and that you can talk about these issues with because that's going to be your single best source of information. It's their job to be your advocate in all areas of health. So don't neglect that. And there's other health-related experts. Physicians are not the only health experts. There are nurses and nutritionists and physical therapists and dentists, etc. So there's lots of other allied health professionals that have their domain. So again, they're excellent sources of information. I'm not going to talk about that anymore, however, in this talk. However, probably most of the health information that gets into your brain comes through the media because that's more of a passive way of receiving information. It's pushed to you. You don't necessarily go out and specifically search for a piece of information. The information is just out there in the media and you come across it. And even when you do go out and look for information, probably if you go onto Google and search for something, you're probably going to come to a news journalistic outlet as one of the main sources of health information. So whether you're just, again, passively receiving or going out and looking for information, you have to know how the media presents information. So I'm going to spend the first half or so of my 20 minutes talking about that. But there's also publications, books and magazines. Again, the full gamut of quality and reliability. Movies, people make documentary movies covering a single health topic. It's amazing how many are out there. There's a documentary movie about Lyme disease, about Wargallon's disease, which is not real, the notion that people are being invaded by some kind of bizarre parasite that's causing these plastic bands or fibers to extrude from their skin. And mainstream physicians think that this is by and large a manifestation of a delusional parasitosis, a psychiatric illness. They're just scratching themselves and working clothing fibers into the wounds that they're creating.  And YouTube now, of course, so it's part of the internet, but most of the videos that you're going to see on health-related topics will be on YouTube. And again, pretty much any health topic you could think about, somebody has made a YouTube video explaining their perspective. And of course, there's other aspects, other corners of the internet, blogs, podcasts, commercial sites, professional sites, and they all have their own character and other commercial sources. So people actually trying to sell you something are going to be a major source of information. And there's also what I like to call pseudo-experts, people who claim to be experts, but either have no special training whatsoever. They just hung up a virtual shingle on the internet and are presenting themselves as an expert because that's how they're going to make their living. Or there are even now licensed professions that are based entirely on pseudoscience. So like homeopathy, for example. You could be a licensed homeopath and present yourself as a state certified health expert.  But if you're not intimately familiar with homeopathy, general members of the public, what they only know, well, this is a licensed health professional. The government certainly wouldn't license somebody unless their profession were legitimate, because that creates a lot of mischief. So as you can see, there's a lot of sources of health information, most of which is bullshit, right? Most of which is misleading, or biased, or just flawed, or just not very carefully vetted. It's also worth mentioning that your physician is unlikely to use any of these sources when they're developing, when they're looking for health information. Certainly, I don't use YouTube as a source for my own knowledge of medical topics. So it's interesting to think about what sources do they go to, and I'll touch on that a little bit as well. So I do want to delve in deeper into health journalism, because again, this is the single most likely source from which you are going to get your health information. Despite Web 2.0 and the Internet and all the new ways in which information is being pushed out there, the traditional media still has about 10 times as much access to the public. And it's getting about 10 times as much information out there as all the other, you know, the new Web 2.0 Internet-based information. Of course, those lines are going to cross at some point, and that's changing every year. The Internet is gaining ground every year, and traditional media is shifting over to the Internet. But, you know, right now, people are more likely to see something on TV on a regular newscast than they are to find it on the Internet. So here are the problems with health media reporting that it's important to keep in mind when you're assessing any news item, the health news item that you come across, no matter what the venue is, the Internet or traditional. Often the journalist reporting on the story is not a science journalist, and specifically not a health journalist. They're not a specialist. And this makes a huge, a huge factor. It has a huge influence on the quality of the stories. Unfortunately, because of the fact that we're in the transition from traditional media to Internet-based media, the traditional business model that has in years past supported full-time professional specialist journalists really is evaporating. And so, generalist journalists, you know, someone who last week was covering a dog show, is now covering a health news item. And they bring the same experience and level of, you know, often fluff journalism to weighty and complicated science, you know, health topics. And they just have no way of navigating through this. So they themselves, you know, don't, they commit all of the fallacies that I'm going to go over in terms of the quality of the reporting that they give. And I'll give you some specific examples that are kind of fun. Here are some very specific things that, again, an experienced journalist and certainly an expert, you know, a scientist or a physician, would immediately know to do, but a generalist reporter just doesn't understand this distinction. And that is the difference between preliminary and definitive research. Right now, you know, in science in general, there are, there's a pyramid of studies that are published, that are performed and published. At the base, most studies are preliminary. They're exploratory. They're, you know, throwing out new ideas and seeing if they have any viability. There are small studies that are relatively easy and quick to do and are not that expensive to carry out just to see if this is something that's worth further exploration. And then as, if studies that show promise get, then get more elaborate studies get done, larger trials, more rigorous until eventually you get to large, multi-center, placebo-controlled, if that's appropriate, double-blind, rigorous, large studies that are consensus or definitive trials that the results of that study are something that you can hang your hat on. Like, that's probably the answer. And it's nice if you have three or four such studies to really tell us, you know, if a treatment is safe and effective, for example. But what that means is that for every definitive reliable study out there, there's hundreds, if not thousands of preliminary small, completely unreliable studies. However, now in the, so before the Internet, what would largely happen is the only people who would hear about these small, preliminary exploratory studies are scientists. We would read them in technical journals that, you know, you probably don't get a, you know, the nature medicine delivered to your home or other technical journals that, you know, you really can't read unless you have a certain amount of training and education in that specific field. I mean, I can't read articles outside of my specialty in medicine because there's too much jargon I don't understand. So in any case, this would all happen behind the scenes at meetings in the literature and then eventually the ideas that had merit would filter their way to the top and then when a new treatment was passing definitive trials and ready for prime time, ready to actually be used, then you would read about it in the news and in the magazines and then the lay public would read about it. That's not pristinely true but that was largely what would happen. Now you're hearing about every single preliminary study that gets done that some journalist can write a sensationalist headline to and there's no distinction being made between the preliminary study and the definitive study. So all you hear is A study showed that there is a link between A and B or that this may be a treatment for the common cold or whatever and it's all noise. 99 times out of 100, that's not going to pan out and scientists know it. But a journalist, all they see is, oh, A study found a link between these two interesting things. Let me publish a headline that says this and they fail to put it into the proper context. This is enough of a problem that we have to wonder, I think we need to adapt to this new situation. In fact, when I was at Google giving a health-related talk somebody asked a very astute question. It's like, well, what should we do about this situation? Should we in some way filter these studies so that the public isn't reading every single preliminary study out there as if it's a definitive news item and that's a really good question. There's no answer to that question right now. What I think, actually I have written about this before and one suggested solution I threw out there was that journals need to segregate their articles from, they need to say this is a section where we're going to publish what we consider to be large definitive trials where the results actually mean something. And then here's a section where we're publishing pilot preliminary studies. Please ignore the results of these studies unless you're a researcher in this area. Don't send out a press release. Don't write a headline. It's like a big warning label. Preliminary data. Do not rely upon this data. Something like that needs to be done. I'm not saying to censor or to not give this, that gene is out of the bottle. Yes, all the information needs to be out there. That's also how we find information now. I go online and search for preliminary studies to not see what's going on. But it needs to come with that warning label so at least, and the public needs to be educated to the fact of what that means. Don't run out and buy the supplement based upon this preliminary study because don't make health decisions about what your lifestyle and what you're eating is totally preliminary data. We also know, and we write and talk about this all the time, that when you look at the literature and you look at these preliminary studies, the results of most of these studies are wrong. It's not only that they're random, they're mostly wrong. And they're mostly wrong for, and that's not to say that most of what scientists believe is wrong or most of what the literature says is wrong because when you get to the definitive trials, that's what we're using as the standard, right? We're saying when you compare the preliminary studies to the eventual definitive trials, most of the preliminary studies are wrong. And the reason why that is, there's a few reasons. One is publication bias. Journals want to publish sexy, positive studies. Researcher bias, which I'll get to in some more detail later, but researchers do things to make their studies more likely to come out positive. And other reasons as well. So there's this huge bias towards making data look good and look positive. And so it's not only is it wrong, but it's mostly falsely positive, which of course generates the headlines. So that's the noise that you're dealing with now and that you have to filter out yourself because there's no longer any filters between you and all of this preliminary research that's getting done and that's massively misleading. I'll comment on another aspect of this, which is interesting, and this relates to the health journalism thing, because there are so few science journalists now not enough to really cover the science news and specifically health science specialists. A lot of news outlets are relying upon press releases. And in fact, to the point where a lot of news outlets that are just aggregating news, just bringing you the news and aggregating into one spot online that they want to drive people to so they get the ad revenue, that what they do is they just take press releases and then they publish it as a news item. But it's a completely unedited, unaltered press release. And when you search on that topic, which of course I do all the time when I'm prepping for talks in the show or whatever, I search on a topic and I get 50 links to the word-for-word identical news item about what some recent study is because they all just copied the press release. Now you would think that a press release coming from a university about one of their own researchers' research would be pretty reliable. But you'd be wrong if you thought that because when you look at these press releases, they're all promotional and sensationalistic too. They weren't written by the scientist. They were written by somebody in the press office who was trying to, and they make all the same, they're just journalists too, trying to get attention to their university. Their job is to drive attention to their researchers and their institution. So they completely distort the outcome of the research, the significance of it. Sometimes they get their findings completely wrong and you wonder if they've even spoke to the researchers before they put the press release out. And also mixed in with those press releases from well-meaning but misguided university press rooms, there are press releases from companies who are trying to look, they're trolling for investors. So they're saying, oh man, we're right on the cusp of this amazing discovery and they're just looking for people to invest in their company. They're abusing the science journalist infrastructure as a free advertising. And it's amazing and we've covered stories like that all the time. Remember the guy who re-grow the end of his finger? Who didn't really re-grow the end of his finger? That was his brother's company who sent out a press release, looking for investors in their magic powder. It wasn't a news item at all. So that's what you're dealing with with health science news. Another big mistake that journalists make is they confuse the authority of a single expert with the consensus of the expert community. So this is classic. What they do is they talk to an expert and whatever that expert says, that's the answer because he's an expert. He's got to know what the answer is. I don't have to talk to two or three experts. I spoke to my expert. I spoke to him for two hours. This is how it works most often. And I pulled out two or three quotes that I plugged into the story I wrote before I even spoke to him because I read the press release. And now if you even bothered to write your own story, your own copy. And so you have an expert to back up what you're saying. I've been on both ends of that, right? I blog, so I talk to other experts to try to get their take on things. And I also interviewed a lot by journalists and I know how that goes too. And it's amazing how what you tell them gets translated into what works into the final article. And sometimes they're listening to you and they're actually letting you guide the story. And sometimes they're just fishing for quotes. They get plugged into a story they already wrote. They already know what the headline is. They already know what the conclusion is because it's fitting into a formula that just exists. The journalist formula that's meant to drive interest which I'm going to cover in a little more detail. They don't understand the fact that if you talk to a random expert it's like you're rolling the dice and you're going to get a random expert's opinion take on a topic. If that topic is at all controversial chances are that expert will not reflect the really broad consensus of opinion. You may in fact be talking to a crank. And in fact the odds are pretty good. You're not randomly going out there. You're looking for experts who have a media footprint. And the cranks go out of their way to have a big media footprint. They're very good at self-promotion. That's how they promote. That's how they rise to the top by self-promotion as opposed to legitimate experts who rise to the top because well they did good research and got published. We like to think that that's the case. But disproportionately the more cranky you are the more likely you are to be rising to the top because you are just good at self-promotion. So yes, they have a huge media presence and they're very likely to draw the attention of a journalist. So a journalist is actually more likely to talk to somebody who does not reflect the scientific consensus than somebody who is just a work-a-day scientist who would give you the sort of boring distilled consensus opinion. So the system is actually geared towards misrepresenting the actual conclusion of any controversy or even not so controversial topic. But it gets worse than that too because there is something called false balance which we complain about a lot on science-based medicine because again this is the journalistic formula. There's two sides to every story. Well no, sometimes there's one, sometimes there's five but they take this. We have to find somebody who thinks the other side. No matter how solid the consensus is that they're talking about they need to find some expert who says the opposite and they can present it as a controversy and that they present themselves as having done a balanced job. So that's false balance. In fact the balance of the article should reflect the balance of opinion in the scientific community not just to random experts on opposite ends. And as I mentioned they often will find a way to fake experts that don't even have the qualifications let alone having qualifications but having an out-of-the-mainstream opinion. It's actually tricky. Sometimes I will address a new topic I've never really looked at in any detail before and so I'm starting pretty much from scratch. I did this actually ten years ago now when I first was hit with this claim that vaccines cause autism. I said okay I'm going to start from scratch and take a look at this question for myself and spent like six months just reading the literature and what was written out there before I ever wrote about it. And it was difficult. It was challenging to sort through all of the opinions and to finally get to the point where you knew who had the last word on each particular part of that claim. That's a lot of work and I had a huge background of scientific and medical information to start from so a journalist trying to do that may not get to the right conclusion at the end. And I've seen journalists who are good science journalists for a long time delving into a question and at the end of the day they come to the exactly wrong conclusion because they make some mistake about how they're interpreting the literature. So that knowing how to put everything into context again is critical. And then we you know I don't know who invented the term manufacturer versi. It's one of those things we all start using it now making up a fake controversy where again like the two vaccines, that's not a scientific controversy. The data is in, it's settled but you know settled science doesn't make really sexy headlines and so you know drive traffic to your website so you manufacture a controversy where none exists. And of course there are groups that are ideologically dedicated to a particular point of view and they of course like to manufacture the controversy as well because they don't want obviously they don't want the settled answer and they're wrong so at the very least they say well this is controversial. Okay so here's an example of in one article a lot of the things I just talked about. This is from MSNBC but this headline in one version or another one permutation or the other was reproduced in every major news outlet so they everyone blew it nobody got this right. Acupuncture real or fake best for back pain. In fact the study that they're talking about is the exact opposite of that. It showed that acupuncture does not work. What they did was I know I speak about this a lot because it's my favorite example now of just the absolute wrong reporting of a science news item they compared real acupuncture by an acupuncture as doing what they think they need to do to do real acupuncture. They compared that to sham acupuncture where you stick needles in the wrong place. They compared it to placebo acupuncture where you don't even insert a needle and those groups were all so those were three blinded comparisons and then they had for completeness a non-intervention group not a standard intervention group that was misreported almost ubiquitously but a non-intervention group meaning they took people with chronic back pain and they did nothing except whatever they were already doing and failing because they had failed their treatment and they had chronic back pain despite whatever they were already doing so of course everyone who got some intervention felt like they were doing better than the people who had no intervention at all that was an unblinded comparison you can't make any conclusions based upon that comparison all that the only reason in fact to include that that group the non-intervention group was to show that the study was capable of showing a difference in outcome so you show that all of the intervention groups did better than the non-intervention group that just means the study was powered and designed in such a way and the outcomes were measuring something so that you can see a difference but that difference means nothing it's all placebo effect because there was unblinded the study was looking at those three groups acupuncture sham acupuncture and placebo acupuncture that was the blinded comparison and there was no difference at all that means it doesn't work acupuncture doesn't work doesn't matter where you stick the needles doesn't matter if you stick the needles the two variables that are acupuncture had no effect it doesn't work that's not what any of the headlines said the headline said was acupuncture works whether or not it's real that's like saying my favorite comparison which puts it into crystal clear perspective a pharmaceutical company doing a study where they have two doses of their drug a placebo of their drug and a non-intervention group where they don't do anything and all of the three placebo medicine and two doses of medicine have no difference in outcome but they all did better than people who had nothing and the company says our drug works in fact it's so powerful even the placebo of our drug works I'm not sure anyone would buy that you know but every science journalist bought that that was essentially true for this acupuncture study in chronic back pain complete fail and they were just reproducing the press release they didn't do any of their own background research no one talked to me about this I could tell you that but many of us and nobody came to science based medicine or any of the people who have been writing about acupuncture for years they didn't talk to any skeptic anyone who is not they talked to acupuncturists and the people who did the study or they just copied the press release there was no actual journalism where they investigated what this really means and they just bought this ridiculous rationalization wholesale here's a fake controversy this is something new I haven't talked about before this particular news item I've spoken about this treatment before CCSBI this is interesting because over the last three to four years we've been able to watch a scientific controversy evolve it from origin through we're getting close to the end and then we'll see what its ultimate fate is I predict it will live on the fringes of quackery but a few years ago an Italian vascular surgeon developed this hypothesis that multiple sclerosis MS is actually caused by blockage in the veins that drain the brain rather than an autoimmune inflammatory disease which is what the last 50 years of research shows it to be he said nope you're all wrong forget all those hundreds of studies and all that immunology and all that stuff it's a blockage in the veins and you can treat it by opening up the veins with a procedure now called the liberation procedure so of course if you're a vascular surgeon and the standard therapy is not working for you and someone says I could cure you of course you want to believe that that's wishful thinking you'll buy that for a dollar hence the controversy studies have been done Zamboni published a study saying 100% of IMS patients had blockage in their venous system that's pretty good 100% we never see that in real science but yeah okay that means there was some bias it explains some of the outcome maybe it explains all the outcome it's been replicated now actually for a hypothesis that not many people took seriously there's a lot of research being done on this which is interesting a lot of people who tried to replicate Zamboni's research no one got the same results he did not even him when he repeated it the 100% thing was not real most of the studies show no correlation between venous blockage some show some correlation although people with non-MS neurological disease also have blockage but not as much as MS and the general population who have no neurological disease also have blockage but not as much as people with neurological disease so we don't know what that means we don't know if it's real if it is real doesn't mean it's causative of MS maybe the inflammation is causing some blockage and maybe that's even contributing to symptoms maybe he's on to something not the cause of MS though there's also been some other studies one interesting study where they tied off the vane the jugular veins in rats and see what happens and they don't get MS so they're rats they're not humans but that's an interesting way to approach that question and there's now we're starting to get some treatment trials the one out of Canada that was recently published that's why this news item came out and these are non-blinded not randomized they're referring themselves for the liberation procedure we're just seeing what happens and you know what they're not getting better they're so far it shows no effect if anything the unblinded nature of that data would bias it towards the positive but even still there's no effect and a subset of those patients as a complication of the procedure their veins completely clotted off and they didn't get worse and these are people already had MS that's pretty telling too and the data seems to be pointing in the direction of this is not the cause of MS it does not make MS worse and treating it does not make MS better so and it's you know it's not that plausible from the point of view of the last 50 years of MS research in the neurological community I could tell you the neurologist just chatting with my colleagues they think this is utter BS that's sort of the consensus opinion because you know you got to go through the motions you got to give it just saying I think this is not true is not enough in science you have to show that it's not true and the studies are being done in a way that if it worked we'd see it otherwise they're pointless they're getting done just not showing that it's effective but immediately immediately a subculture of conspiracy thinking emerged on the internet just popped into existence with pre-made arguments and big pharma conspiracy mongering and of course now the neurologists somehow are now in a conspiracy not to treat MS it really was bizarre from a neurologist point of view here's a recent article written by a journalist trying to cover this pseudo-controversy there's a little bit of controversy in there but it's a completely asymmetrical one 95% think this is nothing to this and there's a subset of people who think it deserves more research no one is bold enough to say that so this is the quote from the article Zamboni's theory challenged the entrenched but though unproven autoimmune model of MS one that underlies a mindset and a US $13 billion industry of symptom modifying drugs that also unleashed the specter of patients demanding an unproven procedure everything but that last line is completely wrong in that article so unproven unless you count the last 50 years of research in multiple sclerosis what's unproven is not a fair background characterization of the autoimmune theory of multiple sclerosis there's hundreds of studies showing in a lot of detail that this is an autoimmune disease it really isn't just some random idea we threw out there notice the big pharma conspiracy mongering in there the $13 billion industry all of medicine is a big industry that has led out to support any conspiracy theory she also characterized the standard treatment as symptom modifying drugs that's a very specific claim she must have got it from somewhere it's not true the MS drugs there's like about 6 drugs now are specifically disease modifying now in 1990 or earlier that statement would be true we had no disease modifying drugs for MS we would shorten the duration of exacerbations we would improve quality of life but nothing that altered the course of the disease but that's not been true for 30 years we now have about 6 drugs approved in multiple countries Europe and the US and Canada that reduced the number of exacerbations that slowed down the course of the disease significantly both by MRI criteria as well as clinical criteria that's just wrong this is a completely wrong characterization of the treatment so this is a journalist trying to cover this interesting topic and she gets all the details wrong and not in a random direction these are all biased in the direction of there's a conspiracy to suppress this new treatment by entrenched interest in this unproven symptom modifying hypothesis and I wonder who she spoke to that gave her this characterization of this issue she didn't speak to any neurologist I know or if she did she didn't listen to them because she had already written this story and wasn't actually doing investigation she was doing quote mining that's probably what happened alright here's another one probably too small to see but the little bar the black part I looked at there is that's Dr. Magda Havas anyone know that name? anyone from Canada? so she's the one expert there who is pushing this idea of wifi electro sensitivity light bulbs and wifi and cell phones and what not are damaging our health causing diabetes and all kinds of poor health so she's the media expert so if you're a journalist and you're writing about the wifi controversy you're gonna find her if you search on it she will come up and she is very amenable to talking to the media so the journalists cite her as their expert that they went to to find out what's really going on and she gives them the minority one percent opinion on this whole thing whereas the rest of the scientific community says not much plausibility there I won't go as far as saying it's impossible or though some people do but I wouldn't go as far as saying it's impossible but there's really plausibility very low evidence and it's negative there's no effect here the World Health Organization has reviewed all this data other organizations have reviewed all this data and there's just no signal there of course you can't rule out a tiny risk but with the amount of data that we have it's gotta be insignificant it's gotta be too small to worry about but to talk to her it's like a scourge on modern life that's who the media go to nine times out of ten on this issue because she's the media expert some other aspects of health journalism to talk about obviously sensationalism force potential applications this is now the formula actually there was a wreath after I've written about this topic another doctor wrote an article in Nature about how to write a science article and it was a parody instructions to a journalist it was perfect I should have wrote that myself but when I focus on a couple of things they say so you have the human interest anecdote in medicine that's huge in health related topics you talk to the doctor who's just trying to cure people isn't he nice and the patients love him and they saved his life and then they talk to the skeptic and we're a talking head nope it doesn't work and the evidence is negative and let's go back to the doctor the nice doctor in his white coat treating the patients and making them saving their lives completely distorted presentation I don't think the journalist intend to so profoundly distort the issue that way they're just following their formula you find a person who's affected by this they're the human interest hook but of course once you do that that completely sets the tone for the whole article and then the skeptical talking head we could say anything it doesn't matter the story is the people whose lives were saved by this crusader the facts get completely lost in the reporting the skeptical talking head so here's a funny one so a cure for the common cold may finally be achieved as a result of remarkable discovery in Cambridge laboratory right that's not true there's nothing to do with the research the research is about how antibodies can enter cells and attack viruses but here's the formula any research about viruses could potentially lead to a cure for the common cold that's it what's the hook because the journalist goes here's an obscure immunology basic science study about antibodies entering cells what's the hook here viruses cold I just imagine asking the researcher so one day could this research lead to discoveries which help us cure the common cold what's the researcher going to say no absolutely not never they'll say well sure theoretically it's possible you guys have read about the invisibility cloak Harry Potter's invisibility cloak no Harry Potter's invisibility cloak any time you do any kind of research that has anything to do with manipulating light waves Harry Potter's invisibility cloak so that's the forced application find what this means to the average everyday person doesn't matter how tenuous the connection is but they're just taking interesting basic science studies and finding something that it has absolutely nothing to do with and that's the headline that's the hook but that's what gets reported that's what gets reported I'm actually running a little long and I want to overshadow my colleagues too much so even good journalists have a hard time deciphering the complicated you know science out there because science is hard it's really complicated I find it very hard once I step even a little bit out of my specialty it's really challenging and I have to really all I could do is talk to experts and try to understand what they think you know they dumb it down for me and give me a summary of what they really think that's the best you could really do once you're outside of your narrow area of expertise and of course if you're not a scientist that's all of science right but even if you are a scientist that's all of science except for your area of expertise and you really have to understand that but you know you can get to the point where you can translate into a reasonable you know story about what's going on putting studies into context and there are genuine controversies out there it's not like all of science is settled and all you got to do is find out what the settled consensus answer is there's real controversies out there and those are very hard to navigate peer review is another one what does peer review mean? people think peer review means this is solid established science no it doesn't it means the journal thought that it should be published most peer reviewed studies are crap most of them are preliminary studies we get back to that right the peer review process itself is being examined is it adequate does it really do what we say it does and even when it works it's just the beginning of the evaluation of a study not the end of the evaluation of the study peer review means alright you're above the bar we'll publish you in the literature and now the scientific community will pick you apart and decide if you actually are worth anything that's what you got to wait for the scientific community to pick it apart peer reviewed is not a guarantee of this is reliable outcome not at all the journalists however generally don't get that false legitimacy doesn't get much worse than NCAM I talked about licensing pseudo experts like homeopaths and acupuncturists there's a lot of things out there that to the public would seem like the imprimatur of legitimacy that are not actually tied to legitimate scientific legitimacy I don't have time to go over that so there's also lots of sources of bias in studies actually touched on that earlier in the talk so there's other sources of health information this has really just been talking about the media but you can actually when you go online to look for information you may not be dealing with the media you may be dealing with other sources of information a lot of them are going to be commercial amazing to me when I talk to alternative medicine proponents or people who are into supplements or natural remedies how successful the marketing campaign of alternative and natural treatments has been they don't even realize that they're being pitched a commercial most people I talk to about that are really proponents oh no the commercials that's something they have problems so do companies do and your doctor does this guy though this is this guru he's just giving me information he's like a real crusader this guy's making millions of dollars I don't make a dime on any of this this guy's making millions of dollars but I'm the one who's selling you something and this guy is the one to be trusted like Mercola or the health ranger these guys are making millions of dollars selling stuff and focusing honing what they're saying towards the sale it's a pitch they're used car salesmen it's amazing to me that the marketing has been so successful that most people don't get that if a website is the product of a single individual you should be very cautious about believing the information on that site no authority does not rest in any single individual it doesn't mean they don't have something useful to say or they're not a useful conduit of information but don't take any individual's word for anything not even mine, none of us they're just individual all we could do is do our best to make sense of a complicated scientific story you really want to get again the consensus of the community is really your best bet so be careful if that's being funneled through a single person with a single perspective group blogs or group sites do a little bit better but you have to be careful of their ideology as well institutional sites like academic institutions are actually the best source of information on health information even then what I find and what we find is that when the subjects are non-controversial they're great when they're controversial then politics intrude and then we find that the reliability kind of goes off the rails a little bit so the more controversial the topic the more skeptical you have to be of any individual source of information news outlets I've already completely trashed what news outlets and why they're completely unreliable I'm going to end with this somebody sent this to me today I had to share it with you pooping wrong is bad for your health did you guys know that you were pooping wrong I bet everyone in this room has been pooping wrong their whole life why choose to be unhealthy alright so here's the solution and look there's a scientific anatomical chart explaining why you're pooping wrong when you're sitting your muscles are kind of bent at an uncomfortable angle and that closes off your anal sphincter when you're squatting in a more natural posture like because in the woods you're going to squat right then everything opens up and your experience is going to be much more natural so the squatty potty problem solved put you in a squatting position opens up your anal sphincter and all your health problems will go away right so this looks newsy you know it's on the internet they've got video very slickly produced video it's all however leading for you to buy this product what's the scientific evidence for this zilch none it's just and it's all based upon the naturalistic fallacy but you know if you watch the video they say you know people squatted to poop for all of human history until the industrial revolution came along and we started sitting and we doubled life expectancy I mean then all of our problems started when we started sitting on the toilet so here we have the solution I'll end there thank you everyone well good morning still by 15 minutes everyone before I get started I'd like to just thank the geniuses at the apple store because they basically saved my computer last night and much of my talk I'm going to start out with what I think the very essence of the way we search for information on the internet is and this is a famous quote from Isaac Asimov there is a cult of ignorance in this country in the United States and there always has been the strain of anti-intellectual has been a constant thread winding its way through our political and cultural life nurtured by the false notion that democracy means that my ignorance is just as good as your knowledge Google is this statement not only on steroids but like on nuclear power okay Steve mentioned that health searches have finally surpassed porn searches and this is just one topic this is breast cancer and this is the number of posts that you see you know since 2004 in a study that was just published a month or two ago and a lot of these posts range from blogs most of its media websites just as Steve said but blogs are like about even though they're only about one quarter of the number it's still a huge number and you'll see this so here's our friend it's my little beard and he's googling cancer so can you have a PhD so you know in 20 minutes or 25 minutes I'll try to get through some stuff that can hopefully serve you well we've flogged about this sort of stuff a lot on science based medicine so but first I'm going to start with three sites that will come up on searches that if there's something on that site you should not believe it if I see on this site that it says that it rained yesterday I'm going to go look at the weather report from yesterday to see if it actually did rain in whatever part of the country they're talking about Mercola Joe Mercola naturalnews.com Mike Adams and of course the whale we will come across these sites doing internet searches for cancer just about any other health issue maybe not so much the whale anymore it's kind of but Mercola gets as much traffic as the NIH website okay Trini Tudero reported that you know a few months ago you know it's a serious force designed to sell so Mercola you know this is just a simple one you know cell phones may trigger ADHD that's actually a mild one from him I'll show you something worse later you know drug company conspiracy mongering it's all there naturalnews okay hell no GMO my favorite one is in the bottom and it's a little hard to read but the discovery of the Higgs boson actually may be the evidence of the power of consciousness to Mike Adams he doesn't discriminate he's into just about every form of pseudoscience you can think of and he's also into some really seriously nasty attacks on conventional medicine for instance this is his view of chemotherapy it's you know it's a concentration camp where the guards are walking around with giant syringes and marching people into what are clearly meant to look like Nazi gas chambers or there's this one you know about breast cancer where you know they're using pink ribbons to tie up women and force them into the cancer treatment center to be pump full of awful chemotherapy horrible awful chemotherapy then of course there's a whale too this if there's a form of pseudoscience or conspiracy theory that exists it'll be on whale it'll be there this thing's been around for probably longer than all of them and it's just incredible what you can find on there I actually have my own page on there so I feel quite honored about I buy that so what are some red now the other thing you can talk about what are some red flags and these doesn't just you know doesn't apply just to cancer it applies to pretty much everything but holistic if you hear the word holistic we treat the whole patient as though primary care docs like Harriet do not it's it's a bit of a it's something that irritates a lot of the primary care docs who do try to practice science-based medicine we treat the real cause of cancer of course that real cause is utter nonsense based on pseudoscience and I'll show you a few examples in a minute but we treat the real cause or our treatment is natural okay it's not like that unnatural chemotherapy that comes from oh bark of a tree like taxol that nasty plant that nasty tree now here's my favorite cancer is not really a disease but a manifestation of something else in one case for instance a German new medicine it's a manifestation of some buried emotional trauma that your body is trying to get rid of by giving you cancer and killing you or as I'll show a couple of other examples later some of these can get to be quite ridiculous and of course it's been used to treat cancer for centuries so was bloodletting see how well that works for most things and of course toxins it's always the toxins not much to say about that we gave a whole session last year on alt med toxins basically of course there are now one thing that also is very common or serious attacks on science based medicine I showed you some of Mike Adams's but for cancer this is a common one that you'll see the three approved paths to the graveyard cut burn poison sometimes it's cut poison burn as in this movie that just came out I've been meaning to try to get a copy of this and do it I don't know if I can stand to watch it but I've done it before for things like the beautiful truth and giercin therapy and a couple anti-vaccine movies so I suppose I could do it for this one but I'll give you one here's one pearl though that is about as close to 100% reliable as I know of if you see one word on a cancer site this word disease this is what you must do because you're on a quack site without a doubt this is about as close to 100% reliable as anything I've ever found so what are some common cancer gambits these are the sorts of things you will find on the internet I'll pick just free versions of them but they metastasize I know I can't help it I can't use that term but you will find these how about this one I call it the 75% gambit here's an example of it from a guy by the name of Tullio Simonsini who I will tell you a little bit about later 75% of MDs refuse chemotherapy themselves if they get cancer wow, sounds pretty damning doesn't it we won't take our own medicine based on a survey from 1985 that was basically looking at one form of chemotherapy that was new at the time cisplatin for lung cancer for advanced lung cancer and it still wasn't clear that it was a good therapy for lung cancer so 75% of docs were like I don't think I would use it more recent surveys there was a follow up survey that they never cite which basically says the question you have stage 4 lung cancer would you take chemotherapy 64% said yes and there are other surveys out there with similar questions where it's as high as 98% of physicians would say yes I've known several physicians who have taken chemotherapy for cancer you know it's nonsense we take standard of care therapy most of us except for some of us who may have gone to the dark side but physicians basically take chemotherapy just like anyone else when they get cancer here's another one, the 2% but this is Joe Merkola the version I'm going to cite you comes from Joe chemotherapy has an average 5-year survival success rate just over 2% for all cancers sounds pretty horrible only 2% with all that toxicity turns out if you dig it's based on two papers one paper came out of Australia in 2004 another paper is by a guy named Ulrich Abel and was published in 1992 the second paper is often represented as having been published in the Lancet I went and looked at the Lancet at the dates that they in a whole date range that they claimed that it was published and it not in the Lancet it's in a relatively obscure journal there are a lot of problems with these both of these but I'll boil it down since this is a short talk because I could actually spend several minutes going through this but both excluded leukemias and the papomas which are the most chemo sensitive cancers can actually cure they mix up adjuvant and curative intent chemotherapy and basically they do everything they can to minimize the seeming effectiveness of chemotherapy now it is true that chemotherapy is not very effective for malignancies when they reach stage 4 that's one of the last frontiers that we have to overcome as cancer doctors however chemotherapy can still be surprisingly good for paliation and even when it only prolongs life a few months to those cancer patients that could mean the difference between seeing their child graduate and not or something like that so so it's a complicated issue and I could perhaps do a whole talk on it but the bottom line is both the papers that they look at both have methodologic problems that almost seem custom designed to minimize the effect that they noted now here's my favorite it's the 0% not satisfied that chemotherapy only works 2% of the time to prolong life we have Mike Adams saying there is not a single cancer patient that has ever been cured by chemotherapy 0% they don't exist not a single documented case in the history of western medicine it seemed rather stupid to me to make such an absolute claim doesn't it and Lance Armstrong agrees and so do just about any child ever cured of childhood cancers which were death sentences 50 years ago and are now between 80% and 90% survivable with chemotherapy being the main treatment now here's a little rogues gallery that you will encounter I picked these as kind of my personal favorites because there are more but they do represent some of the nuttiness you can easily come across so hold a Clark does anyone remember hold a Clark her I use the word loosely all cancers are caused by a parasite and the parasite is a human intestinal fluke right there in the corners a nice little illustration of it and she claims to have she claimed as you will see to have the cure for all cancers you have to get rid of the parasite there's also all this stuff about propyl alcohol that I never figured out where the heck she came up with that and you know various things that she said you had to do the main thing is she came up with this thing called a zapper and this is the thing that will zap you zap your flukes you know it's like and doesn't it kind of look like a Scientology emeter it's pretty much the same circuit and she claims that it's a hundred percent effective regardless of the type of cancer or how advanced that it might be you can even buy it on Amazon oh there's more stuff you can buy on Amazon but you can buy a miracle mineral solution on Amazon that's bleach you know that's the bleach cure that I wrote about not too long ago I could do a whole talk on that too but anyway so does it work? I don't think so Hulda Clark died about three years ago of multiple myeloma and yeah you know it's sad but it's sad but it's also ironic and appropriate I think because she sold this nonsense to so many people it's just you know unbelievable there's the Gerson therapy I don't know how many have heard of this but you will come across it the movie that I mentioned before the beautiful truth was all about the Gerson therapy and basically to him cancer is due to toxins those lovely alt med toxins and detoxification is the cure but how? how do you ask do we detoxify? well the therapy involves juices dietary modifications and coffee enemas yep I I never could understand that when I personally like my coffee the normal way but that's what that's the treatment you will find it online it's everywhere and in fact the Gonzalez therapy that we talked Nicholas Gonzalez's therapy is basically very similar to Gerson's therapy it's sort of developed from it Stanislav Burzynski you may recall the regular readers may remember I wrote about him a lot towards the end of last year because one of his attack poodles was threatening a bunch of skeptics who were writing you know that basically his stuff didn't work and it was wrong of him to be charging tens of thousands of dollars to desperate cancer patients and not doing the clinical trot even really doing real clinical trials he claims to have discovered natural tumor fighting substances from the urine which he dubbed anti-neoplastons it turns out that the main anti-neoplaston is actually sodium phenyl butyrate basically his MO is this back in the 90s he was told that he could not sell anti-neoplastons across state lines and he could not treat patients with them except as part of a clinical trial so what's his solution he has like 60 open clinical trials that never really accrue enough patients and he still charges patients to be on these clinical trials which is generally considered very ethically dubious lately he's been jumping on the genomics bandwagon and doing what he calls personalized gene targeted cancer therapy or what I call basically his personalized therapy for dummies he basically tries to pick various targeted chemotherapy agents based on these genomics tests that he has no idea how to interpret which is the funny thing because he's held up as a paragon of natural treatment but he uses a ton of chemotherapy in a lot of his treatments and in fact his anti-neoplastons are fairly toxic here's another one tuyo simonsini cancer is a fungus that you'll love the reason why he concluded that cancer is a fungus he said cancer is white fungus is white is a fungus I wish I were joking but I'm not in any case I'll just kind of blast through this because this stuff is all you know, Canada attacks different tissues it mutates the thing you need to know because you will come across this not just from him but from the next guy I'm going to talk about is how you treat the fungus so how do you get rid of it there's the fungus no it's not coffee enemas I heard that baking soda baking soda cures cancer because because it's alkaline I guess and this guy has injected women with breast cancer with baking soda directly into their tumors to the point where he screwed them up so bad he killed them but to him it's like this is the cure everybody will be happy but that brings us to Robert O. Young who I talked about before on several occasions so he basically that caricature of him by the way actually hangs in his office because I've seen it discussed he thinks acid causes cancer acid is actually the cause of all diseases to him and he says things such as you know he calls it the new biology anytime anyone calls their stuff the new biology that's actually another time to run away but there's no you know he says there's no such thing as a cancer cell a cancer cell was once a healthy cell that has been spoiled by acid the tumor is not the problem but it's there to protect the healthy tissues from being spoiled by other rotting cells that this is what I mean when they say that you know they say that cancer isn't the disease his treatment of course is basically the same as semencini's now here's another problem discussion forums these are very big in the cancer community and here's one that looks like it should be perfectly reputable breastcancer.org and I just found out about this like within the last few days so I added it to the talk it has some nice things like you know connecting with others with the diagnosis treatments and side effects um you know but it starts to get a little dicey fairly quickly for instance there's in the you can find the alternative medicine section there's a section on baking soda and cancer there's also a disclaimer which I'll get to in a minute elsewhere how can we make this truly safe supportive and judgment free in other words they're getting upset because some skeptics come in there and say you know this stuff is quackery what are we doing you know promoting you know allowing a place for people to promote it and there were actually there's actually evidence that some of the people in there are selling the stuff that they're trying to promote to breast cancer patients but here's the here's another thing to look for it has the quack Miranda warning and this this comes in various forms wordings but it all comes down to the same thing that what we're selling you is not medical device we're not claiming a diagnosis or treat anything so do it at your own risk but we're going to give it to you anyway so let's you know I have a basically and basically all they're selling is testimonials they're not selling science they're not selling um you know randomized clinical trials they're selling single patients who claim that something cured them and there I have two laws of testimonials whenever a believer in alt-med uses both science-based medicine and alt-med and gets better he will always attribute the good fortune to the alt-med not to the science-based medicine if a patient uses alt-med and science-based medicine dies it's always the fault of the scientific medicine and particularly of chemotherapy was involved so let's take a look at this testimonial look at it says a woman stuns researchers by directing by overcoming her cancer with turmeric spice okay so we look a little more closely and here's the news story that it's based on okay breast cancer survivor use super foods to combat her disease but if you read you'll see Vicky from Plymouth Devin told how she had an operation to remove a breast in a lymph node she actually went chemotherapy, radiotherapy and surgery but it was the turmeric spice that cured her so here's another one this showed up on that wretched hive of scum and crackery that I like to call the Huffington Post it's about Annie who formed the Annie Applesey project she claims that a lot of alternative medicine helped her a lot but if you look a little closer it talks about how she had a lumpectomy or basically an excisional biopsy followed by a mastectomy followed by a mastectomy first off the first part shows alternative medicine is what the curator, the second part is oh well she had a lumpectomy and it was followed by a mastectomy so basically let's see what you got to understand is primary therapy versus adjuvant therapy what she's doing is the skipping the adjuvant therapy when the surgery was the primary therapy and you can find a ton of these on the internet there's basically this one, same story she had a lumpectomy and surgery, skipped her chemotherapy she thinks that the alternative medicine cured her Suzanne Summers, same thing unfortunately it doesn't always work out so well I don't know if you remember Kim Tinkham she was on Oprah she basically said that she was going to use Robert O. Young's treatment for herself she didn't have surgery, she didn't have anything she started out looking real healthy she has cancer angel website then a little later support Kim Tinkham her cancer relapsed then two years ago on Facebook this was announced and unfortunately passed away so I'm just going to skip through this because I'm running out of time but basically the most common confounder is the cancer present did it go away was advanced treatment the only one used was it adjuvant versus primary treatment and a lot of this is not told and sometimes these things are just made up for the people that are saying that these things just aren't true so I'll just conclude with one of my favorite guys I don't always research cancer on the internet but when I do I only use cancer.gov and cancer.org thank you so I'm going to cover the side of the story now to do with vaccination and finding accurate information online so I'm going to get straight into it why do people or parents fear vaccines I guess the first thing is that vaccines are really a victim of their own success in many ways most of us no longer see vaccine preventable diseases in the community some of us here may remember people that had polio or that had measles but we don't see it anymore so it's out of mind out of sight so as a result of this people tend to I guess increase the hypothetical risk or the small risk that we know about in medicine of side effects on vaccines and if you look anywhere on the internet you find plenty of misinformation with this in mind and of course this leads to parents getting scared and I'm often delaying vaccines and also either delaying them or not getting them at all and this can have tragic consequences not only for yourself or your children but for other vulnerable people in the community because we lose things called herd immunity so we lose the protection within the community so as Steve mentioned the three main sources really that people use to search for information about vaccines is really health professionals which is obviously a good thing in most cases unless you're asking Joseph McCollough the media, the general media so the news media, newspapers and then online and with respect to the traditional media in the US now about 11% of nightly news shows tend to have stories concerning health but as Steve has already mentioned a lot of those journos are generalists they're not health specialists and so quite often those stories may contain errors they may not be accurate, they're not designed as documentaries of a science nature they're usually a few minutes at the end of a news broadcast so sometimes those errors can actually lead to misinformation and then harm and as Steve has also said they could just be a promotional story for some quack who's selling some new cancer cure and of course the other thing is this favourite practice of the media which we call false balance where they get on the other side of the opinion and of course when it comes to things like politics or just opinion stories this is well and good but often with health and medical information there isn't another side to the story so if the consensus for the effectiveness of vaccines is 95% of people say that they work and they're effective and they're safe and 0.2% of the medical community says that they cause autism why would you give those two people 50% of the time on a news show and I've just added here because celebrities and I'll go into that a little bit more in a moment so studies have been done on how Dr. Google can misdiagnose people and lead to people actually mistreating themselves in fact there's a study from the UK that's quite recent which took a thousand women and got them to search for things including breast cancer, thrush and high blood pressure and about 25% of them misdiagnosed themselves and then 50% actually self-diagnosed incorrectly and they put up with pain and suffering this self-medication for quite a long time before they sought the advice of a health professional in Australia and it's probably about the same in the States now about half of us use the internet to self-diagnose and 2 thirds of us will research our medicines which is not necessarily a bad thing as long as you're finding accurate information and this statistic I think I've found is really interesting and when I first heard it I thought that sounds really bizarre but when you think about it I think it's actually right 97% of us only look on page one of Google now I know that I do that unless I'm looking for something very specific it's unusual for me to go past page one so the important thing about this is if the accurate information that you need is not on page one if you're getting your macolas and your whale twos up on the top 10 results then that's what most people will see and this indeed is the case for vaccinations so if you do a search for vaccination on google.com this is page one you get whale two coming up you get the national vaccine information service which is run by Barbara Lofisher you get vaccine liberation and you get Mike Adams natural news if you go to a google image search you get even more scary stuff some of you might be familiar with David Ike who's a famous conspiracy theorist from the UK now he's okay he's pretty extreme but this stuff will come up in google images so we've got pictures of kids being chased by oversized syringes we've got a vial with a pox written hand showing as vaccination goes up autism goes up Nana is being tasered here I'm not really sure why and babies with syringes coming out of them and this sort of stuff is scare it scares people and it sticks in your mind and it affects people's decisions down the line so the problem we have really is that we've got high quality information which is equally available as misinformation and one of the things that is driving the force behind this in terms of misinformation on web 2.0 as we call it is this thing called the current post-modern medical paradigm and basically this involves individuals wanting to take control of their healthcare and it's all about you'll see these phrases often on natural health websites do your own research empower yourself before you make a decision and I mean it's similar to what David was saying about Isaac Asimov post-modernism is this idea that there's no wrong answer there's just another way of knowing things so YouTube is also a place where you can find a lot of misinformation there's a study from vaccine journal that founded about 32% of videos on YouTube are post-vaccination but importantly these videos had more ratings more views than the accurate videos and I found this really interesting too that even spending as little as 5 minutes on a website that's anti-vaccination can affect people's decisions months down the track and so I like to think of this as kind of like ringing a bell once you've rung a bell you can't unring it so by suggesting to parents or to anyone really that vaccines might be linked to autism that sticks in people's mind and it impacts on their decisions as to whether they're vaccinated later so I guess it wouldn't surprise you to know that when you do studies on this stuff parents who got most of their information online with respect to vaccination are less likely to vaccinate their children as opposed to parents who do and of course the classic here is Jenny McCarthy which you guys have given to the world thanks for that she proudly claims that she learned everything she knows about autism from the University of Google and she doesn't need science and she said this on Oprah that Evan, her son who apparently had autism but apparently hasn't anymore is her science, she doesn't need the science she has him at home every day, that's her science so I just want to show you a short excerpt from a video that I found on YouTube to give you some idea of the sort of stuff that you'll find okay I deliberately edited that to less than 5 minutes so that it wouldn't stick in your mind's months later but if you want to see the full one minute 30 seconds I can give it to you another time so the other thing that you'll find is things like this, this is a lovely book that has just been, is being sold by the Australian Vaccination Network the Australian Anti-Vacces, it's called Melanie's Marvelous Measles and it's about a, it's designed for children aged 4 to 10 and it takes them on a journey of discovery to learn about the ineffectiveness of vaccines and to teach them to embrace their childhood illnesses now interestingly Merrill Dury who's the president of this organisation says that the word measles is Sanskrit to mean a gift from the goddess and apparently children that get measles will get a growth burst after they've had it which indicates that it's good for them but of course in reality we know that measles is not a gift from the goddess and you know in 2010 over 139,000 kids died of measles and it leads to complications and once the vaccine was introduced there was a reduction in cases by about 74% so that's the science that's the pseudoscience the other thing that you'll find on anti-vaccination websites is everything's a motive so there's an emotion behind the information they present and they rely on a distrust of conventional medicine and some of the things that they address they, all of them that this is a survey done in vaccine by Anna Catter looking at a bunch of anti-vaccination websites they all questioned the safety and effectiveness of vaccines, most of them promoted alternative medicine they all questioned civil liberties and said but it's our civil rights to deny getting vaccinated a lot of them were full of conspiracies well 100% of them, they wanted the search for the truth and it's all a big pharma conspiracy and the emotion of appeals and misinformation of falsehoods was in the majority now this is a really interesting piece of data, I think this is also from Anna Catter, this was published earlier this year she did a survey of a series of anti-vaccination websites and then sorry she typed the term vaccination into google.com and then worked out the number of websites that were anti-vaccine versus accurate now on the left here you can see when you type vaccine into google.com in the blue bar the amount of websites that you get that are pro-vaccine sorry let me just swap that around so in the middle type vaccination into google.com 70% will be anti-vaccine 29% will be pro if you type vaccine not vaccination into google.com you switch those statistics immediately if you type immunization into google.com 100% of the information you get is going to be anti-vaccine so it's an indication that the words that you type into a search engine are also going to affect the amount of information that you get that's accurate versus not accurate and of course there's the sort of canards and tropes that the anti-vax crowd use I'm not anti-vaccine I'm pro-safe they cherry pick scientific information to suggest that vaccines are not safe or effective they try to discredit their dissenters like the likes of Steve Navella and David Gorsky and then they move the goalposts as well so they change the villains so initially it was MMR caused autism then it was thimerosal causes autism and now it's just generally mercury or other toxins or too many too soon and of course they try to silence people by slapping lawsuits on them as well and they're misleading in the sort of in the names that they use for their organisations so the National Vaccine Information Centre doesn't particularly sound anti-vaccine the Australian Vaccination Network doesn't sound anti-vaccine and in fact just last week in Australia the Australian Medical Association was calling for the Australian Vaccination Network to change their name after the midwives association accidentally sent an invitation to the Australian Vaccination Network's seminars to over a thousand of their members because they didn't realise they were anti-vaccination now celebrities this is a big problem because the way that the internet works these days a celebrity can open their mouth and condone something or say that a detox product works or that I used homeopathy to treat myself for malaria and it gets stuck in our consciousness it gets splashed all over the magazines it gets splashed all over Google and we're stuck with that forever and we're divided by sense about science which is a charity in the UK this becomes a problem here's our favourite Jenny McCarthy on Oprah she's given a lot of time in high profile shows to talk about her theories that vaccines contain toxins and in 2009 she went into Time magazine and said look it's not our fault that we're not vaccinating if these companies cleaned up the vaccines took out the toxins then we'd use them and those little lines that are in that are swear words which I won't repeat and we're up against this we've got our people like Dr Paul Offit who's preaching accurate science based information but you know he's not as pretty in a bikini and he just made a rotavirus vaccine and he's got all these letters after his name but my god it's so boring because you know Jenny had this boyfriend who was really funny and the thing that's interesting about Jenny is she objects to toxins in vaccines but she doesn't mind a cigarette every now and then as she has said that I really love Botox I absolutely love it I think it's a saviour which is kind of funny because it's one of the most toxic compounds known to man and she puts that in her face but yeah and of course you know doctors are not immune celebrities are guilty yes but doctors aren't either we've got Wakefield who's responsible for one of the biggest health crises in the history of medicine so where do you find good information there are places there are lots of places you just have to be careful this is one of the oldest codes that indicates an accurate website it's called the health on the net foundation it's swiss and it was established many years ago to try and indicate a website that contains accurate information I want to just say as well as I tell you any more that this is not a 100% guarantee either you still have to exercise skepticism you will find websites that have the HON code stuck on them that are not HON certified because people can easily copy and paste this and stick it on their site so you still have to use the tools that Steve and David have told you to determine if you really are getting the right information but the nice thing about the HON code is websites the HON website itself is a search engine you can go in here you can type in vaccination and then you have categories that you can select from as well so you can choose if you want information as a health professional, as a patient if you want it for children, for teens and that can give you you can drill down the information you're after web of trust is a crowdsourced tool therefore it's open to abuse obviously and it just relies on people voting up or down websites it's a browser plugin it allows you to go and vote for sites based on their reliability in your opinion and depending on the crowdsourced to votes sites will get a little red dot next to them or a green dot and you can leave comments and say why you think this site is bad this is a screenshot from the reviews of the Australian vaccination network and by the way they've got a red dot meaning not a safe site and they completely blame us for that but if you look at the comments we didn't do it all and in fact we didn't even know about what until they complained that we'd done it and then of course we went there and voted and if you have that browser plugin you're typing vaccination to google and you can see you get a green dot next to the wiki entry a red dot next to the Australian vaccination network and it just gives you a rough idea of how people have interpreted the information on that site um as Steve's already covered a lot of this so I'll just quickly go through it so you want to make sure that the website discloses who owns it who's running it if it's just one person be aware who's paying for it the quality of information is it coming from a bunch of experts or just one person are they citing scientific information or is it purely references that they've got from whale to or macola or quacks can also cite scientific papers but they can use them in the wrong way how much is the information complete is it cherry picked is it all there and are there lots of anecdotes and testimonials because if there are you should avoid it this is something I just came across in the last few days and I think this is really fantastic this is the who the World Health Organization have actually conducted a project called the Vaccine Safety Net and what they're doing is going through websites that provide vaccine information and determining if they're safe and accurate and then they're giving them sort of a who's stamp of approval which means that you can rely on them for accurate information there's a list of approved websites through the who there's a URL there which is really long but I'm sure if you search the who for vaccine safety net you'll find the list the list is at the moment very long it's got sites from all over the world in different languages and it gives you a guarantee that you're going to find something good there's also a search engine called Vax Fax which is from the UK which just overnight added a link to this so that you can find the who stuff so obviously the other ones are the CDC the who the National Network for Immunization is also a good site and the Children's Hospital of Philadelphia which is where Dr. Poloff it's from and the Immunization Coalition all of these you'll find through the who and the standard sort of Medline Plus and WebMD NHS Choices which is a UK site but it's also very good for general information and of course Google Scholar some of these are a problem because the papers on there will be paywalled so you won't be able to access them unless you've got a subscription so I want to just finish up by showing you a video about celebrities and science I think it's self-explanatory I'm Terence Luthan like millions of Americans I know the facts about vaccines I know Andrew Wakefield recently lost his medical license for fraudulently research and the connection between autism and vaccines I know vaccines are supposed to be essential to improving public health but I also know that all of this information comes from scientists and medical doctors and is based on something called research as an American I rely in a much more credible source of information Jenny McCartney I've heard the British Medical Journal's claim that the anti-vaccine movement has caused such damage to public health is to be without precedent in human history and it seemed fairly convincing until I realized that nobody at the British Medical Journal or expert Paul Offit is actually a celebrity look at Offit's body and face now let's see those very same parts on Jenny McCartney suddenly Offit's argument doesn't quite hold up the Center for Disease Control and the Food and Drug Administration have both condemned anti-vaccination claims as dangerous and misleading but has anybody from these organizations ever co-hosted an MTV dating show? I think not Advantage McCartney So I was obviously going to do the only sane thing and have my child vaccinated but then I heard that Jenny McCartney said that vaccines were dangerous and she was in scary movie three so she must know about vaccines In America the better looking you are the better smarter you are Einstein can talk only once about relativity but look at his gnarly hair experts in the UK claim that because of the anti-vaccine movement measles have become endemic for the first time in 14 years and the incidence of mumps has risen between 13 and 37 times but have any of these experts ever appeared on even one episode of Just Shoot Me? No and Jenny McCartney's been on three three so you can keep your fancy facts and highfalutin information to yourself I subscribe to something much stronger the uninformed amateur convictions of Jenny McCartney, American celebrity That's it, thanks What do I do to make it play? Left upper corner I was thinking you were I forgot yours was not in keynote Okay, we're in business I kind of got short change but I've only got about 15 minutes worth of material so if you can cut into your lunch hour a little bit I'll try to talk as fast as I can My subject is Dr. Google in Complementary and Alternative Medicine and that's 13 syllables so I'm going to cut it down and just call it CAM What can I tell you about Googling information about CAM? Don't bother I mean seriously by definition CAM is medicine that has not been adequately tested and proven to work so if you find something on Dr. Google that says one of those methods works you know that's wrong if you find something that says it hasn't been proved to work well you already knew that there might be other reasons to Google CAM for instance you might Google it in the spirit of a visit to the zoo we all like to go to the zoo to marvel at the variety of life forms and to chuckle at the monkey's antics and CAM is like a human zoo there's a great variety of strange creatures whose vocalizations and behaviors can be very amusing like this breatharian who says he lives on air and he swears he has not had anything to eat or drink for seven decades now I don't know who's stranger this guy or the doctors in the Indian army who are studying him to find out how he does it so they can teach it to their troops just like people like to visit the zoo they like to visit other worlds they do that through travel, science fiction psychedelic drugs, role-playing games but you can also do that through CAM you may not find anything quite as strange as this picture that I found on the internet but you can visit some pretty strange surreal alternate universes where germs don't cause disease wild animals don't get sick DNA has 12 strands, not two water has a memory and you can prevent and cure every disease known to man if you just eat right you might want to go on an anthropology field trip to study other cultures and customs you'll find a tribe that prefers imagination to reality that has its own unique mythology and practices bizarre customs like sticking lighted candles in their ears and drinking their own urine did you find us through our website? yes, as a matter of fact you could study human psychology CAM is a great place to learn about weird ideas how they get started, how they get perpetuated or you could do it as an exercise in logic it's a great place to play name that logical fallacy you could do your homework for logic 101 by finding examples on CAM I think if Mr. Spock looked at the average CAM website he would call it highly logical so I've had my fun but now I'll try to get serious I have a hard time being serious about CAM because there's so much that is just batshit crazy and rolling on the floor hilarious and some of it you've got to laugh or cry but I try to make fun of the ideas and not of the people these are not stupid people they're not crazy they're just misinformed and misguided so I don't want to laugh at them and there are a few of them that are carnartists and scumbags but we shouldn't be laughing at them either we should be figuring out how to stop them so seriously the reason most of us Google for CAM is to find out if a health claim is credible is it science, is it scam is it speculation and I do this all the time and I thought it would be helpful to show you exactly how I go about it and let you follow along step by step as I investigate a typical questionable claim if you remember Winnie the Pooh they went on an expotition to the North Pole well I'd like you to come with me on an expotition to the wiles of the cameraverse where we can thrash our way through the Google jungle in search of the elusive truth this particular expotition starts with a page in my local newspaper at first glance this looks like six columns of news but the whole right half of this page is an advertisement for a diet supplement called Procerra ABH if you have good vision and you're very alert you might notice the little words in the advertisement tiny print at the top but they're counting on you not to do that they want you to think it's a news article the headline says memory pill does for the brain what prescription glasses do for the eyes wouldn't that be wonderful claims US surgeon general candidate well who is this guy they identified him as Dr. Paul Nemeroff and it's easy to find him on Google he's an MD and a PhD great credentials CV medical journalist and he has invented and sells his own diet supplement the Procerra website says he was invited to the White House where he was considered for surgeon general of the United States and I couldn't verify whether that was true or not but even if it is that doesn't carry much weight when you consider that one of our recent presidents followed the advice of an astrologer it says that he's published hundreds of articles he's done research but when you look on PubMed Dr. Nemeroff was invited to the White House in 1998 with his name so my next step it really doesn't matter who says what matters is whether what he's saying is true so I went to the Procerra website the first thing I found there was a video with a title breaking news that's intended to make you think it's from a TV news program but it's actually just an infomercial with Dr. Nemeroff there's a special offer there's testimonials and that's where I'll find it but it didn't help very much it said a study was done but it didn't provide any links or details or even any information that would help me locate the study so I went back to the newspaper ad and it said a randomized double-blind placebo control study published in a leading scientific journal well I went to PubMed and googled JAMA and Procerra nothing came up so I went back to Google and I googled JAMA Procerra that came up was a news story in a tampon newspaper and it pointed out that it wasn't JAMA but JAMA boy did I have egg on my face I had done exactly what they expected me to do and I'd misread it as JAMA which really is a respected journal the JAMA is the Journal of the American Nutraceutical Association it's an obscure journal that was published erratically for a few years was never listed in PubMed and the only way you can get it today is through a CD that has all the back issues but I kept looking there was a clue the Procerra website did happen to mention the name of the principal researcher so I googled his name along with Procerra and I found the study and I read it and then I asked was this a good quality study well in his book Snake Oil Science Basel proposed a simple four point checklist that will give you an idea of whether a study is likely to be credible to cover each of these on the next slide first was it randomized with a credible control well this study probably was but we really can't tell because they didn't describe the placebo they didn't describe their randomization process and they didn't do any exit poll to see if the patients had been able to tell which group they were in were there over 50 subjects in each group no 43 and 31 was the dropout rate less than 25% yes it was 18% published in a high quality journal definitely not so the highest grade I could give it is 50% which is a fail here's what the study showed compared to a placebo group the Procerra group showed significantly more improvement in working memory accuracy long term memory consolidation and one measure of mood but not in all the other measures of mood or any of the other things that they look for like information processing speed information time and it's important to remember that statistically significant doesn't mean clinically significant and the magnitude of the changes in this study were small here's what the website claims that research showed it's not important to read all the details but you might notice that it says things like improved concentration self-confidence reduced anxiety and stress that's not what the study showed compared to what they're saying it said well obviously they're misrepresenting the research which is a polite way of saying that they're lying so next I wondered what was in it and it's easy to find the label on Google the AVH and Procerra AVH stand for acetyl-l-carnitine vimpositine and hooprazine A how much of each? they're not telling they've mixed it into some kind of a proprietary blend they tell you the total amount so the next obvious question is do we have any evidence that any of these three ingredients actually does anything to improve memory the first place I looked was PubMed and when I go there I put it in as a clinical query which cuts out some of the extraneous results and I looked for Cochrane reviews the Cochrane system is like the goal standard for evidence-based medicine but they do reviews where they look at everything that's been published in the literature and they try to put it together and make sense out of it I use Wikipedia a lot I know people make fun of Wikipedia but it's really pretty good most of the time it's a good place to start and get an overview and they give you references so you can go look at the original documents and make up your own mind from them and I use the natural medicines comprehensive database which is I consider that the Bible of natural medicine information unfortunately it's subscription only but it said it listed all three of these ingredients and it gave them possibly effective ratings for dementia safety ratings range from possibly safe to likely safe they listed a lot of adverse reactions and interactions with drugs and when I combine the information from all these different sources here's what it boiled down to for vimpositine there was one study in healthy people with only 12 subjects the Cochrane Review found three studies in adults with dementia and said it was inconclusive for Hooper's DNA there was one small study of neural people and some favorable studies in people with dementia the Cochrane Review found inadequate evidence to make any recommendations for acetyl-l-carnitine the Cochrane Review found that all the available studies were on Alzheimer's disease and there was some evidence of benefit but there was no evidence using any objective assessments so not much there was another website selling procero the brain research labs and they had a big long list of more studies but they didn't amount to much they had things test tube studies and rat studies like this one they had studies of vimpositine for coagulation that doesn't have anything to do with memory and they had a study of oxidative damage and mitochondrial delay and aging which doesn't have anything to do with memory and it doesn't have anything to do with any of the components in the product no clinical studies of procero okay what about the marketing ploys well in the original ad they had pictures of a research facility building in a white coat and they had this picture of eyeglasses in an eye chart to emphasize their fault analogy with glasses but wait there is more 90 day satisfaction guarantee free rapid brain detox formula to the first 500 callers lots of testimonials frankly fault statements like who cuisine has been shown to improve learning memory at all ages well we've just looked at the evidence and we've seen that that isn't true in bombastic language like time travel for your brain well boys and girls this is salesmanship this is not science so my next step was to google for criticism of procero so I didn't find anything on the usual skeptical websites and blogs so next I googled for procero reviews and most reviews amount to testimonials by people who review it by trying it themselves and if they think it works they want to tell the world I finally hit peter at a place called supplementgeek.com and supplement geek had found a lot of interesting information the company's address is a residential area there's no company website just the procero website they're in the bad graces of the better business bureau and when he phoned the company to ask a question that led to a whole series of aggressive phone calls trying to sell him the product he found that when you buy from them you're automatically enrolled in an automatic shipment program that charges your credit card $134 every month until you specifically tell them to stop the TV commercials are misleading dr. Nemerov has a financial interest in selling it and the guy who invented this stuff there's no evidence that he has any background in science he's definitely not an md or a phd they've learned what we google for so if you try googling for procero and scam you get testimonials saying it isn't a scam and if you google for procero and skeptical you get I was skeptical but I tried it and it worked for me so is this science scam or speculation well it's clearly not science and the evidence is low quality and inconclusive they've got faults and overhyped claims so if it isn't a scam it's speculation that's been wildly extrapolated from a grain of truth does it actually work for anything well we have absolutely no way of knowing because it hasn't been properly tested anyone can do what I did you can follow in my footsteps you don't have to be a doctor or a scientist to do this sort of thing and I have a rule that I think will be very helpful before you accept any claim try to find out who disagrees with it and why and when you do that and look at the arguments on both sides it's usually crystal clear which side is right you can brainstorm and look at all sorts of places starting with quack watch science based medicine and skeptical blogs you can look up the people you can look on amazon for customer reviews you can look at the better business bureau product name and complaints and you can be creative you can probably think of a lot of things that I didn't think of and look for red flags these have been covered before so I'm just going to skip over them if you still can't find anyone who disagrees that may mean something in itself because people disagree about everything even about whether men actually went to the moon so if there's no disagreement on the internet yet it's probably because it either it's too new or because it's so silly that your reputable scientists don't take it seriously enough to even talk about it so if you can't find any disagreement your best bet is just to withhold judgment there's always disagreement the TV says studies show people are more likely to disagree with something than agree with it and the guy says that's not true so if you just remember to look for who disagrees with it and why that'll go a long ways towards taming Dr. Google you can work for you instead of against you everybody uses Google even Bart Simpson he's writing I will use Google before asking dumb questions just don't overdo it even skepticism can be overdone I don't believe we've met I don't believe you don't believe we've met that's all thank you well our various talks were so comprehensive and thorough there's no need for any questions so we'll just end right there but if you do want to come up and chat in the break afterwards we'll be happy to hang out thanks


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