Thanks for staying with us. Just before this time, we saw the quote of the day, and it was to take care of your body. It is the only place that we have to leave, and it was very, very deep. If I ask you a simple question, when was the last time you went to the hospital? I wonder what your answer would be to a lot of Nigerians who will be, No, I never go to the hospital. I'm never sick. It's just headache sometimes, and I take paracetamol, and that's the end of it. And to some people, if you tell them to go to the hospital, they will tell you that when I go there, they are going to discover so many things I don't want to hear. Would you rather just pass out even when you have the opportunity to correct whatever may be wrong in your body? So every once in a while, please do that check-up, no matter how small, no matter what about, but just do that check-up and make sure that your body is fit for the next day, because we don't want people just breaking down, just passing out, just falling down. And before we know it, they are six feet under the ground. A lot of things are wrong with us, and we have to be sure that we're taking care of ourselves. Let it not be said that it was our fault that whatever happens to us happens to us. Okay, it's time now to look at the papers. We've been joined by Mr. Tunde Kolaouli, a legal practitioner here in Lagos State. Good morning and welcome to the program, Mr. Kolaouli. Good morning, my brother. Thanks for having me. Good. Okay, we're looking at the papers this morning, and we're beginning with a Guardian newspaper. The Guardian newspaper begins with a story on seven states on Niger borderline. Bandit smugglers rain as sanctions hardship ground communities. That's the headline in the Guardian newspaper. It appears the sanctions on our sister country are affecting Nigerians as well as Nigerians. Well, that's the truth. Bandit trails become the trans-border issues in West Africa. And not even just West Africa alone, one can see almost all over the world. The borders have become so porous that all these bandits and criminals just move from one place to the other. And unfortunately for all of our people, the air force would appear to have broken them. Three of such countries came to Niger, and because of what? They have broken apart the rule out of the air force now. And so fighting these trans-border crimes and all that becomes a lot more difficult. But like somebody have said, when you look at the banditry that we have in this constituency, whether it be a banditry or a kind of a ruler banditry, you will find that they are also home grown, locally met. It's our people that are expensive for some of these things. Since the banditry is home grown and northern, we should be able to find home grown solutions to these trans-border crimes. Too many lives are being lost, too many properties are being destroyed. So much of the air playstyle among the people puts security in jeopardy because of the ruler banditry. So again too, it becomes a very serious challenge to the security of the group, whether they're doing the army, the media and what are they. So much of the air force that they are making seems not to be using the desired results. But I am of the opinion that we can overcome this, that Nigeria can defeat the banditry and then the nation will become new and then we will be able to move forward once again as a people. Okay, in both the punch and the Daily Trust newspaper, we have a kidnapping epidemic. Now that's what we're calling, it's an epidemic in Nigeria. Abductors demand 100 million for a kid to school children and teachers. And the rider is a police, NSCDC, a Motecun OPC Hunters, formed joint tax force arrest five suspects. The brazenness with which these people are demanding for money, it's terrible. 100 million for students, for pupils that were abducted. I don't know why they are so confident nowadays and they are doing what they're doing, asking for amounts of money that Nigerians ordinarily cannot raise. One last question you will recall that last week we discussed something along this line. That the kidnappers are the combat radio officials, that they even have notices in the community that they are coming to attack and abducting people. They also direct the people paying the ransom to go and pay into certain banks and water bills. So when kidnappers become that official and they can tell you and direct you to bring ransom to certain places and also go and pay into the bank and order. They must have been doing this because they know there's never going to be consequences. They will never be arrested. But they will never be punished for their crimes and water bills. And it begins to wonder, where is this obesity problem? Why are these people becoming aggressive and demanding? And then I can really find solutions to these problems and water bills. Like I argued when I should discuss this like this. I would want to say that unemployment is contributing to this, and you shouldn't be honest. You are not saying that because you're unemployed, you should take to criminality and war as well. Furthermore, it would be better if technology is also contributing. Why the security people are using technology to track the criminals and water bills? Those are engaging people. So the criminals are also deploying technology to carry out their nevarius activities. Of course, we also recollect that, as I argued, that the sensations like that the civilians are living, that the people's husbands are living, that the activities among those in the efficient footballers and water bills, who buy those toys and make that they are these mansions and advertise it on social media. It's foiling all this criminality like it happened. And also yawu yawu and then the money-making mutuals. So if you are going to come on top of all these things and others, it's really keeping happening. As well as to the gas to all the footballers who are meeting the task. They just haven't deployed. Policemen haven't deployed. The U.S. government just hasn't deployed and what have they? And what have they done? Eastern Nigeria security network has been found in some of these places. Still, they are unable to arrive at this horrible situation of kidnapping and insecurity. They are part of the U.S. They are required to have an holistic approach to creating jobs for people, also deploying more coordinate technology and others. And also engaging in youths in terms of civic education, in terms of the video education, in terms of educating their children on the need to disease of criminality and kidnapping. Because no matter how intelligent, no matter how smart you are, no matter how brave you think, sooner than later you are going to be caught when you are engaging in kidnapping and murder. The youth that we have to appeal to the youth to disembark from this period of time, we must also begin to engage the youth in such a manner that the devil will so find a job for the I do Han among our youth group population. The newspaper where we have a direct consequence of security or failure in security or insecurity in the country. So tuition fees hike imminent as private schools spend fortune on security. Now the schools themselves have to be the ones that will secure them and their pupils or their students. And because of that, tuition fees are likely to go up. Most of these things have the words may also, we could get at the work they are done, you are calling it that. Society is a chain. When one of the weak link in the chain is broken, I know that sooner than later it will affect all the other aspects of the chain. Say for example, this is a bandit, a group of bandit, for example. I mean, we could not have the say that it is going to have a very serious consequences, such as it is hard to include them in security. But that is the way things work out. We just want to make these issues full of insecurity so that the people can move forward and the people can begin to do or sleep with both eyes closed and we have the opportunity to move around, not just to go to farms, to go to schools, but to even travel around the country that we used to do. To recap, the schools are not aware that the schools are not spending the fortune on security. Say for example, most of them are not reading words, fences are not their schools. The implication of that is that the schools are, again, also becoming a prison and not a prison. In addition, we find out some of these could lie in stores. Security cameras, higher and deeper. Most security cameras are not there. Implications are very, very good. When you spend more money providing security, that will end up with the transfer of security to the school fees. The providers of those who increase the school fees are not there to be able to recover their money and then provide security to the children that are in school. So it is not a one-in-one situation for us as an individual. The security service models put on their thinking cap. And break this visual factor of insecurity. These are these are values that have been reached on our people. And we will not be able to break it onto the natural position, begin to have the change of mind. That some of the children do, in transition life they live in, the national resources, the lack of the natural resources that they are looking to themselves. They are able to enjoy our leaders and realize they are living. They must be ready to do some of these things. They must be ready to make sacrifices. They must also be ready to tighten their own belt, just like there is no one on the street to do. After all, the bandits are human beings too. And when they collect this money, they don't spend it in the bush. It is in our main thing, it is in the city, in the towns and the villages that they spend the money. That tells us that the bandits, the Kitapa, they are not good. They are human beings like any other person, like any other ordinary children, that we have them within us in our houses on the daily basis. Well, we have an arm of the NBA, lawyers also calling on the president to declare a state of emergency. Civil Society Legislative Advocacy Center, known as CISLAC, has called on the president to declare a state of emergency on security. We also have this headline still on the Guardian newspaper, which is saying that the Senate has summoned, once again, the security chiefs to a meeting. The Senate summons service chiefs over insecurity. So is this all doing any good for us? Every day that security chiefs are being summoned and summoned and summoned, we don't seem to see any improvement in the security situation. Is a state of emergency the way to go? I don't think so. When you declare a state of emergency, what are you? What means is that you are breaking the fundamental rights of the people living in the state of, in the environment, in the state of emergency, in the emergency as in declare. What you are doing is giving the security people the kind of escalating good powers for authority to deal with the security challenges they may be confronted with. And when the security people use their legal means and know that, most times, it becomes an entanglement on the right of the people. People will be killed. People will be detained or kept in custody without following the safe of law. And of course, so many other policing will happen when you declare a state of emergency. So I don't support it. And we are dealing with the private places of emergency in different parts of the country and other. And what we are doing is to amaze or provide a solution to the security challenges that we have in our land. I don't think that is the solution. And when you also look at the nature of the security channels that we have in there, they are not amenable to a state of security, I mean to a declaration of the state of emergency. We are talking about kidnappers who live in the bush. So when you declare a state of emergency, they are not. You will be declaring in the towns, in the villages, in the amulets, in the cities, they are not. You will not be able to declare a state of emergency in the kids' forests and with these kidnappers they will play a war on them. Rather, I would want to say a situation in which we are strengthening the identity book. We are already set to claim for more than two years now the children will have been battling the Bukwara with almost their hands, the kind of equipment that they should have, the kind of motivation that we should be given. We are not providing it for them. The difficulty for a human being themselves is not that. We don't expect them to go and start combatting or combat the kidnapper with their hands and then on them to stomach and war at them. Let's get our proper order to rise and war at them because for me, we are not getting it right here. We devote too much attention to politics, to politics and more of that. I almost made the next five years the rest of the nation has been suspended on speciality, I mean on non-policy. So if we deploy half of that resources to tackling insecurity, to tackling unemployment and war at them. To ensure that we have motley bulls all over the country and water. To ensure that we keep the children off the street and off criminality and water. I am sure we will be better for this as a people. It's important the security people, they are in the rural area, they are in the forest, they are in the city. They are on the roads, combat criminalizing the different parts of the country. In the south, they are losing their lives. So I suppose there are no marathons for criminals in those places. So if this is the case, the declaration of reserve agency is really not the solution. But to have a kind of a mystic approach is very, very important, a mystic approach to finding solutions to this criminality to finding to kidnapper that we have now in Nigeria. Imagine, two of us in the city who are brutally murdered this past one week. How do you pass on that? In those views of us, my God, we are not going near the children with ours. But we can now stop of us on the road kidnapping and killing. I'm the general. I'm the general for these commissioners and the IGs and others have also been kidnapped. Honestly speaking, what all this points out to is the failure. Nigeria has already manifested the failures of the failed state. And there we are at this situation the better for all of our people. Okay. Two other matters. Now, let's begin with Sign Executive Order on Unexplained Wealth and Dumetel's Tinubu. Let me combine that with something that a lot of people will see as some kind of gain. Nigeria ranks 145 on graph index call graph index scored 25 out of 100 points. Okay. So your comment on this it seems like we are moving up a little bit. But 25 out of 100, that is 25% of whatever assessment that is being used. What paper did you pick out? The Guardian newspaper is still on the Guardian newspaper. Nigeria ranks 145 on graph index. Take that again, take that again. Nigeria ranks 145 on graph index scored 25 out of 100 points. What? Well, we don't even need any information organization. We are lost where we stand in terms of corrosion in this country. I mean this is as the animal in the face. Like I said, what you require to do is look at the cost of contact in this part of the world. Cost of contact is higher than Nigeria when you compare to some other parts of the world. When you compare to some other other political countries when you compare to some other four countries and what have you. And it is generally the same material that is going to be used for this contact. So why is it higher than Nigeria? And again, to look at the kind of money that we are spending on the politicians that are on account of security boots and what have you. Not only my own understanding of the law is that whatever money is appropriated from the national resources is accountable. We are the governors, we are the local governments who are known. We are the vice presidents and the presidents are not. I've gotten the idea that the security boots are not accountable. This is my own imagination. At the end of the day, where you find out security boots, for example, in the high commission legalization of corruption between the rich and we look at the kind of money that are being done to verify information as we gather the poor citizens of the poor people in the country. Millions and millions of people from Naira. Money that is even higher than what you want to spend on the poverty for the people you say want to rescue from poverty. So, and then again this last week the chairman of the UFCC came out to say that some oppressors of the UFCC now take a bribe to frustrate the education software of the software. So, these are individuals that are carrying us in the state that are already here. And we don't need any international organization to really tell us where we stand. This is just a corruption transparency and it's confirmed much better. Most unfortunately and not there isn't say to say any point up to the say that things will change for the better in the Naira situation simply because businesses are nearly being done by politicians, by businesses, by people in the way and manner we have already been doing and which has put us in this kind of situation where we are found outside. It's indigenous organization across both. So, you subscribe to what Ndume is saying that there should be a law for unexplained wealth. He said sign executive order on unexplained wealth Ndume tells you agree to that? I don't agree with all this executive order in Naira. This is a hypothesis if you sign executive order and order on unexplained wealth and then the police will ensure compliance with the years that we enforce compliance the years that we enforce the compliance and order as themselves particular in the corruption and we will be able to enforce the executive order with regards to unexplained wealth unexplained wealth. Besides, we are not too good or we are not too comfortable in generated data and the easy data in this part of the world. How many of our businesses how many of the so called Ndume that we have can keep the adequate records of their business transactions and order? And even the few mechanisms that the machinery can deal with us to ensure compliance to get people to comply with unexplained wealth the answer is no. Most times when people steal money and pay the money on Ndume or misappropriation of public funds and all that some of these monies are not going to take it to the back for example most times they are trained to dollar fan selling and all that so in some ways that have been done in the private business of some people's homes and water and you will recollect we once had the situation in this country in the past one of the foremost technical sources and orders was sitting on billions of Nira dollars and water and when you see this man you hardly would believe or know that he is a billionaire he dresses in a rag with easy weight profile he flies the economy class and he is traffic and water but when he suddenly died and all that the cat was let out of the bag and then he's honest, plain waste that came into the into the open so executive order identity is the solution so in this country to really cut off with whatever they are culminating with in an unlawful manner the challenge has always been the enforcement of this law too many laws doesn't need to to comply when you make too many laws on the same issues are not people will begin to ignore those laws people will begin to talk with us because the impression you will take is that you don't know what you are doing and I've also said one thing in the past which I want to repeat another laws are not supposed to be a sacrificial for a kind of manual which everybody begin to carry around like a sacrificial like a Bible for behavior for relationship with people and water some of these issues are better handled morally and ethically than just making sure to confront all potential challenges that we have in our world it doesn't work that way okay labor is saying 200,000 minimum wage is no longer realistic what's your comment on that the committee has been set by the the presidency workers demand living wages as federal government on veils negotiation committee they use daily trust to say that tax minimum wage committee to dialogue in good faith but we are taking this story that is from the punch newspaper now 200,000 minimum wage no longer realistic that's according to labor what's your take well I agree with labor even if an employee is paid after a million per month to pay how does that solve their problem say for example the legal environment another in most parts of there are barriers like insolubility and water the human policy container goes for 70,000 per month so if a man in legal 500,000 per month who feels to pay transportation to make to do 10 people are dependent on him and Nora how would 200,000 solve their problem then take what has happened in the past heat and salaries have been increasing in this country has he ever solved the problem of inflation has he ever solved the problem of the people the answer is no because only a fraction of those who work for the government pay this minimum wage and many of them pay the other person who is not earning the minimum wage he is a petty trader he is a transporter and worker he also hikes because of these groups and practices he hikes inflation before the order of the day poverty is eliminated I want to see a situation in which we look at some other ways of solving the problems of people's wages not taking them home for example you can subsidize the schools instead of increasing school fees like the universities have a technical dream next for that cost them dam and water transportation one good thing the federal government did on the last salary they deployed the Nigerian railway to carry people to the south the nations and the khalkis in two of those buildings every child has been to school that uses the railway that uses public transportation like the PRC they will use those facilities free of charge or it will be sold to them as a kind of special education for children who go to school for all people in our needs and for the unemployed people you can also begin to create two bands we have people who are unemployed we have people in the Nigerian can have at least one good square meal in a day I am not talking about I am also not talking about the subuting one combo of rice for about 500 to 300 people and then you say them to and they say we could have the situation with some of these entries to be contracted you will have a special design special package a minimum certain two packages are not with some of these issues and now certain people will be registered in the food bank and then the federal government will say they are related to those food that goes to the entries depending on the number of people that have been listed with that situation the individual people in the site will get good and clean food and water that will also help those people the entries will help that food supply the chain and then of course to let's begin to subsidize agricultural inputs that the farmers are using we could also have provisions for the farmers to be able to buy farm equipment and equipment in a very cheap manner that kind of approach might be more helpful for the farmers and wages of the two civil servants that we have at the federal level at the state level at the local government level we heard that we are judging people in this country in which people just receive the money are taken by an electronics and then the cars and water by the time all the households got in queue with the electronics and knowledge they began to face the challenges of power supply when we did not plan for the power supply to really expand their plant and facilities to be able to cope with the high numbers of electronic gadgets of people who got increases in power and wages began to apply and installed in their homes well I agree with you that solution to the problem is not just increasing the minimum wage because at the end of the day you are increasing the minimum wage and the traders on the roadside are listening, the landlords are listening everybody is listening some of them are workers so they know when this minimum wage is increased and then it is just a fraction of the Nigerian population that works for the government that will be affected but now Naira plunges in the official market CBN wants forex dealers to combine that with the fact that IMF foresees weaker growth I'm sure for our economy so Naira keeps plunging and we were told that whatever policies have been done have been put in place will make the Naira stronger and stronger it's now going and some people are looking at the fact that maybe before the end of this year we are going to have Naira to a dollar 2000 Naira to one dollar and it's an indication that it is going to be a lie at the end of the day we are going to reward Naira I'm sorry I'm being pessimistic it's going to reward Naira we are now noticing this is a basic economic theory that when 12 goods and services are changing the large volumes of money what you get is a kind of inflation it also tells us that what determined the sense of emissions quality it is a productive base the number of goods and services that we provide in that environment in that country look at the number of companies that have left in a year that have talked about and which facilities have been taken over by the churches and what have you just imagine the number and what have you the companies that are leaving Naira and shopping and their plan manufacturers are not taking place and what have you how are you going to send in the value of Naira this much I will beat my imagination the fact my solution is that if you are not careful sooner than later in a very short while the Naira will become like the Zimbabwe dollar in which one you want to buy ordinary tomatoes you have to go to the market to buy the Zimbabwe dollar to be able to buy ordinary tomatoes and that is beginning to happen in the billionaire a house where one company not long ago has a basket of tomatoes in the northern part of the country where tomato is sold is now sold for thousands of Naira in that part of the world when you go to the legal market or the other market the situation may not be different so the prediction that our growth rate is going to be about three percent is coming in this year in northern it's not perfect it's not important if we go to work than that if no effort has been made or if we are not making serious effort to relay resources to revitalize to kind of ignite the productive base of the Nigerian economy and what is the productive base manufacturing agriculture mineral resources exploitation beneficiation and sales in the international market and of course to diversification of the energy needs of the country we need to also begin to embrace the new energy speciality energy sources instead of these it also depends on food we do things sooner than later we also let technology go that nobody wants to have anything to do it it's the world bank or any of these other agencies don't need to tell them these are things that we already know but if we already know what are we doing to ensure that the growth rate in Nigeria does not remain the same that Mandakara don't start starting on their plans and leaving the country this is what we should be addressing the horrendous time as much as the 70% to 50% of the national economy on the politics and you are not going to know what is of no value for any GDP in the nation's economy I wonder where we are headed and we are hoping that we are going to get to the destination we will all be proud of now we have a daily trust airlines differ as CBN claims forex backlog cleared with 64 million dollars we had this time that we were told that this backlog was cleared and we thought that was the end of it but right now airlines are saying it's a different story they have the inside story is the CBN telling lies or they are telling half truths are the airlines being greedy and also are they the ones that are telling the lie I don't even know what it is right now because it's affecting our economy as well they are like putting up and telling lies they say you know it all you say is know it all they are the people who are thinking them so if your creditors can look contrary to what you are saying I am not being paid the backlog of the money that you are holding I don't think the airline could have been lying or telling the nation or the Nigerian people a different story most times when people in government speak they speak with the truth of the DC it's not something that they hope to the people now when you let the people know some of these things it could lead to despondency and also let the people listen to it in the entire system but sometimes it is better to be honest with the people to let them know what is really happening they would get ready for the summer that they are likely to go through because when you lie you know that later people will say if a liar has been lying or on your travel for a thousand years most times you say just one day just one week for the two to catch up with it and if they see the answers hello Mr Kola Wale we we must also address the very difficult task of letting people know the reality of what is happening with regard to the economy with regard to politics and with regard to security okay the second to the last headline I'm willing to take on this segment will be from the Federal Capital Territory wiki approves 30.9 billion naira for rehabilitation of schools you are laughing that's another we just talked about the cost of contact in this part of the world billions to the obligated schools when you say you are obligated schools you are not saying you are building a new world know what you are saying and what you are saying in this thing you need to provide a better or get a newer furniture than water and then the creeps are delighted is that what we are spending billions of naira to do and then you ask yourself how many schools actually exist or do we have in a video of the Federal Capital Territory in terms of secondary schools in terms of primary schools in terms of education in my humble opinion there may not be more than what you have in two or three local governments and they go to for example so we are going to be spending that much naira we are not sure to merely do renovations and that kind of extension I am not saying that we don't have to remove the schools all the schools in the Federal Capital Territory that we have seen on television and in pictures and others are all in batches when the schools in our video of the Federal Capital Territory to be a model for all the other spaces of the education and whatever at least thinking of the education of those schools that the children will no longer have to stand still under the trees and then they will have to be there to share they will have to be there to share to stop them there will be things that are quite different of the people but then I would want to say that spending some of the money of that nature of naira renovation to be desired we can do better than that 30.9 billion ok let's take the final headline here 20 years after 26 states failed to implement new pension scheme the riders are federal government private sector employees benefitting experts urge governors to enroll workers and then pension funds hit 17 trillion naira 26 states failed to implement new pension scheme what do you have to say about that sorry where did you put that so what part did you put that ok that's daily trust daily trust 20 years after well well 20 years after to implement new pension scheme really challenge all the while why is the state that is locked down to implement the pension scheme this is my imagination why do I say this the new pension scheme is because the new pension scheme in which it is not like the mutual benefitted scheme that we have in the past or the defined benefits scheme that we have in the past a worker, a percentage of the workers will be taken from the worker and then the government will also put some cantapas from their needs and then they will be sent to some pension managers and all that in the country to manage and invest and then when somebody retires they are paid from there but to find that even when this money are deducted from the worker salary the local government the state government is another and not to them listen to the pensions that this is a provider all over the country in fact in the past the federal government and the state government have been playing and some of them have actually been given the name in which the state this money and then begin to put it in the corpus of the state in the local government and then begin to spend the money so to say on providing for the people so that when some of these workers retire and then desire for them to begin to draw their pensions and water there is no pension service provider to fall back on their water simply because the state has not been limiting their cantapas and they have not been limiting the funds to the service provider and you know the news pension schemes like an insurance if you take an insurance policy and you are not paying your piano but at one day or another by the time they are making the insurance came much further than water though if you go to the insurance provider and then you not begin to between your money and water but you come back with an empty hand so let's talk to the state the local government the federal government the new pension scheme is easier to implement they should abide by their own laws they should abide by their own proposal they should implement these schemes so that when people leave their jobs and retire and they are all there when the landlord can work they won't be thrown into the abject poverty and on time later that this is how to implement the pension scheme as the current each of the old pension schemes was not in the digital state what activities the government across board does not have not to implement the new pension scheme the new pension scheme corruption and the lethargy and the bureaucracy and who is going to ask us to account for this thing is at the bottom of all these things and it is not fair and imagine what the politicians do for four years they are going for eight years and when they are leaving they are located themselves which is their own packages which is their own packages which is their own packages which is the retirement scheme in terms of all the retirement and laws that can be made in all the states for the governor, for the deputy governor and some other public officers who really start for four years and for eight years so why can't the ordinary worker at the local government at the federal level be cheated in a similar way yeah well eventually this is where we are going to wrap up today it has been a pleasure as always having you join us this morning thank you for your thoughts on the headlines thanks for everyone okay we have been talking with Mr. Tunde Kola the practitioner here in Lagos state we were X-raying the headlines on some of our national dailies we will take a break and when we return we will be talking with our guests on our hot topic this morning Nigeria records improvement in press corruption perception index under Tunde Kola


If you're a GCSE student that's studying Macbeth, make sure you use this grade nine phrase to start any Macbeth essay. The grade nine phrase that you should use is this. Macbeth is a celebrated general whose ambition corrupts him, leading him to become a fallen hero that ultimately dies. This phrase is perfect because number one, when you use it, you are showing your awareness and understanding that Macbeth shifts from being a hero who is celebrated to being somebody who lets himself become corrupted by ambition and ultimately commits treason, which leads to his downfall. Now, don't forget guys, that I'll be running GCSE masterclasses every single week in these final 12 weeks, the final GCSE exams covering language chapter one and paper two, so make sure you sign up.


The Air Force Civil Engineer Support Agency has developed the following video to support the Air Force Qualification Training Program. This video covers step-by-step procedures for a specific task identified in the Specialty Training Standard of the Career Field Education and Training Plan. This video does not take the place of on-the-job training. It is not intended to replace the applicable technical reference. However, this program is intended to enhance the on-the-job training process, standardize the training procedures, provide just-in-time training, and provide the minimum knowledge on a task or piece of equipment when a unit does not have the equipment. We hope you'll find this video a valuable training tool. This Civil Engineer Air Force Qualification Training Program videotape contains contingency operations Damage Control Center. Each base is unique in its layout and mission. Keeping the facilities looking good and the utility systems running smoothly is a major undertaking. The Civil Engineer Focal Point for keeping these systems operational is the Control Center, commonly referred to as Service Call or Customer Service. Each center has the same goal and requires basically the same resources to effectively accomplish the mission. What happens when a contingency strikes your base? This contingency can range from the base being attacked, a terrorist act, or a natural disaster like a hurricane, tornado or flooding. How does the base Civil Engineer Organization respond to the emergency situation? How does it transition from its daily mode of operation to an organization that can effectively respond to and efficiently recover from an emergency? In most cases, the Service Call function will convert to a Damage Control Center or DCC as it is commonly referred to. Some of the larger overseas organizations have separate Damage Control Centers pre-established in hardened facilities that can be activated. Routine non-emergency work is halted at this time. Specifically, the DCC monitors, coordinates and direct civil engineer recovery operations involved in damage assessment, recovery and repair.  They monitor and coordinate their activities through their own in-house control center. The support group commander, base civil engineer, or the operations flight commander can activate the DCC. When you receive the call to activate the DCC, remember to ask for all the information they know about the situation and which key people they want recalled. The DCC staff is usually made up from the senior or most qualified and listed personnel from the various elements of the operations flight. At many locations, a small support staff from the engineering and operations flight may also be included. Additional people may be added as the requirement dictates and space allows. The operations flight commander is in charge of the DCC. There are two centers in the chain of command directly above the Damage Control Center. They are the Wing Operations Center or WACC and the Survival Recovery Center or SRC. The Wing Operations Center is the highest level command post and is only found at bases with a flying mission. This center is responsible for the overall management of the base combat operations and is directed by the Wing Commander. The Survival Recovery Center is subordinate to the WACC and is directed by the Combat Support Group Commander. At bases without a Wing Operations Center, the SRC assumes full responsibility. This includes plotting damage, recommending recovery priorities, and directing recovery efforts. The base civil engineer usually guides CE recovery efforts from this vantage point. Regardless of how many centers are in the chain, specific areas of responsibility must be identified, lines of communication established, and practice exercises conducted to ensure this process works. Once the Damage Control Center is activated, the damage assessment and repair teams need to be assembled. There are a number of different repair teams. There are two damage assessment teams that we want you to be familiar with. They are your main source of reliable damage information. They are the Damage Assessment Team or DAT and the Damage Assessment Response Team or DART. Most bases with a flying mission divide themselves into two different categories for damage assessment purposes. Runways, taxiways, and associated airfield pavement and equipment are surveyed by the Damage Assessment Team. The DAT reports directly to the Survival Recovery Center and normally consists of one explosive ordinance disposal technician, one engineering specialist, and one augmentee. They are responsible for locating and identifying unexploded ordinance and airfield damage pertinent for the development of the minimum operating strip. The remainder of the base falls under the jurisdiction of the Damage Assessment Response Team. This team is used to make a preliminary analysis of major facility and utility damage and isolate utilities in an emergency. Team members consist of structural, utility, and electrical personnel. A number of teams may be needed to adequately cover the base proper. They report their finding to and are controlled by the Damage Control Center. The largest repair team is the Rapid Runway Repair Team. This team is responsible for runway and taxiway bomb crater repair, spall damage repair, airfield lighting, mobile aircraft arresting system installation, and minimum operating strip marking in a base recovery after attack scenario. This team consists of the bulk of civil engineers on a base with a flying mission. The remaining personnel are generally divided into two specialized repair teams, structural repair and utility repair. The structural repair team is responsible for rescue assistance, wrecking and shoring, repair and restoration of damaged facilities, mechanical and POL system isolation, debris clearing and construction of temporary facilities. The utility team is responsible for the isolation, restoration or expedient re-establishment of essential utilities to critical base facilities. This includes electrical, water and waste systems. A number of smaller teams are also required. They include the NBC Reconnaissance, EOD, bomb removal, generator response, and fire department to name a few. Emergency responses are never the same. Civil engineers must remain flexible with the mission of recovering the base foremost in their mind. Keeping track of the assessment and response teams and all the information that will be flowing into the Damage Control Center will take an organized and properly trained crew. The following four forms are used to log and track information. The first form is the Air Force Form 1924 Events Log. This form is fairly self-explanatory and is used to enter events as they happen. Note that this form captures in chronological order each event as it occurs. As each event occurs, the time and description of the event is annotated. It's important to put as much detail as possible because this form will be reviewed after the contingency to evaluate what took place and recommend improvements for future contingency responses. Make sure you have an adequate supply of these or a similar locally developed form on hand to record the events as they happen. There is nothing worse than running out of forms when you need them the most. Both the Damage Control Center and the Damage Assessment Response Teams use a locally developed Facility Damage Report Sheet to report the damage assessment findings. These sheets include the extent of the damage and what repairs are necessary to make the facility or utility operational. Note that this form asks pertinent key questions such as, is the building on fire? Are there UXOs present? It also establishes a damage code to quantify the extent of the damage, provides a description of the damage, and indicates the utility status. Another form used by the Damage Assessment Team and the Survival Recovery Center to record airfield damage information is called the Airfield Damage Report Sheet. This sheet is also locally developed and tailored specifically to meet each airfield's requirements. In the event the Survival Recovery Center turns over control of the operations to the Damage Control Center, these sheets must be readily available in the DCC. The type of information included on this sheet is the type of damage, location by grid coordinates or known reference markers, size, number and UXO data. This information must be extremely accurate because the proposed minimum operating strip will be based on this data. Air Force Form 637 BCE Job Order Log can be used by the DCC to track and control emergency work requirements. During a contingency situation, the only work requirements accepted are emergency in nature which warrant immediate attention to safeguard loss of life or critical resources. This form should use a predetermined block of job order numbers and includes a detailed description of the work required, shop assigned and track the status of the job until complete. These four documents can generally be found in most Damage Control Centers. Locally developed forms are usually present because they have been tailored to meet the requirements of that location. Don't wait until the DCC is activated to find out what forms you'll be using in an emergency. During a deployment exercise or a response to a real world contingency, one of the most challenging tasks is to maintain positive control over personnel, equipment and material. These resources must be accounted for. Should an attack occur, it's much easier to determine their whereabouts if their dispersal location has been pre-established. Likewise, should the Damage Control Center have a tasking for a specific person or piece of equipment, they don't have to waste time hunting. When dispatching craftsmen to perform emergency repairs, the best and most common communication method is the radio. Call the team chief or supervisor and notify them of the requirement. This method of communication is fast, but airtime may be limited and the message garbled. If that method of dispatch is not effective, you may have to use field phones or send a runner. In many cases, the runners are more effective because one-on-one detailed instructions can be given. Keep in mind that the runner method takes more time, something you may be critically short of. Also located in the Damage Control Center is an itemized listing of the equipment that is used in the recovery effort. Each vehicle registration number, type, location and operational status should be reflected on a status report. The DCC commander decision to accomplish certain types of repairs may be based on the availability of equipment reflected on this report. The unit's vehicle control officer or NCO should be the main point of contact for getting information on the CE vehicle and equipment fleet. When the DCC is activated, a vehicle recall should be made and vehicles reassigned to the various response teams. One person should never keep all the keys. A predetermined key location, either in the DCC or in the vehicle, is required to prevent lost time looking for the keys. Whatever method or location is developed, everyone must be aware of the procedure. Vehicles and equipment should be dispersed to ensure their survivability. Dispersal is necessary to keep them from being at target. It is much easier to locate a fleet of vehicles than it is to spot an individually dispersed and camouflaged vehicle. Their dispersed location must be relayed to the DCC to keep the status current. If the status is not kept up to date, it is rendered virtually useless. A complete list of available resources like wood, electrical supplies, piping and backfill material must be known in order to plan for and implement emergency repairs. A copy of this information should be kept in both the Survival Recovery Center and the Damage Control Center. A logistics person is usually co-located in the DCC to assist the commander in making decisions that require these types of resources. Logistics is your link to the emergency local procurement of repair materials. Not only can they help acquire the much needed items, but they can provide insight on delivery times, exact quantities and information on substitutable items. During a contingency, you'll never have an abundance of people, equipment or material. Keeping track of what you have and effectively using these resources is a real challenge. The success or failure of a contingency recovery operation is directly related to how well our communication network functions. There are several means of communications located in the Damage Control Center. Each has its own capabilities, advantages and disadvantages. If at all possible, there should be a backup means of communicating. If you're located on an established base, the DCC should have adequate telephone lines to support all the necessary communications. How many phones are enough? How many key people are going to be located in the DCC? How many workstations are you going to have? Answers to these questions will help determine how many telephones you'll need. The DCC should have direct telephone communications with agencies such as the Wing Operations Center, Survival Recovery Center and Fire Department. These dedicated lines permit instant communication up, down and across the chain of command. At some of the permanent high threat overseas locations, STU-3 type phones may be installed to handle classified transmissions. While these phones are generally found in the Survival Recovery Center, they may also be co-located in the Damage Control Center. The most common method of communication with civil engineers scattered throughout the base is the radio. Radios could become your primary means of communicating with other base agencies when the telephone becomes inoperative. Many deployed locations do not have telephone lines and must rely solely on the radio. The DCC is responsible for controlling the radio resources. Usually, a number of radios are kept in reserve or day-to-day radios are recalled for the emergency. Keeping track of who has been issued the radio is made considerably easier by using an Air Force Form 1297 temporary issue receipt, commonly referred to as the hand receipt. Some organizations use a locally developed master sign out log and inventory sheet. There are a variety of Air Force general purpose forms available to satisfy this requirement. A single form may be easier to keep track of than a bunch of individual receipts. Once the radios have been issued, there are a number of factors that affect their clarity and range. This includes the weather, terrain, antenna, power and the location of the unit itself. Trying to communicate near man-made objects such as buildings and power lines may also affect radio transmissions. The Survival Recovery Center, Damage Control Center and the Fire Department must operate on separate frequencies. All three organizations should have the capability to monitor one another. This enables all three users to communicate independently yet effectively with one another. With today's multi-channel radios, this shouldn't be too big a problem. Communication security or COMSEC denies or delays unauthorized personnel from gaining information from your communications. Common security practices should be followed no matter what method of communication you're using. You never know who's listening. Some of the more common security practices are listed here. These are by no means all the guidelines. Each base mission and the threat potential will determine how in depth the COMSEC guidelines must be. An effective communication program doesn't come easy. Enforcing net discipline and correct radio procedures in the day-to-day workplace will be a tremendous help in a contingency situation where chaos reigns supreme. Non-civil engineers for the most part don't have the same sense of pride that we take driving onto our base each day. They can't appreciate the amount of effort and work it takes to keep the facilities looking good and the utility systems operational. Just let something break and who do they call? Civil engineers. Our ability to respond to peacetime emergencies is the training ground we need to be able to respond to real contingency situations. Civil engineers are organized, trained, and equipped to respond to these emergencies as a matter of routine. Our recovery operations include damage assessment, recovery, and repair to keep the base operating to fulfill its mission. This program was produced for headquarters, Air Force Civil Engineer Support Agency, Operations Support Directorate, Training Division.


Hello again. I'm Dr. Harriet Hall, and this is lecture two in a series of ten lectures on science-based medicine. In the first lecture, I talked about what science-based medicine is. Now I'll talk about what it isn't. Alternative medicine. Today it's more commonly referred to as complementary in alternative medicine, and that's a mouthful. It's easier to cut it down to one syllable and just call it by its acronym, CAM. Sometimes, CAM rejects science entirely. Sometimes it tries to use science and fails. Even when CAM claims to have scientific evidence to support its claims, that evidence doesn't measure up to the rigorous standards of good science. This lecture will be a general discussion of CAM, and in future lectures I'll cover specific areas of CAM like acupuncture, chiropractic, and homeopathy. What is CAM? An old definition of alternative medicine was stuff that isn't taught in medical schools. That definition doesn't really work anymore, since CAM has been sneaking into our medical schools. More about that later. But here's a list of some of the things that weren't taught in my medical school. In fact, I'd never even heard of most of the things on this list when I graduated back in 1970. I had heard a few of the things on this list, like chiropractic and acupuncture, but I didn't understand enough about them to have formed any opinion. And I'd never heard the term alternative medicine. Back then we would have dismissed most of the things on this list as folk medicine or superstition or quackery. Some of them sound more reasonable than others, like herbal medicine. After all, herbal medicine was the beginning of scientific pharmacology. But some of them are just batshit crazy, like sticking lighted candles in your ears or drinking your own urine or deluding all the active ingredient out of a remedy to make it stronger. Now, about the time I graduated, a new term was coined, alternative medicine. It was an umbrella term that lumped all the things on that list together. The impossible right along with the more plausible, the untested right along with the ones that had already been tested and proven not to work. Later, in the 1980s and 1990s, we started to hear the terms complementary medicine and integrative medicine. Alternative medicine may be used alone as an alternative to conventional medicine, or people may hedge their bets by using both alternative and conventional medicine at the same time. Complementary medicine, by definition, is never used alone. It's used along with conventional medicine to complement the conventional treatment. Integrative medicine implies that you don't just use alternative medicine along with conventional medicine, you somehow integrate two into one unified, coherent system of practice. Now, I want to lodge a protest here. There is really no such thing as alternative medicine. There are only treatments that have been tested and proven to work and treatments that haven't. If a treatment had been proven to work, we wouldn't call it alternative, we just call it medicine. My colleague Steven Novella explains that CAM is a political ideological entity, not a scientific one. It's an artificial category created for the purpose of promoting a diverse set of dubious, untested, or fraudulent health practices. It is an excellent example of the successful use of language as a propaganda tool. Some people prefer to call it so-called complementary and alternative medicine, or supplements plus CAM. Either of those gives the convenient acronym SCAM. Science-based medicine starts with an idea, tests it, and if it passes the test, then it applies it to patients. CAM bypasses the step of adequate testing. It's a shortcut from idea to bedside. Let's look at this list again. The real question is not what to call those things, but whether they work. I don't think anyone believes that everything on this list works. If they do, they're not being rational because some of these things are incompatible with each other. But for every item on this list, there are people who are convinced that it works. It's curious that they never seem to fight amongst themselves. You never hear of debates between acupuncturists and homeopaths. Practitioners of one system sometimes incorporate the practices of another system, like chiropractors who adopt acupuncture or who recommend homeopathic remedies. They never seem to care that if the beliefs behind the other system were right, the beliefs behind their own system would have to be wrong. Now, CAM typically attributes all disease to one imaginary cause. Chiropractic claims that all disease is caused when spinal bones get out of alignment and interfere with nerve function. Homeopathies inventor Samuel Hahnemann believed that all disease was caused by miasms. I'll explain about that in lecture five. Acupuncture attributes all disease to disturbances in the flow of a mythical life force called chi. Ayurveda attributes disease to improper digestion, being out of harmony with the environment, and ama due to aggravated doshes. When I think of aggravated doshes, I can't help imagining an angry vicious cartoon beast like the Tasmanian devil. And Christian science says that all disease is merely illusion due to a lack of faith. A few years ago, I did an internet search for the one true cause of all disease. And I found 67 of them. There were probably a lot more, but I got tired of looking at that point. Here's just a few of them. Allergies, oxygen deficiency, toxins, food acidity, parasites, a congested colon, yeast, free radicals, inadequate nutrition. The list went on and on, and it got sillier and sillier. Perhaps the silliest was the United KKK States of America is the one true cause of all disease. Now, I don't know what that means, and I don't think I want to know. So there are at least 67 one true causes in all. Is this some kind of new math where 67 equals one? If all disease is caused by toxins, it can't very well be caused by parasites. If it's parasites, it can't be a congested colon. When scientists encounter two mutually exclusive claims, it bothers them. They experience cognitive dissonance, and they try diligently to find evidence to reject one of the competing hypotheses. They eventually reach a consensus. Now, alternative medicine pseudoscientists don't seem to be bothered by cognitive dissonance. They're content to look for evidence to support their own chosen treatment, and they blithely disregard any competing claims. They don't want to look for evidence that something doesn't work. While each claims to know the one cause of disease, they don't seem interested in looking for the one reality. Often, they don't believe there is one truth. As one woman said to me, it could be true for you, but that doesn't mean it's true for me. In his book, Voodoo Science, here's how Bob Park described a press conference held by representatives of the Office of Alternative Medicine. One insisted that the number one health problem in the United States is magnesium deficiency. Another was convinced that the expanded use of acupuncture could revolutionize medicine, and so it went around the table with each touting his or her preferred therapy. But there was no sense of conflict or rivalry. As each spoke, the others would nod in agreement. The purpose of the OAM, I began to realize, was to demonstrate that these disparate therapies all work. It was my first glimpse of what holds alternative medicine together. There is no internal descent in a community that feels itself besieged from the outside. Each CAM recognizes its own single cause of all disease, a single cause that is wrong. Science recognizes that there are many causes of disease, and it organizes them into these nine categories under the acronym Vindicate. V for vascular, I for infectious or inflammatory, N for neoplastic, D for drugs and toxins, I for interventional or iatrogenic, in other words caused by treatment, C for congenital and developmental, A for autoimmune, T for trauma, E for endocrine and metabolic. And science recognizes that a single illness can involve more than one cause, for instance, when a traumatic injury becomes infected. We're seeing a trend where obsolete treatments are making a comeback. The top picture is the Royal London Homeopathic Hospital founded in 1849. It's still in business, but it recently changed its name from homeopathic to integrative. The bottom picture is the Massachusetts Homeopathic Hospital around 1916. Now back in 1900, there were 79 homeopathic hospitals in the U.S. The last one closed in 1950. So homeopathy was almost extinct in the U.S., but recently it seems to be reviving. Some healthcare providers are recommending homeopathy, and homeopathic remedies are being sold over the counter in pharmacies. So what happened? Why did those old discredited treatment methods that had almost disappeared start to come back in the 1980s and 90s? In 1994, the U.S. Congress passed the Diet Supplement Health and Education Act, exempting herbal medicines from FDA regulation under the pretense that they were diet supplements intended to be used as foods rather than as medicines. In 1998, the NIH founded the National Centers for Complimentary and Alternative Medicine to do scientific studies on alternative medicine. Insurance companies began paying for things like acupuncture and chiropractic. And some of these formerly discredited treatments were introduced into hospitals and medical schools in a movement that we call quacademic medicine. I'll be coming back to these issues in lecture 10. How did attitudes change? Why is CAM suddenly so popular? Well, there's no simple answer, but I think there are several reasons for the trend. For one thing, science had a run of outstanding successes. Antibiotics cured pneumonia. We eradicated smallpox. We transplanted kidneys.  And when that didn't happen, we got frustrated. We're healthier than we've ever been, and now the absence of disease is no longer enough for us. We want something more. We want some elusive state of perfect health. Instead of dying young of infections, we live into old age, and we develop the diseases of aging like arthritis, heart disease, and cancer. Prosperity is increasing. Fewer people have to worry about where their next meal is coming from. And the worried well have the luxury of being concerned about every little mole and itch. The normal vicissitudes of everyday life have been reinterpreted as symptoms requiring treatment. And we've even invented imaginary diseases like chronic candidiasis and the need for detoxification. Science isn't perfect. Drugs have side effects. People distrust the establishment, the government, Big Pharma, the AMA. They perceive the scientific method as artificial and unnatural. People don't really understand the scientific method. There's always been an anti-intellectual tendency in America throughout history. Americans value equality, self-help, individualism, and the democratic idea that everyone's opinion counts. We have derogatory names for people who know stuff like geeks and nerds and eggheads and high-brows. Modern medicine is seen as impersonal and obsessed with technology, and it's perceived as not responding to the patient's experience of illness on a human level. One of the commenters on the science-based medicine blog said this, public demand for scam is due to only one factor, the deplorable widespread lack of critical thinking skills. I tend to agree. Just how widespread is scam? Well, that depends on how you ask the question. This is from a 2002 CDC study. It shows the percentage of people who reported using each scam modality in the previous 12 months. Look at the bottom two items. 62% said they used scam, but when they excluded prayer, only about 36% said they used scam. The most popular scam was natural products at 19%, and leading the list of natural products were echinacea, ginseng, ginkgo, and garlic supplements. Breathing exercises came next at 12%. Chiropractic followed at 7.5%, then meditation, yoga, massage, and diet-based therapies. Notice that acupuncture and homeopathy didn't even make the list. They were only used by 1% each in the United States. They're more popular in other countries, but they're still not very widespread. 10% of the people in the UK use homeopathy, and only 6% of people in Taiwan use acupuncture. Here's what people answered when they were asked why they used scam. 55% believed that combining it with conventional treatment would help. 50% thought that it would be interesting to try. 26% said a medical professional had suggested it. 28% believed conventional medicine wouldn't help them. And 13% said conventional medicine was too expensive. And what health conditions did they use it for? Well, back pain was by far the most common condition treated with alternative medicine. The top three were back and musculoskeletal pain, colds, and anxiety or depression at 50%, 9.5%, and 4.5% respectively. A smaller percentage used it for gastrointestinal problems for headache and for insomnia. Fewer still used it for sinusitis, cholesterol, asthma, blood pressure, and menopause around 1% each. And what kind of people use CAM? Well, CAM users were more likely to be women than men. They weren't the oldest or the youngest. They were most likely to be Asians and least likely to be African Americans. They were likely to be better educated, to have a higher income, to have private health insurance, to live in urban areas, particularly the West Coast, to drink alcohol, to be former smokers, and to have been recently hospitalized. So I think we can conclude that there's no one simple answer to who is likely to use CAM and why. What sets CAM apart from science-based medicine is basically a lack of testing.  Quite often, CAM denies that there's even any need for testing. They're content with testimonials and poorly documented anecdotes, in contrast to science-based medicines rigorously documented case reports and clinical studies. And when CAM does test treatments, it tries to prove that something works rather than to ask if it works. And many of the studies it does are poorly designed and substandard. CAM's ideology tends to ignore biologic mechanisms, to disparage modern science, and to rely on ancient and natural remedies. My friend Carol is very intelligent, well-educated, and skeptical about most things, but here's how she decides whether to use a CAM treatment. She'll try pretty much anything as long as it meets these three criteria. A friend said it helped them, it sounds plausible to her, and it doesn't sound harmful. She's willing to go by anecdotal evidence when a friend says it worked for me. Science isn't even on her list of criteria. She doesn't bother to ask if testing shows that it works. She says science doesn't know everything. She told me that when she feels a cold coming on, she takes echinacea, and she hasn't had a cold in seven years. I told her when I feel a cold coming on, I don't take echinacea, and I haven't had a cold in seven years either. So if she accepted her own experience as proof that echinacea worked to prevent colds, she ought to accept my experience that not taking echinacea works to prevent colds. She decided we would just have to agree to disagree. CAM is considered more natural than conventional medicine, and people find this very appealing, but the appeal to nature is a logical fallacy called argumentum ad neturum. Natural isn't always good, I think strict mean. And there's really nothing natural about many of the treatments CAM offers, like sticking needles in the ear. In his excellent book, Snake Oil Science, The Truth About Complimentary and Alternative Medicine, R. Barker Basel reviewed the published evidence for CAM and concluded, there is no compelling credible evidence to suggest that any CAM therapy benefits any medical condition or reduces any medical symptom, pain or otherwise, better than a placebo. This is my friend Edsard Ernst, an MD from Germany. Early in his career, he was involved with several kinds of CAM, including homeopathy, acupuncture, herbalism, and manipulation. But as time went on, he began to question them. He got a PhD and set out to research CAM treatments and find out what worked and what didn't. He found that most of CAM didn't work. He became the world's first professor of complementary medicine at the University of Exeter in the UK. He and his team have published over 700 scientific papers evaluating CAM. Edsard Ernst and Simon Singh wrote this excellent book, Trick or Treatment, The Undeniable Facts About Alternative Medicine. After reviewing all the undeniable facts, they concluded, while there is tentative evidence that acupuncture might be effective for some forms of pain relief and nausea. It fails to deliver any medical benefit in any other situations and its underlying concepts are meaningless. And note the qualifications, tentative and might. With respect to homeopathy, the evidence points towards a bogus industry that offers patients nothing more than a fantasy. Chiropractors, on the other hand, might compete with physiotherapists in terms of treating some back problems, but all their other claims are beyond belief and can carry a range of significant risks. Herbal medicine undoubtedly offers some interesting remedies, but they are significantly outnumbered by the unproven, disproven and downright dangerous herbal medicines on the market. Wow, that's not very impressive, is it? I'll be covering each of those in separate lectures. There's a spectrum of plausibility in CAM. The plausibility of homeopathy is essentially zero. Acupuncture has some plausibility. The underlying oriental concepts are implausible, but it is plausible that inserting needles in the skin could possibly cause physiological effects. The plausibility of herbal medicine is high. After all, the whole science of pharmacology developed out of studying plants. And about half of all the drugs we use today are derived from plants. So herbal remedies might work, but they need to be individually tested just like any other drug. CAM insists it is better than conventional medicine. They constantly criticize doctors with accusations like these. Doctors cut, burn, and poison, referring to surgery, radiation, and chemotherapy. Well, conventional treatments have side effects, but they also save lives, which CAM doesn't. They say doctors only treat symptoms, not the underlying cause. And that's an outright lie. If you have pneumonia, doctors don't just treat your symptoms of fever and cough with aspirin and cough syrup. They identify the causative bacteria and they kill it with antibiotics. MDs treat real underlying causes. CAM treats imaginary ones. They say doctors are only in it for the money. Well, so is CAM. Doctors have to make a living and so do CAM practitioners. They don't offer their services for free. Then they say that most of conventional medicine isn't evidence-based either. But it is, too. That's another lie. They'll tell you that only 10 to 20% of what conventional doctors do is based on evidence. But that's a myth based on misinterpretation of an old British study about controlling prescription costs. It looked at whether evidence was being followed, not about whether there was valid evidence. By the best estimates, at least 76% of conventional medicine is supported by some form of compelling evidence, and 37% is supported by gold standard randomized control trials. A lot of what we do is common sense and it doesn't need to be tested, like whether we should try to stop wounds from bleeding or immobilize a fracture. And some of what we do, like vaccines, has been adequately tested and is solidly based on good evidence. But vaccines critics ask for more studies, the kind of studies that can't be ethically done because it would put the placebo group at risk of vaccine preventable diseases, as well as risking public health by decreasing herd immunity. Now think about it. Even if it were true that only 20% of conventional medicine was based on good evidence, why would anyone want to trade it for a system that was based on 0% evidence? One of the hallmarks of science is that it's self-correcting. When the evidence shows that something doesn't work, science discards it. We're not doing bloodletting anymore. We're not doing routine annual chest x-rays anymore. Cam rarely discards anything. In over 100 years, chiropractic has added over 200 new techniques and has discarded exactly one thing, a bogus diagnostic technique of tracing nerves with the fingers. If a scientific study appears to support a CAM treatment, they brag about it, and they cite it as justification. If science shows that a CAM treatment doesn't work, they disregard the evidence and make excuses. They say their treatments are special and they're individualized for each unique person, and they can't really be studied with randomized control scientific trials. But of course they can, as long as the studies are properly designed. For instance, a homeopath could prescribe individualized remedies and somewhat else could randomly give the patient either what was prescribed or a placebo. One negative trial concluded that the treatment worked, but this study was unable to demonstrate that.  Bausel, the author of Snake Oil Science, says CAM therapists do not value and often do not understand the scientific process. Here are the typical stages of CAM reasoning. First they say, I've seen it work for my patients. I don't need science to tell me that it works. And then they realize science is important. So they say, okay, we'll do science. And they do studies, not to ask if X works, but to prove to others that X works. They collect proof in the form of small poorly designed studies that are marginally positive. When the flaws in those studies are pointed out, they do better studies. But the better the study, the worse the results. Eventually they realize, oops, the best evidence shows that X is no better than placebo. Finally, they fall back on, placebos are good, so let's use X anyway. They argue that we want people to feel better. And placebos make people feel better. But there are problems with that argument. This is a good place to go into a digression about placebos. Placebos are very widely misunderstood. And understanding them is essential to understanding science-based medicine. First, let me clarify one thing. The word placebo confuses our thinking. It has two very different meanings and two very different settings. Placebos is used in the research setting for a control group in a placebo control trial. And placebos is used in the clinical setting to treat patients in the doctor's office. We can't even talk about placebos meaningfully until we get this straight. Here are some of the things people have said about placebos. It has been proven that placebos can cure 30% of disease. And how about this? The placebo effect is arguably the most underrated discovery of modern medicine. Replace just the placebo effect with the amazing placebo effect, the mind-boggling placebo effect. To my way of thinking, the very existence of this mysterious effect proves that God exists. That's right. You can find evidence for the foundational truths taught by religion in virtually every double-line medical research study. Well, I think most of you would reject the second claim. I sure hope you would. But a lot of people would agree with the first claim that placebos can cure 30% of disease. They would be wrong because placebos have never cured any disease. That's important enough to merit its own slide. Placebos have never cured any disease. The 30% claim is based on a misunderstanding of a 1955 study by a doctor named Beecher. He reviewed studies with treatment and placebo arms and he found that an average of 32% of subjects in the placebo group reported improvement. But that doesn't mean that placebos cured those 32%. In the first place, improvement is not the same as cure. And some of them improved because of the natural course of illness or appeared to improve because of errors in biases in measurement, errors like regression to the mean. In 2001, Rob Jartson did a much more meaningful study. He reviewed studies that had both a placebo and a no-treatment arm so that he could compare the improvement with placebo treatments to the improvement with no treatment at all. And he concluded that placebos don't work. The no-treatment groups improve just as much as the placebo groups, with two exceptions, pain and nausea. Patients may report subjective improvement of symptoms like pain and nausea with placebos, but placebos have no effect on any objective measurements. They don't improve survival from cancer or speed recovery from infections. They won't lower your cholesterol, reduce your risk of a heart attack, or improve your pulmonary function test results in asthma. Here's what Beecher's 32% really means. The response in the drug group is a combination of the specific pharmacological effect in red and everything else in yellow. In the placebo control group, there's no pharmacological effect, only the effect of non-specific factors like suggestion and the natural course of illness. In a placebo control study, we're asking one simple question. Does the drug work better than placebo? The pharmaceutical company doesn't care about why people in the placebo group improved. They're only interested in telling whether their drug works better. But we're interested in finding out what's happening in the placebo group. Some people believe placebos are really doing something. They say, if treatment X were only a placebo, it wouldn't work on animals. Treatment X works on animals, so it must be more effective than a placebo. But there is a problem with that reasoning. Animals can't tell us how they feel. It's their owners who have to interpret their behavior, and there can be placebo effects on the owner. If they expect to see improvement, they probably will. They may treat the animal differently, and animals respond to attention. We know that suggestion plays a big part in the placebo response. Studies have shown that some placebos are better than others. There's a whole hierarchy of placebo response. Surgery is more effective than pills. Injections are better than pills. Capsules are better than tablets. Big pills are better than small. The more doses a day, the better. The more expensive the better. Color makes a difference. And if placebos are given for a firm diagnosis, they work better than if there's uncertainty. Here's a new framework that doesn't require using the word placebo at all. The two bars on the left show the research setting where all we care about is whether the specific effect of the drug being tested in red is greater than the non-specific effects of treatment in yellow. On the right is the clinical setting where red is the specific effect of treatment and green is natural healing. There's a small remaining effect that is not explained by the specific effect of the treatment or by the natural course of healing, and we can call that the contextual effect of the treatment encounter. But how do these contextual effects work? Well, we know about several mechanisms. Psychological mechanisms like conditioning and suggestion, and neurobiological mechanisms like the release of natural painkillers and neurotransmitters in the brain. An elegant study by Thomas demonstrated the power of suggestion. He divided patients into four groups. The first group got a positive consultation. The second group got a positive consultation plus a placebo. The third group got a negative consultation. And the fourth group got a negative consultation plus a placebo. In the positive consultations, the patient was given a firm diagnosis and was told confidently that he would be better in a few days. If no placebo was to be given, he was told that in the doctor's opinion he didn't require any treatment. And if a placebo was to be given, he was told, here's a medicine that will certainly make you better. In the negative consultation, the doctor said, I can't be certain what's the matter with you. If no placebo was to be given, he said, and therefore I will give you no treatment. If a placebo was to be given, he said, I'm not sure that this treatment I'm going to give you will have any effect. And here's what happened. In the two groups that had a positive consultation, the response was 64 percent. In the two groups that got a negative consultation, the response was significantly lower at 39 percent. In the two groups that got placebos, the response rate was 53 percent. And in the two groups that didn't get placebos, the response rate was 50 percent, not significantly different. They concluded that improvement was due to suggestion created by the doctor. And it had nothing to do with whether they were given a placebo object.  This 2008 study of subjects with irritable bowel syndrome showed just how important the doctor-patient relationship is. One group was simply put on a waiting list and got no treatment. 28 percent of them improved. Another group got no-feryls acupuncture, just needle insertion without any interaction with the provider. 44 percent of those improved. The last group got acupuncture with TLC involving special attention from the provider, a warm relationship, building trust, sustained attention, and 62 percent of them improved. They concluded, non-specific effects can produce statistically and clinically significant outcomes, and the patient-practitioner relationship is the most robust component. Placebos are essential in medical research, but they have no place in clinical practice. Here are some of the arguments against using them. They destroy trust in the doctor-patient relationship. Their effect is unpredictable, small, and it doesn't last long. There is an unfavorable risk-benefit ratio with a small possibility of harm. Placebos waste time and money. The use of placebos may involve delaying or rejecting effective treatment, and believing false claims leads to rejection of real science. But here are the two strongest arguments against doctors giving placebos to patients. First, they're unethical. Medical ethicists unanimously agree that doctors should not deceive patients. Second, they're unnecessary. You can get a placebo effect without giving placebos and without lying to patients just from the contextual effects of the therapeutic encounter. Ted Kapchuk thought there might be a way around the ethical dilemma. You could give patients a placebo and tell them it was a placebo, and it might still work. And it did. When patients were told they were getting placebo sugar pills, they got better. So Kapchuk thought he had given placebos without deception. But when you look at what he told patients, it's obvious that there was deception. The informed consent form claimed that placebos could have powerful effects. Now, when is CAM a scam? Stephen Barrett of QuackWatch has defined quackery as the promotion of unsubstantiated methods that lack a scientifically plausible rationale, and that describes most of CAM. Quackery doesn't necessarily require deliberate deception. Some quacks are deliberately fooling their customers, but some truly believe in what they're doing. They fool themselves. The latest incarnation of CAM is so-called integrated medicine. Integrated medicine clinics are springing up everywhere. According to the National Centers for Complimentary and Alternative Medicine, integrated medicine combines mainstream medical therapies and CAM therapies for which there is some high-quality scientific evidence of safety and effectiveness. Which doesn't make any sense, because if there was high-quality scientific evidence of safety and effectiveness, it wouldn't be CAM. It would be part of conventional medicine. What integrated medicine is really doing is combining science-based medicine with non-science-based medicine. Mark Crislip says that integrating CAM with science-based medicine is like integrating fantasy with reality, like integrating cow pies with apple pies. It doesn't improve the taste of either. Michael Vagg calls integrated medicine lipstick on the ideological pig of CAM. So back to the original question, what is CAM? Where we once defined CAM as things that aren't taught in medical schools, today we can define it as medicine that is so unproven, untested, or implausible that it hasn't earned a place in conventional medicine. Here's another definition of CAM. A spectrum of implausible beliefs and claims about health and disease. These range from the untestable and absurd to the possible but not very intriguing. In all cases, the enthusiasm of advocates vastly outseeds the scientific promise. In the next lecture, I'll talk about how these general principles apply to a specific CAM modality chiropractic.


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