OK, thank you. So this is joint work with Debraj Ray, and it's sort of based on our past current work. So it's really motivated by the missing women phenomenon, which was coined by Amartya Sen. He essentially defined it back in the 90s. And it's really motivated. I'm sure everyone's familiar with this. But it was motivated by the fact that the sex ratio, so just looking at males to females in developed countries is typically less than one.  And in particular, India and China were focused on.  So effectively just want to compute the number of women who would have been alive if instead they had been born in the developed country situation. So essentially we think of what it was meant to be was the developed countries embodied where we think if there's at least gender discrimination, that's the sex ratio we should see. So that's where men and women received similar currently. It's not perfect, but it was the best that we had. And this resulted in a massive estimate of at his time 100 million, but these have now been updated to about 200 million. And so this is meant to be a measure of the women that are missing due to inequality and neglect. And to explain this global missing phenomenon, global missing women phenomenon, people have focused exclusively on Asia, essentially. And also on the sex ratio at birth. They really focused in on sex, selective abortion, female infanticide is a key explanation for this 200 million missing girls. So what Debraj and I did in our earlier paper, we said, OK, well, let's see. Are they really all at birth?  So is it the case? So to do that, we moved away from overall sex ratios. And we asked the question, at what age are they missing? And then we went further and said, what are the diseases that are causing this? And what we found about by doing this, we changed the methodology a little bit that Sen had used. But essentially, it's very much in the spirit of his work, was that in fact, the majority are older. They're older than 15 years old. So it can't be, it's true that the sex ratio of birth is biased, and there's sex selection abortion going on in these areas, but it's not explaining the 200 million missing women. So that was the first big finding that the majority are actually older than 15. And secondly, a completely overlooked issue was that a huge chunk of them are actually found in Africa, which was completely overlooked. And in relative to the actual female population numbers there, it's actually very large. So at least 30% of the missing women were found in Africa. So that's where we left that work. So what we're doing in this paper for this chapter is to dig deeper into the African missing women. So we're going to use the same methodology and find out how they're distributed across the country and what diseases are responsible. So just to show you what methodology we're using, so this was Sen's methodology. So he simply took the sex ratio in our country of interest to say India or China, the sex ratio in developed countries, minus one times the population of women in the country of interest. So then ours was we just want to move away from those overall sex ratios. But we're going to stick to the same counterfactual that developed countries are the reference country. So to move away from sex ratios, we moved into using date on mortality rates by age. So we're supposing for each age category that the relative death rates for females to males is free of bias in the developed country. And then we're going to compare this to the actual death rates, so it's exactly what Sen did. But I'll tell you exactly the formula. It is to motivate why we did this in the first place. So this is what sex ratios by age look like. So in the developed country, so everywhere in the world, there are more boys than girls born. So the sex ratio of birth is always biased towards males. And then essentially, the mortality of females is lower than males at all ages. So essentially, you get this downward-slopey relationship so that the overall sex ratio is less than one. And then if you look at China, it follows the same pattern where you see this huge jump at birth. So this is that birth up there. But then it's following the same pattern. So that's consistent with the story that it's mainly a birth, and then it looks similar to the developed countries. There's a little bit of a hump over here. But otherwise, that would be the standard story. But then what we were surprised by was when we looked at the sex ratio across the ages for India, it starts out high. At birth, it's all just way flatter, right? So this implies that just looking at this, that there are missing women all the different ages. And then when we put sub-Saharan Africa in there, the sub-Saharan Africa has a notoriously low sex ratio of birth, so they actually have lower than the developed countries. And that's partly because African ethnicities are more likely to have girls than anyone else. And that's been true in the US. And that's sort of an established fact. So that's sort of partly why looking at the overall sex ratios made Africa look good. But essentially, what you see is it follows a very similar pattern to India. So everyone was grouping India and China together. But when you actually sub-Saharan African India, you look much more similar. So this is what motivated us to do this. If you looked at the relative death rates, you see it difference more strongly. So this is relative male to female death rates by age. So this is the developed region. So you see that there are a lot of excess male mortality here, and then at the older ages too. And then you put in China, again, following a similar relationship, much more bias at birth.  So tons of excess female mortality. And then again, India following a similar pattern. So there was these two groupings that made more sense rather than the China India one. OK, so then we just computed these. So you take age. So at any given age, if A is age, A equals 0 is birth. You take the death rates of males as DMA, death rate of females as DWA in our area of interest. So what we assume is what the unbiased death rate should look like in our country of interest. So say India. It should be the death rate of males India. So this takes care of the mortality rates of different across India in the developed country, right? Divided by the relative ratio of male death rates to female death rates in our reference country. So if in developed countries the death rate of men and women is equal, right? So it's a one-to-one ratio, then the unbiased death rate of women in India should just be the male death rate in India. But it essentially sends exactly in the spirit of sin. And then you just do it by age groups. You've got what it actually is, what the actual death rate of women in, say, India is, whether it should be, times their population. And then you just sum those up to get the total missing women. And again, we're doing it because we're doing mortality rates. We do it just within a given year. So sin was competing the entire missing women ever, right? So we're just doing it within a given year. So this is from our previous paper. So we found 1.7 million in total in a given year in India, 1.7 in China, and then 1.5 in Africa. So in terms of population numbers, it's actually highest relative to female population in Africa. And again, there's none at birth in Africa, but then you see them at all the older ages. So now what we're going to do is look at this and see how it changes across Africa. So we're relying on data that has been a little bit criticize. So it's essentially the best data we have available. Let's put this for the global burden of disease study, which is a collaborative effort between the WHO World Bank and the Harvard School of Public Health. And essentially, it's the only existing comprehensive data set where you can compare across countries by age, by gender mortality rates, by disease. And it estimates all of the, sorry, it reflects all of the information available to the WHO. So any census data, any health surveillance, sites data, and so forth, sites data. And we're going to rely on the most recent estimates for Africa, which is from 2011. But you have to, there is a necessary caveat in that vital statistics are very poor in all developing countries, particularly in Africa. So essentially, they're making a lot of assumptions. They use a lot of epidemiological models. They use, make use of something like 200,000, sorry, 2000 model life tables to get all these estimates for Africa and where there's missing data. But really, it's the best we have. So I mean, the worry would be is there's some systematic bias this drive in our results. I don't think that's necessarily the case, but anyway. And the World Development Report in 2012 sort of replicated our findings from our 2010 paper using different methods and data and they found very similar results. So in that sense, these estimates are robust to serve a few different assumptions with regards to methods for computing these mortality rates. So anyway, you have to use caution, but it is the best we have access to. Okay, so this is now computing. By, this focus on two different age groups is zero to 14 and 15 to 59, which is where all the mortality in Africa is because mortality rates are so high so people aren't living much past 59. So this is now the actual number of excess female deaths in the different regions of Africa. And this is as a proportion of the female population. Okay, so you don't want, you will have large numbers just if it's a very highly populated area. So what you see is West Africa is where the most excess female mortality is for both of the age groups. Okay, so this is, so first 1.7 million per year. So in 2011 there were 1.7 million missing women in Africa. And then this is 200,000 in West Africa, the age group zero to 14 and so forth. And then as a percentage of the population, you also see it was big in Central Africa for the younger age group and then very high in Southern African countries for the older age group. So then we want, so that's the overall looks, then we want to see what diseases are responsible. So essentially the WHO divides the cause or death into three categories. You have first group one disease is communicomaternal, perinatal and nutritional and then two non-communicable diseases. And essentially in developing countries everyone dies of group one and as you become more developed you start dying of group two. And this is essentially known as the epidemiological transition. Okay, essentially in Africa everyone's dying from group one mainly. Okay, so this is just to give you a sense. So this is the age zero to 14, the different areas and the mortality rates. Mortality rates are highest. So you saw the missing women for highest in West Africa, right? But overall mortality is actually highest in Central Africa. And then this is what they're mainly dying from. This is the children, zero to 14, the diarrhea related diseases, malaria is a big killer, respiratory infection and then perinatal conditions are the big killers. And essentially where there's high death rates for this younger age, there's high death rates in these key diseases. And then for the older age group it's essentially HIV and Southern Africa is of course hugely, has the highest death rates from this. Okay, so that was what the overall death rates look like. This is where the missing women are allocated by disease. So this is the younger age group. So essentially, again, West Africa was the highest, right? And essentially they're distributed across these main killers. The diarrheal diseases, the malaria, respiratory and perinatal, but perinatal is only having a role in West Africa and the single biggest killer is malaria, okay? Okay, so this is what it looks like. So this is the zero to 14 and then this is the older age group. So 15 to 59 and you see how big a role HIV has, okay? So everywhere where there's, the single two killers are HIV and maternal mortality, okay? And of course it's very big relative population over Southern Africa. Okay, so then this is how they're distributed by disease and then we went to do it by country to see if certain countries within these regions were more responsible, okay? So this is now looking at East Africa and what you see is there's massive variations. So first it was interesting there's so much variation across the regions of Africa and then secondly, now when you go within these regions there's massive variation across the countries, okay? So for example, for the, this now tells you the missing women is zero to 14 and this is a proportion of the female population. This is 15 to 59. You can see there's just a few countries, right? So Ethiopia, Mozambique, Somalia and Tanzania are mainly where the missing younger girls are and then for the older girls it's again, sorry, the older women it's Ethiopia and then Kenya and then Mozambique and Zimbabwe and it reflects, and these larger numbers over here essentially are also reflecting larger percentages of the female population. Okay, so that's East Africa, this is West Africa where the most of them are and you see Nigeria as a big player in this but they're partly in the hugely populated country, right? So when you look at percentages it could, you know, Niger is as high and so is Burkina Faso as a female population but then as the older age group Nigeria is the biggest but also the biggest percentage, okay? And then other one is Cote d'Ivoire as a percentage of the population. Now this is North Africa, so North Africa has very few missing women in general. So Southern Africa has almost no missing women at the younger ages but tons at the older ages from HIV and North Africa has none. I don't know if this is a surprise to anybody but and if they have any at all it's in the Sudan, okay? Which would be what you might expect. And then this is now Southern Africa and of course it's South Africa, so almost none in the younger category and in the older category it's essentially, you know, the HIV, Southern Africa but then similarly, you know, high percentage, you know, a lot in South Africa but then as a percentage of the female population in the three other countries, Swaziland, sorry, Hanlisty too. And then Central Africa, we see that DRC very high for the lower age group and then as a percentage also Chad in the Central African Republic and then again DRC and is responsible. But again, you see these big variations. Okay, and this is just to show you what the distribution looks like geographically. So this is the excess female mortality as a percentage of the female population for zero to 14. So as we're getting to darker regions, it's more excess female mortality. So this is the age group zero to 14 and then this is the age group 15 to 59. So what's curious is that there's just so much variation and also it's not always the case that the older group, you know, if there's excess female mortality in the younger groups, it's also in the older groups, those aren't consistent and then top of that specific countries are playing a bigger role. So then just one concern is, I mean, this criticism of all this literature is using developed countries as a benchmark. So people think, well, there's so many other things that determine, again, it's just an approximate of where we think, you know, the least gender discrimination is and is the best we have, but there are other possibilities. So for example, we did, Dharajna did this work for India and we used Kerala as a benchmark. And in this case, what we could use is Southern Africa for the lower age group. Okay, so there we had very little excess female mortality. So instead, we recompute these numbers using the Southern African region as the benchmark. Okay, and in fact, we can only do this through zero to 14 because they have a lot of excess female mortality from HIV in older groups. But essentially, what this does is it actually increases our estimates. Okay, so, and it increases our estimates, particularly from dying from diarrhea disease, diarrhea disease related diseases and perinatal conditions. Okay, so what this implies is that, so on average, the overall estimates for the age group zero to 14 increased by about 25%. So essentially relative to developed country references, the relative death rates of males is even higher in the countries in Southern Africa. So what that implies, I'm not sure, but it's also relevant because partly when we're doing this disease estimates, we don't have a lot of deaths from say, some of these diseases that you die from Africa in the developed country. So we're careful with that. We don't, we essentially assume a one to one if we don't have enough observations. Then the Southern African data, we have way more observations. So for example, for malaria deaths and perinatal deaths and diarrhea related deaths, so these are, if anything, the better, more reliable data generating these estimates and they actually show us higher estimates. So what I conclude from this is like, if anything, the earlier estimates are lower bound on possibly what's there. They're not overestimates. There's no, there's no suggestion that they're overestimates. Okay, so then, so that's, so this is really, so that's the purpose of the paper is sort of showing you where they are, how this, you know, the variation, just providing a decomposition of these missing this excess female mortality in Africa. And we can't pinpoint why, okay? So that's sort of for future research. So essentially, but just for, it just, you know, really crude things and what are the possible mechanisms? And one thing that's just, this is just a graph of GDP per capita and these measures of excess female mortality. And essentially, there's no correlation. Okay, so it's not a simple poverty story. And then instead, if you plot adult overall mortality and this excess female mortality, you see a strong positive correlation, okay? So that is certainly, you know, higher mortality regions, there's more excess female mortality. So that's certainly true. But what becomes clear for these estimates is that it's not just overall mortality, certain diseases are playing a role, okay? So for example, excess, and it's not clear why, okay? So for example, excess mortality amongst young girls aged 0 to 14, well highest in Central West Africa, and these regions are played by high comparable death rate, overall death rates from diarrhea related diseases, malaria, respiratory infection, and perineal conditions. So essentially the overall death rate was very close amongst all these four causes. But it was malaria that caused the most excess female mortality, and then secondly, respiratory infection. Okay, so certain diseases have more of a role in explaining this. And then moreover, a certain disease can have a different effect by region, okay? So for example, overall mortality rates from diarrhea related diseases are significantly higher in Central Africa compared to Eastern Africa, but the number of excess female deaths from both of these areas is comparable, okay? So again, the diseases have a different impact in different areas. Similarly, you saw this in the older age group, I mean, I didn't highlight this, but tuberculosis had a bigger impact in Central Africa, but respiratory diseases had a lower compared to other areas. And then it does sort of, I mean, so again, we can't identify the exact channels for this. Likely it's a host of factors, right? So likely, biological, social, environmental, behavior, economic, which explain this variation. But just to put forth some points, I mean, so we just don't know. There's just no research on this stuff. So studying the gender differences by disease is a very new area of research, even in developed countries, right? It's a very, we know very little about it. So for example, like just take malaria as a big player, so why? You know, so for one thing, malaria control is threatened by the rapid development and spread of anti-malaria drug resistance. Possibly there's a gender component to this resistance. Yeah, we just don't know. This is never studied. For example, the acute respiratory infections, there is work in developed countries showing that there's a male bias to this. And there always has been. Your male is more likely to die from TB before and so forth. Historically, I think that's true. But then we're seeing the opposite. So if these estimates are accurate, it's higher in Africa. So there's a female bias to this instead. So there's possibly a lower relative protective immunity in Africa for females. We don't know. But anyway, there's likely a biological, some biological aspects to this. And then of course, and then there's HIV. So this is a massive killer. So 800,000 missing women from HIV a year in Africa. And it's the only place in the world where women are more likely to die from men of HIV. And it's extreme, right? So it's on average for all age groups. 1.2, if you go to younger age groups, it's even higher. And this is relative to any developed countries, any other developing region in the world. Men are way more likely to die from HIV. This is a big study topic. And essentially, there are biological differences for every given heterosexual interaction. A woman is more likely to contract HIV, but this cannot explain these massive differences. And then there's maybe just actual treatment differences. So there's biological innate differences. So for example, malaria, the biggest way to prevent it is treat an insecticide-treated mosquito nets and indoor residual spraying. Is it possible? I mean, no one talks about this stuff for Africa. This stuff's always talked about in Asia. Is it possible the resource constrained households give the nets to the boys and not to the girls? We don't know. There's no work on this. Likewise, diarrheal diseases treated with solution of clean water, sugar, salt, and zinc tablets. Again, possibly they're not treating the girls as much. There's differential treatment. And of course, female decision-making power, we do know. And there is household research and household bargaining and empirical evidence that household bargaining still matters in Africa. So there is evidence that higher female autonomy in the children's health outcomes are better. There's this issue of breastfeeding. So breastfeeding is hugely important for nutrition of infants. And it's proven to significantly reduce risk of these diseases. It's found, for example, in East and Southern Africa, only 40% of babies are exclusively breastfed. So why? This would be the best prevention from these diseases. Is it possible they have inadequate support from the partners? These women, they're burdened by labor constraints. And is it possible in Africa? And we found there's a paper showing evidence of this in India that women are more likely to exclusively breastfeed boys and girls. Is this possibly going on in Africa? Again, not at all analyze these issues. And then there's possibly cultural factors at place. So for example, the tradition of early marriage. So we do know that, for example, pregnancy, people are much more susceptible to malaria if they're pregnant, women are. And it has much more detrimental consequences. And it's true that 12% of girls in sub-Saharan Africa are married before the age of 15. So they would be in our 0 to 14 age group. And for example, rates of child marriage are exceptionally high. So around 28% to 29% of places like Niger, Central Africa, and Republican Chad, these are also the countries amongst the highest rates of excess female mortality from malaria in this age. So possibly. But again, no work being done on this. And then another aspect is just the role of religion possibly. So in very traditional religious of Africa, within Africa, the archetypal institution is the patronage. So just like in the Asia story of having a son is very important, a healthy son for all the inheritance purposes and rituals and so forth. But again, this isn't the talk about typically in Africa. And also, of course, Islam has a strong grip in several parts of Africa. And there is evidence in not, and again, this hasn't been stated in Africa, but there is evidence in non-African Islamic countries that child female mortality exceeds that of males. And that isn't found elsewhere, right? Because all I'll sequel, the female child's a healthier one. And in some Islamic studies in Africa, there is evidence of boys and men. I think this might be elsewhere too. Boys and men traditionally eat first. Girls and women eat the leftovers. If there's very little food, women aren't. Girls are not getting much food at all. So this would be a reason for under-nutrition of females. Again, this is just putting up possibilities of things for future research if we believe these estimates to sort of dig deeper into these issues. So it's beyond the scope of this chapter to pinpoint a specific mechanism. But what it makes clear is that first, access to female mortality, because of vastly overlooked issue, especially with this missing women literature, if we believe these estimates, and there's massive variation across the continent, within regions, by disease. Of course, it's very hard to pinpoint a single explanation, just like it was before. So people really focused on that sex ratio birth, but it wasn't really what explaining all of the missing women that's been talked about. But essentially, these are alarming numbers. If we believe these estimates, I mean, the missing women literature, we believe them estimates for Asia, there's no reason not to believe them necessarily for Africa, unless you think the data's just so much worse. So it seems like future research into this area is crucial. These are very serious estimates and numbers. Thank you, Sivan, quite a heads up. Thank you very much.


Coming here has been our coming out story, honestly. We both were in Georgia and she said that she'd go out there. When we became more than friends, we didn't tell anybody there. It's a different climate in Georgia. Even with the Don't Ask, Don't Tell being repealed, it's just completely different. I do, our idea still feel like there will be people will treat you differently if they knew. When I say people, I mean just leadership or co-workers even. But what matters the most is promotions and EPRs, things like that. So, no, we did not tell anyone that we were more than close friends. But here, it's been a new life for both of us. When I did tell my CSS team, everyone was very accepting. Just like you said, they knew and they were just like, okay. Okay, alright. Like all the way around, you know what you're like. Sometimes the job stresses you out and stuff like that. But to me at the end of the day, you have that person to come home to. And it is now a new time and things are changing progressively. You know, to where you can be with who you want to be with. You can take pride in you're with that person. You're with this person. Nobody's gonna judge you for it.  But now you have a reason to have pride about who you're with. You don't have to hide that. So that's what pride honestly means to me.  Because, you know, I tell people all the time, it doesn't matter. You can be the world's smartest person. And people are still gonna find a reason to talk about you. So why hide the fact that, okay, I want to be with this person. I want to be a woman. I want to be a man. I want to be a boy. I want to be a girl. Just do it.  You're worried about what somebody else thought of you.


It's Sunday, April 11th, and this is For Good Reason. Welcome to For Good Reason. I'm DJ Grohthy. For Good Reason is the radio show and the podcast produced in association with the James Randi Educational Foundation, an international nonprofit whose mission is to advance critical thinking about the paranormal, pseudoscience, and the supernatural. My guest this week, I'm happy to say, is Simon Singh. He's an author focusing on science and mathematics for the general public, and his books include Fermat's Enigma, The Epic Quest to Solve the World's Greatest Mathematical Problem, The Code Book, and Big Bang. His newest book is Trick or Treatment, The Undeniable Facts About Alternative Medicine. He's currently being sued for libel by the British Chiropractic Association for comments he wrote in a column in The Guardian, and recently he won an appeal in the preliminary phase of that lawsuit. Welcome to For Good Reason, Simon Singh. First off, congratulations. You recently won your appeal in the libel case, the charges brought against you by the British Chiropractic Association for an article you wrote against chiropractic, kind of questioning the effectiveness of chiropractic a couple years ago. And to be clear, the case hasn't actually even been brought to trial. This is just the preliminary part of it, and you won an appeal in this stage. That's right. It's an appeal of the preliminary hearing. It's a very complicated situation, but very briefly, I was sued for libel for criticizing chiropractic.  So we had what's called a preliminary hearing that was about a year ago to decide, one, what did I mean in my article, so that we know what we're talking about at trial, and two, what defenses might I be able to use. And last year, the judge ruled that I was calling chiropractors actually downright dishonest, whereas I'm only claiming that reckless. And secondly, he said I had to prove that absolutely, as opposed to merely being able to show that it's a reasonable point of view that somebody could hold based on one or two pieces of evidence. Now, we got permission to appeal. It took over a year, or about a year to get permission to appeal. We had the appeal last week, and the appeal court, which has made up of the most powerful judges in the country, they really brought out the big guns to rule on this.  I'm not calling them dishonest. And the defendant accusation of a recklessness is much easier for me, because it's what I intended all along. And secondly, I don't have to prove that they're reckless, because obviously, recklessness is subjective. It's my opinion. As long as I can base it on a few facts, then I should be able to win when we eventually go to trial. So that's where we're at now. We're set to go to trial, but I'm in a much stronger position than I was two weeks ago. This ruling didn't actually agree with you that treatments and chiropractic are medical quackery, but just that your original statement that got you into hot water, that it was a matter of opinion, that it wasn't a matter of fact, and that that allows you to actually take the case to trial. Yeah, I see, for example, let's say I say all chiropractors are taller than six feet tall. Now, that's a matter of fact, or it's not a matter of fact. We can actually measure chiropractors. We can see whether they're more than six feet tall or not. And we can decide whether my statement is an accurate fact or an inaccurate fact. Whether there is evidence to back up their treatment is always going to be a matter of opinion, because what I call evidence, somebody else may not call evidence, what I call a well-controlled trial, somebody else may not have so much respect for. That's why we have scientific arguments and scientific debates in those margins where interpretation and argument and opinion and so on can play a very important role. And more importantly, the judges made it very clear that if scientists get sued for libel, if scientists end up in court, they should be able to rely on a defense of honest opinion, which is a huge reassurance for scientists in England and elsewhere, because a lot of scientists, medical researchers, science journalists have been hauled through the libel courts. And to know that we can now rely on this defense of honest opinion, well, it really gives us an advantage in that battle. And hopefully that will mean that fewer scientists will end up being sued for libel, because the claimants will know that we've got something that we can rely on thanks to this recent appeal court decision. I want to talk about the implications of the libel laws for the larger, the broader scientific community. You were getting into that. But before we get there, I want to tease out this distinction you're making between honest opinion and fact. So the skeptical assault, let's call it, on bogus treatments out there, whatever they are, you know, some alternative medicine and complimentary treatments, the scientific community thinks there's no good evidence to warrant those claims and that indeed they can be harmful. I don't hear a lot of skeptics saying in my honest opinion, instead, they say look at the scientific evidence, look at the facts, the facts don't bear out those claims. Yes. Yeah, I think that's a good statement. I mean, when it comes down to a libel case, however, there's almost a forensic examination of the words that are used. So for example, in my case, I said there's not a jot of evidence to back up a chiropractic in the treatment of things like ear infections, asthma and colic. You know, things that really seem to have nothing to do with the spine, which is where chiropractors focus their attention. Now the phrase not a jot of evidence, does that literally mean no evidence whatsoever? Well, you know, of course not. And the fact that judges themselves said that the use of the word evidence implies good evidence, reasonable evidence, reliable evidence, because bad evidence is worse than no evidence at all. So again, then we start moving to the area of opinion into what I call good evidence, somebody else may call bad evidence. But as a science journalist, if I'm doing a reasonable job of trying to back up my argument with some reasonable points, then I'm in a much stronger position there. Do you still think there's not a jot of compelling evidence to support the claims of chiropractic being a good intervention for those kinds of medical ailments you just mentioned, ear infections, asthma? Oh, yes. And in fact, that's one of the interesting things that has happened in the last year, well, two years, in fact, since the article was published, was almost two years ago exactly. But not only have I looked at the evidence, not only have people close to me looked at the evidence, but the BMJ, the British Medical Journal, looked at the evidence. Chiropractors themselves held a review of the evidence. And over and over again, I think they're coming to exactly the same conclusion as I had two years ago. And I still hold that conclusion very strongly. One of the interesting things that skeptics in Britain did was to then start holding chiropractors to account. And if a chiropractor advertised on their website, or had leaflets, or however they marketed chiropractic, if they promoted it for the treatment of children's conditions like asthma, colic, ear infections, they would submit complaints, complaints to the Advertising Standards Authority, to the Trading Standards Offices, to the Chiropractic Council. And I think at the moment, one in four chiropractors in the UK is being investigated for making allegedly misleading claims. And all of those cases will be investigated, I think in the next 12 months. So that's an example of the organized effort of the skeptical community, the kind of skeptical activists to shed light on this, and not just rely on public intellectuals to ring the alarm bell. It's a grassroots way of responding. Oh, very, very much so. These people are typically may have interest in all sorts of different areas, but they come together to look at chiropractic. And in a way, they've taken up arms because I think the learned society, the people that we would normally expect to challenge these claims, as far as I'm concerned, they're not really doing their job. Be careful you might engage in libel against them. No, that's true. I ought to be more careful. And what they've also shown is that, you know, I think a lot of us see claims in the high street or see claims made on the internet, and we complain to each other over coffee and we moan. And what they've said is actually, okay, let's quit the moaning. Let's look at what is available to us in terms of legislation, in terms of regulation, to try and stop these claims. And they pursued it. And it's a tough job because once you submit a complaint, you've then got to follow up on that complaint. You've then got to provide evidence. You've then got to attend inquiries when they happen in the next 12 months. But they've really got the bit between their teeth and are really pursuing this. I love this example of grassroots skepticism really coming to the fore and having an impact. Simon, one more question about the case particularly, before we move on to the kind of more general discussion of the libel laws, I want your take on some of that. Your opponent in this libel case, what, it's the British Chiropractic Association, right? That's right. And they kind of brought a libel complaint against you because you implied they knowingly peddled bogus treatments, not just that you said they were wrong or bogus, but that they knew it. Is that the shape of this? What tends to happen is they put forward a range of meanings. And their worst meaning that they could get out of my mouth was this accusation of deliberate dishonesty. But that's not what you were saying. You were just challenging the efficacy of the treatments, right? Yeah, that's right.  Now, bogus can mean deliberately fraudulent. It can mean, you know, you can have a bogus coin, which is a counterfeit coin, but you may not know it's counterfeit. You may be passing it on in all good faith. And bogus can mean just bad, just doesn't work. And a Bill and Ted's bogus journey doesn't mean a fraudulent journey. It just means something completely different. So they seem to have taken the worst possible meaning from my article, when in fact, a reasonable reader would have taken a much more sensible meaning, which is, okay, this stuff doesn't work. Maybe I shouldn't take my child to go and see a chiropractor. And that's exactly what the judges upheld two weeks ago. They were very forthright in their understanding of the article. And that's been a huge relief to me because after two years of fighting an uphill struggle, where all of the decisions have gone against me for the first time I'm involved in this libel case, and feeling much more optimistic about it, still not over yet, it could go on for another two years. But as I said, I'm feeling much happier now than I did a fortnight ago. Last question about this particular case. Are you optimistic that after what you guys, both parties have spent over a half million dollars, and it's not over yet, as you just mentioned, are you optimistic that the libel charge will be thrown out? You still have to defend the original article and the right to write it in court. Yeah, there are three ways it could go from where we stand today. The British Chiropractor Association could drop the case, because I think things look pretty bad for them at the moment. They could continue to trial, which could take another year, possibly two years. I think that would be unwise of them, but it's entirely their decision. Or they could appeal again and take this case to the Supreme Court. That's a very feasible option for them. But your game for that, that would kind of excite you, because you'd love the chance to argue your case in such a high-profile way, right? Yeah, I think I'm perfectly willing to do that, because already the appeal court has refined the law of libel to make it a bit more balanced. The Supreme Court could actually begin to shape libel law in an even more sensible way. If they decide to, it's entirely up to them, and if they take this case, I'm optimistic that they would see it as a good opportunity to bring English libel law more in line with the sort of libel laws that are available in the continent, in Europe, in Canada, Australia, and of course America, where I think you have some of the best laws in terms of free speech in the world. In fact, you've called the UK libel laws the worst in the world. If the US's are the best, well, even in the States, people get into hot water for making such claims. You can't call someone a fraud, even if you really think they're a fraud, unless you have some kind of evidence, and then it becomes almost a law enforcement issue and not a free speech thing. You know, if someone's fraudulently doing psychic surgery or something that quickly moves away from a free speech issue, being able to speak out and, you know, law enforcement gets involved arresting the huckster, isn't it actually a good thing, though, to have written into law a duty not to say things that injure the reputation of well-meaning folks? You know, the British Chiropractic Association, from their vantage, man, here's a science journalist who just is hell-bent on sticking it to chiropractic. Why won't he just leave them alone? Yeah, I put it slightly differently, of course. I'm hell-bent on making the public aware of evidence for various things and so on. But okay, let's look at this from scratch. Libal laws are important because we've all got a reputation, and if somebody besmirched that reputation and sullied it, then we should all have the right in law to protect that reputation. That's why the libel laws were developed and that's why we've got them in all the countries in the world. And we don't want to change that. If an individual has their reputation sullied, they should be able to protect that in law. So where's the problem? The problem in England, and it's the libel laws of England and Wales is sort of officially what they're called, the problems are numerous. So first of all, the libel laws used to be related to an individual, but a company now has the same right in law as an individual.  They can be sued for libel. And there's a very unfair balance there in terms of the money that can be put on the table between a billion dollar corporation and a loan blogger who might be criticizing that corporation. Or that non-profit outfit who the skeptic thinks is peddling quackery, but they think they're just bringing the truth of alternative medicine to the public. So it doesn't have to be a big fortune 500 company. But then you see the problem is that libel laws in this country are horrendously expensive. We're the most expensive libel trials in the world. Compared to Europe, an English libel trial is 140 times more expensive, not twice as expensive, not 10 times expensive, but 140 times more expensive. So that's why my case can ratchet up costs of half a million dollars in two years. And we're still really at first base. We haven't even got a trial yet. Now, whenever this case is settled, the damages involved, I don't think will be anywhere near half a million dollars. If anything at all, I'm clearly hoping I'm going to win the case and there will be no damages at all. But it's clearly ridiculously disproportionate to have such an expensive trial process. And what that does is it favors the billion dollar company. It favors anybody who wants to shut up criticism.  So one of the things we want to do is drive down costs massively. Another problem is that a journalist, the author of the article, is guilty until proven innocent. Unlike almost any other area of law, I'm guilty until I can prove innocent. The entire burden of proof is on the defendant. So one of the things we're very keen to do is to balance that burden of proof. Another problem is in England in particular, we don't have what's called a robust public interest defense in Canada and America as well. If you're writing about an issue that's of interest to the public, health and safety and so on, the libel laws say, look, we're not going to trip you up. You know, this is important that we discuss these ideas openly because it's how society progresses. Whereas in England, if you write about a matter of public interest, you can end up being sued for libel. There's a cardiologist at the moment, Peter Wilmshurst, who's being sued for libel for raising concerns about a new heart device. Now, if he loses, he will be bankrupted, he'll be destroyed. Now, he is criticizing an American company. He gave the interview in America to an American online magazine, to a Canadian journalist at an American conference, and he ends up being sued in London. Now, the reason he's sued in London is because that case wouldn't even get off the ground in America because you realize that it's in everybody's interest that these things are discussed openly rather than shutting down criticism by a libel case. That's why the interesting thing is that a case like that, which seems very American, ends up back in England. In England, we have a problem that people all over the world bring their cases to England because our libel laws are so hostile to journalists. It's the libel tourism that says, go to the UK, that's where you'll win the case, or have the likeliest chance to win the case. That's right, and not only do we have the best chance of winning, it's so horrendously expensive that the likelihood is that the defendant will back down. So we have a Saudi billionaire, Bin Mahfoud, sued an American journalist, Rachel Ehrenfeld, a few years ago. She sold only 23 copies of her book in Britain, and yet she ended up being sued here. We have an Icelandic bank suing a Danish newspaper in London. We have Ukrainian businessmen suing Ukrainian newspapers in England, Tunisian folk suing German newspapers in England. I'm British, and I'm very proud of lots of things that are British, I'm very proud of many parts of English law that have been exported around the world. But the problem of libel tourism is something that I think we really ought to be ashamed about. And so that's exactly why the libel laws make it, you know, something that scientists get so up in arms about. Richard Dawkins, other leading scientific thinkers have spoken out about them. It actually makes doing science harder, or let's say that it makes being in the community of science where there's going to be rigorous disagreement and makes that harder. Yes, so for example, we've now got a big campaign to change English libel laws. And at the heart of the campaign have been scientific. The British medical journal has said that there are papers that it wants to publish, but it's scared of publishing in case it gets sued for libel. There are other journals that have said there are papers we want to withdraw because we know that they're wrong. But we're scared of withdrawing them in case the authors sue us for libel. We had a Swedish professor who came to England recently to talk to politicians because he wrote an article criticizing a piece of lie detection technology. The Israeli company threatened to sue the journal. And now that paper is no longer available. So we don't know what his criticisms were because now that debate has been silent. So a basic value of science, which is the best ideas rise to the top, people debate, people argue, you criticize your intellectual forebears and their ideas, you criticize the prevailing views, that's science. Well, that's not the libel laws. The libel laws are anti-scientific in that they quell that debate. Yeah, and the thing, you know, it was two weeks ago that I came out of the appeal court actually less than two weeks ago. And the thing that really made my spine tingle was that the judges wrote very eloquently. They made two points. They said the law court should not be some Orwellian ministry of truth. In other words, the law courts are not the right place to decide scientific issues. And secondly, they quoted Milton in relation to Galileo and how Galileo was persecuted centuries ago. And they said, look, we do not want to turn England into some kind of 21st century version of the society that Galileo will find himself in. We need to encourage scientists to question because exactly as you put it, that's the way ideas progress. It's the way society progresses. And England should not be notorious for quelling scientific discussion. You were talking about how really any well funded interest group, not just corporations, but push groups and professional societies, all of that, they can basically sue someone if you or Dawkins or a public intellectual or a scientist or a journalist says that they're harmful or fake or dangerous or any of that. This also goes for criticism against religious groups, right? So not just complimentary and alternative medicine, not just big pharma, but even speaking out against, say the dangers of Islamic extremism or something can get you sued in the UK. Yes, the range of cases is very widespread. On the one hand, there are human rights groups who may be working in Africa and criticizing African totalitarian regimes. And then that regime sued the human rights group in London. Wow. One of the recent stories that I don't know whether it will come to fruition or not was cartoons published. I think it was the Danish cartoons that we've been talking about for many years. Right, the Muslim cartoons. Well, I think it's a Saudi lawyer is now trying to bring a class action suit based on the descendants of Mohammed against those Danish cartoons in the London Bible Court. Now, as I said, I don't know if that will get off the ground. But if it does, it'll just have a devastating impact. But regardless how bad it is, and you're recounting the kind of the variety of cases, it's not just in medicine, you're still optimistic that the tide is turning. Yeah, I think we've got a general election in Britain coming up on May the 6th. And for the last year, we've been lobbying politicians. We've got thousands of people supporting us, including very influential people like Richard Dawkins, Stephen Fry, Ricky Gervais, Nobel laureates, the poet laureate, the astronomer royal and so on. And I think the politicians at last have got the message because in the last week, all three major political parties have said that they endorse the idea of radical libel reform. Now, their manifestos will be published in the next week. So we'll see whether or not there's a manifesto commitment. But each one of them has said that they want to enact a libel reform bill by the end of this coming year. And I just think that's a phenomenal tribute to the sceptical community. It's been a lot of teamwork. So there have been human rights groups as an organization called INDEX on censorship, PEN, a writer's organization, Center for Science, a group of science coordination, organization and charity, but also bloggers, sceptical movement. We had Tam London here last year. And again, just the voice from the audience of saying, look, we're fed up of these libel laws. We need them changed. We just know that at least half of the people in that room were massive support of libel reform. It's a real tribute to that grassroots movement. And real boots on the ground. So not just people listening and agreeing, nodding their heads, yes, but people who are rolling up their sleeves, getting to work. What can our listeners do in that respect to help with the effort? Well, we've got a petition, an online petition. We've got 50,000 people signed up now. Just hit 50,000. And not just from the UK. This is people from all over the world can get involved. Yeah, and I'd really welcome people around the world. The website is www.libereform.org. And the reason we welcome signatories from around the world is because of the libel tourism issue we talked about earlier. If you live in Australia, in fact, I gave an interview to an Australian journalist at the Melbourne Age, their health correspondent, and he could not publish the interview with me because his lawyer told him that there was a fear of him being sued in London. And instead he wrote a column about how terrible it was being a health reporter in Australia having to deal with English libel laws. So similarly, if you're an American blogger, you could end up being sued for libel in England. You have a little bit more protection in America because state by state by state, your passing legislation which blocks the impact of English libel law on American citizens. In other words, you're saying to us, you have so little respect for English libel that if one of your guys gets sued in London, you will not enforce that judgment on that individual, which I think is fantastic. It's very embarrassing for us. I think it's one of the reasons that English politicians are beginning to act now, but you can add pressure, further pressure for changing this country by signing the petition. So again, our listeners can go to libelreform.org and sign the petition, get involved. I'd also like to let our listeners know that you can get a copy of the book, Trick or Treatment, Alternative Medicine on Trial, that Simon Singh wrote with Edzard Ernst through our website forgoodreason.org. Simon, before we finish up, you mentioned Tam London. I'd just like to announce to our listeners that you'll be joining us at the amazing meeting in Vegas this year, Tam Vegas, the James Randi Educational Foundation's annual critical thinking conference. It's the largest event of its kind in the world. We're really excited to have you join us in July. I'm really looking forward to it. I attended probably about two or three years ago now. I came over from London with Richard Wiseman and had a fantastic time as somebody in the audience and this time I'm really looking forward to being on stage and being able to talk to those people attending Tam 2010. Yeah, we're excited. Simon Singh, thanks for joining me on For Good Reason. Look forward to seeing you in a few months. Now, in this week's installment of The Honest Liar, we take a trip to Times Square and Witness, an ancient street scam. Here's Jamie Ian Swiss.  Traveling on spring break from college, Matt and Rachel have just arrived at New York City's Port Authority Bus Terminal after 32 hours on the bus from Topeka. They step out into the bustle of 42nd Street and take in the sights, smells and sounds, appreciating the flashing billboards and giant video screens, the exhaust of bus engines and the smoke of street corner food vendors, the doplering sirens and taxi horns, the mass momentum of the crowds. Stopping for a hot dog from a street side cart, they notice a small but happily noisy crowd on the nearby sidewalk. Cheers and cat calls, yaps and yelps of excitement and encouragement escape from the tight circle of people and the kids wiping the mustard and sauerkraut from their mouths wait in to see what all the fuss is about. A little card game is underway. The dealer, a casually dressed black man in his 20s, mixes around three playing cards, a red ace and a pair of matching black 10s and then offers to accept bets of five, 10 or $20 on whether or not the player can find the red ace, which he explains in a colorful rhyming commentary. Red card moves like a snake in the grass, sometimes slow and sometimes fast. The game precedes a pace, a well-dressed white woman in a fur coat, bets and wins several times. The dealer handing her cash, which he adds to a growing roll of bills. A young businessman in a suit bets and Matt thinks he's made a mistake, which turns out to be the case as the dealer collects his bet and sympathetically offering the loser another try. If you think you saw it then stick around, I'll show it round again, I'll show it round again. Now the businessman is cautious and the dealer mixes the cards around a couple of times but there is a pause in the betting. Matt has been watching carefully, however quietly guessing the location of the ace to himself and almost every time the dealer turns up the cards, Matt's guess has been correct. The dealer cautions Matt not to help the businessman. If you think you know it, don't show it, he'll blow it. Now there's another round of betting, some more rapid wins and losses and each and every time as the money passes him by so closely he can almost smell it, Matt's guesses are accurate. Now the dealer mixes the cards and calls for bets but there are none coming. He turns to Matt who is gradually inch closer and closer to the table and offers a free bet. Just take a guess, no bet. Matt hesitates but then thinks there can be no harm in taking a simple guess so he just points to a card on the table. Show me your money, the dealer suddenly insists. Show it to me, just show me that you're good for it. Matt's confused by all this, it's supposed to be a free bet but some of the other players join in. Just show me I have some cash, that's all, show me you're good for it man, show him. Matt reaches into his pants pocket and holds up some money, of course he'd be good for it, he's got cash in his pockets, why not show it. Point to the card, show me where it is, 5 against 10, 10 against 20, 20 against 40. What you got there, 20, point to the card, tell me where it is. Matt, more confused than ever, looks around for a moment but somehow the crowd has gotten between him and Rachel. She's on the other side of several standing bodies now and those same bodies have crowded in tightly to eagerly watch the action so while Matt looks for a path by which to escape it seems closed off to him for the moment so he turns back to the table and weakly points to the card. The dealer turns the card over, it's a black 10. With one hand he reaches out and snatches a 20 out of Matt's hand while with the other he turns over another card to show Matt where the ace really ended up. Oh too bad buddy here try again. As the dealer mixes the cards quickly again a female player encourages Matt, don't worry baby you'll get it back, watch close you'll get him. In a moment Matt loses another 20. The businessman who has sat out the last couple of rounds admonishes him, oh man how could you miss at that time, it was over here, I was going to bet but you beat me to it. The dealer turns over the ace demonstrating that the kibitzer was indeed correct. Now Matt's down $40 a substantial portion of his and Rachel's weekend stake it all happened so quickly so unexpectedly if you looked up to Rachel now he'd see her insistently beckoning to him to come along right this instant but he doesn't look back because he not only needs to prove himself and get his money back but he's just noticed something unexpected. While he was thinking about his next move the friendly businessman has lost another bet and inventing his frustration the player throws the two loose black cards to the ground. The dealer does not take kindly to this and as he bends to retrieve his cards he scolds the player harshly admonishing him not to touch the cards again. In that same instant however as the operator is bending to retrieve his cards from the ground the player quickly reaches out and ever so slightly bends up the corner of the red ace that remains on the playing surface. Matt considers the implications of the shifting battlefield perhaps his fortune is due for a change. The industrious businessman's fortune changes immediately however when he bets on the card with the bent corner and wins. The operator who barely looks at the cards as he mixes them around he's too busy looking at the players and their money he pays off. I pay my money dollar for dollar and if I lose I don't holla but he's still peeved at this guy and he makes it plain he doesn't want him to continue playing.  The operator collects her 50 but leaving the other two cards in place he pauses and offers to take a bet on the remaining situation. This is an option Matt had not previously considered. As the dealer turns towards Matt to encourage a bet the other player the one who bent the corner just a few moments before silently signals to Matt he should watch for the bent corner and take advantage of the windfall he's generously sent Matt's way. Who says New Yorkers aren't friendly to strangers? It's just too much to pass up but when Matt holds up some cash the operator objects no no buddy you you you already got to see one card I'll only take $100 now on this bet odds have changed it's 50 50 now. Matt pauses it's most of the cash he and Rachel have for their weekend.  After all the dealer's bound to notice a bet corner any moment now and any advantage of a sure thing will be lost. Matt's confidence that he can put one over on the operator over takes his doubts. So Matt puts down his $100 in front of the card with the bent corner and the dealer graciously tells him to turn the card over himself. Matt reaches to pick up the card if you could smell the money before he can almost taste it now along with the remnants of that first New York City hot dog and finds himself frozen in stunned silence.  It's an impossibility that Matt can neither comprehend nor explain but the impossible is now his reality. With Matt's money gone the game quickly breaks up. The operator grabs his cards and vanishes in a puff of parting sympathies. This ain't no guess it's just a eye test. The corner bender pats him on the shoulder. Too bad buddy hey you'll get it next time as he heads out into the street and moments later there's no trace of the game or the players. Just Rachel crying now as they walk to find a hostel. How could you do that? We have no money to eat. Where are we going to stay? What happened to you? And Matt wishes he knew. And if you'd like to know all will be explained in next week's installment. This is Jamie Ian Swiss and I am The Honest Liar. Thank you for listening to this episode of For Good Reason. For updates throughout the week find my page on Facebook or follow me on Twitter. To get involved with an online conversation about today's episode join the discussion at forgoodreason.org. Views expressed on For Good Reason aren't necessarily the views of the James Randi Educational Foundation. Questions and comments on today's show can be sent to info at forgoodreason.org. For Good Reason is produced by Thomas Donnelly and recorded from St. Louis, Missouri. Our music is composed for us by MA Award nominated Gary Stockdale. Contributors to today's show included Jamie Ian Swiss and Christina Stevens. I'm your host, DJ Glovie.


It's about 6 45 a.m. and I'm about to start my 96-hour call shift. Let's go. Procedure shoes, much better. Done a whole bunch of cases this morning and keep doing consults through the ER that won't allow me to leave the hospital today. Then we have another emergent case to do right now from the floor. My ICU patients, another embolization after that. So hopefully I'll get out of here at some point tonight and be able to eat dinner or something like that. So the best thing about working a long holiday weekend is that I happen to have the best wife in the world who brings me dinner when I have to stay late for an overnight case. Hey hon, 8 30 p.m. I'm still at the hospital. I've been so busy I haven't even mentioned that this is day two of my 96-hour call or four days of call for my holiday weekend. So one of the reasons I'm so tired is last night or Friday night I was called in the middle of the night for a patient that was bleeding. We did imaging showed bleeding. They called us to embolize something. We ended up setting the whole thing up and then so I was up pretty much the entire night setting this up and dealing with it. I got a few hours of sleep came into the hospital extra early and as I was walking in the hospital the team called me and canceled the procedure. So that was fun. So I was up all night on Friday night slash Saturday morning, got to the hospital this morning, which is Saturday morning. I've been here doing cases all day long, seeing consult, seeing ER patients and now we have a patient also bleeding tonight and it is now 8 30. We plan on embolizing this patient or attempting to embolize this patient tonight. Then I get to go home tomorrow morning. We have a pretty much a full day full schedule. I'll be back here bright and early. So if I get called in tonight pretty much screws up the whole day tomorrow. Also so as you can tell I probably have the best wife in history. So since tonight I'm on call or this whole weekend I'm on call and tomorrow happens to be our one year wedding anniversary we decided to celebrate it tonight sort of together at the hospital but and yeah so now I'm well fed ready to do this case hopefully doesn't last that long and I can get out of here and get some sleep. 11 45 just now leaving the hospital got here at about 6 30 ish a.m. I'm leaving at 11. It's a pretty long day for a Saturday if I do say so myself. I have a case scheduled first thing in the morning so I'll be back here after a few hours of sleep tomorrow Sunday. See you in the morning and good morning. It is day three we're exactly 48 hours in to our 96 hour call shift head back in the hospital got a good six hours of sleep last night plus I don't know pretty tired two more days to go halfway we have an early case uh starting at eight today another case following that um a little tired today but still hanging in there nothing a little coffee can't fix so off we go all right so just finished seeing all these patients procedures all this stuff it's about three p.m. just wanted to check in again I have to go consent a few patients to get them teed up for tomorrow we're going to come in on this Monday holiday and do some cases so that's that I want to go consent these patients make sure we don't have any other procedures to do tonight and we'll do back at this tomorrow and forgot to mention the main thing is today is my anniversary and I would like to spend a little time with your wife that'd be kind of nice but such is the life of a resident honestly I can't believe it but I'm actually leaving in the daytime sun feels amazing all right so I got all of my consult orders in I did all my notes finished all of our procedures got everything teed up for tomorrow now I'm going home while it's still daylight probably take a nap and hopefully not be called in so see you guys tomorrow and we were back at the hospital this Monday morning holiday Monday I didn't get called in last night well I got called last night and woke up but I didn't get called in for any emergent procedures which is fantastic so I got a little sleep not really uninterrupted but whatever um back at the hospital now we have to do probably three or four cases today that we scheduled from yesterday and also you noticed that I shaved overnight so I did have a few hours to myself yesterday so that's good all right off to start the day this thing won't shut up check out with you in a little bit so when I first get here the first thing I do is look at all the consults for overnight and I triage which ones I think are important or emergent and all of the ones that have to go today after I do that I'll call the teams back about non urgent consults see if we can either add them onto the schedule today or work them up for tomorrow but today's the holiday that's my fourth day on call so we're only doing emergent cases today because we have a skeleton crew just me the attending and two me the attending a tech and a nurse there's always backup people but we don't call the man unless stuff starts hitting the fan so after I do that I try to jump in cases intermittently that are going throughout the day and I'll respond to the pages when I get out of the case or go see patients between cases or whatnot so basically my priorities are seeing work up patients organize patients coming down here with the primary teams figure out what exactly they want do procedures make sure patients are doing well after their procedures and also get patients worked up for tomorrow so that when our primary team our full team comes in tomorrow which is Tuesday morning after a holiday we're not completely slammed in behind like 30 patients it probably will be but I'll try my best to try to help them out for tomorrow so I still have a few more cases to do today still have to see a few more patients and then hopefully I'll get everything ready for tomorrow's rounds in the morning at 7 a.m we should be good to go home and I want to call in tonight because I don't know if I can handle another night of no sleep so let's see how it goes so it is now about 11 o'clock I've seen on my console to have a few more procedures to do today hopefully tonight it will go well I can come in and do a nice easy recovery unit shift tomorrow so usually post-call weekends or post-call days we'll do we'll just do consents in the pre-procedural and post-procedural workup area that way I'm not on my feet another day for 12 hours wearing lead and all that stuff so apparently we have one more case ice you ever stops neither do we are done and we made it it's about 6 30 right now leaving the hospital in daylight hours which is absolutely amazing people are yelling in the background I have no idea why and yeah we're almost there keep in mind I have to make it till 7 a.m tomorrow morning Tuesday morning to complete my 96-hour call at Strava Danza so if I don't get called in tonight then I will get to sleep well and go in at normal time tomorrow so on that note if you like these videos make sure you smash that like and subscribe button follow me on Instagram if you don't already I post some pretty cool stuff over there sometimes otherwise I'll see you guys if I don't come in tomorrow I'll see you guys on the next video


What's the difference between as soon as and as long as? That's what we're talking about in this video. And by the end of this video, you're going to know how to use these two expressions confidently and add them to your vocabulary. And having these expressions in your vocabulary are really going to help you sound like an advanced English speaker. Of course, I'm Jennifer from jforisenglish.com and this channel is dedicated to helping you sound like a fluent, confident, natural English speaker. Now, before we go any further, make sure you subscribe and hit that bell notification so you're notified every time I post a new video. Now, let's dive in with this lesson. Lesson was a request from one of my students, Wasim. And Wasim wanted to know what's the difference between these two. Now, in his original question, he also wanted to know what's the difference between as will as. Now, Wasim as will as doesn't exist in English, so you can just cross that one out because that's not an expression. But this is an excellent question because as soon as and as long as are really advanced expressions that are going to add some complexity to your speech. Because these are what we call conjunctions. Don't worry about that technical term. You can simply think of them as expressions that we use to combine ideas. So because we're combining ideas, we know that our sentence is going to become quite complex and advanced by using these expressions. So I'm really excited to teach these to you. Let's start with as soon as you can think of this as a time reference. Okay, we're talking about time and as soon as you can translate that to immediately after. Okay, immediately after something happens.  Okay, so remember, we can think of as soon as as immediately after.  So imagine you're walking home, you open your door, you enter your house. Okay, immediately after.  Call your mother as soon as you get home. Now, it's important to keep in mind that the structure of this is flexible. I can use as soon as to start the sentence and I can say as soon as you get home. As soon as you get home, call your mother and they mean exactly the same thing. Another example, send me that report as soon as you get the numbers. So immediately after you get the numbers, what are you going to do? You're going to send me the report. Send me the report as soon as you get the numbers. And remember, we can switch the sentence structure as well. So write in the comments below, what would be the alternative way to write this starting with as soon as. So pause the video and write that in the comments below to practice. Did you get it? As soon as you get the numbers. As soon as you get the numbers, send me the report. Now let's talk about as long as. As long as and as soon as are very different. The only thing they share is that they both have as and as, okay? But they're used very differently. Now with as long as, we're offering a condition, okay? This one makes sense with an example sentence. So let me give you an example. I'll go to the party as long as you give me a ride, okay? So there's a condition, right? I will only go to the party if you give me a ride. If you don't give me a ride, I won't go to the party. That's the condition. So we use as long as for identifying a condition. I'll go to the party as long as you give me a ride. Now, just like with as soon as, this sentence structure is flexible as well. So think about this, hit pause and change the sentence structure so we begin with as long as, okay? Put your answer in the comments below. Did you get it? As long as you give me a ride, I'll go to the party. Another example, I'll help you with that report as long as you buy me lunch. So my offer to help you is conditional and I'll only help you if, what? If you buy me lunch, right? That's the as long as, as long as you buy me lunch. I'll help you with that report as long as you buy me lunch. Now again, think about changing that sentence structure. Hit pause and write the alternative sentence structure in the comments below. Did you get it? As long as you buy me lunch, I'll help you with that report. To summarize, we have two great conjunctions. As soon as, which you can think of immediately after something and we have as long as, which is used to offer a condition. All right, now you know how to use as soon as and as long as confidently. Now you practice. Make sure you write one example with as soon as and one example with as long as in the comments below and then change that to the other sentence structure so you get comfortable with both of them. If you found this video helpful, please hit the like button, share it with your friends and of course, subscribe. And if you have a question that you would like me to answer for you in an upcoming video, just leave it in the comments and tag it with Q&A Friday. Now before you go, make sure you head on over to my website, J4isEnglish.com and download your free speaking guide. In this guide, I share six tips on how to speak English fluently and confidently. And until next time, happy studying. All right, awesome job today, adding these advanced expressions to your vocabulary. Woo-hoo, don't stop there. Check out this video and don't forget about this video and make sure you subscribe and until next time, happy studying.


What's up everybody JTW here and in this video I'm going to be covering some of my favorite tips tricks and features of trading view that I think either Many people are not aware of we're just aren't taking advantage of so with that. Let's let's dive right in First thing I want to talk about is the layouts in trading view So you can view your different layouts by clicking the menu up here, which will pull up Your current layout will be listed right here, and then you can see any other layouts that you might have and so what the layouts do is they remember any chart properties drawings That you set on this chart and those will be specific to that a particular layout so for example We're looking at Google here on the one hour And let's say I wanted to drop some levels on Google for trading longer term trades. These aren't real levels I'm just dropping some on the chart here And I wanted to set this up for longer term trades based on these levels that I've got here and let's also say Maybe instead of using Standard candles. I want to use hiking candles on this particular layout And so I might have everything set up in this layout like you see here on the screen So I'll go ahead and save that But now if I switch to another layout, let's go to the 15 minute Google chart You'll see that this layout still my candles are my standard bars And I don't have any drawings here on the screen so I could do levels here on this chart that Again might be better for scalping or something along those lines And maybe I don't want to have these Levels co-mingled with my longer term levels. Maybe I prefer to see the shorter term trades and see actual standard candlesticks versus Hiking candles that I might prefer to use for longer term trades So taking advantage of all the things that the layouts can remember that will make it very easy for you to switch between How the chart is set up? Let me save this real quick is is something that you can definitely Use to your advantage Another thing that you might have noticed as I was going through and putting some levels on this chart here is That I was able to quickly drop those price levels on without going over here to the menu bar and pulling the horizontal line tool from the drawing section of the menu bar And that's because trading view provides us with some really nice keyboard shortcuts So the one that I'm using here to drop these horizontal lines down is all H The other one that I really like a lot is alt T, which will drop a trend line Or put you onto the trend line tool so you can then start drawing a trend line Wherever and however you like, but I think horizontal lines and trend lines are probably the most commonly used drawings For anybody that's doing technical analysis another thing just to always take a look at is the different settings That you might have available for each drawing tool For example, if I wanted to extend this line left or right, I can quickly do that I can also turn that off. There's a lot of different things that you can play with I'm not going to go through each of these options But definitely something to familiarize yourself with when it comes to taking Full advantage of the trading view drawing tools Another thing that I really like about trading views I can also set certain drawing tools as favorites. So for example, I like to use the trend-based Fib extension a lot So if I wanted to make that a favorite all I need to do is come over here to the drawings menu And click this little star icon next to the trend-based Fib extension You'll see that that pops up in this essentially like a little tool tip down here in the bottom right And so any other drawings that I add to or drawing tools, I should say that I add to that Get added to this bar down here. So then I can very quickly come down here and just one click To come and draw a trend-based Fib extension You know if I ever saw the need to without having to fish through a bunch of menus and try to find it So anything that can sort of speed up your ability to analyze and look at a chart I think is a good thing Another thing that a lot of people aren't aware of for those of you that like to use extended hours data When it comes to looking at your charts and doing your technical analysis By default the one day is not going to include extended hours And so if you ever want to see a daily candlestick chart But you also want to see extended hours It's actually pretty easy But it's the thing that most people just neglect to do if I come down here and set it to 24 hours and click add Now I've got a 24-hour chart that will include Extended hours with each candle being a daily candle And I'm actually going to switch this back to my other layout because I'm not typically a hiking guy But just wanted to show you guys that that little tip on how to get Extended hours with daily candles because that's not that's something again that just a lot of people aren't aware of And one of the you know best parts of any charting platform is going to be the indicators And one thing that I think trading view does a really good job with are these templates So for example, if I wanted to load up this chart with some of my favorite indicators So I'm gonna go ahead and add Neptune on here I'm gonna add sound wave for my volume analysis gonna add the oscillator by KJ and Let's also add the support resistance that a lot of people have found useful when it comes to Sort of having automated price targets in combination with Neptune So if I put all these indicators on my chart It's very easy for me to then save every element of each of these indicators to a template So that's all of the settings for each indicator. You can tweak those however you want So for example, if I wanted to change these SR levels from orange to white And let's say I wanted to change The higher time frame flag here on Neptune to the one hour So we're running, you know, basically two flags now We're looking at the 15 minute chart flag in the one hour flag. I can save all of that to my template Simply by going up here and going to templates and save indicator template I'll give it the name XT demo And one thing that you're probably never going to want to do is remember the symbol Because then any time you try to load this template, it's going to automatically pull up that ticker by default Something you may want to take advantage of though is remembering the chart interval, especially for any indicators that Can use two different time frames in conjunction with one another So a chart time frame and then the indicator can either load a separate time frame or some sort of a multiplier time frame Similar to what Neptune does with the high interval flag You probably will want to remember your interval for that. And so what that does is now if I switch to the 45 minute chart, let's say and I go up here and I load my XT demo that we just did it automatically flips me back to the 15 minute chart So, you know, again, that's a nice thing to take advantage of one click or a couple of clicks gets you right To where you want to be but if we can cut some of those clicks out I don't see why we wouldn't want to do that So if I come up here to my templates just like with the drawing tools, you can see that we've got this star icon That will allow us to favorite templates And so if I were to for example save this scalp another scalp short swings long swings All it's favorite templates. You'll see they're now listed up here zero one two three And if I click any of them without even having to go in here to the templates menu and select the right template I can then very quickly change between The different templates that I might have you'll notice as I hover over these it shows me what each template is now Mine up here say zero one two three That's just based on how I have them named here when I created them You can you know, it's going to go by the first character In the in the in that template name So, you know if you want to have ABCD or you know, whatever Float your boat up here You know, just make that the first character of the template name and that's how they'll be set up I just happen to have mine at zero one two three last thing I'm going to touch on is With trading view you've always had the ability to turn Certain elements on and off as far as the visibility without fully removing them from your chart So just like with these SR levels I can sit here and I can do this one by one or I can also come over here to this visibility menu and if I click and hold on it You'll see I have the option to hide drawings hide indicators or hide both so I can hide just the drawings if I want to I Can hide the indicators as well, but that switches it that puts the drawings back on or I Can hide both which will just totally you know remove everything from the chart Come back over here click that back off and now I can see everything again So anyway, this is just these are just a few of the Things that I like to leverage when it comes to having trading view is my charting platform that allow me to quickly Do technical analysis put my drawings on there and then as I'm looking at different tickers for possible Plays I can very quickly switch between my templates And and make a decision that is more informed in less time So I hope that this is all very helpful If you guys have any questions about trading view or Neptune feel free to shoot me a DM And I look forward to working with you guys. Take care


Good morning, Hank, it's Tuesday, and I have strep throat, which I rate 0 out of 10, not recommended. So your video about the political situation in Brazil made me think about the political situation here in the United States, specifically the tortuously long Kafka-esque process through which the two major political parties in the United States determined their nominees for president, delving deeply into the whole sorted affair would take like a month. So today, we're just going to look at one state, Missouri. Last week, the people of Missouri voted in their presidential primaries, and on the Republican side, Donald Trump beat Ted Cruz statewide by about 0.19%. And on the Democratic side, Hillary Clinton beat Bernie Sanders by a similar margin. But what actually matters for becoming your party's nominee is not how many votes you get, but how many delegates are pledged to you because the nominees are not actually chosen by voters. They are chosen by delegates at the party's national conventions in July. The Republicans are meeting in Cleveland, the Democrats in Philadelphia. On the Republican side, there will be 2,473 of these delegates voting at the convention, and on the Democratic side, there will be 4,765-ish. It depends a little bit on if anybody dies. Right, so despite only winning the statewide primary by 0.2%, Hillary Clinton emerged from Missouri with 47 delegates to Bernie Sanders 35. In fact, she would have won more delegates than Sanders even if she lost by 0.2% because the Missouri Democratic Party has named 13 so-called super-delegates who can support whomever they want at the convention, and most of them have endorsed Clinton. Missouri's super-delegates include the state's governor, Jay Nixon, Senator Clare McCaskill, and like other prominent members of the state's Democratic Party. Then there are the 71 delegates who actually represent Missouri's Democratic primary voters. By state party rule, their votes are split proportionately according to the results, so if Clinton had gotten 100% of the vote, she would have gotten all 71 delegates, but she just barely beat Sanders, so instead she got 36 delegates to his 35. This year in Missouri, there were about 8,800 Democratic votes for each of these 71 Pledge delegates, which means that at the party's convention in Philadelphia, Governor Jay Nixon will have, you know, around 8,800 times more power than the average Democratic voter in Missouri, and not to belabor the obvious or anything, that's not a power distribution generally associated with the word democracy. But wait, there's more. Over on the Republican side, Donald Trump beat Ted Cruz very narrowly statewide, but emerged with 37 delegates to Cruz's 15. And John Kasich, who got 10% of the vote, won no delegates at all. But it wasn't all bad news for Kasich because on the same day in Ohio, he got 47% of the Republican vote, but all of the state's 66 delegates. That's because the rules of the Republican state party in Ohio dictate that whoever gets the most votes gets all the delegates, whereas the rules created by the state party in Missouri dictate that if no one gets 50%, the winner gets 12 delegates, and then five delegates go to the winner of each of Missouri's eight congressional districts. Trump won the state and five of the congressional districts ergo 37 delegates. All right, this is gonna get a little complicated. A bit of context for non-Americans. There are 435 congressional districts in the United States. Each of these districts selects a congressperson every two years who goes to Washington and fails to pass a budget. Presumably they also do other things, but the main thing is to make sure that we don't accidentally pass a budget. Each state gets a certain number of congressional districts based on their population, and after the 2010 census, it was determined that a smaller percentage of Americans lived in Missouri, so they lost a congressional district. While fast growing states like Arizona and Florida gained districts, but this losing a district offered the state of Missouri an opportunity to redraw its congressional boundaries. Back in 2010, there were six congressional districts represented by Republicans and three represented by Democrats. If one of those had to go, the Republicans obviously wanted it to be a majority Democratic District, which is what happened because, one, they controlled the state legislature, and two, one of the Democratic Congress people helped them because in that process, his district became even more Democratic. You know, now he's less likely to lose his job. Today, congressional districts in Missouri are drawn mostly in a way that makes the elections within them extremely lopsided. Like in 2014, the first congressional district in Missouri voted 73% to 21% for the Democrat. The third district, meanwhile, voted 68% to 27% for the Republican, etc. But per Republican state party rules, no matter which district you win, you get the same five delegates. Like in Missouri's first congressional district, about 34,000 Republican votes were cast. In the seventh district, it was closer to 150,000. So just by virtue of living in the first district, instead of the seventh, your Republican primary vote is five times more powerful. In short, I think all of this is extremely complicated, and none of it is particularly Democratic, at least not in the straightforward way we usually imagine democracy. Political parties are weird institutions in the United States, like they're simultaneously public organizations and private clubs. They make their own rules, the rules are constantly changing, but in many cases the rules are regulated by the states. And political parties are powerful, but only insofar as their supporters allow them to have power. Also, they don't really have card-carrying members, but almost every nationally elected figure belongs to one of them. Now some of this is a legacy from a time when the United States was openly suspicious of what we now call voting rights. I mean, for most of American history, most adults couldn't vote, and political parties served partly as a check against revolution or radical change. In fact, the nominating process has become much more Democratic over time, like as recently as 1968, only 34% of Republican delegates were chosen by primaries and only 38% of Democratic delegates. And for the last 10 election cycles in both parties, the person with the most overall primary and caucus support has also been the eventual nominee. But that may not be the case this year, and it remains to be seen who will actually wield the power when the party and the people disagree. Hank, I'll see you on Friday.


All right, what's up everybody? Sorry guys. I forgot to do the free box giveaway So we're really two free boxes if you bought two or more teams, so let's quickly do that here So again guys remember these customers that got into the team random as long as they have two names Attached with two teams and you get an entry so Aaron you got three spots So you're only gonna get one entry, but you still got one there Then cover man had to that's an entry And Carl bought these straight up this was 12 so he's gonna get six entries Chat with one Chris with one Jared. There you go. Thank you buddy for also reminding me and Then J with one kev bought one straight up want got a team random spots that gives them two now And then Michael two in the team random that gives them an entry and then Oliver one Rob would tune the team random That gives them an entry and then we're actually only have one so No team random there spot for you. So there you go out of the possible 15 potentially we did 12 So let's put that there and then let's get a little dice roll. So never top two one a free box guys top two roll Four four eight the hard way one two three four five six seven eight and There you go eight times eight Carl and Rob Congratulations guys you guys both Carl and Rob so appreciate you guys jaskiesgatesbricks.com


At least 15 people were killed on Tuesday, June 15, in a suicide bombing at an army camp in the Somali capital, Mogadishu. Somali military officer Odawah Reige said on Tuesday that 10 new recruits had been killed, and 20 others wondered when a suicide bomber detonated explosives at a checkpoint outside of General Dagoban military training camp in the capital. There was no immediate claim of responsibility, but Islamist group Al-Shabaab frequently carries out bombings in the Horn of Africa country.