Rationally speaking, is a presentation of New York City skeptics dedicated to promoting critical thinking, skeptical inquiry and science education. For more information, please visit us at NYC Skeptic's Doug. Welcome to, rationally speaking, the podcast, where we explore the borderlands between reason and nonsense. I'm your host, Massimo Putri, and with me, as always, is my co-host, Julia Gillard. Julia, what are we going to talk about today?

Well, today, I'm delighted to welcome our guest, Dr Paul Offit, who is the chief of the Division of Infectious Diseases and the director of the Vaccine Education Centre at the Children's Hospital of Philadelphia. Paul is the award winning co inventor of the rotavirus vaccine Road Attack, the author of over 140 medical articles, and as well as several popular books, including this year's title. Do You Believe in Magic The Sense and Nonsense of Alternative Medicine? Paul, welcome to the show.

Thank you. So do people believe in magic or too many people believe in magic? What's the deal?

Absolutely. I think we need to believe in magic. We need to believe that there's something greater than ourselves. I think that in the world of medicine, we're attracted to the notion of somebody like like Bones McCoy from Star Trek. Take that. He would take that scanner and he would scan the person. He would look on that scanner and he would know what the diagnosis was. There was no uncertainty about it. He was sure of it. And I think we love that.

We love the certainty. So people like Mehmet Oz and Deepak Chopra and Andrew, while I think provide that it's that guru thing and that ex cathedra thing, they are just being handed stuff as if from on high. They're absolutely certain about it. They tell you every aspect of your life and how you should live it.

We love that.

But you don't think it's a good idea, right? No.

I mean, unfortunately, it leads to a lot of bad decision making. There was an article actually by Michael Specter that talked about Mehmet Oz recently in The New Yorker, and he went into the guru thing. You know, that as Oswin approached the studio, people would just come up to him because they just wanted to be near him, to touch him, to to use the New Testament analogy, to touch the hem of his coat. And I think they're in danger.

Lives, while it's good to have faith in your in your clinician or your healer, if you will, you know, if you if you go over the line and you fail to at least critically appraise what they're telling, you know, you're at risk.

Paul, when you practiced as a doctor, have you found that cautioning people about the uncertainty around the diagnosis or around the prognosis actually helps them? Or does that do they find that distressing? Do you notice any kind of pressure, incentive to project certainty whether there maybe isn't, you know, you want to be as optimistic as possible?

I mean, I'll give you an example. The we see children with cystic fibrosis in our hospital. And you know what? When we do that, when we have outpatient clinics for cystic fibrosis, we virtually never have the older children being seen at the same time as the younger children. Because the the the old I think Chinese expression is when the guys are really angry, they show you the future. And so so we don't do that. We don't want them to see the future in a sense.

And so you do you do provide sort of the most positive impression that you can so that you don't want to take away hope, even when situations are grim. On the other hand, you want to be you want to prepare people for what they can expect over the next few days or weeks or months or years. So it's it's it's a balancing act to some extent. Yes. But do you find that the the practitioners of so-called alternative medicine that you've written about, including in do you believe in magic?

Do you find that that they're more successful in sort of convincing the public that their way is the correct way because they're more certain or for other reasons?

Yes, I mean, certainly, I guess the areas that I would pick are the areas in which medicine has largely not been able to provide an answer. So, for example, for children with autism, there is no clear cause or causes. There are no clear cures for certain cancers that are difficult to treat like brainstem glioma or glioblastoma multiforme. I mean, we're pretty it's pretty grim or pancreatic cancer or something so-called adenocarcinomas. It's pretty grim. So I think that's often where you'll see the alternative practitioner thrive.

And then they step in and they use phrases like, you know what, your doctor doesn't want you to know what your pharmaceutical company doesn't want you to know. And and that's when I think people really get ripped off, because there are certainly charlatans out there who are perfectly willing to make a fortune off of people's misfortune.

So but one of the things that I find interesting, however, in these in these cases is that on the one hand, there's the good effect that you were talking about. But on the other hand, there seems to be widespread distrust of sort of expertise, medical expertise in this.

In this particular case, a guru is still an expert or at least pretends to be an expert. And so I find that sort of somewhat paradoxical that people seem to latch on, on even celebrities, for that matter. As as good as I'm thinking because of Jenny McCarthy in the case of vaccine denialism, and while at the same time they distrust the actual experts. So what's going on there? Is it a question? Is it a combination of wanting certainty and also whether distrusting authorities that are somehow officially sanctioned?

I mean, what is the what's the deal?

So that's that's a good question. I guess the example that I would use would be somebody like Andrew Wakefield. I mean, so Andrew Wakefield was that British surgeon who in the late 1990s put forward the notion that the combination measles, mumps, rubella vaccine caused autism. The paper was terrible. It should have never been published. It was published in The Lancet. And it was wasn't a study at all. It was really just a case series. But he was certain that this was true.

And even though study after study after study has shown that his hypothesis was incorrect, he still is certain that it's true. And if you ask him the question, I know this is true because I know someone who asked this question. If you ask Andrew Wakefield the question, is there any study that could be done, it would show you that your hypothesis is wrong. He would say, no, no, no. Scientists say that, obviously.

But that's what he said, the true story. So and yet there are still sort of hundreds of people who when Andrew Wakefield shows up at these these national meetings for autism, like autism, one just again flock to be near him because they love his immutability. They love his certainty. I mean, I think part of what makes science so attractive, at least to me, is that it's mutable that we're willing to take a scientific textbook and throw it over our shoulder as we as we get more and more information.

Because because, you know, as we gather more information, things change. And that to me is actually comforting because science is enormously self-correcting. But some people don't see it that way. They see when they see one study that says one thing and another study that says another thing. See, they say, see, you can't trust science, but that's exactly why you can trust science, because ultimately true truths do emerge over time.

I mean, it may take years, but but ultimately, truths do emerge. You just have to be patient.

That reminds me of this scene happened to me a number of years ago when I was living in Tennessee, Knoxville, and I was active writing for the local paper about and lecturing about evolution and creationism.

And one of the local preachers wrote these these really vitriolic letter, not surprisingly, about me at the local paper. And in one of the things that his main argument was, I just don't understand why people want to believe something that changes every day. I rather believe in something that has not changed for thousands of years. And I guess that captures exactly what you're saying, that kind of mental habit that I can't you was unable to deal with the uncertainty, with the fact that, well, we think that is true today.

We may change tomorrow because, you know, the evidence comes in and we have to change our mind. And that kind of uncertainty is just it doesn't work very well for some people. Yes.

Science waffles. It's a waffler. Just a waffler. That's right. It's a flip flopper. Flip flopper. That was the other one.

Now, however, when we're talking about, let's say, alternative medicine, which is a category that I think like you, I actually a label that I sort of reject. I mean, as far as I'm concerned, there is no such thing as alternative medicine. There is either. That works of some stuff that doesn't work, but but let's use the label as it's normally employed and the question for me is this. So there are some kinds of alternative medicine that clearly at this point, I think definitely don't work.

Homoeopathy is my favorite example. There are, of course, clearly sound examples of very good science. On the other hand, treatments that have come out over the last few years that are clearly, equally, clearly do work. I'm thinking antiretroviral drugs, for instance.

But then there is is there I mean, that's the question for you. Is there a reasonable area in between? Are there things that may fall, the alternative medicine that may still, in fact, have a shot in terms of becoming real medicine, in your opinion?

Well, I guess, again, I struggle with the term alternative because, as you said, it's an alternative medicine works is not an alternative, and it's medicine and it's an alternative. Medicine does work. It's not an alternative.

But, yeah, I think it's when I first wrote this book, Do You Believe in Magic? The original title was Quack's How They Hurt US and Why We Let Them. I really saw no place for for this. But as I read more and more and certainly read a lot of the studies about, I guess, what we call placebo medicine, I became sort of convinced that there is a physiological basis to to a number of aspects of the placebo response.

I mean, the we can certainly there are studies, I think, that are pretty clearly show that one can learn to release their own endorphins. One can learn to regulate and regulate their own immune system. One can learn to release dopamine. There's those studies are pretty clear to me. So I do think there's a there's something to that. And I had to debate this guy on a local NPR show within the past week. And, you know, and he studies sort of moderators of stress.

Fair enough. You know, that that you know, I was in the hospital a few years ago and, you know, a guy came around, he was a chaplain and he comes in. It was like 2:00 in the morning. He asked me that I want him to pray for me. And I sort of felt bad about saying no, even though I didn't really want to pray for him. But I said, sure, I mean, pray for me.

And now, while he was standing there sort of praying for me, it was all very common, you know? And I think I have to believe that there's a physiology to that. That is a value. So I think there is a role for this. And I'll give you another example like this will surprise you, actually, because it involves homoeopathy. Mehmet Oz on his show once said, When my children get sick, my wife gives them homeopathic arnica.

If they stay sick, she calls me. Now, in some ways, you could make an argument for that because probably 80 percent of diseases that we see on an outpatient basis at Children's Hospital thought of yourself limited. They're going to go away on their own. Right. If you come into a doctor's office with a self limited illness, a viral cold or a viral sore throat or viral bronchitis, you may well walk out with an antibiotic which isn't going to help you and could potentially hurt you.

You may walk out with a cough and cold preparation. It contains active ingredients like pseudoephedrine, which certainly can be harmful to young children. So you can make an argument that homeopathic artec is not such a bad idea and it avoids those those things that are potentially harmful. And when they don't get better now, you know that it really is something serious. The problem with that, obviously, is that it promotes the notion that homeopathy is in any way making you better, which it isn't.

All right.

So what do you think about the ethical question of doctors knowingly giving placebos to patients in hospitals to see of some kind, whether that's still far more or, you know, an activity the patient is supposed to do that might help when there's no evidence that it works?

Aside from the placebo effect, I think deception is OK at low risk, at low burden and low cost. I think we do it all the time. If you come into our hospital, we use you will find doctors that have long white coats with red stencilling. They look official. We have big machines. The most interesting noises. You come into that building with an expectation of therapy. You'll have a doctor who, when they give you a medicine, will say, I really think this is going to work for you.

And there are studies done showing that that's more than it is therefore more likely to work for you.

Why did you just ruin that for me by telling me about it? Yes, I got in trouble. Sorry, when you were a little boy.

I'm sorry when I was a little boy. And I give you a sense of how old I am by my pediatrician would would make house calls. And I remember him well. He had this big black bag and I loved it.

I mean, the big black bag I've only ever read about that.

He had the big black bag and there was tubing and syringes and medicines. And I remember there was a little thing of pills. And I remember I remember this. His name was Markowitz, eventually actually became the dean of Connecticut's medical school. He was a brilliant guy. But he I said, what's this? And he said, those are sugar pills. And I said, sugar pills because I had sugar pills in my little doctor's kit. I'm thinking, great, I'm halfway there.

And he said, this is for people who feel the need to take something even though they're going to get better anyway. So I think it's fine. I really do think it's fine because I. We do do it and so better that than giving them the script or the notion that they should take a cough and cold remedy, which isn't going to make their cough and cold better and could potentially hurt them.

Well, that's that's interesting. Well, so let's go back to some of these practices that fall typically under under so-called alternative medicine.

So two that come up often with discussions that I have with friends and even with with people who have a pretty good degree of skepticism about alternative medicine in general.

But there is a couple of of areas that come up as well. There has been enough evidence that may be working and all that. And so I'm going to ask you, what what do you think of the evidence in those two areas? In those two areas are chiropractic and acupuncture.

Right, so I guess I'll start with acupuncture. It's acupuncture is really interesting to me. I mean, I have a friend whose name is Eric. We'll call him Eric because that's actually his name. And he's a professor of law at Penso Law School. Smart guy. He teaches torts. He's a professor, a brilliant guy. And he says, when I was when I had back pain, low back pain, I tried nonsteroidal antiinflammatory. It didn't work.

I tried Cox two inhibitors like Celebrex that didn't work. And when I did acupuncture at work and it did, I mean, I don't think he's lying to me. I think that's right. So what's going on? What's happening? And I think there is something therapeutic in that interaction. I don't think it has, frankly, anything to do with putting needles under the skin. I mean, you know this better than me. You know, acupuncture is the product of second century B.C. China.

That was a culture that not only didn't believe in dissection, but they punish those who dissected by killing them, which I'm sure was a huge disincentive to learning about human anatomy. So they believe there were 12 meridians in which you inserted these needles because there's 12 great rivers in China. They believe the body had composed of three hundred sixty five parts because they're a three hundred sixty five days a year. So if you believe that the human anatomy is based on rivers in China, days in the year, they were just making it up.

There's nothing accurate about acupuncture and there have been studies done showing it for those who benefit. It doesn't really matter where you put the needles and that those recent studies, as you know well, well, well, by Edzard Ernst that when he was at the University of Exeter in England showed that you can use retractable needles.

Now, there's there's a little bit it's not great, but there's some data to suggest that if you give them the locks on to these people, which is an endorphin blocker, that you can, in fact, lock the effect, suggesting that some people are learning to release their own endorphins. And that may be true. And the question is, what is it about that interaction that you're lying down, that the guy's talking to you in a soft voice, that there is there's music in the background that is burning.

Incense is just the touch of the needle. There's something in that interaction that I think probably is therapeutic for some now. I think for most it may just simply be regression to the mean. You tend to go to a physician when you're in your most pain and usually chronic pain, wax and wane.

So so who knows? But I do think that there might be something to that.

Do you know if they've looked at whether it makes a difference if you go in expecting it to work or not?

That I don't know. But that's that's a great point. I suspect most probably do go and expect a friend of mine who tells me the following story, which is great. He said, I have low back pain. I went to an acupuncturist, I got acupuncture and my pain went away the year a year later, it happened to me. I did the same thing. The pain went away. A year later, I had the same pain. I didn't go to an acupuncturist and it went away.

So that's probably the story. But the thing about before we moved to chiropractic. So the thing about you, of course, is prominent from an exquisitely empirical perspective. It is actually very difficult to do seriously well controlled studies, particularly double blind studies. I mean, you mentioned the retractable needles, but even that is only a partial thing because there's still some kind of contact. And clearly it's not double blinded, I assume, because the doctor, the experiment that actually knows what's going on there, right?

Yes.

So it is very difficult to do controlled studies. But the idea is that, as you were mentioning earlier, once you start showing things like, well, as it turns out, the overall magnitude of the fact is not it's not different from from a placebo. When you when you pick the place is the point at random. It doesn't seem to be any difference with when you pick the way you're supposed to become and so on and so forth. At some point, I guess it's a question of inference to the best explanation.

It's like, OK, we cannot do a completely perfect, double blind controlled experiment, but we've done enough variations on the same theme that it's reasonable to conclude that there is nothing other than some kind of placebo induced physiological effect. Does that make sense?

Yes, and I frankly wish we had a different word other than placebo, because I think when people hear the word placebo, they see it as dismissive. Then it's just all in my head. It's not real. I'm really experiencing the same pain. I'm just saying it's less I really do think some people may experience less pain and understanding that is important.

I do think that those who practice things like acupuncture or chiropractic do owe it to the medical profession to if something does work, really try and figure out why it works. So what is it about that interaction that's working? Because because then you shouldn't you should put the patient in the least possible risky position, because if it has nothing to do with putting the needles under the skin, then don't put the needles under the skin because they can break off and lodge livers and hearts and lungs, as has happened.

And they can introduce diseases like HIV and hepatitis B and hepatitis C, so don't put them under the skin if you don't have to. Right.

So what about chiropractic? Yeah, I really have little sympathy for chiropractors. I mean, obviously it's based on this notion in the late eighteen hundreds by Daniel David Palmer that that all diseases were associated with misaligned spines. Right. I mean, he had a guy come into his office. Does Daniel Palmer, the guy can here he then sees that there's a so-called misalign spine that what he called a subluxation.

He. It back in place and suddenly the man could hear it was the crack heard round the world. The problem with that obviously, is that the brain doesn't travel through the neck. So this was just utter nonsense.

And, you know, it certainly can do harm. I mean, we know that there have been many vertebral artery terrors that have caused deaths. That's not conscionable.

And I think, you know, and so what's the value of chiropractic, if any? I mean, if there's any value, maybe it's that people, the chiropractor, spend more time with their patient than an orthopedist is going to spend who may only spend five minutes walking out with a prescription. And maybe there's something to to chiropractors, massage therapists. But I don't see it as anything better than that.

Paul, are there any areas in in medicine or health generally that you think most skeptics don't understand or are misled about? I'm not sure I understand your question exactly. Oh, I'm sorry. So so it's a common topic of discussion. Acupuncture and chiropractic, to a slightly lesser extent and homoeopathy to a much larger extent are common topics of discussion in the skeptic community. So so, you know, self professed skeptics are pretty much on board with your message there.

I was wondering if there's anything that you think skeptics are not on board with that they should be on board with or think they are on board with, that they shouldn't be on board with? In the area of medicine, like vitamines or. I see what you're saying. Here's what I would say. I mean, in in I think that doctors don't at least practicing physicians don't really know much about alternative medicine, to be honest with you.

I think they tend to be very open minded and are willing to accept much of it. I mean, to be honest with you, I'm not sure this answers your question exactly. The reason I wrote this book actually was because of an interaction I had with my orthopedist. I mean, I had no microfracture surgery on my left knee during the recovery period, which was fairly lengthy. It was about a year I saw my orthopedist, my University of Pennsylvania trained sports medicine orthopedist, who told me I should take on chondroitin sulfate and glucosamine.

I mean, it stunned me. I didn't understand why I should take that. He explained to me that that this would help increase collagen deposition in my left knee, when, in fact, I'm probably college is one of the most abundant substances made in the body every day. I'm well, and there is no reason taking that will increase deposition of college in my left knee. He also told me it had an antiinflammatory effect and would therefore decrease my pain.

There is no reason either chondroitin sulfate or glucosamine should cause anti inflammatory effects. So. So I was surprised. I mean, but you know, you want your doctor to like you. I went to the GNC Center. I bought these things which weren't particularly cheap. I took it for a day or two till I felt so ridiculous. I just stopped and looked at, looked it up and realized that that this was this is actually was something that had been studied, doesn't doesn't affect osteoarthritis.

So it was just a silly question. But he why did he do that? I mean, why did he make that recommendation? There's a couple of possibilities. The the more sinister one is that it's a marketplace, that this is a thirty four billion dollar industry and now there is no dividing line between the conventional therapies and the alternative therapies. They see it as a marketplace. They see themselves as waiters in a restaurant. And here's their menu. How would you like this?

The other the more benign notion is that that if he if he gives this to me because it's going to be a placebo, it's not going to have any real effect. And it causes me to not take nonsteroidal anti inflammatories or not take COX two inhibitors, which do have side effects then and I appreciate any benefit or it's just gives me something to do because people like to take things when they have pain, then it's a value, I guess that's of some value.

But but it really did scare me because for the first time I had the notion that there is no divide between the conventional therapies and the alternative therapies.

So one of the things that come up already a couple of times in this discussion is the money issue. So one of the things that I hear often from people who buy into alternative medicine is that they distrust big pharma because, you know, it's a multibillion dollar industry, etc., etc. But in fact, the alternative medicine industry also is a multibillion dollar industry. Right? I mean, we're still talking about huge interests there, financially speaking.

Of course, it's this is big business. This is a thirty four estimated to be by some a thirty four billion dollar industry. The megavitamins is a dietary supplement. Industry is huge. Plus Big Pharma is involved. I mean, Pfizer recently bought Alistaire, which is which makes the emergency line of products so that not probably the biggest makers of megavitamins in the United States, Hoffman, the Roche, has been in this business since the nineteen thirties. I mean, this is Big Pharma.

You know, I think I give credit to those who make vitamins and supplements and being able to convince people that they are like just that these products are made by elves and old hippies on Meadow's pop up.

We just care. We care because we want to give give it to the people. This is people's medicine. It's all natural. It can only help you. It can't hurt you. I mean, that is one amazing marketing effort because this is big business. And like any big business, it sells things and in this case, in an unregulated manner.

Speaking of unregulated, why is that? I have wondered for so long why food is regulated and yet and, you know, normal medicine is regulated, but alternative medicine and vitamins are not.

In the early 1990s, David Kessler, when he was commissioner of the Food and Drug Administration, paired with Henry Waxman, Democrat from California, to regulate this industry. At that time there were about three thousand dietary supplements on the market. It was a it was a billion to two billion dollar industry level roughly. But they were media savvy and they certainly had had political connections. What he was worried about was that people were walking into health food stores and being given these supplements as therapy.

This is going to treat your hypertension. This is going to lower your bad cholesterol. And that worried him. Fair enough. It should have worried him. And so he introduced legislation to regulate the industry. That was what he did. And the industry was so powerful, not that not only did they defeat that legislation, they introduced legislation of their own in nineteen ninety four, the Dietary Supplement Health and Education Act, called appropriately by The New York Times, the Snake Oil Protection Act.

I mean, this was an education act that had nothing to do with education, everything to. Do with the consumer not knowing what they were getting and for that reason, you know, this is an industry that's unregulated. I will tell you something then. This is just happened the last couple of days. On July twenty ninth of this year, the Children's Hospital of Philadelphia was probably the first hospital in this country to take dietary supplements off our formulary.

You can't get you're not getting them from us anymore. And the reason is, is that that at the very least, it violates our home medication policy. We don't let people give give drugs that they bring in from home like, say, amoxicillin, unless we can prove that it is what they claim it to be and that they've stored it correctly. By definition, dietary supplements cannot be proven to be what they're claimed to be. Just the label may well not reflect what's in that product.

And so we now, if you want to use a dietary supplement or hospital, we strongly discourage it. Use if you still want to use it, you have to sign a waiver form. This is the residents are not crazy about this, but this is what we're doing and have been doing since Monday.

But but the food and drug industries are also very powerful. They can't prevent themselves being regulated. Then how can the elves and hippies?

I think it's just history. You know, it's it's you know, this was all drugs were an unregulated industry. And up until nineteen thirty eight, I mean, that was because the elixir sulfanilamide disaster, which was this sulfur product that was that was diluted in a large percentage of diethylene glycol, killed one hundred people, including thirty four children, and thus was born the nineteen thirty eight Food Drug and Cosmetic Act. So now drugs had to be shown to be safe before they were sold.

And then it was the next disaster that the legitimate disaster that led to the nineteen sixty one people over Harris medicinal drugs had to be shown to be effective when they were sold. But what happened here is it was a shadow industry. This dietary supplement industry got more and more powerful as they as they became more and more wealthy. And they they have the political connections, not the least of whom is Orrin Hatch, who continues to defeat any attempt at legislation to regulate this industry.

That's amazing. The story, as usual. I guess what the moral of the story is that it takes for a few people to be killed, especially preferably children, I guess, and then something gets done.

I mean, it's ridiculous because it's it's the kind of thing that you would think that that people would look at the evidence and would look at the actual situation and act proactively before there is a catastrophe like that. But but I guess the history of these field shows exactly the opposite, as you pointed out.

Yeah, I think the Michael Harris was a historian says, and this is this is right, the history of drug regulation in the United States is built on tombstones. But I'll tell you this. This is going to change. It is absolutely going. I don't know if you just saw the most recent FDA recall. It was a recall of vitamin C, it was a recall of B complex vitamins that were made by I forget the name of the company was healthy something products.

And what was it contaminated with? It was contaminated with steroids, including anabolic steroids. And so, in other words, anabolic steroids were part of these vitamin supplements. I just you know, this is the constant drumbeat, if you I don't know if you subscribe to the FDA consumer watch, but but two or three times a month, they're doing these recalls of these heavily contaminated products. I just have to believe that the tide is going to turn and we're going to be right where we were with in nineteen thirty eight eventually with these supplements.

And we're going to regulate them because we have to.

Now, you mentioned megavitamins a couple of times now, as opposed to say, multivitamins that people take on often, I guess on a regular basis. Is there an actual distinction there or is all not particularly good for you?

Well, I think I think multivitamins which contain at or about the recommended daily allowance don't hurt you. I think most people don't need them. I think people get much of the vitamins they need in their diet, although they don't think they do. So it makes for a lot of expensive urine. I I'm talking about megavitamins. So so what I mean are those supplements that are five times 10 times 20 times the recommended daily allowance. All right.

So briefly on the recommended daily allowance or on your point that most of us get the vitamins we need? That's another thing I've been confused about for a while, because when I actually look at the foods that I eat typically during the day, and I think I probably eat more fruits and vegetables than the average American, there's no way I'm getting close to the recommended daily allowance of most of the vitamins and minerals. I don't I don't understand how most people could actually meet those quotas.

Yeah, I mean, I guess what I would say is how many people with scurvy and rickets do you know? I think most of us do do get what we need. I don't understand. You know, I just think it's the it's sort of all part of the toxic environmental health thing that we're always convinced of that that foods are processed. It's not natural. You know, you can't possibly get everything you need. I think we do get what we need and in our food.

And I mean, there's enough data now, I think, to convince one that if you eat foods rich, if you eat diets rich in fruits and vegetables, that that is a value because you're getting presumably more antioxidants and that lessens the risk of cancer unless your risk of heart disease and potentially lengthens your life. So I think that's all good. But the mega vitamin thing, what amazes me, I guess. I give credit to the industry for this, if they can convince you that that's a natural thing to do is remarkable.

I mean, I went into the GNC Center last week and I bought a vitamin A bottle because I had to do this talk in D.C. and I wanted to have props. So I bought vitamin A and on the fun of it, it said vitamin E, natural one thousand. If you looked on the back, it said that it was three thousand three hundred and thirty three percent of the recommended daily. So it's thirty three times the recommended daily list.

If you open up the bottle that had a gel cap, it was about half the size of an eyelid. Now an almond is actually a rich source of vitamin C, but in order to get what was in that that capsule, that one little capsule that was half the size of an almond, you would have to eat about seventeen hundred dollars roughly.

That's that's perfectly natural. Yeah. Yeah.

That's not a natural thing to do. And, you know, people should be a little suspicious of that because no one's going to eat 70 pounds Baumann's because they would think that may be bad for them, but they'll ingest this, assuming it's good for them.

That that is an amazing comparison. One of the things that often come up and in fact, we've discussed it right at the beginning of this of this, is that in the context of the popularity of alternative medicine and in fact, the popularity of skepticism about standard medicine is the is the role of of celebrities, you know, mentioned Jenny McCarthy, who's who's now getting a prime spot on ABC on The View.

So what's going on there? Because we talked about the gurus. You know, I understand somebody like Deepak Chopra who pretends to have the answer to everything, OK, is is is popular because people like certainty.

But what about people like McAdie or similar, you know, other celebrities? Why would anybody in his right mind think that that is a good idea? They didn't. She's a model. So naturally she knows about science. Because people think they know her, they they see her on the big screen or little screen, she's spunky, she's funny, she's distractive, and they they believe they know her. I mean, I you know, when people buy products, they they they they buy the person who's selling the product much more so than the expertise of that person.

I mean, my father was the head of a sales force for men shirts for years, and he would let me go to the sales meetings. And the point that he made to his salesman, these were salesmen across the United States, was that when people buy shirts, they're buying you. They're not buying the shirt. I mean, Good said the line was a good salesman can sell anything. And the point is, it doesn't matter what your expertise is, it people are buying you.

And I think that's that's true with Jenny McCarthy or Suzanne Somers or any of these celebrities who obviously have no particular expertise in medicine or science. But you're buying them. I mean, just watch television and look look who advertises, you know, for for various products. It's not you know, Queen Latifah advertises for CoverGirl. It's not because she's a cosmetics expert. It's because we think we know her. Snooki advertises for her pistachio peanuts because we think we know Snooki.

You know, I guess the first thing that I noticed something that actually was when I was still living in Italy and when I was young, I had the passion for for for astronomy and telescopes. And so I subscribed at some point to Sky and Telescope, which is major, you know, American magazine. And I'm like the Italian equivalent Sky and telescope at the time. And I'm sure still now had these advertisements of, you know, very nice looking telescopes right next to a very attractive young women.

And I remember that my thought was, what is that? What is that about? You know, why do I care that there is an attractive young woman next to the telescope? I want to know about the technical characteristics of the telescope you just didn't see at the time or anything like that in an Italian magazine. And it struck me as a very different way of, you know, what exactly are these people selling? But this is this is essentially what's going on here, as you say, where people are buying into the personality because they're buying into the person they think that they know the person.

You remember those ads, though, Diane? Yeah, that's right. Absolutely. Much more than agree on.

One thing that's really struck me is just how much even if you know that, you know, a single anecdote isn't good evidence or, you know, an attractive person isn't more likely to be right about science, even if you know that I can still be hard to override your sort of automatic intuitive, you know, the automatic heuristics that your brain is using that are subject to things like the, you know, the halo effect or or the availability bias.

I don't know if Jenny McCarthy actually intellectually believes that epidemiological studies are better evidence than anecdotes, but even if she did, I think she might find it hard to look at, you know, a single child like her son who develops autism shortly after being vaccinated and not feel like that's convincing evidence because that's sort of how we're wired. So it's kind of an uphill battle, right.

In fact, she's famous for saying exactly things along those lines. That is exactly that sort of thing.

So that brings me to a related topic, which is the role of the media in one of your books in Autism's False Prophets.

You correctly have been criticized harshly, both Larry King and CNN for not doing their homework, doing and not doing fact checking. During an interview of McCarthy, she was saying things and another guest on the show was saying things that went completely unchallenged and completely unchecked by the CNN staff, even though they were, in fact, demonstrably false. Again, what's going on there? I mean, it's the media themselves seem to be buying into the celebrity culture, not just the public.

And that's a little more difficult to swallow because the media are supposed to be you know, the journalists are supposed to be the gatekeepers of what's going on here, but they're not doing or at least some of them are not doing their job.

Yeah, I'm not sure on what planet you think that journalists are be gatekeepers of what's going on. I know the way that journalists do this thing. It's about it's about being interesting. It's about ultimately selling advertising. And they have this mantra of balance, which is is, I think, wrong, because often they'll tell two sides of a story when only one side is supported by the science. I think they're awful. And obviously, as a general rule, television is the worst.

Obviously, local television is probably even worse than that. But, you know, there I can tell you this is a true story. When there was a show on ABC's 20/20, this when Hugh Downs and Barbara Walters were the co-host and it was about Sovietization was the correspondent, they did a story claiming that the hepatitis B vaccine caused sudden infant death syndrome, caused chronic rheumatology diseases and caused multiple sclerosis now. At that time, there were actually two studies had already been published showing that hepatitis B vaccine neither caused nor exacerbated multiple sclerosis in people who had it.

So. So I emailed I emailed them and called the OR I think I wrote this was my early nineteen nineties. I think I wrote to the correspondent Sylvia Chase. I wrote to the person who was the executive producer, never heard back, but I ran into a junior executive producer for that show a few months later and we got into it and it got sort of the conversation got louder and louder. I was getting frustrated. So was she. Until she finally said to me, and I quote, Look, our job is to be interesting if it also happens to be true.

Great. Wow.

That's a quote from an executive that was really sort of a seminal moment for me. I think I realized that, that when people ask you a question on national television, they don't they're not really interested in the answer. They're just interested in being interesting. And that's what makes us all so awful. The media doesn't see themselves as having a responsibility to educate the public. Not at all. Their job is to be interesting to the public.

And it's kind of a race to the bottom, right? I mean, if if I choose to be boring but committed to the truth and my opponents, the marketplace chooses to be interesting and not so committed to the truth, then, you know, people like me lose out. And I'm sure that's like at the top of journalists and news networks minds. Well, certainly that seems to summarize the history of media, especially the 24 hour news channels over the last several years.

Yes, it has been clearly a race to the bottom.

Unfortunately, before we have to wrap up the segment, I'd love to hear your take on how the anti VAX fight is going right now. Are they gaining ground or are they losing ground? What's the status?

They have clearly lost ground. I mean, if you look at the way this story was covered 10, 12 years ago, it was it was two sides of the argument. You would have people quoted like Andrew Wakefield, Barbara LOE Fisher, J.B. Handley, Lyn Redwood. I mean, all the people who who refused to acknowledge the science that had shown that their hypothesis that vaccines cause autism was dead wrong, they're gone. I mean, their voices are gone.

And I think I'd like to think it's for the right reasons, but I'm not so sure. I think the right reason would be because study after study after study has shown that they're wrong. And so the hypothesis is clearly fruitless, a dead end. But I think it may be in part because Andrew Wakefield was not only wrong, but he was fraudulent, wrong. And people don't like fraud. So I think the media were burned by him and the anti vaccine people attach themselves to his star and came crashing down with them.

Well, that was that was sort of a lucky break. I guess it's too much to hope. I suppose that future dangerous quackery will turn out to have been fraudulent as opposed to just, you know, made up. Actually, I'm not so sure about that because, yeah, well, I suspect I don't have a hard date at the moment, but I suspect that there is actually a fairly decent correlation between quackery and fraudulent. And, you know, it may turn out more often than than than one might think that the purveyors of quackery you're not just wrong.

They're they're also fraudulently wrong, at least some of them. And if enough of them turns out to be the case, then then maybe there is hope for the wrong reason.

Maybe we're saying, Paul, but maybe there is hope.

Yeah, maybe that should be more of our strategy going forward. Focusing not on this is really poor scientific evidence, but instead on like, look, this person was deceitful in this way. Yeah, yeah. We're just about running out of time now. So I'm going to wrap up the segment of the podcast and move on to the rationally speaking facts. Welcome back. Every episode. We pick a suggestion for our listeners that has taken our rational fancy.

This time we ask our guests to pull off it for a suggestion.

So, yeah, they I read a book that won the Pulitzer Prize a couple of years ago called Emperor of All Maladies A Biography of Cancer, but it was by Siddhartha Mukherjee. It's a wonderful book. I mean, it's written by a guy who's a Rhodes scholar, Harvard graduate, researcher and cancer. And he is uniquely talented in his ability to be able to explain cancer therapy, simply starting from the nineteen twenties and thirties when we were we were really lost up until our ability now to define specific genes, to define therapies like Gleevec or Herceptin that are directed against the the products of those aberrant genes.

And it's such a wonderful book because it's great science and it's great storytelling by someone who clearly can write. And at the same time, I read that book, there was a show by Piers Morgan on CNN where he had Suzanne Somers on the show explaining her book about cancer, which was called Breakthrough. And the subtitle was something like talking to leading cancer experts. And her story was all just what you would expect. It's coffee enemas. It's miracle diet.

So celebrity endorsements and patient testimonials knows nothing about about genes. And it's those two books. It's as if they were written in two parallel universes. And what bothered me the most in that was that here's this this wonderful spokesperson for cancer. And on CNN, instead of seeing him, we see her. And what was what did Suzanne Somers what recommends her that she was Chrissy on Three's Company? I mean, I don't think that's good enough.

I have nothing to disagree with in that statement, Paul, it's been a pleasure having you on the show. And I heartily second your recommendation to the emperor of all maladies. We are all out of time, unfortunately. So thanks very much. Call.

Thanks, Massimo. Thanks, Julia. That was fun.

It was. This concludes another episode of rationally speaking. Join us next time for more explorations on the borderlands between reason and nonsense.

The rationally speaking podcast is presented by New York City skeptics for program notes, links, and to get involved in an online conversation about this and other episodes, please visit rationally speaking podcast Dog. This podcast is produced by Benny Pollack and recorded in the heart of Greenwich Village, New York. Our theme, Truth by Todd Rundgren, is used by permission. Thank you for listening.