SGU Episode 908: Difference between revisions
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=== Acupuncture for Backpain <small>()</small> === | === Acupuncture for Backpain <small>()</small> === | ||
* [link_URL TITLE]<ref>[url_from_news_item_show_notes PUBLICATION: TITLE]</ref> | * [link_URL TITLE]<ref>[url_from_news_item_show_notes PUBLICATION: TITLE]</ref> | ||
2511.48 2514.92 '''S:''' All right, so Cara, I'm actually going to do a similar news item. | |||
2514.92 2523.64 '''S:''' I had to talk about this topic, so let me read you the headline of a press release that I blogged about on Science-Based Medicine. | |||
2523.64 2524.64 '''J:''' Oh boy. | |||
2524.64 2526.44 '''S:''' Here we go, ready? | |||
2526.44 2532.64 '''S:''' Acupuncture can relieve lower back slash pelvic pain often experienced during pregnancy. | |||
2532.64 2537.04 '''S:''' That was the headline, that was the bottom line of this study. | |||
2537.04 2541.44 '''S:''' Several people emailed this to us because they're like, hey, what's going on with this, right? | |||
2541.44 2543.92 '''S:''' Because they know I don't think that acupuncture works for anything. | |||
2543.92 2565.00 '''S:''' But here is a meta-analysis published in a high-impact journal, the BMJ, and the authors are pretty, the authors, they're not quite that positive, but that was basically their spin. | |||
2565.00 2568.72 '''S:''' I mean, the press release was basing it on what the authors were saying. | |||
2568.72 2581.72 '''S:''' And of course, I had to dissect the study and see what it shows, and it turns out it's a great example of absolutely everything that can go wrong with a meta-analysis. | |||
2581.72 2583.84 '''S:''' Oh, really? | |||
2583.84 2596.36 '''S:''' The study, in my opinion, clearly shows that acupuncture doesn't work, and yet they manage to still spin it to the opposite bottom line. | |||
2596.36 2600.04 '''S:''' It is almost a textbook of science-based medicine in and of itself. | |||
2600.04 2601.60 '''S:''' So let's take a look at it. | |||
2601.60 2610.20 '''S:''' Again, the authors' conclusion was acupuncture significantly improved pain, functional status, and quality of life in women with lower back pain during pregnancy. | |||
2610.20 2611.20 '''E:''' Significantly. | |||
2611.20 2612.20 '''S:''' What's the mechanism? | |||
2612.20 2617.32 '''S:''' Yeah, well, don't get me started on the mechanism. | |||
2617.32 2630.00 '''S:''' So and you know, meta-analysis, when you combine studies from different trials and the greatest weakness of a meta-analysis, of course, they could be fine, but they do follow the dictum of garbage in, garbage out, right? | |||
2630.00 2635.52 '''S:''' If the individual studies are crap, you cannot rescue them by putting them together in a meta-analysis. | |||
2635.52 2640.32 '''S:''' Meta-analysis is good for combining good studies that need to be great, more powered, right? | |||
2640.32 2646.88 '''S:''' You can increase the power of a meta-analysis by combining lower-powered studies, but it doesn't improve the rigor. | |||
2646.88 2650.48 '''S:''' It doesn't fix the problems of the other studies. | |||
2650.48 2653.96 '''S:''' So all right, first of all, it's not that big a meta-analysis. | |||
2653.96 2655.96 '''S:''' It has 10 studies, right? | |||
2655.96 2657.80 '''S:''' So that's not that big. | |||
2657.80 2662.76 '''S:''' The thing that's interesting is that the authors did a good job of gathering the data. | |||
2662.76 2666.84 '''S:''' Like I didn't have to go to each individual study. | |||
2666.84 2676.00 '''S:''' I still did for many of them, but I didn't have to do that to find the information that I needed because they, the authors published that information in the meta-analysis. | |||
2676.00 2685.52 '''S:''' They just ignored it or just like completely glossed over the fatal problems with the evidence that they were documenting. | |||
2685.52 2692.12 '''S:''' So first of all, we could look at the, just the rigor of the studies, right? | |||
2692.12 2699.24 '''S:''' And they have a nice convenient table showing like which studies were blinded and which studies, you know, in what ways. | |||
2699.24 2704.12 '''S:''' And not a single study was rigorous across the board, right? | |||
2704.12 2706.32 '''S:''' Most of the studies were not blinded. | |||
2706.32 2709.44 '''S:''' None of them were double blind. | |||
2709.44 2711.68 '''S:''' Not one of the studies were double blind. | |||
2711.68 2715.36 '''B:''' I mean, that should be a reason not to do a meta-analysis. | |||
2715.36 2717.76 '''S:''' So right there, you could stop there. | |||
2717.76 2726.08 '''S:''' This is a, this is a study with a subjective outcome with a huge placebo effect and not a single study was double blind. | |||
2726.08 2729.52 '''S:''' That's we're done at that point, but there's a lot more interesting stuff to talk about. | |||
2729.52 2733.64 '''S:''' So there was a, there was a massive quality issue. | |||
2733.64 2744.00 '''S:''' Two of the studies had a greater than 20% dropout rate in the non-intervention group because of course they did, because if you know you're not getting the treatment, why would you stay in the, in the study? | |||
2744.00 2745.00 '''S:''' Right? | |||
2745.00 2748.44 '''S:''' So, but that also has the potential, right? | |||
2748.44 2751.28 '''S:''' If you drop out of a study, it's because it's not working. | |||
2751.28 2754.80 '''S:''' And so that massively biases the results towards a positive outcome. | |||
2754.80 2755.80 '''J:''' Right. | |||
2755.80 2756.80 '''S:''' Yeah, absolutely. | |||
2756.80 2757.80 '''S:''' Right. | |||
2757.80 2758.80 '''S:''' Right. | |||
2758.80 2759.80 '''B:''' If you're doing great, you're not going to drop out of the study. | |||
2759.80 2762.28 '''B:''' So yeah, it's only the people that did, that did well remained. | |||
2762.28 2764.56 '''B:''' Oh boy, look how good this is. | |||
2764.56 2765.56 '''S:''' Yeah. | |||
2765.56 2768.92 '''S:''' So they also, some of the studies included secondary outcomes, right? | |||
2768.92 2776.76 '''S:''' So the primary outcome, you have to pick like, what's the one major thing we're going to look at, but then you can have secondary outcomes, which are supportive. | |||
2776.76 2802.56 '''S:''' So for pain studies, one of the important secondary outcomes that we use, and actually this could be a primary outcome if you wanted to make it one in your study is so you can ask patients like how much pain did you have or, you know, document your pain over time, but you could also ask them how much pain medication did you use over that period of time and you can in fact count their pain medication. | |||
2802.56 2803.60 '''S:''' Right. | |||
2803.60 2811.88 '''S:''' So that's kind of a pseudo quantitative way of assessing their pain because, and in fact, that's actually a better outcome. | |||
2811.88 2812.88 '''S:''' Right. | |||
2812.88 2826.28 '''S:''' So what do you think is going to, is more, more truthful and not that they're lying, but I mean more to the point how much pain you say you're in or how much pain medication you use to treat your pain. | |||
2826.28 2827.28 '''S:''' Yeah. | |||
2827.28 2828.28 '''E:''' The medication you're using. | |||
2828.28 2829.28 '''S:''' Yeah. | |||
2829.28 2832.60 '''S:''' The medication is considered to be a really, really important outcome. | |||
2832.60 2840.32 '''S:''' So that outcome, the use of rescue pain medication was not different in the groups. | |||
2840.32 2846.66 '''S:''' So patients were saying they had less pain, but they were using just as much rescue pain medication. | |||
2846.66 2851.60 '''S:''' So that also massively throws into question the outcome. | |||
2851.60 2853.96 '''S:''' They also looked at a funnel plot. | |||
2853.96 2862.42 '''S:''' Now, a funnel plot is a way of visually documenting whether or not there is publication bias. | |||
2862.42 2865.48 '''S:''' And I know I've talked about this on the show, but this is kind of a wonky statistical thing. | |||
2865.48 2867.64 '''S:''' So let me review it very quickly. | |||
2867.64 2875.36 '''S:''' Basically on the Y axis, you, you rank studies based upon their power. | |||
2875.36 2876.36 '''S:''' Right. | |||
2876.36 2879.68 '''S:''' And on the X axis, you document their effect size. | |||
2879.68 2880.68 '''S:''' Right. | |||
2880.68 2882.48 '''S:''' So you look at each individual study. | |||
2882.48 2883.96 '''S:''' Here's how powerful it was. | |||
2883.96 2885.32 '''S:''' Here's the effect size. | |||
2885.32 2886.68 '''S:''' That's where the dot goes. | |||
2886.68 2888.00 '''S:''' And then you plot them. | |||
2888.00 2902.20 '''S:''' And when you do that, they should form a funnel, meaning that the more powerful they are, the less variable they are in terms of, you know, how far they stray from the average effect size. | |||
2902.20 2906.28 '''S:''' And in addition, they should be evenly distributed. | |||
2906.28 2917.48 '''S:''' And that's the critical part for publication bias, because if, if you're publishing all of the studies, there should be a statistical distribution around the effect size. | |||
2917.48 2925.84 '''S:''' But if you're only publishing the positive studies, then all of the studies should be on the positive side of the effect size. | |||
2925.84 2926.84 '''S:''' That makes sense? | |||
2926.84 2935.12 '''S:''' And so you could instantly visually see how well distributed the studies are and if there is publication bias. | |||
2935.12 2940.92 '''S:''' So what do you think we see when we look at these studies, these 10 studies? | |||
2940.92 2946.16 '''S:''' So there, there are, first of all, we see two things, both of which are fatal, right? | |||
2946.16 2949.88 '''S:''' One is there's definitely publication bias. | |||
2949.88 2965.80 '''S:''' There's more studies on the right than on the left and perhaps even worse than the fact that they showed that, yes, there's publication bias, is that there was an inverse relationship between power and effect size. | |||
2965.80 2970.16 '''S:''' In fact, there's no, there's no funnel through those dots. | |||
2970.16 2984.30 '''S:''' You could draw a line through those dots, meaning that in the upper left hand corner, outside the funnel, there's two of the most powerful studies are dead negative, right? | |||
2984.30 2988.78 '''S:''' As the studies get less powerful, that's when the effect size increases. | |||
2988.78 2990.28 '''S:''' So oh, ding, ding, ding. | |||
2990.28 2991.28 '''S:''' Yeah. | |||
2991.28 2997.88 '''S:''' So there's a decline effect between effect size and power and power also tends to go hand in hand with rigor. | |||
2997.88 2998.88 '''S:''' You know what I mean? | |||
2998.88 3002.74 '''S:''' Cause if you're going to do a really powerful study, you're probably going to also put, make it a more rigorous study. | |||
3002.74 3004.52 '''S:''' So those two, two things tend to correlate. | |||
3004.52 3015.64 '''S:''' So the better studies, the more powerful studies were negative and the less rigorous, the less powerful the study, the more variable that was, the more positive it was. | |||
3015.64 3023.42 '''S:''' And those were the ones that were all on the right side of the line so that there was significant publication bias as well. | |||
3023.42 3024.42 '''S:''' So basically- | |||
3024.42 3029.94 '''J:''' So where did you see that, Steve? Where did you see this publication bias, like those charts or whatever they were, graphs, where'd you see that? | |||
3029.94 3030.94 '''S:''' In the study. | |||
3030.94 3031.94 '''S:''' So in the meta-analysis, they published it. | |||
3031.94 3032.94 '''S:''' They included them. | |||
3032.94 3033.94 '''S:''' They published it, the mistake. | |||
3033.94 3038.60 '''S:''' So like I said, they published all the data you need to see that it's crap. | |||
3038.60 3041.50 '''S:''' They just- How did they come up with the conclusion they came up with? | |||
3041.50 3042.66 '''S:''' That's the question. | |||
3042.66 3046.00 '''S:''' How could they look at that funnel plot and come up with the conclusion they came up with? | |||
3046.00 3047.00 '''S:''' That's the question. | |||
3047.00 3048.80 '''S:''' Do they know what it means? | |||
3048.80 3049.80 '''S:''' They do. | |||
3049.80 3052.24 '''S:''' They say, yeah, it looks like there's some publication bias here. | |||
3052.24 3056.76 '''S:''' Anyway, look how great, I mean, it was just, they just gloss over it, but they say it. | |||
3056.76 3057.76 '''S:''' It's there. | |||
3057.76 3059.08 '''S:''' You can't deny it. | |||
3059.08 3062.28 '''S:''' There's publication bias and there's a decline effect. | |||
3062.28 3076.04 '''S:''' You know, with the tube, I mean, it's so visually stunning to see these two studies outside of the funnel, like all the way at zero that are way above all the other studies in terms of power. | |||
3076.04 3077.68 '''S:''' It's just visually dramatic. | |||
3077.68 3083.64 '''B:''' I mean, they should be the two first pages of that damn meta-analysis. | |||
3083.64 3085.54 '''S:''' No need to go to page three. | |||
3085.54 3090.00 '''S:''' So now there's one more way to look at this, which is specific to acupuncture itself. | |||
3090.00 3092.68 '''S:''' So this could be, so far I could have been talking about anything. | |||
3092.68 3097.26 '''S:''' I could have been talking about cannabis or whatever, where you just, this is just looking at the data. | |||
3097.26 3098.26 '''S:''' Here's a meta-analysis. | |||
3098.26 3100.52 '''S:''' This is why it's negative because of all of these reasons. | |||
3100.52 3102.72 '''S:''' The secondary outcomes are negative. | |||
3102.72 3103.96 '''S:''' There's publication bias. | |||
3103.96 3105.62 '''S:''' There's a decline effect. | |||
3105.62 3109.88 '''S:''' There's none of the studies are double blind, you know, right there, fatally flawed. | |||
3109.88 3116.76 '''S:''' This is, you cannot conclude that this treatment works, but there's an extra added problem because we're dealing with acupuncture. | |||
3116.76 3120.40 '''S:''' That gets back to what Evan said, prior plausibility. | |||
3120.40 3121.40 '''J:''' What? | |||
3121.40 3122.40 '''S:''' Yeah. | |||
3122.40 3123.40 '''S:''' Prior plausibility. | |||
3123.40 3124.40 '''S:''' What's the mechanism? | |||
3124.40 3125.40 '''S:''' Yeah. | |||
3125.40 3130.68 '''S:''' So the question is which acupuncture points are each of these studies using? | |||
3130.68 3131.68 '''S:''' Oh my God. | |||
3131.68 3132.68 '''S:''' Right. | |||
3132.68 3133.68 '''S:''' Right. | |||
3133.68 3134.68 '''S:''' Consistency. | |||
3134.68 3135.68 '''S:''' Oh, you're right. | |||
3135.68 3142.20 '''S:''' So, and how do they, how does each individual study decide which acupuncture points to use? | |||
3142.20 3150.32 '''S:''' So in that gets back even further to the question that I always love to ask when you, when you look at acupuncture studies and that is what is acupuncture? | |||
3150.32 3157.28 '''S:''' Because you know, before you say acupuncture works, you have to have an operational definition of what acupuncture is. | |||
3157.28 3166.88 '''S:''' Now typically it's defined as inserting needles into acupuncture points, which correlate to with specific function in the body. | |||
3166.88 3167.88 '''S:''' Right? | |||
3167.88 3183.42 '''S:''' Now I, I argue that acupuncture points don't exist because that's where the literature shows and now my favorite study to link to is in fact a meta analysis that was produced by acupuncturists who were asking the question, where are the acupuncture points? | |||
3183.42 3193.02 '''S:''' And their conclusion was there are no acupuncture points because there's, if you try to pin down the location of a single point, it's, it's massive. | |||
3193.02 3199.72 '''S:''' Like the, like the distribution of where it could be statistically is like a basketball on the body. | |||
3199.72 3200.72 '''S:''' You know what I mean? | |||
3200.72 3203.32 '''S:''' There's, there's no agreement essentially. | |||
3203.32 3206.18 '''S:''' There's also no agreement about what they do. | |||
3206.18 3212.82 '''S:''' So in this meta analysis, there are 10 studies, two of them are on auricular acupuncture. | |||
3212.82 3217.28 '''S:''' So on the ear, the other eight are on corporal acupuncture. | |||
3217.28 3220.76 '''S:''' So on the body, are they even the same thing? | |||
3220.76 3222.32 '''S:''' They're not even the same thing. | |||
3222.32 3232.16 '''S:''' But then if you look at say the eight corporal acupuncture studies, how many of them do you think use the same, exactly the same set of acupuncture points? | |||
3232.16 3233.16 '''S:''' Zero. | |||
3233.16 3234.92 '''S:''' None of them, none of them use the same set of acupuncture points. | |||
3234.92 3256.14 '''S:''' So there's eight different assortments of acupuncture points, but if you look at the individual and they each use like eight to 10 or whatever different points, how much overlap do you think there is between the, any two studies in terms of like the eight or nine or 10 acupuncture points that they use? | |||
3256.14 3257.58 '''S:''' Some have zero overlap. | |||
3257.58 3261.60 '''S:''' Like they don't even use one of the same acupuncture points. | |||
3261.60 3268.24 '''S:''' And some of the studies have maybe one acupuncture point in common with another study, like one other study. | |||
3268.24 3273.48 '''S:''' I don't know if any of them had two, maybe they did, but there was like almost no overlap. | |||
3273.48 3278.14 '''S:''' Like you almost as if they were trying to be completely different sets of acupuncture points. | |||
3278.14 3280.20 '''S:''' So what does that mean? | |||
3280.20 3281.20 '''S:''' Right? | |||
3281.20 3283.12 '''S:''' I mean, how could we possibly interpret it? | |||
3283.12 3289.76 '''S:''' These are 10 studies looking at 10 different interventions according to acupuncture, right? | |||
3289.76 3291.18 '''S:''' It's a belief system. | |||
3291.18 3295.92 '''S:''' Either that or the points don't matter. | |||
3295.92 3299.14 '''S:''' In which case, what is acupuncture then? | |||
3299.14 3303.20 '''S:''' Is it sticking the body in random locations? | |||
3303.20 3304.54 '''S:''' Apparently. | |||
3304.54 3312.16 '''S:''' And in fact, when you look at studies that do control for needle insertion, it doesn't even matter if you insert a needle. | |||
3312.16 3316.48 '''S:''' So you can randomly poke the body with toothpicks and get the same effect. | |||
3316.48 3318.24 '''S:''' Is that acupuncture? | |||
3318.24 3323.44 '''S:''' Is an untrained person randomly poking the body with toothpicks acupuncture? | |||
3323.44 3337.84 '''S:''' Because according to the literature, that's just as effective as actually having an expert inserting needles into alleged acupuncture points, which actually don't exist if you look at the literature on just where are they? | |||
3337.84 3339.40 '''S:''' They're all over the place. | |||
3339.40 3348.64 '''S:''' So yeah, that is a science based analysis of the data shows that acupuncture isn't a real thing. | |||
3348.64 3350.30 '''S:''' It doesn't work. | |||
3350.30 3354.52 '''S:''' And it's just a placebo effect and research noise. | |||
3354.52 3356.36 '''S:''' That's all it is. | |||
3356.36 3364.94 '''S:''' But the BMJ published a study that says it works based on the most shit data you could possibly imagine. | |||
3364.94 3382.64 '''S:''' And the thing is, if this were anything other than acupuncture, if this were a drug, or were some other intervention, there is no way you would get a major journal to publish this data and claim that the treatment works. | |||
3382.64 3389.96 '''S:''' No way you could get away with this anywhere outside of the alternate reality bubble of acupuncture. | |||
3389.96 3391.86 '''S:''' Just not possible. | |||
3391.86 3395.56 '''S:''' It's just a complete scam that's being inflicted upon the public. | |||
3395.56 3396.56 '''S:''' A total scam. | |||
3396.56 3400.72 '''E:''' And the BMJ is, they cannot see this. | |||
3400.72 3404.24 '''S:''' No, academic medicine has completely turned a blind eye to this. | |||
3404.24 3407.00 '''S:''' My own profession completely fails. | |||
3407.00 3409.44 '''S:''' Oh wow, it's that widespread. | |||
3409.44 3410.44 '''S:''' Absolutely. | |||
3410.44 3419.12 '''S:''' It's a complete failure across the board because they are putting the acupuncturists in charge because they're the experts. | |||
3419.12 3421.44 '''S:''' And no one is even paying attention. | |||
3421.44 3422.44 '''S:''' Oh my gosh. | |||
3422.44 3430.16 '''S:''' Because it's not, I don't know why, it's cultural, it's fringe, it's alternative, I don't know. | |||
3430.16 3432.68 '''S:''' But there are no ones asleep at the switch. | |||
3432.68 3433.68 '''B:''' What's the motivation? | |||
3433.68 3436.12 '''B:''' Is there anyone else that's been railing against that analysis? | |||
3436.12 3440.88 '''S:''' Yeah, are there people in my group of people promoting science-based medicine? | |||
3440.88 3441.88 '''S:''' Absolutely. | |||
3441.88 3443.04 '''B:''' But anyone outside of that? | |||
3443.04 3452.64 '''S:''' Yeah, but there are people who are not affiliated directly with science-based medicine who are, like there are a very small number of people who are like, the emperor has no clothes, guys. | |||
3452.64 3460.44 '''S:''' And then when you show it to, and again, I've had this experience many times, explain it to other professionals, they're like, yeah, you're right. | |||
3460.44 3461.44 '''S:''' Okay, moving on. | |||
3461.44 3462.44 '''S:''' They just don't care. | |||
3462.44 3463.44 '''S:''' It's the shruggies. | |||
3463.44 3464.44 '''J:''' The shruggies. | |||
3464.44 3467.52 '''S:''' Yeah, it's the total shruggy problem. | |||
3467.52 3468.72 '''S:''' It's a total shruggy problem. | |||
3468.72 3472.62 '''S:''' But it's completely unprofessional in my opinion. | |||
3472.62 3480.12 '''S:''' They're allowing a medical scam to thrive within the halls of medicine and major journals. | |||
3480.12 3494.20 '''S:''' And most practitioners I know, most people who are like, you know, they'll recommend their patients get acupuncture because they just haven't done the due diligence to realize that it's complete nonsense. | |||
3494.20 3495.24 '''S:''' It's a real scandal. | |||
3495.24 3496.80 '''S:''' It's a massive scandal. | |||
3496.80 3500.36 '''E:''' Gosh, you've been talking about this for 30 more years, Steve. | |||
3500.36 3501.36 '''S:''' I know. | |||
3501.36 3502.36 '''S:''' I know. | |||
3502.36 3503.36 '''S:''' It is remarkable. | |||
3503.36 3506.36 '''E:''' And this study is emblematic of the whole thing. | |||
3506.36 3507.36 '''E:''' Yeah. | |||
3507.36 3511.04 '''E:''' And then the headline roams around the world and everyone sees more legitimacy to it. | |||
3511.04 3512.04 '''E:''' Yeah, exactly. | |||
3512.04 3513.04 '''S:''' It does so much damage. | |||
3513.04 3516.16 '''S:''' It's self perpetuating legitimacy on utter nonsense. | |||
3516.16 3517.16 '''S:''' Absolutely. | |||
3517.16 3518.16 '''S:''' What a world. | |||
3518.16 3519.16 '''S:''' Scandal. | |||
3519.16 3520.16 '''S:''' Okay, let's move on. | |||
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| SGU Episode 908 |
|---|
| December 3rd 2022 |
 |
_brief_caption_for_the_episode_icon_ |
| Skeptical Rogues |
| S: Steven Novella
|
| Quote of the Week |
Quote |
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| Show Notes |
| [ https://sguforums.org/index.php?BOARD=1.0 Forum Discussion] |
Introduction
Voice-over: You're listening to the Skeptics' Guide to the Universe, your escape to reality.
12.76 17.56 S: Today is Thursday, December 1st, 2022, and this is your host, Stephen Novella.
17.56 19.56 S: Joining me this week are Bob Novella.
19.56 20.56 B: Hey everybody.
20.56 21.56 S: Cara Santa Maria.
21.56 22.56 C: Howdy.
22.56 23.56 S: Jay Novella.
23.56 24.56 J: Hey guys.
24.56 25.56 S: And Evan Bernstein.
25.56 27.82 E: Happy first day of Advent?
27.82 28.82 E: Is that right?
28.82 29.82 C: Yeah.
29.82 32.48 C: Although, I mean, I don't know if that's like a religious thing.
32.48 33.92 C: I just like it because of the calendars.
33.92 34.92 C: It's a religious thing.
34.92 35.92 C: I'm trying to understand here.
35.92 36.92 C: Oh, well.
36.92 37.92 C: Because I have a few Advent calendars.
37.92 39.36 E: Yeah, that's why I brought it up.
39.36 42.32 C: So some of them are 24 days and I'm like, so that sucks.
42.32 43.68 C: They end on Christmas Eve?
43.68 52.20 C: The whole point of me buying myself Advent calendars is so that because I might be spending Christmas alone, I don't know what I'm getting every day.
52.20 53.86 C: I want it to end on Christmas.
53.86 58.00 C: So I'm going to wait until tomorrow for my first day of Advent.
58.00 59.00 S: That's right.
59.00 65.68 S: So an Advent calendar is basically the first season of the Christian church year and it ends on Christmas Day.
65.68 66.68 S: That's why.
66.68 67.68 C: Yeah.
67.68 68.68 C: Okay.
68.68 71.52 C: But it's like if it's a 24-day countdown calendar, I don't get anything on Christmas.
71.52 72.52 J: That's dumb.
72.52 73.52 J: Yeah.
73.52 76.76 C: But my dog got his first dog treat today because that's a 25-day calendar.
76.76 77.76 C: They're all different.
77.76 78.76 E: Oh, sweet.
78.76 79.76 E: Yeah.
79.76 80.76 C: Killer.
80.76 84.36 C: At first he just sniffed it and walked away and I was like, oh no.
84.36 86.48 C: But then he came back for it.
86.48 88.56 S: So Artemis is zipping around the moon.
88.56 89.56 S: It's doing well.
89.56 90.56 S: It's doing well.
90.56 91.56 S: Everything's going great.
91.56 94.32 S: So, so far the mission is a success.
94.32 99.08 S: As we record this, it's getting ready to leave lunar orbit and head back to Earth.
99.08 106.44 S: Apparently it was the farthest object from Earth that is designed to hold people, even though people were actually in it.
106.44 107.44 B: That's a milestone.
107.44 108.44 B: Kind of a weird one.
108.44 109.44 B: I see.
109.44 113.84 S: But I guess that means for the next mission that will actually have people on it, those people will be the farthest people from Earth.
113.84 114.84 S: Yeah.
114.84 116.80 J: Well, they will have traveled the farthest from Earth.
116.80 117.80 E: Yeah.
117.80 122.84 E: So how soon before the next mission, that particular mission?
122.84 125.24 E: Artemis 2 is 2024.
125.24 126.24 E: It is.
126.24 127.24 E: Okay.
127.24 128.24 E: So we have to wait a whole other year and change.
128.24 129.24 E: Yeah.
129.24 130.24 S: Yeah.
130.24 131.24 S: A year and a half.
131.24 132.24 S: All right.
132.24 133.24 S: Yeah.
133.24 134.24 E: It's a big one.
134.24 135.24 E: Then 2025, that's when they land on the moon.
135.24 136.24 E: Oh my gosh.
136.24 137.24 E: That's going to be amazing.
137.24 138.24 E: Wow.
138.24 139.24 E: That's going to be amazing.
139.24 141.24 E: I really hope the world kind of tunes in in a similar way that they did back in 1969.
141.24 142.24 E: I think they will.
142.24 143.24 E: I hope it has that breadth.
143.24 144.24 B: I think they will.
144.24 148.44 B: I think we got to build a party around that event.
148.44 149.44 E: Absolutely.
149.44 150.44 E: We should have a viewing party.
150.44 154.60 J: I mean, arguably, it's one of the biggest deals in human history.
154.60 160.44 J: And I think since there hasn't been much moon activity, it'll be very popular.
160.44 164.68 J: But to your point, it's going to become commonplace.
164.68 174.48 J: Going to the moon, landing on the moon, bringing things to the moon, bringing things back from the moon is going to be like any other news item at some point, not in the distant future.
174.48 177.48 B: I wonder what the moon hoaxers are going to say.
177.48 180.00 B: I just thought about that for the first time.
180.00 181.00 E: Yeah.
181.00 182.00 E: Yeah.
182.00 185.12 E: I see what you're saying, Jay, about it being common at a certain point.
185.12 200.60 E: But at the same time, I'm still personally fascinated every time a space mission occurs in recognizing the scientific advancement and ability and stretches that we've had to make in order to get to these points in human history.
200.60 202.36 E: It's all part of human history.
202.36 206.36 E: And every single step along that that path has been fascinating to me.
206.36 207.56 E: I'm never bored by it.
207.56 211.04 E: I never consider it common or kind of get used to it or ho-hum.
211.04 212.28 J: Yeah, I agree.
212.28 219.36 J: I got accustomed to space shuttles taking off and it wasn't as exciting to watch the launches in there.
219.36 222.44 J: I like to watch the landings better because I thought they were more interesting.
222.44 228.52 J: But bottom line is, I mean, any of this stuff, if done frequently enough, will become common place.
228.52 230.12 J: I'm kind of looking forward to that.
230.12 236.76 J: I want space travel and the moon to be a part of the monthly events that take place.
236.76 238.24 J: I think that'll be a cool time.
238.24 245.04 E: Well, definitely the space shuttle launches, they would seem repetitive and kind of the same old.
245.04 251.50 E: It was the missions themselves that were each unique and had specific goals.
251.50 253.50 E: And those were fascinating to follow.
253.50 260.28 E: And especially things like the spacewalks and the repairing of the Hubble telescope and those sorts of things.
260.28 266.12 E: That kept me really glued to the news and in finding out what was going on up there.
266.12 274.62 S: So yeah, I think it's gonna be a long time before people being on the moon is going to be routine.
274.62 275.62 S: Rocket launches.
275.62 276.62 S: Yeah, I could see that.
276.62 277.62 S: They're so cool.
277.62 280.98 S: But yeah, they happen frequent enough that it's not glue yourself to the TV kind of event.
280.98 285.44 S: But if there are people walking on the moon, I think that we're going to be paying attention.
285.44 286.72 C: Why did we wait so long?
286.72 289.12 S: I mean, that's a $64,000 question, right?
289.12 293.80 C: I mean, it's like it could be commonplace by now if we had just like kept going.
293.80 295.80 B: Don't even get me started.
295.80 299.20 J: Yeah, I mean, politics had a lot to do with it, of course.
299.20 301.92 J: I mean, wasn't that like NASA didn't want to do it?
301.92 302.92 J: You know what I mean?
302.92 313.12 J: In Apollo, the movie Apollo 13, you could see how people were not even watching the launches or caring about people going to the moon and currently conducting a moon mission,
313.12 315.12 B: right? That's until Apollo 13, of course.
315.12 316.12 B: Yeah, things got nasty.
316.12 325.56 J: I mean, I remember in the movie, they didn't even like I remember that one part where they didn't even tell the astronauts like nobody cares, you know, nobody's watching.
325.56 328.20 J: But the you know, there was the political will wasn't there.
328.20 329.88 J: I mean, that's what it comes down to.
329.88 334.12 J: NASA is in a continuous cycle of asking for more money.
334.12 338.28 S: They want it also requires sustained administration, financial support.
338.28 339.28 S: So yeah, that's right.
339.28 342.20 S: It has to be sustained through multiple administrations.
342.20 343.66 S: And that's often the challenge.
343.66 347.56 S: They get funding and then it then evaporates, you know, redirect.
347.56 348.56 S: Yeah.
348.56 356.00 S: And there's been legitimate controversy over whether or not the funding they have should go to robotic science or human spaceflight.
356.00 360.24 S: And that the answer wasn't always we're going to prioritize human spaceflight.
360.24 361.24 S: You know?
361.24 362.24 E: Yeah.
362.24 377.20 E: And it was also the bringing into the picture of the space shuttle program in the 70s because that's when it was being conceived, developed and sort of the next the next phase, the next thing for NASA to do.
377.20 384.80 E: So that's why that's why they moved away from Apollo and went with the the reusable space transport system, the STS.
384.80 385.80 S: Yeah.
385.80 392.14 S: And there's always this multistage plan and we never seem to get to the later stages, you know, like but we are finally now.
392.14 393.14 S: So we'll.
393.14 395.08 S: But yeah, it did take a damn long time.
395.08 401.32 E: But well, here we are, though, finally still in our lifetimes, which, you know, I'm all for that.
401.32 402.32 J: Yeah.
402.32 403.32 J: Well, it goes well.
403.32 404.32 S: Yeah, that's true.
404.32 405.88 S: So, Evan, how are you feeling?
405.88 407.12 E: Steve, thank you for asking.
407.12 410.60 E: I feel like total crap.
410.60 412.60 E: I came down with the flu.
412.60 413.60 E: Oh, man.
413.60 415.16 E: Saturday after Thanksgiving.
415.16 416.76 E: You sure it's the flu?
416.76 418.72 E: Oh, I'm sure it's the flu.
418.72 419.72 E: 103 degree temperature.
419.72 420.72 E: Oh, my God.
420.72 422.44 E: Oh, wait, wait.
422.44 423.44 B: 103.
423.44 424.44 B: 103.
424.44 426.32 B: That's like, you know, go to the.
426.32 427.32 B: It was close.
427.32 429.72 C: But right now or like.
429.72 430.72 C: No, no, no.
430.72 432.60 C: Like, how are you like podcasting?
432.60 435.08 E: No, this was this was on I peaked.
435.08 437.24 E: I seem to have peaked on Tuesday of this week.
437.24 446.12 E: That was the day where I was like, you know, begging, begging some God somewhere to please I'll never I'll never sin again in some way.
446.12 447.88 E: If you please get me get me through this.
447.88 449.26 E: You know, you have one of those moments.
449.26 452.92 E: You can totally see why people have these moments in their life.
452.92 459.84 E: But what happened was on Saturday after Thanksgiving, Rachel and I went to a concert in Baltimore.
459.84 460.84 E: That'll do it.
460.84 466.72 E: You know, well, and we got we got we were treated very well by by the bands there.
466.72 470.24 E: We got all access passes because we're friendly with these bands and stuff.
470.24 471.64 E: And this was the closest they were coming.
471.64 473.48 E: Long story short, they have us an all access pass.
473.48 480.00 E: So we were allowed to go backstage and hang with them and, you know, be in their green room and, you know, just kind of be part of the crew.
480.00 485.36 E: They really, you know, treated us like total VIPs, which was absolutely wonderful.
485.36 486.36 E: And that was great.
486.36 494.04 E: And then, you know, head home and started feeling not, you know, I started coughing on Tuesday and I'm sorry, on Monday.
494.04 495.68 E: And by Tuesday, I was full on.
495.68 502.12 E: Yeah, this is the flu, body aches, headaches, the high fever, the chills, everything that screwed up.
502.12 503.80 C: That was you take over tests, right?
503.80 505.08 E: I did take a COVID test.
505.08 507.24 E: It was not definitely was not COVID.
507.24 509.20 E: Rachel did get her flu shot already.
509.20 510.52 E: She did not come down with flu.
510.52 511.52 E: I had not gotten mine.
511.52 514.16 E: I was going to get mine this week.
514.16 515.48 E: So bad on me.
515.48 518.32 E: My fault entirely, because for delaying it.
518.32 531.48 E: But I delay my flu shot normally because I try to make it coincide more with tax season because I want to be protected for more of the tax season, you know, January through April rather than, you know, November, December and not have it wane off at the tail end of tax season.
531.48 536.02 E: So that's kind of my but flu is hitting with a vengeance early this year.
536.02 537.02 E: And it's terrible.
537.02 538.24 C: I have to have tomorrow.
538.24 542.68 C: I have my appointment to get my bivalent COVID and my flu shot tomorrow at the same time.
542.68 550.76 E: And everyone on all the bands that were there that were in that green room and backstage, like 90 percent of them came down sick.
550.76 557.44 E: So had we not so if we not gotten that all access pass and everything, I may I may, you know, so it happens.
557.44 559.20 E: What you know, what are you what are you going to do?
559.20 563.04 E: Yeah, certainly that that's exactly what did it because we were all commenting about it.
563.04 564.32 E: That's your flu shot.
564.32 565.48 E: You should have gotten it already.
565.48 567.88 S: Actually, October was like the time to get it.
567.88 568.88 S: Is Rachel gloating?
568.88 569.88 S: No, no.
569.88 570.88 C: She feels she feels terrible.
570.88 571.88 E: She should.
571.88 572.88 E: She's not.
572.88 573.88 E: I'm happy for her.
573.88 576.72 E: I mean, my gosh, I shot her man.
576.72 577.72 B: That thing.
577.72 581.60 B: The next day my shoulder was hurting between the bivalence of the flu vaccine.
581.60 583.48 J: The flu flu is not that bad.
583.48 586.48 B: I got my confusing it with the bivalent.
586.48 588.48 B: Yeah, you probably got a shot.
588.48 589.48 E: For sure.
589.48 595.16 E: I want I did want to get mine in time to get it covered for for Arizona.
595.16 601.30 E: We have the Arizona our slew of Arizona shows that are coming up in just a couple in just about two weeks from the time of this recording.
601.30 603.64 C: But now you can't get it until you're recovered.
603.64 604.64 E: Exactly.
604.64 605.64 E: Right.
605.64 609.64 E: So, Steve, tell me when it at this point, do I need the flu shot?
609.64 611.30 S: And if so, when do I get it?
611.30 612.30 S: You should still get it.
612.30 613.30 S: But it's I don't know.
613.30 619.72 C: I think it's like, it's either like one or two weeks from the last time you had symptoms.
619.72 622.92 E: Okay, so I'll have to probably get it right after I get back from Arizona.
622.92 627.60 S: So I've now failed two attempts at getting my bivalent booster.
627.60 631.84 S: What I had to wait because I got I had covered in August.
631.84 634.20 S: So I finally came around to the time to get it.
634.20 637.94 S: I scheduled it during a lunch hour at work.
637.94 641.72 S: And my my morning clinic went late and I missed my window.
641.72 644.24 S: So I rescheduled it for today.
644.24 649.96 S: I show up at the clinic, which is like a 15 minute drive away from my from my offices.
649.96 655.00 S: I show up at the clinic to get my shot and they're closed.
655.00 658.00 S: Because they had to suddenly close for two days.
658.00 660.20 S: I didn't officially get the story.
660.20 665.84 S: They just zombies when like when I got back to my afternoon clinic, I got I had just a little bit of a window.
665.84 669.38 S: I looked it up and they said for unforeseen circumstances.
669.38 671.60 S: That was their entire explanation.
671.60 672.60 S: Unforeseen circumstances.
672.60 675.24 S: But while I was there, there was a security guard there.
675.24 676.36 S: And I asked him what happened.
676.36 677.48 S: He didn't quite know for sure.
677.48 680.20 S: But he thinks there was a gas leak in the restaurant next door.
680.20 682.28 S: Oh, we're yeah, which makes sense.
682.28 684.24 B: Why would they suddenly close the clinic for two days?
684.24 686.12 B: Yeah, yeah, you should have seen that coming.
686.12 687.12 S: Yeah.
687.12 688.76 S: So now I have to schedule for next week.
688.76 689.76 S: So it's my third attempt.
689.76 693.56 S: But it'll hopefully it will still be a full week before we leave for Arizona.
693.56 694.60 S: So that'll be good.
694.60 702.68 S: So for those of you who have had the dive, Valen, I've heard it's not quite as bad as the other boosters in terms of how sick you get.
702.68 708.56 C: I think it just depends because the by Valen is Moderna Pfizer, I think.
708.56 709.76 S: Oh, it's Pfizer.
709.76 715.48 C: So and like different people's reactions to the shots had to do with the formulation.
715.48 718.84 C: And it also had to do with how many boosters you've already had.
718.84 723.40 C: Like the more shots you get, the weaker the reaction you get.
723.40 724.40 C: Okay.
724.40 726.84 C: So like your first booster was brutal.
726.84 732.64 C: If you had that it was and then it gets slightly less bad every time you get boosted.
732.64 738.88 C: But sometimes like people who were Moderna all the way and then switched to Pfizer, they got like knocked on their butt or vice versa.
738.88 739.88 C: I didn't.
739.88 742.84 C: Some people, some people never even had a reaction to any of them.
742.84 743.84 C: I didn't have a reaction.
743.84 744.84 C: I got it.
744.84 745.84 C: I'm so jealous.
745.84 746.84 J: I was so sick.
746.84 747.84 C: I barely had any reaction.
747.84 751.64 C: I felt like I had the flu for a whole three days when I got my first boost.
751.64 752.64 J: Yeah, Steve too.
752.64 753.64 S: Yeah.
753.64 757.92 S: So remember, there is a triple demic happening this winter in the northern hemisphere.
757.92 763.12 S: Three respiratory viruses going around and we have vaccines for two of them.
763.12 764.60 S: So RSV, right?
764.60 765.60 S: No RSV.
765.60 769.76 S: No, but it's usually only a problem if you're a baby or really old.
769.76 776.52 C: So if you're not in those two categories, you're a geriatric over 55 over 65, 65 probably
776.52 778.84 S: your age or older, Bob.
778.84 782.88 B: That's yeah, but not yours a year.
782.88 784.88 J: 13 months previous. That's correct.
784.88 785.88 B: Later.
785.88 786.88 C: Yeah, sure.
786.88 788.36 C: So you're like almost Irish twins.
788.36 789.36 B: Yes.
789.36 790.36 B: Wow.
790.36 791.96 B: Basically we are Irish twins by definition.
791.96 794.08 C: I think it has to be under a year.
794.08 795.88 S: Is there an operational definition or is it just?
795.88 799.76 S: I don't think so, but I'm controlling it now.
799.76 800.76 S: Yeah.
800.76 801.76 S: It says less than 12 months apart is what.
801.76 802.76 C: Yeah.
802.76 803.76 C: So you're almost Irish twins.
803.76 804.76 J: They call those Irish twins?
804.76 805.76 J: Yeah.
805.76 806.76 J: I've never heard of that one.
806.76 807.76 J: That's awesome.
807.76 816.64 S: Is that vaguely racist or is that okay?
816.64 819.28 J: If you have to ask the question, Steve, it's probably racist.
819.28 820.28 C: I disagree with that.
820.28 823.60 S: All right, Bob, get us out of this conversation with a quickie.
823.60 824.60 B: Yeah.
824.60 825.60 B: All right.
825.60 826.60 B: Thank you, Steve.
Forgotten Superheroes of Science ()
"5 to 10 Years" ()
What's the Word? ()
- Word_Topic_Concept[v 1]
_consider_using_block_quotes_for_emails_read_aloud_in_this_segment_
Your Number's Up ()
Quickie with Bob ()
- [link_URL TITLE][1]
826.60 827.60 B: This is your quickie with Bob.
827.60 828.60 B: Girdler loins people.
828.60 833.72 B: New research sheds light, so to speak, on the stellar halo of our Milky Way galaxy.
833.72 841.48 B: Yes, we have long known that we have a stellar halo, but we thought that it was spherical and isotropic, the same in every direction.
841.48 849.16 B: But new impressive studies show that it's actually something closer to a Zeppelin shape, which is called, which is called what, people?
849.16 851.64 B: A triaxial ellipsoid, which is really cool.
851.64 852.64 B: I love that.
852.64 853.64 B: Oh, neat.
853.64 857.76 B: This shape appears to have been caused by a collision with a dwarf galaxy billions of years ago.
857.76 863.64 B: That galaxy was called GSE, which stands for Gaia Sausage Enceladus.
863.64 864.64 B: Don't even ask.
864.64 865.64 B: Look it up online.
865.64 866.64 B: What?
866.64 867.64 B: I thought you were joking.
867.64 870.60 B: No, that's GSE, Gaia Sausage Enceladus.
870.60 873.16 B: Why is out of scope for this quickie?
873.16 883.50 B: The specific shape is actually important because the stellar halo of stars around our galaxy is actually embedded within an invisible galactic halo of dark matter.
883.50 894.50 B: So the more we know about the shape of the stellar halo that's visible, that is composed of stars, the more we can learn about not only the evolution of the Milky Way, but the nature of dark matter as well.
894.50 896.02 B: So check out the details online.
896.02 897.10 B: It's very interesting.
897.10 898.40 B: So un-gird your loins.
898.40 899.64 B: This has been your quickie with Bob.
899.64 901.30 B: I hope it was good for you too.
901.30 902.30 S: That was very quick.
902.30 903.30 S: Thank you, Bob.
903.30 904.30 J: Zeppelin shaped.
904.30 905.30 J: No, triaxial ellipsoid.
905.30 906.30 J: Ellipsoidal.
906.30 907.30 J: Triaxial is a good word.
907.30 908.30 J: Yeah.
COVID-19 Update ()
News Items
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B:
C:
J:
E:
(laughs) (laughter) (applause) [inaudible]
Plan to Occupy the Moon ()
- [link_URL TITLE][2]
908.30 918.88 S: All right, Jay, we were just chatting about Artemis, but you're going to get us up to date on NASA's full plan to colonize the moon.
918.88 919.88 J: If only.
919.88 920.88 J: If only.
920.88 921.88 J: Yeah.
921.88 926.94 J: You know, this is one of those things where when you think about it, you're like, oh yeah, we should do this.
926.94 929.80 J: So here it is like, oh yeah.
929.80 930.80 J: Yeah.
930.80 934.04 J: Well, you know, we're finally returning to the moon here.
934.04 938.40 J: We were having a discussion before the show started about this.
938.40 944.36 J: The moon is wide open and ready to receive its human visitors and we're going to do it.
944.36 957.32 J: So now what's going on is we haven't been to the moon in decades and now returning to the moon and the fact that we know that we have some plans to do quite a bit of things there, there's a lot of implications.
957.32 962.68 J: We have to prepare for doing what we're about to do philosophically, right?
962.68 973.40 J: That's why the Biden administration's National Science and Technology Council recently made public something called the National Cislunar Science and Technology Strategy.
973.40 977.76 J: This document details the goals for occupying cislunar space.
977.76 983.08 J: You know, cislunar space is the area in space that includes both what, the earth and the moon.
983.08 990.88 J: You know, basically everything that's close to us in the moon that's considered to be in cislunar space.
990.88 992.56 B: They must talk about nuclear rockets.
992.56 993.72 B: They better.
993.72 995.76 J: I'm sure somebody is, Bob.
995.76 996.98 J: And they know you love them.
996.98 1000.68 J: So the main thrust of this strategy outlines four different goals.
1000.68 1012.92 J: We have investing in research and development, cooperating with other countries, building communications networks in space, and then boosting humanity's overall situational awareness near and on the moon.
1012.92 1018.10 J: As you can imagine, lots of things fall into these four goals.
1018.10 1029.36 J: So as an example of investing in research and development, one interesting thing to turn over in your head is, you know, we could do things on the far side of the moon, right?
1029.36 1035.82 J: So as you know, the far side of the moon is not facing the earth and it never does face the earth.
1035.82 1038.56 J: So therefore it doesn't have any radio transmissions.
1038.56 1042.00 J: It's not, you know, those radio transmissions don't go through the moon.
1042.00 1043.42 J: So it's free of that.
1043.42 1051.28 J: So it would be a great place to put some type of radio receiver to look at outer space, right?
1051.28 1052.96 J: It'd be a great thing to do there.
1052.96 1059.88 J: Another thing that we're going to do is we're going to develop ways to use the moon infrastructure to launch Mars missions.
1059.88 1066.44 J: Whenever you think about the moon, you have to realize that it is very much a stepping stone to get to Mars.
1066.44 1067.44 J: Meh.
1067.44 1068.44 J: Right?
1068.44 1073.16 J: One of the main thrusts of doing all of this is to give us a gateway to Mars.
1073.16 1078.24 J: So there's also political motivations to have a human presence on the moon.
1078.24 1079.48 J: No big surprise there.
1079.48 1088.26 J: As the document puts it, there will be economic, this is in quotes, economic development activities and there will be economic growth potential for the moon.
1088.26 1092.38 J: The US wants to be the first there and to have the strongest presence.
1092.38 1105.84 J: So we will slowly develop an infrastructure that will include a moon space station, lunar satellites, lunar GPS system, a permanent base in the lunar South Pole and a lot more.
1105.84 1111.56 J: That's just the beginning architecture that they have already thought through very well.
1111.56 1116.04 J: Other countries have said they plan similar goals, but the US is definitely going to get there first.
1116.04 1119.96 J: I mean, they have so much momentum right now.
1119.96 1123.00 J: It's pretty awesome that we're going to see what we're going to see.
1123.00 1126.48 J: Now of course, other countries are involved with the Artemis project.
1126.48 1132.64 J: There has been components that were built by other countries that are going to even into the rocketry and everything.
1132.64 1139.04 J: And there is something I'm about to tell you, something called the Artemis Accord, which has other countries signing on.
1139.04 1144.72 J: But in the end, this is largely run and operated by the United States.
1144.72 1150.92 J: And I do think in my personal opinion that there is political will of course happening here because, and I'll explain this to you.
1150.92 1155.16 J: So there are lunar resources and they're going to be used for the very first time.
1155.16 1159.40 J: And there's also an incredible amount of real estate that we're talking about.
1159.40 1165.88 J: So we have cooperation with other countries, but that cooperation in and of itself is complicated.
1165.88 1167.32 J: No one owns the moon yet.
1167.32 1175.32 J: And the big word is yet the moon is virtually a giant piece of property, 14.6 million square miles.
1175.32 1180.22 J: And to give you a comparison, the United States is 3.7 million square miles, right?
1180.22 1185.48 J: So 14.6 million square miles of real estate that has yet to be claimed.
1185.48 1190.92 J: There's a lot of potential here that are up for grabs and this makes for a very uncomfortable reality.
1190.92 1191.96 J: And it's happening right now.
1191.96 1194.24 J: And that's why this is fascinating.
1194.24 1195.24 E: We can't own it.
1195.24 1196.24 E: I mean, right?
1196.24 1198.44 S: According to international law, we can't own it.
1198.44 1202.00 S: But I think that's also why the Accords are important.
1202.00 1212.64 S: So just to say it, the countries that have signed on so far include Australia, Canada, Italy, Japan, Luxembourg, the United Arab Emirates, United Kingdom and the United States.
1212.64 1218.76 S: And they include things like norms of behavior, like rescuing stranded astronauts on the moon and things like that.
1218.76 1221.12 S: You know, like I guess it's similar to maritime law.
1221.12 1224.64 S: Like there's an international laws that everyone agrees to.
1224.64 1226.10 C: But everyone doesn't agree to them.
1226.10 1227.10 C: That's the problem.
1227.10 1228.36 C: Well, at least these countries agree to that.
1228.36 1231.56 J: It's 20 countries, but Russia and China have not agreed.
1231.56 1232.56 J: Exactly.
1232.56 1241.56 J: And to clarify, just to make sure that our listeners know the Artemis Accords are an attempt to create, you know, like a way of doing business on the moon.
1241.56 1253.24 J: Think of this as a guide to how to explore, how to use the moon, how to have common decency, things like, you know, what are you going to do with your trash?
1253.24 1254.24 J: Right?
1254.24 1255.60 J: That's a big deal on the moon.
1255.60 1259.60 J: There isn't, you know, anywhere for trash to be eaten by bacteria.
1259.60 1260.60 J: Like it has to be taken away.
1260.60 1261.60 J: It has to be dealt with.
1261.60 1263.12 J: It's important to a big creator.
1263.12 1269.56 J: And Russia specifically said, you know, the current version of the Artemis Accord, they are not signing up for it.
1269.56 1275.90 J: And China, like NASA and China, NASA has been forbidden to do business with China by a Congress.
1275.90 1279.86 J: So there is no like involvement with China at all right now.
1279.86 1281.92 J: And this goes back to 2011.
1281.92 1295.00 J: But you know, this is what's fascinating about it, because we're going to watch the Earth and everybody on the Earth and the governments that are on the Earth deal with essentially, you know, a new piece of real estate that has become reachable now.
1295.00 1298.80 J: It's not just, oh, my God, we planted a flag on there 50 years ago.
1298.80 1300.52 J: It's we're going to put people there.
1300.52 1305.46 J: We're going to use the resources on the moon and we're going to like take things off the moon and bring them back to Earth.
1305.46 1309.84 J: And then they're going to be ours, you know, and ours can mean whatever country did it.
1309.84 1312.28 J: So it's, you know, it's nutty.
1312.28 1316.08 J: It's going to be a very difficult time and there's going to be some conflict.
1316.08 1318.56 J: I am absolutely sure that there's going to be some conflict.
1318.56 1320.60 S: I think that's where the Accords are a good idea.
1320.60 1324.40 S: I mean, their subheader is United for Peaceful Exploration of Deep Space.
1324.40 1326.92 S: I mean, I think that's the approach that we need to take.
1326.92 1331.86 S: But obviously, we can only be as united on the moon as we are on Earth.
1331.86 1335.24 S: And we are in the middle of, you know, a new space race.
1335.24 1336.24 S: Definitely.
1336.24 1337.24 J: I mean, a new Cold War.
1337.24 1338.24 J: And look at this.
1338.24 1339.24 J: Look at it like this.
1339.24 1340.44 J: There are landing sites.
1340.44 1342.12 J: There are base locations.
1342.12 1345.24 J: There's undiscovered caches of lunar resources.
1345.24 1346.92 J: There's all sorts of stuff.
1346.92 1347.92 J: Lava tubes.
1347.92 1348.92 J: Right.
1348.92 1350.92 J: And it could be extraordinarily valuable, right, Bob?
1350.92 1353.20 J: And there's only so many of those.
1353.20 1368.36 J: So all of those quote unquote natural resources that are on the moon, like a landing site, right, a nice flat place to land a spacecraft and really good place to put a base, which is, you know, partly shaded by the shape of the moon.
1368.36 1370.44 J: So you don't get direct sunlight too often.
1370.44 1372.16 J: Like those things are wicked valuable.
1372.16 1373.16 J: Oh, yeah.
1373.16 1376.44 B: Or areas where you can actually extract water.
1376.44 1377.44 B: Yeah.
1377.44 1381.80 B: I mean, those are places that you want to like, all right, I'm building my base right here.
1381.80 1383.56 B: You know, that's high priority for sure.
1383.56 1386.04 J: So I hope that there's not a lot of conflict.
1386.04 1388.04 J: I hope that countries sign up.
1388.04 1395.52 J: And it is a, you know, a true equals type of game that they're going to play with each other.
1395.52 1397.32 J: Like, let's give everybody a fair share and all that.
1397.32 1400.20 J: Like there's got to be that has to be in play.
1400.20 1409.76 J: But there are major players here who are, you know, like China and Russia are both saying that they're going to they're going to the moon too, and they're going to be putting space stations out there.
1409.76 1410.76 J: They're going to do it too.
1410.76 1411.76 J: Right.
1411.76 1413.96 B: Well, I mean, but the main player, let's get real.
1413.96 1415.76 B: The main player here is China.
1415.76 1425.60 B: I mean, I mean, when you're talking about, you know, taking, you know, dominating or at least exploring and dealing or staking out a presence within cislunar space.
1425.60 1426.60 B: That's because of China.
1426.60 1430.92 B: If you read between the lines here, a lot of this is like, we got to do this before China does.
1430.92 1432.76 B: But that's why I said there's political motivation here, Bob.
1432.76 1434.80 B: And I'm just I'm just narrowing it down a little bit.
1434.80 1435.80 J: It totally is.
1435.80 1436.80 J: Yeah.
1436.80 1441.84 J: And and, you know, the vast majority of the people on the planet are going to watch it on TV.
1441.84 1442.84 J: You know what I mean?
1442.84 1444.36 J: That we're just basically going to be consuming the information.
1444.36 1446.88 J: There's nothing that we could do other than watch the players play.
1446.88 1447.88 S: Yeah.
1447.88 1449.48 S: It's unfortunate that that's the motivation.
1449.48 1456.16 S: But yeah, it would be better if it was all, you know, purely for science exploration.
1456.16 1457.16 S: Sure.
1457.16 1461.96 S: If you if you guys haven't seen For All Mankind, that show is a great thought experiment.
1461.96 1462.96 S: Yeah.
1462.96 1471.88 S: It's about what happens when exploration of the moon and Mars is not cooperative and it's not pretty, you know, and again, they're imagining.
1471.88 1474.24 S: But it's a good cautionary sort of tale.
1474.24 1475.24 B: Right.
1475.24 1484.00 B: And conversely, if you want to see nations cooperating at unprecedented levels, give a listen or read to Project Hail Mary by Andy Ware.
1484.00 1485.72 B: I just finished it and it was awesome.
1485.72 1486.72 S: Yeah.
1486.72 1489.08 S: You can go back and listen to the interview we did with them.
1489.08 1490.08 S: Yes.
Cannabis for Pain ()
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1490.08 1491.08 S: All right, Cara.
1491.08 1492.08 C: That's me.
1492.08 1495.08 S: Tell us about cannabis for pain.
1495.08 1496.64 S: Oh, yeah.
1496.64 1498.84 S: I read this.
1498.84 1502.04 C: Interesting study that was just published.
1502.04 1508.52 C: Probably some people listening are going to have their biases shocked a little bit during this news article.
1508.52 1517.40 C: You know, cannabis is probably I mean, I don't it's one of the drugs that is used by the most people worldwide.
1517.40 1522.00 C: I don't know if there's an actual like a rank system or if there's a real way to know.
1522.00 1523.92 C: But cannabis is super, super common.
1523.92 1524.92 C: Top five maybe?
1524.92 1525.92 C: Yeah.
1525.92 1528.44 C: I mean, it's definitely up there.
1528.44 1531.56 E: We're talking about what kind of what kind of drug?
1531.56 1534.12 E: I mean, we're not not caffeine, not tobacco.
1534.12 1536.20 E: It's a different it's its own thing, right?
1536.20 1537.20 E: It's different.
1537.20 1538.20 J: THC basically.
1538.20 1543.76 E: Well, as far as compare, right, because I would think caffeine is the most common.
1543.76 1544.76 E: Yeah.
1544.76 1545.76 C: Yeah.
1545.76 1546.76 C: Yeah.
1546.76 1548.92 C: Caffeine, though, you don't really need a prescription for it all.
1548.92 1551.92 C: Let's say, well, yeah, that's a little bit confusing.
1551.92 1559.08 C: But it's definitely even including caffeine and nicotine, it's going to be probably in the top 10.
1559.08 1566.92 C: And cannabis, remember, includes a lot more than just marijuana, pretty much anything with cannabinoids.
1566.92 1583.44 C: So CBD, THC, THC is the ingredient that has psychoactive properties, but CBD cannabinoids aren't always psychoactive, but people still utilize them as drugs.
1583.44 1586.88 C: So there are different, there are a lot of different components to cannabis.
1586.88 1589.00 C: There are a lot of products that are derived from cannabis.
1589.00 1592.58 C: Yeah, all of these different cannabinoids in all their different forms.
1592.58 1593.88 C: It's pretty common, right?
1593.88 1599.28 C: And in, you know, some places, cannabis is completely legal, even recreationally.
1599.28 1605.28 C: In way, way more places, you need a prescription, but you can still get your hands on cannabis.
1605.28 1614.96 C: And of course, there's still parts of the world where it's, you know, incredibly against the law and there are dire consequences for utilizing cannabis.
1614.96 1621.04 C: But regardless, it's very popular, very common, and has been for a very, very long time.
1621.04 1636.84 C: A lot of people who use cannabis and say that they are medicating with it, whether they are self-medicating or whether they are, you know, prescribed cannabis from some sort of professional, a lot of people say that they're using it for pain.
1636.84 1641.60 C: The estimates that are cited in this article are between 17 and 30 percent.
1641.60 1657.16 C: I know that's a wide range, but that's because there's a lot of different sources, that between 17 and 30 percent of adult users, 18 plus, across North America, Europe, and Australia, say that they specifically use it to manage their pain.
1657.16 1663.20 C: So and that's, again, among people who are self-medicating, not necessarily people who are like, I smoke weed because it's fun.
1663.20 1664.20 C: Gotcha.
1664.20 1665.20 C: Yeah, yeah.
1665.20 1678.52 C: So people who are already saying that they're utilizing it as a medication, as a drug to treat something, between 17 and 30 percent of people in these, so in these Western countries, say that they're using it to manage pain.
1678.52 1679.52 C: Okay.
1679.52 1683.48 C: We know that a lot of people use it for pain, but does it work?
1683.48 1685.68 C: This is a big open question.
1685.68 1692.16 C: It's something that I kind of came across a lot when I was doing therapy in the cancer center.
1692.16 1697.68 C: And I'm curious, Steve, how often you have patients who come in and say, yeah, yeah, I use cannabis.
1697.68 1699.48 C: It helps with my migraines or I use cannabis.
1699.48 1700.48 S: Yeah.
1700.48 1701.48 S: Right.
1701.48 1702.48 C: Also.
1702.48 1703.48 C: A lot of patients are using it.
1703.48 1704.48 C: Yeah.
1704.48 1705.48 C: Right.
1705.48 1706.48 C: So what do the studies actually show?
1706.48 1707.76 C: Well, how do we know if a drug works?
1707.76 1710.16 C: We have to compare it to a placebo.
1710.16 1711.16 C: Right.
1711.16 1716.12 C: And I feel like we can do a little bit of background reviewing on placebo and the placebo effect.
1716.12 1728.64 C: But one thing that's really important to remember and Steve, you've written about this in great length, and I think it's important to kind of reiterate that when we're talking about the placebo effect, this is not an actual effect.
1728.64 1733.96 C: This is actually a bunch of nonspecific effects that we have a hard time identifying.
1733.96 1737.96 C: So placebos by definition are inert.
1737.96 1741.88 C: Giving a placebo is by definition not giving the drug.
1741.88 1743.48 C: Yeah, that's right.
1743.48 1751.20 S: It's any effect that derives from something other than a physiologically active response to the treatment.
1751.20 1752.20 C: Exactly.
1752.20 1766.12 C: So even though we can talk about the placebo effect being an actual effect, it's not like there is something wherein everybody takes sugar pill called placebo and then the same thing happens.
1766.12 1771.04 C: This is all of the nonspecific effects that are different for every different trial.
1771.04 1774.76 C: They're different for different types of people, for different types of expectations.
1774.76 1781.08 C: But it's everything from expectation effects to just what's it called, the effect I'm linking where…
1781.08 1782.08 S: Regression to the mean.
1782.08 1784.08 C: Is it so important? Regression to the mean, yeah, yeah, definitely.
1784.08 1787.80 C: But the effect where just going and seeing a healthcare provider, just being enrolled in a trial.
1787.80 1788.80 S: Yeah, just nonspecific effects of being treated.
1788.80 1789.80 S: Yeah, yeah, yeah, all the nonspecific effects.
1789.80 1790.80 S: Exactly.
1790.80 1792.84 C: I thought there was like a specific name for that.
1792.84 1798.32 C: Like you're just, literally something in a white coat is putting their hand on your shoulder and saying, I see you.
1798.32 1799.72 C: People tend to feel better.
1799.72 1806.80 C: And then remember when we're talking about pain, pain has a massive psychological component to it.
1806.80 1808.76 C: It's incredibly subjective.
1808.76 1818.24 C: If you guys want like a nice review of this because we don't have much time to dive into it and do a little self-promotion on the side, my podcast, the Skeptics… Oh, nope.
1818.24 1820.20 C: That's the podcast we're on right now.
1820.20 1828.20 C: My podcast Talk Nerdy, several weeks ago I had a wonderful clinician named Heder Wurreich on the show.
1828.20 1834.20 C: He's at Brigham and Women's at Harvard and he is a palliative care.
1834.20 1838.62 C: Actually he's a cardiologist, but he focuses on heart failure.
1838.62 1853.40 C: And so he does a lot of palliative work and he wrote a beautiful book all about pain and about all of the psychological components that go into pain and how we treat pain and really trying to think about pain as much more than just a physical process because it is.
1853.40 1855.24 C: A lot of it is psychological as well.
1855.24 1858.52 C: Okay, so that's all the kind of caveatting at the top.
1858.52 1861.68 C: Let's look at what this specific study did.
1861.68 1862.68 C: This was a meta-analysis.
1862.68 1866.28 C: So it's sort of like the king of all studies.
1866.28 1874.44 C: What these researchers did is they… Yeah, when it's done well and they like… this seems to be a pretty solid meta-analysis.
1874.44 1879.00 C: I don't know, Steve, if you've looked at the actual source article I was digging into it.
1879.00 1880.76 C: They used, you know, it was pre-registered.
1880.76 1892.04 C: They used some really stringent methodologies here and their outcomes from this meta-analysis are very similar to outcomes from another solid meta-analysis that was just published last year.
1892.04 1902.88 C: So basically they looked specifically at randomized controlled trials where cannabis was compared to a placebo specifically for the treatment of pain.
1902.88 1904.92 C: And they're talking about clinical pain.
1904.92 1912.96 C: They looked at studies where the change in pain intensity was measured before and after treatment.
1912.96 1924.72 C: So a pre-post situation where cannabis products, and we're talking a wide range of cannabis products, were compared to placebo in a randomized controlled way.
1924.72 1935.00 C: Okay, so who got the placebo, who got the drug was random, and I think they were all… they were all double blind too, right?
1935.00 1939.52 C: But there were some differences in how strong the blinding was.
1939.52 1941.68 C: So we're going to talk a little bit about that.
1941.68 1959.04 C: Basically all together they ended up including 20 studies that had 1,459 individuals over the age of 18, mostly in the countries that I listed previously, but they did look at other countries as well.
1959.04 1963.60 C: It's just the bulk of them were in these Western nations.
1963.60 1965.88 C: And what do you think they found?
1965.88 1966.88 C: Doesn't work.
1966.88 1967.88 C: Yeah.
1967.88 1971.40 C: Guess what doesn't… Guess what does seem to be really good at pain?
1971.40 1972.40 C: Placebo.
1972.40 1973.40 J: Yeah.
1973.40 1974.40 J: Oh, oops.
1974.40 1975.40 J: Yeah.
1975.40 1981.96 C: So it's not so much that the cannabis didn't do what people think it did, it's just they didn't do it any better than a placebo.
1981.96 1983.76 C: And a placebo was pretty dang good.
1983.76 1986.36 C: Well, what does that tell you?
1986.36 2002.76 C: In kind of what we already talked about, that there are strong expectation effects and that there are a lot of non-specific effects at play that when you want your pain to go away and you do something that you think is going to help, you can psychologically convince yourself and that is a component of pain.
2002.76 2008.80 C: Don't get me wrong, pain is not all quote in the head and I actually don't like that distinction between something being in the body and being in the head.
2008.80 2010.72 C: It's way more complicated than that.
2010.72 2012.72 S: But there's… A meaningless distinction.
2012.72 2013.72 C: It's meaningless, exactly.
2013.72 2015.84 C: But pain is emotional.
2015.84 2017.74 C: Pain is historical.
2017.74 2019.86 C: Pain is traumatic.
2019.86 2021.52 C: Pain is linked to memories.
2021.52 2032.12 C: There are so many complicated components of pain that are real and also psychological because psychological does not mean it's not real.
2032.12 2038.44 S: It's highly modifiable by mood, by distraction, by other sensations, absolutely.
2038.44 2039.44 C: Yep.
2039.44 2041.20 C: So we think about things like depression.
2041.20 2042.72 C: We think about things like anxiety.
2042.72 2047.08 C: They are, as we often call them, biopsychosocial in nature.
2047.08 2059.64 C: So medications work but so do strategies like diaphragmatic breathing, like grounding exercises, like all of these different cognitive behavioral interventions.
2059.64 2065.30 C: Because it is biopsychosocial in its nature and pain is very similar, it's also highly subjective.
2065.30 2074.92 C: When we use pain scales, which is what we have to do to ask somebody about subjective pain from a one to a ten, there is no way to know if your five is the same as my five.
2074.92 2076.44 C: Yeah, it's exactly like…
2076.44 2081.68 J: Really difficult. It's like, you know, when I see orange, are you seeing orange too?
2081.68 2082.68 J: You know what I mean?
2082.68 2083.68 C: It's all subjective.
2083.68 2091.28 C: Except it's like even more intense than that because at least when you see orange and I see orange, we can both say that we're seeing the same wavelength.
2091.28 2096.60 C: But with pain, we don't even know how our perception of pain is.
2096.60 2098.20 C: We know that there are gender differences.
2098.20 2099.50 C: We know there are age differences.
2099.50 2106.88 C: We know that there are differences based on people's historical experiences with pain, how much trauma they have associated with their pain.
2106.88 2112.44 C: So it's very, very, very difficult to be objective about pain studies.
2112.44 2115.36 C: But here's something interesting that the researchers did on top.
2115.36 2128.76 C: I mean, I could get into the methodology but basically, like by and large, they showed that there's a strong placebo effect when it comes to pain and that cannabis showed a large effect size in reducing pain.
2128.76 2133.12 C: Placebo showed a moderate to large effect size in reducing pain.
2133.12 2143.86 C: And when they specifically went in and looked at the risk of bias in each of the different studies that they were working with, the lower the risk of bias, the greater the placebo effect.
2143.86 2154.20 C: So it may be likely that even in the situations where cannabis was slightly better than placebo, the bias might have been higher in those studies.
2154.20 2162.38 C: So by and large, we're seeing that a, cannabis does not appear to work for pain any better than placebo alone.
2162.38 2171.26 C: And I think it's important to say that because it does work for people because they expect it to work the same way a placebo works for people because they expect it to work.
2171.26 2173.48 C: But then we know it's not the drug that's doing it.
2173.48 2175.58 C: It's all the non-specific effects.
2175.58 2197.28 C: The other thing that the researchers did, which was interesting, although their outcomes were a little all over the place and they're very upfront about that, is that they were like, what if we look at the altmetrics, like basically the kind of popular rating scale of these different studies, and what if we compare how they were talked about in the media?
2197.28 2202.00 C: So basically, this study was cited a lot by the popular media.
2202.00 2207.64 C: And when it was cited by the popular media, they said, cannabis works, cannabis doesn't work.
2207.64 2209.96 C: Like, how did they actually interpret the results of the study?
2209.96 2210.96 C: Was it cautious?
2210.96 2211.96 C: Was it skeptical?
2211.96 2213.60 C: Was it polyanna?
2213.60 2214.68 C: Whatever.
2214.68 2234.56 C: And even though the results were a little all over the place, so they couldn't really say point to point, study to study, we think that media bias is what causes this, they could say that when taken as a whole, media descriptions of studies involving cannabis and pain are very, very rose-colored glasses.
2234.56 2238.58 C: Basically people who write about this say, look how great cannabis is for pain.
2238.58 2241.92 C: And so they're saying, I think there's an effect here.
2241.92 2246.36 C: I think that maybe people think cannabis works because they've been told it works by the media.
2246.36 2259.68 C: And then there's this like positive feedback loop where they keep using it, they keep telling themselves it works, the placebo effect is strong within it, and they feel better so they keep using it.
2259.68 2264.66 C: But we have to remember that in certain situations, there are risks.
2264.66 2268.20 C: Cannabis is still a drug, and it does have negative side effects as well.
2268.20 2276.68 C: And that's not to say, I'm not sitting here saying what you should or you shouldn't do, but you should know why you feel the way you feel when you use a drug.
2276.68 2278.36 C: Is this the effect of the drug itself?
2278.36 2280.76 C: Is it a receptor effect?
2280.76 2281.76 C: You know what I mean?
2281.76 2288.88 C: Are we actually seeing something happening physiologically downstream because the drug is binding to your receptors and nociception is reduced?
2288.88 2291.76 C: No, that doesn't seem to be the case.
2291.76 2293.92 C: It's much more complicated than that.
2293.92 2298.04 C: And so when we start thinking about that risk-benefit analysis, it's important.
2298.04 2308.60 C: And what I would see time and time again, and this is just anecdotal, and I'm curious what you think about this, Steve, I'd love to see a study on this, I don't know if one exists.
2308.60 2317.96 C: Patients who I saw for psychotherapy in the cancer center who already had a history of using cannabis preferred to use cannabis to help with their cancer pain.
2317.96 2326.24 C: Patients who had never tried or used cannabis, who tried it naively, said that they actually felt worse after they used it.
2326.24 2328.64 C: And I would see that time and time again.
2328.64 2342.56 C: It was sort of like people who already relied on cannabis integrated it into their health care and people who didn't, lots of times didn't like it or they were like, this doesn't
2342.56 2347.08 S: work. They might have already been self-selective for a good response to it.
2347.08 2348.08 S: Exactly.
2348.08 2357.28 S: Yeah, I mean, there's been a number of systematic reviews of cannabis over the years and before this segment I reviewed, like whatever, the ones I could find for the last five to ten years.
2357.28 2372.60 S: And they all say similar things, either the studies are preliminary, we can't make any statements or the effect size is tiny or it's a small effect size, but the side effects are actually greater than the pain relief if there is any.
2372.60 2377.56 S: But we can't even say that there is because it was the data is too weak.
2377.56 2379.40 S: So that's basically what we're seeing so far.
2379.40 2389.08 S: There's no big effect and big signal with a clear, replicable, rigorous outcome in the research and that usually means we're dealing with placebo effects.
2389.08 2392.80 S: But cannabis is also more complicated because it's multiple things, right?
2392.80 2403.88 S: And so like some studies look at just THC and CBD studies and a lot of patients tell me that it doesn't really take the pain away, it just mellows them out and they need that.
2403.88 2405.44 S: Yeah, because it's also psychoactive.
2405.44 2408.32 S: Right, but that's the THC.
2408.32 2412.32 S: You may just be distracting them from the pain, not really reducing the pain itself.
2412.32 2416.64 B: Well, that reminds me of when I heard a description of laughing gas.
2416.64 2425.64 B: I remember reading that and tell me if this is true or not, that laughing gas doesn't take away the pain of dentistry, it makes you not give a crap about it.
2425.64 2437.72 S: Yeah, I mean, that's true of opiates as well and that's because the perception of the pain and the negative emotional response to the pain are two different things and you can disconnect them.
2437.72 2442.88 S: The opiates are really good at blocking the emotional effect of the pain.
2442.88 2447.00 S: So you feel the pain, you just don't care, it just doesn't bother you.
2447.00 2448.24 S: So that is neurological.
2448.24 2451.22 S: Yeah, that absolutely can happen pharmacologically.
2451.22 2483.40 S: So it is complicated and to a degree, like on science-based medicine, we've written about the fact that cannabis is like the new herbalism, you know, it's like the evidence is really preliminary and contradictory and often weak and yet people think it works for everything and it's fantastic and whatever, but it's all like the honeymoon phase, you know, before we get down to like really rigorous trials and, you know, wouldn't surprise me at all if we find that it's actually not that good a pain medication and it may have some limited effect.
2483.40 2490.76 S: I think the effect that seems to be fairly substantial in the literature is that it does help with nausea, it does help with anorexia.
2490.76 2509.34 C: And that's also really interesting because very often, at least with the cancer population, they're sort of like multi-treating, they might take it for pain slash appetite, which then can reduce pain, you know, like what's the moderating variable there?
2509.34 2511.48 C: So it's complicated, it's just really complicated.
Acupuncture for Backpain ()
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2511.48 2514.92 S: All right, so Cara, I'm actually going to do a similar news item.
2514.92 2523.64 S: I had to talk about this topic, so let me read you the headline of a press release that I blogged about on Science-Based Medicine.
2523.64 2524.64 J: Oh boy.
2524.64 2526.44 S: Here we go, ready?
2526.44 2532.64 S: Acupuncture can relieve lower back slash pelvic pain often experienced during pregnancy.
2532.64 2537.04 S: That was the headline, that was the bottom line of this study.
2537.04 2541.44 S: Several people emailed this to us because they're like, hey, what's going on with this, right?
2541.44 2543.92 S: Because they know I don't think that acupuncture works for anything.
2543.92 2565.00 S: But here is a meta-analysis published in a high-impact journal, the BMJ, and the authors are pretty, the authors, they're not quite that positive, but that was basically their spin.
2565.00 2568.72 S: I mean, the press release was basing it on what the authors were saying.
2568.72 2581.72 S: And of course, I had to dissect the study and see what it shows, and it turns out it's a great example of absolutely everything that can go wrong with a meta-analysis.
2581.72 2583.84 S: Oh, really?
2583.84 2596.36 S: The study, in my opinion, clearly shows that acupuncture doesn't work, and yet they manage to still spin it to the opposite bottom line.
2596.36 2600.04 S: It is almost a textbook of science-based medicine in and of itself.
2600.04 2601.60 S: So let's take a look at it.
2601.60 2610.20 S: Again, the authors' conclusion was acupuncture significantly improved pain, functional status, and quality of life in women with lower back pain during pregnancy.
2610.20 2611.20 E: Significantly.
2611.20 2612.20 S: What's the mechanism?
2612.20 2617.32 S: Yeah, well, don't get me started on the mechanism.
2617.32 2630.00 S: So and you know, meta-analysis, when you combine studies from different trials and the greatest weakness of a meta-analysis, of course, they could be fine, but they do follow the dictum of garbage in, garbage out, right?
2630.00 2635.52 S: If the individual studies are crap, you cannot rescue them by putting them together in a meta-analysis.
2635.52 2640.32 S: Meta-analysis is good for combining good studies that need to be great, more powered, right?
2640.32 2646.88 S: You can increase the power of a meta-analysis by combining lower-powered studies, but it doesn't improve the rigor.
2646.88 2650.48 S: It doesn't fix the problems of the other studies.
2650.48 2653.96 S: So all right, first of all, it's not that big a meta-analysis.
2653.96 2655.96 S: It has 10 studies, right?
2655.96 2657.80 S: So that's not that big.
2657.80 2662.76 S: The thing that's interesting is that the authors did a good job of gathering the data.
2662.76 2666.84 S: Like I didn't have to go to each individual study.
2666.84 2676.00 S: I still did for many of them, but I didn't have to do that to find the information that I needed because they, the authors published that information in the meta-analysis.
2676.00 2685.52 S: They just ignored it or just like completely glossed over the fatal problems with the evidence that they were documenting.
2685.52 2692.12 S: So first of all, we could look at the, just the rigor of the studies, right?
2692.12 2699.24 S: And they have a nice convenient table showing like which studies were blinded and which studies, you know, in what ways.
2699.24 2704.12 S: And not a single study was rigorous across the board, right?
2704.12 2706.32 S: Most of the studies were not blinded.
2706.32 2709.44 S: None of them were double blind.
2709.44 2711.68 S: Not one of the studies were double blind.
2711.68 2715.36 B: I mean, that should be a reason not to do a meta-analysis.
2715.36 2717.76 S: So right there, you could stop there.
2717.76 2726.08 S: This is a, this is a study with a subjective outcome with a huge placebo effect and not a single study was double blind.
2726.08 2729.52 S: That's we're done at that point, but there's a lot more interesting stuff to talk about.
2729.52 2733.64 S: So there was a, there was a massive quality issue.
2733.64 2744.00 S: Two of the studies had a greater than 20% dropout rate in the non-intervention group because of course they did, because if you know you're not getting the treatment, why would you stay in the, in the study?
2744.00 2745.00 S: Right?
2745.00 2748.44 S: So, but that also has the potential, right?
2748.44 2751.28 S: If you drop out of a study, it's because it's not working.
2751.28 2754.80 S: And so that massively biases the results towards a positive outcome.
2754.80 2755.80 J: Right.
2755.80 2756.80 S: Yeah, absolutely.
2756.80 2757.80 S: Right.
2757.80 2758.80 S: Right.
2758.80 2759.80 B: If you're doing great, you're not going to drop out of the study.
2759.80 2762.28 B: So yeah, it's only the people that did, that did well remained.
2762.28 2764.56 B: Oh boy, look how good this is.
2764.56 2765.56 S: Yeah.
2765.56 2768.92 S: So they also, some of the studies included secondary outcomes, right?
2768.92 2776.76 S: So the primary outcome, you have to pick like, what's the one major thing we're going to look at, but then you can have secondary outcomes, which are supportive.
2776.76 2802.56 S: So for pain studies, one of the important secondary outcomes that we use, and actually this could be a primary outcome if you wanted to make it one in your study is so you can ask patients like how much pain did you have or, you know, document your pain over time, but you could also ask them how much pain medication did you use over that period of time and you can in fact count their pain medication.
2802.56 2803.60 S: Right.
2803.60 2811.88 S: So that's kind of a pseudo quantitative way of assessing their pain because, and in fact, that's actually a better outcome.
2811.88 2812.88 S: Right.
2812.88 2826.28 S: So what do you think is going to, is more, more truthful and not that they're lying, but I mean more to the point how much pain you say you're in or how much pain medication you use to treat your pain.
2826.28 2827.28 S: Yeah.
2827.28 2828.28 E: The medication you're using.
2828.28 2829.28 S: Yeah.
2829.28 2832.60 S: The medication is considered to be a really, really important outcome.
2832.60 2840.32 S: So that outcome, the use of rescue pain medication was not different in the groups.
2840.32 2846.66 S: So patients were saying they had less pain, but they were using just as much rescue pain medication.
2846.66 2851.60 S: So that also massively throws into question the outcome.
2851.60 2853.96 S: They also looked at a funnel plot.
2853.96 2862.42 S: Now, a funnel plot is a way of visually documenting whether or not there is publication bias.
2862.42 2865.48 S: And I know I've talked about this on the show, but this is kind of a wonky statistical thing.
2865.48 2867.64 S: So let me review it very quickly.
2867.64 2875.36 S: Basically on the Y axis, you, you rank studies based upon their power.
2875.36 2876.36 S: Right.
2876.36 2879.68 S: And on the X axis, you document their effect size.
2879.68 2880.68 S: Right.
2880.68 2882.48 S: So you look at each individual study.
2882.48 2883.96 S: Here's how powerful it was.
2883.96 2885.32 S: Here's the effect size.
2885.32 2886.68 S: That's where the dot goes.
2886.68 2888.00 S: And then you plot them.
2888.00 2902.20 S: And when you do that, they should form a funnel, meaning that the more powerful they are, the less variable they are in terms of, you know, how far they stray from the average effect size.
2902.20 2906.28 S: And in addition, they should be evenly distributed.
2906.28 2917.48 S: And that's the critical part for publication bias, because if, if you're publishing all of the studies, there should be a statistical distribution around the effect size.
2917.48 2925.84 S: But if you're only publishing the positive studies, then all of the studies should be on the positive side of the effect size.
2925.84 2926.84 S: That makes sense?
2926.84 2935.12 S: And so you could instantly visually see how well distributed the studies are and if there is publication bias.
2935.12 2940.92 S: So what do you think we see when we look at these studies, these 10 studies?
2940.92 2946.16 S: So there, there are, first of all, we see two things, both of which are fatal, right?
2946.16 2949.88 S: One is there's definitely publication bias.
2949.88 2965.80 S: There's more studies on the right than on the left and perhaps even worse than the fact that they showed that, yes, there's publication bias, is that there was an inverse relationship between power and effect size.
2965.80 2970.16 S: In fact, there's no, there's no funnel through those dots.
2970.16 2984.30 S: You could draw a line through those dots, meaning that in the upper left hand corner, outside the funnel, there's two of the most powerful studies are dead negative, right?
2984.30 2988.78 S: As the studies get less powerful, that's when the effect size increases.
2988.78 2990.28 S: So oh, ding, ding, ding.
2990.28 2991.28 S: Yeah.
2991.28 2997.88 S: So there's a decline effect between effect size and power and power also tends to go hand in hand with rigor.
2997.88 2998.88 S: You know what I mean?
2998.88 3002.74 S: Cause if you're going to do a really powerful study, you're probably going to also put, make it a more rigorous study.
3002.74 3004.52 S: So those two, two things tend to correlate.
3004.52 3015.64 S: So the better studies, the more powerful studies were negative and the less rigorous, the less powerful the study, the more variable that was, the more positive it was.
3015.64 3023.42 S: And those were the ones that were all on the right side of the line so that there was significant publication bias as well.
3023.42 3024.42 S: So basically-
3024.42 3029.94 J: So where did you see that, Steve? Where did you see this publication bias, like those charts or whatever they were, graphs, where'd you see that?
3029.94 3030.94 S: In the study.
3030.94 3031.94 S: So in the meta-analysis, they published it.
3031.94 3032.94 S: They included them.
3032.94 3033.94 S: They published it, the mistake.
3033.94 3038.60 S: So like I said, they published all the data you need to see that it's crap.
3038.60 3041.50 S: They just- How did they come up with the conclusion they came up with?
3041.50 3042.66 S: That's the question.
3042.66 3046.00 S: How could they look at that funnel plot and come up with the conclusion they came up with?
3046.00 3047.00 S: That's the question.
3047.00 3048.80 S: Do they know what it means?
3048.80 3049.80 S: They do.
3049.80 3052.24 S: They say, yeah, it looks like there's some publication bias here.
3052.24 3056.76 S: Anyway, look how great, I mean, it was just, they just gloss over it, but they say it.
3056.76 3057.76 S: It's there.
3057.76 3059.08 S: You can't deny it.
3059.08 3062.28 S: There's publication bias and there's a decline effect.
3062.28 3076.04 S: You know, with the tube, I mean, it's so visually stunning to see these two studies outside of the funnel, like all the way at zero that are way above all the other studies in terms of power.
3076.04 3077.68 S: It's just visually dramatic.
3077.68 3083.64 B: I mean, they should be the two first pages of that damn meta-analysis.
3083.64 3085.54 S: No need to go to page three.
3085.54 3090.00 S: So now there's one more way to look at this, which is specific to acupuncture itself.
3090.00 3092.68 S: So this could be, so far I could have been talking about anything.
3092.68 3097.26 S: I could have been talking about cannabis or whatever, where you just, this is just looking at the data.
3097.26 3098.26 S: Here's a meta-analysis.
3098.26 3100.52 S: This is why it's negative because of all of these reasons.
3100.52 3102.72 S: The secondary outcomes are negative.
3102.72 3103.96 S: There's publication bias.
3103.96 3105.62 S: There's a decline effect.
3105.62 3109.88 S: There's none of the studies are double blind, you know, right there, fatally flawed.
3109.88 3116.76 S: This is, you cannot conclude that this treatment works, but there's an extra added problem because we're dealing with acupuncture.
3116.76 3120.40 S: That gets back to what Evan said, prior plausibility.
3120.40 3121.40 J: What?
3121.40 3122.40 S: Yeah.
3122.40 3123.40 S: Prior plausibility.
3123.40 3124.40 S: What's the mechanism?
3124.40 3125.40 S: Yeah.
3125.40 3130.68 S: So the question is which acupuncture points are each of these studies using?
3130.68 3131.68 S: Oh my God.
3131.68 3132.68 S: Right.
3132.68 3133.68 S: Right.
3133.68 3134.68 S: Consistency.
3134.68 3135.68 S: Oh, you're right.
3135.68 3142.20 S: So, and how do they, how does each individual study decide which acupuncture points to use?
3142.20 3150.32 S: So in that gets back even further to the question that I always love to ask when you, when you look at acupuncture studies and that is what is acupuncture?
3150.32 3157.28 S: Because you know, before you say acupuncture works, you have to have an operational definition of what acupuncture is.
3157.28 3166.88 S: Now typically it's defined as inserting needles into acupuncture points, which correlate to with specific function in the body.
3166.88 3167.88 S: Right?
3167.88 3183.42 S: Now I, I argue that acupuncture points don't exist because that's where the literature shows and now my favorite study to link to is in fact a meta analysis that was produced by acupuncturists who were asking the question, where are the acupuncture points?
3183.42 3193.02 S: And their conclusion was there are no acupuncture points because there's, if you try to pin down the location of a single point, it's, it's massive.
3193.02 3199.72 S: Like the, like the distribution of where it could be statistically is like a basketball on the body.
3199.72 3200.72 S: You know what I mean?
3200.72 3203.32 S: There's, there's no agreement essentially.
3203.32 3206.18 S: There's also no agreement about what they do.
3206.18 3212.82 S: So in this meta analysis, there are 10 studies, two of them are on auricular acupuncture.
3212.82 3217.28 S: So on the ear, the other eight are on corporal acupuncture.
3217.28 3220.76 S: So on the body, are they even the same thing?
3220.76 3222.32 S: They're not even the same thing.
3222.32 3232.16 S: But then if you look at say the eight corporal acupuncture studies, how many of them do you think use the same, exactly the same set of acupuncture points?
3232.16 3233.16 S: Zero.
3233.16 3234.92 S: None of them, none of them use the same set of acupuncture points.
3234.92 3256.14 S: So there's eight different assortments of acupuncture points, but if you look at the individual and they each use like eight to 10 or whatever different points, how much overlap do you think there is between the, any two studies in terms of like the eight or nine or 10 acupuncture points that they use?
3256.14 3257.58 S: Some have zero overlap.
3257.58 3261.60 S: Like they don't even use one of the same acupuncture points.
3261.60 3268.24 S: And some of the studies have maybe one acupuncture point in common with another study, like one other study.
3268.24 3273.48 S: I don't know if any of them had two, maybe they did, but there was like almost no overlap.
3273.48 3278.14 S: Like you almost as if they were trying to be completely different sets of acupuncture points.
3278.14 3280.20 S: So what does that mean?
3280.20 3281.20 S: Right?
3281.20 3283.12 S: I mean, how could we possibly interpret it?
3283.12 3289.76 S: These are 10 studies looking at 10 different interventions according to acupuncture, right?
3289.76 3291.18 S: It's a belief system.
3291.18 3295.92 S: Either that or the points don't matter.
3295.92 3299.14 S: In which case, what is acupuncture then?
3299.14 3303.20 S: Is it sticking the body in random locations?
3303.20 3304.54 S: Apparently.
3304.54 3312.16 S: And in fact, when you look at studies that do control for needle insertion, it doesn't even matter if you insert a needle.
3312.16 3316.48 S: So you can randomly poke the body with toothpicks and get the same effect.
3316.48 3318.24 S: Is that acupuncture?
3318.24 3323.44 S: Is an untrained person randomly poking the body with toothpicks acupuncture?
3323.44 3337.84 S: Because according to the literature, that's just as effective as actually having an expert inserting needles into alleged acupuncture points, which actually don't exist if you look at the literature on just where are they?
3337.84 3339.40 S: They're all over the place.
3339.40 3348.64 S: So yeah, that is a science based analysis of the data shows that acupuncture isn't a real thing.
3348.64 3350.30 S: It doesn't work.
3350.30 3354.52 S: And it's just a placebo effect and research noise.
3354.52 3356.36 S: That's all it is.
3356.36 3364.94 S: But the BMJ published a study that says it works based on the most shit data you could possibly imagine.
3364.94 3382.64 S: And the thing is, if this were anything other than acupuncture, if this were a drug, or were some other intervention, there is no way you would get a major journal to publish this data and claim that the treatment works.
3382.64 3389.96 S: No way you could get away with this anywhere outside of the alternate reality bubble of acupuncture.
3389.96 3391.86 S: Just not possible.
3391.86 3395.56 S: It's just a complete scam that's being inflicted upon the public.
3395.56 3396.56 S: A total scam.
3396.56 3400.72 E: And the BMJ is, they cannot see this.
3400.72 3404.24 S: No, academic medicine has completely turned a blind eye to this.
3404.24 3407.00 S: My own profession completely fails.
3407.00 3409.44 S: Oh wow, it's that widespread.
3409.44 3410.44 S: Absolutely.
3410.44 3419.12 S: It's a complete failure across the board because they are putting the acupuncturists in charge because they're the experts.
3419.12 3421.44 S: And no one is even paying attention.
3421.44 3422.44 S: Oh my gosh.
3422.44 3430.16 S: Because it's not, I don't know why, it's cultural, it's fringe, it's alternative, I don't know.
3430.16 3432.68 S: But there are no ones asleep at the switch.
3432.68 3433.68 B: What's the motivation?
3433.68 3436.12 B: Is there anyone else that's been railing against that analysis?
3436.12 3440.88 S: Yeah, are there people in my group of people promoting science-based medicine?
3440.88 3441.88 S: Absolutely.
3441.88 3443.04 B: But anyone outside of that?
3443.04 3452.64 S: Yeah, but there are people who are not affiliated directly with science-based medicine who are, like there are a very small number of people who are like, the emperor has no clothes, guys.
3452.64 3460.44 S: And then when you show it to, and again, I've had this experience many times, explain it to other professionals, they're like, yeah, you're right.
3460.44 3461.44 S: Okay, moving on.
3461.44 3462.44 S: They just don't care.
3462.44 3463.44 S: It's the shruggies.
3463.44 3464.44 J: The shruggies.
3464.44 3467.52 S: Yeah, it's the total shruggy problem.
3467.52 3468.72 S: It's a total shruggy problem.
3468.72 3472.62 S: But it's completely unprofessional in my opinion.
3472.62 3480.12 S: They're allowing a medical scam to thrive within the halls of medicine and major journals.
3480.12 3494.20 S: And most practitioners I know, most people who are like, you know, they'll recommend their patients get acupuncture because they just haven't done the due diligence to realize that it's complete nonsense.
3494.20 3495.24 S: It's a real scandal.
3495.24 3496.80 S: It's a massive scandal.
3496.80 3500.36 E: Gosh, you've been talking about this for 30 more years, Steve.
3500.36 3501.36 S: I know.
3501.36 3502.36 S: I know.
3502.36 3503.36 S: It is remarkable.
3503.36 3506.36 E: And this study is emblematic of the whole thing.
3506.36 3507.36 E: Yeah.
3507.36 3511.04 E: And then the headline roams around the world and everyone sees more legitimacy to it.
3511.04 3512.04 E: Yeah, exactly.
3512.04 3513.04 S: It does so much damage.
3513.04 3516.16 S: It's self perpetuating legitimacy on utter nonsense.
3516.16 3517.16 S: Absolutely.
3517.16 3518.16 S: What a world.
3518.16 3519.16 S: Scandal.
3519.16 3520.16 S: Okay, let's move on.
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3569.96 3577.46 C: There's a stunning HD display, unlimited storage, super easy setup and here's the best part, no fees.
3577.46 3585.30 C: All you've got to do is hook up your Aura Frame to Wi-Fi and use the free app to add endless photos and videos from anywhere in the world.
3585.30 3592.44 B: Our listeners can take advantage of Aura's extended Cyber Monday sale and get $50 off their best selling Carver Matte Frames.
3592.44 3595.28 B: Just go to AuraFrames.com slash skeptics.
3595.28 3599.38 B: That's AuraFrames.com slash skeptics.
3599.38 3603.44 B: These are Aura's lowest prices ever, so get yours now before they sell out.
3603.44 3606.96 B: And if you miss this sale, there will still be great sales through the end of the year.
3606.96 3608.44 B: Terms and conditions apply.
3608.44 3611.12 S: Okay guys, let's get back to the show.
New SI Units ()
- [link_URL TITLE][5]
911 Call Analysis ()
- [link_URL TITLE][6]
Interview with ___ ()
Who's That Noisy? ()
New Noisy ()
[_short_vague_description_of_Noisy]
Announcements ()
Dumbest Thing of the Week ()
Name That Logical Fallacy ()
Questions/Emails/Corrections/Follow-ups ()
_consider_using_block_quotes_for_emails_read_aloud_in_this_segment_
with_reduced_spacing_for_long_chunks –
Question_Email_Correction #1: _brief_description_ ()
Question_Email_Correction #2: _brief_description_ ()
Science or Fiction ()
| Answer | Item |
|---|---|
| Fiction | |
| Science |
| Host | Result |
|---|---|
| Steve |
| Rogue | Guess |
|---|
Voice-over: It's time for Science or Fiction.
_Rogue_ Response
_Rogue_ Response
_Rogue_ Response
_Rogue_ Response
Steve Explains Item #_n_
Steve Explains Item #_n_
Steve Explains Item #_n_
Steve Explains Item #_n_
Skeptical Quote of the Week ()
TEXT
– AUTHOR (YYYY-YYYY), _short_description_
Signoff/Announcements ()
S: —and until next week, this is your Skeptics' Guide to the Universe.
S: Skeptics' Guide to the Universe is produced by SGU Productions, dedicated to promoting science and critical thinking. For more information, visit us at theskepticsguide.org. Send your questions to info@theskepticsguide.org. And, if you would like to support the show and all the work that we do, go to patreon.com/SkepticsGuide and consider becoming a patron and becoming part of the SGU community. Our listeners and supporters are what make SGU possible.
Today I Learned
- Fact/Description, possibly with an article reference[11]
- Fact/Description
- Fact/Description
Notes
References
- ↑ [url_from_news_item_show_notes PUBLICATION: TITLE]
- ↑ [url_from_news_item_show_notes PUBLICATION: TITLE]
- ↑ [url_from_news_item_show_notes PUBLICATION: TITLE]
- ↑ [url_from_news_item_show_notes PUBLICATION: TITLE]
- ↑ [url_from_news_item_show_notes PUBLICATION: TITLE]
- ↑ [url_from_news_item_show_notes PUBLICATION: TITLE]
- ↑ [url_from_SoF_show_notes PUBLICATION: TITLE]
- ↑ [url_from_SoF_show_notes PUBLICATION: TITLE]
- ↑ [url_from_SoF_show_notes PUBLICATION: TITLE]
- ↑ [url_from_SoF_show_notes PUBLICATION: TITLE]
- ↑ [url_for_TIL publication: title]
Vocabulary
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