No, he is not happy at all. Specifically, he is not happy with the skeptical blogosphere. He apparently feels that we nasty, close-minded skeptics have been so very unfair in our discussions of him. Specifically, he is not happy how several of us have called him to task for his remarks at the 1st Annual Integrative Medicine Scientific Symposium held in April at Yale University. In particular, what stood out (and provoked the sarcasm and contempt of several bloggers devoted to discussing scientific medicine and going after quackery) was Dr. Katz's fanatastically Orwellian advocating for a more "fluid concept of evidence" in evaluating so-called "complementary and alternative medicine" (CAM) or "integrative" medicine. His remarks were lambasted in particular by Professor David Colquhoun (who characterized his remarks as "not science" and "not even common sense"), Dr. Steve Novella (who used Dr. Katz's remark as an example of how CAM advocates play the same game that little children do in trying to change the rules when they are losing under the previously agreed-upon rules), Dr. R. W. (who used Dr. Katz's comment about a "more fluid concept of evidence" as an example demonstrating that we are now in the "era of post-scientific medicine"), and, of course, me (who, as you might expect, applied some of my much beloved not-so-Respectful Insolence⢠to large swaths of Dr. Katz's talk). Fluid evidence, indeed.
No, Dr. Katz does not like his first encounter with the medical blogosphere at all. Indeed, he is so unhappy that apparently a few weeks ago he tried to answer the bloggers who had raked him over the coals for blatantly advocating "integrating" unscientific woo like homeopathy with scientific medicine. Unfortunately for him, he did not do a particularly good job of it. Indeed, what most stood out as I read his rejoinder was that he does not answer a single substantive criticism leveled at his comments. Not one. Instead, he does what pretty much all woo-meisters do when criticized for shifting goalposts and appealing to other ways of knowing besides science as a means of "proving" that their preferred fairy dust works; he wraps himself in the mantle of the brave iconoclast willing to challenge accepted dogma and whines about the peons who criticized him, heaping contempt on the bloggers who had the temerity to criticize his advocacy for pseudoscience because to him they have not earned the right to criticize his (at least in his opinion, apparently) greatness in comparison to him.
Color me unimpressed.
Dr. Katz starts out, as all good wounded woo-meisters, with a whine about how the those unworthy hoi polloi have dared to criticize the Great Dr. Katz:
Being well educated does not guarantee you'll always be right, and it certainly doesn't guarantee everyone will agree with you. But it still matters. Or at least it used to.
There's a big difference between earning the right to express an opinion through years of training, professional credentials, the ardors of publication (books and peer reviewed papers), and the judgment of peers- and simply having an opinion, an Internet connection, and some time to kill. But in the blogosphere, both are equal...
Poor Dr. Katz. Those apparently uneducated and unsophisticated (not to mention close-minded) slobs who didn't "earn the right" to criticize are being mean to him! Never mind that Steve Novella is an academic neurologist at Dr. Katz's own institution of Yale who has studied various CAM modalities for many years; never mind that I'm an academic surgeon with NIH and foundation funding who has done likewise; never mind that David Colqhoun is a well-respected and internationally known Professor of Pharmacology at University College London who has probably been at this longer than Steve and I combined, and Dr. R. W. is an intensivist. Yet, to Dr. Katz, we're just guys who have an "Internet connection and some time to kill." The apparent reason, of course, that we are unqualified in Dr. Katz's eyes to evaluate the modalities he champions is because we haven't personally used woo on patients or published papers in CAM (as he has)--to which I would respond that you don't have to be a dowser to realize that dowsing is woo and likewise you do not need to be a homeopath to realize that homeopathy is pseudoscientific quackery based on pre-scientific thinking and ancient concepts of magic. Certainly, it's not based on science. In fact, my irony meter nearly blew a fuse when I read Dr. Katz's sentence, because Dr. Katz himself provides a beautiful case study of how "being well educated does not guarantee you'll always be right." In fact, he provides an excellent case study showing that being well educated does not mean that you won't be spectacularly wrong most of the time. The difference between the pseudoscientist and the scientist, the latter of whom can also be spectacularly wrong, of course, is that the scientist will eventually admit it and move on when the evidence does not support his or her cherished hypotheses. Advocates for pseudoscience like Dr. Katz will cling to their woo ever more tightly the more evidence comes in that refutes it.
Dr. Kimball Atwood IV does a very amusing feature on Science-Based Medicine called the Weekly Waluation of the Weasel Words of Woo, or W^5/2 for short. It is, as described by Dr. Atwood, a game in which a passage taken from the pro-CAM "literature" is subjected to deconstruction of its misleading language and logical fallacies. The winner, the person who does the best translation of the woo-speak in the selected passage, wins honor, fame, and glory. I mention this because the the next part of Dr. Katz's argument is such classic woo-speak, so laden with misdirection and logical fallacies, that I have a hard time believing he thinks anyone should take it seriously. More importantly, it would make a perfect installment of W^5/2:
My talk was on the importance of respecting both science, and the needs of patients- which often go on long after the availability of relevant results from randomized, clinical trials run out. My view, quite simply, is that dedication to responsible use of scientific evidence, and dedication to responsiveness to the needs of patients can, and must, be reconciled by the caring health care provider. When the applicability of clinical trial results to the care of a patient is least certain, that patient needs options, and the help of compassionate, expert guidance more, not less.
This is a classic false dichotomy based on a false premise, although it's cleverly implied. You see, Dr. Katz is in essence arguing that we can't reconcile science-based medicine, embodied by the results of preclinical scientific evidence and randomized clinical trials, with the needs of patients (this is the false premise; we most certainly can). He then goes on to imply that we cannot both respect patients' needs and maintain a commitment to scientific medicine (the false dichotomy; he argued in the same thing more or less in his Yale talk). I'll state the false dichotomy more explicitly: We either must embrace unscientific/pseudoscientific B.S. about the "memory of water" or manipulating "life energy" or risk not meeting all of our patients' needs. Or so Dr. Katz would tell us. This is poppycock plain and simple. After reading Dr. Katz's column, I'm half tempted to start up my own version of W^5/2, blatantly stealing from Dr. Atwood (I doubt he'd mind too much) and featuring the above choice quote by Dr. Katz's as my first entry. (Heck, feel free to "translate" his blather to you heart's content in the comments.)
Dr. Katz then can't resist another favored technique of woo-meisters everywhere: Crying "Help! help! I'm being repressed!" and whining some more about those horrible bloggers:
In response to such heretical views as these, I've noted that I have been excoriated on numerous sites in the blogosphere devoted to exposing quackery. I've been in the public eye enough to be unruffled by this; my feathers are thick, water off a duck's back, and all that. But I worry about who will learn what from whom in an age when every opinion has access to the same megaphone.
My, my, my, Dr. Katz surely has an inflated opinion of himself, doesn't he? There he is, the brave fighter against dogma gladly suffering the slings and arrows of outrageously low brow blogging, all in a fight for Truth, Justice, and the American Woo. Or at least that's what he seems to be saying about himself:
If a comparable commitment to science and my patients is quackery, I would rather be a duck than a doctor; so I'm guilty as charged. But in my view, this is just what a doctor, not a duck, is supposed to be.
Of course, Dr. Katz's counterattack on the skeptical blogosphere belies his claim that it's all "water off a duck's back." Clearly, Dr. Katz's feathers were ruffled by these criticisms. If all this criticism truly didn't bother him, perhaps he would have spent less time squawking and more time actually providing substantive answers to the substantive criticisms leveled against him by Professor Colquhoun, Dr. Novella, myself, and others. Also, let's not forget what Dr. Katz actually said at his lecture. He did everything he could to undermine the very concept of scientific medicine while wrapping himself in its mantle. For example, he referred to evidence-based medicine as "indoctrination"; played up a nonexistent conflict between EBM and meeting the needs of patients; and proposed a more "fluid concept of evidence," in which poorly controlled anecdotal evidence would apparently trump evidence from randomized clinical trials as long as such anecdotal evidence supports the use of CAM modalities.
I'm sorry that Dr. Katz apparently feels so abused by the blogosphere, but I'm not in the least bit sorry for what I wrote, and I'm guessing that the same can be said for Steve Novella and David Colquhoun as well. Dr. Katz richly deserved all the criticism directed his way, which, in blogospheric terms, was actually rather mild, his cry about its cruelty notwithstanding. (I'd be happy to forward to him some of the examples of real nastiness that have been directed my way over the years for taking on antivaccinationist madness, quackery, creationism, and Holocaust denial. It'd curl Dr. Katz's hair.) Finally, Dr. Katz also demonstrates another characteristic of a crank in that he has an inordinate concern about the identities and credentials of those who criticize him and indeed appears more concerned about that than the actual criticisms leveled at him, leading him to engage in what is in essence an ad hominem attack in which, rather than explaining why we're wrong about him, he says you shouldn't listen to us because we don't have the same credentials he does and thus haven't "earned the right" to criticize him. Of course, one thing about the blogosphere is that "anyone with an Internet connection and some time to kill" can take on the high and mighty, which is apparently what Dr. Katz is in the world of woo. The blogosphere, for all its problems and shortcomings and tendencies to stupidity and nastiness, still remains a great equalizer in which anyone can level substantive, science- and reason-based criticisms at the experts and find an audience. Moreover, when a blogger "hides" behind a pseudonym, no consideration of his or her identity, background, expertise, or "authority" is possible in evaluating the arguments made. It is only the strength of those arguments and the evidence that the blogger can marshal in support of them that matter--the ultimate in democracy! Dr. Katz apparently can't deal with such a leveling of the playing field, and it clearly disturbs him greatly that "just" any old guy with an Internet connection can take him to task for his championing of a pseudoscience as utterly ridiculous and scientifically implausible as homeopathy. He doesn't like it any more than he likes criticisms of his support for quackery and his prominent role in contributing to the rise of quackademic medicine in the U.S.
Good.
For too long, unscientific woo has been infiltrating academia, with self-righteous and deluded doctors like Dr. Katz thinking that they are somehow advancing medicine when what they are really doing is pushing it back to the pre-scientific Dark Ages, when anecdote and tradition were all, and truly rigorous scientific investigation was rare. The blogosphere is emerging as perhaps the first effective and widely read source of skepticism about this co-optation of conventional medicine by CAM, and that's a very good thing indeed. Indeed, the discomfiture of woo-boosters like Dr. Katz should be celebrated.
ADDENDUM: Not wanting to be 100% and totally "mean" to Dr. Katz, I will point out that I fully agree with his strong stand in favor of vaccination against measles. See? Talk sense, and I'll agree. Talk woo, and face some not-so-Respectful Insolenceâ¢.
More like this
...says the guy who's proposing we ditch the usual standards for who gets to use the big, shiny megaphone in favour of something more fluid.
Dr. Katz: "I've been in the public eye enough to be unruffled by this; my feathers are thick, water off a duck's back...If a comparable commitment to science and my patients is quackery, I would rather be a duck than a doctor; so I'm guilty as charged."
So Orac et al try to clean the oily woo off his feathers and release him back into the world of EBM, and he quacks and squawks in protest?
Silly goose.
"advocating for a more "fluid concept of evidence" in evaluating so-called "complementary and alternative medicine" (CAM) or "integrative" medicine."
I reject your reality and substitute my own!
I am particularly impressed by Katz's proclamations during the conference because they are so clearly in opposition to the commitment to "scientific rigor" in Yale's CME program (stated in Disclosure Policy).
My stab at this:
My talk was on the importance of respecting any science which doesn't contradict the pseudoscientific beliefs of patients - which often go on long after the relevant results from randomized, clinical trials has refuted them. My view, quite simply, is that dedication to responsible use of scientific evidence must be reconciled with patients' archaic superstitions by the caring health care provider. When the clinical trial results do not yield a definitive "best option", patients need information about all medical options, including potential benefits and risks and any associated uncertainties. But compassionate, expert guidance requries more, not less: the compassionate doctor should also discuss viable witch spells (should the patient believe in witchcraft), potential benefits of exorcisms (for the Catholic patients), magic memory water, magic crystals, magic needle pokings, magic hand-waving, etc.
Does that translation work?
Be nice, Orac. If we're going to insist that the rules be observed, we should at least try to play by theirs.
So D.r Katz is a professor of public health? What is his opinion of treatment for drug abuse? I presume that he has first qualified himself by using heroin, crack cocaine, ecstasy, etc. Public health certainly involves a good bit of work in sexually-transmitted diseases -- how can he have an informed opinion if he hasn't actually experienced gonorrhea, syphilis, or for that matter AIDS? One hopes that he has become familiar with the public health aspects of arthropod-borne diseases by living with a few. How can he possibly hold an informed opinion on breastfeeding or other issues of child and maternal health?
OK, I'm getting tired. Maybe I should skip the question of qualifications to practice oncology or gerontology. As for forensic medicine ...
Dear Orac:
Would Dr. Katz believe that this is an acceptable example of "fluid concept of evidence" ?
"Board use of psychic blasted
Allegation of sex abuse stems from 'vision' of letter V"
Toronto Sun, Wed. June 18, 2008
The news story begins:
"The mother of an autistic girl says the public school board was "completely unprofessional" to formulate a theory that her daughter was being sexually abused based on a psychic's perception."
I wish I was making this up -- but, that's right -- a school is alleging sexual abuse of an autistic child/ student based on a "psychic's perception".
You can read the rest of the story at http://www.torontosun.com/News/Canada/2008/06/18/5910691-sun.html
and, it only goes down hill from the opening paragraph.
Orac said: "For too long, unscientific woo has been infiltrating academia, with self-righteous and deluded doctors like Dr. Katz thinking that they are somehow advancing medicine when what they are really doing is pushing it back to the pre-scientific Dark Ages."
Well, according to Peterson's College Guide, presently...
[see http://oracle-web.petersons.com/ccc92/display_pdf?p_instance_id=145966… ]...
the queen of woo - naturopathy -- states that the PROFOUNDLY science-ejected vitalistic is, in fact, science-based.
So, sadly, a whole generation of adolescents and young adults will believe this -- per this reference's credibility -- and they will be misled in their career paths by, indeed, woo's infiltration into academia.
Quite an endarkenment.
I have granted Dr. Katz his wish ;-)
http://paulhutch.com/wordpress/?p=300
I've placed the image in the public domain so please feel free to use the image yourselves.
we're just guys who have an "Internet connection and some time to kill."
No, damn it, that's MY job title. And that only because my work machine is slow, giving me oodles of 5 minute breaks to fill.
By the way, Kimball is SOOOO suing you...
My stab:
My talk was on the importance of respecting both science, and the needs of patients - since I do not make money unless I can pretend that these are different things, and since I really, really need people to believe that actual clinical trials are unnecessary if you believe hard enough. My view, quite simply, is that dedication to the pretense of evidence, and dedication to telling patients whatever they would like to hear can, and must, be reconciled by the profitable woo provider. When there is no proven treatment for a patient, that patient is ripe for expert guidance on snake oil, and the more, the better.
Meh. Not a good nugget. Lacks that batshit loony flavor. Just pure quackadoodle swindler is so much less funny.
This asshole is an adjunct associate professor at Yale Medical School, which is purely a courtesy appointment, and gives him none of the rights or privileges of a real faculty member. Just sayin'.
PhysioProf: so it is quite a bit like "sanitation manager"?
"My talk was on the importance of respecting both science, and the needs of patients- which often go on long after the availability of relevant results from randomized, clinical trials run out. My view, quite simply, is that dedication to responsible use of scientific evidence, and dedication to responsiveness to the needs of patients can, and must, be reconciled by the caring health care provider. When the applicability of clinical trial results to the care of a patient is least certain, that patient needs options, and the help of compassionate, expert guidance more, not less."
Owie!!11eleventyone. The bad men took my penis!
I've also seen "adjunct" used for soft-money faculty. i.e. you got a grant to do faculty level work here, but we don't have a formal faculty position opening and have no plans to make one for you.
To paraphrase a common expression used in the fight against quackery and bad science - what Doc Katz needs to realize is that the plural of "anecdote" is not "compassion".
I'll have to steal that one!
Orac
You missed one of David Colquhoun's bona fides - he is an FRS, a Fellow of the Royal Society (for US readers - this is broadly equivalent to being a member of the US National Academy).
As scientists will know, to get to be an FRS the other Fellows have to vote you in - i.e. getting elected is being declared eminent by your eminent peers. You cannot buy an FRS, and you don't get one for sitting on committees, or appearing on TV, or talking yourself up.
For these reasons, the FRS it is the only honour (short of a Nobel) that UK scientists really rate. Contrast, if you like, the endless letters ("RSHom") and non-real titles (see Physioprof's post above) that quack types usually list after their name.
PS Also this side of the pond, noted academic woo-debunker Professor Edzard Ernst has put together a handy summary of the Woo-arguments about why woo can't be tested (and his view on why the arguments don't cut it) here.
Note that Edzard Ernst is a "Professor of Complementary Medicine". However, he takes this to mean that he should be investigating the evidence (or more commonly lack of it) for complementary interventions, rather than doing what people like Katz do and simply promoting the stuff.
People who know assure me that this is never the case at Yale Medical School, and that all adjunct appointments are purely courtesy, and provide none of the rights, privileges, or responsibilities of a real faculty member.
"fluid concept of evidence,"
And a "fluid concept of reality"?
I'm surprised he left out the "sitting in their mom's basement in their pajamas" trope.
One cannot but wonder whether Katz is really so ignorant (and too lazy to Google) that he doesn't know that Colquhoun is not some guy with "an opinion, an Internet connection, and some time to kill," but an internationally renowned pharmacologist. Or is he just presuming that his readers or that ignorant?
Perhaps that is done somewhere, but I've never seen it. Most commonly, positions such as you describe are given the "research faculty" designation. Adjunct may not be entirely a courtesy appointment, but in all cases that I know, it is a secondary appointment to somebody whose primary appointment is elsewhere, but who has some level of involvement with a department, such as giving a few lectures or mentoring a student from that department. Adjunct appointments do not normally receive the same level of scrutiny as full appointments or research-level faculty appointments, because no financial commitment is involved and the appointment can be rescinded at any time..
My humble offering, in the form of haiku:
Pleasant sounding lies
Are easier to swallow
Science takes too long
But is he a homeopathic pharmacologist? Or a naturopathic pharmacologist? If not, he hasn't "worked in the field" or "published" on CAM and is therefore nothing more than a guy with "an opinion, an Internet connection, and some time to kill." :-)
As someone who has been in Ag biotech (and participating in forums and such) for twenty-five years, I can assure you that people like this Katz guy are a dime a dozen. They crawl out from under rocks to discuss a number of issues like GM crops, obesity and global warming. I've come to learn that when someone responds to your argument by reciting their CV or dumping on yours, they must not be too comfortable with engaging in an actual debate of the issues. Lord help us if they have achieved any degree of celebrity (like Suzuki, Nestle, Rifkin, Gore or Heidi Cullen who treats the global warming debate like her sorority rush).
When data, logic, reason and civilty are replaced by emotion, rhetoric, hyperbole and personal attacks, I used to get angry. Now I just say to myself, "GOTCHA!"
Loren
If I understand, Katz is worried that his "credentials" are diluted on the Net. I revel in the notion that he cannot discredit my assertions. And, he cannot. My "credentials" are irrelevant.
C'mon, Orac! Insisting that woo must be scientifically verified is just batmobiling yourself against new ideas. You've gotta think outside the box and take an idea shower!
The current thinking among naturopaths is that their standards for scientific rigor are much higher than those of allopathic (evidence-based) medicine -- because conventional medical research only admits as valid those results which are profitable to the sponsors of the research: you guessed it, Big Pharma. Meanwhile, despite charging $2000 for what amounts to a reverse-operating galvanic battery, naturopathic product vendors are ideologically pure and would never, ever sway or bias research to get results they like.
It's like an alternate universe to these people, and frankly it scares me.
Actually - being a homoeopath will pretty much ensure that one doesn't realise that stuff.
Jeff Read,
What is the connection between the "Ion Cleanse" device you mention and the naturopaths?
What makes the manufacturer a "naturopathic product vendors"?
I did not find mention of any naturopaths or any type of research on the company website.
http://www.amajordifference.com/ioncleanseeducation.asp links
to training seminars taught by a chiropractor, Dr.Ted Winchester. Educational products page sells 3 books, one by an MD.
Hermano, you just don't give up, do you?
Hermano the Apologist:
I know that you are sorely tempted right now to post the entire four year curriculum for the Bastyr Naturopathic Medicine program to show that big meanie Jeff Read that 'Ion Cleansing' is NOT a required course, and to show all the rest of us that there is really only a teensy weensy bit of woo (Homeopathy, Hydrotherapy, Herbology, Arithmancy--whoops! scratch that last...I was thinking of a different school) mixed in amongst the otherwise very 'Doctory' sounding courses.
Please, I implore you, do not give in to this temptation.
(Interested parties may view this curriculum in its entirety--supplied by Hermano--in the comments following Dr. Atwood's Naturopathy Post on the SBM blog)
Why is it that 'fluid evidence' makes me think of a specimen bottle flying through the air ?
It's not uncommon for N.D.s to offer foot bath service in their offices. Combining different forms of woo is more "holistic", don't you see. I just chose that particular site as an example of the ridiculous price you might be expected to pay for what you get.
And the makers of these devices do conduct research, it's just not very well thought out, properly controlled or blinded or randomized, or corrected for bias and confounding factors.
H/T for this item which seems on-point for the rhetoric involved. 1974: Trick or Treatment. John Fuller's indignation and Martin Gardener's robust response are a treat to read and remind one that such exchanges happened without blogs.
Seemed to obtain to both Dr Katz and the N.D. off-thread.
Trrll asks:
One cannot but wonder whether Katz is really so ignorant (and too lazy to Google) that he doesn't know that Colquhoun is not some guy with "an opinion, an Internet connection, and some time to kill," but an internationally renowned pharmacologist. Or is he just presuming that his readers or that ignorant?
From my experience with his breed, he's presuming exactly that. Consumers of woo, as far as I can tell, are best described as "authoritarian followers" (think religious fundamentalist congregations that lap up whatever outrageous lie their pastors feed them). As such, they would never question Katz's characterization of his critics, let alone Google around and check it. Indeed, it fits in perfectly with their perceptions of the world, so it would be accepted without thought.
Orac noted that Katz played the persecution card; this is typical also of New Ager gurus, religious-right leaders, and even neo-conservative elites and pundits: each of these groups spends a lot of ink and air time railing against the vast conspiracies (respectively, science, "western" medicine, and Teh Left) they insist are arrayed against them and are (they claim) actively, though often clandestinely, sabotaging their objectives.
Their followers swallow this meme by the bucket and clamour for more. It's tried, it's true, it works, and Katz has shown exactly what kind of person he is by using it.
Jeff Read,
Thank you for reply and thank you for an excellent link http://www.theherbdoctor.org/foot-bath/ionized-foot-bath.html
Dr. Miles' ionized foot bath is clearly a better deal at $1300 than the 'Ion Cleanse' at $2000.
Do you consider James E. Miles a typical N.D.?
You may or may not know that there are two camps in naturopathy, 'traditional naturopaths' and 'naturopathic doctors'.
Based on Dr. Miles' Board Certifications, http://www.theherbdoctor.org/alternative-health-care.html,
which camp do you think he might belong to?
North of 49,
Your paranoid rant reflects more on you than Katz, eh?
Hermano, if woos didn't constantly whine about how evil we are for asking questions, threaten to sue people for criticizing them, change the subject away from the actual debates, or invoke absurd conspiracies all the time, it'd be paranoid.
But because they routinely behave as North of 49 describes, it's true. Show me a woo advocate who acts otherwise.
Bronze Dog,
"Woos" must be the "breed" I just read about.
Is dehumanizing "them" part of the debate?
Is there an actual debate here?
An "inordinate concern about the identities and credentials" and the peculiar interpretation of evidence reminded me of Dr Briffa. Glad to see the addendum pointing out at least one area where Dr Katz is reasonable.
Woo is a set of dangerous behaviors that often involve argument evasions. Woos perform those dangerous behaviors, including the argument evasions. If you bothered to follow the online debates, you'd see that they do indeed act as North of 49 described. Is it "dehumanizing" to call people evil if they do objectively evil things?
So, you actually show some alleged concern for debate. Got any good evidence for naturopathy's efficacy, Hermano? I may have missed it.
B.D.,
The debate then is regarding "naturopathy's efficacy".
Let's define our terms.
What would constitute "good" evidence?
What is "naturopathy"?
Also, what is your example of "an objectively evil thing" on Katz' behalf?
Does assuming superior attitude and treating others as inferiors constitute one such?
B.D.,
Follow-up,
Are these "dangerous practices" intrinsically dangerous, f.e. DWI?
Or are they "dangerous" when performed by an unskilled practitioner, f.e. surgery?
Surgery is a "dangerous practice" that may be efficacious, often life-saving.
If naturopathy is intrinsically dangerous and evil as you put it, what is the point of debating its efficacy?