“Fluid evidence” strikes back: Dr. Katz versus the skeptical blogsophere

David L. Katz, MD, MPH, FACPM, FACP, Adjunct Associate Professor of Public Health at Yale University is not happy.

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 Insolence™.