Tuesday, March 28, 2017

#1815: Ted Kaptchuk

Ted Kaptchuk is a Professor of Medicine and Professor of Global Health and Social Medicine at Harvard Medical School, which has become notorious for its efforts to legitimize quackery, and most famous for his research on the placebo effect. He has also been an expert panelist for the FDA, served on numerous NIH panels, worked as a medical writer for the BBC, and is quite a big deal in certain quarters. He is accordingly one of the most influential woo apologists alive. Despite his current position, Kaptchuk lacks formal training in modern medicine or biomedical science. Instead, he has a “degree” from the Macau Institute of Chinese Medicine.

Kaptchuk rose to fame in the 80s with his book The Web That Has No Answer: Understanding Chinese Medicine (Andrew Weil himself wrote the foreword for the second edition), discussed here, which is an ambitious attempt to defend traditional Chinese medicine (TCM) through appeal to tradition, special pleading and handwaving. Kaptchuk claims that TCM is very successful, but admits that “studies generally demonstrate that traditional Chinese medicine does work best when left in the context of Chinese logic;” that is, it doesn’t seem to work so well when you use ordinary standards of evidence and you should therefore apply different standards (apparently this is because Western medicine is terribly reductionistic whereas TCM treats the whole person, which one would think would be rather irrelevant when evaluating health outcomes); TCM, you see, is according to Kaptchuk “internally consistent” (it really isn’t, if Kaptchuk’s claims are taken as a guide), and that is apparently evidence enough. As you’d expect, the book contains some interesting contradictions that Kaptchuk tries to brush over with New Age fluff (e.g. that TCM “has standards of measurement that allow practitioners systematically to describe, diagnose, and treat illness,” but “[i]ts measurements, however, are not the linear yardsticks of weight, number, time, and volume used by modern science but rather images of the macrocosm;” perhaps this is an example of the aforementioned “Chinese logic;” Kaptchuk’s book is crammed with offensive orientalism), and the fact that TCM gets the function of most of our organs wrong just means that it has an alternative anatomical theory (that should apparently not be taken entirely literally because it is pretty obviously false and Kaptchuk is working under the presupposition that the theory is correct), just like prescientific Western medicine applied an “alternative anatomical theory” until practitioners began to study how the body actually works a couple of centuries ago. Kaptchuk does assert, though, that “Western clinical studies (done in China) of traditional Chinese medicine, by proving its practical efficacy, have helped it win its battle for survival in the twentieth century, and promise it a place in the future of medicine,” but admits in a footnote (that most readers won’t see) that the studies in question weren’t really studies – they weren’t controlled and used “imprecise assessment methods. They would most properly be called clinical observations.” He doesn’t even seem to try to back up claims like “Chinese remedies are often more effective than Western ones, and they are always gentler and safer[;] Chinese prescriptions, for example, do not produce side effects because they are balanced to reflect a patient’s entire state of being” or “Chinese medicine, because it emphasizes balance and relationship more than measurable quantity, can also frequently discover and treat a disorder before it is perceptible by the most sophisticated Western diagnostic techniques[;] Chinese medicine is capable of touching those places that evade the microscope;” oh yes, he is referring to subtle energies, no less. In the book, he does not discuss how traditional Chinese medicine came to the fore in modern China, which you’d think would be rather important framework information.

After his breakthrough (and influential) book Kaptchuk spent several years championonig various forms of alternative medicine (he seems to be still shilling for TCM), including follow-ups like the Chinese Herbal Medicine: Materia Medica (with Dan Bensky and Andrew Gamble). Currently, he is most famous for his research and “research” on the placebo effect, but his background matters (though he seems, in fairness, to have shied away from defending the most egregious forms of quackery). Kaptchuk still doesn’t seem to mean by “placebo effect” what real researchers mean; rather, placebo is to Kaptchuk powerful, mystic medicine and the power that ultimately legitimizes the altmed practices that he has already convinced himself are efficacious – appealing to “placebo” is a matter of finding a framework of promoting them that might look palatable to those who care for evidence and experiment if they don’t look too closely. He has even suggested that various “CAM” treatments may have “enhanced placebo effects,” effects that are even stronger than specific biomedical treatments. I assume most people realize that “enhanced placebo effects” is a contradiction in terms if “placebo effects” is used to mean what it in fact means, but apparently some of Kaptchuk’s fans don’t. Indeed, for Kaptchuk, “placebo effect” is understood as a postmodern deconstruction of the current authoritative role of randomized controlled trials (RCTs), that reliance on evidence obtained through rigorous testing is really just a cultural contingency, and our predilection for evidence and testing an imperialistic scheme used to dismiss the types of alternative practices Kaptchuk has convinced himself work by not relying on evidence and testing. In his 1998 article “Powerful Placebo: the dark side of the randomised controlled trial,” for instance, Kaptchuk characterizes RCTs as “self-authenticating”: “In a self-authenticating manner, the double-blind RCT became the instrument to prove its own self-created value system.” As you’d expect, the article uses legitimate shortcomings with RCT to imply that altmed that show no effect in RCTs is just as good as real medicine, just like flaws in airplane design is evidence that flying carpets exist (hat-tip: Ben Goldacre). Not that Kaptchuk seems to have a particularly firm grasp of how confirmation works in any case.

When reporting his research on the placebo effect, Kaptchuk has defended active use of placebo in patient treatment for conditions like asthma: “placebo treatment is just as effective as active medication in improving patient-centered outcomes.” Of course, placebo treatments for asthma have no effect on objective measures of lung function – only on subjective measures – so Kaptchuk’s position requires quite a redefinition “patient-centered outcomes”, but such redefinition often seems to be what Kaptchuk is trying to promote. (Apparently he is partly influenced in the effort by anthropologist Daniel Moerman, whom Kaptchuk has worked with and who seems to think that healing responses are cultural constructs – Moerman is a seriously dangerous nutter.) Contrary to Kaptchuk’s claims, “harnessing the power of placebo” is of little clinical value, at least if one is clear about what the placebo effect is. For Kaptchuk, though, promoting the powers of the placebo effect still seems to be primarily a ploy to legitimize a variety of non-efficacious altmed treatments, and rebranding CAM as “medicine harnessing the power of the placebo” has actually become quite athing.

Kaptchuk has even (in an article coauthored with Michelle L. Dossett, Roger B. Davis and Gloria Y. Yeh), promoted homeopathy as a means to achieve “reductions in unnecessary antibiotic use, reductions in costs to treat certain respiratory diseases, improvements in peri-menopausal depression, [and] improved health outcomes in chronically ill individuals.” It should be needless to say that the evidence supports no such claim. The article refers to the article “A critical overview of homeopathy,” which Kaptchuk coauthored with Wayne Jonas in the Annals of Internal Medicine, suggesting that “Homeopathy deserves an open-minded opportunity to demonstrate its value by using evidence-based principles.” Well, evidence-based approaches have been used to investigate homeopathy; it’s been refuted, but somehow Dossett et al. selectively chose to miss that part, as promoters of homeopathy are wont to do.

Diagnosis: Kaptchuk has, in fact, done quite a bit of serious work. But he is also spinning that work in a manner that support an agenda of legitimizing quackery. As a result, he has managed to become one of the most important and influential apologists for woo in the US; he is currently very influential, and very dangerous.

Monday, March 27, 2017

#1814: Raymond Kam

Raymond Kam is a Boston-based former psychiatrist who lost his license in 2013. When a 16-year old girl suffering from “several serious psychiatric symptoms and/or conditions” reported parental neglect and abuse to him, Kam decided that, instead of reporting the abuse (as required by law), the girl was demon-possessed. Upon deciding that the girl’s diagnosis was “spiritual” rather than psychiatric, he officially took himself off her case and appointed himself her “spiritual mentor” instead, apparently giving her a cross to wear (in exchange for an undisclosed other religious symbol) and bringing her to his church. At least the Board of Registration in Medicine voted to suspend his license indefinitely, saying his conduct called into question his “competence to practice medicine,” though they also allowed the suspension to be lifted as early as 2014 if Kam completed a psychiatric evaluation and other assessments, and entered into a five-year probation agreement – we haven’t seen any updates. Apparently Kam was supported in his assessments by another psychiatrist, Enrico Mezzacappa, who was reprimanded but didn’t lose his license – in other words, Mezzacappa is still out there preying on unsuspecting victims.

Diagnosis: It’s astonishing that Kam could get through his education being so abjectly incompetent at what he was doing, but he did. At least Mezzacappa is still at large, and even Kam himself might have returned to practice; watch out.

Saturday, March 25, 2017

#1813: Mark Kalita

Hardly a day goes by without another earth-shattering discovery made by non-establishment amateur scientists who write those discoveries up into book format, publish the book with a vanity press and announces the discovery by hiring a press release service (the WND, for instance, tend to pick up the stories, too, if they express an ideological fit with their readership). Mark Kalita is the proud author of Light Event, which, according to the press release from PR.com, reveals “the ‘Light Formula’ for the Human Being”. Kalita is apparently also the author of 7 Day Bodhi and Secrets of God. Light Event, however, is the first to publish the “Light Formula”, which is a “ground breaking theory places the Human being as a variable in the most unique equation of existence. The ‘Light Formula’ makes All Human beings a measurable quotient of existence. This unique ‘Light Formula’ of the Human being also mirrors the ‘Unified Field Theory’ as Mark uses the Infinite as a constant with claims that all energy is a subtle kinetic energy with a unique ‘Light Event.’” The formula is apparently k = IHx; that is, “the k(inetic) energy that is released when the constant of the I(nfinite) is aligned by the H(uman) variable. ‘x’ is the exponential rise of subtle energies when other H(uman)s are adjoined in the I(nfinite), also known as UNITY.” We are not convinced Kalita knows what “measurable” means. Abbreviating your terms in a metaphor that superficially looks like a scientific law doesn’t imply measurability. It is also unclear from the press release whether he thinks he has tested his formula, but apparently the “‘Light Event’ horizon for Humanity has been predicted [by the prophets of various world religions] since the beginning of time.” Indeed, according to the press release “Mark esoterically relays the cryptic meanings of his discovery. ‘As the Human factor aligns itself with a positive polarity, the subtle kinetic energies emerge as the “Greater Gifts” or the “Three Natures” of existence.’

So what are the applications of his discovery? Apparently “through the understanding and application of the ‘Light Formula’ light workers, or healers, psychics and mediums, can naturally and effortlessly enhance their gifts by taking a few easy steps to align their being with the Infinite.” Apparently rigorous testing is underway: “To further understand and verify the ‘Light Formula’, Mark is currently seeking volunteer psychics, healers, mediums and other light workers for an investigational focus group using the ‘Light Event’ tools to positively align the study subjects.” You have to cover your expenses yourself, however.

As a matter of fact, Kalita seems to have written numerous books, including Apocalypse 2015, End Times 5775, Hidden Messiah: Roman Conspiracy of Christian Apostasy, and One World Religion: The Guide to Money & Prosperity. The titles suggest a certain mindset.

Diagnosis: This doesn’t really even qualify as “pseudoscience”, does it? It’s just rambling nonsense with some New Age esotericism and motivational speech tricks thrown in at random. Probably entirely harmless.

Friday, March 24, 2017

#1812: Robert Kaita

Since he’s already been sufficiently neutralized and thoroughly covered elsewhere, we’ll skip Theodore Kaczynski – even though he is certainly more colorful than Robert Kaita. The latter is Principal Research Physicist in the Plasma Physics Laboratory at Princeton University, and a respectable scientist in his own field with a more than respectable publication record. But being an expert in one field is no guarantee of any deep understanding of science in general but apparently, for some, a source of arrogance. Kaita is also a Fellow of the Discovery Institute’s Center for Science and Culture, and a proponent (or at least defender) of Intelligent design creationism; he is for instance a signatory to the Discovery Institute’s petition A Scientific Dissent from Darwinism and contributed to the anthology Mere Creation: Science, Faith & Intelligent Design, edited by Bill Dembski. He was also involved in (unsuccessful) efforts to convince a textbook board in Alabama to adopt the creationist textbook Of Pandas and People – for which he was a reviewer – in 1993.

Diagnosis: Yes, he has genuine – and rather impressive – credentials, and when people with genuine credentials allow ideology to trump intellectual honesty, accuracy and meticulousness, the results are ugly. Kaita is a pseudoscientist more than he is a scientist.

Wednesday, March 22, 2017

#1811: Kay (Kandeel) Judge and Maxine Barish-Wreden

Homeopathy is nonsense based on medieval metaphysics and pre-scientific mistakes about medicine. And just to make sure it is as nonsensical as it seems to, research has also repeatedly demonstrated that it has no health benefits. But people have been swearing by things that have been demonstrated not to exist for centuries, and there is no reason to think they’ll stop now. Kay Judge and Maxine Barish-Wreden, for instance, continue to push it. They are even medical doctors, illustrating one more time that being an MD is not the same as being a scientist, and that you can get through medical school without understanding the most basic thing about how research and evidence work. So, in the Sacramento Bee weekly “Integrative medicine” column (oh, yes), Judge and Barish-Wreden write, without shame, things like “the homeopathic medicine arnica has been shown to assist in acute pain such as bruises or strained muscles,” which is false and hard not to characterize as an outright lie – though note how they don’t cash out “shown”, or “assist in”, which is nothing but weasel words. But arnica (though the herbal version, not the homeopathic one that Judge and Barish-Wreden push) has been promoted by Dr. Oz!

Both of them apparently practice internal medicine in the Sacramento area. Barish-Wreden is apparently Medical Director of the Sutter Center for Integrative Holistic Health, which is not a place to seek out if anything serious ails you, and is apparently a practicing internist. But her qualifications also include “studies in medicine that encompass the mind-body-spirit connection,” which must count as an anti-qualification at least to the extent that it suggests offensively poor critical reasoning skills. According to her website “[i]n working with her patients, Dr. Barish-Wreden views illness as a teacher and looks at symptoms as signposts that can direct our attention to areas that may be out of balance in our lives.” Yes. It’s humorism, no less. She is also into nutrition woo. According to Barish-Wreden “[f]ruits and vegetables that are raised organically are felt to have more phytonutrients than those raised commercially, since organic plants tend to be hardier as they learn to survive without the benefit of pesticides and insecticides” [my emphasis]. This is New Age religious nonsense, of course, but it is telling that even Barish-Wreden is reluctant to make any substantial claims on behalf of organic food as medicine, which makes one briefly suspect that she at some level knows that she is peddling bullshit. On the other hand, Judge and Barish-Wreden have no qualms about claiming that “sulforaphane [a phytochemical] helps to fight cancer” (note the vagueness) and that kale is a “cancer-fighting” vegetable. It probably isn’t, and methinks Judge and Barish-Wreden know that.

Diagnosis: The world would be a significantly better place if people like Kay Judge and Maxine Barish-Wreden used their skills and resources to actually help people instead of misleading them with New Age religious, demonstrable nonsense. And apparently their influence might, as it is, be substantial enough for them to cause real harm. It’s a tragedy, really.