A Loose End
In the last post I wondered if Ted Kaptchuk, when he wrote the article titled “Effect of interpretive bias on clinical research,” had understood this implication of Bayes’s Theorem: that interpretations of most scientific investigations are exercises in inverse probability, and thus cannot logically be done without consideration of knowledge external to the investigation in question. I argued that if Kaptchuk had
…understood the point when he wrote his treatise, he was dishonest in not explaining it and in not citing at least one pertinent article, such as Steven Goodman’s (which I’m willing to bet he had read). If he didn’t understand the point he should have withheld his paper.
In researching more of Kaptchuk’s opinions I’ve discovered that he had certainly read Goodman’s article, but that he either didn’t understand it or preferred to obscure its implications in deference to his ongoing project in belittling scientific knowledge. In a letter to the editor of the Annals of Internal Medicine in 2001, Kaptchuk opined that even if “more trials of distant healing with increased methodologic rigor” were positive, it still would not “be persuasive for the medical community”:
The situation resembles the predicament with homeopathy trials, another seemingly implausible intervention, where the evidence of multiple positive randomized, controlled trials will not convince the medical community of its validity. Additional positive trials of distant healing are only likely to further expose the fact that the underpinning of modern medicine is an unstable balance between British empiricism (in the tradition of Hume) and continental rationalism (in the tradition of Kant).
…It seems that the decision concerning acceptance of evidence (either in medicine or religion) ultimately reflects the beliefs of the person that exist before all arguments and observation. [Kaptchuk cites the second of the two Goodman articles that I referred to above, discussed here]
There may be an unstable balance in medical academia, but it isn’t between Hume and Kant; it’s between those who mistakenly believe that deductive inference is the same as inductive inference and those who don’t. Kaptchuk would seem to prefer that his “unstable balance”—“this predicament of an ultimate clash between epistemological knowing and ontological knowing”—persist, in order to make absurdities such as homeopathy and distant healing appear merely controversial. He is dead wrong to suggest that informed estimates of prior probability, based on science, are equivalent to religious beliefs “that exist before all arguments and observation.” Whether that suggestion reflects a displeasure with the “privileging” of science or mere ignorance is a mystery.
Regarding Hume, Kaptchuk—his pedantry notwithstanding—did, perhaps inadvertently, call attention to a valid point: Hume’s Maxim, a variation of “extraordinary claims require extraordinary evidence,” can be thought of as a qualitative version of the theorem of Hume’s contemporary Thomas Bayes. The application of either of those precepts shows rather handily that either homeopathy or distant healing would be a far greater miracle than the ‘miracle’ of a rigorous-but-erroneous clinical trial.
Kaptchukian Dialectics: Teaching the Controversy
At the end of the last post, we saw Kaptchuk assert that
In clinical practice a sham medical procedure would be fraudulent and deplorable.
We also saw him acknowledge that for one trial,
…both traditional and sham acupuncture were shown to provide clinically significant improvement in back pain and function, as compared with either no treatment or usual medical care, suggesting that the benefit from acupuncture probably derives from the placebo effect.
There have been enough such trials for Kaptchuk to realize that all apparent benefits from “traditional” acupuncture—which he practiced for years—are similar to those from sham acupuncture, and thus probably derive from the placebo effect. Does he now believe that his own practice was fraudulent and deplorable?
It seems unlikely. Kaptchuk’s entire career has been based on his repeated claim that Chinese medicine (including acupuncture) is
a coherent and independent system of thought and practice that has been developed over two millennia. Based on ancient texts, it is the result of a continuous process of critical thinking, as well as extensive clinical observation and testing. It represents a thorough formulation and reformulation of material by respected clinicians and theoreticians…
It is now evident that Chinese medicine is an effective healing method.
Moreover, Kaptchuk has also argued in favor of the very practice that he called “fraudulent and deplorable”:
Although this alternative standard for evidence-based validation deserves critical scrutiny and serious debate, we believe that it reflects a more patient-centered perspective for symptomatic treatment.
We’ve previously seen numerous other examples of Kaptchuk contradicting himself. As suggested here (scroll to “From Campus Radical to AltMed Superstar”), this may have more to do with intent than with sloppy thinking. Former Columbia SDS Chairman Kaptchuk seems still to revel in that mish-mash of Hegelian dialectics and Marxist-Leninist-Maoist thinking, with its stress on “The law of contradiction in things,” that was in vogue among campus radicals of the 1960s. In the 2000 edition of The Web, he writes:
In the nineteenth century, Hegel finally confronted and denied Aristotle’s law of contradiction and developed the theory that has come to be known as Hegelian dialectics. For Hegel, the intricacies of relationship override the Aristotelian concern that A not be confused with not A. A can, in fact, be other than A, depending on its place in an overall schema. These ideas are so similar to those of Chinese philosophy that Hegelian and Chinese thought have often been compared.
In the introduction to that edition of The Web, Kaptchuk offers a (pretentious) celebration of contradiction that seems consistent with many of the passages previously quoted in this series:
In updating and writing this second edition, I’ve had to contend with the contradiction between a Talmudic intellect and a Hasidic soul. I have grown acutely aware that East Asian medicine is a huge ocean of texts and interpretations. Any assertion is automatically a complex problematic and an opportunity for contending understandings. My hermeneutic tendency would have liked to pursue the paradoxical knowledge produced by irreducible uncertainty.
Yup: Teach the Controversy. OK, the quip is unfair in a sense (we don’t know where Kaptchuk stands on the evolution vs. “intelligent design” pseudo-controversy), but it is entirely fair regarding scientific pseudo-controversies in general: Assertions in East Asian medicine are not automatically “complex problematics.” Most are straightforward questions of fact or myth, and most of those are readily identified as myths. “Contending understandings” seems not only pleasing to Kaptchuk’s hermeneutic tendencies, but has been the key to his maintaining an academic career built on sand.
Shilling for Toxic Chinese Herbs
In the first edition of The Web, Kaptchuk had made the unsupported assertions that “Chinese remedies…are always gentler and safer [than Western ones]” and they “do not produce side effects.” In 1987 he made a similar claim to Vegetarian Times, this time with minor caveats:
Kaptchuk had apparently already decided that he was that someone: by 1986 he had begun shilling for East Earth Herb and in 1999 for Kan Herbals, a gig that he still, apparently, has. Such arrangements have provided him an opportunity to celebrate his poetic passion for ‘contending understandings’ in a way that is both cloying and, presumably, lucrative:
Our Western health care system can greatly benefit from Eastern practices, but this knowledge needs to be sensitively transmitted and applied. Systems of healing always reflect the collective dilemma of human beings and their strivings for intactness and authenticity in the context of their communities and cultures. Medicine is universal, yet is simultaneously shaped by its environs.
In developing these products I have tried to remain aware of the tension between East and West, old and new, preservation and growth, accuracy and adaptation. These products are, and will continue to be, the outgrowth of an immersion in classical Chinese herbal texts, along with an attentiveness to the energies and concerns of Western customers. The intention is to be faithful to China’s ancient herbal wisdom, while conscious of the contemporary clinical needs of Westerners.
These Kan Herbals formulations approach Oriental medicine in the most encompassing sense. Traditional Chinese medicine’s primary concern, its self-definition, lies in attempting to bring harmony to the whole human being…
If you want to delve into Kaptchuk’s herbal offerings in esoteric detail, look here. Unfortunately, two of the products that Kaptchuk pitched had to be recalled in 2000 because they contained a dangerous toxin, aristolochic acid. This is from the FDA recall notice:
EUGENE, OR (November 21, 2000) – East Earth Herb, Inc. is recalling Jade Pharmacy brand Meridian Circulation tablets and liquid extract and Jade Pharmacy brand Quell Fire tablets because they may present a serious health hazard to consumers. The products contain aristolochic acid. Aristolochic acid is a potent carcinogen and nephrotoxin found in certain plants and botanicals. This chemical can cause serious kidney damage and the use of products that contain aristolochic acid has been associated with several occurrences of kidney failure. The use of aristolochic acid containing products has been linked to increased risk of kidney cancer in people who have consumed it.
Jade Pharmacy brand Meridian Circulation, and Jade Pharmacy brand Quell Fire were distributed throughout the United States through licensed health practitioners.
Oh, the disharmony! In the 2000 edition of The Web, Kaptchuk finally admits that Chinese herbs have greater risks than he’d previously granted, including inherent toxicities, contamination with heavy metals and other toxins, and adulteration with synthetic drugs. He begins his description of the aristolochic acid debacle by suggesting that it had been a problem of “interaction with Western drugs” (my emphasis):
The most serious incident of a Chinese herbal iatrogenic effect reported in the biomedical literature first seemed to be due to an interaction between herbs and drugs in a combined drug/herbal product once used in a weight reduction clinic in Belgium. This mixture was prescribed by Western physicians with no training in Chinese medicine. At least 100 women developed interstitial renal fibrosis with terminal or preterminal renal failure. The epidemiology of this tragic incident is still unclear and confusing. One possibility is that a Western drug in the slimming pill cocktail may have [interacted with a Chinese herb], and increased the slight toxicity that already existed in the herb and drug individually…
He ends it this way:
Further complicating the picture, a subsequent report of serious nephropathy associated with Chinese herbs containing aristolochic acids (identification of the exact herb is confusing) raises the distinct possibility that this tragic event should be classified as a toxicity incident and not a herb-drug interaction.
Uh, no kidding. By then there was plenty of evidence both for that “distinct possibility” and for aristolochic acid causing cancer. Kaptchuk didn’t mention, in the 2000 Web, that he’d been working for a Chinese herb company. Nor has he typically disclosed that arrangement in his articles for medical journals; the only exception that I’ve noticed is his 2002 article on acupuncture for the Annals of Internal Medicine. In 2007, Kaptchuk finally acknowledged, in an open letter titled “The Quality Control Crisis in China and Our Profession,” common pitfalls of crude botanical preparations (from China or anywhere else) that have been evident for decades, and that are an inevitable result of, well, how those preparations are prepared. What took him so long, and why should consumers have been led to believe, by Harvard Medical School, the NIH, and other presumed authorities, that his previous opinions had been trustworthy?
The Complex Problematic of Kaptchuk’s Degree
At the beginning of this series I explained that “Dummy Doctors” in the title refers to anthropologist Daniel Moerman and Ted Kaptchuk. Moerman has earned that designation, although he has a PhD, because in his New England Journal of Medicine editorial and elsewhere he has displayed his ignorance of modern medicine and science. Kaptchuk has earned it for a more fundamental reason: he appears to have no doctorate, period. For years, Kaptchuk put “OMD” after his name and was called “doctor” and “Dr. Kaptchuk,” and was said to have a “doctorate“; he had purportedly “earned his doctorate in Oriental Medicine from the Macau Institute of Chinese Medicine in 1975,” as stated on the back cover of the 2000 edition of The Web:
In 2009 I explained the reasons for doubting that assertion, to the extent that we knew them at the time:
[In 2002 or 2003] the late Bob Imrie observed that it was curious, in this era of the World Wide Web, that if you Google the “Macao Institute of Chinese Medicine” you get, well, nothing—other than it being named as the alma mater of two American “CAM” enthusiasts. One of them is Ted Kaptchuk, ‘OMD,’ who has long been Dr. Eisenberg’s second in command of “CAM” at HMS. When I first heard this I didn’t think much about it. My reply to Imrie was something like, “what difference does it make? It’s bogus whether it’s bogus or not, because the entire field is bogus.”
Shortly thereafter I realized that there is an obvious, additional ethical problem with portraying oneself as having earned a degree from an institution that most people would assume had been endorsed by some appropriate body, if such is not the case. At the time I was the chairman of the Committee for the Quality of Medical Practice at the Massachusetts Medical Society, and using that title I wrote to the Macao government asking about the Macao Institute of Chinese (or “Traditional Chinese”) Medicine. Here was the reply (emphasis in the original):
Sent: Tuesday, October 07, 2003 12:41 AM
Subject: Reply to the inquiry about “Macao Institute of Traditional Chinese Medicine ”
Dear Chairman Kimball C. Atwood,
Thank you very much for your e-mail dated 18th Sept (we received it from Government Information Bureau on 6th Oct.). In reply to your inquiry, we would like to inform you that ¡§Macao Institute of Traditional Chinese Medicine¡¨ HAS NOT BEEN one of the higher education institutions in Macao, and the concerned Institute hence HAS NOT BEEN a degree-conferring academic institution.
If there is anything additional you would like to know, please feel free to contact us:
Address: Calçada de Sto. Agostinho. No 19, Edf. Nam Yue, 13o a 15o Andares, Macau
With Best Regards Higher Education Bureau Macao SAR
I realize that this does not settle the matter. It is quite possible that in the 30+ years since Kaptchuk reports having attended the Institute, governmental memory has faded or has become selective. That is all the more possible because Macao, like Hong Kong, was ‘handed over’ from its colonial ruler (Portugal, in Macao’s case) to China on the eve of the 21st century. Nevertheless, there are more reasons to think otherwise. One of my correspondents had traveled to Macau prior to the hand-over and was unable to find any record of the MICM in various libraries and pertinent governmental offices. The [World Wide] Web continues to lack any corroborating evidence of such an institute, although there ought to have been many students there from all over the world: according to the two Americans, the school was a magnet for ‘overseas Chinese.’ Other attempts by Dr. Bartecchi and me to get information—from HMS (see below), from the Massachusetts and California Acupuncture Boards, and from Dan Bensky, the other American who reports having attended the MICM—have been frustrated.
Dr. Bensky’s online CV, however, raises more disturbing questions. He calls his diploma from Macao a “Diploma in Chinese Medicine,” suggesting that the ‘D’ in ‘OMD’ stands for ‘Diploma’, not for ‘Doctor’—as Kaptchuk has represented it (Bensky can call himself ‘doctor’ in any case, because he subsequently completed the osteopathy program at Michigan State University). Bensky reports having attended MICM with Kaptchuk, and that it took two years to complete. Bensky did not have a bachelor’s degree when he began at Macau. Currently, a doctoral candidate at the Chengdu University of Traditional Chinese Medicine must be a college graduate, and the course of study requires three years.
Bensky also reports that at Macao there were “three main teachers…although in the end, one of the teachers refused to allow Westerners to participate in her clinic.” And: “after graduation…as I was identified with the school, no one else in Macau would work with me.” This hardly suggests an ‘Institute’ or a course of study with externally recognized standards.
According to this report, a couple of years ago at the nomenclature conference of the A.A.O.M. (either ‘American Association of Oriental Medicine’ or ‘Association of Acupuncture and Oriental Medicine’—I’m not sure which)
Dr. Benksy dismissed the long-term expert consensus described in Marnae Ergil’s excellent paper on translation principles as simply “wrong.”
An interested observer, suggesting that Bensky’s credentials might be relevant to evaluating his opinion, responded with this:
Both Dan Bensky and Ted Kaptchuk hold degrees from The Macau Institute of Chinese Medicine. According to Dan in that very discussion on CHA to which Bob makes reference, the school came into existence shortly before he and Ted arrived in 1973 and went out of existence shortly after they left in 1975 with their degrees. Or were they diplomas? Or were they doctorates? What is written on those pieces of paper? This was the question I posed in the post that preceded my being banned from CHA. The notion of being “qualified by expertise and training to establish such standards” (of academic freedom) suggests that training standards themselves are of nontrivial importance in the whole matter of academic freedom. Of course they are. And of course it matters whether the word “diploma” or the word “doctorate” is written on the pieces of paper that Dan and Ted took home with them when their respective sojourns in Macau had come to an end. What does the “D” stand for in the “OMD” that appears after the names Bensky and Kaptchuk? Socrates said that to use words wrongly is not only a fault itself, it also corrupts the soul. Certainly it corrupts the use of words to use highly meaningful terms (including their abbreviations) like “diploma” and “doctorate” interchangeably. If one is qualified by expertise and training to establish standards of academic freedom, then we had better at least know with as much certainty as possible what the basis of one’s qualifications actually is…
Are Bensky and Kaptchuk the MICM’s only graduates? In 2003 I queried some of the faculty at HMS who were affiliated with Eisenberg and Kaptchuk. I sent them the message from the Macao Higher Education Bureau. They agreed that it would be ‘disturbing’ if Kaptchuk’s degree were anything but legitimate. After all, he had parlayed it into his entire academic career, including not only his appointment at HMS (where he now appears to be an Associate Professor), but numerous articles in the Annals of Internal Medicine, the British Medical Journal, JAMA, and other journals. He used it to become a licensed health care practitioner in Massachusetts and probably elsewhere. He also used it to gain public roles that some would consider prestigious, such as his long membership on the NCCAM Advisory Council. He has been referred to as “Doctor” in all of those contexts.
About two weeks after I sent the inquiry to HMS, I got this reply from my old fellow intern, Russell Phillips:
Kim-I researched Ted’s background and am convinced that the credentials he lists on his CV, including his doctorate, are correct. When this came up previously he put together a packet of his diplomas etc that confirm his degree. Additionally, several state licensing boards have given him a license to practice acupuncture after researching his background. The Dean’s office (Dan Federman) has also looked into this and is convinced his credentials are correct. Please let me know if you want to discuss further. Russ
I believe that this reply merely begged the question. The several state licensing boards almost certainly did not research his background, which would have been an impossible task for them. I don’t think that HMS or any of the individuals who looked at the ‘credentials’ had either the will or the competence to investigate them thoroughly and skeptically. It is intriguing that in the past few years Kaptchuk’s ‘OMD’ has disappeared from certain contexts, including at HMS: compare this and this, for example.
I reiterate that I don’t know the answer to this question. There is enough doubt about Kaptchuk’s ‘OMD’ degree, however, to put the onus on him, on HMS, and on the other interested entities to produce the evidence. It should then be evaluated by a disinterested, competent investigator.
Well, by 2004 we had verified what should have been obvious to Harvard, that the California board had not “researched his background.” Marilyn Nielson, the Executive Officer of the CA Acupuncture Board, wrote this in an email to Carl Bartecchi, MD:
The Board cannot attest to the status of the Macau Institute of Chinese Medicine @ 31 Rua Sacadura Cabral, Macau, China, or the Macau Overseas Chinese Association’s Chinese Medicine Clinic @ 31A Rua Sacadura Cabral, Macau, China.
Now we know more: fellow blogger Ben Kavoussi read my 2009 post and wrote the CA acupuncture board in another attempt to get information. This time it worked. We now know what is written on those pieces of paper, posted here and here:
What is on those pieces of paper, whether written by his apparent mentors or by Kaptchuk himself, is “diploma”—not “doctor” or “doctorate” or even “degree.” To be certain that the Chinese version could not be construed as implying a doctorate of some sort, even though Kaptchuk appears to have been satisfied with the translation that he submitted to the CA board, Ben K. asked a Chinese graduate student to look at all of the documents. Here is his response:
Hi Ben, I’ve read through the documents in Chinese. There is not a single phrase mentioning an official title of any sort awarded. So no Physician of Traditional Chinese Medicine referred to him in any of the documents.
The case is compelling that Kaptchuk’s “OMD” never existed—with the obligatory caveat that it’s just possible, however unlikely, that some missing piece of information could change this conclusion.
Whither Harvard Medical School? I don’t pretend to know why that institution—my alma mater, it saddens me to say—has insisted on keeping its collective heads buried in the sand, in spite of repeated, initially discrete attempts by Carl Bartecchi, me, and possibly others to alert it to its own folly. I do know that the entire HMS “CAM” project has been rotten-to-the-core since its inception, as documented in excruciating detail in the links at the bottom of this post and elsewhere (here and here, for example). There is evidence that HMS was aware of Kaptchuk’s non-degree, or at least of its likelihood. According to an anonymous source, when Kaptchuk was being vetted for tenure a few years ago HMS asked him to stop using “OMD”—thus explaining why he no longer uses it in most contexts.
If anything comes of this “outing” of Kaptchuk’s non-degree, it should be a thorough investigation of that project (I’ve already done the bulk of the work, so how hard could it be?), culminating in its abolition—not, as is more likely, a mere scapegoating of Kaptchuk himself. The latter course would merely carry on the hypocrisy as usual.
Here’s a prime example. In response to Carl Bartecchi’s 2002 letter to Dean Daniel Federman, in which Dr. Bartecchi wrote, “I long for the day when they label something ‘quackery’,” HMS “CAM” director David Eisenberg wrote, “I share with Dr. Bartecchi a disdain for any practice which intentionally deceives and manipulates a patient in any circumstance.” Eisenberg then wrote that he regularly gives
a didactic presentation entitled ‘Advising patients who seek complementary and alternative medicine’. In this lecture I include a summary of the article by Beyerstein from the Academic Medicine 2001 series on CAM which provides sensible advice in terms of avoiding complementary and alternative medicine practitioners who meet certain criteria consistent with definitions of ‘quackery’.
This series has shown that Kaptchuk meets nearly all of those criteria. (Dr. Eisenberg: I worked with Barry Beyerstein; I knew Barry Beyerstein; Barry Beyerstein was a friend of mine. Doctor, you’re no Barry Beyerstein). Such hypocrisy continues today. The Osher Clinical Center For Complementary and Integrative Medical Therapies, one of Eisenberg’s proudest achievements, is a font of misinformation about acupuncture and other methods. Kaptchuk himself still claims “a degree in Chinese medicine from the Macao Institute of Chinese Medicine,” which is every bit as ethereal as the OMD that he no longer uses.
Another predictable response to revelations of phony degrees is that some people will inevitably defend the perp by arguing that his “mistake” notwithstanding, he is very good at what he does (note to HMS: this never works, as that recent example shows). One of the reasons that I wrote such a long series on Kaptchuk and his writings has been to demonstrate that his views are not really scientific; rather, they are postmodern and consistent with his having invented a ‘degree,’ which he might think of as “a linguistic tool to control medical knowledge.” Nor are his views compatible with what a science-based medical school should look for in a professor. As I suggested regarding the reviewers of The Web, I doubt that anyone who matters, among the HMS faculty, has much familiarity with what Kaptchuk writes. Whatever credibility some might grant him for his placebo articles, moreover, is necessarily lost in the face of his phony degree.
As embarrassing as this revelation is to HMS, it is worse in other contexts. Several medical journals will have to consider how to react (haven’t those journals already wondered why Kaptchuk no longer uses “OMD”?): the fake cardiologist of the “recent example” mentioned above, William Hamman, has had at least one journal article retracted. Past and pending co-authors will have a lot to think about. The NCCAM and the FDA will have to consider how to react to past committee appointments based on a misrepresented degree, and the NIH will have to react to a grant awardee whose credentials are, even now, misrepresented. Are there legal ramifications? If so, I can only hope that Harvard Medical School will step up, rather than let Kaptchuk hang out to dry by himself. As much as I object to Kaptchuk’s own duplicity, the roles of HMS and its unctuous “CAM” program are the larger issues here.
The Dummy Series:
- Dummy Medicines, Dummy Doctors, and a Dummy Degree, Part 1: a Curious Editorial Choice for the New England Journal of Medicine
- Dummy Medicine, Dummy Doctors, and a Dummy Degree, Part 2.0: Harvard Medical School and the Curious Case of Ted Kaptchuk, OMD
- Dummy Medicine, Dummy Doctors, and a Dummy Degree, Part 2.1: Harvard Medical School and the Curious Case of Ted Kaptchuk, OMD (cont.)
- Dummy Medicine, Dummy Doctors, and a Dummy Degree, Part 2.2: Harvard Medical School and the Curious Case of Ted Kaptchuk, OMD (cont. again)
- Dummy Medicine, Dummy Doctors, and a Dummy Degree, Part 2.3: Harvard Medical School and the Curious Case of Ted Kaptchuk, OMD (concluded)
The Harvard Medical School series:
- Dummy Medicine, Dummy Doctors, and a Dummy Degree, Part 2.3: Harvard Medical School and the Curious Case of Ted Kaptchuk, OMD (concluded)