When Lab Research Scientists Play Doctors -The Paul Knoepfler Files

Regenexx - Do you remember that famous 1970s TV quote, “I’m not a doctor, but I play one on TV”? Well, that’s what some research scientists are doing. Let’s dig into that today.

Ph.D. vs. M.D.

A Ph.D. is someone who begins with a Bachelors in Science degree and then takes additional graduate-level course work in their field. Ultimately, on the lab research side, they work in a lab and then perform original research and rigorously defend a thesis, which can take years. An M.D. (or D.O.) is someone who went to medical school, and then a hospital internship, years of residency training in a hospital, and often subspeciality training. There are boards to sit for, licensing tests to take, and finally, after you’ve given away your 20s, you’re finally a practicing physician.

Hence, what do Ph.D.’s know about medicine? Not much outside of their very specific fields. Meaning if a lab Ph.D. tried to treat a patient or provide advice to a patient, that could be practicing medicine without training or a license.

Paul Knoepfler

I’ve blogged before on Paul Knoepfler. On the one hand, Paul’s been instrumental in working toward ending predatory stem cell clinic practices. That began with good stuff, like opposing the crazy wild west of stem cells with clinics offering to treat desperate patients with serious incurable diseases. However, recently, Paul has stepped across a line that makes little sense.

That bright line that Knoepfler has crossed is defined by fellow academics. Meaning, once academic physicians begin to offer biologic therapies to their patients, the research is good enough to meet their definition of “best available evidence”. Hence it means that these biologics are now moving from the bench science stage into the clinical translation stage.

For example, recently Knoepfler was called out for attacking fellow academics like Joanne Kurtzburg. Joanne is a Duke professor and an actual medical doctor in hematology/oncology. She’s been engaged in pioneering work in collecting trial and real-world evidence in how umbilical cord blood may help autism. The good news is that Joanne’s work has shown that certain subgroups of this patient population may benefit from this therapy. You would think that would be a great thing. However, it’s earned Joanne stark criticism from Paul Knoepfler’s blog “The Niche”. Why? I’ve blogged on this issue. Paul and some colleagues know that by Joanne moving these cellular therapies into mainstream medicine, there will be less and less basic science grant funding. It’s just that simple.

Paul has often done the same with academics offering orthobiologics and seems to have little knowledge of the actual clinical research data available on these therapies. For example, he often attacks anyone using PRP, an orthobiologic therapy with dozens of randomized controlled trials supporting its use.

The False Dichotomy Factory

Paul Knoepfler is NOT A MEDICAL DOCTOR but has a Ph.D. As a result, his favorite narrative is to spin a false dichotomy that medicine is either proven or unproven. That’s a logical fallacy because there is a third option that’s in more widespread use by real medical doctors and that’s called Best Available Evidence (BAE). You see, we real doctors are often faced with patients who have conditions and treatment options that aren’t well researched. This dilemma is made more difficult by the fact that existing clinical trials narrow down the participants to a very select group of patients who are more likely to respond. Hence, more often than not, the patient asking you to help isn’t represented by a clinical trial. Joanne’s answer and that of countless academic physicians and private practitioners is to offer these patients a choice of doing nothing or doing something that may work. Again, these physicians make those decisions by looking at the best available evidence.

Playing Doctor

A colleague recently sent me this Q and A from Paul’s blog. Paul represents that this is a reader’s question:

“I went to Regenexx for joint pain, felt somewhat better for a couple of months, but now I’m back to square one. Is this typical and what should I do now? Go again?

Regenexx has become a well-known brand name in the clinic world, but I’m not convinced it gives a real lasting benefit over placebo. I did a review of Regenexx in October so check that out. I’m fairly skeptical because of a lack of strong, relevant, and long-term clinical data.

My impression is that what you’ve experienced with a transient perceived benefit is not that unusual. If the cells or PRP offered by one of the many Regenexx clinics do help people I believe it is mostly a temporary, anti-inflammatory kind of effect, which I’m not convinced is worth it. Getting many injections from such clinics boosts costs greatly and likely increases potential risks too. As to what to do now, I’d recommend talking to your regular doctor to get their advice.”

Let’s dissect what Dr. Knoepfler should have done here, if he was actually a medical doctor, rather than playing one on TV:

1. What type of therapy did this patient receive? PRP, BMC, something else? Regenexx uses PRP in joints more often than anything else.
2. Where was this injected? Knee, shoulder, hands?
3. What structures were injected in that joint?
4. What was the patient’s presenting diagnosis?
5. Regenexx has always published its success and failure rates, is this a treatment failure?
6. What comorbidities did the patient have?
7. What is the severity of this condition?
8. Did the patient follow medical advice?

As you can see, there’s a difference here between a Ph.D. who doesn’t know what he doesn’t know and an actual licensed medical provider.

Let’s take Knoepfler’s comments on PRP having a placebo effect. There are dozens of randomized controlled trials, many against placebo which are double-blinded (1-18). That means that the placebo effect that Paul is discussing has been convincingly ruled out by actual medical scientists.

However, there’s a much bigger issue here. Why would Knoepfler field a patient question in the first place? He seems to be providing actual medical advice here in discussing what he believes are the mechanisms of action for a therapy he has not identified (was this PRP or BMC?). Meaning, the patient may act on this advice and not see their family doctor, as Paul recommends. That action could impact the patient’s medical condition. Is this legal?

Can a Ph.D. Give Medical Advice?

How many Ph.D.’s out there involved in this academic war between bench scientists and physicians are giving medical advice to patients? I would venture to guess that the smart ones know that any engagement with these patients is crossing a dangerous line. However, I would bet that a few, like Knoepfler, do cross that line, not based on a knowledge of the patient’s medical condition and the published best available medical evidence as a physician would, but based on an emotional response around protecting grant funding for their labs.

The upshot? Being a real doctor comes with immense responsibilities. It also comes with sleepless nights as you feel the weight of your medical decisions and the impact they have on real people. However, there’s a reason the statement, “I’m not a doctor, but I play one on TV” became popular. It’s fun to play a doctor and have none of the responsibilities that physicians bear. However, crossing that line between fake doctors and real doctors is a bit too far, even for “Dr.” Knoepfler.

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References:

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(2) Uslu Güvendi E, Aşkin A, Güvendi G, Koçyiğit H. Comparison of Efficiency Between Corticosteroid and Platelet Rich Plasma Injection Therapies in Patients With Knee Osteoarthritis. Arch Rheumatol. 2017;33(3):273–281. Published 2017 Nov 2. doi: 10.5606/ArchRheumatol.2018.6608

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Source: https://regenexx.com/blog/when-lab-research-scientists-play-doctors-the-knoepfler-files/