I wouldn't call it the Passion, rather the Poison.
Regenexx Blog
2-19-20
Dr. Chris Centeno
regenexx.com
This is a blog a decade or more in the making. It’s about a university bench scientist and an out of control wild west stem cell space. Like all good stories, it’s protagonist is neither savior nor villain, as the truth is always somewhere in between. This blog post is written from the point of view of physicians and patients, so it could be the only look at this blogger through that lens. Let me explain.
Who is Paul Knoepfler?
I first met Paul a little more than a decade ago when we were embroiled in trying to establish what the FDA regulations should be around autologous stem cell use. Paul approached me a bit like a journalist with questions to answer about what was happening. Over the last decade, I’ve had countless interactions with Paul over email and have been featured in one way or another in his blog many times.
Paul is a university bench scientist who works at UC Davis in the Cell Biology department and who has a primary research interest in brain development and childhood cancers. I know that Paul is a prostate cancer survivor because he has written about this several times. Meaning, like the rest of us, he is very human.
As a scientist, you can see Paul is different just from reading the publication list on his lab’s website. Since about 2013, while the requisite publish or perish papers are there in his field of expertise, there is also a large chunk of the papers or opinion pieces he’s written about the out of control commercial stem cell space. In addition, for as long as I can remember, Paul has maintained a blog that is mostly about that one topic.
Understanding the History of the ISSCR Pushback Against Clinical Translation
You can’t understand Paul Knoepfler without understanding the history of this space and ISSCR. Most physicians using regenerative medicine procedures today really haven’t been around long enough to understand the full history of the bench scientist pushback and how that has shaped the landscape of regenerative medicine. In fact, few realize that ISSCR has been the main thrust behind the launching of countless news stories. So let’s dig in.
The ISSCR is the International Society for Stem Cell Research. It’s first real statements on the clinical translation of stem cells date back to the 2008/2009 time period. During that time, one of its first presidents, Irv Weissman launched a campaign to educate the public about stem cell clinics. It was shortly thereafter that a spate of negative news articles started appearing featuring quotes from ISSCR members. Hence, it was clear to me (after some online research), that ISSCR had hired a PR firm and had a strategy for getting the word out.
The ISSCR’s own history dates back to the Bush Embryonic stem cell research ban. In what was an unprecedented move at the time, embryonic stem cell researchers formed a society to protect their interests. Hence ISSCR really began as more of an activist organization than most scientific societies. Meaning, it has thrown its hat into the public debate since day one as at the time, the very existence of its members’ life work was being threatened.
he Paul Knoepfler Blog (aka The Niche)
The Paul Knoepfler blog really begins in about 2010, amidst the ISSCR push against stem cell clinics. Looking back at those simple days of a few clinics, most ex-US, it all looks positively tame and calm compared to what we have now. Back then, Paul’s blog topics were mostly focused on the emerging decisions around that existential crisis in embryonic stem cell research and the new Obama administration’s effort to try to right that ship. Then over the years, you see more and more stem cell clinic related stories. At some point, the name of the blog was changed to “The Niche” and most blog entries began to focus on clinics.
The Stem Cell and Exosome Wild West
On one hand, I have to applaud Paul for leading the charge against what has become an out of control wild west environment. I have tracked this for the last decade on this blog and I have to say that I now see things every day that astound me. Companies peddling fake stem cell products, selling illegal exosome concoctions, and altering third party lab reports. We see salespeople giving seminars to draw people in and then hiring barely trained nurses to provide injections of dead tissue after the patients are convinced in a high-pressure sales event that they are being injected with millions of young and vital stem cells. We even have physicians hiring RN’s to hook people up to dead umbilical cord products for anti-aging. This week I found an organization that sends a salesperson to your home to collect the answers to four simple questions and then will send a nurse back to inject you there at home to cure whatever ails you. So I recognize that having a voice out there like Knoepfler to fight that fraud is important.
Paul’s Logical Fallacies
Like all good stories, the moment you begin to believe that the protagonist is a saint, you dig deeper and it all becomes more nuanced. The same is true here. So while I applaud Paul for carrying the torch against the crazy stuff out there, at times, he struggles with logic. Let me explain.
You would think that bench scientists would be logical, as science is their life and logical arguments drive science. I’m sure many are, but many in the ISSCR camp seem to have thrown logic out the window in exchange for often irrational activism. Paul is no different and is guilty of illogic.
A logical fallacy is defined as “a flaw in the structure of a deductive argument which renders the argument invalid”. Paul’s biggest logical fallacy that he uses frequently is called a false dichotomy. He’s a master at convincing journalists that there are only two options in the adoption of new medical care: proven and unproven. In fact, let’s review Paul’s quotes in media stories:
LA Times: “…unproven fat stem cell product…”
Reuters: “Unproven stem cell injections…”
Spectrum” “…unproven stem cell treatments…”
I also reviewed Paul’s last 10 blogs on the topic of stem cell clinics. He uses the term “unproven” about an average of 4 times in each entry.
Most of the Medical Care Being Delivered Today Proven?
Is the medical care we receive every day from our doctors’ binary and either proven or unproven? No, it never has been and Paul should know better. However, he has no medical training but is a Ph.D. who never attended a day of medical school and is not legally able to be responsible for patient care in any way. This is something that the public often forgets. As a speaker said at a recent medical conference when referring to bench scientists like Paul, “They sit on the bench, while the physicians are forced to play on the field”.
The Knoepfler False Dichotomy
A False dichotomy is defined as: “a type of informal fallacy in which something is falsely claimed to be an “either/or” situation, when in fact there is at least one additional option.” By fabricating a myth that medical care should only be categorized as proven or unproven, Knoepfler misleads journalists and the public. Why? There is a third option ignored by Paul. So let’s explore why this artificial narrative created by Paul is not reflected in the published medical literature.
What is the third option? In the real world of Evidence-Based Medicine, the third option is “Best Available Evidence” and it’s actually used more often than the other two. This means that oftentimes physicians and policymakers must use evidence to make clinical decisions which is less than perfect. This lack of a “proven/unproven” dichotomy in real-world medical evidence has been acknowledged for decades by expert panels creating medical treatment guidelines for insurers and governments (1).
Meaning in the real world of seeing patients, it’s a common occurrence that a patient presents to you with a problem for which there is no “proven” intervention. Put simply, your patient has a problem for which there is no “Level 1” treatment evidence. Hence, you look at the evidence that’s available and make a decision. There is no field in which this is truer than in orthopedic care. So let’s explore why Paul’s false dilemma is orthobiologics is so deceptive.
Continued below:
Regenexx Blog
2-19-20
Dr. Chris Centeno
The Passion of Paul Knoepfler-A Review of the Niche Blog
A review of the IPScell or Paul Knoepfler Niche Blog.
regenexx.com
This is a blog a decade or more in the making. It’s about a university bench scientist and an out of control wild west stem cell space. Like all good stories, it’s protagonist is neither savior nor villain, as the truth is always somewhere in between. This blog post is written from the point of view of physicians and patients, so it could be the only look at this blogger through that lens. Let me explain.
Who is Paul Knoepfler?
I first met Paul a little more than a decade ago when we were embroiled in trying to establish what the FDA regulations should be around autologous stem cell use. Paul approached me a bit like a journalist with questions to answer about what was happening. Over the last decade, I’ve had countless interactions with Paul over email and have been featured in one way or another in his blog many times.
Paul is a university bench scientist who works at UC Davis in the Cell Biology department and who has a primary research interest in brain development and childhood cancers. I know that Paul is a prostate cancer survivor because he has written about this several times. Meaning, like the rest of us, he is very human.
As a scientist, you can see Paul is different just from reading the publication list on his lab’s website. Since about 2013, while the requisite publish or perish papers are there in his field of expertise, there is also a large chunk of the papers or opinion pieces he’s written about the out of control commercial stem cell space. In addition, for as long as I can remember, Paul has maintained a blog that is mostly about that one topic.
Understanding the History of the ISSCR Pushback Against Clinical Translation
You can’t understand Paul Knoepfler without understanding the history of this space and ISSCR. Most physicians using regenerative medicine procedures today really haven’t been around long enough to understand the full history of the bench scientist pushback and how that has shaped the landscape of regenerative medicine. In fact, few realize that ISSCR has been the main thrust behind the launching of countless news stories. So let’s dig in.
The ISSCR is the International Society for Stem Cell Research. It’s first real statements on the clinical translation of stem cells date back to the 2008/2009 time period. During that time, one of its first presidents, Irv Weissman launched a campaign to educate the public about stem cell clinics. It was shortly thereafter that a spate of negative news articles started appearing featuring quotes from ISSCR members. Hence, it was clear to me (after some online research), that ISSCR had hired a PR firm and had a strategy for getting the word out.
The ISSCR’s own history dates back to the Bush Embryonic stem cell research ban. In what was an unprecedented move at the time, embryonic stem cell researchers formed a society to protect their interests. Hence ISSCR really began as more of an activist organization than most scientific societies. Meaning, it has thrown its hat into the public debate since day one as at the time, the very existence of its members’ life work was being threatened.
he Paul Knoepfler Blog (aka The Niche)
The Paul Knoepfler blog really begins in about 2010, amidst the ISSCR push against stem cell clinics. Looking back at those simple days of a few clinics, most ex-US, it all looks positively tame and calm compared to what we have now. Back then, Paul’s blog topics were mostly focused on the emerging decisions around that existential crisis in embryonic stem cell research and the new Obama administration’s effort to try to right that ship. Then over the years, you see more and more stem cell clinic related stories. At some point, the name of the blog was changed to “The Niche” and most blog entries began to focus on clinics.
The Stem Cell and Exosome Wild West
On one hand, I have to applaud Paul for leading the charge against what has become an out of control wild west environment. I have tracked this for the last decade on this blog and I have to say that I now see things every day that astound me. Companies peddling fake stem cell products, selling illegal exosome concoctions, and altering third party lab reports. We see salespeople giving seminars to draw people in and then hiring barely trained nurses to provide injections of dead tissue after the patients are convinced in a high-pressure sales event that they are being injected with millions of young and vital stem cells. We even have physicians hiring RN’s to hook people up to dead umbilical cord products for anti-aging. This week I found an organization that sends a salesperson to your home to collect the answers to four simple questions and then will send a nurse back to inject you there at home to cure whatever ails you. So I recognize that having a voice out there like Knoepfler to fight that fraud is important.
Paul’s Logical Fallacies
Like all good stories, the moment you begin to believe that the protagonist is a saint, you dig deeper and it all becomes more nuanced. The same is true here. So while I applaud Paul for carrying the torch against the crazy stuff out there, at times, he struggles with logic. Let me explain.
You would think that bench scientists would be logical, as science is their life and logical arguments drive science. I’m sure many are, but many in the ISSCR camp seem to have thrown logic out the window in exchange for often irrational activism. Paul is no different and is guilty of illogic.
A logical fallacy is defined as “a flaw in the structure of a deductive argument which renders the argument invalid”. Paul’s biggest logical fallacy that he uses frequently is called a false dichotomy. He’s a master at convincing journalists that there are only two options in the adoption of new medical care: proven and unproven. In fact, let’s review Paul’s quotes in media stories:
LA Times: “…unproven fat stem cell product…”
Reuters: “Unproven stem cell injections…”
Spectrum” “…unproven stem cell treatments…”
I also reviewed Paul’s last 10 blogs on the topic of stem cell clinics. He uses the term “unproven” about an average of 4 times in each entry.
Most of the Medical Care Being Delivered Today Proven?
Is the medical care we receive every day from our doctors’ binary and either proven or unproven? No, it never has been and Paul should know better. However, he has no medical training but is a Ph.D. who never attended a day of medical school and is not legally able to be responsible for patient care in any way. This is something that the public often forgets. As a speaker said at a recent medical conference when referring to bench scientists like Paul, “They sit on the bench, while the physicians are forced to play on the field”.
The Knoepfler False Dichotomy
A False dichotomy is defined as: “a type of informal fallacy in which something is falsely claimed to be an “either/or” situation, when in fact there is at least one additional option.” By fabricating a myth that medical care should only be categorized as proven or unproven, Knoepfler misleads journalists and the public. Why? There is a third option ignored by Paul. So let’s explore why this artificial narrative created by Paul is not reflected in the published medical literature.
What is the third option? In the real world of Evidence-Based Medicine, the third option is “Best Available Evidence” and it’s actually used more often than the other two. This means that oftentimes physicians and policymakers must use evidence to make clinical decisions which is less than perfect. This lack of a “proven/unproven” dichotomy in real-world medical evidence has been acknowledged for decades by expert panels creating medical treatment guidelines for insurers and governments (1).
Meaning in the real world of seeing patients, it’s a common occurrence that a patient presents to you with a problem for which there is no “proven” intervention. Put simply, your patient has a problem for which there is no “Level 1” treatment evidence. Hence, you look at the evidence that’s available and make a decision. There is no field in which this is truer than in orthopedic care. So let’s explore why Paul’s false dilemma is orthobiologics is so deceptive.
Continued below: