The Dogtensivist Manifesto
The Thoughtful Intensivist got exclusive access to the manifesto.
WE THE DOGTENSIVISTS hereby commit to the most ordinary inductivist reasoning.
We swear strict adherence to the formula “I bark, invaders walk” as advised by Luke, our Leader and Mentor.
Moreover, we pledge not to have anything in mind or at least not to think seriously about anything before starting a scientific inquiry in the field of Critical Care.
If we carry out this oath, and break it not, may we publish many papers and gain forever reputation among uncritical readers.
But if we break it and forswear ourselves, may the opposite befall us.
Dear subscriber!
What a messy weekend. I planned to post about Iloprost on Saturday morning, but I was so buzzy trying to clear the publication of the Manifesto that I couldn't finish the Iloprost post. It will come anytime in the next few days.
The thing is that a regretting top-tier critical care researcher handed me the Dogtensivist Manifesto, but we had to negotiate the publication. Of course, anonymity was guaranteed. I also compromised to be faithful to the Manifesto wording, that is, I was not allowed to change any word. These guys are so jealous of their secrets.
From now on, I will refer to the Dogtensivist Manifesto as “The Manifesto”, and to the members of their secret society as “The Dogtensivist Society”. The Manifesto has the form of an oath, which I will call “The Dogtensivist Oath”.
Many critical care journal editors and top researchers secretly took the oath, often in those closed sessions during our specialty's meetings. Many Dogtensivists give talks at our conferences and are infiltrated into the commissions that define the speakers. They typically take the front seats during conferences, not because they are more interested in the content than the other attendants. They do so to watch and ensure the speaker's fidelity to their oath. It is about control. That's why you sometimes feel awkward or alienated sitting in congress conferences or watching those Critical Care Reviews online sessions. You can feel there is more going on than you can grasp.
After reading The Manifesto and thinking about it I found it too esoteric and abstract. At the same time, I was terrified to see how far they had gone because it may be challenging for the uninitiated to spot the Dogtensivist. Dogtensivists appear to leverage the vagueness of The Manifesto. I have prepared a small guide to Dogtensivism to help you navigate the critical care journals and find the Dogtensivist disguised between the lines. The guide has the form of operational instructions to help you think like a Dogtensivist. I hope this will help you identify them.
A last-minute remark! I almost published this post without explaining that many, perhaps most Dogtensivists never took The Dogtensivist's Oath and are not members of the Dogtensivists Society. They are good-faith Dogtensivists who can't comprehend they live in an alternative realm prepared by the members of the Dogtensivists Society, but have instinctively learned to adapt and thrive in this environment.
Meet Luke, the inductivist dog, the Dogtensivists Mentor and Leader. Dive deeper into epistemology and learn why Dogtensivism is an imitation of science.
Without further delay, here are the Dogtensivism 9 principles.
Theory-free science
Dogtensivists don't care about having theories. They are inductivists, like their Mentor and Leader Luke. In contrast, real scientists develop and test theories in experiments like randomized clinical trials. A medical theory has to be a disease model, like H. Pylori infection, coronary occlusion, etc. Dogtensivists ignore it. They will mindlessly go on with ideas like statins for ARDS or beta-blockers for shock.
“Hypotheses-generating” studies
A strange consequence of not having theories is that sometimes, Dogtensivists create hypotheses after the study. This curious behavior has always amazed me. Be sure you have found a Dogtensivist whenever you read something like “In conclusion, we found this new association between variables. Further studies are needed to corroborate our finding”.
“Just do it” approach
Keep the wheels spinning! Do you have pulse oximetry and 3-year survival data? It is enough. Just state something like, “The effects of 93% or 96% pulse oximetry are unknown in sepsis 3-years mortality." Do it! Don't lose the oximetry and mortality train!
Clinical constructs
Dogtensivists use clinical constructs instead of disease models. Were they in the ED treating headaches, they would describe a generic syndrome like “strong headache” and prescribe the same treatment regardless of the cause. No matter if it is SAH, migraine, TBI, etc. Clinical constructs allow you to perform an RCT without caring about biological plausibility. ARDS, sepsis, delirium, and acute kidney injury are critical syndromes described as clinical constructs instead of biological constructs.
Shameless Terminal Bullshit
Don't be ashamed! Log a paper in Critical Care Medicine showing the effects of a single sodium bicarbonate injection on quality of life after five years. Go for the lowest-hanging fruit regardless of anything else. Can you randomize for one liter of normal saline or Ringer's? Do it and measure mortality in 90 days. No one will ask how can a few grams of chloride kill a patient in 90 days. Do it! People will be afraid to say it is bullshit!
Cristall-ball subgroups
Dogtensivists have their way of milking their databanks forever. The most recent Milking the Database technique is to search for theory-free associations in large databanks. They only need to sit before the computer screen and enter a divinatory trance. After using their computer like crystal balls, they use buzzwords like “precision medicine” and “artificial intelligence” to disguise what is only good and old p-fishing. Of course, they can't see that the problem is using a clinical construct instead of a biological construct and that it is, therefore, useless to split “phenotypes” that shouldn't have been lumped in the first place.
Post hoc best-guess explanations
My favorite. I have the kind of humor that makes me laugh at embarrassing situations. Like Mr. Bean, Dogtensivists feel they should look serious and sober when desperately trying to explain the spurious inductivist, mindless associations they produced. This is the pure juice of inductivism. Did you find an association between APACHE or SAPS and the incidence of gastric erosions? Just keep pretending it is serious and guess a biological mechanism.
Blindness to marginal utility
Dogtensivists are barely capable of thinking like physicians. They can't grasp the idea of dominance within a disease model. They can't understand what is The Edge of Irrelevance. They ignore that the Additive Paradigm is the major problem contemporary RCTs struggle with. If you are unacquainted with these concepts, please click here.
Augmented data analysis
Dogtensivists know they must have a “positive” result and are confident you will swallow anything. Don't be a fool! They can use a Bayesian analysis to show you a posterior probability of a net clinical benefit while pretending they ignore that frequentist results are already probabilistic at the patient level. They will present the probability of a probability with pomp and circumstance, hoping you won't think too much about it. There is much more to augmented data analysis. I will finish with one piece of advice: complicated data analyses are used to disguise bad or absent research hypotheses. Be aware!
Think seriously about biological plausibility. Discover the missing link in translational science. This will change the way you think about medical research.
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I read this post back in January and thought it a very astute commentary on critical research.
It’s not too far from my field, anesthesiology, where we spend our days manipulating an organ, the brain, and consciousness that are poorly understood. Yet there are machines available that purport to measure depth of anesthesia by manipulating “brain waves”. There is research on drugs that cause a particular effect despite the lack of understanding how consciousness and nociception actually arise.
Dylan once again the consummate philosopher, nailed it years ago:
“ Idiot wind, blowing every time you move your mouth”
One laugh after another. No critical care doc should miss it.