Ultracrepidarians. Individuals offering opinions unconfounded by knowledge

Ultracrepidarian in a recognizable outfit

I recently learned this word from a colleague. Funny, complex word. An ultracrepidarian is a person who conveys opinions or advice on matters not within their realm of knowledge or expertise. The word is used in a pejorative sense.

It does amaze me that I continuously have to say the same things. Unfortunately in the broader scope, beyond the fools I have to deal with on a regular basis, this is one of the problems with podcasters, influencers, etc, who actually have no training or knowledge on subjects they speak about, and this can be very dangerous. In part because the simple fact that the internet allows essentially everyone to have the Shakespearean 10 minutes of fame... so they can easily do this often, and frequency is misinterpreted as knowledge. This is compounded by the general mistrust in 'experts'. The distrust in physicians which is fairly widespread now, does have some basis in reality. But the reality is different from what the surface suggests, it is because physicians often speak authoritatively on subjects they know nothing about. So the issue is not that experts are not to be trusted, but physicians 'posing as experts' should not be trusted. That is why I feel legitimacy should be standardly reported in attachment to opinions. In future presentations I will describe intelligence, there are two forms: memorization and creativity, and wisdom as a separate measure.

So, I can best use myself as an example because I don't have to hunt down information on me. Scholar GPS has been a recently developed entity which provides easily obtained information on credibility. So according to Scholar GPS, for my career I am rated in the top 0.05% of all scholars in all fields, # 10 in MRI, and #12-16 in Medical Imaging. I have written > 400 peer-reviewed articles, authored 9 textbooks, and edited 7 others. I also have wisdom, which means I know what I do know well, and also what I do not know well until I do further study. So this monumental scholastic stature does not make me an expert in everything in medicine, so in fact even in Radiology, although I may be the most accomplished abdominal imager of all time and the most accomplished abdominal MRI expert of all time, this does not make me an expert in neuroradiology or other subspecialties. So a first year assistant professor in neuroradiology would know more about neuroradiology and brain MRI than I do, even though I am the 10th most scholarship accomplished MRI physician or scientist and #12-16 Medical Imaging expert of all time. It is wisdom that gives one the humility to know what you are an expert in and what you are not. In the field of MRI I am likely the most accomplished in the world on the positive use of GBCAs, and also on the safety issues. Among the items that I know more than anyone else on is the broad subject of chelators and GBCAs. Also what wisdom informs me is that with my lengthy years of scholarship at the highest level, I do know how to find out information on medicine on the many subjects I am not an expert in. I may have a baseline good wisdom sense, which is extremely important on its own, but not a detailed knowledge of advances in most areas of medicine, without spending the time to research into them.

I have for years accepted the limitations in knowledge of many individuals in Radiology, but I am coming to the end of my patience after 10 years as the world expert in Gadolinium toxicity, with a focus on Gadolinium Deposition Disease as the important subset. So the following are critical for the respective individuals I describe that they now must know:

1. MR technologists and Radiologists must know that not all Gd leaves the body within 24 hours. The appropriate information to provide patients is "the great majority of the Gd in the administered GBCA is eliminated within 24 hrs, but appreciable amount continues to be eliminated till 3 months, and a small fraction, around 1 %, stays permanently in the body, by 1 year. In the majority of patients this retained Gd is not problematic.

2. If asked: "does anyone experience problems from the small amount of retained Gd?" The correct and only answer is: "Yes, but for most people it is quite rare, maybe 1 in 10,000 of all subjects develop disease, termed gadolinium Deposition Disease (GDD)"

3. If asked "What are the symptoms and how do I know if I have GDD?" The answer is "Most people develop symptoms right after the GBCA injection, but about 25% of individuals develop symptoms later, generally up to 1 month"

4. If asked "What symptoms do I look for?" The answer is "The most common symptoms are persistent head ache, brain fog and other mentation disturbance, muscle twitching, pins and needles sensations, skin pain, and bone pain". Other symptoms also occur related to the digestive tract, heart, hearing, and vision.

5. If asked "What is the treatment?" The answer is "If this is your first GBCA injection and you develop these symptoms, in about 1/3 - 1/2 of patients the symptoms go away on their own, although it may take 2 years. The critical thing is never to get another GBCA agent again. For people who have more severe symptoms that last, or have had multiple GBCA injections, for the majority of patients chelation with iv DTPA is an effective treatment for disease. Remember that you should never get another GBCA injection again".

These are 5 points to remember as health care workers. I have written them in a clear and not frightening way. This is the truth and you must state it. It is not unlikely if you misinform patients then at some point this may be the cause of litigation against you. Also it is not unreasonable to assume that I may be the expert called in to describe if Standard of Care has been met. Up till now I have avoided this, but I see this changing as I still see patients grossly misinformed, and I have lost patience.

I still have to deal with willful ignorance and ultracrepidarians in radiologists, which I confess I am amazed by. Unfortunately it speaks of Greed Based Stupidity Yet Smart - a term I have coined before, maybe I should alter it to Greed Based Stupidity Yet Ostensibly Smart (GBSYOS), as perhaps I have given too much credit to intelligence in the past.

So this huge nebula is a subject I still deal with, including other physicians, referring physicians, etc, also fit into this bubbly stew of ignorance. Ofcourse the manufacturers of these agents must also give clear warning in their product descriptions and inserts.

The other form of ignorance I am still faced with is individuals who think GDD exists (maybe they don't like the term, primarily because they did not come up with it. It is the most appropriate term) but they think that chelation does not work. I can understand where the ignorance of MR technologists and radiologists arises from, but this is a more devious ignorance. I realized as soon as I recognized the disease in 2016, that recognizing the disease alone, is nice but not really helpful to patients. What patients actually need is treatment. In conjunction then with experts in chemistry I came up with DTPA chelation, and have revised the technique over the years. The most central concept in medicine, and most everything else is to treat/ deal with the root cause. The root cause of GDD is the presence of Gd in the body. The principle treatment then is to remove the root cause. Even a child should understand that. And if there are many physiological perturbations that the disease results in, all the more important to tackle the root cause if you are able. To deal with all the disturbances would be nearly impossible, and a treatment for one thing may make another issue worse. We are able to treat the root cause: DTPA chelation with steroids/antihistamines is the best and most effective treatment for the disease. I am amazed that some crepiderians continue to espouse DTPA chelation does not work, who have no knowledge or experience with chelation. So opinion completely untethered from any knowledge, just blowing it out of the seat of their pants. These are somehow even worse then the huge collective of GDD deniers, they tell patients they have a disease, but they lie there is no cure for it, but they are working on it. So here are the two points: 1) shut up, you know nothing about chelation, and 2) if you have a better treatment then where is it? If you have a better treatment I would use it, and probably combine with the root cause treatment, because a number of patients do have complex disease. This is extremely dangerous misinformation for patients, and I have now lost patience with this. EVeryone who posts that chelation does not work also I am paying attention to. It confuses patients who are already struggling with the original lies: that GBCA are completely safe, and since your kidneys are normal you cannot have Gd toxicity. Do not add to it with additional lies that prevents them from obtaining cure.. Finally none of the clown and fools who still perpetuate these lies have anywhere close to my level of scholarship. As I have written above, they should be describing their Scholar GPS standing, before they start speaking dangerous lies, so the readers know how little credence to put to their words..They may have (ostensibly) intelligence but very little wisdom.

Richard Semelka, MD