Evidence Update: Cold Laser Therapy for Dogs & Cats

I first summarized the scant evidence concerning low-level or “cold” laser therapy in companion animals in 2010, and I reviewed a couple of small studies in 2011. A recent checked showed only a couple of studies looking at cold laser since. All of these were small trials, and I am not able to access the full reports, so I cannot thoroughly evaluate the quality of the study design or conduct. None of these studies provide a definitive answer to the usefulness of laser therapy for the problems evaluated, but since we must work with the evidence we have rather than the evidence we would like, I thought I would briefly discuss this new research.

The first is a study from India looking at laser effects on wound healing in dogs.

Efficacy of low level LASER therapy on wound healing in dogs. Indian Journal of Veterinary Surgery 2011 32 2 103-106 Singh, M., Bhargava, M. K., Sahi, A., Jawre, S., Singh, R., Chandrapuria, V. P., Kocchar, G.

Abstract

The study was undertaken to assess the efficacy of low level LASER therapy on wound healing in 30 dogs. The dogs were randomly divided into five groups, each consisting of six dogs. The dogs of group 1 were treated as control, whereas the dogs of groups II, III, IV and V were treated with low level LASER therapy for 2 min, 10 Hz, 1.2 Joules; 4 min, 10 Hz, 2.4 Joules; 2 min, 30 Hz, 1.2 Joules; and 4 min, 30 Hz, 2.4 joules, respectively. The clinical parameters were recorded on day 0 (control) and subsequently on days 3rd, 5th, 7th, 10th and 14th in the animals of all groups. Increased healing percentage, decreased inflammation and exudation with clinically no scab during healing and minimal scar at wound site after healing, early regeneration of granulation tissue, better organization, compactness and intense epithelial regeneration were observed in dogs treated with laser therapy as compared to control animals. Significant increase in rectal temperature with non-significant variation in pulse and respiratory rates were observed in all the groups. The maximum decrease in the size of the wounds was observed in groups III and V, with a maximum healing rate of 94.84% and 88.01%, respectively up to 14 days, with maximum efficacy at 4 min, 10 Hz, 2.4 joules protocol followed by 4 min, 30 Hz, 2.4 joules.

The groups were small, it is unclear if the assessment was blinded, the outcome measures appear to be subjective, and there is no reported statistical analysis to indicate how likely it is that the differences between the groups are due to chance. The authors report a beneficial effect from the laser therapy, but again how reliable this conclusion is cannot be determined from the available information.

The next study was also done in India and evaluated laser therapy for wound healing in dogs.

Madhya Pradesh Pashu Chikitsa Vishwavidyalaya, Jabalpur, MP, India. Low level laser therapy for the healing of contaminated wounds in dogs: histopathological changes. Indian Journal of Veterinary Surgery. 2013 34 1 57-58

Abstract

The study was conducted on 18 dogs, divided into three groups comprising of 6 animals each. In group 1 – dressing of contaminated wounds was done with antiseptic liquid and antibiotic injected parenterally. In group 2, dressing of contaminated wound was done+low level laser therapy (10 Hz+5 min, 3 Joule, for 5 consecutive days)+parenteral antibiotic. In group 3, dressing of contaminated wound was done along with low level laser therapy (20 Hz+10 min, 6 Joule, for 5 consecutive days)+parenteral antibiotic. The biopsy punch was collected from the site on days 0 and 14. No apparent differences could be observed between the non-laser treated group and the laser treated groups with respect to histopathological examination except for the thicker epidermis noticed in five cases of the laser treated group as compared to that in non-laser treated group. It was concluded that low level laser therapy has no significant effect on healing of contaminated wounds in dogs.

Like the previous study, this was a small trial with limited information available about how it was conducted. This study, unlike the first, did not find any benefit from laser therapy on wound healing.

The evidence in humans is mixed and inconclusive on the benefits of lasers for facilitating wound healing, so while some benefit is possible, it is not yet clear if there actually is a clinically meaningful benefit in dogs.

The third article evaluated laser therapy for reducing foot itching in dogs with environmental allergies.

Stich AN, Rosenkrantz WS, Griffin CE. Clinical efficacy of low-level laser therapy on localized canine atopic dermatitis severity score and localized pruritic visual analog score in pedal pruritus due to canine atopic dermatitis. Vet Dermatol 2014 Oct;25(5):464-e74. doi: 10.1111/vde.12144. Epub 2014 Jun 9.

Abstract

BACKGROUND:
Canine atopic dermatitis is a genetically predisposed inflammatory skin disease often requiring multimodal treatment. There is a need to find further low-risk adjunctive therapies.

HYPOTHESIS/OBJECTIVES:
To evaluate the localized effect of low-level laser therapy (LLLT) on the paws of dogs with atopic dermatitis using a localized canine atopic dermatitis severity score (LCADSS) and owner localized pruritic visual analog score (LPVAS) in comparison to treatment with a placebo.

ANIMALS:
Thirty client-owned dogs with symmetrical pedal pruritus due to canine atopic dermatitis.

METHODS:
Dogs were randomly assigned into two groups. In each group, one paw was treated with LLLT and one paw treated with a placebo laser (comparing either both fore- or hindpaws). Treatments were administered at 4 J/cm(2) (area from carpus/tarsus to distal aspect of digit 3) three times per week for the first 2 weeks and two times per week for the second 2 weeks. Scores were assessed for each paw at weeks 0, 2, 4 and 5.

RESULTS:
There were no significant differences in LCADSS or LPVAS between LLLT and placebo treatments between weeks 0 and 5 (P = 0.0856 and 0.5017, respectively). However, LCADSS and LPVAS significantly decreased from week 0 at weeks 2, 4 and 5 in both LLLT and placebo groups (P < 0.0001 for all).

CONCLUSIONS AND CLINICAL IMPORTANCE:
Low-level laser therapy is not an effective localized treatment for pedal pruritus in canine atopic dermatitis.

The study appears to have been well-controlled, though there is no mention of blinding, and the outcome measures are subjective but commonly standardized assessment tools. The study found improvement on both active and placebo treatment, which is almost always the case in clinical trials involving skin allergies, but did not see any benefit of laser beyond that of the placebo.

Finally, another dermatology study looked at cold laser therapy for an ill-defined set of disorders in which dogs have inadequate hair growth. Since the cause of these problems is not understood, and there is no well-demonstrated effective treatment, something like cold laser may be worth trying even without a solid reason to think it will be of benefit.

Olivieri L, Cavina D, Radicchi G, Miragliotta V, Abramo F. Efficacy of low-level laser therapy on hair regrowth in dogs with noninflammatory alopecia: a pilot study. Vet Dermatol. 2015 Feb;26(1):35-9, e11. doi: 10.1111/vde.12170. Epub 2014 Sep 16.

Abstract

BACKGROUND:
Canine noninflammatory alopecia (CNA) is a heterogeneous group of skin diseases with different underlying pathogenesis. The therapeutic approach is challenging, and new options for treatment are desirable.

HYPOTHESIS/OBJECTIVES:
To test the clinical efficacy of low-level laser therapy (LLLT) on hair regrowth in CNA.

ANIMALS:
Seven dogs of different ages, breeds and genders with a clinical and histopathological diagnosis of noninflammatory alopecia.

METHODS:
Each dog was treated twice weekly for a maximum of 2 months with a therapeutic laser producing the following three different wavelengths emerging simultaneously from 21 foci: 13 × 16 mW, 470 nm; 4 × 50 mW, 685 nm; and 4 × 200 mW, 830 nm. The fluence given was 3 J/cm(2) , frequency 5 Hz, amplitude of the irradiated area was 25 cm(2) and application time was 1.34 min. A predetermined alopecic area was left untreated and served as a control area. From one dog, post-treatment biopsies of treated and untreated sites were obtained for histological evaluation of hair density and the percentage of haired and nonhaired follicles.

RESULTS:
At the end of the study, coat regrowth was greatly improved in six of seven animals and improved in one of seven. By morphometry, the area occupied by hair follicles was 18% in the treated sample and 11% in the untreated one (11%); haired follicles were (per area) 93% in the treated sample and only 9% in the control sample.

CONCLUSIONS AND CLINICAL IMPORTANCE:
Our clinical and histological data document promising effects of LLLT on hair regrowth in CNA. Further studies investigating the biological mechanism underlying the effect of LLLT on hair follicle cycling are warranted.

The results suggest laser therapy may have stimulated hair growth in these dogs. However, only 7 dogs were involved, and only one provided skin biopsies, so this study merely hints at the potential for laser therapy, and further work with appropriate controls would be needed to demonstrate there is real benefit to be had.

Bottom Line
The research into cold laser in dogs and cats is sparse and generally low quality. Most studies are small and have minimal or uncertain controls for bias and error. Some show promising results, others do not. At this stage, as I concluded in my initial discussion of this topic, there is enough evidence to warrant further study but not enough to support routine clinical use of cold laser. If vets want to try this therapy, they have an obligation to be clear with client that the risks and benefits have not been established and that the treatment is essentially experimental. There is nothing wrong with using such a treatment given appropriate informed consent, but the aggressive marketing of laser equipment to vets as a profitable treatment is ethically questionable given the lack of good evidence that it is a truly safe and effective treatment for any condition.

 

Posted in General, Science-Based Veterinary Medicine | 7 Comments

Faces of Vaccine Denialism

Been seeing a lot of these folks lately….

 

faces of vaccine denialism

Posted in Humor | 1 Comment

SkeptVet Gets Hate Mail: Update 2015

As regular readers will know, I don’t allow abusive comments or personal rants on the site. Primarily, this is because such nonsense contributes nothing productive, and I am under no obligation to provide angry or crazy people with a forum for their vitriol. Such comments lower the tone of debate and shift the focus away from salient issues and towards personalities, which dumbs down any discussion. Some mainstream science publications have actually blocked all comments on their sites because vacuous attacks come to dominate and crowd out any thoughtful discussion or debate. People are welcome to disagree with me, and I daily allow comments that do so. But as I try to be substantive and civil in my criticism of others, focusing on their ideas and claims, not their personalities, so I hold commenters here to a similarly adult standard of behavior.

That said, I think it is instructive to periodically look at the sort of bile spewed at me by people who have no real evidence or intelligent argument to offer but just want to express their anger at my challenging some of their beliefs. These are the people who drive society away from science and reason, who make compromise and cooperation so difficult in politics that we end up with a dysfunctional government, and who threaten the functioning of a society in which civil disagreement is possible and productive. These folks also illustrate how distant many of the alternative ideologies they espouse are from science and how much more like fundamentalist religion they really are. And, finally, sometimes they are simply funny. Enjoy!

Short and Sweet?
There is one word for you the author of this article….”””IDIOT””””

Skeptvet is a dumb fuck

You’re an idiot.

Are you living under a rock dude?

Homeopathy has healed my dog AND myself. Take your Big Pharma and shove it.

Go take your drugs and destroy your kidneys and liver. And kill all our animals that way as you promote drugs and surgery and toxic immunization a. You are a total moron.

Skepvet, you are an absolute fool. The fact that you would happily prescribe…makes you a complete moron…An education beyond University of Phoenix should be your next life goal.

[This one was creative enough to invent an email to represent me abusing myself!] From: skeptvet@dispostaba.fuck

I am truly a motherfucker… I Have cancer and dying. Im trily sorry I trust in protandim now

Tinfoil Hat Wearers
How much are Hills, Purina and the pharmaceutical companies like Merck slipping you on the side? Clearly, you are attempting to manipulate an uneducated, easily led, public with your claptrap disguised as science.

Your site tag says, “A Vet Takes a Science-Based Look at Veterinary Medicine”. It should more accurately say, “A Vet Takes a Pharmaceutically Skewed Prospective of Veterinary Medicine.” That would be more accurate. You’re sole reason to exist is to try to hold back the tide that threatens your alternative medicine buddies in big pharma.

And for every “expert” that has “scientific” proof that ACTION A is best, there will always be another “expert” that has “scientific” proof that ACTION B is best. Look closely at who pays which “expert” for the proof and you’ll have the answer as to why which ACTION is best. It’s all about the bottom line, folks. Now that the pet industry is a multi-billion dollar a year industry, unfortunately it appears the vets and “pet-care” companies are using our pets in the same way the human medical establishment has done…cause confusion and watch the big bucks roll in!

You are a skeptic because it could put you out of business.

The FDA is a sub contractor for Monsanto. Come to think, so is this website!

Huh, sounds a lot like what you say you aren’t – a pet food company lackey. The strong reason in favor of healthy, appropriate, homemade diets is the health of our pets…the strong reason against is two-fold – money and sickness – both of which I am sure you have no problems with. Sick animals are good for business.

What a HORRID article! If everyone in this world was healthy and living without chronic disease, then how would the pharmaceutical companies make money?

Who is paying you to write all this crap? The AMA? Jeez.

Another example of Government out of control serving Big Pharma both in an alliance and both disserving the unknowing blinded public while they RAKE IN $BILLIONS IN PROFITS. It’s the Government and its Agencies like the FDA THAT CANNOT BE TRUSTED! Do we need any more evidence for this? No, it is clear. SkeptVet clearly takes THEIR side.

You are a typical vet who just wants to stand behind the prescriptions that pay for your lifestyle.

I know one thing for sure……Vets scoff because it is about the $$$$…..they focus on keeping us coming back for the prescription food, meds and their $$$’s…….I do not trust doctors for humans let alone for my precious little ones. They are ALL about the money

To all you ignorant people bought off by Big Pharma . It is getting old by now you all not getting it. America is a fat, diseased very sick nation. The irony of thinking we are this Great nation when we are the international laughing stock. Europe has a seperate factory for making send out food to America because the Ingredients we allow are not allowed in their country due to most are toxic. Even the little cashier at World Market know’s this… If people were well and did not need prescription medicine their would be no money to be made in this billion dollar Big Pharma Industry. They want us sick!

Another sellout medical doctor…Medical doctors and mainstream people are so arrogant. They think they know everything, when behind closed doors, the people who fund these foods and treatments are actively trying to harm them.

Keep being oblivious, so people like me have to live in a perpetual hell, where I can’t even know what is in my food or water. Because of people like you, they have total control… as long as you keep supporting the corporations aspirations, nothing will EVER change.

Maybe you should go through your records and see how many of those dogs you vaccinate develop an illness within 12 weeks of the vaccine.  I think you’d find it more eduational than blindly working for the pharmaceutical industry who are constantly being sued for lying about test results on their products.  Why would they lie if their products have been properly tested and proved to be safe?  I don’t suppose it’s occurred to you that they’re not in the business of healing.  They’re in the business of making as much money as they can… Most vets who switch to a holistic practice earn far less money than you do, so what possible reason could they have for changing?  Has it occurred to you that they have actually bothered to pay attention and have realised that they are hurting our animals with unnecessary medications? That their consciences have stepped in and prevented them from continuing to cause chronic disease in our pets?  Obviously not. Our animals need healers working with us owners, not drug sales people.

Who’s paying you!!?? Talk about biased. I’d like to know the serious side effect of taking cats claw… I always read opposing info when researching but this is so slanted its crazy. So I figure you are either a vet or you are paid/paid off by them. Let’s all feed science diet, shall we!… Seriously, who pays you!!??

If you don’t get a payment from the drug company, it’s not worth recommending.

Big devious lie of an article!!! Probably working for the misinformation industries!!!!!!

Typical hate spewing from the medical field, these studies are only argued against because it affects the medical industries bottom line and making them lose money (and to keep their monopoly of the healthcare market).

After reading this blog and these testimonials, I think the skeptics here are for the most part, on someones payroll. Science has been Hijacked long ago, and the truth is being continually sacrificed on the alter of Corporate profits. I dont know what they are paying you to slander this company, too much if you ask me,

The drug industry ARE the quacks. Its a protection racket. This skepvet is a living testament to that. Ignore them and do what works not what their rigged trials tell you should work.

Someone is paying you to discredit vitamins, glandulars and minerals as beneficial remedies. You probably are a stupid medic. Breast feeding at age 80 off the pharmaceutical TIT. Die quickly so u can be reborn and do something to help someone.go pop a pill. You are an idiot.

Another sellout medical doctor…. These people probably promote heavy metal-laden vaccines; liver destroying drugs and toxic foods that contain genetically modified organisms. Go ahead, be ignorant and take the medical industries junk. They will be happy to benefit off of your illnesses. Big pharma and agribusiness work hand-in-hand… Medical doctors and mainstream people are so arrogant. They think they know everything, when behind closed doors, the people who fund these foods and treatments are actively trying to harm them.

Why do you attack natural products? The conspiracy is for all the chemicals with the phony white papers. I have seen many a healthy person and or pet die from chemical meds and would have survived had they been given a real natural product that actually works.

Unemployed Psychotherapists
I understand your need to feel as if you are flying the EBVMA flag in your posts and blog in general. To be quite honest, it comes across as if you were not able to obtain a real medical position so you chose to rant on “evidence based veterinarian medicine.”… .” If you don’t understand the origin from which we were created you might not see the total picture doc. God actually gave our bodies their own defense mechanism from many diseases, enhanced by utilizing another thing God created that assist this healing process, there called nutrients.

Maybe if you spent more time actually observing the animals and building your practice instead of blogging this nonsense you could find the success and attention you so obviously crave.

This blog is such non-sense and sounds like it has been written by an angry veterinarian with an unsuccessful practice.

You sir, are a disgrace to your profession. Your ego and agenda have overcome your common sense.

Taking pot shots at Nutriscan and scoffing at people who have found flea meds to be dangerous to their pets might make you feel superior but from here you look like an a__.

This treatment is now being used by vets who are not arrogant and close-minded such as you are, with much success. You know–you aren’t always right just because you got a degree in Veterinary Science.

There’s a lot that isn’t thoroughly taught in either vet or (human) medical school. I’ve noticed that the medical professionals who know the least are the ones who are the most arrogant!

I’m a pet parent, not a vet, and whoever wrote this article seems very upset and angry… Do everyone a favor and get over yourself.

 

 

 

 

 

 

 

Posted in General | 13 Comments

Everything We Eat Cures Cancer! (or Causes it?)

Central to the nutritional and general healthcare philosophy of most alternative practitioners is that anything we eat is either good or bad. They often quote that cutting edge physician Hippocrates saying “Let food be thy medicine” (though they less commonly quote him saying “A physician without a knowledge of Astrology has no right to call himself a physician” or “What medicines do not heal, the lance will; what the lance does not heal, fire will.” for some reason). So-called “super foods” are lauded as having nearly magical healing properties, whereas foods like high fructose corn syrup, or even entire categories of foods such as grains are considered off-limits in a healthy diet. One of the most common scare tactics used to promote alternative approaches to pet nutrition is the claim that commercial pet food causes cancer.

So what is the evidence to support these claims that foods cause or cure cancer or other serious disease? Well, often there is little or no evidence at all, but occasionally there will be an observational study (one without any controls for chance, bias, or other sources of error). Usually these studies are done in humans, and they tend to drive food fads for both humans and, to a lesser extent, pets despite the dangers of extrapolating from human research to veterinary patients. However, as has often been pointed out, research studies are only as good as the quality of their design and conduct, and single studies, especially observational studies, are rarely solid enough evidence to justify major changes in behavior. I recently ran across a systematic review which has examined the human nutrition literature and has shed some light on why it sometimes seems like everything we causes or cures cancer.

Schoenfeld JD, Ioannidis JP. Is everything we eat associated with cancer? A systematic cookbook review. Am J Clin Nutr. 2013 Jan;97(1):127-34. doi: 10.3945/ajcn.112.047142. Epub 2012 Nov 28.

This clever little study selected recipes at random from a popular cookbook and then evaluated all the ingredients to see if there was any research literature suggesting they increased or decreased cancer risk. Here are the ingredients for which some research studies were found:

veal, salt, pepper spice, flour, egg, bread, pork, butter, tomato, lemon, duck, onion, celery, carrot, parsley, mace, sherry, olive, mushroom, tripe, milk, cheese, coffee, bacon, sugar, lobster, potato, beef, lamb, mustard, nuts, wine, peas, corn, cinnamon, cayenne, orange, tea, rum, and raisin.

Of these, there were more than 5 studies for 65% of the ingredients, with over 216 publications altogether. About 40% of the studies found an increased risk of cancer associated with one of these ingredients, 33% found a decreased cancer risk, and about 25% found no clear evidence either way. When a risk was identified, the statistical support was weak or not technically significant in 80% of the studies, so most individual did not show very robust results. About half of the meta-analyses included, however, had stronger statistical results, which is not surprising since the whole point of meta-analyses is that evaluations of multiple studies give stronger evidence than the results of individual studies. The distribution of effects reported in the meta-analyses centered around zero, suggesting random variation but no clear real effect.

The authors’ discussion summarizes very well not only the results of this study but the general problem with much of the observational and pre-clinical research often used to justify specific practices in the absence of clinical trials:

80% of ingredients from randomly selected recipes had been studied in relation to malignancy and the large majority of these studies were interpreted by their authors as offering evidence for increased or decreased risk of cancer. However, the vast majority of these claims were based on weak statistical evidence. Many statistically insignificant “negative” and weak results were relegated to the full text rather than to the study abstract. Individual studies reported larger effect sizes than did the meta-analyses.

…the credibility of studies in this and other fields is subject to publication and other selective outcome and analysis reporting biases, whenever the pressure to publish fosters a climate in which “negative” results are undervalued and not reported. Ingredients viewed as “unhealthy” may be demonized, leading to subsequent biases in the design, execution and reporting of studies. Some studies that narrowly meet criteria for statistical significance may represent spurious results, especially when there is large flexibility in analyses, selection of contrasts, and reporting. When results are overinterpreted, the emerging literature can skew perspectives and potentially obfuscate other truly significant findings. This issue may be especially problematic in areas such as cancer epidemiology, where randomized trials may be exceedingly difficult and expensive to conduct; therefore, more reliance is placed on observational studies, but with a considerable risk of trusting false-positive or inflated results.

Overinterpretation of individual studies with often small effects that are only marginally significant statistically and may be insignificant clinically is a major problem in all areas of medicine, and it manifests especially dramatically in alternative medicine, where any data is good data so long as it supports existing beliefs. To find out what is actually true and what will real improve health, we must be mindful of the limitations in the evidence and seek to improve the design, conduct, and reporting of clinical studies. That is a job for the researchers. However, the job for the rest of us is to know at least enough about research evidence to be wary of overinterpretation and placing excessive confidence in data that does not merit it. This will hopefully dampen the wild swings back and forth between claims like “Food X will kill you” and “Food X will make you live forever.”

 

 

Posted in Nutrition | 4 Comments

Dr. Karen Becker Offers Some Classic Veterinary Detox Quackery

Yesterday, I wrote about some environmental chemicals that may play a role in causing disease. While this sort of environmental risk factor is a real and recognized phenomenon supported by good science, it can easily be cited to lend support to a bit of popular pseudoscience that may appear quite similar but which is actually something quite different: detoxification. Detoxification is one of the classic bogus pseudoscientific concepts of alternative medicine, and since I brought up the subject of environmental toxins, I thought it worthwhile to illustrate today some of the differences between the legitimate field of environmental toxicology and the quackery that is detoxification.

The notion of detox suggests that our bodies accumulate harmful substances, either from environmental toxins or the waste products of our own normal metabolism, and that these need to be removed or neutralized by some therapeutic process in order to prevent or cure disease. The details about what is toxic, how we come by it, and what we should do to detox vary widely according to the many and mutually inconsistent theories of different alternative practitioners.

At the heart of this notion is the emotion of disgust, and inherent reaction we have evolved to encourage avoidance of potential sources of harm, particularly infectious disease. Though there is controversy about the details, it is commonly argued that this innate emotional reaction has been generalized to cultural and moral domains, and this has led to the social constructs of contamination and purification. Detox schemes are portrayed as healthcare, but they are really a set of purification rituals intended to ward off harm magically like some religious practices.

The problem with this and many other alternative medicine ideas that are more religion than science or medicine is that evidence for or against specific proposed toxins or therapies becomes irrelevant. It’s not that there is no such thing as a toxin, since there are many well-characterized by science. And it’s not that we can’t remove or neutralize some toxins with medical treatment, because in some cases we can. The issue is that the specific claims about detoxification are often made up completely or extrapolated wildly and irrationally from small pieces of actual scientific knowledge, and they become self-sustaining components of a belief system rather than hypotheses that can be confirmed or disproved.

A typical example of this kind of pseudoscience, which mixes distorted but real science with complete nonsense, comes from the ever-reliable source of pseudoscience, Dr. Karen Becker at Mercola.com. Dr. Becker produces a steady stream of advice for pet owners. It ranges from the perfectly reasonable to the unproven but plausible all the way to the completely ridiculous, often all jumbled together. The key is that real evidence is almost never needed or heeded, and her claims are based predominantly on opinion, hers or that of the other alternative practitioners she interviews.

 

The  Big Scare

Her detoxifications creed begins with The Big Scare, that classic snake-oil sales technique in which the CAM advocate tries to convince an audience that they and their pets are swimming in a toxic soup constantly threatening ruin to our fragile health and well-being. Without this fear, we might not realize that our apparently perfectly healthy pets were actually in terrible danger and that we need to act now to save them! We might be at risk of coming to believe that not all bad things that happen can be avoided if we just do the right things and that those who become ill have only their own poor lifestyle choices and inaction to blame.

It’s actually mind-boggling to think about all the different ways our pets are exposed to toxins in today’s world…. If you’re wondering if your own pet is carrying a toxin load, sadly there’s no doubt he is. The truth is that virtually every pet has measurable amounts of chemicals in their body, because they walk through chemicals, they sleep on them, they breathe them in, and they eat and drink them. And unfortunately, veterinarians prescribe and inject them on a regular basis as well.

Dr. Becker lists a host of the usual bogeymen of alternative medicine, from medicines that actually protect your pet’s health and prevent disease, like antibiotics and parasite preventatives, to poisonous commercial dog food that carry cancer in every bite, to the invisible threat of—gasp!— electromagnetic fields! Some of the specific things mentioned do have potential harmful effects, depending on dose, exposure route, species, lifestage, and many, many other variables. After all, anything, including such necessities of life as oxygen and water, can be harmful under the right circumstances.  Others, such as fluoride in drinking water and electromagnetic fields have been thoroughly investigated and not found to be dangerous. But again, we are dealing with a faith-based, not evidence-based belief system here.

Pretend Science

After The Big Scare, Dr. Becker moves on to explaining precisely how these toxins harm your pet. Well, not precisely, more like generally. Well actually, it’s more like using some vague science-y words that imply stuff without actually meaning anything.

When your pet’s body accumulates too many toxins, it stores them for future elimination. For many pets, that future opportunity never arrives and the toxic load begins to impede the body’s ability to function. Ultimately, toxic overload can interfere with the immune system to the point where cellular abnormalities like tumors and cysts develop. Other serious diseases may also show up as cells degrade and organ function is impaired.

Side effects of an accumulating toxin load cover a wide range of diseases, from skin conditions to organ failure. There can be behavior problems associated with toxicosis, endocrine disease, autoimmune disease, and even cancer.

So basically, your pets is constantly besieged by all sorts of toxins that are everywhere and in everything, and they can cause almost any disease if not eliminated. And while she admits that your pet has its own systems for dealing with toxins (since it would be hardly to explain how any suggests that they can’t be relied on. This, again, is a necessary step in selling you something which you can do to defeat this terrible threat and which will work better than the natural systems evolved over millennia which have kept us all alive so far.

A Magic List
Everyone likes lists. Just put “10 Steps to…” in front of almost any advice, and it will be more fun to read and more persuasive. The only trouble here is that most of these steps are either too vague to be meaningful, unproven hypotheses, or total nonsense.

1. Improve Your Pet’s Diet

What Dr. Becker means by “improve” is really “change to what is recommended by my favorite nutrition mythology.” Avoiding commercial food, which is full of those pesky toxins, and switching to home-cooked, grain-free, ideally raw diets despite the complete lack of evidence to support the claim that any of these changes actually improves health or reduces disease risk. I’ve addressed a number of these myths and claims before, and they are far more about ideology than science.

2. Provide Clean Drinking Water

Presumably, you are unaware that the drinking water we get from the tap here in the U.S., which has eliminated numerous infectious diseases that have plagued humanity for millennia and continue to trouble the developing world, is actually a toxic brew that will poison your pet. Fluoride, in particular, is mentioned as a risk despite the overwhelming evidence that it is safe and effective at dramatically educing dental disease. No evidence needed here, just pure belief!

3. Beware the Air!

Apparently, the very air you breathe in your home is full of perils as well. Avoiding smoking is a sound and well-established way to reduce disease risk. Other than that, the notion that every cleaning product that doesn’t call itself “green” on the label is a poison for your pet and that you can somehow find a magic combination of products and purifiers to ward of sinister unseen toxins in normal household air is just another arrow in the quiver of The Big Scare.

4. Make Your Pet Exercise

The benefits of exercise for humans are well-established, and it is likely that our pets could stand a good deal more physical activity than many of them get. There isn’t actually much research for dogs to tell us how much of what kind of activity is ideal, and the notion that our cats should workout more is pretty far-fetched. Still, among the very real benefits of exercise is not “helping the body’s detoxification efforts.” Suggesting that without more exercise your pet will not urinate, defecate, circulate blood to the liver and kidneys, or breathe sufficiently to perform ordinary removal of waste products is just nonsense.

5. Avoid Pollutants and Chemicals

A perfectly sound bit of advice, except for the problem that everything is made of “chemicals,” and Dr. Becker’s notion of what is a “pollutant” is pretty vague. Sure, washing off your dog’s feet when they come in the house is fine, but there’s no reason to imagine it will dramatically affect their health or ward off any terrible illness.

6. Say No to Drugs!

Dr. Becker recommends avoiding “unnecessary” “drugs,” by which she usually means vaccines and medicines. I too recommend avoiding unnecessary medical treatment, but I suspect we have different definitions of what this is. I have written extensively about the issues involved in deciding what to vaccinate for and how often, and it is a far more complex subject than simply “avoid yearly vaccinations” as Dr. Becker recommends. And while antibiotics and steroids are probably overused, they are also important and beneficial medicines, and it is dishonest to sow fear of them without being clear and evidence-based in presenting both the risks and benefits and without defining “unnecessary” in any way. Making people afraid of medicine doesn’t make their pets healthier. Similarly, there are risks as well as benefits to parasite prevention, as well as to eschewing such prevention, but the “safe, natural alternatives” Dr. Becker mentions are not proven substitutes.

7. Brush & Bathe Your Pet

Sure, why not? But ignore this bit of nonsense: “Your cat or dog eliminates toxins through his skin, and regularly brushing or combing will remove loose fur and debris and help his skin breathe.” Oh, and don’t forget not to use shampoos that contain “toxins.” Make sure they are “natural.” *sigh*

8. Support Your Pet’s Liver and Kidneys

Here’s where the poor logic behind the detoxification scam shows itself especially clearly. We are warned that “chemicals” and all kinds of substances in our food, water, and air are bad for us and should be avoided, despite the lack of evidence in most cases that this is true. We are warned of the dangers of medicines are parasite preventatives without any discussion of the benefits and with no consideration given to the abundant evidence showing that these generally do much more good than harm. And then, after all this fear mongering without good evidence, we are told to protect our pets by giving them a bunch of untested and unproven chemicals! I have collected an enormous volume of evidence showing that the chemicals(!) in herbs and supplements and even needed compounds like vitamins and minerals can cause serious harm. Without proper testing, these cannot simply be assumed to be safe and effective. Giving such substances without this evidence and warning people away from substances for which good evidence of safety is available is bizarre and misleading. Only the fundamentally faith-based nature of the detox myth could explain such inconsistent and illogical recommendations.

9. Support Your Pet’s Immune System

Boosting the immune system is one of the other classic bits of alternative dogma and nonsense nicely dealt with already elsewhere. It suffers from many of the same problems with faith above evidence and illogic as the detox scam.

Dr. Becker lists a number of specific “detoxing” agents, and not surprisingly several of them have come up here before, including Chinese Herbal Medicine, turmeric, resveratrol, and others. None of these have good clinical trial evidence to show that they “detoxify” anything, and while there are some suggestive tidbits of research that some might have some legitimate medical uses, there are not clinical trials showing any to be safe and effective at preventing serious disease in apparently healthy animals. Their use is based entirely on anecdote or entirely unproven theories about health, not real evidence.

Finally, Dr. Becker recommends regular detoxing with these unproven chemicals if your pet has any exposure to supposed toxins, which of course is unavoidable since these malignant substances are everywhere, except apparently in the chemicals she recommends giving to detox your pet.

Bottom Line
The whole notion of detoxification is a non-scientific concept that is part of an ideology which has more in common with religion than science-based medicine. The theories are unproven or outright false, and the specific claims made about toxins and detox treatments are made without real evidence. The strategy is no different in its essence than warding off bad luck or evil spirits, and it serves more to assuage the anxiety of humans than protect the health of pets. Here are some useful resources on the subject for further reading:

The Detox Scam: How to spot it, and avoid it

You can’t “detox” your body: It’s a myth. So how do you get healthy?

Detoxification Schemes and Scams

The Detox Delusion

Detoxification Therapies

 

 

 

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Evidence Update: Flame Retardants (PBDEs) and Hyperthyroidism in Cats

The words “chemical” and “toxin” are among the most popular and misused words in the alternative medicine lexicon. They are often more a vague code for “evil spirits” rather than a specific reference to true environmental health hazards, and they are frequently used to frighten people into avoiding conventional medical therapies or employing unproven or quack treatments. “Toxins” are often more an ideological shibboleth than a useful scientific concept.

That said, there are unquestionably real environmental compounds that cause disease. Many of these have been identified by meticulous and rigorous scientific research. Undoubtedly some remain unidentified, quietly increasing our risk of illness without our knowledge. The trick is knowing what is truly dangerous, to whom, in what form, at what time, and so on. The details matter. If we waste our time avoiding and being afraid of the wrong things, or everything, we aren’t focusing our efforts effectively at identifying and controlling true environmental risks. Science, not scare tactics, is the best way to deal with the problem of environmental toxins.

Which brings me to a recent article which has added a bit of information to an ongoing debate about an all-too-common disease, feline hyperthyroidism.

Jessica Norrgran, Bernt Jones, Anders Bignert, Ioannis Athanassiadis, and Åke Bergman. Higher PBDE Serum Concentrations May Be Associated with Feline Hyperthyroidism in Swedish Cats. Environ. Sci. Technol., 2015, 49 (8), pp 5107–5114

Hyperthyroidism is the most common glandular disease in cats. It involves an excess of thyroid hormone produced by a benign tumor of the thyroid gland. The consensus is that the disease is much more common than it was a few decades ago, though there are not reliable numbers and, as always, it’s not completely clear the degree to which more cases are actually occurring versus more cases being diagnosed since we’ve discovered the disease and started testing for it readily. It is, in any case, a significant cause of illness, and though it is very treatable, it causes a great deal of discomfort for cats and expense and worry for their owners.

The problem of hyperthyroidism is especially frustrating because we do not know precisely why cats get the tumors that cause it, or why it appears to have become more common. Whenever there is this sort of uncertainty, the door is wide open for theories, from the plausible to the ridiculous, and there is little basis on which to discriminate among them. Lots of theories have been proposed for the cause of feline hyperthyroidism, and the fact that no single one has been confirmed suggests that multiple risk factors and causal pathways are involved. However, environmental contaminates are considered a significant potential risk factor, and this study adds some support to the concerns previously expressed about one in particular, polybrominated diphenyl ethers (PBDEs).

The authors selected blood samples from cats seen at a Swedish university and measured the levels of 11 different PBDEs and related compounds. These levels were compared with those found in humans in Sweden as well as between cats with and without diagnosed hyperthyroidism. They found higher levels overall in cats than in humans, higher levels of 4 of these compounds in cats with hyperthyroidism, and different patterns of the relative amounts of the different chemicals in cats compared to humans and in hyperthyroid and normal cats. Other compounds did not differ between the two groups of cats. And one compound was found in all of the cats despite having been banned over a decade previously in Europe and not having been detected in house dust or human blood since.

The authors are careful to point out that these data cannot be used to confirm that PBDEs cause hyperthyroidism because there are a number of potential sources of error that are not controlled for in this kind of study. Much more extensive data exist in humans, and yet it is still not clear what role, if any, these chemicals play in causing thyroid disease. Nevertheless, showing that at least in a small number of cats those with thyroid disease appear to have higher levels of PBDEs that those without does suggest some relationship, and further study is certainly warranted to sort out the details.

Research has suggested a relationship between PBDEs, in the environment and possibly in cat food, and the appearance of hyperthyroidism in cats before, though not all studies have found evidence to support this hypothesis. It seems likely that multiple factors are involved, including environmental, genetic, and possibly nutritional variables.

This complexity is frustrating, as it prevents identifying a single, simple cause that can be avoided. The bulk of the PBDE exposure is believed to come from ingestion of house dust through self-grooming. PBDEs have been incorporated into a bewildering variety of household items, and while many of these compounds are no longer manufactured or used, it is likely indoor cats will continue to be exposed to them through these sources for some time. However, there are a host of other, and generally more severe, health problems associated with letting cats roam outdoors, so this is not a great solution.

Similarly, there is some concern about PBDE exposure through canned cat food. However, there is also some limited evidence that canned foods are better for cats than kibble in terms of other health risks. And while fresh, homemade diets may be ideal in theory, in practice most owners cannot put the time and energy into making truly nutritionally balanced and safe homemade diet.

If PBDEs are a significant part of the cause for, hopefully further research will clarify their role and give us the detailed information we need to reduce exposure and disease risk. Any action we take on this subject, however, needs to be thoughtful and based on solid data, since making dramatic changes in how we feed or otherwise manage our feline companions without a strong foundation in science will very likely lead us into simply exchanging one set of risks for another.

 

 

 

Posted in Science-Based Veterinary Medicine | 3 Comments

Vaccine Confidence in the United States: A New Report

Introduction
As I have been quite involved in the struggle to reform our vaccination exemption laws here in California, I’ve been spending a lot of time reading about childhood vaccination lately. While this is only tangentially related to my usual veterinary focus, I thought I would share an interesting document I found.

Assessing the State of Vaccine Confidence in the United States: Recommendations from the National Vaccine Advisory Committee, DHSS. Draft Report

The purpose of this report was to evaluate the degree of confidence parents in the U.S. have in the recommended vaccination protocols, how this is assessed, and what we might be able to do to increase confidence and improve vaccination rates. There weren’t a lot of surprises in the report, but it’s a concise summary of the situation.

The Good News
One persistent problem with media coverage of most issues, including vaccination, is that it is easy for small numbers of vocal, passionate people to be disproportionally represented and to thereby create an inaccurate impression of how widespread their views are. In the case of vaccine confidence, the vast majority of parents trust and follow the recommendations of the medical community, and this level of adherence has been stable for many years. 80-90% of parents have their children fully vaccinated, which is far more of a consensus than on just about any other hot-button political issue. The emphasis on the exceptions, and the desire to improve vaccine compliance is not a reflection of a widespread resistance to vaccination but a function of the need to have very high rates, generally well over 90%, in order to reap the benefits of herd immunity and protect those who cannot have vaccines for medical reasons or for whom vaccination is not 100% protective.

It is important to remind ourselves that vaccinating your children is not only a good idea for their health and the health of others, it is also a normative social behavior. While people should, ideally, make rational and evidence-based decisions independent of the beliefs of others, the reality is that people are influenced strongly by what they perceive to be the beliefs of other members of their community. If parents mistakenly believe that vaccine-refusal is mainstream, they may take it more seriously despite the misguided and mistaken foundations of anti-vaccine attitudes. However, if people understand that vaccination is not, in fact, controversial but accepted by the overwhelming majority of American parents, they may be more comfortable rejecting the scare tactics and specious arguments of vaccine opponents.

This study also found that there is a high degree of confidence in reliable sources of information about vaccines, especially healthcare providers. Most parents trust their pediatrician’s advice, and many who have reservations about vaccines but ultimately decide to follow the guidelines do so because of information and counseling given by their children’s doctor.

Vaccination has been the most successful preventative healthcare intervention in history, and the high rates of vaccine acceptance in the U.S. have allowed more than one generation to grow up ignorant of the dangers of many infectious diseases that routinely injured and killed children for millennia before the development of vaccines. Even though the number of people who have firsthand experiences with these diseases is few and dwindling in the developed world, most parents still understand the importance of vaccinating their children to prevent the resurgence of these infections.

The Bad News
Despite the overall high and stable levels of acceptance of science-based vaccination guidelines, confidence in vaccination varies dramatically by region. The problem today is not widespread rejection of vaccines but high levels of rejection in localized communities. These communities have proven to be sources of outbreaks of otherwise well-controlled infectious diseases. Regional and demographic factors which are partially but not completely understood have led to such pockets of vaccine rejection in which vaccination rates are low enough to undermine herd immunity and facilitate outbreaks. I know because, sadly, my own child goes to school in such a pocket, with vaccination rates well below the average for the state and the other schools in the district.

As mentioned earlier, the formation of such pockets of mistrust in vaccines are facilitated by the impression they create that suspicion of vaccination is common and mainstream. Even in my community, 84% of children are fully vaccinated, yet the remaining 16% of families are able to sustain misguided beliefs about vaccines within a supportive echo chamber that helps insulate them from the information and arguments that the rest of the community offers in support of vaccination.

Though the report does not address this, I have the subjective impression that there is a strong correlation between vaccine refusal and more general pseudoscientific attitudes and beliefs. Most of the individuals arguing against the scientific consensus on vaccines in my community, for example, also proclaim homeopathy and other alternative therapies to be safer and more effective alternatives. And the organized voice for chiropractors in California, the California Chiropractic Association, has come out in opposition to reforming the state’s vaccine exemption laws and recently gave a hero’s welcome to disgraced physician Andrew Wakefield, who launched the modern anti-vaccine movement:

The California Chiropractic Association is actively lobbying against California Senate Bill 277, which would end the state’s “personal belief” exemption against ten types of vaccinations now required to begin school. [Mason M. Chiropractors lobby against bill ending belief exemptions for vaccines. Los Angeles Times, March 5, 2015] CCA’s Web site advises members to say that they are “NOT anti-vaccine we are pro-inform consent and choice.”

Life Chiropractic College West sponsored a talk by Andrew Wakefield, who lost his British medical license for unprofessional conduct related to vaccine scaremongering. The San Francisco Chronicle has reported that he received standing ovations after he advised hundred of students that SB 277 was a step toward mandatory vaccination that could have dire consequences. The paper also noted that the school’s president was considering hiring buses and canceling classes so students could attend a Senate hearing. consent and choice.”

The importance of legislation like SB277, the initiative to eliminate non-medical exemptions to school vaccination requirements in California, is also emphasized in the report. Such exemptions, particularly those that require only a “philosophical” objection and are easy to get, have increased significantly, and they are directly associated with the growth of local clusters of vaccine refusal, and the subsequent outbreak of vaccine-preventable disease. Such exemptions serve no legitimate purpose because they essentially eliminate vaccination requirements altogether and undermine the public health value of immunization. The legal and scientific legitimacy of such mandates has been settled for over a century, and recent efforts to undermine them by extending vaccine exemptions is supported only by misinformation and fear.

Conclusions & Recommendations
The report concludes that while overall confidence in vaccination and trust in doctors and public health officials is high, there are communities in which misinformation and misguided distrust have taken root, and this represents a real threat to public health. The committee made a number of recommendations for monitoring and improving confidence in vaccination:

  • Objective and standardized measures of vaccine confidence should be developed and ongoing surveillance of these should be conducted by public health agencies
  • Doctors, public health officials, and parents who support vaccination should continue to communicate the benefits of vaccination and reinforce that it is a social norm accepted by the vast majority of Americans. These communication efforts should be supported with evidence-based materials and training.
  • Vaccine exemptions for non-medical reasons should only be available if parents are adequately informed about the safety and efficacy of vaccination and the risks of not vaccinating.

Personally, I don’t believe this final recommendation goes far enough. Given the evidence that accurate information rarely changes entrenched anti-vaccine beliefs, I think the degree to which education requirements will reduce vaccine exemptions is too small to be effective. Such exemptions should not be allowed without sound medical justification. People may have the right to choose not to vaccinate their children, even if the choice is based on inaccurate beliefs and fears, however they do not have the right to then endanger others by sending their children to schools and daycare centers with other people’s children

 

 

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Coconut Oil for Pets?

Healthcare and nutrition fads are an unfortunate fact of life. People are always looking for miracle cures and for clear, defined villains they can blame for illness and try to avoid. The media contributes to the process of fads coming and going by ignoring subtlety, nuance, and uncertainty in scientific research and presenting every new study as a dramatic paradigm shift that replaces existing error with absolute truth. The slow, halting, progress in real knowledge brought about in fits and starts by the scientific process and the community of science over time is still real progress, and it has yielded true revolutionary improvements in health. But it is harder to understand and to narrate and less emotionally satisfying than quick-well-quick schemes and medical bogeymen that we can blame for all our ills.

Healthcare fads in humans readily make the transition to fads among pet owners. Even though human health problems, and their causes and solutions, are often quite different from the health problems our pets experience, people naturally tend to think that if something is good or bad for them it must be similarly good or bad for their pets. Often, even when there is some real scientific evidence for the benefits or risks of some healthcare practice in people, there is little or no evidence to support claims about these practices applied to our pets. Extrapolation from people to pets is inevitable, but it is also very risky.

One fad that has been going on for a few years now in human nutrition, and which is being touted for pets as well by proponents of alternative medicine, is the use of coconut oil to prevent or treat a wide variety of health problems. Some sites, including the ever-unreliable Dogs Naturally Magazine, claim coconut oil can prevent or treat skin disease, allergies, gastrointestinal problems, infections, diabetes, and cancer, and can even help with weight loss. Let’s have a look at this supposed “superfood” and what it can or can’t do for us and our pets.

What Is It?
Coconut oil comes, not surprisingly, from coconuts. Conventionally, it has been produced from dried coconut meat through a process that often includes hydrogenation, however sites promoting coconut oil for health often prefer “virgin” oil obtained through cold pressing of fresh coconut. Coconut oil consists primarily of saturated fats, mostly a fat called lauric acid. These fats range from long-chain to medium-chain triglycerides (MCT). It does not contain trans-fats.

The types of fat in coconut oil are the center of discussions about its health effects. At one time, it was considered the worst type of dietary fat because saturated fats had been generally linked to increased risk of cardiovascular disease (CVD). As the evidence has accumulated and been refined, however, it has turned out that different kinds of saturated fats have different potential health effects. Trans fats and long-chain fatty acids appear to elevate the type of cholesterol (low-density lipoproteins) which increase CVD risk. Other fats, such as medium-chain triglycerides, seem to increase high-density lipoproteins, which may be protective against CVD. Many foods once considered likely to increase CVD risk, such as nuts and avocados, are now believed to be neutral or even possibly protective with regard to CVD.

Some of the fats in coconut oil are MCTs, and this is the foundation for most claims about the potential health benefits of coconut oil. However, only about 15-20% of the fats in coconut oil are true MCTs, and the effects of the most prevalent, lauric acid, on cholesterol are the subject of debate.

Most of the claims about health effects in humans for coconut oil focus on prevention of heart disease, treatment of diabetes and Alzheimer’s disease, and beneficial effects on weight loss. However, all kinds of other dramatic claims are easily found. In pets, CVD is a far different and generally less common entity, so the claims are more general, focusing especially on skin health, gastrointestinal health, and infections, though some vets claim they have cured cancers with it.

Does It Work?
The evidence for beneficial effects from coconut oil in humans is almost all indirect. Studies looking at MCTs in the diet show some potential benefits, and the proponents of coconut oil then extrapolate to assume that this product must have these benefits because it contains MCTs. This is a tenuous type of extrapolation at best. Claims for coconut oil are also often supported mostly by in vitro or lab animal research, which unfortunately can only prove an effect is possible, not that it will actually, reliably, and safely be seen in human patients.

One excellent summary of the existing research summarizes the evidence this way:

Coconut oil is not a cure-all. Research supporting claims of its role in preventing, reducing risk for, or curing HIV/AIDS, diabetes, thyroid disease, or Alzheimer’s disease is sparse or non-existent. There is little evidence to suggest it has a significant effect on inflammation or bacterial infection when consumed in food. And the pre-clinical research in cancer is mixed. Considerable research is needed to determine whether such claims may one day be substantiated. Further research may also help to clarify the potentially beneficial effect of coconut oil on HDL cholesterol levels and waist circumference. In order to reduce cardiovascular disease risk through diet, it will be necessary to determine the appropriate balance of dietary fatty acids that will favorably affect a range of cardiovascular risk factors. It is possible to include coconut oil in a healthful diet. Rather than focus on the saturated fat content of this single food ingredient, it is important to acknowledge that coconut oil contains a blend of fatty acids and other nutrients. It should not replace a significant amount of other plant oils in the diet. Those who enjoy the flavor of coconut oil may consider using it in place of butter or shortening, or paired with other cooking oils. Coconut oil can be one of a wide variety of plant-based foods that are included to support health and wellness, keeping in mind that only small amounts should be consumed.

As usual, there is almost no research available in dogs and cats, and the claims made for coconut oil in these species are extrapolated from human medicine, where we have seen the evidence is not strong to begin with. One study that added coconut oil to dog food to see if it would help with weight loss found that dogs on the diet with coconut oil lost less weight and had more body fat than dogs on diets with other sources of fat. Another study looked at various fats, including coconut oil, and exercise and how they affected the odorant detecting ability of dogs. It isn’t clear this has any clinical relevance to anything, but in any case the dogs getting the coconut oil seemed to have some decline in odorant detecting ability.

Some research has suggested that coconut oil shampoo may be effective against some common parasites in dogs. Another study indicated effectiveness against mange mites. However, both studies were conducted by the same research group with a strong bias in favor of such “natural” treatments and without some key controls for bias, so they need to be replicated to confirm these findings.

There is no clinical research of any kind showing a significant benefit from dietary or topical coconut oil in the prevention or treatment of any significant health problem.

Is It Safe?
No significant short-term risks have been identified for dietary coconut oil in humans in reasonable quantities, though diarrhea and other gastrointestinal problems have been reported. Long-term safety and effect on obesity, CVD< and other health risks hasn’t been determined.

Similar gastrointestinal symptoms have been reported in dogs, and there are anecdotal reports of more serious problems such as pancreatitis. There is no controlled research evidence investigating the safety of coconut oil in dogs and cats.

Bottom Line
There are some theoretical reasons to think the types of fat found in non-hydrogenated coconut oil might have health benefits in humans, but there is no conclusive research to support this. There is virtually no research on coconut oil in dogs and cats, apart from some studies looking at topical use for treatment of parasites. Therefore, the health effects, both risks and benefits, are unknown and supported only by unreliable anecdotal evidence.

 

Posted in Nutrition | 10 Comments

Evidence-Based Veterinary Medicine: What is it & Why Does it Matter?

The Equine Veterinary Journal and Equine Veterinary education journal have just launched a new open-access evidence-based medicine resource, including systematic reviews, critically-appraised topic reports (CATs) and editorials. This includes my most recent editorial on the subject, which I can now share here since it is an open access publication:

McKenzie, B. (2014), Evidence-based veterinary medicine: What is it and why does it matter?. Equine Veterinary Education, 26: 451–452. doi: 10.1111/eve.12216

The term ‘evidence-based medicine’ (EBM) began to appear in the human medical literature in the early 1990s. Since then, both the term and approach have become ubiquitous in human medicine. Although there has been controversy and debate about EBM, it has been widely adopted and almost universally endorsed by medical associations, specialty boards, patient advocacy groups and government agencies (Claridge and Fabian 2005).

References to ‘evidence-based veterinary medicine’ (EBVM) did not become common until nearly 10 years later. The term is now widely used, and references to EBVM are common in veterinary journals and continuing education meetings. However, the principles and practices of EBVM have not yet been endorsed or employed widely in veterinary medicine (Vandeweerd et?al. 2012).

Like other advances in human medicine, EBM must be adapted to meet the unique and varied needs of veterinary practitioners. However, once properly ‘translated’ into veterinary medicine, EBVM offers many benefits to veterinarians and our patients and clients.

What Is It?

At its heart, EBVM is the formal application of the philosophy and methods of science to generating knowledge and making decisions in veterinary medicine. As clinicians we need information to evaluate our patients’ health problems and provide effective preventative and therapeutic interventions. Evidence-based veterinary medicine provides tools and guidance to those who generate this information (through clinical research), those who disseminate it (through publication, continuing education, clinical practice guidelines, etc.) and those who utilise it (in clinical practice as well as public health and policy making). With better information and more efficient information management we are able to make better decisions and provide the best patient care possible.

Traditionally, veterinarians have relied on personal experience and the wisdom of mentors, teachers and opinion leaders to guide their clinical practices. Formal scientific research has played a role in informing clinical practice, but often the use of this resource has been inconsistent and indirect, filtered through the opinions of experts relied on by practitioners to interpret the scientific literature.

Evidence-based veterinary medicine is predicated on the understanding that this approach, which might be characterised as ‘opinion-based medicine,’ involves significant and predictable sources of error. Controlled scientific research effectively overcomes many of the limitations of individual judgement that lead us to the wrong conclusions and decisions.

Therefore, EBVM is partly a system for facilitating the effective use of controlled research to inform clinical practice. In addition to supporting the production of high quality research, EBVM promotes the dissemination of such research in a form which is practical and useful to clinicians. The scientific literature must be accessible to be useful, so EBVM proponents encourage open access publishing models. Since most clinicians lack the time and training to search and appraise the research literature personally, EBVM provides tools for synthesising this information in useful forms such as systematic reviews and clinical practice guidelines.

The main functions of EBVM are to facilitate the production of relevant, high quality scientific research, the effective dissemination of this research in a useful form and the integration of this information with clinical experience, client goals and values and the unique circumstances of each individual patient in order to inform decision-making and optimise patient care.

Why Does It Matter?

There is a robust literature evaluating the causes of error in clinical decision-making by physicians. This literature shows that the most significant sources of error are precisely those EBVM is designed to mitigate: the limitations of individual perception and judgement and inefficiencies of traditional information management approaches (McKenzie 2014). The same limitations and the same strategies for overcoming them likely apply to veterinary medicine.

Even the smartest, most highly trained clinician operates with all the limitations and quirks of the human brain. Science helps to compensate for these and improve the quality of the information available to us. Evidence-based veterinary medicine does not replace the judgement of the individual clinician. The practitioner is always the one to determine the information needed to help a particular patient, the relevance and reliability of the available scientific research and the best course of action within existing constraints, such as the interventions available, the values and resources of the client and other ‘real-world’ variables. However, ready access to relevant, high-quality scientific research supports the clinician in making the most effective diagnostic and therapeutic plan.

Evidence-based veterinary medicine also provides an approach to managing the information needed to make clinical decisions. The traditional approach is the ‘Just in Case’ model (Cockcroft and Holmes 2003). We endeavour to acquire and retain an enormous body of knowledge about health and disease and the interventions currently available just in case we need some of that information to help a given patient. This is an inefficient strategy that places a tremendous burden on the individual practitioner and provides much opportunity for error.

Evidence-based veterinary medicine promotes the ‘Just in Time’ model instead (Cockcroft and Holmes 2003). The clinician is trained to identify the information needed to manage a particular case and is given the tools and skills to locate that information and evaluate its relevance and reliability when it is needed. This reduces the cognitive burden on the practitioner and the opportunity for mistakes.

There is evidence in human medicine that both better information and more efficient information management provided by EBM improve patient outcomes and reduce medical errors and stress for clinicians (Bahtsevani et?al. 2004; Amarasingham et?al. 2009). Veterinarians and their patients would likely also benefit from wider use of these methods.

Finally, there is an ethical dimension to the use of EBVM. Of course, veterinarians are obligated to provide the best patient care possible and EBVM can facilitate this. However, there is also an ethical expectation that we should obtain informed consent from our clients before employing our interventions (Fettman and Rollin 2002). Such consent cannot be truly informed without explicit discussion of the uncertainties involved in a particular situation. Only through deliberate assessment and communication of the quality and limitations of the evidence for a particular intervention can we meet our obligation to properly inform our clients so they can make choices about the care we provide for their animals.

Evidence-based veterinary medicine provides practitioners with more useful and reliable information to support decisions, reduces error and stress, improves patient care and helps us meet our ethical obligations to our clients and patients. Evidence-based medicine is a well developed system widely employed in human medicine and, with appropriate adaptation, EBVM can be a similarly widespread and useful approach in veterinary medicine.

References

  • Amarasingham, R., Plantinga, L., Diener-West, M., Gaskin, D.J. and Powe, N.R. (2009) Clinical information technologies and inpatient outcomes: a multiple hospital study. Arch. Intern. Med. 169, 108114.
  • Bahtsevani, C., Udén, G. and Willman, A. (2004) Outcomes of evidence-based clinical practice guidelines: a systematic review. Int. J. Technol. Assess. Health Care 20, 427433.
  • Claridge, J.A. and Fabian, T.C. (2005) History and development of evidence-based medicine. World J. Surg. 29, 547553.
  • Cockcroft, P.D. and Holmes, M.A. (2003) Handbook of Evidence-based Veterinary Medicine, Blackwell Publishing, Oxford, UK and Malden, MA.
  • Fettman, M.J. and Rollin, B.E. (2002) Modern elements of informed consent for general veterinary practitioners. J. Am. Vet. Med. Ass. 221, 13861393.
  • McKenzie, B.A. (2014) Veterinary clinical decision-making: cognitive biases, external constraints, and strategies for improvement. J. Am. Vet. Med. Ass. 244, 271276.
  • Vandeweerd, J.M., Kirschvink, N., Clegg, P., Vandenput, S., Gustin, P. and Saegerman, C. (2012) Is evidence-based medicine so evident in veterinary research and practice? History, obstacles and perspectives. Vet. J. 191, 2834. doi:10.1016/j.tvjl.2011.04.013.
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SB277- Eliminating Personal Belief Vaccine Exemption in California

I’m stepping outside of my usual territory as a veterinarian to raise a human healthcare issue– vaccination exemptions. In my state of California, it is very easy for misinformed parents with unfounded concerns about the safety and efficacy of vaccinations to choose not to vaccinate their children and yet send those children to school where they can pose a health risk to others. In the wake of the recent measles outbreak centered at Disneyland, the California state legislature is considering legislation to eliminate the “personal belief” exemption from vaccination requirements for schoolchildren. As a parent and a scientist, I support this legislation and am advocating for it in my community. I have put together some information and links on the subject for others in the state who wish to contact their legislators and urge passage of this bill.

I have started a petition to the CA State Senate and State Assembly which I encourage supports of SB277 to sign:

iloveimmunity

 

Here is my letter to the parents in my own child’s school:

Parents,

The CA State Assembly is currently considering SB277, a bill that originated in the state senate and is intended to reduce the risk of vaccine-preventable disease in California by preventing children from attending schools, daycare centers, or other such institutions if they are not appropriately vaccinated. The legislation allows exemptions for medical reasons but not on the basis of the personal beliefs of parents. As this issue significantly affects all of us as parents of school-aged children, I urge members of the community to inform themselves about this legislation and to make their views known to their representatives.

I have collected some useful links below with additional information about the legislation and with reliable sources of information concerning the relevant vaccines. While parents have the right to refuse vaccination for their children, even when this decision is based on misinformation or fear, they do not have the right to endanger other children or vulnerable individuals through this choice. Opponents of this legislation include extreme anti-vaccine activists who have likened the measure to the Nazi Holocaust and have threatened violence against legislators who support it. Though misguided and misinformed, these views could intimidate politicians into not taking action on this important issue, so it is important that they hear from more moderate citizens with all points of view.

Thank you,

SB 277
http://www.vaccinatecalifornia.org/sb277_faqs

How to Contact Your Representatives
http://findyourrep.legislature.ca.gov/

Reliable Information About Vaccines
http://www.vaccines.gov/
http://www.cdc.gov/vaccines/vac-gen/howvpd.htm
http://vec.chop.edu/service/vaccine-education-center/home.html
http://www.vaccine.org/

Parents Supporting Appropriate Vaccination
http://www.voicesforvaccines.org/
http://shotofprevention.com/
http://valueofvaccination.org/

Herd Immunity
http://www.cdc.gov/vaccines/parents/vaccine-decision/prevent-diseases.html
http://www.vaccines.gov/basics/protection/
http://www.who.int/bulletin/volumes/86/2/07-040089/en/
http://eziz.org/assets/docs/IMM-1056.pdf
http://cid.oxfordjournals.org/content/52/7/911.full

Here are some statistics on the risks associated with previously common childhood illnesses and the effects of vaccination on these. I think it is clear that we SHOULD prevent these diseases:

http://www.cdc.gov/measles/about/complications.html
http://www.cdc.gov/mumps/about/complications.html
http://www.cdc.gov/pertussis/about/complications.html
http://www.cdc.gov/chickenpox/about/complications.html
http://www.ncbi.nlm.nih.gov/pubmed/18000199
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6316a4.htm

Vaccines and Autism

  1. A recent study of over 95,000 children looked at those at highest risk for ASD, siblings of those with the syndrome, found no link to vaccination, confirming yet again the results of other studies involving millions of children:

http://jama.jamanetwork.com/article.aspx?articleid=2275444

Conclusions and Relevance  In this large sample of privately insured children with older siblings, receipt of the MMR vaccine was not associated with increased risk of ASD, regardless of whether older siblings had ASD. These findings indicate no harmful association between MMR vaccine receipt and ASD even among children already at higher risk for ASD.”

  1. The American Academy of Pediatrics has clearly stated that the extensive research shows no connection between MMR or specific ingredients in vaccines, including thimerosol, and ASD. The AAP has listed many of the original studies here so parents can investigate them for themselves:

https://www2.aap.org/immunization/families/faq/vaccinestudies.pdf

  1. The Centers for Disease Control has also stated directly that “studies have shown that there is no link between receiving vaccines and developing ASD.” Here is the CDC page addressing the issue, again with links to relevant evidence:

http://www.cdc.gov/vaccinesafety/concerns/autism/

  1. Autism Speaks, a parent and child advocacy group for families affected by ASD has also officially accepted the evidence that vaccines are not linked to the disorder and provides summary of some of the most compelling studies:

https://www.autismspeaks.org/science/science-news/new-meta-analysis-confirms-no-association-between-vaccines-and-autism

“Over the last two decades, extensive research has asked whether there is any link between childhood vaccinations and autism.  The results of this research are clear: Vaccines do not cause autism.  We urge that all children be fully vaccinated.”

  1. For those not into reading research studies, PBS has put together a clear and comprehensible presentation on the vaccine/ASD question and the general issue of childhood vaccinations which is fact-based and informative:

http://www.pbs.org/wgbh/nova/body/autism-vaccine-myth.html
http://www.pbs.org/wgbh/nova/body/vaccines-calling-shots.html

Toxins in Vaccines

In addition to having accurate information about the ingredients in vaccines, it is important to have accurate information about the health effects, if any, of those ingredients. No substance is absolutely safe (it is possible, after all, to die from too much oxygen or water despite the fact that both are necessary for life). Likewise, many substances can be safe or even beneficial at some level or in one form even when they are harmful at a higher level or in a different form.

As an example, people are often familiar with the use of formaldehyde in embalming and with the fact that, under the right circumstances, it can increase the risk of cancer and cause other adverse effects. So it is natural to be surprised to see it listed as an ingredient in vaccines. What people often do not know is:

1. Formaldehyde is produced naturally in the body and is essential in the production and metabolism of certain amino acids needed to make proteins.

2. The amount of formaldehyde in vaccine sis far, far less than what is normally present in our bodies and naturally produced in many foods. The highest possible exposure to this chemical in normal vaccination practice is less than 1% of the amount already present in the body naturally, and the extra is typically metabolized completely within 30 minutes after vaccination.

3. The formaldehyde present in vaccines makes them safer by reducing the risk of vaccines becoming contaminated with viruses and causing infections or other illness.

Here are some further sources of information about formaldehyde and other vaccine ingredients people may have concerns about:

http://www.fda.gov/BiologicsBloodVaccines/ScienceResearch/ucm349473.htm
http://www.harpocratesspeaks.com/2012/04/demystifying-vaccine-ingredients.html
http://www.cdc.gov/vaccines/vac-gen/additives.htm
http://www2.aap.org/immunization/families/faq/vaccineingredients.pdf
http://www.fda.gov/BiologicsBloodVaccines/SafetyAvailability/VaccineSafety/ucm187810.htm

So when considering vaccine ingredients when making decisions about vaccination, it is necessary to find detailed and accurate information about them to determine whether or not we should be concerned about individual compounds.

 

My letter to my representative: 

I write to urge you to vote for SB277, which will make our state’s schools safer.  

I appreciate the critical importance to public health of vaccination both as a veterinarian and as the parent of a student in the California public schools. While our generation has been fortunate enough not to see the epidemics of polio, measles, and other vaccine-preventable disease our parents can still remember, many of these disease can and will return to harm our own children if we are not vigilant. Parents certainly have the right to decline vaccination for their children, even if their decision may be based on misinformation and fear. However, they do not have the right to endanger my daughter or others by sending their children to public schools unvaccinated.

The measles outbreak and the pertussis epidemic are stark reminders of how fragile we are as a community.  SB277 will protect our children and communities by raising the vaccination rates.  SB277 is the best way to ensure that the weakest among us – the young, the ill, the old, and those for whom vaccines don’t work – are safe from vaccine-preventable disease. 

We are relying on you to help protect our communities.  This legislation is the right thing to do.  Please vote for it.

 

 

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