Cupping for Animals- Yes, Apparently that Really is a Thing!

I’ve written before about so-called Traditional Chinese Veterinary Medicine (TCVM). It is the adaptation for veterinary patients of a hodgepodge of pre-scientific folk theories and practices cobbled together for largely political reasons by Mao in the 20th century. The most popular TCVM therapy is acupuncture, which I have discussed in exhaustive detail many times. TCVM herbal therapies are also fairly common, and its variety of massage (Tui Na) as well as some dietary practices are sometimes recommended by TCVM practitioners, though they have not become as common outside this community as acupuncture.

There is one Chinese Medicine treatment that I haven’t discussed before, largely because I had never heard of it being used in veterinary patients: cupping. Cupping has had a moment in the limelight lately because it is the alternative medicine fad du jour among some Olympic athletes this year (much as kinesio taping was in 2012, though that seems less popular this year.

cupping-olympics

Cupping is basically the practice of placing a glass or plastic container on the skin and creating a partial vacuum, with heat or a suction pump. Sometimes, the skin under the cups is cut or scarified (so-called “wet cupping”) to induce bleeding. This leaves a visible bruise, which is often impressive, and is supposed to prevent or treat injury by increasing blood flow, expelling toxins, moving Ch’i, or any of a number of other purported mechanisms. Others have written about cupping, explaining why it is implausible in theory and entirely unproven in practice. And though it is probably mostly harmless, it can be the cause of serious injury if improperly done.

cupping-feature-e1466719915513

After the news media starting discussing cupping by Olympic athletes, I was asked about the use of this practice in veterinary patients. I had assumed it would not be practical since most of my patients are covered in hair, which would impede the creation of a seal necessary for generating a partial vacuum. Unfortunately, even I had underestimated the lengths to which some TCVM practitioners will go to inflict their methods on animal patients. Here is an example of a dog subjected to cupping.

cupping dog There is even a video of this being done to an apparent wound on a horse.

To be fair, cupping does seem pretty uncommon even among TCVM practitioners however, there are references to it on practice web sites along with acupuncture and other TCVM therapies, and lectures on cupping have been given at a number of continuing education conferences for alternative medicine vets (e.g. from the Ch’i Institute, the leading organization teaching and promoting TCVM, and the American Academy of Veterinary Acupuncture and International Veterinary Acupuncture Society joint conference).

So once again, while it shouldn’t need to be said:

There is no legitimate evidence that cupping is effective for any medical condition in any species.

  1. Human patients report it to be moderately uncomfortable, so there is no excuse for applying to animals who cannot give their consent to a painful procedure when there is no reason to believe there will be any benefit.
  2. It can cause serious injury, and while this appears to be rare it is not a risk that it makes any sense to take when, once again, there is no good reason to believe it has any benefits.

 

 

 

 

 

 

 

 

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Tellington TTouch- How to Sell Petting and Magic Rituals as a Powerful Healing Practice

Tellington TTouch is a subject I have long avoided, as I tried to avoid talking about pet psychics, because it is such vapid nonsense that there is really very little to discuss. As Thomas Jefferson once said, in another context,

Ridicule is the only weapon which can be used against unintelligible propositions. Ideas must be distinct before reason can act upon them…

The description provided by the inventor of this magic ritual may help to illustrate the problem with trying to take TTouch seriously as a medical practice:

[TTouch] is a bodywork and training method based on circular movements of the fingers and hands all over the body. The intent of the TTouch is to activate the function of the cells and awaken cellular intelligence — “turning on the electric lights of the body.” The TTouch is done on the entire body, each circular TTouch complete within itself. It is not necessary to understand anatomy to be successful in speeding up the healing of injuries or ailments, or changing undesirable habits or behavior.

This collection of impressive-sounding but meaningless words is worthy of a Deepak Chopra quote generator. “Cellular intelligence” gives the game away by its similarity to the “innate intelligence” of Palmer’s chiropractic, or the “vital force” of Hahnemann’s homeopathy, as well as “Q’i,” “Prana,” and all the other mystical energy forces that cannot be identified or evaluated by science but which magic healers claim to be able to manipulate to affect health.

TTouch, like Reiki, Therapeutic Touch, and all the other varieties of faith-healing and “energy medicine” out there, is simply a spiritual practice masquerading as a medical treatment. None of the “energies” that are claimed to be behind these therapies and to have such tremendous power have ever been shown to actually exist, and none of the therapies themselves can provide convincing evidence of any effect beyond the placebo.

Ms. Tellington further illustrates the fundamentally faith-based nature of this personal religious healing practice in her use of language. She notes that, “My philosophy that all beings–humans and animals alike–are reflections of the Divine Whole formed the early basis of Tellington TTouch and anchors it today.” She frequently refers to “the magic of TTouch. And, of course, she employs the vague and deceptive references to “quantum” phenomena that are so common in efforts to make faith-healing methods sound scientifically legitimate:

This book is an introduction to quantum science, explaining how we can be effective with our intention working from a distance. This is not new but many people are just now awakening to the “infinite possibilities” offered by quantum science…you will discover fascinating studies that have been done around the world with many universities and research institutions about the effect of intention and the understanding that all information is contained in the quantum field and is available to us when we learn to listen.

The claims made for the effects of TTouch are broad, covering almost every aspect of the physical, psychological, social, and spiritual dimensions of life:

a simple and effective means to relieve a vast range of common and uncommon health issues — from a simple headache to a life threatening emergency.

can improve performance and health

solutions to common behavioral and physical problems

helps establish a deeper rapport between humans and animals through increased understanding and more effective communication.

a newfound sense of well-being and renewal

relief from everyday physical and emotional issues such as headaches, backache, neck pain, depression, and sensitivity to touch.

can be effective in relieving asthma

teachers are using these techniques in the classroom to address behavioral issues and to facilitate problem-solving and positive growth and development in their students.

enhance relationships beyond the constraints of language. Parents are finding new channels to connect with their children. Spouses are deepening their relationships and discovering new ways to nurture one another in a non-sexual context. Friends come to new levels of understanding and appreciation. TTouch is a powerful tool to enrich all your interpersonal relationships.

TTouch-for-You is used successfully for:

  • Fostering a sense of well-being

  • Reducing stress

  • Pain relief in neck, back and legs

  • Migraine relief

  • Depression

  • Releasing unfounded fear and anxiety

  • Managing panic attacks

  • Management of arthritis pain

  • Stroke support

  • Enhancing focus and learning in the classroom

  • Helping youth at risk

  • Improved quality of life for seniors

  • Deepening interpersonal relationships

  • And much more

That’s a pretty impressive list of accomplishments for a system of touching rituals made up by one person based entirely on her own intuition. Unsurprisingly, however, there is absolutely no reliable evidence to support any of these claims. The TTouch web site claims, “We have also gathered a rich legacy of anecdotal evidence to support the effectiveness of TTouch to enhance personal wellness and quality of life” without any apparent recognition that this is meaningless in terms of validating the claims made for the treatment (see discussion of anecdotal evidence below).

However, as is so often the case, there is an understanding on the part of those selling quackery that science has marketing value and people want to believe that such a powerful, life-changing treatment has been scientifically validated, even if they rely primarily on anecdotes to judge the practice themselves. So there is a page devoted to “Research and Studies.”

Nothing could illustrate more clearly the contempt and lack of understanding of science than the collection of links grouped under this heading. They consist almost entirely of anecdotes dressed up as science. Uncontrolled case reports or case series with no placebo control, subjective measures of effective, and little to no effort to account for chance and bias are the meat and potatoes of faux science used to promote rather than investigate alternative therapies.

The few links that lead to actual scientific research concern only the effects of touch in general. While there is evidence that some domesticated animal species seek human touch and that they both appear to enjoy it and exhibit physiologic responses that support this interpretation, that says nothing about the validity of the grand claims made for TTouch. Gentle touching almost certainly does have calming effects and generates real physiologic responses in domestic animals. But this gives us no reason to think the specific methods of Tellington TTouch are superior to, or any different at all, from ordinary petting or that there is any mystical energy involved. And it certainly does not justify claims to improve the healing of serious, even “life-threatening” disease!

Ultimately, TTouch is just one in a seemingly endless collection of magic rituals invented and successfully marketed by one individual based entirely on wishful thinking and anecdotes. There is no reason to think it has any more value than any gentle, kind touch, or that it can prevent or treat disease. TTouch is, however, a marvelous illustration of an impressive number of Warning Signs of Quackery. Here are a few of the items on Dr. Walt’s list that appear just on the first few pages of the TTouoch web site:

Is the product or practice promoted as a “Major Breakthrough,” “Revolutionary,” “Magic,” or “Miraculous”?

Do the promotions try to simply elicit an emotional reaction rather than present clear information to help you make an informed decision about the product?

Is only anecdotal or testimonial evidence used to support claims of effectiveness?

Are claims made about scientific support without giving specific details?

Is the information about the therapy or product being provided by a professional lacking in the proper credentials?

Are technical words used without a clear definition?

Would a treatment require you to abandon any well-established scientific laws or principles?

Is the treatment said to be effective for a wide variety of unrelated physiological problems?

Is the product a quick and easy fix for a complicated and frustrating condition?

Do proponents use statements that are basically true but unrelated to the therapy?

Does the proponent disguise the truth with vague and misleading statements?

A Word about Anecdotes and Testimonials
As has happened for every other product or practice I have criticized on this blog, I have no doubt I will receive a steady trickle of comments about TTouch saying, in essence, “I tried it and it worked” or “How can all those people who have used it be wrong?” I will try to pre-empt some of this by referring readers to this collection of articles explaining why anecdotes and testimonials prove absolutely nothing.

  1. They are unreliable because uncontrolled observation is very prone to error and misinterpretation.
  2. There is a bias in the posting of testimonials. People with positive experiences are more likely to share them than people with negative experiences, so they misrepresent what people are actually experiencing.
  3. Similar testimonials can be found to support every single treatment ever invented, including those proven to be useless or even harmful. If we accept testimonials as evidence, than everything works. It’s a test no treatment ever fails.
  4. Tens of thousands of year of trial-and-error and anecdote led to virtually no improvement in human health and longevity. A mere couple of centuries of relying on science instead has double our life expectancy, dramatically reduced death, disease, and suffering, and proven that science work better than stories.

I encourage you to read these articles that discuss in much more detail why anecdote simply don’t help us evaluate medical treatments.

Why We’re Often Wrong Testimonials Lie
The Role of Anecdotes in Science-Based Medicine
Why We Need Science: “I saw it with my own eyes” Is Not Enough
Don’t Believe your Eyes (or Your Brain)

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Surgical Checklists Reduce Complications for Veterinary Surgery Patients

Evidence-based medicine (EBM) is a useful set of principles and tools that can help improve patient care. Unfortunately, there is little that is sexy and dramatic about EBM. Science in general tries to avoid the grandiose generalities that make for good marketing, and EBM in particular tries to focus on narrow, well-defined questions and answers that are constrained by the available evidence. This makes the impact of EBM methods less clear and dramatic, though no less real.

One example of a simple, inexpensive practice that is supported by good evidence and has real impact on patient well-being, but which nevertheless seems dull when talked about, it pre-surgical checklists. In his book The Checklist Manifesto, surgeon Atul Gawande eloquently argued that the simple process of having a formal, explicit checklist of procedures to g o through before, during, and after surgery would reduce medical errors. And despite the scoffing of many surgeons, who felt they were too smart and educated to need anything so obvious as a checklist to prevent their mistakes, the evidence has accumulated that the use of such checklists reduces errors, cost, injuries, and deaths.

Sadly, evidence for even such simple, low-cost interventions is often hard to come by in veterinary medicine. However, a recent study has now provided some data supporting the use of surgical checklists in the care of veterinary patients.

Bergström, A., Dimopoulou, M. and Eldh, M. (2016), Reduction of Surgical Complications in Dogs and Cats by the Use of a Surgical Safety Checklist. Veterinary Surgery, 45: 571–576.

The study involved assessing the rate and severity of surgical complications in 300 dogs and cats undergoing surgery prior to the introduction of a surgical checklist. The checklist was then put in use,  and the next 220 surgical patients were also evaluated for complications. The comparison showed quite clearly that, “The frequency and severity of postoperative complications was significantly decreased after introduction of a surgical checklist.”

This is the sort of simple, inexpensive tool that can be put into use and which, over the many thousands of surgeries done on veterinary patients every year, can have a dramatic effect on the welfare of patients. While it may not be as dramatic as announcing a “revolutionary breakthrough” in disease treatment, it is the kind of tangible improvement in medical care brought about by science and evidence-based medicine.

 

 

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More Nonsense from Holistic Vets about Commercial Therapeutic Diets

One of the subjects that holistic vets and other advocates of alternative practices get really passionate about is the evils of commercial and conventional diets. They promote a laundry list of myths about pet food, many of which I’ve addressed before:

  1. Raw is better than cooked-

Raw Diets for Pets

2.Vets know nothing about nutrition-

This is particularly hypocritical given that the claims made about the evils of commercial food and the virtues of alternative diets are generally made by—yup vets!— and these folks have no more training or expertise than the rest of us. In fact, the most reliable source of expertise on pet food are board-certified veterinary nutritionists, veterinarians with extensive training in nutrition. However, their claims are casually dismissed with innuendos or accusations about financial bias by vets who themselves make their living selling the stuff they advocate for.

What do Vets Know about Nutrition?

3. You can tell the quality of a food from reading the ingredients on the label-

Sorry, you can’t. Partly this is the fault of regulators, who don’t require truly important information to be put on pet food labels in a clear and understandable way. And partly the uselessness of labels as a measure of food quality comes from the meaningless vagueness of the concept of “quality” and all the myths and misconceptions about specific ingredients promoted by these vets.

Pet Food Nutrition Myths
Nutrition Resources for Pet Owners
Dog Food Logic

A recent article from the ever-unreliable Dogs Naturally Magazine gave some alternative vets a platform for repeating some myths and misconceptions about what are often called “prescription diets,” though this is technically incorrect. These are better referred to as “therapeutic diets” because they are intended to be useful in treating or preventing specific medical problems, not simply provide good overall nutrition, but they do not actually require a prescription, merely oversight from a qualified veterinarian.

The evidence for these diets varies from strong (e.g. kidney diets for cats with kidney disease) to weak (e.g. some of the diets for cognitive dysfunction in older dogs), but while there are some good arguments against some of these foods, none of the ones made in this article are worth taking seriously.

The article begins by asking a bunch of holistic vets to rank a few foods based only on the ingredient lists, with one food being a prescription diet. Not surprisingly, the vets tended to rank this diet quite low, based on these sorts of arguments:

Dr Marty Goldstein, author of The Nature of Animal Healing [said] Food #3 ranked last, based on the use of corn for its first ingredient, followed by by-product meal.

Dr Jodie Gruenstern: “This food was the lowest quality in the list. It contains GMO corn, soy (lots of it!), which is a common allergen, synthetic vitamins/minerals, shavings (if you didn’t know, the ingredient cellulose is literally sawdust), natural flavors, which usually mean MSG.”

Dr Jean Dodds: “Poor quality food: the first ingredients are corn, which is often GMO, and chicken by-product meal rather than whole chicken. Flax and soy are phytoestrogens.”

Dr Judy Morgan: “This is a Pet Store Food. Corn is the first ingredient, no muscle meat used, only by-product meal, synthetic vitamin/mineral supplement, corn and soybean are GMO, waste fillers are abundant. Overpriced in my opinion, considering the poor quality, cheap ingredients used).”

Dr Dee Blanco: “This one starts with corn to increase inflammation, then adds lighter fluid to it with soybean products and poor quality protein. Then it tries to make up for the poor quality foundational ingredients by adding synthetic supplements of the poorest quality, such as calcium carbonate, folic acid, ‘generic Vit E supplement’, etc. Looks like they added l-tryptophan to calm the nervous system down after putting the body into overdrive inflammation. Natural flavors?? Could be an entire cadre of carcinogens, allergens and toxins. Argh!”

So we have a long list of villainous ingredients supposed to cause inflammation and other health problems. Any truth in this fear mongering?

Corn and Soy are Evil

Obviously, this sort of simplistic characterization of foods as inherently good or evil is not scientific in tone, and in the case of the particular claims she makes about these ingredients they are not consistent with mainstream opinion or the evidence. Veterinary nutritionists agree that particular sources of protein and carbohydrate in canine diets are not intrinsically harmful or beneficial and that the health effects of diet are a complex set of interactions between many factors. Duck and bison are no more nor less likely to trigger food intolerance than chicken or beef, and tapioca or potatoes or green peas are no better nor no worse than corn and wheat and soy as carbohydrate and protein sources.

GMOs are Evil

This is a hot-button issue these days, and while it is complex, the evidence to date does not support the sort of hysteria about GMOs these vets promote. This is, of course, a topic which deserves multiple posts on its own. Dr. Dodds and others regularly list GMO ingredients as unhealthy, promoting inflammation and food intolerance, and there is no evidence to support this. While there is always the potential that particular modifications of food crops and animals could lead to health risks, the anxiety about genetically modified organisms is generally ideological and based on misconceptions or poor understanding of the relevant science. It is part and parcel of the Appeal to Nature Fallacy, and the existing evidence does not support most of the hysterical fears about GMO. Dr. Dodd’s claims are not based on research from nutrigenomics but are simply part of her own beliefs and prejudices, and she provides no compelling scientific evidence to support her claims. Relevant discussion of this issue and the evidence can be found here: 1, 2, 3, 4, 5, 6, 7.

By-Products are Evil

Here’s what one nutritionist I’ve talked to has say about by-products:

A by-product only means that it was not the intended main product of the industry. It gives no indication on nutrient profile, digestibility and bioavailability, etc. Many people who dislike by-products will happily buy wheat bran (a by-product of the baking industry). Moreover, by-products vary according to country and culture. Liver, an excellent source of nutrition, is considered a by-product in the US because skeletal meat is the primary product of slaughtering an animal and many people do not eat organs any more. By-products can be excellent ingredients in pet food and it would be wasteful (and terribly self-centered) to not use it to nourish humans or animals.

The concept is meaningless, and used to demonize foods that people think of as “icky” without any reference to their real nutritional value.

Let’s look at some of the other claims. he idea that corn is a major cause of inflammatory diseases is an unproven hypothesis. The claim that phytoestrogens in soy used in pet foods have negative effects on health is an unproven theory. Both of these are presented as facts when they are just personal beliefs.

“Natural flavors” usually means hydrolyzed animal tissues, not MSG, so this is just false. And “synthetic” vitamins are identical to those extracted from plants, so the idea that they are somehow less useful or more harmful is just the Naturalistic Fallacy in action.

The bit about “sawdust is particularly silly. Cellulose is a natural part of the wall of plant cells. Sure, it is present in wood, but it is also present in all the fruits and vegetables that these vets would laud as healthy for our pets. The usual source of cellulose as a dietary fiber in pet foods is the bran from cereals such as wheat, not “sawdust.” Such hyperbole is clear evidence of a preference for ideology over facts.

The article also uses a bit of drama to suggest that therapeutic diets are poor-quality or identical to over-the-counter diets and the designation only serves to justify charging more.

Now, a 30lb bag of the regular food is $47.99 at Petsmart. The prescription diet dog food can also be purchased at Petsmart for $84.95 for a 27.5lb bag. It’s twice as expensive!

Now, you might be thinking this is because the prescription diet was formulated and tested with a specific condition in mind. This is completely false.

While an over-the-counter food with a health claim (such as controls weight) is subject to FDA regulations and enforcement, the FDA practices “enforcement discretion” when it comes to veterinary diets. Put another way, this means the FDA has not reviewed or verified the health claims on any veterinary diet. Did you catch that? There are very few ingredients in veterinary diets that aren’t also in other regular diets.

In the example above, I’d say the pet store brand is a better quality food, wouldn’t you? The prescription diet contains by-product meal (which comes straight from the rendering plant), lots of soybean and corn products (a cheap replacement for animal protein) while the regular food contains more expensive, higher quality ingredients.

Again, here’s the response of a nutritionist who actually knows something about veterinary diets to this claim:

This is a misrepresentation. Veterinary diet claims do have to be substantiated as well. The FDA did have some leniency regarding veterinary diets regarding the extent of their health claims because they are usually used under the guidance of a veterinarian to improve the life of the pets. However, the FDA is concerned about many so called therapeutic diets now marketed directly to the consumer, so they might start enforcing legislation if they are not used properly, i.e. under veterinary involvement

Regarding price, good companies invest in research, that goes into designing the food, sometimes funding basic research that would further our knowledge on particular diseases (without an immediate product to market and sell) plus trials in healthy and diseased pets, etc. So, I understand why a veterinary diet from a responsible company costs more money, not because the ingredients are more expensive, but due to the knowledge invested behind it.

These holistic vets are so ideologically biased against commercial diets that they even claim that ingredients they routinely recommend as beneficial for many health conditions magically become harmful when included in such foods:

And fish oil is a terrible addition to pet foods. It’s much too fragile to be added to processed foods and as soon as the bag is opened, it will oxidate and cause inflammation in your dog. Ironic isn’t it, when the food is supposed to be treating inflammation in the first place?

Actually, it’s not ironic, it’s just a bit of ignorance and prejudice masquerading as an informed opinion. Fish oils can be added to foods in a manner that has all the same health benefits of giving them separately, if this is done properly by a company with real nutrition experts who know what they are doing.

Bottom Line
I usually write brief summary of my conclusions for these posts, but in this case I could not write anything that makes the point better than the following, again from a nutritionist knowledgeable about these issues:

All these arguments are just guilt trips and not based on reliable science and assume the quality of a final product depends solely on certain random criteria form the individual ingredients rather than in deep knowledge of the current state of nutritional science, excellent quality control during formulation, reception of ingredients, extrusion, and storage conditions.

What we have here is unsubstantiated belief presented as fact. And this kind of fear mongering has real dangers. There is, for example, very good evidence that feeding commercial diets for cats with kidney disease can reduce suffering and prolong life. Yet I have seen clients feeding unbalanced and completely inappropriate homemade concoctions instead because they have been frightened and misled by this kind of propaganda and are unwilling to feed diets with proven benefits.

As I’ve said many times, no one knows the perfect diet for any given patient, and I am open to the possibility that there are benefits to feeding alternatives to the usual canned and dry commercial diets. But these benefits must be proven, not simply invented out of whole cloth or wrung out of twisted misrepresentations of nutrition science.

Posted in Nutrition | 24 Comments

Anti-Medicine Vets: Should Rejection of Scientific Medicine Disqualify One from Practicing as a Licensed Veterinarian?

There is a wide range of opinions about most medical topics in veterinary medicine, and rarely sufficient evidence to definitively establish who’s right and who’s wrong. For better or worse, we have tremendous individual latitude in deciding what treatments to offer and in counseling our clients.

But is there ever a point where a vet is so vehemently opposed to so much of what constitutes modern veterinary medicine that they shouldn’t be allowed to hold a medical license? If someone reviles the rest of the profession, claims that our most common and well-established interventions are useless or harmful, and offers ONLY unproven or disproven alternative treatments, why should they be allowed to hold the same license and practice under the same terms as the rest of us? Is it misleading for animal owners to call oneself a veterinarian when one’s entire philosophy and practice inconsistent with the accepted approach of the veterinary profession? Are there truly absolutely no standards at all for what constitute legitimate veterinary medicine?

Of course, in reality there is virtually nothing in the way of a standard of care within veterinary medicine. Government seems uninterested in regulating the profession beyond policing drug abuse. And the institutions of organized veterinary medicine, such as the AVMA, have absolutely no interest in interfering with the sacred autonomy of individual veterinarians, regardless of what sort of treatments they employ. The AVMA notoriously refused to consider even the small step of acknowledging that homeopathy is a useless fraud,  and it includes complementary and alternative medicine as part of the definition of veterinary medicine, despite being unable to define what it is. The general approach is that if something makes vets money, it is fine to offer regardless of the state of the scientific evidence.

However, there are some principles of law and ethics that have been articulated which the extreme anti-medicine vets seem to violate. For one, veterinarians are generally required by law to have a degree from an accredited school of veterinary medicine. The overwhelming majority of what is taught in such schools is science-based, conventional medicine. The purpose of such a requirement is to ensure the public is not harmed by practitioners who don’t understand science or scientific medicine and offer instead unscientific, dangerous quackery. But what is the value or meaning of such a degree if an individual repudiates nearly all of what they have been taught? A vet who explicitly rejects the basic principles of science and the core therapies of veterinary medicine is no less a threat to the public than a homeopath or other non-veterinarian who practices on animals without a formal veterinary education. In fact, such faux veterinarians are even more of a threat to veterinary patients because the public can be misled into believing they are practicing as legitimately medical practitioners.

The AVMA ethics guidelines also specifically prohibit deliberately defaming other veterinarians or deceiving the public in one’s capacity as a vet:

Veterinarians must not defame or injure the professional standing or reputation of other veterinarians in a false or misleading manner. Veterinarians must be honest and fair in their relations with others, and they shall not engage in fraud, misrepresentation, or deceit.

Yet the extreme alternative vets who base their practice entirely on dismissing mainstream medicine as useless and dangerous, and who claim to be part of this profession while rejecting its basic foundations are inherently defaming other vets and deceiving the public. What is the purpose, other than being able to make money from clients, of calling yourself a veterinarian while simultaneously denouncing the rest of the profession as greedy, negligent, and dangerous? Why should this be allowed?

Of course, even the majority of so-called “holistic” veterinarians make at least some concessions to science and scientific medical practices. I am not suggesting that merely offering untested on unproven therapies disqualifies one from serving as a licensed veterinarian. Even offering clear nonsense, such as homeopathy and “energy medicine” can be combined with otherwise acceptable patient care in an integrative model, though I believe the profession needs to do more to inform the public about the lack of value to such practices. But there are some pretty extreme voices in alternative veterinary medicine who reject the core values and practices of the profession, and it seems unfair to the public and the profession that these individuals can present themselves as licensed veterinarians on an equal basis with the rest of us. Here are a couple of examples of these most extreme voices in alternative veterinary medicine.

Patricia Jordan-

Dr. Jordan is one of the most vehement opponents of vaccination in the veterinary field. She is the owner and author of the web site and book Mark of the Beast Hidden in Plain Sight: The Case Against Vaccination. Here is a sample of the rhetoric from her site.

mark of beast

WE SHOULD REWRITE THE BOOKS OF MEDICINE TO REFLECT THE UNDERSTANDING THAT DISEASE HAS EVOLVED FROM THE VERY USE OF VACCINES.

NEVER SHOULD WE HAVE ALLOWED THE INNOCULATION OF POISON, THE GRAFTING OF MAN AND BEAST. NOW WE ALL CARRY THE SCAR, OF MEDICAL SUPERSTITION THE GENETIC PLAGUE OF INQUITY

The purpose of putting the Mark of the Beast together was to provide education for the reader or listener to a very important quest that apparently has been going on from the beginning of the illusion of time….conventional medicine [is] not the direct path to true healing and wellness…true health and wellness comes from a very natural setting and one from the relationship of the individual in balance with the earth and all of the treasures a healthy ecosystem has to offer…The important ingredient everyone also needs is right relationship with the other living organisms of the environment we share, respect for each other and the most holy relationship that of the one with the intelligence that designed this most wonderful system. Our fall from right relationship is as much responsible for disharmony and disease as is the turmoil the daily disturbance this imbalance maintains…Vaccines and drugs are at odds with the intelligence of the almighty design and getting back to the garden means getting back to the natural form…

Not only does she espouse absolutely insane ideas about the dangers of vaccination, she promotes bizarre conspiracy theories about cover-ups at the CDC and malign cabals of pharmaceutical companies hiding clear evidence of widespread harm to people and pets from vaccines, and she actively blames the veterinary profession for choosing profit over the welfare of patients.

THE PROFITABLE SECRET OF VACCINE INDUCED DISEASE

Brave veterinarians are speaking out, revealing veterinary malpractice committed through pharmaceutical pressure and greed.  THIS visual documentation is the first on the horrors of VID.

DEATH BY VACCINOSIS
Patricia Jordan, DVM, CVA, CTCVH, & Herbology

Unforgettable photos, video and veterinary records prove widespread veterinary malpractice through unregulated over-vaccination.

Vaccines are criminal in what they are doing to our pets and our people….CRIMINAL

Listen to the parents, not the Pediatricians! Listen to the pet owners and not the vets!

Doctors that spend the time to find and promote health take more time in the exam room, and it doesn’t make financial sense. Doctors aren’t rewarded for the health of their patients; they are rewarded when their patients are sick and they need testing and medical intervention. And even the most idealistic and dedicated doctors arrive in the profession with large student loans to pay. Volume of patients, not vitality of patients will pay the bills

Doctors and veterinarians are not trained in nutrition because it will not help them financially. There is much more money in surgery and drugs. We learn our medicine in programs and teaching hospitals that are typically funded by those who have the most to gain financially: the drug companies.

Have heard good reports on my AVH [Academy of Veterinary Homeopathy] listserve about [pet] insurance. Of course you shouldn’t be getting any of the conventional poison in the first place and it would be highly doubtful you would ever need it anyway.

Bottom line, doctors get paid a lot of money to pander vaccines PERIOD.

[Bill Gates, specifically in his efforts to support avccination of poor children] is NO PHILANTHROPIST he is in fact the biggest money launderer for getting funds to the harmaceutical industry for which our government is intimately involved with profit sharing WAKE UP PEOPLE

Apparently the DEA also works for the FDA which works for the harmaceutical companies…….

Another whistleblower, another bit of truth that is being covered up by the CDC.. The government admits that live virus vaccines should not be administered to those with immune deficiencies. What they ***KNOW BUT FAIL TO DISCLOSE*** are the mechanisms of immunosuppression. It’s a cascade effect that leads to the diseases that are denied by the criminal CDC to protect profits instead of human life.

Of course the WHO is as conflict ridden as the rest of health care and governments who profit directly from it.

The vaccines are unsafe and they are unnecessary, they are also the FOUNDATION of conventional medicine which unfortunately is not to be confused with conventional “wisdom”. This is an example of how the system is built upon a foundation of “speculation” or unethical medicine that is now being questioned. Vaccines DO NOT confer herd immunity and they DO NOT confer individual immunity. They are however, the “golden calf” of the white coats that grows into the “sacred cow” of vaccine induced disease. What will they do when the public figures out they have been lied to for the purpose of “making a living by killing” by the pharmaceutical medical industrial complex that is only in operation due to government financial scaffolding and protection?

This level of vitriolic condemnation of the entire veterinary profession, human medical profession, and public health system would seem to disqualify one from being considered a doctor in any meaningful sense.

Will Falconer-

I’ve written about Dr. Falconer several times. He is a homeopath who is adamantly opposed to almost all vaccination, parasite prevention and treatment, antibiotics, conventional diets, and just about everything else that constitutes the practice of scientific veterinary medicine and animal care.  As with Dr. Jordan, he not only practices the completely worthless nonsense that is homeopathy, he actively recommends it instead of conventional medicine, and his advertising of his practice if founded on denigrating the rest of the veterinary profession.

I put the antibiotics away for good when my own cat Cali, in trying to have her first kittens, did so out in the wilds of Haleakala on Maui, and came dragging herself in with a horribly infected uterus, leaking a foul smelling discharge, and clearly seriously ill. I knew even antibiotics would have a hard time helping her, but I also knew I had something deeply curative to offer now: homeopathic medicine.

Cali was treated with pyrogenium 30C, a remedy made from rotten beef…Ater a few doses of this remedy and a couple of uterine flushes with a bit of anti-infective Chinese herb (Yunnan Paiyao), Cali made a full and remarkable recovery. It was as though she’d never been sick. I had an “Ah-ha!” moment, and tossed my antibiotics in the trash.

The best that conventional medicine can do with chronic disease is to control symptoms through suppressive therapies. This is fraught with problems, including side effects from the drugs, and apparently “new,” more serious diseases arising from the continued course of suppression.

Heartworm prevention kills dogs?

I never knew that when they first came out with the heartworm drugs, back in the 80’s. I learned it when I left conventional practice and started to dig into what can hurt your dog, make her ill, and even kill her…It turns out that the drugs commonly pushed on you as “heartworm prevention,” carry the risk of autoimmune disease.

The Top Five Ways to Healthy Pets

Here are the five things that will have the greatest impact in keeping your animal vital, healthy, and living a long, joyful life with you.

(doing the opposite has been the biggest predictor of illness and dying too soon that I’ve seen in my 30+ years of practice)

  1. Stop Vaccinating Them.
  2. Feed Them What Their Ancestors Ate.
  3. Stop Using Pesticides to Kill Fleas.
  4. Stop Using Poisons for Heartworm Prevention.
  5. Give Them Raw Bones (for the whitest teeth and freshest breath ever).

Imagine avoiding risky vaccinations while getting very strong immune protection against parvo and distemper, the two potentially deadly diseases of puppies.

You know vaccinations are grossly over provided in our broken system of veterinary medicine. The pushing of vaccinations by Dr. WhiteCoat throughout your animal’s life doesn’t add to her immunity…And you know that vaccines are harmful. Chronic disease often follows vaccination, even a single vaccination.

The model of disease prevention put forth by conventional veterinarians is fundamentally flawed. It is in fact damaging the animals whose owners partake in it.

This broken model of disease “prevention” will never change from Dr. WhiteCoat’s side, who sells it:

  • He refuses to see the possibility of it causing harm.

  • He’s comfortable in it; change loses to maintaining the status quo.

  • He profits from providing it and profits again from the disease it causes.

Charles Loops-

Dr.Loops, another homeopathy, is an example of the alternative medicine convert. After practicing conventional medicine initially, he has decided that science-based medicine is worthless, and he uses homeopathy almost exclusively, even for fatal diseases such as cancer. In what sense is he a veterinarian rather than simply a homeopath? What does it matter if he has a veterinary degree if he has repudiated everything he learned in getting it? Should the public know that he has chosen to practice magic instead of medicine, and should he still be able to legally practice as a veterinarian?

Veterinarians and animal guardians have to come to realise that they are not protecting animals from disease by annual vaccinations, but in fact, are destroying the health and immune systems of these same animals they love and care for. Homeopathic veterinarians and other holistic practitioners have maintained for some time that vaccinations do more harm than they provide benefits.

My practice is mainly by referral and 95% by telephone consultation. I have treated thousands of cases using the principles of classical homeopathy and I continue to find this system of gentle healing to be the most effective therapy that has ever existed.

Sixty percent of my new cases have cancer and most of these several hundred companions each year survive longer and have a better quality of life than cancer patients treated with Western medicine or other modalities…Having practiced 32 years as a veterinarian, ten with Western medicine and over twenty with homeopathy, there is little doubt about which is the more effective system and which has the most curative approach to disease. The side-effects of homeopathic treatment are improved, overall health and a heightened sense of well-being; side-effects not typically found with Western medicine.

Jenifer Preston-

Another example of such a convert from veterinary medicine to anti-medicine is Dr. Jenifer Preston. She too bases her approach on blaming the rest of the veterinary profession for nearly all the illnesses pets suffer from. So again, how is she a veterinarian rather than just a homeopath?

Dr. Preston practiced allopathic medicine for twenty five years before realizing that the vaccinations and drugs she dispensed daily were causing more problems than they ever solved and often to a more severe degree…The drugs prescribed every day were literally destroying healthy organs and shortening lives.

Over the years, drugs and vaccines have made our pets, our beloved companions, seriously sicker and have shortened their natural life span. Why do we so often see premature aging? How do we STOP this trend? Treat holistically!

Epilepsy in dogs and cats can develop at any age. Allopathic veterinarians do not give you any real reason that this develops in your beloved dog or cat.

What the vets don’t realize is that they themselves have very likely created this syndrome with vaccines. Yearly administration of multi-valent vaccines assault the animal’s immune system over and over. More and more animals are developing ‘auto-immune’ diseases and the allopathic community has no idea why.

A majority of diseases plaguing dogs, cats, and horses today are what is termed auto-immune syndromes. This means that your companions have had their whole immune system severely compromised, so that their body cannot naturally maintain optimum health. Nature’s defense, so cleverly installed in every mammal, has been dismantled. What are the obvious culprits here?? The use of VACCINES and DRUGS over and over and over.

Do you know that EVERY drug has at least one side effect–many very serious or fatal?

Do you know that animal vaccines always contain mercury, formaldehyde and/or aluminum?

Do you know that animal insecticides are not only poisoning your pet but poisoning our planet?

Over the years, drugs and vaccines have made our pets, our beloved companions, seriously sicker and have shortened their natural life span. Why do we so often see premature aging? How do we STOP this trend? Treat holistically! Naturopathic veterinarians have found that these alternative products are accepted so much easier by the animal’s body and therapy is so much quicker and more complete!

Al  Plechner-

Of course, Dr. Plechner has provided material for some of the most read articles and most virulent hate mail on this blog. He is an odd duck in that his practices fit under neither mainstream nor typical alternative medical systems. Basically, he has invented his own cause of all disease and his own treatment for all disease, utilizing conventional tests and medications in completely idiosyncratic ways. There is no scientific legitimacy to his practices, merely his opinion and those anecdotes he chooses to promote. And I have heard not only from pet owners whose animals have been harmed by him, but also from veterinarians who have had to treat patients injured by his practices. These veterinarians have been unwilling to tell the public about their experiences out of a desire to avoid conflict and a sense of loyalty to the profession. This sense is clearly one Dr. Plechner doesn’t share, as he promotes his practices, once again, on the basis of condemning mainstream veterinary medicine as greedy and ineffective.

profits made by all of the cancer treatment drugs and the associated services involved in treating cancer. Sad to say, the treatment of cancer has proven itself to be, a tremendously successful revenue builder. Why wouldn’t you keep a possible cure under wraps?

But of course, this is purely a hypothetical question. We couldn’t possibly believe that our medical institutions could be callously driven by the pursuit of profit. Why, they’re as ethical as our great financial institutions are and look at how successful they’ve been.

The frightening fact is that a cancer cure could prove to be financially disastrous to the pharmaceutical and all of the other dependent medical industries.

“HE WHO PAYS THE PIPER, CALLS THE TUNE”

Much of so called ‘science’ operates on this basis.

And most of the medical/ big pharma colluded industry has a cozy little relationship with government, msm and the educational institutes to boot.

We should class them as ‘Disease Care’ providers, and not Health Care!

Tom Lonsdale-

Dr. Lonsdale is a promoter of raw diets. This in itself is not unusual. However, his obsession with this topic has led him to a broad rejection of nearly every aspect of science-based  veterinary medicine, and a barrage of accusations characterizing the veterinary profession as fundamentally corrupt and intentionally harmful to animal health.

He has called the move towards more evidence-based practice “laying smoke screens, rearranging the deck chairs on the sinking ship and fiddling whilst the pets crash and burn.”

There’s a creeping realisation that much veterinary ‘evidence’ fails the scientific test. Over-servicing based on dubious interpretations of the evidence — or suppression of the evidence — is commonplace. Needless vaccinations against non-existent diseases prop up the veterinary economy.

Pick up any veterinary publication and you’ll see big pharma exert control and invoke their interpretations of the ‘evidence’. Of greater concern, junk pet-food makers enjoy special relationships with veterinary regulators, schools, associations, researchers, suppliers and practitioners.

Defenders of the system employ dodgy assumptions and defective logic. Little or no consideration is given to subjective assessments, the basis of most decisions by clients and clinicians, or the complex interconnectivity of our world. Vets pursue the reductionist, treatment and germ theory paradigms with varying degrees of commitment and expertise, but seldom or never consider the limitations of those belief systems.

Why there is an alliance between junk pet food makers (‘barfers’ included), many veterinarians and fake animal welfare groups designed to keep pet owners confused and in the dark?

See how incompetence and maladministration characterise the veterinary endeavour.

The situation is grim and starts with the veterinary profession’s inattention to detail. Whilst it is obvious to most folks…that junk foods are bad for health the veterinary profession appears to have been too busy to notice. Once pointed out, the fact that an artificial diet fed monotonously either directly or indirectly poisons animals, the profession should have risen up and acted. Instead the professional ethic ruled that a mass cover up should apply. With the cover up safely in place profits were to be made. Increasingly elaborate ploys are now used in persuading the populace to a. keep more animals and b. feed them high priced artificial concoctions.

It is my belief that the profession’s political mismanagement and acquiescence is matched by a naive scientific methodology… Our way out of the mire is via a holistic assessment…. Since the holistic approach is not usually taught or practised, here are a few tips which may be of help. Firstly, make sure to have fun. There are no columns of meaningless figures in this approach nor disembodied dry facts.

Bottom Line

The purpose of regulating veterinary medicine, licensing veterinarians, and establishing even the minimal standards of practice and ethics that exists is to protect the public. People should be able to expect that a licensed vet not only has an education in the principles of science and science-based medicine but is prepared to utilize them in patient care. While there is great space for individual judgment and variation in exactly how we treat patients, it is deceptive to the public, unfair to other veterinarians, and dangerous to patients to allow vets who actively repudiate the core principles of science and scientific medicine, defame the rest of the profession, and offer only treatments that are untested or directly incompatible with science to practice as if they were legitimate doctors of veterinary medicine. If they wish to abandon the profession and its values and methods, then they ought to give up the rights and privileges of membership and not present themselves as veterinarians but as homeopaths, herbalists, Plechnerists, or whatever other type of alternative practitioner fits their ideology.

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Things Holistic Vets Say About Cancer that Should Make Pet Owners Run the Other Way

Cancer is a common and frightening disease, and many pet owners will have to face making decisions about cancer care for their pets at some point. While there are many therapies that can improve quality of life for a veterinary cancer patient, extend life, and even cure cancer in some cases, the painful reality is that there is much we don’t know about cancer. Often, cancer will be life limiting despite the best care possible.

This unpleasant reality leads many to seek alternative therapies for their pets with cancer. Unfortunately, those alternatives are almost never proven to be safe or effective, and many, such as homeopathy, are unquestionably nonsense. Yet despite the lack of evidence to support many alternative cancer treatments, and the evidence that shows some such treatments can cause real harm, some vets will try to frighten and mislead pet owners into avoiding scientific medical therapies and grasping at the various straws they offer, from homeopathy to acupuncture, from supplements and magical diets to outright magic such as so-called “energy medicine.”

A recent article in the always unreliable Dogs Naturally Magazine provides a number of examples of the kinds of opinion and advice pet owners should recognize as a sign of unreliable, unscientific, and untrustworthy alternative approaches. Along with other warning signs of quackery, statements like these should send pet owners running the other way and seeking legitimate medical advice from real veterinary cancer experts.

The conventional approach is that cancer is a disease separate from the animal, one to be attacked in various ways.

So the attitude is one of attacking something separate from the patient.

The homeopathic approach is to understand the new growth as being generated by the body – by the same energy (life force) that grew other parts of the body. So homeopathic treatment doesn’t fight against the growth or see it as separate.

Instead, nutrition and homeopathic treatment work with the natural healing mechanisms to rebalance the life energy so the tumor is no longer needed or supported.

Then it is resorbed or expelled.
Dr. Richard Pitcairn

Dr. Pitcairn is a leading figure in veterinary homeopathy. Which is to say he is an expert on a large and complex field with no connection to reality and no legitimate medical use. Here, he uses deceptive language to suggest that conventional cancer therapy is aggressive and brutal and that homeopathy is gentle and supportive. The reality is that conventional therapy for pets often provides significant comfortable, enjoyable time for pets with cancer and rarely has side-effects that outweigh the benefits. Homeopathy, on the other hand, is completely and utterly useless, and relying on it for cancer treatment is essentially letting your pet go without any treatment at all. (Here is more information on homeopathy).

Apart from surgery to de-bulk or (hopefully) completely remove the cancer, the conventional veterinary approach is to bombard an already compromised body (scarred by a lifetime spent consuming fake industrial food) with chemical poisons and radiation.

If these modalities don’t kill the patient immediately, they usually promote a more damaging and more aggressive form of cancer, further down the track.

Obviously there are exceptions to this dismal picture, but they are rare exceptions.

Meanwhile, the terminal part of the dog’s life becomes an endless round of treatments, tests and misery.

At this stage, everybody is clutching at straws, hoping against hope that this particular cancer in this particular patient proves to be the exception.

My work (and the work of others who understand that cancer is one of many degenerative disease processes) approaches cancer from the other end of the spectrum.

Instead of weakening the body with poisons and radiation, the far more rational (and genuinely scientific) approach is to strengthen the body, to give it the nutritional tools that allow it to fight the cancer and at the same time use appropriate nutritional means that weaken and take the power away from the cancer.

We find that in most instances, this not only allows longer survival times, but does so with a vastly improved quality of life.
Dr. Ian Billinghurst

Dr. Billinghurst is a well-known proponent of the unproven and theoretically dubious BARF diet (more information about raw diets). In this article, he repeats the inaccurate and misleading characterization of conventional cancer therapy as more harmful than helpful and, without seeing the irony of it, refers to it as “clutching at straws.” His alternative to this is vague and unproven but confidently claims about the ability of his personal dietary theories to provide better outcomes than conventional cancer care. Like Dr.Pitcairn, and the other vets cited in this article, Dr. Billinghurst presents as facts what are really merely his personal opinions. “We find” is code for “there is not controlled research or actual evidence, just our personal anecdotes and beliefs.”

I have written often about why such anecdotes are not reliable substitutes for real science, and this is as true for vets and for pet owners:

Why We’re Often Wrong Testimonials Lie
The Role of Anecdotes in Science-Based Medicine
Why We Need Science: “I saw it with my own eyes” Is Not Enough
Don’t Believe your Eyes (or Your Brai, designn)

I like to use a Traditional Chinese Veterinary Medicine approach: clean up the food, detox the dog and use herbs as well as acupuncture.

I also use herbal chemotherapy agents like Neoplasene and Essiac.

Other options include intravenous vitamin C and B vitamins

The Banerji protocols use two or three remedies in each protocol, with amazing success.

I’ve used these protocols on a lot of animals and many got better.

Cannabis is another option, with different options for different types of cancer.
Dr. Patricia Jordan

Dr. Jordan is one of the most extreme a rabid anti-vaccine vets out there, and I’ve written about her bizarre ideas before. In this article, she illustrates one of the classic alternative practitioner approaches, which is to throw a hodgepodge of different and mutually incompatible practices together into an irrational amalgam that is united only by the practitioner’s fervent loathing for anything scientific or mainstream. I’ve written previously about why TCVM is mystical nonsense that is more religion than medical practice, Neoplasene is a dangerous poison, and cannabis is a mildly promising but as yet unproven remedy that might have some benefits in cancer patients but is not going to cure cancer. Others have discussed the complete lack of evidence to support claims of benefit for Essaic and Vitamin C. The Banerji protocol, of course, is just more homeopathic voodoo.

Apart from the fact that none of the methods Dr. Jordan refers to have any compelling scientific evidence to support their value, they are also completely incompatible in terms of the basic theories about cancer and its treatment that they rely on. Such a mélange exemplifies the desperate and irrational desire to reach for anything not associated with real scientific medicine, and pet owners should avoid any vet who takes such an approach.

Typical conventional medicine includes radical surgery, multiple doses of poisonous chemicals and multiple caustic burning “treatments” to the affected area … slash, poison and burn.

In my holistic practice, homeopathy is the headliner. I use constitutional prescribing to support the entire body, mind and spirit.
Dr. Dee Blanco

Another homeopath, Dr. Blanco repeats the typical fear-mongering mischaracterization of conventional cancer therapy and then promotes replacing real treatment with magic water. She reveals the ultimately faith-based nature of homeopathy by pointing out it is a therapy for the “spirit.” This idea, going back to the inventor of homeopathy, is often concealed by modern homeopaths who realize that many pet owners would be reluctant to replace scientific medicine with a treatment that is more of a religious practice than a medical therapy.

Reliable Cancer Resource for Pet Owners

In the face of the ubiquitous unreliable information from holistic vets such as these, it can be hard to sort out which information is truly useful. Here are some resources that are a good bit more trustworthy.

Veterinary Cancer Society (This group also has a tool for finding a board-certified veterinary cancer specialist.) Here are some of the links the VCS recommends:

The Veterinary Cancer Center

 

 

 

 

 

 

 

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Selected Effects of Neutering in German Shepherd Dogs

As part of my ongoing surveillance of evidence concerning the benefits and risks of neutering, I have identified a new study on the subject.

Hart, B. L., Hart, L. A., Thigpen, A. P. and Willits, N. H. (2016). Neutering of German Shepherd Dogs: associated joint disorders, cancers and urinary incontinence. Veterinary Medicine and Scienc. doi: 10.1002/vms3.34

This study is a retrospective that looks through the records of the veterinary hospital at the University of California at Davis. It is a product of the same research group that has produced several other similar studies I have also reviewed. These earlier studies found some interesting differences between even closely related breeds, such as Labrador retrievers and golden retrievers, which suggests that generalizations applicable to all dogs regardless of breed are unlikely to be very reliable. This is always frustrating, since simply, universal rules are more appealing and easier to apply than nuanced, complicated risk/benefit calculations, but science often shows us that nature is more complex than we might wish. This study illustrates again the importance of breed in evaluating the potential effects of neutering.

This study includes some of the same limitations I have discussed when evaluating previous studies by this group. For example, except when evaluating mammary cancer, the authors did not consider diagnoses in dogs over eight years of age. Their rationale is that the effects of neutering might be swamped by other factors in older dogs, making them harder to detect. While this may be true, it is an assumption that has not been demonstrated to actually be true. And since overall health and disease occurrence, mortality, and longevity are the outcomes of real interest to pet owners, not just diseases that occur in the first eight years of life, using a cutoff like this can misrepresent the real importance of neutering. If, as some evidence suggests, neutered animals live longer overall than intact animals, for example, then neutering might still be the better choice even if one can show it causes more of some types of disease in the first eight years of life.

And a I have discussed in the context of their previous papers, and the authors themselves acknowledge, this study uses records pertaining to dogs seen at a university veterinary hospital. The people and patients who go to vet schools for treatment differ in a number of ways from those who don’t, and these differences may effect the diseases they get and the impact of neutering on health. This doesn’t invalidate the data or conclusions, of course, but it means we must be cautious in extrapolating these to first opinion practice populations.

The authors evaluated the impact of neutering before 6 months of age, between 6 and 11 months of age, between 1 and 2 years of age, and between 2 and 8 years of age on the occurrence of various disease compared with un-neutered dogs. Here is a brief summary of the findings:

  • Neutering before 12 months of age (combining the < 6 months group and the 6-12 months group) was associated with a higher risk of cranial cruciate ligament ruptures in both neutered males and females compared with intact dogs. This is similar to the findings for golden retrievers, though no increase in risk was found for Labrador retrievers except in males neutered before 6 months of age.
  • Neutering, regardless of age, was not associated with any difference in the risk of hip dysplasia or elbow dysplasia. In contrast, similar earlier studies did find an increase in hip dysplasia risk in male golden retrievers neutered before 12 months of age and an increase in risk for female Labrador retrievers neutered before 2 years, but no increase for female goldens or male labs. As always the devil is in the details.
  • Neutering, regardless of age, was not associated with any increase in risk of any cancer. Some earlier studies have found inconsistent and complicated increases in the risk of some cancers that vary with age at neutering, sex, and breed. Broad generalizations about neutering and cancer risk seem difficult to support given this variability in the data.
  • No statistically significant difference was found between neutered and intact females in the risk of mammary cancer. However, very few cases were found (only 14 out of 450 dogs), possibly due to the cutoff of 11 years of age used.
  • Urinary incontinence was significantly more common in females neutered between 6 and 11 months of age than intact females. Differences for other neutering ages and intact females were not significant, but there were no cases of incontinence in intact females.
  •  All cases of pyometra were in intact females, of course. This only occurred in about 2.5% of the females, However, since this disease becomes more common with age and the dogs were only evaluated up to 8 years of age, this likely under-represents the real risk of this problem in intact females.

Overall, this study adds yet another small but useful bit of information for vets and dog owners to consider in making decisions about neutering. It emphasizes yet again that the impact of neutering differs significantly between breeds, and general rules cannot be reliably applied to all dogs.

 

 

Posted in Science-Based Veterinary Medicine | 6 Comments

How to Prove a Therapy is Effective Even When its Not

Over the years, I have written a lot about how we come to hold and maintain false beliefs in medicine. Perhaps the lion’s share of this lies in anecdotes, which are powerfully persuasive despite all the sources of bias and error they contain that actually make their conclusions highly unreliable. Here are some of the articles I have posted making this point:

Why We’re Often Wrong Testimonials Lie
The Role of Anecdotes in Science-Based Medicine
Why We Need Science: “I saw it with my own eyes” Is Not Enough
Don’t Believe your Eyes (or Your Brain)

However, scientific research, while more trustworthy than our personal experiences and the stories we tell, can also be misleading and influenced by many of the same sources of cognitive bias and error that bedevil anecdotes and clinical experience. I have written about this subject before:

Can We Trust Published Scientific Research?

I recently came across a brilliant paper that illustrates how clinical trials, one of the best single tools available for evaluating medical treatments, can be misused to generate the appearance of scientific support for treatments that don’t actually work. The practices described in this paper are all too common in every area of medical research. Sadly, they are especially prevalent in veterinary clinical studies. And the paper provides an almost perfect description of the great majority of research done in complementary and alternative medicine, which is why so much of the literature in that field is truly more marketing than good science.

As I have argued before, this is often the explicit intent of researchers promoting alternative therapies, such as the American Holistic Veterinary Medical Association and its affiliates. However, the misuses of clinical trials, and of statistical analysis of trial data is unfortunately a blight on mainstream medical research as well. Everyone interested in the truth in medicine would do well to read this paper.

Cuijpers and I. A. Cristea How to prove that your therapy is effective, even when it is not: a guideline. Epidemiology andPsychiatric Sciences, Available on CJO 2015 doi:10.1017/S2045796015000864

The authors describe, clearly and in an engaging way, many practices in clinical trial design and conduct that can lead to false positive conclusions. Most are driven, ultimately, by the passionate belief of researchers in the a priori truth of their hypothesis. The following table succinctly describes the major issues.

2015 Cuijpers table 1

Their conclusions are equally succinct and worth bearing in mind when conducting or reading clinical trial research.

In this paper, we described how a committed researcher can design a trial with an optimal chance of finding a positive effect of the examined therapy….We saw that a strong allegiance towards the therapy, anything that increases expectations and hope in participants, making use of the weak spots of randomised trials (the randomisation procedure, blinding of assessors, ignoring participants who dropped out, and reporting only significant outcomes, while leaving out non-significant ones), small sample sizes, waiting list control groups (but not comparisons with existing interventions) are all methods that can help to find positive effects of your therapy. And if all this fails you can always not publish the outcomes, and just wait until a positive trial shows what you had known from the beginning: that your therapy is effective anyway, regardless of what the trials say.

Of course, whenever the weaknesses in scientific research are discussed, this provides an excuse for some to claim that science is inherently unreliable, or at least no more reliable than anecdote or personal experience, and thus we can safely do without clinical trial research. It is very important for us to understand that this is untrue. The purpose of identifying the weaknesses in science is to help find ways to make scientific research better and more reliable. It has already proven itself greatly superior to trial-and-error and anecdotal evidence.

Lest we despair, there here are some previous discussions about the ways in which we can improve scientific research, including choosing what to study more rationally, designing, conducting, and reporting trials more effectively, and minimizing the influence of financial bias.

Evidence-based Medicine Separating the Wheat from the Chaff

Making Medicine Better: Support Registration of All Trials in Veterinary and Human Medicine

Guidelines for Minimizing Commercial Influence in Veterinary Medicine

Ioannidis JPA (2014) How to Make More Published Research True. PLoS Med 11(10): e1001747.

ioannidis how to make research more true box 1

 

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Neutering and Cancer Risk In Cats

I have written extensively about the scientific evidence concerning the benefits and risks of neutering. Overall, the data is complex, and significant effects of neutering on specific health risks are rarely definitively demonstrated. One of the most controversial issues, the influence of neutering on cancer risk, illustrates this. Some cancers are more common in neutered animals, some are more common in intact animals, and the effect of neutering on cancer risk varies with sex, breed, age at neutering, and possibly other factors. When looking at the issue in cats, we have the added challenge of far less research data than is available for dogs. However, one new study has added a bit more information to help evaluate the subject.

Graf R, et al. Swiss Feline Cancer Registry 1965-2008: the Influence of Sex, Breed and Age on Tumour Types and Tumour Locations, Journal of Comparative Pathology (2016).

There are a number of limitations to this paper that have to be considered. Laboratories in Switzerland that analyze tumors contributed data to a central registry. The study reports an analysis of data collected in this registry over a very long period of time. This often creates problems since definitions of disease and the behavior of animal owners and veterinarians, in terms of relevant issues like how likely to diagnose and treat cancer, submit samples to laboratories, and so on, change over time. The data collected at the beginning of the time period analyzed may or may not be truly comparable to the data collected later.

Also, use of the registry is voluntary, so it is not clear how representative this data is of the overall cat population in Switzerland, much less anywhere else. And exactly how the data is collected and processed is not reported in the paper, and many important terms are not well defined. For example, it is not clear how cats are classified as neutered or intact, and there is no discussion of the age at which neutered cats are neutered, which has been an important factor in other studies. So evaluating potential sources of bias and error effectively is impossible, and therefore this is the sort of data that have to be taken with some skepticism.

Nevertheless, given the paucity of data on the effect of neutering on feline cancer risk, this paper is a useful addition. The portion of the report that relates to neuter status is contained in the following two tables:

Graf 2016 Table 1

Graf 2016 Table 2

There are several interesting patterns that can be discerned in these tables. The first is that there is a pretty consistently higher cancer risk in neutered cats compared with intact cats. This ranges from about 25-50% higher for most cancer types, though there are some for which there is no apparent difference in risk (fibrosarcomas for males and adenomas/adenocarcinomas for females).

Looking at specific tumor locations, the general pattern is for neutered cats to have a higher risk of tumors in some locations (skin, gastrointestinal tract, cardiorespiratory system, and oral cavity) and a lower risk for mammary tumors (in both males and females, though females are at much higher risk overall for mammary tumors than males, whether intact or neutered). If these differences are consistent in other study populations, it might help shed more light on the specific mechanisms by which sex hormones could be protective against some cancers while neutral or even a risk factor with respect to others.

While there are many limitations and caveats to these data, they do suggest a pretty consistent mild-moderate increase in cancer risk associated with neutering in cats. As always, this has to be balanced against the other health risks and benefits associated with neutering, as well as other important issues, such as the ethical and environmental impact of cat reproduction. This paper emphasizes the complexity of biology and the multifaceted potential effects, both good and bad, of any intervention which significantly effects the physiology of our animal companions and patients.

Posted in Science-Based Veterinary Medicine | 2 Comments

The Unfortunate Role of Alternative Medicine in the Animal Hospice Movement

I first wrote about the subject of hospice care for animals in the first year of this blog, 2009. I feel strongly that there is a need to adapt the concepts of hospice and palliative care developed in human medicine to the needs of veterinary patients. While euthanasia is, thankfully, an option for most terminally ill veterinary patients, this does not obviate the need for appropriate relief of the suffering of our patients and for thoughtful conversations with pet owners about death and how to approach end of life issues.

One of my favorite authors, Atul Gawande, has written a brilliant book called Being Mortal, which looks at the successes and failures of the medical system in America when handling the end of life. One of the bright spots is the role of hospice care in providing a comfortable, meaningful, and dignified end to human life. Our veterinary patients deserve the same.

However, while I have great respect for the vets who are trying to bring the benefits of hospice care to animals under veterinary care, I have some concerns as well. One is the role of spiritual questions in animal hospice care. Because the end of life brings our spiritual beliefs to the fore, the beliefs of animal owners are certainly relevant to how a veterinarian manages the care of a patient at the end of life. In the most extreme cases, euthanasia may not be an option at all due to some people’s religious beliefs. While I may disagree with such a position, it is not the role of a vet to challenge a client’s personal beliefs in this situation. It is, of course, a vet’s role to act as an advocate for the welfare of the patient. Hospice care provides a way to protect the welfare of the patient even when there may be a conflict between the needs of the patient as the veterinarians sees them and the choices of the animal owner.

However, there are some in the animal hospice community who actively insert their own personal spiritual beliefs into the practice of veterinary hospice care, and this is troubling. The International Association of Animal Hospice and Palliative Care (IAAHPC) specifically supports, for example, the right of a hospice veterinarian to “have a

principled moral objection to euthanasia, in general, and refuse to perform the procedure

regardless of the circumstances.” This seems an untenable position for a veterinarian providing end-of-life care when euthanasia is almost universally seen as an appropriate choice to minimize suffering in terminally ill animals. While the IAAHPC does recommend such veterinarians tell clients about their position before taking on a hospice care role and refer for euthanasia if a client wishes it, this seems an ethically dubious position.

The right of service providers of any kind, including healthcare workers, to refuse to provide services that are legal and ordinarily provided by people in their role as a result of their personal beliefs, including religious beliefs, has generally not been widely recognized as a legitimate right, nor has it been generally upheld by the courts. Personal beliefs don’t typically exempt one from performing the expected duties of one’s profession, so this seems a questionable exception to carve out for hospice veterinarians.

Much more worrisome, however, is the strong and consistent role of alternative medical therapies in educational and policy documents from the organized veterinary hospice community. The IAAHPC guidelines specifically endorse “integrative medicine” and the inclusion of alternative therapies in end-of-life care:

An integrative approach, using conventional and CAVM therapies, is recommended using the most appropriate interventions that control pain or other clinical signs. It is the recommendation of this Task Force that veterinary practitioners and animal hospice team members maintain current knowledge of the available treatment options for patients, whether these options are complementary or allopathic, and to choose therapies that are the most effective in treating the patient’s condition, most beneficial to the patient’s overall quality of life and have the fewest undesirable side effects.

Given the robust reasons to doubt the safety and effectiveness of most alternative therapies, this seems a perilous and irresponsible position to take. If a treatment doesn’t work, it provides no benefit to the patient, and integrating it into patient care cannot improve quality of life. Integrating it at the expense of scientific therapies, however, can certainly worsen patient care. As I discussed in my previous article, this appears to be the result of the fact that many of the leading figures in the animal hospice movement are also CAM providers. They have faith in CAM treatments regardless of the lack of evidence or even evidence against this belief, and as a result they assume the value of these therapies and promote them as a beneficial part of hospice care. Substituting personal belief and experience for scientific evidence is not the best way to protect patients, especially those as vulnerable as animals in hospice care.

There is, of course, limited and weak evidence for many veterinary therapies, conventional as well as alternative. And the area of pain control is especially difficult to generate strong, objective evidence in because the challenges in measuring pain and the effects of pain relieving treatments. Some CAM therapies fall into a grey zone where there is at least some plausible reason to think they may have benefits, or at least a level of evidence no worse than that available for conventional therapies. For example, though the evidence is not strong, there is some reason to think cold laser therapy (1,2), massage, and other kinds of physical medicine may have some benefits in terms of comfort, wound healing, and other issues relevant to hospice patients. Even acupuncture, if divorced from the nonsense of Traditional Chinese Medicine, might have some small beneficial effects, though the evidence is complex and uncertain.

Use of such methods, so long as it is not to the exclusion of science-based treatments, is not entirely unreasonable if measured claims are made and clients are given honest information about the limitations of the evidence. However, there are also CAM methods recommended by proponents of animal hospice that are clearly ineffective and can have no benefits at all. For example, a prominent and extreme proponent of veterinary homeopathy, Christine Chambreau (3,4,5), has lectured at the IAAHPC conference on the use of homeopathy in hospice patients.  As always, suggesting that homeopathy has any legitimate role in veterinary care ignores the overwhelming evidence that it is ineffective, and this is completely unethical. Substituting homeopathy for any real medical therapy is dangerous and wrong, and this should never be even tacitly endorsed by anyone interested in legitimate compassionate end-of-life care.

Similarly, the IAAHPC has had proponents of Reiki speak at their conference, and the organization even has a link to a pro-Reiki web site on their own web page. Reiki, of course, is a variety of “energy medicine,” which amounts to nothing more than a non-denomination variety of faith healing. It is fundamentally a spiritual practice, not only not proven to have any beneficial effects but outside the domain of science altogether since it is entirely faith-based. Offering it as part of hospice care not only promotes an unproven and unscientific practice as if it were a legitimate medical intervention, it blurs the distinction between the veterinarian as a healthcare provider and a spiritual counselor. This intrusion of personal spiritual beliefs into animal hospice is not in the best interests of patients or the hospice movement.

The IAAHPC does appear to view CAM not only as likely to be effective, but potentially as a substitute for some conventional therapies. For example, in the organization’s hospice guidelines, they state, “CAVM therapies may aid in reducing the required dosages of certain drugs.” And the usual misguided notion of scientific evidence as an optional “extra” rather than essential to evaluating the safety and effectiveness of our treatments appears in IAAHPC conference talks about the use of CAM in hospice care:

These therapies are safe, noninvasive, relatively inexpensive, and accessible… Their use can promote natural healing mechanisms… and also will create a sense of wellbeing in the patient. Serious and life-altering medical conditions…have been found to be responsive, to some degree, to the use of diet, nutraceuticals and botanicals and acupuncture.

Patients who are in terminal care may not have the time to wait for the completion of more studies validating the benefit of the concurrent use of complementary therapies… Each clinician needs to decide where they stand in terms of the degree of rigor of the evidence versus the benefit-potential that complementary therapy could provide their patients’ QoL. In the hospice-palliative care realm, using evidence-based measures is of paramount importance, as long as the patient doesn’t suffer as a result of the time spent in academic bickering over the level of quality of the evidence.

This sort of position assumes the efficacy and safety of methods when these are often not, in fact, well-demonstrated, and it assumes that it is somehow better for patients to be exposed to therapies with little to no evidence of safety and effectiveness and significant controversy about their effects than to test these therapies before using them. The normal process of scientific investigation, which has brought such tremendous and unprecedented health benefits to the all of us, is dismissed as “academic bickering,” and it is assumed that any objection to trusting anecdote as the basis for using CAM treatments is a mere pedantry. Such views place the well-being of patients at the mercy of the beliefs and opinions of individual veterinarians, even when these conflict with scientific evidence.

Bottom Line
I believe hospice care has the potential to make the end of life more comfortable and peaceful for many veterinary patients, and I think it is crucial that we do a better job as a profession of serving the needs of patients and their human caregivers at this challenging and emotional time in the cycle of life.  However, I think our clients and patients are especially vulnerable when coping with terminal illness and death, and we have a responsibility at this time, perhaps more than any other, to be sure the care we offer is the best, safest, and most effective possible. Science and scientific evidence offers the best tool available for evaluating the treatments we offer, and it has earned the special roles it plays as the primary means of identifying the risks and benefits of the treatments we employ.  While we must often make due with less than optimal evidence in making clinical decisions, we are ethically obligated to rely on science to the greatest extent possible in choosing therapies and counseling our clients.

Unfortunately, the organized animal hospice movement includes a relatively high proportion of veterinarians who are believers in unproven or even outright ineffective therapeutic practices, including acupuncture, herbal medicine, energy medicine, homeopathy, and others. Because of this representation, organizations and individuals promoting hospice care are often also promoting the misguided “integrative medicine” approach (c.f. 6, 7 for more  on this concept). This includes treating both promising but unproven treatments (such as low-level laser therapy), disproven treatments (such as homeopathy), and even fundamentally spiritual or religious practices (such as Reiki) as if they were the equivalent of science-based conventional medical interventions. This misleads clients and places patient welfare at risk.

While the IAAHPC does acknowledge that hospice therapies should be effective and, to the extent possible, evidence based, in general it leaves the evaluation of these therapies to the discretion of individual veterinarians and takes a very weak stance on how efficacy and evidence are to be judged. While I truly do admire and share the goals of the animal hospice movement, and I appreciate the sincerity and commitment of hospice veterinarians, including those who offer CAVM treatments, to the well-being of hospice patients, I am troubled by the views of the IAAHPC and individual hospice providers towards CAVM and evidence-based medicine.

There is abundant evidence that our perceptions of the efficacy of our therapies are unreliable and misleading, and that caregiver placebo effects readily fool us into thinking we are alleviating suffering in our pets and patients even when we are using ineffective treatments. Sadly, the majority of veterinarians, whether primarily conventional of CAM-oriented, do not seem to appreciate this. In the case of hospice patients and their owners, this attitude has significant potential to lead to unnecessary suffering or ineffective care since there is often a perception of “nothing to lose” at the end of life. However, the experience of dying can be made more uncomfortable than it need be when ineffective treatments are used, and it is imperative the as a community veterinarians are vigilant in minimizing the risk of this in animal hospice patients.

 

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