Woo U. — CAVM as Continuing Education for Veterinarians

Veterinarians are required by the state laws that control their licensure and scope of practice to keep up with changes in the body of knowledge  and techniques that makes up veterinary medicine. Such continuing education is a requirement for all vets, and most actively seek out more than the minimum requirement because they genuinely wish to continually improve the care they provide. However, because there is a political dimension to continuing education, and government bodies are involved in establishing what constitutes legitimate training for the purposes of meeting the legal requirements, the process invariably is influenced by the same sorts of unscientific ideologies that allow for insurance reimbursement for unproven therapies and that prevent sensible regulation of dietary supplements. This is sadly, and yet humorously evident in the offerings at the upcoming American Holistic Veterinary Medical Association  (AHVMA) annual conference, to be held in Fitchburg, MA September 12-15 of this year.

The national standard for accreditation of veterinary continuing education is the Registry of Approved Continuing Education (RACE) established by the American Association of Veterinary State Boards (AAVSB). Most state veterinary medical boards require continuing education courses submitted for maintenance of state licensure be RACE certified. The 2009 AHVMA conference has applied for RACE certification, but this has not yet been officially granted. However, the organization’s 2008 conference was approved, and there do not appear to be any substantive difference in the content of the two conferences.

According to its website, “The American Holistic Veterinary Medical Association explores and supports alternative and complementary approaches to veterinary healthcare, and is dedicated to integrating all aspects of animal wellness in a socially and environmentally responsible manner.” Like most industry organizations, the group engages in lobbying for its agenda, supports social and business networking among members, publishes a journal, and promotes its vision of veterinary medicine. It also provides continuing education opportunities consistent with its CAVM-centered philosophy.

All of this is impressive considering that no clear, consistent definition for “holistic” exists.  It is a warm a fuzzy marketing term that seeks to promote unproven therapies alongside, or even in place of, scientific medicine by peddling the nonsense that somehow science-based medicine somehow ignores the person and just treats the body or treats just symptoms not diseases or their causes. I’ve never actually met a veterinarian who considers the patient irrelevant to the health of the knee or the gallbladder or the white blood cell, but CAVM practitioners like to suggest that such myopia is the only alternative to embracing vitalism and faith-based medicine.

As to the substance of the continuing education offered by the AHVMA, it is an eclectic hodgepodge of methods and philosophies that seem to have little in common beyond their lack of sound supporting evidence. There are, of course, classes on the Big Three of CAM, acupuncture, chiropractic, and homeopathy. Bach Flower Therapy gets some play, and there are some anti-vaccine offerings. The summary for a lecture titled Equine Disease Manifestations from Rabies Vaccination sounds fair and balanced:

“In western N.Y., there has been a true spread of Rabies in the raccoon population. In response to this threat, the state instituted an oral Rabies vaccine drop throughout western N.Y. and requires any horse that steps foot on state land to have an annual Rabies immunization. The result seen from this aggressive immunization procedure is an increase in physical, mental, and spiritual disease in our equine companions. Many of these diseases seem to be not only a combination of an acute reaction to the attenuated rabies virus with a worsening of the animals underlying chronic disease but also new intense emotional diseases that have not been seen. Many of the disease seen are hind leg weakness and lameness, severe mental aggressions and fears, including a almost intentional harm to the rider, and choke. Cases with the homeopathic treatment will be discussed.” [emphasis mine]

Some of the details of the offerings on homeopathy were new to me. The science of homotoxicology apparently warrants its own seminar. According to one site, in homotoxicology “diseases are considered to be ultimately caused by toxins, whether toxic chemicals, bacterial exotoxins, biological endotoxins, post-traumatic cellular debris and also byproducts of the bodies metabolic processes. Furthermore, disease symptoms are said to be the result of the body’s attempt to heal itself and should not necessarily be suppressed.” As usual, the answer to the ill effects of these toxins on the body is to give people water that once contained a few molecules of something that Hahnemann or somebody else once said might cause symptoms like those thought to be caused by the toxins. I am particularly impressed by this testimonial from one of the doctors presenting at the seminar:

“A series of seemingly random events led to my initial foray into homotoxicology, and unexpectedly good results from the therapy intrigued me. I had to know the reasoning, theory, and therapeutics of this medical art. It has consumed my interest for many years, with more magic still to be learned.”[emphasis mine]

 

And speaking of toxins, did you know this?

“The recent increase of animal shoulder and hip mobility restrictions can be attributable to nutrition. “Leaky Gut” syndrome, caused by intestinal GLUTEN, creates protection mechanisms altering gait mechanics. Glycoproteins in gluten have a “glueing”[sic] effect, reducing healthy tissue motility. Osteopathic techniques and modified diets can substantially impact symptoms.”

The conference also promises to discuss the homeopathic concept of the tubercular miasm, defined elsewhere thusly, ” A miasm is not an infection or an intoxication, but a vibratory alteration of man’s vital energy, determining the biological behaviour and general constitution of the individual.” The AHVMA lecture specifically addresses treating this miasm with “remedies sourced from insects.” Yummy!

But consistent with the “holistic” commitment to never critically judging the plausibility or soundness of any idea, the offerings go well being what might be called “mainstream woo.” There is a lecture titled “Plant Spirit Medicine – Deepening Your Relationship with Plants.” Another set of lectures for veterinary technicians involves “Using the Bioenergetic Field to Empower Your Life Personally and Professionally” and considering “How Your Bioenergetic Field Affects Your Patients.” There’s also “The Science of Energy  Medicine,” which “will discuss the underlying mechanism of biofield theory with special attention to quantum physics and wave theory.”

My two favorites, though, might generate some controversy even among proponents of CAM. The first is a lecture entitled “Spiritual Nemenhah Indian Adoption as it relates to legal adoption.” The Nemenah cult is the group that achieved some notoriety when 13 year old David Hauser chose to stop receiving chemotherapy for his lymphoma and was temporarily taken into hiding by his mother. His parents are members of this faux Native American religious group that emphasizes alternative medicine. Even some proponents of CAM have balked at supporting the groups extreme approach. The AHVMA lecture sounds like a “health care choice” gambit to avoid federal laws regulating medical therapies and drugs:

“As an adopted member of the Nemenhah (“village of healers”) Band, I will explain how adopted members can obtain a significant level of protection from CODEX and other laws which are threatening our health liberties.The Nemenhah Indian Band was established as an Indigenous Group based on traditional writings which integrate “medicine and religion as one” under Indian belief. By Congressional and International law Indians are offered unique protection under recent preeminent treaty. Those who manufacture or dispense herbs, homeopathy, nutrients and any other emerging natural healing modality, will be interested to know their products and practice can be protected under Nemenhah Band legal protection.” [emphasis mine]

The ethical and legal questions this lecture raises strike me as significant, and the implicit endorsement of the AHVMA of what amounts to a call to defy federal health and consumer protection laws casts a rather sinister light on the organization’s agenda.

Finally, “holistic” veterinary medicine apparently goes beyond the mere healing of animals with unproven therapies. The greater goal is apparently to heal our hospitals and even the Earth itself (herself?), according to a lecture entitled “Geopathic Stress and Earth Acupuncture–Sick buildings and Sad Houses.”

“During this outdoor demonstration identifying and correcting geopathic stress with earth acupuncture techniques, participants will have an opportunity to find earth meridians using dowsing rods, and directly perceive both healthy and unhealthy landscape chi before and after treatment.”

As humorous as much of this is, verging as CAVM so often does on self-parody, it is sobering to realize that this sort of nonsense has been officially approved as continuing education credit. How can a regulatory structure possibly protect the public and their pets and still allow veterinarians to maintain their licenses by studying Earth Acupuncture and Bioenergetics, or by attending lectures that blame animal illness on vaccination or obscure “toxins” or that actively encourage veterinarians to evade federal law by joining a faux Native American cult that encourages parents to deny life-saving therapy to their children with cancer? One of the reasons why a neutral, live-and-let live attitude towards faith-based medicine doesn’t seem to me an acceptable stance is the kind of real danger that this sort of thinking represents to our patients. Danger that is magnified dramatically by the official imprimatur of regulatory agencies that are supposed to protect our health but who set standards based on popularity rather than science.

 

 

 

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23 Responses to Woo U. — CAVM as Continuing Education for Veterinarians

  1. Bartimaeus says:

    Wow. They must have a stockpile of really old attenuated rabies vaccine in New York, as all the vaccines currently labeled for horses are inactivated.
    I would love to know how to diagnose “spiritual” disease as well. Oh, dowsing for earth meridians! Maybe they should apply for Randi’s million dollar challenge. Seriously though, if anyone promoted any of these things to me, I would run away as fast as possible. Amazing that people will buy this stuff.

  2. Rita says:

    “including a almost intentional harm to the rider”……
    This must be what used to be called “horse sense”.

    Seriously – again we arrive at the same question -a) how can this stuff be accredited, and
    b) how can any veterinarian who goes in for it ever have passed an exam?

  3. skeptvet says:

    I’ve been told by Narda Robinson, who is on the RACE committee, that the new RACE standards in effect beginning this month should make it unlikely that the AHVMA conference will be accredited for CE this year. according to the standards:

    “CE programs that advocate unscientific modalities of diagnosis or therapy are not eligible for RACE approval.
    Furthermore, those programs that promote treatments known to pose significant risks, dangers that outweigh benefits or unproven effectiveness are generally not considered approvable. All scientific information referred to, reported or used in RACE Program Applications in support or justification of an animal?care recommendation must conform to the medically accepted standards of experimental design, data collection and analysis.”

    and
    “Reviews of programs pertaining to complementary and/or alternative medicine or therapies (CAVM) shall be conducted applying the same Standards utilized for reviews of all other Scientific/Clinical programs. While certain CAVM programs may contain material that has not been presented in the AAVSB RACE Standards, effective 9/14/09 11
    curricula of accredited colleges or schools of veterinary medicine or accredited veterinary technician programs, CAVM CE should nonetheless build upon the standards for practice and the foundational, science?based material presented in veterinary school curricula in order to be considered for RACE approval.”

    the full criteria are here:
    http://www.aavsb.org/PDF/RACE/RACE%20Announcing%20Revised%20Standards%20and%20New%20Fees.pdf

    Certainly sounds good, but of course lots of woo can be made to sound scientific, and CAVM has its own system of journals for painting a patina of scientific legitimacy on nonsense. AHVMA is still listed as an accredited CE Provider under RACE, though the confeence has not appparently been approved for CE credit this year. Maybe the political widns have shifted a trifle in the direction of science?

  4. skeptvet says:

    It was recently brought to my attention that Dr. Pitcairn, famous or notorious (depending on your point of view) proponent of CAVM generally and homeopathy in particular is especially upset about the change in the RACE standards and his loss of accreditation as a RACE CE provider. Here is his classic example of politicking and encouraging others to lobby for accreditation of unproven therapies by raising the standard of “health care freedom.”

    http://www.minimum.com/bb/viewtopic.php?t=2000&sid=fb3fccdd164e82cdb6c2040a5cba2859

  5. Bartimaeus says:

    Quite good news about the RACE standards, I hope it sticks over the next few years. Hopefully it will discourage some of the “CE” programs and CAM electives for students provided by some of the veterinary schools as well.
    Narda Robinson is still a bit of an enigma to me though-it seems to me that she is straddling a fine line and may risk eliminating her own acupuncture program at CSU. (that would not bother me, but I suspect it would bother her).

  6. Rita says:

    “Recently one of the major organizations that approve continuing education credit for veterinarians has taken a stand against homeopathy and similar forms of therapy. For most states a veterinarian is required to attend so many hours of education, usually 10-20 a year. I have been one of the approved teachers for such programs since 2001 and have trained almost 500 veterinarians in the use of homeopathic medicine. ”

    From the wretched Pitcairn’s comments linked above – 500? 500 trained, professional veterinarians thought this was a good idea? – or was it just an easy way to get the credits necessary for ongoing formation? Not that you can learn that much in 10-20 hours of anything worthwhile, so woo probably looks like a good way to go. Good to hear they’re tightening up!

  7. Bartimaeus says:

    I think many veterinarians see using different CAM modalities as a way to promote their practice to people. It is relatively easy to get “certified” in homeopathy, reiki, etc. Some of the vets doing this probably believe they are doing something (having never thought critically about it), but I have to wonder if at least some of them are just cynically using CAM as another way to increase charges-especially for CAM-prone clients who may be leery of “western” medicine. Sometimes recovery just takes time, and people like and want something (anything?) to do while they are waiting. It is unfortunately much easier to do some magical hand waving or acupuncture, or sell some sugar pills than to teach some physical therapy or some other kind of real work. Pitcairn has had a good gig teaching homeopathy, and has gotten away with it long enough that he feels entitled to it now, I think.

  8. v.t. says:

    “Dr.” Pitcairn said: “It matters not that there is much evidence of efficacy with homeopathic treatment and many cases of cured animals.”

    I wonder how much more simple it could get. I guess if Pitcairn or his 500 other veterinarian followers could ever prove that homeopathy works and cures whatever ailment in animals he claims, the AAVSB might be more than happy to lend him credibility, what a concept.

    The real question, to me anyway, is why do conventional-trained, intelligent vets even go to these quack conferences? The course headings alone simply invite criticism, do they honestly think they’re learning anything useful in real veterinary medicine? When does voice of reason (will my patients truly benefit?), trump personal grandiose visions of acceptance in their heads (my clients will love me for my extended knowledge!)

  9. gwen says:

    I just spent $375.00 for Nursing CEUs at a National conference. I feel frustrated that alot of what the classes taught were essentially woo. It is impossible to tell from the synopsis of the classes whether they are science bases or woo. The best I can do is complain to the company that arranged the conference and put them on my list of companies whose conferences I will refuse to attend. It is getting more and more difficult as more and more of the conferences are being infected with the mystical woo and CAM. It was not like that when I first began my nursing career…

  10. Squillo says:

    v.t. asks why intelligent vets go to these courses.

    I submit that the reasons are similar to those held by human docs who go to the woo side:

    1. Easier than learning real science?
    2. Looking for a way to expand practice and make an easy buck off the well-heeled and credulous?

    I’ve often said in the past that if I had no scruples I’d either try to start a new religion or resurrect a pseudo-ancient woo; preferably both.

  11. skeptvet says:

    Hi Squillo,

    I guess I’m a bit more optimistic than you are. My experience with other vets has been that their motives are seldom as venal. In amny way, of course, that makes them even harder to dissuade.

    Most vets go out of curiosity, or a desire to be “open-minded,” or because they’ve heard from clients or colleagues that the method is useful and want to see for themselves. Unfortunately, a clinical education doesn’t protect one against well-marketed peseudoscience, so many become believers themselves.

  12. v.t. says:

    But, but but, that’s my point, skeptvet, doesn’t science trump marketing? Still an unanswered question in my mind, they already have the intellect to know better, no amount of another’s marketing skills should affect otherwise.

    Squillo, your term ‘scruples’, I believe that is the actual heart of the matter and makes much more sense to me.

    I have a very hard time believing these well-meaning vets are as well-meaning as they wish you to believe.

  13. skeptvet says:

    Sadly, marketing trumps science most of the time. How long did it take to get a social consensus behind combing smoking? The marketing delayed any meaningful action for decades.

    Obviously, I can only speak to the vets I know, but of the 30 or so I work with regularly, all those pushing woo are doing it out of a sincere belief that it helps their patients. And those who don’t believe in it but don’t fight against it like I do are prevented from doing so not by greed but by a fear of confict and stirring up trouble (the sort of thing that prevents people from talking about politics and religion in the workplace as well), or a sense that people have some magical right to chose what they want in healthcare even if its pointless. Obviously, I think they’re wrong and this is exactly the attitude I want to change, but I don’t think it’s helpful to buy into the CAM steroptype of mainstream medicine as profit-motivated in some way that they aren’t.

  14. v.t. says:

    Sure, but there remains fear-mongering behind the non-smoking campaign, mainly the second-hand smoke theory (which has never been explicitly proven, the so-called studies are highly biased, let alone flawed). Those are personal freedoms and choices, and I often wonder why smokers are targeted as the evildoers inflicting harm against others when alcohol (and more sinister addictions) is clearly more harmful to others.

    I can certainly appreciate your analogy with your colleagues. But, the second group you describe – those who don’t believe in woo, yet don’t support fighting it for fear of conflict – are more or less simply ignoring it, which is the least helpful, IMHO. I suppose that’s a personal choice, not to involve themselves, but when you’re talking about those patients who cannot speak for themselves, that’s a whole other matter. If those vets practicing woo truly believe they are helping their patients, then they need to be honest with the paying client, and prove it.

  15. Tammy says:

    All this talk about science vs. marketing and that only a vet (or doctor) that practices with prescriptions and surgery are worth anything. This is the same mentality that has almost all of Americans frail and sick! My god, when is every person going to realize that we are living breathing cells who need nutrition and balance, not knives and drugs (except in some rare cases)?

  16. skeptvet says:

    “almost all of Americans frail and sic”

    Seriously?! I’m not sure we live in the same country, then, because the Americans I know are on average among the healthiest, longest-lived humans ever to walk the earth. This sort of nonsense abotu our “toxic” world is only possible because medicine has made the ubiquitous suffering and death from now preventable or treatable diseases an abstract historical concept, not the visceral reality it has been for most of history and still is in places where poverty and oppression deny people the benefits we take for granted.

    “we are living breathing cells who need nutrition and balance”
    I don’t see anywhere I’ve denied this. Unfortunately, this has nothing to do with whether science of CAM is better at figuring out and meeting our needs.

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  19. yersmay says:

    Wow. I am wondering why you all waste so much time and energy in this angry fight. Has anyone in this so-called group had a car accident, whiplash so bad you couldn’t move your neck, drive your car or hold your kids. Head into the ER where they X-Ray your neck and an orthopedic surgeon materializes and says remarkably, “There’s nothing wrong with your neck.” Take some medicine for a few days.” You then can’t stand the pain, walk into a chiropractors office, and a few weeks later are beginning to restore function and reduce pain.

    As far as herbal medicine goes, how do you think the pharmaceutical industry models novel drugs? Isn’t it from things we find in nature (i.e plants, microorganisms, etc.)? Penicillin, digoxin, permetrin, etc????

    As far as acupuncture is concerned even Narda teaches it, yet for some reason she thinks that her 30 year old acupuncture (don’t know her real age but assuming she’s practiced about that long) trumps the 3000 year old Chinese acupuncture?

    You all need to realize that western medicine is very young and still learning. How about diabetes? didn’t we figure out that not all Type-2 diabetic humans need insulin, that diet and exercise alone can treat?

    Start from the basics, a good (not processed) diet, moderate consumption, avoid toxins (alcohol, smoking, drugs) get lots of outside activity, laugh, enjoy life and you will ultimately be healthier than those who do the opposite.

  20. skeptvet says:

    Yersmay,

    Not angry, but passionate, certainly. False beliefs hurt people and animals, regardless of what your personal experience tells you. I know you believe that your neck (or whomever’s if it’s not a personal example) got better because of ciropractic. But take enough people in the same situation and compare a few weeks of chiropractic with a few weeks of rest, and you’ll find them all getting better. This is how science distinguishes the truth from fiction, and while it’s less emotionally satisfying than personal experience, it works better.

    Herbal medicine and drug development are not the same thing. Talke a plant and chew on it while guessing what it does, and you have herbal medicine. Take a plant, test numerous constituent ingredients first in the lab then in animal models and finally in people and find the few things that actually do more good than harm, and you have medicine. Both start with an idea and a plant, but herbal “medicine” stops there, science goes on to find the truth.

    3000 years of anecdotes and mythology doesn’t equal the truth. Narda and I disagree about the scientific basis of acupuncture, but the longevity of an idea has nothing to do with whether it’s true or not. Bloodletting, emesis and catharsis, casting out of demons, and many other such methods persisted for thousands of years too, and all did more harm than good. Faith without evidence is religion, not medicine.

    Young or not, Western medicine has improved the length and quality of human life in a few hundred years more than all the folk practices of the previous million years of human existence. And it works whether you believe in it or not, which is why “Western” medicine is as popular in China as it is here.

    “Start from the basics, a good (not processed) diet, moderate consumption, avoid toxins (alcohol, smoking, drugs) get lots of outside activity, laugh, enjoy life and you will ultimately be healthier than those who do the opposite.”

    I agree completely. And this has nothing to do with bogus medical quackery.

  21. yersmay says:

    Skeptvet,

    Would love to hear your experiences of how “false beliefs hurt people and animals…”

    I will agree with you that western medicine has aided the human race reach a new level of longevity. I ask you, does this always equate to quality?

    We veterinarians evaluate “quality of life” every day. Do human doctors? Or do they continue to add “just one more pill” to cover up yet another symptom of chronic disease? I ask you, too, is “good medicine” always realistic? Please tell me you are not one of those vets that humbles his clients when they cannot afford the $10K surgery or the $7K chemo? Would you disrespect a pet owners wishes to avoid putting their pet through invasive procedures? If not, then why are you threatened if they want to investigate another modality– if that is what their wishes are? If there’s nothing to gain in the long run (i.e. terminal disease that the owner can’t treat, what’s the harm in trying alternative modalities??) If you say then the owner must euthanize, then I think you are trying to play God, which is sincerely egotistical.

    How much western medicine is too much? Why is our nation’s healthcare industry in such shambles? I truly believe it’s because people have been conditioned to think that they can eat whatever they want, smoke whatever they want, drink whatever they want, take a pill and erase it all — and have the government pick up the tab if they’re not able to pay. Well that is certainly not reality.

    Most alternative practitioners are proponents of healthy whole foods (cooked or raw), moderate exercise, decreased stress, etc. Most are offering acupuncture, herbals, chiropractic. This is all covered in our human “Western” insurance plans. If a few offer homeopathy, homotoxicology or other “woo” and if these modalities are as listless as you profess, then what is the harm in trying. So why so “voodoo” if practiced in veterinary medicine.

    Yes, vaccines have prevented many thousands of needless deaths each year since their inception. But do you close deny the fact that there are serious adverse reactions that occur as the result of these vaccines? And are they truly safe for the masses, or should they be administered on a more case-by-case basis. It doesn’t matter to you, I guess, unless your kid is one of those who dies or has chronic complications to a vaccine.

    You may not be open in your mind, but you should not try to influence others without proof. I have not seen any data here to reflect any hard evidence that alternative practices are hurting people or animals. In practice, I see how it helps.

    Rock on….

  22. skeptvet says:

    I can give you as many examples of CAM harm as you like. You could start by checking out these sites:
    http://www.skeptvet.com/index.php?p=1_21_What-s-The-Harm-
    http://whatstheharm.net/
    http://neck911.com/
    From lead, aristolochic acid, and many other toxins in unregulated and untested herbal remedies, to strokes caused by chiropractic neck manipulation, there is plenty of direct harm. And most of the damage is the indirect harm or missed diagnoses, people who don’t get effective treatment in time because they rely on ineffective CAM, people exposed to infectious diseases because they distrust vaccines or trust nosodes or homeopathic preventatives instead, and so on. The truth is a lto more likely to lead to true benefits than myths and misconceptions, so the idea that the truth doesn’t really matter is ridiculous.

    Quality of life as well as length of life has indeed improved dramatically with scientific medicine. The fact that today’s diseases are lifestyle related, degenerative, and cancerous is not because we live in a “toxic” world, it is because we’ve stopped dying of the things that killed us so much earlier for most of human history. Science is not perfect and it is never complete. It is merely better than the alternatives of myth, folklore, and pseudoscience.

    As far as how I handle cases in which pet owners cannot afford an effective therapy, I assure you I handle such cases with compassion, and I offer the best comfort care I posisbly can. If you are suggesting that I should offer CAM whether it works or not just to give the owner something to do, that is not real compassion just false hope and deceit. It is a false and disingenuous argument to claim that CAM offers a “choice” when it doesn’t actually work.

    I’ve already said I have no problem with promoting a healthier lifestyle, and contrary to the bogus stereotype you are peddling, most doctors recommend exactly that–sound diet and exercise. This has nothing to do with whether or not CAM is effective or harmful.

    The risk of vaccines is real, but it is far less than the risk of eschewing vaccines or trusting is ineffective alternatives. Only those ignorant of history and the incredibly voluminous science of vaccine safety could try to argue that they are an example of the failure, rather than the success of scientific medicine. Yes, they should be given in a rational way to maximize the benefis and minimize the harm. And they are.

    If you bother to read my blog and articles you will see plenty o proof. Unfortunately, you will not recognize it as you are blinded by your ideology and your faith in CAM.

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