Most of the therapies you would label “unproven” are not made up willy nilly but extrapolated from established knowledge of physiology, pharmacology and so on. If you read the section of Hill’s Criteria, you should realize that clinical trial evidence is only part of establishing the truth about an intervention. If one has established biologic plausibility, coherence with established knowledge, in vitro and animal model evidence, and pilot clinical trial evidence, then one is a lot closer to a justifiable claim of efficacy. Sure, one may still turn out to be wrong sometimes, but these elements to establishing safety and efficacy still have meaning.

And as you point out, there are situations in which action is necessary despite imperfect knowledge, We must of course be honest with our clients about the limitations of our knowledge and evidence, but I think claiming we have to identify all therapies as “investigational” that havn’t been supported by perfect clinical trial evidence is inappropriate and comes perilously close to fulfilling the cliche that Dr. Messonier and others market about evidence-based medicine being exclusibely about RCTs and thus essentially useless in the verterinary domain where we rarely have this level of evidence.

Proven vs. Unproven Treatment

Unproven treatment relies on relative efficacy and safety that has not been shown in controlled peer-reviewed clinical trials.

If a proven treatment is not available (which is often the case in veterinary medicine), or if the treatment not work for the individual patient (also more common then we would like), i see nothing wrong with trying an unproven therapy, as long as the doctor tells the client that using unproven medical care is more likely to harm than help. I think that unproven care should be called investigational medical care when the drug company or the doctor is trying it. When the FDA measures multi million dollar drug studies submitted for approval even then after spending millions only about one out of five pass the mustard. Studys show that expert review cannot be trusted so you cannot rely on the standard of care either. Using unproven medical care is like playing the lottery. Some win but most loose. The odds are against you.

Thats the only sentence of your last post I may not agree with . It depends on how do you measure the word “often”? I have found independent studys that show most of a vets take home income in the USA is from bogus or questionable medicine. That income must be replaced with real medicine income some how. Until the profession can figure out how do do that, those whistle blowers who lead the way may starve before the standard of care and the laws get changed. I do not see a lot of general human practitioners practicing evidence based medicine and making a good living either. I think it is more what the population is used to paying for a service that affects their willingness to pay. Of course, it is also affected by the affluence of the society we live in. So science based doctors can hope the smart people have all the money.

I’ve had clients who came to me with a preconception that woo is what their pets needed, and when we talked about the evidence and their choice, they chose to stay and go with science-based medicine. When their pets got better, that had a big impact on their perceptions of CAM and conventional medicine.

Granted, everyone has to make a lviing, buy supplies, pay rent, pay employees, and both CAM and mainstream medical providers have to pay enough attention to the business end to make these things possible. But for most vets, it’s not so key a factor tat I think it dictates teir choices of therapeutic approaches.

FDA definition of fraud quoted in Sept/Oct 93 NCAHF Bulletin Board: The deceptive promotion, advertisement, distribution or sale of articles, intended for human or animal use, that are represented as being effective to diagnose, prevent, cure, treat or mitigate disease (or other conditions), or provide a beneficial effect on health, but which have not been scientifically proven safe and effective for such purposes. Such practices may be deliberate, or done without adequate knowledge or understanding of the article. (Quoted from a letter from M L Frazier – Director, State Information Branch 6/18/93).

art malernee dvm

Thanks for you comment and support. It seems I spend a lot of time saying things people don’t particularly want to hear, so I always appreciate it when what I say resonates with someone else’s understanding.