Readers of this blog will be familiar with Dr. Shawn Messonier and his style of promoting alternative veterinary medicine by lying about scientific medicine and veterinarians who practice it (e.g. Here, Here, and Here). The latest example of this behavior is also a fine example of the bogus CAM marketing approach known as “healthcare choice.” I written about this strategy before, but in brief it is the claim that any argument against alternative methods, and certainly any attempt at regulation that requires proof of safety and efficacy before marketing a medical intervention, is an unjust suppression of people’s right to choose their own form of health care. Usually the argument is paired with accusations or implications that anyone who questions whether CAM works or is safe is only interested in protecting their own income.
Dr. Shawn makes this argument in its classic form in a recent blog post.
“As an integrative, naturopathic doctor, my practice is all about choice. While I hope I can convince my pet owning clients that using natural therapies whenever possible is the better, safer, usually less expensive, and healthier way to go, ultimately the choice of therapy chosen is up to the client.
If the client chooses a more conventional drug therapy, that’s her choice and I will never interfere with that choice…
It seems to me however that skeptics who rally against natural therapies don’t want their patients or clients to have this choice.
For many of these skeptical doctors, it’s “their way or the highway!”
They consistently try to talk patients out of a more natural approach to healthcare, all the while demeaning and insulting this choice, as if this choice is invalid or irrational…
The only answer I can come to after researching this question is this: economics.
If a doctor only offers one choice, in this case conventional drug or surgical therapy, and you choose a more natural approach, that means you will have to find another doctor. Your current doctor loses your business, and your choice punishes his pocket book. He won’t like that and will do anything to keep you as a patient.”
This argument is, of course, merely a cynical attempt to convince pet owners to choose Dr. Shawn’s methods by hypocritically claiming to offer more “choice,” which sounds better than admitting he has nothing but his word to offer as proof that his alternative methods actually are better for his patients. He criticizes conventional veterinarians for trying to talk clients out of using unsupported or outright quack therapies yet he admits to trying to convince his clients these therapies are better than scientific medicine, to which end he has many books, a radio program, and of course his web site, all of which are ways he makes his living. The argument is blatantly hypocritical on the face of it.
On his website, the good doctor discourages vaccination; claims commercial diets are full of toxins that lead to cancer; refers to pets taking conventional drugs as “pharmaceutical cripples” and encourages pet owners to “say NO to drugs,” and in many other ways discourages conventional medical therapies. Granted, he also makes use of many of the treatments provided by sound scientific medicine, and his practice philosophy seems to consist mostly of adding the unproven and the opinion-based on top of conventional medicine, but this is not about giving pet owners more choice, it is about pushing his own beliefs and opinions and then slandering anyone who challenges him to back those up with real evidence. If trying to convince clients about what one believes to be the true facts regarding a particular treatment is “interfering” with teir choice, than Dr. Messonier is as guilty of this as anyone.
CAM practitioners often claim to promote choice while actively claiming scientific medicine is mistaken and causes great harm. And it is not unusual to find statements such as the following from self-professed “holistic” veterinarians:
“Use of Other Modalities and Medications
The treatment program that we use is not compatible with the simultaneous use of conventional drugs such as antibiotics, corticosteroids, thyroid hormones, etc. As the cases progresses, you may be guided in the gradual discontinuance of some or all these medications. This is necessary so that our methods can take full effect. In addition, if other symptoms appear during treatment (or older, previous conditions return) you will be expected to contact us for appropriate response rather than use drugs that you may have used before. The reappearance of older problems can be a very good sign that the body is beginning to heal and this is usually a very delicate and important time. The use of conventional medications and treatments might make this healing impossible!”
However, the “health care choice” argument is wrong in many ways besides merely being hypocritical. It evades the underlying issue of what the choices being offered actually are. If a client is told that an unproven treatment is safe and effective and that conventional preventative or treatment interventions are toxic and harmful not helpful, then they are being deceived, intentionally or by the genuine mistaken beliefs of the practitioner. A choice to rely on placebos or therapies that don’t work and may very well do harm based on an “educational” harangue is not a true informed choice in an meaningful sense. The whole point of evidence-based medicine is to support our recommendations with objective scientific research, not merely our own biases and opinions. And the motivation behind practicing evidence-based medicine is better patient care, not simply making money.
Alternative therapies have not earned any special exemption from rigorous objective testing or criticism. They should be judged, as scientific medicine is judged, on their merits, not on the strength of the faith their proponents have in them. Viewing the implausible skeptically and asking for evidence rather than taking Dr. Shawn’s or anyone else word for the safety and efficacy of alternative methods is the right way to protect the well-being of our patients, an trying to label it an unfair restriction of consumer choice motivated by greed is simply another example of the unprofessional, hypocritical, and vapid marketing strategies many CAM proponents have to rely on absent the real convincing evidence they fail to provide.
Dr. Shawn has the zeal of a true believer, and the inability to consider the possibility he might be wrong. Claims like his of offering more freedom of choice than conventional veterinarians are simply a marketing strategy based on caricaturing and slandering veterinarians who practice science-based medicine and evading the challenge of backing up their medical practices with something more convincing than their own opinion and experience. Such language is unfortunately often effective in a society that sees choice as automatically a virtue and that likes simple, personalized arguments rather than complex, nuanced, and fact-based ones. We who adhere to the standards of evidence-based medicine are at the disadvantage of not being able to make any claim we like regardless of whether we can support it, and those of us who believe in challenging ideas and arguments rather than people and their motives are at a disadvantage in such debates as well. Rarely do you see too sober, polite, and well-informed adversaries arguing complex scientific issues on daytime television, since it is far less compelling to watch than vapid appeals to emotion like the “healthcare choice” argument. More’s the pity.
I noticed that he is complaining in his “goals for 2010” post about not getting on any national TV shows to promote his nonsense. It has not occurred to him that those producers may see through his self promotion and that “lack of interest” may be a polite excuse.
Also he talks about extending the lives of pets but is not critical of kennel club breeding practices, and talks about his Cavalier King Charles which is one of the breeds most severely afflicted with genetic problems (syringomyelia and heart problems). I’m sure he loves his dog, but he should be aware of the problems with that breed.
I suppose he would not have any national media exposure though if it was not for Dog Fancy, Cat Fancy and the like. Looks like another case of “crank magnetism”.
The link to Bernstein’s site: everything on that site is so self-contradictory it’s almost comical.
And in my opinion, downright criminal.
http://www.newclientform.com/newclientform/nhpc/html/homeopathic_primer.htm
“….It is a complete discipline of medicine and contrary to the writings by some, it is not “harmless”. In nature, anything with this much power to heal can have side effects and is best supervised by a trained homeopath. This is especially true in chronic, weak and long standing cases. It is especially true in cases with a great deal of pathological changes such as tissue destruction or deep lesions.”
I would hope that the client would wisen up long before those chronic conditions “re-surface”.
Yes, that site is an especially egregious alternative medicine, which presents not only unprove methods but a completly alternative philosophy or reality. It’s a shame how easily snowed people are by pseudoscientific verbiage and how such self-evident nonsense seems reasonable to so many, vets included sometimes.
I went to get some CE this month at a new pet hospital in south florida that is for pet cancer only. Alternative medicine was on the menu as well as a CT machine and 360 degree radiation machine.
http://www.animalcancercareclinic.com/Pages/ACC-Specialists.html
I think non surgical Pet Oncologist must be the most optimistic people on the earth. I wonder if the data would show you get more not less traditional medicine going to most alternative medicine pet practitioners offices when medicine has no known cure for a disease your pet has. My wife a RN tells me the big Human cancer clinics all seem to offer alternative medicine also. If i went to a human cancer clinic and alternative medicine was on the menu I might think the radiation and chem was not going to work either producing a negative placebo effect. The alternative medicine vets i know use more traditional medicine than i do. The client gets more medicine both traditional and alternative. The alternative medicine preachers may use less traditional medicine but my guess is the field so called alternative vets use more traditional medicine not less.
art malernee dvm
fla lic 1820
Art’s post leaves me with the question I often ask but am seldom satisfied with the answer. This is so common, alt vets “integrating” the “best of both worlds” (conventional with alternative). But what is best when only one works or has the potential to work or limit symptoms and the other does nothing at all but to placate the practitioner and the owner? The pet sure doesn’t get the best of both worlds! Is it merely because they are reluctant to admit that, or are they so delusional they truly believe it? Or, option three, which I suspect in many cases: they’re getting the best of both worlds in terms of costs. Besides the fact they can credit their alternatives for a successful treatment, (regardless if conventional meds were used), real medicine costs, and alternatives cost even more. Win-win for them, right?
I think you are right VT, it is not unusual to see articles in veterinary economics talking about how adding acupuncture to you practice will increase your income, with very little attention paid to the lack of evidence or efficacy. It also gives vets something to do in a lot of those cases that are going to take time anyway. Sometimes people really want to do something (anything) while tincture of time does it’s work. clients like that can be challenging, and it can be difficult to satisfy them sometimes. I usually try to find something harmless and free or inexpensive for them to do at home instead of selling woo, but I have also had a few clients go to vets that would provide acupuncture or homeopathy or chinese herbs against my advice too.
Thanks for your commentst, Bartimaeus, and I understand the wanting to do *something*. What I have a hard time wrapping my mind around is what is so harmful about tincture of time, we could call it natural. We could call it natural detoxification! 🙂
The added income is true in both conventional and alternative practice, but it seems to me that at least the owner is getting real value with the former as opposed to a double-whammy bill of half the value of the latter. I’d bet the art of persuasion accounts for over half of the 1.5 hour appointment with the alt vet, and the client throws their economic sense right out the window (along with their common sense).
It seems fairly clear in human med, and likely it’s the same in vet med, that one reason CAM is popular is that its practitioners do a better job of managing the psychological aspects of the treatment experience. Our TCM/acupuncturist who comes in to our hospital regularly, burns incense, lights candles, and spends a lot of time talking to clients about their pets and confidently reassuring them, which I think has more to do with why her clients seek her care than the efficacy of the herbs and needles she uses. So it may be that adding CAM, paricularly if one also ads the longer appointments and the “talk therapy” style of history taking that often goes with it, might really improve client satisfaction. Certainly, it would be better received than the “tincture of time” approach. Sadly, doing nothing is almost always seen as failure by the client, even when it is the right thing to do, and it’s very hard for most doctors to comfortably recommend it.
Unfortunately, if one adds CAM for the client psychology benefiots then one has to deal with the ethical dilemma of selling a placebo, especially a placebo by proxy that probably isn’t even helping the pet in the limited way CAM placebos help people who use them. I couldnt’ personally justify it, but it’s not hard to see why some do given it is perceievd as 1) harmless, 2) maybe helpful, 3) good for client relations, and 4) good for generating income. I’m not sure how one combats all of the “pros” when the very fact that it most likely isn’t actually helping the pets medical condition isn’t sufficient reason for most people not to do it.
What if conventional human docs started incorporating the feel-good psychology into their practice? Would this be enough for clients and could we see a reverse back to common sense approach to medicine? Or, is the big pharma/greedy doctor paranoia thing too deeply ingrained to change views? (I realize there is a plethora of arguments here: costs, health insurance, competition, availability of specialists etc). I just don’t understand the hypocrisy (and irony) when the client is satisfied with an extra half hour for an appointment, and is wooed with lies and myths, and pays much more in the long term. Worse when they apply this to their pets.
I think you are getting near the dilemma that we run into v.t. An ethical veterinarian (or doctor) feels an obligation to tell the truth as much as the owner or patient can understand it. Sometimes that means giving bad news and/or not giving a false impression. Since I do house calls, I often spend more time than “average” talking to clients, and often taking time to make sure the owner understands the situation and feels comfortable with the situation works great. That is when doing something like you suggest is effective-just making the client understand that some rest and maybe some kind of gentle attention (massage, etc) is the way to go. The times that extra time and attention does not work are often the times when the client is already a “true believer” anyway, and are set on pursuing their favorite woo.
Certainly, there’s no reason, apart from the economics of how our healthcare system is structured, why MDs (and vets) couldn’t do a better job dealing with the psychology of the treatment situation. I don’t think it necessarily needs to involve bogus or placebo therapies, since it is clar that the placebo effect coming from the therapeutic ritual can improve people’s satisfaction with legitimate, effctive therapies as well as with woo.
Still, I agree with Bartimaeus that we are obliged to be honest with our clients, and sometimes this means telling them things they don’t want to hear and admitting our own limitations.
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