Comments on: More Hypocritical Nonsense about “Healthcare Choice”

By: Holistic Vet Asks, “IF CAM doesn’t work, why is it allowed?” « The SkeptVet Blog

Thu, 17 Jun 2010 02:32:03 +0000

[...] certain “holistic” veterinarian about whom I’ve written before (here, here, here, and—well, you get the idea) has asked a couple of good questions on his own blog, though not [...]

By: Dr. Shawn on Alison Averis’ Essay Fooling Yourself « The SkeptVet Blog

Sat, 17 Apr 2010 05:34:17 +0000

[...] "rubbish." There's a polite and thoughtful critique for you. As for the question of choice, I've addressed this bit of misdirection before. Offering as alternatives treatments which have not been demonstrated to be safe or effective, or [...]

By: Specialist’s Statement on Integrative Methods « The SkeptVet Blog

Specialist’s Statement on Integrative Methods « The SkeptVet Blog — Mon, 15 Mar 2010 19:11:42 +0000

[...] seems a variety of the bogus “health care choice” argument. Yes, adding unproven or implausible therapies to what we do gives us more things to do, but if [...]

By: skeptvet

skeptvet — Sun, 28 Feb 2010 15:47:49 +0000

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.

By: Bartimaeus

Bartimaeus — Sun, 28 Feb 2010 01:12:54 +0000

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.

By: v.t.

v.t. — Sat, 27 Feb 2010 20:53:41 +0000

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.

By: skeptvet

skeptvet — Sat, 27 Feb 2010 15:57:09 +0000

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.

By: v.t.

v.t. — Sat, 27 Feb 2010 05:34:36 +0000

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).

By: Bartimaeus

Bartimaeus — Sat, 27 Feb 2010 02:24:46 +0000

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.

By: v.t.

v.t. — Fri, 26 Feb 2010 21:32:50 +0000

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?