Dr. Susan Wynn, a veterinarian and veterinary nutritionist who promotes “holistic” veterinary medicine, has put up a couple of blog posts recently which I rather liked, so I thought I’d comment briefly on them. I more commonly find myself disagreeing with Dr. Wynn on questions of veterinary CAM, but she does often present a more rational and scientific approach to the subject than most proponents of “integrative” medicine, and I appreciate the few opportunities that arise to find common ground with those who have a different perspective or approach.
The more recent of the two posts consists of advice on how to critically evaluate veterinary medical information on the internet. I have also written about this subject, and I agree wholeheartedly with Dr. Wynn’s comments. The recommendations generally focus on being wary of excessively optimistic or unrealistic claims, sites with a commercial or rigid ideological bias, sites which rely on testimonials in place of properly published and relevant scientific research, and sites which refuse to disclose relevant information, such as the ingredients in the remedies they sell or the qualifications of the people offering advice. All of this is sound advice when looking for medical information on the Internet.
Dr. Wynn also published a post on the subject of evaluating the credentials of those offering veterinary medical advice, How to Avoid Phony Practitioners. For the most part, I agree with her advice on this subject as well, with an important exception I’ll get to in a moment. It is easy to make up impressive-sounding titles and initials, and not much harder to obtain a meaningless advanced degree through fake diploma mills, and this is common practice among those pushing alternative medical therapies. Not too long ago, I wrote about Primal Defense, a probiotic product marketed by Jordan Rubin, a charlatan who routinely tried to give his advice additional gravitas by acquiring fake degrees from unaccredited correspondence schools. If one is going to seek advice on veterinary medicine, it makes sense to give more weight to the advice of someone with years of training in veterinary medicine. Doctors are just as prone to cognitive errors as anyone else, of course, but we have the advantage of getting much of our information from the most reliable source available, scientific research.
My only disagreement with Dr. Wynn’s advice is that it ignores the importance of evaluating not only the quality and rigor of the training a practitioner receives, but also the plausibility and evidence for the subject matter in which they are trained. A credential from a rigorous and well-supervised program teaching astrology or witchcraft is not worth any more than a diploma mill credential since the approach is itself nonsense, and an expert in nonsense isn’t an expert in any meaningful sense of the word.
Dr. Wynn talks particularly about the various levels of credentialing in Naturopathy, but she completely neglects the fact that the discipline itself is a pseudoscientific, faith-based approach to medicine. In principle, naturopathy is a vitalist philosophy that looks to unseen energy forces to explain health and disease. In practice, it is a hodgepodge of sensible nutritional and exercise advice and loads of CAM, varying from the plausible-but-unproven to the completely bogus. The only common theme to methods used by naturopaths seems to be the notion of vital energies of one kind or another, as found in methods such as acupuncture, chiropractic, and homeopathy, which all rely in theory on mystical energies that no one can prove exist. And while naturopaths are theoretically trained to refer patients with serious medical conditions to conventional doctors, many are suspicious of conventional drug and surgical therapies. It is not uncommon for naturopaths to oppose vaccination and to promote not only supposedly “natural” approaches such as herbal medicine but also bizarre, dangerous, and manifestly “unnatural” therapies such as chelation therapy, detoxifying enemas, and so on. If the theory is nonsense and the specific practices unscientific, it doesn’t matter how rigorous the training is.
The same logic applies to Traditional Chinese Medicine, with it’s vitalist theory, idiosyncratic and unscientific diagnostic methods, and inconsistent and mostly unproven therapeutic practices. Chiropractic, likewise, contains a few bits of useful treatment for musculoskeletal pain and a load of nonsense and outright dangerous practices, and of course homeopathy is utterly worthless.
All the training in the world in a philosophy or method which has no value does not protect the patient from harmful or useless treatments. So while I generally agree with Dr. Wynn in terms of checking into the credentials of anyone offering veterinary medical advice, I would go farther and suggest that pet owners should look into the arguments and, most importantly, the scientific evidence concerning the philosophy and methods a particular practitioner offers as well.