A common complaint about conventional, science-based medicine is that it is unduly influenced by commercial interests and agendas, especially the pharmaceutical industry or “Big Pharma.” There is no question that corporations who manufacture medicines, pet foods, and other products used or recommended by vets are interested in making money, and this colors their judgment. There are legitimate concerns about the influence of industry funding on research and how it impacts the quality and conclusions of the evidence we use to inform our practice. However, none of this automatically invalidates the research or the products of industry, it just gives us a cause for some skepticism and care in the judgments we make.
The implied, and sometimes even explicitly stated, corollary to this concern is that “holistic” or alternative medicine and its practitioners are somehow free from the financial motives that taint the practices of conventional veterinary medicine. I’ve addressed this myth before (Big CAM and the David and Goliath Myth), and I wanted to share a recent reminder that proponents of alternative therapies face exactly the same problem of financial motives and corporate influence.
The American Holistic Veterinary Medical Association (AHVMA) is having its annual conference this month (more about that in a subsequent post), and they have quite appropriately identified and thanked their sponsors on their web site. Let’s have a look at the list, shall we?
Rx Vitamins for Pets
A “Diamond” level sponsor of the keynote address.
This is a corporation selling a variety of vitamins and nutritional supplements. They have a representation at most conventional veterinary conferences, and they are actively recruiting paid veterinary student representatives to give out samples and literature. Sound like a pharmaceutical company?
The supplement line is supposedly invented by Dr. Robert Silver, a “holistic” veterinarian from Colorado, who is also an acupuncturist and practitioner of Traditional Chinese Medicine (TCM) and homeopathy. Clearly, Dr. Silver is a “true believer” in alternative veterinary medicine
Diamond level sponsor of the Newcomer Social.
A division of the larger, international company Food Science Corporation, which makes a wide variety of nutritional products for human and animal use. Mom and pop operation? Pure labor of love? Hardly.
A Gold level sponsor.
One of the largest corporate manufacturers of veterinary and human nutritional supplements. And something I didn’t know, the company states on its web site that it is “a private, Christian-based, company…” and that “The real strength and prosperity of Nutramax Laboratories, Inc. comes from The Lord.” Faith-based medicine indeed.
A Gold level sponsor.
A company founded by Bill Bookout, a businessman and president of the primary veterinary supplement industry lobbying organization, the National Animal Supplement Council. The veterinary name behind its products is that of Dr. Ihor Basko, a career proponent of alternative therapies with many related books, videos, and products to sell.
Contributed $10,000 to support student chapters of the AHVMA at veterinary schools.
The veterinarian behind this obviously successful commercial firm is Dr. Michael Fox, an advocate for animal welfare and also a firm believer that modern, technological society and its products (including commercial pet food and pharmaceuticals) are physically and spiritually toxic. Despite his concerns about the rapacious behavior of corporations, he does endorse a variety of commercial pet foods and supplements.
So what does all of this mean?
1. Does the acceptance of commercial sponsorship mean that the AHVMA is the dupe or lackey of commercial interests and their medical recommendations are mere parroting of industry marketing? Of course not.
2. Does the fact that these companies and individuals make money selling and advocating for alternative health products mean their motives are purely financial and their advice can be automatically dismissed? Absolutely not.
3. Is it likely that people who are believers in alternative medical approaches write books, give lectures, and start companies selling alternative products because they truly believe in these things? Without a doubt!
So why is it so often assumed by these people that anybody working for a commercial pet food or pharmaceutical company is motivated by greed? While corporations are primarily driven by profit, and individuals are certainly subject to both the blindness of their own biases and subtle influences associated with their sources of income or research funding, the fact is that people practice science-based medicine and work for medical industries because they truly believe they are doing good for patients. The assumption of benign motives in alternative medicine and venal motives in mainstream medicine is pure self-serving prejudice, nothing more.
4. So are advocates of alternative medicine who complain about the influence of corporate money on conventional veterinary medicine total hypocrites? Absolutely!
They may not always be wrong, since such influence is a legitimate source of concern, but it applies every bit as much to the alternative medical industry as to conventional medicine. Big Supplement may be smaller than Big Pharma, but it is the same type of organism, with the same problems.
5. And are advocates of alterative medical approaches open-minded while science-based veterinarians are blind idealogues? Nonsense!
The people behind these corporate sponsors are, as far as I can see, all deeply committed true believers in the ideological, and often religious foundations of alternative medicine. They filter and interpret the evidence of science to confirm their pre-existing prejudices and assumptions and ignore whatever contradicts them. All human beings are prone to do this, of course. The very value of science and scientific evidence is that is diminishes the impact of these kinds of biases and blind spots. True open-mindedness and humility lies not in steadfastly seeing the world as we believe it is or should be but accepting that our vision is blurry and unreliable, and that we must be prepared to give up even cherished beliefs when the more reliable evidence of science shows us they are false.
The vital importance of faith, of belief in the unseen and untestable, to the ideology of alternative medicine is clear. Nutramax is a Christian company, Dr. Basko is a Zen Buddhist, and Dr. Fox is a pantheist, but all hold a strong belief that the true, most real, and most important aspects of reality cannot be seen, demonstrated, or scientifically investigated but must be appreciated through intuition, introspection, and individual spiritual practice. Is it surprising, then, that these same individuals reject the notion that what seems true to the individual in medicine should be rejected as false on the basis of scientific testing?
Faith-based medicine relies on the very same kind of faith behind all religious beliefs; namely that we must trust what we feel and believe more than what we can see, touch, or study by reason; we must trust ideas and beliefs more than observations and facts. There is nothing “open-minded” about such beliefs, so to claim that the science-based perspective is closed-minded by comparison is ludicrous. A philosohy founded on faith is, in most ways, far more dogmatic and blind to the possibility of being wrong than the scientific approach.
The title of this post was intentionally hyperbolic and inflammatory, and untrue, because I wanted to make what I think is the key point here: The motives of alternative medicine advocates and providers, ideological and altruistic or venal and greedy, are no different from those of science-based medicine advocates or providers. We all tend to live our values and ideologies, and we are all subject to ideological blindness and potential financial influence. The difference between what is true and what is false, what works in medicine and what does not, cannot be determined by looking at only the beliefs or incentives behind different approaches, though these factors do have some relevance. The ultimate answers must come from facts and objective study, and only science is able to provide this, however imperfectly.
I’m not sure how hyperbolic your title really is (OK it is a little).
I’ve gradually become more concerned with all of the corporate sponsorship of speakers, entertainment, food, “free” handouts during the conference I see at veterinary conferences. Sometimes it’s hard to spot the conference name through all the corporate logos. It is interesting that the AHVMA is not any different, except that the supplement companies are not held to the same standard of evidence as the more tightly regulated pharmaceutical companies are. Good post.
Obviously this website is biased against complementary integrative veterinary medicine….keeping comments and ideas one sided and supported pharmaceutical and commercial pet food monopolies which have been raking in the money for many decades.
Threatened financially and ideologically, they must resort to political tactics of attack, shock and awe using headlines inspired by the National Inquirer or some other ladies gossip rag.
There are many places to get accurate information about research on complementary medicine if you are really looking for it. This website does not.
If you were a legitimate blog looking for the Truth and not a shill for the pharmaceutical companies, you would have researched both sides of any issue.
FYI 2 websites for evidence based research and abstracts:
unless we hold our meetings in the open with no tents, no overheads, no toilets and no free food, someone has to pay……..I guess attention to who we choose as sponsors is important.
Sure. I don’t think there is anything inherently wrong with commercial sponsorship. We just have to be aware of the potential risk for bias introduced by this. And, the major point of the post, we have to be honest enough to acknowledge that alternative medicine is just as susceptible to this influence as conventional medicine.
Utter nonsense, but let’s take a look at the specifics.
1. comments one-sided: Clearly, you haven’t read the comments for many of my posts, most of which are from angry proponents of CAM such as yourself. I always try to respond thoughtfully and with civility even to such empty rhetoric as yours.
2. supported pharmaceutical and commercial pet food monopolies: I’m supported by my salary, which I earn like any other veterinarian by taking care of my patients and their owners. The whole point of this post was that pretending conventional medicine is beholden to corporate interests and alternative medicine is a profit-free altruistic labor of love is disngenuous and obviously untrue. You make a living selling the kind of care you believe in and I do the same.
3. Threatened financially and ideologically, they must resort to political tactics of attack, shock and awe: Wow, I never thought of my little essays as “shock and awe” inducing. Thanks!! Of course, if you bothered to read any of them, you will see that they are usually thoughtful opinion pieces or fact-based analysis. The headline got your attention, which was its purpose, but as I said in the post itself, “The title of this post was intentionally hyperbolic and inflammatory, and untrue, because I wanted to make what I think is the key point here: The motives of alternative medicine advocates and providers, ideological and altruistic or venal and greedy, are no different from those of science-based medicine advocates or providers.”
4. shill for the pharmaceutical companies: Just like you’re a shill for supplement companies? Come on, try to at least pretend your making an intelligent, thoughtful defense of your position. Is your irony meter broken? How can you throw rehtorical garbage like this around without even reading the material on my site and then accuse me of bias and unfair tactics? Those rocks you’re tossing aren’t doing much good for you glass house. And apart from being hypocritical, you are certainly not demonstrating any of the compassion or right speech demanded by the spiritual tradition you claim to follow.
What I am biased against is confident, for-profit advocacy of unproven or clearly ineffective medical therapies justified only by anecdote or tradition or personal faith. If you’re not against this, then shame on you.
As you know, it is often so very difficult and extremely time consuming and expensive to scientifically prove things with randomized controlled trials. Especially when there are many neurological, physiological, psychological, etc effects and factors involved. Should we always wait for all traditional therapies and innovative therapies to go from bench side to bedside? And have patients potentially suffer in limbo while waiting for modern science to catch up?
Especially if the therapy does not cause harm?
Indeed, it is a quandary. Ideally, we would have many RCT for every single item we recommend or prescribe. That, however is not possible in our lifetimes. We have to make use of the best knowledge we have, sometimes that is anecdotal based on centuries of experience and use or limited numbers of RCTs as sometimes is the case with Traditional Chinese Veterinary Medicine, Herbal Medicine, Chiropractic and Osteopathic. However, when I see patients survive and recover that I know would definitely not have done so without innovative ideas and classical therapies, I no doubt am very happy I tried them. So are the patients and the clients!
We are all definitely pioneers in some way and we are all learning. It is important to keep an open mind, and keep trying and learning in all ways. Those are just some of the many benefits of continuing education seminars, conferences and discussions amongst peers, patients, companies and researchers alike.
Julie Schell BSc(Hons), DVM, CVA
Nowhere have I suggested we need an RCT for every intervention, so that is a bit of a strawman argument or charicature of my position. If you actually read my articles, I think you’ll see that I am fully aware of the limitations in the available evidence for both conventional and alternative therapies. I focus on alterative therapies on this blog because, as I explained to Dr. Basko above, these are most often promoted and adhered to beyond the justification of real evidence, whereas conventional practices shown to be useless are more readily abandoned. There are certainly times when the need to intervene is pressing enough that taking a risk on the unproven is justified, so long as we are clear with owners about the state of the evidence.
That is not, however, how most alternative medicine is presented. The safety and efficacy are assumed based on tradition, personal experience, or other unreliable levels of evidence. People are told that this therapy WILL help and IS HARMLESS even when we do not truly know that to be true. There is ample evidence that such therapies can be harmful (http://www.skeptvet.com/index.php?p=1_21_What-s-The-Harm-), and the reality is that most new therapies, both scientificallly plausible and implausible or made up out of whole cloth, ultimately don’t fulfill their proimise. So the ethical and reasonable path is to acknowledge the limitations of our knowledge and the poor validity of our personal clinical impressions, to be honest with clients about these limitations, and to refrain from acting when there is significant uncertainty unless the need to act is great enough and we have been thoroughly honest.
An open mind does not mean accepting as valid everything claimed by others. It means accepting as possible and then requiring evidence. An open mind and true humility also means abandoning interventions that are clearly shown not to work. For example, I am open to the possibility that many herbal remedies may have value, though I think there is little reliable evidence for most of them so their use must be considered experimental. On the other hand, the evidence is overwhelming that homeopathy does nothing at all, so continuing to use it is not being open-minded, it is wilfully denying the evidence and persisting in an unjustified belief. This is an act of faith with more in comon with religion than science, and it should be acknowledged as such.
I have accepted many new ideas in my years of practice, and I have also abandoned many that turned out not to be worthwhile. The problem I have with much of CAM is that people refuse to accept that their beliefs or impressions might not be true no matter what the evidence, that people value their own perceptions and subjective opinions far beyond what is reasonable, and that people react to critcism or questions about the validity of their approaches with anger, personal attavks, and empty rhetoric as if I had insulted their religion, not with reasoned counter arguments and evidence as a scientist out to respond. (note, I’m not referring to you here, but a quick perusal of the comments, not to ention the emails I get, will demonstrate my point)
Dr. Schell asks, “Should we always wait for all traditional therapies and innovative therapies to go from bench side to bedside? And have patients potentially suffer in limbo while waiting for modern science to catch up? Especially if the therapy does not cause harm?” Good questions, all.
First, therapies should all be judged by the same standard. In fact, we should have good evidence of effectiveness before applying therapies – no matter what therapy. Failing that, we should offer such treatments to people that are fully informed, and then keep track (as an experimental therapy would be offered).
Second, there’s absolutely no reason at all to believe that by “waiting for science to catch up,” anyone is being harmed. To the contrary, many, many people have been harmed by eager and careless administration of therapies for which good evidence hasn’t been accumulated; examples would include thaldomide (which, paradoxically, was eventually tested, and turned out to be a great treatment for some kinds of cancer.”
Finally, as to harm, unless one tests, how does one know if there’s no harm?
To offer patients unproven therapies under the aegis of “doing all one can” isn’t compassionate, it’s cavalier, and it’s demonstrably harmful. Sometimes practicing good medicine means having to say, “I don’t know, we need to find out.”
David Ramey, DVM
as a pet owner i’ve never given any thought as to a veterinarian’s religion or faith and how his/her beliefs might impact the medical care my animals receive. but your post really got me thinking. if I knew the doctor was, say, a scientologist or a creationist, it would give me serious pause for thought. if they aren’t rational critical thinkers, how can they practice sound medicine and make intelligent decisions on behalf of my pets?
dr. martin goldstein
dr. deva khalsa
Ah yes, the hypocrisy.
Get the records from the conventional vet (the work has already been done for you). Convince the client the conventional vet didn’t do right by the pet (that procedure wasn’t necessary, that medication is toxic to your pet, the vet didn’t address the pet’s vital energy or chi). Convince the client you will magically cure the pet (you of course have all the unproven herbs, vials of water, faith-based healing methods). Convince the client to cease all rationale concerning diet, vaccinations, and whatever else you have personal issues with. Convince the client to abandon all rationale in favor of your unproven methods because scientists, big pharma and conventional vets and other shills are working together in some conspiracy.
Your website, Dr. Basko, is quite revealing. You first state you pride yourself in combining conventional medicine with integrative medicine. Yet, on another page, you state your preference for treatment is exhausting all holistic methods before considering conventional medicine. (the former is not practicing medicine at all). That little bit of information tells me you are not giving your clients proper disclosure.
For the record, skeptvet’s site and blog has never had a shock and awe theme. It’s informative, detailed, presented clearly and concisely, among one of the most valuable sources for evidence in veterinary medicine. You expect unbiased information, try presenting the same on your own site.
ellen, I’m not sure religious convictions should discourage your confidence in a vet. If the vet is educated, qualified, skilled and can perform the required procedures, his/her religious beliefs shouldn’t determine the outcome, nor your expectations. Veterinarians and doctors of all faiths practice medicine, it doesn’t make them incompetent.
A scientologist who is an alternative vet however, might be a different story. 🙂
v.t., good point, but if they’ve already suspended rational thinking to embrace scientology or creationism, they’re more likely, imho, to use therapies that have little basis in science, like homeopathy and “energy medicine.”
a holistic vet once told me that i had to give a homeopathic remedy *with intent* or it wouldn’t work –that’s faith healing.
ellen, you have to consider that if common majority thinking is any indication, then 80-90% of, at least Americans, believe in creationism (that is, if the definition alludes to believing in God). So, part of that percentage would include professions of all types that you must place your trust in throughout your life.
I know a vet who is mormon. It doesn’t mean the vet is living in polygamy (although I believe they think they may, so to speak, in the afterlife). It doesn’t mean the vet has any reason or need to project the beliefs into the practice or dictate how a procedure or treatment is done. This particular vet denounces CAM, and is a well-respected vet and an excellent surgeon. I would place my trust (and have) in the vet’s hands any time.
I know what you’re getting at, though, it’s a scary thought.
“ladies [sic] gossip rag”
v.t. said: “I know what you’re getting at, though, it’s a scary thought.”
i think we’re on the same page, v.t. 🙂 it wasn’t my intention to make broad brush statements or get into a dissertation about religion vs reason. lol i just find it interesting that some holistic vets can cast aside everything they learned in school about the laws of chemistry and physics, for example, and prescribe homeopathic remedies for their patients. it’s that leap of faith that makes me wonder if there’s an underlying predisposition toward CAM use.
ellen, I’ve wondered that exact same thing, and I think your term ‘predisposition’ says it well. I really wish I knew what makes their minds tick, but at the same time, would I understand if I knew! 🙂
I think the issue of religion and alternative medicine is an interesting, and probably quite complex and slippery one. As I mentioned in a previous post, there is some limited survey evidence that alt med practitioners are more inclined to cite “spiritual” beliefs as critical to their everyday approach to life, but less likely to belong to a traditional organized religion, than others. And there tends to be less religious belief in general among the most highly accomplished in the sciences. But there are lots of exceptions, as v.t. points out.
I think there is no question that there is a general tendancy towards faith, as understood in the religious sense of belief in the unprovable and non-material, as a core value for people drawn to alt med. But people are very good at holding multiple incompatible ideas at the same time, so it is possible (though a bit unusual) for a dedicated philosophical naturalist to buy into water memory or chi and for a dedicated believer in the supernatural to reject alt med (as many fundamentalist Christians due, claiming it conlficts with their orthodoxy). Interesting stuff. Hmm, I see a post coming on… 🙂
“National Inquirer or some other ladies gossip rag.”
-oh, Lisa Preston already said it – but really!
the economic argument
i thought y’all might enjoy a little humor. 🙂
skeptvet said: “Dr. Basko is a Zen Buddhist..”
i wanted to read dr. basko’s bio, but there’s no mention of zen buddhism on his new website (http://www.drbasko.com/site/about/). i found the old website page using internet archive: http://snipr.com/1bxv4r
btw, nice website, dr. b. looks like you’re living an idyllic lifestyle in beautiful hawaii. 🙂
Yes, the site available when I wrote the post indicated “He is devoted to his weekly Yoga practice and follows the Zen Buddhist philosophy.” The new site does not include that bit of information.
Personally, I will not go to a medical doctor or vet who I know to be a member of any cultish religion (mormonism, scientology, christian science, et. al) whose members routinely suspend rational belief. At least mainstream religions (Catholic, Lutheran, and other Protestants) by and large accept science/evolution.
Sorry, but I cannot take someone seriously in matters of health who believes that Jesus came to America (in a submarine, I believe) and begat many offspring with the native people, and that one certified nutter, J. Smith, dug up golden tablets that told of this–and much more. (Not to say that the Bible is much less goofy, but at least it has some foundation in history).
The whole problem with combatting CAM is that we, as a nation, have already established that ANYTHING that anyone “believes” is equal in merit to anything established by scientific method and must be not only tolerated, but “respected”.
Can’t argue with you there.
Janet, while I understand your position, I’ll just say I don’t agree, if not for the simple reason/example I posted above. If you count the number of people who provide valuable services to you in your lifetime, if you didn’t know of their religious affiliations, how could you judge them on their performance and service?
The mormon vet has a mormon client, who I never knew was mormon until the vet revealed it to me. The mormon client was, and continues to be, my husband’s urologist. We are less concerned about how they practice religion as to how they are able to perform their medical duties, both of whom have saved lives and never interjected their practice of faith into their medicine. I’m sure there are countless professionals of various religious faiths that are completely competent to practice medicine.
Had the mormon vet started prescribing herbs and acupuncture in his veterinary practice, I might think a bit differently, but that he practices mormonism is the least of the problem in a town with a few other alternative vets who truly are wacky – in my opinion, their religious beliefs wouldn’t even matter, for they’ve already opened themselves up to scrutiny, and questions of medical ethics.
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