I’ve written before about the ludicrous subjects the American Holistic Veterinary Medicine Association offers “continuing education” courses on, including “Earth Acupuncture” to heal the Earth by poking sticks in the ground and adoption into a fake Native American religion to avoid federal laws concerning use of drugs and other medical therapies, as well as the more usual nonsense therapies such as homeopathy and homotoxicology. In my previous post, I also discussed briefly the process by which educational offerings qualify for credits needed to maintain licensure as a veterinarian, via the Registry of Approved Continuing Education (RACE) established by the American Association of Veterinary State Boards (AAVSB). There is no point to requiring veterinarians to stay current on the scientific knowledge in their field if there were no standards for what qualified as continuing education. Getting credit for a course on using astrology to choose the timing of drug therapies or some such would violate the intent of the continuing education requirements, to ensure the public that licensed veterinarians are knowledgeable about the current science in their field.
However, the RACE committee and the AAVSB are, like all organizations involved in medical licensure and regulation, subject to the influence of politics and the ideologies of its members. The quality of scientific evidence concerning a medical approach is not always the deciding factor in whether or not teaching this approach can qualify as continuing education for licensing purposes.
Recently the most ridiculous pseudoscience promoted by the AHVMA has failed to qualify for RACE approval as continuing education. This has been due in large part to the effort of RACE committee member Dr. Narda Robinson. While Dr. Robinson and I disagree about the evidence supporting some CAVM methodologies, most notably acupuncture, she does at least attempt to do what many proponents of alternative medicine do not, which is to apply an objective scientific standard to evaluating CAVM. The natural consequence of this approach is, of course, not to legitimize pseudoscience by supporting it as continuing education material for veterinary licensure.
The AHVMA is, not surprisingly, seeking ways to gain such legitimacy regardless of the lack of sound scientific support for some of the nonsense they promote. And they are clearly attempting to use political means to accomplish this, which is certainly easier and more likely to succeed than trying to rigorously test their methods scientifically to see if they actually work.
The AHVMA web site provides links to a couple of documents concerning the continuing education credit process. First, regarding RACE and Dr. Robinson:
The RACE committee denied approval for CE credits for over 60% of the 2009 AHVMA annual conference. AHVMA appealed this and as of October 14, 2010, had still not heard about any decision of the AAVSB (parent organization of RACE). After the conference we received notice that AAVSB had denied our appeal. Their website states that the appeal is directed to the AAVSB Board of Directors. However, the letter of denial indicated that if it has merit, they direct it back to the RACE committee for final evaluation. We would not have bothered with this procedure if we had known it would be submitted back to the RACE committee, since we already know the attitude of the RACE committee’s sole judge of CAVM, Narda Robinson.
Subsequent to their communication with us, the RACE committee has denied credit to an increasing variety of CAVM meetings. At the same time, many states have approved those meetings for CE credit. Most states have reciprocity with other states for approved CE. AHVMA applied to the state of Kentucky for approval of this meeting for CE credits. Just before the meeting we were told that because we do not have RACE certification, we are not approved in Kentucky. However, with the help of convention center staff, we hope to reverse this at the next meeting of the Kentucky state board in December.
They go on to detail the specific courses that have qualified for credit by specific membership organizations, which often have their own requirements apart from those needed to maintain one’s state license. Not surprisingly, the Academy of Veterinary Homeopathy doesn’t share the persnickety scientific standards of the RACE committee and accepts most of the AHVMA’s offerings.
Another document on the AHVMA site discusses directly the “CE Approval Crisis for AHVMA and other CAVM organizations.”
The RACE committee of the AASVB is the body that approves courses for continuing education credits, given by organizations that are not part of the AVMA House of Delegates. In December 2008, Narda Robinson was appointed as the sole person on the RACE committee of the AASVB to judge Complementary and Alternative Veterinary Medicine (CAVM). In 2009, the RACE committee denied CE credits for all homeopathic and homotoxicology meetings. They denied credit for most acupuncture and Chinese herbal medicine that included Traditional Chinese Medicine.
Can you imagine not allowing credit for such standard veterinary practices as homeopathy, homotoxicology, or Traditional Chinese Medicine? A crisis indeed.
Sadly, the AHVMA has found at least some political solutions to this “crisis” which do not require they provide real scientific evidence for the subjects they wish to offer as continuing education. In California, for example, courses offered by the California Veterinary Medical Association (CVMA), a membership organization representing vets practicing in the state, are automatically eligible for credit. And it is possible to form an organization affiliated with the CVMA and have voting rights in the CVMA house of delegates with the signatures of only 25 CVMA members. So a group of veterinarians interested in pseudoscientific medicine, such as homeopathy, can form an organization, become affiliated with the CVMA, and then offer continuing education courses. And since many other states recognize the approval of the California Veterinary Medical Board, these credits can be used by veterinarians around the country. Here’s how the AHVMA materials describe the process:
In California, there is already a process in place to form a new organization that is recognized by the state association. In order to be able to present continuing education that the state of California will offer credits for, an association must be a member of the California Veterinary Medical Association (CVMA) House of Delegates. Those who sign the petition must be members of the CVMA. The CVMA does not care how many non-CVMA members are included in the organization, as long as they have 25 CVMA members to start the organization, and maintain 20 CVMA members once the organization is accepted….
In 2011, the AHVMA meeting will be in California and co-hosted by the California Holistic Veterinary Medical Association (CHVMA). Because the CHVMA is a member of the California Veterinary Medical Association House of Delegates (CVMA HOD), and all CVMA CE is approved by the state of California, this means next year’s meeting is approved by the California State Board of Veterinary Medicine for CE credits for all lectures. Most states have reciprocity with the state of California. As long as your state has reciprocity with California, they will accept these lectures for CE credit.
According to the president of the Academy of Veterinary Homeopathy, the AHVMA is attempting to pursue this same strategy nationally by getting the AHVMA recognized in the American Veterinary Medical Association (AVMA) house of delegates:
AHVMA has been trying to become a voting member of the AVMA House of Delegates. It is important that AHVMA has enough AVMA members to meet the requirements of membership.
Once AHVMA becomes a member of the House of Delegates, AVH RACE CE is also automatically approved since we are, essentially, part of AHVMA as an Allied Group.
Through processes such as these, the legitimacy of medical approaches is established not on the basis of scientific evidence, but through the political lobbying efforts of a minority of practitioners who believe in such approaches regardless of the evidence, and through the apathy and desire not to offend or engage in controversial debate of the silent majority who do not use such therapies. Of course, all human social institutions rely on politics to solve disputes without violence, and certainly this is appropriate. Unfortunately, when there are clear right or wrong answers in such dispute unequivocally established by objective scientific means, it is unfortunate that such mechanisms can be used to make an end run around the truth and promote failed ideas that science and reason would require us to abandon. It is certainly not in the interests of our patients or our profession to have homeopathy, Earth Acupuncture and other similar nonsense gain legitimacy as medical therapies by popular vote regardless of the underlying facts about such therapies. One can hope that enough people within veterinary organizations such as the AVMA and CVMA will recognize that politics and belief is on the verge of triumphing over truth and will object, but I fear such hope will prove unfounded.