The primary focus of this blog is to examine carefully the claims and evidence concerning alternative veterinary medical therapies. I focus less on the failures of conventional therapies and providers to always adhere to the highest standards of science-based medicine partly because the sins of Big Pharma and other such issues are already well-covered, and partly because the problem of inadequate evidence and pseudoscience is far greater in the alternative medical domain.
However, there are some areas of conventional medicine which strike me as inconsistent with good science-based practices, and which are reminiscent of the exaggerated claims and ethically questionable marketing practices commonly associated with alternative approaches. The current wave of commercial stem cell therapies falls into this category.
As I have said before, I have no objection to the idea of stem cell therapy. Unlike some alternative methods which are based on unscientific or pseudoscientific theories, stem cell therapy is a biologically plausible approach with encouraging preclinical and pilot clinical trial research behind it. My only concern is that expensive and invasive clinical interventions are being aggressively marketed to vets and pet owners without adequate evidence to support that they are safe and effective.
There is always a balance to be struck between the need to address important clinical problems and the uncertainty about the best way to do so. I am concerned that the companies currently pushing these interventions have tipped the scale too far in the direction of acting before there is adequate information to ensure that we do more good than harm. The proponents of these interventions undoubtedly believe they work, but they seem to base this belief on personal experience and theory, not sound clinical research, and these lower levels of evidence are inherently not very reliable. There is also, without question, clear financial motivation to be the first to offer these therapies and capture the dominant market position, which will likely prove a very lucrative one if time and further research does eventually bear out the claims made for these therapies.
I recently came across some advertising materials, for veterinarians and also for pet owners, from the MediVet company, the other major provider of veterinary stem cell therapies along with VetStem. These advertising materials exhibited many of the hallmarks of quackery I have written about before. None of these warning signs allows us to conclude this therapy doesn’t work, but because they tend to be found along with unproven or clearly bogus approaches, the more of them we see, the more cautious we should be in believing the claims being made.
1. Appeal to emotion in lieu of presenting real evidence
2. Claims of major scientific breakthrough without supporting published research evidence
3.Use of testimonials to support claims and encourage use of the method
4. Claiming extensive research validates the therapy without providing this evidence
5. Playing to fears about conventional medical treatments
6. Claiming to be “natural” and invoking the fallacy that “natural” means “safe” and “beneficial”
7. Claiming to produce a benefit with absolutely no risks or side effects
1. Appeal to emotion
Of course, emotions is a more compelling marketing tool than facts, and it is unavoidable in any effort to sell something. However, appeals to emotion that are not accompanied by solid factual support for the claims being made are often a smokescreen to obscure the absence of such support. And because of the unique dangers inherent in medical treatment, and the constraints on pet owner’s abilities to make medical decisions for their companions in a purely rational way given the intense emotional connection they have with their animals, it is easy to inappropriately manipulate people with emotional appeals.
The client brochure for MediVet shows a serious looking cat and somewhat sad looking dog staring directly at the reader, and the text reads:
If your pet suffers from pain, arthritis, or joint disorders, ask your vet about the healing power of stem cells. Don’t let your pet suffer any longer.
Clearly an appeal to emotion, with a good dose of guilt and an implied promise of relief if you buy the product.
The marketing materials for vets uses this tactic as well.
Bring back that “PUPPY FEELING”
Enjoy long walks, running and playing again
[Pet owners benefit from] knowing they are easing the suffering from…degenerative diseases
Don’t just live and let live, live and help live.
It is, of course, perfectly appropriate to care about our pets’ pain and to feel good about making it better. This is one of the great rewards of being a veterinarian. But the implications in these materials of dramatic improvements credited to an as yet unproven therapy, and the emphasis on emotion with a relative absence of evidence is a warning sign because it is frequently associate with therapies that must rely on emotion for promotion because they don’t have real evidence of their benefits. Skepticism is appropriate when confronted by highly emotional marketing of a medical therapy.
2. Claims of major scientific breakthrough:
The leading spokesman for MediVet (and previously for VetStem), Dr. Mike Hutchinson, is quoted as saying the company’s product is “the biggest breakthrough in veterinary medicine I have seen since entering the field 24 years ago.” That’s a pretty extraordinary claim given the dramatic improvements in the technology and scientific knowledge supporting veterinary care over the last 2 decades. Elsewhere in the marketing materials, the process is described as “the miracle of stem cells.”
Again, such hyperbole is not unusual in advertising, but it creates an impression of dramatic benefits from this therapy that is not yet justified by solid scientific research. Exaggerated claims are the stock in trade of hucksters selling snake oil, but they are not the appropriate way to market legitimate, science-based medical therapies.
3. Use of Testimonials:
The MediVet pamphlet and website have heartwarming stories of individual pets who, by their owner’s description, suffered severe disability before being treated with stem cells and were dramatically better afterwards. It is always a good thing when a pet’s suffering is relieved, but the hard reality is that stories like this can be told about bloodletting, faith healing, homeopathy, glucosamine, internal mammary artery ligation, and countless other therapies that are clearly worthless or even harmful. Such stories are psychologically compelling while telling us nothing useful about the truth of the claims they support, so they are really a form of deceptive advertising. Testimonials are the mainstay of alternative medicine marketing and justification, and they undoubtedly are highly convincing and sell products and services. But they are a questionable and disappointing technique to rely on when marketing what is purported to be a legitimate, science-based medical therapy.
4. Claiming extensive, but unavailable, supporting scientific evidence.
The MediVet marketing materials claim their product is “the result of hundreds of millions of dollars of research.” Dr. Hutchinson is further quoted as saying “my independent research” supports MediVet’s claims. These sorts of statements are not consistent with the number of clinical studies of stem cell therapy published in the peer-reviewed veterinary literature (a couple of which I have reviewed previously).
There is certainly a huge volume of preclinical and early human clinical research data, but none of this supports the use of this technology even in humans, much less in our pets. An organization of researchers studying stem cell therapies in humans, the International Society for Stem Cell Research, has stated that these therapies are not yet ready for widespread clinical use, and some veterinary scientists researching stem cells have voiced the same cautions regarding their use in animals.
When academic researchers believe the science does not support clinical application of a new technology, and the researchers actively promoting such use are primarily associated with companies selling that technology, there is good reason for the consumer to be cautious. Many products are aggressively marketed during the window between the appearance of promising preliminary research and reliable clinical studies, and the clinical research often does not find the early promise of these products to be fulfilled. If this turns out to be the case for these stem cell therapies, we will at the least have wasted a lot of our clients money and at worst may have actively harmed some patients.
I’m also concerned about the general attitude towards scientific evidence demonstrated in the marketing of these therapies. In the MediVet materials sent to veterinarians, Dr. Hutchinson says he has been “encouraging all of you to use this procedure in animals as I have done over 60 times…The positive results I witnessed were incredible.” This resembles the “try it and see for yourself” argument so often made by proponents of less plausible therapies, and which for reasons I often talk about is not a reliable way to evaluate a novel therapy. Is Dr. Hutchinson’s “independent research” really just experience with clinical cases? As emotionally compelling as such experiences are, they are only a starting point for suggesting hypotheses that must then be shown either true or false by controlled clinical research. Clinical experience, even that of a smart, well-educated, experienced medical professional, is a very unreliable guide to the safety and efficacy of medical treatments, especially for the complex, chronic, waxing and waning diseases such as arthritis that this therapy is being marketed to treat.
The MediVet materials also suggest that one benefit to the company of veterinarians using their product will be to “build thousands of cases to support our findings.” It should be clear to anyone familiar with the scientific method that research should always be done with the goal of disproving, rather than confirming one’s hypothesis, since it is all too easy for our biases to lead us to see confirmation where it doesn’t really exist. And conclusions based on thousands of anecdotes or case histories is little better than conclusions based on only a few. What is truly needed is more properly controlled clinical research, ideally done independently of the companies which stand to benefit financially from the products, though this is not always practically possible.
It never surprises me when proponents of alternative medicine fail to understand what constitutes reliable scientific validation of an idea and what does not, but it is surprising and disappointing when researchers and clinicians who purport to practice science-based medicine appear not to clearly understand this distinction.
5. Playing on fears about conventional medicine:
The logo for MediVet includes the motto “Drug Free Veterinary Solutions.” The theme that a virtue of their therapies is that they avoid “drugs” is repeated throughout the company’s marketing materials. This is the worst kind of pandering to irrational fear of pharmaceuticals. All effective therapies have potential side effects, and I’m sure these scientists and doctors understand that medicines in common use have great benefits that, in most cases, clearly outweigh and justify their risks. For example, the most common therapy currently for arthritis, which is the largest target indication for MediVet’s product, are the non-steroidal anti-inflammatory drugs, and the evidence clearly shows that these are overall quite safe and their benefits far outweigh their risks when properly and judiciously used.
The marketing materials also talk about the safety of the procedure, stating it is “completely drug and chemical free.” I’d be surprised if the process is free of chemicals, since water is a chemical, as are all of the other substances that are involved in the normal functioning of living organisms. This use of the word is simply an attempt to invoke irrational fear of nebulous “toxins” and as such is more consistent with the style and ideology of pseudoscience than true science-based medicine. It is closely related to the problem of the naturalistic fallacy or appeal to nature, which unfortunately also appears in these advertising materials.
6. Appeal to nature:
The advertising materials state that “the process is entirely ‘natural.'”
“Natural” is one of the most malignant words in medical advertising. It creates an impression that what is being described must be safe and beneficial while really just being an empty buzzword with no real meaning. Cholera, bubonic plague, and hookworm are all “natural.” And antibiotics, polio vaccine, and toilet paper are all “artificial” or “unnatural.”
One could reasonably wonder, of course, whether surgically removing fat from an animal, centrifuging it, and “activating” the stem cells with an L.E.D. machine can fairly be described as “natural,” which probably explains the scare quotes used in the advertisement. But despite this, and despite the fact that the word itself has no relevance to whether the procedure is safe or effective even if it did apply, the authors of the materials undoubtedly included it because of its positive, “feel-good” associations, which again seems a disingenuous, even deceptive advertising gimmick more appropriate to bogus therapies than to real medicine.
7. Claiming a benefit with complete safety:
MediVet actually states, unequivocally, that “there are no side effects at all” to their procedure. Apart from the obvious fact that this cannot be true since the pet must undergo general anesthesia, surgical removal of tissue, and injection of something into their joint or blood, all of which have potential risks under the best of circumstances, the fact is that the research evidence is not nearly strong enough to justify such a dramatic assertion. And as I frequently point out when such claims are made about alternative therapies, there is no free lunch in physiology, so any intervention that has beneficial effects will have potentially harmful effects as well. The obvious problem here is that without systematic, controlled observations, any side effects of stem cell procedures are not noticed, correctly attributed to the procedure, or reported to the professional community. It is difficult to believe that the scientists and doctors involved in this work actually believe they can assure owners their procedures are absolutely without risks, so one must assume this is a willful exaggeration for the purposes of selling a product.
Show Me the Money
Which raises the issue of the financial motives involved in the promotion of stem cell therapies. As I’ve said, I have no doubt the promoters and scientists or doctors at VetStem and MediVet honestly believe their products work. And they may even turn out to be right! But the evidence in human medicine is clear that the source of funding behind a scientific research project influences the results obtained. Subtle, and sometimes not-so-subtle, biases associated with financial interests can easily color one’s perceptions enough to filter out disconfirming evidence and exaggerate the strength and importance of confirmatory evidence. And there is no doubt that making money is an important part of the agenda associated with the creation and marketing of veterinary stem cell therapies.
The MediVet materials aggressively promote the potential income their product will create for veterinarians.
Create a substantial additional revenue stream for your practice.
MediVet’s free marketing will that will drive additional leads to your clinic.
Participate in our “Stem Cell Day” and create an additional tier of income.
2 Procedures a week x 4 = 8per month x 12 = 96 per year. Total additional revenue stream of approximately $150,000.
65% of all animals are candidates for Regenerative Stem Cell Therapy
The pressure to capture market share in this potentially lucrative area is great enough that there has even been litigation between VetStem and MediVet. It is especially interesting that, in the announcement of the settlement agreement between the two companies, it is stated that,
MediVet and VetStem also agree to advertise and promote only factual data regarding the methods, results, technologies, and safety of their respective systems and agree that any comparison used in promotions must be supported by objective data when named or referenced directly.
So while they advertise beneficial effects and safety claims far beyond what is supported by the scientific literature, they have at least agreed not to make claims about each other’s products that are not supported by objective data?
Of course there is nothing wrong with making money from providing high quality healthcare. As I have often pointed out, almost all veterinary medicine, whether science-based or alternative, is provided by the private sector by people who make their living doing so. However, we cannot be blind to the influence of a profit motive on our judgment and our conclusions. The drive to discover and develop effective stem cell therapies may very well be the desire to help our patients, but the drive to bring them to market before they are adequately tested and shown to be safe and effective is clearly a desire to capture market share in a profitable section of the veterinary industry. The excesses of the marketing that I have illustrated here would probably not be as dramatic if there were not potentially a lot of money to be made in this area.
My fervent hope is that stem cell therapies will eventually prove to be of great benefit to pets with many different conditions, and that they will, like most therapies that survive the rigors of proper scientific testing, have benefits which outweigh their inevitable risks. I also hope that the premature marketing of these therapies before such testing has been done will not turn out to be a mistake, either in teasing the public with promises we cannot fulfill and thereby stoking suspicion of scientific medicine or, even worse, in actually harming the patients we intend to help. If my concerns prove unfounded, no one will be more relieved than I. But for now, I am still concerned that inadequate understanding of the limitations of clinical experience, and the incentives of the market, are driving these products into veterinary practices with appropriate and necessary research has been done to ensure they are truly beneficial and safe.