For a while now, the Huffington Post has been providing a platform for a prominent voice in the alternative veterinary medicine community, Dr. Richard Palmquist. Dr. Palmquist is involved in the American Holistic Veterinary Medical Association (AHVMA), and has had some rather unkind things to say about CAM skeptics in general, and about my criticisms of the AHVMA in particular. It is unfortunate that someone whose ideas are so far outside the mainstream has been given such a prominent pulpit for disseminating misinformation, and that pet owners are unlikely to realize that Dr. Palmquist’s theories do not accurately represent the science of veterinary medicine or the opinions of most veterinarians.
He must be given credit, however, for representing his position skillfully. One element to putting a positive PR spin on unproven or disproven remedies is the technique known as bait-and-switch (though it is more commonly referred to as “integrative medicine”). This involves recommending or using widely accepted conventional therapies based on scientific reasoning and evidence, and then tagging on unproven therapies or pure nonsense treatments as if they were in the same category. In his most recent post, Dr. Palmquist discusses allergies, which in dogs and cats usually manifest as itching and infections of the skin in response to allergens from fleas, food, or environmental sources (such as dust mites, pollens, etc). There is a good deal of sound scientific research on allergies in pets, and the veterinary dermatology community regularly provides summaries of the research in statements on Evidence-Based Allergy Treatment.
Much of Dr. Palmquist’s post is perfectly consistent with a scientific understanding of the cause and treatment of allergies. He discusses antihistamines, corticosteroids, immunotherapy (aka allergy shots), limited antigen diets, and fish oil supplements, all of which are therapies supported by reasonable plausibility and research evidence. In this discussion, of course, he continuously minimizes the benefits and expounds at length on the potential risks, a clear effort to bias the reader against these therapies while ostensibly acknowledging that they have proven efficacy.
In particular, he harps on the notion that antihistamines and steroids “turn off” parts of the immune system. This sounds like a terrible thing, because everyone knows the immune system is necessary to protect us from infectious disease. So are we compromising the defenses of our patients with these drugs? If properly and judiciously used, no. The implication ignores the complexity of immune function and the effects of anti-inflammatory medications, probably deliberately in order to increase the negative associations people may have in their minds with these medicines.
In response to stimuli, such as infectious agents or allergens, cells in the immune system release chemicals, called cytokines, which lead to the classic inflammatory response: redness, swelling, itching or pain, and sometimes systemic effects such as fever or lethargy. Inflammation is not inherently a good thing. In fact, it can be quite harmful. While a mild fever may help fight off an infection, a high fever that causes brain damage is clearly doing more harm than good. And while activation of the immune system in an effort to fight off disease-causing organisms is a good thing, allergies are by definition an inappropriate activation of the system against proteins that are not inherently harmful. They are uncomfortable chronic diseases caused by excessive, unnecessary activity of the immune system. Even worse are auto-immune diseases, like lupus, hemolytic anemia, and so on, are serious, even deadly consequences of inappropriate immune-system activity. So the implication that turning off part of the immune system is a dangerous or unnecessary part of treating diseases that manifest as excessive immune system activity is nonsense. Suppressing excessive inflammation is exactly what is needed to treat the discomfort or even serious harm these diseases can cause.
It is possible, of course, to increase a patient’s susceptibility to disease with excessive or prolonged use of anti-inflammatories, and undoubtedly some doctors do not use these drugs judiciously. But anything in medicine that has a benefit has a potential risk, and it is disingenuous of Dr. Palmquist to focus primarily on the risks of conventional therapies and the unproven but assumed benefits of alternative methods regardless of the state of the evidence.
Of course, the agenda behind this damning with faint praise of conventional treatments is to build a case for the alternative treatments with which he concludes his article. He first includes limited antigen diets in his list of alternative treatments, though it is a widely accepted conventional therapy, probably because of the mistaken notion that any treatment that is not a drug must be a form of alternative medicine. He also includes fish oils, which are another treatment widely used in conventional medicine, though with only limited supportive evidence.
His descriptions of herbs and supplements, homeopathy and homotoxicology, and other such alternative therapies fairly glow with praise: “can be amazing,” “allergic responses can vanish entirely,” etc. And with the sole exception of high-dose Vitamin C supplementation, no potential risks or unwanted effects are mentioned for any of these treatments.
Dr. Palmquist does state that, “The scientific evidence varies for these methods,” and he supports this statement by reference to the summary of evidence-based allergy treatment I referred to above. However, with the exception of diets and fish oils (neither truly alternative) and phytopica (which Dr. Palmquist doesn’t mention), this review does not provide any evidence in favor of alternative therapies, and in fact it mentions almost none of those he recommends. There is no legitimate scientific evidence to support the utility of acupuncture, Traditional Chinese Medicine theory, homeopathy, homotoxicology, glandular extracts, or digestive enzyme supplementation in the treatment of pet allergies. And most of the herbs and supplements he recommends have little to no evidence to support veterinary allergy use. And yet he discusses these therapies as if they were as effective, and certainly safer, than the proven conventional therapies he so lukewarmly discussed at the beginning of the article.
No question this is a slick bit of propaganda designed to cast doubt on the safety of conventional therapies and to guide readers towards unproven or outright useless alternatives that are presented as if they were legitimate, accepted therapies of proven safety and efficacy. There is an impressive list of supporting references, though many of them are either books written by other proponents of alternative therapies, or articles which, like the dermatology task force review, don’t actually support the safety and efficacy of the alternative therapies being promoted. Some are legitimate studies investigating the safety or efficacy of conventional treatments, but the purpose is clearly not to review the available treatments fairly but to build a public relations case for alternative and against conventional science-based allergy treatments. Though I’m sure Dr. Palmquist feels this is for the greater good, since he is a true believer in the therapies he promotes, in reality such misinformation presented as if it were established fact and biased towards the unproven is not truly in the best interests of our patients or clients.