Integrative Veterinary Cancer Care: Are Claims without Evidence Dishonest?

One of the most frustrating problems with the promotion of alternative medicine and approaches that have not been validated through appropriate scientific testing is that proponents often feel free to make sweeping claims about safety and efficacy despite the
absence of evidence to support these. Personal experience, tradition, or
suggestive pre-clinical research are touted as “proof” of these claims, rather than as the suggestive but poorly reliable bits of evidence they actually are.

Responsible, science-based practitioners are ethically bound to acknowledge the imitations in our knowledge and in the evidence supporting our practices (though being imperfect human beings, of course we may sometimes fall short in this). But practitioners
of alternative approaches can much more aggressively market their practices
beyond the claims justified by good research data, either because they accept
anecdote, intuition, tradition, and personal experience as sufficient evidence,
or sometimes because they disdain the whole epistemological enterprise of mainstream science.

Unfortunately, pet owners and other consumers of veterinary products and services don’t generally evaluate the validity of medical claims from a rigorously evidence-based perspective. In fact, a survey published in the journal Integrative Cancer Therapies, found that scientific evidence was not highly valued by cancer patients investigating
alternative medicine and that anecdotes, information from friends or the Internet, and other sources with low reliability were more highly valued.

Of course, this shouldn’t be surprising. I don’t have the knowledge or expertise to effectively evaluate the competing claims of rival economists, art critics, or automobile mechanics, and we shouldn’t expect every human patient or pet owner to be an expert on
medicine, statistics, epistemology, or the other areas of knowledge and training required to evaluate the evidence and determine the validity of scientific hypotheses and medical claims. That is, after all, our job as doctors. There is a strong ethical duty on the part of doctors to communicate the true state of the evidence for therapies their patients or clients might choose.

However, if we neglect to take this responsibility seriously and accept lower-quality standards of evidence as sufficient, the claims we make are going to be just as persuasive to our clients as those that are actually founded on high-quality scientific evidence.
There is, in fact, a significant advantage to being unconstrained by the limitations and inevitable ambiguities and complexities of scientific evidence when making claims about our treatments. If the only basis needed to claim your interventions work better than anybody else’s is that you believe they do, you are free to say about anything and say it with confidence!

A classic example of this is the blog of a prominent advocate for “integrative” veterinary medicine. This veterinarian makes extensive use of the “bait and switch” approach to
marketing alternative therapies. He advocates many conventional treatments and
then adds unproven “natural” therapies to these. Any positive outcomes are credited to the added natural therapies, rather than the conventional treatment or normal individual variation among patients. However, negative outcomes, such as cancer developing despite the use of natural remedies promoted as protective, are never cited as evidence that the unconventional therapies might not be effective. The whole package is aggressively promoted as superior to conventional therapy, which is denigrated whenever possible. Here is an example:

About 40 years ago, President Nixon declared war on cancer. His goal was to find a cure for this horrible disease. Sadly, we are no closer to reaching that goal today than we
were 40 years ago. In most cases…we really haven’t done a better job of treating or curing cancer. While it is true that survival rates have increased, this is mainly due to early diagnosis. People and pets with Stage 3 or Stage4 metastatic cancer rarely survive.

The situation is no better for our pets. While treatment protocols have changed over the last 40 years, most pets with cancer are expected to only live 6 to 12 months following
diagnosis, and that’s ONLY if owners spend thousands of dollars treating the pet with surgery, radiation, and chemotherapy.

The good news is that using an integrative approach changes these sobering facts and statistics. Designing individualized treatment protocols for each person or pet with cancer,
incorporating a proper diet, nutritional supplements, and other natural therapies offers a much better prognosis for the cancer patient. We now have large volumes of research to show exactly how these natural therapies work in killing cancer and extending the lives of cancer patients.

In my own practice, the average pet with cancer, given a prognosis of 6 to 12 months of life
expectancy from conventional veterinarians, typically lives 12 to 24 months or even longer. Additionally, many pets with “incurable” cancers are cured from their cancers using an integrative approach to boost the pet’s immune system, kill cancer cells, reduce the spread of cancer, and detoxify the patient.

The world of integrative oncology offers much hope for the cancer patient. Integrative
doctors are helping people and pets with cancer live longer lives and in many cases curing cancers that are still considered incurable by conventional medicine.

…After surgery cuts out most of the cancer, and chemotherapy kills most of the cancer, and radiation burns most of the cancer, what’s left to do destroy any remaining
cancer cells? Absolutely nothing! Unless the patient continues therapy, using a combination of proper diet, mind-body medicine, and nutritional supplements, any cancer cells that have survived conventional therapy will, at some point, continue to grow, spread, and ultimately kill the patient.

The sad news is that so many cancer patients will ultimately die after surviving conventional therapies because nothing is done to prevent the recurrence of cancer…not one of these patients is doing anything “natural” to support her immune system or continue the fight against cancer once conventional therapies have finished. How sad and tragic to know that many people will needlessly die out of ignorance once their cancer returns.

…In my own veterinary practice, while I can never offer guarantees to my patients, I tell them that based upon my years of using natural therapies to help pets with cancer, I expect my patients to live one and a half to two times longer than their conventional doctors expect them to live IF they will use properly prescribed natural therapies.

So what are the general messages in this article?

 

1. Conventional medicine has made almost no meaningful progress in cancer treatment in the last 40 years.

2. Conventional therapy is icky (cutting, burning, and killing), expensive, and ultimately not very effective since most pets die of their cancer anyway after less than a year.

3. An “integrative” approach adding “natural” therapies to conventional treatment can
reliably help patients live up to twice as long as those treated conventionally, and can frequently cure cancers when mainstream medicine cannot.

Despite the reference to “large volumes of research” supporting these claims, none is provided in this article. The first claim is obviously and demonstrably untrue. The second consists of an attempt to derogate life-saving therapies by describing them in hostile
language combined with a falsehood. And the third claim is merely opinion with no reliable evidence supporting it.

Clearly, the burden of proving medical claims that are not generally accepted by the medical profession properly falls on the person making the claims. The absence of any effort to support these statements and implications with any evidence beyond personal opinion is a deliberate choice reflecting the author’s lack of interest in careful scientific
demonstration of the value of the therapies he recommends. While I do not intend to do the work of collecting and evaluating the research evidence for this author, I will point out some of the clear factual errors and (deliberate?) misstatements he makes.

1. We haven’t made any significant progress in cancer treatment in 40 years.

This is common claim on the part of those promoting alternative cancer therapies is patently false and has been debunked extensively elsewhere (e.g. A New Perspective on the War on Cancer, which reviews a book on the subject, the Emperor of All Maladies: A Biography of Cancer). Cancer has become a prominent cause of death as people have stopped dying as soon and often from infectious diseases, trauma, malnutrition and many of the other causes of mortality that science and science-based medicine has dramatically reduced. We have a long way to go in figuring out all the factors that contribute to the development of cancer and in preventing and treating cancer. But that is a far cry from saying that we have made no significant progress in the last four decades.

In addition to Acute Lymphocytic Leukemia, which the author acknowledges as an example of a cancer for which we have seen dramatic progress in treatment and patient outcomes, many other childhood cancers are now curable or can be very successfully treated (1). Overall cancer incidence and mortality are falling due to a combination of efforts aimed at prevention, early detection, and improvements in treatment (2). While some cancers have been resistant to the development of effective therapies, others
have seen dramatic increases in the length and quality of life granted by treatment. The National Cancer Institute regularly reports on trends in cancer diagnosis and treatment, and their data clearly shows significant progress since the passage of the National
Cancer Act in 1971
.

There is no question the dramatic changes in cancer treatment in the early 20th century have largely been replaced by more incremental and less satisfying small improvements, and we all hope for much greater success in the future. But there clearly has been
significant progress in the last 40 years, and it should be noted that it has
all been due to improvements in science-based, conventional therapy, not so-called alternative medical approaches.

2. “People and pets with Stage 3 or Stage 4 metastatic cancer rarely survive.”

This is one of those statements that is trivially true and also deeply misleading. Of course the most advanced cancer has the shortest life expectancy. The whole point of cancer screening and early treatment is to prevent cancers from progressing to these advanced
stages. The implication for a statement like this is, of course, that by using the author’s methods we could do better. As usual, no evidence is provided to support this assertion.

Since I, like the author of this article, am a general practitioner, I asked a colleague, Dr. Gerald Post, who is a veterinary cancer specialist, to address some of the other specific factual claims made in the article. He was kind enough to share his expertise, and here
is what he has to say:

I usually don’t comment on or disparage my fellow veterinarians, but the claims made by this person were so egregious I could not stop my fingers from pounding on my
keyboard.

Claim A:  “most pets with cancer are expected to liver 6-12 months following diagnosis, and that’s ONLY if owners spend thousands of dollars treating the pet with surgery, radiation, and chemotherapy.” HOGWASH! As a veterinary oncologist, all is see, day in day out is cancer. Many of the cancers that I treat have median survival times of 12 months or longer. We recently published a paper documenting that the survival time for dogs with B cell lymphoma treated with our protocol was over 600 days!!!! Median means that 50% of these dogs lived OVER 600 days.

There are many cancers, such as mammary tumors and many skin tumors that don’t ever see an oncologist—not because they die, but because they are very adequately treated by general practice veterinarians. In many cases these tumors are cured by them and don’t even need an oncologist (and for a veterinary oncologist to say he is not needed is saying a lot).

Claim B: “ In my own practice, the average pet with cancer, given a prognosis of 6 to 12 months of life expectancy from conventional veterinarians, typically lives 12 to 24
months or even longer. Additionally, many pets with “incurable” cancers are cured from their cancers using an integrative approach to boost the pet’s immune system, kill cancer cells, reduce the spread of cancer, and detoxify the patient.”

At the risk of repeating myself HOGWASH!!

Where is the proof for any of these statements? As an ethical doctor, if I were to make any of these statements, I would need to have some evidence –aside from my own beliefs—that
the statements were true. After an exhaustive search of the veterinary medical literature, I was unable to find one reference to support any of the assertions made. Immunotherapy is a very valid treatment, don’t get me wrong. The use of IL-2 in dogs with metastatic cancer is documented. Feline interferon can be used to improve the immune response and increase survival in cats infected with feline leukemia.  These very reputable articles, however, make no claims on curing cancer.

Claim C: ”After surgery cuts out most of the cancer, and chemotherapy kills most of the cancer, and radiation burns most of the cancer, what’s left to do destroy any remaining
cancer cells? Absolutely nothing!”

I am assuming that the author just never heard of metronomic chemotherapy or small molecule inhibitors/tyrosine kinase inhibitors. To make the statement that absolutely
nothing can be done post-chemotherapy, radiation therapy, or surgically is
……you guessed it HOGWASH! Metronomic therapy—the use of very low dose cyclophosphamide, an NSAID, as well as doxycycline, has been shown to decrease
the recurrence rate for soft tissue sarcomas, hemangiosarcomas, and theoretically, because it works by inhibiting the in-growth of new blood vessels—something all tumors need to grow larger than 1-2 mm—it can work on any tumor type.

Please make a note that for the claims I am making, I give you the reader and my clients
information based upon documented and peer-reviewed studies. No one is saying that all studies are absolutely factual or that future studies will not refute some claims made by earlier studies. But I am saying that basing my recommendations and claims on evidence IS important. As a reader and as a client you deserve it. When you see a doctor you are relying not only on his or her expertise, but also on the combined knowledge of all the
clinician/scientists in the world!

At the end of the day, the reason why evidence is important is respect! Respect for my clients, respect for my patients and respect for my profession. I truly believe that
those people who seek out cancer treatment for their pets love their pets dearly and are intelligent people, who deserve the best information possible. This empowers them so that they can ultimately make the wisest decision for themselves.

3. Adding “natural remedies” to conventional cancer treatment can prolong life and even cure cancers conventional treatment alone cannot.

This is the core advertising message in the article, and there is not a speck of evidence to show it is true. Substituting alternative medicine for conventional cancer treatment is almost always harmful, as the sad outcome of the NCCAM-funded study of the Gonzalez cancer therapy for pancreatic cancer and many individual anecdotes illustrate. As for adding unproven therapies to conventional treatment, there have been numerous pre-clinical studies and small, low-quality clinical trials published investigating specific alternative therapies used in this way. A few positive results have been reported here and there,, but there is certainly no clear and persuasive body of evidence to show that such an
approach improves quality of life, survival, or any other meaningful, measurable outcome of cancer treatment. This claim is pure ideology and advertising unsupported by solid science. As such, it is at least deeply unethical and at worst false advertising.

Bottom Line

The claims made in this article disparaging scientific cancer therapy and lauding the benefits of adding unproven alternative methods to conventional treatment are unsupported by reliable scientific evidence. Science has made significant progress in
preventing, detecting, and treating cancer and undoubtedly will continue to do
so. This progress has been, and will continue to be due to rigorous, systematic
scientific research. A reliance on tradition, anecdote, personal clinical
experience, and low-quality scientific evidence to justify cancer therapies is
not in the best interest on cancer patients. The good news is that scientific medicine offers real hope for continued improvement in the length and quality of life for cancer patients. The bad news is that some of these patients will be denied the full benefits of scientific medicine and subjected to unnecessary, unhelpful, and sometimes even harmful alternatives if they are misled by sweeping and confident claims unsupported by real evidence. It is our responsibility as doctors to ensure our patients and clients have the full and true facts about their options so they can choose the best possible care for
themselves and their pets.

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12 Responses to Integrative Veterinary Cancer Care: Are Claims without Evidence Dishonest?

  1. Art says:

    Has anyone tried to blog on dr Shawn’s blog? I think my post on his blog a few months back was pulled. If someone has posted there without post removal let me know and I will try again.
    Art Malernee dvm
    Fla lic 1820

  2. skeptvet says:

    I commented a few of times when he first wrote about this blog, but he always deleted anything I wrote.

  3. v.t. says:

    The petcarenaturally blog doesn’t even allow posting (at least that I’ve ever seen), heaven forbid an opposing viewpoint.

    His contributing blog to basilansdspice blog however, allows comments. I don’t think he or the blog owner regularly screen comments.

    Thank you, skeptvet and Dr. Post for weighing in on this subject, it happens to be a hurtful thorn in my side. This article should be posted all over the net.

    Integrative is the new holistic way. An equal number of holistic vets at least still employ conventional medicine, but some are abandoning that principle altogether which is just scary. Messonier is an example of the latter, but I prefer to call him what he is, a quack of the highest order.

  4. Peter says:

    Another excellent post – thanks very much skeptvet. I have linked to it on my Facebook page and also quoted from it. The wider this sort of reasonable, thoughtful approach is disseminated the better, in my opinion.

  5. skeptvet says:

    Thanks, Peter, I’m glad it was useful.

  6. Peter Amantia says:

    I’m not commenting in order to document the natural methods I have taken but because I find a common theme to almost all these posts: Just because a scientific study hasn’t been done, an alternative treatment is either a water of time or detrimental (HOGWASH).

    When it comes to nutrition, wouldn’t you agree a dog who eats a balanced, homemade diet of (cooked) chicken, fish, and beef with numerous (uncooked) fresh vegetables and fruits, might just have a stronger immune system than one who is fed commercial dog food?

    Do you think you’d be as healthy and able to fend off disease if you ate nothing but Cheerios? (Remember their old slogan, “All the vitamins and minerals you need ….”).

    Is there a scientific study I can reference to back up my claim? Not one I’m aware of, after all, study’s cost money and what incentive would a pet food company have informing you there’s a healthier alternative than using their product.

    I stumbled on your blog a couple of weeks ago and have enjoyed reading your posts. My sense is you’re enraged that some in your profession have embraced alternative treatments to such an extreme that you feel you must take the other side (to the extreme).

    I submitted this post not to document my success in treating my siberian husky but to say that what has worked for me is combining conventional treatments (surgery followed by one round of chemotherapy) with alternative treatments. My oncologist agrees and I’d put her qualifications and successes. at a minimum, on par with those of Dr. Post.

  7. skeptvet says:

    Just because a scientific study hasn’t been done, an alternative treatment is either a water of time or detrimental (HOGWASH).

    Wrong. If no appropriate research has been done, an alternative method is unproven. If research has been done showing it doesn’t work (e.g. homeopathy), or if it relies on well-established scientific principles being wrong and some untestable form of magical energy, then it is hogwash.

    When it comes to nutrition, wouldn’t you agree a dog who eats a balanced, homemade diet of (cooked) chicken, fish, and beef with numerous (uncooked) fresh vegetables and fruits, might just have a stronger immune system than one who is fed commercial dog food?

    No. Most homemade diets and diet recipes that have been examined turn out to be nutritionally inadequate. A good quality homemade diet can certainly be formulated, and I often encourage clients to consult a veterinary nutritionist to help do this. But the idea that this is healthier than commercial diets is just an assumption or ideological prejudice on your part, not an established fact.

    Do you think you’d be as healthy and able to fend off disease if you ate nothing but Cheerios? (Remember their old slogan, “All the vitamins and minerals you need ….”).

    This analogy is just the sort of thing opponents of commercial diets make up to convey the impression that these diets are unhealthy. It is a false and misleading analogy.

    Not one I’m aware of, after all, study’s cost money and what incentive would a pet food company have informing you there’s a healthier alternative than using their product.

    Many pet food companies spend a great deal of money researching nutrition generally, and specific dietary interventions in particular, which is why commercial diets improve over time. And proponents of alternative diets are often selling the food themselves or the recipes and instructions for making the food, so they ought to invest similarly in research to back up their claims. But regardless of whether the economics of the industry makes it easy to do such studies, that doesn’t change the fact that if studies are not done then your claims are just theories you’ve made up based on your beliefs, and as such they are not reliable guides to healthy nutrition.

    My sense is you’re enraged that some in your profession have embraced alternative treatments to such an extreme that you feel you must take the other side (to the extreme).

    Wrong. For some reason, people seem to feel that the only reason to ask challenging questions about evidence and, when the evidence is lacking to openly say so, is out of some bizarre personal psychological “problem.” I am interested in the welfare of my patients, and I believe this is poorly served by unsubstantiated claims and unscientific approaches to healthcare. I do ocassionally find it frustrating that people can make stuff up as a basis for pushing unproven or clearly useless therapies and nobody seems to care what is true and what isn’t. But the blog is fundamentally about providing people with information to use as they choose. It seems to offend some because the information challenges people’s deeply held beliefs, but that is not a reason to deny the scientific perspective to pet owners and leave them with only the marketing literature and personal narratives of believers in alternative therapies to use as a basis for their decisions.

    Your response would be more useful if you eschewed psychoanalyzing me and provided some information to demonstrate that my arguments are wrong. But as you repeatedly admit, you don’t have this information. All that leaves is faith, and while you are welcome to believe what you like, I think evidence is a more reliable basis for making decisions about our pets’ health.

  8. I would love to see your blog on the Huffington Post. I wonder if they would publish it, considering that “Dr. Shaun” is a frequent poster there. Next time he writes an article for HP, I’ll post a comment with this website address.

  9. skeptvet says:

    Dr. Richard Palmquist, an Elder of the American Holistic Veterinary Medical Association is also a frequent Huffpo columnist. The blog has a strong preference for pro-alternative medicine authors, so I’d be shocked if they would carry my articles.

  10. Art says:

    Petmd has been pulling post of mine. Anyone else?
    Art Malernee dvm

  11. cyborgsuzy says:

    Great article. Thank you. I wish there were more and louder voices like yours out there.

  12. skeptvet says:

    It’s a fact because you say it’s a fact, even though you only give your opinion and no facts? Hmmm…

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