Back in May, I wrote about a lawsuit involving the Academy of Veterinary Homeopathy (AVH) and the American Association of Veterinary State Boards (AAVSB) committee that certifies continuing education courses veterinarians must take to maintain their state licensure (the RACE committee). In brief, the RACE committee changed their standards for approving continuing education programs to require some minimal standards of scientific legitimacy for veterinary continuing education. The standards requires approved courses,
build upon or refresh the participant in the standards for practice and the foundational, evidence-based material presented in accredited colleges or schools of veterinary medicine or accredited veterinary technician programs…CE programs that advocate unscientific modalities of diagnosis or therapy are not eligible for RACE approval…All scientific information referred to, reported or used in RACE Program Applications in support or justification of an animal-care recommendation must conform to the medically accepted and scientifically supported standards of experimental design, data collection and analysis.
As I’ve discussed in detail before, homeopathy cannot by any but the most absurd contortions of reason be viewed as a scientifically legitimate or validated approach to health care, so it is not surprising that once RACE ceased rubber stamping applications for approval and applied these reasonable standards, homeopathy courses were judged ineligible for continuing education credit. It is also not surprising, of course, that homeopaths and others practicing scientifically questionable veterinary medical methods would object.
What is surprising and disturbing, however, is that the limited media coverage of the AVH lawsuit has been generally biased in favor of the AVH position, and there has been virtually no criticism of the deeply anti-science stance of the AVH, which if successful will essentially end all meaningful regulation of veterinary continuing education. Like much media coverage of creationism, journalists seem to believe that fair coverage requires ignoring the overwhelming consensus among scientists and veterinarians that homeopathy is nonsense and presenting veterinary homeopaths as a legitimate minority community being unjustly discriminated against. The media reports I have seen so far seem to entirely ignore the underlying issue of the scientific evidence against homeopathy or the threat the lawsuit, if successful, poses to the very idea of regulating the standard of veterinary care through the process of state licensure.
The Media Gets It Wrong
The Veterinary Practice News reported on this lawsuit in early August. In a roughly 2000 word article, the author extensively quoted five supporters of homeopathy and of the lawsuit. She also quoted an official at the AAVSB who was not free to comment on pending litigation. And finally, she interviewed me for the article as the sole critic of the AVH position.
I was quoted as saying that homeopathy was not a science-based intervention, which is accurate. I was also quoted as saying that, “Alternative medicine providers are often better at treating psychological aspects of a medical incident an owner is dealing with, and there’s no doubt they are caring and compassionate…”This is partially correct in that I did acknowledge that alternative practitioners are undoubtedly as caring and compassionate as other veterinarians, but it misrepresents the point I was making that the reason methods like homeopathy are popular with a small percentage of the pet-owning public is not because they actually work but because of the psychological effects, essentially a placebo-by-proxy, that the interaction with the practitioner has on the owner.
Lastly, I was quoted as saying that, “these therapies are not taught in veterinary schools.” This is followed by a “gotcha” list of veterinary schools that offer elective courses in “integrative medicine” or have “holistic medicine” student organizations. This is clearly intended to undermine the credibility of my comments. However, this is again a manipulative misrepresentation of my position.
Homeopathy is clearly not part of the core veterinary curriculum, nor is it generally accepted as a valid approach to medicine at U.S. veterinary colleges. The AVH does not dispute this in their complaint. And of the four veterinary schools (out of 28 in the U.S.) mentioned in the article as having “elective courses in CAVM or integrative veterinary medicine,” I could not find any that actually do have a course in homeopathy, though CSU does offer an elective called “Critical Overview of Complementary and Alternative Medicine” taught by Narda Robinson, who is a vocal critic of homeopathy. It is possible, of course, that a couple of schools do have credulous individuals on faculty who teach that homeopathy is scientifically legitimate, but if so these represent a rare minority opinion which is discounted by the overwhelming majority of veterinary scientists. The article was a barely disguised propaganda piece for the AVH position with only a superficial nod towards the idea of journalistic neutrality.
Another article on the subject was released today by the Veterinary Information Network (VIN) News Service. This article is more neutral than the VPN piece, but it still creates a false impression of the nature of the debate. It misrepresents the conflict as a balanced difference of opinion within the profession, when in fact it is about a small group of believers in a long-discredited belief system agitating for a special exemption from the scientific standards normally applied to mainstream veterinary medical practices.
The article extensively quotes the AVH veterinarian and attorney who filed the lawsuit, and also less extensively the president of the AAVSB. In general, much attention is given to the idea that homeopathy and other alternative approaches are “discriminated against,” and almost no attention is given the underlying scientific issue and the question of whether education of licensed veterinarians should be rooted in accepted science.
What’s the Point of Continuing Education for Vets?
I have discussed the legal and historical issues of licensing healthcare providers, including veterinarians, in detail elsewhere. In brief, the state is required to establish standards for the practice of medicine and issue licenses to healthcare providers in order to protect the public health and prevent unsafe and ineffective treatments from being sold as legitimate healthcare. Prior to the development of this practice, quacks and charlatans routinely sold useless or harmful, even deadly “remedies” freely, to the great harm of patients in need of real care. Continuing education requirements are part of this system, and they are intended to ensure that veterinarians stay current on progress in veterinary medicine.
It makes no sense to have such standards if there is no reasonable, scientific criteria for what counts as legitimate continuing education. Should veterinarians be able to maintain their licensure by studying anything they want? Psychic surgery, astrology, voodoo, faith healing, etc? The AVH argues that the standard of scientific evidence is fundamentally unfair. According to the VIN article, the new RACE standards’ emphasis on science, “worked to preclude homeopathic courses that were not based on what RACE committee members considered to be clear, evidence-based science. It narrowed the road to acceptance, critics say, giving more weight to published science and less to the experts in homeopathy. ”
This as much as admits that homeopathy is not accepted as scientifically legitimate by anyone but homeopaths. The logical consequence of this, apparently, is that only experts in homeopathy should be allowed to judge if homeopathy is scientifically legitimate. And presumably only psychics, astrologers, and voodoo priests should be allowed to judge whether these are legitimate veterinary medical approaches?
This is a form of special pleading which says that there is no real scientific standard of evidence that can prove anything is or is not effective medicine, so followers of every individual approach should simply be free to judge their own practices by their own standards and then the state should simply endorse their judgments. Such an approach effectively eliminates any meaningful standard of quality for veterinary care and takes us back to the medical anarchism of the 19th century.
Taking this sort of approach even further, the American Holistic Veterinary Medicine Association has formed its own standards group, the Registry of Alternative and Integrative Veterinary Medical Education (RAIVE) to circumvent the RACE standards board with one stacked with believers in alternative therapies and more inclined to rubber stamp continuing education in these approaches. This will be meaningless, of course, unless state veterinary boards agree to accept RAIVE in lieu of RACE approval. Of course, since such boards are fundamentally political, rather than scientific, agencies, and they have a solid history of ignoring blatantly even the most egregiously ridiculous and harmful sorts of medical nonsense so long as it is promulgated by a licensed veterinarian, it seems not unlikely that this separate-and-equal approach to deciding what is legitimate medicine will succeed.
Why Does It Matter?
The simple answer to this is that our patients are better off if they receive effective care. And this is more likely to happen if veterinarians are trained in legitimate scientific medicine. We have a special privilege by virtue of the license we are granted by the state to practice veterinary medicine. We can make our living providing healthcare for animals. And this privilege is granted us with the understanding that we will employ safe, effective, scientifically valid treatments. Our clients come to us trusting that our status as licensed veterinarians means we are meaningfully different from unlicensed individuals who might offer veterinary services. The state has essentially certified that we can be trusted to take proper care of our clients’ companion animals using valid methods.
If any and all methods are considered equally acceptable as support for our licensure, and if only believers in a given method are allowed to judge the legitimacy of that method, regardless of how few they are or how lacking the scientific evidence in support of their beliefs, than licensure is meaningless. A pet owner has no way of knowing if the licensed veterinarian they go to is practicing accepted, scientific medicine or a completely bogus method they have invented and judged legitimate all by themselves.
The harm that unscientific approaches to medicine, including homeopathy, can do is real and easy to illustrate (here and here, for example). The issue behind the AVH lawsuit is not fairness or open-mindedness, it is about whether scientific evidence and regulatory standards are to have any meaning or any influence on the quality of veterinary care the public is offered. The AVH is fundamentally seeking an exemption from any such standards and the right of any group to judge their own beliefs and promote them as legitimate under the imprimatur of state government without interference from the judgment of the rest of the profession or state regulators.