One of the biggest problems with alternative veterinary medicine is the promotion of specific therapies or practices without reasonable scientific evidence that these are safe or effective. Sometimes, the evidence is actually clear that a specific approach is not effective, and yet advocates refuse to acknowledge this and abandon the practice. They often defend such practice on the basis of anecdotal experiences suggesting an effect while ignoring all the reasons uncontrolled observations are often wrong and why miracle stories and other testimonials can’t be trusted. However, sometimes scientific research is used to defend a practice even when the research doesn’t truly validate it.
There are several ways to use science to support a therapy that doesn’t actually work.
1. Extrapolation from tangentially related theories:
Proponents of an untested or demonstrably ineffective method will refer to scientific ideas in unrelated areas to suggest their theories must be true. Quantum physics is commonly relied on in this way since it is complex and not really comprehensible to most of us without facility with advanced mathematics. Homeopaths, have made much of the phenomenon of hormesis to suggest that it validates the ultradilution of homeopathic remedies, though it clearly does not.
The problem with this time of defense is it creates the appearance of scientific legitimacy without actually saying anything substantive about the method being defended.
2. Extrapolation from pre-clinical research:
In vitro or animal model studies can be very useful in demonstrating a basic concept or in screening for possible safety concerns or other biological effects from a therapy. But what happens in a test tube or a lab mouse is not a reliable guide to what happens when an actual patient, often of a different species, with naturally occurring disease. Such research can generate hypotheses and provide support for them, but it cannot be the primary validation for medical therapies.
Again, the problem is that such research is real, legitimate science used illegitimately to imply that we know more about the effects of a medical therapy than we really do.
3. Low-quality, poorly controlled clinical research:
For some CAM therapies, such as homeopathy and acupuncture, there is an enormous body of clinical research in humans. You would think this would make a decision about whether these therapies work easier, but that isn’t always the case. It has been persuasively argued that most published research is wrong, in conventional as well as alternative medicine. It is very easy to set up an experiment to confirm what you already believe. Even with reasonably good controls, single studies often generate unreliable, usually positive results.
The Decline Effect is a well-known phenomenon in which small, early tests of a hypothesis generate positive results, but as independent investigators get involved and potential sources of error are better understood, the effect of the intervention get smaller and sometimes evaporate altogether. This is how science is supposed to work, but it leads to trouble when early, small, low-quality studies without confirmation by replication are cited as evidence to support a therapy.
The National Center for Complementary and Alternative Medicine (NCCAM) was set up specifically to investigate therapies which had committed believers but had little in the way of plausible theories or preliminary research evidence to suggest they were worth subjecting to clinical trial analysis. Its parent was politics, not science, and after more than 10 years and $1.4 billion, the results have been largely negative and have had little impact on the popularity of CAM therapies, even those shown to be useless. The political figure most responsible for this organization, Senator Tom Harkin, reacted to the negative scientific findings with disappointment and a clear lack of understanding of the purpose and methods of science:
One of the purposes of this center was to investigate and validate alternative approaches. Quite frankly, I must say publicly that it has fallen short. It think quite frankly that in this center and in the office previously before it, most of its focus has been on disproving things rather than seeking out and approving.
Of course, real science doesn’t set out to prove what one already believes but to find out what is true.
Which makes me ambivalent about an initiative by the American Holistic Veterinary Medical Association (AHVMA) to generate funding for alternative veterinary medicine research through the American Holistic Veterinary Medical Foundation (AHVMF).
There are certainly some CAVM therapies which deserve rigorous scientific investigation, particularly in the area of herbal medicine. There are also some that we would be better off without, and if clear scientific evidence that these are useless would lead to their decline in popularity, this too would be a good thing. However, based on both human nature and the example of NCCAM, I am suspicious that the AHVMA efforts are more likely to lead to the promotion of alternative therapies without strong, robust scientific evidence that they are worthwhile.
What is the AHVMF, and what is its purpose? Here’s what the AHVMF web site says:
The Foundation was established to receive and administer funds for research and education in all aspects of integrative medicine, especially as it pertains to that part which is called variously, holistic, alternative, or complementary veterinary medicine, or CAVM. The Foundation concentrates on 3 aspects: scholarships for veterinary students who are interested in this branch of veterinary medicine, research in this aspect of veterinary medicine, and support for the use of and education in this branch in veterinary schools.
So from the beginning, the purpose seems largely about promotion of alternative therapies. Research to investigate objectively the potential value of some specific therapies is certainly appropriate. Supporting students who wish to study these therapies seems a bit premature given the lack of evidence that the therapies themselves have value and deserve to be taught. Likewise, supporting the teaching of CAVM in veterinary schools presumes the value of the methods to be taught. So it is difficult to imagine the AHVMA supporting truly rigorous and impartial research given it seems to be focused primarily on promoting therapies that have yet to demonstrate their worth through such research.
Obviously the AHVMF is an offshoot of the AHVMA, sharing office space and many individuals in leadership positions. The AHVMA is a professional association and lobby for CAVM practitioners, so again this suggests that the AHVMF has been formed as a promotional organization rather than to sponsor truly independent research.
This is further supported by the AHVMF statement specifically about the research aspect of their activities:
Holistic medicine often has answers to chronic disease that use methods with few to no side effects. It may have an answer that is non-existent in conventional medicine. But this type of research is always under-funded and overlooked. The AHVMA Foundation is the best way to bring these modalities into the consciousness of mainstream medical thinking and practice.
Clearly, the starting point for AHVMF-funded research is the proposition that CAVM methods work and research is a useful tool for convincing others of this. This does not suggest a truly critical, open-minded approach to the subject. And if there were any doubt about this, it should be eliminated by the fact that the AHVMF has a page specifically devoted to testimonials for the miraculous benefits of CAVM therapies.
Inspiring stories about patients who have been helped by Integrative Medicine. If you have a story, please send it to us, along with a picture and the name of your veterinarian.
Inspiring stories about the success of specific therapies are not typically found on the web sites of organizations supporting research aimed at finding new or better therapies, such as the American Heart Association, American Lung Association, the National Multiple sclerosis Society, and such. Testimonials are he tool of organizations selling something even if, as in his case, it is not a product but a point of view being marketed.
Organizations like the Bravewell Collaboration and others have been very successful at promoting the integration of unproven or disproven therapies into mainstream medical schools and hospitals by providing financial incentives to hop on the bandwagon. Little good-quality science has resulted, and as mentioned earlier what research has been done hasn’t served to effectively validate much CAM or to discourage the use of methods shown not to be effective.
Obviously, it is impossible and inappropriate to judge in advance the quality of the research the AHVMF claims to be raising money to sponsor. The foundation has already raised over $400,000, a not inconsiderable sum in veterinary medicine, and is aiming for $20 million. I hope these resources lead to good-quality, rigorous studies that will let evidence-based medicine advocates like me accept and begin using new, effective therapies and that will convince CAVM advocates to abandon practices which are shown to be effective despite their a priori beliefs. Perhaps the involvement of veterinary schools will ensure the marketing and promotion activities of the AHVMF don’t damage the integrity of the research it funds. I am skeptical that this will be the case, but I will certainly be watching closely and hoping for the best.