Early on in my effort to understand and evaluate alternative veterinary therapies, I had the naïve notion that learning about their mechanisms of action and the research evidence behind them would enable me to tell which were safe and effective and which weren’t. In some cases, there turned out not to be any plausible mechanism and no evidence, or even evidence against these therapies. I was, again naively, surprised to find that not only were most self-described “holistic” veterinarians not disturbed by this, they were offended that I would ask for such evidence or that I would see the lack of it as a reason to distrust their practices.
It was at this point that I came to realize the primary difference between conventional medicine and alternative/holistic/integrative medicine is one of philosophy. Science-based medicine relies on the processes of science to understand how the world works and what is an effective way to protect and restore health in our patients. Being human beings, conventional vets and scientists are not immune to the kinds of thought errors and emotionally driven reasoning that leads us astray, but we have at least the philosophical approach that scientific research methods intended to compensate for these work and should be relied on whenever possible.
Alternative practitioners, on the other hand, have much greater faith in their own experiences and those of others, especially those they trust or those who agree with them. They tend to see scientific research as a nice extra at best, or entirely irrelevant or misleading at worst, but not in any way a necessary part of evaluating the effectiveness and safety of their therapies. Intuition, revelation, tradition, and other subjective and experience-driven methods of evaluating treatments are more meaningful and compelling to them that science.
This creates the appearance of a conflict about facts which is really a conflict about values and beliefs. Most alternative veterinarians pay lip service to the need for a value of science, and yet their actions are inconsistent with their words. They see science as most useful for marketing therapies they already believe in and convincing or battling skeptics, not as a necessary step towards a true understanding. They are, in essence, asserting the primacy of faith over reason in understanding health and disease and our responses to them.
Such a philosophical position is fair enough, though obviously I feel it is mistaken and leads away from a true understanding of the world. However, it is disingenuous or deceptive when it is presented not as a philosophical, essentially a religious, point of view but as the practice of medicine. Pet owners have a right to know that they are being seen by a doctor with a faith-based approach to medicine that essentially rejects the basic foundations of science and modern healthcare.
In an effort to expose this underlying difference in philosophies, so pet owners will have a fair choice of which approach to follow, I occasionally discuss examples of veterinarians openly promoting this perspective. The latest that I have run across comes from Dr. Marcie Fallek, a veterinarian currently promoting a new book, Krishna’s Flute: The Spiritual Journey of a Holistic Veterinarian. The promotional materials begin with a fairly straightforward example of fear mongering: “Are Vets Killing Pets?” Asks Holistic Veterinarian in New Book….’Trust your intuition for your dog’s survival,’ warns Dr. Marcie Fallek.” No unreasonable appeal to emotion there, eh? Oh, but it gets better. Dr. Fallek goes on to ask a series of inflammatory rhetorical questions with a clear message and little regard for facts:
Are prescription drugs killing pets? Are they necessary? Is there a better, safer way? Are yearly or triennial vaccinations really necessary? Are they safe?
Why are dogs and cats now ‘old’ at 8 years, when 30 years ago, they lived until their late teens and early twenties?
Are the thousands of dollars spent on diagnostic tests worth it? Are the tens of thousands of dollars spent on therapies like chemo and radiation effective? Isn’t there a cheaper and most importantly, safer and more effective way to treat disease?
Why do elderly clients say their old family dog lived ‘til 18 and was rarely at the vet’s? With vet bills often more than yearly mortgage payments are pets really better off?
Why do many animal companions have the same chronic diseases as people? Why don’t squirrels have allergies? Deer skin infections? Crows asthma? Raccoons ear infections? Why don’t wild animals share human illnesses, while domestic animals do?
Do pets really have to die?
There is plenty of recourse to the usual misrepresentation of science-based veterinarians as greedy and unconcerned about the well-being of their patients, and the usual unsupported assertions that conventional medicine is harmful and alternative medicine superior, but the core of this approach is to undermine the very idea that science can be a useful way to approach healthcare.
The notion that there used to be a Golden Age before modern science and medicine in which animals were healthier and lived longer and which has been ruined by money-grubbing doctors sowing disease and poisoning our pets for gain is the rankest sort of ignorant historical revisionism imaginable. There are few reliable data on the historical health and longevity of pets, but all the voluminous data for humans shows our lives to be longer and healthier by far in the last century than ever before in history, and there is no reason to believe this is different from the pattern in our pets.
Similarly, the ridiculous appeal to nature fallacy that suggests wild animals frolic in an Eden of health and well-being and outlive their captive brethren stuck in a toxic artificial environment runs counter to all the data and evidence. Life for wild creatures is, in the classic words of Hobbes, “nasty, brutish, and short,” and it is a deep delusion to envision it as Dr. Fallek apparently does.
So how is such a blithe disregard for fact and reality maintained? Why through faith, of course. The “spirituality” invoked here is simply an ideological a get-out-of-jail-free card employed to excuse substituting wishful thinking and fantasy for reality. Dr. Fallek clearly explains that intuition trumps all other sources of knowledge because it is ultimately the voice of God speaking to us:
Please listen to your inner voice. This inner voice is our God-given intuition, it is our birthright, ingrained in our DNA, installed to protect us and our loved ones….With LOVE and TRUTH as the bottom line, not marketing masquerading as medicine, following the heart leads to a safer truer path of healing.
She goes even farther in the sample chapter of her book offered for free, asserting that this inner voice is infallible:
The most important lesson we can learn in life is to trust our inner voice. It is never wrong.
This sample chapter consists almost entirely of an anecdote. This story purports to describe a dog seen by three conventional veterinarians, including board-certified specialists, and wildly misdiagnosed. After many expensive and useless diagnostic tests and multiple harmful and unnecessary treatments, Dr. Fallek diagnosed an obvious congenital abnormality and relieved his symptoms with a few acupuncture treatments.
My inner voice tells me this is a grossly biased and self-serving misrepresentation of what actually happened. But since I prefer to rely on facts when possible, and there are none available to corroborate or challenge this narrative, I will simply have to refrain from judging the accuracy of the story. However, even if it is true exactly as told in Dr. Fallek’s book, it is merely an example of individual incompetence, not proof that conventional medicine is useless and harmful and the alternatives Dr. Fallek sells are safe and effective. Stories are just stories, not evidence, though of course the whole point here is that alternative medicine prefers compelling narrative to evidence.
So what does Dr. Fallek offer as an alternative to conventional medicine, which she dismisses blithely as “an endless cycle of cortisone and antibiotics?” Apparently, the usual hodgepodge of practices which are, in their own theoretical justifications, incompatible with one another but which share the only important characteristic: a preference for faith, intuition, and personal narrative over controlled research data as the guiding principle. Homeopathy, which is the quintessential faith-based medical practice completely incompatible with reality and already convincingly disproven. Acupuncture, which might have some reasonable basis for scientific study if not practiced, as by Dr. Fallek, according to the mystical nonsense that is mislabeled Traditional Chinese Medicine. The dubious and as yet unproven dogma of raw diets. Hysterical and exaggerated fear mongering about the dangers of vaccination.
In other words, this independent thinker committed to listening to her own inner voice espouses nearly all the core dogma of the alternative veterinary medicine community. While there is, of course, some diversity of opinions among veterinarians promoting alternative medicine, just as there is among proponents of conventional medicine, there are common ideological themes which lead to common practical approaches. These themes include:
- The trope of science and technology as dangerous and “natural” or historical approaches as benign.
- Science-based vets as money-driven dupes or shills of the malign pharmaceutical and pet food industries compared to the purely caring and spiritually-guided alternative practitioners working only for the well-being of their patients.
- A misty-eyed misreading of history to suggest the past and the natural world as healthful and benign and the modern, technological world as toxic and harmful.
- A deep suspicion of scientific research and a blind trust of personal experience.
As I said previously, it is perfectly fine for Dr. Fallek and anyone else to believe whatever they wish to about the nature of the universe and about health and disease. Her approach to medicine is her religion, and everyone is entitled to their religious beliefs. However, our society has generally chosen to expect our doctors to provide care based on science and evidence to the greatest extent possible, largely because these approaches have created the dramatic improvements in our health and longevity that Dr. Fallek denies have happened. Improvements in sanitation, nutrition, public safety, and both preventative and therapeutic healthcare have given us more and better life than any previous human generation, and the evidence of this is voluminous and has led to a societal contract with healthcare providers that emphasizes science-based care.
The days of medical anarchism, where any and all medical approaches were treated as equally legitimate, ended in the early 20th century, and the scientific approach was given precedence. If we choose to retreat from that and emphasize spiritual, faith-based medical approaches above scientific ones, we deserve to at least understand that is what we are doing and make an informed choice to do so. When members of the Academy of Veterinary Homeopathy, such as Dr. Fallek, vociferously deny in public that homeopathy is inconsistent with science and claim it is in fact scientifically proven to work, they are not only factually wrong, but they are being deceptive. Elsewhere, they clearly describe the spiritual nature of this practice and fundamentally treating not the patient’s but their “energy” or “emotions” or “vital force,” in short their soul. If they would honestly admit homeopathy is a spiritual practice, not a scientific medical treatment, then at least pet owners would get an honest and fair choice between medicine and faith healing.
Incredible that this needs saying at all, but it does. The view of kindly spiritual forces weighing in to heal all the problems has little attraction for me, personally, but one can also overstate the idea of nature being “red in tooth and claw”: wild animals do have a lot to cope with, but see also Jonathan Balcombe’s work on animal pleasure to see that the picture is not all dark.
Undoubtedly the animals who have it worst on the planet are those (of all species, including our own) who are confined, exploited and killed for human caprice: the billions of animals “raised” for food, clothing, entertainment and experiment. If their suffering were alleviated or even (Utopia!) stopped, as it could be, in great part, humans would have taken a grand step forward without worrying about whether antibiotics or homeopathy were responsible. The spotlight does indeed need to be turned on human thought processes: get rid of the woolly/holistic thinking, but also the fog of (apparent) self-interest and mental confusion which makes us abuse so many nonhumans even whilst pinning medals on ourselves for lavishing care our “pets” in ways logical and illogical.
One wonders if the Age of enlightenment actually happened??
Where to start! I like your blog and read it every week. You bring logic and reason to the topic at hand. However, focusing on an extreme example of a holistic approach to veterinary (or any) medicine I think does a great disservice to many, if not most, holistic practitioners. Holistic practitioners bring a “holistic” approach to the study of illness; they look at the “Whole” being, not just the part that is injured. Conventional vets (and doctors) fail to do this most of the time – and after being on this planet for 51 years and having had many pets, I have some experience with this. A couple years ago my then 9 y/o dog developed a small ‘tumor’ on one of her digits and a seemingly very different bump on her nose. My local conventional vet aspirated (?) the tumor and found nothing but elevated white blood cells indicating an infection. Mostly because of the bump on my dog’s nose, the vet immediately started talking about auto-immune diseases and wanted to surgically remove the tumor which would have likely resulted in amputating the digit. I ALMOST agreed, but after a couple days I trusted my “intuition” and sought a second opinion – from a “holistic” veterinarian. This holistic vet practices alternative modalities including kinesiology (muscle testing) and herbal remedies (not homeopathy) in addition to his ‘conventional’ practice. Within 10 minutes of examining my dog he (correctly) diagnosed her with hip dysplasia (HD) and developing arthritis. Now, HD is a life-long condition, albeit ‘symptoms’ may not appear until later in life. Nevertheless, no other vet had EVER diagnosed my dog with HD. How did they all miss it? Further, this holistic vet considered that her HD/arthritis were likely causing inflammation, pain and stress, which could compromise her immune system (looking at the whole dog – not just the bumps). We hear almost daily now, how stress is bad, bad, bad – and can wreak havoc on the body. He prescribed a long dose of antibiotics for her two ‘bumps’, since he also had no other indication of a problem except infection. While neither the holistic vet nor I really like to use antibiotics, he was quick to acknowledged that there are times when they are warranted. He also prescribed some Chinese herbs to help alleviate the inflammation/pain/stress of her HD/arthritis. It took two weeks of antibiotics, but the bumps disappeared and never returned. No surgery needed. No amputation. No “Auto-immune disease”. And within a few weeks on those herbs, my dog’s mobility had improved so much, that I hadn’t realized how much she had slowed down!! Less pain – less stress means more ability for the body to fight infections. That “fear-mongering”, “faith-based healer” as you refer to Holistic veterinarians did more for my dog in 30 minutes than any conventional vet had done in her 9 years of life!! Because he looked at the whole dog and not just the bumps. Now, I’m a scientist myself, a biologist, so I fully understand and appreciate science-based evidence. “show me the data” is one of my favorite sayings! But I also know that there are sooo many things we do not understand; and there are so many biases and ways to manipulate data; and ‘medicine’ is, in many cases, more of an art than a science. As with all things – “buyer be ware” applies. I have encountered “holistic” vets AND conventional vets who were worthless!! Though I must say, I have yet to find a conventional vet half as good as my current holistic vet!! Use your common sense and DO trust your intuition!!
Your continued criticism of ‘raw food’ diets also amazes me. Every day we hear about how real foods have amazing abilities to heal and possess compounds that rival the best synthetic drugs. We are learning everyday. And every day we’re told to reduce our consumption of “processed” foods and eat whole foods! Why should this be any different for our pets. How can that kibble honestly be any good for our dogs and cats! yeah, I could survive on McDonalds but it wouldn’t be good for me! (and McDonald’s is probably better than kibble!!) Vitamins, minerals etc from “real” food and not synthetically manufactured are often better absorbed/used by the body! Of course there are no good studies of the benefits of raw/real food diets! Who could afford to fund one? It’s the same reason the only studies of stem-cell therapy for pets are done by the stem-cell companies. It’s almost a catch-22 you are completely ignoring. Companies with big coffers of cash are not going to fund a study demonstrating that raw or real food diets are as good or better for our pets than the kibble they are manufacturing. Universities who rely heavily on those big companies for donations are not going to fund such a study either – with the exception of UC Davis who has a financial interest in offering a nutritional vitamin mix for real-food diets – gee, not exactly objective either. And you quickly point to “studies” of the “risks” of raw food diets, yet you fail to acknowledge, in the same sentence, all the pet food recalls and the thousands of pets that have died from the contaminated commercial kibble you seem to think is so terrific. Feeding a raw diet to my dog poses no more risk to me than feeding myself! How is cutting up a chicken for my dog’s dinner any less safe, or more risky, than making myself chicken for dinner, which requires my handling the raw chicken!? Get serious! BE OBJECTIVE! Sometimes your biases really show through. Yeah, you’ll cite a bunch of studies . . . . none of which prove anything! Careful handling of food is always in order, and our pets can handle alot more salmonella – etc than we can. Feed your dog – wear gloves and/or wash your hands! Sure, if you give your dog a large leg bone too big for his mouth, he could break a tooth. Which is why we don’t give our kids jawbreakers. We use our heads! Bones given by raw feeders are the smaller, softer bones such as chicken necks. Yes, there is likely a problem with nutritional adequacy of home-prepared diets for pets because people are lazy. If you’re going to make your pets’ food you need to do your homework and insure that all the necessary vitamins/minerals, fats, proteins, amino acids etc etc etc are there. It’s challenging but doable. there are good books out there to teach you how to do it, or nutritionists to hire to develop a nutritionally balanced diet for your pet. Follow the NRC guidelines. I’ve done – am doing – both. My dog with HD/arthritis is OFF her nasty Rimadyl and has better mobility on her raw/cooked real food diet; and I have less time and a little less cash for myself . . but . . . these are the costs of doing things right. (and a little less time after writing this long reply. tee hee!)
Sorry to rant, but this article really got to me! It’s not your usual objective reasoning. You took an extreme example and applied it across the board. It’s an unfair representation.
Where to start indeed. Lots of subjects, and I can’t address all of them, but let’s see what we can work on.
On one level, I do think it is worthwhile to call out the extremists so that people can be warned about them and the ideas and practices they promote. I don’t see how conventional or alternative medicine can be improved without idenitfying and discouraging the abd ideas and inappropriate practices in each. Holistic practitioners are free with their criticism of science-based medicine and practitioners, but they are remarkably reluctant to even suggest there is anything inappropriate or outright wrong in any of their colleagues statements or actions. You can find plenty of mainstream folks challenging established dogma (vaccination protocols, inappropriate anntibiotic use, unproven therapies marketed too aggressively, even the long-standing dogma about neutering), but it’s much harder to find a holistic vet willing to pulically challenge anything another holistic vet says or does. So I think idnetifying the extremes serves a useful purpose.
That said, I agree that characterizing and entire group using only extreme examples is misleading and unfair, and I try to avoid that. I think you are mistaking my use of a particular individual to illustrate themes and trends I see as widespread in holistic medicine. If you read my editorial on the philosophical intersection between evidence-based medicine and alternative medicine, I tyhink you will see that there are some fundamental differences in world view at play. And among these is a different attitude towards the relative value of faith and evidence. This doesn’t mean holistic practitioners are not good people or good doctors or that their practices are all invalid. It just means that one needs to understand what one is getting as part of this package, and more often than not one is getting a set of treatments validated in ways other than through science because such practitioners don’t value science in the same way as conventional medicine does. I suspetc you and I also differ in this way. You say you are a scientist and data-driven, yet you are willing to draw large generalizations and firm conclusions about cause and effect from your own anecdotal experience, and that is not consistent with the philosophy or methods of science.
As for raw diets, my criticism of them is not that they are not useful since we have no idea if they are beneficial or not. It is that they are claimed to be useful for a tremendous number of health conditions with absolutely no evidence, and with very shaky reasoning. “Processed food” for humans means high fat, high sugar, high salt, low nutrient foods that we choose to buy because they are cheap and trigger our evolved taste preferences for such ingredients. “Processed foods” for dogs and cats are carefully forulated, nutritionally balanced products based on decades of research and testing. There may very well be advantages to properly formulated fresh, home-cooked diets, but the comparison of commercial dog food and Twinkies or McDonalds is inaccurate and misleading. And the idea that raw is better than cooked is simply a hypothesis with no real data to support it. It appeals to some peoples ideology and intuition, but this does not justify dramatic changes in how we feed our pets in the absence of real evidence. If you want anecdotes, I have had healthy dogs who have lived well beyond the average for their breeds fed primarily commercial dry food, so in the absence of real scientific data why should I believe this is an unhealthy practice?
Overall, I don’t think I’m doing what you accuse me of doing in terms of unfairly characterizing holistic practitioners. There are some who value science and many with who I agree about a great many things, and I don’t intend to demonize them as a group. However, the whole category of “holistic” has moved beyond any real sense of “looking at the whole patient” and has become a code word for ignoring or rejecting cience as the best way to validate practices and relying instead on history, tradition, intuition, or pure theory. This has led to a hodgepodge of practices under this label, some of which probably have value, some of which clearly do not, and most of which remain to be properly tested.
If one wants to sell a product (herbs, raw diets) or a service (“holistic” medicine), it is that person’s responsibility to either generate the evidence to support their claims or make sure people understand the lack of evidence so they can make a fair choice. It is not unfair of skeptics such as myself to be critical of disregard for science or scientific evidence or to respond to the kind of misleading adn really quite hateful nonsense that so often is used to market this approach (as in this article, which sells holistic medicine through blatant appeals to fear and distrust of science-based practitioners).
It truly breaks my heart to know that desperate people who are searching for a way to keep their family members with them longer find this blog. Hopefully most people realize that while you may be a skept, a vet you are most certainly not. A vet who’s life work is to care for sick animals wouldn’t have this kind of time. In fact, you have provided no credentials and have featured exactly 0 photos of the many pets you’ve helped live to be 100 with all the peddling of drugs, radiation and grain kibble… I’d even settle for one photo of one dog who lived above the average lifespan.
If you would take the trouble to read my FAQ page, you can find my CV which lists my credentials. A brief Google search will also tell you a lot about my clinical work. None of this is relevant, since whether I’m right or wrong doesn’t depend on my resume but on the strengths of the arguments and evidence I provide. Besides, you are so thoroughly closed-minded that no evidence suggesting I am a compassionate and effective doctor would make any difference to you anyway, which is why I don’t waste time trying convince people of those things.
Similarly, I can provide you plenty of anecdotes of patients of mine who have survived well beyond their expected lifespan, beaten cancer, and led healthier and happier lives because of science-based medicine provided by me. But that wouldn’t touch your closed ideology, and it wouldn’t prove anything anyway, which is the point you’ve managed to miss about this article and this blog. You’re factually completely wrong, but facts clearly don’t interest you.
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A vet who’s life work is to care for sick animals wouldn’t have this kind of time.>>>
I keep sayin skeptvet has superhuman powers.
As do thousands of other professionals finding time to EDUCATE the masses so duped that it is an even bigger disservice to “diss” those who choose to help others wading through the quagmire that is CAM or CAVM. Funny how everyone has time to peruse the net, but only those who do something worthwhile on the net are chastised for it.
I’d say skeptvet stands apart from the crowd and I personally couldn’t be more proud to call him a hero for championing for science/evidence based medicine for our pets.
With desperation, SaraPr, comes those who prey upon your desperation. Skeptvet is here to give you the tools you need to think critically about your decisions, those that he and all of us hope are the ones that truly benefit our pets, and yours, the most.
Sarah Pr.: Perhaps a little less time composing foolish comments and a little more time on English grammar: “whose”….who’s”, hmmmm?
I’m a little surprised no one has accused Skeptvet of being one of the ‘sheeple’ as this seems to be the insult of choice amongst those who think a few hours reading on the net has the same validity as peer reviewed research. But to be fair I haven’t read all of the comments on all of the posts, so I may have just missed the accusation 😉
Keep reading, Beccy. LOL.
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