The University of Florida’s Integrative Medicine Service: Good Science or a CAM Trojan Horse?

The American Holistic Veterinary Medical Foundation (AHVMF) recently announced the winner of their 2014 education grant. The University of Florida will receive the $10,000 award for demonstrating “their intent and ability to become a force in integrative veterinary medicine.”

I have discussed the term “integrative medicine” before and how it serves as a Trojan horse for smuggling untested or pseudoscientific ideas into academic institutions. Integrative medicine usually means mixing alternative therapies, by definition either unproven or disproven therapies, with conventional science-based medicine as if they were epistemologically or scientifically equivalent. It allows proponents of these therapies to make them more familiar to conventional doctors, which builds a sense of confidence in the methods independent of any research evidence showing they work.

In academia, the push for integration of alternative therapies into the mainstream is also often cloaked in the language or evidence-based medicine. It is claimed that bringing “experts” in these methods into the university will facilitate sound scientific research to determine if they are truly safe and effective. While this is a noble idea, it is often put forward disingenuously by advocates of CAM who are already convinced beyond any doubt that their methods work and who have no willingness to abandon any of them regardless of what the evidence turns out to show. The leaders of the AHVMF have demonstrated repeatedly that their beliefs do not require scientific validation (e.g. 1, 2). It is quite clear that the real purpose of AHVMF grants is not to study CAM and identify both effective and ineffective therapies but to market CAM and develop scientific camouflage for ideas they have no intention of ever truly questioning.

The University of Florida School of Veterinary Medicine is becoming a regular participant in the infiltration of unscientific ideas and practices into ostensibly science-based veterinary medicine. This is the second $10,000 grant the university has accepted from the AHVMF, the first specifically intended to support the school’s acupuncture program. There is a close and reciprocal relationship between alternative medicine advocates and the UF Integrative Medicine service which is much like the potentially problematic relationships often seen between universities and other private industries, such as pet food companies and pharmaceutical companies. In addition to the AHVMF funding, two faculty members in this program are also faculty at the Chi Institute, a leading organization teaching and promoting the pseudoscience of Traditional Chinese Veterinary Medicine (TCVM). And the school has a nutrition residency which is jointly sponsored by the Chi Institute and the pet food company Waltham.

As is typical for integrative medicine departments, the University of Florida group tends to speak both the language of science and the language of alternative medicine freely, even when these contradict one another. The school’s statement on acupuncture cites many conventional mechanisms proposed to explain the possible medical effects of this therapy, including stimulation of nerves, releases of endogenous opioids and endorphins, and so on. These are certainly plausible hypotheses, though despite a great deal of effort they have not been consistently validated by research, so they are still unproven hypotheses. However, the same document employs the mystical, pre-scientific language of TCVM: “There are 361 acupuncture points located throughout the body on meridians. Meridians are the energetic channels that connect all the points to each other.” Unfortunately, acupuncture points probably don’t exist, and the “energy” referred to here is a vitalistic concept that serves no legitimate purpose in scientific medicine.

This document goes on to talk about aspects of acupuncture that clearly depend on an acceptance of traditional, pre-scientific theories of health and disease:

Hemo-acupuncture is performed by inserting a hypodermic needle into a blood vessel that contains an acupoint to draw a few drops of blood. The purpose of this modality is to release heat from the body.

[This is clearly a form of bloodletting, an ancient and completely useless medical therapy found in Europe as well as China and abandoned by science-based medicine long ago. Much of what is described today by acupuncture proponents as ancient acupuncture was likely really bloodletting.]

Moxibustion is a form of stimulation that works by warming the acupoint and causing activation of the point. It uses crushed dried leaves of Artemisia argyi rolled into a cigar-shaped fashion. The herb is burned and then placed over an acupoint without touching the skin. The warming effect of the burned herb causes stimulation of the acupoint….Be cautious when using moxibustion in the summertime because it warms the body and might lead to too much heat.

[Again, this refers to the notion of disease caused by imbalances in theoretical concepts like warm and cold, dry and damp which are distinct from the ordinary meanings of these terms. It is essentially the same as the Western Humoral Medicine which underlay all the ineffective pre-scientific medical practices used in Europe and North America prior to the development of science-based medicine]

In another example of the inconsistencies that arise from the doublethink of trying to practice science-based medicine and pre-scientific ritualistic medicine like TCVM, one of the UF professors admits, unusually for a proponent of acupuncture, that the modern practice is not likely to have much relationship to ancient Chinese medical practices: “There is little argument that canine and feline acupuncture is a modern Western invention… Both detractors and proponents should regard the current practice as a distinctly modern adaptation with unclear lineage to antiquity, even more so when examining small animal treatment systems.” Nevertheless, the UF acupuncture document clearly states, “Veterinary acupuncture has been practiced in China for at least 2,000 years.”

The same professor acknowledges the mystical and religious foundations of modern TCVM and acupuncture, yet he seems untroubled by teaching and employing these methods as if they had meaning, based apparently on personal positive experiences and the dubious and irrelevant tu quoque fallacy that because evidence-based medicine is imperfect anything goes:

The Chinese approach to human disease was historically rooted in changing philosophies, including Daoist, Naturalist, and Confucian traditions. The relative popularity of these philosophies influenced the emphasis on certain Chinese medical concepts, such as the system of opposites (ie, yin-yang theory) and the natural relationships of organs in Five Element theory.

Veterinary medicine has followed the homogenization of Chinese medicine for humans and is now an adapted and standardized mixture of the Five Element, yin-yang, and bian zheng systems.

Modern transpositional meridians, or channels, form the basis for veterinary acupoint nomenclature but remain controversial because of associations with Five Element theory and traditional concepts of Qi (broadly defined as energy).

… detractors should acknowledge the widespread deficits in evidence-based medicine throughout the veterinary profession.

He also says, “Proponents of acupuncture should accept limitations in the technique’s application…” Yet it is puzzling what he means by “accepting limitations in the technique’s application” since his own department’s explanation of acupuncture for clients states, “There are no specific diseases that cannot be treated with acupuncture.”

Most of the academics involved in this sort of integrative medicine appear to honestly believe in the central role of science for evaluating medical therapies, though they often appear not to understand the philosophy or methods of science very well. They often contribute valuable and legitimate scientific knowledge to the profession in other areas. I don’t doubt that their desire to apply science and evidence-based medicine to alternative therapies is genuine.

However, I do doubt their willingness to accept the invalidation of the methods they believe in and champion. It is rare for high quality scientific research to demonstrate an alternative therapy is truly effective unless there is a plausible mechanism consistent with a scientific understanding of nature to begin with. Most of the numerous studies sponsored by organizations like the National Center for Complementary and Alternative Medicine (NCCAM) find no benefit to patients. This would be a perfectly appropriate and legitimate application of science to these therapies if it led to the abandonment of therapies that are ineffective, and an improved awareness of the importance of establishing a plausible hypothesis before spending limited resources on clinical research.

The reality, unfortunately, is that the rare positive studies are trumpeted as vindications, even when they are unreliable, and the many negative studies are ignored or rationalized away. When science is put to the service of advocacy for unscientific beliefs, the result is rarely good science or an improved understanding of nature. Given the obvious anti-science views of the leadership of the AHVMF and the Chi Institute, it seems likely that the work they sponsor will be much like that supported by CAM advocates in human medicine—unlikely to validate many therapies and even more unlikely to lead to anyone giving up on therapies that fail to be validated scientifically.

So while I approve of legitimate scientific inquiry into any therapies that could possibly be beneficial, in which I include many herbal therapies, some manual therapies and even possibly acupuncture (though there, the light of hope is dim and growing dimmer), I fear that UF and other veterinary institutions will be influenced by the financial and ideological support of groups like the AHVMF and the Chi Institute with agenda’s that are incompatible with such legitimate scientific inquiry. Time will tell, but the lesson of such integrative medicine in the human medical field does not encourage hope that veterinary medicine will become more effective or more evidence-based by following this path.

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