Science Through the Looking Glass- The Integrative Veterinary Care Journal

While much of so-called complementary and alternative medicine (CAM), also referred to by the latest marketing buzzword “integrative medicine,” is clearly inconsistent in theory and practice with science and science-based medicine, nevertheless practitioners of CAM like to assume the trappings of legitimate medical science. From copying the title of Doctor for professions like chiropractic, naturopathy, and “Oriental Medicine” which have little to do with science-based healthcare, to holding “scientific” conferences and conducting research studies (sometimes legitimate, often pure propaganda), proponents of CAM try to look as much like practitioners of science-based healthcare as possible even while simultaneously denigrating it and claiming to have entirely different and superior methods. Another element to this effort is the publication of CAM-centered journals.

Legitimate research into plausible therapies, such as dietary supplements and herbal remedies, is often published in mainstream medical journals. But much of CAM research is so clearly ridiculous or so methodologically sloppy that it cannot be accepted into scientific journals. This has led to the creation of a parallel system of journals with all the trappings of real medical journals but willing to publish almost anything that makes CAM therapies look like they work.

In the past, I have written about articles appearing in some of these publications, including the Journal of the American Holistic Veterinary Medical Association journal of the Academy of Veterinary Homeopathy. I recently had an opportunity to look at the current issue of another example of this genre, the Integrative Veterinary Care Journal (IVC).

Despite the title, this is really more of a magazine than a journal, publishing opinion pieces and anecdotes primarily rather than formal research studies. It is also dense with advertising, some of which is cleverly formatted to look like articles rather than ads, apart from the small label of “Advertorial” or “Product Profile” in the header. Legitimate journals, of course, also employ sometimes excessive or ethically questionable use of advertising, but there is an added layer of hypocrisy in the blatant commercialism of the IVC given the tendency of CAM advocates to attack science-based medicine for financial ties to healthcare product industries. This reminds us that practitioners of alternative therapies have every bit as much financial interest in their products and services, and in the industries that support them, as conventional practitioners.

The Advisory Board for the IVC includes many familiar individuals associated with the AHVMA and other pro-CAVM organization. I have previously discussed statements made by Dr. Richard Palmquist (1, 2, 3, 4, 5) Dr. Jean Dodds (1, 2), Dr. Barbara Fougere (1), Dr. Joyce Harman (1) and Dr. Christina Chambreau (1), and all have staked out positions incompatible with a science-based approach to veterinary medicine. Dr. Steve Marsden is a well-known practitioner of so-called Traditional Chinese Veterinary Medicine (TCVM), which is a soundly mystical, pseudoscientific practice, and he is a driving force behind the Cured Cases database and forum, a project for collecting anecdotes to generate the impression of evidence in favor of alternative therapies and for providing a forum in which talking about disease being caused and treated by alterations of Heat, Wind, Ying, Yang, Chi and so on is taken seriously. So it is not surprising to find that the contents of the IVC reflect the disdain for the scientific approach to medicine these folks often express.

While there are certainly reports and ads for mainstream medical practices in the IVC, these are “integrated” with some pretty egregious pseudoscience and nonsense. No effort is made to distinguish legitimate science from outright magic. This illustrates a serious problem with the whole concept of integrative medicine. It gives the appearance of legitimacy to nonsense while degrading the overall quality of veterinary medicine. Or as Mark Crislip colorfully puts it, “If you integrate fantasy with reality, you do not instantiate reality. If you mix cow pie with apple pie, it does not make the cow pie taste better; it makes the apple pie worse.”

Essential Oils and Chinese Medicine
The first example of nonsense in this issue of IVC is an article discussing the use of essential oils according to the principles of Chinese Medicine. The article is written by Dr. Cynthia Lakenau, a “holistic” veterinarian, and Jeffrey Yuen, a Chinese Medicine practitioner. Dr. Lakenau practices the usual hodgepodge of mutually inconsistent methods which are unified only by their opposition to science-based medicine. She also has some of the usual uncharitable views of conventional veterinary medicine:

I am very encouraged by the acceptance in some corners of the conventional world, enough to truly hope and believe that every veterinary college in the future will offer training in all alternative modalities, minimize drug use, and truly practice wellness maintenance medicine.  But I see two problems both created from greed.  I am nervous that when the conventional world realizes the loss of income from animals being truly healthy, they might wage an aggressive smear campaign. [I imagine that is how she’ll categorize this article if she sees it]

Mr. Yuen has no conventional medical training but describes his credentials this way:

Jeffrey C. Yuen comes from two Daoist lineages. He is an 88th generation Daoist master of the Yu Qing Huang Lao Pai (Jade Purity Yellow Emperor Lao Zi School) and a 26th generation Daoist Master of the Quan Zhen Long men Pai (Complete Reality Dragon Gate School)… Having a strong resonance with Daoist teachings ever since childhood, Jeffrey studied extensively under Master Yu Wen and was allowed to openly practice and serve the community when he was 16 years old… Mr. Jeffrey C. Yuen also studied Chinese herbal medicine with Master Gong Song-Liu, a eunuch for the last two emperors of the Qing Dynasty who apprenticed with the imperial medical physicians. As a friend of Master Yu Wen, Gong was persuaded to teach Jeffrey, imparting his deep knowledge of Chinese medicine over a period of 8 years. ..Today Jeffrey Yuen is recognized internationally as a master scholar, teacher and practitioner of Classical Chinese Medicine. This includes Acupuncture, Herbal Medicine, Nutrition/Dietetics, the therapeutic use of Stones and Essential Oils, Tai Qi, Qi Gong and Daoism. Indeed, as a Daoist priest, Jeffrey is at the forefront of the restoration of the spiritual roots of Chinese Medicine. His teachings rooted in the spiritual tradition of Daoist mysticism bring a clarity, wisdom and depth to Chinese Medicine rarely found today.

This resume illustrates the explicitly religious nature of TCM and TCVM. The health practices employed in TCM are fundamentally spiritual practices based in a faith-based ideology, not medical practices aimed at curing physical ills or based on modern scientific principles. Despite the use of herbal remedies and the recent adoption of acupuncture among mainstream medical professionals, at its core TCM has more in common with Christian Science, Voudou, and other forms of faith healing than it has with scientific medicine. Sadly, it is often presented to patients and veterinary clients as a medical rather than a religious practice.

The mystical nature of this approach is evidence in the IVC article concerning essential oils.

Essential oils represent the genetic unfolding of the plant, the Jing, the essence of the plant. They therefore have potential effects on physical developmental problems as well as the mental and spiritual…The plant’s Jing will resonate with the body’s Jing. As a result, a vast degree of possible healing can occur when essential oils are applied to acupuncture meridians..

The article goes on to suggest that if children and animals fear needles or do not willingly ingest Chinese herbal concoctions, one can achieve similar effects by applying essential oils to magic locations on the body (despite the problem that acupuncture points cannot be shown to exist or be consistently identified and agreed upon by acupuncturists).

And while it is claimed that scientific sounding rationales for the use of such oils can be found (what the authors call “the chemotype theory”), this is not considered essential to evaluating the safety or efficacy of such products. Instead, TCM categorizes these agents in term of the mystical system it employs for other interventions, “law of signatures, five elemental associations, nature or temperature, taste, aroma, relationship to neighboring plants and channel (or meridian) affiliation.” This collection of mystical theoretical constructs, and the associated diagnostic practices employed in TCM, renders even potentially plausible interventions like herbal medicine unreliable when they are employed according to what is essentially a system of magic.

Additionally, according to Lakenau and Yuen, essential oils are categorized and employed according to their “notes.”

High Notes- Oils that evaporate rapidly, influence the Wei Qi (defensive immune system or external) level, Primarily used for acute conditions. “They awaken the senses, serving as the first invitation for a patient to change.”

Middle Notes- “used for more sub-acute problems that tend to be in the Ying level, which affects plasma in the blood…useful for circulatory issues (movement of Qi moving blood), to regulate digestion…and for cognitive function (digesting and assimilating the information around us and eliminating that which is not needed” [which, presumably, includes biochemistry, physiology, and clinical trials]

Base Notes- “for chronic, constitutional issues at eh Yuan level (which can influence genetic tendencies)”

While the theory here is fanciful, the fact that it is suggested employing these remedies in this manner is actually a responsible way to treat serious disease is outrageous.

…if you have a dog with an autoimmune joint disease such a rheumatoid arthritis, you could use a top note…to help with his ability to rest during any acute situations; a middle note…to help clear the heat of the latent infection; and a base note…to help treat the fascial pain

Since rheumatoid arthritis is a serious, painful disease which is not due to the “heat of a latent infection” and does not involve the fascia, following this advice would be gross malpractice.

Finally, the authors suggest topical application of essential oils for “bodywork and cranial-sacral work,” thus merging the theoretical nonsense of certain manipulative therapies with the nonsense of TCM. They also suggest deciding where to apply the oils based on acupuncture points (which are, of course, as objectively real as constellations in the night sky) or which “humors” you want to affect. Apparently, the ears affect the nervous system whereas the paws effect circulation. At this point, I suspect no one will be shocked to learn that no scientific research is cited to support any of the claims or recommendations in this article.

Treating Canine Lipomas
Another article in this issue addresses the treatment of a common benign tumor called a lipoma. These are aggregations of fat which typically occur in middle-aged and older dogs. The exact cause is not known. They are more common in certain breeds and possibly in overweight dogs. Research in humans suggests possible genetic risk factors, but the definitive cause is not known. This, of course, provides an open field for rampant speculation of how to treat and prevent these benign tumors.

Conventional medicine recommends no treatment unless they cause clinically important problems, based on size and location, and then surgical removal. However, the author of this article, Dr. Christina Chambreau, who is predominantly a homeopath (meaning, she believes in magic) has a different perspective.

The holistic perspective looks at all symptoms as clues to an underlying vibrational imbalance (Qi, vital force, etc.). Most integrative practitioners see lipomas as the body’s way of exteriorizing toxins…TCVM lists lipomas as stagnation of body fluids.

This paragraph manages, completely without irony, to lump together a variety of mutually incompatible theories that share only the feature of being nonsense incompatible with actual science. Qi, vital force, etc. (by which she means other alternative medicine constructs such as chiropractic’s “innate intelligence,” Ayurveda’s “prana,” and so on) are mystical forces that are fundamentally spiritual in nature. These are undetectable, unmeasurable, magical energies that apparent cause all disease and can be manipulated to cure disease, but only if you are willing to believe in them with no actual evidence. Once again, this illustrates the fundamentally religious nature of much alternative medicine.

The notion that disease is caused by mysterious, unidentified “toxins” is another popular alternative medicine trope. It is theoretically inconsistent with the notion of spiritual imbalances causing disease, but this never seems to bother alternative practitioners. In any case, it shares at least the quality of being arrant nonsense.

Stagnation of body fluids is a reference to the humoral theory of health and disease. This is a popular concept in pre-scientific folk medicine. It was the basis for all the bloodletting and purging that European and early North American physicians used to practice, but these ideas and associated practices were abandoned by conventional medicine when science proved them to be untrue an ineffective. TCVM and other holdovers from pre-scientific medical practice retain such notions despite the evidence against them and the dramatic improvement in health that accompanies abandoning these ideas.

Of course, the fantastical theories are merely a way of introducing equally fantastical treatments that are equally lacking in any evidence of efficacy other than the testimony of the faithful. Though Dr. Chambreau admits that most integrative practitioners report being able to predictably cure lipomas with their therapies, she nevertheless uses anecdotes of responses to treatment as the basis for recommending specific therapies. Of course, she recommends minimizing the use of “chemicals and drugs in medical treatment” and of flea and tick preventatives. There is no evidence that these are risk factors for lipomas, of course, but Dr. Chambreau is willing to overlook this lack of evidence of causality, as well as the evidence of beneficial effects from medicines and parasite prevention, in order to imply that avoiding these substances will somehow reduce the risk of lipomas. Why work to prove something you can simply imply without evidence?

She also suggests looking out for her Early Warning Signs of Internal Imbalances, a dog’s breakfast of random clinical findings that she suggests, again without evidence, are somehow related to mysterious “imbalances” that might lead to actual disease. To this she adds the suggestion that some alternative vets believe lipoma risk can be reduced by “natural rearing,” a philosophy I’ve discussed before which is consists of an irrational hodgepodge of unproven or quack practices. And, not surprisingly, raw foods are mentioned as possibly preventing lipomas, just one among the many miraculous, and as yet unproven, claims for raw diets.

Speaking of miracles, Dr. Chambreau discussed one treatment for lipomas that really can’t be characterized in any other way. She reports the case of a dog who somehow managed to get lipomas despite “being raised naturally with few to no vaccines, a great diet, and no chemical exposure.” (Not that this casts any doubt, of course, on the value of these preventative strategies). He was treated with “Tui Na…Chinese massage to enhance Qi and lymph flow…[using] acupressure points on the meridians above and below each lump.” And as we all know, “Pericardium 8 is a spot in the center of a person’s hand that emits a significant amount of chi, so [the acupressure practitioners] held their palms on the lipoma. The lumps would resolve within a few days…” So by literally laying on of hands, we can supposedly make lipomas go away using the chi we project from a point in our palms named after the sack around the heart? Amazing!

Apparently, as the dog aged, this magic ritual didn’t entirely make the lumps go away anymore, but Dr. Chambreau confidently reports that “they were much less problematic than they would have been if not treated.”

The article goes on to suggest that some lipomas have been shrunk or cured using acupuncture, Chinese herbs, “a high fiber macrobiotic diet,” homeopathy, colostrum, flower bud therapy, probiotics, and chiropractic. No evidence other than anecdotes is provided for any of these claims. She does also mention liposuction, steroid injections, and surgery, all of which actually do have scientific research evaluating their effects.

With regard to surgery, however, Dr. Chambreau suggests that the most common and clearly effective treatment for lipomas is actually a bad idea, and buttresses this claim with a mishmash of sloppy reasoning and mystical ideology:

Several surgeons stated that removing one lump resulted in multiple lumps appearing later in the dog’s life. [And we know the surgery is the cause of the subsequent tumors how?]

This is because surgery removes only the tip of the iceberg. Surgery will do nothing to address the toxins causing the fatty tumor, and will leave scar tissue behind; this blocks the point of discharge the body needs to release those toxins. Once scar tissue is created, the toxins feeding the tumor are forced deeper into the patient’s body, causing damage to deeper organ systems. [A frightening prospect made less disturbing by the fact that it’s completely made up and that these “toxins” have not been shown to actually exist or cause any of the terrible consequences Dr. Chambreau proposes]

Reiki for Shelter Animals
Reiki is another form of spiritual healing in which a healer directs a mysterious form of spiritual “energy” to heal physical disease. It has the advantage over some alternative therapies of being benign in itself since it relies on magic rather than plant chemicals or needles. Nevertheless, no reliable scientific evidence has demonstrated any actual healing effects. If magic is real, then perhaps someday we will be able to demonstrate such effects, but as Tim Minchin has pointed out, “Throughout history, every mystery ever solved has turned out to be—not magic.”

The process of performing Reiki, however, might have some actual behavioral and physical effects on animals. It does, after all, involve quiet, gentle interaction and sometimes touch from a human. Anyone who has ever shared a bed or petted a dog or cat will be unsurprised by the idea that animals might enjoy this sort of interaction and find it comforting. It seems gratuitous to take ordinary kind and comforting interaction that might help shelter animals and load it down with a pile of mystical baggage and then claim that is why the animals benefit.

In this issue of IVC, however, Ms. Kathleen Prasad makes some pretty dramatic claims for Reiki in shelter animals, some of which may be actual effects of the interaction (though claiming this would require controlled research) and others are farfetched at best.

Despondent cats and dogs become more social and seem happier

I wouldn’t be at all surprised if this is true. I just would like to see some evidence it has anything to do with “spiritual energy” instead of loving human contact.

Sick animals are aided in their recovery

This kind of claim needs to be proved to be taken seriously

…Animals who have been here for a long time often get adopted shortly after treatments…One of the amazing benefits of Reiki is the inner transformation it creates in these animals..[who] can release their stress and get back in touch with their true essence. Once they remember who they are, their sweet spirits can shine through so potential adopters can see…

Clearly, these folks haven’t heard of confirmation bias or any of the other ways we fool ourselves into thinking our actions have effects they really don’t. While gentle human interaction may indeed relieve stress, all of this spiritual and psychological language is merely the projection of humans’ feelings and beliefs onto animals. And the idea that there is a direct relationship between being treated with Reiki and getting adopted is an empirical claim which needs to be demonstrated before being made.

[Some Reiki believers] often speak of how Reiki transforms the hospice experience…Since learning Reiki and using it to help with animal care during hospice, [they] report that all the deaths they have witnessed are extremely peaceful.

The use of spiritual practices in animal hospice care is something I have written about before, and it does come with significant risks. While the humans involved may find such practices comforting, and that is a good thing, there is no reason to think our animals share any of our many specific and often incompatible spiritual beliefs. I have personally seen animals who are suffering be denied appropriate pain control and human euthanasia by owners whose spiritual beliefs precluded the use of these therapies. While animal owners are entitled to these beliefs, veterinarians have a duty to advocate for the welfare and interests of our patients. It is all too easy for psychologically comforting rituals like Reiki, acupuncture, homeopathy, and so on to fool us into thinking we have done something real to reduce an animal’s suffering when we actually have not. We must rely on objective scientific evidence to help us determine if what we are doing is truly comforting our patients and not just us.

The article also claims that Reiki can help people working with shelter animals cope with stress. Again, I suspect this is true. People are often surprised to learn that I meditate and find it helpful personally. That is quite a different thing, however, from claiming that one can channel a spiritual energy force to improve physical health and the chances of a pet being adopted!

Evidence-based Chinese Herbs for Horses?
Dr. Kendra Pope contributed an article to this issue of IVC which makes use of a popular buzzword in both conventional and alternative veterinary medicine, “evidence-based.” I have been deeply involved in the promotion of evidence-based veterinary medicine (EBVM) for years, and unfortunately I often find that when people use the term I am reminded of the movie the words of Inigo Montoya in the move The Princess Bride, “You keep using that word. I do not think it means what you think it means.”

Evidence-based medicine is a set of principles and practices that extend the basic epistemological principles and methods of science to the development and use of scientific knowledge in medicine. It involves explicit and structured incorporation of scientific research evidence into clinical practice. Merely citing case reports or methodologically weak and biased studies in support of your claims and announcing “QED!” is not evidence-based medicine.

In this article, a number of citations are made in support of specific claims. These include the claims that acupuncture can effectively treat lameness and that a variety of Chinese herbal remedies, presumably applied according to the mystical system of TCM, can effectively treat tendonitis, acute and chronic respiratory disease, chronic sinusitis, colic, seizures, infertility, hepatitis, fibrous osteodystrophy, and other maladies. Since published literature is cited to support these claims, it is tempting to simply assume they have been proven and accept them at face value.

This ignores, however, the critical element of known as critical appraisal, the explicit evaluation of published research to determine the degree of confidence it is appropriate to have in the conclusions of research studies and their applicability to particular patients. A closer look at the citations in this article revealed some interesting facts. For one thing, of the 27 publications cited, 24 were in journals or textbooks devoted exclusively to TCM or alternative therapies. Of the remaining 3 articles, two were narrative reviews (essentially individual opinion pieces), and only one was a report of a clinical research study. And guess what this one study found? “Treatment with the composite did not result in statistically significant changes in any of the parameters evaluated.” That’s right! The only study cited that wasn’t from an alternative medicine journal found the remedy didn’t work! Yet it was cited in support of this practice. How’s that for evidence-based medicine?

The bulk of the studies come from the American Journal of Traditional Chinese Veterinary Medicine, and when reviewed most of these are either narrative reviews and opinion pieces, case reports and case series, or uncontrolled trials at high risk of bias. This is typical of the reports in journals dedicated to alternative veterinary therapies. They create the impression of real science by borrowing the terminology and some methodological features of scientific research but ignore the fundamental principles and key controls for bias and error that make science and science-based medicine work. This is part of the reason why a recent systematic review of veterinary homeopathy written by full-time advocates for the method was unable to find convincing evidence of real clinical effects despite many hundreds of published reports. The quality is nearly always so poor as to render the results unreliable.

Bottom Line
The IVC journal is a classic example of the effort of alternative medicine advocates to have their cake and eat it too. They want to have the legitimacy and the marketing value of being seen as scientific without giving up those beliefs and practices which are fundamentally incompatible with science. They want scientific evidence to support their beliefs but never see it as an adequate reason to abandon any therapy. And they want to be seen as open-minded doctors “integrating” alternative therapies into accepted conventional medical practice while at the same time portraying conventional medicine as frequently misguided, ineffective, dangerous, and subordinate to malign financial interests.

If CAVM proponents want scientific legitimacy, they should earn it through real, rigorous research published in real veterinary journals, and through a willingness to treat their methods as scientific hypotheses open to testing and even rejection rather than tents of an essentially religious faith that can be justly accepted without evidence on the basis of belief alone. Products like IVC are merely marketing masquerading as science, and this is fundamentally deceptive.
















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