No Vet for My Pet? Veterinary Nurses Can Sell Woo Too!

Despite the real harm unproven or bogus alternative therapies can cause, I get a lot of flak here for being critical of alternative practitioners. Some of that stems from the natural resentment of having one’s beliefs questioned. Alternative medicine is more of a philosophy, even a religion, than it is a rational approach to healthcare (1,2,3), so challenging it is much like questioning someone’s religious beliefs, and it tends to draw the same sort of response as illustrated by the sometimes vicious hate mail I get (4,5). And pointing out the lack of scientific evidence or a plausible theory behind an alternative practice can (hopefully) dissuade people from pursuing it, which obviously threatens the livelihood of some practitioners, so naturally this would engender some angry responses.

However, this criticism of criticism is pretty hypocritical given that the foundation of most alternative medicine marketing is exaggerating the risks and minimizing or ignoring the benefits of science-based medicine. The criticism alternative practitioners level at conventional medicine in promoting their own practices is often dramatic, and even those who claim their methods are compatible with conventional therapies and that they employ these still most often give more credit to the alternative treatments they use.(6, 7, 8, 9, 10, 11, 12) Ultimately, most alternatives to science-based medicine have to be sold with the claim, or at least the implication, that they work better than conventional medicine or in situations where it does not, whether or not there is evidence to support these claims.

A reader recently pointed me towards a particularly egregious example of the marketing of complete nonsense as a substitute for real medical care. See if you can spot the subtle suggestion that the methods being offered can replace conventional care.

AlyBhimjiLogo96

That wasn’t hard, was it? Now in the U.S. it is illegal to claim to diagnose or treat any disease without a license to practice veterinary medicine. I presume the same rule applies in Canada, where this quack is located, and as a result the web site is all about implying therapeutic powers without ever actually directly stating this. The usual sort of disingenuous CYA disclaimer appears on the home page:

The information contained on this website is for educational purposes only. It is not to be used as medical treatment or diagnoses. Do not alter any medical treatment, or the use of any medication without the permission of your medical care provider.

So if you aren’t supposed to use these products and services as medical treatments, why is the site called “No Vet for My Pet?” And why are there lists of medical conditions, from allergies to infections to cancer, paired with the names of specific products? Doesn’t that perhaps suggest the products are recommended as treatments for those conditions?

The site belongs to a veterinary technician/nurse named Salina Bhimji. Veterinary nurses, like nurses in human medicine, are in many ways the backbone of clinical medicine. They provide much of the direct patient care, and they serve as eyes, ears, hands, and often brain and conscience for veterinarians. I am blessed to work at a hospital with an amazing staff of highly intelligent, motivated, and trained nurses, and they make life incalculably better for me and my patients.

Unfortunately, in human medicine nurses are often a driving force for the integration of pseudoscience and nonsense into patient care, and I have seen at least some examples of the same problem in veterinary medicine. Healing Touch is the classic example of such a method among nurses in the human medical field. A form of “energy medicine,” which really amounts to a spiritual rather than a medical practice, it was invented by a nurse and has been accepted and promoted primarily by nurses despite clear evidence that it is nothing but a placebo ritual.

It is actually understandable that nurses in human and veterinary medicine might be more inclined towards alternative therapies than many doctors. Their training is often more practical and involves less basic science and scientific method and theory. And nurses provide most of the direct comfort to patients, so treating psychological, emotional, and spiritual needs more often falls within their domain than in the territory of doctors.

Most nurses, fortunately, believe in providing comfort and high-quality, science-based medical care, but a small group do tend to be sympathetic towards the kind of nonsense Ms. Bhimji sells. It is critical that those of us committed to evidence-based medicine include the nursing/technician community in our ranks and in our education and training efforts, because they are a large and indispensable part of the healthcare system for our patients.

According to her bio, Ms. Bhimji has an undergraduate biology degree and became a certified veterinary technician working at veterinary emergency hospitals. Apparently finding real medicine not to her liking, she has begun offering a wide array of the most ludicrous pseudoscientific and mystical nonsense available in the alternative medicine “toolbox.”

So what sort of alternatives does she offer? She seems to specialize in the more spiritual styles of therapy. This may be because of her personal beliefs, but I suspect it has more to do with legal restrictions on providing the more “medical” forms of alternative therapy (herbal remedies, acupuncture, chiropractic, and so on) without a license to practice medicine. She states that she is pursuing a doctorate in naturopathy, so I expect once she achieves that she will expand her product line—uh, I mean “toolbox.”

Reiki
This is is essentially a form of spiritual healing in which a healer directs a mysterious form of spiritual “energy” to heal physical disease.(13) 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.

The use of spiritual practices in medical care 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.

Ms. Bhimji has a variety of certificates from training as Reiki practitioner. This may qualify her as a spiritual advisor of sorts to people who believe in the sort of ideas behind Reiki, but it does not give her any legitimate medical expertise or right to imply that she can treat health problems in veterinary patients.

A separate service Ms. Bhimji lists on her site is “energy healing,” but it is unclear how this differs from Reiki, which is just one of many forms of “energy medicine” (aka faith healing).

Crystal Healing
Here is how Ms. Bhimji describes this therapy:

What is Crystal Healing

This is a healing method that is used to heal animals using various types of crystals. There are many different crystals that work well with animals, it is about what crystal resonates with you.  If a crystal jumps out at you, or you are attracted to one, that is the stone that you are meant to use.

What does it do?

Using crystals in conjunction with other healing methods can enhance the healing process for an animal.  They simply amplify the energy that is flowing throught [sic] the animal.

It should be fairly obvious that this is again more religion than medicine, but there is no scientific evidence that crystal healing is anything other than a placebo therapy. (14, 15) While one can legitimately debate the merits of offering people placebos, it is clear that it is ethically unacceptable to treat disease in animals with placebos for their owners. (16)

Essential Oils
Essential oils are one of the products and services Ms. Bhimji offers which sound less obviously like religion and more like actual medicine. The claim that odors distilled from plants can heal disease, however, is still pseudoscience unsupported by reliable research evidence. There is little doubt smells can have potent emotional effects on humans, and they could potentially have behavioral effects on veterinary patients. BThere is weak evidence for beneficial effects on subjective mood states, such as anxiety, in humans, but the notion that they can influence the outcome of serious diseases, such as cancer, diabetes, and so on, is entirely unproven and highly implausible. (17, 18, 19, 20)

Ms. Bhimji specifically offers a type of essential oil therapy called Raindrop, and she proudly attributes the practice to Gary Young. Mr. Young is an infamous character with a long history in alternative medicine. Though the details are often in dispute, and Mr. Young does not hesitate to threaten legal action against those who criticize him, he has apparently been in regular legal trouble for practicing medicine without a license, making illegal drug claims, and other alternative medicine marketing activities for decades. (21, 22, 23, 24, 25, 26). This is not a source anyone should trust, and the fact that Ms. Bhimji uses Mr. Young’s method and appears to admire him speak poorly of her own judgment and reliability.

Consultations
Finally, Ms. Bimji offers consultations in person or via Skype for $50-65 per hour to help pet owners “achieve their goals in enhancing the health and wellness of their pet.” She also offers a variety of educational  presentations in person and online. While I suspect there is nothing illegal in this, it seems obviously unethical and fraudulent by every other definition. Ms. Bhimji essentially offers either spiritual guidance or completely unsupported pseudoscience and calls it “healing” or “wellness.” It is hard to imagine how anyone could come to this web site and view the material there as anything other than healthcare advice for their pets, despite all the careful language and disclaimers, so the site strikes me as misleading even if Ms. Bhimji actually believes the nonsense she is preaching.

Bottom Line
I have no quarrel with people who find comfort during times of illness from spiritual practices. And I see no problem with utilizing these practices for our pets when they are intended to give us spiritual and emotional comfort. But there is a meaningful difference between medicine and religion, and when the distinction gets muddled patients suffer. Treating serious disease in animals with religious rituals and pseudoscience in lieu of science-based medicine denies these patients real, effective medical care and causes real and unnecessary suffering. Advertising oneself as a spiritual advisor helping people cope with their pets’ illness is perfectly fair. Advertising spiritual services and bogus treatments as if they had real medical benefits is misleading and dangerous.

Ms. Bhimji seems to take great care to avoid explicit claims that could get her in trouble with the law though I suspect those will appear if and when she gets licensed as a naturopath. But she clearly creates the impression that what she offers can have real medical benefits and can replace science-based medical care, and that is wrong whether legal or not.

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15 Responses to No Vet for My Pet? Veterinary Nurses Can Sell Woo Too!

  1. Mixti says:

    Absolutely horrifying. And it besmirches my profession. But so many breeders and fanciers choose the holistic route out of ignorance.
    Mixti Cox. BS, LVT, VTS (ECC)

  2. It’s really unfortunate. I had to “unlike” a FaceBook page that I enjoyed, Ricochet The Surf Dog, because it was advocating for an “energy healer” in California. The FaceBook recommendation even said “She does long-distance work as well.” :/

  3. skeptvet says:

    Yes, it’s frustrating. I often find that many of the people with whom I share a lot of values and aesthetic tastes seem to be into woo, and it requires lot of effort to handle the topic delicately so as to be honest yet not sour relationships. And, of course, colleagues who I otherwise respect will sometimes repeat the most ridiculous things they’ve heard from CAVM advocates, and again it’s challenging to educate without creating animosity. Few people are defined only by one set of beliefs or attitudes, so I do try to see other aspects of folks as well even when we disagree about this stuff. But sometimes, as in Ms. Bhimji’s case, the real harm being done shouldn’t be minimized, and I do think it’s important to take a stand for reason and science.

  4. v.t. says:

    Bhimji needs to go back and get a refresher course on her “education”.

    That she learned nothing about toxic substances, particularly in cats, and has no scruples in “practicing” toxic essential oil therapy applications on cats, is beyond unconscionable (not to mention practicing anything when she is not a licensed veterinarian).

    Young Living Oils and doTerra (MLM) distributors all do this, they claim they are experts in essential oil therapies for pets, and the companies sit back and do nothing but rake in the money at the expense of badly informed pet owners and innocent pets. When educated individuals call them out on it, they are ganged up upon and banned from forums, facebook, wherever these idiots are selling their crap. These people have lost any sense of ethics or morality they might have once had – it’s quite maddening to listen to them preach how wonderful they and their products are (very few of them have any background in science) – all for a tiny and very expensive vial of oil that has never been proven to do what is claimed.

  5. NurseMedic says:

    Pardon the tangential question, please; but I expect I can get an intelligent answer from you.

    The term ‘veterinary nurse’ seems fairly recent to me. I always heard them called techs. I don’t lack any respect for the professional, compassionate care I see them give regularly (including to my own animals).

    In human nursing (bias: I have a BSc., BSN, and board certification in critical care transport, as well as paramedic and military senior medic certs) there are many RNs with an Associate’s degree; but the trend (and maybe eventual requirement) is to BSN level education. In addition, many hours of clinical education are required to complete a program and sit for the NCLEX exam.

    Are veterinary techs now called ‘nurses’ because they’re clinical roles are similar, and/or because they are receiving similar levels of didactic and clinical education? Is this an increase in education and skills from previous generations; or is the change stylistic?

  6. skeptvet says:

    The “nurse” vs “technician” issue is a long-standing and contentious one, and there isn’t a simple answer to which term is used under what circumstances. In the U.S., the term “technician” is used in most educational titles and in regulatory and licensing processes. However, the term “nurse” is commonly used in practice. By contrast, in the U.K., the term “nurse” is used in official educational and regulatory processes.

    As both a vet and the son of an RN/FNP, I can tell you the practical role of veterinary nurses is very similar to that of nurses in human medicine. There are varying levels of education and expertise as well as specialization. Though an Associate-level degree is still the norm, advanced education and board-certification in specialties such as Surgery and Anesthesia, Internal Medicine, and Emergency and Critical Care are available. Veterinary nurses perform the bulk of direct patient care, are responsible for most technical clinical procedures (at least in larger and more advanced practices), and are critical in both patient care and in the care and education of clients.

    I prefer the term “nurse” because I think it more accurately conveys the nature and duties of the role. And clients tend to understand this role correctly when they hear the term “nurse,” whereas they tend to view the role as more limited and procedural when they hear the term “technician.” The didactic standards for licensing are likely less for veterinary nurses than RNs, and there is not yet an equivalent of the NP or PA role. However, there are similar differences in the training and function of MDs and DVMs, yet “doctor” is generally seen as the most appropriate term for this role (heck, even the stodgy New York Times finally changed its style manual to allow the title Dr. to be applied to vets). I think the same principles applied to veterinary nurses.

  7. R says:

    It was almost a decade ago, but I will never forget it. A vet tech gave my dog the wrong dose of medication…..it was a significant error (the dog was okay).
    I did not make a fuss, but knowing this person was still employed there, I did not return. My trust was broken.
    I only want the vet to give my dog injections. I don’t like it, but it seems to be the trend now to take the dog to the back room for lab work and diagnostic tests.

  8. R says:

    BTW: I am an RN. They admitted to the error and made light of it. I am the one that called their attention to it.

  9. NurseMedic says:

    Thanks for the excellent and informative reply.

    As for DVMs and MDs, I think the education and roles are highly comparable. I’m married to an MD who has worked several different specialties over the years; and I’ve worked with physicians in situations from combat to the ER to the ICU and surgery. In our house we agree that DVMs are the last great medical generalists. The average DVM is still expected to be able to do a range of medicine and clinical skills that MDs lost long ago. When’s the last time you heard of a FP doc doing any sort of surgery requiring general anesthetic, for instance? And when we speak with our vets over the years, it is always evident that you guys retain a broader knowledge of medicine than most MDs bother to do (once they’ve specialized). It may be that DVM specialists also lose a lot of their breadth; but the general practice DVM still rocks.

  10. Sara P says:

    To “R”: I am a veterinarian and I can tell you that a mistake is probably just as likely to be made by a vet than a tech. In fact, sometimes they catch our mistakes. Also, it may have even been the vet who had instructed the tech to give the (improper) dose. Regardless of who actually made the error, no one is perfect and unfortunately sh*t sometimes happens, and it doesn’t make that tech bad–it’s certainly not a fireable offense in my book, unless it was part of an overall pattern of carelessness. Now, if they really did “make light of it,” I would have a problem with that. If they apologized sincerely and promised to treat any complications related to it, I would be a lot more understanding.

    As for taking the pet to the “back room” for procedures, there are many legitimate and benign reasons for this. A few off the top of my head: it is a central location where all needed supplies are kept handy; we may need another assistant who is busy working on other things back there and it’s more efficient to have him/her help there rather than call him/her to the room; better lighting for things such as blood draws; many dogs behave better when away from owners; and yes, most doctors/techs do prefer not to have owners watching as we do things (I’m more likely to hit a vein on the first shot when I’m not under that pressure). Please don’t be offended if we ask to borrow your pet for a few minutes–I promise there’s no malicious reason for it (at least 99.99% of time–you do hear once in a blue moon about vets or techs being abusive to pets).

  11. skeptvet says:

    It is a bit off topic, but still an interesting subject, so I thought I’d address the issue of having clients present during procedures.

    While I agree that the vast majority of vets who separate pets from their owners for procedures do so for appropriate reasons and with the best intentions, I have to say I have a different perspective on this than most of my colleagues. I work at a hospital which has always had a policy of allowing clients to be with their pets for nearly all procedures, from vaccines to surgery. This has been the rule for over 40 years (long before I started working there!), and I have worked this way for over 10 years. While most vets are aghast at the idea, I have to say that I think such a practice has many benefits and far fewer risks than most vets imagine.

    Obviously, increased client confidence is the most tangible benefit. We ask people to trust us to do scary and expensive things to their family members, and we shouldn’t underestimate what a leap of faith this requires. I find clients are almost always reassured by seeing how we handle their pets. I also think many pets are more comfortable with their owners nearby, though sometimes the opposite is true, and it’s a difficult thing to measure objectively.

    I also believe both techs and vets are encouraged to maintain a higher standard of professionalism in their behavior, including their handling of patients, when clients are frequently present. That isn’t to say that we aren’t kind, gentle, and professional when clients aren’t around. But I think their presence reminds us continually of the importance of the individual patient to their owners and of their role in a family, and that encourages us to stay focused on careful and compassionate care when we might tend to slide into more automatic, habit-driven behavior during routine activities. It also facilitates ongoing communication with clients about the progress of their pet’s condition, especially during emergencies when the situation may be changing rapidly. And I think clients have a greater appreciation for the challenges of what we do and the effort, skill, and caring required of vets and techs in our work when they are there to see what we do. In particular, I think our clients have a far greater and more appropriate regard for our nurses when they spend some time in the ICU watching the nurses care for their pets and other patients.

    While clients can be disruptive to efficient care of their pets, and there are potential safety and legal issues that arise when they are present, I think vets overestimate these problems. I have rarely had to insist clients not be present due to inappropriate behavior or a disruption to our work, and I have never had a situation in which a client was injured due to being “in the back” with their pet. Such risks need to be considered, but they can be managed with appropriate policies and procedures.

    So I tend to support the desire of clients to be with their pets for nearly all the procedures, and I feel like it improve the experience and quality of care for everyone to a degree that more than justifies the anxiety or risks associated with the practice. This is just one opinion, but such a practice has worked well for our hospital, and the dozens of doctors and hundreds of techs who have worked there over the years.

  12. SC1 says:

    How do you prevent patient’s family from causing a hindrance during a surgery? I definitely agree that they should have the choice to be there during more simple procedures such as vax etc, but wouldn’t their presence cause extra pressure in a more complicated setting?

  13. skeptvet says:

    Having clients around during surgery does take some getting used to, but I just haven’t found it a problem. The majority, of course, choose not to be present, so the offer makes them happy without their having to actually be there. But those who do choose to be present are usually very interested in the process and behave appropriately. We always explain each step in advance, and the nurses are very good at communicating with these clients. We always have them sit to avoid fainting (I’ve actually never had it happen during surgery, though I have had clients faint at bad news given in the exam room), and in our new hospital where we’ve been for a couple of years now we actually have a viewing window so clients can watch from outside the suite, so there’s no issues with sanitation or pestering the surgeon if the procedure is complicated.

    I think all of the potential issues are easily manageable with proper planning, staff training, and experience, and again I think the benefits outweigh the risks, at least in our practice.

  14. R says:

    I had to have a dog that was suffering from hemangiosarcoma euthanized, she was having difficulty breathing and I was very upset. I made the mistake of going to the emergency place (as I had waited till the last minute).
    They took hours, and they kept taking her away from me (30 minutes at a time)….let’s just say it didn’t go smoothly.
    Otherwise I understand that the dog has to go in the back for procedures.

    I didn’t faint, but my mouth was extremely dry despite frequent sips of water. I felt the staff was annoyed with me and had no clue as to what I was experiencing.

  15. bdalzell says:

    In relation to being separated from your animal for routine procedures such as vaccines, simple exams, etc. I am a breeder/owner of large powerful dogs which are pretty well obedience trained but of course respect the people who work with them on a daily basis. I am quite willing to put on radiation gear and help holding for radiographs, for example.
    Several years ago I had to take one of our dogs who was called “Crazy Rocky” (so we would not forget his base personality) to an emergency facility for an exam for possible AGDT. As a precaution I brought him with a muzzle as I suspected they would not let me be back with him and I explained that he was a paranoid hysterical 90 lb dog and spoke my willingness to go stare at him and dominate him while he was on the table for the radiograph. They took him back for the films and several minutes later the vet emerged rather shaken. CR had managed to smack him in the temple with his head and caused the vet to have an episode of vertigo. I do not think CR gave the vet a concussion however. Fortunately CR was not in an episode of AGDT.

    When I was a teaching assistant in vet anatomy at U Penn vet school one of the faculty, Gail Smith asked me if one of my dogs could be a demo dog for how to put splints on a dog. Sure, several of my dogs were always present for the vet students to practice palpation and locating anatomical structures on a live dog, so they were used to crowds and having their limbs palpated and manipulated.

    Smith thought he would have to do a full isoflourine sedation on the dog of choice (one named Midnite) but I said Midnite would be fine without it. Midnite lay on the demo table relaxed for the entire demo with several different limb placed splints put on and one different limbs and all he needed was for me to massage his ears and neck during the demo.

    I took a wolf behavior seminar at Wolf Park in Indiana and they used gentle rhythmic massage to relax the wolves. The physiological “explanation” was that regular firm rhythmic stroking at crossed the neurological dermatomes can generate natural relaxing endorphin release in mammals so that relaxation occurs. This does seem to work in my experience and there is no need to call for some mystical connection or woo.

    The massage is most effective, in my experience, if it is delivered as relatively slow firm strokes – 7 seconds or so to traverse a 70 lb dog from mid neck to pelvis. I have noticed that my own dogs do not get particularly tense or nervous at the vet’s until after they have had a serious surgery. Later visits after a surgery seem to result in a dog being nervous. Recently I had to take a dog in for drain removal and she was very nervous, almost hysterical when we first came to the vet’s, but I had to wait for almost 30 minutes until she could be seen so I spent that time doing the relaxing massage, and they I continued the massage during the drain removal. She was relaxed during the procedure and when I returned a week later for staple removal she was not nervous beyond her base behavior at the later visit. It should be fairly simple to design an experiment to test the efficacy of this massage technique. The main problem would be the double blind but the person evaluating the behavior of the dog could not view the massage session.

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