I ran across this article recently with a board-certified specialist in veterinary emergency medicine recommending so-called Traditional Chinese Veterinary Medicine (TCVM) for critically ill patients.
As I’ve discussed in detail, there is some very limited evidence for a few potentially useful effects from passing electricity through acupuncture needles. However, the bulk of TCVM practice, and all of the theories behind it, is pure folk mythology and pseudoscience. It is always amazing and disappointing to see someone with an advanced scientific education treating such beliefs systems, and the therapies associated with them, as if they were in any way equivalent to science-based medicine or legitimate to experiment with on our sickest patients without good research evidence to support the claims made for them.
Such individuals would never tolerate the same near complete absence of evidence for a conventional drug or therapy. They are willing to give untested chemicals (herbs) and needle patients based solely on individual clinical experience and the belief that these practices have been used historically with success (which is often untrue).
Ultimately, it comes down to believing that a therapy is helpful based on individual clinical experience not only in the absence of high-quality evidence but in the absence of any controlled evidence or even a plausible theory. The history of medicine is one long lesson in why uncontrolled clinical observation is a very, very poor second to scientific research in evaluating the efficacy of our therapies. From bloodletting to internal mammary artery ligation, from Lourdes water to antibiotics for cats with interstitial cystitis, every ineffective therapy ever tried has appeared to work sometimes based on trial-and-error use. Either every possible treatment works for some patients, or clinical observation is an unreliable way to validate our treatments. Personally, I think the case is much stronger for the latter conclusion than the former.
I also think it is more than a question of whether or not we have clinical trial evidence. Of course we lack that for many of our treatments. But even therapies based on sound basic physiology and pre-clinical in vitro and animal model testing fail most of the time when subjected to clinical studies. Isn’t even less likely that a therapy based on Tonifying Yang or Releasing Wind is going to be truly effective? The rationale matters, especially in the absence of good controlled evidence.
Of course, in challenging these beliefs, I am immediately subjected to accusations that I am “closed-minded.” An open mind means not judging automatically and without regard to evidence, but it doesn’t mean not judging. We all have to make judgments about the safety and efficacy of the therapies we use. There is nothing inherently better or fairer about a positive judgment. If someone chooses to believe TCVM or bloodletting, or any other unscientific approach works based on the weak evidence on uncontrolled personal observation, they are not being more fair or open-minded than a critic who asks for better evidence than this before accepting such therapies. They are simply applying a different, looser standard of evidence.
I don’t claim with certainty that these therapies do not work, only that their theoretical foundations are unscientific, which makes the prior probability of their working very low, and that there is no good reason to believe they work in the absence of good-quality evidence to raise this probability. This is not being closed-minded, merely applying the principles of science and evidence-based medicine, which it seems to me have proven their worth quite dramatically compared with history, tradition, and anecdotes.
While this vet is usually careful to recommend these treatments with conventional care or instead of it only if the owner declines conventional treatment, I still can’t help feel it is unethical for a specialist to promote and legitimize such pseudoscience. We are essentially experimenting on sick patients without acknowledging this and claiming to have effective treatments when they are both implausible and not properly tested. We are giving a special pass to something to avoid the usual scientific testing we require of all our other therapies only because someone has slapped the label “alternative” on it.
Here are some examples of the comments in the article that I find disturbing:
If you have a patient that is bleeding post-operatively (post-op spay) or an unstable hemoabdomen that needs to go to the operating room, you can try dry needling Tian-Ping.
One indication for acupuncture could be in a post-op soft palate resection in a brachycephalic dog. By injecting B-12 at An-Shen to help calm a patient instead of writing an order for Acepromazine PRN
there are six typical Traditional Chinese Veterinary Medicine (TCVM) patterns for heart failure….If an owner is unwilling to do MV and the pet has collapse of Yang Qi, points for shock can be used as well.
If you have a feline patient with megacolon, and the owner is unwilling ? or it is too risky ? to place a pet under anesthesia for a de-obstipation, then enemas, lactulose, intravenous fluids and acupuncture can be used. There are 2 typical patterns for the Eastern diagnosis of megacolon, it is either Qi deficiency, or Yin and Blood deficiency. The acupuncture points would be selected based on what pattern they were exhibiting.
We treat many primary IMHAs and when they respond quickly it is great, but often we have patients that do not respond to the typical immunosuppressives. The traditional Chinese medicine pattern would need to be identified since there are different patterns. Typically for an extravascular hemolysis case, the main issues tend to be spleen Qi deficiency/blood deficiency. So selecting acupuncture points that would tonify the Qi/Blood, support the spleen, and immunomodulating points such as (LI-4, LI-10, LI-14, ST-36, GV-14) would be best. If the patient has evidence of intravascular hemolysis, clearing the heat and damp would be important and thus direct your acupuncture approach. The use of herbal therapy is becoming more popular and for a non-responding, primary ITP case Gui Pi Tang may be helpful.
the cat that is having an acute asthma attack that is not responding to typical interventions such as oxygen, steroids, and bronchodilators. Knowing LI-20, Bi-tong and Lung-hui acupuncture points can come in very handy. There are really countless uses for dry needling, aqua and electrical acupuncture in the CCU and it will likely become a more routine treatment in the critical care veterinary setting.