The American Veterinary Medical Association (AVMA) is the main professional organization for veterinarians in the United States. It is not a government or regulatory body, but it does sometimes promote policy statements or guidelines intended to encourage or discourage certain practices by veterinarians. In general, I have been disappointed in the unwillingness of the AVMA to confront the danger pseudoscience presents for veterinary patients, clients, and the integrity of our profession.
For example, despite the clear statement of its own Council on Research acknowledging that, “there is no clinical evidence to support the use of homeopathic remedies for treatment or prevention of diseases in domestic animals” the AVMA House of Delegates overwhelmingly rejected a resolution identifying homeopathy as an ineffective therapeutic intervention. This was a pure case of politics trumping science and of a political organization refusing to protect the public from quackery because doing so would discomfit part of its constituency.
Similarly, the AVMA House of Delegates admitted the American Holistic Veterinary Medicine Association (AHVMA), the most prominent advocacy organization for pseudoscientific medical practices, as a constituent organization in 2013. This was based solely on such criteria as having enough AHVMA members who were also AVMA members, and the move ignored the blatant promotion of pseudoscience and untested or clearly ineffective treatments that is the main reason for the AHVMA’s existence.
Given that the AVMA has not been very strong or consistent in promoting science-based standards for veterinary medicine, I was pleasantly surprised by the recent AVMA position statement on stem cell therapies. I have written about stem cell therapies frequently. It is a promising area of research that, unfortunately, has been promoted and put into widespread use far ahead of appropriate scientific evidence establishing safety and efficacy for particular methods and indications.
The FDA has essentially chosen not to exercise its regulatory authority over veterinary stem cell therapies so long as they involve cells taken from and given back to the same individual and are not used in food animals. As a result, many stem cell products are legally available that have never been properly tested to show they do more good than harm. I am quite optimistic about the potential for stem-cell-based therapies to provide useful therapeutic tools eventually, once appropriate research is done, but for now they are essentially an uncontrolled experiment on individual patients.
The AVMA, uncharacteristically, appears to largely agree with this position:
While regenerative medicine holds promise of improvements in the treatment of a variety of diseases, many of which lack adequately effective treatments, questions remain…While data continue to accumulate suggesting therapeutic benefit from regenerative medicine, published peer-reviewed studies definitively documenting benefit are still lacking for many diseases. Nor has a scientific consensus for stem cell type, stem cell origin, dosage, transfer media, or method of administration been developed for each disease being treated. Despite these scientific insufficiencies, the adoption of regenerative medicine in the veterinary profession has grown rapidly. Unfortunately, some therapies being propounded and the processes and equipment being sold have outpaced the science which supports them.
Of course, like any fundamentally political organization, the AVMA has to try to please everyone, even when that results in an internally inconsistent position. For example, the policy is quite clear about the importance of validating stem cell therapies with proper research evidence before utilizing them:
Regenerative therapy protocols should be formulated from evidence-based medicine. Veterinarians should refrain from recommending regenerative medicine protocols for which documented benefit has not been shown by clinical trials.
Regenerative therapies should utilize systems, equipment, and processes which have been adequately validated to produce therapeutic cell numbers, documented cell types, adequate cell viability, and sterility. The use of systems without such validation poses unnecessary risk to the patient, compromises treatment successes, impedes collection of therapeutic data, and exposes the attending veterinarian to potential liability.
Veterinarians engaged in the use of regenerative medicine and vendors of cell products, equipment, laboratory services, and processes should refrain from making claims in client communication, advertising, or websites that are not fully supported by peer-reviewed, published data.
Since no extant stem cell therapy can meet these criteria, effectively this should mean using stem cell treatments only as part of a clinical trial research or, perhaps, as a last-ditch treatment in desperate circumstances with full disclosure to clients that the treatment is untested and experimental. That, of course, is not at all how stem cell companies and veterinarians typically present these treatments. And the AVMA weakens its own policy by not being willing to directly discourage the use of such treatments by veterinarians. Throughout the policy it is assumed that veterinarians will continue to use these treatments despite the absence of the kind of evidence the AVMA suggests should be a prerequisite for their use:
The AVMA supports the continued scientific development of these modalities while at the same time encouraging its members to employ caution with respect to their use.
…it is incumbent upon veterinarians engaged in regenerative therapies to be well versed in the emerging science of the field in order to successfully select the specific therapeutic protocols, processes, equipment, and vendors most likely to result in clinical benefit for their patients.
Despite this equivocation, however, it is encouraging to see the AVMA clearly acknowledge that the evidence base is not yet sufficient to justify claims of safety and efficacy for veterinary stem cell therapies and that their use is not supported by adequate, appropriate science. Hopefully, this will lend some weight to the voices of caution in the profession trying to restrain the proliferation of stem cell therapies until we have sufficient reason to believe they are helpful and not harmful.