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Vitamin Supplements- Do they prevent cancer?

Monday, August 30th, 2010

Few purported medical interventions have such wide appeal or such an entrenched reputation for being benign and beneficial as vitamin supplements. Vitamins are chemicals (yes, they are, though you can call them “compounds” or even “essential nutrients” if it sounds nicer) that are required for normal health in minute quantities and cannot be made internally but must be obtained from the diet. Different species have different vitamin requirements, of course, so the defining characteristic is dependent on the organism, not the chemical. Vitamin C, for example, is a dietary requirement for primates and guinea pigs, but all other mammals can make enough on their own from other chemicals that they don’t require it in the diet, so it is not truly a vitamin for them.

Part of the reason vitamins are so widely believed to be good for us is the vague memory (at least in developed nations, though it is still ordinary reality in many parts of the world) of a time when vitamin deficiencies were common due to inadequate diets. Correcting such deficiencies has the kind of tangible, dramatic impact on health that antibiotics or polio vaccine can have, so it is easy to see such things as miraculous. And in America, where more is always better, the idea that it is a good idea to give vitamin supplements even to people with an adequate diet and no obvious signs of deficiencies is a naturally appealing one.

Unfortunately, the grim naysayers of science such as myself are often stuck with the thankless job of dispelling even appealing misconceptions, and recent editorial in the American Journal of Epidemiology has done that for some the proponents of vitamin supplements most hoped to be of benefit in preventing one of the major classes of illness that has replaced nutritional deficiencies and infectious diseases, cancer.

Byers T. Anticancer Vitamins du Jour—The ABCED’s So Far. American Journal of Epidemiology 2010;172:1–3.

The editorial surveys the history of anti-cancer vitamins from early reason for hope seen in observational and animal model studies through disappointing and often frightening clinical trials. In alphabetical order, then (citations are omitted and can be found in the full text of the article):

Vitamin A

Animal experimental models led us to the notion that cancer risk might be ‘‘materially’’ reduced by supplementation with beta-carotene, a retinol precursor. Although that idea was seductive, we were all disappointed when 2 large randomized controlled trials that began in 1985 in Finland and the United States reported an 18% increased risk of lung cancer caused by high-dose beta-carotene supplementation and a 28% increased lung cancer risk caused by a combination of beta-carotene and retinol. The vitamin A era was over. 

Vitamin B

Again, based on animal experimental evidence and supported by epidemiologic evidence of connections between diets low in B vitamins and increased cancer risk, a large randomized controlled trial was begun in 1985 in central China, where micronutrient deficiency was common and where rates of cancers of the stomach and esophagus were extraordinarily high. Nonetheless, several years of supplementation with a combination of riboflavin (vitamin B2) and niacin (vitamin B3) had no effect on incidence of upper gastrointestinal cancers. Interest in folic acid (vitamin B9) persisted, though, in part because of its striking effect on neural tube birth defects, coupled with speculation about possible benefits of food fortification for diseases such as colorectal cancer that were inversely associated with diets rich in folate-containing foods and supplements. However, a 7-year randomized controlled trial found that high-dose folic acid supplements actually increased risk of colorectal adenomas. The vitamin B era was over.

Vitamin C

Next came vitamin C, a popular charge led by none other than Linus Pauling, the brilliant and charismatic 2-time Nobel laureate. Of all the cancers thought to be related to vitamin C deficiency, gastric cancer led the way, and of all the places on Earth where a vitamin C deficiency correction trial might yield benefits for gastric cancer, Linxian, China, would be the best. Indeed, vitamin C was tested in the Linxian trial, but just as for the B vitamins, vitamin C produced no change in gastric cancer rates .

Vitamin D

Over 2 decades of searching for an anticancer vitamin, we had seemed to skip over vitamin D in its proper alphabetical sequence…the International Agency for Research on Cancer conducted a comprehensive review of the evidence for vitamin D and cancer prevention, concluding that vitamin D may play a protective role in colorectal cancer, but not for prostate cancer, and that the evidence is weak for breast cancer. The conclusion by the International Agency for Research on Cancer about the weakness of the evidence for breast cancer has been a source of controversy among vitamin D protagonists, but subsequent nested cohort studies have found no relation between breast cancer risk and circulating levels of vitamin D. Nonetheless, vitamin D remains the cancer-preventing vitamin du jour.

…An outstanding set of papers in this issue of the American Journal of Epidemiology reports on findings about the relation between circulating levels of vitamin D and subsequent cancer risk…These studies found no suggestion of an inverse association between vitamin D levels in the circulation and later incidence of 6 types of cancers (upper gastrointestinal, ovary, endometrial, pancreatic, kidney, and non-Hodgkin lymphoma)… The only association observed in this set of 6 analyses was a troubling one: that risk of pancreatic cancer was doubled for those in the highest quintile of circulating vitamin D levels.

…many ongoing randomized controlled trials are now using quite high doses of vitamin D. As we await clearer evidence of benefits from those trials, we will also need to be prepared to be vigilant about their individual and collective power to assess any potential harms.

Vitamin E

In 1993, we launched headlong into a love affair with vitamin E fueled by compelling observations that those who chose to take vitamin E supplements were at lower risk of heart disease. Vitamin E supplementation became the rage as several large, randomized controlled trials were mounted. When those results finally came in, the findings were again disappointing: vitamin E supplementation offered no benefit for heart disease, and it slightly increased overall mortality. In the meantime, though, because of a secondary observation that prostate cancer incidence was lower in the vitamin E arm of the same Finnish trial that tested beta-carotene (vitamin E had also been included as a factor), a large factorial trial of vitamin E (and selenium) was carried out for reducing prostate cancer incidence. Disappointment again: there was no effect of either selenium or vitamin E on incidence of prostate cancer. The vitamin E era ended in a whimper.

Of course, alternative medicine proponents often dispute this evidence, and it is easy to find claims of efficacy for all of these vitamins in preventing or treating cancer: Vitamin A, Vitamin B, Vitamin C, Vitamin D, Vitamin E.

Given the ease with which the evidence can be ignored, cherry-picked, or distorted, the underlying conclusion of this editorial is even more salient and important than the specifics of the failed promise of vitamin supplementation to prevent:

It is timely for us to now reflect on the history of the past 25 years of our alphabetical approach to studying single vitamin deficiency states as causal factors for cancer. We have learned some hard lessons along the alphabetical way. We now know that supernutritional levels of vitamins taken as supplements do not emulate the apparent benefits of diets high in foods that contain those vitamins, and we now know that taking vitamins in supernutritional doses can cause serious harm. In short, we have found that the reality of human biology is far more complex than is suggested by our simple ideas.

Let me emphasize again these key points:

1. Supernutritional levels of vitamins taken as supplements do not emulate the apparent benefits of diets high in foods that contain those vitamins.

 2. Taking vitamins in supernutritional doses can cause serious harm.

 3. The reality of human biology is far more complex than is suggested by our simple ideas.

Point 3 is one of the most important principles of science-based medicine. The understandable search for simple answers and the inevitability and challenges posed by complexity and uncertainty naturally drive us to accept simple, clear explanations and recommendations and make us shy away from the messiness and limitations of reality. But unfortunately we must accept that reality is more complex than our ideas, and that as a consequence we will often be wrong and our understanding and ability to control our health will always be limited and incomplete. The best chance we have of actually doing good is to strive for this acceptance and to deal with reality as it is rather than as we would wish it to be.

Alternative medicine often relies on the idea that belief is enough and that reality can be forced into our simple models of one cause/one cure for disease. Science can, and should do better, and though the process is slow, cumbersome, and often not psychologically comforting, the truth is that it just works better. 25 years of scientific research has shown us what supplementation of some vitamins can and cannot do for some diseases, and this information is worth the wait and the effort, and it will serve us better than the false hope and comfort of simplistic theories and wishful thinking.

Posted in Discussion of Specific CAM Approaches, General | No Comments »

CAM and Advance Healthcare Directives

Tuesday, August 17th, 2010

Disclaimer: This topic strays outside my area of professional expertise, so I offer these personal musings as food for thought, not in any way as official recommendations in my role as a veterinarian.

It has become quite common these days in the United States for people to complete some form of advanced directive for health care or living will. The format and legal implications of such documents are regulated by the states and vary across the country, but in general the intent of an advanced directive is to express your wishes concerning the care you do or do not wish to receive if you are unable to make healthcare decisions for yourself, particularly in cases of terminal illness or long-term incapacitation. An advanced directive also often appoints someone to make healthcare decisions for you in accordance with the guidelines you develop in advance.

The usual subjects addressed by an advanced directive include life support care, such as mechanical ventilation and artificial nutrition, as well as palliative care such as pain control. However, it occurs to me that a common circumstance in which alternative medical therapies are employed is that in which there is no curative or definitive scientific therapy available. People reach for the implausible or the bizarre when they are desperate and unable to accept the limitations of scientific medicine or the inevitability of death. This is the kind of circumstance one might expect when someone is facing the end of life or a permanent incapacitation.

There are certainly advocates for integrating so-called complementary and alternative medicine (CAM) into hospice care for humans. And the nascent veterinary hospice movement has advocates for the use of all the usual alternative approaches as well as such truly bizarre methods such as those of pet psychics. It is difficult to know how widespread the use of CAM in the terminally ill really is, but with the growth of quackademic medicine, it seems likely that family members or other responsible agents for terminally ill or incapacitated patients who are unable to make their own healthcare choices are likely to be offered CAM therapies as part of the palliative care package.

For those of us who doubt the value, and sometimes the safety, of such approaches to medicine, it might be worthwhile to consider addressing this possibility in our advanced healthcare directives, as well as discussing it with those who are likely to be making medical decisions on our behalf should this become necessary. As the horror of the “Gonzalez Regimen” study illustrates, alternative approaches to serious disease can be more (or less) than simply ineffective. They can actively worsen the suffering of terminally ill patients. If the purpose of an advanced directive for healthcare is to protect oneself from unwanted treatment, and presumably the attendant suffering, then CAM is a group of treatments one might wish to protect oneself against.

One difficulty with addressing alternative therapies in an advanced directive would be defining them accurately enough to be useful to providers and family members making treatment decisions. Alternative medicine can be tricky to define, and one must be careful to distinguish between nonsense therapies that are either untestable or have already been falsified, and the kind of plausible therapies with limited supporting evidence that are sometimes the focus of clinical trials sought out by the terminally ill, or that are used prior to definitive scientific evidence concerning their safety and efficacy under “compassionate use” rules. The best approach might be a general definition with a list of examples, which would provide at least some guidance to decision makers. My own advanced directive contains the following statement:

I specifically refuse any treatments in the general category of “alternative medicine” which have not been validated by appropriate scientific research, including but not limited to the following: acupuncture, chiropractic, homeopathy, reiki or therapeutic touch, traditional Chinese Medicine therapies, Ayurvedic therapies, naturopathic therapies, and dietary, herbal, or nutritional therapies not supported by substantative clinical research evidence. This is not intended to exclude experimental therapies used within the context of properly regulated clinical trials or compassionate use guidelines at the discretion of my appointed healthcare agent.

This is undoubtedly an imperfect statement, and probably painfully imprecise to the ears of any lawyer, but it conveys the gist of my wishes, which is as much as such a document can be expected to accomplish.

I don’t intend to suggest that the use of CAM therapies is as pressing an issue for the terminally ill or incapacitated as questions of how intensive and prolonged life-support measures should be, or how we should palliate the discomfort of the dying. But despite the widespread presumption that such therapies are benign at worst, and possibly even beneficial regardless of the evidence, the reality is that unproven or clearly bogus alternative treatments can be harmful. They can harm patients directly, and they can provide false hope or a mistaken sense that the patient is being properly treated, which can interfere with the use of truly effective palliative therapies. In light of this, it seems worth considering the issue of CAM use when planning for the possibility that you may someday not be able to articulate your wishes concerning the care you are given.

Posted in General | 3 Comments »

Consumer Reports–The Dangers of Supplements

Monday, August 9th, 2010

There is an article in the upcoming issue of Consumer Reports discussing the sorry state of regulatory oversight for dietary supplements, herbs, and vitamins, and some of the concrete harm that has come to consumers as a result. It is encouraging to see the mainstream media recognizing that the marketing of such supplements is full of misinformation and that there is real danger in the inadequate regulatory system currently in place.

According to the industry publication Nutrition Business Journal, Big Supplement sold $26.7 billion worth of its products last year. However, according to the relatively neutral, though perhaps sometimes a bit too charitable in its interpretation of the evidence, Natural Medicines Comprehensive Database, only about a third of the 54,000 products in the database have any scientific evidence concerning safety and efficacy. And nearly 12% (over 6000 “medicines”) have known problems with safety or quality control. This is a pointed reminder that when talking about supplements, we are not talking about natural products proven to be safe and effective and provided out of altruistic motives to people not well served by the conventional “disease industry.” We are talking about products containing chemicals with poorly understood effects on the body and products which may or may not contain what the label claims is in them. And we are also talking about large profit-making corporations capable of manipulating politicians and the law to avoid appropriate regulation of their industry and both willing and financially able to vigorously defend themselves in court against people hurt by their products.

The Consumer Reports article points out that contamination of supposedly natural supplements with toxins, such as heavy metals, and with prescription drugs, is a serious danger due to the exemption of the supplement industry from the quality control regulations the FDA applies to pharmaceutical companies and other providers of medicines and healthcare products. Many of the most harmful products and ingredients come from China, which has abysmal quality control and is not in any way under the supervision of any trustworthy regulatory or watchdog organization.

The article also gives several examples of specific products that have harmed consumers, and the complete denial of responsibility on the part of manufacturers. The notion that these companies and their products differ from the mainstream pharmaceutical industry, beyond being less effectively supervised and regulated, is belied by these kinds of problems. Even the regulations that do exist concerning such products are rarely enforced, and vigorously opposed by the supplement industry. When the FDA attempted to ban ephedra, it took years of legal maneuvering despite thousands of cases of suspected illness and death from the ingredient. This has discourage the FDA from attempting to invoke it’s regulatory authority, especially in the anti-regulation atmosphere of the last administration.

And unlike Big Pharma, for most of the time since the relevant legislation (DSHEA) was passed in 1994, Big Supplement companies haven’t even been required to report serious adverse events associated with their products to the FDA. And the reports that now come in are rarely made public. So it’s not surprising that consumers, and many health care providers, have little idea how dangerous these products can be. Of course, mainstream pharmaceuticals have their dangers, but at least we have some idea what they are and some reason to think they may have benefits which justify the risks.

The article lists an even dozen supplements to be specifically avoided due to known hazards. It also lists a number it considers safe and likely effective.  I would quibble a bit with these lists. The “bad” list is a bit arbitrary and incomplete, and it ignores the danger of the nearly complete ignorance concerning the safety and efficacy of most supplements. And the “good” list includes a couple of products (e.g. glucosamine and St. John’s Wort) which are listed as “likely effective” despite pretty clear evidence they are ineffective. But these are relatively minor objections given the vital importance of having a mainstream consumer group address the serious problems in the supplement industry and advocating for better consumer protection.

Not surprisingly, Big Supplement rejects the conclusions and advice in the article, cherry picking facts to present a misleading image of the industry as benevolent providers of safe products. Their rebuttal, weak as it is, is further undercut by the presence on the same page of a banner reading “Grassroots Victory: Congress rejects expanded FTC powers.” Clearly, despite their own propaganda, Big Supplement is as interested in protecting their prerogatives and profits as Big Pharma or any other for-profit industry. This is to be expected. What is harder to understand is why we continue to let them guard the henhouse.

Posted in Discussion of Specific CAM Approaches, General | 1 Comment »

Vet Stem’s Stem Cell Therapy and Chemaphor’s Oximunol Join Forces

Wednesday, June 30th, 2010

I recently ran across a press release which identified a business relationship I found interesting. Apparently, the Canadian company Chemaphor, maker of the nutritional supplement Oximunol which I have discussed in the past, has entered into a licensing arrangement with Vet Stem, an American company marketing fat-derived stem cells in animals as a treatment for arthritis and other orthopedic problems as well as, potentially, just about any other disease under the sun. This will make it possible for the Vet Stem process to be marketed in Canada.

I haven’t addressed the Vet Stem marketing issue directly here, but I’ve been involved in some discussions on the subject elsewhere. As I pointed out in my recent post about stem cell therapy in general, the approach has significant biologic plausibility and some supportive in vitro and animal model evidence to suggest it may someday be a valuable clinical therapy. Unfortunately, the selling of it as a product for humans and, primarily via Vet Stem, for pets, is far out in front of the evidence that this hope will be borne out in the real world. For example, the only clinical research I have yet found concerning autologous fat-derived stem cell treatment for dogs is two papers, both funded by Vet Stem.

1. Black, L. L., Gaynor, J., Adams, C., Dhupa, S., Sams, A. E., Taylor, R., et al. (2008). Effect of intraarticular injection of autologous adipose-derived mesenchymal stem and regenerative cells on clinical signs of chronic osteoarthritis of the elbow joint in dogs. Veterinary Therapeutics : Research in Applied Veterinary Medicine, 9(3), 192-200.

2. Black, L. L., Gaynor, J., Gahring, D., Adams, C., Aron, D., Harman, S., et al. (2007). Effect of adipose-derived mesenchymal stem and regenerative cells on lameness in dogs with chronic osteoarthritis of the coxofemoral joints: A randomized, double-blinded, multicenter, controlled trial. Veterinary Therapeutics : Research in Applied Veterinary Medicine, 8(4), 272-284.

The first lacked a placebo or standard treatment control, blinding, and randomization, so it essentially amounted to an uncontrolled case series funded and evaluated by the company selling the therapy. Both investigator and owner subjective evaluations showed changes in some measures, up to about 30-40% improvement at the most. This cannot be distinguished from a non-specific experimental effect with this design.

The second was reported as a double-blinded, placebo controlled randomized study, though the details of these controls were not reported. There was a 14% dropout, which is not excessive though it is difficult to tell if it would have changed the statistical outcomes given that dropouts in studies tend to be treatment failures. Of 13 measures evaluated by investigators, there were statistically significant differences in 3 when the data for all investigators was pooled (none for investigators singly, obviously with smaller sample sizes). Of the subjective owner evaluations, 13 measures graded on a 5-point scale, 1.9 measures improved by >/= 2 points in the placebo group and 4.7 measures by >/= 2 points in the treatment group, but this was not statistically significant (and 5 of the 18 dogs that completed the study were not included in this evaluation for a variety of reasons).

Both of these studies do provide some support for the claim that fat-derived autologous stem cell injections may have clinical benefit for the conditions examined, but the evidence they provide is very weak due to limitations in the study size, design, and possible biases. My concern is that such weak evidence, even added to the suggestive pre-clinical information and to study results from other species, does not justify selling an invasive and expensive medical procedure to pet owners. At best, the therapy should be offered as an experimental intervention with strict informed consent guidelines and a system for evaluating outcomes that is as objective as possible and as independent as possible of the company hoping to profit from the therapy. The situation is similar for other species that Vet Stem offers to treat, though there is a bit more clinical evidence for horses.

Similarly, the Chemaphor product Oximunol is supported only by theory and in vitro studies with no published clinical trial evidence to suggest safety or efficacy in veterinary patients. Even under the lax standards of regulation applied to nutritional supplements, the company would likely not be allowed to make the medical claims for the product they make in marketing materials, but they specifically acknowledge pursuing the veterinary nutraceutical market partly because they face “lower regulatory hurdles” than the human market. In their current press release, the company states ” With the recent announcement of the Vet-Stem stem cell licensing arrangement, Chemaphor is evaluating the establishment of a sales team to promote the use of Oximunol(TM) Chewables as well as the Vet-Stem products for companion animals.”

The two companies clearly see a synergy between their products and corporate philosophies. Unfortunately, the common bond seems to be a desire to rapidly and effectively market medical therapies in advance of adequate safety and efficacy data. The regulatory structures applied to medical devices and drugs in the U.S. by the FDA are not capricious bureaucratic hurdles, they are the response to a series of medical tragedies in which the public was harmed by therapies that had not been adequately tested. The exemptions to this process offered by DSHEA, and by the pragmatic inability of the FDA to enforce existing rules in veterinary medicine, should be understood as weaknesses and a danger to the public, not opportunities. I have little doubt that the promoters of these therapies believe they are safe and beneficial, and the current state of the evidence does not by any means show they are wrong. But the history of medicine makes it clear that such faith often turns out to be misplaced, and that shortcutting the process of vetting new therapies does more harm than good. We can only hope that does not turn out to be the case with these products.

Posted in General, Scientific Veterinary Medicine | 3 Comments »

Edzard Ernst on How to Spot Medical Nonsense

Friday, June 25th, 2010

Edzard Ernst is well known as an “insider” in the world of alternative medicine who has come to see the need for rational, scientific analysis and evidence to justify inflicting any treatment of whatever provenance on patients. His book, with Simon Singh, Trick or treatment: The Undeniable Facts About Alternative Medicine, which I have previously reviewed, is a model for how to look scientifically and CAM, and it is an indispensible resource for anyone interested in the truth about alternative approaches.

Ernst has a new short article in the oxymoronically named journal Evidence-Based Complementary and Alternative Medicine. The unfortunate title of this otherwise useful article is Winnowing the Chaff of Charlatanism from the Wheat of Science.

In his article, Ernst suggests a possible strategy for evaluating medical claims. It is not especially novel, but it’s a clear introduction to some of the key methods by which nonsense can be distinguished from real science.

The first test is Karl Popper’s time-honored concept of falsifiability. At its simplest, this just means that it is possible for a claim to be proven false. If, for example, all disease is claimed to be caused by vertebral subluxations, then showing that any disease has another cause demonstrates this claim to be false. Many CAM approaches rely on mystical “energies” that can only be intuited, and many practitioners claim that the methods or even the skeptical attitudes of scientific researchers interfere with their treatments, so these treatments can never be tested and are, in either theory or practice, unfalsifiable. Unfortunately, many CAM proponents will argue that their approaches are theoretically falsifiable but we simply do not yet have the technology or methods to test them, so they squirm out of meeting this criterion.

Ernst then suggests moving on the test of plausibility. This is one of the concepts which separates the close but not identical domains of evidence-based medicine from more generally science-based medicine. If an idea is inconsistent with well-established scientific knowledge, then we can reasonably dismiss the idea right there, without wasting resources testing it empirically. The theories of Alternative Flight are sufficiently implausible that no one has serious suggested we test them. This criterion will also not successfully contain all pseudoscientific nonsense, because it is always possible to claim, with some justification though disingenuously in most cases, that what is plausible is based on current knowledge, and this is incomplete and imperfect. Powered human flight would have seemed extremely implausible 500 years ago, and yet it is possible, so plausibility is not always by itself a sufficient basis for final judgment of a claim.

Finally, Ernst moves on to warning signs of quackery as another criterion to help separate real science from pseudoscience. I have written about these a number of times (my own partial list, and Dr. Walt’s list), and there is significant overlap between other lists of such signs and Dr. Ernst’s. He refers to advocates of quackery as Proponents of Absurd Claims (PACs), and he describes some of the red flags they often wave about:

Intolerance: Many PACs are consumed with evangelic zeal and find it hard to accept or even consider well-reasoned criticism or debate. Anyone who has tried to have a rational discussion with someone making irrational claims will have experienced this phenomenon. As intolerance can exist everywhere, its discriminating power is, of course, low and further criteria are required.

Selectivity: Most PACs tend to ignore facts that contradict their own assumptions. Instead they favor selected anomalous data or anecdotal findings which apparently support their notions. Clinical trials, for instance, are designed to overcome the many biases associated with simple observation. Whenever their results fail to confirm their belief, PACs insist that, for this or that reason, case reports, observational studies or years of experience are preferable. In arguing their case, PACs often seem to first formulate their conclusions, then selectively identify those bits of information that apparently confirm them.

Paranoia: Many PACs believe in conspiracy theories which posit that ‘the establishment’ is determined to suppress their views or findings. The world wide web, for instance, is full with suggestions that ‘big pharma’ is conducting a campaign against ‘alternative cancer cures’ such as laetrile or shark cartilage. Anyone who points out what the evidence really shows is likely to be accused of being part of the conspiracy.

Misuse: Some PACs misuse science, for instance, by using terminology like energy, chaos theory, quantum mechanics or entanglement in inappropriate contexts, devoid of their actual meanings. Accepted standards are rejected and double standards are proposed for their own area. In case this strategy fails, other means might be employed, including outright fraud.

I wouldn’t suggest Ernst’s criteria are foolproof, and neither does he, but it is a nice simple starting point, especially for those not steeped in skepticism and already familiar with the many dodges, obfuscations, and deceptive marketing techniques of the CAM world.

Posted in General | 11 Comments »

Uncertainty-What It Means and What It Doesn’t

Tuesday, June 8th, 2010

It is in the admission of ignorance and the admission of uncertainty that there is a hope for the continuous motion of human beings in some direction that doesn’t get confined, permanently blocked, as it has so many times before in various periods in the history of man.
Richard P. Feynman

I’ve written before about uncertainty and how it affects medical decision making and also about why pet owners often prefer simple, unambiguous answers to the messy uncertainties of reality. But I’d like to take a slightly different perspective on the issue of uncertainty in science and medicine. The fact that science is incomplete and imperfect is undeniable. Unfortunately, some people take this fact as justification for throwing out the whole enterprise of trying to understand and acquire real facts and knowledge. If vaccines don’t protect us completely, this means they are useless. If science doesn’t know everything, than anything must be possible. These naïve arguments ignore the very clear fact that uncertainty and the impossibility of knowledge are not the same thing.

There are different kind of uncertainty in science. One is the uncertainty of what we don’t know. A big part of what makes science fun is that the universe is so vastly more complex than our little brains that we are never going to be in danger of running out of new things to learn and discover. I like to imagine my own ignorance as a vast abyss yawing before me. Every day I throw in a few grains of sand, but it shows no sign of being filled in. So there is no denying that the surprising and unexpected is out there waiting for us.

But that is not the same thing as saying anything we can imagine is likely to be true. Most of our guesses about the nature of reality turn out to be wrong. Until science came along, this left us fighting over belief systems and led to a bewildering proliferation of different, interesting, and usually mutually incompatible mythologies to explain the world. Now, science is creating the kind of knowledge that works everywhere, in every culture, and that endures through time. Sure, such secure knowledge is only tidbits compared to the vastness of reality, and there is plenty that falls by the wayside. But never before have we been able to have even this much enduring knowledge. Barring the complete collapse of human civilization, we are always going to know that the heart circulates blood, that emotions live in the brain not the heart, that smallpox used to be caused by a bacterium, and so on. What we don’t know is an opportunity, not an invalidation of what we do know.

Another kind of uncertainty, though, is the uncertainty about what we know. Scientists like to say that all knowledge is provisional, tentative and subject to revision. This is true, but non-scientists tend to overread this and believe it means all knowledge is ultimately just opinion and is unreliable. Sure, theories of gravity have changed from Newton’s day to our, but if you have to leave your 8th floor apartment, you can rely confidently on the knowledge that it is better to do so by the stairway than the window. It is possible that gravity will stop working tomorrow, but I wouldn’t bet on it. So while proponents of bizarre ideas like to make much of the fact that scientific explanations are “only theories,” they ignore the fact that those ideas that endure and are refined over time can reach a point where having confidence in their truth makes a lot more sense than doubting them.

A different flavor of uncertainty about the known is statistical or probabilistic uncertainty. I recently put my age, gender, total cholesterol level, and a few other factors into a nifty little calculator that told me I have a 3% chance of dying of a heart attack in the next 10 years. So does anyone know if I’m going to die of a heart attack or not? Can anyone tell me with certainty that I will if I stop taking my fish oil and baby aspirin every day, but I’m safe if I keep taking them? No, of course not. Much scientific research generates knowledge and conclusions that are statistical, that apply reliably to groups but don’t give precise predictions for individuals. So, does this mean such knowledge is worthless for helping us decide what to do as individuals? Of course not.

If you go to a casino in Vegas and play roulette, the odds are you’re going to lose. Sure, you could win. Some people do. But most people don’t. This is a truth, though it is only a statistical or probabilistic truth. So is it worthless in helping you decide whether or not to bet the farm on red? Not at all. Casinos make lots of money betting against you, and you’re a lot more likely to be able to afford that Winnebago when you retire if you play the odds and don’t play roulette. Even though statistical truths apply imperfectly to the individual, they are real and useful guides for our choices. The uncertainty of probabilities does not justify ignoring the odds and doing whatever we like.

Uncertainty is inevitable, in science as in all areas of human life. But this doesn’t mean knowledge is an illusion and blind belief is as good as facts in deciding what to do or not to do. Human beings have changed our planet and our own lives, both for the better and for the worse, through the power of discovering and applying knowledge about the physical world. Such knowledge is limited, incomplete, tenuous, and a damn site better than guessing or hoping. And science has generated more reliable, trustworthy knowledge in the past couple centuries than hunches, guesses, and trial-and-error managed in all the rest of human history. Place your bets, ladies and gentlemen. I’m placing mine on science.

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The Placebo Effect In Song

Saturday, June 5th, 2010

Happy Birthday, SketpVet! :-)

Today marks the first anniversary of this blog. Not a momentous event for the world at large, but yet another reminder of the fleeting nature of time for me. Apparently, in the last year I have put up 135 posts and the site has been visited 7468 times. I’ve certainly learned a great deal, about medicine and about writing, and I’ve met a number of interesting people. I hope it has been interesting and useful to at least a few of you.

As an anniversary post, I thought I’d put up something I started on near the beginning but never actually posted.

Last summer, I spent a week at Lark Camp, a folk music workshop/festival/party in the Mendocino Woodlands. I tend to refer to it, affectionately, as Hippie Drum Camp, mostly because I went with the idea of learning to play the bodhran (hence the “drum” part; the “hippie” part should be self-evident). Apart from a brief and agonizing (for me and everyone around me) flirtation with the clarinet in grade school, I have never played an instrument. But I’ve always gone to Celtic cultural events (and pubs) and I know all the songs, so I wanted to learn more about the music. It was a fantastic experience, and I’ve spent the last year trying to learn a couple of instruments so I can go back this summer and participate more fully.

One of the folks I met there was a fiddle player who shared a song he had written called The Placebo Effect. We had a very interesting conversation about his experiences with managing his own diabetes and trying to avoid medication, and about all of the things he had investigated or tried as part of this experience. I had just started this blog, and I thought the song offered some eloquent and funny insight into the issue of placebo effects and unproven or alternative therapies from the perspective of an intelligent, educated non-scientist. At the time, I wasn’t certain he would welcome my making the lyrics public, but I recently found he did so some time ago on his own blog so hopefully he won’t mind.

Apart from the internal merit of the wit and humor, the song illustrates how someone can come to look at the complex relationship between individual experience and scientific knowledge. It is always difficult to argue with someone who feels better after using a therapy, even if the facts are pretty clear that the therapy doesn’t work. Feeling better is real whether or not it means what the person thinks it does or has any relationship to actual physical health.

In trying to promote science-based medicine, my ultimate goal is always to steer people toward what will truly help them or their pets and to steer them away from false hope and the harm that comes from mistaken ideas about cause and effect. But I try always to remember that CAM is popular because it meets a need. It provides hope, even false hope, and it addresses the psychological dimensions of illness in ways that mainstream medicine doesn’t always (though I think this is less true in veterinary medicine for a variety of reasons). I think we can have the best of both worlds–effective science-based medicine and humane, affirming care. But to do this we have to try and understand what appeals to people about CAM and what about scientific medicine pushes them away even when it is the more likely to help them.

This song touches on the issues of uncertainty in medicine, on the fact that general data can’t always predict what will help or harm the individual, and that the slow process of scientific progress, though it is far more likely to reach the right answer in the end, is often too slow to help those who are suffering right now. None of this justifies unproven or outright bogus medicine, but it does explain a bit why even ineffective therapies can be popular, and it reminds us of some of the limitations to scientific medicine that we have to deal with in the effort to guide people towards the best, real therapies available. It also reminds us that CAM is not the sole province of the ignorant, gullible, or stupid. I don’t necessarily agree with the writer’s take on science and knowledge, but from our conversation and his blog I have no doubt he is smart and well-informed. We must be careful not to make the mistake of caricaturing or patronizing those who don’t see the issues around CAM the way we think they are best seen. This blog is as much about learning for me as it is about trying to teach others, and from this fellow and his song I think I have learned a few valuable things.

Oh, and did I mention it’s funny?

In the woods on a sunny day late in July,
all the air was abuzz with mosquito and fly.
In an effort to cope I was spraying some DEET
on my arms, elbows, shoulders,
legs, ankles, and feet,
when a fiddler came by and said
“Don’t waste your time –
there’s no evidence that that stuff
works worth a dime”.
I explained to him I wouldn’t
care if there was,
’cause it helps me so long as
I think that it does.

Chorus:
I would never reject any fake remedy;
the placebo effect is what works best on me.

If I take enough fish oil, I
need not grow old,
if I take echinacea I won’t
catch a cold.
And if I should come down with a
cold anyway,
a few doses of zinc will soon
make it okay.
Now as far as I know there’s no
clinical study
showing zinc really makes you feel
one bit less cruddy.
So it might not be true, yet
I’ve heard that it’s so.
In such matters as this there is
no way to know.

I would never reject any fake remedy;
the placebo effect is what works best on me.

If you can’t afford insulin,
I have heard tell
that ground cinnamon does the job
perfectly well.
There are herbs with strange nicknames
in English and Latin
which I’ve heard are as useful
as Pfizer’s new statin.
I suppose that some day we will
know for a fact
how a body exposed to such
cures will react.
By the time that these answers are
finally found,
I’m afraid I’ll already be
under the ground.

I would never reject any fake remedy;
the placebo effect is what works best on me.

All this week in a tent, yet my
back feels just fine
I assume all that yoga
protected my spine.
And it seems my blood pressure has
come down a bit;
I conclude making music can
help me stay fit.
These are only assumptions, they
may not be true,
and if I wanted proof, well,
my options are few.
For, to test your health habits, there’s
one thing to try:
life your life over different
and see if you die.

I would never reject any fake remedy;
the placebo effect is what works best on me.

And it really is not just good
health that’s at stake,
for the thoughts that we live by
are most of ‘em fake,
and we get through each day by
accepting as right
every half-assed conception
we dreamed up last night.
If I master this dance, then it
means I’m no fool,
if I wear the right clothes it will
mean that I’m cool,
and if I could play well every
tune on this list,
it would prove to me I have a
right to exist.

I would never reject any fake remedy;
the placebo effect is what works best on me.

Though to say it out loud here takes
plenty of gall,
I think music’s the greatest
placebo of all.
For as long as we’re playing we
think life is fine
and the wide world around us is
not run by swine.
Through a skeptic might ask what
this fake joy is worth,
at least fake joy’s the kind you can
have here on earth.
So that moral that I would leave
with you is this:
do not seek tragic wisdom
where bullshit is bliss!

I would never reject any fake remedy;
the placebo effect is what works best on me.

Posted in General | 4 Comments »

Don’t Be Such a Scientis or The Negating Culture of Science and its Costs

Tuesday, June 1st, 2010

I recently finished reading Randy Olson’s book Don’t Be Such a Scientist, and I definitely recommend it. It is an entertaining read and has a number of useful insights into the perennial problem of communicating complex, nuanced, and incomplete scientific information in a way that is engaging and accessible and still in some meaningful sense truthful. I won’t say I agree entirely with Olson’s take on the subject, of course. Sometimes I think he lets the public off too easily, expecting too little from the intelligent lay person. And as always when making generalizations, he seems to stray sometimes into caricature and stereotype. Still, there is no denying that there is currently an enormous divide between mainstream culture and the subculture of science. The days of standing room only public science lectures, such as those of the 19th century, are gone. And the days of scientists being seen as respected and trusted white-coated heroes who invented antibiotics, stopped the scourge of polio, and won the Second World War are over too. There is now a profound suspicion of science, and intellectualism generally, in the U.S., and scientists can no longer take for granted that they will listened to, trusted, or supported by the general public unless they can compete in the busy and bewildering media from which most of us get our understanding of complex issue.

The one concept that struck me most forcefully in Olson’s book, was the image of science as fundamentally a negating enterprise. For all the reading and writing I’ve done on the subject of medical research and the dangers of simply seeking to confirm our preconceptions, I never fully appreciated the implications of this for the appearance of science to non-scientists.

It is very difficult to reliably prove an idea true. Certainly informal assessments of our personal experiences almost always confirm our pre-existing beliefs. Confirmation bias, the availability bias, cognitive dissonance, and a host of other such factors make this inevitable. But even scientific research studies, with all their attempts at controlling personal bias, will almost inevitably prove true whatever investigators set out to prove. The best way to get to the truth is to attempt to prove ideas wrong. A negative finding, especially from a source predisposed in favor of the hypothesis, is worth more than a positive finding. Of course, technically one cannot prove a negative. But the failure to disprove an idea with multiple, vigorous attempts is certainly more reliable an indicator of the idea’s veracity than multiple studies set up to confirm what is already believed to be true.

The implications of this for the culture of science, and the barriers to effective communication between scientists and non-scientists, are profound. Scientists expect criticism and see it as a sign that they and their ideas are being taken seriously. Sure, we are human and so as full of ego and narcissism as anyone else. But by training and experience, most of us acquire relatively thick skins, and we come to see strong challenges to our ideas as a good thing, a kind of intellectual personal trainer that will cause us pain but ultimately make us stronger.

I have been through the peer review process for several publications I have written, and it isn’t pretty. Seeing something I have put months of hard work into torn apart, and facing the prospect of more work to revise what I was sure was perfect to begin with, causes lots of hurt and anger. But at the end of the process, I am generally grateful that the final product is better and that I have been saved the embarrassment of public error. I understand that the criticisms are not personal (the reviews are anonymous, of course, which helps) and I accept the ego bruising as a fair price to pay for weeding out bad work and weak ideas. Likewise, I try as hard as I can to give up beliefs and practices that have been reasonably shown to be wrong, even if I am attached to them and personally convinced of their value. I trust the process, based on the logic of the underlying philosophy and the evidence of history, and this helps me to appreciate the value of the sometimes painful experience of having my ideas and work criticized.

As part of this enculturation, I also feel it normal to respectfully but aggressively criticize the ideas of others. I’ve discussed before how proponents of CAM often resent such criticism and see it as fundamentally unfair and inherently personal. In the culture of faith-based medicine, where truth is judged on the basis of one’s personal experiences or the received wisdom of one’s mentors, challenging someone’s beliefs is the same thing as challenging their intelligence, honesty, or worth. In the culture of science, no one’s beliefs are beyond challenge, at least theoretically (though of course scientists are political animals like all humans, so this principal isn’t always followed). This is one of example of the clash between the negating culture of science and other, non-scientific ways of looking at health and disease.

Olson also makes a big point of talking about how unlikeable scientists can seem to the rest of the world. This is particularly a concern for an endeavor like this blog, which is to a great extent devoted to identifying ideas which are not true and therapies which don’t work. It is far more pleasant to hear proclamations of hope and optimism than to hear all the reasons why something which purports to offer hope really doesn’t. Debunking is inherently negating, and it is easy to see why this leads to the image of skeptics as sour, curmudgeonly, and willfully choosing not to believe in anything. Of course, anyone the least bit of a skeptic themselves knows this isn’t true, just as anyone who actively practices science knows how positive and affirming it can be. The sense of wonder and discovery and the joy of figuring things out is a big part of the rewards in doing science, but for some reason they are less often communicated to the public than the contempt many scientists feel for bad ideas supported by wishful thinking, sloppy logic, and few facts. Science communicators, one might even say science entertainers, like Carl Sagan and Neil deGrasse Tyson are notable exceptions.  

So I agree with Olson that in many ways the culture of science is built on negation, on aggressive intellectual attack and defense of ideas, on a disrespect for those who make stuff up, botch their facts, and show more concern for what they wish to be true than for what really is true. This kind of negativism is not a bad thing, of course, since it is what enables the discovery or real, practical truths that benefit us all. And the negating aspects of science are not all there is to the enterprise. There is a great deal of awe and wonder, creativity, community, and true hope for meaningful progress and improvement in the world. But the negating aspects of the scientific approach do present a public relations problem. Most people seem to take a pretty quick dislike to dispassionate, cerebral, fact-based exposition and to the negation of hopeful, feel-good ideas no matter how nonsensical.

So what do we do about this? Abandoning reality for wish fulfillment doesn’t strike me as a good choice, so we are stuck having to challenge bad ideas no matter how popular. But as Olson suggests, this can at least sometimes be done with humor and humility and with frequent reminders of the elegance, wonder, and real benefit inherent in pursuing and defending the truth. While I think Olson sometimes goes too far in the degree to which he seems to suggest we simplify our messages and make them more entertaining and less instructive, nevertheless his underlying point is valid. The positions staked out by science and reason must compete in a marketplace of ideas, and some of the competitors they face are much more marketable.

The advances of science are often more complex and less obvious than the early triumphs of vaccination and antibiotics, which make them less self-evidently proof that the approach is the right one. And the misuses of scientific knowledge and technological progress are better understood, which further tarnishes the image of science. But the fundamental nature of science as a method which relies on challenge and disproof is itself a weakness from a public relations point of view. And the cultural reverence for factual accuracy and distaste for excessive, hyperbolic, and ultimately unjustified claims also sets those of us promoting science-based medicine at something of a disadvantage. Yet all of these marketing weakness are strengths from the point of view of discovering real and useful truths, so we cannot give them up.

We must strive to make what we do and what we stand for as engaging and accessible as possible without cutting the heart out of it. Being open about our own joy and passion for the truth and the scientific path to reach it is an important step, and being always clear that the truth, even when it may not be what we might wish it to be, is the only way to really better all our lives. Millennia of faith and wishful thinking have failed to accomplish what science has wrought in a few generations, and we must not allow the public to forget that. We must being humble, but at the same time not afraid to be definitive where it is justified. Homeopathy doesn’t work, vaccines don’t cause autism, and we needn’t tiptoe around those assertions to satisfy an excessive epistemological caution. And as always in life, we must make the effort to maintain our sense of humor, about ourselves as well as our ideological adversaries. This will not only make our own efforts more enjoyable to us, but it will do a lot to dispel the myth of the emotionless scientist out of touch with ordinary human feelings. We are as driven by our own feelings as anyone, we simply trust in a method of inquiry which diminishes the danger of these feelings misleading us, and hopefully we can succeed at illustrating that and thus humanizing science and scientists.

Posted in Book Reviews, General | 4 Comments »

GAO Report on Deceptive Marketing and Contamination of Herbal Products

Wednesday, May 26th, 2010

The GAO today released a report to Congress that had previously been reported on in the New York Times. The report investigated deceptive or illegal marketing practices among sellers of herbal remedies and dietary supplements. Under the Dietary Supplement Health and Education Act of 1994  (DSHEA), there is precious little restriction on manufacturers and marketers of these products. All supplements are presumed to be safe without any pre-marketing evidence required, and the FDA can only restrict such products or their sale if post-marketing surveillance, which is haphazard at best, indicates a health threat. Marketers of such products can technically only make vague claims about their products, not claiming that they prevent or treat any specific disease unless they pass the stringent standards of evidence applied to pharmaceuticals. However, this report shows that even these weak limits are being widely ignored.

Many examples of deceptive and illegal marketing practices were identified. GAO employees posing as elderly consumers were told that herbal products could cure several diseases, including cancer, that they could be substituted for prescription medications, and that they could be used safely along with medications even when there is evidence this is untrue.

The GAO also tested 40 supplements for heavy metal and pesticide contamination and found contaminates in 37 of them. The levels were low, but because such products are under-regulated, clear standards for safe levels of these substances have not been established, so it is impossible to know how much risk this poses to the consumer. Certainly, the claim that such products are “all natural” and thus safer than pharmaceuticals is belied by these test results. Can you imagine what the alternative medicine folks would say if lead or pesticides were found in prescription drugs? Yet the manufacturers of these products express no concern, and they have effectively blocked attempts by Sen. John McCain and others to strengthen the regulation of their products. So much for the David and Goliath Myth. Big Herb and his buddy Big Supplement are playing the same game as Big Pharma, they just don’t have any referee watching to see if they play by the rules.

Posted in General | 1 Comment »

Guest Post from Alison Averis–The Rise of Equine CAM in the UK

Wednesday, May 19th, 2010

Alison has offerred another interesting piece that offers insight into the role of CAM therapies in equine medicine “across the pond.” I’m not sure whether to be comforted or saddened by the fact that the retreat from rationality and the new Age of Endarkenment is an international, rather than primarily an American, phenomenon.

THE RISE OF EQUINE CAM
Alison Averis

Thirty years ago, equine CAM wasn’t an issue in the UK.  If your horse was ill you called the vet.  Twenty years ago, a few people were giving their horses homeopathic remedies, but there wasn’t the huge range of therapies that is on offer today, and the vet was still the first port of call.  It wasn’t until the early to mid 1990s that alternative therapies became really popular for horses in this country.  In her book For the good of the horse (1997), the riding teacher Mary Wanless was one of the first to introduce the reader to a large range of New Age ideas and alternative treatments: “… many horse owners who have successfully used complementary techniques in their own healing now call on these approaches [for their horses] at the beginning of treatment – they no longer wait for orthodox veterinary medicine to fail”… “both systems [conventional and alternative] are valid and useful when the appropriate choices are made” … “Whilst many vets remain sceptical, the tide of public opinion is increasingly behind complementary practitioners”.

Since the mid-1990s, acupuncture, shiatsu, osteopathy, chiropractic, massage, reiki, homeopathy, Bach flower remedies, aromatherapy, herbalism and many others have become accepted as valid and useful in the care and treatment of horses.  The tide of public opinion has become a flood.  When a British trainer and well-known advocate for horse welfare wrote “It should be appreciated that such therapies are no longer regarded as ‘alternative’ to what is presently known as orthodox or conventional veterinary (or medical) treatment.  Nowadays complementary practices and treatments can be used in conjunction with other therapies to enhance the all-round healing effects for both animal and human.”, she was simply stating the current consensus of opinion.  Owners are now considered strange if they don’t use alternative therapies.

These therapies are practised by many veterinary surgeons, uncritically promoted in the mainstream magazines and on website forums, endorsed by successful competitors and cheered on by the power of The Testimonial.

While in the 1990s many vets were still sceptical, in 2010 the majority, at least in my small part of the UK, now offer acupuncture or homeopathy or both as an adjunct to mainstream treatment.  Mary Wanless also raised the question that the reluctance of vets to endorse alternative therapies might have had less to do with the intrinsic implausibility of those therapies and more to do with protecting their own area of expertise and their own income.  It is impossible to say.  It may be that they now embrace some of the alternative therapies for the same supposed mercenary motives.  It may be for equine welfare -  if owners are going to use these therapies anyway, surely it’s better if the practitioner is someone with enough knowledge and experience to know when an alternative method isn’t enough.  It may be that they, too, have been swayed by the power of personal experience – and it is powerful, especially with horses who often respond enthusiastically to any sort of human attention.  Whatever the reason – and I suspect that there are more than one – this apparent endorsement of CAM by mainstream vets has made the sceptic’s job more difficult.  The believer will retort that her therapy has been validated: “See – even the vets know that it works.  They wouldn’t do it if it didn’t work, would they?”

The monthly equine magazines receive a considerable income from advertising and sponsorship by CAM therapists and companies.  Most readers seem to be unaware that the editorial and articles in the magazines might be strongly slanted towards supporting those businesses.  In one magazine the ‘Ask The Experts’ feature was sponsored at one time by a company manufacturing herbal supplements: herbal remedies were suggested in the responses to each query from a reader.

In 2009, a UK-based horse magazine published an article entitled Weird or Wonderful?.  It was an excellent illustration of the widespread acceptance of equine CAM.  It began, “When conventional medicine fails to work, many owners turn to alternative therapies”, and went on to describe 24 of these.  Each account had three sections: What Is It?, How It Works, and What It Helps.  There were no questions on the lines of Does It Work?, Can It Possibly Work?, Is There A Simpler Explanation For What Is Observed? or What Harm Can It Do?.  Readers were not given enough information to make an informed decision and would have finished the article thinking that every therapy was wonderful and nothing, but nothing, was too weird to contemplate.  They would also have been given the idea that alternative therapies could help to cure everything from most forms of lameness to skin conditions, digestive problems and nervous disorders.  The article was peppered with little boxes in which the heading ‘Fact!’ was followed by a snippet of totally implausible information.  Some samples:

“Cranial sacral therapy has been known to restore the proper position of misaligned bones.”

“Hair samples taken from the mane or tail can show evidence of weaknesses and emotional disorders.”

“Radionics can treat almost all physical, mental and spiritual problems”.

… and from within the text itself:

“Chromotherapy can help horses through many problems … Green … is good for killing off germs … Purple … effective against bacterial infections”

“Crystal and gem therapy … can help almost any ailment”.

“Faith healing can treat any illness or ailment – it has even been known to perform what we consider ‘miracles’, healing horses with terminal illnesses.”

“Bach flower remedies … are great for healing the horse’s emotional and mental state”.

“Iridology can diagnose a disease before any symptoms appear … it can detect deficiencies and genetic abnormalities”.

“Horses suffering from allergies show great improvement after treatment with homeopathic remedies made from the things that trigger the allergy”.

“Magnets can help arthritis, rheumatism and navicular, as well as tendon problems and muscle cramps.”

“[Reiki] promotes healing in general, so any problem can be treated.”

 “Horse whispering can be used … to detect physical problems in a horse”.

“Copper therapy is beneficial for any horse who suffers with osteoarthritis and rheumatism”.

Indeed, the only “Fact!” that I couldn’t find was the fact that almost all of this is illegal unless done by a qualified vet trained in the method.  Now, one cannot blame the average horse owner, reading this in an award-winning reputable magazine with a circulation of tens of thousands, for believing that all this is true.  I also think that the writer of this article probably took his or her information from the websites and promotional literature put out by the therapists themselves – it obviously hadn’t been informed by anything like the Skeptic’s Dictionary or Quackwatch – or even Wikipedia.  Reference to these would have made it quite clear that these ‘facts’ are not widely accepted by scientists, and for very good reasons.  No – all the ideas seemed to have been taken at face value and presented to the public without a shred of scepticism.  I don’t want to give the impression that the writer of this article was negligent, or less than conscientious.  Far from it.  A lot of work went into it and it is well-written.  But the point is that the validity of these approaches to treatment is now so thoroughly accepted by the horse world that nobody even thought to look for contrary evidence.

Demographic studies show that the typical user of alternative therapies is a middle-aged, middle-class, reasonably well-educated woman with spare money and time.  This description fits a large number of horse owners, too, so perhaps it isn’t all that surprising that matters have reached the point where Andy Lewis could write on his Quackometer blog, “horse ownership and quackery could form a whole blog in its own right.”  To many modern horse owners, the vet is merely one of many options to call on when a horse is ill or injured.  Despite what the law says, and despite what many therapists assert, it is common for the owner to make her own diagnosis and select the practitioner she thinks will do the most good for the least money.

What is really worrying about all this, though, is that the horses themselves have no choice in the matter.  Many of these innocent beasts have had their healthcare taken out of the hands of science-based vets and put into the hands of people who may know a great deal about their therapy, but very little about the actual anatomy, physiology, biochemistry and pathology of their clients.  People who through no fault of their own are simply not able to recognise when a horse has a problem that needs medical treatment.  People who have been taught to believe that their therapy really does everything that they think it can, in a world where personal experience is considered the highest form of proof.  People who have been taught, and who tell their clients, that vets are useless because there is so much they can’t cure.  Many owners now expect science-based medicine to fail to cure their horses.  The law and the veterinary profession are apparently being bypassed by people who are using questionable techniques to diagnose illnesses and disorders, and recommending untested or discredited treatments for those conditions.  It’s a sub-culture that has dismissed the scientific knowledge and expertise of the veterinary profession in favour of a do-it-yourself approach based on mystical beliefs.  And if anything goes wrong, it is always the horse that suffers.

References

www.quackometer.net/blog/2007/08/if-it-quacks-like-a-horse.html.

Wanless, M (1997).  For the good of the horse. Published in the UK by Kenilworth Press and in the USA by  Trafalgar Square Publishing.

Posted in General, Guest Posts | 4 Comments »

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