This is the only event, and the only organization, dedicated entirely to promoting evidence-based veterinary medicine, and I encourage anyone interested to join us in New Orleans!

When: Wednesday May 30, 2012, 9am-5pm (One day before the start of the ACVIM Forum, one of the most popular CE events of the year!)

Where: Springfield Suites Marriott Downtown, New Orleans, LA

Program An Introduction to Evidence-Based Veterinary Medicine This interactive workshop, led by some of the leading teachers and practitioners in the field, will introduce you to the key concepts and methods of evidence-based veterinary medicine.

The Latest in Applied Evidence-Based Veterinary Medicine A series of lectures discussing recent research and practical application of evidence-based medicine methods, including the latest Veterinary Emergency & Critical Care guidelines for CPR, research reporting guidelines, outcomes assessment tools, and more. Speakers include Dr. Daniel Fletcher (Cornell), Dr. Paul Morley (CSU), and Dr. Sandi Lefebvre (Banfield).

Registration Morning Workshop (9am-12pm)- $50 (students $25) Afternoon Lectures (1pm-5pm)- $50 (students $25) EBVMA Business Meeting for members (5pm-7pm)- no charge

Combined all-day registration (includes 1-year EBVMA membership for first-time members)- $75 (students $40)

Late Registration (after April 15)- $65 each session ($40 students), $100 combined (students $65)

Details and Online Registration at www.ebvma.org

I recently read an article by Fiona Fox, CEO of the Science Media Centre, which is an information and resource center for journalists and scientists focused on improving the accuracy of science journalism.

What if There Were Rules for Science Journalism?

The article was originally published in New Scientist magazine and appeared today on Slate.com. Ms. Fox begins  by illustrating the seriousness of the problem with an example all too familiar to proponents of science based medicine–the bogus link between childhood vaccination and autism.

When the press gets it wrong on science, the results can be devastating. The furor over MMR, which started in 1998 after a rogue doctor claimed a link between the vaccine and autism, is the best-known example of how poor reporting can cause harm. Vaccination rates dropped to 80 percent, and cases of measles in England and Wales rose from 56 in 1998 to 1,370 in 2008.

The media were not solely responsible for the MMR scare, but some of the news values that caused the problem are alive and well: the appetite for a great scare story; the desire to overstate a claim made by one expert in a single small study; the reluctance to put one alarming piece of research into its wider, more revealing context; journalistic “balance”—which creates the impression of a significant divide in scientific opinion where there is none; the love of the maverick; and so on.

All of the problems she lists are common in media coverage of alternative medicine as well. An impression of scientific legitimacy can easily be manufactured through “false balance” and an exaggeration of the evidentiary value of low-quality evidence. And the love of a heartwarming narrative, including mavericks proven right and miracle cures, lead people to accept pseudoscientific ideas despite the scientific and  rational reasons to reject them.

Ms. Fox then goes on to provide a sample of a checklist of guideline that journalists could use to avoid misleading the public when reporting on scientific issues: 

• Every story on new research should include the sample size and highlight where it may be too small to draw general conclusions.
• Any increase in risk should be reported in absolute terms as well as percentages: For example, a “50 percent increase” in risk or a “doubling” of risk could merely mean an increase from 1 in 1,000 to 1.5 or 2 in 1,000
• A story about medical research should provide a realistic time frame for the work’s translation into a treatment or cure.
• [Such stories] should emphasize what stage findings are at: If it is a small study in mice, it is just the beginning; if it’s a huge clinical trial involving thousands of people, it is more significant.
• Stories about shocking findings should include the wider context: The first study to find something unusual is inevitably very preliminary; the 50th study to show the same thing may be justifiably alarming
• Articles should mention where the story has come from: a conference lecture, an interview with a scientist, or a study in a peer-reviewed journal, for example.

As a member of the American Society of Veterinary Journalists (ASVJ), I am interested in encouraging the most accurate media coverage of veterinary medical issues. As usual, this effort in the veterinary field is smaller and less fully developed than similar efforts in the human medical domain, but the problems and the goals are much the same. The better our clients understand the science underlying our recommendations, including the inevitable degree of uncertainty involved in any scientific endeavor, the better they will be able to work with veterinarians as partners to manage the health and well-being of their pets. And the more clearly people comprehend both the strengths and limitations of scientific evidence, the more difficult it will be to sell them pseudoscience and nonsense.

The media plays a key role in interpreting and disseminating scientific information, and the sort of guidelines Ms. Fox is suggesting would be a great step towards improving the quality of science journalism. I would very much like to see organizations such as the ASVJ and the Evidence-Based Veterinary Medicine Association (EBVMA) involved in developing and promoting such standards for the general press.

Like many alternative medicine practitioners, Dr. Jones offers advice that ranges from routine and well-accepted principles of well-care and nutrition, which all veterinarians offer their clients despite his claims that his insights are somehow special secrets the veterinary profession wishes to suppress, to unproven assertions about benefits from untested therapies (such as herbal remedies), to outright quackery such as homeopathy.

Dr. Jones recently Googled himself and found my article, and while none of the information can possibly be a surprise to him, it apparently hit a nerve. Not surprisingly, he made no effort at all to provide a factual defense of the “secret” remedies he recommends or any justification for his behavior. Instead, he simply rehashes the irrelevant issue of anonymity, which I have addressed in detail before. Here’s his response.

It appears that Dr Skeptvet, if this person really is a veterinarian, has a strong dislike of me.

We are all entitled to our opinions, but when they become public on the internet, I feel that the author should be public.

So this is an entire blog dedicated to bashing and discrediting alternative veterinary medicine, yet the author is anonymous.

Hmmm

I could have started my Internet business anonymously, and never had to deal with all of the ‘challenges’…in fact I would likely then still be practicing.

But that goes against all I believe in…

You have always known who I am, what I do, and even where I live

I have been very transparent and truthful.

Do you have to agree with me?

No

Do you have to buy anything from me?

No

But do I at least have ‘the balls’ to put myself out there?

Yes

Best Wishes,

Dr Andrew Jones, DVM

P.S. Ultimately it comes down to results..not what is said on the internet, but whether or not some of what I discuss actually helps dogs and cats.

My book, Veterinary Secrets Revealed literally has over 1000 testimonials from ‘real’ dog and cat owners.

So what does this boil down to?

1. Since he cannot begin to imagine why I,  the British Columbia Veterinary Medical Association (BCVMA) for that matter, would disagree with what he does, the only motive must be personal dislike for him.

2. He is a brave man for publically selling unproven or even clearly bogus therapies under his own name, and internet anonymity is far worse than selling therapies that don’t work or branding the rest of the veterinary profession as greedy tools of Big Pharma who want to deny their patients access to his treatments.

3. He can provide testimonials that claim his treatments work, so they must actually work and science is irrelevant.

Despite the fact that facts are of no interest to Dr. Jones, including the fact that he has been repeatedly judged guilty of violating the law and of reneging on promises to abide by the rules governing veterinary licensure in his country, he is still required to put his personal version of the Quack Miranda Warning.

DISCLAIMER: This information is for educational
purposes only and is not intended to replace the
advice of your own veterinarian. Dr Andrew Jones
resigned from the College of Veterinarians of
B.C. effective December 1 2010, meaning he
cannot answer specific questions about your
pet’s medical issues or make specific medical
recommendations for your pet.

There is no question that Dr. Jones has a loyal following, which resembles a personality cult in its expressions of blind loyalty and vicious condemnation of anyone with the temerity to doubt their leader. Here are some of the comments made on Dr. Jones’ site and here by his defenders.

I’m not thrilled about vets but I trust you implicitly. You are definitely a doctor of good practices, no matter if you have a license or not.

You run into “JERKS” every where you go.
Seems to me you ran into one more in your life to add to your list.
 

This idiot must not have much to do, or the jam to say who he is.
That makes him a weak minded, useless piece of dog poop!

As a life long animal lover I have met many vets and only trusted 3 of them. I have never met you, but I would have loved to have you as my pets Doctor!

What a spineless excuse for a human being. This person thinks people will believe these lies about you.
 

I’m am truly sorry for the outright lying that is being put on the internet.
I for one believe in who you are as a person and secondly how you treat animals is nothing but exceptional. It’s too bad your home doesn’t give you the respect you deserve and have earned.

every individual that challenged the establishment through history has been ousted by the establishment…Dr Merkola is in the same boat, as well as Dr Weil, and so many others( for humans)… As you know, the attacks come out of fear and ignorance- nothing more..

This sceptivet sounds suspiciously like another site run by an individual calling themselves ‘scepticat’ or ‘sceptikat’- a highly volatile dictatorial site run by a wannabe megalomaniac. A truly disturbed person with a anger management issue venting via their little site to their own personal herd of sycophants. I would dismiss them like a fly on your arm. Just troubled souls with no purpose.

Just another stooge for corporate interests such as big pharma

I cannot believe what this idiot has put up on the internet and I would do my best to shut him down.

I really find your blog quite upsetting…Why you have to be so anti is very unfair, and abhorrent. More like large companies likely to lose revenue pulling strings on the veterinary regulatory body .. There is no profit in healthy animals…

Jehovah created all of the real foods & spices for treating specific diseases. It is admirable that some vets as well as medical doctors are returning to the idea that real foods & spices are an alternative to the poisons that big pharmaceuticals invented to increase their profits and destroy their customers.

You are a lying scumbag…… eat dog shit and die !!!! you evil money monger !!!!

These comments all share the usual characteristics of blind faith in alternative therapies and distrust of scientific medicine.

1. Personal loyalty to individual authority figures and personal attacks on critics, with no reference to facts, evidence, or any substantive argument about ideas.

2. A refusal to even consider any criticism or contradictory evidence as valid in any way.

3. A reflexive and automatic assumption that any criticism must be motivated by personal antipathy, greed, fear, psychological disturbance, or anything other than a reasoned, thoughtful consideration of the evidence leading to a conclusion that their ideas are wrong.

4. Dismissal of the entirety of scientific medicine and all its accomplishments as meaningless fictions generated by the evil pharmaceutical industry or some other bogeyman.

There isn’t much use in responding to such vacuous and personal attacks since there is no indication that any of these folks have any interest in reasoned arguments or scientific evidence. How exactly I could be “lying” when all I did was repeat the coclusions of the BCVMA reports (many of which Dr. Jones acknowledged as truthful in writing) is a bit of a mystery. As far as the issue of anonymity, the mindless personal comments of Dr. Jones and his followers do more than I could to explain why one might blog under a pseudonym, but I’ll just repeat what I’ve said before on the subject in the FAQ for this blog:

Who are you and why don’t you blog under your real name?

It doesn’t matter who I am. My ideas and arguments should be judged on their own strengths and weaknesses, not on the basis of whatever prejudices you may have about me as a person. Am I more likely to be right if I am a woman or a man? Does my analysis of scientific research suddenly become more or less accurate if you discover where I went to school, where I practice, or what color I am? These are irrelevant facts that people use to distract from the points I make rather than deal with them directly. I choose to blog under a pseudonym primarily so that the focus remains on the issues, ideas, and facts under discussion, not on irrelevant personal details about me.

I also choose to blog as the SkeptVet because it makes it a little easier to write about individual patients and questions that my clients ask me while still protecting their privacy. This blog grew out of my efforts to become better informed about alternative medicine and to respond thoughtfully and accurately to my clients’ questions. My clients certainly know my views on the subjects I discuss here because these discussions are simply a part of my ongoing effort to provide my clients, and the public in general, with scientific, evidence-based information. I often refer existing and potential clients to my website, so there is no question of my hiding this information from them.

I have no particular desire for attention or notoriety, but I am certainly willing to take responsibility for the statements I make here. While it is (barely) possible to blog completely anonymously, it requires a great deal of effort, and I have not made that effort (though given the amount of angry, even hysterical hate mail I get, I sometimes wish I had). It is relatively easy to discover my identity. But before you try, ask yourself if it is really relevant to the merits of my argument, or if it is just going to make it easier to dismiss what I say by applying your pre-existing biases and prejudices to me.

As for other accusations, I will repeat that unlike Dr. Jones my Internet presence is entirely non-commercial. I write these articles in my free time to provide a counterweight to the almost universally commercial sources of information on the Internet so that pet owners can have all the facts and arguments to consider when making decisions. I make no money from these efforts, and I lose no money to Dr. Jones or anyone else because they choose to sell therapies that I choose not to employ because they lack convincing evidence of safety and/or efficacy. Despite the vacuous personal abuse I receive as a result, I feel people have a right to an independent source of information and criticism of unproven or quack methods.

The timing of this outburst is particularly interesting, coinciding as it does with the recent attempts by the Burzynski Cancer Clinic to threaten and intimidate critics and to respond to criticism with empty vituperation rather than logic and facts. Such responses resemble the reaction of religious fundamentalists to criticism of their beliefs, which only highlights the ultimately faith-based nature of much belief in alternative medicine, which is impervious to any rational argument or discussion. Fortunately, most pet owners, and even many proponents of alternative veterinary medicine, are far more reasonable and open to substantive debate than these folks appear to be, and so these alternative methods will still have to prove themselves to the majority on the basis of real scientific evidence, not just the passionate faith of their adherents.

We all know that in reality, advertising often falls short of the ideal of factually accurate and civil content. While many practitioners of complementary and alternative veterinary medicine (CAVM) advertise in a way that is at least civil, if not in my opinion factually accurate, I also frequently find examples of advertising for alternative veterinary products and services that are not only inaccurate but also blatantly hostile towards conventional, scientific medicine.

This makes sense in that “alternative” medicine, by definition, must consist of therapies intended to replace conventional medicine, and such therapies would have no value if conventional medicine were accepted as generally safe and effective. “Integrative” and “complementary” interventions are, at least theoretically, not incompatible with conventional medicine, so they could more easily be advertised on their own claimed merits, without the need to claim that scientific medicine is unsafe and ineffective. But even when labeled with these less confrontational buzzwords, such interventions are often promoted on the basis of at least implying, of not claiming outright, that scientific medicine is harmful and not very effective.

Despite disagreements over the theories and scientific evidence associated with alternative veterinary medicine, it seems to me that there might be some common ground possible between skeptics, such as myself, and more reasonable advocates of CAVM to agree that advertising by veterinarians which is egregiously hostile or which depends on painting one’s colleagues as incompetent, venal, or otherwise not genuinely interested in the well-being of their patients is inappropriate. Despite the fact that this blog consists primarily of critiques of therapies I believe make claims not supported by reasonable evidence, I make great efforts to repeatedly affirm that most practitioners of these therapies have honest intentions and are truly seeking the best for their patients and client. I am seldom accorded the same courtesy by my own detractors.

I have previously discussed examples of what I believe to be inaccurate and inappropriate advertising by alternative veterinary practitioners (such as Andrew Jones, Gloria Dodd, and Erik Weisman, all of whom have face legal or regulatory board action for their actions). And to be fair, I have also criticized advertising of conventional interventions that are advertised in inappropriate ways, such as Medivet’s stem cell therapy.

Recently, I came across a couple of web sites which exemplify the worst sort of advertising rhetoric and techniques found in CAVM promotion. If the more reasonable proponents of alternative methods wish to be treated respectfully they might consider challenging such practices among their own colleagues.

Dr. Jenifer Preston of HolisticVetExpert.com provides several examples of negative and inaccurate advertising. The claims and comments made on this veterinarian’s web represent the use of exaggerated and unsupported allegations, and lack of regard for fact, that characterizes the more extreme CAVM propaganda.

Dr. Preston, for example, claims to have an herbal remedy that prevents and cures heartworm disease and other parasitic infestations. Such a claim, if not supported by FDA licensure, is illegal according to the terms of the Dietary Supplement Health and Education Act of 1994 (DSHEA), which forbids prevention and treatment claims and allows only vague “structure and function” claims.

These claims are also dangerous in that they can mislead consumers into failing to properly protect their animals from this deadly disease or to treat them appropriately when they become infected. And because there is no scientific support for these claims, they are sold through disparaging and misleading criticism of truly effective heartworm preventative and treatment agents and the implication that veterinarians sell these “poisonous chemicals” knowing they are dangerous out of simple greed.

Heartworm preventatives are a huge income to both veterinary clinics and the big pharmaceutical companies that manufacture the drugs…There are other alternatives to these poisonous chemicals…

Our parasite formula has been used for several years now to treat heart flukes successfully….In my holistic practice, I find flukes and a host of other rarely diagnosed parasites through radionic testing.

We are now using our HVE Parasite Formula to treat all stages of heartworms. As with heart flukes, we have found that a slow killing of these heart parasites is much safer to the patient than the immediate kill-off with drugs such as Melarsomine (Immiticide). We are recommending a therapy (by weight) of daily treatment for seven days for a total of three rounds with two- four day breaks in between. In other words, treat the heartworm-positive dog once daily for seven days; stop for four days; repeat for seven days; stop for four days and repeat daily for a third round of seven days. In severe cases, we may have to go another round or two of therapy.

So far, we have NO side effects in these positive cases–all dogs are doing very well. I also believe that HVE Parasite Formula can be used to prevent heartworm infections.”

This is the most beautiful natural wormer we have found. It is a liquid herbal wormer that we have found to be effective against:

Intestinal Flukes
Liver Flukes
Lung Flukes
Heart Flukes
Intestinal Flukes
Blood Flukes
Cryptostrongyloides (roundworms in the lungs)
Sparganosis (migrating tapeworm larvae)
Pin Worms
Threadworms
Hook Worms
Whip Worms
Roundworms (in any organ including the brain)

Dr. Preston tests for these in her practice, and this is the number one wormer she uses.

There is no evidence to suggest that the undisclosed ingredients in this product, or any herbal product, is a safe and effective preventative or therapeutic agent for heartworm disease, and even many proponents of herbal and holistic therapies acknowledge that conventional medications are the safest and most effective agents for this purpose. What is more, though there are well-known risks to conventional prevention and treatments, these pale in comparison to the tens of thousands of dogs who have been spared illness and death by these products.

Regardless of what I am sure is Dr. Preston’s genuine, though deluded, belief in the statements she makes here, there is no justification for regulatory agencies, or responsible proponents of alternative veterinary medicine, to allow these kinds of claims to go unchallenged.

The rest of the site contains many other cases of misleading and unsupported claims about the dangers of conventional medicine and the superiority of her approach. Dr. Preston’s bio contains a fairly typical conversion story indicating that she began practicing as a conventional veterinarian and then became convinced that she was doing far more harm than good, which led to a conversion to alternative methods. The narrative contains the usual unsupported claims that vaccines and medicines are terrible toxins responsible for most of the diseases science hasn’t yet found a clear cause of or cure for, laments about the unpleasant fact that not all illness can be prevented of cured, and claims that alternative medicine is obviously safer and better but that it is suppressed by greedy corporations and the blindness of  unenlightened mainstream veterinarians.

Dr. Preston practiced allopathic medicine for twenty five years before realizing that the vaccinations and drugs she dispensed daily were causing more problems than they ever solved and often to a more severe degree. So the leading income-producer in her practice–vaccines–was obviously creating havoc in most of her patients. The drugs prescribed every day were literally destroying healthy organs and shortening lives.

Ten years ago, Dr. Preston turned to holistic veterinary medicine–it seemed to be the only answer to the overwhelming set of diseases that were not responding to conventional therapy. For decades, allopathic medicine has been revered and taught in every veterinary college in this country without exploring alternatives! One only needs to realize that many of the biggest subsidizers of veterinary schools across America and Europe are Big Pharma. Who donates new, expensive equipment? Who provides large scholarships? Who provides most of the grants to research veterinarians? Major pharmaceutical companies. She realized that their goal was not to improve the lives of millions of companion animals but to line their own pockets.

She is confident that HolisticVetExpert supplements will tackle diseases that have up to now baffled you and your pet, such as:

-cancer
-mild to severe arthritis and degenerative joint diseases
-joint injuries
-hypo- or hyper- thyroidism.
-cushings disease
-liver and kidney disease
-cystitis-acute or chronic
-urinary incontinence
-constipation
-asthma
-allergies
-obvious or unobvious underlying parasitic diseases
-chronic infections in any system or organ
-vaccinosis–diseases caused by vaccines themselves

As is common in the advertising of “holistic” medicine, the emphasis in this site is on sweeping statements about the dangers of conventional care  and sweeping claims about the superiority of alternative care, all presented with no supporting evidence beyond opinion and anecdotes. The ignorance of conventional veterinarians is portrayed as a positive danger to their patients.

Allopathic veterinarians are trained to relieve symptoms with little or no emphasis placed on the consequence(s) of the treatments selected…

Over the years, drugs and vaccines have made our pets, our beloved companions, seriously sicker and have shortened their natural life span. Why do we so often see premature aging? How do we STOP this trend? Treat holistically! Naturopathic veterinarians have found that these alternative products are accepted so much easier by the animal’s body and therapy is so much quicker and more complete!

By using natural, holistic supplements, we all enjoy a better quality of life, because we ourselves are not exposed to the toxins that go onto or into our pets’ systems!

Here’s another example.

Epilepsy in dogs and cats can develop at any age. Allopathic veterinarians do not give you any real reason that this develops in your beloved dog or cat.

What the vets don’t realize is that they themselves have very likely created this syndrome with vaccines. Yearly administration of multi-valent vaccines assault the animal’s immune system over and over. More and more animals are developing ‘auto-immune’ diseases and the allopathic community has no idea why.

The culprit for seizures – except for the cases of malignancies of the brain or chemical poisonings-is often distemper and/ or rabies vaccines.

One other common contributor to seizures is the use of topical flea products-any brand-they are all nasty.

Another case of dodgy advertising that caught my attention recently, though I have discussed the individual’s advocacy of alternative veterinary nutrition before,  is the site of Dr. Tom Lonsdale, who promotes his book, products, and overall agenda with inflammatory statements like these:

Why there is an alliance between junk pet food makers (‘barfers’ included), many veterinarians and fake animal welfare groups designed to keep pet owners confused and in the dark?

See how incompetence and maladministration characterise the veterinary endeavour.

 The situation is grim and starts with the veterinary profession’s inattention to detail. Whilst it is obvious to most folks…that junk foods are bad for health the veterinary profession appears to have been too busy to notice. Once pointed out, the fact that an artificial diet fed monotonously either directly or indirectly poisons animals, the profession should have risen up and acted. Instead the professional ethic ruled that a mass cover up should apply. With the cover up safely in place profits were to be made. Increasingly elaborate ploys are now used in persuading the populace to a. keep more animals and b. feed them high priced artificial concoctions.

It is my belief that the profession’s political mismanagement and acquiescence is matched by a naive scientific methodology… Our way out of the mire is via a holistic assessment…. Since the holistic approach is not usually taught or practised, here are a few tips which may be of help. Firstly, make sure to have fun. There are no columns of meaningless figures in this approach nor disembodied dry facts.

We have standardised error such that incompetence has become the standard.

Such negative advertising may not be the rule for alternative veterinary practitioners, but it is by no means rare. There is a natural tendency for proponents of alternative methods to promote them in terms of the inadequacies or dangers of conventional medicine. Insofar as they present reasonable evidence to support their criticisms, this is fair play. However, at a minimum, there should be some attempt to offer such evidence, and efforts to claim superiority by insinuating greed, ignorance, or stupidity on the part of the majority of veterinarians practicing conventional should be eschewed.

Dr. Cormick Begins with some frightening statistics (which are also oddly comforting only in that they challenge the assumption I sometimes make that the United States is the center of gravity for antiscientific thinking).

So what are we to make of the facts that in Australia roughly every second person believes in psychic powers such as ESP, one in three believes in UFOs and one in five believes in magic?

And a 2005 survey published in the Medical Journal of Australia stated that half of all Australians are taking alternative medicines with one in four not even telling their doctor they are taking them.

Other surveys conducted in Australia and in the USA indicate that about 80% of the population hold at least one paranormal belief which includes astrology. One in ten Americans said that astrology was ‘very scientific’, in the UK belief in UFOs is about evenly divided into thirds between those who say UFOs have visited the earth, those who say they have not and those who were undecided…

According to the US Centre for Disease Control, one in five Americans believes that vaccines can cause autism and two in five Americans have either delayed or refused vaccines for their children. And in Australia according to the Australian General Practice Network vaccination rates have been dropping over the past seven years, with now only 83% of 4 year olds covered which is more likely to lead to outbreaks of fatal, but preventable, diseases.

And in some areas, usually where there are high pockets of alternative lifestyle supporters such as south-east Queensland, the northern rivers of NSW and Adelaide Hills and the south-west of Western Australia vaccination rates are as low as 70%.

He then goes on to point out that providing facts and data which contradict unscientific beliefs doesn’t seem to be very effective in undermining these beliefs. As an example, he points out that despite the comprehensive disproof against the notion that childhood vaccines cause autism, and despite the retraction of the original paper by Andrew Wakefield and the revocation of ex-Dr. Wakefields medical license, belief in a vaccine-autism connection has not been much reduced. Dr. Cormick then gives examples of a number of factors that promote pseudoscientific beliefs based on current research.

The first on our list is scales of belief. People don’t divide into simple for and against camps on those things…There’s usually a wide scale, or a continuum of strengths of belief. So just because you believe in homeopathy and think that genetically engineered crops are unnatural it doesn’t mean that you don’t prescribe to a scientific view of the world on other things. But the further along the continuum you travel towards extreme anti-science thinking end, the more science-thinking is rejected and people at that end are very unlikely to ever shift their position.

It seems quite true that there are such scales of belief. I know of one prominent advocate for alternative veterinary medicine who seems reluctant to criticize the more mystical and obviously faith-based alternative approaches despite being an outspoken critic of religious belief (though I cannot say if the person is truly a believer in these spiritual forms of alternative medicine or is merely being politic). I know another perfectly rational person who proudly claims to be an advocates of evidence-based medicine and who also practices Healing Touch, a non-denominational form of faith healing. So it can be difficult to clearly identify exclusively pseudoscientific thinking because it is often accompanied by perfectly sound scientific thinking in the same brain.

However, as well as being a problem, this could potentially be an opportunity for those of us advocates of the scientific approach. Recognizing that promoters of approaches that are unscientific in some aspect may also me supporters of science in other domains might give us common ground and a common language, which could facilitate dialogue and perhaps education. Or am I being too optimistic?

Next, Dr. Cormick talks about heuristics, the “mental shortcuts” that lead us into false beliefs and keep us there. I have discussed these many times before, but Dr. Cormick takes a slightly different approach to the subject.

It’s the way we respond to rapid and complex information being fired at us. We need to quickly sort it into categories and an easy way to do this is to sort it according to our existing belief systems or values…the cultural cognition effect which put simply, argues that our values are more strongly going to influence our attitudes than any standard demographic like age, gender, race or socio-political status…And through ongoing affirmation and reinforcement of wacky ideas, they become values or beliefs and don’t easily move for anything. If you doubt this, just google “The Royal Family are Seven Foot Shape Shifting aliens’ and look at the sheer amount of confirmation on different sites about this.

Access to the enormous breadth of opinions on the internet has revealed that people, when swamped with information follow up by ‘motivated reasoning’ which means only acknowledging information that accords with our beliefs and dismissing information that does not accord with them.

The next item on Dr. Cormick’s list is the depressing reminder that because of this values-based, motivated reasoning, facts don’t change beliefs very often.

Brendan Nyhan at the University of Michigan undertook a study that found that when people were shown information that proved that their beliefs were wrong they actually became more entrenched in their original beliefs. This is known in the business as ‘backfire’. And what’s more, highly intelligent people tend to suffer backfire more than less intelligent people do, making us immune to any facts that are counter to our strongly held beliefs…

Dr Andrew Binder at North Carolina State University found that most people when faced with an issue related to science and technology fairly quickly adopted an initial position of support or opposition based on a variety of mental shortcuts and predisposed beliefs. Dr Binder stated ‘This is problematic because it suggests that individuals are very selective in choosing their discussion partners and hearing only what they want to hear during discussions of controversial issues.

Dr. Cormick then addresses the “fear factor,” the phenomenon by which the emotional content of issues, particularly those that generate anxiety or fear, impedes a reasoned judgement based on facts. When an alternative medical approach, for example, is marketed through fear, fear of toxins, chemicals, or other nebulous dangers, then people are more likely to accept it despite the evidence against it.

Lastly, Dr. Cormick touches on what I believe is one of the most important factors, one related to the issue of fear: control. Alternative approaches are especially attractive to those who feel a need for more control, over their health or other sources of fear. Simple, confident, direct answers are reassuring and appealing even if they aren’t consistent with the often complex and ambiguous nature of reality. Pseudoscience has an inherent marketing advantage over science in catering to people’s anxiety and need for control because it is not constrained by the true nature of reality.

At the heart of a lot of our non-science beliefs is control. We live in an ever uncertain and more out of control world, but superstitious beliefs and pseudoscience can give people a sense of control and certainty, providing simple answers, which reduces our level of stress which again is a necessary adaptive mechanism and something we tend to be wired to seek out. But here’s the cruncher – science is predominantly based on uncertainty and the simple answer to this simple statement is that unfortunately there is no simple answer.

So what to do? Well, Dr. Cormick doesn’t claim to have a comprehensive answer (which increases his credibility, since any such answer would likely be wrong), but he does have some sensible suggestions.

…good science education can help. There is some evidence that adults with more science training will more often reject astrology or lucky numbers and more often accept things like evolution. Likewise a 2002 PhD study by Alyssa Taylor in Queensland found that a course on critical thinking led to significant decline in belief in paranormal claims.

So we need to educate people before attitudes and beliefs are strongly formed and in this it is more important to teach them how to think than what to think. The only way to make people bullet-proof to pseudoscience is to effectively teach the values and ways of science thinking whilst still young before alternative belief systems have formed.

A recent survey of hospitals found, “The number of hospitals offering complementary and alternative medical services has tripled since 2000, driven principally by patient demand…” This will undoubtedly be seized upon by advocates of alternative medicine as evidence that these therapies are now “mainstream” and this must mean they work. But the details of the survey tell a different story.

Forty-two percent of the 714 hospitals surveyed said they provide unconventional therapies, and executives listed patient demand as the top criterion in choosing which therapies to offer… “They are responding to the needs of their patients and the communities they are serving, while trying to differentiate themselves in the marketplace,” said Sita Ananth, a Samueli Institute researcher who wrote the report… Though 70% of executives at hospitals providing unconventional therapies said they are doing so because they are clinically effective, only 42% said they use patients’ health outcomes to gauge the success of the alternative medicine programs. Instead, they are principally using patient satisfaction and volume as evaluation metrics, the report said. The programs were most often started by hospital administrators, with physicians championing the idea 20% of the time.

Clearly, patient demand and perception, not proof of efficacy, are driving the expansion of alternative therapies in these hospitals.

Most of the growth in alternative services is in the alternative services offered comes in the “soft” aspects of CAM- treatments like “massage, guided imagery, meditation and the “healing touch” practice known as Reiki.” This is consistent with the results from previous surveys of hospice providers and with the National Health Interview Survey of 2007, which found that practices which focus primarily on psychological comfort and relaxation, and which arguable aren’t truly medical interventions intended to affect a patient’s physical health, make up most of the CAM use in the United States. “Hard” CAM practices, like homeopathy, chiropractic, acupuncture, TCM, herbs and supplements, and others that claim to prevent or cure disease, are far less widely used.

Personally, I have no objection to relaxation and comfort therapies, and I suspect they have some meaningful psychological value for people struggling with illness. But it is misleading and disingenuous to label these as “alternative medicine” and then either claim they are truly medical therapies, rather than forms of supportive care. There is no consistent or high-quality evidence that suggests these sorts of therapies have meaningful effects on disease outcome or physical health, and for some, such as Reiki, the evidence is quite clear that they do not. And it is equally misleading to cite the popularity of these therapies and then imply that other, “hard” CAM treatments are widely accepted as safe and effective medical treatments.

The question then arises, what harm is there in the acceptance of such comfort therapies in mainstream hospitals? I would argue that the therapies themselves are unlikely to be harmful, particularly since they are rarely substituted for science-based therapies, and they probably do offer legitimate comfort to human patients (though the case is far less clear for veterinary patients). However, there is an inherent problem in allowing patient demand, rather than scientific evidence of safety and benefit, to dictate what care hospitals offer. It is very easy to stray into areas of alternative therapy where the risk to benefit ratio is far less favorable.

And insofar as these “soft” CAM interventions form a bit of a bait-and-switch, in which the positive feelings and negligible risk of these comfort interventions are implicitly extended to more questionable practices which share the ideological/political label of CAM, thus opening the door to these interventions as well, then the overall quality of healthcare patients received may be at risk.

There is no question that part of the appeal of CAM is that providers of such therapies often address the psychological needs of patients more effectively than the mainstream medical system. We should certainly be willing to accept that conventional medicine has its flaws and that there are useful things to be learned from the approach many CAM providers take to communicating with and comforting their patients. But this cannot be at the expense of a rigorously scientific approach to evaluating the safety and efficacy of particular interventions, or we will risk diluting the unprecedented strength of the scientific medical approach, which has proven its superiority to any other countless times in actually preventing and treating disease.

Colleen Paige is one of America’s premier Family & Pet Lifestyle Experts…She is also an Animal Behaviorist, Best Selling Author, Interior Designer for both people and pets, Artist, Gourmet Cook, Beauty Expert, former Paramedic, Child & Pet Safety Expert, Family Crisis Counselor, Wellness Aficionado and Publisher of Pet Home and Style & Bliss Magazines.

Wow! She also apparently likes to create holidays, usually to raise awareness and money for some animal-related cause; 19 holidays according to her foundation website. She sounds like a remarkable person, and browsing through her various web sites, I am impressed by her energy, creativity, and the depth of her commitment to her vision of animal welfare. She is undoubtedly doing a lot of good things for pets and people.

Unfortunately, as is so often the case, sincerity and a commitment to doing what is best for pets don’t always correspond with a deep or accurate understanding of what actually is best, at least in the area of healthcare. Her description of National Holistic Pets Day includes all too many of the usual myths and misconceptions and fuzzy thinking that characterize the meaningless buzzword “holistic.” Ms. Paige dedicates this holiday to a companion she lost to cancer, and her description of the experience is both touching and representative of the mixed up thinking behind the idea of holistic medicine:

After the Feb. 2010 death of my fur child Tinkerbelle, from a brain tumor…I began to think about her diet and health regimen and wondered if somehow I could have done better in terms of her health care. I gave her filtered water, fresh filtered air at home and only all-natural food and treats void of corn, wheat, sugar and chemicals.

I didn’t however, give her vitamins and supplements. Could the addition of these have fought against free radicals and other toxins in her body that caused this tumor? Maybe, maybe not, but it made me really uneasy to know that there were other things I could have done that would have at least left me with the surety that I did everything I could.

Already committed to the belief that illness is caused by mysterious “toxins,” despite the lack of evidence for most specific chemical suspected to be harmful and ignoring the role of genes, age, and simple random bad luck, Ms. Paige followed many “holistic,” and completely pointless, guidelines in trying to protect her pet from “this overly toxic world we live in.” When her pet unfortunately developed cancer anyway, did this cast any doubt on the theories or practices she followed? No. Sadly, Ms. Paige was just filled with a vague guilt that she hadn’t kept her pet’s life “pure” enough and was somehow responsible for the cancer. So she rededicated herself to adding still more unproven and largely irrational preventative measures to her pet care routine. If her subsequent companions develop cancer, will she follow the same road even further? And if they don’t, will this constitute “proof” that the new additions worked?

This is an understandable but very dangerous pattern of thought that we are all in danger of succumbing to. We fear pain and illness and loss, naturally, so we try to prevent them and comfort ourselves with the idea that we are in control of our fate, that if we do the “right” things in terms of our physical and spiritual care of ourselves and our loved ones, we can prevent the suffering and pain we fear. But the universe gives little us little reason to believe that our magic rituals really work. The only thing in all the history of humankind, with all the myriad of lifestyle and spiritual practices we have employed, that has ever made a dramatic and unequivocal improvement in the length and quality of our lives has been the development of science, and the growth of true understanding and effective manipulation of the world science has allowed us. Many things are, maddeningly, beyond our control. But magical thinking, however sincere and well-intentioned, is not truly the best way to give our pets the best lives we can.

Other supporters of National Holistic Pets Day go even farther than Ms. Paige in misleading the public with comforting nonsense. This press release (ostensibly from the PetMD web site, though I can find no mention of the holiday on the PetMD site, and it would be a bit inconsistent for this company to promote the myth of holistic medicine since it runs a pet food and pet pharmacy business selling all the “toxins” the holistic crowd) contains the usual clichés from some of the usual sources.

homeopathy can treat the deepest constitutional causes of dog diseases and cat diseases…”While the ‘find it and kill it’ Western medical approach may work for infectious diseases, holistic medicine takes preventative measures by treating the whole body,” says Dr. Nancy Scanlan, executive director of the American Holistic Veterinary Medicine Association (AHVMA). “Holistic veterinary care can be much more effective when treating chronic illnesses like heart disease.”

While I respect Ms. Paige’s motives and efforts to improve the lives of pets in many different ways, it is unfortunate that her misconceptions about medicine have led her to throw those efforts behind the kind of nonsense that only drains energy, talent, and resources away from finding and employing truly effective healthcare for our pets. Many of the pets in the U.S. have too little access to preventative healthcare, or even treatment for illness, due to both economic factors and misconceptions about the need for regular care and the reliability of information found on the Internet. A campaign to raise awareness about the need for veterinary care should focus on those measures that are proven to benefit our pets, and despite Dr. Scanlon’s assurances, this is not the case for so-called holistic medicine. Perhaps we need a National Science-Based Pet Medicine Awareness Day?

The cure for a fallacious argument is a better argument, not the suppression of ideas.

Largely because of the dramatic successes of scientific medicine, the label of “scientifically proven” has also become a potent marketing tool. There may be suspicion of scientists and technology, and plenty of interest in vague and comforting alternative philosophies, but when the chips are down people throughout the world trust science and scientific medicine more as the most reliable source of information and healthcare.

This is why even those dedicated to ideologies clearly incompatible with science, such as homeopaths, attempt to label their practices as scientifically validated.

Because of this, it is nearly impossible to find advertising for a healthcare product or service that does not claim the product is “scientifically proven” to work. Unfortunately, most of those who use this language to market their wares do not appear to know, or to care, what it actually means, and the information to judge the truth of the claim is rarely made available to consumers.

Can We Ever Really Prove Anything?
It is often said that nothing is ever absolutely proven in science. This is true to some extent in that, contrary to anti-science propaganda, science as a method is quite open-minded and aware of the limitations of human reason, and so the method allows for the possibility that any idea, no matter how established and venerated, can be proven false with adequate evidence. However, realistically there are some propositions that achieve a level of supporting evidence that makes any serious doubt about their truth perverse and irrational. I have no fear of being wrong when I say the Earth is not flat nor poised on the back of a turtle.

Similarly, it is often said that the absence of evidence is not evidence of absence, meaning that something as yet not thoroughly tested scientifically cannot be dismissed as false, only regarded as unproven. This is certainly true as well. Unfortunately, in the marketing of unconventional healthcare products this idea is often twisted into a claim that nothing can be regarded as false without an unachievable standard of voluminous and perfect quality evidence against it. But in the real world, we can’t have perfect evidence for everything, and we must apportion our limited resources rationally.

Homeopathy, for example, has a theory that cannot be true unless much of established science is wrong; the in vitro evidence of biologic effects or water memory is overwhelmingly negative; the lab animal and human clinical trials and the few veterinary clinical trials are overwhelmingly negative, with a strong correlation between the quality of the study and the failure to find a beneficial effect. It has been exhaustively evaluated for over a century without generating compelling scientific evidence that it works. Adding all this up, it is more than reasonable to dismiss it as a failed idea and move on without insisting that without more evidence we cannot “prove” homeopathy is a waste of time.

Sorry, Reality Really is Messy
So when deciding whether or not to trust a claim that something is scientifically proven, it is important to have some idea what such a claim might actually mean, if true, and what level of evidence is necessary to reasonably make it. To begin with, the level of evidence available in medicine rarely reaches the degree of certainty of that for the hypothesis that the Earth is round and not balanced on a turtle. Therefore, reliable science-based claims for medical services should usually be circumspect and should reflect the degree of supporting data. “Scientifically proven to treat cancer with no side effects!” is not a claim that is very likely to be supportable through real evidence. “May relieve the symptoms of cancer therapy in some patients with few side effects” is far more likely to be true.

An especially frustrating conundrum for proponents of science-based medicine is that it is far easier to sell something with strong, confident, absolute claims that are probably not true than with measured, realistic assessments supported by good evidence. Ambiguity and complexity are far less attractive than simple, confident narratives. And statistics and the details of scientific evidence are less compelling to potential customers than heartwarming testimonials with far less real evidentiary value. This gives faith-based medicine a significant public relations advantage over science-based medicine and skepticism. But the fact remains that truth is messy and full of uncertainty, and if someone is selling you something as extremely simple, clear-cut, and too good to be true, they probably are selling you a hope or a fantasy, not a real medical therapy.

The Hierarchy of Evidence
The core of evidence-based medicine is the idea that not all evidence is created equal. There are levels of evidence ranging from the suggestive but not very reliable to the solid and trustworthy, though never perfect. When reading a claim that something is “scientifically proven,” you should try to find out what kind of evidence supports the claim, and make your acceptance of the claim proportional to the quality and quantity of the evidence provided.

One key principle to bear in mind is that we are by nature inclined to generate and trust evidence that confirms our beliefs. Even the smartest and most honest scientists have deep, unconscious biases in favor of their own ideas, and these biases influence how they conduct their work and how they interpret data. And such biases extend even beyond the individual. For example, it is generally far easier to publish, and publicize, studies that show a positive result than those that show a promising treatment doesn’t work. In some countries, such publication bias is so severe that negative studies are effectively never reported.

Therefore, a key principle in evaluating medical claims is Negative Evidence is More Reliable than Positive Evidence!!!! Sure, if you have ten studies by different researchers in different parts of the world, including some that deliberately set out to disprove the findings of earlier researchers, and they all get the same answer, you can be pretty sure that is the right answer. But when the evidence is conflicting, when early studies look better than later ones, when low quality studies are positive and better ones negative, or when only one research group can get positive results, the better bet by far is that the treatment being studied doesn’t work.

The following is a simplified list of kinds of evidence commonly encountered and how they ought to be interpreted. In general, the list goes from least reliable to most reliable.

1. Mere opinion- Bias and cognitive blind spots are part of being human, and they affect everybody no matter how smart or well-educated. Linus Pauling, for example, was a brilliant scientist, and arguably a really good person who won a Nobel Prize for chemistry and a Nobel Peace Prize. He was also spectacularly and obstinately wrong about the health benefits of megadoses of Vitamin C. While those who make no effort to acknowledge or control their own biases and rely entirely on faith are especially vulnerable to errors in judgment, absolutely no one is immune. So if the only evidence for a medical claim is that someone smart, kind, famous, or otherwise admirable believes it, the claim should be viewed very skeptically since this kind of evidence is deeply and persistently unreliable.

2. Testimonials- Testimonials are just stories people tell about their experiences and how they interpret them. They are not controlled in any way for bias or error, and they are highly unreliable. Testimonials are also subject to a kind of publication bias in that no one marketing a medical product or service is going to seek out, collect, and report every person’s experience. Positive stories are promoted as evidence the product works, and negative stories are ignored, suppressed, or explained away. Though the most common and emotionally compelling kind of evidence offered to sell medical products, testimonials are not scientific or trustworthy and deserve to be ignored.

3. Reasoning from First Principles- Sometimes marketers will tout something as scientifically proven and then describe some features of basic chemistry, physics, physiology, and so on to suggest how their product might work and why you should believe it does. Certainly, a theory based on established scientific principles is a lot more likely to be true than one which is not compatible with well-established knowledge. However, living organisms are complex and extrapolating from basic science to actual patients is risky and unreliable. Just because something makes sense or ought to work based on a plausible theory does not mean it actually does. This is one of those bits of evidence that is necessary but not sufficient to demonstrate a therapy is useful.

4. Test Tubes and Guinea Pigs – Basic preclinical research into a promising medical treatment begins with testing the underlying theory behind an idea. If a proposed cure for cancer doesn’t kill cancer cells in a test tube, it’s probably not worth giving to patients. But again just because something works in the simplified, controlled environment of the lab doesn’t mean it will be safe or effective in living animals. Bleach kills cancer in the test tube, but that doesn’t mean we should drink it or inject it into people or pets with cancer! Similarly, all mammals have a lot in common, so if it kills rats it could be dangerous for dogs or people, and if it cures cancer in mice, it might be useful for cancer in cats and cows. But, there are also important differences between species, and it is never appropriate to simply assume the results seen in one species will also be seen in another. This again is a type of evidence necessary to demonstrate a treatment could work, but not sufficient to claim it does.

5. Clinical Trials- This is a huge category of ways of investigating a medical treatment with many levels of reliability. Rather than describe all the different kinds of studies and their pros and cons, I will list some general factors that are useful in deciding whether the existence of a positive clinical trial justifies calling a product “scientifically proven.”

A. Strength in Numbers- Small trials are less reliable than large trials. A few trials are less reliable than many trials. Trials conducted by a couple of investigators or all in the same place are less trustworthy than trials conducted in multiple locations by many different investigators. Individual case studies or small case series are less reliable than larger group studies. In general, the credence given to clinical studies should be proportional to the size and number of the studies.

B. Controls for Bias- The more layers of control in place to minimize potential bias, the more likely the result is believable. Such controls include:

Treatment, Placebo, and No Treatment Groups
Random assignment of subject to these groups
Blinding so that as few people as possible, especially patients and those evaluating them, know who is in which group

C. Replication and Persistence- Since we all tend to see what we expect to see, even with the most honest intentions, individual studies are almost never the last word on a medical subject, especially positive studies that find what the investigators want and expect to find. A key feature to demonstrating something really works is repeated testing by different investigators in different populations. It is especially convincing when someone sets out to disprove the results of a previous study and ends up getting the same results as the original, because this requires data robust enough to contradict the biases of the researchers involved.

The Decline Effect is a phenomenon in which early studies of a new intervention look very impressive, and as further studies are done the results get less and less positive until the original effect essentially goes away. This most likely represents the scientific process gradually correcting an initial erroneous finding through attempts to replicate it. Because of this effect, single studies are rarely to be trusted as the final word on a scientific hypothesis. A true idea, a really effective therapy will withstand repeated testing and will continue to accumulate positive evidence, while a promising idea that isn’t actually true will fail to hold up to prolonged, repeated scrutiny. This is part of why systematic reviews, which are methodologically formalized surveys of the totality of the evidence provided by individual studies, are a more reliable indicator of the truth behind a claim than any of the individual studies themselves.

The Bottom Line
Because most people understand that science works better than any other method for determining which medical claims are true and which are false, promoting a therapy as “scientifically proven” is a powerful marketing tool. However, the level of evidence usually available in medicine rarely justifies sweeping, absolute claims. Less dramatic, more qualified and realistic claims are more likely to be true. And not all evidence is created equal. Some of the most common and emotionally compelling kinds of evidence used in medical advertising, such as the opinions of smart, famous people and the testimonials of satisfied customers, are actually the least reliable and most misleading kinds of evidence.

Even truly scientific evidence varies from merely suggestive to pretty clear and definitive. A plausible theory and preclinical research in test tubes and animal models are necessary to show a medical treatment could work, but they are not sufficient to prove it really does work. And even evidence from published clinical trials must be given credence in proportion to the size, number, and quality of the studies that support a claim. Finally, since our biases are almost always in favor of confirming what we already believe to be true, negative evidence is far more reliable than positive evidence.

WOT can be both useful and problematic for skeptics. It is useful for us to be able to rate and comment on sites that offer unreliable, unscientific information on alternative medicine, for example. However, it also provides an opportunity for those who don’t like our message to rate our sites negatively, which can discourage those seeking information from coming to them.

Tim Farley, of the site What’s the Harm? and Erik Davis of Skeptic North have discussed the potential positive and negative effects of WOT on the ability of skeptics to educate the public, and Erik has created the WOT Project, an effort to identify reliable skeptical web sites and encourage skeptics to rate them positively so that their information will be more readily available.

This project is currently of particular interest to me since after reading about it I discovered that the SkeptVet and SkeptVet Blog have poor WOT reputations. Partly this stems from a hacking issue which I only became aware of several months ago when my host notified me that my site had been cleaned of some malware and that I had to reset all of my passwords. The blacklisting site that originally flagged my domain has since removed it’s warning.

But I also have had a small number of ratings by individuals (18) which are all negative. I suspect this is the work of CAM proponents angered by the content of my posts. So as well as encouraging everyone to participate in the WOT Project in general, I would like to ask readers who believe the content here is useful to got to the SkeptVet WOT profile and provide a positive rating and comment. Hopefully, this will help prevent those who see the site when searching for information about alternative veterinary medicine from being warned away from it by WOT.

Thanks!