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.

The debate about the scientific evidence for acupuncture is muddled by the lack of a consistent definition for what acupuncture actually is. Many studies claiming to investigate acupuncture actually use “electroacupuncture” (a CAM pseudonym for what scientific medicine calls TENS, Transcutaneous Electrical Nerve Stimulation). This was the case for a recent set of studies in dogs, and it is also the case for a recent study in humans:

Suarez-Almazor, M., Looney, C., Liu, Y., Cox, V., Pietz, K., Marcus, D., & Street, R. (2010). A Randomized controlled trial of acupuncture for osteoarthritis of the knee: Effects of patient-provider communication Arthritis Care & Research

Orac at Respectful Insolence discusses the study in detail. In brief, it compared electroacupuncture with “fake” electroacupuncture (needles in different spots and different amount/duration of electrical stimulation) and with a no-treatment control, and it also compared these treatments between groups of patients given high expectations of success by the providers and those given neutral expectations. The results?

Not surprisingly, there was no difference between “real” and “fake” acupuncture. Both groups reported some improvements compared to the group that got no treatment, which is exactly what you’d expect if the “real” treatment was a placebo just like the “fake” treatment. What is cool about the study is that there were several measures that differed significantly between patients given high expectations and those given neutral expectations, regardless of which treatment they got. Placebo effects are well known to be greater when the fake treatment is presented with confidence by a supposedly knowledgeable professional. In this study the way the treatment was presented to the patients affected how much benefit they got from it and mattered more than which treatment they got, just as one would expect for a placebo therapy.

Of course, real therapies will also appear to be more effective for subjectively reported symptoms if the patient is given high expectations. However, since there was no difference between the effects of “real” and “fake” acupuncture, but there was a difference caused by the expectations the patients were given, the study is a nice illustration of both the fact that acupuncture is a placebo and that expectations are a key element in achieving placebo effects.

This is of particular concern to me as a veterinarian because I believe it is impossible to influence the expectations of my patients about the benefit of the treatments I give them. So unlike humans, they are unlikely to experience any benefit from placebo effects based on expectancy. Unfortunately, their owners are very likely to be influenced by a vet presents a therapy, which leads to a situation in which the client and the vet think the treatment is helping when in fact the patient feels no better. It is this placebo effect by proxy that I think keeps many ineffective CAM therapies alive and profitable in veterinary medicine, especially since the large, well-designed studies necessary to show the underlying reality about the treatments are seldom possible due to cost and practical constraints. We need to take not of such studies done in humans and recognize the implications they may or may not have for our field given the differences between humans and our patients.

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.

Our latest example has all this and much, much more! Meet the revolution in veterinary medicine that is Double Helix Water! What is Double Helix Water? Here’s what the “inventors” and promoters of this product say:

Double Helix Water^™ is solely ultra-pure H₂O but we believe it is H₂O in a hitherto undiscovered fundamental “phase”; not liquid, ice or vapor “phase” but a molecular solid phase even at room temperatures.…this “phase” may be the key to many of the body’s inherent healing properties thus explaining many of the mysteries of alternative health practices. They demonstrate through rigorous scientific experimentation that water can form a solid particle at room temperature. The discovery of this particle then, begins to unravel the mystery behind the differences between allopathic and homeopathic medicine as we know it.

Ahhh, so there is a connection with homeopathy, eh? Well, sort of. the promoters certainly claim their “discovery” explains the powerful effects of homeopathy (which they seem to take as a given, despite the strong, consistent evidence that homeopathy is no better than a placebo). However, there is no talk of the Law of Similars, Dilution and Sucussion, which are core theoretical concepts behind orthodox homeopathy, so one wonders exactly what the connection is beyond the absence of anything but water in this product and in homeopathic remedies. Despite this, the forward to the promoters’ book on their product states clearly that the “discovery” takes,

the concept of homeopathy into the twenty-first century…Their demonstration of microscopic clusters in water is groundbreaking and revolutionary! Their purification of water, with the atmospheric purity described, places homeopathy on a scientifically valid foundation that is equal at least to the discovery of atomic energy.

What Are the Claims?

On another site devoted to this product, the promoters first weasel out of any liability or fraud allegations by stating,

It is not a drug or a curative agent (medicine) in any respect. [We] are not medical doctors and we want all to know that we make no representations that this water treats or cures anything, period….let’s all be careful about how we introduce this discovery to the world: Do not make claims, please! This water does not “cure” cancer, does not “cure” diabetes—it does not cure anything. It is not a drug; it is not a medicine. It is simply water…

Disclaimer out of the way, they then merrily go on to say

It is our belief that this phase of water is a central agent in the arsenal of the body’s immune response….we theorize that these particles are the molecular basis for what Chinese Medicine has suggested for over two thousand years: that an electrical matrix surrounds the body and this electrical matrix is the senior dominating factor in all health issues….Therefore it is very feasible that we have found a material basis for the Chinese meridians.

Wait, I thought their “discovery” proved the scientific basis of homeopathy. So, it also proves the scientific basis behind Traditional Chinese Medicine? Wow! Anyway, on to more medical claims:

….have numerous MDs and scores of other healthcare professionals recommended this new phase of water to their clients, patients and family members for a healthy lifestyle? Absolutely. If one is a rational, sane individual and witnesses large numbers of people with many varied health problems experiencing remarkable changes in their wellness, something occurs deep inside oneself. It becomes more a crusade than a research line. And the people whose lives have been saved or changed greatly for the better want others to know what they think of this water—so the word spreads.

And not to leave out the important (and potentially lucrative?) veterinary sector, the promoters of Double Helix Water provide some additional endorsement on this site from a paragon of the holistic hodgepodge school of veterinary medicine, Dr. Deva Khalsa, who says:

I have found Double Helix to be a cutting edge product that works deeply to heal my canine and feline patients. I’ve found it helpful in cases of arthritis, autoimmune disease, cancer and diabetes along with other medical problems.

The folks marketing Double Helix Water, clearly have a philosophical agenda that goes beyond their claims of mere scientific interest in the nature of water, or even the possibly genuine belief that anecdotes and testimonials have really shown it to be useful. This is clear from the preface to their book, which contains a remarkable number of quack warning signs efficiently packaged in a small space:

 The Secret of Life has been the foundation of philosophy and medicine throughout history. The Chinese called it chi; the Japanese, qi; the Indians, prana; and Wilhelm Reich, orgone. Much of medicine before 1940 was rather pragmatic empirical practice with many errors. Since 1940 the bulk of modern medicine has been a takeover by the PharmacoMafia—my title for the pharmaceutical industry. Today Modern Medicine is at least the third leading cause of death in the United States (JAMA, July 2000). Drugs that have little justification and serious risks, called side effects, are added almost daily to the stream of offerings. Numerous brave souls question the current system, and yet it is THE SYSTEM rejecting and attacking viciously virtually every alternative.

Nothing as inspiring as an open-minded individual disinterestedly pursuing the greater good of all, eh? Well, perhaps not entirely open-minded philosophically, as this passage illustrates. What about disinterested? Well, let’s not forget that even though it’s “just water,” they aren’t exactly giving it away. Here’s the “bottom line” from one of their two official vendors, Dr. Khalsa:

One bottle of Double Helix Water™ (a three months supply) at an average usage price of $1.22 a day – $109.95

One bottle of Double Helix Water™ (a two months supply) at an average usage price of $1.33 a day – $79.99

Special Subscription Pricing Offer – Receive a three month supply every three months at an average usage price of $1.12 a day – $99.99

Who’s Behind It?

Interestingly, two of the promoters, David Gann and Dr. Shiu-Yin Lo appear to have a long history of selling dubious forms of magic water. Dr. Lo was Director of Research and Development for American Technologies Group (ATG) in the 1990s. He claimed to have discovered another form of structured water with elements called “IE crystals” in it, which was marketed in the form of a detergent-free cleaning product called a “laundry ball” and also an automobile engine performance enhancer called The Force. According to one source, these products were investigated by the Oregon Department of Justice and determined to be fraudulent, and the company paid a fine and eventually closed down. Affidavits from a an independent analytical laboratory and a professor of chemistry at the University of Oregon were submitted refuting the company’s claims about IE crystals, and the DOJ concluded that these claims were not supported and not consistent with appropriate scientific practices. David Gann was the Director of Marketing for ATG.

Dr. Norm Shealy, who wrote the preface to the marketing book about Double Helix Water, is a committed proponent of Hodgepodge Holism on the human side, including spiritual and prayer healing, hormones and all manner of supplements, energy medicine, and a wide variety of unproven and quack therapies. All three of these individuals obviously have lifelong personal, and financial, commitments to bogus medical therapies.

And there is the veterinary face of Double Helix Water, Dr. Deva Khalsa. From her web site, she subscribes to any and all forms of alternative therapy grouped, for no obvious reason, under the label “holistic.” Acupuncture, homeopathy, herbal therapies, chiropractic, applied kinesiology, prolotherapy, energy medicine, hair analysis, all sorts of supplements, and of course Double Helix Water. Dr. Khalsa will even consult and prescribe these remedies by phone, which is certainly a more convenient way of assessing your pet’s needs than a bothersome in-person visit or physical exam.

What About the Science?

So, what about this “scientific breakthrough”? Any chance it’s real? Well, not being an expert in physics or chemistry, despite some training in those fields, I can’t evaluate the underlying theory very extensively. Of course, neither can the doctors who believe in the remedy, despite their glowing testimonials and deep faith. Those of us who practice science-based medicine are sometimes at a disadvantage since we cannot as blithely dismiss the claims we haven’t investigated or understood thoroughly as easily as those who practice faith-based medicine can affirm them without investigating or understanding them. However, there are some with the appropriate expertise who do dismiss the claims about “structured water” in general, including a product previously “invented” and sold by one of the promoters of Double Helix water. Apart from the affidavits and analyses submitted in association with the fraud investigation of ATG, there is an entire web site devoted to structured water quackery, provided by a former professor of chemistry, Stephen Lower.  Apparently, there is an entire industry built around claims that manipulating the atomic or molecular properties of water can solve all your health problems. Dr. Lower mentions Dr. Lo’s claims about IE crystals and points out that the only scientific publication concerning these claims was in a journal, Physics Letters B, that does not require reporting the details of one’s methodology and has minimal peer review, so it is difficult to assess the quality or reliability of the data presented. The findings have been challenged on practical and theoretical bases both by Dr. Paul Engelking, the author of the affidavit in the ATG case (here) and by Steven Bittenson, a physicist who is actually a proponent of homeopathy (here). Another paper of Dr. Lo’s, on so-called “stable water clusters” and presented on the front page of the Double Helix Water website (here) is from the companion journal Physics Letters A. No other journal appears willing to publish Dr. Lo’s claims about water, which should be cause for some skepticism about them.

Dr. Lower provides lengthy discussions on his site of the science, and pseudoscience, behind “structured water,” and while my expertise only permits me to say with confidence that the medical claims for Double Helix Water are implausible and without any real evidence to support them, Dr. Lower cogently argues that the same is true of the underlying physics and chemistry claims made by the inventors of this wonder product.

So in essence we have a group of individuals dedicated not only to theories and practices which are improbable and not supported by solid evidence or accepted by mainstream science, but also with a long history of trying to make a living selling products based on these theories. The perfect storm of cognitive dissonance, philosophical bias, and financial self-interest to prevent any rational consideration on the part of the promoters that they might be mistaken. The result is yet another unproven and most likely thoroughly useless product sold to people who only want the best for their sick pets, and most often to those whose animal companions have serious medical problems for which highly effective real therapies don’t exist. Empty promises and false hope, for only $79.99-199.99 per bottle (plus shipping and handling).

The PetWellbeing website offers a brief, and inaccurate, description of the disease and then claims their product:

is gentle yet effective, safe for long-term use without adverse side effects…Supraglan is designed to restore your pet’s quality lifestyle and to increase life expectancy by reducing thirst and regulating elimination (liver/kidney and digestive); balancing blood sugar levels (endocrine); increasing muscle use and ability (anti-inflammatory); protecting against infection (immune); and by promoting a healthy skin and coat (natural herbs)

Of course, to cover their behinds legally, the company includes the Quack Miranda Warning on their page acknowledging that the FDA has not approved the product for what they are selling it for, but this is intended to apply only to products that are making so-called “structure and function” claims, meaningless and unscientific statements that the product “supports” some body system, not that it treats or prevents an actual disease. So the treatment claims are illegal to begin with since the drug is not FDA approved as a treatment for Cushing’s disease.

Unfortunately, even the minimal restraint showed by the actual manufacturer is not found on other web sites promoting this snake oil. One site states, “There are many similarities between the symptoms of Cushing’s Disease and Addison’s Disease in dogs–both considered fatal in canines. There are many rumors in regard to the miraculous healing of the natural supplement Supraglan, reported to cure both diseases.” Addison’s disease is a lack of adrenal steroid hormones produces by destruction of the adrenal glands. It is, essentially, the opposite of Cushing’s disease, and yet Supraglan is reported to cure both! How does it accomplish this miracle? Apparently, it uses, “natural ingredients to decrease the adrenal system in dogs from a completely hyperactive state, the product slows the overproduction of the corticosteroid hormones which have become overloaded in the dog’s system.  Side effects have not been seen yet in the usage of Supraglan.”

So a natural, side-effect free cure for Cushing’s disease and it’s opposite. See any warning signs of quackery yet? So what’s in this miracle elixir?

• Borage: contains natural precursors of adrenal glands hormones; supports endocrine system functions; helps with detoxification; supports adrenal cortex.   
• Astragalus: tonic; nutritive; supports liver function; helps maintain immune system.
• Bistorte: astringent, soothing, anti-inflammatory, has a tonic effect on liver and kidneys.
• Eleutherococus Senticosus: helps maintain normal hormonal actions (ACTH and cortisone) on adrenal glands; supports the immune system.
• Wild Yam: natural inflammation management; contains steroidal saponins (dioscin, dioscorin) used as sources of saponins in the preparation of steroid hormones.
• Licorice: adrenal supporting (contains glycyrrhizin, a compound similar to corticosteroids); immune support; anti-inflammatory.
• Dandelion: highly nutritious food; supports liver function, digestion and appetite.

Ok, now here’s the tough part. What’s the evidence to support these dramatic claims? You guessed it–reams of testimonials from “satisfied customers” and not one single research study of any kind. Some of the claims for the specific ingredients are found in reference guides to herbal therapy, usually based only on tradition or limited suggestive in vitro or lab animal studies. A search of the usual source, including Pubmed, Cochrane Reviews, even the National Center for Complementary and Alternative Medicine, which is quite friendly to herbal medicine in general, turned up not a single study that lent any support at all to the idea that these ingredients, individually or in combination, are a safe and effective treatment for Cushing’s disease.

I did find a few studies suggesting why some of the ingredients might be a bad idea to use in these patients. Licorice is known to cause pseudohyperaldosteronism, a hormonal imbalance which messes up the levels of sodium in the blood and can cause high blood pressure and even interfere with proper diagnosis of adrenal disease. Wild yams have been thought to increase some steroid hormones, and so have been used as a treatment for menopausal symptoms, but in reality it does not actually increase steroids, and its apparent effects on symptoms was likely due to adulteration of commercial yam products with synthetic hormones

There probably are some in vitro or lab animal studies, maybe even a small human clinical trial or two, that might have some suggestion of some potential effects on the adrenal hormone system. After all, herbs are essentially drugs, though usually unpurified and inadequately standardized and tested, so they likely do have some effect. I would be interested in any such studies any of you are aware of, but I can promise you there is nothing that would justify selling pet owners whose dogs have a serious, life-threatening disease, this concoction with claims that it will cure them or even meaningfully improve their quality of life. Testimonials, tradition, and blind guesswork based on in vitro studies are not sufficient to make such claims or profit from people with sick animal companions.

I expect I will now receive the usual angry comments of the following sort:  ”Who do you think you are?! I used it and my dog got better so you’re stupid! You’ve just been bought by Big Pharma to push their toxic drugs!” I have received such comments following previous posts on similar nostrums such as Neoplasene, Yunan-Paiyao, and so on. I don’t expect to be able to head these off, but I will try to save myself some time later and make a few points:

1. For reasons discussed at length here and anywhere critical thinking is respected, anecdotes are not proof, only suggestions of areas to study more formally. A million people are capable of being wrong as easily as one, so if you believe my assessment of this product is incorrect, show me real evidence, not testimonials. The hierarchy of evidence is the best guide to what is real evidence and what isn’t, if there is any doubt.

2. I make my living practicing medicine, and that includes treating Cushing’s disease. This has nothing to do with my objections to this product. If there were proof it worked, I would use it just like I use conventional treatments now. And don’t forget the folks making and selling this have a financial incentive to promote its use the lack of evidence it works that is far greater than any incentive I have to discourage its use. I am motivated by a belief that evidence and the truth serve my patients and clients better than false hope and misleading marketing.

3. I am not closed-minded, dogmatic, and I am happy to change my mind if the evidence warrants it. Being skeptical doesn’t mean disbelieving things automatically. It means withholding judgment until the facts are in. There are almost no facts to base a judgment on here, so the burden of proof is on those making wild claims (and a profit) on the product, not on those of us pointing out there is no good reason to think it works.

Acupuncture has been used on animals for over 4000 years. Legend has it that veterinary acupuncture was discovered when lame horses used in battle were found to become sound after being hit by arrows at distinct points. In any event, there is evidence that Chinese “horse priests”, the caretakers of the army’s horses, practiced acupuncture during the Zang and Chow Dynasties around 2000-3000 BC.

Similarly, the International Veterinary Acupuncture Society (IVAS) website claims,

Acupuncture may be defined as the insertion of needles into specific points on the body to cause a desired healing effect. This technique has been used in veterinary practice in China for at least 3000 years to treat many ailments. The Chinese also use acupuncture as preventive medicine against such problems as founder and colic in horse.

Of course, the notion that the length of time a methods has been in use is somehow proof of its safety or efficacy is fundamentally unsound. Unsafe and ineffective treatments (bloodletting, various forms of burning or “cauterization,” faith healing and, I would argue, acupuncture) often endure for centuries, even millennia despite having no benefits and even being harmful, due to the many, many reasons people are prone to making inaccurate judgments about such things. Even if acupuncture has endured for thousands of years, it has failed in all that time to extend our life expectancy, reduce infant and childbirth mortality, eliminate any infectious disease, or accomplish any of the other dramatic improvements in human and animal health scientific medicine has given us in the last 200 years.

Still, it is understandable why people might find the tenacity of a method to be a strong argument for it being effective. Unfortunately, in the case of veterinary acupuncture, the appeal to longevity argument is not only misleading, it doesn’t happen to even be true!

A recent article in the German science history journal Sudhoffs Archiv makes a strong and detailed case that most of the sources cited to support the argument that the Chinese have practiced acupuncture on animals for thousands of years are actually describing bloodletting and cauterization practices that have no meaningful relationship to what is considered to be acupuncture today. The authors also argue that many of the veterinary techniques these Chinese sources describe using on horses correspond closely to techniques found at the same time or even earlier in Greek, Egyptian, Arabic, and Indian sources, and that they may have derived originally from Western practices or had common sources. The article’s authors include two professors of East Asian history and an equine veterinarian, Dr. David Ramey, who has written extensively on equine medicine in generally and on complementary and alternative veterinary medicine.

Buell PD, May T, Ramey D. Greek and Chinese Horse Medicine: Déjà vu All Over Again. Sudhoffs Archiv. 94(1);2010:31.

According to the authors, the earliest written records of Chinese veterinary medicine, from the 3rd century BC, concern primarily herbal treatments. By the 6th century recommendations concerning bleeding and cauterization are found, though herbal therapies are still the primary treatments recommended for animals. The earliest surviving Chinese text specifically devoted to veterinary medicine dates from 1384, though much of the material it contains appears to have originated in the 11th and 12th centuries. none of these early texts refer to anything that could be considered acupuncture in the modern sense. The IVAS defines acupuncture as, “the insertion of needles into specific points on the body to cause a desired healing effect.” Though there are a variety of techniques, including using heat, laser light, and electricity on supposed acupuncture points, most commonly veterinary acupuncture takes the form described by the Australian Veterinary Acupuncture Group: “Acupuncture is the technique of using very fine needles that pierce the skin at specific points in order to treat or prevent disease.”

There is no evidence for such techniques in the early Chinese veterinary texts. Though the term “zhen” used in such texts is often incorrectly translated as “acupuncture,” it is clear from a thorough reading of these texts that the term was used to refer to bleeding, cauterization, and even surgical interventions, not acupuncture as applied to people and animals today. Such interventions become more prominent in later Chinese veterinary texts, however these texts also do not describe anything that can be reasonably called acupuncture. Methods resembling modern veterinary acupuncture apparently were not widely practiced in China until the 1960s.

The historical Chinese texts do describe specific interventions at specific points on the body of the horse, and they include detailed charts and diagrams to guide these interventions. Such charts are often presented in modern works, without translation of labels or inclusion of accompanying text from the original works, as evidence of historical acupuncture point designations. Actually reading the text associated with such diagrams makes it clear that these are not charts showing acupuncture points or meridians. In reality, most such charts for animals date back no further than the 1970s. (For a more detailed look at the history of veterinary acupuncture, see Dr. Ramey’s book Complementary and Alternative Veterinary Medicine Considered).

The authors of the Sudhoff Archiv article also describe some of  the remarkable similarities between Chinese veterinary practices and those described in Greek, Roman, and other Western cultures. I don’t have the expertise to judge the plausibility of their suggestion that some of this similarity may be due to the spread of ideas from the West into China via Arab or Indian sources. Though I would not be at all surprised if disparate cultures came up with very similar theories about unseen forces responsible for disease and methods of manipulating these forces, it is an interesting hypothesis that the similarities are more direct.

Overall, the article is a detailed scholarly look at the truth about early Chinese equine medicine, and veterinary medicine more generally. It is particularly helpful in challenging the many inaccurate claims about the antiquity of veterinary acupuncture. While I do not believe the antiquity of a medical practice is useful in assessing its validity, it is a compelling argument for some, so knowing the truth about this particular practice is of more than just academic interest.

In any case, even if the suggestion that how many recalls one can remember for a given company or type of food was a reliable guide to safety, it is simply not true that alternative products or those marketed as “natural” and so on are not recalled. I don’t have any statistical analysis comparing the relative rate of recalls, precautionary or related to confirmed health threats, for all the pet food products out there, but it is easy to find examples of recalls involving raw diets, “natural” diets and supplements, and other products marketed as safer or healthier than conventional foods and treats. Dr. Susan Wynn, a veterinarian with specialty training in nutrition and an advocate of many veterinary CAM approaches, frequently reports such recalls on her blog, including several recently involving a raw diet for cats contaminated with Salmonella, and a long list of vitamins and supplements, also with possible Salmonella contamination.

These particular products may or may not present a danger to animal or human health, and certainly if there is a possibility that they do then voluntarily recalling them is the responsible thing for their manufacturers to do. But it’s important to remember that the claims of greater safety or health benefits from raw diets or supposedly “natural” food products are not substantiated by any evidence, and that these products, like any other, can have risks.

The study was performed in Brazil at the School of Veterinary Medicine and Animal Science in Sao Paulo, where a similar study published last year and another in 2007 were also performed. The authors created 3 study groups, all of which consisted of dogs that had severe neurological disease of >48 hours duration attributed to intervertebral disk disease (IVDD). Group 1 (DSX) was a group of dogs (N=10) selected retrospectively from patients that had undergone surgery for IVDD at the authors’ hospital between 2003 and 2006. Group 2 (dogs treated with electroacupuncture-EAP, N=19) and Group 3 (dogs treated with both surgery and electroacupuncture-DSX+EAP, N=11) consisted of dogs seen at the hospital between 2006 and 2008, and patients were assigned to these groups based on their owners’ choice.

All dogs were treated with oral steroids. Dogs in Group 1 were treated surgically with a couple of different techniques and presumably with whatever unspecified medical treatment and post-surgical care the individual surgeon elected. Dogs in Group 2 were treated surgically (and again presumably with additional unspecified followup care) and were also treated with electroacupuncture. This treatment consisted of the insertion of metal electrodes into the body at points determined by “traditional Chinese theory.” Electrical current was passed through these electrodes for 20 minutes weekly for from 1-6 months. Scores were assigned to quantify the level of neurologic dysfunction initially and at 6 months after the beginning of treatment. Improvement was judged based on decrease in neurologic score and regaining the ability to walk unassisted.

The results can be summarized as follows:

 The text indicates that the proportion of dogs in the DSX group that improved was statistically significantly lower than in the other two groups, and the proportion of DSX dogs that remained unchanged was significantly greater than in the other groups. From this, the authors concluded that “EAP was more effective than DSX for recovery of ambulation and improvement in neurologic deficits in dogs with long-standing severe deficits attributable to thoracolumbad IVDD.”

So is this conclusion justified? I believe not. To begin with, of course, we must decide what if anything this paper has to do with “acupuncture.” Electroacupuncture has been referred to as a bait-and-switch, because it is arguably not acupuncture at all. Obviously, the ancient Chinese lacked electricity, so the theories and guidelines developed for acupuncture in humans are not really relevant to the effects of electricity on the body (there were no specific guidelines for animals, and despite claims to the contrary it does not appear the Chinese routinely practiced acupuncture on animals before the mid 20th century). There is, however, a scientific medical therapy involving electrical stimulation to treat pain, transcutaneous electrical nerve stimulation (TENS). The only difference between TENS and electroacupuncture appears to be the selection of electrode location. TENS places electrodes in locations associated with known nerves, and in electroacupuncture the electrodes are placed at acupuncture points with no consistent relationship to any identifiable anatomic structures. However, by chance or perhaps some trial and error experience, some acupuncture points do happen to coincide with the locations of nerves, so it is possible that electroacupuncture might effectively be the same thing as TENS in some cases. So one might justifiably question whether any benefit seen in this study represents a validation of the theory and practice of acupuncture or an example of TENS with irrational selection of electrode locations.

However, there are other reasons to view the authors’ conclusions skeptically. A major methodological flaw of the paper is the process of selecting and assigning subjects. It is highly likely that there are biases inherent in allowing owners to choose what treatment group their pets should be in and in selecting one group retrospectively from one period of time and another prospectively during a different time period. This process does not allow the owners or researchers to be blinded in any way to the treatment, and it makes it likely that the patients and the treatment they receive in the various groups will differ with respect to many variables other than the one of interest in the study. The lack of blinding is of particular concern since the research center has consistently produced papers showing positive results for electroacupuncture and thus the researchers likely have a strong a priori bias in favor of the approach.

Very little information is presented to allow us to evaluate whether the patients differed in meaningful ways in terms of the medical therapy, surgical care, and post-surgical care they received. We do know that the EAP and DSX+EAP subjects received weekly treatments at the hospital for from 1-6 months after the onset of the study, and it is likely that they received much more intensive followup and post-surgical care (for the DSX+EAP group) as well as better owner compliance due to seeing the doctor so often after the study commenced. It is also quite possible that the differences in outcome were due to any number of differences in the populations of the various groups or the biases of the authors since these were not controlled for effectively.

There are other methodological problems, particularly the small number of subjects, but overall the two factors already discussed are enough to make me question the strong conclusions the authors draw from their results. It is certainly possible that electrical stimulation of some parts of the body could have a beneficial effect on outcome for dogs with neurological deficits attributable to IVDD. Better studies involving random prospective allocation of subjects, more consistency in the treatment of the subjects, blinding of the researchers and owners, and perhaps more precise assessment criteria would be valuable. I would be particularly interested, if there turns out to be some value to so-called electroacupuncture for this condition, in seeing a comparison of this procedure with electrode locations selected according to anatomic structures such as nerves compared with locations selected according to traditional Chinese medicine principles (insofar as such principles can be called “traditional” with respect to treating animals with electricity). It would take a robust and repeatable superiority of treatment at traditional acupuncture points compared with locations selected according to the principles of TENS to convince me that this procedure has anything to do with acupuncture.

They divided the claims into those for which there is reasonable evidence of some benefit (lower back pain) and those for which no good evidence of efficacy exists (headaches, migraines, colic, asthma, ear infections, neck pain, and whiplash). What is not surprising is that chiropractors, and the professional organizations that represent the profession generally, routinely suggest or outright state that their manipulations can treat conditions which they cannot. 95% of individual chiropractic websites made at least one such claim, and all of the professional associations did as well. 38% of the chiropractors made treatment claims concerning all of the conditions in the survey which chiropractic has not been shown to actually treat.

What is a bit more surprising is that many of the sites and organizations did not promote chiropractic for lower back pain, the one condition for which the evidence of some benefit is decent. Only 28% of the individual sites and 4 out of 9 association web sites specifically mentioned lower back pain. One would think they would be most aggressively advertising their treatments for the diseases for which the best evidence exists that they actually help. But remember, chiropractic is, for the most part,  really a faith-based practice founded on the non-existent subluxation and the vitalist “innate intelligence,” not an evidence-based medical specialty. It is true some individual chiropractors are exceptions to this rule and limit themselves to treating musculoskeletal pain. And there are some signs that the profession may be moving to downplay the subluxation mythology. But in general, the practice of chiropractic is still dominated by 19th century spiritualist notions and isn’t much interested in the verdict of science on its efforts.

So how do we explain the apparent de-emphasizing of the most reasonable claims chiropractic could make? I suspect that there is a deliberate effort on the part of the chiropractic profession to avoid getting limited in the public’s mind to treatment of musculoskeletal pain. Chiropractors want to be seen as an alternative choice to conventional medical providers, and they want to be involved in much more than just the treatment of musculoskeletal pain. So despite the lip service they may pay to the concept of evidence-based medicine, in reality they are convinced their treatments work for all sorts of problems regardless of the lack of evidence, and they want to protect and nurture the false impression the public may have that chiropractic is good for more than just back pain.

An example of the enthusiasm, and irrationality, of some proponents of this treatment can be found at the joint web site of the International Association of Veterinary Chiropractors and American Animal Adjusting Association.

The article on cold laser begins by anticipating and defying criticism:

Invariably a new technique or process is often fraught with counter-intentions that are usually seen throughout the field of study and across the board.  The relative benefit of such a process or new technology is directly proportional to the amount of consternation, doubt, and criticism that, it in fact receives….This author has seldom seen a technology as valuable and inspiring, as this particular technology appears to be. Suffice to say you are witnessing the emergence of a completely new age in healing and certainly a total paradigm shift in veterinary health care.

So the existence and strength of opposition to the technique should be seen as evidence of its benefits? Interesting logic. And if I haven’t mentioned it before, the use of the term “paradigm shift,” not to mention “completely new age,” are not only examples of ludicrous hyperbole, they are highly correlated with quackery, if not pathognomonic for it.

The underlying theory presented to explain the benefits of cold laser treatment is a bit of pseudoscience known as the Biophoton or Ultraweak Photon Emission idea. It is possible to detect very low energy photons emitted from living cells as the result of biochemical reactions. The significance, if any, of this for health and disease has never been demonstrated, which makes it a gap in real scientific knowledge into which all kinds of mystical nonsense can be stuffed, much like the pseudoscientific misuse of quantum physics. The veterinary chiropractic site advertising this treatment explains it this way:

It has been proven that cells communicate through coherent light.  When a sperm and ovum fertilize, they immediately give off coherent light at precisely 632.8 nanometers.

Cells in the living matrix also communicate throughout the total body living things via a coherent light, and that communication is done instantaneously through the living matrix to direct all aspects of healing, growth, regulation of metabolism, and general cell survival.    

To be able to dial into this communication process via an artificial methodology such as a cold laser is the ability to emulate the exact methodology is that the cells themselves use to heal themselves and also to grow, to change, and to survive. It has been said, “it is the way God talks to all cells, tissues, organisms and creatures.”

None of this is based on any sound science. It is merely vitalist, mystical speculation, which does not, of course, limit in any way the certainty and authority with which the fantasy is presented as scientific fact. This is yet another example of how chiropractic is fundamentally a pseudoscience based on imaginary “energy” and fake abnormalities like the “subluxation.” As such, it is open to any similar sounding nonsense, and any benefits it might have in practice are accidental and unrelated to the irrational and bogus underlying principles.

Like most pseudoscientific therapies, cold laser not only addresses the one true underlying cause of disease, it can also be applied in almost any way. Directly over diseased organs, in the general area of a symptom, even on acupuncture points associated with the meridians connected to the problem area. And since the proponents here are chiropractors, we should not be surprised to find that the use of lasers “is particularly effective in rehabilitating the effects of vertebral subluxation complex and their effects on the myofascial tissues affected by these subluxations.”

What else do these folks claim cold laser can do?

These protocols are designed to enhance a particular disease therapy or can be used in a general sense as the sole treatment of choice.

If a practitioner were to master only these protocols and use only these, he would be still far more effective than any of his colleagues to date using methods other than cold laser.

They list a number of general protocols first:

 Arthritis/Spondylitis/Myelopathy Protocol
Neuropathy Protocol
Immune Protocol
Lymphatic Drainage Protocol
Pre and Post Surgical Protocol
Liver Detox Protocol
Hormone Balance Protocol
Acute Pain-Injury Protocol
Sympathetic-Parasympathetic (S-PS) Balance Protocol
Acupuncture Meridian Balance Protocol
Infection Protocol
Allergy Protocol (Specific or General)

If one prefers a slightly more specific indication for the treatment, they can also provide protocols for laser treatment of:

Feline-

Abscesses
Chronic Inflammatory Bowel Disease (CIBD)
Feline Hyperthyroidism,
Feline Skin-Spinal Reflex, Feline Neurodermatitis, Endocrine Alopecia, Milliary Eczema
Kidney Disease, FUS, FLUTD
Megacolon
Pyorrhea

Canine-

Canine Hip Dysplasia Syndrome
Canine Idiopathic Epilepsy
Chronic Inflammatory Bowel Disease
Cushing’s Disease
Canine Wobbler’s Disease
Hypothyroid
Progressive Degenerative Myelopathy
Urinary Incontinence

Equine-

Arthritis, (General or Focal) Sore Back etc.
Bleeder (exercise induced naso-pharyngeal hemorrhage) Elevated Blood Pressure
Bronchitis, Bronchopneumonia, Pneumonitis
Bruising, Subcutaneous Hemorrhage, Wound Reorganization
Bursitis
Colic (all kinds), Bloat
Bone Injury, (splint bone and acute boney injuries)
Dermatosis, Urticaria, Hives, Rain Scald
Ear and Guttoral Pouch Disease
Edema, (general, hypostatic, ventral, extremities)
Equine Protozoal Myelitis (EPM)(see also Neurotropic Herpes)
Facial Nerve Paralysis, Lip Paralysis
Fear, Terrors, Miss-emotion, Training Problems
Hepatitis, Hepatosis
Hock Distension
Heart and Heart Related Conditions
Focal or General Inflammation
Lacerations
Lack of Focus in Training
Laryngeal Hemiplegia
Kidney Disease
Malignant Hyperthermia
Navicular Disease and Laminitis
Neurotropic Herpes (West Nile Virus?)
Proud Flesh, Excessive Granulation Tissue
Sepsis, (General or Focal)

So what is the truth behind all of these claims? Despite the nonsense of the underlying theory, is there any evidence cold laser therapy might have real benefits?

The answer for the vast majority of conditions is “No!” For a few conditions, the answer is more appropriately a “Maybe, but probably not much.”

Extensive reviews of the human literature have been done by the Cochrane Collaboration and the insurance companies Aetna and Cigna. These have found mixed but generally poor evidence for benefit as follows. A review of the veterinary literature on the subject can be found in Ramey 2004.

1. Cochrane Review for rheumatoid arthritis: 6 studies with a  total of 660 people were examined. There was limited evidence for a small benefit, with an improvement in self-reported pain of 1.1 points on a 10 point scale. The studies were short term and methodologically weak and inconsistent, and the conclusion was, as usual for Cochrane reviews, that no firm conclusion can be drawn and more research is needed.

2. Cochrane Review for osteoarthritis: This examined 6 studies, three of which found no effect and three of which found a benefit. The studies were methodologically weak and inconsistent and more research was recommended. The review has since been withdrawn pending analysis of additional evidence and correction of some statistical errors.

3. Cochrane Review for nonspecific low back pain: 7 studies of 384 people. Three studies (168 people) showed very small improvement in pain compared with fake laser. Three studies (102 people) found no difference. All the studies used different treatment protocols and short-term evaluation, so no firm conclusions could be made.

4. Cochrane Review for tuberculosis: One poor quality study from India was available and did not meet even basic methodological standards, so no conclusion could be drawn.

5. CIGNA Review: References 1-36

            A. Musculoskeletal Conditions: A number of studies and reviews in addition to the Cochran Reviews were examined. Generally, they showed no effect from most treatments for most measures but small benefits for a few measures in some trials. Overall, the evidence was weak and of poor quality, and it suggested some small  benefit for discomfort and range of motion might be possible.

            B. Wound Healing: Several systematic reviews were discussed, none of which showed convincing evidence of benefits for wound healing.

            C. Oral Mucositis: Two small studies were reviewed, one of which showed a benefit to laser therapy and the other of which did not.

            D. Other Medical Conditions: Reviews of laser use for temperomandibular joint disease and acute and chronic Achilles tendinitis found no clear evidence of benefit.

Summary: Low-level laser therapy (LLLT) has been proposed for a wide variety of uses, including wound healing, tuberculosis, and musculoskeletal conditions such as osteoarthritis, rheumatoid arthritis, fibromyalgia and carpal tunnel syndrome. There is insufficient evidence in the published, peer-reviewed scientific literature to demonstrate that LLLT is effective for these conditions or other medical conditions.

6. Aetna Review: References 37-81 (duplicates with CIGNA deleted)

” Although the results from large, uncontrolled, open trials of low-energy lasers in inducing wound healing have shown benefit, controlled trials have shown little or no benefit. The analgesic effects of low-energy lasers have been most intensely studied in rheumatoid arthritis. Recent well-designed, controlled studies have found no benefit from low energy lasers in relieving pain in rheumatoid arthritis or other musculoskeletal conditions. Furthermore, although positive effects were found in some earlier studies, it was not clear that the pain relief achieved was large enough to have either clinical significance or to replace conventional therapies.”

Published reviews indicate a lack of evidence for effectiveness for the following conditions:
chronic wounds, arthritis, tuberculosis, tinnitus, pain, smoking cessation, epicondylitis, Achilles tendinitis, plantar heel pain, back pain, and carpal tunnel syndrome.

Some evidence of benefit was found for the following conditions:
Raynaud’s phenomenon, pain following endodontic procedures, palpation sensitivity and passive extension in patients with shoulder pain (but not other measures), swelling following dental extraction when used in combination with steroids, tennis elbow pain in combination with plyometric exercise

Most of these studies were small and had methodological weaknesses, an most of their authors conclded that the treatment was promising but more research was needed to conclusively demonstrate a benefit.

7. Ramey 2004: References 82-100

Some studies have found evidence of improved wound healing in diabetic mice, dairy cattle, and laboratory rats. Other studies in rats and rabbits find small but clinically insignificant effects, and several studies have found no evidence of any effect on wounds in rats, guinea pigs, pigs, beagle dogs, and horses. A couple of poor quality studies of tendon and ligament injuries in horses have had conflicting results, one showing benefit and the other not. Other unblinded or uncontrolled studies in horses have suggested benefit for a variety of conditions. “Laser acupuncture” has been examined in uncontrolled and unblinded studies in horses, with the expected claims of benefit. Overall, there is weak evidence to suggest possible benefit in wound healing (though this conflicts with the results of higher quality studies in humans), and many claims made based on studies so poorly designed as to be no different from mere anecdotes. There is no good quality clinical research on which to base firm conclusions, or to support the dramatic claims of laser therapy proponents.

Overall, then, the theoretical foundations for low power laser therapy range from questionable to completely nonsensical pseudoscience. The in vitro research does suggest some real effects on living cells, but it does not indicate that such effects would be achievable or beneficial in actual patients. The human clinical research is extensive but of generally poor quality with no consistency to the laser treatment methods investigated, and it provides only very weak evidence of any clinically meaningful effects. The veterinary research is even more limited and of poor quality, ad it to is mixed with little convincing demonstration of real clinical benefits. All of this suggests an appropriate stance towards this therapy would be neutral to somewhat pessimistic, though certainly better quality research could identify some meaningful clinical benefits. The evidence does not support, and in some cases directly contradicts the claims made by the chiropratic organization website and much of the marketing materials on cold laser therapy veterinarians receive.

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