Frequently Asked Questions (FAQ)

Who are you?

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. The focus remains on the issues, ideas, and facts under discussion, not on irrelevant personal details about me.

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). You can find my identity here. But before you do, 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.

Have you tried all the methods you criticize for yourself? How can you know if something works or not without trying it?

A core belief that seems to run through all kinds of alternative medicine is that personal experience is the best way to evaluate a medical treatment. This is the central issue that divides scientific medicine from pseudoscience and faith-based medicine. If you believe that the personal experience of pet owners and veterinarians is as reliable, or even better than, objective scientific research, then nothing I say in this blog is going to make any sense to you.

I am often criticized for being arrogant, for thinking that just because I have studied the scientific evidence I know better than people who have practiced or used alternative medicine for years. The truth is that arrogance is believing our own perceptions and impressions are trustworthy and sticking with what we believe regardless of the amount of evidence against it. True humility lies in recognizing our limitations and acknowledging that we are easily fooled, especially by ourselves. We see what we want and expect to see, we notice facts that support our beliefs and ignore those that contradict us, and we cannot suspend or compensate for our own biases just by willpower and honest intentions. Sure, I’ve tried some alternative therapies, and some seemed to help while others didn’t. But I know enough to know that that is not how I should decide whether or not they work!

The history of medicine makes it clear that the scientific method is not simply one of many equally valid ways of looking at heath and disease. It is a more effective way because it compensates for the innate flaws in human perception and judgment. In only a couple hundred years, science has allowed us to double the average life expectancy of human beings (at least where modern nutrition, sanitation, and healthcare practices are available), eliminate some diseases all together (such as smallpox), and make other improvements in health and well-being that were never achieved in the thousands of years we relied on intuition, tradition, and individual experience to evaluate the causes and treatments of disease and the best ways to maintain health. Pre-scientific medicine persisted in practices such as bloodletting, purging, and the use of toxic “natural” medicines such as mercury because they seemed to be effective, although they actually did more harm than good.

In the modern era, many practices that patients and doctors believed were effective based on personal experience and judgment turned out, when studied scientifically, to be worthless or even harmful. Mammary artery ligation surgery and arthroscopic debridement and lavage of arthritic joints are a couple of examples in human medicine. And there are just as many examples in veterinary medicine. For years we gave antibiotics to young cats with blood in their urine because we thought they had urinary tract infections. They almost always got better on the medication, so the vet got the credit and everybody was happy. Unfortunately, controlled scientific researched showed that the cats didn’t really have infections and they would get better just as often and just as fast if we didn’t give them antibiotics, and without the risk of vomiting and diarrhea from the medication.

Personal experience and anecdotes are incredibly powerful and persuasive. They just aren’t reliable guides to the what really works and what doesn’t. And the hardest part of accepting science-based medicine, and all the remarkable successes that have come from it, is having the humility to acknowledge that what seems obvious to us isn’t necessarily so. Below is a collection of resources which I recommend for starting to come to grips with this unpleasant truth.

Books 

Don’t Believe Everything You Think: The 6 Basic Mistakes We Make in Thinking by Thomas Kida

Why People Believe Weird Things
by Michael Shermer.
Becoming a Critical Thinker- A Guide for the New Millenium by Robert T. Carroll

Blog Articles

The Role of Anecdotes in Science-Based Medicine

Why We’re Often Wrong

A Budget of Anecdotes  

Why We Need Science: “I saw it with my own eyes” Is not Enough

Videos

Pitfalls of Thinking: Anecdotal Evidence

 

 

Are you paid by the pharmaceutical industry or commercial pet food companies? Aren’t you just afraid of alternative medicine because it threatens your income?

I am an employee in a private, small animal practice. I get paid a salary, so how much money I make isn’t connected at all with which/how many drugs or other medical products I use or sell. I could also make a lot more money doing other things, but I stick with clinical medicine because I believe it is important and ethical work and because it is challenging, interesting, and satisfying intellectually and emotionally.

I do not receive any money directly from pharmaceutical companies or commercial pet food companies. I do not accept gifts from such companies, though I cannot guarantee that I haven’t ever used a pen or pocket calculator with some company’s logo on it. And I have participated as a researcher in clinical trials sponsored by pharmaceutical companies investigating new veterinary medicines.

I do think there are legitimate and serious concerns about the influence of industry funding on the reliability of scientific research and the practice habits of individual doctors.  As a supporter of the All Trials Initiative, I feel strongly that all the information produced in the course of drug development should be freely available to the public, as should potential sources of bias or conflict of interest.

However, the notion that scientific medicine is all about corporate profit and that alternative medicine is an altruistic labor of love is self-serving nonsense. Providers of alternative therapies make their living selling the products and services they believe in, and so do I. And all those “free” and “unpatented” natural remedies are manufactured and sold by a multi-billion dollar supplement industry that is no more altruistic than any pharmaceutical company. Attempting to dismiss my arguments as financially motivated is inaccurate, lazy and, for anyone who also works in healthcare, hypocritical.

Some more detailed responses to this line of argument:

The David and Goliath Myth

Big CAM, and Getting Bigger

The AHVMA-Bought and Paid for by Big Supplement?

The “pharma shill” Gambit

The Ad Hominem Fallacy

93 Responses to Frequently Asked Questions (FAQ)

  1. skeptvet says:

    Thanks for the feedback. The purpose of all the work that goes into the site is to be useful, so it’s always great to hear when someone feels it is!

  2. Dave says:

    Thanks for the great site. I was just curious if there has ever been an “alternative” treatment for pets that turned out to be scientifically sound?

  3. Kathy M says:

    Your comments are so refreshingly well-reasoned, concise, and kindly delivered. It is so hard to find information, like good medical studies, on things like probiotics, and you did help me think it through without any hard evidence to go on. Thank you and keep up the good work!

  4. skeptvet says:

    Thanks so much for the kind comment. Helps balance all the hate mail! 😉

  5. broken_hearted_ says:

    I personally wish more vets would question certain scientific evidence. I recently lost my 9 year old dog to congestive heart failure. On four separate occasions I addressed one of his medications (Pimobendan) as possibly overloading his heart. My dog suddenly presented with loss of appetite, lethargy, an arrhythmia and chordae tendineae rupture while on this medication. You could literally see his heart beating against his little chest wall. My concerns were completely dismissed and within two weeks he died tragically in the ICU after going into severe respiratory distress. We didn’t even have time to euthanise him painlessly as they called me two minutes before he went into arrest and there was no time. I now have to carry the weight of the sorrow, guilt, blame and anger for the rest of my life. I have since learnt a lot more about the medication that I wasn’t told (such as the recommendation of exercise restriction and that dogs in early CHF who still have strong hearts should not take this med).

    This particular drug seems to be touted as some kind of miracle drug with unquestionable benefit. While it may work for some dogs it certainly didn’t help mine. I feel like my dog died (or at least had his heart disease accelerated) due to a reliance on scientific data rather than his individual case. My dog was my responsibility and trusted me to keep him safe. I questioned daily whether to remove him from this medication myself but continued to follow the cardiologists advice. Like I said I’m the one who has to try and live with that (meanwhile, no offence, the vet just walks away).

    I am not condoning purely holistic remedies or ignoring your vets advice but I do believe in anecdotal evidence and that no one knows a pet like their owner. Therefore I believe the owners observations of that animal should be taken into account when deciding treatment.

  6. skeptvet says:

    I am sorry for your experience, and of course I can’t have an opinion on the medical decisions made because I don’t have access to the details. And certainly the observations of an owner are a key factor that always has to be taken seriously.

    But I think the problem with saying that more account should be taken of individual experiences and less of scientific data is that it leads to complete arbitrary and irrational decisions. Of course I believe the scientific evidence in favor of proper use of pimobendan is strong. But if we are relying on personal experience, I have also seen literally dozens of dogs whose live shave been saved and whose suffering has been greatly diminished by it. So if my experience is different from your experience, and we don’t rely on more objective data, then we are stuck with no way to decide what to do. Do we stop the medicine because you fear it may be doing harm? Or do we continue because I feel it is helping? You can find every possible anecdote, from miraculous success to complete disaster, for every medical therapy ever tried. If this is all we have to go on, medicine becomes a matter of mere individual whims.

    And the fact is that research evidence in human medicine has repeatedly shown that when doctors disregard the evidence in favor of their personal experience, most of the time their patients do worse than the patients of doctors who follow the evidence. And historically, anecdote and experience was the driving force behind all medical care for thousands of years. Yet it is only in the last few centuries, when we turned away from anecdote and towards science, that we have seen the miraculous improvement in health and lifespan that we now all take for granted. So I think there is strong reason to believe our patients are better off if we follow the science.

    Of course, it is tempting to imagine that when something awful happens, as it did to you and your companion, that it could have been prevented if only we had made different choices. Unfortunately, I believe that often that is simply our anger or guilt or grief talking, and that the reality is we cannot always control everything that happens. Again, I am not in a position to make a judgment about your dog’s care, but having been a vet for many years, I have reason both to believe that evidence-based medicine works better for my patients and that many times the judgments we make in the immediate aftermath of a tragedy are driven but our emotions and don’t always lead to the best decisions.

    In any case, as a pet owner myself, I am sorry for your loss.

  7. Kelly says:

    broken hearted,

    People die, dogs die.
    Medicine is still a practice, not a definitive science or mathematical equation.
    Nothing you could have said would have swayed the treatment.

    I understand your anger and hurt… I have lost dogs as well, one in particular was such a difficult loss that I swore off ‘forever’ to ever have another.

    Enjoy them while they are here… good advice for people too.

  8. kathryn lewis says:

    How do you feel about probiotics for dogs after being on antibiotics?

  9. skeptvet says:

    I’ve written a number of posts on probiotics. While there is a long way to go in figuring out exactly which organisms are useful for which problems at what dose, etc., I do think there is good evidence for benefit in prevention and treatment of diarrhea associated with antibiotics in humans, and some evidence in dogs, so I think this is a reasonable use of these products. The catch is that studies have shown most over-the-counter probiotics for animals don’t actually contain what is on the label, and many don’t have any live organisms at all! So you have to be really careful about the product you choose. Prostora and FortiFlora both have some evidence to suggest better quality control than many products.

  10. Judith Raimondi says:

    I truly appreciate your effort to provide evidence based information. I am sickened by the confusion that fear and influence produce in what many believe to be ‘real’ information. That being said I often find it difficult to find the information I am looking for when I am searching the internet for genuine input in places other than yours. One example is the interest I have in evaluating and deciding which oral flea treatment to choose for my dog (who is only 9 weeks old at the moment, so I have some time to decide). Do you have data in support of a particular oral flea treatment, or a warning against others? I find hysteria and exaggeration everywhere I look when all I really need is an educated and informed choice.

  11. skeptvet says:

    I generally recommend relying on scientific research data published either in peer-reviewed journals or as part of testing for regulatory approval because this is the most reliable data we have about safety for these products. Anecdotes can be useful to suggest uncommon reactions that might occur, but they can’t prove these are actually related to the products, so they have to be followed up with controlled testing. The published data, of course, are never perfect. Limited number of animals and limited periods of time as well as association with the companies selling the products do introduce some limitations. However, these data are still more reliable than random horror stories collected on web pages like “Drug X Killed My Dog.com”

    Here are a few of the product inserts for common oral flea control products that list the kinds of side effects seen in the treatment and placebo groups in regulatory trials:
    Comfortis
    Trifexis
    Nexguard

    As far as personal experiences, I prescribe all of these, and I’ve seen a few minor reactions, mostly nausea or diarrhea. I don’t see any big advantage or disadvantage to any particular product. But again, this is just uncontrolled observation, so not particularly reliable.

  12. Hi Thanks for the thoughts about scientific evidence. I have been practicing Vet Medicine for 34 years and have to take a back set from time to time reflecting on the value of a few of the procedures we do at our Veterinary practice. I am the oldest Vet in a 11 Vet Hospital and maybe question more than I should. The younger Vets are very good but I think its easy to get caught up in believing that a new product is always a good product or always a good therapy .

  13. Kay P says:

    I really appreciate your blog and Facebook page. So much information, opinions and emotion is swirling around “out there” concerning pet care and husbandry. It can be extremely confusing to find reason and credible information, even in something as simple as deciding on what food to feed my dog. Too bad the internet has become so useable by the snake oil salesmen of today.

  14. skeptvet says:

    Thanks, I’m glad my work here has been useful! 🙂

  15. Justin says:

    Hello, I just wanted to thank you for what you do here. I don’t know how you put up with the hate mail and the rambling irrelevancies people post here – I would have thrown in the towel long ago. Thanks again!

  16. skeptvet says:

    Thanks, such support helps a lot! 🙂

  17. Mike says:

    Can you recommend a kibble for my 1 year old female siberian husky who weighs 50 lbs. I’ve fallen prey to the raw cookoos and am now turning back to science but I want to feed her the very best kibble. I’m not concerned about cost and I live in british columbia canada

  18. skeptvet says:

    I don’t have brand preferences since I think most of the differences claimed between brands are just marketing. There is no science behind the idea that some foods are generally “better” than others. Apart from a food that meets the AAFCO standards for nutritional adequacy, there aren’t and simple tests to evaluate the quality of pet foods. I would strongly suggest reading Dog Food Logic, a really informative guide to the dog food business that may help you in your decision making.

    Good luck!

  19. R says:

    @ Mike
    If I may add, I have owned a lot of dogs over the years and have learned that different things work for individual dogs. For example, if I give one of my dogs a chopped up green vegetable, he vomits about an hour later. My other dogs have no problem with greens.
    Trial and error. I have had good luck with Nutrisca (Salmon and Chickpea), or Wysong as a base, but, I like to add a bit of cooked chopped up chicken breast or lean meat. Newman Organics canned seems to agree with my senior. Best of luck.

  20. Paula McGlashan says:

    Greetings from Oz. What an invaluable service you provide to counter the plethora of pseudo-scientific nonsense flooding social media. Recently in Melbourne, we had a group of “holistic” devotees, including Dr. Karen Becker and Dr. Ian Billinghurst (former a homeopathy & acupuncture promoter and the latter a ‘leading light’ for BARF). Rodney Habib (apparently an editor for Dogs Naturally Magazine – BS detector lights up on this one) was also a presenter. I could have gone but I would have been kicked out of this ‘conference’. The anti-science brigade is strong in Australia when it comes to pets. Hopefully more vets will support the fight against non-scientific dogma. Cheers mate. Paula

  21. skeptvet says:

    Thanks for the comment. Helps to balance all the hate mail! 🙂

  22. patricia says:

    hello, your link to “who I am” is broken.

  23. skeptvet says:

    The link, which leads to a Word doc with my CV, seems to be working for me. Perhaps it’s a firewall issue?

  24. Mia says:

    Hi, I am a medical student and find your blog to be so helpful! I have a 3.5-yr-old cat with periodontal disease and many missing teeth (lots of incisors and 1 canine) when I adopted him at 1-yr-old. He has had several health issues recently (weight loss, yeast infection) and shows elevated WBC in his blood work. He is negative for FeLV and FIV. The vet thinks it is all related to his dental disease and has noted that it is unusual for him to be missing so many teeth. We are trying to schedule surgery and cleaning but are waiting for him to return to health. Do you have any idea what could be the cause of so many missing teeth? I’ve been trying to do my research online but when it comes to pets, resources seem to be limited to inane pet forums and natural remedies. Wishing I went to veterinary school!

  25. skeptvet says:

    A young cat missing a lot of teeth may still simply have advanced periodontal disease (remember, most get zero brushing, flossing, or other preventative dental care), but it is more common for this to be due to FORL (Feline Oral Resorptive Lesions). Here is an article from a veterinary dental specialist discussing this problem. I would encourage you to see a dental specialist if possible unless your regular vet has a lot of experience with advanced dental disease, as opposed to routine prophylaxis.

    Good luck, and glad the blog is useful for you.

  26. Tracey savva says:

    Hi could do with some objective advice. My beloved 13year old border terrier has arthritic pain in front legs which has steadily been getting worse, he had bad case of pancreatitis two years ago and vet then said not to use steroids now vet has put him on tramadol 50mg , in a divided dose. Pain seems a little better but he is very dopey, he is very stoical but I obviously want to manage his pain , my vet very vague about what a therapeutic dose is. Would be grateful of your thoughts.

  27. skeptvet says:

    I’m afraid this is the sort of specific question it really isn’t appropriate for me to handle on the internet. There are a wide variety of medications and non-pharmaceutical options for dogs with arthritis, and the best choices depend on all the details of your particular situation. If you aren’t getting very specific, clear communication from your vet, you might be better off finding another doctor you can discuss these options with in detail.

    Good luck!

  28. Carl says:

    So, what is a natural remedy for arthritis in dogs that work? My poor baby is really hurting.

  29. skeptvet says:

    The term “natural” is basically meaningless, and it doesn’t tell you anything about whether a treatment is safe or effective. There are many effective treatments, but you can’t choose to try some and avoid others on the basis of what claims to be “natural.” Non-steroidal anti-inflammatory medications, other pain relievers, weight control, physical therapy, and fish oils are all treatments with some good evidence for efficacy. Don’t let your baby suffer out of fear of real medications that can help. Here is a summary of some common arthritis treatments.

  30. Annie says:

    I found your blog while looking for a community of skeptic pet owners. There’s no forums or anything that I know of. I’m really tired of all the woo woo belief and exploitative holistic crap I see out there – especially since the types that push those things often act like you’re killing your dog if you do anything against what they recommend. It tends to leave one with few friends in the dog world. I’d like to be able to talk to others about training, nutrition, and health in a inquisitive, critical, and logical way, but those woo woo types are often too high strung…

  31. skeptvet says:

    There is a listserv mailing list, altvetskept-l @ po.missouri.edu.

  32. Gary says:

    Please unsubscribe me from your blog emails. Thank you

  33. skeptvet says:

    I don’t see your email in the subscriber list. If, however, you are getting emails from the site, there will be an unsubscribe link you can use to stop receiving them.

  34. Todd says:

    Have you ever taken a good luck at Five Leaf Botanicals for canine kidney disease? I’m guessing you’d find it lacking, but just curious. Like many, our little girl is in kidney failure and we are desperate to help her.

  35. skeptvet says:

    You’re right, I find the claims on the web site not only unconvincing but troubling. The products are a kitchen-sink mix of herbs, and there is no research evidence to show the mixture is safe or has any benefits. And the claims about “toxins” and “blood cleansing” and other aspects of health are pretty strong warning signs of snake oil.

    While herbs undoubtedly contain chemicals that can affect health, they can benefit or harm the patient or have no effect at all depending on the plants used, the compounds they contain, the formulation, and the details of the disease being treated. It’s very complex and requires extensive research to ensure safe and effective treatment, and sadly this is virtually never done. Safety is assumed and efficacy is judged by testimonials, which are unreliable and can lead to serious harm.

    I understand your desperation, but I hope it doesn’t lead you to make rash choices or grasp at straws, and I am sorry that so many companies like this are going to try and take advantage of your desire to help you companion. My advice is to work with a soundly science-based veterinarian, ideally a board-certified internal medicine specialist if one is available, and make sure that the treatments you try have at least some reasonable evidence to suggest they might help and won’t hurt your girl.

    Good luck!

  36. Holly says:

    Seeing the use of snake oil alternative ‘medicine’ grow like a malignant tumour amoung pet owners makes me want to throw in the towel and I’m not even practicing yet! I admire your strength.

  37. jules says:

    By the way “your identity doesn’t matter”? Your background and education doesn’t matter? You are crazy. No one in their right and critical thinking mind is going to go off of what you say if you can’t tell people who you are and what your background is. You gave the woman who asked you a very curt and sarcastic answer as well. Just wanted to point that out to you in case you may not have realized it.

  38. skeptvet says:

    And I will point out to you that judging the truth of a claim based on the identity or credentials of the person making it is itself biased and fallacious reasoning. You will likely take this as unkind of “sarcastic,” but the fact is you are mistaken. When I present an argument and supportive evidence for that argument, knowing who I am only gives you excuses to dismiss things I say you don’t like or accept things I say that you do like on the basis of things that aren’t actually relevant. And, as I said before, you obviously have embarked on a criticism of the blog before bothering to read much of it or carefully consider what I’m doing here, since my identity and credentials are readily accessible to anyone who makes the effort. But before you go looking for them, ask yourself why it matters. Will you change your mind about what I’m saying based on who I am. If I have extensive scientific training, does that make what I say more acceptable to you, or will you just say I am part of a system that unfairly rejects or ignores the types of treatments you like? If I have “holistic” credentials, does that make my critiques of holistic medicine more acceptable? If I’m a self-educated janitor, does that mean you can ignore what I say despite the detailed arguments and voluminous evidence I present? How are you going to use what you learn about me to inform your judgments? I suspect you will use it to reinforce the judgments you have already made, which is what most people do and which is why, ultimately, it’s an irrelevant distraction from the substance of discussions here.

  39. Sandy says:

    Just wondering if you have heard about a product called Synovan. This is for the treatment of arthritis in dogs. My vet thinks my dog should be put on this medication but I want to find out more about it. Thanks

  40. skeptvet says:

    The product contains glucosamine, which I’ve written about extensively and which likely has no benefits. It also contains pentosan polysulfate. There are only two studies on this compound, using a different product, both with significant limitations. One suggested some benefit and the other found no benefit. So uncertain but no strong evidence either way.

    Good luck!

  41. Clare Pattison says:

    How does Ubiquitol compare with COQ10 in aiding heart health. I have cavaliers a breed predisposed to MVD conditions.

  42. skeptvet says:

    There’s no meaningful difference. Ubiquinol is simply the active form which the body produces from CoQ10, so either way you end up witht eh same compound in the body.

    More importantly, there is no research evidence to suggest coenzyme q10 is of any value in cavaliers with MVD. It is recommended entirely on theoretical and anecdotal grounds.

  43. amanda says:

    I, fellow skeptic, landed here after a vet recommended Cranandin to help combat my 13 year old dog’s recurrent UTIs. Looked into it and was immediately put off by the product’s heavy handed marketing speak (a sure way to trigger my BS detector). After reading your critique, I decided not to spend $50/mo on Cranadin’s “FIM0806 (registered trademark) proprietary veterinary researched” magic and picked up some regular cranberry extract at the local healthfood store for $9 (3 month supply) as a trial.

    Thank you for this site, whoever you are (I bet you probably type as an INTJ on Myers-Briggs!).

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