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

100 Responses to Frequently Asked Questions (FAQ)

  1. CMCK says:

    OK, I get that you want to remain anonymous, but…
    Maybe a little info about where you studied and graduated, how long you’ve been in practice, etc might be helpful.
    Its a little hard to argue for Empirical Data when your source is just “some anonymous blog on the Internets” dontcha think?

    I’m betting in your practice you roll your eyes at least once a week when a patient’s owner says “I read on the Internet that…”.

    Also – I’m new to the blog (and digging it so far), but can you explain why you (or maybe its a wider school of argument) put complimentary treatments in the same place as “alternative” treatments?
    And do you equate one or both with holistic veterinary medicine or are there differences (because I see you call it CAM and not Holistic.

    Thanks for your time…

  2. skeptvet says:

    To be fair, if you’d like more information about me to judge the validity of my statements, shouldn’t you provide similar information about yourself? I would probably use very different approaches to explaining my position to a vet who practices exclusively holistic medicine than to a lay person or the owner of a nutritional supplement company. And how can I know if you are honestly interested or just looking for ways to attack me if I don’t know who you are? See the dilemma? Of course, on the Internet there is no way to verify that anything either one of us says is true. After all, “On the Internet no one knows you’re a dog.” 🙂

    As for arguing for the value of data over opinion, I am careful to cite such supporting data when I make factual statements, so you are always free to find and examine the source directly rather than take the word of some anonymous blogger for it. That is, after all, the whole point.

    Anyway, for what it’s worth (not much, in my opinion), I am a small animal general practitioner with 10 years in private practice, graduated from a highly ranked U.S. veterinary school, and my CV contains all kinds of impressive-sounding awards, a few mainstream journal publications, and lots of related and unrelated extracurricular activities. Life is too interesting to just do this all the time! But again, as I say in my FAQ, try to be careful, and honest, about what you use such information for. If I said I was a nutritionist working for Purina, would that make my points sound more valid because I had extensive education and experience in animal nutrition, or worthless because I was obviously a mindless drone serving the evile Corporate Dog Food Empire? Would the difference have anything to do with whether what I said was true, or just with your preudices?

    Personal information tells us a little about a person’s biases, but it doesn’t tell us whether what they say is true or not. Ultimately, it just feeds our desire to categorize that person according to our preconceptions and then judge what they say accordingly, which doesn’t strike me as seving the search for truth very well.

    As for “complementary” vs “alternative,” the difference is mostly a marketing approach. Alternative is the older term used to market therapies without good scientific rationales and supportive data as if they were exempt from having these things because they obeyed some seperate-but-equal philosophy of medicine that could supplant scientific, or as its detractors like to call it “Western,” medicine (as if somehow antibiotics aren’t widely used or effective in, say, China). When the public refused to buy into this on a large scale and give up conventional medicine, the CAM community changed tactics and started to argue that the very same therapies could be used along with scientific medicine and that they complemented it.

    This was a more successful strategy because people didn’t have to give up what is proven to work but could imagine they were simply doing even more for their health. Unfortunately, this is a specious argument because these therapies either have a benefit or they don’t, and if it is proven that they don’t (as with homeopathy, for example) then adding a useless therapy to real treatment doesn’t add any value. Nonsense doesn’t “complement” real treatment, and giving more “options” or “choices” to the patient isn’t a real benefit if those options are not actually doing anything.

    So for the time being both terms are in use by both proponents of CAM and skeptics, sometimes interchangeably but usually with the distinction being whether the unconventional treatment is billed as compatible or incompatible with conventional treatment. The treatments themselves are the same, it’s just the philosophical approach and advertising that goes with them which differs.

  3. Kevin Saldanha says:

    Thank you for providing this forum. I learned about it from Vet Practice News and the court case against the RACE organization.

    Kevin

  4. skeptvet says:

    The VPN article was terribly biased and one-sided, and my remarks were taken so far out of context as to be at best incoherent and at worst interpreted in opposition to what I intended. It shouldn’t be a surprise given the generally friendly tone towards CAM usually found in VPN, but still disappointing to see no more than the barest pretense of objectivity in the press and to see a small group with such an extreme anti-science ideology portrayed as a significant and reasonable segment of the profession.

  5. Richard McAroy, DVM says:

    Bravo. As a fellow veterinarian, I’m elated to find a voice of reason regarding veterinary “fads” and “quackery” on the Internet.

    For example, it’s often nearly impossible to have a rational discussion with a client regarding the use of “holistic” or “organic” diets which make dubious claims of miracle cures while simultaneously casting veiled threats against veterinarians who recommend mainstream proven diets. After all, the irrational and loud voices on the internet claim that veterinarians are in the pay of the big pet food companies.

    If this is indeed the case, would you please let them know that I have about 13 years of back pay coming my way? I have yet to receive a single kickback check.

    Thanks again 🙂

  6. skeptvet says:

    Always nice to hear from someone who finds my work useful. Balances out the hate mail!

    Good luck collecting your kickbacks. 😉

  7. Douglas Schrepel, DVM says:

    I become more and more dismayed every day as I see my colleagues promoting therapies for which little on no scientific evidence exists. And then there is the almost daily, and always exhausting, effort of explaining to my clients the nature of reliable evidence, and the importance of proportioning ones beliefs about a claim to the amount of evidence that exists.
    I started looking on the web for some help, and your blog and website look fantastic. Thanks for taking up this important fight.

  8. skeptvet says:

    Yes, it is dismaying and often exhausting. But comments like yours definately help keep me going, so thanks.

  9. Sam says:

    Hi Skeptvet. I actually really enjoyed your site and appreciate your views. I am not a vet. In fact, I don’t know much about animal physiology at all which is what brings me to contacting you… I work in the field of CAM. Evidenced based CAM for humans. I work with a consortia of fellow researchers developing clinical trial protocols for assessing the efficacy of nutraceuticals and herbal medicines for an array of conditions in humans. This industry could certainly do with more folks like yourselves particularly in the up-front protocol and clinical trial design process with the aim to remove bias and confounding elements as much as possible before a costly study takes place. Is this something you have considered before?

  10. skeptvet says:

    Thanks for the comment.

    In addition to my clinical practice, I do have some training in epideiology, and I am actually designing a clinicl trial involving probiotics that I hope to begin next year. However, I am not primarily a researcher nor a clinical trials specialist, so I don’t have any place to make clinical trial design a career.

  11. Caroline says:

    Hello, I have just discovered your website through a similar blog of a french veterinary (http://www.boulesdefourrure.fr/index.php). I am really happy to have found another interesting, useful and humourous veterinian blog! (And in addition in english which is good for my language practice!) Thank you and greetings from France, I am going to read some articles now 😉

  12. Elena says:

    I have a question about the BARF diet but it’s long and involved. Is this the right place to ask it?

  13. Howard Paul says:

    My dog (Rikki) was diagnosed with arthritis almost a year ago. I think it had been with her for 2yrs or so. I had noticed that she was less active ….if you were not with her 24/7; you probably wouldnt notice it. Anyway; a few years ago I took levaquil to treat my pneumonia….it was great…..Except i noticed that 1st 1 shoulder then the other started to become painful and increasingly so. I did not put the 2 together until i saw on the internet there were lawsuits all over the place claiming levaquil,,,,blah blah.
    I was sent to specialist who said i had an impingement and gave me a shot of cortisone . He said it may work for a week…..forever or not at all. That was 4+ yrs ago. My shoulders are fine. My inquiry is why wouldnt it have the same effect on an arthritic condition? I know they are not the same (arthritis/impingement); but seem very similar…..So maybe you can educate me and maybe give me some hope for Rikki

  14. skeptvet says:

    Steroids (specifically glucocorticoids) are anti-inflammatory medications, and so they can provide relief from arthritis symptoms when given orally or injected into joints. The problem is that they have a number of serious side-effects when used at high doses or for prolonged periods, including contributing to the futher deterioration of arthritis joints. Non-steroidal anti-inflammatory drugs (NSAIDs) are also effective for arthritis symtpoms but have far fewer side-effects, so they are the treatment of choice. You can take a look at my review of arthritis treatments, but I would certainly talk to your vet about the options for Rikki.

    Good luck.

  15. Kate says:

    CMCK says: “”I’m betting in your practice you roll your eyes at least once a week when a patient’s owner says “I read on the Internet that….”””

    Just the opposite. Last week after a battery of (very scientific) blood tests, my dog was found to have very low level of T4. The vet wanted to put him on thyroid supplement instead of thyroid replacement treatment. After I went home and “read from the internet”, that Levothyroxine is the chemical I need to get for him. When I asked for a prescription the next day, the vet rolled her eyes because I questioned the effectiveness of her $53, 11 grams, 100% recycled paperboard packaged formula. She said, “Trust me.” I felt so uneasily inferior.

    A science based vet has no problem issuing a Rx for his patient, and the owner goes elsewhere to have the prescription filled. A vet who practices “mixed” medicine, however, becomes irritated when she can’t profit from the in house, not available online supplement which she sells right in her clinic.

  16. Kate says:

    I have become very disillusioned with mixed vet.
    Here is what I found: http://doctorsupportdata.com/documents/Potential%20Revenue%20-%20Vets

  17. Ola Bovin says:

    Thank you!
    I was asked by my wife to figure out why our dog is eating pot-soil. I started reading on the Internet and soon realized that there are a lot of self-proclaimed experts and less scientific evidence. I looked at the dog- food manufacturer’s website and found nutrients, but how do I know if it is enough nutrients for my dog? The recommended daily allowance is not something that is stated on the web-site.
    I saw websites where it was stated that a male Labrador should be max 80 lb. Our lab was 100 when he was 1 year old and you could clearly see his ribs. How can I say things like that just based on the breed? Jeez! Does all humans look the same too? Should a male Caucasian weigh 72 kg?
    I need my truth to be based on something else than a hunch.
    Cheers!
    Ola.

  18. Phil Hart says:

    Thank you for sharing information about your background and experience. I respect you choice not to share your name, but to share your reasoning. Keep on doing what you are doing.

    Yes, I have a 9 year old German Shepherd recently diagnosed with cancer.

    I have a friend who believes Steven Eisen and his diet can cure her dog of cancer. My vet has also discussed Chemo with me. I have read and believe what you have written about Eisen. I researched him before watching his tapes and reading his books.

  19. Thanks for the blog. I really appreciate the research based information. I have a lot of questions about treatments that are available that everyone will tell you how wonderful they are without understanding why. I hope to become less confused with each new post.

  20. Tony Smith says:

    Putting the most ridiculous questions in your FAQ – how self-serving. I am totally committed to evidence. But the evidence shows you are as biased as the folks you criticize.

  21. skeptvet says:

    Care to share any specific objections, or did you just want to snarl and run?

  22. v.t. says:

    How about a change of subject, after all, this is a FAQ page. And I have a question 🙂

    Skeptvet, would it be possible to extend the “recent comments” on the sidebar to allow for more shown? Around 10-15 maybe? I realize WordPress can be difficult sometimes to work with but if possible, could you pretty pretty please consider?

  23. v.t. says:

    Oh, thank you, thank you! I hope it was no trouble for you, it’s cool to be able to see more comments, especially since your blog moves so fast!

    Thanks, again, skeptvet, I’m a happy camper now 🙂

  24. Murray Webb says:

    I can appreciate your desire to rely on published literature in peer-reviewed journals in terms of guiding your decision-making around animal care. I’m sure that much published research is worthy, and adds something to the body of knowledge in the discipline concerned.

    That said, money talks – and sometimes it talks quite emphatically. Back in the mid-late ’90s I worked for a top 3 global pharmaceutical company with turnover (then) in the mid $20B range. One of their market-leading drugs was nearing the end of its patent life, so a small modification was made to create a “new” drug and, therefore, a new patent was born.

    Thirty-eight clinical trials were done with the revised drug prior to commercial launch, comparing it to the older drug. Thirty-six of those trials showed no advantage to the new drug – 2 did. The 2 favorable studies were put forward to peer-reviewed academic journals and were subsequently published. The other 36 – some of which actually showed the new drug to be inferior – reside in the company’s library, gathering dust, invisible to decision-makers at the coalface of medical practice.

    Henceforth, all medical marketing and data sheets for the product made reference to those two favorable studies. All sales staff at the company were made to learn those two studies inside-out and back-to-front, and to include reference to them in their communications to doctors.

    The drug became another “winner” for the company, although patients would have been just as well-served by the older, cheaper drug that had roughly 15 years of safe, reliable usage history.

    So to rely solely on published research, or to weight it too heavily above clinical experience, is potentially risky -not to mention intellectually slothful.

  25. Vogel says:

    Murray, we’ve come a long way since the mid-90s. It’s not as easy to suppress negative findings as it used to be. We now have a clinical trial registry (Clinicaltrials.gov) where the details of planned drug trials are to be listed prior to the launch of a new study. The entries are expected to include, among other things, the planned primary and secondary endpoints and the details of the statistical analyses to be used. This minimizes the possibility of moving goal posts (i.e., picking new endpoints and/or methods of data analysis when the ones initially planned on being used produce negative results), cherry-picking, and negative data suppression (if a registered study is never published, it is suggestive of data suppression and does not look good for the study’s sponsor).

    When evaluating published efficacy and safety research, the funding source and the affiliations of the authors should always be considered. It is important to determine whether findings have been replicated by researchers who are independent of the product manufacturer, and in studies where there is conflict of interest, it is critical to ensure that the experimental design was adequate to minimize the effect of bias (i.e., well-designed RCTs). Journal quality is also important. Poor quality journals publish bad research but this is far less likely with top-tier journals.

    Furthermore, where there is a body of research on a particular drug, meta-analyses can discern the biasing effects of conflict of interest, through the use of funnel plots for example. If company-sponsored studies show a strong trend for reporting results that are more favorable than those reported in independent studies, then the company-funded studies would be regarded as biased and unreliable. A company that relies on such studies for product marketing runs the risk of losing credibility in the marketplace, and that can be devastating. It is a powerful disincentive to leveraging shoddy research.

    Lastly, there are few therapeutic areas in which any one product/company has a monopoly – i.e., competition is fierce. If a company were to disseminate distorted or misleading research, they would run the risk of a competitor trying to replicate the results and failing, which would be taken as evidence that the original research was flawed. That would not bode well for the company that disseminated the flawed research. In addition, more research comparing the efficacy/safety of different treatments is now being funded by managed care organizations in an effort to improve cost-effectiveness.

    So Murray, your admonition that “to rely solely on published research, or to weight it too heavily above clinical experience, is potentially risky -not to mention intellectually slothful” is itself risky and intellectually slothful. Observation is sort of like experimentation, but with a very small N and inadequate procedures to detect cause and effect relationships and control for bias. Observation can be useful but it is never as good as properly executed scientific experiments. In the scenario you put forth about the drug company coming up with a new variant on a patented drug that was no more effective than the parent drug, personal observation would not have been adequate for comparing efficacy, so what you are proposing as an alternative to scientific experimentation is just a far less effective means for getting at the truth.

  26. skeptvet says:

    I agree completely. If you haven’t yet, I strongly recommend reading Bad Pharma, by Ben Goldacre, which talks about the terrible influence of industry behavior on the reliability of the published literature.

    However, that begs the question of what might be better than the published evidence. It seems like recognizing the kinds of problems you raise leaves with the choice of working to fix them (as is happening, for example, with the All Trials Initiative, which I have linked to on the front page of this blog), or giving up and going back to relying on intuition, personal experience, tradition, authority, and all the methods that failed far more consistently than the current scientific approach. To paraphrase Winston Churchill, the current system is the worst of all possible systems, except for all the others that have been tried.

    Clinical experience and published research evidence both have their limitations, but there is pretty good evidence to support the idea that on balance published systematic research is still the better bet most of the time. This doesn’t mean we don’t pay attention to its limitations as well, it just means we have to do the best we can with the inevitable imperfections and uncertainties we must face, and the best seems to come most often from relying on the highest level of critically appraised research whenever possible.

  27. v.t. says:

    One of the vets yesterday completely floored me with a comment about feline UTI’s, mentioning a specific homeopathy remedy (the practice owner would be floored as well – the practice frowns on alt med).

    She stated, “I don’t know how homeopathy works, but I understand the pathways in which it does work”. When asked for evidence, she stated, “I only read high impact journals” and went on to describe anecdotes from owners she has recommended the homeopathic remedy to. Sigh.

  28. Tom says:

    I happened on your web site while researching for my pet. At first I found what I read intersting and started to read on. The more I read, the more I found I could not stand your arrogance and questioned your value.

    In the name of “science” one can find an argument to attack almost anything that has ever been proposed by man. Just look at the constant battles between pharmaceutical companies, doctors, and lawyers regarding human health.

    To “use science” to put every company and person down who has an opinion or product which you yourself did not create. To any person who even remotely questions your advice you respond with arrogance and petulance. The problem is, you don’t use science. Put some value in your life. If you are so G D smart create something to HELP people don’t just attack people under the disguise of helping others.

  29. skeptvet says:

    So it’s ok to market supposedly miraculous therapies without doing the hard work of proving they are safe and effective, but it’s not ok to warn people about believing the hype for such therapies? Anyone can claim whatever they want, but questioning someone’s claim is arrogant? Every one of my articles looks at the acgtual evidence, for and against. Now I admit I spend more time warning people about therapies that are questionable or totally bogus than I do talking about well-established and effective medicine, but isn’t that the point? People can find a hundred sites selling alternative medicine, don’t they have a right to at least a few illustrating the lack of evidence behind the marketing? I’m sorry if criticism always seems bad, but if you were about to give your pet some alternative remedy that didn’t work and might even hurt them, wouldn’t you want someone to warn you, or would you only want to hear from believers in the remedy?

  30. v.t. says:

    Tom, attacking the messenger does what, exactly?

  31. Liz says:

    Hello 🙂 Long time lurker, first time poster here – thanks for providing such succinct information on what is and isn’t evidence-based in veterinary care. I have a question and didn’t know where else to post it, so…

    In human medicine, the current consensus seems to be that carrying a few extra pounds in weight can have a protective effect; generally if a person contracts an illness, those who are slightly overweight (not obese) tend to fair better than those who are the correct weight. (According to SkepticForum. Sorry, I don’t know the exact reference for this theory).

    Does this theory not translate to animals? (In particular, dogs?). I adopted my first dog about 5 months ago, and since there I’ve heard a lot of pet owners say “being a little bit underweight is a lot better than being a little bit overweight” with regards to their dogs health. Would you consider this to be true? (I am familiar with the standard poster used to represent what you’re supposed to look for to tell if your dog is the right weight or not).

  32. skeptvet says:

    In general, there is strong evidence that an optimal, lean body condition is protective against a number of potential health risks in dogs. A classic study in labradors, for example, found restriction of calories led to longer lifespan and less age-associated disease. So while I am not faamiliar witht he evidence for or against the hypothesis in humans, there is no evidence I am aware of in dogs to suggest that there is any benefit to being overweight, and there is ample evidence to demonstrate that a leaner body condition (provided essential nutrient needs are met) is protective.

  33. v.t. says:

    I agree with skeptvet, the optimal body condition score is, well, optimal for decreasing the risks for several weight-related health conditions.

    In cats, the “just a bit overweight” problem can be problematic in the fact that when they do lose weight, and particularly on a continued basis that is *not* a healthy rate of loss, then they could be at risk for liver disease and diabetes. An example, for indoor-only cats, these cats may be less active, a number of owners don’t encourage their activity, neutered inactive males may be at a higher risk for urinary tract issues as well as weight gain, etc. I think there are also a fair number of owners (obviously) who ignore slight weight gain and sadly, let it escalate until it becomes more difficult to manage (or treat a potential health condition due to the weight problem).

    Also, companion animals have a relatively short life span compared to humans, so conditions like diabetes, arthritis and heart disease are likely to occur far faster in overweight pets and keeping ahead of those diseases by maintaining appropriate weight is far better for the pet in the long term.

  34. Diane says:

    All the research I’ve ever heard of in humans also supported that calorie restriction/being slightly underweight is also linked to longer lifespan and lower incidence of multiple serious diseases such as diabetes and cancer.

  35. Catherine says:

    I was reading your articles about glucosamine use not being an effective treatment for pets (or people) with arthritis. I’m confused because I am also a frequent visitor over at the petdiets.com website and over there, it has been stated that Cosequin is effective for mild to moderate arthritis. Cosequin, as you know, is glucosamine and chondroitin, which have to be taken together in order to work, according to petdiets. It has also been stated (at petdiets.com) that Hill’s JD is effective for arthritis, but isn’t that just basically, food? My dog has just been diagnosed with mild arthritis in his left elbow and I am giving Cosequin DS a try first, but after reading your posts I’m not feeling too hopeful anymore. I’m also planning on using Virbac Allederm EFA caps HP (Omega 3) but only after I’ve tried the Cosequin to see if that helps. If I use them together right away, how will I know what worked, or what didn’t? Any thoughts to clear up this confusion?
    Thank you.

  36. skeptvet says:

    Unfortunately, there is no simple way to know if a treatment like this works in an individual pet. The disease can vary in severity for many reasons, so simply starting the treatment and waiting to see how the symptoms change isn’t very relaible. However, many people think glucosamine in one form or another is effective because of exactly this kind of trial-and-error anecdote. Controlled clinical studies are more reliable, and they show pretty conclusively that it does little or nothing, however, this is hard for peopel to accept when they have an anecdotal experience that suggests it really does work.

    The good news is that there is little risk of harm from glucosamine, so you aren’t likely to do anything bad for your pet by using it. But you won’t necessarily know if it is helping if the symptoms improve because there are always other possible explanations for that including, in this case, the effect of other supplements given at the same time. It’s not worng to try, but I agree there isn’t good evidence to support being very hopeful.

    Good luck!

  37. JE says:

    I like to hear/read a variety of perspectives, in general, especially the skeptical side of a discussion. In topics of health, it is more seriously important to scan the entire horizon. If a critique doesn’t shake my beliefs or inspire, then no harm done. One can find opposing arguments even against the commonly agreed upon color of the sky. But if it makes me look at something a new way or maybe even a better way, or simply worry less or be less absolutist- then why not!? Thinking makes us grow! Thanks for being willing to bear the inevitable tomato-throwing. (ps. I found your site researching ways to handle my dog’s cancer)

  38. Aly Copeland says:

    Can Azodyl cause seizures in a dog.

  39. skeptvet says:

    I have not heard of this, and it seems unlikely.

  40. nikki says:

    Hi Skeptvet,

    you sound genuine (and there is no ‘but’ after that).

    when I surf the net for supplements/cures/medication etc. (whether drugs or natural remedies), it is very difficult to know whom to believe.

    I have 4 cats and to me they are like ‘children’. my husband and I live in France and we import (when we visit the UK 2 x a year) premium cat food which we cannot buy in France and also Yesterdays News cat litter, which seems to be the best kind for maintaining animal health.

    2 of the cats are Burmese. (I had a Burmese before who was diagnosed with kidney disease when he was 15. we gave him medication and appropriate diet and also Tumil K for potassium deficiency and also something for high blood pressure. he lived to be 20 and a half.) my current oldest Burmese is 13 and although she is still very active and happy and loving, I noticed she was becoming hungrier and losing weight. I asked my vet to take a blood sample, to check for kidney disease, hyperthyroidism and potassium deficiency. the French seem to have different measurements, so not sure if this will mean much to you. her ALT, ALKP and CHOL are in normal range.
    her urea is 0.890 (range given is 0.336-0.756) and her CREA is 31.0 (range given is 8.0-24.0).

    2 days ago, (on vet’s advice) I started giving her Ipakitine for kidney condition and Fortekor for blood pressure (he seemed to think this would go hand in hand with kidney problem).

    [I am still waiting on hyperthyroidism check, because blood sample had to be sent to a laboratory in Nantes (I live in SW France, between Bordeaux and Bergerac). The potassium reading was 3.4 (range given is 4.0 – 5.5). They don’t seem to have Tumil K
    in France, so I am currently talking to a former English vet as to whether her potassium level is low enough to warrant taking a supplement].

    the reason I’m currently surfing and came across your blog is that last night she started peeing a bit out of her litter box and there was traces of blood. she seems to have a UTI. I gave her a Lithacat tablet (ethylene diamine) which I had from before when one of my other cats had cystitis. but I am worried that she seems to have very suddenly developed a UTI after starting her on the other medication two days ago. (maybe she was stressed from the visit to the vet for blood samples etc. ?)

    I want to do the best I can for my cat and was thinking of trying to find a holistic vet. (someone told me there was one in the area and is trying to find out for me). Now I’ve read some of your blog and don’t know what to do.

    can you advise me please? it is hard to understand everything my vet says because my French is OK, but not brilliant.

    I love my Burmese girl very much and want to do what’s best for her. I don’t know from the readings how advanced her kidney disease is and I know it’s best if one can diagnose and treat as early as poss. do you have any advice you can give me please?

    thank you so much (in anticipation of your help).
    bon continuation as they say in France.

  41. skeptvet says:

    Of course, it would be unethical and illegal of me to offer you specific medical advice for your pets via the internet. Only a veterinarian physically present to examine and care for them and to speak directly with you can do this.

    In general terms, I can say that there are pretty stndard and well-supported guidelines for the diagnosis and treatment of kidney disease in cats, and all the relevant information (bloodwork, urinalysis, blood pressure, etc) can be measured by most vets to guide treatment. Here is a site that has the diagnosis and treatment guidelines which you or your vet may want to refer to.

    Blood in the urine can mean cystitis or infection or any of a number of other things, so if this is new, you should have it evaluated by your veterinarian. Stress can be a factor in cystitis, but it is never safe to assume an answer without proper diagnostic testing.

    FInally, “holistic” is largely a meaningless word use to signify the use of unproven or disproven treatments, either alone or along side conventional medicine. Want you want is a vet who is methodical, who is familiar with contemporary standards of scientific medicine, and with whom you can communicate effectively. By calling themselves “holistic” they simply advertise that they believe in therapies which are scientifically questionable, so while many such vets are smart and well-qualified, there is no reason to believe their approach is any better than that of science-based medicine, and there is plenty of reason to believe it is not the safest or most effective aproach.

    Good luch to you and your kitty.

  42. Chelsea says:

    I was wondering what your thoughts are on the “Budwig Diet Protocol”? I have a 9 year old lab X with nasal cancer. There seems to be many different views on this and it seems to fit the whole, “too good to be true” statement. So wasnt sure if you knew of any real data to prove its validity. I tried to find info on your blog about this, but i couldn’t find a search bar, so I appologise if this is the wrong area to ask this question.

    Thanks for your help.

  43. skeptvet says:

    I haven’t had a chance to take a look at this one, but I’ll try to do so.

  44. skeptvet says:

    Though I have not read through the website thoroughly, I did look at a couple of reliable sources of information on cancer and nutrition. The consensus seems to be that this diet is based on a theory of how cancer works that is not widely accepted, and that despite being developed more than 60 years ago, there is no reliable scientific evidence to support claims that this diet improves outcomes for cancer patients. Like all restrictive diets, it can cause side effects, so I wouldn’t be inclined to recommend it without more evidence that it is useful.

    Cancer Research UK

    There is no reliable scientific evidence to show that the Budwig diet (or any highly specific diet) helps people with cancer. It is important to make sure that you have a well balanced diet when you are ill, especially if you are undernourished. We know from research that a healthy, well balanced diet can reduce the risk of cancer.

    At the moment we don’t fully understand how the diet interacts with other medicines. We know that some people taking flaxseed have had the following side effects
    Diarrhoea
    Wind
    Feeling sick

    There have also been reports of a few allergic reactions. Taking high doses of flaxseed without enough water can cause bowel blockage (obstruction).

    Sloan-Kettering Cancer Center

    Although Budwig had written books and papers to provide anecdotal evidence and biochemical mechanism of the diet, no clinical trials have been published in any peer-reviewed medical journal. Polyunsaturated fatty acids, like omega-3 found in flaxseeds, have been shown to exert anticancer activities (2) but there is no evidence that such diet has any benefit in preventing or treating cancer in humans. Whereas a balanced diet consisting of vegetables and fruits can be beneficial for general health, restricted diets may increase risk of nutritional deficiencies (3). High levels of sun exposure can result in increased risk of sunburn and skin cancer.

    Budwig diet is not recommended by most mainstream cancer treatment centers.

    Huebner J1, Marienfeld S, Abbenhardt C, Ulrich C, Muenstedt K, Micke O, Muecke R, Loeser C. Counseling patients on cancer diets: a review of the literature and recommendations for clinical practice. Anticancer Res. 2014 Jan;34(1):39-48.

    RESULTS:

    We evaluated the following diets: raw vegetables and fruits, alkaline diet, macrobiotics, Gerson’s regime, Budwig’s and low carbohydrate or ketogenic diet. We did not find clinical evidence supporting any of the diets. Furthermore, case reports and pre-clinical data point to the potential harm of some of these diets. From published recommendations on counseling on complementary and alternative medicine, we were able to derive 14 recommendations for counseling on cancer diets.

  45. Yvette says:

    I don’t see a “follow” button/widget on your blog. I’d like to follow your blog, but don’t see it. Perhaps I’m blind. Could you please advise how I can subscribe to your new posts as they appear?
    Thanks!

  46. skeptvet says:

    You can get announcements of new posts by following my Facebook or Twitter pages:

    https://www.facebook.com/pages/SkeptVet

    https://twitter.com/SkeptVet

  47. Hamilton says:

    Great site. Good to see that some evidence-based information can still be found within the top search results. I arrived to the site while looking for information regarding peer-reviewed studies on the D.A.P since two different vets had recommended as an aid for my dog’s fear problems but the too-good-to-be-true benefits raised some red flags. I also got a recommendation for homeopathic treatment, even after mentioning that I knew it was useless and even after he admitted that it was not scientifically proven.
    It’s all very convenient since you are already training the dog to slowly get used to the feared objects/situations.
    I really want to think that they recommend this stuff because they believe that it will make the owner calmer and the dog will somehow feed on that, but I’m finding it very hard. With the prices of standard veterinary procedures regulated by law here in Germany there is an obvious incentive for them to sell additional “treatment”. I don’t know, I just think that a visit to the vet shouldn’t have to have to include discussions of the scientific method (which apparently is something common from the comments I read here) it’s embarrassing for everybody.
    Thanks a lot for making available information which would clearly be much harder to find and digest for someone who’s not in a university setting a who doesn’t have full access to a bunch of subscription journals.
    I will promptly be following you on twitter

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