Who’s Behind the The Truth About Pet Cancer?

I have been asked several times in the last few months to evaluate a new series of videos called The Truth About Pet Cancer. I actually purchased the full transcript of this series and am in the process of investigating the general themes and specific claims. It is an enormous undertaking, and doing it justice will take a while.

To get started, I have been looking into the participants to get a sense of their background, perspective, and agenda. Though this is quicker than going through the full content of the videos, it has still taken me several weeks! I will present what I have found here to help provide context for my investigations of the videos themselves.

Though not all participants express the same views or emphasize the same points, there are a number of general themes in this series:

  1. Cancer is rampant in dogs and cats, much more so than in the past when our pets were healthier.
  2. Causes for this include
    a. our toxic environment, commercial pet diets, vaccines, conventional parasite preventatives and medicines, GMOs, wifi and other emf sources, and many other bad things
    b. mitochondrial damage and metabolic effects of high-carbohydrate diets
  3. Conventional methods for preventing and treating cancer in dogs and cats are (depending on the person being interviewed) useful but insufficient, totally ineffective, or actually a cause of more harm than benefit.
  4. The solution involves
    a. avoiding the toxins mentioned above or detoxing with food and alternative therapies
    b. complete overhaul of feeding practices, with an emphasis on fresh, raw, ketogenic diets
    b. supplementing, minimizing, or eliminating most conventional medical interventions (again, depending on who’s talking)

 

The following profiles of the organizers and participants will include comments, from this series and from other sources, that illustrate these themes and the general perspective of each of the participants towards these issues. The claims made in the videos must, of course, be evaluated on their own merits, most importantly the relevant scientific research evidence. My purpose in discussing the background, affiliation, and other advocacy efforts of the participants is not to use this information to judge the specific claims they make in the videos. However, understanding their overall perspective on science and medicine, and uncovering the personal, institutional, and financial relationships between them will help inform consideration of the videos.

The fact, for example, that the organizers and many participants are vehement advocates for alternative medicine is relevant to their claims about both conventional veterinary nutrition and alternative nutritional approaches. The repeated attacks on science-based medicine, the pet food industry, government regulators, and other groups made by many figures in these videos suggests an iconoclastic, maverick-outsider perspective that should be taken into account when evaluating the type of bias behind statements they make in these videos.

A lot of people were involved in this project! Some were key drivers of the effort, others contributed only brief interviews. They seem to fall into several broad categories: 1) Proponents of pseudoscience and critics of science-based approaches in human health.  2) Proponents of pseudoscience and critics of science-based approaches in the veterinary field, and 3) Mainstream veterinarians or researchers in legitimate scientific fields with an interest in or sympathy for “integrative medicine” or for unconventional nutritional approaches, such as ketogenic diets.

Individuals in the first two categories are clearly the architects of this bit of propaganda. Many will be quite familiar to regular readers of this blog as I have addressed their anti-scientific and pseudoscientific claims before. Some I haven’t written much about in the past, since their activities are primarily confined to human health. Several of these are not only evangelists for alternative medicine and lifestyles but purveyors of quite astonishing and bizarre conspiracy theories.

Those in the third category seem like pretty reasonable people, so their reasons for participating in this project are less clear. Some have been so blinded by their enthusiasm for a particular idea, such as ketogenic diets, that they are willing to overlook the use of the videos to promote pseudoscience and attack science and science-based medicine. Others may have been misled as to the nature of the project and how their participation will be used. Many say perfectly reasonable and science-based things in their interviews, though these comments are often interwoven with more extreme or unscientific comments to build a narrative that might not accurately reflect these views.

I have spoken to one person in this group who was actually quite angry about how their words were used and the implications which was created that they support claims they do not actually support. Others I have communicated with indicate that they stand by their own comments but take no position for or against the claims made by others.  It is undoubtedly true that not every individual who participated agrees with every claim made by all of the other participants. It may well be that some participants are not even aware of how bizarre and anti-science in their views some of the organizers and other participants are.

Regardless of how the more reasonable folks interviewed came to be associated with this project, however, their reputations are now tied to it to some degree, and it is their responsibility to disavow any aspects of the project they feel are inaccurate or untruthful or that misrepresent their views in some significant way. Failing to do this gives tacit approval and support to the project, and to the many falsehoods, errors, and attacks on science-based medicine it contains.

In addition to the affiliations of many participants with alternative medicine and their personal relationships through alt med advocacy, there are a couple of specific organizations which connect multiple participants. One of these is Ketopet Sanctuary. Supported by a ketogenic diet advocacy group called the Epigenix Foundation, this is a project organized around the belief that a ketogenic diet, hyperbaric oxygen, and some other practices can significantly improve the lives, and long-term outcomes, of dogs and cats with cancer. Quite a few dramatic and specific claims are made about research done at the facility, but none of this has been published in the scientific literature as of yet.

Another organization which connects several participants is DogRisk. This is a group of veterinarians and nutrition researchers led by Dr. Hielm-Bjorkman, a faculty member at the University of Helsinki. The organization is independent of the university, and it appears to focus on generating evidence to support raw diets, supplements, and other unconventional nutritional interventions. While the members are all legitimate scientists, they also have a clear agenda to generate evidence supportive of their beliefs in unconventional diets. They have conducted an online survey and presented a few posters, but as yet no peer-reviewed published research has been provided to make the general case that raw diets are healthier than conventional feeding practices.

Finally, several fringe organizations connect several of the organizers and participants. Mike Adams’ site Natural News, the web site of Joseph Mercola, and Alex Jones’ InfoWars are three prominent outlets promoting and selling quackery and anti-science propaganda, and all three are heavily represented here. Mr. Adams and Dr. Mercola are both involved, and Dr. Karen Becker is a veterinarian who runs the animal side of Dr. Mercola’s site. Several participants have been associated with the right-wing conspiracy project InfoWars. Mike Adams has been a guest host, Dr. Mercola has promoted his site and books on Jones’ show, and Edward Group has been a longtime contributor as well as the provider of many supplements sold by InfoWars.

I will briefly outline relevant information about each participant and try to provide some examples of comments made by these folks that illustrate the perspectives they each bring to this video series. Detailed analysis and fact-checking of their comments in the videos will have to wait for subsequent posts. My purpose here is to elucidate the perspectives and agendas of the participants and some of the links between them, so that the specific claims they make, and which I will evaluate in future posts, can be understood in a complete context.

 

Promoters of Pseudoscience in Human Health

Mike Adams
The individual behind the infamous Natural News web site, Mike Adams is one of the most prominent quacks of our era. He promotes and markets all manner of snake oil, viciously attacks science and scientists, and proselytizes for some bizarre conspiracy theories. He opposes almost all conventional medical treatment, most vociferously vaccinations and pharmaceuticals, and he frequently claims that healthcare professionals, researchers, and of course the biomedical industry, deliberately create disease in order to profit from treating it. He also promotes fringe conspiracies, such as arguing the 9/11 terrorist attacks were “an inside job,” Barack Obama’s birth certificate is a fake, and the Sandy Hook school shooting massacre was faked.

The inclusion of this person in this video series illustrates the deep lack of concern for science or objective truth on the part of the organizers, and it should embarrass anyone associated with the project regardless of their own contributions. Reasonable people can disagree about many of the subjects in this series, but there is nothing reasonable about Mike Adams or his quack evangelism, attacks on legitimate science, and general promotion of nonsense. His comments on his own site, and in these videos, undermine the credibility of any ideas and any participants. Here are some examples:

From the video series-

“’So, if your dog gets diagnosed with cancer, the doctor says “Oh, they have to have chemotherapy.’ You put the dog on chemotherapy, and immediately their health starts to deteriorate because they’re being poisoned, right?”

The doctor says, ‘Look how bad the cancer’s getting.’ This is a fraud. It’s actually—it’s worse than a stage magician in Vegas hiding a tiger in the back of a cage, and then putting a curtain on, and then ‘Boom! There’s a white tiger here all of a sudden. It’s magic!’ This is charlatanism. This is con artistry in medicine that is more deceptive than any kind of stage magic.”

“That’s what these people are doing. They’re conning pet owners into chemically poisoning their dogs and cats and calling it medicine. But it isn’t. It’s animal cruelty. It’s the worst form of animal cruelty because that dog trusts you. You’re their owner.”

From other sources-

“If you’re being forced to take a vaccine against your will (by a totalitarian medical regime like California), are there things you can do to protect yourself from vaccine toxins? [….] The key to surviving this assault on your body is to eliminate these chemicals quickly. In this video…I reveal nutritional strategies for accelerating your body’s natural detox so that you can safely survive a vaccine assault that’s forced upon you by a coercive, fascist medical regime.”

“the AIDS industry is much like the breast cancer industry… or the prostate cancer industry: Most of what they push onto people is medically unjustified, scientifically unproven and actually harms more people than it helps. But it’s great for generating more profits for Big Pharma.

And that’s the point of all this. AIDS is just another profit center for the drug industry”

“Mammograms — which claim to “detect” breast cancer — actually cause breast cancer. So if you get enough mammograms, eventually you’ll develop breast cancer and require expensive cancer treatments.”

 

Dave Asprey
Mr. Asprey describes himself as “a Silicon Valley investor and technology entrepreneur who spent two decades and over $1 Million to hack his own biology.” Without the benefit of any formal biomedical expertise or controlled research evidence, he claims to have discovered the secret to “taking control of and improving your biochemistry, your body and your mind so they work in unison, helping you execute at levels far beyond what you’d expect, without burning out, getting sick, or allowing stress to control your decisions.”

These secrets mostly involve untested and unproven beliefs about ketogenic diets (a recurring theme throughout the video series). Asprey is a true promoter not only of ketosis but a variety of other alternative medicine practices, and he relentlessly proselytizes for these without much concern about facts or the evidence and arguments of most experts in the fields he dabbles in.

Like most evangelists for unproven fads, he cherry picks legitimate science to find bits that seem to support his belief and ignores any contrary evidence. He relies the probative value of anecdotes, especially his own, despite the inherent unreliability of anecdotal evidence. His blog promotes various pseudoscientific positions, including claiming wi-fi and other electromagnetic fields cause cancer, the quackery of Emotional Freedom Technique (EFT) and homeopathy, and the idea that some foods are “toxic” and others magically beneficial.

Here are some discussions of Mr. Asprey and his claims: 1, 2, 3.

From the video series-

“Everything about you is driven by the something called the exposome, which is the set of things in the environment you’re exposed to. All of the toxins, all of the stress, all of the emotional stuff, all of the light, heat, sound. Every variable that there is, that is what your body’s listening to. That’s what drives epigenetics.”

“When you’re buying commercial dog food, they are taking the lowest quality fats. They don’t even care really where the fat comes from, what the ratios of the different types of fat are. Then they’re exposing it to heat, and light, and air. And they’re rendering it, and they’re cooking it, and then they put weird preservatives in it that prevent your body from using the fat right. So, what you are getting is the equivalent of margarine, which we all know is bad for us. It is unacceptable to put that stuff in your dog’s mouth. It has no place in our food supply. It should be used as biodiesel.”

“Inflammation is at the root of every single disease.”

From other sources-

“[ask] for an IgG/IgE blood panel testing for food allergies. You’ll get a report listing the foods that you’re sensitive to—your list of personal Kryptonite.”

“mold makes your immune system more sensitive to the damaging effects of gluten.”

“The same drive that makes someone want to run a company can also make them want to complete an Ironman triathlon. But all that exercise on top of a stressful job will drive up your cortisol levels. This causes weight gain, muscle loss, a decline in testosterone, and burnout.”

“There is a reason that stressed women crave fatty and salty foods—adrenal exhaustion.”

“If you’re not feeling amazing, there is always a reason!”

 

Ty Bollinger
Another notorious peddler of pseudoscience and bizarre conspiracies, Mr. Bollinger not only participates in the videos, he is one of the authors of the project and a primary inspiration for the series, having previously produced his own video propaganda piece entitled The Truth About Cancer, which consists largely of attacks on science-based medicine and promotion of unproven or quack alternatives. Mr. Bollinger, like Mike Adams, opposes almost everything about mainstream medicine, from  vaccines and cancer treatment to the idea that infectious organisms cause disease.  Also like Adams, Bollinger is a promoter of multiple wacko conspiracy theories,  from 9/11 to some that are so bizarre and incoherent you have to hear him talk about them to really appreciate how unhinged he is.

The fact that he not only participates in this series but was organizer and inspiration for it severely reduces any credibility the project might have.

Here is some more information about Mr. Bollinger and his oeuvre: 1, 2, 3

From the video series-

“They say “Beware of Zika. It causes microcephaly.” And then they bombard us with chemicals that we know causes microcephaly, and then they blame it on the virus instead of the chemicals. It’s the same thing they do with chemotherapy, isn’t it?”

“The big round of vaccines for the dogs and the cats….when they get like six or eight vaccines in one day….a month or two, inevitably, they bring their dog back and they’re itching, they’ve got allergies, and it’s all—I’m thinking the same thing that happens with the babies after the shots. A couple months later, they’re having autistic symptoms or reactions or whatever. It’s the same with the pets.”

“The similarities that I see between you know the pets, preventing disease, preventing illness, preventing whatever it might be, and actually causing that very thing or causing something worse. We see that with chemotherapy, that we try to treat cancer with chemotherapy but that actually causes cancer, right? We try to prevent disease with vaccines, but they actually cause disease, actually cause cancer.”

“You look at the tribes of people worldwide that eat raw food diets and never get sick until they come to eat our food and then they get sick. You know you’ve got the animals in the wild, there’s very little cancer in the wild, there are still sick animal but not many. Very seldom do they get sick but then you bring them into captivity, they start getting sick.”

“We’ve got an industry that seems to be driven by the dollar as opposed to trying to help pets. Just the same way the cancer industry with people is driven by profit motive and they don’t care about the cancer patients. It seems the vet practice is the same.”

From other sources-

“Non-toxic, effective, natural treatments for cancer are being systematically suppressed and cancer patients are dying due to lack of this vital knowledge. Why? Because the Medical Mafia and their “leg breakers” (like the FDA and FTC) control the flow of information and regulate the “approved” treatments.”

“We realized that the “official story” about 9/11 is about as believable as the Easter Bunny, Keebler Elf, Santa Claus, and fairies with wings of pixie dust. It’s a monumental myth… a ruse… a fable… a “tall tale” concocted to deceive the masses. And it worked like a charm on me and my wife – we swallowed it “hook, line, and sinker” – at least for a while. But sooner or later, we all must wake up from the dream.”

“As it turns out, many pharmaceuticals are offshoots of various chemical weapons developed and used during the two major world wars, and some were even tested on prisoners in Nazi concentration camps. “

“If we sit back and allow the government to enslave (and dehumanize) us in these areas, then we will gladly allow them to violate the Constitution and take our health freedom. Just look at a few recent examples the FDA raid on Rawesome Foods for selling raw milk the Detroit SWAT team kidnapping (and raping) of Maryanne Godboldo’s daughter for refusing to keep using psychiatric drugs the “gunpoint” forced chemotherapy of Jacob Stieler (a child) who showed no signs of cancer and the list goes on and on and on.”

“We are witnessing the end of America as a nation-state right now, and with these changes, none of our domestic laws or constitutional rights are secure. We are facing a frightening future, not to mention the fact that children born after 1990 have no clue about their food, water, vaccinations, or anything else. Our food supply is full of irradiated food, pasteurized milk and juice, viruses sprayed on our meat, chemicals sprayed on fruit and vegetables, and now we’re being forced without our consent to eat genetically modified foods.”

 

Travis Christofferson
Mr. Christofferson is a promoter of ketogenic diets, hyperbaric oxygen therapy, and several other unproven therapies, which he believes are not only superior to conventional cancer treatment but will ultimate cure cancer as a whole. He claims cancer therapy is practically useless and that attacking the metabolism of cancer will be more fruitful. While it is possible this avenue will someday lead to significant breakthroughs in cancer treatment, plenty of real scientsists are investigating the area, and Mr. Christofferson routinely cherry picks evidence and ignores the work of many within mainstream oncology in order to buttress his particular beliefs.

Mr. Christofferson is a popularizer of the work of Dr. Thomas Seyfried, and both are zealously devoted to one particular hypothesis and willing to work with quacks like Mike Adams and Ty Bollinger to promote it. While not all of their claims are unreasonable, they lose credibility with their single-mindedness and their association with peddlers of pseudoscience. Mr. Christofferson is not out on the fringes with the likes of Adams and Bollinger, but he makes it into the category of promoters of pseudoscience because of his obsession with the One True Cause of cancer, his frequent association with outright quacks, and his attacks on conventional cancer research and treatment.

From this video series-

“For an MD, they’re taught “For me to do something to change standard of care I need a phase three, double blind, placebo-controlled trial to point to, to do that.” So, you can’t do that with a dietary therapy, there’s no way. There’s no funding to pull it through and they’re very difficult to get through anyway.”

“So, Linus Pauling, you know two-time Nobel Prize-winning scientist has said, “Cancer research is the most fraudulent branch of research in the world.” And just we encourage this narrow thinking, non-reproducible results. Guys that have very bold visions that may lead to cures don’t get funded typically. So yeah, we’re stuck in this dogmatic, narrow-minded view about what cancer is and it’s just not working.”

From other sources-

“The most important statistic, the one that told the story with the most unbiased clarity, was that the current death rate from cancer was still the same as it was in 1950.”

“the prime cause of cancer is the replacement of the respiration of oxygen in normal body cells by a fermentation of sugar.”

 

Edward Group
Group is a chiropractor and naturopath most often associated with the right-wing conspiracy celebrity Alex Jones. There’s not really much to add to that. Of course, he believes vaccines cause autism and other terrible diseases and fluoride is a poison. He sells a variety of supplements with illegal medical claims, and he rejects the very foundations of science-based medicine. Yet another example of the role of the ideological, anti-science fringe in this project.

Here are a few examples of his ideas and agenda: 1

Video of Dr. Group on InfoWars

Another InfoWars Video

From this video series-

“I’ve done a lot of research into looking at the root cause of disease and what’s happening with pets is the same thing that’s happening with humans. You look at the toxins in water, the toxins in food, the toxins in the air, and the thing with pets is they’re so small that just a tiny, tiny amount of toxic chemicals can cause cancer.”

“All of this food, and they just stir it around in these big, huge rendering plants. And then they take some of the water out and they press this into a food. So, I mean, most of the food is cooked, which means there’s no activity left in it. And the fact that it’s extremely toxic. I mean, you’re basically poisoning your pet.”

“What causes thyroid problems? Excess fluoride. Excess chlorine. Excess bromine. People feed their pets bread all the time, okay. You have gluten. Pets are not meant to break down gluten. They don’t know how to break down gluten. It’s very toxic to them. So is corn. So is genetically modified ingredients, is very toxic to a pet’s digestive system, to their immune system.”

“So let’s say you inject an animal with a vaccine. They might already—see, no one can really tell us what the effect is of high-levels of mercury, arsenic, aluminum. A lot of pets actually consume aluminum because someone will leave an aluminum food, an aluminum foil, and they’ll just eat the whole thing. They eat chocolates, wrapped Hershey’s Kisses or something wrapped in aluminum, so aluminum is a big toxin for pets as well. But when…you know, what happens when you mix aluminum and mercury together, for example – you get a violent, deadly reaction.”

“With my dog, before I feed her every day I put the food on the plate and then I’ll act like I’m eating it for a couple minutes. So she sees that I’m the alpha male, or the alpha, in the house. And then I’ll put it down for her.”

“A lot of animals, believe it or not, suffer from cysts. You see all these little bumps and these balls on animals and that’s also an iodine deficiency just like fibrocystic breast disease, polycystic ovarian disease in females. I mean, any time you start having these cysts grow, these lipomas or these cysts, it’s always usually a— I can’t say 100% of the time, but very close, over 90% of the time, it’s going to be from an iodine deficiency.”

From other sources-

“Dr. Group centers his philosophy around the understanding that the root cause of disease stems from the accumulation of toxins in the body and is exacerbated by daily exposure to a toxic living environment.”

“I’m not the type of person to try to instill fear, doom and gloom,” he said. “But I am here warning everybody that this may be the most devastating flu season in the history of the world. Because I’ve never seen such a possibly, potentially — I’m not even going to say possibly — slew of ingredients that are going to be injected in our moms, our dads, our grandparents. We’re on the verge of seeing a massive shift in disease and sickness and possibly even death.”

“Dr. Group asks President-elect Trump to assemble a team of scientists, experts, and independent researchers with no ties to the pharmaceutical, food, or chemical industries to evaluate the safety and effectiveness of all artificial ingredients, genetically modified foods, artificial sweeteners, colors, dyes, fluoride, herbicides, pesticides, phthalates, refined sugars, preservatives, and other toxic compounds added to, or used in our food and beverage production. He also recommends appointing a third-party research team with no ties to the pharmaceutical industry to evaluate the safety and effectiveness of vaccines and flu shots.”

 

Joseph Mercola
Dr. Mercola is one of the most enduring and successful, personally and financially, of the anti-science, anti-medicine gurus. His web site and supplement business, his books, and his appearance on Dr. Oz, InfoWars, and even plenty of mainstream media programs create quite a public appearance of respected expertise. In reality, he is a purveyor of fear and pseudoscience,  attacking science-based medicine and promoting quackery. He is vehemently anti-vaccine, warns against fluoridation and the use of amalgam dental fillings, and promotes a variety of other myths and misconceptions about health.

There is also almost no form of alternative nonsense he has not endorsed, from homeopathy to mysterious “energy therapies” such as EFT to “grounding” or “earthing,” the idea that good health requires regular physical contact with the ground. And, of course, he sells not only his bogus ideas but lots of unproven supplements.

Dr. Mercola has been warned and fined by his state medical board, the FDA, and the FTC multiple times for illegal medical claims and fraudulent marketing. His prominence and financial success do not, alas, indicate that his advice is sound or scientific, and the truth is quite the opposite. He is also the host for Dr. Karen Becker’s peddling of veterinary pseudoscience.

From this video series-

Mercola- “Do you know what the primary component of most of that dog food is?”

Ty Bollinger- “GMO grains maybe?”

Mercola “You would think so. Actually it’s sugar. Ranging anywhere from 40% to 60%”

“Look at the difference between residential cats and cats that go outside or are kept outside, there’s a quite dramatic difference in health. Because they’re exposed to sunshine and they’re grounded, the way they’re supposed to be, they’re designed to be.”

“Fluoride is by definition a drug. Look it up it’s a drug and it’s put in the water supply. That doesn’t make sense…It’s a direct metabolic poison, but it stops the body’s or the pet’s ability to take the energy from the sun. And many experts believe that most of the energy they produce is actually produced by exposure to light.”

“The hydroxyl free radicals and other oxidative reactants that are produced by exposure to microwave radiation which would be cell phones, Wi-Fi, smart phones, smart meters, can cause, and frequently does most of the time, more damage than hundreds of X-rays.”

“Your body and your pet want to be healthy. They are designed to be healthy.…If you give them the right food, enough movement and exercise, sunshine, pure water. You know, it’s pretty hard to overcome that. And avoid poisons, and there’s a lot of poisons out there, you know, like EMF is a poison.”

“I put myself in a faraday cage every night to essentially—it’s a sheer fabric imbedded with cotton, silver and copper threads that form a cage around me so that the frequencies can’t penetrate them, and I sleep and my mitochondria are repaired and restored rather than being damaged.”

From other sources-

“I firmly believe you can reduce you exposure to toxic metals quite dramatically, thereby giving your body a fighting chance to eliminate accumulated toxins and restore health:

Avoid vaccinations that inject mercury or aluminum directly into your bloodstream.

Avoid and remove dental amalgam fillings.”

“The fact that manmade vaccines cannot replicate the body’s natural experience with the disease is one of the key points of contention between those who insist that mankind cannot live without mass use of multiple vaccines and those who believe that mankind’s biological integrity will be severely compromised by their continued use.”

“[I]s it better to protect children against infectious disease early in life through temporary immunity from a vaccine, or are they better off contracting certain contagious infections in childhood and attaining permanent immunity? Do vaccine complications ultimately cause more chronic illness and death than infectious diseases do? These questions essentially pit trust in human intervention against trust in nature and the natural order, which existed long before vaccines were created by man.”

 

Maria Ringo
Ms. Ringo is a homeopath, which says about all you need to know about her credibility to give scientific or medical advice. Homeopathy is one of the most clearly useless bits of quackery out there, and anyone who takes it seriously is not someone you want to trust on matters of health. Regardless of this, she somehow is also the founder of a “natural” pet food company

From this video series-

“You can’t eat highly processed, highly adulterated food, full of synthetics from a fast food place or from the grocery store, and expect to live a fully authentic healthy life.”

“There is an epidemic of cancer. There’s a lot more cancer…. And of course, food and drugs and lifestyle and emotions, all play a part in that. We are in a stressed-out world.”

From other sources-

“Homeopathy’s principles are older than Hippocrates himself and have remained unchanged since Samuel Hahnemann formulated them in the early 1800’s”

[Advice for flea control] “Diligence rather than toxins and chemicals is the best solution. Harsh chemicals will only serve to contaminate your home and weaken your companion’s health.”

“I had never vaccinated [my dogs] and used only natural remedies to get my dogs over illnesses and accidents.”

“I am sensitive to remedies, and can feel the moment when the energy shifts in the patient and you know the remedy is active.”

 

Robert Scott Bell
Mr. Bell is an associate of Mike Adams and a co-author with Ty Bollinger, and he is another member of the right-wing conspiracy community. He is vehemently anti-vaccine, views any public health measures as fascism, rants about the HIV/AIDS “fraud,” promotes conspiracy theories about 9/11 and the Newtown, CT school massacre, and basically hits every note in the far-right anti-science, anti-government symphony. Oh, and he’s a homeopath. But by all means, let’s take his advice on pet nutrition and cancer.

From this video series-

“If you were in the wild, and you see an animal that eats what it knows to eat, no humans intervening, no veterinarians saying “Hey, you need to eat this cat,” or dog, or whatever you are. They know what to eat. Do you find much cancer in the wild? Well, not unless they’re hanging out around Chernobyl.”

“Again, there’s a lot of crony-ism in a sense. There’s a lot of money flowing in to say “Hey, prescribe our scientific diets,” basically. And we find out that the diets are so species inappropriate that you’re literally facilitating cancer via the food that they’re giving these animals.”

“As a homeopath, of course we have to be the ultimate generalist, and we’re not species specific. That’s the good news about homeopathy. We can apply what we’ve learned in human health to animal health.”

From other sources-

“Six days a week Robert Scott Bell empowers his listeners with healing principles that can aid in physical, emotional, mental, spiritual, economic and yes even political healing! Bell tackles the tough issues and shows no fear when confronting government and corporate bullies who would stand in the way of health freedom. You will be amazed by the amount of information about healing that is kept secret from you”

“Modern medicine wasn’t always around; it was rather new and rooted in patented petro-based molecules manipulated to produce many different medicines that are not healthy, similar to alopathic medicine, whereby physicians used mercury on their patients, which is a poison.”

“Robert Scott Bell, who broadcasts on the Natural News Network, accused [Jon Stewart] of waging war on “all of us who believe in health freedom and healing liberty.”…Bell took exception to Stewart’s comments, saying, ‘He’s ready to take us out and put us in concentration camps.’”

“The danger of democracy in action occurs each year when welfare scientists on the Flu Shot Advisory Committee meet to vote on next year’s influenza vaccine… “Every vote must count!” Actually, the only ones that are counted are those from the Pharmaceutical Industrial Complex with conflicts of interests heavier than the mercury-based thimerasol still found in most flu vaccines. The CDC and its flu shot cronies are evidence of immunological insanity stemming from their infantile perspective on immune function… I dub thee the Centers for Disease Creation and Abomination. You no longer have to become their willing participant or victim.”

 

Nasha Winters
Dr. Winters is a naturopath and practitioner of the pseudoscience of Traditional Chinese Medicine. She is an advocate of a wide range of alternative therapies and a firm believer in narrative over evidence (I find it a bit ironic that she supports a non-profit dedicated to funding research into alternative therapies that is called “Believe Big!”). Needless to say, her perspective on nutrition isn’t scientifically trustworthy.

From this video series-

“I’ve been working with integrative oncology for 25 years, because of my own experience with cancer. I’m 25 years out as of October 21st, 2016, with a Stage IV ovarian cancer diagnosis that didn’t give me any options. And thanks to spending the last quarter of a century exploring my own metabolic processes, I have been able to remain, we call it ‘cancer stable,’”

“We just recently lost our 15-and-a-half-year-old dog.. We were pretty sure that she was in end stages of the cancer at that time. So, we really stepped up her diet. Even though it was a grain-free diet, we started adding in more of the MCT and really pushing her into a therapeutic ketosis. Within a few weeks her symptoms were gone and she was regaining her walking again…We then added in high dose CBD oil… Within a month her tumor went from the size of a very large grapefruit to the size of a grape.”

From other sources-

“Uninsured, out of options, before the internet, and long before “Dr. Google,” it was up to me to find hope, since no one else had any.  It also pushed me to go deep within myself to find an inner strength and will to live that simply hadn’t existed for me before…  I found things that worked, things that didn’t work, got better, got worse, got scared, and eventually, got calm. After removing a root canal tooth that had given me grief since I was 14 years old, after I had quit all grains (as I had Celiac and other autoimmune patterns), and after I had done some deeper emotional work… things have been stable as of the last scan nearly 5 years ago.”

“According to Nasha Winters, a naturopathic doctor in Durango, …HPV and cervical cancer are ‘treatable through natural medicine. In states where naturopathic medicine is licensed, there is an incredible success rate in curing women with both HPV and cervical cancer.’”

 

Promoters of Pseudoscience in Veterinary Medicine

Erin Bannink
Dr. Bannink is a veterinary oncologist and a promoter of the flawed but superficially reasonable concepts of “integrative medicine” and “integrative oncology.” The idea that we should take “the best of both worlds” from science-based and alternative medicine and blend them sounds reasonable. In practice, however, this really means setting up a double standard of evidence in which some therapies have to be scientifically tested and others are accepted as safe or effective based on alternative theory, tradition, or anecdotal experience. Dr. Bannink practices both legitimate conventional cancer treatment and the unscientific mystical nonsense that is Traditional Chinese Medicine, and she chooses to see this as being open-minded and “integrative” rather than as an evidentiary double standard.

While I appreciate her apparently sincere desire to apply scientific methods to herbal therapies, the fact that she begins by accepting and practicing such treatments based on mystical unscientific nonsense and appears to view scientific validation as not fundamentally necessary is both epistemologically and ethically problematic. This approach avoids the pitfalls of anti-science or ideological extremism seen in other participants, but it still privileges personal experience and belief over objective evidence and subjects pets to therapies not effectively tested for safety and effectiveness. Integrative medicine is essentially a Trojan horse for smuggling unscientific ideas and practices into mainstream medicine.

From this video series-

“I’ve always had a really heavy interest in alternative medicine… I had some health issues that responded to diet changes and so there is a very personal impact that that understanding about how the food we eat impacts our state of well-being and our health in ways that conventional medicine didn’t appreciate at the time. I mean I received little assistance from the conventional medicine realm of things and sort of went on an exploration on my own to try to figure out what I could do to optimize my own state of health.”

“I practice Traditional Chinese Medicine. So, that’s a combination of multiple herbs which are in one prescription that are usually given about twice a day. And we also do a lot with nutritional counseling because what we put in our mouth has a very important impact on the state of the body and the health of the body… The less processed the diet is the less inflammation tends to be triggered by the food that we’re eating.”

“I think organic foods and non-GMO foods are very important… I think the chronic low-dose exposure to a lot of the chemicals and pollutants in the environment is probably a significant contributing factor to the reason that those types of diseases are on the rise…[Pets should be] eating wholesome foods that aren’t processed that are picked from the field, you know, that have life in them still.”

 

Karen Becker
Dr. Becker is one of the organizers of this video project, and one of the most prominent promoters of veterinary pseudoscience. She runs the veterinary division of Joseph Mercola’s quack web site, and I have discussed her work often on this blog (1, 2, 3, 4, 5). She practices homeopathy, acupuncture, and herbal medicine, and she routinely condemns conventional medicine and nutrition practices as “toxic” and ineffective. To hear her tell it, our pets are living in the most horrible, toxic world possible, suffering and dying constantly due to unnatural and poisonous food, water, air, and medicines, and science-based veterinarians are clueless or corrupt and so only make things worse.

Dr. Becker is one of the more consistently anti-science voices in the veterinary profession, despite paying lip service to science and misusing or cherry-picking evidence when it suits her ideology. The fact the she is one of the drivers of this series undermines the credibility of the series and illustrates the barely concealed anti-science agenda behind it.

From this video series-

“Veterinary schools in North America are reactive. Which means we go to school and we learn how to identify symptoms of a disease, and then what drugs to use to treat the symptoms… So, we’re waiting until these animals get cancer and then we have to talk about cutting it out, poisoning it out with chemotherapy, or burning it out with radiation.”

“But veterinarians have convinced an entire 100 years of pet owners that if you feed anything other than pet food, dry kibble, or canned food, you could be harming your pet. In fact, veterinarians are the only wellness profession that actually tell you to eat more processed food and fresh food could be risky.”

“Cellular malnutrition really is a front and center issue with the pet food industry…The other aspects of environmental toxins come about from living in a polluted world…the two big sources of toxins for pets in North America come from the immediate home environment and the veterinarian.”

“You can break the cycle with enough knowledge to be able to make excellent choices. And I wish I could say go to your veterinarian, they’re the source of this knowledge. You end up, usually, out of desperation sadly…unless you are, by nature, a wildly proactive human, you end up usually having heartbreak.”

From other sources-

“I suspect another reason (aside from today’s tough economic climate), is because many traditionally trained DVMs practice ‘reactive’ veterinary medicine. This means they don’t have much to offer pets unless and until they’re good and sick…”

“The whole debate about raw food doesn’t make a lot of sense to me. Dogs and cats have consumed living, raw meats for thousands of years…The truth is both cats and dogs are designed specifically to consume raw meat. Their bodies are adapted to process raw, living foods.”

“I absolutely recommend that you never again vaccinate a mast cell patient.”

“Vaccinosis is a problem only holistic veterinarians seem willing to acknowledge. It is …chronic reactions to not only the altered virus contained in the vaccine, but also to the chemicals, adjuvants, and other components of tissue culture cell lines — as well as possible genetic changes — that can be induced by vaccines…Since the introduction of dog and cat vaccines, the traditional view of their use has been that they are safe and can be given as frequently as once or twice a year. This approach, tragically, has caused a tremendous amount of suffering for millions of pets.”

“Animals innately know what they need to heal themselves. Wild animals have access to Nature’s pharmacy, but our pets don’t. As doctors we dictate what medicine our patients will receive and at what dose. But we often prescribe incorrectly, with disastrous results.”

 

Ian Billnghurst
Dr. Billinghurst is a veterinarian most well-known for his promotion of the BARF (Bones and Raw Food Diet). Like so many of the alternative vets associated with this project, he blames most disease on toxins in the environment, especially in commercial pet foods. He believes raw diets and other unproven nutritional approaches can prevent or cure most disease, and he is another evangelist for ketogenic diets as a a cure for most cancer.

From this video series-

“Our oncologists simply want to use the current standard of care; cut, burn, and poison, and they don’t end up with a great deal of success, unfortunately.”

“Unfortunately, oncologists don’t know anything about the metabolic theory of cancer. They have no idea that the mitochondria are actually in charge. So, the only thing they’re ever taught at university is the genetic theory of cancer…and that is absolutely not the case.”

“We are feeding the perfect cancer growth diet. Our veterinarians, our oncologists, and our friends in human medicine appear to have no idea that this is the case. And isn’t that terrible? We recommend foods to our cancer patients that are going to make the cancer worse, that are going to kill the patient.”

“Processed pet food feeds cancer, feeds the cancer industry”

From other sources-

“Apart from surgery…the conventional veterinary approach is to bombard an already compromised body (scarred by a lifetime spent consuming fake industrial food) with chemical poisons and radiation. If these modalities don’t kill the patient immediately, they usually promote a more damaging and more aggressive form of cancer, further down the track. Meanwhile, the terminal part of the dog’s life becomes an endless round of treatments, tests and misery. At this stage, everybody is clutching at straws, hoping against hope that this particular cancer in this particular patient proves to be the exception.”

“While surgery has its place… the chemotherapy and radiation used by modern medicine … mostly does more harm than good. The newer targeted therapies—while promising much—are proving a costly and cruel failure.”

“Most degenerative disease processes in pet animals are the direct result of a lifetime being fed cooked and/or processed foods…Processed pet foods contain barely adequate levels of the known vitamins…Many contain biologically inappropriate antioxidants, enormous levels of refined sugars and masses of salt together with other chemicals used as colorings and flavorings. This chemical cocktail is a lethal brew which is a major factor in producing the epidemic of degenerative disease leading to the early death and suffering we see in pet animals fed such rubbish, including cancer, arthritis and a range of allergies and auto immune diseases.”

[Cancer is] a complex story. It’s one that our oncologists currently either don’t know about or don’t want to know about, because there’s a lot of money tied up in using chemotherapy and radiotherapy.”

 

Steve Brown
Steve Brown is another pet nutrition “expert” with no formal scientific training in nutrition who has still managed to discover that all the official experts are wrong about almost everything. He has written books about his nutrition theories and founded a company, with which he is no longer affiliated, to produce commercial raw dog food.

From this video series-

“If the great granddad ate this poor carbo­hydrate-laden diet with rancid fats, then his offspring will be less healthy, and then their offspring could be less healthy. So, each generation gets weaker and weaker and more susceptible to cancer because of the epigenetics parts.”

From other sources-

“I asked Steve why he thinks it is that most veterinary nutritionists are against fresh pet food. Is it because their lack of education in that area makes them defensive? Or are they so completely obligated to the processed pet food industry that they would never consider accepting, much less condoning fresh food for pets?”

“Steve believes they don’t want to know and don’t want to learn. Lots of vets make lots of money selling dry dog foods, prescription diets, and so forth. He feels they are brainwashed, and this is especially true for older practitioners, who don’t want to question what they’ve been recommending and selling to their clients for the last 30 years. They don’t want to find out they’ve been listening to the wrong pet food “experts” their entire career.”

 

Jean Dodds
I’ve written about Dr. Dodds many times, including an exhaustive analysis of her book on nutrigenomics and her misleading work on vaccine dosing. (1,2) Despite some useful early work on transfusion medicine, Dr. Dodds, has waded into the deep end of the alternative medicine pool and left science behind. She promotes all manner of bogus and unproven therapies, and she sells endocrine and allergy testing methods that are not accepted as effective or legitimate by actual experts in those fields. She continuously claims scientific support for her beliefs, but when one investigates her references, they are mere window dressing, either research that doesn’t actually support her claims or citations of her own opinions or those of other alternative theorists.

Her views about nutrition, like her views about allergies, thyroid disease, vaccination, and many other subjects, are not consistent with established science. Despite her accomplishments, Dr. Dodds has become one of the most consistent and prominent supporters of pseudoscience in veterinary medicine.

Here are some additional articles discussing Dr. Dodds and her views: 3, 4, 5

From this video series-

“The epigenetic things would be the environment, in terms of over-vaccination, deple­tion of the ozone layer, pollution of the earth.”

“The biggest problem I have with kibbles is the grains that are in them that could be genetically modified or are glutens, and glutens cause all kinds of diseases in pets as well as people today.”

“[For cancer] I would do acupuncture. I would do Chinese herbal medicine, absolutely, if they can tolerate it, because some animals can’t, do the right nutrition, and maybe spiritual growth for the family so that there’s more joy in their life for the pet, so it’s not gloom and doom.  If all else fails, you talk to an animal communicator and you find out what the animal wants. Does the animal want to stay and fight and live and be happy? Quality of life. Or does the animal have the eyes that are gone, wants to leave and be in heaven? Animal communicators can be really— good qualified ones can be really good with that.”

“With vaccines or preventives or other pharmaceuticals, the industry generally doesn’t look for toxicity and carcinogenicity. They look for general safety and efficacy. Does it work? The government doesn’t require them to report carcinogenicity or toxicity. They don’t study that.”

“This lovely client says “I just want Peanut not to suffer. I’m not going to cut her up anymore. I want her not to suffer and when it’s her time, God will make that decision.” Wonderful! What we’re going to do is give a liver – it’s a liver problem – liver cleansing diet and liver cleansing herbs, give her a hug, and give him a hug, and send them on their way.”

“Vaccines clearly can contribute to cancer….If an animal’s immune system is depressed or dysfunctional, right, you’re giving them all these antigens with adjuvants, if they’re killed. You’ve got mercury, aluminum, whatever. You’ve got fetal calf serum. You have all these growth-promoting factors in there.”

From other sources-

“Low-grade autoimmune reaction to gluten can trigger a wildfire of chronic inflammation that affects every organ system in the body, including the brain, heart, joints and digestive tract. It can even create an immune response that causes subclinical brain inflammation, resulting in age-related dementia”

Tthe menacing powers of corn, wheat and soy go even further than you might imagine.”

“Fluoride likely contributes to osteosarcoma”

“Standard allopathic treatments for immunologic disorders can be replaced with holistic alternatives and homeopathic remedies.”


Sharon Doolittle
Dr. Doolittle is an exclusive practitioner of alternative therapies and an advocate for a classic type of quackery known as Applied Kinesiology. In veterinary use, the main way this is practiced is by having a client touch the animal patient, waving some proposed toxin, allergen, or other substance over the animal and then testing how strongly the client can resist when the practitioner pushes on their arm. The subjective assessment of weak resistance is used to determine if the animal is having health problems associated with the test substance. Anyone advocating this sort of nonsense clearly has little understanding or respect for legitimate science in guiding their medical practice.

From this video series-

“In holistic medicine, I think we’re extending lifespans and extending quality of life in a way that conventional medicine is unaware of.”

“I get them off of their kibble, which I lovingly call “death in a bag” in my practice”

“We talk over vaccination. I say, ‘Say it with me.’ I make them say it with me ‘No more vaccines.’ So, we repeat that chant, ‘No more vaccines.’”

“’Why do we get this?’ I say, ‘To me the trifecta is poor nutrition, death in a bag, over-vaccination, and environmental toxins.’”

“It’s tragic to me that my clients can better answer just logically without having to see a study, but conventional medicine – especially the higher you go up — I think they are so study bound and research bound and whatever which is fine to a point, but when it gets to a point just superseding simple logic, then I think it becomes problematic.”

From other sources-

“Dr. Doolittle concentrates exclusively on holistic animal healthcare, including Nutrition Response Testing, Applied Kinesiology, Animal Chiropractic, Clinical Nutrition, and other alternative therapies.”

“My opinion on raw diet is that this is the optimal plane of nutrition for dogs. Kibble & canned foods have been over-processed and overcooked, causing all the nutrients to be destroyed in the process. Also they are grain based (often wheat & corn) which are generally poorly tolerated by canines & are pro inflammatory (leading to health issues).”

“The 5 main stressors that affect whether an animal (or human!) is switched or blocked, or that can test locally to a particular organ are food (and/or digestion), heavy metal toxins, solvent or chemical toxins, immune challenges such as bacteria, yeast, parasites, or virus, and scars…We live on such a toxic planet, that no being is safe from accumulating toxins in their body. We humans have done a GREAT job of destroying the air, water, and soil on this planet, and turning it into a toxic waste dump.”

 

Will Falconer
Dr. Falconer has been a frequent subject of my posts because he is one of the most extreme and potentially dangerous proponents of quack medicine in the profession. He practices primarily homeopathy, and he regularly represents this worthless nonsense as not just an adjunct but a replacement for legitimate medical care, even in the face of life-threatening disease. He vociferously rejects nearly all aspects of scientific medicine, regularly counseling against vaccination and the use of conventional medicines and claiming that most veterinarians who haven’t seen the light are doing more harm than good for their patients. His participation in this project, like that of Adams and Bollinger, reveals the deeply extremist, anti-science agenda of the organizers.

Here are numerous previous posts discussing the quack views of Dr. Falconer: 1, 2, 3, 4, 5, 6, 7, 8, 9

From this video series-

“This bag of kibble, nothing like it. It’s dead, it’s full of toxic ingredients, and genetically speaking the dog is saying, ‘Hey, you domesticated me and I’m cute and all, but digestively I still got that call from within saying where’s the prey.’”

“The name of the game for sickness now is chronic disease, meaning these diseases the last for years if not for life. So, you won’t see wild animals with chronic disease, it’ unheard of. It’s a manmade disease and we are making it often in the name of prevention.”

“Education in homeopathy was life shattering. It was the best thing I’ve had since vet school and eclipsed vet school actually.”

“Conventional veterinarians miss it all the time. But if you give a round of shots which is often what we call a combo-wombo shot, it’s five things in that syringe. It’s not just one virus, it’s five. You give that and the dog goes home or the cat goes home…About a month later they’re back for reasons of illness. Sometimes it’s up to two months, but right in that window is when things start to break loose.”

“We’re causing illness with these vaccines…they’re not doing any good for the pets or the horses or, you know, the people. Whoever is getting them…even holistic vets who learn that same information that we learned, I remember one of who became the president of the Holistic Vet Association said, “Well I’m not changing my policies…I’m going to keep vaccinating…” Okay, so how holistic is your holistic vet?”

“The benign being a fatty tumor like a lipoma or a wart, all the way over to the malignant, which is of course the cancer that kills you. The correlation between vaccines and that has been established long before I ever was born on the planet.”

“When this particular article came out about this drug, this new miracle drug for itch, that search term for that drug name just popped my article up time and time again. I just rose to the first page of Google search results…when this article took off and got really viral, and so many hits and I rose to the top of the search engines for the term of this drug, all of a sudden my website started going dark and I’d get alerted to it…that was a creepy feeling to know that—sounded like big pharma was trying to shut me down.”

“We’re doing all these things in veterinary medicine in the name of prevention and ironically creating illness. So back in the day when vets didn’t have so much interaction with pets, they lived till ripe old ages.”

“Pet owners are being advised to if you really care about these animals you will take this pack of poison—they don’t call them poisons, they call them preventatives, right. It’s a kinder word.”

“The heartworm drugs are some of the worst; we’ll see autoimmune disease from those.”

From other sources-
“I put the antibiotics away for good when my own cat Cali, in trying to have her first kittens, did so out in the wilds of Haleakala on Maui, and came dragging herself in with a horribly infected uterus, leaking a foul smelling discharge, and clearly seriously ill. I knew even antibiotics would have a hard time helping her, but I also knew I had something deeply curative to offer now: homeopathic medicine.”

“The model of disease prevention put forth by conventional veterinarians is fundamentally flawed. It is in fact damaging the animals whose owners partake in it.”

“The pushing of vaccinations by Dr. WhiteCoat throughout your animal’s life doesn’t add to her immunity…And you know that vaccines are harmful. Chronic disease often follows vaccination, even a single vaccination.”

“This broken model of disease “prevention” will never change from Dr. WhiteCoat’s side, who sells it:

He refuses to see the possibility of it causing harm.
He’s comfortable in it; change loses to maintaining the status quo.

He profits from providing it and profits again from the disease it causes.”

 

Marty Goldstein
Dr. Goldstein is another celebrity participant, a veterinarian to the stars. He is also a strong advocate of the bait-and-switch known as “integrative medicine.” This means he will sometimes use science-based treatments, but then often gives the credit for any improvement to homeopathy, acupuncture, raw diets, herbs, and other alternative treatments he also employs.

Dr. Goldstein, much like Jean Dodds, is one of those alternative practitioners who is so nice and caring and respected (at least by celebrity clients and alternative medicine advocates) that it is considered almost taboo to point out that much of what he sells is unproven at best and, as in the case of homeopathy, completely useless nonsense.

I’ve talked frequently about the problem with the concept of alternative medicine experts. Being learned and experienced in the use of unproven or quack therapies makes one an expert only in a narrow, and fundamentally misleading sense. An “expert” on homeopathy is like an expert on astrology or a long-dead religion: they know a great deal about something fictional, but this knowledge is only useful to believers, and there is no reason for those who don’t share the faith to take their proclamations seriously. For all his good intentions, Dr. Goldstein charges people lots of money to provide unscientific advice and fake medicine, along with the real medicine and, presumably, sound advice he “integrates” with the snake oil. This does not make him an expert but mistaken and, thanks to his prominence and PR skills, a bit dangerous.

From this video series-

“There is no focus on healthcare in our profession. Our profession is a disease-oriented establishment. We learn how to diagnose disease and then drug it. But more importantly, we learn how to prevent disease using agents that cause disease. So, our focus in this profession is one on disease. So we have manifested what our focus is called disease and the end result of that, the last stop on the track, is called cancer.”

“Over my 44-year career I’ve seen so many mistakes in healthcare that cancer had to happen and now when it does happen it gains a consciousness greater than that of man.”

“DR. BECKER: Describe cancer in one word.

  1. GOLDSTEIN: Stupidity. Three words. Stupidity in healthcare. It’s the end result, it’s the end marker of how much in the wrong direction we’ve gone in the field of healthcare. Period. We created it. To me, cancer does not exist as an entity.”

From other sources-

“Through his book, The Nature of Animal Healing, Dr Marty provides advice on a wide range of practical topics central to a pet’s health including why we shouldn’t feed our animals commercial pet food or why vaccines can actually do more harm than good.” Oprah Winfrey

“Instead of turning to external therapies such as chemotherapy and radiation, Goldstein looks within, analyzing his patients’ blood profiles and prescribing nutritional supplements, herbs, and homeopathic remedies to help their bodies return to balance.”

“[In the] typical hour-long consult for which Goldstein charges $420…Goldstein talks about the common veterinary practices that can steer dogs toward disease — first and foremost, overvaccination….Goldstein is an advocate of raw diets.”

“Goldstein has inspired fanatical devotion in pet lovers with his alternative approach to veterinary care: herbs, supplements, vitamins, homeopathic remedies and acupuncture as opposed to the staples of conventional care–antibiotics, steroids, cortisone injections. While most veterinarians still dispense annual vaccines, Goldstein blames many chronic ailments on this practice. He encourages his clients to feed their pets raw meat.”

 

Jodie Gruenstern
One more “integrative” veterinarian promoting the usual suspicions of science-based medicine and unproven or disproven claims for alternative medicine. Vaccines are dangerous, Chinese Medicine is taken seriously, conventional ideas about nutrition are all wrong, science-based medicine doesn’t usually work and often makes everything worse, etc. Belief in the basic tenets of alternative medicine seems to be the main qualification for being asked to participate in this series (and it helps to have written a book or created a alternative health product line).

From this video series-

“I got involved with essential oils because of my dog having cancer…I learned how to soak a dog in essential oils and since then I’ve become enamored with essential oils as a modality for managing cancer.”

“I couldn’t practice anymore without the Yunnan Bai­yao…I don’t know what I would without it, not only internally like a capsule for a lot of bleeding disorders. Pretty much any type of anemia. Autoimmune hemolytic anemia, for hemangiosarcoma it’s defi­nitely the go to herb. But also, topically. It stimulates granulation tissue like you just can’t believe. So, open wounds we will use that. It has an antiseptic impact. An anti-cancer impact and stimulat­ing the granulation tissue to promote healing. It’s just amazing.” [Except, of course, the evidence mostly shows it doesn’t work.]

“My newest thinking about the positive thoughts and conscious languaging and pets hear what you say and think and how many of them are sponges and get the same diseases that we are getting… I had a new client that came in telling me that they had heard that if they fed raw food, their dog wouldn’t get diabetes. Their previous dog had diabetes….Four years later, their new dog got diabetes on raw. I was blown away….We were talking and he said, “I don’t get it Dr. Jodie, my first dog had diabetes. My second dog has diabetes. I have diabetes. My son has diabetes.”  I’m like, “That’s it. That’s why.” You people are constantly thinking about diabetes. You cannot keep thinking about it.”

From other sources-

“Too many pets are developing severe allergies and cancer. Their immune systems are severely compromised due to excessive vaccinations, processed food nutrition and toxic environments,”

 

Rodney Habib
Mr. Habib is a professional activist and well on his way to becoming the Mike Adams or Joe Mercola of animal health. He would likely view that as a compliment, but clearly it is not. While it is possible to admire Mr. Habib’s passion and success as a manipulator of the media, unfortunately most of what he is selling is pseudoscientific nonsense. He skillfully uses social media to instill fear in pet owners; fear of pet food, vaccines, and virtually anything mainstream veterinary medicine recommends. And despite absolutely no training or expertise in science, he confidently tells the public that vets and scientists have it all wrong, and they should listen to his advice instead.

This advice consists of the usual evidence-free arguments for raw food, ketogenic diets, dietary supplements, herbal remedies, the dangers of vaccination, and many of the usual unproven or bogus ideas promoted in this series. Mr. Habib is one of the main architects of this project, along with Mr. Bollinger and Dr. Becker. If ever there was a group of people better at public relations than at health science, it is this trio.

From this video series-

“[Referring to Ty Bollinger’s Truth About Cancer series] I was up all night, researching, researching, and that’s where I stumbled upon your documentary, right? And it was literally mind-boggling for me. It opened my eyes up to see a whole different world that’s not talked about in the pet realms. So, your series really put me onto a path where I am today.”

“You talk to veterinarians back in the 70s, and they’ll tell you that the average dog used to live to be around 15, the golden retriever used to live to be 17 back in the 70s. Today, the golden retriever lives to be 9. We don’t feed our animals anymore, we let the manufacturers do it”

“Imagine knowing, as a pet owner, ‘Oh my God, my dog had a giant tumor on the side of it and I feed my dog 4 cups a day, and 50% of that is sugar. I’m feeding my dog two cups of starches and sugars a day.’ Imagine what that’s going to do to tumors.”

“It’s almost like the anti-virus company. You know, you put that virus out and then they force you to go and buy that anti-virus software to cure it. So, these animals that go on these supermarket foods that are laden with these sugars and develop these yeast infections and yeast diseases and diabetes, then go to their veterinarian clinic, and they tell you, “Here’s the cure here.” The same company that made it. It’s terrible.”

“Over-vaccinating is a huge issue Ty, and it’s a very, very sensitive topic today. We know that we can cause copious amounts of cancer… So, I started to release these blogs that became very, very popular, viral blogs on over-vaccinating, but the problem today, Ty, it’s such a taboo subject, that Facebook actually went in and started to haul my blogs out… Literally, you write about it, it’s being removed and erased off social media.”

“I recently had this encounter with this police officer who brought me his dog…He vaccinated that pet, Ty, on Friday. By Monday morning, that dog was seizuring. And that dog, for the rest of his life, was seizuring.”

“We know the challenge today in the veterinary realms is of course, it’s a business. Where’s the money going to come from? So, you come in, I have to vaccinate you, I have children, I have a livelihood.”

Pesticides. Flea and tick treatments. We are putting poisons on the back of the necks of animals, or pills in their bodies that change the biochemistry of the blood. So, when a flea or tick bites you and drinks your blood it dies. That’s not going to cause any cancer? There was a study that was done on this…and it was muzzled and hidden”

From other sources-

“The veterinarian of the future will give no medication, but will interest their animal patients in the care of the animal frame, diet, and in the cause and prevention of disease.”

“Pet owners no longer trust veterinarians.”

“Today, in the 21st century, we are experiencing a disease epidemic. We are the sickest we have ever been and toxins play a major role in this.”

“We can be feeding our furry loved ones the best foods in the world but pores clogged with toxins will not allow essential nutrients to pass, causing a weakened immune system. A pet’s weakened immune system equals a multitude of problems! Milk thistle is the boss of detoxifiers!”

“Today we live in the most toxic environment ever!… Diseases and illnesses are soaring at an all-time high, as our pets’ immune systems are constantly being beat up!”

 

Kohl Harrington
Mr. Harrington was likely drawn into this project through contacts associated with his own film about pet health, Pet Fooled. This documentary takes a very strident stance against the pet food industry, suggesting that companies are motivated primarily by profit, not the well-being of pets, and that commercial pet food is a health hazard. Mr. Harrington, like several other participants, has no formal expertise or training. Apparently, his groomer told him to Google “grain-free pet food,” and he that led him to a self-driven “internet education” that, as so often happens, convinced him he knows more than actual experts in veterinary nutrition.

Judging from his film and interviews (e.g. this interview with Dr. Becker) Mr. Harrington thinks pet food companies are all pretty awful. He interprets pretty much anything they do as sinister. For example, he suggests that the unwillingness of any individual company representatives to participate in his documentary demonstrates they have something to hide, rather than recognizing that they aren’t stupid enough to offer sound bites to someone constructed a biased, one-sided “exposé” about them. But when an industry lobby group does agree to talk with him, he finds it horrifying that they deny some of the claims made about their products. Can’t win for losing?

I have no doubt that pet food companies, like all large for-profit industries, have an inclination to some bad behaviors which must be controlled through regulation and investigative journalism. However, Mr. Harrington’s approach of starting with an agenda, doing “research” on YouTube, then talking with extremist anti-science activists, and finally suggesting that industry representatives are awful both for not talking to him and for what they say when they do talk to him, illustrates this is not investigative journalism but simply a sensationalist hatchet job.

Interestingly, one of the nutritionists interviewed in this video series, Dr. Bartges, has publically disputed much of what Mr. Harrington claims in his documentary:

“While there is some excellent storytelling, there’s also a lot of misinformation designed to alarm you.”

“Although this movie says dogs are wolves and eat the same things, this is not true.” [a point I have been making repeatedly for years; 2013, 2014, 2016]

“Dry food does not cause kidney disease in cats just as crackers do not cause kidney disease in people. Protein also does not cause kidney disease.”

“BHA is a synthetic antioxidant that has been shown to be safe.”

From other sources-

“He got the idea for the film five years ago when a friend’s dog had itchy skin on its stomach. A veterinarian was unable to diagnose what its groomer recognized as a common side effect of food allergies.”

“Kohl knew nothing about pet food when he took on the project. “I was basically stepping into it clueless,” he says. Growing up, his family had dogs and cats, but they were free-roaming indoor/outdoor pets who mostly hunted their own food.”

“The film exposes the motivation of companies mass producing pet food from corn, wheat and other non-nutritionally sound ingredients that cause illness and disease in pets.”

“The pet food industry is exceptionally misleading and deceptive.”

“Since major pet food companies are involved with and have influence over vet students, lack of education surrounding raw diets exists heavily among traditional vets.”

 

Doug Knueven
Dr. Knueven is a practitioner and advocate for a wide variety of alternative therapies, from acupuncture and homeopathy to herbal medicine and unconventional diets. In his various writings, he promotes the philosophy of vitalism, the idea that the fundamental nature of living things is located in non-physical, spiritual elements and that medicine can only be effective at preserving health and treating disease by addressing the spiritual aspects of patients. This is a common view among alternative medicine advocates, and many alternative therapies ultimately depend on some core spiritual belief  (e.g. “innate intelligence” for chiropractic, “vital force” for homeopathy, “Ch’i” for Chinese Medicine, etc.).

The problem with this view is that since such forces cannot be objectively measured or evaluated, every person has their own completely untestable beliefs about them. This means that any idea about disease and medical care must be valid is it conforms with the spiritual understanding of a particular practitioner, and we should give up on the idea of “proving” anything to be true or false in medicine. This strategy failed us spectacularly for most of human history, and the scientific approach, which sets aside spiritual beliefs and focuses on what we can all examine and study together, has been much more effective at promoting health and reducing suffering.

From this video series-

“If you talk to the experts, they’ll say “Oh we are seeing more cancer because we are feeding the pets so well, and they are living longer, so of course we are going to see more cancer.” But in my experience, we are seeing cancer in younger and younger animals.”

“I look back and I think when I just got out of vet school, I believed in Science Diet. I believed in dog food, because it says on the bag, “dog food.” We’re all brainwashed to think that this is what animals are supposed to eat.”

“Fear is not a good place to come from when you’re dealing with a pet that has a problem….there’s an energy connection between the person and their pet…animals will walk into my office with these big tumors and they’re wagging their tail, you know, they don’t know they have some kind of problem until the client communicates it with their energy. And I think that that makes the situation worse.”

“I had a case…where this mass was sticking out of its face…I was doing acupuncture, we were doing herbs, and the cat got better for about 6 months…then it started going downhill…and I told the client that I thought this was getting close to the end. And she came back in two weeks later and the tumor was 50% smaller…She said “I talked to an animal communicator and the animal communicator was talking to the cat and talking about energy medicine and how to use energy medicine to heal the tumor. And apparently the cat said back “Oh, I can do that.”…There was nothing that I did, there was no other change besides this energy medicine. So, I really think that there is more to health and healing than what we know physically and tapping into that can be very helpful.”

From other sources-

“I’m a Holistic vet. Holistic medicine addresses the patient as a whole – body, mind, and SPIRIT. There is a level of reality beyond, and yet enmeshed in, the physical, material universe. If I did not have an appreciation of the spiritual aspects of my patients and their caregivers, they and I would become little more than robots. Don’t settle for treatment by a robot.”

“The concept of holism stands in direct opposition to the Western reductionist view. Holistic practitioners believe that vital life energy is the most important factor in the health of the patient…Because medical science has defined itself on a strictly physical basis, it is true that vitalism is unscientific. By definition, vitalism embraces a concept about a nonphysical force that can never be understood within the current scientific, medical paradigm.”


Kevin Landau
Dr. Landau is a “all alternative” practitioner, focusing on animal chiropractic, Chinese Medicine, laser therapy, and applied kinesiology, though he also uses homeopathy and alternative nutritional practices. Apart from laser, which is a promising but unproven method, these are all pseudoscientific practices. On his Facebook page, he regularly claims to prolong life and reverse disease when conventional medicine was ineffective. This is the usual sort of self-serving and self-validating anecdotal narrative that is commonly employed to justify untested or unscientific therapies, and it part of a deeply anti-science world view.

From this video series-

“The real downside for what’s going on in the veterinary community is that everyone likes to get super specific and talk about percentages and fats and proteins and carbohydrates and micronutrient ratios, and to me food is really simple. It’s either good food or bad food.”

“I see a huge correlation between pro­cessed, commercial, grain-based diets where companies spend so much money on the packaging and so little on what’s actually in the bag. It’s just quite frustrating and disappointing.”

“You can get cancers that are really driven by poor diet which tend to be hot, inflammatory or damp heat. You get other tumors that are more from diets and environmental situations that lead to deficiency in the circulation and then blood stasis, that is a different variety of tumor. And then there is energetic things that can happen to the body that create blockages that lead to tumor formation. So, for me it’s about categorizing…what is going on in the body energetically and then figuring out how to unlock that body’s potential to get energy moving.”

From other sources-

“With the power of Applied Kinesiology and many imbalances can be identified and corrected even before they create pain or illness! Acupuncture will get energy flowing through these stagnant, painful acupuncture points treats the problem.”

“Horses and people tend to anger easily when there is an imbalance in the body that leads to stagnation of energy….The liver is responsible for the smooth flow of energy or qi. Liver qi stagnation is the imbalance that often creates this imbalance…People who are stubborn and pushy often have liver qi stagnation also. Many times when I am working on a horse with liver qi stagnation, I realize that I am feeling quite annoyed or frustrated only a few minutes into an examination. The horse’s imbalance is stagnationg [sic] my liver qi making me frustrated! When I get to acupuncture points associated with liver, this horse will often be painful and may even try to kick me (making me feel even more angry!). Most importantly, at this point I just let the owners know what is going on by saying, ‘I am feeling quite frustrated and angry around your horse. I believe he/she has a lot of stagnation in the liver. Have you been noticing yourself feeling more angry around your horse?’.”

 

Steve Marsden
Dr. Marsden is a prominent Chinese Medicine vet, and though he practices homeopathy, naturopathy, chiropractic, and other alternative methods, he is best known for his advocacy of the pseudoscience of Chinese medicine. In a classic example of the approach of alternative medicine to evidence, he has started the “Cured Cases” web site as a forum for discussion of Chinese medicine approaches and a repository for anecdotes to support belief in the practice.

From this video series-

“’We’re coming at this the wrong way.’ Now we’re coming at it in a way that’s profitable, and we’re coming at it in a way that’s scientifically plausible, but here’s the problem…Food I think is the problem….Perhaps 2/3 of tumors are linked to diet…and it’s probably a lot more than that.”

“We need to stop thinking about ‘do I have the right nutrients?’ We need to start think­ing about ‘how does this body react to this food in this form?’”

“This disruptive microcirculation that Chinese medicine was all about for the past 2,000 years, is directly caused by high insulin levels….It’s this disrupted microcirculation, and it’s inflammation that can just never stop. It can’t stop because the blood vessels are in control of it. Who is controlling the blood vessels? It’s high insulin levels.”

From other sources-

“When we want to both tonify Blood and pull off fluid, Dang Gui Shao Yao San is a consideration”

“Given the overt Blood deficiency and history of chronic vomiting, I’d wonder about adding in Yi Guan Jian.”

“I agree with your Damp Heat assessment, and would suggest starting with Si Miao San…I hear what you’re saying about coolness. However, long term damage to Blood and Yin by Damp Heat can create Blood deficiency, and with that a superficial chilliness. If you’re quite sure, however, that he’s too cold, then I’d wonder about Chu Shi Wei Ling Tang. This augmentation of Wei Ling Tang might address the skin condition, even as the Wei Ling Tang at its core addresses long term IBD and even the insulin resistance characteristic of Cushings. So, for a Cold, dog (with, for example a cold tongue and overt sun-seeking), it would be my first choice.”

“Homeopathic Ferrum metallicum 30C can be helpful in animals vomiting their food undigested hours after eating.”

 

Rick Palmquist
Dr. Palmquist is an alternative veterinarian about whom I have written many, many times (e.g. 1, 2, 3, 4, 5, 6, 7, 8). He employs and promotes nearly every imaginable form of pseudoscience, and he is a major figure in the leadership of the AHVMF. Dr. Palmquist is the classic example of an advocate for pseudoscience who talks about the importance of science and who often cites scientific research, but only when it supports his beliefs. He rejects or flatly ignores any evidence that contradicts them in favor of anecdotes, personal experience, and pure faith. Science is not, in the approach he puts forward, necessary for true knowledge, only a secondary means of supporting or promoting what one knows from direct experience.

Dr. Palmquist seems to be a genuinely nice guy, but he is deeply anti-science in his world view, he seems unable to imagine that his own experiences might be misleading, and he promotes a wide range of useless or harmful nonsense as well as unproven ideas.

From this video series-

“Our problem is that we have very invisible and insidious things damaging our health. The food has been changed. The soil has been changed.  We have so many toxins in the environment now in small amount that those things are causing these micro-injuries.”

“Evidence-based medicine is the last to know.”

“We actually know, from an energetic and intuitive phase, which isn’t a popular word to use in the scientific environment, that when we feed cancer patients less sugar they live for a longer period of time….Has anybody done a study on that? No.

“I love evidence based medicine….But here’s the situation. If …you ask an evidence based specialist what’s the truth about this, the only data they have to answer is the data that has been done. Actual re­search that’s been done. So, the question is, is there evidence that increased sugar, increases cancer?”

“I can’t point you to a paper today that says that… But we know that increased sugar, increases inflammation in the body… Anything that changes the inflammatory profile of the body in a chronic way is by virtue of chronic inflammation going to increase cancer rates.”

“There’s a huge lobby that wants not to find that. Since most of the research is funded by pet food companies, and low-cost carbohydrates are easy ingredients in pet foods, we can’t an­ticipate that the pet food companies are going to do studies to look at the relationship…They’re not going to fund those studies.

That’s not what they want to do….Their board of directors say, “We want to make a corporate profit.” That’s not a bad thing. Companies do a lot of good research but they’re not going to fund those studies because they don’t have anything to gain from them.”

“I have a tremendous number of dogs that prefer beef….From an energetic standpoint, as a Chinese practitioner, I wouldn’t recommend that because they’re a lot of times having other kinds of problems where I think the beef is too hot for them. …I like to start most of my dogs on turkey, to be honest….It’s a cooling meat and most of our cancer patients are too hot from a Chinese medicine stand­point. That’s why they got cancer in the first place.”

“Cancer is the body’s solution to a condition that it can’t solve any other way…. The truth of the matter is health is gardening and tumors are a sign that there’s a problem with the soil. If we change the soil, we change the health, we change the garden and we get less cancer. We don’t get no cancer.”

“Sometimes we change the food and the cancer falls off….And you say, “Well, that can’t happen.” Well, it just did. While some people say that one case isn’t statistically significant, I don’t have a lot of other patients that I give chemotherapy to where the cancer falls off and doesn’t come back. The only cases I have where the cancer fell off are cases that we changed the diet.”

From other sources-

“When we use “science” to kill hope by stopping progress we find real harm occurring.”

“When a miracle surpasses our science, we can deny the miracle or use our science to pursue improved understanding. It’s a choice.”

“If you want to treat disease study chemicals. If you want to heal seek love and truth. They align all things to healing and Life.”

“It might take science >100-1000 years to categorize and understand some basic healing principles. Pioneers go first, science comes later.”

“Perhaps love is the basis of placebo. In that case let’s fill the world and to hell with the research. Ascendant mindfulness finds healing.”

“The doctor saw a symptom and gave a pill. The healer just smiled, looking past the disease to find the smile that brought recovery.”

 

Gary Richter
Dr. Richter is yet another integrative veterinarian, mixing science-based medicine with untested or quack therapies freely and claiming to be selecting the best of both. I’ve discussed elsewhere why this is a successful marketing approach but not actually a sound way to determine which treatments work and which don’t. Dr. Richter’s approach treats his personal anecdotal experience and controlled scientific research as equivalent, thus missing the entire point of science. As he says in advertising his book, “Each treatment recommended in this book has the backing of scientific research OR years of successful outcomes his clinical practice.” [emphasis added]

Dr. Richter includes acupuncture, chiropractic, stem cell therapy, PEMF, herbs, and unconventional nutrition among his list of alternative practices. He’s also a prominent advocate for cannabis in pets. Despite being less opposed to conventional medicine than many alternative practitioners, he seems perfectly comfortable making confident claims about the safety and efficacy of untested therapies based only on opinion and anecdote, which is the fundamental difference between science-based medicine and faith-based alternative medicine.

From this video series-

“From a doctor’s perspective, that’s a really tough conversation to have, to basically sit down with somebody and say, “There’s nothing else that we can do.” So, that really led me to start to investigate other areas of medicine outside of the scope of what I learned in veterinary school.”

“Our environment is a bit of a toxic soup”

“The truth of the matter is, is that dry dog and cat food…is far from optimal nutrition. And regardless of how good the ingredients were that went in,…by the time it gets down that processing line and it’s been cooked and extruded at over 400 degrees, there is not only a lot of nutrition that’s lost, but there’s actually a lot of things that are produced chemically within that food that legitimately cause cancer.”

From other sources-

“I got trained in acupuncture and chiropractic and began doing herbal therapy and a variety of other alternative treatments. I found it was enormously helpful and I was able to help conditions and fix things that I was never able to do with Western medicine alone”

“People who are against using cannabis as medicine just don’t understand the science…It’s indisputable at this point. The only reasons why people are against it at this point have to do with politics, really.”

“From a Chinese medical perspective, cancer is often described as stagnation, or phlegm, or interruption of energy flow. Chinese herbs are sort of categorized as what we would call either blood movers or something to break up stasis. And these are the herbal formulas that you tend to use to help treat cancer…Some of these herbal formulas that have been used for these purposes for thousands of years,…The Chinese didn’t have the vocabulary that we now use to describe that, but they sure did know which plants to use. They knew that it worked.”

 

John Robb
Dr. Robb is a veterinarian best known for his defiance of science and his state veterinary practice act with regard to vaccination practices. He is convinced that the “dose” of vaccines routinely given, especially for rabies, is harmful, and he has chosen to substitute his personal belief not only for scientific evidence but for the laws under which he practices. As a result of his refusal to follow scientifically establish vaccination guidelines and state law, his veterinary license was placed on probation for 25 years, and this decision was upheld in court.

I have discussed the issue of vaccine “dose” before, and Dr. Robb’s view is not based on sound science. Yet he viciously attacks the competence and motives of the veterinary profession for daring to believe experts and evidence rather than his opinion. He has painted himself as a martyr in a battle against corporate profits at the expense of animal health, but that is a self-serving and disingenuous characterization. In reality, he simply believes his personal beliefs should be deferred to and that he shouldn’t be held to standards of evidence other than his own opinion. Naturally, he is popular with the anti-vaccine crowd. How this or anything else makes him an expert of pet cancer or nutrition is unclear.

From this video series-

“Horrific diseases that cause so much pain and suffering. And yet the veterinarian—the word idiopathic is throughout the textbook. Idiopathic, it means we don’t know what causes it. Well, all these idiopathic diseases are all directly a result of vaccination.”

“So it’s a law and you know you’re killing them but you’re going to do it because it’s the law? Where’s your oath? Where’s your soul? Where’s your heart? That’s what the problem is here.”

”Who benefits when they get sick from—who does the surgery to remove the tumors? A veterinarian. So, they benefit when the animals get sick by charging more money. Now,I’m not saying they would do that on purpose, although some of them would, you know? So, you know, we’ve got to bring morality back into veterinary medicine.”

Well, [I’ve] been persecuted. That’s all I can tell you. Been persecuted. In other words, I’ve been in front of the state board two or three times. I’ve been locked out of meetings… I want to keep the pet healthy. I mean, but they want to—how to get them in the door. For what? Give them vaccines. Give them drugs. Prescription foods. All these things that make them sick… Well, you know, between being arrested, handcuffed to a stretcher, taken to the psych ward, had police sent to my house, okay? And I can go on and on with what they’ve done to try and intimidate me. But I don’t have a choice. I can’t sell out. Then who would I be?”

“They went to the state board and said, “Dr. Rob is lowering his volume on the rabies vaccine,” because I was! I said, “You’re darn right I am!” I have that right, as a doctor, to figure out the dosage, not some manufacturer of pharmaceuticals.”

“I’m writing immunity certificates. They’re not legal documents, but anybody who shows me a titer, I’ll write one. I’ll put my stamp on it…I don’t care what the law is.”

From other sources-

“It was while at Banfield that Dr. Robb came up against the Veterinary Establishment represented by the Mars Candy Bar Company. Mars put profits first and pet lives second.
Dr. Robb could not be bought or blackmailed….Dr. Robb told Mars that he, not Mars and not the Connecticut State Board, had the right to choose what volume of rabies vaccine he injected into a pet.”

“Dr. John Robb, a veterinarian based in Connecticut, said pets are being over-vaccinated as a way for the veterinary industry to make money. ‘These animals – they’re so sick. And they suffer so much. And we’re doing it to them for money. It doesn’t have to be that way.’”

“’Banfield says they treat you like family: since when are you being treated like family when your pets are lined up and injected with toxins’ said Dr Robb.”

 

Barbara Royal
Dr. Royal is a well-known integrative medicine vet and leader in the AHVMA. Though she claims to blend science-based and alternative medicine, she is not only an outspoken advocate for alternative treatments but a strong critic of the foundations of conventional medicine. She perpetuates the beliefs that vaccines and pharmaceuticals prevent and treat only superficial symptoms, not the actual causes of illness, and she regularly exaggerates the dangers and ignores the benefits of science-based treatments. At the same time, she promotes alternatives validated only by faith and anecdote.

As one might expect, knowing this, her theories about nutrition are a mish-mash of the appeal to nature fallacy, unsubstantiated fears about the toxic properties of commercial diets, and dramatic extrapolations from preliminary and limited science. Dr. Royal operates in a world where belief is more important than evidence and one is free to make confident claims based only on the strength of one’s personal belief, regardless of the lack of evidence.

From this video series-

“I definitely think there’s a correlation between food and cancer. I know it from 20 years of experience of watching animals eat themselves healthy.”

“I don’t think there’s a really good way to fight cancer if you’re feeding processed foods. I just don’t think it’s possible.”

“The perfect diet would be basically eating what would be completely natural to them, and what they’ve evolved to eat… the intestinal contents, the eyes, the spleen, liver, they’re going to eat everything there…We don’t put in nails and feathers and beaks and feet and toes. But, there’s a reason why they chew on those and eat them. It actually is something they’ve developed over time to help their GI tract”

“When someone says cancer to me, the first word I think of is im­balance. It’s just about making sure we’re providing all the causes of health in the right balance. It’s like the whole world, to me the earth is my biggest patient. How balanced is the earth would affect how healthy the earth is. Are there weird things happening? It’s happening with each animal, every species, are we bal­anced? Are we doing the thing we are supposed to do on the planet? Are we touching the ground, are we being involved, are we breathing good air?”

From other sources-

“If you are near a holistic veterinarian, ask for a post-vaccine detox – this can include homeopathic supplements.”

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

“Cure CANNOT be achieved in the physical body alone. Cure cannot be achieved by focusing on symptoms but on CAUSE…It is as if there is a dirty spot on a lens of a slide projector that is projecting an image on a screen. The traditional doctor works away on scrubbing the spot off the screen, while the holistic doctor cleans the lens, the cause of the spot on the screen…”

“When an animal is showing flu signs, conventional medical treatment will include antibiotics, cough medicine, subcutaneous fluids and B vitamins. Alternative medicine options include

HOMEOPATHY

Homeopathic viral nosodes, and other homeopathic combinations for flu and colds, like Oscillococcinum or Bryonia, are effective for reducing signs, lowering fever and improving upper respiratory condition. They are effective and safe

CHINESE HERBS AND OTHER SUPPLEMENTS

Six Gentle Pets is a very effective Chinese herbal combination that can reduce phlegm and decrease coughing.

Colloidal silver, either in a nasal spray or oral, may also be beneficial.”

 

Marlene Siegel
Dr. Siegel is an integrative veterinarian who practices nearly every questionable and quack therapy available, including, “chiropractic…Chinese medicine, acupuncture, Jin Shin jyutsu, Chinese herbs, intrinsic energy products, therapeutic laser, essential oils, Bach Flowers, emotional healing, and…Live Blood Analysis… magnetic resonance (Magnesphere), ozone, laser, homeopathy, touch healing,…aromatherapy, botanical medicine, flower, light and gem essences.” She has a decidedly mystical and unscientific concept of health and disease.

From this video series-

“Okay, well we’re old enough to remember. So, what do animals eat in the wild? They eat another animal. And they don’t barbecue it, and they don’t roast it. They eat it in the state that they killed it in. If we can start going back to our species-appropriate diets, if we can start eating that way ourselves, the amount of disease in our societies would go down dramatically.”

“What is really special for me is that I never, ever, ever look a client in the eye and say, ‘There’s nothing more I can do for you…’ That’s not an answer. That’s not acceptable…There is always something I can do my very first step in my healing quest, or my prevention quest, is to stop toxicity. So, we look at toxicity in every area that we can come across. The products that we clean the house. I have people read their labels, and if they can’t pronounce what’s on that label, I say don’t use it.”

“Did you know that there are over 60,000 chemicals in tap water? And the government put out a study that many of them are known carcinogens. And they’re not being filtered by our government…That’s a huge amount of toxic load.”

From other sources-

“Energy travels through meridians…Chakras are energy centers that encode and process physical, mental, emotional and spiritual experiences. They bath the organs in energy as well.

The aura surrounds the body, attracting beneficial energies and helps process necessary nutrients from the environment, like sunlight. The aura also helps us harmonize with the magnetic fields of the earth. It too impacts physical, emotional, and spiritual health.”

“Associated with every disease are trapped emotions. We know we pass our genes to our children, but we also can pass trapped emotions. These are emotions that are not “processed”, they do not pass through our body, but get “stuck” somewhere in the body. When they are “stuck” they continue to emit frequency, becoming energetically disruptive to the area they are stuck in. For example, people who experience extreme grief often trap these emotions in the lungs. If not released, these individuals may develop breast cancer or lung disease.”

“I address physical and energetic alignment through chiropractic and chakra balancing. Next I address detoxification and restoration of cell function.”

 

Rob Silver
Dr. Silver is an alternative medicine vet and prominent member of AHVMA and the Veterinary Botanical Medical Association. He also owns a line of “natural” supplements, teaches Chinese medicine and herbalism, and advocates for the benefits of cannabis in veterinary patients.

From this video series-

“I think processed food is toxic. There are some studies that indicate it’s probably carcinogenic…Plus, it’s not real food, and a lot of the foods, the raw materials that go into processed food are even worse than the food itself. I really think that’s a big cause.”

“We have huge amounts of pollution. People don’t realize how pervasive pollution is in our environment, and that’s big. It’s everywhere. It’s in our air, it’s in our water. It outgasses from our fabrics, in our drapery, in our cars. It’s everywhere…certainly, GMOs…”

“We give much more vaccinations than they need. And the vaccinations contain things like thiomersal which has mercury which has potential carcinogenic effects. I don’t think that veterinarians knowingly contribute to this….It’s just they’ve been brainwashed by the industry that’s trying to get them to sell their products.”

“Since I’ve been teaching veterinarians about cannabinoid therapy…a lot of people are coming up to me and sharing with me their own personal information. So yes, we are seeing cases where it does appear as though it causes the cancer to go into remission… I know an oncologist out in California who uses cannabis with her metronomic chemotherapy because it has all the same properties of the other metronomic drugs and a much greater safety profile… the big problem is just all this regulatory crap that no one seems to be willing to really settle as of yet. A lot of it has to do with money and investments of pharma and the government’s fear of a molecule like THC which has some anti-establishment activity as well.”

From other sources-

“Silver reminds us that archeological evidence indicates that early hominids observed animals using plants for food and medicines, and emulating their use of these plants was the beginning of the art and science of herbal medicine for humans. Our domestic animals have lost much of their herbal instinctual knowledge. Dr. Silver believes in view of this historical perspective, it is appropriate that we humans give back to them the benefits that we have learned from their ancestors by practicing herbal medicine on animals.”

“I find that instituting an effective behavioral modification program entails the integration of: training or re-training my patient’s behavior combined with specific nutritional, botanical and nutraceutical protocols; and both acupuncture (if the patient will allow) and a patient-specific prescription of Chinese herbs, based on tongue, pulse and behavioral assessments.”

“Chinese medicine assigns emotions to each of the Zang-Fu organs. The practitioner can assess aspects of those organs disharmony by observing their patient’s emotional expressions and through conversation.”

 

Lea Stogdale
Dr. Stogdale is a boarded internist and an integrative veterinarian who employs and promotes a variety of untested or questionable therapies alongside of science-based medicine. She is also an advocate of raw diets. Like many integrative practitioners, she alternates seamlessly between reasonable, science-based advice, advocacy for plausible but unproven interventions, and endorsement of complete nonsense such as homeopathy. Such individuals seem to think making no distinction between scientifically proven or at least plausible treatments, hopeful guesses, and misguided wishful thinking is being “open-minded.” Such a lack of distinctions, unfortunately only serves to given unjustified confidence in the safety and effectiveness of treatments that either haven’t been properly tested or simply don’t work.

Dr. Stogdale also has some interesting ideas on the nature of scientific evidence. She complains about the limitations of statistics, sample sizes, and other methodological problems with much veterinary research, which is all quite true. However, she then suggests that this justifies uncontrolled trial-and-error with individual patients as a superior alternative, which is just another way of rationalizing opinion-based and anecdote-based practice.

I will say that Dr. Stogdale sometimes pushes back against some of the beliefs in the holistic field that conflict with the evidence. In her interview, there were points at which she was willing to go against the agenda of the project (admitting, for example, that we really don’t know that cancer rates are increasing in pets), and the interviewer had to redirect her to more friendly subjects (such as the evils of dietary carbohydrates). This is a good reminder that opinions within the group participating in this project, even those actively promoting alternative medicine or critical of conventional veterinary practices, are not uniform or monolithic.

Dr. Stogdale’s expertise as an internist is genuine, which makes it all the more unfortunate that she has bought into so much pseudoscience and uses her credentials to support it.

From this video series-

“Currently what students are taught in vet school are taught by the veterinary pet food companies and I consider that a gross conflict of interest.”

“The problem with dog food is just the same problem as processed human food. It’s processed”

“As a veterinarian, it’s our responsibility to give all our owners every option. Make sure they are aware of any other options, so that maybe surgery or chemotherapy or radiation. Most of my owners decline that because they are more interested in integrated or holistic, with more gentle approach, but I make sure they have the options.” [a bit disingenuous since veterinarians have a great deal of influence over their clients as well as, selecting their client base by using language like “holistic medicine” and “more gentle approach”]

“BECKER: Perfect. Think back to vet school, what did you learn in vet school about cancer and nutrition?
STOGDALE: In vet school, I learned no nutrition.
BECKER: Excellent. That’s the best sound bite that we’ve had.” [these little editorial asides occur often in the transcripts and illustrate the goal of the project organizers to produce a very agenda-driven product to advance their point of view]

“What I do and what is still valid, when I talk about studies, and we need to study 10,000 cases or in cancer, 3,000 cases of something or other, and we can’t get the numbers unless you do multiple multi-centric trials…What we have to do is actually use the patient as its own control. And that is far more valid.”

“Why I come here, and why I can vaguely tolerate this conference, if I can get a lecturer that will actually tell me something new, which has yet to happen, is it is a little bit of a problem being informed and up to date, and open-minded and changing ideas. Because if I’m ahead of the curve, there aren’t that many people that are going to tell me a lot of new stuff, you know?”

From other sources-

“The Holistic Approach or Integrative Medicine considers the whole animal, not just the physical signs. The patient’s physical and mental well being as well as diet, exercise, life-style and environmental influences are all important considerations. The aim is to allow the patient’s body to heal itself and not just to use drugs to cover up the signs.  Therapies include the medical approaches or modalities of nutrition, supplements, herbal remedies, conventional western medicine, behavior modification and immune system support. We endorse and refer patients for physiotherapy, acupuncture, chiropractic adjustment, massage, homeopathy and Traditional Chinese Medicine.”

 

Susan Thixton
Ms. Thixton is a vehement activist at war with the pet food industry, government regulators, and anyone who doesn’t share her views about pet nutrition. She blames the death of one of her dogs on a preservative in pet food and identifies this experience as the genesis of her crusade.

Unfortunately, her passion is not matched by a respect for science or evidence or a very sophisticated understanding of epidemiology, nor does she have any apparent willingness to consider she might be mistaken or others might know more than she does about such issues.

Ms. Thixton is one of these “experts” whose expertise consists of all the information she can find that supports what she is determined to believe no matter what. She has served as a public member of AAFCO, the group that generates much animal feed regulation, but was dismissed in 2017 for personal attacks against other board members. She expresses deep contempt for science and for anyone who doesn’t see the industry/government conspiracy poisoning our pets that she warns about, and her participation in this series illustrates the degree to which it is ideologically driven.

From this video series-

“There are ingredients of pet food that are so inferior, they absolutely are causing cancer and more than likely a whole lot of other diseases in dogs and cats.”

“Absolutely, grains can play a significant role on a risk of cancer…t’s a roll of the dice. Are you going to roll the dice and feed grains or not?”

From other sources-

“The chemical that killed Sam – was ethoxyquin; it is still commonly used in many dog foods, cat foods, and pet treats.  The pet food company that killed her, is still one of the top pet food companies; although they no longer use ethoxyquin in their foods, they use many disease causing ingredients including dangerous chemicals/”

“If all the raw pet food recalls have you a little worried, when you learn of the action behind many of the recalls you’ll be even more worried. Fabricated lab results, intentional contamination, refusing to abide by law…and this is the regulatory authorities.”

“What we are seeing – what we have certain evidence of – is a regulatory bias that is a collective effort to destroy the fastest growing segment of the pet food industry (raw pet food). What we are seeing is all other toxic pet food issues ignored (including direct violations of federal law) while the attack on one segment of pet food is pushed forward directly by regulatory authorities.”

“Manufacturers, trade associations, veterinarians, pet store chains and even the regulatory system itself are all interwoven into a system where industry prevails and consumers (and their pets) struggle.”

“A wise man (Rodney Habib) taught me a lesson today. The Pet Feed industry is worried…worried that consumers are learning too much. So worried they can’t stop talking about us. And interestingly enough – they keep trying to convince each other pet feed is wonderful. As my wise friend explained – it’s snake oil salesmen trying to convince other snake oil salesmen how wonderful snake oil can be…that is, if they can just keep selling their snake oil.” [some may sense a hint of irony here, others not]

 

Allie Troutman
Dr. Troutman is an integrative veterinarian, practicing Chinese medicine and chiropractic along with conventional medicine, and she is a member of the AHVMA Board of Directors.

From this video series-

“We really want to feel like we are loving our pets in the most full, best way we possibly can by feeding them good food that says organic or natural or whole or nutritious. And then when we come to find out six months down the road, ten years down the road that we have been feeding them processed crap their whole life, that’s emotional.”

“I would say 30 to 40% of all the patients I see are second, third opinion can­cer consultations…They have been to traditional veterinarians, …and they’re just not getting what they need, what they’re looking for as far as a whole body approach.

They’re being told “your dog has cancer and there’s nothing we can do about it” and they are not satisfied with that answer because they know that there’s something they can do about that. And there is, and I always start the conversation with food.”

 

 

Other Participants

Dominick D’Agostino
Dr. D’Agostino is a researcher and advocate for ketogenic diets and hyperbaric oxygen theray. He is certainly a legitimate scientist, but he is also a bit single-minded on the subject, flirting with the One True Cause of All Disease fallacy. He also extrapolates freely from lab animal and human research data to clinical veterinary patients, which can be an unreliable way to predict the risks and benefits of new approaches. Generally, however, he avoids the extremes of many other alternative diet advocates involved in this project. He is also one of the leaders of the Epigenix Foundation and the Ketopet Sanctuary project.

Here are some sources of information about Dr. D’Agostino- 1, 2, 3

From this video series-

“Dogs have a different diet than what’s currently being advertised and employed. But we know that grain-based pet food is dirt cheap. That the companies that sell this pet food make much larger margins and profit if they’re able to peddle it and sell it without incorporating or acknowledging the real needs of pets and their metabolic physiology, and what it’s adapted to from an evolutionary perspective.”

“The current forms of cancer therapy are the most powerful carcinogens that we know. Including chemotherapy and radiation are probably the most powerful carcinogens.”

 

DogRisk Group
Johanna Anturaniemi
Anna Hielm-Bjorkman
Robin Moore
Noora Sjogren

As Mentioned above, DogRisk is an independent group which appears to be focused on generating evidence to support health benefits raw foods and a few other alternative health practices (such as acupuncture). The team is composed mostly of academic researchers, both vets and PhDs, working on issues of animal nutrition. The team all have legitimate credentials and research topics, but as a group they seem pretty dedicated to proving a set of pre-existing beliefs about raw diets rather than investigating the subject impartially. This is not, frankly, all that unusual in academic research, which is why a body of evidence from a variety of research groups with different methods and biases is needed to confidently judge any particular hypothesis.

It appears the group has struggled for funding, and they have not yet produced many peer-reviewed publications from their research, though they have presented some results of an online survey project. Hopefully, their work will eventually provide more insight into the pros and cons of raw and commercial diets, especially when replicated and evaluated by the larger research community.

From this video series-

“There is actually no science that says that we need to eat carbohy­drates, that we actually do need to use that glucose.”

“The dogs that we gave this high carbohydrate…what we see is that these dogs, they get into a chronic inflammatory state. And when you think that they’re eating this maybe for 12 years, it’s not any coincidence that we see all of these diseases that correlate with having cancer… they also, during their lifetime, they have much more skin diseases, they have ear infections, they have lipomas, they have tartar, they have anal gland infections. So, they have all these metabolic—what we see as metabolic diseases that comes from a metabolic inflammatory state produced by the diet.”

“They don’t have the knowledge. It’s an ignorance and it’s a frustration issue for veterinarians that they actually do not know. And they haven’t really taken the time to look at it as much as their customers. So, when—it’s like going into a doctor’s office and you know that the client knows more than the doctor. And that is a frustration issue. So, it’s kind of a normal counterattack from the vet to kind of react really negatively to it.”

“[raw food is] not really researched in universities. Most universities get sponsored by these big billion-dollar companies, and you don’t really want to step on their toes, I guess. But, I think that that’s not really ethical. I think that we have—if we know something and we know it to be true, then you just have to be able to do research on it.”

 

Joe Bartges
Dr. Bartges is a veterinary internist and nutritionist and a professor at the University of Georgia. He is another mainstream vet with some sympathy for “integrative medicine.” He avoids the extremes of some alternative medicine advocates, and his contributions to this series are quite minimal and, in themselves, reasonable. Though I disagree with Dr. Bartges on the subject of integrative medicine, I have no specific quarrel with what he says in his interview for these videos. I do feel, however, that he does a disservice to the veterinary profession and science-based medicine by allowing his name and credibility to be attached to a project which is dominated by much more unreasonable and extreme people and views.

More information about Dr. Bartges-

Raditic DM, Bartges JW. Evidence-based integrative medicine in clinical veterinary oncology. Vet Clin North Am Small Anim Pract. 2014 Sep;44(5):831-53.

UGA Faculty Bio

 

Tamar Geller
Ms. Geller is a celebrity dog trainer and activist known primarily for her emphasis on positive training methods. As happens all too often, she sometimes uses her celebrity to advocate for position on animal health despite no training or scientific expertise in the field. For example, she warns about the dangers of vaccines in her book, complaining that her dog “developed a case of hemophiliac anemia from being overvaccinated.” I presume she is referring to hemolytic anemia, since hemophilia is an entirely different disorder. The evidence is inconclusive about what role, if any, vaccines may play in triggering this disease (1, 2)

Ms. Geller also recommends raw diets and “holistic” medicine, suggesting that she has bought into the alternative medicine view. Of course, this is not a surprise given that anyone who has not would be unlikely to appear in this series, which is firmly devoted to promoting alternative medical approaches.

It is worth noting, though, that her appearance in the series is very brief, only a couple of short quotes. Given that other people interviewed have indicated that they were not told the agenda behind the project or how their comments would be interwoven with those of other people to create an impression of support for ideas they might or might not actually hold, it is possible that Ms. Gellar simply didn’t know how prominent extreme and anti-science perspectives would be in the final product.

From this video series-

“Let me tell you why your vet didn’t tell you [about alternative nutrition theories]. Your vet is an innocent victim; your vet simply doesn’t know. When vets go to vet school they come with open hearts. They’re trusting to be taught up-to-date, the best information, but they’re not.”

“They take food that is not fit for human consumption and they package it and they sell it to dogs and then they ask why do we have dog cancer?”

 

Miriam Kalamian
Ms. Kalamian is a human nutritionist inspired, as several others have been, by the work of Dr. Seyfried on ketogenic diets. She also has a personal story she tells on her web site and which incorporates a lot of disdain for conventional medicine, cancer treatment, and of course the pharmaceutical industry. She is the sort of practitioner who puts “evidence-based medicine” in scare quotes and sees the preference for data over anecdote and experience as a failing, not a strength, of mainstream healthcare. While there is some substance to some of the arguments in favor of ketogenic diets (I’ll talk about that issue in much more detail in my analysis of the content of the videos), many of the advocates for these diets, like Ms. Kalamian, are a bit single-minded about the subject and seem to view any pushback against the idea as proof of ignorance or unsavory motives.

 

KetoPet Group
Shannon Kesl
Amber Merjil
Daniel Orrego
Ron Penna
Shannan Penna
Paul Raybould
Teri Swanson

KetoPet Sanctuary is a non-profit focused on treatment of rescued shelter dogs with cancer using a raw ketogenic diets, hyperbaric oxygen, and exercise along with conventional cancer treatments. Some members of the group recommend a variety of other unproven methods or alternative methods (e.g. Yunnan baiyao)The organization is supported by the ketogenic diet advocacy charity The Epigenix Foundation and the Petco Foundation.

The Ketopet web site and marketing materials claim dramatic improvements in outcome, but there is not yet published evidence of this. They also deny that there is any risk of infectious diseases being spread by feeding raw meat, despite the evidence to the contrary. The group essentially appears to be conducting an experiment on alternative cancer therapies combined with conventional treatment, but without the usual formal mechanisms of research studies, such as oversight by ethics and animal welfare panels and methods for controlling bias and producing reliable, publishable data.

I appreciate the fact that this group is providing care for animals who would otherwise get none.  I also think some of the interventions, such as ketogenic diets and hyperbaric oxygen, deserve to be researched. My hope is that appropriately rigorous and ethical clinical studies are being done at KetoPet Sanctuary and they just haven’t made them public yet. However, my fear is that they are simply “trying out” ideas they believe in and generating anecdotes to support these beliefs rather than conducting real research, and this is not an approach that has been very successful at finding truly effective therapies. It is, in fact, an approach that tends to perpetuate ineffective treatments. In the best interests of veterinary cancer patients overall, I hope KetoPet will eventually produce good quality data we can all use.

From this video series-

Many people from KetoPet participated in this series, and there are too many to select individual quotes. Their comments tend to be about the mission of the KetoPet Sanctuary and about ketogenic diets in general. My only significant concern about the comments these folks make is that they continually use individual patient anecdotes to suggest they are doing “research” to validate their beliefs. Observation of individual patients and comparison with “expected” survival or other outcomes is not a very reliable way to evaluate whether a new treatment works, especially a complex set of interventions involving diet, exercise, hyperbaric oxygen, nutritional supplements, and others. At the end of the day, such case studies provide hypotheses to test, not proof of efficacy or safety. This requires controlled prospective studies with controls for bias and other error sources.

The KetoPet folks also complain that there is no money for such research because there is no patentable product to be produced. This has never been a convincing argument. They have raised millions of dollars to create the sanctuary and implement their approach, so it is disingenuous to suggest they couldn’t also find funding for high-quality, publishable research. Again, I hope they intend to do this, but the only time they talk about “research” at KetoPet, they are referring to case studies, to following individual patients, not to the kind of clinical trials needed to really demonstrate the true effect of their methods.

From other sources-

“We have seen a 94% success rate in reversing cancer in our dogs with our protocol. We believe that our nutrition protocol is doing the heavy lifting.”

“In the past 22 months…we have seen a 73% success rate in reversing cancer, reducing cancer or stopping tumor growth…We have seen zero metastases in any of the dogs…We believe that is is our ketogenic diet…that accounts for this high success rate.”

“At our KetoPet Program, …we have been reversing cancer in dogs with our ketogenic diet based protocol. We have achieved a 68% success rate in prolonging quality of life for our dogs and providing them forever homes.”

“Raw food closely replicates what a wild canine might eat in nature. When feeding dogs suffering from cancer, we believe that it’s important to only offer species appropriate nutrition that improves a dog’s metabolism.”

“Bacteria does not persist in the mouth of a raw-fed canine.”

“Pet Parents, hug your fur baby close- were you aware that the rendered meats used in mainstream pet foods contain the flesh of diseased stock yard animals, euthanized cats, dogs and horses, slaughter house scraps, and can even include road kill?”

 

Laurie McCauley
Dr. McCauley is a rehabilitation specialist. Rehabilitation and sports medicine are evolving areas in the veterinary field, and as such practices are often highly variably and rarely proven effective through rigorous clinical trial research. Many of the practices are borrowed from human medicine, in which there is good evidence to support them, so they are usually plausible and have at least some support in pre-clinical and human clinical research. Laser therapy and pulsed electromagnetic fields are a couple such practices Dr. McCauley recommends and which I have written about. These and many others used in rehab show some promise but lack strong, compelling evidence to support most of their uses and claims.

It is not surprisingly to find some sympathy with alternative medicine ideas in folks practicing in this evidentiary grey area. In addition to rehabilitation, Dr. McCauley is also certified in acupuncture and chiropractic, she recommends essential oils and Bach flower therapy, and she is deeply involved in the Amerian Holistic Veterinary Medical Association (AHVMA) as a board member and recipient of the organization’s Holistic Veterinarian of the Year award. Clearly, then, though much of what she promotes in the rehabilitation field is quite conventional and reasonable, if often not fully validated, she is at least supportive of more extreme and unscientific practices.

 

Loren Nations
Dr. Nations is a canine/feline medicine specialist. His contributions to the series consist mainly of, not surprisingly, promoting ketogenic and raw diets (that is, after all, a main theme of the series, so he likely wouldn’t have been invited if he didn’t). He is also an advocate for hyperbaric oxygen therapy. While I believe his enthusiasm is a little ahead of the evidence, he is one of those participants who doesn’t stray into the territory of pseudoscience advocacy, and I have to wonder if he is really aware of what is reputation and comments are being used to promote.

From this video series-

“Cancer has not made really significant im­provements over the last 40 or 50 years, even though we’ve got this war on cancer that everybody has been working so hard on. We just really haven’t moved the dial yet.”

“When I started getting really involved, there was a book called Pottenger’s Cats, and we talked about this. Back in the 1930s there was Dr. Francis Pottenger had a set of research cats and he noticed that when they were being fed unpasteurized milk and meats that had not been rendered or processed, he had a very, very healthy population of cats.

When they started pasteurizing the milk and cooking the food products he started noticing genetic problems and all these degenerative conditions… It turns out those are enzymes. Those enzymes that are found in natural, live, unprocessed foods…And that’s where raw foods come into play, because raw foods obviously have that enzyme compo­nent there which is taken out.”

[Pottenger’s study comes up often in discussions of raw diets. Though not bad for his era, his work with the cats is pretty sloppy by modern standards, and there is not enough information in his published writings to determine crucial things like whether there were differences other than cooking between the food the two groups received, whether the groups of cats themselves were different in terms of condition, health, age, sex, and all sorts of other relevant variables. And even from the information that is out there, it is clear that neither group received an adequate diet, especially in terms of taurine, not discovered to be an essential amino acid for cats until after Pottenger’s time. So his work cannot legitimately be regarded as scientific evidence in favor of raw diets, though it is often cited as such.]

 

Greg Ogilvie
Dr. Ogilvie is a respected veterinary oncologist and researcher. While he is a bit more sympathetic towards what I view as implausible treatments (e.g. this article), he is a rational, scientific clinician, and it is always frustrating to see his reputation attached to the kind of pseudoscience promoted by many of the other participants in this series. His own comments in the videos are quite circumspect, and from comments he has made in other contexts I know he is not yet convinced of the claims for ketogenic diets as a cancer therapy. As with Dr. Bartges and Dr. Nations, I am not sure he is fully aware of the sort of pseudoscience being promoted through this series or the attacks on science-based medicine in includes.

 

Richard Patton
Dr. Patton is an academic animal nutritionist (as opposed to a board-certified veterinary clinical nutritionist), focusing mostly on large and exotic animals). He is also a raw food advocate and believes, as most of the participants in this series do, that carbohydrates are the root of most or all health evils. He takes the approach that the optimal diet is the “natural” diet or what animals were able to find to eat in the wild. I’ve discussed previously why I think this is a reasonable but flawed view that suffers from the appeal to nature fallacy.

From this video series-

“What do I think of a starch diet? Well, I think it’s going to be a problem, and sooner rather than later. I think the individual on that diet, if it’s a dog, it’s going to die at seven or eight instead of 14. And it’s going to die after many trips to the vet and a lot of money.”

“Why do we buy the dog food we do? It’s because they sell it. Why do they sell it? Because we buy it. And no one is willing to look at the consequences in the same way that you or I might, and so nothing is changing.”

“Even the experts don’t get it. They think a calorie is a calorie and that’s not so. A calorie from carbohydrate is much more sinful than a calorie from fat.”

From other sources-

“A bowl of kibble once a day is tantamount to daily endocrine abuse and is unhealthful.”

 

Tom Seyfried
Dr. Seyfried is a biologist and researcher investigating metabolic and dietary approaches to treating disease, including cancer. He is one of the legitimate scientists included in this series who has done useful preliminary work but who is also convinced he has found a miracle cured the rest of the scientific and medical community has missed. Much of what he promotes remains to be proven safe and effective in clinical trials, though it rests on reasonable theoretical and pre-clinical grounds.

Unfortunately, while his research is contributing to the advancement of science and, hopefully, to the development of new strategies for preventing and treating disease, his participation in this project simply adds a patina of legitimacy to all the nonsense and quackery promoted by many other participants. Dr. Seyfried’s enthusiasm for his ideas seems to have blinded him to the potential harm of promoting them alongside advocates for pseudoscience and opponents of science-based medicine. It has also made him a pretty vicious critic of the mainstream scientific and medical communities. He appears to believe that any resistance to his ideas must stem from ignorance or evil motives.

From this video series-

“And it’s very hard to change dogma because dogma is a form of indoctrination. So, even when you look at these data and you’ve been indoctrinated, you can’t accept it….You can’t. You’re already—when your job depends on you not accepting this, you’re not going to be able to accept it.”

“But in cancer, why should we sacrifice millions of people and dogs and all these animals that are dying from cancer while we wait for the misinformed to die off? These people are dying now…Will we have to have another 50 years of dead cancer patients, dogs or people, before the paradigm changes? I said no. This is a tragedy of monumental proportions that needs to be addressed immediately.”

“BECKER: The American College of Veterinary Nutrition says, which are board certified veterinary nutritionists, they go to three extra years of school, their professional recommendation is that diet, a dog’s diet, does not influence cancer in any way. Thoughts?

“SEYFRIED: I don’t know what to say. Are they brain damaged? Do they have any functional brain cells? Do they read the literature? Can they comprehend the information? Why would they say that?”

“Giving a dog a food that it didn’t evolve to eat. Now that’s got to rain havoc on its metabolism… High processed nutritionally depleted foods are killing us, you know.”

“Drugging people to make them healthy or dogs, drugging them and radiating them and doing this absurdity, when you can do the same thing with food.”

“I talked to another vet from a dog food company, and they indicated that the dog has now evolved over the last thousand years to be able to eat grains. And I said this person is absolutely clueless as to the nature of evolution.”

“Misinformation and lacking knowledge are a dangerous combination, and this is what we have. This is what we have, and it’s institutionally supported, which is even more crazy…And the vets and the MDs and the people who don’t understand better get on board soon because they’re not going to have any customers or clients or patients, whatever you want to call them.”

“Study it when we have time. In the meantime, why don’t we try to help all these people that we know we can help right now?…We don’t need any new drugs…The academic community is focused on minutia, metabolic minutia that doesn’t translate well into the clinic at all… In the meanwhile, we have the corpses are piling up in the clinics…Why are all these people dying here? There’s a disconnect between the academic research on cancer and what’s actually is going to help the person in the clinic.”

“The pharmaceutical companies are not interested in this because there’s no profit in it. And the pharmaceutical companies and the top academic institutions and the NCI, they’re all back slapping and they’re all happy about this whole thing except for the guy in the clinic; he’s the one suffering.”

“How come nobody knows about this? Because every night we get a pharmaceutical thing on TV telling us how wonderful this drug is…Where are the commercials to support [dietary treatment]? The government should be doing that…but they’re corrupted in some way.”

“If I have 50 GBM patients that are four years out and they’re all healthy, you don’t think that’s evi­dence based medicine? What do you call that? The guy’s healthy. Look at Pablo on the YouTube. He chose no radiation, no surgery, no chemo. No surgery, no radiation, no chemo. Metabolic diet ther­apy and he’s doing fine. And then they say the evidence is weak? Well look at Pablo. How weak is he?”

“Surgery to the max, poisoned people to an inch of their life, irradiate them to the point—with the hope that they’re going to survive. This is nuts. This is insane. These people don’t know biology. They should not be allowed to practice medicine.”

From other sources-

“The low-carb, high-fat ketogenic diet can replace chemotherapy and radiation for even the deadliest of cancers.”

“’The reason why the ketogenic diet is not being prescribed to treat cancer is purely economical,’ said Dr. Seyfried, author of Cancer as a Metabolic Disease. ‘Cancer is big business. There are more people making a living off cancer than there are dying of it.’”

 

Tim Spector
Dr. Specter is a professor of genetic epidemiology and an expert on GI microbes. He has written a popular book as well as numerous research articles on the subject of GI flora and its impact on health. He is both a legitimate scientist and an eloquent popularizer of his area of expertise. In popularizing science, of course, some of the detail and nuance is inevitably lost, but Dr. Specter seems consistently on the side of science and against pseudoscience. Once again, this makes me wonder if he really understood who else was involved in this project and what the agenda was.

From this video series-

“I gave my son a McDonald’s diet for two weeks. He basically lost 40% of the diversity of his species in that time. I think from my recent studies, I can’t think of anything worse than giving high starch, highly processed, non-diverse foods to any animal for sustained periods of time.”

“If you look across large populations, cancer can be pretty much down to diet and lifestyle, or bad luck.”

From other sources-

“Most doctors have a few hours of medical school on nutrition and haven’t really updated themselves and don’t follow the trends whereas a lot of the public are extremely well informed but may be unable to separate the science from the pseudoscience,”

“If you don’t submit things to scientific peer review, any nutter can put up a theory online that is perpetuated as fact. I found lots of websites that claimed to have studies (but didn’t). A good example is coconut oil, claimed to be the best thing ever and so much better than any other type of oil and olive oil especially; when you followed it up the studies didn’t exist or were in such obscure journals your cat could have written it and been published.”

“Spector is worried that we are in a stage of transition, of wanting to change our ways and look after our health, but those who don’t know where to find information or understand complex issues are at risk of being lured away by snake-oil salesmen and cult figures. ‘Everyone should be a bit more critical about what they’re reading,’”

“It’s as if we have given up faith in God and religion and we’re now on a mission to convert people to join our club, or our group, (and) practise gluten-free or lactose-free or whatever it is.”

 

Alice Villalobos
Dr. Villalobos is a pioneer in hospice care for terminal pets. Though this is sometimes a controversial subject, I am supportive of high-quality palliative care, and I think the veterinary profession needs to be better informed and more aggressive about providing it. Given that there is not yet a well-established animal hospice field within veterinary medicine, there is little or no evidence available to identify best practices. Unfortunately, this opens the door for the use of untested or dubious methods, and these seem to be fairly common in the veterinary hospice community.

As Dr. Villalobos puts it, “pioneers always have arrows in their backs, so I developed a thick skin.” She clearly has a lot of confidence in her own experience and judgment, and the deserved recognition for her many accomplishments surely strengthens this. Along with conventional treatments, she recommends a variety of “natural” products and supplements, and she is convinced her integration of “Eastern” medicine with conventional medicines has been validated, despite the lack of much scientific evidence to support this.

From this video series-

“Why don’t we start looking at what we’re feeding our animals as a big, perva­sive, and self-destructive problem?”

“Most of the veterinary nutritionists in the world I believe are not in private practice. I believe they are actually working for industry, which is being supported by the corn belt and the sugar belt.”

From other sources-

“Back in the 1970s, I wanted to integrate the best of Eastern medicine into our modern medicine, surgery and oncology practices. We began by encouraging associates to study acupuncture and used nutraceuticals  as immunonutrition to support the immune system and organ function of our chemotherapy patients to reduce adverse events… Back then, I was out on a limb using beta glucans from mushrooms and antioxidants for my cancer patients. Now, we use antioxidants openly…It is great to see the validation coming in now!”

Posted in General | 18 Comments

Low-level Laser Treatment does not Improve Healing after TPLO Surgery in Dogs

I have been covering the subject of low-level, or “cold” laser treatment for many years. While there is some plausibility to the idea that laser light might have beneficial effects on tissue, very little convincing evidence of actual benefits in real patients. This is not surprising since the majority of good ideas that look promising on paper or in the lab fail to ever turn into safe and effective clinical treatments. Real life is more complicated than the research lab.

There have been very few clinical trials in dogs and cats, and most have had significant methodological limitations, so we can’t have much confidence in their findings. These findings, such as they are, have been mixed, with little consistent or compelling evidence of real-world benefits.

While this doesn’t mean lasers can’t be useful, it does mean that claims made for them by proponents, and the widespread use for many problems in dogs and cats, are based primarily on theory and anecdote, not on reliable research evidence. For something that is promoted as a dramatic breakthrough and is heavily marketed and widely used, it is surprising that it has been so difficult to actually demonstrate the supposedly amazing benefit in controlled research.

Another study has recently been published which follows up on the laboratory research suggesting laser might improve healing of bone and soft-tissue wounds. This is a well-conducted study with a reasonable number of patients, good control for bias and error (randomization, blinding, placebo controls, etc.), and reasonably reliable outcome measures. To steal my own thunder, it doesn’t look very good for laser therapy.

Renwick SM. Renwick AI. Brodbelt DC. et al. Influence of class IV laser therapy on the outcomes of tibial plateau leveling osteotomy in dogs. Veterinary Surgery. 2018: epub before print.

About a hundred dogs undergoing a TPLO (a common orthopedic surgery for cruciate ligament disease) were randomly assigned to receive laser treatments or placebo laser after the procedure. Though it’s not entirely clear if the people conducting the actual treatment were blinded to whether they were giving actual laser or placebo, everyone else (owners, surgeons, staff reading x-rays, etc.) appears to have been. The study used a couple of questionnaires to evaluate owners’ perceptions of comfort, function, and wound healing and had a surgical specialist evaluate the healing of the cut in the bone made as part of the procedure. Overall, none of these outcome measures showed any difference between real and fake laser treatment.

A subset of one questionnaire, looking at gait, did show a statistically significant difference between the treatments. This is not surprising since it is common for at least one outcome measures compared to show a statistical difference between treatments when many things are measured and compared. However, without a consistent pattern of such difference across outcomes, and with the difference in this particular measure being so small it is doubtful that it would be meaningful to the patients in terms of their comfort or function, the study provides pretty strong evidence against any value of laser therapy in these patients.

The authors, not surprisingly, emphasize the one small difference seen and suggest this might provide at least “mild clinical justification” for using lasers in patients undergoing TPLO. Personally, I think it is more reasonable to view the difference as a statistical fluke and to emphasize the failure to find any benefit in all the other measures evaluated, as well as the failure to show strong results in other clinical trials. Of course, there are many different techniques for using laser therapy, and proponents can always claim any single negative study is only negative because the technique used wasn’t quite right. This is the kind of “Yes, but….” Argument that supports the use of a lot of therapies even when clinical trial results consistently fail to find benefits. It is a reasonable argument up to a point, but eventually the failure to find positive effects does begin to suggest that there are none to find.

Absence of evidence can be evidence of absence once we’ve tried hard enough and long enough to find support for a scientific hypothesis. I don’t think we have reached that point yet with cold laser, and I do think more research is justified. However, it would be worthwhile for veterinarians and animal owners to be mindful that all the time and money being spent on laser treatment has so far not been proven worth it by good research, and in fact the balance of the evidence is not that encouraging.

 

Posted in Science-Based Veterinary Medicine | 2 Comments

Lysine for Feline Herpesvirus: A Therapeutic Zombie

Introduction
Science is a process for developing and refining our understanding of nature over time. The work of a community of scientists, often with vigorous competition and conflict between individuals, gradually improves the accuracy of our understanding. Perfect comprehension of something as complex as the health of living organisms seems unachievable, but little by little we get better at knowing how nature works and how we can influence natural phenomena. This progress often involves realizing that some aspects of our current understanding are actually wrong, and that our strategies for manipulating nature based on this flawed knowledge may turn out not to be effective.

In medicine, this process creates a kind of life cycle for medical interventions. The popular conception of this life cycle is the story of effective treatments. An insight or accident leads to a hypothesis, which is tested at various levels from in vitro to animal model to clinical use, and ultimately we validate the hypothesis and conquer the original problem.

Unfortunately, this is the exception rather than the rule. Far more often, the life cycle of medical therapies involves an insight or accident leading to a hypothesis which early, flawed evidence appears to support but which ultimately turns out to be wrong. This is a well-established phenomenon of the clinical trial literature, often called the Decline Effect or the Proteus Effect.1-2

Treatments based on such hypotheses are eventually abandoned in most cases, though some prove quite tenacious. Anecdote and personal experience frequently lend ineffective interventions a prolonged post-mortem existence, therapeutic zombies that stagger on long after the scientific evidence should have put them to rest. A great example of the life-cycle of an ineffective treatment is the use of L-lysine for the prevention and management of feline herpesvirus (FHV-1).

Herpesvirus & Lysine: The Scientific Evidence
Early in vitro work on human herpesvirus (HHV-1) suggesting lysine might inhibit replication and could potentially have clinical utility first appeared in the mid 1960s.3 This was followed by the first clinical studies of lysine for HHV-1 about ten years later.4 By the 1980s, the literature on lysine and HHV was glowing, and it seemed a safe and effective therapy had been found.5

Veterinary medicine caught the coattails of this process in the 1990s, with the first published in vitro study of lysine for FHV-1 appearing in 1995.6 Clinical studies followed in the early 2000s, and lysine quickly became a widely available supplement used for FHV-1 management.7

However, the scientific process rolled on, and despite the enthusiasm of clinicians and researchers, cracks in the lysine narrative soon appeared. Limitations and potential sources of bias in the early literature were addressed in subsequent studies, and the apparent benefits melted away. The most recent reviews in human medicine have concluded that there is no reliable evidence to support the use of lysine for herpesvirus management, and it is not included in current treatment guidelines.8-10 Lysine supplements are still available and marketed for this use, of course, because patients and some clinicians cling to their belief in the efficacy of this treatment despite the evidence, based predominantly on anecdotal experience. That patients do this is understandable, but it is always disappointing to see clinicians choose anecdote over science when they have the training to know better.

The story has played out in a similar way in veterinary medicine, with the usual time lag. The initial theoretical rationale for use of lysine, for example, has not held up to subsequent study. According to the theory, lysine should antagonize arginine and reduce the level of this amino acid. This, in turn, should inhibit FHV-1 replication and reduce clinical symptoms and viral shedding. However, research in cats has failed to validate any of the steps in this chain of reasoning. Oral lysine does not appear to antagonize or reduce intracellular levels of arginine, and it does not seem to inhibit FHV-1 replication under normal physiologic conditions.7

A similar fate has befallen the initial claims for clinical effects of lysine Early studies, with small numbers of patients and methodological limitations, produced some positive results which could not be reproduced in larger, better-controlled research.7

The most recent comprehensive reviews of the evidence for lysine in FHV-1 patients are not encouraging.7,11 The more optimistic of the two states that “there is considerable variability” it the research results and that while “data from these studies suggest that lysine is safe when orally administered to cats and, provided that it is administered as a bolus, may reduce viral shedding in latently infected cats…the stress of bolus administration in shelter situations may well negate its effects and data do not support dietary supplementation.”11

A comprehensive systematic review of the subject by Bol and Bannik (2015) is considerably more blunt, systematically rejecting every aspect of the rationale for lysine use:

There is no evidence for lysine-arginine antagonism in the cat.

Lysine supplementation does not have an inhibitory effect on FHV-1 replication in the cat.

The claim that lysine supplementation is effective for the prevention or treatment of herpetic lesions in humans cannot be supported by scientific evidence.

Lysine supplementation is not effective to prevent cats from becoming infected with

FHV-1, it does not decrease the chance of developing clinical signs related to active FHV-1 infection, and it does not have a positive effect on the clinical course of its disease manifestations.

Based on the complete lack of scientific evidence for the efficacy of lysine supplementation, we recommend an immediate stop of lysine supplementation for cats.

The accumulation of evidence against the use of lysine for FHV-1 cases has had an impact. Some shelter medicine specialists, for example, now recommend against this practice.12-13 However, there has also been resistance to abandoning this treatment despite the evidence. Unfortunately, such resistance has not been based so much on any substantive dispute about the science but instead on the seductive power of anecdotal evidence.

When the review by Bol and Bannik (2015) was reported in Veterinary Practice News, for example, objections from some respected veterinarians explicitly cited anecdotal experience as a reason for continuing the use of lysine:14

Anecdotal evidence should not be discarded…I have clients who tell me that every time they take the cat off lysine the problem returns…Maybe it’s just as well to leave those cats on lysine if the clients genuinely feel that it’s making a difference.

[Lysine] is used frequently by many of my clients at the recommendation of Dr. Google…Some cats have a very convincing response in spite of what the science says…Its use should be based on response, whether scientific or not.

Science is, by nature, a competitive community process. Disagreement between individuals is healthy and an integral part of this process, spurring replication of research that helps compensate for the inevitable blind spots and biases we all suffer from. However, the explicit preference for anecdote over controlled research evidence is counterproductive and lends itself to the retention of treatments that do not truly help our patients and which deserve to be abandoned.

There is some limited evidence suggesting lysine could actually exacerbate FHV-1 symptoms, which would certainly make abandoning it the right choice.7 Even if it is completely harmless, however, wasting resources on treatment that has been through the scientific vetting process over 50 years and has still failed to show convincing evidence of benefits is not justified.

As I argued last month, evidence-based medicine is a necessary pillar of effective and ethical clinical practice. This means we must be willing to acknowledge our limitations and set aside anecdotal evidence, even our own, when appropriate research evidence indicates we are mistaken.

References

  1. Lehrer J. The truth wears off: Is there something wrong with the scientific method. The New Yorker. 2010. pp. 52-7.
  2. Alahdab F. Farah W. Almasri J. et al. Treatment Effect in Earlier Trials of Patients With Chronic Medical Conditions: A Meta-Epidemiologic Study. Mayo Clin Proc. 2017. Epub before print. Available at: http://www.mayoclinicproceedings.org/article/S0025-6196(17)30836-4/pdf Accessed February 21, 2018.
  3. Tankersley Jr RW. Amino acid requirements of herpes simplex virus in human cells. J Bacteriol. 1964;87:609–13.
  4. Griffith RS, Norins AL, Kagan C. A multicentered study of lysine therapy in Herpes simplex infection. Dermatologica. 1978;156(5):257–67.
  5. Griffith RS. Walsh DE. Myrmen KH. Et al. Success of L-lysine therapy in frequently recurrent herpes simplex infection. Treatment and prophylaxis. Dermatologica.1987;175(4):183-90.
  6. Collins BK. Nasisse MP. Moore CP. In vitro efficacy of L-lysine against feline herpesvirus type-1. Proc 26th Ann Meeting Amer Col Vet Opthalmologists. Newport, RI. 1995;141.
  7. Bol S. Bunnik EM. Lysine supplementation is not effective for the prevention or treatment of feline herpesvirus 1 infection in cats: a systematic review. BMC Vet Res. 2015:11:284.
  8. Chi CC. Wang SH. Delamere FM. et al. Interventions for prevention of herpes simplex labialis (cold sores on the lips). Cochrane Database of Systematic Reviews.2015;8. Art. No.: CD010095.
  9. Mailoo VJ. Rampes. S. Lysine for herpes simplex prophylaxis. Integrative Medicine. 2017;16(3):42-46.
  10. WHO Guidelines for the Treatment of Genital Herpes Simplex Virus. Geneva: World Health Organization; 2016. Available from: https://www.ncbi.nlm.nih.gov/books/NBK396232/
  11. Thomasy SM, Maggs DJ. A review of antiviral drugs and other compounds with activity against feline herpesvirus-1. Vet Opthalmology. 2016;19(Suppl 1):119-130.
  12. UC Davis Koret Shelter Medicine Program. Feline upper respiratory infection aka URI. 2015. Available at: https://www.sheltermedicine.com/library/resources/?utf8=%E2%9C%93&search%5Bslug%5D=feline-upper-respiratory-infection-aka-uri Accessed February 21, 2018.
  13. Slater M. Interpreting research (and making it work for you): Is lysine a good investment for shelters wanting to prevent URI in cats? Available at: https://www.aspcapro.org/blog/2017/05/03/interpreting-research-and-making-it-work-you-lysine-good-investment-shelters-wanting Access February 21, 2018.
  14. Niedziela K. Researchers question lysine use in FHV cases. Vet Pract News. 2016;28(1):36-7.

 

Posted in Herbs and Supplements | 5 Comments

Ethics and Evidence-based Medicine

The relationship between evidence-based medicine (EBM) and ethics may not be immediately apparent. EBM focuses on facts and data, safety and efficacy, and determining what we know and don’t know. Veterinary ethics is about what is right or wrong to do in the context of veterinary practice. The values that inform ethical principles are subjective and not always shared between individuals or different segments of the profession. The evidence used to evaluate the safety and efficacy of medical treatments, in contrast, should ideally be produced by methods broadly agreed to be the most objective and reliable possible. However, EBM turns out to be a key tool for achieving ethical clinical practice.

Despite inevitable controversy and disagreement, there are some ethical principles broadly accepted by most veterinarians. Some of these are articulated in statements such as the American Veterinary Medical Association’s Principles of Veterinary Medical Ethics.1 This document was adapted from the principles established for physicians by the American Medical Association, and similar statements have been adopted by veterinary associations around the world.2-6

Other widely accepted ethical standards are simply common elements of more basic cultural norms. For example, most of us would likely agree that we should try to help our patients and our clients, we should be honest with clients, and we should do our best to be technically competent and familiar with the current scientific knowledge that underlie clinical medicine.

These basic ethical precepts are formalized in the domain of medical ethics as several core principles, which usually include:

Beneficence–  Clinicians should attempt to help their patients, to benefit them.7

Non-maleficence– Clinicians should attempt to avoid harming their patients or to do more good than harm.7

Autonomy– Patients (or in veterinary medicine, their owners) have the right to accept or reject treatment. This is the foundation for the more specific concept of informed consent.7

Informed Consent– Clients have the right to make choices about the treatment of their animals based on accurate, relevant information they can understand.8

So what does EBM have to do with meeting these ethical obligations? Well, ethical judgements cannot be made without facts. The best path to abide by one’s ethical principles cannot be determined without an accurate understanding of the context. EBM informs ethical practice by giving us, and our clients, an accurate understanding of the risks and benefits of our actions as well as the degree of uncertainty about these.

In terms of beneficence and non-maleficence, for example, one cannot successfully help patients and minimize harm without an accurate understanding of the causes of disease and the effects of our treatments. If we attribute illness to the wrong cause, we are unlikely to stumble across an effective remedy. And if our treatments don’t actually work, or if they have risks that we are not aware of, then we are less able to do good and avoid harm to our patients.

Similarly, we deny clients their right to informed consent if we give them incorrect information about diagnosis, prognosis or the likely outcome of our treatments. This is equally true whether we are deliberately lying or are simply mistaken. The history of medicine is a long, frightening tale of incorrect beliefs about disease and of ineffective, even harmful treatments enthusiastically applied by well-meaning doctors. We are no smarter or better intentioned than our predecessors, but thanks to science, we are better informed.

Evidence-based medicine, then, is arguably a necessary component to ethical veterinary practice. It serves to provide clinicians with the most current and accurate understanding of the causes of disease and the risks and benefits of our therapies. EBM also helps us quantify the inevitable uncertainties we must accept and communicate to our clients.

There is rarely optimal evidence, so the most conscientious practitioner of EBM will often not be able to accurately predict the outcome of his or her treatments. However, even in this situation, EBM is useful because it supports truly informed consent. If the evidence supporting a particular therapy is weak, I may well still offer that therapy. However, I am able, even obligated, to understand the limitations of the evidence and share this with the client to help support informed decision making.8

There is often anxiety among veterinarians about disclosing uncertainty to clients. We fear they may not trust in our competence or may eschew beneficial treatment if we express any uncertainty or discuss the limitations of our knowledge. However, there is evidence that may allay this anxiety. Surveys have shown that clients expect to be told about the uncertainty associated with our recommendations and that they do not lose confidence in us as a result.9 Even more significant from an ethical perspective, clients in one study emphasized that their central expectation for the information they were given by their veterinarians was that it be the truth.10 EBM helps us meet the ethical obligation and client expectation that we communicate truthfully about our recommendations and our uncertainty.

So far, this idea that EBM can facilitate ethical veterinary practice by giving us the most accurate information and helping us measure our uncertainty may not seem especially controversial. Unfortunately, if we commit to EBM as the best source of information to support effective and ethical medicine, we eventually enter more tendentious territory.

For example, EBM includes the presumption that some sources of evidence are more reliable than others.11-12 This often leads to a conflict between what we believe, based on anecdote or personal experience, and what scientific evidence supports. Clinicians dislike being told that therapies which seem and effective in use are either scientifically unproven or have significant evidence against their safety or effectiveness. Yet our obligation to be informed and competent, and to provide accurate and truthful information to clients, can sometimes mean accepting the unreliability of anecdotal experiences, even our own.

An even more contentious topic is the ethical appropriateness of theoretical systems and treatment methods with core principles that conflict with established science. Much of what is often called alternative medicine consists of beliefs about the causes of illness and methods of treatment that are either scientifically unproven or even demonstrably incorrect based on research evidence.13-14 Alternative medicine raises many complex ethical issues,15 and it has been argued, in both human and veterinary medicine, that the use and sale of such approaches, however honest and well-intentioned, violate some broadly held ethical principles.14-19

Informed consent and autonomy are denied when clients are given information about their animals’ health that is inaccurate by the best available standards of evidence and scientific consensus. Beneficence and nonmaleficence cannot be maintained if ineffective treatments are offered.16

Often of course, there are legitimate disagreements about the meaning or strength of the evidence. However, there must be some generally accepted standard of proof required beyond simply the personal belief of the individual clinician to justify our treatments. If not, then there is no purpose to the systems of licensing and regulation intended to protect the public from unsafe and useless medical treatment. The caveat emptor free-for-all of medicine in the 18th and 19th centuries was ultimately rejected in the 20th as unsafe, and this was predicated on the belief that scientific evidence could provide a common basis for evaluating medical practice. This is a key pillar of the ethical structure of modern medicine, and EBM is an important tool for supporting ethical, science-based practice.

References

  1. AVMA Principles of Veterinary Medical Ethics. Available at: https://www.avma.org/KB/Policies/Pages/Principles-of-Veterinary-Medical-Ethics-of-the-AVMA.aspx Accessed January 31, 2018.
  2. AMA Principles of Medical Ethics. Available at: https://www.ama-assn.org/delivering-care/ama-principles-medical-ethics Accessed Access on January 31, 2018.
  3. CVMA. Principles of Veterinary Medical Ethics. Available at: https://www.canadianveterinarians.net/documents/principles-of-veterinary-medical-ethics-of-the-cvma Accessed January, 31, 2018.
  4. FVE. European Veterinary Code of Conduct. Available at: http://www.colvetalbacete.es/images/contenidos/cecv.pdf Accessed on January 31, 2018.
  5. AVA. Code of Professional Conduct. Available at: http://www.ava.com.au/conduct Accessed January 31, 2018.

6.Veterinary Council of India. Code of Ethics. Available at: http://www.tnsvc.org/forms/codeethics.pdf Accessed January 31, 2018.

7.Beauchamp TL. Childress JF. Principles of biomedical ethics. 5th Ed. (2001) New York, NY: Oxford University Press.

  1. Fettman MJ. Rollin BE. Modern elements of informed consent for general veterinary practitioners. J Amer Anim Hosp Assoc. 2002;221(10):1386-1393.
  2. Mellanby RJ. Crisp J. De Palma G. et al. Perceptions of veterinarians and clients to expressions of clinical uncertainty. J Small Anim Pract. 2007;48(1):26-31.

 

  1. Stoewen DL. Coe JB. MacMartin C. et al. Qualitative study of the information expectations of clients accessing oncology care at a tertiary referral center for dogs with life-limiting cancer. J Amer Vet Med Assoc. 2014;245(7):773-83.
  2. McKenzie B. A new perspective on evidence-based medicine. Vet Pract News. July, 2017. Available at: https://www.veterinarypracticenews.com/a-new-perspective-on-evidence-based-medicine/ Accessed January 31, 2018.
  3. Cockroft, P. Holmes, M. (2003). Handbook of Evidence-Based Veterinary Medicine. Oxford: Blackwell.
  4. McKenzie, BA. Is complementary and alternative medicine compatible with evidence-based medicine? J Amer Vet Med Assoc. 2012;241(4):421-6.
  5. Ramey, DW. Rollin, BE. (2004). Complementary and Alternative Veterinary Medicine Considered. Ames: Iowa State Press.
  6. Nuffield Council on Bioethics. Complementary medicine: ethics. 2014. Available at: http://nuffieldbioethics.org/wp-content/uploads/Complementary_medicine_FINAL_FL_paper-1.pdf Accessed January 31, 2018
  7. Smith K. Against homeopathy-A utilitarian perspective.Bioethics2012;26(8):398–409.

 

  1. Ernst E. Cohen MH. Stone J. Ethical problems arising in evidence based complementary and alternative medicine. J Med Ethics. 2004;30:156-9.

 

  1. Milstein M. The case against alternative medicine. Can Vet J. 2000;41:769-72.

 

  1. Macdonald C. Gavura S. Alternative medicine and the ethics of commerce. Bioethics, 30: 77–84.

 

Posted in General | 7 Comments

Veterinary Practice News Evidence-based Medicine Column

Last summer, I was asked to take over the Evidence-based Medicine Column (previous the Alternative Medicine Column) in the trade magazine Veterinary Practice News from Dr. Narda Robinson. This was an excellent opportunity to  illustrate the principles and techniques of evidence-based medicine in action, evaluating specific medical practices and discussing general issues related to EBM. Some of these columns will cover alternative therapies, but many focus on conventional medical therapies as well, since I have always advocated evaluating all therapies by the same, science-based standards. I will keep a running collection of links to these columns here as each becomes available to the public, as well as occasionally posting those with content that hasn’t appeared here before. Enjoy!

 

A new perspective on evidence-based medicine
July 27, 2017

Cannabis-based remedies lack reliable clinical evidence for veterinary use
August 9, 2017

Pros, cons of surgical sterilization, neutering options for females
September 14, 2017

Surgical sterilization, neutering options for male cats, dogs
November 21, 2017

Yunnan baiyao for patients with hemorrhage, neoplasia
December 11, 2017

Probiotics and today’s pets
January 10, 2018

Why do we run diagnostic tests?
February 7, 2018

Pheromones’ therapeutic use in animals
March 14, 2018

Evidence-based Medicine is Key in Achieving Ethical Clinical Practice
April 17, 2018

Lysine: A therapeutic zombie?
May 16, 2018

Is tramadol an effective analgesic for dogs and cats?
June 26, 2018

What is a placebo?
July 10, 2018

Uses, evidence, and safety of laser therapy: The future of laser therapy and it’s conflicting evidence.
August 16, 2018

Assessing claims of vaccine-induced ITP, IMHA
August 29, 2018

Posted in Presentations, Lectures, Publications & Interviews | 8 Comments

SkeptVet Gets Hate Mail 2018

It will come as no surprise to readers that I receive a steady stream of hate mail in the form of email and comments on the blog. Occasionally, someone calls me up at work, sends me a snailmail letter, but the vast majority of the negative comments I get are anonymous through the internet. In contrast, the positive comments I get, which are often accompanied by the name of the reader or given to me directly in person. Something about the anonymity internet frees people to say the darkest things in their heart without the usual social restraints that prevent us from being shitty to one another. (Before anyone cries “hypocrite” let me point out once again that this blog is not anonymous. My identity and credentials are easily found here and online, and I take ownership of the blog openly in my public lectures. I choose not to make myself the center of attention here, since I think the ideas and evidence should be the focus, but I am not hiding behind any serious attempt at anonymity).

I don’t, of course, allow people to post abusive comments directly on the site. Civil and substantive disagreement is welcome, but I am under no obligation to give people a platform to rant or abuse me or my profession. However, I do periodically review the best of my hate mail for several reasons. On one level, it is instructive to see the patterns in how people respond to my critiques of unproven or quack therapies. These comments give an insight into how people think and why they are attached to these kinds of treatments, which is useful for anyone trying to oppose pseudoscience.

It is also worthwhile to point out that advocates of the practices I challenge are hardly peaceful, saintly individuals minding their own business when vicious skeptics like myself come along to attack them. As I’ve discussed in detail before. Alternative therapies are marketed primarily by attacking the safety and efficacy of science-based medicine and the motives of mainstream doctors. Skeptics such as myself are responding to the assault of pseudoscience on scientific medicine, we are hardly the instigators of conflict. And apart from the occasional slip into sarcasm, most of my critique is aimed at claims and arguments and based on reason and evidence. I am far more likely to be the subject of vicious personal attacks than the perpetrator.

Finally, I have to admit that much of the angry feedback I get is amusing in its own right. Just as Jimmy Kimmel turns his hate mail into comedy I enjoy a chuckle over some of the outrageous things people say to me from the safety of their keyboards.

Some of the trends in the negative comments I get are obvious. There is a constant drumbeat of paranoia and conspiracy theorizing, blaming “Big Pharma” and the greed and immorality of mainstream medicine for all sorts of horrors which supposedly justify quack alternatives. There is the deep distrust of government and regulators, scientists and intellectuals, and anyone who makes a living in medicine except alternative medicine practitioners, supplement companies, and others who profit from “alternative medicine.”

There is also an obvious but rage in many of these comments that is harder to understand. Apart from a few individuals I have written about directly, the majority of those who write furious, hateful comments have no particular reason to be taking what I say here so personally. My blog doesn’t come into people’s living rooms or business. They have to search the internet, find the blog, and choose to read it. If they disagree, they are free to ignore me with no harm done. But even those who shout “No one cares what you think!!!” clearly do care enough to spend time writing angry comments (though they clearly don’t take much time to proofread these comments). I still find that puzzling.

Lastly, I have to point out that not once have any of these folks I’m quoting ever presented a piece of scientific research evidence to support their objections or challenge my claims. Plenty of commenters say “I don’t care what you/science/anyone says, I’ve seen XX work for myself.” None, however, have backed up their anger with anything other than anecdote or argument from authority.

Here are my previous hate mail collections:
Hate Mail 2011

Hate Mail 2015

I have organized the selections below into broad, loosely defined categories, and I will occasionally insert comments like so: [SV: Xxxx] Enjoy!

 

Being Nice?
[SV: Some commenters don’t seem to appreciate the strange and humorous inconsistency in tone when they simultaneously chastise me and wish me well. Perhaps they recognize that they are being much harsher than would ever be acceptable in person and are trying to soften the message, or maybe just make themselves look like they are taking the ”high road?”]

You are such a rabid skeptic and that keeps you from some great things in life. By the way, the crap works- do more research on it- ask a client if they want to try it- One that has NOTHING to lose and see. Hope your life gets better and you quit being so negative. Wishing you the best.

You are clearly uneducated…Bless you though.

After reading a few articles on this page, I come to the conclusion that it is not necessary to read the other’s content, as anything and everything mention here the author is clearly AGAINST. Its a bit pitiful, I think to be SO sceptical, how can you enjoy life at all.

i can feel the intense negative emotion you are feeling toward Dr. Plechner and other doctors that don’t follow the herd. I am sorry you are festering in this emotion. Does it upset you to think of all the success stories?

are just a Big Pharma shill. That’s OK. Everyone has the right to protect their interests. I wish you luck in your endeavor to frighten people away from innexpensive therapies which might save their termial pets’ lives. If it makes you happy, I wish that for you sincerely.

your ignorance and pride is a disgusting excuse for lack of wisdom. You obviously must be carrying a lot of disease in your own body and soul. Bless your heart, poor thing. Hope you get well soon.

You sound like a pompous ass. ..I don’t think anyone stands a chance of turning on a light for you at all. Just had to express my irritation on wasting my time trying to find an unbiased opinion from your site. Good luck with your journey on the narrow path you travel.

Hahahahahahahahahaha. You think that you’re enlightened, hahaha, you’re not, you’re nescient at best and ignorant at worst. Enjoy your pontificating though.


IN MY HUMBLE OPINION, YOU ARE PURE EVIL, MAKING MONEY OFF YOUR BLOG’S, AND SCREWING OVER THOUSANDS OF DOGS AND CATS, AND OTHER CREATURES, WITHOUT A SINGLE PIECE OF EVIDENCE SUPPORTING YOUR CLAIMS IT DOESN’T WORK ANY BETTER THAN A PLACEBO,..

I hope that GOD FORGIVES YOU for YOUR NONSENSE, MISLEADING PEOPLE, CAUSING THEM TO END UP GIVING UP, WITHOUT TAKING A MINOR CHANCE ON GIVING THEIR LOVED ONE’S A DAMN CHANCE AT LIVING LONGER!!!

IMHO, YOU CAME STRAIGHT OUT OF HELL!

AGAIN, THIS IS STRICTLY MY OPINION,…

 

The Shill/Evil Industry Conspiracy Tactic
[SV: This is, by far, the most common objection raised. The idea that someone could honestly disagree with their beliefs after careful, open-minded evaluation of the arguments and evidence is apparently inconceivable for these people. They accuse me or arrogance freely yet imagine that any belief other than theirs is willful ignorance or deliberate dishonesty. Irony meter broken!]

FDA are the real killers of USA that only approve side effect medications to cause more problems in your body. I agree with Alex Corp. FDA stands For Death Administration and that to the point. FDA should be banned from the whole of USA. They just as corrupt as the Government!!!

You are correct about herbalist? Seriously? They why are so many being killed off? Around 100 within a year as of May of 2016. Read about it already. I guess it is because what they practice and treat never works?????

Homeopathy has worked for me many times in treating both my family and our pets. It is safe, effective, and inexpensive if you choose the right remedy. It is so diluted that there is almost nothing left of the original substance in the remedy. Those who don’t want to use it don’t have to, but those of us who recognize how miraculously effective it is have the right to continue to buy it easily, cheaply, and over the counter. It’s just the exorbitant pharma companies who want to rub out their much more effective competition.

The only reason I don’t follow up on this is I’m afraid the FDA will get a hold of these and find out how well they work and shut them down! As a typical bumbling corrupt (Paid off by the pharmasudical industry) government agency should!

If I want to live long and healthy I almost always do the exact opposite of what the government, media and scientific communities tell me to do.
Seriously. Yeah.
Big pharma underwrites the nation’s medical schools.

It’s a shame you and so many other conventional veterinarian’s are brainwashed by Big Pharma, The Big Pet Food companies, the FDA, the USDA, the CDC, and the media!!.. WAKE UP from your brainwashed, sheeple coma and gain some knowledge before writing an article you know nothing about!

But you must get paid well by druggies as I call the big pharm guys.
This is not funny, this is criminal brain washing of the gullible for the purpose of gazillions made on ignorance of the many. Good job.

This blog is paid for by drug companies either directly or indirectly. Any time you see the word “Skeptic” you know the website is written by paid liars and shills for the drug cartels.

I remarked to my wife when I ordered tha stuff that if it actually worked it would would either disappear from the market or sales forbidden. Why, you might ask?

There are two obvious reasons :- first, if it worked, if would deprive doctors, nut press, opticians and a whole host of other of MONEY. The entire medical profession is a giant hamster wheel. If CURES were actually found for things like cancer ‘flu, and a whole host of other diseases, it would throw millions of people out of their jobs. Just think about it. Learned professors spouting the bullshit that the Govt tells then to, doctors, nurses, drug companies, high street pharmacies. We can’t have that now can we?

You have to be a guy paid by pharmaceuticals to bash these people and their products. What are you afraid of? That millions will stop taking your drugs with mike long lists of side effects? Lots of money at stake right?  I say go f yourself! Clinical studies you want? Are you really satisfied with the non transparency of clinical studies used to validate the safety of the pharmaceuticals prescribed by docs like candy? I am not! You know why? Because there is no money in telling the truth! The money is in misinformation!

So I tell you what! Your bitch ass should go to your doc and refill your script for statins, psycho drugs and dick hardeners and let those who want to take bogus supplements do so!

Please help me understand why you would write such a horrible article. Do the vets and pharmaceutical companies just want to make more $ at the expense of our best friends?… I’m really disgusted by your article. Your thoughts?

Most vets are against Raw feeding because they have been brain washed by Big Business in their training to sell bags of dried ‘food’ to pets (to make money on) instead of proper food.

I think Skeptvet ought to change his handle to PhillipMorrisVet or perhaps ExxonMobilVet.

Mainstream vets are like mainstream vets under the FDA – they discourage you from the truth about products that work and encourage you to the harmful drugs that keep them in business.
Stick with your chemicals and I’ll stick with my natural plants that God created, not man. Don’t give a hoot about clinical trials or what the FDA says because none of you want a cure for cancer cuz there’s too much money to be made.

This person is obviously blinded by the pro big med drugs training/our system ( anti biotics are big biz people)… This article is a blatant lie and so, so, so many people have gotten fabulous results with this supplement, but what’s the problem – no kick backs from the med company for you?

Who is getting paid by the pharmaceutical companies to do fear mongoring ah??? that would be you. You are an uninformed moron who has NO experience what so EVER in what you talk about! what a joke! go do something useful that would really help the animals!!! there’s a thought! but no too busy getting paid off arnt you…


Vaccines CAUSE allergies. You are nothing but a pHARMa shill.

some vets are upset because this product works better than their surgery attempts and they are bitter enough to call the FDA to stop the production and sale of this lifesaving product dooming thousands of pets to an agonizing death! The FDA and Big Pharma are in bed with each other and totally corrupt!

Big Pharma, and their lackeys like skepvet like to use clinical trials as a bludgeon for their own distortions. If you are not pimping one of their patented drugs they will tell you [ypur evidence isn’t good enough].

What a nasty article full of menace and lies… It is only the studies of the articles and videos of vets like the one you are battering unjustly, that I realize how the crooked pharma and commercial petfood industry lies to us, owners, making our pets sick while earning more by ‘treating’ them even sicker medicine, creating thus a viscious circle, making us feel dependent on them.

 

Simplicity and Creative Writing
[SV: Some commentators go straight for the simple, direct approach without a lot of complex thinking or argument. Others engage in a bit of creative writing at my expense.]

You know SkypeVet , you have to be connected to the world of Big Pharma and anything natural is beyond your way of thinking ..

I’ve read your negitive articles for a very long time now. I hope ppl see you for what you really are… Your a complete joke !

All pets under your care will suffer because of your ignorance and arrogance. You should have studied accounting.

Who so ever is the author of the article is an ass of the highest order.

Get lost loser

Who ever wrote this information on this website is an idiot.

Skepvet here is just a dinosaur coughing up a death rattle.

I find you a worthless drug pusher…and you need to seek another profession,


You slam all who disagree with you, are you related to Donald Trump?

I have seen miracles at Dr. Plechner’s hands, so take your contempt and put it where the sun don’t shine.

Skeptvet is a moron.

I found your comments/post/whatever to be obnoxiously close to exactly what I’d expect to hear from another incompetent, undereducated, but still egomaniacal, “old school” veterinarian

Ur ignorant idiot

skepvet is a quack…Skepvet is a shill for Big Pharma,

Skeptvet. You are a complete moron… Shut down and shut up. The people have spoken.

Your a fear mongering putz!

Arsehole! arsehole arsehole

To be honest you sound like a frustrated raving idiot… Your qustions are a rant of arrogance and self importance. See ya. Wouldn’t want to be ya.

If your practice was worth a crap you wouldn’t have time to babble on here

What a load of old rubbish.

You are full of shit.

You are all ignorant idiots.,,The traditional medical system and vets are crooks and under trained and under exposed. Shame on you

One should remind you that anyone with an Average IQ can Discern that you are What you are Complaining about, and that Morally, if not Ethically, and possibly Legally; you engage in Freely Committing Slander.


you are a real fool and an idiot. As stated you are the biggest fool I have EVER seen in my 30 years of using ozone in my practice.


You have both demonstrated you are nothing but babbling blow hogs with nothing better to do than babble about something you know nothing about. Get a job and stay off the internet!


What a sad human you are and I’m glad I found your blog so I can safely steer clear of you in the future.

This blogger is merely weaving a carpet of self enhancement thinking perhaps it will take him to the White House or some delusion of grandeur !


Someone is paying you to discredit vitamins, glandulars and minerals as beneficial remedies. You probably are a stupid medic. Breast feeding at age 80 off the pharmaceutical TIT. Die quickly so u can be reborn and do something to help someone.go pop a pill. You are an idiot.


So my remedy for someone like you and your advice…is to shut it.

What a pedantic piece of dog poop…. You sir apparently have a hidden agenda or are trying to prove your self esteem to yourself.

Maybe u should do like I was raised…if you can’t say something nice then keep ur mouth shut.

You are such a pompus ass egomaniac… I was trying to give you benefit of doubt until you went to espousing the global warming bullshit. You have shown your true colors – brown like the bs you write.

OMG, do you have any idea what sort of fool you sound like writing this post? Get your head out of your ass

You are probably one of the most arrogant people I have encountered on a forum that is meant to help people. You are not a help to anyone with your condescending attitude. EGO- look it up. Your lack of compassion is a testiment.

I read your article in its entirety and have to ask: what rock did you just crawl from under?

i cured high blood pressure arthritis and arithmia with these supplements – this article is moronic

Are you living under a rock dude?

 

Really Mad
[SK: Obviously, all of the critics here are mad. But with some comments, the visceral rage radiates from the monitor like heat. Whether it’s the use of ALL CAPS, exclamation marks!!!!!! Or just the language, these folks are making it clear that they are REALLY MAD!!!!!!!]

To say that I find this piece appalling, unprofessional and slanderous is an understatement… I would ask out of respect and decency that before publishing such a slanderous, potentially damaging piece you would at LEAST have the courage and courtesy to call your colleagues before marring their reputation and being so utterly vitriolic. As you have made it your life’s mission to brutally eviscerate anyone who speaks out in favor of any holistic modality. Which is especially admonish able considering the high rate of suicide and anxiety in our profession. [SV: This is actually one of the few comments from an individual I have written about (1, 2 While I understand that no one appreciates being criticized, public comments are fair game. I did respond to Dr. Conway offering to have a more thoughtful and civil dialogue about our disagreement (**see below), but she never responded.]

 

Big devious lie of an article!!!…in my opinion it’s like a miracle medicine and it’s a must habe for all pets with kidney failure!!!!!!any !, any one telling u otherwise is Probably working for the misinformation industries!!!!!!
THANK U THESE PEOPLE R JUST JEALOUS THEY DIDNT COME UP WITH #NZYMES
.I START NEXT WEEK… GO TO HELL SKEPTVET

This article you have written skepvet is absolute rubbish, oozes with hatred, ignorance, pouting, sulking and immaturity. Once again an stupid, narrow minded and unedcuated article by THE conventional vet that has more time on his hands than he should…. What has troubled your childhood that badly that you just can’t stop your endless fight against mother nature and you need to voice your opinions, that truly nobody cares about… Dr Xie. He trains thousands of vets on planet earth yearly, yet have the atrocity to criticize a man in a field you have ZERO KNOWLEDGE about. Why are you opening your mouth? Wake up. The world doesn’t care about your opinion.


THIS IS MY OPINION OF SKEPTVET and HIS BLOG!!!!!!! HE IS MAKING MONEY FROM THESE MISLEADING STATEMENTS!!!!!

Here is what I believe,.. I believe that YOU are MAKING MONEY from a BLOG, from the advertisements, and that is why you continue to say something but say ABSOLUTELY NOTHING,…. STOP MISLEADING PEOPLE, WITH YOUR OWN SNAKE OIL CLAIMS, BECAUSE YOUR MAKING MONEY OFF A BLOG’s AD’S, and AT THE END OF THE DAY, YOU GO TO BED, PROBABLY ALLOWING THOUSANDS OF DOGS AND CATS GO TO THEIR DEATHS, WITHOUT HAVING ONE LAST CHANCE AT LIFE!


Once again old man skeptvet is bashing another product. You want to keep killing dogs with Rimadyl. Just shows what a worthless vet you really are… As I have said before, your opinion is irrelevant. You have made a fool of yourself time and time again. You think you are a know it all but you are a know nothing. Nobody cares what you have to say anyway.


Slept-vet you remind me of a man named Hitler that everything he said was taken as the truth and no-one else was correct.

What shocks me – and I consider particularly evil – is the fact that [my name] went after the blood bank. Ridicule all you want, [my name]. But you, [my name], as a vet, should know better. You put dog lives in danger by refusing veterinary emergency medicine. Your statements, [my name] DVM of Northern California, make you ultimately a pet killer. Dr. [my name], you are on the same level as Kristen Lindsey, the veterinarian who killed the cat with an arrow. You, Dr. [my name] probably agree that cats should have arrows through their heads and wave them gallantly over your head in triumph, [my name] aka SkeptVet. [SV: This person apparently felt very clever in discovering my name and imagined inserting it repeatedly in this comment would show me a thing or two.]

Just wanted to let you know you are a fraud….your science sources are all either anonymous, just like you to avoid all accountability for your fraudulent non-advice or obvious industry sites. You should be ashamed of yourself. You are a disgrace! Disgusting!

MD’s and vets are lying criminal drug pushers who do not cure anything. They pump unnatural crap into gullible people’s pets and still sleep at night in satin sheets.

SkeptVet, You sound like the precise commercial kibble peddling Vet that has ended up killing dozens of dogs with your conventional passive income steroid therapies and regular income generating vaccinations

Your aggressiveness and that of your tribe is distasteful and a signal that you’re swayed by commercial interests.

Any moron can create a free blog and become an expert. It takes a particular jackass to use it with the viciousness that you do. You’ll pay for your selling yourself to conventional medicine.
I AM LIVID THAT POINTED HEADED CORPORATE DOCTORS CAMPAIGN AGAINST NATURAL TREATMENTS THAT WORK SO THEY CAN PROMOTE INEFECTIVE FDA APPROVED CHEMICAL PHARMACEUTICALS…I hope you are happy Dr. DEATH. You scumbag SkepVet.

Go take your drugs and destroy your kidneys and liver. And kill all our animals that way as you promote drugs and surgery and toxic immunization a. You are a total moron

It is a great product it reversed my cat numbers until he wasn’t showing signs of kidney failure , even his urine started to have a smell to it again. But what you think the FDA should do their barbaric tests to see how much cats and dogs need to take before the die! The tests are terrible and should be out lawed.

 

Just Plain Weird
[SV: Some comments go beyond paranoid conspiracy theories and personal outrage to the realm of the bizarre]

This article is a perfect example of someone who obviously has zero ability to communicate with animals. Just because you cannot understand and talk to animals, doesn’t mean others can’t. Yes, animal communication is real and to someone who said what turkeys are saying in heaven after you ate them for your thanksgiving, know that they are cursing you and it’s accumulating in your bad karma.

Typical douchbag blog crusader…Enjoy eating your cheese.

Don’t let people take the reproductive parts off of their pet.
Zoosexuals need to not be rejected too even as your harmless selves don’t want to be rejected. Non-human animals have their way of communicating. Please your pet even as you want to be pleased. Both sexes.  It should not be a crime to be seen pleasing or being pleased by a non-human animal.

 

 

** Here is my response to Dr. Conway’s outrage.
I saw your comments posted to my blog, and I’m sorry you feel my characterization of your comments was unfair. However, I believe my review of your interviews was both fair and accurate, and I think terms like “brutal evisceration” and “slanderous” are unreasonable hyperbole. I notice that you completely ignore the section of my article that is complementary towards you and Dr. Raditic:

“To be fair, both Dr. Raditic and Dr. Conway acknowledge the importance of basic science and conventional veterinary medicine, and I don’t doubt they are sincere. Like most CAM vets I have met, they are most likely nice people and competent conventional clinicians. However, despite their genuine belief that they are working in the best interests of patients and veterinary medicine and in a way consistent with the principles of science, the reality is that their statements and actions are deeply inconsistent with the principles of scientific medicine.”

We clearly disagree about the concept of integrative medicine and the legitimacy of most of the therapies you wish to integrate into our profession, such as chiropractic, homeopathy, and TCVM. I don’t believe this disagreement requires personal antipathy, and as I’ve said I have no doubt you are a good clinician with a genuine desire to do what seems best to you for your patients. I do, however, believe you are mistaken as to what that is, that your belief in the alternative therapies you mention is contrary to the best evidence concerning their efficacy, and that ultimately the research and integrative training you recommend and that AHVMA and Mercola are funding will serve only as a marketing tool to persuade people of the value of alternative therapies, not rigorous research which will elucidate the real effects, or lack thereof, for these methods.

You are correct that public comments on these issues have consequences, and these include enduring criticism of your comments from those who disagree with your views and assertions. If you intend to advocate for alternative therapies, that advocacy will draw criticism. This is a natural and appropriate part of the competition of ideas within our profession. Believe me, I have been the subject are far more hostile public comments for my views than anything I have written about you.

If you want an opportunity to clarify your position and respond to what you believe is inaccurate in my article, I am happy to let you do so in the comments section of the article. However, any such response needs to address specifics and avoid the kind of emotional language in the comments you attempted to post. Despite your view of the article, I did not use such language directed at you, but instead focused on the implications and assumptions in your actual words. You can say whatever you like elsewhere, but while I am happy to entertain disagreement and debate on my blog, I am under no obligation to provide a platform for you to attack me just to vent your anger without a substantive response to what I have actually written.

Dialogue can be productive, but argument rarely is. I am open to dialogue, but I don’t get the impression from your messages that you want anything more than to yell at me for saying things about your words that you don’t appreciate, and I don’t see how anything useful will come from that.

 

Posted in Humor | 16 Comments

Presentation of Placebos in Animals

Here are the notes and slides for a recent presentation on placebo effects in veterinary medicine.

WHAT IS A PLACEBO?
Despite the fact that most people have heard of the placebo effect and feel they have some understanding of what it means, the concept is a complex and contentious one. There is no consensus definition of a placebo or of the placebo effect. However, it is generally accepted that placebos are inert, and they have no direct physiologic effect on a patient’s disease or symptoms. Placebo effects, then, are effects associated with the administration of an inert substance or treatment, and these effects are perceived as beneficial by the patient or observers. Negative effects associated with inert treatments do occur, and these are referred to as nocebo effects.1

There are a number of mechanisms by which an inert treatment can lead to reported or observed responses. Many placebo effects are psychological responses based on belief and expectation, which influence a patient’s perception of his or her symptoms or have physiologic effects through centrally mediated changes in autonomic function.1-2 Placebo effects may also be caused by classical conditioning, in which physiologic responses to active treatments are paired with inert stimuli that are eventually able to elicit the same responses as the active treatment.2

Some effects associated with inert treatments in clinical research studies are actually not placebo effects mediated by conditioning or expectations. Research subjects in a placebo control group may experiences changes in their symptoms or other outcomes for a variety of reasons, and the use of an inert treatment can reveal that these changes are not due to the active treatment. However, not all such changes are true placebo effects.

For example, the Hawthorne Effect is a phenomenon in which subjects improve simply as a consequence of being enrolled in a research study.3 Subjects get more care and attention, they tend to be more compliant with existing treatments because they are being monitored, and their condition may improve due to better overall care regardless of any active test treatment or expectation-based placebo effects.3

Regression to the mean and the natural course of disease are other phenomena that can be seen in subjects receiving placebos in a research study which is not actually a true placebo effect.4 With chronic conditions, symptoms tend to wax and wane spontaneously. And some conditions may resolve spontaneously Patients are more likely to seek care, or enroll in research studies, when their symptoms are waxing, and thus they tend to improve after receiving care or beginning a study due to the natural course of disease. This, again, can be revealed by placebo assignment, but it is not an effect of the administration of the inert treatment.

It is worth noting that all of the factors that cause placebo effects and apparent response to inert treatment can also be seen with active treatments. Pain relievers with direct physiologic activity can elicit a greater reported response than explained by the pharmacological effects of the treatment. Part of the purpose of inert treatments in research trials is not only to assess whether treatments have specific effects but what proportion of the apparent response may be explained by concurrent non-specific effects and placebo responses.

In general use, placebo effects refer to those changes in reported or measured symptoms associated with beliefs or expectations about treatment. However, in the context of medical research, any effect seen in the placebo control group is classified as a placebo effect even if it is due to other factors.1 This complicates the clear use of the term and an understanding of what effects can be attributed to inert treatments and the associated mechanisms. It also impacts the relevance of placebo effects to veterinary patients, in which the relative role of various causes for non-specific treatment effects likely differ from human patients.

PLACEBO EFFECTS IN ANIMALS
It is clear that animal subjects in research studies exhibit changes in symptoms commonly identified as placebo effects when seen in human research subjects. These include subjective symptoms reported by owners or observed by investigators and clinicians as well as objectively measured outcomes.2,5-8 There is no clear research evidence showing such effects in clinical veterinary patients not participating in research. However, the circumstances and variables responsible for placebo effects seen in veterinary research studies are usually also present in the clinical context, so it is likely such effects exist in clinical patients as well as research subjects.

Animals receiving inert treatments often show improvement in subjective outcomes, such as pain, which are assessed by caregivers, clinicians or researchers. While it is generally accepted that most animals are not cognitively capable of having beliefs and expectations about their medical care, and so cannot have the classic direct placebo response, caregivers and other humans involved in these studies are susceptible to such effects. The caregiver placebo effect, in which humans report improvement in subjective  symptoms for animals receiving inert treatment, has been clearly demonstrated.5,7

It is also likely that animals receiving inert treatments may show improvement due to causes other than direct placebo effects. Research has shown human contact has predictable effects on behavioral and physiologic responses in domesticated animals, and these effects can easily be interpreted as improvement in clinical symptoms.2,9 And just as classical condition contributes to placebo effects in humans, such conditioned responses are certainly present in other animals and likely generate changes in the condition of animal patients and research subjects receiving inert treatments.

Even relatively objective outcome measures have been shown to change in response to the administration of inert treatments. Seizure frequency, heart rate, and other objectively measurable outcomes show non-specific treatment effects in animals just as in humans.2,8 Conditioning, the Hawthorne Effect, general response to human contact, and other variables are likely responsible for these apparent placebo effects.

 CLINICAL IMPLICATIONS
The presence of placebo effects and other responses to inert treatments has several important implications for clinical care. One is that apparent responses to treatment, especially in subjectively experienced symptoms such as pain, nausea, and fatigue, may reflect placebo effects rather than true improvement in the underlying condition. Human asthma patients, for example, may report improvements in the symptoms experienced during an asthma attack when given a placebo inhaler.10 However, such responses are not typically seen in objective signs of disease, especially in patients not in clinical trials receiving more intense and comprehensive monitoring and care than clinical patients. For example, the asthma patients who reported feeling better with placebo inhalers had no measurable improvement in lung function, unlike those patients receiving bronchodilator therapy.10

This demonstrates that placebo effects generally improve the perception of symptoms but not the actual physical disease. Such effects can fool patients, caregivers, and clinicians into believing they have provided effective treatment while allowing the disease to remain of progress. Asthma patients consistently treated with an ineffective medication would likely perceive some relief, but they could also be experiencing ongoing lung damage and ultimately have poorer outcomes due to the lack of objectively effective treatment. It is critical, then, that clinical therapies be demonstrated to be truly effective through clinical trial research because uncontrolled clinical observation is an unreliable guide to efficacy.

There are also ethical implications to placebo effects.11-12 In human medicine, there may be some benefit to improving the perception of uncomfortable symptoms, with a placebo or with placebo effects attached to active treatments. However, such effects are typically negligible if patients are informed that they are receiving inert treatments. Obtaining the subjective benefits of placebo effects requires misleading patients into believing they are receiving an active therapy, which is arguably unethical.11

In veterinary patients, placebo effects are largely obtained by proxy through caregivers.5,7 This creates an additional ethical challenge since caregivers and clinicians may perceive benefits the patients are not actually experiencing. This makes the necessity of objective research validation for treatment efficacy even more critical in veterinary medicine.

CONCLUSIONS
Placebo effects, and other related factors that create true or perceived improvement in clinical symptoms, are manifest in veterinary patients and animal research subjects. Controlling for these effects in research studies is crucial to identifying the true benefits of the treatments we employ. The existence of such effects also makes clinical observation of response to therapy highly unreliable as a measure of the true efficacy of our treatments. We, and our clients, often see what we hope or expect to see in response to the therapies we employ, and it is possible to be fooled into believing ineffective treatments are working without appropriate controlled research evidence. This creates an ethical imperative to base our interventions on good-quality research evidence rather than uncontrolled observations. Fortunately, some kinds of non-specific effects seen with inert treatments can also add to the real benefits of active treatments, and we can take advantage of this to maximize the benefits of our therapies once we have established objective efficacy.

REFERENCES

  1. De Crae AJM. Kaptchuk TJ. Tjissen JGP. et al. Placebos and placebo effects in medicine: historical overview. J Royal Soc Med. 1999;92:511-15.
  2. MacMillan FD. The placebo effect in animals. J Amer Vet Med Assoc. 1999;215(7):992-9.
  3. McCarney R. Warner J. Iliffe S. et al. The Hawthorne Effect: a randomised, controlled trial. BMC Med Res Methodol. 2007;7(30).
  4. McDonald CJ. Mazzuca SA. Mcabe PG. How much of the placebo ‘effect’ is really statistical regression? Statistics Med. 1983;2:417-27.
  5. Conzemius MG. Evans RB. Caregiver placebo effect for dogs with lameness from osteoarthritis. J Am Vet Med Assoc. 2012;241(10):1314-9.
  6. Malek S. Sample SJ. Schwartz Z. et al. Effect of analgesic therapy on clinical outcome measures in a randomized controlled trial using client-owned dogs with hip osteoarthritis. BMC Vet Res. 2012;4(8):185.
  7. Gruen ME. Dorman DC. Lascelles BDX. Caregiver placebo effect in analgesic clinical trials for cats with naturally occurring degenerative joint disease-associated pain. Vet Rec. 2017;180(19):473.
  8. Muñana KR. Zhang D. Patterson EE. Placebo effect in canine epilepsy trials. J Vet Intern Med. 2010;24(1):166-70.
  9. Zulkifli I. Review of human-animal interactions and their impact on animal productivity and welfare. J Anim Sci Biotech. 2013;4(1):25.
  10. Wechsler ME. Kelley JM. Boyd IOE. Et al. Active albuterol or placebo, sham acupuncture, or no intervention in asthma. N Engl J Med 2011;365:119-126.
  11. Asai A. Kadooka Y. Reexamination of the ethics of placebo use in clinical practice. Bioethics.2013;27(4):186-93.
  12. Gold A. Lichtenberg P. The moral case for the clinical placebo. J Med Ethics. 2014;40(4):219-24.

Placebos in Veterinary Medicine Slides

Posted in Presentations, Lectures, Publications & Interviews | 1 Comment

Presentation on Choosing Diagnostic Tests

Here are the notes and slides for a recent presentation on strategies for effectively choosing diagnostic tests.

GOALS OF DIAGNOSTIC TESTING
Ultimately, the goal of any test we run should be obtaining information that allows us to more effectively treat or prevent health problems in our patients. This seems obvious, but it is all too easy to lose sight of this core purpose. We may feel obligated to run tests to confirm a diagnosis even when the level of confidence is already high and the outcome of the test won’t change what the client chooses to do. We may employ diagnostic tests as a preemptive defense against litigation or because of a perceived pressure from the client to do something even when our action likely won’t change the outcome for the patient. In some situations, we may be completely confused by a case and throw a bunch of tests at it hoping for some insight to emerge.

All of these are understandable, and all too common, reasons for using diagnostic tests, but unfortunately such approaches reduce the reliability and utility of the tests themselves. Effective testing requires not only an understanding of the strengths and weaknesses of the tests we use but also a clear understanding of how to employ them and how to integrate the results into our clinical decision making. We need a rational strategy for when and how to test, how to interpret results, and somewhat counterintuitively, when not to test at all.

BEYOND SENSITIVITY AND SPECIFICITY
The most common measures used to describe diagnostic test are sensitivity and specificity . These are characteristics of the tests themselves, and they indicate how likely, compared with some gold standard, a test is to correctly identify a disease which is present or to correctly identify that a patient does not have the disease. Unfortunately, the meaning of these numbers is often misunderstood. If a test has, for example, a 98% sensitivity, this is the proportion of patients with the disease who will correctly test positive. It is NOT an indication that any patient who tests positive has a 98% chance of having the disease. Under certain conditions, the majority of patients testing positive on such a test may actually not have the disease even with such a high sensitivity.

More clinically useful measures of a test’s reliability are the positive predictive value and the negative predictive value (Fig. 1). These are, respectively, the probability a patient with a positive test actually has the disease and the probability a patient with a negative test result does not have the disease. These numbers depend not only on the test but also how common the disease is in the population being tested.

As an example, if a population of feral cats has an FIV prevalence of 2%, 2/100 cats tested will test positive with a perfectly sensitive test (sensitivity=100%). If the test also has a specificity of 98%, then about 2/100 cats will test positive even though they do not have FIV. The positive predictive value, then, is 50%, meaning half of the cats who test positive do NOT have FIV. Even with a great test, this is a pretty big error rate, especially if we are planning on euthanizing cats diagnosed with FIV!

This example illustrates how important it is we have some idea how likely a disease is to be present before running a test for that disease if we want our test results to be reliable. Which brings us to a new and somewhat fashionable way to look at diagnostic testing….

BAYESIAN ANALYSIS FOR THE MATHEMATICALLY CHALLENGED
The work of 18th-century mathematician Thomas Bayes is enjoying something of a renaissance as an alternative, in some respects, to the frequentist statistical methods most of us were taught in vet school. The details of the math involved are complex, but the logic of the approach is simple and intuitive. Diagnostic tests should not be viewed as determining whether or not a disease is present. They should be viewed, instead, as one piece of evidence shifting the existing probability of a diagnosis higher or lower.

If, as in the example above, I know that the prevalence of FIV is 2% in this population of cats, I can say the probability of any given cat having FIV is very low. A positive test does not mean a cat has FIV, only that the probability it might have the disease has increased a bit. The test doesn’t make or break the diagnosis, it simply shifts out understanding of the likelihood of the diagnosis.

In a practical sense, then, a Bayesian approach means estimating the probability of a diagnosis based on all of the usual factors we consider (signalment, personal history, prevalence rates, physical exam findings, other test results, etc.). If this probability is high enough or low enough to make or rule out a diagnosis, no additional test is needed. If, however, the probability leaves significant uncertainty, then we should select a test that will meaningfully raise or lower that probability to help us make the diagnosis.

SCREENING
Screening is a special case in which we are testing asymptomatic individuals with the idea of detecting preclinical disease so we can more effectively intervene to reduce symptoms and mortality. Because the prior probability of disease is usually very low by definition in screening, since patients have no symptoms, the positive predictive value of even very good tests is low. It has been recognized in human medicine that screening can often lead to overdiagnosis and overtreatment, which can waste medical resources and ultimately do more harm than good for patients.1There are, therefore, requirements for screening programs, and these include not only accurate tests but proven interventions that actually improve outcomes for patients diagnosed with the disease and rational plans for confirming and following up both positive and negative test results.

In veterinary medicine, we often employ diagnostic tests in asymptomatic patients “just in case” we might find subclinical disease. Whether or not such testing improves outcomes for patients or leads to significant overdiagnosis is almost never evaluated, so the benefits and risks of screening are often assumed but not truly known. This means that significant caution is warranted in conducting screening and interpreting the results of diagnostic tests in clinically well individuals.

 

CARDINAL RULES OF DIAGNOSTIC TESTING

Based on this understanding of the limitations of diagnostic testing, there are a few cardinal rules we can apply to reduce the potential mistakes and harms resulting from our tests:

Cardinal Rule #1

If the results of the test isn’t going to change what you do, don’t run the test.

Cardinal Rule #2

If the prior probability of a diagnosis is very high or very low, don’t run the test.

Cardinal Rule #3

Don’t screen (test asymptomatic individuals) without a plan of action based on solid evidence that the benefits of testing and diagnosis outweigh the risks.

REFERENCES

  1. McKenzie, BA. Overdiagnosis. J Amer Vet Med Assoc. 2016;249(8):884-889.

 

Choosing and Using Diagnostic Tests Slides

Posted in Presentations, Lectures, Publications & Interviews | 8 Comments

Presentation on Surgical Neutering Techniques

Here are the notes and slides for a presentation I recently gave comparing various surgical sterilization and neutering techniques.

INTRODUCTION
Among the most common surgical procedures in small animal practice are those for sterilization (preventing reproduction) and neutering (removing the gonads). The goal of these procedures is both to prevent reproduction and to provide a net health benefit for the patient. This benefit may include avoiding the risks of reproduction, reducing the incidence of those disease that are more common in intact animals, and reducing behaviors associated with intact status that can lead to relinquishment.1-2

There are many variations on these procedures, and the specific techniques used by individual veterinarians seem to depend more on tradition, personal habit, and cultural preference than on explicit evaluation of the pros and cons from a scientific perspective.3 There is, however, research evidence concerning some of these procedures which we can use to make rational decisions about our choice of technique. We can also use this research to inform the recommendations we make to clients. Pet owners are increasingly aware that there are multiple alternatives to choose from, and they may come to us with strong opinions or misconceptions about the most appropriate procedure to their pets.

Most procedures are intended to prevent reproduction. Some also involve gonadectomy, which has a complex array of both beneficial and harmful effects that depend on breed, sex, age, timing of surgery, and many other factors. The long-term pros and cons of gonadectomy are controversial, and I have reviewed them in detail elsewhere.2 In brief, there appears to be a net health benefit for most female dogs and cats from neutering, though the details of the risks and benefits and the effect of the timing of neutering are quite variable. There is much less evidence for a net health benefit in neutering males, though there are other justifications for doing so. Today I will consider the relative advantages and disadvantages of different surgical sterilization methods for males and females.

STERILIZING FEMALES
The most common spay procedure in the United States is ventral midline ovariohysterectomy (OVH). This is an effective technique for sterilization and neutering of both dogs and cats with very low complications rates when performed by experienced surgeons.4-6 There are many minor variations with no research evidence comparing the relative merits of most.

One exception is the flank approach to ovariohysterectomy, preferred in some countries for cats and small dogs. There are theoretical advantages and disadvantages to this approach, and research evidence comparing flank and midline approaches is mixed. Some comparisons suggest the flank approach is faster with fewer complications,7 but other studies find no difference8, and some indicate more discomfort associated with the flank approach.9-10 Access to both ovaries is more difficult with the flank approach unless bilateral flank incisions are made, which significantly complicates the procedure, and hysterectomy can be difficult by this method.11 The flank and midline methods both achieve the goal of gonadectomy and sterilization.

Traditionally, ovariohysterectomy has been preferred in the United States while ovariectomy (OVE) is the more common choice in some other countries.12 Both techniques are equally effective at achieving gonadectomy and preventing mammary carcinoma and pyometra.12-14 Some studies have suggested that OVE is less painful than OVH15, however other studies have not identified any difference in post-operative pain or other complications.10,16

A relatively recent option is the laparoscopic spay. Both laparoscopic ovariectomy and ovariohysterectomy have been reported, using a variety of equipment and techniques. Comparisons are difficult given the many different approaches, equipment, and assessments used in published studies. In general, the disadvantages of laparoscopic OVE and OVH include the cost of equipment, the need for extensive training and practice to achieve proficiency, and the longer surgical time.17-20 Laparoscopic spay may have the advantage of decreasing post-operative pain, complications, and recovery time, though the literature is not consistent and there is a lack of high-quality studies.21

With a growing awareness of the potential negative effects of neutering, there has been some increased interest among breeders and pet owners in sterilization procedures that do not involve gonadectomy. For females, two such procedures are hysterectomy (sometimes called an “ovary-sparing spay”) and ligation of the fallopian tubes or uterine horns. Both procedures have been described in the literature,22-23 but neither have been widely adopted.

There are no controlled research studies comparing tubal ligation or hysterectomy to OVE or OVH. While ligation of the fallopian tubes or uterine horns can prevent reproduction, it is highly likely that any risks and benefits associated with the presence of ovaries2 are the same for females having a tubal ligation as for those not spayed at all. A complete hysterectomy, including removal of the cervix, likely eliminates the concern for pyometra while the other risks and benefits of intact status remain unchanged.

STERILIZING MALES
Despite the uncertainties, surgical neutering is the most common approach to sterilization of male cats and dogs. For dogs, frequently used techniques include closed castration (removal of the testes without opening the vaginal tunic) and open castration (which involves opening the vaginal tunic prior to ligating the vessels and ductus deferens). Both procedures can be performed through a scrotal or pre-scrotal incision, and there are a number of variations of each.

There is much debate about the relative merits of open and closed castration in dogs, but it is based mostly on theoretical reasoning and anecdotal evidence. Some argue that closed castrations are safer because there is no direct communication with the abdomen, reducing the risk of ascending infections or herniation of abdominal contents. Others claim that open castrations are less likely to lead to hemorrhage or scrotal hematomas. Typically, closed castration is recommended for small dogs and cats and open castration for larger dogs.

There is little research evidence to inform these debates. One prospective randomized trial did find more overall complications in dogs undergoing open castration.24 However, problems with recruitment of subjects for this study significantly limit the strength of this evidence. Overall, serious complications are few in dogs undergoing castration, and it is unclear if there is a consistent advantage to either technique.

The research evidence comparing scrotal and pre-scrotal approaches in dogs is also quite sparse. A randomized, prospective study comparing the two approaches found similar complication rates.25 The scrotal approach had the advantage of inducing less self-trauma and of being about 30% quicker to perform (though the absolute difference, from about 5 minutes to 3 minutes, is of doubtful clinical significance). Once again, both techniques are effective, and it is not clear that one is superior to the other.

Several techniques have been described for neutering male cats,26 but there is virtually no formal research comparing complication rates. A scrotal approach appears to be the most common, and methods for securing the ductus and vessels include suture ligation and various methods of tying the tissues on themselves. One comparative study of these ligation methods found no significant complications and no difference between methods.27

An uncommon surgical technique used for male dogs in some resource-poor countries is pinhole castration. The spermatic cord is ligated with suture percutaneously to induce necrosis of the testes.28 While this technique is less expensive than standard surgical castration and it does reduce functional testicular tissue volume, it is unclear how effective it is as a means of sterilization, and some reports suggest a higher rate of infection, pain, and other complications compared with standard techniques.29-30

Finally, surgical or laparoscopic vasectomy is sometimes recommended as a means of sterilizing male dogs and cats without neutering.26 Both approaches are effective at achieving this outcome. There have been no direct published comparisons between surgical and laparoscopic vasectomy. One small study comparing laparoscopic vasectomy with surgical castration in dogs found few differences except for a subjectively greater level of post-operative discomfort in the surgical patients.31

REFERENCES

  1. New JC. Characteristics of shelter-relinquished animals and their owners compared with animals and their owners in U.S. pet-owning households. Journal of Applied Animal Welfare Science 2000;3(3):179–201.
  2. McKenzie B. Evaluating the benefits and risks of neutering dogs and cats. CAB Reviews: Perspectives in Agriculture, Veterinary Science, Nutrition and Natural Resources. 2010;5(45):1-18. Updated version available at: https://goo.gl/pWCKYl
  3. May S. The flank cat spay: eminence-driven fashions in veterinary surgery. Veterinary Record. 2012;170:460-461.
  4. Howe LM. Surgical methods of contraception and sterilization. Theriogenology. 2006 Aug;66(3):500-9.
  5. Berzon JL. Complications of elective ovariohysterectomies in the dog and the cat at a teaching institution: clinical review of 853 cases. Veterinary Surgery. 1967;8:89–91.
  6. Burrow R. Batchelor D. Cripps P. Complications observed during and after ovariohysterectomy of 142 bitches at a veterinary teaching hospital. Veterinary Record 2005;157:829–833
  7. Kiani FA. Kachiwal AB. Shah MG. et al. Comparative Study on Midline and Flank Approaches for Ovariohystrectomy in Cats. Journal of Agriculture and Food Technology. 2014;4(2):21-31
  8. Coe RJ. Grint NJ. Tivers MS. et al. Comparison of flank and midline approaches to the ovariohysterectomy of cats. Veterinary Record. 2006;159(10):309-313
  9. Oliveira JP. Mencalha R. dos Santos Sousa CA. et al. Pain assessment in cats undergoing ovariohysterectomy by midline or lateral celiotomy through use of a previously validated multidimensional composite pain scale. Acta Cirúrgica Brasileira. 2014;29(10):633-38.
  10. Burrow R. Wawra E. Pinchbeck G. et al. Prospective evaluation of postoperative pain in cats undergoing ovariohysterectomy by a midline or flank approach. Veterinary Record. 2006;158(19):657-60.
  11. Janssens LA. Janssens GH. 1991. Bilateral flank ovariectomy in the dog—surgical technique and sequelae in 72 animals. Journal of Small Animal Practice. 32: 249– 252.
  12. Van Goethem B. Schaefers-Okkens A. Kirpensteijn J. Making a rational choice between ovariectomy and ovariohysterectomy in the dog: a discussion of the benefits of either technique. Veterinary Surgery. 2006;35(2) 136-143.
  13. DeTora M. McCarthy R. J. 2011. Ovariohysterectomy versus ovariectomy for elective sterilization of female dogs and cats: is removal of the uterus necessary? Journal of the American Veterinary Medical Association. 239: 110
  14. Okkens AC. Kooistra HS. Nickel RF. Comparison of long-term effects of ovariectomy versus ovariohysterectomy in bitches. Journla of Reproduction and Fertility Suppl 1997;51:227–31.
  15. Lee SS. Lee SY. Park S. et al. Comparison of ovariectomy and ovariohysterectomy in terms of postoperative pain behavior and surgical stress in dogs. Journal of Veterinary Clinics. 2013 30 3 166-171
  16. Peeters ME. Kirpensteijn J. Comparison of surgical variables and  short-term postoperative complications in healthy dogs undergoing ovariohysterectomy or ovariectomy. Journal of the American Veterinary Medical Association. 2011:238;189-194.
  1. Davidson EB. Moll HD. Payton ME. Comparison of laparoscopic ovariohysterectomy and ovariohysterectomy in dogs. Veterinary Surgery. 2004;33:62–69.
  2. Ataide MW. de Brun MV. Barcellos LJ. et al. Laparoscopic-assisted or open ovariohysterectomy using Ligasure AtlasTMin dogs. Ciência Rural. 2010;40(9):1974-1979.
  3. Gower S. Mayhew P. Canine laparoscopic and laparoscopic assisted ovariohysterectomy and ovariectomy. Compendium of Continuing Education for the Practicing Veterinarian. 2008;30:430–440.
  4. Case JB. Boscan PL. Monnet EL. et al Comparison of surgical variables and pain in cats undergoing ovariohysterectomy, laparoscopic-assisted ovariohysterectomy, and laparoscopic ovariectomy. Journal of the American Animal Hospital Association. 2015;51(1):1-7.
  5. Phypers C. In Cats and Dogs Does Laparoscopic Ovariectomy Offer Advantages Over Open Ovariectomy for Postoperative Recovery?. Veterinary Evidence. 2017; 2(2). doi:http://dx.doi.org/10.18849/ve.v2i2.59
  6. Grier RL. Tubal ligation-alternative sterilization operation. Iowa State University Veterinarian. 1973;35(2):49-50
  7. Belfield WO. Partial spay (hysterectomy). Veterinary Medicine. 1972;1223-1224.
  8. Hamilton KH. Henderson ER. Toscano M. et al. Comparison of postoperative complications in healthy dogs undergoing open and closed orchidectomy. J Small Anim Pract. 2014 Oct;55(10):521-6.
  9. Woodruff K. Rigdon-Brestle K. Bushby, PA. et al. Scrotal castration versus prescrotal castration in dogs. Vet Med. 2015;110(5):131-135.
  10. Howe LM. Surgical methods of contraception and sterilization. Theriogenology. 2006 Aug;66(3):500-9. Epub 2006 May 23.
  11. Karen Maciel de Oliveira, Leonardo Augusto Lopes Muzzi, Bruno Benetti Junta Torres, et al. A comparative study among three open orchiectomy techniques in cats. Acta Scientiae Veterinariae. 2010;38(2):177-183.
  12. Okwee-Acai J. Omara R. Onyait JS. et al. evaluation of pinhole castration as an alternative technique for dog population control in resource-poor communities. Bulletin of Animal Health and Production in Africa An. 2013;61(3):337-345.
  13. Baba MA, Fazili MR, Athar H, et al. Pinhole castration technique: an alternative to orchiectomy in stray dogs. Anim Reprod Sci. 2013;137(1-2):113-8.
  14. Abd-el-Wahed RE. Korritum AS. Abu-Ahmed HM.et al. Evaluation of pinhole castration technique compared with traditional method for castration in dogs. Alexandria Journal of Veterinary Sciences. 2014;42:90-98.
  15. Anburaja Mahalingam; Naveen Kumar; Maiti S.K. et al. Laparoscopic sterilization vs. open method sterilization in dogs: a comparison of two techniques. Turkish Journal of Veterinary & Animal Sciences. 2009;33(5):427-436.

 

OVE, OVH, OMG: Pragmatic Review of Surgical Neutering Techniques Slides

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Presentation on Cannabis for Pets

I recently gave a presentation for veterinarians on Cannabis as a potential source of medical therapies for veterinary patients.  There haven’t been many new studies in veterinary species since my last post on the subject in 2016, but that is about to change. A number of veterinary schools have studies in progress, one pharmacokinetic study has already been reported, and a study of CBD for arthritis in dogs has reportedly been completed but not yet published. There has also been a recent article on CBD for refractory epilepsy in children, and this product looks likely to be approved by the FDA very soon.

Hopefully, this wave of evidence will come soon, and we will start to better understand the potential in Cannabis-based treatments.  In the meantime, here is the summary and the slides from my recent presentation on the subject.

INTRODUCTION
Medical marijuana for humans has been a hot topic for many years. Much of the debate about it has focused on ethical and legal issues that aren’t directly answerable through scientific research. Participants in these debates often gravitate towards ideological extremes. For some, any use of marijuana, medical or recreational, is immoral and dangerous. For those at the other extreme, marijuana is a perfect, risk-free cure for anything from depression to cancer.

In the last several years, these debates have migrated to veterinary medicine, with both extremes well represented. It has grown easier and more common for animal owners to provide their pets with cannabis-based remedies, both marijuana itself and products specifically produced for companion animals.

Insufficient attention, however, is generally given to the critical scientific question, “What are the risks and benefits of medicinal use of cannabis-based products?” Any consideration of the medical use of cannabis should be based on rational, objective evaluation of the scientific evidence concerning risks and benefits, uninfluenced by the surrounding ethical and legal debates.

RISKS AND BENEFITS: WHAT’S THE EVIDENCE?
Cannabis sativa contains a bewildering variety of chemical compounds. Some have been shown to have significant effects on many different body systems, from the CNS to the GI tract to the immune system. Different varieties of Cannabis have different concentrations of various cannabinoids as well THC, the compound responsible for the psychotropic effects of marijuana and humans and the toxic effects in some animal species. This variation makes it likely that medical and recreational products will differ significantly in their constituency and effects.

In vitro and lab animal research shows a variety of promising effects for some of the many compounds in Cannabis as well as multifaceted and complex potential physiologic effects. There is, therefore, good reason to believe cannabis-derived medicine could have real benefits, as well as real risks, in veterinary patients. However, the vast majority of compounds which appear promising in pre-clinical studies never prove safe or effective in actual clinical patients, so such evidence only provides potential avenues for clinical research, not a validation of claims for real-world effects.

Unfortunately, so far there is no reliable clinical research evidence for the use of cannabis-based remedies in small animal patients. That means we cannot say with confidence what the benefits or risks of any such remedy might be. We can hypothesize, based on the pharmacology of cannabis compounds or on anecdotal evidence. We can also extrapolate from studies in lab animals or humans. However, we have no direct, reliable evidence to support any claim about any veterinary medical marijuana treatment.

This lack of research is primarily due to strict laws regulating the availability of marijuana, for research purposes as well as medical or recreational use. Hopefully, as these laws change, more data will be produced. For now, the best we can do is look at what we know about the risks of marijuana in veterinary species, as well as the risks and benefits identified in humans.

A recent comprehensive literature review has been produced by the National Academies of Science, Engineering, and Medicine.7 This review evaluates those risks and benefits of cannabis-based therapies that have been studied in humans, and classifies them using a straightforward system. The strength of evidence is rated as insufficient to draw a conclusion, limited, moderate, substantial, or conclusive.

Here are the conditions for which moderate or better evidence exists in humans for a beneficial effect and which might be relevant to veterinary patients:

  • In adults with chemotherapy-induced nausea and vomiting, oral cannabinoids are effective anti-emetics.
  • In adults with chronic pain, patients who were treated with cannabis or cannabinoids are more likely to experience a clinically significant reduction in pain symptoms.

For these conditions the effects of cannabinoids are modest; for all other conditions evaluated there is inadequate information to assess their effects.

While it is encouraging that some Cannabis-derived products have validated clinical benefits for these indications in humans, this still leaves us far from having reasonable evidence to support veterinary use. Our patients often respond quite differently to medicinal compounds than humans, and extrapolation across species is a risky proposition.

With any medical intervention that has benefits, there are certainly going to be risks, and these must be identified and understood in order to balance risks and benefits in the context of specific patients. Many of the risks identified for humans may not be relevant to veterinary patients (such as the risk of impaired driving). However, cannabis use has been associated with increased risk of schizophrenia and other psychoses and with some anxiety disorders in a dose-dependent relationship in people, and this raises the possibility of adverse behavioral effects in veterinary patients.

It is clear that marijuana exposure can have toxic effects on dogs and cats.1-2 These range from mild to severe, though exposure is rarely fatal. There is also evidence that the greater availability of marijuana associated with legalization for human medical or recreational use can increase the incidence of marijuana toxicosis in pets in some areas.3 These effects are likely due to products which contain relatively high levels of THC, and it is likely, though unproven, that products with little THC and higher levels of other cannabinoids might be safer for veterinary patients.

There are many cannabis-based products on the market specifically for use in animals. Unfortunately, there is virtually no information on the safety of any of these products. Assessment of both benefits and risks is entirely based on anecdote, which is a very unreliable form of evidence. One survey of owners using such products, for example, did report low rates of undesirable effects, as well as some perceived benefits.4 However, history is full of medical products for which anecdotal evidence has proven a poor guide to the true risks and benefits.

There is also concern about the consistency and labeling accuracy of medical cannabis products. Some states that allow medical marijuana use in humans have standards for labeling and quality control testing. However, there is evidence cannabis products are frequently inconsistent in composition and labeling despite these regulations.5-6 Given the complete absence of regulation or testing for veterinary cannabis-derived remedies, it is impossible to evaluate the consistency or labeling of these products, but they are likely to be at least as unreliable as products intended for human use. Even if the safety and clinical benefits for some Cannabis compounds is validated in veterinary patients, veterinarians and animal owners cannot rely on specific products having the appropriate type and amount of these compounds with no regulatory oversite or objective quality assurance mechanisms in place.

THE FUTURE
Ideally, changing attitudes towards cannabis will allow more clinical research to be done and the true risks and benefits for veterinary patients will be determined. Cannabis have many active chemical compounds., and it is likely some will turn out to have beneficial therapeutic effects. There is substantial evidence for only a couple of uses in humans, including pain and chemotherapy-induced nausea. There is no direct evidence for any use of cannabis in dogs and cats, though there is clear evidence for the toxicity of marijuana. All veterinary cannabis products are unregulated, and most have not been tested for safety or quality control, much less clinical benefits. Until further research is available, use of cannabis in dogs and cats is entirely experimental and based only on anecdote, and it is most likely illegal for veterinarians to provide or recommend any of these products.

REFERENCES

  1. Janczyk, P. Donaldson, C. W. Gwaltney, S. Two hundred and thirteen cases of marijuana toxicosis in dogs. Vet and Human Toxicol 2004 46 1 19-21
  2. Donaldson, C. Marijuana exposure in animals.Vet Med. 2002;97(6):437-439.
  3. Meola SD, Tearney CC, Haas SA, et al. Evaluation of trends in marijuana toxicosis in dogs living in a state with legalized medical marijuana: 125 dogs (2005-2010). J Vet Emerg Crit Care (San Antonio). 2012 Dec;22(6):690-6.
  4. Kogan, LR. Hellyer, PW. Robinson, NG. et al. Consumer perceptions of hemp products for animals. J Amer Holistic Vet Med Assoc. 2016;42:40-48.
  5. Vandrey, R. Raber, J. C., Raber, ME. Et al. Cannabinoid dose and label accuracy in edible medical cannabis products. 2015;313:2491–2493.
  6. Thomas, BF. Pollard, GT. Preparation and Distribution of Cannabis and Cannabis-Derived Dosage Formulations for Investigational and Therapeutic Use in the United States. Frontiers in Pharmacol. 2016;7:285.
  7. National Academies of Sciences, Engineering, and Medicine. 2017. The health effects of cannabis and cannabinoids: The current state of evidence and recommendations for research. Washington, DC: The National Academies Press. Accessed on April 30, 2017 at https://www.nap.edu/read/24625/chapter/1

Confused About Cannabis Presentation Slides

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