Call it coincidence, confirmation bias, or a trend, but I once again ran into the issue of a specialist I refer to recommending a questionable therapy for one of my patients. I recently diagnosed a dog with a nasal cancer and sent him to a board-certified oncologist to consult of options for advanced therapy. The particular disease can’t be cured, but radiation and chemotherapy can have some symptomatic benefit and may prolong a reasonable quality of life. The owner, however, didn’t feel the possible benefits justified the risks and costs, which I think was a reasonable decision. So the oncologist was only able to offer minimal symptomatic care. He offered a non-steroidal anti-inflammatory for pain, and also told the owner to go to a human herbal remedy shop and find the Chinese herbal preparation yunnan paiyao to help with the intermittent nosebleeds the cancer was causing.
I expect specialists to be more cognizant of the need for evidence-based practice than general practitioners, but I am beginning to doubt the truth of this assumption. I accept that sometimes, when there is a compelling need to treat and no established effective treatment available or acceptable to the owner, it may be appropriate to try things that have a weak basis in basic or clinical evidence. However, I am still concerned about the wisdom of recommending therapies that we don’t have at least some reasonable evidence are safe or effective.
Absence of evidence is not, of course, proof something doesn’t work. But it is absence of any good reason to think it does. And the reverse is true for safety. Absence of evidence of harm does not mean it isn’t harmful, only that we don’t know whether it is or not. Yet anecdotal experience is used to justify both safety and efficacy despite the clear evidence of history that this isn’t reliable. Of course, this logic is preferentially applied to CAM therapies. If clinical testing of a pharmaceutical company medicine finds no significant side effects, and then rare harm does appear once the drug is in widespread use, this is trumpeted as a failure of the whole scientific testing paradigm and proof of the evil venality of drug companies and the innately poisonous nature of their products. Yet we seem very comfortable prescribing herbal products about which almost nothing is known concerning safety or efficacy, with the assumption that they must be safe and that even if the only evidence they work is anecdotal at least we they can’t do any harm.
So what is yunnan paiyao, and what is the evidence for or against it? It is an herbal concoction apparently invented in China in the early 20th century, and the details of the ingredients are still kept secret. However, it is widely considered to consist primarily of Panax notoginseng of pseudoginseng root, with a number of other possible plant ingredients. Right away I wonder at the wisdom of prescribing a remedy when no one knows exactly what is in it. Can you imagine a major pharmaceutical company getting away with selling a drug that doctors actually prescribed without disclosing the actual ingredients?! And given the well-documented problem of heavy metal and pharmaceutical contamination of Chinese herbal remedies, and the general inconsistency of such preparations, it is remarkable that any doctor, much less a boarded specialist, would feel comfortable assuming the safety of such a product based on personal experience and anecdotes.
There have been a few papers published in China and in some alternative medicine publications that show the substance has some influence on platelet aggregation, an important step in blood clotting. However, you can mix sand or many other substances in a test tube with platelets and they will activate. One of the reasons it is so hard to make a safe artificial heart is that it’s tough to find substances that don’t trigger platelet aggregation. Some studies have compared the effect of yunnan paiyao with wheat flour or other substances to show it is more likely to cause clotting than these others, but the reliability of the tests and the choice of substances doesn’t make a very convincing case. And we have to remember the problem with the reliability of different sources of published research. Publication bias (the publishing of only positive results and “round-filing” of negative studies) is a problem everywhere. But Chinese journals almost never publish negative studies, and CAM journals are especially prone to select only those papers for publication that support the kinds of therapies the journals were started to promote.
The same issue arises in considering the few clinical trials in humans. A small number of trials with a small number of patients conducted and/or published in low reliability sources might be enough to justify further research, but not to justify widespread clinical use of the product. And, of course, the testimonials and anecdotes of clinicians and users have the same lack of reliability. If the product has been in use for over 100 years, and in that time we have only a handful of small studies of it, I think that is fair reason to be skeptical. If the drug truly has a dramatic impact on bleeding, topically or orally, it shouldn’t be difficult to conduct and publish a well-designed trial for a mainstream journal. Even one such trial would doubtless excite enough interest, through NCCAM or private industry, to stimulate more. Whether this has never been done because the proponents of such therapies don’t see the need for such evidence, or because the drug doesn’t truly have enough promise to survive such a test, is an open question.
Finally, I have found only two published veterinary trials investigating yunnan paiyao. An abstract presented at the 2002 International Veterinary Emergency and Critical Care Symposium took a group of 6 healthy ponies, and anesthetized them twice to check activated clotting time (ACT) and template bleeding time (TBT). The ACT is a moderately reliable test of blood clotting, though it can be affected by temperature, how vigorously and consistently the test tube is shaken, and a number of other factors. The TBT is a much less reliable and more subjective test in which a lancet is used to cut the patient (usually on the oral mucosa) and the time it takes for the cut to stop bleeding is measured.
The only difference reported in methods between the control trial and the yunnan paiyao trial was the position of the patients. They were on their side in the control trial and on their back in the test trial. I wonder if this might affect TBT since the blood flow to different parts of the body is affected by body position, but there isn’t any information in the abstract to determine if this is a factor. The study reported no difference in the ACT value with or without the yunnan paiyao but did report a non-chance difference in the TBT.
The other trial was a placebo-controlled trial of yunnan paiyao and another herbal preparation called Single Immortal using five Thoroughbred horses. The horses were run on a treadmill after having received either one of the herbal preparations or the placebo (cornstarch) orally twice a day for 3 days before the experiment. A number of variables were measured, with the main goal to see if there was any effect on exercised-induced pulmonary hemorrhage (EIPH), bleeding in the lungs during exercise. No effect of either remedy on EIPH was seen.
So we have a treatment with uncertain and unregulated ingredients, no demonstrated plausible mechanism of action, a few in vitro and lab animal studies in journals of questionable reliability, a few small human clinical trials in similarly questionable sources, and two very small veterinary trials in equids which found no effect except possibly on a poorly reliable and subjective test of blood clotting. At the same time, we have almost no published reports of adverse effects. There is one case report in a Chinese journal of a contact dermatitis reaction and some suggestion that high doses or chronic use may affect bone marrow cells. And we have a well-established history of toxic contamination and poor quality control in Chinese herbal remedies in general.
For me, this information clearly shows the oncologist’s use of this preparation in my patient to me essentially an uncontrolled experiment with no reasonable assurance of safety or efficacy. It is disturbing to me and certainly shakes my confidence in the judgment and recommendations of this particular specialist, though I fear he may not be at all exceptional but simply part of a larger phenomenon in which anecdote, personal experience, and “expert” opinion is given undue weight and the need for more reliable evidence is underestimated in veterinary medicine.
References:
Epp TS, McDonough P, Padilla DJ, et al. The effect of herbal supplementation on the severity of exercise-induced pulmonary haemorrhage. Equine and Comparative Exercise Physiology 2005;2:17-25.
Graham L. Yunnan Paiyao–Where’s the clinical evidence? Veterinary Botanical Medicine Association Symposium Archive 2005. Available at: http://www.vin.com/Members/proceedings/Proceedings.plx?CID=VBMA&PID=13730&Print=1&O=VIN
Graham L, Farnsworth K, Cary J. The effect of yunnan baiyao on the template bleeding time and activated clotting time in healthy halothane anesthetized ponies. Proceedings International Veterinary Emergency and Critical Care Symposium 2002, San Antonio, TX. Journal of Veterinary Emergency and Critical Care 2002;12(4):279. Abstract only.
Robinson N. Yunnan Paiyao; The following references come from Dr. Robinson’s document:
1 Bergner P. Panax notoginseng Yunnan bai yao): A must for the first aid kit. Medical Herbalism. 10-31-94 6(3):12.
2 Fratkin J. Chinese Herbal Patent Formulas – A Practical Guide. Santa Fe: Shya Publications, 1986. P. 133.
3 Fratkin J. Chinese Herbal Patent Formulas – A Practical Guide. Santa Fe: Shya Publications, 1986. P. 133.
4 Zheng YN et al. Comparative analysis of the anti-haemorrhagic principle in ginseng plants. Acta Agriculturae Universitatis Jilinesis. 1989;11(1):24-27, 102. [Article in Chinese].
5 Jin H, Cui XM, Zhu Y, et al. Effects of meteorological conditions on the quality of radix Notoginseng. Southwest China Journal of Agricultural Sciences. 2005;18(6):825-828.
6 Fan C, Song J, and White CM. A comparison of the hemostatic effects of notoginseng and Yun Nan Bai Yao to placebo control. Journal of Herbal Pharmacotherapy. 2005;5(2):1-5.
7 Fratkin J. Chinese Herbal Patent Formulas – A Practical Guide. Santa Fe: Shya Publications, 1986. P. 133.
8 Liu Y, Xie M-X, Kang J, et al. Studies on the interaction of total saponins of panax notoginseng and human serum albumin by Fourier transform infrared spectroscopy. Spectrochimica Acta. Part A. 2003;59:2747-2758.
9 Chan RYK, Chen W-F, Dong A, et al. Estrogen-like activity of ginsenoside Rg1 derived from Panax notoginseng. Journal of Clinical Endocrinology and Metabolism. 2002;87(8):3691-3695.
10 Cicero AFG, Vitale G, Savino G, et al. Panax notoginseng (Burk.) effects on fibrinogen and lipid plasma level in rats fed on a high-fat diet. Phytotherapy Reearch. 2003;17:174-178.
11 Epp TS, McDonough P, Padilla DJ, et al. The effect of herbal supplementation on the severity of exercise-induced pulmonary haemorrhage. Equine and Comparative Exercise Physiology. 2004;2(1):17-25.
12 Chung VQ, Tattersall M, and Cheung HTA. Interactions of a herbal combination that inhibits growth of prostate cancer cells. Cancer Chemotherapy and Pharmcology. 2004;53:384-390.
13 Chen FD, Wu MC, Wang HE, et al. Sensitization of a tumor, but not normal tissue, to the cytotoxic effect of ionizing radiation using Panax notoginseng extract. American Journal of Chinese Medicine. 2001;29(3/4): 517-524.
14 Chen FD, Wu MC, Wang HE, et al. Sensitization of a tumor, but not normal tissue, to the cytotoxic effect of ionizing radiation using Panax notoginseng extract. American Journal of Chinese Medicine. 2001;29(3/4): 517-524.
15 Leung KS-Y, Chan K, Chan C-L, et al. Systematic evaluation of organochlorine pesticide residues in Chinese materia medica. Phytotherapy Research. 2005;19:514-518.
16 Leung KS-Y, Chan K, Chan C-L, et al. Systematic evaluation of organochlorine pesticide residues in Chinese materia medica. Phytotherapy Research. 2005;19:514-518.
17 Leung KS-Y, Chan K, Chan C-L, et al. Systematic evaluation of organochlorine pesticide residues in Chinese materia medica. Phytotherapy Research. 2005;19:514-518.
18 Leung KS-Y, Chan K, Chan C-L, et al. Systematic evaluation of organochlorine pesticide residues in Chinese materia medica. Phytotherapy Research. 2005;19:514-518
I have had a couple of instances like this in the last few years as well, also in cases where there was no really effective treatment or the owner had decided not to treat for one reason or another. I kind of just put it down to giving the owner something to do at the time, but it does make me wonder. There is still a lot of uncritical acceptance of CAM in quite a few veterinary schools. I’m just glad to see so many academic veterinarians in the EBVMA. Hopefully things will gradually improve with things like “what’s the evidence?” in JAVMA.
If you don’t mind my asking, skeptvet, how did, or how do you approach the situation with the oncologist? Did you have a meaningful discussion of the questionable treatment, and if so, how did he respond, by simply quoting the same studies you provided or something else? Did you approach the owner in any meaningful discussion?
Will you be referring other clients to this specialist, now that you are aware of this alt recommendation? Or do you have additional resources in which to refer?
The reason I ask, is because if neither of you discussed the questionable treatment with the owner, then essentially, you are both promoting it without disclosure. I realize that beyond such disclosure, you can’t change the owner’s mind, but at least you would have given that professional opinion.
I also worry about clients like this who go on to continue questionable therapies, demanding of it for their pets and future pets, and making recommendations to their friends, family members etc that the *specialist* “recommended it”, thereby increasing the merit of and “validating” the specialist’s opinion and practice of prescribing ineffective and dangerous remedies.
This is why I often question is it really better to do something like this rather than nothing? The obvious risk of adulterated chinese herb preparations alone is not worth any risk, particularly to pets when they have no idea of the dangers or say in the matter. Why should placating the owner even factor in? The owner isn’t suffering the cancer, quality of life, and inevitably going to die from it, yet CAM practiioners put the value of the owner’s emotions above the quality treatment of the suffering pet.
v.t,
Thanks for the comment. I debated whether or not to directly challenge the oncologist on the use of yunnan paiyao, but ultimately I decided against it. There are several oncologists at the practice I sent this patient to, and while I always recommend one in particular, the reality is that logistics sometimes require my clients to see someone else, so it is possible some will end up seeing this doctor again. And, on balance, I thought his recommendations perfectly appropriate, apart from tacking on this bit of “experimental” terapy when the client declined conventional treatment. It’s not a practice I approve of, but it’s not something I feel strongly enough about to debate with this particular doctor at this point.
I do always make available the information and conclusions I develop when investigating these sorts of things to the client, which is one of the major reasons I look into them in the first place. Some clients will elect to forgoe questionable practices when I inform them of how little evidence there is for their safety and efficacy, many will coninue the practice anyway. And I make it a point not to engage in confrontation with clients over these things because that only damages our relationship in a way that lessens my ability to guide them in their pets’ care. It’s a bit of a tightrope walk, always, but one I take regularly.
Thank you for your open and honest answers, skeptvet.
I guess I just really worry about something like chinese herb preparations, with all the adulterants and toxins and even those we’re yet unaware of, making their way into treating pets. The non-regulation and no standards of quality control just scares the living daylights out of me. As if cancer isn’t bad enough, what if life was shortened unexpectedly due to some unkonwn toxin? When would it be determined suspect, who would consider testing it, and what would the result be? I think I know the answer and it scares me even more.
You are assuming that there is nothing about the safety of Yunnan Baiyao. It is extremely annoying when people spout off about things that they are uneducated about, as if they are experts. I would not make derogatory comments about your profession. TCM is a medically licensed and certified profession in this country. Just because you don’t know about the research does not mean it doesn’t exist. It just means that you do not know.
TCM practitioners are aware of safety issues with all of their herbal medicines. So before you go spouting off go to the source. Dr John Chen is THE expert on safety of herbal issues since he has degrees in both TCM AND pharmacology and has written the books on the subject of herbal safety. He also teaches seminars on herbal safety at all the top TCM schools in the country as well as at the national acupuncture organizations.
read about John Chen here
vhttp://www.evherbs.com/about_us/family.html
you can find his books on herbal safety here
http://www.redwingbooks.com/Contributor.jmdx?action=displayDetail&id=265
If you are concerned about the safety of this herbal formula then contact him and I’m sure he can help clarify the situation. That is the professional thing to do. Not spread more problems for the TCM community by posting your opinions as facts.
Baronesse,
I notice that you don’t actually address any of the facts or many, many sources of information I cite in my post. You seem limited to attacking me directly, assuming that my concerns are founded in ignorance without knowing anything about my training or expertise. That is a meaningless and unconvincing argument.
You obviously prefer the expertise, and opinion, of Dr. Chen. While he is clearly well-educated in the area of herbal medicine, like any other person he may or may not be correct in terms of any particular belief he holds. As he has devoted his life to herbal and TCM treatments, it seems reasonable to assume he believes deeply in the value of these therapies and is not inclined to be skeptical about them. Such a source of information is potentially quite biased, so he, like any other scientist, should be expected to demontrate his claims through objective research evidence. If you or he have any such evidence concerning the safety or effectiveness of yunan-paiyao in veterinary patients, please feel free to correct my misunderstanding. However, if you are claiming that the only people qualified to have an opinion on TCM are practitioners of TCM, then you are mistaken.
I can’t help but wonder if you have ever offerred a client an opinion on the safety of conventional pharmaceuticals. If so, by your logic you were spouting ignorant nonsense unless you happen to be a professional pharmacologist. Does that make any sense at all? I don’t think so. You have certainly given freely of your opinion, but facts would be more useful, and pursuasive.
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You can doubt Yunnan paiyao as you wish for the lack of laboratory evidence. However, there are plenty of clinical samples taken from the Sino-Japan war, the Chinese civil war, the Vietnam-American War, the Sino-Vietnam war, etc. to prove its effect other than what you said being “anecdotal”. And during these wars, tens of thousands of lives were saved by it.
Just like all the lives “saved” by bloodletting, leaches, and faith healing? The key to the success of scientific medicine is the humility to recognize that how things appear is not always how they really are. To see the impact of this, try reading a history of how Florence Nightengale changed ineffective medical practices in the Crimea by replacing anecdote with careful analysis and recordkeeping. That is how lives are truly saved.
I see your point. By comparing a massively used mordern medicine to bloodletting and leaches and faith healing, you showed your ignorance prejudice against Chinese medical science. How do you know Chinese scientists didn’t do their math job?
Do you have any data to share? Any peer-reviewed scientific publication with adequate controls and methods? I’m always open to being convinced, but if you bothered to read my post you’ll see that proponents of this never seem to provide more than tradition, opinion, personal anecdotes, or at most some in vitro studies. You’re the one making the claims here, so it’s your job to provide the evidence for them. It’s not prejudice to refuse to just take your word for it.
I have been using unnan Paiyao since my auto accident on friday 12/10/2010. I was diagnosed with concussion and brusises sprains and bruised ribs. I roled a compact car 4 times on a country road. The Doctor said from my condition on saturday that I would be layed up for a couple weeks. That I would be balck and blue for a few weeks.
I can tell you That I have full range and motion and almost no pain now and almost no discoloration.
Needless to say it will be in my medacine cabinet from now on. My Chinese co workers say it is found in most homes in China and for injury and pain it is more popular than asprin. Sure you can say this is anictdotal. I say who cares it worked for me. I’m 66 years old and seen a lot of bad medacine come from companies that should have known better. I’ve seen ginned up cvlinical trials and the FDA fail to protect .
I suggest caution when using ANY medacation. Do your own research. ask people who are using it.
“Do your own research”
Absolutely!
“as people who are using it”
Nearly Useless.
The fact that you used this concoction and didn’t have all the symptoms your doctor thought you would is not proof it did anything. If you carry a magic charm to ward off polar bear attacks and never get attacked by a bear, does that prove the charm works? Maybe you just live in Florida. Clinical trials aren’t perfect, but they are much better than personal stories and anecdotes, which is why modern medicine has been so much more successful in just a few hundred years than all the thousands of years of folk medicine that preceded it.
Here are some further illustrations of why anecdotes can’t be trusted, no matter how persuasive they seem:
Why We’re Often Wrong
The Role of Anecdotes in Science-Based Medicine
Why We Need Science: “I saw it with my own eyes” Is Not Enough
I use it when I have some annoying pain in a joint /muscle at times.. works for me! It’s very popular here in Cape Town. Our pharmacies often run out of stock! So it must work musn’t it!!! And I doubt it does any harm either.
“Our pharmacies often run out of stock! So it must work musn’t it!!! ”
I’d like to think you’re being ironic here, but of course you’re probably not. Actually, one study at least shows useless remedies are likely to be more popular than ones that actally work because people have symmptoms longer and so have a longer period of time in which to tell other people “I’m trying X, and I think it’s working.” People who take something effective get better too fast, so they don’t have as much time to spread the word about what they are using.
“And I doubt it does any harm either.”
Why do you think it’s harmless? Because nothing bad happened when you took it? I smoked a few cigarettes in college, and nothing bad happened. Does that mean they are probably harmless?
Here’s an educational opportunity for the “skeptvet”
Chi Institute of Chinese Medicine, Inc. was founded in Reddick, Florida in 1998. It is now the leading veterinary continuing education (C.E.) provider of Traditional Chinese Veterinary Medicine (TCVM). The mission of the Chi Institute is to train licensed veterinarians to become cutting edge animal health care providers, capable of practicing veterinary acupuncture, Chinese herbal medicine and other TCVM skills.
All the C.E. programs have been approved by the State, and endorsed by the China National Society of TCVM, China, and China Southwest Agricultural University College of Veterinary Medicine. These programs include:
Unfortunately, calling oneself an “Institute” and offering certifications, even with the imprimatur of state approval, doesn’t make Tooth Fairy Science any more legitimate. TCM is a largely mystical practice, though some of the as yet unproven herbal elements might have real medical effects. Then again, some of them have been shown to be poisonous as well, hence my interest in objective research rather than relying on folk traditions.
If you have specific factual information about Yunan Paiyao to contribute, I’m happy to review it. But just because somebody has set up a school to teach its use doesn’t mean it actually works.
Wait — was that a commercial or a blog post?
You say “TCM is a largely mystical practice” ?!! Wow… guess now I understand why you call yourself skeptvet.
Traditional Chinese Medicine has been around for thousands of years, and is a proven methodology of health care. Just because it doesn’t follow the Western medical culture doesn’t mean it doesn’t exist!
Yunnan Paiyao (also called Yunnan Baiyao), has been in use for many hundreds of years and is about as common in the medicine cabinet in China and other Asian countries as aspirin is in the U.S. It is in my kitchen first aid box and works a lot better than sand to stop bleeding when I get a cut or scrape. (It also has some antiseptic qualities which I don’t think that sand has).
It has prolonged the lives (with a better quality of living) of many dogs with nasal tumors and hemangiosarcomas. It is a shame that no Western medical studies have been done on this product- because that is the only way that close-minded people like you will ever even give it a try. You can read more information about Yunnan Baiyao here- http://www.shopsuigetsu.com/Yunnan_Baiyao_Yunnan_Paiyao_s/147.htm- this includes veterinary testimonials, history of the product, usages, and links to publications in western medical journals.
Irrelevant and proving nothing. Astrology, bloodletting, and slavery were around for thousands of years. That doesn’t validate any of them. There are ways to decide if something is true or false, effective or ineffective, safe or nsafe, but simply how long it’s been around and how many people accept it isn’t one of them.
I don’t think “proven” means the same thing to us. To you, it ust means people have used it and think it works. To me, it means it has been validated by rigorous, objective research that accounts for all the biases and errors in ou judgements we are so vulnerable to.
As usual, you don’t offer any real evidence, just your vehement opinion. And yet you are stunned that I don’t just take your word or the word of all the other people who believe what you do for things. Sorry, but history shows quite clearly that lots of people can be wrong about something for long periods of time, and that what you call “Western” science works everywhere for everyone better than any other epistemological approach we’ve ever tried. It’s not cultural bias o closed-mindedness, it’s the humility of recognizing ou limitations and the clear evidence that science compensates better for our limitations than tradition, folklore, personal experience, or any of the ways of knowing processes like TCM rely on.
“Traditional Chinese Medicine has been around for thousands of years…”
No, TCM is less than one hundred years old. It was a product of, and instrument for, Mao Tse Tung’s Communist Revolution.
Why don’t you or someone you respect in your profession establish the protocol for a clinical trial and run it. Take a control group of dogs diagnosed by biopsy with visceral hemangiosarcoma whose owners have decided to let nature take its course without treatment. Then take a 2nd group of dogs that when they show clinical signs of a bleed, treat them with Yunnan Baiyao. You can then statistically determine whether the Chinese Herb lengthened the life of the animals treated with it (The cancer will still kill them but perhaps you will find they don’t die of acute hemorrhage and have a longer quality life).
My dog has hemangiosarcoma of the heart. She was diagnosed March 3, 2011. I opted for palliative care. She is 10. I have given her Yunnan Baiyao, changed her diet from grain based to protein based, supplement her diet with ubiquinol and Curcumin. I took her in for an ultrasound April 14. Her RBC’s, clotting time and platelets are normal. Her liver and kidney function is normal. I also give her salix 50mg 2 x a day for right sided heart failure. Her lungs are clear and the tumor in her right atrium has shrunk. The oncologist and her regular vet were stunned and even wrote that in her report after her ultrasound and electrocardiogram (Both run by specialists). I guess this makes me anecdotal, but my dog’s still here (April 21, 2011) and we still walk 2 miles a day. She certainly still has the cancer but cardiac tamponade or a hemorrhage in her spleen clearly haven’t happened. As an owner of a dog with a terminal illness who’s life expectancy can’t be significantly extended by today’s treatments, I felt she and I had nothing to lose and possibly a LOT to gain by trying something that I have read about over and over again (anectdotally, of course) on the German Shepherd, Golden Retriever and other canine cancer forums. I don’t object to what you say. I object to the arrogant way you say it.
I wonder if this attitude extends to the concerns of the people who bring their pets to you in good faith. Knowing your medicine without people skills won’t give you a successful business in the long run. People talk. All things being equal, pet owners will become long term clients of vets who leave no stone unturned, whose care DOES extend to the emotions of the owners and works with them to find a combination of treatments that help the body and the soul. Based on the things you’ve said in your blog, you may win Kudos from like-minded vets, but I would NEVER bring my pet to you.
A study would certainly be informative if properly done. Of course, the same is true for a hundred other remedies that people claim are helpful, and I can’t personally test them all. It seems to me that such a study is the responsibility of those making the claims that this treatment works, and selling it to their clients.
As for your dog’s case, I’m glad things are going well, but I don’t believe it is proof on anything. Has the tumor shrunk, or has the blot clot surrounding the tumor been reabsorbed? I have certainly seen cases in which bleeding stopped spontaneously and did not resume for weeks to months, so the only reason to I’ve credit to the treatment is that doing so makes us feel like we have some control over the outcome. It serves a psychological need, but it ma or may not actually be helping the patient.
As for arrogance, what about the post is arrogant? People who disagree with what I say seem to assume that having an opinion they don’t like is in itself arrogant. Making a judgement based on the facts is not arrogant, and believing what someone else says, what tradition says, or what we want to believe is not humiliation. In facthumility is accepting the limitations in our individual judgenents, which means not relying on our experiences and anecdotes but on the methods of science.
I certainly hope you dog does well, but I think my clients and patients would disagree that I am not caring or compassionate because I don’t encourage them to follow unjustified promises and to hope blindly in the unproven.
Thank you for your thoughtful response. Until Hemangiosarcoma can be beaten into submission, it is ONLY the hope that sustains us because it IS a terminal diagnosis with a bleak prognosis whether the dog receives surgery (if possible), and chemo or not. I guess if we’re talking “Dog years”, 285 extra days with treatment translates into several years extra life.
I think clinical trials are being run in Colorado using Curcumin from the spice turmeric to retard angiogenesis. It seems if ANY cancer could benefit slowing angiogenesis, it would BE Hemangiosarcoma.
I can’t name it but a small clinical trial WAS performed which showed the ingestion of Yunnan Baiyao decreased blood clotting time by 35-55% in human patients during surgery.
My choice to use it was based on the inevitable result of my dog’s condition. I very concerned about her quality of life these last months. With a big dose of my time, attention and love as well as palliative measures working in concert with my vet, checking her heart , lung and kidney function monthly so I can actually see how her systems are functioning.
You may be right, Maybe there was a blood clot on the tumor that broke off. Either way, it bought her some more time without the symptoms of her pericardium filled with fluid.
Didn’t aspirin come about because South American Indians used Willow Bark as an anlgesic? Maybe Yunnan Baiyao will give rise to another spectacularly effective weapon in our modern pharmacopia.
I would never try to talk someone out of having hope. The hard reality is that there is much we don’t know, and much we cannot control, and hope is necessary to cope with that.
But while skepticism and caution are a harder sell than hope and optimism, in the long run I believe they lead us to more real therapies and down fewer dead ends. My hope, and my belief, is that someday, we will beat hemangiosarcoma, and it will happen because we did the hard, unglamorous work of rigorously testing all new ideas to find the few with real promise and discard the many with only false promise.
A few useful medicines have come from investigating traditional herbal practices. The vast majority of these practices, however, have turned out not to be useful, and the majority of the progress in medicine made in the last couple of centuries has come from rejecting most of the traditions handed down to us and pursuing those ideas that held their own against the tough challenge of scientific testing. Perhaps yunan baiyao will be one of these, or perhaps like most ideas we place our hope in it will fail to live up to its promise. My only point in the original post is that we don’t know enough to know yet, and if we turn to this remedy in desperation we must understand that we are grasping at straws.
I have lived through my own dog’s death from hemangiosarcoma, as well as those of many patients I cared for, so I truly do understand what your situation is like, and I wish you well.
I have been reading all this with interest and would like to offer my personal experience with this product. I have used this on my son for his bedsore. After 3 years and spending thousands of dollars in wound care and specialists, a Chinese acupuncturist put me onto Yunnan Paiyao. I have never seen better results, in two weeks it was almost completely gone. Another two weeks and that was the last I have seen of the bedsore, it has been two years since it has healed.
I then gave some to my uncle who has diabetes and already had to cut off part of his foot, his foot was not healing. After two weeks it was healed, no problems since. I have given to others with wounds that refuse to heal and all have had similar experiences. I even used some on my cousin who had severe burns from chemotherapy and she said that it helped soothe them and healed quickly without marks.
I am no doctor but I can tell you that from personal experience this has worked wonders where others ave failed miserably and at horrendous cost to the patient. I believe in this powder and will continue to help others who need it. There comes a time when after trying all the conventional methods, you are willing to try alternative methods. For an inexpensive product it has performed impressively each time I have put it to use. Many people are living better lives because of this.
Thank you for your time, I just wanted to share my experiences with this product.
I’m glad things worked out as well as they did for you. I will repeat what cannot be emphasized enough, which is that such stories, though emotionally compelling, are not reliable predictors of which therapies work and which do not. Every medical therapy in history, including alll those that turned out not to work, had such stories to support them.
skeptvet: I couldnt agree more with your logical approach in ascertaining qualified / scientific facts as they pertain to valid uses of herbs and other substances and their ability to treat certain ailments. However, you have demonstrated a great deal of bias yourself. Your ego is quite evident in affecting your judgement. I dont know much about modern veterinary schools of thought but I am aware of the AMA and its extremely biased school of thought. The west has ‘much’ to learn from other cultures and their medical practices but unfortunately they think as you do. Bias and ego is the very reason why these alternative treatments have ‘not’ been thoroughly studied. You are the product of your environment. Dont be afraid to think outside the ‘box.
What, specifically, is “thinking outside the box?” if you mean believing the claims made about this product or others without reasonable scientific evidence that these claims are true, that’s simply blind faith, not open-mindedness. While we all have biases, asking “Why should I believe this?” and relying on evidence rather than just other people’s belief is not an expression of bias; it is thinking critically for oneself.
Interesting observations by yourself and others. You present thoroughly and eloquently. Arrogance I suppose, is in the perception of the recipient of the presentation. I wonder if you have read a book by Allen M Schoen, D.V.M. M.S, called “Love, Miracles and Animal Healing”? His book is also well presented and eloquent. I had a copy of it delivered here in Australia from Better Worl Books for AU$8.37, if I remember correctly. i have also written to Schoen and referred him to this blog, with much the same comments as I have written here. I think you two might have a somewhat interesting dialogue…. Cheers.
I haven’t read that book, though I have read many of Dr. Schoen’s articles and parts of his text on alternative veterinary medicine. I’m certainly always open to constructive dialogue, though I have a hard time imagining a great deal of common ground between our philosophies of medicine.
Dr. Schoen approaches the conflict between science-based medicine and alternative medicine the way an intelligent design advocate approaches the divide between creationists and those who believe in biological evolution: as if the two points of view should be assumed to be equally sound, valid, and deserving of credence and as if a debate or reconciliation between equals is to be desired. Unfortunately, this sort of post-modern cognitive relativism negates the notion that actual facts about the physical world exist and can be known, and it places belief and faith on a par with empirical evidence, which I believe is a mistake.
Integrating alternative therapies with scientific medicine sounds like a good and reasonable idea, but only if one accepts a priori that these therapies have any benefits to bring to the mix. This belief is, for the most part, one based on faith or on the least reliable levels of evidence: personal experience, intuition, spiritual revelation, anecdote, traditional, theorizing from general principles, and so on. If one accepts that scientific kinds of evidence or proof are superior to these pre-scientific forms of justification, which I think the history of science and medicine in the last couple of centuries makes almost an inescapable conclusion, then many of the mtherapies Dr. Schoen recommends have little claim to bringing any real benefit to our patients, and integrating them with medicine that actually heals the body is misguided.
Interestingly, outside the domain of medicine I think Dr. Schoen and I have a fair bit in common. There is much of Buddhist theory and practice in his writing, which I believe has great value as an approach to living. For my part, I suspect it is his manner, the mindfulness and compassion he evinces in person and in his writings, that comforts his clients and his patients far more than the alternative remedies he provides. The one area in which I think conventional medicine needs to learn from the alternative medical community is in how we deal with the psychological needs of our clients/patients. I think the psychological effects of the therapeutic rituals and character of the therapeutic relationship often found in CAM is what creates the impression of real health benfits despite the truly inert nature of many CAM interventions.
Thanks for that. Thoughtfully and tactfully expressed. If I may coin a phrase, ‘the proof of the pudding is in the eating’, and many of the alternative therapies that Schoen has cited success with have been achieved after conventional practise has failed. Of course we don’t hear of his inevitable faillures along the way and I wonder what tha statistics would show. I agree with your comments that positiveness and compassion, aka bedside manner must have a bearing on the case. It’s perfectly observable that my dogs (a border collie/blue heeler cros and a dingo) respond empathetically to my and my partner’s highs and lows and our occasional tiffs. However from where I sit, I think we can rule out the placebo effect as that requires the power of suggestion and one would be accused of anthropomorphism!
I note that his book was copyrighted in 1995 and a Google search will illustrate that his fame and reputation have swelled considerably since then. In any case I recommend his book to you. Although I am a bit leary of some points of conventional medicine (a case in point being big pharma and its influence on the FDA), I am not a spiritualist, nor superstitious. Would a reasonable approach to take when an alternative approach works repetitively AFTER conventional medicine has failed, to conduct the necessary experiments to confirm its efficacy and bring it into main stream medicine? Another instance I have taken interest in lately is the Burzynski movie and the antineoplastin controversy. The cynic in me would suggest that that big pharma is more interested in treating the symptoms rather than finding a cure, the former being far more lucrative. But I digress. Thanks for the discussion. Cheers.
I appreciate the discussion as well. So much of the response I get is vacuous hate or simple repetitions that I am wrong without any further argument or evidence. It is always preferable to have a substantive, respectful discussion.
The real question here is “Do these therapies actually work in those cases which have failed conventional treatment? You are taking this as a given, with the “proof of the pudding” being that there are anecdotal reports of successes. There are many reasons why this approach to deciding if a treatment is effective is not a trustworthy one. For one thing, every therapy ever invented has been able to muster stories of success. Either every therapy works for someone, or anecdotes are an unreliable guide to what is effective. And the dramatic and unprecedented changes in the length and quality of our lives in the last 200 years were never achieved despitethousans of years of medical practices based on such a method. So there seems good reason to question whether the methods Dr. Schoen claims have been successful really have been, despite the fact that many people may believe this is true.
Though there is a vast literature on the fallibility of human judgement and the benefits of a scientific approach to seeking the truth, one small book I might suggest as a place to start is Thomas Kida’s “Don’t Believe Everything You Think.” It seems to me that a big problem with CAM in general is an excessive confidence in our own individual perceptions and judgements, despite ample evidence of their unreliability.
In terms of the placebo effect and animals, this too is a complex subject. While subjective expectations most likely to not lead our pets to perceive they are getting better when they really aren’t, as is one of the classic ways in which placebos fool human patients, there are actually many other ways in which therapies can appear o work in our pets when they do not. These include:
1. Placebo by Proxy-We see what we want, need, and expect to see, and we are the ones who judge our pets’ condition in many cases. I have seen many clients in denial about painfully obvious sufferig in their pets due to the influence of their own feelings and beliefs.
2. Classical condittioning-We can train animals to show behavioral and physiological reactions to stimuli. If you inject a dog with insulin several times, and the blood sugar decreases due to the hormone, and then you inject the dog with saline, the blood sugar will also decrease due to conditioning effects. This can give the false appearance of a physical response to an actual treatment.
3. Human interaction-Our pets respond to us and our behavior, and there have been studies which suggest that uman contact can reduce apparent pain, the heart rate and blood pressure, and many other variables in our pets. It is hard to separate this fro any effects of a purported medical treatment outside of a controlled study.
http://www.sciencebasedmedicine.org/index.php/is-there-a-placebo-effect-for-animals/
http://skeptivet.blogspot.com/2009/07/placebo-effect-in-animals-and-their.html
I agree that if there is consistent and rigorous prooof of effectiveness for an alternative therapy, it should be accepted into conventional medicine. I just think this is an extremely rare circumstance, and the vast majority of test of such therapies have failed to demonstrate real benefits.
Finally, it baffles me that Burzynski is somehow seen as a maverick alternative doctor struggling to help the sick against the venal resistance of big pharma. As the articles below illustrate, he takes huge sums of money from sick people in exchange for giving them conventional chemotherapeutic drugs in an idioscyncratic and irrational way mixed with chemicals of his own devising which have never shown any real benefit, and he does so in the name of research without ever actually publishing any results. The man may be sincere and deluded or deliberately taking advantage of people, but either way he is dangerous and in no way the kind of man he is portrayed to be.
http://www.sciencebasedmedicine.org/index.php/stanislaw-burzynski-bad-medicine-a-bad-movie/
http://www.sciencebasedmedicine.org/index.php/stanislaw-burzynskis-personalized-gene-targeted-cancer-therapy/
http://www.sciencebasedmedicine.org/index.php/stanislaw-burzynski-antineoplastons-and-the-orphan-drug-sodium-phenyl-butyrate/
http://www.sciencebasedmedicine.org/index.php/compassion-gambit/
http://scienceblogs.com/insolence/2011/12/burzynski_and_the_cult_of_personality.php
http://scienceblogs.com/insolence/2011/12/what_dr_stanislaw_burzynski_doesnt_want.php
Hmmmm. There are a lot of references there to read and digest and I have no medical background, but a lot of years in IT and a lot of reading done on the internet. One link leads to the next and I suppose the links lead you to where your interests lie. Is it possible therefore that we selectively read from the sources our convictions lead us to and use them to bolster those convictions?
If a man is given a placebo in the belief it is a cure and his affliction disappears forever, is it merely a coincidence or is it just remotely possible that his belief in the placebo led to the cure? How many doctors say the attitude of a patient has an immense bearing on the possibility or progression of a cure? The vet I used here for over 30 years once told me that dogs are sometime notoriously difficult to diagnose for some of the lesser ailments because of the positive attitudes they naturally possess.
‘Either every therapy works for someone, or anecdotes are an unreliable guide to what is effective.’ I suffer from the occasional bout of gout. One of the things one is not supposed to eat is oily fish ( from a list of items to be eliminated one at a time). In my case, a couple of fish oil capsules I take daily for omega 3s has, I believe, helped to keep the gout away with its anti-inflammatory properties. I recommended this to a friend and it brought abot a gout attack in him! Further reading pointed out that it was all about individual metabolism and what affected one person may have the opposite effect on another.
On the Burzinski matter, a number of things I have read led me to believe that he has been exonerated (legally) in court a number of times, but the powers that be keep coming back at him with new charges. This, apparently, whilst he was in the midst of one of his legal battles, those same authorities tried to patent the very things they were prosecuting him for. Of course, this is all just anecdote. All I can do here is parrot off what I have read elsewhere. Suffice it to say that big pharma is huge business and it would appear contrary to their interests to pour vast amounts of dollars into research that threatens those same profits. Obviously, this is just conjecture on my part, but it is echoed frequently all over the web. Anyway, I have to go. Other business call at this point. Thanks for the discussion. BTW, do you KNOW the type of man Burzynski is? Cheers.
Absolutely! Confirmation bias is a huge problem, and engaging with ideas and aguments in opposition to one’s own is vital to keeping oneself intellectually honest.
If such happens consistently, then it suggests the placebo may actually have the kind of mind-over-matter power often attributed to it. If it happens randomly and unpredictably, then it is likely an artefact of our unreliable perceptions. Even diseaes usually thought to be invariably fatal (e.g. renal carcinoma, which is usally a rapidly ad inevitably metastatic cancer) soemtimes turn out not to be (e.g. 3% of renal carcinomas turn out to regress spontaneously, which we only know since we’ve developed advanced imaging and started finding tthem before they cause symptoms). In any case, the placebo effect has been studied in detail for over 60 years, and no such power over physical illness has been found. The placebo effect only changes our perception of our disease, not our disease itself.
http://skeptvet.com/Blog/2011/07/placebo-treatment-for-asthma-works-for-the-mind-but-not-the-lungs/
http://www.sciencebasedmedicine.org/index.php/the-rebranding-of-cam/
Admittedly it is a sample size of one, but I have no doubt that Yunnan baiyao prolonged my dogs life almost 1.5 years. I’m not a vet, but I am a scientist and agree with a lot of your statements, but my dogs response was proof enough for me.
My dog had advanced advanced nasal carcinoma and was anemic when I started him on Yunnan baiyao
He started out with small nose bleeds about 3 months before the cancer was diagnosed. By the time the meds started he had developed a slow steady nose bleeds and was anemic from all the blood loss. Basically he would almost bleed to death slowly, and then the bleeding would stop because his red blood cell count got so low. He would make some red blood cells, and it would start over again. By
the time we got the meds in him he was basically unresponsive, and his gums were white. The Chinese herb worked overnight, but the vet recommended it only once a
day, but it was just a guess (studies lacking). About 20 hrs later he got another nose
bleed, and so I started giving it to him twice a day. I continued to give him two a day and he did not get another nose bleed after that. We also gave him tremadol and Firocoxib, but those were started weeks before the Yunnan baiyao and probably did not have any effect on the bleeding.
In the end my dog died from misdiagnosis of salmon poisoning, even though I repeatedly told the Dr.s that is what I thought he had. Bioposy showed his cancer had not spread in over a year, but that was probably from the Firocoxib stunting the tumor growth. At any rate he would have bleed to death, long before the tumor caught up. I can refer you to vets, and have copies of his records if needed.
Case reports are great for generating hypotheses, but unfortunately terrible at confirming or disproving them. While I understand that having a clinical change happen right after a therapy is begun feels like compelling evidence of a therapeutic effect, I also know that exactly the same kind of story is available for every other medical treatment ever tried, including many that have been conclusively disproven liek bloodletting. It is certainly possible that the Yunnan baiyao had a beneficial effect, and I would love to see controlled studies validate this so we would have a reliable tool for these situations. But I also know that this kind of story misleads us more often than not in medicine, so it doesn’t really change the conclusion that any use of this product is a roll of the dice.
I more or less agree with what you are saying, but I have a womon on her way to my house right now to pick up the Yunnan baiyao that I had left over from my dog. Should I tell her to wait for the studies to come out, or give this a shot to potentially easy the dogs pain? The answer is very easy for me.
Her dog also has advanced nasal carcinoma and has been bleeding non-stop for some time, and probably has very little time left if the bleeding is not stopped. The vets have said they can not do any more it. She is going to start him on it today, and I will send an update.
The reason you think the answer is easy is because you believe that while the benefit is likely but not formally proven, there is no risk. But there are many, many examples of harm done by herbal remedies due to toxic heavy metals, undisclosed pharmaceuticals, and direct poisoning from the deliberate ingredients. The risks are as unknown as the benefits, and several studies have shown patients who take such remedies can actually do worse than those who don’t. So while it might help, it also might cause suffering of hasten death, and one anecdote alone doesn’t reliably tell us which. It may be appropriate to take risks in a desperate situation, but you have to be clear about the risk you are taking, and in this case there is no better evide this remedy is safe than there is to show it is effective.
Consider the examples in these articles:
The Harm CAM Can Do This article talks about many forms of alternative therapy, but there is an extensive list of reference illustrating specifically the dangers of untested Chinese medicines and other such remeides, including these (links are in the article but not copied here):
Huang WF, Wen KC, Hsiao ML. Adulteration by synthetic therapeutic substances of traditional Chinese medicines in Taiwan. J Clin Pharmacol. 1997 Apr;37(4):344-50
Chung-Hsin Chen, Kathleen G. Dickman, Masaaki Moriya, Jiri Zavadil, Viktoriya S. Sidorenko, Karen L. Edwards, Dmitri V. Gnatenko, Lin Wu, Robert J. Turesky, Xue-Ru Wu, Yeong-Shiau Pu, Arthur P. Grollman. Aristolochic acid-associated urothelial cancer in Taiwan. Proceedings National Academy of Sciences, April 2012. Panax ginseng: A Systematic Review of Adverse Effects and Drug Interactions. Drug Saf 2002;25(5):323-44 Drug Saf 2002;25(5):323-44
Burkhard PR, Burkhardt K, Haenggeli CA, Landis T.Plant-induced seizures: reappearance of an old problem. J Neurol 1999 Aug;246(8):667-70
Shad JA, Chinn CG, Brann OS Acute hepatitis after ingestion of herbs. South Med J 1999 Nov;92(11):1095-7 Smolinske SC J Am Med Womens Assoc 1999 Fall;54(4):191-2Dietary supplement-drug interactions.
Lai MN, Lai JN, Chen PC, Tseng WL, Chen YY, Hwang JS, Wang JD. Increased risks of chronic kidney disease associated with prescribed Chinese herbal products suspected to contain aristolochic acid. Nephrology (Carlton). 2009 Apr;14(2):227-34.
Lawrence JD. Potentiation of warfarin by dong quai. Page RL 2nd, Pharmacotherapy 1999 Jul;19(7):870-6
Means C. Selected herbal hazards.Vet Clin North Am Small Anim Pract 2002 Mar;32(2):367-82
Nizsly N, Grizlak B, Zimmerman M, Wallace R. Dietary Supplement Polypharmacy: An Unrecognized Public Health Problem? eCAM 2010 7(1):107-113
Norred CL, Finlayson CA Hemorrhage after the preoperative use of complementary and alternative medicines. AANA J 2000 Jun;68(3):217-20
Wang JD, Lo TC, Chen PC. Increased mortality risk for cancers of the kidney and other urinary organs among Chinese herbalists. J Epidemiol. 2009;19(1):17-23. Epub 2009 Jan 22.
Contamination of herbal products with undisclosed pharmaceuticals.
Widespread contamination of supplements with undisclosed toxins and parmaceuticals
Lead, mercury and arsenic in herbal preparations.
Lead in TCM preparations.
Skeptvet,
I spent a long time speaking with the woman to make sure she knew this may or may not work, and could possibly cause more harm. I recommended she consult her vets, she did, and they gave her the Ok. Let me make this point very clear, in general I do not support non-traditional medications, but I make and exception for Yunnan baiyao.
You are missing the picture if you are concerned with heavy metal poisoning. Usually individuals that have issues with Chinese herbs are taking very large doses for long periods of time. They may or may not be present in trace amounts in the Yunnan baiyao. However, we are giving very low doses, and the time it would take to accumulate to dangerous levels in a pet are beyond the life expectancy the animals have. I’m talking about animals that are weak and dying from anemia related to their tumors. My dog was on this med for 1.5 years and was fine and his autopsy showed no metal poisoning, again I can send you medical records. He did however die from a misdiagnose of Salmon poisoning, because he “didn’t show the classic signs”. Even though I told the vets repeatedly he ate a salmon, and I thought he had salmon poisoning. So, in the end my dog died because a vet refused to listen to me and followed textbook protocol, but I digress.
The dog I recommended Yunnan baiyao is on clinically tested medications that are known to cause liver problems long term, so I don’t really see your point with the reference to heavy metals. Most medications have negative side effects long term, how about Chemo.
Anyhow, the sample size is now two. I saw this dog I recommended the chineese herb for. It was lethargic, bleeding out it’s nose and was doing very poorly. It could hardly stand let alone walk, had vomiting food, and the owner said it was basically not eating. To me it looked like the dog had given up and was waiting to die. She stared it on the herb this a.m., and the results appear positive (see email below). This really was a last ditch effort, and we talked about it. She just wanted to make her dog comfortable, and try to improve it’s quality of life for what time it had left. I also had her run it by her vets, since her dog was having sesures and vomiting.
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Hi Jason – Dr. ***** gave me the OK to give it to Casey, and I gave her the first capsule this morning – I think its already doing some good.
Didn’t seem to bother her at all, stomach-wise (big relief), she seemed to have a bit more energy thru the day, and ate well tonight, which has not been the norm. I am very happy so far, and will give another capsule tomorrow.
Thanks for sharing your story and recommending the Chinese medicine. Having this new avenue to explore has lifted our spirits and gives us hope we can get Casey feeling better, at least for a little while. So very good
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This person just wanted her dog to feel better even if it is just for a few days.
How can you be so dismissive that this medicine stops bleeding in animals? I could see arguing for improved mood being placebo effect, but not hemostasis. Animals don’t typically just stop bleeding.
In a perfect world clinical studies would happen on everything, and we would come to statistical conclusions by deductive reasoning. However, you can also reach a statistical conclusion through inductive reasoning if the sample size is large enough. Obviously you can not scientifically say anything about a sample size of 2, but I don’t think Casey’s owners really care about the stats, or if their dog is going to get metal poisoning in 6 months (she has and aggressive cancer in both nostrils and her brain). They just wanted their dog to be comfortable, and have some quality time with it for what little time it had left.
I’m just curious how many cases of spontaneous hemostasis after this herb is started would you need be convinced, via to inductive reasoning, that this particular herb works?
Also, just wanted to point out “The Harm CAM Can Do” is not a peer reviewed article, it’s just a few paragraphs you put up on the web referring to a lot of others work.
The point about heavy metals was not that this is a risk for these individual patients, since of course heavy metal toxocity is a chronic problem. The point was that the assumption of safety often made about these remedies is mistaken since there are frequent contaminates. If the contaminate was arsenic (which has also commonly been identified in TCM remedies) or aristolochia or some other acute toxin, then the product would do immediate harm. So without the ability to know what the ingredients are, what the dose is, and whether there are toxic contaminants, we are taking a chance, that is the point. As I said, that may be appropriate in dire circumstances (as in this case), but we have to acknowledge that the risks and benefits are unknown. You seemed to be implying that it might help and couldn’t hurt, and I was simply pointing out we don’t have enough information to confidently assert either.
And you are mistaken to think I am dismissive of the possibility that this product controls hemorrhage. All I’ve said is that the idea is unproven, not that it isn’t true. However, two anecdotes, or a thousand, don’t serve to demonstrate it is true either. Contrary to what you think, I have seen many dogs with hemangiosarcoma have intermittant bleeding, often with weeks or months between episodes. So simply reporting that some dogs cease bleeding and seem to feel better after starting this product doesn’t tell us the product works.
Clinical trials aren’t a luxury or a nice extra; they are essential to knowing what works. People used thousands of years of anecdotes to validate bloodletting, for example, and they were wrong. At this point, all we can say is that it is possible the product may benefit dogs with bleeding, and it is possible it may not or that it may even make them worse, and we really don’t know. Would you use a prescription drug with that level of evidence behind it? Why is an herb different?
I think the key to what’s happening in this case lies in this, “Having this new avenue to explore has lifted our spirits and gives us hope.” People desperately want to feel they have some control, something they can do to make a bad situation better, and giving them something to do serves this purpose.
Unfortunately, it serves it equally well whether or not the intervention actually works. Glucosamine has been demonstrated to have almost no effect in studies with thousands of people, for example, yet it is widely used anyway and people frequently report improvement in themselves and their pets when using it. The same is true for hundred of other interventions that have been shown pretty clearly not to work.
And wile I have nothing against giving people help in coping with the illness of their pets, I simply think it is our duty as vets to be honest about what we know and don’t know about the choices we offer, and that we have an ethical responsibility not to offer false hope or ineffective treatments. In this case, I don’t object to offering this product so long as all other options and the fact that we really don’t know if we will help or hurt the dog, are clearly stated and understood by everyone. Unfortunately, such honesty often diminishes the psychological value of the therapy for the owner, which puts those of us committed to explicit, evidence-based medicine at a bit of a disadvantage compared to those willing to offer therapies for which the evidence is lacking or even negative base don anecdotes suggesting they might help.
Of course my blog posts aren’t peer-reviewed articles. I did not suggest they were. The one you mention refers to many peer reviewed articles as well as anecdotes, not unlike yours, showing potential harm from alternative therapies. Its purpose, again, is to dispute the common notion that such remedies might help and can’t hurt when the reality is that they very well might hurt.
Jason, I would suggest you “research” the risks and harms done by TCM – Skeptvet has covered that pretty well, but safety and quality of ingredients should always be brought into question. Do you know where your product ingredients are sourced? Do you know the formulation used? Do you know the manufacturing standards used for the products? Just a few questions you truly should be concerned about when using, and most importantly advising such products to others for use in their innocent pets.
I used Yunnan Paiyo on my own dog who had a right atrial hemagiosarcoma. She had 1 pericardial bleed at diagnosis and then once I started the Yunnan Paiyo she had NO further bleeding episodes for 6 months. By then her tumor size was large enough to cause obstruction. She was followed with several echocardiograms with no futher pericardial fluid noted. I also work in a small animal oncology practice and have seen good results on several cases when we were offering Yunnan Paiyo as a hospice treatment. I realize there aren’t any studies but this is just my personal experience.
Thanks for this post! I have recently found myself in a similar situation, but on the client side instead of the veterinarian’s. My dog was recently diagnosed with very advanced hemangiosarcoma of the skin, with multiple tumors in the spleen seen on.ultrasound. It was obvious that the cancer was too advanced for the standard treatment to have any benefit, so we decided we would do what we could to keep him comfortable as long as possible and then opt for euthanasia when his quality of life declined.
My spouse and I are both trained biologists, with years of experience in cancer and immunology research. We take all our pets to the clinic associated with a major US veterinary school, because we know they will receive the most up-to-date and scientifically-based treatments. The oncologist who diagnosed our dog prescribed Yunnan baiyao. I’m generally skeptical about herbal medicines, but I assumed that there must be at least some quality studies done that would justify using this medication. I was quite unhappy to see that this wasn’t so.
I looked for studies published after your post, but didn’t find any that I would call convincing or even well-designed. All I found were the three that you cited above. I am quite annoyed that I was led to pay $90 for two weeks of pills that were likely to have no positive effect and could even make dog sicker, at a stressful time when I really needed to rely on the judgement of my vet. I am shocked that this happened at a top-rate vet school.
Fortunately, our primary vet is fantastic, and I know I can trust her judgement in whatever arises in the future. But if we ever have another pet with cancer, I’m doing my best to avoid this particular oncologist. I feel that perhaps I should lodge some kind of complaint, but I know that this vet was just trying to do something when faced with something so devastating, so I’ve decided to just let it go. But having false hopes dashed at this horrible time just adds to our pain.
BTW, after 10 days of using the pills, I have seen no real effect. My dog is still bleeding from his skin tumors, and I imagine he probably is bleeding internally as well. I don’t expect him to live a month after diagnosis, and there’s a good chance we’ll have to put him to sleep within the next week or so.
Thanks again for this post. I’ve added your blog to my rss feeds!
I’m sorry that your pet is suffering from this awful disease. One of my own dogs died of hemangiosarcoma years ago, and it is truly devestating.
I am often surprised how comfortable even smart, well-trained, really excellent conventional vets are at mixing in totally baseless therapies with real medicine. I understand the sense of needing to do something, especially when there aren’t any really good options. But I agree that it is a bit misleading and unfair to our patients and clients who are under a lot of stress and looking to us for reliable guidance.
thanks for sharing your story. It’s a perspective we seldom get to hear.
@Pam – “I feel that perhaps I should lodge some kind of complaint, but I know that this vet was just trying to do something when faced with something so devastating, so I’ve decided to just let it go. But having false hopes dashed at this horrible time just adds to our pain.”
Pam, while it is absolutely none of my business to intrude on your personal situation and decisions, may I kindly ask, did you ask this oncologist for an alternative treatment method before he prescribed this? Did he offer an explanation why he felt this treatment would benefit your dog?
I certainly understand your reluctance to forge a complaint. Owners with terminally ill pets have more pressing matters to attend to (like doing whatever they can to help their pet and to enjoy whatever time may be left). However, if there was no reasonable disclosure or informed consent in this prescribing, you have every reason to be concerned and to forge a complaint. It can possibly help other owners from being swindled out of precious money that could be spent on something more useful (like pain medication to alleviate discomfort), and a misguided belief that such prescription is likely to help the patient at all. If we as pet owners (and vets) do not question efficacy of such treatments, then this only serves to allow these practitioners to practice at will and put a larger number of patients at risk (not to mention the propagation of unproven treatments).
Perhaps the oncologist was in fact, “trying to do something” in the face of hopelessness, but that does not mean his action or prescribing was ethical and of sound judgement. Our pets deserve much better than that (as to their owners).
My heart goes out to you, I hope you can form a reasonable approach with palliative care measures to help your treasured friend remain comfortable and treasure your time together.
I have read Skeptvet’s original post and every comment made here, in this blog. I’m not one who reads very quickly, so this took some time! Nevertheless, I agree with Skeptvet in that ALL it seems that (he?) is asking for is some real scientific proof , i.e. – real, peer-reviewed, evidence-based practice information about yunnan baiyao. And, no one who has responded so far seems to have possession or knowledge of any. Seems to me, ALL he is trying to say is that a vet should not recommend this sort of treatment without first disclosing the lack of scientific evidence and lack of clinical trials associated with this alternative therapy. He is not saying it does NOT work. He is not saying it CANNOT work. He merely spoke about the need for clinical trials. AND, the need for full disclosure about the actual ingredients. AND, the need for humble admissions of the possibility of harmful affects. AND, the need for disclosure of the exact mechanism through which this alternative therapy stops bleeding or how it produces its other types of (reported) seemingly magic results. I do not know whether it works or not – seems a lot of people have had good results – but we still need actual clinical trials. I feel (in my own humble, layman opinion) that Skeptvet has responded to every comment with logical, thought-provoking, investigation-worthy questions or suggestions.
Regarding mechanism, my immediate thought, as a curious nursing student and someone interested in biology and physiology, was – If this product works on platelet aggregation, then how, when taken orally, does it not affect the entire blood supply or body system, as a whole? How does it localize itself to the problem area (nasal bleeding)? Does it not expose the pet to possible unwanted clot formations and possible harm from emboli? There is probably a very simple answer to this, and I have only had several core biology and physiology classes in preparation for nursing school (which I just started 2 semesters ago), but I do not understand how it gets localized to stop the nasal bleeding, but does not, at the same time, cause unwanted blood clots in other places. I understand how, if put (in powder form) onto a bleeding area, topically, it could stop bleeding – like the Quik Stop product my vet used on my dog’s nail when she accidentally cut it to the quick. But how does it work systemically and not adversely affect the rest of the dog’s clotting/anti-clotting mechanisms? I am curious about this.
I came across this conversation because my dog has been experiencing sneezing fits with nosebleeds. And, I am not talking about a little nosebleeds – there is a lot of blood. My house looked like a crime scene the other day. Now, I am only a nursing student – not a vet or scientist or anything, really. I am just a dog-owner (or lover, since “owning” another living creature seems weird to me). And, someone on a Facebook page (Rudy’s Story-Canine Nasal Cancer) posted something about trying yunnan baiyao and, since I never just blindly try out others’ suggestions, I was doing research on it. As I’ve been taught so far in what little nurse schooling I’ve had thus far, always search out evidence-based practices.
With regard to my dog (12 yo), the vet has put her on a 21-day course of the antihistamine, hydroxyzine pamoate, to see if the sneezing stops – after about 11 days, it has not. Granted, the sneezes have not been accompanied by blood since taking the medicine, but that means nothing to me, since my dog will go months without the bloody noses. But, they always seem to return sooner or later. They have just been really bad, here lately (started over a year ago and have been intermittent). Anyway, she will also jump up from a seemingly dead sleep (or any other random quiet moment) and just start panting heavily, like she just got winded and is having trouble breathing. She also makes a snorting noise every now and then, but not often. She also paws at her face/nose sometimes like something is bothering her. The blood usually comes out of only one (left) nostril and I have also noticed recently that the eye on that same side always seems to be draining or have “junk” in it, when the right eye does not. She also always seems to have a runny nose (clear) on her left nostril, but I just thought that was part of the wet nose dogs always have. But now, I am trying to put all of this together and I don’t know what to think. I have NOT, however, noticed any outward appearance or evidence that any sort of subcutaneous tumors may be growing around her nose area, but then again, if she does have a tumor (not saying she does, just don’t know), then I guess it could be growing inward, instead of outward.
The vet said that if the antihistamine does not work with sneezing, we might want to have her nose looked at by a specialist, i.e. – put her under gen. anesthesia and have some sort of instrument placed up into the canal for further observation/biopsy, etc.
THEN, I noticed this word that was mentioned a lot in these posts – hemangiosarcoma. So, I looked that up and from some of the photos I was able to see, the ones on the skin look exactly like what my dog has a tendency to form. The spots I’m talking about look like normal, skin-colored growths at first (like warts or raised moles?), then over time, they somehow rupture and become blood-filled. She had one removed from her shoulder, which the vet removed. I thought maybe it just suddenly became bloody-looking because maybe she was running through the back yard woods and caught it on a tree limb. But now I see that those hemangiosarcomas can spontaneously rupture – which is what seemed to happen, out of the blue, that day when I took her to the vet and they removed it. Now, she has what looks like another of the same, on her leg. When I called the vet to see what the pathology report said about the one on the shoulder, they told me they did not send it off. I was shocked. I am not sure why they did not send it off to see what it was – that’s what we thought they were going to do – except that she did have a very large lipoma removed from her rib cage area once (and has since had several what appear to be more of the same spread around her body – underneath the skin – that I have not had removed) and maybe since the doctor said they are harmless, that is why they did not send it off, thinking it was another harmless growth. Anyway, now the growth on her leg (above the skin – like the one on her shoulder that was removed) is starting to bleed. But she can reach it, so I am wondering if it is just because she has chewed it. So, with the nose symptoms and the skin symptoms, I am wondering if she has this hemangiosarcoma. But, since she has been experiencing these symptoms for a long time and since it is reportedly such an aggressive, high-grade soft-tissue sarcoma, it seems it would be quite evident by now if she had this. But, on the other hand, I did read that not all dogs who have it will develop metastatic disease. (sorry – about all of the “buts” and the “on the other hands” – I guess I am just playing Devil’s Advocate here in real time, as I type).
Again, I am not a scientist or vet or anything, really, and I am sorry to intrude on this very interesting, scientific, sophisticated discussion with my layman (probably silly) comments / questions. But, I am wondering if Skeptvet can help to drive me down the right road as to what types of tests I should pursue with my dog (given everything I have described) and what types of questions I should be asking of my vet. Thank you. (Sorry this is so long).
There is also a pdf document out there called “Yunnan Baiyao-Where’s the Clinical Evidence?” which is recommended by this website (http://www.dogcancerblog.com/chinese-herb-for-bleeding-dog-cancers/), but I cannot get it to open and cannot read it. You may have already made reference to this particular article, though, and I just missed it. (just fyi)
Hemangiosarcoma is a pretty rapidly progressive and aggressive cancer, so if the symptoms have been going on for longer than a couple of months, that seems unlikley. However, other nasal tumors, fungal infetcions, and a variety of other diseases in the nose can cause similar symptoms. The specific list of possible causes and the order or liklihood for them depends on the details of the patient (age, breed, activisities, other symptoms, etc), the area the patient lives in (some diseases only occur in certain areas) and lots of other factors.
I can’t, of course, help figure this out for your pet specifically, but in general most of the diseases that cause significant bleeding from the nose will require a rhinoscopy (that is, putting a camera in the nose) to take a look and obtain biopsy and culture samples. So based on the specific of your situation, at some point your vet will likely recommend this. They may or may not have the equipment and expertise to do the procedure (often general practitioners refer to a specialist or the nearest vet school for this, depending on where you live), so you might want to ask about where you could have this done if you reach the point where you and your vet think it’s appropriate.
Perhaps the most important thing is that you and your vet have good communication and that you feel comfortable your questions are being answered. I always suggest seeking another opinion if you are at ll uncertain since a differene in personality or communication style can be a real problem and can delay proper care even if you have an otherwise great vet.
Kat, in addition to skeptvet’s excellent advice, I would ask your vet about the lipomas, as lipomas can become infected or irritated and cause bleeding – this could be a simple rule-out when exploring diagnostics. An FNA (fine needle aspirate) can be used to give a better idea if it is a harmless lipoma – sometimes, when they become infected or irritated (in a location the dog can easily lick at), removal of the lipoma is an option. If the FNA isn’t conclusive, then your vet would most likely suggest biopsy.
That said, skeptvet’s advice is right on. If medications have been given to your dog in the course of a year with no resolve, it might be time to explore further (rhinoscopy).
Here’s wishing you much luck and success with this.