Last fall, I wrote about the American Holistic Veterinary Medical Foundation (AHVMF), an offshoot of the American Holistic Veterinary Medical Association (AHVMA), which is devoted to raising money for the promotion of alternative therapies. The AHVMA is a vigorous advocate of unproven and outright bogus therapies, and I have frequently discussed their activities. From the annual “scientific” meeting that includes promotion of ridiculous pseudoscience on the dime of herb and dietary supplement companies to its vigorous defense of homeopathy, the AHVMA has demonstrated a commitment to the standard of no standards when it comes to veterinary therapies. Despite lip service paid to science and free use of the language of evidence-based medicine, the organization is clearly an advocate for any and all therapies under the broad, essentially ideological label of complementary and alternative veterinary medicine (CAVM).
So while the AHVMF also talks about supporting legitimate scientific research, I have some skepticism about such claims. The parent organization, and many of the individuals involved in the AHVMF, have clearly demonstrate that they are unwilling to reject CAVM therapies even when they are inconsistent with established scientific knowledge or the results of scientific research. My suspicion (and I would certainly be pleased to be wrong here), is that the AHVMF is purely a marketing effort, aimed at promoting what its members already believe rather than finding the truth, and an attempt to create the impression of scientific and institutional legitimacy for therapies that have not been able to achieve these on the strength of the evidence for their effectiveness. A recent article on the AHVMF blog appears to support this interpretation.
The Veterinary School at the University of Tennessee recently received a $10,000 grant from the American Holistic Veterinary Medical Foundation to support “integrative medicine.” The faculty member who runs the Integrative Medicine Center at UT has written a blog post for the AHVMF which illustrates very clearly the goals of this effort.
These goals do not appear to be focused on supporting research to identify which CAVM therapies are actually effective. They appear to be more about pursuing a marketing strategy for bringing CAVM therapies into acceptance within the mainstream by making them more familiar, part of the veterinary curriculum, and something that everyone can see works “with their own eyes,” despite the absence of controlled research support or the existence of negative research data. This is pure proselytizing rather than research. For example:
I remember breaking ground for my own hospital, offering alternative veterinary medicine. It was exciting, but there was something missing. I was alone in my work so I dreamed I could turn my hospital into a center to bring in other alternative veterinarians to do lectures. I wanted to share this new knowledge…the clients heard me, but no one else
…My voice was not any louder, when I left my practice, to start an Integrative Medicine service at The University of Tennessee College of Veterinary Medicine. I worked the service knowing the clients would come, but I would smile quietly when I heard, “Why is Integrative Medicine seeing this case” while my neurologic patient was awaiting an MRI.
[When we achieved full faculty status,] I reached out to tell someone that would understand what this appointment meant and my voice was heard by the AHVM Foundation. Now it is time for all of us to reach out and be heard; the foundation is our voice. And for clients who have experienced alternative care, a vested veterinarian, we need to encourage them to support our Foundation
.…as full faculty at a veterinary teaching hospital, we have brought the Foundation here. We have students on our service being exposed to integrative veterinary care. We provide that comprehensive care to many of the faculty’s own furry pets; therefore, we are educating the educators. We are working to gather funds to launch an Integrative Medicine Fellowship, with the university’s mark and the Foundations support. We have Dean approval and are outlining the Fellowship program for maximum impact; we will need funding to make this happen
.…this is our opportunity to bring into the conventional veterinary medicine forum, another black bag: integrative veterinary medicine. I am overwhelmed with what the Foundation has done to date and the goals we have outlined going forward.
The article also illustrates how holistic medicine is so often promoted–not on the basis of evidence, of which there is usually little to none, but as a kinder and gentler and more hopeful approach than science-based medicine. Regardless of how one feels about acupuncture, chiropractic, Chinese Medicine, etc., I wonder how conventional veterinarians are expected to feel about this characterization of what holistic medicine is and what, presumably, conventional medicine is not:
I now realize is that what makes holistic and veterinarians different is not just our type of treatment, but how we approach our patient. In the integrative health movement we are constantly seeking therapies and approaches that are outside the box of conventional veterinary medicine. And for various reasons we need access to these therapies as many of our patients have failed to respond to standard approaches. They come to us with hope of finding help not available elsewhere.
…we approach with a lot of thoughtfulness, gentle treatment plans, and a lot of caring. We are vested in our patients. And once you become a vested, willing to travel a different path to investigate all the options, there is no turning back.
It’s nice to know that when we emotionally detached doctors who are stuck on the whole science thing have given up on our patients, at least they have someone caring to go to who is willing to try almost anything regardless of the absence of anything as pointless as evidence of safety or efficacy.
The infiltration of unproven, or disproven, alternative therapies into legitimate teaching and research hospitals, largely driven by the irresistible allure of funding for research and faculty contingent on a friendly approach to such therapies, has been dubbed “quackademic medicine,” and it represents a real threat to the well-being of patients.
The diversion of scarce resources to research on implausible or already disproven therapies when this research will never discourage advocates from using them regardless of the results impedes real progress in developing better treatments. The perception that such therapies must be legitimate and demonstrably safe and effective (otherwise, why would universities allow teaching and using them in academic hospitals?) creates a false impression of the evidence concerning these therapies and of their value. And despite claims to the contrary, inadequately tested CAVM therapies can directly harm patients. And the integration of unproven methods with science-based medicine can decrease quality of life and survival for patients with serious illnesses.
For all of these reasons, it is unfortunate that the strategy of promoting the integration of unproven or pseudoscientific therapies with legitimate science-based medicine at academic medical centers has reached the veterinary profession. The money this brings to the institutions involved will only harm the profession and our patients if, as seems likely, it is used to promote CAVM rather than conduct legitimate research that will separate the useful from the useless. Such funds would be better spent supporting independent research involving not only dedicated advocates of CAVM but neutral and skeptical researchers with a commitment to rigorous methodological quality and no pre-existing commitment to a particular outcome. Establishing centers to integrate CAVM therapies with conventional medicine when these therapies have not yet demonstrated they are safe and effective is premature and diminishes the integrity of veterinary medicine and is not in the best interests of our clients or our patients.
So what can be done to counteract the ‘infiltration’? If deans and the boards are willing to accept it, then what?
And what about the students, they must be saved! 🙂
And what about the poor human clients, who find it ever more difficult to get away from all the nonsense so as to get a proper diagnosis and clear treatment guidelines for our charges?
So what can be done to counteract the ‘infiltration’? >>>>
I have given that a lot of thought. When I am confused and looking for answers in the veterinary profession I turn to human medicine to see what’s up there to try and understand a medical issue. I see a solution.Change the laws so groups of doctors can kick groups like the chiropractors out of their offices. The md’s are not allowed to do this under current restraint of trade law. Let the veterinarian crack the backs of their patients but do not call them a Dvm or let me group together with other vets who do not want to crack backs and call us something besides a Dvm. This worked for the MD when the group split off from other doctor degrees in the USA.
Art Malernee Dvm
Fla Lic 1820
Absolutely! I’m working on a piece right now about the ethics of referring people to CAM providers. We have a responsibility as doctors to provide recommendations according to established standards of evidence. Basing our own practices, or sending clients to people who bas theirs on personal experience, ancient tradition, or the other evidentiary pillars of faith-based medicine is unethical.
Well, money always speaks loudly, so I’m a bit pessimistic about the ability of proponents of science-based medicine to combat this. This grant alone is more than the entire annual budget for many pro-EBM associations, so we can’t compete directly in a marketing war.
I think it is vital that individual doctors, especially respected faculty at these universities, directly address the problems with the theories and evidence-base for CAVM therapies. If students only get glowing and slanted narratives from CAVM practitioners, and uncontrolled clinical experiences which will inevitably generate a positive impression for these therapies whether they work or not, then they will assume this stuff is legitimate regardless of the balance of the real evidence. However, it only takes a little effort to show that the claims for CAVM don’t stand up well to critical thinking, and that most academic veterinarians aren’t convinced by the shoddy evidence that most of these methods can muster. Sadly, it seems culturally acceptable, even laudable, to promote bogus or unproven therapies while there is an unspoken taboo against criticizing the claims or practices of other veterinarians, so few individuals are willing to draw the anger of their peers by expressing their skepticism openly.
On the positive side, there isn’t much substitute for true clinical efficacy, and the rise of science-based medicine to dominance hasn’t been an accident or a mere cultural process. Science works better than pseudoscience, so pseudoscience, while it will never go away, will always be a bit player in the story of medicine.
Bit of anecdote here, but I imagine it’s typical. (Speaking of the situation here in Spain, of course). What I find with the CAM-recommending vets is a sort of laissez-faire attitude: life is tougher these days than it was for young vets say 20 years ago: the economic crisis has meant that a shortage of jobs has coincided with a flood of graduates who “went in for it” under happier financial auspices and many who would have set up their own practices have, instead, to work for bosses – sometimes chains of consulting practices owned and operated by a central team – and I get the impression that:
a) the training/degree/practice process has not been so rigorous as it might have been (especially in terms of critical thought &/or ethics – again, economic circumstances force vets to work against the interests of their patients and for the interests of their paying clients very often, notably so in horse work, I should say).
b) and related to (a) some young vets are thoroughly steeped in the ideas current in society in general that “natural” alternatives work and, perhaps more importantly, are what the paying public wants to hear about, to the extent that these are the first port of call for many. (a) & (b) together produce this lackadaisical, “give the customer what they want” attitude: there is resentment at working for others’ benefit (a lot of these “chain” practices are quite abusive of their workers, I think) and a perception that the customer wants something “alternative” – many produce anecdotes of their own about having used aloe vera or whatever it is with great success in their own/other patients’ cases – and a fear that customers will be turned off by “big pharma”.
More rigour, both intellectual and in selectivity on the part of the Univerisities seems the only way to tackle all this and a reinforcement of professionality in the process. I know it is the case that architects’ and lawyers’ professional bodies are doing nothing to protect their younger members from ruthless exploitation in practice positions, internships etc (in deed, posts with abusive conditions are actually advertised by these bodies): perhaps vets are in a similar position and the professional body needs to look to its own ethics in this respect?
http://en.wikipedia.org/wiki/Wilk_v._American_Medical_Association
@Rita
Interesting comments, Rita (and I mean that). You give the impression that new grads in your neck of the world have given up or capitulated to the path of least resistance (i.e. going woo), simply because the proverbial pot of gold was not readily available upon their entry into the profession. And, if such is the case, it is a sad precedence for our profession. I don’t remember my career ever being easy. And, yes, I was essentially used and abused in my early years but was of the clear understanding that such was a rite of passage that all medical practitioners must endure. It was a learning experience that simply made me a better doctor. At no time did I lose sight of my goals or forget the tenets of the science I worked so very hard to learn, despite the contempt I sometimes held for my superiors.
As far as today’s lackadaisical attitudes and perceived half-hearted approach to science based medicine, I see them as a function of our time. The times, they are a changin. Not all but many graduates in the U.S. no longer envision owning a practice or dedicating their every waking hour to a life of medicine. They’re more content to put in their limited hours, reference the 5-Minute-Vet, collect a grandiose paycheck and concentrate on what to do in their free time. And, with that, they seem more likely to embrace the “I hug dogs” mentality and, yes, bend over backwards to appease their clients for the purpose of being liked. Because, as the Cancer Treatment Centers of America duly note, customer satisfaction is important.
But, regardless of one’s angst, frustration, pursuit of balance, desperation to be liked or age, I fail to understand how the established facts of science – that we all learned in our respective accredited schools of veterinary medicine – can simply be forgotten. Did clinical pathology do nothing for those people? Was nothing driven home? Were clinical rotations not the most incredible, titillating, mind-awakening/numbing, information-saturated experiences of our respective professional lives? Did they not mold our futures? How could one forsake all that was learned and default to the stupefying illogic of woo? To hell with society’s ideas of the natural fallacy; why would anyone trade knowledge and fact for fallacy and ignorance? Or, to paraphrase the genius of Pink Floyd, “[why would] you exchange a walk on part in the war, for a lead role in a cage?”
For once, I think I agree with Art’s comment: there should be recognized science-based DVM’s; and, then, there should be separate, not-so-recognized, quasi-DVM’s. That ought to do it.
Yes, an actual division might be a good idea: btw: here is an article which suggests that these problems are not only in the non-human medical profession: interesting that doctors fall back on “I’ve had great success with this myself/other patients” when pushing placebos. http://www.cbc.ca/news/health/story/2013/03/21/placebo-effect.html
I wonder if placebos are given to Munchausen patients….that would really be moving into uncharted realms!
No question that the future of CAVM is in the vet schools. That’s why AHVMF is raising and giving all that money to vet schools here in the U.S. If they can convey the impression that this stuff is widely accepted and legitimate, or even “cutting edge,” people will be more likely to sell it once they are in practice.
I remember the moment I realized that clinicians aren’t really scientists, and we aren’t trained think scientifically despite relying heavily on knowledge gained from scientific research to do our jobs. If we want truly evidence-based, science-based veterinary medicine, we have to train vet students in what science is, how it works, and why it is a better way of getting at the truth than the less structured alternatives. If we train students in a mentor/apprentice model to simply imbibe and regurgitate the beliefs of their mentors, then of course it will seem appropriate to them to validate CAM therapies through anecdote, tradition, and the opinions of respected older practitioners.
Hit the nail smack on the head there!
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A lot of interesting information from both “sides”. Now I know who Plechner is so that I can make judgements on his efficacy. I need to know who wrote this critical, interesting article so that I can do the same for him or her. (need to make sure it’s not one of Plechner’s old girlfriends).
Who, meaning a name with credentials, wrote this article?
I am not “pro Plechner” nor “pro natural”. I am pro knowing.
I wonder if knowing who Plechner is really adds much useful information to evaluating his claims. Are they more likely to be true if he is a Nobel prize winning scientist, a vet, or a janitor? Are my critiques somehow more or less accurate based on who I am, or should the arguments and evidence be evaluated on their own merits, unbiased by our preconceptions about the people making them?
In any case, the FAQ for the blog addresses your question, so I would look there.