The leadership of the American Veterinary Medical Asociation (AVMA) has recommended the House of Delegates (HoD) reject a resolution discouraging the use of ineffective therapies and identifying homeopathy as ineffective. While not disputing that there is no clinical evidence to support any benefit from homeopathy, the leadership does not want the organization to get involved in evaluating or discouraging any veterinary therapy.
The case for this position begins with a positive statement about the role of science in veterinary medicine:
The AVMA believes that scientific discovery is critically important for the continual evolution of clinical practice and should be the basis for the development of public policy in veterinary medicine, public health, agriculture, food safety and the environment.
It is the role of the scientific community to engage in high-quality research and publish their findings in the scientific literature. Clinical practitioners must critically review the literature to determine the best practice for their patients; this is the model for evidence-based medicine. These standards are, of course, constantly evolving and should be the subject of vigorous debate.
It is encouraging to see the AVMA indicate that science, and critical evaluation of scientific research, should be the standard by which veterinary therapies are judged, and to acknowledge the role of evidence-based medicine. It is unfortunate that the organization has not been willing to make such an assertion in the policy concerning complementary and alternative medicine, and that there has been little public support for the centrality of science and scientific research in validating veterinary therapies.
However, part of the reluctance to make such a public statement may stem from the inevitable inconsistency that arises when the organization then refuses to discourage therapies that are inconsistent with science and science-based medicine. The AVMA has acknwledged the overwhelming case against homeopathy and admitted that “there is no clinical evidence to support the use of homeopathic remedies for treatment or prevention of diseases in domestic animals.” So if scientific research should be the basis of veterinary medicine, and if after 150 years of study there is no scientific research the convincingly demonstrates the value of homeopathy, why shouldn’t the AVMA acknowledge this method is a failure and that veterinarians shouldn’t be inflicting it on their patients? The AVMA answers this question with a classic slippery slope argument:
There is a role for professional organizations to convene experts to review the scientific literature on broad subjects, and to develop evidence-based guidance for developing policy. However, as the board of the national organization for the veterinary medical profession, the AVMA must ask itself whether it is the proper arbiter of specific clinical practices. Furthermore, the Executive Board must ask itself whether going down the path of reviewing and judging particular clinical therapies, whether traditional or alternative/complementary, will be supportive of our mission or divisive in our community.
Where does it stop? Consider the wide range of current medical and surgical interventions that could be adjudicated by the AVMA, many of which have varying and conflicting levels of scientific evidence. Popular practices, over time, often turn out to be ineffective, or even harmful.
The claim here is that while organizations like the AVMA should see establishing evidence-based guidelines as part of their mission, they should not challenge the validity of specific clinical approaches because it would be “divisive” and becasue there are a lot of practices they might end up being asked to evaluate.
The first part of this claim is simply a reflection of the fundamentally political nature of the AVMA. The organization exists, of course, to serve the needs of verterinarians, as a lobbying and marketing entity. The needs of veterinary patients and their owners are not a central priority for a professional lobby. This is fair enough so long as the AVMA does not portray itself as serving the larger public. The mission and objective statements of the organization are vague, and open to interpetation in this respect.
Mission Statement
The mission of the Association is to improve animal and human health and advance the veterinary medical profession.
Objective
The objective of the Association shall be to advance the science and art of veterinary medicine, including its relationship to public health, biological science, and agriculture.
It seems that improving animal health and advancing the science of veterinary medicine could legitimately include discouraging ineffective therapies left over from the days when bloodletting was the chief tool of mainstream medicine. But there is no question that challenging any therapy supported by more than a few veterinarians would be divisive and alienate some part of the AVMA’s constituency. The reluctance to do this is understandable for a membership-based professional lobby, but it does reinforce that the public cannot look to the AVMA as an advocate for their interests or the interests of their animals. When member veterinarians encourage the AVMA to take controversial positions on animal welfare issues, including discouraging pseudoscientific practcies like homeopathy, this challenges the core mission of the group, and so resistance is to be expected.
The slippery slope claim, however, is less convincing. There is quite a large window of opportunity for positive action between tolerating any and all therapies veterinarians wish to employ and micromanaging every clinical practice. A general statement that science and evidence-based medicine should be the foundation for veterinary practice, and specific policies discouraging egregiously and ridiculously pseudoscientific practices like homeopathy, does not commit the AVMA to evaluate every single medical practice available.
The question “Where does it stop?” cuts both ways. The choice the leadership has made not to take a position on any therapy no matter how inconsistent with science-based medicine, is just as extreme as the imaginary problem of having to investigate and rule on every possible therapy. I have heard veterinarians who rely on psychics to guide their patient care, who use astrology to help choose the timing of surgical procedures, who actively discourage the use of vaccines and all other conventional therapies, and who employ other similarly indefensible practcies even more irrational than homeopathy. Is anything a veterinarian wishes to do to a patient, any practice they choose to sell which is not illegal, acceptable? Does the profession, and its most influential organization in the United States, have no responsibility to set standards for patient care or honest informed consent? It seems we have already slid quite a ways down the slippery slope towards medical anarchy and a complete lack of reasonable standards if even something as clearly contrary to established science as homeopathy must be protected from even a purely advisory, non-binding public censure.
The leadership’s statement concludes with assertion that they are taking no position at all on homeopathy by recommending the House of Delegates reject a statement against it
For the AVMA not to condemn homeopathy should not presume endorsement; it simply means that we trust our system of research, practice, teaching and continuing education to sort through the evidence and determine appropriate therapies.
It is disingenuous to suggest that the AVMA leadership can actively oppose a policy identifying homeopathy as ineffective and still claim to be neutral on the practice. To refuse to inform the public of the state of the evidence against homeopathy is certainly to facilitate its continued use, and to put the unity of the veterinary profession above any commitment to a scientifc basis for veterinary medicine or the interests of patients and owners. Though the political realities that inform this position are understandable, it is still choosing sides, and it is still in conflict with the purported belief that science should be the foundation of veterinary medicine.
The leadership claims that we can trust the system to sort out legitimate medical therapies from pseudoscientific nonsense. To a certain extent this is true. The process of scientific investigation can give us reliable information about the value of specific therapies. In the case of homeopathy, over a century of extensive research has been conducted. Most of it is poorly done and highly biased towards demonstrating what the homeopaths conducting the research already believe. However, the better the methodological controls for such bias are, the less likely one is to find any effect, and the balance of the evidence is against any clinical benefit. Combined with the fundamental inconsistency of homeopathic theory with basic principles of established science, the system has rendered a verdict, and that verdict clearly identifies homeopathy as nothing more than a placebo for owners and veterinarians, not an effective therapy for veterinary patients.
The vast majority of the veterinary profession has accepted this verdict and left homeopathy behind, along with many other mainstream and alternative practices of the 18th and 19th centuries. Unfortunately, some veterinarians refuse to acknowledge reality, and they continue to mislead animal owners into believing homeopathy has value. It seems that the system has failed these patients and these owners, and the AVMA could choose to take a stand for science and for our patients and clients by providing a clear statement that homeopathy is not consistent with scientific medicine. This would not make homeopathy illegal or unavailable, or limit anyone’s choice of therapies. It would simply inform the public that the mainstream veterinary profession, committed to science as the foundation of medical care, recognizes homeopathy as a pseudoscientific relic of history and does not support its continued use.
It seems unlikely that the organization will do so in the face of the opposition of senior leaders. While this is disappointing, it is not entirely surprising. And it at least serves the interests of the public that this debate has happened and that the positions staked out by various parties, along with their rationales and evidence, are clearly and publically visible.
Urrgh. ‘Slippery slope’ is such a weak reason for not making a clear statement. If the countries that permits limited and controlled euthanasia can manage to avoid the ‘slippery slope to killing all old people’ it shouldn’t be beyond the wit of the AVMA to define areas where they should assess supposed therapies.
The AVMA may be taking a defensive stand by not making an outright condemnation of Homeopathy, and other scientifically unsubstantiated treatment modialities. To openly and categorically discredit the efficacy of such practices for lack of scientific proof of efficacy would seem to be an invitation to ‘court’ to prove the contention. Failure to provide such proof via ‘scientific evaluation’ as defined by the AVMA, would tend to support the opposition’s claims, unfortunately. All logical thinking people recognize the impossibility to ‘prove’ a negative proposition (that something does NOT exist), other than by demonstrating EVERY conceivable search failed or will fail, every time tried, everywhere, whether known about, or not, past, present, or in the future! Anything less is still supposition, or could be argued in court.
After all, is it not the inherant right of a free population to pursue whatever legal means available to achieve its desired result, with no guarantees of success… or failure? According to the AVMA’s Mission Statement, “…to improve…and advance the veterinary profession”, simply stating publically that it does not RECOGNIZE the claimed effectiveness of these questionable treatment philosophies would seem to advance that goal. Or at least not detract from it, as a weak or noncommittal comment does.
‘Alternative therapies’ is simply an implicit endorsement of such non- or sub-standard veterinary practices…which have resulted in the public perception of a new veterinary clinic as less than up to date, or even full service, unless it also provides chiropractic, homeopathic, and other even less organized philosophies of practice.
I hazard a guess that few, if any, state veterinary medical examining boards recognize a chiropractic education as compatible enough with a veterinary education to license either as such, but here we are… using chiropractic practices on animals in our vet practices. Granted, increasingly, the practitioners have degrees in both professions, but it has not always been so. Why is that so? I suspect because it would be considered ‘practicing without a license’ to do otherwise. But, condoning such alternatives would seem to fall within that category. A degree in vet medicine has more similarities to human medicine than, say, chiropractic and veterinary. Yet we now have chiropractic therapies applied to both animal and human clients. What could possibly be next…Government medicine for everything? No…never happen…! ?
I’m afraid I don’t find the fear of litigation a convincing reason to avoid taking a position on homeopathy. The AVMA is a private, membership organization, not a government agency, and as such is entitled to advocate freely for whatever position it pleases. It does take positions on all sorts of animal welfare issues, and certainly campaigns aggressively against any therapy performed by non-veterinarians that could possibly be seen as a threat to the income or prerogatives of vets.
And when the homeopaths have tried suing other organizations (such as the Association of Veterinary State Boards), the courts have ruled against them.
As for people’s freedom to make bad healthcare choices for their pets, that is not infringed in any way by the AVMA informing the public that homeopathy is useless. Again, the AVMA is not a government agency and has no binding authority over what veterinarians do. It can encourage or discourage any practice it likes, and animal owners are still free to seek those practices out. Other similar organizations, notably in Australia and Europe, have publically acknowledged that homeopathy is unscientific and no more effective than placebo. Presumably, these groups feel more of a commitment to the welfare of patients and the rights of animal owners not to be deceived, even if it is by licensed veterinarians offering legal quack therapies.
Other associations, in Australia and Europe, have taken science-based positions against quack therapies.
Something not brought up often, although skeptvet has brought it to attention on occasion here, is that pet-owners are already deceived on many levels. For example, many believe that the AVMA has some sort of governing authority over the profession. When they see position statements, mission statements or guidelines and acts, they tend to take them seriously. When the AVMA represents the veterinary profession and does not take a strong stance against a completely useless so-called therapy that has every potential for harm (by delaying proper and effective medical care), they are doing the organization, the profession, vets, pet owners and pets a huge disservice. When they hem-haw a position (such as homeopathy), they pretty much give it some level of legitimacy and it only serves to cause confusion among the profession and their clients, and gives full leeway for the quacks to take advantage. Medicine disregards that which is ineffective or proven harmful, in favor of safer and more effective medicine – why should veterinary medicine be any different?
This is just a small part of a larger problem, which is the widening trust deficit between the general public–who have limited and varying degrees of education and scientific understanding–and the medical establishment. Firstly, most people, including doctors and scientists, have a hard time intuitively understanding and interpreting statistics. Everyone has had the experience of a doctor or vet telling them something that sounds completely self contradictory, or just turns out to be wrong. The pharmaceutical companies have repeatedly violated the public trust by covering up mistakes, fudging research, lobbying government, and price gouging. The very fact that pharma advertises to the public causes huge numbers of people to distrust the industry out of hand. Even doctors themselves recognize that sales reps and industry sponsored “education” are problematic. Add medical mistakes, hospital acquired infections, insurance scams, and rampant upselling. When the AMA and physicians lobby government to prevent laws that would protect patients from predatory billing, as happened recently in California, a few more people are turned against science based medicine. Everyone knows there are HUGE amounts of money at play here, and that money impacts supposedly “science” based decisions and policies. Every news cycle includes some health recommendation that flies in the face of the previous recommendation–cholesterol, fats, antioxidants, on and on. Unfortunately, the medical establishment has done a massive amount of self inflicted harm to it’s own credibility, while simultaneously dismissing any other approaches to healing, so physicians and vets shouldn’t be surprised when their advice is sometimes met with cynical skepticism. Worse, this ends up undermining the public’s trust in science overall, which sets up a dangerous political climate for dealing with larger issues like public health, healthcare policy, research funding, climate change, etc..
I don’t disagree with the problems you mention, but it’s a bit one-sided. The public distrust of science goes well beyond medicine or anything justified by mistakes or malfeasance on the part of doctors and others in the biomedical field. People fail to understand climate science, new developments in agricultural science, such as GMOs, and even such well-established concepts as evolution. There are cultural factors, factors related to our educational system, the influence of religious belief, and many other variables that cause people to mistrust and misunderstand science, so simply blaming scientists is oversimplifying.
As for the apparent swings in recommendations, that is not a good example of a problem with science but a problem with perception. Scientists usually make small, measured statements about new research findings which the media turns into revolutionary discoveries which the public then laps up as panaceas so they won’t have to eat less and exercise more, and then when science refines its understanding people see it as some kind of haphazard or willy-nilly swing in opinion because they don’t understand the process and are fed an entertainment-centered version of it by the media.