I’ve written several times about how proponents of alternative therapies appear to view science and evidence-based medicine. (1, 2, 3) I think it is critical in evaluating these practices, as pet owners or veterinarians, to understand the philosophy and approach behind them. Alternative medicine advocates will frequently talk about their respect for science, and will laud studies that appear to support their claims. But in many cases, they are fundamentally not convinced that science is superior to personal experience or faith as a method of evaluating medical therapies, and they are virtually never willing to abandon a practice they believe they have seen work no matter how clear the evidence against it is. If people wish to apply such practices, of course they are free to make that choice. But they should be fully and honestly informed when they are being asked to choose belief and opinion over science and evidence.
The following are comments veterinarians who are advocates for alternative veterinary therapies and critics of conventional medicine. These illustrate some of the views that should concern those of us committed to a scientific approach to evaluating the treatments we use for our patients and animal companions. I will be adding to this collection of comments over time, just to have examples available of the kinds of misconceptions those of us committed to a science-based approach to medicine need to address in our efforts to educate and to promote evidence-based medicine.
Evidence-based Medicine
“Remember evidence based science is last to know.”
“#AHVMF strongly supports scientific process, but in seeking real answers we recognize that scientific practice is last to know. #pioneers”
“Since evidence based medicine can’t know what hasn’t been studied, a false separation of proven vs unexamined data fields arises.”
“Evidence based medicine is being miss used according to its creators. It was about integrative informed decision processes.”
“The evidence said the case would die, the people felt otherwise. They tried, they lived, they danced together & finally all died. Life! :-)”
“Evidence should inform decision making but not limit treatment options. Combining experience and evidence is called evidence based practice, an excellent model for advancing veterinary care in areas with less evidence. Patients need access to all options and guardians and clinicians want to know.”
Placebo
“At the root a healing from placebo IS real healing from the person. How do we improve self healing? Can we align w/ Nature simply powerfully.”
“Perhaps love is the basis of placebo. In that case let’s fill the world and to hell with the research. Ascendant mindfulness finds healing.”
Anecdotes/Stories
“Stories have an important place in discovery of new approaches and therapies in medicine. No cure? Find the stories and follow those paths.”
“Narrative medicine allows the telling of a story, the discovery of truth, its sharing and consequences. Help write a happy ending.”
Leading integrative veterinarian Richard Palmquist will describe how he went from skeptic to champion of integrative veterinary medicine through witnessing miraculous outcomes from integrative approaches, after conventional options were exhausted.
“I suggested we apply a dose of Caulophyllum 30c…about 45 minutes later a live calf was eased into the world.
I readily accept this is not a scientific experiment that would satisfy the cynically minded, but when one saw this repeatedly over a period of 15 years it held much greater sway for us than any scientific experiment.”
“As a veterinarian now practicing homeopathy and chiropractic almost exclusively, I have all the proof I need every day in my practice to justify these modalities.”
Science
“It might take science >100-1000 years to categorize and understand some basic healing principles. Pioneers go first, science comes later.”
“#RealSearch is actual scientific pursuit of truth without interference in design or reporting of data. It seeks causal discovery. Support it. We don’t look because we believe, we believe because we have seen so many people and animals benefit from integrative therapies. Did you know the word believe means we find truth in or feel affection for an area? It’s an interesting word when we consider its origin. When we find something true, we love. When we love we find truth. These go hand in hand with healing, too. First we look, then we test, then we believe. THEN we LIVE. BE LIVE!”
“Universities exist to provide a circle for the exploration & perfection of love. At their core each subject, each expert is examining this.”
“Pearls of wisdom handed down through the generations, scientific studies, and Chinese terminology bring together knowledge that is most certainly true. Modern science and the trend toward evidence based medicine has many pitfalls, whereas the “tried and true” passed through centuries holds as much truth for me.”
“Science is powerful and wonderful and so important. We must not lose ourselves in the game of science while ignoring healing.”
Alternative Medicine
“Holistic medicine addresses the patient as a whole – body, mind, and SPIRIT. There is a level of reality beyond, and yet enmeshed in, the physical, material universe. If I did not have an appreciation of the spiritual aspects of my patients and their caregivers, they and I would become little more than robots.
Don’t settle for treatment by a robot.”
“There is evidence-based research that holistic medicine works, but many people are quick to dismiss it because the studies are not funded by pharmaceutical companies,” she says, “the research is there if people would just do it.”
“If your veterinarian (or medical doctor for that matter) is relying strictly on published medical information for his prescribed treatment options, then his therapy will be 90% flawed. In other words, he will get it right 10% of the time.”
“Lack of ‘adequate’ research is why alternative medicine is considered alternative and is excluded from EBM. This lack of “evidence” is also an excuse for the rejection and criticism of many helpful alternative therapies by well-meaning, conventional practitioners. This attitude may lead your veterinarian astray.”
“Critics of homeopathy like to throw up the term “evidence based medicine”, as if to suggest that pharmaceutical drugs are more scientifically arrived at. If they are evidence based, why are they always being withdrawn after causing injury and death? Let’s explore the actual evidence.
Bottom line: Drug companies commit fraud in drug testing, lie about drug effectiveness and safety, publish positive articles in peer reviewed journals and then sell those drugs to the public. The FDA redacts the wrong doing from their reports.
Now you know…. pharmaceutical drugs are NOT evidence based… period.”
“How does acupuncture work? We know that it does work from thousands of years of experience.”
“Traditional Chinese Veterinary Medicine (TVCM) has been used in China for about 3000 years. Originally the practice was handed down from father to son and you were only paid if you made your patient well. So you either got good at it or your family line died out. “
“Holistic practitioners believe that vital life energy is the most important factor in the health of the patient…Because medical science has defined itself on a strictly physical basis, it is true that vitalism is unscientific. By definition, vitalism embraces a concept about a nonphysical force that can never be understood within the current scientific, medical paradigm.”
The thing is, people who want to believe all that non-science will find not a single thing wrong with the quotes you posted. In fact, they’ll use them to prove their beliefs were right all along.
Not only do they not care about actual science, they don’t even care to learn more than they think they already know. Cognitive dissonance at its finest.
As someone in the animal rescue world, you would not believe the massive amount of fake “holistic” snake oil salesmen/women out there. Daily I see fraud push “natural” kennel cough cures, herbal remedies to cure torn ACLs in dogs without surgery, even ridiculous ways to “detox” dogs from “over-vaccination”. It’s sad that so many buy into the flat out lies.
Sure, the true believers aren’t going to be disturbed by these comments because, after all, that’s who’s making them. But there is a large majority of vets and pet owners who don’t have opinions about this stuff and who can easily be misled into thinking it is compatible with science-based medicine based on the more mainstream rhetoric these folks often employ. The intent here is simply to make available some insights into an underlying attitude that CAVM promoters often obscure in the interest of more effective marketing or their practices.
Totally agree. I’ve stopped trying to convince people. I just put the true information out there and if they choose not to accept scientific fact and instead want to cling to beliefs and anecdotes, well… I can’t do much about that.
The hypocrisy, irony and downright stupidity of those comments makes me literally ill. Worse, that reasonable human beings fall for it. Unconscionable that those same human beings are so willing to, without question or thought, apply unproven and worthless treatments to their children and pets.
What’s perplexing is that these are people who have trained in one of the most rigorous scientific careers that there are. Think of how difficult it is to get into vet college and how hard vet students have to study. If once they qualify they can’t analyse and think scientifically, what hope for the rest of us? One for psychological research, I think.
No defense of those who are oblivious to evidence . . . where it exists.
But certainly, you must concede, it’s often hard to find good evidence, particularly for the big questions. As for Joe Public, who will have to pay to access veterinary journals, and probably won’t understand many articles if he can access them, he’s pretty much dependent on a veterinarian . . . and what fraction of vets actually keep up with the literature? what fraction have a good grasp of statistics?
For example: No question that there’s a lot of malarky circulating about diet. But there are precious few studies that consider diet over the whole lifespan or do a credible job at looking at the relationship between diet and chronic conditions. Eg., in the days when I bred Labradors, I was ready to buy the hypothesis of ‘fast growth’ and over-done exercise as risk factors for hip dysplasia, and guided puppy buyers accordingly. Then Krontveit’s (2012) results seem to have seriously challenged those concepts. (http://www.sciencedaily.com/releases/2012/03/120326112842.htm the whole PhD is available somewhere but I can’t find it today).
The reasons for lack of evidence are apparent: It’s very hard to get clean statistics from collected veterinary records. The enormous variability of dogs (and the environments in which they live) hinders the first step in statistics: defining a sample that represents the population. It’s very expensive to conduct studies that require keeping dogs under controlled environments for years at a time. Funding for research is biased toward studies that test a product that may be marketable for one or another condition. The regulatory environment on ‘supplements’ is horrible.
Is a double blind study conducted on laboratory beagles for a few weeks or months relevant to my dogs’ conditions? Sometimes it obviously is. Othertimes it’s hard to know.
The available evidence often doesn’t get at the bigger question. I am a fan of Linda Case’s thesciencedog.wordpress.com, but often I find myself saying, “so what?”. Ok, dogs don’t digest rawhide and digest pig skin better. I don’t buy chews to provide nutrition, and who knows, maybe passing collagen has some benefit or cost other than nutrition.
I do wish there was more evidence looking at the whole dog, as opposed to this or that treatment. It would be wonderful to see careful studies of dogs who lived long, healthy lives with minimal veterinary care to see if there were common threads. Seems to me the bigger picture is not on specific treatments but on the interaction between genetics and environment (including both diet, training, and care). As a dog owner, I wish evidence did more to help me select and raise a puppy so as to avoid the large problems in dog ownership: eg, chronic diseases, difficult behavior(s)/temperament, and ‘minor’ but significant problems like irritable bowel disease and allergies. I’m inclined to believe arguments against inbreeding, and find the semi-scientific tales of such and such a disease arising from a bottleneck in the breeding this or that breed. But that doesn’t tell me what is an acceptable COI . . . or whether measures of heterozygosity in the DLA are more relevant than COI.
In sum, for evidence based medicine / veterinary care to prevail, it needs to do a better job of addressing whole dog questions.
Lots of great issues raised here. As I’ve said many times, we need to make decisions based on the evidence we have, not the evidence we wish we had. And nothing in EBVM says we have to stand around with out hands in our pockets in the absence of perfect evidence. I make recommendations all the time to clients which are not supported by anything like optimal research evidence. But in doing this, there are several things we need to acknowledge and deal with, which unfortunately most holistic vets choose to ignore:
1. A lack of evidence means there is significant uncertainty. If I give a medication based entirely on my personal experience with it and in the absence of good research evidence, I am ethically obligated to explain to the client that there is significant uncertainty about the effects, good or bad, of that medication. What is wrong with much of the communication about alternative therapies is that they are promoted with strong, confident claims about safety and efficacy that are not justified by evidence, and this is misleading.
2. All research evidence is imperfect, and one central pillar of EBVM is critical appraisal. We should look at every study we wish to use to inform our decisions and assess its limitations and applicability to our specific situation. This will off decrease our confidence in the results, but again this is an honest, clear assessment of the uncertainty without which we are misleading ourselves. The imperfections in the evidence are not reasons to ignore the evidence or imagine that we can proceed confidently without it.
3. We absolutely need more and better evidence. But we will not get it until we accept the need for it. One of the main dangers of the kinds of attitudes I highlight in this post is that they reassure us that decision-making without good quality controlled scientific evidence is safe and reliable and that the kind of evidence I believe we need is so often unattainable or imperfect that we might as well forget about it. You are correct that we need more evidence, but it is people in the EBVM and skeptic movement who are trying to get it for us. People like these folks in the AHVMF are raising and spending hundreds of thousands of dollars on “research: that is often biased, pseudoscientific propaganda for their pre-existing beliefs, not actual scientific evidence that will help us make better decisions for our pets.
4. Certainly, it is not reasonable to expect pet owners to find and evaluate scientific evidence for themselves. However, it is reasonable to expect them to demand their vets do this, and that their vets communicate clearly and explicitly with them about evidence and uncertainty. When I advise clients on care for their pets, I always discuss the evidence that exists and its limitations so they understand the level of uncertainty they have to accept as part of their decision making, This is my job, and it is sad that, as you indicate, many vets don’t make the effort to do this very effectively. Of course, I would argue the problem is most dramatic among “holistic” vets precisely because they often see scientific evidence as a nice extra, at bets, or irrelevant at worst because they believe relying on uncontrolled individual observation is acceptable.
So while I agree with your specific complaints, I would just suggest we have to both do the best with what we have and make a commitment to doing better, and that EBVM advocates are the ones making the most effort to drive veterinary medicine in this direction.
” I have all the proof I need every day in my practice to justify these modalities.””
Anytime anyone uses the word “morality,” my BS meter goes on alert.
“As a veterinarian now practicing homeopathy and chiropractic almost exclusively, I have all the proof I need every day in my practice to justify these modalities.”
Out of curiosity, is “all the proof I need” by any chance related to the guy’s bank account?
Of course, I am not a vet, so what do I know…
The worst for me, being a pet store owner, is that vets recommend products or supplements or any number of unproven things to their patients, then those patients come to me and ask if I carry them. Now usually I can convince them that such and such doesn’t work but since I don’t have a DVM behind my name, even though I show them the evidence, they only see me as a lowly business owner and not a vet.
Even though I’ve read and studied the same texts that most DVMs have used for clinical nutrition, NRC requirements report for small animal nutrition, have consulted several journals of Vet medicine, because, well I’m weird that way. The DVM carries weight and these vets are doing damage.
So I just don’t carry stuff that doesn’t work, period. Though I can make tons of money on selling joint tablets that don’t work, or any number of supplements. I have ethics.
Teaching customers is tough when you are fighting ill informed vets. So now I’m off to get my MS in clinical nutrition. Maybe that might give me a bit more clout with the MS behind my name.