Integrative Medicine- Mixing Apple Pie and Cow Pie
A recent issue of the journal Today’s Veterinary Practice contained a couple of articles form some familiar folks who represent the problematic notion of “integrative medicine.” This is a poorly defined term which typically is a way of signaling support for including alternative therapies with little scientific validation alongside legitimate science-based medicine. It creates an aura of open-mindedness and signals that proponent are not extremists but reasonable and willing to use any tool that helps their patients without prejudice. Science-based and alternative therapies are simply tools in a toolbox, and whatever tools suits the job is the one that should be chosen.
This, of course, ignores the fact that we have good reason to believe science-based “tools” actually work, while the safety and effectiveness of alternative methods is often unproven, and sometimes clearly disproven. All therapies should have to meet the same standard of evidence, that of scientific testing, and integrative medicine is simple a way of exempting some treatments from proving their worth objectively.
Mixing treatments that don’t work with those that do isn’t going to improve care. Or, as infectious disease specialist Mark Crislip has put it, “If you mix cow pie with apple pie, it does not make the cow pie taste better; it makes the apple pie worse.”
Nevertheless, the integrative ideology is popular because it feeds into the middle-ground fallacy, the belief that when there are two opposing sides to an issue, the truth is always a compromise somewhere in the middle. In reality, sometimes one side is actually right and the other side is wrong, so eschewing both exclusively scientific and alternative medicine in favor of an integrative mix of the two isn’t necessarily the best path.
Fresh Foods vs Conventional Diets
The first article that drew my attention was concerning the possible benefits of “fresh” pet foods. The first author was Dr. Donna Raditic, a nutritionist I have written about a number of times. She was involved in running an integrative medicine fellowship program, and she has been a consistent proponent of mixing alternative therapies, such as herbal medicine, acupuncture, Bach flowers, and homeopathy, with conventional treatments.
The focus of this article is essentially that fresh foods are safer and healthier than “highly processed” conventional diets, due mostly to the concern about potentially carcinogenic chemicals created by “heat processing” (“cooking” to most of us). She advocates using the NOVA classification system, or something like it, to rate pet foods and avoiding those that are highly processed.
I have written in detail about the issue of processing, and the limitations of the concept. While the idea that fresh diets might have some health benefits is a reasonable hypothesis, it is currently supported mostly by associations in observational studies in humans or by lab animal studies that poorly reflect the reality of what people and pets actually eat. Nutritional composition and quality may well be more important for health outcomes, and processing may be a confounder rather than a problem in itself. There is also significant doubt about the value of the NOVA classification system in human nutrition, and about whether using it as a primary guide to the healthiest diet is actually beneficial.
In keeping with the tone of “integrative medicine” thinking, the article contains reasonable hypotheses and raises issues worth considering. However, it presents the benefits of the NOVA system and the risks of processed foods with far more confidence and certainty than is justified by the existing evidence, and it assumes the superiority of the alternatives without any evidence at all. This reveals the underlying bias of the authors, who have clearly already made up their minds regardless of the limitations of the evidence. Assuming the truth of the proposition you are arguing is a type of logical fallacy known as begging the question, and it is prominently displayed in this article.
The authors may, of course, turn out to be right about some of their claims, and if the data showing this appear, I will happily shift my position on fresh diets from neutral to strongly in favor. For now, however, as veterinary professionals and pet owners, we should not obsess about the “processing” involved in the making of the pet foods we use. While inclusion of some fresh or whole foods may well turn out to have some health benefits, it is far more important that making sure our pets are eating complete and balanced diets that meet their nutritional needs, regardless of the form they take.
An Integrative Approach to Aging
Regular readers will know that for the last several years I have been deeply involved in canine aging science, working at a company developing drugs to extend healthy lifespan and as part of several scientific collaborations in this area. So I always pay attention to articles and books about aging and longevity.
Unfortunately, there is at least as much hyperbole and outright nonsense in this field as there is legitimate science, and lifespan extension is claimed freely by lots of folks as a benefit for unscientific or unproven treatments that they have long been advocating. I have illustrated this in a number of book reviews, most clear for the book Forever Dog, which is a superficial reframing of many myths and cliches from alternative medicine into an “anti-aging” approach.
Dr. Gary Richter is another of the integrative medicine crowd I have discussed previously, and he has a book on a “holistic” approach to longevity for dogs that I have read but not yet reviewed. Suffice it to say the book contains the usual mixture of reasonable lifestyle advice (maintain a healthy body weight, exercise regularly), mainstream veterinary advice (see a vet regularly, get at least some vaccinations), unproven or exaggerated claims (for unconventional diets and supplements), and outright nonsense (Chinese and other herbal medicine, chiropractic, etc.). Mixing the good, the bad, and the ridiculous may sound enlightened and “open-minded,” but it’s really just cow pie and apple pie again.
In this article, Dr. Richter reviews the hallmarks of aging, a common system used to categorize factors contributing to aging in a way that facilitates study and that might someday be useful as targets for therapies to slow aging. However, as usual there is a lack of any distinction between scientifically validated tools, plausible but unproven hypotheses, and pet theories with no substance or evidence whatsoever. Almost everything is presented equally positively, which makes for an inspiring, but ultimately misleading read.
The real danger of the integrative approach is evident in the fence-straddling Dr. Richter does about vaccination and parasite prevention. He does recommend these as “protect[ing] pets’ immune systems,” but then he almost immediately adds, “inappropriate or overuse of vaccines, antibiotics, and other medications, as well as early spay and neuter surgeries, may have equally impactful negative effects on longevity.” This broad statement is supported by a citation to a paper on the potential risks and benefits of neutering different breeds at different ages, which isn’t really relevant to the doubt he is casting on vaccines or “other medications.”
The reality is that there is zero evidence that recommended vaccination practices constitute “overuse” or have any negative effects on health and longevity. Antibiotic overuse is absolutely a problem in terms of antimicrobial resistance and some effects on the microbiome, but it is not at all evidence that it plays a role in reducing lifespan. And while there are complexities to the issue, the bulk of the evidence in multiple species suggests that neutering increases lifespan. This caveat is fundamentally misleading and creates unnecessary anxiety about beneficial veterinary treatments.
I am all for generating excitement about the potential for new preventive approaches to extending lifespan and healthspan. I think new therapies, from lifestyle changes to drugs and more we haven’t even considered yet, will be available and practical not too far in the future. However, we do no favors to our patients or the longevity field by stoking inappropriate anxiety or unjustified enthusiasm about current practices or those still under investigation. Dr. Richter’s book reads very much like this article, and while it is not as egregiously anti-science as some have reviewed (such as Forever Dog and Nutrigenomics), its strengths are undermined by the credulous and unhelpful “integrative medicine” perspective.
