From both my twenty-five years of clinical practice as a general practice vet, and also my work studying aging in dogs, I have developed a particular interest in the care of senior pets. One important aspect of this care is the management of chronic diseases, including palliative care for the symptoms they create, and also the care patients receive at the end of life. While we are fortunate in veterinary medicine to have euthanasia as an option to prevent unnecessary suffering, there is often a period before this point where intensive management of symptoms that can diminish quality of life is needed.
All of us in general practice, and in some specialties, such as oncology and internal medicine, have experience trying to manage such symptoms and support good quality of life in aging pets with chronic or life-limiting illness. However, doing this effectively can take a lot of time and a close relationship with the patients’ human family, and this can be difficult to achieve in the context of routine practice. Many of us have short appointment times (15-30minutes), long wait times for open appointments, and no ability to see the patient at home, where most palliative and end-of-life care takes place. This makes providing the level of such care we feel our patients deserve challenging at times.
One way of meeting this challenge is to work with veterinarians who focus on providing palliative and hospice care, many of whom do so in the patients’ home. These individuals are likely to have additional training and experience, and a context for their practice (often mobile and independent), that can support a higher level of palliative care.
I was intrigued recently when I saw that a group of such veterinarians have begun the process of seeking formal recognition as a medical specialty through the American College of Veterinary Hospice and Palliative Medicine (ACVHPM). This, in turn, has triggered a public comment period, during which anyone interested in the subject is asked to submit an opinion on the proposal to the American Board of Veterinary Specialties (ABVS).
Acceptance as an official specialty acknowledged by the ABVS is an important practical and symbolic step. As I have discussed often in the past, many individuals and organizations claim specialized expertise, and often this is self-serving and misleading to pet owners. Self-designation of specialty status is common in areas of alternative medicine, and it has no value in helping people distinguish safe and effective science-based care from pseudoscience and nonsense. Such fake specialty designations create the false impression of scientific legitimacy where it has not been earned.
In contrast, specialties recognized by the ABVS are generally expected to have a strong foundation in science and rigorous training for diplomates. This doesn’t make any individual or organization perfect or omniscient, of course, but it provides a solid foundation for confidence in the true expertise of specialists and specialty societies. This helps both general practice vets and pet owners recognize reliable sources of information.
I have explicitly opposed applications for ABVS specialty status in the past for both acupuncture and herbal medicinebecause these fields are dominated by pseudoscience and superstition, and specialty recognition would create a false impression of a scientific standard of evidence and training that the fields do not actually have. This would mislead rather than help primary care vets and owners.
I have been supportive of most other specialty designations, though I admit to a bit of ambivalence about the status of the American College of Sports Medicine and Rehabilitation (ACVSMR). Physical therapy (typically called “rehabilitation” in U.S. veterinary medicine for legal reasons) is an important and generally science-based field in human medicine, and I strongly support its development for veterinary patients. Managing and maintaining physical activity and function and dealing with chronic pain and musculoskeletal disease is critical for wellbeing in senior patients in particular, and we do far too little of this.
As the field is quite new, there is understandably limited evidence for most specific interventions. This is a deficit that will hopefully be remedied with time and effort, and having a specialty college can support the necessary research. However, the lack of evidence also means many working in this field are accustomed to and comfortable with limited evidence, and they may naturally turn to anecdote, personal experience, and theoretical reasoning to support specific treatment choices, even those these are often unreliable evidence. My experience is that questionable or likely ineffective treatments, such as acupuncture, chiropractic, cold laser, and others I have evaluated repeatedly, are quite common in the rehabilitation field, possible due to the high level of comfort with low-quality sources of evidence.
This is problematic not only because patients may be exposed to ineffective treatments but also because the use and endorsement of these treatments by recognized specialists lends them a validity that the scientific evidence does not support. I do worry that this will lead to these therapies becoming entrenched in the discipline and actually impede research on them or the abandonment of treatments when the evidence warrants it.
So when I heard about the ACVHP petition, I was similarly ambivalent. I have written here many times about hospice and palliative care, and the tension between our need for more and better care of this kind and the deep entrenchment of dubious and pseudoscientific therapies in the field. The leading organizations and individuals in the field explicitly endorse therapies with questionable supporting evidence (e.g. herbal remedies and acupuncture) and those which are clearly only placebos (e.g. homeopathy and “energy” therapies) alongside science-based medical practices.
As much as I admire the vets who do this kind of work, I feel very strongly that providing ineffective and unscientific therapies are not in the best interests of patients, and they can cause real harm, both directly and indirectly. Having members of a recognized mainstream specialty offering such therapies would create the same kind of false impression of legitimacy seen with questionable treatments used by rehabilitation specialists.
I know there are members of the hospice and palliative care community committed to science-based medicine, and several have reached out to me over the years expressing their frustration with the prevalence of alternative and unscientific practices in their field. The question raised by the ACVHP proposal is whether building and recognizing a specialty would increase the standards of scientific evidence for interventions used in the field and squeeze out the bogus and questionable practices or simply legitimize and sustain them.
I can’t honestly predict which possible outcome is true. My experience with the ACVSMR so far in its relatively short existence has been mixed. The increased attention to rehabilitation has been a positive force, and there is a growing body of research to develop more evidence-based therapies. However, the questionable practices often used in this field are also growing in popularity in many cases, and it does seem that the endorsement of specialists for these practices makes it harder to explain the scientific case against them and convince regular vets that they are better off not adopting or recommending these practices.
Ultimately, I feel like the prevalence of questionable practices in the hospice and palliative care field is too high. Research is especially challenging to do in this population and setting, which adds a further barrier to building a better evidence base and pushing out ineffective treatments. I don’t believe specialty status is warranted based on the existing level of scientific evidence, and I am not confident that having a recognized specialty will improve the evidence and the quality of care. I fear it will simply sustain and entrench the practices favored by the most persuasive voices in the field, leading to standards set by personal opinion rather than science.
Based on this concern, I submitted the following comment to the ABVS in opposition to the proposed specialty-
I must oppose this position, with reluctance. I think expanded and high-quality palliative and hospice care for veterinary patients is much needed. Unfortunately, the IAAHPC and many of its leaders and members explicitly support the use of implausible and disproven alternative therapies in hospice and palliative care patients. Homeopathy, Reiki, TCVM acupuncture, and other such alternative methods lacking scientific validation don’t benefit our patients. Providing them with, or even in lieu of, science-based medicine harms patients and misleads clients. Board specialty status would be more likely to legitimize such therapies than replace them with evidence-based medicine, so I must oppose granting this status.
I remain cautiously hopeful that the voices in this field advocating for an evidence-based approach will grow stronger and more influential, and that the field will move towards a more science-based approach. Unlike acupuncture, which has had more than a fair chance to prove itself and has failed consistently, I believe robust and science-based hospice and palliative care is a necessity in veterinary medicine, and I would like to see this develop to the point where a specialty is warranted and can be a positive force for the advancement of the field.
You don’t say this explicitly, although I think you agree, that if the field were given recognition in it’s current state it would give all the useless alternative treatments an ‘in’ to say that they were recognised as valid by the ABVS, which would obviously be very bad.
I am an independent veterinarian who is outspoken in my advocacy for independent end-of-life services. I was removed from the organizing community after I created a social media post about how Lap of Love and Coda Pets models have positioned themselves in a way that independent veterinarians cannot be found by families looking for help online. Their ad spend has created an unlevel playing field for the rest of us. I was told that my post violated the college’s social media policy (which was the same one that the IAAHPC uses). I asked for a discussion about their decision and they have repeatedly ignored me. Not only that, their vice chair of their organizing committee, then created her own social media post calling my behavior unprofessional. So they violated their own social media policy making that statement plus they did it in retaliation, another violation. There is too much involvement and overlap between the IAAHPC and this organizing committee. This organization would rather terminate me to protect their own interests in corporate medicine and the money they can get from sponsorship from corporate organizations. Just take a look at all of their sponsorships from their past annual conferences and add up the money. It’s pretty easy to figure out who the decision-maker was in my termination. I am filing a formal complaint about the disparagement and retaliation tactics of this organization. it’s a mess right out of the gate. So combine the concerns about supporting non-evidence based medical treatment plus an absolutely shitty governance structure- good luck to them. And shame on them for attempting to silence dissent from an opposing viewpoint. That’s what a rigorous academic program is about – being able to listen to and respond to dissenting voices.
Obviously, I am not in a position to have any opinion on the specifics of your experience or the governance structure and funding of the IAAHPC. I do agree that this organization is clearly heavily represented in the ACVHPM, and part of my concern about the proposed specialty is that the latter group will adopt the same permissive approach to questionable therapies as the former.
From the outside looking in — I.M.H.O. and with zero claim to veterinary science — what I do see is a governance problem that has nothing to do with medicine and everything to do with control, money, and fear.
When a “new” organisation is built and run by the same people, with the same sponsors, and the same internal culture, it’s not a fresh start. It’s the same cake baked in the same kitchen — just iced differently.
That’s not reform. That’s replication.
And let’s be honest:
Any group heavily funded by corporate players ends up, intentionally or not, beholden to those same players. It’s no different to a newspaper refusing to criticise its biggest advertiser — it simply won’t happen while the snout is still in the trough.
In the pet end?of?life space, I’ve watched the I.A.O.P.C.C. drift into exactly that trap. When an organisation is financially tied to a dominant corporate operator, it becomes unrealistic to expect them to challenge that operator’s behaviour — even when pet parents or independent vets are the ones paying the price.
Not because the people are bad — but because the structure is compromised.
So when I see a new specialty group forming under the same leadership ecosystem, with the same sponsorship dependencies, I don’t see independence. I see a fox being handed the keys to a new henhouse.
If this field truly wants credibility, trust, and scientific integrity, then it needs:
transparency, independence, balance, and zero fear of upsetting the people with the fattest wallets.
Otherwise the cycle repeats — same inputs, same pressures, same outcomes.
Disruption isn’t a threat here.
It’s the only path to something better.
One of my dogs is 17 1/2 years old. Multiple ailments that she is well medicated for. Now the dementia has kicked it. Awakens at 2a-3a, confused, agitated, it can take as much as an hour to settle her down.
We are at the point that she appears to be only comfortable when medicated and sleeping. Oddly the vets she sees have not mentioned euthanasia as an option yet. Of course, it has crossed my mind, but I would like to avoid it unless she is truly suffering.
But how do you know? This is a very difficult time for pet parents. I agree, there should be more options for chronic and palliative care. Thanks for listening.
anyone know how human medicine handles pts? If you live in a state or another country that allows human pts does your family doctor do it or is it done by a specialist? Going from one house to another putting pets to sleep for people you do not know and pets you have never seen before reminds me of some humane society veterinary work.
Update: My 17-year-old dog was euthanized. Couldn’t deny the suffering anymore.
What do vets think of the $300 plus charge for cremation. I think it’s emotional blackmail. The dog is gone. But of course, you want the body treated with respect.
I’ll now have another bag of dust I’ll have to figure out what to do with 🙁