The tireless promoter of “natural” veterinary medicine (whatever that is) and himself, Dr. Shawn Messonier, has applied his characteristic fuzzy logic and love of strawmen and misleading hyperbole to a recent guest post by Alison Averis on Fooling yourself: An example of how to fool yourself and how the placebo effect can work in animals. I shall reproduce his post below, with appropriate commentary and clarification (in bracketed, boldface type).
“I recently came across a post on another blog purporting to show that there is no proof that natural/alternative therapies work. [Actually, actually reading Alison’s post will make it clear that this is not the point of it at all. Throughout his essay, Dr. Shawn seems unable to distinguish between an anecdote used appropriately as an illustration and example of a phenomenon, and his preferred use of it as proof of something. Alison’s story was a parable illustrating how easy it is for one’s expectations to color one’s judgment about the efficacy of a therapy not evaluated in an objective, scientific way, not a statement or proof that “natural/alternative” therapies do not work.] This particular blog is devoted to debunking any therapy that falls outside the mainstream. [Actually, this blog is devoted to, as it says at the top of the page, taking a “Science-Based Look at Complementary and Alternative Medicine.” I am happy to validate any non-mainstream therapy that can be demonstrated to be effective in an appropriately scientific way, and I am equally happy to condemn any mainstream therapy that cannot.] The writer of this blog constantly seeks to show that there is no proof that any natural therapy ever works or helps anyone or any pet. [strawman and flagrant demonization]
The post I read was submitted by a reader of this particular blog. Briefly, she shared the following information in her post.
An “alternative therapist” told the owner of a horse that she would “work on” the horse for free if the owner would give her feedback on how the horse performed following the “free therapy session.” Unknown to the owner, the “therapist” never worked on the horse but led the owner to believe she had done so.
The day following the supposed “therapy,” the owner was happy to report that the horse actually “rode better than normal.” The writer of the blog used this one example to prove that natural therapies don’t work and that the reason the owner thought the horse rode better was simply due to the power of suggestion, or the placebo effect. [Again, the example was never purported to prove that “natural therapies,” or even the specific therapy referred to, don’t work. It was intended to illustrate how subjective, uncontrolled observations are an unreliable basis for making a judgment on what works and what doesn’t.]
While this was an interesting post to read, and it can easily deceive people into thinking that this one simple experiment proved that all natural therapies only work by the placebo effect, a more careful examination of the post leaves a lot to be desired.
First, I don’t know what an “alternative therapist” is or what one does. I assume the writer of this blog is referring to some sort of physical therapy such as massage therapy, but that is never explained.
Second, there’s a big difference between someone who claims to be an “alternative therapist” and a licensed doctor trained in integrative medicine. [How, exactly, does one get “licensed” to practice “integrative medicine?” This is a buzzword that simply means the use of unproven therapies alongside scientifically validated ones, and there is no process by which one becomes licensed to do this.]
Third, this particular website on which the blog appears always chastises alternative medicine for the lack of proof for alternative therapies since there are so few well controlled, double-blind placebo-controlled studies. [I have rebutted this charge of relying only on double-blind placebo controlled trials before HERE, yet Dr. Shawn continues to state the falsehood that I rely solely on such evidence.] It’s interesting that this website now uses an example of a poorly designed “study” (if an observation of one patient even constitutes a study) to prove that no natural therapies ever work! [Yet again, the hypocrisy that he gleeful implies is not present, despite his inability to distinguish an example from a proof.]
Fourth, the observation in this case was entirely subjective rather than objective. Rather than using an owner’s observation that the horse “rode better” after a particular therapy, why not use a more objective measurement such as gait analysis or forced plate analysis? In my practice, I can objectively measure things such as a pet’s blood pressure or blood count and easily determine if my therapy (conventional or natural) is working. This can totally eliminate the subjective assessment an owner may make in determining if a pet simply “feels better.” [I would be very interested in how much “objective” measuring of outcomes Dr. Shawn actually does. He seems to imagine he can “eliminate” subjective owner assessments in his practice, but I find this hard to believe. He routinely claims better outcomes for his patients with cancer, for example, than those possible through scientific medicine, yet I am unaware of any formal, scientifically controlled or objective research he has published on the subject, so I wonder how exactly he makes his assessments of his interventions more objective and independent of owner history than the rest of us in clinical practice.]
Fifth and finally, the same “conclusion” could easily be reached in this case if a conventional drug had been used rather than an alternative therapy. For example, suppose a doctor told the same horse owner that he was going to give the horse a pill which would improve its performance. But suppose the doctor secretly did not give the horse the medication but the owner still reported that the horse “rode better” the next day. If we follow the blogger’s (lack of) logic, we have to draw the same conclusion-namely that this one example proves that conventional drug therapy doesn’t work! [No, as I’ve made clear, and as should be obvious from reading the post, the conclusion we would draw would be that the owner report of how the horse performed subsequent to the sham therapy, be it conventional or alternative, is not a reliable assessment of the efficacy of the therapy. The point is that we must have a better level of evidence, and my evaluations of alternative practices such as those advocated by Dr. Shawn is intended to identify whether such evidence is or is not available. He is the one who routinely relies on his personal experiences and intuition and anecdotes as evidence to justify implausible or simply “made up” theories and practices. The whole purpose of this blog is to do better than this sloppy and outdated approach, not to replicate it in favor of or in opposition to any particular therapy.]
It’s interesting how much hatred and negativity one encounters among people who don’t like natural/alternative medicine. [It is also interesting to see how reasoned and civil criticism and a call for real evidence rather than simply opinion is identified as “hatred and negativity.”] To use one example as this blogger has done as universal proof that integrative medicine doesn’t achieve successful results is ludicrous and deceiving. [And, fortunately, not at all what has been done with this example] Fortunately, it’s easy to see through all the hypocrisy in this blog and understand the real goal of people who write this rubbish-destroy your choice in determining what kind of therapy you would like for you, your family members, and your pets. [Wow, “rubbish.” There’s a polite and thoughtful critique for you. As for the question of choice, I’ve addressed this bit of misdirection before. Offering as alternatives treatments which have not been demonstrated to be safe or effective, or which have actually been clearly demonstrated not to be so, is not offering choice–it is offering false hope at best and lies at worst, and these are not what our patients or clients deserve from us.]”
Wow, way to totally dismantle an article to fit your agenda, Messonier.
If I’m allowed to post links, here’s Messonier’s blog post:
And he “contributes” nonsense on another blog. Here’s an example of Messonier’s own rubbish, one among many:
On posting an “FDA 10 questions to ask your veterinarian when medication is prescribed.”:
“**And possibly the MOST important question of all…is there anything other than this medication I can give my pet or do for my pet to help it recover? Don’t forget that MOST conditions can be treated with natural remedies rather than conventional medications!”
It’s interesting how Dr. Shawn and others love to use testimonials and anecdotes as “proof” of the effectiveness of their therapies, but then turn around like this and criticize an anecdotal story that they don’t like, even when not used as proof of anything more than human gullibility. Vague claims such as “improved quality of life” (OK-compared to what?) are also very popular, but usually don’t hold up to scrutiny.
At least you seem to be getting under his skin-rants like his probably don’t really help his cause with anyone but the true believers.
As I and others have suggested before, I think one reason for the kind of reaction Dr. Shawn had to this essay is the role of anecdote in CAM. Because anecdotes and eprsonal experiences are the primary justification for many CAM practices, they are seen as very powerful. If negative anecdotes such as that from Alison’s essay are available to CAM clients, they could potentially shake their faith in the methods being used.
In scientific medicine, anecdotes are understood not to have such probative power, and so such stories are not seen as critical in judging the value of an intervention.
I’m truly amazed. Although I’m well aware that lots of people believe that positive anecdotes and testimonials are the highest form of evidence, I had never for a minute imagined that anyone would feel threatened or alarmed by a negative anecdote – particularly one that does not actually imply what was inferred from it.
But since that does seem to be so, why are we all spending so much time and effort constructing elegant, evidence-based arguments when a furious bombardment of negative testimonials might be much more effective as a way of communicating?