American Animal Hospital Association Promotes CAVM and Quackery

The American Animal Hospital Association promotes itself as an organization which accredits veterinary hospitals and claims, “The Standards developed and published by AAHA are widely accepted as representing those components of veterinary practice that represent high quality care…Because of the AAHA Standards of Accreditation, you can be sure that your pet will receive top-quality care at an AAHA-accredited hospital.” Unfortunately, a recent uncritical fluff piece on “complementary medicine” on the AAHA site suggests that rigorous adherence to legitimate science-based medicine may not be a component of the AAHA standards. It does not stimulate confidence in the value of an AAHA certification if the organization freely promotes bogus therapeutic approaches.

The piece begins by assuming that complementary and alternative veterinary medicine (CAVM) is beneficial for humans and suggesting it ought to be applied to animals as well:

Have you ever basked in the luxury of a professional massage? Ever been to a chiropractor to have that creak in your back fixed? Are you a true believer in taking Echinacea to recover from colds more quickly or gingko to improve your circulation? If you answered yes to any of these questions, then you understand how alternative forms of medicine can benefit you. But did you ever think Spot or Fluffy might want to give these methods a try, too?

Massage? It is certainly relaxing and feels good, which can ease the discomfort of anyone who is ill. This is a legitimate and perfectly mainstream practice. But when massage therapists begin to claim healing or disease prevention benefits from their practice, it does become an alternative practice, and there is no evidence-based reason to believe massage affects the course of any disease or prevents any medical condition.

Chiropractic? An implausible and thoroughly debunked theory,  in humans clinical benefits only for lower back pain which are no better than standard therapy, and no reliable evidence that it is safe or beneficial in animals.

Echinacea? Thoroughly tested and consistently found to have no meaningful benefits for cold prevention or treatment.

Gingko? No benefit for cognitive dysfunction, and no benefit for intermittent claudication.

So if these remedies don’t work for humans, under what “standards of excellence” would we suggest they are good for Spot and Fluffy?

Next, the article cites an AAHA survey suggesting an increasing number of pet owners are using CAVM.

According to the American Animal Hospital Association’s 2003 National Pet Owner Survey, 21 percent of pet owners have used some form of complementary medicine on their pets. Compare this to the 1996 survey, in which only six percent of pet owners said they’ve used alternative therapies on their pets.

It’s always difficult to know how to interpret such figures because the percentage of people using CAVM depends on how CAVM is defined and explained. Does it include massage? Glucosamine? Prayer? If the trend seen in the survey is real, it certainly is a sign for concern given that most of the approaches that fall under the CAVM rubric are unproven at best or in many cases clearly worthless.

What such a figure does not indicate is anything about the safety or efficacy of such therapies. Just because something is becoming more popular does not mean it is true or a good thing. The implication proponents of CAVM make when citing such statistics is that such things are growing in popularity because they are effective or because they are becoming a legitimate and accepted part of mainstream medicine. However, science is not a popularity contest, and truth is determined by evidence not by the extent of public belief.

Next, the article drags out the tired cliché about “holistic” medicine treating the entire patient while conventional medicine treats only symptoms or isolated parts. It then offers what amounts to a guarantee that CAVM treatments are safe and helpful:

Holistic practitioners consider your pet’s entire well-being, not just individual symptoms or conditions, and mix and match treatments to best serve Spot’s or Fluffy’s needs. A holistic approach to your pet’s problem will likely prove beneficial in nearly all cases.

Unfortunately, “holistic” is a marketing term that CAVM proponents have long ago stripped of any consistent, real meaning. It is used almost exclusively as a buzzword to suggest that conventional medicine ignores any treatment or preventative that isn’t a vaccines, drug, or surgical procedure, which is patently ridiculous. Of course, considering the entirety of relevant variables in health and disease “will likely prove beneficial,” but focusing on nonexistent entities like “energy” or the vertebral subluxation, or adding worthless therapies like super diluted water to real medical treatments doesn’t provide any benefit. And the evidence of potential harm is clear.

Finally, this article lists a number of CAVM therapies and makes a variety of claims about them, most of which are unproven or outright untrue.

A) Acupuncture:

1. “Acupuncture has been practiced by the Chinese for more than 3,000 years.”

No, it hasn’t. The best available historical research shows that acupuncture, understood as the placing of small needles into the skin at points believed to have effects on internal organs or health, has only been commonly practiced on companion animals since the 1960s.

2. “Acupuncture can relieve muscle spasms, increase blood circulation, stimulate nerves, and help release natural pain control hormones and other helpful chemicals produced naturally by the body…. You may want to consider acupuncture for your pet if it has musculoskeletal, skin, respiratory, or digestive problems. It can also help with some reproductive problems.”

In humans, the only consistent beneficial effects are on pain and nausea, and these are psychologically mediated, meaning they are less than achieved with pain control medications and can be achieved through “fake” acupuncture techniques (placing needles randomly or stimulating the skin with toothpicks, for example). Beneficial effects based on psychological mechanisms, such as expectancy and therapeutic ritual, may have small but real benefit for people. Unfortunately, it is unlikely that these benefits are available to veterinary patients, so there is little reason to think that acupuncture is useful to our patients.

3. “Research shows that this complementary medical procedure can work well in many instances.”

This claim is not supported by the limited research available on veterinary acupuncture, which in the most charitable light can only be said to be inconclusive. Studies routinely claim benefits not actually seen in the data generated, or confuse the effects of electrical stimulation of nerves and muscles with the mystical Chinese practice of acupuncture.

B) Chiropractic

1.”Chiropractors believe that some illnesses result from misaligned vertebrae that diminish the flow of impulses from the spinal cord to the body’s muscles, organs and tissues. By manipulating and adjusting specific joints and cranial sutures in animals, veterinary chiropractors try to restore the flow of impulses.”

As already mentioned, though chiropractors may believe in the myth of the subluxation as a cause of disease, it is just that: a myth.

2. “Chiropractic treatments may help if your pet has a spinal disability, such as a slipped disc or pinched nerve; or even in some cases of epilepsy, skin disorders, and behavioral problems.”

There is absolutely no scientific evidence to support these claims in animals, and most of them have proven untrue in humans.

C) Physical Therapy and Massage

These approaches certainly do have proven benefits in humans. There is less research in veterinary patients, but it is quite likely that these approaches have real benefits for our patients. The problem is, they aren’t “complementary” or “alternative,” they are mainstream science-based medicine. I routinely refer patients to a veterinary physical therapy facility, and I am certainly not a CAVM practitioner. This is an example of those who are CAVM practitioners trying to falsely claim that truly effective therapies, other than drugs and surgery, are ignored by conventional medicine. Diet and exercise are frequently presented in human health care as somehow alternative therapies even though they are among the most commonly discussed and recommended strategies in primary care practice. This is a marketing strategy designed to convey a false impression of the differences between alternative and science-based medicine.

D) Homeopathy

1. Homeopathic treatment relies on the administration of substances that can produce clinical signs similar to those of the disease being treated. The idea is to provide the substances in small enough amounts to be harmless, yet enough to encourage the body to develop a curative response to the disease…The substance is diluted and made more potent, after which it’s usually put into pellet or liquid form.

The Granddaddy of all Quackery, homeopathy is pure mumbo jumbo. The so-called Law of Similars described above is merely the mystical idea of sympathetic magic, and the Law of Infinitesimals that says the less of something you have the stronger it is can only be true if the fundamental principles of physics and chemistry are all wrong.

2. “Administered properly, homeopathic treatment can help a wide variety of ailments, including allergies, wounds, poisonings, viral infections and many diseases.”

No high quality, repeatable scientific study has ever shown homeopathy to be effective in treating anything, in humans or animals. Enough studies done by enough believers in the practice will eventually lead to some claiming a positive effect. But the overwhelming, consistent pattern of the available evidence is that homeopathy doesn’t work.

E) Herbal Medicine and Nutraceuticals

1. “Many modern drugs, such as aspirin, are derived from plants, but these drugs go through chemical processing that is thought by some to diminish the plant’s original healing power.”

Yes, many medicines originate from plants. But there is no sound scientific basis to the notion that impure, inconsistent, and complex mixtures of chemicals contained in whole plants are in any way as safe or as effective as purified, identified, extensively tested isolated compounds (aka “medicine”). This is a mystical belief, not an established fact, and there is abundant evidence that it is untrue. Certainly, some herbal and nutraceutical products may be safe and effective, but others aren’t. There is nothing about being an herb or dietary supplement that guarantees safety or positive effects. These things need to be tested scientifically like any other medicine, and few of them have been, mostly for political reasons.

The American Animal Hospital Association portrays itself to the public as the source of reliable standards that can ensure a pet owner the veterinarian they go will provide high quality care. It is worrisome that the organization blithely endorses the kind of misinformation in this article. If adherence to accepted scientific methods and principles is not a part of their standards, then of what value are they? If the organization is willing to promote such utter quackery as homeopathy, how can they claim to be a trustworthy source of information about the quality of veterinary care individual doctors and hospitals offer.

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29 Responses to American Animal Hospital Association Promotes CAVM and Quackery

  1. Jana Rade says:

    As a matter of fact my experience is such that chiropractic adjustment works for both humans and dogs.

  2. Bartimaeus says:

    Jana, if you read more of this blog and the links provided, you will learn why and how personal experience can be so misleading. There is some evidence that shows chiropractic has some moderate effectiveness for back pain in humans, similar to several other treatments, but no evidence at all for the more outlandish claims of chiropractic (treating conditions such as asthma, infectious diseases, etc). There is a reason Mark Crislip considers “in my experience” the three most dangerous words in medicine.

  3. Joan VanDewater says:

    It’s interesting to watch the same discussion that happened, and is continuing to happen, in human medicine now come over to Veterinary Medicine. While there is need of some additional oversight of CAVM therapies for Veterinary medicine I believe there is a place for them. I would venture to guess that Veterinary medicine will eventually follow the human model that has learned to embrace some aspects of CAM – bringing them into the hospital setting to provide oversight and palliative care for many patients – see University of Colorado Hospital’s Integrative Medicine program.

    Discrediting clients who use the phrase “in my experience” is poor medicine if it decreases the Veterinarians openness to listen and understand what is going on the with pet.

  4. skeptvet says:

    Batimaeus is correct. As I make clear in my FAQ for this site, if you believe personal experience is as good as or better than controlled research in determining what works or not in medicine, then nothing I say will make any sense to you. Personal experience is a starting point for investigating cause/effect relationships and the safety and efficacy of therapies, but the history of medicine shows unequivocallly that it is unreliable and often leads large numbers of people to believe in and use worthless or outright harmful therapies. We are simply too easily fooled to rely solely on our personal experience.

    I don’t agree with the characterization of recognizing our human fallibility and the liitations of our judgement as equivalent to not listening or communicating effectively with clients. I absolutely take what clients say seriously. But I don’t automaticallly accept their observations or conclusions as accurate any more than I accept my own judgement when it is contradicted by solid research evidence. I’ve seen pets treated inappropriately for epilepsy for years because the vet accepted the clients claim the pet had a “seizure” only to find when I investigated and questioned the client more closely that what they labeled a seizure was actually something else entirely, such as spasms from back pain or fainting episodes. Part of our role as veterinarians is to integrate the information we get from our patients caretakers with our own professional knowledge, clinical experience and, most of all, sound scientific knowledge, to most effectively manage the patient’s health.

    Sadly, the characterization of CAM gaining popularity in human medicine is an accurate one. There is abundant evidence that this is the result of ideological factors and politics, not the validation of such methods by good science, and as such it is not necessarily a good thing. I have no doubt veterinary medicine will follow suit to some extent, but I hope that the notes of caution sounded by myself, organizations such as the Evidence-Based Veterinary Medicine Association, and others committed to science-based veterinary medicine will help minimize the harm that comes from accepting practices that haven’t been adequately tested to ensure they are safe or effective.

  5. skeptvet says:

    Thanks, Narda for the link. I intended to check out these papers, but the site you referenced says it all. The Linde paper is a famous, and since disproven and retracted, study, and the others are typical of the nonsense that proponents of homeopathy try to pass off as scientific evidence for their magic.

    Additional good sources of information on homeopathy are:

    Science-Based Medicine
    and the classic book Trick or Treatment: The Undeniable Facts about Alternative Medicine

  6. ellen says:

    interesting discussion. if CAVM services were integrated into a small animal emergency and critical care hospital, wouldn’t it create legal and ethical problems? isn’t emergency medicine (human and veterinary) supposed to be science and evidence-based?

  7. Pingback: Human woo increasingly inflicted on animals in place of science-based medicine « Gilgablog

  8. ellen says:

    the veterinary referral and emergency hospitals in my area offer traditional services including 24-hour critical care, surgery, cardiology, neurology, internal medicine, ophthalmology and oncology. i thought this was the norm, but after doing a web search, it appears that some ER/referral hospitals offer CAVM therapies as a “specialty” area. is this a growing trend?

    oakland veterinary referral services
    (acupuncture, deep infrared therapy/PDT, botanical/herbal therapies, nutritional supplements, nutritional counseling, energy therapy)

    southpaws veterinary specialists and emergency center
    (homeopathy, acupuncture, TCM)

    katonah bedford
    (acupuncture, massage)

  9. skeptvet says:

    I don’t think there is accurate data on whether or not particular CAVM methods are growing in popularity among referral or emergency practices. It wouldn’t surprise me, though, if such practices are being used more widely than say 10 years ago. Continued exposure to such things, and the constant stream of marketing and propoganda fro proponents of these things make them seem less foreign and more mainstream after a while. That, unfortunately, is not a reliable gide to whether the claims made about them are true, but once someone starts toying with any method, legitimate or quack, it will appear to be useful and they will be inclined to continue using it (confirmation bias and cognitive dissonance, which I have written about before).

  10. ellen says:

    skeptvet- thank you for your reply. wouldn’t offering CAVM therapies, such as homeopathy, in a referral and emergency care practice create legal and ethical problems for the hospital and medical staff?

    i can’t imagine homeopathy or energy therapy being used in a critical care situation–it reminds me of the youtube video “Homeopathy in the ER”.

  11. There’s not only CAVM in the ER, there’s CAVM on the battlefield:

  12. Oops…I meant CAM in the battlefield.

  13. Rita says:

    Surprising no-one has tried psychoanalysis for pets along with all the other useless quackeries there are around. I suppose “animal communicators” occupy this niche.

  14. Joan VanDewater says:

    Hopefully there will be more such studies:

    Effectiveness of the Homeopathic Preparation Zeel Compared with Carprofen in Dogs with Osteoarthritis
    Stephan Neumann, Pelle Stolt, Gabriele Braun, Klaus Hellmann, and Erich
    J Am Anim Hosp Assoc 2011;47 12-20

  15. skeptvet says:


    I have examined this study in detail, and it is not very convincing. In fact, it is emblematic of the poor quality and exaggerated conclusions of most homeopaty studies. The real question is are more such studies truly justified? Despite a completely impossible fundamental theory, we have conducted clinical studies on homeopathy in animals and huans for decades. And yet no solid evidence for a real effect has accumulated despite all this work. Apparently positive findings alway turn out to be the result of poorly controlled studies by true believers in homeopathic magic. Real therapies work whether you believe in them or not, but apparently homeopathy only works if your believe. So perhaps the scarce resources for research in veterinary medicine would be better used on more promising ideas.

  16. richard says:

    A couple of months agao, I wrote to the editor of PetsMatter and complained about this article. The author, Bess Maher, replied as follows:

    “Thanks for writing about my article in Petsmatter. We definitely appreciate your opinion. In my opinion, however, the article isn’t meant to prove that acupuncture works for pets but to introduce the idea that some veterinarians practice acupuncture and that there are standards of care that pet owners should know about. The middle section of the article contains quotes from veterinarians who are certified to practice acupuncture and who tout the benefits of acupuncture. The anecdotal comments are not put forward as proof but as a friendly way to open and close the article. Since the article is for pet owners, it is meant to be lighter in tone, which I think those without a scientific background appreciate. Also, a group of veterinary technicians and veterinarians looked at this article, so Petsmatter does attempt to vet the information in the articles. If it had been a more scientific article to determine the efficacy of acupuncture, we could have had a counter-point from veterinarians who do not think it’s been proven to be effective. Perhaps Petsmatter will include an article like that in the future. I just wanted to let you know that I appreciate your comments and the Petsmatter team has taken them into consideration.”

    Apparently, opinion is all that matters. And facts, after all, are just another person’s disagreeable opinion. Also, the article was not ‘scientific’ and therefore does not have to be accurate. I get the impression that AAHA feels that any practice that can be dressed up as medicine and sold to consumers meets their ‘standards’.

  17. skeptvet says:

    A disappointing response, but thanks very much for making the effort!

  18. ellen says:

    sleptvet said: “homeopathy only works if your believe.”

    clap your hands if you believe in fairies…and in ‘tooth fairy science’. :))

  19. Rita says:

    “Since the article is for pet owners, it is meant to be lighter in tone, which I think those without a scientific background appreciate.” Patronising buggers! Compare the approach of the late, great James Rooney, in “The Lame Horse”!

  20. Chris says:

    “If adherence to accepted scientific methods and principles is not a part of their [the AAHA’s] standards, then of what value are they? If the organization is willing to promote such utter quackery as homeopathy, how can they claim to be a trustworthy source of information about the quality of veterinary care individual doctors and hospitals offer.”

    They’re NOT a trustworthy source of information! I feel they offer the perception of higher standards of vet care, for which they may charge higher fees. Besides higher prices, the biggest difference I see when I compare regular Canadian vets around here and our local AAHA clinic are the gas fireplace, flatscreen TV, landscaping, fancy scales built into exam tables, their new computer system, recent renovations and abundant art prints!

    They may have different policies about the way they do things, but I have no way of knowing if they’re absolutely necessary, improve pet health or are a good value. Do they have to keep newly neutered animals overnight? Is it good for pets & pet owners that their staff only seem to have education about nutrition provided by Hills & the clinic pushes their food? Corn cereal for cats? For those animals that may really benefit from the food, the price is increased because of the freebies the staff have received as well as Hill’s high-profile advertising, grants & sponsorship. It appears most (all?) vets around here also don’t follow vet association policy about declawing cats, that is, proper disclosure about the nature of the surgery (that it’s extremely painful because it involves the amputation of the cat’s digits at the last knuckle), and that they’re supposed to council about alternatives and behaviour modification because surgery should only be considered as a last resort, not advertised in a special discount package; they could (gasp!) even show clients how to trim cats’ claws! It should come as no surprise to you that it’s more about money than ethics or animal health. Many concerned pet owners who ARE willing to look at data & research the AAHA & others continue to discount are coming to realize this and naming the AAHA, AVMA & others for what they really are – trade associations that represent the business interests of veterinary professionals.

  21. Suzanne says:

    Thank you for this well-written article. It frustrates and saddens me that so many of the otherwise wonderful vet and rescue and dog sport people I know believe in this kind of quakery. So often I feel like the lone voice, saying, “uh, I don’t think there’s evidence that actually works…” when a friend or co-worker talks about their horse’s recent (expensive) chiropractic “adjustment” or their dog’s homeopathic “treatment”, only to get patted on the head and told I’m just “closed minded”. Your blog is like a breath of fresh air. I wish it got more attention.

  22. skeptvet says:

    Thanks! It’s nice to get a break in the flood of hate mail! 😉

  23. vettechkatie says:

    wow….i am just confused at your intent here. The people you should be aiming this at have some interest or belief in some types of alt medicine. You write it in such a way that you immediately turn them off. I agree with the majority of what you are saying in that AAHA shouldnt be promoting such things with out more facts, but i do use glucosamine and chondroitin in my dogs, and ive used other boarderline drugs on them as well. You arent happy with people who fully promote alternative medicines but you are the polar opposite believing in nothing. Wheres the middle ground? Many things we use now in veterinary medicine where once considered bunk. Some of this may become accepted years down the line, with scientific facts to back it up. Please dont close the door on what your saying by how your saying it.

  24. skeptvet says:

    My intent is not to convert those with strong faith in CAM because I doubt those people can be reached. Many CAM approaches are fundamentallly belief systems, philosophies, even religions, and reason and evidence are rarely effective tools for challenging those.

    As for people without a strong commitment either way, the truth is you can’t please everybody. I get lots of feedback that the information and critiques I provide are helpful, but sometimes people such as yourself feel I am too harsh or aggressive. I admit words like “quackery” are polarizing, and I think I probably use them less than I used to. I certainly never referred to glucosamine that way. I think it is a plausible idea that just happens to be wrong, and unfortunately people have a hard time accepting that.

    But homeopathy, pet psychics, energy medicine, and lots of other CAM approaches deserve the contempt in the word quackery. They are manifestly nonsense, and the evidence concerning them is not at all ambiguous. People cling to them for ideological and psychological reasons, but true humility and intellectual honesty ought to make us abandon them entirely, and I feel no shame at describing them for the nonsense they are.

    As far as factual arguments, I think you’ll find my posts are full of them. I rely primarily on facts as the basis for the opinions I form, which is what I think distinguishes science-based medicine from CAM, which relies far more heavily on experience, intuition, tradition, and other less reliable epistemological methods. You claim that many practices now accepted were once dismissed. I would point out that while this is true, far more practices once dismissed as nonsense actually were nonsense and we have simply forgotten them. I would also point out that new ideas are more likely to be accepted by those of us committed to science-based medicine because we are inclined to judge them on the basis of facts. Most CAM practices rely on tradition and authority and reject any evidence that these may be wrong. Is it more open-minded to practice what you believe is an unchanged thousand year old tradition, or to constatntly update and alter your practices based on the latest evidence, as cientific medicine does?

    I’m not sure what you mean by “middle ground.” I try to examine each claim fairly and objetcively, and I often end up simply asserting that the evidence is inconclusive and that no firm position is justified for or against the idea. This, again, distinguishes my approach from many of the people I critique, who are actively promoting unproven hypotheses or guesses as facts. The open-minded, middle ground, it seems to me, is not making no judgements, but making judgements when the facts justify doing so and remaining open-minded and skeptical when the evidence is unclear.

    Finally, I sense a little dislike of the very fact that I criticize other people and their practices. There does seem to be a subset of commenters here who feel it is just rude to criticize anybody who is promoting something in good faith, even if what they are promoting is pure BS. I disagree. For one thing, if you read the writing of pro-CAM advocates, who FAR outnumber the few skeptics out there, they are often vicious in pointing out the failings of conventional medicine, and even blaming science-based practices for all the health problems they claim to treat. And if you make even a cursory search of the Internet, you will find hundreds of sites promoting these ideas, most of them also selling related products. Yet you choose to chastise one of the very few sites trying to present the facts and arguments these sides won’t, and doing so in my spare time as a public service, without marketing anything. Am I really the problem?

  25. vettechkatie says:

    I guess you misunderstood my intent. As you say i am chastising you. I think you may see things as i agree with you, or i think your an idiot. Its not that way for most people. I am saying even though i agree with most of what you are saying, your tone makes me NOT want to agree with you. I know thats sad, and its possible that since you are an analytical thinker it is that clear cut for you. I am simply saying that getting your point accross in a lighter, thus middle ground, tone, may entice people to read your posts, and think about what information you put in it, rather than deciding they dont like you and that makes your post irrelevant. Its human nature to feel this way, as you too became defensive about my critique of your blog. Maybe you also play a hand in the types of responses youre receiving?

    Its not the information you give, more the way you approach it. Making people feel as if “you must be stupid if you believe this” will only make those who already agree with you agree. Yes most natural herbal mumbo jumboists do say all sorts of things and shove ideas down your throat, but, that same approach will hurt them as it turns people off to there cause. This is just an avarage joe readers feelings after reading your blog. I had no prior impression of you, just wanted to know what aaha was up to. I did feel sad your point was lost to me in feelings that were created reading your post, so i figured being on the same team for the most part i would tell you my opinion.

  26. skeptvet says:

    I think I understand what you’re saying, I just don’t see it the way you do. For one thing, I think you are taking your personal taste and emotional reactions and extending them into a generalization about how others see what I write and what works most effectively in communicating with everyone. Some people do object to my tone, many see it as quite civil and calm, and others think I am not nearly aggressive enough. If you look at Mark Crisplip or Stephen Barrett, both activists for science-based medicine whom I greatly admire, they make far greater use of ridicule and sarcasm than I do. I submit I am the middle ground.

    And if you read a selection of my posts, you will see that in almost every one I take great pains to clarify that I believe the people I am writing about are mistaken but honest and well-intentioned (which is far more charitable than how they often characterize me). I constantly point out that the reason we need science to tell us what works and what doesn’t is that all humans, myself included, share cognitive blind spots that lead us to false conclusions. I explicitly say over and over again that smart, eduated people are just as easily fooled as anyone, so I don’t agree that there is any implication that people who don’t see things my way are stupid.

    So I’m not sure what you are reacting to, apart from the very occassional moment of passion or amzement in which I identify a particular egregious practice as “quackery” or “nonsense” (still almost always careful to label the practice and not the person whenever posisble). I accept that you have the reaction you do to my writing, and there may be places where it would generate a similar reaction in others, but overall I don’t agree with your assessment of my tone or impact. The overwhelming majority of offended comments I get are from true believers who resent any criticism of their beliefs, and the majority of those like yourself wwho tend to agree with my positions tell me they appreciate and enoy my work here. So I suspect your reaction, though perfectly legitimate, is not representative. And in any case, as I tried to say before, you can please everybody, and we all have to stay true to our values and our authentic voice, even if not everyone appreciates it. Anyway, thanks for the comment.

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