There must be something in the air. Lately, I’ve run across a number of stories about regulatory agencies trying to crack down on illegal or unsupported medical claims, in Switzerland and the United Kingdom. I am a bit pessimistic about the practical effects of these efforts, but it is always good to see any attempt to promote science and reason as key elements in the regulation of medicine. Now a private veterinary group, the California Veterinary Medical Association (CVMA) is getting into the act (well, sort of).
Professional veterinary associations such as the CVMA and the national AVMA, are lobbies for veterinarians, and they are membership organizations. As such, they tend not to take strong stands on issues about which there is any controversy among their members. For example, since proponents of “holistic” and other alternative veterinary medical approaches are active members of such groups, the organizations rarely make any but the most superficial and vague statements about the scientific legitimacy of CAM practices or the importance of evidence-based standards of care. However, such lobbies are aggressive in protecting the turf of veterinarians, which tends to lead to a tacit position of “Anything goes, so long as it is a licensed vet doing it.” As disappointing and irresponsible as this is, it is probably an inevitable outcome given the internal politics of these groups.
The CVMA recently announced a vigorous Illegal Practice Campaign. According to the organization’s statement:
The CVMA is strongly opposed to the illegal practice of veterinary medicine by unlicensed persons providing illegal services in unregulated locations. We further promote and support efforts by the California Veterinary Medical Board and the Department of Consumer Affairs to enforce criminal sanctions against unlicensed activity, thereby protecting the consumer and safeguarding the health and welfare of animals.
The CVMA conducted a survey of its members, and many reported illegal treatment of animals by unlicensed individuals. Most of these reports came from clients, who told their veterinarians about having used such services, or from advertisements. The largest single treatment was anesthesia-free teeth cleaning, reported by 62% of veterinarians. This is a procedure once commonly offered by veterinarians, but it is now generally believed to be useless in the prevention or treatment of dental disease and so it has been replaced by dental cleanings performed under anesthesia
Interestingly, the next most commonly reported activity was chiropractic treatment of animals, reported by 32% of veterinarians. As I have discussed before, the California Veterinary Practice Act is very specific about the requirements for chiropractic treatment of animals. The full text is copied at the end of the post, but in brief:
1) First that a vet examine the pet, determine that MSM is appropriate and safe, and take official responsibility for supervising the treatment.
2) Then the owner is supposed to sign a form as follows: (This is a direct quote from the regulations) “The veterinarian shall obtain as part of the patient’s permanent record, a signed acknowledgment from the owner of the patient or his or her authorized representative that MSM is considered to be an alternative (nonstandard) veterinary therapy.”
3) Then a licensed chiropractor can examine the pet, determine that MSM is appropriate, and then consult with the supervising vet before performing treatment.
Other common unlicensed activities reported by small animal veterinarians included vaccination and acupuncture. And in its report on the subject to veterinarians, the CVMA emphasized that veterinarians are violating the law when they refer clients to unlicensed providers of veterinary services.
This campaign is being marketed in terms of “protecting the consumer and safeguarding the health and welfare of animals.” I have no doubt this is a genuine motive behind this campaign. I have seen the harm irrational therapies can inflict on pets, both directly and by interfering with the use of appropriate scientific diagnostic and treatment interventions.
Unfortunately, it is hard not to suspect that protection of the territory and livelihood of veterinarians is also part of the motivation for this campaign. The campaign is very specific in targeting interventions performed by unlicensed individuals, which is appropriate, while also ignoring the problem of veterinarians utilizing bogus, unscientific therapies, which is not appropriate. As an organization made up of veterinarians, this inconsistency is probably unavoidable, but it is disappointing nonetheless.
Nevertheless, if veterinary licensure and regulation is to have any meaning, and to be of any value in protecting animals and their owners, the regulations must be enforceable, so I thoroughly support the CVMA campaign. Hopefully, this campaign will improve enforcement of these consumer protection laws and discourage these practices, though I fear it may only shift the application of unproven or useless therapies to the domain of veterinarians, which would largely undermine the benefit for the public.
I think it is significant that two prominent alternative therapies are among the most commonly offered illegally to pet owners. Proponents of such therapies often believe passionately in their value despite the evidence against them, and they are ideologically inclined to view any regulatory limitations on their activities as solely protectionist rather than as an attempt to protect the public from unproven or unsafe treatments. This makes ignoring the law seem almost like a moral duty. And despite the fact that groups such as the CVMA may have some self-serving motives in acting against such practices, this is no different from the self-serving motives chiropractors and acupuncturists have in offering their therapies to pet owners illegally, so this issue doesn’t alter the fact that providing such services is illegal and not supported by legitimate scientific evidence.
The CVMA also states that in addition to encouraging enforcement of existing laws and regulations, “Our next step is to introduce legislation to strengthen the laws…” This campaign could be improved, and made more effective in protecting animals and their owners, if this new legislation included language setting rational, science-based standards of veterinary care. As I recently discussed with respect to the AVMA model practice act, language in medical practice acts regulating MDs would be appropriate for veterinary regulations as well, such as sanctioning “employing methods of treatment or diagnosis that do not conform to the standards of acceptable and prevailing scientific medical practice.” It would be a powerful (and surprising) act of principle for the CVMA to propose such language in veterinary practcie laws, since this would involve actually regulating the therapies offered by licensed veterinarians, which veterinary organizations have historically been loath to do.
California Veterinary Practice Act: Animal Chiropractic (Musculoskeletal Manipulation)
2038. Musculoskeletal Manipulation.
(a) The term musculoskeletal manipulation (MSM) is the system of application of mechanical forces applied manually through the hands or through any mechanical device to enhance physical performance, prevent, cure, or relieve impaired or altered function of related components of the musculoskeletal system of animals. MSM when performed upon animals constitutes the practice of veterinary medicine.
(b) MSM may only be performed by the following persons:
(1) A veterinarian who has examined the animal patient and has sufficient knowledge to make a diagnosis of the medical condition of the animal, has assumed responsibility for making clinical judgments regarding the health of the animal and the need for medical treatment, including a determination that MSM will not be harmful to the animal patient, discussed with the owner of the animal or the owners authorized representative a course of treatment, and is readily available or has made arrangements for follow-up evaluation in the event of adverse reactions or failure of the treatment regimen. The veterinarian shall obtain as part of the patients permanent record, a signed acknowledgment from the owner of the patient or his or her authorized representative that MSM is considered to be an alternative (nonstandard) veterinary therapy.
(2) A California licensed doctor of chiropractic (chiropractor) working under the direct supervision of a veterinarian. A chiropractor shall be deemed to be working under the direct supervision of a veterinarian where the following protocol has been followed:
(A) The supervising veterinarian shall comply with the provisions of subsection (b)(1) prior to authorizing a chiropractor to complete an initial examination of and/or perform treatment upon an animal patient.
(B) After the chiropractor has completed an initial examination of and/or treatment upon the animal patient, the chiropractor shall consult with the supervising veterinarian to confirm that MSM care is appropriate, and to coordinate complementary treatment, to assure proper patient care.
(C) At the time a chiropractor is performing MSM on an animal patient in an animal hospital setting, the supervising veterinarian shall be on the premises. At the time a chiropractor is performing MSM on an animal patient in a range setting, the supervising veterinarian shall be in the general vicinity of the treatment area.
(D) The supervising veterinarian shall be responsible to ensure that accurate and complete records of MSM treatments are maintained in the patients veterinary medical record.
(c) Where the supervising veterinarian has ceased the relationship with a chiropractor who is performing MSM treatment upon an animal patient, the chiropractor shall immediately terminate such treatment.
(d)(1) A chiropractor who fails to conform with the provisions of this section when performing MSM upon an animal shall be deemed to be engaged in the unlicensed practice of veterinary medicine.
(2) A veterinarian who fails to conform with the provisions of this section when authorizing a chiropractor to evaluate or perform MSM treatments upon an animal shall be deemed to have engaged in unprofessional conduct.