Introduction
As regular readers will know, herbal medicine is the area within complementary and alternative medicine I am most sympathetic to. Plants obviously contain chemical compounds that can have significant physiologic effects, for good or ill. And many conventional medicine have been derived from such plant compounds. The idea, then, that the medicinal use of plants and plant-derived substances might have real value is plausible, even likely, in my opinion. So far, very few uses of herbal remedies have been scientifically validated (as distinct from isolated and purified compounds derived from plants and used as drugs). However, I believe there is significant potential in plants as sources of medicines, and I support rigorous scientific research in this area.

Unfortunately, herbal medicine as a discipline is often not focused on scientific evaluation of the potential risks and benefits of herbal remedies. Instead, it tends to be uncritically accepting of truly alternative theories about health and disease and of traditional or anecdotal evidence alone as the foundation for the selection and use of plant products as medicines. Traditional Chinese Medicine (TCM or TCVM for the veterinary variety), the Indian folk tradition of Ayurveda, and other dominant approaches in herbalism often reject scientific principles or evidence in favor of mystical folk models of health and disease, and such herbalists often view scientific evidence only as a tool for gaining wider acceptance of their practices, not for determining which are effective and safe and which are not. As is true in so many areas of CAVM, herbal medicine practitioners tend to find science useful only insofar as it supports their beliefs, but they tend to reject negative findings or the failure to find good evidence for their practices and persist in these beliefs and practices based on personal experience, tradition, and anecdote regardless of what science says.

There are also other serious problems with the area of herbal medicine as it currently exists. There is virtually no regulation and very little scientific investigation of herbal products. When sampled, many herbal products turn out not to contain what they are supposed to contain, and contamination with toxic heavy metals, potentially poisonous plant chemicals, and even conventional pharmaceuticals appears to be common (1, 2, 3, 4, 5). There is evidence that these unregulated and untested remedies cause significant injury and illness (6, 7, 8).

So while I think there is significant medical potential in plants and their incredible array of natural compounds, the herbal medicine industry (and make no mistake, it is a multi-billion dollar industry: 9, 10) as it currently exists is largely unscientific and insufficiently regulated and herbal remedies and supplements have very few proven benefits and some serious risks. The unfortunate tendency of herbalists is to rely on tradition, anecdote, and unscientific folk theories about health to guide their use of untested plant remedies and to utilize science primarily as a marketing tool rather than a necessary means of developing safe and effective herbal treatments. There are certainly individual exceptions, but this is the general character of the industry.

I was therefore both interested and concerned when I recently learned that the American College of Veterinary Botanical Medicine (ACVBM) is in the process of seeking recognition as a veterinary specialty organization. The American Board of Veterinary Specialties (ABVS) is the unit of the American Veterinary Medical Association (AVMA) that recognizes areas of specialization in veterinary medicine and the organizations that certify individual veterinarians as specialists in these areas. Similar organizations perform his function in other countries (such as the European Board of Veterinary Specialisation (EBVS) Australasian Veterinary Boards Council (AVBC)) and in human medicine (e.g. American Board of Medical Specialties  and the European Union of Medical Specialties).

What is a Medical Specialty?
The purpose of official recognition for medical specialties is so that patients and pet owners can know which clinicians are likely to have a high-level of training or expertise in a particular medical area. In human medicine, specialists are often very highly focused on narrow subjects. After more than a decade of education and training, for example, surgeons may only perform a few procedures on one part of the body. While there are some problems with excessive specialization, it is clear that medicine is far too large a body of information, tools, and techniques for any one person to master it all. Specialists do fewer things, and they tend to do them better than more generally trained and experienced doctors.

In veterinary medicine, specialization is less common than in human medicine due to economic factors. Because specialists, and their additional training and experience, are more expensive than general practice vets, many vets without board certification in a specialty will still commonly work in areas that have recognized specialists. I do cardiac ultrasounds, treat cancer with chemotherapy, perform a wide range of surgical procedures, and manage chronic skin conditions despite the fact that there are recognized specialists in the areas of veterinary cardiology, oncology, surgery, and dermatology. There are pros and cons to choosing a specialist or a generalist to treat your pet for particular health issues, but there is no question that specialists have deeper knowledge and greater experience and expertise in their specialty disciplines than I or other general practitioners have.

The concept of expertise is, unfortunately, under some attack generally these days, especially in the U.S. (e.g. 11) There seems to be a feeling that anyone can be an expert, or declare themselves to be, by virtue of their independent study or experience without going through a recognized educational and training program. This applies more in areas in which the subject and outcomes are not clear and distinct. Few people would attempt to fly a jet or perform open heart surgery without the appropriate specialized training because the consequences of inadequate skill and expertise are obvious and dramatic. However, people with little or known scientific or medical training often feel equipped to doubt or deny the consensus among true specialists in areas like climate change or medicine.

In CAVM, the concept of specialization is especially problematic in a different sort of way. Homeopaths, Chinese Medicine vets, even psychics and astrologers will often declare themselves to be “experts” in their fields and deny the legitimacy of criticism from others, regardless of the credentials of critics or the evidence presented, if their critics do not have the same training and experience in these fields. However, if homeopathy and TCVM are just sets of made-up ideas without scientific validity, what is the value of expertise in these subjects?

The analogy I often use is that of the Catholic priest as an expert in Catholicism. There is no question a priest has superior knowledge and experience in the details of the Catholic faith, so in some sense he is an expert. However, if you are a Jew or a Muslim or an atheist, this expertise is not very meaningful, and it is unlikely to convince you that the priest is right about the details of religious controversies. Similarly, while I agree homeopaths know more about homeopathy than I do, I know enough to understand the subject of their expertise is an unscientific fantasy, so I have no obligation to defer to their views on the controversies about it.

Should Herbalism Be a Recognized Veterinary Specialty?
All of this is intended to provide a context for answering the question, “Should herbalism be recognized as a veterinary medical specialty?” This has to be answered both generally and in terms of the specific application of the ACVBM for recognition as a specialty organization by the ABVS.

In general terms, I think specialty status for herbal medicine is not warranted because the evidence base for the area is too limited and it is still plagued with deep-rooted unscientific concepts and practices. In theory, such an area could be a legitimate scientific specialty if the attitude towards science changes and the evidence base is properly developed, but that is not yet the case. No herbalism specialty is recognized in human medicine or veterinary medicine in the US, Europe, or Australia, which would make recognition of the ACVBM unprecedented.

In terms of the specific application, it is clear after reading it and investigating the provenance and the leadership of this organization that recognition of the ACVBM as a specialty organization would be a serious mistake. I will discuss why in detail below, but this organization is dominated by TCVM vets and key figures in the American Holistic Veterinary Medical Association (AHVMA), a deeply anti-science organization that promotes every imaginable alternative practice, from herbal medicine to homeopathy and faith healing. Most of the leadership practices multiple varieties of CAVM, not only herbal medicine, and many have made worrying comments about science and conventional medicine that suggest they fundamentally don’t accept the principles and practices of science-based medicine. This application is less about making herbalism a scientific specialty within veterinary medicine than it is about getting a foot in the door to obtain the AVMA’s imprimatur of mainstream legitimacy for alternative veterinary medicine of all sorts without demonstrating the truth of their theories or the safety and efficacy of their methods through sound scientific research.

The ACVBM Application for Specialty Status
The ABVC is the AVMA organization that recognizes veterinary medical specialties. It consists of representatives from the existing specialty groups and non-voting members from a couple of other organizations. The ABVS has a detailed description of the standards for obtaining specialty recognition. Unfortunately, and in keeping with the general approach of the AVMA to support veterinarians in virtually anything they choose to do but to assiduously avoid setting standards for veterinary medicine, these criteria go into great detail about the mechanisms and procedures for functioning as a specialty board but make little mention of science or any criteria for judging the legitimacy of a proposed specialty area. Obviously, any organization can follow a template for governance and for administering examinations and such, so being able to meet these standards says nothing about the legitimacy of the subject area. The few sections that seem to address this more important issue are these:

The AVMA American Board of Veterinary Specialties (ABVS) is the umbrella organization for veterinary specialties within the United States. It is composed of one voting representative from each of the AVMA-recognized veterinary specialty organizations, plus non-voting liaisons from the Association of American Veterinary Medical Colleges and the AVMA Council on Education.

For a veterinary specialty organization (or their independent certification board) to be recognized by the AVMA, they must:

Demonstrate that improved veterinary medical services will be provided to the public.

Serve a clearly defined need within the profession.

Represent a distinct and identifiable specialty of veterinary medicine, one that is supported by a base of scientific knowledge and practice that is acceptable to the profession and the public. [emphasis added]

Let’s take a look at the ACVBM application and some of the problems and questions it raises, including the extent to which it might or might not meet the ABVS criteria for recognition.

Would Recognition Improve Veterinary Medical Services to the Public?
The ACVBM medicine asserts that “improved veterinary medical services” will be available to animal owners by the recognition of ACVBM based on the assumption that herbal medicine is a safe and effective tool for improving patient care. Unfortunately, this is not a scientifically demonstrated assertion. The debate about the research evidence for herbal remedies is a complex one, and the devil is in the details. There are many published research studies that appear to show benefits to herbal remedies and supplements. However, there are many published studies support the same claims for homeopathy, but a detailed examination of the literature shows that homeopathy almost certainly has no real benefits at all (12, 13). The ability to cite lots of papers does not by itself show a robust scientific support for a specific medical approach.

While I have not examined the herbal literature in as much detail as that pertaining to homeopathy, I have studied the main textbook for veterinary herbal medicine and looked at many of the specific studies cited in the ACVBM application. The evidence is generally weak and inconsistent, it often does not support the claims it is cited by the ACVBM to support, and overall the body of robust, consistent scientific evidence supporting herbalism that the ACVBM claims does not exist. There is good evidence for a few specific remedies used for a few specific conditions. But there is no evidence to support most of the theoretical foundations on which most herbalists rely. TCVM as a diagnostic and therapeutic system, the concept of “tonics,” the general principle that mixtures of plant compounds given in raw form are safer and more effective than isolated compounds used as drugs, and many other key concepts herbalists rely on run counter to established science or are, at best, unproven beliefs.

So the claim that giving greater legitimacy to the group would enhance the care provided to the public rests on shaky ground. You cannot improve care by calling pseudoscience a specialty, and much of the popular approach to herbalism, especially the dominant approach of TCVM, is pseudoscience.

Is Herbalism Supported by Scientific Knowledge and Practice?
I have already answered this question to a certain extent. There is much scientific evidence relating to specific compounds or remedies, but the vast majority of herbal remedies remain untested outside of lab animals. And the concepts upon which diagnosis and prescribing by herbalists rests are not only not yet validated but typically inconsistent with a scientific understanding of health and disease. However, I want to explore in more detail why the claims to a scientific approach made in the ACVBM application appear disingenuous and generally untrue.

For one thing, the ACVBM claims it would become the specialty responsible for pharmacognosy, the practice of identifying medicinal compounds in plants. This is currently the domain of pharmacology, a recognized specialty area (under the American College of Clinical Pharmacology (ACCP)). The organization also claims it should take over the use of plant-based remedies and supplements for their nutritional effects, an area currently thought to fall in the territory of the American College of Veterinary Nutrition (ACVN). Finally, they claim that their diplomates would be in a better position than specialists in these areas or than diplomates of the American Board of Veterinary Toxicology (ABVT) to recognize and manage the potential toxic effects of plant remedies and their interactions with conventional medicine.

However, while botanical medicine overlaps many other specialties, the depth of knowledge required of a specialist in phytopharmacology and phytomedicine is not covered by any of these. Even the pharmacology College, which might be the closest relation of all the specialties, would concentrate on only a subset of the mechanisms by which herbs work. There are tens of thousands of medicinal plants described in the herbal medicine literature, likely overshadowing the conventional drug pharmacopeia by orders of magnitude. Pharmacology focuses on isolation of a single constituent to characterize and use therapeutically. By contrast, herbalists advocate for the complex actions initiated when a plant or plant extract containing hundreds of compounds – both nutritional and pharmacologic – are in play.

American College of Veterinary Clinical Pharmacology: An important basis of herbal medicine is the pharmacology and mechanisms of actions of plants and plant extracts, however they differ from drugs in their complexity, and in the underlying ethnomedical knowledge base used to prescribe them.. The botanical medicine diplomate can provide context to client and referring veterinarian inquiries, both ethnobotanical and scientific.

American College of Veterinary Nutrition: Functional foods including herbal medicines are being employed in therapeutic diets and products in veterinary medicine. The herbal medicine diplomate will be able to advise on suitable herbs to meet therapeutic needs in product development in the pet food industry and also provide advice on the addition of herbs to diet plans and critical care nutrition to benefit the patient therapeutically.

American Board of Veterinary Toxicology: Toxicologists are familiar with toxic principles of plants. Many of the plants that are considered toxic by toxicologists are also considered therapeutic by botanical medicine specialists, who are necessary to provide this complementary information on plant use and abuse. Herbal medicine specialists will be more informed on dosing that “makes the medicine or the poison”.

However, the basis on which the ACVBM claims it can replace the role of these specialties is a claim of special knowledge specifically derived from areas outside of the realm of science. The claim is essentially that by knowing the folk theories and practices of traditional herbalism, ACVBM diplomates would know more about the safety and use of plant products than specialists who focus on the scientific evaluation of these. The presumption is that folk knowledge is equivalent, if not superior, to scientific knowledge when evaluating the safety and efficacy of herbal remedies. This reveals one of the fundamentally anti-scientific principles that makes much of modern herbal medicine unreliable and unscientific:

[Our vision is to] enhance the integration of scientific, clinical, and traditional knowledge into veterinary medicine practice [emphasis added; This explicitly places folk beliefs on an equivalent level with scientific knowledge.]

An important basis of herbal medicine is the pharmacology and mechanisms of actions of plants and plant extracts, however they differ from drugs in their complexity, and in the underlying ethnomedical knowledge base used to prescribe them. [emphasis added; This reveals the often unmentioned fact that traditional theories and historical practices, rather than scientific evidence, generally guide the prescription of herbal remedies.]

The effective use of herbal medicine often requires knowledge of their ethnobotanical medical uses – or familiarity with the culture and medical system that popularized the use of a medicinal plant. [This assumes such traditional folk knowledge is a reliable guide to the medical use of plants, which is unproven and contradicted by the evidence of history, in which traditional folk medicine has never achieved anything like the effectiveness of science-based medicine.]

The herbal medicine diplomate must have an expanded understanding in the areas including, but not limited, to principles of herbal medicine (whether ethnomedical or scientific principles are being used in decision-making)…

The uniqueness of this new specialty is that it is using treatments outside of the established pharmacological research model, yet still having a strong rational basis in pharmacology. [Unfortunately, it is clear that herbal treatments are often outside the science-based model, but it is not at all clear that most have a rational basis in pharmacology.]

Veterinarian herbalists understand the dosing of herbs because of the variability of the plant medicines and clinical and patient related factors affecting dosing of botanical medicines. The herbal medicines are variable in form and concentrations and bioavailability; knowing how to relate research to the form of herb is important for efficacy and safety. This is distinct from use of drugs with more consistent formulations, but also distinct from the science of clinical nutrition where food ingredients are generally safer than herbal drugs. [Herbs are quite variable in the compounds they contain from batch to batch, which is part of why isolation and standardization of such compounds into drugs has been so much more effective than the historic folk-based empirical use of raw plants. Herbalists only know more about these issues in the sense that they trust traditional wisdom and practice to guide them even without scientific research into the risks and benefits of specific remedies.]

For instance, there are many plants used as traditional “tonics”, intended to invigorate normal organ functions. While some of these traditional tonics and alternatives have recognized activities, such as antioxidation or microbiome support, some are still not well enough understood to classify them in a physiologic or pharmacologic sense. [The concept of a general “tonic” is an unproven folk belief.]

The Role of Traditional Chinese Medicine in the ACVBM
It is clear from the application itself, and even more so from the personnel composing the organizing committee of the ACVBM, that the dominant approach which will be promoted by this group as a specialty board will be TCM. Nearly all of the members of the organizing committee have an affiliation with the Chi Institute, a private school teaching Chinese Veterinary Medicine, include Dr. Husheng Xie, the founder of this company. Most have studied TCVM there, and many are instructors in this method. All but three explicitly advertise their use of TCVM in their own practice. There is no question that TCVM is the foundation for herbal prescribing favored by the leadership of the ACVBM, and it is specifically mentioned several times in the descriptions of the subject matter potential diplomate will need to master. This is much of what is meant by “traditional knowledge” in the ACVBM document.

The problem with this is that TCM is an alternative system for understanding health and disease which is entirely independent from, and inconsistent with, the scientific understanding. It views disease as arising from imbalances of mystical forces, such as Chi or Yin and Yang, and metaphorical humors such as Wind, Damp, Heat, and so on. Diagnoses such as “rebellious Chi” or “Excess Wind” are made based on behavioral and historical information, tongue color and texture, pulse quality, and other unvalidated traditional means. These diagnoses are then used to guide acupuncture treatment and the use of herbs, which are categorized in their effects by taste, appearance, and historical use rather than any scientific analysis of their components or physiologic effects. TCVM is not a specialty area within scientific veterinary medicine, it is an alternative to it. It would make no sense to legitimize this practice by calling it Veterinary Botanical Medicine.

There are, of course, other herbalist approaches represented in the leadership of the ACVBM. Some also promote Western Herbalism, and this is mention along with Chinese medicine in the application. However, this is simply a different, but equally unscientific, set of folk traditions about the use of plants to treat disease, and again not a scientifically legitimate therapeutic approach. Some members of the committee do also advocate a conventional scientific understanding of plants as potential medicine, but even they rely primarily on traditional means of selecting and using herbal remedies, viewing science as following rather than leading the way in developing herbal medicine.

The ACVBM as a Trojan Horse for Alternative Medicine
The background, writings, and practices of the members of the ACVBM organizing committee quickly makes it clear that this effort involves more than strictly herbal medicine. As I mentioned, almost all of the members practice acupuncture and Chinese Medicine generally, not simply the use of Chinese herbal products. Nearly all of them are also members of the American Holistic Veterinary Medicine Association (AHVMA). This organization promotes all CAVM practices, not only herbal medicine, and they have been on the forefront of defending and promoting homeopathy, energy medicine, faith healing, and many other pseudoscientific or unscientific practices. Many are also affiliated with the College of Integrative Veterinary Therapies (CIVT), which teaches courses not only in Chinese and Western folk herbalism but acupuncture, alternative nutrition, homeopathy and homotoxicology, and other alternative approaches. A majority even list homeopathy as part of their practice. These are not merely individuals with expertise in botanical medicine but committed advocates and practitioners of a wide range of alternative and unscientific methods.

Finally, in their teaching and advocacy of alternative therapies, a number of the leaders of the ACVBM have expressed views about science or scientific veterinary medicine that appear to contradict the claim of the ACVBM application that scientific evaluation and use of herbal remedies will be a focus of the group. I have listed the members of the committee, some of their professional affiliations, some of the CAVM methods they advocate, and some of the comments they have made that should concern the ABVS. I don’t mean to suggest that these individuals are not smart, educated, caring veterinarians, as they most certainly are. However, I believe they share an ideological approach to veterinary medicine that is at odds with science and, therefore, ultimately not in the best interests of patients or the profession. I also believe that their purpose in seeking specialty recognition for the ACVBM is to obtain the appearance of a scientific legitimacy to herbal medicine, and to a wider array of alternative medicine practices, that has not been earned through rigorous scientific evaluation.

Bottom Line
I believe there is great potential in plants and plant-derived compounds to provide safe and effective medicines for veterinary patients. However, current dominant views and practices in herbal veterinary medicine, especially those from the folk traditions of Traditional Chinese Medicine, Ayurveda, and traditional Western herbalism, are unproven and frequently unscientific. Herbal remedies are frequently mislabeled or contaminated with potentially harmful ingredients, and without greater research and regulation, they are unpredictable and sometimes dangerous to patients.

The ACVBM is led by a group of veterinarians with a long history of supporting and advocating alternative medicine generally, not only herbal medicine. Many belong to the AHVMA, practice homeopathy or other unscientific and unproven or clearly ineffective therapies, and several have expressed views about science and conventional medicine inconsistent with status as board-certified veterinary specialists. There are members who I believe have a genuine commitment to scientific evaluation of herbal remedies, but they are a small minority and they are, at the least, willing to accede to the promotion of unscientific ideas in CAVM.

The recognition of ACVBM as a specialty board would be a mistake. It would create, in the eyes of other veterinarians and animal owners, the appearance of scientific legitimacy to unproven and inherently unscientific herbal medicine theories and practices. And it would undoubtedly be a foothold for the spread of even more dramatically unscientific alternative medicine practices under the color of specialized expertise. Herbalism has not been recognized as a legitimate medical specialty in human or veterinary medicine in Europe, Australia, or the United States because the evidence does not exist to validate most of the theories and practices involved. The purported expertise this certification would recognize is largely a mastery of ideas and information not consistent with nor validated by scientific methods. Scientific evaluation of plant medicine should continue as part of the normal course of medical and pharmacologic research.

Sample Letter to ABVS
Below I have copied a letter I will send to the ABVS opposing recognition of the ACVBM as a specialty organization. I encourage anyone else who shares my concerns to contact the ABVS as well, and you are welcome to use any or all of the text of my letter or the information posted here. Comments from the public will be accepted until September 1, 2017.

American Board of Veterinary Specialties
c/o Mr.David Banasiak
1931 N. Meacham Rd, Suite 100
Schaumburg, IL, 60173
DBanasiak@avma.org

Dear Mr. Banasiak:

I am writing to oppose the recognition of the American College of Veterinary Botanical Medicine (ACVBM) as a veterinary specialty organization. The ACVBM does not meet the core criteria set forth by the ABVS, and recognition would not be in the best interests of animal owners nor the veterinary profession.

Botanical medicine is not recognized as a medical specialty, in human or veterinary medicine, in the U.S., Europe, Australia, or most other scientifically advanced nations because the research evidence concerning herbalism and botanical remedies does not support this status. Prescribing practices are largely untested and based on folk medicine beliefs and traditions, and most herbal products are untested and un-regulated. Very few herbal therapies have been validated by the type of high-quality clinical trial evidence typically required for pharmaceutical medicines. Problems with mislabeling and contamination by toxic adulterants and pharmaceuticals is frequently reported for herbal products, with documented harm to patients. While there is great potential for medicinal use of plant-derived compounds, this potential can best be realized through pharmacognosy and other conventional forms of scientific research under the auspices of clinical pharmacology, toxicology, and other existing medical specialties.

The primary distinction the ACVBM offers between its approach and current conventional research and application of herbal remedies is the use of “traditional knowledge” to guide herbal prescribing. This means that the theories and practices of folk medicine traditions are considered sufficient to guide the use of herbal medicines, even when controlled research evidence is unavailable or contradicts traditional theory and practice. Almost none of this “traditional knowledge” has been validated by controlled research, and much of it is incompatible with established scientific principles and knowledge.

Illustrating the reliance of the ACVBM on unscientific principles is the affiliations and practices of the members of the ACVBM Organizing Committee. Nearly all are affiliated with the Chi Institute or other Chinese Medicine organizations, and most are practitioners of Traditional Chinese Medicine (TCM). TCM is an alternative system for understanding health and disease which is entirely independent from, and inconsistent with, science-based medicine. It views disease as arising from imbalances of mystical forces, such as Chi or Yin and Yang, and metaphorical humors such as Wind, Damp, Heat, and so on. Diagnoses such as “Rebellious Chi” or “Excess Wind” are made based on behavioral and historical information, tongue color and texture, pulse quality, and other traditional means. These diagnoses are then used to guide the use of herbal products, which are categorized in their effects by taste, appearance, and historical use rather than any scientific analysis of their components or physiologic effects. TCVM is not a specialty area within scientific veterinary medicine, it is an alternative to it. Recognizing the ACVBM would effectively identify TCM herbalism as a legitimate scientific medical practice without appropriate evidence to support this status.

Additionally, a majority of the ACVBM leadership is also affiliated with the American Holistic Veterinary Medical Association (AHVMA), and many have served in the leadership of this group. The AHVMA promotes and defends every type of alternative medicine, from herbalism and acupuncture to homeopathy and faith healing. Most of the Organizing Committee members promote or utilize numerous alternative therapies other than herbal medicine, and many have been publicly critical of conventional and evidence-based medicine and have recommended greater reliance on traditional knowledge and personal experience. These views do not support a rigorous scientific standard for developing safe and effective therapies and would not promote more evidence-based and higher-quality patient care.

The best way to develop the potential of plant-based medicines is to continue rigorous scientific research into herbal remedies, based on established scientific principles and methods. This progress can best be accomplished through the existing veterinary specialty areas. Traditional use may suggest testable hypotheses, but it is not a reliable guide for prescribing. Recognition of the ACVBM would be counterproductive in encouraging folk medicine-based approaches and in giving the ABVS imprimatur of scientific legitimacy to theories and practices which do not merit it. This would mislead veterinarians and animal owners and encourage the promotion of unscientific alternative practices.

Members of the ACVBM Organizing Committee:

Signe Beebe
CAVM Affiliations- Chi Institute, AHVMA, several TCM and integrative medicine organizations
Other CAVM Methods- TCVM, Reiki, IV vitamin C for cancer, prolotherapy

Ihor Basko
CAVM Affiliations- AHVMA
Other CAVM Methods- TCVM, homeopathy, alternative nutrition
Comments-
In response to an article I wrote critical of the AHVMA-

“If you were a legitimate blog looking for the Truth and not a shill for the pharmaceutical companies, you would have researched both sides of any issue.”

“Keeping comments and ideas one sided and supported pharmaceutical and commercial pet food monopolies which have been raking in the money for many decades. Threatened financially and ideologically, they must resort to political tactics of attack, shock and awe using headlines inspired by the National Inquirer or some other ladies gossip rag.”

Shauna Cantwell-
CAVM Affiliations- Chi Institute, AHVMA
Other CAVM Methods- TCVM, electrotherapy, chiropractic, homeopathy/homotoxicology
Comments-
In a CE lecture, Dr. Cantwell suggests that “clinical wisdom” is ahead of science and sufficient to act on while we watch for science to catch up to our knowledge.

“…the question remains as to whether clinically the data support effectiveness, and whether the right questions are being asked to produce illustrative data. Evidence-based medicine is the integration of the best research evidence with clinical expertise and patient needs. Research in this field has yet to catch up with clinical wisdom.”

Cynthia Lankenau-
CAVM Affiliations- Chi Institute, CIVT, AHVMA
Other CAVM Methods-TCVM, chiropractic, homeopathy/homotoxicology, Reiki, Shamanism
Comments-
“I am very encouraged by the acceptance in some corners of the conventional world, enough to truly hope and believe that every veterinary college in the future will offer training in all alternative modalities, minimize drug use, and truly practice wellness maintenance medicine.  But I see two problems both created from greed.  I am nervous that when the conventional world realizes the loss of income from animals being truly healthy, they might wage an aggressive smear campaign.”

Rob Silver–
CAVM Affiliations- AHVMA , Chi Institute
Other CAVM Methods- TCVM, homeopathy
Comments-

Recommends, “a patient-specific prescription of Chinese herbs, based on tongue, pulse and behavioral assessments.”

“Chinese medicine assigns emotions to each of the Zang-Fu organs. The practitioner can assess aspects of those organs disharmony by observing their patient’s emotional expressions and through conversation. Animals speak to us of their emotional landscapes by means of their behaviors. Some emotions and behaviors are fairly easy to assess. Anger, as an expression of liver imbalance, for instance, can manifest as an act of aggressiveness in a dog or cat….There are a number of Chinese prescriptions that can help to address these Zang imbalances.”

Steve Marsden-
CAVM Affiliations- AHVMA, CIVT
Other CAVM Methods-TCVM, homeopathy, chiropractic, naturopathy
Comments-
Examples of prescribing style:

“When we want to both tonify Blood and pull off fluid, Dang Gui Shao Yao San is a consideration”

“Given the overt Blood deficiency and history of chronic vomiting, I’d wonder about adding in Yi Guan Jian.”

“I agree with your Damp Heat assessment, and would suggest starting with Si Miao San…I hear what you’re saying about coolness. However, long term damage to Blood and Yin by Damp Heat can create Blood deficiency, and with that a superficial chilliness. If you’re quite sure, however, that he’s too cold, then I’d wonder about Chu Shi Wei Ling Tang. This augmentation of Wei Ling Tang might address the skin condition, even as the Wei Ling Tang at its core addresses long term IBD and even the insulin resistance characteristic of Cushings. So, for a Cold, dog (with, for example a cold tongue and overt sun-seeking), it would be my first choice.”

“Homeopathic Ferrum metallicum 30C can be helpful in animals vomiting their food undigested hours after eating.”

Hubert Karreman-
CAVM Affiliations-none found
Other CAVM Methods- numerous (see comment)
Comments-

In a newsletter, Dr. Karrman provides this view of CAVM:

“My opinion is that we should use whichever mode of treatment that we feel intuitively drawn to.”

“A short listing of CAVM groupings with specific some examples follow: food therapy – preventive nutrition, therapeutic nutrition, glandular therapy and orthomolecular medicine; manual therapy – massage, acupressure, acupuncture, osteopathy, chiropractic, and physical therapy; biological therapy – hyper-immune plasma, hyper-immune eggs, serum therapy, bee sting therapy, and pharmaceutically reared leeches and maggots; botanical therapy – western herbal medicine, traditional Chinese medicine, essential oils and aromatherapy; energy medicine –  Christian laying-on of hands, classical homeopathy, homotoxicology, Bach flower remedies and non-traditional homeopathy. This is not a complete list of course and there are combinations of treatment, like injecting homeopathic remedies at acupuncture points.

In approaching cases and coming up with possible solutions, I like to use hands-on touch to sense where problems may be, careful observation, heightened sense of smell, listen for subtle sounds (with a stethoscope) and intuition to pin point problems. Then I choose from whichever CAVM treatment seems best for each case. Anyone can do this. And while it’s satisfying to be part of a successful outcome, I don’t feel it’s actually me that gets the patient better – that is up to Holy Spirit. I am just a channel for healing to hopefully occur. You can be, too. Using natural therapies honors God’s creation.”

Constance DiNatale-
CAVM Affiliations-Chi Institute, AHVMA
Other CAVM Methods- TCVM, homeopathy, chiropractic

Barbara Fougere-
CAVM Affiliations- AHVMA, Chinese Medicine organizations, CIVT
Other CAVM Methods- TCVM, homeopathy, chiropractic
Comments-
“The greatest joy of being involved in naturopathic oncology is that our toolbox is so much larger than the one other veterinarians draw upon. It is empowering to know that there is always something more than can be done to help our patients, and even more phenomenal to be able to improve their health well beyond expectations, and create “spontaneous remissions”—something that the veterinary paradigm says is impossible…”

“The diagnosis of cancer is important, but the definitive diagnosis is not central to our approach…We need to address all aspects of health and well-being, including physical factors…environmental factors, spiritual aspects, and even genetic factors.”

“From a naturopathic perspective, cancer arises from an imbalance or accumulation of toxicity…”

“Ideally, herbs are prescribed according to the patient’s vitality, energetics, symptoms, concurrent treatments, prognosis, and diagnosis.”

“Detoxification is an herbal medicine principle in cancer treatment, because cancer is thought to be the end result of accumulated toxins in the body.”

Susan Wynn–
CAVM Affiliations- Chi Institute, AHVMA, CIVT
Other CAVM Methods- TCVM
Comments- Dr. Wynn seems to be one of the few members who seems to have a consistent and real regard for the value of scientific evaluation of alternative therapies, including herbal medicine, though she still gives significant deference to traditional practices.

Joyce Harman-
CAVM Affiliations- Chi Institute, AHVMA, CIVT
Other CAVM Methods- homeopathy, chiropractic
Comments-
“Western herbology is based on observations from centuries of experience along with an understanding of the pharmacology of the herbs and modern research. Many of the old texts, from the 1800’s and earlier are still valid sources of information as the authors of the day wrote detailed observations about cases they treated.”

“Make your assessment based on the modality you know well or think will be the best one to start with (i.e.: what is the imbalance?) Ex: Chinese-Spleen Qi deficiency; allopathic–elevated liver enzymes, homeopathic–weak vital force with watery diarrhea, etc.”

Huisheng Xie-
CAVM Affiliations- Founder of Chi Institute, also owns a Chinese Herb supply business
Other CAVM Methods- TCVM
Comments-
According to Huisheng Xie, the leading figure in veterinary TCM in the United States, “no disease occurs if Yin and Yang maintain a relative balance.”

Here are a couple of examples from Dr. Xie’s TCVM textbook illustrating how the method is used to guide diagnosis and prescribing.

1. Signalment: Seven year old, female spayed Labrador Retriever

Primary Complaint: Separation Anxiety

History and Physical Findings: From a Western perspective, the dog has all the signs of separation anxiety. Acupuncture treatment did not help much. She has been on the herbal formula Long Dan Xie Gan Wan for signs of Liver Stagnation. Her tongue is slightly red and dry and her gums are tacky. Her eyes are red. Her pulses are thready and fast.

Assessment: This is a Yin Deficiency Pattern (Deficient Heat), specifically a Heart Yin Deficiency pattern. The Yin Deficiency can be determined from the red, dry tongue (Heat signs) and the thready and fast pulse. The association with the Heart is based on the major complaint of separation anxiety because this is due to a Shen (Spirit or Mind) disturbance. Of the five Yin organs, the Heart is the one that houses the Shen. Separation anxiety and other behavior problems are mostly related to the Heart. The treatment strategy is to balance Yin and Yang by enhancing Yin. The acupuncture points An Shen, HT-7, Da Feng Men, and KID-3 as well as the herbal formula Shen Calmer (Modified Tian Wan Bu Xin Dan) are recommended for this case.

2. Signalment: A thirteen year old female spayed American Eskimo dog.

Problem List:
a. Cushing’s disease which has been treated with Mitotane for the past four years.

1. Seizures which began last month and clustered about once a week.
2. Hypothyroidism
3. Generalized stiffness with weak hind end. There is no limping, but the dog’s gait is very stiff. The dog takes three to four steps then huffs and puffs and lies down.
4. Generalized lethargy, weakness, lack of energy.

Physical Findings: Pulse is thin and fast; Ravenous appetite and thirst; Bilateral cataracts; Deafness; Panting Constantly; Poor teeth and gums; Rose colored thin ocular discharge; Stool dark brown and foul smelling; Chronic urinary incontinence, all day, all the time; Draining pressure sore on left hip; Pot-bellied with muscle wasting; Tongue is pink with thin coating

Assessment: This can be considered a Deficient Heat (Yin Deficiency) condition, with a Qi Deficiency and Internal Wind. The old age, weakness, urinary incontinence and lethargy indicate a Qi Deficiency. The fast pulse, thirst, ravenous appetite, constant panting and foul smelling stool can indicate Heat. Seizures are caused by Internal Wind.

The treatment strategy is to use acupuncture to balance Yin and Yang by enhancing Yin and clearing the Wind. In addition, acupuncture can be used for the stiffnedd while using Chinese Herbal medicine for the internal organ problems. Acupuncture points such as GB-20, LIV-3 and GV-20 may be beneficial for the seizures (Wind). The points KID-3 and SP-6 may be beneficial for Yin. Two herbal formulas may be beneficial: Tian Ma Gou Teng Yin for Internal Wind and Suo Quan Wan for incontinence and Kidney Qi Deficiency.

Nancy Scanlan–
CAVM Affiliations- CIVT, AHVMA, Chi Institute
Other CAVM Methods- homotoxicology/homeopathy; As leader of the AHVMA, Dr. Scanlan vigorously opposed the AVMA HOD resolution identifying homeopathy as unscientific and ineffective.
Comments-

”While the ‘find it and kill it’ Western medical approach may work for infectious diseases, holistic medicine takes preventative measures by treating the whole body…Holistic veterinary care can be much more effective when treating chronic illnesses like heart disease.”

“When traditional medicine looks on disease and physiology as circular, as seen in the Five Element cycle of Traditional Chinese Medicine (TCM), different practitioners may decide to attack the same disease process at different parts of that cycle. The treatments may be seen as different by conventional medicine, but…final conclusions should be based on two criteria: were the cases treated successfully, and were all cases within the series consistent based on the traditional, not the conventional, view?”

“In order for acceptance to occur, initial research may need to be more standardized…the fact that a remedy consistently “improves” (to the conventional eye) symptoms of a specific “disease” (as defined by conventional medicine) may open the door to acceptance of homeopathy as a valid part of integrative medicine.:”

“Echinacea…has usually been studied with the expectation that it will increase immune reactions in some way. However, it may have more of an immune-modulating effect, as evidence by at least one trial showing a decrease in WBC activity. Instead of viewing this as conflicting evidence, it would be better to examine herbal tradition…to see whether this herb has been used as an immune “normalizer.” If so, the conflicting evidence is actually supporting evidence for the original premise.” [In other words, any result can be viewed as supporting the hypothesis if we simply interpret it through the correct lens.]

“AHVMA maintains that one must include an expert in any discussion of a treatment modality… Experts are those who use the modality in practice, and who are invited by practitioners of CAVM to lecture and write about its use.”[This view of expertise suggests only those who have an a priori belief in a method and elect to train in and use it are qualified to judge its value. This is the perfect closed shop for unproven or unscientific methods.]

Richard Palmquist-
CAVM Affiliations- CIVT, AHVMA, Chinese medicine organizations
Other CAVM Methods- homeopathy, energy medicine
Comments-
Dr. Palmquist often comments on the relationship between tradition, experience, faith, and science, and he makes little distinction between them other than to sometimes suggest scienceis the least useful.

“Acupuncture reconnects and balances Life energy.… Energy medicines such as homeopathy, homotoxicology, Reiki, craniosacral therapy, and others align the physical, mental, and spiritual portions of the organism. Yes, I did say spiritual and that is a big part of holistic medicine-recognizing the spiritual nature of Life.”

“Scientific advance can be fueled by a few people who have experienced the impossible and who care enough to investigate and share.”

“When we use “science” to kill hope by stopping progress we find real harm occurring.”

“When a miracle surpasses our science, we can deny the miracle or use our science to pursue improved understanding. It’s a choice… Thanks for believing in miracles.”

“Miracles provide us the opportunity to see and share the unexpected as we gain insight into new relationships. RT if u believe in miracles.”

“Placebo effect (that means YOU) are responsible for HALF of a drug’s effect. How about making more of YOU!?”

“90.1 percent of AVMA delegates voted against the anti homeopathy resolution. Veterinarians free to pursue whatever tools needed to help.”

“In the end we do not heal from finding out what is wrong. We heal when we find and connect what is right with our lives.”

“We will have health reform when doctors become team members celebrating and developing potential and not simply pill prescribers.”

“People who are sure they know how the universe works are often in for a surprise. “Scientists” often fight what turns out to be right.”

Donna Raditic-
CAVM Affiliations- CIVT, AHVMA
Other CAVM Methods- chiropractic, homeopathy

Carmen Colitz-
CAVM Affiliations- Chi Institute, AHVMA
Other CAVM Methods- unclear
Comments-
Dr. Colitz has been involved in the development of Ocul-glo, one of the few herbal/nutritional supplements in the veterinary market that has good quality evidence for its effectiveness. Like Dr. Wynn, her approach seems to be more consistent with good scientific practice. However, she has also allowed her name to be associated with comments like those below, in articles from the Integrative Veterinary Care Journal which were co-authored by Dr. Colitz.

“Besides optimizing nutrition, losing weight, and getting proper daily exercise, daily insulin is needed in most patients to control hyperglycemia unless optimally treated with homeopathy or TCVM.  It is estimated that 68% to 75% of dogs with diabetes will develop cataracts within a year of diagnosis, despite the best of care.”

“Once diabetes is diagnosed, support includes specific antioxidants, proper diet, homeopathy, TCVM and aldose reductase inhibitors.”

“Anecdotally, homeopathic veterinarians have seen resolution of cataracts with careful prescription of the homeopathic medicines that match the constitution of the dog or cat.”

“Careful monitoring for changes by veterinarians using homeopathy or TCVM, or frequent exams by a veterinary ophthalmologist, are recommended to avoid negative changes that can occur due to lens-induced uveitis.”

I originally wrote about the Chinese herbal product Yunnan Baiyao in 2010, concluding at that time that the evidence supporting its use to reduce bleeding was poor and largely anecdotal:

So we have a treatment with uncertain and unregulated ingredients, no demonstrated plausible mechanism of action, a few in vitro and lab animal studies in journals of questionable reliability, a few small human clinical trials in similarly questionable sources, and two very small veterinary trials in equids which found no effect except possibly on a poorly reliable and subjective test of blood clotting.

I reviewed the literature again in 2016, finding a few new studies which did nothing to strengthen the case for this product:

Despite some suggestive in vitro and low-quality studies, the best evidence available so far does not support that Yunnan Baiyao has any benefit for dogs. The fact that it is unregulated, that there is demonstrated inconsistency in the mineral and metal contents of Yunnan Baiyao from different sources, and that the ingredients are still kept secret by the manufacturers, should also give clinicians pause in considering this for their patients.

Though it hasn’t been very long since my recent review, I ran across another study looking for possible effects of Yunnan Baiyao on one aspect of blood clotting, platelet function and the Buccal Mucosal Bleeding Time (BMBT), which involves measuring the time for bleeding to stop after a standardized cut is made in the gums. Like most of the studies in veterinary patients so far, this one found no reason to believe Yunnan Baiyao can stop hemorrhage.

Frederick J, Boysen S, Wagg C, Chalhoub S. The effects of oral administration of Yunnan Baiyao on blood coagulation in beagle dogs as measured by kaolin-activated thromboelastography and buccal mucosal bleeding times. Can J Vet Res. 2017 Jan;81(1):41-45.

In a randomized controlled crossover trial 8 beagle dogs were given either placebo or 1000 mg of YB orally every 12 h for 5 consecutive treatments. Blood was drawn 24 h before treatment and 2 and 24 h after the last treatment, and the BMBT was measured in each sample in duplicate…There were no adverse effects of treatment and no significant differences between the control and treatment BMBTs or [platelet function] parameters at any time point….Thus, at the dose and frequency of administration in this study YB did not appear to have any clinically significant effects on the measured coagulation parameters.

As I always take care to emphasize, no single study is sufficient evidence to definitively answer most medical questions. But despite the anecdotes that seem so persuasive to many owners and veterinarians, the gradual accumulation of evidence is not encouraging. And though no obvious harm has yet been found, the fact remains that the ingredients in this remedy are not standardized or tested for quality of contamination, and since this would certainly be considered unacceptable and illegal for any conventional medicine, it is hard to justify using it when the chances of significant benefits appear to be quite low.

One of the recurring subjects I have covered on this blog is the contention that cranberry supplements can help prevent or treat urinary tract infections. Each time I address the subject, the evidence points to pretty much the same general conclusion:

March, 2012

There is weak theoretical justification for using cranberry products for UTIs, though none of the supporting preclinical evidence involves dogs or cats. There is conflicting clinical trial evidence in humans, and no clinical studies in dogs and cats.

October, 2012

This [Cochrane] review indicates pretty clearly that overall, cranberry juice is not effective in preventing UTIs despite theoretical reasons why it might be. This illustrates, yet again, why we cannot rely on extrapolation from pre-clinical or in vitro studies to tell us what will work in actual patients.

April, 2016

The in vitro portion of this study is consistent with existing research that suggests cranberry extracts may reduce the ability of some bacteria to stick to the lining of the urinary tract. This could theoretically help prevent some urinary tract infections, though clinical research in human patients suggests this doesn’t really work to a significant extent in living people.

The portion of the study looking at prevention of UTIs in actual dogs, unfortunately, doesn’t help establish what benefit, if any, this product might have.

So basically, while there is a plausible argument that cranberry supplements might be helpful based on lab research, clinical studies don’t seem to show they actually do much in real human patients, and there isn’t any real research in veterinary patients. Fortunately, the last part of that conclusion is now less applicable, thanks to a newly published clinical trial in dogs. Unfortunately, the results of the trial tend to support the existing human literature which has failed to find any real-world benefits.

N.J. Olby, S.L. Vaden, K. Williams, et al. Effect of Cranberry Extract on the Frequency of Bacteriuria in Dogs with Acute Thoracolumbar Disk Herniation: A Randomized Controlled Clinical Trial. J Vet Intern Med 2017;31:60–68.

This study specifically evaluated cranberry extract as a method for preventing bacterial urinary tract infections in dogs with newly acquired neurologic dysfunction due to herniated intervertebral disks damaging their spinal cords. Dogs with this condition are predisposed to such infections, and it was hoped the supplement would reduce this risk. The supplement used, Crananadin, was the same I reviewed in my original post on this subject.

The study employed excellent methodology, with appropriate randomization, blinding, placebo control, and pre-determined objective outcome measures. The results were clear and consistent. The cranberry group actually had a higher rate of infections than the placebo group, though the difference was not statistically significant. And though pre-clinical evidence suggests cranberry supplements might be most likely to be useful with E. coli infections, there was no statistical difference between the groups in the rate of this type of infection, with most occurring in the cranberry group. The study was ultimately smaller than the investigators initially intended because an interim analysis clearly showed no trend towards any benefit and very little chance that a benefit would be seen even if more animals were enrolled.

While no single study should be the final word on any complex medical question, this trial is about as strong a clear a negative finding as one can get. And given the similar failure to find significant benefits in many human trials, it adds to a growing body of evidence suggesting that cranberry supplements are not useful in preventing or treating urinary tract infections. While additional studies may help clarify the issue, especially those involving different types of supplement and different patient populations, at some point consistent failure to find a benefit has to be seen as a reason to question the wisdom of expending scarce research resources on studying the question. We aren’t, in my view, quite at that point yet, but at least clinicians should be clear with pet owners that the evidence does not look good for cranberry supplements, and these should not be relied on in lieu of effective monitoring and medical treatment.

Bottom Line
Despite some promising laboratory studies suggesting cranberry supplements might help prevent or treat urinary tract infections, the evidence of studies in clinical patients has been disappointing. Conflicting studies in humans suggest, on balance, that there is probably no significant benefit. And now a high-quality clinical trial in dogs has failed to find any effect, even in the the of infections the pre-clinical research most strongly suggested there should be one.

While the risks of cranberry supplements are probably negligible, pet owners should understand, and veterinarians should make in clear to their clients, that there is no good reason to believe they have any real value in preventing or treating urinary tract infections.

I have addressed the question of medical marijuana and the use of other cannabis-derived medicinal products twice before. My conclusion in 2013 was this:

The current research evidence supports a couple of uses in humans, including treatment of nausea and poor appetite and possibly pain. Most other uses are poorly supported by clinical research. And there are unquestionably side effects that make marijuana often less useful than isolated cannabinoids or other unrelated treatments.

There is virtually no useful research evidence in companion animals, so any use of cannabis products is based entirely on theory and extrapolation from the limited research results in humans. Canna-Pet as a specific product, is being marketed with very dramatic and aggressive claims about safety and efficacy that do not appear to be supported by specific research on the product but, again, are based entirely on theory and anecdote, both notoriously unreliable sources of evidence.

There are recognized behavioral and medical risks associated with marijuana use in humans. While the behavioral risks do not apply to use in companion animals, and the medical issues associated with THC do not apply to products with negligible amounts of this compound, the risks of cannabis-derived compounds in dogs and cats are largely unknown. Any use of such products, then, should be undertaken with a clear understanding of the high levels of uncertainty about the results, and claims should not be made for these products that go beyond the available evidence.

When I looked again in 2016, I found no further research in veterinary patients, and the basic bottom line had not changed. We often must extrapolate from research in humans to clinical practice in veterinary medicine because we often don’t have the research we need in our own patients to guide us. This is necessary, but it is also risky. Humans are not dogs or cats, and while there are many similarities in basic physiology and in disease and response to treatment, there are also critical differences. The ibuprofen or sugarless gum that is safe for us will easily kill our pets. And the problems with blood lipids and cardiovascular disease that are a major source of human suffering and death are virtually non-existent in our canine and feline companions. So we must also be aware of the risks of leaping from evidence in humans to evidence in veterinary patients even when we have no choice but to make such a leap.

In the case of marijuana and other cannabis-derived products, there is still effectively no research on the risks and benefits in companion animals. Unfortunately, this has not stopped an explosion of marketing of cannabis products to pet owners, with no testing or regulation to ensure safety and efficacy. This is a dangerous situation. The evidence of risks and benefits in humans can help us to some extent to guess at the effects in companion animals, though unfortunately we cannot know how accurate these guesses will be without doing the careful work of rigorously studying these products in the actual species in which we are thinking about using them.

As for the human evidence, on that front there is some good news. The stigma that has hampered research for so long is waning, which is beginning to open the doors to researchers investigating the real effects of the many compounds found in cannabis. And a new review has just been produced which clearly and comprehensively summarizes the existing evidence, making it a lot easy to see the potential risks and benefits that we should focus on investigating in dogs and cats.

The National Academies of Sciences, Engineering, and Medicine. The Health Effects of Cannabis and Cannabinoids: The Current State of Evidence and Recommendations for Research (2017)

This review does the valuable work of comprehensively searching the research literature and then grading the strength of evidence for specific uses. Here is the grading scale the report uses:

Conclusive Evidence
For this level of evidence, there are many supportive findings from good-quality studies with no credible opposing findings. A firm conclusion can be made, and the limitations to the evidence, including chance, bias, and confounding factors, can be ruled out with reasonable confidence.

Substantial Evidence
For this level of evidence, there are several supportive findings from good-quality studies with very few or no credible opposing findings. A firm conclusion can be made, but minor limitations, including chance, bias, and confounding factors cannot be ruled out with reasonable confidence.

Moderate Evidence
For this level of evidence, there are several supportive findings from good- to fair-quality
studies with very few or no credible opposing findings. A general conclusion can be made, but limitations, including chance, bias, and confounding factors cannot be ruled out with reasonable confidence.

Limited Evidence
For this level of evidence, there are supportive findings from good- to fair-quality studies with most favoring one conclusion. A conclusion can be made, but there is significant uncertainty due to chance, bias, and confounding factors.

No or Insufficient Evidence
For this level of evidence, there are mixed findings, a single poor study or health endpoint has not been studied at all. No conclusion can be made because of substantial uncertainty due to chance, bias, and confounding factors.

This is a reasonable and fairly user-friendly scheme for categorizing the strength of the research evidence for or against specific proposed risks and benefits. The summary of the study lists the specific risks or benefits that were reviewed and classified according to this scheme. The benefits and risks are divided into several categories. There are too many to list here, but I will highlight those for which the evidence is at moderate or better and which might be relevant to veterinary patients (meaning, I will skip uses of cannabis for diseases not seen in dogs and cats or risks, such as auto accidents or risks from smoking marijuana, which obviously don’t apply to these species.)

Therapeutic Benefits:
Treatment of chronic pain in adults (cannabis)
Treatment of chemotherapy-induced nausea and vomiting (oral cannabinoids)

Risks:
Lower birth weight with maternal use
Impairment of cognition, including learning, memory and attention with acute use
Variable increase in risk of development or in symptomatic worsening of various psychiatric disorders (relevance to behavior problems in veterinary patients?)

That’s pretty much it. There are plenty of other risks and benefits with at least moderate evidence that appear only to be relevant to humans. And there are many risks and benefits which could be relevant to veterinary patients but for which the evidence in humans is weak or insufficient to draw any conclusions. And, as I keep pointing out, there is virtually no evidence for any of the many different products out there that directly evaluates risks and benefits of those products in dogs and cats.

So right now, we are at a place where the hype and the marketing far exceed the real evidence that cannabis-based products are safe and useful for our pets. Using them could be worthwhile, but currently it is essentially rolling the dice, an uncontrolled individual experiment that could also make the patient’s life worse. Hopefully, further research will elucidate the real harms and benefits for our pets so we can make sound decisions about the appropriate role of cannabis-based products in veterinary care.

There are an enormous number of unregulated over-the-counter remedies marketed to pet owners, often for serious health problems, and most of them have never been scientifically tested to see if they are safe or effective. It is difficult to evaluate these products objectively when there is no real evidence. There are always, of course, plenty of anecdotes and testimonials, but while people frequently find these persuasive, I have explained many times in detail why they do not actually tell us much at all about the safety or effectiveness of such products.

Often, the best pet owners and veterinarians can do is consider whether the claims made for such products are reasonable or fanciful, whether the theoretical justifications for how they might work make sense or not, and whether there is any obvious danger. This is not a very reliable or satisfactory way to evaluate healthcare products, but in the absence of regulatory requirements to prove any claims manufacturers make or any ethical commitment on the part of these manufacturers to back up their own claims, this is sometimes the best we can do.

Even when there is some research on a product, however, often the evidence is of limited reliability. And of course, companies never accept any negative reports on their products, and they tend to exaggerate or even mislead consumers regarding the strength of the evidence for their products. I recently ran across a nice study on an herbal product called Pet Remedy, which led me to look at the company marketing materials. Not surprisingly, the marketing does not reflect the evidence for this product.

What Is It?
Pet Remedy is a mixture of several plant extracts. According to the manufacturer, these include extracts from valerian root, vetiver, sweet basil, and Spanish sage. The exact amount of these ingredients, unfortunately, is not disclosed, though the company indicates the valerian content is “very low,” suggesting enough to have the purported benefits of relaxation without the potential. The product comes in a variety of forms, including sprays and plug-in diffusers. The advertising material provides this information about the development of Pet Remedy:

Developed as a result of one of our directors having a cat with behavioural issues! Pet Remedy sorted the problem so effectively that Pet Remedy was then created as a marketable product with a range of plug diffuser, calming sprays, and battery operated atomiser. Pet Remedy was developed with the help of a team comprising several vets, nurses, a psychiatrist and using our own experience in the aromatherapy and essential oil markets.

The company makes broad and sweeping claims for it including:

Clinically proven to calm pets without sedating

Pet Remedy is 100% safe for all mammals and birds, including dogs, cats, rabbits, guinea pigs, hamsters, parrots and horses.

Regular readers will be familiar with my views on claims of significant benefits with absolutely no risk, which I have codified into McKenzie’s Law:

The company quite explicitly claims scientific support for their product. They propose a mechanism of action based on previous studies of valerian extracts:

…the active ingredients in the special Pet Remedy blend will sit on the cell receptor as if a GABA molecule was sitting on it, and that activates (excites) the receptor into giving the cell the message to calm.

The other ingredients are presented in terms of their traditional use, with a lot of vacuous language and extravagant claims that sound like they were copied out of herbal medicine books:

This plant has been appreciated for its calming properties since records began.

Basil oil is a good tonic for the treatment of nervous disorders and stress related headaches, migraines and allergies. It is used to clear the mind and relieve intellectual fatigue, while giving clarity and mental strength.

The therapeutic properties of sage oil are anti-inflammatory, antibacterial, antiseptic, antispasmodic, astringent, digestive, diuretic, emmenagogue, febrifuge, and hypertensive,.There also seems to be a more general relaxant effect, so that the plant is suitable in the treatment of nervousness and excitability. It helps to fortify a generally debilitated nervous system.

The company is also quite specific about the strength of the purported scientific evidence behind their product:

We have already conducted three major clinical Trials…The results of all trials are consistent with pet remedy being an effective natural aid to calm stressed pets.

They also list a number of other studies in progress and offer to send copies of the study reports upon request. Needless to say, I sent such a request since I was otherwise only able to find the one study I had initially run across.

Does It Work?
Valerian has been claimed to be useful as a sleep aid and anxiety reducing herb. The evidence for these claims is limited and mixed in humans (e.g. 1, 2), suggesting there may be some benefits but without definitive proof of these. As usual, there is virtually no good scientific research on the use of this herb in veterinary patients. It is plausible that this herb might have some calming effects in the species the company markets it for, but this does not obviate the need for actual clinical studies of the product itself.

The evidence for medicinal uses of vetiver, basil, and Spanish sage in humans is weaker than for valerian, and again there are essentially no controlled clinical studies to support veterinary use.

When I requested copies of the studies the company uses to promote Pet Remedy, I received two unpublished reports from a statistical analysis firm hired to analyze data collected in two studies and also a draft report of the published study I had already seen. Interestingly, the company did not direct me to the published report of this last study, even though that is available freely through the journal. The company representative also sent me the unpublished results of a survey of groomers suggesting that, when asked, many reported they would be willing to recommend the product. This, of course, amounts to no better evidence than the many testimonials and anecdotes available on the company web sites.

The first unpublished study involved 60 dogs receiving behavior modification therapy who were alternately exposed to Pet Remedy or a placebo. The report doesn’t indicate that important controls for bias were included (randomization, blinding, etc.), and it reports vague and subjective outcome measures: “excitement” on a 5-point scale from “not excited” to “very excited” and “behavior” on a similar scale from “poor/unacceptable” to “better/good.” These are certainly not the hallmarks of good-quality behavioral research, which likely explains why the study has not been published.

The company statistician appears to recognize that the design disallows any meaningful conclusions about the efficacy of the product. Despite reporting some differences in the outcome measures for the dogs when exposed to Pet Remedy or placebo, several cautionary statements are included, such as:

It was noted that as no data were available on the baseline (pre-study intervention) behaviour scores and excitement levels for the dogs, it would not be appropriate to compare the August outcomes between the dogs receiving the Pet Remedy and the placebo in the first month. This would fail to take into account the baseline excitement level and behaviour score of the dogs when they entered the study.

It is important to acknowledge that, due to the design of the study, it is not possible to directly attribute the changes observed to the study treatment received in the current month in each case. As each dog was switched between placebo and Pet Remedy from month-to-month, it is not possible to rule out the possibility of so-called carryover or lagged effects of the treatments received in previous months.

It should be reiterated that, due to the design of the study, it is not possible to directly attribute the changes observed in the trial to the study treatment received in the current follow-up month in each case. This is because of the possibility of so-called carryover or lagged effects of the treatments received in previous months.

We would recommend running another study to replicate the effect with a study design that would allow us to determine whether this was indeed due to the study treatment. Select would be more than happy to provide advice on how best to design the study from a statistical point of view.

I was sent another report from the same statistical company that was named as reporting a different study. The date on the report was different, but the content was exactly the same, so I suspect this may have been an error, but I was not able to evaluate the report from this trial. Information from the company web site indicates both trials used the same design and outcome measures, so it seems likely the caveats of the one I was able to review apply to the one I was not, especially given neither have been published.

I was also sent a couple of Excel spreadsheets with data and notes about the subjects in the two studies.  These were surprisingly revealing. In fact, they contain individual identifying information for study subjects and owners, which is typically not supposed to be shared outside of the study team. The study was conducted at a private training facility, not an academic institution, which may explain the failure to follow standard study design or ethics guidelines.

These spreadsheets do seem to confirm the lack of blinding and randomization, and support the subjective nature of assessments and potential for bias. A note from one of the investigators, for example, indicates that dogs in one of the studies who were exposed to Pet Remedy in the first month were switched to placebo in the second month, as per the study design, but that those owners who thought the remedy was helpful the first month and asked to switch back to it were allowed to do so. This would be a pretty serious violation of basic study design procedures.

One of the spreadsheets also contains notes about the prognosis for the dogs. These show that the evaluators make judgements about whether or not the dogs could be helped as part of their initial assessments. Some were described positively (e.g. “this one will be easy to resolve” and “can’t wait to work with this little man.”) and others quite negatively (e.g. “Not all together put together this dog has brain issues… This dog needs to be PTS ASAP he has mental health issues” and “This dog is a menace.”).

A rather large number of these comments, in fact, suggest the dogs are very dangerous or should be euthanized. This both indicates this is not a typical population of dogs whose owners are likely to want an over-the-counter herbal remedy and also that, in the absence of blinding and randomization, there is a significant risk of individual bias in how the dogs and the treatments were evaluated. In any case, neither of these studies has been published or appears to meet the basic criteria for a reliable controlled scientific study.

The final study was the one I originally found published in the journal Animals.

Taylor,  S. Madden, J. The Effect of Pet Remedy on the Behaviour of the Domestic Dog (Canis familiaris) Animals 2016, 6(11), 64; doi:10.3390/ani6110064

The published study had much better methodology than the other two, including appropriate randomization and blinding. It involved exposing 28 dogs (a pretty small number) to either Pet Remedy or a placebo in an unfamiliar and evaluating for behavioral signs of anxiety. Dogs were chosen whose owners had indicated that they showed signs of anxiety or aggression in unfamiliar places. The study concluded that the product had no effect:

In the current study, no statistically significant differences in behaviour were found in either the Pet Remedy or placebo condition. A lack of a discernible effect under either condition suggests that Pet Remedy did not affect behaviour of dogs’ placed in a potentially stressful non-familiar environment.

This is a pretty clearly negative result in a study that did a much better job controlling for bias than the unpublished studies the company publicizes. In fact, I initially thought it pleasantly surprising that the company would direct consumers to scientific evidence that does not support their claims. However, it turns out the company is doing everything it can to present this study as a success despite the lack of any actual effect.

For one thing, the company lists and describes the study on its web page but leaves out the fact that it found no benefit. The site even says say, “The results of all trials are consistent with pet remedy being an effective natural aid to calm stressed pets.” This is clearly not true. The reality is that the two unpublished studies are unreliable and the published study showed no effect.

The misleading attempt to spin weak and even negative evidence even extended to sending me an unpublished preliminary version of the study report that differed from the published version, even though the published paper is freely available. This was done because the preliminary version presents a much more positive interpretation of the data. In the initial version, two of the many outcome measures evaluated were reported as showing a statistical difference between Pet Remedy, and then this was presented as suggestive of a benefit despite the lack of any difference on all the other measures.

Pet Remedy also significantly decreased overall yawning behaviour; indicative of reduced anxiety although overall heart rate did not significantly differ between treatments. Pet Remedy also significantly affected rates of change in locomotory behaviour but not change in heart rate, with activity decreasing more slowly in comparison to a placebo. The results suggest that Pet Remedy may be a useful tool for reducing canine stress and anxiety in dogs that display suppressed behaviour by increasing activity whilst reducing anxious behaviour. Reduced anxiety may also lower the number of dogs being relinquished to shelters as a result of anxiety related behavioural problems. In turn, Pet Remedy may have potential value in enhancing the welfare of these individuals.

The final paper in published form was apparently edited as a result of the peer review, resulting in the removal of these likely spurious findings and a conclusion more clearly reflecting the lack of any real effect in the data.

Is It Safe?
As pointed out already, the claim of 100% safety can only be true if there is no effect at all, since any treatment which has beneficial effects will almost certainly have potential undesirable effects as well.  The company acknowledges that some such effects have been reported with valerian, but of course they claim that their product is perfectly designed to reap the benefits without these side effects:

Many Valerian preparations are too potent and can sedate rather than calm. Pet Remedy is a low concentration valerian blend and the diffuser delivers a constant slow release, which is very kind and gentle in its effect on the metabolism.

No evidence is provided to substantiate this claim.

Given the limited veterinary research available on this product and its ingredients, the question of safety remains unanswered. It seems unlikely that small amounts of these substances volatilized through a diffuser would have serious risk, just as it seems unlikely they would have dramatic benefits, but in the absence of good evidence, we can only speculate.

Bottom Line
Pet Remedy is an example of the tremendous number of herbal products marketed to pet owners with extravagant claims but little real evidence to support these. This company explicitly claims strong scientific support for their dramatic claims of safety and efficacy. However, the evidence consists only of anecdote, poor-quality unpublished studies funded by the company, and one reasonably good published study that shows no effects, despite the company’s attempts to imply otherwise.

Like the purported benefits, the claimed absolute safety of the product is also not supported by good scientific evidence. There is little reason to think it is especially dangerous, just as there is little reason to think it has significant benefits, but the marketing claims for both safety and efficacy are not, as the company claims, supported by good science.

The company claims a number of additional studies are in progress. If these turn out to have appropriate design and execution, they may clarify whether there are any benefits to this product. If, however, the company persists in exaggerating the significance of poor-quality unpublished studies and ignoring negative results from more reliable research, then these additional studies will do nothing but create the false appearance of scientific legitimacy where it does not exist.