Does Challenging or Ridiculing Crazy Ideas Change Anyone’s Mind?

Posted on December 24, 2016 by skeptvet

It has long been a sad and frustrating but generally accepted notion among skeptics that facts don’t matter to people who believe in pseudoscience, conspiracy theories, and other dubious ideas or claims. The so-called “backfire effect” appears to mean that people will only fortify their beliefs if challenged with contradictory facts, so arguing with people only reinforces their beliefs. And it is also widely believed that, as the old saw has it, “You catch more flies with honey than vinegar.” Finding common ground, building trusting relationships, and showing empathy and respect are generally believed to be more conducive to changing someone’s mind than ridicule or hostility.

A recent study appears to challenge these concepts, suggesting that beliefs about conspiracy theorie can be wekaned by both facts and ridicule directed at those beliefs.

Gábor Orosz, Péter Krekó, Benedek Paskuj, et al. Changing Conspiracy Beliefs through Rationality and Ridiculing. Frontiers in Psychology. 2016, Vol 7.

Orac has done a thorough job of summarizing this study, so I will just hit a few highlights. This study exposed subject to unfamiliar conspiracy theories and then to several different attempts to undermine these theories, divided into factual rebuttal, ridicule, and attempting to generate empathy for the “villains” of the conspiracy theory. They then measured several indices of the subjects’ views. The authors concluded that,

Rational and ridiculing arguments were effective in reducing CT [conspiracy theories], whereas empathizing with the targets of CTs had no effect. Individual differences played no role in CT reduction, but the perceived intelligence and competence of the individual who conveyed the CT belief-reduction information contributed to the success of the CT belief reduction. Rational arguments targeting the link between the object of belief and its characteristics appear to be an effective tool in fighting conspiracy theory beliefs…

They also recognized that this conclusion is contrary to established ideas and existing evidence, and so it must itself be treated with a bit of skepticism.

Our findings on the efficiency of rational argumentation go against the mainstream of the communication literature and “common wisdom,” as well as the current affective wave of social psychology emphasizing that emotions constitute the most important factor behind shaping beliefs and attitudes. Considering the modest effect sizes, we assume that rationality has a bigger impact on shaping (sometimes irrational) beliefs than previously expected, given that in the current communication environment, people are overloaded with emotional messages coming from ads, political and social campaigns. Future studies should also investigate the role of rationality and the “rationality heuristic” in belief change.

Orac points out what may be a key aspect of this study. The subjects were not established believers in the conspiracy theories they were exposed to. They were, to relate the study to the issues of this blog, less like homeopaths and more like conventional vets or pet owners with little knowledge and no firm opinions about homeopathy. I have long argued that while battling with true believers accomplishes nothing in terms of changing their minds, playing out such arguments in public may have an influence on the uncommitted majority, who should be the real audience for factual rebuttal and ridicule of unproven and false medical claims. This study provides at least a tiny bit of hope that such an approach may have value.

Posted in General | 3 Comments

Another Systematic Review of Homeopathy and–Wait for It– Still No Good Evidence It Works!

Posted on December 18, 2016 by skeptvet

Yet another systematic review of veterinary homeopathy has just been published, bringing the total to six. I have discussed several of these before (e.g. 1, 2). They have consistently failed to find high-quality research evidence to support homeopathy in animals, despite the fact that the previous reviews have been conducted by advocates for homeopathy. Most of the studies identified fail even basic methodological criteria for reliability, and there is a lack of consistency and reproducibility to any positive findings. So while there are individual studies that appear to show homeopathy having some effect, a comprehensive review of the evidence at all levels fails to support any specific use. And while this failure might not be damning for a new therapeutic approach, after more than 150 years, it is past time that a truly effective therapy should have been able to prove its worth.

The same conclusion has been reached by many others, from the systematic reviews of homeopathic trials and systematic reviews of these systematic reviews, to the formal investigations of governmental agencies such as the British House of Commons Science and Technology Committee and the Australian National Health and Medical research Council. While homeopaths have had more than a century to try, they have not been able to produce a body of scientific evidence to convince anyone but themselves that homeopathy works.

C. Doehring, A. Sundrum. Efficacy of homeopathy in livestock according to peer-reviewed publications from 1981 to 2014. Veterinary Record doi:10.1136/vr.103779

The latest review is the first in veterinary medicine not written by the group of homeopathy advocates that has produced the previous systematic reviews. Not surprisingly, it too concludes that despite some trials appearing to show benefits, the scientific literature does not provide good evidence sufficient to validate or recommend homeopathy. As well as reinforcing this consistent finding, it also provides support for a number of the objections that I and others have raised regarding the apparently positive literature often cited by homeopaths to justify their claims, including:

  1. Frequently there is poor reporting of study details, so it is not possible to accurately assess the risk of bias (this, sadly, is a general problem in the veterinary literature, not just in the domain of alternative medicine).
  2. Studies with better control for bias are less likely to show positive results.
  3. Studies published in dedicated alternative medicine journals are more likely to show positive results than those in the mainstream scientific literature, suggesting publication bias.
  4. Positive studies are not replicated. This is key since no single study can prove any hypothesis, much less one as inherently dubious as those behind homeopathy. Consistent findings by different researchers in different settings is required to have confidence in positive effects of a treatment.

The authors made perhaps the most comprehensive search of the livestock literature yet for homeopathy studies. Their goal was to identify any study of homeopathy used in farm animals in a way that might reduce or replace antibiotics, either in the prevention or treatment of infectious diseases or as a growth promoter. Since this is a common use claimed for homeopathy, this is a relevant subject within the larger literature.

From 1981-2014, they found 48 published studies that fit their search criteria. Only 11 of these were double-blinded randomized controlled trials, the best kind of study to evaluate medical treatments. The trials included had a variety of shortcomings. 39 of the studies were considered to have a significant risk of bias based on how they were conducted. Many also included only very small numbers of patients. Some selected a conventional treatment for comparison that did not meet current guidelines or standards for selecting antibiotic treatment, which would have been a misleading comparison.

Slightly over half of the studies showed a positive effect, whereas the rest did not. A number of factors were associated with the chances of a positive finding. For example, the better the study design and the controls used for bias, the less likely a study was to find a positive effect:

Homeopathic trials performed as a single-blind or non-blind RCT, parallel groups or an observational trial (Fig 4) tended to be more frequently efficacious than a double-blind RCT, indicating that positive outcomes may partly be due to a bias caused by a conscious or unconscious preference for a certain treatment.

Altogether, studies with a high possible risk of bias were more prone to report efficacy of homeopathy than studies with a low risk of bias (OR 1.71, 95 per cent CI 0.48 to 6.11, P=0.41 vs OR 0.58, 95 per cent CI 0.16 to 2.09).

Also, studies published in alternative medicine journals were far more likely to show an effect than those published in mainstream journals:

In journals focusing on alternative treatments, 15 of 18 trials reported that the homeopathic remedy tested was effective (odds ratio [OR] 3.75, 95 per cent confidence interval [CI] 0.63 to 22.04, P=0.14), while in journals with a broader focus on veterinary medicine, 12 out of 18 trials found the homeopathic treatment was ineffective (OR 0.27, 95 per cent CI 0.05 to 1.57).

Finally, not a single positive study has been reproduced, which is an essential criterion for establishing an effective treatment:

When taking the total number of studies into account, not even one study was repeated under comparable conditions. Consequently, the existing conditions, which enable a systematic review to be carried out completely are not given. The current evidence of studies providing evidence in favour of homeopathy lacks reproducibility and therefore cannot claim to have sufficient prognostic validity.

This review reinforces the conclusions of previous reviews. Despite 150 years of effort, no reliable, high-quality evidence has been produced showing homeopathy to be consistently effective for any veterinary use. Added to the inherent inconsistency of homeopathic theories with established scientific principles, and the much more rapid and dramatic validation many other treatments have been able to achieve, it is past time to accept that this practice has no value beyond placebo and is inherently a waste of resources and misleading to animal owners.

Posted in Homeopathy | 4 Comments

A Critical Analysis of a Study of Essential Oils and Apipuncture—Oh, Forget It, This is Just Ridiculous….

Posted on December 18, 2016 by skeptvet

I recently ran across a prime example of lousy science done solely for the purpose of propping up alternative-medicine beliefs or practices. Good science aims to discover what is true, not simply buttress one’s existing beliefs or provide marketing material for them. And good medical research requires that there be a reasonable chance the treatment being tested will solve an important clinical problem in a way that improves the welfare of patients. This study fails on those basic criteria, as well as on more technical but still important methodological grounds.

Shin Jin Cheol; Kim SangHun; Park HyungJin; Seo KyoungWon; Song KunHo. Effect of aromatherapy and apipuncture on Malassezia-related otitis externa in dogs. Journal of Veterinary Clinics, 2012, 29, 6, pp 470-473.

Malessezia is a form of yeast normally found in the ears of dogs. In some individuals, these yeast can be present in excessive numbers, and this is usually associated with inflammation and associated discomfort. The fundamental problem is typically not the yeast itself, but the factors that lead to inflammation and overgrowth of yeast. These are often underlying allergies (to dietary proteins or environmental allergens), the conformation of the individual patient’s ear (dogs with long, hairy ear canals and floppy ears are often at greater risk of otitis or inflammation in the ear), and the past history of the patient (recurrent otitis damages the ear canal in a way the increases the risk of future episodes).

Medication to reduce the number of yeast present is often included in treatment of otitis, but it is important to realize the yeast themselves are almost never the problem. Inflammation, bacterial overgrowth, and predisposing factors must also be addressed, or treatment will only provide partial or temporary relief. Most commonly, dogs with yeast otitis are given topical medications with steroids and medications that reduce bacterial and yeast populations. Ideally, if the problem is severe or recurrent, underlying causes are investigated and addressed.

Oral medications are sometimes used, though there is no compelling evidence for their efficacy in yeast otitis. In fact, I found this paper while I was looking for studies that might show whether or not the oral antifungal drug ketoconazole alone was effective in treating yeast otitis. I suspect it rarely is since it addresses only part of the problem, and likely not the most important part in many dogs. In any case, I did not find any such studies, so whether or not this drug is helpful is an open question.

However, in this study ketoconazole is used as a positive control, so the design begins with an unfounded assumption that this treatment should be effective. The comparison is then a combination of essential oils poured into the ear and, for the most ridiculous part, the injection of bee venom into a purported acupuncture point, Small Intestine 19, located next to the opening of the ear canal. So we have a comparison between an unproven oral drug and a variety of other untested chemicals (calling them “essential oils” doesn’t change their status as untested or as chemicals) combined with an insect toxin injected near the ear. Add in the fact that subjects weren’t randomized, investigators weren’t blinded, and the outcome measures evaluated were subjective, and you have the perfect recipe for crappy science:

  1. Start with an implausible but deeply held belief as your hypothesis
  2. Choose an unproven or lousy conventional treatment to compare with your alternative medicine
  3. Make sure the outcome is a judgment call and that you do little or nothing to control for the effects of chance or bias
  4. Toss in some questionable statistical analysis and voilá, you have BOGUS SCIENCE!

In terms of plausibility, a number of essential oils have been shown to have anti-microbial properties in test tubes. Of course, so does bleach and boiling water, so this by itself does little to support their use in actual patients. Bee venom has, not surprisingly, a lot of interesting chemicals in it. However, there is little good quality research, and it has not yet been shown to be a truly effective for any condition, though there might be some potential for medical use in the future. As for injecting it into acupuncture points, which arguably don’t exist anyway, that’s nonsense.  There are a couple of interesting small studies suggesting acupuncture could have some impact on otitis in dogs generally, but these are preliminary, and overall the evidence is too limited to draw a conclusion.

Not surprisingly, given the lack of control for bias, the study showed no difference between the dogs given oral anti-fungal medication and those given essential oil and “apipuncture” treatment. Both groups appeared to improve significantly by 2 weeks, though not at the 1-week assessment. Given the design of the study, there is no way to determine if this had anything to do with the treatments given, or how either would compare with standard therapy, usually consisting of topical medication containing a steroid, antibiotic, and anti-fungal combination.

The group receiving the antifungal medication did show some slight changes in a couple of liver enzymes. This is not unusual with the oral antifungal, and it is not clear this had any clinical significance. Nevertheless, the authors use this as an argument to prefer their alternative therapy.

So we have a comparison between an unproven and not typically used “conventional” treatment and an implausible and unproven alternative with no effort to control for bias or other sources of error. We find no difference between the groups except a bloodwork change of uncertain significance. And the whole focus of the study is treating an aspect of the problem that isn’t generally the cause. What we have is less an argument for the alternative therapy presented than it is a fine example of the misuse of scientific research in alternative medicine.

 

Posted in Miscellaneous CAVM | 2 Comments

Petition Petco to Stop Selling Worthless Homeopathic Products!

Posted on December 5, 2016 by skeptvet

I have discussed many time the evidence that homeopathy is nothing but a placebo. This has moved beyond the realm of reasonable doubt, and despite the misguided advocacy of homeopaths and some consumers, more and more governments (e.g. UK, Australia) are coming to acknowledge that time and money spent on homeopathic treatment is wasted and delays appropriate and effective medical care.

Just as homeopathy is being challenged in the human healthcare field (e.g. disappearing from national healthcare in the UK), so it is being opposed by veterinarians who believe it offers only false promises to pet owners (c.f. efforts in the US, Australia, Europe, and the UK to discourage veterinary homeopathy). While these efforts are not always completely successful they represent a growing recognition that homeopathy offers no real health benefits and that suggesting it might and offering it as a treatment is unethical.

Recently, the Federal Trade Commission (FTC) ruled that over-the-counter (OTC)homeopathic remedies cannot be sold unless there is a clear disclaimer indicating that any claim for actual effects is unscientific and inconsistent with modern medical knowledge:

[Marketers must] effectively communicates to consumers that (1) there is no scientific evidence that the product works and (2) the product’s claims are based only on theories of homeopathy from the 1700s that are not accepted by most modern medical experts.

While it is unclear whether this rule will be enforced by the incoming administration, it indicates yet again that regulators are recognizing a duty to protect the public against false and unscientific medical claims for homeopathic products. Veterinary patients deserve the same protection!

I have started a petition on change.org to ask Petco, one of the largest pet supply retailers, to discontinue the HomeoPet OTC product line and all other homeopathic products.

petco-image

Petco currently sells these remedies in stores and online, through Petco.com and its subsidiary Foster and Smith. These products clearly intend to falsely imply they can treat medical conditions in pets. With names like “Digestive Upsets,” “Anxiety Relief,” “Skin and Itch,” “Worm Clear,” “UTI+,” and so on, these products suggest they can treat real medical conditions when the evidence is clear and robust that they cannot. This misleads and deceives consumers and endangers pets whose owners waste time and resources on these products instead of seeking real medical treatment.

So how can you help? Well first, SIGN THE PETITION!

In addition, I am writing the company leadership. Since the CEO is  schedule to step down in February, I have addressed my letter to his successor, currently President and Chief Merchant. I encourage anyone concerned about this issue to write the incoming CEO. My letter is copied below,  and you are welcome to reuse any portion of it for your own contact with the company.

Brad Weston
President and Chief  Merchant
PETCO Animal Supplies Stores, Inc.
9125 Rehco Rd.
San Diego, CA
92121

Dear Mr. Weston:

I am writing to ask that your company discontinue selling the HomeoPet product line and all other over-the-counter homeopathic products, whether sold online through Petco.com and Fosters and Smith or in your retail stores. These products offer no therapeutic benefit to your customers’ companion animals, and they can harm these pets by encouraging owners to delay seeking appropriate veterinary care.

The scientific evidence is clear and robust that homeopathic products lack any benefit beyond placebo.1-2 This is widely accepted by regulators and other government agencies throughout the world.3-4 Here in the United States, the Federal Trade Commission (FTC) recently concluded that marketing over-the-counter homeopathic products constitutes false advertising unless clear disclaimers are present to inform consumers that any claim of benefit for these products is inconsistent with scientific evidence and consensus.

For the vast majority of OTC homeopathic drugs, the case for efficacy is based solely on traditional homeopathic theories and there are no valid studies using current scientific methods showing the product’s efficacy.  Accordingly, marketing claims that such homeopathic products have a therapeutic effect lack a reasonable basis and are likely misleading…

[Marketers must] effectively communicates to consumers that (1) there is no scientific evidence that the product works and (2) the product’s claims are based only on theories of homeopathy from the 1700s that are not accepted by most modern medical experts.5

For Petco to stop selling these ineffective products would be in the best interests of your customers, and the animals they care for, and consistent with your company’s mission to provide products that truly support animal health and well-being. Thank you for your attention.

References

  1. Ernst E. A systematic review of systematic reviews of homeopathy. British Journal of Clinical Pharmacology. 2002;54:577-582.
  2. Shang A, Huwiler-Muntener K, Nartey L, Juni P, Sterne J A C, Pewsner D et al. Are the clinical effects of homoeopathy placebo effects? Comparative study of placebo-controlled trials of homoeopathy and allopathy. Lancet 2005; 366:726-732.
  3. Great Britain. Parliament. House of Commons. Select Committee on Science and Technology. Evidence check 2: homeopathy : fourth report of session 2009-10 : report together with formal minutes, oral and written evidence.
    London : TSO, 2010. Accessed December, 2016 at http://www.publications.parliament.uk/pa/cm200910/cmselect/cmsctech/45/45.pdf
  4. Australian Government. National Health and Medical Research Council. Statement on Homeopathy and NHMRC Information Paper – Evidence on the effectiveness of homeopathy for treating health conditions. 2015. Accessed December, 2016 at https://www.nhmrc.gov.au/guidelines-publications/cam02
  5. United States Government. Federal Trade Commission. Enforcement Policy Statement on Marketing Claims for OTC Homeopathic Drugs. 2016. Accessed December, 2016 at https://consumermediallc.files.wordpress.com/2016/11/p114505_otc_homeopathic_drug_enforcement_policy_statement.pdf

 

 

Posted in Homeopathy | 13 Comments

Glacier Peak Holistics Pet Wellness Life Scan Stress Test or How Much BS Can Fit on One Web Page?

Posted on November 27, 2016 by skeptvet

Allergies are a common and frustrating problem for many pet dogs. While the details are incredibly complicated and not completely understood, allergies are the result of inappropriate inflammation and other immune system responses to triggers in the environment. These triggers can be anything from flea saliva to food ingredients to pollens or dust. Dogs with allergies likely have a genetic predisposition to such excessive immune reactions, and early environmental exposure may play a role. While there are many therapies available that significantly reduce symptoms, improve quality of life, and modulate the abnormal immune response that is the cause of allergies, there is no simple or single cure.

The unpredictability of allergy symptoms, their chronic waxing and waning nature, and the lack of a definitive cure make allergies a popular target for alternative therapies. And just as alternative practitioners ignore much of the science behind vaccines in order to promulgate made-up theories that support their own methods, so many CAVM advocates ignore all that is known about the pathophysiology of allergies and the available diagnostic and treatment interventions and instead make up their own unscientific theories to sell alternative allergy treatments. A reader recently drew my attention to a particularly ridiculous example of this that approaches self-parody: Glacier Peak Holistics Pet Wellness Life Scan Stress Test.

What Is It?
This is actually a relatively difficult question to answer since the company materials about the test are mostly faux-scientific gibberish with a lot of repetition of the meaningless term “energy.” Here’s a sample:

Most allergy-type symptoms are not caused by actual allergies at all…Certain stressors in your pet’s diet are more likely the root source of the allergy symptoms.

Because dogs and cats lack the proper digestive enzymes to digest starchy root vegetables, grains and most fruits, feeding these types of foods can contribute to yeast overgrowth and immune system issues.

Traditional medicine usually prescribes steroids that only mask the allergy symptoms by suppressing the natural function of immune system and can cause damaging, irreversible side effects…Sadly, most pet’s allergy symptoms return stronger than before treatment beginning a vicious cycle that has ZERO lasting benefits.

The Pet Wellness Life Stress Scan, formerly “Healthy Dog and Cat Alternative Sensitivity Assessment”, is the original hair and saliva scan for identifying over 300 stressors in your pet’s diet and environment…The Pet Wellness Life Stress Scan uses biofeedback, which has the ability to read the energetic resonance that emanates from the hair and saliva samples.

Biofeedback energy status analysis measures the body’s bio energetic balance or homeostasis in relation to various food and environmental factors that an animal is exposed to.

The Chinese would call this a balance of yin or yang, with the ultimate goal removing or reducing incompatible energetic disturbances that diminish the body’s Qi or life-force. It is well known in TCM, homeopathy and western holistic medicine, that energetic and spiritual disturbances often precedes physical disturbances…It is a non-invasive energetic analysis seeking to identify and diminish non-harmonic energetic factors.

Using biofeedback analysis, the biofeedback device can identify over 300 food and environmental factors that may disturb an animal’s energy balance.

So, how many woo-woo clichés and warning signs of quackery could you spot? A partial list would include:

  1. Rejection of established scientific knowledge- While allergies aren’t completely understood, the idea that they aren’t really allergies or that they are due to vague “stressors” is nonsense. There is extensive scientific evidence demonstrating the causes and processes of allergic problems in humans and dogs which this company ignores.
  2. Dismissal of science-based medicine as “only symptomatic” and causing more harm than good- While much allergy treatment is symptomatic because a true cure would involve either changing the genetic constitution or past exposure of a dog or eliminating all allergens from the environment, which often is not possible, some treatments do address the closest we can get to the root cause by either eliminating the triggers (limited antigen diets, for example) or desensitizing the immune system to prevent the initial inappropriate reaction to antigens (immunotherapy or “allergy shots”).
  3. Focusing on risks and ignoring benefits from conventional treatment- All treatments that do anything at all have both risks and benefits. Steroids (and the many, many other topical and system allergy medications this website neglects to mention) can have risks, especially when inappropriately used. However, they also can give dogs suffering from allergies relief and a good quality and normal length of life, which they might otherwise not be able to have.
  4. The nonsense about “grains” that has become quite the alternative nutrition fad, and which I’ve addressed many times (e.g. 1, 2).
  5. Vague pseudoscientific language that is actually meaningless as used here: biofeedback, energy, energetic resonance, energetic status analysis, homeostasis, non-harmonic energy factors.
  6. Reference to non-scientific folk beliefs or fundamentally religious concepts that must be taken on faith and cannot be evaluated scientifically- Qi, energy, life-force, spiritual disturbances.
  7. Complete absence of any scientific evidence to support the claims made.
  8. Presence of anecdotes and testimonials in place of reliable evidence

Does It Work?
In terms of the test itself, it is pretty easy to recognize the complete lack of validity to it. The concept of energy employed here is vague and mystical with no relationship to the science of allergy medicine. The terms biofeedback and homeostasis have real meanings, but those are unrelated to their use here, which is just a smokescreen intended to make folk beliefs and completely made-up explanations sound scientific. Hair analysis is an old and long-debunked practice, and I have already addressed the bogus use of saliva testing for allergy diagnosis in my respond to Dr. Jean Dodds’ claims about it.

Of course, as is often the case with quack medicine, the promoters try to have their cake and eat it too. In addition to trying to make the test sound scientific, the site clearly implies that the test identifies the cause of allergy symptoms:

More Than an Allergy Test

Certain stressors in your pet’s diet are more likely the root source of the allergy symptoms…

The Pet Wellness Life Stress Scan…is the original hair and saliva scan for identifying over 300 stressors in your pet’s diet and environment.

We can show you what foods and environmental factors are currently impacting your pet’s well-being

However, the company also wants to sound “alternative” and, perhaps, to dodge around legal restrictions on claiming to test for allergies when there is no scientific support for the test they are selling. This leads to the usual empty disclaimers that contradict the clear overall message of the advertisement:

This is not a traditional medical laboratory allergy test…It is complimentary and is in no way meant nor to be inferred as a substitute for traditional allergy testing methods that use blood samples such as the ELISA and antibody testing.  We highly recommend that you consult with your vet if you wish such traditional testing be done for your pet.

The company also can’t legitimately claim to diagnose or recommend treatments for allergies since this requires a licensed veterinarian. Instead, they use a lot of doublespeak to suggest that they can help you solve your dog’s allergy problems without actually saying they offer diagnosis and treatment of allergies:

We have Pet Wellness Coaches standing by to help you understand your results and show you the road map back to balance…Our Wellness Coach will go over the results with you page by page….

Bottom Line
The Glacier Peak Holistics Pet Wellness Life Stress Scan (formerly “Healthy Dog and Cat Alternative Sensitivity Assessment”) is a completely implausible test based on vague, mystical nonsense and pseudoscientific theories that contradict the legitimate scientific evidence regarding the cause and management of allergies. The general concept that hair and saliva testing can identify the causes of allergies is false. The marketing of this test is misleading and contains many of the hallmarks of quack advertising. Dog owners struggling with allergies would be far better spending their time and money consulting a veterinary dermatologist for a science-based approach to helping their canine companions.

Posted in General | 44 Comments

Victory! The Federal Trade Commission Acknowledges that Homeopathy is a Placebo

Posted on November 16, 2016 by skeptvet

Last year, two important regulatory agencies in the U.S. undertook to review their regulation of over-the-counter homeopathic remedies. The evidence is clear that homeopathy is nothing more than a placebo, but it has persisted for historical and cultural reasons. As I discussed in an earlier post, the Food and Drug Administration (FDA), which has legal authority over the selling of such remedies, solicited public comment in 2015 on the possibility of changing its very permissive policies on such remedies. That review is still underway.

The Federal Trade Commission (FTC), also took comment on its regulation of the advertising for homeopathic products. While the FTC, unlike the FDA, cannot set conditions for the sale of these remedies nor prohibit their sale, it can require truthful advertising, which in the case of homeopathy would mean declaring it to be a placebo with no scientific basis. Amazingly, that is exactly what the FTC has done in its final report. Here is the core of the findings:

The FTC Act does not exempt homeopathic products from the general requirement that objective product claims be truthful and substantiated.  Nevertheless, in the decades since the Commission announced in 1972 that objective product claims must be substantiated, the FTC has rarely challenged misleading claims for products that were homeopathic or purportedly homeopathic.

For the vast majority of OTC homeopathic drugs, the case for efficacy is based solely on traditional homeopathic theories and there are no valid studies using current scientific methods showing the product’s efficacy.  Accordingly, marketing claims that such homeopathic products have a therapeutic effect lack a reasonable basis and are likely misleading in violation of Sections 5 and 12 of the FTC Act.

In summary, there is no basis under the FTC Act to treat OTC homeopathic drugs differently than other health products.  Accordingly, unqualified disease claims made for homeopathic drugs must be substantiated by competent and reliable scientific evidence.

Nevertheless, truthful, nonmisleading, effective disclosure of the basis for an efficacy claim may be possible.  The approach outlined in this Policy Statement is therefore consistent with the First Amendment, and neither limits consumer access to OTC homeopathic products nor conflicts with the FDA’s regulatory scheme.  It would allow a marketer to include an indication for use that is not supported by scientific evidence so long as the marketer…effectively communicates to consumers that  (1) there is no scientific evidence that the product works and (2) the product’s claims are based only on theories of homeopathy from the 1700s that are not accepted by most modern medical experts.

What the FTC has done is essential what skeptics asked for. Homeopathic remedies may still be sold and advertised, since the agency has no authority to prevent this, but they must be advertised truthfully. This means that any claim that such remedies have any effects must either be supported by legitimate scientific evidence (which is impossible since no homeopathic remedy has ever been scientifically proven to work), or it must be accompanied by a clear statement that the claim is based on 18th century theories unsupported by science and believed by the vast majority of scientists to be false.

I suspect that enforcement of this policy will be limited if not non-existent, especially given the anti-science and post-fact nature of the incoming presidential administration. However, the ruling at least shows that non-politicians in government do hear and consider the voices of skeptics and scientists related to science-policy issues.

In summarizing the comments the agency received during its review, the FTC noted that, “The vast majority of the comments received were from individual consumers who had personally used homeopathic products.” Of 530 public comments received, 400 were from users of homeopathy and 30 from homeopaths. Only 50 individuals (myself included) wrote to express a skeptical view of homeopathy. However, several organizations, including Sense About Science, the Society for Science-based Medicine, the Center for Inquiry, and the Richard Dawkins Foundation for Reason and Science contributed opinions. Ultimately, the logic and evidence of the skeptics won out over the greater number of comments promoting homeopathy through personal faith and anecdote. Though one lesson from this is that skeptics need to get off their lazy butts and share their views more often, a more optimistic lesson is that sometimes science and reason can carry the day even when, sadly, it is the perspective of the minority

 

 

 

Posted in Homeopathy | 2 Comments

Evidence Update: Neutricks Still up to Same Tricks

Posted on November 13, 2016 by skeptvet

In 2011, I reviewed a product called Neutricks that claimed to help dogs with cognitive dysfunction, a condition in old dogs roughly analogous to dementia in elderly humans. At the time, there was little evidence to support the claims made for this product. Last year, I wrote an update evaluating a new study in dogs of the supposed active ingredient in this product. This study had numerous flaws and a high risk of bias, and it did not provide convincing evidence to support the use of Neutricks. I recently noticed a few additional facts about this product that add to the existing information which makes me inclined to recommend people avoid it.

The first is a recent study of the human version of the product, Prevagen, which involves flaws and biases similar to the canine study and which once again fails to provide compelling supportive evidence for this product.

Moran DL, Underwood MY, Gabourie TA, Lerner KC. Effects of a Supplement Containing Apoaequorin on Verbal Learning in Older Adults in the Community. Adv Mind Body Med. 2016 Winter;30(1):4-11.

To begin with, this study was published in the journal Advances in Mind-Body Medicine. Not exactly a reputable scientific heavyweight journal. In fact, it appears to exist primarily to publish lightweight and outright woo research not able to meet the standards of mainstream journals. As for the study itself, it showed little difference between the treatment group and the placebo group until some questionable post-hoc subgroup analyses were done. A detailed critique is already available elsewhere.

In addition, I am not the only one who has noticed that the company makes claims that go well beyond reasonable evidence. In 2012, the FDA issued a warning letter to the company, pointing out that not only was it making claims not acceptable under the minimal rules governing dietary supplements, but that since it was manufacturing the active chemical ingredient synthetically, it didn’t qualify as a supplement anyway and needed to be tested and regulated like any other new drug. What is more, the company apparently ignored numerous reports of side effects and failed to comply with quality standards for supplement manufacturing.

Sadly, the staff and political will to follow such letters with meaningful action are rarely available in today’s political climate, so the company continues to make and sell its product without going through the appropriate scientific or regulatory processes of a new drug approval. However, if the company was misrepresenting their product, ignoring reports of possible harm, and not complying with quality control standards for supplement manufacturing for their human product, there is no reason to believe they do any better with the veterinary version Neutricks.

Finally, in 2015 a class action lawsuit was filed against the manufacturer of Prevagen claiming that consumers were being misled by medical claims for which there was no legitimate supporting evidence. The courts rejected this element of the lawsuit on the technical legal grounds that only government regulators can require proof of advertising claims, not private citizens. The court did not make any ruling on the accuracy of the accusation, only that the plaintiff had no legal standing to make it in court.

However, the court allowed to stand the element of the suit claiming that the product could not work because the purported active ingredients either could not be effective taken orally because they would be destroyed by digestion (a point I made also in my original post) or because they were not present in sufficient quantity. The case is still being argued at this time.

Bottom Line

In the five years since I originally looked into Neutricks, no compelling evidence has emerged showing it is a safe or effective treatment for dogs with cognitive dysfunction. Furthermore, the company has been warned by the FDA for making illegal claims about the human version of the product and apparently not properly handling reports of possible adverse effects. The company is also being sued by individuals who feel they were misled by the advertising claims made for the human product. While none of this amounts to conclusive evidence the product doesn’t work or is harmful, it also does not give any reason for confidence in the product or the company’s claims. Though people continue to offer positive anecdotes in response to these posts, the evidence shows that there are also negative anecdotes out there, and that regulatory authorities have concerns about the conduct of the company in promoting its human version of this product. In my opinion, the safest and most rational choice given the current information available would be to avoid this product until better evidence is provided in dogs with cognitive dysfunction.

Posted in Herbs and Supplements | 36 Comments

Evidence Update: Neutering and Cancer Risk in Dogs

Posted on November 13, 2016 by skeptvet

I have written extensively about the risks and benefits of neutering in dogs and cats. This is an area of active research, and new data emerge regularly to challenge existing beliefs and illustrate the amazing complexity of living organisms and he factors that lead to disease. One subject within this larger field concerns the effects of neutering on cancer risk. The data is complex and inconsistent, but there are some trends that emerge from multiple studies of different types in various populations. Some cancers almost certainly occur less often following neutering, and others almost certainly occur more often, and this relationship is heavily influenced by genetics, most clearly manifested as different effects of neutering on cancer risk in different breeds. A new publication has added a bit of evidence to this subject, which provides a good opportunity to review what we know and don’t know.

Grüntzig K, Graf R, Boo G, et al. Swiss Canine Cancer Registry 1955-2008: Occurrence of the Most Common Tumour Diagnoses and Influence of Age, Breed, Body Size, Sex and Neutering Status on Tumour Development. J Comp Pathol. 2016 Aug-Oct;155(2-3):156-70.

This study looked retrospectively at biopsies of both living and deceased dogs included in a cancer registry that has been collecting data since 1955 and compared the results with other information about these dogs, including age, breed, and neutering status. The general findings confirm the results of previous research, showing that cancer risk typically increases with age, that different breeds have different overall cancer risk as well as predisposition to different types of cancer, and that there are exceptions to almost any generalization one can make about cancer in dogs. These are certainly not surprising findings, and they generally confirm the results of other studies.

One finding that was a bit surprising was that mixed-breed dogs did not appear to be at lower overall cancer risk than purebred dogs, which has appeared to be the case in other studies. The difference between the populations studied or the methods used may be responsible for the different findings, but it raises some doubts about the general assumption that purebred dogs are more likely overall to get cancer than mutts.

In terms of cancer risk and neutering, the findings are summarized in the following table. This compares the odds of cancer in neutered and intact animals, separated both by sex (males and females) and also by the method used to detect the cancer (biopsy samples from living animals compared with post-mortem samples from deceased animals). The odds ratio is given, indicating the odds of a particular cancer in the indicated group compared with intact animals of the same sex using the same detection method.

In general, these data confirm the findings of several other studies, though there are differences. Neutering appears to reduce the risk of adenocarcinomas, especially in females. This primarily relates to breast cancer, which occurs much, much more often in intact females than in neutered females or males. Other types of cancer either showed no difference in risk with neutering or appeared to be more common in neutered animals of one or both sexes.

The differences in odds were consistently larger in post-mortem samples. This reflects a source of bias in the data. Samples of testicles and mammary tissue from living animals undergoing surgery are likely commonly submitted, while samples of other types of cancer from other organs are much less likely to be analyzed and submitted to the registry. This influences the numbers of cancers of different types seen, and means that post-mortem submissions are more common for most tumors except breast and testicular tumors, which are more likely to be sampled in animals that are neutered. In any case, the study accounted for this source of bias by separating the data as seen in the table.

gruntzig-table

The best way to identify real trends is to compare data from different studies, often involving different populations (ages, breeds, geographic locations, etc.) and study methods (clinical patients, cancer registry studies, pathology lab studies, insurance company data, etc). I have collected results from various studies comparing risk between neutered and intact males and females for the types of cancer most commonly thought to be influenced by neutering (other than mammary cancer, of course, which is quite clearly less common in neutered females than in intact females). These data show both some patterns suggesting an increase in the risk of several cancers with neutering as well as some inconsistency in the data, indicating this risk varies by breed and sex and possibly other population factors.

Studies involving neutering and osteosarcoma risk.

gruntzig-table-osa

Studies involving neutering and mast cell tumor risk. gruntzig-table-mct

Studies involving neutering and lymphosarcoma risk.

gruntzig-table-lsa

Studies involving neutering and hemangiosarcoma risk.

gruntzig-table-hsa

Posted in Science-Based Veterinary Medicine | 11 Comments

Are Our Dogs Dying Younger Than They Used To?

Posted on November 8, 2016 by skeptvet

One of the most popular ways to promote unconventional ideas, including alternative therapies, is through fear. Claiming that health, longevity, and other measures of well-being have declined from some time in the past opens the door to claims that science-based healthcare is ineffective and that we should return to some past practice or adopt something radically different. Dr. Karen Becker, a popular promoter of veterinary pseudoscience, recently made just this sort of argument, claiming that dogs are not living as long as they used to and then implying that this can be blamed  on commercial pet food and “toxins,” by which her past writing indicates she means vaccines, parasite prevention products, and pretty much any conventional medical treatment.

To demonstrate this, she cites two surveys of pet owners conducted by the U.K. Kennel Club, one in 2004 and another in 2014.

Why Are These Popular Dogs Dying So Much Younger Than They Used To?

The 2014 survey also found that tragically, the average lifespan of a pedigree dog in the U.K. is just 10 years. In a 2004 Kennel Club report, the average was 11 years, 3 months.

This means the median longevity of Britain’s purebred dogs has dropped by 11 percent in just a decade.

Dr. Becker then goes on to list specific breeds with reported median longevity that is lower in the 2014 survey compared with the 2004 survey.

As we have seen many, many times in the past, Dr. Becker cares far more for her own narrative than for the truth, and she is perfectly comfortable misrepresenting or ignoring facts if doing so will make a story that fits her beliefs and her pitch. This bit of fear-mongering is yet another example.

It is true that the life expectancy figures in the 2014 survey are lower for many breeds than those in the 2004 survey. So, does this mean our pets are not living as long as they used to? Not quite. For one thing, life expectancy figures for some breeds are actually higher in the 2014 report than in the 2004 survey. For example:

Breed 2004 Lifespan 2014 Lifespan
Flat-coated Retriever 9.83 years 10 years
Gordon Setter 11.08 years 12 years
Great Dane 6.5 years 7 years
Greyhound 9.08 years 10 years
Newfoundland 9.67 years 10 years
Old English Sheepdog 10.75 years 11 years

Cherry-picking just the figures that support your claims is a classic move in creating a story that fits what you want to say regardless of the facts.

Overall, the pattern of longevity in the two surveys is nearly identical, as you can see from these figures.

2004 Life Expectancy Histogram

uk-survey-2004-histogram

2014 Life Expectancy Histogram uk-survey-2014-histogram

As you can also see, however, the number of deaths reported is very different, and there is no statistical comparison to show whether the difference in the median or mean is significant. Why is this? Well, it turns out the data were collected in very different ways, they represent different methods and different dog populations, and the two surveys can’t legitimately be compared! Here’s what the actual authors of the survey have to say.

Please note there were substantial differences in the way the 2014 survey was conducted compared to the Purebred Dog Health survey, which was carried out in 2004…Given the difference in methodologies between the surveys, the data from each is not fully comparable and differences observed do not definitively imply changes in population parameters.

Furthermore, there were 5,864 deaths reported in the 2014 survey compared to 15,881 deaths reported in the 2004 survey. This significant drop reduces the likelihood of the sample accurately representing the wider dog population, and so would likely have an impact on median longevity figures if the two sets of data were compared, which would not be reliable.

In other words, Dr. Becker is comparing apples to oranges to show that apples were better in 2004 than in 2014. The actual reality, as determined by facts and evidence not one’s pre-existing beliefs, is that we don’t know whether our pets are living longer or not over the last 10, 20, or 30 years. There is excellent data in humans, and that shows conclusively that life expectancy and nearly every other objective measure of well-being has improved steadily for at least the last 100 years. For humans, at least, science and science-based nutrition, sanitation, and healthcare work far better than anything that went before.

There is no reason to believe the same is not true for our pets, however, there is also no reliable evidence either way. What we need is data, and a respect for legitimate scientific research, not more fear-mongering and twisting of the facts to sell an ideology.

Posted in General | 22 Comments

Acupuncture for Hip Dysplasia In Dogs: Putting some Spin on the Data

Posted on November 6, 2016 by skeptvet

Another study of acupuncture in dogs has been published, and it’s worth a look. It’s a classic illustration of clearly negative results being misrepresented as positive. The authors set up a nice study of acupuncture compared with a common non-steroidal anti-inflammatory or an oral placebo for treatment of pain and lameness in dogs with hip dysplasia. The results pretty clearly showed no effect, and the authors duly wrote a conclusion suggesting acupuncture was a good choice for treating these dogs. Ah, the magic power of confirmation bias!

Teixeira LR, Luna SPL, Matsubara LM, et al. Owner assessment of chronic pain intensity and results of gait analysis of dogs with hip dysplasia treated with acupuncture. Journal of the American Veterinary Medical Association. November 1, 2016, Vol. 249, No. 9, Pages 1031-1039.

The authors of this study concluded that “acupuncture alleviated HD-related pain [and] …decreased lameness” and that “acupuncture performed with the protocol and acupoints used in this study appears to be a viable option for improving quality of life in dogs with HD.” Unfortunately, the results of the study do not support this conclusion.

For one thing, the authors stated that “the acupoints were selected on the basis of their functional effects in traditional Eastern medicine.” That is the only reference they make to the fact that the entire theoretical basis for the treatment rests on the mystical folk system of so-called Traditional Chinese Medicine (TCVM). This is undoubtedly intentional since it would be difficult to present acupuncture as a scientifically legitimate treatment if vets understood that needles were being placed in non-existent channels intended to control the flow of spiritual energy, balance heat and wind, and in keeping with other such pre-scientific notions. TCVM is incompatible with the scientific understanding of health and disease, and whether or not needling has any clinical benefits, it is irrational to use TCVM to select needling locations.

A more concrete problem with the study, however, is the data. The graphs below show the changes in various measures of pain and function over the course of the study, from 2 weeks before treatment to 6 weeks after. Treatment consisted of weekly acupuncture from Week 0 to Week 4 or an oral medication (carprofen) or placebo (lactose) daily from Week 0 to Week 4. Before even looking at the specific outcome measures, it is clear that all of the groups improved almost exactly the same and that overall the placebo group did as well or better than the acupuncture group. Not much more should be needed to conclude this study does not support acupuncture for dogs with hip dysplasia.

teixiera-2016-fig-1

Figure 1—Mean scores derived by use of the HCPI questionnaire completed by owners of HD-affected dogs 2 weeks before (week –2), immediately before (week 0), and at 2, 4, and 6 weeks after initiation of treatment with acupuncture (diamonds), carprofen (squares), or placebo (triangles) and by owners of HD-free dogs (cross) at week 0 only. Fifty-four HD-affected dogs were initially allocated to receive once-weekly sessions of acupuncture (5 sessions within a 30-day period), 4.4 mg of carprofen/kg orally once daily (2.0 mg of carprofen/lb; positive control group), or placebo capsules containing lactose (1 mg/kg [0.45 mg/lb]) orally once daily (negative control group). Acupuncture-treated dogs also received capsules containing lactose orally once daily and carprofen- and placebo-treated dogs were brought to the acupuncture clinic once each week for a total of 5 occasions within a period of 30 days. All of the oral treatments were administered for 30 days. Data from only 15 acupuncture-treated dogs, 16 carprofen-treated dogs, and 16 placebo-treated dogs were available for analysis. The HD-free dogs (n = 16), were selected from kennels or belonged to clients interested in HD-free certification for their dog. At each time point, each owner evaluation involved 3 assessment instruments: the HCPI; the CBPI, including total scores and those corresponding to pain severity and pain interference; and VASs regarding pain and locomotion. *At this time point, the value for each group of HD-affected dogs differed significantly (P < 0.001) from the value for the HD-free dogs.

teixiera-2016-fig-2

Figure 2—Median scores for pain severity (A), pain interference (B), and total pain scores (C) derived by use of the CBPI questionnaire completed by owners of the HD-affected and HD-free dogs in Figure 1. For the HD-affected dogs, assessments were made 2 weeks before (week –2), immediately before (week 0), and at 2, 4, and 6 weeks after initiation of treatment with acupuncture (diamonds), carprofen (squares), or placebo (triangles). The HD-free dogs (cross) were assessed only once (week 0). †At this time point, the value for the acupuncture-treated dogs differed significantly from the week –2 or week 0 value or both values. See Figure 1 for remainder of key.

teixiera-2016-fig-3

Figure 3—Median scores derived by use of a VAS for pain completed by owners of the HD-affected and HD-free dogs in Figure 1. For the HD-affected dogs, assessments were made 2 weeks before (week –2), immediately before (week 0), and at 2, 4, and 6 weeks after initiation of treatment with acupuncture (diamonds), carprofen (squares), or placebo (triangles). The HD-free dogs (cross) were assessed only once (week 0). See Figure 1 and 2 for remainder of key.

The study employed three subjective measures (pain scales designated HCPI, CBPI, and VAS scales) and one objective measure (force plate analysis). There were also several subsidiary categories within most of these measures. These were compared within and across treatments at multiple points in time before, during, and after treatment, yielding a large number of potential outcomes and comparisons. The more opportunities researchers have to select some comparisons and ignore others, the more opportunity for bias to determine the conclusions. The strongest studies are those in which the outcomes are consistent and all show the same result. That was certainly not the case for this study.

According to the authors, “Outcomes of the 3 treatments did not differ significantly [and]…kinetic evaluation did not differ among the groups.” All groups showed variation and overall improvement, but those treated with acupuncture did no better than the other groups, including the placebo. A few comparisons showed a difference between acupuncture and placebo or carprofen treatment in selected comparisons between a few points in time, but these were the exceptions, and the majority of potential outcome measures failed to show any difference. Basically, the authors cherry picked a few comparisons they could make statistically significant and largely ignore the vast majority that were not. This is cheating, though it is sadly very, very common, and not just in alternative medicine research.

The authors used carprofen as a “positive control” and oral lactose capsules as a placebo in this study. Though it might be helpful to include a sham acupuncture treatment as well, these are reasonable choices for control groups, and blinding appeared appropriate. There is robust evidence carprofen and other NSAIDs are effective analgesics in dogs with osteoarthritis.1-2 It is surprising, then, that carprofen had no apparent effect beyond placebo in this study. This calls into question the accuracy of the outcome measures employed. If a proven arthritis therapy didn’t appear to work better than placebo, it is unclear why we should trust the other results of the study.

Given the apparent lack of efficacy of the positive control and the failure to identify differences between treatment groups in nearly all outcome measures, it seems the most appropriate conclusion is that this study does not provide evidence to support the use of acupuncture for dogs with hip dysplasia. The data are far more compatible with the hypothesis of no difference between treatment and placebo, and the improvement seen in all groups is likely the result of nonspecific clinical trial effects (e.g. the Hawthorne effect3) and natural variation over time.

Negative findings are just as important and useful as data that do show efficacy. This study makes a valuable contribution to our understanding of the potential role of acupuncture in treatment of hip dysplasia. But it is misleading to characterize the results as supportive of utilizing this acupuncture protocol to treat pain of lameness associated with this disorder. Undoubtedly, people will cite this as a positive study when advocating acupuncture for dogs, but it takes very little investigation to realize it suggests exactly the opposite.

 

Update 12/27/2016:

I wrote a letter to the editor of the Journal of the American Veterinary Medical Association (JAVMA) which presented a shorter version of my critique of this article. The authors’ response was disappointing, to say the least, and a classic example of cognitive dissonance, the inability to objectively consider evidence that challenges a strongly held belief.

Dr. McKenzie is correct that in our study1 of dogs with hip dysplasia treated with acupuncture, carprofen, or a placebo, results for our subjective (Helsinki Chronic Pain Index, Canine Brief Pain Inventory, and visual analogue scales for pain and degree of lameness) and objective (kinetic variables obtained with a pressure platform) outcome measures did not differ among groups at any time point. In addition, results of kinetic evaluations did not differ over time in any of the groups.

Nevertheless, we did detect some differences among groups. For instance, the percentage of dogs with at least a 30% improvement in CBPI score, compared with baseline score, was significantly (P = 0.034) higher for dogs treated with acupuncture (13/15) than for dogs treated with a placebo (7/16), although not significantly (P = 0.446) different from the percentage for dogs treated with carprofen (11/16). Only 2 dogs required rescue analgesia, and both were in the carprofen group. In addition, only dogs in the acupuncture treatment group were found to have significant improvements in CBPI scores (total score and pain severity and pain interference subscores) and the VAS score for pain at various times, compared with baseline scores, and only dogs in the acupuncture and carprofen groups had improvements in the VAS score for locomotion. Therefore, we do not agree that the statistical testing created “an impression of effect,” as suggested by Dr. McKenzie.

We are aware that carprofen and other NSAIDs have been reported to be effective analgesics in dogs with osteoarthritis, and we do not have an explanation for why dogs in the carprofen group in our study did not perform better than dogs in the placebo group. However, in one of the reviews supporting the efficacy of NSAIDs in the treatment of osteoarthritis mentioned by Dr McKenzie, Innes et al2 reported that none of the selected studies met all 3 of their criteria for inclusion of essential elements for evidence-based medicine. Therefore, the efficacy of NSAIDs should perhaps be questioned and we should possibly seek new strategies to treat osteoarthritis.

The authors have considerable experience in working with acupuncture and conventional medical approaches to treat dogs with chronic neurologic and musculoskeletal diseases, and our clinical impressions support the benefit of acupuncture. Therefore, we feel confident in our conclusion that acupuncture may be a viable option for improving the quality of life in dogs with hip dysplasia. However, we understand that conventional medicine, including NSAIDs, is very important as a multimodal approach to alleviate chronic pain and argue that we should use all possible therapeutic tools to treat our patients. [emphasis added]

The idea that the failure of the positive control (carprofen, an NSAID) might indicate that the most widely used  and thoroughly studied class of drugs for arthritis pain is actually ineffective rather than that there is a serious flaw in this study is far-fetched, to say the least. And the final paragraph of this response illustrates the deep problem at the core of so much veterinary research, and in my opinion especially CAVM research; the use of science not to discover the truth but to buttress and provide marketing support for one’s existing beliefs. The fact that academic veterinarians and scientific researchers would openly admit that they believe a treatment is effective based on personal experience no matter what their own research evidence shows is a very bad sign for the health and usefulness of veterinary clinical research.

Reference

  1. Innes JF, Clayton J, Lascelles BD. Review of the safety and efficacy of long-term NSAID use in the treatment of canine osteoarthritis. Vet Rec. 2010 Feb 20;166(8):226-30.
  2. Aragon CL, Hofmeister EH, Budsberg SC. Systematic review of clinical trials of treatments for osteoarthritis in dogs. J Am Vet Med Assoc. 2007 Feb 15;230(4):514-21.
  3. McCambridge J, Witton J, Elbourne DR. Systematic review of the Hawthorne effect: New concepts are needed to study research participation effects. J Clin Epidemiol 2014 Mar; 67(3): 267–277.
Posted in Acupuncture | 4 Comments