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Skeptvet’s Acupuncture Adventure- Part 7: Emerging Themes

Posted on January 24, 2016 by skeptvet

I haven’t updated my acupuncture adventure in a while, largely because I’m past the part of the course making general claims and justifications of acupuncture and into the portion that consists mostly of memorizing individual points and associated anatomical and functional elements. The details don’t matter a great deal if the general principles and the evidence related to them don’t hold up, and I remain unconvinced on that count. I appreciate the absence of mystical explanations concerning energy fields and extensive empty metaphors about Heat, Wind, Yin/Yang, and so on. However, the themes that are emerging in place of these concepts still seem quite problematic. I thought I would summarize some of the major principles being expounded in this course, and my concerns about them.

Evidence of anatomical connection is taken as evidence of functional connection.

The instructors seem to feel that if any sort of physical connection can be traced between an acupuncture point and some other part of the body, it is fair to assume that stimulation at that point should influence that part. For example, if a point on a limb has sympathetic innervation that can be traced back to sympathetic nervous system (SNS) centers in the brain, it is assumed stimulation of that point can influence SNS.

There are several problems with this assumption. To begin with, as I discussed earlier, one can stick a needle almost anywhere on the body and find a nerve, muscle, blood vessel, or some other organ that it is claimed responds to needle stimulation. There is little evidence to suggest the particular points identified in traditional acupuncture, and still used in supposedly scientific acupuncture, are anatomically or functionally special. The assumption that they are underlies all the use of these, but the case for that assumption is weak and contradicted by abundant research showing that needling location makes little if any difference in the response to needling.

The other problem with the idea that because one can trace a nerve or blood vessel at one location back to other parts of the nervous or circulatory system one can manipulate the distant structures by needling this point is similar. In the body, everything is connected to everything else. There is almost no part of the body that can’t be connected in some way to any other part. Without showing that particular points used to cause specific effects, such as modulation of the SNS, have unique or specific connections that should cause those effects which other points don’t have, you are just arbitrarily identifying some locations as more special or connected than others in a way that isn’t evidence-based.

2. Any stimulus provided is assumed to result in the desired effect.

There seems to be another unproven assumption that when one stimulates a point believed to have special influence over some body organ or system that the stimulation will result only in the desired effect. Again as an example, if you needle a point that influences the SNS, it is assumed the influence will be what you want for the patient, increasing or decreasing SNS activity as desired. The main evidence for this seems to be the historical use of particular points for particular purposes. But if you can stimulate the SNS by needling a given muscle point, why isn’t it just as likely to cause undesired change? If point X downregulates SNS and point Y upregulates the parasympathetic nervous system (PNS), why couldn’t it be the other way around?

While the instructors acknowledge that acupuncture can have negative effects, these are mostly described as errors in needling, such as puncturing blood vessels, internal organs, or other structures one does not intend to puncture. It is also acknowledged that the needling itself can be painful. But the idea that correctly stimulating a particular point could have effects other than those desired has not, so far, been mentioned. This implies only beneficial effects with no side effects, which violates McKenzie’s Law.

3. Myofascial trigger point theory.

Dr. Robinson is an osteopath as well as a veterinarian, and a common element of osteopathic training is myofascial trigger point theory. This is the theory that pain and dysfunction, both locally and at distant parts of the body, can be caused by “knots” or “taut bands” of tension in muscles, which one can relieve by manipulation of these trigger points with massage, laser therapy, and needling. Dr. Robinson seems to suggest in her course that perhaps the most important way to identify which acupuncture points to treat in a given patient is to look for these trigger points and focus on relieving them locally, as well as treating the patient’s problem through other effects of acupuncture at points elsewhere on the body.

The problem is that trigger point theory is itself not much better supported by scientific evidence than acupuncture. It is widely believed and utilized among osteopaths, massage therapists, chiropractors, physical therapists, and others in both conventional and alternative medicine who treat musculoskeletal problems, but there is plenty of controversy and not a robust body of evidence to show the theory is correct or the effects of manipulative treatments occur through trigger point release. So it isn’t helpful to explain the unproven benefits of acupuncture using a similarly unproven, though somewhat more widely accepted, theory.

4. Vague terms with little specific evidence for their meaning

There is a lot of use of scientific and general terminology in ways that are not always defined very specifically and which seems to cover up the lack of evidence for implied clinical effects. For example, many purported effects of acupuncture are explained in terms of “neuromodulation.” I discussed this briefly earlier in the course, and the explanation or evidence presented for this concept hasn’t gotten a lot more detailed. Again, the assumption seems to be that if a point is connected to part of the nervous system then stimulation of that point will have desirable effects on that part of the nervous system. Calling this “neuromodulation” doesn’t explain or prove it to be true.

Similar problems pertain to other terms like “stimulating,” “releasing,” and so on. These may be descriptions of real actions and effects, but often they seem not to have very specific meaning or much evidence behind them.

Ultimately, I think Dr. Robinson and the other instructors are sincere in their belief that acupuncture can and should be scientific in its principles and validation. However, I also think they tend, as we all do, to interpret the limited and ambiguous evidence in ways that support beliefs they hold primarily based on clinical experience and habit. The tendency to gloss over evidence that contradicts our experiences and beliefs and to put the best possible face on evidence that supports them, even when it is weak, is universal. Unfortunately, even with the best intentions, that phenomenon can leave us with a firm commitment to our beliefs without a sound, scientific basis for them.

Posted in Acupuncture | 17 Comments

It’s the Law

Posted on January 20, 2016 by skeptvet

Posted in Humor | Leave a comment

Another Study Shows Acupuncture is a Placebo Treatment

Posted on January 19, 2016 by skeptvet

One consistent theme in acupuncture research is that it has proven very difficult to show any difference between the effects of acupuncture intended to treat a symptom or disease and the effects of various kinds of fake or sham acupuncture intended as a placebo control. Often, pretending to do acupuncture (inserting needles at places not thought to be acupuncture points or just pretending to insert needles) has as much of an apparent effect as “real” acupuncture treatment. (e.g. 1, 2, 3). The evidence also strongly suggests that where one places the needles during acupuncture treatment is largely irrelevant since the effect, such as it is, will be the same.

The most reasonable interpretation of this evidence is that acupuncture functions primarily a s a placebo. It is the therapeutic ritual, and possibly some small, non-specific counterirritant effects, that influence the patient. This means that all the theorizing about points and channels and both Chinese Medicine explanations of acupuncture (Five Elements, Yin/Yang, Qi, etc.) and conventional scientific attempts to explain it (endorphins, nerve stimulation, etc.) are just rationalizations for placebo effects.

The strength of this conclusion is, as always in science, proportional to the strength of the evidence. One more small piece of evidence has recently been released that supports this understanding of acupuncture.

Carolyn Ee, MBBS; Charlie Xue, PhD; Patty Chondros, PhD; Stephen P. Myers, PhD; Simon D. French, PhD; Helena Teede, PhD; and Marie Pirotta, PhD. Acupuncture for Menopausal Hot Flashes: A Randomized Trial. Ann Intern Med. Published online 19 January 2016.

This study randomly assigned 327 women with menopausal hot flashes to either acupuncture as guided by TCM principles or fake acupuncture with non-inserted needles. The bottom line was that both groups improved about 40%, but there was no difference between targeted acupuncture treatment and fake acupuncture. This is exactly what one would expect for a placebo therapy, ,and it is consistent with the growing body of evidence indication acupuncture is no more than a placebo for most uses.

Posted in Acupuncture | 7 Comments

What’s the Right “Dose” of a Vaccine for Small-Breed Dogs?

Posted on January 18, 2016 by skeptvet

There’s a common misconception out there about vaccines that small animals should have lower “doses” of a vaccine than larger animals. This is a natural assumption stemming, most likely, from our familiarity with how medicines are dosed. However, while there are some differences in the amount of a vaccine given in different species, it is far less of a difference than would be expected if vaccines worked like drugs.

An analogy I often use to explain this is that drugs work like a dimmer switch for a lamp. You get some light with a small movement of the switch. The farther you push the switch, the brighter the light gets. There is a minimum movement below which the light stays off and a maximum above which the light won’t get any brighter. In between, however, the amount of light is proportional to the amount you move the switch. This is much like a drug, which often will have more effects the larger the dose given (though, of course, the reality is much more complicated since different drugs work in different ways, and in the real world pharmacokinetics and pharmacodynamics are highly complex and variable).

Since the dose of the drug is really the concentration in the blood or tissues, the larger an animal, the more drug has to be given to get the same amount in each milliliter of blood or each gram of body tissue. Assuming the simplest kind of drug dosing relationship, the size of the animal is directly proportional to the dose needed, meaning a dog that is 10kg will need twice as much drug as a dog that weighs 5kg. Again, reality is much more complicated, but as a basic starting point, we often dose drugs in milligrams per kilogram of body weight to reflect this kind of relationship.

However, vaccines don’t work this way. A better analogy for vaccines is a traditional light switch rather than a dimmer switch. There is a critical point at which the light goes from all off to all on. Movement below the threshold yields no light, and additional movement above the threshold gives no more light. For vaccines, there is a minimum immunizing dose (MID), a threshold at which the immune response is fully stimulated. Vaccines don’t work by being distributed throughout the body at a certain concentration, like drugs, but by triggering an essentially all-or-nothing immune response through interacting with special cells in the immune system.

The MID does vary a little by size, but not much. A horse, for example, will get complete protection form rabies after receiving only about twice as much vaccine as a dog, though the dog may be much less than half the size of the horse.

The same logic applies to any adverse effects from drugs and vaccines. In general, harmful effects get worse as the tissue or blood concentration of a drug goes up, which is very closely related to the dose given. With vaccines, adverse effects are unpredictable and not clearly related to dose. It is true that smaller dogs are more prone to allergic reactions to vaccines than larger breeds, but this likely has to do with genetic differences between breeds, not size. Smaller individuals within a breed have not been shown to be more prone to such reactions than larger individuals. The difference in size between members of the same species is almost never great enough to affect the MID, and the idea that a 10lb dog needs half the vaccine of a 50lb dog simply isn’t consistent with the biology of vaccines and the immune system.

Nevertheless, alternative medicine advocates frequently recommend smaller “doses” of vaccine for smaller dogs. There is not yet any real evidence to indicate that this would be an effective strategy to maintain immunity while reducing the risk of adverse effects. A recent “study” by Dr. Jean Dodds claims to provide some such evidence. However, this research has been supported by the American Holistic Veterinary Medical Foundation (AHVMF), and it bears many of the characteristic features of that group’s approach to research. As I’ve pointed out before, the AHVMF and associated groups and individuals seem to feel the purpose of scientific research is not to uncover the truth but to convince others of claims they already “know” are true based on personal experience or simple belief. Dr. Dodds herself has certainly shown this to be her approach before.

While Dr. Dodds’ study is only a pilot trial, and thus isn’t intended to prove anything, it is already being used as if it were evidence for giving smaller doses of vaccine to smaller dogs. The study has been published in the AHVMA journal, which is not accessible except to AHVMA members. From the information reported on her web site, it isn’t possible to evaluate completely what, if anything, we can reasonably conclude from it. But it is clear even from this limited information that the study does not provide a reason to change vaccination practices.

Thirteen dogs under 12lbs who had not been vaccinated in at least three years were enrolled in the study. Over a two-year period, antibody titers for distemper and parvovirus were taken for each dog at enrollment and then 4 months and 6 months after vaccination with a parvo/distemper vaccine. The vaccine was given as a “half dose,” though exactly what this means or how it was determined isn’t clear. The results reported were only that antibody levels went up in all of the dogs after vaccination and stayed higher than initial levels through the 6-month check.

This tells us almost nothing of relevance to the question of whether lower doses of vaccine can protect small dogs and reduce their risk of adverse events. Is the Hemopet titer a validated titer test with meaningful cutoff levels? What were the original titer levels? Were they already protective? How much did they increase, and would this make a difference between immunity and susceptibility? What vaccine history did the dogs have? Were any even susceptible to these diseases and, if so, would the vague half dose have protected them? Did any have adverse reactions? Had they had any adverse reactions to full-dose vaccination? Would they be less likely to have such reactions at the lower dose?

The unanswered questions are nearly endless, and many of them are crucial to the actual question. While a pilot trial, again, is only intended to test whether a real study is feasible and safe, the reality is that this trial is already being used to imply that giving less of a vaccine to smaller dogs is safer and just as effective as giving the intended dose. Dr. Dodds implies that on her site, and others reporting her results elsewhere do the same. Nothing about this trial justifies that claim.

Hopefully, more rigorous and transparent research will be done, but I am not optimistic. The goal is clearly to convince others of something Dr. Dodds and most of the AHVMA members already believe on faith, not to find out if this belief is actually true. As is often said about politicians, alternative medicine proponents often use science the way a drunk person uses a streetlamp: for support, not for illumination.

Posted in Vaccines | 31 Comments

Evidence Update: Pheromone Therapy for Stress in Cats

Posted on January 3, 2016 by skeptvet

Back in 2010, I reported on a systematic review evaluating the use of pheromones to treat stress or other undesirable behaviors in cats and dogs. Of the 7 studies in cats and 7 in dogs that were of sufficient quality to be reviewed, no convincing benefit was seen in cats, and only one study showed a possible small effect in dogs. In another dog study published later that year, a few of the behaviors measured seemed to be affected by the pheromone, but there wasn’t any compelling evidence of a meaningful benefit. Now, another cat study has been published looking at the effect of a widely available pheromone product on physical and behavioral response to handling stress in cats both at home and in a veterinary hospital.

Conti, LMC. Champion, T. Guberman, UC. et al. Evaluation of environment and a feline facial pheromone analogue on physiologic and behavioral measures in cats. J of Feline Med and Surg. 2015. Epub before print.

This was a quite nicely done study in which 30 cats were evaluated at home and in a veterinary clinic for responses to pheromone (Feliway) or a placebo. Objective measures, such as heart rate, respiratory rate, blood pressure, and so on were taken, as well as more subjective measures, such as struggling. Cats were tested in response to routine handling at home and in the clinic after environmental treatment with either the pheromone or a placebo containing the vehicle (ethanol).

The results were pretty clear. While the clinic environment is generally more stressful than the home (reflected in differences in heart rate and respiratory rate), cats tolerate being handled and restrained in an unfamiliar environment better than in their own home (reflected in behavioral differences). In neither environment did the pheromone make any difference in the cats’ responses compared with placebo. The authors concluded that the pheromone had no influence on the markers of stress evaluated in this study.

Given the consistency of results across a number of studies, it is pretty clear at this point that pheromone products are unlikely to have any beneficial effects for dogs and cats.

Posted in General | 41 Comments

Make Medicine Better: Support Registration of All Trials in Veterinary and Human Medicine

Posted on December 18, 2015 by skeptvet

Scientific research is the most powerful tool we have to discover and improve the therapies we offer our patients. However, research only helps us if the studies are well-conducted and the results are available for other researchers and clinicians to evaluate. As doctors, as owners of veterinary patients, and as patients ourselves, we need to know how medical research studies are conducted, and we need access to all the data they produce so that we can make effective and informed decisions.

Unfortunately, sometimes medical researchers make good plans for their studies but fail to follow through with them. And all too often research results, especially negative results showing a new treatment doesn’t work or has risks, aren’t published at all. This reduces the value of the research done; it wastes money and resources and places patients at risk.

One way to improve the quality of research and to make sure all the results are available is through clinical trial registries. When the plan for a research study is published in advance, it is more likely to be followed, and any weaknesses can be identified. And when government agencies, funding sources, and journals require advance registration and full publication of results, medical trials are of better quality and more vital information is available to the research community, doctors, and patients.

All Trials is an initiative to encourage registration and publication of results in human medical research. This initiative is having dramatic success. There has been significant progress in bring the pharmaceutical industry and other commercial research companies on board, as well as convincing government regulators, scientific journals, and organizations funding research to support registration. This initiative will make medicine research better and more transparent and will ultimately benefit both doctors and patients.

In veterinary medicine, clinical trial registration is almost non-existent. There are no registries available for most studies, and no mechanism to encourage or require advance registration. The evidence is clear that there are significant deficiencies in the quality and reporting of veterinary clinical trials, and the extent of negative publication bias is largely unknown. A system for clinical trials registration in veterinary medicine is even more critical than in human medical research.

Vet All Trials is a consortium working towards developing an effective veterinary clinical trial registry. Please consider learning more about the work of All Trials and the Veterinary All Trials Initiative and getting involved. Help make veterinary medicine better, for veterinarians, animal owners, and most of all veterinary patients.

You can go to our web sites to get more information and to sign the All Trials and Veterinary All Trials petitions.

Here is a short message you can share to raise awareness about this important issue.

Thank You!

Posted in Science-Based Veterinary Medicine | Leave a comment

More Misuse of Science as Propaganda Tool by Mercola and the AHVMF

Posted on December 13, 2015 by skeptvet

I’ve written quite a bit about the problematic relationship between advocates of alternative medicine and scientific research. While I’m all for appropriate, high-quality research into any therapy with reasonable plausibility, which would include many alternative treatments, I object to the misuse of research as a propaganda tool. Many proponents of alternative medicine have a fundamentally religious faith in their practices. They don’t believe scientific research is necessary to prove what they “already know,” and no research evidence could ever convince them their practices don’t’ work. With this type of mindset, it is very hard to generate fair, high-quality research evidence that actually gets us closer to the truth.

The American Holistic Veterinary Medical Foundation (AHVMF) is particularly guilty of this type of misuse of science. A recent interview by Dr. Karen Becker (at the Mercola web site) with a recipient of AHVMF funding, Dr. Danielle Conway (whom I’ve written about in this context before), illustrates the serious misconceptions about science that undermine the legitimacy of the research these folks support and conduct.

The interview is titled, “Finally! A Study That Proves Processed Foods Can Cause Disease.” This clearly illustrates that the author is viewing the research as confirmation of a pre-existing belief that did not require scientific validation. She confirms this in the interview itself, where she says, “I know for a fact that processed pet food causes inflammation in dogs’ bodies because I see it in my practice. Dr. Conway is going to be able to prove scientifically that it is happening, and hers will be the first study I’m aware of in pets.” Knowing something “for a fact” for which there are no studies is not consistent with a science-based approach.

It turns out that the research she is referring doesn’t even remotely “prove” what she is claiming anyway. She is apparently referring to an unpublished pre-clinical study by Dr. Conway looking at the effect of heat on the production of compounds suspected to be a risk factor for some diseases in humans.

…the preliminary pilot study, in which she looked at the presence of AGE in different types of pet foods, is complete. What she found across-the-board is that the less processing that occurs, the less heat applied, the more moisture maintained, the lower the AGE.

This is certainly worth following up on, but it is totally inconsistent with the claim of the interview title. The bias here is clear and strong. This is incredibly ironic since Dr. Becker dismisses any research funded by pet food companies as meaningless because of presumed bias, and yet she considers research funded by Mercola and AHVMF as “independent” and trustworthy.

Dr. Conway also shows some serious flaws in her view of science and scientific research in this interview. When asked what sort of research she would like to see funded and why, she responds:

She would also like to see more research into herbs. She has found that when she can cite a study on a particular herb that she wants to try, everyone immediately gets on board. They don’t even need to read the study. Just the fact that a study exists is enough for them. It’s a good demonstration of the benefit of published research on medical treatments.

A clearer example of how not to use scientific research would be hard to find. I doubt Dr. Conway or Dr. Becker would feel as positive about students or vets automatically accepting any treatment for which a proponent can cite any study if the studies cited were funded by the pharmaceutical or pet food industry. Yet they are happy to see uncritical, blind enthusiasm for their therapies based on research their audience hasn’t even read, much less critically evaluated.

Once again, for many CAVM advocates, certainly the AHVMF and Mercola, scientific research is not a means of finding out what is true. They already feel their knowledge based on personal experience and theory is already sufficient and requires not empirical validation. The only use for research, and for the money they spend on funding it and training alternative practitioners in academia, is to promote what they already believe. This is simply a cynical use of science as a marketing tool for spreading the faith, not as a tool for better understanding health and disease in our patients.

Posted in Nutrition | 9 Comments

SkeptVet’s Acupuncture Adventure- Part 6: Neuromodulation of Cranial Nerves

Posted on December 2, 2015 by skeptvet

The latest lectures in my acupuncture course have covered the use of acupuncture (and, incidentally, massage and laser therapy) for “neuromodulation” of the twelve cranial nerves. “Neuromodulation” is a somewhat vague term often used to suggest some clinically relevant and likely beneficial effect on the function of the nervous system. More casually, this is described with terms like “give it a boost” or “help that nerve be a happier nerve.” This is a theme in this course, in which the fact that needling, electrical stimulation, and possibly laser stimulation have measurable effects on nerves is assumed to imply clinically meaningful and beneficial effects in patients. As I’ve said before, this is a plausible hypothesis, but it has to be proven with appropriate clinical research, which often turns out not to be the case.

Many of the cranial nerves are not directly accessible, and often they have functions that are not likely to be associated with clinical problems we deal with in veterinary patients. However, some nerves, especially CN V, VII, VIII and X do have functions associated with fairly common and important clinical problems, so modulation of these functions could potentially have clinical value.

Much is made in these lectures of the anatomic relationships between elements of the nervous system, with the implication that these anatomic connections imply relevant functional connections we can manipulate with acupuncture. However, it is important to realize that one can’t reliably infer functional relationships solely form anatomic relationships. Exercise, for example, stimulates gastrointestinal motility despite the lack of a simple and obvious anatomic relationship to predict this. On the other hand, the spinal cord is pretty widely and directly connected to nearly everything in the body, yet the evidence is strong that chiropractic manipulation of the spine has virtually no significant effects on the body apart from the spine itself. The obvious anatomic relationship turns out not to have a corresponding functional relationship.

The real question, of course, is whether there is actual clinical value to acupuncture etc. in patients with problems that we might reasonable suspect could be influenced by modulation of cranial nerves. That seems to be far from clear based on the evidence presented in these lectures.

As an example, the role of acupuncture in controlling seizures is mentioned several times. Direct and indirect stimulation of CN V and CN X are suggested as likely ways to influence seizures due to anatomic and functional relationships between these nerves and the parasympathetic nervous system, which does play a role in controlling seizure activity. And there is evidence that direct stimulation of CN X via an implanted electrical nerve stimulator. However, this is clearly not the same thing as acupuncture. So what does the clinical evidence suggest?

As usual, there is poor evidence in veterinary patients. A couple of uncontrolled studies in dogs have been done. One suggested improvement in seizure frequency, but such improvement has also been seen in epileptic dogs receiving placebo treatment, so uncontrolled studies can’t be taken as reliable evidence of an effect. The evidence is still limited and at high risk of bias in humans, but there is more research, and reviews do not suggest a strong or repeatable clinical benefit.

Cheuk DK, Wong V. Acupuncture for epilepsy. Cochrane Database Syst Rev. 2014 May 7;5:

MAIN RESULTS:
We included 17 RCTs with 1538 participants that had a wide age range and were suffering mainly from generalized epilepsy. The duration of treatment varied from 7.5 weeks to 1 year. All included trials had a high risk of bias with short follow-up. treatment in the included trials.

AUTHORS’ CONCLUSIONS:
Available RCTs are small, heterogeneous and have high risk of bias. The current evidence does not support acupuncture for treating epilepsy.

Yang C, Hao Z, Zhang LL, Guo Q. Efficacy and safety of acupuncture in children: an overview of systematic reviews. Pediatr Res. 2015 Aug;78(2):112-9.

Abstract
We aim to update the evidence for the efficacy and safety of acupuncture for children and evaluate the methodological qualities of these studies to improve future research in this area. We included 24 systematic reviews, comprising 142 randomized controlled trials (RCTs) with 12,787 participants. Only 25% (6/24) reviews were considered to be high quality (10.00?±?0.63). High-quality systematic reviews and Cochrane systematic reviews tend to yield neutral or negative results (P = 0.052, 0.009 respectively). The efficacy of acupuncture for five diseases (Cerebral Palsy (CP), nocturnal enuresis, tic disorders, amblyopia, and pain reduction) is promising. It was unclear for hypoxic ischemic encephalopathy, attention deficit hyperactivity disorder, mumps, autism spectrum disorder (ASD), asthma, nausea/vomiting, and myopia. Acupuncture is not effective for epilepsy. Only six reviews reported adverse events (AEs) and no fatal side effects were reported. The efficacy of acupuncture for some diseases is promising and there have been no fatal side effects reported. Further high-quality studies are justified, with five diseases in particular as research priorities.

Another example was the condition of xerostomia or “dry mouth.” This can occur with radiation or surgical therapy around the mouth as well as for other reasons, It is hard to assess in veterinary patients and so not a regular target for therapy, but it is used as an example in these lectures of clinical benefits from neuromodulation through acupuncture, in this case of CN IX. However, the evidence in humans does not suggest that the theoretical benefits of acupuncture stimulation of CN IX translate into significant benefits for actual patients with xerostomia.

Jedel E. J Oral Rehabil 2005 Jun;32(6):392-6. Acupuncture in xerostomia–a systematic review.

Abstract
The aim of this systematic review was to assess the efficacy of acupuncture in the management of xerostomia….Three articles met the criteria for inclusion and a criteria list was used to assess the quality of these studies. The studies were considered to be of high quality or low quality in accordance with the criteria list utilized. The results of the trials were considered positive, negative or indifferent based on statistically significant between group differences. The criteria list utilized indicate that one of the three studies was of high quality and it presents indifferent results. One of the two studies of low quality presents positive results and one presents indifferent results. An analysis of the results degree of evidence resulted in no evidence for the efficacy of acupuncture in the management of xerostomia. This systematic review shows that there is no evidence for the efficacy of acupuncture in the management of xerostomia. There is a need for future high quality randomized controlled trials.

Wu X, Chung VCh, Hui EP, et al. Effectiveness of acupuncture and related therapies for palliative care of cancer: overview of systematic reviews. Sci Rep. 2015 Nov 26;5:16776.

Abstract
…There is evidence for the therapeutic effects of acupuncture for the management of cancer-related fatigue, chemotherapy-induced nausea and vomiting and leucopenia in patients with cancer. There is conflicting evidence regarding the treatment of cancer-related pain, hot flashes and hiccups, and improving patients’ quality of life. The available evidence is currently insufficient to support or refute the potential of acupuncture and related therapies in the management of xerostomia, dyspnea and lymphedema and in the improvement of psychological well-being. No serious adverse effects were reported in any study.

Hanchanale S, Adkinson L, Daniel S, et al. Systematic literature review: xerostomia in advanced cancer patients. Support Care Cancer. 2015 Mar;23(3):881-8.

Abstract
CONCLUSION:
Limited published data exists reporting the effectiveness of measures in the treatment of xerostomia in cancer patients. Based on primary research of low quality, firm conclusions cannot be drawn. However, pilocarpine, artificial saliva, chewing gum and acupuncture can be tried based on the available data. This highlights the explicit need to improve our evidence base. Properly constructed randomized controlled trials demonstrating effectiveness of pharmacological and non-pharmacological interventions for dry mouth are required.

Furness S, Bryan G, McMillan R, et al. Interventions for the management of dry mouth: non-pharmacological interventions. Cochrane Database Syst Rev. 2013 Sep 5;9:CD009603.

There were nine studies (total 366 participants randomised) included in this review of non-pharmacological interventions for dry mouth which were divided into three comparisons. Eight studies were assessed at high risk of bias in at least one domain and the remaining study was at unclear risk of bias….There is low quality evidence that acupuncture is no different from placebo acupuncture with regard to dry mouth symptoms, which is the most important outcome …There is insufficient evidence to determine the effects of electrostimulation devices on dry mouth symptoms. It is well known that dry mouth symptoms may be problematic even when saliva production is increased, yet only two of the trials that evaluated acupuncture reported dry mouth symptoms, a worrying reporting bias. There is some low quality evidence that acupuncture results in a small increase in saliva production in patients with dry mouth following radiotherapy….Reported adverse effects of acupuncture are mild and of short duration, and there were no reported adverse effects from electrostimulation.

Similar results are found when the other main examples of purported neuromodulation of cranial nerves through acupuncture are investigated. What this says to be is that despite plausible anatomic relationships that suggest acupuncture could be useful in altering the function of these nerves to the benefit of patients, it seems to be very difficult to prove in the real world. This might mean we need more and better research, as the reviews usually conclude. Or it might mean that there is no effect to find. Certainly, therapies with a strong and definitive benefit aren’t not usually difficult to validate in clinical research, so the difficulty in showing benefits for acupuncture is reason for some skepticism.

Posted in Acupuncture | 8 Comments

Ahhh, Dr. Google

Posted on December 1, 2015 by skeptvet

I’ve always made it a point to remind people that expertise is low-level evidence. Plenty of folks with advanced scientific training hold blatantly untrue, anti-science views. The notion that who you are is sufficient to prove what you claim true is known as the Appeal to Authority fallacy. Being an expert (especially a self-proclaimed one) doesn’t mean your claims should be accepted without further evidence.

However, it is also false that all opinions are equally likely to be true and that expertise carries no evidentiary weight at all. Surgeons do surgery and pilots fly airplanes better than people without training in those fields, and legitimate experts with recognized credentials are more likely to have credible opinions and information about subjects within their area of expertise.

The trick is to balance the excessive respect for expertise that leads to uncritical acceptance of claims contrary to evidence with the illusion that one can make judgements about absolutely anything that are just as sound as people who truly are experts in those subjects. The appeal to authority problem comes up most frequently here, with vets or others in medicine making false claims and expecting them to be accepted without evidence beyond their word. However, in my daily life as a practicing vet, the more common problem I see is the belief that expertise is irrelevant and anyone’s opinion is as likely to be true as that of someone with formal training and experience in medicine.

Just last month, I saw a client who became very angry, and quite abusive, when I refused to prescribe a drug she wanted for her cat. When I tried to explain why the drug was not going to help her pet, and was more likely to do harm than good, she kept saying “That’s just your opinion” and “I read on the internet that he needs that drug.” Though I’ve run into this before, I still found this woman’s faith in the advice of anonymous strangers and random web site above the actual veterinarian who was seeing her and her cat pretty stunning.

Fortunately, just this week I ran across two lovely comments on this problem which I thought I would share. The first is a coffee cup I dearly hope someone will get me for Christmas.

The second is the latest offering from Veterinary Chanteuse Extraordinaire Kelsey Beth Carpenter:

Posted in Humor | 7 Comments

Are Homeopaths Innocent Victims of Skeptical Attacks?

Posted on November 28, 2015 by skeptvet

Homeopaths often claim they are being unfairly “attacked” when skeptics point out that homeopathy is irrational, pseudoscientific, or simply ineffective. They portray themselves as innocently minding their own business until we spontaneously attack them. This ignores the reality, however, that homeopaths frequently promote homeopathy as an alternative to scientific medicine, and they often do so with their own vigorous criticism of conventional veterinary medicine. Here are a few examples:

Did you know that conventional veterinary medicine (excluding surgical options) and its conventional drug therapies – is capable of relieving symptoms but not curing your pet? If you have a pet you love or farm animals you care for – homeopathy is the only system of veterinary medicine that holds the potential to actually cure animals of disease.
Academy of Veterinary Homeopathy Facebook page

Veterinarians and animal guardians have to come to realise that they are not protecting animals from disease by annual vaccinations, but in fact, are destroying the health and immune systems of these same animals they love and care for. Homeopathic veterinarians and other holistic practitioners have maintained for some time that vaccinations do more harm than they provide benefits.
Dr. Charles E Loops

The model of disease prevention put forth by conventional veterinarians is fundamentally flawed. It is in fact damaging the animals whose owners partake in it.
Dr. Will Falconer

Dr. Preston practiced allopathic medicine for twenty five years before realizing that the vaccinations and drugs she dispensed daily were causing more problems than they ever solved and often to a more severe degree…The drugs prescribed every day were literally destroying healthy organs and shortening lives.

Over the years, drugs and vaccines have made our pets, our beloved companions, seriously sicker and have shortened their natural life span. Why do we so often see premature aging? How do we STOP this trend? Treat holistically!

Epilepsy in dogs and cats can develop at any age. Allopathic veterinarians do not give you any real reason that this develops in your beloved dog or cat.

What the vets don’t realize is that they themselves have very likely created this syndrome with vaccines. Yearly administration of multi-valent vaccines assault the animal’s immune system over and over. More and more animals are developing ‘auto-immune’ diseases and the allopathic community has no idea why.
Dr. Jenifer Preston

Doctors that spend the time to find and promote health take more time in the exam room, and it doesn’t make financial sense. Doctors aren’t rewarded for the health of their patients; they are rewarded when their patients are sick and they need testing and medical intervention. And even the most idealistic and dedicated doctors arrive in the profession with large student loans to pay. Volume of patients, not vitality of patients will pay the bills

Doctors and veterinarians are not trained in nutrition because it will not help them financially. There is much more money in surgery and drugs. We learn our medicine in programs and teaching hospitals that are typically funded by those who have the most to gain financially: the drug companies.
Dr. Barbara Royal

From the AVH Facebook page-

The model of disease prevention put forth by conventional veterinarians is fundamentally flawed. It is in fact damaging the animals whose owners partake in it.

This broken model of disease “prevention” will never change from Dr. WhiteCoat’s side, who sells it:

He refuses to see the possibility of it causing harm.

He’s comfortable in it; change loses to maintaining the status quo.

He profits from providing it and profits again from the disease it causes. From the Academy of Veterinary homeopathy Facebook Page-“There is a big push underway to get pet owners to return to conventional veterinarians… and guess who is paying for it. Yup big pharma and the commercial food companies like Hills… what a surprise!!! Don’t be fooled. Holistic vets actually keep your pets healthy and happy at a fraction of the cost. To find one visit www.theavh.org”

“Did you know that when it comes to feline leukemia, EVERY SINGLE vaccine is unnecessary. Why? FeLV is a chronic disease, and vaccines by definition don’t prevent chronic disease. And FeLV is very much an opportunist virus, attacking and setting up housekeeping in only 10% of those exposed. You can imagine these are the weaker, poorly nourished animals, likely eating an unnatural kibble diet.”“

We interrupt our normal posts for an important announcement. The CDC is reporting sharp increases in the number of patients with swine flu. Homeopathic physicians have long used the homeopathic remedy Influenzinum to safely protect their patients from the flu with great success. The normal protocol – Influenzinum 200C – one pellet dissolved in the mouth once a month. In cases where flu is widespread – a dose every two weeks during a period of widespread flu is often advised. There are also an array of wonderful remedies one can take for flu symptoms – again that are safe, quick acting and effective.”

“Allopathic (conventional Western) medical thinking generally seeks immediate gratification: just make the symptom go away. So the patient may be better in the short term, but is usually worse in the longer term. Homeopathy is just the opposite: sometimes the symptoms are worse in the short term (such as with aggravation or the reversal of a previous suppression), but the real benefit is in the longer term.”

“Treatment with allopathic drugs (antibiotics, steroids, hormones, etc.) should be avoided unless absolutely necessary. The need for drug treatment is actually quite unusual, and should be considered a last resort.”
“Dr. WhiteCoat and the monstrously huge pet food industry (sales of $20+ billion per year) would like you to believe you can’t possibly make a raw diet for your pets. They are invested in selling you bags of kibble, cans of mucky meaty glop, and the best marketing of all, “prescription diets” for those health challenges your animals may confront.”
“As I look time and again at when my patients started their decline into poor health, I repeatedly see the timing being “about a month” after a round of vaccinations. Not in every case, but in a large percentage of my patient population, this is true.”
“What things make your pet more vulnerable to cancer? Anything that impairs immune system function. The following are, in order of importance, those things your animal receives that cause immune system breakdown: Vaccination Heartworm pills Flea pesticides Antibiotics”
Dr. Will Falconer

AVH standards of practice-

1) Only the remedy that is homeopathic to the patient is to be used.

2) Drugs and methods of treatment which are not homeopathic to the case are to be avoided because of the possibility of interference with the progress of cure.

Examples of truly dangerous practices recommended by homeopaths-

I’m building a custom homeopathic emergency kit, with remedies that will get your animal well in the common emergencies you are likely to confront. Things like:

parvo

vomiting after eating spoiled food

bee stings and worse, the allergic reactions to them that can shut off airways

burns

injuries: car accidents, tails in a car door, sprains, etc.

bite wounds, cuts, gunshot wounds

bloat

pain from overexertion

splinters, fox tails, thorns

abscesses

shock

Imagine: your dog or cat or horse finds herself suddenly in a crisis, and you can treat that crisis on the spot, with powerful medicine that’s got a long history of curing people and animals quickly and effectively.

In most cases, you’ll likely be able to avoid a trip to the emergency vet, and all the stress and side effects and expense that goes with that. In the worst case scenario, you’ll give a remedy on the way, and help the healing process get a great start before you arrive. You might even arrive at the E.R. and be told you can head home, everything’s well, thanks to your efforts on the spot.

The Top Five Ways to Healthy Pets (doing the opposite has been the biggest predictor of illness and dying too soon that I’ve seen in my 30+ years of practice)

Stop Vaccinating Them.
Feed Them What Their Ancestors Ate.
Stop Using Pesticides to Kill Fleas.
Stop Using Poisons for Heartworm Prevention.
Give Them Raw Bones (for the whitest teeth and freshest breath ever).

Imagine avoiding risky vaccinations while getting very strong immune protection against parvo and distemper, the two potentially deadly diseases of puppies.

You know vaccinations are grossly over provided in our broken system of veterinary medicine. The pushing of vaccinations by Dr. WhiteCoat throughout your animal’s life doesn’t add to her immunity…And you know that vaccines are harmful. Chronic disease often follows vaccination, even a single vaccination.

A lecture on parvo by Dr. Todd Cooney lit us up, as he showed us statistics from his homeopathic practice in Indiana that the vaccinated pups had less chance of surviving parvo than those not vaccinated for that disease!

Parvo vaccine itself was immune suppressive.

Parvovirus was ubiquitous in the environment.

Animals treated homeopathically when sick with parvo had far better survival rates than those treated with the usual drugs.

Distemper was prevented by taking pups to a known wildlife area where raccoons with distemper lived.

Dr. Rosemary Manziano learned of the outbreak of canine distemper in raccoons in her area through the CDC. She boldly suggested to her puppy owners over a period of 11 years that they visit a pond known to be a hangout for these raccoons. After a brief period of sniffing around the bushes and maybe drinking the water, the pups were brought home.

This was repeated a week later, and on the third week, the good doctor would test for distemper titers, the evidence of immune response. Lo and behold, these pups had fantastic titers indicating strong immunity! And, in case you’re wondering, not one puppy ever got sick in the least. This happened in well over a hundred pups and was, as Dr. Manziano called it, “fool proof immunization.”

After eleven years, it stopped working. She assumed that the disease in raccoons had run its course, natural resistance having been gained by their population.

Dr. Manziano suggested that her new pup owners who wanted natural immunization take short, five minute visits to the most popular dog parks. Those parks with the highest dog traffic were recommended

A collection of anecdotes claiming homeopathy should be used to treat life-threatening disease-
Cooney, T. Homeopathic treatment for epidemic diseases: Focus on parvo and distemper. Integrative Veterinary Care. 2015;5(4);54-58.

Regarding heartworm prevention-
Over the years at holistic and homeopathic conferences, various veterinarians have reported problems with each of the preventatives.

[I] have seen few problems. One was a Boston Terrier who tried to re-landscape the yard, moving heavy boulders until we stopped the preventative.

From the AHVMA conferences, many holistic veterinarians feel that dogs do fine [without preventatives]. We all agree that the drug companies are suggesting doses too high and too often.

Keep you dog as healthy as possible using homeopathic principles. A healthy dog will kill those migrating larvae…The solution is to make your dog as healthy as possible by vaccinating the least, feeding the best diet (probably a raw meat…and treat the energy problem…Homeopathy is great for this. A healthy dog will be very unlikely to be ill from heartworms.

Your dog could become infected…yet not be ill from the infection at all…. A healthy body should tolerate a low level of parasites. Therefore, many clients choose to use no preventative and I support them in that choice.

If you are very afraid of your dog getting heartworms, give the preventative carefully. Observing your dog will give you clues that you need to try one of the other preventatives or use none at all….Learn how to ask yes/no questions of the universe B dowsing, pendulum, intuition, applied kinesiology talks of checking with nature for all your decisions in life and teaching a yes/no finger method)….You can certainly do energy healing after giving a preventative such as Reiki or Healing Touch which you can learn top [sic] do yourself or go to a practitioner.

Herbs and homeopathic treatment for adult heartworms are about 75% effective.

Most dogs seem to recover from heartworm infection without the conventional drugs and without serious heart problems. There is, of course, a risk that your dog has an energy weakness for heart problems and if infected, will have serious problems. A healthy dog will usually have no heart problems and the worms will die in a year or so on their own.

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