This is an article I originally posted on a preliminary SkeptVet website which I no longer update since it has been replaced by this blog. I have copied it here since the links to the prior site no longer function.

Acquiring clinical experience is a major part of improving one’s medical knowledge and skills. Unfortunately, extensive practical experience can often lead to the erroneous the belief that we can reliably determine the safety and efficacy of a particular therapy based on our personal experiences or those of other doctors, especially specialists or experts. “I’ve used it, and I know it works/doesn’t work” is the most common response by doctors or clients to the suggestion that research evidence contradicts what we believe about a given medical practice. Another common response from experienced veterinarians is “I don’t need to run Test X. I know what this is because I’ve seen a hundred cases like it.” Such personal experiences are very compelling, but science is built on the premise that our imperfect brains can make mistakes and that careful use of appropriate research techniques can compensate for our limitations. Here are a few reasons to be skeptical of one’s own clinical impressions and those of “experts” and to look for guidance in good quality research evidence when it is available. (much of this has been adapted from “Why Bogus Therapies Often Seem to Work” by Barry Beyerstein, Ph.D.)

1. Self-Limiting Disease Many diseases are self-limiting. If the condition is not chronic or fatal, the body’s own recuperative processes usually restore the sufferer to health. Thus, to demonstrate that a therapy is effective, its proponents must show that the number of patients improved exceeds the number expected to recover without any treatment at all. Without detailed records of successes and failures for a large enough number of patients with the same complaint, someone cannot legitimately claim to have exceeded the norms for unaided recovery.

2. Waxing and Waning Chronic Disease (also known as Regression to the Mean) Such conditions as arthritis, allergies, and gastrointestinal problems normally have “ups and downs.” Naturally, clients tend to seek therapy during the period or greatest clinical symptoms. In this way, a treatment will have repeated opportunities to coincide with upturns that would have happened anyway.

3. Placebo Effect Through suggestion, belief, expectancy, cognitive reinterpretation, and diversion of attention, people given biologically useless treatments often experience measurable relief. Some placebo responses produce actual changes in the physical condition; others are subjective changes that make patients feel better even though there has been no objective change in the underlying pathology. Of course, in veterinary medicine, the effect is mostly “by proxy,” in which the owner’s beliefs and desires lead to a report of improvement in the pet’s symptoms when none has actually occurred.

4. Multiple Concurrent Therapies If improvement occurs after a pet has had several interventions, and probably other unremarked changes in the owner’s treatment of the sick pet, one or another of the changes often gets a disproportionate share of the credit or blame. Frequently, the latest in a series of interventions or the newest thing tried is credited with improvement even though many things were done.

5. Misdiagnosis Scientifically trained veterinarians are not infallible. A mistaken  diagnosis, followed by an irrelevant intervention, can lead to a glowing testimonial for curing a condition that would have resolved by itself. In other cases, the diagnosis may be correct but the time frame, which is inherently difficult to predict, might prove inaccurate.

6. Human Psychology Even when no objective improvement occurs, people with a strong psychological investment in the pet can convince themselves the treatment has helped. And doctors, who want very much to do the right thing for their patients and clients, have a vested interest in the outcome as well. A number of common cognitive phenomena can influence one’s impression of whether a treatment helped or hurt a patient. Here’s a brief list of common cognitive errors in medical diagnosis. Any of these sound familiar.

7. Cognitive Dissonance When experiences contradict existing attitudes, feelings, or knowledge, mental distress is produced. People tend to alleviate this discord by reinterpreting (distorting) the offending information. If no relief occurs after committing time, money, and “face” to a course of treatment internal disharmony can result. Rather than admit to themselves or to others that their efforts have been a waste, many people find some redeeming value in the treatment.

8. Confirmation Bias is another common reason for our impressions and memories to inaccurately represent reality. Practitioners and their clients are prone to misinterpret cues and remember things as they wish they had happened. They may be selective in what they recall, overestimating their apparent successes while ignoring, downplaying, or explaining away their failures. Or they may notice the signs consistent with their favored diagnosis and ignore or downplay aspects of the case inconsistent with this.

9. Anchoring This is the tendency to perceptually lock onto salient features in the patient’s initial presentation too early in the diagnostic process, and failing to adjust this initial impression in the light of later information. This error may be severely compounded by the confirmation bias.

10. Availability The disposition to judge things as being more likely, or frequently occurring, if they readily come to mind. Thus, recent experience with a disease may inflate the likelihood of its being diagnosed. Conversely, if a disease has not been seen for a long time (is less available), it may be underdiagnosed.

11. Commission Bias results from the obligation toward beneficence, in that harm to the patient can only be prevented by active intervention. It is the tendency toward action rather than inaction. It is more likely in over-confident veterinarians. Commission bias is less common than omission bias.

12. Omission Bias the tendency toward inaction and rooted in the principle of nonmaleficence. In hindsight, events that have occurred through the natural progression of a disease are more acceptable than those that may be attributed directly to the action of the veterinarian. The bias may be sustained by the reinforcement often associated with not doing anything, but it may prove disastrous.

13. Diagnosis Momentum Once diagnostic labels are attached to patients they tend to become stickier and stickier. Through intermediaries (clients, techs, other vets) what might have started as a possibility gathers increasing momentum until it becomes definite, and all other possibilities are excluded.

14. Feedback Sanction Making a diagnostic error may carry no immediate consequences, as considerable time may elapse before the error is discovered, if ever, or poor system feedback processes prevent important information on decisions getting back to the decision maker.

15. Gambler’s Fallacy Attributed to gamblers, this fallacy is the belief that if a coin is tossed ten times and is heads each time, the 11th toss has a greater chance of being tails (even though a fair coin has no memory). An example would be a vet who sees a series of patients with dyspnea, diagnoses all of them with a CHF, and assumes the sequence will not continue. Thus, the pretest probability that a patient will have a particular diagnosis might be influenced by preceding but independent events.

16. Posterior Probability Error Occurs when a vet’s estimate for the likelihood of disease is unduly influenced by what has gone on before for a particular patient. It is the opposite of the gambler’s fallacy in that the doctor is gambling on the sequence continuing.

17. Hindsight Bias Knowing the outcome may profoundly influence the perception of past events and prevent a realistic appraisal of what actually occurred. In the context of diagnostic error, it may compromise learning through either an underestimation (illusion of failure) or overestimation (illusion of control) of the decision maker’s abilities.

18. Overconfidence Bias A universal tendency to believe we know more than we do. Overconfidence reflects a tendency to act on incomplete information, intuitions, or hunches. Too much faith is placed in opinion instead of carefully gathered evidence. The bias may be augmented by both anchoring and availability, and catastrophic outcomes may result when there is a prevailing commission bias.

19. Premature Closure A powerful error accounting for a high proportion of missed diagnoses. It is the tendency to apply premature closure to the decision making process, accepting a diagnosis before it has been fully verified. The consequences of the bias are reflected in the maxim: ‘‘When the diagnosis is made, the thinking stops.’’

20. Search Satisfying Reflects the universal tendency to call off a search once something is found. Comorbidities, second foreign bodies, other fractures, and coingestants in poisoning may all be missed. Also, if the search yields nothing, diagnosticians should satisfy themselves that they have been looking in the right place.

21. Yin-Yang Out When patients have been subjected to exhaustive and unavailing diagnostic investigations, they are said to have been worked up the Yin-Yang. The Yin-Yang Out is the tendency to believe that nothing further can be done to throw light on the dark place where, and if, any definitive diagnosis resides for the patient, i.e., the vet is let out of further diagnostic effort. This may prove ultimately to be true, but to adopt the strategy at the outset is fraught with the chance of a variety of errors.

I have written frequently about the tendency of leaders in the alternative veterinary medicine community to talk about science as if they valued it while really either not understanding how science actually works or simply rejecting its basic principles (e.g. 1, 2). Alternative medicine, at its heart, is philosophically opposed to the method for understanding nature that has been so successful when applied through science. Supporters of alternative therapies will cite scientific evidence when it supports their beliefs, but they generally ignore or dismiss it when it does not, and they nearly always believe individual personal experience is a better guide to the nature of reality than controlled research. Science is more a means to advertise and promote their beliefs than a method for discovering which of those beliefs are true and which false.

A recent article in the Integrative Veterinary Care Journal by Dr. Nancy Scanlan, another leading figure in the alternative veterinary medicine community, illustrates this problem.

Choosing the Best Models for Integrative Research. IVC Summer 2015, 60-62. By Nancy Scanlan

It sounds pretty good, right? Looking for the best approach to do scientific research on so-called integrative therapies? However, the piece starts and ends by questioning the basic premises of medical research and suggesting science isn’t really needed to understand the truth about alternative therapies.

Conventional medicine focuses on separating out the individual actions of substances that have an effect on systems or diseases defined by conventional research.

To an extent, this is quite true. Science does make use of the principle of reductionism, minimizing the number of variables and potential sources of error in research studies to help separate out which effects are most significant. This does not deny the importance of complex interactions within systems, but it does recognize that human beings simply don’t have the ability to keep track of every element and every interaction in such systems, and when we try to view them without simplification, we are often wildly wrong about the true cause and effect relationships at work. Reductionism does have limitations, but it’s been a very successful tool in compensating for our own limitations in understanding how nature works.

Dr. Scanlan also tosses in the phrase “defined by conventional research” to suggest that this is simply one arbitrary way to define health and disease and that there may be others equally legitimate. This is a very post-modern view that rejects the concept of a stable and definable natural world that has whatever properties it has regardless of our beliefs and instead suggests that all human understanding should be viewed as no more than metaphor, with one set of metaphors being as “real” as another (though they often inconsistently choose to prefer their own paradigm over that of science-based medicine even while insisting that scientific rejection of their claims is merely bias in favor of one of multiple legitimate world views). She expands on this later in the article:

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

Essentially what she is saying here is that the problem, the method of treatment, and the outcome should all be defined by the standards of the alternative therapy being tested, not that of scientific medicine. We should view a series of case reports that have, by scientific standards, different diseases and which receive different herbs or other treatments and have success defined differently and however the practitioner chooses to define it, as legitimate scientific proof of the practice being tested. It is just like real science, except it ignores all the principles of scientific research and presumes the legitimacy of its own principles from the beginning.

Similarly, Dr. Scanlan argues that it is not legitimate to try and isolate individual compounds, or even individual herbs, when testing herbal remedies because the effects we are evaluating likely come from the specific combination of herbs ina  remedy. And how do we know this? Because, “If a formula has withstood the test of time and has been used for decades or even hundreds or thousands of years, it is most likely there’s a reason for using a specific combination of herbs.” In other words, if people claim to have used an herbal remedy successfully for a long time, without any proof of this claim, then the only appropriate way to test that remedy is to assume those claims are true and structure our research around them, rather than following the standard scientific practices that have so far proven far more successful in improving human health than thousands of years of uncontrolled, trial-and-error folk medicine did.

While Dr. Scanlan makes a few reasonable suggestions, such as encouraging standardization of herbal formulas so different researchers studying them are at least studying the same thing, she makes it clear throughout the article that the purpose of research is not to find the truth but to use the marketing value of science to convince others of what alternative practitioners already “know” through unscientific means. The possibility that these therapies might not work or that research results may necessitate abandoning any practice is never once even hinted at in this article.

“Studies structured to meet the expectations of conventional medicine…will encourage a better understanding and wider acceptance of integrative medicine.”

“When designing a study for integrative medicine, this approach can help satisfy both the conventional method of choosing treatments, and traditional methods that ensure better outcomes.”

“A standardized formulation and dose meets the conventional need for studies of a standard disease with a standard treatment. Once acceptance occurs, individual variations can be introduced.”

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

“Echinacea…has usually been studied with the expectation that it will increase immune reactions in some way. [based, she neglects to mention, on claims by herbalists that it “boosts” or “strengthens” the immune system] However, it may have more of an immune-modulating effect, as evidence by at least one trial showing a decrease in WBC activity. Instead of viewing this as conflicting evidence, it would be better to examine herbal tradition…to see whether this herb has been used as an immune “normalizer.” If so, the conflicting evidence is actually supporting evidence for the original premise.” [In other words, any result can be viewed as supporting the hypothesis if we simply interpret it through the lens of pre-scientific folk medicine texts or our own experiences, and we never have to judge any practice to be inconsistent or ineffective.]

The recent canine influenza outbreak in the Chicago has generated a lot of anxiety among dog owners around the country. Unfortunately, the understandable and appropriate stream of questions from dog owners about this disease has generated a great deal of misinformation in the media and on the internet, and sadly some of it has come from veterinarians. While there is much we do not know, there are some things which are certainly not true and not helpful to dog owners.

To begin with, the most reliable sources of information about this disease are reputable veterinary infectious disease experts. Cornell University’s Animal Health Diagnostic Center (AHDC) has been the gold-standard lab for testing samples from dogs involved in this outbreak, and this is a great source of information. The Centers of Disease Control (CDC) and American Veterinary Medical Association AVMA) are also reliable sources. In brief, the current outbreak is a new variety (H3N2) of the previously identified canine influenza virus (H3N8), which itself originated in horses. Neither has been shown to be transmissible to people or most other animals, though the H3N2 variant can infect cats. The vast majority of infected dogs will show mild to now symptoms. Affected dogs typically have a mild persistent cough for 10-30 days, though the rare case that develops serious illness can show high fever and pneumonia. There is no direct treatment for the disease, but supportive care and treatment of secondary infections is very important in severely affected dogs. There is a vaccine which can reduce the risk of disease from the H3N8 strain, but it is not clear if there is any cross-protection against the H3N2 strain.

Since dogs do not travel as widely and readily as humans, influenza outbreaks are much less prone to spreading in this species. Unfortunately, as in humans, during an outbreak every dog with any symptoms that even vaguely resemble influenza is often assumed by its owners to have the disease. This leads to a lot of claims about the disease being present in places where it is not, as well as claims about animals either dying from the illness or being cured of it when they likely have not had it at all. Only appropriate diagnostic testing, as done through the AHDC, can confirm the presence of canine influenza, so we cannot make decisions about managing outbreaks or individual patients by assuming the disease is present based on compatible symptoms. These same symptoms are caused by many other, far more common, illnesses. The most up-to-date summary of cases tested and confirmed by the AHDC can be found on their web site.

As an example of egregious and dangerous misinformation about canine influenza, we can turn to our old model of veterinary quackery, Dr. Will Falconer. This fellow regularly attacks science-based veterinary medicine and essentially recommends magic as a substitute. He has a fondness for homeopathy, despite the abundant evidence that it is useless pseudoscience, and he has a particular loathing for vaccines. Predictably, he recommends homeopathy as treatment and prevention for canine influenza, providing an excellent model of the ridiculous fake science of homeopathy, and he derides vaccination as a preventative measure with arguments that are clearly and demonstrably false.

To begin with, he has posted his process for determining which homeopathic products to use to treat canine influenza. This involves the usual nonsense of listing symptoms which are in no way unique to this disease and then turning to collections of substances organized by the symptoms they are supposed to cause in healthy individuals based on so-called provings. Extremely dilute versions of these substances are then given one at a time. If the pet gets better, the treatment gets the credit. If not, another remedy is chosen just as capriciously and on and on until the patient either recovers or dies or the owner realizes that they are being scammed.

Dr. Falconer used this process to select a classic homeopathic remedy, Nux vomica (the poison strychnine diluted into non-existence), as the “cure” for canine influenza. However, after a couple of clients tried a different product (phosphorus, also diluted into non-existence) and their dogs got better, he decided this was the first choice cure. The fact that none of these patients were ever actually tested to see if they had influenza doesn’t bother Dr. Falconer, which given his demonstrated belief in magic isn’t surprising. One can easily see how this sort of extended process of trying one fake remedy after another without obtaining a real diagnosis or making any effort to employ real medical treatment could be dangerous for a dog who actually has influenza, or any other serious illness. It is ethically inexcusable for a veterinarian to practice this way, and it astounds and depresses me that Dr. Falconer is permitted to do so.

Of course, practicing voodoo in place of medicine doesn’t work nearly as well if you don’t try to mislead and frighten people away from actual medicine, and Dr. Falconer has shown himself cheerfully willing to do that before. In the case of canine influenza, he asserts that vaccines are useless and potentially dangerous and only considered because of the malign influence of, you gussed it, Big Pharma:

The Influence of Big Pharma

it’s widely known there’s no cross immunity between flu virus strains.

But, [a reporter sufficiently naïve to interview Dr. Falconer] went with, “experts don’t know” if the current vaccine will help.

Damn.

Here we with go with the “uncertainty” again, that keeps the doors open for lots of dogs to be unnecessarily vaccinated for this flu. With all the inherent risks vaccination carries.

The current vaccine will not prevent it. Any vet who’s uncertain about that is shining you on.

Despite what is “widely known” in homeopathy fantasyland, cross protection between vaccines for different influenza strains is common, and the CDC, AVMA, and AHDC have no reason to “shine us on” when they admit that the protective value of the H3N8 vaccine against the H3N2 strain is unknown.

Bottom Line
There is no need to panic about canine influenza. The current outbreak is not spreading like wildfire across the country, most dogs who have coughing and other respiratory symptoms do not have influenza, most dogs exposed to influenza do not get seriously ill, and it is probably not worthwhile vaccinating your dog if you live outside of the area where confirmed cases have been detected or if your dog does not have extensive contact with other dogs. There are plenty of reliable sources of information, but you cannot assume that just because someone is a veterinarian that they have the facts about this disease. Certainly, anyone claiming miraculous cures, effective prevention, or some sort of vast conspiracy or willful ignorance on the part of mainstream infectious disease and public health experts is not someone you should consider a reliable source of information about this or any other health risk to your dog.

As I’ve discussed before, the terminology associated with alternative medicine is complex and inconsistent, so it makes discussing and debating the subject that much more challenging. Terms like “alternative,” “holistic,” “integrative,” “natural,” etc. are often used interchangeably, but they tend to have subtle distinctions in meaning or in the underlying ideology they represent, and their popularity varies over time.

Mostly for fun, but hopefully to generate at least a little insight into the use of such terms, I have been playing around with Google’s ngram viewer to track the use of common alternative medicine terms over time. This tool identifies the frequency of occurrence of words of phrases in the enormous collection of published books digitized by Google. While it is not a complete collection of everything ever published, since no such resource is likely even possible, it does include a large enough sample of books published in the last two centuries to provide a rough guide to the popularity of specific terms in published writing.

My understanding has long been that the terms used to label, and to market, alternative therapies have changed in response to ideological shifts and to changes in the perception of these practices. For example, I would guess that the earliest term would be “alternative,” which arose to suggest such therapies could be used in place of science-based medicine. When people proved unwilling to give up conventional medicine, the term “complementary and alternative” and ultimately just “complementary medicine” arose to suggest one could benefit by using both science-based and other therapies. This, however, carries the implication that alternative medicine is subsidiary or an afterthought to conventional treatment, which some CAM practitioners dislike. The most recent innovation, in my view, has been “integrative medicine,” a term which implies that alternative and science-based therapies are equally legitimate and that there is some advantage to using them together despite the lack of evidence for many specific CAM practices and for any real improvement in outcomes to mixing these with conventional medicine.

In general, the ngram view supports this understanding, though with some interesting twists. First, the term “alternative medicine” yields this result:

Clearly, the term came into use during the late 1970s and was used with markedly increasing frequency starting in the early 1990s. Interestingly, it appears to have declined in frequency beginning in the early 2000s, which I would not have expected. Of course, given the limitations of the ngram viewer, it is not clear if this is entirely a real change in the popularity of the term or simply an artefact of the database. However, looking at the results for other CAM terms might shed some light on this question. For example, here is the result for “complementary and alternative medicine:”

As expected, this term seems to have appeared later than “alternative medicine,” emerging in the mid 1990s. Unlike “alternative medicine,” this term does not yet appear to have peaked or started to decline in popularity.

Interestingly, my assumptions about the term “integrative medicine” appear to have been mistaken, as the usage of this term follows a pattern almost identical to that of “complementary and alternative medicine,” whereas I would have expected it to have arisen later.

Another popular term, “holistic medicine,” shows features of both the patterns seen with the previous terms:

This term appears to have shown up slightly before “alternative medicine” and reached its peak popularity earlier, though it was never nearly as popular as “alternative medicine.” However, this term too appears to have begun declining in use beginning in the early 2000s. One might hope this represents a decline in the popularity of these questionable concepts as well, but of course this data cannot really determine that.

The slightly more common term “natural medicine” shows pattern similar to that of “alternative medicine:”

Though this one has been around at a low level for longer than either “holistic medicine” or “alternative medicine,” it appeared to have a big jump in usage in the 1990s and to have had a drop in popularity since about 2000:

I also thought that checking the usage of the names for specific alternative therapies might help sort out whether the apparent patterns seen in the use of these more general terms are accurate, and the results suggest they may be. First, acupuncture:

This term takes off in frequency in the 1970s, likely stimulated by the writings of journalist James Reston, who wrote glowingly, and somewhat inaccurately, about the use of acupuncture following his surgical treatment for appendicitis in China. A second step up in usage seems to have occurred in the late 1990s, similar to that seen for most of the general terms examined above. Also similar to the patterns for these terms, the use of “acupuncture” in published writing seems to have declined since about 2000. The related term “traditional Chinese medicine” follows a very similar pattern:

Though the terms “chiropractic” and “homeopathy” appear somewhat earlier, these too show a marked increase in usage in the 1990s followed by a decline since 2000.

Once again, it is possible that the apparent decline in the appearance of these terms represents an artefact of the database, so to test this idea I also evaluated a few common terms from science-based medicine. These show marked increases in use associated with their introduction, but no apparent decline such as that seen for CAM terms.

So what does all of this tell us? Well, given the limitations in the underlying database, we cannot make any confident pronouncements. However, what these data suggest is that terms associated with alternative medicine as a general ideological concept, and with specific alternative therapies, have experienced a significant increase in frequency of appearance in published English in the last few decades, primarily in the 70s-90s. Interest in these approaches seems to have increased as a function of larger cultural trends, including the increase in cross-cultural communication and awareness, the counterculture movement, the rise of post-modernism, and so on. Arguably, there has also been a growing anti-science and anti-intellectual trend, at least in the U.S., over the same time period, which would likely increase the attractiveness of pseudoscientific approaches that question the meaning of specialized expertise and the privileging of scientific evidence over belief and personal experience that is an intrinsic part of science-based medicine.

I would like to see some glimmer of hope in the apparent decline in the use of these terms which has occurred for most of them since about 2000. The idea that the cultural pendulum may be swinging back towards science and reason and away from opinion-based and faith-based medicine is appealing, but these data alone are not sufficient to demonstrate such a shift is really happening. Nevertheless, for the sake of human and veterinary patients, I will continue to hope this is the case!

As regular readers will know, I don’t allow abusive comments or personal rants on the site. Primarily, this is because such nonsense contributes nothing productive, and I am under no obligation to provide angry or crazy people with a forum for their vitriol. Such comments lower the tone of debate and shift the focus away from salient issues and towards personalities, which dumbs down any discussion. Some mainstream science publications have actually blocked all comments on their sites because vacuous attacks come to dominate and crowd out any thoughtful discussion or debate. People are welcome to disagree with me, and I daily allow comments that do so. But as I try to be substantive and civil in my criticism of others, focusing on their ideas and claims, not their personalities, so I hold commenters here to a similarly adult standard of behavior.

That said, I think it is instructive to periodically look at the sort of bile spewed at me by people who have no real evidence or intelligent argument to offer but just want to express their anger at my challenging some of their beliefs. These are the people who drive society away from science and reason, who make compromise and cooperation so difficult in politics that we end up with a dysfunctional government, and who threaten the functioning of a society in which civil disagreement is possible and productive. These folks also illustrate how distant many of the alternative ideologies they espouse are from science and how much more like fundamentalist religion they really are. And, finally, sometimes they are simply funny. Enjoy!

Short and Sweet?
There is one word for you the author of this article….”””IDIOT””””

Skeptvet is a dumb fuck

You’re an idiot.

Are you living under a rock dude?

Homeopathy has healed my dog AND myself. Take your Big Pharma and shove it.

Go take your drugs and destroy your kidneys and liver. And kill all our animals that way as you promote drugs and surgery and toxic immunization a. You are a total moron.

Skepvet, you are an absolute fool. The fact that you would happily prescribe…makes you a complete moron…An education beyond University of Phoenix should be your next life goal.

[This one was creative enough to invent an email to represent me abusing myself!] From: skeptvet@dispostaba.fuck

I am truly a motherfucker… I Have cancer and dying. Im trily sorry I trust in protandim now

Tinfoil Hat Wearers
How much are Hills, Purina and the pharmaceutical companies like Merck slipping you on the side? Clearly, you are attempting to manipulate an uneducated, easily led, public with your claptrap disguised as science.

Your site tag says, “A Vet Takes a Science-Based Look at Veterinary Medicine”. It should more accurately say, “A Vet Takes a Pharmaceutically Skewed Prospective of Veterinary Medicine.” That would be more accurate. You’re sole reason to exist is to try to hold back the tide that threatens your alternative medicine buddies in big pharma.

And for every “expert” that has “scientific” proof that ACTION A is best, there will always be another “expert” that has “scientific” proof that ACTION B is best. Look closely at who pays which “expert” for the proof and you’ll have the answer as to why which ACTION is best. It’s all about the bottom line, folks. Now that the pet industry is a multi-billion dollar a year industry, unfortunately it appears the vets and “pet-care” companies are using our pets in the same way the human medical establishment has done…cause confusion and watch the big bucks roll in!

You are a skeptic because it could put you out of business.

The FDA is a sub contractor for Monsanto. Come to think, so is this website!

Huh, sounds a lot like what you say you aren’t – a pet food company lackey. The strong reason in favor of healthy, appropriate, homemade diets is the health of our pets…the strong reason against is two-fold – money and sickness – both of which I am sure you have no problems with. Sick animals are good for business.

What a HORRID article! If everyone in this world was healthy and living without chronic disease, then how would the pharmaceutical companies make money?

Who is paying you to write all this crap? The AMA? Jeez.

Another example of Government out of control serving Big Pharma both in an alliance and both disserving the unknowing blinded public while they RAKE IN $BILLIONS IN PROFITS. It’s the Government and its Agencies like the FDA THAT CANNOT BE TRUSTED! Do we need any more evidence for this? No, it is clear. SkeptVet clearly takes THEIR side.

You are a typical vet who just wants to stand behind the prescriptions that pay for your lifestyle.

I know one thing for sure……Vets scoff because it is about the $$$$…..they focus on keeping us coming back for the prescription food, meds and their $$$’s…….I do not trust doctors for humans let alone for my precious little ones. They are ALL about the money

To all you ignorant people bought off by Big Pharma . It is getting old by now you all not getting it. America is a fat, diseased very sick nation. The irony of thinking we are this Great nation when we are the international laughing stock. Europe has a seperate factory for making send out food to America because the Ingredients we allow are not allowed in their country due to most are toxic. Even the little cashier at World Market know’s this… If people were well and did not need prescription medicine their would be no money to be made in this billion dollar Big Pharma Industry. They want us sick!

Another sellout medical doctor…Medical doctors and mainstream people are so arrogant. They think they know everything, when behind closed doors, the people who fund these foods and treatments are actively trying to harm them.

Keep being oblivious, so people like me have to live in a perpetual hell, where I can’t even know what is in my food or water. Because of people like you, they have total control… as long as you keep supporting the corporations aspirations, nothing will EVER change.

Maybe you should go through your records and see how many of those dogs you vaccinate develop an illness within 12 weeks of the vaccine.  I think you’d find it more eduational than blindly working for the pharmaceutical industry who are constantly being sued for lying about test results on their products.  Why would they lie if their products have been properly tested and proved to be safe?  I don’t suppose it’s occurred to you that they’re not in the business of healing.  They’re in the business of making as much money as they can… Most vets who switch to a holistic practice earn far less money than you do, so what possible reason could they have for changing?  Has it occurred to you that they have actually bothered to pay attention and have realised that they are hurting our animals with unnecessary medications? That their consciences have stepped in and prevented them from continuing to cause chronic disease in our pets?  Obviously not. Our animals need healers working with us owners, not drug sales people.

Who’s paying you!!?? Talk about biased. I’d like to know the serious side effect of taking cats claw… I always read opposing info when researching but this is so slanted its crazy. So I figure you are either a vet or you are paid/paid off by them. Let’s all feed science diet, shall we!… Seriously, who pays you!!??

If you don’t get a payment from the drug company, it’s not worth recommending.

Big devious lie of an article!!! Probably working for the misinformation industries!!!!!!

Typical hate spewing from the medical field, these studies are only argued against because it affects the medical industries bottom line and making them lose money (and to keep their monopoly of the healthcare market).

After reading this blog and these testimonials, I think the skeptics here are for the most part, on someones payroll. Science has been Hijacked long ago, and the truth is being continually sacrificed on the alter of Corporate profits. I dont know what they are paying you to slander this company, too much if you ask me,

The drug industry ARE the quacks. Its a protection racket. This skepvet is a living testament to that. Ignore them and do what works not what their rigged trials tell you should work.

Someone is paying you to discredit vitamins, glandulars and minerals as beneficial remedies. You probably are a stupid medic. Breast feeding at age 80 off the pharmaceutical TIT. Die quickly so u can be reborn and do something to help someone.go pop a pill. You are an idiot.

Another sellout medical doctor…. These people probably promote heavy metal-laden vaccines; liver destroying drugs and toxic foods that contain genetically modified organisms. Go ahead, be ignorant and take the medical industries junk. They will be happy to benefit off of your illnesses. Big pharma and agribusiness work hand-in-hand… Medical doctors and mainstream people are so arrogant. They think they know everything, when behind closed doors, the people who fund these foods and treatments are actively trying to harm them.

Why do you attack natural products? The conspiracy is for all the chemicals with the phony white papers. I have seen many a healthy person and or pet die from chemical meds and would have survived had they been given a real natural product that actually works.

Unemployed Psychotherapists
I understand your need to feel as if you are flying the EBVMA flag in your posts and blog in general. To be quite honest, it comes across as if you were not able to obtain a real medical position so you chose to rant on “evidence based veterinarian medicine.”… .” If you don’t understand the origin from which we were created you might not see the total picture doc. God actually gave our bodies their own defense mechanism from many diseases, enhanced by utilizing another thing God created that assist this healing process, there called nutrients.

Maybe if you spent more time actually observing the animals and building your practice instead of blogging this nonsense you could find the success and attention you so obviously crave.

This blog is such non-sense and sounds like it has been written by an angry veterinarian with an unsuccessful practice.

You sir, are a disgrace to your profession. Your ego and agenda have overcome your common sense.

Taking pot shots at Nutriscan and scoffing at people who have found flea meds to be dangerous to their pets might make you feel superior but from here you look like an a__.

This treatment is now being used by vets who are not arrogant and close-minded such as you are, with much success. You know–you aren’t always right just because you got a degree in Veterinary Science.

There’s a lot that isn’t thoroughly taught in either vet or (human) medical school. I’ve noticed that the medical professionals who know the least are the ones who are the most arrogant!

I’m a pet parent, not a vet, and whoever wrote this article seems very upset and angry… Do everyone a favor and get over yourself.

Yesterday, I wrote about some environmental chemicals that may play a role in causing disease. While this sort of environmental risk factor is a real and recognized phenomenon supported by good science, it can easily be cited to lend support to a bit of popular pseudoscience that may appear quite similar but which is actually something quite different: detoxification. Detoxification is one of the classic bogus pseudoscientific concepts of alternative medicine, and since I brought up the subject of environmental toxins, I thought it worthwhile to illustrate today some of the differences between the legitimate field of environmental toxicology and the quackery that is detoxification.

The notion of detox suggests that our bodies accumulate harmful substances, either from environmental toxins or the waste products of our own normal metabolism, and that these need to be removed or neutralized by some therapeutic process in order to prevent or cure disease. The details about what is toxic, how we come by it, and what we should do to detox vary widely according to the many and mutually inconsistent theories of different alternative practitioners.

At the heart of this notion is the emotion of disgust, and inherent reaction we have evolved to encourage avoidance of potential sources of harm, particularly infectious disease. Though there is controversy about the details, it is commonly argued that this innate emotional reaction has been generalized to cultural and moral domains, and this has led to the social constructs of contamination and purification. Detox schemes are portrayed as healthcare, but they are really a set of purification rituals intended to ward off harm magically like some religious practices.

The problem with this and many other alternative medicine ideas that are more religion than science or medicine is that evidence for or against specific proposed toxins or therapies becomes irrelevant. It’s not that there is no such thing as a toxin, since there are many well-characterized by science. And it’s not that we can’t remove or neutralize some toxins with medical treatment, because in some cases we can. The issue is that the specific claims about detoxification are often made up completely or extrapolated wildly and irrationally from small pieces of actual scientific knowledge, and they become self-sustaining components of a belief system rather than hypotheses that can be confirmed or disproved.

A typical example of this kind of pseudoscience, which mixes distorted but real science with complete nonsense, comes from the ever-reliable source of pseudoscience, Dr. Karen Becker at Mercola.com. Dr. Becker produces a steady stream of advice for pet owners. It ranges from the perfectly reasonable to the unproven but plausible all the way to the completely ridiculous, often all jumbled together. The key is that real evidence is almost never needed or heeded, and her claims are based predominantly on opinion, hers or that of the other alternative practitioners she interviews.

The  Big Scare

Her detoxifications creed begins with The Big Scare, that classic snake-oil sales technique in which the CAM advocate tries to convince an audience that they and their pets are swimming in a toxic soup constantly threatening ruin to our fragile health and well-being. Without this fear, we might not realize that our apparently perfectly healthy pets were actually in terrible danger and that we need to act now to save them! We might be at risk of coming to believe that not all bad things that happen can be avoided if we just do the right things and that those who become ill have only their own poor lifestyle choices and inaction to blame.

It’s actually mind-boggling to think about all the different ways our pets are exposed to toxins in today’s world…. If you’re wondering if your own pet is carrying a toxin load, sadly there’s no doubt he is. The truth is that virtually every pet has measurable amounts of chemicals in their body, because they walk through chemicals, they sleep on them, they breathe them in, and they eat and drink them. And unfortunately, veterinarians prescribe and inject them on a regular basis as well.

Dr. Becker lists a host of the usual bogeymen of alternative medicine, from medicines that actually protect your pet’s health and prevent disease, like antibiotics and parasite preventatives, to poisonous commercial dog food that carry cancer in every bite, to the invisible threat of—gasp!— electromagnetic fields! Some of the specific things mentioned do have potential harmful effects, depending on dose, exposure route, species, lifestage, and many, many other variables. After all, anything, including such necessities of life as oxygen and water, can be harmful under the right circumstances.  Others, such as fluoride in drinking water and electromagnetic fields have been thoroughly investigated and not found to be dangerous. But again, we are dealing with a faith-based, not evidence-based belief system here.

Pretend Science

After The Big Scare, Dr. Becker moves on to explaining precisely how these toxins harm your pet. Well, not precisely, more like generally. Well actually, it’s more like using some vague science-y words that imply stuff without actually meaning anything.

When your pet’s body accumulates too many toxins, it stores them for future elimination. For many pets, that future opportunity never arrives and the toxic load begins to impede the body’s ability to function. Ultimately, toxic overload can interfere with the immune system to the point where cellular abnormalities like tumors and cysts develop. Other serious diseases may also show up as cells degrade and organ function is impaired.

Side effects of an accumulating toxin load cover a wide range of diseases, from skin conditions to organ failure. There can be behavior problems associated with toxicosis, endocrine disease, autoimmune disease, and even cancer.

So basically, your pets is constantly besieged by all sorts of toxins that are everywhere and in everything, and they can cause almost any disease if not eliminated. And while she admits that your pet has its own systems for dealing with toxins (since it would be hardly to explain how any suggests that they can’t be relied on. This, again, is a necessary step in selling you something which you can do to defeat this terrible threat and which will work better than the natural systems evolved over millennia which have kept us all alive so far.

A Magic List
Everyone likes lists. Just put “10 Steps to…” in front of almost any advice, and it will be more fun to read and more persuasive. The only trouble here is that most of these steps are either too vague to be meaningful, unproven hypotheses, or total nonsense.

1. Improve Your Pet’s Diet

What Dr. Becker means by “improve” is really “change to what is recommended by my favorite nutrition mythology.” Avoiding commercial food, which is full of those pesky toxins, and switching to home-cooked, grain-free, ideally raw diets despite the complete lack of evidence to support the claim that any of these changes actually improves health or reduces disease risk. I’ve addressed a number of these myths and claims before, and they are far more about ideology than science.

2. Provide Clean Drinking Water

Presumably, you are unaware that the drinking water we get from the tap here in the U.S., which has eliminated numerous infectious diseases that have plagued humanity for millennia and continue to trouble the developing world, is actually a toxic brew that will poison your pet. Fluoride, in particular, is mentioned as a risk despite the overwhelming evidence that it is safe and effective at dramatically educing dental disease. No evidence needed here, just pure belief!

3. Beware the Air!

Apparently, the very air you breathe in your home is full of perils as well. Avoiding smoking is a sound and well-established way to reduce disease risk. Other than that, the notion that every cleaning product that doesn’t call itself “green” on the label is a poison for your pet and that you can somehow find a magic combination of products and purifiers to ward of sinister unseen toxins in normal household air is just another arrow in the quiver of The Big Scare.

4. Make Your Pet Exercise

The benefits of exercise for humans are well-established, and it is likely that our pets could stand a good deal more physical activity than many of them get. There isn’t actually much research for dogs to tell us how much of what kind of activity is ideal, and the notion that our cats should workout more is pretty far-fetched. Still, among the very real benefits of exercise is not “helping the body’s detoxification efforts.” Suggesting that without more exercise your pet will not urinate, defecate, circulate blood to the liver and kidneys, or breathe sufficiently to perform ordinary removal of waste products is just nonsense.

5. Avoid Pollutants and Chemicals

A perfectly sound bit of advice, except for the problem that everything is made of “chemicals,” and Dr. Becker’s notion of what is a “pollutant” is pretty vague. Sure, washing off your dog’s feet when they come in the house is fine, but there’s no reason to imagine it will dramatically affect their health or ward off any terrible illness.

6. Say No to Drugs!

Dr. Becker recommends avoiding “unnecessary” “drugs,” by which she usually means vaccines and medicines. I too recommend avoiding unnecessary medical treatment, but I suspect we have different definitions of what this is. I have written extensively about the issues involved in deciding what to vaccinate for and how often, and it is a far more complex subject than simply “avoid yearly vaccinations” as Dr. Becker recommends. And while antibiotics and steroids are probably overused, they are also important and beneficial medicines, and it is dishonest to sow fear of them without being clear and evidence-based in presenting both the risks and benefits and without defining “unnecessary” in any way. Making people afraid of medicine doesn’t make their pets healthier. Similarly, there are risks as well as benefits to parasite prevention, as well as to eschewing such prevention, but the “safe, natural alternatives” Dr. Becker mentions are not proven substitutes.

7. Brush & Bathe Your Pet

Sure, why not? But ignore this bit of nonsense: “Your cat or dog eliminates toxins through his skin, and regularly brushing or combing will remove loose fur and debris and help his skin breathe.” Oh, and don’t forget not to use shampoos that contain “toxins.” Make sure they are “natural.” *sigh*

8. Support Your Pet’s Liver and Kidneys

Here’s where the poor logic behind the detoxification scam shows itself especially clearly. We are warned that “chemicals” and all kinds of substances in our food, water, and air are bad for us and should be avoided, despite the lack of evidence in most cases that this is true. We are warned of the dangers of medicines are parasite preventatives without any discussion of the benefits and with no consideration given to the abundant evidence showing that these generally do much more good than harm. And then, after all this fear mongering without good evidence, we are told to protect our pets by giving them a bunch of untested and unproven chemicals! I have collected an enormous volume of evidence showing that the chemicals(!) in herbs and supplements and even needed compounds like vitamins and minerals can cause serious harm. Without proper testing, these cannot simply be assumed to be safe and effective. Giving such substances without this evidence and warning people away from substances for which good evidence of safety is available is bizarre and misleading. Only the fundamentally faith-based nature of the detox myth could explain such inconsistent and illogical recommendations.

9. Support Your Pet’s Immune System

Boosting the immune system is one of the other classic bits of alternative dogma and nonsense nicely dealt with already elsewhere. It suffers from many of the same problems with faith above evidence and illogic as the detox scam.

Dr. Becker lists a number of specific “detoxing” agents, and not surprisingly several of them have come up here before, including Chinese Herbal Medicine, turmeric, resveratrol, and others. None of these have good clinical trial evidence to show that they “detoxify” anything, and while there are some suggestive tidbits of research that some might have some legitimate medical uses, there are not clinical trials showing any to be safe and effective at preventing serious disease in apparently healthy animals. Their use is based entirely on anecdote or entirely unproven theories about health, not real evidence.

Finally, Dr. Becker recommends regular detoxing with these unproven chemicals if your pet has any exposure to supposed toxins, which of course is unavoidable since these malignant substances are everywhere, except apparently in the chemicals she recommends giving to detox your pet.

Bottom Line
The whole notion of detoxification is a non-scientific concept that is part of an ideology which has more in common with religion than science-based medicine. The theories are unproven or outright false, and the specific claims made about toxins and detox treatments are made without real evidence. The strategy is no different in its essence than warding off bad luck or evil spirits, and it serves more to assuage the anxiety of humans than protect the health of pets. Here are some useful resources on the subject for further reading:

The Detox Scam: How to spot it, and avoid it

You can’t “detox” your body: It’s a myth. So how do you get healthy?

Detoxification Schemes and Scams

The Detox Delusion

Detoxification Therapies