This video shares some of the highlights of the recent evidence-based veterinary medicine conference I participated in, EBVM 2014. The full presentations will eventually be available as well, and I will post those also.
Back in May, I wrote about yet another “cancer wonder drug” called Tumexal. As usual, claims were made by the company that were not supported by real research evidence but only by unreliable testimonials and pseudoscientific verbiage. There were many warning signs of quackery in the company advertising, and my conclusion was this:
TumexalTM is yet another purported wonder drug with a “secret ingredient” that has been discovered by a lone genius and offered to the public out of altruism. It is supposed to be very effective and perfectly safe, and anyone who doesn’t take the company’s word for this is a “cynic” with questionable motives or a lack of compassion. Such claims are cheap and easy to make, but they are worthless without real scientific data, and none are available for TumexalTM. While it is impossible to prove it doesn’t work based on the nothing the company will tell us about it, it is not the job of skeptics to prove such wild, implausible claims untrue. It is the job of those who make them to prove they are valid. Anecdotes aren’t data, and cannot be used to prove a medical therapy is safe and effective. So to date, the company expects us to buy their product and administer it to our ill pets based only on their word for the safety and effectiveness of TumexalTM. Does this seem like a good idea?
Now, the FDA has taken the rare but welcome step of warning the company that produces tumexal to stop making illegal unsupported claims about the product’s safety and efficacy. The FDA has authority to require veterinary medicines be proven to work and to be safe before being marketed, as human medicine must be. But the agency has neither the resources nor the political support to enforce this vigorously, apart from products that in some way affect human health or food safety. However, when a product violates the rules intended to protect the public egregiously enough to draw complaints, sometimes the agency will act.
As I also said in my article on Tumexal, “Unproven remedies are as likely to hurt your pet as to help them, especially when substituted for real medicine. And even in the face of a disease as terrible as cancer, it is possible to make your pet’s life worse by rolling the dice on a snake oil like Tumexal.” The fact that the FDA has taken this action illustrates how irresponsible and dangerous the behavior of this company has been in selling snake oil as if it were real medicine for pets with cancer.
I have previously discussed the problem with so-called “integrative medicine.” It is ultimately a Trojan Horse intended to gain acceptance for alternative therapies without the bother of demonstrating they actually work through rigorous scientific research. Proponents of integrative medicine want to generate the impression that there is no meaningful difference between cardiology and acupuncture, oncology and chiropractic, surgery and homeopathy. All of these are just equivalent areas of specialization within medicine. The problem is that this is a lie.
Most alternative therapies are either unproven or already disproven, which is why they are in that category to begin with. And while some do deserve serious research to determine whether or not they are safe and effective, proponents aren’t interested in doing this, because they already “know” these methods are effective based on personal experience and faith. They only wish to convince their mainstream colleagues, and they view science as a marketing tool rather than a way to find out the truth about these practices.
I have also previously written about the integrative medicine program at the University of Tennessee veterinary school as an example of this problem. It is funded in part by the American Holistic Veterinary Medical Foundation (AHVMF), whose leaders have repeatedly demonstrated their commitment to pseudoscience and their fundamental rejection of basic scientific principles. The center also receives funding from the Mercola Healthy Pets, a branch of the web site founded by Dr. Joseph Mercola, one of the most effective promoters of quackery and opponents of science-based medicine out there. Of course, accepting funding from these sources does not automatically mean the program shares their goals and methods, but it is reason to look closely at the program itself.
A recent interview with Dr. Raditic, founder of the UT integrative medicine program, and Dr. Danielle Conway, the inaugural fellow in integrative medicine at UT, published on the Mercola veterinary web site, provides examples of the CAM marketing strategy embedded in the notion of integrative medicine (Part 1, Part 2).
Dr. Conway, in a previous interview, explained that her faith in alternative therapies is founded on her personal experience as a child. She recounts her parents’ decision to turn to a naturopath for help with a serious illness she experienced. According to the interview, “After a few rounds of herbs, homeopathy and acupuncture, she was able to be a normal kid again.” Given the evidence that homeopathy is a useless placebo, most herbal therapies remain unproven and have significant risks, and acupuncture is almost certainly a placebo as well, this anecdote-driven faith seems misplaced. Yet Dr. Conway has already received training in the pseudoscience that is Traditional Chinese Veterinary Medicine, and it seems likely that she comes to this fellowship with her mind pretty well made up. This is not a perspective conducive to rigorous, open-minded scientific work.
This attitude seems to underlie an anecdote from the interview which is clearly intended to imply alternative therapies can be not only equal but superior to conventional medicine. Dr. Conway relates seeing a patient that had already been seen by numerous veterinary specialists “who hadn’t been able to help.” Despite being a brand-new veterinarian, Dr. Conway claims to have been able to properly identify the problem these experts missed thanks to her alternative training.
She was at that moment very grateful for the complementary medicine training she had already received in acupuncture and chiropractic, because it added a new dimension to her physical examination of the dog.
Dr. Conway began to do some basic chiropractic manipulations on the dog, paying attention to little subtleties that veterinary students don’t learn about in conventional vet medicine training. She realized there was something going on with the dog’s larynx. She thought to herself, “It’s stuck. It’s just not right.”
Shockingly, Dr. Conway turns out to have been right when conventional veterinarians were wrong, as the dog reportedly had an abscess of the larynx. The story goes on to suggest that the dog was successfully treated by alternative medicine alone, though I suspect some details of the diagnosis and therapy have been left out in the interest of creating a narrative that serves the purposes of CAM promotion:
Not only was Danielle able to accurately diagnose the dog, she was also able to treat him successfully with aromatics.
The article goes on to strongly imply that alternative practitioners are more skilled at physical examination and that conventional medicine relies too heavily on technology. Just as exercise, nutrition, and other completely conventional and mainstream health practices are often labeled “alternative” to suggest that CAM practitioners employ them and conventional doctors do not, so the universal expectation that veterinarians should learn and perform an effective physical exam as a routine part of clinical practice is twisted to suggest that this technique is somehow a feature of alternative medicine that mainstream doctors often don’t understand or apply.
In addition to such disingenuous spin, the story also ignores the overwhelming evidence against the theory and most clinical applications of chiropractic, which relies on a vitalistic understanding of health and disease completely incompatible with the real science both Drs. Conway and Raditic claim to also value.
The article reinforces in several other ways the role of programs such as this as advertising vehicles rather than true efforts to discovery the real value of alternative therapies. Dr. Raditic, for example, implies that preventative health care, like a good physical exam, is an alternative, rather than mainstream practice:
Seeing patients as puppies and kittens and embarking on a proactive approach to their lifelong health care is the goal. To do that, integrative programs must be available in every veterinary school.
And she once again identifies the goal of research as not discovery of the truth but marketing and promoting alternative medicine:
And good-quality research needs to be done. Danielle says, “That’s how I think we’re really going to change hearts and minds, and convince veterinarians to incorporate complementary medicine into everyday practice.”
To be fair, both Dr. Raditic and Dr. Conway acknowledge the importance of basic science and conventional veterinary medicine, and I don’t doubt they are sincere. Like most CAM vets I have met, they are most likely nice people and competent conventional clinicians. However, despite their genuine belief that they are working in the best interests of patients and veterinary medicine and in a way consistent with the principles of science, the reality is that their statements and actions are deeply inconsistent with the principles of scientific medicine. A deep, unshakeable faith in therapies that have not yet been proven or, in many cases, have already been demonstrated to be ineffective is not compatible with an open or scientific mindset.
The purpose of integrative medicine programs like the one at UT is clearly to promote therapies despite the lack of evidence for them or the evidence against them. By making such therapies familiar, by implying they are equivalent to scientific medical specialties, by mischaracterizing science-based medicine and appropriate as “alternative” aspects of conventional care, such as nutrition and physical exam skills, these advocates hope to spread their faith in alternative therapies regardless of the scientific evidence for or against them.
This is not, despite all the best intentions, truly what is best interests of patients. More homeopathy, chiropractic, acupuncture, aromatherapy, and the like will not bring better health to our patients. Rigorous scientific evaluation of plausible therapies will. The right way to handle alternative therapies is to discard the category itself and simply treat them like any other kind of medicine. Those that show plausibility through basic science and pre-clinical study should be subjected to high-quality clinical trials. If they demonstrate consistent, meaningful benefit and acceptable risks, they should simply become “medicine,” not “alternative medicine.” Those that fail this test should be abandoned. An honest, fair, science-based approach will separate the worthwhile from the worthless, rather than merely making the unproven or worthless seem more scientifically legitimate, as integrative medicine programs like this currently do.
I was recently asked by a reader to comment on yet another product marketed for arthritis treatment in dogs and cats: Duralactin. Because arthritis is a very common disease for which there is no definitive cure, it is a popular target for commercial remedies. I have reviewed many of these, but of course there are far more out there I have not addressed. Some, like non-steroidal anti-inflammatory drugs (NSAIDs) are well-researched and their risks and benefits are clearly known. Others, like glucosamine, are quite popular despite little or no evidence of efficacy. Some, like homeopathy, are certainly useless quackery. Duralactin falls into that enormous area of remedies that have so little evidence associated with them almost nothing definitive can be said about their safety or efficacy.
What Is It?
According to the manufacturer, Duralactin is “a patented milk protein concentrate from the milk of hyperimmunized cows.” That sounds very “science-y,” but it really isn’t very revealing. Theoretically, this means the product contains antibodies extracted from the milk of cows stimulated by some means to produce those antibodies. What these antibodies are, how they were produced and processed, and of course what if anything they do for patients with arthritis is not revealed.
Does It Work?
I have not been able to find any published research evidence to answer this question. This is never a good sign. In fact, marketing a product with vague ingredients described in “science-y” language and supported primarily by anecdotes and testimonials is part of a constellation of warning signs for snake oil.
The company does refer to some in vitro experiments which suggest that injecting cows with a bacterial vaccine can stimulate production of compounds in the milk that reduce the activity of some cells involved in the inflammatory response. It is a long, long road, however, from there to a clinical therapy for arthritis, and the company does not appear to have paved the way with much relevant research.
The company also refers to a clinical trial comparing the product to a placebo in dogs. The value of this evidence is, however, quite low as it is a study performed by the company and not apparently published in the scientific literature. Even the limited report available on the company web site suggests some problems with the study. Fifty dogs entered the trial but only 35 completed it, which is a pretty high dropout rate which could easily bias the results. Outcome measures were entirely subjective, and the reported response ranged from 10-14 points over placebo on a 100 point scale, which is of questionable clinical significance.
The company does, of course, offer plenty of testimonials to suggest the product works well, but it is well established that such testimonials are highly biased and misleading.
Is It Safe?
Once again, the answer has to be “Who knows?” The company reports no adverse effects in their unpublished clinical study, but without formal assessment under more reliable conditions, the risks are, like the possible benefits, unknown.
Bottom Line
Ultimately, real proof that a medicine is safe and effective requires careful, rigorous, and often expensive and time-consuming research. It is easier and cheaper for companies to produce supplements that can be marketed without this level of proof and then provide far less reliable sources of evidence that their products do more good than harm. Duralactin may well have benefits for patients with arthritis, though there is currently little to support this claim. And while there is no obvious reason to think it is harmful, without real research this is as much of a guess as the question of whether or not it helps.
There is ample evidence that under the current lax regulatory system in the U.S., dietary supplements are frequently mislabeled and adulterated with pharmaceuticals, toxins, and other undesirable substances. Apart from the lack of evidence to support the claims of benefits for most such products, this unreliable labeling represents a real danger to consumers. There are many examples of people injured or killed by such products.
The FDA has made some efforts to control this problem, and one tool used for this purpose is the mandatory recall. A recent short feature in the Journal of the American Medical Association (JAMA) has examined the impact of such recalls and found that, unfortunately, they do not seem to be very effective in encouraging better compliance with the law or quality control on the part of supplement manufacturers.
Cohen PA, Maller G, DeSouza R, Neal-Kababick J. Presence of banned drugs in dietary supplements following FDA recalls. JAMA. 2014 Oct 22-29;312(16):1691-3. doi: 10.1001/jama.2014.10308.
According to this study, about half of the Class I mandatory recall in the last 10 years have been of adulterated dietary supplements. Over the four-year period from 2009-2012, the FDA recalled 274 dietary supplements. In this study, the authors tested about 10% of these recalled supplement for common banned substances. The results show how unconcerned this industry appears to be about consumer health and safety:
One or more pharmaceutical adulterant was identified in 66.7% of recalled supplements still available for purchase.
Supplements remained adulterated in 85% (11/13) of those for sports enhancement, 67%(6/9) for weight loss, and 20%(1/5) for sexual enhancement. Of the subset of supplements produced by US manufacturers, 65% (13/20) remained adulterated with banned ingredients.
Sixty-three percent of analyzed supplements (17/27) contained the same adulterant identified by the FDA. Six of the 27 (22.2%) supplements contained 1 or more additional banned ingredients not identified by the FDA… Some supplements contained both the previously identified adulterant as well as additional pharmaceutical ingredients.
It is particularly important to note that this was not simply a problem with supplements manufactured outside of the United States, since a majority of domestically produced supplements remained adulterated even after being recalled for representing a serious safety hazard. I completely agree with the authors’ conclusions:
More aggressive enforcement of the law, changes to the law to increase the FDA’s enforcement powers, or both will be required if sales of these products are to be prevented in the future.
I have just returned from one of the most exciting scientific meetings I have ever attended, the EBVM 2014 conference organized by the RCVS Knowledge, the charity arm of the Royal College of Veterinary Surgeons. Over 250 people from around the world attended, full of enthusiasm and ideas for improving veterinary medicine for patients, animal owners, and veterinarians, through the development and promotion of evidence-based veterinary medicine (EBVM). Vets from teaching and research institutions, general and specialty private practice, other sectors of the veterinary profession, and affiliated industries spent two days meeting and talking about EBVM and how it can be developed and implemented to make veterinary care safer and more effective.
The conference grew out of an earlier, smaller meeting in 2012, Sceptical Vet: Evidence or Eminence?, which I also attended. The RCVS first formed an EBVM Network open to everyone interested in EBVM. Members of this network, along with the staff of the RCVS, then put together the goals and agenda for the EBVM 2014 conference. Speakers included pioneering academics involved in EBVM research and teaching, like Dr. Mark Holmes; private practitioners such as myself and Dr. David Ramey; veterinary nurses and other veterinary professionals; and representatives of existing organizations devoted to promoting EBVM, including the Centre for Evidence-based Medicine (CEVM) at the University of Nottingham and the Evidence-Based Veterinary Medicine Association (EBVMA).
The full program is available here, and eventually recordings of all the talks and associated slides will be available on the web. I just wanted to highlight a few key themes and projects addressed at the meeting.
The first of these was the importance of moving EBVM beyond the universities and specialty centers and into general practice. The vast majority of veterinary care is provided by first-opinion veterinarians, and the full impact of EBVM on the welfare of veterinary patients can only be achieved by overcoming resistance and obstacles to widespread practice of EBVM in this setting. Teaching primary care veterinarians what EBVM is, and what it isn’t, and dealing effectively with barriers to adoption of EBVM are all necessary steps that were discussed at this meeting. Examples were also presented of successful implementation of EBVM in general practice, such as a presentation about the adoption of clinical practice guidelines for small animal CPR in my own hospital.
Of course, the lack of high quality and relevant research evidence is one of the greatest barriers to widespread use of EBVM, and much discussion was focused on ways to grow and improve the evidence base. Speakers were not afraid to directly address limitations and weaknesses in the scientific evidence that might reduce the usefulness of EBVM in the clinical setting. If we are to be successful in using EBVM to improve veterinary medicine, we need to be clear-eyed about the limitations in EBVM theory and practice and the pitfalls involved in widespread adoption of it so we can successfully use EBVM methods to improve veterinary care.
Much time was also given to practical strategies for using EBVM, including the best practices for developing and implementing clinical practice guidelines, the uses and misuses of systematic reviews, the teaching of EBVM to veterinarians and veterinary students, and the economic issues of implementing EBVM in different areas of veterinary medicine, from food production and public health to companion animal practice.
Lots of ideas were discussed for future projects. The EBVMA, CEVM and RCVS Knowledge have all endorsed the AllTrials Initiative, a movement in human medicine to encourage the registration of clinical research studies and the open sharing of all data from these trials so that doctors and patients can make the best-informed decisions possible about the use of the treatments studied in these trials. There is currently no way for most veterinary researchers to register their studies, or for others to access their data, and an AllTrials Initiative for veterinary medicine was a popular idea. Projects for generating more and better research evidence, including more research conducted in general private practice, were also discussed, as well as projects to make useful critical synthesis of existing research more widely available to clinicians. RCVS Knowledge also announced their intention to produce a Journal of Evidence-Based Veterinary Practice, and to open a web-based forum for interested veterinary professionals to discuss particular projects and topics in EBVM. I will create a post specifically to provide links to these and other EBVM resources as they become available.
Many of the ideas and projects discussed at EBVM 2014 will take shape in the two years between now and the next major EBVM meeting RCVS plans to sponsor, to be held in Edinburgh in 2016, and I look forward to participating in this process. It was inspiring to spend these two days talking with so many people full of enthusiasm for improving veterinary medicine and the care veterinary patients receive using the tools of science. Evidence-based medicine has changed the landscape of human healthcare dramatically and for the better, and I am confident it will do the same for veterinary medicine. It is truly an exciting time to be in the veterinary profession, and I am proud to be contributing in a small way to this movement.
I have reviewed the overall evidence concerning homeopathy, from basic science through clinical trial research in great detail previously. Despite more than 150 years of effort by advocates for this practice, virtually no reliable evidence has been developed to show it can work or does work.
The same conclusion has been reached by many others, from the systematic reviews of homeopathic trials and systematic reviews of these systematic reviews, to the formal investigations of governmental agencies such as the British House of Commons Science and Technology Committee and the Australian National Health and Medical research Council. While homeopaths have had more than a century to try, they have not been able to produce a body of scientific evidence to convince anyone but themselves that homeopathy works.
In response to criticism of homeopathy based on this lack of believable scientific evidence, veterinary homeopaths have tried presenting their own review of the science, putting as positive a spin on the evidence as they possibly can. However, when I examined this attempt in detail, it was so rife with bias and poor quality research that it amounts to little more than an example of propaganda masquerading as science. Of all the studies presented by the Academy of Veterinary Homeopathy, the overwhelming majority were so clearly biased or poorly conducted that they were meaningless. Many actually found that the homeopathic intervention didn’t work but were cited as positive anyway. Only one paper had reasonably good methodology, but in the face of overwhelming negative evidence, it takes more than one study in 150 years to validate a deeply implausible practice.
There is now a new systematic review which specifically evaluates clinical trials of homeopathy in veterinary medicine and which attempts to employ conventional standards of evidence to control for bias and other study weaknesses.
Mathie RT. Clausen J. Veterinary Homeopathy: systematic review of medical conditions studied by randomized placebo-controlled trials. Vet Rec. 2014;175(15):373-81.
This review was conducted by two advocates for homeopathy, clearly with an interest in supporting the practice: “Each of us is employed by a homeopathy charity to clarify and extend an evidence base in homeopathy.” Yet despite this obvious agenda, the authors attempt to follow the conventional standards for a systematic review, and the result is not very encouraging for homeopaths.
An extensive search found only 18 clinical trials that were eligible to be evaluated. Of these, one had a low risk of bias, six had an uncertain risk of bias, and eleven had a high risk of bias. Of the seven that had a low or uncertain risk of bias, three showed a statistically significant effect, three showed no effect, and one could not be evaluated. Of these seven trials, two were judged to provide “reliable evidence” based on an overall assessment. One showed a significant effect and the other did not. Both, the authors note, had some odd design features that made them different from the standard clinical trial format.
So the best that two committed supporters of homeopathy could find when attempting an objective evaluation of the veterinary homeopathy literature were two studies that were probably pretty reliably conducted, one of which found an effect and one of which didn’t. Once again, in the face of the inherent implausibility of the practice (despite the nonsense about “nanoparticles” which these authors themselves reference as if it solved the plausibility problem), and a century and a half of dedicated effort, such a glaring lack of positive evidence is far more consistent with homeopathy being a placebo than with it being the dramatically effective therapy its proponents claim.
Radical new ideas in medicine just as widely scoffed at as homeopathy have been able to prove themselves and be widely adopted in far less time than this. The notion, for example, that a bacteria could be the major cause of ulcers in humans went from ridicule (when proposed in 1982) to a Nobel prize (in 2005). It is plainly irrational to keep claiming homeopathy has dramatic benefits and that science will one day vindicate it when so much effort has turned up virtually nothing encouraging in the way of clinical research.
Now, undoubtedly proponents of homeopathy will respond to this systematic review by saying “See, there is evidence it works, all we need are more studies!” While the authors did a pretty good job trying to follow the procedures of a good systematic review, these reviews are not infallible. Garbage in can lead to garbage out, and I’ve written before about the danger of uncritically relying on the conclusions of systematic reviews where there is a potential for bias. Even if this review, and my own, did not find obvious reasons to reject the findings of two studies of homeopathy, out of all the many hundreds of those that have been published, this is not a vindication of homeopathy. It is simply a reflection of the limitations of the scientific process to exclude every single source of error when hundreds of attempts are made by committed believers to conduct clinical trials to prove what they already believe is true. Most positive trials in conventional medicine turn out to be false, and there is far more reason to doubt the rare positive study of magical nonsense like homeopathy.
Science never closes a door all the way. Could there possibly be evidence someday that would, consistently and repeatedly and with the best possible controls for error, show homeopathy really can be a miracle cure? The possibility cannot be ruled out 100%, but it must be recognized to be as unlikely as the idea that the next time someone leaps off a twenty-story building they will soar into the sky rather than fall to their death. The odds are so long as to make continued betting a foolish waste of resources. If homeopathy truly were dramatically effective, then like Vitamin C for scurvy and the first antibiotics, the results of clinical trials should be striking and obvious, not incredibly hard to pick out from the mass of negative findings.
This systematic review emphasizes that even with the darkest of rose-colored glasses, it is impossible to see the scientific study of homeopathy as anything other than an utter failure to find real, meaningful benefits, and that the best thing medical researchers could do for patients, human and veterinary, is to give up on this failed idea and move on to more promising research.
I try to keep track of new research on the subject of raw food for pets. So far, the research only allows us to conclude:
The latest study adds to point number 2, that such diets are far more likely than cooked pet foods to be contaminated with bacteria that can cause disease in humans and other animals.
Nemser SM, Doran T, Grabenstein M, et al. Investigation of Listeria, Salmonella, and Toxigenic Escherichia coli in Various Pet Foods. Foodborne Pathog Dis. 2014 Sep;11(9):706-9. doi: 10.1089/fpd.2014.1748. Epub 2014 May 13.
Conducted by the FDA Center for Veterinary Medicine, this study looked at over 1000 food samples over a two-year period. The results clearly show that the risk of contamination with disease-causing organisms is much greater for raw commercial foods than for cooked pet diets.
Of the 480 dry and semimoist samples, only 2 tested positive: 1 for Salmonella and 1 for Listeria greyii. However, of the 576 samples analyzed during Phase 2, 66 samples were positive for Listeria (32 of those were Listeria monocytogenes) and 15 samples positive for Salmonella. These pathogens were isolated from raw foods and jerky-type treats…
This study showed that raw pet foods may harbor food safety pathogens, such as Listeria monocytogenes and Salmonella. Consumers should handle these products carefully, being mindful of the potential risks to human and animal health.
While this doesn’t answer many of the other questions about the risks and benefits of raw diets, it strengthens the position that until some tangible benefits are shown through controlled scientific research, not simply armchair theorizing and anecdotes, there is little reason to take the risk of feeding these diets to our pets. If proponents of these diets want to convince the rest of us the risk of disease is worth taking, they have to do more than say, “It makes sense” or “It worked for me.” They will need to produce genuine scientific data to show the benefits they claim are real and greater than the risks.
My first contribution to the Swift blog at the James Randi Educational Foundation (JREF) is up today.
Alternative Medicine & Placebo Effects: In Pets?
Placebo effects, of course, operate for all medical therapies, effective or ineffective, conventional or alternative. But when considering alternative therapies, it is especially important to be aware of such effects because these therapies usually lack convincing scientific evidence that they have benefits beyond that of a placebo. As mentioned, uncommon alternative therapies like acupuncture and homeopathy are no better validated scientifically for pets than for people. Even some of the most commonly used therapies, like glucosamine, which is ubiquitous in the treatment of arthritis in old dogs and cats, often lack any reliable evidence they actually help.
Because the false impression of a benefit from an ineffective therapy can truly harm our animal companions, who cannot speak for themselves or tell us directly when we have failed to relieve their symptoms, it is especially important to insist on reliable, controlled scientific evidence for the safety and efficacy of the therapies we use for our pets.
The evidence has been accumulating for some time that acupuncture is an elaborate and very potent placebo that can effectively make subjective symptoms better without actually influencing the underlying disease. I have written about a number of studies illustrating this (e.g. 1, 2), and a new one has recently been published.
Rana S. Hinman; Paul McCrory; Marie Pirotta; et al. Acupuncture for Chronic Knee Pain: A Randomized Clinical Trial. JAMA. 2014;312(13):1313-1322. doi:10.1001/jama.2014.12660.
This study compared “real” acupuncture using needles and lasers with sham laser acupuncture and a no treatment group. Predictably, all the therapies showed a short-term benefit compared to nothing, but the sham therapy was just as successful (or unsuccessful) as the real therapy:
Analyses showed neither needle nor laser acupuncture significantly improved pain (mean difference; ?0.4 units; 95% CI, ?1.2 to 0.4, and ?0.1; 95% CI, ?0.9 to 0.7, respectively) or function (?1.7; 95% CI, ?6.1 to 2.6, and 0.5; 95% CI, ?3.4 to 4.4, respectively) compared with sham at 12 weeks. Compared with control, needle and laser acupuncture resulted in modest improvements in pain (?1.1; 95% CI, ?1.8 to ?0.4, and ?0.8; 95% CI, ?1.5 to ?0.1, respectively) at 12 weeks, but not at 1 year. Needle acupuncture resulted in modest improvement in function compared with control at 12 weeks (?3.9; 95% CI, ?7.7 to ?0.2) but was not significantly different from sham (?1.7; 95% CI, ?6.1 to 2.6) and was not maintained at 1 year. There were no differences for most secondary outcomes and no serious adverse events.
In patients older than 50 years with moderate or severe chronic knee pain, neither laser nor needle acupuncture conferred benefit over sham for pain or function.
Such studies clearly show that while acupuncture might make you feel better temporarily, via the placebo effect, it does not produce a real or lasting improvement. This is the definition of a placebo, and while people should be free to seek placebos to feel subjectively better if they want to, they should not be fooled into thinking the effects are real or that truly effective therapies are not needed. And in the case of our pets, it is very likely that the placebo benefits of acupuncture accrue only to us, and that while we feel as if we have helped our pets, we really have not. It is in this misconception, more than the rare physical injuries associated with acupuncture, that the real risk in this treatment methods lies.
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