It can be very instructive when proponents of alternative medicine respond to comments or criticism from skeptics. Sometimes, they respond with reasoned, even evidence-based defense of a specific practice. This is a good sign and can lead to productive discussion. More often, they respond with passionate but empty rhetoric simply asserting that they are right and their critics are ignorant, greedy, or simply terrible people. This is not a good sign, but it is still instructive because it often reveals, in their own words, underlying beliefs or attitudes that inform their practices and give the lie to any impression they may try to create that they are offering evience-based therapies.

Such is the response of Dr. Will Falconer to “skeptics,” which I suspect may mean me given his blog post comes a few months after several of mine mentioning him and his dangerous rejection of science-based medicine in favor of homeopathy (here and here). Dr. Falconer’s posts are regularly recommended on the Facebook page of the Academy of Veterinary Homeopathy, so I think it fair to say he is not a lone extremist but a representative of a perspective widely accepted among veterinary homeopaths, and I suspect the larger holistc veterinary medical community.

The core of his response to skeptics is a straightforward rejection of science in favor of personal experience, which is one of the key philosophical underpinnings I have previously identified as a characteristic feature of alternative medicine. He calls this “Common sense vs The Age of Science,” and makes it clear that when science is in conflict with belief and intuition, science is to be rejected. He uses one of the classic examples of quackery to suggest that what science says is untrue is patently obvious to anyone with common sense–the disproven but still widely feared link between vaccines and autism:

The “science” drum is beaten loudly when skeptics enter a conversation. Instead of being open minded and inquiring, these minds have snapped shut like a steel trap, rebuking anyone who doesn’t toe the line they’ve drawn on what’s real.

“Where’s the research, the double blind studies?!” “There’s no scientific proof that homeopathy is anything more than water. Anyone who gets well from it is making it all up! It’s a placebo response!!” “Vaccinations do not cause autism.” Etc. etc.

Meanwhile, mothers are seeing their perfectly normal, well adjusted toddlers lose all vestiges of normal life shortly after getting vaccinated. The rising autism incidence parallels closely the rise in vaccine requirements for children over the last 20-30 years. Any careful medical research could uncover this.

The evidence is overwhelming that vaccines do not cause autism and that the irrational fear of vaccines has sickened and killed many children, but Dr. Falconer believes we are all so infallible that simple, everyday experience outweighs the evidence of hundreds of studies involving millions of children. Except, of course, for the everyday experience of those of us whose common sense tells us vaccines have nothing to do with autism.

Dr. Falconer then goes on to try and show that scientific research is worthless, and that even leading figures in science and evidence-based medicine don’t believe in it. His failure to understand what he reads, and his ability to twist it to fit his ideology despite the fact that the people he discusses are in direct and active opposition to his view, is truly amazing.

He begins by citing John Ioannidis’ work showing that false positive findings and exaggerated effect sizes are common in publishes scientific research. Quacks love to cite this study because they believe it means science is worthless and they are free to ignore it. As others have discussed in detail, this is not at all what this research means or what Dr. Ioannidis believes. Science, unlike “common sense,” intuition, and personal faith is an ongoing, self-correcting process. We are constantly identifying each other’s mistakes and working as a community towards better understanding. Identifying and correcting the sources of error in the conduct and reporting of research is part of this processes. Dr. Ioannidis is not suggesting we give up on science. In fact in his latest paper, which I wrote about last week, he lays out a strategy for using scientific research to do precisely what faith-based practitioners like Dr. Falconer are so unwilling to do: to identify and abandon ineffective therapies using scientific research.

Dr. Falconer also cites one of the founding figures of the evidence-based medicine (EBM) movement, Dr. David Sackett, stating that he has given up on evidence-based practice. However, even the quote Falconer uses shows that the reason Dr. Sackett has quit teaching EBM is precisely because he’s afraid his status as an expert might inappropriately lead others to value his opinion and experience as an individual over objective data.

Sackett is not doing this because he has ceased to believe in evidence based clinical practice but, as the BMJ comments, because he is worried about the power of experts in stifling new ideas…

Dr. Sackett has twice announced he is quitting a specialty in which he has been recognized as an expert, and in a recent interview he explains why. He feels that recognition of expertise too easily leads to the fallacy of appeal to authority, in which the personal experience and opinion of the expert is given too much credence and contrary arguments or evidence is ignored.

Yet this is exactly what Dr. Falconer is arguing for, the rejection of scientific evidence in favor of the opinion and experience of supposed experts. He lauds Andrew Wakefield and Samuel Hahneman for the wisdom of their experience and ignores the fact that extensive scientific research has proven them both to be wrong. Rather than a brave, independent thinker challenging dogma and orthodoxy, Falconer is advocating uncritically accepting and following the word of supposed experts based on their individual experience. And rather than humbly accepting human fallibility and accepting the need for mechanisms to guard against our own errors and misjudgments, he, like Dr. Fallek and so many other alternative practitioners, believes his own experiences and perceptions to be so reliable that no amount of data or evidence to the contrary can cause him to question his beliefs.

And then, without a trace of self-consciousness or irony, he concludes his response to skeptics by asserting his proud refusal to listen to anything that challenges his beliefs and his adherence to two of the most definitively false beliefs of alternative medicine, and he bizarrely tries to turn the world on its head and call this attitude “evidence-based medicine.” Bizarre but instructive:

Just as you’ll never convince mothers of autistic children that vaccinations are harmless, you’ll never convince veterinary homeopaths that animals are getting well by delusion. We’ve got volumes of patients that speak otherwise. Animals don’t live in delusion.

We don’t have time for the skeptic’s blathering. We’ve got work to do. Medical research marches on, pet by pet, horse by horse, tot by tot: real patients, real results.

Homeopathy: Evidence based medicine at its finest.

Early on in my effort to understand and evaluate alternative veterinary therapies, I had the naïve notion that learning about their mechanisms of action and the research evidence behind them would enable me to tell which were safe and effective and which weren’t. In some cases, there turned out not to be any plausible mechanism and no evidence, or even evidence against these therapies. I was, again naively, surprised to find that not only were most self-described “holistic” veterinarians not disturbed by this, they were offended that I would ask for such evidence or that I would see the lack of it as a reason to distrust their practices.

It was at this point that I came to realize the primary difference between conventional medicine and alternative/holistic/integrative medicine is one of philosophy. Science-based medicine relies on the processes of science to understand how the world works and what is an effective way to protect and restore health in our patients. Being human beings, conventional vets and scientists are not immune to the kinds of thought errors and emotionally driven reasoning that leads us astray, but we have at least the philosophical approach that scientific research methods intended to compensate for these work and should be relied on whenever possible.

Alternative practitioners, on the other hand, have much greater faith in their own experiences and those of others, especially those they trust or those who agree with them. They tend to see scientific research as a nice extra at best, or entirely irrelevant or misleading at worst, but not in any way a necessary part of evaluating the effectiveness and safety of their therapies. Intuition, revelation, tradition, and other subjective and experience-driven methods of evaluating treatments are more meaningful and compelling to them that science.

This creates the appearance of a conflict about facts which is really a conflict about values and beliefs. Most alternative veterinarians pay lip service to the need for a value of science, and yet their actions are inconsistent with their words. They see science as most useful for marketing therapies they already believe in and convincing or battling skeptics, not as a necessary step towards a true understanding. They are, in essence, asserting the primacy of faith over reason in understanding health and disease and our responses to them.

Such a philosophical position is fair enough, though obviously I feel it is mistaken and leads away from a true understanding of the world. However, it is disingenuous or deceptive when it is presented not as a philosophical, essentially a religious, point of view but as the practice of medicine. Pet owners have a right to know that they are being seen by a doctor with a faith-based approach to medicine that essentially rejects the basic foundations of science and modern healthcare.

In an effort to expose this underlying difference in philosophies, so pet owners will have a fair choice of which approach to follow, I occasionally discuss examples of veterinarians openly promoting this perspective. The latest that I have run across comes from Dr. Marcie Fallek, a veterinarian currently promoting a new book, Krishna’s Flute: The Spiritual Journey of a Holistic Veterinarian. The promotional materials begin with a fairly straightforward example of fear mongering:  “Are Vets Killing Pets?” Asks Holistic Veterinarian in New Book….’Trust your intuition for your dog’s survival,’ warns Dr. Marcie Fallek.” No unreasonable appeal to emotion there, eh? Oh, but it gets better. Dr. Fallek goes on to ask a series of inflammatory rhetorical questions with a clear message and little regard for facts:

• Are prescription drugs killing pets? Are they necessary? Is there a better, safer way? Are yearly or triennial vaccinations really necessary? Are they safe?

• Why are dogs and cats now ‘old’ at 8 years, when 30 years ago, they lived until their late teens and early twenties?

• Are the thousands of dollars spent on diagnostic tests worth it? Are the tens of thousands of dollars spent on therapies like chemo and radiation effective? Isn’t there a cheaper and most importantly, safer and more effective way to treat disease?

• Why do elderly clients say their old family dog lived ‘til 18 and was rarely at the vet’s? With vet bills often more than yearly mortgage payments are pets really better off?

• Why do many animal companions have the same chronic diseases as people? Why don’t squirrels have allergies? Deer skin infections? Crows asthma? Raccoons ear infections? Why don’t wild animals share human illnesses, while domestic animals do?

• Do pets really have to die?

There is plenty of recourse to the usual misrepresentation of science-based veterinarians as greedy and unconcerned about the well-being of their patients, and the usual unsupported assertions that conventional medicine is harmful and alternative medicine superior, but the core of this approach is to undermine the very idea that science can be a useful way to approach healthcare.

The notion that there used to be a Golden Age before modern science and medicine in which animals were healthier and lived longer and which has been ruined by money-grubbing doctors sowing disease and poisoning our pets for gain is the rankest sort of ignorant historical revisionism imaginable. There are few reliable data on the historical health and longevity of pets, but all the voluminous data for humans shows our lives to be longer and healthier by far in the last century than ever before in history, and there is no reason to believe this is different from the pattern in our pets.

Similarly, the ridiculous appeal to nature fallacy that suggests wild animals frolic in an Eden of health and well-being and outlive their captive brethren stuck in a toxic artificial environment runs counter to all the data and evidence. Life for wild creatures is, in the classic words of Hobbes, “nasty, brutish, and short,” and it is a deep delusion to envision it as Dr. Fallek apparently does.

So how is such a blithe disregard for fact and reality maintained? Why through faith, of course. The “spirituality” invoked here is simply an ideological a get-out-of-jail-free card employed to excuse substituting wishful thinking and fantasy for reality. Dr. Fallek clearly explains that intuition trumps all other sources of knowledge because it is ultimately the voice of God speaking to us:

Please listen to your inner voice. This inner voice is our God-given intuition, it is our birthright, ingrained in our DNA, installed to protect us and our loved ones….With LOVE and TRUTH as the bottom line, not marketing masquerading as medicine, following the heart leads to a safer truer path of healing.

She goes even farther in the sample chapter of her book offered for free, asserting that this inner voice is infallible:

The most important lesson we can learn in life is to trust our inner voice. It is never wrong.

This sample chapter consists almost entirely of an anecdote. This story purports to describe a dog seen by three conventional veterinarians, including board-certified specialists, and wildly misdiagnosed. After many expensive and useless diagnostic tests and multiple harmful and unnecessary treatments, Dr. Fallek diagnosed an obvious congenital abnormality and relieved his symptoms with a few acupuncture treatments.

My inner voice tells me this is a grossly biased and self-serving misrepresentation of what actually happened. But since I prefer to rely on facts when possible, and there are none available to corroborate or challenge this narrative, I will simply have to refrain from judging the accuracy of the story. However, even if it is true exactly as told in Dr. Fallek’s book, it is merely an example of individual incompetence, not proof that conventional medicine is useless and harmful and the alternatives Dr. Fallek sells are safe and effective. Stories are just stories, not evidence, though of course the whole point here is that alternative medicine prefers compelling narrative to evidence.

So what does Dr. Fallek offer as an alternative to conventional medicine, which she dismisses blithely as “an endless cycle of cortisone and antibiotics?” Apparently, the usual hodgepodge of practices which are, in their own theoretical justifications, incompatible with one another but which share the only important characteristic: a preference for faith, intuition, and personal narrative over controlled research data as the guiding principle. Homeopathy, which is the quintessential faith-based medical practice completely incompatible with reality and already convincingly disproven. Acupuncture, which might have some reasonable basis for scientific study if not practiced, as by Dr. Fallek, according to the mystical nonsense that is mislabeled Traditional Chinese Medicine. The dubious and as yet unproven dogma of raw diets. Hysterical and exaggerated fear mongering about the dangers of vaccination.

In other words, this independent thinker committed to listening to her own inner voice espouses nearly all the core dogma of the alternative veterinary medicine community. While there is, of course, some diversity of opinions among veterinarians promoting alternative medicine, just as there is among proponents of conventional medicine, there are common ideological themes which lead to common practical approaches. These themes include:

1. The trope of science and technology as      dangerous and “natural” or historical approaches as benign.
2. Science-based vets as money-driven dupes or      shills of the malign pharmaceutical and pet food industries compared to      the purely caring and spiritually-guided alternative practitioners working      only for the well-being of their patients.
3. A misty-eyed misreading of history to suggest      the past and the natural world as healthful and benign and the modern,      technological world as toxic and harmful.
4. A deep suspicion of scientific research and a      blind trust of personal experience.

As I said previously, it is perfectly fine for Dr. Fallek and anyone else to believe whatever they wish to about the nature of the universe and about health and disease. Her approach to medicine is her religion, and everyone is entitled to their religious beliefs. However, our society has generally chosen to expect our doctors to provide care based on science and evidence to the greatest extent possible, largely because these approaches have created the dramatic improvements in our health and longevity that Dr. Fallek denies have happened. Improvements in sanitation, nutrition, public safety, and both preventative and therapeutic healthcare have given us more and better life than any previous human generation, and the evidence of this is voluminous and has led to a societal contract with healthcare providers that emphasizes science-based care.

The days of medical anarchism, where any and all medical approaches were treated as equally legitimate, ended in the early 20^th century, and the scientific approach was given precedence. If we choose to retreat from that and emphasize spiritual, faith-based medical approaches above scientific ones, we deserve to at least understand that is what we are doing and make an informed choice to do so. When members of the Academy of Veterinary Homeopathy, such as Dr. Fallek, vociferously deny in public that homeopathy is inconsistent with science and claim it is in fact scientifically proven to work, they are not only factually wrong, but they are being deceptive. Elsewhere, they clearly describe the spiritual nature of this practice and fundamentally treating not the patient’s but their “energy” or “emotions” or “vital force,” in short their soul. If they would honestly admit homeopathy is a spiritual practice, not a scientific medical treatment, then at least pet owners would get an honest and fair choice between medicine and faith healing.

Stumbled across this blog post from VancouverFeline recently. Warms my skeptical heart!!

In medicine, we have many habits and quirks handed down through the generations. Often, we think nothing of these, and even believe that these well-accepted practices are grounded in rational evidence-based thinking. Surprisingly many are not, and even today, medicine is heavily influenced by fashion and eminence.

The word “believe” and all its derivatives has no place in sound medical practice. I cringe every time that word used by specialists in a peer-reviewed journal, article or lecture. If we want medicine to be a religious experience, then there are faith-healers happy to be consulted. Use of the word “believe” implies “I have not thought about this and am accepting faithfully this concept”. Granted no doctor has time to individually explore every medical concept that we use, but a collective level of skepticism is absolutely necessary.

We often think we are being healthily skeptic when, in questioning medicine, we head off in a New Age direction, feeding ourselves and our pets with naturopathic, homeopathic and expensive wonder products. Words that should stop you in your tracks, prompting some deep questions and caution, are “traditional”, “cure”, and “natural”. Just because the ancestors used something, when nothing else was around, and they believed it helped, remember that placebo effect, desperation and faith all come into play (as it does in all medical fields) – before popping something into my body, I would rather see the evidence.