How Important Was Acupuncture in Ancient China?

Posted on October 27, 2013 by skeptvet

Acupuncture is arguably one of the more popular alternative therapies, after dietary supplements and chiropractic. The mystical explanations for its supposed benefits, such as balancing the mysterious energy force known as Ch’i, are not generally accepted in the mainstream medical community. But there are a fair number of healthcare providers who believe acupuncture has meaningful clinical benefits, and some individuals make attempts to explain these in more conventional scientific terms. In my opinion, the evidence is still most consistent with the position that acupuncture is an elaborate placebo that affects how people feel without truly altering the state of their physical health. But there is room for debate about the effects of sticking needles in patients.

Regardless of the issue of whether or not acupuncture is a beneficial therapy in some instances, however, many of the claims made to promote it are clearly exaggerated or simply false. In the veterinary field, for example, it is often claimed that acupuncture has been used to treat animals for thousands of years. Yet a close look at the actual historical record shows this to be untrue. And while acupuncture is more popular than some other alternative therapies, its popularity is routinely exaggerated, and conventional therapies are preferred even in China and other places where acupuncture has been a generally accepted practice for some time.

A recent article in the Journal of Integrative Medicine provides some interesting information concerning on of the most common claims made for acupuncture—that it was a popular and successful therapy in ancient China for thousands of years. The author, a practitioner and advocate for so-called Traditional Chinese Medicine (TCM), makes the case that acupuncture was actually a marginal practice in ancient China and that its current popularity is a recent, 20th century phenomenon. Though the author probably wouldn’t agree, it strikes me that this fits quite well with the hypothesis recently discussed in Slate magazine that TCM is not actually an ancient historical method but an ad hoc collection of unrelated, even competing practices pulled together in a bit of nationalist historical revisionism by Mao Tse Tung.

Lehmann H. Acupuncture in ancient China: How important was it really?J Integr Med. 2013; 11(1): 45-53.

The abstract summarizes the author’s conclusions that acupuncture was never a popular or important therapy even in ancient China.

…the clinical application of the needle therapy in ancient China was always a limited one. From early times there have been warnings that acupuncture might do harm. In books like Zhang Zhongjing’s Shanghanlun it plays only a marginal role. Among the 400 emperors in Chinese history, acupuncture was hardly ever applied. After Xu Dachun called acupuncture a “lost tradition” in 1757, the abolition of acupuncture and moxibustion from the Imperial Medical Academy in 1822 was a radical, but consequent act. When traditional Chinese medicine was revived after 1954, the “New Acupuncture” was completely different from what it had been in ancient China.

Of course, the author puts a positive spin on these conclusions, suggesting that the marginal role of acupuncture historically doesn’t negate its benefits (despite the fact that these are often justified by claiming a long, successful history) but simply, “The best time acupuncture ever had was not the Song dynasty or Yuan dynasty, but is now – and the future of acupuncture does not lie in old scripts, but in ourselves.”

The author reviews the written records of ancient Chinese medicine and concludes that while there is discussion of the theory and practice of acupuncture, there is no evidence that it was widely accepted or employed. He also discusses the artifacts often cited as evidence of ancient acupuncture practices and why they do not support the idea that an intervention similar to modern acupuncture was widely used. The author also identifies several mentions of the risks of historical acupuncture, which include the same problems of infection and organ damage that still occur today.

And although people in ancient time knew nothing about microbes, they knew very well that needling could do harm to the body. For example, the Zhenjiu Juying  talks about “poison” contained in iron.

Moreover, there were always warnings of the dangers of the needling. As early as in 81 BC, the Yan Tie Lun criticizes incompetent physicians with the words: They

stab in their needles at random, without the least beneficial influence on the illness, and only succeed in injuring the flesh and the muscles. And Wang Tao writes in his Wai

Tai Mi Yao: Acupuncture can kill healthy people, and cannot revive those who are dead. If one desires to adopt this technique, I am afraid he will harm life. [Therefore] at this present compilation I do not adopt [the technique of ] the Acupuncture Classic, I only adopt moxibustion.

He then goes on to cite prominent ancient Chinese medical authorities to illustrate that they rarely recommended acupuncture and sometimes recommended against it. And he emphasizes that while the best and most esteemed therapies would have been employed for the emperors in ancient China, it appears the emperors almost never received acupuncture.

He also makes a particularly interesting point that claims about acupuncture as an ancient “lost art” may simply be part of the tradition of complaining that previous generation possessed medical skills and techniques that have been lost and must be rediscovered:

…when Xu Dachun in 1757 lamented acupuncture as a “lost tradition”, this is only a proof that it was not widely used at his time. It does not prove that it really had been very important before. Remember: complaining that the medical art of the ancients was lost has been part of Chinese medical writing from its very beginning – the Huangdi Neijing itself does nothing else.

This seems consistent with the ubiquitous human tendency to imagine the past as a Golden Age better than the present. Certainly, this is a mainstay of the marketing of alternative therapies, which are often promoted as a rediscovery of or return to better ideas and approaches despite the convincing evidence that human beings today enjoy the longest and healthiest lives of any who have ever lived.

Finally, the article discusses an event often ignored or downplayed by acupuncture advocates who wish to portray the modern practice as a well-established and historically continuous practice handed down from ancient times, rather than a politically motivated invention of the 1950s communist leadership. In 1822, the emperor officially prohibited acupuncture from being taught or practiced at the Imperial Medical Academy.

Emperor Daoguang, in the second year of his reign and at this time 40 years old, declared: Acupuncture and moxibustion, as not being suitable to be applied to the Emperor, will be banned forever from the Imperial Medical Academy.

This move is sometimes portrayed as the result of Western influence, however the author of this article claims that the move predates any significant influence of European medicine on China:

One reason which makes it so interesting is the time of the decree: this was the last period in Chinese history where medical aspects were discussed WITHOUT comparing TCM to scientific medicine.

Indeed, the conflicts with Western countries had already begun. However, it was not before 1830 that the foreign missionaries adopted “the idea of making the practice of medicine an auxiliary in introducing Christianity to China.”

Whatever came later (for example Wang Qingren’s Yi Lin Gai Cuo in 1830, in which he attempted to correct some of the many errors in TCM literature) could not escape the everlasting struggle in which traditional practitioners tried to defend TCM theory against the superior methodology of scientific medicine. We might say: Banning acupuncture from the imperial court was the last independent act in the history of traditional Chinese medicine.

Furthermore, he argues that the ban was almost certainly not a whim on the part of the emperor, but a considered rejection of the practice by the most prestigious Chinese scholars of the day:

In fact, it is unlikely that the idea of the edict originally came from the emperor himself…Like today, such things were left to a court commission. There, specialists discussed the matter and presented a suggestion.

…So, we can be sure that there were extensive discussions among court advisors, physicians and teachers of the Imperial Medical Academy before the edict was decided. And we may believe that the men deciding this question were the most learned scholars of their time. Even if some of them were no medical experts we can be sure that they listened very carefully to what the physicians and the teachers of the Imperial Medical Academy said.

And if this commission nevertheless recommended the abolition of acupuncture, we can be sure of one thing: that they saw very good reasons to do so.

This author also argues that there was no outcry against this edict from the physicians of the day, suggesting that acupuncture was not widely valued in the medical community. And there appears to be little evidence of acupuncture being commonly used in China after the 1822 edict, until “re-invented” in the 1950s. His conclusion starkly contrasts with the usual acupuncture mythology:

When acupuncture was revived after 1954, this was no continuation of an unbroken tradition,but in fact a completely new invention… the methods and experience of ancient acupuncture are mostly irrelevant for us.

Now clearly, it is irrelevant how old acupuncture is or how commonly practiced it was in ancient times to the issue of whether or not it works. If it were true that modern acupuncture were a revival of a long-standing ancient practice, this wouldn’t be evidence that it was safe or effective any more than the long history of bloodletting somehow validates that therapy. However, from a marketing point of view, people appear to find the claims made for modern acupuncture more palatable or believable if they imagine it as the revival of  ancient wisdom, instead of a politically motivated invention of the 1950s. It may be useful, therefore, to recognize this as an unsubstantiated myth that does not help us in evaluating the risks and benefits of acupuncture today.

Posted in Acupuncture | 8 Comments

When Homeopathy Becomes Truly Dangerous

Posted on October 23, 2013 by skeptvet

I have often written about homeopathy, not because it is a particularly popular or important therapy (only about 3.5% of Americans, for example, report having tried it) but because it is one of the clearest and most egregious examples of pseudoscience. The case against homeopathy is very strong, and it is clearly theoretically implausible and clinically proven to be nothing more than a placebo.

Proponents of homeopathy try to claim it is scientifically reasonable and even “evidence-based,” but the evidence they present is consistently deeply flawed and unconvincing. What is more, individuals and groups advocating for homeopathy often deny that they reject or discourage the practice of science-based medicine even while clearly doing just that. The Academy of Veterinary Homeopathy (AVH) has gone so far as to hire a public relations consultant to facilitate misleading the public into thinking homeopathy is a safe and effective therapy and that veterinary homeopaths do not discourage the use of necessary and effective scientific medical therapies.

However, if one keeps an eye on their marketing efforts, it is easy to find clear examples of accepted members of this group engaging in practices that seem difficult to view as anything other than malpractice or fraud (though I suppose the latter requires an awareness of misleading clients, and unfortunately I do not doubt the individuals involved believe the nonsense they are selling).

A recent post on the Holistic Care for Animals Facebook page (which is described as “the Facebook presence of the Academy of Veterinary Homeopathy.”) directed readers to a page promoting “Emergency Vet Alternatives.” This page, part of a site run by homeopathic veterinarian Will Falconer, provides some of the most egregiously dangerous advice for pet owners I have come across. Dr. Falconer promotes his “homeopathic emergency kit,” which he suggests can substitute for a visit to an emergency veterinary clinic even in the case of serious I injury and illness.

I wanted a way for you to be able to have this safety net at home and avoid the E.R. like my many patients have successfully done with my help over the years.

But I can’t be everywhere and serve thousands of clients. It’s just not practical. Even the broader category of holistic vets are not yet in every town and city.

Here’s what I’ve decided to do to “clone” myself, and give you holistic medical options when your animal is in a pinch and you need emergency help right away.

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

  • parvo
  • vomiting after eating spoiled food
  • bee stings and worse, the allergic reactions to them that can shut off airways
  • burns
  • injuries: car accidents, tails in a car door, sprains, etc.
  • bite wounds, cuts, gunshot wounds
  • bloat
  • pain from overexertion
  • splinters, fox tails, thorns
  • abscesses
  • shock

This custom kit will include remedies in various potencies, or strengths, that you won’t find without buying multiple kits elsewhere. I’ve individually chosen potencies that match the seriousness of the various emergencies you may find your animal in.

That’s right! Dr. Falconer is suggesting homeopathic remedies can “get your animal well” and possibly “avoid the E.R.” even if your pet has parvovirus, bloat, or shock or if they have been bitten by another animal, hit by a car, or shot! These are serious, often life-threatening emergencies for which there is absolutely no evidence that homeopathy has any value at all. Even with the best treatment, these emergencies can be fatal, and to suggest these things should be treated at home by an owner, with homeopathy or any other remedy, is completely irresponsible.

Dr. Falconer does promise this kit will come with some support.

To go with this excellent emergency kit, and help you use the remedies properly, a practical ebook (now at the publisher) explaining how to choose the best remedy for your animal’s emergency, how to dose, and an introduction to this amazing art and science that I practice daily, called homeopathy.

A webinar series that will visually and audibly help you learn each remedy, so you’ve got them already in mind ahead of time, and can choose the proper remedy quickly in a time of need.

Unfortunately, advice about how to use a placebo therapy to treat life-threatening medical problems, even if provided by a (*sigh*) licensed veterinarian, is not in any way safe or appropriate. Yet Dr. Falconer goes on to suggest, yet again, that his ebook and homeopathic emergency kit can substitute for real, in-person veterinary care.

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

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

This is one of those situations where all the good intentions and honest belief in his own advice cannot excuse recommendations which endanger the lives of pets. The idea of homeopathy as a primary treatment for authentic emergencies is so laughable it has been the subject of televised parody. And even the ridiculously lax and irrational laws that govern homeopathy in the U.S. specifically prohibit claims that homeopathic remedies can be used to treat “diseases that require diagnosis and treatment by a physician.” The FDA has recently warned manufacturers of over-the-counter homeopathic remedies intended for unsupervised use at home that they cannot claim these remedies are appropriate for treatment of serious illness or injury. Handing clients a bag full of homeopathic remedies and an ebook to treat such serious illness in their pets makes no more sense, and may quite possibly be illegal (though the FDA has historically paid little attention to the use of homeopathy in animals, so that would be a matter for the FDA or the courts to decide). Regardless of the legal technicalities, in my opinion such a practice cannot be reasonably viewed as sensible or ethical.

Now individual veterinarians may not always be representative of a whole method of practice. I have no doubt homeopathy proponents could produce lots of stories of conventional veterinarians practicing in unethical and indefensible ways, and yet clearly such stories don’t fairly represent, much less invalidate, all of conventional medicine. Though the principles and evidence of homeopathy clearly mark it as ineffective pseudoscience, I am sure the majority of homeopathic veterinarians are ethical by their own standards. Then again, so is Dr. Falconer. He undoubtedly believes he has found a better way of treating his patients and that he is doing good while I and the rest of the profession who do not share his delusion are doing harm. Does this justify making the recommendations he makes?

And while many veterinary homeopaths might agree that Dr. Falconer’s recommendations regarding emergency care are inappropriate, I have not found any evidence to suggest the AVH repudiates them. After all, the AVH promoted his claims on its Facebook page. And Dr. Falconer is still listed on the AVH web site as a member and certified veterinary homeopath. The AVH describes this certification this way:

Accredited veterinarians have demonstrated a basic level of competency in theory, principles and philosophy, remedies, and prescribing in veterinary homeopathy. Currently, this certification process is the best method available to the AVH to ensure competency of homeopathic veterinarians to the public.

Plenty of caveats are given elsewhere on the page, and likely this cannot meet the legal definition of an “implied warranty” or anything, but it seems reasonable to infer that the AVH at least does object to Dr. Falconer’s practices.

The remainder of Dr. Falconer’s web site reads like a pretty typical example of the most extreme type of alternative medical practitioner. He tells a frightening story of his conversion experience from conventional to alterative practice.

I put the antibiotics away for good when my own cat Cali, in trying to have her first kittens, did so out in the wilds of Haleakala on Maui, and came dragging herself in with a horribly infected uterus, leaking a foul smelling discharge, and clearly seriously ill. I knew even antibiotics would have a hard time helping her, but I also knew I had something deeply curative to offer now: homeopathic medicine.

Cali was treated with pyrogenium 30C, a remedy made from rotten beef, and described by Dr. H.C. Allen, a brilliant homeopathic MD of the mid-1800s. He wrote, “In septic fevers, especially puerperal (pertaining to child bearing, around birth time), Pyrog has demonstrated its great value as a homeopathic dynamic antiseptic.”

After a few doses of this remedy and a couple of uterine flushes with a bit of anti-infective Chinese herb (Yunnan Paiyao), Cali made a full and remarkable recovery. It was as though she’d never been sick. I had an “Ah-ha!” moment, and tossed my antibiotics in the trash.

In my view, the treatment of a serious illness in a suffering animal with unproven and almost certainly useless homeopathic remedies is not justified by the good fortune of the cat in surviving such inappropriate treatment.

Apart from his recommendations for treating emergencies, Dr. Falconer promotes a pretty standard list of unproven or clearly false alternative medicine claims:  

  1. He presents the usual exaggerated and unsubstantiated claims about the dangers of vaccination.
  2. He provides similarly exaggerated and unsubstantiated claims about the dangers of heartworm preventatives and goes further in claiming that alternative methods are effective, which is not accepted by experts on this disease or even by most proponents of alternative veterinary medicine (it is not clear specifically what alternative preventative he recommends since you have to buy another ebook from him to find out).
  3. He promotes raw diets despite the lack of evidence to support such claims.
  4. He even recommends a local practitioner of Gerson Therapy, a thoroughly discredited mélange of practices that include coffee enemas.

As I’ve often said before, reasonable people can disagree politely and substantively about the merits of alternative therapies. But even honest belief and a kind heart cannot excuse practices which clearly and needlessly endanger patients. Dr. Falconer is clear and direct in his claims that conventional medicine is often ineffective and outright harmful, yet likely believers in his methods, and even others who doubt them, will feel my criticism of his claims and actions is unkind or wrong.

I have no doubt that clients of Dr. Falconer, who genuinely believe his absurd claims and feel he has helped their pets, will make all sorts of personal attacks and insinuations about me in response to my criticism of him, as supports of Dr. Plechner and Dr. Andrew Jones and others I have criticized have done in the past.

Though it is probably pointless, I will make try to make clear ahead of time that I don’t consider myself any smarter or any better a person than Dr. Falconer. I don’t believe he is a bad person or that he deliberately misleads anyone.  However, I do believe that some ideas are true and others are false, and that science is the best way to tell the difference. Science has clearly identified homeopathy as nothing more than a placebo, so it is genuinely wrong to claim it is an effective therapy for serious medical problems.

Furthermore, testimonials and other personal experiences, intuition, and faith are not reliable ways to decide if a therapy works, and they do not justify denying therapies which have been proven effective (like vaccination and antibiotics, which Dr. Falconer largely rejects) or recommending implausible, unproven, or outright bogus therapies. Good intentions notwithstanding, making such recommendations harms patients, and challenging these claims is a duty for those of us who honestly believe them to be wrong.

That said, I understand true believers in homeopathy, or in Dr. Falconer personally, will be deeply offended by my having the temerity to criticize his methods. While I do not expect to change any already made-up and solidly closed minds, I do hope some pet owners considering substituting a homeopathic emergency kit and an ebook or webinar for actual emergency veterinary care will consider the real danger for their animal companions in such a choice.

Posted in Homeopathy | 47 Comments

Dr. Plechner Rallies Supporters to Correct the SkeptVet & Other “Disease Care Providers”

Posted on October 14, 2013 by skeptvet

Last spring I wrote an article about a Dr. Al Plechner, who claims to have discovered a glandular imbalance, which he has named Plechner Syndrome and which he claims is responsible for a wide range of health problems. Dr. Plechner’s web site includes many of the classic warning signs of medical nonsense, including: grand claims that a lone individual has discovered, through trial and error rather than formal scientific research, a major breakthrough that the rest of the medical profession has missed; that there is one entity responsible for an enormous number of seemingly unrelated diseases; that one simple  therapy can cure or improve many seemingly unrelated diseases; that mysterious “toxins” in the environment can be blamed for health problems without specific evidence for such a connection; that anecdotes and personal experience is sufficient to demonstrate these claims; and that scientists and veterinarians who disagree with Dr. Plechner are motivated by ignorance, greed, or other malign motives rather than a genuine interest in the truth and the welfare of patients.

Following my earlier criticism of Dr. Andrew Jones (here and here), his followers leaped to his defense through a combination of anecdotes and personal attacks on me. The same has now happened with Dr. Plechner’s followers, and this time it appears he has actively solicited people to come forward in his defense. Starting a couple of days ago, I began receiving a number of comments on my original post, most offering anecdotes suggesting Dr. Plechner had helped their pets, often after conventional veterinarians have failed or given up. I have, according to my usual policy, approved these comments and tried to offer reasonable and polite responses. I am always open to constructive debate and discussion focused on ideas and facts.

A fair number of the comments have also included personal attacks or abusive language. I do not generally approve such comments since they are both uncivil and not productive. In the past, I have collected anonymous examples of the sort of abusive or hysterical hate mail I get just so people can understand the kind of tone and thought processes so often marshaled in support of unconventional medical practices.  In this instance, a supporter of Dr. Plechner has forwarded to me an email in which Dr. Plechner asks his supporters to set me straight. I think this provides some additional insight into Dr. Plechner’s approach and why pet owners should be highly skeptical of his claims.

His original request to his followers is as follows:

 

When you have time to waste, Google drplechner.com and go to Plechner’s Syndrome and the Art of Making Things Up

Now I know why my son said, “Pop do not look at the comments against you on the internet”!

WOW!

I think the time has come to have you comment on the statements that have been made about my faulty research!

What a shame that a person that is so “academically impaired”, has so little to do accept to show their “ignorance with an attitude”, by trying to discredit new research studies that have not been included in their education in schools of medical learning just yet.

Treating the cause of disease is just as important as treating the effects, if not even more important!

The fact that my profession does not know the cause of a disease at this time, does not mean that a cause does not still exist.

On line notifications like this only hurts the patients based upon this contributors ignorance!

I know how busy all of you are, but the time has come when venomous misconceptions like what this person is preaching, must end.

If you have time, I would really appreciate you sending your comments and experiences using Plechner’s Syndrome to the website information at the end of the article.

My only feeling is that this kind of article is only hurting people and animals with health problems and keeping them from getting proper treatment.

The time is coming, when my research findings will be accepted by the medical professions and make a huge difference for their patients.

Thank you for understanding and believing in me.

Sincerely,

AL

This message contains a number of clear examples of Dr. Plechner’s belief that he is a misunderstood visionary and that the reason the rest of the veterinary profession rejects his claims is because we are all ignorant. It is a remarkable display of arrogance to assume you are right and the vast majority of other medical professionals are wrong, so this somewhat contradicts the more sympathetic descriptions of Dr. Plechner by his supporters.

He also refers to “new research studies that have not been included in their education,” yet neither he nor any of his supporters ever produce any published research on his claims for us to evaluate.

And while I understand that no one likes to be criticized, it hardly supports Dr. Plechner’s case that he responds to this criticism not with evidence or substantive arguments but simply repeated assertions that he is right and the rest of us are wrong and with personal attacks on a critic he knows nothing about. Phrases like “academically impaired” and “ignorance with an attitude” are just vacuous, petty attempts to insult, not an argument against anything I have written. And “venomous misconceptions” is not only a silly attempt to imply some sinister motive for my lack of acceptance of his claim, but also a bit hypocritical given his personal attacks in this message to his supporters.

In a follow-up message thanking one of his supporters for defending him, Dr. Plechner goes further, revealing his conspiracy theory driven agenda and his underlying rejection of the scientific and medical profession generally.

 

One crucial pt to always keep in mind: “Follow the money trail”

“HE WHO PAYS THE PIPER, CALLS THE TUNE”

Much of so called ‘science’ operates on this basis.

And most of the medical/ big pharma colluded industry has a cozy little relationship with

government, msm and the educational institutes to boot.

We should class them as ‘Disease Care’ providers, and not Health Care!

Once again the pharma shill gambit and the blithe dismissal of all doctors who don’t agree with Dr. Plechner as greedy and more concerned about money than about the welfare of their patients. This sort of insulting nonsense deserves no respect or response other than to show it for what it is and let the public judge whether it is fair and reasonable or extreme and self-serving.

While some of Dr. Plechner’s supporters have, as I pointed out earlier, have been civil and even thoughtful in their defense of him, others have been even less reasonable and less substantive in their attacks on his critics than he has. Here are some samples from comments and messages posted to this site or sent directly to me. Such hysterical ranting and abuse belongs in the realm of debates about religious cults, not about the causes and treatments of disease in our animal companions.

“That Skep Vet is a jerk”

“Some scientist YOU are!!! With NO evidence or EXPERIENCE of using Dr. Plechner’s Protocol, you have MADE UP a MOST INCREDIBLE diatribe which amounts to character assassination. This article is outright libelous you should be sued for for an attempt to destroy the reputation of someone who has worked hard for fifty years and has saved countless lives. You have NO actual scientific experience with this protocol, yet you have judged it in the extreme. HOW can you do this and call yourself a scientist??? Talk about a personality disorder, this is cognitive dissonance.

The truth is geniuses are ahead of their times and the little minds always do what you are doing.”

“Well, the above diatribe from one self-proclaimed know-it-all,”skeptvet,” just goes to prove that any pompous ass with a computer and keyboard can make denouncements of Biblical proportions denigrating the findings of others, about which they neither have any direct knowledge or proof to the contrary.

Yes, Mr. or Mrs. Skeptvet, we who have first hand experience with Dr. Plechner and what’s possible when the mind is not a steel trap, encourage you to waste more of your time, attempting to deny and negate the life work of one man who has actually been in the thick of it for 5 decades. A man who has demonstrated his enormous heart and compassion and humanity countless times, while you’ve been at your keyboard, “working” hard at slicing and dicing someone’s reputation.

We absolutely encourage you to waste more of your value-less time, along with all the other flat-earthers. Opinions cannot sway those with FIRST-HAND knowledge of what works! I bet we could give a damn whether science agrees or not.

Personally, I’d rather have a live cat and pass (or piss) on the studies.”

It seems pretty clear from the information cited in my original post, and from the responses of Dr. Plechner and his supporters to that critique, that Dr. Plechner believes himself to be a visionary possessed on an insight not appreciated by the rest of the veterinary profession, and that his followers are willing to accept his claims based on anecdotes alone, without concern for whether there is any real scientific evidence to support them. That is, of course, their right. However, history is littered with the work of such iconoclastic visionaries who were wrong, and justly forgotten. And, unfortunately, history is also littered with people hurt and killed by mistaken beliefs about health and ineffective or dangerous medical therapies, and a greater understanding of the value of scientific assessment of these therapies could have saved many of them

As I’ve discussed before, the kind and brilliant pediatrician Dr. Benjamin Spock, guided much of the childcare practices in the English-speaking world for decades with his incredibly popular book Baby and Child Care. Among his many insights, unfortunately, was a tragic mistake. Based on his own experience and reasoning, he decided the risk of Sudden Infant Death Syndrome (SIDS) could be lowered by putting babies to sleep on their bellies, so they wouldn’t choke if they vomited. Most parents from the 50s to the 90s followed this advice. But from the 1970s, there was good scientific evidence Dr. Spock was wrong. A systematic reviews of the subject has concluded that:

Advice to put infants to sleep on the front for nearly a half century was contrary to evidence available from 1970 that this was likely to be harmful. Systematic review of preventable risk factors for SIDS from 1970 would have led to earlier recognition of the risks of sleeping on the front and might have prevented over 10 000 infant deaths in the UK and at least 50 000 in Europe, the USA, and Australasia.

When a campaign was instituted in the U.K. to reverse the practice Dr. Spock had recommended, the number of SIDS cases dropped dramatically. That is the danger or following the intuition or experience of one person, however smart or well-intentioned, and ignoring the need for real scientific evidence. I bear no personal ill will to Dr. Plechner, but I stand by my assessment that his claims are implausible, not supported by meaningful scientific evidence, and a dangerous assertion of the intuition of the individual over objective research as the measure of medical hypotheses.

 

 

 

Posted in General | 57 Comments

What is a Spay: Ovariectomy versus Ovariohysterectomy for Female Dogs

Posted on October 13, 2013 by skeptvet

This is a short informational handout that I developed for my clients discussing simply and briefly the two most common approaches to spaying female dogs. For those interested in more detail, the relevant references are provided.

What is a Spay?
“Spaying” refers to any surgical procedure which removes the ovaries, the source of hormones that cause female dogs to have estrus cycles (“heats”) and allows them to reproduce. There are actually several different ways to spay a female dog. Removing only the ovaries is called an ovariectomy. This can be done through a surgical incision into the abdomen, which is most common, or through several small holes using a special instrument called a laparoscope. Removing both the ovaries and the uterus is called an ovariohysterectomy, and this procedure also can be performed through open surgery or laparoscopy.

Historically, veterinarians in the United States and Canada have mostly performed ovariohysterectomies, while vets in Europe and other places have more often done ovariectomies. However, ovariectomies are becoming more common in the U.S. and are now being taught as the procedure of choice in some veterinary schools.

Why Spay a Dog?
There are several benefits to spaying female dogs. Spaying prevents them from reproducing, which helps reduce the large number of unwanted puppies that must be adopted or euthanized every year. Spaying also prevents infections of the uterus (pyometra). Research has also suggested that spayed female dogs are less likely to get mammary tumors (breast cancer) than intact females, though not all studies agree. And there is some evidence that spayed females may live longer than intact females.

As with all medical procedures, there are also some risks to spaying. Complications associated with surgery are generally uncommon and mild, but serious complications can occur. Spayed females may also be at increased risk of urinary incontinence (leaking urine) later in life, and some orthopedic problems and types of cancer may be more common in spayed dogs of some breeds, though the information on these risks is quite incomplete.

Which Type of Spay is Better?
There is very little difference in the outcomes of different types of spay surgeries. The benefits are the same whether the ovaries and uterus are removed or only the ovaries. Because ovariectomy involves a smaller surgical incision and is generally quicker to perform than overiohysterectomy, there may be a slightly lower risk of surgical complications and a little less discomfort for the patient with this procedure. Laparoscopic procedures require even smaller incisions, so they might be less uncomfortable than open surgeries, but they take quite a bit longer and require expensive specialized equipment.

Some vets believe it is safer to remove the uterus as well as the ovaries in older females who have gone through several heat cycles or have had one or more litters, though there is little research on this subject.

Bottom Line
Since there are no universally accepted guidelines for when to perform different types of spay surgery, individual veterinarians may make different decisions about the best procedure for any individual pet. A pet’s medical record will reflect which procedure was performed so there is no confusion in the future about whether or not the uterus has been removed.

References

  1. van GoethemB. Schaefers-Okkens A. Kirpensteijn A. Making a rational choice between ovariectomy and ovariohysterectomy in the dog: a discussion of the benefits of either technique Vet Surg. 2006;35(2):136-43.
  2. Lee, S. S.  Lee SeungYong. Park SeJin. Kim YoungKi. Seok SeongHoon. Hwang JaeMin. Lee HeeChun. Yeon SeongChan. Comparison of ovariectomy and ovariohysterectomy in terms of postoperative pain behavior and surgical stress in dogs. Journal of Veterinary Clinics. 2013;30(3):166-171.
  3. McKenzie, BA. Evaluating the benefits and risks of neutering dogs and cats. CAB Reviews: Persp in Agricul, Vet Sci, Nutr, Nat Res. 2010;5(45).
  4. Okkens AC, Kooistra HS, Nickel RF. Comparison of long-term effects of ovariectomy versus ovariohysterectomy in bitches. J Reprod Fertil Suppl. 1997;51:227-31.
  5. DeTora M, McCarthy RJ. Ovariohysterectomy versus ovariectomy for elective sterilization of female dogs and cats: is removal of the uterus necessary?J Am Vet Med Assoc. 2011;239(11):1409-12.

 

 

 

Posted in Science-Based Veterinary Medicine | 12 Comments

FDA Warns Homeopathy Manufacturer Hyland to Stop Mislabeling its Products

Posted on October 2, 2013 by skeptvet

I’ve written previously about the official regulation of homeopathy by the Food and Drug Administration (FDA). The bottom line is that homeopathy was exempted from the standards of proof for safety and efficacy required of all other medications regulated by the FDA due to the efforts of the senator who first introduced the Food, Drug & Cosmetics Act (FD&C), who happened to have practiced homeopathy. It is legal to sell homeopathic remedies without a prescription for conditions people can reasonably be expected to diagnose and treat themselves. And it is legal to claim safety and efficacy and sell such remedies with a prescription for more serious illnesses. Fortunately, few doctors authorized to write such prescriptions are foolish enough to believe homeopathy is appropriate as treatment for such illnesses.

Homeopathic drugs are subject to the same regulatory requirements as other drugs; nothing in the FD&C Act exempts homeopathic drugs from any of the requirements related to adulteration, labeling, misbranding, or approval. We acknowledge that many homeopathic drugs are manufactured and distributed without FDA approval under enforcement policies set out in the Agency’s Compliance Policy Guide entitled, “Conditions Under Which Homeopathic Drugs May be Marketed (CPG 400.400)” (the CPG). As its title suggests, the CPG identifies specific conditions under which homeopathic drugs may ordinarily be marketed; thus, in order to fall under the enforcement policies set forth in the CPG, a homeopathic product must meet the conditions set forth in the CPG. One of those conditions is compliance with Section 503(b) of the FD&C Act. Under the CPG, only homeopathic products intended solely for self-limiting disease conditions amenable to self-diagnosis (of symptoms) and treatment may be marketed OTC. Homeopathic products offered for conditions not amenable to OTC use must be marketed as prescription products.

Despite this historical accident, the reality is that the FDA does not endorse the safety and efficacy of homeopathy as homeopaths often claim. Unlike all other drugs and medical devices, FDA approval of homeopathy does not imply any real evidence or scientific testing of safety or efficacy. The FDA says as much on its web site, ““FDA is not aware of scientific evidence to support homeopathy as effective.” With regard to veterinary use of homeopathy, it is technically against the law, but the FDA has bowed to political reality and decided not to enforce this rule.

A recent warning letter issued to one of the largest homeopathy manufacturers in the U.S. emphasizes the fact that the FDA does not consider homeopathy as a valid form of therapy for serious disease despite its formal status as legal under the Food and Drug Act. It reminds the company that marketing homeopathic remedies without prescription for serious health problems is illegal.

Your firm markets numerous drugs that are misbranded in violation of sections 503 and 301 of the Federal Food, Drug, and Cosmetic Act…The products [mentioned in the letter] are prescription drugs within the meaning of section 503(b)(1) of the FD&C Act because they are intended to treat diseases that require diagnosis and treatment by a physician or are intended to provide treatment for symptoms usually caused by an underlying disease process that requires diagnosis and treatment by a physician. Because they may be dispensed only by prescription of a licensed practitioner, these products are misbranded… If an indication requires the supervision of a practitioner licensed to prescribe drugs, adequate directions for use cannot be written for an OTC drug product for that indication. 

Furthermore, your products listed above are misbranded within the meaning of section 502(a) of the FD&C Act [21 U.S.C. 352 (a)] in that their labeling is false or misleading because the labeling represents the products as suitable for use by consumers to treat conditions which the Agency has found not appropriate for OTC drug treatment.

In this letter, the FDA also addresses the issue of testimonials, that meaningless yet ubiquitous and persuasive form of marketing preferred by purveyors of unproven or bogus alternative therapies. The agency recognizes that such testimonials are presented with the intention of suggesting that the products are safe, effective, and appropriate for the conditions customers claim to use them for, and that this creates a false, and in this case illegal, impression even if the words used are not those of the company itself.

We also note that you include customer reviews of products on your websites. These customer reviews are evidence of the intended uses of your products; your firm is responsible for ensuring that statements made by customers and included on your websites do not cause your product to be misbranded…

So the next time you hear a homeopathy advertise their magic water as “FDA Approved,” remember this does not in any way suggest that homeopathy has been scientifically proven to work or that the FDA believes it to be an effective therapy for any condition.

Posted in Homeopathy | 29 Comments

Toxicologists Recommend “Say ‘No!’ to Unregulated Herbs and Homeopathy”

Posted on September 30, 2013 by skeptvet

The Choosing Wisely project is an effort by the American Board of Internal Medicine Foundation to encourage physicians and patients to choose diagnostic and therapeutic interventions in a rational, evidence-based way. Specialists make recommendations about tests and treatments in their area of expertise. The most recent recommendation list comes from the American College of Medical Toxicology and the American Academy of Clinical Toxicology. It contains a number of recommendations relevant to potential toxins, and the first highlists the dangers of unregulated herbal remedies and homeopathy.

Toxicologists Recommend Against Herbs and Homeopathy

 

Posted in Herbs and Supplements, Homeopathy | 27 Comments

Evidence Update-Safety of Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) in Dogs

Posted on September 29, 2013 by skeptvet

One of the most common and effective classes of drugs for the treatment of pain are the non-steroidal anti-inflammatory drugs (NSAIDs). Like all medicines that have any benefits, they do have potential risks as well. Unfortunately, an unrealistic assessment of these risks is just as harmful as an unrealistic assessment of benefits. While many pets take these medications safely, and find relief from their pain, dramatic stories of animals who have been harmed are widely circulated, and these can generate an excessive fear in pet owners, which can lead to their denying their pets the pain relief these drugs can provide. Proponents of alternative therapies often exaggerate the risks of NSAIDs in order to frighten people into using their remedies instead, despite the fact that these are often untested and their risks and benefits not truly known.

I have previously discussed a paper reviewing the safety of NSAIDs, which concluded that while the evidence was often weak, it suggests that the risk of serious adverse effects from NSAID use is very low. This is essentially the same conclusion reached by the authors of a new, more rigorous systematic review of the literature concerning NSAIDs side effects in dogs.

Monteiro-Steagall BP, Steagall PVM, Lacelles BDX. Systematic review of nonsteroidal anti-inflammatory drug-induced adverse effects in dogs. J Vet Int Med 2013;27:1011-19.

This paper identified and critically appraised 64 studies concerning 14 different NSAIDs. The quality and quantity of the evidence was high for 3 of the drugs (carprofen, firocoxib, and meloxicam), moderate for 3 (deracoxib, robenocoxib, and ketoprofen), and low for the others drugs evaluated.

Adverse effects were reported in about ½ the studies, however aspects of the design and reporting of the studies made it impossible to determine a reliable rate of such events or the severity of them. Overall, adverse effects were reported at rates from 0% to as high as 37.5% of dogs. However, the drugs, study characteristics, and patient populations different widely, so it was not possible to directly compare particular drugs or studies.

Interestingly, when the highest quality studies were considered (randomized, placebo-controlled clinical trials), no difference in adverse effects was detected between dogs receiving NSAIDs and those on placebo. Though it is clear that such side effects do, of course, occur in some dogs on NSAIDs, and while real clinical patients are likely to respond differently than research subjects, this at least suggests that worries about common and severe harm from these medications are not justified.

A couple of interesting observations were made from these data. Adverse effects were more common in clinical trials than in research studies. This is likely associated with the fact that research subjects are usually healthy young dogs, whereas clinical trial subjects represent a variety of ages, medical conditions, and use of medications and other therapies. It is a reminder of why we cannot entirely trust research studies to predict the effects of medical treatments used in actual patients.

Gastrointestinal side effects, such as vomiting and diarrhea, were the most common in all studies, but the evidence did not allow calculation of specific rates if these symptoms.  More serious side effects, involving liver and kidney problems, were only detected very rarely, and liver problems seemed only to occur in dogs with pre-existing liver abnormalities.

Overall, this study adds to the existing evidence base to suggest that NSAID side effects are uncommon, apart from gastrointestinal symptoms, and that serious injury is rare. There is unquestionably some risk associated with these medications, and the patients they are used in have to be selected and monitored carefully and appropriately. However, they are very effective pain control drugs, and denying their benefits to our pets without a realistic assessment of the risks is a disservice to our animals.

Posted in Science-Based Veterinary Medicine | 23 Comments

Vaccines

Posted on September 27, 2013 by skeptvet

Posted in Humor | 1 Comment

Turmeric for Pets

Posted on September 23, 2013 by skeptvet

One of the more popular herbal products in the last few years has been turmeric. Used as a spice in cooking, this herb has also been used for the usual wide range of unrelated conditions in traditional folk medicine, particularly in Ayurvedic and Chinese medicine. Turmeric is sometimes suggested for use in the treatment of cancers and inflammatory conditions, such as arthritis, in veterinary patients. A recent question from a reader prompted me to have a look at the evidence concerning the use of this herb.

What Is It?
Turmeric is a root cultivated as a spice and herbal medicine throughout Asia and parts of Africa. It contains a plethora of compounds, however the most studied in terms of medical applications are the curcuminoids.

What’s the Evidence?
There are abundant in vitro studies examining the chemical and biological properties of compounds found in turmeric. These studies suggest antioxidant, anti-inflammatory, and anti-cancer activity for curcumin and other constituents of turmeric. Such in vitro studies can never, of course, prove a clinical benefit for patients. Bleach kills cancer cells in a petri dish, but it is hardly a cure for cancer. However, these studies are important for identifying possible uses to be investigated and for building a plausible foundation for conducting clinical studies. The in vitro research certainly does suggest a number of potential medical uses for turmeric.

The actual clinical research, however, is sparse. As the National Center for Complementary an Alternative Medicine (NCCAM) puts it, “There is little reliable evidence to support the use of turmeric for any health condition because few clinical trials have been conducted.” Many of the studies that have been done in humans have focused on curcumin and have found that it is poorly absorbed when taken orally. Large quantities must be taken to achieve detectable levels of curcumin in the blood.

There has been one systematic review of the research concerning the use of turmeric for a wide range of conditions:

Ulbricht C, Basch E, Barrette EP, et al. Turmeric (Curcuma longa): An Evidence-Based Systematic Review by the Natural Standard Research Collaboration. Alternative and Complementary Therapies. August 2011, 17(4): 225-236.

The summary conclusions of the review have been posted here. All potential uses were given the evidence grade of C, meaning the evidence is unclear, conflicting, or insufficient to draw any conclusions. Overall, there is no compelling clinical evidence in humans supporting any use of curcumin or other turmeric compounds.

As usual, there is less evidence in companion animals. One study comparing a turmeric compound to placebo in dogs with arthritis found not significant effects in an objective measure of weight bearing or in subjective owner assessment, though there was a small difference according to the subjective assessment of investigators. There are no other controlled clinical trials. A few experimental studies have been done on potential topical applications for ringworm and bacterial infections, and one research group in Brazil has published several papers looking at specific physiologic effects of turmeric compounds in dogs intentionally injected with snake venom. These studies have little relevance to the clinical use of turmeric for treatment of arthritis, cancer, and other clinical problems.

Is It Safe?
As I emphasize frequently, any therapy that has meaningful benefits will also have potential side effects. The body is simply too complex to expect to tinker with one element and not have wide-ranging effects on other elements. Therefore, it is actually a bad sign when a treatment is promoted as having no side effects since it likely suggests that treatment doesn’t actually do anything.

Potential adverse effects have been reported for turemric, including gastrointestinal upset, possible effects on blood clotting, possible increase in the risk for some kinds of bladder and kidney stones, and interactions with other herbs and pharmaceuticals. The limited clinical research so far suggests these risks are small. However, there is far less research available than is typical for a new drug before it is put on the market, and it is not unusual for unanticipated side effects to show up after a medicine is used and studied in a much larger and more diverse population. Therefore, the best we can say about the safety of turmeric for medical use (which, of course, means doses dramatically greater than its use as a spice in cooking) is that there is no obvious evidence of great risk but that the safety profile is no more clearly established than the efficacy profile.

Bottom Line
Turmeric contains a number of potentially useful chemical compounds, of which the most studied is curcumin. There is sufficient in vitro research to establish biological effects which might have clinical benefits, so the concept that these compounds could have therapeutic value is plausible. There is very little clinical research in humans, and there is not yet any convincing evidence to support the use of turmeric for any condition. There is virtually no clinical research in companion animals, and what there is does not support claims of benefit from turmeric compounds. Finally, the limited research to date suggests a few potential risks but the significance of these is unclear.

Posted in Herbs and Supplements | 90 Comments

Resources for Evidence-Based Veterinary Medicine

Posted on September 19, 2013 by skeptvet

I write extensively about the ways in which alternative therapies are justified, and the problems with much of the evidence used to promote them. I talk less here about the way all veterinary therapies should be evaluated and appraised, through the processes of evidence-based veterinary medicine (EBVM). This is a subject I write and speak about often elsewhere, but which hasn’t been a major focus of this blog, though it is the EBVM approach which I use to evaluate all the therapies I do write about.

Since I suspect many readers will be interested in how the veterinary profession can do the best possible job determining the risks and benefits of the therapies we offer, I thought I would highlight a few resources that illustrate the EBVM approach. Even though these do not directly address the issues of alternative medicine, they demonstrate the kind of critical, science-based evaluation that should be applied to all veterinary treatment. It is this kind of appraisal which often reveals how little substance there actually is behind the claims made for many CAM practices.

The Evidence-Based Veterinary Medicine Assocation (EBVMA) is the main organization promoting EBVM here in the U.S., and it is a great resource for learning more about EBVM and for veterinarians seeking to support an evidence-based approach.

The Centre for Evidence-Based Veterinary Medicine (CEVM) at the University of Nottingham is a robust and vibrant center of research and teaching in EBVM. They have recently launched a couple of tools for veterinarians that illustrate the possiblities for the future of our profession.

The first is their new critically appraised topic database BestBETs for Vets  “BET” stands for Best Evidence Topic. The BestBETs concept was first developed for doctors working in emergency medicine (http://www.bestbets.org/). In collaboration with our medical colleagues, the folks at CEVM have developed a freely accessible database of BestBETs for veterinarians. Though the number of topics is currently small, this is a dynamic project which will eventually be an important resource for veterinarians interested in making the best, most evidence-based decisions.

The team at CEVM has also launched VetSRev. VetSRev is a freely-accessible online database of citations for systematic reviews of relevance to veterinary medicine and science.  As regular readers know, a systematic review is the most comprehensive and unbiased assessment of the total body of clinical research on any given subject. The number of systematic reviews in veterinary medicine has exploded in recent years, which makes it much easier for veterinarians to quickly and reliably find the “bottom line” for many diagnostic tests and treatments.

Posted in Science-Based Veterinary Medicine | 11 Comments