AVMA Leadership Fears Slippery Slope if Homeopathy is Publically Identified as Ineffective

Posted on December 22, 2013 by skeptvet

The leadership of the American Veterinary Medical Asociation (AVMA) has recommended the House of Delegates (HoD) reject a resolution discouraging the use of ineffective therapies and identifying homeopathy as ineffective. While not disputing that there is no clinical evidence to support any benefit from homeopathy, the leadership does not want the organization to get involved in evaluating or discouraging any veterinary therapy.

The case for this position begins with a positive statement about the role of science in veterinary medicine:

The AVMA believes that scientific discovery is critically important for the continual evolution of clinical practice and should be the basis for the development of public policy in veterinary medicine, public health, agriculture, food safety and the environment.

It is the role of the scientific community to engage in high-quality research and publish their findings in the scientific literature. Clinical practitioners must critically review the literature to determine the best practice for their patients; this is the model for evidence-based medicine. These standards are, of course, constantly evolving and should be the subject of vigorous debate.

It is encouraging to see the AVMA indicate that science, and critical evaluation of scientific research, should be the standard by which veterinary therapies are judged, and to acknowledge the role of evidence-based medicine. It is unfortunate that the organization has not been willing to make such an assertion in the policy concerning complementary and alternative medicine, and that there has been little public support for the centrality of science and scientific research in validating veterinary therapies.

However, part of the reluctance to make such a public statement may stem from the inevitable inconsistency that arises when the organization then refuses to discourage therapies that are inconsistent with science and science-based medicine. The AVMA has acknwledged the overwhelming case against homeopathy and admitted that “there is no clinical evidence to support the use of homeopathic remedies for treatment or prevention of diseases in domestic animals.” So if scientific research should be the basis of veterinary medicine, and if after 150 years of study there is no scientific research the convincingly demonstrates the value of homeopathy, why shouldn’t the AVMA acknowledge this method is a failure and that veterinarians shouldn’t be inflicting it on their patients? The AVMA answers this question with a classic slippery slope argument:

There is a role for professional organizations to convene experts to review the scientific literature on broad subjects, and to develop evidence-based guidance for developing policy. However, as the board of the national organization for the veterinary medical profession, the AVMA must ask itself whether it is the proper arbiter of specific clinical practices. Furthermore, the Executive Board must ask itself whether going down the path of reviewing and judging particular clinical therapies, whether traditional or alternative/complementary, will be supportive of our mission or divisive in our community.

Where does it stop? Consider the wide range of current medical and surgical interventions that could be adjudicated by the AVMA, many of which have varying and conflicting levels of scientific evidence. Popular practices, over time, often turn out to be ineffective, or even harmful.

The claim here is that while organizations like the AVMA should see establishing evidence-based guidelines as part of their mission, they should not challenge the validity of specific clinical approaches because it would be “divisive” and becasue there are a lot of practices they might end up being asked to evaluate.

The first part of this claim is simply a reflection of the fundamentally political nature of the AVMA. The organization exists, of course, to serve the needs of verterinarians, as a lobbying and marketing entity. The needs of veterinary patients and their owners are not a central priority for a professional lobby. This is fair enough so long as the AVMA does not portray itself as serving the larger public. The mission and objective statements of the organization are vague, and open to interpetation in this respect.

Mission Statement

The mission of the Association is to improve animal and human health and advance the veterinary medical profession.

Objective

The objective of the Association shall be to advance the science and art of veterinary medicine, including its relationship to public health, biological science, and agriculture.

It seems that improving animal health and advancing the science of veterinary medicine could legitimately include discouraging ineffective therapies left over from the days when bloodletting was the chief tool of mainstream medicine. But there is no question that challenging any therapy supported by more than a few veterinarians would be divisive and alienate some part of the AVMA’s constituency. The reluctance to do this is understandable for a membership-based professional lobby, but it does reinforce that the public cannot look to the AVMA as an advocate for their interests or the interests of their animals. When member veterinarians encourage the AVMA to take controversial positions on animal welfare issues, including discouraging pseudoscientific practcies like homeopathy, this challenges the core mission of the group, and so resistance is to be expected.

The slippery slope claim, however, is less convincing. There is quite a large window of opportunity for positive action between tolerating any and all therapies veterinarians wish to employ and micromanaging every clinical practice. A general statement that science and evidence-based medicine should be the foundation for veterinary practice, and specific policies discouraging egregiously and ridiculously pseudoscientific practices like homeopathy, does not commit the AVMA to evaluate every single medical practice available.

The question “Where does it stop?” cuts both ways. The choice the leadership has made not to take a position on any therapy no matter how inconsistent with science-based medicine, is just as extreme as the imaginary problem of having to investigate and rule on every possible therapy. I have heard veterinarians who rely on psychics to guide their patient care, who use astrology to help choose the timing of surgical procedures, who actively discourage the use of vaccines and all other conventional therapies, and who employ other similarly indefensible practcies even more irrational than homeopathy. Is anything a veterinarian wishes to do to a patient, any practice they choose to sell which is not illegal, acceptable? Does the profession, and its most influential organization in the United States, have no responsibility to set standards for patient care or honest informed consent? It seems we have already slid quite a ways down the slippery slope towards medical anarchy and a complete lack of reasonable standards if even something as clearly contrary to established science as homeopathy must be protected from even a purely advisory, non-binding public censure.

The leadership’s statement concludes with assertion that they are taking no position at all on homeopathy by recommending the House of Delegates reject a statement against it

For the AVMA not to condemn homeopathy should not presume endorsement; it simply means that we trust our system of research, practice, teaching and continuing education to sort through the evidence and determine appropriate therapies.

It is disingenuous to suggest that the AVMA leadership can actively oppose a policy identifying homeopathy as ineffective and still claim to be neutral on the practice. To refuse to inform the public of the state of the evidence against homeopathy is certainly to facilitate its continued use, and to put the unity of the veterinary profession above any commitment to a scientifc basis for veterinary medicine or the interests of patients and owners. Though the political realities that inform this position are understandable, it is still choosing sides, and it is still in conflict with the purported belief that science should be the foundation of veterinary medicine.

The leadership claims that we can trust the system to sort out legitimate medical therapies from pseudoscientific nonsense. To a certain extent this is true. The process of scientific investigation can give us reliable information about the value of specific therapies. In the case of homeopathy, over a century of extensive research has been conducted. Most of it is poorly done and highly biased towards demonstrating what the homeopaths conducting the research already believe. However, the better the methodological controls for such bias are, the less likely one is to find any effect, and the balance of the evidence is against any clinical benefit. Combined with the fundamental inconsistency of homeopathic theory with basic principles of established science, the system has rendered a verdict, and that verdict clearly identifies homeopathy as nothing more than a placebo for owners and veterinarians, not an effective therapy for veterinary patients.

The vast majority of the veterinary profession has accepted this verdict and left homeopathy behind, along with many other mainstream and alternative practices of the 18th and 19th centuries. Unfortunately, some veterinarians refuse to acknowledge reality, and they continue to mislead animal owners into believing homeopathy has value. It seems that the system has failed these patients and these owners, and the AVMA could choose to take a stand for science and for our patients and clients by providing a clear statement that homeopathy is not consistent with scientific medicine. This would not make homeopathy illegal or unavailable, or limit anyone’s choice of therapies. It would simply inform the public that the mainstream veterinary profession, committed to science as the foundation of medical care, recognizes homeopathy as a pseudoscientific relic of history and does not support its continued use.

It seems unlikely that the organization will do so in the face of the opposition of senior leaders. While this is disappointing, it is not entirely surprising. And it at least serves the interests of the public that this debate has happened and that the positions staked out by various parties, along with their rationales and evidence, are clearly and publically visible.

Posted in Homeopathy, Law, Regulation, and Politics | 6 Comments

Evidence Update-Importance of Vitamin D Supplementation Revealed

Posted on December 20, 2013 by skeptvet

Over the years, I have been skeptical of the safety and value of vitamin suppkements. However, a new study in the Medical Journal of Australia has finally set me straight. I’m off to stock up on Vitamin D tablets!

Hopkinson JA. Hopkinson NS. The Hobbit: An unexpected deficiency.  Med J Austr. 2013;199(11):805-6.

Abstract:

Objective: Vitamin D has been proposed to have beneficial effects in a wide range of contexts. We investigate the hypothesis that vitamin D deficiency, caused by both aversion to sunlight and unwholesome diet, could also be a significant contributor to the triumph of good over evil in fantasy literature.

Design: Data on the dietary habits, moral attributes and martial prowess of various inhabitants of Middle Earth were systematically extracted from J R R Tolkien’s novel The hobbit.

Main outcome measures: Goodness and victoriousness of characters were scored with binary scales, and dietary intake and habitual sun exposure were used to calculate a vitamin D score (range, 0–4).

Results: The vitamin D score was significantly higher among the good and victorious characters (mean, 3.4; SD, 0.5) than the evil and defeated ones (mean, 0.2; SD, 0.4; P < 0.001).

Conclusion: Further work is needed to see if these pilot results can be extrapolated to other fantastic situations and whether randomised intervention trials need to be imagined.

 

 

Posted in Herbs and Supplements, Humor | 4 Comments

American Veterinary Medical Association Admits Homeopathy is Useless, But Doesn’t Care

Posted on December 18, 2013 by skeptvet

About a year ago the Connecticut Veterinary Medical Association introduced a resolution to the American Veterinary Medical Association House of Delegates recommending the AVMA acknowledge that homeopathy is an ineffective therapy and discourage its use. This resolution was supported by the Evidence-Based Veterinary Medicine Association, as well as a number of other veterinary groups, and I had a role in supporting it through the white paper outlining the scientific case against homeopathy. I have collected the series of articles and all the evidence associated with this resolution as well as links to discussion of this matter in the Journal of the AVMA (JAVMA).

The House of Delegates chose not to decide the matter but to refer it to the AVMA Board, which sent it to the Council on Veterinary Services (COVS) and Council on Research (COR). Given the statements of the AVMA president condemning the resolution as divisive, I assumed it would disappear forever at this stage. However, the COVS and COR have issued statements on the resolution, and the Board has sent it back to the House of Delegates for a vote. The essence of the COVS and COR statements is summed up in the title of this post

The scientific issue is disputed by almost no one, excepting of course homeopaths. Large quantities of scientific evidence, most of it of very poor quality and reliability, have been accumulated over 150 years, and homeopathy has never been demonstrated to be effective. The better one controls for placebo effects and bias in a study, the less likely one is to get a result compatible with the belief homeopathy works. And since homeopathy could not possibly work without a major revision of basic laws of physics and chemistry, this is surprising to no one, excepting again homeopaths.

These are essentially the findings of the Council on Research, though they are phrased a bit more diplomatically:

The COR scanned the literature for evidence on the clinical efficacy of homeopathic treatments. The council found that studies claiming a benefit from homeopathic remedies in veterinary medicine were either anecdotal in nature—that is, case reports—or were generally flawed in the experimental design or analysis. Furthermore, the council found that well-controlled clinical studies generally failed to substantiate any beneficial effect of homeopathic remedies. The COR concluded that there is no clinical evidence to support the use of homeopathic remedies for treatment or prevention of diseases in domestic animals.

While the COVS and the AVMA Board do not dispute this finding, they suggest that the use of a demonstrably ineffective therapy by veterinarians is not a problem.

The COVS recently revised the AVMA policy on Complementary, Alternative, and Integrative Veterinary Medicine—with approval by the HOD in July 2013—and believes the policy clearly states the AVMA’s position that the same standards should be applied to any treatment modality. The COVS believes that the AVMA should not at this time single out homeopathy or any other treatment modality in alternative or traditional medicine for additional scrutiny of effectiveness.

The board agreed that it is not the purview of the AVMA to adjudicate individual therapies, whether traditional or alternative, and that the current policy on alternative medicine is adequate. Therefore, the board recommended that the HOD disapprove the resolution on homeopathy.

The policy that this statement refers to is quite simple:

The AVMA believes that all aspects of veterinary medicine should be held to the same standards, including complementary, alternative and integrative veterinary medicine, non-traditional or other novel approaches.

  • The foremost objectives in veterinary medicine are the health and welfare of the patient.
  • Diagnosis and treatment should be based on sound, accepted principles of veterinary medicine and the medical judgement of the veterinarian.
  • Veterinarians should have the requisite knowledge and skills for every treatment modality they consider using.
  • A valid veterinarian-client-patient relationship must exist.
  • Owner consent should be obtained prior to initiating treatment.
  • Medical records should include outcomes of treatment.
  • Veterinarians should be aware of and abide by local, state, and federal statutes.

All attempts to define CAM or discuss how it differs from science-based medicine have been eliminated. The statement indicates all medical practices should be held to the same standard, but doesn’t say what that standard is. Clearly, it is not the standard of evidence-based medicine.

The AVMA appears to feel that if a licensed veterinarian believes in a therapy and the therapy is legal, it is automatically ethical and appropriate to sell that therapy and make any claims one likes about its safety and effectiveness regardless of any scientific evidence to the contrary. The prerogative of veterinarians to do what they like clearly trumps the right of the public to give fully informed consent about the therapies they are offered. There is no ethical way to offer homeopathy without explaining that the scientific evidence shows it to be only a placebo, yet homeopaths clearly don’t do this. The AVMA doesn’t seem to care about this deception of clients. Nor does the organization appear to care about the harm done to patients when given placebo therapies instead of real medical care.

No one is suggesting that the AVMA individually evaluate the evidence for each and every medical therapy. But if veterinarians were offering bloodletting, astrology, or ritual sacrifice as medical therapies, how could the organization that represents some 80% of the profession not take a principled, evidence-based stand against such nonsense. Homeopathy has no greater claim to legitimacy or efficacy than these practices, yet it is more popular among veterinarians, and the AVMA values the power of a united lobby above the welfare of patients or the ethical treatment of animal owners.

My guess is that the House of Delegates will accept the recommendation to reject the resolution since the group initially seemed more concerned about the implied criticism of other veterinarians than about the truth of the statement that homeopathy is ineffective, or about the ethical issues involving clients and patients. I would love to be surprised, but I am not optimistic.

The Academy of Veterinary Homeopathy (AVH) and other homeopathy advocates will undoubtedly claim this as a victory, and it a political sense it is. The fact that no one accepts their claim that homeopathy is an effective therapy does not disturb the true believers so long as they are allowed to sell this quackery without interference or the public censure of the rest of the veterinary profession, which is apparently just fine with the AVMA.

 

Posted in Homeopathy | 9 Comments

CAM Vets Attacking Conventional Veterinary Medicine

Posted on December 15, 2013 by skeptvet

The nature of science is fundamentally critical. Science works best when it shows us what is not true. This is largely a function of the fact that most of the biases and cognitive quirks that lead us astray when trying to evaluate the natural world lead us specifically in the direction of seeing what is not there and of confirming our own beliefs. We find patterns where there are none, we underestimate the role of chance, and we inevitably filter what we see to build a case for our existing theories. Science brings us closer to the truth by compensating for these tendencies and poking holes in our cherished beliefs.

For this reason, a science-based approach to medicine often involves critique, testing claims by attempting to disprove them. But while I think substantive and civil critique is essential to the process of finding the truth and improving medicine, I understand that critical comments are often perceived and received negatively. It doesn’t surprise me, then that proponents of alternative medicine often bristle at the questions I ask about their methods, or at the conclusions the evidence often leads to about their effectiveness.

However, there is a certain hypocrisy in much of the hate mail I get, which frequently berates me for being unkind or arrogant simply because I ask such questions and rely on the evidence rather than the testimonials and belief of CAM believers. It is frequently argued that, right or wrong, I have no business criticizing alternative medicine. CAM practitioners are apparently minding their own business, doing what they think best for their patients, and along come skeptics rudely challenging their claims.

This is hypocritical because so much of alternative medicine is marketed predominantly on the basis of criticisms of the safety and efficacy of conventional medicine. CAM advocates are not at all shy about claiming conventional medicine is inferior to their methods or even outright harmful. Skeptics do not begin these debates, they simply respond to the claims CAM proponents make.

Personally, I think it is fair game to criticize conventional medicine when it makes claims that go beyond the evidence (as I do when talking about stem cell therapies or annual vaccination, for example) just as I think it appropriate to criticize CAM therapies marketed without good supporting scientific evidence. But I object to the clear double standard involved in resenting criticism of CAM while routinely mischaracterizing or denigrating science-based medicine.

The following are examples of veterinarians or veterinary organizations who promote CAM expressing typical criticisms of conventional medicine. I have limited my examples to veterinarians to illustrate that this is not simply a phenomenon of random zealots on the internet making claims that do not fairly represent common thinking in the CAM community. (There are plenty of examples of these as well in my general hate mail and well as in the attacks on me from defenders of CAM proponents I have criticized, such Dr. Andrew Jones, Dr. Al Plechner, and others.) While there is undoubtedly a great diversity of opinion among CAM proponents, and many also utilize science-based therapies, it is common for “mainstream” CAM doctors and organizations to criticize conventional medicine with at least as much vigor, and generally less evidence, that found in my criticisms of CAM.

These criticisms of conventional medicine levied by CAM proponents fall into a few general categories. One of the most popular is the claim that the fundamental theoretical mechanisms of science and science-based medicine are mistaken and that only the theories of the particular alternative a given practitioner favors can identify the true cause of illness or effect real healing. Conventional medicine only suppresses symptoms but doesn’t actually find or treat the cause of disease.  

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

Academy of Veterinary Homeopathy Facebook page

 

The word “disease” is really a bastardization of the original word “dis-ease” meaning the body was uneasy because it was/is imbalanced. The word “disease” was instituted to place labels on symptoms and is used to lend an element of fear that states only a licensed physician can cure and/or treat the “label” using invasive measures such as surgery and synthetic pharmaceuticals to “control or manage the labeled symptom”. Really there is no such thing as “disease” in the Westernized meaning of the word – merely symptoms of a body out of balance.

Today’s veterinarians are in the business of disease care, not health care. They hold doctorate titles from colleges that teach them chemistry and surgery. They are taught the labels or names of a set of symptoms as a disease. They are taught how to use modern, high tech equipment to diagnose while the pharmaceutical companies teach them which drug to prescribe to suppress the symptoms of the dis-ease or illness the animal is presenting with.

American Council of Animal Naturopathy Facebook page

 

traditionally trained DVMs practice ‘reactive’ veterinary medicine. This means they don’t have much to offer pets unless and until they’re good and sick…

…preventive medical care in the mainstream veterinary community has evolved to mean not much more than yearly vaccines and chemicals to discourage pests and parasites like fleas, ticks and heartworm.

There is rarely discussion between vets and pet owners about nutrition (because vet students receive almost no education in the subject), exercise and other physical therapies, or the importance of a strong, resilient and balanced immune system.

Dr. Karen Becker

 

Allopathic veterinarians are trained to relieve symptoms with little or no emphasis placed on the consequence(s) of the treatments selected…

Dr. Patricia Jordan


Conventional medicine looks at the body as being made up of various parts that, when sick, have nothing to do with the rest of the body, or overall health of the animal.  

Pets treated conventionally also do NOT truly achieve a higher level of health,

Dr. Michael Dym 


Doctors know a lot about medicines and surgeries but not enough about the causes of health. We are not trained to recognize the impediments to health that we ourselves have constructed, much less to remove them.

Dr. Barbara Royal


Cure CANNOT be achieved in the physical body alone. Cure cannot be achieved by focusing on symptoms but on CAUSE, the true nature of symptoms exhibited. It is as if there is a dirty spot on a lens of a slide projector that is projecting an image on a screen. The traditional doctor works away on scrubbing the spot off the screen, while the holistic doctor cleans the lens, the cause of the spot on the screen… 

Dr. Gloria Dodd

 

In my own practice, the average pet with cancer, given a prognosis of 6 to 12 months of life expectancy from conventional veterinarians, typically lives 12 to 24 months or even longer. Additionally, many pets with “incurable” cancers are cured from their cancers using an integrative approach

The sad news is that so many cancer patients will ultimately die after surviving conventional therapies because nothing is done to prevent the recurrence of cancer…How sad and tragic to know that many people will needlessly die out of ignorance once their cancer returns.

I’m still bewildered by the fact that many conventional veterinarians choose euthanasia as a solution for failure of their conventional treatments, rather than simply opening their minds to the healing power that exists when using clinically proven, time-honored natural therapies.

Dr. Sean Messonier

 

In addition to suggesting that conventional medicine is misguided and ineffective, CAM practitioners frequently assert that it is actively harmful, particularly vaccines and medicines.

Vaccinations are for the most part unsafe and unnecessary and actually the very “thing” that is making the branch of medicine known as “internal medicine”…. Vaccination is the cause of disease not the answer to stopping disease…vaccination is not legitimate, it is not ethical medicine.

We should rewrite the books of medicine to reflect the understanding that disease has evolved from the very use of vaccines.

Never should we have allowed the innoculation of poison, the grafting of man and beast. Now we all carry the scar, of medical superstition the genetic plague of inquity.

Vaccines and drugs are at odds with the intelligence of the almighty design and getting back to the garden means getting back to the natural form…

Dr. Patricia Jordan

 

The bodies of most animals have a tremendous capacity to detoxify poisons, but they do have a limit. I think we often exceed that limit and over-whelm the body’s immune system function with toxins from vaccines

Dr. Pat Bradley

 

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

Dr. Charles E Loops

 

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

Dr. Will Falconer

 

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

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

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

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

Dr. Jenifer Preston

 

I firmly believe in holistic medicine for pets.

We are killing them with the most of the terrible dog foods on the market along with pesticides contained in flea and tick medications and also medicines the vets want you to purchase.

Pay Close Attention – today, I’m going to show you why conventional veterinary medicine is harming your pet and step-by-step what you must do to prevent it.

“Regular” veterinary care has lost it’s [sic] effectiveness over the years, and in some cases is causing illness in our pets.

Dr. Andrew Jones

 

Most offensive of all, CAM practitioners commonly attribute the refusal of skeptics to believe their claims as evidence of greed or the malign influence of industry, the so-called Pharma Shill Gambit. These individuals show an incredible arrogance in believing that the only reason someone might not believe their claims or accept their methods is if they have a sinister financial incentive not to or are dupes of industry. The very thought that someone might honestly and intelligently evaluate the evidence and conclude that some alternative practices simply do not work is apparently inconceivable. And yet these same advocates are among the most outspoken and offended when faced with skepticism about their practices.

 

The vaccines are unsafe and they are unnecessary, they are also the FOUNDATION of conventional medicine which unfortunately is not to be confused with conventional “wisdom”. This is an example of how the system is built upon a foundation of “speculation” or unethical medicine that is now being questioned. Vaccines DO NOT confer herd immunity and they DO NOT confer individual immunity. They are however, the “golden calf” of the white coats that grows into the “sacred cow” of vaccine induced disease. What will they do when the public figures out they have been lied to for the purpose of “making a living by killing” by the pharmaceutical medical industrial complex that is only in operation due to government financial scaffolding and protection?

Dr. Patricia Jordan

 

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

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

Dr. Barbara Royal

 

So the leading income-producer in her practice–vaccines–was obviously creating havoc in most of her patients

Heartworm preventatives are a huge income to both veterinary clinics and the big pharmaceutical companies that manufacture the drugs…There are other alternatives to these poisonous chemicals…

Dr. Jenifer Preston

 

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

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

  • He refuses to see the possibility of it causing harm.
  • He’s comfortable in it; change loses to maintaining the status quo.
  • He profits from providing it and profits again from the disease it causes.

Dr. Will Falconer

 

The profits that a cancer cure would accrue wouldn’t even come close to the profits made by all of the cancer treatment drugs and the associated services involved in treating cancer. Sad to say, the treatment of cancer has proven itself to be, a tremendously successful revenue builder. Why wouldn’t you keep a possible cure under wraps?

But of course, this is purely a hypothetical question. We couldn’t possibly believe that our medical institutions could be callously driven by the pursuit of profit. Why, they’re as ethical as our great financial institutions are and look at how successful they’ve been.

The frightening fact is that a cancer cure could prove to be financially disastrous to the pharmaceutical and all of the other dependent medical industries.

“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!

Dr. Al Plechner

 

Why haven’t I heard of the VOM Technology before?

Because it works! That may not make sense at first, but consider this: if the VOM Technology does what it appears to do, it makes a lot of techniques, surgeries and medications obsolete. The professionals that provide those techniques, surgeries and medications will be placed in academic and financial jeopardy. These are the people that control publications in the field and control licensure and applications. AKA politics.

Dr. William Inman

 

Why there is an alliance between junk pet food makers (‘barfers’ included), many veterinarians and fake animal welfare groups designed to keep pet owners confused and in the dark?

See how incompetence and maladministration characterise the veterinary endeavour.

Once pointed out, the fact that an artificial diet fed monotonously either directly or indirectly poisons animals, the profession should have risen up and acted. Instead the professional ethic ruled that a mass cover up should apply. With the cover up safely in place profits were to be made. Increasingly elaborate ploys are now used in persuading the populace to a. keep more animals and b. feed them high priced artificial concoctions.

Dr. Tom Lonsdale


It seems to me however that skeptics who rally against natural therapies don’t want their patients or clients to have this choice. For many of these skeptical doctors, it’s “their way or the highway!”

They consistently try to talk patients out of a more natural approach to healthcare, all the while demeaning and insulting this choice, as if this choice is invalid or irrational…

The only answer I can come to after researching this question is this: economics.

If a doctor only offers one choice, in this case conventional drug or surgical therapy, and you choose a more natural approach, that means you will have to find another doctor. Your current doctor loses your business, and your choice punishes his pocket book. He won’t like that and will do anything to keep you as a patient.

Dr. Sean Messonier


At the end of the day it boils down to money. If the public are not lining vets pockets with unnecessary visits, purchasing processed foods from which vets also take a percentage, that’s quite a reduction in income.

I am “positive” that many ‘conventional” veterinarians think that Veterinary Secrets Revealed is a bunch of “hocus pocus” and should be shut down.

What does this mean?

It means that other veterinarians are upset about my website, ebook, and Complete Home Study Course.

After all, I’m showing people how to treat their own pets and save money on Vet bills

Most veterinarians just choose to ignore the research because either they still feel the benefits of vaccines outweigh the risks, or that they don’t want to lose income from giving booster shots to all those animals each year.

Dr. Andrew Jones

 

Obviously this website is biased against complementary integrative veterinary medicine….keeping comments and ideas one sided and supported pharmaceutical and commercial pet food monopolies which have been raking in the money for many decades.

Threatened financially and ideologically, they must resort to political tactics of attack, shock and awe using headlines inspired by the National Inquirer or some other ladies gossip rag.

Dr. Ihor Basko

 

To be clear, I don’t object to civil and substantive criticism of conventional medicine. I believe criticism based on evidence is essential to improving the quality of medicine, to identifying those therapies worth employing and those that should be discarded. And I sometimes agree with specific criticisms of conventional practice, such as the inappropriateness of annual vaccinations and the dangers of bias introduced by the influence of commercial industries on scientific research. The problem with critiques such as those I have cited is not that they are challenges to conventional practices, but rather that they are often purely ideological and without supporting evidence, and they are frequently distorted or cherry-picked to mischaracterize the safety and efficacy of scientific medicine for the purpose of marketing alternative medicine.

In any case, these examples should serve to demonstrate that the debate about alternative therapies does not begin with skeptics, and it is not a consequence of angry, arrogant, or mean-spirited critics unfairly attacking humble practitioners quietly trying to make the world a better place. The debate is a natural consequence of the claims made by CAM proponents, which often include vigorous criticism of the principles and practices of science-based medicine. In responding to such claims, we are not spontaneously attacking CAM without purpose but participating in a debate already launched by CAM advocates about how best to find the truth about nature and care for our patients.

Posted in General | 9 Comments

European Food Safety Authority Rejects Prostora, a Probiotic Product for Dogs

Posted on December 9, 2013 by skeptvet

I have written frequently about probiotics,(1,2) and the health effects of microorganisms seems a promising area of research. The current evidence for meaningful beneficial effects, however, is quite limited. There is reasonable evidence for some benefit in treating antibiotic-associated diarrhea or acute diarrhea of unknown cause(3). The evidence is not very good for many other claimed benefits, such as strengthening of immune system function, treatment of kidney disease(4,5), management of feline upper respiratory viral infections(6), and so on. And there are serious problems with irresponsible, excessive hype(7) and poor quality control(8) for probiotics.

One product I have written about, and used in my own patients, is Prostora from the Iams company. This product is attractive in several ways. It has good quality control and some supportive clinical trial evidence. However, I recently ran across an evaluation of the product produced in 2012 by the European Food Safety Authority (EFSA), which rejected the company’s application for approval to market Prostora in the European Union.

In terms of the efficacy of the product, the EFSA concluded that it could not reach a definitive judgment. According to the report, eight research studies were submitted in support of efficacy. Five of these were rejected for inadequate methodology (lack of a control group, for example). The three evaluated (including one I have reviewed here) did show some evidence of a beneficial effect. However, the effects were inconsistent and not always strong enough to be meaningful even if statistically significant.

More interesting to me was the concern raised in the report about the issue of antibiotic resistance. Apparently, the organism in Prostora has shown some resistance to the antibiotic clindamycin. A number of genes that confer antibiotic resistance have been identified, and some of these can be transmitted from one bacterium to another. The specific source of the resistance to clindamycin seen in the Prostora bacterium is not known, so it is not clear if this resistance could be transmitted to other bacteria in animals or people exposed to Prostora.

Because of this uncertainty, and the serious and growing problem of antibiotic resistance in infectious organisms, the EFSA chose not to approve the sale of Prostora in the EU. It has been approved here in the U.S. under the much less strict laws governing dietary supplements.

The EFSA in general has taken a conservative stance on probiotics, which some argue is appropriate based on the currently available evidence, and which others, notably probiotic manufacturers, have claimed ignores relevant science. There is some scientific evidence indicating that antibiotic resistance can be exacerbated by the use of probiotic organisms with such resistance, though the extent of the risk is not well-documented.

As I have often said about probiotics, because they clearly have the ability to affect the health of people and animals, they undoubtedly have risks as well as benefits. The devil is in the details, and they should neither be rejected out of hand nor embraced unquestioningly as beneficial. The specific risks and benefits of particular organisms for particular health conditions in particular species have to be understood through the careful and laborious process of scientific research. There is nothing intrinsically “alternative” about the use of microorganisms to affect health, but the indiscriminate use of them in the absence of appropriate scientific evaluation would be a mistake in the tradition of the worst kind of alternative medicine.

Posted in Herbs and Supplements | 20 Comments

Evidence Update-Review of Risks and Benefits of Raw Meat Diets for Dogs and Cats

Posted on December 8, 2013 by skeptvet

A nice new review of the evidence concerning raw meat-based diets appears in the most recent issue of the Journal of the American Veterinary Medical Association.

Freeman LM, Chandler ML, Hamper BA, Weeth LP. Current knowledge about the risks and benefits of raw meat-based diets for dogs and cats. J Am Vet Med Assoc. 2013 Dec 1;243(11):1549-58.  

The article reviews many of the studies looking at basic issues such as the effects of cooking on digestibility and the risks of nutritional inadequacy and infectious organisms in raw diets. I have previously written about a number of these studies. The bottom line, which is consistent with my own understanding, is that there are no proven benefits of feeding raw diets, a few small but well-established risks, and little direct research evidence involving comparisons of pets fed different kinds of diets. Here are some of the conclusions of this review:

Proponents of RMBDs claim that they are a safe and natural way to promote animal wellness; these claims are made without long-term supportive evidence and largely ignore the potential life-threatening consequences to pets and their human caregivers when contaminated RMBDs are fed.

Pets often consume RMBDs without developing any health problems, but sometimes even healthy adult dogs and cats can develop adverse effects, ranging from relatively benign effects (eg, increased colonic fermentation and gas production with higher protein intakes) to more overtly life-threatening concerns (eg, higher fat diet fed to an animal with a history of pancreatitis), as a result of consumption of these diets. Additionally, raw meat has an inherent risk of bacterial and parasitic contamination, and animals that consume RMBDs may pose a risk to other pets and people in the household and surrounding community, including veterinarians and veterinary support staff.

If a commercial RMBD is formulated to meet AAFCO nutrient guidelines…there should be minimal risk of nutritional inadequacy. However, few manufacturers of raw diets conduct AAFCO feeding trials or digestibility…Thus, the assumption that these diets are truly complete and balanced for long-term feeding relies heavily on the expertise of the individual formulating the original recipe…

If these diets are manufactured in accordance with current FDA regulations for handling of foods and requirements for microbial testing during food manufacturing and storage, there should be minimal risk of exposure to foodborne pathogens. However, variation in quality-control testing practices or inadequate testing conducted by a manufacturer of a raw food may allow for introduction of pathogens into pet-owning households.

On the basis of published diet reviews, most home-prepared diets (both raw and cooked) are deficient in 1 or more essential fatty acids, vitamins, or minerals or a combination thereof. Although the perceived benefits of home-prepared diets may be reinforced daily to owners through a pet’s appetite or coat quality, nutrient deficiencies and excesses in adult animals are insidious and can lead to long-term complications if not detected and corrected.

Posted in Nutrition | 14 Comments

When Hope becomes Delusion and Compassion becomes Deception: An Alternative Medicine Approach to Testing New Therapies

Posted on December 5, 2013 by skeptvet

One of the most attractive features of alternative therapies is that they offer hope. CAM treatments, by definition, are almost never validated by the usual scientific research evidence used to test mainstream medical therapies. If they were, they would no longer be alternative. And while there is sometimes in vitro or pre-clinical research to support particular CAM treatments, and always mountains of positive anecdote and individual belief, a distinguishing feature of alternative medicine is that practitioners don’t feel controlled, high-level, high-quality clinical research is necessary to claim therapy is successful. Personal experience and faith count for much more, and CAM practitioners frequently see it as inappropriate to ask for better evidence because this might discourage the use of therapies they believe in.

Conventional medicine, more closely tied to science and mindful of the unreliability of anecdotes and trial-and-error in medicine, is more often reluctant to make strong claims for untested treatments or encourage optimism where there is only hope and desire, but little evidence, to suggest it is warranted. This is a less effective marketing position, but it is arguably more honest and less likely to encourage the use of ineffective or harmful treatments.

There is always, of course, a balance to be struck between the urgency of intervening in a health problem and the uncertainty about the effects of one’s intervention. Doing nothing may work a surprising percent of the time, giving the robust innate healing abilities of living beings, but there are times when choosing not to intervene undoubtedly leads to greater suffering or even death.

On the other hand, rushing to use untested treatments has proven time and time again to cause great harm. And since most new ideas in medicine turn out to be wrong when thoroughly investigated, the odds of not helping or hurting a patient when using an inadequately studies treatment are greater than the odds of helping them.

It seems to me that the most rationale and ethical approach is to stick with well-understood and investigated therapies unless the need to intervene is great, such as when there is significant suffering or a high risk of death or disability. And when using therapies not validated by good science, but only believed to work on the basis of weak and unreliable evidence, it is vital that patients (in human medicine) or clients (in veterinary medicine) be given their right to fully informed consent. Our clients must understand the risks and the uncertainty and be willing to freely choose to take a chance on an unproven treatment, knowing they are as or more likely to harm their pet than help them.

This is where I feel alternative practitioners often fail in their ethical duty, even when they are acting out of compassion and an honest desire to help their patients and clients. There is a point where optimism and hopefulness becomes delusion, and where doing everything possible to help becomes irrational and potentially harmful. It is widely believed that false beliefs are harmless, though there is plenty of reason to believe this is a dangerous misconception. And who could argue with hope and optimism even when completely unjustified? Well, if sustaining hope means ignoring the truth and grasping at straws, there is also reason to believe this can do more harm than good (for example).

An illustration of the different perspectives on epistemology (the philosophy of how we find and test what we know) and ethics between science-based and alternative medicine appeared in a recent Huffington post blog by well-known CAM practitioner and activist Dr. Richard Palmquist. In my interactions with Dr. Palmquist, I have found him pleasant, intelligent, well-informed, and sincere in his desire to help his patients. Given our frequent disagreements, it might surprise him the extent to which we agree on many topics outside of veterinary medicine. However, Dr. Palmquist is also deeply committed to a variety of medical practices which range from the promising-but-unproven to complete quackery.

A major difference in our approaches is that he views individual case reports and anecdotes as reliable evidence and comfortably, confidently exposes patients to treatments that have not been systematically tested. He appears to feel he is giving hope and “a chance” where science has nothing to offer. In my view, however, he is exposing patients to unnecessary risk and unintentionally misleading clients into believing the straws they are grasping at are really stout ropes that can pull their pet to safety. Unjustified hope may be comforting, but it is a cheat that denies clients the right to fully informed choice and leads us to make bad decisions.

In his latest blog post, Dr. Palmquist exhibits his characteristic mix of the reasonable and the absurd. He begins by stating, quite correctly, that most new potential medications (like other proposed novel medical therapies) turn out not to work. It is estimated that 95% of new drugs put through the appropriate premarket testing process fail to demonstrate sufficient safety or efficacy to justify approval, and the cost of bringing a drug from initial hypothesis to marketed product may be close to $5 billion. Most good ideas turn out to be wrong, and in medicine finding out which those are is difficult and expensive.

However, even on this point Dr. Palmquist shows his innate optimistic bias. He states, “if there are not enough cases of a disease to make it possible to recoup the expense of approval, many good drugs just languish in the patent office.” But if we haven’t done the clinical trials to get approval, or equivalent studies, we don’t know these are “good drugs.” The approval process is rigorous because failure to test drugs adequately can easily lead to such dramatic disasters as the thalidomide debacle. Given the cases of drugs which survived the approval process turning out to have unexpected dangers or less than expected benefits once brought to market, it is likely that the process is not tough enough.

Of course, there will always be limits to how much uncertainty we can eliminate from medicine, and we must always act on imperfect evidence. And there is no doubt that companies fail to even seek therapies for conditions when they don’t believe they will ultimately make a profit from doing so. But it is not really the case that therapies which work fail to get approved when the potential market is too small but that they either never get invented or are not tested sufficiently to determine if they work.

Dr. Palmquist also makes the usual claim that “The problem is even larger for natural therapies as the profit potential is much smaller.” This is likely untrue simply because so-called “natural” products have already proven to be extremely profitable even when they rarely have good evidence showing they actually work. Billions of dollars are made on likely worthless supplements which are not required to prove safety and efficacy as drugs are. And producers of herbal remedies and supplements have demonstrated they are happy to spend more of their money on marketing and less on research event than the pharmaceutical industry.  This argument is simply an attempt to imply that rigorous testing of these therapies will not be done by commercial firms, which then allows proponents of such remedies to claim that we should feel free to use such therapies without such testing. Neither is correct or in the best interests of patient health.

Next, Dr. Palmquist displays the feature of CAM philosophy I have previously called “panepistemia,”  the notion that scientific and non-scientific sources of evidence are equivalent. “Integrative medicine investigates the use of…forms of healing that have some scientific basis in support of their use.” This is often true, though even the phrase “forms of healing” contains the implication that these are effective. However, he goes on to say, “This type of practice involves doing a lot of research, both of traditional literature as well as reading publications far off the beaten path. Integrative doctors even read anthropology literature as we seek knowledge from indigenous cultures…”

Here, “research” means reading the opinions and experiences of individuals and, in most cases, basing one’s choices predominantly on this form of evidence rather than controlled scientific evidence. This is, of course, often necessary in veterinary medicine when we lack good quality scientific data, but it requires us to have great humility and skepticism about the treatments we offer on such a basis, which CAM practitioners generally do not have. Optimism generally triumphs over skepticism, which sounds like a good thing until you remember all the harm done by inadequately tested medical treatments.

The blog post then talks about the viral disease known as canine distemper, which Dr. Palmquist appropriately characterizes as uncommon, thanks to vaccination, but quite serious. This positive stance on vaccination is uncharacteristic of veterinarians who practice homeopathy, as is repeatedly demonstrated by the anti-vaccine propaganda put out by the Academy of Veterinary Homeopathy. However, this sound information and advice is seamlessly paired with a statement that is unfounded and, in one respect, complete nonsense; “distemper does not need to be a death sentence for a dog. A combination of homeopathic, nutritional, herbal and conventional drugs and support often does the trick.”

There is no evidence beyond unreliable anecdote to suggest herbal therapies have any benefits in treating canine distemper. Homeopathy, as I have discussed in detail many times, is a completely worthless practice that has more in common with faith healing than medicine. What is meant by “nutritional” therapy is unclear. Certainly, nutritional support is essential in any critical illness, but this term is often used as a code for use of supplements which have not been shown to have any benefits. This is “integrative” medicine at its core, suggesting without evidence that whatever untested or even disproven therapies one likes are effective and add value to conventional care.

Dr. Palmquist then comes to the core subject of his post, the “new hope” that may be offered by an experimental anti-viral therapy. PVX (previously known as Panavira) is an experimental drug described in a patent application as a collection of polypeptides (subunits of proteins) derived from snake venom (this apparently counts as “natural origins” from a holistic vet perspective). The patent application posits a wide range of possible medical conditions that could be treated with this product, from viral infections to cancer. It is currently owned by the company Nuovo Biologics.

PVX appears to be undergoing the process of evaluation as an Investigational New Animal Drug, which is intended to lead to FDA approval for clinical use. Though some pilot trial results and case series have been made public, there is little information available on this product. It has not yet been approved for any specific use, and the information upon which FDA evaluation is based is all confidential and proprietary. At this point, it seems a worthwhile substance to investigate, and the company appears to be taking a scientifically appropriate path to establishing safety and efficacy. I am absolutely in favor of such research. Unfortunately, as is so often the case, optimistic tidbits about early, uncontrolled use are easier to find than actual data, and they tend to encourage an unjustifiably optimistic expectation for the ultimate results of this research.

Despite acknowledging that most promising medications never survive to market, Dr. Palmquist seems quite confident in claiming PVX works before the results of clinical trials are available: “veterinarians who are using it have seen many cases where it worked.” What he means, of course, is that veterinarians who have used it have seen patients get better after the drug was given. That is often considered the gold standard of evidence in alternative medicine, with clinical trials seen as a nice extra or even outright unnecessary. Unfortunately, this view ignores the evidence of history, in which innumerable ineffective therapies persisted for many years despite having no measurable effect on health. Clinical trials exist precisely because “I tried it and the patient got better” is an unreliable measure of efficacy. It is such a well-recognized reasoning error, it has its own name, the Post Hoc Ergo Propter Hoc Fallacy.

Palmquist then proceeds to relate an anecdote of a single patient, sent to him when conventional medicine had nothing to offer, who got PVX and a variety of other treatments, both conventional and alternative, and recovered. As wonderful as this story is, it of course proves nothing about any of the treatments employed. Reported mortality rates for distemper cases with neurologic symptoms are about 50%. While this is very high, it still means that at least half of patients survive with supportive care. And given that these figures are quite old, and supportive care is more sophisticated and available than it used to be, it may well be that current figures are better (as is the case with parvoviral enteritis, another important viral disease seen rarely in insufficiently vaccinated puppies). In any case, the fact that the patient appeared to improve following use of the PVX does not demonstrate the PVX was responsible.

This seems especially questionable given that the story continues with a marked worsening of the patient’s symptoms. Rather than considering the treatment might not be working, Dr. Palmquist ,”intervened quickly with additional doses of PVX at twice the normal dosage.” This is a completely reckless way to use an experimental drug, and while the patient fortunately survived, it does not demonstrate PVX works or justify this kind of irresponsible use of an investigational agent.

The anecdote strays even farther from the reasonable compassionate use of an unproven drug with additional claims like these:

Sheena’s seizures were controlled almost immediately with homeopathic medicine (Belladonna Homaccord). Her ravaged body responded to nutritional care that supported her organs and immune system and helped drain the toxins away before they overwhelmed her.

There is, of course, absolutely no reason to believe homeopathy is effective in treating seizures, and using a demonstrated placebo for a serious, life-threatening problem is completely unjustifiable regardless of the delusional belief that homeopathy might work. The vague, mystical concept of “toxins” is a modern day version of “evil humours” that explains nothing, and the idea that nutritional supplements can combat the symptoms of viral distemper by draining away toxins is pure fantasy. Any benefit such supplements might have, for which there is currently zero evidence, will certainly not be through this sort of magical purification.

Even while acknowledging the uncertainty about the effects of a drug still undergoing clinical trials, Dr. Palmquist cites a purported “success rate,” as if such a number could be known at this stage: “Participating veterinarians have treated over 50 cases with an incredible 80 percent success rate.” Once again, this goes beyond hopeful investigation of a promising new drug and amounts to a deceptive portrayal of yet another “wonder drug.”  

If PVX fails to fulfill its promise, as the overwhelming majority of new drugs do, this will simply erode further the public’s confidence in the scientific process. Instead of giving reasonable, evidence-based assessments as the process unfolds, and generating appropriate expectations about the difficulty of rigorous science and the odds of success, the media and practitioners such as Dr. Palmquist stir up hype and expectations that are repeatedly dashed, and people come to believe that it is the scientific process, rather than this hype, which is unreliable. Of course, this suits practitioners of alternative therapies since they generally don’t rely on rigorous science to prove their therapies are effective, and in fact often prefer to ignore it when it finds they are not.

Dr. Palmquist quite explicitly claims a moral high ground for the experimental use of unproven therapies.

It took love enough to ask for more options and persistence to check out things on the Internet, do research in rare literature and dedication to drive Sheena two hours to our clinic. It also took a pioneering spirit to take chances and work with others regardless of the outcome and odds against us.

He characterizes a desperate experimentation with untested remedies and completely disproven treatments as a brave expression of love. This, of course, implies that choosing not to roll the dice with such treatments shows a cowardly character or a deficit of love for one’s animal companions. Faith and hope are, in Dr Palmquist’s view, unquestionable virtues, and doubt and caution vices, or at least weaknesses. I believe this is a perspective deeply connected to a faith-based spiritual world view, and while I respect Dr. Palmquist’s right to his beliefs, in bringing this approach to medicine I think he has fallen into error.

Finding the truth means seeing what is there, not what we wish to see. Helping our pets means accurately understanding the illnesses that afflict them and the risks and benefits of our therapies. Science reaches truth more reliably than hope or instinct or trial-and-error because it compensates for our tendency to substitute our hopes and desires for reality. With a scientific perspective, we may have lost some of the comfort of the placebo (though not all!), but we have gained far more in terms of reducing suffering and improving our health and longevity by understanding the world as it is rather than as it seems to be or as we wish it were. And the kind of hopeful, uncontrolled, “try it and see” approach Dr. Palmquist supports has led us into every useless and damaging therapy in history, from bloodletting to bear bile to laetrile to homeopathy. Sometimes, hope becomes delusion and compassion becomes deception, and when this happens they do more harm than good.

Attempted Pre-emption of Angry Comments Based on Misunderstanding
Since I can already see the hostile comments from people who object to my perspective and do not read my arguments carefully, I will try to be very simple and clear about what I am saying:

  1. I am not making any judgment about whether PVX/Panavira is a useful therapy for any disease. In the absence of any published research evidence, I would only be guessing. While Dr. Palmquist and others are comfortable projecting an optimistic future for the product on the basis of pre-clinical and uncontrolled use, I am not. It may truly be a wonder drug, and I certainly hope it is. If reliable evidence eventually shows this to be the case, I will be first in line to give it to my patients. If not, as is so often the case, I will not be disillusioned or discouraged because I understand the value of the process of separating truth from hope through science.
  2. I am not saying Dr. Palmquist is stupid, unethical, or deliberately misleading anyone. I am saying he is completely wrong about the value of homeopathy, and given the extensive evidence showing this I believe it is not too strong to call faith in the value of this therapy a delusion. I also believe he is strongly biased in favor of believing therapies which meet his somewhat arbitrary definition of “natural” or “holistic” work if he or anyone else has positive personal experiences using them. I believe this way of approaching the evaluation of new therapies consistently leads to false beliefs in the value of ineffective therapies and that the approach of scientific skepticism (withholding judgment until reliable scientific evidence is available) works better to find the truth and serve the interests of our patients.
     
  3. I am not against people hoping for the best or striving hard to help their pets or their patients. I am against people being led by their doctors to believe in the value of therapies based on unreliable evidence (anecdotes and uncontrolled trial-and-error) because again I think this encourages the use of useless and even harmful therapies. While hope is comforting, and we all deserve to be comforted, encouraging unjustified hope denies people the chance to make fully informed choices and to develop a genuine acceptance of the inevitable limitations of our abilities. It is unfair to our animal companions to expose them to risky and untested treatments without extremely good cause, since we are likely only to prolong or increase their suffering. And it is unfair to our clients to tell them, “This may help and can’t hurt” when we don’t have good evidence to know that’s true.

 

 

Posted in General | 7 Comments

“One and Done” Approach to Rabies Vaccination is Misguided and Dangerous

Posted on November 27, 2013 by skeptvet

Recently, I wrote about claims made by a veterinary homeopath that booster vaccination was unnecessary because single, initial vaccination provides lifelong immunity for our pets. There is ample evidence that this is frequently untrue, but today I ran across an article that illustrates quite nicely that this claim is false.

Ippei Watanabe, Kentaro Yamada, Akira Aso, Okio Suda, Takashi Matsumoto, Takaaki Yahiro, Kamruddin Ahmed, and Akira Nishizono. Relationship between Virus Neutralizing Antibody Levels and the Number of Rabies Vaccinations: a Prospective Study of Dogs in Japan. Jpn. J. Infect. Dis., 66, 17-21, 2013

This study involved sampling blood from 756 dogs and evaluating the rabies antibody levels. This antibody level, and the proportion of dogs with enough antibody to be protected from rabies, was then compared to the number of rabies vaccinations the dogs had received, the age and sex of the dog, the time since the last rabies vaccine, and other factors. The results illustrate the need for a rational, evidence-based approach to determining the number and frequency of vaccinations.

The authors found that puppies who had never been vaccinated for rabies almost never had protective antibody levels despite receiving some antibodies through nursing.

we found that only 1 unvaccinated dog exhibited protective VNA levels whereas many unvaccinated dogs exhibited inadequate VNA levels…we set the VNA level of 0.25 IU/ml as the cutoff value…Of the 72 unvaccinated puppies aged 90 days or less, 11 samples (15.3z) exhibited VNA levels of Æ0.25 IU/ml. In contrast, only 1 of the 35 unvaccinated puppies aged over 90 days (2.9z) exhibited VNA levels of Æ0.25 IU/ml.

Of the dogs vaccinated only once, between 33% and 77% exhibited protective antibody levels at various time points during the 13 months after vaccination. Of the five time points sampled, only at one (13 months) did the proportion of protected dogs reach a level above the 70% believed to be necessary to prevent rabies from becoming established in the population at large. When the dogs who are not vaccinated are considered, it is unlikely that 70% of the population will ever be protected if only one rabies vaccine is given to vaccinated dogs.

Of the dogs vaccinated more than once, the proportion protected ranged from 79% to 100%. However, of the 7 time points sampled, the proportion of dogs protected was greater than 97% at all but one (25 months after vaccination). This indicates that giving at least two vaccinations to each dog ensures that nearly all dogs will be protected for at least two years. Since the rabies vaccine has elsewhere been demonstrated to protect the vast majority of dogs for at least three years, this is a reasonable minimum frequency for vaccination. However, better data is needed to determine how often we should be recommending revaccination since there is some evidence adequate population protection may last quite a bit longer than three years.

Interestingly, there did not appear to be any difference in the proportion of the population with protective antibodies between dogs receiving two vaccinations and dogs receiving more than two, so this suggests that two vaccines per dog may be sufficient to provide herd immunity. However, the specific details of how long protection lasts in what percentage of dogs aren’t clearly known, and this information is needed to make reliable decisions about limiting rabies vaccination to two vaccines only.

Because a high antibody titer is indicative of protection from disease for rabies (which is not true for all other diseases), individual dogs could have their titers measured to confirm they are protected and don’t require repeat vaccination. However, a low titer does not necessarily mean the dog is susceptible to the disease, so it isn’t necessarily a good indication of when a vaccine is needed. And, of course, the majority of the long-term health risks attributed to vaccination by vaccine opponents like Dr. Falconer have not actually been shown to be cause by vaccines, so choosing not to vaccinate based on these purported risks is not a rational, evidence-based decision.

This study, of course, does not provide all the answers about how often and when to vaccinate even for rabies, much less all the answers about all vaccines. It illustrates, however, both the kind of information that has to be accumulated to make rational decisions about vaccination and the nonsense of Dr. Falconer’s claims that one vaccine can be assumed to provide lifelong immunity for most dogs. As always, reality is complex and nuanced, with inevitable uncertainty, but we still make better decisions for our dogs if we accept this and try to work with the evidence we have rather than making simplistic and mistaken generalizations about medical procedures like vaccination.

 

 

Posted in Vaccines | 30 Comments

Evidence Update: Resveratrol

Posted on November 27, 2013 by skeptvet

In the first year of this blog, I wrote about a supplement called resveratrol, calling it “a promising but unproven compound.” Last year, I reported on a scandal in which a major researcher of resveratrol retracted over 100 research articles for fraud. At that time, I concluded the product was “still promising but unproven.” Last July, the most recent review of the evidence concerning resveratrol was published in a special issue of the Annals of the New York Academy of Sciences (Vol. 1290). The overall conclusion of this very thorough review seems to support much the same bottom line: there is lots of laboratory research suggesting resveratrol should have all kinds of health benefits, but the actually clinical research showing real-world benefits in humans is still lacking, and virtually no companion animal clinical research appears to exist.

Here are some of the conclusions of various authors contributing to the special issue.

Despite the substantial preclinical evidence, human clinical data are very scarce, and even though the compound is widely distributed as an over-the-counter human nutritional supplement, its therapeutic rationale has not been well characterized.

…the likelihood of benefiting from resveratrol as a result of ordinary dietary intake appears dubious, since a conventional diet at best provides a few milligrams of resveratrol daily.

At the preclinical level, resveratrol has demonstrated reproducible effects in modifying various aspects of metabolic health. This finding is consistent overall with the suggestion that resveratrol acts as a [calorie restriction] mimetic. In terms of cellular experiments, various aspects of resveratrol action have been investigated. Resveratrol seems to be a strong anti-inflammatory compound in cell culture as well as in animal models.

Another prominent effect of resveratrol is the improvement of glucose homeostasis, which has been demonstrated in diverse animal models. Due to the close association between diabetes and obesity, a range of obesity-related measures have also been explored, but only very few studies have been able to demonstrate an antiobesity potential for resveratrol.

Furthermore, resveratrol has demonstrated chemopreventive potential in relation to diverse cancer types, including mammary and colonic cancer. Resveratrol has been shown to provide neuroprotection, and in cardiovascular health, resveratrol has demonstrated cardioprotective potential, partly due to antihypertensive and lipid-lowering properties.

The three most methodologically robust intervention studies were published in December 2011 by Timmers et al., in October 2012 by Yoshino et al., and our own contribution published in December 2012. In the study by Timmers et al….Significant albeit moderate improvements were recorded in various metabolic markers…

In the work by Yoshino et al., 29 nonobese (BMI < 30 mg/m2) postmenopausal women with normal glucose tolerance were randomized…Resveratrol supplementation failed to affect any physiological parameters or putative molecular targets.

This is consistent with the findings in our own human clinical trial: in an investigator-initiated, randomized, double-blinded, placebo-controlled, parallel-group design, 24 male volunteers were randomly assigned treatment for four weeks…Insulin sensitivity was similar in both groups, and endogenous glucose production and the turnover and oxidation rates of glucose remained unchanged. Resveratrol supplementation also had no effect on blood pressure, resting energy expenditure, and oxidation rates of lipid, ectopic, and visceral fat content, or inflammatory and metabolic biomarkers.

In terms of human safety and pharmacokinetic properties, the available data are fairly solid, and both acute exposure to high doses of resveratrol (5 g daily for 28 days)as well as more chronic exposure to lower doses (8 mg daily for one year) have not induced any observable adverse events.

Taken as a whole, this paper—and research on resveratrol in general—serves as an illustrative example of the major challenges associated with translating basic research into human clinical practice. Moreover, there are numerous examples in modern medicine of major discordance between treatment effects obtained in animal and human studies.

In contrast to the first review, written by academic researchers (Aarhus University, Denmark), the authors of this review are employed by “DSM Nutritional Products Ltd., a supplier of resveratrol.”  Not surprisingly, this review of the same evidence is somewhat more positive.

Numerous animal and in vitro studies suggest that resveratrol could improve cardiovascular and metabolic health in humans. In view of this compelling preclinical evidence, several human studies investigating the effects of resveratrol on vascular and metabolic health have been initiated. Collectively, the animal, human epidemiological, and first human intervention studies support a role of resveratrol in vascular and metabolic health.

The study indicates that resveratrol, at doses that can be readily achieved in humans, mimics some aspects of the action of CR and may be a useful micronutrient to help prevent age-related chronic diseases.

Recently, Timmers et al. showed that the metabolic benefits observed in animal obesity models could also be translated into effects in humans…resveratrol significantly reduced systolic blood pressure and improved blood glucose levels as well as insulin…Moreover, a significant decrease in liver fat and inflammatory markers was observed.

However, Yoshino et al. found that 75 mg/day of resveratrol after three months of supplementation did not improve metabolic function in nonobese healthy women with normal glucose tolerance. Moreover Poulsen et al. observed no effect on glucose turnover and insulin sensitivity with a high dose of resveratrol (1 g/day).

Future studies need to further evaluate the effects of different doses of resveratrol and discriminate possible distinct effects in various target populations like the obese, diabetics, children, and the elderly.

…many clinical trials investigating the beneficial effects of resveratrol are ongoing (see: www.clinicaltrial.gov database). As of April 2013, there were 15 studies in the field of metabolic health and four studies in the area of cardiovascular diseases, indicating relatively high interest.

Bottom Line
So the bottom line appears to be similar to my conclusion from four years ago. There is ample reason to think resveratrol might be a beneficial supplement based on in vitro and animal model studies. There is inconsistent evidence as to whether any beneficial effects actually occur in humans taking it as a supplement. And there is no direct evidence that it is beneficial for companion animals. Additional clinical studies are certainly warranted, and hopefully they will coalesce around a finding of real benefits. In the meantime, supplementation is probably not justified for most people or for our pets, however there is no convincing evidence of harm associated with the supplement so any risk from taking it is probably very small.

The pace of careful, thorough scientific investigation is slower than those of us treating patients in the clinical setting might wish, but the long-term benefits of reliable, trustworthy information are worth waiting for.

Posted in Herbs and Supplements | 3 Comments

Please Support S. 1425: The Dietary Supplement Labeling Act of 2013.

Posted on November 20, 2013 by skeptvet

I have written previously about the woefully inadequate regulation of dietary supplements in the U.S. under the Dietary Supplement Health an Education Act (DSHEA). Much has previously been written at the Science-Based Medicine Blog on the subject of the Dietary Supplement and Health Education Act of 1994 (DSHEA) (e.g. 1, 2, 3, 4). Essentially, the supplement industry and sympathetic lawmakers created this law to pretend to regulate herbal remedies and other dietary supplements while effectively stripping the FDA of the ability to control the sale of these products for the prevention or treatment of disease. This was accomplished by classifying all such products as foods and codifying the principle that they must be assumed to be safe unless the government can generate substantial evidence to the contrary. There are some restrictions on the medical claims manufacturers can make on the labels of these remedies, but they are routinely ignored and the resources and will behind enforcement of them are manifestly inadequate.

Proponents of supplements claim they are inherently safe because they are “natural,” but this is patent nonsense. There is ample evidence of the harm such unregulated products can cause. While it is likely some of these products will have real benefits (as has been shown for fish oils and probiotics, for example), there is no reason not to require the same standards of evidence for safety and effectiveness applied to any other medical therapy.

Attempts to require some reasonable evidence of safety and efficacy before marketing supplements as medical therapies have been made, and these have consistently been defeated by the supplement industry and lawmakers influenced by their campaign donations. This year, another bill has been introduced to require just a little bit of oversight to these potentially dangerous products. It doesn’t, in my opinion, go far enough, but it is absolutely a step in the right direction. I urge everyone to call and write your U.S. Senators and urge them to support S. 1425: Dietary Supplement Labeling Act of 2013.

Here are some of the provisions of this law:

 1.      Manufacturers of dietary supplements will be required to list their facilities in a public registry so we can know who is producing supplements and what they are making.

 2.      Within one year of passage, the government will compile a list of supplement ingredients and mixtures that could potentially cause serious adverse effects, interfere with prescription medications, or harm vulnerable groups such as children or pregnant women.

 3.      Within 18 months after passage, the independent, non-artisan, non-profit Institute of Medicine will produce an evidence-based report evaluating the risks of potentially dangerous supplement ingredients or blends.

 4.      Within 2 years of passage, the Institute of Medicine will establish mandatory warning labels for potentially dangerous supplements.

Posted in Herbs and Supplements, Law, Regulation, and Politics | 5 Comments