The University of Tennessee School of Veterinary Medicine is one of the most noticeable academic institutions that appears to have been co-opted for the promotion of pseudoscientific veterinary medicine (along with Louisiana State and the University of Florida). I have written previously about the Integrative Medicine program at UT and the $10,000 grant the college received from the American Holistic Veterinary Medical Foundation (AHVMF) explicitly for promoting (not studying) alternative therapies. Now, the university has presented its Distinguished Alumni award to two self-proclaimed “holistic” veterinarians. And these doctors were not honored despite their promotion of mystical pseudoscience but specifically because of it:

Dr. Marc Smith of Natchez Trace Veterinary Services and Dr. Casey Damron of White Oak Animal Hospital were recently honored with the “2012 Distinguished Alumni” Award at UT College of Veterinary Medicine in Knoxville, TN, for the creation of Pet-Tao Pet Foods and their service in the field of Alternative Veterinary Medicine.

Curious as to what about the creation of a pet food company might have merited such an award, I took a look at the Pet-Tao Foods web site. It is unashamedly dedicated to an approach to veterinary nutrition and health founded in the mystical nonsense of so-called Traditional Chinese Veterinary Medicine (TCVM). 

Our diets are truly “holistic” because each and every ingredient is chosen according to two Eastern theories that define the term “holistic” – Yin/ Yang and The Five element theory. No other pet food company has this unique perspective, experience, or credibility.

The theory [of TCVM] states that all naturally occurring events in the universe have two opposite aspects: male & female, up & down, hot & cold, dark & light. These opposing aspects are interdependent, dynamic and constantly struggling to maintain balance with each other…Food is a powerful determinant in the body’s struggle to maintain health and the balance of Yin and Yang.

In Traditional Chinese Veterinary Medicine, the five element theory explains the intricate relationships between the five naturally occurring elements in the environment: Metal, Water, Wood, Fire and Earth…When using this theory in regard to foods, one can control how organs function in the body.  For example, a geriatric dog with increased liver enzymes should be fed LIVER according to the 5 element theory. Feeding liver promotes liver function and healing while re-establishing balance of the liver with respect to other organs.

In keeping with this fanciful and completely unscientific approach to nutrition, the company does not produce foods for specific nutritional needs or medical conditions as understood in scientific medicine, but for balancing Yin & Yang and the Five Elements. This allows them to recommend a limited set of diets for any medical conditions regardless of the cause or the specific nutritional composition of the diet based entirely on their assessment of the degree of imbalance in these mystical principles identified in a TCVM evaluation (which is itself a complex and completely subjective evaluation of the tongue, the pulse, and other physical and historical factors according to rules based entirely on tradition and trial-and-error). The company’s diets include:

• Harmony (Balanced) – No health problems, IBD.
• Chill (Yin Diet) – Yin deficiency, panting, pacing at night, restlessness, cool seeking, hot environments, over-energetic dogs.
• Zing (Blood Diet) – Blood deficiency, dry flaky skin, cracked dry footpads, anemia.
• Blaze (Qi Diet) – Qi deficiency, tires Easily, warm seeking, chronic diarrhea, cold environments.
• Soothe – Limited ingredient cooling diet.

It is probably unnecessary to point out that there is no scientific evidence to support the practice of selecting food ingredients to balance Yin/Yang or the Five Elements. This is an entirely mythological folk model similar, and likely historically related, to the Greek system of Humoral Medicine that led to the now mostly abandoned practices of bloodletting, purging, and other methods of  “balancing” the vital humours to manage health and disease.

The fact that veterinarians who are thoroughly trained in scientific medicine and who are often, at least in my experience, practicing perfectly competent science-based medicine, are able to believe in such nonsense and use it in their clinical work is a bit of an embarrassment to the profession. However, the fact that a mainstream university research and teaching institution sees the promotion of such mystical anachronisms as worthy of lauding with an award for “excellence” is much worse. This lends a thoroughly undeserved aura of legitimacy to ideas that belong on the rubbish heap of medical history along with the treatment of infection by bloodletting and of epilepsy by application of leeches.

The terminology associated with unconventional therapies has shifted a bit over the last 40 or so years. Initially, such therapies were often described as “alternative.” This fit well with the still widespread philosophical position that new or different ways of looking at health and disease which are not part of the scientific tradition are necessary or valuable. But it wasn’t the most effective marketing for these practices since it suggests substituting these therapies for conventional medicine. The dramatic effectiveness of science-based medicine is hard to ignore, and most people aren’t willing to give it up for the promises of unproven alternatives.

The term “complementary and alternative medicine” (CAM) emerged to suggest a more flexible approach in which unconventional therapies could add benefits along with, not only in place of, conventional medicine. This is still a popular term, but some advocates of CAM therapies dislike the implication it carries that science-based medicine is the mainstay of treatment and CAM simply “complements” it. And it can be quite clumsy to say.

So the latest term that seems to be gaining ground quickly is “integrative medicine.” This suggests a seamless merging of the best of conventional and unconventional medicine. Integrative medicine advocates often present this approach as focused only on the welfare of the patient and willing to use whatever tools are appropriate without any prejudice regarding their origins. What could be wrong with that?

Well, to begin with, there is a hidden and untrue assumption behind this approach; that individual practices from both CAM and scientific medicine are equivalent, equally likely to be useful regardless of the philosophies behind them. The problem with this assumption is that there is, in fact, good reason to believe that therapies based in science and validated by scientific research are far more likely to be safe and effective than therapies based on implausible or pseudoscientific theories and validated by historical use, individual anecdotes, and little to no controlled scientific research.

Among some skeptics, integrative medicine programs in academic medical centers have been labeled quackademic medicine. This is the integration of implausible and unproven alternative therapies into academic medical practice not, as is often claimed, with the intent of investigating whether or not such therapies are safe and effective but with a pre-existing faith in their benefits.  Such integrative medicine programs are founded on a desire to use the platform of an academic institution to give an aura of legitimacy to such practices, and to use the authority of a faculty position to convince veterinary students these are legitimate medical therapies regardless of the evidence for or against them.

There are a number of problems with such programs. As Mark Crislip from the Science-based Medicine blog has put it, “If you mix cow pie with apple pie, it does not make the cow pie taste better; it makes the apple pie worse.” In other words, integrating unproven therapies or outright ineffective nonsense with conventional medicine doesn’t improve patient care or outcomes, it makes them worse. And there is growing evidence of the harm this can cause, both directly and indirectly (e.g. 1, 2).

Such integrative medicine programs are also, alas, quite successful at conveying the impression that the therapies they promote are evidence-based or widely accepted as legitimate in the medical community even when they are not. And they tend to create this impression among doctors and medical students as well as the public, despite the lack of compelling evidence of effectiveness for most of these therapies. They are very successful public relations efforts.

These programs are not, however, very successful at stimulating the research needed to make truly evidence-based judgments about CAM therapies. The clinicians involved in these programs are themselves already convinced their practices are effective, so they tend to produce research at high risk for bias. And when research results are not supportive, they are ignored or rationalized away since the self-reinforcing clinical experiences and anecdotes most doctors rely on do seem to support what they are doing, and this has more psychological impact than less influential, but more reliable, objective research. Rarely do integrative medicine programs discourage even the most obviously useless of CAM therapies, such as homeopathy, but they tend to encourage acceptance of the whole mélange of unrelated and ideologically affiliated practices within the CAM family.

The folks at Science-Based Medicine and the James Randi Educational Foundation have recently published an e-book with a number of essays discussing the problems with the infiltration of unproven or bogus CAM therapies into academic medicine, which I highly recommend: Quackademic Medicine

The marketing and PR campaign under the label of “integrative medicine” have begun to appear in veterinary medicine in the last several years, thanks largely to the recent availability of significant funding from proponents of alternative medical practices. For example, I recently wrote about a grant of $10,000 the American Holistic Veterinary Medical Foundation gave to the veterinary school at the University of Tennessee (UT) to promote alternative veterinary medicine. Based on the fundraising and marketing materials of the AHVMF, this organization certainly seems to share the typical marketing and PR goals of most integrative medicine programs. There is some talk of research, but always with the emphasis of demonstrating to the skeptical mainstream that CAVM practices are safe and effective, which is already taken as a given. And there is much talk of widening the appeal and availability of CAVM therapies, regardless of whether the evidence supports their use.

And based on the blog post written for the AHVMF by the grant recipient at UT, this certainly seems to be the agenda for the leadership of the integrative medicine programs the AHVMF is supporting there. Dr. Donna Raditic, who runs the integrative medicine service, made it clear in a blog post on the AHVMF site that she has no doubts about the effectiveness of CAVM and seeks to make alternative therapies more popular and acceptable not by conducting objective research but by providing “hand-on” exposure and the opportunity for generation of anecdote and personal experiences that are, despite their unreliability, so persuasive for most of us.

The AHVMF has also given a total of $110,000 to the Integrative Medicine program at Louisiana State University’s (LSU) School of Veterinary Medicine. The LSU integrative medicine folks have, of course, been actively promoting the AHVMF fundraising efforts, and they have hosted as speakers a number of prominent advocates of a variety of alternative therapies. The web site for this integrative medicine division, which was apparently made possible initially by a substantial private grant, also talks considerably more about promoting alternative therapies than about researching their safety and efficacy. The grant comes from individuals with a strong interest in promoting alternative therapies, and it has been used, in part, to send staff and students for training at the Chi Institute and the annual convention of the American Holistic Veterinary Medical Association, two of the biggest promoters of unproven and even clearly ineffective and pseudoscientific alternative practices.

Despite the numerous connections between these integrative centers and prominent advocates of unproven and pseudoscientific therapies, and the clear bias evident in the promotional materials which talk not about testing CAVM practices but promoting them, it is possible these centers could be useful if they have a commitment to rigorous scientific research and if they are willing to openly rejecting therapies which fail to prove their value in such research. I would like to think that the academics involved in these centers understand the indispensability of evidence-based medicine and scientific validation of claims for any therapy. However, starting from a position of embracing alternative therapies, talking about promoting rather than investigating them, and exposing students to the pseudoscientific rationalizations of homeopaths and other CAVM extremists from the AHVMA all suggest that these centers are more of a marketing and PR effort on the part of true believers than a genuine academic endeavor to find out the truth about these therapies.

So what sorts of services are these programs offering and promoting? The LSU center advertising a variety of therapies, including so-called Traditional Chinese Veterinary Medicine, which includes acupuncture and herbal therapies. I have written extensively about TCVM and acupuncture before. TCVM is a hodgepodge of pre-scientific and pseudoscientific vitalist myths used to identify not disease as it is understood in science-based medicine but “imbalances” in energies and other metaphorical entities which cannot even be proven to exist, much less to play a vital role in health and illness. These mythic concepts are then used to guide the application of therapies which undoubtedly have real physiological effects but which have not been demonstrated to be safe or effective in maintaining or restoring health. Herbal therapies, for example, are among the most promising CAVM treatments because they contain pharmacologically active chemicals. However very few have been consistently shown to be truly effective for any disorder in any species, and there is ample evidence that they, or contaminates they contain, can be very harmful.

Acupuncture is the most popular form of CAM after chiropractic (though still not as widely used as proponents would make it seem). Despite extensive research over decades, it has not been convincingly shown to be anything more than an elaborate and rather potent placebo. To be clear, that doesn’t mean it heals disease through the power of the mind. It means that it can cause us to believe we are better, and even to feel better, when our disease actually hasn’t changed, and it is no more effective than randomly poking us with needles or even toothpicks.

Such a placebo might have a meaningful benefit in treating subjective symptoms such as nausea or pain in humans, so long as it was not substituted for therapies that actually affect the disease directly. However, there are serious doubts about how effective such a placebo ritual and non-specific irritant might be in animals, particularly since they cannot report how they feel and must rely on us to judge their comfort, and it is clear that we experience a significant placebo effect on their behalf. I have seen patients in obvious and serious pain whose owners felt they were fine thanks to acupuncture treatment.

The LSU integrative service offers a few other therapies, some of which are a bit of a bait-and-switch in that they are frequently claimed as CAM even though they are widely used by conventional veterinarians (such as physical therapy and nutritional therapy). The most egregiously ridiculous kinds of therapies, such as homeopathy, flower essences, energy healing, and so on, are not listed and, I hope, not offered by the LSU integrative medicine service. And the folks at LSU are careful to emphasize that they do not restrict the use of established, science-based therapies. So while the hazards of direct harm to patients from unproven therapies are probably quite small (both acupuncture and herbal products can be dangerous), the bigger problem is that pseudoscientific practices such as TCVM are offered and presented to students and clients as if they were just as reasonable as science-based practices, despite the many reasons they are not.

There is less readily accessible information on the services offered in the integrative medicine department at UT. Dr. Raditic is certified in acupuncture (not, of course, a recognized medical specialty in human or veterinary medicine) and is apparently pursuing a board certification in nutrition (which is a recognized specialty area). As a member of the AHVMA, she is at least to some extent affiliated with proponents of other, less reasonable CAVM practices, but I have no way of knowing what her views are on these or the extent to which she practices, teaches, and promotes them.

The UT Facebook page recently promoted an “educational” event in which the “National Acupuncture Detoxification Association” will be teaching “ear acupuncture” Both the concept of detoxification, through acupuncture or other means, and the various systems of ear acupuncture are pseudoscientific and unproven concepts that certainly shouldn’t be promoted at a veterinary medical college. Dr. Raditic is also reported to offerchiropractic, cold laser, and herbal/dietary supplement therapies. These are all fairly typical CAVM therapies with mixed, but generally poor, evidence concerning their effects. Cold laser and some herbal or supplement therapies are at least plausible and might have benefits in some cases. Chiropractic, however, has little claim to any legitimate veterinary use based of the bogus theory behind it (the “vertebral subluxation complex”) and the lack of reliable evidence of safety or benefit.

Reportedly, the University of Florida College of Veterinary Medicine has also received $10,000 from the AHVMF for its acupuncture program. Some of the faculty members associated with the integrative medicine program at UF are also affiliated with the Chi Institute, the largest organization teaching TCVM and acupuncture in the U.S., and other organizations promoting all aspects of TCVM, not merely acupuncture. Educational materials provided by the UF integrative medicine web site promulgate some of the common myths about veterinary acupuncture (that it is an ancient practice validated by this history, that there are identifiable specific points along “energetic channels” that can be stimulated to achieve specific therapeutic effects, that it has been validated for specific indications, such as pain, by controlled research, etc). This does not suggest an open, evidence-based approach to TCVM but a pre-existing belief that it is effective despite the lack of compelling research evidence to that effect. 

Bottom Line

So the efforts of proponents of integrative veterinary medicine appear directed at the same goal as such programs in human medical centers. They are not so much concerned with finding out if these therapies are safe and effective since they already believe this to be true based on their underlying theories, personal experiences, historical use, and other non-scientific sources of evidence. Instead, they wish to make such therapies comfortable and familiar to students and practitioners of scientific medicine so they will be more readily accepted, regardless of the state of the evidence. And while for now they are avoiding promotion of the most egregious nonsense, such as homeopathy, energy healing, dowsing, they do not appear to be making any effort to distance themselves from such practices or those who do promote them. TCMV and acupuncture share much philosophical and ideological ground with these sorts of practices, in particular a feeling that validation through scientific research is a nice extra with PR value but not essential to judging the value of a therapeutic practice. It is difficult, then, to see how these centers can be anything other than marketing efforts or contribute the kind of rigorous data and unbiased evaluation needed to separate those CAVM therapies that may have real value from the useless nonsense.

Last fall, I wrote about the American Holistic Veterinary Medical Foundation (AHVMF), an offshoot of the American Holistic Veterinary Medical Association (AHVMA), which is devoted to raising money for the promotion of alternative therapies. The AHVMA is a vigorous advocate of unproven and outright bogus therapies, and I have frequently discussed their activities. From the annual “scientific” meeting that includes promotion of ridiculous pseudoscience on the dime of herb and dietary supplement companies to its vigorous defense of homeopathy, the AHVMA has demonstrated a commitment to the standard of no standards when it comes to veterinary therapies. Despite lip service paid to science and free use of the language of evidence-based medicine, the organization is clearly an advocate for any and all therapies under the broad, essentially ideological label of complementary and alternative veterinary medicine (CAVM).

So while the AHVMF also talks about supporting legitimate scientific research, I have some skepticism about such claims. The parent organization, and many of the individuals involved in the AHVMF, have clearly demonstrate that they are unwilling to reject CAVM therapies even when they are inconsistent with established scientific knowledge or the results of scientific research. My suspicion (and I would certainly be pleased to be wrong here), is that the AHVMF is purely a marketing effort, aimed at promoting what its members already believe rather than finding the truth, and an attempt to create the impression of scientific and institutional legitimacy for therapies that have not been able to achieve these on the strength of the evidence for their effectiveness. A recent article on the AHVMF blog appears to support this interpretation.

The Veterinary School at the University of Tennessee recently received a $10,000 grant from the American Holistic Veterinary Medical Foundation to support “integrative medicine.” The faculty member who runs the Integrative Medicine Center at UT has written a blog post for the AHVMF which illustrates very clearly the goals of this effort.

These goals do not appear to be focused on supporting research to identify which CAVM therapies are actually effective. They appear to be more about pursuing a marketing strategy for bringing CAVM therapies into acceptance within the mainstream by making them more familiar, part of the veterinary curriculum, and something that everyone can see works “with their own eyes,” despite the absence of controlled research support or the existence of negative research data. This is pure proselytizing rather than research. For example:

I remember breaking ground for my own hospital, offering alternative veterinary medicine. It was exciting, but there was something missing.  I was alone in my work so I dreamed I could turn my hospital into a center to bring in other alternative veterinarians to do lectures.  I wanted to share this new knowledge…the clients heard me, but no one else

…My voice was not any louder, when I left my practice, to start an Integrative Medicine service at The University of Tennessee College of Veterinary Medicine.  I worked the service knowing the clients would come, but I would smile quietly when I heard, “Why is Integrative Medicine seeing this case” while my neurologic patient was awaiting an MRI.

[When we achieved full faculty status,] I reached out to tell someone that would understand what this appointment meant and my voice was heard by the AHVM Foundation.  Now it is time for all of us to reach out and be heard; the foundation is our voice.  And for clients who have experienced alternative care, a vested veterinarian, we need to encourage them to support our Foundation

.…as full faculty at a veterinary teaching hospital, we have brought the Foundation here. We have students on our service being exposed to integrative veterinary care. We provide that comprehensive care to many of the faculty’s own furry pets; therefore, we are educating the educators.  We are working to gather funds to launch an Integrative Medicine Fellowship, with the university’s mark and the Foundations support. We have Dean approval and are outlining the Fellowship program for maximum impact; we will need funding to make this happen

.…this is our opportunity to bring into the conventional veterinary medicine forum, another black bag: integrative veterinary medicine.  I am overwhelmed with what the Foundation has done to date and the goals we have outlined going forward.

The article also illustrates how holistic medicine is so often promoted–not on the basis of evidence, of which there is usually little to none, but as a kinder and gentler and more hopeful approach than science-based medicine. Regardless of how one feels about acupuncture, chiropractic, Chinese Medicine, etc., I wonder how conventional veterinarians are expected to feel about this characterization of what holistic medicine is and what, presumably, conventional medicine is not:

I now realize is that what makes holistic and veterinarians different is not just our type of treatment, but how we approach our patient. In the integrative health movement we are constantly seeking therapies and approaches that are outside the box of conventional veterinary medicine. And for various reasons we need access to these therapies as many of our patients have failed to respond to standard approaches. They come to us with hope of finding help not available elsewhere.

…we approach with a lot of thoughtfulness, gentle treatment plans, and a lot of caring.  We are vested in our patients.  And once you become a vested, willing to travel a different path to investigate all the options, there is no turning back.

It’s nice to know that when we emotionally detached doctors who are stuck on the whole science thing have given up on our patients, at least they have someone caring to go to who is willing to try almost anything regardless of the absence of anything as pointless as evidence of safety or efficacy.

The infiltration of unproven, or disproven, alternative therapies into legitimate teaching and research hospitals, largely driven by the irresistible allure of funding for research and faculty contingent on a friendly approach to such therapies, has been dubbed “quackademic medicine,” and it represents a real threat to the well-being of patients.

The diversion of scarce resources to research on implausible or already disproven therapies when this research will never discourage advocates from using them regardless of the results impedes real progress in developing better treatments. The perception that such therapies must be legitimate and demonstrably safe and effective (otherwise, why would universities allow teaching and using them in academic hospitals?) creates a false impression of the evidence concerning these therapies and of their value. And despite claims to the contrary, inadequately tested CAVM therapies can directly harm patients. And the integration of unproven methods with science-based medicine can decrease quality of life and survival for patients with serious illnesses.

For all of these reasons, it is unfortunate that the strategy of promoting the integration of unproven or pseudoscientific therapies with legitimate science-based medicine at academic medical centers has reached the veterinary profession. The money this brings to the institutions involved will only harm the profession and our patients if, as seems likely, it is used to promote CAVM rather than conduct legitimate research that will separate the useful from the useless. Such funds would be better spent supporting independent research involving not only dedicated advocates of CAVM but neutral and skeptical researchers with a commitment to rigorous methodological quality and no pre-existing commitment to a particular outcome. Establishing centers to integrate CAVM therapies with conventional medicine when these therapies have not yet demonstrated they are safe and effective is premature and diminishes the integrity of veterinary medicine and is not in the best interests of our clients or our patients.