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Evolution Diet Update: Selling Food with Fraud

Posted on May 11, 2011 by skeptvet

Early on in the writing of this blog, I posted an article and Evolution Diet, yet another “natural diet” promoted through fallacies, half-truths, and outright lies. I pointed out at the time that the CEO of the company selling this diet, Eric Weisman, had dubious, likely fraudulent academic credentials, a wildly irrational philosophy about health and disease, and a pretty paranoid vision of mainstream medicine. That was about as far as my investigative journalism went. However, a reader has brought to my attention a few additional facts about Mr. Weisman that do seem relevant for anyone trying to evaluate the truth of his claims about the diet.

Mr. Weisman was apparently licensed as a chiropractor in the state of Minnesota in 1979. He was then subsequently investigated and reprimanded multiple times between 1982 and 2002, when his license was finally revoked. Here’s a summary of the series of disciplinary actions and a small sample of the actions that led to them.*

a. Respondent was licensed by the Board on October 16, 1979. On January 18, 1982, the Board issued a consent order concerning Respondent in which Respondent was reprimanded and placed on probation for one year, from January 15, 1982 until January14, 1983. The January 18, 1982 Order included a requirement that Respondent cease to use any advertisement, office designation, or patient informational material that contained any statement or representation from which it might reasonably be inferred that Respondent possessed special qualifications in one or more areas of chiropractic practice, including “holistic chiropractor,” “holistic practitioner,” “M.T.” and “workmen’s compensation specialist,” and/or that Respondent had an ability to cure patients or necessarily make them well.

b. On July 1, 1986, the Board issued a second consent order concerning Respondent whereby Respondent was censured and again placed on probation for one year. The July 1, 1986 Order included, but was not limited to, provisions requiring Respondent to provide only necessary services to patients, to post and display a listing of services, goods and procedures with the current fee for each, and to maintain complete, accurate, current, legible, and readily retrievable records on every patient.

c. On June 18, 1987, the Board issued a third consent order concerning Respondent that, in part, reissued provisions of the July 1, 1986 Order and placed Respondent on probation. The terms, conditions and restrictions of the June 18, 1987 Order remained in effect until July 17, 1997.

d. On July 17, 1997, the Board issued a stipulation and order based on Respondent’s unprofessional conduct and numerous violations of chiropractic statutes and rules (“1997 Order”). Respondent’s violations included, but were not limited to, the following:

1. Respondent has practiced beyond the scope of his chiropractor’s license by performing chiropractic on andotherwise treating animals. Respondent has also advertised that he performs chiropractic on animals.

2. Respondent has used numerous advertisements that are unprofessional, misleading, indicate that Respondent guarantees a cure and/or fail to identify Respondent as a chiropractor, including: . . .Numerous advertisements in which Respondent represents that he “guarantees” results or has the “guaranteed fastest, finest treatment available.”

e. The 1997 Order placed Respondent on probation for a minimum of five years….

f. On September 16, 1999, the Board issued a supplemental stipulation and order (“1999 Supplemental Order”), based, in part, on Respondent’s failure to comply with the community service requirement of his 1997 Order… The 1999 Supplemental Order also extended Respondent’s period of probation to three years from the date of the 1999 Supplemental Order and added a requirement that the Board’s approval or disapproval of Respondent’s proposed advertising….

The misconduct that is the subject of this proceeding is particularly egregious.

Respondent falsely held himself out as qualified and authorized to provide an “emergency service” for both humans and animals suffering from life-threatening conditions, claiming that his treatments save “money” or “sometimes a life.” In addition,

Respondent falsely claimed to have “treatment programs” that could “cure” certain forms of heart disease, cancer, diabetes, kidney failure and other conditions. Such advertising preys on vulnerable people and shows that Respondent poses a serious danger to the public.

Respondent has also flagrantly violated the 1997 Order. Despite stipulating to and thus being clearly aware of its terms, Respondent violated five separate provisions of the 1997 Order on multiple occasions. Placing conditions on Respondent’s license was, obviously, not sufficient to prevent his further acts of misconduct.

Taking into account Respondent’s extensive disciplinary history, his failure or inability to rehabilitate himself and his serious misconduct demonstrated by the record in this matter, the Board has concluded that revocation of Respondent’s license is warranted and is necessary to protect the public.

On top of the sanctions from the Board of Chiropractic, Mr. Weisman was also accused of practicing veterinary medicine without a license and sanctioned by the court for this. The stipulation of the finding against him include a number directly related to the Evolution Diet he is still selling on the internet with all the same claims and false credentials, apparently in violation of this court order.

The order specifically forbids Mr. Weisman from making any claims related to preventing or treating disease in animals, including mentioning the “Evolution Diet Plan” by name. He is also forbidden from making any advertising claims that are “untruthful, misleading, or not substantiated by competent and reliable scientific evidence…” It appears Mr. Weisman and his Evolution Diet are yet another example of the failure of government regulation to effectively suppress even the most egregious and dishonest forms of quackery.

While I generally prefer to focus on the evidence and plausibility of particular claims rather than the people behind them, there can be no question in this case that the persistent and proven fraud Mr. Weisman has engaged in are relevant to any judgment about the product he is selling. If ever there were someone from whom one shouldn’t buy water in the desert, much less pet food, it is this man.

*http://www.mn-chiroboard.state.mn.us/Orders/SO%20Weisman%20Eric%20H%2097%2007%2017.pdf

http://www.mn-chiroboard.state.mn.us/Orders/SO%20Weisman%20Eric%20Revocation%20Order%2002%2011%2005.pdf

http://www.mn-chiroboard.state.mn.us/Orders/SO%20Weisman%20Eric%20H%2099%2009%2016.pdf

http://www.vetmed.state.mn.us/portals/22/weisman.pdf

http://www.oah.state.mn.us/aljBase/602015383.FDG.htm

Posted in Nutrition | 11 Comments

Behavior, Expectation, and the Meaning of “Effective”

Posted on May 6, 2011 by skeptvet

This is a guest post from an author who I hope will become a regular contributer. I’ll let her introduce herself:

“Kyzyl is a Ph.D. candidate in biology at a public university on the west coast and a member of the Association of Pet Dog Trainers. She has been involved in dog training since childhood and participates in several dog sports including nose work, agility, rally, obedience, and herding with her border collie.”

Recently, I received a call from a woman who had adopted a pit bull mix puppy several months earlier for help with the dog’s many developing behavior problems which were driving the woman quite batty. The puppy, Ziggy (not her real name), exhibited the typical “cute” puppy behaviors of jumping up and mouthing for attention, which now at 4.5 months old and 35 pounds, had become potentially dangerous for the woman’s elderly mother. In addition, Ziggy had developed a taste for her mother’s lunch, taken right off her plate, and would leave ‘surprises’ in the form of feces and urine in different rooms of the house.

I listened to her concerns with the dog over the phone, reassured her that these were all solvable problems, and talked about management and training plans. When I showed up at her home two days later, the first thing she said to me was, “I think that Ziggy must have overheard our conversation on the phone, because ever since we talked, she hasn’t had any accidents and has been much more cooperative! I’m so relieved!” I explained to her that dogs were incredibly sensitive to our moods and body language, and just the expectation that help was coming was probably enough to make her, and hence the dog, relax and start getting along a bit better.

Now imagine the same scenario, except when scheduling the appointment I had told Ziggy’s owner to give her a certain homeopathic remedy that would start to relieve stress and help cure behavior problems along with management and training. If the same result occurred, what would have the improvement been attributed to: the owner’s expectation of relief and the dog’s response to this change in her demeanor, or the action of the homeopathic ‘cure?’

Not long ago, Ziggy’s behavior would have been attributed to her being ‘dominant’ over her family. Dogs, as dominance theory goes, are nothing more than domesticated wolves in need of a strong leader. Behavior problems were addressed by making the dog submissive to you and every other member of the family, often by forceful means. The basis of many behavior problems were explained this way, and we know now that dominance theory is wrong.

As the result of scientific study, we know that dogs are not wolves and do not construct strict hierarchical relationships between each other or humans (neither do wild wolves, it turns out). Today most behavior problems are explained in terms of learning theory, scientific principles derived from systematic study. A puppy jumps to get attention (not to assert her dominance), and a fearful dog will bark and lunge to keep frightening things away (not as an effort to lead and protect the family). Dogs are now taught alternate, incompatible behaviors to solve problems, and the days of forcing dogs into submission as the result of pseudoscientific dominance theory are, thankfully, coming to an end.

Many trainers and behaviorists have joyfully embraced the modern science of dog behavior and methods of behavior modification based on positive reinforcement because they are more humane, safe, and easier than punitive training techniques often rooted dominance theory. However, some trainers also advocate for decidedly pseudoscientific complementary and alternative medicines as well. Homeopathy and Bach Flower Essences (BFE), a near-homeopathic preparation, are often recommended for difficult to resolve behaviors such as those associated with fear, separation anxiety, and aggression (Hanson 2006, Wilde 2006). While these trainers will swear by how effective these treatments are for some of their clients, the treatments find little support in the scientific community. How can trainers decide what is the best mode of treatment to recommend for difficult behavior problems?

In reality, behaviors are the result of complicated and dynamic brains interacting with complicated, dynamic surroundings. Great care must be taken to understand and minimize as many confounding factors and biases as possible to systematically study the treatments for behavioral problems. Having expectations about a treatment outcome allows you to fool yourself into believing that a treatment is effective far easier, whether you are the owner of a dog with behavior problems or a researcher studying those effects. For the trainer or researcher, expectations based on seeing improvement first-hand or event timing may allow you to convince yourself that patterns between events exist when in reality they do not. For the owner, the impact of expectation of treatment benefits is part of the placebo effect; a phenomenon where treatment with sugar pills, which have no active ingredient, create improvement in a dog’s symptoms. Dog owners are often desperate to help their distressed animals or find relief from behaviors that cause them distress, and this desperation can lead to unconsciously inflating positive outcomes. Fooling yourself is extremely easy when studying complicated systems, especially when both parties have vested interests in the outcome.

There are two methods in well-designed clinical trials that control for the effects of bias and the placebo effect: placebo-controlled and double-blinding. Placebo controls consist of using a “sham” treatment with no active ingredient, such as sugar pills or water, in addition to a “real” treatment with the active ingredient being tested. When neither the doctors nor the patients know who is on which treatment, it is double-blind. Any difference between the control and treatment groups is likely due to the active ingredient in the treatment being tested, or the treatment is said to have a “specific effect” beyond what is seen with placebo treatment. This is the definition of effective from the viewpoint of a science: a treatment that has specific, measurable effects beyond that of a placebo.

These are the same standards by which most science-based medical treatments are judged for efficacy, and ideally the standards should also apply to treatments recommended by trainers and behaviorists for behavior problems in pets. Evidence for complementary and alternative modalities is often either non-existent or not promising (Overall 2008), and the use of homeopathy and BFE for a variety of behavior problems are not exceptions. The few double-blind, placebo-controlled trials which have been conducted using homeopathy to treat fear showed no difference between homeopathic preparations and placebo (Cracknell and Mills 2008), even when their owners knew their dogs were receiving the placebo (Cracknell and Mills 2011). More well-designed trials on homeopathy use for treating fear, anxiety, and stress in people have had similarly negative results (Walach et al. 2001, Halberstein et al. 2007). Additionally, systematic reviews of many trials using homeopathy and BFE for treating behavior problems have found no meaningful effects of these treatments beyond placebo (Thaler et al. 2009).

Why is there inconsistency in recommending science-based behavior modification and unsupported complementary and alternative remedies? According to many professionals, these treatments are effective because dogs and owners benefit from a decrease in the unwanted behavior. Although improvements, apparent or real, are almost certainly a result of the placebo or other non-specific effects, in many cases they make owners feel like they are doing everything they can for their struggling pets.

While some trainers and behaviorists believe that CAM treatments represent truly effective, superior alternatives to ‘traditional’ medicine, I believe many more doubt their benefits but want to help in any way they believe is safe and might be effective. For them, recommending something with no side effects that could produce improvement (regardless of the mechanism) to an owner who may refuse pharmaceutical intervention and wants treatment beyond behavioral modification is a reasonable decision.

However, the recommendation to use a CAM treatment has consequences. First, knowingly recommending placebos for treating unwanted behavior is a sticky ethical issue. Recommending a treatment that has no specific effects to owners without disclosing these facts is deceptive, even if benefits are ultimately gained through non-specific effects. Deception damages the professionalism of a trainer or behaviorist and certainly leads to a degradation of trust between professional and client.

Second, there are indirect consequences in recommending CAM remedies. Many people treat these remedies as truly alternative and will shun traditional medical and behavioral treatments which are demonstrated to be effective, safe, and reliable. This might be especially problematic for behavioral problems for which behavior modification is a difficult and time-consuming endeavor or is not as effective without pharmaceutical intervention (such as severe separation anxiety and compulsive disorder).

Third, recommending CAM therapies also reinforces the idea that these treatments are part of a legitimate healthcare regiment and will often accept other advice offered regarding healthcare, such as the rejection of vaccines, which have significant impacts on the health and well being of pets. These consequences of suggesting CAM treatments should be seriously considered before recommending them to clients desperate for a cure.

Trainers are often the first line of professionals contacted when their pet’s behavior problems become too much to bear. The stakes are high: many dogs are euthanized in the US for severe behavior problems, and many more are surrendered to shelters with the same ultimate result. Most of these problems can be treated effectively with behavior modification and traditional pharmaceuticals administered by a veterinarian or veterinary behaviorist, and trainers have a responsibility to know about and explain the possible options to distressed owners. We also have a responsibility to advocate treatment plans which have a solid basis in science, treatments that rise to the same definition of effective as treatment for medical conditions.

Cracknell, N.R., and D.S. Mills. 2008. A double-blind placebo-controlled study into the efficacy of a homeopathic remedy for fear of firework noises in the dog (Canis familiaris). Vet. Journal 177, 80–88.

Cracknell, N.R. and D.S. Mills. 2011. An evaluation of owner expectation on apparent treatment effect in a blinded comparison of 2 homeopathic remedies for firework noise sensitivity in dogs. J. Vet. Behavior 6: 21-30.

Halberstein, R., L. DeSantis, A. Sirkin, V. Padron-Fajardo and M. Ojeda-Vaz. 2007. Healing With Bach® Flower Essences: Testing a Complementary Therapy. Comp. Health Practice Review 12: 3.

Hanson, D. 2006. An overview of the Bach Flower Essences. APDT Chronicle of the Dog. March/April issue.

Overall, K.L. and A.E. Dunham. 2009. Homeopathy and the curse of the scientific mind. Vet. Journal 180: 141-148.

Thaler, K., A. Kaminski, A. Chapman, T. Langley, and G. Gartlehner. 2009. Bach Flower Remedies for psychological problems and pain: a systematic review. BMC Complementary and Alternative Medicine 9:16.

Walach, H., C. Rilling, and U. Engelke. 2001. Efficacy of Bach-flower remedies in test anxiety: A double-blind, placebo-controlled, randomized trial with partial crossover. Anxiety Disorders 15: 359-366.

Wilde, N. 2006. “Ch. 43: Flower Power,” Help for Your Fearful Dog: A Step-by-Step Guide to Helping Your Dog Conquer His Fears. Phantom Publishing, 1st ed.

Posted in Guest Posts | 8 Comments

Failing to Make their Case through Science, Veterinary Homeopaths Choose to Sue

Posted on May 1, 2011 by skeptvet

I recently discussed in detail the Academy of Veterinary Homeopathy’s (AVH) annual conference, and it’s apparent focus on demonstrating the scientific legitimacy of homeopathy, and I discussed in detail why this attempt was a failure and homeopathy is not compatible with legitimate science by the standards either of science or those of the AVH. The unscientific attitude of homeopaths, including their self-righteous indignation at any criticism of their reasoning and methods, was subsequently emphasized by an attempt to suppress my criticism with the threat of litigation for copyright infringement. I didn’t realize at the time that this is part of a consistent strategy on the part of the AVH to achieve the appearance at least of scientific legitimacy by any means necessary when scientific arguments alone fail.

Due to a relatively recent shift in the membership and attitude of the Registry of Approved Continuing Education (RACE), the group that establishes standards for the continuing education courses veterinarians need to complete to maintain their licenses, RACE approval has been denied for a number of AVH continuing education courses in the last few years. This is perfectly appropriate as the purpose of continuing education requirements is to encourage that high-quality, scientific quality of veterinary medicine is available to clients and their animals.

However, rather than behaving like scientists and working harder to demonstrate the truth of their claims (which, admittedly, I would expect to be unsuccessful given the mountains of evidence already accumulated against these claims) veterinary homeopaths have chosen to pursue political means to get what they can’t get by making their case through the accepted methods of science. The American Holistic Veterinary Medical Association (AHVMA) encourages members to skirt national accreditation standards for continuing education by forming state organizations that are affiliated with state veterinary medical associations, and thus automatically eligible for continuing education credit regardless of the nature of the content. This is a transparent “end run” around the national standards set by RACE.

And now the AVH has gone a step further, filing a lawsuit against the American Association of Veterinary State Boards (AAVSB), the parent organization of RACE. The only details I have been able to find concerning the lawsuit are from the AVH press release, which obviously is not an impartial source of information. But whatever the details of the suit, using the courts as a way to force a professional standards body to accept as legitimate a pseudoscience like homeopathy is clearly inconsistent with the very philosophy of real science. It is also, unfortunately, a savvy political move.

I have written extensively about the relationship of the courts to medical licensing and standards of practice. The hard reality is that the courts are not always as concerned about the scientific truth concerning a practice like homeopathy as they are about issues such as the prerogatives and limitations of government regulatory bodies, fairness of competition in the “marketplace” of medicine, and other non-scientific issues. While it would seem obvious that the RACE is under no obligation to certify as scientifically legitimate a clearly unscientific practice like homeopathy, in reality the issues of “breach of contract and fraud” cited in the press release may or may not be seen as legitimate, and more important, by the courts.

If this lawsuit succeeds, it will have potentially serious implications for the quality of veterinary medicine. The acceptance of homeopathic continuing education courses as valid for maintaining one’s veterinary license could have a direct impact simply by encouraging the practice of homeopathy, which has never been proven to be an effective therapy for any condition. But this is probably the least significant concern, given that most veterinarians recognize the lack of real evidence to justify using homeopathy, and therefore most don’t use it.

More concerning, however, is the intimidating effect a ruling in favor of the AVH would have on state boards and other organizations which set standards for veterinary medicine. The antitrust lawsuit by chiropractors against the AMA essentially deterred the AMA from officially challenging the legitimacy of any other alternative therapy. A ruling for the AVH could convince AASVB and other organizations that it is not worth it to try and maintain any scientific standards in the face of pressure from veterinarians or clients who believe in unscientific approaches. RACE accreditation for training in psychic animal communication, veterinary astrology, crystal therapy, and so on would be just as reasonable as accreditation for homeopathic education, and just as bad for the quality and reputation of veterinary medicine.

The RACE position against granting legitimacy to the pseudoscience of homeopathy is a refreshing exception to the general lack of rigorous, science-based standards applied to alternative veterinary medical approaches generally by professional and regulatory organizations. If it is undone by the use of litigation, it will be a sad comment on the ability of the veterinary profession to continue to honestly promote itself as a legitimate branch of scientific medicine. And, despite claims by homeopaths, it will be a sad day for our patients and our clients, who will be even more easily sold useless nonsense as if it were legitimate medicine.

Evidence-Based Medicine Works Better

Posted on April 27, 2011 by skeptvet

There are a lot of theoretical arguments in favor of science-based and evidence-based medicine and against the alternatives of opinion-based, tradition-based, or faith-based medicine, and I have discussed many of these (for example, Medical Cognition, Spiraling Empiricism, the Dunning-Kruger Effect, and a host of reasons why clinical judgment is unreliable). However, the bottom line that I always come back to is that evidence-based medicine works! This is evident from the simple and obvious story of medical history, which illustrates the dramatic and unprecedented improvement in the length and quality of human life that science and its application to sanitation, nutrition, and medicine have brought us. But it is also evident in a more quantifiable way in a new study which found that the adoption of consistent, evidence-based standards of care for hospital patients with heart disease resulted in a marked improvement in both short and long-term survival.

The study was conducted in Sweden and involved a national database that covers almost all hospitals in the country. It included records for over 67,000 patients treated over a 12-year period for a particular kind of abnormal heart rhythm associated with a heart attacked. The study demonstrated that specific evidence-based practices, including surgical procedures and the use of new medications, gradually increased over the course of the study. Along with this, in-hospital complications decreased, and survival improved markedly at 30 days, 1 year, and 12 years after the heart attack. Looked at another way, this translates into an average of almost 3 years longer survival for a patient treated at the end of the study, with more evidence-based methods, than at the beginning of the study.

For all the confidence we have in our judgment and experience, and those of our mentors, and all the optimistic promises made for ideas justified by tradition and anecdote, the bottom line is that the slow, laborious, rigorous process of basing our treatments on ever-changing scientific evidence simply works better.

Posted in General | 1 Comment

Is Surgery Really Necessary for Dogs with Ruptured Cruciate Ligaments

Posted on April 25, 2011 by skeptvet

In a recent article concerning an herbal product used for treatment of a dog with a ruptured cranial cruciate ligament (the equivalent of the “ACL” in humans), I stated, “Surgery is the treatment of choice for a ruptured cruciate ligament. Weight loss, physical therapy, and possibly medications are all helpful and important, but without surgery a large dog will have permanent instability in the knee and will develop progressive arthritis.” One of my regular readers challenged this statement and referred to evidence in humans suggesting that surgical therapy was no better than non-surgical therapy in treating this disease. This stimulated me to look into my assumption that surgery was superior to medical management for large dogs and see whether or not the evidence supports this claim.

Following the usual approach I take in evaluating a proposed therapy, I will look at the plausibility of the intervention first. A great deal has been written about the biomechanics of the canine knee and all the factors that may play a role in cruciate ligament ruptures (e.g. 1, 2, 3, 4, 5, 6, 7, 8). The bottom line of all this is that ruptures of the ligament are caused by multiple interacting factors including breed (and hence genetic influences), size, the structure of the canine knee, and activity. The various surgical procedures recommended for this disease are all rational and plausible based on a detailed understanding of the basic biomechanics of the disease.

There have also been many studies looking at the effect of various surgical procedures in animal models of the disease, usually laboratory dogs with ligaments that have been deliberately damaged. While this sort of model does not replicate all the features of naturally occurring disease, it can provide some clue as to whether the surgical therapies are likely to be effective. These sorts of studies, often used as models for arthritis in general, show clearly that severe joint disease and marked dysfunction results over time without surgical treatment of a ruptured cruciate ligament (e.g. 9, 10, 11, 12, 13, 14, 15)

There is extensive clinical research in humans concerning whether surgical repair of cruciate ligament rupture is necessary. I am quite skeptical of the applicability of this research to the same question in dogs since the biomechanics of the canine knee are quite different from those of the human knee. Also, conservative management for humans includes exercise restriction, physical therapy, and often immobilization of the knee with a brace, all of which are challenging and not often used in dogs with ruptured cruciate ligaments. However, the basic anatomy and pathophysiology of arthritis are quite similar, so research in humans may have some value in answering the question for dogs.

The results of clinical trials in humans are mixed. One Cochrane Review examining older surgical techniques found they were generally superior to conservative management. Some studies have found no advantage to surgical management, but these are not large or methodologically robust trials. It appears that both conservative and surgical management can have good outcomes, but the differences depend on the patient population (age, nature of injury, activity level, compliance with treatment, etc) and the specific therapy employed, so not incontrovertible conclusion can be made as to whether surgery or conservative management is superior overall.

There are a many studies looking at the outcome of surgical treatment of cruciate ruptures in dogs. Overall, they find good outcomes in the range of 70-80% or more of patients returning to normal or near normal function (e.g. 16, 17, 18, 19). Comparisons of different methods of surgical repair do not support the clear superiority of one method. However, there are few studies directly comparing surgical and non-surgical treatment in dogs. The best of these, published in 1984, compared outcomes of non-surgical treatment in dogs weighing more or less than 15kg (about 30lbs). For the dogs over 15kg, only 19% were normal (7%) or improved (12%) years after their injury, and all had clear evidence of severe arthritis in the affected knee. For dogs weighing less than 15kg, almost 86% were normal (75%) or improved (11), and while all of these had evidence of moderate arthritis, it did not seem to affect the function of most of these dogs. Other less rigorous studies have the same general findings (20, Paatsama S: Ligament Injuries of the Canine Stifle Joint: A Clinical and Experimental Study. Master’s thesis, Helsinki, 1952)

Conclusion
As is almost always the case, the evidence is not of the highest possible quality or unequivocal, but this does not exempt us from having to draw conclusions and make recommendations to our clients. My interpretation of the available evidence is that overall, cruciate ligament disease causes significant arthritis and loss of function when untreated. For most dogs under 15kg, conservative management (primarily restricted activity for 3-6 weeks, achieving and maintaining and appropriate body weight, and possibly physical therapy and pain medication) can achieve acceptable comfort and function. In larger dogs, significant arthritis is inevitable and dysfunction is extremely likely without surgical treatment. No single surgical technique is clearly superior, so the choice of specific surgery should be determined by the judgment of the individual surgeon and the needs of the owner.

Posted in Science-Based Veterinary Medicine | 226 Comments

Milk Thistle in Dogs and Cats

Posted on April 20, 2011 by skeptvet

Milk thistle is an herbal product that is widely recommended and used by veterinarians. Like glucosamine, it is a supplement which has leapt over the gap between alternative and conventional medicine. Unfortunately, like glucosamine, this acceptance has come about on the basis of pretty weak evidence.

The active ingredient is a cluster of compounds called silymarin. There has been extensive in vitro research on silymarin, and it has a wide range of potentially useful effects. It appears to interfere with pro-inflammatory chemicals, functions as an anti-oxidant, and may interfere with the metabolism of some chemicals into toxic compounds in the liver. It also has some activity which could be potentially harmful, including interfering with the metabolism of a number of drugs and stimulating the effects of hormones like estrogen. As usual, these laboratory findings indicate the possibility of useful clinical effects, but most compounds that have these sorts of potentially useful effects in test tubes don’t work out to be good medicines.

The primary uses of silymarin in humans are to protect against or treat liver damage from toxins and infectious diseases, to improve the condition of diabetics, and to protect the kidneys from toxins. Some of these uses are based on traditional folklore, but as usual there are many traditional uses no longer recommended and for which there is not yet scientific support, including disease of the spleen, uterine disease, malaria treatment, appetite stimulation, stimulation of lactation, and others. In dogs and cats the primary use of for non-specific “support” of the liver regardless of the specific disease.

In humans, clinical trial evidence is mixed. A couple of studies have suggested it reduces insulin resistance in diabetic and may lower blood lipid levels. A Cochrane review of 13 studies including 915 people “could not demonstrate significant effects of milk thistle on mortality or complications of liver disease in patients with alcoholic and/or hepatitis B or C liver disease.” High quality trials were negative, and low quality trials suggested a benefit.

Very little research exists in dogs and cats. A small study of 20 cats given acetaminophen, a known liver toxin, found that those given a single oral dose of silymarin did not show the elevation of liver enzyme levels seen in those not given the compound. A similar study of dogs found some differences in elevations of kidney values between those that got silymarin and those that didn’t following exposure to a kidney toxin, though there was not a completely consistent pattern.

A study done in 1978 showed that dogs given a toxic mushroom compound orally and then given silymarin intravenously did not show the increase in liver values that was seen in control dogs. Another in 1984 found that 30% of the control dogs died whereas none of the dogs given IV silymarin along with the mushroom toxin died, and the livers from the treated dogs did not appear damaged by the toxin.

As far as risks, there appear to be few. Nausea, diarrhea, and other gastrointestinal effects are sometimes seen, and allergic reactions have been reported in humans.

So overall, the in vitro and laboratory animal evidence indicates it is plausible that milk thistle extract might have beneficial effects, though harmful effects in some situations could be expected as well. In humans, the clinical trials show weak evidence for benefit in diabetics and inconsistent but generally negative evidence for benefit in alcoholic or hepatitis-associated liver disease. Very little experimental, and apparently no high quality or controlled clinical research exists in dogs and cats. What there is suggests a benefit is possible. But we must bear in mind that preliminary, low-quality trials of milk thistle in humans looked promising but were not supported by subsequent better quality trials.

A clinical trial comparing animals with naturally occurring liver disease treated identically except for receiving either milk thistle or a placebo would be quite useful. In the meantime, use of the compound is not unreasonable given the suggestive low-level evidence, but it is not much more than a hopeful shot in the dark at this point.

Posted in Herbs and Supplements | 29 Comments

Chamomile Tea for Arthritis in Dogs

Posted on April 19, 2011 by skeptvet

I recently had a case which illustrates alternative therapies commonly present themselves in my daily practice. A patient, an older large breed dog, came in for an annual exam. He was in good general health but moderately overweight, and the only complaint was gradually progressive weakness in his hind legs. This is common in large older dogs and is often due to arthritis in the spine or hind legs. In this case, the patient had been diagnosed with a ruptured cranial cruciate ligament years before. At that time he was unable to use the leg and surgery had been recommended.

Surgery is the treatment of choice for a ruptured cruciate ligament. Weight loss, physical therapy, and possibly medications are all helpful and important, but without surgery a large dog will have permanent instability in the knee and will develop progressive arthritis. The acute pain of a recent ligament rupture will change to the nagging, chronic pain of degenerative joint disease, and the patient will learn to compensate for the disability, but the joint will not be fully functional or comfortable without repair.

There are a variety of surgical procedures available, and the evidence is not definitive as to which is the best, though most work well. Sometimes surgery is not possible because of the cost or other conditions the patient may have, but in this case surgery was not performed because of a misconception generated in part by the use of an alternative herbal remedy.

A veterinarian who practices primarily alternative therapies (mostly TCM and acupuncture but an assortment of others as well) had recommended Sleepytime herbal tea for treatment of the dog’s presumed arthritis. The main ingredient, chamomile flowers, is sometimes recommended for reducing anxiety, soothing an upset stomach or skin ailments, though like most herbal products one can find a recommendation for using it in dozens of unrelated conditions. It is reported to have anti-inflammatory properties and is one of a number of herbal ingredients in some products marketed for arthritis in dogs.

So what’s the evidence for using chamomile for arthritis? None that I can find. The Desktop Guide to Complementary and Alternative Medicine: An Evidence-Based Approach states:

There is little convincing evidence to support the therapeutic effectiveness of chamomile extracts. Encouraging evidence is emerging for a specific combination preparation in patients with functional dyspepsia. Given the risk of allergic reactions and the few rigorous clinical trials that have been conducted, it is not entirely clear whether the potential benefits outweigh the possible risks.

Neither this resource, nor PubMed, nor the Natural Medicine Comprehensive Database list any clinical trials in any species for chamomile as a treatment for arthritis. There are a couple of in vitro studies which suggest it might interfere with some enzymes that are involved in inflammation, but that is a far cry from proof of any clinical benefit in dogs with degenerative joint disease.

Are there any risks? Probably few. I happen to really like Sleepytime tea for the taste, and it has been a popular herbal tea for decades. It certainly is unlikely to be a significant health risk when brewed and drunk in the ordinary way. Severe allergic reactions to chamomile extracts have been reported in humans, but these are not apparently common, and there is no data on whether this is an issue for dogs.

So once again, the remedy itself is probably harmless and probably useless. Then what’s the problem? Well, the owners of this dog believed it helped their pet. The lameness gradually decreased over weeks to months of time, as it would be expected to do without any treatment at all. The owners took this as evidence the therapy was working and that surgery or real medical therapy was not needed. So now the dog has progressive arthritis and decreased use of one of its legs due to a lack of appropriate treatment for a very treatable problem. And this is largely because of the owners misperception and misplaced faith in a useless therapy. Such is often the way seemingly benign interventions like this can do harm.

Posted in Herbs and Supplements | 10 Comments

Veterinary Homeopathic Standards of Practice

Posted on April 19, 2011 by skeptvet

I have been writing a bit about homeopathy lately, which may not seem like the most important CAM method to focus on since it is not widely practice and since the remedies, being only water after all, are themselves usually harmless. However, I have found that wherever there is a pseudoscientific theory of veterinary medicine, and wherever there is vehement opposition to vaccination, commercial pet food, and many science-based medical interventions, there is often a practitioner of homeopathy behind it. Homeopathy is, ideologically, a parallel universe where the rules that govern the physics, chemistry, and biology of our universe do not apply. Though it is sometimes marketed as compatible with a scientific outlook, or even as a legitimate science itself, it is truly an alternative approach to health and deeply, fundamentally incompatible with science.

The homeopathic community themselves know this, though they often try to avoid acknowledging it outside of their ranks. And while I’m sure there are the kind of internal disputes within homeopathy that plague every profession, those voices that present themselves as the mainstream, authoritative guardians of standards for veterinary homeopathy also indicate quite clearly that they do not consider it compatible with scientific medicine, which they view as at best good for crises only and at worst the cause of many of the problems they believe they are treating. Vets or pet owners considering homeopathy should understand that they are dabbling in an approach which views all of mainstream science, and especially scientific medicine, as mistaken and often malign.

The following are excerpts from the Standards of Practice published by the Academy of Veterinary Homeopathy, which certifies veterinarians to practice homeopathy (though as I’ve mentioned before this organization is not recognized by the American Board of Veterinary Specialties, so this certification is only recognized in Homeopathy Land). These are mostly taken directly from the original writings of Samuel Hahnemann, the inventor of homeopathy and a figure often cited and revered even by those “mixers” among homeopaths who incorporate other treatment approaches into their practice.

The most important directive from these sources is that the purpose and goal of homeopathic treatment is the cure of the patient. Cure is not left vague, but is carefully defined by Hahnemann to be the rapid and gentle restoration of health with disappearance of the whole pattern of the signs of illness. Not only is health restored, but it is also permanent, not requiring continued treatment with medication.

Homeopathy by definition intends to cure every patient treated. Of course, the meaning of “cure” is not the standard one of eliminating the underlying cause of a disease since homeopaths often do not believe that what science identifies as a cause is really the source of the problem. Homeopaths would claim that a bacterial infection, for example, is itself only a symptom of a deeper imbalance or defect in the patient’s underlying “vital force,” a mysterious spiritual energy that Hahnemann proposed was the ultimate source of health and “dis-ease.” Since this vital force cannot be detected or measured in any way, treating it is all guesswork based on symptoms, of course, so it is a bit bizarre to claim it is conventional medicine treats symptoms and homeopathy treats the “true cause” of disease.

Though all of the instructions in the Organon of Medicine are a guide to practice, the following guidelines are stated for their value as detailing the method of curative homeopathic treatment:

1. Only the remedy that is homeopathic to the patient is to be used.

2. Drugs and methods of treatment which are not homeopathic to the case are to be avoided because of the possibility of interference with the progress of cure. [the footnote reads,” Organon of Medicine, 6th edition, paragraphs 23, 25-45, 69, and 291. Here discussion of the curative effect of similar medicines and the harmful effects of non-similar medicines is made clear. Drugs, herbs and other forms of treatment prevent cure and cause ultimate harm to the patient. Hahnemann states that only the medicine homeopathic to the patient’s condition is to be used in treatment.”]

3. Use of acupuncture and moxa is not compatible with homeopathic treatment because of its effect on the vital force of the patient.

4. Treatment of symptoms by electrical or electromagnetic application is to be avoided because of its tendency to suppress symptoms in the patient. Use of electricity and effects of magnets are suitable in treatment when administered according to homeopathic indications only.

5. Only one homeopathic medicine is to be given at one time.

6. Medicines are most suitably given by mouth. [This one is especially interesting since the magic “water memory” that supposedly makes homeopathy medicine is often claimed to be transmissible via electromagnetic apparati but apparently loses it’s potency when not given orally]

7. The patient should receive nutritious food which does not, in itself, have medicinal effects.

8. Symptoms on the skin or surface of the body that have expressed as a localized lesion are not to be treated in a vigorous way with the intent to cause their disappearance or by surgery to remove them. These are to be treated primarily by internal homeopathic treatment.

Clearly, many homeopaths do not follow these “classical” guidelines. Giving multiple homeopathic remedies and combining homeopathy with acupuncture, TCM remedies, herbal medications, and even conventional treatments is common. Such “mixers” might argue that their practices are the result of development in the knowledge available to homeopaths since Hahnemann’s time. This misses the point that such development is merely the adding of guesswork and intuitions to Hahnemann’s original guesswork an intuition. All the development in mainstream science, which demonstrates the uselessness of homeopathy, are generally ignored. And given that the justifications given for using homeopathy are primarily based on Hahnemann’s original theories, it is quite inconsistent to pick and choose those dicta you want to follow and those you want to ignore. This is the hallmark of a religious faith, not a scientific healthcare approach.

The AVH recognizes that these rules are often breached and has some rather stern things to say about this.

In spite of the careful elucidation by Dr. Samuel Hahnemann of the essentials of homeopathic practice based on his 50 years of clinical experience, many people have chosen to develop different forms of practice. Most often, the deviations consist of dropping one or more of the methods of practice elicited above.

For example:
1. Giving more than one remedy at a time.
2. Not keeping detailed records of symptoms.
3. Mixing therapies so that the homeopathic remedy is counter-acted by use of non-similar methods of treatment or so that the patient’s response to homeopathic treatment is confused and proper evaluation is not possible.
4. Eradicating or suppressing a localized lesion.
5. Injecting remedies into the body rather than administering by mouth.

These few examples convey the ways in which practices can differ. The difficulty is that those homeopathic physicians who have successfully followed Hahnemann confirm that only careful adherence to the details of his method will result in consistent cure of patients. It therefore becomes a problem when practitioners, on their own, decide that certain parts of practice are not necessary (as outlined above). This leads to confusion among clients (who expect a consistency of treatment) and division among practitioners who cannot agree about an approach to treatment.

A further difficulty is that the Academy of Veterinary Homeopathy will be a representative organization in the sense that if a homeopathic practitioner is challenged, this organization will be asked to evaluate the situation. If a practitioner has not adhered to Hahnemann’s method, then it will be very difficult, if not impossible, to make a favorable evaluation.

For these reasons, it is necessary to establish standards of practice, e.g., state what the essentials of practice are. In establishing the Academy of Veterinary Homeopathy it was decided that the best standard is that given by Hahnemann’s writings, as described above.

So the AVH says very clearly that not following the original guidelines of the founding guru is less effective and that the organization cannot vouch for any practitioner that deviates if they are accused of malpractice. However, the organization does allow for a few exceptions.

1. A patient is taken on for treatment who is already on allopathic medication that cannot be immediately stopped.
2. A case becomes critical yet not responsive to homeopathic treatment.[In other words, if it is so obvious the treatment is not working that this cannot be covered up with nonsense about a “healing crisis” then real therapy may be necessary]
3. There is an acute illness or injury that is an immediate threat to life and the practitioner either does not know how to resolve the situation or does not have the physical facility required.[Again, critical illness requires real medical care. Only conditions that are less serious and for which response is harder to define and measure are appropriate for fake therapy]
4. There is failure of a body function, for example bladder paralysis that cannot be repaired and may necessitate the use of antibiotics to control recurrent infection. [Again, real disease requires real medicine, at least when it is obvious and undeniable]

While it is fairly clear that homeopathy is scientifically unsound theoretically and that the balance of the evidence is heavily against any meaningful clinical effects, it is sometimes easy to take the approach that it is at least benign and “might help” so why not try it. Perhaps this impulse can be opposed by a clearer understanding that “trying” it means, according to the leadership of the veterinary homeopathic community, giving up all mainstream scientific reasoning and practice.

Posted in Homeopathy | 1 Comment

Holistic Dog Breeding

Posted on April 18, 2011 by skeptvet

The vast majority of our companion dogs and cats are neutered, for a variety of good reasons. As a consequence, the healthcare of breeding animals is not a major part of most small animal practices, and it hasn’t been a subject I have covered often here. However, it should be no surprise to learn that there is an abundance of alternative medicine products and services advertised for assisting in breeding companion animals and treating breeding problems. And for the most part these products have no greater foundation in real scientific evidence than any other CAM interventions.

A good example is the NaturalRearing.com web site. This site manages to hit almost every cliché and bogus claim found in alternative medicine and raise every red flag on the list of warning signs of nonsense:

“Natural” and “holistic” are mere synonyms for “good” and “healthy.”

Vaccines and commercial diets are labeled toxic, while raw diets and herbs are automatically assumed to be safe and healthy.

Scientific medicine treats symptoms with technology, “holistic” medicine treats the vital life force of the patient to achieve true wellness.

Any and all alternative methods are good even when they each claim different and incompatible causes and treatments of disease.

There’s a big conspiracy to brainwash us into mindlessly believing in science while the truly brave, independent thinkers are following these mutually incompatible paths laid out by “ancient” traditions or misunderstood geniuses.

Cures and perfect health are implicitly or explicitly promised.

While science and its accomplishments are persistently derided and dismiss, it is still claimed that science validates the claims made by the alternative medicine community.

The site goes even farther than many others. Chlorination and fluoridation of drinking water are identified as unappreciated health hazards, as are fabric softeners, genetic modification of crops, antibiotics, and pretty much anything that would not have been a common technology or practice 200 years ago.

And what is the evidence for all of these warnings and promises? Well, there isn’t any. Apparently, “those who think for themselves” are expected to swallow all these claims based only on the word of the people making them.

The cast of characters at NaturalRearing.com includes some we’ve seen before and others who haven’t yet appeared here. What they share is a deep ideological commitment to the idea that conventional scientific understandings of health and disease are wrong and that completely incompatible alternative explanations are the real truth. The site is owned by Marina Zacharias, who is apparently a homeopath practicing on humans as well as animals. And there is Dr. Deva Khalsa of magic water fame, among other accomplishments. And Catherine O’Driscoll, an anti-vaccine activist and proponents of raw diets and numerous corporate conspiracy theories about animal care. Also Dr. John Fudens, a “holistic” veterinarian who argues that rabies vaccination is a “Big Scam” and who appears to believe that one of the most important causes of cancer is negative emotions.

Besides carcinogens, stresses from viruses and pollutants, there also exists an insidious degenerative process within the person or animal and the family connected to them. This process starts in the mind and emotions. It is an illness that leaves the individual paralyzed in poor self esteem, powerless to control their lives and destiny and feeling they or the body cannot create anymore.

It could involve suppressed emotions like anger, grief from loss of love or respect, guilt from resentment toward a person close, augmented by a loss in ability to communicate and trust. A big factor is the physical loss of a loved one. This despair is the breeding ground for an unhealthy attitude towards life. In such an environment a cancerous process grows strong.

These individuals are not simply promoting traditional or novel therapies. They are ultimately rejecting the entire scientific understanding of biology and medicine that has so greatly improved our lives and health and seeking it to replace it with an incoherent mish-mash of idiosyncratic and mystical theories. It is important to know this when evaluating their advice, since their arguments can seem quite reasonable and even consistent with science on the surface.

What, specifically, does this site recommend in terms of interventions for breeding? A more accurate question would be what doesn’t the site recommend?! Homeopathy is touted as a preventative or outright cure for many problems, despite being a baseless pseudoscience with no reliable evidence it helps fertility or in any other way facilitates breeding and rearing healthy dogs. Herbs of various kinds, usually in complex proprietary mixtures, are recommended for everything from deworming and fertility enhancement to treating panosteitis and other disorders. Traditional Chinese Medicine remedies and arbitrary individual food ingredients along with lots of extra vitamins are also recommended.

The only theme appears to be that food or homeopathic magic water cure everything and one should never give anything that could be considered a scientifically tested and proven medicine, except of course in a real emergency. If a little of something, like a vitamin, is good then more must be better, despite the growing evidence that this is dangerously untrue. And while the owner of the site sells many of the remedies she recommends, we can rest assured that concerns about financial motives only apply to conventional medical practitioners.

This site engages in one of the most frustrating and disingenuos CAM marketing practices. It dismisses science-based medicine as useful only for emergencies (by which is meant cases where a pet is genuinely sick and the success or failure of treatment is easily determined), and then make all sorts of baseless claims for alternatives in promoting “wellness” or “real health” in animals that either aren’t sick in the first place or have chronic, waxing and waning illnesses where it is impossible to legitimately make a clear, direct connection between interventions and changes in symptoms. It’s a classic case of “heads I win, tails you lose.”

I’m sure Ms. Zacharias breeds many healthy, happy dogs. And while she gives the credit for this to the unproven or outright mystical nonsense she promotes and sells, the reality is that these dogs likely do well despite the remedies she applies to them, and would likely do as well or better with conventional care. But of course that is impossible to prove, so she is free to believe and claim what she likes without having to back it up with any real evidence. But I would not recommend taking breeding advice, or any other healthcare advice, from a site that opposes vaccination, antibiotics, and many other proven beneficial therapies and promotes, homeopathy and other pseudoscientific fantasies.

Posted in General, Herbs and Supplements, Homeopathy | 12 Comments

SkeptVet Survey Results

Posted on April 17, 2011 by skeptvet

The results of the SkeptVet Survey are in! In the week the survey has been available, I have collected 28 responses. While this is by no means a scientific poll, I appreciate everyone who took the time to contribute, and I hope to take your responses to heart and improve the site.

The bulk of the comments were positive, which provides a nice antidote to the hate mail I often get, so thank you! Respondents were pretty evenly divided between medical professionals and interested pet owners, and as is generally true for both groups women outnumbered men. There was also a nice range of ages represented.

The bulk of the positive feedback concerned the skeptical tone and scientific, fact-based nature of the content. That is gratifying since that is exactly what I hoped to provide in a digital medium dominated by marketing and credulous opinion.

The negative comments were often about the rather slow rate of new articles being written. As I have pointed out before, and as most respondents clearly understood, I maintain this site in my sparse free time not given to my other professional and personal commitments. But I appreciate that the demand is there, and I will do my best to keep up!

A number of readers also found the detail and length of my posts daunting and excessive. This is a huge weakness of my writing in general! I’m a bit compulsive about being thorough, and as long as many of my posts are, I often feel I have failed to adequately address all the aspects of complex subjects. But I recognize the value of concise, readable summaries with the availability of more detailed information for those who want it, so I will experiment with my posts a bit and see if I can better accommodate both those who want detailed, technical treatment of the subjects I address and those who want shorter, more readable assessment.

I am always keeping an eye out for potential guest writers, and I hope to have more content available from others in the future.

Thanks again for participating, and even though the poll is closed please feel free to offer feedback or suggestions at any time.

1. How would you identify yourself?

Category	Number of Responses	Percentage of Responses
Conventional Veterinary Professional	10	35.7
Alternative Veterinary Professional	1	3.6
Pet Owner	14	46.4
Pet Breeder/Trainer	1	3.6
Interested Bystander	3	10.7

2. How long have you been reading SkeptVet?

First Time	7.1	2
Less than 6 months	39.3	11
6 months to 1 year	28.6	8
More than 1 year	25	7

3. Gender
Female 19 (67.9%)
Male 9 (32.1%)

4. Age

Age	Number of Respondents	Percentage of Respondents
Under 20	0	0
20 to 30 years	6	21.4
30 to 40 years	8	28.6
40 to 50 years	9	32.1
50 to 60 years	3	10.7
Over 60 years	2	7.1

5. What do you like best about SkpetVet?
Real life examples of non-skeptic experiences

Nice to see finally some real EBM when it comes to pets.

Evidence-based analysis of CAM fads and/or veterinary habits lacking real benefit in recommended animal care. The voice of reason you offer – and often, research citations/links I can share so people can evaluate these issues more intelligently.

Your honest, straight-forward approach to disseminating veterinary information as it relates to CAM.

Good science based information. (that can be hard to find, especially regarding animal care) Assists me in making treatment decisions for my geriatric dog and cat.

Well-written, thoughtful articles

Citing Dr. Crislip was a great way to get started. I really appreciate his style of skepticism. More generally, pets are at least as subject to woo as people, and I suspect moreso. At the same time I have found a miserable paucity of information presented in a forum that I have access to and a format that is comprehensive an convincing.

The science

There’re aren’t many resources like it about science-based veterinary medicine. It’s refreshing, and well-written

Its honesty and careful questioning of conventional assumptions about pet care.

Wide range of topics covered

Intelligence and relevance.

the content

Generally well written and material presented as factual is clearly distinguished from opinion. Appropriate cites and links to primary research.

The well researched and thought out articles that directly relate to my practice (most of them).

I love animals, and I love science. It is nice to see them coming together in a great blog! The articles are wonderful and well written!

High quality of writing and plenty of information accessibly presented. It’s one of the few sceptical veterinary blogs therefore very much needed.

Content!

I don’t think there’s anyone else out there looking at the vet literature or applying these skeptic principles to the family pet. I really appreciate having this as a resource rather than trying to wade through the internet cesspool of untested pet advice.

Your medical and science based opinions of alternative treatments for pets.

I like seeing “CAM” debunked on this site, and learning about treatments that work.

Well researched, informative posts.

Your skeptical and scientific approach to vet and general medicine topics. I read many such blogs though.

The information based on facts and not just opinion and preference.

Links to supporting evidence and your overall grasp of evidence based medicine

skeptical approach

You bring to my attention issues and research I do not always come across in my own reading. The information is presented clearly and succinctly and is a great resource for those who have an interest but do not have the time to search out this research on their own. Being new to your blog, i find your categories list very helpful to browse entries on an area of specific interest.

i like your opinions about alternative medicines…. helps me remember that there is rational discussion out there… all i have is irrational discussion at work…

6. What do you like least about SkeptVet?
The entries are very long, which makes it less likely that I read all entries as a whole in between other tasks. Esp for a non-native English speaker.

Hmm. Some of your posts detail-wrangle at great length in a way that’s beyond the attention span or interest of most people to whom I’d otherwise like to forward the fundamental information about animal care. I realize you may be writing in a tone intended to engage challenge other vets and researchers as one would in a scholarly journal, but I think of public blogs as general interest vs. pedantry-for-specialists, and lively, engaging science-writing – particularly re: animals and the gullible humans who love them, about whom few write – as a much-needed public service which needs to be welcoming to all, not just specialists. It’s a delicate balance, since both things you do with your writing here – and both audiences – are valuable. That’s the only criticism I can think of, though: I would like the info you’re sharing here to be as widely accessible as possible.

It won’t make any difference; many doctors and clients are more interested in ‘believing’ than in knowing

A quick glance shows a lot of articles about homeopathy and acupuncture, two topics that I regard as dead issues.