I have written at length about the relationship between unproven, unscientific, and pseudoscientific alternative medicine and the legal and regulatory systems intended to protect the public from quackery (including Medical Licensure, Malpractice Law, and Regulation of Drugs, Supplements, and Homeopathy). In researching these issues, I discovered how little importance scientific validity has as a criterion for establishing and judging the legality of medical practices. Politicians, lawyers, and judges are more concerned with the issues of their own domains, including what the public wants, the tension between the public good and the rights of the individual, the right of individuals to earn a living, and others. These are all legitimate issue, but the debates and legal decisions related to alternative medicine often seem backwards to me. If a therapeutic approach is clearly ineffective or dangerous then it makes no sense to protect it as a “choice” or a “right.” And if the claims a provider makes about their therapies are manifestly untrue by objective scientific standards, then how can they have a “right” to lie to people, even unknowingly? How is prohibiting people from selling false hope and ineffective therapies to the sick or dying an inappropriate government interference with individual rights?

In any case, past attempts of government to regulate medical practices have certainly had some beneficial effects. Though most “healthcare choice” and alternative medicine advocates ignore or don’t recognize it, there is ample evidence (and here) that in the freewheeling days before the Food and Drug Administration and state medical licensure quacks of innumerable varieties sold useless or outright harmful nostrums and procedures that hurt or killed people. Unfortunately, there is also clear evidence that these efforts have been far less successful than we might hope, and quackery continues to thrive.

A case example in the veterinary field is Dr. Gloria Dodd. According to her web site, Dr. Dodd graduated from the University of California at Davis School of Veterinary Medicine in 1960. She is a bit of a celebrity and well-regarded in the alternative veterinary medicine community. She is an author and speaker and is involved in the American Holistic Veterinary Medical Association and other CAVM organizations. Her state veterinary license is current, though she states that she is retired, and she has a consulting business and an internet-based store for selling a variety of healthcare products, Everglo Natural Veterinary Services.

Dr. Dodd is a proponent of truly alternative medicine. Apart from a few emergency measures, such as intravenous fluids, fracture repair, blood transfusions and so on, she universally condemns conventional medical treatments as “toxic” and “traumatic and foreign to the body.”  Her overall philosophy of healthcare is classic vitalism, which views illness in the physical body as a secondary symptom of primary abnormalities in the spirit of “Life Force” of the patient, most of which are due to unnatural human activities. Here is a selection of descriptions of her theoretical approach from her web site.

3000 years of oriental medicine has proven there is a Life Force energy (Chi) that flows like the arborization of a tree throughout the entire body, touching every cell of every organ of every system in the body…Health is maintained by a balance of two opposing energy flows, Yin and Yang, which make up this Life Force. Each cell of each organ of each system has both Yin and Yang energy flows. Any imbalance, either deficiency or excess of these energies produce aberrations that filter down into the physical body and produce what we see as “symptoms”. Any “cure” in the patient as seen by the doctor as a relief of these symptoms, MUST occur in the balancing of this excess or deficiency of these two opposing energy flows.

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

…WE GET SICK FROM ANY AND ALL THINGS THAT WEAKEN THE BODY’S PROTECTIVE ELECTROMAGNETIC FORCE FIELD OR LIFE FORCE. We have to stop thinking of our animals as physical beings alone. All things exist in physical and energy forms…

Why Do Animals Get Sick?

• Inheritance of a genetic code that is flawed and produces a weakened constitution. This may produce impaired organ function, immune response or coping with stress. Yes animals do suffer illnesses due to stress as we do.
• Environmental toxins– chemicals in the food, water and air that is foreign to the metabolism of the body. To this I add the toxic affects of drugs and vaccines.

• Trauma to any part of the body but especially to the head, which deranges the natural flow of Chi or Life Force. This touches every cell in the body depriving it of the needed energy for health.

• Noxious energy fields where we work and live. These are EMF’s of the earth known as Geopathic forces and man-made noxious EMF’s. Geopathic forces are produced where two underground streams of water intersect, giving up a ray of energy. Any animal confined over this point for a period of time will develop painful arthritis, malfunction of the internal organs and impairment of the immune system. I have seen cases of cancer in animals in such areas. In Europe there are documented areas known as “Cancer” houses where people and animals living there, have developed this disease down through the years… Man-made noxious energy fields are more important, because this element is becoming more omnipresent. Every electrified building, system of telephones, computers, radios, television, telecommunication of every nature from cellular telephones to military and commercial satellites in the stratosphere, which circle this planet, are radiating an ever widening destructive force field to our bodies.  
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• Chronic Stress of emotional, physical illness, and toxicity and exposures to noxious energy fields in the environment. Please see my new product Anti-Stress Support Formula 30C
• CHANGE THE ENERGY OF THE ENVIRONMENT BOTH INTERNALLY AND EXTERNALLY.

Despite the best health care that this country has available, many animals and people still suffer from chronic degenerative diseases. There are many reasons for this; i.e., misdiagnosis, failure of the patient to follow through with therapy, adverse affects of combining different drug therapies prescribed by more than one doctor (iatrogenics), the deleterious affects of persistent chemical exposures of environmental pollutants and pesticides, poor nutrition, genetic weaknesses and persistent stress.

However, there is one more factor that has just come to light in the United States and this is the noxious energy radiation fields from the earth…What are geopathic noxious energies? These are noxious earth rays that come where underground water veins cross; locations of earthquake fracture faults, underground voids (caverns or hollows) in the rock structure and certain deposits of coal, oil and minerals.

These are natural disturbances in energy flows, but there are noxious energies that are man-made too. These are microwave, television, electrical transformers, high- energy electrical power lines, and all electrical units; fluorescent lights (which are insidiously weakening to the health), computers, printers, copiers, cellular telephones, your electrical typewriter and radio. Additional noxious energy fields by man are the increasing numbers of satellites launched overhead by both the military and commerce…There is an increased griding[sic] of this planet by telecommunications on land, in the air and within the oceans. Especially damaging are the ELF rays, (extremely low frequency bands) broadcasted by the military and foreign countries.

Many of these ideas are truly alternative in the sense that for them to be true, many fundamental established principles of science must be false. And many of these are fundamentally faith claims because they cannot be proven or disproven by any objective means but must be believed in and understand through personal intuition and experience.

Such untestable beliefs are, of course, common. Most people in the world believe in things science cannot test, examine, or prove true or false. The problem with basing medical therapies on such beliefs, however, is that there is no way beyond the experience and faith of the individual to know if you are right or wrong. And as I have discussed many times, the evidence is overwhelming that individual judgment and experience is unreliable in deciding which medical therapies work and which don’t.

Science functions on the basis of doubt and skepticism, and these have been stunningly successful strategies in compensating for the natural tendency of people to believe what they want and to seek only confirmation of these beliefs. In contrast, trying to prove something wrong is actively discouraged in vitalist philosophies such as that of Dr. Dodd because such “negative” thinking supposedly interferes with the processes involved in maintaining and restoring health.

Such intuitive, faith-based theories were the basis for medicine, such as it was, for most of human history, and these medical approaches were a dismal failure. Human life remained short and uncomfortable for thousands of years, and the scourges of malnutrition and infectious disease raged unchecked. The scientific approach has changed this dramatically in a mere couple of centuries. The evident failure of so many methods based on such beliefs, and the successes of scientific medicine, argue strongly that a scientific, naturalistic approach to medicine works better, regardless of how one feels about the underlying issue of belief in supernatural forces.

Dr. Dodd does stray out of the territory of pure mysticism and into pseudoscience in her theories as well, by claiming to be able to photograph the Life Force and both measure and manipulate it with electronic devices. The specific processes she uses have been soundly disproven, as have most of the more “mainstream” alternative methods she uses.

In the interest of brevity, rather than critiquing all of the specific methods she uses and why they are, in most cases, utterly useless and without merit, I will simply list a number of those she highlights on her web site with a brief description and links to more detailed discussions of each. In general, her therapies involve underlying principles that contradict well-established principles of science, have not been and perhaps cannot be objectively proven or disproven, and have primarily or exclusively testimonial evidence to support them. None of them come close to meeting the prevailing standards of acceptable care in mainstream, science-based medicine which, theoretically at least, state licensing laws and malpractice laws require doctors to adhere to.

1. Kirlian Photography: This is a pseudoscientific practice that advocates claim can take pictures of the “aura” or “Life Force” of a patient and identify abnormalities and response to treatment. Dr. Dodd has several examples of such photos purporting to show abnormalities and improvements with treatment. (1, 2)

2. Dowsing: Dr. Dodd claims “health hazard earth-made energies can only be detected and diverted by a skilled dowser.” Dowsing is a process of locating water, minerals, or apparently “energies” through mystical intuition and some sort of tool, from a simple forked stick to complex devices. Apparently, Dr. Dodd does not even need to come to your house to detect and “divert” noxious energies. You just have to email her a plan of the house and a list of health symptoms and for only $200 she will deal with the problem remotely. (3)

4. Hair Analysis for Heavy Metals: A classic quack medical test designed to provide a rationale for equally bogus “detoxification” treatments. (4, 5)

5. Color Therapy: In this bit of nonsense, the body is believed to have locations (chakras) which are magical energy centers that somehow have associated colors, and thus diseases in particular organs are due to energy imbalances which can be corrected by exposing the patient to that color. (6, 7).

6. Crystal Healing: Yet another form of “energy medicine” in which mystical energies are thought to be manipulated through magic crystals. (8, 9)

7. Oral Oxygen Therapy: This relies on the mistaken belief that disease is caused by inadequate oxygen in the blood (wait, I thought it was caused by unbalanced Chi, or Yin/Yang. Or was it noxious geopathic energy waves? Toxins? How many “most important” causes of disease are there?). Of course all living things need oxygen, but this is pure pseudoscience, mixing bits of basic chemistry, atmospheric science, and biology with magical thinking. In cases where a patient needs more oxygen is needed in their blood (such as carbon monoxide poisoning or anemia), they certainly won’t be helped by drinking hydrogen peroxide or Dr. Dodd’s magical “crystal-charged” spring water. And too much oxygen can be toxic. Fortunately, she also sells anti-oxidants! (10, 11)

7. Homeopathy: The old classic but with one new twist (new to me anyway): “I see a bright future for homeopathy in eugenic treatment, treating animals in utero. Homeopathy lessens genetic tendency toward disease and by strengthening the breeding stock, “super babies” are produced.” (12, 13)

8. Radionics Broadcasting: This bit of quackery speaks for itself (14):

Today our planet’s air, water, food crops and livestock are polluted by Man’s intervention into Nature. It is his alphabet soup of chemicals, vaccines and doctor produced illness by drugs that must be sequentially detoxed with homeopathic nosodes made from these specific causative agents before acupuncture can be of benefit…A wonderful adjunct therapy to my use of German Sequential

Detoxification and Support with German homeopathic Nosodes/ Support homeopathy, is the European method of Radionics Broadcasting. Strange as it may seem, one can take the exact homeopathics that are needed to treat a patient, and make them into the highest potencies of DCM and place them in an electromagnetic machine (a Radionics machine) and broadcast this energy to the patient via the patient’s own witness.

A witness can be a photo, blood spot or hair sample of the patient. This energy is received and utilized by the patient! Many times, the patient improves with this broadcasting alone, even before giving the remedies orally.

This list could go on for a long, long time, with a lot of other truly bizarre nonsense as well as a solid dose of the standard “mainstream” CAVM  like acupuncture and chiropractic. But the big picture should be pretty clear:

A) Most disease is caused by unnatural human activities, with scientific medicine and nutrition being a leading culprit despite the apparent (but I suppose imaginary) improvements these have brought about in human and animal health.

B) All unscientific or pseudoscientific medical theories are true so long as they make some reference to some kind of mystical energy or Life Force and avoid imaging that the cause and solution to disease lies in the bodies of our patients. The fact that the details of chakras, Chi, chiropractic’s innate intelligence, and all the other vitalist theories contradict one another is not a concern.

C) There is no scientific evidence accepted as legitimate outside of the circle of CAM true believers to support any of these therapies. This is also not a problem because Dr. Dodd has actually seen these things work for herself, and she spent 16 years practices the inferiors kind of scientific medicine the rest of us still believe in so she knows it doesn’t work.

Apart from the extremity of her views and practices, Dr. Dodd is not unlike many notable figures in alternative veterinary medicine. She has some background in conventional medicine, which she has rejected as inadequate. She has adopted a wide variety of theoretically incompatible treatment methodologies that are also mostly incompatible with established science. She truly believes, based on her personal experiences, that these therapies work, and she dismisses any objective evidence that contradicts her beliefs. She is also deeply religious and sees faith in the unseen as an indispensible part of understanding how the world works, including understanding health and disease. I have no doubt she is a nice, caring, and sincere person.

The reason I chose to use Dr. Dodd as a case study is because her interactions with the government mechanisms intended to regulate veterinary medicine and, in theory, ensure some standard of legitimate, effective care illustrate especially well the problems with such mechanisms. She makes her living providing healthcare products and treatments that mainstream scientific medicine judges as questionable at best and often outright useless. She deliberately and openly rejects both the mainstream scientific approach to disease, all the evidence for it and against her methods, and any attempt by government to require her to adhere to standards of care the veterinary profession believes are appropriate.

Dr. Dodd was the subject of a California Veterinary Medical Board (VMB) action which was decided by an administrative law judge and ultimately reviewed in superior court. The superior court decision is available on the internet and describes the  VMB allegations and the administrative law judge’s ruling, though it does not detail the evidence presented to support and defend against the allegations. The accusations of the VMB were as follows:

The accusations three cause[s] for discipline were characterized as Sales of Products via Internet, Treatment of Phido,  and Violation of Local Rabies Ordinance. These charged Dodd with false or misleading advertising, violation of federal drug laws, violation of a local rabies ordinance, and fraud, deception, negligence and/or incompetence in the practice of veterinary medicine. (See Bus. & Prof. Code,  4883, subds. (f), (g)(3) & (i).) They also alleged she had dispensed dangerous drugs or devices without a license. (Health & Saf. Code,  11352.1.) Additionally, they stated Dodd had, in treating Phido, violated two state regulations. (See Bus. & Prof. Code,  4883, subd. (o).) The first regulation requires veterinarians to act in a manner consistent with current veterinary medical practice in this state. (Cal. Code Regs., tit. 16,  2032 (regulation section 2032).) The other regulation section 2032.1requires establishment of the veterinarian-client-patient relationship.

According to an account of the original judicial review (written by a supporter of Dr. Dodd who testified as an “expert” witness on radionic therapy), the VMB presented facts about Dr. Dodd’s practices and the relevant laws and regulations, while Dr. Dodd responded with client and colleague testimonials to her skill and efficacy. According to the same source, VMB documents had characterized Dr. Dodd’s practices this way:

Its[sic] a smoke and mirror power of magic type of practice…bizarre…no medically scientific basis for the idea that she can detect disease in a patient who is 3000 miles away…ludicrous that she can broadcast therapy across the same distance…claims defy basic established principles of physics

These certainly seem fair, even self-evident characterizations to me, and it is not surprising that the VMB might have expected the courts to view them in the same light. But unfortunately, as I discussed in my articles on medical law, courts rarely take a scientific perspective on medical matters.

The Dodd supporter and “expert” witness records being optimistic that the administrative law judge would rule in Dr. Dodd’s favor because he appeared to be ethnically Chinese and so “may have been familiar with Chinese medicine and the functions of “chi”, which, in the Chinese system, is a kind of “vital fluid” or “force” operating on a non-mechanical “subtle” level.” I’m not sure if this witness was correct, but according to his report the judge seemed convinced by the testimonial evidence Dr. Dodd presented that her practices were generally appropriate.

In any case, according to the summary from the superior court judgment, the ruling was overwhelmingly in Dr. Dodd’s favor:

In the revised proposed opinion adopted as the Boards decision, the ALJ noted the Board had the burden of proving cause for discipline under the clear and convincing standard of proof. (See Ettinger v. Board of Medical Quality Assurance (1982) 135 Cal.App.3d 853, 856.) With respect to the cause for discipline entitled Violation of Local Rabies Ordinances, the ALJ concluded the Board had not met its burden of proof. Similarly, regarding the cause for discipline relating to Sales of Products via Internet, the ALJ concluded that the Board had failed to show that Dodd had engaged in false or misleading advertising, or that she had committed fraud, deception, negligence and/or incompetence…On the other hand, the ALJ concluded that the Board had shown cause for discipline for violation of a federal drug law (Bus. & Prof. Code,  4883, subd. (g)(3)), in that Dodd herself had acknowledged such a violation in connection with federal regulations requiring licenses for the preparation and production of biological products. The ALJ noted, however, that Dodd was now in compliance with federal requirements.[this refers to an FDA action against Dr. Dodd, discussed below]

As for the cause for discipline concerning Treatment of Phido,  the ALJ concluded the Board had shown a cause for discipline for unprofessional conduct. (Bus. & Prof. Code,  4883, subd. (g).) Again, this was based not so much on the evidence presented by the Board as on Dodds acknowledgment that she was subject to discipline on this ground after dispensing lactated ringers and hypodermic needles to G.E. Otherwise, the ALJ concluded the Board had not proved any false or misleading advertising, any violation of federal drug laws, or any fraud, deception, negligence and/or incompetence in connection with her treatment of Phido.

The judge did find against Dr. Dodd on the issue of not conducting physical examinations of her patients, and revoked her license. However, he immediately suspended the revocation and put her on probation with the understanding that she would actually see and examine patients if she intended to be their primary doctor. He did allow that she might not have to meet this requirement if she were to act only as a “consultant,” which is how she now advertises her services.

On balance, the judge felt that the VMB had not proved its allegations. This may have been the fault of the VMB, which may have assumed as I would have that the conduct at issue was so manifestly irrational and incompatible with accepted medical standards that providing extensive evidence and testimony to this effect would not be necessary. If the characterization of her methods attributed to the VMB above accurately reflects the Board’s attitude, then this may well be the case.

However, there are suggestions that the judge also found in Dr. Dodd’s favor for reasons that have more to do with how lawyers and lay people see the issues of medical regulation than a simple failing of the VMB to adequately argue its case. Again, from the superior court’s summary:

[the administrative law judge] detailed other circumstances mitigating against the license revocation sought by the Board, including evidence that she had changed or ceased the conduct found to be a cause for discipline, the lack of evidence she had ever actually harmed an animal, the lack of any prior disciplinary action in over 45 years of practice, and scores of testimonials from clients and fellow veterinarians attesting to Dodds[sic] integrity and the quality of her care.

The lack of evidence of direct harm is often a point raised in favor of permitting the practice of ineffective or bogus therapies. This argument is mistaken on several bases. First, there often is direct harm from therapies marketed as safe or “natural.” Even something like homeopathy, which is usually nothing more than water, can be harmful when it actually contains some of the original compound, such as the teething remedy for babies containing poisonous belladonna. And far more difficult to quantify is the indirect harm caused by discouraging patients from seeking truly effective therapies or blaming imaginary causes for illness rather than finding and dealing with the real cause.

The issue of testimonials as evidence is, of course, a core issue distinguishing science-based medicine from alternative medicine. As non-scientists, judges are unfortunately rather likely to mistakenly imagine that scientific truth is a popularity contest, and if they are presented with testimony from doctors or patients/clients that a quack therapy has been effective, they may accept this regardless of the state of the actual objective evidence.

Dr. Dodd appealed even the limited probationary terms that required she “obey all federal and state laws and regulations substantially related to the practice of veterinary medicine” because she argued they would prevent her from practicing her profession and deny clients access to her services. The supporting briefs filed on Dodd’s behalf by clients and other veterinarians argued “the Boards[sic] interpretation of regulation section 2032.1, so as to require a physical examination of an animal patient in order to establish a veterinarian-client-patient relationship, is calculated solely to attack [Dodds] form of alternative veterinary medicine without any substantive justification.”

The administrative law judge did not accept this reasoning, but concluded that while “the Boards[sic] interpretation was reasonable as a general rule…it may be possible to comply with the regulation in other ways (for example by remote video, telemetry, other technology, or as a consulting veterinarian).” Claiming status as a consultant has allowed Dodd’s to practice legally without even the minimal requirement that she ever see the patients she treats, so long as another veterinarian who does see the patient agrees to take formal responsibility for the case.

This seems a bit of a sham on the face of it, and it doesn’t of course address the issue of Dr. Dodd’s selling products intended to diagnosis, treat, and cure disease over the internet without any kind of relationship with client or patient at all. That, of course, would fall under the jurisdiction of the FDA rather than the state veterinary medical board. And interestingly enough, Dr. Dodd has had some interactions with the FDA over this very issue.

In 2004, the FDA sent Dr. Dodd a letter informing her that her sale of nosodes, so-called “homeopathic vaccines,” for West Nile Virus was in violation of federal law. The claims made for the safety and efficacy of these products can only be made for approved drugs which have objective research to substantiate claims about their risks and benefits. Essentially, she was selling water and claiming it could protect people and animals against a dangerous infectious disease, and the FDA quite reasonably told her to stop. This was her response:

In response to your letter of Feb. 25, 2003, I called your office to clarify the USDA’s definition of “biologics”. Essentially I learned it is any product that has the claim of immunizing an animal against disease. I sell homeopathic Nosode remedies, which do not contain any biological agents, yet historically they have proven to not only detox drug vaccines noxious effects but confer immunity. We have over 300 years written documentation of homeopathic nosodes being used to immunize livestock (re: Dr. Wilhelm Lux in Germany circa 1700’s) against Anthrax, Black Leg etc. and more recently in Great Britain, homeopathic veterinarians are using homeopathic Detox Vaccinosis nosodes to immunize against the common dog and cat virus/bacterial diseases with much success, and no serious side effects like the drug vaccines cause. However in this country in order to be licensed, I would be unable financially to undergo the rigid and expensive testing to prove their efficacy.

I have instructed my web master to edit my web page, to delete any reference to these remedies being used to immunize animals…I hope this settles the matter satisfactorily for you.

She then provides a link to a page full of myths, misinformation, and propaganda that urges voters to lobby sympathetic legislators for an exemption of nosodes from federal vaccine laws.

Of course, the claims that nosodes contain no biologic materials is true. The claim that they confer immunity is completely false. And while there are risks to vaccination, they are far smaller than Dr. Dodd claims and they must be balanced against the risk of the diseases against which they protect. (See this article for a more detailed discussion of veterinary vaccines). Unfortunately, even this extremely limited effort to apply public health protection laws to rein in Dr. Dodd’s use of ineffective therapies was itself ineffective. Dr. Dodd still sells these products, and her description of them still claims safety and efficacy in an unmistakable way, though in a way that just might comply with the letter of the law:

Detox noxious affects of the drug vaccine given and strengthen the EMF with my newly developed Detox Homeopathy West Nile Virus nosode 30C. The safe, non-toxic and effective way. There is a killed virus vaccine being sold under governmental limited license by Fort Dodge for horses, but like any drug vaccination we have found many horses develop “Vaccinosis “ following vaccination with this drug vaccine. Vaccinosis is a medical term for illness caused by vaccines. We have seen mare abortions, fetal anomalies, very high fever, lethargy and some cases of paralysis and death after the vaccine is administered. I recommend using the homeopathic nosodal form to Detox Vaccinosis and strengthen the EMF to keep your horses healthy and strong.. My Detox Vaccinosis nosode comes in two forms: Homeopathic Detox WNV nosode 30C for dogs, and orses[sic] or combined with Leptospirosis Pomona ( Homeopathic Detox WNV /Lepto Pomona nosode 30C for horses) Lepto Pomona bacteria has been incriminated in producing uveitis and blindness in horses. So I am giving you two very important nosodes for the price of one for horses. Available in 250 tab bottles for $69.95 plus S/H. [emphasis in original]

West Nile Virus Vaccinosis Detox Nosode Formula 30C- to build EMF after detoxing with 12X, 30C, 60C or if animal that has never had the drug vaccines yet, use this in lieu of drug vaccines. FDA #1042 [emphasis added]

As I stated before, I have no doubt Dr. Dodd sincerely believes she is doing good work, and that she is a caring veterinarian. I also believe she is utterly deluded in her approach to medicine, and that her remedies do little to no good and potentially harm her patients by discouraging them from receiving appropriate disease prevention and treatment. I have no doubt that her activities violate any conceivable mainstream, scientific standard of care. So why, then, do the laws and regulations in place ostensibly to enforce such a standard and protect the public against irrational and ineffective medical care fail to interfere in any meaningful way with her practice?

I think the answer is simply that government cannot be an effective arbiter of scientific truth nor an effective force of restraint against nonsense that is sufficiently popular and not sufficiently obvious and direct in the harm it causes. Scientific truth may not be a popularity contest, but of course in a democracy government largely is.

The features of our system which protect our freedom of thought and expression and our right to hold unpopular views also hamstring government efforts to enforce reasonable objective standards on medicine. The tension between individual freedom and the public good tends to be resolved in favor of the individual, and while one can debate whether this is right or wrong, it is a fact of our culture and our government.

Legislators are likely to write laws with more concern for such ideological issues, and the wishes of their constituents, than for what is actually true or false. And judges are likely to be as or more concerned about the right of an individual to practice their profession, or to choose the medical therapy they want, than about whether the therapies involved actually work or not. And not being trained as scientists, judges are often fooled by pseudoscientific arguments and the psychological power of anecdote and testimonial, and they are likely to interpret the laws from this perspective, with the objective scientific facts being a secondary consideration.

Certainly, this is not always true. And there have been cases in which even judges expected to favor a pseudoscientific position due to their personal biases have appreciated and respected the true scientific position, such as in the Dover, PA case concerning the teaching of the pseudoscientific notion of  intelligent design in public schools. However, as a general rule, we cannot expect government to have the resources or the political will to retrain any but the most dangerous and extreme forms of medical nonsense, as Dr. Dodd’s case illustrates.

So while I certainly support educating and lobbying legislators to enact and enforce laws based on sound science, I think the more productive avenue to maintaining a marginal status for ineffective or quack therapies is through education. Pet owners, and the public in general, may not have the knowledge and training to see through the pseudoscientific fog around many of these ideas, but they are not stupid, and they are highly motivated to seek the best care for their pets.

One of the most important reasons scientific medicine has largely replaced traditional folk medicine so rapidly and thoroughly is simply that it works better and people can see this. My grandmother may have only had a limited rural education, but she saw the terror of polio and how effectively vaccination destroyed it, and this and many other examples of the success of scientific medicine gave her a pragmatic skepticism of snake oil that did not require her to care about abstract philosophical principles of epistemology and the scientific method.

Of course, such principles are the cornerstone of why the edifice of science is stronger than that of opinion-based and faith-based medicine, and we certainly should teach them and good critical thinking skills. And it is important that we try to emphasize the unreliability of such empty, though compelling, forms of evidence as personal anecdotes and testimonials. But we also shouldn’t let the perfect be the enemy of the good, and this means we must use all the tools at our disposal. Web sites like What’s the Harm are an important educational tool, and though I am by temperament more inclined towards the more abstract and philosophical forms of public education, I fully support such efforts as well.

And, of course, we must educate veterinarians. As I so often repeat, the biases and blind spots that lead people to mistaken beliefs in medicine are an intrinsic part of how our brains work, and being intelligent and educated in the sciences is not enough to immunize us against them. Veterinarians, like pet owners, are highly motivated to help their patients, and though they want to do so effectively, they may not always realize the limitations of the kinds of evidence that comes from clinical experience. That is why the work of organizations such as the Evidence-Based Veterinary Medicine Association are so important.

When I first became concerned about the proliferation of unproven or ineffective veterinary approaches, I had hopes that government regulation might be an effective way to guard against the infliction of these methods on our patients and clients. Unfortunately, the more I have learned the more I understand that for better or worse the role of government in this effort is necessarily very limited. So while I will continue to advocate for the implementation and enforcement of sound laws and regulations, I will emphasize my personal efforts, as a clinician, a blogger, and a pet owner, to promote science-based veterinary medicine and challenge unfounded claims about veterinary health care.