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Cold Laser Therapy

Posted on May 26, 2010 by skeptvet

A popular therapy among chiropractors who treat pets is low level laser or “cold laser” treatment. It is an impressive bit of showmanship to pull out a complex-looking device and with a serious expression wave a beam of light over a patient, but the evidence to suggest it is anything more than showmanship is weak at best.

An example of the enthusiasm, and irrationality, of some proponents of this treatment can be found at the joint web site of the International Association of Veterinary Chiropractors and American Animal Adjusting Association.

The article on cold laser begins by anticipating and defying criticism:

Invariably a new technique or process is often fraught with counter-intentions that are usually seen throughout the field of study and across the board. The relative benefit of such a process or new technology is directly proportional to the amount of consternation, doubt, and criticism that, it in fact receives….This author has seldom seen a technology as valuable and inspiring, as this particular technology appears to be. Suffice to say you are witnessing the emergence of a completely new age in healing and certainly a total paradigm shift in veterinary health care.

So the existence and strength of opposition to the technique should be seen as evidence of its benefits? Interesting logic. And if I haven’t mentioned it before, the use of the term “paradigm shift,” not to mention “completely new age,” are not only examples of ludicrous hyperbole, they are highly correlated with quackery, if not pathognomonic for it.

The underlying theory presented to explain the benefits of cold laser treatment is a bit of pseudoscience known as the Biophoton or Ultraweak Photon Emission idea. It is possible to detect very low energy photons emitted from living cells as the result of biochemical reactions. The significance, if any, of this for health and disease has never been demonstrated, which makes it a gap in real scientific knowledge into which all kinds of mystical nonsense can be stuffed, much like the pseudoscientific misuse of quantum physics. The veterinary chiropractic site advertising this treatment explains it this way:

It has been proven that cells communicate through coherent light. When a sperm and ovum fertilize, they immediately give off coherent light at precisely 632.8 nanometers.

Cells in the living matrix also communicate throughout the total body living things via a coherent light, and that communication is done instantaneously through the living matrix to direct all aspects of healing, growth, regulation of metabolism, and general cell survival.

To be able to dial into this communication process via an artificial methodology such as a cold laser is the ability to emulate the exact methodology is that the cells themselves use to heal themselves and also to grow, to change, and to survive. It has been said, “it is the way God talks to all cells, tissues, organisms and creatures.”

None of this is based on any sound science. It is merely vitalist, mystical speculation, which does not, of course, limit in any way the certainty and authority with which the fantasy is presented as scientific fact. This is yet another example of how chiropractic is fundamentally a pseudoscience based on imaginary “energy” and fake abnormalities like the “subluxation.” As such, it is open to any similar sounding nonsense, and any benefits it might have in practice are accidental and unrelated to the irrational and bogus underlying principles.

Like most pseudoscientific therapies, cold laser not only addresses the one true underlying cause of disease, it can also be applied in almost any way. Directly over diseased organs, in the general area of a symptom, even on acupuncture points associated with the meridians connected to the problem area. And since the proponents here are chiropractors, we should not be surprised to find that the use of lasers “is particularly effective in rehabilitating the effects of vertebral subluxation complex and their effects on the myofascial tissues affected by these subluxations.”

What else do these folks claim cold laser can do?

These protocols are designed to enhance a particular disease therapy or can be used in a general sense as the sole treatment of choice.

If a practitioner were to master only these protocols and use only these, he would be still far more effective than any of his colleagues to date using methods other than cold laser.

They list a number of general protocols first:

Arthritis/Spondylitis/Myelopathy Protocol
Neuropathy Protocol
Immune Protocol
Lymphatic Drainage Protocol
Pre and Post Surgical Protocol
Liver Detox Protocol
Hormone Balance Protocol
Acute Pain-Injury Protocol
Sympathetic-Parasympathetic (S-PS) Balance Protocol
Acupuncture Meridian Balance Protocol
Infection Protocol
Allergy Protocol (Specific or General)

If one prefers a slightly more specific indication for the treatment, they can also provide protocols for laser treatment of:

Feline-

Abscesses
Chronic Inflammatory Bowel Disease (CIBD)
Feline Hyperthyroidism,
Feline Skin-Spinal Reflex, Feline Neurodermatitis, Endocrine Alopecia, Milliary Eczema
Kidney Disease, FUS, FLUTD
Megacolon
Pyorrhea

Canine-

Canine Hip Dysplasia Syndrome
Canine Idiopathic Epilepsy
Chronic Inflammatory Bowel Disease
Cushing’s Disease
Canine Wobbler’s Disease
Hypothyroid
Progressive Degenerative Myelopathy
Urinary Incontinence

Equine-

Arthritis, (General or Focal) Sore Back etc.
Bleeder (exercise induced naso-pharyngeal hemorrhage) Elevated Blood Pressure
Bronchitis, Bronchopneumonia, Pneumonitis
Bruising, Subcutaneous Hemorrhage, Wound Reorganization
Bursitis
Colic (all kinds), Bloat
Bone Injury, (splint bone and acute boney injuries)
Dermatosis, Urticaria, Hives, Rain Scald
Ear and Guttoral Pouch Disease
Edema, (general, hypostatic, ventral, extremities)
Equine Protozoal Myelitis (EPM)(see also Neurotropic Herpes)
Facial Nerve Paralysis, Lip Paralysis
Fear, Terrors, Miss-emotion, Training Problems
Hepatitis, Hepatosis
Hock Distension
Heart and Heart Related Conditions
Focal or General Inflammation
Lacerations
Lack of Focus in Training
Laryngeal Hemiplegia
Kidney Disease
Malignant Hyperthermia
Navicular Disease and Laminitis
Neurotropic Herpes (West Nile Virus?)
Proud Flesh, Excessive Granulation Tissue
Sepsis, (General or Focal)

So what is the truth behind all of these claims? Despite the nonsense of the underlying theory, is there any evidence cold laser therapy might have real benefits?

The answer for the vast majority of conditions is “No!” For a few conditions, the answer is more appropriately a “Maybe, but probably not much.”

Extensive reviews of the human literature have been done by the Cochrane Collaboration and the insurance companies Aetna and Cigna. These have found mixed but generally poor evidence for benefit as follows. A review of the veterinary literature on the subject can be found in Ramey 2004.

1. Cochrane Review for rheumatoid arthritis: 6 studies with a total of 660 people were examined. There was limited evidence for a small benefit, with an improvement in self-reported pain of 1.1 points on a 10 point scale. The studies were short term and methodologically weak and inconsistent, and the conclusion was, as usual for Cochrane reviews, that no firm conclusion can be drawn and more research is needed.

2. Cochrane Review for osteoarthritis: This examined 6 studies, three of which found no effect and three of which found a benefit. The studies were methodologically weak and inconsistent and more research was recommended. The review has since been withdrawn pending analysis of additional evidence and correction of some statistical errors.

3. Cochrane Review for nonspecific low back pain: 7 studies of 384 people. Three studies (168 people) showed very small improvement in pain compared with fake laser. Three studies (102 people) found no difference. All the studies used different treatment protocols and short-term evaluation, so no firm conclusions could be made.

4. Cochrane Review for tuberculosis: One poor quality study from India was available and did not meet even basic methodological standards, so no conclusion could be drawn.

5. CIGNA Review: References 1-36

A. Musculoskeletal Conditions: A number of studies and reviews in addition to the Cochran Reviews were examined. Generally, they showed no effect from most treatments for most measures but small benefits for a few measures in some trials. Overall, the evidence was weak and of poor quality, and it suggested some small benefit for discomfort and range of motion might be possible.

B. Wound Healing: Several systematic reviews were discussed, none of which showed convincing evidence of benefits for wound healing.

C. Oral Mucositis: Two small studies were reviewed, one of which showed a benefit to laser therapy and the other of which did not.

D. Other Medical Conditions: Reviews of laser use for temperomandibular joint disease and acute and chronic Achilles tendinitis found no clear evidence of benefit.

Summary: Low-level laser therapy (LLLT) has been proposed for a wide variety of uses, including wound healing, tuberculosis, and musculoskeletal conditions such as osteoarthritis, rheumatoid arthritis, fibromyalgia and carpal tunnel syndrome. There is insufficient evidence in the published, peer-reviewed scientific literature to demonstrate that LLLT is effective for these conditions or other medical conditions.

6. Aetna Review: References 37-81 (duplicates with CIGNA deleted)

” Although the results from large, uncontrolled, open trials of low-energy lasers in inducing wound healing have shown benefit, controlled trials have shown little or no benefit. The analgesic effects of low-energy lasers have been most intensely studied in rheumatoid arthritis. Recent well-designed, controlled studies have found no benefit from low energy lasers in relieving pain in rheumatoid arthritis or other musculoskeletal conditions. Furthermore, although positive effects were found in some earlier studies, it was not clear that the pain relief achieved was large enough to have either clinical significance or to replace conventional therapies.”

Published reviews indicate a lack of evidence for effectiveness for the following conditions:
chronic wounds, arthritis, tuberculosis, tinnitus, pain, smoking cessation, epicondylitis, Achilles tendinitis, plantar heel pain, back pain, and carpal tunnel syndrome.

Some evidence of benefit was found for the following conditions:
Raynaud’s phenomenon, pain following endodontic procedures, palpation sensitivity and passive extension in patients with shoulder pain (but not other measures), swelling following dental extraction when used in combination with steroids, tennis elbow pain in combination with plyometric exercise

Most of these studies were small and had methodological weaknesses, an most of their authors conclded that the treatment was promising but more research was needed to conclusively demonstrate a benefit.

7. Ramey 2004: References 82-100

Some studies have found evidence of improved wound healing in diabetic mice, dairy cattle, and laboratory rats. Other studies in rats and rabbits find small but clinically insignificant effects, and several studies have found no evidence of any effect on wounds in rats, guinea pigs, pigs, beagle dogs, and horses. A couple of poor quality studies of tendon and ligament injuries in horses have had conflicting results, one showing benefit and the other not. Other unblinded or uncontrolled studies in horses have suggested benefit for a variety of conditions. “Laser acupuncture” has been examined in uncontrolled and unblinded studies in horses, with the expected claims of benefit. Overall, there is weak evidence to suggest possible benefit in wound healing (though this conflicts with the results of higher quality studies in humans), and many claims made based on studies so poorly designed as to be no different from mere anecdotes. There is no good quality clinical research on which to base firm conclusions, or to support the dramatic claims of laser therapy proponents.

Overall, then, the theoretical foundations for low power laser therapy range from questionable to completely nonsensical pseudoscience. The in vitro research does suggest some real effects on living cells, but it does not indicate that such effects would be achievable or beneficial in actual patients. The human clinical research is extensive but of generally poor quality with no consistency to the laser treatment methods investigated, and it provides only very weak evidence of any clinically meaningful effects. The veterinary research is even more limited and of poor quality, ad it to is mixed with little convincing demonstration of real clinical benefits. All of this suggests an appropriate stance towards this therapy would be neutral to somewhat pessimistic, though certainly better quality research could identify some meaningful clinical benefits. The evidence does not support, and in some cases directly contradicts the claims made by the chiropratic organization website and much of the marketing materials on cold laser therapy veterinarians receive.

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96. Marr CM, Love S, Boyd JS, McKellar Q. Factors affecting the clinical outcome of injuries to the superficial digital flexor tendon in National Hunt and point-to-point racehorses. Vet Rec. 1993 May 8;132(19):476-9.

97. Gomez-Villamandos RJ, et al. He-Ne laser therapy by fibroendoscopy in the mucosa of the equine upper airway. Lasers Surg med 19995;16(2):184-88.

98. McKibbin LS, Paraschak D. Use of laser light to treat certain lesions in standardbreds. Mod Vet Pract. 1984 Mar;65(3):210-3.

99. Martin BB Jr, Klide AM. Treatment of chronic back pain in horses. Stimulation of acupuncture points with a low powered infrared laser. Vet Surg. 1987 Jan-Feb;16(1):106-10.

100. Klide AM, Martin BB Jr. Methods of stimulating acupuncture points for treatment of chronic back pain in horses. J Am Vet Med Assoc. 1989 Nov 15;195(10):1375-9.

Posted in Miscellaneous CAVM | 86 Comments

Evaluating Medical Advice and Credentials on the Internet

Posted on May 24, 2010 by skeptvet

Dr. Susan Wynn, a veterinarian and veterinary nutritionist who promotes “holistic” veterinary medicine, has put up a couple of blog posts recently which I rather liked, so I thought I’d comment briefly on them. I more commonly find myself disagreeing with Dr. Wynn on questions of veterinary CAM, but she does often present a more rational and scientific approach to the subject than most proponents of “integrative” medicine, and I appreciate the few opportunities that arise to find common ground with those who have a different perspective or approach.

The more recent of the two posts consists of advice on how to critically evaluate veterinary medical information on the internet. I have also written about this subject, and I agree wholeheartedly with Dr. Wynn’s comments. The recommendations generally focus on being wary of excessively optimistic or unrealistic claims, sites with a commercial or rigid ideological bias, sites which rely on testimonials in place of properly published and relevant scientific research, and sites which refuse to disclose relevant information, such as the ingredients in the remedies they sell or the qualifications of the people offering advice. All of this is sound advice when looking for medical information on the Internet.

Dr. Wynn also published a post on the subject of evaluating the credentials of those offering veterinary medical advice, How to Avoid Phony Practitioners. For the most part, I agree with her advice on this subject as well, with an important exception I’ll get to in a moment. It is easy to make up impressive-sounding titles and initials, and not much harder to obtain a meaningless advanced degree through fake diploma mills, and this is common practice among those pushing alternative medical therapies. Not too long ago, I wrote about Primal Defense, a probiotic product marketed by Jordan Rubin, a charlatan who routinely tried to give his advice additional gravitas by acquiring fake degrees from unaccredited correspondence schools. If one is going to seek advice on veterinary medicine, it makes sense to give more weight to the advice of someone with years of training in veterinary medicine. Doctors are just as prone to cognitive errors as anyone else, of course, but we have the advantage of getting much of our information from the most reliable source available, scientific research.

My only disagreement with Dr. Wynn’s advice is that it ignores the importance of evaluating not only the quality and rigor of the training a practitioner receives, but also the plausibility and evidence for the subject matter in which they are trained. A credential from a rigorous and well-supervised program teaching astrology or witchcraft is not worth any more than a diploma mill credential since the approach is itself nonsense, and an expert in nonsense isn’t an expert in any meaningful sense of the word.

Dr. Wynn talks particularly about the various levels of credentialing in Naturopathy, but she completely neglects the fact that the discipline itself is a pseudoscientific, faith-based approach to medicine. In principle, naturopathy is a vitalist philosophy that looks to unseen energy forces to explain health and disease. In practice, it is a hodgepodge of sensible nutritional and exercise advice and loads of CAM, varying from the plausible-but-unproven to the completely bogus. The only common theme to methods used by naturopaths seems to be the notion of vital energies of one kind or another, as found in methods such as acupuncture, chiropractic, and homeopathy, which all rely in theory on mystical energies that no one can prove exist. And while naturopaths are theoretically trained to refer patients with serious medical conditions to conventional doctors, many are suspicious of conventional drug and surgical therapies. It is not uncommon for naturopaths to oppose vaccination and to promote not only supposedly “natural” approaches such as herbal medicine but also bizarre, dangerous, and manifestly “unnatural” therapies such as chelation therapy, detoxifying enemas, and so on. If the theory is nonsense and the specific practices unscientific, it doesn’t matter how rigorous the training is.

The same logic applies to Traditional Chinese Medicine, with it’s vitalist theory, idiosyncratic and unscientific diagnostic methods, and inconsistent and mostly unproven therapeutic practices. Chiropractic, likewise, contains a few bits of useful treatment for musculoskeletal pain and a load of nonsense and outright dangerous practices, and of course homeopathy is utterly worthless.

All the training in the world in a philosophy or method which has no value does not protect the patient from harmful or useless treatments. So while I generally agree with Dr. Wynn in terms of checking into the credentials of anyone offering veterinary medical advice, I would go farther and suggest that pet owners should look into the arguments and, most importantly, the scientific evidence concerning the philosophy and methods a particular practitioner offers as well.

Posted in General | 13 Comments

Voodoo Fog

Posted on May 23, 2010 by skeptvet

Went to an art/craft fair this weekend and saw this painted on the side of a station wagon covered with voodoo dolls:

Posted in Humor | Leave a comment

Oh No! A Homeopathic Bomb!

Posted on May 20, 2010 by skeptvet

The deadly New Age terrorists threaten the security of the world with the ultimate Weapon of Mass Dilution: A Homeopathic Bomb. As this terrifying expose tells us, “A homeopathic attack could bring entire cities to a standstill…Large numbers of people could easily become convinced that they have been killed and hospitals would be unable to cope with the massive influx of the ‘walking suggestible’.” What will the fiends think of next?! 🙂

Posted in Homeopathy, Humor | 1 Comment

Guest Post from Alison Averis–The Rise of Equine CAM in the UK

Posted on May 19, 2010 by skeptvet

Alison has offerred another interesting piece that offers insight into the role of CAM therapies in equine medicine “across the pond.” I’m not sure whether to be comforted or saddened by the fact that the retreat from rationality and the new Age of Endarkenment is an international, rather than primarily an American, phenomenon.

THE RISE OF EQUINE CAM
Alison Averis

Thirty years ago, equine CAM wasn’t an issue in the UK. If your horse was ill you called the vet. Twenty years ago, a few people were giving their horses homeopathic remedies, but there wasn’t the huge range of therapies that is on offer today, and the vet was still the first port of call. It wasn’t until the early to mid 1990s that alternative therapies became really popular for horses in this country. In her book For the good of the horse (1997), the riding teacher Mary Wanless was one of the first to introduce the reader to a large range of New Age ideas and alternative treatments: “… many horse owners who have successfully used complementary techniques in their own healing now call on these approaches [for their horses] at the beginning of treatment – they no longer wait for orthodox veterinary medicine to fail”… “both systems [conventional and alternative] are valid and useful when the appropriate choices are made” … “Whilst many vets remain sceptical, the tide of public opinion is increasingly behind complementary practitioners”.

Since the mid-1990s, acupuncture, shiatsu, osteopathy, chiropractic, massage, reiki, homeopathy, Bach flower remedies, aromatherapy, herbalism and many others have become accepted as valid and useful in the care and treatment of horses. The tide of public opinion has become a flood. When a British trainer and well-known advocate for horse welfare wrote “It should be appreciated that such therapies are no longer regarded as ‘alternative’ to what is presently known as orthodox or conventional veterinary (or medical) treatment. Nowadays complementary practices and treatments can be used in conjunction with other therapies to enhance the all-round healing effects for both animal and human.”, she was simply stating the current consensus of opinion. Owners are now considered strange if they don’t use alternative therapies.

These therapies are practised by many veterinary surgeons, uncritically promoted in the mainstream magazines and on website forums, endorsed by successful competitors and cheered on by the power of The Testimonial.

While in the 1990s many vets were still sceptical, in 2010 the majority, at least in my small part of the UK, now offer acupuncture or homeopathy or both as an adjunct to mainstream treatment. Mary Wanless also raised the question that the reluctance of vets to endorse alternative therapies might have had less to do with the intrinsic implausibility of those therapies and more to do with protecting their own area of expertise and their own income. It is impossible to say. It may be that they now embrace some of the alternative therapies for the same supposed mercenary motives. It may be for equine welfare – if owners are going to use these therapies anyway, surely it’s better if the practitioner is someone with enough knowledge and experience to know when an alternative method isn’t enough. It may be that they, too, have been swayed by the power of personal experience – and it is powerful, especially with horses who often respond enthusiastically to any sort of human attention. Whatever the reason – and I suspect that there are more than one – this apparent endorsement of CAM by mainstream vets has made the sceptic’s job more difficult. The believer will retort that her therapy has been validated: “See – even the vets know that it works. They wouldn’t do it if it didn’t work, would they?”

The monthly equine magazines receive a considerable income from advertising and sponsorship by CAM therapists and companies. Most readers seem to be unaware that the editorial and articles in the magazines might be strongly slanted towards supporting those businesses. In one magazine the ‘Ask The Experts’ feature was sponsored at one time by a company manufacturing herbal supplements: herbal remedies were suggested in the responses to each query from a reader.

In 2009, a UK-based horse magazine published an article entitled Weird or Wonderful?. It was an excellent illustration of the widespread acceptance of equine CAM. It began, “When conventional medicine fails to work, many owners turn to alternative therapies”, and went on to describe 24 of these. Each account had three sections: What Is It?, How It Works, and What It Helps. There were no questions on the lines of Does It Work?, Can It Possibly Work?, Is There A Simpler Explanation For What Is Observed? or What Harm Can It Do?. Readers were not given enough information to make an informed decision and would have finished the article thinking that every therapy was wonderful and nothing, but nothing, was too weird to contemplate. They would also have been given the idea that alternative therapies could help to cure everything from most forms of lameness to skin conditions, digestive problems and nervous disorders. The article was peppered with little boxes in which the heading ‘Fact!’ was followed by a snippet of totally implausible information. Some samples:

“Cranial sacral therapy has been known to restore the proper position of misaligned bones.”

“Hair samples taken from the mane or tail can show evidence of weaknesses and emotional disorders.”

“Radionics can treat almost all physical, mental and spiritual problems”.

… and from within the text itself:

“Chromotherapy can help horses through many problems … Green … is good for killing off germs … Purple … effective against bacterial infections”

“Crystal and gem therapy … can help almost any ailment”.

“Faith healing can treat any illness or ailment – it has even been known to perform what we consider ‘miracles’, healing horses with terminal illnesses.”

“Bach flower remedies … are great for healing the horse’s emotional and mental state”.

“Iridology can diagnose a disease before any symptoms appear … it can detect deficiencies and genetic abnormalities”.

“Horses suffering from allergies show great improvement after treatment with homeopathic remedies made from the things that trigger the allergy”.

“Magnets can help arthritis, rheumatism and navicular, as well as tendon problems and muscle cramps.”

“[Reiki] promotes healing in general, so any problem can be treated.”

“Horse whispering can be used … to detect physical problems in a horse”.

“Copper therapy is beneficial for any horse who suffers with osteoarthritis and rheumatism”.

Indeed, the only “Fact!” that I couldn’t find was the fact that almost all of this is illegal unless done by a qualified vet trained in the method. Now, one cannot blame the average horse owner, reading this in an award-winning reputable magazine with a circulation of tens of thousands, for believing that all this is true. I also think that the writer of this article probably took his or her information from the websites and promotional literature put out by the therapists themselves – it obviously hadn’t been informed by anything like the Skeptic’s Dictionary or Quackwatch – or even Wikipedia. Reference to these would have made it quite clear that these ‘facts’ are not widely accepted by scientists, and for very good reasons. No – all the ideas seemed to have been taken at face value and presented to the public without a shred of scepticism. I don’t want to give the impression that the writer of this article was negligent, or less than conscientious. Far from it. A lot of work went into it and it is well-written. But the point is that the validity of these approaches to treatment is now so thoroughly accepted by the horse world that nobody even thought to look for contrary evidence.

Demographic studies show that the typical user of alternative therapies is a middle-aged, middle-class, reasonably well-educated woman with spare money and time. This description fits a large number of horse owners, too, so perhaps it isn’t all that surprising that matters have reached the point where Andy Lewis could write on his Quackometer blog, “horse ownership and quackery could form a whole blog in its own right.” To many modern horse owners, the vet is merely one of many options to call on when a horse is ill or injured. Despite what the law says, and despite what many therapists assert, it is common for the owner to make her own diagnosis and select the practitioner she thinks will do the most good for the least money.

What is really worrying about all this, though, is that the horses themselves have no choice in the matter. Many of these innocent beasts have had their healthcare taken out of the hands of science-based vets and put into the hands of people who may know a great deal about their therapy, but very little about the actual anatomy, physiology, biochemistry and pathology of their clients. People who through no fault of their own are simply not able to recognise when a horse has a problem that needs medical treatment. People who have been taught to believe that their therapy really does everything that they think it can, in a world where personal experience is considered the highest form of proof. People who have been taught, and who tell their clients, that vets are useless because there is so much they can’t cure. Many owners now expect science-based medicine to fail to cure their horses. The law and the veterinary profession are apparently being bypassed by people who are using questionable techniques to diagnose illnesses and disorders, and recommending untested or discredited treatments for those conditions. It’s a sub-culture that has dismissed the scientific knowledge and expertise of the veterinary profession in favour of a do-it-yourself approach based on mystical beliefs. And if anything goes wrong, it is always the horse that suffers.

References

www.quackometer.net/blog/2007/08/if-it-quacks-like-a-horse.html.

Wanless, M (1997). For the good of the horse. Published in the UK by Kenilworth Press and in the USA by Trafalgar Square Publishing.

Posted in Guest Posts, Miscellaneous CAVM | 4 Comments

Pet Psychics

Posted on May 17, 2010 by skeptvet

I have tried to avoid this topic since it is not by even the most tortured stretch of the imagination really about medicine, even most forms of alternative medicine. Unfortunately, all too often I see people making medical decisions for their pets based on what supposed pet psychics (or “animal communicators” which seems to be the currently favored marketing term) tell them, so I feel obliged to state the seemingly obvious: No one can communicate psychically or telepathically with your pet, and you should not pay someone to make up stuff about what your pet is supposedly thinking! You certainly should not make decisions about your pet’s healthcare or about euthanasia and quality of life based on what a psychic tells you your pet is thinking.

The details of the fraud and self-deception engaged in by pet psychics really are no different from those employed by people who claim to speak with the dead, divine the future, and otherwise know things through mystical mind powers. Joe Nickell, a well-known investigator of paranormal phenomenon, has addressed the subject of animal communicators in his article Psychic Pets and Pet Psychics. Such charlatans use a variety of techniques, but the bulk of their show consists of cold reading, a set of strategies designed to take advantage of the subject’s desire for the psychic to be right and to help them communicate with their pet. Some of these strategies are described by Nickell in his article:

1. Noting the obvious. Fitzpatrick (2002) visits an animal clinic with a couple and their infant daughter to tell them which dog is right for their family. After the selection is narrowed to three choices, each is brought out in turn. The first is ambivalent; the second ignores everyone; and the third, Patty, greets the couple and nuzzles the child. Sonya writes her choice on a slip of paper and it proves to be the same the couple made: Patty. The audience applauds: Patty was apparently their choice too! (I know she was mine!)

2. Making safe statements. Fitzpatrick (2002) announces that one pooch “says” he wants to go out more often, and the dog’s owners accept the assertion. Similarly, Gerri Leigh (1992) tells the owner of an outgoing little dog, who immediately licks Leigh’s hand, that the animal “fears no one”; but then she quickly adds that it is “not an unconditional lover.” She continues by stating that the pet is “independent” and “not a yes dog.” Such virtually universal declarations are not apt to be challenged.

3. Asking questions. Psychics frequently seem to provide information when they are in reality fishing for it. The asking of a question may, if it is correct, credit the reader with a hit; otherwise it will seem an innocent query. For instance, Fitzpatrick (2002) asks a dog owner, “When was there someone who was with him who went away?” (Unfortunately, this is too good a hit, since the young woman seems puzzled and replies that it could have been various persons—possibly, one imagines, former boyfriends or other acquaintances.) Questioning also keeps the reader from proceeding too far down a wrong path and allows for mid-course correction.

4. Offering vague statements that most people can apply specifically to themselves. Alleged psychics take advantage of what is known as “the Barnum effect”—after showman P. T. Barnum who strove to provide something for everyone (French et al. 1991). They learn that people will respond to a vague, generalized statement by trying to fit it to their own situation. Thus Fitzpatrick (2002) tells the owner of a pet iguana that the creature had experienced “a move.” Now most people can associate a “move” with their pet: either when they acquired it, when they changed residences, or when they left it with someone to go on vacation, etc. Thus the pet psychic was credited with a hit (never mind that she incorrectly referred to the female iguana as “he”).

5. Returning messages to animals. People who are convinced pets give information to psychics may be willing to believe the reverse. Thus Fitzpatrick (2002) claims to give animals “messages”—for example a clarification of something by the owner—by silently concentrating for a moment.

It doesn’t take much effort to expose the shallow and vacuous nature of the “communication” a psychic is having with an animal. Karen Stollznow illustrates this with a simple experiment she has written about as The Ballad of Jed (and the Pet Psychic). She borrowed a neighbor’s cat and invited a psychic over to perform a reading. The interview was a series of guesses, attempts to fish for information, and confabulation of vague but plausible stories about the cat. Almost none of the few details offered by the psychic were correct based on the known history of the cat.

The video below is a good example of such a cold reading (at least in form, though since the breeder and the psychic worked together to produce a series of videos demonstrating the psychic’s work, it could in fact be an example of a hot reading, in which the psychic has advance information about the subject they are reading).

The psychic begins by noting the obvious, that the pet (who is clambering all over the owner wagging her tail and licking) is affectionate and loves the owner. She makes a series of vague and relatively neutral statements like “she is something else.” She starts talking about how the dog “likes to be seen” but doesn’t necessarily like to be petted or shown affection by strangers since it might “mess up my hair” (at which point the dog leaves the owner and jumps on the psychic to get some attention). She says the dog is “happy and loving” but also “conservative,” “very playful, but not too much so,” and so on. Such descriptions could be easily applied to almost any dog of this age exhibiting the kind of behavior she shows in the video, and they certainly don’t require any special telepathic communication or insight. At one point, the psychic suggests the dog could be used in one kind of service work (“canine good citizenship”) and when the owner offers “I was thinking of using her in therapy work,” the psychic responds that she was just about to say that.

I don’t suggest that most animal communicators are deliberately lying, though undoubtedly some are. Often, psychics believe they really are in touch with the living or dead animals they claim to communicate with. That they are deluded rather than lying does not do much, unfortunately, to mitigate the fact that they are deceiving people, often pet owners in grief or struggling with heartrending decisions concerning their pet’s well-being.

When I am asked why it matter whether someone gets comfort from untrue information about their pets’ thoughts, I have to answer on both a philosophical and a practical level. Philosophically, I believe the truth matters and that deception, intentional or not, is wrong. Even comforting false beliefs are still false, and they are cheats that deny us the chance to face honestly and directly the truths of our lives. I don’t recommend my clients lie to their children when a pet dies, telling them it “went to the farm,” because it seems wrong to me to try and avoid pain by denying the true nature of reality. Likewise, I cannot convince myself that it is ok to lie to a pet owner and claim to be hearing the thoughts or feelings of their pet.

Such philosophical objections are, of course, personal and subject to debate. However, there are also more pragmatic reasons to disabuse people of the myth of pet psychics. People often consult psychics during times of stress and uncertainty seeking information to help them make decisions. They may want to know if their pet is in pain so they can make decisions about medical treatments. Or an owner may be thinking about euthanizing a severely ill pet and want some guidance from the pet concerning its feelings or opinions about the quality of its life. These situations and decisions are difficult and painful, and at such times people are even more easily deceived by their own needs and desires and by the tricks of psychics and mystics.

The most benign of pet psychics are merely psychological mirrors; they reflect the owners feeling much like a psychotherapist. But others go farther and make definitive statements about an animal’s thoughts or wishes. I once saw a dog with bone cancer in severe pain whose owners denied the obvious symptoms of limping and crying and were convinced their homeopathic pain medication was working, all because according to a pet psychic the dog said he was comfortable. And I’ve seen terminally ill dogs suffering terribly whose owners refused to consider euthanasia because an animal communicator told them their pet wanted to stay with them longer. Decisions based on fairy tales and deception are not likely to be good decisions. And because our pets truly cannot speak for themselves, the stories told by charlatans who claim to be speaking for them are not likely to represent their real feelings or to further their interests.

Posted in Miscellaneous CAVM | 21 Comments

Therapies to Soothe all Four Legs–From the NY Times

Posted on May 10, 2010 by skeptvet

There was a scary article yesterday in the New York Times talking about the popularity of a variety of CAM therapies for racehorses. It is a laundry list of nonsense complete with outrageous prices and weak rationalizations. I also thought it nicely complemented my last post, illustrating some of the “empirical” competition we poor vets mired in mere science have to face.

Of course, there are the usual players, acupuncture and chiropractic. The acupuncturist quoted recites the usual rationalization for unscientific therapies of all kinds, “We would like what’s best for the horse, however we get there isn’t the point.” In other words, “We are willing to try anything and decide it works based on uncontrolled observations.” The chiropractor quoted suggests “balance” is needed between mainstream and alternative therapies. The way the article is written makes this sound almost like a voice of caution and moderation, as if chiropractic and acupuncture were themselves mainstream. Of course, they may very well be in comparison with some of the other “alterative’ therapies mentioned.

As always, the “equine telepaths” used as “psychic diagnosticians” win the prize for most ridiculous and embarrassing “therapy.” One of them manages to say with (presumably) a straight face, “I speak with them telepathically…I can do that from anywhere in the world, it doesn’t matter where I am…Usually by the time they get to me, their skepticism is tempered by their need.” The last sentence is particular revealing. When people are desperate, they suspend critical thinking in favor of wishful thinking. I’ve talked before about the risks of such “last resort” use of CAM. It is understandable, but it doesn’t really help people or their animals.

I was also a bit concerned about the hyperbaric therapy mentioned. I admit I don’t know much about hyperbaric medicine generally, though there are certainly some legitimate uses of it. However, I find no evidence to suggest that it has been demonstrated safe and effective for “healing wear and tear on…muscles” as the article suggests. And there are real risks for oxygen toxicity (see also) which can seriously damage an animal’s lungs, so such a therapy is not risk free, though it appears such side effects are uncommon in properly administered and monitored hyperbaric treatment.

Finally, the article had some interesting information about the cost of such therapies. Half an hour in a hyperbaric chamber, for example, will set your horse back about $300. This is cheap, though, compared to the $500 for an in-person consult with an “animal communicator.” I shudder to think what the reaction would be if I charged $500 for a consultation! Apparently, I could have just skipped 4 years of vet school and the six-figure debt that went with it and learned to communicate telepathically with horses instead.

Posted in General, Miscellaneous CAVM | 7 Comments

Veterinary Quackery–Circa 1921

Posted on May 10, 2010 by skeptvet

I recently ran across an edition of the Journal of the American Veterinary Medical Association from 1921 which contained a few tidbits that I found interesting concerning the distinction between scientifically trained veterinarians and their “empirical” competitors. Such documents are always entertaining for the dramatic difference in tone and cultural perspective between then and now, and for the insight into how things were different and, sometimes, how they were the same. The entire issue is available on Google books.

Merillat LA. Some notes on the comparative study of veterinary medicine in France and the United States. Journal of the American Veterinary Medical Association 1921;58(11):64-73.

The author apparently spent two years working with French veterinarians during the First World War, and he has nothing but praise for the high standards of scientific training and expertise among them, which he seems to consider better than the contemporary standards in the U.S. The passage of particular interest here is the following.

There are no veterinary laws in France as we know them in our several States. Anyone may practice, but the nongraduate is under such restrictions as to the particular disease he may treat and the drugs he may prescribe that the activities of the empirical practitioner are somewhat curbed. I say “somewhat” advisedly, because quackery is not unknown in France. In my travels in the rural districts I made a special effort to gather some information in this respect, and found that almost every community supported its handy horse and cattle doctor. The fact that all of the regular veterinarians were at the front may have intensified the situation and may have made it appear more grave than under normal peace-time conditions. I fear, however, from information thus obtained and that gathered by living almost a year in the home of a leading veterinarian of Paris, that the situation as regards empiricism is far from satisfactory to the practicing veterinarian, and I am also assured that the condition in Holland, Belgium, Germany and Italy is no better. In these countries empiricism and the patent-medicine industry thrive uncurbed. Judging from advertisements in the lay press and periodicals, it is legal to sell nostrums regardless of contents or of the effects claimed for them. Thus the veterinary practitioner, after having made this splendid preparation to practice, is little protected against cheap opposition. Then it appears that medical enormities and superstitions are practiced more among ‘the European laymen than among the more intelligent American.

The one feature in which the French veterinarian differs most from us in this respect is the way he has been able to dignify his calling and separate himself from the empiric. Here we are still classed with the lowest type of charlatan, while in France everyone knows that the veterinarian and the quack belong to two entirely different categories of individuals. Here we fight the quack to rid ourselves of an undesirable companion, while in France no complaint is entered so long as the quack does not overstep his legal domain. The French practitioner looks on cheerfully as if rather satisfied to be rid of the uncanny and gruesome jobs he might be called upon to do if the quack were not in existence. This I think explains the status of the quack situation in Continental Europe.

First, of course, we note the natural and relaxed use of the term “quack,” which today would never find its way into any official publication of the AVMA. While the haughty and paternalistic attitude of the medical mainstream in the early 20th century is deservedly a thing of the past, we have perhaps become too democratic in banning any sort of pejorative characterization of useless or nonsensical treatments. I suspect the successful anti-trust litigation pursued by chiropractors against the American medical Association in 1976 may explain this to a significant degree. In any case, “quack” is now a much rarer term, for better or worse.

We also see the beginnings of the desire for American veterinarians to be seen as scientists and professionals, which of course required emulating the kind of scientific training and methods the author so admires in his French colleagues. ” Here we are still classed with the lowest type of charlatan, while in France everyone knows that the veterinarian and the quack belong to two entirely different categories of individuals.” Certainly today, veterinarians are pretty respected and trusted as a profession, but one of the dangers of not being vigilant in maintaining a high scientific standard for our clinical practices is that of becoming indistinguishable in the public eye from “charlatans.” Embracing unproven methods and a anecdote-based epistemology is a sure way to dilute the credibility we have earned as a profession through our dedication to progress and sound science.

There’s a bit of unselfconscious ethnocentrism in the statement ” medical enormities and superstitions are practiced more among the European laymen than among the more intelligent American” that we can afford to think of as quaint since it is so obviously not an attitude that would be acceptable today.

And finally, there’s the discussion of the relationship between mainstream, scientific veterinary medicine and the alternatives, unscientific folk practices, patent medicines, and so on. On one hand, there is an obvious sense of resentment at the idea of veterinarians undergoing rigorous scientific training only to be in competition for patients with untrained lay people who are allowed to sell whatever nostrums they like regardless of their usefulness. And in contrast is the picture painted of an almost idyllic division of labor between the scientific practitioner and the quack. The situation in France is described as one in which the laws allow unscientific, or “empirical” veterinary practices so long as they are confined to domains not reserved for “real” veterinarians. What sort of restrictions are in place is not stated, but one can imagine it might be a system analogous to the veterinary practice acts of the states, in which the “practice of veterinary medicine” is limited to veterinarians, and debates then ensue as to what this encompasses.

In California, for example, performing chiropractic on animals is considered veterinary medicine, so it is required to be done by licensed chiropractors but only under the “direct supervision” of licensed veterinarians. This really only amounts to an exam by the vet within the last year and a referral for chiropractic, but occasionally I am able to catch a case in which a patient comes to our hospital for chiropractic only but I find a serious disease that requires real treatment during my “pro forma” exam of the patient, so I am able to steer them towards real therapy.

Today, the position of the AVMA and other professional veterinary lobbies seems to be that they don’t care what kind of treatment is offered or whether it has any scientific legitimacy so long as only veterinarians are allowed to offer it. This seems a total abdication of any responsibility for protecting the public from quackery and a bit of crass protectionism to me. Granted, there are political considerations since a fair number of veterinarians believe in CAM treatments, so the kind of direct condemnation of them found in this old article wouldn’t be politically possible these days. Still, the article clearly demonstrates that much the same sort of conflict that exists today, between legitimate medical practices based in science and “empirical” practices based in folklore or personal intuition, existed nearly a century ago. The more things change, the more they stay the same.

Posted in General | 2 Comments

“Holistic Medicine”–It means whatever we say it means

Posted on April 27, 2010 by skeptvet

The American Holistic Veterinary Medical Association (AHVMA) has a statement on their web site explaining what “holistic” medicine is. I was interested in this because it’s a slippery word, seemingly simple on the surface but hard to pin down. Superficially, the word comes from the Greek root for “whole” and simply means a perspective that looks at phenomena (organisms, systems, etc) as wholes, rather than analyzing them at the level of component parts. This is simply one of many levels on which phenomena can, and should be examined.

The problem is that this perspective is difficult to distinguish from mysticism and the notion that natural phenomena are irreducibly complex and nothing meaningful can be learned by examining their components. Reductionism and holism should be complementary, but philosophically and politically they are more often seen as incompatible. Thus “holistic” becomes less a term describing an epistemological perspective and more a philosophical or political shibboleth distinguishing those who disdain the methods and explanatory power of science and prefer mystical, vitalist explanations to scientific ones from those of us who see utility and real truth in the explanations science gives at the component as well as the system level. Let’s go through the AHVMA statement and see if we can find some clarity.

First, it recommends looking at “all aspects of the animal’s life.” Of course, that isn’t what they really mean since that is a practical impossibility. Could the patient’s cancer have been caused by once walking across a linoleum floor? Is she diabetic because the light shining through the bedroom window is filtered by oak leaves not maple? If we truly believe everything is relevant then we are helpless to make any useful conclusions at all. What they really mean is just that they want to know about things they consider relevant and which scientific medicine often does not. The trick, then, is to demonstrate that these things truly are relevant, which often fails to happen.

Next the statement recommends “employing all of the practitioner’s senses” when evaluating the patient. I’d be surprised if holistic veterinarians make a lot more use of taste than conventional vets, so generally the idea of using all ones senses in examining a patient doesn’t distinguish scientific from holistic medicine since both use a multisensory examination. Of course, this may be referring to “senses” which science does not acknowledge as being real, such as the psychic awareness of thoughts and emotions or “bioenergetic field” techniques that have been discussed in some of the organization’s continuing education literature and its journal. In that case, it would be true that conventional vets don’t use these “senses.”

Now we get to the heart of what “holistic” is truly used to signify, when the statement recommends “the combination of conventional and alternative (or complementary) modalities of treatment.” There is nothing intrinsic in the concept of holism that requires accepting or using CAM therapies. As I’ve pointed out before, CAM therapies often have theoretical foundations that are completely incompatible with each other, though they tend to be united by vitalist tendencies. Chiropractic is not “holistic” at all according to the root sense. It focuses exclusively on supposed misalignment of the spine as the source of all disease and the object of all treatments. Homeopathy, on the other hand, couldn’t care less about the spine when diagnosing or treating an illness but does treat all diseases with whatever substances are believed to mimic the symptoms of the patient when given to healthy people. CAM therapies are not necessarily any less reductionist than scientific medicine, so identifying their use as a component of the holistic veterinary medical approach betrays the ultimately political and marketing nature of the term. It is a warm and fuzzy umbrella under which to gather methods not usually validated by science. CAM therapies are often very narrowly focused on “one true cause” of all disease or the “one true therapy” for all ailments, they just pick a cause or therapy that is unproven or disproven by science.

The statement claims that a vet who follows the holistic approach “wants to find out all about its behaviors, distant medical and dietary history, and its environment including diet, emotional stresses, and other factors.” These sound like the same sort of historical variables any veterinarian considers in gathering data about a patient’s health and disease. The specific meaning attributed to each factor is likely different between science-based and “holistic” vets, but it is a bit of dishonest marketing to suggest conventional doctors are reductionist to the point of ignoring such obviously relevant factors as diet and prior medical history. As I’ve said before, ” I’ve never actually met a veterinarian who considers the patient irrelevant to the health of the knee or the gallbladder or the white blood cell, but CAVM practitioners like to suggest that such myopia is the only alternative to embracing vitalism and faith-based medicine.”

Next we have a very broad-brush paint job illustrating how really nice holistic vets are:

“Holistic medicine, by its very nature, is humane to the core. The wholeness of its scope will set up a lifestyle for the animal that is most appropriate. The techniques used in holistic medicine are gentle, minimally invasive, and incorporate patient well-being and stress reduction. Holistic thinking is centered on love, empathy and respect.”

All of these vague, pleasant characterizations apply equally well to veterinarians who practice science-based medicine. I might quibble with what is really meant by “love” and “empathy,” since I think these terms are often a cover for claims that alternative practitioners are psychically in touch with the spirits or souls of their patients, a claim I think is more about religion than medicine. But the fact that conventional veterinarians are interested in facts, evidence, and truth does not, as CAM vets like to suggest, imply that somehow they aren’t human beings capable of treating their patients and clients with as much kindness and compassion as anyone else. I would argue evidence-based medicine is a pre-requisite for truly compassionate care since without it we are likely to offer our patents ineffective and even harmful therapies that don’t really help them.

Now comes a summary of the holistic medicine methodology:

“The holistic practitioner is interested in genetics, nutrition, family relationships, hygiene, and stress factors. Many patients present in a state of “disease.” At this point the holistic challenge lies in the question “why?” By a series of analytic observations and appropriate testing the goal becomes finding the true root source of the pathology. A simple-appearing symptom may have several layers of causation. Only when the true cause of the ailment has been found is there the possibility for a lasting recovery.

It is at this point that the most efficacious, least invasive, least expensive, and least harmful path to cure is selected. “

This sounds like a fair description of clinical medicine in general. Nothing here distinguishes a holistic approach from a conventional approach. The implication, of course, is that this is not the method a conventional veterinarian follows because presumably we’re so busy focusing with tunnel vision on superficial symptoms and reaching for toxic drugs that we aren’t looking deeply enough. Fortunately for our patients, this is just a vapid cliché.

Finally, we have this qualifier:

” In many acute situations, treatment may involve aspects of surgery and drug therapy from conventional western technology, along with alternative techniques to provide a complementary whole. This form of treatment has great value for severe trauma and certain infections. It often outperforms other methodologies. It is also at this time that other treatment plans such as those listed below are brought into use. Once the symptoms have been treated, the task is not complete until the underlying disease patterns have been redirected. The patient, as well as the client, will be guided to a new level of health. “

I have taken the liberty of translating this for those not intimately familiar with CAM-speak:

When we have a definable disease or an urgent medical problem, we reach for scientific medicine because it works better. However, when we have vague or hard to define symptoms or we’re just trying to convince the owner that ongoing health can only be achieved and maintained by constant subtle adjustments of the unmeasurable essence of life, then we reach for alternative methods since they and their effects are also vague and hard to define.

There is no question that the concept of holism in its original form has some value. Things can be understood about complex systems at the whole system level that may be missed when looking at their component parts. And some systems may exhibit behavior that is intrinsically not predictable at the component level even though they are fundamentally deterministic (see chaos theory) while other systems may be fundamentally indeterministic. However, none of this legitimate epistemological theory has anything to do with vitalist mysticism or the embracing of unproven or even disproven medical approaches. Looking at the whole patient in its real life context is a valuable element to understanding health and disease. Using any and all therapies that sound good to us regardless of whether or not they have real value is a mistake. Unfortunately, the popular use of “holistic” to market CAM therapies confounds these unrelated approaches.

Posted in General | 13 Comments

Spinmaster Messonier at it again

Posted on April 25, 2010 by skeptvet

I recently discussed, and corrected, some comments Dr. Shawn Messonier made on his blog concerning Alison Averis’ post here illustrating how personal experience can be unreliable in evaluating whether a medical treatment works or not. Dr. Messonier has responded to some of the comments I made in that post, as usual trying to warp them to fit his pro-CAM “talking points.” He begins by dredging up that vacuous marketing label of “healthcare choice” which I’ve discussed before.

While most doctors and healthcare providers are open to natural care and support your choice and the type of medicine you desire, sadly there are still many that will come up with any argument and do anything to prove to you that your choice is wrong.

This argument presumes that giving people more therapies to chose from, even if they are useless or even harmful, is somehow a good thing. It also suggests that informing people about what reliable, scientific evidence is and how they can use it to help them make good choices for their pets is somehow limiting the freedom or autonomy of pet owners.

I offer choices to my clients every day, and I expect them to be full partners in caring for their pets. I do not offer them the option of psychic diagnosis or therapy, animal sacrifice to propitiate the gods of health, or homeopathy because those would be false choices of no real value. And if there is a therapy that I believe might be beneficial but about which there is significant uncertainty, I give them that information so their choices will be informed. Adding meaningless buzzwords like “natural” to what one does, regardless of whether there is reliable evidence to support that it is safe or effective, is purely a marketing strategy, not a means to give greater autonomy or choice to pet owners.

Dr. M then goes on to quote my recent post and respond to specific bits and pieces.

1.“Doctors rely on their personal experiences, intuition and, anecdotes as evidence to justify implausible or simply “made up” theories and practices.”

This is partly true, but it’s also true for doctors who practice conventional medicine as well. In the good old days before strictly controlled, well-funded (usually by the drug companies seeking approval for their latest drug) studies, ALL doctors learned and shared knowledge based upon their personal experiences with various medications (both natural and conventional.) There is nothing wrong with learning from experience and sharing these experiences. Yes, we all would love to have well researched studies “proving” what we already know to be factually correct. However, the company funding the study determines which studies are ultimately published. While most companies are ethical, there have been some well-publicized incidents of companies ignoring negative studies and only publishing positive studies showing benefits for their medications.

*Evidence is evidence. Either a treatment works or it doesn’t. While skeptics selectively ignore evidence showing the effectiveness of natural therapies, they never seem to ignore evidence showing natural therapies don’t work.

Several problems here. First, Dr. M is unfortunately correct that many doctors practicing primarily conventional medicine rely unduly on anecdote and personal experience. This does not, of course, mean it is the right approach, and I hope that the practice of science and evidence-based medicine will come to be the predominant approach to medical knowledge among all veterinarians. It is certainly more likely to take hold among those who already practice medical approaches that are based on sound scientific reasoning and evidence than among those who, like Dr. M, confidently assert the value of therapies that are unscientific in their underlying premises or without good supporting evidence. I certainly do not claim perfection in conventional medicine, I simply advocate for all of us as veterinarians and pet owners to recognize our limitations and attempt to do better by turning to the most reliable evidence available concerning the therapies we use.

The underlying problem with the CAM approach to knowledge is explicit in this statement. Dr. M pays lip service to scientific evidence, but he clearly views it as icing on the cake, “‘proving’ what we already know to be factually correct.” The arrogance of this kind of self-certainty is breathtaking. Science and the knowledge it generates is not merely a way of better promoting and marketing what we already believe. It is a way of finding the truth despite our own limitations and cognitive biases. There can be no learning or improvement without the recognition that our knowledge is incomplete and flawed, and yet Dr. M clearly does not believe this. To him, science is simply another tool in the promotion of his beliefs, not a way to find out what is true and what isn’t.

As far as the issue of funding bias and publication bias, there is no question these are real problems. They do not, however, invalidate the whole enterprise of scientific research, as the good doctor suggests. There is plenty of research evidence available, both from industry-funded research and from other sources (academia, government, private clinical practices, etc), and acknowledging that there are weakness in some of this research is not license to ignore it and simply do what we feel like doing.

“Evidence is evidence” is nonsense. There are levels of evidence ranging from the least reliable (personal opinion and experience) to the most reliable (multiple consistent well-designed and conducted clinical trials). The problem many CAM practitioners have is reading the pyramid of evidence upside down:

Undoubtedly, we all suffer from confirmation bias, so it is true we attend to evidence that supports our beliefs more than evidence that disconfirms them. This is a major reason why scientific evidence is more reliable than anecdote and personal experience, so raising the issue simply undermines Dr. M’s own approach. If he has specific evidence for particular therapies he thinks I am ignoring, his is of course always welcome to provide it for consideration.

2.“I would be very interested in how much “objective” measuring of outcomes doctors using natural therapies actually do. They often seem to imagine they can “eliminate” subjective owner assessments in practice, but I find this hard to believe.”

Let me quickly answer this objection by sharing with you two recent cases. One involves a dog with elevated kidney enzymes that did not respond to treatment by his prior conventional veterinarian. The other case involves a cat with elevated liver enzymes and also did not respond to treatment by her conventional veterinarian. After using several natural therapies, follow-up blood tests showed that the kidney and liver enzymes returned to normal.

There is nothing subjective about this. The laboratory, which did not know what kind of therapy I used on these patients, reported the results objectively.

Even in trying to show how objective his medical practice is, Dr. M cannot help but rely on anecdotes to prove his point. Of course, the flaw here is glaringly obvious. He assumes that improvements in the clinical laboratory values measured was due to his therapy. This is the post hoc ergo propter hoc fallacy, and it ignores the fact that medical problems can improve for all sorts of reasons other than the ones we assume. Some possibilities include:

1. Self-Limiting Disease Many diseases are self-limiting. If the condition is not chronic or fatal, the body’s own recuperative processes usually restore the sufferer to health. Thus, to demonstrate that a therapy is effective, its proponents must show that the number of patients improved exceeds the number expected to recover without any treatment at all. Without detailed records of successes and failures for a large enough number of patients with the same complaint, someone cannot legitimately claim to have exceeded the norms for unaided recovery.

2. Waxing and Waning Chronic Disease (also known as Regression to the Mean) Such conditions as arthritis, allergies, and gastrointestinal problems normally have “ups and downs.” Naturally, clients tend to seek therapy during the period or greatest clinical symptoms. In this way, a treatment will have repeated opportunities to coincide with upturns that would have happened anyway.

3. Multiple Concurrent Therapies If improvement occurs after a pet has had several interventions, and probably other unremarked changes in the owner’s treatment of the sick pet, one or another of the changes often gets a disproportionate share of the credit or blame. Frequently, the latest in a series of interventions or the newest thing tried is credited with improvement even though many things were done.

The overall tone of Dr. M’s response is that I am somehow on a crusade against “natural” medicine. That cannot be true for the simple reason that “natural medicine” is a meaningless term filled with assumptions and the naturalistic fallacy. I am actually on the same crusade as Dr. M. I am dedicated to giving my patients the best, most effective care and the highest quality of life possible, and to protecting them from things that are useless or harmful. The difference is not one of intention, but one of philosophy. I believe there is such a thing as truth and that the best way to care for our pets is to know what is true and what is false about the therapies we offer. I believe that we often don’t know what we think we know, and that our confidence in our own intuition and judgments is often excessive and unjustified. I believe that science is the most powerful tool we’ve ever invented for separating truth from mythology, and that with it we have done, and will continue to do, better in medicine that we did in all the thousands of ears we relied exclusively on storytelling, respect for tradition and authority, and random trial and error to decide what works and what doesn’t.

If this blog is controversial or challenging, it is because when I find the evidence doesn’t support the claims people make about veterinary medicine I have the temerity to say so. I try to do so in a civil way, and I try to focus on the problems of reasoning and evidence rather than personality, though I won’t claim I never give in to irritation at the persistence of mischaracterization and misinformation in some people’s arguments. But helping pet owners to take better care of their companions isn’t accomplished by ignoring the evidence or by letting unsupported claims or misleading arguments stand, and I make no apologies for trying to help people filter the information available to them and separate the strong, reliable claims from the weak or thoroughly bogus ones. I’m happy to discuss what the evidence is and what it means with anyone, but Dr. M prefers simply to insinuate and allege motives, to throw around meaningless marketing terms, and to talk about anything but the specific evidence for or against the therapies he advocates.