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.

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.

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.

The fundamental belief underlying this blog is that the truth matters, and that science is the best hope we have of approaching a true understanding of health and disease. I make an effort to investigate and understand the scientific evidence behind veterinary medical approaches and then communicate those findings to my clients and the public because I believe that this is the best way to make the right healthcare decisions for our pets and to avoid the harm and waste of  time, effort, and resources involved in utilizing approaches that don’t work. While I am a realist, and I understand that no amount of objective evidence can change the beliefs of someone with a deep faith in a particular approach or a compelling personal experience that is contrary to the rational, scientific conclusions about it, I still hope that information will truly be power for veterinarians and pet owners, and that we can learn to compensate for our biases and cognitive blind spots and make better, informed decisions.

I do, however, have my doubts. Most polls show that Americans trust scientists more than politicians, but really what does that prove? I trust chiropractors more than, say, the government of Iran, but that doesn’t mean my faith in chiropractors is all that deep. And while polls show most Americans believe science has made life better, most Americans also can’t distinguish between legitimate science and pseudoscience. Purveyors of bogus medical therapies can take advantage of the public’s trust in science easily by simply borrowing or manufacturing jargon than gives the impression of scientific credentials regardless of the real evidence for or against their snake oils. The media can easily manufacture “scientific controversies,” such as those between evolution and intelligent design or between proponents and opponents of the concept of anthropogenic global warming, simply by present on an equal footing two “experts” with differing opinions, regardless of the underlying difference in plausibility or evidence behind these opinions.  So while people trust science to some extent, this is a poor safeguard against the unscientific.

And as a culture, we are deeply faith driven. The overwhelming majority of Americans believe in God, and a solid majority believe God and other spiritual powers are active in daily life, affecting health and disease among other things (for example). So the habit of believing in what cannot be scientifically evaluated is natural to many of us. This makes it difficult to convince people that the scientific evidence against a particular medical therapy should outweigh the personal convictions or testimonials of believers in it, which are generally viewed as at least as good, perhaps better a form of evidence than that provided by science.

A friend recently passed along a social psychology study which, while not definitive by any stretch, does suggest that the picture is even bleaker than this, and that the conclusions of scientists may actually influence people to believe even more strongly in something science demonstrates is not true. The study is called Social influences on paranormal belief: Popular versus scientific support (Curr Res in Soc Psych 2009;15(3)).

Briefly, the investigators gave subjects (the usual undergraduate volunteers) some information about the popular belief and scientific consensus concerning ESP according to four conditions:

Condition 1: Participants read that 25% of the American public believes in ESP and that the scientific community rejects the possibility of ESP.

Condition 2: Participants read that over 90% of the American public believes in ESP and that the scientific community rejects the possibility of ESP.

Condition 3: Participants read that 25% of the American public believes in ESP and that the scientific community is becoming more open to the possibility of ESP.

Conditions 4: Participants read that 90% of the American public believes in ESP and that the scientific community becoming more open to the possibility of ESP.

The subjects then watched a video of a person supposedly demonstrating ESP by guessing the suit of playing cards they could not see. In the video, the guesser is actually informed of the suit and so does much better than one would expect by chance, as someone with ESP would be expected to do. The subjects then completed a questionnaire evaluating their belief in ESP and whether the video was a demonstration of ESP powers.

The mean belief scores were as follows:

Condition 1 (25% of public believes; science rejects): 4.58 (SD = 1.92)

Condition 2 (90% of public believes; science rejects): 4.50 (SD = 1.60)

Condition 3 (25% of public believes; science accepts): 3.58 (SD = 1.84)

 Condition 4 (90% of public believes; science accepts): 4.80 (SD = 1.70)

Analysis of these results showed a significant effect of public belief, with subjects being more likely to believe in ESP if told that most people do. Overall, the scientific community opinion on ESP did not affect the subjects’ level of belief, a depressing hint that science doesn’t have as much influence on the acceptance or rejection of an idea as the popularity of the idea does. However, there was a statistically significant effect of scientific consensus on subject’s belief when ESP was described as not commonly accepted. In this condition, people were more likely to accept ESP as real if scientists rejected it, and more likely to reject ESP if scientists accepted it as possible.

These are not particularly strong findings easily applicable to popular tendencies towards accepting or rejecting the scientific view on implausible propositions, and I don’t mean to make too much of them. However, my personal biases are affected by my own experiences, as everyone’s biases are. I am confronted with depressing regularity by the attitude that what everyone believes cannot be wrong regardless of the soundness of the scientific evidence against it. Personal experience and faith seem in most of us to be far stronger influences on belief than scientific evidence, and even the hint that scientific rejection of an idea may be seen as a reason to believe in that idea worries me.

CAM proponents frequently dismiss scientific evidence with ad hominem reasoning, claiming that the ideological biases or financial interests of those promoting science-based medicine make their conclusions untrustworthy. It is almost automatic for those with unconventional beliefs to assume any evidence provided by commercial researchers (such as those in the pharmaceutical or pet food industries) is worthless at best, if not intentionally deceptive. Could we actually get to the point where the same suspicion was widely applied to science in general, and where scientists were assumed to have ideological or more venal biases that invalidated their conclusions on any idea that claimed itself to be outside the purview of science and more properly in the realm of faith and personal experience? Am I wasting my time trying to convince people that intuitive and traditional ways of knowing the truth about health and disease are inferior to scientific ways? Am I actually promoting the very therapies I criticize because mistrust of science and scientists may incline people to decide in favor of those propositions science argues against?