Shocking Study! Chiropractors Make Unsubstantiated Medical Claims!

Posted on June 2, 2010 by skeptvet

A new study by Edzard Ernst and Andrew Gilbey recently appeared in the New Zealand Medical Journal surveying Internet advertising claims made by individual chiropractors and major chiropractic organizations from Canada, the U.S., New Zealand, and The U.K.

They divided the claims into those for which there is reasonable evidence of some benefit (lower back pain) and those for which no good evidence of efficacy exists (headaches, migraines, colic, asthma, ear infections, neck pain, and whiplash). What is not surprising is that chiropractors, and the professional organizations that represent the profession generally, routinely suggest or outright state that their manipulations can treat conditions which they cannot. 95% of individual chiropractic websites made at least one such claim, and all of the professional associations did as well. 38% of the chiropractors made treatment claims concerning all of the conditions in the survey which chiropractic has not been shown to actually treat.

What is a bit more surprising is that many of the sites and organizations did not promote chiropractic for lower back pain, the one condition for which the evidence of some benefit is decent. Only 28% of the individual sites and 4 out of 9 association web sites specifically mentioned lower back pain. One would think they would be most aggressively advertising their treatments for the diseases for which the best evidence exists that they actually help. But remember, chiropractic is, for the most part,  really a faith-based practice founded on the non-existent subluxation and the vitalist “innate intelligence,” not an evidence-based medical specialty. It is true some individual chiropractors are exceptions to this rule and limit themselves to treating musculoskeletal pain. And there are some signs that the profession may be moving to downplay the subluxation mythology. But in general, the practice of chiropractic is still dominated by 19th century spiritualist notions and isn’t much interested in the verdict of science on its efforts.

So how do we explain the apparent de-emphasizing of the most reasonable claims chiropractic could make? I suspect that there is a deliberate effort on the part of the chiropractic profession to avoid getting limited in the public’s mind to treatment of musculoskeletal pain. Chiropractors want to be seen as an alternative choice to conventional medical providers, and they want to be involved in much more than just the treatment of musculoskeletal pain. So despite the lip service they may pay to the concept of evidence-based medicine, in reality they are convinced their treatments work for all sorts of problems regardless of the lack of evidence, and they want to protect and nurture the false impression the public may have that chiropractic is good for more than just back pain.

Posted in Chiropractic | 22 Comments

Don’t Be Such a Scientist or The Negating Culture of Science and its Costs

Posted on June 1, 2010 by skeptvet

I recently finished reading Randy Olson’s book Don’t Be Such a Scientist, and I definitely recommend it. It is an entertaining read and has a number of useful insights into the perennial problem of communicating complex, nuanced, and incomplete scientific information in a way that is engaging and accessible and still in some meaningful sense truthful. I won’t say I agree entirely with Olson’s take on the subject, of course. Sometimes I think he lets the public off too easily, expecting too little from the intelligent lay person. And as always when making generalizations, he seems to stray sometimes into caricature and stereotype. Still, there is no denying that there is currently an enormous divide between mainstream culture and the subculture of science. The days of standing room only public science lectures, such as those of the 19th century, are gone. And the days of scientists being seen as respected and trusted white-coated heroes who invented antibiotics, stopped the scourge of polio, and won the Second World War are over too. There is now a profound suspicion of science, and intellectualism generally, in the U.S., and scientists can no longer take for granted that they will listened to, trusted, or supported by the general public unless they can compete in the busy and bewildering media from which most of us get our understanding of complex issue.

The one concept that struck me most forcefully in Olson’s book, was the image of science as fundamentally a negating enterprise. For all the reading and writing I’ve done on the subject of medical research and the dangers of simply seeking to confirm our preconceptions, I never fully appreciated the implications of this for the appearance of science to non-scientists.

It is very difficult to reliably prove an idea true. Certainly informal assessments of our personal experiences almost always confirm our pre-existing beliefs. Confirmation bias, the availability bias, cognitive dissonance, and a host of other such factors make this inevitable. But even scientific research studies, with all their attempts at controlling personal bias, will almost inevitably prove true whatever investigators set out to prove. The best way to get to the truth is to attempt to prove ideas wrong. A negative finding, especially from a source predisposed in favor of the hypothesis, is worth more than a positive finding. Of course, technically one cannot prove a negative. But the failure to disprove an idea with multiple, vigorous attempts is certainly more reliable an indicator of the idea’s veracity than multiple studies set up to confirm what is already believed to be true.

The implications of this for the culture of science, and the barriers to effective communication between scientists and non-scientists, are profound. Scientists expect criticism and see it as a sign that they and their ideas are being taken seriously. Sure, we are human and so as full of ego and narcissism as anyone else. But by training and experience, most of us acquire relatively thick skins, and we come to see strong challenges to our ideas as a good thing, a kind of intellectual personal trainer that will cause us pain but ultimately make us stronger.

I have been through the peer review process for several publications I have written, and it isn’t pretty. Seeing something I have put months of hard work into torn apart, and facing the prospect of more work to revise what I was sure was perfect to begin with, causes lots of hurt and anger. But at the end of the process, I am generally grateful that the final product is better and that I have been saved the embarrassment of public error. I understand that the criticisms are not personal (the reviews are anonymous, of course, which helps) and I accept the ego bruising as a fair price to pay for weeding out bad work and weak ideas. Likewise, I try as hard as I can to give up beliefs and practices that have been reasonably shown to be wrong, even if I am attached to them and personally convinced of their value. I trust the process, based on the logic of the underlying philosophy and the evidence of history, and this helps me to appreciate the value of the sometimes painful experience of having my ideas and work criticized.

As part of this enculturation, I also feel it normal to respectfully but aggressively criticize the ideas of others. I’ve discussed before how proponents of CAM often resent such criticism and see it as fundamentally unfair and inherently personal. In the culture of faith-based medicine, where truth is judged on the basis of one’s personal experiences or the received wisdom of one’s mentors, challenging someone’s beliefs is the same thing as challenging their intelligence, honesty, or worth. In the culture of science, no one’s beliefs are beyond challenge, at least theoretically (though of course scientists are political animals like all humans, so this principal isn’t always followed). This is one of example of the clash between the negating culture of science and other, non-scientific ways of looking at health and disease.

Olson also makes a big point of talking about how unlikeable scientists can seem to the rest of the world. This is particularly a concern for an endeavor like this blog, which is to a great extent devoted to identifying ideas which are not true and therapies which don’t work. It is far more pleasant to hear proclamations of hope and optimism than to hear all the reasons why something which purports to offer hope really doesn’t. Debunking is inherently negating, and it is easy to see why this leads to the image of skeptics as sour, curmudgeonly, and willfully choosing not to believe in anything. Of course, anyone the least bit of a skeptic themselves knows this isn’t true, just as anyone who actively practices science knows how positive and affirming it can be. The sense of wonder and discovery and the joy of figuring things out is a big part of the rewards in doing science, but for some reason they are less often communicated to the public than the contempt many scientists feel for bad ideas supported by wishful thinking, sloppy logic, and few facts. Science communicators, one might even say science entertainers, like Carl Sagan and Neil deGrasse Tyson are notable exceptions.  

So I agree with Olson that in many ways the culture of science is built on negation, on aggressive intellectual attack and defense of ideas, on a disrespect for those who make stuff up, botch their facts, and show more concern for what they wish to be true than for what really is true. This kind of negativism is not a bad thing, of course, since it is what enables the discovery or real, practical truths that benefit us all. And the negating aspects of science are not all there is to the enterprise. There is a great deal of awe and wonder, creativity, community, and true hope for meaningful progress and improvement in the world. But the negating aspects of the scientific approach do present a public relations problem. Most people seem to take a pretty quick dislike to dispassionate, cerebral, fact-based exposition and to the negation of hopeful, feel-good ideas no matter how nonsensical.

So what do we do about this? Abandoning reality for wish fulfillment doesn’t strike me as a good choice, so we are stuck having to challenge bad ideas no matter how popular. But as Olson suggests, this can at least sometimes be done with humor and humility and with frequent reminders of the elegance, wonder, and real benefit inherent in pursuing and defending the truth. While I think Olson sometimes goes too far in the degree to which he seems to suggest we simplify our messages and make them more entertaining and less instructive, nevertheless his underlying point is valid. The positions staked out by science and reason must compete in a marketplace of ideas, and some of the competitors they face are much more marketable.

The advances of science are often more complex and less obvious than the early triumphs of vaccination and antibiotics, which make them less self-evidently proof that the approach is the right one. And the misuses of scientific knowledge and technological progress are better understood, which further tarnishes the image of science. But the fundamental nature of science as a method which relies on challenge and disproof is itself a weakness from a public relations point of view. And the cultural reverence for factual accuracy and distaste for excessive, hyperbolic, and ultimately unjustified claims also sets those of us promoting science-based medicine at something of a disadvantage. Yet all of these marketing weakness are strengths from the point of view of discovering real and useful truths, so we cannot give them up.

We must strive to make what we do and what we stand for as engaging and accessible as possible without cutting the heart out of it. Being open about our own joy and passion for the truth and the scientific path to reach it is an important step, and being always clear that the truth, even when it may not be what we might wish it to be, is the only way to really better all our lives. Millennia of faith and wishful thinking have failed to accomplish what science has wrought in a few generations, and we must not allow the public to forget that. We must being humble, but at the same time not afraid to be definitive where it is justified. Homeopathy doesn’t work, vaccines don’t cause autism, and we needn’t tiptoe around those assertions to satisfy an excessive epistemological caution. And as always in life, we must make the effort to maintain our sense of humor, about ourselves as well as our ideological adversaries. This will not only make our own efforts more enjoyable to us, but it will do a lot to dispel the myth of the emotionless scientist out of touch with ordinary human feelings. We are as driven by our own feelings as anyone, we simply trust in a method of inquiry which diminishes the danger of these feelings misleading us, and hopefully we can succeed at illustrating that and thus humanizing science and scientists.

Posted in Book Reviews, General | 4 Comments

GAO Report on Deceptive Marketing and Contamination of Herbal Products

Posted on May 26, 2010 by skeptvet

The GAO today released a report to Congress that had previously been reported on in the New York Times. The report investigated deceptive or illegal marketing practices among sellers of herbal remedies and dietary supplements. Under the Dietary Supplement Health and Education Act of 1994  (DSHEA), there is precious little restriction on manufacturers and marketers of these products. All supplements are presumed to be safe without any pre-marketing evidence required, and the FDA can only restrict such products or their sale if post-marketing surveillance, which is haphazard at best, indicates a health threat. Marketers of such products can technically only make vague claims about their products, not claiming that they prevent or treat any specific disease unless they pass the stringent standards of evidence applied to pharmaceuticals. However, this report shows that even these weak limits are being widely ignored.

Many examples of deceptive and illegal marketing practices were identified. GAO employees posing as elderly consumers were told that herbal products could cure several diseases, including cancer, that they could be substituted for prescription medications, and that they could be used safely along with medications even when there is evidence this is untrue.

The GAO also tested 40 supplements for heavy metal and pesticide contamination and found contaminates in 37 of them. The levels were low, but because such products are under-regulated, clear standards for safe levels of these substances have not been established, so it is impossible to know how much risk this poses to the consumer. Certainly, the claim that such products are “all natural” and thus safer than pharmaceuticals is belied by these test results. Can you imagine what the alternative medicine folks would say if lead or pesticides were found in prescription drugs? Yet the manufacturers of these products express no concern, and they have effectively blocked attempts by Sen. John McCain and others to strengthen the regulation of their products. So much for the David and Goliath Myth. Big Herb and his buddy Big Supplement are playing the same game as Big Pharma, they just don’t have any referee watching to see if they play by the rules.

Posted in Herbs and Supplements, Law, Regulation, and Politics | 2 Comments

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.

References-

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2. Bingol U, Altan L, Yurtkuran M. Low-power laser treatment for shoulder pain. Photomed Laser Surg. 2005 Oct;23(5):459-64.

3. Bjordal JM, Lopes-Martins RA, Joensen J, Couppe C, Ljunggren AE, Stergioulas A, Johnson MI. A systematic review with procedural assessments and meta-analysis of low level laser therapy in lateral elbow tendinopathy (tennis elbow). BMC Musculoskelet Disord. 2008 May 29;9:75.

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69. White AR, Rampes H, Campbell JL. Acupuncture and related interventions for smoking cessation. Cochrane Database Syst Rev. 2006;(1):CD000009.

70. Markovic A, Todorovic Lj. Effectiveness of dexamethasone and low-power laser in minimizing oedema after third molar surgery: A clinical trial. Int J Oral Maxillofac Surg. 2007;36(3):226-229.

71. Ziganshina L, Garner  P. Tuberculosis (HIV negative people). In: BMJ Clinical Evidence. London, UK: BMJ Publishing Group; July 2008. 

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87. Braverman B, McCarthy RJ, Ivankovich AD, Forde DE, Overfield M, Bapna MS. Effect of helium-neon and infrared laser irradiation on wound healing in rabbits. Lasers Surg Med. 1989;9(1):50-8.

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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/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 | 22 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