“Who would ever know from our public face that we are so “soft on CAM’ when forced to be so in privacy of our own consulting rooms?”

I’m sure that language between professionals (of any type) is much more explicit that that used by them amongst the public that they serve (example: the leaked emails from the CRU of the UEA). But if, in the case of the medicos posting here, that can indeed be characterised as “soft on CAM”, that would amount to hypocracy. I would hope that is not the case. I would hope it would be more accurately characterised as ” telling the truth about CAM, softly”.

http://knowyourmeme.com/photos/9722-ceiling-cat

I have no great argument with you. “Homeopathy is nothing more than a placebo for you and does not help your pet in any way.” is a fairly accurate representation of the state of the science concerning veterinary practice. This is less clear within human medicine, wherein it is the patient who may be very placebo responsive and who also brings a panel of other human needs into medical interactions, ones that may not be fully dealt with by mainstream care, for a variety of likely reasons.

It was not criticism of CAM that I suggested risked personal freedoms, it was the processes involved in “Trying to stamp it all out —, the explicit intent of some of the commenters here and the clear implication of some of common rhetoric, to the alarm of some of those we wish to influence.

We are obliged to state what we know, but even that requires more qualifications than we normally allow for when it comes to complex interventions like acupuncture (in humans).

I think there are many reasons people seek CAM, and the failure of conventional therapies to solve their particular clinical problem is only one of them. It seems pretty unlikely to me that we are ever going to have perfect, all-encompassing medical care, but even if we did I suspect CAM would remain since there are ideological, esthetic, and cultural reasons for choosing it as well.

However, I think you’re mistaking the condemnation of useless therapies for condemnation of those who seek them out. The only reason I see to challenge these practices is that I believe they are ultimately bad for my patients. Few people, at least in my experience, use a CAM therapy while being fully cognizant that is nothing more than a placebo. They use it because they believe, or at the very least hope, that it will make them better in a meaningful way, not simply trick them into feeling a bit better while their disease goes merrily on. So there is inevitably some deception involved in offering these therapies to patients, and that seems more disrespectful of their autonomy than criticizing useless treatments.

And in my field, where the patients cannot speak for themselves, I see real suffering that goes unrelieved because of the mistaken belief, on the part of pet caretakers and vets, that something like homoepathy is helping. There is no abstract moral or ideological crusade involved in wanting to reduce the danger of this sort of thing by discouraging the use of such therapies. And while I am pleasant and respectful to my clients, and continue to have clients who appreciate my care for their pets while not always following my guidance, I am always clear that since they are paying for my advice and my judgment, I am obliged to give it to them. They are not obliged to take it, but I have an ethical duty to say, “Homeopathy is nothing more than a placebo for you and does not help your pet in any way.”

So I think your concerns about criticism of CAM interfering with individual freedom is misguided. True freedom involves making not only a free, but an informed choice, so offering accurate information can only facilitate truly free helthcare choices.

Any time you wish to take me up on the scientific background to anything I say, let’s be having you. My positions are based upon what I believe to be a more accurate understanding of why people use CAM and what they might get out of it despite its content of fraud and nonsense.

Oh please. You just claimed that people know acupuncture is “dubious.” Which the slightest bit of examination of how the general public talks about it clearly shows that to be false.

To be a little more permissive is also not the same thing as “legitimizing”. Did you miss where I said there remain grounds why the mainstream should not fully endorse acupuncture for its own use?

Pure smoke screen on your part. You make it VERY clear that you want nothing less than for quackery to be fully accepted and embraced.

So, we gave our cat drips. Under skin on her neck, because we had to do it at home, she wouldn’t allow any vet to do it without sedation and sedating her every day just to give her an IV drip would make no sense.

OK, yah, sub-Q fluids are totally standard. I’m surprised the vet had trouble with it, unless there’s some confusion with actual IV fluids, where you have to shave the cat and so forth.

About 100ml of physiological saline once a day, with furosemidum.

So the cat wasn’t urinating. That sounds like acute kidney failure.

And also one of B group vitamins (don’t remember which one) and a few steroid injections to improve the cat’s appetite and help fight gum inflammation. After about two weeks the cat got much better and since then the improvement was steady. Now, over two years after the initial diagnosis, we give her a very small dose of Enalaprili maleas every day and a drip once a week. And of course she’s on a special renal support diet.

OK, treating for hypertension is a very good idea in CRF (particularly if you want to keep the retinas attached). I guess I’m not clear on whether this was preexisting CRF that hadn’t been detected and turned into a crisis, or whether there was some insult that provoked things. But anyway, the treatment doesn’t really sound experimental at all.

Thanks for the description, though; I can very much empathize with dealing with this stuff.

This has nothing to do with ideology. Any time you wish to take me up on the scientific background to anything I say, let’s be having you. My positions are based upon what I believe to be a more accurate understanding of why people use CAM and what they might get out of it despite its content of fraud and nonsense.

I am supporting an as yet still tentative re-examination of a “scientific ideology” that cannot see beyond (or does so only dimly, selectively, inconsistently and self-servingly) the “working better than placebo” model of medical practice. Sometimes that model defines everything that is important in a medical interaction, yet, given the complexities of illness and of human nature, all too often it does not.

To be a little more permissive is also not the same thing as “legitimizing”. Did you miss where I said there remain grounds why the mainstream should not fully endorse acupuncture for its own use?

I was actually suggesting that this was the “final solution” to “the CAM problem”, at some very distant point in the future. Who would believe that we have those answers right now?

Until that point is reached there will always be some demand for other treatments to try. Trying to stamp it all out before then, an end-point that you and many others hint at within these pages, involves too much interference in individual freedoms, some small risk of useful measures being overlooked, and a much greater risk of some being deprived of useful medical support of some kinds.

Certainly most skeptics don’t sufficiently acknowledge the role of unmet medical needs within 95% of CAM. I have had to defend that pretty obvious fact here. Some skeptics may not say as much but they convey the message that the mainstream should be enough for anyone and that there is no real need to looking elsewhere. This is an insult to both the intelligence and the suffering of many who use CAM.

We should also impress upon them that CAM is even further from this laudable goal and no more time and resources should be wasted upon CAM. It is definitely not where the answer lies.

I agree. Yet who is to make that judgment, when it is at the patient’s own expense and risk? What became of our new-found desire for less authoritarianism and paternalism in medicine?

Our role is an advisory one, but even in that we need to acknowledge the complexity of the needs that people bring into medical interactions and in how they respond to them.

Why do you assume that a cat doesn’t believe in a god? Cat’s seem extremely religious to me – They just happen to be religious from the perspective of the deity rather than that of the lowly worshipper.

Few patients would not already know that the method is “dubious” — even from the simple fact that I had not previously recommended it myself?

Good grief. News flash – the overall perception of acupuncture in society is NOT that it is “dubious.” If you’re assuming that people know the least bit about how grossly out-of-touch with reality it is, well, with most people you’re (yet again) dead wrong.

It’s astounding how you so often just Make Stuff Up in order to support your ideological commitment to legitimizing quackery.

I have little objection to that. Few patients would not already know that the method is “dubious” — even from the simple fact that I had not previously recommended it myself?

Also, I would be surprised if any medicos here would say to a patient contemplating using acupuncture:
“Don’t use it. It doesn’t work”.

I am sure of that. Yet that is definitely the message that these pages are sending in spades, and that is what I am talking about. Who would ever know from our public face that we are so “soft on CAM’ when forced to be so in privacy of our own consulting rooms? I’d like to get away from that inconsistency, too.

And she proposed a treatment that, while science-based, was rather experimental.

Alia, would you mind sharing what it was? (No snark; I know CRF in cats up close and personal.)

Or perhaps an even more mature, but perhaps a little less relaxed but at least more inclusively honest message:
“If you are thinking of using acupuncture, please take into account that there is no evidence that it actually works apart from making you feel better because something is being done; and please continue to use the treatments that have been shown to work”.

Also, I would be surprised if any medicos here would say to a patient contemplating using acupuncture:
“Don’t use it. It doesn’t work”.

” I personally believe it wasn’t a miracle”

Well, did your cat have end stage renal failure due to a reversible or limited cause which just managed to reverse or stop before your cat actually died of renal failure, or did one of those gods, that I assume neither you nor your cat believe in, decide to intervene and save its life.

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If that is the case, that the public has this unwarranted faith that we have a near-complete portfolio of safe and truly effective methods for everything, then we should quickly disabuse them of this belief. We should also impress upon them that CAM is even further from this laudable goal and no more time and resources should be wasted upon CAM. It is definitely not where the answer lies.

I understand all this, and have at times said the same, but in the long run the fate of CAM depends upon the mainstream having a near-complete portfolio of safe and truly effective methods for everything, a point that is nowhere near yet reached, and also the public having faith that this is so. At the moment we and our various processes have only grudging and easily shaken public trust, and perhaps rightly so. Anything that damages public trust further is therefore of critical importance.

From such different perceptions as to why people resort to CAM, the role of placebo influences and compulsive consumption of medicine, and other realities that we face, even allowing a little for the oft-demonstrated contrariness and rebelliousness of human nature, one can develop subtlely different approaches to “the problem of CAM”, even defining the problem differently. “Don’t allow/use CAM — it doesn’t work” may evoke a very different response to “if you are thinking of using it, don’t use it alone for serious illnesses”.

This states up front the major practical concern from CAM use and one that the public can more easily understand. Expressing concern for their welfare will evoke a different public response to brow-beating them about “the science” and leaving them with conflicted impulses (although the scientific background is also needed).

I am not saying that any of the views expressed here are wrong, merely that they are not secure enough to justify the degree of contempt often expressed for those who favour a slightly more relaxed (and possibly instinctively more mature and politically savvy) attitude towards the use of these agents (not “support”, BSM).

Partly I am seeking a position that more obviously puts us by the side of the patient in the battle against the common enemy of disease, rather than sets us against certain of his primeval instincts. In the long run it will come down to trust.