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Special Challenges of Science-Based Veterinary Medicine

On this site there have been several thoughtful posts (e.g. by Dr. Atwood and by Dr. Novella), and subsequently much heated commentary, on the distinction between Evidence-Based Medicine (EBM) and Science-Based Medicine (SBM). I agree wholeheartedly with the position that the two are not mutually exclusive, and that SBM is essentially EBM as it should be practiced, with a comprehensive consideration of all relevant evidence, including the subject of plausibility. As a practicing veterinarian, and an officer of the Evidence-Based Veterinary Medicine Association (EBVMA), I am keenly interested in bringing to my profession a greater reliance on high quality research evidence and sound scientific judgment, and reducing the reliance on individual practitioner intuition and experience in making clinical decisions. However, those of us in veterinary medicine face some special challenges which make the subtle but important distinction between EBM and SBM especially salient. 

Where’s the Evidence?

The first of these challenges is the paucity of high quality clinical research evidence. As an example, in his 2007 book Snake Oil Science, R. Barker Bausell examined the research evidence concerning the use of glucosamine as a treatment for osteoarthritis in humans. He was able to analyze the strengths and weaknesses of a Cochrane Review which included 20 studies with 2570 patients (the most recent revision of this review includes 25 studies with 4963 patients), a NEJM study with 1583 patients, and an Annals of Internal Medicine study with 222 patients treated for two years. His conclusion was that the intervention was not more effective than placebo.

I recently did a targeted search of the PubMed literature database for a brief evidence-based medicine feature on the subject of glucosamine and chondroitin as treatment for osteoarthritis in dogs, currently in press at the Journal of the American Veterinary Medical Association. A search of the terms “glucosamine,” “arthritis,” and “dog” yielded eight references, of which three were relevant (a more comprehensive search strategy yielded sixteen references, but only the same three were relevant to the clinical question). The three useful references included two clinical trials involving a total of 113 dogs and each lasting about 2 months, and a systematic review of treatments for canine osteoarthritis which evaluated one of these two clinical studies. Predictably, the larger, better designed trial with objective measurement criteria showed no benefit of glucosamine, while the smaller, less well-controlled trial with only subjective criteria and a 23% dropout rate in the glucosamine group showed some benefit at some assessment points.

Where’s the Money?

Glucosamine is an extremely popular, and profitable, supplement routinely recommended by veterinarians and administered by owners to their geriatric dogs. Yet the clinical trial evidence concerning its effects is nearly non-existent. The depth of the evidence is no better for many, many routine clinical interventions in veterinary medicine. The primary reason for this is simple: money. 

Obviously, the health of companion animals is not as high a societal priority as human health. Many countries have little or no formal companion animal medicine at all, of course, much less high quality, evidence-based pet medicine. And even in the developed world, the absolute size of the veterinary medical profession and associated industries is dwarfed by that of the human medical industry. 

In the United States, surveys show that most dog and cat owners have come to consider their pets to be members of their family, and their willingness to pay for veterinary care has increased along with this shift in attitude. The same appears to be the case in Europe and other developed nations. This has allowed the quality and technological sophistication of veterinary care to increase. 

Pharmaceutical companies have followed this trend, increasing their financial investment in their own internal research activities, as well as funding the lion’s share of companion animal health research generally (with all the ethical and practical problems that creates). Pfizer, the largest fish in the “Big Pharma” pond, claims to spend $300 million annually on veterinary research globally, for both companion and agricultural animals. However, the company is expected to spend $9-$9.6 billion this year on its human research and development. The same pattern is true of government research spending. Veterinary medicine will always be the poor stepchild of medicine, and we cannot expect to have anything close to the quantity or quality of research evidence available to MDs trying to practice evidence-based medicine. 

A Pack of Lone Wolves?

Another barrier to effective utilization of research evidence in veterinary medicine may be demographic and cultural. In the United States, the average veterinary practice has fewer than three veterinarians, and between one-third and one-half of veterinarians are self-employed practice owners. And most companion animal veterinarians are general practitioners, only about 10-15% of practicing vets being board-certified, with the extended academic training and, hopefully, greater awareness of and respect for research evidence that might be expected to come from this training.

As a profession, we veterinarians tend to be entrepreneurial, self-reliant, and independent. This contributes to a reluctance to let anyone tell us what to do, which may be how veterinarians perceive the position of evidence-based medicine. There is no solid data on the subject (though I am involved in a survey study which will hopefully provide some soon), but in discussions with colleagues I have sensed a great deal of anxiety about the notion of “cookbook medicine” which disdains the hard-won wisdom and experience of the individual clinician. Veterinarians are reluctant to accept the idea that there may be broadly applicable standards of care they ought to adhere to, even if their personal judgment conflicts with the evidence for these.

Undoubtedly, our colleagues in human medicine share a similar temperament and similar sorts of anxieties about “cookbook medicine”. However, these may be tempered to some extent by more widespread advanced training, more structured and supervised practice environments, and greater assessment and monitoring of outcomes, which may partially explain the greater acceptance of EBM in the human medical profession. And though the case of Dr. Rolando Arafiles, Jr. illustrates the weaknesses in the systems for monitoring physician behavior, I think it is clear that the influence of government regulation, and the threat of litigation, give the concept of adhering to a recognized medical standard of care far greater teeth in the field of human medicine than it has in veterinary medicine.

SBM, EBM, or OBM?

So how does this relate to the difference between SBM and EBM? Well, traditionally the scarcity of clinical trial evidence has led veterinarians to practice primarily opinion-based medicine. Personal experience and intuition and the opinions of individual experts or mentors are the predominant foundations for clinical decision-making. There is little or no outcome assessment, so veterinarians must rely on their own clinical experience to judge whether their practices are effective. 

The negative consequences of these strategies are many. There is dramatic inconsistency in the diagnosis and treatment of even common diseases. I routinely have to explain to my clients that if they ask ten vets a question, they are likely to get seven or eight different answers. You can imagine how frustrating this is for them, and how little confidence it inspires in our expertise.

OBM Leads Kids to the Hard Stuff, FBM!

As most readers of this blog likely already know, there are many reasons why individual judgment is an unreliable guide to the true efficacy of a medical intervention, and why we should be reticent to entirely trust our own intuitions and experience. But opinion-based medicine is also a “gateway drug” to faith-based medicine, otherwise known as complementary or alternative medicine. If you are accustomed to judging the safety and efficacy of interventions on the basis of the cases you have seen personally or the opinions of “experts,” you are more likely to be persuaded by the individual experiences of clinicians promoting and alternative practice, and more likely to think that giving it a try yourself is the most reliable way to know if it really works or not. 

The Internet abounds with holistic veterinarians who claim they started their careers as scientific, skeptical doctors but that their frustration with the limitations of mainstream medicine and the problems they could not solve led them to experiment with, and ultimately become promoters of, faith-based miracle therapies of every kind that share no theoretical or practical features in common other than being validated primarily by testimonial and not consistent with scientific knowledge or evidence. 

Tooth Fairy Science exists in veterinary medicine, but it is less of a problem than the simple lack of research evidence and the consequent reliance on even less trustworthy forms of evidence. So veterinary medicine needs a science-based approach even more desperately than human medicine because we have so little clinical trial evidence to rely on, and so few resources to generate more and better evidence. The tragedy of money and talent wasted on studying therapies that have vitalist theoretical foundations inconsistent with established scientific knowledge is even more poignant in the relatively impoverished world of companion animal medical research. Plausibility must play an important role in deciding how we allocate the scarce resources we have in order to maximize the useful information we can generate, and the subsequent clinical benefits for our patients.

Towards a One Health Approach

Veterinarians must also take advantage of the evidence that our colleagues in human medicine have generated for us. There are serious dangers in extrapolating research evidence across species, of course, but we cannot afford to entirely ignore the wealth of human medical research that is relevant to our patients. Examined cautiously and judiciously, this data can help us target our own research efforts more efficiently. Just as animal models have an important role, despite their limitations, in human health research, so human clinical research can inform veterinary medicine. As clinicians, we can make more science-based decisions, even when relevant veterinary research is lacking, if we are aware of the research in humans that already exists on the conditions and interventions we are considering. 

If glucosamine is shown to be no more than a placebo after years of research in thousands of people, how much money and effort should we invest in studying its effects in dogs? And how strongly should we promote it to our clients, the vast majority of whom must pay for their pet’s care out of pocket, without insurance coverage, and who commonly must eschew needed care or even euthanize their companions for want of money to pay medical costs?

A Worthy Goal

There has been a steady growth in the quality and sophistication of care available to companion animals in the last several decades, and I am hopeful that this will continue. But I believe the interests of our patients and clients will be best served if the care we provide is as soundly science-based as possible. And while I think evidence-based medicine can become the standard in the veterinary field, with beneficial effects on the quality of the care we provide, we need the additional features of the science-based medicine approach even more than our MD colleagues: a respect for the importance of plausibility in allocating research resources and an understanding of the need to integrate all relevant evidence when making clinical decisions about interventions in the face of a scarcity of high quality clinical trial research. 

Despite all the histrionic accusations of some alternative medicine advocates about mainstream veterinarians being tools of the pharmaceutical industry or reluctant to accept unconventional approaches only out of closed-minded prejudice or a fear for our income, the reality is that we care deeply for our patients and want to provide them with the best care we can. I truly believe, and I hope the profession as a whole will come to accept, that science-based medicine is far more likely to help us do so than the opinion-based medicine we have traditionally relied on.

Posted in: Veterinary medicine

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27 thoughts on “Special Challenges of Science-Based Veterinary Medicine

  1. cervantes says:

    It seems to me that one difficulty is that your patients cannot tell you if they feel better. In conditions such as osteoarthritis, the major outcome measures are patient self-reports. There are other criteria that can be used but they are also fairly difficult to do with non-humans who cannot follow complex instructions to undertake a functional test of some sort. I suppose you could put a dog biscuit at the top of the stairs or something and see how easily they make the climb but objective scoring would seem highly problematic.

    The associated humans may have an impression about how the animal is feeling but there’s no way of knowing how reliable that is. It seems to me you have some fairly intractable difficulties.

  2. Robin says:

    THANK YOU.

    My Cornell-educated, normally strictly evidence based vet has suggested chondroitin/glucosamine supplements for my aging, large mixed breed. When we discussed it he mentioned a few studies in Europe that were promising, and concluded it might work and wouldn’t hurt. I was skeptical but I’ve been faithfully buying the supplements for a few years now. The recommended brand runs $80/month.

    Glucosamine has become so prevalent in the last few years, it’s unbelievable. It’s in my dog’s food. It was in the adoption contract my sister signed from a rescue agency — she had to agree to give the dog a “join supplement” after a certain age. It’s so predatory because you want to do the best you can to take care of your pet.

    The accusation of mainstream vets as tools of the pharma industry is ridiculous. My vet recommends gentle regular exercise, first and foremost, for older dogs and is very insistent that their weight stay moderate so that they can push up off the floor. Between that and prescription NSAIDS (he prescribes the human generic so I can save $) you can keep the old dogs going for a long time.

  3. Scott says:

    Here’s a semi-random thought. What if, when human-medicine researchers were doing animal trials, they favored using cats and dogs if those would be suitable for their purpose? Then you get some extra veterinary data almost for free.

    Of course, it may well be that there’s insufficient flexibility in the species used for animal trials to make this a meaningful benefit – I happily defer to those with relevant experience on that issue.

  4. art malernee dvm says:

    before everyone starts feeling real sorry for veterinarians let me remind everyone vets get to do challenge studies on our patients. I started selling glucosamine to my clients decades ago. Someone before the internet days came to me with a randomized dog study translated from German to English. Dogs were joint injected with arthritic causing chemicals and half got glucosamine half did not. Xrays were taken and you could see on xrays the ones that got glucosamine had better looking joints. The study was done by those selling glucosamine. Why the study could not be repeated by independent sources is open for debate. I can tell you it was hard for me to stop selling the stuff. I was making money, the clients thought it was working because arthritis wax and wanes and I did not want to fess up and tell them they had bought something from me that was a waste of money. It would help if laws did not allow vets to prescribe and then sell what they prescribe.

  5. Cervantes,

    Interestingly, the inability to obtain subjective reports from our patients may be a protection for us against the misleading impact of placebo effects on our assessments. Granted, such effects still influence owner reports, which we rely on excessively in my opinion. But the best studies try to utilize objective measures.

    For example, in osteoarthritis studies the gold standard is force plate analysis, in which the patient is walked across a device that measures the amount of weight it bears on an affected limb. And recently, there has been some interest in using small accelerometers that a pet can wear at home which record activity over an extended period even when no humans are around. Such measures are not only more reliable than owner reports, that are probably more reliable than the self-reported pain score of human subjects in arthritis trials.

  6. Calli Arcale says:

    It would help if laws did not allow vets to prescribe and then sell what they prescribe.

    The major problem there, as I see it, is that there are extremely few freestanding veterinary pharmacies. In fact, the only one I know which is not also a veterinary clinic is the online service PetMeds. Similarly, how many optometry offices do you know who do not also sell eyeglasses? Laws now require them to give you your prescription if you request it, so that you are not obliged to actually buy the frames and lenses from the same person who told you you needed them. But it’s still the standard to get your prescription and then walk across the hall to talk to an optician working in the same practice. To some extent, it makes sense, like being measured by the same tailor who is going to make your suit. But it also introduces the potential for them to recommend products you don’t really need, knowing that if you buy them, it’s money in their bank.

    If my dog needs antibiotics (and he recently did, for an infected cyst), I can’t pop across the street to Walgreens to get it filled, and waiting for an online pharmacy would mean a needless delay in starting the therapy. For all practical purposes, I need to buy it from the vet who prescribed it, and I don’t see that situation changing in the forseeable future.

  7. LovleAnjel says:

    @Scott

    There are a number of things that go into which species is used for a study. If an animal has an excellent model for a human system being studied (cardiac system in dogs, for example) they do get used. But there are several major factors that weigh in:

    Cost. Four hundred mice are way cheaper to purchase & care for than 400 dogs (no one buys mystery stray animals, they are lab-bred).

    Regulation. Dogs & cats are USDA/FDA-regulated species. Rats & mice are not.

    Public approval. People are a lot more upset if you induce brain damage in Fido than if you do it to a rat, and it makes it more likely animal rights protesters will target you.

  8. Scott says:

    Similarly, how many optometry offices do you know who do not also sell eyeglasses?

    Seems to me like a(nother) good reason for going to an ophthalmologist instead of an optometrist. That’s what I’ve always done, and none of them have ever also sold glasses. (They’ve also been uniformly willing to say “your prescription’s changed, but not by enough to justify a new pair”.) My assumption is that, as MDs, they’re barred from that just like a GP is barred from selling you the antibiotic they just prescribed.

  9. Josie says:

    @scott

    That is a nice idea in concept, it would be really great to have veterinary data ‘automatically’ come out of human targeted research.

    Something to consider about animal research though is that these are living, sexually reproducing mammals. They need food, a proper environment particular to the species and time to make babies.

    At one point in my career I maintained a breeding colony of 12 separate strains of transgenic mice. I had 300 breeding females each producing litters of 6-8 babies –each of which had to be genetically tested to verify utility in a study. I would sometimes have up to 1300 pups born in a single month.

    Studies typically had 15 animals in each test group, all one sex, all age matched and even that was a lowish sample size…and of course studies had to be repeated.

    I say all this simply to make the point that we use mice/rats/rabbits because their husbandry is relatively easy, they breed quickly and in large numbers and they are relatively easy to tailor to particular areas of research.

    Dogs and cats are in fact used sometimes, but they are typically more expensive and the numbers are just not there the way they are in rodent/lagomorph studies.

    All that said, I’ll echo what Dr. McKenzie said –we can still use rodent data to help target research in veterinary applications, it just won’t be as direct as we would perhaps like.

  10. Scott says:

    @ LovleAnjel:

    Why must all of my seemingly good ideas run aground on the cruel reef that is reality?

    But thanks for the information – always good to learn more!

  11. I buy prescription medication from my vet, and special food for geriatric dogs with chronic conditions, but when it’s a question of supplements like glucosamine my vet tells me what to get and I pick them up at the pet store or my local pharmacy. (Or not.) It works for me, and my vets aren’t pushy.

    Whether your vet is pushy about upselling seems to depend largely on the neighbourhood you live in.

    I live in a working/ middle-class neighbourhood, and my vet refers to pets as being members of the “household,” emphasizes that the animal’s needs do not come before the needs of any other member of the household, and is not shy to initiate an end-of-life conversation.

    Friends who live in more upscale neighbourhoods have vets who describe pets as being members of the “family” and emphasize how wonderful modern interventions are: we’ll do an ultrasound and keep your kitty overnight for tests and sell you this expensive medication so you can keep your kitty alive for another six months, we know she’s barely breathing but there’s no reason to give up hope! Nope, no end-of-life conversations here: pets are family, and just as you wouldn’t euthanize your child or your grandmother, we do not entertain conversations about euthanizing animals… at least not without a great deal of guilt-tripping.

    The difference seems to be not just customer base but also age. Vets older than I am think that pets are part of the household; younger than I am, think that they are family. I wonder if this has something to do with the role of pharmaceutical and equipment companies in vet education.

  12. Calli Arcale says:

    Scott:

    Seems to me like a(nother) good reason for going to an ophthalmologist instead of an optometrist. That’s what I’ve always done, and none of them have ever also sold glasses. (They’ve also been uniformly willing to say “your prescription’s changed, but not by enough to justify a new pair”.) My assumption is that, as MDs, they’re barred from that just like a GP is barred from selling you the antibiotic they just prescribed.

    If there’s a law, it’s by state and not federal. Here in Minnesota, all the opthamologists I’ve seen (admittedly, not a huge number) have shared their practice with an optician (person who fits you for glasses and sells you the glasses). So going to an opthamologist around here doesn’t really help avoid the conflict of interest. However, they aren’t always part of the same actual company; sometimes the one is just subleasing space from the other.

    Allison:

    Nope, no end-of-life conversations here: pets are family, and just as you wouldn’t euthanize your child or your grandmother, we do not entertain conversations about euthanizing animals… at least not without a great deal of guilt-tripping.

    There are a range of trends. Some cater to the unrealistic, like that. Others have actually expanded euthanasia services to make it more friendly and comfortable. My vet offers, at no additional charge, in-home euthanasia. Initially, they only did it for extraordinary circumstances, such as large dogs with small or frail owners who couldn’t carry them to the office, but it proved so much kinder for pet, owner, and other pets in the family that they now recommend it routinely. (They’re also one of the few clinics around here that will deal with exotics like birds and reptiles.)

  13. cervantes says:

    Brennen — Those sound like reasonable approaches although I should think the home monitoring would still likely be influenced by owners’ expectations and behaviors toward the animal.

    But it’s true – they would be even less dependable with humans because they would be nearly as susceptible to the placebo effect as verbal self-reports. It’s pretty easy to manipulate people’s pain thresholds.

  14. cervantes says:

    And, BTW, not that there’s anything wrong with that. Coping with pain and not succumbing to inactivity is a positive outcome.

  15. Calli Arcale says:

    BTW, as far as “euthanizing grandma”, sometimes I do wonder why it is we consider it inhumane to let an animal suffer but will condemn our loved ones to suffering. Euthanasia is a tricky topic, and there are massive pitfalls, but I think it’s often opposed for the wrong reasons.

  16. qetzal says:

    Scott laments:

    Why must all of my seemingly good ideas run aground on the cruel reef that is reality?

    Don’t feel bad. We’re all aground on the same reef with you. It’s just that some people are unable or unwilling to acknowledge it They insist that they’re still a-sail on the smooth waters of Da Nile!

    ;-)

  17. Squillo says:

    Excellent article. Nice to see vet med get some attention.

    The several (general, small-animal) vets I know operate on very slim profit margins, even in the wealthy community I live in. Given the debt load young vets come out with, it’s not surprising that there is great temptation to add supplements or unproven CAM modalities to practice, especially in my area where these things are very popular.

    @Calli–after having participated (as a vet asst.) in numerous pet euthanasias, I’ve come to the conclusion that it’s the best way to go.

  18. dulcinea says:

    @ calli – I get my dog’s meds (phenobarbitol, and some NSAID-like meds) @ walgreens, they carry most of the common ones – with the exception of the very pet specific (heartworm meds, flea/tick prevent). The pharmacists there didn’t seem surprised to see her scripts in the least.

    Also, re: the idea of at home euthanasia as more kind? I put my dog down about 3 months ago at the vet; we had to bring the pets back for their check-ups a month or so later, and I almost cried just walking past the exam room where we put her down. I can’t imagine walking past that spot in my house every day!

  19. dulcinea,

    The thing about places where you spend a lot of time – like home – is that you build up layers and layers of associations. The couch where you held her the last time would also have been the couch where many other things happened: it wouldn’t be your only association with the couch.

    I had my dog put down at the vet around the corner from us almost a year ago. We wrapped his body in a towel and carried him home and buried him in the back yard. For months I would look out into the back yard and think, He must be so cold out there! It’s so cruel to leave him buried! I need to dig him up and bring him in… But now I sit at the picnic table and smile fondly at the spot where he’s buried. Good memories.

    (And all those folk songs lamenting someone buried in the “cold, cold ground” that had always seemed so nonsensical to me because corpses don’t feel cold, especially when they are decomposed — well, now I know how it feels to think that.)

  20. Regarding bury me not on the cold prairie.

    Here’s another version.

    “Bury me out on the prairie
    where the coyotes can howl over my grave.
    Bury me out on the prairie
    and some of my bones please save.
    Wrap me up in my blanket
    and bury me deep in the ground.
    Cover me over with boulders
    of granite, gray and round.”

    That’s another one of our favorite family songs (even better than “Pesky Sarpent”). I believe it’s called “I Have No Use for the Women” But I omited the first part that covers the evils of women.

    I love our vet’s office. They are caring, yet sensible and yes they’re all older than me. I can not figure the socio-economic factor since they are located between a few different neighborhoods of various descriptions. They have never recommended a questionable supplement or drug (That I know of). They are very open when they prescribe a medication “to see if it works” Like they did with our kitty who had fever of (temporarily) unknown origin. I don’t know what I’m going to do when they start to retire.

    I can understand the benefit of at home euthanasia. I’ve never had a cat that didn’t hate the car and our vet is 1/2 hour drive away. Seems a shame to subject them to that when they are feeling awful.

    Sadly, I believe in our state if an animal is euthanized in the vet’s office, they body can not be returned to the owner. It must be disposed of through cremation (not 100% sure, though.) So no at-home burials here.

  21. Kultakutri says:

    Brennen, so I’m likely delusional when it seems to me that my cat improved after the w/d diet? Darn. And, well, I cannot afford the whole battery of tests to check how her pancreas is working (or not) now, so I’m relying on guesswork.

  22. Calli Arcale says:

    I’m not Brennan, nor a vet, but here’s my two cents…..

    No, you are not likely delusional. However, it can be very difficult to objectively determine whether a treatment has had a positive effect on a pet’s comfort. You can’t ask the pet; they don’t understand the question. And most pets will tend to hide pain. Some say this is an adaptive thing to keep them from being abandoned by the pack, but I think it’s much simpler — if you can’t communicate that you are in pain, there is no point wasting effort making a big dramatic production about it, and you instead just try and get on with your life. The animal isn’t hiding the pain so much as getting used to it.

    Maybe the w/d diet is helping. Maybe it isn’t. I certainly wouldn’t know. My dog was recently in a lot of pain due to an infected cyst (which had to be surgically cleaned out; he got the stitches out yesterday, yay!) and even considering the level of pain, I had a hard time telling if the anti-inflammatories were helping. They definitely helped control the fever and inflammation, but he didn’t really act like he was in pain before. He just wasn’t as active. How do you tell “tired” from “sick” from “hurting”? I wish I knew. My dog’s such a stoic that it’s hard to tell any of those at the best of times, much less tell them apart.

    And sometimes relying on guesswork is all we can do, even when you can afford a full battery of tests. There’s only so much the tests can tell you, after all, and they can’t, by themselves, answer the ultimate question for any veterinary intervention: is it improving the animal’s quality of life? Sometimes that’s obvious, but more often it’s not. I don’t think there will ever be an easy answer for that.

  23. LovleAnjel says:

    @Scott

    The cruel reef of reality is an excellent place to be. It has a swim-up bar.

  24. Man, If I’d know reality had a bar, I would have spent a lot less time trying to escape it.

  25. Angora Rabbit says:

    Dr. McKenzie, you raise many excellent points and I look forward to your future posts. I wear twin hats as a biomedical researcher and as an animal rescuer (hence my nom) and I daily experience the challenges that you pose, with the additional complication that my own species (domestic rabbit) has an even smaller data base than do cats and dogs. What do to in the land of SBM/EBM, particularly when nearly everything our vets do with us is off-label for our species? Moreover, while at least there’s the potential for funding research on popular species like cats and dogs (e.g. Hills, internal vet school pools), for other species those resources are even poorer unless we can get the Vet School interested.

    So how do we tackle this? We can’t wait for the SBM/EBM data – that won’t happen for decades, if ever. Meanwhile the animals need treatment. So we’ve used several strategies. They include extrapolation from other species, searching PubMed for biomedical studies using our species (great for cardiology, btw), and having a firm grasp of pharmacology and thus being able to “guestimate” a particular drug’s efficacy.

    Another useful tool is the Internet. The rescue community and our vets stay connected, and if a treatment works, then we communicate the results to others who will try it and report the results, good or bad. Yes, it is anecdote, but where else can we begin? We are building a web-based database (with vet input) into which vet records will be submitted and someday we hope will be analyzed by vets to identify promising treatments.

    Sure, it would be fabulous if we could practice vet medicine with only SBM/EBM data. And sure there’s a lot of woo in the field (drives me wild). But should we stop treatments because the data aren’t there? That would be unethical and immoral. In a perfect world we’d have the data, but I haven’t seen that day and, sadly, won’t in my lifetime. So we have to do something to treat the pain and suffering. I agree that there are ineffectual treatments out there (I much prefer Metacam to glucosamine), but if we wait till the database exists, my patients will be dead. I attended the Exotic Vet Conference last year, and most of the studies presented had N=1 patient. Hardly SBM. But we have to start somewhere.

    I’d love to hear your thoughts, and those of others, on how we balance the need to practice medicine and alleviate pain and suffering against the lack of a data base.

  26. jrhutch says:

    Great post! Please more veterinary related posts, there is a goldmine of quackery out there waiting to be plundered!

  27. Dev_Null says:

    You leave out – though perhaps its not relevant to your point – one of the greatest dangers of FBM in veterinary medicine. One of the largest single reasons why FBM medicine flourishes is the placebo effect. With human medicine, the placebo tricks you into feeling better for no apparent reason – but at least you feel better. With veterinary medicine, presumably, the placebo effect is tricking you into thinking that your pet feels better when they actually don’t. The animal in question is still suffering!

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