Note: Lest you think that SBM is becoming “turtles all the way down,” let me apologize for the duplication and explain that I had already written this right before I read Mark Crislip’s Turtle Agony article on Friday. My focus is different, and turtles were only a small part of my article, so I decided to leave the turtles in. If you prefer to avoid a turtle overdose, you can just skip the Turtlepuncture section and go on to the Motion Style Acupuncture section. They are clearly labeled for your convenience.
The “science” of acupuncture trudges ever onward without really getting anywhere. New developments include a report of turtlepuncture and a study about treating low back pain with a new kind of “motion style” acupuncture using passive or active movement while the needles are in place. I found the first amusing and the second unconvincing.
A group of Ridley sea turtles were rescued after being stranded during a cold spell that left them hypothermic and unable to function. In addition to the usual rescue and rehabilitation efforts, two of the turtles, Dexter and Fletcher Moon, were treated with acupuncture. It was intended to “decrease inflammation and swelling on their front flippers, restore a full range of motion on those limbs and help the animals regain their appetites.” It allegedly worked: their appetite and the use of their limbs improved. But without any controlled observations, this is only an anecdotal report and means very little. They might have recovered just as well without the treatment, for all we know.
Animal-assisted therapy is a huge topic: almost 1500 hits using those terms alone. There is no way I am going to cover all of them and do them justice. Instead I am going to cherry pick, er, I mean, select references of interest to illustrate issues surrounding animals in the hospital. Sometimes I get the impression that readers of the blog expect encyclopedic knowledge and understanding of a topic whenever we put pixel to screen. That is only true of the other contributors to the blog, not me.
I would like to mention that I do, in fact, like animals, even dogs. I loathe most dog owners, as confirmation bias suggests there is no such thing as a considerate dog owner. But I never have contact with the dogs that don’t bark, that don’t crap on my yard, that don’t run up to me to nip at my legs. I only see the dogs that their owners allow to behave in ways I would never allow a human to behave.
It is no surprise that my kids have grown up mostly animal free. My eldest did wear me down and I bought him a hamster. It promptly bit me, drawing blood. Great, I thought, LCM. Just what I need. Then in the dead of winter it escaped, fell down a heating duct (we were putting in new floor) and electrocuted itself on the heating coils so every time the heat turned on we smelled rotting, roasting hamster. It cost $500 to take the furnace apart and clean it. Good thing it wasn’t a beagle. That was enough pets in the house for me. (more…)
It can be frustrating, and sometimes even a little depressing, to be a skeptic. Promoting reason and science-based medicine often feels like a Sisyphean effort that garners lots of hostility and ad hominem attacks from proponents of pseudoscience and few concrete victories. But once in a while, something happens to give a little hope and inspiration.
In 2010, for example, the House of Commons Science and Technology Committee report on homeopathy came out, clearly unmasking homeopathy for the vitalist 18th century relic it is (though, sadly, politics is complicated and often unmoved by mere scientific truth, and the government didn’t eagerly embrace the findings or recommendations of the committee). About the same time, the British Medical Association called homeopathy “witchcraft,” and recommended it no longer be supported by the National Health Service. More recently, the Chief Medical Officer in Britain openly acknowledged homeopathy is “rubbish.” Perhaps there has been a shift in the winds? Maybe there is hope that the institutions of government and organized mainstream medicine here in the U.S. might be willing to start taking a stand against pseudoscience in the way they used to in the days before Wilk vs American Medical Association?
As a veterinarian, I was particularly delighted and inspired in March, 2012 when the Australian Veterinary Association (AVA) joined in this movement and took a firm and public stand on unscientific therapies, in particular washing its hands of homeopathy:
Australian Veterinary Association (AVA) resources will not be used to promote therapies that, in the Board’s opinion, are not compatible with current understanding of physiology and pathophysiology and have been demonstrated to be ineffective by the current accumulated body of knowledge.
That the Board agreed that the veterinary therapies of homeopathy and homotoxicology are considered ineffective therapies in accordance with the AVA promotion of ineffective therapies Board resolution.
This echoed the policies of the British Veterinary Association, and other national veterinary groups in Sweden, Denmark, and elsewhere in Europe. The idea that the central player in organized veterinary medicine in the U.S., the American Veterinary Medical Association (AVMA), which has as members more than 80% of the licensed veterinarians in the country, could be moved to take a similar stand started to seem like a realistic possibility.
In 2005, cardiologist Barbara Natterson-Horowitz was called to the zoo to examine a non-human patient, an emperor tamarin with heart failure. She was surprised when the veterinarian told her not to look her patient in the eyes because eye contact could cause capture myopathy. In this condition, when an animal is captured, restrained, and feels threatened, there is a catastrophic surge of adrenaline that damages muscle tissues and can kill. It was described decades ago, but medical doctors don’t read the veterinary literature. It wasn’t until the early 2000s that American doctors began to recognize a similar phenomenon in human patients, takotsubo or stress-induced cardiomyopathy.
She began to wonder whether animals got other human diseases. She quickly learned that they did. Jaguars get breast cancer and may carry the same BRCA1 gene that plagues Ashkenazi Jewish women, rhinos get leukemia, penguins get melanoma, gorillas die from ruptured aortas, and koalas are in the midst of an epidemic of sexually transmitted chlamydia. Wild dragonflies infected with parasites become obese and develop a form of metabolic syndrome. Pretty much every human disorder occurs in animals too.
With the help of writer Kathryn Bowers, she distilled her findings into a book: Zoobiquity: What Animals Can Teach Us About Health and the Science of Healing. It’s a good read: informative, well argued, spiced with intriguing trivia, and more entertaining than a trip to the zoo. (more…)
Today’s guest article, by By Ragnvi E. Kjellin, DVM, and Olle Kjellin, MD, PhD, was submitted to a series of veterinary journals, but none of them wanted to publish it. ScienceBasedMedicine.org is pleased to do so.
Animal chiropractic is a relatively new phenomenon that many veterinarians may know too little about. In Sweden, chiropractic was licensed for humans in 1989, but not for animals. Chiropractors claim that their field is scientific, while others consider it to be a form of ”alternative medicine” with an implausible and unsubstantiated theoretical foundation and little evidence of efficacy. Chiropractic is not taught in medical or veterinary schools.
Courses in “veterinary chiropractic” are offered by two companies in Germany. In their classes, veterinarians and human chiropractors are purposely mixed. A recent malpractice case in Sweden involved one of their students, a veterinarian who was accused of injuring a horse with chiropractic neck manipulation. That case led us to inquire into the underlying theory, clinical practices, and training of “veterinary chiropractors”.
Human chiropractic was founded in 1895 when D.D. Palmer, a grocer and magnetic healer with no medical training, decided that 95% of all diseases were due to vertebral subluxations that blocked the flow through the spinal nerves to all muscles and organs of the body, including the brain, eyes and ears. Adjusting subluxations supposedly allows the body to heal itself by “innate intelligence.” Over a century later, there is still no evidence that such subluxations or “intelligence” exists.
Mainstream medicine has always been skeptical of chiropractic1. Even some chiropractors have criticized the practices of their colleagues2,3. Several recent meta-analyses of chiropractic for various ailments4,5,6 have concluded that musculoskeletal back and possibly neck pain may benefit from spinal manipulation therapy; but the results are not superior to other treatments, and there is no evidence of benefit for other ailments.
Considerable controversy surrounds the chiropractic field. It is therefore essential that veterinarians understand the facts about chiropractic before they consider practicing it, recommending it, or even condoning it for the animals they treat.
An Embarrassment of Riches?
Much has been written here about the dietary supplement business, a multibillion dollar industry with powerful political connections, and about the woeful inadequacy of regulation which allows widespread marketing of supplements without a solid basis in science or scientific evidence.
The veterinary supplement market is a pittance compared to the human market, but still a billion-dollar pittance that is growing rapidly. Unfortunately, the resources available for good quality research in veterinary healthcare are also a pittance, and it is not at all unusual for our pets to suffer, or even be euthanized, as a result of treatable diseases for want of money to pay for needed care. So $1 billion a year spent on nutritional supplements may not be such a good deal if these products don’t effectively prevent or treat disease.
The variety of supplements available is staggering. Many proprietary concoctions of vitamins, minerals, herbs, and other ingredients are marketed for health maintenance, “boosting the immune system,” retarding aging, or treating specific diseases. A comprehensive review of this multitude of moving targets is impossible. But the lion’s share of the pet supplement market goes to a few specific compounds, so I will focus on these. Most of these ingredients are also among the most popular supplements for humans, so there will be substantial overlap with previous discussions of the plausibility and evidence for many of these substances. (more…)
One cannot play charades forever.
European veterinary groups have long been more skeptical about “alternative” veterinary practices than their American counterparts. For example, the European Board of Veterinary Specialties refuses to grant continuing education credits for non-scientific endeavors attempting to masquerade as a way to improve one’s clinical knowledge, and the practice of veterinary homeopathy is forbidden in Sweden.
Now comes good news (for pets, and pet owners), out of the UK. In an effort to improve animal health and welfare, the Veterinary Medicines Directorate’s (VMD) has targeted “alternative” remedies, which, of course, pose both real and potential dangers to pets. The VMD is the body responsible for the authorization of veterinary medicinal products in the United Kingdom.
Specifically, the VMD is targeting a number of unauthorized products that lack scientific proof of effectiveness, including:
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.
Some of the most rewarding interactions we have with our pets involve food. Most dogs respond with gratifying enthusiasm to being fed, and this activity is an important part of the human-animal bond. Providing food is also part of the parent/child dynamic that in many ways characterizes our relationships with our pets. Giving food is an expression of affection and a symbol of our duty of care to our pets.
Because of these emotional resonances, pet owners are often very concerned about giving their pets the “right” food to maintain health and, if possible, to prevent or treat disease. This has allowed the development of a large, and profitable commercial pet food industry that aggressively markets diets with health-related claims. This industry resembles in some ways the pharmaceutical industry. It is regulated by the FDA, and also by individual states, according to a somewhat Byzantine set of standards established by the FFDCA (the guiding document governing the FDA) and by the Association of American Feed Control Officials (AAFCO), a private organization made up primarily of state and federal feed control officials. Thanks to this regulatory structure, imperfect though it is, there is a good deal of solid science and research behind the products and claims the industry produces.
Periodically, one sees newspaper articles extolling the virtues of acupuncture for animals. To those familiar with the practice of acupuncture, the tag lines are nauseatingly familiar, e.g., acupuncture has been around for thousands of years, it works to stimulate the animal’s natural energies, etc., etc. Ditto the testimonials; Fluffy wasn’t helped by anything else; now, after a few months of treatment (and plenty of time), Fluffy is running around happily. Some may even take such testimony further, asserting, for example, with some rather tortured logic, that since acupuncture “works” in animals, and animals aren’t thought to be susceptible to placebo effects, then acupuncture must therefore work in people.
In fact, other than testimonials, there’s really no good evidence that acupuncture does work in animals. In fact, acupuncture isn’t much practiced in veterinary medicine – a distinct (but very vocal) minority of veterinarians may practice it. In fact, the most recent review on the management of canine arthritis concluded, “There was weak or no evidence in support of the use of” various modalities, including electrostimulated acupuncture and gold wire acupuncture,”1 and a recent study of electroacupuncture for postoperative pain after back surgery in dogs concluded that there was “equivocal evidence” for an effect, even though there was no difference in analgesics used between treatment and control groups.2