Saturday, June 30, 2007

Complementary and alternative veterinary medicine

Creeping into textbooks: one example

There have been rumblings here an there that discussing the many fallacious and uncritical alternative and complementary approaches to medicine is just a continually boring re-hashing of old already debunked claims. That may be so to a certain extent, but so many of these claims keep coming back around, either with some new “legitimizing” outer wrapping or as just the same re-regurgitated inanity and they need to be addressed and not ignored.

Indeed, how else can one deal with the interminable stream of blather that even seems to be creeping into the halls of higher education? The growing consensus within the scientific community to act against this tide of ignorance through cooperative groups such as American Association for the Advancement of Science (AAAS) or the ebm online digest , as well as educational websites such as Seed and Sense About Science among many other resources are exciting out reach programs. Of course, the many wonderful science blogs also serve a useful purpose by providing added perspectives, sometimes unique, that are available to anyone who is interested, and who knows, may even help expand the practice of reason and measured thought.

So it is today, I have been presented with news that a new and informative chapter has been added to the veterinary reference book “Clinical Avian Medicine” and- you guessed it- the title of this all important new addition is “Integrative Therapies.” Not the best thing for a grouchy “allopathic” vet to receive early in the morning! (By the way, I apologize for the alternative medicine rant the past few days, but this week at work it seems as if I am literally tripping over the stuff.)

The information service providing this news was kind enough to e-mail the whole added section of “Integrated Therapies” and it is brimming with an amazing assortment of assumptions, inaccuracies, fallacies, and implausible goodies. In the interests of brevity, I will address only a few of these items for illustration (although occasional future posts will consider this particular chapter again).

This new section to Clinical Avian Medicine is written by an R D Ness DVM, of the Ness Exotic Wellness Center. Certified in Chirpractic and Veterinary Acupuncture his web site states; Dr Robert Ness graduated from the University Of Illinois College Of Veterinary Medicine in 1990 with a strong interest and determination in avian and exotic pet medicine…Dr Ness continued to expand his knowledge and training, but kept thinking that there was more to being an animal healer than just mainstream medicine. As frustrations grew over the limitations of standard conventional care for chronic diseases and common problems encountered in his patients, Dr Ness began exploring the realm of holistic medicine and, as they say, the rest is history.”

It seems many who turn to alternative medicine modalities have similar expressions of frustration, but the reality is we all do. Some practitioners though can more readily shed the constraints of the rigors of science based discipline. It seems there forms a disconnect between expanding ones knowledge regarding the process of disease- its natural history, and the earnest wish to do something- to heal. The danger here is that a practitioner risks crossing a line where reality becomes imaginary; not good for medicine.

Right away, there is an illicit assumption that there is something more beyond “mainstream” medicine.This may be a yearning to reach out for the human component of medicine- but CAM is not the way. Indeed, I have felt the attraction and allure that “another way of knowing” might expand my reach as a healer. Unfortunately, this is a road that leads to anecdote, testimony, and belief; the pillars of a postmodernist version of healing and a house of cards.

According to the website, Dr Ness has authored articles in journals and magazines such as the Journal of Avian Medicine & Surgery and the Journal of Small Exotic Animal Medicine. He has also published in veterinary texts such as Veterinary Clinics of North America, the Exotic Animal Formulary, 3rd ed., and Ferret, Rabbits, & Rodents Clinical Medicine & Surgery, 2nd ed.

Along with all this impressive publication history, the web site has an index that offers a dizzying platter of alternative and complementary modalities- you name it, they do it. The topics include Veterinary Chiropractic, Veterinary Acupuncture, Western Herbal Therapy, Nutraceutical supplements, Bach flower therapy, Aromatherapy, Therapeutic Touch (energy therapy), Homeopathy, and Clinical Nutrition…..enough to see that this practice is indeed deep into the “mystic.”

This background information provides a pretty good picture of what this added chapter in “Clinical Avian Medicine” will discuss and the likely orientation and mindset of the author- and it does not disappoint. It also serves to illustrate how CAM modalities can insidiously creep into unlikely realms such as an apparently well done veterinary medical text.

Right off, there is an editors note stating:According to the American Holistic Veterinary Medicine Association, ..."the word "holistic" means taking in the whole picture of the patient – the environment, the disease pattern, the relationship of pet with owner – and developing a treatment protocol using a wide range of therapies for healing the patient."

Here in a brand new textbook (2007), there appears the familiar attempt to co-opt a part of normal practice in medicine - that of taking in the "whole" picture- and this even before the chapter begins. At the same time, a wedge is cleverly and implicitly made between general “mainstream” and a more complete “holistic” practice. That this “holistic” definition practically defines the essence of evidence based practice and the classic medical study of Semiology (study of signs and symptoms) is not considered.

"This includes integrating conventional protocols with possible complementary and alternative therapies – whatever are the most efficacious, least invasive, least expensive and least harmful paths to cure."

When one describes efficacious….least harmful paths to cure from a relativistic viewpoint as in CAM, it is difficult to ascertain what works and what doesn’t. When you blur the boundaries between “conventional” medicines -another false descriptor of science based medicine, and blend in the quagmire of untested, unproven, and implausible therapies the door opens to anarchy, delusion, and more harmful paths.

"Integrative therapies constitute a very wide range of disciplines from around the world. Many of these therapies can be utilized to treat pet birds, although none was specifically developed for avian species. Because birds have not been domesticated, remaining genetically and evolutionarily close to their wild counterparts, they tend to be very responsive to natural therapies. Certain modalities, such as chiropractic and acupuncture, must be modified for differences in avian anatomy and physiology. Others can easily be extrapolated to pet birds from human or other mammals with only slight adjustments. Some examples include homeopathy, flower essences, nutriceuticals and many herbs. Other therapies, such as diffusion aromatherapy, must be used with caution to avoid toxic reactions. Integrative therapy in birds has existed for centuries in poultry medicine through acupuncture and herbal therapy in China."

This paragraph is a mish mash of contradictions, assumptions, unsupported claims, and allusions to implausible therapies such as homeopathy and aromatherapy. For example, the second sentence claims that integrative therapies can be used in birds, though none have been specifically designed for them. However, the last sentence in this paragraph claims that integrative therapy in birds has existed for centuries??

Chiropractic and acupuncture are vitalistic (qi, energy flows) and unproven modalities in humans. To contemplate extrapolating for instance, the concept of the subluxation- never proven to exist- to the avian species pushes the boundaries of reason. There is no historical evidence that acupuncture, as practiced centuries ago was ever created with animals in mind in China. Nutracueticals are a vastly overrated jumble of compounds that have very little evidence to back medical claims in humans or animals.

This is a simple reaction to just a few paragraphs of the introduction. There follows a discussion of different CAM modalities and their supposed application in birds. The goal here is to relate the fact that these types of publications are making it into more serious texts. More alarming is the fact that critical evaluation and judgment have been suspended and ignored somewhere along the publishing process. Authors, publishers, and others of the scientific and medical community need to urgently consider the incipient encroachment of non- science based and ineffective therapies that pretend to “integrate” into the fold of legitimacy without earning it.


BB said...

My DH and I are faculty at a med school and we see the same thing. We say when the "alternative" medicine shows up as part of the regular curriculum at med school, it's no longer alternative! More frightening is the fact that alternative therapies are cheaper for insurance companies so they are covered, whether or nor they work. And the placebo effect of empowerment can be heady - until it turns deadly (delayed treatment for cancer, eg).

Walter Brameld IV said...

"Because birds have not been domesticated, remaining genetically and evolutionarily close to their wild counterparts, they tend to be very responsive to natural therapies."

That made me laugh out loud.

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