Wednesday, January 30, 2008

Complementary and alternative veterinary medicine and vet schools- the darkening (part 2)

The problem with pretending

Today our clinic received some rather disconcerting news. The local specialty veterinary hospital will be sponsoring a visit by a veterinary behavioral consultant. This, in and of itself is no big deal- on the contrary. Veterinary medicine is in need of more professionally trained doctors in this important and somewhat neglected specialty. The degree of dissonance between what a human assumes and the natural behavior of their beloved pets are often at odds. The right kind of advice can be an eye opening and gratifying experience amplifying the wondrous human/animal bond and be a life saver –literally- for some.

However, what concerned us in this case were the other specialties this fine consultant professes to specialize in- acupuncture and chiropractic. Indeed, this is an even larger and more insidious dissonance than animal/human behaviors “gone bad”. It reflects a deepening problem in veterinary medicine.

It’s not so much that a person can somehow include paradoxical ontologies in their head- being scientifically trained yet at the same time dole out non-science without skipping a beat. That is an unfortunate but common malady.

There is a deeper and more pervasive problem here. It is that a specialty hospital is endorsing this doctor, and by default –whether they realize it or not- Complementary and Alternative Veterinary Medicine (CAVM)1 giving it rubber stamp approval. This is a looming problem in medicine of any kind because it mixes non-science with science in a bastardization known as “integrative medicine”.

The public and even generalist veterinarians with their busy schedules may put more weight on this kind of endorsement than is deserved. They, like the specialty hospital might not have paused for a moment to ask important questions regarding the current evidence base for acupuncture and chiropractic. Nor for that matter, would they have delved into the nuances of the placebo effect, the natural history of disease2, or the history of medicine. There may be, as in this particular case, a tacit approval from the local veterinary college adding to the veneer of legitimacy. Given these endorsements- who would spend the time and energy to put out a skeptical voice?

It seems little thought is given to the implications of accepting this integration of science with non-science. It doesn’t seem to occur to people that many “integrative” veterinarians tend to fluidly combine therapeutic modalities in unique and difficult to repeat ways. It isn’t uncommon to find them practicing in a “because it works for me” paradigm where well known and accepted methods of practicing medicine are fused together with an assorted jumble of acupuncture, good advice, and/or some type of nutritional support or therapy with the goal to, for example, attain some imagined “synergistic” effect.

The bottom line is that this type of medicine crosses a line. It goes beyond accepted standards by taking an experimental/experiential approach to medicine to extremes- not relying on the method of science for authentication. It is reminiscent of a postmodernist philosophy where delusions of “relativeness” coalesce with flatly wrong interpretations of reality. It is a realm where undetectable energies exist everywhere and a plethora of “dysfunctions” inhabit imaginary maladies- it is a belief paradigm.

To be clear, beliefs have a place in a socio-cultural context and might be helpful for some practitioners. There is room for these issues in the realm of evidenced based medicine when you take into account the three spheres of influence (practitioner experience/"bedside manner" , client/patient needs, and current best evidence).

One can believe whatever one wants to. On the other hand, when it comes to medicine these beliefs take a back seat and are subservient to evidence, plausibility, and reality. Practicing non-science based modalities in this context makes little sense. This is the problem with pretending.

Just because everyone is doing it doesn’t make it right

The sad thing about these scenarios; where pseudo-science -almost under the radar- becomes “integrated” and accepted into mainstream consciousness, is that it represents a step backward in medical progress.

Based on its relative success (due to genuine interest & some veterinary apathy) with the public, CAVM has also been steadfastly calling for a place at the table of accepted practice. In this regard, the foothold CAVM has attained in academia is a sign of its success.

Unfortunately, there is an even larger form of dissonance occurring at these levels than the previously described instances. Just how CAVM has begun to infiltrate the mostly science based realm of veterinary medicine probably involves a complex interplay between educational issues, funding needs, political pressures, history, and public demand to name some.

For example, anecdotally some in academia have noted that college students seem to have a lack of fundamental critical thinking tools and are therefore less well equipped to handle an important exptectation in university level academics- learning how to "think on ones feet". Add to this the caveat that state funding for school budgets has been decreasing thus increasing the pressure to get it where you can – to follow the money so to speak. This is a recipe for disaster.

As a result, graduate schools may be bending to the wants and whims of incoming classes more than ever before which may affect the type of educational curriculum that is offered. This would include catering more to applying students (and their tuition) which means –according to one academic voice- giving them more of what they want rather than what they need- not good in a credulous society.3

The following quotes highlight the seriousness of these deeper problems. It is not a huge leap to realize how the veterinary profession can be negatively impacted as a result.

"A number of reports in the past several years have raised serious concern about America’s ability to compete with the rest of the world going forward, particularly in science and technology. Sadly, as with the issue of greenhouse gases, this problem will get worse before it gets better. If we begin today, it will take us nearly a generation to develop the needed scientists, engineers and mathematicians. The children currently in U.S. schools are performing badly when measured against children in other industrialized nations, so our pipeline has slowed to a trickle. Children in elementary school must first catch the excitement of science and mathematics, and by middle school, be ready to do well in algebra, in order to be on track to take more advanced mathematics and science courses in high school."

Elisabeth Muhlenfeld, President, Sweet Briar College

"One cannot be a fully engaged citizen in this or any other democratic society without having at least a basic familiarity with the scientific thinking related to such subjects as global climate change, community health, and technology."

Brian Rosenberg, President, Macalester College

"Several recent reports from the National Academies, notably “The Gathering Storm” and “Beyond Bias and Barriers”, have highlighted the increasing dangers facing U.S. science. Our national science efforts are perceived as less and less relevant to America’s youth, and careers in science, technology and engineering are not attracting our most talented."

Phoebe Leboy, President, Association for Women in Science

Whatever the reasons for CAVM’s successful inroads into academic colleges it needs to be made clear that they are gaining ground in areas that imply an acceptance into the mainstream it has not earned and this is a profound development.

Defenders of CAVM often take on a “tu quoque” (you did it too) position claiming that much of “evidence based medicine” is in fact not evidenced based and that CAVM could comfortably fit into this area of veterinary practice and education. This reasoning is based on false assumptions and leads to a slippery slope because CAVM is composed of a spectrum of practices that include marginally plausible (some herbs) to completely implausible (homeopathy, chiropractic) therapies.

These modalities are not being taught as interesting socio-cultural phenomena in a philosophy of science class. They are –one way or another- being stitched into the fabric of everyday academic practice and consciousness.

That CAVM is, for the most part, fundamentally incompatible with evidence- based veterinary medicine seems to go unnoticed. This is a dangerous trend for reason and science and will hurt veterinary medicine in the long run.


1) Or whatever you want to call it.

2) A good review of these issues can be found in the wisdom of Oliver Wendel Holmes:

Suppose, then, a physician who has a hundred patients prescribes to each of them pills made of some entirely inert substance, as starch, for instance. Ninety of them get well, or if he chooses to use such language, he cures ninety of them. It is evident, according to the doctrine of chances, that there must be a considerable number of coincidences between the relief of the patient and the administration of the remedy. It is altogether probable that there will happen two or three very striking coincidences out of the whole ninety cases, in which it would seem evident that the medicine produced the relief, though it had, as we assumed, nothing to do with it. Now. suppose that the physician publishes these cases, will they not have a plausible appearance of proving that which, as we granted at the outset, was entirely false? Suppose that instead of pills of starch he employs microscopic sugarplums, with the five million billion trillionth part of a suspicion of aconite or pulsatilla, and then publishes his successful cases, through the leaden lips of the press, or the living ones of his female acquaintances,-does that make the impression a less erroneous one? But so it is that in Homoeopathic works and journals and gossip one can never, or next to never, find anything but successful cases, which might do very well as a proof of superior skill, did it not prove as much for the swindling advertisers whose certificates disgrace so many of our newspapers. How long will it take mankind to learn that while they listen to "the speaking hundreds and units, who make the world ring" with the pretended triumphs they have witnessed, the "dumb millions" of deluded and injured victims are paying the daily forfeit of their misplaced confidence!”

3) Also in some cases, the onus to comply with the wishes of large donors may play some role in the development of accepting non-science and unproven modalities so uncritically into veterinary teaching hospitals.

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