Monday, January 28, 2008

Complementary and alternative veterinary medicine and vet schools- the darkening (part 1)

The beginnings of an anti-enlightenment era?

Over the past several years, there has been a resurgence of intuitive and subjective practices in the world of veterinary medicine that seems to have paralleled what has been going on in the human realm. Many of the posts on this small blog have, in some way or another, repeatedly lamented the slow insidious dilution of reason that pops up in many places in the world of medicine.

To some, this might seem like a broken record and they may be right. I might touch on some particular pseudo-medical related topic and discuss some of the crucial issues that make them disturbing themes. Through it all though, there is a continual thread of discussion that belies a very basic need medical practitioners and patients need to exercise.

It is simply that critical thought and reason are irreplaceable tools without which the allure of “crank” science and belief based medicine -along with the dangers they pose- would quickly begin to overwhelm whatever truth we have thus far managed to eek out over the last one hundred years.

At times, this is indeed a theme that tends to go around in circles. The same old thing again and again, one dubious practice after another all sharing the same neglect towards critical evaluation while bathing in self deception. On the other hand, because of this very problem, it is necessary work to combat this at a time- ever more so today- when there seems to be a slide back into the slime of pre-enlightenment medicine; a place of increasing delusion where snake oil and charlatans all have equal say with real medicine and effective care is drowned in a sea of anarchic turbulence.

In an effort to grasp just how bad things might be, it is important to gauge to what degree this creeping anarchy (better known as CAM and CAVM) has succeeded in penetrating into the foundations of today’s medicine. A good place to start would be to monitor the prevalence of these modalities -not just across the realm of general practice where it thrives for the moment- but in some critical and pivotal place where CAVM could directly influence the concept of medicine itself.

What could be more crucial a place than the very halls of academia- where young professional minds begin their journey as physicians and veterinarians? In fact, Orac and Dr RW have long warned of this creeping infiltration of CAM into the halls of medical academia and associated institutions. The growing list of human medical institutions that Orac has been compiling is a sobering account (the academic woo aggregator) that this might be- at some level- a real threat to evidence based medicine and not just a fringe issue. Putting together this list is important as it begins to establish non-science and pseudo-science based medical modalities as something real in this important setting and therefore a topic well worth discussing.

It is in the fine tradition of copying a great idea that I will attempt to create a list of those veterinary institutions that may have some type of pseudo-scientific modality infiltrating their “sacred” halls.

It seems the job at hand might be easier as there are far fewer veterinary schools (27) in the US than medical schools. So, in the interest of shedding light on the level of CAVM involvement at US veterinary universities along with some modicum of morbid curiosity here is the pseudo-science in academia “veterinary academic woo aggregator” (This is only a cursory and partial list focusing mostly on teaching hospitals, somewhat on continuing education seminars- which may reflect university support, and to a smaller extent student clubs).

1) Colorado State University College of Veterinary Medicine

2) Iowa State University College of Veterinary Medicine

3) North Carolina State College of Veterinary Medicine

4) The Ohio State University College of Veterinary Medicine (externships)

5) Oregon State University College of Veterinary Medicine (continuing education)

6) Tufts Cummings school of Veterinary Medicine

7) UC Davis College of Veterinary Medicine Student Programs

(The holistic veterinary medicine club)

8) University of Florida Veterinary Medical Center

9) University of Minnesota Veterinary Medical Center

10) University of Pennsylvania School of Veterinary Medicine

11) The University of Tennessee College of Veterinary Medicine

12) Veterinary Medical teaching Hospital University of Wisconsin-Madison

13) Virginia-Maryland Regional College of Veterinary Medicine (elective complement med)

14) Washington State University College of Veterinary Medicine (Student Chapter)

College of Veterinary Medicine Student Chapter of the American Holistic Veterinary Medical Association

15) Cornell University College of Veterinary Medicine

This list -even if you take out the two student chapter associations- represents 48% of the veterinary universities in the US. Granted, at this early point, the veterinary academic woo aggregator only notes the existence of CAVM in academia- not the level or intensity.

Over all, it seems that infiltration of CAVM is not uncommon in academic veterinary hospitals, though it is often relegated to less obvious pain management or "support" areas- Colorado State University being one of the exceptions. However, the trend seems to be for “integrating” CAVM more into the fold. Whatever the case may be, the fact these unsubstantiated modalities exist in some form so insidiously in academia should be cause for increasing concern if not down right alarm.

CAVM and vet schools- the darkening (Part 2)


Suzanne Z, DVM said...

I hear that my alma mater, Cornell University/NY State College of Veterinary Medicine, has succumbed to the woo as well in its curriculum. I'm appalled.

wandering primate said...

Unfortunately, you are right! Got it now.

Thanks for the input.

Random Muse said...

First a minor technical note. University of Pennsylvania is a private school and not affiliated with Penn State. Penn State has no veterinary program.

Secondly I agree with your exposition of the dangers of CAM but how much of its current popularity would youi assign to the increasing commercialization and corporatization of conventional veterinary medicine. I've known many patients who preferred CAM because they felt like the practitioner was actually paying attention to them and not just a bottom line.

Thirdly how do you think the scientific process could be effectively used to evaluate CAM therapies especially considering that practitioners and manufacturers would have no financial stake in the results. For example proving the efficacy of acupuncture is a tough study to fund since no one will make any money off it.

wandering primate said...

1) Thanks…corrected.

2) I think you’re quite right in pointing out the sometimes lamentable state of the doctor/client/patient bond. This is probably one reason people often go to CAVM. However, the current and changing state of the veterinary industry, how it is structured, and how it might impact doctor/client bonds is a different problem (though an important one). The bottom line –at least in my experience- is that there seems to be a deep conceptual problem with very bright and sharp clients perceiving CAVM as an established “science”. This gives legitimacy it hasn’t earned and hints at even deeper societal issues (gaps in critical thinking, science illiteracy...).

3) First of all many CAM and CAVM therapies reflect differing tautologies- alternative philosophies of science- and claim to describe a version of reality. As such, they need to walk the gauntlet of predictability, falsification…ect. That many don’t even fall into the rubric of plausibility is a problem. The scientific process here - though sometimes cumbersome- is generally more interested in getting to some type of truth. I’m not so sure linking this general process, practitioners, manufacturers, and financial gain is as tight a package as you imply.
Granted, if you get down to the level of special interests (pharma, vitamin & suppl co.) there are often significant problems (bias, file drawer effect…) and you need a sharp eye. Most practitioners want to be effective and there’s a balance between “credulity” and “cynicism” as we try to make a living.
As for acupuncture (AP) part of the problem is that it seems to have a big placebo/bias component making it hard to tease out anything real- same for a lot of other CAVM modalities- but research can and is getting done. Regarding AP research; there is plenty of opportunity for funding- from university research programs, NIH (NCCAM), and private sources to name some. Also, research gets done for more than financial interest- especially if the science is solid. Anyway, there is huge financial potential to establishing a real benefit to a CAVM modality- not to mention a possible nobel. That said people are making lots money off of CAVM in spite of the lack of evidence!