Tuesday, February 19, 2008

Should Complementary and Alternative (aka Integrative) Veterinary Medicine be taught in vet schools?

The short answer is NO.

The core of today’s veterinary education has, for good reason, been built upon a vast web of interconnected and established science. With this in mind, the belief in the need to teach Complementary and Alternative Veterinary Medicine (CAVM) at veterinary schools immediately brings to the fore a looming dilemma.

Science is a powerful filter and provides a foundation from where medicine has discovered truly effective therapies. It has proven an excellent tool for excising the useful from the useless (i.e.; statistical significance vs. fanciful testimony and tenuous beliefs). To date, science is the only way to assure that medicine stays on the straight and narrow and optimizes its effectiveness. Without it, no matter how well intentioned, the practice of medicine falls prey to a world of delusion and fairy tales.

Medicine develops and refines innumerable modalities and therapies based on accumulating evidence. Though this evidence may vary in robustness and quality it is always grounded in science. In general, you can’t skip over this basic filter and practice any kind of “medicine” that suits your fancy- that usually leads to the realms of metaphysics and belief.

The machinery for seeking and establishing effectiveness in medicine assumes the plausibility of what is being studied. If it is not a plausible modality the best the research can offer is often just garbled noise -equivocal statistical data- that is neither here nor there. This is something novice students are not being taught and herein lays the problem.

Medical education needs to emphasize critical thinking tools and teach aspiring doctors how to navigate within the depth of established science based medicine before tackling fringe areas such as alternative medicine.

If a student sees a CAVM modality as part of the curriculum of veterinary education the assumption is made –whether these young minds know it or not- that there must be something to this particular practice. It falls under the rubric of an accepted standard of practice and therefore is a part of general practice. This simply is not the case because if it were there would be no “alternative” in alternative medicine.

When it is implicit to students that academia tolerates alternative medicine as “just another way” you compromise these students science based education. Dr. Colquhoun points out that “Once any treatment is shown beyond doubt to be effective, it ceases to be ‘alternative’ and becomes just like any other part of medical knowledge. That means that ‘alternative medicine’ must consist of unproven treatments.” It is not the domain of academia to be teaching unproven treatments to young students.

Introducing unsubstatntiated non science based modalities and therapies that might have some plausible basis (acupuncture), no matter how scientific they might appear, to these aspiring professionals before they are ready to critically evaluate them is a bad idea. It opens the doors to a Pandora’s Box as other alternative medical paradigms (i.e.; homeopathy, energy medicine) will inevitably also demand a place in academia.

This is reminiscent of “teaching the controversy” of evolution that intelligent design advocates support so vehemently. This red herring demonstrates an alarming lack of actual scientific knowledge regarding proper methodology and smacks of dogma and pseudoscience.

Dr. Colquhoun points out an interesting observation with respect to the curious confounding of pseudoscience and science ("quackademics") in medical schools. He states that “All these outfits have two things in common. They all claim to be scientific and evidence- based, and none has produced any real evidence that any of their treatments work.”

This is one of the weaknesses to claiming that the CAVM offered in veterinary schools is being scrutinized under the framework of science. If they were, they would be pulled out of the cirriculum or possibly relegated to research. As noted though, you can't use evidence-based research very well when the underlying science is suspect.

In addition, the fact that CAVM has become a fairly popular practice among some people and practitioners outside academia is not an excuse to teach it in school. This is an appeal to popularity and gets medicine no-where.

It has been noted that veterinarians need to be more non-judgmental and not stigmatize CAVM; implying a rush to judgment and a bias against CAVM. In some cases, the implication goes; this may threaten a client/doctor relationship and could lead to the loss of clients who might move entirely to alternative medicine. Medicine needs to “adapt to changes brought about by societal influence” and the popularity of CAVM –another effective way of doing medicine- needs to be accepted, embraced, and taught in school. This is threading misrepresentation with populism- a dangerous mix.

Fallacious reasoning like this creates false realities and gives little credence to the ability of a skilled practitioner and the influence they can have on client/doctor relationships. The opportunity to communicate and teach science based medicine is taken seriously my many practitioners.

They feel obligated to create a comforting, supportive, and trusting bond that openly and honestly approaches the situation at hand. Practicing the best science and evidence based medicine they can goes hand in glove with this bond and most clients will respect that.1

Though, there may be emotionally charged biases against CAVM at times, the fact remains that -for the most part- it is not science and it is definitely not a substantiated medical modality. Disregarding or not recommending CAVM if it does not fulfill the requirements of science and evidence based medicine is not being biased.

Learning how to communicate and interact empathetically with people is by far one of the most important skills a veterinary student can learn. This is what should be stressed more in university curriculums than teaching pseudo-science. On the other hand, future practitioners need the critical thinking tools and knowledge to clearly and dispassionately discuss why a given CAVM modality may not be the most ideal approach to a given problem. This can be done without creating the impression that CAVM is or should be an accepted part of scientific medicine.


1. If a client elects to proceed with a CAVM modality then it’s their decision, and though sometimes difficult, practitioners should strive to continue working with these clients if possible and promote what is in the animal’s best interests.


David Colquhoun said...

I couldn't agree more with what you say. it would be very interesting to hear about specific examples of what is taught in vet schools.

Incidentally, I'm grateful for the link but it is now DC's Improbable science ( http://dcscience.net/ . The "quack page" link goes to tje old page, no longer updated.

Anonymous said...

I once read about how a master musician in India was called in to play music to a disturbed elephant in order to calm it down.

Perhaps "alternative" methods should not be taught.

But then again, to paraphrase Shakespeare , there is far more under heaven and earth than what your "philosophy" can account for.

That having been said please check out this unique understanding of the non-humans and everything altogether.

1. www.fearnomorezoo.org
2. www.dabase.org/broken.htm
3. www.dabase.org/christmc2.htm
4. www.dabase.org/dht6.htm

wandering primate said...

If you mean animal welfare on that site- that's always good. The web of life is indeed a beautiful thing- but "beleifs" about its meaning don't always reflect reality.

You're implying that science is just a "philosophy"- not so (though philosophers will philosiphize about it!). It is more like a method -the best we have to get to any semblance of truth...as Sagan once noted.

Science is open ended, self correcting, and ever inquisitive..."spirituality" Spinoza style...

As for understanding the "human condition" have a look at some of the writings of Kahlil Gibran...

BTW, I know a cowboy who can quiet many an excited horse with just his movements- no magic involved, no alternative paradigm needed.