Case studies in debunking fallacious thinking: anti-vaccine apologists and acupuncture "effects"considered

Here are three fabulous examples of lucid and clear analysis in action against the dogma and fallacy of ideological thought - critical thinking at it's best.

Respectful Insolence: Can we finally just say that acupuncture is nothing more than an elaborate placebo? Can we?

Heal Spiel: Response to antivaccination parent

Neurologica: Some follow up on migraines

These excellent fellow bloggers confront psuedo-science with clear, referenced, factual and reality based discussion cooly eviscerating delusional thinking; whether confronting antivaccine supporter claims or analyzing putative acupuncture "effects".

Very refreshing and stimulating...think I'll do a post on an animal related psuedo-science issue soon.

Elevating Science, Elevating Democracy

Very nice and well written piece in the New York Times.

"The knock on science from its cultural and religious critics is that it is arrogant and materialistic...So the story goes...But this is balderdash. Science is not a monument of received Truth but something that people do to look for truth."

Statistical Literacy Guide

DC's Improbable Science has an interesting link -the Statistical Literacy Guide- located in the UK commons library archive regarding the oft misunderstood and abused science of statistics.

This is a great read and introduces the reader to many of the nuances of statistical analysis and how these important tools can be inappropriately spun "a la politico" into down right meaningless and vacuous interpretations.

A very helpful piece for those of us trying to tease out real meaning from a sea of confusion regarding "new" (or old) research purported to "prove" or support grandiose claims that pop up from most every sector in the medical and -especially- the psuedo-medical world.

Medicines that contain no medicine and other follies

David Colquhoun wrote a very nice article regarding the blurring between "alternative medicine" and outright quackery and self delusion. This is an important statement in the struggle to redirect all too limited funds towards more appropriate areas of medical research.

It also brings to the fore a telling problem for Complementary and Alternative supporters. They just don't know when to call off or discontinue a modality when there is little or no supporting evidence of efficacy.

Some of the commentators I read on this humble blog seem to exude a mix of active denialism, ignorance or mistrust of scientific methodology and a curious rigid undergirding of belief based opinions not very amenable to objectivity.

Indeed, many in the CAM field defend their particular fixations (be it acupuncture, homeopathy, nutritional supplement...etc.) claiming "more studies are needed"ad infinitum, that you just can't properly test it -when you can if it's real, that it's "complicated" (appeal to complexity) or "you do it too" accusations (Tu Quoque).

They very commonly support demands and claims with an astounding quagmire of classical fallacious reasoning (dare I say mental masturbation) and resist reality and science based information - especially if it is unsupportive of their cause.

Dr Colquhoun nicely sums up some CAM modalities as follows (I'm sure to the shagrin of beleivers) thusly:

"Homeopathy: giving patients medicines that contain no medicine whatsoever.

Herbal medicine: giving patients an unknown dose of a medicine, of unknown effectiveness and unknown safety.

Acupuncture: a rather theatrical placebo, with no real therapeutic benefit in most if not all cases.

Chiropractic: an invention of a 19 th century salesmen, based on nonsensical principles, and shown to be no more effective than other manipulative therapies, but less safe.

Reflexology: plain old foot massage, overlaid with utter nonsense about non-existent connections between your feet and your thyroid gland.

Nutritional therapy: self-styled ‘nutritionists’ making unjustified claims about diet to sell unnecessary supplements."

At any rate, read the article when you can.

How can you recognize pseudoscience?

What is it?....How can I recognize it?

From the Pseudoscience blog:

"A pseudoscience is a belief or process which masquerades as science in an attempt to claim a legitimacy which it would not otherwise be able to achieve on its own terms; it is often known as fringe- or alternative science. The most important of its defects is usually the lack of the carefully controlled and thoughtfully interpreted experiments which provide the foundation of the natural sciences and which contribute to their advancement.

Of course, the pursuit of scientific knowledge usually involves elements of intuition and guesswork; experiments do not always test a theory adequately, and experimental results can be incorrectly interpreted or even wrong. In legitimate science, however, these problems tend to be self-correcting, if not by the original researchers themselves, then through the critical scrutiny of the greater scientific community. Critical thinking is an essential element of science -----------------------------------------

science	pseudoscience	comment
The primary goal of science is to achieve a more complete and more unified understanding of the physical world.	Pseudosciences are more likely to be driven by ideological, cultural, or commercial goals.	Some examples: astrology (from ancient Babylonian culture,) UFO-ology (popular culture and mistrust of government), Creation Science (attempt to justify a literal interpretation of the Bible), "structure-altered" waters (commercial quackery.)
Most scientific fields are the subjects of intense research which result in the continual expansion of knowledge in the discipline.	The field has evolved very little since it was first established. The small amount of research and experimentation that is carried out is generally done more to justify the belief than to extend it.	The search for new knowledge is the driving force behind the evolution of any scientific field. Nearly every new finding raises new questions that beg exploration. There is little evidence of this in the pseudosciences.
Workers in the field commonly seek out counterexamples or findings that appear to be inconsistent with accepted theories.	In the pseudosciences, a challenge to accepted dogma is often considered a hostile act if not heresy, and leads to bitter disputes or even schisms.	Sciences advance by accommodating themselves to change as new information is obtained. In science, the person who shows that a generally accepted belief is wrong or incomplete is more likely to be considered a hero than a heretic.
Observations or data that are not consistent with current scientific understanding, once shown to be credible, generate intense interest among scientists and stimulate additional studies.	Observations or data that are not consistent with established beliefs tend to be ignored or actively suppressed.	Have you noticed how self-styled psychics always seem eager to announce their predictions for the new year, but never like to talk about how many of last years' predictions were correct?
Science is a process in which each principle must be tested in the crucible of experience and remains subject to being questioned or rejected at any time.	The major tenets and principles of the field are often not falsifiable, and are unlikely ever to be altered or shown to be wrong.	Enthusiasts incorrectly take the logical impossibility of disproving a pseudoscientific priniciple as evidence of its validity.
Scientific ideas and concepts must stand or fall on their own merits, based on existing knowledge and on evidence.	Pseudoscientific concepts tend to be shaped by individual egos and personalities, almost always by individuals who are not in contact with mainstream science. They often invoke authority (a famous name, for example) for support.	Have you ever noticed how proponents of pseudoscientific ideas are more likely to list all of the degrees they have?
Scientific explanations must be stated in clear, unambigous terms.	Pseudoscientific explanations tend to be vague and ambiguous, often invoking scientific terms in dubious contexts.	Phrases such as "energy vibrations" or "subtle energy fields" may sound impressive, but they are essentially meaningless.

Detoxin' your wallet dry!

...on todays snake oils
Steven Novella at Nuerologica blog has -as usual- an excellent take down of some really juicy pseudoscience and related hubris that can only be described as classic scam artistry.

He notes "There is a cycle to the snake oil market - like the fashion industry. Words and claims come in and out of fashion, used for marketing impact rather than scientific accuracy. Some words, like “natural” and “energy” have staying power, while others last for a time and then may fade, but can come back into fashion like wide ties.... Recently “detox” is all the rage."

Dr Novella notes that the Sense about Science group is in the forefront of taking down the ridiculous and spurious claims purveyors of "detox" nostrums blantantly trumpet to a sadly creduluos populace.

As their Debunking Detox pamphlet puts it:

" The multi million pound detox industry sells products with little evidence to support their use. These products trade on claims about the body which are often wrong and can be dangerous."

Dr Novella concludes his post noting that "What the marketers of detox products have done is made the term “detox” meaningless - actually the term now is nothing but a red flag for snake oil."

On a related note, I was recently introduced to a "super juice" supplement product called Goji juice. Of course it's supposed to be nothing short of some miraculous nectar from the gods.

Not!

Under closer scrutiny, other than being made from dehydrated goji berrys from China, this product does not live up to the rather outlandish claims of many of its distributors (looks like fodder for a future investigative post!).

In fact, these wild statements are reminsent of the false hype and hyperbole from the Mangosteen crowd. It's the same old pimping up of some "exotic" special elixir....basically fruit juice in a golden wrapper. An interesting skeptical blog seeks to take this issue head on. I wish them well!

"Alternative" Medicine and Bullshit

...either way, the stink still comes through

"The Touch That Doesn't Heal" is a very insightful article regarding the rather sad tale of the insiduous and undeserved penetration of unproven...and disproven (within the realm of reason) "alternative' or "integrative" therapies into more mainstream medicine.

Steve Salerno nicely articulates the problem of incorporating therapuetic modalities built on smoke and mirror "logic" into the real world of disease, limited funds and the false assumptions of efficacy proffered by CAM (Complementary and Alternative Medicine) to a credulous population (many doctors included).

"...A survey of 32,000 Americans by the National Center for Health Statistics, released earlier this month, suggests that 38% of adults use some form of "complementary and alternative medicine," or CAM -- now aggressively promoted for everything from Attention Deficit Disorder to the Zoster virus. The survey polled consumers on 10 provider-based therapies -- for example, acupuncture -- and 26 home remedies, such as herbal supplements.

On the other hand, it should be noted that all is not lost. The reality of CAMs inroads may not be as entrenched as appears as suggested by Mark Crislips excellent post at the Science Based Medicine Blog . Still, there is a critical disconnect -a collective cognitve dissonence- opening a "back door" and for non-science based practices to garner a legitamacy that doesn't exist. You can use all the perfume you'd like...but bullshit is bullshit and that ol' smell eventually comes through!

Salerno continues "...This should be a laughing matter, but it isn't -- not with the Obama administration about to confront the snarling colossus of healtallowing h-care reform. Today's ubiquitous celebration of "empowerment," combined with disenchantment over the cost, bureaucracy and possible side effects of conventional care, has spurred an exodus from medical orthodoxy. As a result, what was once a ragtag assortment of New Age nostrums has metastasized into a multibillion-dollar industry championed by dozens of lobbyists and their congressional sympathizers..."

"Indeed, one of the great ironies of modern health care is that many of the august medical centers that once went to great lengths to vilify nontraditional methods as quackery now have brought those regimens in-house. "We're all channeling East Indian healers along with doing gall-bladder removal," says Arthur Caplan, director of the University of Pennsylvania's Center for Bioethics. Mr. Caplan harbors no illusions about what's behind the trend: "It's not as noble as, 'I want to be respectful to Chinese healing arts.' It's more, 'People are spending a fortune on this stuff! We could do this plus our regular stuff and bill 'em for all of it!'..."

"...Meanwhile, CAM has secured its own beachhead within the National Institutes of Health in the form of the National Center for Complementary and Alternative Medicine (NCCAM). "Special commercial interests and irrational, wishful thinking created NCCAM," writes Wallace Sampson, a medical doctor and director of the National Council Against Health Fraud, on the Web site Quackwatch.com. And Sen. Tom Harkin (D., Iowa), who credited bee pollen with quelling his allergies, was single-handedly responsible for the $2 million earmark that provided seed money for NCCAM, chartered in 1992 as the Office of Alternative Medicine. Despite the $1 billion spent in the interim, the center has failed to affirm a single therapy that can withstand the rigors of science..."

This article is well worth reading. One take away is that the battle for reason goes on...and on. Here's to a great year of critical thinking!

On occasion, I will be passing previous posts relating to evidence and science based veterinary medicine, complementary and alternative veterinary medicine and other pertinent skeptical issues to the Vetskeptics blog.

This is an attempt at consolidating veterinary & other medical information relating to skeptical information about CAM/CAVM that may prove useful and interesting in a more focused venue. Time permitting, some of these posts will be expanded upon. As always, posts from anyone interested in contributing (see vetskeptic blog) are welcome.

The Beyond the illusion post touches on some of the factors that confound and fool practitioners and others into thinking ineffective therapies work when they really don't.

Acupuncture: still no point to the point...

This has been a summer full of distractions and challenges needing a lot of attention. Add to that a touch of blog writer “blues” and you get a dry spell regarding postings. Consequently, this blog –not to mention the new blog baby - has been neglected and hungry for forward movement and novel discussion.

Hopefully, this little post will get things going again. All in all, this is a fun and gratifying way of expressing ideas and thoughts and helps to keep the mind sharp and attentive.

The following is a comment on my “Veterinary acupuncture” post that, although friendly and thoughtful, latches on to a few canards and fallacies in order to defend the concept of acupuncture as a viable medical therapy. Obviously, I disagree and felt compelled to write a quick response which follows the commentators blurb.

"Unfortunately there are far too many veterinarians, physicians and researchers who dismiss acupuncture as a hoax or as in this case lacking adequate scientific and clinical proof to warrant its use. Clearly the problem has been that clinical and scientific studies of acupuncture have lacked adequate controls. Without proper controls study results are nothing more than hearsay. However more recent scientifically controlled studies would argue that perhaps acupuncture therapy has merit. In this regard recent studies using microarray technology to examine acupuncture effects on gene expression in peripheral blood are no less than fascinating. For example Shiue et al (2008) have shown that acupuncture therapy significantly reduced allergic rhinitis symptoms, including nasal symptoms, non-hay fever symptoms, and sleep in human patients and this was accompanied by and alteration in the balance between T-helper 1 and T-helper 2 cell-derived proinflammatory versus anti-inflammatory cytokines in the blood. Such studies are paving the way for a more scientific explanation of acupuncture's effects. One only has to examine the recent fMRI studies of acupuncture effects on brain activity in humans and animals to conclude that acupuncture point stimulation has remarkable effects on brain activity compared to non-acupoint stimulation (see for example Napadow et al., Hum Brain Mapp, 2005). These are real effects and whether they underlie the ability of acupuncture to alter pain sensation in humans and animals remains to be proven with certainty, but nonetheless acupuncture has the capability to change brain activity. In our own studies we have found that acupuncture can prevent tumor growth if given at the very early stages of tumor cell proliferation. Conversely if acupuncture is applied later on after a tumor begins to grow, it significantly enhances tumor growth, which is why acupuncture is typically not recommended as a treatment for cancer. On the other hand acupuncture provides clear relief of pain in animal models of neuropathic pain and inflammatory pain. These effects are real folks and I have seen them first hand, so I refuse to believe that acupuncture is of no value in the medical community, be it veterinary or human medicine. There is evidence that acupuncture does not work in certain individuals and works well in others, so there is clearly individual variation in the ability of acupuncture therapy to work effectively. Taking all of this into account, I would argue that you shouldn't dismiss acupuncture until you have tried it!”

The real unfortunate issue is not that acupuncture is dismissed as a hoax, but that – even with a preponderance of disappointing evidence- this modality continues to expect unearned acceptance.

Though plagued with poorly designed studies that are often replete with equivocal results or laced with regional geographic bias, better designed acupuncture studies are out there. However, the news is not good for any real acupuncture effect. The infamous placebo –among other problems (i.e.; expectation, suggestion, counter-irritation, operant conditioning, and other psychological mechanisms) - continue to confound even “modern” acupuncture technique (that is to say; those acupuncture practices that use needling and claim no association with the ‘elam vital’, points, or meridians).

The studies you mention do not address a critical issue with respect to acupuncture- whether or not its putative effects exist. The attempt to correlate a claimed acupuncture effect to epigenetic influence puts the cart before the horse (and is reminiscent of what ‘nutritional supplement support’ advocates claim for a favorite herb, vitamin, or tonic du jour) and purported brain responses apparently observed by fMRI are interesting but it seems apparent that any mechanical puncturing of the dermis –on points or no points, shallow or deep- will effect changes.

There is little or no evidence that acupuncture is effective for any real medical disease (i.e.; neoplasm) nor, for that matter, for less well defined symptoms (including chronic pain, depression, allergies, asthma, arthritis, bladder and kidney problems, constipation, diarrhea, colds, flu, bronchitis, dizziness, smoking, fatigue, gynecologic disorders, headaches, migraines, paralysis, high blood pressure, PMS, sciatica, sexual dysfunction, stress, stroke, tendonitis and vision problems). Interestingly, promising and plausible mechanisms –if any- seem associated with completely different modalities that are confused with acupuncture (i.e.; TENS, psychosomatic, placebo).

Seeing acupuncture effects “first hand”, no matter how impressive, is simply anecdotal testimony and adds nothing to a scant evidence and science based foundation supporting acupuncture. In short, the accumulating evidence suggests most of the perceived beneficial effects of acupuncture are probably due to the power of suggestion and forms of the ‘placebo effect’.

Whether or not acupuncture is of any value to the medical community might be better discussed in a philosophy of science course. For example, acupunctures place might be better off in the realm of personal belief or preference (i.e.; priest or shaman) and well outside of medicine (If you believe in it, it will make you think you feel better – that’s your business).

As for having tried acupuncture…been there done that. I’ve also extensively observed its use in animals by certified veterinary acupuncturists.

Not impressed.

Vetskeptics blog

A blog baby!
This little blog project at wanderingprimate has always been about pondering on a rather wide breath of topics. Hopefully regular readers- if any- have enjoyed some of these posts as I have meandered- or wandered- about from topics in physics, medicine and other science related themes that have caught my fancy. As long as it is enjoyable, I plan to continue writing and perhaps broaden the scope a bit- touching more on other sciences and philosophy from time to time.

Along the way, I have managed to build up a fairly significant body of veterinary posts that have proven useful and may be of some use to others. With that in mind, I’ve decided to create a new veterinary specific blog site -Vetskeptics- with the goal of collecting these posts into an easier to access format and, at the same time, initiate a veterinary specific site that promotes critical thinking and skepticism.

My goal is to add to the scarce resources on the "ether" net for veterinary skeptics, or any animal lover tired of the pseudo-scientific blather out there. I hope to improve on some of the old posts and have new authors send in their own quality posts in an effort to put together a more collaborative site of like minded veterinarians, veterinary technicians, animal care-givers or any animal lover interested in sharing their thoughts.

If nothing else, it will be a nice skeptical reference blog. If you are interested in helping out, please have a gander at the site and drop me a line at (drg at vetskeptics dot com).

It could be a lot of fun!

Prions: mysterious shape shifters

Everywhere and nowhere

It is the strangest thing to see a vibrant and healthy Colorado bred elk begin to shrivel and waste away before your eyes. It is even more frustrating to feel that old familiar tinge of complete helplessness when the realization comes to you that chronic wasting disease has taken (CWD) hold of another victim. No matter how aggressive and careful you are there is literally nothing that can be done once this mysterious disease takes hold.

Thankfully, the incidence of this prion based sickness is relatively rare and slow to ravage whole herds. This is good as the best we can do to control CWD is to monitor it by testing the tissues of captive adult animals that have died or researching “test and cull” methods for eradicating it from wild herds.

The mechanisms that make this disease so bizarre and counter intuitive starts with the causative agent – a prion- a small protein structure without any nucleic acid. They are described as “small proteinaceous infectious particles which resist inactivation by procedures that modify nucleic acids.”

This is indeed beyond strange. The idea that a protein structure by itself can cause disease defied a lot of what was known about infectious disease. The infected animals are usually neurological and the disease is now classified into a family of “spongiform encephalopathies” based on the post mortem lesions found in affected mammals¹- of which most seem to have some version of this thing (table 1). They are all characterized by varying degrees of loss of motor control, dementia, wasting (paralysis) and eventually death.

Table 1 some prion diseases:

• Scrapie: sheep
• TME (transmissible mink encephalopathy): mink
• CWD (chronic wasting disease): muledeer, elk
• BSE (bovine spongiform encephalopathy): cows
• CJD: Creutzfeld-Jacob Disease: human
• GSS: Gerstmann-Straussler-Scheinker syndrome: human
• FFI: Fatal familial Insomnia: human
• Kuru : human
• Alpers Syndrome: human

An interesting historical anecdote regarding early prion research is touched on by Dr Shaun Heaphy lecturer at the University of Leicester “Kuru is the condition which first brought prion diseases to prominence in the 1950s. Found in geographically isolated tribes in the Fore highlands of New Guinea. Established that ingesting brain tissue of dead relatives for religious reasons was likely to be the route of transmission. They ground up the brain into a pale grey soup, heated it and ate it. Clinically, the disease resembles CJD. Other tribes in the vicinity with same religious habit did not develop the disease. It is speculated that at some point in the past a tribe member developed CJD, and as brain tissue is highly infectious this allowed the disease to spread. Afflicted tribes were encouraged not to ingest brain tissue and the incidence of disease rapidly declined and is now almost unknown.” This rather macabre custom did illustrate how this strange infection behaved and how it might work through a population of people.

Even more intriguing, these prions seem to be related to a normal and abundant cellular protein (PrPc) located on the membrane on run of the mill neural cells. These prion like structures have a different structural shape than infectious prions and are perhaps functionally linked with normal neural transmission, though no one really knows for sure.

Prions and these PrPc proteins seem to have species specific structures but these configurations are fairly similar across the board. This species specificity dramatically slows down cross species infections and makes such jumps far less probable, but not impossible- especially if there is a susceptible individual on the other end.

The prion varies in its structural three dimensional forms from the normal PrPc protein and it’s this structural difference that seems to make them so insidiously pathological. To make matters worse, it seems there may be genetically susceptible individuals that are more prone to having their own PrPc proteins “shape shift” into the pathological infectious prion by coming into contact with a prion (by the way, not all shape shifted prions are lethal).

Interestingly, that it is possible to eventually “transform” an infectious prion from one species to another susceptible species is a prime example of witnessing evolution “unplugged” right before our eyes. The ability of these prions to evolve structurally and in time come up with the right configuration to cross species without any genetic elements is remarkable.

As ERV puts it “How does something with the same amino acid sequence evolve??”. With respect to prion research being done by Dr Bartz she adds “The idea I pitched to Dr. Bartz (the idea he was already planning on pitching to the scientific community hehe, I iz smrt) is that prions operate like HIV-1. But instead of exploring sequence space like my HIV, his prions explore structure space. One protein exploring all possible structural configurations. It has an optimal configuration for minks, but needs to explore and find a more optimal configuration for ferrets.” Amazing stuff!

What does a normal PrPc do? What makes its shapeshifted version so lethal? According to the Prion Institute “Studying how and why proteins misfold and the genetics, diagnoses and treatments of prion diseases will have positive implications for both animal and human health issues.”

Indeed, the possible breakthroughs for understanding the prion phenomenon may have staggering implications towards not just understanding the spongiform encephalopathies, but other degenerative neural diseases (i.e.; Alzheimer) as well as shed light on normal brain physiology. All this from a tiny inert blob of protein- reality is indeed far stranger than fiction.

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1) Visible end results at post-mortem are non-inflammatory lesions, vacuoles, amyloid protein deposits and astrogliosis.

Pet Foods: notes from the experts

Towards a greater understanding (part 3)

The idea of government oversight has always been a bit of a touchy subject in the United States; a country known for an independent citizenry strong on "freedom of choice". This admirable quality though can sometimes create a lot of tension. The struggle to balance between allowing an indiscriminate free flow of goods and the need to protect the public has been the source of many regulatory headaches. Depending on the subject in question, there are varying degrees of expected government intervention the public expects.

For example, entertainment is one thing and medical care another. The intensity of control between the two is very different. Since the early nineteenth century society decided to filter a haphazard and dangerous quackery filled world of medicine through the tried and proven framework of science. Those practices that couldn’t pass muster (i.e.; homeopathy and bloodletting) fell out of favor or were disregarded. Though, unfortunately today there is a resurgence of non-science in medicine, this framework has worked extremely well in disseminating effective medicine to many more people than would otherwise have been possible.

This basic concept (though not nearly as tight as in medicine) is also utilized in the oversight of food safety for animals in the United States, but the current regulatory system is probably not what most people imagine.

Last years pet food recall illustrates some of the strengths and weaknesses of the US regulatory and inspection system for pet food ingredients. Laflamme notes that “There are issues at all levels: USDA issues in terms of guidelines and inspections, import issues, domestic issues, and, of course, pet food companies have their own standards for determining the nutritional value of the ingredients and tests for known contaminants...What happened in the 2007 recall was deliberate contamination of an ingredient from something that we wouldn’t even think to look for. There’s little that can be done if somebody wants to deliberately put toxins into a food, whether it’s for humans or pets.”

In other words, the current regulatory model was not looking for what McChensey described as a “strictly economic adulteration of a product.” He adds “The other thing is that pet food and animal feed are regulated under the adulteration provision of the Food, Drug, and Cosmetic Act. So, the presumption is that a company will make a product that is not adulterated or unsafe.” Though most companies will operate under these constraints there are no set regulations that require them to follow quality practices for “non-medicated feeds” which comprises almost all of the pet foods. So if there is a problem its “difficult to take action against someone because of a problem.”

On the other hand, regulatory agencies and regulations have a two pronged strategy. They are there not only to protect the consumer but as Roudebush notes “are there to protect the companies too.” He states that industry plays a critical role in helping to set up standards that protect them as well as the public. He uses the aircraft industry as an example; “every 5 years, a group that represents industry- airplane manufacturers, the government, academics- comes up with standards for lubricants that are used on commercial and private aircraft. Industry is important. Companies have the technological know-how and share that information, allowing industry as a whole to come up with the regulations that protect the users and also the companies.”

On a related note it is important to realize that neither the AAFCO nor the Pet Food Institute are regulatory bodies nor have they been created by the pet food industry. The AAFCO for example, is composed of regulatory people from all 50 states that among other things facilitate interstate commerce. Though they may contribute opinions about regulations they don’t have the ability to establish regulations.

The USDA is charged with regulating many food related products. For example, they have a person assigned to all slaughter plants that are making a USDA-regulated product. On the other hand, it’s the FDA- under the Food, Drug, and Cosmetic Act- that is ultimately charged with the oversight of the safety of imported ingredients into the US. McChensey notes that “The FDA does look at about 1% of the products crossing the borders...ultimately it falls to the company to make a safe product.”

Daritotle adds that “Most of the major pet food companies have been fairly vocal about the quality control in place and have quality-assurance programs accordingly.” And as Roudebush states “the reality is that most of us think if the company is reputable, then it is assumed that quality-control procedures are in place.” For the most part, this is true and a part of the combined effort it takes to produce a generally safe product.

But there are still plenty of holes and inefficiencies, especially in this era of increasing globalization, and it behooves the veterinarian and pet owners to be vigilant. Having a better idea of how things are set up helps us to perhaps find other more constructive solutions.

As we struggle to balance a full plate of sometimes contradicting issues (i.e.; the need to protect ourselves vs cost of that protection, freedom of choice vs limiting that freedom to choosing among safe products, cheaper vs expensive food ingredients) it all comes down to being well informed and finding ways to cooperate together.

Taken as a whole, cats and dogs in this country have the opportunity to be healthier and live longer than ever before. By working as a team, pet owners, veterinarians and others can successfully navigate these challenges and come up with excellent nutritional solutions for our beloved pets.

Pet Foods: notes from the experts

Towards a greater understanding (part 2)

There are many variables that go into making informed decisions regarding what to feed a healthy dog or cat. Having a solid veterinary/ client relationship forms the foundation from where information can be sifted taking into account each pets unique circumstance in order to come up with a reasonable dietary plan.

Among the most important issues with respect to pet food is that we have to make dietary choices based on the best science and evidence available and avoid the allure of unsubstantiated claims. The big challenge here is that things aren't always clear cut. For example dog food companies, whole food advocates, and purported alternative nutritionists all -in one form or another- fall under the sway of faddism, premature nutrient recomendations, consumer driven demands, and market pressures.

The more informed we are the better. If our information is balanced, dispassionate and accurate then picking a path through this quagmire is easier. With that in mind, we can go back to the Veterinary Forum nutritional expert panel for more interesting discussion regarding pet food and the state of the industry.

On ingredients

This appears to be one of the most pressing issues when it comes to some of the common general misunderstandings. Part of the problem stems from a general lack of basic skills in science and general nutrition which can impede a more nuanced perpective of this complex issue.

At least some of the details regarding food ingredients, preservatives, additives, and other constituents need to be understood enough so that prudent choices can be made by veterinarians and pet owners. For example, a pet food company might cut corners too much, or someone may claim a certain chemical additive is just poison. Armed with the right tools, a person could effectively analyze the issue at hand and make a rational more balanced determination of the problem or claim and what to do about it.

One of the interesting points mentioned in the discussion was that people in general seem to lose sight of the fact in spite of the huge number of available foods products on the market, animal needs have not changed too dramatically. Delaney notes “the nutritional needs of dogs and cats really haven’t changed. Yet, so many new products are being introduced. Veterinarians need to start by understanding the nutritional needs of dogs and cats and the individual factors that affect those needs.”

A rough analogy is that a shirt and jeans are always the basic and essential part of a teen’s attire. You can dress it up, loosen the pants, change the colors, add jewelry, or add whatever puffery the teen demands; but in the end the jean and t-shirt never goes away.

A detailed discussion of all the common components of food such as micro and macronutrients is beyond the scope if this post. However, we will touch on one topic mentioned by the experts on the panel as an example of some of the issues involved with food sources and pet food ingredients.

There is a lot of misunderstanding regarding the meaning of macronutrients in pet food. These are the main components of a diet and comprise the bulk of for example proteins, fats, and carbohydrates. Freeman notes “There’s so much misinformation about ingredients on the list. For example, lamb listed as the first ingredients is sometimes perceived as better than a by-product, which has become a frightening term to some people. Yet, some labeling might list the first ingredients as beef heart, beef liver, or beef lung without the word by-product.” This belies a very basic problem with the attitude and general perception of what an acceptable macronutrient might be. Daristole adds that “Consumers may not understand that most of the macro-ingredients in commercial pet foods are indeed by-products of the human food industry, not because they are bad for anyone but because of food preferences.”

If one stands back and thinks for a moment, it becomes evident that these are big issues and could be barriers towards comprehending nutrition at the most basic levels. Roudebush very eloquently reminds the panel that “My grandfather and father grew up on farms, and when an animal was slaughtered, all of it was used. There were no by-products. We have gotten away from that practice. People who are entering veterinary medicine today have less of that background. Then, so much of it is cultural in the United States, where people are less accustomed to having contact with where our food comes from and how it is used.” This is not really a yearning call for days of old. It is an important observation that requires our attention as we try to navigate through the issues of pet food ingredients.

On the other hand, a promising and positive development has been the increasing consumer awareness of “greener” and more wholesome (organic) food ingredients as well as concern for how our food sources are handled and treated. This opens the doors to perhaps a more balanced approach to a host of agricultural practices and animal husbandry techniques.

Roudebush states that “The AAFCO manual defines organic as a formula feed or a specific ingredient within a formula feed that has been produced and handled in compliance with the requirements of the USDA natural organic program.”

The problem seems to be, that due in part to a “disconnected” consumer, terms and descriptions like “organic”, “nature”, and “human grade”(1) that supposedly denote some type of superiority either in production methods or nutritive value over “conventional” methods turn out to be more semantics than anything real.

In other words, we shouldn’t throw the baby out with the bath water when it comes to evaluating the pet (or human) food industry. Though a laudable ideal, the organic industry has its own “foot print” to contend with. The book “An Omnivores Dilemma” is a good introduction to the realm of food production and the challenges of feeding the masses well while balancing food gathering and distribution.

Raw, commercial, and homemade pet food

In and of itself, the concept of raw food diets is simply another way of delivering food to pets. The problem is when people claim that it is a superior method for feeding dogs and cats. Though still a fairly rare practice in the US (more common in Australia) it is on the rise and there are several companies that distribute different types of commercial raw food mixes.

According to Freeman “ there are no proven benefits linked to raw diets, yet there are multiple studies showing nutritional imbalances, both in commercial and homemade raw diets, and multiple studies showing contamination in the vast majority of raw diets. There is a risk for the people in the household but also for the pets themselves. So, in terms of raw-food diets the risks far outweigh any potential benefits.”

Freeman, Curchill, Laflamme and Tefend note that there are more reports of nutritional deficiencies and excesses with raw and homemade diets than with many commercial diets. Roudebush notes that no AAFCO maintenance feeding trials have been done on any homemade prepared diets and this is a problem when looking for evidence.

Laflamme mentioned that there have been two independent studies that “compared dogs fed commercial pet food with dogs fed homemade diets. The study (1999) I’m most familiar with involved 1,000 dogs in three different groups…There were significant differences in terms of health problems being greatly reduced by the feeding of commercial pet foods.”(2)

On the other hand, this is not to say that home made foods in general don’t have a place “on the table” and indeed can often be a critical part of the nutritional puzzle for some pets and for any owner willing to put in the effort needed to do it right.

However, they need to be complete and balanced and Churchill cautions that “I frequently see well meaning owners make substitutions to the recipe, until over time, ‘diet drift’ occurs, and the diet may no longer resemble the original formulation.”

McChesney and Churchill also add that salmonella risk is higher when dealing with the day in/ day out processing of homemade and especially raw diets and extra care needs to be given for maintaining routine hygienic standards. Cooking homemade food does not significantly diminish its dietary quality (problems with heat labile substances can be corrected) and reduces the risk of food borne disease.

Again, it is more advantageous to take note of the evidence, science, and -to a degree- the opinions of experts in the field. No, it’s not perfect and problems abound, but the ability to make the best decisions regarding what to feed our pets lies here and not on assumption, hearsay, what we’d like to believe.

(Part 3 touches very briefly on the recall and regulatory issues)

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1) Roudebush notes “According to AAFCO the term human grade cannot be used anymore. However the term continues to be used on websites, in brochures and on some labeling.”

2) Interestingly, there is an often repeated study alternative veterinary nutritionists fondly allude to that claims to support raw foods or the broad use of nutritional supplements. It is an old 1940’s report known as “Pottingers cats” that seemed to evidence multi-generational deficiencies in cats with cooked or “processed” foods. The more likely reality was that the affected cats suffered from other confounding issues such as a species specific sensitivity to taurine deficiency, a heat labile protein, that when added to a cooked diet corrects this problem.

Pet Foods: notes from the experts

Towards a greater understanding (part 1)

There is a huge body of information regarding pet nutrition that plays loose and fast with the facts. With so much misrepresentation floating around out there, getting a clear understanding of an already complex issue becomes nearly impossible. This rather confused state of affairs has to do with a whole assortment of issues some relating to pet food sourcing, preparation, and quality control, others to changing consumer expectations. These are not necessarily all bad things; especially when it comes to owners who want to feed their pets the best food they can get and afford.

The pet food industry is an extremely competitive and active field. For example, in the past three or four years 1,000 pet food products have been introduced into the US market.This has resulted in a dizzying surge of pet food nutritional claims, a plethora of new ingredients, and advertising gimmicks that cater to an increasingly discriminating pet owner.

Trying to evaluate all these pet foods is indeed a formidable task for veterinarians and pet owners alike. This is made even harder when many people lack the knowledge or tools to navigate all the crazy details in the constantly changing world of nutrition. Though it is hard to select a pet food with all these choices (including home-made), the bottom line is that veterinarians and pet owners really want to select the most appropriate dog or cat food for their own individual pets.

The good news is that it can be done- at least reasonably well. It all comes down to education, education, education. For example learning how to read labels, understanding ingredients, where they come from, why they’re used, and how pet food is regulated would go a long way towards getting the most out of this experience.

A discussion

A recent round table discussion among several veterinary nutritional experts sponsored by Veterinary Learning Systems Veterinary Forum discusses many of these concerns. These specialists offer up an interesting glimpse into many of the challenges clients and veterinarians face when trying to make sense of the confusing world of pet food and offer up some sound advice regarding pet foods.

One of the most important issues they note is that there needs to be a solid foundational client/doctor relationship from where –as a team- the best science and evidence based choices for a particular pet can be considered and actually implemented. With respect to food choices the matter might actually be a bit easier with a sick animal than a healthy one. There are often clear therapeutic choices and perhaps a better idea of a pets’ nutritional needs in the case of illness.

On the other hand, a healthy animal poses a problem because of the hundreds of choices out there. In this case, a routine healthy visit can become a frustrating experience when it comes to recommendations. Both doctor and client need to be invested and interested in focusing on these nutritional issues because it can vary from pet to pet, region to region, and pet food to pet food. A place to start is to check the label and make sure the pet food in question was subjected to AAFCO feeding trials (and not approved only through its nutritional profile).

According to Dorothy Laflamme, DVM, Phd, DACVN “Animal feeding tests, according to AAFCO, are certainly a greater level of assurance , but even that , in my opinion, is probably a minimum level. Those studies will identify gross nutritional deficiencies. But we’re formulating diets that we anticipate to be fed for years- sometimes the lifetime of a pet- and you have to look at an AAFCO feeding trial as an important component, but only one component. You also have to look at the history of the company, and the research it does. Veterinarians need to complete diet histories for all their patients to establish a pattern of diets that are associated with healthy pets and diets that are associated with pets that aren’t doing quite so well.”

This is where the doctor/patient team becomes a vital clearing house for the the endless streams of a veritable media and propaganda blitz from pet food companies, tips from some misguided pet shop clerks (most do their objective best), and alternative nutritional “experts” (veterinarian or otherwise) pushing unsubstantiated theories. Add to that a plethora of self prescribed nutritional supplement gurus ready and willing to steer the topic of nutrition into a world of conspiratorial accusations (of “the man” – big industry- big pharma) against the pet food industry proselytizing about unproven claims of superiority for their “pet feeding paradigm” and you just want to pull your hairs out! That said there are many people out there genuinely interested in the pets’ health and act as objective support to the client doctor team.

Even without the confusing blather of misrepresentation regarding pet food, it can still be really difficult to hone in on the “ideal” diet for a pet. Each animal has general as well as unique requirements that play into the equation. For example, some pets are over-weight, others extremely active, and yet even others prone to food intolerances.

Labels can be difficult to read and do not say much about actual nutrient levels. They do give a general idea of the list of ingredients (ordered by weight), crude protein, and crude fat percentages for example, but they don’t give other important details. For example Sean Delaney, DVM, MS, DACVN notes “I would provide the proximate analysis, meaning the protein levels and then, by difference, the carbohydrate level. Being able to calculate and compare that information can be useful…My favorite example is Fancy Feast- the fat level among different flavors can range from 25% up to 55%. That’s a huge difference from a physiological point of view.”

Another example is that reduced calorie diets are often based on a particular original formulation and may not be what you think. Daniel McChesney, Phd adds “if product X started with 2,000 calories, a reduced-calorie diet must be less than 2,000 calories. However, if another brand also claims to be a reduced- calorie but started with 3,000 calories, the calorie intake would be substantially higher than that found in product X.” Though not the norm for now, adding some calorie information to the label would help the doctor and client along with their decision.

Keeping an inventory of the available pet foods in the area help veterinarians establish a solid baseline from where to establish recommendations with their clients. Laflamme states that “By completing dietary histories on all patients and then considering additional pertinent information from pet food manufacturers, veterinarians can identify a number of different foods they can feel confident recommending in different price categories to meet the financial capabilities of all their clients.”

Fortunately, there is usually a range of acceptable products (and recipes) to choose from. Pets today can be offered very good and balanced diets with the help of their concerned owners and veterinary care givers. In the end, it goes back to a good doctor/client relationship and old fashion education.

(Part2 touches on ingredients, raw food diets, home prepared diets, last years recall, and regulatory issues)

Alternative medicine and fallacious arguments

Some impressions from reading recent CAM defender statements

Debating with alternative medicine apologists can sometimes be a tedious affair. Reading through posts on some of the threads going at the Science Based Medicine site (lots of activity there recently), it becomes evident that -knowingly or not- many of these folks tend to fall back on recurring themes.

It appears that some of these apologists do not appear to be interested in a frank and honest discussion of the issue at hand, but rather many insist on focusing on an almost reflexive and hermetic defense of their “pet” position. These CAM supporters appear to be oblivious to the sometimes enormous gaps between the solid weight of evidence against their topic “du jour” and the naked precariousness of their defense. This is a classic example of the cognitive dissonance often observed throughout CAM in general.

The following list just touches on some recent problems with the arguments of many CAM supporters I’ve noted that muffles effective communication and blunts open discussion (a more thorough examination of these arguments would likely uncover a host of even more fallacious reasoning):

1) A priori assumptions. This is taking the whole scientific process of observing phenomena to then eventually formulating a hypothesis about it and turning it on its head. Placing a conclusion first, then attempting to gather data that supports this view brushes away objectivity and completely disconnects the observer from reality. This is a recipe for creating a belief system and allows for abstractions far removed from what actually occurs. This approach reveals a deeper level of inflexible conviction that permeates their argument, crystallizes these beliefs, and makes them impervious to self doubt and critical analysis.

2) Mioptic views. Many CAM apologists tend to focus almost exclusively on one small area of the topic at hand. They discuss the fine details and deep intricacies of one drug or concept and completely miss a broader and more significant point. By obsessing on one tree many CAM supporters completely miss the entire forest of trees around them. One reason for this is because; the deeper they go on their merry journey the more they tend to lose connection with the broader base of scientific knowledge- this becomes a rabbit hole to no-where. This reasoning is a form of causal reductionism where so much attention is given to one variable that a whole host of other fatcors are not taken into account. This is where many obesity and cholesterol folks can sometimes get lost.

3) Vomiting data. This approach seems to be a favorite among many of the nutritional supplement apologists. You will suddenly be confronted with what appear to be reams of cold hard data supporting one pet theory, belief, or whatever. On closer scrutiny one finds that these studies or other data sources are cherry picked from a much larger body of evidence that –on its whole- is either inconclusive or actually argue against the CAM topic at hand. They are often obscure in detail or discuss a tangentially related topic and do not support the argument at hand. At times these sources are very old documents and disconnected from present day scientific activity (it is not uncommon to find no mention of them on PUBMED or any other scientific data bases).

4) Because of this/therefore that (confusing correlation and causation). Many CAM supporters like to inappropriately blend and confound their theories with others from an unrelated field. In quantum theory nonlocality and superposition are often correlated to the claimed health effects of many CAM modalities. Supporters seem to completely and blatantly ignore the real science in a spectacular misrepresentation of the facts literally making up a story that “fits’ their paradigm.

5) Repeating the same claim. This is an argument of repetition, where a CAM defender will seem to ignore a clear counterpoint, not address it, and continue to ramble on in a defense of their claim. A related version is when a supporter claims his/her counter claim was not addressed when in fact it was.

6) Lack of knowledge in the scientific method and critical thinking. This is a common thread throughout many CAM arguments. There seems to be a lack of understanding that science is a messy, complex, and often slow endeavor. Many want to bypass the rigors of this work and jump to a favored conclusion. On a similar vein, other CAM supporters will use the complex nature of scientific observation to “move the goalpost” and continually refine their defense beyond what is known. Many others take the tact of asking more and more questions eventually hitting on something an opponent may not be expert on (a demand to impossible perfection). They thereby claim a victory- hollow as it is.

7) Testimonials and emotional reasoning. This is a big one. It relates to not having a solid grasp on how probability and statistics "behaves". This reflects a lack of knowledge with respect to how real nature works. Appealing to these personal stories is the bread and butter of innumerable CAM modalities and is intimately related to aspects of delusion and, in many cases, outright deception.

8) Conspiracy theories. Claims of “the man”, big pharma, or some other ominous entity overseeing and buying off whole sectors of society are a favorite staple of many CAM defenders. These attitudes are reminiscent of mind sets that made Molder of the X- files so famous. This is a weak attempt to defend failed hypothesis without considering much simpler reasons for that failure. For example, that they actually do not work!

9) Ad hominem. When in doubt attempt to destroy the messenger. Though tired and repetitive, this is another reflexive reaction against those critically probing a CAM modality and seems to be as common as ever.