Three Ways Your Vet May Be Led Astray
There is currently a trend in veterinary medicine toward what is called Evidence-Based Medicine (EBM). The idea is that we veterinarians should only treat pets with scientifically proven therapies. This process is intended to eliminate the doctor’s personal bias and therapies that are ineffective or possibly harmful.
With EBM there is a hierarchy of evidence that should be considered when a vet chooses a therapy for a particular animal. At the lowest level of evidence is personal experience with an individual case. This is often called rather disparagingly, anecdotal evidence. Let’s face it, anything can happen once. Just because a pet’s cancer disappeared after taking a particular supplement does not mean that that supplement will help the next pet with cancer.
Highly regarded in EBM are the almighty double-blind, placebo controlled studies and research based on them. These studies appear to be essential as they separate out the body’s ability to heal itself (placebo response) from the actual action of the drug or therapy. The fact that the studies are double-blind is supposed to eliminate researcher bias (more on this coming up). The emphasis on EBM has gone to the extreme such that for the most part, only treatments that have been proven with double-blind, placebo controlled studies are considered to be legitimate.
This is a great concept. Who doesn’t want to be treated by scientifically validated therapies? Unfortunately, there are several problems with the practical application of EBM.
- Medical research is expensive – A single clinical trial can cost as much as 100 million dollars. Small supplement and natural pet food companies or holistic associations cannot afford such research.
- It only makes sense to spend research dollars on patentable treatments – This rules out truly natural substances such as herbs. You can patent Milk Thistle. If you can’t make money off the research via a patented medication, why would you spend the needed money for the research?
- Pharmaceutical companies and major pet food manufacturers are the major source of veterinary medical research – The problem with that is that multiple studies show that industry-sponsored research is often biased. Dr. John Ioannidis has published papers with 1,328 different co-authors at 538 different institutions in 43 countries. According to Dr. Ioannidis, up to 90% of published medical information is flawed.
If your veterinarian (or medical doctor for that matter) is relying strictly on published medical information for his prescribed treatment options, then his therapy will be 90% flawed. In other words, he will get it right 10% of the time.
Lack of “adequate” research is why alternative medicine is considered alternative and is excluded from EBM. This lack of “evidence” is also an excuse for the rejection and criticism of many helpful alternative therapies by well-meaning, conventional practitioners. This attitude may lead your veterinarian astray.
Have you experienced bias against natural therapies?
Oh, yes! There’s certainly a nasty group of EBMers out there on the web and working diligently behind the scenes to try to squelch anything that might go against their view of what constitutes science. I ignore them on the web, and was thrilled to see that the resolution to discourage homeopathy failed epically with the AVMA (first thing they had done right since passing that idiotic resolution against raw food – which will go down in infamy.) As far as our mainstream vet goes, he’s climbing up Mt. Everest with no gear when he tries to push Rimadyl on to us. We use many wonderful modalities which are far safer: Body Sore (chinese herbal prescription from our other vet who practices acupuncture and chinese medicine), homeopathic remedies, and oils. All can be effective. Thank you for the reminder of the narrow-minded views which constitute the EBM groups, though you are far kinder than I because you give them the benefit of the doubt in terms of motivation. I do not see them as altruistic at all. When I run across one on the web, they virtually all have this over-weaning sense of self-importance, arrogance and disdain. I wonder that they have any clients at all. They would certainly never get my business if they were the only game in town!
I guess I’m of the disposition to give these folks in general the benefit of the doubt. I certainly hear you about the outspoken EBMers. Last year a quote from my book, The Holistic Health Guide http://amzn.to/1nr29B0 was used in an article by an EBMer that was published in the Journal of the American Veterinary Medical Association. The article was very anti-alternative medicine and the quote was taken out of context – twisting my original meaning and intent. His conclusions about what I had written made it clear that he had not read the entire chapter in question. Yes, I too have experienced the vitriol of some “skeptics.”
I guess I’d consider myself an EBMer. While I agree there should be no room for hubris in this discussion, unfortunately it becomes pervasive when various camps try to build support for their chosen methods. At the end of the day, however, as available information swells on an ever increasing menu of options for care, it is the client or the patient that struggles with the burden of uncertainty, and often an agonizing uncertainty, of what is the best choice for care.
I agree, in part, with the comments above. Research is fraught with short-comings including most significantly limitations on available resources to adequately investigate any given therapy. Multiple this by the varied species in veterinary medicine and the dilution factor is indeed a daunting obstacle for adequately funding of a body of research large enough so we can be sure what we are seeing is indeed real. It takes time and continued financial support for a body of research to mature enough for us to trust what we are seeing. Unfortunately with limitations on both time and money we are left navigating a see of options which may be only vaguely supported by compelling evidence.
Perhaps a more helpful discussion may be one rooted in acceptance of the limitations of both an imperfect research arena, which has had to prioritize limited resources on few therapy types, but also, respectfully, with an appreciation that “the plural of anecdote is not data”. In this light, genuine consideration is equally warranted for alternatives which, although not necessarily supported by the traditional western empirical model of evaluation, may provide solace and relief for the patient.
It’s a pity when the discussion deteriorates into a war of which is better. We are all trying to swim in a sea of uncertainty working with limited tools and resources for finding out what is best. Evidence based medicine is but one tool and I appreciate it for the important role it plays but also accept its limitations.
Sheila Keay, DVM, MBA, MPH
Thank you for your open minded comments and for calling me out on my antagonistic rhetoric. I find it difficult to be attacked by those with an extreme EBM superiority complex without jabbing back here and there. There are certainly abuses on both sides of the issue and it is difficult for clients to navigate their way. I am thankful that there are many choices available and that we live in a society where people have the freedom to choose. I too believe in science, but I feel strongly that a medical practice base strictly on the current interpretation of EBM is incomplete.