Ok - so you've got a Facebook Page, maybe a Twitter account, what about Pinterest? Instagram? You Tube? Google+?
No, I'm not suggesting you get them all, but maybe you've got one or two on the go.
So who posts information to them?
How often do they do it?
What sort of information do they post?
If your answer was a vague.."Errr...don't know...but it seems to be going ok?" then I've got the resource for you!
I've put together a super basic 'Social media posting calendar'
So this is what it looks like.. click on the image below to visit the original blog post & then download an excel version.
Although I appreciate control and planning I also love flexibility. The idea behind the Calendar is to help you approach the very powerful tool that is social media with a level of professionalism AND help you get the most out of it. But you don't have to record every post and update. The power of the Calendar is in the planning stage - planning the monthly focus, planning the general topics and associated promotions, etc.
This also fits neatly in with the 'Vetanswers Blog Posting Calendar' - put the two together and you'll have total control over all your social media AND you'll find you'll save heaps of time by planning before hand what you'll be posting and blogging about!
So what do you think? Will it be useful for you? Tell me what you think in the comments section below - or tell me if there is another resource you'd like me to put together.
If you'd like to see more blog posts or download FREE resources just visit Vetanswers - www.vetanswers.com.au. While you're there feel free to sign up to join our online veterinary community - it's FREE and you'll receive our weekly eNewsletter too
My attention was recently drawn to another dietary supplement product with pretty dramatic claims, this time for treating both oral disease (gingivitis and periodontal disease) and joint disease (osteoarthritis). As usual, the company web site and promotional materials are unequivocal about the benefits you can expect.
Comprehensive oral health care is now a reality!
Safe, No Side Effects…Only Side Benefits
A truly major advancement…
Far more effective and much faster acting than current natural joint products
Of course, there is the usual disclaimer, which one presumes is present because the company has not met the FDA requirements for making health claims:
This information is presented for informational purposes only and is not intended as an endorsement of any product. The information is not intended to be a substitute for visits to your local veterinarian. Rather, these testimonials / research pages and/or case studies offer the reader information written by pet owners and/or veterinarians concerning animal health and products that have shown results.
It is hard to imagine anyone actually claiming this information is “not intended as an endorsement of any product” given that the context is entirely product advertising, but that’s a relatively minor example of the weird things that happen when one tries to advertise a health care product not approved by the FDA as a health care product.
Several of the warning signs of bogus claims are present, including:
Claims of a major scientific breakthrough, initiated by a hunch or guess and an uncontrolled personal experience
Support for these claims primarily through testimonial and anecdote
Reference to scientific proof with few details
Claims of great benefits with absolutely no side effects
A money back guarantee
And while science is often used as a marketing point, this company goes farther, making several references to evidence-based medicine and making a number of statements about the need for meaningful scientific evidence with which I agree completely:
[this product is] not just another one of the multitude of unproven joint products, as it is also evidence-based. This is an often used term and at the same time an often abused term. As an example, we often see “contains clinically proven ingredients” In reality this usually implies that the actual product was in fact never tested clinically.
Esterified oils are the only evidence-based product for gum or periodontal health.
There is scientific support for natural approaches, but at the same time there are a lot of half truths and at times totally misleading statements made in order to sell products. We will let the science speak for itself.
The company also aggressively challenges the usefulness of what they appear to see as their major competition for the arthritis supplement market, glucosamine products. And here again, they make a case I am in complete agreement with about the lack of clinically meaningful, proven benefits for glucosamine supplements*:
It is quite amazing that so many people, including physicians just assume that glucosamine is effective. This is understandable when we consider how much joint health advertising that takes place. The sad reality is that in well controlled clinical trials that the placebo pills produced just as good effects as glucosamine.
Advertisers have frequently referred to GAIT and the 72 patient’s that seem to benefit, but they fail to mention the other 95% of trial participants or the fact that this 72 patient group went on to experience more cartilage loss than placebo.
So let’s take a look at this “evidence-based” product, what it is and what the evidence says about it.
What Is It?
The exact active ingredient in the product is listed as a “proprietary blend” of an “esterified fatty acid complex” from “beef tallow”. Esterified fatty acids are similar to other fatty acids, such as fish oils, with some chemical modifications. The other ingredients are a variety of vehicles and some compounds with Vitamin E activity, which are commonly included with fatty acid supplements since these tend to reduce Vitamin E activity in people or animals taking them.
Does It Work?
Given the heavy promotion of this as an “evidence-based” product, is there strong evidence to support the strong claims made for it? Well, not really.
The company claims, “EFAC has been studied with seventeen (17) animal and clinical studies, with six (6) studies presented at scientific meetings and six (6) published in pre-eminent scientific journals.” Of these, they provide links to 5 papers and once conference presentation, however all but one of the links are currently broken. It’s not clear what other studies they are referring to.
In terms of the use of esterified fatty acids in general (not this product specifically) for osteoarthritis, there are a few clinical trials that suggest some improvement in human patients with osteoarthritis. (1-3) These are the sort of small, early trials which can suggest a potential effect is worth investigating further, but the results often are not supported in larger, better controlled, and independently funded research. In fact, the clinical trial evidence supporting glucosamine as an arthritis treatment is far greater, and yet the largest and highest quality trials have turned out to show, as this company points out on their site, that there is not a real benefit. It seems a bit self-serving to correctly identify the weakness in the evidence for glucosamine and yet to aggressively promote their own product as “evidence-based” on the strength of far weaker clinical trial evidence.
As for the use of this product to prevent or treat gingivitis and periodontal disease, I have only found one related published paper, a report of a study involving the topical application of esterified fatty acids to the gums of 18 rabbits in which periodontal disease was artificially induced.(4) This is the sort of animal model study that is useful for providing proof of concept, but it is not appropriate to justify widespread clinical use in dogs and cats based on one laboratory study in rabbits. The company also claims a trial has been done in cats, and provides a testimonial from a veterinary dentist supporting the product, but apparently that study has not yet been published
The company also promotes the fact that they have been granted a patent for their product. This does not, however, have anything to do with whether or not it is effective. Evidence of clinical safety and efficacy is not required for a patent application, and patents have been granted for a wide range of bizarre and useless inventions.
Is It Safe?
A few safety studies in laboratory animals have been done and did not identify any hazards. I am also not aware of any reported side effects in humans or other species taking these supplements, though there does not appear to be any formal surveillance or reporting mechanism in place.
It is certainly possible that esterified fatty acids could have clinically meaningful benefits. There is no clearly established physiologic mechanism by which this would occur, but there are a few small clinical studies in humans suggesting a benefit for osteoarthritis and at least one animal model study suggesting some benefit for periodontal disease. There is no evidence of any risk at this time.
At this level of evidence, the proper assessment is that benefits are possible but unproven. Use of the product would certainly be appropriate in controlled research studies and situations in which established therapies are not available or tolerated. Substituting these products for established therapies is not appropriate. And, unfortunately, despite all the talk of being scientifically validated and “evidence-based,” the claims made for these products go well beyond anything justified by published scientific evidence. Such language indicates only a recognition of the marketing value of science and the term “evidence-based medicine,” not any qualitative difference between the level of evidence behind claims for these products and that supporting similar claims by other nutritional supplements marketed to treat or prevent disease.
*Articles I have written about glucosamine for arthritis
The terminology associated with unconventional therapies has shifted a bit over the last 40 or so years. Initially, such therapies were often described as “alternative.” This fit well with the still widespread philosophical position that new or different ways of looking at health and disease which are not part of the scientific tradition are necessary or valuable. But it wasn’t the most effective marketing for these practices since it suggests substituting these therapies for conventional medicine. The dramatic effectiveness of science-based medicine is hard to ignore, and most people aren’t willing to give it up for the promises of unproven alternatives.
The term “complementary and alternative medicine” (CAM) emerged to suggest a more flexible approach in which unconventional therapies could add benefits along with, not only in place of, conventional medicine. This is still a popular term, but some advocates of CAM therapies dislike the implication it carries that science-based medicine is the mainstay of treatment and CAM simply “complements” it. And it can be quite clumsy to say.
So the latest term that seems to be gaining ground quickly is “integrative medicine.” This suggests a seamless merging of the best of conventional and unconventional medicine. Integrative medicine advocates often present this approach as focused only on the welfare of the patient and willing to use whatever tools are appropriate without any prejudice regarding their origins. What could be wrong with that?
Well, to begin with, there is a hidden and untrue assumption behind this approach; that individual practices from both CAM and scientific medicine are equivalent, equally likely to be useful regardless of the philosophies behind them. The problem with this assumption is that there is, in fact, good reason to believe that therapies based in science and validated by scientific research are far more likely to be safe and effective than therapies based on implausible or pseudoscientific theories and validated by historical use, individual anecdotes, and little to no controlled scientific research.
Among some skeptics, integrative medicine programs in academic medical centers have been labeled quackademic medicine. This is the integration of implausible and unproven alternative therapies into academic medical practice not, as is often claimed, with the intent of investigating whether or not such therapies are safe and effective but with a pre-existing faith in their benefits. Such integrative medicine programs are founded on a desire to use the platform of an academic institution to give an aura of legitimacy to such practices, and to use the authority of a faculty position to convince veterinary students these are legitimate medical therapies regardless of the evidence for or against them.
There are a number of problems with such programs. As Mark Crislip from the Science-based Medicine blog has put it, “If you mix cow pie with apple pie, it does not make the cow pie taste better; it makes the apple pie worse.” In other words, integrating unproven therapies or outright ineffective nonsense with conventional medicine doesn’t improve patient care or outcomes, it makes them worse. And there is growing evidence of the harm this can cause, both directly and indirectly (e.g. 1, 2).
Such integrative medicine programs are also, alas, quite successful at conveying the impression that the therapies they promote are evidence-based or widely accepted as legitimate in the medical community even when they are not. And they tend to create this impression among doctors and medical students as well as the public, despite the lack of compelling evidence of effectiveness for most of these therapies. They are very successful public relations efforts.
These programs are not, however, very successful at stimulating the research needed to make truly evidence-based judgments about CAM therapies. The clinicians involved in these programs are themselves already convinced their practices are effective, so they tend to produce research at high risk for bias. And when research results are not supportive, they are ignored or rationalized away since the self-reinforcing clinical experiences and anecdotes most doctors rely on do seem to support what they are doing, and this has more psychological impact than less influential, but more reliable, objective research. Rarely do integrative medicine programs discourage even the most obviously useless of CAM therapies, such as homeopathy, but they tend to encourage acceptance of the whole mélange of unrelated and ideologically affiliated practices within the CAM family.
The folks at Science-Based Medicine and the James Randi Educational Foundation have recently published an e-book with a number of essays discussing the problems with the infiltration of unproven or bogus CAM therapies into academic medicine, which I highly recommend: Quackademic Medicine
The marketing and PR campaign under the label of “integrative medicine” have begun to appear in veterinary medicine in the last several years, thanks largely to the recent availability of significant funding from proponents of alternative medical practices. For example, I recently wrote about a grant of $10,000 the American Holistic Veterinary Medical Foundation gave to the veterinary school at the University of Tennessee (UT) to promote alternative veterinary medicine. Based on the fundraising and marketing materials of the AHVMF, this organization certainly seems to share the typical marketing and PR goals of most integrative medicine programs. There is some talk of research, but always with the emphasis of demonstrating to the skeptical mainstream that CAVM practices are safe and effective, which is already taken as a given. And there is much talk of widening the appeal and availability of CAVM therapies, regardless of whether the evidence supports their use.
And based on the blog post written for the AHVMF by the grant recipient at UT, this certainly seems to be the agenda for the leadership of the integrative medicine programs the AHVMF is supporting there. Dr. Donna Raditic, who runs the integrative medicine service, made it clear in a blog post on the AHVMF site that she has no doubts about the effectiveness of CAVM and seeks to make alternative therapies more popular and acceptable not by conducting objective research but by providing “hand-on” exposure and the opportunity for generation of anecdote and personal experiences that are, despite their unreliability, so persuasive for most of us.
The AHVMF has also given a total of $110,000 to the Integrative Medicine program at Louisiana State University’s (LSU) School of Veterinary Medicine. The LSU integrative medicine folks have, of course, been actively promoting the AHVMF fundraising efforts, and they have hosted as speakers a number of prominent advocates of a variety of alternative therapies. The web site for this integrative medicine division, which was apparently made possible initially by a substantial private grant, also talks considerably more about promoting alternative therapies than about researching their safety and efficacy. The grant comes from individuals with a strong interest in promoting alternative therapies, and it has been used, in part, to send staff and students for training at the Chi Institute and the annual convention of the American Holistic Veterinary Medical Association, two of the biggest promoters of unproven and even clearly ineffective and pseudoscientific alternative practices.
Despite the numerous connections between these integrative centers and prominent advocates of unproven and pseudoscientific therapies, and the clear bias evident in the promotional materials which talk not about testing CAVM practices but promoting them, it is possible these centers could be useful if they have a commitment to rigorous scientific research and if they are willing to openly rejecting therapies which fail to prove their value in such research. I would like to think that the academics involved in these centers understand the indispensability of evidence-based medicine and scientific validation of claims for any therapy. However, starting from a position of embracing alternative therapies, talking about promoting rather than investigating them, and exposing students to the pseudoscientific rationalizations of homeopaths and other CAVM extremists from the AHVMA all suggest that these centers are more of a marketing and PR effort on the part of true believers than a genuine academic endeavor to find out the truth about these therapies.
So what sorts of services are these programs offering and promoting? The LSU center advertising a variety of therapies, including so-called Traditional Chinese Veterinary Medicine, which includes acupuncture and herbal therapies. I have written extensively about TCVM and acupuncture before. TCVM is a hodgepodge of pre-scientific and pseudoscientific vitalist myths used to identify not disease as it is understood in science-based medicine but “imbalances” in energies and other metaphorical entities which cannot even be proven to exist, much less to play a vital role in health and illness. These mythic concepts are then used to guide the application of therapies which undoubtedly have real physiological effects but which have not been demonstrated to be safe or effective in maintaining or restoring health. Herbal therapies, for example, are among the most promising CAVM treatments because they contain pharmacologically active chemicals. However very few have been consistently shown to be truly effective for any disorder in any species, and there is ample evidence that they, or contaminates they contain, can be very harmful.
Acupuncture is the most popular form of CAM after chiropractic (though still not as widely used as proponents would make it seem). Despite extensive research over decades, it has not been convincingly shown to be anything more than an elaborate and rather potent placebo. To be clear, that doesn’t mean it heals disease through the power of the mind. It means that it can cause us to believe we are better, and even to feel better, when our disease actually hasn’t changed, and it is no more effective than randomly poking us with needles or even toothpicks.
Such a placebo might have a meaningful benefit in treating subjective symptoms such as nausea or pain in humans, so long as it was not substituted for therapies that actually affect the disease directly. However, there are serious doubts about how effective such a placebo ritual and non-specific irritant might be in animals, particularly since they cannot report how they feel and must rely on us to judge their comfort, and it is clear that we experience a significant placebo effect on their behalf. I have seen patients in obvious and serious pain whose owners felt they were fine thanks to acupuncture treatment.
The LSU integrative service offers a few other therapies, some of which are a bit of a bait-and-switch in that they are frequently claimed as CAM even though they are widely used by conventional veterinarians (such as physical therapy and nutritional therapy). The most egregiously ridiculous kinds of therapies, such as homeopathy, flower essences, energy healing, and so on, are not listed and, I hope, not offered by the LSU integrative medicine service. And the folks at LSU are careful to emphasize that they do not restrict the use of established, science-based therapies. So while the hazards of direct harm to patients from unproven therapies are probably quite small (both acupuncture and herbal products can be dangerous), the bigger problem is that pseudoscientific practices such as TCVM are offered and presented to students and clients as if they were just as reasonable as science-based practices, despite the many reasons they are not.
There is less readily accessible information on the services offered in the integrative medicine department at UT. Dr. Raditic is certified in acupuncture (not, of course, a recognized medical specialty in human or veterinary medicine) and is apparently pursuing a board certification in nutrition (which is a recognized specialty area). As a member of the AHVMA, she is at least to some extent affiliated with proponents of other, less reasonable CAVM practices, but I have no way of knowing what her views are on these or the extent to which she practices, teaches, and promotes them.
The UT Facebook page recently promoted an “educational” event in which the “National Acupuncture Detoxification Association” will be teaching “ear acupuncture” Both the concept of detoxification, through acupuncture or other means, and the various systems of ear acupuncture are pseudoscientific and unproven concepts that certainly shouldn’t be promoted at a veterinary medical college. Dr. Raditic is also reported to offerchiropractic, cold laser, and herbal/dietary supplement therapies. These are all fairly typical CAVM therapies with mixed, but generally poor, evidence concerning their effects. Cold laser and some herbal or supplement therapies are at least plausible and might have benefits in some cases. Chiropractic, however, has little claim to any legitimate veterinary use based of the bogus theory behind it (the “vertebral subluxation complex”) and the lack of reliable evidence of safety or benefit.
Reportedly, the University of Florida College of Veterinary Medicine has also received $10,000 from the AHVMF for its acupuncture program. Some of the faculty members associated with the integrative medicine program at UF are also affiliated with the Chi Institute, the largest organization teaching TCVM and acupuncture in the U.S., and other organizations promoting all aspects of TCVM, not merely acupuncture. Educational materials provided by the UF integrative medicine web site promulgate some of the common myths about veterinary acupuncture (that it is an ancient practice validated by this history, that there are identifiable specific points along “energetic channels” that can be stimulated to achieve specific therapeutic effects, that it has been validated for specific indications, such as pain, by controlled research, etc). This does not suggest an open, evidence-based approach to TCVM but a pre-existing belief that it is effective despite the lack of compelling research evidence to that effect.
So the efforts of proponents of integrative veterinary medicine appear directed at the same goal as such programs in human medical centers. They are not so much concerned with finding out if these therapies are safe and effective since they already believe this to be true based on their underlying theories, personal experiences, historical use, and other non-scientific sources of evidence. Instead, they wish to make such therapies comfortable and familiar to students and practitioners of scientific medicine so they will be more readily accepted, regardless of the state of the evidence. And while for now they are avoiding promotion of the most egregious nonsense, such as homeopathy, energy healing, dowsing, they do not appear to be making any effort to distance themselves from such practices or those who do promote them. TCMV and acupuncture share much philosophical and ideological ground with these sorts of practices, in particular a feeling that validation through scientific research is a nice extra with PR value but not essential to judging the value of a therapeutic practice. It is difficult, then, to see how these centers can be anything other than marketing efforts or contribute the kind of rigorous data and unbiased evaluation needed to separate those CAVM therapies that may have real value from the useless nonsense.
The University of Tennessee School of Veterinary Medicine is one of the most noticeable academic institutions that appears to have been co-opted for the promotion of pseudoscientific veterinary medicine (along with Louisiana State and the University of Florida). I have written previously about the Integrative Medicine program at UT and the $10,000 grant the college received from the American Holistic Veterinary Medical Foundation (AHVMF) explicitly for promoting (not studying) alternative therapies. Now, the university has presented its Distinguished Alumni award to two self-proclaimed “holistic” veterinarians. And these doctors were not honored despite their promotion of mystical pseudoscience but specifically because of it:
Dr. Marc Smith of Natchez Trace Veterinary Services and Dr. Casey Damron of White Oak Animal Hospital were recently honored with the “2012 Distinguished Alumni” Award at UT College of Veterinary Medicine in Knoxville, TN, for the creation of Pet-Tao Pet Foods and their service in the field of Alternative Veterinary Medicine.
Curious as to what about the creation of a pet food company might have merited such an award, I took a look at the Pet-Tao Foods web site. It is unashamedly dedicated to an approach to veterinary nutrition and health founded in the mystical nonsense of so-called Traditional Chinese Veterinary Medicine (TCVM).
Our diets are truly “holistic” because each and every ingredient is chosen according to two Eastern theories that define the term “holistic” – Yin/ Yang and The Five element theory. No other pet food company has this unique perspective, experience, or credibility.
The theory [of TCVM] states that all naturally occurring events in the universe have two opposite aspects: male & female, up & down, hot & cold, dark & light. These opposing aspects are interdependent, dynamic and constantly struggling to maintain balance with each other…Food is a powerful determinant in the body’s struggle to maintain health and the balance of Yin and Yang.
In Traditional Chinese Veterinary Medicine, the five element theory explains the intricate relationships between the five naturally occurring elements in the environment: Metal, Water, Wood, Fire and Earth…When using this theory in regard to foods, one can control how organs function in the body. For example, a geriatric dog with increased liver enzymes should be fed LIVER according to the 5 element theory. Feeding liver promotes liver function and healing while re-establishing balance of the liver with respect to other organs.
In keeping with this fanciful and completely unscientific approach to nutrition, the company does not produce foods for specific nutritional needs or medical conditions as understood in scientific medicine, but for balancing Yin & Yang and the Five Elements. This allows them to recommend a limited set of diets for any medical conditions regardless of the cause or the specific nutritional composition of the diet based entirely on their assessment of the degree of imbalance in these mystical principles identified in a TCVM evaluation (which is itself a complex and completely subjective evaluation of the tongue, the pulse, and other physical and historical factors according to rules based entirely on tradition and trial-and-error). The company’s diets include:
It is probably unnecessary to point out that there is no scientific evidence to support the practice of selecting food ingredients to balance Yin/Yang or the Five Elements. This is an entirely mythological folk model similar, and likely historically related, to the Greek system of Humoral Medicine that led to the now mostly abandoned practices of bloodletting, purging, and other methods of “balancing” the vital humours to manage health and disease.
The fact that veterinarians who are thoroughly trained in scientific medicine and who are often, at least in my experience, practicing perfectly competent science-based medicine, are able to believe in such nonsense and use it in their clinical work is a bit of an embarrassment to the profession. However, the fact that a mainstream university research and teaching institution sees the promotion of such mystical anachronisms as worthy of lauding with an award for “excellence” is much worse. This lends a thoroughly undeserved aura of legitimacy to ideas that belong on the rubbish heap of medical history along with the treatment of infection by bloodletting and of epilepsy by application of leeches.
Much of complementary and alternative medicine (CAM) is offered either as an addition to conventional, science-based treatment or in situations in which conventional therapies are unavailable or ineffective. This doesn’t excuse offering treatments that haven’t been properly tested, and it doesn’t mean such therapies can’t do harm. However, such an approach at least avoids the harm that can come from delaying or rejecting effective treatment.
However, sometimes CAM providers actually believe their practices are an appropriate and effective substitute for conventional medicine, even in the case of serious disease. This attitude is truly inexcusable when, as is usually the case, there is no sound evidence to support the belief and when irrational and inaccurate denigration of conventional treatments is used to scare people away from medicine that could really help their pets. One of the most egregious examples of this kind of irresponsible medicine is the promotion of “natural” or “holistic” methods for preventing and treating heartworm disease in dogs.
Heartworm disease is a parasitic infestation transmitted from infected dogs (or other animals) to uninfected individuals by specific kinds of mosquitos. It is, of course, most common in areas that have both a reservoir of infected hosts and a population of the right kind of mosquitos. In the U.S., heartworm disease is quite common in warm, humid regions, and transmission often varies seasonally with the mosquito population. Heartworms can cause devastating, often fatal disease.
Fortunately, there are safe and effective medicines to prevent heartworm infestation. While all medications have risks as well as benefits, the risks of these preventatives are well understood and very, very small. Certainly, in areas where heartworm disease is endemic, the risk of preventatives pales in comparison to the risk of the disease. So despite the often hysterical nonsense about these “chemicals” and “insecticides,” the real facts are clear: heartworm prevention is safe and effective and far better for your pet than getting heartworm disease.
If your dog is unfortunate enough to become infected with heartworms, there are effective treatments. The risk of treatment is, however, significantly higher than the risk of prevention, though in most cases still far less than the risk of leaving the disease untreated. The American Heartworm Society (AHS) has a thorough discussion of the pros and cons of different treatment options, and working with your veterinarian you can almost certainly cure this disease and minimize the risks of treatment.
The AHS is also very clear about alternative therapies for this disease: “No “natural” or herbal therapies have been shown to be safe and effective prevention or treatment for heartworm disease.” And fortunately, many proponents of alternative therapies also recognize that no CAM therapies have been shown safe and effective for preventing or treating this disease. The most popular veterinary herbal medicine textbook states, “The authors do not recommend substituting an unproven herbal formula for effective conventional therapy.” Even as radical a proponent of alternative therapies as Dr. Karen Becker at mercola.com grudgingly agrees that,“treatment for heartworm infection is one area where conventional veterinary medicine offers valuable options [and] is preferable to leaving the dog untreated, or using unproven, alternative methods that may have no effect or even be harmful.”
Unfortunately, there are still plenty of unscrupulous companies, and sadly even veterinarians, willing to exaggerate the risks of conventional prevention and treatment and claim that unproven alternatives are safe and effective. Below is a long list of sites promoting unproven methods of preventing or treating heartworm disease. None of these have been demonstrated to be legitimate or reliable, and trusting your dog’s life to any of them is a dangerous mistake.
There has been quite a bit of public discussion and debate about veterinary homeopathy this year. This is due in large part to the Connecticut Veterinary Medical Association (CVMA) resolution presented to the American Veterinary Medical Association (AVMA) House of Delegates identifying homeopathy as an ineffective and unscientific therapy. Though the resolution was ultimately relegated to “consideration” by a committee unlikely to act on it in any substantive way, it did expose the overwhelming evidence that homeopathy is nothing more than a placebo. The resolution also stimulated a vigorous, often highly emotional response from supporters of homeopathy, and several complex but ultimately unconvincing attempts to present homeopathy as scientifically valid and legitimate.
A key organization involved in promoting and defending homeopathy is the Academy of Veterinary Homeopathy (AVH). I have written about them several times in the past, including a detailed look at their recommended Standards of Practice and coverage of the AVH lawsuit against the American Association of Veterinary State Boards (AAVSB) attempting to force recognition of their continuing education courses when the AAVSB ruled they did not meet acceptable scientific standards. The most recent issue of the Journal of the Academy of Veterinary Homeopathy provides some useful insights into how the members of this organization think and how they plan to continue promoting this discredited therapeutic approach.
As I have discussed before, proponents of alternative therapies generally, including homeopaths, tend to rely heavily on case reports as supporting evidence. Case reports are simply structure, published anecdotes, and while they are useful for suggesting hypotheses to test, they prove absolutely nothing. They are no more reliable than any other medical miracle story.
Yet the AVH goes so far as to call their annual meeting “The AVH Annual Case Conference,” and the journal reports almost exclusively anecdotes and no formal, controlled studies. Though there are controlled clinical trials done to investigate homeopathy (which, when looked at carefully, do not support any real effects), homeopaths still rely on uncontrolled individual observation as the core type of evidence both to validate specific homeopathic interventions and to guide the development of the discipline. This is fundamentally inconsistent with scientific and evidence-based medicine, which recognizes the low reliability and high risk of bias associated with such evidence.
Many of the case reports share some common elements:
All of these cases are therefore emotionally compelling arguments against conventional medicine and for homeopathy which, unfortunately, include absolutely no control for bias or error and actually prove nothing. This is marketing, or perhaps more accurately proselytizing, masquerading as science.
Here are a couple of examples:
a three-year-old miniature stallion…presented with acute and persistent seizure activity which occurred a week after a rabies vaccination coupled with a very traumatic tooth floating experience. The complementing video clips clearly demonstrated the symptoms, patient care and the progression to full recovery!
a two-year FS, mixed breed dog presented after an array of suppressive and intensive therapy (including a ligated carotid artery) for a chronic purulent and bloody nasal discharge. Once every(!) diagnostic and therapeutic technique had been tried, [the owner] turned to homeopathy. [The homeopath], using Aurum, guided [the pet] and her guardian through the re-emergence and eventual clearing of suppressed skin, emotional, digestive and nasal symptoms.
A family crisis results in a serious symptom emerging [in a MN DSH]: a suspected nasal squamous cell carcinoma…Gradual, ascending potencies (along with nutritional support from CoQ10, Standard Process Cataplex ACP and Feline Immune Support) resolved all symptoms. Since the last remedy, he has remained well for over a year. [This illustrates] Aphorism 17 regarding cure: “through taking away the entire complex of perceptible signs and befallments of a disease, the internal alteration of the life force which is lying at its base (consequently the totality of the disease) is simultaneously lifted.”
one of her patients was sent home to die in an anemic almost comatose state after diagnosis with inoperable bleeding tumors. Her courage and patience in prescribing assisted this very fragile individual to make what so far is a complete and miraculous recovery.
Apart from a misleading emphasis on uncontrolled anecdotes, the AVH journal illustrates the inconsistent attitude of the veterinary homeopathy community towards science and the disingenuous use of scientific research as a marketing tool.
Dr. Shelley Epstein is one of the most prominent homeopaths claiming that homeopathy is a proven and scientifically legitimate field. I have responded to her arguments in detail before (The Science of Homeopathy?, The Evidence for Homeopathy-A Close Look). Essentially, she simultaneously claims that randomized clinical trials support the efficacy of homeopathy (referring primarily to poor quality positive trials with high risk of bias and completely ignoring better quality negative trials and the systematic reviews of the literature which show no convincing evidence of a clinically measurable effect beyond placebo) and argues that typical RCT design is inappropriate to apply to “individualized” homeopathic therapy.
In this issue of the AVH journal, Dr. Epstein is reported as continuing to assert that there is consistent and reliable evidence for the mechanism and benefits of homeopathy, despite the lack of acceptance of this evidence by anyone in the scientific community, apart from practitioners of alternative therapies:
We have moved well beyond whether homeopathy can be measured, into being able to measure nanoparticle quality control issues among the starting homeopathic products; measure specific frequency differences between remedies and their potencies; measure variation in particle and aggregate size and shape; and measure elemental composition of the homeopathic particles. Studies are finding out how nanoparticles remain dispersed in solution via the hypotheses that trituration generates nanofraction formation, lactose acts as stabilizer to prevent aggregation, dilution allows larger raw particles to settle out and nano-clusters to disperse freely in the medium. Other research involves remedies as nanomedicines and how their dissolved silicate structures carry remedy information into the body.
I have discussed the subject of “nanoparticles” as a validation of homeopathy elsewhere. I have also previously addresses the subject of “hormesis,” which Dr. Epstein also attempts to stretch from a narrow scientific phenomenon having nothing to do with homeopathy into some kind of scientific validation of homeopathic principles. Such misuse of nanoparticle physics, quantum physics, and other obscure but legitimate scientific fields is a hallmark of pseudoscientific rationalizations of alternative therapies.
However, even more dramatic examples of pseudoscience taken seriously are available in the AVH journal.
One speaker openly discusses the true nature of homeopathy as a form of spiritual healing, a religious belief rather than an approach to medicine compatible with science:
Let’s look at Aphorism11 of the Organon:”…initially only the spirit-like, autonomic life force…is mistuned… Only the life principle…can induce in the organism the irregular functions that we call disease.” We know this, but it is still easy to get lost in the perceptions of material agents as causes of disease. When we use vision in homeopathy, it is not to observe the causal agent but to perceive the effects of this disturbance of the life force….Homeopathy is right in the mix with a growing evidence base to show that homeopathic preparations can affect gene expression. While gene expression is in the physical realm, it can be altered via an energetic medicine.
And in his presentation, the legendary veterinary homeopath Richard Pitcairn
continues to stretch our perceptions of time and reality. Thought provoking indeed was the discussion of multiple personalities. Some with individual disease processes were definitely confounding. In one personality there would be a documented severe eye injury which would completely and instantly disappear as he shifted to his other personality….Some multiples changed eye colors between the personalities.
How the AVH can simultaneous claim scientific legitimacy and promote nonsense like this is truly mysterious. However, the AVH appears to recognize that homeopathy has an image problem (though not that this problem is that too many vets recognize it for the pseudoscience that it is). The journal editor speaks directly to this subject:
holistic or CAVM or integrative veterinary medicine is taking a more prominent role. With that increased visibility and scrutiny comes the need to act and practice responsibly. We have often been viewed as the insurgents in veterinary medicine and…it behooves us to present ourselves in a more conventionally professional way. I think we need to be aware that every column we write, every blog we post or forum letter we write can have a far-reaching impact. This is doubly true if we are venting or criticizing colleagues, organizations or disciplines.
I certainly support respectful, substantive disagreement within the veterinary profession, and I have often been disturbed by the extreme, sometimes religious zeal with which proponents of alternative therapies sometimes respond to quite polite and evidence-based critiques of their methods. For example, one prominent supporter of homeopathy responded to the CVMA resolution presented to the AVMA by linking it to the Holocaust. Another once responded to a post of mine criticizing the American Holistic Veterinary Medical Association (AHVMA) by calling me a “shill for the pharmaceutical companies” and claiming that “threatened financially and ideologically, [he] must resort to political tactics of attack, shock and awe using headlines inspired by the National Inquirer or some other ladies gossip rag.”
To be fair, I too have sometimes been guilty of letting my emotions get the better of me and expressing my objections to specific practices in an excessively personal and inflammatory way, especially in the early days of blogging about the subject. However, I think it is a greater problem that healthy debate about the merits of alternative therapies is often impossible due to the passionate hostility that often greets any criticism of such approaches. It would be better for our profession if we could keep our disagreements civil and focused on ideas and evidence.
Unfortunately, I suspect this call for a more thoughtful tone in responding to critics of homeopathy may be more about perception and public relations than a true desire for substantive and respectful engagement. This suspicion is heightened by the announcement in the AVH journal that,
The AVH has hired a public relations representative. Peter Gold has experience working with the National Center for Homeopathy (NCH) and other organizations. Our goals are to increase awareness about homeopathy, build membership and raise funds for AVH.Your contributions (case testimonials, anecdotes, homeopathy tips etc.) are also needed….
AVH is blessed to have marketing director Peter Gold, who has been very helpful promoting AVH and homeopathy. His latest accomplishment was establishing a connection with Dogs Naturally magazine. I’d like to give everyone a gentle push to submit your success stories to Peter and the magazine. This is an excellent opportunity to get the word out about homeopathy.
The summer issue of the AVH journal also provides an update on the AVH lawsuit against the AAVSB. The AVH lost their case at every level, including a final failure on appeal to the Virginia State Supreme Court. However, they still consider it a worthwhile effort:
There was speculation that perhaps the AVH’s stand against AAVSB may have been the instigation for much of the current interest in homeopathy, reorganization of the holistic review committee of RACE and the impetus for other similar suits from holistic veterinary organizations.it was well worth the fight and achieved some worthy goals.
It is telling that the AVH has a legal advisor who has helped them pursue a 4-year lawsuit and now a marketing and public relations advisor, both employed to promote homeopathy by means other than rigorous scientific research. This illustrates the purpose of this organization, which is to function as an advocacy and marketing agency and a support group for practitioners of homeopathy, not as a scientific “academy” investigating homeopathy in an objective way. Homeopathy is a faith-based system in which scientific evidence is never a reason to question or reject existing dogma. The selective use of research findings by the AVH is not about discovering the truth but about developing marketing tools to create the impression of scientific validity.
There’s nothing inherently wrong with promoting a practice one believes in, of course. It is simply worthwhile for anyone evaluating the claims or evidence put forward by the AVH and its members to be aware that the organization is not interested in questioning or investigating the dogma of homeopathy in any objective way, and that scientific evidence is only employed by this group as a marketing tool, not as an impartial guide to what is true or false. While the group may claim that science supports homeopathy, this claim is inconsistent with
The AVH purports to represent the mainstream beliefs and attitudes of veterinary homeopaths. If this is true, then there is no better illustration of why homeopathy as a discipline is inconsistent with science and should not be viewed as a legitimate veterinary therapy. The scientific evidence is clear and consistent that homeopathy is nothing more than a placebo, and all the litigation and public relations spin the AVH generates can do nothing to alter this.
One of the biggest problems with alternative veterinary medicine is the promotion of specific therapies or practices without reasonable scientific evidence that these are safe or effective. Sometimes, the evidence is actually clear that a specific approach is not effective, and yet advocates refuse to acknowledge this and abandon the practice. They often defend such practice on the basis of anecdotal experiences suggesting an effect while ignoring all the reasons uncontrolled observations are often wrong and why miracle stories and other testimonials can’t be trusted. However, sometimes scientific research is used to defend a practice even when the research doesn’t truly validate it.
There are several ways to use science to support a therapy that doesn’t actually work.
1. Extrapolation from tangentially related theories:
Proponents of an untested or demonstrably ineffective method will refer to scientific ideas in unrelated areas to suggest their theories must be true. Quantum physics is commonly relied on in this way since it is complex and not really comprehensible to most of us without facility with advanced mathematics. Homeopaths, have made much of the phenomenon of hormesis to suggest that it validates the ultradilution of homeopathic remedies, though it clearly does not.
The problem with this time of defense is it creates the appearance of scientific legitimacy without actually saying anything substantive about the method being defended.
2. Extrapolation from pre-clinical research:
In vitro or animal model studies can be very useful in demonstrating a basic concept or in screening for possible safety concerns or other biological effects from a therapy. But what happens in a test tube or a lab mouse is not a reliable guide to what happens when an actual patient, often of a different species, with naturally occurring disease. Such research can generate hypotheses and provide support for them, but it cannot be the primary validation for medical therapies.
Again, the problem is that such research is real, legitimate science used illegitimately to imply that we know more about the effects of a medical therapy than we really do.
3. Low-quality, poorly controlled clinical research:
For some CAM therapies, such as homeopathy and acupuncture, there is an enormous body of clinical research in humans. You would think this would make a decision about whether these therapies work easier, but that isn’t always the case. It has been persuasively argued that most published research is wrong, in conventional as well as alternative medicine. It is very easy to set up an experiment to confirm what you already believe. Even with reasonably good controls, single studies often generate unreliable, usually positive results.
The Decline Effect is a well-known phenomenon in which small, early tests of a hypothesis generate positive results, but as independent investigators get involved and potential sources of error are better understood, the effect of the intervention get smaller and sometimes evaporate altogether. This is how science is supposed to work, but it leads to trouble when early, small, low-quality studies without confirmation by replication are cited as evidence to support a therapy.
The National Center for Complementary and Alternative Medicine (NCCAM) was set up specifically to investigate therapies which had committed believers but had little in the way of plausible theories or preliminary research evidence to suggest they were worth subjecting to clinical trial analysis. Its parent was politics, not science, and after more than 10 years and $1.4 billion, the results have been largely negative and have had little impact on the popularity of CAM therapies, even those shown to be useless. The political figure most responsible for this organization, Senator Tom Harkin, reacted to the negative scientific findings with disappointment and a clear lack of understanding of the purpose and methods of science:
One of the purposes of this center was to investigate and validate alternative approaches. Quite frankly, I must say publicly that it has fallen short. It think quite frankly that in this center and in the office previously before it, most of its focus has been on disproving things rather than seeking out and approving.
Of course, real science doesn’t set out to prove what one already believes but to find out what is true.
Which makes me ambivalent about an initiative by the American Holistic Veterinary Medical Association (AHVMA) to generate funding for alternative veterinary medicine research through the American Holistic Veterinary Medical Foundation (AHVMF).
There are certainly some CAVM therapies which deserve rigorous scientific investigation, particularly in the area of herbal medicine. There are also some that we would be better off without, and if clear scientific evidence that these are useless would lead to their decline in popularity, this too would be a good thing. However, based on both human nature and the example of NCCAM, I am suspicious that the AHVMA efforts are more likely to lead to the promotion of alternative therapies without strong, robust scientific evidence that they are worthwhile.
What is the AHVMF, and what is its purpose? Here’s what the AHVMF web site says:
The Foundation was established to receive and administer funds for research and education in all aspects of integrative medicine, especially as it pertains to that part which is called variously, holistic, alternative, or complementary veterinary medicine, or CAVM. The Foundation concentrates on 3 aspects: scholarships for veterinary students who are interested in this branch of veterinary medicine, research in this aspect of veterinary medicine, and support for the use of and education in this branch in veterinary schools.
So from the beginning, the purpose seems largely about promotion of alternative therapies. Research to investigate objectively the potential value of some specific therapies is certainly appropriate. Supporting students who wish to study these therapies seems a bit premature given the lack of evidence that the therapies themselves have value and deserve to be taught. Likewise, supporting the teaching of CAVM in veterinary schools presumes the value of the methods to be taught. So it is difficult to imagine the AHVMA supporting truly rigorous and impartial research given it seems to be focused primarily on promoting therapies that have yet to demonstrate their worth through such research.
Obviously the AHVMF is an offshoot of the AHVMA, sharing office space and many individuals in leadership positions. The AHVMA is a professional association and lobby for CAVM practitioners, so again this suggests that the AHVMF has been formed as a promotional organization rather than to sponsor truly independent research.
This is further supported by the AHVMF statement specifically about the research aspect of their activities:
Holistic medicine often has answers to chronic disease that use methods with few to no side effects. It may have an answer that is non-existent in conventional medicine. But this type of research is always under-funded and overlooked. The AHVMA Foundation is the best way to bring these modalities into the consciousness of mainstream medical thinking and practice.
Clearly, the starting point for AHVMF-funded research is the proposition that CAVM methods work and research is a useful tool for convincing others of this. This does not suggest a truly critical, open-minded approach to the subject. And if there were any doubt about this, it should be eliminated by the fact that the AHVMF has a page specifically devoted to testimonials for the miraculous benefits of CAVM therapies.
Inspiring stories about patients who have been helped by Integrative Medicine. If you have a story, please send it to us, along with a picture and the name of your veterinarian.
Inspiring stories about the success of specific therapies are not typically found on the web sites of organizations supporting research aimed at finding new or better therapies, such as the American Heart Association, American Lung Association, the National Multiple sclerosis Society, and such. Testimonials are he tool of organizations selling something even if, as in his case, it is not a product but a point of view being marketed.
Organizations like the Bravewell Collaboration and others have been very successful at promoting the integration of unproven or disproven therapies into mainstream medical schools and hospitals by providing financial incentives to hop on the bandwagon. Little good-quality science has resulted, and as mentioned earlier what research has been done hasn’t served to effectively validate much CAM or to discourage the use of methods shown not to be effective.
Obviously, it is impossible and inappropriate to judge in advance the quality of the research the AHVMF claims to be raising money to sponsor. The foundation has already raised over $400,000, a not inconsiderable sum in veterinary medicine, and is aiming for $20 million. I hope these resources lead to good-quality, rigorous studies that will let evidence-based medicine advocates like me accept and begin using new, effective therapies and that will convince CAVM advocates to abandon practices which are shown to be effective despite their a priori beliefs. Perhaps the involvement of veterinary schools will ensure the marketing and promotion activities of the AHVMF don’t damage the integrity of the research it funds. I am skeptical that this will be the case, but I will certainly be watching closely and hoping for the best.
I am all for Return On Investment (ROI).
However, defining ROI in any small service business, particularly in marketing, can be incredibly difficult to be even remotely useful. Most businesses don’t bother except when it is easy. But for some reason, when it comes to social media, ROI is mission critical.
You can place an ad for discounted services, with a coupon, running for a month, and a unique web address, and a unique phone number, and track that (but honestly how many actually do this?) But how can you track the person who becomes aware of your business through that ad, spots your sign one day while driving by, and then six months later needs and uses your services unrelated to the ad?
What is the ROI of your fax machine?
What is the ROI of customer service?
What is the ROI of a strong brand?
How do you place a value on communicating with a significant proportion of your clients every day?
Most businesses consider word of mouth one of the most important forms of promotion. It is essentially free and it is highly effective. With social media, we have the opportunity to insert our businesses into the “word of mouth” of our customers, and thereby their friends, and their friends friends. Why would you not get involved and take advantage of that?
Facebook for my business probably takes up 15 minutes of my day on average. An email, or even a call by the time I’ve documented it, to an upset client can easily take an hour. Should I not deal with an upset client when I don’t have to because the ROI is lousy? Yes, you can place a value on a client and on retaining that client. You can even track that you do get some clients from Facebook, but you may also get clients because you have an email address or a telephone number. When was the last time that anyone figured out the ROI of their email system? Even when buying a new phone system most businesses to not justify it with ROI, but rather than as the cost of doing business.
Small businesses often look up to companies such as Nike and Apple and see their devoted, and almost rabid, fan bases as evidence of marketing in action. I would argue, however, that companies like Apple and Nike create devoted fan bases is by being approachable and interacting with their clients – Apple in particular. I’m not the greatest Steve Jobs fan, but there are lots of examples of Steve taking the time to reply to ordinary consumers and being very interested in what they had to say. HP, Dell, et al. for a number of years, sold dramatically more computers than Apple, but it was Apple who held Mac World every year. Nike became cool because they did not go after deals, they went after people who actually used their shoes – athletes. They engaged their most high profile target market.
Of course, there is a lot of other marketing involved, but remember Apple’s most famous ad only ran once in most markets. Apple, and Nike for that matter, opened their own stores that operate on a quite a different model from other retail outlets. There is some argument that this was to help control the customer experience, but I also feel it was to be able to respond, and engage, with customers. Like all companies, they do not always get it right, but I do think that it is the willingness to attempt true engagement, and a real concern for the customer experience, that breeds fierce loyalty.
Social media is not a strategy – engagement, however, is.
So how to do social media and get some results and some traction?
To me, a major issue for small businesses is when they are on Facebook, Twitter, Google +, YouTube, and are doing all of them badly. Focus on one, and only one, and do it well. Then you can move on to another one.
Create things,or provide a service, using social media that other people will value.
Share other people’s content sparingly.
Self promotion has to have value, or at least not look like self promotion.
Don’t be afraid to ask questions of your fan base or ask them to share.
Drive fans to your website, or blog, from places like Facebook or YouTube not the other way round.
Pick your social media sites carefully. In my opinion, YouTube, for example, is very useful and can expose you to an enormous audiences, but the attention span is fleeting and the sense of community is almost non-existent. Embed videos in your site or page. Facebook works for my business and my previous business. Twitter does not. However, Twitter will almost certainly work for my new business, and it works for me personally. This has a lot to do with the small towns versus large cities and the nature of my business – it may well be different for yours. Google+ has some personal value, and some SEO benefits, but has little real world value at this point in time in my opinion. But it does look very pretty!
Numbers of likes or followers are pretty irrelevant. It is the level of engagement that counts. I’d much rather have two hundred relevant, and engaged, fans or followers than 6,000 just making up the numbers. As someone much smarter than me once said: “If you believe business is built on relationships, make building them your business.”
And finally, don’t cross post, post from one social network to another, unless you really know what you are doing.
And even then just don’t do it.
I beg of you.
I see people I respect and who should really know better, cross posting and it is counterproductive. Content for Facebook does not translate well to Twitter because of the character limit. Twitter’s special characters are not understood by most Facebook users.
There are social networks where cross posting seems to work pretty well, but again, it is a black art, and if you are questioning the ROI of any social network, cross posting from a different network is not any kind of an investment.
To sum up this long, and sprawling post, the ROI of social media is the ROI of engagement. If talking to existing and new customers is not for you then I wish you well.
That just means more customers for the rest of us.
Many thanks to my friends and colleagues on the Marking in Veterinary Medicine LinkedIn group for the conversation that this post was cannibalized from. Also many thanks to Ali Burden-Blake (@inkspotsocial) for her excellent blog post: “Stop! Why using social media won’t work for your veterinary practice.” which inspired the conversation in the first place.
I’ve written extensively about herbal remedies and dietary supplements both because these seem among the most likely to be useful of CAM therapies and also because they are widely used despite the lack of good evidence that they are safe and effective in most cases. The success of pharmaceutical medicines and vitamin supplements to treat deficiency diseases has created an expectation that taking a pill can have beneficial effects. When combined with the naturalistic fallacy (that we can identify some things as “natural” and then trust that these are safe) this predisposes people to believe dietary supplements and herbal medicines are good for them.
At least one NIH study suggests that about 18% of adults in the U.S. take some form of “natural product,” that is an herb or remedy that is not a vitamin of mineral. These consist mostly of herbal remedies, with Echinacea, Gingko biloba, garlic, glucosamine, St. John’s Wort, Ginseng, and fish oil being among the most popular. However, there is growing research evidence that these popular products don’t have the health benefits for which most people take them.
Echineacea does not appear to have consistently demonstrable benefits for cold and flu sufferers (1, 2), and there is even less evidence to support other purported benefits (3). The strongest evidence of benefit for Gingko biloba initially was for Alzheimer’s and dementia (4), however two large, long-term clinical trials have failed to support this hoped-for effect (5, 6). I’ve already written repeatedly about the consistent failure of glucosamine to perform better than placebo, and about the equivocal findings for garlic. Ginseng doesn’t perform much better, with mixed results in generally small and not high-quality research studies. (7)
Among the strongest cases for herbal or other “natural” supplements are those made for St. John’s Wort and fish oil. St. John’s Wort does appear to have some benefit for mild depression, though no greater and with no fewer risks than conventional pharmaceuticals, which aren’t themselves always consistently better than placebo (8). Not exactly a ringing endorsement for one of the most intensively studies herbal remedies, to say that it works about as well as the lousy conventional therapies it is meant to replace or complement.
The evidence is better for fish oils, which have shown some consistent, repeatable benefits in clinical studies (9). However, additional recent work has called into question even this widely accepted conclusion (10). I myself have taken fish oil supplements for years, though I have recently decided to skip the capsules and just eat more fish since, as seems to be turning out to be true most of the time, the health benefits associated with eating particular foods don’t necessarily translate into benefits from supplements based on those foods. (For what it’s worth, I also took glucosamine for a while, with no obvious effects, until the evidence against a real benefit became strong enough to convince me I was wasting my money. The key to an evidence-based approach to healthcare is both being open to new ideas and willing to abandon ideas that fail to live up to their early promise).
So while there is support for using some popular herbal remedies and other supplements, generally the evidence is far weaker than most people suppose. And the Decline Effect is readily apparent in the research on such remedies, with pre-clinical evidence and small, low-quality early trials showing apparent benefit which then gets progressively smaller and often disappears entirely and the amount and quality of the research grows. Promising ideas are worth investigating, but most fail to live up to their promise, so jumping on a new supplement bandwagon early is usually a mistake.
Vitamin and mineral supplements are the other major piece of the supplement market. Unquestionably, there is a real benefit for these in preventing specific nutritional deficiencies. However, the optimal intake of most vitamins and minerals for most individuals isn’t known. Age, sex, lifestyle, health, and many other variables affect how much of what we need to be as healthy as possible, and almost all recommendations to take more of these products than needed to prevent a deficiency are simply made up. General and irrational use of vitamin and mineral supplements not based on specific scientific evidence has consistently proved not only to not be beneficial but in some cases to be actively harmful (11, 12, 13, 14, 15, 16).
Of course, it is a given that people will continue to take supplements even based on flimsy evidence or even when the evidence is clear that benefits are lacking and there is real risk. The desire to control our health through therapeutic rituals, to believe what we wish were true even if it may not be, and the cognitive dissonance involved in letting go of deeply held beliefs when there is strong evidence against them are all factors that make it hard to give up behaviors that we feel, even mistakenly, are beneficial for us. So what should doctors do about our patients’ supplement use?
There is a lack of consistent and coherent policies among regulators and healthcare institutions to help doctors and patients manage the use of supplements concurrently with conventional medical therapies. Many patients (or veterinary clients) don’t tell their doctors about supplement use. Given that these products can interact in dangerous ways with conventional medicines, this present a real risk. So there are a number of things doctors should do, regardless of how favorably or skeptically they view herbal remedies and supplements, to minimize the risks to their patients associated with these products.
Doctors should ask their patients or clients about supplement use at every visit. I always ask my clients if their pets are on any medications. If they say “No,” I then ask about vitamins, supplements, herbal remedies, or other healthcare products, and they very often then reveal a whole host of things they are giving their pet.
Despite their belief that these products treat or prevent disease in their pets, these owners don’t think of the products as medicine since that word is generally associated with pharmaceutical products. Only specific and detailed questioning is likely to yield a true picture of what chemicals an owner is putting into their pet’s body.
We cannot counsel our clients effectively without being knowledgeable about the products they are interested in using. If a supplement or herbal remedy is truly beneficial, we should know this and know how to use it to help our patients. And if such a product presents a danger to our patients, or is simply a waste of our clients’ money, we should know that as well.
Obviously, I am skeptical about the value of many supplements. But I own quite a few references and textbooks about such products which I consult regularly, I maintain a subscription to the Natural Medicines Comprehensive Database, and I make the effort to be informed about the current scientific evidence regarding herbs and supplements (and to make that information available to others through this blog when I can). This seems a crucial part of being a truly useful resource for my clients and patients, even if often I end up having to tell that that the evidence is inconclusive and what they are giving their pets may or may not be in their best interests.
This is not to say that all veterinarians or veterinary students should undergo specialized training in herbal medicine or the use of supplements. All too often, such training is produced by individuals with firm beliefs about the value of such products who recommend them on the basis of historical use, personal experience, or kinds of evidence weaker than, and often in conflict with, the evidence of scientific research. To have an educated, informed, and science-based understanding of supplements does not require one to be trained in their use by practitioners already committed to their worth any more than being an educated, informed, and science-based critic of astrology or homeopathy requires one to train as an astrologer or homeopath.
I see educating and informing my clients as a crucial part of my job. I cannot care for my patients effectively if I cannot communicate effectively with their owners. This means presenting the facts as I understand them, and my informed opinions (which, after all, is what the client is paying me for), clearly and in a way my clients can understand. This also means not taking an adversarial position against the values and beliefs my clients hold. I see it as an ethical duty to tell my clients when I believe they are treating their pets in a way that is useless or harmful, but this message cannot be heard unless it originates from a position of respect for their intentions and their feelings and a shared desire to do what is best for the animal.
My critics would likely be surprised at how many of my clients, with whom I have long-standing relationships of trust and cooperation, utilize therapies that I actively recommend they not use. Disagreement need not lead to personal antipathy, and my clients understand that even when I tell them something they don’t believe or don’t want to hear, I am not challenging their commitment to their pets’ wellbeing or their own competence as an owner.
Veterinarians need to be honest and explicit with their clients about the evidence concerning the therapies we offer and those we recommend against, and we need to not only share what we know but also admit what we do not know. When it comes to counseling clients about the use of supplements, making clear the uncertainty about these products, and that this uncertainty applies to their safety as much as to their purported benefits, is a necessary part of helping our clients make rational, informed decisions about their pets’ care. The biggest problem with the promotion and advertising of such supplements is that they make confident claims well beyond anything even remotely justified by real evidence.
Overall, there is some reason to hope that some herbal remedies and nutritional supplements will one day be a useful tool in treating our patients. However, even the best-studied of such remedies currently have only weak evidence to support safety and efficacy, and most have nearly nothing but wishful thinking to justify their widespread use, especially in veterinary medicine where good quality clinical trials of such products are almost non-existent.
This means that we need to be aware of the evidence that does exist and explicit with our clients about what it does and does not tell us. And we need to be vigilant in watching out for harm from products that are often mistakenly assumed to be inherently safe. Clearly, such products will continue to be in fairly widespread use until the political climate changes to allow meaningful regulation of them and requirements that they be validated through proper, rigorous scientific study. Until then, veterinarians need to make the effort to be a source of reliable and honest information for our clients in order to protect and care for our patients.
Most of the individuals I write about who are promoting questionable veterinary medicine, or outright nonsense, are veterinarians. Such individuals have some claim to legitimacy and authority in recommending veterinary treatments, and so their voices tend to carry more weight than those of most lay people. This isn’t always a good thing since veterinarians are no less prone than anyone else to getting bad ideas stuck in our heads or to being misled by all the features of the world and our own brains that so easily fool us. Experts, that is individuals with recognized credentials and formal training in a specific area of medicine, do tend to have more factual knowledge in that subject. But they are not immune to making mistakes, so as always it is the ideas and the evidence that must be given the greatest way, not the authority of the individual.
Because advice from veterinarians is more likely to be trusted, even when it’s bad advice, I focus on these sources when pointing out why certain ideas, practices, or products are not supported by good evidence and science. However, once in a while I run across a particularly egregious example of misleading a negative advertising for alternative medicine that I feel obliged to challenge even though the source is not a veterinarian. Here’s a quick example of why I noticed this one:
If your dog has been given the heart-breaking diagnosis of terminal cancer… Just About EVERYTHING Your Vet Told You Is WRONG!
Subtle, thoughtful argument, eh?
Steven Eisen is a “Holistic Dog Cancer Expert.” How did he get to be an expert? Well, first he read about holistic medicine in college, then he studied at the New Age Esalen Institute, and then he graduated from a college of chiropractic. Oh, and when his own dog got cancer he ignored his veterinarian’s advice and made up a bunch of stuff about diet and supplements, and since his dog lived longer than he says the vet predicted, he must have discovered the cure for dog cancer. Now, he would like you to buy the secret to curing cancer from him in the form of his book, Dog Cancer: The Holistic Answer.
I wasn’t willing to support the promotion of this nonsense by buying the book, but Dr. Eisen does offer some glimpses of his ideas on his web site and in a number of free videos. These exhibit nearly all the warning signs of quackery, and Dr. Eisen doesn’t provide any evidence beyond his own opinion and the usual unreliable miracle stories for his claim that he has a simple, safe, effective therapy that scientific medicine either doesn’t know about or doesn’t want you to know about.
His primary web site, DogCancerAdvice.com, offers the usual sorts of unsubstantiated attacks on the ignorance and futility of conventional veterinary medicine. For example:
“The training of these professionals [veterinarians] has superbly equipped them to treat acute problems like infections, heartworm, and trauma. However, there are no standard veterinary protocols for dog cancer. The only treatments taught in veterinary school are the toxic ones…despite the scientific evidence that they are not effective. “ “Although some veterinarians claim to combine conventional and alternative dog cancer treatments, it’s rare to find one that has a thorough understanding of the principles of holistic medicine and holistic treatments for cancer in dogs. An issue that’s consistently ignored is that the two approaches are often incompatible because the underlying assumptions are worlds apart. If a gardener said he would take care of your lawn with both pesticides and organic methods, I think you would wonder about his expertise, his intelligence and/or his honesty.” “If there were a brush fire in the forest, would it make sense to set the rest of the forest on fire? That is essentially the conventional approach to treating dog cancer.”
“Unfortunately, many have been following dangerously mistaken advice from their vets. The quality of your dog’s life can improve, and even be healed from cancer with the right information. “
“In vet speak, a dog with lymphoma is considered “cured” by conventional treatment if it survives 8 months.” [This is simply an outright lie. No legitimate veterinarian would claim to be able to cure lymphoma. Only Dr. Eisen claims that. The word he’s looking for is “remission,” and the mean remission time for lymphoma with conventional treatment is about 10-14 months]
Dr. Eisen then gives detailed (and completely made up) numbers showing so-called “holistic” treatment is cheaper than conventional cancer therapy, which seems a transparent attempt to prey on people who would like the best care possible for their pets but have significant financial limitations. He lists the potential side effects of conventional treatment without any information about how common or severe these might be and no mention of the benefits of treatment. And he finishes with the usual nonsense that “Holistic dog cancer treatments generally have no side effects if the correct dosage and protocol are followed.” The bottom line:
“Not only are alternative treatments less toxic and more effective, they also cost just a fraction of what you would pay for conventional treatments. “
So a cheap, simple, effective cure for cancer with no risks or side effects which, for reasons we can only guess at, almost none of the veterinarians (or physicians, for that matter) know about or use. Hmmm, how likely does that seem to you? Well, let’s see what Dr. Eisen’s argument is.
Part of being an expert in dog cancer is apparently being a toxicologist. Well, ok he’s not actually a toxicologist, but he says dog cancer is all about toxins, so we have to believe him, right?
Most of Dr. Eisen’s rant about toxins as a cause of cancer is indistinguishable from the usual oversimplified, mythologized nonsense about how the whole world is full of poisonous chemicals. The fact that some substances, both natural and human made, can cause disease, including cancer, in some people at some dose has nothing to do with the almost religious notions about contamination and purification behind the notion of “detoxification” as a treatment for disease.
Dr. Eisen lists a myriad of substances that are to blame for your pet’s disease, including vaccines, commercial pet food ingredients (including pretty much every part of the animal except muscle meat), bacteria as well as the antibiotics used to treat them, vaccines, flea and tick control products, and both tap water and bottled water (which are allegedly full of pharmaceuticals and that classic bugbear of quacks—fluoride). All of the accusations are presented as fact despite the absence of real data to support them. Nothing sells like fear!
Examples of Dr. Eisen’s sophisticated, thoughtful reasoning balancing risks and benefits include these remarks:
“If your dog has cancer, it is imperative that they never receive another vaccination. Not ever again for the rest of their life.”
“I can’t emphasize this too much. You need to eliminate the application of all commercial flea and tick products if you want to keep your dog healthy.”
(Quoting an opponent of water fluoridation) “In point of fact, fluorine causes more cancer death, and causes it faster, than any other chemical.”
Apparently, despite having no formal training in veterinary nutrition, Dr. Eisen is also an expert in cancer nutrition as well. With his usual abundance of confidence, and lack of evidence, he makes a number of claims about cancer and diet.
First, he recommends a homemade diet because, “there is no healthy commercial dog food that fully meets the nutritional requirements for dogs with cancer.” He dismisses the one cancer-specific diet on the market because of the usual myth about “byproducts” (the parts of the animal affluent Americans find yucky but that are routinely eaten by people in other cultures and universally enjoyed by wild and feral carnivores). And he completely ignores the strong evidence that homemade diets are almost always nutritionally incomplete.
Next he recommends a low-carbohydrate diet for dogs with cancer. There is some research which suggests carbohydrate restriction could have benefits for cancer patients. There is, as yet, no consistent body of evidence in humans or in dogs to indicate they actually do have benefits, so the idea is reasonable but still tentative. Dr. Eisen recommends a lower carbohydrate content than most veterinary nutritionists for cancer patients, and again he ignores evidence that high protein diets and nutritionally unbalanced diets can be harmful.
He makes some unfounded arbitrary restrictions, such as banning pork as a protein source, and recommends a host of herbs which rumor, but no convincing scientific research, suggests might have anti-cancer properties. Despite the lack of any evidence to show this diet is nutritionally adequate, much less that it has a significant impact on the health or longevity of cancer patients, Dr. Eisen concludes, “This truly is healing food for your dog with cancer.”
Why? Apparently because he says so.
Dr. Eisen states repeatedly, that cancer is growing more and more common in dogs. He bases this on reports indicating cancer is diagnosed more frequently now than ten or twenty years ago. This is likely true, though the data is not from very high quality controlled studies. Unfortunately, one area in which Dr. Eisen is not an expert is epidemiology, the study of the occurrence and causes of disease. He assumes simplistically that more cancer diagnosis means more cancer, which he then goes on to attribute, again based only on opinion, to a more toxic environment. However, more diagnosis of cancer does NOT mean that our dogs are sicker than they once were or that the environment is less healthy. Here are other reasons why cancer diagnoses can increase:
a. An Aging Population- Cancer occurs more frequently in older animals because it is frequently caused by defects in the control of cell division that accumulate over the lifetimes of many cells. The longer you live, the more times your cells have had to divide, and the more opportunities there are for the kinds of errors that can lead to cancer. Every epidemiologic study must account for differences in age between populations when comparing the rates of cancer and other disease. So if our pets are living longer as a result of better nutrition, disease prevention, and medical care, then we will see more dogs with cancer.
b. Better Control of Non-Cancerous Disease- For most of human history, almost half of all people born died before they reached adulthood. Very, very few of these children died of cancer, which is much more common in the elderly. They died mostly of malnutrition, infectious and parasitic diseases, and accidents. As science improved the quality of our food supply, provided the technology that raised our standard of living, and generated vaccines, antibiotics, pediatric and neonatal intensive care units, and all the other healthcare interventions that prevent these kinds of deaths, guess what happened? Yup, more people lived longer, the average age of the population increased, and cancer became a more common cause of death. NOT because the environment got more toxic but because it got healthier and safer! Cancer is one of the things you die of if you succeed in avoiding the age-old standards that used to kill most people.
The same is true for our pets. The very vaccines and pet foods and medicines Dr. Eisen condemns so blithely are responsible for reducing deaths from many non-cancer causes, leading to an increase in the number of cancers seen. This is a sign of past success for scientific medicine, and a challenge for the future. It is not a sign of the failure of conventional healthcare or the poisonous nature of the environment.
c. Better Diagnosis and Treatment- Diagnostic methods like ultrasound, CT scanners, and biopsies are becoming more accurate and more available all the time, and more people are willing to pay for tests to identify cancer in their dogs. This alone can increase the number of cancers diagnosed. And as we develop the ability to diagnose cancer more accurately and at an earlier stage, and as we find treatments for cancer which can (contrary to Dr. Eisen’s misleading claims) benefit cancer patients and even sometimes cure cancer, more people are willing to test their pets for these diseases and consider treating them.
I certainly wouldn’t claim that there is clear evidence cancer rates are not truly increasing. The reality is that we don’t have the appropriate epidemiological evidence to know. What is clear, however, is that the claim that there is more cancer due to increasingly toxic environments is absolutely without legitimate scientific support
So what does Dr. Esien say is the #1 Worst Thing for dogs with cancer? It’s not the commercial pet foods, flea and tick products, and tap water that he claims are contributing to a supposed cancer epidemic in dogs. Bad as these are, apparently they pale before the worst toxin of all–vaccines.
“The #1 worst thing you can do to a pet with cancer is to have them vaccinated.”
“Vaccines are loaded with toxic heavy metals like mercury and aluminum”
“Cancer is an auto-immune disease, so vaccines can cause cancer”
“Most vets administer vaccines routinely to our pets and tell you that they are safe, with very little risk. The fact is, nothing could be further from the truth.”
“Immunity is an all or nothing thing, either you have it or you don’t.”
“Any vaccination given to your dog will further impair their immune system and greatly reduce their likelihood of recovery.”
Now, there is nothing wrong with suggesting that vaccination may not be appropriate for dogs with cancer, or any other serious illness. It is widely accepted and routine to defer vaccination of dogs when they are ill. The problem with Dr. Esien’s diatribe about vaccination is that is takes this sensible recommendation and expands it into an indictment of vaccines as toxic and as a routine cause of cancer. It is like saying that because you shouldn’t drive while drunk, having a glass of wine with dinner is a major cause of auto accidents.
There are examples of vaccines being associated with an increased risk of some cancers. A type of cancer called a sarcoma can occur in between 1 out of 1,000 to 1 out of 10,000 cats vaccinated with an aluminum-containing rabies or feline leukemia vaccine. Such cancer is likely triggered by inflammation, which can also be induced by trauma, parasites, and many other causes. As a result of careful research identifying this problem (which we would not have found out about simply by casual observation or guessing), vaccines and vaccination practices have been altered to reduce this risk.
This example is misused to suggest that vaccines in general are a risk factor for cancer in general, which is not the case. And such arguments ignore the fact that vaccinations save many, many lives. It is easier to sell an idea that is simplistic and makes the world seem like a place where all risks can be controlled and we can have the outcome we want so long as we do everything “right.” But the world we live in is more complicated than that, and anyone who tells you differently is selling something.
Dr. Eisen also belabors the fact that vaccine manufacturers state their vaccines should only be used in healthy animals. While I agree this is usually true, vaccine manufacturers also state their vaccines are safe and effective. Why does Dr. Eisen reject these claims and yet accept the recommendation not to give vaccines to ill dogs? Simply because it fits his personal beliefs about vaccination and cancer. He picks and chooses which information to accept and which to ignore not based on the strength of any evidence but on his personal prejudices. This is called confirmation bias.
Finally, Dr. Eisen also argues that vaccines aren’t effective in dogs with cancer based on manufacturer cautions about using them in immunocompromised individuals. This is a reasonable hypothesis, but one that has rarely been tested. The only specific study of the subject in dogs actually found no difference between the response to vaccination in dogs receiving chemotherapy and dogs not being treated for cancer.
Effects of chemotherapy on immune responses in dogs with cancer J Vet Intern Med. 2006 Mar-Apr;20(2):342-7. Claudia U Walter, Barbara J Biller, Susan E Lana, Annette M Bachand, Steven W Dow Animal Cancer Center, Department of Clinical Sciences, Colorado State University, Fort Collins 80523, USA.
Abstract- Chemotherapy is assumed to be immunosuppressive; yet to the authors’ knowledge, the effects of common chemotherapy protocols on adaptive immune responses in dogs with cancer have not been fully evaluated. Therefore, a study was conducted to evaluate the effects of 2 common chemotherapy protocols on T- and B-cell numbers and humoral immune responses to de novo vaccination in dogs with cancer. Twenty-one dogs with cancer (12 with lymphoma, 9 with osteosarcoma) were enrolled in a prospective study to assess effects of doxorubicin versus multi-drug chemotherapy on adaptive immunity. Numbers of circulating T and B cells were assessed by flow cytometry, and antibody responses to de novo vaccination were assessed before, during, and after chemotherapy. The T- and B-cell numbers before treatment also were compared with those of healthy, age-matched, control dogs. Prior to treatment, dogs with cancer had significantly fewer (P < .05) CD4+ T cells and CD8+ T cells than did healthy dogs. Doxorubicin treatment did not cause a significant decrease in T- or B-cell numbers, whereas treatment with combination chemotherapy caused a significant and persistent decrease in B-cell numbers. Antibody titers after vaccination were not significantly different between control and chemotherapy-treated dogs. These findings suggest that chemotherapy may have less impact on T-cell numbers and ability to mount antibody responses in dogs with cancer than was previously anticipated, though dogs with lymphoma or osteosarcoma appear to be relatively T-cell deficient before initiation of chemotherapy.
So while there are good arguments for avoiding most vaccination of dogs with cancer, Dr. Eisen isn’t making them. He is simply asserting that vaccinating dogs with cancer is ineffective (which there is evidence may not be true) and harmful (for which there is no evidence at all). In short, he is making stuff up to suit his phobia about vaccines and toxins, and he is willing to borrow and misinterpret any information from any source to do make his case.
“What I do is help people learn about holistic protocols for treating dog cancer so they can get their dogs better without the side effects and often life-threatening consequences of conventional treatments.”
Dr. Eisen makes the usual misleading arguments for why you should take his advice. He claims his dog lived longer than expected after being diagnosed with cancer, so that proves his treatment works. Such miracle testimonials are not, however, a reliable guide to what works and what doesn’t, for reasons I’ve discussed before. He talks about individualizing therapy, which is a common marketing ploy for alternative medicine that doesn’t mean what he wants you to think it means. And he claims that many of his recommendations are “scientifically proven,” which is another empty marketing phrase. And, with the usual ambivalence towards science that characterizes most promotion of pseudoscience, he claims it as a source of legitimacy while simultaneously deriding it as worthless:
“Limiting your treatment options for dog cancer only to those proven by scientific research could be harmful to your dog’s health.” [he then goes on to talk about how individual observations are often so obvious that clinical research isn’t necessary, which is only rarely true, and how “today’s profit-driven scientific community” isn’t interested in studying treatments which are cheap (though they still require buying his book)].
Dr. Eisen offers tidbits of advice on three web sites, dogcanceradvice(dot)com (which mostly serves to advertise the book), dogcanceracademy(dot)com (which has a couple of videos you can watch in exchange for your email address, which allows more direct marketing), and bestdogcures(dot)com, which is a subscription site open to those who buy the book. All of this is classic internet marketing, very similar to what Dr. Andrew Jones does for his Veterinary Secret book and site.
Dr. Eisen is a chiropractor who claims to be an expert in veterinary nutrition, toxicology, and cancer therapy based on having read a lot of books and invented his own “holistic system” by selecting which information he wanted to believe and which he felt he could ignore. The core of his marketing strategy is 1) to generate fear, by claiming that cancer is an epidemic and that we are surrounded by cancer-causing toxins in the very food and medicine we trust to keep our dogs healthy and 2) to claim that veterinarians have only dangerous and ineffective cancer treatments to offer and are ignorant of, or deliberately ignore, proven safe and effective alternative treatments. He provides no evidence for any of these claims, only his opinion and some testimonials.
A few of his claims are distantly based in real science and then stretched and twisted to support a pseudoscientific approach. Most of his claims are completely made up and contradict well-established science. He gets away with this by offering the usual unjustifiable promise of something for nothing, of effective treatments, or even cures, for cancer that are easy to use, completely safe, and cost little.
His web sites manifest many of the classic warning signs of medical quackery, including:
Claims of miraculous results
Claims of special knowledge unknown to or ignored by mainstream medicine
Claims of scientific legitimacy without any actual research data
Claims of expertise with no relevant credentials
Claims of simple and easy solutions to complex, difficult problems
Reliance on testimonials as proof
Claims that disagreement is driven by ignorance, fear, or greed
Misleading and selective use of real facts mixed in with made-up claims
And I have little doubt that, once his followers see this article, these signs will be joined by the inevitable personal attack on the critic rather than substantive response to the criticism, lots or testimonials supporting Dr. Eisen’s approach, lots of claims about the fear, anger, ignorance, greed or, most ironic of all, the arrogance of anyone who dares to criticize someone who has declared themselves an expert and who claims to know better than everyone with actual training and expertise in the subjects he talks about (true followers rarely see the irony in this).
The saddest thing about this sort of nonsense is that it is far more accessible and palatable to people whose pets have cancer than legitimate scientific information from true experts in veterinary cancer treatment. The bulk of what pet owners find on the internet is marketing materials designed to feed on their hopes and fears while not honestly helping their pets. Compassionate care is not limited to bogus “holistic protocols” like Dr. Eisen’s, despite the fact that he markets himself more effectively than genuine experts. True compassionate care is treatment based on legitimate science, not made up out of myths, misinterpretations, and wishful thinking.
Here are some real experts with real information for you if your pet has cancer:
Veterinary Oncolink, University of Pennsylvania
Pet Owner’s Guide to Cancer, Cornell University
The Cancer Center at Cares
Canine Cancer Library, National Canine Cancer Foundation
Animal Cancer Center, Colorado State University
I’ve written before about the unethical and misleading negative advertising that so often characterizes the promotion of alternative veterinary medicine. But I ran across another example that set my teeth on edge and illustrated a particular problem I have with this kind of thing.
Dr. Karen Becker, a prominent CAVM vet who writes for one of the most notorious sites promoting quackery through denigrating conventional medicine, Mercola.com, recently blogged about the much-reported decline in veterinary office visits. In this article, she makes a number of assumptions for which there is little or no evidence, and several accusations about the inadequacy of conventional veterinary care.
The accusations essentially amount to saying that conventional medicine ignores preventative care apart from given vaccinations and selling pest-control products, both of which Dr. Becker frequently cites as significant health hazards for our pets.
Perhaps a reason for fewer vet visits is the new canine vaccination guidelines which will hopefully put an end to the dangerous and unnecessary practice of yearly re-vaccinations.
I suspect another reason (aside from today’s tough economic climate), is because many traditionally trained DVMs practice ‘reactive’ veterinary medicine.
This means they don’t have much to offer pets unless and until they’re good and sick…
…preventive medical care in the mainstream veterinary community has evolved to mean not much more than yearly vaccines and chemicals to discourage pests and parasites like fleas, ticks and heartworm.
There is rarely discussion between vets and pet owners about nutrition (because vet students receive almost no education in the subject), exercise and other physical therapies, or the importance of a strong, resilient and balanced immune system.
This also raises the cliché about conventional veterinarians being ignorant in the area of nutrition, which is nonsense. The definition of ignorance most likely meant here, is simply a failure to agree with specific theories about what constitutes a healthy diet, including the unsubstantiated beliefs often promoted about the benefits of raw diets, the dangers of grains, and so on.
This then leads to the suggestion that alternative veterinarians do a better job of preventative care, because they promote “wellness” therapies.
For some reason the methods used to maintain a pet’s vibrant good health – everything from species-appropriate nutrition to maintenance chiropractic care to homeopathic remedies and herbal supplements – fall into the category of ‘alternative medicine.’
Isn’t it strange that natural modalities used not to cure illness (although they do that, too), but to maintain health are thought of as ‘alternative,’ yet chemical drugs and invasive surgery are considered mainstream health care?
Actually, it isn’t strange at all. There is no reliable scientific evidence for the preventative health benefits of maintenance chiropractic care, homeopathic remedies or herbal supplements. These products are touted as “wellness” care based solely on the personal beliefs of the vets who use them and the beliefs of previous generations of vets and animal owners. This is the same level of evidence that has supported such winning strategies as bloodletting, purging, and animal sacrifice as preventative health measures.
What is strange is that someone with medical training can so blithely denigrate preventative and therapeutic methods proven to work and wonder at the failure of mainstream medicine to accept without proof her belief that these alternative therapies are better.
I recommend twice yearly wellness examinations to my Natural Pet clients.
A thorough nose-to-tail professional checkup every six months is the best way for you and your vet to detect and stay on top of any changes in your pet’s health. This is especially true for older pets.
This is undoubtedly great for the bottom line, but again there is no evidence that biannual or annual wellness examinations recommended for all pets is an effective or efficient strategy for preventing disease or extending length and quality of life. In humans, the evidence in fact is building against the value of annual exams for well people. There is no evidence either way in veterinary medicine, so while I myself think it likely that regular examinations could have some benefit, there is no objective reason for a strong recommendation of this kind. And certainly such visits are not a substitute for the “chemical drugs” and vaccinations that have been far more effective than any other measure and reducing disease and preserving health in our companion animals.
…Proactive vets are typically obsessive about clinical pathology…most proactive vets recommend annual vector borne disease testing instead of waiting until lyme disease has set in, causing incurable auto-immune polyarthritis.
This is a completely irrational and baseless recommendation. Screening tests without an appropriate reason for doing them waste money and cause far more harm than they prevent. There is a strong movement in human medicine now to reduce exactly this kind of misguided thinking. So to imply that the care such alternative vets provide is superior to that of conventional veterinarians because the former recommend unproven preventative measures and unnecessary testing is misleading and unethical. Given the complaints so often made by CAM vets about the purported financial motivation behind many mainstream practices, it is quite ironic that this sort of advertising promotes far more aggressive, and likely expensive, use of approaches with no proven value.
I have written several articles previously about veterinary stem cell therapies, which I view as a promising but as yet unproven treatment for a number of medical problems. (e.g. 1, 2, 3, 4, 5) Though not “alternative” in origin, the marketing of these treatments and the arguments used to justify them in advance of adequate scientific data establishing safety and efficacy resembles the promotion of many alternative therapies.
I have received some pretty harsh criticism for suggesting this, so it was satisfying to read a recent editorial in the journal Veterinary Surgery:
Jeffery ND. Is ‘Stem Cell Therapy’ Becoming 21st Century Snake Oil? Veterinary Surgery 41 (2012) 189–19.
The author begins by cautioning us against “a non-critical acceptance of new advances because of a complacent assumption that previous mistakes regarding poor medical regulation will not be repeated in the modern world.” Obviously, this blog exists precisely because such mistakes, and reliance on prescientific methods of evaluating new ideas through personal experience, uncontrolled experimentation, and trust in authority, rather than reliance on rigorous controlled scientific research, are still widespread in our profession. As Dr. Jeffery correctly points out, the majority of veterinarians rightly deride pseudoscientific methods such as homeopathy (though too many still fall for it’s propaganda). And yet the same approaches to justifying other kinds of clinical interventions, both conventional and alternative, are all too common.
He then goes on to remind us that the promising preclinical research involving stem cell therapies does not justify their widespread clinical use without properly designed and conducted clinical trials. Most research on these therapies published so far has been methodologically inadequate to justify the burgeoning market in stem cells. However, the uncritical reports in the media of preclinical research, and the easy availability of testimonials and uncontrolled anecdotes about stem cell treatment, not to mention the aggressive marketing by stem cell therapy companies, make it “easy to sell to owners as a respectable treatment, even in the absence of rigorous proof of efficacy.”
Finally, Dr. Jeffery emphasizes something with which I conclude most of my own articles about unproven therapies, a call for a stricter standard in veterinary medicine for scientific evidence about our interventions.
Whilst stem cell therapy has rapidly achieved high profile in medicine and therefore even misplaced claims for efficacy are noteworthy it is not the only therapy in veterinary medicine or surgery for which there is insufficient evidence of benefit to support widespread implementation. Novel interventions for common conditions are published frequently in veterinary journals, including Veterinary Surgery. Whilst it is undoubtedly important that new interventions are explained through publication, it is essential that they should subsequently be subject to critical testing of their effectiveness before being widely accepted. This is currently not standard practice in veterinary medicine and surgery… Strict testing of novel interventions must become the norm for veterinarians to be able to maintain our view of ourselves as a ‘science-led’ profession.
I couldn’t agree more.
H.G. Wells is credited with saying, “Advertising is legalized lying,” though I cannot imagine he is the first person to have thought so. Of course, the difficulty with identifying actual lying in advertising is that it is impossible to know whether the person making false claims actually believes their statements are true. When talking about inaccurate advertising of alternative medicine, supplements, unconventional diets, or even conventional therapies such as stem cell injections, I try to make the safer and more charitable assumption that the advertiser believes what they are saying, however egregiously implausible and inaccurate it may be.
Unfortunately, whether inaccurate claims made to sell a product are genuine misconceptions or deliberate deception, the truthfulness of the claims is often not something the consumer can judge, so false claims sell just as effectively as the truth. And because of the undeniable effectiveness of science as a means of identifying the truth, claims of “scientifically proven” benefits are often made in advertising healthcare products and services, which creates an undeserved and false appearance of legitimacy to unsupported, pseudoscientific ideas.
The latest example I have run across of this phenomenon, and a particularly brazen one, is the advertising of Souly’s Raw Pet Food. I’ve written in detail about raw diets before, and the bottom line is that there is no reliable research to indicate any benefits at all to feeding our pets raw food. The theories behind these diets are a mixture of reasonable supposition and nonsense, but there is no sound evidence to support any of them. There is, however, abundant evidence that cooked food is more nutritious than raw food, and that raw diets come with serious risks, including nutritional inadequacy and contamination with harmful bacteria. Despite this lack of any real reason to believe raw diets are good for our pets, manufacturers and promoters of these diets are not shy of making aggressive claims.
A press release from the makers of Souly’s sounds like a report on a new scientific study, but a close reading finds no evidence of any research at all, merely unsupported opinion and error.
Soul’y Raw Pet Food Discovers that Switching Your Pet to a 100% Handmade Raw Food Diet has been Successful as an Alternative Treatment for Coprophagia
The most common cause [of coprophagia] is usually a dog that is lacking a diet that provides him with sufficient vitamins and minerals to quell the desire to seek out other food sources to make up for the deficiency….Soul’y Raw Pet Food in San Marcos CA has noticed that the practice of dogs consuming their own feces or that of other dogs has all together stopped in their loveable following of furry friends when transitioned to their high quality raw food diet. One could say that this simple breakthrough in successfully deterring pets from seeking out feces as an alternative food source is just what the Doctor ordered.
To begin with, the consensus among veterinary nutritionists is that medical and nutritional causes of coprophagia are quite rare. It is usually behavioral in origin and can be a normal activity for healthy dogs and cats. The claim that it is the result of a nutritional deficiency is not supported by any evidence, and the implication that a raw diet would prevent such a deficiency better than conventional commercial diets is even more preposterous. And in this case, the “evidence” appears to be nothing more than the opinions and observations of the diet manufacturer and their friends, which hardly merits a press release announcing a scientific “breakthrough.”
But further reading clearly illustrates that the folks at Soul’y Raw Pet Diets do not understand nutritional science and care little about what scientific evidence supports or doesn’t support.
Soul’y Raw Pet Food does not chemically alter any of our ingredients by cooking or any other manufacturing process. Research has shown that most pet food allergies are derived from denaturing the ingredients and their bodies are not able to recognize them as a protein and their bodies will try to fight off the foreign body which creates the chronic allergic reactions.
This explanation is, in fact, the exact opposite of the true nature of dietary allergies. Whole proteins are the primary trigger for allergies in animals predisposed to have them. And when there is a malfunction in the GI tract such that it fails to break proteins down into small enough pieces, this can make allergies more likely. Finally, one of the most effective treatments for food allergies is to feed hydrolyzed protein diets, diets in which the proteins are chemically processed (gasp!) into small enough pieces that they cannot trigger an allergy reaction.
I certainly don’t expect lay people to be experts in the mechanics of digestion and food allergies, but this level of ignorance is frightening and inexcusable in a manufacturer of a pet food. It also indicates the blatant disregard for scientific fact so often seen in the marketing and promotion of raw and other unconventional pet diets.
The company’s web site contains many other examples of unproven or simply incorrect assertions. Their diet is claimed to be “PROVEN” to control allergies, though there is no research to support this. The company also claims eating their diet will prevent lawn staining, reduce vet bills through the ever-popular “strengthening the immune system” nonsense, and even prevent flea infestation! These are all implausible claims presented with no real evidence.
Finally, the terms “human grade” and “restaurant grade” are frequently used for the ingredients despite the fact that these are not legally defined terms or part of the USDA meat grading system. Use of such meaningless terms cannot be anything but misleading and deceptive since they appear to indicate an official judgment on the quality of the food’s ingredients when the manufacturers must know that no such judgment has been made by anyone but them.
My purpose is not to pick on a single manufacturer, though the advertising by this company is certainly inaccurate and misleading. The unfortunate truth is that advertising full of unproven claims and inaccuracies is widespread in the marketing of veterinary health products. A blithe disregard for the meaning of the term “scientifically proven,” as shown by using this term and others like “research proves” and “studies show” without citing any actual published scientific studies, is a warning sign for the consumer. Such terms are meaningless at best and a signs of active deception at worst.
The best chance for us to identify what is truly beneficial for our pets is not to rely on advertising but to demand claims be supported by actual scientific evidence. Where such evidence doesn’t exist, claims that the benefits of a product are “proven” should be regarded as deceptive. The most that should be said in the absence of true scientific evidence is that a product might have benefits and that some people believe they have seen it work. The same, of course, has been said of every health practice ever invented, whether it worked or not, so this is not a very reliable guide to the truth of such claims, but at least it is not actively misleading.
The first article here was written about two years ago. Since that time, a case report illustrating some of the dangers of this product has appeared in JAVMA, and the second article discusses that.
A reader recently drew my attention to a form of CAM that is particularly dangerous and irresponsible but that like the mythological Hydra manages to raise its ugly head again and again despite efforts to kill it. Its latest incarnation in the veterinary field is as Neoplasene, yet another example of how CAM can achieve success through marketing unsupported by any evidence of real benefit.
According to the marketing materials, the ingredient in Neoplasene is “one of the prominent candidates deserving of the wonder drug designation.”(1) Pretty exciting, no? The promoters go on to follow the well-traveled road of CAM marketing, explaining why scientific medicine has missed the obvious truth, and only the iconoclastic promoters of the “wonder drug” can see it. “[Pathologists] clearly have not made reliable sense out of biopsy analysis…they just aren’t up to the task of reliable diagnostics.”(1) Of course, that doesn’t really matter since “this author…believes that inordinate attention is paid to diagnostics because, until now, little could be done to eliminate neoplastic disease so instead of treatment mainstream protocol has been to study the symptoms a lot and treat the disease a little.”
Oh, instead of studying the disease, we should be treating it!!! Gosh, how could we have been so blind? Oh, maybe because of “the barriers to the development and use of really effective cure oriented chemical treatment of neoplasm which are intertwined with political, economic and regulatory realities.”(1) See where this is going? “Cancer treatment and research are big business. Tremendous resources of facilities, personnel and funding are allocated to address education, equipment, real estate, personnel and patented designer drugs. Big organizations have momentum; they do not change direction easily or quickly…It has been viewed by drug developers that patentability may not be attained on some pharmaceuticals.”(1) So we in mainstream haven’t seen that “these alkaloids clearly attack neoplasm preferentially” and “this fact has been known and largely ignored by pharmaceutical researchers for nearly two hundred years” because of institutional inertia and the fear that we won’t make back the cost of developing such a miraculous cancer cure.
Such clichés seem as obviously ridiculous and unbelievable as the fake moon landing sort, yet they are just as persistent, and even more dangerous in that they drive people away from real medicine and into the arms of CAM.
The Neoplasene marketing materials go on in some detail, using testimonials and sloppy semi-scientific verbiage to clearly claim that the product treats, and even cures cancer, despite a few lame disclaimers to the contrary. And what is this miracle elixir the bloated bureaucracy of scientific medicine has overlooked?
Neoplasene is a derivative of bloodroot, which is one of several caustic herbal products known as escharotics(2). When applied topically in sufficient concentrations, these derivatives burn the flesh and cause tissue necrosis, often leaving thick scabs called eschars, and tremendous local devastation of healthy tissue. The danger of these products is well-illustrated by case reports in the scientific literature(3,4). Though the promoters claim the chemicals somehow recognize cancerous tissue and spare healthy tissue, there is no clinical evidence of this. Some preliminary in vitro research certainly shows the chemicals can kill cells. And there is some limited evidence that they may even be better at killing diseased cells than healthy cells in culture.(5) But when you smear the stuff on your skin to “draw out” the neoplastic cells and leave untouched the healthy tissue, you’re likely to wind up with a gaping hole and a lot of plastic surgery to look forward to. If you’re especially lucky, though, some deeper neoplastic cells will be left behind, and the provider of the salve can then explain why the recurrence or metastasis of your cancer despite its apparent removal by the product is not their fault. Probably chemicals in the water or something.
The promoters of Neoplasene acknowledge, while downplaying, the risk of tissue damage from topical use of their product. They say you should “expect a wound to manage. It size will be in proportion to the extent of the tumor and the amount of Neoplasene compound applied…expect some scarring.”(1) The relevance of their earlier claim that “bloodroot chemicals and Neoplasene are simply not escharotics. They do not burn flesh” isn’t entirely clear, since they seem to be arguing that causing tissue to die and slough off leaving a bloody great hole is fine, so long as it’s through some mechanism other than chemical burn. Hmm.
The FDA has actually gone so far as to ban importation and marketing of bloodroot and other escharotics for cancer treatment, an all-too-rare example of government challenging “Big CAM” which further illustrates how frightening these products are(2). And yet these products are easily found on the Internet and used by a depressingly large number of CAM-oriented veterinarians, likely with a genuine belief that they are curing cancer through a miraculous means ignored by the corrupt and blind medical-industrial complex. I can’t say whether the active use and promotion of such products in the veterinary field, free from government sanction, is due to a loophole in the law or just the fact that the Hydra has many more heads than the FDA has paid investigators.
The only FDA-approved use of a bloodroot derivative, sanguinarine in dentifrice, is no longer popular as it proved to be a significant risk factor for leukoplakia, a potentially pre-cancerous disease(6). And while removal of low-risk, superficial skin tumors can be accomplished with escharotics, there are safer and more effective methods. Far from being a “wonder drug,” these products are an inappropriate and dangerous substitute for real scientific diagnosis and therapy of cancer. And contrary to the nonsense about the venality and blindness of the “cancer industry” and their own great insight, the promoters of Neoplasene are simply the latest head of the corrosive hydra that is bloodroot derivative cancer salves.
1. Fox, T.S. Discussion of and clinical guide for: the treatment of neoplasm, proud flesh and warts with sanguinarine and related isoquinoline alkaloids. Buck Mountain Botanicals, Inc., www.neoplasene.net, 2008.
2. Barrett, S. Don’t use corrosive cancer salves (escharotics); Quackwatch. www.quackwatch.org, 2009.
4. Moran, AM., Helm, K.F. Histopathologic findings and diagnostic difficulties posed with use of escharotic agents for treatment of skin lesions: a case report and review of the literature. J Cutan Pathol 2008; 35:404-406.
Two years ago, I wrote about an herbal product called Neoplasene, an excharotic derived from bloodroot that is marketed for treatment of cancer. I pointed out in that article that apart from a couple of in vitro studies suggesting the active chemical ingredient has some interesting effects on cancer cells, there is little evidence the product is an effective cancer treatment. And there is ample anecdotal and in vitro evidence of harm caused by the product, which kills healthy tissues as well as cancer cells and has been shown in humans to create horrible wounds while leaving hidden cancer that later spreads and kills the patient. No controlled research has been done in dogs and cats, and there is no reliable evidence to support the claims made by the marketers of this product.
Nevertheless, due to the power of anecdotes, and the weakness of government regulation of herbal products, this preparation is still marketed for use, and there are veterinarians who employ it. A recent case report in the Journal of the American Veterinary Medical Association (JAVMA) discusses the lack of evidence supporting the use of bloodroot and illustrates the significant harm these products can do.
Childress, MO. Burgess, RC. Holland, CH. Gelb, HR. Consequences of intratumoral injection of a herbal preparation containing bloodroot (Sanguinaria canadensis) extract in two dogs. Journal of the American Veterinary Medical Association 2011;239(3):374-379.
The report discusses two dogs, belonging to the same owner, who had Neoplasene injected into skin tumors. The first, a 2 year old golden retriever, had a benign tumor about 2cm in diameter. Such masses usually cause no problem for dogs, but if they are disturbing to owners or if they become injured or infected, they can be easily removed surgically, which is curative. Unfortunately, the treating veterinarian elected to inject the mass with Neoplasene. Six days later, the tumor had become bruised and much larger. The veterinarian instructed the client to give an oral homeopathic remedy to reduce the swelling of the tumor (which, given the mountain of evidence that homeopathy is nothing more than water and a bit of placebo effect, cannot reasonably viewed as an acceptable standard of care). After the swelling failed to resolve following drainage and bandaging, the pet was taken to the hospital of the veterinary medical school at Purdue University. By this time the benign 2cm diameter mass had become a 6cm area of severely inflammed and necrotic (dead) tissue.
The dog had surgery to remove the mass and a margin of healthy tissue around it, which involved a very extensive surgical procedure. After many weeks involving several additional surgical procedures and physical therapy to treat the loss of mobility caused by the large wound, the patient eventually made a full recovery.
The second patient discussed in the report, owned by the same client and treated by the same original veterinarian as the first dog, also had bloodroot injected into a benign tumor. A smaller amount of Neoplasene was used, and it appears that some of this leaked out after the injection. As a consequence of this, or perhaps of the variability in unregulated herbal products, the tissue reaction was not as severe as in the first patient. When the mass was surgically removed, an area of inflammation and tissue necrosis was observed near but not in the tumor. Luckily, this dog experienced minimal complications.
Clearly, complications can occur with any medication or treatment that has a measurable physiological effect. Anything that has no possibility of any side effects isn’t doing anything! And it is important to remember that anecdotes cannot be used to prove either the safety or the efficacy of a treatment. Anecdotes of benefit provide only enough evidence to justify more rigorous, systematic testing, not proof that a therapy works. In the majority of cases, such anecdotes turn out not to be accurate when more objective testing is done. Cases in which harm may have resulted from a treatment also cannot prove the treatment is unsafe. They do, however, provide reason to be cautious, and they raise the level of supportive evidence of benefit that should be expected prior to employing the treatment. Medicine is always about balancing the urgency of intervening in a patient’s condition with the available information about the risks and benefits of the intervention.
In the case of bloodroot, there is limited preclinical evidence to suggest it might be a useful treatment. It does kill cancer cells, but so does bleach, which is obviously not a good candidate for use as a medicine. The evidence that bloodroot kills cancer cells and spares healthy tissues is weak and contradicted by numerous cases of obvious tissue damage following application of the chemical. And there simply are no clinical studies to indicate a benefit in actual patients, much less a benefit greater than the potential risks. So we are left with anecdotes about bloodroot curing patients, which are of limited value as such anecdotes are often wrong for many reasons, and anecdotes of patients suffering severe, sometimes disfiguring or disabling injury after using it. Severe injury may not always happen, but it is an extreme risk to take when there is no real reason to expect the treatment has any benefit. Both of these patients would have been effectively cured, with much less suffering, injury, and expense for the owner, if they had been treated with conventional surgery rather than bloodroot.
Given the current state of the evidence, it is irresponsible of veterinarians to use bloodroot products on their patients. And in my opinion it is absolutely unethical for companies and individuals to profit from marketing these remedies without investing the resources in proper clinical studies to prove that they can be used safely and that they actually benefit patients. As I have discussed many times, herbal remedies are likely the most promising area of alternative medicine in which we will hopefully find effective medicines. But until they have been rigorously tested, and until they are regulated as stringently as pharmaceuticals, they are a dangerous gamble with our pets’ health and cannot reasonably be viewed as an alternative to established conventional treatments. Just as the pharmaceutical industry must be carefully watched to constrain the bad behavior that the profit motive can generate, so the herbal medicine industry cannot be trusted to provide trustworthy information and safe and effective remedies without much more oversight that it currently receives.
This week's blog entry for me may be viewed as shameless promotion, but I'd really like you all to check out the new referral website we recently completed for pet parents.
The site is designed to help veterinary teams who want to help their clients when they must begin to plan for their pet's deaths. Our intention is to provide credible information, based on our experiences working side-by-side with veterinarians for twenty years, about the decisions and plans you can make BEFORE your pet dies.
We know from research and clinical experience that, even though it's emotionally challenging to think ahead to this sad event, it can be of tremendous help.
Because it can help ensure that your pet gets the kind of good-bye he or she deserves
It can help minimize the regrets you may have later if you can't do or say the things you want to say or do for your pet because you get caught off guard and are unprepared to say the kind of good-bye you want to say
It can help you understand what your veterinarian is and is not able to provide for you during euthanasia or even post-death support and counseling
It can help you be prepared to support your children, other relatives, neighbors, pet sitters, people you visit if your pet is a therapy animal, etc. If you don't think ahead, these folks may not have a chance to say good-bye in ways that are meaningful for them
Because planning ahead can spur you to gather the items that may make a huge difference for you in dealing with your own grief...that wonderful poem you want to read at your pet's memorial gathering, but can't lay your hands on...the "container" (casket, urn, or even an acceptable box of some sort) that you won't be able to locate when you need it most...
I think you get the idea.
When I talk with people who are anticipating the loss of their dear pet, I find they actually feel better when they can feel they are taking some action for their pet and for themselves that will be comforting in the long run.
And, as sad and anxious as the pre-death time may be for pet parents, it's actually a bit easier to think straight and make plans BEFORE a loss occurs. After the death of a pet, grief hits like a ton of bricks and your brain feels fuzzy and your energy often ebbs away just when you have lots of details and decisions to attend to...
Visit www.veterinarywisdomforpetparents.com and get a feel for what you might do now to help you and your family cope just a little bit better later...We Care and we're here to help. (photo from istockphoto.com)
Seven cities into my 29-city bus tour (plus the open "no bus" round in NYC that made it an even 30) and our team has snapped into an efficient routine. And we had to: Our daily schedules leave no time for mistakes or miscommunication. We are on the go from before dawn when I head to the local TV station until long, long after dark, when the bus rolls up to a hotel in another city that can be many hours of driving away.
And we're doing that five or even six days a week.
As more than a few people have pointed out, it's a crazy schedule. Many people didn't think I could put the tour together, but I did. Many people think no one can survive such a grueling schedule, but I will.
I'm driven by passion and committment, for people, pets and our profession.
The fact is, I didn't have to do this. The "hook" for the tour is my newest book, "Your Dog: The Owner's Manual." And while I'm proud of this book more than any other I've done, and want it to sell and sell well, I didn't need to wrap a 45-foot bus with the "Healthy Pets Visit Vets" message and take my show on the road. I could have done most of the book promotion on a "satellite" tour, sitting in a studio in L.A. or New York and doing live interviews with stations from coast to coast. That's how it's mostly done, these days, anyway. Or I could have simply mapped out a travel schedule and gone on my own, by air, sparing myself the rigors of touring.
But the reason I didn't is because I love dreaming large and making those dreams come true, and even more, because I truly love our profession, and I want help reverse some troubling trends, and shine the light on my colleagues. And I'm doing so, every day, taking the message out large through the media, then meeting in VIP power hours with colleagues, then going out into the community again with a meet-and-greet booksigning at a local PETCO in each city.
Healthy pets visit vets, and smart pet-owners work as a team with their veterinarian. That's the message I'm sharing on this tour.
Here's a photographic journey of my day:
5:30 a.m., and I'm preparing for a morning TV show. I travel with a box of props, which I carry in the green bin in the picture. Our crew includes a "demo dog," my co-author's 6-year-old retriever.
Sometimes there's a lot of waiting in TV stations, but the reading material is often great!
On the set, I'll go over the segment quickly with the producer.
Then it's time for the segment. Most are live, but some are taped for the noon show.
Then it's time to meet with colleagues at the hotel, for my VIP Power Hour. Each colleague gets an autographed book, Courtesty of Vetstreet.
When I get to the PETCO, the bus is already there.
I encourage adoption outreach at all events.
People are often waiting before I get there.
There's usually more media at the PETCO.
Inside, I sign books, talk to people and pose ... a lot!
Then it's off to the next city. I usually ride in the support vehicle, because the drives are long and the seats in the rental Tahoe are more comfortable. We get into the next city as late as midnight ... and then it all starts at 4 a.m. or 5 a.m. the next day!
Hope you enjoyed this. The schedule for the tour is at DrMartyBecker.com and I'll continue to update as we roll through America. But now ... I gotta run!
The American Veterinary Medical Association has recently added a few words to the Veterinary Oath. Every person to graduate from an American veterinary school recites the Oath at graduation. The current Oath reads:
Being admitted to the profession of veterinary medicine, I solemnly swear to use my scientific knowledge and skills for the benefit of society and the protection of animal health and welfare, the prevention and relief of animal suffering, the conservation of animal resources, the promotion of public health, and the advancement of medical knowledge.
Since I graduated, the AVMA has twice made subtle changes to the Oath. In 1999, they added “the promotion of public health,” which is significant. From dog and cat intestinal roundworms, which can infect children leading to blindness; to food-borne E. coli and Salmonella; to bovine spongiform encephalopathy (“Mad Cow Disease”), which causes degenerative neurologic disease in people (Creutzfeldt-Jakob Disease); to the notorious viral hemorrhagic fevers Ebola and Marburg; to top bioterrorism threats (anthrax, plague and tularemia), all of which are zoonotic diseases; veterinary medicine is integrally linked with public health.
Last month, the AVMA added the “animal welfare” and “prevention of suffering” parts. The prevention of suffering is certainly important; that includes things I already recommend, like regular dental care to prevent development of painful abscessed teeth, or preemptive “tacking” of the stomach in big dogs to prevent excruciating stomach bloat and torsion (fatal twisting).
But I’m not as convinced by the welfare part. In my mind, animal welfare is part of animal health, when “health” incorporates physical and mental health, nutrition, freedom from infectious diseases, etc. Veterinarians are already stuck in the middle of arguments about animal welfare and animal rights, from whether we should eat meat, to whether wild animals should be kept in captivity, to whether laying hens should be kept in cages. For the record, I eat meat, I take my kids to the zoo, and I buy cheap (i.e., presumably not free-range) eggs. I’m not sure throwing a phrase into an oath is going to contribute anything meaningful to a bitter debate which doesn’t look like it will be resolved any time in the next few decades.
The Time is NOW, to Engage Quality Pet Health Insurance as a Common Informational Protocol for Companion Veterinary Practices!
September 29, 2010
By Loran Hickton
Pet health insurance is now a proven, practical, viable and robust industry. However during this challenging economy and throughout the past decade the number of veterinary office visits and revenue are decreasing. With the news of one million less companion veterinary office visits as reported by the AVMA and DVM 360, it seem like an appropriate time NAPHIA to urge greater support by the veterinary community, practitioners, academia, industry suppliers and other related stakeholders.
We need support to raise even more awareness and make quality pet health insurance a common and supported resource at all clinics and hospitals. The critical role quality pet health insurance can provide in the delivery of veterinary medicine is clear. It not only improves the health of pets, of course, it also increases the life-span of the patient; thus it can also improve the financial health and security of the veterinary practice.
Pet health insurance has received a bad rap over the years, and perhaps some of it has been well-deserved. Historically, there has been a perception that pet health insurance has not always delivered or has been inconsistent in two key areas of business. First, the market penetration has been weak with only 1-2% of insurable pets in North American having some form of pet health insurance. The ability of the pet health insurance industry and the provider companies has been slow and mostly non-existent in raising consumer awareness, providing consumer education and undertaking meaningful advertising. The other issue has been the methods of communication, education and marketing directly to the veterinary profession. There are some that have viewed various efforts as over the years as over promising and under delivering on the promoted values and benefits.
The North American Pet Health Insurance Association (NAPHIA) was formed as a result of a single meeting “The North American Pet Health Insurance Summit”. The Summit took place in 2006 in Sun Valley Idaho. All pet health insurance providers in the United States and Canada were invited and encouraged to attend. Also invited were distinguished members and leaders of the AVMA, AAHA, Brakke Consulting, Faust Management, Morris Animal Foundation, Hill’s Pet Nutrition, PAW Consulting, Veterinary Consulting International, and many members of academia, the veterinary companion practice community and veterinary business consulting community. At the conclusion of the meeting four pet health insurance providers agreed to form a non-profit to increase education, awareness and to develop higher standards. The North American Pet Health Insurance Association (NAPHIA) was formed as a not-for-profit in 2007.
There is much good news to report about NAPHIA and the industry and market for all quality pet health insurance. The growth and health of the industry and the positive impact for pets, pet owners and care providers is clear. NAPHIA has been diligent in working closely with members of consumer and industry news and media. The coverage of the values and benefits of pet health insurance are now reaching a much larger national audience. As an association, we have carefully focused on the general values of all quality pet health insurance and the NAPHIA efforts have been universally well received. The consumer print news stories have been covered regionally and nationally. Publications including; USA Today, The New York Times, The Wall Street, and The AARP Magazine are just a few of the major publications that have produced news stories within the past year. Most if not all of these publications have provided ample consumer education about how to review the value and benefits of quality pet health insurance and while making a decision that is well-informed and correct for the pet and the pet owners budget.
Some of the improvements in the market place must be attributed to improved transparency of the benefits, values and limitations of quality pet health insurance. Even the National Association of Insurance Commissioners has developed a guide for consumers on the values and benefits of quality pet health insurance. Several state regulatory agencies have distributed press releases providing guidance. The robust level of growth and competition in the market place is also a contributing factor more values and benefits for pet owners and care-providers alike. Pet insurance is simply improving!
But for those who supported pet health insurance in the past and may have been disappointed, there may still be challenges in the future. We know for certain that a practice that adopts a communication protocol for pet health insurance can realize a healthier pet, client and practice. But there will always be claims that will be denied. Being proactive and understanding the general terms and conditions of pet health insurance can avoid potential problems. Creating a clear communication protocol and participation or engagement in education for veterinarians and staff will reduce most of the perceptional risk of the practice or the veterinarian being responsible for the amount or value of the insurance claim.
If the veterinary profession and industry work together and provide unified and correct communication and education, revenues and resources can certainly be increased while also providing needed guidance to avoid confusion about policy limits, exclusions and other factors that are not in any way in the control of the care-provider.
The positive changes in the marketplace and the pro-active role of NAPHIA, as well as other associations, groups and businesses to support and maintain the highest possible levels of transparency in pet health insurance are working. The net result is that more pets are insured, higher levels of needed care are being provided and the lifespan of pets and the relationship with clients increases. Quality pet health insurance is not only good for the health of pets, but it can also be healthy for the financial future of the veterinary profession and related industry!
NAPHIA has worked carefully to be a neutral and separate body among the majority of pet health insurance provider / companies in Canada and the United States. NAPHIA has a shared and committed vision among all of our member companies, our sponsors and our partners to make pet health insurance less complicated, and the coverage and exclusions more transparent. We are committed to working with all members (and many non-members), as well as related stakeholders to create and set industry standards and education that improves resources and care. NAPHIA does not engage in the promotion of any one company or companies. While NAPHIA is not directly endorsing any one company over another, we certainly recognize and recommend that pet owners and care-providers consider NAPHIA member companies. There are approximately twelve pet health insurance providers in Canada and the United States, and nine of those companies are current members of NAPHIA.
We encourage and welcome more affiliates, associations, educational partners, and stakeholders and ask that intereested parties contact NAPHIA! We look forward to hearing from and engaging new groups and partners. All can be assured that working together and in participation with NAPHIA, there will be a certain and measurable form of support delivered where it is needed most, directly to the veterinary companion practice!
Executive Director, North American Pet Health Insurance Association www.naphia.org
The employment relationship creates a large amount of paperwork. It is a good idea to organize the mounds of paper so that you can ensure compliance with federal and state laws, quickly produce documents if required, and have a quick place to look to make sound employment decisions. At times it can be confusing trying to figure out which form or document should (or should not) go in the personnel file. Below is a helpful list:
Personnel files should only include items that are related to an employee's job or employment status.
What should be included in a basic personnel file:
ü employment application and résumé
ü reference checks
ü college transcripts
ü job descriptions
ü records relating to hiring, promotion, demotion, transfer, layoff, rates of pay and other forms of compensation, and education and training records
ü letters of recognition
ü disciplinary notices or documents
ü performance evaluations
ü exit interviews
ü termination records
What should not be included in a basic personnel file:
v medical/insurance records (The federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) requires employers to protect medical records as confidential, separate and apart from other business records)
v immigration (I-9) forms (It is recommended that I-9 Forms be kept in a separate file, apart from your personnel records. Many government agencies are authorized to review I-9 forms. If forms are in personnel files, it can cause many more questions and issues to arise)
v safety training records
v FMLA documents
v return to work documents
v applications or claims forms for short-term & long-term disability
v child support/garnishments
v litigation documents
v workers' compensation claims
v requests for employment/payroll verification
Be sure to periodically review personnel and other files and maintain them in a safe and confidential place! If you need more information about Personnel File Management, please contact Christie Williamson at Blackwell & King, firstname.lastname@example.org or visit us on the web at www.blackwellandking.com to learn more about our recruiting and HR services!
Disclaimer: This information is provided with the understanding that Blackwell & King is not engaged in rendering legal services. Blackwell & King (and all its employees) disclaim any liability, loss or risk incurred as a consequence, directly or indirectly, of the use and application of any of the contents of this information. This information is not a substitute for the advice of a competent legal professional. If legally binding advice is being sought, please contact a legal official. Blackwell & King is not responsible for, and expressly disclaims all liability for, damages of any kind arising out of use, reference to, or reliance on any information contained within the blog.