Alternative Veterinary Medicine

In the old days, when your pet got sick, you took it to the vet. Maybe you got some big horse pills to force down its mouth. Maybe you got one of those big plastic cones around its head. But today it's a little different. You're more likely than ever to be offered a type of treatment that — so far as you know — is pre-scientific, witch doctor stuff; and what's really confusing is that it's being offered to you by someone who appears to be a legitimate Doctor of Veterinary Medicine with board certification and all kinds of credentials on their wall. What's going on here? Today we're going to take a scary and surprising look at the biggest shift in veterinary medicine in a century: alternative medicine, including treatments like homeopathy, chiropractic, and acupuncture, including talk of yin and yang, qi, innate intelligence, and ancient wisdom.

As interest in alternative medicine has risen among human patients, so have these same people sought out the same for their animals. A survey of the veterinary literature found just 7 academic articles published in the year 2000 matching the keywords veterinary and integrative; 29 in the year 2005; 88 in 2010; and 379 in 2015. Patient demand has sent the veterinary industry into a frenzy. According to a 2017 article in Minneapolis St. Paul Magazine:

More than a thousand practices across the country bill themselves as "holistic," compared to just a handful in the early 1980s. The Minnesota veterinary board has seen an uptick in vets seeking continuing-ed credits in acupuncture and spinal manipulation. Demand for such unconventional treatments is also growing, according to the veterinary magazine dvm360. In a 2017 poll of dog owners, the magazine found that 30 percent of millennial respondents said they now turn to massage, acupuncture, and other alternative therapies to help manage their pup's pain.

Integrative, as you probably know, refers to an approach that seeks to integrate non-traditional care with traditional care. More to the point, it means integrating unproven therapies with proven ones; or even more to the point, integrating BS with medicine. This should not be considered a merit. Integrating a cow pie with an apple pie does not make the cow pie better; it makes the apple pie worse.

This rising interest in the metaphysical and rejection of the empirical is very much consistent with the modern Western Esotericism movement that's been trending since the late 20th century. It has brought us organic foods, vaccine denial, Deepak Chopra, and placentophagy. Also symptomatic of this is the explosive growth of the alternative pet foods industry, the market size of which is currently closing in on $10 billion. Organic pet food. Non-GMO pet food. Gluten-free pet food. Raw pet food. All products that are provably no better than conventional pet foods that are made to provide the requisite nutrition rather than to conform to the pet owners' food fad of choice. Alternative veterinary medicine exists because of modern Western Esotericism; it's a neatly-fitting piece in the puzzle of marketing trends targeting those who want to show off their enlightenment.

However, any discussion of the sociological basis for alternative veterinary medicine is secondary to what's on a responsible pet owner's mind when their furry friend has an actual medical problem. You want to get treatment. You want it inexpensive, effective, and fast. It's still easy to find science-based vets, but the online listings are becoming increasingly clouded with holistic and integrative clinics. What do you do when you find yourself at the vet's office, and you are offered an alternative therapy?

Generally the vet will assert that a robust body of research shows that the alternative therapy is effective. They may even cite the name of a journal or of a particular article. And this is true — but what's also true is that a more robust body of research finds the alternative therapy to be completely worthless. And when we compare the two, we find — unequivocally — that the research finding no value is larger. Compounding this is the quality of the studies. Universally, the larger the study and the better controlled it is, the smaller the effect that alternative therapies have. We see this in veterinary studies just as we see it in human studies.

Here's a pretty good representative of what your holistic vet is likely to show you as evidence that acupuncture is good for your pet. It was published in 2006 in the Journal of Veterinary Internal Medicine, titled "Effectiveness of acupuncture in veterinary medicine: systematic review," and the full text is freely available online if you want to check it out. What this review of many studies shows is that plenty of studies have found a positive effect from acupuncture for conditions such as pain, diarrhea, spinal cord injury, hepatitis, and others. But what you have to read much more carefully to discover is that the study data was provided mostly by veterinary acupuncture associations, so it's heavily biased; and that the authors' independent assessment found that the studies were of low average quality. In fact the majority of them were not even randomized, which is a fundamental of a clinical trial.

Standards of care and regulations are much looser in veterinary medicine than in human medicine — enormously so. And what standards do exist are quite often ignored, as enforcement is virtually nonexistent. Various states and countries have laws governing the use of protected terms like chiropractic or veterinarian, but the terms are so hopelessly abused by many professionals who lack the legal certifications that it's essentially a free-for-all. Complicating this from the perspective of the pet owner looking for quality care is that competing certification boards exist. In the United States, actual veterinary specialties are accredited by the American Board of Veterinary Specialties; in Europe, it's the European Board of Veterinary Specialisation. But as alternative therapies are not recognized medical specialties, no vets are accredited to provide them. Yet consumer demand has to be satisfied, so alternative therapists made up their own self-accreditation boards, like the American Veterinary Chiropractic Association, the American Holistic Veterinary Medical Association, the American Academy of Veterinary Acupuncture, and others — and these are just in the United States. Many other countries have their own. They are all fairly described as fake certifications, made up by their own members because the actual medical boards rightly refuse to recognize unscientific, unproven, implausible therapies.

Where does this leave the consumer? Unfortunately, at the mercy of any vet who wants to sell them anything. Any vet who chooses to — and in many cases, any person off the street, trained in anything or not — can pay a modest membership fee and hang an official-looking board certification on their wall, and advertise themselves as a certified veterinary homeopath, or any other alternative therapist. In a few jurisdictions, they can even legally call themselves doctors, with nothing more than this pay-to-play wall hanging; and in all jurisdictions, there exist unscrupulous practitioners who call themselves doctors with no legal basis — we often see mail order diplomas from unaccredited holistic colleges in India. The result is that pet owners are duped into the logical assumption that because some official-looking board is certifying practitioners, these therapies must therefore be real.

However, we can also be pretty certain that few (if any) of these holistic vets are being consciously deceptive. We have good data and good theory underlying why they believe something — wholeheartedly — that is at odds with everything we know from science based medicine. The fact is that alternative medicine for your pet has nothing to do with the pet. We know that the treatments provide no medical benefit to the animal. Who, then, are they for? You guessed it: alternative veterinary medicine treats the people involved, not the pet.

This is not conjecture; it is a studied phenomenon that's well established in the literature. It's called the caregiver placebo effect, and it applies to people who treat people as well as to people who treat animals. To illustrate, let's look at a study published in 2012 in the Journal of the American Veterinary Medical Association. The study took dogs who had lameness caused by osteoarthritis, lameness that was directly measurable and quantified by reading the ground reaction force on an instrumented treadmill while the dogs trotted. Of the group of dogs whose treatment was a placebo only, 9% got slightly worse over the course of the study and 12% got slightly better, but the vast majority (79%) showed no change in the severity of their pain. Nevertheless, the people watching them — owners and vets alike — noticed significant improvement. But take a moment to guess: do you think owners perceived a greater nonexistent improvement, or vets?

It was the vets, by a significant but not extraordinary margin. 40% of the dog owners perceived an improvement in their pet's pain level as a result of the sham treatment when the treadmill showed there had been no improvements; but the vets believed there had been improvement in 45% of those same dogs.

One conclusion to draw from this is that when you go to a vet who sells alternative treatments, the vet is even more likely to honestly believe in the effectiveness of an ineffective treatment than is the average customer. This is one reason why Slate science writer Brian Palmer wrote the 2014 article "If Your Veterinarian Offers Acupuncture, Find a Different Vet".

If there is a middle ground to be found here, it probably lies in the fact that human contact helps pets to relax, in many cases, especially with dogs and horses. This is not just an observation, it's thoroughly documented in the literature that a social action as simple as petting reduces heart rates and can even produce vascular changes. When such an action is done frequently, it can produce what we call a conditioned placebo effect, where the person need not even actually pet the animal so long as the animal perceives familiar conditions under which petting takes place. Thus, a vet's bedside manner, especially a vet that's familiar to the pet, can play an important role in reducing stress associated with an injury or illness; and as we know, all too often, the vet and/or the owner will attribute that improvement to whatever treatment may be administered at the same time, whether it's real or alternative. Where we need to be careful is to avoid crediting a worthless therapy for improvement due to human contact, and similarly, to avoid classifying human contact as an alternative therapy simply because it doesn't involve drugs or surgery.

It's this middle ground of simple human contact which combines with the fact that we all want our pets to recover from illness and not to suffer, whether we accept science based medicine or we believe in alternative therapies. We all love our pets; that's why we have them. Pets, to their credit, are free of cultural trends like Western Esotericism. They are no more aware of your gluten-free granola kick than they are of the intricacies of the surgery to treat an intestinal blockage. All they know is how they feel, and more importantly, how we can help them to feel. For no matter what type of treatment we hope will work best, our true nature is revealed by how diligently we seek it, and by the tenderness with which we provide it.

By Brian Dunning
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