Letter to the AVMA
 
 

John I. Freeman, DVM
President, American Veterinary Medical Association
Pocomoke Rd.
Franklinton, NC 27525

Dr. Freeman,

A growing number of veterinarians have registered concern over the recently adopted "AVMA Guidelines for Alternative and Complementary Veterinary Medicine." In October of 1997 the National Council Against Health Fraud established a special task force to deal with the issues of pseudoscience, critical thinking, and health fraud in veterinary medicine. The mission of the NCAHF Task Force on Veterinary Pseudoscience is to promote animal health and welfare, to protect consumers from fraudulent, unsafe, and unproven veterinary practices, to promote science-based medicine and the critical examination of medical claims and to provide sound information and leadership to veterinary practitioners and their clients.

We believe the honest and rigorous scientific examination of new and unconventional ideas, claims and therapies is absolutely essential to the sound future of medical practice. Therefore, we support such rigorous investigation. Furthermore, when the preponderance of evidence from properly designed and implemented studies supports the efficacy and safety of a particular "alternative" therapy, said therapy should be embraced by the veterinary profession. Likewise, if it fails to meet this standard, it should be repudiated by the profession.

In keeping with these principles, we hereby request that we be allowed to take an active part in any future consideration by the AVMA of their 1996 "Guidelines for Alternative and Complementary Veterinary Medicine."

We object to the current "Guidelines" on several grounds including the following:

1. They contain inaccurate and misleading statements (several of which are cited below.)

2. The "Guidelines," in fact, condone and promote the general employment of unproven and scientifically untenable therapies without prior, rigorous scientific validation. Therefore, they are not in the best interest of either the consuming public or the veterinary profession. As consumer advocates, we believe they constitute a "breach of contract" by the AVMA with the public interest.

3. While the "Guidelines" emphasize our responsibility as practitioners to employ "alternative" therapies only on the basis of "a valid veterinarian/client/patient relationship," only after obtaining "education in their proper use," no mention whatever is made of our responsibility to base any therapy we employ on the best available science. In fact, the word "science" appears exactly nowhere in the "Guidelines." We believe this is a telling omission.

4. The "Guidelines" state: "Veterinary acupuncture and acutherapy are now considered an integral part of veterinary medicine." They are? "Considered integral" by whom?... by advocates of acupuncture therapy?... by veterinary acupuncturists? How did the "Guidelines" committee or the Board determine that acupuncture is "considered an integral part of veterinary medicine"? We don't believe "rank and file" veterinarians have ever taken a vote on this issue. If the committee means that acupuncture is "considered integral" in the same sense that, in a pre-scientific age, "bleeding," purgatives, and mercurial "therapy" were "considered integral parts" of human medicine merely because they were widely employed, we would have to agree. On the other hand, if they mean that science-based veterinary medicine has embraced acupuncture on the basis of scientific support for its efficacy, we strongly disagree. We object to the notion that, merely because unproven and scientifically untenable therapies have become "popular" among some practitioners, they have "become an integral part of veterinary medicine." The most rigorous scientific data available, based on properly designed and controlled studies, suggest that alleged acupuncture efficacy is due almost entirely to a very potent placebo effect.*

5. The "Guidelines" state: "... sufficient research exists documenting efficacy of chiropractic in humans..." This statement is simply wrong. The best available science strongly indicates that chiropractic "subluxations" are imaginary and that the alleged benefits from chiropractic manipulation are due to the placebo effect.*

6. In several places, the "Guidelines" recommend that "further research be conducted... to evaluate efficacy." We feel it's inappropriate, irresponsible, and against the public interest for the AVMA to condone the general employment of any therapy until and unless its efficacy has been clearly and unequivocally established by means of rigorous, objective science. Most of the modalities cited in the "Guidelines" have, to date, clearly failed to met this criterion.

7. The "Guidelines" state that, in homeopathy, patients are treated "by the administration of substances that are capable of producing clinical signs in healthy animals... These substances are used therapeutically in minute doses." This is not entirely true. According to homeopaths, by virtue of the alleged "Law of Infinitesimals," "medications" which contain not a single molecule of "solute" (i.e. the "substance on the label") constitute the most potent (or highly "potentized") homeopathic "medications." Therefore, the patient is literally being treated by the absence of the ingredient on the label. Homeopathy is clearly a pseudoscientific medical cult based on the "revelations" of 18th Century physician and eccentric Samuel Hahnemann. Its tenets are steeped in mysticism and have no basis in bona fide science. The most rigorous scientific trials have failed to demonstrate any "homeopathic effect" beyond placebo.*

8. In view of these and other points, contrary to condoning unproven and scientifically questionable therapies and practices, we feel the AVMA has a moral and ethical responsibility to take a pro-active stand against their employment outside of formal scientific research programs.

9. We suspect that, in part, the guidelines were adopted to provide some legal protection to practitioners who employ "alternative" and otherwise unproven therapies. We believe this effort is ill-advised, counter-productive, and will ultimately fail. Including unproven and unscientific therapies under the "standard of practice" umbrella, merely serves to lower that standard and make the AVMA, itself, vulnerable to liability. Furthermore, it seems unlikely to provide much protection to practitioners guilty of employing unproven and unscientific therapies, and could be construed as making the AVMA a party to such behavior. The public has a right to expect and to demand that veterinary practice be based on the highest quality science available, and the veterinary profession has a moral and ethical obligation to provide such science-based medicine. We feel the AVMA can best serve and protect both the public, and the veterinary profession by issuing the simple, firm caveat "avoid unproven and unscientific therapies."

10. We believe that rigorous science, rather than popularity, metaphysical appeal, or social/fiscal considerations should be the final arbiter of what is and is not deemed acceptable therapy and/or practice by the AVMA.

11. By "exempting" veterinary practitioners from any requirement for scientific rigor, the AVMA has in effect "exempted" itself from serious consideration by the scientific community. They have, thereby, diminished the scientific standing of the entire profession. Science and the scientific community have little regard for "what is popular" or "what is metaphysically pleasing." A professional organization cannot acquiesce to bad science, pseudoscience, or anti-science, and expect not to be "tarred by the same brush" when the scientific community repudiates the nonsense - as it must inevitably do. We feel the "Guidelines" constitute an effort by the Association to "promote 'inclusiveness' among all practitioners - science-based and otherwise" while at the same time maintaining "scientific respectability." The reality is, you can't have it both ways. We are convinced the AVMA has promoted this "inclusiveness" at the expense of "scientific respectability." As advocates of rigorous Veterinary Science, we find this situation unacceptable.

12. We suspect the Committee on Alternative and Complementary Therapies was unduly swayed by questionable and unreliable information provided by "advocates" of said therapies rather than by objective, scientific investigators of "alternative" therapeutic claims. This is not difficult to understand since the great bulk of existent "alt med" literature has been produced by practitioners and advocates of such therapies. (It seems unlikely that, under any circumstances, a practitioner already employing -- and therefore committed to -- such practices without "prior scientific proof of efficacy" would be inclined to advise the committee that they are a "bad idea.")

A small but growing body of rigorous, critical, and genuinely scientific literature is available on the subject of "alternative" and "complementary" medicine. We hope, in the future, we can help any committee charged with reviewing "alternative" and/or "complementary" therapies by availing them of not only critical literature and the best scientific evidence available, but also expert opinion from "non-advocate" scientists and veterinarians.

The original Committee on Alternative and Complementary Therapies recommended that the Guidelines be reviewed within three years (before mid-June of 1999). We agree whole-heartedly, and look forward to taking part in the review process. We hope that one or more Task Force members might be named to sit on any committee designated to that end. If such a review process has not yet been initiated, we urge you and the Executive Board to address the situation in the near future.

We look forward to your response.

Sincerely,

Robert Imrie, DVM
Coordinator
NCAHF Task Force on Veterinary Pseudoscience

David W. Ramey, DVM
Equine advisor
NCAHF Task Force on Veterinary Pseudoscience
*references available on request

cc: Harmon A Rogers (Dist. XI Delegate)

Stanley Held (Chairman, Committee on Alt. and Comp. Vet. Med)

J Clyde Johnson (Chairman, Judicial Council)

Robert W Fulton (Chairman, Council on Research)

Janver Krehbiel (Chairman, Committee on Veterinary Informatics)

Samuel E Strahm (Chairman, AVM Foundation Directors)

J Karl Wise (Director of Information Management)

Lyle P Vogel (Director, Scientific Activities Division)

Janis A Audin (Editor-In-Chief, JAVMA)

Craig A Smith (Assistant Editor, Publications Division, JAVMA)

William Jarvis, (Executive Director, National Council Against Health Fraud)

Stephen Barrett, (Co-Chair., Paranormal Health Claims Sub-Committee, CSICOP)

James Randi (Chairman, James Randi Educational Foundation)

Wallace Sampson (Editor, Scientific Review of Alternative Medicine)

Alan Moghissi (Chairman, American Council for Science and Health)

Michael Shermer, (Director, Skeptics Society)