Recent discussions on the alternative veterinary medicine e-mail list and on Pet Connection have made me think more about Cognitive Dissonance and the other ways humans can deceive themselves. Prometheus at Photon in the Darkness coincidentally has an excellent post up about cognitive dissonance today.
Unfortunately, Narda Robinson seems to be an excellent example of cognitive dissonance as well. For those of you who are not familiar with Dr. Robinson, she is the Director of Colorado State University's Center for Integrative Pain Medicine. While she seems to be very skeptical and science based in her analysis of many alternative modalities such as homeopathy, herbal medicine, and others, she often credulously endorses Reiki and possibly therapeutic touch, and teaches a $4,400 dollar course in acupuncture at CSU. She has studied the "neuroanatomical" approach to acupucture for many years. There is no doubt that sticking needles into living bodies causes a reaction in the nervous system. This reaction seems to include an effect on nerve transmission and can cause the release of endorphins in the central nervous system. The question is, does this have any significant clinical effect? Increasingly, the answer seems to be no.
Detailed and well-referenced discussions of the scientific evidence for the efficacy of acupunture are available here, and here. The acupucture archive at Science-Based Medicine is well worth a look as well. In short, the development of sham acupucnture procedures such as placing needles in random points, the use of fake needles that do not puncture the skin but appear to and tricking patients into thinking they are being needled by using things like toothpicks to create an illusion of being needled all seem to be as effective as "real" acupucture. This would indicate that the act of inserting needles has a potent psycological effect that can induce a placebo efect in humans, and possibly animals as well. (My previous post discussing the placebo effect in animals and their owners shows how thismight happen.) People often like to do something, indeed anything to help alleviate their animal's suffering. Unforunately, using an inefective or minimally effective treatment may convince the owner and veterinarian that they are helping, but the animal may still be suffering.
This is my foremost concern with the promotion of veterinary acupuncture. It is quite common for the proponents of veterinary acupuncture to claim that acupucture can reduce the need for anesthetic drugs, or help with postoperative pain and chronic pain. This may result in the use of inadequate doses of other, effective analgesic drugs and techniques. Veterinary pain relief has come a long way in the past few decades, and acupuncture to me seems to be a step backward rather than an improvement.
The reason I think that Dr. Robinson is an excellent example of cognitive dissonance is because she tries to force unscientific isdeas into her inconsistent idea of what the evidence shows. A true scientist and skeptic will put all their ideas, no matter how treasured, to the test of the evidence. While acupuncture is more plausible than homeopathy, the results of the best trials do not show much effect. Dr. Robinson and CSU are making a lot of money from their courses in acupucture and from treating pets with acupucture and other therapies with weak evidence. It is their responsibility to produce good evidence or effectiveness or to stop deluding themselves and others.
M
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Thank you (and skeptvet) for bringing attention to Robinson's unbalanced position, unfortunately CSU isn't the only university with alternative medicine curriculum, I fear for the younger generation of vet students falling for these lectures from professors. Another part of the problem is the information extrapolated from previous "teachers", virtually unchanged over the years, acupuncture among the most common. It's scary how many of these alternative vets still think, despite evidence to the contrary, that acupuncture was performed on small animals over a century ago, thereby validating it's use. Horses and livestock possibly, companion animals, not.
ReplyDeleteYes v.t., many veterinary schools and human med schools have alt med programs. I am a CSU alum, so the program there particularly bothers me, and criticism from alumni can sometimes have an effect. I plan on offering criticism of other programs as well, but the CSU program is the one I am most familiar with.
ReplyDeleteJust discovered your blog through skeptvet...very refreshing, thank you. Indeed, cognitive dissonance describes the CAVM phenomenon at CSU & other universities (quackademics) quite well. Today recieved a CSU CE offer for "medical massage therapy for animals". Hmm, maybe ok ...except "myofacial release" pops up in the title yet the course emphasizes science & evidence based perspectives?!? Instant red flags....
ReplyDeletePerhaps a bit more research of the veterinary curriculum at CSU is needed before you espouse that “cognitive dissonance” is being embraced at this institution. As a current veterinary student at CSU I can assure you that we are still receiving an evidence based education as well as striving to increase our knowledge so that we may practice better medicine than the generations before us. Since the topic here is acupuncture I will address that area of the curriculum. Dr. Robinson teaches one elective, during which she spends 50% of her time debunking currently espoused “homeopathic” products marketed to veterinarians that are in fact toxic to their animal patients. The rest of the class time is spent on subjects such as rehabilitation, chiropractics, and “Dubious Diagnostics and Worry Some Treatments.”
ReplyDeleteIt is obvious that homeopathic medicines as well as other alternative therapies need further research into their efficacy. This fact is constantly reiterated at CSU, especially be Dr Robinson. However, to espouse it all as “quackery” is a completely uneducated approach. A case example, to explain this point is as follows. We needed to handle a snake patient, however, this particular snake was not amicable to being handled and in order to conduct a physical exam would require that we sedate the snake. Unfortunately, the drugs that are so accepted in today’s medicine are in fact quite toxic and we cannot use them routinely without harming our patients. Therefore, instead, we place two acupuncture needles in the patient and this sedated the patient long enough to allow us conduct a physical exam. Thankfully, this approach did safely allow us to reduce our need for anesthetic drugs and by doing so, saved our patient from more harm.
Yes, this is an antidotal report. However, it is case reports such as this that demand that we further research these alternate therapies and don’t just dismiss them because they are not what are considered “traditional medicine.” Do not forget that not too long ago “traditional medicine” endorsed bloodletting and purging as acceptable therapies. Let us never think too highly of ourselves currently, to not allow for new approaches to alleviate the suffering of our patients.
@ Learn;
ReplyDeletePerhaps you should ask Dr. Robinson if anyone has ever done any controlled trials on the use of acupuncture to "reduce our need for anesthetic drugs". Sorry, but this kind of claim is exactly what bothers me about the use of acupuncture in animals-they can't complain when such an approach fails to relieve pain the way a human patient can.
Anecdotes like yours are exactly why things like bloodletting were used for so long-doctors and patients thought it worked.
Your comments about Homeopathy would seem to demonstrate some ignorance of the nature of homeopathic treatments. Typically homeopathic preparations are so dilute that none of the original substance is present, meaning that the treatments are likely to be harmless, but useless. Occasionally something may be marketed as homeopathic with higher concentrations of the original substance, but even these are typically very dilute. For truly homeopathic preparations to work, the principles of Chemistry and Physics as we know them would have to be wrong, so doing more research on homeopathy is likely to be a waste of time and money.
While Acupuncture is more plausible than Homeopathy (Dr. Robinson has spent the last 15 years studying the plausibility of acupuncture, but has failed to prove clinical effectiveness),
well controlled clinical studies in humans consistently demonstrate poor effectiveness.
For more on prior plausibility, homeopathy and acupuncture, take a look at Science-Based Medicine. It is certainly important to allow for new approaches, but your mind should not be so open that your brain falls out! :)
Anesthetic drugs are needed, obviously. However their toxic effects have been well documented. Therefore, if we can use acupunture to help an animal relax so that it is possible to conduct a NON-PAINFUL and ROUTINE physical exam where no analgesia is needed, it is obviously helpful. If for no other reason than it is not causing the animal harm, as anesthetic drugs do.
ReplyDeleteI am not espousing to be a proponent of all homeopathic medicines, quite the opposite. In fact, the majority of your response makes it clear that you did not actually comprehend the meaning of my comment, whatsoever.
I will sum it up for you so that it is simple:
CSU IS PRACTICING EVIDENCE-BASED MEDICINE. CASE REPORTS HAVE SHOWN THAT THERE MAY BE BENEFITS TO SOME ASPECTS OF ACUPUNTURE. DR. ROBINSON ESPOUSES THE DANGERS OF "TRADITIONAL CHINESE MEDICINE" AND FOLKLORE. HOWEVER, WE SHOULD NOT "THROW OUT THE BABY WITH BATHWATER" BUT INSTEAD WE SHOULD INVESTIGATE THE SCIENTIFIC BASIS BEHIND THESE REPORTS OF POSITIVE EFFECTS AND ANALYZE THEIR VALIDITY.
I suggest you do not keep your mind so closed as to cut off the blood to your brain. :)
Quick update:
ReplyDeleteI just finished a 55 minute lecture by Dr. Narda Robinson, the entirety of which was devoited to highlighting the dangers of "chinese herbs." Highlighting the fact that many contain strychnine and illegal and/or dangerous animal parts.
Dr. Robinson's point?
Don't buy into chinese "herbal therapies" marketed to veterinarians. Instead analyze the herbs for their active chemical compounds (using chemistry) to see why these herbs are said to have a positive effect.
@ Learn;
ReplyDeleteI do realize that Dr. Robinson is skeptical and looks at the evidence for many alternative therapies. She has written many popular articles critical of unproven herbal remedies and TCM. On the other hand, she has at times promoted Reiki despite a lack of evidence, and still has very little clinical evidence (case reports are fine, but are a weak form of evidence-also, links would be nice if you are going to claim evidence for the effectiveness of acupuncture).
Since you returned to your snake anecdote-consider that there may have been other factors involved in that case. Obviously, I was not there so I don;t know exactly what went on, but is it possible that during the application of acupunture everyone involved calmed down and handled the snake more calmly and gently? Reptiles often respond positively to calm and gentle handling, and taking a few minutes to let the animal and yourself relax can have the same effect that you are attributing to the acupuncture.
The point of my post is that evidence, preferably in the form of controlled trials, should be the standard for claims like some of those made for veterinary acupuncture. Dr. Robinson is in an excellent position to provide such evidence, and has not done so.
I know that CSU is teaching evidence-based medicine for most of your classes (I graduated from CSU not so long ago, so I am not unfamiliar with the curriculum). I am also quite pleased with many of the things Dr. Robinson has written, but I am concerned that there may be a different standard in respect to acupuncture. Again, if you are interested in learning more about where I am coming from and the weaknesses of EBM as it has developed over the last 20 years, the Science-Based Medicine Blog is an excellent resource. A search or their acupuncture archive will show you why I think that acupuncture is an elaborate placebo. The history of medicine-western, eastern, traditional, etc. is littered with therapies that seemed to work, but were found to be ineffective when tested scientifically.