Dr. Palmquist continues to abuse science on HuffPo.

I wrote last summer about Dr. Richard Palmquist's first post on Huffington Post, and how his idea of science does not match science as most people understand it. He continues to rely heavily on emotional anecdotes, confuses correlation with causation, and lists a lot of scientific sounding references which usually are of poor quality or do not support his conclusions. In his most recent post, he continues the pattern he established with his first post, but this time promoting the homotoxicolgy ideas he is fond of as scientific advances.

He begins his post with a description of  an old cocker spaniel with multiple benign skin tumors that is about to have surgery to remove the masses. As in his other posts, Dr. Palmquist presents these anecdotes in such a dramatic and emotional fashion that it is difficult to tell if he is describing the case accurately, exaggerating, or just making up a good story. That said, I don't know that I have seen a 13 year old cocker spaniel that did not have multiple sebaceous adenomas. Sebaceous adenomas, cysts and other benign masses on or just under the skin are very common in older dogs, and are even more prevalent in certain breeds such as cocker spaniels. I am not sure why anyone thought it was necessary to remove all of the adenomas-as small benign tumors it is fairly common to leave them alone and simply monitor them for problems like inflammation, infection or bleeding. If benign masses like sebaceous adenomas are stable and not causing any problems, most veterinarians will not insist on removing them surgically, and sometimes they will resolve on their own. Often they will bother the animal's owner more than the animal, which is one reason to remove them, and since they are usually fairly small, superficial skin  tumors, they can often be removed fairly easily using a reversible sedative, local anesthetics, and a few days of fairly safe pain relievers, so Dr. Plamquist's representation of the surgery as quite painful, seems like an exaggeration, as well as the impression that not doing the surgery is some kind of revolutionary idea on his part.  Where He really goes off the rails however, is in his representation to the owner that the adenomas, which very likely have a genetic component to their development because of their high incidence in certain breeds, are caused by ill-defined "toxins" and should be treated with a variety of homeopathic preparations. If the adenomas really resolved on their own as Dr. Palmquist describes, it is more likely to be a result of inflammation related to the previous biopsies (described as "special testing" in the post) or simply a coincidence than due to the homeopathic remedies he provided. Some of the remedies made by Heel are low dilutions, so there is the possibility that there was some active ingredient in the treatment, but the dose was still likely to be very small. Amusingly, the one mass that did not resolve on it's own is explained away as being on an acupuncture point. Somehow the point or the tumor magically "knows" something and is trying to tell us the dog needs it there to maintain circulation to the brain and cognitive ability. There are some Chinese studies that claim to demonstrate this type of benefit, but unfortunately nearly all studies of acupuncture from china are positive, suggesting publication and other biases, which make it difficult to evaluate such studies. There has not been any research replicating these findings elsewhere. Because of this magical location on an acupuncture point, they decided to watch the tumor, which has been stable for years. As I said before, many veterinarians will do the same thing with no need to come up with magical rationalizations for it.

These ideas come from a early to mid 20th century offshoot of homeopathy called "homotoxicolgy". Hans-Heinrich Reckeweg, the inventor of homotoxiclogy, denied the germ theory of infectious disease and included vaccines and pharmaceutical treatments in the "toxins" which he thought needed to be removed from the body. Heel, the company founded by Reckeweg, has been in trouble in the past for fraudulent claims and marketing of it's products, and a review of randomized trials of Heel products by Edzard Ernst and K. Schmidt revealed serious flaws in the studies and a lack of evidence supporting their use. For a self-proclaimed "research geek", the references Dr. Palmquist supplies to support his views seem to be accepted credulously and uncritically, and perhaps with the expectation that nobody will actually check to see what the references actually say. Most of the studies are in-vitro, preliminary and published in questionable journals such as Medical Hypotheses or alternative medicine journals which are often uncritical of poor studies and biased toward promoting their particular modality. One of the references has been thoroughly discussed by Dr. Rachie and Orac, (shockingly, the 87% alcohol used as diluent for the remedies is toxic to cancer cells in vitro!) the Cochrane review provides very weak support despite being authored by homeopaths. the authors concluded; 

     "This review found preliminary data in support of the efficacy of topical calendula for prophylaxis of acute  dermatitis during radiotherapyand Traumeel S mouthwash in the treatment of chemotherapy-induced stomatitis. These trials need replicating. There is no convincingevidence for the efficacy of homeopathic medicines for other adverse effects of cancer treatments. Further research is required."

The one study of companion animals published in a more mainstream journal (Neumann S, Stolt P, Braun G, Hellmann K, Reinhart E. 2010. Effectiveness of the Homeopathic Preparation Zeel Compared with Carprofen in Dogs with Osteoarthritis. J Am Anim Hosp Assoc. Dec 16. [Epub ahead of print]) was uncontrolled, unblinded, and has other problems, including an average age difference of nearly 3 years between the two treatment groups, with the younger group recieving the homeopathic remedy. This study was also funded by Heel, the producer of the homeopathic remedy.

Finally, Dr. Palmquist describes how he thinks medicine should "work", by which he means new therapies should be developed. Unfortunately, the order of investigation he describes is somewhat backward. Plausibility should be the first test for any treatment, and his statement that homeopathic remedies have been proven to work and have understandable mechanisms flies in the face of our understanding of basic physics and chemistry, and is only accepted by true believers in homeopathy. Anecdotal evidence for effectiveness is not a reliable way to discover new treatments and is only a very preliminary way  to start to investigate a new treatment. Exceedingly implausible treatments like homeopathy are probably not worth studying further, as preliminary weakly positive results are likely to be the result of bias, coincidence and random chance. These type of preliminary positive results seem to always disappear in better designed trials of homeopathy. While I am sure Dr. Palmquist means well, he is a poster child for demonstrating how cognitive errors and wishful thinking can lead us down a path full of dead ends and useless therapies. Unfortunately, his influence as president of the AHVMA and a member of AAHA gives him an undeserved platform to promote his delusions. In this case, no harm was done to the patient, but sometimes the result is not so good.

Veterinary Nonsense on the Huffington Post.

The Huffington Post is home to some of the most ridiculous and idiotic writing on human alternative medicine, and now, not to be left out, the have a veterinarian writing on "integrative" veterinary medicine. A recent post by Dr. Richard Palmquist brings veterinary integrative medicine into the world of woo that is the medical and lifestyle pages of the Huffington Post.

He begins with a statement of his scientific background;

My parents were science-based people: my mother was a dental educator and my father was a microbiologist. Many of my friends were children of members of the medical community. These people were my heroes and not one of them did "crazy, voodoo crap like acupuncture, homeopathy, herbs or reiki." These people did "modern medicine," which came from science and used the best of our knowledge to help people. I was, and still am a science guy.

Apparently he forgot to pay attention to his heroes, and in science class as well, because he proceeds to interpret anecdotes, testimonials and possibly outright fraud as scientific proof that various alternative medicine techniques actually work. He also discusses bias in a twisted way. It is true that prejudices can lead to premature judgments, but it does not mean we should accept anything based on the kind of evidence he presents in his article. being open minded is a good thing, being so open minded that you stop thinking critically, or even stop thinking at all is just as bad as any other bias that can affect our thinking. He goes on to present several anecdotes to prove his point, but to anyone who does utilize critical thinking, the flaws in these stories are fairly obvious.

The first anecdote is about a discussion he had with an alternative practitioner;

I said, "I understand you cure cancer." I knew this question would expose him for the fraud I knew him to be. He responded, "No, absolutely not. We don't cure cancer. Frankly we don't even treat cancer. What we do is support individual patients' immune systems and sometimes remarkable things happen."

This is pretty remarkable; the veterinarian admitted that he did not treat cancer, but then makes the fairly meaningless claim, common to many evidence-free treatments, of "supporting the immune system". Mark Crislip has an excellent post about supporting or boosting the immune system here .
He then proceeds to discuss cases where he thinks cancer was cured by alternative methods.

Then he presented a case complete with documentation from the top referral small animal hospital in New York. This case was a cat with a massive brain tumor diagnosed with state of the art brain imaging and found to be too severe for treatment. The cat was blind and semi-comatose on presentation to his office. After receiving dietary therapy the cat regained its sight and later had new x-rays taken only to reveal the tumor was 50 percent smaller. I had never seen anything like that before.

Top hospital or not, Dr. Palmquist knows that  an image, no matter how high-tech, of a mass is not a diagnosis of a tumor. It is a picture of something which may be a tumor, an infection, or even an artifact that only looks like a mass. Either he is leaving out many details (was the mass biopsied, was the cat treated with any other evidence-based treatments, etc.) or he is not asking the scientific questions he should be asking.
The next anecdote is another cat with a tumor;

On Monday I went to his clinic to observe him work. The first case was a terrible oral tumor that was recovering after receiving cryosurgery -- freezing the tumor to kill it. I had not seen this type of surgery for this kind of disease before and was amazed at how well the cat was doing. I also noticed the intensely honest communication and loving connection he had with both the people and then cat. My heart melted a bit.

This is another common tactic of alternative practitioners; co-opting  science based treatments and calling then alternative. Cryosurgery has been used to treat many different types of tumors and other lesions for many years. It may be true that Dr.Palmquist had not seen it used to treat oral tumors, but it really should not have been such a surprise. Cryosurgery was commonly used for many years before Dr. Plamquist's epiphany. Honest (debatable) and loving communication is also not limited to alternative practitioners. The next case also should raise some red flags, but apparently by this time Dr. Palmquist was so ready to believe anything that he fainted;

The next case was a paralyzed German shepherd dog which was treated by top specialists. The dog was carried in on a stretcher and a neurological exam showed the dog to be
non-functional. I knew after such a long time that euthanasia or hopeless surgery was the only option, but the "likable quack" began applying acupuncture needles to the dog. The dog lay there happily, and then the needles were removed at which point the patient simply got up and walked over to the owners.

Extraordinary claims require extraordinary evidence. Either Dr. Palmquist was cruelly played, or he is again using weasel words to imply more that what actually happened. If the dog was really non-functional and was "cured" so quickly using acupucture, that really would have been remarkable. Again, what does "non-functional" really mean? The story sounds amazing, but many questions need to be answered before we accept the claims made here.

Since Dr. Plamquist's conversion to integrative medicine, he has apparently published many case reports, which are really just formalized anecdotes, and are not scientific proof of much of anything, and has written a textbook on integrating alternative medicine into veterinary practice. He is apparently a proponent of the pseudoscience of homotoxicology, and is the president elect of the American Holistic Veterinary Medical Association. The kind of fuzzy thinking Dr. Palmquist has demonstrated in his post does not inspire confidence in the scientific rigor of his association.

Addendum; Steve Novella has an excellent post today demonstrating the harm that can come from honest, caring and well-meaning quackery.