The usefulness and danger of herbal medicine.

This is just a short post to draw attention to an excellent post by Edzard Ernst discussing the pitfalls of traditionally practiced herbal medicine. The only thing I would like to add is that the evidence for effectiveness and knowledge of potential toxicity is even less well known in animals than in humans. Especially in cats, which over the course of their evolution as obligate carnivores have lost some of the enzymes most other animals use to metabolize plant compounds.

 As the research Dr. Ernst discusses demonstrates, traditional methods of individualized herbal treatment simply do not work, and should be avoided. The risks of toxicity, interaction and contamination are much higher than the basically random chance of benefit. This risk/benefit ratio is likely even more negative when treating animals, for which there is little to no strong evidence of efficacy, and potentially a higher risk, especially in cats of harm.

Rabies case in Florida

A sad story from Florida illustrating the importance of keeping Rabies vaccinations up to date. The dog involved in this case had not been vaccinated in 7 years, and contracted Rabies after being exposed to a raccoon. Two other dogs in the house were apparently not currently vaccinated and had to be euthanized, and the entire family is undergoing post-exposure treatment for Rabies. Some folks insist that a single Rabies vaccine is effective for life-this case illustrates (along with other evidence of declining immunity after 3-4 years) that that idea is potentially disastrously wrong. While it is worth studying the duration of immunity conferred from rabies vaccines, and the 3 year requirement may be somewhat arbitrary, immunity does decline over time, and modern rabies vaccines are a very safe, inexpensive form of protection against a deadly disease. It is not safe to assume that all vaccines are equally effective, and individual and breed variations in response to vaccination mean that while some dogs may have immunity for many years, others need more frequent boosters. This individual variation is the reason for the common 3 year booster requirement for dogs-while some dogs have immunity that lasts longer than this, some will start to lose protective immunity around this time.

How to investigate wildlife (or cryptozoology) sightings.

In light of the recent Jaguar sighting in southern Arizona, I thought it was interesting to get this email from the Arizona Game and Fish Department on how they investigate reports of rare and/or endangered species. Note that eyewitness sightings need to be corroborated with other forms of evidence for such sightings to be officially confirmed. Good quality photographs or video, or other physical evidence are required to confirm these sightings. It is interesting that animals as small as domestic cats are often mistaken for lager cats, and that reports from the public go up dramatically after a sighting, confirmed or not, is reported in the media.
(Click on the email for a larger view)

                                                                               

New Jaguar sighting in southern Arizona.

The Arizona Game and Fish Department and The Arizona Daily Star are reporting a new sighting of a Jaguar in Arizona. This is the first sighting since the tragic case of Macho B back in February of 2009. It is good to see that Jaguars are still making their way into Arizona despite all the border issues which are potentially getting in their way.

More genetic information on dog breeds, their relationships and possible effects.

     A recent genetic study in PLoS Genetics has some interesting implications relating to claims made by some dog breeders and many practitioners of alternative veterinary medicine.  As our ability to collect and analyze large amounts of genetic data improves, we can learn a lot about how genetics affect the susceptibility of dogs and humans to various diseases. The genetic history of the domestic dog is at least 15,000years, and possibly as much as 100,000 years. Over most of this time, dogs were used for a variety of work including hunting, herding, guarding, and as pets, but breeding practices were haphazard and mixing between types of dogs and even back to wolves as common.
   
     Basically all modern breeds have been developed in the last 200 years, with many deliberate (small founding populations) and inadvertent (low numbers of dogs during social and political upheavals such as the two world wars) genetic bottlenecks. The history of the Irish Wolfhound is a good example-claims that the breed as it exists today is the same as hounds used in ancient times are not supported by any solid evidence. While it is certain that large sight hounds existed thousands of years ago in the British Isles, the modern breed is the creation of Victorian fanciers who "recreated" the breed in the mid to late 1800's based on their ideas about how the breed should look and on current Victorian ideas of "improving" animals through selective and "pure" breeding.

     While these genetic studies are still preliminary, they are starting to identify gene sequences which have been strongly selected for in the process of creating these breeds. These sequences often contain mutations with major effects on both the phenotype of the dogs and on their health. The diseases which some breeds are very susceptible to are often similar to diseases which also occur in humans, and knowledge of dog genetics is applicable  to human health as well. As the specific portions of the genome which affect disease susceptibility are identified, we will learn more about how to avoid many of these health problems in the future. Unfortunately for many of the alternative medicine crowd, claims that diseases like cancer are product of vague "toxins" and modern industrial society are unsubstantiated by the evidence. While it is true that pets can develop cancer due to exposure to specific, known toxins such as secondhand smoke, these exposures are fairly well known and documented in both animals and humans, and are often related to the owner's lifestyle choices more than any generic effect of modernity. While avoiding known toxins such as tobacco smoke is always a good idea, trying to improve our chances with supplements or "superfoods" generally does not work the way we would wish it did.

     The more we learn about the interaction of our genes with the environment, the more we know that disease is often a result of genetic influences which we can control to some extent in domestic animals.
Claims that cancer and autoimmune diseases are caused by specific diets, vaccines, or undefined toxins remain unsubstantiated, and support for them is getting weaker as we learn more about the genetics of dogs and other species.

Arizona Black Rattlesnake

This little (approximately 18inches long) rattlesnake was hiding in the raspberry bushes along the top of the Mogollon Rim last weekend. It rattled when we got close to warn us away. This is a subspecies of the Western Rattlesnake (Crotalus viridus subspecies cerberus) They tend to occur at relatively high elevations (this one was at about 7500feet above sea level). Some people think that the black color is an adaptation to high altitude that allows the snake to absorb more heat from the sun, although the leaf/needle litter in their habitat also tends to be quite dark. The dark color may serve as good camouflage as well as helping the snake warm up after cool mountain nights. Most rattlesnakes will assume a defensive position such as this, and usually will not strike unless a person or animal steps on them or persists in approaching within striking distance or tries to handle or contact the snake. This snake rattled a little to warn us and retreated into the raspberry patch. Venomous snakes  in the wild should be left alone to fill their place in the ecosystem and to avoid injury. See my previous post for information on first aid and treatment of rattlesnake bites.

Buying influence in the early stages of veterinary careers.

 I found a commentary in the latest issue of JAVMA by a second year veterinary student at Colorado State University who is also a lawyer. The commentary addresses the wide variety of free goods, pet foods, medications and industry sponsored seminars provided to veterinary students. When I attended Colorado State 20 years ago, I remember a handful of pharmacy company sponsored seminars and a few coupons for free dog food over the entire 4 years. The seminars were unusual occurrences and there was usually some post-seminar commentary by faculty discussing where the company line may have diverged from the scientific evidence. It would appear things have changed drastically since then.

Here is Michelle Dally's description of the flow of swag that starts the first day of freshman year;

Every first-year veterinary student at Colorado State
University is assigned a small desk in a dingy warren
in the Anatomy building affectionately known as
“the cubes.” These desks are unremarkable in all ways
but one: when students first arrive, they find their desks
piled high with a variety of freebiespens, notepads,
backpacks, notebooks, highlighters, academic calendars,
pet treats, pet food bowls, reference books, and
more—all emblazoned with pet food, pharmaceutical,
and other corporate brand names from across the veterinary
industry. And that is only the beginning.
As the year unfolds, students discover that they are
entitled to free and sharply discounted dog, cat, and
horse food; free heartworm preventative; a free laboratory
coat; and a free clipboard for use in their gross
anatomy laboratory.

 In addition to all of the gifts, students are also invited to "work" as student representatives for many of these companies, often for fairly significant amounts of money;

Soon, first-year veterinary students
are receiving e-mails through the official veterinary college
e-mail distribution list encouraging them to apply
to be corporate student representatives for a variety of
companiespositions that typically involve little more
than distributing additional freebies to their classmates
and organizing one or two free lunchtime lectures. In
return for their efforts, these student representatives are
generally paid between $750 and $2,000 per semester.
Some companies employ as many as two student representatives
in each of the 4 veterinary college classes,
whereas others employ only a single representative for
each class or a single representative for the entire college.
Regardless, the upshot is that there are typically
one or two corporate-sponsored free lunches each week
for veterinary students, and the corporate presence in
the veterinary college is palpable.

In addition to the conscious and unconscious effects these gifts and sponsorships may have on students ideas and practices far beyond veterinary school (which is discussed well in the commentary) it leaves the profession as a whole open to other criticisms. Often one of the first accusations used to defend alternative practices or denigrate any science-based treatment which is produced by a pharmaceutical company is that veterinarians are just shills for "big pharma" or "big pet food". The same companies often sponsor veterinary conferences and seminars for veterinarians as well. The alternative veterinary industry really should not throw this particular stone, as their conferences are sponsored by supplement manufacturers and other companies to a similar extent.

The things that I found particularly disturbing about the commentary were the discussion of how these practices are tacitly and actively supported by the veterinary school with very little time spent educating the students on how they may be influenced by them. This is yet another way that veterinary schools are failing to teach their students critical thinking skills and how to evaluate evidence. This type of corporate influence may be even more insidious than teaching alternative practices which are not evidence based in a credulous manner. Students really should be taught how to critically analyze the claims of all of the players in the veterinary industry, from the pharmaceutical companies to the promoters of supplements and alternative treatments. Increasing the access companies have to students as described in this  commentary really does open the door for legitimate criticism, as well as giving charlatans something to point to to distract from their own lack of evidence.

I commend Michelle Dally for her commentary and for drawing attention to this topic.

Citation;  

Journal of the American Veterinary Medical Association

June 15, 2011, Vol. 238, No. 12, Pages 1551-1554

doi: 10.2460/javma.238.12.1551

Ethical considerations raised by the provision of freebies to veterinary students

Michelle Dally, JD

College of Veterinary Medicine and Biomedical Sciences. Colorado State University, Fort Collins, CO 80523. (Dally)

Ms. Dally was a second-year veterinary student at the time of submission.

Cancer, Autoimmune disease and MHC diversity-should we blame vague toxins and food or inbreeding and closed registries?

It is common among proponents of certain types of diets and supplements (raw diets, the "evolution" diet, and many types of herbal supplements) to claim that cancer and autoimmune diseases are caused by unidentified "toxins" in commercial foods, vaccines or simply toxins from the environment. Unfortunately, some breeders and even some veterinarians, particularly the "CAVM" crowd, have bought into these ideas, and sometimes try to require new puppy owners to feed specific foods, delay or avoid vaccinations and sometimes avoid certain types of exercise in an attempt to avoid problems that have a strong genetic basis.

Many ideas about breeding dogs date back to the Victorian era when little to nothing was known about genetics and their relationship to the function of the immune system, and ideas of pure blood and avoiding undesirable mixing of different breeds were considered to be the appropriate way to "improve" dogs and other animals. Unfortunately, these ideas were institutionalized and perpetuated through kennel clubs and many breed clubs in the form of policies that allow and even encourage inbreeding (often called "line breeding") and specifically prohibit out-crosses for any reason. The only way to try to eliminate a problem under this system is to eliminate individuals carrying the undesirable genes, which may remove one problem, but is likely to further constrict the gene pool and cause other problems at the same time. While the "holistic" veterinary medicine crowd tries to blame toxins and vaccines, and the large kennel clubs do their best to ignore the underlying problems with their policies, scientists have been working hard to identify the reasons why some breeds are so much more susceptible to certain types of cancer and autoimmune diseases than other dogs or less inbred dogs are.

The underlying genetics associated with susceptibility to several autoimmune diseases and cancers have been discovered in the last few years. While we have known that certain breeds have much higher incidences of certain diseases than others for years (some diseases are named for the breeds which they occur in most frequently), the complexity of the immune system and the genetics associated with it means that only recently have we started to unravel how this affects the health of our pets. There are two main types of Major Histocompatability   Complex (MHC) genes in vertebrates-which are also one of the most polymorphic sets of genes in vertebrates-which are involved with identifying different proteins (antigens) and presenting them to the immune system as "self" or "non-self". This is how the immune system regulates which things to attack and remove (bacteria, cells infected by viruses, cancer cells, etc.) and which things to leave alone (normal cells, harmless proteins from food and the environment).  In general, having a larger number of diverse MHC genes means that the immune system is better equipped to identify and distinguish good and bad antigens in the body.

In the last few years, researchers have identified varying MHC diversity in different dog breeds. Although it is probably still quite early to use MHC haplotype testing to test for suceptiblity to most diseases, such testing is starting to become available. Many studies have been done identifying specific problems and relationships of specific MHC haplotypes with specific diseases. Some examples include; Autoimmune Hemolytic anemia, Hypothyroidism, Canine Masticatory Myositis, Toller arthritis (a disease similar to Lupus), Canine chronic superficial keratitis, and Doberman Hepatitis. These are just a few of the heritable autoimmune diseases which occur in dogs, and active research continues. MHC diversity is also important for detecting and eliminating cancers, and a lot of research has been done into transmissible tumors in an attempt to discover a way to fight
Devil facial tumor disease in Tasmanian Devils. This research is helping to show how many types of tumors in addition to transmissible tumors evade the immune system. Some inheritable diseases have unsurprisingly been discovered to be unrelated to the MHC genes as well.

This body of research is providing both a broad knowledge of how limited gene pools increase the risk of autoimmune disease and cancer, and which specific genes affect susceptibility to specific diseases. While this line of research will result in specific tests for many of these diseases, eliminating carriers from the population may further restrict genetic variability and is very likely to cause other problems. It would be a much better idea to try to increase diversity in HLA haplotypes first, before eliminating undesirable genes. In some cases, this may mean outcrosses from other breeds to introduce the desirable genetic diversity. In the rare casees that this has been tried, the kennel clubs and breed organizations have not reacted positively. Another problem is that often kennel clubs and breed organizations fund genetic research on purebred dogs, which may deter criticism from organized veterinary medicine.Even worse, the "holistic" or CAVM crowd enthusiastically promote a wide variety of diets, supplements, and even antivaccine nonsense while ignoring the growing body of evidence of genetic problems in purebred dogs. "Holistic" indeed.

For further discussion of these issues in dogs and other animals, see these thoughtful posts;
Pedigree dogs Exposed-How to breed dogs with stronger immune systems.
Border Wars-Inbred Mistakes.
Desert Wind Hounds-MHC, DLA, WTF?
Retrieverman-Misunderstanding the concept of inbreeding tolerance.

Veterinary Homeopaths don't like criticism.

Please see this post over at The SkeptVet blog; witin 24 hours it is recieving threatening comments from one of the veterinary homeopath's through the North American Veterinary Conference, who should know better. Please repost  if you can.

Evidence for using caution with herbal medications in cats.

photobucket

 

Veterinarians have known for a long time that cats do not handle certain drugs as well a dogs and other animals do. Drugs such as aspirin, acetaminophen, and other NSAIDs can be much more toxic to cats than to other animals. If we give them to cats at all, they are given in very low, infrequent doses (aspirin) or not at all (acetaminophen). We have known for a long time that cats have much lower levels of the liver enzymes which humans and other animals use to metabolize these drugs. Cats are considered "hypercarnivores", meaning they are adapted to a diet that is 70% or more animal matter. Since most drugs are quite recent inventions, it is obvious that these enzymes did not evolve in response to the drugs which they metabolize but to something else.

A recent paper on PLoS One has worked out the genetics behind this enzyme difference in cats (and a few other animals). These enzymes (Glucuronyltransferases) have developed over many millions of years to deal with toxins found in plants used for food. In species such as cats that do not eat many plants, there is no selective pressure to maintain this type of enzyme function, and mutations can cause the genes coding for them to become inactive. This is what has happened in cats with these particular enzymes, with the result that certain drugs that are chemically similar to some types of plant toxins are much more toxic to cats than they are to other species. This type of issue with drug metabolism is known as a "species defect". While the specific difference in metabolism being discussed here is one of the best known and documented of these species defects, other less well documented differences occur as well.

This has important implications for not only the use of pharmaceuticals of known and controlled dosages, but even more importantly for the use of herbal medications in different species. The problems with herbal medicines are best described in David Colquhoun's Patients Guide to Magic Medicine as  "Herbal medicine: giving patients an unknown dose of an ill-defined drug, of unknown effectiveness and unknown safety." The bit about unknown safety is especially applicable in the case of the types of species defects in metabolism that we are discussing here. While some of them are well known, giving an herbal medication that has many different chemical compounds in it may increase the risk of adverse reactions. In addition, the actual dose of active ingredients in herbal products is often very variable, so a product that seems safe when taken once may be toxic the next time. Just because herbs are natural does not mean they are safe, and animals have evolved a lot of natural variability in sensitivity to plant compounds, as this paper documents.

More evidence that acupuncture does not really work.

  There have been several new developments in the evidence base for the effectiveness of acupuncture recently. The first, and more important is a recent systematic review of the evidence for the effectiveness of acupuncture for pain. The Skept Vet has addressed this review in detail here. In short, the review found that the evidence for pain relief in general was contradictory and weak, with the possibility of rare but serious side effects to consider as well. As The Skept Vet points out this type of mild, patient expectation-related effect (placebo effect) may not exist in our animal patients, and any perceived effect may be due more to owner and clinician expectation and observation bias than to any real effect felt by the patient.

     Another human study was published recently on the effects of acupuncture on nausea in humans being treated for cancer. This study is interesting because it is one of the few studies which included not only a standard care control group, but also had a sham acupuncture group in addition to the acupuncture group. The sham group involved both a telescopic sham needle and a sham acupuncture point to help control for both patient perception and any effect possibly related to the specific acupuncture point used. The sample sizes in this study were not huge, but were better than many other acupuncture studies, with 62 (standard treatment), 88 (acupuncture) and 95 (sham acupuncture) patients completing the study. The participants in the study were also interviewed top measure their expectations related to the treatment.

    The results of the study showed that both the acupuncture and sham acupuncture groups  had lower levels of nausea and vomiting than the standard care group, and that this effect was strongly correlated to patient expectations. While the therapists applying the acupuncture were not blinded, the results between the two groups were not significantly different. This study is better controlled than most acupuncture studies in the past have been despite the lack of double blinding.  This reinforces the view that many skeptics have that the apparent effects of acupuncture on subjective symptoms such as the perception of pain and nausea may be due to patient expectation rather than any specific physiological effect of the acupuncture itself. Veterinarians claiming that acupuncture is effective should be very careful-their patients may be experiencing some discomfort or pain related to the acupuncture, without any benefit of expectation of improvement, while the veterinarian and owner may believe they see improvement because of their own expectations and desire to help. While an argument may be made that inducing positive expectations in human patients may be useful for managing problems such as pain and nausea, this should be done without misleading the patient or exposing them to risks of serious side effects. In the case of animal patients, it is probably unrealistic to assume that they have the same type of expectation of benefit, and we should be doubly careful to be sure the treatments we use have good evidence of effectiveness.

Pedigree dogs-many health problems are genetic, despite what some say.

 A short video well worth watching if you are not familiar with the problems associated with breed standards and the inbreeding allowed and even encouraged by the large kennel clubs. Unfortunately, many breeders do not understand these problems well enough either and often blame (often with the encouragement of holistic vets) vaccines, ill defined "toxins", commercial dog food, and sometimes the owners for problems that quite clearly have strong genetic components, even when not entirely genetic diseases. These problems have not really received enough attention from organized and science and evidence-based veterinarians, but the alternative and integrative veterinarians seem to be exploiting them without any mention of the responsibility the kennel clubs and breeders hold for creating so many health problems in the first place.

Nonsense On Stilts by Massimo Pigliucci

Nonsense on Stilts, Massimos Pigliucci's most recent book is and interesting read for anyone interested in distinguishing science from pseudoscience, or from "bunk". The author also discusses the book on the Rationally Speaking podcast, produced by the New York City Skeptics.

While the book does not directly address CAM, it is an interesting and detailed look at the development of science from an historical and philosophical viewpoint that provides a lot of insight into what makes a subject or field scientific, proto-scientific, or just plain nonsense. It includes interesting discussions of what the differences and similarities are between different fields of science (physics and biology, for example) and how something like SETI may not be currently considered science due to it's lack of evidence, but could become scientific if such evidence is found. Some types of alternative medicine clearly fit into the bunk category (homeopathy, reflexology, Reiki, traditional chinese acupuncture) due to the lack of evidence for effectiveness and the complete lack of plausible mechanisms for action. Other things such as herbal medicine can be scientific or not depending on how they are approached by the people pursuing them.

 The book is well worth reading for anyone interested in a deeper understanding of how science can be understood as a process practiced by humans, and how it has developed over time. It will give you a better understanding of what science is and how to evaluate claims about different topics.

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.

Life and Death in the winter snow.

I noticed feathers falling past my front window this afternoon and looked outside to find this Sharp-Shinned Hawk eating a small bird in the Ponderosa Pine tree in the front yard. The temperature outside was 13 degrees Fahrenheit. A small bird needs to consume a lot of calories to survive in these temperatures.

Twisting facts to suit "theory". How smart people can fool themselves.

              “It is a capital mistake to theorise before one has data. Insensibly one begins to twist facts to suit theories instead of theories to suit facts.”
Sir Arthur Conan Doyle

   It often seems strange how frequently smart, well educated people seem to fall for pseudoscience. Doctors and Veterinarians are certainly no exception, and it is not unusual to see veterinarians recommending poorly evidenced treatments or even treatments with evidence against their effectiveness. People often ask how a trained medical professional can fall for such things and then promote them. In addition to regression to the mean, selection bias and other cognitive errors, we are all prone to the illusion of control. A recent paper in the British Journal of Psychology (discussion by Ben Goldacre here as the entire paper is behind a paywall) helps to demonstrate how this illusion can develop in medical professionals and suggests some ways to avoid it. Unfortunately, many veterinary school curricula and continuing education rely heavily on a fairly authoritarian presentation of information and rote memorization that do not help students to learn to evaluate claims critically and understand the evidence base behind various treatments.

  In recent comments on The SkeptVet Blog, several different people have suggested that skeptics should not criticize alternative treatments until they have tried them.This advice is given without an awareness of how easily we all make cognitive errors and how those errors can give us an illusory view of the effectiveness of our treatments. To be fair, we are all just as susceptible to this type of cognitive error no matter what type of treatment we are using, and we should always be wary of misdiagnosis or inappropriate treatment selection, situations in which these types of cognitive errors are common in both evidence based and alternative medical treatments. It underlines the importance of blinded, controlled trials, and the evaluation of the strength of the evidence supporting any treatment in  as objective a way as possible. "Trying it for yourself" is just a good way to fool yourself, and the more confident you are in your experience and ability, the more likely you are to believe that an ineffective treatment works. This new psychological paper just demonstrates the idea again in a relevant way.

Bad Science

An excellent read, with well written descriptions of how ineffective treatments can seem to work, and how smart people can believe that they do. Recently released in the US, so pick one up if you are interested.

Discovering a new species; what kind of evidence is good enough?

Well, the actual animal in hand is usually sufficient. Scientists are still discovering new species (unknown to science, if not to the local residents) on a regular basis. For some reason, it is biologists making these finds, not cryptozoologists, who seem to spend more time either chasing after or perpetrating hoaxes rather than finding real evidence for unknown animals. While a large primate living in North America would be an amazing discovery, the fact that no one has found any definitive evidence in the form of a body, bones, DNA, or even fossil evidence would seem to indicate that the probability of it's existence is close to zero. The real animals still being discovered are fascinating enough.
 
Photo credit; Durrell Wildlife Conservation Trust

An Anti-vaccine Veterinarian-an interesting mix of pseudoscience, faith, and nonsense.

A particularly egregious example of an anti-vaccine veterinarian was brought to my attention recently (hat tip to Terrierman). Dr.Patricia Jordan has published online a poster she presented at the 5th annual joint North American Homeopathic Conference this year. Her personal website (titled "Mark of The Beast-hidden in plain sight-the case against vaccinations" by which she appears to mean that vaccinations are the mark of the beast) also reveals similar ideas which add up to an interesting mix of misinterpreted and misrepresented science, what appears to be the influence of evangelical style christian creationism, big-pharma and government conspiracy theories, and just plain making things up to suit her ideology. This type of ridiculous reasoning is one of the things that makes me very skeptical of information coming from alternative medicine professional organizations such as the American Holistic Veterinary Medical Association or Homeopathic associations-all to often they seem to accept ideas such as Dr. Jordan's uncritically.

From the Curriculum Vitae page on her website, it would appear that Dr. Jordan had a distinguished undergraduate and veterinary school career in the 1980's with several externships and even some type of award for epidemiology. Since the late 1990's it would seem that she has not found a variety of alternative medicine she does not like, including Reiki, homeopathy, acupuncture, traditional Chinese medicine, spinal manipulation and "pulse diagnosis". The legitimate scientific veterinary conferences and seminars she has attended in that time appear to consist mostly of vaccine related events, which she has apparently interpreted as evidence that vaccines are the cause of nearly all disease and some kind of spiritual menace. She conveniently ignores the fact that many vaccine preventable diseases in animals and humans have huge costs in mortality and morbidity by orders of magnitude over any evidence for adverse effects of vaccinations. It makes me wonder if she has ever seen a case of canine distemper, parvovirus or Rabies, or any of the other viruses we routinely prevent with vaccination.

To be fair, there has been a legitimate scientific debate over vaccination of pets over the last 10-20 years which has resulted in some significant changes in vaccination protocols for pets. All Rabies vaccines were changed to killed virus vaccines in the 1980's when it was found that the modified live virus vaccines could, in rare cases, cause rabies. In cats, this had the unintended result of causing malignant tumors in some cats (1). This can also happen in dogs, but is much more rare than it's incidence in cats, which has been reported between one in 1,000 to one in 10,000 cats. Other adverse effects of vaccination are primarily acute and delayed allergic reactions, with very little evidence that other diseases, such as autoimmune disease, other types of cancer, neurological or behavioral diseases are caused by vaccination. For a detailed analysis of these issues, visit The SkeptVet here. While vaccinations can trigger allergic reactions and on rare occasions various autoimmune diseases, this is not proof that the vaccination causes these problems. The greatly varying incidence of allergies and autoimmune disease among different breeds would suggest underlying genetic susceptibilities, and any naturally acquired infection or allergen exposure is as likely or more likely to trigger an outbreak as a vaccination is. As evidence has accumulated about the duration of immunity from vaccination, most veterinarians have switched from annual vaccination protocols to 3-4 year protocols for most vaccines, and I would not be surprised if some of these were extended even more as more evidence is accumulated for longer duration of immunity. Despite this active scientific evaluation of animal vaccination over the past decade or so, Dr. Jordan seems to have decided for ideological reasons that all vaccinations are bad.   Lets look at some of the claims she makes and compare them with the science.

This paragraph from Dr. Jordan's poster illustrates many of the distortions and errors which she makes;

Only vaccinated individuals were found to develop auto antibodies in a landmark study done at Perdue University. Auto antibodies are made with the vaccines from the viruses, from the microbial antigens, from the aluminum and mercury and other ingredients that would mutate or disrupt the pathogen. The increase of molecular mimicry increases with vaccines and these examples of pathways to increase the number of auto antibodies formed the trigger necessary to promote genetic expression of autoimmune disease. Certainly, autoimmune disease expression is one step closer to genetic disease and that handicap will transfer vertically to the next generation in many instances. The important understanding is that the adulteration of the genome came in via the injection of vaccine.

  

It is true that several scientists at Purdue have done a lot of work evaluating the efficacy and potential adverse effects of vaccination in dogs (examples of their work in references 2, 3, and 4). However, auto antibodies are antibodies which react to normal tissues in the body, and may be formed by exposure to animal protein contaminants of vaccines, and occasionally from injuries to tissues such as the lens of the eye, not normally from viral or bacterial antigens, or by exposure to the small amounts of aluminum or mercury present in some vaccines. Let's see what they have to say from reference 3;

 To date, routine vaccination of these Beagles has not caused any overt signs of clinical disease.  However, the blood of all the vaccinated dogs contains significantly elevated concentrations of antibodies directed against proteins that are present in commercial vaccines as contaminants of the production process.  None of the unvaccinated control dogs has had a similar increase in these antibodies.  These proteins are typically of bovine origin since fetal calf serum is used to grow the viruses for vaccine production.  The close similarity in structure of the bovine proteins to dog proteins results in a situation whereby the antibodies produced by the vaccinated dogs may cross-react with dog tissue proteins in a process similar to autoimmunity. Experiments in other animal species suggest that these autoantibodies might eventually cause diseases in the vaccinated animals, but these
Beagle dogs will need to be followed longer to determine if this is the case.  In addition, the pattern of individual responses of the immune system to vaccination in this study suggests a possible genetic predisposition to autoimmunity.

(this paper appears to have been published online and is no longer available at Purdue's website-this extract was taken from a breeder's website). These results are much more preliminary than Dr. Jordan or some breeders make them out to be, and while they are cause for concern and may be reason to change vaccine production methods, there is no mention of the vaccine directly causing mutations. I have not been able to find any evidence that vaccines cause "adulteration of the genome" which is transferable to the next generation. Perhaps one of the most insidious results of this type of reasoning is that some breeders use it to blame problems caused by inbreeding on vaccination instead. The Purdue paper seems to be commonly misused in this way on many breeder's and "holistic" veterinarian's websites. Unfortunately Dr. Jordan and others are taking a legitimate scientific controversy and distorting it beyond all recognition and far beyond the actual evidence. This quote from Dr. Jordan's personal website's mission statement illustrates in her own words how she has abandoned evidence and science for the ideologically based view she prefers;

It was a decade out of medical school before I clearly saw that the beliefs of modern medicine were simply beliefs and not in alignment with the innate wisdom of the body. Vaccines and drugs are at odds with the intelligence of the almighty design and getting back to the garden means getting back to the natural form and using the optimal nutrition, energetic repair and right relationship of living.

There are many more examples of distorted ideas about evolution and the immune system in Dr. Jordan's poster and website. Since she does not list any references(there are no references on the poster and the references and resources pages on her website are blank), it is difficult to discover where she gets most of her ideas. Many probably come from her own head, and others are from sources I was unable to track down.
In any case, following ideas such as these would be extraordinarily dangerous for pets and humans, indeed far more dangerous than vaccinations have ever been. For an excellent discussion of the relative risks and consequences of antivaccine movements on the human side, see Prometheus' recent post here. It is sad that Dr. Jordan seems more interested in fear mongering and selling books than rationally evaluating the evidence.

References;

1.Journal of the American Veterinary Medical Association

June 1, 2005, Vol. 226, No. 11, Pages 1821-1842

doi: 10.2460/javma.2005.226.1821

The current understanding and management of vaccine-associated sarcomas in cats

2.Journal of the American Veterinary Medical Association

July 1, 2007, Vol. 231, No. 1, Pages 94-100

doi: 10.2460/javma.231.1.94

Adverse events after vaccine administration in cats: 2,560 cases (2002–2005)

George E. Moore, DVM, PhD, DACVPM, DACVIM; Andrea C. DeSantis-Kerr, DVM; Lynn F. Guptill, DVM, PhD, DACVIM; Nita W. Glickman, MPH, PhD; Hugh B. Lewis, BVMS, DACVP; Lawrence T. Glickman, VMD, DrPH 

3.Effects Of Vaccination On The Endocrine And Immune Systems of Dogs,  Phase II Purdue University, November 1, 1999 
Drs. Harm HogenEsch and Larry T. Glickman 

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4.J Am Vet Med Assoc. 2002 Aug 15;221(4):515-21.

Evaluation of antithyroglobulin antibodies after routine vaccination in pet and research dogs.

Scott-Moncrieff JC, Azcona-Olivera J, Glickman NW, Glickman LT, HogenEsch H.

Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Purdue University, West Lafayette, IN 47907, USA.

 

"Heads I win, Tails You Lose"

This is an excellent article by Richard Wiseman on psi research and how studies are poorly designed, statistics are misused, and results are distorted to support psi research. Many of these problems are also common to many types of CAM research and unfortunately, sometimes other medical researh as well, so this is a useful article to keep in mind when evaluating medical claims. Basically, it illustrates many things which pseudoscience and sometimes just bad science does which should be kept in mind when critically evaluating claims.