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American College Of Veterinary Internal Medicine

A Report from the Trenches

In veterinary medicine, as in human medicine, people now find themselves besieged with dubious claims for a variety of therapies.

In October of 1997, William Jarvis, president of the National Council for Reliable Health Information (NCRHI), asked me to establish a veterinary task force to deal with the issues of unproven therapeutic claims, critical thinking, and pseudoscience in veterinary medicine. He was responding to an obvious need. In veterinary medicine, as in human medicine, people now find themselves besieged with dubious claims for a variety of therapies. It's the goal of the NCRHI Veterinary Task Force to help animal owners and veterinarians understand what they are being told, and to help keep them from drowning in a vast sea of medical misinformation.

From the outset the Task Force has had its hands full.

In order to try to reach as many people as efficiently as possible, our first goal was to start a Web sire titled the "Alt Med Advisory Page." Later we added the "Entirely On-Line Alt Med Primer" and then the "Alt Med Book Review Page." This Web site has been successful beyond all expectation, even winning acclaim from USA Today Weekend Edition.

But our efforts haven't stopped there. We've also lobbied vigorously and successfully to have the notoriously uncritical 1996 American Veterinary Medical Association's Alternative Medicine Guidelines re-evaluated. Various members and supporters have published critical letters to the editors of U.S. and Canadian veterinary journals, often in response to featured articles by proponents of unproven therapies that have extolled the virtues of such at-best-unproven modalities as veterinary homeopathy, chiropractic, acupuncture, "energy therapy," and herbalism. Others have broken new ground by writing and publishing articles and books critically evaluating "alternative" veterinary medical claims. Task Force equine advisor Dave Ramey, DVM, has lectured on these subjects at veterinary schools across the country.

Yet another Task Force goal has been to provide sound information to veterinary practitioners and academicians. This past year our organization (with financial support from CSICOP, SKEPTICAL INQUIRER, and other concerned parties) has begun to offer scientifically accurate, fact-based information regarding unproven "alternative" therapies at major veterinary conferences across the United States.

The American College of Veterinary Internal Medicine Conference

Our first target was the May 2000 annual conference of the American College of Veterinary Internal Medicine (ACVIM) in Seattle, Washington. Dave Ramey and I were allowed to set up a small "educational display table" near the registration area. Though our table was far from the main exhibitor's area, we attracted a great deal of positive attention and support from attending veterinarians, academicians, and veterinary internists. Our material proved more popular than anticipated and keeping up with the demand for additional copies of the various handouts we were distributing became a welcome problem.

The ACVIM is the organization that represents what one would hope to be among the "best and the brightest" among practitioners of veterinary internal medicine (i.e., veterinary "internists"). One might reasonably expect that medical pseudoscience would be afforded short shrift at a convention of board certified specialists in veterinary internal medicine. Unfortunately, while the quality and scientific rigor of the formal presentations seems to have been generally high, the information presented by some commercial exhibitors at the conference was less impressive.

For example, a company called NaturalHealingDoctor operated a commercial exhibit at the conference. A visit to NaturalHealingDoctor's Web site at www.naturalhealingdocror.com/cgi-bin/nhd.storefront sheds light on the nature of the company and the "therapies" they sell to veterinarians and the pet-owning public. Their promotional material explains that "NaturalHealingDoctor sells suggested remedies for over 100 human and thirty pet ailments. Naturopathic or Ayurvedic Doctors and Veterinarians have developed these suggested remedies."

One of the "ailments" Natural HealingDoctor claims to treat is "aggression." They claim that "Pets can become aggressive towards their owners, strangers, and other animals. [...] At times, this aggression is bred into the animal. Other factors can be physiological, such as negative reaction to vaccinations, blood sugar level, virus, and inflamed nervous system. No matter the cause, many of these can be helped by herbal medicine."

The claims may sound persuasive, but they fall apart under scrutiny. "Inflamed nervous system"? "No matter the cause"? This sounds like the pitch for a nineteenth-century patent medical nostrum. In fact, that's essentially what it is. It's also alarming to see phrases like "negative reactions to vaccination" pop up in the veterinary field. Naturopaths, homeopaths, some chiropractors, and various other nonscientific medical practitioners sometimes claim that vaccines cause a wide range of maladies and refer to the "problem" as "vaccinosis." However, while serious adverse reactions to vaccination do occasionally occur, there is no scientific data supporting the existence of widespread vaccine-related disease entities. The fact is that vaccination and the provision of clean drinking water are the two most effective enhancements to public health (human and animal) of all time. Vaccination over the last century has, without a doubt, saved many hundreds of millions of animal and human lives. The same cannot be sai d of any herbal therapy.

Herbal remedies, when effective, are merely crude drugs. Drugs, of course, may have side effects, and pharmaceutical companies generally take great pains to list them. Such caution is not evident in the veterinary herbal field. For example, for just $41.35, NaturalHealingDoctor will sell you their remedy for the "ailment of aggression." This consists of 6.7 oz. of extract of German chamomile, valerian, scullcap, and passion flower in water, alcohol, and glycerine. The company offers no warning about giving this remedy to pregnant animals, even though scullcap has been shown to cause birth defects when administered orally to pregnant rats (Kim 1993). When it comes to alternative medicine, "caveat emptor" seems to be the order of the day.

As is the case with most "alternative" approaches (and in contrast to the claims that "alternative" medicine treats the "whole" patient), treatment seems to be directed primarily at symptoms, rather than disease. This oversight can have serious consequences. For example, NaturalHealingDoctor advises that dogs presenting with "liquid bowel movements, stools with mucous or catarrh, blood in stools, electrolyte and fluid loss, and dehydration" be treated with extract of "barberry, mullein, bayberry, myrrh, thyme, German chamomile, peony root, ginger, Oregon grape, in glycerin." What the company fails to mention is that bloody liquid diarrhea in dogs, accompanied by dehydration and depression, are the hallmarks of the common and often lethal disease canine parvoviral enteritis. The first thing the owner of a dog so afflicted urgently needs is not an unproven "herbal remedy," but an accurate diagnosis and immediate intervention by a competent veterinarian followed by round-the-clock Intensive care, including intr avenous fluids, antibiotics, and nutrient support. The sooner such supportive therapy is instituted, the higher the survival rate--and, with early diagnosis and intensive care, the survival rare for parvoviral enteritis is generally quite high.

NaturalHealingDoctor fails to even mention the possibility that such clinical signs might suggest parvoviral enteritis. Nor do they even suggest that a dog with such signs should be examined by a veterinarian. Telling consumers that some herbal nostrum should be given in the face of such clinical signs will almost certainly delay accurate diagnosis and implementation of appropriate life-saving therapy, and therefore cost patient lives.

Fortunately, most of the presentations at the ACVIM conference were based on sound science and good medicine. However, in a presentation titled "Alternative approaches to the treatment of epilepsy," internist Karen R. Munana, DVM, MS, told her audience, "The first report of epilepsy in traditional Chinese medicine appeared in a publication written by a group of physicians between 770 and 221 B.C. Since then, the use of acupuncture to treat epileptic seizures has been described in both humans and in animals."

Unfortunately, such comments, though common, appear to be made with little concern for either their historical or clinical accuracy. In the first place, epilepsy is not a traditional Chinese medical diagnosis. Second, the Huangdi neijing, the collection of ancient Chinese documents to which Munana refers, can't be reliably dated to earlier than the fifth century A.D. More important, there is no evidence that the ancient Chinese medically treated dogs or cats at all (Despeux 1981). Finally, neither acupuncture points nor meridians have been shown to exist.

In spite of such inaccuracies, one might still hold the possibility that needling is an effective therapy for epilepsy. Unfortunately, even that assertion can't be supported. While Munana also stated that "the mechanism by which acupuncture controls seizures is not completely understood," the only randomized controlled study ever undertaken to establish the efficacy of acupuncture in the treatment of epilepsy in humans was "unable to document a beneficial effect" (Kloster et al. 1999). No such controlled study involving animals has ever been conducted.

Examining the "data" that was provided is perhaps even more illustrative. Support for acupuncture in the treatment of epilepsy came in the form of two small and uncontrolled studies wherein gold beads were surgically implanted at acupuncture points" in dogs concurrently receiving anticonvulsant drugs (this was nor acupuncture). One of these studies involved only five subjects, eliminating the possibility of a statistically significant result. However, while all five dogs apparently experienced an initial decrease in seizure frequency, two subsequently experienced an increase in seizure frequency. The other uncontrolled canine study involved forty dogs and concluded that "50% of dogs were able to be taken off all anticonvulsant medication ... without the risk of further seizure episodes unless the dog was stressed." (That is, when these dogs that "no longer needed anticonvulsants" continued to have seizures, it was apparently not viewed as evidence that the "gold beads" didn't work, but that stress was to blame for the seizures.) An apparent optimist, Munana concluded: "Nonetheless, the positive response reported in these studies suggests that this form of therapy may be of use in patients for which satisfactory results cannot be obtai ned with anticonvulsants alone." That's a pretty big "may."

American Veterinary Medical Association

In July 2000, Dave Ramey and I traveled to Salt Lake City, Utah, to offer educational material at the annual conference of the American Veterinary Medical Association (AVMA). The conference was attended by some 7,000 veterinarians, making it one of the largest annual veterinary conferences in the world.

In contrast to the ACVIM conference, the AVMA "exhibitor's area" was a veritable hotbed of "alternative" medical promotion and sales. ANTECH Diagnostics, one of the nation's largest veterinary diagnostic laboratories, was promoting something called BioNutritional Analysis, whereby veterinarians are enticed to submit blood samples from perfectly normal animals with entirely normal blood chemistry profiles, along with a filled-out "questionnaire," in order to determine the "exact blend of homeopathics, nutriceuticals, and supplements" required to engender optimum health and performance in said normal animals. Thorne Research, a nutritional supplement manufacturer, was handing out literature advocating the extraction of all amalgam fillings from people's mouths. At the Friskies/Alpo booth they were pitching dog food containing "whole natural chickory root" as an aid to digestion. Various publishers throughout the ball were selling books dealing with everything from veterinary acupuncture to herbal therapies for pets.

Perhaps because its emphasis is on general information, unlike the ACVIM conference, the AVMA convention featured an entire program section devoted to unproven and disproved alternative veterinary therapies. These lectures consisted entirely of "how to" information, and were devoid of any critical assessment of the therapies in question. (Nonetheless, attending these sessions did qualify veterinarians for "continuing medical education" in the eyes of state veterinary licensing boards across the country.)

For example, Sheryl Schwartz, DVM, author of Four Paws, Five Directions, a text promoting the application of acupuncture and traditional Chinese medicine to dogs and cats, offered a lecture titled "A traditional Chinese medical approach to hip dysplasia" (Schwartz 2000). Her presentation, in essence, dealt with a "traditional Chinese medical approach" to a disease traditionally unrecognized by Chinese medicine in a species that, traditionally, the Chinese did not treat. Most of the Chinese medical "theory" she presented was apparently taken directly from the human Traditional Chinese Medicine (TCM) literature--a process the ancient Chinese specifically advised against (Guo).

Schwartz described acupuncture meridians as "energy pathways that travel close to the surface and in the muscle layers and include aspects of the nervous and circulatory systems, as well as an individual's vitality or qi." This sort of historical endorsement, though common, is simply nonsense. In fact, the term "acupuncture meridian" was coined in the late 1930s by Georges Soulie de Morant, a French diplomat in China who was fascinated by acupuncture as a cure for cholera (Soulie de Morant [1939] 1994). Soulie de Morant was also the first person to describe qi as energy (The ancient Chinese referred to "conduits" or "conduit vessels," and the earliest such references are dearly to blood vessels. The dassical Chinese characters for qi describe "vapor rising from food" rather than "energy" a definition remarkably similar to ideas proposed by the ancient Greeks.) Of course, there is no compelling scientific evidence that either acupuncture points or meridians exist in humans or any other species.

To her credit, Schwartz never claimed that acupuncture has been proven effective in the treatment of canine hip dysplasia (CHD), only that it "may be used" to treat the condition and that needling certain points has personally offered her "good results" over the last twenty years. While there are no controlled clinical trials investigating the efficacy of acupuncture in dogs with CHD, there are many well-designed, controlled studies showing that acupuncture is ineffective in the treatment of osteoarthritic conditions in humans (see www.seanet. com/[sim]vettf/Medline2.htm). There is no reason to expect it to be more effective in other species.

Unfortunately, veterinary pseudoscience at the AVMA conference was not limited to anecdotal assertions about putative Chinese therapies. Schwartz offered yet another presentation, this one titled "Introduction and clinical indications for homeopathy." She began her presentation with the assertion that homeopathy is a "natural pharmaceutical science." The fact is that it's neither natural (since homeopathic solutions don't occur in nature), nor pharmaceutical (since homeopathic remedies contain nothing other than water, and perhaps a little alcohol or lactose, none of which have documented therapeutic qualities pertinent to the conditions for which homeopaths prescribe them). Neither is homeopathy a science, since it violates several well-established scientific principles and is supported by none.

Nor is there any good evidence that homeopathy is effective for the treatment of anything. In recent decades, a number of controlled clinical trials have been conducted to study the efficacy of homeopathy in humans. A recent meta-analysis of these studies (conducted by homeopathy proponents) concluded that "we found insufficient evidence from these studies that homeopathy is clearly efficacious for any single clinical condition" (Linde 1997). There are, in fact, no controlled clinical trials of homeopathy in animals.

Schwartz went on to make the following self-contradicting statements: "It [homeopathy] is based on a set of symptoms that a particular patient expresses, rather than the name of a disease. In treatment, homeopathy seeks to cure the patient, not the disease."

While there's no evidence that homeopathic water has ever successfully cured any disease, it seems absurd to claim that a therapy strictly devoted to the suppression of symptoms "seeks to cure the patient." Incredibly, the homeopaths who make such claims seem to believe that diseases are nothing more than collections of symptoms.

In explaining to her audience how homeopathic remedies are manufactured, Schwartz mentioned that they contain only "minute doses" of the substances on the label. In fact, many if not most homeopathic remedies contain not a single molecule of the ingredient on the label. While no known physical process seems remotely likely to account for such a process, homeopaths claim that the water has somehow been induced to "remember" the former presence of now absent solute molecules. Schwartz explained that, as the remedy is repeatedly diluted either one part solute to nine parts of solvent or one part solute to ninety-nine parts of solvent, it is "dynamatized" by means of "succussion"--i.e., by shaking the container against a table top or palm, or by means of a shaking machine. In her lecture notes, she states:

The succussion manipulates and releases energy molecules [sic] into solution, thereby activating the medicine. [...] The vital energy liberated during the process is what appears to be responsible for its actions and interactions with the individual. The single remedy where the patient's individual history is assessed to determine her essence and then is matched with the essence of a particular natural substance [sic]. The single remedy includes the totality of the patient's symptoms and is extremely individualized. The single remedy is what is known as the simillimum.

If SKEPTICAL INQUIRER readers find this prose impenetrable, I'm afraid I can't offer any help.

Not only are some veterinarians asserting claims for expertise in ancient Chinese traditions and discredited eighteenth-century whimsy, they're claiming to be chiropractors, too. In that regard, veterinarian and chiropractor Kevin Haussler (of the Department of Biomedical Sciences, College of Veterinary Medicine, Cornell University) offered two lectures on veterinary chiropractic." In the published notes for his lectures (Haussler 2000), Haussler assures readers that "chiropractic is a complementary modality that can be used in veterinary medicine for the diagnosis and treatment of select musculoskeletal disorders." Unfortunately, not once in either presentation does he note exactly which musculoskeletal disorders in animals he feels may be effectively diagnosed and/or treated by means of chiropractic manipulation. Also, it's unclear how he might have decided this issue, since no controlled clinical trials involving veterinary chiropractic have ever been conducted. In humans, investigators have concluded tha t "we don't know whether it [chiropractic] does more good than harm" (Ernst 1998). Haussler does concede, however, that chiropractic is not a "cure-all." Of course, the real issue is whether or not chiropractic, human or veterinary, is a "cure-anything."

The Continuing Effort

While proponents of unproven and disproved "alternative and complementary" veterinary therapies have done little to scientifically investigate or validate their claims over the years, they've worked tirelessly to promote them by whatever nonscientific means available. This process has been going on now for almost three decades. Some U.S. veterinary schools currently offer "elective" courses dealing with acupuncture, homeopathy, chiropractic, herbalism, "energy therapy," and other "alternative" modalities. While the NCRHI Veterinary Task Force strongly supports the critical examination of "alternative" therapeutic claims in veterinary classrooms, the courses in question appear to universally involve only uncritical "how-to" instruction presented by proponents of such therapies and based on highly inaccurate advocate literature.

The Veterinary Task Force intends to continue to offer "a candle in the alternative medicine dark" at major veterinary conferences across the country. We need your help. Those interested in learning more about our organization, or contributing to our effort, should visit our Web site at www.seanet.com/[sim]vettf/.

Robert Imrie, DVM, is Coordinator of the National Council for Reliable Health Information.

References

Despeux, C. 1981. Apercu historique de 1'art veterinaire en Chine. Revue d'acuponcture veterinaire 9:2l-22

Ernst, E., and W.J. Assendelft. 1998. Chiropractic for low back pain. We don't know whether it does more good than harm. British Medical Journal 317(7152):160.

Guo, Huaixi: Xinke zhushi ma niu to jing da quan ji ("Newly Printed and Annotated Horse, Ox, and Camel Classics"), 40.

Haussler, K.K. 2000. Introduction to and clinical indications for animal chiropractic. Convention Notes, 137th AVMA Annual Convention, American Veterinary Medical Association. pp. 490-491.

Kim S.H., Y.H. Kim, S.S. Han, and J.K. Roh. 1993. Teratogenicity study of Scutellariae Radix in rats. Reprod Toxicol7 (1): 73-79.

Kloster, R., P.G. Larsson, R. Lossius, K.O. Nakken, R Dahl, X Xiu-Ling, Z. Wen-Xin, E. Kinge, and Edna Rossberg. 1999. The effect of acupuncture in chronic intractable epilepsy. Seizure 8(3): 170-4.

Linde, K., N. Clausius, G. Ramirez, D. Melchart, F. Eitel, L.V. Hedges, and W.B. Jonas. 1997. Are the clinical effects of homeopathy placebo effects? A meta-analysis of placebo-controlled trials. Lancet 350 (9081): 834-43.

Schwartz, C. 2000. A traditional Chinese medical approach to hip displaysia. Introduction and clinical indications for homeopathy, Convention Notes, 137th AVMA Annual Convention, American Veterinary Medical Association. pp. 485-489.

Soulie de Morant, G. [1939] 1994. ChineseAcupuncture. English edition edited by Paul Zmiewski. Brookline, Mass.: Paradigm Publications.

The Fallacy of 'Traditional Chinese' Veterinary Acupuncture

Over the last thirty years, veterinary acupuncture proponents have repeatedly claimed or implied that the ancient Chinese applied acupuncture to various animal species, (including dogs and cats), and that the practice is described in the ancient Chinese veterinary literature. On the other hand, they never directly cite any of the ancient Chinese veterinary literature to support such claims.

Recently, Veterinary Task Force members commissioned what appears to be the first-time-ever translation into English of key selections from the various ancient Chinese veterinary texts in question, including the seventeenth-century Yuan Heng liaoma ji (Yuan and Hen g's Recipe for Treating Horses), the fourteenth-century Simu anji ji (The Herdman's Pacification of Horses Collections for the Pacification of Stallions), and the sections covering large animal veterinary medicine from the sixth-century agricultural manual Quimin Yaoushu (Essential Arts for Assisting the People), the earliest recipes of their kind.

None of the early Chinese veterinary texts deal with the treatment of dogs or cats at all. Animals covered include horses, donkeys, asses, cattle, camels, pigs, goats, and sheep, with the most extensive tradition covering the larger species. The manuals covering the horse are typical of the tradition and none of them refer to anything that might reasonably be construed as acupuncture in the modern sense. The Yuan Heng liaoma ji even quotes the earlier Simu Anji ji to explain not only why horses don't have acupuncture points equivalent to those in humans, but why human medical practices, including acupuncture, may not be appropriate to the treatment of animals (cited from Guo Huaixi, Xinke zhushi ma niu to jing da quan ji. (Newly printed annotated great collection of horse, ox, and camel classics, Beijing: Nongye chuban she, 1988 [orig. 1785], 40):

Dongxi said: "[...] The needling depressions for horses are not the same as those of humans. Why?" Qu Chuan said: "The human is the divine element among the myriad things. Humans avail of the great movement of Yin and Yang. They receive the choicest aspects of Heaven and Earth. Their bodies are the proper way of the Five Elements. They receive the primeval influences and become replete and fertile. [. . .1 Now, as for animals, they are things. They avail of the partial movement of Yin and Yang. They receive the excess essence of Heaven and Earth and receive the insufficiency of the Five Elements."

So, in the eyes of traditional Chinese medicine, animals are mere "things," and are fundamentally different from human beings. According to these ancient texts,, the "depressions"-which modern proponents have interpreted as acupuncture points-are quite different from the acupuncture points found in people.

It's important to note that, in these ancient texts, the word zhen, which is usually translated as "needling," applies to an extremely wide variety of interventions involving sharp and/or heated instruments. The word certainly does not necessarily imply the insertion and manipulation of fine needles. To the contrary, it's clear from a careful reading of the texts that the "depressions" described are sites where therapeutic phlebotomy (bloodletting), scarification, cautery, and even minor surgical procedures are to be undertaken. These texts, in fact, make no clear reference to the insertion and manipulation of fine needles at all.

AVMA Revises Guidelines Toward Greater Rationality

The National Council for Reliable Health Information Veterinary Task Force has, from its inception, taken a very proactive stance with regard to having the American Veterinary Medical Association (AVMA) re-evaluate the egregiously "promotional" 1996 AVMA Guidelines for Alternative and Complementary Veterinary Medicine. An intensive letter-writing campaign to this end was mounted early in 1998, and Task Force member and equine advisor Dave Ramey, DVM, was eventually able to win a seat on the nine-practitioner AVMA committee seated in 1999 to re-evaluate same. The result was accepted by the Executive Board of the AVMA April 9, 2001. The original and highly "alt med promotional" 1996 alternative veterinarian medical guidelines are available online at www.seanet.coml[sim]vettf/Guidelines.htm. The new, and vastly more rational, 2001 guidelines appear, verbatim, below.

Robert Imrie

Guidelines for Complementary and Alternative Veterinary Medicine

Introduction

These guidelines are intended to help veterinarians make informed and judicious decisions regarding medical approaches known by several terms including "complementary," "alternative," and "integrative." Collectively, these approaches have been described as Complementary and Alternative Veterinary Medicine (CAVM). The AVMA recognizes the interest in and use of these modalities and is open to their consideration.

The AVMA believes that all veterinary medicine, including CAVM, should be held to the same standards. Claims for safety and effectiveness ultimately should be proven by the scientific method. Circumstances commonly require that veterinarians extrapolate information when formulating a course of therapy. Veterinarians should exercise caution in such circumstances. Practices and philosophies that are ineffective or unsafe should be discarded.

Terminology

The identification of standard and broadly accepted definitions applicable to CAVM, including the definition of CAVM itself, is challenging. These guidelines identify CAVM as a heterogeneous group of preventive, diagnostic, and therapeutic philosophies and practices. The theoretical bases and techniques of CAVM may diverge from veterinary medicine routinely taught in North American veterinary medical schools or may differ from current scientific knowledge, or both. It is not the intent of these guidelines to determine or describe the relative value of the individual modalities. The evidence pertaining to, and the practice of, individual CAVM modalities differ. Current examples of CAVM include, but are not limited to, aromatherapy; Bach flower remedy therapy; energy therapy; low-energy photon therapy; magnetic field therapy; orthomolecular therapy; veterinary acupuncture, acutherapy, and acupressure; veterinary homeopathy; veterinary manual or manipulative therapy (similar to osteopathy, chiropractic, or physi cal medicine and therapy); veterinary nutraceutical therapy; and veterinary phytotherapy.

Education, Training, and Certification

The AVMA believes veterinarians should ensure that they have the requisite skills and knowledge for any treatment modality they may consider using. The AVMA does not officially recognize diplomate-status or certificates other than those awarded by veterinary specialty organizations that are members of the AVMA American Board of Veterinary Specialties (ABVS), nor has it evaluated the training or education programs of other entities that provide such certificates. Recognition of a veterinary specialty organization by the AVMA requires demonstration of a substantial body of scientific knowledge. The AVMA encourages CAVM organizations to demonstrate such a body of knowledge.

Recommendations for Patient Care

The foremost objective in veterinary medicine is patient welfare. Ideally, sound veterinary medicine is effective, safe, proven, and holistic in that it considers all aspects of the animal patient in the context of its environment.

Diagnosis should be based on sound, accepted principles of veterinary medicine. Proven treatment methods should be discussed with the owner or authorized agent when presenting the treatment options available. Informed consent should be obtained prior to initiating any treatment, including CAVM.

Clients usually choose a medical course of action on the advice of their veterinarian. Recommendations for effective and safe care should be based on available scientific knowledge and the medical judgment of the veterinarian.

Responsibilities

State statutes define and regulate the practice of veterinary medicine including many aspects of CAVM. These guidelines support the requisite interaction described in the definition of the veterinarian-client-patient relationship. 1 Accordingly, a veterinarian should examine an animal and establish a preliminary diagnosis before any treatment is initiated.

The quality of studies and reports pertaining to CAVM varies; therefore, it is incumbent on a veterinarian to critically evaluate the literature and other sources of information. Veterinarians and organizations providing or promoting CAVM are encouraged to join with the AVMA in advocating sound research necessary to establish proof of safety and efficacy.

Medical records should meet statutory requirements. Information should be clear and complete. Records should contain documentation of client communications and informed consent.

In general, veterinarians should not use treatments that conflict with state or federal regulations. Veterinarians should be aware that animal nutritional supplements and botanicals typically are not subject to premarketing evaluation by the FDA for purity, safety, or efficacy and may contain active pharmacologic agents or unknown substances. Manufacturers of veterinary devices may not be required to obtain premarketing approval by the FDA for assurance of safety or efficacy. Data establishing the efficacy and safety of such products and devices should ultimately be demonstrated. To assure the safety of the food supply, veterinarians should be judicious in the use of products or devices for the treatment of food-producing animals.

If a human health hazard is anticipated in the course of a disease or as a result of therapy, it should be made known to the client.

Note

(1.) Model Veterinary Practice Act. In: 2001 AVMA membership directory and resource manual. Schaumburg, III: American Veterinary Medical Association, 2001: 319.

COPYRIGHT 2001 Committee for the Scientific Investigation of Claims of the Paranormal
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